Dr. Peter Boylan:

A number of points have been raised. The issue of suicide has come up again, as has the incidence of suicide in pregnancy. Until recently, the CSO did not stipulate that it had to be included on a death certificate whether a woman was pregnant in the recent past. We will never know the incidence of suicide among women in the early stages of pregnancy. From time to time, coroners have issued verdicts that avoided the use of the word suicide out of sensitivity to the families involved. It is understandable but perhaps not helpful in other contexts. I will say no more about suicide; it is a matter for the psychiatrists, but it is important that members understand that we just do not know. A question was directed to me about Professor Ferguson's paper and bad science. I defer to the College of Psychiatrists of Ireland, which will deal with this in evidence on Monday. I am not a psychiatrist and, as I emphasised before, we should be wary of people interpreting articles, information or papers in a field in which they are not practising on a daily basis and in a field in which they are not expert.

I would not give an opinion on an orthopaedic problem to somebody who might need a hip replacement. I would not dare give that opinion. Similarly, I would not give an opinion in regard to psychiatric problems. I am not trained for that and I have no experience in it. We will always strive to save the life of the baby. We make those decisions on a daily basis. There are ethical issues involved and we deal with those on a daily basis as well. That is what we do in our practice so there is no big problem in respect of that.

Under the heading of reasonable opinion in my statement, I said that I welcome the confirmation that the constitutional protection to the right to life of the unborn child is retained at all times where practicable. Some campaigners are attempting to suggest that late terminations will be performed in Irish hospitals if this legislation is passed, implying that doctors would deliberately kill an unborn baby who is capable of existence outside the uterus. Some of the more extreme groups are suggesting that newborn babies might be killed if this legislation is passed. These views are clearly extremist, have no basis in fact and are, quite frankly, insulting. There should be no suggestion that obstetricians and neonatologists would ever fail to make every effort to maintain the life of a baby once the threshold of viability is reached.

I refer to the issue of how we assess the risk. The legislation reflects the judgment in the X case by saying it is not necessary for medical practitioners to be of the opinion that the risk to the woman's life is inevitable or immediate, as this approach insufficiently vindicates the pregnant woman's right to life. We are talking here about the right to life of a woman and we need to remember this in discussing this entire issue. It is interesting, though, that no figures are available for what percentage risk of death is acceptable and I hope that, in the future when the legislation is passed, that we, as obstetricians, will be able to take into account a woman's point of view as to the degree of risk she is willing to accept. Some women are willing to accept an extreme risk and are willing to die in order to hope that they might have a child; other women decide that the risk is too great for them and, in these circumstances, when the outlook is utterly hopeless they prefer to have a termination of pregnancy and perhaps try again. I need not elaborate on that anymore. We have to be careful about trying to quantify risk that is unquantifiable.

The question of consultant numbers and ratios has come up and the committee would like some figures. The figure in our maternity hospitals is approximately one consultant per 1,000 deliveries. The ratio in the UK, with which we are frequently compared in all sorts of ways, is less than one in 500. We are one in more than 1,000. Those of working in the National Maternity Hospital recently visited a hospital in Malmo, Sweden, which is of similar size to our hospital. There were 30 consultants on the staff there; we have eight. I hope that answers the question. It means that obstetricians working in this country have no shortage of experience in dealing with complicated obstetrical cases and are well able to make decisions in the best interests of both patients for whom they are caring.

Have I left anything out?