Professor Fionnuala McAuliffe:

Deputy Mattie McGrath was wondering if an obstetrician would disagree with two psychiatrists. Just to reiterate, these are rare situations involving complex medical disorders. We take a multidisciplinary team approach. No individual doctor, or two doctors by themselves, will make these decisions. However, it is our opinion in the institute that if two experienced doctors feel, in good faith, that there is a risk to a woman's life that can only be averted by termination of pregnancy, and if it is our assessment also, then we would be in agreement with that decision.

There were a couple of questions about viability, and Senator Walsh and Deputy Mattie McGrath also discussed this. Foetal viability changes over time. When I first started in medicine the earliest point of viability was 28 weeks. It is now about 23 or 24 weeks, so it is changing all the time. Therefore I would favour not putting gestational age into the law, because it changes. At present, foetal viability is 23 or 24 weeks, so if a baby is delivered at 20 weeks' gestation, there is unfortunately no chance of survival.

If we have to intervene in a pregnancy - for example, if a woman has overwhelming infection or there is some other life-threatening maternal cause at 20 weeks - if we could extend that pregnancy to 24, 25 or 26 weeks, of course we would. Every effort would be made and every effort is made. Regardless of what this Bill shows when it comes to fruition, we will continue our current practice of trying to get every pregnancy to a stage at which the baby will survive, but we have to do that if it is medically safe. If the mother died while we were waiting for that time, that would be a disappointing situation. We work together with our neonatal colleagues in multidisciplinary teams to try to advance gestational age.

With regard to Deputy Naughten's question, our institute's opinion is that we favour legislation plus regulation.

In terms of destruction, to reiterate, if a pregnancy needs to be ended before viability, the baby is delivered and it will die, unfortunately. If it is after the point of viability, the baby will survive.

I was asked if I was aware of any cases of suicidal ideation requiring early delivery. I cannot say that I am particularly aware of it without a review of cases. If a pregnant woman is sick and needs medication, we work together to get a plan in place. Sometimes that may involve pre-term delivery, but we have to take the mother and foetal longevity and life together. We do that every day.

A general point has come up with a lot of the questions. The institute's view is that this Bill will just put a legal framework around current practice. We do not see any significant changes to current practice. It will just give us a legal framework for current practice, so we do not see big changes to how we approach the equal rights to life of a mother and a baby in pregnancy.

The average gestation at which a pregnant woman presents to hospital is generally about 15 to 18 weeks. If she is identified as having a medical disorder she will be seen much earlier. There are medical clinics available at all tertiary referral centres and patients can be seen there from as early as four or five weeks. We often see patients with medical disorders much earlier on. The patients we are talking about will be identified as having medical disorders by the general practitioner and will be referred to us. It is our experience that general practitioners appropriately refer patients in a timely manner.

As regards our opinion on suicide, it is a very rare situation in which a woman is suicidal and the only option is to terminate the pregnancy to avert the risk to life. This is a very rare situation. We have not seen this case, so we know that these cases are very rare. Of course, that does not mean that is not possible or would not happen.

Therefore, it is the institute's preference to put heads 2 and 4 together, as they both relate to risk of loss of life. I ask Dr. Ní Bhuinneáin to briefly address Deputy Naughten's question about what happens if three consultant obstetricians have conscientious objections in a smaller unit. I am not talking about emergency treatment.