The issue at hand is twofold – the medical profession and women need certainty on the issues around a crisis pregnancy or a pregnancy where there is a medical crisis. On those grounds we welcome many of the provisions in the Bill. Obviously, like many of my colleagues, section 9, which deals with the risk of loss of life from suicide, is the big issue. In a country which has one of the highest rates of suicide in Europe, after the Ukraine, Lithuania and Finland, that this issue is to the fore when it comes to abortion is tragic and sad in many ways. For many weeks and months we have sat here and listened to evidence for and against on suicide and abortion.
Few studies have been done in the area. However, one of the few I have come across was in Finland which, like Ireland, has a high rate of suicide. This study for the period 1987-2000 on injuries, death, suicide and homicides associated with pregnancy concluded that the low rates of death from external causes suggested protective effects of childbirth but the elevated risks after a terminated pregnancy need to be recognised in the provision of health care and social services. What that meant in Finland was that the annual suicide rate per 100,000 was 11.3. When associated with a live birth, the annual suicide rate per 100,000 was 5.9 but when associated with an induced abortion the suicide rate per 100,000 was 34.7 – six to seven times the rate for women who had gone through with the birth. This is a limited study but it shows the link between a higher rate of suicide after abortions.
We do not have enough evidence on the other issue. Colleagues have quoted experts who have come before us who said that of 100 patients who say they are pregnant and suicidal, three will commit suicide. Given that we do not have wide-ranging studies it is difficult to have the figures verified. However, what we do know is what has happened in other jurisdictions. I listened to colleagues who say they hope this is the end of it and that this will be the sum total of abortion legislation being brought into Ireland. We all know in our heart of hearts that once a door is opened it is very hard to get it closed.
We are aware that abortion was introduced in England in 1967 for the hard cases and that there are no easy answers and no answer is 100% correct. Those of us here are faced with making difficult choices. In 1968, there were 22,332 abortions in England and Wales; by 1972 the number was 108,000; and in 2011 in England, Scotland and Wales there was 200,000 abortions. One in five pregnancies in England ends in abortion.
I have heard colleagues say this will not be a mechanism to open the door. The evidence is clear. As we have seen in England, when it was introduced for hard cases, it was turned into a mechanism by those who are in favour of pro-choice. Those who are pro-choice and honest have said they will move the boundary forward and keep opening the door. If that is their belief that is what they wish to do. Aborting America by Dr. Bernard Nathanson is relevant when it comes to this particular case. It has been quoted by others but I will quote it again. In his book, Dr. Bernard Nathanson mentioned how he went after the issue of abortion and tried to liberalise the laws on abortion in America. He said:
The attack had to be made in the weakest area, the psychiatric indication, which was inexact, unmeasurable, yet sufficiently threatening. Once a breach was made in that area, once a few precedent-setting cases got by, then we could pour them through in unlimited number. The supposed threat of suicide was the logical battering ram. It was just a question of finding a squad of complaisant psychiatrists.
How was the structure set up?
The typical hospital abortion committee required that all appeals be submitted in duplicate, accompanied by two letters from consultants who agreed with the obstetrician-advocate. Thus in the case of psychiatric indication, two psychiatrists on the staff of that hospital must write letters on behalf of the patient. In a typical instance, the committee would meet one morning each week in the office of the director of obstetrics and gynaecology. The obstetrician would have to appear in person, armed with the documents and prepared to defend his application. Fair and workable, in theory, though the “old boy” network among doctors sometimes produced a special advantage.
He further states:
The committees were approving virtually all applications, rejecting only those in which the paperwork was inadequate or incorrect, or in which the obstetrician failed to show up altogether.
This was after a number of years. The Attorney General has said it will be watertight, but over time in America the system fell apart. Having allowed the first few abortions on psychiatric grounds, they could hardly reject the next 100 when the letters came from the same staff psychiatrists, couched in the same ominous, though opaque, psycho-jargon. That is what happened in America and, unfortunately, there is the threat that the same will happen here. Others have said we will continue to export to England what some describe as a problem but which I would describe as a human tragedy. Those who live in the hope that this will close the door are probably badly mistaken; this will be the opening of the door.