Psychiatry and the Eighth Amendment

Sir, – Breda O’Brien in “Questions to be asked about detained pregnant teenager” (Opinion & Analysis, June 17th) managed to avoid asking the one question that begged an answer: why was the child not offered access to an abortion under the existing legislation?

That the child is reported as travelling to Dublin expecting to have an abortion, and was then disappointed to find this was not the case, would strongly imply that she had wanted to have an abortion.

The psychiatrist’s stated opinion in court was that an abortion would not solve “all” the child’s problems. This is neither a criterion that any medical intervention could ever meet, but, more importantly, this is not a criterion for eligibility to have an abortion in Ireland.

Access to an abortion under the Protection of Life During Pregnancy Act 2013 does not require that a person is “actively suicidal” or has “suicidal intent” nor even has “suicidal ideation”, that is, thinking about killing themselves, and these expressions do not appear in the Act. It is also obviously not a criterion that an abortion would solve “all” of a child’s problems. The only requirements for accessing an abortion on mental health grounds in Ireland is that there is a “risk of suicide” and that risk is only resolvable by an abortion.

It is clear that a psychiatrist who believes that a child is at risk of suicide because they are unable to access an abortion can certify on those grounds.

As a result of the Eighth Amendment, the issue of due regard to the right to life of the foetus (unborn child in the legislation) is then down to the two certifying psychiatrists’ views on non-medical matters, that is, on their religious and political opinions.

The Supreme Court judgment in the X case made it clear that the “risk of suicide” is grounds for an abortion, given the risk to the life of the pregnant child was also considered a risk to the foetus, but that this risk did not need to be either imminent nor inevitable.

This advice can, of course, be rejected solely on the basis of the certifying psychiatrist’s or obstetrician’s own non-medical opinions on law, religion or politics.

While there is therefore ample room for psychiatrists to certify eligibility for access to an abortion in these circumstances, it is not acceptable that the decision on a child’s access to an abortion is ultimately made based on the non-medical views of the certifying doctor.

Breda O’Brien’s suggestion that doctors be commended for encouraging a child to continue their pregnancy is also in breach of valid consent.

Every effort should be made to support a child’s ability to make a decision on how or whether to continue their pregnancy but this should include being non-directive and free of duress if it is to be truly consenting.

The concerns regarding the possibility of an abuse of this child’s right to supportive and appropriate care underline the need to repeal the Eighth Amendment and the Protection of Life During Pregnancy Act and provide abortion on the basis of valid consent to good-quality services and not on the doctor’s non-medical, religious and political opinions. – Yours, etc,


Consultant Child


Dublin 12.