Dr. Maeve Doyle:

I am Dr. Maeve Doyle, consultant child and adolescent psychiatrist and chair of the child and adolescent faculty of the College of Psychiatrists of Ireland. I welcome the invitation from the Joint Committee on Health and Children to make a submission on specific issues with regard to children, particularly because the X case involved a 14 year old girl, a child, who had been raped and sought a termination because she said that she was suicidal. The written submission, which was sent by the college, includes a number of key and detailed points about the care of children in circumstances where they may be pregnant and request an abortion and how the proposed heads of Bill must be amended to address these. My opening statement summarises some of these key issues.

On the definition of a child, the heads of Bill do not define the word "child". This is very important as in cases involving children there are very specific and complex issues regarding their care which must be addressed. On consent, under the Children Act 2001, and other legislation, a child is someone under the age of 18 years unless married. A person over the age of 16 years can give consent to surgical, medical or dental treatment and it is not necessary to obtain consent from parents and guardians. For psychiatric assessment the law has been interpreted as meaning that until the age of 18, children are still not in a position to legally consent to a psychiatric assessment and, as such, require consent from their guardians. For children in the care of the HSE the issue of consent is even more complex. I make these points to highlight the need for these issues to be considered by those drafting the final Bill.

The issue of confidentiality is also quite complex. Generally, when young people are first seen by a child and adolescent psychiatrist they are informed that what they say will remain confidential unless the information disclosed constitutes a risk to themselves or to others. This may well result in the young people censoring what they say. This is particularly true in the area of sexual activity. The age of consent to sexual intercourse remains at 17 years. In many cases, however, parents of 17 year olds expect to be informed if their 17 year old child is sexually active, so issues regarding a possible abortion will require expert, experienced and sensitive handling and clarity for the child, family and professionals involved.

While there are no figures available, the occurrence of pregnancy within a population attending a child and adolescent mental health service is rare. For a pregnant young person to attend such a service, the consent must come from her parents. In addition, if the young person is under the age of 17, the professional will have to report to the HSE and the Garda. The likelihood of parents of pregnant girls seeking advice from a child and adolescent psychiatrist as to whether or not to proceed with a termination of pregnancy is, therefore, very low.

What may happen is that in the case of a young girl who is in the care of the HSE, becomes pregnant and indicates a wish to have a termination of pregnancy on grounds of suicidality, the HSE, acting in loco parentis, may well seek the advice of a child and adolescent psychiatrist in making that decision. This is probably the main group of pregnant teenage girls for whom the proposed legislation will, in effect, apply.

I hope that the foregoing will draw attention to some of the difficulties which would need to be overcome in any legislation involving young women, children in the eyes of the law, who present with suicidality in the context of pregnancy.