Pregnant women in Ireland could be blocked from having an abortion even if they are at risk of suicide after conceiving as a result of rape or incest, under new guidelines issued to Irish doctors.
Experts said that the Guidance Document for Health Professionals which has yet to be made public, but has been obtained by the Guardian, will give power to anti-abortion doctors, obstetricians and psychiatrists to prevent vulnerable women from terminating their pregnancies.
Pro-choice clinicians, including one of the Irish Republic’s leading psychiatrists, said the rules would leave women “at the mercy of a local, moral and political lottery.”
Veronica O’Keane, a professor of psychiatry at Trinity College Dublin, said a woman could potentially have to see up to seven medical experts before getting a decision on her right to an abortion.
The UN Human Rights Committee, which has also been shown the document, has described the guidance on dealing with women contemplating suicide as “an excessive degree of scrutiny by medical professionals.”
The guidelines were drawn up after the Irish government introduced legislation last year to allow for abortion in extremely limited circumstances. The law followed the death of Savita Halappanavar, 31, who was denied an emergency termination that could have saved her life.
Pro-choice campaigners are concerned that conservative attitudes among health professionals will put more women’s lives at risk. More than 100 Irish psychiatrists — nearly one in three in the country — signed a statement last year opposing any kind of abortion reform, including those cases of women at risk of suicide.
The 108-page guide does not include provisions for a national independent medical committee to make decisions on treating those with “suicidal intent,” which was a key demand among campaigners for reform. They argue that an independent committee would be more objective than local medics and allow women more privacy.
Pro-choice doctors are also concerned that the language in the first few pages of the guidelines is more stridently anti-abortion than last year’s law.
PSYCHIATRISTS
In its introduction, the document states that “the purpose of this act is to restate the general prohibition on abortion in Ireland.” Medical professionals are also advised on the first page that the act provides “a clear criminal prohibition on abortion.”
On page 10, a diagram explaining the procedure for applying for a termination makes clear to Irish doctors that the initial referral for women including those with “suicidal intent” begins with her own doctor.
If the doctor agrees, he or she will refer the woman to three doctors — including one obstetrician and two psychiatrists — who will decide whether there is a real risk to the woman’s life through suicide. If her request is rejected, she will go through an appeal system involving another two psychiatrists and another obstetrician.
The guidance states that the first psychiatrist to assess the woman has the right to “seek a second psychiatric assessment” or appoint a psychiatrist of their own choice. Critics say this will allow anti-abortion psychiatrists to recommend a colleague sharing the same views.
It advises that any of three medical experts, including an obstetrician, can assess a woman with suicidal intent and certify whether or not the woman should be allowed an abortion, although obstetricians have no mental health training.
EXAMINATIONS
O’Keane, a consultant psychiatrist for more than 21 years, said because there was no national body to rule on these cases vulnerable women “could come up against anti-choice physicians who in effect become conscientious obstructors to abortion.”
“The repeated examination of a woman’s mental state by at least four doctors, and possibly seven, and the repeated questioning specifically about suicidal ideation and intent, will not only be overly invasive, confusing and emotionally distressing, it will also be time-consuming in a period of crisis when a suicidal woman needs access to a termination as soon as possible,” she added.
O’Keane called the guidelines “completely inappropriate.”
“I would have preferred a national review panel to make these decisions because Ireland is a small country,” she said.
“It would have been better in terms of privacy and access to mental health professionals who are committed to enacting the spirit of the legislation. We have a very strong anti-choice lobby in psychiatry and there should have been procedures put in place to allow women to bypass them and their moral, political, theocratic obstacles,” she added.
O’Keane said that the section entitled “Risk to life from Suicidal Intent” means pregnant women have to state explicitly that they are going to kill themselves before being considered for a termination.
“This is very bad practice because if psychiatrists are practising within these guidelines then that will be the stipulation, that the woman in question must state that. Yet in the majority of cases of suicide that psychiatrists deal with there is no stated intention of killing themselves,” O’Keane said.
“The terms of reference are too narrow and dangerous, and we in Ireland have very high rates of suicide and even a government drive to reduce suicide numbers. In these guidelines, what we are actually doing is saying to Irish women, ‘You have to actually tell us that you’re going to kill yourself or you won’t get that abortion.’ It is completely contrary to good psychiatric practice,” she added.
A spokesman for the Department of Health in Dublin said that the guidelines were not yet finalized and have to be ratified by the new Irish Minister for Health Leo Vradkar. He said that the publication of the guidance was “fairly imminent” once it was signed off by the minister.
“It would not be appropriate to make any further comment on this at this juncture,” he said.
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