In a sharp turnaround of policy, the Irish Medical Council voted in September 2001 to adopt new guidelines on abortion. The ruling, which took immediate effect, permits the procedure when there is 'a real and substantial risk to the life of the mother' and represents a move away from the council's previous stance which regarded the deliberate and intentional termination of a pregnancy as professional misconduct.1 In addition, the government has come under pressure, from both pro-life and pro-abortion groups to hold another referendum on the issue. Spring 2002 is the proposed timing.

In contrast to the UK, the Republic of Ireland has a written Constitution. Therefore any amendment is subject to a referendum. Following much discussion, the Constitution was previously amended in 1983 with the insertion of the following clause:

'The State acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right.' (Article 40.3.3)[2]

Apart from some legal scuffles relating to the provision of information regarding UK abortion services, it appeared as though the issue had been settled until the famous 'X-case' in 1992. Parallels with the landmark Rex v Bourne case in the UK are striking, as both involved a 14 year-old rape victim. The Supreme Court ruling at the time stated that abortion should be allowed in the case of a serious threat to the mother's life, including that posed by suicide. Another referendum was subsequently held, in which the right of individuals to travel to take advantage of abortion services in another state was affirmed, as well permitting the dissemination of information about abortion services in the UK. The proposal recently adopted by the Irish Medical Council, allowing abortion where there was 'real and substantial threat to the life of the mother', was rejected at that stage. The proposed wording of the next referendum would exclude suicide as a risk to the mother's life (thereby reversing the 1992 Supreme Court ruling). It also defines abortion as 'the deliberate destruction of the foetus after implantation' - this will allow for liberalisation of the provision of the morning-after pill and IUCDs.

Current practice

Based on figures from 1998, nearly 6,000 women who had an abortion in the UK give an Irish address.[3] This figure however is probably an underestimate of the actual number, as it does not allow for those who provide the UK address of a friend or relative. The 'official' abortion rate (number of abortions over number of women of childbearing age) in Ireland is therefore 6.9 per 1,000 (1998), compared with the UK rate of 13 per 1,000 (1996).[4] Analysis of the 1996 figures shows a remarkable similarity to the trends in the UK, with the peak age in the 20-24 group (38.2%). 80% are single and, as with most abortions in the UK, most (99.7%) are carried out on Grounds C (risk to mother's physical or mental health) and D (Risk to existing children's health) of the Abortion Act.

Conclusion

Ireland is in an interesting position. The legal issues are complex and difficult to interpret. Although a majority, at present, opposes the concept of abortion 'on demand', it seems that it will soon be permitted for limited clinical reasons. Of course, abortion is easily available in the UK, so in many ways the current situation is an 'Irish solution to an Irish problem'. This provides something of a safety valve preventing a more vocal demand for greater liberalisation. However, attitudes are changing rapidly in Ireland. If you are like me, then you will find it easy to ridicule or criticise our political leaders when what they need is our prayers for wisdom from God in such difficult decisions. 1 Timothy 2:1-4 is a timely reminder to us:

'I urge, then, first of all, that requests, prayers, intercession and thanksgiving be made for everyone - for kings and all those in authority, that we may live peaceful and quiet lives in all godliness and holiness. This is good, and pleases God our Saviour, who wants all men to be saved and to come to a knowledge of the truth.'