Professor Patricia Casey:

I am probably not the person who should answer the question relating to a workable proposal because I do not believe we should be legislating for suicide risk under the proposed legislation. I am of the view that it is going to be bad law because it is not based on any evidence relating to suicide and pregnancy that we know of.

Senator Colm Burke referred to specialist referrals. CMACE - the British equivalent of CMAC - commented that 69% of women dying by suicide received sub-optimal care. Some of that was not because of delays in referral, it was actually after referral that they were not treated properly. Anything that promotes early referral and vigorous treatment is absolutely essential as a way of combatting maternal suicide.

Senator MacSharry raised the question of how rapidly suicidal patients can be referred. Even though there are only three perinatal psychiatrists in Ireland, there are psychiatrists all over the country. People can be referred to accident and emergency departments because all of the psychiatrist services in Ireland have psychiatrists on call 24 hours a day. These services have junior doctors and consultants on call and people can be referred to them. There is not, therefore, a problem with regard to emergency referral for any person, whether it be a pregnant woman or anyone else.

The point relating to whether the unpredictability will increase the potential number of women who are being referred for abortions and who turn out not to be suicidal is absolutely correct. If one predicted that 100 women were suicidal and in need of abortions and if only three of them would actually die by suicide, then there is going to be an over-referral. That is one of the difficulties. We would err on the side of caution. When men or women who are suicidal come into the accident and emergency department of the Mater hospital, if I am not sure whether they are actually suicidal, then I will admit them. If the choice is between abortion or not, some psychiatrists may err on the side of caution rather than running the risk of a woman taking her life. That is a concern.

The UK statistics indicate that four women there die in pregnancy each year and a question was asked as to whether the number would be higher if abortion were not available. I doubt it because abortion is available there. If it was thought that abortions would have helped these women, they would have had them. As already stated, the CMACE report emphasised that there were also deaths by suicide after the birth of children. It also emphasised that all of these were due to mental illnesses which had not been adequately or vigorously treated. Unfortunately, some did not fall into that category. However, suicide sadly does occur even when the best treatment in the world is provided. This is because it is unpredictable.

Senator Crown accepts that suicide is rare and speculates that I am incorrect in stating that abortion never ends a suicidal tendency. We must practice evidence-based medicine. I do not know if the Senator has read the relevant royal college's report - perhaps he did not hear that part of my evidence - during the compiling of which it carried out a systematic review and concluded that, for all the relevant confounders, regardless of whether a woman with an unwanted pregnancy had an abortion or gave birth, it made no difference to her mental health. There is also a study which was carried out in Finland, which I did not have an opportunity to refer and which focuses on related suicide in women who had abortions or miscarriages or who gave birth. That study indicates that among those who had abortions, the suicide rate was three times the national average. In those who gave birth, it was half the national average. There is data to support the proposition that there is no evidence that abortion helps women's mental health.

On the floodgates phenomenon, I have already outlined my view that there will be a gradual attempt to extend the law. It has already been suggested at these hearings that it should include mental health as well as suicidality. That process has begun and I think there will be widespread abortion in a short period.