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ICGP AGM – 2 of 3 motions relating to abortion passed

3 motions relating to abortion were brought to the ICGP AGM this weekend in Galway. 2 of the 3 motions were passed. These are listed below.

1) This meeting calls on the ICGP to call on the government to introduce clarity in the law, founded on evidence based medical guidelines where there is a real and substantial risk to the life of the mother.”

Carried 60 votes to 40 votes

2) The ICGP calls on the government to include within the proposed legislation the provision that women who become pregnant as the result of a criminal act, such as rape or incest, have access to the choice of legal abortion in the Republic of Ireland.

Defeated 55/ votes to 52 votes

3) The ICGP calls on the government to include within the proposed legislation the provision that women who are pregnant with non-viable foetal anomalies have access to the choice of legal abortion in the Republic of Ireland.

Carried 55 votes to 52 votes

Dr Mary Favier comments on the motions passed today:

Letter from Dr Mary Favier, a Doctors For Choice member, in today’s Irish Times

Sir, – In reference to the planned Protection of Life in Pregnancy Bill, Muiris Houston (Home News, May 1st) correctly questions how an expert in obstetrics can offer an opinion on suicide risk when it will be outside of their accepted skills and expertise? Without specific ongoing education and training in the area it will be a personal rather than an expert opinion and will need to be recorded as such.

Competent hospital risk managers will be soon minded to advise their obstetricians to continue to practise only within their established competencies so as to avoid likely legitimate complaint (and litigation) by a patient or family of a patient. This is likely to mean that obstetricians will not, and should not, offer a psychiatric or non-expert opinion on suicide risk. The Medical Council is also likely to have an opinion on any doctor opining outside their area of expertise. The proposed legislation as structured is fundamentally flawed and will need to be changed. – Yours, etc,

DFC Irish Times Letter

Letter from Dr Peadar O’Grady in The Irish Times

Sir, – Breda O’Brien (Opinion, April 27th) has grossly misrepresented the mental health evidence in relation to abortion. She derides the “faith-based dogma” of “fundamentalists” and praises “scientists” “adhering only to empirical evidence”.

Good scientists, however, do not rush to judgment on new research. The research Ms O’Brien quotes, by New Zealand academic David Fergusson and two colleagues, was just published in April in a relatively obscure psychiatric journal and has not yet been scientifically critiqued by Fergusson’s peers.

Good scientists do not ignore the previous research. Two previously published systematic scientific reviews in 2008 and 2011 by organisations representing tens of thousands of psychologists and psychiatrists have found no increase in mental health problems in women choosing an abortion. These studies have been critiqued by peers and their findings are well-founded scientifically. While Fergusson is correct that there is a lack of direct evidence of mental health benefits in abortion, there is indirect historical evidence that in countries where access to abortion is restricted the suicide rate in pregnancy is higher.

Most importantly, good scientists do not misrepresent the very evidence they are claiming to promote. In this same research paper David Fergusson concludes: “. . . it would be premature to conclude emphatically that this evidence is sufficient grounds for believing that abortion has adverse effects on mental health”.

Despite that Ms O’Brien emphatically did just that.

She also failed to mention Fergusson’s own conclusion in his paper of the alternative to certifying on mental health grounds: “On the face of it the most straightforward way of resolving these tensions between the law and clinical practice . . . is to extend these criteria to include serious threats to the social, educational, or economic wellbeing of the woman and her immediate family as legitimate grounds for authorising abortion”.

In other words, the only scientific paper the anti-choice movement can find which seems to back up its conclusion for restricting abortion actually recommends the opposite: an easing of the restrictions to make abortion more easily available. This means the fact stands that there is no scientific basis for restricting access to abortion unless, of course, we rely on the faith-based dogma of fundamentalists. – Yours, etc,

 

Response to Heads of Bill of Protection of Life During Pregnancy Bill 2013

Doctors for Choice welcomes steps to deal with the X-case. 21 years after the Supreme Court decision, compelled by the ECHR, the Irish Government has provided the first draft of legislation that will give those women who have a life threatening illness, and their doctors clarity on whether a termination can be legally performed. However, Doctors for Choice has concerns regarding the practical implications and limitations of this bill.

While Doctors for Choice welcome any improvement in the care of women who choose to have an abortion it remains unclear whether this Bill would provide an ‘effective and accessible’ procedure for someone in the position of Savita Halappanavar or the X case. Women in situations of rape, child sexual abuse and fatal foetal anomalies will have to wait for further legislation to allow for the option of abortion in those cases. Women who are unable to travel risk being denied an abortion or being harassed into travelling to England despite being unfit to do so.

