Psychiatrists could be seen to be the “gatekeepers to abortion” if the provision allowing for terminations where a pregnant woman is suicidal is enacted, the Oireachtas health committee has heard.
Consultant perinatal psychiatrist Dr John Sheehan told TDs and Senators that "psychiatrists are doctors not judges". He said that under section 4 of the Protection of Life during Pregnancy Bill, "psychiatrists are being asked to determine if there is a real and substantial risk to the life of the mother in order that the mother may procure a termination".
Section 4 would create a role “many Irish psychiatrists have not been involved with to date. I think that many Irish psychiatrists will not see this as their role as medical practitioners.” He said: “The role could be construed as making psychiatrists the gatekeepers to abortion.”
Three perinatal psychiatrists in Irish maternity hospitals have never had a single case of suicidal intent during pregnancy. The actual incidence of suicide in pregnancy was between one in 250,000 and one in 500,000. "In practice, therefore, it would be impossible for any psychiatrist to accurately predict who will die. So it could lead to multiple false positives."
Patient profile
He said if the section on suicide was enacted "it may well change the patient profile currently seen by Irish psychiatrists. Women who currently travel are more likely to be referred for treatment in Ireland." And the extent of mental health problems and suicide ideation in that population was unknown.
Consultant psychiatrist Prof Kevin Malone said legislation to allow abortions for suicidal women could actually place more young males at risk of suicide. The UCD professor of psychiatry and co-founder of the charity Turn The Tide of Suicide, told the Oireachtas health committee, that by highlighting suicide the State could be seen as legitimising it, sending the wrong signal to young men who were most at risk of suicide.
He asked how mental health literacy would be taught in schools, where suicidality is legitimised for women in some circumstances where the risk is two in one million while it is never legitimate in any circumstances for young men where the risk is with a 350 per one million.
Overall he said the effect of the legislation might be greater loss of life than life-saving. Dr Malone said there were more than 12,000 cases every year of people presenting at A&E for suicidal behaviour.
Consultant psychiatrist Dr Seán O'Domhnaill warned that the legislation would turn doctors into abortionists. Abortion has no role in modern medicine he said and termination was a mediaeval response to crisis pregnancies.
Appropriate treatment
Consultant psychiatrist Dr Jacqueline Montwill said "we do not need this legislation". She said the appropriate treatment for any suicidal patient was to ensure their safety either at home or in hospital, to offer psychological support and counselling and psychotropic medication.
Dr Bernie McCabe, consultant psychiatrist at Navan hospital said suicide could not be predicted even in those with mental illness. No research “has been carried out on those who are suicidal simply due to the pregnancy. Yet the Government is proceeding as if such evidence exists.”
