Dear Prof Bury, We the undersigned as members of the Medical Council wish to clarify our position in relation to the council and its deliberations on abortion, which we consider to be totally unsatisfactory. At a meeting on May 30th, 2001, the Medical Council at the request of one of its members discussed an item, All Party Oireachtas Committee on the Constitution 5th Progress Report-Abortion. Following this discussion a number of motions, not previously on the agenda, were proposed. These were:
1. That the Medical Council recognises that termination of pregnancy can occur where there is a real and substantial risk to the life of the mother;
2. That the Medical Council recognises that termination of pregnancy can occur when the foetus is no longer viable.
We expressed concern that these motions should be considered without adequate notice or without first of all consulting the medical profession and we thus moved the following resolution: "That the Medical Council consult the profession and the professional bodies as has been the practice before."
After a brief discussion on the three motions, the first two were voted through by a majority despite the concerns we had expressed. The third motion was rejected and defeated by virtually the same majority for the first two motions.
We were alarmed at the failure to give notice of these proposals, at the brevity of the discussion and especially at the decision not to consult the profession or the public, as had been the practice of the Medical Council since its establishment in 1979.
We were also very concerned that the second motion might be in breach of the criminal law in Ireland since it allows for abortion in cases of foetal abnormality. As a mark of protest we walked out of the meeting.
Since our walkout the Medical Council has failed to reconsider its position regarding the three motions. It has been a matter of dismay to us that, in spite of our exhortations to the contrary, council has persistently not agreed to consultation with the full medical profession, all of its professional bodies, and the public about ethical issues relating to the pregnant mother.
Legal opinion was sought by the Medical Council and obtained from two senior counsel, one of whom attended a subsequent meeting of the Medical Council. The latter formed the opinion that the two motions were invalid since proper procedures had not been followed and that the second motion may be advocating a breach of the criminal law. The second counsel provided an oral opinion that the council should "err on the side of caution and provide its members with notice . . ."
The Medical Council strenuously resisted our attempts to have these motions declared invalid, at a meeting on June 29th and at an extraordinary meeting, called by the undersigned on July 12th. To date all attempts by us to even discuss this matter have failed. An application to the High Court by some of the undersigned on July 23rd seeking leave for judicial review was also unsuccessful.
It is a matter of further concern that there is a failure to inform the public, on an ongoing basis, about the Medical Council's deliberations on this matter. Further, at a meeting on June 13th the council sought, in our view, to impose a gag on media inquiries relating to this issue.
Apart from confidentiality in respect of Fitness to Practise matters, we consider that there is no obligation of secrecy in respect of other council matters, especially since the Medical Council is a statutory body fulfilling important public functions, not alone in regulating the profession but most of all in protecting the public interest.
The process of reviewing the ethical guide takes place every five years, and is devised to protect the public by requiring the highest standards of medical practice. Irrespective of the individual views on the substantive issue of abortion, we believe all doctors and the public would wish for wide and transparent consultation when any or all of the issues in the guide are being reviewed.
As doctors it is our ethical duty to seek where possible to preserve the life and health of our patients, including those who are pregnant. Irish doctors have always striven, even in high-risk pregnancies, to save the lives of the mother and baby.
We also recognise that in rare circumstances this may not be possible and that the risk of death to the mother and baby is almost certain if delivery of the immature baby is not undertaken. In this regard we note the submission of the Institute of Obstetrics and Gynaecology (the professional body representing this speciality) to the All Party Oireachtas Committee which states that because of rare complications in pregnancy "therapeutic intervention is required to protect the life of the mother at a stage in pregnancy when there is little or no prospect for survival of the baby due to extreme immaturity".
It is our view that this action is an essential part of the mother's treatment and reflects current medical practice which is in accordance with good ethical principles as contained in the current ethical guide of the Medical Council, a position that was supported by the current Medical Council in its oral submission to the All Party Oireachtas Committee on abortion in March 2000. We would support constitutional and legal safeguards to protect doctors who practise according to these principles.
In conclusion, we believe the Medical Council should now:
1. Rescind the motions that were carried at its meeting of May 30th;
2. Have the council's ethics committee commence with a wide and transparent consultation with the profession and the public over the next two years on all ethical matters - including those that relate to the mother in pregnancy - culminating in the final publication of a revised guide;
3. Adopt a more transparent approach in providing information on an ongoing basis to the profession, the public and the media regarding its deliberations when reviewing the guide.
Yours etc.
Hugh C. Bredin, J. Brendan Healy, Miriam Hogan, Eamon McGuinness, Martin Mahon, Rosemary O'Connor, Helena Stokes