Health (Family Planning) Bill, 1978: Committee Stage (Resumed).

Question again proposed: "That section I stand part of the Bill."

Mr. Kelly

Before we adjourned I had been trying to deal with some points raised by Deputy de Valera and with which I am sure no one in the House would disagree essentially. However, in relation to the 1861 Offences Against the Person Act the offences created either in section 58 or section 59 are offences in which the element of knowledge is essential to the committing of the crime. In other words in order to commit an offence under whichever is the relevant section of that Act a person would have to administer the contrivance with the intent to procure a miscarriage. I do not think that is the situation with which Deputy Boland is concerned mainly because clearly somebody who innocently administers something in the belief that it is a simple contraceptive but which transpires to be more than that cannot be caught by the relevant section of the 1861 Act. Section 10 of the Minister's Bill forbids the sale, importation into the State and the manufacture, advertising or display of abortifacients. I do not care much for the use of that word but I do not suppose that anyone has produced an alternative to it.

The question of abortifacients is the one that is causing concern but I am totally unqualified to pronounce as to whether various drugs on the one hand or inter-uterine devices on the other hand act abortively by putting an end to an incipient pregnancy. Perhaps Deputy Browne or Deputy O'Connell would be worth hearing on that subject. The prohibition on the sale of such items is emphatic. Therefore, it is not unreasonable to say to the Minister, to the extent that one believes him to be serious at all about this Bill, that before telling us that the Bill forbids emphatically the importation or sale of abortifacients, we should like to know what are abortifacients. Undoubtedly there will be differences of opinion on this question even among the medical and scientific people who would probably argue as to whether one kind of preparation or another was abortifacient as well as being contraceptive. It was in order to confront that problem that Senator Cooney when he was Minister for Justice proposed a medical committee that would have the statutory power to define this term in a manner which they considered to be satisfactory. There is no such proposal in this Bill. I am sure that everybody here would take the point made by Deputy de Valera in regard to offences concerning abortion and would agree with his obvious determination that the law on abortion here should not be changed but he is somewhat beside the point at which Deputy Boland was aiming.

I understood the Minister to say, as if this were an adequate response to what was being said here before lunch, that he was in the hands of the parliamentary draftsmen and that if these people told him that something was satisfactory he could not be expected to quarrel with them. That is a respectable point of view but it is not too much to ask that when a Minister is sponsoring a Bill here, even if he must be helped to some extent by his officials, that he should be able to tell the House what is meant by something in a definition section or why other terms which are absolutely essential to the Bill are not included in the definition section with a proper indication of what they are supposed to mean. Anyone will sympathise with an office holder who is expected to be an expert draftsman while on his feet but that is not what the Minister is being asked to do. He is being asked either now or after he has had a chance to make inquiries, to put into the Bill some phraseology that will tell us something about some of the Bill's central elements and to do this in such a way as to enable us to deal with them. One matter is the question of what is bona fide family planning.

Regarding the admittedly very marginal point I raised concerning the meaning of the word "sell", the Minister will realise that the resources of the Oireachtas Library in regard to legal material are fairly scant and that what is available is very old. Therefore, I have not been able to carry out satisfactory research on this question of the word "sell" since lunch time but so far as I can ascertain from reading the 1893 Sale of Goods Act and also the 1913 edition of Hallsbury's Laws of England—the last edition of Hallsbury to be published and the only one which is available in this building—and subject to the possibility that I am wrong, the word “sell” means to sell for a money price.

As the Minister has indicated his willingness to consider this question I shall not bore him with a long lecture on it now but would merely refer him to the two sources I have mentioned. On page 109 of the 1913 edition of Hallsbury's Laws of England, a sale is defined as being a transfer of the ownership of a thing from one person to another for a money price. Where the consideration for the transfer consists of other goods, or some other valuable consideration not being money, the transaction is called exchange or barter. It goes on to say that, in certain circumstances, it may be treated as one of sale, but these are not circumstances referable to a pure exchange.

I want to emphasise also to the Minister that this is a penal statute. What we are dealing with here is a criminal statute. I have already voiced my objection several times to the criminal law poking its nose into this area of life. If the criminal law is to poke its nose at the behest of Fianna Fáil into this area of life, let it be noted that a court in the common law world interprets a penal statute strictly against the party seeking to enforce it. Deputy de Valera will confirm that that is so. If the Bill says "sale" when it becomes law, unless that can be proved clearly and absolutely to encompass the transaction under review, the person charged will get off.

I would be glad if we did not have such an idiotic dilemma. I know the Minister has not made this a point of contention and that he said he will ask his advisers to look at it, but if he is serious about it, he ought to look at this question of sale, and whether it really does the whole of the job which he appears to expect it to do.

Mr. Haughey

I just want to make one point. It baffles me why Deputy Kelly keeps making these abrasive and contentious comments on this matter. He has just dragged in by the hair of the head the phrase that the criminal law should not poke into this area but is doing so at the behest of Fianna Fáil. I would ask the House is that calculated to contribute to a mature and reasonable debate here, particularly when this Bill is being introduced by the Minister for Health, whereas the Bill for which Deputy Kelly was Chief Whip was a criminal measure purely and simply, introduced by the Minister for Justice. In all fairness, honesty, and decency, he cannot make the attack on Fianna Fáil that we are dragging the criminal law into this area in view of the history of the Coalition Bill.

Dr. O'Connell

I do not see any need to include a definition of abortifacient in the Bill. In the present state of our medical knowledge, we are not in a position to say what are and what are not abortifacients. There is only medical conjecture about how these drugs act.

It has never been established as yet how the pill works. It suppresses ovulation and various professors and experts in the field of pharmacology have suggested that it might act as an abortifacient. In the present knowledge of the reproductive physiology, it is felt that it acts by supressing ovulation. I do not think we could define an abortifacient except by saying "anything which causes an abortion". We could list weeds and plants. Right down through history women have chewed various plants in an effort to produce an abortion. They have taken gin, castol oil, so on. Nobody has ever been able to define what causes an abortion in the line of drugs or medicines, apart from physical interference by means of physical instruments or an injection of saline into the womb.

We could not set up a committee to determine what would or would not cause an abortion in the line of therapeutic drugs. The experts in America, Britain and other famous medical centres have not yet established that. It would be futile for us to set up a committee to examine this problem. In the light of continuing research in medicine, we will have to learn from various medical centres what causes or does not cause an abortion. The courts will determine accordingly if the problem ever arises. I did not see very much logic in the committee suggested in the 1974 Bill. Many agents have been used as abortifacients which could never be established as such.

I was rather disappointed that the Minister did not try to clarify the situation in the Bill about bona fide family planning. There is a big question mark over that whole area. I recognise the dilemma he is in, and the dilemma of any Government in this situation. This is an attempt by the Minister to meet all interests. He said he sought advice from and had consultations with various groups, but I feel he may have had consultations with extreme groups on both sides. They do not necessarily represent the views of the majority. At this time he might have listened to the majority rather than small pressure groups on either side in getting advice on the formulation of this Bill. He may be mistaking the majority view of the public for the view of these pressure groups. He may have gone wrong there.

Sometimes when you listen to small pressure groups, unfortunately you can be misled about what people really think. Small groups do not necessarily reflect the views of the majority. The Coalition Government could have taken the initiative at the time and called for an all-party committee of the Dáil to resolve this problem once and for all. As legislators we have all failed in this area.

An Leas-Cheann Comhairle

We are again moving away from the definitions. Deputy Kelly wanted to come in on the debate.

Mr. Kelly

I wanted to reply to what the Minister said, but I will bite it back until I get more provocation.

Major de Valera

One point is almost clear now, that is, the impossibility of defining these things. I agree with Deputy O'Connell. The same substance may give you a number of ambiguous answers if you attempt to interpret it in any rigid legal way, quite apart from the chemical affinities of many of these things. For instance, the sex hormones, cortisone and cholesterol are all very closely related. You are getting into an impossible area either chemically or medically as Deputy O'Connell is competent to state.

What is the resolution on that? The resolution on that was given very long ago by Lord Coleridge, C.J., in the case of Rex v Cramp in 1880. He asked the question: “What is a noxious thing?”

It as said that "noxious thing" in the statute means some kind of poison, and probably that is so. But what is a poison? It is something which, when administered is injurious to health or life. There is hardly any active drug which, taken in large quantities, may not be so, and, on the other hand, is there any poison which may not in small quantities be useful and salutary. It is therefore in each case a question of the quantity and the circumstances under which the drug is administered.

There is the only answer a lawyer can give in regard to these matters. It is a question of fact to be intepreted in relation to the law as laid down in the statute. We cannot go any further than that. I would suggest that, having thrashed out this point, we should accept that we have arrived at a conclusion and prevent further delay.

