Professor John Crowe:

I represent the Royal College of Physicians of Ireland, the body responsible for postgraduate training in all medical specialties - paediatrics, pathology, public health, occupational health and obstetrics and gynaecology. We thank the Joint Committee on Health and Children for the invitation to make a submission on the recently published heads of the Protection of Life During Pregnancy Bill 2013.

To discuss the Bill and to prepare a submission, a meeting was convened of Fellows from the relevant specialties within the Royal College of Physicians of Ireland as well as the chairman of the RCPI Institute of Obstetricians and Gynaecologists, Professor Robert Harrison, and Professor Fionnuala McAuliffe. Professor Harrison presented to the meeting the institute's submission to the Joint Committee on Health and Children. The institute's submission represents a majority view from institute members on the draft heads of the Bill. Our meeting considered the heads of the Bill, the institute's submission and the involvement of consultant physicians in the very rare clinical instances where a decision is required to terminate the pregnancy of a woman whose illness during pregnancy poses a real and substantial risk to her life. The recommendations of that meeting were conveyed to the 32 members of the council of the Royal College of Physicians of Ireland. The council fully supports the submission of the constituent institute, the Institute of Obstetricians and Gynaecologists, with the following additions.

Head 2 relates to risk of loss of life from physical illness, not being a risk of self destruction.

We believe that in addition to the support of a second obstetrical opinion, and where the patient's condition warrants the opinion of another medical practitioner from a different specialist register, two specialist opinions from that register should be involved.

We accept that while only one specialist is required to examine the patient, the opinion of an additional independent specialist should be sought. In an elective situation, and where practical and in conformity with best practice, a multidisciplinary team would consider a decision to terminate pregnancy. It should be noted that in modern clinical practice generally it is considered appropriate in complex or difficult cases, regardless of whether the patient is pregnant, for a specialist to seek a second opinion and, where practical, to have the issue discussed within a multidisciplinary team. That is modern medicine. Clearly, in emergency situations this may not be practical and we agree with the content relating to emergency situations under head 3.

In conclusion, it is important to recognise that legislation should not seek to define treatment pathways that are more appropriately and safely dealt with through professional judgment in a given clinical situation. Doctors seek to treat patients in line with best clinical practice which is continually evolving. The guidelines for the operation of the legislation will be complex and will require the input of the relevant professional bodies. The Royal College of Physicians is prepared to participate with the Department of Health and the HSE in the development of guidelines on the operation of the legislation. I thank the Chairman.