Fletcher Ruth
Senior Lecturer in Medical Law, Queen Mary University of London, London, UK.
Reprod Health Matters. 2014 Nov;22(44):10-21. doi: 10.1016/S0968-8080(14)44818-3.
This article draws on legal arguments made by civil society organisations to challenge the legal reasoning that apparently produced the decision in the Ms Y case in Ireland in August 2014. I show how legal standards of reasonableness and practicality ought to be interpreted in ways that are respectful of the patient's wishes and rights. The case concerned a decision by the Health Service Executive, the Irish public health authority, to refuse an abortion to a pregnant asylum seeker and rape survivor on the grounds that a caesarean section and early live delivery were practicable and reasonable alternatives justified by the need to protect fetal life. I argue that the abortion refusal may not have been a reasonable decision, as required by the terms of relevant legislation, for four different reasons. First, the alternative of a caesarean section and early live delivery was not likely to avert the risk of suicide, and in fact did not do so. Second, the consent to the caesarean section alternative may not have been a real consent in the legal sense if it was not voluntary. Third, an abortion refusal and forcible treatment fall below the norms of good medical practice as interpreted through a patient-centred perspective. Fourth, an abortion refusal that entails forms of cruel, inhumane and degrading treatment ought not to be a reasonable action under the legislation.
本文借鉴了民间社会组织提出的法律论点，对明显导致2014年8月爱尔兰Y女士案裁决的法律推理提出质疑。我阐述了合理性和实用性的法律标准应以尊重患者意愿和权利的方式进行解释。该案件涉及爱尔兰公共卫生当局——卫生服务执行局的一项决定，即拒绝为一名怀孕的寻求庇护者兼强奸幸存者实施堕胎手术，理由是剖腹产和早产分娩是可行且合理的替代方案，这是出于保护胎儿生命的需要。我认为，基于四个不同原因，拒绝堕胎可能并非相关立法条款所要求的合理决定。第一，剖腹产和早产分娩的替代方案不太可能避免自杀风险，事实上也并未避免。第二，如果剖腹产替代方案的同意并非出于自愿，那么从法律意义上讲，这种同意可能并非真正的同意。第三，拒绝堕胎和强制治疗不符合从以患者为中心的角度所诠释的良好医疗规范。第四，根据该立法，导致残忍、不人道和有辱人格待遇形式的拒绝堕胎不应是合理行为。
