Dr. Rhona Mahony:

Chairman and members of the committee, I thank you for the opportunity to comment on the draft heads of the protection of life during pregnancy Bill. I am the master of the National Maternity Hospital. I am a practising obstetrician, having practised for 17 years, and am a specialist in foetal and maternal medicine. I have practised as a consultant at the National Maternity Hospital since 2008.

This Bill is about saving women's lives. Women sometimes die during pregnancy and it is my belief that everything possible must be done to prevent such a tragic outcome. Where there is a substantial risk to a woman's life during pregnancy there should be no hesitation to save her life. If she dies her baby will die too. Despite this fundamental imperative there remains today in Ireland a lack of clarity surrounding when termination of pregnancy is legally permissible. It could be argued that the State has gone to great lengths to avoid legislating for this reality, the reality of maternal death as a consequence of pregnancy. This is inexcusable.

Provision has been made in Ireland for women to access termination of pregnancy outside of this jurisdiction despite the fact that it remains a criminal offence in Ireland. I believe this Bill, which is restricted to circumstances where a pregnant woman is at risk of dying, sets out to provide clarity in a number of key areas which directly affect clinical obstetric practice. Despite the Supreme Court judgment in the X case which provides for termination of pregnancy when there is a real and substantial risk to a pregnant woman's life which may be ended or removed by ending the pregnancy, there remains today no legal framework through which this risk can be determined. This leaves doctors and their patients, women at risk of dying, legally vulnerable. This Bill addresses this issue.

The Offences Against the Person Act 1861, sections 58 and 59, means that abortion, termination of pregnancy, is a criminal offence in this country. This is addressed also by the Bill and provision is made to remove this which is necessary. At present there is no formal process through which a woman who perceives that she is at risk of dying can access opinion on whether termination of pregnancy is appropriate. I believe women deserve that consideration and this Bill addresses that issue. I therefore commend the Government on the decision to provide legal protection for women and their doctors in this very difficult, rare and complex circumstance when termination of pregnancy is necessary to save a woman's life.

Most importantly, I understand that according to this Bill the constitutional protection of the unborn is preserved where practicable. We must vindicate the life of the foetus where it is practicable. This obligation has underpinned my clinical practice over 17 years and will continue to do so. In current practice all efforts are exhausted within the medical margins of safety to prolong pregnancy in the foetal interest. When a foetus has reached a gestation where survival is possible, every effort is made to optimise that survival. This is regardless of the indication for termination of pregnancy which in this context will be to save a woman's life. In practical terms with current neonatal intensive care, neonatal survival is now possible from as early as 23 weeks' gestation. Every year in Holles Street we look after at least 20 babies who were born somewhere between 23 and 26 weeks' gestation. This is not strange to us.

I want to leave the committee in no doubt of the following: we do not destroy or kill foetuses. We deliver them and on occasion delivery in order to save a woman's life is required at gestation so early that very sadly foetal survival is not possible. In this context if a pregnant woman dies her baby will die too. It is my experience - and I am experienced in this area, I specialise in foetal and maternal medicine - the majority of women do not wish to lose their babies but they do not want to die. The indications for termination of pregnancy prior to foetal viability include situations such as infection, choreoamnionitis, blood pressure that we are unable to control, haemorrhage, treatment for some cancers and management of severe medical disorders in pregnancy such as heart disease. These situations are very complex and very rare. At the National Maternity Hospital, which is one of the busiest maternity hospitals in Europe, we have annually up to five cases.

Following the months of debate regarding the draft heads of this Bill one could be forgiven for thinking that this Bill is about the risk of suicide in pregnancy.

It is not. It is about saving a woman's life regardless of whether that risk to life is physical or mental. Suicide is death just the same as death from infection chorioamnionitis; women are dead. A woman who is intent on suicide is indeed at risk of dying. She needs to be assessed appropriately, she needs to be believed and she needs expert psychiatric care.

The committee has already obtained my written submission in regard to each of the heads of the Bill and all my comments on those are set out in it. I think some practical amendments to them will need to be included. For example, in respect of the person carrying out the termination and the definition of obstetrician-gynaecologist, not all obstetricians and gynaecologists are on the specialist register. It is a technical point but it would be more pragmatic to refer to the term "obstetrician-gynaecologist".

The issue of location is also very important. We are a stand-alone maternity hospital in Dublin. When women become very ill we are often required to transfer our patients to a hospital that has a broader medical network where women can access a variety of areas of specialist care. Therefore, provision should be made to include all Government approved hospitals in the Bill.

I am pleased to note that conscientious objection is addressed in the Bill. I am also pleased to note that provision is made to remove the Offences Against the Person Act 1861.