Protection of Life During Pregnancy Bill 2013: Second Stage (Resumed)

Question again proposed: "That the Bill be now read a Second Time."

Deputy Michael Healy-Rae was in possession and he has eight minutes remaining.

I compliment Deputy Martin and the Fianna Fáil Party for allowing a free vote on this important issue. The Taoiseach made a mistake in not allowing a free vote in his party and the same applies to the Labour Party. Every person should have a free vote because they should be allowed to take this important decision from their heart. I highlighted earlier that in 1967 when the laws were amended in England, nobody could have foreseen or imagined the number of abortions that would take place. If politicians had their time back, they would seriously reconsider what they did.

I would like to strengthen my challenge to the myth that we are compelled to legislate for abortion on foot of the X case judgment and ECHR judgment in the A, B and C v. Ireland case. There is no legally compelling argument to do this. Dr. Maria Cahill of the faculty of law in UCC proved this beyond doubt when she argued before the Oireachtas Joint Committee on Health and Children that while head 4 was faithful to the detail of the test laid down in the X case, it was not faithful to the later development of that test in the Cosma case of 1999. In that case, the reading of the X case test under head 4 would fail to meet the necessary standards because the proposed legislation does not require evidence of a treatment plan or consideration of other means of avoiding the risk to life and because it does not take into account, as the Minister insisted we should, the public policy arguments that are relevant in addressing claims of suicidality.

An advocacy procedure on behalf of the unborn child is absent from the proposed legislation. This blatantly contradicts the Taoiseach's endless assertions that the Bill is faithful to the constitutional parameters of Article 40.3.3°. How can there be even the appearance of equality under the law when one of the parties involved, namely the unborn child, has no right to have its interests protected? I believe in my heart and soul that this is an important point.

As the Bill stands, it will introduce a right to termination of pregnancy up until birth. There are no time limits within which the abortion must take place.

This is a provision which even countries with the most liberal of abortion regimes have resisted as a step too far. In Britain, for example, the cut-off point is 28 weeks.

The Bill will inevitably place the Health Service Executive and the Government, on the one hand, in conflict with those hospital facilities, on the other, for which the provision of abortion is in direct contravention of their established ethos. We are already witnessing this scenario in the United States where the forced implementation of Obamacare has resulted in a flood of legal cases being brought against the federal government as it forcefully imposes its own agenda on health care providers without any regard for their ethos.

It is the experience of jurisdictions throughout the world that where a right to a termination is granted, even on the sole ground of a mental health exception and where that standard is apparently very restrictive, such a right cannot be contained or limited to genuine cases under the mental health provision. An American legal scholar has proved this through rigorous research, with particular reference to an analysis of the consequences of California's Therapeutic Abortion Act 1967. In Britain, likewise, it is estimated that more than 70% of all abortions are carried out on mental health grounds. As the people involved in Women Hurt have demonstrated, abortion has devastating effects on women and their families. Many of these women remain silent because of the hurt and shame they feel and, as a consequence, do not register in statistics about the negative impact of abortion on women's mental and physical health.

I attended a briefing organised by Senator Rónán Mullen some time ago where we were given the statistics from the three main maternity hospitals for the number of suicides by pregnant women. The figure was minuscule out of the totality of pregnancies in this country every year. The suicide clause is the main cause of my deep concern about the Bill. It leaves open the possibility that we will find ourselves in a situation which many of us do not want to see happening in this country. I totally respect the opinions of those with a different view from my own. We are fortunate to live in a democracy where it is possible to have a reasoned and rational debate. I would question some of the accusations of nasty behaviour made against elements in the pro-life campaign. I have seen no evidence of this and genuinely hope it is not happening.

As I said, we must have a reasonable and plausible debate on these issues. Every Member of this House must consult his or her own intelligence and conscience before deciding how he or she will vote. I am all in favour of protecting the health and safeguarding the rights of pregnant women, but my sense of moral duty tells me that it is of paramount importance to stand up and do everything I can to protect the unborn child who is defenceless and cannot speak for himself or herself. I have always been of that opinion and I am not for changing now or in the future.

I once again thank my colleagues in the Technical Group for allowing me the time to contribute.

I propose to share time with the Minister of State at the Department of Health, Deputy Kathleen Lynch.

Deputy Michael Healy-Rae might like to come to my house some day at 7 a.m. when there is a protest outside. Some of the things that are said and the things left behind are scandalous.

I welcome the opportunity to express my support for the Bill before us. It is not often that we hear an Opposition spokesperson commending the Taoiseach and the Government for the introduction of legislation. The comments by Deputy Caoimhghín Ó Caoláin in this regard were most welcome. He praised the Government for persisting with the introduction of these provisions, despite opposition from a variety of groups and organisations. I agree with his comment that we may be seeing a piece of history in the making.

