‘Facts have no agenda. Real news has value.’

Screenshot 2017-07-07 20.25.14

Thus reads the Irish Times slogan for its online subscription service. It’s correct, of course. To quote Ricky Gervais, who seems to be the originator of the phrase now trumpeted by Ireland’s paper of record, ‘Facts have no agenda. They can’t be racist or sexist in any way. They can’t be softened or changed to avoid offence. They just are.’ The people reporting on those facts, however, do have agendas, and in promoting those agendas, the facts that represent a case are remoulded, twisted out of proportion, boundaries redrawn and blank spaces filled with supposition, until agenda-less facts are made to portray a story that never truly existed. The reportage on the pregnant girl who requested an abortion and was subsequently sectioned under the Mental Health Act is a perfect example of this.

The story emerged as part of the Child Care Law Reporting Project (CCLRP) (https://www.childlawproject.ie/about/), an independent project established under the Child Care (Amendment) Act 2007 and which has been in existence since 2012. It aims to inform the public and professionals about ‘how and why children are taken into care, and what happens then.’ Identities of the children involved, their families, foster parents, social workers and judges are protected. The case in question was reported by the CCLRP as ‘Order detaining pregnant girl seeking abortion discharged’ (https://www.childlawproject.ie/publications/order-detaining-pregnant-girl-seeking-abortion-discharged/). In brief, the report tells us that a pregnant girl who wanted an abortion was adjudged to be at risk of suicide. She was detained in a mental health unit. Later, on examination by two other consultant psychiatrists, she was found not to be suicidal and the detainment order was discharged. At no stage was an abortion recommended as treatment for the alleged suicidal ideation.

There are three possible premises here: one, the girl was actually suicidal at all times; two, the girl was not actually suicidal at any time; three, the girl was suicidal when examined by the first consultant psychiatrist (CP1), but not suicidal at a later stage when examined by the second and third consultant psychiatrists (CP2 and CP3). If we accept the first premise (that the girl was actually suicidal at all times), then we would have to conclude that CP2 and CP3 each reached incorrect conclusions as to the girl’s mental health. This is not impossible, but is quite unlikely. Premises two and three are the more plausible: either the girl was not suicidal, but CP1 erroneously concluded she was, or she was actually suicidal at the time of examination by CP1, but not at the time of examination by CP2 and CP3. Let’s assume that CP1 made a mistake, or prized his or her personal beliefs over the needs of the girl.

CP1, who gave evidence that led to the making the Order detaining the girl, found her to have a mental health disorder within the meaning of the Mental Health Act 2001 (MHA).* The girl was ‘at risk of self harm and suicide as a result of the pregnancy.’ However, CP1 was of the opinion that ‘this could be managed by treatment and that termination of the pregnancy was not the solution for all of the child’s problems at that stage.’ From this set of facts was conjured up a variety of headlines:

‘Young girl who asked for an abortion is sectioned’ Daily Mail, 12 June 2017

‘Fury as young Irish woman sectioned for wanting an abortion’ Irish Mirror, 12 June 2017

‘Irish teenager who asked for an abortion was sectioned under Mental Health Act’ Huffington Post, 13 June 2017

They make it seem as if the girl at the centre of the case was made the subject of a detainment order simply for wanting an abortion, that she had committed a sort of Orwellian thoughtcrime. Certainly, the girl wanted an abortion. Certainly, she was detained. But she was not detained because she wanted an abortion: she was detained because, in the opinion of CP1, there was an immediate and serious risk that she would kill herself. Irresponsible, sensationalist reporting has mangled this very relevant piece of information. How responsible would it have been on the part of CP1 to identify someone as being suicidal and then not support detainment? How would the headlines have read had the girl at the centre of the case in fact taken her own life when that could have been prevented by supervision in an enclosed unit? Even if CP1 was mistaken, is it really wrong to err on the side of caution?

