Dr. Gerard Burke:

I thank the Chairman for his invitation to attend this discussion. I welcome the publication of the Protection of Life during Pregnancy Bill 2013 and commend the Government on bringing it forward. I also commend the members of the committee and other Members for the intellectual effort they have put into this debate through the course of the day. It has been a long day, so I will be brief.

On the issue of resources, in the next decade we can expect in the order of 100 maternal deaths in Ireland. It is possible that one, two or three of these potential maternal deaths might be affected by the legislation before us. In terms of the number of possible deaths, therefore, this great intellectual effort will affect a relatively small number of women. It is important that the Oireachtas would at some point address the state of the maternity services. The unit in Limerick which I represent, for example, has the lowest number of obstetricians in the whole of Europe at two per 100,000. This shortage of resources will likely lead to some difficulties in the future.

Turning to the specifics of the heads of the Bill, the first issue that has come up for discussion in my department is the question of what is a real and substantial risk to the life of the woman. I note that this is not defined clearly in the heads and I understand the reasons for that. The issue has been raised in the submission by the Institute of Obstetricians and Gynaecologists, which I support. My personal preference is that there would be an explicit statement setting out that this is a matter which cannot be defined in terms of real numbers or percentages, and that it should really be left to the medical experts to determine. It would be wrong if what is actually a matter for legislators were ultimately to be decided by a court.

We have identified two minor technical issues that should be addressed, the first of which relates to the question of an ectopic pregnancy. It is possible to have an ectopic pregnancy within the womb, in the cervix, in the neck of the womb or in the scar of a previous caesarean section. We are seeing more and more of the latter as the rate of caesareans has risen. One can have a pregnancy that is ectopic but within the womb, and that is an extremely dangerous condition which could fall under this legislation.

The second issue, which was also pointed out by the delegates from the institute, relates to locations. Some 40% of babies in Ireland are born in stand-alone hospitals, namely, the three in Dublin and my own unit in Limerick. Some of the more difficult work we have to do is carried out in the general regional hospital. A caesarean section on a critically ill woman, for instance, would have to be done in a general hospital. That needs to be included in the legislation.