Dr. Peadar O'Grady:

In terms of Deputy Ciara Conway's question about pathways and the delay in referral, it is delay, delay, delay. The concern that we would have is that elements of the legislation are either designed to delay, which we hope would not be true, but also could be used to delay processes and procedures. How long to see one consultant? How long to see two? How long to see three doctors? Is this medically necessary?

I think we are being very clear today that it is not. Outside the legislation, it is not necessary to see any psychiatrist at all unless consulted for a medical reason by a colleague. We are only addressing today the reasons a psychiatrist might be consulted on the legislative side in certifying for eligibility, which all of us have said we will try to integrate into good medical practice. I am trying to clarify that there are differences here. All of these delays around three consultants are to do with eligibility under the law. They do not have strong connection with good medical practice. As Deputy Conway has pointed out, one, two and three doctors is a matter of delay. There is no medical issue there.

On the question of criminality, as I pointed out earlier, it is dangerous to have criminality hanging over women who may then feel restricted from sharing their medical details openly and on which we rely constantly - even more so in psychiatry. We would not distinguish ourselves from our colleagues but much of what we do is putting someone at their ease so that they can tell us where they are at and guarantee them some degree of confidentiality so that they feel free to do so. It could happen, for example, that 14 years would be hang over someone who, for example, has taken medication ordered over the Internet and would not then say that they had taken it because they feel that it is a criminal act to have done so. They might at some later stage need to undergo an anaesthetic. I would never want my anaesthetist not to know what drugs were in my body. That will put people at risk.

The second thing it does is add to stigma. There is much work being done by support and mental health agencies to reduce stigma and to say that travelling as one can, lawfully, to Great Britain and having an abortion in the case of fatal foetal anomaly or for any other reason. To say this is equivalent to a grave crime is stigmatising women unnecessarily. It makes absolutely no difference and seems only designed to stigmatise and delay and for that reason, is dangerous.

There is no need for specific laws to criminalise bad practice. If it requires a registered medical practitioner to carry out an abortion, which it does, anybody who is not so registered should be sanctioned. I do not have an opinion on that sanction but it is up to legislators if the sanction is a criminal one. If a registered medical practitioner engages in poor practice, there is already a process of sanction for poor practice. Most of what we are talking about is not seen as good or bad practice anywhere in Europe. It is not literally a medical issue.

In respect of interventions other than suicide, I see many of my colleagues go to extraordinary lengths. Very often I look at what a colleague, be they a social worker, psychologist, nurse or doctor, is doing and think that they are going above and beyond the call of duty to intervene to support a young person. Given the infrastructure of education, child protection and health with which we are trying to deal, sometimes extraordinary and heroic acts are carried out on a daily basis by the ordinary mental health workers around the country and they deserve much credit for that.

People have drawn attention to this notion of women hurt by abortion that needs to be addressed and I will take this moment to do so. Women are hurt by abortion. The WHO estimated that 40,000 women died in 2012 from unsafe abortions. The figure changes a lot because it is hard to count them. They were women hurt by abortions. A total of 5 million women were disabled by unsafe abortions. In countries where abortion services are well developed, we still have the concern about coercion. When we argue for choice, we mean choice in either direction. One should not experience coercion but we know that often people do, from relationships and economic stress. We should do everything in our power to make that decision as free from coercion as is humanly possible.

To return to the issue of criminalisation, we should also make it free of stigma. Before the decision is made, every support to make that decision with informed consent should be given. After the decision is made and an abortion or a birth is chosen, we should give absolute support to that person and not stigmatise them. As someone said, there is no right response to pregnancy or abortion. We support people no matter which decision they take, which is already the status quo. I do not think there are many left who are trying to demonise women going to Great Britain every year for an abortion. Unfortunately, this legislation does.

The key issues were raised this morning. These will likely centre on children in care with a concern about travel and the ability to help a young person make a decision. These raise issues of consent and the capacity legislation. I am not advising on legislation today and do not pretend to have any expertise in what sort of legislation will address this. The point we would bring up relates to children in care and the capacity of children to make decisions. The greater clarity is brought to that the easier it will be to deal with children under this legislation. I am not convinced there is anything specific required for under 18s in this legislation. There will be concerns about applying it. The question of what appears in this legislation is a matter for the legislators.