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Sunday, January 29, 2012

Opportunity to clarify abortion law


By Paul Brady, Sunday Business Post, 29th January 2012


The group considering the implementation of the European Court's abortion decision must produce a 'series of options' that covers all the issues


The government has established an expert group to "recommend a series of options" on how to implement the decision of the European Court of Human Rights in A, B, C v Ireland.

This case involved a challenge to Ireland's abortion laws by three women who claimed, on various grounds, that Irish law violated their rights under the European Convention on Human Rights.
There was widespread — but needless — confusion when the court's judgment was published in December 2010. Some sought to portray it as a ruling from Strasbourg that Ireland was now legally obliged to legislate for a right to abortion on the terms of the 1992 Irish Supreme Court decision in the X case. This interpretation is contradicted by the actual judgment.

In fact, the decision rests on two key conclusions. First, the court held that current restrictions on abortion in Ireland constitute a fair balance of the rights and interests in what the court called the "wide margin of appreciation" enjoyed by member states on this issue.

Secondly, the court found that the "uncertainty" arising from the lack of legislation or "effective and accessible procedures" for deciding what is legally permissible in individual cases violated the third applicant's right to private life. All other complaints were dismissed.

The judgment is fairly straightforward. The court noted that it was up to each state to decide if it would legally protect unborn human life and, if so, to balance such protection fairly with the rights of others. Once that balance is struck, states must provide "implementing…and institutional procedures" to ensure that the legal implications for individuals can be readily established with reasonable certainty.

But even a "wide margin of appreciation" is not the same as a blank cheque, and its exercise remains — at least in principle — subject to review by the court.

The current "balance" in Irish law was created by the Supreme Court decision in the X case. It held that an abortion is lawful only when there is a "real and substantial risk" to the life, as opposed to the health, of the mother. The court also ruled that such a risk included any real and substantial risk that the mother might commit suicide. However, the court reached this conclusion without hearing expert psychiatric evidence.

In the past ten years, knowledge of the potential mental health effects associated with abortion has been greatly advanced by peer-reviewed studies. This raises a legitimate question as to the appropriateness of basing Ireland's legislative response on terms decided by five judges 20 years ago, uninformed by the findings of expert research.

The experience of Britain of abortion on psychiatric grounds is instructive. Of the 189,574 abortions recorded in England and Wales in 2010, 97.7 per cent were carried out on the reported ground that a doctor considered that continuing the pregnancy carried a greater risk of injury to the mental health of the woman than an abortion. In other words, almost one in five pregnancies in England and Wales are ended by abortion on mental health grounds.

It is no exaggeration to say that it has been an fundamental working assumption of the law and practice of abortion in Britain over the last 40 years that ending a pregnancy by abortion will typically lead to improved mental health outcomes.

This assumption has been challenged by one of the most sophisticated studies on the question ever conducted. Writing in the British Journal of Psychiatry in 2009, Professor David Fergusson concluded that his research "clearly suggested that unwanted pregnancy leading to abortion was likely to be a risk factor for subsequent mental health problems, whereas unwanted pregnancy leading to live birth was not a risk factor for these problems".

Fergusson noted that no study had ever reported that abortion reduced mental health risks. In other words, on the empirical evidence available, it appears that a primary assumption underlying both the reasoning in the X case and the legal basis for the vast majority of abortions in Britain is, at best, questionable and, at worst, dangerously wrong.

Given the long debate over abortion in Ireland, it is perhaps understandable that some view the establishment of an expert group with a mix of cynicism and suspicion. If it is to confound such critics, the group must be fully cognisant of the Irish state's right — confirmed in ABC v Ireland — to determine its own substantive view on abortion and the equal dignity of every human life.

As persons chosen for their technical expertise rather than the representativeness of their moral views, the members of the expert group can best add value to the political process by producing as extensive and comprehensive a "series of options" as possible. Their report should detail objectively the constitutional, medical, legal and ethical issues and technicalities in respect of each option identified.

After that, as Europe has made clear, the responsibility will be on us, not only to decide our position, but to implement it clearly and thoroughly.

Paul Brady is a barrister and co-author of Psychiatry and the Law (Blackhall, 2010)

Thursday, January 19, 2012

Supreme Court 'X' case ruling not good basis for abortion law - Professor William Binchy


The Irish Times – Thursday, January 19, 2012

WILLIAM BINCHY

OPINION: THE GOVERNMENT’S appointment of the expert group to address the implications of the European Court of Human Rights decision in A, B C v Ireland gives us all the opportunity to reflect on the issue of legal protection for mothers and their unborn children.

Ireland has the enviable record of being among the very safest countries in the world for mothers during pregnancy – safer than a range of countries with far greater economic resources that have wide-ranging legalised abortion.

The task for the expert group is to recommend legal support for doctors to continue to uphold the principle of doing the best possible for two patients – mother and child – during pregnancy. There are times when this can result in the death of the unborn child, which is not the intended purpose of the treatment of the mother.

The mistake that the Supreme Court made in the X case was to embrace a quite different principle: that it is permissible to target the unborn child and intentionally terminate his or her life.

