PLC Briefing Document Feb. 2013

LEGISLATION FOR THE X CASE IS ABOUT ABORTION, NOT ABOUT MEDICAL TREATMENTS NEEDED TO SAFEGUARD WOMEN’S LIVES

THE GOVERNMENT’S ARGUMENT THAT ABORTION IS NECESSARY TO TREAT THREATENED SUICIDE IN PREGNANCY WAS DEMOLISHED AT THE RECENT OIREACHTAS HEARINGS ON ABORTION. THE PSYCHIATRISTS WHO ADDRESSED THE HEARINGS WERE UNANIMOUS THAT ABORTION IS NOT A TREATMENT FOR SUICIDAL IDEATION. THERE IS NO EVIDENCE WHATSOEVER THAT ABORTION REDUCES THE MENTAL HEALTH RISKS OF UNPLANNED PREGNANCY. BUT THERE IS EVIDENCE THAT ABORTION INCREASES THE RISK OF FUTURE MENTAL HEALTH PROBLEMS FOR A SIGNIFICANT NUMBER OF WOMEN. IF THE GOVERNMENT LEGISLATES FOR ABORTION ON THE BASIS OF THE X CASE, IT WOULD CURE NO WOMAN OF SUICIDAL IDEATION, BUT IT WOULD PUT SOME WOMEN'S LIVES AT RISK. IF WE ARE SERIOUS ABOUT PROTECTING THE LIVES OF WOMEN AND BABIES IN PREGNANCY, WE CANNOT INTRODUCE A LAW THAT DIRECTLY TARGETS THE LIFE OF THE UNBORN CHILD AND PUTS WOMEN’S LIVES AT RISK.

VIOLATING THE MOST BASIC HUMAN RIGHT Legislation based on the X case would mean that for the first time, psychiatrists would be asked to propose a procedure for which there is no psychiatric justification.

For the first time, obstetricians would be asked to terminate the lives of babies in physically-healthy women.

Likewise, for the first time, legislators would be violating the most basic human right of an innocent unborn child.

Laws shape public values. If X legislation were passed, society would see the right to life of the unborn as not that important – after all, we would not be really serious about protecting it - the lives of unborn babies would be ended on an entirely irrational and unjustifiable basis. Soon this would become the general view, replacing our culture of life with a culture of abortion.

WHY LEGISLATING FOR THE X CASE WOULD LEAD TO WIDE-RANGING ABORTION Claims by senior Government Ministers that legislation based on the X case would be extremely restrictive do not stand up. It cannot be and would not be.

Any legislation based on the X case ruling would mean that Members of the Oireachtas would be sanctioning and legitimising the taking of innocent human life. Once the principle is conceded that some human lives can be directly targeted, there is no going back. Inevitably over time the grounds for abortion would be widened.

The reality is that the X case ruling does not impose any duty of care to preserve the life of the baby in the course of medical interventions to safeguard the life of the mother. No medical evidence whatsoever was heard in the case. And in the twenty years since the X ruling, medical research, far from confirming that abortion helps women with mental health problems, has failed to find any benefit to women from abortion. Many peer-reviewed studies, however, indicate that abortion exposes women to significant negative after-effects.

Despite hundreds of thousands of abortions annually on mental health grounds in Britain, there is no evidence that abortion improves the mental health of women.

As Professor David Fergusson comments in the conclusion to his 2008 study, published in the British Journal of Psychiatry: “In general, there is no evidence in the literature on abortion and mental health that suggests that abortion reduces the mental health risks of unwanted or mistimed pregnancy. Although some studies have concluded that abortion has neutral effects on mental health, no study has reported that exposure to abortion reduces mental health risks.” 1

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EXPERTS EXPOSE INHERENT FLAWS IN X CASE RULING The hard truth is the Supreme Court got it wrong in the X case ruling. The judges mistakenly took it for granted that the threat of suicide is a medical emergency in which the appropriate medical intervention is abortion to protect the mother’s life.

In his evidence to the recent Oireachtas hearings, perinatal psychiatrist Dr John Sheehan corrected this mistaken view: “The notion of carrying out an emergency termination is completely obsolete in respect of a person who is extremely suicidal. … In such situations, one can see clearly the intervention usually is to admit such people into hospital, day hospital or home care but the intention is to support and help them through the crisis they are in. It is not to make a decision that is permanent and irrevocable.” 2

We know from the expert evidence at the hearings that abortion is not medically indicated as a treatment in the case of threatened suicide in pregnancy. We know too that some peer-reviewed studies confirm the testimony of many post-abortive women that abortion itself heightens the risk of future mental health problems. An example is the comprehensive Finnish study3 which shows that women who have abortions are more likely to commit suicide than women who continue with their pregnancies.

