Dr. Rhona Mahony:

I appreciate the Deputy's concerns about the health grounds factor. There is the question of what is health and what is dying. As I keep coming back to it, clinical courses are very difficult to predict with precision. An illness in a woman can very quickly kill her. It is our difficulty in exactly predicting a clinical course, so we should therefore err on the side of ensuring women are safe and appropriate and timely decisions can be made. It is not appropriate that a woman must be dying before she qualifies for a termination of pregnancy.

When we look at maternal deaths, a significant proportion are related to women with other diseases during pregnancy, like cystic fibrosis and bleeding disorders. We must acknowledge that when we consider risks to women. What is required is sound clinical judgment. There must be trust in society that doctors and women will come to make a good decision that will keep women safe.

In most cases of pregnancy women really want to be pregnant and I have seen women risk their lives in order to have a baby. It is not really the risk of dying that makes women suddenly want to terminate a pregnancy. These are often babies that are really wanted but the women become too ill or are at risk of dying. As clinicians, we are charged with getting complex clinical diagnoses right in what can be a very narrow therapeutic window.

I will bring the committee back to the example of ruptured membranes at 14 weeks. There is very little chance a baby in that scenario will survive but there is a significant risk for that woman that she will develop an infection called chorioamnionitis. This is where the pregnancy itself becomes the infection and the woman would be at a substantial risk of dying. The only way to treat the infection is to terminate the pregnancy and give an antibiotic. When we have a clinical suspicion of chorioamnionitis, we might not get microbiology results as confirmation for 48 hours and we must make a clinical decision. Therefore, doctors are concerned that if they intervene too early, it might not really be chorioamnionitis and they might have got it wrong. They might be at risk of a custodial sentence. They may wait too long. Women and young women in particular often decompensate very suddenly and can appear much better than they are. They can appear quite well and have very advanced infection. If they decompensate, the clinician would be in a position where he or she must conduct a termination of pregnancy in a woman who would be very ill. It can be a very narrow therapeutic window and doctors are charged with getting it right. Somewhere in society we must accept that women and their doctors will make responsible decisions there to protect life.