Professor Fergal Malone:

The Deputy's initial question is a very real concern and we have had experience with it. A patient goes to the UK, has a pregnancy termination and we do not have a clear diagnosis when she leaves. What would have happened in Ireland is an autopsy with some extensive genetic testing. In respect of some of the newer genetic tests, an individual genetic test can cost €500, €600 or €800 for one test so that would be done here and in many cases, we get an answer. However, if the patient is in the UK and is not entitled to free care on the NHS because she is not registered as an NHS patient - she is an Irish patient - and she wants that testing, she will have to pay for it. Some parents will pay for it because it is medically crucial information but we know some patients already struggle to reach the €800 to €1,500 a termination in the UK costs and now also have to find another €500, €1,000 or €1,500. We have had parents who have decided not to have the relevant testing done and are then left with an incomplete diagnosis - "my baby died because of a brain abnormality but we are not exactly sure what kind of brain abnormality" - and they have no idea what the chances of it coming back again are so it is a real issue and would be one that would not be there if we could undertake the complete care for our patients here.

As regards training, it is important to differentiate between doctors in training and a senior consultant of 60 or 65 years of age who has been around the block for 20 or 30 years. The self-confidence that comes with being a clinician who is 60 years of age and who can make a stand and say, "This is what I am going to do" is very different to a 24 or 25-year-old intern or SHO. It is expecting a young inexperienced doctor to have such a spine as to say, "You know what, I don't care what the criminal code says. This is the right thing to do and I'm going to do it". I can see a 60 or 65-year-old experienced clinician saying, "That is what I am going to do" and the legislation not having a chilling effect on them but it is very different for a doctor in training, so I do think it has an impact. One of the earlier questions suggested that other doctors have come into the committee and said that they do not see that as a problem. That is great and that comes with 20, 30 or 40 years of practice but these are not necessarily the doctors at the coal-face at 2 a.m.