The Government has no peer-reviewed evidence to support its decision to legalise abortion on grounds of threatened suicide. It would be putting women's lives at risk, not safeguarding them, if it legislated on the basis of the X case ruling. These are the facts and they cannot be ignored.

FAILINGS OF GOVERNMENT’S WORKING GROUP ON ABORTION It is hard to see why the Government made its decision to legislate for abortion before the Oireachtas hearings on the issue were held. Equally hard to fathom is how the Government’s Expert Group on abortion issued its report before the hearings happened.

The result was that both the Government and the Expert Group made up their minds before they had an opportunity to hear the expert evidence.

The most glaring example of this is the way the Expert Group proposed abortion where the mother is feeling suicidal even though there is no evidence that abortion is a medical treatment for suicidality.

Equally disturbing is its proposal, pretending some duty of care to the baby is being retained, that where the mother presents at the “fringes of viability”, the baby should be delivered early and rushed to an intensive care neonatal unit.

This would be a monstrous injustice to the baby - to induce the pregnancy at the fringes of viability, exposing the baby to brain damage, blindness or loss of life itself, when the consensus of psychiatric evidence is that the termination would confer no benefit on the mother. This one example highlights the scant regard and thought that was given to vindicating the right to life of the baby throughout the entire process to date.

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THE DUTY NOT TO BE DUPED

LESSONS TO BE LEARNED

Lord David Steel, the architect of the 1967 law that brought wide-ranging abortion into Britain recently said it would be “a mistake” for Ireland to introduce abortion on the ground of threatened suicide, adding he “never envisaged there would be so many abortions” in Britain resulting from the law he introduced.5 British abortion statistics have a truly chilling lesson to teach us in Ireland, a lesson that should give us pause before we follow their example. In 2011, a staggering 97% of the 189,931 abortions in England and Wales were 6 performed on mental health grounds. No responsible legislator can ignore these statistics.

The late Professor Anthony Clare stated in evidence to the previous Oireachtas hearings on abortion in 2000, that when he worked as a locum in Bermuda, the “threat of suicide” grounds for abortion was widely exploited, placing psychiatrists in an impossible position.7 In California, the Therapeutic Abortion Act 1967 allowed abortion where “the woman is dangerous to herself or to the person or property of others or is in need of supervision or restraint.” Only three years later, 98.2% of all abortions (61,572) in California were on this ground.

Britain’s biggest abortion provider, the British Pregnancy Advisory Service, openly admits “it is not the case that the majority of women seeking abortion are necessarily at risk of damaging their mental health if they continue their pregnancy. But it is significant that, because of the law, women and their doctors have to indicate that this is the case.” 8

Members of the Oireachtas have a responsibility to be practical and realistic and to learn from the experiences of other countries and not be taken in by the “restrictive abortion” argument.

It is absolutely clear that those pushing for abortion want wide-ranging abortion, not life saving treatments for women in pregnancy. But they know well from experience in other jurisdictions, that the hardest step in their fight is the first step, to get the door to legalised abortion unlocked and opened, no matter how slightly. Once they achieve that, the rest is just a matter of ridiculing the restrictions and attacking them in the courts.

Our legislators have a duty not to be duped. It is entirely predictable what is going to happen if the Government proceeds with its decision to legislate for abortion on the basis of the X ruling. The legislation will include restrictions, committees of medics, psychiatrists, whatever. The pro-abortion voices will feign horror at the restrictions and some members of the Labour Party will even wonder aloud whether or not the legislation is worthy of support. But surprise, surprise, they will manage to vote for it on the day.

And before the ink is dry on the legislation, they’ll be picking holes in it and calling for changes.

Indeed, already, Labour Party Minister of State, Kathleen Lynch is on record attacking the approach the Government is proposing to adopt on the grounds that those who want abortion but are not suicidal will have to pretend.

Make no mistake what they want is social abortion, abortion on request. There is no such thing as a little bit of abortion. Once the principle has been dislodged, then it is only a matter of time before the grounds are widened.

As the recent newspaper undercover investigation 9 brought to light , women attending HSE-funded agencies like the IFPA have been advised that if they suffered physical complications from their abortions, they should lie to their doctors and pretend they had a miscarriage. Not surprisingly, the Master of a Dublin Maternity Hospital described this advice as “life endangering” for women.

The Minister for Health has done nothing whatsoever to date to address these abuses in HSE-funded agencies. What reason has anyone to believe that rules on abortion would be any more rigorously upheld?

