Dr. Rhona Mahony:

I will answer the questions Deputy Kelleher raised. If the X case did not exist, would we still legislate for suicide? Suicide is death. We are legislating here for the substantial risk to life. If one commits suicide, one dies so, inherently, when someone plans to take their life, they are at risk of dying. I make no distinction between medical and physical risk to life. I am not talking about mental health disorder but about the intent to commit suicide which can occur without a history of mental disorder.

In terms of suicide and all the evidence we talk about, the incidence of suicide is about one in 500,000. There is no evidence. When a condition is that rare, it is impossible to perform adequate research or studies which inform one because the condition and the outcome are so rare. If one was to truly examine the issue of suicide, one would have to take a group of women who planned to kill themselves and randomise them to termination of pregnancy to prevent them from killing themselves or to not being allowed have termination of pregnancy. I suggest that studies should never be done. What we do instead is we defer to our psychiatric colleagues who are expert in the assessment of suicide ideation and they use their clinical experience and acumen.

Does the legislation do what we wish and does it give us clarity? I think it does in a number of key areas. It now gives us a framework in which we can define a substantial risk to life. That is supported by the law and that is one of the key issues. It also addresses the issue of the 1861 Offences Against the Person Act which hangs over us with that chilling effect. In addition, and very importantly, it gives women, if they feel they are going to die or are at risk of dying, a process through which they can determine whether termination of pregnancy is appropriate. That is very important.

I have said a lot already about the threshold of viability and I am concerned that this message still does not seem to be getting across. When we deliver babies, we do our utmost to protect and vindicate that baby's life. We are mandated to do that; we must do that and we wish to do it. I have no desire to see late termination of pregnancy coming into this country. That would be an affront to me. I spend a great deal of time in my own medical practice trying to look after both the mother and the baby but I am aware that if a mother dies, her baby dies too and we must prevent the unnecessary death of two people. Therefore, we will do our best to prolong the pregnancy until a baby is viable and again if a baby is born at that threshold of viability, every effort is exhausted to optimise that baby's chances of survival but one simply cannot allow a woman to die.

In terms of the scenario of delivering the 20-week old baby at the threshold of viability of a woman who has suicidal intent, that woman requires assessment by an experienced psychiatrist. In terms of the method, we do not kill babies; we do not destroy babies. We induce babies medically. Dilation and extraction at 18 to 20 weeks is a very dangerous procedure. We are not trying to kill women; we are trying to save their lives and so they will be induced medically - a medical induction of labour where, as Dr. Coulter-Smith has said, after viability is achieved and by whatever method is practicable.

I will address Deputy Ó Caoláin's issue. Again, I am echoing my colleagues on the whole issue of intensive care. The three Dublin maternity hospitals are quite unusual and unique in terms of obstetric care in that they stand-alone. This is not normal for an obstetric hospital and it means that not only are we deprived of intensive care facilities but we are deprived of a whole range of on-site medical facilities that would be very useful to us. For example, we transfer our tiny babies to access an MRI scanner because we do not have one on our site. We must transfer patients everyday for simple scans to see if they have a deep venous cloth in their legs. There is no doubt that co-location with an adult hospital is the way to go. It is not just me saying this, that is supported by an independent international recommendation in the KPMG report.

I refer to the technical issue on the wider number of hospitals. Sometimes we elect to deliver women in a general hospital because of the concurrent medical difficulty she might have. In addition, in an emergency, we cannot have a situation where we have to require to transfer a patient to an obstetric unit for determination of pregnancy. Therefore, it is very important that we include all Government-approved hospitals in this legislation.

Again, Dr. Boylan has covered the issue of specialist omission. This is a historic omission. Some doctors have simply not put themselves on to the specialist register, which began in 2005, so perhaps for the sake of safety we should use the term "obstetrician-gynaecologist". This again would cover the situation of locums.

I was asked about the recommendation of the European court in the case of A, B and C v. Ireland. Central to that is that we are now obliged to find a process for women through which they can see if they qualify for termination of pregnancy and, when that happens, whether they are able to access termination of pregnancy when their lives are at risk. Today all of this is restricted to when a woman is at risk of dying.

Again, I would say that this legislation gives us the protection we need to allow this happen. It addresses the issue of providing a process. It allows us to establish substantial risk in a way that is supported by the law and it gives a woman a process through which she can explore this risk when she perceives herself to be at risk of dying. In terms of suicidal intent, it is always a psychiatric assessment and we defer to our psychiatric colleagues in this.