Dr. Bernie McCabe:

I thank the committee for providing me an opportunity to present my concerns about this legislation in the absence of Professor Patricia Casey. As a consultant psychiatrist, it is my duty of care to my patients to provide them with a non-judgmental and evidence based treatment programme in accordance with their needs. It is my opinion that such treatment is their right and, in the absence of an evidence base, I am in breach of my duty of care to them and their rights. These ideals are reflected in the guidelines of my governing bodies, the Medical Council of Ireland and the College of Psychiatrists of Ireland. In view of the submission made earlier on behalf of the college, I now have to report to the committee that the text of its submission was sought last week by members but the request was refused until today. A growing number of members of the college no longer feel the speaker from the college is representing their views. The college has been informed of this in writing, as of Friday, 17 May.

It has been stated by a number of speakers at various Oireachtas hearings that evidence is not available for the use of abortion as a treatment in suicidality. Suicidality is a dynamic state which varies from suicidal intent, where a person has no hope and does not plan for his or her future beyond his or her death, through suicidal ideas, to a crisis state where a person becomes aware of a sudden change in circumstances - in this case we are referring to an unplanned or unwanted pregnancy - and is now fearful or negative about the future. Clearly these are fearful, distressing and despairing states and have many underlying causes requiring a full multidisciplinary assessment of needs. It must also be emphasised that we have, as a scientific professional body, a number of evidence based treatments that work in terms of helping to remove a person from a despairing, distressing or mentally ill state to one where judgment is more robust and the person is again in a position to consider options for the future.

For those individuals who do not fall into the aforementioned categories, that is, people who do not have mental illness, are not despairing or distressed or have needs that cannot be met by a multidisciplinary psychiatric service, such as those who present to psychiatric services with social issues, it is important to accept that psychiatry has nothing to offer over and above those who are not trained as mental health professionals. These are social issues and, accordingly, psychiatry should not be involved. It must also be accepted that the prediction of suicide is recognised to be poor. This is a worldwide and evidence based view held by the profession. The test of whether there is a real and substantial risk to the life of the woman that can only be avoided by abortion cannot be met given that suicide cannot be predicted even among those with mental illness. Offering a pregnant suicidal woman an abortion if she says her pregnancy is the reason may seem like common sense. However, caution is required in this regard. Interventions that seem intuitively correct may turn out not to be so. Intuition is not enough. An evidence base is required. As we are members of a scientific profession which uses an evidence base for the planning of treatment, to expect psychiatrists to recommend abortion as a treatment for an unwanted pregnancy in the group I have just described is an abuse of the profession in order to facilitate the requirements of the State. The psychiatric profession has no role beyond saying that a person has no mental illness and we must not be used by the State to duck the ethical and constitutional debate that must take place or else the profession will once again fall into disrepute under the current proposals.

As it is currently constructed, head 4 should not be included in the legislation. It should be replaced by an evidence based clinical care pathway that would assist women who are suicidal in accessing psychiatric assistance because abortion as a treatment for suicidality is not evidence based. This view is supported by a growing number of professional colleagues. Of 302 consultant colleagues who received a postal questionnaire, over 130 responded and this number continues to grow. Some 90% of the respondents were in agreement with the aforementioned view. Some have sought to criticise this work but it must be made clear that respondents were asked to put aside their personal views and answer solely based on their clinical experience. It remains the only piece of work to consider the level of concern among practising consultant psychiatrists and it is worthy of consideration for that reason. In the event that the Government disregards these concerns and the recommendations expressed more thoroughly in Professor Casey's submission and proceeds with legislation, a number of concerns have been set out in the website submissions and are beyond the scope of this presentation.

There is a dearth of information on the value of abortion among suicidal pregnant women. It has never been studied. The Government is acting as though evidence is available to support this. Psychiatrists should not be involved except in so far as we can treat women with mental illness, which must be evidence based.