Is abortion ruling any help to doctors?

Ruling by European Court of Human Rights reopens debate on need for new referendum

LAST WEEK’S ruling that the State violated the rights of a woman who had to travel abroad for an abortion has brought to the fore once again an issue successive governments have failed to tackle.

The woman at the centre of the case had a rare form of cancer and feared her condition would deteriorate when she became unintentionally pregnant.

Under our existing abortion laws, it was her right to obtain a lawful abortion if her life was at risk. However, she was unable to find a doctor willing to make that determination and was forced to travel abroad for a termination.

On Thursday, the European Court of Human Rights unanimously ruled that in forcing her to do so, the State failed to properly implement the woman’s constitutional rights.

Referring to the bind in which those with a crisis pregnancy and their doctors can find themselves, the court said Irish law “constituted a chilling factor for women and doctors, as they both ran the risk of a serious criminal conviction and imprisonment if an initial doctor’s opinion was later found to be against the Constitution”.

The local GP is often the first port of call for women who become pregnant. But if the woman is considering termination, the consultation can be difficult. Will the new ruling make things any easier?

Dr Mary Favier, a Cork-based GP and a member of Doctors for Choice, welcomes it, saying: “It brings some clarification to a situation that was decidedly murky.

“There’s such a lot of silence and negativity around the issue of abortion in Ireland that it interferes with consultation and doctors feel quite inhibited. The ruling will help.”

On the issue of whether women felt there was a stigma around asking for abortion advice, she says: “There’s a significant amount of stigma – I would see a number of women who say they can’t attend their own GP because of what they might say, or the perception of what they might say.”

She says that another consequence of the rules on limited abortion is the increasing number of women who are opting for illegal terminations, citing a recent seizure of more than 1,200 pills known to induce abortion by the Irish Medicines Board and customs.

Favier says: “Women should not take these tablets after a certain stage and you need a scan to determine gestation . . . I’m sure there is so much desperation out there, women will do it anyway.”

With regard to debate in the UK about allowing GPs to conduct some abortions at their surgeries, she says she is in favour of it. “It would be hugely de-stigmatising. Nobody would know if they are attending their GP for an abortion or an in-grown toenail, whereas if you were to open an abortion clinic in Ireland, it would be picketed.”

Favier says: “Ireland needs to face the problem head on. We’ve got 5,000 women plus going abroad for abortions every year. We need to legislate for it in Ireland, provide good healthcare and get on with it.”

One Kerry-based GP says: “I don’t know what the significance of the ruling is. I don’t think it’s going to make any difference to me day to day.

“I would generally do my own thing and that’s provide non-directive counselling about whatever decision the woman made. I’m quite happy to counsel the woman before and to see her after, but it’s her decision.”

Regarding C’s inability to find a doctor willing to determine the risk to her life, he says: “She was asking the impossible. It’s nothing to do with the law, it’s just very difficult to answer her question.”

With a further two women unsuccessful in their claims, arguing that Ireland’s abortion restrictions had “stigmatised and humiliated them”, does he think it is difficult for women to raise the topic with their GP?

“People might be shy of coming in to talk about it, but that applies to hundreds of medical conditions,” he says.

Regarding those pushing for a change in legislation he says, “I don’t think de-stigmatisation is what they are looking for. They want to use hard cases to make bad law. They’re not being honest – it’s not the difficult cases they’re concerned about, it’s wider availability of abortion, and they are pursuing that through the hard cases.”

Dr Mary Condren, a GP in inner city Dublin, says she welcomes the ruling. “It’s time for the Government to implement our own Supreme Court ruling from 18 years ago . . . Then at least there will be some clarity for doctors, obstetricians and for women.”

While Condren says that the “risk to life” scenario is not one that GPs typically have to adjudicate, she does deal with women who are “in crisis pregnancy for social or economic reasons”.

She says that while she doesn’t feel hamstrung in her own practice and would “act within the guidelines of the ICGP to provide non-directive counselling”, she feels the issue of abortion needs much more public discussion.

“Debate needs to be opened up again and a new generation of people need to be listened to. There’s a new generation of women who haven’t had a say and these are now the women who are having crisis pregnancies.”

An obstetrician and gynaecologist who is Lithuanian, the home country of C, and who works at a general practice in Ireland, says she does not want to see any changes to Irish law because, “abortion is not a good thing”.

The doctor, who has been working in Ireland for three years, says her patients are mostly from Lithuania, Russia, Latvia, Ukraine and Belarus.

Asked if women coming to her surgery seek advice on abortion, she says: “No, they know there is no abortion in Ireland, so they don’t ask me about it.”