Article 40.3.3: “The State acknowledges the right to life of the unborn child 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”.
The eighth amendment is the provision in the Irish constitution which guarantees the right to life of the unborn baby and its mother. It is the last remaining legal protection for children in the womb. It was passed by referendum in 1983 by a two-thirds majority, in response to the effects of the legalisation of abortion in other countries. Ireland, without abortion, has consistently ranked in the top league in the world in terms of safety for women in pregnancy. As it stands, Irish law guarantees that pregnant women are never denied life-saving medical treatment, even if, despite everyone’s best efforts, the baby dies as a consequence of that treatment.
Repeal of the 8th Amendment would remove the right to life of the unborn baby from our constitution. Current practice involves the care of two patients. In our existing model of healthcare, both the mother and her baby are cared for in a manner which ensures an optimal outcome for both individuals throughout the pregnancy and beyond. This dynamic requires careful decision making on the part of all involved. However, as demonstrated by our world leading record in maternal health outcomes, Ireland has shown that the existing framework results in a consistently high record in safety for both mother and baby. Removing the eighth amendment would result in the situation whereby we are unsure if we are caring for one or two patients until the mother indicates her intentions, which would represent a fundamental shift in the delivery of antenatal healthcare.
Ireland, without abortion, has consistently ranked in the top league in the world in terms of safety for women in pregnancy. The WHO report on international maternal mortality rates from 1985-2015 ranks Ireland joint 6th of 41 European and 183 worldwide countries. This places Ireland ahead of England and the US in terms of safety for pregnant women. The Maternal Death Enquiry published in December 2017 shows that Ireland’s maternal mortality rate was 6.5 per 100,000 maternities, compared to the UK’s rate of 8.8. As it stands, Irish law guarantees that pregnant women are never denied necessary life-saving medical treatment, even if, despite everyone’s best efforts, the baby dies as a consequence of that treatment.
Similar to all sectors of society, there is a diverse range of opinion amongst GPs in relation to abortion. However, the Minister for Health’s recent proposal that abortion, if legalised in Ireland, would become a GP led service has been met with widespread discontent amongst the profession. The president of the National Association of General Practitioners, which represents over 2,000 GPs, said on 5th February 2018: “for the Minister to suggest that our profession should lead out an abortion service without consultation with our member GPs is an affront to our profession and could pose yet another strain on the provision of general practice healthcare services”.
Ethical issues aside, it is worth noting that in the vast majority of countries with abortion regimes, including Sweden, the UK and the Netherlands, where abortion is long established, GPs do not prescribe abortion pills. These pills are associated with increased complications and failure rates when used in the latter stages of the first trimester. Accurate staging of pregnancy and detection of ectopic pregnancy would necessitate the involvement of trained personnel in the use of ultrasonography. This is not a resource commonly available within the general practice setting.
Abortion being rapidly incorporated into general practice would fundamentally change the relationship that GPs have with their patients and communities, as well as being both unethical and impractical. This would have serious implications not only for GPs but for practice nurses, administrative staff and wider society.
In a recent closed survey of 497 GPs, almost seven in ten said that they would not be involved in medical abortions. Some of those GPs indicated that they would vote to repeal but are not prepared to partake in the process of intentionally ending a baby’s life.
Despite assurances from government politicians, several TDs have called for no conscientious objection for doctors.
In the London Supreme Court, in 2014, two midwives in Scotland, Mary Doogan and Connie Wood, lost their court battle to be treated as ‘conscientious objectors’, and be excused from participating in abortions. The Supreme Court ruled that the women had the right to refuse to carry out the procedures themselves, but that they were obliged to delegate these duties to other staff and to supervise the staff during the abortions.
If Ireland follows this route, doctors and nurses who do not wish to be part of the procedure would be obliged to refer onto someone who will, and thereby become complicit in the process.
In other countries with extensive abortion regimes, such as Sweden, Bulgaria, Finland and Iceland, there is no conscientious protection at all for health care professionals. Academic campaigners are arguing for the removal of conscientious objection across Europe, claiming that it can be used as a “subtle method for limiting” access to abortion.
In 2013, a resolution to make abortion a human right and to restrict the right of health care professionals to conscientious objection was narrowly defeated in the European parliament. Some Irish MEPs voted for this.