Professor Veronica O'Keane:

I will not repeat what my colleagues have said. I do not disagree with any of it. I would like to make two further points. In respect of the two psychiatrists, I believe it should be one psychiatrist because the initial point of contact will be the general practitioner. The general practitioner is in a very good position to look at a woman they know, hopefully, quite well over a long period of time and to say whether they think this woman is suicidal or not. It is not one opinion about suicidality. It is two opinions about it, one which belongs to the general practitioner and the other which belongs to the psychiatrist and, as Dr. Ferguson said, preferentially the local psychiatrist.

In response to Deputy Conway, time is of the essence. We work within structures that allow us to deal with emergencies so there is a certain amount of flexibility, obviously, within a normal medical timetable allowing for emergencies. We respond within hours. GPs and accident and emergency officers telephone us directly and we deal with them immediately. Another problem I have with two psychiatrists is that it potentially slows down the process and also causes unnecessary emotional distress because the woman must repeat her story twice. It is very difficult for people in distress to open themselves up twice. The process of opening up is quite painful and it is a very difficult for a person to tell somebody one is so vulnerable that one is suicidal and looking for their help. To have to do that twice is putting too great an emotional burden on women.

There is also a practical consequence. If it slows down the process and it could mean the difference between a woman being able to have a medical or a surgical abortion. About 50% of abortions in the UK are medical abortions. This involves taking a tablet and another tablet 12 hours later. This must be supervised medically but it can be done at a general practice level. In the future, more and more early abortions will be medical abortions and will not be complicated procedures. The best strategy in medicine is one that is least interventionist so we want to treat women as early as we can.

I know we are pressed for time but I have an important point to make regarding head 6, subhead (2). This relates to timeliness as well. I wanted to draw the committee's attention to the fact that the last sentence in subhead (2) implies that the medical practitioner in the initial certification procedure need not give an opinion. It is quite dangerous for us to allow the first group of medical practitioners who review a woman not to give an opinion. They should either give an opinion or not give one. If we allow people to not give an opinion, the review panel may also be in a position of not having to give an opinion so the woman could be going from one situation of not having been given an opinion to another.

In my view it is absolutely fair that a group of medical practitioners may say they do not think this woman fulfils the eligibility criteria for an abortion. That is okay. The woman then says, "I want to appeal this decision", and she goes to an appeal panel. However, if a woman is left in a position where a group of experts say they are unable to make up their minds and they do not have an opinion, it is a very difficult situation for that woman. I ask the committee that it should consider that there should be an onus on the group of practitioners who see the woman initially to come to an opinion, even if that opinion is in the negative.