AFTER THREE SEPARATE weeks in which the Eighth Amendment Committee spoke about legal issues, it it is now speaking about medical care.
Today, the masters of two Irish maternity hospitals spoke before the committee, Rhona Mahony of Holles St and Fergal Malone of the Rotunda.
Before that, international experts spoke about developments in healthcare in relation to the termination of pregnancy.
You can follow the proceedings here as they happen.
Hello, Rónán Duffy here again for today’s committee hearings.
It’ll take place in two parts. One beginning soon after the members have finished speaking in private session and then another scheduled to begin from 4pm.
First up today is Dr Abigail Aiken, assistant professor at LBJ School of Public Affairs in Texas.
She’ll be joined by two people from the Department of Reproductive Health and Research in World Health Organisation, Dr Ronald Johnson and Dr Bela Ganatra.
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The deadline for the committee’s report is Christmas and although some members have expressed doubts about whether that will be met, Chair of the Committee Senator Catherine Noone has insisted they are on schedule.
In light of that, the committee is also set to have another meeting tomorrow, the first time there has been two formal public sessions in one week.
Tomorrow’s meeting will hear from representatives from the Irish College of General Practitioners and the HSE.
Noone is opening with a letter from Justice Mary Laffoy, chair of the Citizens’ Assembly, who has written about the recommendation of the assembly in relation to reason 13.
She says there may have been some confusion among the committee and among the media about this reason.
In this recommendation, the assembly recommended termination be made available without restriction up to 12 weeks of pregnancy.
An Irish Times opinion poll last week asked voters if they favoured general access to abortion up to 22 weeks, not 12 weeks.
Abigail Aiken is now making her opening statement.
She is speaking about Irish women who have accessed illegal abortion pills online.
She points to research which shows that of women accessing abortion pills, the majority of these women (54%) were using contraception when they became pregnant “and thus experienced a contraceptive failure.”
Only 2% of women reported requesting early medication abortion due to rape.
Aiken is speaking about why Irish women choose abortion medication instead of travelling to the UK.
She quotes interviews with Irish women who have spoken about their experiences of travelling. One said:
But the very worst part was when I got back to the airport afterwards and had to wait five hours to get a plane home, sitting there feeling I’d just committed a crime. I was so traumatized by that travel experience. I still can’t wrap my head around it.
“At-home use of abortion medications obtained using online telemedicine has been demonstrated to be both highly effective and safe,” Aiken says.
Of 1,000 women who used Women on Web between 2010 and 2012:
“Overall, 99% of women were able to end their pregnancy, and 95% were able to do so without needing a surgical intervention to help complete the abortion.”
Aiken says that some Irish women may be unable to avail of either travel or online telemedicine.
She says interviews conducted with Irish women have detailed other methods they would have had to to resorted to if that could not access abortion services.
She quotes one woman, Rebecca (39), who said that she was doing “everything they were warning you not to do”:
I was walking up to 20 km every day. I was doing sit ups, I was doing squats. I was doing anything I could possibly do to make this happen. I don’t think I ate for several days because I had read that if you have an extremely low calorie count and you’re taking high doses of Vitamin C that can cause a miscarriage.
“In conclusion, the lack of abortion services within the formal healthcare system in Ireland means that to access safe and effective care, Irish women must rely either on travel to a clinic 7 offshore or on online telemedicine,” Aiken says.
Dr Ronald Johnson of the WHO says that: ”Health systems should aim to respect and serve the human rights and dignity of women.”
“The should minimise the right of unwanted pregnancy by providing a good range of contraceptives,” he adds.
Bernard Durkan TD is asking Dr Aiken about this graph she provided, about the feelings of women after they access abortion.
Jan O’Sullivan TD is seeking information on whether women are entitled to better healthcare than those outlined by Aiken.
The deputy also wants to know the health implications for women who travel abroad for an abortion.
Aiken says that while there is a high level of satisfaction of women who access online abortion pills, they are still forced to do it illegally.
She says it also restricts women from availing of follow up services.
Dr Bela Ganatra of the WHO says, in relation to abortion pills:
“From the WHO we think it is a safe option, but only if it is in addition to care that is available. If it is a choice”.
O’Sullivan is seeking additional information from Dr Ganatra about international comparisons on safety and the instances of abortion.
“You can have a situation where you have low rates and high safety, and that is the case in most of northern Europe, ” Ganatra says.
Liss Chambers TD is asking Aiken’s presentation that focuses heavily on the use of abortion pills.
She is seeking opinions on whether they should be decriminalised.
Dr Ronald Johnson of the WHO opens his answer by saying “there are different levels of criminalisation”.
He points to the case of Romania which had severe criminalisation of abortion and led to very unsafe practices.
Ruth Coppinger TD is asking Ganatra about a WHO study which looks at how the availability of abortion affects abortion rates.
