Tuesday 28 February 2017

Live: Psychiatrist warn of unnecessary terminations

Lyndsey Telford and Eilish O'Regan

PSYCHIATRISTS have no way of accurately predicting whether a distressed pregnant woman will kill herself, a leading expert has warned.

John Sheehan, a perinatal psychiatrist at the Rotunda Hospital in Dublin, suggested changes to Ireland's strict abortion laws could therefore lead to unnecessary terminations.

"In practice, it would be impossible for any psychiatrist to accurately predict which woman will die by suicide in pregnancy," Dr Sheehan said.

"Being unable to predict who will die by suicide is likely to lead to multiple 'false positives'. As psychiatrists, we are trained to assess and treat, not to predict the future."

Dr Sheehan was among a string of psychiatrists to give evidence on the proposed legislation which, if enacted, will legalise abortion if there is a real and substantial risk to the life of the mother, including the threat of suicide.

As the second day of public hearings on the Protection of Life during Pregnancy Bill 2013 got under way, Dr Sheehan warned the legislation would have "major implications" for psychiatrists.

A panel of two psychiatrists and an obstetrician/gynaecologist will be required to determine whether a pregnant woman with suicidal ideation is at real risk of killing herself to find grounds for an abortion under the proposed changes to the law.

The bill aims to legislate for the 1992 X case judgment from Ireland's Supreme Court , which found abortion is legal if there is a real and substantial risk to the life of the mother, including the threat of suicide.

The case was taken by a 14-year-old rape victim who became pregnant and was refused permission to travel for an abortion.

The loosening of the rules is also intended to meet requirements from a European court decision that found a woman in remission from cancer should not have been forced to travel oversees for a termination.

Meanwhile, a Dublin psychiatrist said the assessment of a suicidal pregnant woman who is seeking an abortion will not be a "tick box" exercise.

Dr Joanne Fenton, a perinatal psychiatrist at the Coombe Hospital in Dublin said she did not believe that "termination of pregnancy is a treatment for mental illness".

But she conceded she could not say there "will never be a case where a woman is in such as state of distress and turmoil" that termination will be the only a life saving option.

Dr Fenton suggested the proposed legislation is very restrictive and many  women will still travel abroad for abortions.

She agreed that two pychiatrists should assess a woman and be in agreement their decision.

But the doctors should not see the woman at the same time.

She called for the change in the proposal to allow seven days for the initial asessment to take place and another seven days for an appeal.

This is too long and could lead to a woman deteriorating.

Dr Anthony McCarthy, perinatal psychiatrist in the National Maternity Hospital, told the committee that suicide in pregnancy is real.

"It does happen. Two lives are lost."

He added: "This is about saving women's lives."

Elsewhere, another leading psychiatrist has claimed that only one psychiatrist should assess the suicidal risk of a patient.

 

Veronica O'Keane, professor in psychiatry at Trinity College Dublin, said the service available to a woman with suicidal ideation should be "accessible and efficient".

 

"I think that a national panel of those prepared to lawfully engage with this process should be established and an efficient executive put in place to administer requests for termination of pregnancy," she said.

 

"The GP should make the recommendation for an abortion and one psychiatrist assess the suicidal risk."

 

The legislation as currently drafted requires two psychiatrists and an obstetrician/gynaecologist to assess a pregnant woman in distress.

 

Prof O'Keane, who is also a consultant psychiatrist at Tallaght Hospital, added that women had been referred to in an "obstructive" way throughout the abortion debate to date.

 

She said it was regrettable that they have often been portrayed as "passive, unreliable and sometimes manipulative".

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