How the Eighth Amendment affects healthcare

'The restrictions on abortion can lead to doctors being unable to, or afraid to, provide proper care for pregnant women who become ill'

Photo:- Saibh Egan

Photo:- Saibh Egan

We deserve compassionate healthcare in Ireland. The Eighth Amendment prevents this, which is why it is vital to remove it from the Constitution when we have the opportunity to vote in the May/June referendum.

We have lived under the shadow of the Eighth since 1983. The amendment makes the right to life of a fully grown woman, who may already have children, equal to that of a foetus. It has resulted in decades of suffering, pain, and even death for women and girls in Ireland.

The Eighth affects everyone who is pregnant or can get pregnant. At least nine women from Galway travel to the UK to access abortion care every month. They are denied health services at home and forced to travel. Many women who have accessed abortion abroad have spoken and written heartbreakingly about the feeling that their country has “abandoned them” at the most difficult moment of their lives.

Thousands of abortion pills are ordered online every year. Women who use them are at risk of a 14-year prison sentence and often are too afraid to go to their doctors to access aftercare. Many pregnant people cannot travel or access abortion pills. Our laws cause undue hardship and risks to women’s health and lives.

The Eighth also has a chilling effect on medical professionals and can prevent doctors from acting in the best interests of their patients. Currently, abortion is only legal in Ireland if there is a substantial risk to the life of the woman. If an abortion is performed outside narrow criteria, the woman and her doctor could face a 14-year prison sentence. A doctor should be free to prioritise a woman’s health throughout pregnancy without fear of prosecution. Decisions around pregnancy, as with any healthcare, should be made in line with medical best practice. This is currently not always legally possible in Ireland.

Repeal by Saibh Egan

The Eighth also prevents decisions being made by a woman in consultation with her doctor. Access to abortion ends up being a legal decision rather than a personal or medical one. This prevents women from accessing healthcare they need and is unnecessarily traumatic.

It should be said that the Eighth does not stop women in Ireland from having abortions – it simply makes it harder for them to access them. During the recent proceeding of the Joint Oireachtas Committee, Dr Bela Ganatra of the World Health Organisation said: “Our information shows that rates of abortion do not vary owing to the degree of restrictiveness of the law. The statistics show that the level of safety changes as the restrictiveness of the law increases. I would not say Ireland is immune from this.”

We cannot continue to export this problem. People who decide to travel usually opt for a surgical abortion because these are quicker than medical abortions. These people often delay travelling because they need to save up or borrow money for the trip and procedure, meaning they have an abortion later than they would have otherwise. Doctors in Ireland also cannot directly refer patients to clinics providing abortion care abroad – which is challenging for many patients, including those who face language barriers, have literacy issues, or have complex medical conditions.

Local GP Sophie Faherty shared with us the impact the Eighth Amendment has; “As a GP specialising in women’s health, my hands are tied and my hearts sinks every time I’m faced with an unplanned and unwanted pregnancy...when it comes to this fundamental event in life, a simple act: repealing the Eighth could simply eradicate the angst, guilt, and fear we face when we attend a patient who does not want to be a mother/continue a pregnancy.”

The restrictions on abortion care can even lead to doctors being unable to, or afraid to, provide proper care for pregnant women who become ill. Prof Fergal Malone, the master of the Rotunda Hospital, examined the barriers the Eighth poses to quality reproductive healthcare in Ireland during his presentation to the Joint Oireachtas Committee. He explained that forcing women to travel means they cannot access care in a timely manner, or have continuity of care, both of which put their health at risk. He also flagged that some doctors were unsure if they risked conviction if they provided aftercare for a woman who has accessed abortion in another jurisdiction.

The law as it stands risks women’s health and lives. Dr Rhona Mahony, master of the National Maternity Hospital, outlined the current situation, where doctors must wait “for a woman to be sufficiently ill in order that she is perceived to be at risk of dying” before performing an abortion because “an error in clinical judgment is potentially punishable by a custodial sentence of 14 years for both the mother and her clinician in the event that an identified risk is deemed not substantial enough”.

This highlights how our laws prevent doctors and other medical professionals being able to deliver a high standard of healthcare which protects both women’s health and lives. The consequences of women not being able to access an abortion that would save their lives and preserve their health should be all too familiar to the people of Galway given the death of Savita Halappanavar, on October 28 2012 at University Hospital Galway, after she was denied a life-saving abortion.

Savita is not the first woman who died after being assessed as “not sufficiently ill” to be given abortion care. Michelle Harte had been receiving life-saving treatment for cancer when she became pregnant. Doctors at Cork University Hospital advised her to terminate the pregnancy – but, despite this medical advice, the very same hospital’s ethics forum denied her an abortion, stating her life was not under “immediate threat”.

Michelle was forced to travel to London to terminate the pregnancy, despite being very ill with cancer. She had been unable to receive any cancer treatment during her pregnancy, and upon returning home fresh scans revealed the cancer had become more aggressive and spread to her brain. She died in 2011.

The Eighth has also had far-reaching unintended consequences across healthcare. In the tragic case of PP v HSE, a 26-year-old pregnant woman and mother of two was pronounced clinically dead, having suffered a brain stem death on December 3 2014.

Against the wishes of her family, her father was informed that, for legal reasons medical staff were “constrained to put his daughter on life support because her unborn child had a heartbeat”. She was kept on life support for several weeks, as her doctors – in two separate hospitals - were unsure of the legal implications of the Eighth. Ultimately, the decision over her care took place in a courtroom, instead of with her family in consultation with her doctors.

We all want compassionate, effective, healthcare services. The first step to achieving this is repealing the Eighth. This will protect women’s health and lives, whether they decide to end or continue a pregnancy. We must support women in whatever decision they make. Vote to remove the Eighth so women can access healthcare at home.

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