Protection of Life During Pregnancy Bill 2013: Second Stage

I move: "That the Bill be now read a Second Time."

I stand before the House today fully aware of the sensitive and complex nature of the matter we are about to deal with. I am also fully cognisant of the wide range of views that exist in the House and throughout our country so from the outset I want make very clear this legislation is about saving lives, the life of the mother and her child wherever possible, and that it upholds the constitutional equal right to life of the unborn. I believe it is a Bill which is measured and provides for a robust framework around a very real legal vacuum that currently exists.

The main purpose of the Protection of Life During Pregnancy Bill 2013 is to restate the general prohibition on abortion in Ireland. It does not confer any new substantive rights to a termination of pregnancy.

Twenty-one years ago, the Supreme Court legalised the termination of pregnancy in cases where the mother's life is at risk. At present, nobody is able to say how many terminations have been carried out in Ireland since then. Nobody has accurate figures on the number of terminations that were performed in Ireland last year. Nobody knows whether one hospital is responsible for the lion's share of these procedures or whether a small number of doctors carry out a disproportionate number of terminations. It is not possible to inform the House whether uncertainty over our termination laws is being abused. Worse, we do not know whether women's lives are put at risk from this lack of clarity. Equally disconcerting for me is the fact that I cannot assure the House with certainty that women have clarity regarding the medical interventions available to them to save their lives.

Article 40.3.3° of the Constitution was inserted by the eighth amendment in 1983 and reads, "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." The Supreme Court decided in 1992 in Attorney General v. X that the Constitution permitted a termination of a pregnancy where there was a real and substantial risk to the life of a woman which could only be removed by terminating the pregnancy. It must be remembered that the X case decision did not bring about a change in the law on abortion in Ireland. In the X case, the Supreme Court set out the correct interpretation of the law as it has stood since the eighth amendment. The difficulty is that no statutory framework has ever been established to vindicate the equal right to life of the mother and her unborn. Sections 58 and 59 of the Offences against the Person Act 1861, which in various ways provide for a broad offence of doing acts with the intention of procuring the miscarriage of a woman, whether the act be committed by the woman or not, is, of course, qualified by the X case. There is no legislative or regulatory framework which currently exists to determine whether a woman is entitled to a termination of pregnancy according the X case test. This situation is dangerous for women who may be denied treatment to which they are entitled when a real and substantial risk to their life exists, and dangerous for the unborn as there is no procedure whereby unscrupulous operators who wish to abuse the X case test can be checked.

As a result of this uncertainty, the European Court of Human Rights in A, B and C v. Ireland found:

the [Irish] authorities failed to comply with their positive obligation to secure to the third applicant effective respect for her private life by reason of the absence of any implementing legislative or regulatory regime providing an accessible and effective procedure by which [C] could have established whether she qualified for a lawful abortion in Ireland in accordance with Article 40.3.3° of the Constitution.

At no stage did the European Court of Human Rights require that the law should be altered or amended. The decision simply called for a legislative or regulatory regime to be established to allow a woman to ascertain whether or not she qualified under the X case test, and to provide for a review mechanism where a woman is refused treatment. The Government decided the most appropriate way to provide for this clarity was by legislation with regulations, strictly within the parameters of Article 40.3.3° of the Constitution as interpreted by the Supreme Court. Legislation is required to amend the 1861 Act and provide for the general prohibition on abortion in Ireland in an effective way, and to set out clearly the situations in which doctors are allowed to intervene to treat a pregnant woman where a real and substantial risk to her life exists.

In short, as matters stand, there is no clarity around the issue of terminations of pregnancy in Ireland. This means that the chilling effect of the 1861 Act can cause uncertainty for doctors. It also means that terminations of pregnancy can be performed under the Constitution as interpreted by the Supreme Court, by any doctor anywhere in Ireland at any gestational age if he or she believes that suicidal risk can only be averted by a termination of pregnancy. The Protection of Life During Pregnancy Bill corrects all of this.

For the first time, there will be legal clarity that any terminations are only carried out where the risk to the woman's life has been fully assessed and certified by specialists. For the first time, information on these rare terminations will become publicly available. It will become crystal clear to all of us whether certain hospitals or certain medical professionals are responsible for a disproportionate number of terminations. If the legislation is abused I will have the power to suspend it and I will not be afraid to exercise this power. For the first time, medical professionals will be provided with clear guidelines detailing where and when a termination can take place to save a woman's life. Most importantly, Irish women can be assured that everything possible will be done to save their lives in Irish hospitals.

I will now go through the Bill section by section to clarify its provisions. The Bill is divided into three Parts and includes a Schedule. Section 1 makes standard provisions setting out the Short Title of the Bill and arrangements for its commencement. Section 2 deals with the interpretation of the Bill; it defines the meanings of some of the terms used for the purposes of the Bill, including appropriate institutions, reasonable opinion, and relevant specialty.

Section 3 defines what is meant by "appropriate institutions" for the purposes of the Bill. Locations for the delivery of this treatment will be limited to public obstetric units or, where needed, large public multi-disciplinary hospitals with critical and intensive care facilities. This definition widens the definition of "appropriate institutions" somewhat from that set out in the general scheme published in April. This was deemed necessary from the information provided by the Institute of Obstetrician and Gynaecologists to the Oireachtas committee and to the Department of Health. It indicated a small number of pregnant women with severe illness, such as cystic fibrosis or congenital heart conditions, require delivery in locations with immediate access to intensive and critical care facilities which are not available in some obstetric units. For this reason, the definition of "appropriate location" includes a small number of large multi-disciplinary hospitals with intensive and critical care facilities. However, I believe the State's constitutional obligation and its responsibility to act in the common good demand that provision of terminations of pregnancy only be allowed in public health care facilities where they can be duly monitored and investigated, should the need arise.

Section 4 deals with regulations, allowing me as Minister to make regulations to bring the legislation into operation and other such procedural matters. In this regard, I will be making regulations to set out the way in which medical practitioners will certify their opinions regarding the risk of loss of life to the woman and whether a termination of pregnancy is required. These regulations will require, for example, certificates to indicate the clinical grounds for the opinion and other relevant details of the case at hand. Under the legislation, any such regulation will need to be laid before the Houses of the Oireachtas for approval.

Section 5 repeals sections 58 and 59 of the Offences against the Person Act 1861, as they are replaced by the provisions made in sections 22 and 23 of this Bill.

Section 6 allows that approved expenses associated with the administration of the Bill may be paid for from public funds.

Sections 7 to 9, inclusive, deal with medical procedures permissible under this Bill. Section 7 deals with the risk of loss of life from physical illness. It provides that it is not an offence for an obstetrician or gynaecologist to carry out a medical procedure in the course of which or as result of which unborn human life is ended under certain circumstances - those being that the procedure is carried out in an appropriate institution and that two medical practitioners registered on the specialist division of the Medical Council register, having examined the woman, have certified that, in their reasonable opinion, there is a real and substantial risk to her life, as opposed to her health, arising from a physical illness that can only be averted by carrying out that medical procedure. Some people have interpreted the Bill's provisions as meaning that termination would be used as the best treatment. The law is clear - termination must be the only treatment available to avert the risk.

The process requires an assessment on medical grounds to determine if the test set out in the Supreme Court judgment in the X case is met. The Supreme Court held that the correct test was that a termination of pregnancy was permissible if it was established as a matter of probability that there was a real and substantial risk to the life of the mother, and that this risk could 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 definition of "reasonable opinion" requires that this opinion must be formed in good faith and must have regard to the need to protect the right to life of the unborn and preserve unborn human life where practicable. The emphasis on preserving unborn human life means that a doctor will be obliged to make every effort to safeguard the unborn and, where it is potentially viable outside the womb, to make all efforts to sustain the life of the child after delivery. The registered medical practitioners will be obliged to record this opinion in writing if certifying a procedure that will end unborn human life.

