ANALYSIS/ THE MEDICAL FALLOUT: Doctors, psychiatrists and the Medical Council now have to contend with the issue of suicide, writes Dr Muiris Houston, Medical Correspondent
The rejection of the abortion referendum, albeit by a slim majority, will almost certainly mean that legislation will be introduced to allow for abortion in the case of suicide.
As the referendum campaign illustrated, even psychiatrists are divided on the issue. Some have stated that psychiatry has no role to play in abortion; others dispute this and feel that mental distress and psychological disorders must be taken into account.
The Government faces a major decision on legislating in this matter. Will it insist on a psychiatrist's opinion as part of a woman's suitability for abortion or will it allow any registered medical practitioner to sign the necessary documentation?
The situation which existed in Britain pre- and post-1967 may influence its choice. Before 1967, only psychiatrists could assess a pregnant woman who was suicidal and seeking abortion. After this, any two medical practitioners could give a valid opinion on the matter.
For doctors and patients, the final legislative decision will determine how the situation unfolds.
If it is a psychiatrist's opinion only, then presumably psychiatrists will divide into two camps - those willing to see such referrals and those who will continue to maintain they have no role to play.
In practice, general practitioners and others will refer women to those psychiatrists who are known to be sympathetic to the need for abortion on the grounds of suicide.
If any physician is allowed to make an assessment, then obtaining an opinion will be a straightforward exercise.
The No vote will now focus attention back to the Medical Council. It will have to reformulate its ethical guidelines on the area of reproductive medicine which were changed only last autumn.
The guidelines now state: "The council recognises that termination of pregnancy can occur when there is real and substantial risk to the life of the mother and subscribes to the views expressed in part 2 of the written submission of the Institute of Obstetricians and Gynaecologists to the All-Party Oireachtas Committee on the Constitution."
The relevant extract from that submission is: "In current obstetrical practice, rare complications can arise where therapeutic intervention is required at a stage in pregnancy when there will be little or no prospect for the survival of the baby, due to extreme immaturity.
"In these exceptional situations, failure to intervene may result in the death of both mother and baby. We consider that there is a fundamental difference between abortion carried out for social reasons and the unavoidable death of the baby resulting from essential treatment to treat the life of the mother."
The council will have to debate the matter and it is likely to alter or add to the view of the Institute of Obstetricians and Gynaecologists to bring the ethical guidelines into line with new legislation.
It may also seek advice from the Irish division of the Royal College of Psychiatrists on the basis that the new substantive issue is now one of suicide.
Arising from the referendum campaign, the Medical Council will also have to consider the issue of foetal abnormalities which are incompatible with life.
In the past week, it is understood that Senator Mary Henry has written to the council asking it to address the issue of termination of pregnancy in case where the foetus could not sustain extra-uterine life.
She did this following the support given by the Masters of the three Dublin maternity hospitals to the case of Ms Deirdre De Barra which was highlighted in a letter to The Irish Times.
She is carrying a foetus with a congenital abnormality, meaning it cannot survive outside the womb.
The rejection of the referendum, nonetheless, is unlikely to have any practical impact on current medical practice where interventions are made to protect the life of the mother.