Professor Kieran Murphy:

I will deal with Deputy Peter Fitzpatrick's questions first. He raised issues regarding the guidance on conscientious objection and also the guidance on abortion. As I previously read the detailed guidance for doctors, I do not propose to waste the members' time by going over the issue again. I have dealt with that issue previously.

The Deputy's point about the absence of markers for suicide is most appropriately put to representatives of the College of Psychiatrists of Ireland who will be before the committee on Monday.

Senator Burke asked for the rationale as to why the Irish Medical Council proposes heads 2 and 4 should be merged. The council clearly emphasises the significant role of the obstetrician in the process. It is the obstetrician who will perform the procedure so he or she must have a central role in the process. The issue for the council relates to ensuring all doctors work in their particular scope of practice. To deal with physical health under head 2, if a cardiac problem arises and it is judged by a cardiologist that there is a real and substantial risk to the life of the mother and the only intervention to save the woman's life is a termination it may be appropriate, and this would be up to the clinicians involved, that the two people best placed to make the decisions are cardiologists, but not necessarily so. It may very well be that one of the two is an obstetrician. If this is the case an obstetrician will be involved in the certification in the first part at least.

Head 4 relates to assessment of suicide risk. The council is concerned to ensure doctors work within their scope of practice. In the assessment of risk of, as the draft heads of the Bill state, a threat of self-destruction, the council's view is that psychiatrists are best placed to make the assessment. If the psychiatrists agree there is a real and substantial risk to the life of the mother and that the only way it can be dealt with is by a procedure of termination then, as the Irish Medical Council put in its submission, these psychiatrists should consult with the obstetrician. It is very important that Deputies and Senators understand the council's view is that obstetricians have a central role in the process but doctors must work within their scope of practice to ensure the safety of the woman is protected at all times.

Senator Burke also raised the issue of age of consent. In my verbal submission I did not make this point because of time but I will mention it now. In our written submission we state in circumstances where the pregnant woman's capacity to consent is, or may be, impaired it is not clear from the draft heads how a decision regarding termination of pregnancy will be made and how the woman will be enabled and supported to participate in this decision. Furthermore we state the draft heads do not make reference to the legal age of consent for minors. Specifically it is not clear who will have decision-making authority in circumstances where the pregnant woman is under 16 years of age. In accordance with national policy, the council believes the voice of the young person should be considered and appropriate provisions should be made.

I hope I have addressed the questions asked by Senator Bacik on heads 2 and 4. We address her final question in our submission, but it is worth stating again that it is very clear only a very small minority of psychiatrists are attached to the appropriate locations. Importantly, not all psychiatrists are employed in institutions which are registered with the Mental Health Commission. Ms Spillane wishes to make a further point on one of the questions.