"IMG until the 9th month for '' psychosocial distress '': the danger of an imprecise reason"

Today, except in the case of a serious condition of the unborn child, it is necessary, for an interruption of pregnancy to be practiced for medical reasons, that the continuation of the pregnancy puts in "serious danger" the health of the child. wife. This practice, called medical termination of pregnancy or IMG, is possible until the 9th month of pregnancy.

IMG should not be confused with abortion, which can be performed without medical reason until the twelfth week of pregnancy.

Regarding the IMG, this notion of serious danger was already included in the Veil law and, during parliamentary debates, had given rise to some clarifications. On November 28, 1974, during the examination of the former article L.162-10 of the public health code, an amendment was tabled to specify that the concept of maternal health included physical and mental health. . Mrs. Simone Veil herself had specified: "The very term health covers, it seems to me, the mental aspect as well as the physical aspect". Under these conditions, at the time, this amendment had been rejected, the law simply retaining the criterion of continuing the pregnancy seriously endangering the health of the woman.

In fact, for several decades and to this day, the possibility of having recourse to medical interruption up to the 9th month has been possible when a situation of serious psychiatric danger to the health of the mother was observed.

This is the analysis adopted by an article in the journal La lettre du Gynécologue of September 2003 entitled: "Medical termination of pregnancy for serious psychiatric danger " . For the editors of the article, “dangerousness is linked to impulsivity and poor drive control rather than a delusional state. The major risk is the passage to the suicidal act and / or to hetero-aggressive behaviors on the fetus (blow, bladed weapon, drugs, etc.) ”.

The article thus summarized the process to be followed to assess the risk to the mother's life and to check whether there is indeed a serious danger: “The medical team must respond within the framework of the law. The psychiatric evaluation is enriched with psychosocial data which makes it possible to pose the risk of danger to the mother and her child. The initial assessment relates to the existence or not of a psychiatric pathology established. Secondly, the risks of taking action on the mother and the child are posed. "

The summary of a doctoral thesis in medicine defended on March 6, 2013 by Mrs. Lucie Versnaeyen underlines that, in practice, IMGs have been accepted for broader reasons: “At the medical level, the little existing literature On the subject, there are three main types of indications of admissibility of a request for IMG for psychological peril. The first is the major risk of self-harm related to pregnancy. The following refer to the notion of psychological suffering incompatible with the continuation of the mental life of the woman: a severe and / or chronic mental illness aggravated by the pregnancy and a risk for the mental health of the woman in the event of continued mental health. the pregnancy."

Thus, under the legal regime currently in force, in practice, it would not only be the risk of switching to a self-injurious act that would make it possible to agree on a serious psychiatric danger, but also psychological suffering that is absolutely incompatible with the mental health of the patient. wife.

Recently, however, the desire to broaden the concept of serious psychiatric danger has emerged. On October 31, 2019, the National College of French Gynecologists and Obstetricians published a press release listing the cases in which, according to it, a “medico-social IMG” could be performed. By the use of the term "psycho-social IMG" and by the cases cited, the press release appeared to increase the possibilities of having recourse to it: the sole situation of serious psychiatric danger gave way to conditions such as the finding of "personal danger, violence, major psychological difficulties or extreme precariousness".

In addition, in a letter of April 23, 2020 that France Info said it had consulted but of which we do not know the exact content, Mr. Olivier Véran, Minister of Health, affirmed that “psychosocial distress” would be retained as the reason for the requests. late abortions, delayed beyond 12 weeks due to confinement. It was to engage the government explicitly on a path which was not envisaged by the legislator on the subject of the abortion.

Last May, two associations were moved by the possibility of performing IMGs for the hazy reason of "psycho-social distress". In an appeal filed with the Council of State they considered that this interpretation, defended in particular by the National College of French Gynecologists and Obstetricians, was unlawful. In a judgment of June 15, 2020, the Council of State rejected the plea. But he recognized a contrario that an IMG until the 9th month decided for the sole reason of a "psychosocial distress" without a certain and immediate serious danger for the health of the mother not being noted, would constitute an illegal practice. .

Secondly, the Council of State noted, in view of the documents produced, the absence of proof, to date, of IMGs practiced for reasons of “psychosocial distress”.

However, shortly after, on the night of July 31 to August 1, 2020, with the amendment adopted in the middle of the night, on the sly, within the framework of the bioethics bill, the IMG until the 9th month becomes possible when "the continuation of the pregnancy seriously endangers the health of the woman, which could result from psychosocial distress ”. The notion of “psychosocial distress” becomes a sufficient factor to justify a serious danger and to perform an IMG. From now on, the serious danger risks being observed independently even of the risk weighing on the health of the woman, simply as a consequence of a "psychosocial distress" of variable geometry: precarious social situation, risk of conjugal or intra-family violence, psychological fragility. not risking the mother's life in danger.

With this risk of embezzlement, militant associations would rush into the breach to push women to have recourse to the IMG because they have exceeded the 12-week deadline and they can no longer go abroad. . This diversion would be possible until the last day of pregnancy, even when the child is viable.

Step by step, because of existing pressures, abortion would risk becoming, even in the case of a very advanced pregnancy, the only solution to respond to a precarious situation. One can fear, in the long term, that this amendment will only be a step in asking as a consequence of a “right to abortion” constantly brandished, the elimination of any time limit.

A solution necessarily traumatic for mothers and for the medical profession instead of alternative support solutions, always possible in the event of psychosocial distress. A solution revealing that the unborn child would no longer benefit from any protection in our country. In the first days of its existence, it would become material for the most hazardous research and experiments. Until the last months of pregnancy, even the absence of disability could no longer protect him. It is therefore absolutely essential to encourage senators to reject the amendment which was adopted by the deputies.

This column is written by Hubert VEAUVY , lawyer, and co-signed by Fabien BOUGLÉ , lawyer, municipal and community councilor of Versailles; Claire BOUGLÉ-LE ROUX , lecturer at the University of Versailles-Saint-Quentin; Jean-Eloi DE BRUNHOFF , lawyer; Adeline LE GOUVELLO , lawyer; Aude MIRKOVIC , lawyer for children, lecturer in private law and Bernard RINEAU , lawyer.