There is also a cognate problem in regard to the definition of family planning. It is not easily susceptible to precise legal definition. That being so, the section as it stands is adequate.

Mr. Kelly

I know that Deputy de Valera is a most conscientious and painstaking Deputy when it comes to teasing out legal problems. I painfully remember that the House was here week after week during the debates on the financial legislation of the previous Government while Deputy de Valera took time and pains to point to what he considered were weaknesses in the drafting. I am amazed to hear from him that we should pass a Bill which contains some definitions which are inadequate and fails to contain others which one would think desperately necessary because they are at the core of the Bill, and say that for that reason we should pass on because the definition is difficult. This is as much a penal measure in its own way as is the Offences Against the Person Act, 1861, which he first introduced into this debate. What does he think Lord Coleridge, or any of Lord Coleridge's brethren, would have said in 1880 had he been asked to interpret an Act which contained the expression "bona fide planning family” where the Legislature had given him no hint or clue as to what that phrase meant and where, had he consulted Hansard he would have found that, although the matter was specifically put and repeatedly put to the Minister, he had not said one word by way of reply?

I can understand the Minister's attitude towards this Bill. He regards the Bill as a sore cross for him to carry. He wants to get out of the House and be done with it and continue on his career of more lucrative publicity than the Family Planning Bill is likely to provide him with.

An Leas-Cheann Comhairle

We are dealing with definitions.

Mr. Kelly

He cannot brush out of the way what is coming from this side of the House on the grounds that I personally am in a morally weak position to be making these points. I remember exactly the point of view of the other side in 1974. They did not give a tráithnín what was or what was not in the Bill introduced by Senator Cooney when he was Minister for Justice. They could smell a Government defeat in the lobby. They gave not a tráithnín for conception or contraception.

An Leas-Cheann Comhairle

I must put the question.

Mr. Kelly

We have not heard one word from the Minister.

Mr. Haughey

Deputy Kelly is so carried away with his personal animosity that he will not even let me in. Of all things, he should not say that I want to get this Bill out of the way as quickly as possible. I have spent time over this Bill and I think that any fair-minded person would reject that criticism. This Bill has taken me longer than any other piece of legislation I have brought before the House. I did not attempt to curtail the Second Stage debate. I listened patiently to the Second Reading discussion and I am listening patiently to everything that is being said on Committee Stage. Only a man blind with personal prejudice would make that attack on me.

In reply to Deputy O'Connell, I took positive steps to ascertain what the ordinary man in the street thought and to do that I took the best possible scientific avenues open to me. As a result, I am convinced that what is in this Bill is acceptable to the overwhelming majority of sensible people.

On the question of defining or not defining "abortifacients", there is no sustainable political case for the Opposition to make in this regard. As many of them have been involved in the preparation of legislation, they know as well as I do that the decision of a skilled and experienced parliamentary draftsman is accepted in relation to the mechanics of a Bill. If the parliamentary draftsman thinks that a word should be defined he puts in the definition of it. If he says that the Bill is better without a definition, his word is also accepted. In this case I agree with the parliamentary draftsman. Attempting to define "abortifacients"—and Deputy O'Connell has put the case clearly—would limit the scope of the section because the very definition would permit things which should not come within the ambit of the definition. This is one of those cases in which it is better to adopt the simple old drafting method "Thou shalt not kill". Let the word speak for itself. As medical opinion changes the interpretation of the word also changes. In this case relying on the word itself is stronger and clearer.

Mr. Kelly

I assure the Minister that I do not intend to lay on a performance like that which I had to suffer when I was on the other side of the House. I remember the House spending three days on a single amendment during a debate on financial legislation so I make no apologies for taking time with this matter.

If the Minister looks at section 4 he will find that the last subsection states that anyone who contravenes the section, or regulations for its purpose, is guilty of an offence. The contravention consists in supplying contraceptives otherwise than by way of sale under and in accordance with the section. In other words, under and in accordance with the foregoing subsection which restricts the supply and sale of the things we are talking about to the qualified persons who supply them or sell them bona fide for family planning purposes. With exquisite assiduity the Minister has avoided answering me and I want to know what "family planning" means and what "bona fide family planning means”. If the Minister chooses to waive that aside I will let the people and the press draw their own conclusions.

Mr. Haughey

Up to now we have been talking about abortifacients. Deputy O'Connell demolished Deputy Kelly. Deputy Kelly asked for a doctor to talk on this matter but as soon as he heard a doctor talk with authority he switched his ground and now wants a definition of "family planning".

Mr. Kelly

The point was first raised by Deputy Boland. A view was taken of it by Deputy O'Connell and I accept what he said. The point I originally made, which I am making for the fourth time, is can I hear from the Minister what "family planning" means and what "bona fide family planning” means? That is at the core, heart and guts of this Bill. Unless the Minister tells us what these phrases mean he might as well wrap the farce up now and withdraw the Bill.

Mr. Haughey

I maintain that the words speak for themselves; they mean exactly what they say. If Deputy Kelly is not happy with the drafting it is open to him to put down an amendment defining them as he sees fit. Until such time as he does so he should maintain silence.

Mr. Kelly

That is a terrible attitude for a Minister who is supposed to be sponsoring a Bill. The Minister has people at his disposal. He saith to the one "Come" and he cometh, and to the other "Go" and he goeth. Why can he not say to one of them "Go and get from the draftsman something of what he thinks ‘ bona fide family planning’ means”? Before lunch I put the case to the Minister of a couple who go to a medical practitioner for advice under this Bill. I want to know on what criterion the medical practitioner is supposed to make up his mind whether the advice being sought is for bona fide family planning purposes.

An Leas-Cheann Comhairle

At this stage the Chair would like to point out that we are having repetition.

Dr. O'Connell

I am not endeavouring to read the Minister's mind on this matter but I think that we should try to be honest about what we mean by "bona fide family planning”. It means either a legitimate marriage or a stable sexual relationship. I should like the Minister to clarify the position. The Minister should say honestly what he has in mind and what the term means. We must know whether it means that there is a marriage or a stable sexual relationship which may not be legalised. We should have the courage to say that we are in favour of that and that contraceptives should not be available to all and sundry.

Mr. Haughey

On the very day this Bill was published I said during a radio discussion almost exactly what Deputy O'Connell is now saying. I said we could not confine this Bill to married couples because the term "marriage" is subject to many different interpretations. I am using the word "family" instead and the availability of contraceptives is for families. "Family" can be defined as one wishes; the word "family" is not defined in the Constitution. As to what I mean by "family planning", I mean the ability of a family to decide the number of children they will have and the spacing of those children. By "bona fide family planning” I mean the genuine decision of a couple in a family context to make those decisions.

Mr. B. Desmond

May I press the Minister further? He is beginning to elucidate very clearly what I can only classify as some of the blundering hypocrisy contained in this Bill. The Minister says that a family is also a family if it happens to be a couple who are living in what might be called a family climate. Deputy O'Connell suggests that perhaps it should apply where people have stable sexual relations. What about those who have unstable sexual relations and wish to avail of contraception? It appears they are outside the ambit of the Minister's mind. We on this side have extreme difficulty in trying to divine what exactly the Minister means when he uses those phrases which underline the irrelevance and blundering hypocrisy of the Bill.

I can name at least a dozen Dáil Deputies on the Minister's side who, if they believed for one moment that the Minister was legislating for people other than those engaged in formal, legitimate marriage, would vote against this Bill. That includes some members of the Cabinet, not just the Minister for Agriculture. I do not know what happened when the Minister went before his parliamentary party in January and gave them an outline of what was meant by bona fide family planning. He gave the impression—so every Deputy and Senator in his party says—that this Bill was purely to confine the issue and sale of contraceptives to married persons, in the popularly defined term. Now the Minister waves another wand over the concept of “family”. He seems to imply people engaged in a family situation, a family climate, a couple living together but not married. I should like to know exactly what the Minister thinks. It would be a matter of historic interest, not only for the prurient in Irish society but for the Supreme Court who will have to deal with what we meant as legislators when we enacted this Bill. The Supreme Court will have a field day in interpreting this Bill; thanks be to God they have clarity of mind when we have cowardice of intent.

It has been entirely appropriate for Deputy Kelly to raise the issue of bona fide family planning services. The restrictions envisaged in the Bill and now elaborated more broadly by the Minister make nonsense of the Bill. We should hear further on this because it is a fascinating interplay of words and non-words when we all know precisely what the Minister really means and has not the nerve to say.

