Friday 23 March 2018

'Suicide risk hasn't opened the floodgates'

Master of Rotunda: Fears over surge of terminations wrong

Outgoing Master of the Rotunda Sam Coulter-Smith: ‘I overestimated that people would use the mental health clause.’ Photo: Steve Humphreys
Outgoing Master of the Rotunda Sam Coulter-Smith: ‘I overestimated that people would use the mental health clause.’ Photo: Steve Humphreys

Eilish O’Regan

The law allowing for ­termination of pregnancy where a ­woman is at risk of ­suicide has not "opened the floodgates" ­despite ­predictions, the Master of the Rotunda ­Hospital, Dr Sam ­Coulter-Smith, has revealed.

Dr Coulter-Smith said he was among those who feared the inclusion of suicide risk in the Protection of Life During ­Pregnancy Act would lead to a rise in requests for ­terminations.

"I over-estimated that people would use the mental health clause," said Dr Coulter-Smith in wide-ranging interview ­before stepping down as Master of the Rotunda in December.

In the first year of its ­operation, his hospital has seen no change in the number of pregnancies which needed to be ended to save the life of the mother where she was at risk.

While he declined to give the reasons for terminations, he said there were somewhere between four and eight over the course of a year, a number broadly in line with figures before the legislation.

The law, which was passed in July 2013, allows for a ­termination where a woman's life is at risk due to ­physical complications or threat of ­suicide.

Nationally, 26 pregnancies were terminated in 2014. Of those, 23 were ended due to the risk to the life of the mother from physical illness, with nine of these done in an emergency.

Three pregnancies were ­terminated as the pregnant ­woman was at risk of suicide.

Dr Coulter-Smith said he was glad to see the term 'abortion' was not used in the legislation.

"Where a mother's life is at risk and pregnancy ­is ­terminated, to use the term ­'abortion' is not correct," he said.

"There are appropriate ­guidelines to assist and they are mostly pretty clear," he continued.

"The whole area of risk of suicide is still difficult and ­controversial. There is no ­universal agreement among all psychiatrists. That is still be ­difficult one. The ­floodgates have not opened in that ­particular area.

"There is still an issue around gestational age. The law does not mention gestational age.

"That can create a challenge - not in an emergency situation where a woman is going to die or where she becomes unwell due to some other complication. But if there is a situation where someone at risk due to suicidal ideation - if she is 24 weeks pregnant, what do you do in that situation?

"If you are going to ­terminate that pregnancy you can't ­intentionally destroy the life of the child. Is it right to deliver a 24-week-old baby because someone has suicidal ideation? The baby could die or survive or have serious issues like cerebral palsy.

Who is responsible for that child? They are complex issues and the legislation does not help that situation."

Asked about the repeal of the 8th Amendment, Dr ­Coulter-Smith said as an ­obstetrician he would like to be able to offer support to a ­pregnant woman who is ­carrying a baby with a fatal foetal abnormality.

"We would like to be in a ­situation to provide care for women regardless of ­circumstances - if a woman is carrying a baby that has a life-limiting foetal abnormality and she chooses termination and we can support and mind her and not make her travel abroad," he continued.

"By the same token if she ­carried on with the pregnancy we need to provide a standard of care and have the appropriate infrastructure to do that.

"It is really about being able to provide the care and ­attention people require ­regardless of their choices.

"I would like legislation that covers all varieties of ­scenarios that happen - both carry on with the pregnancy, or ­termination after appropriate counselling. It is a woman's decision."

He said: "Quite a number of women choose not to carry on with the pregnancy. They don't hit the 12-week gestation which is the time we would normally book them. They don't come to us. They go to the UK and have terminations in the UK."

He believes the area of embryo selection where couples will choose one that does not carry inherited disease will become more prevalent in the future.

This will also have implications for gender selection, he added.

Irish Independent

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