Psychiatrists alone should apply abortion suicide 'test'
OPINION:An evaluation by two psychiatrists is sufficiently robust for tiny number of women asserting suicidality
Noel Whelan (Suicide ‘test’ should now be key focus of abortion debate, Opinion Analysis, January 12th) has much to say that is positive about the Oireachtas health committee’s recent hearings.
As a witness before that committee, I drafted outline legislation to show how an abortion law might be codified within the strictures, properly understood, of article 40.3.3. I also echo his view that the hearings illuminated many issues for the undecided and for those who Catherine McGuinness termed the “middle ground”.
However, I part with him when he focuses on the question of the threat of suicide as a ground for the X case and suggests (wrongly, in my view) that there is potential for significant ongoing disagreement about how to legislate for the question of suicide.
As one basis for this argument, he advances the discrepancies between the proposed statutory measures contained in Clare Daly’s draft Bill and those in the draft Bill I offered for consideration by the committee. He concludes the different approaches “illustrate there is still a debate to be had about the safeguards in cases involving threat of suicide”.
In reaching his conclusion about different approaches to date on legislating for suicide, he omits a critical consideration: at the time of the drafting of both Bills, no one knew quite what Irish doctors, especially Irish psychiatrists, thought about all of this.
Both Bills were drafted in advance of helpful exposition before the Oireachtas health committee and did not have the benefit of the full discussion that the health committee hearings both facilitated and subsequently generated. As a result, differences between the two Bills are understandable given the lack of clarity when they were drafted.
Before considering what an abortion law should say about the threat of suicide, there are two other issues. The first is whether we can legislate for suicide at all. I think both Bills (their differences notwithstanding) make clear workable frameworks can be codified without great complexity. It is also instructive to recall that complex aspects of mental health (including threats of suicide) are already unexceptionably legislated for in the Mental Health Act 2001.
The second issue is the main distinction noted by Whelan in his article: who should assess suicidal risk?
Clare Daly’s Bill envisaged the risk could be assessed by either a psychiatrist or a psychologist; my Bill provides that it can only be a psychiatrist who carries out the assessment. I think I understand the reasoning behind Daly’s Bill. First, in the X case itself the evidence from a psychologist was accepted; and secondly, there may be questions of accessibility if all assessments must be carried out by consultant psychiatrists.
But that is, I think, to misunderstand three things. The first is that (as the evidence to the Oireachtas committee confirmed) we are dealing with tiny numbers of women who are (a) suicidal in pregnancy, (b) suicidal because of that pregnancy and (c) falling into the X case scenario of requiring a termination to treat their condition.