Dr. Meabh Ní Bhuinneáin:

Regarding the use of language in terms of termination for "medical reasons", there is not enough clarity in "medical reasons". We are discussing health and risk to health, but "health" is broader than "medical reasons". As to the use of the word "doctor", there may in time be task shifting to other cadres of specialist staff who come from a nursing or midwifery background. "Clinician-woman relationship" is the broader interpretation of the Deputy's question.

It is not possible to be proscriptive on every indication as to why a woman or girl may request a termination. The commonest reasons where there are liberal laws are that the pregnancy is not affordable for her at this time or her other responsibilities would be compromised at this time, for example, the impact on other people for whom she is responsible. If we become restrictive as regards purely clinical indications of physical and mental health, which is what the Citizens' Assembly has recommended, we will miss the other social determinants of health and well-being that influence women's decisions to seek termination of pregnancy and we may not legislate for those women who are currently self-terminating for what we may not consider to be socioeconomic or medical reasons.

Regarding the Deputy's question on model 3 hospitals, a safe termination of pregnancy is part of what is considered basic emergency obstetric care. Centres of excellence have an important role in termination care where the woman has complex medical disorders or the foetal complexity may prove difficult to manage in a rural hospital setting that is in a model 3 unit. There is still one unit in a model 2 hospital. Occasionally, there will be reasons to attend a tertiary unit where there is a maternal foetal medicine specialist practising with a full multidisciplinary team. In general, termination of pregnancy would be considered within the core competencies of general obstetricians and gynaecologists and general practitioners, GPs.