Fidelma Healy Eames (Fine Gael) | Oireachtas source

I move amendment No. 30:

In page 10, between lines 3 and 4, to insert the following:"9. (1) Any pregnant woman who presents as suicidal at her general practitioner or at an accident and emergency department shall be entitled to a Care Pathway which shall comprise the following steps--

(a) a full psychiatric assessment and an assessment of capacity within two hours of presenting at her general practitioner or at an accident or emergency department,
(b) a suicide prevention algorithm shall be formulated by the psychiatrist to assess the need for hospital admission, day hospital care or care at home as appropriate,
(c) a full psycho-social assessment of her needs shall take place within 24 hours of presenting at her general practitioner or at an accident or emergency department,
(d) an integrated multi-disciplinary care plan for the woman will be formulated between the psychiatrist, an obstetrician (if she is already under the care of an
obstetrician), her general practitioner, a social worker, and her family,
(e) if the woman is still expressing suicidal ideation, she shall be entitled to focused therapy which, based on the evidence, should include dialectical behaviour
therapy, in her home if necessary,
(f) day hospital care, and/or pharmacological treatments will be concurrently made available within 24 hours of the request for same, depending on need,
(g) the psychiatrist shall evaluate the woman twice weekly during the crisis stage of her treatment and thereafter depending on the consideration of the psychiatrist and the perspective of the woman and her family, based on clinical need,
(h) thereafter the woman's interdisciplinary care team will meet at least once in every 14 days to assess her progress.".

Section 9 is the crucial section, as everybody has said. It concerns the risk of loss of life through suicide. I want to correct matters because I may have been misunderstood earlier in respect of the way I presented my points. We wandered into the section on suicide by accident and came out of it. What I am saying here is that everyone agrees, and psychiatrists have clearly put it on the record, that they are really good at assessing pregnant women at risk of suicide but that they are really poor at predicting suicide. In fact, up to 15% of women express suicidal feelings but may not go on to take their lives. Psychiatrists have been very clear that while they are skilled at identifying patients at high risk of suicide, even in the high-risk group, they are likely to predict incorrectly 97 times out of 100.

As there is no reliable body of evidence that access to abortion reduces suicide rates or improves women's mental health, it is not possible to develop clinical practice guidelines based on medical evidence to clarify where it is justifiable to certify a woman as eligible for abortion. The Oireachtas was informed that none of the three consultant perinatal psychiatrists in Ireland, in their collective experience of 40 years, had seen a woman for whom termination of pregnancy was the only suitable treatment. In the context of this, 113 psychiatrists produced a statement explaining and outlining their huge difficulty with the notion that abortion was a suitable treatment for suicidal feelings or intent. That is where this care pathway is coming from.

Before I look at the exact wording of the care pathway, I would like to share with the House an e-mail I received from a young woman only two days ago. She asked me to share this story with the House because she had an abortion for mental health reasons.

Here are her words:

I remember going into the theatre hoping that the [doctor] would ask me would I like to change my mind but he never did. Straight afterwards, not only was the life and soul of my child suctioned out of me but a crucial part of me had died as well.

I felt it [deeply]. It was a feeling that I could not shake off and hence I used prescription medications daily and weekend binge drinking to numb and block out the horror of killing my baby. I desperately tried to forget what I did and tried to convince myself that it was the best decision. I slowly [turned] from being a caring nurse into an impatient and sometimes cold and cynical nurse. I became withdrawn and depressed and at times I entertained suicidal thoughts after the abortion as this brought hope to me, because my life was not worth living, I was just existing. I worked extremely hard maybe 60 to 70 hours a week, a lot of night shifts. This has been the worst decision of my life.

I implore of you and your colleagues to appreciate your privileged position to be aware that your elected post has not been by chance and that you are in this role at this time and that the fate of the unborn is now in your hands and you are in a position of power to choose life or death.

This young woman clearly states the critical role of the doctor, who at that moment might have been able to change her mind. She is also explaining that she is under incredible pressure. This is why this care pathway is so critical. I know many people have much to say on this.

Amendment No. 30 states:

In page 10, between lines 3 and 4, to insert the following:

"9. (1) Any pregnant woman who presents as suicidal at her general practitioner or at an accident and emergency department shall be entitled to a Care Pathway which shall comprise the following steps--
(a) a full psychiatric assessment and an assessment of capacity within two hours of presenting at her general practitioner or at an accident or emergency department,
(b) a suicide prevention algorithm shall be formulated by the psychiatrist to assess the need for hospital admission, day hospital care or care at home as appropriate,
(c) a full psycho-social assessment of her needs shall take place within 24 hours of presenting at her general practitioner or at an accident or emergency department,
(d) an integrated multi-disciplinary care plan for the woman will be formulated between the psychiatrist, an obstetrician (if she is already under the care of an obstetrician), her general practitioner, a social worker, and her family,
(e) if the woman is still expressing suicidal ideation, she shall be entitled to focused therapy which, based on the evidence, should include dialectical behaviour therapy, in her home if necessary,
(f) day hospital care, and/or pharmacological treatments will be concurrently made available within 24 hours of the request for same, depending on need,
(g) the psychiatrist shall evaluate the woman twice weekly during the crisis stage of her treatment and thereafter depending on the consideration of the psychiatrist and the perspective of the woman and her family, based on clinical need,
(h) thereafter the woman's interdisciplinary care team will meet at least once in every 14 days to assess her progress."

The underlying intention here is to provide care for someone who is expressing suicidal feelings in pregnancy and is carrying another life. There is a great intention here of the very best care for mother and child. The psychiatrists who have proposed this have requested that this would be designed by the college of psychiatry. How could we wish against this? It is wholesome, holistic and caring. It proposes to give life every chance and mind the woman whose life may be at risk. I ask the Minister of State to strongly consider accepting the amendment on the basis of the previous testimony I have presented from just one young woman who had to have an abortion.