28 October 1999 Edition
Green Paper cuts through grey areas
By Michael Pierse
From 1983 on, the Irish public has periodically engaged in hugely divisive debates surrounding the difficult issue of abortion. Shortly after Bertie Ahern became Taoiseach in 1997, he indicated the Fianna Fáil/Progressive Democrats government's intention to issue a Green paper on the subject. That paper, which was recently published, goes through the various options proposed to resolve what it terms the ``substantive'' issue of abortion and examines the wide diversity of views on how to proceed. Its objective was to set out the issues, provide a brief analysis, and consider possible options for resolution. Whether or not it has achieved this task will ultimately be for legislators and the public to decide. This article is an initial examination of the Green Paper, designed to open debate.
The Green Paper on Abortion, published recently by the 26-County government, is the latest contribution to an often confusing issue. The massive level of interest attracted by this issue was apparent from the weight and content of submissions received by the government's Interdepartmental Working Group. Approximately 10,000 submissions were received from both individuals and interested bodies. ``The vast majority of submissions,'' the report states, ``expressed a wish for a referendum which would seek to achieve an absolute prohibition on abortion.'' However, despite this bias, all avenues of debate are examined with a great deal of attention to detail. The international experience figures strongly throughout. This ensures that each dimension is studied closely in line with the diverse experiences of other states and also the opinions of professional analysts. The most recent statistics for Irish women travelling to England for abortions are also studied in detail, although they are three years old.
The `X' Case
Since the Abortion Act of 1967 in England and Wales, at least 95,000 women with addresses in the 26 Counties have had abortions there. In 1992, following the fallout from the `X' Case, the Supreme Court decided it was constitutional that if a pregnancy poses a real and substantial risk to the life of the mother, including the risk of suicide, such a risk could not be averted except by means of abortion. In line with the European Court of Human Rights, the government then inserted into the 26-County Constitution the provisions that freedom to travel abroad could not be limited and that information on abortion services abroad should be obtainable in legally defined circumstances. That same year, those provisions were approved by the electorate in referenda, but a further constitutional amendment dealing with the issue of substantial risk to the life of the mother, but excluding the risk of suicide, was rejected.
The Green Paper
The first chapter of the report deals with the issue of pregnancy and maternal health. Maternal deaths in Ireland during pregnancy, it states, are amongst the lowest worldwide. While maternal mortality at the turn of the century was at a rate of 400 per 100,000, it is now at 2 per 100,000. Although different countries use different procedures to measure risk of maternal death, their findings and reasonings are ambiguous. A report by the Institute of Obstetricians and Gynaecologists, cited in the Green Paper, says that the absence of termination of pregnancy services did not appear to have significantly influenced Irish maternal mortality rates. The term ``significantly'' influenced, however, is not clarified.
The international experience
Although the paper states that comparisons with other countries are not always wise, it does elaborate upon the different approaches they have adopted.
In England and Wales, the paper states: ``Legalised therapeutic abortion was originally introduced with the stated objective of saving the life of the mother. However, there has been a gradual relaxation in legal restrictions in many countries over the past 30 years.'' In England, abortion is available when the mother's life is at risk, where there is a possibility of permanent injury to the physical or mental health of the mother or family of the pregnant woman, or where there is a substantial risk that the child will be seriously handicapped.
Since legalisation, the paper states, abortion rates have steadily risen in both England and Wales. According to the Office for National Statistics for these countries, in 1996, 180,000 abortions were performed. In 1996, there were 4,894 abortions carried out on women who gave Irish addresses. This figure does not include those women who, for a variety of reasons, did not use their home address in Ireland. The report states that only a small number of these were considered necessary to prevent grave permanent injury or risk to life.
Ethical guidelines
According to the Irish Medical Council's ethical guidelines, ``refusal by a doctor to treat a woman with a serious illness because she is pregnant would be grounds for complaint and could be considered to be professional misconduct''. So, doesn't this mean that doctors are obliged to conduct abortions in certain circumstances? Yes and no. In Ireland, the report says, there is no medical evidence to suggest that clinicians do not treat women on the grounds of damage to the unborn. However, some submissions in the Green Paper specified a difference between `direct' and `indirect' abortions, `direct' abortions being those conducted with the primary objective of terminating the foetus. `Indirect' abortions, it is argued, are conducted in circumstances where medical treatment for the mother results in the ``secondary effect'' of foetal death. Various forms of medical treatment, including chemotherapy, may result in unavoidable foetal death.
