The Government's abortion referendum will enshrine the stigma of suicide and of mental ill-health in the Constitution, with specific reference to women, argues Tom Fahy
This referendum appears on the surface to be about abortion, suicide, the health and rights of women, and the law. Abortion nowadays is safe; effects on the mental health of the woman are good, bad or indifferent depending on circumstances.
The connection, if any, between suicide and abortion is complex. Suicide itself is rare; it is rare after childbirth, miscarriage or abortion. It is very rare in pregnancy but does occur.
Let us consider the implications of the proposed legislation for the mental health of women and, by extension, of all of us.
For a while now, Irish doctors from time to time have been carrying out or recommending procedures resulting in termination of pregnancy, mainly, if not exclusively, to save the lives of patients.
The referendum, if passed, would maintain these procedures in approved centres in Ireland, by doctors without conscientious objection, and would make abortion for suicide risk a criminal offence punishable by up to 12 years' imprisonment.
What will happen then? To address this question we must move from science to fortune-telling.
Since Victorian times, the decline of suicide as a response to unwanted pregnancy coincided with a steady shift of abortion from back street to hospital ward. At the same time, suicide rates for women, always lower than for men, further declined - and continue to do so in Britain.
The Government's consultative Green Paper on abortion notes there was an increase in Irish abortions and infanticides due to wartime restrictions on travel to Britain in the 1940s. Suicides probably also occurred but were not recorded.
Suicide was then a crime - and a mortal sin. Persistently low rates of suicide in pregnancy have made "the protective effect of pregnancy" a catchword in Irish referendumspeak.
The main exception to this rule is, of course, where the pregnancy is unwanted, as for example in the X and C cases.
Unwanted pregnancy is undoubtedly an important factor in some suicides, few of which ever come to the notice of psychiatrists, here or anywhere else. A likely protection against this in Ireland is easy access to abortion abroad, currently availed of by some thousands of Irish women annually. Greater acceptability of single parenthood may also figure in this.
The referendum, if passed, would criminalise abortion specifically for suicide risk. Otherwise, we are told, the "floodgates" to abortion on demand will be opened for women by their psychiatrists - neither of whom is to be trusted, it seems. The two cases so far, X and C, hardly amount to a flood. In Britain, abortion on psychiatric grounds is allowed but unusual and is seldom if ever based solely on "threat of self-destruction".
If the referendum is passed, where are Irish women, so desperate to avoid carrying on with pregnancy that they are thinking of suicide (and they exist), to go for help?
They will not be attracted to Government-funded counselling agencies with a mandate only to discuss with them their "meaningful options within Ireland", either before or after abortion.
As depicted in Government "key questions" (see www.irlgov.ie), crisis pregnancy counselling services sound like interrogation centres to pressurise women to continue with pregnancy. At least that is how they will be perceived. Women with unwanted pregnancy often feel like criminals. Now they will have good reason.
What any frightened woman needs in crisis pregnancy is a wise friend who will not condemn her. But what is the doctor or counsellor to say if she blurts out that she'll kill herself unless granted an abortion? She is now proposing to commit a crime, or get someone to do so. Should the doctor tell her she may rest assured, pregnancy is a great protective factor?
ETHICAL constraints on doctors not to impose their moral views on patients and to facilitate second opinions might weaken in such circumstances, and understandably so.
A "big brother is watching you" atmosphere will dispel that trust which is so essential if nondirective counselling is to be effective. Doctors and counsellors, patients and clients will become wary of what they say to each other.
Written guarantees of rights to information and travel will make no difference. Clinical notes will become sparse. Word will spread as to which doctor is "hard on abortion" or "soft on suicide". Continuity of medical care will disappear for women afraid to come back to an unsympathetic doctor. Adverse effects on the mental and general health of women are depressing to contemplate.
Socially disadvantaged women will, as always, bear the main brunt of this: they are important contributors to the worrying trend of late - and less safe - abortions of Irish women in Britain.
It will be of concern to psychiatrists that mental health problems linked to pregnancy might become even more stigmatised than they now are - if that is possible in Ireland, with cash-starved psychiatric services, antiquated laws, reluctance by coroners to return suicide verdicts, and suicides anonymously encrypted in the Central Statistics Office.
In effect, this referendum, if passed, would enshrine the stigma of suicide and of mental ill-health in our Constitution, with specific reference to women.
Even if some of these gloomy prognostications prove groundless, the passing of the referendum would guarantee Ireland a place in history as the first advanced country to create new restrictive conditions for women in the 21st century.
We would enjoy a new if dubious distinction: already in the suicide premier league and the last country in Europe since the French Revolution to decriminalise suicide (in 1993), Ireland would become the first country in the world to criminalise abortion on specific grounds of suicide risk.
Afterwards, neither suicide nor abortion will have gone away, and we all may have a lot of explaining to do.
Tom Fahy is emeritus professor of psychiatry at the National University of Ireland in Galway. He has been a practising consultant psychiatrist for 33 years and has also published on suicide and on attempted suicide in scientific journals. He is not a member of any political party or lobby group