Wednesday 24 August 2016

Doctors are being asked to play God without getting proper training

Eilis O'Regan

Published 19/08/2014 | 02:30

Are doctors playing God if they refuse a pregnant and suicidal woman an abortion because the baby she is carrying is within two weeks of standing a better chance of survival?

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It's a question that has put the spotlight back on the role doctors can play in determining life and death.

The woman at the centre of the abortion controversy was around 22 weeks pregnant when seen by the three-doctor team, with two psychiatrists deeming her suicidal

But the obstetrician decided the baby could be delivered rather than aborted. By the time the baby was born two weeks later, against the woman's initial resistance and ongoing distress, the chances of the boy being born alive increased and the risk of disabilities reduced. Every additional week of pregnancy at that point was crucial.

Doctors make medical and moral decisions every day, often based on instinct rather than vague guidelines. Often the doctor is driven by their own values. But who would want to face the dilemma which these three doctors were confronted with?.

This is the first case we know of where a woman sought an abortion on grounds of suicide under the Protection of Life During Pregnancy law.

Yet despite it being passed last summer and coming into force in January, guidelines on its implementation have yet to be widely circulated to medics.

It took months to draw them up in draft form and "officially " they have still not been finalised although they are widely available. The doctors would have had access to this advice but the delay in issuing the direction on this very grey area is difficult to defend.

It has meant the representative bodies for psychiatrists and obstetricians, the College of Psychiatrists and the Institute of Obstetricians and Gynaecologists, have been unable to provide the necessary training for doctors on implementation of the law.

The College of Psychiatrists said yesterday that once the guidelines are issued, the training programme will begin. This should help fine-tune the understanding of doctors who are making decisions on abortion, where there is risk of suicide, for the first time.

The Health Service Executive (HSE) asked for expressions of interest months ago from specialists interested in being part of a panel of doctors it could draw on to sit on three-person committees.

The HSE has refused to say how many have signed up, insisting membership is on a "confidential basis".

A spokeswoman said it had "sufficient numbers" on the panel. But is there a need for such secrecy? The doctors are accepted on the basis of their credentials but no question is asked of them on where they stand on the broad so called pro-choice and pro-life divide.

A woman who appears before them must wonder how their decisions are influenced by their own personal opinions.

Some would argue that even keeping a veil over who is on the panel only serves to generate more unease among the public, although there are also good arguments for not making them public.

Others will find it difficult to understand why they should be paid for this work.

While doctors working in the public system will receive no payment, unless they have to sit on a committee outside of normal hours this will not apply to the private consultants who have signed up.

They are to be paid €120 an hour, up to a maximum of €415 a day. If a GP is called on to attend they are to be given an hourly rate of €60, subject to a maximum of €197.24 a week.

Their unions argued this was not pro bono work and pointed to the time away from their practice the committee work could involve.

Inevitably, this case has been highly emotive. And there is no point in making knee-jerk decisions at a time of such furore.

But the Department of Health and the HSE need to learn lessons in deciding just how much information should be given to the public about its operation, while observing the confidentiality of the woman involved.

It is also not fair to plunge doctors into these life and death judgments without equipping them with the clearest of guidelines and training.

Irish Independent

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