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LAW, PREVENTIVE PSYCHIATRY, AND THERAPEUTIC ABORTION

Antiabortion laws, many of which have remained unchanged since their origins in the late 19th century, have been under increasing pressure from three modern developments: 1) advances in medical science minimizing the risk of operative procedures; 2) the desire to control overpopulation; 3) the growing emphasis on individual human rights and civil liberties. Because of certain political pressures, however, legislators have not abandoned the archaic laws but have liberalized them. By means of definitional transformations and the granting of dispensations from their inherent restrictions, these liberalizations allow the laws to retain their seemingly anachronistic form while ameliorating many of their consequences. The inclusion of mental health provisions in the liberalized laws places the psychiatrist in the de facto position of granting dispensations and forming new definitions. Such a situation is not new to the history of jurisprudence nor to the psychiatric profession. Several examples are discussed. Some authors object to such utilization of psychiatrists by the legal system. However, the central contention of this paper is that, if the psychiatric profession is to function in the primary prevention of mental illness, then we have no choice but to remain on the scene, for there now seems to be evidence to support the proposition that to force a woman to carry a pregnancy to term against her will may be detrimental to her mental health as well as to the mental health of her as yet unborn child. The evidence is reviewed by comparing previously reported psychiatric outcome in women who were refused abortion with the outcome in women granted abortion in the United States and Sweden (24 per cent of women denied abortion show significant, continuing psychiatric disability at 7− to 11-year follow-up, vs. 0 to 2 per cent significant psychiatric disability after therapeutic abortion). In addition, a study of 120 children born after application for therapeutic abortion was refused shows that they had greater social and emotional handicaps than their peers. The authors' own data collected by follow-up questionnaires sent to 70 consecutive women granted therapeutic abortion for psychiatric indications under the new California therapeutic abortion law are presented in this context and agree with previously reported results: no serious psychiatric sequelae were found, guilt feelings were short lived, and depressive phenomena decreased significantly between 2 weeks and 3 to 4 months postoperatively.