Dr. Jacqueline Montwill:

I want to clarify the issue of impairment of judgment. If any patient presents to the psychiatric emergency department with a severe mental illness, an adjustment crisis reaction in which she is threatening suicide and saying "I am completely upset, Doctor; I can't think straight," or severe symptoms of mental illness, then, during that emergency time, her judgment is impaired. That only means that we ask the patient to come into hospital or offer to treat her at home where our nurse can go and see her. If at that time the law says that the patient has full capacity to make the decision about an abortion, then that is the issue, not whether she is suicidal. We believe that what patients say is true for them. We always believe what the patient says because that is part of the clinical presentation. The issue about capacity is this: are you suggesting that we should offer an abortion to a woman who might be seriously psychotic, who might be severely depressed or who might be suicidal in a crisis reaction, when perhaps her judgment is impaired just for that period? What we are saying is that we should treat the woman, and when her judgment is more robust, then she will be able to make that decision - not when she is acutely suicidal.

Senator Hayden asked whether I can guarantee that any woman who is suicidal can be cured. We aim to cure all our patients, but the problem with suicide is that there could be an impulsive thought that comes into the patient's mind or there could be outside circumstances that we do not know about. The tragedy of a completed suicide must be assessed completely. The most important thing is whether the person got a full and proper assessment and proper treatment, whether he or she was complying with the treatment and whether we were managing him or her as closely as possible. We can never guarantee that a person will be completely cured. We would hope to.