Professor Kieran Murphy:

To deal firstly with Deputy Mitchell O'Connor and the question that she raised about to what is evidence based, it is important for committee members to understand that, increasingly, the practise of medicine is evidence based. What does that mean? It means that to make a decision, a doctor must weigh up the available evidence. He or she must ensure the treatment option he or she is providing for his or her patient is based on the best available evidence. Consistent with that council approach in its guidance to doctors, all decisions should be made using an appropriate evidence base. That means being familiar with the literature in this area to ensure doctors are guided to act in the best interests of their patients.

The role of the Medical Council is to ensure doctors act in the best interests of their patients. It might be helpful if members could look at the introduction to the ethical guide. It states in the first paragraph that the patient-doctor relationship is a privileged one that depends on the patient's trust in the doctor's professionalism. The role of the Medical Council is to safeguard the public by ensuring the quality of the doctor's competence, behaviours and relationships that underlie this professionalism is maintained in the patient doctor relationship. Of particular relevance to the current discussion is the second paragraph on page 7 of the guide, which states that doctors must always be guided by their primary responsibility to act in the best interests of their patients, without being influenced by any personal consideration. They should act independently in the service of their patients and have a responsibility to advocate with the relevant authorities for appropriate health care resources and facilities. It is very important that doctors understand they need at all times to act with the patients as their primary interest. Every action that doctors take has to be guided by that principle. As part of that process, the council reminds doctors that any decisions they take need to be guided by what the evidence is that supports their decision.

With regard to Deputy Ó Caoláin, who referred to the formal review process, clearly, as Ms Luddy indicated earlier this morning, a lot more work needs to be done to tease out the individual detail that will be contained within the regulations.

Clearly the process we are undertaking today and for the next two days will inform the debate. It is important that the Members of the Oireachtas seek information from the obstetricians and psychiatrists who are faced in clinical practice with these scenarios. The purpose of the Medical Council document is to set out the principles which need to be safeguarded so that it can be assured that the protection of the public is maintained. I think this clearly will evolve with the development of regulations. As I mentioned earlier, we are very keen to work with the Department and other stakeholders to ensure that those principles on which the Medical Council has set its position are maintained in the development of these regulations.