Draft Irish Abortion Law: Protection of Conscience
Testimony before the Joint Committee on Health and Children
Houses of the Oireachtas (Tithe an Oireachtais)
In response to criticism following the death of
Savita Halappanavar the Irish government
has published an early draft of the proposed abortion law, the
Protection of Life During Pregnancy Bill 2013. It is
technically called a draft "heads of bill." Each "head"
corresponds to what is likely to become a section of the final bill, but
the wording and content of each head have not been settled.
three days in May, 2013, a committee composed of Oireachtas deputies and senators heard evidence
from a number of expert witnesses concerning the proposal. What
follows are extracts of their testimony broadly relevant to the
protection of conscience provision in the draft. Links to the
pages from which the extracts were taken are found below each entry.
Links to full transcripts of the hearings are provided in the column to
Based on the testimony of the witnesses, the committee will forward a
report to the Irish Minister of Health, who will then finalize the
actual wording of a proposed bill.
20 May, 2013
Redacted Witness List:
Dr. Anthony McCarthy:
President, College of Psychiatrists of Ireland
Dr. Joanne Fenton:
Consultant adult psychiatrist,
specialist perinatal psychiatrist, Coombe Women and Infants University
Dr. John Sheehan:
Perinatal psychiatrist, Rotunda Hospital, Dublin [Written
Dr. Anthony McCarthy: There are concerns among many psychiatrists that somehow this legislation
will result in them being placed in very difficult clinical circumstances.
For some this is because of their religious, philosophical or ethical
beliefs, and these must be respected. I welcome that those views will be
heard today as well. For others, there is a fear of increased workload for
their already overstretched services, and doing this with no extra
resources. For others it is a fear of being faced with very difficult
clinical issues and dilemmas where, for example, a woman may be genuinely
highly distressed, such as after rape, and wants a termination but is
assessed as not being actively suicidal because she does not want to die.
This woman may just want an end to the pregnancy but she will have to be
refused an abortion under this legislation. That will be difficult for her
and us as clinicians.
2, accessed 2013-05-27]
Dr. Joanne Fenton: Many psychiatrists do not wish to partake in the assessments of these
women for many reasons and their concerns must be respected. In my role as a
perinatal psychiatrist I believe it is my responsibility to continue to
assess pregnant women in distress and aim to provide the best and most
compassionate care to them.
3, accessed 2013-05-27]
Dr. John Sheehan: I thank the committee for the opportunity to
contribute. I am a perinatal psychiatrist working in the Rotunda Hospital in
Dublin. A perinatal psychiatrist is a psychiatrist based in a maternity
hospital and he or she treats women in pregnancy or, for example, following
delivery. I also work as a liaison psychiatrist in the Mater Hospital,
Dublin, which has one of the busiest accident and emergency departments in
Ireland. Last year, we had the highest number of treated episodes of
attempted suicide in the State, and part of my work is assessing and
treating people who present with attempted suicide. I therefore work both in
a perinatal setting and in an accident and emergency department setting.
I will confine my comments to the aspect of the Bill that is pertinent to
psychiatry, namely head 4, which is concerned with the risk of loss of life
from self-destruction. It has major implications for psychiatrists. First,
there is a fundamental difference in the management of medical and
psychiatric emergencies in obstetrics. In obstetrics, medical emergencies
and psychiatric emergencies require different interventions. In a medical
emergency, speedy delivery of the baby is required while, in a psychiatric
emergency, speedy delivery of the baby is contraindicated. It is exactly the
opposite of that required in a medical emergency. In a psychiatric emergency
such as when a patent is depressed and has suicidal intent, the patient may
have impaired capacity and should be advised not to make irrevocable
decisions. The patient probably cannot give informed consent. Those of us
who see people with suicidal intent often see people who feel overwhelmed,
unsupported and hopeless and who are often desperate and agitated. The
person often has what is called cognitive constriction and can see no other
option in front of them except ending his or her life. Such a patient needs
professional help, not an urgent termination of pregnancy.