One of the two medical practitioners involved in the certification process will always be an obstetrician or gynaecologist and the other will be a medical practitioner in a specialty relevant to the risk to the life of the woman, for example, an oncologist, cardiologist, etc., or another obstetrician. As indicated in the definition of "reasonable opinion", the test requires a clinical diagnosis in respect of the risk to the life of the pregnant woman and a foetal assessment. Therefore, the expertise of an obstetrician will always be required in ensuring patient safety, as well as in accessing services. In addition, the Bill now makes it the duty of the obstetrician involved to deal with the issuing of the required certification so that the medical procedure may be carried out. In such situations, the obstetrician or gynaecologist involved is responsible for making the arrangements with the appropriate institution. Provision is also made in the legislation for consultation with the woman's general practitioner in the course of the diagnostic process where she has given her permission and where it is practicable and feasible to do so.

Section 8 deals with emergency situations where there is an immediate risk of loss of life arising from physical conditions only. In an emergency situation, the opinion of one registered medical practitioner will be sufficient for the termination to be lawful. Doctors should not be prevented from saving a woman's life in a situation of acute emergency because, for example, the required numbers of doctors are not available to certify or the woman in question arrives at a health facility that is not covered as an appropriate institution under this Bill - that is, not a public obstetric unit or large public multidisciplinary hospital. Therefore, in emergency circumstances, the reasonable opinion of one medical practitioner is required to certify, after having examined the pregnant woman, that the medical procedure is immediately necessary to save her life. The medical practitioner who carries out the procedure will be required to certify the reasons for his or her actions before carrying out the medical procedure. If necessary, the certification for the procedure may be issued by the medical practitioner after the medical procedure has been carried out and reported as soon as may be, but in any event no later than 72 hours afterwards. Again, this opinion must be formed in good faith and have regard to the need to preserve unborn life where practicable. The emergency exception will not apply in the case of a risk to life from suicide.

Section 9 deals with a risk to the life of the pregnant woman from suicide. Assessment of self-destruction is more subjective and there are recognised clinical challenges in accurately assessing suicidal ideation - for example, the absence of objective biological markers. Therefore, this assessment requires that more safeguards be put in place. In these cases, three medical practitioners registered on the specialist division of the Medical Council register must certify that, in their reasonable opinion, there is a real and substantial risk of loss of the woman's life by way of suicide that can only be averted by carrying out that medical procedure. Of the three medical practitioners, one of them must be an obstetrician or gynaecologist practising in an appropriate institution and the other two must be psychiatrists, one of whom must practise in an appropriate institution and the other of whom must practise at an approved centre or for or on behalf of the HSE. In addition, the Bill now specifies that at least one of the psychiatrists must have experience in providing mental health services to women during pregnancy and childbirth and after delivery.

This section contains similar provisions to those made in section 7 regarding the duty of the obstetrician involved to issue the required certification for the medical procedure and for consultation with the woman's GP with her consent where practicable.

I am aware that questions have been raised about the role of the obstetrician in this assessment. However, the test in this case will always be a multidisciplinary one, as it requires a clinical diagnosis in respect of the risk to the life of the pregnant woman as well as a foetal assessment. Therefore, the expertise of an obstetrician will always be required.

The establishment of a formal framework providing for an accessible, effective and timely review mechanism is one of Ireland's obligations under the judgment in A, B and C v. Ireland. The purpose of this formal medical review process is to provide a mechanism for the woman, where she so requests, to have access to a review of the clinical assessment made by the original doctor or team of doctors. In practice, this will only arise where the woman's request for a termination in line with the X case criteria has not been granted or when she has been unable to obtain an opinion in this regard. The review process is provided for in Chapter 2 of the Bill, sections 10 to 15. It is important to note that this formal review pathway is in addition to and not in substitution for the option of a woman's seeking a second opinion as in normal medical practice.

Section 10 sets out the process for applying to have a medical opinion reviewed. The woman or a person acting on her behalf must apply in writing to the HSE for a review of the relevant decision.

Section 11 provides for the establishment of a review panel by the HSE, which may be drawn upon to form a review committee. The panel will consist of at least ten relevant experts for the purposes of the formal medical review, all of whom must be medical practitioners under the terms of the Bill. Members will be nominated by the Institute of Obstetricians and Gynaecologists, the College of Psychiatrists of Ireland, the Royal College of Surgeons in Ireland, the Royal College of Physicians of Ireland, and the HSE. The HSE will draw from this panel when it needs to establish a review committee to consider an application for a review made under the Bill.

Section 12 deals with the establishment of the review committee. The Health Service Executive will act as the convenor for the purpose of the formal medical review process. As soon as possible, but no later than three days after receiving a written request from a pregnant woman, the HSE will establish and convene a committee drawn from the review panel to consider the relevant decision in question. The composition of the review committee will exactly mirror the requirements in sections 7 to 9, inclusive.

Section 13 specifies that the committee shall complete its review as soon as possible, but no later than seven days after it is established, and that it must inform the woman in writing as soon as possible as to its decision.

Section 14 sets out the procedures of the review committee. It provides for the woman herself, or a person authorised to do so on her behalf, to be heard by the review committee. It also aims to empower the review committee to obtain whatever manner of clinical evidence it requires to reach a decision and to call any relevant medical practitioners to give evidence in person. It provides that the HSE will make administrative arrangements for the operation of the committee, including providing facilities and covering expenses. The provisions contained in this section make failing to comply with a direction issued by the committee an offence, for which a fine may be imposed.

Section 15 provides that the HSE must submit a report to me, as Minister for Health, not later than 30 June each year regarding the operation of review committees. Information that will have to be provided in the report includes the total number of applications received; the number of reviews carried out; in the case of reviews carried out, the reason the review was sought; and the outcome of the review. This information is required to monitor the implementation of the legislation to ensure the principles and requirements of the system are being upheld. This section also clarifies, however, that any information that might identify a woman who has made an application for a review shall be excluded from the report by the HSE.

The third Part of the Bill deals with miscellaneous matters. Section 16 deals with consent, and states that nothing in the Bill will affect the law relating to consent to medical treatment. The intention is that the provisions of the Bill will operate within the existing legal provisions in regard to consent for medical procedures.

Section 17 concerns conscientious objection. In this regard, professional health personnel, namely, medical and nursing personnel, will not be obliged to carry out or assist in carrying out lawful terminations of pregnancy if they have a conscientious objection, unless the risk to the life of the pregnant woman is immediate. Where a doctor or other health professional has a difficulty in undertaking a required medical procedure, he or she will have a duty to ensure another colleague takes over the care of the patient, as is normal in current medical ethics. I point out that the right to conscientious objection is a human right, which is limited to persons only and which cannot be invoked by institutions. The prohibition of conscientious objection for institutions was removed from the wording of the Bill because the provisions make it clear that this right is limited to persons involved in the delivery of the treatment.

Section 18 reaffirms the freedom to travel and freedom to information as per the 13th and 14th amendments to the Constitution, for the avoidance of doubt.

Section 19 deals with certification and states that it must be made in the prescribed form and manner and must contain the prescribed information, which may include the clinical grounds for carrying out the medical procedure.

Section 20 provides for a notification system in respect of all terminations of pregnancy carried out under the terms of this Bill. I consider it very important to record the number and nature of terminations of pregnancy to monitor the Bill's correct implementation and to detect any potential abuse of its provisions. Therefore, the legislation includes a clear requirement on providers to notify me, as Minister for Health, of all terminations carried out under this legislation within 28 days. The report will contain the following information: the Medical Council registration number of the medical practitioner who carried out the procedure; the grounds for carrying out the procedure; the name of the appropriate institution concerned or other location used in emergencies; and the date on which the procedure was carried out. This section also contains a requirement on me, as Minister for Health, to prepare and publish an annual report on the notifications received. This will be done without disclosing the names of the women involved.

Section 21 amends section 9 of the Health Act 2007. These amendments were necessary to permit me, as Minister for Health, to suspend relevant medical procedures in an institution when an investigation is being undertaken by the Health Information and Quality Authority, HIQA, in regard to a serious risk of failure by an institution to comply with the provisions of this Bill. Such medical procedures may be suspended until I am fully satisfied that the institution in question is compliant with the legislation.

Section 22 sets out the offence of intentional destruction of unborn human life. This updates the law in this area, which as I mentioned earlier, was until now governed by the Offences Against the Person Act 1861. The penalty for the offence is up to 14 years imprisonment, or a fine, or both. Prosecutions may only be brought by, or with the consent of, the Director of Public Prosecutions. For the avoidance of doubt, the Bill clarifies that the offence does not apply to a medical practitioner carrying out a necessary medical procedure as laid out in sections 7, 8 and 9. Section 23 provides for the offence by a body corporate.

I reassure the House that the only purpose of this legislation is to clarify what is lawfully available by way of treatment in cases where there is a real and substantial threat to the life of a pregnant woman, and to set out clearly defined and specific circumstances in which this treatment can be lawfully provided. My Department has begun a consultation process with the relevant professional bodies, including the College of Psychiatrists of Ireland, the Institute of Obstetrics and Gynaecology, and the Irish College of General Practitioners, with the ultimate aim of developing guidelines for their members on the implementation of the legislation following enactment of the Protection of Life during Pregnancy Bill. It is expected that a multidisciplinary committee to develop these clinical guidelines will be established before the Bill is enacted. It will be asked to complete its work as soon as possible.

As Deputies will be aware, a significant amount of work was involved in producing the Bill. More than 50 drafts were composed as we moved to produce what we believe to be balanced proposals that meet our obligations. The public hearings held by the Oireachtas Joint Committee on Health and Children informed the composition of this Bill and I wish to express my gratitude to the Chairman, Deputy Jerry Buttimer, and members of the committee for their invaluable contribution to the issue and for the assistance they provided to me and my officials. I also wish to acknowledge the Deputies on both sides of the House who have discussed these matters with me and I thank all those who recognise the great sensitivities involved and the need for our discourse to be respectful of differing views. I genuinely wish to reflect that such was the nature of the debate on this extremely sensitive and often divisive issue.

I am a doctor. For more than 30 years, I have looked after patients with a view to helping them with their problems and improving their quality of life, and indeed sometimes saving their lives. Sometimes we are presented with the most difficult and challenging problems. I believe this legislation strikes the right balance in providing legal clarity around existing rights while at the same time providing the clearest reassurance that any attempt to abuse this legislation will be thwarted.

I would not support the Bill if I did not believe it strikes this balance. This is about clarifying the law so that the women of this country who use our health services are in no doubt about what is legally available to them and how they can access these services, and the many excellent men and women who work in our health services know what is legally permissible for them to provide. It will remove any doubt or danger of delay in the making of decisions that can be the difference between life and death. I commend the Bill to the House.

I support the Bill on a personal basis, although I fully understand the difficulties certain Deputies and Senators have in supporting it. Some people will argue that the Bill does not go far enough. When Deputy Clare Daly published her Private Members' Bill last year I stated that we would act responsibly by taking an approach that would not be divisive and would encourage an open debate to make life easy on Deputies who have strong views on this issue. I like to think we have avoided the partisan political debates that have previously taken place in this House and elsewhere over many years. In the 20 years I have been in the Oireachtas, this is the one issue that divides people not only within parties, but also in wider society. We must be respectful of the strong and deeply held views people hold. Sometimes these views held on both sides are too extreme to allow for a calm and rational debate on the substantive issue of legislating for a constitutional right for women in this country under Article 40.3.3°, as interpreted in the X case in 1992.

It is important to put this debate in its historical context. Once Article 40.3.3° was enshrined in the Constitution it was inevitable that a court would have to decide how to vindicate the rights of the individuals concerned, namely, the pregnant woman and the life of the unborn. Since the X case in 1992 there has been a lacuna in legislating for what is now the constitutional right for a woman to have a lawful termination in the event of her life being at real and substantial risk. There were three referendums in 1992, in respect of which two amendments were passed by the people and one, on the substantive issue, rejected. A referendum was held in 2002 on another amendment which I supported. I consider myself pro-life in general. I do not like to stereotype people or to put them in boxes but I am pro-life in the sense that I believe we should do everything possible to vindicate the life of the unborn. It is something I hold personally dear. I am not a member of any organisation that espouses that view but as a Deputy I believe it is something we should do. It is the fundamental right of the unborn to be brought into this world. However, we face conflicting difficulties when we must provide for complicated medical procedures. I find it difficult to oppose this Bill because I would not like our clinicians and those who deal with this issue every day of the week to have their hands tied because there is not clarity or certainty in the law in terms of clear and definitive guidelines on when they can intervene to save the life of the woman without facing the prospect of a criminal sanction.

The various aspects of the Bill have been extensively discussed. I do not believe it will introduce a liberal abortion regime to this country because Article 40.3.3° and some of the sections contained in the Bill will not permit a move towards abortion on demand. It has been noted that when legislation was introduced in Britain in 1966 the outcome was more liberal than envisaged. That may be the case but there is no chance of a liberal abortion-on-demand regime creeping into this country in the context of our constitutional obligation as legislators to vindicate the life of the unborn. However, we also have an obligation on foot of the judgment in the X case to bring certainty and clarity to this area. The legislation goes no further than that.

I am sure the Minister will be open to discussion on amendments on Committee and Report Stages with a view to improving the Bill. Perhaps he also will be able to address the concerns of those who oppose it without undermining its substance and purpose. The committee hearings in January and April were useful in terms of dealing with my concerns and hearing from expert witnesses. The difficulty in hearing from expert witnesses who have strong views from both sides is that we were left with the task of adjudicating on their claims. We tried to find a middle ground but in the interest of fairness and avoiding partisan treatment we heard from various experts with strong pro-choice and pro-life views. I do not believe we would have reached consensus had we discussed the issue for the rest of our days. It is now up to the Legislature to find a consensus and this Bill offers a balanced approach to that objective.

I accept the Minister's assurance that in the event of the legislation being undermined, for whatever reason, we will move quickly to address it. Some people have asked for a sunset clause in the Bill. Perhaps there are political reasons as to why such a clause could not be included but I do not want to go down that road. We in this Chamber can amend legislation whenever we want. We can introduce Private Members' Bills or the Government can bring forward its own legislation. I do not believe this legislation is cast in stone forever and a day. If difficulties arise, it is incumbent on us as legislators to bring forward amendments. We are obliged to introduce legislation because of our duty to vindicate the right to life of the unborn.

On the broader issue, we must accept that some people take the view that the Bill does not go far enough. We should not make decisions on the basis of polls but recent polls indicate there are definite views on making provision for fatal foetal abnormalities, rape and incest. It is wrong to suggest that we could cover those areas in this legislation, however, because we cannot go beyond what is provided by the Constitution. However, people will raise these issues in the years to come. In trying to persuade as many people as possible to take the middle ground, it is not helpful to raise matters that go beyond the legislation. We must uphold the Constitution in our legislative activities, and this is why the Bill is clearly defined and narrow in focus. None the less, it will have an important outcome in bringing certainty and clarity to the clinicians who deliver children into the world and save the lives of women in the process.

We must also pay heed to our obligations as defined by the European Court of Justice in A, B and C. This was an interesting judgment in many ways because it was claimed by some who are fundamentally opposed to the Bill that it would incrementally introduce abortion into this country. All the judgment demanded was certainty with regard to when a woman could vindicate her constitutional right to a termination in the event of her life being at real and substantial risk.

The Oireachtas hearings were helpful to those of us who were trying to decide our position on the Bill.

They allowed us to tease out issues and, in some cases, expose the extreme views held by some on both sides. People on both sides are raising matters that either cannot be included in the Bill or were not proposed to be included in it. I welcome the mature debate the House is having on this issue because this debate has been anything but mature for the past 20 years. This issue has been used as a political football and in a distasteful manner for the purposes of garnering support and undermining others. If this Bill is passed substantially as drafted, it will, I hope, bring to an end the unseemly saga we have had in this society for many years.

Two referendums have been held on removing the risk of self-destruction as a ground for a lawful termination and on both occasions citizens voted "No". While we can argue about the reasons they did so, the people were asked twice and answered "No" on both occasions. At some stage, we must accept the validity of the view expressed by the people when they were consulted. In 1992, they were asked to vote on three questions in a referendum. They voted "Yes" in the case of two questions and in the case of the third and substantive issue, they voted to reject the wording put forward at the time. To bring further clarity to the matter, we held a second referendum proposing to remove suicide as a ground for a termination. Again, the people voted "No" for many reasons. Some will argue that the proposal was rejected because the pro-life side believed it went too far and the pro-choice side believed it did not go far enough, resulting in both sides voting against the proposal. The political parties also became involved. For example, Fine Gael opposed the referendum, and this muddied the waters to a certain extent. Regardless of what arguments were made in the constituencies, the substantive issue was that the people told the Oireachtas to get on with the business of legislating in accordance with the Constitution and as laid down in the judgment on the X case. This is what the House is doing today, no more and no less.

The Fianna Fáil Party has had long discussions on the Bill, which we have studied in detail. I attended all the hearings of the Oireachtas joint committee and read the expert group's report numerous times. I expressed to party colleagues my belief that passing the legislation would not in any way undermine the right to life of the unborn. I genuinely believe the purpose of the Bill is to save lives, bring clarity to clinicians and give certainty to women that their constitutional right will be vindicated in the event that their life is at risk. The issue is not a woman's health but her life. I do not believe anybody could argue that we should place obstacles in the way of clinicians and obstetricians who must make very difficult decisions on whether they can intervene to terminate a pregnancy and save the life of a woman.

Greater clarity is needed on the issue of term limits, which is sometimes lost in the debate. People hold different views on term limits. When I was asked whether they should be included in the Bill, I stated it would not be possible to do so because doctors and clinicians could have to intervene at any stage in gestation to save the life of a woman. We cannot allow circumstances to arise where a woman's right to a lawful termination would be vindicated up to 22 weeks and no longer vindicated thereafter. I do not believe the Attorney General would have allowed the Minister to proceed with such a proposal. Nevertheless, the concerns expressed about this issue need to be addressed. In a case where an unborn child is on the cusp of viability and it is found that the woman's life can only be saved by a termination, we must ensure every effort will be made to sustain the life of the unborn for as long as possible in order that it is, where practicable, brought beyond the cusp of viability. Clarity is needed in this area, especially in the section on suicide and self-destruction. Many people have raised this issue. It should be addressed on Committee or Report Stage.

Where a woman's life is under threat of self-destruction, the Bill provides that she will go before a panel of an obstetrician and two psychiatrists who will make an assessment as to whether a termination is the only way to avert a real and substantial risk to the woman's life. Many Deputies on all sides are concerned that this should not become a box-ticking exercise. In such circumstances, the women should be given every assistance and support in making a decision. Counselling, therapy and support are critical to women who are suicidal. I ask the Minister to address this issue.

The suicidal ideation provisions are very restrictive. In such circumstances, the woman will be required to go before a panel to be assessed by an obstetrician and two psychiatrists, and in the event that the panel refuses her request for a termination, a review panel may consider the matter. In light of the number of tests to assess a woman's suicidal ideation, I do not believe many women will present on the suicidal ideation ground. The statistics provided to the Oireachtas hearings show it is highly unusual for women to be suicidal during pregnancy, although such cases sometimes arise.

I hope, when we consider the Bill in more detail, that Deputies will have an opportunity to tease out issues, discuss amendments and express views in a non-partisan manner. This could allay some concerns and persuade more people to support the legislation. Most concerns about the Bill are genuinely held. For some Deputies, it is a matter of conscience and they passionately believe the Bill undermines the right to life of the unborn. People have formed their view on the basis of their faith or a fundamental view of when life begins. I would not support the Bill if I believed it undermined the constitutional right of the unborn. Notwithstanding this constitutional right, most people would like every effort to be made to bring the unborn into this world.

Every year, 5,000 Irish women travel to Britain for terminations. We should not pretend this is not the case. We should show moderation in our use of language when discussing this issue to avoid offending others and be conscious of the need to avoid being judgmental about the 5,000 women who travel abroad for terminations each year. I do not want to make their decision any more difficult by using inflammatory language or making them feel bad. They are our mothers, aunts, sisters, daughters and neighbours. I feel very strongly that people should not use nasty, inflammatory language to try to vindicate an argument, because these women are living among us. We should not be judgmental and our language and tone should reflect the fact that at least 150,000 Irish women have travelled overseas for terminations in the past 30 years and they are among us. I welcome the fact that Members of the Oireachtas and people outside the House have, by and large, been responsible and moderate in the language they have used when expressing their views on this issue.

Having waited 30 years for this legislation, one would expect it to be substantial, but it is a short Bill. While I do not seek to take credit for it, the Bill had been largely drafted previously, although it now includes the threat of self-destruction on the basis that the people rejected the 2002 referendum.

There are many safeguards in the Bill. It is important there is confidence in the reporting of the figures and statistics but not in a way that we become obsessive at looking at every individual case where a termination may be carried out to save the life of the woman. However, if there are genuine concerns they should be addressed in a very quick and meaningful manner.

The Minister happens also to be a doctor but the Minister for Health may not always be a doctor. It is important that we look at that again.

Perish the thought.

The Minister has 20 good years anyway.

The point I am making is that the Minister of the day might have a very different view from that of the current Minister in which case the spirit of this legislation could be slightly undermined in terms of whether the reporting and actions on difficulties would be carried out. There is no obligation on the Minister to take action in the event, for example, that a public facility is out of step with the norms in terms of the number of terminations being carried out. The Minister might not always be Deputy Reilly and other Ministers might have different views. That may need to be reconsidered in the context of giving more comfort to people in the House with concerns about the Bill. I ask the Minister to look at that in the round.

I could go back through the history of this whole issue. Some people have said that the judgment in the X case was flawed and that we are now passing legislation on a flawed judgment. Obviously it is a judgment of the Supreme Court and regardless of whether people like it, it is the judgment. However, reading the judgment with regard to the particular case before it at the time - Mrs. Justice Catherine McGuinness has said this also - it was a very human decision. The court was confronted with a very difficult case and as the Legislature had failed to put any clear legislation in place, it had to make the adjudication. It made the adjudication that a 14-year-old girl who had been raped would commit suicide in the event of her being unable to be allowed travel to England to have a termination. Clearly that is why we are now legislating for the X case itself.

It is very difficult for us to understand the huge trauma facing any individual. Every day many girls find themselves in crisis pregnancies for many reasons and they go to England for a termination. We must also be mindful that we can support people in crisis pregnancies. We need every support available and not only in the context of this legislation. I know the Crisis Pregnancy Agency was set up to give support and some of the faith-based groups also give support. However, we need to do more as a society and a Parliament to support women who are in a crisis pregnancy. In previous times crisis pregnancies could have arisen because the child was being born out of wedlock. That would have been a crisis pregnancy at one time when there were very strong particular religious views in the country and societal constraints. There are now many other reasons why women may go to England.

If we say we do not want a liberal abortion regime in this country, it is our obligation to assist every woman and girl going through a crisis pregnancy to make the decision not to go to England easier and that she can stay at home and be given support. That is an area in which we are inclined to wash our hands. They go to England and we do not discuss it very much. We need to discuss that and see if we can assist girls and women who are in crisis pregnancies which arise in situations which are outside the scope of this legislation.

The other key area that has been raised by many people is that of conscientious objection - not only in the context of parliamentarians having a conscientious objection but also individuals. We all know the right to a conscientious objection is conferred on an individual and cannot be conferred on institutions. However, I wonder whether that should be reconsidered. A particular institution might decide that the only way for someone to get employment in that institution is by having a conscientious objection to carrying out terminations. In effect, almost everyone in that institution would exercise his or her right to a conscientious objection thereby making that institution incapable of dealing with this legislation in terms of carrying out a termination where there is a real and substantial risk to the woman's life. I presume the Minister has considered this, but on my reading of the Bill there is potential for institutions to ensure as many people as possible had a conscientious objection and thereby would not be able to carry out a termination in the context of the Bill. It could limit in certain areas large institutions which may have all the facilities, supports and services in the institution but because there are a few key conscientious objectors the system cannot function as envisaged in the Bill.

I welcome that the Minister has broadened the scope to cover 19 hospitals. Clearly that issue was also raised at the Oireachtas committee hearings. A woman whose life is at immediate and substantial risk for physical reasons would not necessarily present herself to a maternity hospital but her first port of call would be to an emergency department. That issue was raised by obstetricians and clinicians at the Oireachtas committee hearings.

Over the coming weeks I am sure the Minister will listen to the varying views. I am sure many strong views will be expressed in this House by many Deputies. It is important that we hear the view of as many Deputies as possible. I am not saying this in any way to make it political. There are many Fine Gael Deputies who have strong views on the matter. I know the Whip is being applied on its Members, which is its entitlement as a political party and I have no difficulty with that decision. I am not trying to make myself purer than white on this issue. We decided on a free vote for many reasons. Equally we could have taken a partisan approach and opposed the Bill thereby raising the temperature in this Chamber and in broader society. However, I believe this issue is above and beyond that. It has been with us since 1992. The Minister has pointed out that this would not be the seventh Government to fail to legislate. If my party and others made it more difficult for the Minister, this might have ended up being the seventh Government to fail to legislate. It is important that we give space to the Government and society to discuss it. That is broadly welcome.

Some Deputies have raised the issue of term limits and clarity needs to be brought to them. I would not suggest including it in the legislation. However, a large number of people need an explanation regarding the efforts that will be made to save the life of the child in the event of a medical termination taking place. There is a view that we could have abortions up to minutes before birth being due. It seems to be lost in the debate the whole time, but there is an obligation in the Constitution and in this legislation that every effort is made to bring the child into the world alive. However, I believe the Minister needs to explain that more to convince people that this is the case. I heard obstetricians, gynaecologists and others say it is offensive to suggest that they would not do that. People are saying there is no obligation on our obstetricians to make every effort to save the life of the child. It is their duty to do that on a daily basis and they do it in such a way that we can all be proud.

On the broader issue of maternity services, we have had the very tragic case of Savita Halappanavar in Galway. We have had reports and are awaiting a further report from HIQA.

That woman died tragically in hospital because there was a lack of clarity and people were unsure when they could intervene. I am not saying that was the only reason - she died from sepsis - but having read the report, I believe there was certainly a lack of clarity about when clinicians could or should have intervened. The recent report indicated that certainty and clarity are needed in legislation to give confidence to clinicians that they are acting within the law. Equally, we have obligations because of the A, B and C v. Ireland judgment of the European Court of Human Rights to bring clarity to vindicate the constitutional right of a woman to know when she is entitled to a lawful termination in this country to save her life.

I look forward to the debate and I hope we can have a constructive debate. Certainly, I will be tabling amendments in a personal capacity and perhaps on behalf of my party over the course of Committee and Report Stages. I hope that as many people as possible can contribute. The last thing we need is for the debate to be short or cut down to the point where some views may not be expressed and then subsequently to be told that those views were not heard or taken into account. It would be impossible to listen to everyone but we should try to accommodate the middle ground at least on this matter.

Before Deputy Ó Caoláin begins, I have been asked by the Minister if the Deputy would yield so he could offer a point of clarification before the Deputy begins. Is that okay?

I thank the Deputy and I appreciate it. I noticed when I was reading my statement that one point could be somewhat confusing. Where I said, "If the legislation is abused I will have the power to suspend it and I will not be afraid to exercise this power", I meant that "it" to refer to the service, not the Bill. That is for the purposes of clarity.

Few tranches of legislation in the history of Dáil Éireann have been as widely debated and anticipated prior to their publication as the Protection of Life During Pregnancy Bill. The issues have been addressed in great detail in the Oireachtas Joint Committee on Health and Children, of which I am a member. I participated in all the hearings on the report of the expert group and on the heads of the Bill. While some cynics have dismissed these hearings, I believe they deepened awareness, in the Oireachtas and in public discourse generally, by giving voice to widespread expertise and to views across the spectrum. It was an exercise in participatory democracy.

Far better to have these complex issues addressed in a calm and considered way, based on evidence and reasoned argument, than to have the type of hysterical so-called debate on the issue of abortion that we have seen too often in the past. That is not to say that there are not still strongly, and in most cases sincerely, held views on all sides on this most difficult issue. Nor is it to ignore the ugly tactics engaged in by some, but by no means all, who are opposed to the legislation. By and large, the debate has been conducted in a far more reasonable manner than before, and that is a positive.

For our part, this necessary legislation is welcomed by Sinn Féin. I take this opportunity - it occurs rarely but not uniquely - to commend the Taoiseach, the Minister for Health, Deputy Reilly, and the Fine Gael and Labour Party coalition on their follow through on this issue despite considerable opposition from church and advocacy voices. We have stated consistently that legislation in line with the X case judgment and in compliance with the A, B and C v. Ireland judgment and the expert group recommendations is required. In fact, it is long overdue. There is now a widely held view - we believe it is a majority view - in society that legislation along the lines originally set out in the heads of the Bill and now in this legislation is necessary. We must safeguard the lives of women. We must provide legal clarity. We must ensure there are clear guidelines for clinicians. Let no one forget that we must act at all times in strict adherence to the people's wishes as laid down in the relevant articles of our Constitution.

For many - I include myself - this has been and is a difficult issue. I have always been and remain pro-life, yet I must face the fact that the lives of some are placed at a real and substantial risk due to their pregnancy and only a termination of the pregnancy, as distinct from the termination of the life of the unborn, though that can be a consequence of the intervention, is going to save their lives. This is already accepted practice in Ireland. It is also the current legal position, as is an intervention where the woman's life is at real and substantial risk due to the threat of suicide. The Medical Council guidelines for all registered medical practitioners states:

Abortion is illegal in Ireland except where there is a real and substantial risk to the life (as distinct from the health) of the mother. Under current legal precedent, this 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 the clinical research on this issue.

As a legislator I have a responsibility, as do all Members of the Dáil and Seanad, to evaluate all legislation as it will or might apply in practice, mindful of all the circumstances that do and that can present. I must fulfil my role in the interest of all the people, not only those who may share my personal religious, moral or ethical outlook on any given issue. This I have always strived to do. It is not right that I or any section of Irish opinion should seek to impose our outlook or will on society generally, and certainly not where the consequences of doing so could result in the loss of a pregnant woman's life. That could, in reality, be the loss of two lives.

I have been baffled by the arguments of some who describe themselves as pro-life but who will, in their rigid adherence to a black and white view of the world, countenance the loss of a woman's life, always some other woman's life, or the life of another's wife, partner or daughter. They never contemplate for one moment that it might be their life or their wife's, partner's or daughter's life. What would their answer be if the woman in the hospital bed was not known by the name Savita, but bore their name or the name of someone they loved? Would their position change or would they be prepared to take the risk or see her take it?

I am pro-life. I could not countenance risking the life of the wife I love or our daughters in such circumstances or in any circumstances. It is beyond me how some can be so sure it will never be about them or those close to them. God grant that it be so. Let us make no mistake about it: this Bill is about what it states in the Title. The legislation is about protecting the life and lives of women during pregnancy where a real and substantial risk presents. It happens, all too sadly, and we cannot close our eyes to that fact.

The whole debate around this then promised Bill was of course thrown into sharp focus by the tragic death of Savita Halappanavar. The HSE report on her death was published last week on the same day as this Bill and because of its direct relevance to the legislation I wish to comment on it. I take the opportunity to again extend deepest sympathy to Praveen Halappanavar and all the relatives and friends of Savita. Like the outcome of the inquest, the report is a damning indictment and has far-reaching implications. It is extremely serious and distressing that the report found that Savita’s death resulted from inadequate assessment and monitoring of her condition, failure to offer all management options to her, and University College Hospital Galway’s non-adherence to clinical guidelines relating to the prompt and effective management of sepsis, severe sepsis and septic shock from when it was first diagnosed.

The report does not identify individuals involved in the care of Savita but there will be a justifiable public expectation that if serious lapses by individuals, as well as systems, occurred, then individuals should be held to account. The HSE has pointed to the forthcoming HIQA report in that context. A crucial question that needs to be answered by the HIQA report is whether the hospital was adequately staffed and resourced to provide the standard of care required by this dangerously-ill, pregnant woman. That is a crucial question for all pregnant women in this State - for all women - including those who will be directly affected by the passage of the legislation. Indeed, we may ask how workable the legislation will be if adequate staffing, management and resources are not in place.

In looking at the HSE report in the context of the Bill before us, the key recommendation is that which highlights the need for clear legislation and guidelines on termination to save the life of a woman. We will never be able to say definitively that this Bill, if enacted at the time of Savita’s hospitalisation, would have saved her life. However, there are good grounds, based on expert evidence, for believing that this would indeed have been the case, as a termination would have been regarded as a life-saving option to which Savita should have had timely access. I wish to quote from the HSE report in that regard: "When the patient and her husband enquired about the possibility of having a termination, this was not offered or considered by the clinical team until the afternoon of the 24th October, due to their assessment of the legal context in which their clinical professional judgement was to be exercised". Some have argued that the clinical team could have provided a timely termination within the current law, but the point is that there was uncertainty and a lack of clarity which, combined with the identified serious lapses in the care of the patient, led directly to her tragic death. The uncertainty and lack of clarity provides a very strong argument in favour of this legislation. The gap in the law has been long identified and it is long past time it was rectified.

The judgment of the European Court of Human Rights in the A, B and C v. Ireland case confirmed that there is an imperative to put into legal effect the judgment of the Supreme Court in the X case. The European Court of Human Rights 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. We must ask why that is so. As the European Court of Human Rights accepted, 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 in this State if it is established 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. Therefore, this 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.

The expert group report recited the sorry saga of the 1983 amendment and the later legal battle that had to be fought to establish the right to travel and the right to information, culminating in referendums and legislation which provide for those rights. "X" was a 14 year old girl, pregnant as a result of rape, and put through the additional trauma of a High Court injunction to restrain her from leaving the State for a termination of the pregnancy. 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 also, the court found that the threat of suicide constituted a real and substantial risk to the life of the mother. The immediate result of that case was the lifting of the injunction so the young girl could travel abroad. I believe that any other outcome would have outraged the vast majority of people in this country, not to mention the likely international reaction.

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, over a decade ago, and long before the A, B and C v. Ireland case was initiated, the clear obligation on 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 the millennium year, 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 v. Ireland 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 now know all too well, women can die.

The European Court of Human Rights judged that there is what it called 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". It was against that background that we in Sinn Féin developed our policy on abortion to which I wish to briefly refer. Like all parties and all sections of society we have members with varying and strongly-held views on the issue and we respect those views and their right to hold them. However, we have a policy, democratically decided, and we as elected voices of Sinn Féin have a duty to articulate and uphold party policy irrespective of our own personal positions.

Over many Sinn Féin Ard-Fheiseanna, we have debated this issue and reached an agreed policy position. It is the members of our party, as democratically delegated, who decide policy and all organs of the party and, as I have already said, all elected representatives are bound by those policies. The policy as reaffirmed by our 2008 Ard-Fheis states that Sinn Féin is not in favour of abortion and nor do we believe that the British Abortion Act 1967 should be extended to the Six Counties. Sinn Féin believes that all possible means of education and support services should be put in place to prevent crisis pregnancies. It believes that Irish society has a responsibility both to address the issue of abortion and to address the fact that at least 5,000 Irish women travel to Britain each year for abortions.

When the abortion issue was discussed in the Northern Assembly, Sinn Féin placed on record our very firm opposition to the extension of the British 1967 Act to the North. We supported an amendment that this complex matter should be referred to the Assembly Health Committee. Following a discussion by the Health Committee and the recommendations made to her by all the parties, including the SDLP, the Women’s Coalition and the Alliance Party, the then Sinn Féin Minister for Health, Bairbre de Brún, extended the availability of the morning-after-pill.

Sinn Féin believes the way to reduce the number of women seeking abortions is by way of State provision of comprehensive sex education, full access to safe birth control options, full access to child care and comprehensive support services, including financial support for single parents. Sinn Féin believes that full information and non-directive pregnancy counselling should be freely available. It is opposed to the attitudes and forces in society that compel women to have abortions and which criminalise those who make that decision. We accept the right of a woman to seek a termination of the pregnancy where her life is at risk or in grave danger and in cases of rape or incest. Sinn Féin believes that women in crisis pregnancies have the right to receive accurate information by means of counselling that is impartial, non-directive and non-intimidatory. We support the introduction of legislation to ensure this standard is met by all agencies providing crisis pregnancy counselling.

Sinn Féin's assessment of the Protection of Life During Pregnancy Bill, informed by the party policy as outlined above, is that it does offer greater protection for women and clarity for front-line practitioners and, accordingly, we will support this Bill's passage through both Houses of the Oireachtas. It is not perfect legislation - far from it. It diverges from Sinn Féin's policy in a number of respects but judged in the round and taking into account the pressing need for long overdue legislative certainty, we believe it is worthy of our support. Sinn Féin of course has concerns about certain sections of the Bill and I will touch on one or two of them. The issue of fatal foetal abnormalities is a serious and complex aspect of the abortion issue, which requires the most careful consideration. The definition of the unborn in section 2 of the Bill is relevant to this question. Sinn Féin has stated previously that the woman’s voice must be at the centre of the process and that no undue obstacles or delays must be put in the way of necessary treatment and the party will assess sections 7, 8 and 9 in light of these requirements. The criminalisation of women who have terminations outside the scope of this legislation and as the threatened imposition of a prison sentence of up to 14 years as penalty, as provided for in section 22 of the Bill, also are serious concerns. Sinn Féin may address some or all of these and other matters on Committee Stage.

As I stated last December in the debate on the expert group report, as Members of these Houses we are obliged to legislate. All Deputies have an obligation to address this need and to step up to the mark as legislators. Members must approach this Bill with compassion, understanding and mutual respect. I believe that now, more than ever, the majority of people know the complexity of this issue and know that simple black-and-white attitudes are inadequate and insufficient to address what is involved. Members must face up to their responsibilities and this Bill, flawed in some respects though it may be, does exactly that and for this reason, I am pleased to confirm that Sinn Féin will support it.

I wish to share time with Deputies Wallace and Boyd Barrett.

Is ten minutes each agreed? Agreed.

I do not believe, as has been alleged by one contributor, that abortion is the divisive issue it once was. Many people in Irish society have very different views on the subject, as is their right, but they also recognise it is a private health matter that primarily is one for the woman herself, as well as her doctors. Repeated opinion polls have revealed the fact that the overwhelming majority of Irish citizens support the need for legislation for abortion where a woman's life is in danger, where she has been raped and impregnated as a result of the rape, in cases of fatal foetal abnormalities and in cases where a suicide risk occurs. Many citizens also recognise that the choice should be the woman's, no matter what the circumstances.

I am aware that because of the constitutional restrictions it would not have been possible for the Government to legislate for all of those circumstances but the Minister could have done a lot more, even within the confines under which he was operating. I do not agree the legislation provides the necessary legal clarity and neither do I believe it makes the situation safer for women. For me, it really is the absolute minimum with which the Minister could get away, to satisfy in part, the European Court of Human Rights and to pacify some Government backbenchers.

The deep irony is that the Labour Party which, when Members on this side moved our legislation previously, criticised us for not going far enough and told us it could not support our legislation because it did not make enough provision, is now putting forward this legislation, which could have gone further even within the constitutional restrictions.

Other Members have explained why we are here. Successive Governments have failed to legislate for the X case, to provide for abortion where there is a real and substantial risk to the life of a woman. That has been the legal position in this country for decades but because it was not legislated for and did not have an Act to back it up, no woman could avail of the provision. I do not think the legislation clarifies the situation sufficiently. In fact, the point made by the Chief Justice in the X case ruling, that the risk need not be immediate or inevitable, has not been addressed in the Bill. That is something on which great clarity could have been given.

We have had a good deal of discussion in the media but much of that has been a false debate. It is as if what we are discussing is a way of minimising or restricting abortion in Ireland or providing for abortion in Ireland. The reality is that Irish abortion exits. We are just in a hypocritical situation in that we provide for it legally. If she is Irish, a woman has an absolute legal right to have an abortion. We have enshrined her right to travel but we do not allow her to have an abortion here at home. That is not good enough. That is a denial of the rights to more than 150,000 Irish women who have been forced to leave these shores in past decades. All of the reasons those women had to travel, and none of them was easy, were invalid in my opinion. The problem is that against the backdrop of increased austerity, the option to travel will be removed for many women on low incomes and will jeopardise women from non-national backgrounds. I would look at this debate from a starting point of it being a basic human rights and health issue.

In some ways it is not the Minister's fault that this Bill is so limited. The problem rests with our inadequate Constitution, a Constitution his colleague, the Minister for Justice and Equality, previously characterised as ensuring that not all our citizens are treated equally. Under our Constitution, there are no impediments to medical treatment for men when their health is in jeopardy. That is a qualified right for women and means that some citizens are not equal to others. That is not good enough. The 8th amendment of the Constitution should be repealed. It is something we have called for and will be pushing for beyond this, but I realise the Minister is operating within the confines of the Constitution as it stands.

I will refer to some points in that regard which we will tease out on Committee Stage through amendments because serious problems arise in this Bill. It criminalises women and doctors. The restrictions in it will continue to put the lives of women and girls at risk, and that is something we cannot stand over. We intend to move a huge number of amendments to the Bill.

A major problem with the Bill is that it continues to pose abortion as a criminal offence, with a fine or imprisonment for a term of up to 14 years for women or doctors, including those who would use abortion pills to end an unwanted pregnancy. It raises the spectre that a women who presents herself as suicidal and seeks an abortion potentially could face a period of imprisonment longer than the perpetrator of her rape would endure. That is not good enough.

This legislation brands thousands of Irish women as criminals. They have to sneak away or secretly get abortion pills, and in that sense it does not eliminate the chilling effect described by the European Court of Human Rights where women seek to get this treatment. It will deter women from seeking aftercare where they have used abortion pills or where they travel abroad to seek an abortion. As we know, criminalisation will not reduce the abortion rate. It simply puts the lives of women and girls at risk, and that is something on which we will table an amendment because it is not good enough that it remains in the Bill.

The Bill does not overcome the difficulties outlined in the case of Savita Halappanavar and highlighted in the Health Service Executive report where it was clear that under law, as one of the consultants stated, if there is no evidence of risk to the life of the mother, our hands are tied as long as there is a foetal heartbeat. That is a problem that is being enshrined in this legislation as well because what we are seeing is that medical conditions due to pregnancy are not, of themselves, life-threatening. A miscarriage, for example, must be allowed to become life-threatening before a woman can legally get the necessary termination of pregnancy. We will have the scenario of medical practitioners having to wait and see if their patient's health deteriorates to the point where their life is in danger before the matter can be addressed.

One of the issues the Minister's expert group dealt with was that under any circumstances, the opinion of only two medical practitioners should be sufficient. We went to the trouble of convening an expert group. That was its call on the matter for either mental health issues or medical issues, yet this Bill contains a requirement for up to four practitioners - an obstetrician, two psychiatrists and possibly the woman's own general practitioner. They have to examine the woman, they must agree that she is suicidal and so on. There is no doubt that will deter despairing women from even asking for an abortion in Ireland, especially when they have to face that type of tribunal. It will drive them further overseas, and that is not good enough. We could have done more.

One of the biggest problems with this Bill is the definition of the unborn. Government Deputies will have to examine this matter. We have all been struck by the tragedy of the families who have come forward with their very difficult stories where their foetus had a fatal abnormality and how those people had to endure the torture of either being faced with bringing that pregnancy to full term, with all the questions being asked of them such as when they are due and how they are getting on, or travelling to England like outcasts. The existing legislative provision could have allowed the Minister to provide for cases of fatal foetal abnormality, but he has not done that. That cannot be allowed to stand. Not only has he not done it but by defining unborn human life, as he proposes to do in this legislation, as existing from the moment of implantation in the womb until delivery, and giving that an equal right to life as the woman or the girl, the Minister is removing the very possibility of legislating to deal with fatal foetal abnormalities. He is closing off the D case ruling where the State argued that a fatal foetal abnormality could be grounds for a termination, even within the confines of the Constitution. This is a cruel blow to the 1,500 women and couples who face that situation every year. As an absolute minimum, that part of the Bill has to go.

We will have a debate over the coming weeks. It is important that this Bill is before the House. I am glad we have some legislation, but it could have been much better. I hope we will amend it to ensure it is improved.

This Bill is important symbolically but, in truth, very few women in Ireland will benefit from the legislation. Very few women will avail of abortion in Ireland because of this Bill. Women who require medical treatment will continue to be exported out of this country under a veil of silence - hidden, stigmatised, and away from the support network of family and friends. The same mentality that saw women incarcerated behind the walls of the Magdalen laundries, unsupported and hidden from public view, will continue to prevail in Ireland.

I am glad the legislation has arrived. We regret that it does not provide for more comprehensive provision of abortion where a woman's life is in danger or in cases of fatal foetal abnormalities, which would have been possible even within the limitations of the current constitutional restrictions.

It is ironic that the legislation was published the same day as the Minister of State, Deputy Kathleen Lynch, appeared before an Oireachtas committee to discuss the Government's suicide awareness strategy. It is clear from this Bill that the Government's concern for those at risk of suicide does not extend to pregnant women. Under this Bill, a suicidal pregnant woman could potentially have to deal with seven medical practitioners before she is granted access to an abortion.

In A, B and C v. Ireland, the European Court of Human Rights expressed concern about the absence of an effective and accessible domestic procedure in Ireland for establishing whether some pregnancies pose a real and substantial medical risk to the life of the mother. I ask the Minister to explain how the proposal around suicide in this Bill constitutes an effective and accessible procedure. The Government should be mindful of other case law from the European Court of Human Rights such as the 2007 Polish case in which the court stated, "once the legislature decides to allow abortion, it must not structure its legal framework in a way which would limit real possibilities to obtain it". To quote Noeleen Hartigan of Amnesty International Ireland, for a law to be meaningful, it must be accessible.

The proposed Bill falls well short of international human rights standards on women's reproductive rights. In my view, the proposal for suicidal, pregnant women in this Bill is barbaric. It is tantamount to torture. It tells women mental health is not real health. It tells them the State does not trust them, that they must be interrogated and prove themselves not to be liars. The Bill is based on the premise that women are manipulative and untrustworthy. It is an insult to them. No more than two medical practitioners should be required to assess a woman in such a situation. The Minister's proposal is neither effective nor accessible for pregnant women.

What are the options for a suicidal pregnant woman who would rather not put herself through this inquisition? If possible, she may travel abroad to seek a termination, which involves a significant financial cost, and God knows money is scarce in this age of austerity, or she may, like thousands of other women, order the abortion pill on-line and self-administer it at home in Ireland. The Irish State ignores the former option but will potentially imprison her for up to 14 years for the latter. The level of hypocrisy is shocking.

The severe criminal penalties for women and doctors in the legislation are completely out of step with international best practice. Not only are they cruel and unduly harsh, but they are ineffective because research has shown criminalisation does not reduce the number of abortions. Only this week in The Irish Times, Dr. Peadar O'Grady wrote:

A study published in the Lancet medical journal in 2012 reports that restrictive abortion laws are not associated with lower rates of abortion. The region with the highest rate, 32 abortions per thousand women aged 15-44, is Latin America, where 95 per cent of abortions are illegal. The region with the lowest, 12 abortions per thousand, is western Europe, where abortion is available on broad grounds and almost all are safe and legal...Unsafe abortion, by untrained staff in unsuitable facilities, happens where there is restricted access to legal abortion services and is one of the top three causes of maternal mortality in the world.

One of the reasons Ireland can boast such low levels of maternal mortality is that we have access to safe and legal abortion, mainly in the UK.

The UN Special Rapporteur on the right to health, Anand Grover, has called on states to decriminalise abortion. He said:

Criminal laws and other legal restrictions on sexual and reproductive health may have a negative impact on the right to health in many ways, including by interfering with human dignity. Respect for dignity is fundamental to the realisation of all human rights. Dignity requires that individuals are free to make personal decisions without interference from the state, especially in an area as important and intimate as sexual and reproductive health.

Criminalisation generates and perpetrates stigma. Criminal laws and other legal restrictions disempower women who may be deferred from taking steps to protect their health to avoid liability and out of fear of stigmatisation. The likely effects of the criminal penalties in the legislation is that they will make women afraid to disclose information to their doctors about previous abortions and to seek medical assistance in the event of complications arising from an illegal abortion. Section 22 must be removed from the Bill.

According to the latest opinion poll in The Irish Times, 83% of voters support abortion where the fetus is not capable of surviving outside the womb. For those of us in this Chamber who have taken the time to listen to the harrowing experiences of women forced to terminate much wanted pregnancies abroad due to fatal fetal abnormalities, it is difficult to understand why the Minister refuses to cover these circumstances in the legislation. As has been stated repeatedly, there are many strong and convincing arguments that abortion in cases of fatal fetal abnormality could be included in this legislation without the need for constitutional referendum. The Government argued before the European Court of Human Rights in 2005 that given the circumstances the Irish courts were unlikely to interpret Article 40.3.3° of the Constitution with remorseless logic. Case law form the European Court of Human Rights indicates that the Council of Europe member states must ensure women seeking lawful terminations are not exposed to inhuman and degrading treatment, contrary to Article 3 of the European Convention on Human Rights. The Irish Council for Civil Liberties has argued that the current treatment of women with pregnancies involving a defined set of fatal fetal abnormalities potentially falls foul of Article 3 of the Constitution. I commend the families of the campaign group Termination for Medical Reasons, who have worked tirelessly to make legislators and the public aware of this issue and who have shared their deeply personal experiences with us.

Ultimately we must ask if the Bill complies with Ireland's obligation with the European Court of Human Rights' judgment in the A, B and C v. Ireland case. Does it comply with the European Convention on Human Rights or international human rights standards generally? It is doubtful that it does for the reasons I have already mentioned. This was an opportunity for the Government to break with the past and take a real step forward. It was an opportunity to produce practical, accessible legislation for women whose lives are at risk because of pregnancy. It is a lost opportunity.

This debate and this legislation are at least 20 years too late. Given the tragic circumstance surrounding the X case, when a 14 year old rape victim was denied the right to have an abortion in this country, and initially denied the right to travel to Britain for an abortion, who then became suicidal, and only as a result of public outrage was the Supreme Court finally forced to acknowledge she had the right to an abortion because her life was threatened as a result of suicide, it is shameful that 20 years on we still have not acknowledged the legal right to termination in those circumstances, which was decided by the Supreme Court.

That 20 year delay, a result of the cowardice of successive Governments, contributed substantially to the tragedies of the A, B, C and D cases and, most recently, the tragic death of Savita Halappanavar. Let me say before dealing with the specifics of the Bill, whether it passes or not - it probably will pass - it will still leave us with the disgraceful situation where, if a 14 year old is raped but not suicidal, she will be denied the right to have an abortion in this country and will be forced to travel abroad. It will deny huge numbers of other women in crisis pregnancies where their mental or physical health might be threatened the right to terminate those pregnancies. Thousands more women, irrespective of whether the Bill passes, will be forced to travel in the dead of night, with all the stigma associated with abortion, which this legislation sets out to reinforce with its continuing criminalisation of abortion, will continue. Disgracefully, where the health of women is threatened, they will be forced to leave the country and their support and family networks to seek abortions elsewhere because the Constitution maintains an utterly false distinction between the life and the health of a woman.

Any doctor will tell the Minister there is no such distinction. There is no distinction between the life and the health of a woman. Whatever happens with this legislation, as soon as it is passed, as it probably will be, the campaign to repeal the eighth amendment, and to remove the prohibition on abortion that exists that results in a situation where thousands of women every year in tragic and difficult circumstances must travel abroad, must begin immediately. That, in a way, is a campaign and a debate for another day.

I accept that the Government must deal with the current constitutional framework set down in the X case judgment. However, this legislation is the absolute most minimal possible interpretation of the X case judgment and needs to be radically amended if it is not to leave us in a situation where many of the injustices and the ignominies that are inflicted on women in this country as a result of our laws on abortion will continue.

First, let me address the issue of fatal foetal abnormalities. Here the Government has no excuse. There is no reason whatsoever this legislation should not contain the right for women who are pregnant in situations where the foetus has fatal abnormalities which are incompatible with life to terminate those pregnancies. As someone who had a daughter with fatal foetal abnormalities, I am aware that the diagnosis that one is given when one gets that terrible news from the doctors is that the condition is "incompatible with human life". Therefore, as a series of professors of law, barristers and solicitors have testified in a letter to The Irish Times this week, because such conditions are incompatible with life, to allow for terminations in that circumstances does not run foul of the Supreme Court judgment and of the current constitutional position. The Government could legislate for that in this legislation and it should. Its failure to do so is really quite reprehensible and will lead to a situation where people who have wanted pregnancies but get this terrible news that the foetus has fatal abnormalities will continue to be forced to have to travel to Britain where they do not have their family and support networks, etc.

Added to that, they will still have surrounding their actions in seeking terminations abroad the stigma that the terminations they seek will in this jurisdiction be considered criminal actions, and it is absolutely incomprehensible to me that the Government could include in this legislation a 14-year prison sentence sanction, for example, for somebody who had a pregnancy with fatal foetal abnormality and sought a termination in this country, and that she could be criminalised and, potentially, imprisoned for 14 years. It is unbelievable that such a sanction would be included. I seriously ask anybody on the Government side if he or she really believes that a woman in those circumstances who seeks an abortion in this country is a criminal and should be subject to a 14-year prison sentence? Does any of them really believe any woman in a crisis pregnancy situation who, for example, takes an abortifacient should be criminalised? Nobody in all of the committee discussions stated that should happen or such women should be jailed, yet it is included in this legislation. It is simply unbelievable. It means, with the stigma surrounding abortion, that the thousands of women who under whatever circumstances still have to travel abroad to Britain for an abortion will be under a veil of criminality that what they are doing is shameful and criminal according to the law of the State. That is absolutely unacceptable and that section of this Bill should be removed.

Furthermore, in the situations of suicidal intent, it is unacceptable that a distinction is made in this Bill between mental health and physical health. For doctors in the medical world, no such distinction exists. The idea that there should be a higher threshold for someone whose life is threatened as a result of suicidal ideation or mental health issues and somebody whose life is threatened as a result of physical health issues, that any distinction of that sort should be made, is unacceptable.

The requirement that women who are suicidal should face interrogation by up to seven doctors is simply inexplicable. There is no medical justification for it whatsoever. For example, why do we need an obstetrician? An obstetrician has no role whatsoever to play in assessing whether somebody is suicidal. An obstetrician is simply not required in this equation. There is only a requirement for one psychiatrist and for a GP, as in other cases where the life of the woman is threatened as a result of a physical threat. Why make this distinction? The only reason the Minister is making that distinction is to assuage the opposition of Members in this House who believe they have the right to impose their morality on the bodies of women in such a way as, potentially, would threaten the life and the health of those women, and that is unacceptable.

This legislation must be radically amended and I appeal to the Government to accept the amendments that will come forward on those issues.

Debate adjourned.