Examination of Witnesses (Questions 100-119)|
15 OCTOBER 2007
Q100 Chairman: The Royal College
of Obstetricians and Gynaecologists is a fairly respectable body.
Do we agree on that?
Professor Norman: Yes.
Professor Casey: Provided they
obtain psychiatric information about it and I have read the RCOG
Q101 Chairman: Apart from you, Dr
Casey, who does not feel they are a respectable body
Professor Casey: I do. This is
quite serious, Chairman. Anybody commenting on
Q102 Chairman: Can I just ask a question
and then perhaps you will give me an answer?
Professor Casey: Yes.
Q103 Chairman: The bit I do not understand
is that the Royal College of Obstetricians and Gynaecologists
in their evidence to us say that the incidence of seeing negative
reaction to abortion is low. In other words, they do not believe
that there is a strong correlation between abortion and mental
illness. Why have they got it so wrong?
Dr Richards: They agree on association.
The question is: is it causal? These new studies are very good
studies. Statisticians and psychiatrists are in agreement that
these are gold standard studies, particularly that of Fergusson
but there are others. There is a question about why suicide is
much more common after abortion. The studies show clearly it is.
The question is: is it causal?
Q104 Chairman: It can also show us
that road accidents are more.
Dr Richards: There is six times
the rate of suicide in the year following induced abortion in
the Finnish paper. Someone looked at the rates of presentation
of attempted suicide in Glamorgan in this country and found a
very striking effect, which was that the time before and after
the suicide or the birth, in those who had just had a birth, the
suicide rate fell or stayed very steady, but comparing before
and after abortion it rose very substantially in some age groups.
Q105 Dr Harris: I was late into the
private meeting where we declare our interests and for the record
I need to declare my interest as a member of the British Medical
Association's Medical Ethics Committee and say that my partner
works in this field in policy. While we are on that subject, Professor
Casey, you said that you were absolutely convinced that there
was a causal association between abortion and mental illness.
Professor Casey: Yes.
Q106 Dr Harris: You are a professor
of psychiatry. I just wanted to clarify where you are coming from
and what is your perspective to give you that certainty. You have
done reviews of this but you have not done research on this yourself.
You are not a research active psychiatrist in this particular
field, but you have reviewed the work?
Professor Casey: I am not a research
active psychiatrist in the area of abortion because it is impossible
to do that in Ireland for obvious reasons, but I have treated
many women who have had abortions. I am a clinician as well.
Dr Harris: This is in no way a criticism
of you. I want to make that clear, but you have not declared any
particular associations with the anti-abortion movement. Would
you say that you are anti-abortion? Are you opposed to abortion
being legal in Ireland?
Dr Spink: Chairman, we have not asked
any particular questions of any witnesses. Are we going to ask
all witnesses, because
Dr Harris: I would like to know, when
we are having a scientific evidence session, whether an assertion
that the witness is convinced that there is a causal association
between abortion and mental healthand indeed Chris Richards
said between abortion and suicide, which is even stronger than
Professor Casey said in her paper; Dr Richards has declared his
interests in this areaand I wanted to ask that question
if I may. It is usual practice in select committees.
Q107 Chairman: I understand the question
but I think Dr Casey has made the point that she has formed that
view on reviewing the evidence that was before her.
Professor Casey: Yes.
Q108 Dr Harris: Can I remind you
what you wrote in a paper in Ireland just last year on 9 July
2006? "It is sad that the state is being asked to declare
as a non-human a voiceless group within the human community. If
it succeeds it will truly be an oppression since it will prevent
the full potential of these tiny humans from being realised by
casting them aside at this early point in their development."
You go on at length to give a pro-life position. Would it be fair
to say that you are pro-life but that has not influenced your
judgment on whether abortion causes mental health problems?
Professor Casey: Yes, I am pro-life
and I am glad that you accept that being pro-life does not necessarily
affect my brain's ability to assimilate scientific information.
Q109 Dr Harris: On that basis, can
you explain why you left out the Gilchrist study of 1995 in the
evidence you submitted? I know it falls before 2000 which is a
Professor Casey: The Gilchrist
study is a very weak study that involved over 1,000 general practitioners
in this country. There was no quality assurance that they were
all trained to identify psychiatric illness in the same way. I
have been involved in a big European study of depression and we
have regular meetings for quality assurance purposes to make sure
that everybody does the same thing all the time. There was no
Q110 Dr Harris: I understand you
think it is a poor study.
Professor Casey: Yes, I do.
Q111 Dr Harris: What about the confidential
inquiry into maternal death 2002, which attempts to measure every
single death in this country? That has failed to show in their
published report any causal association between abortion and suicide.