Mr. Boland

It is now becoming a little easier to understand why confusion has arisen in the minds of people in different organisations associated with the passage of this Bill. In the past 15 minutes the Minister has told the House that this Bill relates to couples in a relationship rather than those who would be defined as being married in the strict sense. While discussing the same section this morning the Minister was at pains to tell the House that the Bill went no further than to amend the hand of the law in relation to making contraceptives available to married people—no more and no less. This morning the Bill provided no more and no less than that married people can avail of the right which the Minister seems to feel the Supreme Court have given to them; this afternoon the Bill provides for people in a stable relationship to avail of contraceptives. It is no wonder that not only some members of the public but some of the Minister's colleagues appear to have become confused as to what the Bill provides.

I have not yet had the opportunity of replying to the interesting points made by Deputy Vivion de Valera in relation to the definition of "abortifacient". His intervention in the debate was useful. In quoting from the Offences Against the Person Act of 1861, he pointed out that it would be quite within the competence of a lawyer, and certainly of a judge, to decide what was or was not abortifacient in its effect. That is precisely the reason for my reservation and the fears of my party about the working of this Bill. It should not be left to a judge to decide whether the use of a particular drug or appliance had been abortifacient. There is an eminent school of medical thought which believes that IUDs are abortifacient in their effect rather than contraceptive. It should be made clear to doctors, chemists and those who will be involved in the implementation of this legislation that the prescription of those articles would not be an offence under this Act. They would not then be left in the dilemma of wondering whether they might be leaving themselves open to prosecution by prescribing an appliance or a drug at the request of the patient. The Minister often points out that legislation will apply to his successors in office. The Minister of the time might decide to see prosecution instituted because of these appliances. I agree with Deputy de Valera that the courts would be capable of deciding that a particular drug or appliance was an abortificant, but it is not fair that doctors or chemists should be asked to supply articles which are, in the opinion of some eminent medical people, abortifacient. They know that according to this legislation the prescription and sale of abortifacients is illegal.

I disagree with Deputy O'Connell about the setting up or otherwise of a committee of medical experts who would decide what were abortifacients in their effects. I do not think that Deputy O'Connell would hope that I would accept that merely because he is one doctor and decides that a committee would not be helpful that the House should immediately decide to fold up the debate which was the suggestion then made. There are many other doctors with many other opinions. I accept the fact that Deputy O'Connell on a very regular basis agrees with the Minister for Health in many of his objectives and is agreeing with the Minister here that there is no need to define abortifacients. Fair enough, that is his opinion and he is entitled to it, but I am equally entitled to mine and I believe that the procedure adopted in 1974 which would have meant a committee being appointed with medical experts on it and that committee saying: substance A is abortifacient in its effects; substance B is not, was correct. That would have meant—whether they were right or wrong was perhaps immaterial—that all who had to implement the Act would know where they stood. They would know if they supplied or prescribed substance A they would be in violation of the law whereas if they supplied or prescribed substance B they would not.

If this Bill passes as it is framed at present no doctor or chemist will know whether he is within or without the law, certainly, in prescribing or fitting inter-uterine devices. There will be considerable doubt in the minds of some as to the prescription or supply of some of the low oestrogen pills. There is need for a definition of abortifacient so as to allow the insertion subsequently in the Bill of a section which would allow for the setting up of a committee that would define abortifacient. That is why it is so important that the question of whether or not there should be some definition of abortifacient in the Bill should be discussed at some length at this time.

The question of the lack of a definition of family planning has been debated and highlighted fairly clearly in the House. I cannot at all accept the attitude the Minister adopted to it from 11 o'clock this morning when, according to himself, the Bill was to do no more and no less than make contraceptives available to married people, to 4 o'clock this afternoon when the Bill is now making a range of contraception and family planning services available to non-married people in a stable relationship. Perhaps it is not important that a Minister explaining his Bill should vary as much as that in the space of a few hours; perhaps we should accept in the words of his colleague, the Minister for Agriculture in a different context that: "It is only a Dáil debate", but I would have thought it might have been better and more helpful for the discussion if the Minister were at least consistent in trying to explain what he hopes to achieve in this Bill. If in replying to different points raised he is going to give a different explanation of the purpose of the Bill, all that serves to do is to reveal to the rest of us the confusion that appears to have arisen in his own party and in other places about the intent of the Bill. It certainly will not help the discussion on what now appears to be becoming a very tortuous and slow Committee Stage and Report Stage of the Bill.

Dr. Browne

My case this morning was slightly naîve because when I came to read the letter which I got this morning on my way in and compared it with the amendments, my case that we would be given a chance to help the Minister by putting down amendments is rather blown apart in that most of the effective amendments which I felt were valuable and strong amendments that I had put down had been ruled out of order. Possibly the cynicism of the Opposition was wiser than my ingenuousness in thinking that a serious Committee debate on this matter would be permitted. However, there is no doubt that this Committee Stage has been very useful even up to the present. We have had that most recent statement of the Minister's, the stable couples statement, that the obscurity of the law in relation to nullity and marriage clearly creates a very serious dilemma for establishing the criteria which the doctor will use—if the doctor is going to run the scheme—when he decides on a bona fide family planning pair.

It should be emphasised that the Minister has moved away from the idea that contraception would be allowed only to married people. I did not misinterpret him there because I have him on record as having said on the radio, when asked what bona fide family planning meant “that contraception would be allowed only to married people”. Obviously, this is a very remarkable advance, a considerable liberalisation of the interpretation of the Minister's family planning scheme and it would be interesting to know how the people behind him react when they find that this advance has been made during the Committee Stage, whether they will be completely happy about it.

The Minister went on to say that the law relating to marriage here was not clear which is a most extraordinary statement for a Minister to have to make. He has to make it because Deputy Collins has done the same thing in his turn. So, you have the unfortunate doctor—I had intended to delay my intervention on this until the section which deals more specifically with it was reached—facing a couple and deciding as Deputy Desmond suggested what is the relationship. First of all, it need not be a marriage; now it is a couple, a stable couple. Can we move on from there to what happens with an unstable couple, just two individuals who get together? How does the doctor make his decision about a bona fide attempt to plan a family or to plan to have no family?

The Minister has produced an extraordinary Bill and most of the analysis of it is completely permissible because it must take place later on, possibly in the courts. When one listens to Deputy de Valera's recitation of the dreadful 1861 Act—I think the last time it was used was in relation to Nurse Cadden and the lady went to prison for penal servitude for life, I think—this is a very frightening prospect for a doctor who breaks this law because the 1861 Act is there and it would be my case for not concerning ourselves with abortion on this Bill. But there is some validity in the case put forward by Deputy Boland and Deputy Kelly because at the last meeting of the IMA or the Medical Union—one of them—the question was considered and they could not come to a decision, yes or no. There is no doubt that a good case was made for saying that high oestrogen content pills are an abortifacient and one must face the reality here from one's own ethical point of view whatever it may be and the doctor has to face it from the legal point of view, that you may be encouraging him or trying to make or persuade him as the Minister did in his letter to take part in a scheme which may lay him open to the charge of providing abortifacients.

There is no doubt that there are two minds about the IUD. In the Seanad a case was made that the IUD was an abortifacient. It is a matter that must be considered. If an abortifacient is as repugnant to everybody as a deliberately carried out abortion, then you must face the fact that you are doing that under this Bill, that you are making it available, possibly making an abortifacient available. A court may decide that a doctor is making an abortifacient available, and remember that this debate, as anybody who has spoken in public on this subject from time to time is aware, has created great bitterness, particularly amongst those with very deeply felt views—I am not criticising them, in any way—but there are a number of people who are bitterly opposed to this, in my view, very mild proposal. A doctor may, possibly, inevitably will, face a charge from one of these people who will go to him and see that they get what they consider to be an abortifacient and then take him to the High Court for procuring a miscarriage, for conniving or conspiring to produce a miscarriage. If the Minister declines to face this problem he leaves a number of fairly hefty mantraps for the unfortunate doctor who decides to try to implement the provisions of the Bill.

The Minister should try to get a definition of what is an abortifacient. As you know this Union, whatever it was, has set up a committee to consider the question, but there is no doubt they would not have done that if they could clearly say high eostrogen, or the pill, or the IUD is not an abortifacient. Therefore you must be left with the possibility that what you are legislating for here is the provision of an abortifacient under the law.

Mr. Kelly

I want to put a couple more matters to which I have not got a reply. The Minister said, on the only occasion on which he did address himself to the question of what was bona fide family planning—I could not write it down fast enough but if I am misquoting him, he might be good enough to say it again—that bona fide family planning was the kind of family planning which represented what he called a genuine decision by a family—I suppose he means by the parents of a family—to space their children. That would be a fair shot at a layman's paraphrase of what a layman might mean by family planning but, of course, we are not supposed to be laymen here, we are supposed to be making law, on the strength of which people are going to go to prison, if the Minister is serious about using this as a law.

