Anti-choice spinning of California’s 1967 abortion law

We’ve heard a lot lately from anti-choice campaigners about California’s 1967 Therapeutic Abortion Act. It’s being cited to support the argument that legislating for the X case – to allow abortion where a pregnant woman’s life is at risk, including by suicide – will inevitably open the floodgates and effectively allow abortion on demand.

One example is this Tweet from the Pro-Life Campaign’s Cora Sherlock:

California legalised abortion for suicide in 1967. 3 yrs later, 98% of all abs in Cali carried out on this ground @reginado @finegaeltoday

— Cora Sherlock (@CoraSherlock) February 10, 2013

Subsequently, an email circulated to Oireachtas members by a group of anti-choice politicians (parts of which were published in this Irish Independent article) claimed that the California law

was enacted in 1967 on the strict grounds of ‘where the mother was a danger to herself’

And then on the Vincent Browne show the other night, Dr Patricia Casey said that under the law, the woman had to be “certifiable”.

Three different claims about the California law. All wrong.

The actual text of the law was found in §25951 of the California Health and Safety Code. It allowed abortion where a committee, established by the hospital performing the abortion and consisting of at least two licensed physicians and surgeons (or at least three after the 13^th week of pregnancy), found that there was

a substantial risk that continuance of the pregnancy would gravely impair the physical or mental health of the mother

“Mental health”, meanwhile, was defined in §25954 as

mental illness to the extent that the woman is dangerous to herself or to the person or property of others or is in need of supervision or restraint

Right away, we see that the text is logically problematic – how on earth can “mental health” be defined as “mental illness”? – but we don’t need to spend time on that. The more important thing is what the legislators intended in this requirement. Clearly Cora Sherlock got it wrong, because there’s no need that the woman actually be at risk of suicide, and the Oireachtas group also got it wrong, because the element of danger to herself is only one of the possible criteria under the law.

Dr Casey is closest to the truth, but even she is not quite correct. The text is based on an old standard under which a person could be deemed “certifiable” (a term I find a bit offensive, personally, but we’ll put that aside for now) but there is a crucially important difference. The old standard – which was found in §5550 of California’s Welfare and Institutions Code – allowed for involuntary commitment where a person was

dangerous to themselves or to the person or property of others, and are in need of supervision, treatment, care or restraint

What’s changed there is that the “and” was replaced by “or” for the abortion law. To be committed, a person had to be both dangerous and in need of supervision or restraint; to be allowed an abortion on mental health grounds, either was sufficient. So clearly, a lesser threat to mental health was required than that the woman would need to be institutionalised.

Still, it is a fairly high standard, and the anti-choicers are right when they say it was given a much broader interpretation in practice.  But it still doesn’t follow that the Irish law would do the same thing. For one thing, any way you look at it, “dangerous to herself or to the person or property of others or … in need of supervision or restraint” lends itself to a much looser interpretation than “at real or substantial risk of suicide”. (In fact, the California law was struck down as unconstitutionally vague in 1972 – two months before Roe v Wade – precisely because it had proven impossible for doctors to agree on what these criteria meant.)

For another thing, the California law operated in California. California isn’t Ireland, and it always took a more permissive attitude toward abortion. Even before the 1967 Act, it wasn’t actually difficult to get an abortion there – though the standard of care varied widely depending on the quality of provider the woman could afford. Women didn’t need to travel for abortion as they do in Ireland, where doctors are simply not willing to breach the law. It’s unlikely to the point of absurdity that the flexible interpretation applied by California doctors will be repeated here.

A comparable situation is the way that abortion laws are interpreted in Britain and Poland. On paper, the two countries have a pretty similar regime: both allow abortions in case of fatal foetal abnormality or risk to life or health. In practice, however, they couldn’t be more differently applied: Britain, as we all know, is more or less effectively abortion on demand, while Poland is regularly hauled before the European Court of Human Rights for denying even crystal-clearly legal abortions (and in the most appalling circumstances too; the latest example, P and S v Poland, reads like something Franz Kafka might have written with Margaret Atwood). Cultural views, and the constitutional context, have a huge impact on how liberally abortion laws are interpreted – and Ireland is far closer to Poland than Britain in this respect.