  • In the case of the risk of suicide, imposing a requirement for three doctors is unnecessary and in excess of the maximum of two doctors recommended by the expert group
  • Certification for involuntary detention under the Mental Health Act only requires two doctors: a GP and a Consultant Psychiatrist. The requirement for an obstetrician to certify suicidal ideation is incomprehensible. No obstetricians claim skills in this area. GPs and psychiatrists are the doctors that routinely deal with this presentation.
  • That one obstetrician could veto the decision of two psychiatrists makes no sense except restriction for the sake of it.
  • There is no medical basis for differentiating between a medical emergency and a psychiatric emergency. All psychiatric emergencies are medical emergencies.
  • The requirement that psychiatrists work in a hospital will exclude most Child Psychiatrists who deal with children up to the age of 18 and will have to be amended to include them.
  • The inclusion of a 14 year prison sentence for women who have an abortion outside of these guidelines and describing that as due to the ‘gravity of the crime’ is particularly offensive. Every day more than a dozen women will have an abortion outside of these guidelines; only in a different country The right to travel for an abortion means that no-one in Ireland believes that choosing to have an abortion is a grave or serious crime and this odious section on criminal punishment should be removed.

The role and value of GPs is mentioned in Head 4. As primary care is the most common first point of contact in medicine, a suicidal woman in early pregnancy will most likely go to her GP and be cared for in this setting initially. In reality therefore a woman could be seen by at least 4 doctors before being ‘certified’ as requiring an abortion. A GP and a Consultant Psychiatrist would be the most relevant combination if two doctors were required.

We believe that the safest way to protect all women in Irish society is to decriminalise abortion, leaving medical matters outside the criminal law. This way we avoid legalistic terms and sanctions which have so far served solely to intimidate those who work in the field of medicine. Women should have the choice to access safe abortion services with fully informed consent. To achieve this we will need to repeal the 8th amendment.

Suicide in Pregnancy is much rarer now ‘thanks to legal abortion’

Some years ago, facing a series of tearful and terrified teenage girls who wanted to travel to the UK to have an abortion, I was struck by the cold-heartedness of putting traumatised teenagers through the hoops of questionable legal procedures to access medical services they had clearly given informed consent for. These were ‘unaccompanied minors’ in the care of the HSE whose carers were looking for approval to facilitate access to abortion services by accompanying these pregnant children to the UK. The certification I issued advised that where informed consent had been satisfactorily given then restricting access to abortion would increase the risk of suicide and this was accepted by the High Court unquestioned. However, forcing these vulnerable children through such a process of fear, uncertainty and delay left me with an abiding sense that we were not much further on from the days of the Magdalene laundries.

It had taken the tragic case of Ms X, a 14-year-old child who had been raped by a neighbour, to bring Ireland to its senses. The idea of continuing to refuse an abortion to a child, who had become suicidal after she was refused permission to travel for an abortion, was more than we could bear and thousands marched to demand her right to access an abortion. A constitutional amendment in 1992 meant the threat of criminal sanction was removed from the roughly 5,000 Irish women who travel abroad for abortions every year, a normal health service in every European country bar Malta and Vatican City. Despite this step forward, the costs of travel and accommodation means for many women a delayed and lonely process that complicates their medical care and reinforces the sense of stigma attached to women’s reproductive health in Ireland.

In its 2009 report on Maternal Mental Health, the UN’s World Health Organisation (WHO) has highlighted the increased risk of mental health problems in, “unintended pregnancy especially among adolescent women”. The WHO emphasises the further risk from factors such as poverty and lack of support, “including lack of reproductive rights” which means access to abortion services but also access to good quality obstetric, gynaecological and contraceptive services as well as sex education and information. Denying women ‘the right to choose’ raises the risk of suicide in pregnancy. Professor Robert Kendell summarised this conclusion in the title of his 1991 review in the British Medical Journal: ‘Suicide in pregnancy…much rarer now: thanks to contraception, legal abortion and less punitive attitudes’. The availability of abortion services in the UK and elsewhere in Europe has saved countless women from the horrors of backstreet abortions and suicidal despair.