4, accessed 2013-05-27]
Deputy Caoimhghín Ó Caoláin: . . .For the
panel, there is a requirement for three professional opinions, somebody from
obstetrics and two psychiatrists. I would like to ask for your individual
opinion. We would like to know, whether, in the witnesses' respective
opinions, this number is too high? Does the requirement of unanimity of all
three medical professionals render it difficult or, perhaps, even unworkable
in practice and place an undue burden on the woman? In relation to their
respective experiences - and they have indicated they reflect both City of
Dublin and outside the City of Dublin experiences - will the issue of
conscientious objection have any impact on the numbers available, those in
practice associated with the respective 19 indicated-for-approval sites?
Many psychiatrists are not actually associated with any of these yet one
must be in terms of the way the draft legislation is presented. Do you see
difficulties presenting there? In your own opinion, who should lead the
process? It is not clear in the legislation whether it should be an
obstetrician or two psychiatrists. One would expect it would be one, at
least, of the two psychiatrists and that person would be attached to the
5, accessed 2013-05-27]
Dr. Anthony McCarthy: We pointed out in our submissions real practical difficulties because of
conscientious objectors - I fully support conscientious objectors - about
the heads of the Bill as there could be one, for example, Dr. Sheehan,
working in the Rotunda on his own. If he does not agree or I do not agree in
my hospital, there must be a panel of persons outside and that must be
looked at in the heads of the Bill.
6, accessed 2013-05-27]
Dr. John Sheehan: The Senator made a point about good medicine. I have not looked at the
issue of conscientious objection - I have been focusing on head 4, which
deals with a woman who has suicidal intent and whose life can only be saved
by a termination of pregnancy.
15, accessed 2013-05-27]
Dr. John Sheehan: As stated, Dr. McCarthy, Dr. Fenton and I, with more
than 40 years combined experience, have not seen one case in our work as
perinatal psychiatrists. The question about what the Bill, if enacted, might
do to the position of psychiatrists was raised. That was one of the points I
tried to address earlier. I believe it will cast psychiatrists into a role
they have not been in to date. That is a change in role for psychiatrists.
It is quite different to, for example, the working of the Mental Health Act,
under which there is the option of detention of a person with increasing
suicidal risk. This Bill as drafted deals with the woman with increasing
suicidal intent whose life can only be saved by a termination of pregnancy,
which is an entirely different situation.
16, accessed 2013-05-27]
Deputy Billy Timmins: It is clear to me based on what I heard in January
and today and from various submissions I have received, that there is clear
division within the profession of psychiatrists. Unfortunately, it is that
profession with whom the buck will ultimately stop. I do not envy them their
position. Dr. McCarthy stated that many in the profession predominantly
believe that this is a social and political issue. Unfortunately, it has
landed at the door of professional psychiatrists.
16, accessed 2013-05-27]
Redacted Witness List:
Dr. Yolanda Ferguson:
Consultant general adult & community psychiatrist
(Dublin south central psychiatric service & Tallaght Hospital) [Written
Dr. Peadar O'Grady:
Doctors for Choice Ireland [Written
Professor Veronica O'Keane:
Professor of psychiatry, Trinity College Dublin [Written
Dr. Seán Ó Domhnaill:
Consultant psychiatrist [Written
Dr. Jacqueline Montwill:
Consultant psychiatrist, Mayo Mental Health Service
Deputy Bernard J. Durkan: I thank the expert witnesses for their
attendance today and their clear responses. I wish to comment on the Women
Hurt group. It was suggested on Friday that in many cases women who had
abortions outside of this jurisdiction and had feelings of guilt afterwards
had a prior psychiatric condition. Is that generally accepted? To what
extent has the evidence of the Women Hurt group, who came before another
group in the House, been adduced, if at all?
Given the tendency in this country to have an Irish solution to an Irish
problem, is there evidence to suggest that in certain circumstances, by
virtue of the existence of conscientious objection, there is a possibility
that some women presenting with a crisis pregnancy might find themselves
unable to access treatment appropriate to their condition, either from a
psychiatric point of view or medical point of view?
30, accessed 2013-05-27]
Dr. Yolanda Ferguson: It is important that conscientious objection be included in the Bill.