The increasing calls of the Irish pro-choice movement to repeal the 8th Amendment are a reflection of this. If legislating for X really would “open the floodgates” and allow abortion on demand, there’d be no need to amend the Constitution. When the legislation gets through eventually, and it will, we will see how little impact it really has on the abortion rate in Ireland. And then we can get on with campaigning for real change.

Free Clothes*

*By “free” I mean “you have to give Choice Ireland a fiver first.”

Click on the photo for more details.

Savita, abortion and the right to health in international law

Commentary around the Savita Halappanavar inquest has, understandably, focused on the Irish constitutional law context but I haven’t seen much discussion about the breach of her rights under international law.

This is perhaps unsurprising, as abortion itself has a nebulous standing in international human rights law. As its opponents never tire of pointing out, it isn’t protected per se in most of the world’s major human rights treaties. The only real exception is in the 2003 Maputo Protocol to the African Charter on Human and People’s Rights – that continent’s counterpart to the European Convention – which sets out in Article 14(2):

States Parties shall take all appropriate measures to:
…
(c) protect the reproductive rights of women by authorising medical abortion in cases of sexual assault, rape, incest, and where the continued pregnancy endangers the mental and physical health of the mother or the life of the mother or the foetus.

None of the human rights treaties to which Ireland is party even mention the word “abortion”, though that doesn’t mean they can’t protect the right in limited circumstances. The obvious example of this is the European Court of Human Rights decision in ABC v Ireland, which held the State in breach of an applicant’s right to her private life for failing to provide a clear mechanism by which she could establish and exercise her right to a legal abortion. This is similar to the way that other treaty monitoring bodies have approached the issue, such as the UN Human Rights Committee in KL v Peru and the CEDAW committee in LC v Peru. In both cases, the decision wasn’t that there was a right to abortion per se in the relevant treaty (respectively, the International Covenant on Civil and Political Rights and the Convention on the Elimination of All Forms of Discrimination Against Women), but that the particular abortion sought would have been legal under state law and thus various treaty provisions were breached by denying the petitioner access to it.

But what I want to talk about here is a more general right – namely, the right to health, and how it was breached in Savita’s case. The right to health is protected in a number of treaties that Ireland is party to, most importantly under Article 12 of the International Covenant on Economic, Social and Cultural Rights. Then there’s CEDAW, mentioned above, which has its own Article 12 protections for women’s health, while in the European Social Charter, “The right to protection of health” is set out in Article 11. It’s important to realise that these treaties are all fully binding on Ireland as a matter of international law. There’s often confusion on this point, because Ireland has a “dualist” system which means a treaty isn’t domestically enforceable unless it’s incorporated into national law by the Oireachtas (as with the European Convention on Human Rights Act 2003). You can’t go down to the High Court to sue the State for breaching your ICESCR rights – in fact, at the moment you can’t go anywhere. But it’s still legally obliged to protect them, even though there’s not much you can do if it doesn’t.

In and of itself, the fact that Savita died wholly avoidably in a public hospital proves the State’s failure to protect her right to health. If her death really had been due only to the “system failures” we keep hearing about, then perhaps we could chalk it down to a one-off, individual failure. But the more we hear from the inquest, the more apparent the truth becomes: the breach is in the law itself, not merely the way it was implemented or (mis)understood by her medical team. In fact, even if she had survived – and I know of a few women in similar circumstances who, thankfully, did – her right to health would still have been violated. Ireland’s ban on abortions in all but life-threatening cases will inevitably violate the right to health in those cases that fall short of the “real and substantial risk” threshold set by the Supreme Court. Here’s why.

The most widely-accepted definition of the right to health – the Article 12 ICESCR definition – is the “right to the highest attainable standard of physical and mental health”. The General Comment on this right by the treaty’s monitoring body, the Committee on Economic, Social and Cultural Rights, goes quite a bit further in defining that to include “the right to control one’s health and body, including sexual and reproductive freedom”. This is a fairly unambiguous, though legally non-binding, interpretation. But we don’t even have to go there, because on the plain terms of Article 12, you cannot enjoy the highest attainable standard of health if you’re denied an abortion that you need for the sake of your health. Simple as – and there’s no getting around it by hypothesising whether Physical or Mental Condition X would entitle someone to an abortion under this rule. Yes, there may be cases where it’s uncertain if abortion really is indicated for health reasons, but that’s completely beside the point: Irish law doesn’t allow for any of them if you aren’t considered likely to die otherwise. An absolute prohibition on “therapeutic” abortions for non-life threatening cases is not made compatible with the right to health just because it’s not always easy to determine who needs a therapeutic abortion.

