Psychiatrists against abortion on ‘spurious’ mental health grounds

A group of psychiatrists has said proposed abortion legislation in Ireland should not be used to facilitate terminations on "spurious" mental health grounds.

In an open letter published on Wednesday, 26 consultant psychiatrists outlined their concerns over a potential law that would, they believe, misuse the concept of “healthcare”.

The group, three of whom elaborated on their views at a briefing, said that after 12 weeks' gestation the law would require a reason for termination on health grounds, similar to the approach adopted in the United Kingdom.

Citing data from the UK Office for National Statistics, Prof Patricia Casey said 97.4 per cent of abortions in 2016 were carried out under a part of the legislation that allowed them where there was a risk of either physical or mental injury to the mother. Of those, 99.8 per cent related specifically to mental health grounds.

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Under the general scheme of the proposed Irish legislation, a termination after 12 weeks would be lawful where two medical practitioners certify that “in their reasonable opinion formed in good faith” there is a risk to the life of, or of serious harm to the health of, the pregnant woman.

The definition of health refers to mental and physical. The conditions also specify that the foetus would not have reached viability.

The psychiatrists' letter says the reason for the majority of abortions was in fact socio-economic. This is a finding also held in the final report of the Oireachtas committee on the Eighth Amendment published in December.

“This is yet another reason why it is so dishonest to justify the proposed and radical change to the current law as ‘healthcare’,” it said.

“Given the experience in the UK, we can confidently say that abortions taking place in this country after 12 weeks will be authorised under the ‘mental health’ ground. As in the UK, there will be little or no justification for this in the great majority of cases.

“We do not want to see spurious appeals to ‘mental health’ being used to justify post-12 week abortions.”

During the briefing Prof Casey, emeritus professor of psychiatry at UCD and consultant at the Mater hospital, said her profession must operate on evidence-based healthcare and there was no evidence that abortion was a benefit to women’s mental health.

“I was very surprised that the Government decided to include mental health risks in the proposed legislation if the referendum is carried. But of course they did it because in the UK they have done that in their abortion Act,” she said.

Before its publication, the letter was sent for consideration to about 60 psychiatrists for whom contact details could be found. Of those, 26 signed their names and, Prof Casey said, a further 20 expressed support but did not wish to do so publicly. The group was unable to say how many consultant psychiatrists were practising in Ireland but estimated the number at fewer than 300.

“To use ‘health’ as a justification for abortion, when the vast majority of abortions do not take place on any kind of health ground, inverts the true purpose of medicine and doctors who value their calling should have nothing to do with this,” the letter states.

Prof Casey said she was invited to address the committee on the Eighth Amendment but withdrew as she felt the process was “clearly biased”.

“There were four people of a broadly pro-life disposition and 24 or 25 taking a contrary position,” she said, adding that while Prof Veronica O’Keane had addressed the committee she had done so from a “different perspective” to her own.

In her submission, Prof O'Keane, consultant psychiatrist at Tallaght Hospital and professor of clinical psychiatry at Trinity College Dublin, said the separation of mental health from physical health had been at the centre of the abortion debate for the past 30 years.

“It is now recognised in law that suicide constitutes a risk to the life of the woman in the circumstances of an unwanted pregnancy,” she said.

“The Citizens’ Assembly [in examining the issue] understood there was no distinction between physical and mental health and made its understanding explicit. The importance of that recommendation cannot be underestimated.”