Monday, July 21, 2008

Abortion in Northern Ireland

Abortion report - Legal battle leads to landmark abortion consultation paper - More than 40 years after abortion was legalised in Britain, the public in Northern Ireland are being asked for the first time for their views
Date: Thursday, July 17, 2008
Source: Irish News
Author: Seanin Graham

A landmark legal battle launched seven years ago about abortion services in Northern Ireland has led to the first ever public consultation on the issue. The Department of Health yesterday published a 20-page 'guidance' document on the laws and clinical practices relating to the procedure, which remains strictly limited to women whose physical or mental health may be seriously damaged by the pregnancy. It insists existing laws on abortion in the north will not be changed with the report's publication.

The development stems from legal action by the Family Planning Association (FPA)in 2001, which claimed that not all women were being made aware of their rights by healthcare professionals. After the FPA won the right to a judicial review in 2004, the courts ordered the department to review the "adequacy" of services for women seeking terminations and to issue "appropriate guidance". A 10-week consultation period will now begin, allowing the public to have their say on the matter.

Abortion laws in the north differ radically from those in England, Scotland and Wales. The guidance document repeatedly states that abortion is only legal in the north if there is a "serious threat to the life of the woman" or it "would adversely affect her physical or mental health". Women seeking abortion must show that continuing their pregnancy would lead to "real and serious" risks to their health, which are "permanent or long term". Foetal abnormality is not recognised as grounds for termination, unlike in Britain.

Authors accept that the onus will be on the patient's GP to determine whether an abortion is warranted and that this will be a "difficult decision". "Each case requires careful and sensitive assessment within the law as outlined in this guidance," the paper states. "It is important for practitioners to appreciate that anyone who unlawfully performs a termination of pregnancy is liable to criminal prosecution with a maximum penalty of life imprisonment."

The guidance highlights that two doctors - if it is practical - who are familiar with the patient's medical history should make a clinical judgment on whether an abortion is legally warranted. However, it states that in an emergency "it may be sufficient" for a single doctor to assess whether a termination is appropriate.

One of the most difficult issues for medics lies in determining if the pregnancy is likely to cause long-term difficulties for the patient's physical or mental health. The paper points to specific problems in assessing women who have a history of psychiatric problems or severe learning disabilities. It recommends that a psychiatrist should be involved in the care of patients with mental health problems.

Similarly, child and adolescent psychiatrists should be involved in any assessment of under-18s suffering from mental illness. There are long waiting lists in the mental health sector in Northern Ireland, especially in child and adolescent services.

The guidance, meanwhile, states that staff who have "conscientious objections" to abortion on moral or religious grounds should have their rights "recognised and respected" - except in circumstances where the woman's life is in "immediate danger". There are no measures in place across the north's health trusts to deal with such objections and the document recommends that "appropriate arrangements" should be introduced to deal with such requests. If a doctor, nurse or midwife has an objection, they should refer the patient to another health professional. The guidance adds: "Staff with a conscientious objection cannot opt out of providing general care for women undergoing termination of pregnancy. The personal beliefs of staff should not prejudice general patient care."

Gaining patient consent and providing adequate information and services to women both before and after abortion is also dealt with in the document. Women must have "sufficient competence" to understand the procedure, and their consent must be voluntary. Counselling and support should be provided to the woman, both before and after the procedure. The guidance document notes that counselling is not a regulated activity in the north. Access to services should also be ensured for non-English-speaking women and those with speech problems, hearing impairments and physical or learning disabilities.

The Department of Health last night said the guidance "simply restates the legal position" and cannot make any changes to the law. "Health professionals involved in this area of work have told us they are uncertain about the law in relation to abortion and this guidance offers clinical advice and good practice advice to help them make informed decisions and take appropriate action," a spokesman said. "It is intended that, following consultation, the finalised guidance will be published in early October 2008."

Q: Is abortion legal in Northern Ireland?
A: Abortions are strictly limited and can only be performed if it can be proved that the pregnancy would damage the physical or mental health of the woman. Fetal abnormality is not recognised as grounds for termination in the north, unlike in Britain.
Q: What is the law in England, Wales and Scotland?
A: The 1967 Abortion Act legalised terminations up to 24 weeks of pregnancy. Women from Northern Ireland are not entitled to an NHS abortion in England.
Q. Do the 2008 guidelines on abortion for Northern Ireland change existing laws?
A: The Department of Health has said it simply restates the current legal position.
Q: How many legal abortions are carried out in Northern Ireland each year?
A: Official government figures suggest there are 70 to 80 abortions carried out annually.
Q: How many women travel to Britain for abortions?
A: An average of 1,300 women travel from Northern Ireland to England for abortions each year. The average cost is £1,000 for medical fees and travel.