Ethical Issues Arising From The Involvement Of Psychiatrists In Late Termination Of Pregnancy Dr Kirsty Morris

Background Psychiatrists have a long history of involvement in advising decision making in termination of pregnancy (TOP) Prior to liberalization of abortion laws, TOPs were often permitted if the mother’s life was at risk from psychiatric or medical conditions Once abortion laws were liberalized, the involvement of psychiatrists declined

Legal setting Abortion legislation in all Australian states was originally based on British law In 1967 the United Kingdom Abortion Act was passed Most Australian states then liberalized their laws, although there has been some variability between states

Ethical setting Status of the fetus with regard to personhood Conflict of rights Conflict of duties Who is the patient? Relevance of fetal abnormality

Late TOP Originally performed for maternal medical indications Late diagnosis – psychosocial factors Fetal abnormalities

Current roles for the psychiatrist EARLY TOP Counselling a patient with an unwanted pregnancy Expertise in the area of mental illness and pregnancy Supporting a patient after diagnosis of fetal abnormality

Current roles for the psychiatrist Late TOP Similar role – Late TOP more emotionally challenging Complex medical decision (cf organ transplants) “Clinical ethicist” Staff support

Problems A valid contribution to make? Double agent role Abuse of power Diminishment of profession

A valid contribution to make? Difficult to predict suicide No good evidence that carrying a pregnancy to term will be more harmful than TOP Patients are assumed to be competent and able to make treatment decisions Danger of over-identification with patient’s plight

Double agent problem Arises from conflicting responsibilities, loyalties and goals Psychiatrists are frequently responsible to parties other than the patient (hospital, family, community, justice system, insurance companies, social security system) Conflict of interest

Abuse of power Power arises from coercion powers, from the fact of being a physician and from patient vulnerability Society gives psychiatrists a role in non- psychiatric decisions based on mental function Pressure to manipulate diagnosis Agents of social control: Nazi Germany and former Soviet Union

Diminishment of profession What is psychiatry? Historical assumption of trust Fidelity as an important virtue Essential for someone to become a patient Cannot be maintained if acting for another party

Conclusions Decision to perform a late termination of pregnancy is a difficult and complex one Clarity needed regarding society’s views Need for legal reform? Psychiatry as a profession needs to consider its position

THE END