The College of Psychiatrists has advised its members not to participate
in review panels, provided for under new abortion legislation to assess
pregnant women expressing suicidal thoughts, until clinical guidelines are in place.
The
professional body for psychiatrists in Ireland described the enactment
of the Protection of Life During Pregnancy Act without clinical
guidelines as “very haphazard and unsatisfactory”.
It
is also expressing “extreme concern” at the absence of any guidance
for GPs on accessing suitable psychiatrists to assess a pregnant woman
showing signs of suicidality; at the absence of guidelines for a
psychiatrist seeking a second psychiatric opinion; and the lack of
training for obstetricians in up-to-date psychiatric issues as well as
for psychiatrists in obstetric issues.
The Protection of Life During Pregnancy Act
came into force on January 1st. It sets out for the first time the
circumstances where abortion can be carried out – where there is a “real
and substantial” risk to the life of the pregnant woman, including by
suicide.
A “Guidelines on Implementation Committee” was appointed last year by the Department of Health
to draw up clinical guidelines on how the legislation would work in
practice.
It includes representatives from the department, the HSE, the
Institute of Obstetricians and Gynaecologists, the College of
Psychiatrists, the Royal College of Surgeons, the Royal College of
Physicians as well as experts in cardiology and oncology.
It has yet to
report.
Suicidal thoughts
Suicidal thoughts
According to the Act, a pregnant woman who is expressing suicidal thoughts and seeking an abortion may have one if three medical practitioners, including two psychiatrists, have “jointly certified in good faith” that there is a real and substantial risk to her life by suicide which can only be averted by an abortion.
It also provides for a
review panel, to be “established and maintained” by the HSE “of at least
10 medical practitioners”, and says the HSE must request medical
bodies, including the College of Psychiatrists, to nominate members to
be appointed to it.
Guidelines
Guidelines
Chief executive of the college Miriam Silke told The Irish Times that until the guidelines were issued the college would not recommend to its members participation in the panel.
“We
simply do not know when they will be issued. We have not heard anything
since the Bill came into law. I presume work is progressing but they
aren’t imminent. It is very haphazard and unsatisfactory.”
Dr Anthony McCarthy, perinatal psychiatrist at the National Maternity Hospital
and former president of the college, said the new legislation failed to
provide “real solutions” for women in distress.
A pregnant woman
expressing suicidal thoughts would be seen by a psychiatrist, he said,
but if that psychiatrist wanted to get a second opinion it was unclear
how this would be obtained.
He said there should
be a process whereby a GP in a particular area could “by-pass” the local
HSE psychiatrist if they were concerned about that psychiatrist’s
ideological stance on abortion.
“There is no
clarity. What is the point of having a committee to draw up guidelines
if the Act can be implemented without guidelines? It is completely
unsatisfactory,”he said.
A spokeswoman for the
Department of Health said: “The guidance document to assist health
professionals in the implementation of the Act is at an advanced stage
and it is expected to be signed off early this year.”
A statement from the HSE said: “A review panel has been established and comprises all of the relevant clinical specialities.”