I am entitled to ask him, without calling up any more bad temper on his side, if bona fide family planning is a genuine decision by the parents of families to space their children and if the discretion whether to provide facilities of contraception and so on, which this Bill permits, is vested in the medical practitioner, would the Minister give us an example of the exercise of that discretion? Could he give us an example of what would be, in the medical practitioner's view, a non-genuine decision to space a family—possibly non-genuine, possibly ungenuine. On what criterion is the doctor supposed to judge? Could the Minister give an example, by way of making up the words which the doctor would use, speaking to the person consulting him, of how the doctor would express an unfavourable decision to people asking for a prescription?

I said on Second Stage that one of the meanings which might be attached to the expression "bona fide family planning”, though there is nothing in the Bill to say this, would be the kind of thing which is relevant also to what I suppose the Minister means by natural kinds of birth control, namely, the moral proposition that marriage is intended to procreate children, that this is its primary purpose and that, while the church does not expect non-stop procreation, there is an expectation that a married couple will not be selfish in limiting the size of their family. Now, how is a medical practitioner with the people sitting in his consulting room by the dozen to decide, no matter how much time he takes, what is a selfish and unselfish decision?

Yes, but the Minister is accepting that we could have a situation then where a married couple would be allowed to have no children at all.

Mr. Haughey

Of course, that is their decision.

Dr. Browne

I understood from the Minister that one used a contraceptive service to space the number of children and so on. In fact the Minister is accepting that a married couple can opt to have no children?

Mr. Haughey

I could not possibly assume any other right.

Question put.

The Committee divided: Tá, 69; Níl, 42.

Tá

Ahern, Bertie.
Ahern, Kit.
Allen, Lorcan.
Andrews, Niall.
Aylward, Liam.
Barrett, Sylvester.
Brady, Gerard.
Brady, Vincent.
Briscoe, Ben.
Browne, Seán.
Burke, Raphael P.
Callanan, John.
Calleary, Seán.
Colley, George.
Collins, Gerard.
Conaghan, Hugh.
Cowen, Bernard.
Cronin, Jerry.
Daly, Brendan.
Davern, Noel.
de Valera, Síle.
de Valera, Vivion.
Doherty, Seán.
Leyden, Terry.
Lynch, Jack.
McCreevy, Charlie.
McEllistrim, Thomas.
MacSharry, Ray.
Meaney, Tom.
Molloy, Robert.
Moore, Seán.
Morley, P.J.
Murphy, Ciarán P.
Noonan, Michael.
O'Connor, Timothy C.
Farrell, Joe.
Faulkner, Pádraig.
Filgate, Eddie.
Fitzgerald, Gene.
Fitzpatrick, Tom (Dublin South-Central).
Fitzsimons, James N.
Flynn, Pádraig.
Fox, Christopher J.
French, Seán.
Gallagher, Dennis.
Geoghegan-Quinn, Máire.
Haughey, Charles J.
Hussey, Thomas.
Keegan, Seán.
Kenneally, William.
Killeen, Tim.
Killilea, Mark.
Lalor, Patrick J.
Lawlor, Liam.
Lemass, Eileen.
Lenihan, Brian.
Leonard, Tom.
O'Donoghue, Martin.
O'Hanlon, Rory.
O'Kennedy, Michael.
O'Malley, Desmond.
Power, Paddy.
Reynolds, Albert.
Tunney, Jim.
Walsh, Joe.
Walsh, Seán.
Wilson, John P.
Woods, Michael J.
Wyse, Pearse.

Níl

Barry, Peter.
Barry, Richard.
Begley, Michael.
Belton, Luke.
Bermingham, Joseph.
Boland, John.
Browne, Noël.
Bruton, John.
Burke, Joan.
Byrne, Hugh.
Cluskey, Frank.
Conlan, John F.
Cosgrave, Liam.
Cosgrave, Michael J.
Creed, Donal.
D'Arcy, Michael J.
Desmond, Barry.
Desmond, Eileen.
Donnellan, John F.
Enright, Thomas W.
Fitzpatrick, Tom. (Cavan-Monaghan).
Griffin, Brendan.
Harte, Patrick D.
Horgan, John.
Keating, Michael.
Kelly, John.
Lipper, Mick.
McMahon, Larry.
Mannion, John M.
Murphy, Michael P.
O'Brien, Fergus.
O'Brien, William.
O'Connell, John.
O'Keeffe, Jim.
O'Leary, Michael.
O'Toole, Paddy.
Quinn, Ruairí.
Ryan, Richie.
Taylor, Frank.
Treacy, Seán.
Tully, James.
White, James.

Tellers: Tá, Deputies P. Lalor and Briscoe; Níl, Deputies Creed and B. Desmond.

Question declared carried.

SECTION 2.

An Ceann Comhairle

Amendments Nos. 3 and 4 have been ruled out of order.

Question proposed: "That section 2 stand part of the Bill."

Mr. Boland

We have the same difficulties here as we had in relation to the definition section. Paragraph (a) obliges the Minister to secure the orderly organisation of family planning services and paragraph (b) obliges him to provide a comprehensive natural family planning service. The phrase "orderly organisation of family planning services" itself needs definition. This morning Deputy Kelly complained that he did not see a definition of "natural family planning service". On the Second Stage I made the point that a natural family planning service is defined not in the definition section but in section 2 (b), because when you take out some of the verbiage you find that a natural planning service involves methods of family planning that do not involve contraceptives.

From that it would seem that in an effort to get a further definition we should assume that, if you remove the word "natural", family planning services other than natural family planning are by default defined in this section rather than in section 1 as being services that involve contraceptives. I would have thought that a comprehensive family planning service would have included advice in relation to fertility guidance, for example, which does not involve the use of contraceptives. Would that not be part of a comprehensive family planning service?

I was surprised that in the course of the debate on the previous section the Minister did not refer to items of that kind. Therefore I should like the Minister to explain now what exactly he has in mind in paragraph (a). Does it mean that in a period of time such services might be provided and is this to be taken to mean that the great reservations a number of us have in relation to the obligation of health boards to provide a service and staff that service with properly trained personnel are to be taken as valid? What is the definition of the word "orderly" in this context?

Dr. Browne

This section places the Minister's choice of what he calls natural family planning services which do not involve the use of contraceptives as quite clearly his first choice in relation to family planning services. It seems to me that he must have some good scientific reason first of all for introducing a special section to empower health boards to provide a natural family planning service and consequently for the implied rejection of what hereafter must be referred to as unnatural contraception.

Here we are in deep water, but we should try to find out what is in the Minister's mind, why he seems to play down various forms of contraception which imply the use of contraceptives. And then, to go back to a point I made this morning, the Minister for Health being the authority on family planning under this Bill, why has he chosen to take the various forms of what I will call, for the sake of clarity, the unnatural methods of family planning and treat them as less worthy or less desirable forms of family planning than the natural system?

I mentioned this morning tubal ligation and male sterilisation as being without doubt the most efficient form of family planning, which is denied to us. After that comes the pill, which generally speaking is probably the most widely used, extremely efficient but not perfect form for the various reasons mentioned, such as the possibility of thrombosis or blood pressure in ladies of more than 35 years, and other reasons which would make the pill slightly dangerous in certain circumstances. But, generally speaking, it is easily the most efficient, simple and safe contraceptive to use. What are his grounds for putting what we now consider the natural family planning system in this special position—echoes of Article 44—in our contraceptive services? This natural family planning service is, of course, the Billings method. I assume that is what he is referring to rather than the rhythm method.

I am sure it is not coincidence that the Billings method is generally accepted as being the system of family planning which has been miscalled the natural family planning method because it allows for coition only 34 per cent or 36 per cent of the time of the female cycle. It therefore denies the couple the right to intercourse for a very considerable part of the menstrual cycle. How can this be called a natural system of family planning where human frustration, probably one of the most powerful—and, in many ways, damaging where it is sufficiently intense—forms of abstention is implicit in the acceptance of the Billings method?

The Conference of Bishops in April, as we know, condemned all contraception but are favourably disposed to the general position of acceptance of the natural method. The Minister made it clear in his speech on the Second Stage that he intends to promote this natural family planning method. The Irish Catholic Bishops Conference in December 1978 claimed there was a growing world interest in natural family planning. The religious affairs correspondent in The Irish Times noted that the proposed limitation goes a good way towards meeting the points made by the Bishops in their detailed work in April. The Minister stated on the Second Stage, at column 328, Volume 312 of the Official Report:

When the Bill has been passed, I propose to work closely with NAOMI and with the Catholic Marriage Advisory Council and to obtain their assistance in providing a comprehensive natural family planning service so that in coming to a decision about the manner in which they wish to plan their families, couples have available to them appropriate advice and information on this method of contraception in addition to other methods and that there will be available to them, if they desire to utilise this method, informed guidance and assistance in doing so.

