Suicide in pregnancy a real risk, committee is told

Suicide in pregnancy was a real risk and did happen, president of the College of Psychiatrists of Ireland Dr Anthony McCarthy has told the Oireachtas health committee.

“This is always a tragedy, at least two lives are lost, and many others are hugely affected,” he added. “We must do everything we can to prevent such deaths. “

The committee, chaired by Fine Gael TD Jerry Buttimer, has resumed hearing submissions on the heads of the Protection of Life during Pregnancy Bill in Leinster House.

A total of 15 experts will today address the committee’s ongoing hearings on abortion, including 11 psychiatrists, an oncologist and a cardiologist.

The chairman of the Mental Health Commission and the president of the Irish Nurses' and Midwives' Organisation will also speak at the meeting, on the second of three days of hearings on the Bill.

The main focus of the 10 hours of proceedings today will again be on suicide and its inclusion in the legislation, the heads or general proposals of which form the basis for the discussion.

Dr McCarthy is a specialist in perinatal psychiatry at the National Maternity Hospital, Dublin, and the psychiatric assessor for the confidential inquiry into maternal deaths in Ireland.

He told the committee much had been made, and would be made, about the “so-called lack of evidence regarding abortion” and whether it would ever prevent a suicide. He said believed here would never be statistical evidence to prove that point, one way or other.

Trying to prove anything statistically for such a rare event is extremely difficult if not impossible, Dr McCarthy said, adding there was no treatment for suicide.

“What society needs to address in general, and what we psychiatrists have to do specifically, is to try to prevent suicide and this requires looking at what are the causes and what can be done to address them,” he added. “And so the question here is not does abortion treat suicide, but is there ever a case where a woman will kill herself because of an unwanted pregnancy and, if so, what can we do to save her life and would that ever be a termination of pregnancy?”

Dr McCarthy said the Bill was about legislating for that very small but real possibility.

Consultant perinatal psychiatrist Dr John Sheehan said psychiatrists could be seen to be the gatekeepers to abortion if the provision allowing for terminations where a pregnant woman is suicidal is enacted, the Oireachtas health committee has heard.

He told TDs and senators that psychiatrists are doctors not judges and said that under section 4 of the Protection of Life during Pregnancy Bill, psychiatrists are being asked to determine if there is a real and substantial risk to the life of the mother in order that the mother may procure a termination.

He pointed out that the three perinatal psychiatrists in Ireland, psychiatrists dealing with women during and after pregnancy, had never had a single case of suicidal intent during pregnancy in 40 years of practice.

Dr Sheehan said the actual incidence of suicide in pregnancy was between one in 250,000 and one in 500,000. In practice, therefore, it would be impossible for any psychiatrist to accurately predict who will die, he said. “It could lead to multiple false positives.”

He said that if the section on suicide was enacted it may well change the patient profile currently seen by Irish psychiatrists. Women who currently travel are more likely to be referred for treatment in Ireland. He said the extent of mental health problems and suicide ideation in that population was unknown and the utilisation of the proposed legislation by that population was unknown.

“Section 4 would create a role that many Irish psychiatrists have not been involved with to date. I think that many Irish psychiatrists will not see this as their role as medical practitioners,” he said. “The role could be construed as making psychiatrists the gatekeepers to abortion.”

Founding member of Doctors for Choice Dr Peadar O’Grady said imposing a requirement for three doctors to assess a suicidal pregnant woman would cause unnecessary delay.

There is no medical basis for differentiating between a medical emergency and a psychiatric emergency, he added. “All psychiatric emergencies are medical emergencies.”

Dr O’Grady, a consultant child and adolescent psychiatrist, said children were not specifically mentioned in the legislation, even though they were most likely to experience difficulties in their ability to travel for an abortion. This could result in them being at increased risk of suicide.

Dr O’Grady said women and children, in situations of rape, child sexual abuse and fatal foetal anomalies would have to wait for further legislation to allow for the option of abortion. That this Bill does not provide for this is a serious limitation, he added.

The full legislation will be drafted after the report on the hearings is published and considered and is expected to be debated in the Dáil and Seanad next month.

If enacted, the Protection of Life during Pregnancy Bill 2013 will legalise abortion if there is a real and substantial risk to the life of the mother, including the threat of suicide.The Bill would legislate for the 1992 X case judgment from the Supreme Court, which found abortion is legal if there is a real and substantial risk to the life of the mother, including the threat of suicide.