The College of Psychiatrists has advised its members not to participate in review panels, provided for under new abortion legislation to assess pregnant women expressing suicidal thoughts
, until clinical guidelines are in place.
The professional body for psychiatrists in Ireland described the enactment of the Protection of Life During Pregnancy Act without clinical guidelines as “very haphazard and unsatisfactory”.
It is also expressing “extreme concern” at the absence of any guidance for GPs on accessing suitable psychiatrists to assess a pregnant woman showing signs of suicidality; at the absence of guidelines for a psychiatrist seeking a second psychiatric opinion; and the lack of training for obstetricians in up-to-date psychiatric issues as well as for psychiatrists in obstetric issues.
The Protection of Life During Pregnancy Act came into force on January 1st. It sets out for the first time the circumstances where abortion can be carried out – where there is a “real and substantial” risk to the life of the pregnant woman, including by suicide.
A "Guidelines on Implementation Committee" was appointed last year by the Department of Health to draw up clinical guidelines on how the legislation would work in practice. It includes representatives from the department, the HSE, the Institute of Obstetricians and Gynaecologists, the College of Psychiatrists, the Royal College of Surgeons, the Royal College of Physicians as well as experts in cardiology and oncology. It has yet to report.
According to the Act, a pregnant woman who is expressing suicidal thoughts and seeking an abortion may have one if three medical practitioners, including two psychiatrists, have "jointly certified in good faith" that there is a real and substantial risk to her life by suicide which can only be averted by an abortion.
It also provides for a review panel, to be "established and maintained" by the HSE "of at least 10 medical practitioners", and says the HSE must request medical bodies, including the College of Psychiatrists, to nominate members to be appointed to it.
Chief executive of the college Miriam Silke told The Irish Times that until the guidelines were issued the college would not recommend to its members participation in the panel.
“We simply do not know when they will be issued. We have not heard anything since the Bill came into law. I presume work is progressing but they aren’t imminent. It is very haphazard and unsatisfactory.”
Dr Anthony McCarthy, perinatal psychiatrist at the National Maternity Hospital and former president of the college, said the new legislation failed to provide "real solutions" for women in distress. A pregnant woman expressing suicidal thoughts would be seen by a psychiatrist, he said, but if that psychiatrist wanted to get a second opinion it was unclear how this would be obtained.
He said there should be a process whereby a GP in a particular area could “by-pass” the local HSE psychiatrist if they were concerned about that psychiatrist’s ideological stance on abortion.
“There is no clarity. What is the point of having a committee to draw up guidelines if the Act can be implemented without guidelines? It is completely unsatisfactory,”he said.
A spokeswoman for the Department of Health said: “The guidance document to assist health professionals in the implementation of the Act is at an advanced stage and it is expected to be signed off early this year.”
A statement from the HSE said: “A review panel has been established and comprises all of the relevant clinical specialities.”