Response to Head 4: Risk of loss of life from self destruction.
It is striking that this head proposes that a threat of suicide would make something legal that would otherwise be illegal i.e. the taking of innocent human life. Furthermore it proposes that the medical profession would be complicit in the direct and intentional taking of innocent human life. As far as we can ascertain there is no other situation in law or medicine where a threat of suicide would be deemed a justification for an attack on the life of human being.
In proposing this the government claims they have no choice but to implement the Supreme Court decision in X. We reject this claim. The Supreme Court in that case did not hear any medical or psychiatric evidence, and the young girl at the centre of the case was not referred for, or offered, any treatment or counselling. A bad or mistaken judgement is not a sound basis for a good law.
There is insufficient reliable scientific evidence to justify abortion as an effective treatment for pregnant women. We believe that Psychiatrists should be supported by the government and the Minister for Health in using only treatments which are based on sound scientific evidence in Irish hospitals. A recently conducted survey found that 113 of Ireland’s Consultant Psychiatrists believe any legislation that includes a proposal that an abortion should form part of the treatment for suicidal ideation has no basis in the medical evidence available.
As the evidence given by the majority of Psychiatrists to the Oireachtas committee indicated that there is no clear evidence from international research that abortion provides any overall benefit to women’s mental health, and there is no evidence indicating abortion is an appropriate treatment for pregnant women with suicidal ideation.
It should be further noted that that although psychiatrists are very good at identifying and managing patients at high risk of suicide that because suicide in pregnancy is so rare it is not possible to predict which high risk patients will complete suicide . Furthermore the reliable research evidence that concern for dependents including dependent children is protective against suicide should be emphasised. In order to manage the risk that one in an estimated 250,000 to 500,000 thousand pregnant women may complete suicide in Ireland, it is proposed to introduce legislation here which will in time I have no doubt lead to the abortion of up to one in five live births. Currently in the UK there are an average of 190,000 abortions per year, one in five live births.
If this law is passed then any psychiatrist any refusing an abortion to a woman who sought one, could expect there to be a very critical public outcry in the media if that woman went on to complete suicide. The Psychiatrist and team would likely be subject of a statutory enquiry which would receive extensive media coverage usually negative. This would add to the natural personal grief which all Psychiatrists experience when a patient for whom they have cared, completes suicide. Being acutely aware of the terrible burden of pain a suicide inflicts on a family is naturally an additional pressure for the treating Psychiatrist. In summary, it is essential to point out that abortion is not an evidence based treatment of suicide risk in pregnancy.
Psychiatrists themselves are the first to admit they cannot accurately predict suicide. Consequently there would be a very large number of terminations in order to potentially get it right. Review of the evidence shows the risk of suicide is significantly less in pregnant females, one third to one half of the risk of non-pregnant females of similar age. However, the risk of suicides increases significantly after an abortion. Pregnancy appears to confer a protective role against suicide. This has been shown in studies published by the British Medical Journal (1996) and the American Journal of Psychiatry (1997). Indeed the Finnish studies looked at all their registers between 1987 and 1994 and found no cases of suicide in pregnancy but a 3 fold increase in suicide in the first year after abortion.
Recommendation:
Doctors should seek only to care and to cure and to provide the best possible care for all their patients, born or unborn. They should not be complicit in the direct and intentional taking of human life. All doctors, including psychiatrists must practice evidence-based medicine and refuse to act as ‘social police’. There is no evidence that abortion (the direct and intentional killing of the unborn baby’s life) is a treatment for suicide ideation.
There is a real and substantial risk of loss of the pregnant’s woman’s life by way of self destruction. It is unclear and potentially possible that the present wording of the proposed Act could allow for the direct intentional killing of the child where a doctor construes Head 4 subhead (1) (b) (i) to allow them to carry out a procedure that involves the direct intentional killing of the child rather than simply terminating the pregnancy because the existence of a living child could still result in the loss of life of the mother from self-destruction.
The wording of the proposed Act does not definitively protect the unborn child from direct intentional killing in the event that a woman threatens suicide because of the existence of the child. Although the explanatory notes (on page 8, 2nd last paragraph and page 11 last paragraph) imply that the life of the child must be protected if at all possible, because the Act does not contain wording that specifically states this, that protection will not exist in law. We, furthermore.maintain that no specific wording could possibly fully prevent such a thing from happening with the continued inclusion of Head 4 and we therefore move that they strike it out.
Recommendation:
The government has not adequately protected the right to life of the unborn with its present wording and, a the very least, should makes its assumption of protecting unborn life (as expressed in its explanatory notes mentioned above) by including wording that confers that protection (in as far as that is possible) if it insists on the continued inclusion of head 4.
