Dr. Rhona Mahony:

On the question of whether it would alter my practice if we passed the legislation, the answer is “No,” although there are some amendments we have discussed today that need to be taken into consideration. We have had a discussion on the concept of physical illness versus mental illness. One is objective - we have definite signs - and one is very subjective. I am an obstetrician and cannot assess suicidal ideation, but I am very confident that my colleagues who are experts in psychiatry can assess it. They do this very commonly in the course of their practice. As an aside, one very tragic objective outcome of suicidal ideation is death.

On Senator David Norris’s comments, the Bill, of course, is not about physical health but about the risk to life. That needs to be very clear. We are not talking about physical or mental health but about the risk of death from any cause, be it physical or mental. In the majority of cases it will pertain to death from physical causes.

With regard to Archbishop Martin’s letter, I really hope that by now it is clear to everyone that we are not in the business of killing babies and there is no question that a baby that is capable of surviving will not be offered every support to optimise its survival. There is no question that a baby born at 28 or 30 weeks gestation would somehow be killed. That is murder, a criminal offence, and out of the question. One must understand that we will do everything and exhaust every single medical avenue open to us to prolong pregnancy such that a baby may achieve viability and to give babies born at early gestations every support to optimise their survival. We do this all the time. It is a very fundamental part of our job.

I have been asked directly to clarify what I am worried about. The 1861 legislation still stands and nobody has yet told me it does not. The Supreme Court judgment is in place, but it has not been legislated for. I presume we are all here because we see a necessity to legislate for the Supreme Court case. We need legal clarity surrounding the termination of pregnancy to save women’s lives and the sort of legislation and regulation that will afford us legal protection and flexibility to do our job. It is really important that everyone take on board that the 1861 legislation pertains not only to doctors but also to women. That is very important. The question of women being at risk of penal servitude must be taken on board. Therefore, I welcome this legislation and commend the Government for introducing this long-overdue Bill.

We return time and again to the question of suicide which is extremely rare in pregnancy. I am not a psychiatrist, but I have some expertise in publishing papers and setting up studies. There is no evidence regarding suicide. There is a lot of evidence on mental health and many papers dealing with different aspects, but there is no paper in this country that deals specifically with the outcome of suicidal ideation. Gold standard therapy would involve a randomised controlled trial. That would give us the best evidence. All other evidence is quite flimsy, actually, and one will have different papers stating different things. I do not believe there should be a randomised controlled trial. Are we really going to take women with suicidal ideation and randomise them into two arms, one that is allowed a termination of pregnancy in the belief we are saving their lives and another prevented from terminating their pregnancies in the belief this might result in their dying. That study should never be undertaken. There is no evidence; this is extremely rare and there cannot be compelling evidence when the numbers are very tiny.

With regard to head 19, I agree that we need to be very careful. Women should not be liable for criminal prosecution on the grounds of this, particularly considering that when we may perform a termination of pregnancy, the women concerned would be taking a doctor’s advice that they should have a termination of pregnancy to save their lives. There should be no question under any circumstance of a woman being liable legally. That answers that question.

We had a discussion on the circumstances concerning two patients and it was stated 5,000 women travelled to England. That is not the issue; today we are talking about the heads of a Bill that deals with the protection of life during pregnancy.

On the question of suicide, the idea that women will turn up in front of expert psychiatrists and lie in vast numbers and the suggestion our psychiatrists who are extremely well trained and competent have no idea how to assess ideation just have no basis in fact. Furthermore, we need to be very careful. Women with suicidal ideation need to be taken seriously and believed. I would be a very bad doctor if I began every single medical consultation with the presumption that my patient was lying.

We have had a conversation about resources. I would be the first person to say obstetrics and maternity services in this country are dreadfully under-resourced. There is an urgent need to address the resource issues within the maternity sector. The approach we should have is not to fail to legislate in this Bill; the approach should be to address the issue of resources in the maternity sector. I hope the Government will take on board these views and give maternity services the attention they so urgently need and deserve.