Ms Marie O'Shea:

When I spoke to consultants working in the foetal medicine area, they said there are some situations where it is clear-cut that a condition constitutes a "fatal foetal anomaly" - let us call it that - which would satisfy the terms of the legislation. There are many conditions that do not. “Fatal foetal anomaly” is not a medical term. The guidelines accompanying the Act refer to the fact it is not always possible to tell until quite late or at all at what point death will occur, whetherin uteroor one day after birth, or whether the baby could be an outlier and live beyond that, even though they know the condition is ultimately fatal and the life of the baby will be poor. They are unable to inform their patients as to what the outcome will be. There is a sense of practising defensive medicine because they are afraid of making a wrong call and because of the cases that have gone wrong, the media attention and the prospect of criminalisation. They are erring on the side of safety and there is an attitude among some that this person can go abroad anyway so will ultimately get treatment.

I recall talking to one patient who had presented with foetal anomaly and who they could not advise. They said they did not know if it would be fatal enough. They thought it would not live long after birth or might die before birth. She ended up going to England for a termination of pregnancy. Her second pregnancy was affected by the same condition and she had the benefit of the genetic services in the National Maternity Hospital, which were able to pinpoint what was wrong with the baby and more or less emphatically say the child would not survive 28 days. After it was born, it survived for an hour. That person had previously gone to England beyond the 24 weeks pregnancy, had to pay €5,000 to a national health hospital, which is the only place where that is provided, and had to go through an ethics process there for a condition where the previous pregnancy would have easily fitted into the section 11 criteria, save that there is no way for doctors to determine it one way or another definitively. Also, educational supports were not really provided in time. Lack of standardised clinical guidance has not helped-----