Dr. Rhona Mahony:

Deputy Conway said suicide was among the top four causes of maternal death. It is very difficult to estimate the incidence of suicide. Occasionally, that verdict can be returned as an open verdict. According to the triennial report on all deaths in Ireland between 2009 and 2011, there were two cases of suicide and I understand there was an antenatal case of suicide last year. Suicide is extremely rare and the numbers can be difficult to estimate.

I was asked if legislation will save lives. Legislation will provide legal protection and flexibility for doctors to do their job. I believe it will give doctors some peace and prevent hesitation where doctors are uncertain about whether they may act. Doctors will always try to save a life but at the moment what is wrong is that they do not have the necessary legal protection. That is really what the Bill is providing.

In terms of mandatory care for a late delivery, we care for all babies. I have to keep saying this. Once a baby is viable, we give that baby every support to survive, regardless of why the baby is born. If the baby requires support to survive, we do that. We will always vindicate the life of the foetus. That is not at issue.

I will allow Dr. Coulter-Smith to address the ethical dilemmas surrounding suicidal intent. In terms of the Irish Medical Council's proposal on head 4 and whether or not there are two psychiatrists, we must be clear that obstetricians and psychiatrists have very different roles. I am not qualified to assess suicidal intent or ideation. However, in a patient who may require termination of pregnancy because an expert psychiatrist feels she will kill herself, there are obstetrical considerations and, therefore, there must be a team involved. We work as a team, generally. These are rare, complex cases and it is very much our culture that we function as a team and include a broad range of disciplines. It was interesting that Senator Burke asked about the patient who is under 18 years of age. Of course, she is X. I interpret this head of Bill as legislating for the X case and would argue that it is X who is very vulnerable and who needs to be protected by the State.

Let me just remind members about X - she is a 14 year old child who has been abused and raped and who is pregnant and wants to kill herself as a result of that pregnancy. She needs to be listened to, believed and protected.

I was asked about something I said when I presented in January about defining risk at 1%, 5% or 20%. The point is that two qualified specialist doctors in whatever field, such as an obstetrician and a cardiologist, an obstetrician and a liver doctor, or two obstetricians in the case of an obstetric intervention, can assess the patient's clinical case in its entirety and can come to a conclusion in a way that is supported, or will be supported, by law. It will be impossible to draw up a list of the reasons we can terminate a pregnancy because, invariably, that is impossible. Now we have a process supported by law, and I welcome that.

In terms of the legislation being silent, and the comment that there is no upper limit and that we can destroy foetuses, at the risk of repeating myself time and again, I understand that Article 40.3.3° still stands. Perhaps this needs to be clarified when the lawyers appear before the committee. I understand the 25th amendment still stands and I understand that, according to these provisions, where it is practicable, I am obliged to vindicate the life of the foetus. I have always practised in this way and I always will. I have no wish to kill babies but I want to make sure no woman under my care dies. If she dies, her baby will die too.

All 19 units are able to cope with routine obstetric emergencies and they are all able to give that comprehensive cover. In an emergency setting, all units are equipped to deal with that. When it comes to complicated medical cases, not all 19 units have that medical expertise. Indeed, the National Maternity Hospital, which is one of the busiest maternity hospitals in Europe, will often refer patients to St. Vincent's Hospital, for example, because of medical complications. We are well used to networking and it is normal medical practice to refer patients for opinion. We can obtain opinions over the phone and it is our culture to practise obtaining as much opinion as we can about the patient. We discuss patients quite often and we get as many opinions as we think we need. We are caring for women and we will obtain the opinions we need. We are well used to networking. This goes on all the time, day in, day out, in terms of psychiatric practice.

I am not a psychiatrist, but with regard to this business that there is no evidence that termination of pregnancy is a treatment for suicide, we are not talking about treating - we are talking about the risk to life. If members want to remove suicide from the legislation, in the X case, involving a 14 year old girl, is everyone in the room absolutely certain there was no way that X would kill herself and no way that she would die? In the case of a woman who does not want to be pregnant and who is so distressed by her pregnancy that she tells us that she wants to kill herself, can we all sit here and say we are absolutely certain she will not kill herself? I cannot.