Anti-choice psychiatrists undermine abortion law
Opinion: A society that aspires to be humane must recognise the reality of human difficulties
The Protection of Life during Pregnancy Act (PLDP Act) was signed into law in July last year and became operative at the start of 2014. This law was 20 years in gestation, since the Supreme Court ruling in the X case in 1993, which allowed for lawful abortion when the mother’s life was at risk, including the risk to life from suicide. In two subsequent referendums the Irish people voted to support the Supreme Court decision that suicidality could be a legitimate reason for terminating a pregnancy.
The regulations and procedures about how the service will operate are laid out in the PLDP Act and statutory instrument. But a hitch has now come to light: guidelines for clinicians on the new legislation are still pending. This was brought to light in an Irish Times article by Kitty Holland on January 3rd. While there are some minor professional issues related to training that remain to be resolved, the real problem is how women will access the service. The College of Psychiatrists of Ireland had expressed “extreme concern” at the absence of guidance for GPs in finding suitable psychiatrists to assess a suicidal woman requesting an abortion.
Let us imagine a hypothetical case. A woman, let us call her Kate, becomes pregnant following an act of sexual violence. She is distressed and inconsolable and cannot contemplate continuing with the pregnancy. She would rather die than continue with the pregnancy and forced motherhood. She is not depressed, but she is suicidal and the only remedy for her is the termination of the pregnancy.
Where does she turn for help? Her first option is to go to her GP who would refer Kate to her local HSE psychiatrist. Psychiatry services are provided on the basis of geographical location and patients are sent to whoever provides the service in their area. Let us suppose that Kate is referred to an anti-choice psychiatrist. This is the nub of the problem. We have had a public debate in which some psychiatrists have said that abortion is never a treatment for suicidality. Prof Patricia Casey has stated that “there are no grounds for recommending abortion as a treatment to prevent suicide” and further that it is “deeply insulting” and “discriminatory” that some psychiatrists should be excluded from determining suicidality under the Act because of their “personal position on the issue”.
Let us return to Kate, who might still possibly have the resilience to request a review of this opinion, as is her right. At the review committee stage, she could also encounter a psychiatrist whose “personal position on the issue” is that abortion is never a treatment for suicidality. She may feel humiliated and abandoned. She may lack financial resources; she may be unable to travel abroad; she may be a refugee. She may feel desolate and unable to go on . . . and she may kill herself.