The Full Hot Press Interview with Dr. Peter Boylan

Of late, Dr Peter Boylan’s friends like to joke – with very good reason – about Johnny Cash’s ‘Ring Of Fire’ being one of his favourite songs. Since he put his head above the parapet to air his views on abortion, the former master of the National Maternity Hospital has been in the hot seat, when it comes to the Repeal debate.

Given the highly emotive attitude of some to the issue, whatever Boylan says in this Hot Press Interview is likely to needle the pro-life side. Over the past couple of years, several politicians have told us that they have received hate mail, or been accosted on the street for expressing pro-Repeal views. Not so Peter Boylan, and he is hoping that it will stay that way, no matter how heated the debate becomes during the next few weeks.

“The majority of people I would be familiar with, whose views would differ from mine, are very respectful,” says Boylan. “They know I respect their views. Nobody is forcing anybody to have a termination of pregnancy. And nobody is forcing anybody to change their views.

“There are zealots, undoubtedly, who are abusive. And there are people who are propagating lies, left, right and centre about the Eighth Amendment and about what would happen – and denying the difficulties that it has caused.”

As someone who spent his entire life working in the field of obstetrics and gynaecology, Dr Peter Boylan – who personally delivered 6,000 babies – can clearly speak with authority on the issue. An expert witness in the tragic Savita Halappanavar case, he’s in a unique position to debunk many of the myths surrounding the proposed changes to our constitutional law. Yet, while Dr Peter Boylan is clearly passionate about Repealing the Eighth, he manages always to keep a cool head – even as he matter-of-factly sets out the harrowing facts about the irrevocable damage the Eighth Amendment has done to our society.

Jason O’Toole: Why did you decide to be so vocal in this campaign?

Dr Peter Boylan: I’m doing it because I spent my entire professional life dealing with the care of women in pregnancy and outside of it, gynaecologically as well. In this respect, I’ve seen the effect of the Eighth Amendment. It needs to be repealed.

According to one profile, you’ve overseen the delivery of 6,000 babies. Some people might argue that it’s strange that you’re pro-choice.

I’ve delivered 6,000 babies. But in my role as a consultant obstetrician, I would’ve been involved in the care of many thousands of other pregnant women and their babies. I would’ve had a lot of experience of dealing with women who had a foetal abnormality – and of breaking the diagnosis to the couple, discussing with them what their options were. And many of them chose to continue with the pregnancy, and many chose to travel to have a termination of pregnancy. And there was very little we could do apart from explaining what the process is, where they could go, give them as much information as we could. We were not, we are not still, allowed to refer them to a hospital in the UK. And obviously we got to see them when they came back. But it’s very inhumane. It’s also profoundly hypocritical, the way our constitution works, in that it bans the termination of pregnancy in this country, but facilitates women going abroad for termination.

Have you had to deal with cases of rape as well?

No. I’ve only seen one or two women who’ve been raped. But I know my colleague, Maeve Eogan, who’s the clinical director of the Sexual Assault Unit in the Rotunda, is very much in favour of repealing the Eighth and changing the law to allow for termination in cases of rape. It’s very interesting actually. You know John McGuirk, the communications director for Save The 8th?He used to work as a political advisor for Declan Ganley’s Libertas. He did a really interesting interview yesterday with Jonathan Healy on Pat Kenny’s show. In it, he said the position in Spain is that a woman who has been raped is entitled to a termination – if she reports it to the police.

That’s not true – you can have an abortion in Spain, like any other country in the EU, without having to report it.

Isn’t that interesting? (Dr Boylan begins to read from a transcript – JOT.) He said, “There are at least 14 countries in the world that have gone down to legislating just in cases of rape.” And Jonathan Healy said, “But we can’t do that here because of the nature of the Eighth Amendment.” John McGuirk said, “That’s not necessarily true.” Then Jonathan Healy said, “What would you propose?” And John McGuirk said, “My job is not to propose solutions for the government. But it would have been possible, perhaps, to amend the constitution rather than strip out all constitutional protection… In Spain, for example, the legislation allows for abortion in cases of rape where a report has been made.” That’s exactly what he said. It’s worth listening back to it on the podcast.

