Legal and State positions would be in accord

When asked by a journalist if there had been consultation between the Medical Council and the Government on yesterday's proposals…

When asked by a journalist if there had been consultation between the Medical Council and the Government on yesterday's proposals, the Minister for Health, Mr Martin, emphatically answered "No". Even so, if these proposals are passed, for the first time in nine years the legal position in the State will accord with that of the Medical Council.

This would bring to an end the situation where abortion was legal in Ireland if the mother was suicidal, but could not be performed because the ethical guidelines of the Medical Council ruled it out.

Last month, after months of acrimonious debate, the council amended its guidelines to say that the termination of pregnancy was permissible where there is "a real and substantial risk to the life of the mother" .This ended the terminology which distinguished between the deliberate destruction of foetal life, and where it was the unintended by-product of a medical procedure needed to save the life of the woman.

The "real and substantial risk to the life of the mother" is exactly the term used in the proposed legislation on abortion, which will be the basis for another constitutional amendment.

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If passed, it will copperfasten the position of obstetricians and gynaecologists who, when faced with a number of rare conditions in pregnancy, including cancer and circulation disorders which could cause the mother's death, terminate the pregnancy.

However, it may allow for an amount of leeway beyond that, and the Medical Council initially, and eventually the courts, are likely to be asked to define the extent of that leeway.

The Bill, which was published along with the proposed Amendment, allows a termination of pregnancy "at an approved place . . . where that procedure is, in the reasonable opinion of the practitioner, necessary to prevent a real and substantial risk of loss of the woman's life, other than by self-destruction."

This firmly outlaws the threat of suicide as a ground for abortion, which was one of the main changes sought by the Pro-Life Campaign. The Medical Council, in its recently revised guidelines, did not explicitly exclude the threat of suicide, though it stated it subscribed to the view of the Institute of Obstetricians and Gynaecologists that it was not a ground.

However, some of the other terms in the legislation may be open to more liberal interpretation. An "approved place" will be defined by an order. It will not include family planning clinics, Mr Martin said yesterday, but is likely to include the major maternity and teaching hospitals.

A "medical practitioner" is any registered doctor, not just an obstetrician or gynaecologist. This means that a GP could conclude that a patient's life was at risk from a complication of pregnancy, and refer her to a sympathetic obstetrician for a termination. The proposed legislation requires a written record to be kept but there is no provision for a second medical opinion on the "real and substantial risk".

The legislation leaves the definition of "real and substantial risk" up to the doctor. There are different views within the medical profession as to whether, to justify a termination, such a risk should be an immediate one or one likely to occur after the birth. It may fall to the Medical Council ethics committee, or to the courts, or both, to adjudicate on this in the future.

Some anti-abortion campaigners may see dangers of an over-liberal interpretation of the legislation on the part of individual doctors. However, it is difficult to see how this can be prevented under the proposed legislation, except by limiting the "approved places" to those with Catholic ethics committees. Such a move would provoke widespread controversy.

The Bill defines abortion and the unborn for the first time. Abortion is "the intentional destruction . . . of human life after implantation in the womb of a woman".

This buries once and for all, at least in terms of legislation, the battle over whether the IUD contraceptive and the morning-after pill are abortifacients. There has been much opposition to these devices, which prevent the implantation of the fertilised egg, from some pro-life campaigners on the grounds that they destroy human life. These devices will now be protected by legislation.

It also protects in vitro fertilisation programmes and does not outlaw the destruction of unimplanted embryos.

The legislation also clears up the question posed by Mr Justice Geoghegan in the C case, when he stated that the Constitution did not confer a right to abortion outside of Ireland. Section 4 of the Bill provides that "this Act does not operate to restrict any person from travelling to another state on the ground that his or her intended conduct there would, if it occurred in this State, constitute an offence under Section 2 of this Act".

However, it is not clear what would happen if another C case arose, that is, if a minor wished to travel out of the State for an abortion and her parents or one of her parents opposed it. Nor is it clear whether a State agency, such as a health board, could take a suicidal minor under its care out of the State for an abortion. Although much is clarified, this legislation will not bring to an end the role of the courts in interpreting abortion legislation. Nor does it clarify other related issues, like the extent to which the right to life must be vindicated, as was raised in the case of the pregnant brain dead woman in Waterford.

If passed, it will endure for a while. Any amendment must go to referendum again, but it now seems this is an issue which must be revisited by each generation.