It won't go away you know...

Despite the wishes of some, the issue will just not go away. Abortion is back on our shores, in more ways than one. On Thursday, a Dutch floating abortion clinic is due to dock in Dublin harbour. It will be offering terminations just outside of Irish territorial limits. In recent days, officials at the Department of Health have been discussing what to do about this issue with the Attorney General.

Closer to home and before the Dutch ship arrives, the Medical Council meets in private session this week to debate its own abortion crisis. The Council protects the public interest in policing Irish doctors and its ethical guidelines are supposed to be followed, on pain of serious penalty.

The Council's current guidelines from 1998 state that the deliberate and intentional destruction of the unborn amounts to professional misconduct. This is the ethical position from the medical viewpoint. However, the legal position is more clouded as the Supreme Court X case judgment remains, allowing for termination of pregnancy where there is a real and substantial risk to the life of the mother - in that test case there was the stated risk of suicide.

Is there a test case by a doctor looming? - 'Any sanction by the Council against a doctor performing an abortion would ultimately end up to be decided by the courts'.

No doctor has yet tried to test the issue - challenging the Medical Council to take action against a medical practitioner who has performed an abortion. However, irishhealth.com understands that a doctor has identified himself as one such possible candidate, claiming to have performed a termination in the past. Any sanction by the Council against such a doctor would ultimately end up to be decided by the courts.

What has now thrown the Medical Council into chaos, facing threats of legal action is a recent vote during a debate on the All Party Oireachtas Committee report on the Constitution and abortion.

The meeting voted by 11 to 7 to accept two motions which stated that:

• The Medical Council recognises that termination of pregnancy can occur when there is a real and substantive risk to the life of the mother

The first motion seems to recognise the X case judgment, the impact of cancer treatment and other serious health conditions, while the second allows for cases where the brain is only partially formed and affected infants are stillborn or will die within hours of birth. However, the effect of these two motions, if accepted as the new rule, would be to radically change the existing guidelines for the country's 5,500 working doctors.

'The Council's current guidelines state that the deliberate and intentional destruction of the unborn amounts to professional misconduct'.

As Medical Council meetings are held behind closed doors, the full detail of what has been happening is not clear. Given that the Council has, under statute, a clear public interest role, this is deeply unsatisfactory.

Some Medical Council members claim to have been taken by surprise at the motions that were tabled while others insist that the whole matter has been due for debate since last December.

Whatever the actual position, seven Council members walked out of the last meeting and tomorrow a report on where things stand will be presented to the Council by a Senior Counsel. The issue has the potential to provoke a major row among doctors around the country.

What is happening within the Medical Council is a microcosm of the debate nationally. Bring any group of individuals together, be they health professionals or from other backgrounds and there will be a divide, often a deep divide on the issue.

The Pro-Life organisations are currently engaged in a battle to secure a new referendum and some of those who are involved in this area, were also involved in the 'No' to the Niece Treaty campaign. They will take extra heart from the outcome of that battle with government.

The real failure however has been on the part of politicians. Successive governments have singularly failed to decide what to do on this issue. There have been promises of a new referendum, legislation or a mixture of both. Behind it all there is a fear of getting it wrong, a lack of backbone and will to finalise one of the most burning social issues of the last few decades here.

When the Green Paper on abortion was produced in 1999, it was hailed by most people as a very balanced document. It was - because there was no firm decision taken.

Ireland's recent history has been one deeply affected by the issue of abortion on many occasions. The experience of the 1983 and 1992 referendums on the issue show how difficult it is to formulate referendum proposals on the subject.

The recent Oireachtas Committee report suggested three solutions:

• A major concentration on reducing the number of crisis pregnancies and the rate of abortion and to leave the legal position unchanged.

Since this was proposed, the number of abortions has reached a record level and there is no sign that the measures in place are having an impact in terms of reducing abortions. Today, one in ten pregnancies here end in an abortion in Britain.

• The second proposal was to continue with the plan to cut crisis pregnancies, accompanied by legislation to protect medical intervention to safeguard the life of the mother, within the existing constitutional framework

Whatever one's strongly held views on the subject, there should at least be agreement now that Ireland must face up to its responsibilities and deal with the abortion controversy.

A deeply unsatisfactory situation exists whereby the current Medical Council ethical rules are at odds with the Supreme Court judgment in the X case. Some doctors on the Council recently sought to have that position changed and now there is a level of confusion as to the status of the motions passed.

There is no queue of Irish doctors just waiting to perform terminations. In the event that abortion is legally permitted by way of a referendum or legislation, there would only be a small minority of doctors who would become involved in the procedure.

With a General Election just a year or so away, this subject is coming back onto the national agenda. The surprise split in the Medical Council shows that among doctors too, there is pressure to have a clear position for all.

The arrival of an abortion ship may be a crude way of reviving the public debate. But unlike those who travel to Britain for the procedure, it won't go away until it is resolved.