One must ask whether the Minister is acting responsibly in advising the use of this service, pre-eminently giving special consideration to the use of this service, special powers, no supervision, providing finance and various other facilities in order to push this particular measure. It is a notoriously unreliable method. It has a high failure rate. It is not simple like the pill or like tubal ligation and the other form of sterilisation. It requires a high level of education and of commitment to the scheme. It is wrong of the Minister to appear to subscribe authority, as he is, to one form—the form put forward by the Catholic Bishops—when he must know that, in the first instance, in calling it the "natural family planning method" implicity suggests and seems to me to call into question the ethical values or standards of people who use the condom, spermacide, cap, pill, IUD or unnatural methods.

The first place I ever saw the wording appear was in the 1946 Censorship of Publications Act. There is no doubt that the Catholic Hierarchy are attempting to proposition the form they favour against the other forms as the natural against the unnatural. The Church of Ireland, the Presbyterian Church, the Society of Friends and the Jewish religion all consider that the various unnatural forms of contraception are perfectly permissible and acceptable. The Minister, using what appears to be religious discrimination in respect of a particular kind of family planning, is indulging in a gratuitously offensive slight on the minority religions in the Twenty-six Counties or, taking it as we did this morning, the Thirty-two Counties. He is putting himself in an invidious situation when it comes to trying to establish that we have in fact abolished Article 44 and that our laws are not based on one particular church.

That is one of the defects I see in the promotion by the Minister of the natural family planning method, but infinitely more important is the reality that the Billings method is a complicated, difficult method and a highly repellant form of attempting to plan a family. However, each person to their own likes and dislikes. Its inefficiency is the most important point. Why should the Minister favour an inefficient form of family planning against a number of demonstratively efficient forms of family planning? A Lancet study in September 1976, conducted by Professor John Marshall, who advised the Pope on Humanae Vitae, found a failure rate of 22 per cent—one in five. That was a postal survey and I assume that if Professor Marshall produced these figures it is a survey that can be relied on.

An Leas-Cheann Comhairle

The Deputy is going into very great detail and that would not be in order at this Stage. It is all right to debate one method as against another but to go into a long detailed exposé of it is not in order.

Dr. Browne

I have no intention of doing that. I will just quote two or three sentences and then I will be finished with it. It states that all the women had been successfully instructed in the method by the correspondence service of the Catholic Marriage Advisory Council. A Mrs. Noreen Ryan, who is secretary to this Catholic Marriage Advisory Council on this subject, said it is really only successful with a very attuned couple who have a very good relationship. She is really one of the most powerful proponents of this method. The Council of Europe Commission of Inquiry said the natural family planning and rhythm methods of contraception are too ineffective to be trusted and the World Health Organisation took up the same position that this form of family planning is, on the existing evidence, unreliable. As the Minister told us, they are carrying out a further survey and the Minister himself is proposing to promote a seminar here to inquire into the merits of this form of natural family planning.

Accepting that it is effective in certain circumstances, the reason given for its failure is patient failure and not method failure and that may be right but the World Health Organisation dismissed this idea that patient failure did not effectively mean method failure. But even assuming that it is, in the best terms, effective to between 15 and 20 per cent and the other methods, particularly the one I mentioned this morning, are all 100 per cent safe, efficient and simple giving the multiple choice which is imperative in this sort of situation, I find it very difficult indeed to understand why the Minister appears to favour this above what we call for convenience sake unnatural methods of family planning.

It is unfortunate that there is only one lady deputy present and that she is outnumbered by the men here but I would emphasise that medical safety is a constitutional right for our citizens. The lives of too many women are at stake for the Minister to take what appears to be a politically expedient decision or one which is determined by one religion over another, to offer avoidable risks, unnecessary risks to the lives of mothers and their children. The figures I gave this morning are worth repeating. In 1973 the maternal mortality rate for women between 18 and 25 was eight per 100,000; for those between 35 and 40 it was 30 per 100,000 and for those over 45 it was 120 per 100,000. So pregnancy can be a matter of life and death and therefore the Minister has a completely bounden responsibility which he cannot evade.

I have no objection whatever to any of the Churches and all of the Churches—the Presbyterian Church, the Church of Ireland, the Roman Catholic Church, the Jewish Church, the Society of Friends—advising their members on these things; that is what they are there for. But I believe that it is the responsibility of a Minister of State, having considered the various methods open to him, to provide these various services to the community and then accept that the community is mature and is going to behave in a mature way and make a decision in line with their own conscience, feelings and beliefs. The Minister appears to favour this so-called natural method; I do not accept that it is natural—I think it is most unnatural. I do not know how the Minister reconciles this with the provisions of the Bill but according to the Bill one must get a lecture on the Billings method even if one is simply coming to the doctor for a prescription for condoms or spermicides. This is quite obviously a public relations exercise. The Minister is attempting to ingratiate himself with the Catholic Hierarchy. I have no objection to him doing that but he should not do it by providing a deficient or a defective or a substandard family planning service which, let us remember, our citizens will accept as being the best service that can be provided simply because the Minister provides it, because we must assume that he will act bona fide in the best interests of the citizens.

Mr. Horgan

I want to say a few words on the section and in the process to answer the question raised by Deputy Browne. Why should the Minister favour one particular form of family planning service rather than another? I doubt if my answer to that question is the one which the Minister would give. This is a core section in the Bill and it is a fundamental part of what I see as the Minister's strategy in bringing this Bill before the House in this way. It is easy to see—and we would be dishonest if we did not admit we saw—the very many political difficulties faced by the Minister when he sat down to draft this legislation. But it is possible to sympathise with the Minister's difficulties without agreeing with his solutions. The solutions that he has advanced in this Bill—and I do not think anybody who reads it carefully can come to any other conclusion—are based on a balancing off of interests. My case is that it is this balancing off of interests that is at the core of the Bill and which has led to a need for a change in the law and not the needs of the people.

I would like to refer first to 2 (a) which lays down that the Minister shall secure the orderly organisation of family planning services. Like Deputy Boland I find it very difficult to understand what this means, if it means anything at all. Will we have inspectors, cigiri an Roinn Sláinte, going around securing the orderly organisation of family planning services? It seems to be unnecessary at best and at worst it gives the Minister even more powers in a broadly based way than he is given elsewhere in the Bill.

I now come to 2 (b) which is rather more important. There are two points I would like to make. The first is simply a drafting point. It would have been quite possible for the Minister to come to exactly the same conclusion and to have provided a subsection with exactly the same effect if he had left out all the words after "provide" down to "a comprehensive service"—if he had left out the words which read "a comprehensive natural family planning service that is to say" because, as has been pointed out, the latter part of the subsection simply defines what the Minister believes to be the kind of service which the Minister should provide. But we have here the insertion in this subsection of the phrase "natural family planning service". It is not needed to achieve the legal effects the Minister feels he wants to achieve. It is the purpose of this subsection to achieve a political effect, not a legal effect. The political effect is that it is intended to distract as much attention as possible from the fact that the Minister in other parts of this Bill is making available, however unwilling, partially or inadequately other forms of family planning via agencies other than those over which he has control.

The politics of this Bill, which are not negligible, are that the Minister and the Government were put in the situation, not only by the McGee case but by their pre-election commitments, that they had to introduce some piece of legislation. It was inevitable that it should allow for some availability of contraceptives of the non-medical kind. It was equally inevitable that there should be a substantial public lobby—we have seen the fruits of it over the last few days—against any legislation whatsoever. It is as plain as the nose on the Minister's face that much of the impetus and the force behind the lobby, which is associated with opposition to any legislation on contraception which would make ordinary non-medical contraceptives more widely available or even, as in this Bill, less widely available than they are at the moment, is allied in many ways with a current of opinion which believes that the so-called natural family planning method is the only form of family planning which can and should be organised in this country.

I have nothing to add to Deputy Browne's excellent resume of the personal, medical and social drawbacks of this particular method. I do not like making the Minister's case for him but I might point out that, even though the Catholic Church here and in other countries is the most effective, most organised and the most vocal lobby in favour of natural family planning, natural family planning methods are to some extent endorsed by other denominations and are used and endorsed by people of other denominations. It is not, strictly speaking, a sectarian issue; but it is certainly true that the Catholic Church and its spokesmen are powerful and effective spokesmen for this point of view. The Minister has decided that the only way he can secure any widespread acceptance for even this restricted Bill is to build into it a substantial goodwill gesture towards that lobby. That gesture is contained in this section and in section 9.

I find it repugnant that the Minister should be using a section of a Bill in this public relations way. It is not just a section of a Bill and it is not just public relations, because under section 2 (b) we are authorising the Minister to spend public money on one kind of family planning service only. The part of his Second Reading speech which was read out by Deputy Browne noted that he proposed to insert this section in the Bill to authorise spending public money on the investigation of natural family planning so that couples would have information and advice available on this in addition to other methods. "In addition to other methods" is an exact quotation from what the Minister said. He was carefully making a distinction here because the other methods to which he referred in such an offhand way are not to be provided by him but by other people, if they are to be provided at all.

