Denis Naughten (Roscommon-South Leitrim, Independent) | Oireachtas source

I welcome the opportunity to speak on this important legislation. This is an extremely difficult and contentious issue, and everyone’s view should be respected. It is estimated that around 5,000 Irish women avail of abortion services in Britain each year. We should not be judgmental of the thousands of women who travel to the UK for terminations. Each is a woman who has had a difficult situation to decide on. Without being in their shoes, no one should judge what they have done. It is not an easy decision for them to take that journey and it is imperative that proper supports are put in place for their after-care.

This legislation broadly covers three clinical scenarios: when a woman’s life is at risk in an emergency situation due to a complication of pregnancy; when the urgency of the situation may not be immediate but its severity relates to co-morbidity such as cancer, significant heart disease or some other related illness; and when there is a risk of death from suicide or self-destruction. We must provide clarity and must act on best medical practice. I do not have a principled objection to a law that clarifies and restates current medical practice in favour of protecting the lives of pregnant women. In fact, it may address concerns expressed to me about regulatory creep within the Medical Council as a result of the way the guidelines in this area are drafted. I have been informed that the elections for Medical Council positions are based on the candidates’ positions on abortion. Accordingly, there is always a conflict when drawing up the next draft of the Medical Council’s guidelines. It is not good that those who are not directly accountable to the people should dictate policy in this regard.

The best approach was to bring in enabling legislation with regulation. This seems to have been the Government’s decision after the publication of the expert group report. Such a mechanism could have provided the clarity required, including the legal certainty, and allowed for term limits and silence on the issue of suicidal ideation, thereby complying with the Supreme Court judgment. In the first two categories of medical emergency or a medical threat to the life of a mother at some stage during pregnancy, a pregnancy will be terminated early where there is a significant threat to the life of the mother and she has an underlying illness. However, under the third category of suicidal ideation, it will only be legal to avail of a termination where there is no underlying illness. In this case, we are talking about mental illness. Where there is an underlying mental illness that is treatable, a woman will not be legally entitled to a termination under this legislation. Does this not undermine the argument made by those in favour of the suicide provision that they are treating mental illness as a physical illness? Pregnant women with suicidal ideation and no underlying mental health issues are the only women who can practically avail of this particular provision.

It was interesting to hear the evidence given by Professor Kevin Malone to the Oireachtas hearings on the Bill. He expressed concern that the provision of termination based on a 20 year old risk assessment excluded consideration of 50% of the population, namely males. While some might believe it is an abomination to mention men during this debate, the fact remains that men die by suicide and suicide rates among young men remain stubbornly high. In Professor Malone’s evidence, he expressed his concern that this legislation could accelerate the already high rates of suicide among young Irish men by legitimising it for women and girls who suffer crisis pregnancies. Overall, he believed the provision of the suicide clause could actually cost more lives than it could potentially save.

At the same set of hearings, Dr. Sam Coulter-Smith, the master of the Rotunda Hospital, said: "My overriding concern, however, in relation to the whole area of self-destruction and termination of pregnancy to prevent same, relates to the lack of evidence to show that termination is of any assistance in this scenario and that we as obstetricians and gynaecologists must be able to stand over the decisions we make as being based on good medical evidence." It is important that all Members read Dr. Coulter-Smith’s evidence before they make a decision on this legislation.

The incidence of suicide during pregnancy came up as evidence at the committee. Suicide in pregnancy is a real risk. The committee was informed that one in 500,000 pregnant women will - not may - die by suicide. That fact is misrepresenting the situation, however. The key question is how many women are suicidal during pregnancy. In the western world, recent epidemiological research has demonstrated that suicidal ideation may be detectable in a range of between one in eight and one in three pregnant women. That means that up to one third of pregnant women may have suicidal ideation at some stage during their pregnancy. It is therefore more than probable that a large proportion of women travelling to the UK for terminations would be eligible for a termination here under this legislation.

Much focus has been put on a UK study which suggested that predictions of suicide by psychiatrists were accurate in only 3% of cases. The question is which 3%. Psychiatrists are competent in assessing intent and risk factors. It is impossible to predict when and whether intent will actually be acted upon.

There is no scientific data on women who are suicidal because of a pregnancy rather than because of an underlying mental illness. There are clinical markers for people with mental health difficulties. These can be treated and there are alternatives to termination. However, if a woman is suicidal with no mental health issues other than being pregnant, then the psychiatrist has no choice and there is no alternative treatment available. The Mental Health Act 2001 makes it clear that it is not permitted to impose treatment on a patient who is not mentally unwell. The X case test, therefore, is unworkable in psychiatric terms as it requires a prediction that a woman will die by suicide unless her pregnancy is terminated. That test does not require the risk to be inevitable or immediate.

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