Rónán Mullen (Independent) | Oireachtas source

I am opposed to the amendment. It would have the clear effect of extensifying - if that is a correct word; I am referring to extending or widening - the health grounds for abortion. This is contrary to medical best practice and to unequivocal promises given to the people before the referendum. The people were promised that the Bill would require a threshold or test of serious harm to health and, therefore, the measures would not lead to abortion on demand.People were assured that the health grounds were accompanied by sufficient safeguards and that they were contrasted with their British counterparts. This amendment would have the effect of watering that down to a standard no better than the British equivalent which has resulted in abortion on demand, up to viability. The difficulty with changing it, as Senator Kelleher wishes, is that the threshold being required here is not a serious risk of serious harm but a risk of serious harm and this is occurring in the second trimester, by and large, because abortion is not required for any reason, although I suppose it could conceivably be, earlier but it could take place prior to viability.

I recall prior to the referendum Dr. Mary Holohan, a very eminent obstetrician from the Rotunda Hospital, making it clear that doctors had the scope they needed under the eighth amendment to treat women effectively. Prior to the repeal appropriate law was followed within the constitutional requirements of the eighth amendment, the best standard of healthcare was available to women in pregnancy, including in situations where it would not be possible to save the life of their unborn child as a result. That has changed now. As my colleague said, nowhere in medicine is seriousness used as the required test. That is because nowhere else in medicine is the consequence of the intervention the death of another human being. That is why the assessment of risk cannot be made subjective. There has to be an attempt to assess harm.

The distinction between mental and physical health situations is very relevant to this amendment because Senator Kelleher asked the Minister whether there would be guidelines, and, if I understand her correctly, about how the risk of serious harm to health would be assessed. If there are to be guidelines may I draw the Minister's attention to the need to consider the real situations that could occur. If there is a real scenario containing risk to health that refers to physical health, I do not think that people will disagree that all necessary medical treatment must be in place. That was Dr. Holohan's point. That was the status quopre-repeal. If, however, we are talking about the possible sudden emergence of a risk of serious harm to mental health, then it is absolutely vital there would be guidelines which take account of what the science is telling us about mental health and abortion, which is the point I made earlier and do not need to rehearse at length again. If anything, abortion, according to the literature, is associated, although this is contended, with an increased risk of adverse mental health sequelae, particularly in women who are vulnerable. There is contention in the literature but the literature is clear that abortion is not associated with an improvement in mental health. That is the situation as best I can put it as a layman. If that is the case, it would be vital if there is to be assessment of what constitutes risk of serious harm that it would be brought into the guidelines as well so that medicine is truly evidence based in this regard.

I submit to Senator Kelleher that the vagueness of the section is the problem.If this was a section that actually looked at the reality of the different kinds of medical issues that can emerge, be they mental or physical, the proposed amendment would get much closer to the point. However, in a context of vagueness it would actually expose us to a dangerous approximation of the current practice in Britain.