“But rights aren’t absolute”, I hear you say. Well no, they aren’t, but when they’re guaranteed in a legally-binding treaty they can only be limited under the terms set out in that treaty. The ICESCR limitations clause, Article 4, states that the rights can be subjected

only to such limitations as are determined by law only in so far as this may be compatible with the nature of these rights and solely for the purpose of promoting the general welfare in a democratic society.

Now, admittedly, this is a bit woolly, and a casual reading might well lend itself to a utilitarian interpretation, or suggest that a society which considers abortion a generally bad thing could legitimately consider an abortion ban to promote society’s general welfare. It’s not an absurd argument, on its face.

But it’s also not supported by the aids we have to interpret the meaning of the text. The Convention’s travaux préparatoires – the official records of the negotiation process (not online, but detailed in this book) – don’t exactly explain what the drafters of Article 4 had in mind. They do, however, show the rejection of various proposals to include grounds of public order, public morality and the interests of the community – all things which might suggest a person’s rights could be trumped in the interests of some aspirational “greater good”. The CESCR, for its part, states that Article 4

is primarily intended to protect the rights of individuals rather than to permit the imposition of limitations by States

which would mean that the State has a heavy burden of proof in justifying any such limitations.

In Irish law, of course, this is met by Article 40.3.3′s protection of “the right to life of the unborn”. But that won’t cut it in international law, because there is no right to life of the unborn in international law.  (As with the “right to abortion”, there is one exception, but it’s in a treaty that Ireland isn’t party to – the American Convention on Human Rights). And again, in terms of the treaties we’ve ratified that protect the right to life – the International Covenant on Civil and Political Rights, the Convention on the Rights of the Child, the European Convention on Human Rights – there is either travaux or case law leaving the foetus out of this protection. (This nifty fact sheet from the Center for Reproductive Rights has lots more detail about this.) So the balancing exercise that would be required to make the denial of therapeutic abortion compatible with the ICESCR is, in international legal terms, simply a nonsense. There is no legal “individual” to balance the woman’s rights against.

There’s another way in which I think Savita’s right to health was infringed, and that’s in the discriminatory way her health needs were dealt with. Article 2 ICESCR requires that the Covenant’s rights be protected “without discrimination of any kind”. Patently, there was discrimination in her case: she was treated differently because she was pregnant. A non-pregnant person would not have had a medically-indicated course of action refused to them at a time of comparable need. There may also be an issue around the antibiotic she was given, which wasn’t strong enough but was “recommended for use in maternal cases”. I’ve found the newspaper reports on this a bit unclear, and I’m not sure whether she was purposely given a weaker antibiotic because she was pregnant, or whether the staff simply didn’t realise, when they gave her the one they always give the pregnant women, that her infection needed a stronger dose. If it’s the former, then she clearly received discriminatory treatment – especially given that it was already known her foetus wouldn’t survive and anyway, she’d already asked for an abortion. The use of less effective medication in the interests of foetal health may certainly be justified, with the woman’s consent, in a wanted and viable pregnancy. But this wasn’t one of those cases.

I said earlier that there’s no place we can go to complain about a breach of the Covenant on Economic, Social and Cultural Rights. Well, that could change in the near future. The Covenant’s Optional Protocol, which allows individuals to bring complaints to the treaty’s monitoring body, will come into force on the 5^th of May. Ireland has yet to ratify the Protocol, but it did finally sign it last year and ratification is the next step. Again, since this is international law, the CESCR won’t have enforcement powers – but there’s plenty of potential to shine the world’s spotlight on Ireland, and how it fails to adhere to its international obligations. Abortion rights campaigners should call for the government to ratify the Protocol now.

The Snapper and Ireland's attitudes to "unmarried mothers" and unplanned pregnancy..

Reblogged from Activism and Agitation:

Last night while radio and tv stations broadcast debates on the announcement by government to bring in legislation in relation to the X Case (which is 20 years overdue), Roddy Doyle's The Snapper was also broadcast.

While the film was released in 1993 the book was written in 1990. Back when condoms were for sale with prescription only, the morning after pill was not legal and the Magdalen Laundries were still up and running.

