Professor Fionnuala McAuliffe:

In response to Deputy Ó Caoláin, we feel strongly that there must be a legal framework within which to make our clinical decisions. That would protect the public, our patients and health care professionals. We are not aware of a case of maternal death because obstetricians were reluctant to act, but we strongly feel robust legislation is needed to give a framework for our work.

In respect of the chair of the review panel, we discussed this issue briefly and felt they could be recruited from either the medical or the legal profession. That is our position; we have not come down strongly on one side or the other.

In response to Deputy Naughten regarding the situation in smaller hospitals, if a woman presents at a smaller unit on a Saturday night with severe blood pressure and needs delivery as her life is in danger, that patient will be looked after. That must be clearly stated. We have lovely data from Professor Greene. Our units in the hospitals are of very high quality and the results are excellent. In an emergency a specialist can make these decisions and offer life-saving treatment. If time allows and the patient is unwell but not immediately in danger, one could refer her to a larger unit where, perhaps, there is more expertise available. However, if a woman arrives at any maternity unit in the country at the weekend, at night and is very unwell and needs delivery at whatever stage of the pregnancy, she will receive that treatment. That is part and parcel of running a maternity unit, regardless of its size. As Dr. Ní Bhuinneain said, if a patient arrives and there is some uncertainty as to whether she needs delivery, a second opinion can be sought by telephone. That is why it is important that we make provision for emergency cases, whereby one doctor can make this decision to allow a woman's life to be saved.

With regard to suicide, the institute believes two obstetricians should be involved in any decision to deliver a baby before or after viability, termination of pregnancy or delivery of a pre-term baby in the suicide case. We feel that in any case in which there is a substantial risk to the life of the mother, be it suicide or medical, two obstetricians should be involved in that decision.