‘Complexity’ of fatal foetal abnormality diagnosis underlined

Senior doctors and politicians have warned that diagnosing a fatal foetal abnormality is a “complex” decision which should be made by doctors and not legislators.

It comes after Solidarity TD Ruth Coppinger and People Before Profit TD Bríd Smith told the Dáil this week a woman had been denied an abortion in the Coombe hospital despite her foetus being diagnosed with a fatal anomaly.

In a letter to the woman this week, the hospital said the anomaly was complex, but not fatal under the terms of the newly introduced abortion legislation. This states that a termination can be carried out if there exists an anomaly that is likely to lead to the death of the foetus either before or within 28 days of birth.

Fine Gael TD Kate O’Connell criticised the decision to raise the woman’s case on the floor of the Dáil, saying it should be left in the hands of doctors.

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“I think it was ill-judged. I think as elected members of Leinster House we have a responsibility to constituents when they come to us with issues to gauge the most appropriate way of dealing with the constituent, who in this case was in a crisis. My personal view would be that it was irresponsible and I would question the decision-making process that led to what happened,” she said.

Certifying practitioners

“It is a complex issue and that is why two doctors must make this decision.”

One of the two certifying medical practitioners has to be an obstetrician while the other has to have a relevant speciality, she noted.

She said there was “no ambiguity” in the law in that there was no provision for terminations on the grounds of disability and a termination would only be given where an anomaly was fatal.

Speaking in a personal capacity, obstetrician and former master of the Rotunda Hospital Dr Sam Coulter-Smith said decisions around what constitutes fatal foetal abnormality were not clear-cut.

“A foetal medicine doctor has to make a judgment on whether the baby’s abnormality will be fatal within 28 days of birth and a colleague has to agree with that,” he said.

“Decisions will have to consider situations whether a baby with an abnormality will die without treatment or if the condition might be treatable with surgical intervention.”

According to Dr Coulter-Smith, it is the interpretation of these scenarios which makes these decisions difficult. “These are individual clinical situations which need to be dealt with and interpreted within the existing new legislation and new guidelines. These situations are complex and clinicians need time and experience of the complexities of providing this new service,” he said.

‘Affected families’

Independent Senator Rónán Mullen said he believed the legislation in this regard went further than many had expected. “I have had concerns and I have expressed them previously. I think we have to find a way to care for the affected families and to also cherish the lives of the children involved. I think if it was the case that the prognosis was that they might live well beyond a short time, then I think that would be farther than a lot of people expected.”

In the lead-up to the referendum on the Eighth Amendment, politicians were warned of the complexities involved in diagnosing fatal foetal abnormalities.

Peter Thompson, a consultant in foetal medicine at Birmingham Women and Children’s Hospital, told the Oireachtas committee on the Eighth Amendment of potential difficulties in legislating for fatal conditions.

“The first thing is to decide what is the definition of ‘fatal’,” he said. “As a result of the history of the law on abortion in Ireland, it will be very difficult for Ireland’s obstetricians to decide. If it is decided in law that a fatal condition is one in which the baby always dies in utero, then we must consider that those conditions are exceptionally rare. I worry that if the term ‘fatal’ is used, some would argue that everything is fatal. The contrary argument is that nothing is fatal because it does not result in a death in every single case.”