Coppinger references the regular claim from pro-life campaigners that the Eighth Amendment in Ireland has “saved 100,000 lives”.
Ganatra says that WHO research shows that abortion rates are more likely to be similar depending on the region, such as western Europe, rather than based on the legal situation.
“When compared by the legal status, we did not find that there was a significant difference in rates,” Ganatra says.
Senator Lynn Ruane is asking Aiken about her statement that 54% of women who accessed abortion pills had been using contraception when they became pregnant.
She wants to know whether is any evidence to suggest that women would use abortion “as a method of contraception” in a more liberal regime.
Aiken says that there is “no empirical” evidence to suggest this would happen.
Kate O’Connell TD is asking whether there is information on whether women who access abortion pills online may lie about being under 10 weeks pregnant.
Aiken says that she believes that “people are generally following the advice they are given.
O’Connell also wants to know whether the WHO sees Ireland’s abortion laws are surprising,
Dr Ronald Johnson says that the WHO “would never describe Ireland as being in the dark ages”, but said that the country’s laws are “an outlier”.
Dr Ronald Johnson also states that gestational limits vary greatly in countries where abortion is available.
Johnson describes abortion as “a very safe procedure”.
He says that the mortality rate for an abortion procedures is about 0.6 per 1,000 women.
He adds that by way of comprison, it is far more safe than completing a pregnancy.
“Abortion is still safer than carrying a pregnancy to term. It is about 14 times safer than carrying a pregnancy to term,” he says.
Senator Rónán Mullen says that there is a “glaring exception” to the WHO’s claim that abortion laws do not have an impact on abortion rates.
He says that abortion rates in the UK are 60 times higher than in Ireland
“You’re making a comparison that seems bizarre,” he says.
Mullen says he is not being given enough time to asks his questions as the Noone seeks to encourage him to give the guests a chance to respond.
Mullen says that “given the seriousness of the issues”, he be given “leeway”.
Other members then seek to interject to move things along.
Mullen says there is an “imbalance” between “both the views of members and those invited” before the committee.
“I don’t want to get into an argument about that with out guests present, we are trying to make the best of the time we have,” Noone says in response to the senator.
Dr Ronald Johnson outlines that unsafe abortion was identified as a public health concern in 1967
“It is a huge concern… It is a huge issue for women and the issue goes beyond medical and to mental health,” he adds.
Senator Paul Gavan wants to “get rid of some of the myths” that have been propagated by opponents of abortion, particularity relating to breast cancer rates and mental health problems.
Johnson says that breast cancer rates among women who’ve had an abortion is no higher than among “the general population”.
Senator Jerry Buttimer wants to know how long would it would take between the enactment of new laws to terminations taking place.
Dr Johnson says that it’s “tricky” to say because “cultures of healthcares” in different countries.
He says, however, that it “should be easy” to add to a healthcare system, if healthcare professionals are enthusiastic participants.
Peter Fitzpatrick says the “whole focus of today has been abortion”.
He says after Googling the issue he feels that abortion “is being put on front of people’s faces”.
“I do trust women. I’ve been getting a lot of flak over the past four weeks of these meetings. I do trust women. The most important people in my life are my wife and children,” he adds.
Fergal Malone of the Rotunda Maternity Hospital is now speaking.
He says he is at the committee in neither a”so-called pro-life nor pro-choice capacity” and is speaking about cases of fatal foetal abnormality.
“It is generally accepted in obstetrics that approximately 2%-3% of all fetuses have a significant congenital abnormality,” he says.
Malone outlines what happens in these cases at the hospital
Currently at the Rotunda, when a patient is given a prenatal diagnosis of a so-called “fatal fetal abnormality”, non-directive counselling is provided. This means that all options for management are discussed in a non-judgmental manner.
“Initially, the specific diagnosis is explained together with what exactly is meant by the term “fatal” or “lethal”. This includes quoting statistics on the chances of survival to birth and thereafter,” he adds.
Malone says that in these cases, there are two options, continuation of pregnancy or termination of pregnancy.
“We do not believe that it would be appropriate to specify a precise gestational age limit in weeks beyond which a pregnancy termination would be illegal,” Malone says.
Dr Rhona Mahony of the National Children’s Hospital says that about 3,000 Irish women travel to the UK each year to procure a termination.
Mahony is outlining the difficulties for doctors in determining whether a woman’s life is at significant risk, at which point a termination is currently permitted.
Mahony notes that a woman’s view is not considered in this
“Her view deserves considering but is not considered at the moment,” she says.
Mahony is also outlining the December 2014 case of a pregnant woman who was kept on life support in an Irish hospital subject to a court judgement.
She says that in this case the woman was 14 weeks pregnant, “weeks away from viability”.
She describes this case as futile and says “it could happen again”.
Mahony say clinicians need flexibility:
“We shouldn’t have have to wait until a woman is at a substantial chance of dying.”
