Professor Veronica O'Keane:

In terms of practice, my view is that the majority of women who are suicidal because of an unwanted pregnancy are still travelling. I do not think we are treating the women who are suicidal, because of unwanted pregnancies, in Ireland. I think we are treating the women who are suicidal with unwanted pregnancies, who are unable to travel, in Ireland.

So far, seven women, theoretically, have had their lives save by the legislation. Obviously that is a very good thing in itself. It is a very good thing that we have legislation that will save women's lives if their lives are at risk because of being pregnant. In that sense the legislation has worked. It is very clumsy legislation and the majority of my colleagues feel very uncomfortable with trying to work within this legislation. It is very difficult for women. As most people here probably know, three specialist assessments are required. The legislation also requires that the woman would go to a GP or an accident and emergency doctor who would initially refer her. In order to have a legal abortion because of a risk of suicide a woman must see a minimum of five doctors. If one of those doctors is unwilling to see her the process is clearly lengthened and that has happened quite a lot with this legislation.

Colleagues feel uncomfortable with the legislation and do not want to deal with the matter. A woman who has been referred by a GP or an accident and emergency department presents to the doctors. The first person may say, "I am not comfortable with this, call me a conscientious objector". He or she rings up his or her clinical director who also says: "Call me a conscientious objector, I am not comfortable with this legislation."

The clinical director then rings another colleague. It may escalate to a national level and a psychiatrist from a national panel might have to be called. There is usually a period of delay in which the woman does not know what is happening because no one knows what is happening. She may then see someone who does not believe that she fulfils the criteria, so the process must restart. It is distressing for a woman who is feeling suicidal, is pregnant and is highly vulnerable to have to repeat her story to everyone. Every time she tells the story, it is an emotional journey that takes an emotional toll on her, and she is someone who is suicidal. In my practice, I try to minimise the number of people to whom my sick patients have to talk. If a patient has already been clerked in an accident and emergency department, I will see him or her next and say that the patient does not need to be clerked again in a ward. The repetitive intrusion into a patient's extremely private crisis is counter to good sensitive practice.