Dr. Maeve Doyle:

What we are most likely to see is the most vulnerable group presenting again. These are children in the full care of the HSE. They will be subjected to the process here and I do not think it has been thought through adequately.

In terms of resources, obviously child psychiatry is a younger speciality. There are approximately 90 consultants in the country and approximately 70 multidisciplinary teams. There are supposed to be approximately 100 teams. There are five approved centres - that has been referenced in the document - and only 60 beds there. Most of the child psychiatrists are working in the community in catchment area services. Therefore the stipulation in the heads of the Bill that a psychiatrist needs to be attached to an approved centre will not happen and those who are attached to approved centres are not attached to maternity units either. Those are two very practical points that will make this extremely difficult to work on.

The issue of consent, which Deputy Ó Caoláin brought up, will be very difficult for the legislators. If a child is placed in care voluntarily by the parents and is suicidal, pregnant and seeking a solution under this legislation, the HSE and guardians must give consent. What happens if the guardians disagree?

Head 4, subsection 4 states that the woman can always decide whether to proceed with any procedure. That is not elaborated on in the case of a child. How will children presenting with acute psychosis or significant intellectual disability be able to decide whether to proceed? Our interpretation of the Non-Fatal Offences Against the Person Act is that a child may not refuse treatment as she is not viewed as having the capacity to refuse. Therefore, if a panel decides that a child can go ahead, the child may find herself undergoing a procedure that is potentially life-threatening without the capacity to refuse.

There is an appeals process for a woman. It is unclear who can appeal on behalf on a minor. While there is a review procedure, should a panel disagree among themselves on a course of action, there is no equivalent mechanism for disputing guardians. In respect of the unanimity of the panel, if the issue is suicidality, one would expect it would be the psychiatrists' view that would be taken primarily. We would certainly not be able to advise the obstetricians on when it is appropriate for them to carry out their procedures.