Ms Caroline Simons:

Good morning Chairman, members of the committee, Senators, Deputies, members of the press and the public. Once again I thank you for the invitation to attend today now that we have the heads of the Bill. I have tried to listen, not to everybody's contribution over the last two days, but to some of them. We have all been impressed by the professionalism and dedication shown by the medical experts. I use that term to cover the experts from all the areas of medicine who we have been listening to. In this phase of the committee's deliberations it has been particularly nice to hear testimony from some of the doctors who work in related areas.

Yesterday we heard from Dr. Janice Walshe, the consultant medical oncologist from St. Vincent's University Hospital. I was particularly struck by her when she said that oncologists who are dealing pregnant women who are suffering from cancer strive for foetal maturity rather than viability while providing all the care and cancer treatment the patient needs. We also heard from Dr. Kevin Walsh, consultant cardiologist at Crumlin and the Mater hospitals, who spoke of the outstanding success of the Mater and Rotunda team approach to dealing with congenital heart disease in women. I was delighted to hear about that because women listening to these proceedings need to know the medical teams in the hospitals are doing their best for patients with whatever complication of pregnancy they have and, happily, with great success.

If the opportunity and time allows I might suggest the committee might also seek the advice and testimony of doctors from another branch of medicine which touches on this. I refer, of course, to consultant neonatal intensive care doctors, who might have something valuable to tell us too, given the kind of conversations we have been having over the last few days about delivery of very premature babies.

Our function today as lawyers is to assist the members in their analysis of the Bill. As lawyers we can look to the formulation of the words in the heads of the Bill and advise the members as to its meaning and, more importantly, to the possibilities to which it might give rise based on our knowledge and understanding of the law. We are not obstetricians or psychiatrists and so we rely on those experts for their expert testimony within their area of expertise. I was interested and particularly impressed in the last couple of days with the understanding the psychiatrists have shown of the law and what this Bill will mean regarding the practice, although it is not their area of expertise. When I hear Dr. Mills and others talk about merging heads 2 and 4, I think there will be some difficulty with that given the difficulty there has been around the suicide issue, which is the subject, as members know, of head 4.

It is interesting that we have come to a point yesterday, which is a considerable development, when we heard the chief medical officer of the HSE talking about this Bill conferring procedural rights on a woman who believes she has a life-threatening condition. We heard another psychiatrist talk about this Bill providing a service which should be accessible and efficient, which is a slightly different requirement than was made of us by the decision in A, B and C v. Ireland. We need to examine what exactly this Bill is doing. Is it about a service provision? Does it have the backing of medical evidence? It seems that it does not. Even though medicine does not prescribe this procedure, it seems the law will demand it. I agree with Mr. Brady beside me that, potentially, the law will allow it throughout the nine months of pregnancy, on a fair reading of the X case from paragraph 35 on and a subsequent case I dealt with in my submission.

In my written submission to the committee I made a number of points. The decision in the X case and these heads of Bill permit the termination of the life of an unborn child, not just the termination of pregnancy, and without any time limit, notwithstanding any of the statements of comfort which appear in the explanatory notes. No evidence has been given to the committee that abortion is efficacious in the clinical care of suicidal women in pregnancy, while there is evidence of increased risk of suicidality following abortion. The decision in the case of A, B and C v. Ireland does not require Ireland to legislate for the X case. There are alternatives which this committee ought to consider, even at this point.

The Bill proposes a procedure as a treatment which is untested, without any scientific basis and which must, therefore, be considered experimental treatment. The usual criteria for the use of an experimental treatment cannot be satisfied by this formula. There is an inconsistency throughout the Bill regarding what procedure the Bill permits. I referred to this in my submission. In head 1 it refers to the medical "procedure that will end unborn human life". In heads 2, 3 and 4 the wording is "medical procedure in the course of which or as a result of which unborn human life is ended" and in head 12 the wording is "termination of pregnancy". There are differences between these three wordings that have very different outcomes and this has ramifications throughout the rest of the Bill particularly regarding the conscientious objection clauses.

Members will see that in my written submission I have dealt with the requirements of the European Court of Human Rights decision in the case of A, B and C v. Ireland and the requirements of the X case, and then I have looked at the law regarding experimental treatments. Finally, because it is so important, I have looked extensively at the law on conscientious objection internationally. Having said that, the law on conscientious objection should have no relevance whatever where we are talking about doctors wanting to practice good medicine and wanting to avoid something which has not been proven to be in any way useful to the management of a patient in circumstances where suicide is an issue. I shall leave it at that and welcome questions the committee raises.