The Bill is complex in legal terms, but I found the testimony of the medical and legal experts to the Oireachtas Joint Committee on Health and Children very helpful. I refer, in particular, to the evidence given by Dr. Rhona Mahony, Master of Holles Street hospital; Professor Veronica O'Keane, professor of psychiatry at UCD and consultant psychiatrist at Tallaght hospital; and Mrs. Justice Catherine McGuinness, all of whom provided great clarity on many aspects of the Bill.

Dr. Mahony observed that both medical practitioners and women required legal protection if there was to be sufficient flexibility to allow for professional clinical decisions based on the medical probability, as opposed to certainty, of a risk to life. The Bill will meet the requirement of affording the medical profession greater clarity when making decisions in cases of emergency. Dr. Mahony also expressed the view that the proposed legislation, because it would facilitate termination of pregnancy only in extremely rare scenarios, was not likely to lead to widespread abortion in Ireland, yet we have heard claims that it will lead to precisely that. In fact, Dr. Mahony offered an assurance that clinicians in Ireland would continue to work tirelessly to preserve life in all circumstances. That is a very strong statement from a prominent professional who deals with pregnant women every day in the course of her work.

Professor O'Keane indicated her view that legislation for abortion, where a woman's life was at risk because of mental health problems, was a minimum and necessary requirement. She went on to say it was especially necessary in order to protect the lives of those women who were unable to travel to Britain or elsewhere to obtain an abortion.

Mrs. Justice Catherine McGuinness, meanwhile, pointed out that the claim that we had no abortion in Ireland was simply not true, given that thousands were travelling abroad every year for that purpose. She described the legislation as an effort to regularise the current situation whereby thousands were travelling and as a sensible response to what she described as a human situation, as well as a legal question. The views of these medical and legal experts, for whom I have the highest regard, offer adequate assurance that the Bill is balanced and must be enacted without further delay.

As a legislator, I am aware that the legislation is long overdue, 20 years being far too long to wait for this very complex subject to be addressed. The women who do not write to, telephone or e-mail their public representatives deserve to have their voices heard. They are the silent witnesses who face a very difficult choice. Whether it is a 14 year old rape victim or a woman who, for reasons we can only imagine, has been brought to the edge of despair by a crisis pregnancy, all are deserving of compassion. As legislators, we owe it to them to ensure the Bill is enacted.

As a mother, I have experienced both the joys of giving birth and the sorrow of losing babies. I have the greatest sympathy for any woman who is faced with making the difficult decision to seek a termination of her pregnancy.

In the past few months I have given great thought to the contents of the Bill. I have listened carefully to all sides of the debate and I am in no doubt that the legislation, the Protection of Life During Pregnancy Bill, will give every possible protection to the life of the mother and her unborn child, as its title states.

I am grateful to all those who contributed and shared their expertise in framing the Bill. It is appropriate at this stage to thank the Chairman of the Oireachtas Joint Committee on Health and Children, Deputy Jerry Buttimer, for the fairness of the manner in which he chaired the hearings. The contributions of all parliamentarians led to a passionate and very open debate. In particular, the contributions of Deputies Caoimhghín Ó Caoláin and Billy Kelleher were very valuable. The respect given to all those who participated in the debate, regardless of opposing views, is also to be commended. I commend the Bill to the House and hope it will be passed.

I am pleased to be here to participate in this very important parliamentary debate on the Protection of Life During Pregnancy Bill. I have been following the debate for a couple of days. Women like me, who have been involved in the women's movement all our lives, have been following it for more than 20 years. It is clear that while the Bill enjoys broad cross-party support, it does not please everyone. This is no surprise. We said, when we had the debate on Savita Halappanavar's tragic circumstances, that what we could do would be very limited, in respect of the Constitution. This Bill was never going to please everyone. There are those who have grave concerns about the inclusion of section 9 dealing with a risk to the life of a pregnant woman arising from suicide. There are others who, like me, would have liked to see other grounds being included such as where there is a diagnosis of a fatal foetal abnormality or when the health of the pregnant woman is in serious danger because any woman who has any experience in this area knows that some women's pregnancies have had an enduring and profound lifelong effect on their health. I understand, however, the reasons behind the provisions enshrined in the Bill and the reasons some provisions cannot be included. This is because the sole purpose of the Bill is to make provision for procedural rights for a pregnant woman who believes she has a life-threatening condition in order that she can have certainty on whether she requires this treatment. The purpose of the Bill is not to confer new rights to termination of a pregnancy but only to meet existing rights, that is, within the constitutional provisions and the Supreme Court's judgment in the X case and in order to implement the judgment of the European Court of Human Rights in the A, B and C v. Ireland case.

