Dr. Ciaran Craven:

I will deal with the questions in the order in which they were put to me. I will deal with Deputy Kelleher's question first. What he said about the Medical Council guidelines on suicide is correct but the council is simply making a statement of its understanding as to the current legal position. It is doing no more than that. I certainly do not think on any reasonable reading of that particular provision that it is actually saying this is nevertheless ethical. Having said that, I recognise there is a fundamental inconsistency between a bald statement in relation to legality divorced from any consideration of the ethicality of what is actually stated. I should say that I do not hold a brief for the Medical Council and I am not here to defend its position or what it has said in this area.

Moving on Deputy Ó Caoláin's comments, he was quite right in what he said. It is fair to say that I am highly critical of the approach the Bill has taken. There is a certain philosophical inversion in terms of what is required. Rather than simply examining what the evidence is and, therefore, what is ethically and legally mandated, it seems to decide there are certain procedures which are not defined which somehow are lawful and defensible and then it invites the professional bodies and the regulatory agencies to provide assistance in relation to the implementation of the legislation. With respect, in terms of a very significant policy issue, that strikes me as being an inversion. Whatever doctors, the regulatory bodies and the professional bodies may say about these matters, the questions of policy and the principle are not ones which, in my respectful submission, are capable of being avoided by the Oireachtas.

My comments in relation to conscientious objection have to be taken in context. If the proposed Bill is reflecting proper ethical, legal consideration, then the question of conscientious objection simply cannot arise because it accords with both the ethical imperative and the legal imperative as I tried to make out. If, on the other hand, it is doing something different, then it may well be the case that a question of conscientious objection arises. Whereas the case has been made that conscientious objection is something of a personal right and is vested in individuals, it in itself, as we know from other jurisdictions, is capable of giving rise to all kinds of issues and difficulties when one steps one position more remote from the person who is involved in the procedure. In our neighbouring jurisdiction there have been significant problems in relation to it.

In so far as the question of whether this is a right which vests in institutions is concerned, again the courts recognise that no doctor or health care professional can be obliged to do something which he or she considers to be contrary to the best interests of the patient. Institutions do not have arms and legs or eyes and ears, they can only operate through the personnel they employ or engage. Trying to make a distinction between a right to object in relation to institutions, on the one hand, and individuals, on the other, is, in my view, not sustainable.

Moving on to deal with Deputy Healy's question, I hope I have not misled him in regard to the Mental Health Act. That Act of itself is one with issues related to it. Since the question has been raised, that Act evolved and was designed with a particular policy objective in mind and it sets out the various principles which were to apply and then it sought to import those principles by way of giving effect to the policy objective. While I am certainly not holding it up as a paradigm in terms of how it might be done, the point I wish to make is that with the policy having been decided one cannot then seek to implement it without having reasonable regard to the ethical legal principles which will result in proper implementation of the policy.

Deputy Conway's question has probably already been dealt with by Ms McDonagh in her response. In so far as Dr. McCarthy is concerned, the evidence given before the committee on 8 January of this year was pretty much to the same effect. The argument is not being made that abortion is a treatment for suicidal behaviour, suicidal intent, suicidality or however one wishes to characterise it. If it was the case that the Oireachtas seeks to introduce a regime for other reasons, then that is policy debate of an entirely different order. As Ms McDonagh has already pointed out, what this Bill purports to do is to medicalise the matter. If we were to engage with it from a rights-based perspective, that would be a debate on an entirely different matter.