Dr. Mary McCaffrey:

I am merely saying we do not have the gynaecology wards to put these women in. A pregnant woman, who is already fragile because of her condition, would be put into a ward with pregnant women who are having babies and we did not feel that this was appropriate in a number of units.

We then looked at obstetric emergencies. The consensus of the group was that this is something we carry out on a day-to-day basis in our practice. We are talking about women with severe infections, severe sepsis, severe haemorrhage, a condition called fulminant pre-eclampsia, or HELLP syndrome. We manage these on a regular basis as obstetricians in smaller maternity units, and we decide on some occasions that we will transfer them to bigger hospitals. In many circumstances it is inappropriate for a pregnant woman to be sent 70 or 80 miles in an ambulance and in those circumstances, we ourselves stabilise and manage the women. This is regular practice, and we felt this practice should continue. We felt that most people, as best practice, consult with other colleagues in managing complex cases and that such practice would continue. We were not really convinced that a formalised signatory process was necessarily appropriate.

Another issue is that of babies who may be born on the cusp of viability. This issue of what is extreme immaturity has come up already today; one is looking at babies who are born at 23 or 24 weeks, and a woman's dates might be wrong. Such women would be better served in a maternity unit of larger size. If it was unsafe to transfer a woman, we would utilise the services of the neonatal transport team, which already exists and serves rural areas very effectively.

Lastly, I want to deal with the issue of conscientious objection. One of my colleagues is aware of a situation in the United Kingdom in which nine out of ten anaesthetists - the people who put patients to sleep - would not anaesthetise for terminations of pregnancy. The conscientious objection clause is very important in the hearts of many people here, and the current Medical Council guidelines facilitate that.

There was concern about one sentence in paragraph 6.9 of the expert report, which states: "Most jurisdictions accept that an individual's right to conscientious objection is not absolute and ... has limitations." All of my peers accept that they will always do what is best for a patient in an emergency situation, but people have the right to conscientious objection and that must be respected. I have worked in the United Kingdom. Everyone I have spoken to has worked in other jurisdictions where termination of pregnancy is performed and everyone's right to conscientious objection has been respected elsewhere. It is important to us that this will also be the case under future legislation here in Ireland and that nobody is discriminated against in his or her job or future job prospects. I thank the committee for taking time to listen.