(Image by Darko Stojanovic from Pixabay)

The three-year review into Ireland’s abortion legislation has just been published, and there’s a lot in it. We’ll be looking at different aspects in the days ahead.

The first thing to note is that whatever Marie O’Shea’s personal commitments are, this is a very, very pro-choice report. Throughout the whole thing the widespread availability of abortion is treated as an unalloyed good, never as a difficult compromise or a tragic necessity. It is not written as though by someone who wants to make abortion “safe, legal, and rare”. You can see the maximalism clearly as soon as page 6, when O’Shea notes that women are still traveling to the UK to get abortions, mostly for two sets of reasons. First when they are more than 12 weeks pregnant but fewer than the UK’s no-questions-asked deadline of 24 weeks. Second, under the UK’s ‘Ground E’, “where there is substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped”. This is the UK’s disability clause, under which foetuses with Down Syndrome are aborted with no gestational limit. What’s O’Shea’s comment on this? “These figures indicate that not all needs are being met.” Any time anyone is denied an abortion, that’s an unmet need, a problem to be solved.

That quote is typical of O’Shea’s report, which is written in a familiar kind of stern, confident officialese. It doesn’t actually make a case for its deep, controversial commitments, because it doesn’t have to: it’s just implementing best practice. Its author knows that there are a lot of other documents issued by the UN and the WHO which assume the same values in the same stern tone, and it knows that by citing them it’s doing all it has to do to make an argument for its pro-choice values. What’s going to happen, is Simon Coveney going to say that the UN is wrong about something?

Whenever a point is raised against further liberalisation of the law, or in favour of any changes to it that might be read as making it more restrictive, it’s swiftly dealt with. Sometimes this is with a one-sentence rebuttal, as here (page 76) :

The issue of whether pain relief is desirable for the foetus undergoing Foeticide has been raised in the Dáil and in the Seaned [sic].  As the Chair is not a medical practitioner, this issue is not within her field of competence.  However, the opinions of two fetal medicine specialists and one obstetrician were ascertained as part of the Review and their views were that the administration of pain relief was not required.

What a passage! What exactly is meant in it by “desirable for the foetus undergoing Foeticide”? Is the question “is it desirable to us that the foetus receive pain relief?” or “is it desirable to the foetus that they receive pain relief?” That is not the kind of clarification that you get in this sort of document. Without it though it’s very unclear what the last sentence of the paragraph is about. What does it mean by “required”? Required in order to what?

Did the two (nameless) fetal medicine specialists and the obstetrician conclude that foetuses undergoing foeticide don’t feel pain from a lethal injection to the heart and so pain relief isn’t “required” to prevent it? Or was their judgement that preventing fetal pain is not a “required” objective in the best practice of foeticide? I don’t know. But that’s not the point. The point is that the matter is taken care of. The experts are on hand. There’s no need to doubt or worry. You can just move on and read the next paragraph.


I’m not really making this point to criticise the report (Breaking News: pro-lifer opposed to ideologically pro-choice document!). I just want us all to be clear where it stands. Lots of pro-choice people in this country think abortion is tragic and that there should be less of it, but for a variety of reasons they didn’t support the eighth amendment. This report is not written by a person like that, and it’s not written for people like that. If you search through the document for the word “reduce”, you’ll find references to solutions that “reduced the inequities in access to care experienced by women who do not have a GP or community provider close to home”; you’ll find recommendations which aim to “reduce delays in the process to review refusals to requests for termination of pregnancy”. You won’t find any mention of reducing the abortion rate as any kind of desirable goal. The only thing this report wants to minimise are “barriers to access”. These are to be “removed”, “overcome”, “addressed.” There’s never so much as an acknowledgement that a barrier to access might be a good feature of the legislation rather than a flaw. For O’Shea, abortion is healthcare, and that’s it.


Given that the review is coming from this perspective, there’s nothing at all surprising about its ambition to make sure that pro-life doctors are gradually made a thing of the past.

There’s no conspiracy here, no secret agenda. The fact that the review doesn’t say “the aim is to get to a situation where there are very few pro-life doctors” isn’t because it’s ashamed of the ambition. Rather it just takes this goal completely for granted. It just wants to get care delivered to people who need it, and to remove obstacles in the way. Who could disagree with that? So you get passages like this (page 14):

Initiatives have been taken by the HSE to overcome barriers to access caused by conscientious objection. These include arranging values clarification sessions in hospital settings (which has been shown to be effective). The ICGP is planning to facilitate its members attending values clarification workshops.