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IMPORTANT ETHICAL DISTINCTIONS It is important to be clear what we mean by phrases like “termination of pregnancy” or the need for abortion “where there is a real and substantial risk to the life of the mother.”

IRELAND – A WORLD LEADER IN PROTECTING WOMEN DURING PREGNANCY Based on recent media coverage, one could be forgiven for thinking that Ireland, without abortion, is among the most dangerous countries in the world for pregnant women. The fact and truth is, that out of 171 countries Ireland is consistently in the top five for women's safety in pregnancy over the last 25 years. That's a stunning statistic. And that world class care is delivered today by the medical professionals in this country under existing principles and guidelines.

Trends in Maternal Mortality 1990 to 2010, WHO, UNICEF, UNFPA and the 10 World Bank: Estimates, (2012) is a study that allows us to compare the rates around the world according to the same criteria and using the same method over a twenty year period.

It finds that over the ten year period, Ireland is in the joint fifth group of safest countries in the world for women in pregnancy with an average maternal mortality rate of 6 maternal deaths per 100,000 live births. Over this period, our maternal mortality rate was half that in Britain and under a third that in the US. Over the same period, furthermore, our maternal mortality rate fell by 12% while the rate in Britain rose by 23% and in the US rose by 65%.

This is an outstanding achievement for Irish medical practice, making Ireland’s maternal mortality rate a striking testament to the appropriateness of the principle underlying the practice of Irish medicine in relation to women in pregnancy, in stark contrast to the dramatically poorer records of Britain and the US both of which have wide-ranging abortion regimes.11

Those campaigning for abortion purposely use emotive language, blurring the key ethical distinctions to push the case for legalised abortion.

Words like “abortion” and phrases like “termination of pregnancy” are routinely used in quite different ways in different contexts.

Regarding the phrase “termination of pregnancy”, it is important to remember that all pregnancies are terminated. Most of them terminate with the birth of a normal healthy baby. Some unborn babies die as an unavoidable and unintended result of some life saving treatment of the mother.

Furthermore some babies die, in spite of the best efforts of all involved, as a result of being born too early: such births may occur spontaneously or may be induced in cases where it represents the only, albeit very low, chance of survival.

Clearly, then, there is a huge ethical distinction between necessary medical interventions in pregnancy where the baby may be exposed to some risks and induced abortion where the life of the baby is directly and intentionally targeted.

Recent attempts to cast doubts on Ireland’s high ranking among the world’s safest countries for women in pregnancy by comparing the above report with a report drawn up using different parameters fail, in the first place, because they are not comparing like with like; in the second place, because they still show Ireland, with no abortion regime, ranking higher than Britain with its wide-ranging abortion availability; and in the third place, because until a table for all states is compiled using the new parameters, we won’t know what difference it will make to the overall ranking.12 13

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WHY THE POSSIBILITY OF ANOTHER REFERENDUM SHOULD NOT BE RULED OUT As the Report of the Government’s Expert Group on abortion says, two referendums seeking to address the problems posed by the X case ruling were defeated. Why then, should the possibility of another referendum be ruled out?

First, it is factually incorrect to interpret the majority NO votes in the referendums of 1992 and 2002 as an endorsement of the X case decision.

In the 1992 referendum, voting patterns clearly show that the measure was defeated by a resounding rural vote because of the absence of any duty of care for the baby in the proposal. The 2002 referendum to overturn the X case decision narrowly lost with 49% of the electorate voting YES. The YES vote was clearly a pro-life vote. In the immediate aftermath of the referendum an IMS (now Millward Brown Lansdowne) poll identified that over 5% of those who voted NO did so for pro-life reasons as they were dissatisfied with the referendum wording. When you add the two votes together, the pro-life vote clearly exceeded 50%.

PUBLIC BACKING FOR LEGAL PROTECTION OF THE UNBORN CHILD It is true that there is a lot of public confusion at present on the issue. But, contrary to what some people claim, no broad middle ground consensus has emerged in favour of abortion.

Media commissioned polls on abortion invariably fail to distinguish between necessary medical treatments in pregnancy and induced abortion, thereby falsely creating the impression that a large majority of the public backs legalised abortion. However, polls that make the distinction clear consistently show a sizeable majority opposed to abortion being available in Ireland. Recent Millward Brown Lansdowne research found that over 60% of those who expressed an opinion support legal protection for the unborn child, while at the same time ensuring that women receive all necessary medical interventions in pregnancy.

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The second reason for not ruling out another referendum is the fact that regardless of where one stands on the issue, it is indisputably a defining issue for society. The fact that previous attempts to overturn the X case ruling failed is no reason not to try again. After all, we are talking about protecting the most precious right of all, namely the right to life, without which all other rights are meaningless.