Suicide
The Green Paper also makes some interesting points on the issue of suicide as a reason for abortion - an issue which was at the centre of the `X' Case.
According to a British study, the rate of suicide in pregnancy was found to be only one twentieth of that in a similarly matched non-pregnant population. The paper states that the fact that legal abortion is available in Britain could be a factor in reducing the rate of suicide during pregnancy. According to the Green Paper, ``it is considered important that major life decisions should not be made while suffering from acute psychiatric illness''. This proves difficult for doctors when attempting to predict the likelihood of suicide amongst pregnant women. Again, there is a tendency to present the facts only to produce further areas of debatable fudge.
International law
The obligations facing Ireland under international law are clearer, though not without ambiguities. In 1992, a case taken to the European Court of Human Rights ensured that information on abortion services were made legally available. The Open Door and Dublin Well Woman Centres' contention that their freedom to obtain and impart information had been breached was upheld. The court maintained that attempting to curb information on abortion services abroad was ``not necessary in a democratic society''. Although the guidelines on freedom of information are relatively plain in European law, on the issue of abortion itself, each member state has a wide margin of discretion.
In individual cases, the European Court of Human Rights has ruled in favour of applicants seeking abortion services. An abortion carried out at ten weeks, the court found, in order to avert the risk of injury to the physical or mental health of the pregnant woman - was admissable. In a case where two doctors took the view that the pregnancy, birth or care of the child might place the woman in a difficult situation, it was found by the court that a decision could be left at the discretion of the state's authorities. Contrarily, the court has also rejected the claim that the right to respect for private life requires a state to permit the termination of pregnancy during the first 12 weeks development. More confusion.
Other international bodies and agreements tend to be equally indecisive. The International Convention on the Rights of the Child leaves open the question of when childhood begins, while recognising that some legal protection for the foetus must exist. The Convention on the Elimination of All Forms of Discrimination against Women is a lot more forthright. It states that all women should have the same rights as men to decide freely and responsibly on the number and spacing of their children. Alternative human rights agreements are hesitant to interfere with the deliberations of individual states on the issue.
The international context is explored in detail in the Green Paper. Application of abortion laws in some countries can be more liberal than the legislation itself. In England and Wales, 95% of abortions are carried out on the grounds that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman. Time limitations are also in place in many other countries. In Belgium, an abortion can be carried out after 12 weeks only if two doctors agree that the woman's health is in danger and in Denmark the same is permitted when necessary to avert serious deterioration to the woman's physical or mental health.
Rape and incest
Situations in which rape or incest has occurred are also explored in the study. However, the analysis of statistics particular to the effects of sexual abuse is confusing. This is due largely to the fact that many women are afraid or unwilling to take legal action. Unwilling, because of the emotional trauma and agonising wait that such a course of action invariably involves. Women are forced to wait longer for an abortion in most countries if they use sexual abuse as a reason, as opposed to using the premise of serious mental damage. There is also no information available on how many women opt for emergency contraception following rape or incest. This further obscures the issue. According to Dublin Rape Crisis Centre statistics, only 36 per cent of adult rape and 17 per cent of child sexual abuse cases are reported to the Gardaí.
Issues surrounding education, contraception, counselling services and adoption are also analysed. The prevention of unwanted pregancies also figures strongly in the report. The Green Paper also discusses possible constitutional and legislative approaches.
In the past ten years, there has been a total increase of more than 2,000 in the number of women travelling to Britain annually for abortions. There has been a marked rise in the number of those under the age of 20.
Conclusion
The figures demonstrate that this is an issue that can no longer be ignored. This Green Paper is a valuable aid in assessing the various options open to the government on this issue, which poses such ethical and practical quandaries for voters.
Sinn Féin's position is that the party accepts the need for abortion where a woman's life and mental health is at risk or in grave danger, and in cases of rape or sexual abuse.
