Psychiatrists alone should apply abortion suicide 'test'
The numbers cannot be known: with 4,000 travelling to Britain for terminations, we cannot be sure of their health profile prior to travelling. However, small numbers mean resources are unlikely to be an issue.
A second factor is one of equality: the test under all other aspects of Clare Daly’s draft Bill and my draft Bill is a medical one, not a paramedical one. It is preferable, I think, to have equality of assessment within any legislation by doctors who are all subject to the same regulatory checks and balances and whose broader training across medical disciplines will necessarily bring benefits to any assessment.
Third is the question of broader consistency across legislation: for the purposes of the Mental Health Act, all relevant assessments are medical and not paramedical. In my original draft Bill, I provided that in the assessment of suicide, there should be assessments by two doctors (one of whom should be a consultant psychiatrist) and that each doctor should assess the woman on two separate occasions. However, that was my view when, as it were, “drafting blind”.
Having heard the various submissions and having reflected on the report of the expert group, I think that the test set out in my draft Bill is not the proper one. First, by requiring – in effect – four examinations, it creates obstacles for women with mental health problems that are not in place for a patient with physical health problems, which may be discriminatory.
Second, the original Bill raises the prospect that one assessment of suicide risk could be carried out by a doctor who is not a psychiatrist, which on balance would be to stray from the requirement for appropriate specialisation that was called for by the expert evidence (and, indeed by the report of the expert group).
Thus, I would now suggest that any Bill would apply a test for women threatening suicide that is identical to the test for women facing physical threats to life, with one important distinction. The required assessments and opinions by doctors should both come from consultant psychiatrists, independently examining and assessing the patient on separate occasions. I think the requirement for double psychiatric assessment is sufficient to allow for robust assessment of the small number of women asserting suicidality.
All of this is, of course, quite aside from a discussion about whether suicide should be legislated for at all. It seems clear to most legal commentators that it would not be possible to legislate for abortion without legislating for suicide as a ground.
By all means, adherents of the contrary view can wage their campaign for constitutional reform, but that should not delay the Government, in the meantime, from legislating for abortion promptly, thoroughly and in accordance with article 40.3.3 of the Constitution.
SIMON MILLSis a barrister, former doctor and author. He presented a draft Termination of Pregnancy Bill to the Oireachtas Committee on Health and Children