Still no clear answers as abortion debate goes on

Analysis: There was little agreement among witnesses

Prof Kevin Malone, School of Medicine & Medical Science at UCD. Photographer: Dara Mac Dónaill

Prof Kevin Malone, School of Medicine & Medical Science at UCD. Photographer: Dara Mac Dónaill


Regardless of whether you are in favour of or against the planned abortion legislation, it is difficult not to be concerned by the divisions between the professionals on its contents. There was a clear divergence of opinion between the masters of the State’s main maternity hospitals when the Oireachtas health committee began its hearings into the legislation last week.

Divided psychiatrists
Yesterday it was the turn of psychiatrists to disagree about the proposals in the Protection of Life during Pregnancy Bill to permit terminations in cases where there is a threat to the life of a woman because of the threat of suicide. It was clear that there are deep divisions within the profession in relation to their envisaged role of assessing such women.

Even the perinatal psychiatrists were split, and there are just three of them in the State. Again, the divergence was most marked between staff working at the two big Dublin maternity centres: the National Maternity Hospital/ Holles Street and the Rotunda.

Dr Anthony McCarthy, who works in Holles Street and is also president of the College of Psychiatrists of Ireland, siad that, while rare, suicide in pregnancy is “a real risk, it does happen”.

While accepting that abortion was never a treatment for suicide, he said the Bill was about legislating for the “very small but real possibility” that a woman might kill herself because of an unwanted pregnancy.

However, Dr John Sheehan, perinatal psychiatrist at the Rotunda, said the legislation will lead to multiple “false positives”, where women are wrongly diagnosed as suicidal.

A number of witnesses called for a shorter time period for assessing women seeking terminations, but Dr Sheehan argued that medical and obstetric emergencies require very different interventions. The first involves the speedy delivery of a baby but in a psychiatric emergency speedy delivery was “contra-indicated” as it was likely the patient had impaired capacity.

‘Normalise’ suicide
Fine Gael backbenchers again raised the spectre of the suicide clause opening up the “floodgates” to abortion and Senator Fidelma Healy Eames argued that it would “normalise” suicide in society.

Independent Senator John Crown countered that a woman trying to “game” the system by pretending to be suicidal to obtain an abortion would only be able to do so with the “informed collusion” of two psychiatrists, an outcome he suggested was not likely to occur.

Kevin Malone, professor of psychiatry at UCD, also expressed concern about the effects of “normalising suicidality” in legislation. One result could be to increase the suicide risk among Irish men as well as women who are not pregnant, he suggested.

The divergences between witnesses grew. Dr McCarthy talked about hard cases, about a woman “who’s been kicked three times in the stomach” while pregnant and who knows that if she has the baby she’ll never get away from the man abusing her. Life was messy and seldom “black and white”, he said.

On the other side of the argument, psychiatrist Seán Ó Domhnaill claimed the Bill would “turn doctors into abortionists”.

Some new light was shed on issues relating to consent and confidentiality applying to minors under the legislation, but overall it was clear that the profession with the key role in operating the legislation is hopelessly split.

Some psychiatrists are set to opt out on grounds of conscience. Others see their job as merely assessing whether a woman is eligible for a termination with the patient herself choosing the treatment. For Fine Gael,it wasn’t a good day for settling the horses.