Of course, it’s possible that CP1 did not make a mistake. He or she may have intended that the girl be detained in order to prevent her from having an abortion. In a press release, the Abortion Rights Campaign declared: ‘Looking at the report, it’s hard not to think that the psychiatrist in this case essentially used the Mental Health Act as a tool to force a child into continuing an unwanted pregnancy because of their own personal beliefs.’ Although the CCLRP report mentions three different psychiatrists, it is fair to assume that they are referring to CP1. However, looking at the CCLRP report, it’s actually pretty hard to conclude that CP1’s personal beliefs had anything to do with his/her opinion as to the girl’s mental health. We can guess, sure. But it’s by no means certain, and it’s in no way probable, because section 25 of the MHA acts as a significant bulwark against personal beliefs colouring psychiatrists’ opinions. Consultant psychiatrists do not make detention orders. Section 25(2) MHA provides that:

‘[A] health board shall not make an application [for detention] unless the child has been examined by a consultant psychiatrist who is not a relative of the child and a report of the results of the examination is furnished to the court by the health board.’

Involuntary detention of a child in Ireland is a three-stage process: first, a consultant psychiatrist examines the child and submits a report to the health board. Second, the health board submits that report to the court. Third, the court grants, or does not grant, the detention order. CP1’s opinion that the girl was at risk of suicide and that abortion would not have been a solution, then, was not merely CP1’s opinion. It was the opinion of CP1 AND the health board AND the court, but the health board and the court decide whether to move forward with detention orders. If CP1’s opinion was not backed up by believable evidence, it is unlikely that a detention order would have been granted. This is obviously conjecture, but it is reasonable conjecture, based on the facts as presented and the law as it exists. Arguing that CP1 was motivated by personal beliefs is mere guesswork.

It’s worth noting, too, that just because someone reaches a different conclusion to you doesn’t automatically make them wrong. A single person or a single group adhering to a single ideology does not possess all morality, all intellectuality, all ability or all humanity. Other people can think differently and act differently, and the result they reach can still be right. To the outrage of the pro-choice lobby, none of the psychiatrists involved here are recorded as having recommended abortion as treatment for suicide. In fact, CP1, in finding a risk of suicide but not recommending abortion, acted in line with psychiatric consensus. A nationwide survey of psychiatrists in 2013 found that 116 of 127 respondents believed that allowing suicide as grounds for an abortion ‘has no basis in the medical evidence available’ (‘Doctors: Abortion not right care for suicide’ Irish Independent, 26 April 2013). Media Guidelines for Reporting Suicide and Self-Harm, issued by the Samaritans and the Irish Association of Suicidology, stress that ‘People don’t decide to take their own life in response to a single event, however painful that event may be, and social conditions alone cannot explain suicide either. The reasons an individual takes their own life are manifold, and suicide should not be portrayed as the inevitable outcome of serious personal problems’ (http://www.ias.ie/wp-content/uploads/2016/08/Media-Guidelines.pdf). Scientific American puts this pithily as ‘the message that suicide can have simple, or a simple set, of causes, or that suicide represents some type of solution, is unfortunate. There is never one reason why, or even thirteen’ [referring to the Netflix drama 13 Reasons Why, which deals with a teenage suicide]. So, really, how likely is it that if CP1 had recommended the girl have an abortion, the risk of suicide, if it ever existed, would have entirely dissipated? Answer: according to the evidence, very unlikely. So, really, didn’t CP1 do the right thing? With enough evidence of suicidal risk for a health board and a court to agree to detainment, CP1 chose to pursue an option that would save two lives: the girl and the unborn child.

On the facts as presented by the CCLRP, which are all we have to go on at the moment, members of the Abortion Rights Campaign would probably happily have recommended the girl for an abortion. But CP1, who actually met the girl, actually examined her, actually talked to her, who is actually a qualified psychiatrist, did not do that. Neither did CP2 or CP3. Neither CP2 or CP3 found the girl to be suicidal at all, so either she had never been suicidal or was no longer suicidal. Either way it wouldn’t have made sense to recommend abortion. Abortion will not alleviate a non-existent mental health disorder. It will not make a non-suicidal person non-suicidal. It will only end a pregnancy. It will only end a life.

