To suggest that we are second guessing psychiatrists or questioning their judgment is erroneous. That is not the motivation behind it. There is a difference between the diagnosis of physical and medical issues, as psychiatry and psychiatrists have acknowledged. I acknowledge we can cite different texts as different people made different submissions. In the report Dr. Anthony Clare said:
I would say that the only reason that I am here, I think, and that you will find psychiatrists involved in this, is, in a way, because, I suppose we have been drawn in to try and get people off the hook over this issue of a danger to the health and life of a woman who is pregnant and wishes to terminate the pregnancy, so who better than to get the psychiatrist to tell you that if this is refused, this woman will kill herself. Well, no such statement can be made with any great safety, whether the person making it is a psychologist, psychiatrist or a general practitioner.
Dr. John Sheehan, consultant in perinatal psychiatry at the Rotunda Hospital, said that suicide is what he and his colleagues call "multi-factorial". It is not related to a single factor, but to multiple factors, including the presence of psychiatric illness. It can be related to depression, psychosis or alcohol problems coupled to with absence of social supports, socio-economic class or marital status. There is no test or fail-safe way to indicate if a person will or will not commit suicide. Dr. Sheehan also indicated that the medical response to a pregnant woman considered to be at risk of committing suicide is to help and support her while treating her underlying mental condition. Professor John Bonnar, chairman of the Institute of Obstetricians and Gynaecologists, told the Oireachtas All-Party Committee on the Constitution that prior to the introduction of the UK's abortion Act, risk of suicide was grounds for termination and that large numbers of patients used to have terminations on psychiatric grounds linked to risk of suicide. Those cases suddenly disappeared when the abortion Act came in.
The problem with risk of suicide and psychiatric indications is that they are clearly different from the physical problems we have been discussing, such as pre-eclampsia, ectopic pregnancy and cancer of the cervix. In practice the psychiatric indications become exceedingly elastic. Legislation to control that has usually been unsuccessful and has been used to achieve abortion. Those are the kinds of submissions that were made and there were others. The Master of the Rotunda, Dr. Peter McKenna, took the different view that one cannot ever rule out the possibility of suicide. Dr. Sean Daly, Master of the Coombe, said he had never come across a case where a risk of suicide was posed. The Psychological Society of Ireland, which is in favour of freedom of information, argued that one can identify a risk of suicide, but psychiatrists say there is no test to do so. A key point is that it is very unlikely a psychiatrist would recommend abortion as a treatment for a suicidal woman.