Dr. John Sheehan:

I refer to Deputy Terence Flanagan's question on whether we, as perinatal psychiatrists, have ever seen a situation in which termination of pregnancy has been the treatment for a suicidal woman. To reiterate our statement, with more than 40 years of clinical experience between us, we have not seen one clinical situation in which this is the case. While I acknowledge Dr. O'Keane would state that suicide is a leading cause of maternal death, one should consider how rare is maternal mortality. It is a statistical leading cause because the rate is so rare with one in 500. That is the first point I wish to make. On the question of pregnancy at 30 weeks, such a pregnancy is viable and if the baby is induced at that stage, it is likely to do very well. At the Rotunda Hospital, we try to save lives from 24 weeks onwards and, consequently, 30 weeks certainly is a very viable foetus.

As for the reason we are in attendance, Deputy Ó Ríordáin raised the question of what is the best approach regarding the expert report. We have tried to discuss and consider this question because from listening to all of us, one can discern exactly how complex is the situation. In our clinical practice, we regularly see women who are suicidal. Some will have thoughts of suicide, some will have intention of suicide and others will have thoughts that they wish they were dead. As is evident here today, what tends to happen is the notion of suicidality tends to get narrowed down to a person being suicidal or not. Clinically, however, this is not the situation as clinically, the situation is highly changeable. A person may have strong suicidal feelings on one day but may change on the next day or vice versa. As Senator Crown noted earlier, I am not a legislator but when one considers what is the best option for legislators, the job they have is extremely difficult. Even if one merely tries to follow what is being discussed at this meeting today, it is extremely difficult because of all the different dimensions.

Another aspect that really has not been brought out pertains to when the expert group considered the emergency situation in a medical context. In such a situation as when, for example, a woman has had an epileptic fit and the baby must be delivered very quickly, speed is of the essence. In psychiatry, precisely the opposite is the case. Someone who is intensely suicidal often needs admission to hospital. It is exactly the opposite to the medical intervention and, consequently, even the notion of carrying out an emergency termination is completely obsolete in respect of a person who is extremely suicidal. I reiterate that in our practice, we see people who are profoundly depressed, who feel hopeless, worthless or utterly helpless to deal with situations. In such situations, one can see clearly the intervention usually is to admit such people into hospital, day hospital or home care but the intention is to support and help them through the crisis they are in. It is not to make a decision that is permanent and irrevocable. In a manner, this covers the other question raised by Deputy Durkan on how do we treat women who present. Members can perceive that our emphasis really is on providing the best care possible to the women we see. This is because it both benefits the woman and there is loads of research demonstrating that good mental health care for the woman leads to better child development, better bonding between mother and infant, better infant development and better IQ development. There are loads of potential benefits and this is the reason we strive to provide the best care possible for women.

In addition, the question raised by Senator Brennan on whether there is a floodgate phenomenon or whether this could happen has come up several times. However, as psychiatrists, we distinguish between assessing risk - at which we are good - and actually picking out the individual who will go on to complete suicide or, in other words, predicting the future. None of us can actually do that; it cannot be done. Unfortunately, the proposed legislation is almost at the curve, which for psychiatrists is whether one can identify that woman where there is a real and substantial risk. As I noted, that is for legislators but even from a mental health perspective, we are good at the assessment of risk but it is impossible to be absolutely certain about prediction.