From 1983 on, the Irish public has periodically engaged in hugely divisive debates surrounding the difficult issue of abortion. Shortly after Bertie Ahern became Taoiseach in 1997, he indicated the Fianna Fáil/Progressive Democrats government's intention to issue a Green paper on the subject. That paper, which was recently published, goes through the various options proposed to resolve what it terms the ``substantive'' issue of abortion and examines the wide diversity of views on how to proceed. Its objective was to set out the issues, provide a brief analysis, and consider possible options for resolution. Whether or not it has achieved this task will ultimately be for legislators and the public to decide. This article is an initial examination of the Green Paper, designed to open debate.
The Green Paper on Abortion, published recently by the 26-County government, is the latest contribution to an often confusing issue. The massive level of interest attracted by this issue was apparent from the weight and content of submissions received by the government's Interdepartmental Working Group. Approximately 10,000 submissions were received from both individuals and interested bodies. ``The vast majority of submissions,'' the report states, ``expressed a wish for a referendum which would seek to achieve an absolute prohibition on abortion.'' However, despite this bias, all avenues of debate are examined with a great deal of attention to detail. The international experience figures strongly throughout. This ensures that each dimension is studied closely in line with the diverse experiences of other states and also the opinions of professional analysts. The most recent statistics for Irish women travelling to England for abortions are also studied in detail, although they are three years old.
The `X' Case
Since the Abortion Act of 1967 in England and Wales, at least 95,000 women with addresses in the 26 Counties have had abortions there. In 1992, following the fallout from the `X' Case, the Supreme Court decided it was constitutional that if a pregnancy poses a real and substantial risk to the life of the mother, including the risk of suicide, such a risk could not be averted except by means of abortion. In line with the European Court of Human Rights, the government then inserted into the 26-County Constitution the provisions that freedom to travel abroad could not be limited and that information on abortion services abroad should be obtainable in legally defined circumstances. That same year, those provisions were approved by the electorate in referenda, but a further constitutional amendment dealing with the issue of substantial risk to the life of the mother, but excluding the risk of suicide, was rejected.
The Green Paper
The first chapter of the report deals with the issue of pregnancy and maternal health. Maternal deaths in Ireland during pregnancy, it states, are amongst the lowest worldwide. While maternal mortality at the turn of the century was at a rate of 400 per 100,000, it is now at 2 per 100,000. Although different countries use different procedures to measure risk of maternal death, their findings and reasonings are ambiguous. A report by the Institute of Obstetricians and Gynaecologists, cited in the Green Paper, says that the absence of termination of pregnancy services did not appear to have significantly influenced Irish maternal mortality rates. The term ``significantly'' influenced, however, is not clarified.
The international experience
Although the paper states that comparisons with other countries are not always wise, it does elaborate upon the different approaches they have adopted.
In England and Wales, the paper states: ``Legalised therapeutic abortion was originally introduced with the stated objective of saving the life of the mother. However, there has been a gradual relaxation in legal restrictions in many countries over the past 30 years.'' In England, abortion is available when the mother's life is at risk, where there is a possibility of permanent injury to the physical or mental health of the mother or family of the pregnant woman, or where there is a substantial risk that the child will be seriously handicapped.
Since legalisation, the paper states, abortion rates have steadily risen in both England and Wales. According to the Office for National Statistics for these countries, in 1996, 180,000 abortions were performed. In 1996, there were 4,894 abortions carried out on women who gave Irish addresses. This figure does not include those women who, for a variety of reasons, did not use their home address in Ireland. The report states that only a small number of these were considered necessary to prevent grave permanent injury or risk to life.
Ethical guidelines
According to the Irish Medical Council's ethical guidelines, ``refusal by a doctor to treat a woman with a serious illness because she is pregnant would be grounds for complaint and could be considered to be professional misconduct''. So, doesn't this mean that doctors are obliged to conduct abortions in certain circumstances? Yes and no. In Ireland, the report says, there is no medical evidence to suggest that clinicians do not treat women on the grounds of damage to the unborn. However, some submissions in the Green Paper specified a difference between `direct' and `indirect' abortions, `direct' abortions being those conducted with the primary objective of terminating the foetus. `Indirect' abortions, it is argued, are conducted in circumstances where medical treatment for the mother results in the ``secondary effect'' of foetal death. Various forms of medical treatment, including chemotherapy, may result in unavoidable foetal death.
