Professor Sabaratnam Arulkumaran:

I will start with Savita's case which was very clear. There are certain conditions in which a disease can escalate steeply and there is no time. By the time the condition is recognised one has missed the boat. For example, the maternal mortality rate in cases of severe sepsis is between 20% and 40%. If the mother develops septic shock, the figure rises to 60%. For every hour treatment is delayed, the chances of maternal mortality occurring rise by 6%. There is no time to waste and a clinician must recognise that the mother is going into septic shock, has a fever and a high pulse rate. However, because there is a heartbeat the clinician starts to dilly-dally. There is no question that the medical practitioner should be given the opportunity to act.

The second question was about the dispensing of tablets by nurses, pharmacists and so on. The crucial issue in liberalising termination is that it must come under regulation. As Dr. Boylan mentioned, it must come within the remit of a medical council, or a nursing council if nurses are to be allowed to dispense. The most important point is that the patient be registered with some clinical medical professional, whether it be a nurse, a midwife or a doctor, who could say the patient was at such a gestation period and that such a medication had been given. This person should give a telephone number to the patient in order that she could call if she was to experience fever, have a high pulse rate or bleeding in order that she could make immediate contact. There is no medical procedure without risk. The moment the patient feels something is wrong, she should be able to ring and gain access to health services in order that it can be managed. There are a number of countries which allow nursing and midwifery professionals to prescribe and administer the drug, but they always have communication and a centre which can deal with complications should they arise.