Sir, - A novel method of making an amendment to the Constitution is being used in the proposed referendum on abortion. A piece of quite complicated legislation passed by the Oireachtas will be represented in a few short words on the voting card and many voters may not know all the details of the legislation. And there is danger in the detail.
At present doctors are trusted to carry out life-saving procedures on pregnant women whenever they have to do so, even if the procedure means the death of the child. Usually such procedures are carried out in maternity hospitals, but not always. It is taken for granted that the doctor has no option if the mother's life is to be saved. If the referendum is passed it will be legal to carry out such procedures only in "approved centres".
There is no exact description of "approved centres" in the Act but the Taoiseach, in a written reply to Mr Michael Noonan, said they would be hospitals with obstetric and paediatric facilities suitable for neonates.
With the contraction of maternity services in Ireland, there will be only 15 or 16 such centres soon. There is no provision in the Act for dealing with emergencies. This was discussed in detail in both Houses. The Minister for Health and Children appeared to be well aware of the problem but refused to accept amendments to allow for emergencies. It signifies a lack of trust in doctors, suggesting "emergencies" might really be socio-economic abortions.
Despite all the advances in modern medicine, haemorrhage is one of the commonest causes of the death of a woman during pregnancy or delivery. Often bleeding is most unexpected and can occur early in pregnancy. The termination of the pregnancy may be the only method of stopping the haemorrhage. It will be illegal to do this anywhere in Ireland except in an approved centre.
Maternal mortality is low in Ireland so doctors involved in obstetrics are encouraged to note "near misses" - cases which might have had fatal consequences if it were not for good management. The results of a survey carried out by doctors in the Coombe Womens' Hospital from January 1st 1999 to October 30th 2001, presented to the Junior Obstetric and Gynaecology Society meeting recently, showed that in over 21,000 patients there were 50 "near misses" and this did not include ectopic pregnancies or patients in the early months of pregnancy. Thirty-one of the "near misses" were due to haemorrhage. Each woman needed five or more units of blood, a large transfusion. Many haemhorrages were unexpected and not all were initially treated at the Comb. I know I am not the only doctor concerned about this feature of the legislation. Women's lives will be put at risk.
Then there is the question of "conscientious objectors. Doctors and others can refuse to undertake or assist at a perfectly legal procedure to save the life of a pregnant woman if the foetus may be lost due to the procedure. While it is to be hoped that all doctors will hold to their ethical obligations to their patients, what if all on duty decide that they are "conscientious objectors
The Medical Council is in charge of our ethical conduct, but The Minister for Health is in charge of the hospitals and the legislation should have ensured that patients will be properly cared for in all approved centres. Women's lives will again be put at risk.
Not for one moment do I think any member of the Government would want to see the loss or even the endangering of the life of any woman, but these are the sort of details which may not be apparent to voters, whom I will encourage to vote know to this unnecessary referendum.
To my certain knowledge no doctor in Ireland has used the risk of suicide as a reason for carrying out an abortion since the X case, nine years ago. Why should we start now, when following the Government's instruction to send such women to England is traditional and much less troublesome? - Yours, etc.,
Senator MARY HENRY,
Seanad Éireann,
Dublin 2.