Thursday, 3 November 2011

More Massive Criticism of Article Claiming Abortion to Cause Mental Health Problems

The article by Priscilla Coleman purporting to demonstrate a causal link between abortion and mental health problems has been the subject of posts on this blog two times already: here and here. In summary: Coleman's attempt at meta-analysis seems to suffer from all the flaws one may imagine and it is a mystery how the peer review of the British Journal of Psychiatry can have let it pass, lest the integrity of the referee and editorial procedures of this journal is put into question.

The other day, six further so-called rapid responses to Coleman's article appeared on the BJP site. Of these, all but one expand and further develops the criticism. One response (Koch et al) tries to make the point that the recommendation to inform abortion seeking women about a risk that an abortion may endanger their mental health may still hold, even if the scientific criticism is sound. This is the exact claim that I questioned in my first posting even assuming that Coleman were to be right in her conclusion (which now seems highly unlikely). Let me quote:
...suppose that Coleman indeed is right in the strongest sense, is the most obvious conclusion then that we should move to restrict access to legal abortion? Actually not, since there is strong scientific support for the claim that such actions lead to no good (in particular, they do not prevent abortions). How about informing about the risk then? Well this looks more sensible, although, if the underlying explanation of abortion being a risk factor is that a certain portion of abortion seeking women are already burdened by mental health problems that threaten to become more serious if they are exposed to trauma of some kind, one may doubt the efficacy of such actions.

Instead, the practical conclusion that would seem to be gaining the most support would be this: Researchers like Coleman should rapidly proceed to develop instruments to identify those at risk, and abortion services should offer these women special post-abortion care and counseling, or even preventive actions before the procedure is undertaken that may serve to decrease the risk. If such an instrument proves difficult to develop, such care and counseling should become a standard ingredient of good clinical abortion practice all across the board. I must say that I find it a bit odd and worrying that Coleman's own practical suggestion does not focus on this. After all, if women's mental health is what you care about, practical implications should focus on actions directed at promoting that aim.
Koch and colleagues (one of which has a bioethics affiliation) try to make their point using the precautionary principle, and since this is the subject of a recent book of mine (likewise a forthcoming article in the forthcoming International Encyclopedia of Ethics) you may imagine that I'm tempted to enter the rapidly growing rapid response community myself. For that reason, I will wait a bit commenting on that particular thing until I decide whether or not to address to BJP what is, in several elementary senses, either severe misuse of the notion of this principle or the use of an obviously implausible version of it.