‘The State acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right.’
Those words were inserted into our Constitution by the Irish people in 1983. As a consultant obstetrician, and later as chairman of the Institute of Obstetricians and Gynaecologists, I served Irish women and their children under the auspices of the Eighth Amendment.
It should be a matter of some national pride that Ireland, in that time, has been one of the safest places on earth to be a pregnant woman, and one of the safest places in the world to be an unborn child.
In recent times, a sustained campaign has been waged by some people, including several of my colleagues in obstetrics and gynaecology, to suggest that the words at the beginning of this article put women’s lives at risk.
If that were true, I myself would be leading the charge to have them expunged from the Constitution. A constitutional restriction on my ability, or the ability of any of my colleagues, to save the life of a pregnant woman would indeed be intolerable. Let me therefore be clear: no such restriction exists.
The Eighth Amendment has one medical effect only: it prevents Irish doctors from deliberately, as an elective matter, causing the death of an unborn child. It awards to the child in the womb the right to have their life protected in Irish hospitals, in Irish GP surgeries, and in Irish operating theatres.
That right does not restrict doctors from acting to save the life of a woman where a serious complication arises.
Medical Council guidelines
In fact, Medical Council guidelines oblige doctors to act, even if that means the baby’s life may be lost. They state that: “During pregnancy, rare complications can arise where a therapeutic intervention is required which may result in there being little or no hope of the baby surviving. In these exceptional circumstances, it may be necessary to terminate the pregnancy to protect the life of the mother while making every effort to preserve the life of the baby.”
In plain English, that means: If a doctor feels that a pregnancy poses a real threat to a woman’s life, even if that threat is not immediate, they may perform a termination, usually by delivering the baby.
Some of my colleagues have a personal view which is supportive of abortion; others, and I include myself in this number, believe the unborn child has a right to legal protection. However, the medical facts around the amendment are undeniable.
As recently as December 12th last, the Maternal Death Enquiry (Ireland) found that maternal deaths in Ireland were “extremely rare”. Simply put, if doctors were being prevented by the Eighth Amendment from acting to save women’s lives then this could not be the case. The facts support the contention that doctors are not restrained from carrying out life-saving interventions under the amendment.
Stories and claims
In recent weeks I have been made aware of a series of stories and claims being made online and elsewhere that simply do not reflect the reality of Irish medical care. For example, a pro-choice meeting in Kildare was recently told that a woman who has cancer while pregnant cannot avail of chemotherapy in Ireland. This is simply false, and it appals me that such a claim would ever be made about our health service. Let there be no doubt: in such a situation, a woman can indeed be treated, even if the treatment leads to a detrimental outcome for the unborn child.
However, we now also now know that research has shown that chemotherapy and other treatments are usually safe for the unborn child.
Dr Frédéric Amant has been described by the Lancet as "leading the agenda on cancer in pregnancy". His research, published in peer-reviewed medical journals and presented at the European Cancer Congress, showed that cancer treatments for the mother do not harm the unborn child as was previously believed.
Fear of chemotherapy is no reason to terminate a pregnancy, maternal treatment should not be delayed, and chemotherapy can be given, Dr Amant concluded, adding that there was “no evidence termination improves outcomes for the mother”.
My colleagues in Ireland in oncology practice tell me they have always been able to achieve an optimal cancer treatment for the mother without the need to forgo the life of the child. There is no question of women being denied life-saving cancer treatment because of the amendment.
Other pro-repeal stories have said that women will often be asked if they are pregnant before some tests are administered – this is true, but it is also true that in every jurisdiction, including those where abortion is fully legal, a doctor will want to know if a woman is pregnant before performing certain tests.
From where I am seated, it has been very disturbing to see what amounts to a campaign of fear and misinformation deployed to tarnish the image of Irish medicine and make Irish women fearful of the treatment they might receive.
The truth is that the Government proposes to legalise terminations through to the sixth month gestation, on the same basis as in Britain, in cases of a risk to the physical or mental health of the woman. In Britain, 98 per cent of all terminations are performed on these grounds.
Of those abortions, only 0.2 per cent are performed on the basis of a risk to physical health. The remaining 99.8 per cent of British “health ground” abortions are performed on the basis of a threat to mental health, and in nearly all cases this threat is not specified. This “health” ground, in Britain, is simply a pro-forma statement used to justify any abortion sought by and performed on a woman.
There is a legitimate moral debate to be had about abortion. As somebody who spent his life delivering and caring for young children and their mothers, I have a very clear view about where I stand on it.
For me, years of experience of sharing moments of joy and tragedy with Irish women has left me certain that a child is as human in the womb as it is when it first sees the light of the world.
Others take a different view, and I believe the debate should be measured and respectful. What is regrettable, however, is the publication of untruths about Irish medicine and the role of the amendment we are debating.
Terminations required to save a woman’s life are legal in Ireland. They have been legal since 1983. The amendment does not inhibit our ability to treat a woman. It does one thing only – it bans us from intentionally killing one of our patients. I shall vote to retain it.
Prof Eamon McGuinness MA FRCPI FRCOG is a consultant obstetrician and gynaecologist and a former chairman of the Institute of Obstetricians and Gynaecologists. He is a medical adviser to the Save the 8th Campaign