You’re entitled to an abortion in Spain – the same as in Germany. They have the same time limits as the majority of EU countries. So why would he say that?

It’s not a practical proposition, anyway.

Were you always pro-choice?

No. When I was a junior doctor in training, way back in the early 1970s, I was very much against abortion and termination of pregnancy. But that, I think, was a consequence of my upbringing in the Ireland of the ’60s.

What changed?

I went to work in London and had my horizons broadened. I worked with colleagues who performed terminations and got to know them and their attitudes. And I participated in a very peripheral way with terminations for fatal foetal abnormalities – I would look after the women after they were undergoing the induction process. And then I worked in the US for four years, in an academic position. And, again, I met many colleagues who had been brought up in a different environment. We had lots of conversations about the whole thing, and I came to the conclusion that one’s views are very much influenced by the environment that you grow up in and that there’s nothing uncivilised about termination of pregnancy. It’s a very difficult decision – women don’t make the decision lightly. I then came back to Ireland in 1988 as Master of the National Maternity Hospital, from 1991 to 1997, for seven years. And in that capacity, you gain a huge amount of experience at the coalface, so to speak, with women in pregnancy. So, my views evolved.

Are hospitals and doctors and nurses here bending rules when it comes to helping a woman terminate a pregnancy?

Not that I’m aware of, no. I think people would be very foolish to do that. Because in a hospital situation, for example, you don’t know whether a nursing colleague or even another patient in the ward would be aware of what’s going on. And they could report you to the police – and there’s a possibility of 14 years if you’re convicted. So, it would be very foolish to go down that road. But that sort of concern is something that makes it very difficult in some circumstances to look after women.

Can you give us an example?

A good example I remember would be a woman who came in, in similar circumstances to Savita Halappanavar, whose waters had gone in the early stages of pregnancy, say 15/16 weeks. And under the current law, we can only do a termination if there’s a real and substantial risk to her life. So, in other words, she may die if we don’t do a termination of pregnancy. So, we have to wait until it looks like she’s ill enough that she might die before doing a termination. Now, if we wait too long she may well die; if we intervene too soon, we could be open to an allegation of doing an unnecessary termination of pregnancy.

You have to start calculating to protect yourself.

I distinctly remember on the ward in the National Maternity Hospital, weighing up when would it be acceptable to intervene – at what stage will I be safe from a legal point of view? And there’s the possibility that another patient on the ward, who’s a member of a pro-life organisation, might report me to the police for having intervened inappropriately. And that’s the environment which doctors in Ireland work in now. So, how close to death does the woman have to be before we can intervene?

Barbaric.

Well, it’s worse for the woman. This is about the women – it’s not about the doctors.

Dr Mary Holohan, a consultant obstetrician in the Rotunda, said she was concerned about statements claiming obstetricians are curtailed in their ability to care for pregnant women who are seriously ill. She claimed that such statements were causing “unnecessary fears”.

Scaremongering! I’ve described to you the actual situation on the ground when you’re dealing with a woman. It means that doctors are practising in the context of a threat of a custodial sentence of up to 14 years, your reputation ruined and your livelihood taken away from you. And the woman, also. There is disagreement, but that’s inevitable. You will always get disagreement. It’s the same in the UK, in the US, and so on.

She’s saying that doctors have full freedom under existing laws but you’re saying you can get 14 years in prison. So, her argument doesn’t hold up.

No. it doesn’t. Not at all.

When it comes to shocking cases like Savita Halappanavar does the Irish state have blood on its hands?

That’s a bit (nervous laughter) of a hard quote really, to be honest with you. I think there’s a realisation from the political classes now – and certainly among the leadership of Fine Gael – that the Eighth Amendment needs to be taken out of the constitution. It hasn’t worked. It hasn’t achieved its aim. And that’s particularly true when you look at the Protection of Life and Pregnancy Act, which had to be enacted in order to account for problems created by it. And it hasn’t achieved its aim of preventing abortion.

It’s being claimed by so called ‘pro-life’ campaigners that one in five pregnancies in the UK ends in abortion.

That’s wrong. That’s a lie. And there’s posters up all over Dublin saying that. The true figure is about one in ten. And the reason why’s it’s one in ten is because they exclude miscarriages from their definition of pregnancy.

