Hard-line positions such as anti-abortion carry costs

Editor's note: Jamie Manson is on hiatus to work on several writing projects. Jamie has invited NCR Today contributor Kelly Stewart to fill in for her while she is away.

On the day after Christmas, the Irish High Court ruled that a clinically dead pregnant woman could be removed from life support. The young woman — who has not been named — suffered head trauma on Nov. 29 and was declared brain dead on Dec. 3. Because she was 15 weeks pregnant, however, doctors declined the family’s wishes to take her off life support, unsure of whether doing so would violate Irish anti-abortion law.

At issue was the interpretation of Article 40.3.3, the Eighth Amendment of the Constitution of Ireland. The Eighth Amendment states: “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.”

The Eighth Amendment was passed in 1983 to prevent the legalization of abortion, but its definition of the legal rights of the fetus left this young woman’s doctors, in the words of one neurologist who treated her, “very uncertain about the legal standing. We didn’t know.” He described sitting down with a colleague to try to “figure out” the amendment.

Doctors had little trouble figuring out the medical evidence, however. The fetus had virtually no chance of surviving, and none of the seven medical consultants who testified recommended continuing life support. The woman’s body, an intensive care specialist reported, had become infected and inflamed and bore little resemblance to the woman’s photograph beside the bed. As one physician put it, continuing life support would mean “going from the extraordinary to the grotesque.”

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The court was persuaded by the medical testimony and ruled that the hospital could remove life support. To continue life support, the court argued, would subject the fetus to “a perfect storm from which it has no realistic prospect of emerging alive.” Additionally, it would subject the woman’s father, partner, and two children to “unimaginable distress in a futile exercise” and diminish her dignity.

The case is striking both because it is so tragic and because it went to court despite being so medically and ethically unambiguous. As Ruadhán Mac Cormaic writes at The Irish Times, “The unanimity among medical experts about the prognosis for the survival of the unborn made this relatively straightforward. As the judges noted, the medical evidence was ‘all one way.’ ”

Not only was the medical evidence “all one way,” but the woman’s family members all agreed that she should be removed from life support. And, though he expressed reluctance to comment on the specifics of the case, Dublin Archbishop Diarmuid Martin remarked that, “From the point of view of Catholic teaching in general medical ethics, there is no obligation to use extraordinary means to maintain a life,” saying that, “A woman isn’t simply an incubator.”

Thus, in the case of this young woman’s heartbreaking death, it happens that medical opinion, her family’s wishes, and the conclusions produced through approved structures of Catholic moral reasoning coincide. Still, despite the straightforwardness of the case, her doctors found themselves poring over a copy of the Constitution of Ireland, trying to “figure out” the nuances of the Eighth Amendment. And the hospital ended up keeping a dead woman on life support for three weeks until the court made its decision.

Martin said it was “a pity” that the case went to court. “It should be within the area of the medical profession,” he said, “but there seems to be a polarization and a fear that if things go wrong then there will be a difficulty legally or with insurance and so on.”

It is a pity, of course, but given the history of anti-abortion laws in Ireland and elsewhere, it also isn’t surprising.

Why wouldn’t doctors, under a government that grants a fetus the same legal rights as a woman, fear the legal consequences of performing any procedure that ends fetal life?

Why wouldn’t doctors, most of whom have no advanced legal training, worry about how their decisions might be interpreted by jurists, most of whom have no advanced training in healthcare?

Why wouldn’t doctors, in a country whose government has failed to provide clear guidelines for complicated cases related to pregnancy and childbirth, be uncertain about what they are and are not legally permitted to do for a brain-dead pregnant woman?

Ireland has had the Eighth Amendment for over 30 years. Long-standing problems with the amendment, and with the Irish government’s failure to provide clear guidelines to healthcare providers, are well-documented. Savita Halappanavar’s preventable 2012 death from blood poisoning is one of the most horrific recent examples, but the case the High Court decided Dec. 26 also shows some of the problems of sweeping anti-abortion laws.

Serious threats to the life, health, dignity, and well-being of pregnant women can require immediate and decisive responses that sweeping laws do not allow. The realities of reproductive ethics are more complicated than those sorts of laws acknowledge, and efforts to address these complexities in Ireland have been reluctant and incomplete.

This is important for Catholic anti-abortion activists in the U.S., some of whom point to Ireland’s Eighth Amendment as a shining example, to consider.

If you want to ban or seriously restrict access to abortion, it is not enough to believe deeply that abortion is wrong. It is also important to ask why people have abortions and what might happen to them if abortions were made unavailable. To ask how the burdens of such a ban might be distributed across lines of gender, race, and class. To consider that pregnancy can kill women, can cause serious and sometimes irreparable damage to women’s health. It can prevent women from working, from going to school, from leaving abusive partners. Laws banning abortion can and sometimes do prevent women from receiving life-saving medical care and dying with dignity.

Hard-line positions carry costs. It’s important to understand what those costs are before deciding that they’re worth it.

[Kelly Stewart earned her Master of Arts in Religion at Yale Divinity School, where she studied feminist and queer theory and Catholic sexual and reproductive ethics. She is a former Loretto Volunteer.]

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