That is why we suggest a panel. If a woman cannot avail of the normal
pathway of care because her psychiatrist is a conscientious objector, that
panel should be formed.
31, accessed 2013-05-27]
Dr. Peadar O'Grady: . . . As to whether conscientious objection would disrupt access, that could be
the case, and the issue will have to be monitored. It has been noted in
ethical papers that there is a conscientious objection to the restriction of
abortion. Doctors such as me would face criminal sanction if we were to
exercise our right to assist a woman in following up and having an abortion
on the basis of her decision of informed consent. This in contrast to those
who wish to have a conscientious objection not to take part in the process.
While I believe people should have every right not to take part, this right
should not be an institutional one.
32, accessed 2013-05-27]
Professor Veronica O'Keane: . . . On conscientious objectors, it is important to ask whether it will delay
a woman's access to an abortion if her local psychiatrist is a conscientious
objector. This is an incredibly important point and it is the reason I and
others have proposed the establishment of a national panel. We could screen
the panel for people who are prepared to co-operate in the full spirit of
the law. If the local psychiatrist is on the panel, that is fine, and he or
she can be requested to determine eligibility. However, if he or she is not
on the panel, the woman would be poorly served by seeing somebody who did
not want to comply with the legislation. For this reason, it is important to
have a panel where it is stated that specific psychiatrists are happy to
work within the legislative framework.
32, accessed 2013-05-27]
Dr. Seán Ó Domhnaill: I had better respond
to the question about why I might have concerns about head 4 in relation to
the assessment of colleagues who might deem people as being suicidal and who
might be prepared to sign off on forms that would allow them to travel for
abortions or to have abortions because of mental health issues. Quite
honestly, the reason is that I have worked in other jurisdictions and in the
very first jurisdiction in which I worked where abortion was legal, which
was Jersey in 1997, I saw consultant colleagues at that time who signed off
in advance. I remember one particular individual who had a pile of forms
pre-signed, and the reason for that simply was that the ideology of that
individual was completely pro-choice and they had so little regard for the
unborn child or for the rights of the unborn child. My concern is that we
would reduce the value of the life of the unborn, as this Bill seeks to do
for the first time ever. This is the first time a piece of legislation seeks
to allow any human being in this country to be killed. That is how serious
this is. We outlawed the death penalty. The only person at risk in this
country at the moment of having a death warrant signed is an unborn child.
40, accessed 2013-05-27]
Dr. Seán Ó Domhnaill: On the question of why
have the fear that somebody is going to sign these forms if suicidality is
not a ground for abortion, again, ideology is an incredibly strong thing and
there are those who cannot see beyond their ideology. I believe and hope
that as clinicians - many of us consider ourselves somewhat vocational in
our work - we are able to go beyond our own ideologies to provide the best
possible treatment. However, the people who are watching and who will read
the record of this hearing now and down the years may wonder what we were so
42, accessed 2013-05-27]
Dr. Jacqueline Montwill: I can answer that.
Colleagues have already stated that they want to have a panel of doctors who
will not obstruct the process. I presume, therefore, that there will be some
kind of bias. The second issue is that, as we have stated from the
beginning, there is no way we can say which patient will kill herself. To be
honest, I am not sure how many women with a crisis pregnancy have committed
suicide. However, we can never say that it could not happen. Under the
proposed legislation, if a woman tells the panel she will kill herself, what
psychiatrist can say she will not kill herself?
50, accessed 2013-05-27]
Dr. Seán Ó Domhnaill: To respond to Senator Crown, he knows my position
on abortion. It has been made clear by some of the psychiatrists who have
appeared today that anyone who holds my position on abortion should be
excluded from the panels. If all doctors who believe that abortion is not a
treatment for suicidality are excluded, we will be left with certain
psychiatrists and their friends. We are relying on the Oireachtas to provide
a safeguard. That is the simple truth of the matter.
50, accessed 2013-05-27]
Senator John Crown: On a point of information, the evidence base in
medicine is available for all doctors who can all see the same evidence.
There is not different evidence for different doctors.
50, accessed 2013-05-27]