Are there other myths that need to be debunked?

That no woman has ever died as a consequence of the Eighth, you’ve done that one. That doctors have no difficulty in practising medicine in the context of the Eighth. And that there’ll be abortion up to birth.

Professor Eamonn McGuinness claimed no woman has died as a result of the Eighth Amendment.

Well, Savita Halappanavar died as a result of the Eighth Amendment. Michelle Harte, who was looked after by Professor Louise Kenny, died as a consequence of the Eighth Amendment. Sheila Hodgers died as a consequence of the Eighth Amendment. We have the Miss P Case.

You’ve quite clearly just debunked that claim.

Now, Eamonn McGuinness, quite interestingly – you should Google him and the Medical Council 2001. He was one of a group of seven doctors who tried to get a judicial order stopping the Medical Council agreeing to a proposal that termination should be allowed to save a woman’s life. He tried to take a judicial action to stop the Medical Council saying that it was reasonable to terminate to save a woman’s life. He also said that he’d never heard of the Miss P case. He wasn’t familiar with it. He was chairman 25 years ago and he’s been retired 10 years. There are doctors, certainly, who have had no difficulty with the Eighth Amendment. But they wouldn’t have had the same experiences as many other doctors, and particularly doctors like Professor Louise Kenny, who’s working in a very high risk pregnancy area. And people working in the major hospitals in Dublin who are specialising in foetal medicine, for example, or in very complicated pregnancies.

But didn’t Savita Halappanavar die from sepsis?

She died of sepsis. There’s no question about that. But the reason she got the sepsis was because her womb, her uterus was not emptied. And the source of the sepsis was inside in her uterus. The foetus was getting infected. And the placenta, the afterbirth, the surrounding tissues in her uterus were getting infected. But if her uterus had been emptied, she would not have got the sepsis. So, she did die of sepsis. And there were elements of mismanagement in her case. I’ve never made any bones about that. And I said that, during my evidence to the inquest. There’s also no doubt that if she had had her termination on the Monday or Tuesday she would be alive today. We’d never have heard of her. And actually, Professor Sabaratnam Arulkumaran, the former president of the Royal College (of Obstetricians and Gynaecologists) in London agrees 100 percent with me – that she died of a consequence of the Eighth Amendment.

The ‘pro-life’ campaign produced a woman with sepsis who they pointed out didn’t need an abortion.

They produced a woman who had sepsis and she said her life was saved without anybody ever mentioning abortion. She had a spinal sepsis. Savita had sepsis in her womb – they’re radically different conditions. The woman they produced at the press conference had her spinal sepsis at 28 weeks gestation. Now, if she needed to be delivered she needed to be delivered: that is not a termination of pregnancy. So, they produced a woman who is completely irrelevant.

You’re pro-choice – do you believe in time limits?

I think that the proposal of the government – that if the Eighth is repealed, the legislation would allow for abortion without implication as to reason up to 12 weeks – is a reasonable one. And that allows both for the importation of abortion pills, which is happening; and for cases of rape.

After 12 weeks?

Now, beyond 12 weeks the proposal is that they would legislate for women who are seriously ill, or whose life is at risk, up to viability, which is around about 23 or 24 weeks. And after that, if a woman’s pregnancy needs to be ended in her health interest, then she would be delivered and the baby would be looked after because it has a potential to survive.

What about fatal foetal abnormality?

In those circumstances, it doesn’t matter when the baby’s born – it’s going to die. When it’s in the womb, it’s in an intensive care unit and very similar to a patient whose outlook is hopeless, where further treatment is futile. Now, some couples choose to continue the pregnancy and they are looked after, and when the baby’s born there is palliative care, and the parents hold it, and so on. So, basically when there’s a fatal foetal abnormality what you’re doing, effectively, (by terminating) is delivering the baby earlier, at the time where the parents feel it is most appropriate.

Have you dealt with women faced with such a traumatic pregnancy?

I have experienced looking after women who’ve continued on with the pregnancy to full term – and beyond, in fact, and needed to have an induction to deliver the baby. And they found that a very rewarding experience. One such woman, on her next pregnancy, came back. It looked as if the same thing was happening. She said, “I can’t do this again. I want a termination of pregnancy.” So, those are the lived realities of women’s lives.