The Supreme Court heard no expert psychiatric evidence. Over the 20 years since the X case, the international research has shown a different reality: studies have been published that identify abortion as involving a significant increase in suicidal ideation and outcome.

The work of Dr David Fergusson and his colleagues in New Zealand in 2005 is perhaps the most striking example, especially since Fergusson’s own personal value position favours the “right to choose”. Fergusson noted the difficulty he had experienced in getting his research published.

Contrary to sustained misrepresentation by advocates of legalised abortion, the decision of the European Court of Human Rights does not require Ireland to give legislative effect to the Supreme Court decision of 20 years ago. What it does require is that we in Ireland choose a law that is clear.

We could, choose to endorse what the Supreme Court did but, if we took that course, we would be introducing into our hospitals an abortion regime, requiring abortion at all stages of pregnancy up to birth – the Supreme Court mentioned no time limits, in stark contrast to the notorious decision of the United States supreme court in Roe v Wade.

The Supreme Court decision represents injustice to the child, since it requires that his or her life be intentionally terminated. That abortion targets the child is a sad fact we should not ignore, however unpalatable it is to contemplate.

In England, some children – a small number – survive abortion. The Confidential Inquiry into Maternal and Child Health reported in 2007 that 66 babies had survived in one year. The policy in these cases is not to attempt to resuscitate them but rather to ensure that they die. That is not the policy of Irish hospitals but, if abortion was authorised on the principles set out in the Supreme Court decision, it would have to apply.

I do not believe that Irish people would wish to introduce a legal regime where the destruction of a child’s life was the object of the exercise.

We are free to make a different choice: one that ensures that Ireland can continue to be in the forefront of maternal safety and that does not target the child.

If the debate is about medicine, then Ireland, with its world class record on the care and safety of mothers during pregnancy, is a living example of how respect for human rights maximises positive outcomes.

But in truth the debate is really about values – not just about personal autonomy and privacy but about the dignity and equal worth of every human being. It is not easy to justify the intentional termination of the life of another human being, however small, powerless or undeveloped she or he may be. The insight of human rights philosophy is that, regardless of the estimation of others, every human being has inherent dignity and worth.

An unborn child is a distinct human being, with a unique identity different from that of his or her parents. He or she is no more or no less “a lump of cells” than a mature person.

Of course many (though not all) mature people lead lives of impressive intellectual and interpersonal fulfilment that bear no comparison with the experience or capacity of an infant in its mother’s womb or in the care of its parents in the years after birth. To build a lethal distinction on these differences in capacity and experience is not consistent with respect for the core values of human dignity and equal worth.

I hope that the expert group will take a broad view of its mandate and will guide the Government on the range of social supports that parents need in the awesome challenges that they may face in rearing the children who depend on their care.

William Binchy is regius professor of laws, Trinity College Dublin and legal adviser to the Pro-Life Campaign.

Read this article on the Irish Times website

Friday, January 13, 2012

Pro Life Campaign Says Expert Group on Abortion Presents Opportunity to Clarify Key Ethical Distinctions


The establishment by the Government of the Expert Group on abortion presents an opportunity to clarify important ethical distinctions in this area, the Pro Life Campaign (PLC) has said.

The Government this evening announced the members of the 14-member group from the medical, legal and nursing professions, in response to the A, B and C v. Ireland ruling on abortion from the European Court of Human Rights in 2010. The Expert Group will be chaired by Mr Justice Seán Ryan and has to report back to Government within six months with options on how to implement the judgment of the European Court.

In a statement responding to the announcement, spokesperson for the Pro Life Campaign, Dr Ruth Cullen said:

“The establishment of the expert group presents a genuine opportunity to re-affirm the ethical distinction between necessary medical interventions in pregnancy and induced abortion, which intentionally targets the life of the baby.

“Pro-choice activists are falsely claiming that Ireland is obliged to introduce abortion following the European Court of Human Rights decision. In reality, the court recognised the right of the Irish people to decide on the issue.

“It is also of critical importance that the new expert group take account of the latest peer-reviewed research, published in leading periodicals, which highlights the negative psychological effects of abortion for many women.”

Ends

The Composition of Expert Group on Abortion is as follows;

The Group will be chaired by Mr. Justice Seán Ryan and consist of thirteen other members;
Dr Peter Boylan, Consultant Obstetrician and Gynaecologist
Dr Mary Holohan, Consultant Obstetrician and Gynaecologist
Dr Imelda Ryan, Psychiatrist,
Dr Ailish Ni Riain, General Practitioner
Dr Mark Walsh, General Practitioner
Ms Christine O’Rourke, Office of the Attorney General
Ms Mary O’Toole, Senior Counsel
Ms Joanelle O’Cleirigh, Solicitor
Ms Denise Kirwin, Solicitor
Dr. Deirdre Madden, Medical Council
Dr Maura Pidgeon, An Bord Altranais
Dr Tony Holohan, Chief Medical Officer, Department of Health
Mr Bernard Carey, Assistant Secretary, Department of Health

You can access the Government Press Announcement here