THE Government
has announced its intention to legislate for the 'X Case' , which includes
suicide risk as grounds for abortion. This is on foot of a judgment delivered
21 years ago that did not involve psychiatric evidence. It is now providing for
psychiatrists to prescribe abortion as a treatment for those who are suicidal
in pregnancy. This is unique in the world history of abortion legislation.
Multiple flaws and diverse flaws arise from the proposals.
The first and most obvious is that there is no evidence that abortion is an
intervention that reduces suicide. No textbooks of psychiatry or research
papers suggest this. There are treatments, psychological and pharmacological,
to do this.
Indeed suicide risk assessment and the treatment of suicide
intent is a process that every psychiatrist engages in almost every day. Even
psychiatrists who are pro-choice agree that abortion is not a treatment for
those who are suicidal.
What figures do we have from Ireland to suggest that such
legislation is required? Those who favour legislation for suicide claim that
Irish women who are suicidal travel to Britain for abortions. There is no data
to support this contention since UK statistics do not provide specific
information on this.
Data on suicide in pregnancy in Ireland is almost totally
lacking. I reviewed the reports of the Masters of the three Dublin maternity
hospitals covering the periods 1950 to 2011. These show that in total there
were 394 maternal deaths. Of these, five died by suicide – one during pregnancy
(at 30 weeks' gestation) and four shortly after giving birth.
Vitally and crucially, the data obtained from these reports
shows that the five women who died by suicide did not do so because of their
pregnancy but because of problems external to it such as mental illness.
In the context of the present debate, the records cover a
period that begins almost 20 years before the liberalisation of the British
abortion laws in 1967. This makes it much harder to claim that suicidal
pregnant women in the first part of the period under examination were going to
Britain for abortions.
Even in countries where abortion is legal women still die by
suicide, as recent maternal mortality statistics from Britain show.
The present legislation will cause huge problems for the
Government. Last week four colleagues in psychiatry presented the results of a
survey of just over 300 psychiatrists in Ireland – almost the totality of
psychiatrists in this country. There was a 42pc response rate and of those 90pc
had serious concerns about the proposed legislation and agreed that the
profession should not be involved.
This may create practical difficulties in finding sufficient
psychiatrists to carry out the assessments on women seeking abortions.
The legislation requires that the abortion can only be
granted if in the reasonable opinion of the two psychiatrists the risk can only
be averted by the procedure.
Will doctors have to show that the person had psychological
or pharmacological treatments, that the treatments were delivered by competent
professionals and their duration was adequate?
If a woman is acutely distressed must the psychiatrists
report the details of a formal assessment of decision-making capacity?
The explanatory notes to the proposed legislation state that
the risk to life need not be immediate or inevitable. So doctors are being
asked to predict who, on the balance of probability, will take their lives
sometime in the future because of the pregnancy.
The major difficulty is that inevitably there will be an
over-prediction of suicide, since doctors always err on the side of caution
where threats of suicide are concerned.
IN practice, the risk of suicide, even in high-risk groups
such as those with serious mental illness, is very low. And among pregnant
women the risk of dying by suicide is lowest of all.
The requirement to predict a rare event is an inexact
science and inevitably women will be granted abortions on this basis even
though suicide would not have been the outcome.
A chilling aspect of the law is the possibility, stated by
the Minister for Health yesterday, that when a woman is having a termination
because she is suicidal a baby who is near viability will be delivered and
every attempt made to sustain its life.
What will happen if the mother, who will not have wanted the
baby in the first place, refuses to take the baby? Will it be brought up in
state care?
Will the State be liable if by its law it is responsible for
the baby having a disability resulting from its fragile state at the time of
early delivery?
And when the woman having an abortion is on the cusp of
viability, say 18 or 19 weeks, will every effort be made to sustain the baby's
life or will it be killed in utero. And how? This vista is almost too cruel and
terrifying to contemplate.
The Independent today has published an article by Professor
Patricia Casey in which she points out the multiple and diverse flaws in the Governments
proposed legislation on abortion.
