Dr. Sam Coulter-Smith:

I thank the Chairman. With regard to suicide and where it ranks in terms of maternal mortality, suicide is extremely rare in pregnancy. According to the UK figures, it is around one in 500,000. It is extremely unusual and there are much more common causes of maternal death. This is really more a question for psychiatrists. From my discussion with psychiatrists, particularly in our hospital, it can be extremely difficult to decide how suicidal a woman is and how to rate it. Our psychiatric colleagues tell us that, in pregnancy, if a patient's mental state is so altered that she has suicidal ideation or suicidal intent, she needs psychiatric treatment. If the psychiatrists tell us the only way the woman's life can be saved is through a termination of pregnancy, it will require a number of psychiatrists to agree with that view. If that is the case, following a multidisciplinary meeting about the case, that is what we will do. The legislation confirms, reassures and provides clarity, certainty and protection for the doctors involved in the treatment of pregnant women in these very difficult situations. It also provides clarity, reassurance, certainty and protection for the mothers and their families. With regard to the protection of the baby, I totally agree with what Dr. Mahony has said. In every situation where intervention must be made in order to save the mother's life, we do our utmost to prolong the pregnancy as long as we possibly can to give the baby every chance of survival. Intervention is only made at the point at which we feel that if we do not intervene the mother may die.

With regard to the Medical Council recommendation on the number of psychiatrists and obstetricians involved in the decision, it is a resource issue for our professions. I will allow the psychiatrists to answer the question about their specialty. If we get an increase in the number of women seeking to avail of termination of pregnancy in this country based on the legislation, there will be resource issues for our obstetric personnel, our psychiatric personnel and our hospitals.

On the question of the legislation being prescriptive or silent on the methods of termination, I do not think the legislation should be prescriptive in any way. The decision on how a pregnancy needs to be brought to a conclusion is based on a large number of factors. The method used will be one that is the safest for the mother in any particular situation.

On the question of whether the scheme of the Bill provides adequate protection for us as doctors, I think it does. It goes a long way towards bringing forward legislation that sits well with the Medical Council guidelines, which is good. In the case of a minor - someone under the age of 18 years - there are appropriate services that need to be put in place to deal with younger women. Professionals in mental health care need to be made available to allow the appropriate care to be given. The same multidisciplinary team involvement will be required in any major decision-making for patients who are minors and for older women.