The facts of this case demonstrate problems. One, that neither the girl nor her mother were aware she was being detained under the MHA is acutely concerning. Two, that an underage person is pregnant at all raises questions—questions of consent, questions of contraception. Three, that the girl wanted an abortion. Why was this the only option she and her mother wanted to pursue? Why was it the only option they felt to be open and acceptable to them? But it shows strengths, too, in the guardian ad litem system and in the diligence of consultant psychiatrists who clearly make efforts to get to know their patients and their needs and to address those needs to the best of their ability. The case is a deeply personal and sad affair, but the anger of much of the public seems directed at the medical professionals who did not recommend abortion. Can we, as people merely reading reports of the case and in many instances only reports of reports of the case, really claim to know better than them? Can we really claim to know for certain that the best answer here was abortion? We can’t—the facts don’t give us that. What the facts give us is that a vulnerable girl was at one stage found to be at risk of suicide, and that the evidence at the time was so convincing that a consultant psychiatrist, an entire health board and the District Court were persuaded of its accuracy, but not that an abortion was necessary. The facts are that abortion is not, and never has been, considered a suitable treatment for suicidal thoughts. The facts are that, at a later stage, the girl was not found to be suicidal, so could not be found to be in need of an abortion. Given that the girl’s representatives were prepared to make applications surrounding her right to travel, it seems likely that she will proceed with an abortion anyway. It should be stressed that the case does not represent a failure of the Protection of Life During Pregnancy Act 2013 (PLDPA), as some have attempted to argue (‘Protection of Life During Pregnancy Act is “unworkable”’ Irish Times, 13 June 2017). There is no indication that the PLDPA was even invoked.** What it does represent is agenda-driven reporting and dangerous misconceptions. To detain a person for considering abortion is wrong. But that is not what happened here. What happened was that medical practitioners, health boards and courts examined the evidence and did the best they could to save the life of a vulnerable girl and her unborn child. And these are the facts. And facts have no agenda.

–HB–


* Section 3(1) of the MHA provides that:

‘[M]ental disorder’ means mental illness … where—

  1. because of the illness … there is a serious likelihood of the person concerned causing immediate and serious harm to himself or herself or to other persons, or
  2. (i) because of the severity of the illness … the judgment of the person concerned is so impaired that failure to admit the person to an approved centre would be likely to lead to a serious deterioration in his or her condition or would prevent the administration of appropriate treatment that could be given only by such admission, and

(ii) the reception, detention and treatment of the person concerned in an approved centre would be likely to benefit or alleviate the condition of that person to a material extent.

Section 3(2) defines ‘mental illness’ as meaning ‘a state of mind of a person which affects the person’s thinking, perceiving emotion or judgment and which seriously impairs the mental function of the person to the extent that he or she requires care or medical treatment in his or her own interest or in the interest of other persons’.

**There is nothing in the facts to suggest that the girl was in fact being examined for the purposes of assessing eligibility for abortion in cases of real and substantial risk of loss of the woman’s life by way of suicide. Section 9 of the Protection of Life During Pregnancy Act 2013 (PLDPA) requires three medical practitioners to examine the pregnant woman to determine this. Two of these medical practitioners must be psychiatrists. One must be an obstetrician. If these medical practitioners do not recommend that the woman in question have an abortion, they must inform the woman of her right to have the decision reviewed by a panel of medical experts (section 10 PLDPA). Nothing of this sort is contained in the CCLRP report. This would indicate that the girl was not being assessed by CP1 for her suitability for abortion, but only as to  whether or not she had a mental health disorder that at the time could only be treated while subject to a detainment order.