The Abortion (Northern Ireland) Regulations 2020, which came into effect on 31st March 2020, set out the framework for legal abortions within Northern Ireland. Under the regulations, ‘a registered medical profession may terminate a pregnancy’ under the following circumstances:
Ethical considerations & wider issues
There are many discussion points relating to the new abortion law in Northern Ireland and some strong opinions on either side of the debate. The following are some associated wider issues which you may want to research further and include in your discussion of the topic, should it arise during your medical school interview:
- How the law was passed
The UK Parliament passed the Northern Ireland (Executive Formation etc) Act 2019 to ‘give more time for the Northern Ireland parties to agree to return to the Northern Ireland Executive’, following the collapse of devolution at Stormont. Failing to do this meant that the UK Government had an ‘obligation’ to change the law in relation to three key issues in Northern Ireland, including abortion laws, and therefore resulting in this change. You can find out more about how these changes came into effect here.
Although it had no effect on the passing of the new abortion regulations, the Northern Ireland assembly voted to reject the changes, a motion which was brought forward by the DUP, and which they said ‘would send a message to Westminster that the regulations are not supported by Stormont’. It was also reported that the ‘Health Committee of the Northern Ireland Assembly was looking into whether it was possible for the Assembly to challenge and review Northern Ireland’s new abortion laws’. - The arguments for and against
There have been fierce debates regarding abortion rights and protests by those on both sides of the argument, particularly in the period before the new law was passed. Researching the key arguments for and against abortion rights will support you to discuss this topics within your interview.
Northern Ireland Humanists, part of Humanists UK, and Amnesty International UK both campaigned for legal abortions within Northern Ireland, as well as the Now for Northern Ireland campaign. Opposing the change to the law, organisations such as Precious Life and Right to Life have campaigned to prevent the changes and now to repeal them. Whilst it’s advisable to research these campaigns, to gain an understanding of the opposing viewpoints, you should be conscious of bias information which may be presented and ensure that you critically analyse these and distinguish between fact and opinion.
During your research and preparations for this topic, you should consider the following ethical concerns and their implications for abortion laws:
- An individual’s right to make their own decisions
As we covered in the medical ethics section, individuals have a right to make their own decisions in relation to their health and care, provided that they’re able to do so. Doctors have a duty to work in partnership with patients and to share information to support them to make a decision, but they cannot make the decision for patients, except in particular circumstances. This can be considered in relation to the change to Northern Ireland’s abortion law: does it allow individuals choice and the right to make their own deicisions? Is that the only consideration or the priority in these situations? - The unborn child’s rights
Arguments opposing abortion will often refer to the unborn child’s rights, stating that these should be the same as others, and therefore they should have a right to have their health protected. Doctors’ duty to ‘show respect for human life’, as outlined by GMC guidance, may also be considered in relation to this point. In contrast, debates around this topic and how it affects moral decision-making will often center on when a foetus can be considered ‘alive’, for which there is no medically agreed answer.
Where the Abortion (Northern Ireland) Regulations 2020 deem that a pregnancy can be terminated in circumstances of ‘severe fetal impairment and fatal fetal abnormalities’, there are debates about whether this is acting in the best interest of the unborn child or not. You’ll remember from the medical ethics sections that doctors are required to act in the best interest of their patients. - Patient safety
Under the Abortion (Northern Ireland) Regulations 2020, after 12 weeks of pregnancy, other than in circumstances of ‘severe fetal impairment and fatal fetal abnormalities’, a termination of pregnancy is only consider if there is ‘risk of injury to the physical or mental health of the pregnant woman’ or it is ‘immediately necessary to save the life, or to prevent grave permanent injury to the physical or mental health, of the pregnant woman’. It’s argued whether an unborn child’s rights should have precedence over the rights of the mother carrying it, particularly where it has been deemed a risk to their physical or mental health. As doctors have a duty to ‘protect and promote the health of patients’ what implications does this have for abortion laws?
Another consideration in relation to the ethical duty to protect the health of individuals and the public, is the risk to health if pregnant women seeking abortions are not provided with legal, safe options. Previous to the law changing in Northern Ireland, woman were able to access abortion services in other parts of the UK; however, this was still problematic and made the process for women in Northern Ireland more difficult. Amnesty International UK reported that ‘more than 1,053 women travelled from Northern Ireland to England to access abortions’ in 2018; what impact may this have had on women choosing to terminate their pregnancy? Consider the implications of this in relation to the moral debate and what you believe the responsibility of doctors to be in relation to this. - Doctors’ right to ‘conscientious objection’
Some arguments in opposition of the changes made to the aobrtion law have referred to the impact on medical professionals who do not wish to carry out these procedures. The General Medical Council (GMC) have provided guidance in relation to the ‘changes to abortion law in Northern Ireland’, outlining that doctors ‘may opt out of providing a particular treatment’, outwise known as ‘conscientious objection’, as detailed in the ‘good medical practice’ and ‘personal beliefs and medical practice’ guidance. However, doctors must ensure that they ‘treat patients fairly and with respect whatever their life choices and beliefs’ and patients ‘must have access to necessary information and timely care’. Right to Life, who are campaigning for the repeal of the law changes, have claimed that ‘protection in law’ for those who exercise their right to conscientious objection will be ‘limited’. Consider what you think the implications are for doctors in relation to ethical guidance and their duties as a result of this. - Consent
The issue of consent is not generally included in the debate about the changes to abortion laws; however, it’s worth always bearing in mind when discussing abortion more generally, as it can be an area where patients may make the decision based on external pressures and, therefore, it can be an area of concern in relation to consent. To explore more about consent and the ethical implications of this, refer to the previous section titled ‘medical ethics’.
Throughout these ethical concerns we’ve asked questions or suggested you consider different implications and your response to these, to encourage you to think about what the different viewpoints are and how you would use these ethical considerations in your discussion of the topic.
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Further research
As mentioned above, researching the different campaigns that support and oppose the change to the abortion law will support you to understand their different standpoints. For example, Amnesty International UK provide a range of information relating to abortion within Northern Ireland, including information about the new regulations, the implications of previous restrictions on abortions and the challenges during the COVID-19 pandemic. You’ll also find their timeline of the campaign history to decriminalise abortion. However, remember with any of the campaign information, that while there may be a wealth of resources, they may present one side of the argument, and this should be counteracted by looking at the opposing argument.
The abortion law in Northern Ireland, and indeed more generally, is a wide topic and as we mentioned previously, there are strong debates on either side of the argument. As well as an awareness of the different views in relation to this topic, you should focus on developing your understanding of the ethical implications relating to it and your duties and responsibilities as a medical student and doctor in the future. As with all of these topics, if you’re asked to discuss it, ensure that your response is not judgmental of either stance but demonstrates your understanding of the topic and the ethical responsibilities linked to it.