This section is drafted in such a way as to give the impression that the Minister and the Government are in some sense in favour of a comprehensive family planning service. In practice the Bill restricts it to one kind of family planning, the kind which is open to many criticisms, and in doing so it gives the Government and any Minister for Health the right to spend a great deal of money on family planning—no doubt to the exclusion of spending money on any other forms of family planning—and in the process it effectively pre-empts the free, voluntary and responsible decision of many people in the State. I find this extremely repugnant because of the misplaced and unworthy sense of public relations deemed necessary to squeeze this Bill through the Fianna Fáil Party, the Government, the House, and because it goes to the length of encouraging the Minister or any future Minister to spend public money in the pursuit of this particular end.

Mrs. Lemass

As a woman I should like to say that there are a considerable number of women and of married couples who are in favour of natural family planning. While I am a rather liberal person and hoped that this Bill would be expanded in various ways, I am very happy to see that in it natural family planning is given a special section and that money will be available to do research and to find out exactly what natural methods are safest and are the best. Many of the natural methods do not work very well and this is why it is important to do research to find out better and more acceptable methods. If a couple can find a safe natural method, it is best. Very few couples would prefer to indulge in the kind of operations which were suggested this morning or make a final decision not to be able to have any more family. Couples like to think that they are spacing their children. If they have been using the natural method and after two or three years the woman conceives a child, it is not the end of the world. It is a couple's own choice and they can choose, as has been mentioned here, unnatural or mechanical methods if they wish. They should be allowed to choose natural family planning and not be downgraded, as has been happening here for the last half hour, for using those methods. I am all for research to find better and safer natural methods. The majority of our people want these methods.

Mr. Haughey

I expected to be accused of many things in relation to this Bill but I did not think anybody in the House would accuse me of indulging in public relations in regard to it. I want to assure Deputy Horgan that he need have no worries about that. As far as my political assessment goes, there is no public relations benefit of any sort for me in this measure, no matter what provisions I put in or leave out. As far as I am concerned, and as far as Deputy Horgan or Deputy Boland are concerned, I do not think any great public relations benefit will ensue to any of us as a result of getting this measure through the Dáil.

Paragraph (a) of this section places on the Minister for Health the obligation to secure the orderly organisation of family planning services. I would have thought that that was perfectly simple and straightforward. I want to assure the House that it is not wording to which I gave any particular attention. I knew what I wanted to say in that connection but thereafter I left the drafting of that paragraph to the draftsman. I wanted to ensure that we provide a family planning service on as wide and as suitable a basis as possible for the general public. If any Deputy wants to put forward any other form of words to achieve that same objective, I will accept it because I am not particularly wedded to that form of words. I want to assure the House that there is nothing sinister in that form of words. They mean exactly what they say—that I, as Minister for Health, will endeavour, with the co-operation of the medical profession in particular, with the nursing profession also and others, to build up throughout the country and to make available to married couples a suitable adequate family planning service. That is exactly what paragraph (a) says: "to secure the orderly organisation of family planning services."

Basically the Bill suggests that this should be done through the general practitioner service. We are placing on the general practitioner the obligation to become knowledgeable and expert in family planning matters and to be able to provide family planning advice, information and education to patients throughout the country. That is the first step in the provision of a family planning service. There will be others, the need for which will become obvious as this Bill comes into operation.

The Bill provides that a family planning service may be provided by others, for example, the health boards. Here I want to make the point that the health boards were unanimous in telling me, when they came to see me that they did not want to be involved with the distribution of contraceptives. They have no objection to providing a family planning service in the sense that family planning is used in this legislation, namely, a family planning service which consists of advice, information, education and so on. The health boards did not, under any circumstances, wish to be involved in the provision of artificial contraceptives as such. We may ask them to undertake the provision of these services. We may ask some of our larger maternity hospitals to provide family planning services as envisaged in this Bill. If all these fail we may have to devise some other way of ensuring that every couple who wish sensibly and maturely to plan their families will be advised and informed on how to do exactly that. That is all that is involved in paragraph (a).

Paragraph (b) has attracted some comment, I think very unfairly. I reject any suggestion that this is a public relations exercise. I do not think that stands up. If one goes into it, and leaving this debate aside, one could not maintain that suggestion. This section places on the Minister a statutory obligation to provide this type of service, a comprehensive natural family planning service. That is not window dressing. That is not a charade; it is a reality. If the obligation is placed on the Minister to provide a service, he must provide that service. That is something of effect, something that will have to be done.

Why do I suggest that this service should be provided? Deputy Lemass has given a good point of view on this aspect. There are a very large number of people in our community and whether Deputy Browne or Deputy Horgan likes it, they are there and they have their views and their convictions——

Mr. Horgan

I do not deny that.

Mr. Haughey

——and they are entitled to their views and their convictions. If this very large volume of married persons—I would say the majority—could possibly find a form of family planning or contraception that did not involve artificial contraceptives, they would be very happy people. This would solve for them a very serious agonising dilemma. That is a fact and let us recognise it. Surely I, as Minister for Health, aware of that situation must do something about meeting it. I must do what I can to see if it is possible in our circumstances to meet that need of that very large number of persons.

Deputy Browne said a couple of things today which I was not going to comment on but I think I had better. He is a medical doctor and therefore what he says here carries some weight in a medical context. I do not pretend to be in any way expert on any of these matters. My personal knowledge of them is minimal. I can only take what advice I get, listen to it as carefully and intelligently as I can and try to devise policies accordingly.

Deputy Browne has been very scathing about natural family planning as a method. I do not think he is right in what he says. I do not think he is up to date. I think he is medically wrong. Again I qualify what I am saying by telling the House that I am not medically qualified but the evidence available to me indicates that Deputy Browne is misleading the House. I do not say he is deliberately misleading the House, but he is putting forward a view which I do not think is tenable. There is very good evidence, and I am quoting the World Health Organisation—not the Department of Health in Ireland, the Eastern Health Board or anybody else—who have just published a report in which they say that where it was correctly used the Billings method was 98.5 per cent effective. If any Deputy wishes to have a look at this report I will be delighted to make it available to him or her. I will quote one sentence from that report, which is entitled Special Programme of Research, Development and Research Training in Human Reproduction, Seventh Annual Report, November, 1978:

However, only three of the pregnancies occurred under circumstances where the method definitely appeared to be used correctly. Thus the theoretical effectiveness of the method is 98.5 per cent.

As I understand it, that corresponds more or less exactly, or favourably, with the effectiveness of the pill. Therefore, if, simply on the evidence, you are to take a decision as between one and the other purely on the scientific medical aspect you would be entitled to opt for the natural family planning method. I say that only to balance this debate. I do not maintain that what I say is correct or has any finality about it. That is the latest report from the WHO and I put it forward in contradiction of the rather sweeping condemnation made by Deputy Browne. This morning he also at very considerable length advocated vasectomy as a method of family planning. I am advised that in the UK, the USA and elsewhere studies are now being made into vasectomy because it is alleged that it has very serious after-effects in later life. It is not entirely legitimate for anybody in the course of this debate to take up these very dogmatic stances about any aspect of this matter.

As Deputy O'Connell very honestly said this morning, medical knowledge is far from complete. Indeed, the views of medical people and the theories of medical science change from time to time. I say all this by way of counteracting the argument that natural family planning is something not even to be contemplated. Deputy Browne was quite scathing in his assessment of it as a method. Whether it is or not, as Deputy Lemass points out, if we could come up with some safe natural family planning method we would be providing a very acceptable answer for a very large number of genuine, sincere people in this country who want only to lead their lives in accordance with their own codes, consciences, religious beliefs and convictions. For that reason I have put in here this obligation on a Minister for Health to provide a natural family planning service. That is the only way to ensure that it is done. A statutory obligation on the Minister to do something will ensure that it is done and anybody can take the Minister to task here in this House or elsewhere to find out why it is not being done, if it is not. Both the provisions in paragraphs (a) and (b) of this section are perfectly reasonable provisions and perfectly suitable to include in a family planning measure of this sort. The obligation to secure the orderly organisation of family planning services means no more than that, and the obligation to research fully natural family planning methods and provide a service based on them for those who want that type of service is a reasonable provision.

I am aware that the WHO are doing an enormous amount of high level work in this whole area of family planning, particularly in investigation into natural family planning methods. In an endeavour to advance our knowledge of the situation I intend to arrange later this year for an international seminar on natural family planning. I emphasise that it would be a scientific seminar of, I hope, very high international standing which will bring before us in this country the very latest information of the highest scientific quality on the development of natural family planning.

