MONDAY WAS THE second day of the Oireachtas hearings on the new abortion law designed to legislate for the X Case and allow for abortion in cases where there is a risk to the life of the woman involved.
The hearings are intensive. Monday’s session began at 9.30am and lasted for almost 12 hours as TDs and Senators heard from thirteen psychiatrists, as well as representatives of other medical specialties over the course of four separate sessions. As with the first hearing on Friday, there was intensive questioning, particularly over the inclusion of suicide in the legislation and how that may work in practice.
We liveblogged everything as it happened yesterday but here are the most interesting moments to catch up on.
1. Suicide in pregnancy is real but there can be no evidence-based research
Dr Anthony McCarthy, the consultant perinatal psychiatrist from Holles Street, opened proceedings with the stark line, “Suicide in pregnancy is real..and a real risk.”
Echoing remarks made by his colleague Dr Rhona Mahoney last Friday, he said that much has been made about a lack of evidence of suicide ideation in pregnancy but that such statistics would be impossible to gather as any kind of study (which would have to gather suicidal pregnant women and treat some, without treating others) should not and could not be done.
He also said that there is no treatment for suicide, be it abortion, counselling or anti-depressants. Psychiatrists work by preventing suicide.
Meanwhile, Dr Bernie McCabe of Navan Hospital said that psychiatrists are very poor at predicting suicide and they tend to “over predict” the likelihood – adding that experts have no real way of knowing “who is going to proceed to suicide”. Speaking from the same position, Dr Jacqueline Montwill, Consultant Psychiatrist, Mayo Mental Health Service, said that as “there is no way to say which women will kill themselves” it is probable that a request for an abortion would be granted by an assessment panel.
2. Clarification is needed for when the patient is still a child in the eyes of the law
Child psychiatrist Dr Maeve Doyle noted that the draft heads of bill are missing a proper definition of the word ‘child’, adding that clarity is needed for dealing with a teenage pregnancy.
In the second session Dr Peadar O’Grady said that while it is an issue, the question around consent is not restricted just to the psychiatric area of medicine. He said problems have arisen for children in care as uncertainty around whether a carer can give consent and decisions about them travelling with a child where a parent normally would have caused dangerous delays.
3. Psychiatrists are doctors, not judges
Dr John Sheehan noted that a speedy delivery of a baby is contraindicated in psychiatry, a significant difference between his field and that of obstetrics, where rapid inducement is often favoured. He said a patient should be advised not to make irrevocable decisions.
He added that psychiatrists are doctors, not judges and that the bill could make them the “gatekeepers to abortions”. However, there was some disagreement between the morning’s witnesses about whether suicide could be “predicted”.
During the morning’s hearing, Ireland’s three perinatal psychiatrists were keen for their audience to understand theirs is a field of medicine, just as obstetrics is and the decisions they make are distilled from training, expertise and experience.
4. It is ‘excessive’ to have two psychiatrists assess a woman
All psychiatrists in the second session of the hearing today agreed that it was unnecessary for a woman to be assessed by a GP and by two psychiatrists, with Dr Eamonn Moloney calling it “excessive”. Like the witnesses from the medical profession last week, they emphasised the import role of the GP as the first point of contact for a woman.
Moloney said GPs have a huge amount of experience dealing with people who are suffering emotional distress and also have the experience to carry out an assessment and then refer a woman onto a psychiatrist. He said this course of action is the “usual and ideal care pathway” for all suicidal patients and is likely to be the least distressing for the woman.
Meanwhile, Dr Janice Walshe, Consultant Medical Oncologist, St Vincent’s University Hospital recommended that two practitioners along with obstetrician be part of assessment panel.
5. Including a criminal sanction in the legislation is ‘dangerous’
Psychiatrists and mental health experts speaking in front of the committee today warned that the inclusion of a criminal sanction with a 14-year prison sentence attached to it could cause a lot of problems.
Dr O’Grady said it would be “dangerous” to have this hanging over women as it may mean they feel restricted from sharing medical details openly and could increase the risk of suicide in vulnerable patients.
He also said that there is already a process to deal with poor medical practice and so there is no need for specific laws. Witnesses stressed that psychiatrists had no intention of abusing the law and rubbished suggestions that some doctors may use the legislation to make abortion available on demand.
6. Some medical experts would like a mandatory second opinion in an emergency
Dr Janice Walshe, a consultant oncologist, said the likelihood of a cancer patient falling pregnant is fairly rare – in fact, despite the cancer rates, every year there tend to be only about 60 or 70 cancer patients whose condition is impacted by a pregnancy.
This means that an obstetrician or other medical expert – even when they have a particular speciality on a certain subject – is unlikely to have faced a similar example in the past if they were presented with a pregnant woman whose life was at risk.
In cases like that, Dr Walshe suggested, it might be useful for the medical expert to seek a second opinion – if only to ensure that their own opinion was shared by a colleague.
7 . The legislation could ‘normalise’ suicide
Professor Kevin Malone of St Vincent’s Hospital and UCD raised some eyebrows among Oireachtas members when he claimed that the new legislation could end up legitimising and even normalising suicide in Ireland. He also suggested that it could lead to higher rates of suicide among men.
The consultant psychiatrist questioned how young people will be taught about mental health issues in schools, and put forward the idea that the proposed law would legitimise suicidality when it comes to women, but not men, despite their far higher rate of suicide.
8. The capacity of a woman to indicate a suicide risk is up for debate
The final session heard from John Saunders, the chair of the Mental Health Commission, who had some interesting notes about the capacity of a woman to suggest she is at risk of suicide.
Given the probability that a person at risk of suicide is suffering from a mental health difficulty, Saunders accepted arguments that a woman ‘of unsound mind’ may not in fact have the legal capacity to make any such claim – and therefore to trigger a legal process.
Saunders said the point of the three-person panel in that case was essentially to gauge the woman’s capacity by evaluating the risk of suicide and discerning if it was a genuine one – but also pointed out that the Oireachtas has been due to overhaul Ireland’s antiquated capacity laws for years now and has yet to do so.
There could be some interesting legal challenges ahead.
Compiled by Sinead O’Carroll, Michelle Hennessy, Christine Bohan and Gavan Reilly.
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