Dr. Sam Coulter-Smith:

On the question of whether we should legislate for suicide, even in the absence of the X case, my view is that this legislation is required to protect doctors and give reassurance to mothers and their families that when a woman's life is at risk for whatever reason, doctors are duty bound to look after the baby, if at all practicable.

When there is no option but to terminate a pregnancy, then that is what they should be covered to do.

We are not mentioning cancer or heart disease; I am not sure whether we should be mentioning suicide. I think there is an issue there. It widens the problem by including suicidality - risk of self-destruction - but my understanding is that we have been told by the European court that this is what we must do. I suppose what I am trying to do here is trying to point out the issues for obstetricians if suicidality is included in its present form.

In regard to whether we look at the viability of the baby, of course we do. If we are lucky enough to be in a situation where a woman who becomes unwell is 37 or 38 weeks pregnant, then we terminate the pregnancy by induction of labour or by caesarian section, depending on the situation. If bringing her pregnancy to a conclusion happens at 27 or 28 weeks, then those babies have a very good chance of survival given the standard of intensive care we have for those babies in this country. As Dr. Mahony rightly said, we have babies surviving in all our maternity hospitals from 23 weeks on but before 23 weeks, these babies unfortunately do not survive. I am not sure if that answers the question in totality.

Dr. Boylan mentioned methods of termination and I would be entirely in agreement with him. I am glad the committee has picked up on the fact that none of three biggest maternity hospitals in the country have access to intensive care on-site. This is a big issue for us. We transfer patients not on a daily basis but certainly on a weekly and a monthly basis to our sister hospitals. These are our sickest patients and we should have access to intensive care facilities on-site - not five minutes away by ambulance but actually plugged in and in the right way, and in hospitals designed in the right way so that we can look after our sickest patients appropriately.

There was a question about what does one do with a patient who is suicidal at 20 weeks. I think one gets a psychiatrist to see her. The psychiatrist will take a view on the best method to manage that. If, in extremely rare circumstances, termination of pregnancy is what is required in that situation, then a discussion will have to be had with obstetric colleagues as to how that should be best achieved. I echo the comments Dr. Mahony and Dr. Boylan made in regard to the specialist register. That is an important area which needs to be covered in this legislation.