Read more… 885 more words

Costa Rica - Call to action to help Aurora

Reblogged from European Pro-Choice Network:

via http://www.colectiva-cr.com/node/180

Aurora is a 32-year old Costa Rican woman. She has a university degree, a job that she likes, a good relationship, and after months of trying, she is finally pregnant.    However, at 8 weeks of pregnancy, the doctors informed her that the fetus has multiple severe malformations that would not allow it to survive outside the uterus, including severe scoliosis, decreased level of amniotic fluid, and a complete absence of abdominal wall which leaves the internal organs such as the liver and intestines outside of the body.

Read more… 469 more words

There have been many Savitas in Latin America, where some of the world's most restrictive abortion laws are found. It is rare that their individual names or circumstances are heard. Costa Rican campaigners are spreading the word about Aurora in the hope that international pressure can force their government to relent and recognise her right to terminate her pregnancy. Please, please help them accomplish this.

Pics from the Pro-choice Demo last night at Leinster House

Reblogged from Consider the Tea Cosy:

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Related articles

• Irish Pro-Choice Protesters Cry, "Never Again!" (urbantimes.co)
• Never Again: Protesters to march and hold vigil outside Dáil in memory of Savita Halappanaver (thedailyshift.com)
• Dublin: Marching for Savita (proudtobeyou.wordpress.com)
• Thousands attend pro-choice rally in Dublin (slendermeans.wordpress.com)
• Begging for Our Lives: Savita and Ireland (persephonemagazine.com)
• Never Again: A response to the death of Savita Halappanavar (stillnotshakespeare.wordpress.com)

Read more… 30 more words

Abortion, X and the Eighth Amendment: why legislation isn’t enough.

Abortion, X and the Eighth Amendment: why legislation isn’t enough.

It looks like Ireland is finally going to get legislation on abortion. Following the massive outcry over the fate of Savita Halappanavar, with the publication of the expert group report this week, there’ll be a debate in the Dail tonight on what- not if- to do about legislating for abortion to save pregnant people’s lives. With any luck, we’ll finally get that 20-years-overdue legislation on the X case, guidelines for doctors that spell out their responsibilities when faced with pregnant people whose lives are at risk, and Savita’s death, while unnecessary, will not have been utterly in vain.

But it won’t be enough. Why?

Continues at Consider the Tea Cosy

My country kills women.

My country kills women..

 spent the last week of October visiting my family. Catching up with my cousin after her honeymoon. Calling over to friends from back home. Dinners with family and friends, full of that wonderful bustling laughter and warmth of sharing with the people you love.

While I was passing the potatoes and poking around the kitchen for a bottle of wine, a few hours drive away Savita Praveen Halappanavar was dying.

Savita did not need to die.

1992 – 2012 Legislating for X and Savita?

Savita Halappanavar was a 31 year old Indian dentist based in Galway, Ireland. She was married to Praveen Halappanavar who was a 34 year old engineer. Savita was pregnant. On the Sunday 21^st October 2012, she presented to University Hospital Galway with back pains while in her 17^th week of pregnancy.

Sadly, hospital staff told her she was miscarrying her pregnancy but there was still a foetal heartbeat present.

The doctors in the hospital told Savita and Praveen that her cervix was fully dilated and that amniotic fluid was leaking. They also told Savita that the foetus would not survive – but it would be over in a few hours.

For the following three days, Savita was upset and in “agony” but according to Praveen she had accepted that she was having a miscarriage and the doctors continued to check the foetal heartbeat. She asked the doctors on several occasions to terminate her pregnancy. They had said there was no prospect of the foetus surviving.

On Monday 22^nd October, the consultant did ward rounds. Savita asked the consultant if there was no prospect of saving her pregnancy, could doctors induce to end the pregnancy instead. The consultant responded “As long as there is a foetal heatbeat, we can’t do anything.”

The same conversation took place with the consultant on the morning rounds of Tuesday 23^rd October, and the consultant said that nothing could be done, as it was “against the law” and “this is a Catholic country.” Savita responded that she was a Hindu but the consultant said that there was nothing to be done. During that evening, Savita began to shake and shiver. The pregnant 31 year old began to vomit. She went to the toilet where she collapsed. Doctors took blood tests and gave her anti-biotics.