You did not even in passing mention that in your evidence and
other people I have spoken to say that it is astonishing that
your review of the evidence around abortion and suicide would
not mention that.
Professor Casey: I did not mention
the confidential inquiry into homicide and suicide because it
is not scientific in the sense that there is not a particular
research design around it. It is basically number crunching based
on the numbers available. It is not in peer reviewed journals.
I specified I wanted to use peer reviewed papers.
Q112 Dr Harris: Dr Richards, you
felt the Gilchrist study was good enough to cite in your own evidence
when there was a part of it that you felt backed up your conclusions.
Could you explain to us and Professor Casey why you think the
Gilchrist study is good enough quality to cite in your evidence?
Dr Richards: I cannot and I cannot
recall that. I would like to address your question about the confidentiality
inquiry into maternal death because that is important. It is raised
as the gold standard for maternal death in this country. It is
not the way we are going to find out whether induced abortion
causes death in women in this country. There is a number of reasons
why that is the case and I outline those in my paper.
Q113 Dr Harris: I have now found
the reference, xi, and you should have your evidence before you
which is in paragraph 5.2. You said, "A further study"you
do not say it is a poor study"found levels of deliberate
self-harm to be almost 3 times more frequent in those with unplanned
pregnancy and who had no history of psychiatric illness, but went
on to have an induced abortion, as compared to those who kept
their baby." I know you are not a psychiatrist and you have
declared your interest as a member of the Christian Medical Fellowship
and a director of the organisation that produces materials from
a Christian perspective for schools. I am just wondering why you
think that bit of the study was good enough but Patricia Casey
thinks the rest of it was lousy. Was it selective?
Dr Richards: I was not trying
to be selective. I was trying to look at these studies. There
are vast numbers of them and many of them support an association
between suicidal ideation, depression, mental disorders and having
had an induced abortion. That is one part of that paper that shows
Chairman: To be fair, Dr Richards has
not in fact rubbished that particular piece of evidence. I want
to leave that at that point.
Q114 Mrs Dorries: Dr Richards, you
have made quite clear your belief that there is a link between
abortion and later suicidal and mental health, as has Professor
Casey. It is back to the RCOG guidelines again, I am afraid. Should
a woman not be informed, when she goes to seek a termination from
a doctor, of the fact that she may suffer later in lifeor
what the statistical evidence ismental health problems
as a result of this termination? Should the RCOG guidelines be
updated so that a woman is fully informed when she requests a
Dr Richards: I am sure they should
be amended. Certainly at the moment they do not reflect that.
They suggest that if there is a low mood after abortion it is
transient and not necessarily associated with the abortion itself.
I am sure these new studies that have come out show an unanswerable
case that we must be warning women of a significant risk of depression
and suicide following abortion.
Q115 Chairman: Would you agree?
Dr Richards: Yes, I do agree.
Q116 Chairman: To balance the argument,
the Royal College should review the evidence before it gives guidance?
Dr Richards: Yes. I would like
their guidance to be evidence based. There is now strong evidence
Q117 Chairman: It is not for them
to decide whether that evidence is strong or not.
Dr Richards: It is also up to
this Committee to see
Q118 Chairman: I am accepting the
point but I am saying they ought to do that.
Professor Norman: I have in front
of me what the RCOG advises doctors to tell women about abortion
and there is a list of issues. Number nine is that they suggest
we advisethis seems to me to be reasonablethat some
studies suggest that rates for psychiatric illness or self-harm
are higher among women who have had an abortion. It goes on to
say, "It must be borne in mind that these findings do not
imply a causal association." I think that is a reasonable
interpretation of the literature as it is and I think that is
sensible advice for doctors to give.
Q119 Mrs Dorries: I would say it
plays it down, considering the issue of suicide.
Dr Richards: It says it is on
the wane immediately after abortion and that is not the case.
These studies show that there is prolonged low mood in these women
who have had abortions. It continues for some months or years
after the event of the induced abortion.
Mrs Dorries: Which is why the guidelines
play the situation down. Dr Lee, I am interested in the comment
that you made about women and the reasons why they present. You
said that some women present because of difficulties with a partner.
This is probably a slightly emotive question but I still want
to ask it anyway. On the previous panel we heard particularly
from Professor Wyatt that in his unit at UCL 42% of babies born
at 23 weeks live and that gives up to 60 something per cent at
24 weeks. It is even higher in the States. Who do you think has
the greater right? The woman who comes to you at 23 weeks because
she wants a termination because she is having difficulties with
her partner, which is one of the reasons you have cited
Chairman: I am sorry. With due respect,
this is not for this inquiry. I am trying to get evidence which
comes out of our experts in terms of evidence that they can put
rather than their personal opinions.