Professor Fergal Malone:

The Deputy is absolutely correct in her initial characterisation of my comments. When I call for access to complete health care I do indeed mean the pregnancy termination procedure in Irish hospitals followed by the after-care, because that is the only appropriate way to perform any medical care. I do not know of any other aspect of medicine where we suggest that people would go to another country to have part of their care but we will look after them afterwards. As a general theme this is what we mean.

As regards a late diagnosis of the foetal abnormality and a patient travelling then, I absolutely agree it is true there will be more potential complications if the patient travels then. The uterus is much bigger. There is much more blood supply to the uterus later in pregnancy. There is much greater chance of significant bleeding. A patient travelling later in pregnancy is absolutely associated with much more risk. We would never like to see that happening but, unfortunately, it does.

As regards a perinatal autopsy, this is an absolutely crucial point. At present, since patients have to pay for everything themselves when they to go to the United Kingdom for termination of pregnancy they are often in a dreadful situation, having a certain amount of money to spend on the flights, hotel and basic procedure, and they just cannot afford an autopsy and special genetic testing. Unfortunately, they will decide they cannot do it. If the procedure was done in Ireland, public or private would make no difference as complete testing is done as part of the public health service. Patients in Ireland would have a total diagnosis.

Having a total diagnosis is crucial. Some genetic conditions have as much as a 25% or 50% chance of coming back again, whereas other conditions may have less than a 1% chance. I would think most families would want to know if the condition they have just gone through had a 25% or 1% chance of recurring. Additionally, the advent of preimplantation genetic diagnosis means that after certain types of genetic diagnoses are made, if a patient undergoes IVF, on the next pregnancy before the embryos are reimplanted it is possible to biopsy those embryos and find the ones that have the genetic condition and, crucially, the ones that do not, and then only replace an embryo that has been proven not to have the genetic condition. When a patient does not have this information as she cannot afford it because she is forced to undergo a procedure in a different jurisdiction, it has profound implications for her future fertility.