Professor Fionnuala McAuliffe:

In response to Deputy Peter Fitzpatrick, it is fair to say the lack of evidence on the role of termination in the treatment of suicidal pregnant women is an ethical concern for our members. However, we need to remember that we are talking about pregnant women, in respect of whom after consultation two senior obstetricians, plus or minus physicians or psychiatrists, feel there is a significant risk to her life which can only be averted by termination of pregnancy or early delivery of the baby. We are talking about a small number of cases of very sick women who need access to life-saving treatment. The general view of the institute - the majority view - is that we will not differentiate between causes of risk to life, whether they be mental or physical.

The Deputy asked if it was ethical to perform a termination for a suicidal woman. Again, we are down to the expert assessment of two psychiatrists, plus an obstetrician. The Deputy needs to remember what we are talking about. We are talking about risk of threat to the life of the mother which can only be averted by termination of pregnancy. Therefore, we are talking about very serious conditions and we are talking about small numbers of cases. These are issues that we will resolve using a multidisciplinary approach.

There was a question about late terminations which I addressed in my opening submission. There is no question of late terminations in the Bill, as far as the institute is concerned. If the baby is delivered before viability, it will die unfortunately - that is a very sad consequence. If the baby is born after viability, every effort will be made to support its life. I hope that is clear.

Senator Colm Burke asked about the role of the obstetrician in suicidal cases. As obstetricians, we need to be centrally involved in any decision in terms of termination of pregnancy or early delivery of the baby because we are the experts in pregnancy and can assess it. There could be other comorbidities in the patient who is suicidal. There could be comorbidities that need to be assessed. She needs to be assessed for her health to assess whether she is even suitable for any procedure or process. Therefore, we in the institute strongly believe one obstetrician should examine the patient and sign the documentation, but he or she should seek a supportive second opinion - at least one. It is normal practice that there be multiple opinions, but we are stipulating that one obstetrician in all of these cases, regardless of the cause of risk to life, examine the patient and sign the documentation but seek the support of a second opinion.

In terms of the smaller units, we envisage that networks would be available. As the Senator knows, earlier this week proposed networks were published. It would be good clinical practice for smaller units. There are informal networks where people will refer to certain hospitals. I often receive telephone calls from my colleagues outside Dublin. I am happy to receive a telephone call at any time of the day or night and any day, including weekends. Therefore, we are there to support each other. I would certainly favour having a more structured referral pathway for all complex pregnancy disorders.

Senator Ivana Bacik mentioned location. The Institute of Obstetricians and Gynaecologists believes this should be available in all Government-approved hospitals which would include the 19 maternity units because these women are sick and need to have access to the appropriate medical care, whether it be psychiatric care or a coronary care unit or an intensive care unit. We believe very strongly that it needs to be opened up outside these maternity units. It needs to include Government-approved general hospitals.

In terms of the unborn, if a foetal heartbeat is absent, that is a miscarriage. There is no ethical dilemma that I am aware of around this. If a foetal heartbeat is absent, unfortunately, the baby has died and either the patient will miscarry naturally or we can give her medication or perform a procedure to speed up the process.