When a woman wants to have an abortion of her own volition, what do you think is the maximum timeframe?

I think 12 weeks. I think that’s reasonable – that seems to be the way in most European countries. It seems to be acceptable to most civilised Western democracies.

You support the right of a woman to abort a baby, be it healthy or sick?

Well, to terminate a pregnancy in the first 12 weeks.

At what stage do you believe a pregnancy becomes an unborn child? Is it after 12 weeks?

I think in terms of viability – that is when it becomes potentially able to survive outside the womb. If a baby’s born at 23 weeks, at least 50 or 60 percent of them will die, because they’re so premature. And of the remainder, a proportion will have significant disability. At 24 weeks, the figures are about 50/50. And then it gets progressively better. So, at around 28/29 weeks, you’d expect a baby to survive and have a very good chance of being normal – but with a huge amount of intensive care in a natal intensive care unit. So, I suppose, a simple answer is: from the time of viability onwards.

When, as a doctor, you meet a pregnant woman for the first time, do you think you’re dealing with one patient or two patients?

There’s very little you can do to influence the outcome from a foetal or a baby point of view. There’s a lot a mother can do by not smoking, not drinking, and so on. If the woman has diabetes, you can certainly influence the outcome by controlling diabetes well. If the baby is very small because of the afterbirth not working well, there are things you can do: you can monitor the baby and you can deliver it at an earlier time. You can do some foetal surgery in limited ways. So, there are limited things that you can do certainly to influence the outcome from the baby’s point of view. But not that many, in fact. One of the other things they’ve talked about is Down Syndrome.

What are your thoughts about that?

In a practical sense, Downs is not diagnosed at less than 12 weeks. It is possible, but, in a practical sense, it doesn’t happen. And the legislation proposed by the government excludes disability as an indication for termination of pregnancy. So, the proposition that Downs would be eliminated is just incorrect – another lie. Now, the reason why women can have termination for Downs in other countries is because they don’t exclude disability as indication for termination of pregnancy. But in Ireland, the proposition is that it would be excluded. So, again, they’re comparing what happens in the UK and transposing it to an Irish situation, which is quite wrong.

So, couples who want to have a termination after 12 weeks because of Down Syndrome will have to continue to travel abroad – is that fair?

Yes. It’s not only fair, it’s correct. It’s very straightforward. It’s also important to understand that not all babies with Down Syndrome are the same. Some of them have very complex cardiac, brain and stomach abnormalities – and they may die anyway. And the stillbirth rate among babies with Down Syndrome is significantly higher than that among babies who don’t have it. So, Downs is not straightforward at all. A lot of couples just want to know in order to prepare themselves. And they don’t always go off and have a termination.

Under the law proposed by the government, given that 90pc of abortions take place in the first 12 weeks, very few women will be refused an abortion. So how would the law be restrictive?

Well, the law will be restrictive in that it’s limited to the first 12 weeks of pregnancy. And after that, it’s only for serious risk to the mother’s health, or a fatal abnormality. So, that is restrictive certainly in relation to UK law.

Some doctors won’t want to participate in a termination when it’s legalised.

Yes, that’s absolutely true. And conscientious objection is one of the fundamental principles of medicine. But doctors are obliged under Medical Council guidelines to transfer the patient to another doctor who will look after them appropriately. It’s about the woman – it’s not about the doctor.

Pro-lifers argue that, as a doctor, you are about “first, do no harm”.

Well, what about the woman? First do no harm to the patient in front of you, who is the woman – that’s who you have the responsibility towards primarily.

Some of your detractors say that your pro-choice views are not just medical, but also political; that you attended the launch of a Labour Party launch position paper prior to the 2016 election.

I’m invited to give expert medical opinion by a whole range of people and organisations: People Before Profit asked me; Fine Gael asked me; the Labour Party asked me. And I have no problem providing information and going to meetings for anybody. Nobody from the anti-Repeal side has asked me to put to them what the arguments might be! If they do ask me, I’ll certainly go and explain my reasoning. But they haven’t asked me. But, no, it’s not political. My interests lie with women basically – what they have to go through.

