It might shock, or surprise, some of my international readers to know that abortion is still illegal in Ireland- and there is a right-wing Christian conservative element in Irish society that wishes to keep it that way- forever.
Thousands of Irish women leave Irish shores for the UK each year in order to have an abortion- a right they are denied in their own country.
The abortion debate has been re-ignited in recent times in Ireland, mainly because of the death of savita halappanavar. Savita was denied an abortion in Ireland even though there was a threat to her life. Because of her death the abortion debate has been thrust back into the Irish political and socio-cultural arena, with many opinions about abortion bandied about in the media- and elsewhere- throughout Ireland for the past few months.
In the Irish abortion debate- as in most countries- there are effectively two camps of divided opinions- the ‘pro-life’ side and the ‘pro choice’ side. But what makes this debate in Ireland particularly interesting has been the involvement of psychiatrists in the debate. I personally think it should be a woman’s right to choose, no matter what the circumstances, but for the purpose of this post I would like to concentrate mainly on the abortion and suicide issues– as I think as you will see- the raising of this controversial taboo has also flagged massive holes in the logic, legitimacy and credibility of Irish psychiatry in general- not just in relation to abortion and the threat of suicide because of it- but also in relation to the entire practice of Psychiatry in Ireland as a whole.
Current legislation is now being drafted in Ireland in order to address the blatant incongruities in Irish abortion laws. One of the controversial elements of this legislation includes a risk assessment of a hypothetical suicidal pregnant woman by psychiatrists. In Ireland- as it stands- there is a so called ‘equal right to life of both mother and fetus’. But there is also a stipulation that in cases where there is a substantial threat to the life of the mother- an abortion can be performed.This is where the threat of suicide comes in- as suicide is surely a valid threat to the life of the mother? Not so – it seems- according to some Irish psychiatrists.
David Quinn, director of the Iona Institute, a religious advocacy group which opposes abortion, said the organisation was “very concerned” at what was contained in the heads of the Bill, particularly in relation to the provision on suicide which he said, if implemented, would see Irish law “crossing a moral Rubicon”.
“The suicide provision is the most worrying provision in it because, if and when this becomes law, for the first time in Ireland, it will provide for the direct killing of an unborn child where there is an alternative treatment,” he said.
Mr Quinn reiterated the organisation’s contention that suicide was not a cure for suicidal ideation, a viewpoint which he said had been supported by 113 Irish psychiatrists who last week signed a statement indicating their opposition to suicidality as grounds for an abortion.
He said the organisation would also be reviewing the part of the Bill which deals with conscientious objection as to what implications this had for Catholic hospitals.
Anti-abortion organisation the Life Institute accused Fine Gael of “caving in” to Labour on abortion. Spokeswoman Niamh Uí Bhriain said the smaller Coalition party represented “less than 10 per cent of the people now, according to polls, yet they are deciding for the whole country on this issue of life and death”.
She said the Government “had ignored all the medical evidence that confirmed abortion was not a treatment for suicide”.
“This Government asked medical experts to give evidence on this issue, and the evidence they heard demolished the case for legalising abortion on suicide grounds, but now they have roundly ignored the evidence and moved to allow unborn children to be deliberately killed for the first time in Ireland.”
Although pro-choice groups welcomed the publishing of the heads of the Bill, they also expressed concern at some of the elements therein.
The Abortion Rights Campaign welcomed the publication as a step toward securing access to safe and legal abortion in Ireland but added that it was “deeply disappointed” by several sections of the draft legislation.
Spokeswoman Cathie Doherty said the campaign was “extremely alarmed” by the inclusion of the assessment of three doctors for termination when a woman is at risk of suicide.
“Requiring three doctors to assess a suicidal pregnant woman is outrageous. This legislation will be redundant if the women affected will continue to travel to England rather than face interrogation by multiple doctors,” she said.
The organisation also labelled a possible penalty of 14 years in prison for illegal abortion in Ireland as “nothing short of barbaric”.
“To threaten women facing this difficult decision with imprisonment is not only wrong in and of itself, but it may prevent women from disclosing information about previous abortion to their doctors, or seeking medical care in the event of complications from illegal abortion,” said another spokeswoman, Sarah Malone.
Sinead Kennedy of Action on X said the organisation was “very disappointed” by elements of the Bill, particularly around suicidal ideation. She criticised the requirement for a suicidal woman or girl to receive the unanimous consent of three medical practitioners before an abortion could take place in these circumstances, describing it as a “callous disregard for women’s lives”.
