Contesting the cruel treatment of abortion-seeking women

Abstract

This article draws on legal arguments made by civil society organisations to challenge the legal reasoning that apparently produced the decision in the Ms Y case in Ireland in August 2014. I show how legal standards of reasonableness and practicality ought to be interpreted in ways that are respectful of the patient’s wishes and rights. The case concerned a decision by the Health Service Executive, the Irish public health authority, to refuse an abortion to a pregnant asylum seeker and rape survivor on the grounds that a caesarean section and early live delivery were practicable and reasonable alternatives justified by the need to protect fetal life. I argue that the abortion refusal may not have been a reasonable decision, as required by the terms of relevant legislation, for four different reasons. First, the alternative of a caesarean section and early live delivery was not likely to avert the risk of suicide, and in fact did not do so. Second, the consent to the caesarean section alternative may not have been a real consent in the legal sense if it was not voluntary. Third, an abortion refusal and forcible treatment fall below the norms of good medical practice as interpreted through a patient-centred perspective. Fourth, an abortion refusal that entails forms of cruel, inhumane and degrading treatment ought not to be a reasonable action under the legislation.

Résumé

Cet article se fonde sur les arguments juridiques présentés par les organisations de la société civile pour contester le raisonnement légal qui a apparemment produit la décision dans l’affaire de Mme Y en Irlande en août 2014. Je montre comment les normes juridiques relatives au caractère raisonnable et pratique doivent être interprétées de manière respectueuse des souhaits et des droits du patient. L’affaire concernait la décision du Health Service Executive (HSE), l’autorité irlandaise de santé publique, de refuser un avortement à une femme demandeur d’asile enceinte et victime d’un viol au motif qu’un accouchement précoce par césarienne était une solution praticable et raisonnable justifiée par la nécessité de protéger la vie fłtale. J’avance que le refus de l’avortement peut ne pas avoir été une décision raisonnable, ainsi que l’exige la législation compétente, pour quatre raisons différentes. Premièrement, la solution d’un accouchement précoce par césarienne avait peu de chances d’éviter le risque de suicide et en fait n’y est pas parvenue. Deuxièmement, le consentement à la césarienne pouvait n’être pas un consentement véritable au sens de la loi en cela qu’il n’était pas volontaire. Troisièmement, le refus de l’avortement et le traitement forcé sont en deçà des normes de bonne pratique médicale interprétées dans une perspective axée sur le patient. Quatrièmement, un refus d’avortement qui comporte des formes de traitement cruel, inhumain et dégradant ne devrait pas être considéré comme une mesure « raisonnable » en vertu de la législation.

Resumen

Este artículo se basa en los argumentos jurídicos presentados por organizaciones de la sociedad civil para cuestionar el razonamiento jurídico que al parecer produjo la decisión en el caso de la Srta. Y en Irlanda, en agosto de 2014. Yo muestro cómo los estándares jurídicos de sensatez y sentido práctico deben ser interpretados en maneras que respeten los deseos y derechos de la paciente. El caso examinó la decisión del Ejecutivo de Servicios de Salud (HSE), la autoridad de salud pública irlandesa, de negar un aborto a una mujer embarazada y sobreviviente de violación que solicitó asilo, con el argumento de que una cesárea y parto temprano del feto vivo eran opciones viables y razonables justificadas por la necesidad de proteger la vida del feto. Arguyo que la negación del aborto quizás no fue una decisión razonable, como disponen los términos de la legislación pertinente, por cuatro razones diferentes. Primero, la opción de una cesárea y parto temprano del feto vivo probablemente no hubiera evitado el riesgo de suicidio, y de hecho no lo hizo. Segundo, el consentimiento para la cesárea no hubiera sido un verdadero consentimiento en el sentido jurídico si no fue voluntario. Tercero, la negación del aborto y tratamiento forzado están por debajo de las normas de buena práctica médica interpretadas desde una perspectiva centrada en la paciente. Cuarto, la negación del aborto que implica formas de trato cruel, inhumano y degradante no debe ser una acción "razonable” según la legislación.

Keywords:

• abortion
• refusal of treatment
• caesarean section
• rape
• asylum
• cruel
• inhuman and degrading treatment
• consent
• human rights
• negligence
• Ireland

Acknowledgements

This paper draws on the blog “Contesting the cruel treatment of pregnant women”, Human Rights in Ireland. 19 August 2014. http://humanrights.ie/constitution-of-ireland/contesting-cruel-treatment-ruth-fletcher/? My thanks go to Mary Donnelly, Máiréad Enright, Claire Murray, Peadar O’Grady, and Maeve Taylor for their helpful comments on an earlier version.

Notes

* The Health Information and Quality Authority found numerous failures, including 13 missed chances to save her life.¹¹

* See for example a clip from the Today Tonight Referendum Special on the Eighth Amendment, Radio Telefís Eireann (the public broadcaster of radio and TV) featuring Mary Robinson of the Anti-Amendment Campaign and William Binchy of the Pro-Life Amendment Campaign.¹³ For a recent example of civil society critique of Irish state practices, see the submissions to the UN Human Rights Committee for Ireland’s review under the International Covenant of Civil and Political Rights, including six pro-choice submissions from the Abortion Rights Campaign, Centre for Reproductive Rights, Doctors for Choice, Irish Council of Civil Liberties, Irish Family Planning Association and Women’s Human Rights Alliance.¹⁴

† There does seem to have been conflict within the Department of Health and the Health Service Executive over how to respond to the case.¹⁵

** The draft report was featured on Prime Time, a leading current affairs programme, before Ms Y was consulted or interviewed, and before she received a copy of it.²⁰

†† Women in Northern Ireland are in a similar situation given the failure to extend the Abortion Act 1967 to that part of the United Kingdom.²⁹

* Article 40 3 3 provides: “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.”⁴⁷

* The Health Service Executive strategic plan 2008–2013 commits to making the service user central to their own care and the design and delivery of health and personal social services.⁷³

† Available electronically via a fee-paying legal database service such as Lexis Nexis.⁷⁴

* Polls regularly record high levels of popular support e.g. 80% for the legalization of abortion in cases of fatal fetal abnormalities.⁸⁴