Dr. Gerard Burke:

This has never happened in my career and I do not expect that it will. The numbers are so small, most of us will never see this in an entire career.

The idea that you would have a patient arriving into your office with two abortion tickets from random psychiatrists is nonsense. That is not the way that medicine works. We would have a working relationship with the psychiatrist. If you did not know the psychiatrist and did not trust them you certainly would not be doing anything near terminating a pregnancy. The institute has made a suggestion in this regard, there would be a second obstetrician involved and I would support that. I can tell you, there are very few of us in the country - 125 consultant obstetricians - and we are not beholden to psychiatrists telling us what to do. We have to do this procedure ourselves so we are going to be absolutely certain that it is thoroughly justified, medically and ethically. That is the way medicine operates.

In regard to Deputy Ó Caoláin's question on whether Limerick is different, Limerick has 5,000 babies and eight obstetricians so it is more like Dublin and Cork. We do not have the problem of small numbers. We have the entire range of sub-specialty facilities available. I would say that when there is any question of a maternal death, the entire resources of the hospitals are wheeled out to deal with that woman. It goes to the top of the priority list, as you can imagine. They are taken extremely seriously. Cardiologists etc. would drop everything to deal with a thing like that.

In regard to resources, we have very few obstetricians. When the country was awash with imported money a few years ago not a red cent was voted to improve the resources by this House. The Deputies were aware of the issues because the numbers were well known but not a red cent was put into maternity services.

With regard to the question of an ectopic pregnancy, this happens in about maybe one in 2,500 cases so we will see a number of cases. In my unit we will see two every year. They are extremely difficult to deal with. They are one of those issues that could come under this legislation. We do not refer people to England for terminations but a lot of our patients, in difficult circumstances, elect to go to England for a second opinion. Of course, we have a responsibility to make sure, if they are critically ill or unwell, that they do not go to an inappropriate place. They would be pointed in the right direction of where they could get top class care in a university type hospital with a full foetal maternal medicine service. We do not have data on this, in terms of numbers, but certainly it is not extremely rare.

A conscientious objection would not arise in my unit. There are eight of us and I do not think there will be any difficulty about providing opinions and care.

Is there adequate clarity? The one issue that I would bring up is that I think you, the legislators, should determine what is meant by a real and substantial risk to the life of the mother. I think that is your job but because we cannot put numbers on it, because we do not have data, because things change over time, because the timeframe is very unclear, because the dates in the literature are very unclear, and we often only have our expertise, experience and knowledge to work with, I think it would be beholden of the Deputies here to sign that job over to the obstetricians and the other medical experts. I think that should be specific in this piece of legislation. You can trust us in this regard. The people who are in at night and at the weekend dealing with haemorrhages and heads that are impacted, we are not waiting in the long grass to start doing terminations. That is not the way we operate. I think that the Oireachtas can trust the medical profession that it is going to do its absolute best to save every single life. That is what we do, day and night.