You were in charge of Holles Street during a deeply religious time in Ireland. Were you hauled over the coals by the Archbishop?

I was Master from ’91 to ’97. I introduced tubal ligations into female sterilisation. There was clearly a need for it and women were requesting it. Once we started introducing it, the Archbishop called me up to the Archbishop’s Palace and told me that we shouldn’t be doing it, that it wasn’t medically indicated, and that it wasn’t a proper operation. I said, “I’m sorry. It is medically indicated.” And he said, “Psychological reasons are not a medically indicated reason.” And I said, “Sorry, but they are.” He said, “You shouldn’t be doing this.” I said, “I’m sorry but we are doing it.” And that was it. We continued doing it and didn’t hear anymore from him. But, yeah, he tried to influence me.

What first piqued your interest in gynaecology? Some people might think it isn’t a job for a man.

(Laughs) No. When I was training as a medical student, I went to Holles Street and I enjoyed it enormously. I thought that the staff were very happy and enjoyed that it involved both surgery and medicine. When I finished my intern year, I went back to see what it would be like to train as an obstetrician. And I enjoyed it so much that I stayed on. Now, at that time very few women did obstetrics. There were no female consultants in the hospital. Now it’s completely reversed: there are very few men in the training; it’s almost entirely women. There’s been a huge change. But, at that time, it was all men doing it.

Would it make you look at sex differently?

No. It’s a professional relationship. So, no, not at all. You’ve got to be very careful and maintain a professional relationship all the time because women are vulnerable in those situations. And our job is to look after them – not to take advantage of them.

You were very vocal against the nuns getting involved in the new national maternity hospital. I was reading that you couldn’t sleep from the stress.

That’s true. It was very stressful. But the plan was: the national maternity hospital would be effectively donated to the Sisters of the Charity, and the company set-up to run the hospital would be owned by the Sisters of the Charity. And the proposed board structure gave an undue influence to the Sisters of Charity’s nominees. And I just thought that was completely inappropriate. The Sisters of Charity eventually said that they were withdrawing from running St Vincent’s Hospital, and any involvement whatsoever in the national maternity hospital, which is to be built on the site shared with St Vincent’s Hospital. They said that they would set-up a charity to run the hospital and so on. Now, that was about a year ago. And as far as I’m aware, that charity still hasn’t been set-up. So, there’s still work to be done. But the new hospital is a fantastic design. It needs to go ahead. There’s no question about that.

It would be bizarre to have the nuns involved in a maternity hospital just when the Government is trying to Repeal the Eighth.

It was naïve to think that Ireland would be the only place in the world with a maternity hospital owned by the Catholic Church, which would not do any of the procedures for women that are antithetical to Catholic Church teaching. It was very naïve to think that that was going to be the case, despite what apparent legal protection was there. There’s no other hospital in the entire world in similar circumstances.

As a result of all that, you fell out with your sister-in-law, Rhona Mahony, who is the current master of Holles Street.

Well, that’s correct. We shared directly opposing views.

Is the relationship still frosty?

Yes.

You two aren’t on speaking terms.

I think that’s reasonable.

Is your wife on speaking terms with her, or is it still frosty between them?

The temperature isn’t as low! (Laughs).

Are you religious?

No. I lost all… there were the child abuse scandals. And then the way the Church has treated women over the centuries, but more recently in the 20th century. And the thing that finally put the nail in the coffin for me was the concept of mental reservation, where it’s acceptable to tell a lie. It was Archbishop Connell who said that. It was do with child abuse, and not reporting child abuse. The problem I have really with the hierarchy is that they answer to Canon Law, but not to State law. And that was one of my concerns in relation to the National Maternity Hospital. They’re obliged to Canon Law; state law takes second place. There are Catholic priests and nuns who have done phenomenal work. I know a lot of clergy who are in despair at what’s has been coming out of The Vatican, and in despair about all the various misogynistic activities of the Church over the years. I feel sad for them because they’re good people.

So, you don’t believe in heaven and hell?

No. I don’t. I think when you die, that’s it. But if there is something, well, wow! It’ll be really interesting (laughs). But I actually don’t think there is anything. In fact, my experience of dealing with older people is that a lot of them come to that conclusion the closer they get to death. Certainly, my mother felt that.