Mr. John Saunders:

The first issue was around the difference between head 2 and head 4 in terms of the number of practitioners involved. When the commission was discussing the issues it noted the difference and that in the case of physical severe illness there was a requirement for a consultant obstetrician plus medical specialists up from the disease entity - that was the issue - whereas head 4 refers to two psychiatrists. This is explained in the heads by the statement that the provision for two psychiatrists in addition to an obstetrician arises from the recognised clinical challenges in accurately assessing suicidal intent and the absence of objective clinical markers. In these cases the Bill provides that the opinion will be jointly certified by an obstetrician gynaecologist and two psychiatrists. I suppose that is the answer. There is a recognition in general that the ability to predict the seriousness and consequence of suicidal ideation is a difficult one. There is a distinct difference between head 2 and head 4. One could argue conversely that perhaps it should be the same and that there should be an obstetrician and one psychiatrist in the same way that there is one obstetrician and one physical specialist in the case of head 2, but I believe it is a matter of debate and opinion rather than a matter supported by scientific fact.

The question of children was raised. We have noted the absence of any specific legislative proposals around children.

Again, in most social legislation dealing with children and adults, a specific part of the Act details the provisions for children. This legislation should recognise that children who find themselves in a situation where there is a pregnancy are a particularly vulnerable set of people in the general population of women. Second, there is the issue of their capacity around their status as a child versus the wishes of their parents, for example, and there are also issues around decision making and competency around decision making. Members may be aware that there is also assisted decision making legislation on the schedule of the Oireachtas and both pieces of legislation will have to reflect the provisions of the other piece of legislation. To answer member's question about decision marking, there is the capacity and vulnerability of the person who is below the age of 18 as opposed to an adult. An additional group of people are children who are in care, usually of the HSE, and there is the matter of where the responsibility lies in terms of decision making on behalf of those children should one of them find themselves pregnant and in the situation that has been outlined.