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Bloody Sunday, election, Irish, Ireland, British, Ulster, Unionist, Sinn Féin, SDLP, Ahern, Blair, Irish America

Muddled abortion laws demand clarity

(by Liam Clarke, Sunday Times)

When you get a political consensus in Northern Ireland. it is usually a sign that the politicians either don't fully understand the issues or have agreed between them to fudge it. Nowhere is this more obvious than in the area of abortion law. All the main parties and all the main churches are firmly opposed to change.

Alliance for Choice, a pro-choice group, is threatening to provide medical abortions in Northern Ireland. Goretti Horgan, a spokesperson, says members of the group are prepared to "offer ourselves for arrest" . Actually the law is such a shambles that they will probably be safe enough, provided they have a sympathetic obstetrician on hand.

The term "medical abortion" applies to the administration of two pills, Mifeprisone and Misoprostol, which are alreadt available on the internet free of charge from sites like Women on the Web, along with instructions for home use. But there are risks of haemorraging, particularly if these drugs are used later than the ninth week of pregnancy.

In addition, a BBC investigation has discovered less scrupulous commerical websites selling pills without medical advice, some of which contain none of the active ingredients and may be poisonous.

Many women in Northern Irealnd order them each year. Certainly the number is likely to exceed the 80 who obtain legal, surgical abortions in the province, and the 40 a week who are referred to British private clinics by the Family Planning Association. When travel and accomodation are included, the cost of such abortions is likely to be about £2,000, which prices poorer wormen out of the market and makes cheaper pills a more attractive option. Some women are tempted to take them later in pregnancy, despite the higher risks.

By adminstering the abotificants under medical supervision, Alliance for Choice can justifiably argue that it is reducing the risks of unregulated home medication and providing back up if complications do occur.

But even if the pressure group gave surgical abortions up to full term, it would not be breaking the law if a supervising obstetrician or gynaecologist felt that continuing the pregnancy would cause serious and long term damage to the mother's mental or physical health.

But how is an obstrician or gynaecologist equipped to asess long term mental health? And what exactly does the law mean by "long term" or serious? And won't doctors differ if they make a subjective assessment?

There are no good answers to any of these questions. The specialist doesn't have to give a reason for his opinion or make any record of it. In practice the approach differs widely across the province and surveys show that medical professionals had a widely differing understanding of what the law is.

Covering up such issues is the agreed fudge which unites the politicians and the church leaders. According to the statute book things should be pretty clear. The issue is governed by the 1861 Offences Against the Person Act, a no nonsense piece of legislation. Anyone who "attempts to procure a miscarriage" can be sentenced to hard labour, even if there is no evidence that the woman is pregnant. These provisions were introduced before reliable pregnancy testing, so the law had to fudge this issue.

The legislation did not regulate the premises in which terminations could be carried out, so Alliance for Choice, could, if it found a willing obstetrician, set up an abortion clinic in a lock up garage.

In Britain the 1967 Abortion Act updated the situation, but Northern Ireland was exempted from its provisions. Then as now, Stormont parliamentarians asked Westminster to leave the matter up to them and then failed to legislate.

The courts shied away from sending medical professionals to jail or creating martyrs and, as a result, case law has built up which effectively allows obstetricians and gynaecologists to make whatever medical or psychological judgments they think appropriate. The judiciary, understandably reluctant to rush in where legislators fear to tread, has not required doctors to spell out the grounds for their decisions. If no detailed explanations for an abortion are recorded, there is less chance of the courts being called in to adjudicate.

In October 2004 Justice Kerr, ruled that a doctor need not seek a second opinion, as is required in Britain. The judge also held that guidelines were unnecessary because, he believed, medical professionals probably understood the law well enough. However he did recommend that surveys be carried out to see if this was really the case.

"The results made nurses and midwives very twitchy indeed" according to Breda Hughes, of the Royal College of Midwives which is campaigning for guidelines and a change in the law. "Nurses don't know if they are acting illegally."

One survey of the health service also found that some doctors thought abortion was illegal, others believed it was permitted for foetal abnormality and still more thought it could be used to end pregnancies caused by rape or incest.

In some hospitals, older mothers are offered amniocentesis tests, which carry a slight risk of foetal damage or miscarriage. Patients are often asked to sign a form agreeing to have an abortion if a severe abnormality, such as Down's syndrome or spina bifida, is detected. The logic is that there is no point having a risky test if you aren't prepared to act on its results, but how would this stand up in law?

Neither the politicians nor judges are keen to explore these issues. Other, less invasive tests, can pick up abnormalities at around twenty weeks, but, according to Hughes, specialists differ widely on what course they will take. Some will recommend an abortion for any abnormality, others will only agree to one if the foetus is unlikely to survive birth and, even in sucg cases, some suggest that the woman may find it comforting to prepare a proper funeral so that she can feel supported in her grief when her pregnancy is completed.

The extent of the mess and confusion may become clear this month. Michael McGimpsey, the Stormont Health Minister, is due to present draft guidelines on abortion to the Assembly's health committee. But on 22 October, Diane Abbott, the Labour MP for Hackney in London, will attempt to extend the British 1967 Abortion Act to Northern Ireland through an amendment to the Human Fertilisation and Embryology Bill.

We could write the script now for the Westminster debate. When a similar move was mooted in July, Gordon Brown moved against MPs backing it. There is a strong suspicion that his cracking the whip may have been a thank you for the support of the nine DUP members in passing anti-terror legislation a month earlier. Now Labour whips are telling backbenchers that if the 1967 Act is extended to Northern Ireland it could damage the peace process.

This is such arrant nonsense that no Northern Ireland MP would have the cheek to make that point locally. Instead they will say that the matter should be left to the Assembly even though it has no competence to legislate on abortion because the DUP has vetoed the devolution of policing and justice powers.

Resistance to British interference seems an unlikely cause for unionists. It is especially rich since, just a few months back, Northern Ireland MPs voted for an unsuccessful move to reduce the threshold for abortion in England to 12 weeks.

Westminster can afford to call their bluff on this one; and it should.

October 14, 2008
________________

This article first appeared in the Sunday Times on October 12, 2008.

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