Abortion law controversy in Republic of Ireland

The death of Savita Halappanavar, an Indian dentist, has led to renewed questions about abortion law in the Republic of Ireland. Abortion is illegal there, in contrast to the situation in England, Scotland and Wales. A 1992 Irish court judgment allows abortion in cases of 'real and substantial risk' to the mother's life. The Irish Medical Council's professional code allows doctors to become involved in abortion in this rare circumstance. UK figures suggest that less than 1 in 5,000 abortions are carried out for this reason.

Mrs Halappanavar had presented in the 17th week of pregnancy, suffering from severe back pain, which reportedly was from an infection that progressed to septicaemia. Initial reports suggested that an abortion might have saved Savita's life, and that this had been denied because of Irish law, though some have suggested that the case should have been managed differently anyway. It is difficult to comment without full access to the facts.

The case has been followed by a number of calls to change the abortion law in Ireland, from groups as diverse as more than 50 Members of the European Parliament, to Amnesty International. Demonstrations calling for changes to the law have been reported at a number of Irish Embassies around the world, as well as in Dublin itself.

A clinical review of the case is currently underway in Ireland, with a government report on any changes to the law expected soon. An opinion poll in early December suggested a majority favoured new legislation that made explicit in law the previous judgment allowing abortion to save the life of the mother, to include occasions when suicide is considered a risk.

bbc.co.uk, 14,18,23,27 November and 1 December 2012, cmfblog.org.uk

Department of Health reshuffle

September 2012 saw a change of ministers at the Department of Health. Health Secretary Andrew Lansley was replaced by Jeremy Hunt, previously at the Department for Culture, Media and Sport. The new ministerial team also includes Liberal Democrat Norman Lamb, and Conservatives Anna Soubry and Daniel Poulter. Poulter is a graduate of King's College London Medical School, and had practised largely in Obstetrics and Gynaecology before being elected to parliament.

Hunt indicated in October his personal view that the legal time limit for abortion in the UK should be twelve weeks. Women's minister Maria Miller had also indicated support for a lower limit, as had a number of cabinet ministers (albeit largely for a 20 week limit, rather than twelve weeks). Prime Minister DavidCameron had voted for a 20 week limit in 2008, and reiterated his personal view that a 'modest' reduction in the limit was desirable. However, there have been no government moves to bring forward new legislation.

Hunt also came under attack for having supported a 2007 Early Day Motion stating 'That this House welcomes the positive contribution made to the health of the nation by the NHS homeopathic hospitals; notes that some six million people use complementary treatments each year; believes that complementary medicine has the potential to offer clinically effective and cost-effective solutions to common health problems faced by NHS patients, including chronic difficult to treat conditions ... [and] expresses concern that NHS cuts are threatening the future of these hospitals; and calls on the Government actively to support these valuable national assets.' Speaking on Radio 4's Today programme a month or so later, he said that his decisions would be guided by science, though he didn't comment on whether his views on homeopathy were evidence-based.

news.bbc.co.uk 6, 19 Oct 2012, telegraph.co.uk 4 Sep 2012

Barack Obama second term; US State polls

US President Barack Obama was elected to a second and final four year term in November. Although his margin over challenger Mitt Romney in the popular vote was close (less than 3%), he won clearly in the electoral college (by 332 votes to Romney's 206). This result was not unexpected, but perhaps more interesting were the results of a number of ballots about specific laws in individual states.

Several states backed measures to legalise possession of cannabis (Colorado, Washington), but a more far-reaching proposal to allow sales of cannabis through licensed stores was defeated in Oregon. Maine, Maryland and Washington all backed proposals to legalise same-sex marriage. Florida rejected a ban on use of state funds to provide or promote abortion, whilst Californians narrowly rejected an anti-death penalty measure.

One of the closest votes was in Massachusetts where, by a 51-49% margin, voters rejected a change in the law which would have allowed assisted suicide. The question read 'Should a doctor be legally allowed to prescribe medication, at a terminally ill patient's request, to end that patient's life?' The Massachusetts Medical Society had opposed the move, as had a number of disability rights groups.

Politico.com, accessed 5 Dec 2012

Contraceptives in schools

A Daily Telegraph survey in October showed that girls as young as 13 were being supplied with contraceptive implants and injections in schools, sometimes without their parents' knowledge. More than 900 pupils aged 13-16 had been given the contraceptives over a two year period (according to a Freedom of Information request), though many NHS bodes said that they did not keep figures, meaning that true numbers are likely to be higher.

Dr Phillip Lee, a GP and Conservative MP said: 'I'm prepared to accept it [contraceptive implants and jabs in schools] but only if it reduces teenage pregnancy rates'.

Dr Dan Poulter, a recently appointed health minister, said: 'Young people under the age of 16 are legally able to access contraceptive and sexual health services and any advice given will be kept confidential. However, the health professional must always encourage a young person to talk to their parents about their sexual health.'

The policy was criticised by the headmaster of Wellington College, Anthony Seldon, who said 'sexual intercourse is the very highest and most mature spiritual relationship that can exist between two human beings. Anything that trivialises or treats it as something mundane or easy, particularly for young people, is damaging their ability to grow up and to properly form a loving lasting relationship. It devalues sex; it makes it like an ordinary, everyday thing like going to have a McDonald's.'

telegraph.co.uk, 28 Oct 2012

Controversy over women bishops

The Church of England's General Synod has narrowly rejected legislation that would have allowed the ordination of women as bishops. Although at first glance there appeared to be more than a three to one majority for change, the structure of the Synod means that each house – the Bishops, Clergy and Laity – must pass a measure by a two thirds majority for it to be carried. This threshold was reached in the Houses of Bishops and Clergy, but narrowly failed to be reached by the Laity.

Concerns appeared mainly to be around the provisions for parishes and clergy who were opposed to women bishops, with opponents feeling these were not strong enough. Both current Archbishop of Canterbury Rowan Williams, and his appointed successor Justin Welby (currently Bishop of Durham), had argued strongly in favour of the change.

Bishop Welby tweeted after the vote: 'Very grim day, most of all for women priests and supporters, need to surround all with prayer & love and co-operate with our healing God.'

Tony Baldry MP, a Church Estates Commissioner responsible for taking questions on church matters in parliament, said: 'What has happened as a consequence of the decision by General Synod is the Church of England no longer looks like a national church, it simply looks like any other sect.'

news.bbc.co.uk, 21 October 2012

Liverpool Care Pathway

Controversy over the Liverpool Care Pathway continued, with many media reports. The pathway is intended for those in the last days or hours of life, and it is estimated that about a third of those who die in the UK have been on the pathway. The pathway encourages those giving care to consider whether interventions (such as checking blood pressure, or doing blood tests) are in the best interests of a dying patient. The pathway does ask staff to consider whether provision of artificial nutrition and hydration is appropriate, but does not debar use of such artificial feeding when deemed appropriate.

Health minister Norman Lamb has announced a review of the pathway, saying 'It is clear that everyone wants their loved ones' final hours of life to be as pain free and dignified as possible, and the Liverpool Care Pathway is an important part of achieving this aim.'

'However, as we have seen, there have been too many cases where patients were put on the pathway without a proper explanation or their families being involved. This is simply unacceptable.'

'Today I have committed to appoint an independent chair to review how end of life care is working and oversee the reviews into the LCP. This will report back to me in the new year. This review will also consider the value of locally set incentives, and whether they are leading to bad decisions or practice.'

www.nhs.uk, 27 November 2012