What exactly these values clarification workshops are is left quite muddy by the report. We hear that they are a “key enabler to enabling participants to reflect on their values and thoughts about termination of pregnancy services by looking at their own beliefs and attitudes from the needs of women seeking the service.” Apparently as of June 2022 seven of them had taken place, at the Rotunda, the Coombe Women and Infants’ Hospital, the National Maternity Hospital, Cork University Hospital and Limerick University Hospital. They were “run in conjunction with the World Health Organisation who facilitated the sessions” and apparently were very effective at getting people to sign on to providing abortion services.

The review goes on (page 102).

The HSE NWIHP (National Women and Infants Health Programme) Director has also confirmed that efforts to overcome conscientious objection as a barrier to service provision are ongoing and include the development of peer support mechanisms, increased senior clinical leadership both within and between maternity hospital networks, ongoing engagement between the HSE NWIHP office, the Clinical Lead for termination of pregnancy services and individual hospitals and maternity hospital networks.

I actually admire this in a way, because this kind of thing will be effective. Pro-choice policymakers clearly have an organised, thought-through plan to network, train, and values-clarify until as many people as possible working in Irish hospitals are firmly pro-choice.

And if that doesn’t work they aren’t afraid to get tougher. Page 19:

To support the recruitment process to positively discriminate in favour of persons willing to provide termination of pregnancy services in settings where there are no providers or the numbers are so low that the service is untenable, the Department of Health should consider amending section 22 of the 2018 Act to include a provision similar to section 15 Contraception, Sterilisation and Abortion Act 1977 (New Zealand) which sets out in statutory form the employer’s obligations to accommodate the rights of conscientious objectors except in circumstances when it is necessary to uphold the right to health care.

All job specifications for staff required to run the service in hospitals where there are insufficient numbers to sustain the service, should feature provision of termination of pregnancy services as mandatory requirement as should the contract of employment.  Candidates should be informed at interview of the contractual obligations and of the legal consequences of breaching the condition, which could be termination of employment.

There’s no mention of these hiring policies ever being rescinded once in place. The view expressed here is clear: if you become a problem, we will simply ban you from getting hired. Conscientious objection to abortion should only be allowed to exist as long as it stays in a small and ever-shrinking box.

What Marie O’Shea and the people who got her appointed to chair the review want to avoid is Ireland becoming anything like Italy. Although abortion on request has been legal in the first 90 days of pregnancy in Italy since 1978, the fact that so many doctors refuse to provide it means there are more safeguards for unborn children in practice than in theory.

CNN reports:

Across Italy, 68.4% of gynaecologists identify as “conscientious objectors,” according to 2017 Italian Ministry of Health data. In some parts of the country, accessing an abortion can be nearly impossible, with gynaecologists in the southern regions of Molise and Basilicata objecting at rates of 96.4% and 88.1% respectively.

Surprisingly, this number is going up. In 2005, only 59% of gynaecologists were conscientious objectors. A pro-choice maximalist would, by their own lights, be absolutely right to head off any possibility of something like this occurring.


Irish pro-life doctors, though, should see it as inspiring. There is real potential to save lives here. But that potential can only be realised if pro-life doctors are still around in numbers in ten or twenty years. And that can only happen if they get much, much better organised than they currently are. They need to establish their own networking sessions, their own workshops, their own mentorship programmes. This will have to happen with zero institutional support. The aim must be that any young doctor, or nurse, or staff member who has reservations about abortion is made aware that there are others like them and strongly supported in not being values-clarified out of their convictions. There will have to be alliances made with open-minded pro-choice doctors in hospital governance so that contracts do not discriminate against pro-lifers. Doctors will have to get better at having conversations about abortion so that they’re able to convince their colleagues to take the right side on this fundamental human rights issue. (We’re happy to help with that last one!)

I know that pro-life doctors are embattled and struggling as it is. But the moment asks even more of them than they are already giving, because the stakes are incredibly high here. Marie O’Shea’s review makes clear that there is a sustained and well-organised effort to make Ireland like the UK, where there are virtually no pro-life obstetricians and gynaecologists left. This effort has to be resisted with an equally well-organised and sustained response. The alternative is the end of pro-life obstetric medicine.