Dr. Anthony McCarthy:

I thank Deputy Kelleher for his questions. He raised the issue of the number of women who may go abroad but who now might come here and maybe that is a good thing. It is quite extraordinary sometimes that those who are most opposed to any legislation here, almost totally disregard the fact that, yes, of the thousands who go abroad, most, no doubt, have no mental illness or anything of the sort.

Unequivocally, within that group there are women who could do with expert psychiatric care that might well reduce their mental health difficulties. These women could be psychotic, have voices in their head telling them to kill the baby. It might be the worst they have ever done. We have seen some women who have suffered after abortions because they regretted them, and maybe if they had had a psychiatric assessment and treatment, those women would not have gone abroad and would have been treated here and they and their children would now be alive today. We completely disregard these women.

On those who are worried about and want to protect the unborn, we are completely ignoring this reality that there are women going abroad now. We want to pretend that they are not our issue, that if they go abroad and have an abortion that is just not our issue, and we only want to address those who are here now and who want to present in this tiny little narrow window.

This is a personal view rather than a professional view. I think it is a sign of our national ability sometimes just to ignore difficult questions and say let them go to England, Northern Ireland, Norway or wherever they go now to have their terminations or, increasingly, let them take their medication that they buy over the Internet and take it in their hotel rooms here or in their homes, and abort their babies here, as women over centuries have done. I have seen women, now in their 80s, who have talked about sticking knitting needles in themselves before abortion was available in England. There is a terrible Irish social history of the treatment of women in pregnancy who are in distress and if some of those women, who now go and maybe will regret it afterwards, could have professional care and support here, no doubt some of those women could well be treated, some of those women could well be helped and some of their children might be alive today, and that would be a very good thing.

With regards to the panels, the workings of the panels will be difficult. They must be organised. The reality is that the first psychiatrist will have to see the woman. If that psychiatrist, after that evaluation, comes to the conclusion that a termination would be important here - this is a very rare group because I re-emphasise, looking at the procedure here of seeing three different people, the vast majority of women will continue to go to England or take their medication or whatever it is as they are not going to come near us - he or she will then ask a second psychiatrist for a second opinion. I note Deputy Ó Caoláin asked the same question - do I think that is reasonable? In the current social situation in which we live in Ireland, but also as it is reasonable clinical practice, in difficult situations like this it is very reasonable to ask for a second opinion, as long as the obstetrician is not also being asked to assess her suicidality way beyond his or her level of competence. Some of the comments from some of the obstetricians on Friday last just showed a complete failure of understanding of mental illness and mental distress and the reality of the sort of women with whom we deal in our clinics. That will have to be dealt with.

We need an increase in resources. Between Dr. Sheehan, Dr. Fenton and myself, if one added all of our sessions together, that is not one consultant post in this country. All of us are part-time. There needs to be a huge increase in resources. That is why I finished my opening statement saying that if the result of this is better resources in hospitals for women, that would be a really good thing.

To address Deputy Ó Caoláin's specific question on precision, some of the questions that Dr. Sheehan raised about psychiatrists not being judges and Deputy Mattie McGrath's question about probability, truthfully, we must make probable decisions every day of the week. When somebody comes in to me - not one psychiatrist the committee will hear today will not be regularly in a situation in an emergency department or in an inpatient psychiatric ward or wherever saying: "On probability, I will let this person go home because my clinical judgment is this person will not kill themselves." I make that decision every day of the week. Equally, there is not one psychiatrist who will talk here today, whether for or against this legislation, who has not written on a Mental Health Act form officially "I am certifying this person into a psychiatric hospital today against their will on the basis of a risk to their life.", because we are making clinical judgments here that there is a suicidal risk. If any psychiatrist standing up here today says we cannot make these predictions, ask that psychiatrist, "Have you ever written on a mental health form saying, "On the balance of probability, this person needs to be admitted into hospital against their will, and sometimes treated against their will, because my view is that they have a significant suicidal risk.". That is what we do in our work all of the time and it will not be any different here.

With regards to the issue of unanimity, it is important the psychiatrists are unanimous. Of course, they can be unanimous. Most likely, our unanimous view will be that a termination here is not likely to help. That is likely to be our view because of the tiny little group we will be seeing to whom it would apply. I have total confidence that in the vast majority of cases psychiatrists will be able to agree, "Probably, no," because of the restrictiveness of this legislation, but sometimes "Yes".

We pointed out in our submissions real practical difficulties because of conscientious objectors - I fully support conscientious objectors - about the heads of the Bill as there could be one, for example, Dr. Sheehan, working in the Rotunda on his own. If he does not agree or I do not agree in my hospital, there must be a panel of persons outside and that must be looked at in the heads of the Bill.

On appeals being too long, I am very concerned about the appeals process being so long, particularly because a small number of these women may be very mentally ill. A woman may be very unhappy that we have turned her down, and for two weeks she may have a mental illness untreated. People are worried about what the appeals process will lead to and suggest stretching it out so that no woman will have an abortion who might regret having an abortion. I am worried that if we stretch it out for too long women who need psychiatric treatment will be missed. That is very important. The committee should think of the increased risk because of that. That is the sometimes horrible reality for those of us who have dealt with patients who have gone on to kill themselves.