In response to questions from Catherine Murphy TD, Fergal Malone again repeats that determining viability in cases of fatal abnormality is best done on a case-by-case basis.
“The doctor and the patient are best placed to make that decision,” he says.
Mahony is speaking about the difficulties in travelling as pregnant woman when they are in a situation where their child has a fatal foetal abnormality.
“And to know in your own country, that it would actually be a criminal offence,” she adds.
Fergal Malone that it in cases Trisomy 18, there is roughly a 50/50 split in the numbers of women who chose to continue with a pregnancy or travel to the UK for an abortion.
He says that it demonstrates the “balanced counselling” provided at the Rotunda Hospital.
Lisa Chambers TD is seeking information on the decision-making process where a “substantial risk” is determined.
When determining “substantial risk”, Mahony says two clinicians make this decision but the questions remains what exactly substantial means
“I do believe the definition of a substantial risk can create problems for doctors because there is a custodial sentence if they make a wrong decision, ” she says.
Peter Fitzpatrick TD asks Malone about his contention that it would not be appropriate to provide a list of specific foetal diagnoses that would be considered “eligible” for pregnancy termination.
Malone says part of the reason it would not work is because there could well be situations where a foetus has numerous abnormalities that together could be fatal.
Malone says that he does not foresee additional training required in Ireland should terminations be made legal here.
He says such procedures are not very different to procedures already carried out here, such as in cases of miscarriage
“I don’t foresee any changes in the need for different training for personnel. I do see foresee that changes would be needed in terms of resources,” he says.
These resources would be in terms of both additional personnel and in the location where patients would be cared for.
Lynn Ruane says members hear every week about how safe Ireland is for women to be pregnant and give birth in. She says the two guests might be in the best position to answer this, “so we don’t have to hear this again”.
Mahony says that Ireland does compare very well in terms of the mortality rate for pregnant women.
In Ireland, the rate is about 8 per 100,000 compared to the US at 17 per 100,000 and the UK at about 10-12 per 100,000.
Mahony says the developing world makes up about 99% of the deaths of women due to pregnancy, with rates that can be as high as 350 per 100,000.
Clare Daly TD notes that the issue of the criminalisation of abortion is not actually part of the committee’s remit, “although I increasingly think it should be”, she adds.
Daly wants to know how the “chilling effect” of this criminalisation is dealt with in gynecological training.
Mahony:
There are no other areas where people are charged with making medical decisions under the shadow of a custodial sentence of 14 years. We had a chance to discriminate that in the case of the Protection of Life During Pregnancy Act, and we chose not to do that. And I think that was a mistake.
Kate O’Connell TD wants to know at what point of pregnancy do doctors refer to “stillbirths” as opposed to “miscarriages”.
The deputy also notes that the committee has heard claims about foetal heartbeats developing at 21 days and “foetuses jumping around” at another point of destination.
She wants both masters to give some indication, as best they can, about these claims and about when a foetuses central nervous system develops.
Malone says that ‘miscarriages’ traditionally have been recorded before 24 weeks and at a weight of under 500 grammes.
On the central nervous system question, he says there is consensus is that foetal pain is not possible before 25 weeks “and is closer to 30 weeks”.
“This is an issue about balancing risk, and you are experts in that, but is also about values,” Senator Rónán Mullen says.
He wants the guests to address that.
Mullen says Mahony cannot point to any cases where doctors have been prosecuted.
He says that it is his view that the current legal position is allowing doctors ‘do what they have to do’.
He is speaks about chorioamnionitis infections and he says they are being dealth with in Irish hospitals.
“Is there a problem here if we are dealing with this issue?,” he asks.
“What I am here today to tell you, is that we would like to care for all our patients, irrespective of the moral, ethical or religious backgrounds of our patients,” Professor Fergal Malone says.
Mattie McGrath TD compares rates of terminations in cases of Down Syndrome of patients at the Rotunda Hospital, as provided by Malone, with other rates which he quotes.
“What is the Rotunda Hospital doing wrong?,” he asks Malone.
Malone says that the 50% rate he provided to the committee demonstrated that balance was achieved.
“I think Ireland is a punitive place to practice medicine,” Dr Rhona Mahony says, before referencing a number high profile cases like the X case and the C case.
“No doctor wants to find themselves part of the next media sensation,” she adds.
In response to questions from Billy Kelleher TD about “young girls in their bedrooms”, who may have taken abortion pills, Mahony says it is vital that women who may have taken them and feel in need of medical care, should seek that care.
Ruth Coppinger TD has brought up a TV debate she took part in with Cora Sherlock of the Pro-Life Campaign.
Rónán Mullen has raised an objection to Coppinger mentioning a third-party.
Noone says it is long-standing practice third-parties are not named and suggested that Sherlock may wish to write to the committee if she feels the need to correct something that was said.
That’s the end of today’s committee. It will return tomorrow at 2pm.
We will be sending out an email round-up of what happened at the committee later today.
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