Maternity hospital Masters differ on suicide provision

The Masters of two Dublin maternity hospitals have differed on the suicide provisions in the abortion legislation at an Oireachtas hearing.

Dr Rhona Mahony, of the National Maternity Hospital, said the life of the foetus must be vindicated where it was practicable. It was her experience that the majority of women did not wish to lose their babies, but they did not want to die.

She added that one could be forgiven for thinking that the Bill was about the risk of suicide in pregnancy. It is not, she added. It is about saving women’s lives, regardless of whether that risk to life is physical or mental.

Dr Mahony said a woman who was intent on suicide was indeed at risk of dying. She needed to be assessed appropriately, believed, and expert psychiatric care provided.

Dr Sam Coulter Smith, of the Rotunda Hospital, said that loss of life from self-destruction was an extraordinarily rare situation, with incidence of suicide in pregnancy of the order of one in a half-million pregnancies, as per UK figures.

“Our psychiatric colleagues tell us that there is currently no available evidence to show that termination of pregnancy is a treatment for suicidal ideation or intent and, as obstetricians, we are required to provide and practice evidence-based treatment,” he added.

It, therefore, creates an ethical dilemma for any obstetrician who is requested to perform a termination of pregnancy with the treatment of somebody who has suicidal ideation or intent” he said

He was sure, he said, that the legislation was designed to create clarity and reassurance for both health professionals and patients alike. The fact that there was no gestational limit relating to suicide was a major ethical issue for obstetricians.

Dr Coulter Smith said he welcomed the fact that the legislation provided for a termination of pregnancy in an emergency situation in any of the 19 maternity units in the country.

Earlier former master of the National Maternity Hospital Peter Boylan said the current situation in Ireland in which doctors have to operate to deal with cases where the life of a woman is under threat in pregnancy is wholly unsatisfactory and unreasonable.

He said doctors were aware of the Supreme Court judgment in respect of the X case. However, in the absence of legislation and regulation, they were left to attempt to interpret that judgment on an ad hoc basis when it comes to termination of pregnancy in order to save the life of the mother, he said.

He also said the 1861 Criminal Offences against the Person Act remained on the statute books. “This is a wholly unsatisfactory and I believe unreasonable situation to expect doctors to operate in,” he said.

Welcoming the Government’s intention to enact legislation to protect life in pregnancy, Dr Boylan said the situation in Ireland where there was a real and substantial risk to the life of the mother remained unclear.

He said Ireland was in a unique position in that there is ready access to termination in the UK for Irish residents despite abortion being illegal here.

He said it could be interpreted that the State has implicitly agreed to facilitate this access because of the 1992 constitutional amendments which guaranteed the right to access information and the right to travel to obtain a termination.

The current situation also placed the woman in the highly unsatisfactory position where doctors caring for her are unsure as to whether or not they may be breaking the law in cases where they feel they have to intervene to save her life.

During the hearing, Independent TD Mattie McGrath was ruled out of order when he suggested there could be “group think” among obstetricians.

Addressing the current and former masters of the National Maternity Hospital Dr Rhona Mahony and Dr Peter Boylan he said:

“I understand that both of you are related through marriage”. He was immediately asked to withdraw his comments. Committee chairman Jerry Buttimer said the Tipperary North TDs comments had no relevance to the heads of the Bill.

Mr McGrath persisted said that both were leading obstetricians in favour of the proposals and there is a danger of group think.

Dr Boylan responded that they were related by marriage but not that closely.

Later Independent senator David Norris hit out at what he called buffoonery by some Oireachtas members.