GUIDELINES NOT LEGISLATION

CONCLUSION

The European Court of Human Rights judgment in A, B and C v. Ireland does not oblige Ireland to introduce abortion by way of X case legislation, regulation or any other way. It simply requires that we have accessible procedures by which people can know the law and where they stand.

Any legislation based on the flawed X case ruling would corrupt the practice of psychiatry and the practice of obstetrics.

The Government should respond to the judgment in two steps: • First, it should give a commitment to the Committee of Ministers of the Council of Europe that Guidelines will be drawn up in consultation with the appropriate bodies of expertise within the medical profession based on best medical practice, addressing the requirement of clarity for women in pregnancy.

• Second, the Government should give a commitment that the difficulties associated with the X case will be examined and the options for clarifying them identified, and that the Government will revert to the Committee of Ministers on the progress of this at a later stage.

It would also corrupt the law because despite all the half-truths and worse being told by those touting the proposal, it would legalise abortion, the deliberate taking of innocent human life, and once that principle is gone, it’s gone.

And when those seeking wide-ranging abortion arrive at the door of the Court and start pushing, they would find that the door against abortion has been opened and there is no legal principle to prevent them getting the wider level of abortion that they wanted all along.

Once the principle has been conceded, once it is legally permissible to deliberately destroy an innocent life, from that point on, no innocent human life can be sure of the protection of the law.

It is not unusual or disrespectful to take time in responding to judgments of the European Court. In fact, the Committee of Ministers’ 3rd Annual Report 2009, Supervision of the Execution of Judgments of the European Court of Human Rights, reported that from 1996 to 2009, 8,661 cases were still incompletely implemented, and they explain the reason for the delay: “The last few years have seen a significant increase in the number of cases relating to complex and sensitive issues, which need more time to resolve.”

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Pro Life Campaign - 10-02-13

104 Lower Baggot Street Dublin 2, Ireland 01 6629275 info@prolifecampaign.ie www.prolifecampaign.ie

FOOTNOTES

1

David M. Fergusson, L. John Horwood and Joseph M. Boden, ‘Abortion and mental health disorders: evidence from a 30-year longitudinal study,’ British Journal of Psychiatry (2008), 193, pp. 444-451.

2

Oireachtas Hearings on Abortion, 8th January 2013, pp 74-75

3

Gissler, M, et al., ‘Injury deaths, suicides and homicides associated with pregnancy, Finland 1987–2000’, European Journal of Public Health, Volume 15, Issue 5, 2005, pp. 459-463.

4 5

Report of the Expert Group on the judgment in A, B and C v Ireland, p 37 Irish Independent, 21st December 2012

6

Abortion Statistics, England and Wales: 2011, National Statistics, Department of Health, May 2012, pp 8-9. https://www.wp.dh.gov.uk/transparency/files/2012/05/ Commentary1.pdf 7

Fifth Progress Report: Abortion, The All Party Oireachtas Committee on the Constitution, November 2000, page A 130 8

Abortion Review, 2nd May 2012, http://www.abortionreview.org/index.php/site/ article/963

9

Irish Independent, 27th October 2012

10

Trends in Maternal Mortality 1990 to 2010, WHO, UNICEF, UNFPA and The World Bank: Estimates, (2012) http://whqlibdoc.who.int/ publications/2012/789241503631_eng.pdf 11

Using only information from death certificates, the Infant Mortality, Stillbirths and Maternal Mortality, CSO Report on Vital Statistics 2010, (2012) gives Ireland’s maternal mortality rate as 4 deaths per 100,000 for 2009, 1 death per 100,000 for 2010. This method gives the figure for one year rather than an average over a number of years. http://www.cso.ie/en/media/csoie/releasespublications/ documents/vitalstats/2010/chapter42010.pdf 12

In addition to death certificates, the Confidential Maternal Death Enquiry in Ireland, Report for the Triennium 2009 – 2011, August 2012, also draws information from coroners, pathologists, maternity units, general hospitals, public health nurses and GPs, and give Ireland’s maternal mortality rate as 8 deaths per 100,000 for the combined years 2009 and 2010. http://www.mdeireland.com/pub/MDE_ report_w_2012.pdf 13

Notwithstanding attempts to make political capital out of the new way of calculating the rate, the idea of drawing new sources of relevant information into the analysis could well prove to be a valuable addition to understanding all the factors relevant to maternal safety, though the higher the level of data required, the fewer countries will be able to reach it and the greater the role of estimates in drawing up the comparative table.