Mr. Boland

It is exactly a year since, speaking publicly at the annual conference of my party, I made the very point that Deputy Lemass and the Minister have made. I doubt if anyone in the House would disagree with the suggestion that if there is an effective and acceptable natural method of family planning the vast majority of people would favour the use of that method. Of course it is certainly up to Deputy Browne to speak for himself, but listening to him I would have thought that he was not in disagreement with the suggestion that if there is available to people an efficient, safe method of natural family planning it would meet with the general acceptance of everybody.

I got the impression that what Deputy Browne was endeavouring to convey was that some of the more widespread methods, which are known as natural methods in this country, have not had the success rate that one would have hoped for. Any man or woman would need to be a fool to continue to use artificial or mechanical methods of contraception if there was available a natural method for producing the desired result.

I accept that the figures that the Minister has quoted in relation to the Billings method have been quoted in the international context, but if we are going to spend some time discussing the success rate of the Billings method we ought also to discuss the success rates of the methods used in this country and in the western world—generally. If the Minister has those detailed figures made available to him by his officials it might be appropriate for him to produce the success rate for the Billings method in this and other European countries and to see how they compare with the 98.5 per cent which was the overall figure produced. The information which I have is based on statistics compiled generally for the Third World. It has been suggested, though I have no evidence to make me believe it, that they may have been compiled in a less than efficient manner. Certainly my party would accept, as I am sure would everybody else, that there should be an emphasis on natural family planning methods that are efficient and safe. I am afraid that, so far, very many people still do not believe that the various methods of natural family planning advocated in this country produce as efficient a result as some of the mechanical or artificial methods.

I make one further point on which I had hoped the Minister would elaborate. In order to provide education in the Billings method it is required that the people providing that education would themselves be very highly specialised in order to be able to impart very highly specialised knowledge. Otherwise the women employing the Billings method will not do so efficiently. The Minister was at pains to emphasise that the success rates he quoted are only success rates where the method itself had been used properly. There is some evidence to suggest that for whatever reason— rather difficult to understand—people in the more affluent and better educated countries appear less efficient in the use of the Billings method than people in the third would countries.

I had hoped the Minister might have explained to some extent in what way he was going to ensure that those providing the education in natural family planning methods would themselves receive education so that they could properly impart the technical and highly specialised knowledge necessary to enable a couple to practice the Billings method properly. I am also disappointed—if we are to have an honest debate about it—that the Minister did not give the figures in the Irish context which are substantially less impressive than the overall figure the Minister quoted.

What I had hoped the Minister would have explained also was the difference between paragraphs (a) and (b). In one he obliges himself to secure the orderly organisation of family planning services but, in the other, he places an obligation on himself to provide—rather than to secure—a "comprehensive" natural family planning service. Why comprehensive for one and not for the other? Ought it not be to secure the orderly organisation of comprehensive family planning services? Or is the comprehensive nature to relate merely—apparently as it stands it certainly does solely relate—to the natural family planning methods?

Why are we apparently endeavouring in this section to deliberately ensure that there is comprehensive natural family planning service information available but no statutory obligation on a Minister to ensure that there is organisation of comprehensive family planning services which would include methods other than the natural? Perhaps I did not make myself sufficiently clear when I spoke initially; it was rather difficult with people departing from the chamber after the last vote. But that was the point I had intended making, that the comprehensive insistence placed in paragraph (b) is not, for some reason, outlined in paragraph (a), when one would have thought it would have improved that paragraph.

I am concerned also as to the use of the word "orderly". The Minister tells us that he did not concern himself personally to any great degree with the use of that word. Very often the word is used where it is envisaged that the provision of a service cannot come about overnight, simultaneously throughout the country, or in a comprehensive, efficient way at the same time. The word "orderly" is then often used to signify that on a scaled, progressive, even gradual base, a service is provided, perhaps initially in some parts, subsequently in others and possibly never in more remote areas. Certainly, through the use of the word "orderly" a Minister could be forgiven for admitting that the service was not uniform in different parts of the country because he was endeavouring in an orderly way to extend it to the different areas of the country.

When I spoke on Second Stage I said that, as far as many people are concerned, this debate is a non-starter. It is quite wrong when Parliament get itself to the stage where we are endeavouring to mend our hand, to catch up with the decision taken by thousands of ordinary, decent Irish men and women in planning their families. They have made their own arrangements quite satisfactorily. The people about whom we need to concern ourselves most are those mainly poorer people in the remoter areas who do not at present have access to family planning clinics, to some of the more sophisticated and large maternity hospitals, some of which incidentally already provide a family planning service, as I am sure the Minister and the House well know.

Therefore, to suggest that some of the larger maternity hospitals might subsequently, as part of this orderly development, provide the service is somewhat misleading. Indeed I understand that one of the largest Catholic maternity hospitals in this city for some years now has been running a comprehensive family planning service for its patients. But we should be endeavouring to ensure that the poorer people in the remoter parts have as easy an access to as comprehensive a service as the Minister for Finance's friends—the well-heeled and articulate women in the better-class suburbs of Dublin. I do not see that section 2 in any way places an obligation on the Minister, within a reasonable period of time, to ensure that that happens because he has only to secure the orderly development of the services. In four or five years time the Minister could reasonably say that he had found it impossible so far—although he still intended at some stage—to provide a service in, say, Donegal, Kerry, parts of the West because of the paucity of numbers of trained personnel in those areas.

I had hoped that when the Minister was explaining to us what he meant by orderly organisation he would have put at least a verbal obligation on himself to ensure that some decent service was provided, on a standard, uniform basis throughout the country, within a reasonable length of time. I should still like to invite him, again very much in a non-political way—I am rather concerned that the Minister appears to feel that all points being made are being scored against his unfortunate personal reputation—to speak on that matter, to give the House some enlightenment as to his plans to see the service provided on a uniform basis throughout the country over a particular time scale.

I should like the Minister also to explain why the word "comprehensive" is used in paragraph (b) and not in (a). I have been thinking since the Minister spoke on Second Stage about the fact that he mentioned then, as he mentioned today, that the representatives of the eight health boards were unanimous when they came to see him, all saying that whilst they did not object to providing information or advice in relation to family planning, they did not want to become involved in the actual distribution of contraceptives. Thinking about that since, I realise it was the most obvious and logical thing for the representatives of any health board to say. As we know, health boards are comprised of representatives of different areas. Many of the health boards are unable to fulfil quite a number of the statutory functions they hold already. I am quite sure if the representatives of the eight health boards were brought together now and invited to say whether they wanted to continue the public dental service, which many of them are unable to operate, they would probably say, for their own convenience, that they are quite prepared to advise people on dental hygiene but they would be delighted to see taken away from them the statutory obligation to provide the service because they know they have been falling down on it.

If the Leas-Cheann Comhairle were present he would be reminding the Minister that he was moving to the next section and would not allow this discussion but it is relevant to take the two sections together. To state "under the direction of a general medical practitioner" does not mean the doctor must be sitting there with his diploma under his arm while the entire operation of giving advice is going on. When we reach that section we will discuss in detail the devious mind that conceived this method. A clinic can be under the direction of a general medical practitioner who may be dangling his toes in the Adriatic while the clinic is still operating. A health board clinic can be open to receive visits from medical card holders or other people without a doctor being present. A health board could purport to operate a family planning advice centre in a health centre without a doctor being present. I envisage that happening in certain cases under the Bill. The example I gave is one which will take place in reality. I invite the Minister to think again as to whether or not it was the easiest thing for the representatives of the health boards to say that they did not want to be involved in the dispensing of contraceptives.

I am answering points I wrote down which were made by the Minister, Deputy Lemass and Deputy Boland. I am attempting to answer statements made by them. Deputy Boland and Deputy Horgan were quite right to take up the point about the difference between paragraph (a) and paragraph (b) and the use of the words "secure" and "provide". I was fascinated by these two words when I saw them. I looked them up in a dictionary to try to work out what the Minister had in mind, and I have to say I could not. To secure is to tie up a boat, or to tie a rope, or something like that. It is sufficiently vague not to be of any help. To provide is obviously very much more clear-cut. There is no doubt in my mind that there is something the Minister is not telling us about in the use of those two words in the two paragraphs.

If paragraph (b) read:

provide a comprehensive natural family planning service, that is to say, a comprehensive service for the provision of information, instruction, advice and consultation in relation to methods of family planning ...

that would necessarily include all forms of family planning, including so-called natural family planning, and would not give the impression that the priority in the new family planning scheme will be to bow to the wishes of the natural family planning lobby and to try to downgrade the most efficient, most effective and simplest forms of family planning. The Minister has some explaining to do about his clear preference without substantial evidence. He must accept the point I made conceding the reference he made to the World Health Organisation. Of course, he did suggest that I was misleading the House in being scathing about the Billings method. I made the point that the need for cooperation between couples was the important consideration in regard to the effectiveness of the Billings method. None of that applies to anything like the same extent in regard to the pill, the condom, the diaphragm and the IUD.

