Dr. Peadar O'Grady:

It may help to clarify this area from the point of view of Doctors for Choice Ireland. We are being very clear. The alternative to this legislation is to allow women to decide for themselves and not to require certification by doctors about their eligibility. That is what they do in Canada where there is no criminal sanction in making this decision. There is lots of good practice. If one wants doctors to certify, one cannot also tell them that they think it is a good idea. All one can ask them is whether they can carry out that certification. This is what we are trying to advise today. Does Doctors for Choice Ireland, for example, think it is a good idea? No. One does not need certification for eligibility for abortion. One only needs it where legislators put that requirement on one. On Friday, we heard from the Medical Council and the Irish College of General Practitioners. This morning we heard from the College of Psychiatrists of Ireland. Can we do it? Of course we can do it.

Legislators will have to own some of the complications that arise from the legislation. What we can do is to be as helpful as we can. Do the cases occur? Yes, they do, as Senator Bacik has pointed out. They arise episodically. Why they might arise again the future, why there might be a restriction on travel, or why there might be concerns about whether or not consent is adequately given - we cannot predict in what way they will present.

I will not go into the 16 versus 18 issue in detail. That was well argued in terms of the whole capacity debate, which I really think is a separate issue. Does it apply to this area? Absolutely, it applies to this area, but not differently than it applies to any other area of medicine. Where a question arises around consent with a young person or someone, for example, with an intellectual disability, we do need a resolution concerning access to medical treatment. Whether they can give consent, but also whether they can refuse consent, is a whole other debate.

I would favour one GP plus one psychiatrist instead of an obstetrician and two psychiatrists. Obviously, the second doctor should be optional, in my view. As I have been at pains to point out, the first doctor is and should be optional also, in terms of eligibility - not in terms of advice, but in terms of counselling and helping someone to come to a decision, but not making that decision for them.

Deputy Naughten raised a point about suicidal ideation and pregnancy, which is absolutely correct and is often overlooked. Professor Kendall's study pointed out that, years ago, there was a coincidence between suicides and pregnancy, particularly before the Second World War and before the 1950s and 1960s when abortion was made more available in terms of being free, legal and safe. It very much coincided with missing the second menstrual period, which is literally when a woman starts to realise that she is pregnant. That is when the clusters of suicide in pregnancy occurred.

As the Deputy points out, one is likely to get those cases where suicide risk arises - not all of them, but the vast majority - in the first trimester, i.e. before ten to 12 weeks which is early. Medical abortions would be carried out predominantly in that period and a delay would lead to more surgical abortions. I am not sure what advice was given on Friday. I am not an obstetrician or a general practitioner. It is not my area of expertise but I am 100% certain on that point, that medical abortions are early, including the morning-after pill if one is of the persuasion that believes that is abortion.

As regards reasonable opinion, I think the issues of viability are best referred to obstetricians. It concerns that point in time. It is not that general practitioners will not be involved, but any decision about prolonging pregnancy in order to deliver a viable baby at that stage, rather than a foetus - that is, decisions about viability and the discussion with the parent about that - is an issue for an obstetrician. There is really no role in psychiatrists. In the same way as we might object to an obstetrician advising about the risk of suicide, I think that obstetricians would quite properly object to any psychiatrists giving their opinions about viability.

As the Deputy indicated, for most people, the word "fatal" in fatal foetal anomalies implies that viability is very much the moot point. It is the point around which the heartache of parents arises. The diagnosis of fatal foetal abnormalities often does not happen until the second trimester and, sadly, sometimes not even until the third trimester. The Deputy is correct in saying that these are the more difficult situations where someone had a wanted pregnancy. These are the changes that all of us are very sensitive to. There is nothing more tragic than wanting to have had a baby and where the mother decides she will call this a baby rather than calling it a pregnancy. Nobody, except doctors, really talks about a foetus. People either have a pregnancy or decide that they are going to have a baby. That is changed where that is not going to happen and it is a tragedy for all of us.

To come back to the issue of treatment, anyone involved in certification should never lose track of the fact that they are dealing with a human being. I do not care whether one is certifying that they need to be off work or off school, in my case - one is not just certifying and saying "Next".

One is looking at a person and asking what else, besides the certificate, is going on with that person and whether one is missing something because primarily, one's role is as a doctor, and not as a form stamper and certifier. In jurisdictions where some of that is lost, stuff like advising someone to go for the suicidal option, about which people keep talking, can only occur in a situation in which there is a legal obstacle to access to abortion. Again, it is neither within the ability nor the job of doctors to deal with that. It is the job of the public and its relationship with the legislators. In the same way that doctors get accused of trying to open some kind of floodgate - I really object to the notion of women being like water flooding through a gap, which simply is objectionable - the notion that doctors might facilitate this is as objectionable as doctors who might obstruct the process. This is a social process and attitudes to abortion in Ireland have changed fundamentally. In the most recent poll, 92% of Irish people agreed with abortion in at least some circumstances. The change this causes from a legislative point of view is between the population and your good selves.

Finally, in response to the last question raised regarding suicide, I believe Professor O'Keane has dealt with that very well. On the issue of women being hurt by abortion, I reiterate the need to get rid of coercion. It is a poignant fact that people who have a personal ethical objection to abortion are a group to which we must pay particular attention. If they came under coercion to have an abortion, rather than feeling more free to follow through with their own ethical ideals and carry through a pregnancy, and if they chose to have an abortion, they would be a group of people we would be obliged to follow up very carefully. They would be likely to suffer feelings of regret, guilt, anxiety and so on. This means we should not be idle certifiers. We should detect, engage with and follow up risk and support people, no matter what their viewpoint. Again, this is the point made by Doctors for Choice Ireland. We are for choice, not for forcing our views on anyone else. I will leave it at that.