Ms Kennedy also criticised the Bill for distinguishing between medical and psychiatric emergencies. “Psychiatric emergencies are medical emergencies and any psychiatrist will tell you that,” she said.
Now if you notice the play on words here, by David Quinn of the ultra-conservative Catholic Iona institute- he is claiming- with the apparent backing of 113 Irish psychiatrists – that ‘abortion is not a treatment for suicide’. Whoever said that it was? It is the threat to the woman’s life by suicide that is the issue. Nobody- apart from right-wing Christian fundamentalists- has alluded to abortion being a treatment for mental illness or suicidality but completed suicide and suicidality may indeed be the result of the trauma of an unwanted pregnancy. It seems that the ‘pro-life’ brigade are not so much ‘pro-life’ but merely anti-abortion in all circumstances- even if that means that a woman would take her own life because she cannot get access to an abortion procedure.
Psychiatrists in Ireland have been telling us for decades that suicidal thoughts should be taken with the utmost seriousness, that they are a sign of mental illness, clinical depression etc, and that psychiatric intervention should be sought immediately – because – they told us- suicide is life threatening and they tell us- depression itself is life threatening because of the risk of suicide.
Yet- 113 Irish psychiatrists have basically just come out and said that suicidality should not be taken seriously if that suicidal individual happens to be a pregnant woman- and suicidality- according to Irish psychiatry – should be viewed with suspicion, contempt and skepticism when that pregnant woman is also seeking an abortion because of it. In other words- they know that they can’t assess whether someone is really suicidal or not.
For decades psychiatrists have been telling us that they are the experts on suicidality but now they seem to saying that they can’t predict suicide. If – as they now admit- they cannot predict suicide, can they be trusted to diagnose ‘mental illness’ at all?
This undermines the credibility of the entire practice of psychiatry because it is their so called ‘expertise’ in matters of suicidality, in particular suicidality and its relation to mental illness -which are exposed under the spotlight by this debate. Their expertise in matters of mental distress are revealed to be –not so expert -after all.
Do you see the gaping holes in the logic here?
On the one hand Irish psychiatry have been saying for years that depression is a life threatening illness solely because of the risk of suicide inherent with depression. But on the other- they are now saying that up to three doctors have to assess the ‘suicide risk’ of a pregnant woman before she is effectively deemed authentically suicidal enough to have an abortion. Or at least convincing enough to warrant an abortion in order to protect her life.
This is not about ‘abortion as a treatment’ for suicidal pregnant women- it’s the so called ‘pro-life’ brigade who have inserted this baseless mantra into Irish media discourse- this is about Irish psychiatrists caught up in their own religious views clouding reality- it is also about psychiatry in Ireland being unwilling and blatantly ill-equipped for the position which for so long they have claimed legitimacy over: the treatment of suicidality.
You can’t have it both ways.
Take for instance, the vociferous ‘pro-life’ opinion of Dr Patricia Casey, a member of the Iona Institute Catholic think-tank. Casey is a controversial Irish psychiatrist for many reasons which I won’t cover here but in the context of suicidality she says :
In practice, the risk of suicide, even in high-risk groups such as those with serious mental illness, is very low. And among pregnant women the risk of dying by suicide is lowest of all.
Casey states here that ‘the risk of suicide even in high risk groups such as those with serious mental illness is very low.’
That statement is completely at odds with what psychiatrists have been telling us for years- in particular in relation to the risk of suicide in depressed people. So all of a sudden- suicidality in serious mental illness is not really that much of a big deal?
She also says that the risk of dying by suicide is lowest of all in pregnant women. While this might be true- just because it’s a low risk- doesn’t mean it is zero risk. So effectively, Casey and her cohorts admit there is a risk – albeit low. Therefore what Irish psychiatry are really implying is- Irish women seeking abortions will lie about their suicidal states in order to get one and Irish psychiatrists don’t want to be involved in assessing or facilitating this process. Is this not insulting – not only to all women in Ireland? but does it not also demean the seriousness of suicidality itself? And furthermore does it not indicate the blatant hypocrisy of the Irish psychiatric profession, which for decades has claimed to be the only authority on ‘mental illness’, ‘suicide’, ‘depression’ etc?