This brings one to the question of the attempt I made to discuss fitting and supply and whether the Minister could answer my question as to how he proposes the clinic to operate. I agree with Deputy Boland's point that the health boards will get out of providing anything they can get out of providing. What happens in the case of a lady who wants a diaphragm? Is she fitted with a diaphragm? The idea, I suspect, is that she would be fitted. What happens then? Does the doctor take the diaphragm back and tell her to get a diaphragm in the chemists? If that is true then what Deputy Boland said is correct. There will be an appalling waste of time on the part of the doctor, the chemist and the lady looking for help and the greatly added expense of a prescription charge and a doctor's consultation charge. What will happen about the fitting of an IUD and the use of a spermicide? What will the liasion be between the chemists, the health boards and the suppliers of these mechanical devices?

The other objection to the Billings method is its complexity. To use it requires instruction, high motivation and persistence. I think the IMA told the Minister that there were ten or 11 doctors in the country who were really experienced in family planning methodology. Does the Minister believe that it will be possible for a busy general practitioner who believes in natural family planning to explain it in a way which will make sure that we get a serious family planning service in a reasonable time?

The other question relates to the doctor who does not believe in natural family planning but who, according to subsection (5) "shall ensure that the service includes information, instruction, advice and consultation in relation to methods of family planning that do not involve the use of contraceptives". He will find himself having to talk about natural family planning. In a later section he is told he can use his discretion but he will not be compelled to do anything he does not believe in as a doctor in his medical relationship with the patient.

There are many points of confusion in the Bill. I am not attempting to make difficulties for the Minister. I am simply attempting to show him the points about which I believe many people are confused. It is in the Minister's interest that we should make it clear. Why does the Minister accept the health board recommendations if he really believes that it is their job to provide these facilities or to reduce the difficulty which people in rural areas will have in finding a doctor who accepts the scheme, a chemist who stocks the devices, and so on. There is a compelling case for insisting that the health clinics be responsible for the family planning service, including the fitting and supplying of devices.

An Ceann Comhairle

Unless there is something new to be said, I am putting the section.

Question put: "That section 2 stand part of the Bill."

The Committee divided: Tá, 67; Nil, 43.

Tá.

Ahern, Bertie.
Ahern, Kit.
Allen, Lorcan.
Andrews, Niall.
Aylward, Liam.
Barrett, Sylvester.
Brady, Gerard.
Brady, Vincent.
Briscoe, Ben.
Browne, Seán.
Callanan, John.
Calleary, Seán.
Filgate, Eddie.
Fitzgerald, Gene.
Fitzpatrick, Tom.
(Dublin South-Central).
Fitzsimons, James M.
Flynn, Pádraig.
French, Seán.
Gallagher, Dennis.
Geoghegan-Quinn, Máire.
Haughey, Charles J.
Keegan, Seán.
Kenneally, William.
Killeen, Tim.
Killilea, Mark.
Lalor, Patrick J.
Lawlor, Liam.
Lemass, Eileen.
Lenihan, Brian.
Leonard, Tom.
Leyden, Terry.
Lynch, Jack.
McCreevy, Charlie.
Colley, George.
Collins, Gerard.
Conaghan, Hugh.
Cowen, Bernard.
Cronin, Jerry.
Daly, Brendan.
Davern, Noel.
de Valera, Sile.
de Valera, Vivion.
Doherty, Seán.
Farrell, Joe.
Faulkner, Pádraig.
McEllistrim, Thomas.
MacSharry, Ray.
Meaney, Tom.
Molloy, Robert.
Moore, Seán.
Morley, P. J.
Murphy, Ciarán P.
Noonan, Michael.
O'Connor, Timothy C.
O'Donoghue, Martin.
O'Hanlon, Rory.
O'Kennedy, Michael.
O'Malley, Desmond.
Power, Paddy.
Reynolds, Albert.
Smith, Michael.
Tunney, Jim.
Walsh, Joe.
Walsh, Seán.
Wilson, John P.
Woods, Michael J.
Wyse, Pearse.

Níl.

Barry, Peter.
Barry, Richard.
Begley, Michael.
Belton, Luke.
Bermingham, Joseph.
Boland, John.
Browne, Noel.
Bruton, John.
Burke, Joan.
Cluskey, Frank.
Conlan, John F.
Cosgrave, Liam.
Cosgrave, Michael J.
Creed, Donal.
D'Arcy, Michael J.
Desmond, Barry.
Desmond, Eileen.
Donnellan, John F.
Enright, Thomas W.
FitzGerald, Garret.
Fitzpatrick, Tom.
(Cavan-Monaghan).
Griffin, Brendan.
Harte, Patrick D.
Horgan, John.
Keating, Michael.
Kelly, John.
Kenny, Enda.
Lipper, Mick.
McMahon, Larry.
Mannion, John M.
Mitchell, Jim.
Murphy, Michael P.
O'Brien, William.
O'Connell, John.
O'Keeffe, Jim.
O'Leary, Michael.
O'Toole, Paddy.
Pattison, Séamus.
Quinn, Ruairi.
Ryan, Richie.
Taylor, Frank.
Treacy, Seán.
Tully, James.

Tellers: Tá, Deputies P. Lalor and Briscoe; Nil, Deputies Creed and B. Desmond.

Question declared carried.

SECTION 3

An Leas-Cheann Comhairle

Amendments Nos. 5, 6 and 7 have been ruled out of order.

Dr. Browne

I move amendment No. 8:

In page 3, subsection (3), lines 23 to 27, to delete paragraph (b).

The feeling that one has in regard to this section is that in some way this would tie up with the Minister's vagueness in section 2 (a) about the provision of family planning services involving the use of contraceptives. My belief is that if there is need for a family planning service and if it is provided under the law, and lawfully constructed, under adequate supervision, or supervised by trained family planning personnel, then it should be possible for a clinic to be established. It seems that this subsection is aimed at the existing family planning clinics. We all know these were established with great difficulty against considerable hostility and that it took quite a lot of courage by people to provide for what it transpired was a very real need.

These clinics since their establishment have provided a very valuable service. They are economical, well-run, efficient. They provide various tests, smear tests, cancer tests, breast examination, pregnancy testing, psychosexual counselling and they are recognised from the point of view of the Department for grants towards training by doctors, nurses or social welfare workers or anybody else. These are helped by the Department of Health in attending courses run by the clinics to become eligible for the College of Obstetrician—Gynaecologists and the General Practitioners' Association, the joint group, the Royal College of General Practitioners, which provide a certificate to certify that those who have that certificate are competent in the training and advising of people in regard to contraceptives and in fitting of contraceptive devices of various kinds.

While in principle, as is probably well known, I am not a great believer in voluntary organisations, at the same time where they are providing a good service—there is no doubt about the value of the service these clinics provide—then until as good a service or a better service is provided by the State every encouragement should be given to the continued survival of the family planning clinics. They cannot survive unless they are allowed to sell contraceptive devices. This is precluded under the Bill and in these circumstances it would seem that the Minister is aiming to close down these clinics. Certainly it does not appear that he is going to do anything to prevent them from being closed down.

The extent of the service provided includes various diagnostic services and various services associated with family planning, contraception and also associated with the provision of information and lectures to doctors and a postal service. The latter is important because with our background we are very slow to discuss sexual matters in our culture for various reasons. That certainly applies to those over 24. As regards the survey carried out by the Minister and referred to by Deputy Boland, it would be interesting to know if there was any difference between the replies from the 18-25 age group and the 25 plus group as to their attitude to the kind of contraceptive service they needed. There is a large group of people who will not go to a doctor. There are also many doctors who are not very good on these matters. It is not implicit in the fact that a person is a doctor that he is able to discuss these extremely delicate, difficult and complicated matters, all the various problems associated with sexual relations in marriage and out of marriage.

By post in 1977, 80,000 orders came from people who will not go to family planning clinics. That is a very important service which I think should be continued, because if they need contraceptives the facility for them to get them any way they want to get them should be provided. There were 11,000 callers in 1977. That is a remarkable achievement by these clinics. I should like to know what plans the Minister has for these clinics. I understand one-third of their income comes from the sale of contraceptives of different kinds.

Progress reported: Committee to sit again.

Dáil Éireann debate - Wednesday, 9 May 1979

Health (Family Planning) Bill, 1978: Committee Stage (Resumed).

Tá

Níl

Tá.

Níl.

Dáil Éireann debate -
Wednesday, 9 May 1979