On Wednesday 24^th October, Savita was still sick, and she and Praveen again pleaded with doctors to end her pregnancy and the response was unchanged from the previous days.

It is the law. It is a Catholic country. There will be no termination.

An open cervix has the same risk of infection as an open head wound.

Her cervix had been dilated since Sunday.

At around lunchtime, the foetal heart stopped and doctors brought Savita to theatre where they removed the womb contents. After the procedure she spoke to her husband Praveen, but she was very sick. This was the last time Praveen spoke to his young wife.

At 11pm that night Praveen received a call from the hospital to say she was being moved to an intensive care unit. Her heart was low. Her pulse was low too. Her temperature was high. The doctors said she was critical but stable.

By 7pm on Saturday her heart, kidneys, and liver were no longer functioning. She had contracted septicaemia and E.coli ESBL.

Savita Halappanavar, 31 year old Indian dentist, and wife of Praveen, died during the early hours of Sunday morning in this “Catholic country”. Praveen brought his wife home to be cremated in India. She was laid to rest on November 3^rd.

Savita should have been celebrating Diwali this week with her husband.

Instead, the Health Service Executive have started an investigation in to her death and University College Hospital have extended their sympathy to her family and friends. External experts are being consulted and a ‘risk review’ is being carried out.

Under Irish law, the Supreme Court decision handed down in the 1992 X Case, Savita would have had a right to a legal termination of her pregnancy where there was a “real and substantial risk to her life.” There must not merely be a threat to a woman’s health. She must be at risk of death for an abortion to be performed legally in Ireland. But it is a Constitutional right in that case, according to the Supreme Court.

There is no legislation to give effect to this though.

Seven different governments have decided that women at risk of dying as a result of their pregnancies are not important enough to provide a law for. There are no legal rules to say to a doctor that yes, an open cervix for a number of days is a risk to a pregnant woman’s health, or that it may be such a risk to her health that it veers in to the category of being a risk to her life, and she is therefore constitutionally entitled to an abortion. Yes, the medical profession will know when a woman is at risk and when she isn’t, but there is no clarity as to whether there is legal cover for them to be able to act in a case such as Savita’s. They could be liable for severe penalties under the Offences Against the Person Act 1861 if they are found to not have the legal cover required.

Perhaps the doctors in this case genuinely felt that there was not such a high risk of infection and that this did not reach the very high standard of being a “real and substantial risk to her life”. However, the response the consultant gave Savita and Praveen while she was pleading in agony for a termination was that it was “against the law” in “this Catholic country” – rather than “you don’t actually need a termination.” Strange that.

The European Court of Human Rights said during the ABC v Ireland case that women should know under what circumstances they are entitled to a lawful termination in Ireland. It is a ruling based on the constitutional law of Ireland.

For many years, some prochoice activists have been of the clearly held view that, when it comes to the political establishment, someone would actually have to die before the Government would legislate for the Supreme Court decision in the X Case handed down twenty years ago. If the HSE inquiry finds that Savita died as a result of not receiving a termination, leaving her open to the massive risk of infection which eventually killed her, this Government, and the six Governments that have gone before them must realise her blood is on their hands. That is not to be melodramatic about things. A woman has died. If the HSE inquiry finds that Savita did not die from being prevented from having a termination and it was something else, her story will still send shivers down the spines of every woman in Ireland who has had a miscarriage who may well think “what if that had been me? What if the foetal heartbeat hadn’t stopped when it did?”  - because under those circumstances there is still a real and substantial risk of death. The fact remains, there are some conditions that will arise in pregnancy that will make the pregnancy itself life-threatening.

At this stage, it is either wilful ignorance or complete and utter misogyny that prevents the Government in Ireland from legislating for the X case to allow women in life-threatening situations have abortions legally and safely. The ABC case judgment was delivered in 2010. The Government responded by convening an Expert Group to examine “options” rather than actually produce legislation. The time is now over for the Expert Group.

While the Expert Group are examining, there is no way of knowing whether there is a woman in a hospital somewhere in Ireland with a dilated cervix miscarrying and pleading for a termination to take place. We have no way of knowing whether there is a woman contracting the e.coli that will kill her at this very moment because doctors have refused to terminate her pregnancy.

It is time to legislate for X. Savita Halappanavar should not be dead.

This must never happen again.

 

RIP.

Never again.