by Dr. Geoff Mulligan

Anencephaly is a genetic malformation that results in the top of a baby’s head failing to develop so that when the child is born he or she can only survive for a few hours outside of the safety of the womb. It’s a heart wrenching diagnosis for the expectant parents who typically first learn of this half-way through the pregnancy. For months they have to live with a feeling of hopelessness, after nine months of hope and anticipation all they can expect is a baby who is going to die within hours. It’s an unimaginable scenario, and one in which the option of termination has been suggested as a solution, but one that is currently illegal in Northern Ireland, but which is under debate by our legislators as our stance has been deemed illegal. It is an intensely delicate dilemma but one that requires an opinion.
Some years ago, I was asked by an expectant grandmother if I would advise her on how to handle exactly this crisis. I realised this was a no win situation and whatever choices were made, there would be a great deal of pain and grieving. There is no simple right or wrong choice; a hoped for child will not survive in this world and the time between diagnosis, delivery and death is the only measure that can be changed.
Our natural inclination regarding pain is to limit it; to take whatever course of action that will reduce it in quality or quantity. The options in this scenario are extremely limited; the pregnancy can be allowed to progress until delivery and a natural death, or the process can be cut short by intervening and terminating the pregnancy. 
The dilemma in Northern Ireland is that the latter option is not allowed, and it has been deemed unconstitutional by Lord Horner. So, the expectant Grandmother’s question has become one for all of us to wrestle with.
From the perspective of the crushing feeling of hopelessness the solution appears obvious — to cut short the intense pain by ending the pregnancy? But what if the perspective is about now rather than the future? Hope rather than hopeless? There is a life in the womb that can only survive within the safety of that space. 
Can the life that exists be enjoyed for as long as it can last? If the answer to these questions is ‘yes’, then maybe, just maybe the pain of future loss does not have to begin now, it can be postponed allowing the cycle of life to fit within months instead of weeks, to allow the most fragile of relationships to begin. Intervention might seem to offer the only solution but is there another solution if we take the time of explore the options and their meaning? 
The option to choose life will remain no matter what the outcome of the current debate.

Dr. Geoff Mulligan is a semi-retired GP living in Enniskillen. 
He has worked at Devenish Practice and now writes a blog at www.medium.com/@healthelocum