Monday, May 20, 2013

“the inclusion of suicidality within the legislation may [...] lead to an increase in demand for termination [...]"

Fine Gael back benchers are likely to increase the pressure on the Government to alter the provisions for suicide in the draft abortion legislation after the emergence
of key divisions between the masters of the country's two main maternity hospitals.

The first day of the current Oireachtas health committee hearings on Friday highlighted sharp divisions in the evidence presented to it  by the Masters of Irelands main maternity hospitals. Dr Sam Coulter Smith Master of the Rotunda Hospital questioned the inclusion of suicidal intent as grounds for abortion.
He also said the provision of suicide raised ethical dilemmas for doctors and could lead to a rise in the number of women in Ireland looking for a termination, and he was critical of the absence of a gestational time limit.
Dr Coulter Smith told the committee.
“Our psychiatric colleagues tell us that there is currently no available evidence to show that termination of pregnancy is a treatment for suicidal ideation or intent and, as obstetricians, we are required to provide and practice evidence-based treatment,”
Coulter Smith also said in his view and the view of many of his colleagues;
 “the inclusion of suicidality within the legislation may, and I stress may, in the long-term lead to an increase in demand for termination in this country.” 
Dr Coulter's Smith's evidence was in sharp contrast to that from Dr Rhona Mahony, the Master of the National Maternity Hospital, who supported the suicide clause in the legislation. She said a woman who was intent on suicide was indeed at risk of dying, and needed to be assessed appropriately, believed, and provided with expert psychiatric care.

The issues raised by Dr Coulter Smith, one of Ireland's most experienced obstetricians, are expected to place additional pressure on the Fine Gael party and Taoiseach Enda Kenny. Many Fine Gael TD’s have reservations about the Government's draft legislation on abortion, particularly the inclusion of a suicide clause and there is strong pressure for amendments to the proposed legislation to drop the issue of suicide and for the inclusion of a provision for legal representation for the unborn and a time limit for terminations of pregnancies.

There is no doubt that the evidence given by Dr Coulter Smith is evidence based as there are a number of major national and international studies which support his submissions.
A large record based study in Finland that linked actual death certificates to medical records, reported a 650% higher risk of suicide after abortion compared to women who carried to term. Gissler M et al. Suicides after pregnancy in Finland: 1987-1994: register linkage study. British Medical Journal 1996; 313:143,4.

A records based UK study comparing suicide attempts before and after abortion indicated the increase in suicide rates after abortion was not related to prior suicidal behaviour but was most likely related to adverse reactions to the abortion
Morgan CM et al. Suicides after pregnancy: mental health may deteriorate as a direct result of abortion. British Medical Journal 1997: 314-902

A study of more than 173,000 California Medicaid records showed an increased rate of suicide that persisted for 8 years, not explained by prior mental illness.
Reardon DC et al. Deaths associated with pregnancy outcome: a record linkage study of low-income women. Southern Medical Journal 2002; 95(8): 834-841

The proposed legislation is ill conceived and can only lead to abortion on demand. The best solution would be for the Government to abandon its plans and retain the status quo.