Irish psychiatry have shot themselves in the foot once again. Abortion is a secular and civic debate, it is a human rights and personal rights issue. It is one of personal individual autonomy. Moral and religious persuasions should not influence professional and scientific opinions.
So hypothetically – if we be the devil’s advocate here- and take Irish psychiatry’s oxymoronic opinion that ‘abortion is not a treatment for suicidality’ then what do they suggest a distressed and pregnant Irish woman do if she is feeling suicidal? Presumably they will try to offer her psychiatric treatment? If so- what psychiatric treatment is available to a suicidal pregnant woman in Ireland. Well- according to Dr Moosajee Bhamjee– there is little or no ‘talk-therapy’ available in Ireland and the waiting lists for psychotherapy can be month’s long. Therefore- I presume that the ‘treatment’ available to a depressed and suicidal pregnant woman in Ireland would predominantly be SSRI drugs?
SSRI drugs are known to cause birth defects, they can also be addictive and cause severe side effects- which includes suicidal ideation, aggression, etc.
Is this really an adequate treatment for a woman who is already depressed, anxious, suicidal and traumatized by an unwanted pregnancy? Or will the panel of psychiatrists who are called upon to assess whether she is adequately suicidal enough, or at least convincingly suicidal enough -permit her to have a medical procedure which might save her life? Or faced with a draconian style inquisition of skeptical and intimidating psychiatrists- will, emotionally fragile and distressed, pregnant Irish women continue (as they have done for decades) to seek proper medical care elsewhere?
Only time will tell..
Personally I think Ireland needs to propel itself pronto into the 21st century.
The Catholic church has had a strangle-hold upon the monopoly of morals, how people live, their sexual persuasion, what they should believe, their marriage rights and their education for far too long.
Irish psychiatry has also had unquestionable authority upon the ‘mental and emotional’ health of Irish citizens for far to long too…
Despite the fact that both are utterly corrupt- and in the case of Irish Psychiatry – utterly devoid of compassion, logic and reason…
Ironically- the Irish psychiatrist Dr Veronica O’Keane seems to be the only one who sees sense.
Although I am not a fan of her opinion on SSRI drugs- but when it comes to abortion and suicide -at least someone in Irish psychiatry seems to possess an iota of humanity and logic:
Professor of Psychiatry at Trinity College Dublin Veronica O’Keane has said psychiatrists are legitimately deemed best placed to assess suicide risk and if there was a mental illness in a woman it would be their role to treat that illness.
Speaking on RTÉ’s Today with Pat Kenny, Dr O’Keane said if there was the presence of mental illness it sometimes would make a doctor less likely to recommend an abortion.
She said situations are different, and she thought it was much easier to make a decision in the absence of mental illness.
“I think this legislation is primarily for women who are suicidal because they have an unwanted pregnancy and that is the only way of resolving their suicidal problems – is to have a termination,” she said.
Responding after the programme, Psychiatrist Prof Patricia Casey said that the legislation will allow for abortion in the case of women without mental illness, who simply do not wish to give birth to an unwanted baby.
Prof O’Keane also described as “an absolute farce” a survey by a “pro-life” group that claimed 120 psychiatrists who responded did not agree with proposed legislation to legislate for the X Case based on the suicide provision.
Prof Keane said it was a survey conducted by a statedly-biased group and it was done without the permission of the College of Psychiatry Ireland.
She said that those conducting the survey had not gone through the college’s procedures and the survey would not have passed through the college’s guidelines.
She said the survey did not represent psychiatrists.
Describing the survey as it stood as “incomprehensible, and garbled”, she said it did not make any sense.
Prof Casey threatened to leave the studio if she could not respond.
Prof Casey said that the reason they did not do the survey through the college was because they could not get the names of the college membership, in relation to a previous study.
So, she said, when this study was happening she said that “they could not get the numbers from them”.
In a statement following the programme, Prof Casey said: “This was not a College of Psychiatry survey, nor did it purport to be. It was a letter that was sent, asking consultant psychiatry colleagues if they agreed with a particular statement, relating to the involvement of psychiatrists in relation to the current abortion proposals.
“The issue of obtaining permission from the college does not apply. We received a 42% response rate, and it cannot be reasonably argued, by Prof O’Keane, that it was incomprehensive. The overwhelming majority agreed with the statement.
“The question of peer review does not arise.”
For an interesting insight into the hypocrisies of the abortion/suicide debate – check out the podcast from RTE’s Pat Kenny here: