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Dáil Éireann debate -
Thursday, 6 Dec 2012

Vol. 785 No. 3

Report of the Expert Group on the Judgment in the A, B and C v. Ireland Case: Statements (Resumed)

I am pro-life and anti-abortion. I also support the protection of the mother's life. Every debate on abortion over the years has been very emotive, polarised and, in most cases, carried out in highly-charged circumstances with little respect shown to the opposing view. I would have hoped that this time it could be different but so far the signs are not good.

I was one of those who genuinely held that sufficient guidelines were in place to protect the mother's life. I was clearly of the view that the law and the Irish Medical Council guidelines allow doctors to intervene to provide essential medical treatment to women and recognise this may sometimes result in the unintentional death of the baby. In all circumstances where a pregnant mother experiences a life-threatening complication, the ethical and legal requirement should be to provide whatever treatment is necessary to protect the life of that mother.

The tragic case of the death of Savita Halappanavar, which touched the heart of the nation and the wider world, has been used by some to heighten the emotion in this debate, without the facts of the circumstances of the case being established. The facts of the case must be established and only when this happens can we use them as an example or can blame be attached.

The media will also be very much under scrutiny when the true facts emerge. How many true facts got lost in the reporting, such as that UCHG had not had a maternal death for the previous 17 years, how some parents of staff working in the hospital were visited in their homes by media outlets trying to get a sensational angle as the story developed and how UCHG staff members were confronted with vitriolic comments on the streets of Galway based on comments made in the media? I thought it could be taken for granted in a democratic country that one was innocent until proven guilty. In this context I note the journalist who broke the story is coming to the view that we should await the outcome of the inquiries before reaching judgments.

It is now being put forward that nothing has been done for 20 years so we should now make a decision and act on it within a few weeks. I do not agree with the analysis that nothing has been done, as two referenda have been held, one of them in 2002 which was narrowly defeated. In 2002 people were confused by the attempt to deal with the X case. This is evidenced by the fact pro-choice and pro-life supporters, who had dramatically opposing views, voted "No".

I will support any measure which will bring clarity to the medical profession attempting to save the life of a mother. However, I am of the view that while one can bring clarity or put Medical Council guidelines into legislation, one cannot possibly legislate for all eventualities. I also believe the suicide issue is too complex to deal with in the short timeframe suggested.

I welcome the opportunity to speak on what is a very complex issue. It is evident that this debate, which has been ongoing since 1983, is one which divides the nation like few others. Since my election to Dáil Éireann I have not received as much correspondence on any other issue as this one. The labels of "pro-life" and "pro-choice" are regrettable and do not account for the complexity of the various issues and problems which can arise during pregnancy. I believe the vast majority of the people in this country do not wish to see abortion on demand. I do not and I feel it is important to state this.

I welcome the publication of the expert group report. The establishment of the group was a commitment given by the Government. The complexity, sensitivity and multifaceted nature of this issue demanded that it be properly examined which is why the expert group was established. Its purpose is not to direct Government policy but to assist by examining and analysing the facts to provide a series of recommendations which can then be considered, accepted and amended.

At the heart of the debate, but strangely not commented upon to any great extent, is our Constitution and respect for the primacy of law. In 1992, the Supreme Court, which is the chief interpreter of our Constitution, passed a judgment focusing on the inclusion of the risk of suicide under the definition of the risk to the life of the mother. Therefore, with this judgment it is clear the highest court in the land has interpreted our Constitution as permitting a termination when the life of the mother is endangered either through physical or mental health conditions.

As the expert group report notes, "The Supreme Court decided in 1992 Attorney General v X2 (the X case) that the Constitution permitted abortion in certain limited and particular circumstances, namely, where there was a real and substantial risk to the life of the woman which could only be removed by terminating the pregnancy". The reality is that this judgment has been ignored by several Governments, and as I have pointed out to people who have contacted me on this matter it is not at all healthy for a society's Government to ignore the courts. It shows a lack of regard and respect for the primacy of law which all right-thinking members of society will agree is a very necessary feature for any democracy. Other Governments attempted to mitigate the Supreme Court's decision through holding two referenda, which it must be emphasised were both rejected by the people of Ireland.

In A, B and C v. Ireland the European Court of Human Rights found that Article 8 of the European Convention had been violated because although our Constitution contains Article 40.3.3 there is no provision in Irish law to measure or determine the risk referred to in the X case. Therefore, in effect we have uncertainty, and uncertainty is the anti-hero of properly functioning legislation.

The recent, tragic events in Galway have exposed the uncertain environment which is operating.

I do not know the precise details of what happened in University College Hospital Galway. Too many people have made assumptions on what went wrong. While not knowing where fault lies, it is important to note, for balance, that the hospital in which I was born, University College Hospital Galway, formerly known as the regional, did not experience a single maternal mortality in years prior to the tragic death of Ms Halappanavar. In that time, my seven nephews and nieces were safely delivered, as were countless others.

What we do know for certain is that Ms Halappanavar died before her time and because of this, the need to investigate is paramount. It is only right that three investigations are under way, one each by Galway Roscommon University Hospital Group, the HSE and HIQA. I am confident these inquiries will determine precisely what happened at UCHG which led to the tragedy. Furthermore, we must also note that the Minister, Deputy Reilly, has not ruled out a public inquiry. However, it is also important that the staff of UCHG is not deprived natural justice. Much commentary in the media, and elsewhere, has been unfair speculation.

As with most other Fine Gael Deputies, I have received postcards on this issue containing a message, which reads: 'Without the right to life, all other rights are meaningless". I could not agree more with this statement, but I also believe that this statement applies to pregnant women as it does to unborn children. The task before us is to remedy the uncertainty which exists. The women of Ireland and the medical profession need to know where they stand in relation to the law. The opinions and views of the masters of the maternity hospitals must also be carefully considered as it is these men and women who are the front line of this issue. Above all, in addressing the complexities of this issue we must proceed carefully. This issue requires careful consideration because of the far-reaching consequences of any decisions taken which will undoubtedly be of a legal, medical, ethical and constitutional nature.

The constitutional position on the legality of abortion has been clear for 20 years. The Supreme Court, in the X case, established that Article 40.3.3° of the Constitution permits lawful abortion in Ireland in circumstances where the life of a pregnant woman has been established as a matter of probability to be at real and substantial risk and that risk can only be avoided by a termination of the pregnancy.

The judgment of the European Court of Human Rights in A, B and C v. Ireland confirmed that Article 40.3.3° of the Constitution is not inconsistent with the European Convention for the Protection of Human Rights. In this case, the court found, however, that there had been a violation of C's right to a private and family right contrary to Article 8 of the Convention. C had been treated for cancer for three years. When she became unintentionally pregnant she was in remission and, being unaware of this fact, went for a series of follow-up tests related to her illness. She was unable to obtain clear medical advice as to the effect of the pregnancy on her health-life or as to the effect of the medical treatment on her foetus, and feared the possibility that the pregnancy might lead to a recurrence of the cancer. She decided to have an abortion and travelled to the UK for that procedure. The court held that there was no accessible and effective procedure to enable her to establish whether she qualified for a lawful abortion, defined as a lawful termination of pregnancy, in accordance with Irish law.

Ireland has signed and ratified the European Convention on Human Rights, Article 46 of which states that signatories agree to abide by any judgment of the court in any case to which they are parties. Therefore, Ireland is under a legal obligation to implement the judgment of the European Court of Human Rights in A, B and C v. Ireland. This is the factual position and it is up to all of us to deal with the implications of this. I believe we should not rush to a decision on this matter, but I accept the reality that it must be dealt with and the public wants it dealt with. Irish society is much divided on the issue of the circumstances in which abortion should be available, but I believe everybody deserves clarity on the issue.

There have been a number of referendums to try to deal with the implications of the X case. In 1992, the proposed 12th amendment, which was designed to exclude the risk of suicide as a ground for lawful abortion, was defeated. In 2002, the Twenty-Fifth Amendment of the Constitution (Protection of Human Life in Pregnancy) Bill 2001 was also defeated. It aimed to prohibit abortion except in circumstances where there was a risk to the life as distinct from the health of the mother. Under the proposed legislation, a threatened suicide would have been excluded as a risk to life and would thereby have limited the effect of the X judgment.

I believe that a substantial majority of the public does not want to see abortion on demand made available in Ireland. For the record, I do not want to see abortion on demand made available in Ireland. I believe that most people in this country feel that the physical act of aborting a foetus is abhorrent. Many feel that the decision in the X case, in particular the inclusion of risk of suicide as a legitimate ground for seeking an abortion, will be open to widespread abuse and will lead to the situation that exists in England. Many of those who argue this point would have a lesser objection if they could be assured that strict safeguards were put in place to ensure the risk of suicide was real and substantial. Many of these same people would have less of an issue with the availability of abortion for those who are victims of rape or incest and believe, notwithstanding their general objection to the availability of abortion, that a termination should be available in those circumstances. Others believe that the long-term health of the mother is also of paramount importance. It is not a black and white issue and legislating for the X case will not deal with these situations.

I have been contacted by many constituents who believe that the long-term solution is another referendum to seek once again a removal of the inclusion of risk of suicide as a ground for obtaining a lawful abortion while, in the interim, introducing non-statutory guidelines. Many others have contacted my office by e-mail. In fact, it is probably the biggest issue I have faced since I was elected as a Deputy. There have been a substantial number of e-mails and letters, both for and against legislating on this issue. Many have contacted me demanding legislation for the X case immediately. I am conscious that the Cabinet has decided to agree on a course of action before the end of December. My preference would be the introduction in the interim of clear guidelines for the medical profession. This has the advantage of being speedy and it would allow time to debate fully the implications of legislating for the X case and explain fully to the people how safeguards could be put in place preventing the introduction of abortion on demand and preventing the real potential for abuse which could result in legislating for the X case. Whatever the final decision reached, I believe the medical profession and pregnant women deserve clear guidelines on this issue from politicians.

We speak again on this sensitive and emotive issue. It is emotive in view of the tragic circumstances surrounding the recent death of Ms Halappanavar in Galway. That certainly heightened and charged the debate on this issue. The publication of the report under discussion around the time of Ms Halappanavar's death has brought this issue very much to the fore in the public consciousness in terms of the debate on whether to legislate. This debate is taking place in the context of the report's recommendations but also, and more importantly, in the context of what the Constitution states in Article 40.3.3°, the interpretation in the X case and the European Court of Human Rights Grand Chamber findings that there was a breach of C's constitutional rights to clarity on the issue of whether a lawful termination could be sought in this country. The debate has been respectful by and large. It is a divisive one, obviously, and we have stated this on numerous occasions. We have come to the stage where a decision must be made by the Government on foot of the publication of the expert group's recommendations, and that is something that will bring further debate on this issue.

It is healthy that we in this Chamber have this debate because the issue divides families, parties and society. It is truly very divisive. The key point on all sides is that people are allowed to protest and to voice their opinion but, equally, as parliamentarians, we should be allowed to go unhindered about our duties as elected representatives. In the interests of having a debate that allows all sides express their view without fear, that courtesy should be afforded to all public representatives irrespective of whatever opinion they hold on the issues.

This debate is about the report and its recommendations and findings. The background to the report is well known. Three women, A, B and C, brought proceedings against Ireland before the European Court of Human Rights claiming violations of Articles 2, 3, 8, 13 and 14 of the European Convention on Human Rights and Fundamental Freedoms. A and B complained about the prohibition of abortion for health and well-being reasons in Ireland. C complained about the alleged failure of Ireland to implement the constitutional right to an abortion in Ireland in the case of a risk to the life of the woman. The Grand Chamber of the European Court of Human Rights delivered its judgment on 16 December 2010. It dismissed the claims brought by A and B and upheld the claim brought by C. It found that Ireland had failed to respect C's private life contrary to Article 8 of the convention, as there was no accessible and effective procedure to enable her to establish whether she qualified for a lawful termination of pregnancy in accordance with Article 40.3.3° of the Constitution. The European Court of Human Rights stated that it was not its function to identify the most appropriate means for the State to comply with its obligations. It accepted that the implementation of Article 40.3.3° would be "a sensitive and complex task".

As Ireland is part of the European convention it is obliged to abide by and implement the judgments of the European Court of Human Rights. This was recognised by the Irish Government in a press release issued on the same day the decision was delivered. It stated that the Government will examine the judgment carefully and consider what steps are required to implement the judgment. The body charged with supervising the implementation of the European Court of Human Rights is the Committee of Ministers. The current Government committed itself - on page 8 of the programme for Government 2011-2016 - to establish an expert group to address this issue, drawing on appropriate medical and legal expertise with a view to making recommendations to the Government on how this matter should be properly addressed.

In the action plan on the implementation of A, B and C v. Ireland case submitted to the Committee of Ministers on 16 June 2011, the Government informed the committee of its intention to create the expert group. The Government announced the terms of reference of the expert group on 29 November 2011. These were as follows: 1. to examine the A, B and C v. Ireland judgment of the European Court of Human Rights; 2. to elucidate its implications for the provision of health care services to pregnant women in Ireland; and 3. to recommend a series of options on how to implement the judgment, taking into account the constitutional, legal, medical, and ethical considerations involved in the formulation of public policy in this area and the overriding need for speedy action.

The expert group was established on 13 January 2012. The report of the expert group was published on 27 November 2012. The report is 56 pages long and it is divided into eight chapters. Chapter 1 is the introduction and sets out the terms of reference of the expert group. Chapter 2 gives an overview of the current legal provisions governing the termination of pregnancy in Ireland. Chapter 3 outlines the historical developments which have taken place on abortion in Ireland over the last 30 years. Chapter 4 sets out the decision of the ECHR and its legal implications. Chapter 5 sets out the principles adopted by the expert group for the implementation of the ECHR decision. Chapter 6 sets out the procedural options. Chapter 7 outlines the implementation options and chapter 8 sets out the conclusion. The key chapters in this report are chapters 4 and 8.

It is useful to start at the end and mention what the expert group stated about the report in its conclusion, since this informs everything in the report. At page 53, the expert group stated:

Under the expert group's terms of reference, it was not its function to specify how the judgment should be implemented but rather to provide options. The group has endeavoured to put forward options that are practical and consistent with the Constitution and the law of the State.

At paragraph 4.7, the expert group summarises the legal obligations on the State pursuant to the ECHR decision as follows:

a. Provide effective and accessible procedures to establish a woman's right to an abortion as well as access to such treatment;

b. Establish criteria or procedures in legislation or otherwise for measuring or determining the risk;

c. Provide precision as to the criteria by which a doctor is to assess that risk;

d. Set up an independent review system where a patient disputes her doctor's refusal to certify that she is entitled to a lawful abortion or where there is a disagreement between doctors as to whether this treatment is necessary; and

e. Address sections 58 and 59 of the Offences Against the Person Act, 1861.

Having summarised the legal obligations, the expert group goes on in chapter 5 to set out the general principles that should apply to the implementation of these legal obligations. These are as follows:

1. The entitlement to have the right to lawful termination of pregnancy ascertained should be established;

2. The State's constitutional obligations under Article 40.3.3o should be reflected in the options proposed to implement this judgment;

3. Termination of pregnancy should be considered a medical treatment regardless of whether the risk to the life of the women arises on physical or mental health grounds; and

4. It will always be a matter for the patient to decide if she wishes to proceed with a termination following a decision that it is clinically appropriate medical treatment.

In chapter 6 the expert group goes on to examine the procedure for determining entitlement and access to termination of pregnancy. At paragraph 6.2 the test to be applied is set out. This is the test set out by the Supreme Court in the X case, as follows:

The Supreme Court in the X case held that the correct test was that a termination of pregnancy was permissible if it was established as a matter of probability that:

(1) there is a real and substantial risk to the life of the mother; and

(2) this risk can only be averted by the termination of her pregnancy.

It is not necessary for medical practitioners to be of the opinion that the risk to the woman's life is inevitable or immediate.

The expert group stressed that "implementing the decision does not, therefore, require another definition of the test" and added, "neither is it necessary or desirable to seek to explain it with synonymous terms."

The expert group then considered, at paragraph 6.3, the qualifications of doctors involved in the process. At paragraph 6.4, the expert group considered the number and role of doctors. It considered three options: option 1 - two doctors of relevant speciality; option 2 - two doctors, one of whom is an obstetrician; and option 3 - two doctors of relevant speciality plus an obstetrician.

At paragraph 6.5 the expert group considered whether provision should be made for emergency situations where the risk to life is "imminent and inevitable" rather than "real and substantial" and a medical practitioner is unable to seek the advice and assistance of another medical practitioner. It posited two options, the first of which was to make provision for emergencies, and the second of which was not to make provision for emergencies.

The expert group then went on, in section 6.7, to consider a formal review process. The expert group stated that the review process would have to be before an independent body; competent to review (i) the reasons for the decisions and (ii) the relevant evidence; the procedures should include the possibility for the woman to be heard; it should issue written reasons for its decisions; and decisions must be timely.

The expert group underlined the words "independent", "competent", "heard", "written reasons" and "timely".

The report has obviously presented the Government with a number of options. While it is important for us to debate the report's recommendation, it is also important to continue to debate this matter based on what is available to us as legislators.

The key issue is that Article 40.3.3o interpreted by the Supreme Court decision in the X case in 2002, which lays out quite clearly that a lawful termination may take place when a woman's life, as opposed to her health, is at risk.

People may have strong views - as expressed in the Upper House today and here also - on other issues such as incest, rape and fatal foetal abnormalities. The fact of the matter is, however, that unless there is an amendment to the Eighth Amendment to the Constitution, or it is repealed, we are talking about the very narrow, defined interpretation in the context of the X case. That clearly is what the expert group consistently says in its findings regarding the options available.

Both in the debate here and in the Upper House, many speakers have referred to the Irish Medical Council's guidelines. It is not true to say that there are no guidelines available to the medical professionals. The Institute of Obstetricians and Gynaecologists has requested that there be a proper legal framework. The masters of the two largest maternity hospitals have said that clarity is needed.

The Irish Medical Council's guidelines were most recently updated in 2009. Under section 21.1, they state that:

Abortion is illegal in Ireland except where there is real and substantial risk to the Iife, as distinct from the health, of the mother. Under current legal precedent, the exception includes where there is a clear and substantial risk to the life of the mother arising from a threat of suicide. You should undertake a full assessment of any such risk in light of clinical research on this issue.

Under section 21.4, the guidelines state that:

In current obstetrical practice, rare complications can arise where therapeutic intervention (including termination of a pregnancy) is required at a stage when, due to extreme immaturity of the baby, there may be little or no hope of the baby surviving. In these exceptional circumstances, it may be necessary to intervene to terminate the pregnancy to protect the life of the mother, while making every effort to preserve the life of the baby.

The Irish Medical Council's guidelines clearly give guidance to medical professionals. However, when those charged on a daily basis with assisting women and at times saving their lives, say they need legal clarity it is important for us to listen to them.

There is a big division of opinion on the issue of suicide. Most people in this Chamber would support any measures that will protect the life of the mother on medical grounds. However, the matter becomes very divisive when one discusses suicide or a threat to self destruct.

Clearly, this point will be the difficulty for both this Parliament and the Government when bringing forward options that are recommended in this report. I listened to the debate last April, as well as a number of weeks ago when Deputy Clare Daly reintroduced her Bill and indeed during this discussion, and this clearly is the issue.

One minute remains to the Deputy.

I am trying to make the point as clearly as possible, if it is possible to state it clearly, that until such time as a decision is made on the broader issues, Members should not make it more convoluted by talking about issues for which they simply cannot legislate, even if people wished to so do, because the Constitution is quite clear, as is the interpretation in the X case judgment. Moreover, the cases that were taken to the European Court of Human Rights also vindicate that position regarding the interpretation of the X case and Article 40.3.3°. However, one interesting case, which has not been discussed, is the D case. Perhaps it should have been included in the terms of reference for the report under discussion but I believe it will engender further discussion in this debate. In the meantime however, Members should be responsive to the actual needs that are being called for and respectful of the fact that many people, both within and beyond this Chamber, have different and opposing views.

In this context, whatever position a person may have, I ask that the language be tempered. Many thousands of Irish women have gone and continue to go abroad and Members should be highly conscious of this when they speak on the issue of abortion. They should be conscious of this because they are our sisters, mothers, daughters and neighbours and one must be conscious of the use of language that is inflammatory, hurtful and destructive even if people hold strong views on the issue. While I can respect those views, people should be conscious of that. I also note that people on the other side sometimes have used highly intimidatory tactics but the Chamber itself should be a venue in which Members are allowed to reflect on and discuss this issue, while coming forward with proposals that can bring clarity to meet the needs of both the European Court of Human Rights judgment and the medical professionals who deal with the issue every day of the week.

Finally, it is of equal importance that the word goes out that Ireland has the best maternity services in the world, bar none, and it is very important that people have full confidence in that. I still believe there is a need for an independent inquiry into the death of Savita Halappanavar in Galway to satisfy her family and the broader public and to find out precisely what happened, why it happened and to ensure it will never happen again. In the meantime, people should not use these tragic circumstances to advance either side of the argument.

I call on Deputy Tom Hayes and then Deputy Twomey, who have 15 minutes between them.

I am glad to have the opportunity to say a few words in this important discussion that allows Members to make a statement prior to the Government's decision in respect of the recommendations by the expert group. Members must be humane and open-minded with regard to their views and those of the public. Consensus is the element I believe Members must strive to achieve and if that takes longer then the time laid out by the Minister, then so be it. Time should not be an inhibiting factor in letting everyone get across their viewpoint in an open and honest way.

When dealing with what is an important and difficult subject, more time should be given, if necessary. As the Leas-Cheann Comhairle is aware, the issue is complex with medical, legal and ethical dimensions. It is extremely difficult to deal with all the issues involved and this is the reason I consider it to be important to provide time and space to allow for an informed debate on the matter. It is not helpful to have a discussion based on presumptions and the issue of presumptions relating to the area of suicide must be dealt with. I recognise the Minister for Health, Deputy Reilly, is a medical doctor of great experience. Members are fortunate to have a medical doctor dealing with this serious issue, with which I find it highly sensitive to deal and on which there are strongly-held views on opposing sides of the debate. I also recognise the Oireachtas cannot ignore its responsibility and that women and medical professionals in Ireland are entitled to legal clarity. Many people in the medical profession have told me in the past that they need legal clarity and they are entitled to that. Consequently, it is the duty of Members in the Oireachtas to provide such clarity as we live in an age in which litigation is widespread and is sometimes the order of the day. There may be a temptation on the part of the Government to shy away from controversial issues, which is understandable as it is impossible to meet everyone's expectations. However, this debate is not about populism or about pleasing people but pertains to recognising the duty of the Oireachtas to provide legal clarity.

I welcome the Government's commitment to allow Members to make statements no matter what their perspective and to set forward their views in an open and transparent manner. Many Members of this House have strong feelings in this regard and consider themselves to have a clear view. My views at all times have been anti-abortion. I am not in favour of a free-for-all or liberal abortion regime in our society and I hold this up as a principled stand I wish to declare and take on this issue. All Members have been forced to examine their views in recent times due to the tragic situation of Ms Savita Halappanavar in Galway and the publication of the report of the expert group on the judgment in the A, B and C v. Ireland case. The stark reality is that Ireland is in breach of the European Convention on Human Rights. While there are those who will state we are not compelled to legislate, I believe we must deal with the issue, due to the extraordinary level of public concern in respect of these issues.

I have confidence that my party colleagues in Cabinet, and indeed those of the Labour Party, will listen to the views of Members when coming to a decision regarding the expert group report. The Taoiseach and Deputy Reilly both have made it clear to Members that they will not allow for a liberal abortion regime in Ireland. I do not want a liberal abortion regime and that is a principled position I always have held. More importantly, I do not believe the people of Ireland want it either. I want to protect the life of a pregnant woman where life is threatened by the pregnancy and that is the issue here. This is about the health of a woman and that is the priority. While that may be a straightforward wish, I recognise there are legal and medical complexities involved in giving effect to it. I am neither a medical nor a legal expert but I am a legislator and believe I must face up to my responsibility in dealing with the report before the House. The Government has both the time and the access to national and international expertise to frame appropriate measures. The Medical Council guidelines must be adhered to and medical and legal experts must be involved. Members can work their way around to a position in which they can deal with this issue. They must do the right thing for the women of Ireland. Abortion on demand should not be allowed in this country. However, the life of the mother must be protected in all cases. I wish the Government well in this regard and I thank it for giving Members the opportunity to have this discussion. I again appeal to all sides in the House to try to achieve a consensus view based on the best medical practice and protecting the life of the mother and child. I am assured by what the Taoiseach has said on the matter and am confident the decisions the Cabinet ultimately will take will reflect the views of both the House and the vast majority of the people of Ireland.

I had reason to be in the Four Courts this morning and while there, I listened to the President of the High Court and another High Court judge, Mr. Justice Gerard Hogan, who were debating points of law on the issue of assisted suicide.

If there is one thing for which I can give credit to those gentleman, it is that they know how to discuss law. That is where we are heading and there has been much discussion around the legal issues.

The Supreme Court has ruled that termination of a pregnancy where there is a real and substantial threat of suicide by the mother is lawful in Ireland. However that came about - whether we messed up amendments or discussions - that is the way the law currently stands. The European Court of Human Rights has upheld the position and we must legislate for it. We are discussing two issues: the matter of A, B, C v. Ireland and the matter of Irish Medical Council guidelines, and both of them can be dealt with conclusively with legislation.

With a very emotive issue like this I can understand perfectly why many Members may not like to spell out their position as clearly but we have no choice but to legislate. We must make regulations for how the medical profession assesses the risk of suicide so as to look after the best interests of mother and child. Legislation will come first but we also need regulations, as it will be up to the Irish Medical Council to give doctors guidelines. The doctors will include obstetricians, psychiatrists and general practitioners, and the council is well up to ensuring those guidelines are to the satisfaction of Members in these Houses and people in the communities.

In the United Kingdom the mental health of the mother is the basis of whether an abortion can be sought. The expected Irish law will concern the risk of suicide, which is vastly more restrictive than what is evident in the United Kingdom. People are discussing comparisons between the United Kingdom and Ireland but it is chalk and cheese: there is no comparison with what we will legislate for. All the other issues being discussed, including abortion on demand, pregnancy associated with rape and incest or unviable pregnancies that could go to full term, are emotive and sensitive but would require a referendum. That would be completely different from what we wish to deal with here, which is legislation and regulations dealing with Irish Medical Council guidelines and the X case, as has already been decided upon by the Supreme Court.

As the legislation stands, it does not protect doctors or give the confidence needed by pregnant women. Aside from that, the care in our hospitals is world class and women have absolutely nothing to fear. Obstetric care in our hospitals is fantastic and patients are very well looked after and highly respected. I do not know what will come of the inquiry in Galway but I ask people to hold their counsel: I have worked in obstetrics and I know how fraught cases can become. If we had more time I would give examples of what I experienced working as a junior house officer in obstetrics. People would see the issue differently if they saw the human side of work in our health services.

A patient may present to her general practitioner and state she is suicidal due to her pregnancy. The first responsibility of the GP is to ensure the risk is assessed properly, and if necessary, the patient can be placed in an appropriate care unit. Ideally, this should be like any other medical emergency, and a case where an obstetrician, GP or potentially a psychiatrist has to make a decision over one or two hours is wrong. A decision could be made over days as long as the appropriate level of care is given to the patient in the mean time. This must be taken into account when framing legislation. We do not need to rush into a decision making process and much time can be given to how we work this out.

Some people feel there will be no limit to when an abortion can be carried out. At this time, a child in a neonatal unit at 25 weeks gestation has a great chance of surviving because we have moved on so far in neonatology. A full-term baby would be approximately 40 weeks. I have no doubt that we could push this further. If we had proper guidelines for behaviour and medical practice, we could continue to keep a person in appropriate care while the most appropriate action is decided. Many people fear this debate because they know we need very good checks and balances with guidelines and regulations. The legislation can do this, and this may be the most closely monitored piece of legislation or regulations we have. That is why we must work really hard to ensure we get it right.

Everybody must remember that this is what the people of Ireland want us to do and not about Members' personal beliefs. The people want us to face up to our responsibilities and deal with this very sensitive issue. I am delighted this debate is taking place but nobody is baiting opponents to get views on record. The discussion has been very measured and people are treating it with the respect and sensitivity that is due to it. I am glad to see that.

The idea that one of my patients would feel she had to have an abortion would upset me greatly but we all strive to be as human as possible and not pre-judge people. I would be the first to admit that it is probably easier to do this as a doctor than a politician. Others might rush to judgment, taking their own ideology on board. We have a very open-minded health care system and we have always been very fair with people having their own consciousness in dealing with issues. I know of doctors who would not prescribe and pharmacists who would not dispense morning after pills, contraceptive pills, the Mirena coil and, even up to a number of years ago, condoms. This was because of their personal beliefs. The law existed but nobody prosecuted these people, took away licences or reported them to the council. People have a human understanding of how our culture works, and it is not the same as that in the United Kingdom. We should stop making those comparisons.

I have written medical reports when a young woman has told me she was going for a termination in the United Kingdom. I would not want that woman to go to the United Kingdom without doctors being fully aware of her medical condition; I would be putting her life at risk on the back of my own beliefs otherwise, which would not be right. The woman may need to return to my practice because of complications after the termination, and I have had women return with quite advanced complications arising from a termination. They feared that if they came to me sooner, I would have reported them to the Garda. We do not need that kind of environment or fears that people will be treated like that in the Irish health care system. It is not the way they would be treated, and people are seen with the utmost humanity. We must continue to aspire to that.

Over the past 30 years, as I went through secondary and medical school and progressed to being a doctor, I saw the strong divisiveness of what we call the abortion debate. In the past weeks and months I have been amazed at how ordinary people in this country are engaging in the debate in a fashion not seen before. We need to encourage that behaviour when we discuss the issue. There will be no choice but to have legislation and we should be discussing what will be in that legislation, how the guidelines will be considered and how doctors should act.

Suicide is subjective. If I perform a CAT scan I could see a tumour in a bowel and remove it but because suicide is subjective, the opinion of a psychiatrist would be needed before a final decision can be made. We should be moving the debate in that direction.

The publication of the Report of the Expert Group on the Judgment in A, B and C v. Ireland should mark the final stage before legislation in line with the X case judgment is initiated, debated and enacted by the Oireachtas. In time the publication of this report will always be associated with the tragic death of Savita Halappanavar, a tragedy that once more placed the issue of abortion high on the political agenda and in public consciousness. The courage of Ms Halappanavar's husband, Praveen, and family in speaking out should be commended and we offer them our continuing condolences.

Coincidence or not, the publication of the report in the immediate aftermath of the tragic death in Galway university hospital has concentrated minds on the issue and this concentration needs to be maintained in order that appropriate action will follow. The public consideration by society of the very difficult and fraught issue of abortion has been punctuated by tragedies. From the X case in 1992 to Savita Halappanavar in 2012, we have seen women in a variety of very difficult circumstances bringing legal challenges, all of which are cited in this report. These cases represent only the tip of the iceberg as they are only the visible manifestation of the experiences of countless women over the past 20 years and more.

The authors are to be commended on a clear report that gives an overview of the current legal provisions on the termination of pregnancy in this State and the historical background to the legal developments regarding abortion that have taken place over the past three decades. In a cogent manner the report sets out principles for the implementation of the judgment of the European Court of Human Rights in the A, B and C v. Ireland case. It sets out proposed procedural options for determining if and when termination is lawful, options for decision making by doctors and an appeals process. Finally, and crucially, it sets out options for how this should be implemented in law.

The judgment of the European Court of Human Rights confirmed that there is an imperative to put into legal effect the judgment of the Supreme Court in the X case. The European court found that there was no accessible and effective procedure to enable Ms C to establish whether she qualified for a lawful termination of pregnancy in accordance with Irish law. Why is this the case? The reason, as the court accepted, is that Article 40.3.3° of the Constitution, as interpreted by the Supreme Court in the X case, provides that it is lawful to terminate a pregnancy if it is established that there is a real and substantial risk to the life - as distinct from health - of the mother, which can only be avoided by a termination of the pregnancy. Therefore, the State is in breach of the European Convention on Human Rights in failing to give effect to the right identified by the Supreme Court in the X case.

In setting out the current legal position, the report reminds us of what have been described as the chilling words and effect of the Offences Against the Person Act 1861 and its blanket criminalisation of all terminations of pregnancy. Anyone responsible for a termination under this Act is "guilty of a felony and being convicted thereof shall be liable to be kept in penal servitude for life."

The report recites the sorry saga of the 1983 amendment and the legal battle that had to be fought to establish the rights to travel and information, culminating in referendums and legislation which provide for these rights. It is important to recall, as the report does, that "X" was a 14 year old girl who became pregnant as a result of rape and was put through the additional trauma of a High Court injunction to restrain her from leaving the State for a termination of the pregnancy. It is important also to recall that the Supreme Court judged in the X case that if it were established as a matter of probability that there was a real and substantial risk to the life as distinct from the health of the mother and that this real and substantial risk could only be averted by the termination of the pregnancy, such a termination is lawful. Crucially, the court also found that the threat of suicide constituted a real and substantial risk to the life of the mother.

The immediate result of the X case was the lifting of the injunction to enable the young girl to travel abroad. Any other outcome would have outraged the vast majority of people in this country and led to a regime in which the State operated effectively as an internment camp for pregnant women, release being possible only if they could prove they were not travelling abroad to terminate their pregnancy.

The 1992 referendum followed, allowing for the right to travel and to information. In 1992 and again in 2001, the electorate in referendums rejected proposals to exclude the risk of suicide as a ground for lawful termination. Thus, more than a decade ago, and long before the A, B and C case was initiated, the clear obligation for the Oireachtas to legislate in line with the X case judgment, including the threat of suicide as a real and substantial risk to the life of the mother, was confirmed. As well as the referendums, there was the 1996 Constitution review group, the 1999 Green Paper on abortion and the all-party Oireachtas committee on abortion which reported in 2000. Following the defeat of the 2001 referendum, there was legislative inaction as successive Governments again failed to face up to their responsibilities.

The A, B and C case, begun in 2005 with judgment delivered in December 2010, effectively reaffirmed the Supreme Court judgment in the X case. The absence of legislative implementation of these judgments has created very dangerous grey areas in which, as we know all too well, women can die. The European Court of Human Rights judged that there is a "striking discordance between the theoretical right to lawful abortion in Ireland on grounds of a relevant risk to a woman's life and the reality of its practical implementation." The real dangers this position creates were shown in the case of Miss D in 2007. In that case the Health Service Executive prevented a 17 year old girl in its care from leaving the State to have an abortion and even notified the Garda that she was not permitted to leave. The court ruled that the actions of the HSE were without foundation in law and vindicated Miss D's right to travel. If a young woman could face such denial of her rights in circumstances where the law was very clear and had even been affirmed in a referendum, how much more danger must women face when they are legally entitled to a termination in line with the X case judgment, albeit in the absence of the required legislation?

This matter is addressed explicitly in the report which states: "Indeed, while the constitutional provision in Article 40.3.3° (as interpreted by the Supreme Court in the X case) qualified sections 58 and 59 of the 1861 Act, those sections have never been amended, so that, arguably, they remain in force with their absolute prohibition on abortion and associated serious criminal offences, thereby contributing to the lack of certainty for a woman seeking a lawful abortion in Ireland." This also has implications for the medical and legal professions.

The case for legislation now is compelling and the report makes it even more compelling. The five obligations of the State, as set out in the report are to provide effective and accessible procedures to establish a woman's right to an abortion as well as access to such treatment; to establish criteria or procedures in legislation or otherwise for measuring or determining the risk to her life; to provide precision as to the criteria by which a doctor is to assess that risk; to set up an efficient independent review and appeals system; and to address sections 58 and 59 of the Offences Against the Person Act 1861.

The four principles for the implementation of the European court judgment are that the entitlement to have the right to a lawful termination of pregnancy ascertained should be established; the State's obligations under Article 40.3.3° should be reflected in the options for implementation; termination should be considered a medical treatment regardless of whether the risk to the life of the woman arises on physical or mental health grounds; and it will always be a matter for the patient to decide if she wishes to proceed with a termination following a decision that it is clinically appropriate.

We in Sinn Féin believe that those formulations of the State's obligations and the principles for implementation are sound. We have long held that legislation in line with the X case judgment is necessary. The challenge before the Oireachtas, in particular this Government, is to summon the political will to legislate and to legislate in the best possible manner.

This brings us to the core of the report. Chapter 6 addresses the procedures to be applied for determining entitlement and access to termination of pregnancy. It notes that where there is a real and substantial risk to the life of the mother, it is not necessary for medical practitioners to be of the opinion that the risk is inevitable or immediate. The options for procedures in terms of numbers and types of doctors involved in these decisions and the form of review process to be adopted need careful consideration.

Two factors are essential. First, the woman must be at the centre of the process and her voice must be heard and heeded at all times. Second, the process must not be so cumbersome and complex that vital time is lost, thus creating further dangers. For this reason, we would advocate the medical model of review rather than the legal model.

It is clear from chapter 7 of the report that regulations alone will not suffice and that primary legislation is essential. Likewise, legislation alone will not likely be sufficient to meet the requirements. A combination of robust primary legislation and regulations, in careful balance, would seem to be the optimum approach.

It is a pity that the review group was not mandated to produce recommendations rather than options. This forces us to read between the lines, especially in chapter 7, which I have cited. I would urge that the review group members be permitted to appear before the Oireachtas Committee on Health and Children to address us and to answer questions when we sit specifically to carry out that function in the second week of January.

We must legislate. This is the task that the Oireachtas must face up to. All Teachtaí Dála, without exception, have an obligation to address this need and to step up to the mark as legislators. As I have stated previously, there is no selfish political advantage in this for any party. This is not 1983, it is 2012. We must approach this issue with compassion, understanding and respect, conscious of the strong and sincere views held on all sides of this debate. Now more than ever the majority of Irish people know the complexity of this issue and that simple black and white solutions do not exist.

We have a task before us. We should face it together.

I welcome the opportunity to contribute to this debate on a sensitive issue that causes extreme difficulties for many people. The decision of the Supreme Court in respect of Article 40.3.3° provided in law that the State must facilitate a termination where there is a real and substantial risk to the mother. This is the judgment of the highest court in the land and, therefore, is binding on all courts.

The Supreme Court stated that it was lawful to terminate a pregnancy if it was established that there was a real and substantial risk to the life, as distinct to the health, of the mother that could only be avoided by termination of the pregnancy. According to the X case judgment, no matter how high the probability that the mother will die, it is not and never can be a certainty. This point has already been discussed.

In 1996, a review group recommended legislation that would include definitions, protections for appropriate medical intervention, certification of real and substantial risk to the life of the mother and a time limit on the lawful termination of pregnancies. The 2009 Medical Council guidelines stated that abortion was illegal except where there was "a clear and substantial risk to the life of the mother" including suicide, in which event it directed medical professionals to "undertake a full assessment of any such risk in light of the clinical research on this issue". This is one of the clearest statements on the matter. Clinical research is a developing area in which new information is coming to light.

The European Court of Human Rights legally obliges Ireland to put in place a legislative or regulatory regime to provide procedures to establish whether a pregnant woman is entitled to a termination if there is a real and substantial risk of suicide that can only be avoided by that termination. We must establish criteria and procedures for measuring real and substantial risks to life that can only be removed via terminations. This is key to the situation. There should be some type of risk index that consultants can examine to ensure that there is a real and substantial risk to a mother's life. We accept that a medical diagnosis is not always a clear-cut process and does not exclude differences of opinion.

The constitutional obligation to defend and vindicate, as far as practicable, the right to life of the unborn must also be recognised and included in any consideration of the issue and the dignity of the foetus must be protected. As recommended, all of the steps involved in reaching a decision on a real and substantial risk to a mother's life must be documented clearly. Extra regard should be given to suicide risks, given the clinical challenges involved in diagnosing suicidal behaviour. It has been suggested that two psychiatrists and perhaps an obstetrician should form the team that would make the decision, with the backup of other professionals, such as psychotherapists, and the involvement of the woman's general practitioner, GP, who may have a great deal of knowledge about her. It will be argued that since two team members are sufficient for a medical situation, having three in a potential suicidal situation is discriminatory. While there is a case for this argument, we should accept that the team to decide whether there is a real and substantial risk of suicide should comprise two psychiatrists and one obstetrician, given the clinical challenges involved in diagnosing suicidal behaviour. There has been a great deal of debate on this issue.

It is understood that motherhood and pregnancy are protective influences against suicide, as borne out by studies in the UK and the US. One UK study shows that the rate of suicide among pregnant women is one sixth of the rate among women who are not pregnant. There are no figures to indicate whether suicides resulted from a real and substantial risk owing to their pregnancies, only that they died while pregnant. No figures are given for the number of terminations completed. Abortions are available under the liberal regime that pertains in the UK.

As such, we must temper any figures from the UK and the US on the basis of their liberal termination regimes which make abortion less strictly controlled than we intend to introduce. Consideration must also be given to the fact that a liberal abortion regime influences the number of suicides recorded during pregnancy. However, while there is substantial evidence from research that pregnancy reduces the risk of suicide, there is no evidence that pregnancy prevents suicide. Every life is important. The saving of one of the 600 lives of people who died by suicide last year would be welcome.

I am often critical of the psychiatric profession because of the way it deals with families. However, I have the utmost confidence in the psychiatric profession to diagnose mental illness in the most ethical and professional manner. I have confidence that the profession will not endeavour to subvert the law in any way in the course of coming to a decision on whether a pregnant woman is at real and substantial risk of suicide. Medical diagnosis is not a clear-cut process and there are clinical challenges to a psychiatric diagnosis of someone as a suicide risk. The Medical Council will have a key role in that regard.

I am a member of the advisory board of the College of Psychiatry of Ireland. I have been involved with psychiatrists for more than 20 years and I have the utmost respect for their ethical approach to the issue. It has been argued that women will attempt to deceive. That is debatable given the nature of the crisis situation. I do not believe women will be deceitful to the extent of persuading a psychiatrist that they are at a real and substantial risk of suicide which only a termination could avoid. I do not believe two consultant psychiatrists who are dealing with seriously mentally ill patients all their lives could be persuaded by someone who is not in that category that they are suicidal, and that they would come to a decision to grant a termination on that basis. A total of 4,000 women in this country with crisis pregnancies decide to have an abortion each year. That is another situation with which we must deal. I do not know the solution to the problem.

Reference has been made to the significant number of unplanned pregnancies in this country. That is the case, within and without of marriage. However, it does not mean they are unwanted pregnancies. We know of situations where people are in crisis because they had not planned the pregnancy but after a week or two their attitude changes and they look forward to having a new baby regardless of the initial shock they experienced on discovering their pregnancy. Whether pregnancies are unplanned is irrelevant to the issue we are discussing.

There has been discussion on whether we should introduce legislation or regulation. Whatever route we choose we must introduce rules to implement the decision of the Supreme Court, which has decided that termination in certain circumstances is legal in this country.

Discussion on the suicide aspect of the matter has been positive to date. We must consider vulnerable people with crisis pregnancies who are listening to or reading comments we make. We are aware of the copycat element of suicide where people with suicide ideation could be tempted to take their lives when otherwise they would not do so. We must consider whether what we say would make it more likely that women in a vulnerable situation would take their lives or seek help. Vulnerable people will listen to the debate and relate what they hear to their particular crisis.

We must also take into consideration how what we say will affect those who have been bereaved by suicide. Bereavement by suicide falls outside the normal range of human experience. It is an overwhelming loss which leaves the bereaved confused and helpless, overwhelmed by many emotions and unanswered questions. As well as the normal range of grief reactions, those bereaved by suicide often experience a sense of stigma, shame, loneliness or rejection. We must take that trauma into account when discussing the overall issue. A friend of mine is involved with public meetings on bereavement because his son died at 23 years of age. There is a stigma surrounding suicide. People say when someone dies from cancer or heart failure that they wanted to live but their illness got the better of them. One could erroneously say that someone who completes suicide wanted to die. Nothing could be further from the truth. People who complete suicide want to live as much as anyone else, but living becomes too painful. They do not want to die but they just cannot bear to live with the incredible pain their illness causes them. It is important for people to hear the message to clear up one misconception surrounding suicide. People think that suicide is a cop-out of life, but nothing is further from the truth. People who complete suicide are not copping out of life; they cannot bear the pain anymore. They have reached the end of their tolerance. They have fought long enough and hard enough and the time has come when they know no other way to end their pain. That is the issue we are discussing.

Suicide is no longer a crime. It was decriminalised in 1993. It is no longer a sin on the basis of the test I was taught going to school, namely, grave matter, clear knowledge, and full consent. It is certainly grave matter but hardly clear knowledge or full consent given the pain a person suffers. We must try to change the language we use. A person who dies by suicide does not commit a sin or a crime. He or she dies by suicide or takes his or her life. There has been a great improvement in the past 20 years in our campaign to change the language we use.

On 2 October 2009 a pastoral letter on suicide from the Irish Bishops' Conference was published. It stated:

Life matters. It is commonly accepted that those who die by suicide don’t want to die; they simply wish to end their pain. Suicide prevention is, therefore, a duty of everyone in our society. In this area we need to be particularly concerned for other people and sensitive to their difficulties. [Bishop Fleming concluded] I welcome the updated media guidelines ... Everyone has a responsibility to treat the tragedy of suicide in a conscientious manner, being sensitive not to stigmatise it, understanding and supportive of those affected by it and at the same time avoiding its glorification.

I agree with the bishops.

Deputy Richard Boyd Barrett and Deputy Seamus Healy are sharing the allocation of 15 minutes. Is that agreed? Agreed.

It is very depressing that we are debating this issue 20 years after the terrible circumstances of the X case and have done nothing in the interim. Successive governments have not had the courage to deal with the issue after the tragic circumstances following the rape of a young teenager. The State attempted to prevent her from travelling abroad to have an abortion. The Supreme Court ruled that where there was a threat to the life of a woman, she had the right to an abortion. That view has been confirmed in referenda and attempts to limit that right as set out in the X case judgment have been rejected on two occasions by the people. The opinion polls in the past week or two confirm that the majority believe at the very least that where there is a threat to the life of a woman, she has the right to have an abortion. In spite of the clear legal position and a clearly expressed view on the part of the majority in the country, politicians have still failed to do anything about it. I believe the decision of this House to vote down on two occasions an attempt to bring forward a Bill that would allow for that legislation to be passed is more of the same cowardice, delaying tactics, refusal to respect the law and the wishes of the people and crucially the rights of women.

It has taken successive tragedies, the most recent being the tragic death of Savita Halappanavar who died begging for a termination, which she was denied. The obstetricians and gynaecologists, people who know more than the public about these matters, say there is a legal problem which has impeded medical practitioners from being sure they have the legal right to intervene to save a woman's life because of the failure of politicians to legislate on the issue. It is shameful that we have failed to do it. We have had successive admonitions by the Supreme Court. The now deceased Supreme Court Judge, Mr. Justice Niall McCarthy, the European Court of Human Rights and in March of this year the Committee of Ministers of the Council of Europe have all told us that we must act and yet we have failed to do so.

As far as I am concerned this report adds nothing at all. It tells us what we knew - we need legislation. It gives us options - legislation, legislation, or legislation. We need legislation. We needed it 20 years ago. We must get on with the work and provide the legislation that we should have had 20 years ago. It is particularly depressing that this failure has resulted in people dragging up almost medieval arguments.

People say this is a sensitive and divisive issue. It is at one level. It is very sensitive, when one sees tragic circumstances such as the X case, the C case and the case of Ms Savita Halappanavar. Everybody is entitled to his view, when it comes to his life, his freedom and the right to decide what to do with his own body. All of the problems arise from the fact that people seem to think they have the right to decide what other people do with their lives and with their bodies, specifically they think they have the right to tell women what to do with their bodies, with their lives with their health. We get into arguments that I do not believe we should be having about when a threat to one's health becomes a threat to the life of the individual. There is no conclusive answer and no matter how many doctors sit down to tease out the law, one will not get the right answer.

In life as opposed to the law there is no distinction between health and life. One can die from the flu. Will a person definitely die from the flu? No, but millions die from it every year. One cannot draw a distinction and we should not attempt to do so. We are in a legal limbo as a result of the X case and we must draw this distinction and in so far as we are tied by the Constitution we must say if there is a possibility that a woman might die, she must have that right. We can push that far within the constitutional framework and we should do so. If we do not we are playing with the lives and bodies of women. We must push it as far as we can go in order to safeguard the rights of women.

No man can have somebody else intervene in his medical treatment. If a man goes to the doctor, the doctor identifies his condition and sets out how it should be treated. The man can then make a decision on the treatment. With women, it is different. That must end. A woman's welfare and life must be safeguarded. One cannot have a situation where other people make these distinctions and because of this we must repeal the eight amendment to the Constitution. At the minimum, we must repeal the law dating from the 19th century that criminalises abortion. We have known this for 20 years and it is confirmed in the report of the expert group. Can we make progress on it? We must repeal the eight amendment so that the only people who can make these decisions in any sort of fair way that truly respects the welfare and autonomy of the individual and safeguards the life of the woman is women. That is the right we must uphold and vindicate.

Deputy Healy has six and a half minutes.

I welcome the opportunity to speak on the report of the expert group. It is both a difficult and sensitive issue, with which we must deal with compassion and understanding. The issue must be dealt with urgently. We simply cannot continue to put women's lives at risk. We cannot have a situation where the medical profession is unclear as to the legal position of the professionals on this issue. This Government must take its responsibilities seriously and in my view legislate urgently on this matter.

We have been discussing this issue for 30 years, dating from the referendum on the right to life of the unborn.

The amendment was passed and is part of the Constitution as Article 40.3.3o. Some ten years later, in the Supreme Court case known as the X case, the court found a termination is lawful if, as a matter of probability, a woman faces a real and substantial risk to her life, including through suicide. The decision of the Supreme Court has been dealt with by the people on two occasions, in referendums in 1992 and 2002. The finding of the Supreme Court was endorsed by the public on both occasions.

The A, B and C v. Ireland case was heard in the European Court of Human Rights in 2010. That, and recent developments, led to the issue arising. The late Mr. Justice Niall McCarthy, in the Supreme Court case of 1992, said the delay was not just unfortunate but inexcusable. How much more inexcusable is it not to have dealt with the issue 20 years later? There are no further excuses for delay. The courts, including the European Court of Human Rights, dealt with the issue and the people have spoken on it on two occasions. Now we have the expert report. Six successive governments have failed to deal with it and this Oireachtas must deal with the issue.

I welcome the report, which is thorough and detailed on a sensitive issue. I compliment Mr. Justice Sean Ryan and the members of the expert group. It is a difficult area and the report refers to this where it states: "The reasons are not hard to understand. Intense ethical, religious, social, political and intimate personal issues coincide." There are opposing views but there is an absolute and significant majority in the middle ground in favour of legislating for the X case based on the finding of the Supreme Court. The terms of reference of the report are specific and deal with the A, B and C v. Ireland case with the X case in the background. Many people argue that other issues should have been included in the terms of reference, particularly in respect of fatal foetal abnormality and pregnancies arising from rape or incest. The report lists various options and comes down in favour of legislation and regulations.

With regard to legislation, the reports states: "The issue of how to provide for the X case has been considered by other bodies, who have all concluded that legislation ... is the most appropriate way in which to regulate access to lawful abortion in Ireland." The report refers to the advantages of the legislation and regulations option being that it fulfils the requirements of the judgment, provides for the appropriate checks and balances between the powers of the Legislature and the Executive and would be amenable to changes that may arise from clinical practice and scientific advances. It also refers to a range of other advantages to that option. It has been recommended in previous reports. It is past the time when the Oireachtas should deal with the issue and I hope legislation will be prepared and brought before us in the very near future.

I propose to share time with Deputy Ann Phelan. This afternoon, I was very pleased to be able to attend the address by US Secretary of State Hillary Clinton on her visit to Dublin when she spoke about human rights. She spoke very clearly about recognising the need for the human rights of women to be vindicated all over the world. It was a timely speech considering what we are discussing.

Some speakers have picked up on the following sentiment. When we are talking about women and their bodies and the right to medical treatment when they need it, in this country we are often outraged about how women are treated in other countries. The Taliban refuse to let women work, yet, in the 1970s in Ireland, a woman who got married no longer had the right to work. For years, women had to try to get access to contraception so they could plan their families and space children apart. This is something developing countries are getting right with their young women because they understand that if you educate women and allow them to space their children apart, they are in a much better position to provide for them. However, in this country, we grappled with these issues in the not too distant past. In this spirit, I am not shocked it has taken us this long to deal with the issue under consideration.

Another reason is the lack of female legislators in the country. As legislators, we have acted as cowards over the past 20 years. We made extremely difficult circumstances unbearable for women. We colluded with our cowardice to make this country an inhumane place for women. In the spirit of the speech made by Hillary Clinton, we should hang our heads in shame. Let us not forget that, often, we look far away to those whose human rights are not being vindicated. We jump up and down about them, yet we have cases of human rights not being vindicated for half of the population. What did we do? Nothing. As part of this Government, I am proud the Labour Party has campaigned on the issue and has often been targeted by parties for political gain. We took a stance on the issue and continue to do so.

I thank the expert group for its clear report. Paragraph 7.4.3 of the report alludes to legislation and regulation. In the game of politics, we also talk about advantages and disadvantages. Considering what the expert group has written, the only option for legislators is to provide the primary legislation that will allow for regulations. The expert group has helpfully drawn up the advantages and disadvantages of this approach and includes only one disadvantage, which is that it may take a long time to draft legislation. This is not an insurmountable barrier. As legislators, we must act to ensure and vindicate the rights of women.

The people have had two opportunities to reverse the X case and twice the people confirmed the judgment in the case. Political cowardice and conservatism that is out of step with the reality of women's lives and their bodies have meant we have failed the women of the country for 20 years. I do not say that lightly. I mean it.

It is incumbent on all of us in the House to address this so that the disadvantage suffered by women will not remain. We must act. We must legislate to ensure the safety, health and well-being of women in the future.

I will not need much time because I will not repeat what has been said by other Deputies.

I am grateful for the opportunity to speak on one of the most important, complex and sensitive issues in the State. We must try to grapple with this legislation and deal with it. I support my colleague. The speech made by the United States Secretary of State, Ms Hillary Clinton, today was illuminating. It clarified for me that women make up 50% of the population of the world and that we are able to be responsible. When one delegates to women and gives them responsibility and economic choices, we are able to stand up and be counted.

People have significant fears about abortion and our ability to destroy. On a very basic level, human beings are programmed to produce. We are not programmed to destroy. We are trying to be compassionate to the women of this country, and we can do it. If we legislate for the X case I do not believe the whole world will fall off its axis. We just need to get on with it.

The Government set up the expert group to examine the judgment of the European Court of Human Rights in the case of A, B and C v. Ireland. This followed a 20 year old judgment by the Supreme Court in the X case that termination in life threatening circumstances, including a risk of suicide, can be lawful. This was further upheld by two referendums. Despite the 1992 ruling, no legislation has been introduced to allow abortion to protect the mother's life.

The Government's commitment to this issue is clear and is reflected in the agreed programme for Government which committed to the establishment of the expert group to examine these issues and make recommendations to Government on how the matter should be properly addressed.

The Labour Party unanimously voted against two motions brought before the House this year which called for immediate legislation to be implemented in the light of the X case judgment. The expert group was made up of doctors, psychiatrists, the general practice and legal professions, and doctors in obstetrics. It was, therefore, inconceivable that legislation be enacted prior to the recommendations of the group.

Abortion is a sensitive, not to mention emotive, issue but it is also a female issue. I am not trying to disparage any of the sentiments expressed by our male colleagues on this issue. I find it hard to take, however, when men feel it incumbent on themselves to oppose a woman's right to a termination if or when her life is at risk. It is a position they will never have to deal with in the same way as a woman must. The House has only 15% female representation. If the situation were reversed in favour of women, would this legislation have been implemented years ago?

The expert group's report has been published and the legislation in question provides for the drafting of regulations to deal with the detail and practical matters relevant to the issue, such as changing medical practices and scientific advances, as well as addressing emerging challenges to implementation. Most aspects of the provision of lawful termination of pregnancy would be set out in primary legislation with certain operational matters delegated to the Minister to govern by way of regulation.

The Labour Party has had a long history on this issue. We have repeatedly outlined that we will not be part of the seventh Government in the history of the State not to act on the Supreme Court judgment of 1992. This is one of the most complex issues we will ever have to deal with. It is both medically and legally intricate. It does not fit easily into legislation. Other Bills in this area have been brought before the House. They were not appropriate nor were they fitting to form a legislative foundation around the issue. In fact, I question the bona fides of some of the Members who brought Bills before the House on this issue. If we are to legislate for the X case, we will require an overall majority. The Labour Party, although united in our stance on this issue, makes up 35% of the votes in the House. If and when we legislate for this case, it will not be the end of the world. It may even be the beginning for women.

It is incumbent on us to ensure that all the relevant facts and legal clarity on the issue are provided, based on the core principles of the expert report. I am neither pro-abortion nor pro-choice. I have been contacted by pro-life and pro-choice people. None of them was pro-abortion.

The women of this country who find themselves in a crisis situation, such as A, B and C, are not just statistics or fictional examples. They are real, rational human beings. They are our daughters, our nieces, our mothers, our sisters, friends and colleagues. Although I respect the views of those who are pro-life, I cannot help but wonder whether protecting the right of the unborn is obliterating the rights of the living.

I welcome the chance to speak on the report of the expert group. The report was due around this time but the sequence of events means discussion of it is happening against the backdrop of the death of Ms Savita Halappanavar in Galway University Hospital, which we know as "the Regional" in my part of the country. I must refer to that because Galway University Hospital is my regional hospital and I need to know, on behalf of my family and my constituents, that every procedure and process in the hospital is safe. I welcome the fact that HIQA and the HSE are conducting investigations but I would be more assured and confident if those investigations were independent and involved people who had no strategic interest or involvement and could make an independent assessment. There is still time for the Government perhaps to expand the HIQA remit. We have not heard the end of this case and, potentially, other cases. The people who depend on the hospital not just for maternity services, but for services across the board, need to know the fantastic staff who work there, particularly the nursing staff, are vindicated and have our confidence. Whoever is responsible for the sequence of events in those few tragic days needs to be held to account for whatever happened.

I am conscious of not linking what happened in Galway with the publication of the report. The report was due to be published and we would be having this debate regardless. As a representative for Mayo and the west, I would be failing in my duty to the people I represent if I did not put these concerns on the record.

We have had a far more respectful debate generally about this report and the options presented in it than we have had for some time on the entire issue of abortion. Space has been given to those with very strong opinions on either side to express them and I hope that continues, especially in this House.

One of my concerns is that we are having this debate on the publication of the report, the Government will come up with recommendations and then go to the Oireachtas Joint Committee on Health and Children to debate and discuss those recommendations. We would be far better off, however, if this went to the committee first and the various groups, particularly the medical groups, gave their presentations. I look forward to hearing how the Medical Council views this report, along with the other medical groups that are made up of the people we entrust with decisions. I would like to hear them before being presented with the Government's decision.

I have absolute confidence that the Chairman, Vice Chairman and members of that committee will run the hearings in a way that will give us information in a non-partisan and neutral fashion. I need information, I am not a qualified medical practitioner and there are so many areas that confuse me that I still am at a loss how to make a judgment I can be happy with. It would be better if the committee hearings had taken place in a calm manner, with the various groups coming in to discuss this and then we debated what we had heard from those various groups. We could then make a judgment on whatever recommendations came from of this. That said, the hearings in January will be important and the committee must give as much time as possible to the hearings. I get a sense the Government is trying to rush this without proper debate on the report and what follows. There was a sense this could all be done and dusted by February. We must resolve it quickly but if we rush it, we will make bad decisions and end up with bad law. We must be far more careful.

The notion nothing was done for 20 years is wrong. Significant efforts were made to come to a consensus. I cannot allow the record of my late friend and colleague, Brian Lenihan, to be distorted in this regard. He chaired an all-party group in the House and brought recommendations forward. We had a referendum in 2002 and the decision reached in that referendum was not as clear-cut as people have presented it. There were conflicting interest groups campaigning for a "No" vote in that referendum so people voted "No" for very different reasons. Time was lost after the referendum, it was ten years ago, but the political process was so bruised by it that it is not so much there was a lack of courage but a wondering where we would go from there. I am not being smart when I say that, or defensive, but when we look at the amalgam of groups that combined to oppose that referendum, there was a genuine political sense of confusion about what to do. No matter what way the political process had turned, there would have been consequences for all sides, and not just political consequences.

We then had the hearings in the European Court of Human Rights and now we have the report of the expert group. I started by thinking whatever we do, we must respect maternal health. We have a strong record in this country but we cannot take it for granted. There have been three maternal deaths since September. There are three families tonight who were expecting the happiest time of their lives and that has now become a nightmare of proportions we cannot begin to understand. We cannot take the strength of our maternal health care system for granted and we cannot assume it will always be the way. I understand there may be a report that measures maternal safety next year that might not paint as rosy a picture. Whatever decision we reach as a Legislature must be based on our having the maximum possible information and tonight we do not have that. I cannot say with confidence that I can reach a definitive position on the recommendations without seeing that information. It would be a disgrace if we as Oireachtas Members allowed this issue to go beyond this Dáil. We must have it finished by this time next year but we must not rush it if a few weeks in February would allow an informed debate where those of us without a medical background can ask questions that might seem stupid to medics but might help me find some clarity and security on these decisions.

Various claims have been made by both sides. We have had information meetings in this House in the last two days where eminent people directly contradicted each other. I listen to one person and he makes complete sense and then at the next meeting, someone who is equally qualified has the complete opposite view and he makes sense. Rushing this, then, for the sake of a few weeks is a bad idea. We will not do anyone any service if we rush this. We cannot allow it to go beyond next year but we must not put unnecessary deadlines in place because that will not serve the interests of the women or families of this country.

I ask the Government to give the committee time. We respect our committee system and we should give it the support it needs. Whatever resources the Oireachtas Joint Committee on Health and Children needs to do this it must be given so it will have the budget for the hearings and legal and medical advice available. This cannot be a normal committee session in the basement of Leinster House 2000 and I hope the Ceann Comhairle would hear the message that those hearings should allow for a specific budget so it can get the sort of advice committee members will need so that advice can, in turn, be made available to us.

I am delighted to have the opportunity to say a few words on this difficult subject. At the outset, I listened carefully to Deputy Calleary and I respect his views and judgment. He is a serious politician but I disagree with his conclusions. This is not the time to wait for the committee to make a decision. It is a decision the House must make and we must give political direction. The expert group has shown us the options and it is the political direction that is important now. It is still up for the committee to look in detail at how that recommendation we decide upon is to be framed, be it by legislation or otherwise. We can no longer set up committees and say we will not make any decision until it makes its findings.

We have been dealing with this serious issue for 30 years, with reproductive rights for women being the most contentious issue in the history of the State in the last century. The programme for Government we signed up to was categoric that we would acknowledge the recent ruling of the European Court of Human Rights subsequent to the established ruling of the Irish Supreme Court on the X case and that we would establish an expert group to address the issue, drawing on appropriate medical and legal expertise. When we read the report we see the expert group did that with a view to making recommendations to Government on how this matter should be properly addressed.

It is essential that we, in this House, address in depth the findings of that report and that we give political direction as to how to proceed.

We have reached a very sad situation where the lives of women were at risk down along the line. We have seen what has happened most recently with the tragic death of Savita Halappanavar. We will not know the full outcome until we receive the final report from the HSE and HIQA. Certainly a strong case has been presented that based on the words of her husband, Savita Halappanavar had been seeking a termination and that no termination was permitted. She had requested it on several occasions but was refused because there was still a foetal heartbeat. The termination only took place after the heartbeat had ceased. In the course of the contents of the womb being removed subsequently, she died, having contracted e-coli and septicaemia.

It was a terrible tragedy that reminds us of the tragedy of the X case 20 years ago where a girl of 14 was abused for two years and then raped. A case was taken in the High Court, which decided that she should not be allowed to travel for an abortion. That decision was overturned in the Supreme Court, which led to further referenda. The outcome of the three referenda that took place was conclusive in the minds of the people. Article 40.3.3° of the Constitution states: "The State acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right." It established, as a right, the right to life of the mother and the right to life of the unborn also. The Supreme Court then interpreted that very carefully in the context of circumstances where there was a real and substantial threat to the life of the mother, which could only be removed by terminating the pregnancy.

Clearly the result of the referendum on which the people voted was that the State should introduce laws that would vindicate that right. It states in a straightforward manner: "guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right." Once the right was spelled out, it should have been compulsory on the State to introduce those laws, but that has not taken place over a very considerable period of time. It has not been addressed by this House or by any Government until now. It is a significant failing of this House not to address the matter of citizens having a right that was vindicated in the Constitution. We can no longer put it on the long finger.

When the matter was reviewed and attempts were made to limit it further by leaving suicide out of the equation, two further referenda enhanced the right by specifying the right to travel across the board and not for any particular purpose, but the right to travel to have a termination of a pregnancy in another country was the context in which it was debated. That is now part and parcel of Article 40.3.3° of the Constitution. That was supplemented by a further right to information, including information to a pregnant woman that could be used to facilitate the termination of a pregnancy. There was no provision for pregnancy termination in this country, but the right to information is written into the Constitution.

When Article 40.3.3° of the Constitution is read in its entirety, it cries out to the Legislature to introduce legislation to act on the right ensconced in the Constitution. It is telling us that the only meaningful option and the only option, as envisaged in the Constitution, is legislation because it states that the State shall guarantee "in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right". It is written in the Constitution.

There are four options before us in the expert report and they are addressed very carefully. They are that we could have regulation, guidelines, primary legislation, or primary legislation and regulation. It does not make sense to have guidelines unless they are statutory guidelines, which automatically means legislation. Likewise, it is not possible to have meaningful regulation unless it is statutory regulation. So there is no option other than having primary legislation or primary legislation plus regulation. The constitutional provision is crying out for us to introduce legislation. It would seem it is preferable to introduce primary legislation plus regulation which can deal with changing medical circumstances as medical and scientific developments in the area move on.

I state categorically that as far as I am concerned there is no other choice. We in this House have no choice but to be true to the Constitution, which means that we must legislate on the matter. The sooner we do so the better. The function of the committee, to which we should refer this matter after we finish our deliberations, should be to decide how to frame and formulate the best possible legislation to allow the right ensconced in the Constitution to be vindicated as proposed in Article 40.3.3°.

I welcome the opportunity to speak in this debate. Few subjects in Irish public discourse are as sensitive as the subject of abortion, which is the focus of the report of the expert group. Views are polarised on both sides and no solution will ever be found that will satisfy the demand of these polar opposites. However, it is worth noting that the tone of the current debate is much more reasoned than the previous debates on the topic. This debate has been led by those in the centre as opposed to the extreme views held on either side, which is most welcome, as it will allow the important issues to be teased out in a reasoned manner.

At the outset, I state that I have no particular medical or legal expertise or background. As a Member of the Dáil and a representative for Galway East I believe it is important that we all have an opportunity to explain our views on the matter. I would always have considered myself to be pro-life. However, I do not believe in having to fall within the narrow parameters of being either pro-life or pro-choice, which obscures rather than illuminates the issues. I have no issue with or concern over providing legal clarity for doctors dealing with a mother whose life is at risk, which is the minimum for which we should be providing.

One other thing about this that always comes up when one moves on from that is the issue of suicide. To bring that up then means one needs to have much more expertise on that matter. Even having sat in this Chamber for the past hour and heard many different people's opinions and experiences on that, it is not easy to make a decision on it. I heard Deputy Neville, Deputy Twomey and some of the other Deputies who spoke on this. That is why it will be important in January to hear what the Oireachtas Joint Committee on Health and Children comes up with and what the legal experts say on the matter.

It has been two decades since the Supreme Court made its decision in the X case and 2013 should not pass without the Government putting the legislation on the Statute Book to provide clarity for doctors dealing with the complex medical issues involved.

The report of the expert group is an important document as it brings forth the views of experts in the fields of obstetrics, psychiatry, general practice, law and public policy and was chaired by a High Court judge. It considers the A, B and C v. Ireland judgment in the European Court of Human Rights and puts forward various courses of action. The case was brought to the court three years ago by three women who alleged a breach of their rights under the European Convention on Human Rights in respect of abortion in Ireland. All three had unintentionally become pregnant and travelled to the UK for abortions. The judgment in that case found that the Constitution is not inconsistent with the European Convention on Human Rights and accepted the Supreme Court interpretation of the X case, which found that it is lawful to terminate a pregnancy in Ireland if it is established as a matter of probability that there is a real and substantial risk to the life as distinct from the health of the mother which can only be avoided by a termination of the pregnancy. The European Court of Human Rights found there had been no violation of rights under the convention in terms of Ms A and Ms B but in respect of the third applicant found that Ireland had failed to respect the applicant's private life as it has no procedure for her to establish whether she qualified for a lawful termination of pregnancy in accordance with Irish law.

This is the nub of the difficulty which now faces the State. The court ruled that no procedures had been laid down in Irish law which can measure or determine risk and this has led to uncertainty. It stated that further legal clarity was required. This further legal clarity must be provided and can and will be provided by this Government, but I do not accept that the judgment of the European Court of Human Rights means that Ireland must legislate to introduce a much more liberal abortion regime. Ireland has signed and ratified the European Convention on Human Rights and thus is under a legal obligation to implement the judgment of the European Court of Human Rights, an obligation that successive Governments have sidestepped because it was not politically expedient to do so.

However, the issue can no longer be sidestepped, particularly in the wake of the death of Savita Halappanavar in Galway University Hospital. Savita presented in hospital 17 weeks into her pregnancy and was miscarrying her baby. She died later of blood poisoning after enduring days of pain and her treatment is the subject of multiple inquiries. It is important to let those inquiries report before making any further judgment. Savita's death has promoted a debate which has often centred on the limits facing doctors operating in a legal fog unsure of the ramifications of their actions. What the debate should have focused on was the limits facing women presenting to hospitals in such difficulties and their rights in terms of treatment.

The report of the expert group which is before us was in train before Savita's tragic death but her death has brought home to people on all sides of the debate the human tragedies that lie behind all the legal terminology. Successive governments may have shied away from this emotive, controversial and difficult subject but when the highest court in the land has recommended that clarity is needed and the European Court of Human Rights has echoed that call, we as legislators must recognise that and deal with the problem presented to us.

I am conscious that after a 20 year delay, we have had a flurry of debates on this matter in the Dáil over the past number of weeks. The extent of the debate serves to highlight the extent of the delay which ran to two decades and the disrepute in which it places this Oireachtas. Many speakers have spoken about the sensitivity on the issue of abortion and I would not disagree with them. We all know from history, certainly in the 1980s, just how polarising was the issue and the debate. It is true that politics and politicians have taken a safety-first attitude to the issue and run for cover because it was considered too contentious. The fact that we are discussing legislation for the X case two decades later does politics, politicians and this institution no credit.

I am glad the report of the expert group has been published. My colleagues and I have studied it and I have a few things to say about it which I hope will be useful and in some way insightful. The main thing I want to say is that we cannot countenance any further delay. While it is very useful and indeed appropriate that the report is considered and debated and that every Member who so wishes has a right to put his or her views or misgivings on the subject on the record, this cycle of debates should not be used as a pretext for further delay. I say this to the Minister of State with the utmost respect and urge the Government now that it has the report and will hear the views of the Members of this Dáil to lose no time in making clear which option it will select and move that forward with all due haste.

It is very important that we understand the kinds of restrictions the Constitution contains and the X case reiterates. The X case reiterates the need for legislation in very narrow terms. It is important that people, regardless of their views on the broader issues of women's reproductive rights and abortion, understand what is constitutionally permissible and stated within the X case. We are concerned with very restrictive circumstances in which a medical termination is permissible. There are two tests that must be met. The first is that the woman's life must be in jeopardy. It is not a matter of health, rather it is a matter of life and death. The second test is that in the event that the woman is heading towards death, only a termination can save that life. These are very important things to understand. There are many who would argue that this is far too restrictive but that is a debate for another day. As we debate in the here and now, that is the current position.

When we come to the element of suicide, it is in those circumstances that the restrictive nature of the judgment must be most particularly borne in mind. In order for a medical termination to be allowable on the grounds of suicide, the woman's life must be in jeopardy. There must be a real peril to the woman, which is the first test. The second test for the suicidal person is that it would have to be established that only a termination could spare that life. Those are remarkably high thresholds. I found it disturbing that some commentators in the media sought to portray the X case and the grounds of suicide as some sort of permission for termination on the basis of mental health. That is not the case. In a scenario, heaven forbid, where a pregnant woman was suicidal, a doctor, physicians, clinicians and experts would have to judge the range of medical treatments that would be appropriate for that woman, be it hospitalisation, medication or the other full range of treatments.

We need to be very careful as we move to the point of legislating for the X case that we do not allow the public debate to be captured by a kind of hysteria, be it by accident or design, that would confuse mental health as a general category with a woman who is suicidal and who can only be saved by a medical termination. Those things are worlds apart from each other. Having said that, I hope the Government is not minded to legislate for the X case and somehow try to rule out the suicide risk. I do not believe this would be legally possible and would cause any legislation to fall at the first hurdle. It would also be very wrong to proceed on that basis because although the restrictions are in place, the law is clear.

If a woman's life is in danger and that danger can only be offset by a medical termination of pregnancy, it is legally allowable to do so.

Having studied the report it is evident that the expert group was not asked to arrive at any recommendation or conclusion. Perhaps from the Government's point of view there was merit in this to set out the options but it is a pity the experts, given their expertise, were not asked to make a clear-cut recommendation. As the Minister of State, Deputy Costello, stated, it set out four distinct options. When one reads the report, it becomes clear that primary legislation is necessary and that such legislation needs to be bolstered with regulation. Although the expert group does not recommend this, it is clear if one reads between the lines that it is the logical conclusion of its deliberations. The report states the legislative plus regulation approach fulfils the requirements of the judgment and provides for appropriate checks and balances between the powers of the Legislature and the Executive and would be amenable to changes that might arise out of clinical practice and scientific advances. This is sensible and it is the way to go. To reiterate, the powers of the Legislature and the Executive are fully bound by what is permissible within the Constitution. Therefore, this is not a blank cheque for anyone elected to this Chamber or anyone in a ministerial position to expand the horizons of where abortion is permissible in the State. This cannot happen without another constitutional referendum or without the say so and permission of the people.

There is some discussion in the document on the appropriate level of qualification of the medics who would make a determination in any individual case. It is a question of striking a balance between the best medical expertise which can be accessed as a matter of good practice and issues with regard to timing and promptness. Situations can arise where a woman's life is in danger and time is of the essence, and it will be for the Government to strike this balance to have in place the necessary expertise which can have the full confidence of the public, the Legislature and women who are having babies and using the maternity services. We must ensure we put in place a system which is sufficiently efficient and does not leave somebody in danger which might result in the loss of life.

Decisions must also be made in respect of the appeals procedures, and balances need to be struck in this regard being duly conscious of the rights of the woman and the needs of the medical profession, and some consideration must be given to whether a woman might have the right to make an application to the High Court for a review of a decision she might contest. On one level these issues are complex, and in another sense it is a matter of the Government finding an orderly, reasoned and reasonable approach to resolve these matters. Decisions can be taken on these matters quite speedily. I do not believe they will require months of deliberation.

I listened very carefully to the Minister for Justice and Equality, Deputy Alan Shatter, who made a very thoughtful and interesting contribution in the course of the debate on Deputy Clare Daly's legislation. I sensed from his contribution that he, or perhaps the Department and officials, are probably some way down the road in puzzling out the technicalities and architecture which might be contained in the legislation. I read this as a very welcome signal and I hope I am right.

Is the Deputy being pre-emptive?

I do not believe so.

We are a Parliament, not a pre-emptive debating chamber.

Allow the Deputy to speak.

I accept that and I do not presume to pre-empt anything. I am simply putting on the record the position of my party, which is that we require legislation for this matter and Deputy Mathews is familiar with this, and also my sense of where the debate is at and my reading of the report.

This is why we have a Ceann Comhairle, to keep debate within its confines.

Deputy McDonald has two minutes remaining.

On several occasions attempts were made to overturn the decision in the X case, both of which failed. We can all analyse why this happened but the people spoke. It is now abundantly clear that we need to act and to legislate. We need primary legislation and we will also require regulation.

Savita Halappanavar has, not surprisingly, been mentioned in the Chamber. The distressing element of this young woman's death is that she had lost her pregnancy and died at a time of such terrible distress. The public reaction to this from everybody, and particularly from women, was that one could place oneself in her position, which was a truly horrific circumstance. The occasions upon which a pregnant woman's life is in danger are, thankfully, very rare, but it falls to us as legislators to legislate for these very rare occasions. Far from this debate being led by what are called extremes, which is an unfortunate way of describing deeply and passionately held views, there is a bulk of public sentiment which is somewhere in the middle and understands that for the most important things in life there are no absolutes and no 100%. In legislating for the X case we legislate for restrictive measures at this time to protect women's lives and the medical profession on these very rare occasions.

I welcome the opportunity to speak on this issue. When we speak about this issue the word "abortion" is thrown into the ether and it is on the radar. However, terminology should be carefully considered when we contribute to this debate. This Chamber is a political forum, but anyone who has studied philosophy or theology or addressed any moral issue such as abortion or suicide knows there is a moral and religious element to the issue. The debate is intertwined between politics, morality and religion. Over centuries religious baggage has been accumulated and famous philosophers have tried to come to a conclusion and offer clarity on abortion but they have not been able to do so, and we will not be able to do it in this Chamber unless we address the core element of the issue which is about saving lives, be they that of the mother, child or embryo, with the conjoined lives being the important factor therein.

We are also tempted as legislators to talk about our personal journeys and tap in to our personal judgments to form value considerations. That is dangerous. Our personal journeys are not enough because here we are dealing with moral choices, whether objective or subjective, be it the moral choice that I make with respect to my core belief in the protection of life or the subjective value judgments of others on the right to travel to the United Kingdom or on the right of access to information. There is an intertwining of moral consideration in this debate about which we need to be careful.

We also must be careful around the inherent dangers in the timeframe that we are allowing to discuss this. Deputy McDonald offered a window, stating that this needs to be done in two or three months. I hope I reflect accurately her point of view. There is an inherent danger in the time restriction that we afford to this. If we think for a second that we can come to a careful considered viewpoint in the short window afforded to us, we are starting off on the wrong foot. We should allow as much time as possible and allow for enough consideration to harness as much as possible of the ethical viewpoints and judgments, be they of theologians or persons with a moral compass. We need help here. We cannot come to a careful conclusion on this as politicians as we are only one element of a trilateral jigsaw of morality, politics and religion.

I find myself agreeing with Deputy McDonald on how stifling this debate is when a battle line is drawn in the sand between pro-life and pro-choice. That is extremely unhelpful. Perhaps I have been leading a humble quiet existence, but I have never come across a person who is not pro-life. I am sure the other 165 Deputies have shared a similar experience. The battleground to which I refer does not exist. Maybe I have had a sheltered upbringing and in living in Philadelphia, the Middle East and London, I led a sheltered existence, but in all my time I have not met anybody who is not pro-life with a core value system regarding the protection of life.

I want to talk about the role of those who are involved at the coalface, the obstetricians and medics. They take their job extremely seriously and are faced with the choice of co-joined lives where a decision must be made. We as adults know such decisions are being made on a daily basis. If we do anything in this House, we should facilitate an enabling mechanism for these medics, who are making these important choices with their own moral compass and strict code of ethics as medical practitioners, where their core moral belief is in the protection of all lives, be it the mother or the unborn.

We need their help. The Irish Medical Council, IMC, has made statements, but we need its help. We need it to articulate exactly what is going on and the choices it faces on a daily basis. If it feels restricted because of the lack of legislation and there is a barrier in place with respect to its work, we need to find out the status quo. I have had communication with persons of a strong pro-life view and I was surprised on Friday when one of them said: "We are happy with what is going on in the hospitals already. We know what is going on. We know the choices are being made." If anything comes out of this process, it should be an enabling mechanism to address what is happening and protect those faced with the decision, which is a moral decision obviously intertwined with a medical one.

We should go further with respect to this debate, and I say this carefully. In the past four or five years, we have been talking about the economy. That is the reality of where we are as a society. People are hurting and have less money. There is a danger that we have monopolised the conversation in this House around the economy and forgotten about society and the type of country in which we want to live and into which we want to bring the next generation. Even if tomorrow morning we get a debt write-down from the EU-IMF-ECB and everything is sorted, our deficit is paired back, everything is hunky-dory and the unemployment problem evaporates, we still need to allow a space in this House to talk about society. The constitutional convention will certainly play a role, primarily at a nuts and bolts level, but we have a role in talking about the type of society we want. From my communication with the people, we are at a new level and it is not because everybody got greater access to education and the people are smarter than 50 or 100 years ago. There has been an empowerment process over the past 30 or 40 years due to a myriad of factors such as greater independence, less adherence to restrictive autocracy leadership, be it at a political or a religious level, and greater confidence. We should have the confidence as legislators to articulate where the people are at.

I have total confidence in the ethical judgments of obstetricians and medical staff who have the important task of saving co-joined lives, be it the mother or the child. As they are faced with a decision in the theatre with lives at stake, we need them to rise up and get involved in this conversation because we cannot do it on our own. We can have the political forum to articulate viewpoints on either side, be they strongly held or less so, but we do not have the moral compass on this issue that the medical staff at the coalface have. I call on the Irish Medical Council to get more involved in this debate. We need its help.

We need the help of civic leaders. We also need the help of the church and theologians. While they have a right to stand outside this House and to join in protests, I call on them to get involved in the debate because we need their help. We cannot do this on our own. For centuries, philosophers and theologians have tried to do this and they cannot do it on their own. We need their help. I make that appeal to the IMC and the religious and civic leaders because this is an opportunity to start the debate on the type of country in which we want to live and in which we want to raise our children.

Like other speakers, I welcome this debate. I also welcome the opportunity for Members to analyse and respond to the expert group's report. As Deputy McHugh has said, it is important that we, in conjunction with others outside this House, consider this report in its entirety, including its recommendations and options, and offer our response to them. As much as people want this issue to be resolved - some want it resolved as soon as is humanly possible - it is only right and proper that an opportunity for in-depth analysis is given by society as a whole. I await the Government's comments on the exact procedures that will follow from the Committee on Health and Children after Christmas, including what its terms of reference will be and for how long it will engage with experts and the professions affected and associated by what may be proposed thereafter in legislation.

There are many wide-ranging views on this area. Many people are very stringent in their views. I expect and hope that Members will continue to respect the sincerely held views and opinions of all Members of this House. It is impossible to discuss the contents, findings, recommendations and options of the report, as well as the background to it and the reasons for it, without being conscious of the recent death of Savita Halappanavar. Our entire country was saddened by this horrible and unfortunate event. The outpouring of grief exercised the nation in a manner we have not seen in recent years.

That case in its own right cannot be judged in isolation until the relevant investigations and explanations come from the process that has begun. On the issue of that investigation and efforts to establish the chronological order of events, I want to place on record my disappointment at the manner in which the Government, in particular the Minister for Health, handled that process in the immediate aftermath of that terrible event. The insensitive manner in which they dealt with the family was unfortunate. I hope that, even at this late stage, relationships in that regard can be retrieved and that there can be a mechanism and process that will meet with the support of all parties involved.

In the immediate aftermath of that event, we heard the masters of the maternity hospitals state that existing legislation needs further legal clarity with regard to the safeguards of the mother in the event of the threat to her life being real at the expense of her unborn child. I would have thought that the existing legislation catered for this matter, as allegedly was the case in Galway. I think the majority in this country would have thought that the existing legislation was sufficient in that regard. Since then, I am sure the country is also united in its wish to uphold that existing legislation and strengthen it, if that is what has to be done.

With regard to the expert group and its recommendations following the judgment in the A, B and C v. Ireland case, we acknowledge the expertise concerning the configuration of that group. We welcome and respect its report and we expect a considered and informed debate on the options contained therein.

Many speakers have referred to the series of events that have followed the 1983 referendum and more specifically the Supreme Court judgment in 1992 on the X case. To say that nothing was done or attempted by governments since then is somewhat disingenuous. The 2002 referendum was held on both a text for the Constitution and a supporting legal framework to allow medical practitioners to intervene to save the life of the mother where there was a real and substantial risk of loss of life other than by self-destruction. It also involved the repeal of sections 58 and 59 of the Offences Against the State Act 1861. In 2002, the Government felt that it was a moderate proposal excluding suicide as a reason for abortion. However, it was rejected by 10,000 votes. Irrespective of whether it was rejected by one vote or hundreds of thousands of votes, that result charged the State with a responsibility to act on the Supreme Court's decision.

The decision of the European Court of Human Rights has reinforced that onus of responsibility. We will have to look at the debate that has ensued recently. Some commentary could lead one to believe that any mechanism - whether it be by the options mentioned or by legislation ensuing from them - could lead to the provision of limited abortion on demand or abortion as an option for those affected by rape, incest or those carrying children suffering from foetal abnormalities or which cannot survive outside the womb. Obviously, however, that is not necessarily the case. It is only in that context and as a result of any of those issues, that suicide is emanating from those horrible predicaments. It is only then that those issues become real.

It therefore needs to be clarified that the expert group's findings, recommendations and options contain only options which cater for a framework to deal with the X case. Our Constitution guarantees the right to life and we must uphold that right for all our citizens and protect those who cannot protect themselves. It is against that backdrop that one must consider the options proposed by the expert group. It is against that background that one must also consider the response to these options from the medical and legal professions. Only then can we afford the legal framework and clarity for the medical profession to carry out its duties.

Make no mistake, it remains a most difficult procedure for this State to provide specifically for the findings of the X case while protecting the right to life as enshrined in our Constitution.

Regardless of how much help and assistance has been given by this expert report in providing options and narrowing the focus, as Deputy McHugh has noted, assistance to the Government does not necessarily stop there. Members must encourage engagement on the part of society as a whole in this regard. It is against these backdrops that Members await further details of the role of the Committee on Health and Children in giving assistance. Thereafter, Members can await the Government's consideration and can analyse its proposals. Moreover, as I indicated earlier, Members will be mindful of their absolute willingness to safeguard the right to life because allied to their own opinions and thoughts in this area, as well as to the consideration they must give to those they represent, Members also must be mindful of their obligation to legislate for the common good. They are not necessarily here to legislate as they see fit and while that formulates the majority of their opinions in any area, they must give some credence and weight to the effect of legislating in the common good.

I thank the expert group's members for their work in preparing the report, in narrowing the focus and in seeking to advise the Government and the Legislature of their responsibilities in respect of what has been acknowledged to be a most difficult mechanism to be devised to address the predicament in which we find ourselves. However, as Members of the Government have stated, doing nothing is not an option. Fianna Fáil Members accept that but are conscious of everyone's opinions and are conscious of the role that is to be played by Members of the Oireachtas, the medical profession and by society at large. Ultimately, however, the decision then rests with the Government to bring forward legislation. Thereafter, there will be further analytical exchanges and perhaps further amendments from this side of the House, if it is forthcoming, in arriving at a solution that can be agreed by all. I hope there can be a consensus in this area to bring forward legislation. I wish the Government well in what I acknowledge is not an easy task. As for any assistance that any Member can elicit from whatever quarter, let that be done and let it be done with the best intentions and in the best interests of those they represent.

While the colleagues on the list before me do not appear to have arrived, Deputy Catherine Murphy is in the Chamber and I will call on her. The Deputy has 15 minutes.

A small but significant number of women each year find themselves in circumstances where, because of an underlying medical condition, the continuation of a pregnancy would involve a serious risk to their health or life or both. It is important to be clear about the scope and intent of the expert group report. There must be no confusion about the report and one must not allow any misrepresentation of the report to frustrate the efforts of this Legislature to implement the judgment in the A, B and C v. Ireland case. The scope of the report is extremely limited, regrettably so. However, as legislators Members must deal with the report that has been presented to them and not with misrepresentations or misinterpretations of its aims and contents. The task of the expert group was to propose mechanisms to give effect to the limited constitutional right to abortion which is established under the X case, that where as a matter of probability, there is a real and substantial risk to the life of a pregnant woman, which can only be averted by the termination of the pregnancy, such a termination can lawfully take place. While I acknowledge that other Members have made this point earlier in the debate, the preface to the report is unambiguous in stating "the X case decision is the law of the State". Moreover, this was declared by the highest court of the land and is binding on all the lower courts and is the law. The report does not advocate or present options that would allow termination of pregnancy in circumstances that fall outside the limited constitutional right and nor does it advocate for or propose options that would be more restrictive than the existing case law allows. The options outlined in the expert group's report address only the rare cases that arise where pregnancy presents a risk to the life of a pregnant woman, with a view to ensuring that all necessary medical treatment can be carried out within the law in such cases.

The report is grounded in four principles that govern all the options discussed and seek to strike a balance between a woman's right to a termination where her life is at risk and the constitutional obligation to protect and vindicate, as far as practicable, the life of the unborn. The first principle was that the entitlement to have the right to lawful termination of pregnancy ascertained should be established. The second principle was that the State's constitutional obligations under Article 40.3.3° should be reflected in the options proposed to implement this judgment. The third was that termination of pregnancy should be considered a medical treatment, regardless of whether the risk to the life of the woman arises on physical or mental health grounds. The fourth principle was it always will be a matter for the patient to decide if she wishes to proceed with a termination, following a decision that it is clinically appropriate medical treatment. In this context, I can recall Mr. Praveen Halappanavar talking about how he and his wife were looking forward to a healthy baby at the end of the pregnancy. This was a much-wanted baby and in many cases in which there is a risk to life, the baby is much wanted. I have listened to some of the debates in recent weeks in which people were talking about walk-in and walk-out-type services. This is not what Members are talking about. This is an extremely limited report with a limited scope that is in line with the constitutional provision in Article 40.3.3°.

In scope, the expert group report addresses the court's finding of a violation of the privacy rights under the European Convention on Human Rights in the case of one of the three applicants in the case, namely, Applicant C, who was in remission from cancer when she became pregnant and was unable to obtain clear advice about the risks to her health and life and to the foetus if she continued to term. It is regrettable that the scope of the report is so limited because there are cases that require serious consideration beyond the scope of the expert group report. While the court did not hold that there had been a violation of the rights of the two applicants whose cases did not involve risk to life, the court did find that the necessity to travel to the United Kingdom for an abortion amounted to an interference with their rights. The court held that the State was free to decide on how such cases should be addressed. The expert group could have considered how the law might be changed to bring Ireland's abortion regime into line with the approaches in other European countries that allow terminations in a wider range of circumstances but it did not do so. In this context, it is useful to study the third appendix at the end of the report to see how other European countries deal with this issue. The only one with which Ireland is absolutely comparable in this regard is Andorra. However, as the latter has a population of 86,000, the situation is hardly comparable.

The report states the legal position that the European Convention on Human Rights is legally binding on the State and that Ireland's duty to comply with the judgment of the European Court of Human Rights is integral to the scheme of the convention.

The report is unambiguous about Ireland's legal obligation as a result of the ruling. In the words of the court, "It would obviously be insufficient for the State to interpret the court's judgment as requiring only a procedure to establish entitlement to termination without also giving access to such necessary treatment".

The report addresses a number of issues relating to access to treatment. It details the working of the Offences Against the Person Act 1861 and one can consider how a doctor would read it. It is very much something from two centuries ago, even if we just take in its terminology. The report addresses one of the central concerns of the European Court of Human Rights, the continuance on the Statute Book of the criminal provisions of the 1861 Act and the chilling effect on women and doctors due to the risk for both parties of criminal conviction and imprisonment. The report recognises that only legislation that would provide a defence to these provisions would give the required legal protection for woman and their doctors.

The report proposes a number of models of appeal processes for cases of disagreement between a woman and her doctors or between doctors. It highlights that a right to legal abortion must be supported by procedural safeguards to ensure that the law is correctly applied. Medical and legal models and models that combine both perspectives are proposed. The report is clear that the core issue is medical, not legal, and that a seriously ill pregnant woman should not be subjected to an adversarial legal process which would be protracted, embarrassing and invasive of her privacy. It outlines the attributes of an appeal process, including that it must be independent, competent and give written decisions in a timely manner, and that the procedures must include the possibility for the woman's voice to be heard.

With regard to conscientious objection, the report highlights the need to regulate individual rights to conscientious objection in such a way that it cannot be exercised to frustrate a woman's right to receive treatment. The report highlights cases where particular options could create procedural or practical barriers to access to treatment, such as options creating the necessity for two psychiatrists to make a decision in a case of suicide intent and options imposing a requirement for lawyers to be included in any review panel.

The expert group makes it absolutely clear that the judgment in the A, B and C v. Ireland case implies an obligation on the State to the ruling of the Supreme Court in the X case. The report gives some consideration to aspects of the X case that have been considered particularly problematic. The issue of suicide arises most often. The report is unambiguous that termination of pregnancy should be considered a medical treatment in cases where the risk arises on mental health grounds, which is an obvious reference to suicide. The report acknowledges that diagnosis of suicide intent presents challenges and considers whether a risk to life from suicide warrants extra safeguards such as, for example, the involvement of two psychiatrists in the decision-making process. This might give the woman and her doctors more security in the diagnosis and decisions but there are also significant disadvantages outlined by the report. These include the extra burden on a patient by imposing a practice which is not standard when a patient is not pregnant, the risk of stigmatising mental health conditions and the possibility of delay due to geographical and service delivery issues.

The report directly addresses concerns that the judgment in the X case establishes a right to a termination at any gestational age. The expert group is clear that the right to have the pregnancy brought to an end does not entail the right to end the life of a viable foetus. The report proposes measures to maximise the chances of survival of a foetus that is at the "fringes of viability". The report highlights that the issue of how to provide for the X case has been considered by other bodies which have all concluded that legislation in some form is the most appropriate way to regulate abortion in Ireland. It casts doubt on whether any implementation option that does not include legislation will satisfy the requirements of the court for substantive measures that will give effect to the right to abortion in the X case.

Nevertheless, the report also expresses serious concern about the lengthy nature of the process of legislative drafting and democratic scrutiny. Attention was drawn to this in 2000, as if we had legislated for the issue at that stage, we would not now be talking about a lengthy process. The Government must introduce emergency legislation or other interim measures, such as, for example, the announcement of a moratorium on prosecutions, in order to ensure that no pregnant woman will be denied a termination of pregnancy in circumstances where her life is at risk. Even with legislation to implement the judgment in the A, B and C v. Ireland case, Ireland will still have one of the most restrictive legal system approaches to abortion in the world. I draw attention for anybody who cares to read it to the last couple of page of the report, which outline how such issues are handled in other countries.

The expert group gave consideration only to the requirement to give effect to the right to an abortion where a woman's life - as distinct from her health - is at risk. No other country in Europe makes that distinction. It is a very hard line to draw with certainty, meaning a clinician can be left with a very difficult decision. The great majority of countries with otherwise highly restrictive abortion laws, such as Colombia and Costa Rica, recognise that when women's lives or health are threatened by a pregnancy, measures must be taken in order to preserve women's health. The right to life of a foetus cannot be absolute, as it must be understood in tandem with the woman on whose life it is dependent.

Some have suggested that the right to lawful therapeutic abortion should be further restricted by the exclusion of the threat of suicide. It is clear that introducing legislation to exclude suicide as reason for a therapeutic abortion is currently unconstitutional and would require a referendum. Proposals to amend the Constitution with this intent have twice been rejected in referendums. Rather than propose a further referendum, the expert group outlines a number of ways of regulating the application of the law, such that women whose mental health condition leads to a real and substantial threat of suicide have access to all appropriate treatment, including the option of a termination. These merit consideration by the Legislature. If suicide were to be excluded, inevitably, at some point, the death of a pregnant woman would occur. Are we willing to be implicated in such a death?

The expert group was not mandated to consider the ban in Ireland on abortion to preserve a woman's health in cases of rape or incest, cases of serious foetal abnormality or in any other case. We know that 4,000 women every year travel to the UK for abortions. The European Court of Human Rights accepted that these women experience significant physical, financial and psychological burdens and those whose experience is the hardest are those who are most marginalised and who experience most disadvantage and discrimination in our country. These are women with little or no income, with care responsibilities, with disabilities, with mental illness, women experiencing violence, young women and women of uncertain residency status who are unable to leave or re-enter the State freely.

The report is limited in scope. If its scope were broadened, a constitutional referendum would be needed to address such issues as the right to health as well as rape, incest and fatal abnormalities in a foetus. All of these issues deserve consideration in a civil society.

I thank Deputies Mary Lou McDonald and Catherine Murphy for their contributions. I often find in debates of this nature that men should perhaps shut up and listen to women.

Deputy Murphy critiqued the circumstances in which we find ourselves. This is a sensitive time in the history of the nation. Before coming to the Chamber, I listened on the monitor to Deputy McDonald describe with passion the hurt the abortion issue has caused for generations. The Government has signalled the importance it attaches to the issue by providing more than 20 hours of Dáil time to discuss it.

I thank Sinn Féin and Deputy Clare Daly for tabling valuable motions earlier this month which allowed us to frame this debate in the context of the actions the Government must take. These motions were tabled in good faith and the Minister and Cabinet are working on this issue in good faith. The Government acted on its commitment in the programme for Government to establish an expert group on the judgment in the A, B and C case. The expert group published its report only shortly after an unfortunate young woman passed away in a Galway hospital. I welcome the Government's commitment to make a decision before the Christmas recess on what action it will propose to take on foot of the report. I also welcome the decision by the Joint Committee on Health and Children to hold public hearings into the issue. It will be important that the committee ensures all sides are afforded an opportunity to speak and be heard.

Abortion divides society and has been a major political issue for the past 30 years. The 1983 referendum on the eighth amendment to the Constitution was only the second campaign in which I became involved. I was also involved in a long and bitter strike at the time. During the campaign, posters were put up on my housing estate and I recall explaining to people in the area that the amendment was in my view wrong. On the evening of the vote, I was in my sitting room when a neighbour knocked on my door and asked whether I could give her a lift to the polling station, which was some distance from my home. I agreed to drop her to the polling station and within ten or 15 minutes of my return, five or six more neighbours, mainly women, had called to my home asking for a lift. I recall that it was not a particularly nice evening. It emerged in the course of our conversations that the husbands of the women had refused to drive them to the polling station because they were not happy with their wives' voting intentions. This incident had a major effect on me. The reason I stated that men should perhaps shut up in this debate is that I find it difficult to stomach listening to men articulate a position on an issue that affects women and their health.

Society has come far in recent years. For the remainder of the time I lived on the housing estate in question, I had the label of "abortionist" hanging over me. The term was used in my presence to describe me, although I am as pro-life as anyone else. Given that people have deeply held positions on abortion, we must respect the feelings and convictions of others on this issue. At one stage, it was dangerous to be a progressive voice in this country. Most Deputies will remember the two referendums on divorce and a time when one could not openly buy contraceptives. It is only recently that the rights of the lesbian, gay, bisexual and transsexual, LGBT, community, are starting to be recognised and members of that community only now feel comfortable with being open.

Thousands of women who must leave Ireland and travel to England for abortions do not receive any recognition. They are hidden members of our families and society - in my view society is our family. If we are truly caring, we must accept that these women experience torment as they travel alone and endure an abortion before returning and hiding their experience from their families. Many of these women cannot sit down over a cup of tea and discuss this traumatic event in their lives.

Tonight, the House is full of men discussing the health issues of women. Progress is being made, however. The introduction of a gender quota will be an interesting and welcome development that will fundamentally change politics. We have heard about women's influence on the budget. Few women are present for this discussion of a women's issue. It is time we allowed women to make decisions about their own health. I believe every Member of the House will try to show consideration for the deeply held beliefs of others. Fulfilling our responsibility to legislate will be a difficult challenge because Members will come under extreme pressure. However, the least the House can do is legislate for the outcome of the X case.

I will not discuss the detail of Deputy Catherine Murphy's contribution. I am proud of the Labour Party, not of symbols such as the rose but of its members. In the previous general election, some of my campaign workers had holy water and rosary beads thrown at them while canvassing. They are deeply religious people who were shocked to encounter this type of aggression on doorsteps. Their experience illustrates how deeply divided society remains on the issue of abortion. I still recall the bitterness that marked the 1983 referendum and my view on abortion was formed on the basis of experience.

I do not propose to discuss the recommendations of the expert group's report. Instead, I appeal for tolerance and an understanding that others have deeply held views. A fundamental health issue arises in this debate. Moreover, women have a right to make decisions about their bodies.

I would prefer if an equal number of male and female Deputies were present for this debate. Voting in the 1983 referendum, during which men would not drive their wives to polling stations, was not especially long ago. I appeal to everyone to listen carefully to their wives, daughters and sisters because the legislation we pass will affect them and subsequent generations.

There is no appetite to revisit this matter time and again. We must deal with the X case, but that is only the beginning and the Dáil must take a further step and address other issues, for example, rape, incest etc. I thank the Acting Chairman for allowing me time.

I am glad to be able to contribute on this debate. It has been 30 years since I first spoke publicly about this issue. In the early 1980s, a campaign was under way to introduce a constitutional ban on abortion. Some wanted the amendment inserted into the Constitution because of their concern that we could otherwise have seen a decision similar to that in the Roe v. Wade case in the US in the early 1970s. I was on the students union of UCD at the time and a motion was placed on the agenda asking that the union affiliate with the anti-amendment campaign. I remember the strength of the debate and the intensity of feelings across the campus and in the lecture theatres. I also remember the discussions in the bars and the churches of our home towns. Everyone got involved in the debate and contributed a viewpoint. It was an intensive campaign and some of the arguments and tactics used were shocking. Like my colleague, Deputy Kevin Humphreys, it educated many of us on the problems facing half of our society.

It is shocking that so little has changed in 30 years. Despite a number of amendments to the Constitution, there is still uncertainty about the rights of a pregnant woman in Ireland. There has been no legislation on the back of any of the amendments and individual tragedies have since occurred.

I have received hundreds of e-mails since the publication of the expert group report. I have probably received more e-mails about this issue from constituents than I have received about any other issue in my time as a public representative, which goes back eight years. Those constituents are concerned that a failure to legislate and to give clear guidance to doctors on terminations has led to an inequality in medicine. Medical professionals are also concerned. I have seen them on television and heard them on radio expressing their concerns that the lack of legal clarity on this issue has led to certain treatment options for sick women being ignored. We need to ensure that we remove this lack of clarity. We must give legal clarity to the medical profession so as to remove the grey areas.

The Labour Party has campaigned on this issue for many a year - decades, in fact. It was in our manifesto last year and the agreed programme for Government is clear on the issue. The latter reads: "We will establish an expert group to address this issue, drawing on appropriate medical and legal expertise with a view to making recommendations to Government on how this matter should be properly addressed." The expert group report has been completed and we have sent our action list to the European Court of Human Rights.

As Deputies have stated, this is a polarising issue. I have not just received communications from one side of the debate. I have also received communications from the other side. Opinions on both sides are undoubtedly well held. As such, it is important that we approach this issue with the sensitivity it deserves. However, it is 20 years since the X case and the Dáil has still not acted despite the fact that the Supreme Court laid out exactly what we should do. We cannot ignore a Supreme Court decision. That is not debatable. The House has been spineless on this issue for far too long.

The expert group report provides us with options and it is clear that we need to act. The report cannot be left to gather dust. We were elected to deal with a range of issues facing the Ireland of today. Some of those issues are economic and some are social. I am clear on the fact that this is an issue that I was elected to address. The Cabinet is discussing what we should do. I wish to add my voice to those of my colleagues - this situation has gone on for far too long and we need legislation now.

In order to discuss this report and its ramifications, we must focus on the findings of the expert group and their implications for the issue of abortion legislation. However, given the tragic circumstances of Savita Halappanavar's death in Galway in late October and the efforts of both sides - the pro and anti-abortion lobbies - it is impossible not to include it in any discussion of A, B and C v. Ireland and the report before us.

That this sad occurrence is now an integral discussion point associated with the findings of the report is a testament to the power of the media and indicative of an exercise in opportunism, shamefully focused on the death of Savita. I would like to take this opportunity to extend my heartfelt sympathy to her husband and family. While I cannot adequately express my horror at the sad death of Savita, I have had a sense of disquiet from the moment her situation was highlighted. The timing of the release of the information regarding her circumstances on the morning after the report under discussion was given to the Minister for Health was questionable to say the least. I am sure that it was no coincidence that, although she died on 28 October, her death was not extensively reported until the day after this report was delivered to the Minister. The circumstances of her death have been shamefully used as a justification mechanism by both the pro and anti-abortion lobbies.

One could perhaps call the revelations about Savita's death coincidental, but the resultant media outbursts and overwrought reactions seem too opportunistic for that. From being a weapon to try to force the Government's hand, I hope that calm will prevail and that this report will be assessed and viewed in an independent light. However, I am anxious that any legislation should not be rushed through in a knee-jerk reaction to the report, the death of Savita and the other matters that are impacting on it.

Having had major reservations about the timing of the news of Savita's death, the publication of which came as a shock and surprise to her family, the fact that there is now a question mark over some of the reporting of the facts of the case only serves to add credence to the opportunism of the exposure of this tragic death. I am shocked to read that the sequence of events may have been at least muddled but, at worst, distorted. That what was reported or not reported, whatever way one looks at it, prompted a recent independent inquiry into the death of Savita, was inexcusable.

Despite the worldwide reporting to the contrary, Ireland is not in the dark ages medically. I have always been of the opinion that judgment should be reserved until the independent reports into Savita's death have been published. Medical opinion at the highest level is divided on this case, but only an in-depth investigation or investigations will give all of the facts. That people with little or no medical background are rushing to judgment and being listened to is extraordinary.

While it could be said that discussing the circumstances of Savita's situation is to diverge from the matters concerning us vis-à-vis this report, timing and media intervention have made it part and parcel of any discussion on abortion or abortion-related topics. The most important aspect of the current report is that it shows the need to bring clarity for the health of the women of Ireland and those treating them. It should not be regarded as an invitation for the pro and anti sides of the abortion debate to stir up that debate in a manner that is designed to cloud the issues as presented by the report.

It is essential that we try to separate this report on the A, B and C v. Ireland case from the upcoming reports into the death of Savita Halappanavar so as to provide clarity and safety for mothers-to-be and to copperfasten guidelines for the medical profession.

Abortion in cases of potential suicide is very much an ongoing debate. It is a particularly grey area and one that is open to abuse. Should this provision be included in any future legislation, it would require medical guarantees and judgments, which would be extremely difficult, given that a decision would have to be made in what would necessarily be a fraught and rushed scenario. The threat of suicide is used as a tool in many different ways. I speak outside and beyond the area of the termination of pregnancy, but the implicit threat of suicide is one that is extremely difficult to rationalise and could lead to abortion on demand in the broadest sense. While there is, as yet, a lack of well-established medical evidence, it is held that abortion can negatively affect a woman's mental health. However, in a recent poll on the X case, 85% of respondents said they supported legislation allowing abortion where the mother's life is threatened, including by suicide; 10% said they would not support it; and 5% said they did not know. On the other hand, a separate question excluding the threat of suicide as grounds for termination was supported by 63%. Such surveys are totally dependent on the way questions are framed and are by no means conclusive.

While I fully agree with the need for legal certainty and clear guidelines for pregnant women, the issue of threatened suicide is likely to be potentially abused. I do not believe the unintentional death of a baby while medical care is given to the mother should be regarded as abortion. I do not advocate the viewpoint of the Catholic Church or any other organisation, but the church, despite accusations to the contrary, does not teach that the life of the child in the womb should be preferred to that of a mother but rather that both are sacred with an equal right to life. In addition, where a seriously ill pregnant woman needs medical treatment which may put the life of the child at risk, such intervention is ethically permissible provided every option has been exhausted to save both the mother and the child. It is standard medical practice in this country to do everything possible to save the life of a pregnant woman when complications arise. That may include interventions which result unintentionally in the death of a baby. Death in such circumstances does not constitute abortion. As it stands, the Medical Council's guidelines are very clear. Women in pregnancy must receive all necessary medical treatment to protect their lives, even where the death of the baby unavoidably results. The Supreme Court has already established that women with complications whose lives are at risk must have, or be allowed, therapeutic intervention.

Much abuse has been heaped on the situation in Ireland and the lack of availability of abortion on demand. It might be more appropriate to consider the benefits or otherwise of such a determination by the State. In the UK, for example, 6 million abortions have taken place since the introduction into law there of the Abortion Act in 1967. That is now leading to a situation where people consider it a right to abort a foetus on grounds of sex or even to take matters to extremes, which might be implausible as yet, on the basis of eye colour. What makes it a right of the human condition to abort a foetus at will or on a whim? I hope that will never be the situation in this country where we have forged a medically and morally acceptable protection of the mother, while accepting the right to life of the unborn. We have come a long way in this country since the days when a husband would be told in the same breath that his wife had died and that he had a beautiful baby girl or boy. The reality was often indescribably tragic. A family might already consist of six or more children who would be left without a mother and a grieving husband without a wife. Sense has prevailed and directed our actions. I hope that will continue to be the case.

I am puzzled by the statement of the Taoiseach late last month that he wanted to get "maximum consensus" to settle the divisive issue of abortion. He further elaborated by saying this is not a matter for any individual parties, this is a matter for the country to get maximum consensus on what is the best and correct thing to do here. I could not agree more but, nonetheless, I am at a loss to know how that can be achieved without a referendum. Such consensus would be extremely hard to gauge without a referendum. However, the Taoiseach has ruled out a referendum and we are told there is no appetite in the country for such. That is not the case and after 20 years of foot-dragging by previous Administrations, we urgently need to gauge the view of the country and to adhere to people's wishes on the matter. There must be a referendum in this case. As a member of the Constitutional Convention, I am particularly aware of the need to engage with the broader context of the Constitution in this matter for the protection of women and the unborn. A blurring of the provision of Article 40.3.3° and the two-patient model it inspires is not the way forward. A referendum is the only way to finally judge the view and wishes of the nation in this matter. I am totally opposed to abortion and would not stand over any legislation that would introduce abortion on demand in this country.

My contribution will be different in emphasis from Deputy Bannon's but what is important in the debate in this House and elsewhere is that we respect everyone's views. As citizens of a republic, we might have different views that are strongly and sincerely held, and in the best interests of the country. I am also pleased the Minister of State, Deputy Alex White, is present this evening because he has a strong track-record on these issues over many years. It gives me confidence that he is a Minister of State in the Department of Health when this sensitive issue is being tackled. I wish to place that on record.

The current abortion debate and the tragic cases that are now in the public domain end the convenient fiction that pregnant women in this country receive all the medical treatment they require. Recent weeks have seen an extraordinary outpouring of comment and analysis from doctors who specialise in obstetrics and gynaecology, politicians and commentators. Most significantly, we have heard the testimonies of numerous women on their experience within the health service when pregnancy has threatened their health or lives.

That circumstances arise in which abortion is necessary to save a woman's life has been routinely dismissed by those who oppose abortion as some kind of abstract ideological construct, invented by pro-choice organisations and advocates. There is no doubt that cases occur where real women experience genuine risks to their health and to their lives and actual practising doctors are placed in the appalling situation of trying to navigate the grey areas of the law and to protect themselves from prosecution while trying to do the best for their patients.

Women in these circumstances travel abroad for an abortion rather than risk being refused one in Ireland. This is one of the reasons that Irish maternal mortality rates appear very low. Without the safety valve of UK abortion clinics, the rates would be higher.

Many doctors, including the masters of the three Dublin maternity hospitals have called for a statutory framework and workable clinical guidelines so that they can provide best medical services in these circumstances. In response the Government is finally and slowly moving to restore Ireland's tarnished human rights reputation by giving effect to the constitutional right to abortion established 20 years ago in the Supreme Court judgment in the X case, in which it ruled on a right to abortion where there was a real and substantial threat to the life of the mother, including suicide, as decided by the Supreme Court of the Republic.

It is a principle of human rights law that access to a right must be practical and effective. The current regime of case, constitutional and criminal law combines with inconsistent application of the law in clinical practice to render the narrow constitutional right in the words of the European Court of Human Rights illusionary and theoretical.

The expert group sets out a series of proposals for practicable legislation and a regulatory framework for the implementation of the judgment of the European Court of Human Rights. It is critical that the options decided upon and enacted by the Government retain this practicable approach. Efforts to appease those who oppose abortion must not be allowed to result in legislation and guidelines of such procedural complexity as to be rendered completely ineffective in practice. The expert group makes crystal clear that only legislation will suffice to give effect to the A, B and C v. Ireland judgment. The report makes repeated reference to the considerable period of time this will entail. What will be in place for women while we wait for the Government to act?

The Committee of Ministers of the Council of Europe expressed concern about the lack of interim measures. I raised this question with the Minister for Health last March and in response he outlined measures which he acknowledged as neither satisfactory nor appropriate. If a situation such as that of applicant C, a woman who was in remission from cancer when she became pregnant or when cases similar to the A, B and C v. Ireland arises, it will be the responsibility of the doctor of the seriously ill pregnant woman to determine whether the criteria of the law were met and if so a termination could lawfully occur. In the case of disagreements between a woman and her doctor or a refusal of a necessary life saving treatments, she could seek a second medical opinion or apply to the High Court for orders directing the necessary treatment be provided. She or presumably her family could subsequently take a case for medical negligence invoking the European Convention on Human Rights Act 2003.

The action plan submitted to the Council of Ministers on 30 November includes similar statements, in other words no new measures have been put in place or are contemplated until such time as the Government introduces legislation to address the judgment in the A, B and C v. Ireland case. A woman who finds herself in the situation of applicant C will be in exactly the same position as has been the case for the past 20 years, with no effective means of asserting or giving effect to her democratic rights under Bunreacht na hÉireann.

Those who voted for the eighth amendment to the Constitution did not intend that it would result in such a scenario or in the endangerment of women's health and lives through delays in or refusal of care. The current scaremongering by anti-abortion campaigners is unfortunate but entirely predictable. Implementing the X case they tell us, will inevitably open the floodgates to "abortion on demand", that dreadful phrase. Absurdly, it is claimed by anti-abortion groups that the inclusion of the threat of suicide as a risk to life that fulfils the X case, means that Ireland has the most liberal abortion regime in the world. This is incorrect. The campaign to exclude the threat of suicide as grounds for an abortion to save a woman's life rests on two false assumptions. The first is that women, doctors, psychologists and psychiatrists will collude in claims of suicidal intent and will do so in large numbers. The second is where services are made less restrictive, more women will be encouraged to have abortions. Both these assumptions are entirely false and insulting to Irish women and their families.

On the first assertion, the export group has outlined an approach to the issue of suicidal intent in the context of pregnancy which would place such a situation within the health services that already exists and would not stigmatise mental ill-health or termination of pregnancy. Women have abortions because they have an unplanned or unwanted pregnancy and not because the service is easier to access. In any event two referenda have rejected attempts to exclude suicide from the rights in the X case judgment. As Mr. Justice Seán Ryan succinctly and definitively states in his preface to the expert group report: "The X case decision is the law of the State, as declared by its highest court. It is binding on all lower courts and generally".

As legislators it is our responsibility to implement the law of this State. The opinions of those who disagree with the ruling of the Supreme Court are irrelevant to the debate we are engaged in at present. The expert group report is an excellent report and the Government must consider its recommendations carefully and act promptly as a matter of urgency to put in place the necessary measures of the report. It is regrettable that the expert group did not look beyond the implementation of the X case and address the broader context of abortion.

Ireland's prohibitive regulation of abortion and the discriminatory nature of its application runs contrary to a number of UN human rights treaties to which Ireland is a signatory. This has been subject to criticism by international human rights bodies, including the UN Human Rights Committee, the UN Committee Against Torture, the UN Committee on the Elimination of Discrimination against Women and the Council of Europe Commissioner for Human Rights, which have criticised the following: the extremely restrictive legal regime whereby abortion is lawful only to save the life as distinct from the health of a pregnant woman and in no other circumstances; the failure of successive governments to give legislative effect, even in limited circumstances, so that abortion is available to women who need it and are in crisis; the continued existence on the Statute Book of harsh criminal sanctions dating back to the 19th century in relation to abortion; the need for women who seek abortion to travel to other jurisdictions to avail of these medical services and the consequent psychological, financial and health burdens this places on women, particularly women from lower socio-economic groups; and the discriminatory ways in which the regulation of abortion impacts on vulnerable women, minors, undocumented, and migrant women and women living in poverty is particularly unfortunate in a modern western democracy.

At Ireland's universal periodic review in 2011, Norway, Denmark, United Kingdom, Slovenia, Spain and the Netherlands made recommendations on the restrictive abortion regime in Irish law and called for firm time-lines for the implementation of the judgment of the European Court of Human Rights in A, B and C v. Ireland. It is a shame that the expert group was not asked to focus its expertise on the broader context and looked only at the violation of the rights of applicant C in the A, B and C cases.

It did not consider the interference with the rights of applicants A and B that the court also found. The court held that it was for the Government to decide how to address the situation of these two women, and women in similar situations, and that it was a case of what the Government must now do. There is nothing to stop the Government from going further than the expert group’s recommendations or reconvening the expert group to continue its excellent work and consider the future of the debate in Ireland when we, hopefully, legislate shortly for the limited terms of the Supreme Court judgment on the X case.

We know that at least 4,000 women travel to Britain each year for terminations. The figure does not include those who do not give Irish addresses or those who travel to countries such as Spain or the Netherlands. These are women from all walks of life and each has her reasons and story. Women’s experiences of abortion are diverse and complex and the decision to have an abortion is not one any woman takes lightly. Women’s reasons for choosing abortion, such as financial worries, concern about the well-being of other children, diagnosis of serious foetal abnormality, pre-existing health problems, including mental health, and relationship issues, can be extremely stressful. As a male Deputy, I am conscious I will never be faced with the difficult decision women must make. For those inside or outside the House to imply the decision is taken lightly is, at best, misinformed. For these women, the need to travel abroad involves unnecessary hardship and, in many cases, a huge financial burden.

For any progress to be made, the Constitution must be addressed. To hold a third referendum to attempt to exclude the threat of suicide from the right to termination of pregnancy in Article 40.3.3° would be a farce but a referendum to remove or amend Article 40.3.3° would allow Ireland to progress and to bring its laws into line with the highest standards of human rights and the best medical care, similar to that of our European neighbours. A good start would be to legislate for the X case and I know the Minister of State will make every effort to ensure it happens.

I acknowledge the recognition by Deputy Nulty of the various strands of opinion in this debate and how it should be held in a sensible and humane manner. No one has a monopoly on concern for the life and health of women and the unborn. This debate has the potential to bring out the worst in us. Many people who purport to have an intellect can let their individual prejudice cut across a reasonable view. I do not like using the term pro-life or pro-choice. I have received many e-mails from, let us say, people who want to legislate for the X case and beyond. If I was to produce them, many of the 500 e-mails may amount to cyberbullying in the current climate. Politicians on all sides of the argument are subject to e-mails that have no place in a democratic society. Perhaps we should reproduce some so the public can see what a small minority on either side thinks.

I also have a document I am sure other Members received from Family Life:

There will be a massive and sustained programme of actions, some of which will be directed towards securing a referendum to remove the intended legislation, as well as those who support it. It is worth noting that in the 10 years since the 2002 referendum all those TDs who campaigned against that amendment have lost their seats.

I am not beholden to any group. I will listen to every group's views and these will be an influence but not a deciding factor. Most politicians legislate for the common good and what they believe is the right thing to do in the best interests of society. Many aspects inform their opinions, including personal views, the people they meet and experts in the area. There is not much expertise in this area from the medical profession in the House.

I refer to the case of Savita Halappanavar. Some 300 or 400 people who sent e-mails to me seem to know the details of how she died. I am not sure what happened in this sad and tragic case and my sympathies go to her family and her husband as they go through extreme difficulties. Some people dispute the figures on maternal mortality. Be that as it may, Ireland is one of the safest places in the world for a woman to go through pregnancy and have a child. The statistical information is one maternal fatality in 17,800 while the rate is one in 4,700 in Britain and one in 6,600 in France. While one can dispute the accuracy of the figures on the basis of the criteria used to establish them, it is important to acknowledge that our medical profession does an excellent job. It is unfair to send a message around the globe that Ireland is an unsafe place for pregnant women. It is one of the safest places in the world. I hope the independent inquest under the remit of the HSE and the HIQA report are published and brought into the public domain as soon as possible.

Speaking previously on the issue, I mentioned the sad and tragic death of Tania McCabe. An excellent report carried out by the HSE found she died from sepsis linked with haemorrhaging. Not many women die from sepsis during childbirth. In England, between 2006 and 2008, some 13 women died from the condition. One death is too many but it is important to acknowledge the HSE carried out the report without much controversy and did a good job.

The claim has been made that we are 20 years waiting to deal with this issue and that political cowardice is the reason behind it. I do not agree. In the period 1992 to 2002, efforts were made to bring some clarity to the issue. Despite two referendums, it was no clearer in 2003 than in 1992. It has been stagnant for the past ten years and part of it is due to the inability to find a solution in addition to the old Irish adage of leaving well enough alone. A hard and tragic case came up and now causes difficulty.

I cannot recall the Institute of Obstetricians and Gynaecologists or the Medical Council asking for clarity on the issue. Whether we legislate or do something else, there will always be a grey area. We will not be able to legislate to remove the grey area.

Regarding the report of the expert group, I refer to the commitment in the programme for Government:

We acknowledge the recent ruling of the European Court of Human Rights subsequent to the established ruling of the Irish Supreme Court on the X-case. We will establish an expert group to address this issue, drawing on appropriate medical and legal expertise with a view to making recommendations to Government on how this matter should be properly addressed.

This is a fair commitment in the programme for Government. It was not the same as the Fine Gael commitment before the election or a commitment to legislate for the X case, as per the Labour Party. Many of the promises made by parties prior to the election were superseded by the programme for Government. Some of the commitments in the programme for Government will not be adhered to. I am concerned that, when the terms of reference were drawn up for the expert group, the decision was made there and then. On 29 November 2011, a decision was made at Cabinet that we would go from A to B, without recourse to the House or the parliamentary parties that make up the Government. We always decry the irrelevance of the House and this is a case in which the House has been made irrelevant. We are debating an issue but the decision has been made and the only question is how we will go from A to B. Should we go via C, via D or both? The Minister read the terms of reference into the record.

The chairman stated: "The only brief the Minister gave this group was to deal with the requirements of the European Court of Human Rights judgment and to advise the Government on how to give effect to existing constitutional provisions". In other words, the terms of reference tied the hands of the expert group to coming up with a process for implementing the Supreme Court decision which interpreted the 1983 constitutional amendment and referred to the substantial risk to the life of the mother, including suicide. That is regrettable.

I am not sure if all the members of the Government are aware of this or if it was the Government's intention, but it is certainly the interpretation the chairman of the expert group put on the terms of reference. He also state, in his preface:

There are groups that think the X case was wrongly decided and there should be another referendum to row back on the right to an abortion, especially in the case of suicide. Two referendums tried to remove suicide as a ground and were defeated. There are still some advocates of another vote by the People.

The chairman does not pass judgment because that was not within his remit. It was my expectation, albeit due to misinterpretation by me, a lack of attention to detail or a misunderstanding of the terms of reference, that the expert group would give its views on the broad issue and how we would move forward on that. Despite the fact that we are having this debate, it is irrelevant if the Government adheres to the group's decision.

Of course, the Government does not have to accept all the recommendations of the expert group. It can decide to act on only one recommendation. It cannot implement all of them. Many review groups are established and governments often choose, for one reason or another, to ignore their recommendations.

I acknowledge that this is a difficult decision for Government. There is no easy way out. It is, nevertheless, important that we analyse it. When I say do not rush the cynics will say we have had 20 years to think about this. We have not debated this issue in the Dáil in ten years, however. It has not been discussed. At the time of the bank guarantee, there was a huge momentum towards guaranteeing the banks. Very few people questioned it. I accept that the Labour Party did not support the guarantee but it supported the nationalisation of banks, which was the same thing. I am sure you agree with me on that, Acting Chairman. Deputy Kieran O'Donnell questioned certain aspects of the guarantee but the momentum was to support it. There was a herd mentality. We are all familiar with it. It is easy to roll over before that mentality.

There is a large common ground of uncertainty on this issue. I am unsure about it. I do not have a monopoly of wisdom. I have a view, however, that the decision of the electorate in 1983 might not have been as the Supreme Court interpreted it. I was severely rebuked in an e-mail from a post-graduate law student for challenging the Supreme Court's interpretation of legislation. I was told it was not my role.

There were two referendums, in 1992 and 2002. The chairman of the expert group mentioned that the issue of suicide was voted upon on those occasions. I am not a spokesperson for the church and many church figures have let society down. Nevertheless, I remember Cardinal Connell and a number of bishops supporting a "No" vote in 1992. I do not think they were advocating for suicide to be used as a ground for termination or to intervene in a pregnancy.

I am uncertain of a few things. I am uncertain where the Irish people stand on the issue of suicide. I am conscious of the opinion polls carried out over the weekend. I am also conscious of the inaccuracy of opinion polls on social issues. We need look back no further than the children referendum campaign, when opinion polls predicted an 8:2 vote in favour of the amendments. Despite the fact that there was a very limited "No" campaign, the result of the referendum was a much closer 55% for the amendments and 45% against.

I do not take my lead from opinion polls on social issues. I do not even take my lead from the majority of people. I take my lead from what is the right thing to do. Trying to establish that is very difficult. We could have a referendum on the suicide issue tomorrow and if it were defeated people would still want it included as a ground. Many people might vote against it because they want to go a step further.

Irrespective of what the Government decides to do, I am of the view that the two extreme ends of this bell curve will not be satisfied. If legislation is brought forward with very tight controls on the suicide issue it may be challenged in the Supreme Court and overturned, and we may well have to have a referendum anyway. That is a danger and I do not know how it would go.

Dr. Alex Bourne was the gynaecologist who, in 1938, used the danger to the mental health of the mother as a defence for carrying out a termination. Many years later he changed his view. Ms Norma McCorvey, for whom the pseudonym Jane Roe was used in the case of Roe v. Wade in the United States Supreme Court in 1973, later changed her position. In reading the following I am conscious of the danger of scaremongering. I remember at the time of the mobile telephone masts it was put to us that one would not want to be walking behind coffins going down the road. It is, however, important to read this because it shows the complexity of the issue. I do not want to say, in a number of years, that I felt it was not right but I let it go through because that was how the flow was going, that I did not stand up and express my view, that I did not take a stand and that I should have done so because what I did was wrong. This is a concern for me and for many others like me. It is important to acknowledge that.

This is, to the best of my knowledge, a correct statement by Ms Norma McCorvey. If others want to verify or refute it that is fair enough:

It was my pseudonym, Jane Roe, which had been used to create the "right" to abortion out of legal thin air. But Sarah Weddington and Linda Coffee never told me that what I was signing would allow women to come up to me 15, 20 years later and say, "Thank you for allowing me to have my five or six abortions. Without you, it would not have been possible". Sarah never mentioned women using abortions as a form of birth control. We talked about truly desperate and needy women, not women already wearing maternity clothes.

I do not want to sensationalise this issue, but it is important to realise that Ms McCorvey sought a judicial review to overturn the decision in her own case some time in the mid-1990s. She failed in her attempt to do so.

People on all sides of the argument have concerns. I recognise the bona fides and difficulties of everyone involved in the debate and for women, many of whom claim men do not have a right to talk on this issue because we have not experienced birth and the difficulties associated with it.

I am also concerned that we lack medical and clinical statistics on the issue of suicide. How many pregnant women commit suicide as a result of their pregnancy? How many go on to have terminations and commit suicide afterwards? Is that statistical information available? It would be important for the Minister for Health or the Minister for Justice and Equality to come to the House before the end of the debate and outline those details.

I thank the Acting Chairman for allowing me to speak. I acknowledge the difficulties this issue presents for people. It is important that we do what we believe is right and in the common good.

I too am pleased to be able to speak on this very difficult and challenging issue for our society.

When the expert group was set up I commented that expert groups are usually made up of civil servants and the professions concerned, and rightly so. I do not question the inclusion of any of the eminent professors or members of the group. However, I asked at the time if any lay people had been asked to serve on the group. On a group of such a size surely there is room for one or two lay people, especially a mother. Some of the members of the group may be mothers, but was there an ordinary home-maker or ordinary person among them? We can sometimes forget that ordinary people are intelligent, progressive and au fait with matters.

Who better to talk to about any life situation than a mother who has given birth once, twice, three, four times, sometimes more, and is living with the day to day issues of running a family, rearing children and trying to ensure sanity prevails, especially in these challenging times, particularly of austerity and media interference?

I am not here to shoot the messenger by any manner of means but I am here to ask some questions of the media, especially in this case, although not the report, which I welcome. I question why we have not been given an answer as to why one member of the group resigned. That is a matter for herself but it has not been made clear to me at any stage why. Were there differences or was the group told what to come up with? I am suspicious of a lot of issues like this.

I believe this case, obviously a tragic case, in Galway has catapulted this issue on us. I have to take issue with The Irish Times and the lady who broke the story. I will not mention her name but we all know who it is. The media are picking up on the story and there was an astonishing interview with Marc Coleman recently on Newstalk where The Irish Times journalist who broke the story on Savita Halappanavar's tragic death now says the story may be muddled and it may be found there was no request for a termination. All I am asking for, and I ask for it all the time, and most ordinary sane people would ask for it, although it was a tragic situation that happened to Mrs. Savita Halappanavar, is to await the outcome of the inquiry in the hospital in Galway.

That hospital has many specialties and does good work on an hourly basis. Why should we demonise that institution and make all kinds of assertions without any investigation or facts? We must caution against the hysteria here. We do not know. While I agree there is no need for three consultants to be put on the investigative committee from Galway University Hospital, certainly the hospital's side of the story must be told, in fairness to every member of the staff of that hospital, from the porter at the front gate right through to all the staff and clinicians and all the different clinicians who are in that situation of quite eminent qualifications. They are entitled to due process and fair play: we can never forget that.

The Life Institute has said there are extraordinary admittances given to the global hysteria raised by the sensational reporting of Savita's death by a certain newspaper. The Life Institute is an institution of some renown. The newspaper's description of events led to an uproar when it was suggested that Savita had been allowed to die because of Ireland's ban on abortion and because of a supposed Catholic interfering with necessary medical treatment to save her life. That was reckless reporting because we simply do not know. We should await due process. This is a democracy. It was fought hard for and I like to call myself a republican and many of us are so we must wait and give due process to the people working in the hospital. We cannot let hysteria rule us.

In an interview on the "Coleman at Large" programme, the journalist was firstly asked why she wrote in a later article in The Observer that the fact that Savita had been refused a termination was a factor in her death has yet to be established. She wrote that in a later article when she omitted it from the story that first broke the news of Savita's death to the world. She was then pressed to explain discrepancies in the newspaper reporting as to when Savita was started on antibiotics in Galway University Hospital. She then said all one could surmise is that in her husband's recollection of events, the actual timeline and days may be a little muddled. We only have Praveen and his solicitor's take on what was in or not in the notes: we are relying all the time on their take of what happened. Any of us who were lucky enough to be present at the birth of our children know it is a wonderful time, but a challenging time too, especially if anything should go wrong. We can all be quite nervous and apprehensive in normal deliveries and births so I appeal for calm and sanity to prevail.

Thankfully I think it is starting to sink in and settle down. I will not say much more but at a time when Indian newspapers are printing headlines saying that Ireland murders pregnant Indian dentists, perhaps it is time for the truth to emerge from the so-called newspaper here. India cannot hold up its head proudly in human rights. I am not boasting about that but I am challenging it. Thankfully, in studies by the World Health Organisation, Ireland is deemed as the second or third safest place for pregnant mothers in the world. We might not have that proud record for many things but we have it for that. I am testimony to that, as is the Cathaoirleach and any of us who are here who have family. I salute and compliment all the people who work in the gynaecology wards, nurses, midwives and specialists, and those who work in aftercare in South Tipperary General Hospital and across the country.

We have to be very careful, very sane and very understanding. In this modern world that we now like to cherish I, for example, am pro-life, as I believe are the vast majority of people in this country. I want to challenge the people who now proclaim themselves as pro-choice - and rightly so if they want to, it is a democracy. I want to challenge them on the behaviour that happened outside this House last week, when there was such a frenzy and such an attack on people who, like myself, dare to speak in favour of pro-life. I am elected by the people of south Tipperary and they will not all agree with me but I have to make that decision, speak with my conscience and deal with the people at the next election for decisions I make. To be unable to leave this Parliament, along with many others like me, because of the aggression, violence, intimidation, innuendo and insults that were thrown by so-called pro-choice people was appalling and it was a landmark in our society and we must challenge it very seriously. Are we going to be bullied into opening the flood gates? Are we going to be bullied into not making a decision we want to make honestly and openly in our own Parliament as representatives of the people for the time being?

One of the main advantages of both guidelines and referenda approaches is that they avoid legislation for the X case. Why have seven successive Governments decided against legislating for the X case despite a resolutely pro-abortion media? The answer is simple. The X case was a flawed judgment based on non-existent medical evidence and did not foresee how open to misinterpretation its test would be. That is a fact. The Governments did not do it and are being challenged and attacked for not doing it, with comments they did not do it out of cowardice. They did not do that for fun. The majority of people who come in here over the years and who will come in here are honest people who will act according to their conscience and will act lawfully with the best intent.

The X case provides for abortion on mental health grounds, specifically where there is a risk of suicide. By sad way of comparison, and I mentioned this last week in my contribution, roughly 95% of the 190,000 abortions that happen in Britain each year are on mental health grounds. That is a staggering figure. During the debates on the British Abortion Act 1967, I was only nine years old. The Bill's sponsor, David Steel, promised it would not lead to abortion on demand and I believe he did that honestly. Over the course of the last decade he has on numerous times acknowledged how wrong he was. International experience is unanimous in showing that once abortion is introduced on supposedly narrow grounds, it quickly expands into a much more liberal regime. Why will Ireland be any different? We must ask that question in this modern age. Any mental health grounds are the most elastic, subjective and open to manipulation.

This is not even to mention that the medical science of psychiatry does not consider abortion as a treatment for suicidal indication in pregnancy. On the contrary, there is a growing consensus that abortion can actually damage women's mental health in some cases. Do we really want to provide for abortion on grounds that have no basis in medical science? I am no medical expert but I accede to the medical experts. We need to take care not to actually harm women.

We must make haste slowly and give the matter careful consideration. We cannot be bullied or pushed by this frenzy and we cannot be forced. I appeal to the media and the programme makers. I have received some of the nastiest e-mails. I remember the last two referendum campaigns. I was involved in some of them. We had a recent referendum in which opinion polls indicated one thing and the result by the people was completely different. Let us not forget we have an intelligent electorate. There was another opinion poll last week but one must question these opinion polls in the way the questions are phrased and the types of answers they want to get.

We cannot be bullied and while we can have this debate, we must await the outcome of all the investigations. In the fullness of time when we have done the investigations I hope the Indian media, which have castigated us here, might be able to see fit to apologise to our country because we have a pretty proud record on human rights, unlike the record in India and in other parts of the world. I think of Mother Teresa and others who have given valiant service in helping children in that country. We cannot be forced to legislate in an environment of a frenzy of international madness. We must await the facts.

I have heard reports that members of staff of University Hospital Galway and their parents have been subjected to all kinds of allegations. We are not a democracy if we are going to be pushed into legislation without the facts. We live in a modern world of fast communications. I challenge some of the pro-choice groups over last week's behaviour and over the people involved, whether knowingly or unknowingly, at those gates. They were there again last night and they threatened to come to my town and Deputy Tom Hayes's town last week, and we had to have a huge Garda presence. I challenge the people who organised the rally and invited them down. We must have responsibility for our actions and cannot allow mob law. We cannot allow a frenzy to push us into voting in a particular way.

I thank the Acting Chairman for his forbearance. I add my voice to the call for cool, calm reflection. We should await the outcome. I salute those working at UHG because we cannot throw the baby out with the bathwater. It is challenging to work in any hospital and life-saving decisions are made on an hourly basis. We have to await due process.

I am glad to have this opportunity to comment on the report of the expert group on the judgment of the A, B and C v. Ireland case. The reason we have this report at all is that Labour insisted on it being part of the programme for Government. For 20 years now, the Labour Party has been a strong, and often a lone, voice on the need to act on the judgment in the X case. The Labour Party has never been silent on this matter. I have the scars on my back from this debate. I am only too well aware that this issue has been with us for 20 years. This is the first Government that has decided we are going to deal with it. Six previous governments have, shamefully, in my opinion, neglected and failed to act on the 1992 Supreme Court judgment. As the Minister for Health has said on the record of the House, this Government will not be the seventh.

None of us needs reminding of the tragic circumstances that propelled this issue back into the national and international headlines. Savita Halappanavar's name has now become a sad chapter in Ireland's history. When Savita and her husband came to Ireland they did not plan on becoming household names. Their plans were simple, the same as every ordinary couple who work hard and plan to start a family and build their lives together. The appalling tragedy of her death has touched a nerve across the country. Along with other Members of this House, I have never previously received so many letters, e-mails and telephone calls on any one issue. Ordinary people are appalled that this could happen. I am sure all Members of the House experienced a similar response, often from people who had never previously contacted a Deputy.

For me and my colleagues in Labour it has without doubt highlighted the need to deal with the legacy of the failure to act on the judgment in the X case. While we still do not know the exact details of Savita Halappanavar's case, it has once again become starkly obvious that there is no clear guidance in this area. We do not yet know whether her life could have been saved, but it is clear that medical staff are being forced to work in a grey area. Staff in all our hospitals are forced to make life and death decisions every day. It is a fearsome and sobering responsibility, and it is only fair to those staff and to their patients that they are free to apply their expertise and make those critical decisions within a clear legal framework. Doctors and consultants should be able to act in the best interests of their patients without having to second-guess the outcome of a possible court case. They do not have the time nor should they have the responsibility to interpret the provisions of Bunreacht na hÉireann and make an informed, safe and, crucially, lawful decision on a medical dilemma that may face them.

The majority of the correspondence I have received has called for legislation, a view with which I concur. Legislating for the judgment of the X case has been a long-standing policy of the Labour Party. I have read the report in detail and nothing in it has changed my view that legislation is required. I was of that view at 16 years of age when this issue first came to public prominence, and little did I know at that stage that a full 20 years later I would be one of the people required to address this issue once and for all in this House.

As I said, the majority of the correspondence I have received has called for legislation, but it would be remiss of me not to acknowledge that I have also received correspondence expressing a different view and, by and large, that correspondence has been important to me. It is important we respect everybody's opinion. I know that this is a very difficult issue for some people and that their gut instinct is to shy away from any legislation which would allow for abortion even in the most limited circumstances. Equally I am sure that they would not in a million years wish to see a mother dying unnecessarily. Their fear, if I understand it correctly, is that any legislation could effectively lead to abortion on demand. I speak honestly in saying that this is a red herring.

Our Constitution as it stands now expressly forbids termination of pregnancy except when there is a direct threat to the life of the mother. That cannot be changed without a referendum carried by a majority of the people. I hold my own views on that and I believe that sometimes in very limited circumstances, a termination can be the least bad option available. However, they are views for another day.

Leaving aside the prospect of a referendum and returning to the Constitution as it stands now in the aftermath of the judgment in the X case, I believe we are confronted with one fundamental question. What constitutes a direct threat to the life of the mother? The only honest answer I can give to that is that I do not know. I am a politician, not a qualified medical practitioner. I cannot make those decisions nor should I be making them. However, what I can do and what I should be doing as a politician and a legislator in this House is to provide a clear legal framework to allow those who are qualified to make such decisions the autonomy to do so.

As we are all aware, Deputy Clare Daly recently introduced a Bill and, while I welcomed the debate it generated, I do not believe it was the finished article in terms of what is required now. The best and most appropriate place to draft legislation of the complexity required to address this issue fundamentally and definitively is in the Office of the Attorney General.

It should then be debated thoroughly in these Houses. I hope that this House will, after the engagement process outlined at the outset of this debate by the Minister and on publication of the report of the expert group, legislate to give effect to the X case ruling, having fully considered the implications of this report and the legislation tabled before us.

There is an infuriating tendency in this House and the political system in general to long-finger and prevaricate, hoping that complex issues of this nature might one day sort themselves out but we know that they do not. Politicians who are serious about their job should not live their lives by opinion polls but I would implore those who are uncomfortable with taking a stand on this issue to reflect on the views of the people. Last week's Red C poll showed a huge majority, unimaginable in its scale just a short time ago, who were in favour of legislating for the X case.

Statements from experienced and familiar opponents in this area in recent weeks advising that we all must be subject to the "court of the conscience" in regard to this issue are offensive to me and offensive to the intelligence of Members of this House. The court of somebody else's conscience should not be allowed to sentence any sick woman to be imprisoned in the narrow confines of his or her own minority views. If Members of Dáil Éireann are not prepared to uphold judgments of the Supreme Court and if the representatives of the Irish people choose to dispense with the mandate given to them in referenda by the Irish people directly then we should all reflect on our function here. I read today the statement from the Catholic bishops on their approach to this debate. I fully respect the right of the Catholic Church and leaders of other faiths to make their views known. That is their right and I will always defend that right but nobody in this House and Republic should feel compelled to be bound by it. The nature of these interventions reminds me of Talleyrand's remarks about the Bourbons and how they were doomed to learn nothing and forget nothing. No republic worth the name should impose one ideology over any other on the rights of women to safe health care and medical interventions, or on any other issue.

Today the Council of Europe Committee of Ministers expressed its concern regarding the situation of women who are of the opinion that their life may be at risk due to their pregnancy. It also invited the Irish authorities to take all necessary measures to implement the European Court of Human Rights ruling. The council's human rights commissioner is quoted on RTE News this evening as saying:

If you have a provision that grants this legal possibility - in very limited circumstances - then there has to be some way for people to actually access this possibility. If you have a court ruling - we're talking about the rule of law here - we are talking about implementing a court ruling, as well as providing this provision.

Today, US Secretary of State Hilary Clinton spoke very eloquently at Dublin City University about the human rights challenges facing the world. She set out four pillars on which those human rights challenges can be addressed. She said the full vindication of women's rights across the globe represents what she termed "unfinished business". I urge Members here and the citizens of Ireland to closely consider those words shared with us in Dublin today and commit to definitively resolve this critical social and human rights issue once and for all.

This is a very difficult issue for anybody to speak on. I know that everyone who has spoken on this thus far has his or her individual views on and feelings about it. This has been a very divisive issue in Ireland over a very long period of years. If I would ask for one thing - Deputy Mattie McGrath spoke about it earlier - it would be to have a calm debate on this issue. This is the first time since I was elected to the Oireachtas in 2002 that this issue has been debated so extensively.

When I speak to some colleagues who have been here for 15, 20, 25, 30 or 35 years, they tell me their own stories. They remember the most recent constitutional referendum on abortion and how difficult and emotive it was. I have no doubt that what happened then will happen again because, as many Deputies have said, there are people on both sides of the argument who have very strong views - on the pro-life and pro-choice sides. We as Members of this House have a very difficult decision to make. Some people can make it easily while others make it with very heavy hearts. We must strike the right chord between everybody in the House and on both sides and I believe that can be done if we listen to each other's views on this issue.

Deputy Timmins said something that struck a chord with me. I heard it recently on the radio. It is when people query what a man would know about abortion, having babies, maternity units, etc. We have come a very long way in Ireland over a long period of years. I am a father of two children and was present at both births. I have seen the very thin line regarding what can happen and nature at work. It is unbelievable. One looks at this with a totally different perspective when one has children and sees their birth and what can go wrong. One can see things going very smoothly and things going very wrong very quickly. The most important thing is the health and well-being of the mother. It is paramount in this debate.

It is a very thin line when one sees the birth of any child and one does look at it in a totally different way. In another way, one can see the risks involved in the birth of a child. Deputy Mattie McGrath said that the birth of a child is probably one of the happiest moments in one's life and there is no doubt this is true. It is something one will always remember. One remembers what time your child was born at, the date of birth, who was there, whether it was morning or night, whether it was raining, the time one brought one's partner or wife to the hospital, who delivered the child and the nurses who were there. I have no doubt that every father and mother across the world remembers and relives that on many occasions.

This Government has a duty to listen to every side of the argument.

The Government is doing so. When the expert group published its report a number of weeks ago the Government decided to debate it in the Chamber so all Members could give their views after which, prior to Christmas, the Government would come forward with an option. It will then bring experts before an Oireachtas committee to see what is the best way forward.

I have no doubt it will be one of the most difficult decisions I will make, and this will also be true for other Deputies from my party. I know Labour Party Deputies see it differently and I respect their views. I hope those on the other side respect our views. I ask for respect and that people do not push down our necks what we have to do. We must take our time on this and look at it from different angles to ensure we make the right decision. The decision we will make will affect many other people around the person about whom we are making the decision. I have reservations about parts of it, but in having these reservations I believe we are not rushing this and that we will make the right decision.

Deputy Kyne stated he has never received as much correspondence about an issue as he has about this one. I can state the same. I have received more correspondence on this issue than I have on any other issue since becoming a Member of the House.

We know what happened in Galway a number of weeks ago, and I expressed my sadness and sympathy to the husband of Savita Halappanavar because I can imagine what he went through over those days and what he has been going through since. However, we must wait for the true facts to come out before jumping to any conclusions. I know Ireland has changed in recent weeks, and conservative people have spoken to me about how sad it was, and it was terrible. That husband was expecting a wife and child to come out of hospital healthy, but unfortunately this did not happen. It shows the very thin line that is there and the risks which exist and what consultants, gynaecologists, nurses and midwives go through on a daily basis. They do a very difficult job because they help another life to come into the world and we must respect the work they do and respect the decisions they make on a daily basis.

In saying all of this, it goes back to the very difficult decision we must make. However, I have confidence the Government can strike the right chord and listen to all Members of the House. We will not rush it. There are many legal and medical complexities in the A, B and C v. Ireland case, the X case and the area of abortion. I hope all of these complexities are well examined before any decision is made. This is a very difficult issue for everybody to speak on and if there is one issue on which people speak from their heart it is this one. I have listened to the debate and those who contributed spoke from their hearts.

Debate adjourned.
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