Dr. John Sheehan:

I thank the committee for the opportunity to contribute. I am a perinatal psychiatrist working in the Rotunda Hospital in Dublin. A perinatal psychiatrist is a psychiatrist based in a maternity hospital and he or she treats women in pregnancy or, for example, following delivery. I also work as a liaison psychiatrist in the Mater Hospital, Dublin, which has one of the busiest accident and emergency departments in Ireland. Last year, we had the highest number of treated episodes of attempted suicide in the State, and part of my work is assessing and treating people who present with attempted suicide. I therefore work both in a perinatal setting and in an accident and emergency department setting.

I will confine my comments to the aspect of the Bill that is pertinent to psychiatry, namely head 4, which is concerned with the risk of loss of life from self-destruction. It has major implications for psychiatrists. First, there is a fundamental difference in the management of medical and psychiatric emergencies in obstetrics. In obstetrics, medical emergencies and psychiatric emergencies require different interventions. In a medical emergency, speedy delivery of the baby is required while, in a psychiatric emergency, speedy delivery of the baby is contraindicated. It is exactly the opposite of that required in a medical emergency. In a psychiatric emergency such as when a patent is depressed and has suicidal intent, the patient may have impaired capacity and should be advised not to make irrevocable decisions. The patient probably cannot give informed consent. Those of us who see people with suicidal intent often see people who feel overwhelmed, unsupported and hopeless and who are often desperate and agitated. The person often has what is called cognitive constriction and can see no other option in front of them except ending his or her life. Such a patient needs professional help, not an urgent termination of pregnancy.

Second, psychiatrists are doctors, not judges. If head 4 is enacted, psychiatrists will be asked to determine if there is a real and substantial risk to the life of the mother in order that she may procure a termination of pregnancy. This is a role in which Irish psychiatrists have not been involved to date. Many will not see this as their role as medical practitioners. The role could be construed as making psychiatrists the gatekeepers to abortion. Psychiatric practice relates to assessment and treatment of patients, not assessment and adjudication. Psychiatrists are not judges.

My third point relates to the women who currently travel abroad for terminations. In the submission to the committee earlier this year, the three Irish perinatal psychiatrists - Dr. McCarthy, Dr. Fenton and myself - stated that with more than 40 years of combined clinical experience, we had not seen a single case where termination of pregnancy was the treatment for a mental disorder. If head 4 is enacted, however, it may well change the patient profile currently seen by Irish psychiatrists. It is likely that women will be referred from that population who currently travel for abortion. The extent of mental health problems and suicidal ideation among that population is unknown and, hence, the utilisation of the proposed legislation by that population is unknown.

Fourth, it is impossible for psychiatrists to predict the future. The explanatory notes for head 4 state, "It is not necessary for medical practitioners to be of the opinion that the risk to the woman's life is inevitable or immediate". The risk of a woman dying by suicide in pregnancy is between one in 250,000 and one in 500,000 live births.

The risk is exceedingly small. In practice, therefore, it would be impossible for any psychiatrist to accurately predict which woman will die by suicide in pregnancy. Being unable to predict who will die by suicide is, therefore, likely to lead to multiple "false positives". Psychiatrists are trained to assess and provide evidence-based treatments not to predict the future.

My final point relates to the potential adverse effects on the woman's mental health due to late abortion. There is no time limit set in the heads. That is, termination could, theoretically, occur up to a very late stage of pregnancy. Late abortion could potentially have a very deleterious effect on the woman's mental health.