Four former chairs of the Institute of Obstetricians and Gynaecologists and the current chair of the Joint Institute of Obstetricians and Gynaecologists/HSE Working Group on Maternal Mortality, have called this week on Dr Rhona Mahony and Dr Peter Boylan to withdraw their remarks regarding the Eighth Amendment.
They were particularly appalled at Mahony's claim that, in Ireland, we play medical roulette with women's lives, and Boylan's statement that the Eighth Amendment makes "makes it difficult for us to treat women with compassion and give them the proper care that they need".
Both Boylan and Mahony have implied that women have to be dying before a doctor can intervene in serious conditions like threatened sepsis. Neither seems familiar with the Medical Council ethical guidelines.
Article 48.3 states: “Abortion is legally permissible where there is a real and substantial risk to the life of the woman which cannot be prevented by other means. This risk, while substantial, may not be immediate or inevitable in all cases.” There is no need to wait until death is imminent – and if Dr Mahony or Dr Boylan ever did, they would be in breach of their own professional guidelines.
While both Boylan and Mahony are actively campaigning for abortion in the Irish health system, it appears, however, that Boylan and Mahony do not agree on the diagnosis of Down syndrome and its implications.
Mahony, master of Holles Street, recently stated that non-invasive prenatal testing (NIPT) for Down syndrome is 99 per cent accurate and is available from nine to 10 weeks’ gestation.
Diagnostic test
She also said that “Down syndrome is a spectrum of disorders, ranging from babies who won’t survive the first trimester, babies with very serious heart defects, all kinds of other congenital anomalies, and babies that are quite well and relatively healthy. It is not one condition.”
Given that no screening or diagnostic test at this early stage can predict what level of disability a baby with Down syndrome will have, what is Dr Mahony’s point? The justification of abortion of babies with Down syndrome?
She said that most people would opt after NIPT to have the gold-standard diagnostic test, that is, chorionic villus sampling.
However, if the Eighth is not retained, suppose a woman, Anne, opts for NIPT at 10 weeks. Some companies guarantee a result in five days. Given that a positive diagnosis is 99 per cent accurate, Anne might then ask for an abortion. No reason will be required.
If she thinks 99 per cent accuracy is not enough, Anne can have chorionic villus sampling at 11 weeks. Irish companies offer results within two-three days, leaving Anne within the 12-week limit even with a three-day waiting period.
Abortions on the grounds of Down syndrome will be possible under the proposed legislation.
We are told to trust doctors but rarely advised what to do when doctors disagree. Dr Mahony believes that screening tests are highly accurate and available long before 12 weeks.
Dr Boylan took to Liveline to state that it is virtually impossible to receive a definitive diagnosis of Down syndrome before 12 weeks on the grounds that 99 per cent is not the same as 100 per cent. Prenatal screening and diagnostic testing is a multibillion dollar industry. There is fierce competition to be the first to develop an earlier NIPT and to become the new gold standard.
But Dr Boylan said that even if such screening became available at seven weeks, the Government could legislate to prevent abortion on the grounds of Down syndrome.
Abortion for disability
How exactly? Will women have to sign an affidavit stating that the abortion is not on the grounds of disability? How can any society deny abortion for disability, but allow aborting a healthy baby?
Abortion will be available up to 24 weeks on grounds of serious risk to health, with no distinction between physical and mental health. Just like the UK, two doctors will have to sign off, and in the UK this rapidly became no scrutiny at all.
In Germany, abortion is not permitted on grounds of disability but is permitted after the 12th week to "avert the danger of grave injury to the physical or mental health of the pregnant woman". This is the ground on which German abortions for Down syndrome and disability are carried out.
Just how much of a barrier “serious risk” will be is illustrated by what Boylan said in February: “I don’t really have a problem with them saying ‘serious risk’, because if the woman regards it as serious, then it is. It should be the woman’s assessment of the risk that counts.”
So, abortion for any reason until 12 weeks, and on virtual self-certification up to 24 weeks? And this is allegedly restrictive?
Before the last German election, Natalie Dedreux, a teenager with Down syndrome, asked Angela Merkel why nine out of 10 babies with Down syndrome are aborted in Germany. Merkelwas visibly discomfited and had no answer. Neither will we if this referendum is passed, no matter what Dr Boylan tries to tell us.