Suicide
The Green Paper also makes some interesting points on the issue of suicide as a reason for abortion - an issue which was at the centre of the `X' Case.
According to a British study, the rate of suicide in pregnancy was found to be only one twentieth of that in a similarly matched non-pregnant population. The paper states that the fact that legal abortion is available in Britain could be a factor in reducing the rate of suicide during pregnancy. According to the Green Paper, ``it is considered important that major life decisions should not be made while suffering from acute psychiatric illness''. This proves difficult for doctors when attempting to predict the likelihood of suicide amongst pregnant women. Again, there is a tendency to present the facts only to produce further areas of debatable fudge.
International law
The obligations facing Ireland under international law are clearer, though not without ambiguities. In 1992, a case taken to the European Court of Human Rights ensured that information on abortion services were made legally available. The Open Door and Dublin Well Woman Centres' contention that their freedom to obtain and impart information had been breached was upheld. The court maintained that attempting to curb information on abortion services abroad was ``not necessary in a democratic society''. Although the guidelines on freedom of information are relatively plain in European law, on the issue of abortion itself, each member state has a wide margin of discretion.
In individual cases, the European Court of Human Rights has ruled in favour of applicants seeking abortion services. An abortion carried out at ten weeks, the court found, in order to avert the risk of injury to the physical or mental health of the pregnant woman - was admissable. In a case where two doctors took the view that the pregnancy, birth or care of the child might place the woman in a difficult situation, it was found by the court that a decision could be left at the discretion of the state's authorities. Contrarily, the court has also rejected the claim that the right to respect for private life requires a state to permit the termination of pregnancy during the first 12 weeks development. More confusion.
Other international bodies and agreements tend to be equally indecisive. The International Convention on the Rights of the Child leaves open the question of when childhood begins, while recognising that some legal protection for the foetus must exist. The Convention on the Elimination of All Forms of Discrimination against Women is a lot more forthright. It states that all women should have the same rights as men to decide freely and responsibly on the number and spacing of their children. Alternative human rights agreements are hesitant to interfere with the deliberations of individual states on the issue.
The international context is explored in detail in the Green Paper. Application of abortion laws in some countries can be more liberal than the legislation itself. In England and Wales, 95% of abortions are carried out on the grounds that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman. Time limitations are also in place in many other countries. In Belgium, an abortion can be carried out after 12 weeks only if two doctors agree that the woman's health is in danger and in Denmark the same is permitted when necessary to avert serious deterioration to the woman's physical or mental health.
Rape and incest
Situations in which rape or incest has occurred are also explored in the study. However, the analysis of statistics particular to the effects of sexual abuse is confusing. This is due largely to the fact that many women are afraid or unwilling to take legal action. Unwilling, because of the emotional trauma and agonising wait that such a course of action invariably involves. Women are forced to wait longer for an abortion in most countries if they use sexual abuse as a reason, as opposed to using the premise of serious mental damage. There is also no information available on how many women opt for emergency contraception following rape or incest. This further obscures the issue. According to Dublin Rape Crisis Centre statistics, only 36 per cent of adult rape and 17 per cent of child sexual abuse cases are reported to the Gardaí.
Issues surrounding education, contraception, counselling services and adoption are also analysed. The prevention of unwanted pregancies also figures strongly in the report. The Green Paper also discusses possible constitutional and legislative approaches.
In the past ten years, there has been a total increase of more than 2,000 in the number of women travelling to Britain annually for abortions. There has been a marked rise in the number of those under the age of 20.
Conclusion
The figures demonstrate that this is an issue that can no longer be ignored. This Green Paper is a valuable aid in assessing the various options open to the government on this issue, which poses such ethical and practical quandaries for voters.
Sinn Féin's position is that the party accepts the need for abortion where a woman's life and mental health is at risk or in grave danger, and in cases of rape or sexual abuse.