Dr. Rhona Mahony:

Deputy Kelleher expressed concern that legislating for the termination of pregnancy in order to save a woman's life could have a major impact in terms of numbers. I do not believe that will be the case. We are speaking about a tiny proportion of women who we believe will die if their pregnancies are not terminated. This is an extremely rare scenario. Nobody is proposing to open the floodgates or create a situation in which we will be performing multiple terminations of pregnancies. The risk of death in pregnancy is extraordinarily rare but it does exist. I do not believe this particular issue gives rise to concerns about numbers.

In regard to conscientious objection, we are discussing women who might die. I am a doctor. I do not conscientiously object in my duty to save life. We are not dealing with broad issues surrounding termination of pregnancy. We are addressing cases in which we believe a woman is going to die during pregnancy and where the risk of death can be ameliorated by ending her pregnancy. I refer to serious medical disorders which we believe will result in death.

On the issue of suicide, nobody is suggesting that termination of pregnancy is a cure for mental anguish or the disorders associated with suicide ideation. However, in very rare cases women commit suicide. There have been two deaths relating to suicide between 2009 and 2011.

A woman wishing to take her life in pregnancy is rare. It can be assessed by our psychiatric friends. It involves women being listened to, believed and treated in the totality of the condition. Nobody suggests that the termination of pregnancy is a cure for suicide, but it may be appropriate in certain very rare circumstances as part of a general treatment plan.

The next issue that Deputy Ó Caoláin raised was the idea of probability versus certainty. Doctors always deal with probability. We rarely have the certainty that death is inevitable until it has happened. So we deal all the time with probability. We are asking to have the flexibility and the legal protection to make sound sensible medical decisions based on medical probability. We do not have the luxury of certainty or of being able to look into the future and say: "Yes, that woman will definitely die." We do not have that certainty but we need to have flexibility where we believe there really is a risk that a woman might die. We come across women who have serious underlying medical disorders and who die. We see this in the triennial report into death. We treat women who wish to continue their pregnancy and for whom the treatment during pregnancy is terribly challenging. We need flexibility and legal protection. This is about saving life where possible. Society may be reassured that our aim is to preserve life where possible.

The question about timeframes relates to emergencies. In an emergency case where a woman is definitely dying, there is no hesitation, but obviously in most units in the country we have a number of consultant obstetricians. For example, in a hospital such as the National Maternity Hospital we always have a consultant obstetrician who is first on call. They are on the specialist register. There is always a second obstetrician in reserve on call for those difficult cases when we are very challenged. There is generally an adequate quorum, I believe, in terms of whether the need for a termination of pregnancy arises in an emergency or an acute situation. Where we have a bit more time - doctors work in teams - we very much work in a multidisciplinary fashion. When we are making important decisions such as this, we will gather all the information available to us from within our own field and, if required, from other specialist fields. We will put that information together and make the best decision we can, but we will make that in a multidisciplinary fashion. Nobody is suggesting that doctors would ever make such decisions in isolation, but this can be done in an expeditious manner, I believe.

Sections 58 and 59 remain in force. Abortion in Ireland is a criminal offence which is punishable by penal servitude. That law stands today and I need to know that I will not go to jail if in good faith I believe it is the right thing to save a woman's life to terminate her pregnancy. I want to know I will not go to jail and I want know, by the way, that she will not go to jail. It does not matter whether anybody has been sent to jail previously - that is not at issue. The point is there is a significant risk that I could be sent to jail or I believe and perceive there to be a significant risk I might go to jail. That is something I want clarified or further guidance in.

Deputy Mattie McGrath asked about suicide. Suicide is extremely rare in pregnancy. A woman's wish to take her own life during pregnancy is terribly aware. As I have said, I am not for one moment suggesting that termination of pregnancy is a cure for suicide, but perhaps we must allow for the fact that in certain cases certain women will kill themselves during pregnancy and we must have a way of assessing that and we must treat these people with compassion and with expert care.

We should be very careful of absolute statements such as the so-called Dublin declaration, which I do not particularly recognise. I think it is not correct to say there is never an indication for termination of pregnancy and we need to be very careful about absolute statements. We are talking about real life and in real life there are rarely absolutes.

With regard to mental health, as Dr. Coulter Smith has pointed out, approximately 10% to 15% of women will be affected by a variety of disorders of mental health. In the vast majority of these cases, these women can be very successfully treated during pregnancy. They do not have to stop taking anti-depressants - they can receive their expert care and treatment during pregnancy. For many of these women we have no concern that they will kill themselves. They require treatment for their disease but we do not have a concern that these women will kill themselves. We have excellent perinatal psychiatrists. I appreciate we only have three, but we are not talking about dealing with all issues pertaining to mental health. We are talking about the very tiny number of women who wish to kill themselves during pregnancy. It is a tiny number of women and I believe we have the capacity to do that, but that is obviously a question that needs to be put to the expert psychiatrists who will address the committee later today. It must be stressed that we are talking about a small number of women.

Deputy Ó Caoláin asked a very interesting question about how the substantial risk to life is assessed. He also asked how we develop a tool with such precision that we can identify those women who will die either because of medical disease or through taking their lives. Of course, it would never be possible to come up with perfect legislation or regulation. We are asking for lawyers to draft legislation that will allow us some flexibility. It would be impossible, for example, to write a list of disorders that might qualify. That is not really what I am suggesting. I believe that two expert medical doctors or additional doctors in the variety of specialties might be required - for example cardiology, psychiatry or whatever. I believe that two consultant obstetricians, who are experts in the field and who are able to gain all the information they need and obtain advice from their colleagues, are able to determine when there is a significant risk to life in a pregnant patient. I believe they should have the ability and flexibility to identify those women and to treat those women appropriately without fear of prosecution. It is for doctors to make the medical decision whether someone is likely to die. This is a medical decision based on medical fact. Doctors must be able to make these decisions if they are to do their job properly and preserve life.