Dr. Tony Holohan:

There is, and this has been part of the some of the public discourse on the issue, a clear policy choice as to whether one would seek to put these types of protections around a process which is voluntary or to put some mandate and some obligation in statute around what doctors and nurses would do. We have formed the judgment that the former is more appropriate. We think that a balanced assessment of the international evidence on this issue says there is a risk in the first instance that we may increase the fears on the part of doctors and nurses that if something is prescribed around their behaviour, it might contribute further to their sense of legal liability. There is a risk we might get a tick-box style of compliance, so that open disclosure is now a case of "I have to tell you, so therefore I am telling you." However, the hearts and minds Dr. MacLellan has spoken about is about getting doctors and nurses into a space and then protecting them in that space to allow them to do the job in the way it needs to be done. As I said in my earlier statement that can be a process, it might not be a single event for the patient but may be a process over a period of time and much more than ticking a box. Doctors and nurses will have to understand what to do, why they are doing it and, in a sense, to feel supported in doing it. That is the reason we have gone down that road. I know there has been some criticism of that particular determination but we have a good and strong rationale as to why we think that is necessary.

There are areas in legislation, and we can point to examples of it, where behaviours and notifications and so on in respect of health professionals are mandated in legislation but very often do not occur. When one looks at the international evidence, one will find that in countries where there is such a requirement on doctors and nurses, large percentages of them do not know such a requirement exists. It might feel like that it will address something, it seems intuitively the right thing to do, but our view is it might actually contribute to a further likelihood of doctors and nurses not doing the right thing or perhaps not doing it right.