Professor Fionnuala McAuliffe:

In response to Deputy Kelleher's question about the lack of legal clarity, we feel strongly that it is in a patient's and the public interest that doctors work within a legal framework. If a woman is at substantial risk of dying in the immediate hours and days, there is no legal difficulty, we press on and offer treatment. I am, however, aware of cases in which there is a substantial risk to the woman's life which is not immediate and around which there is legal uncertainty. We have referred those cases to the UK for treatment.

In response to Deputy Ó Caoláin's question about general hospitals and termination of pregnancy, most of the cases we deal with involve patients with severe medical disorders. Many of them need access to intensive care units, physicians and so on, for example, a patient with a deteriorating heart problem would be in coronary care in a general hospital. If a time came when we felt that termination of pregnancy or delivery of a very premature infant was required that would happen in the general hospital because the maternity unit would not have the facilities to look after that patient. That is why we feel strongly that the general hospitals need to be included. If, for instance, the woman was in an intensive care unit in a general hospital and deteriorated suddenly and needed delivery of the baby there would not be time to transfer her to a maternity unit. It would not be safe to do so. That is why we feel these life saving procedures should be carried out in all hospitals. Most of our patients are medical patients and need access to intensive care units and physician input. Many of these are already being cared for in general hospitals.

In response to Deputy Conway's question about minors, the age of consent is 16 so if the patient is over 16 we treat her as any other patient. If she is under 16 her next-of-kin needs to consent. Thankfully, our rates of teenage pregnancy are relatively low. If the patient was medically very unwell and was under the age of 16 we would require her next-of-kin to consent on her behalf. If she is very unwell we will go ahead and treat her. If somebody was at substantial risk of a life-threatening problem she would receive intensive psychiatric or medical treatment. That treatment would continue and the issue of delivering the baby earlier, termination of pregnancy, would require her input and that of her next-of-kin.

In regard to the review panel, the patients we are discussing are usually receiving intensive medical treatment which is ongoing and the issue of the termination of pregnancy or delivering the baby early is part of that package but the other treatment will continue in the background. I agree with Deputy Conway that we need a review panel that would be timely. We discussed this at institute level and decided that there should be a panel available of ten, 20 or 30 doctors so that one could quickly get a second opinion if required. The details will have to be worked out but I totally agree with the Deputy that we need something that will act in a timely way and will be workable. The psychiatrists have a system for a second opinion in place whose structure we might consider for this panel.

In response to Senator Crown I am not aware of any case in which a woman died as a result of the legal vacuum. If a woman is in imminent danger we press on and treat her. One of our concerns about the emergency situation is that if a woman is really very unwell we do not want doctors to delay treating her because they have to get two consultant obstetricians, plus or minus a physician, filling out paperwork while she needs to proceed to deliver the baby either before or after viability. I am not suggesting any great change in practice. If any pregnant woman in any hospital in the country is very unwell she will receive treatment. It is important that doctors be protected so that in the emergency situation they can get on and deliver that emergency treatment.