Dr. Peter Boylan:

Deputy Billy Kelleher raised the issue of self-destruction or suicide in pregnancy. My expertise and that of obstetricians is in the area of obstetrics, not psychiatry. I understand the council of the College of Psychiatrists of Ireland has made a submission. It is the representative body of the more than 800 psychiatrists in the country. As an obstetrician, I am happy to defer to their expert opinion. If a woman is referred to me by a psychiatrist whose opinion I respect - an opinion which is not driven by ideology but by care for the woman, taking everything into account - and if that psychiatrist believes the only way she will be prevented from killing herself - it is her life I am talking about - is by terminating that pregnancy and if I trust the psychiatrist's opinion, I will terminate the pregnancy. If the mother dies through suicide, so too does the baby. This is about the protection of life in pregnancy. That is my comment in that regard.

I advise the committee that it should not really give much credence to evidence which is not expert in this area. I also advise it and perhaps the broader public and the Government in general not to be misled by bad science. Medicine and society are littered with examples of the damage bad science can cause. One of the most recent examples which will be fresh in people's minds is the evidence from the United Kingdom of the bad science about vaccination and a link with autism in children. The consequence of that bad science has been many children dying and many ending up mentally handicapped. If the committee plans to interpret scientific studies, I advise that members should make sure they are from a good reputable source and that they have been properly conducted. That is all I wish to say about suicide.

Dr. Sam Coulter-Smith will deal with the point raised about the Medical Council. I am very satisfied with the legislation proposed. I did not go through my commentary on the various heads of the Bill because I did not understand that was part of my opening presentation but, no doubt, it will arise during the course of the discussion. I am happy to deal with the individual heads, if the committee wishes and there is time to do so.

Foetal viability is considered in all of our clinical decisions. This arises, for example, in the case of women with extremely severe hypertension. In that case if a mother has seizures, she may well die or she may effectively become brain dead or blind if we do not deliver the baby. We will deliver a baby at 23 weeks in order to save a mother's life. As I said, we cannot allow a woman who is pregnant to die in front of our eyes. We cannot allow her to get to a situation where she may kill herself. If she kills herself or she dies, the baby dies too.

Deputy Mattie McGrath and others asked about the method of termination. The majority of terminations of pregnancy will be done medically by induction of labour, certainly in the early stages of pregnancy. We do not at any stage set out to destroy life. The Bill is about the protection of life in pregnancy; it is not about the destruction of life in pregnancy. The concept that Irish obstetricians would involve themselves in dismemberment of a living foetus is, frankly, on the extreme end of I am not sure what, but it is on a very extreme edge of opinion and not one that would be shared by us.

In reply to Deputy Caoimhghín Ó Caoláin, there are no intensive care units in the three Dublin maternity hospitals. That is one of the reasons we need relocation in order to be located close to general hospitals with intensive care facilities. Despite this, we have very good working relationships with the general hospitals. Holles Street Hospital has a very good relationship with St. Vincent's Hospital. We transfer women to St. Vincent's Hospital when they are very ill and require intensive care. It is not entirely satisfactory because they have to be put in an ambulance, sometimes on a ventilator, and transported. We deliver babies in St. Vincent's Hospital on occasion when we believe the mother will be at risk, particularly in a case of a severe form of placenta previa where there can be dangerous bleeding. There is that precedent, but it would be much better if we were co-located. When the Deputy is in government, no doubt he will accelerate that process.

On the question about designated hospitals, I make the point in my submission that because of the way things will happen in emergencies all Government-approved hospitals in the State should be designated rather than just the maternity hospitals or maternity units in general hospitals. Things can happen very fast. One cannot have a situation in Mount Carmel Hospital, for example, where a woman is going to die if she does not have a termination of pregnancy, but she is put in an ambulance and dies on the way to a designated hospital. It is a minor point, but it should be considered by the committee when reviewing the Bill.

On the specialist register question, some of the more senior colleagues are not on the specialist register, even though they have been consultant obstetricians for many years. This is a result of historical reasons because a specialist register was introduced by the Medical Council in 2005 and some specialists have not bothered to put themselves on the register. That is a minor matter.

Everyone in this room will be aware of the relative shortage of specialists in the country. We have the lowest ratio of specialists per head of population in the European Union. On occasions such as at weekends and holiday times, particularly in smaller hospitals around the country, there is a dependence on locum consultants who may be registrars and who are in an acting up capacity. They are not on the specialist register. That point needs to be taken into account when the committee is considering alterations to the Bill.

Dr. Mahony will answer the question about the expert group. I think I have dealt with all the questions raised.