Professor Kieran Murphy:

I will deal with Senator Burke's questions first. Senator Burke asked if the council had a view on the roles and number of doctors who should be involved in a decision. I refer members of the committee to our submission at paragraph 6.4 of page 4 where it is set out that, in regard to the number and role doctors, the view of the Irish Medical Council is that legislation and-or regulation should set out criteria in that regard. It further sets out that the council will actively engage with the Department on the development of regulations in collaboration with other stakeholders and submits that legislation and-or regulations should include a requirement that relevant doctors have sufficient knowledge and skills to facilitate appropriate clinical decision making. The primary role of the council is to protect the public, which is done by ensuring doctors have the necessary knowledge and skills to practice safely. As Ms Spillane outlined, our specialist division is one we see as providing a hallmark of quality. A doctor registered in the specialist division has a standard of training which is benchmarked with the best in the world. It is the council's view that a doctor who makes these decisions should be in a specialist division of the register. It assures the public that decisions are being made by the most appropriately qualified individuals. Senator Burke asked about the number of perinatal psychiatrists, from three of whom the committee will hear later a joint submission. It is a matter for the HSE and employers to determine whether there is sufficient capacity in the health service to meet needs. I am sure the committee will ask the perinatal psychiatrists whether they feel that capacity is sufficient.

I was asked in the context of suicide how many terminations had been carried out since the X case. The council does not have this information. It is important for the committee to be aware that the council is made aware of situations only where a complaint is made. Approximately 420 complaints were received by the council last year. If the council receives a complaint on any matter, well established robust procedures are followed to ensure it is thoroughly investigated. A committee of the council has a significant range of powers to permit it to adequately investigate any complaint and each one is taken seriously. A decision is made on the basis of that committee's deliberations as to how a complaint should be addressed. In certain circumstances, a complaint proceeds to an inquiry. Members of the joint committee will have seen that since the advent of the Medical Practitioners Act inquiries are held in public. While inquiries have been always held, they were conducted in private in the past. Following the commencement of the legislation in 2008, an inquiry is held in public unless there is a particular sensitive reason it should be held in private.

I was asked if there were similar guidelines in place prior to the X case. It is important to understand that each medical council has a five-year term and publishes its own guidance, which usually constitutes a refinement of the existing guidance.

Each council publishes its own guidance. It is usually a refinement of the existing guidance so the council would see each edition of the ethical guide as a further refining of guidance that the council offers. It is important for Members to be aware that because medicine is constantly changing we need to ensure that the guidance that we provide to doctors takes note of the fact that medicine is continually evolving. The reason that the council publishes editions of guidance is to reflect this fact. We of course had guidelines which pre-existed the X case but the current guidelines that the Medical Council has produced, which Members can see in paragraph 21 of our submission, reflect the current legal framework.