on being worthy of abortion

Patient sitting on hospital bed waiting

A few weeks ago, I was at a family gathering and someone brought up the topic of abortion. A living room full of women, ranging from early twenties to late sixties, proceeded to drunkenly debate the issue into the wee hours of the morning. One of those women, who we’ll call “Jemima”, is a former NHS doctor. She informed us that, throughout her career, she had routinely refused to sign forms for women seeking abortion because she did not approve of their reasons for wanting one. She spoke with particular scorn about a woman she had refused on the grounds that she was wealthy and married, with two children already, and so could surely provide a loving and stable home for a potential third child? The idea that there were almost certainly considerations of which Jemima was not aware – or the novel concept that her patient simply did not want to be pregnant and her reasons are her own – didn’t enter the equation. Jemima insisted that, as a Catholic, she should not have to sign off on a procedure that goes against her beliefs.

I was appalled that it is (apparently) legal for medical professionals to engage in this sort of gatekeeping, especially in a country with relatively liberal abortion laws. And perhaps that’s naïve of me, but given what I know of the UK, I assume (I hope) that woman went on to find a GP who doesn’t refuse treatment on religious grounds and was able to get an abortion, having only been mildly inconvenienced by Jemima and her anti-choice views.

In Ireland, it’s a different story. Thanks to our Constitution’s Eighth Amendment, the conditions under which a woman can legally access abortion are so narrow as to be functionally non-existent. The only exception is the Protection of Life During Pregnancy Act 2014, under which abortion can be carried out if the life of the mother is at risk. Crucially, this includes risk of suicide due to distress caused by unwanted pregnancy. In this situation, three doctors, including two psychiatrists, must certify that the risk of suicide is “real and substantial” and that it can only be averted by termination of the unwanted pregnancy.

Yesterday, the Child Care Law Report Project published the case of a suicidal teenage girl who, along with her mother, thought she was travelling to Dublin to get an abortion. Instead, upon arrival, she was forcibly detained in a psychiatric unit. The referring psychiatrist had acknowledged that she was at risk of self-harm and suicide as a result of the unwanted pregnancy, but decided that “this could be managed by treatment and that termination of pregnancy was not the solution […]” So instead of referring her for the medical treatment she had requested and was entitled to under the PLDPA, the psychiatrist deceived her and diagnosed her with mental illness so that she could be sectioned under the Mental Health Act 2001.

This case should have be a textbook example of one of the vanishingly rare times when an abortion can be legally performed in Ireland. Instead, it’s the story of a suicidal child who was wrongfully imprisoned for several days at the behest of her doctor, presumably with the end goal of forcing her to continue with a pregnancy she categorically did not want to keep.

Some anti-choicers – when confronted with the various acts of barbarism Ireland has inflicted on pregnant women under the auspices of the Eighth Amendment – concede that abortion is, occasionally, the correct course of action. But when it comes to legislating on it, they insist that we can’t put the decision directly into the hands of women. Otherwise they’ll be having abortions left, right and centre for any old reason at all, the hussies! To forestall this dystopia, they favour restrictions-based legislation in which abortion is legal in certain exceptional cases (rape, incest, fatal foetal abnormality) but illegal in more common ones (failed contraception, drunken one-night stands.) In this model, abortion is a necessary evil that needs to be regulated by a moral hierarchy which ranks cases as deserving or undeserving, usually based on how much the woman suffered in the process of becoming pregnant. If the Eighth must go, this is the only alternative they will accept.

But as the Child Care Law case shows, the restrictions-based model leaves the door wide open for abuse. If we, as a society, decide that women can’t be trusted and we need gatekeepers to stop them making the “wrong” decision about abortion, then we need to be very clear on who those gatekeepers are and why they are qualified to wield unilateral decision-making power over someone else’s body. In this case, the gatekeeper was a psychiatrist who was willing to disregard the law to ensure that a suicidal teenager remained pregnant against her will. In light of this, can we guarantee that our medical professionals will stay neutral and put the wellbeing of their patient over their personal stance on abortion?

This is what happens when vulnerable people are stripped of their bodily autonomy and their decision-making power is ceded to strangers who do not always have their best interests at heart. The reality is that there will always be anti-choice doctors (and nurses and counsellors and social workers and judges and gardaí) willing to use their authority to coerce and manipulate vulnerable people, such as immigrants and asylum seekers, those living in poverty, those with disabilities and, of course, suicidal minors. This is why we need legislation to protect these people. This is why we emphatically do not need a system that forces them to jump through hoops to prove they are traumatized enough to be worthy of abortion. Consider, for example, how hard it is for a woman in this country to convince a jury that she was raped and then imagine adding Irish anti-choice animus into the mix. The result would be an ethical and logistical nightmare, even in the most straightforward of cases.

The Eighth Amendment is a human rights violation and needs to be repealed as soon as possible. After that, we need comprehensive and unambiguous legislation on reproductive rights to replace it. It is becoming increasingly clear that abortion without restriction as to reasons is the only viable replacement. This was the conclusion of the Citizens Assembly, convened by our government to make recommendations on this issue.

There is no individual or body in this country qualified to untangle the complex web of circumstances that lead a woman to seek an abortion. There is no individual or body that is morally, intellectually or emotionally equipped to sit in judgement over someone else’s reproductive choices: not the state, not the courts, not the church, and, as this case so starkly illustrates, not the medical establishment. Women should be trusted to make their own decisions, based on their best judgement and informed by transparent, accurate and unbiased medical counsel. We need legislation that reflects this. A pregnant person should not have to convince three doctors, or one doctor, or anyone at all, that they are suicidal enough – or sick enough, raped enough, violated enough, young enough, old enough, pure enough – to deserve an abortion. We are the experts on our own lives and our bodies are our own.

2 thoughts on “on being worthy of abortion

  1. As far as I know, what Jemima did in refusing to be involved with an abortion is entirely legal in the UK. (There might be a case for a tort or civil wrong.)

    But, and it is a large but; if any medical practitioner refuses a person treatment because they have a religious or faith objection to the procedure, that practitioner is obliged to refer the patient to a practitioner who does not have such objections. This is required by the General Medical Council, the medics regulatory body. It is a type of ‘duty of care’. If you don’t follow the GMC’s rules, you can be struck off the register.

    I understand that both nurses and pharmacists have a similar duty.

    I’m not certain if the Medical Council in Ireland has similar rules.

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