Sir, - Since Mary Holland's excellent article, "Hope signs of national debate on abortion" was published in your newspaper (November 5th), there have indeed been signs of a more rational and reasonable debate on abortion, showing a growing acceptance of the real experiences of Irish women who have abortions. It even appeared that members of the medical profession might at last be willing to accept responsibility for carrying out abortions in Ireland, where required under the Constitution.
However, the Medical Council's ethical guidelines, published last week, mark an unfortunate departure from the growing realisation that abortion is an Irish reality. The guidelines state that the "deliberate and intentional destruction of the unborn child" is professional misconduct. As Senator Mary Henry says (December 2nd), this position is unclear, is unhelpful to doctors faced with real-life crises, and will be of little practical significance to medical practice.
Moreover, the guidelines are clearly in conflict with the Constitution, which has been held by the Supreme Court to provide that where a pregnancy causes a "real and substantial risk" to a pregnant woman's life, she has a right to an abortion. In those circumstances, if the doctor refuses to perform an abortion sought by the woman in order to save her life, the woman herself (or her family, if she dies as a result of the refusal to carry out the abortion) can sue both doctor and hospital for negligence and breach of constitutional rights. A doctor who carries out the abortion in those circumstances, but is disciplined by the Medical Council for breaching its ethical guidelines, may of course apply to the High Court for a review of the Medical Council's decision.
Apart from the legal problems posed by the Medical Council guidelines, they may also have the effect of stifling debate on abortion among the medical profession, and this would be most regrettable. An important debate needs to be conducted, in particular, on the effect of unwanted pregnancies on the health of women. While the X case judgment is limited to those pregnancies which are directly life-threatening, crisis pregnancies which do not fall within this category can still be mentally and physically devastating for women.
Indeed, over 5,000 Irish women every year obtain abortions in England under the Abortion Act 1967, which permits abortion where continuance of the pregnancy would involve risk of "injury to the physical or mental health of the pregnant woman". As Irish women, we should seek to ensure that our health needs are recognised by the medical profession, and that "health" is defined to include physical and mental well-being. In short, more rational debate is needed on this issue, and the Medical Council has missed an opportunity to further that debate. - Yours, etc., Ivana Bacik,
Law School, Trinity College, Dublin 2.