Dr. Mary McCaffrey:

I represent the second smallest unit. Clonmel is a little behind us. The questions asked by Deputies Ó Caoláin and Healy about smaller units are quite similar. I think we need to step back and look at the three indications which are outlined under this Bill. When we talk about the risk of loss of life from a physical illness in a medical emergency, we are looking at women who have severe infections, bleeding or severe pre-eclampsia. As I said already, sadly we deal with this every year in all of the small maternity units throughout the country. We deal with it appropriately and in a manner that is clinically appropriate.

Obviously, we all want more resources. In an ideal world, there would be no three-person maternity units in the country. That stance would certainly be taken by many senior obstetricians. We have three-person maternity units at this time. We deliver care to women in emergency situations. We deal with it adequately and appropriately. We link into our sister hospitals. Tralee General Hospital's sister hospital is Cork University Maternity Hospital. Some of our patients from north Kerry go to Mid-Western Regional Maternity Hospital in Limerick. We have access to the expertise from those places.

When a woman who walks in the door needs to be dealt with there and then, we have the resources to deal with her. Ironically, the maternity unit in our hospital has an intensive care neo-natal unit and access to a cardiology service in the town. We regularly do teleconferencing for non-maternity cardiology cases. The cardiology team sends down teams to look after patients who are not pregnant. Our resource is better, in many ways, even though we have a smaller maternity unit.

We were also asked about the risk of loss of life from physical illnesses such as cancer. Severe cardiac disease was the other example that was used. As a general principle, patients in those types of situations tend not to need immediate care within the next hour. We have access to the specialist care units in Dublin, Limerick and Cork. I think most small maternity units have appropriate links and are able to care for their patients. There are multidisciplinary cancer teams. There is an oncology team looking after each unit at this stage.

I am not here to speak for the psychiatrists. The committee will have access to them on Monday. The psychiatrists in my unit appear to think that they would not have the resources to deal with this and that additional resources would be needed. Ironically, it is not an obstetric resource in that situation.

Conscientious objection would never come into play when someone's life is in danger there and then. That has always been our practice at the time the woman is dealt with. Nothing will change in that regard. Obviously, we would expect every doctor to look after an acute medical situation. In a less acute situation, we would expect doctors to meet their requirements under the Medical Council guidelines. If they are not going to look after a patient, we would expect them to ensure someone else looks after that patient in a timely manner. I would be disappointed to hear there is any unit where a person would suffer due to a conscientious objection of all the staff. I do not think such a unit exists. We will always look after the life of a mother and the life of a baby.

I do not think I have missed anything that was asked about small units. We will keep saying we need more resources. I do not think any woman will suffer in a small maternity unit as a result of a lack of resources if this legislation is enacted.