Professor Kieran Murphy:

I will take Deputy Healy's question first, as he asked for an elaboration on the Medical Council's position with regard to conscientious objection. Perhaps it might be helpful for Deputies and Senators if I outline the current guidance. Before doing so it may be worthwhile for me to articulate how the Medical Council came to produce such guidance. Approximately every five years, the council completely revises its ethical guidance, doing so in a way that engages a range of stakeholders. We engage with members of the profession, employers and patient groups. We want to ensure that the guidance we produce to assist doctors will be useful and informed by our engagement with stakeholders. It is also important to say that the guidance produced by the Medical Council is a principle-based document, meaning it cannot deal with every day-to-day eventuality; it deals with principles rather than operational day-to-day matters.

The guidance, as mentioned earlier, follows on from legislation. As legislators, Deputies and Senators are tasked with ensuring that appropriate legislation is in place. Once the legislation is in place, it is the task of the Medical Council to draft guidance based on the legislation. As we heard from the Chief Medical Officer this morning, once the new legislation has been passed, he intends to work with a range of stakeholders, including the professional bodies and the Medical Council, to ensure that the subsequent regulations will implement what is passed by legislators.

Deputy Healy asked a specific question on conscientious objection, so I will outline the current Medical Council guidance on the issue. There are a number of points taken from the guide to professional conduct and ethics for registered medical practitioners, and members may recall that during our submission in January, we circulated copies of the guide. We have not done so this time because we assume they have seen it already. If Members wish to see copies of the guide afterwards, we would be very happy to circulate them. With regard to conscientious objection, the guidance is as follows:

10.1 As a doctor, you must not allow your personal moral standards to influence your treatment of patients.
10.2 If you have a conscientious objection to a course of action, you should explain this to the patient and make the names of other doctors available to them.

That addresses the point made by Deputy Kelleher, which was also addressed by Dr. O'Riordan in her response. The council wishes to see this particular head extended in regard to the Medical Council's third point in the guidance, "10.3 Conscientious objection does not absolve you from responsibility to a patient in emergency circumstances." As we noted in our submission, the Medical Council suggests that head 12 should be expanded to ensure that the holding of a conscientious objection does not absolve the registered medical practitioner of responsibility to a patient in emergency circumstances. The view of the council is that the right to conscientious objection must be balanced against the right of the patient, particularly in the case of a medical emergency.

I will take the questions from Deputies Kelleher and Ó Caoláin together as they relate to the Medical Council guidance on abortion. It might be helpful for Deputies and Senators for me to outline the current guidance provided by the Medical Council to doctors on abortion. The guide states:

21.1 Abortion is illegal in Ireland except where there is a real and substantial risk to the life (as distinct from the health) of the mother. Under current legal precedent, this exception includes where there is a clear and substantial risk to the life of the mother arising from a threat of suicide. You should undertake a full assessment of any such risk in light of the clinical research on this issue.

To address Deputy Kelleher's point, the council formulates its guidance based on the current legal position. The council drafted its guidance in the light of the Supreme Court judgment. The guide continues:

21.2 It is lawful to provide information in Ireland about abortions abroad, subject to strict conditions. It is not lawful to encourage or advocate an abortion in individual cases.
21.3 You have a duty to provide care, support and follow-up services for women who have an abortion abroad.
21.4 In current obstetrical practice, rare complications can arise where therapeutic intervention (including termination of a pregnancy) is required at a stage when, due to extreme immaturity of the baby, there may be little or no hope of the baby surviving. In these exceptional circumstances, it may be necessary to intervene to terminate the pregnancy to protect the life of the mother, while making every effort to preserve the life of the baby.

It is worthwhile restating that this guidance was drafted and published by the council after extensive consultation with a range of stakeholders, particularly the Institute of Obstetricians and Gynaecologists. As I stated earlier, we ensured that this guidance would target to the doctors faced with these decisions and be useful in ensuring that doctors had the appropriate guidance.

Deputy Ó Caoláin asked if Medical Council guidance would change. We are engaged in a process today that will lead to the subsequent development of legislation, and nobody can predict at this stage how the legislation will look. Once the legislation is passed, the Medical Council will examine it and reconsider its advice based on the eventual legislation.

Ms Spillane wishes to make a point on specialist division of the register.