Despite this evidence from history, and from other countries even today with severely restrictive abortion laws and high rates of death from unsafe abortion and suicide, the opposing notion that choosing an abortion increases the risk of mental health problems, and even suicide, persists. When this allegation is systematically investigated by emphasising good quality research it is found to be false. In the US, the American Psychological Association in 2008 found there was no credible evidence that freely choosing to have an abortion raised the risk of mental health problems. In the UK, the National Collaborating Centre for Mental Health’s review in 2011 reached the same conclusion. While a higher rate of mental health problems may be found in women who have had an abortion, when factors such as unwanted pregnancy and previous mental health problems or experience of violence is taken into account there is no higher rate overall. This means previous mental health and unwanted pregnancy are the likely risk factors; not the choice of abortion. It is also well known that, following abortion, mental health problems are more common where a woman has had a negative attitude to abortion before or a negative reaction after, especially when she has been under pressure to have an abortion. Clearly, the ‘right to choose’ must be without pressure to choose a certain way. Women who have repeated abortions are also a group who need particular attention aimed at preventing further unwanted pregnancies. Good counselling and practical social support, before and after the decision to have an abortion or not, is the key to supporting women with unwanted pregnancies. Being prochoice means supporting a woman’s right to choose to have a child by advocating for the back-up of good obstetric and childcare services after the child is born.

Anti-choice proponents have repeated the slogan that ‘Abortion is not a treatment for suicidality’. No doctor has actually argued that it is. However, in response to this crude formulation, it could be argued that abortion, for those who choose it with proper supports, can be as much a ‘treatment’ for the risk of suicide as blood pressure tablets are a ‘treatment’ for the risk of a heart attack. Both can be preventive, lowering the impact of a relevant risk factor: that is, the distress of an unwanted pregnancy and high blood pressure respectively. The ‘treatment’ for unwanted pregnancy is ‘non-directive counselling’ and the ‘treatment’ for suicidal risk in unwanted pregnancy is ‘risk-reduction’, which includes facilitating the choice of accessing abortion services.

In the Irish context, the restriction of access to abortion services is mediated by restrictions on travel. This means a greater risk of suicide in women too sick to travel, but also adolescents, women with young children, migrant women, women with disabilities, women with no or low incomes and practical difficulties travelling may also affect women whose pregnancy involves a fatal foetal malformation or was the result of rape or child sexual abuse.

The obvious solution to all these risks is to end the unnecessary, dangerous, and, for the most part, ineffective legal restrictions on abortion services in Ireland. This is the very successful approach taken in Canada for the last 25 years. Abortion there is subject to healthcare guidelines and not criminal law; just like every other medical service. Abortion as an option in unwanted pregnancy is a decision between the patient and her doctor. Support services should try to ensure that the woman has the best informed choice but do not attempt to influence that choice or take it for her. Coercion has no place in this decision. Restricting access to abortion increases suicide risk and supported choice reduces that suicide risk. While ultimately there is no medical need for a special legal framework for abortion, doctors are perfectly capable of certifying the need to support a woman’s choice of abortion services to reduce her risk of suicide. It does not take a panel of doctors to do this. It is time to move on from the Magdalene era where religious and political prejudice was allowed overrule the personal freedom to choose.

Article written by Dr Peadar O’Grady (Consultant Child and Adolescent Psychiatrist and member of Doctors for Choice) for the Sunday Business Post, Ireland, April 28th 2013

Doctors For Choice Statement April 20th 2013

Savita Halappanavar was a tragic victim of our State’s restrictive legal position on abortion.

We, as doctors, need the freedom to provide the best medical care to our patients. For too long, the health of Irish women has been compromised by restrictive laws, which have no logical grounding in the field of Medicine. Irish doctors have been unable to follow best-practice, unable to offer women the treatment they desire and unable to follow internationally-standardised guidelines. We need to be released from the chill of these legislative restraints so that doctors can treat an illness before a life-threatening situation develops.

We need Action on X. Following the outcome of Coroner Dr. Ciaran MacLoughlin’s inquest, Doctors for Choice demands that both the government and the Irish Medical Council urgently provide security and clarity to doctors, that they can terminate a pregnancy before a life-threatening situation develops. Otherwise women’s health will continue to suffer, women’s lives will be jeopardised and more tragedies will follow.’

Welcome

Welcome to the website of Doctors for Choice Ireland.

Doctors for Choice is an alliance of independent medical professionals and students advocating for comprehensive reproductive health services in Ireland, including the provision of safe and legal abortion for women who chose it.

We believe that women should be supported to make their own decisions regarding their sexual and reproductive health and to manage their own fertility, with doctors and nurses providing expert advice and care without judgment, recourse to the law or fear of criminal sanction.

We welcome your support. If you are a doctor or a medical student we will gladly welcome you into membership. You can contact us at doctorsforchoice@gmail.com