Before I proceed, it is worth reminding ourselves of the findings of this judgment. Three applicants, A, B and C, all of whom had crisis pregnancies, brought proceedings against Ireland before the European Court of Human Rights claiming violations of Articles 2, 3, 8, 14 and 13 of the European Convention on Human Rights. In its judgment, delivered on 16 December 2010, the Grand Chamber determined that there had been no violation of the convention in respect of the first and second applicants, Ms A and Ms B. It determined that there had been a violation of Article 8 of the Convention in respect of applicant Ms C. The court found that Ireland had failed to respect Ms C's right to 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 Irish law. The aim of Bill is to provide such a procedure. Pregnant women whose life is at risk have a right to be able to access appropriate medical treatment, including a lawful termination of pregnancy, when they fulfil the necessary medical and legal criteria. The Bill represents the culmination of a process set in train in the programme for Government. This agreement committed the Government to establishing an expert group to examine these issues and advise on how this matter should be properly addressed.

The expert group's report was published at the end of last year and provided a clear roadmap for action. While the report did examine a number of options for implementation of the judgment in the A, B and C v. Ireland case, it was my reading of it that legislation with regulations was the preferable route to satisfy the requirements of the implementation process of the judgment of the European Court of Human Rights. Legislating for the X case judgment is, however, a serious and legally complex issue. I believe the Bill strikes a balance between providing an accessible procedure for establishing whether a pregnant woman might undergo a medical procedure which will end the life of the unborn and ensuring safeguards are put in place for the protection of the unborn, where possible. As the Minister for Health last week provided a detailed run through of the provisions of the Bill, I will not cover the same ground, but I will take the opportunity to address some of the confusion and concerns raised in the past few days and months.

For example, concerns have been raised around the need to insert a gestational limit on carrying out the medical procedures covered by the Bill. In this regard, it is important to stress again that the proposed legislation only covers situations where there is a real and substantial risk to the life, as distinct from the health, of a pregnant woman which may only be averted by a termination of pregnancy. To be clearer, it will only allow a pregnancy to be terminated in situations where it is expected that a woman will otherwise die. It should also be clarified that in such situations, while a woman has a right to have the pregnancy brought to an end, the provisions made in the Bill intend to ensure that in circumstances where the unborn may be potentially viable outside the womb, doctors must make all efforts to sustain its life after delivery. It should be noted, however, that the decision to be reached is not so much a balancing of competing rights, rather it is a clinical assessment of whether the mother's life, as opposed to her health, is threatened by a real and substantial risk that can only be averted by a termination of pregnancy.

Taking a more holistic approach to the whole issue, I am aware that some of my colleagues in the Opposition have raised the issue of greater supports for crisis pregnancies in general. I am conscious that the ongoing debate and media coverage of the issue of abortion in the past few months have not been conducted in a vacuum but might have affected the thousands of Irish women who every year go abroad to access a termination of pregnancy for various reasons. In this regard, I remind my colleagues and the general public that there are supports available. Like Deputy Catherine Byrne, I felt the former Supreme Court judge Mrs. Catherine McGuinness made very valid and telling points about the number of Irish women who go to England every year to terminate pregnancies. We should not judge them. There is a reason behind every one of these decisions and no decision is taken in a way that would lead us to believe it was done in a light-hearted manner. I do not believe that for one minute. It does not just apply to young girls or women who are raped. There are all sorts of circumstances and reasons for this decision.

The HSE crisis pregnancy programme funds 15 service providers to provide counselling services in over 50 locations nationwide. Several of these services also provide access to free post-termination counselling and medical check-ups. I urge all women who have a termination of pregnancy to avail of these services, to which they are entitled and which are provided free of charge. Listening to Deputy Michael Healy-Rae say women who have had a termination of pregnancy do not discuss it owing to the shame and hurt they feel, one would wonder why. The language and images used once again during the debate have been appalling.

One cannot expect people to step forward knowing that this is the type of abuse they will get.

The main purpose of the Protection of Life During Pregnancy Bill 2013 is to restate the general prohibition on abortion in Ireland while regulating access to lawful termination of pregnancy in accordance with the X case and the judgment of the European Court of Human Rights in the A, B and C v. Ireland case. It is my sincere hope that it will provide clarity to women and doctors on the process that is available to them to ascertain whether a termination of pregnancy can lawfully be carried out. If there are minute numbers of women who feel suicidal as a result of a pregnancy, then what are we afraid of? No one has said there is not an issue with suicide and pregnant women. While it is very rare, it does happen. To vote against this legislation on the basis that it will not happen is reckless in the extreme. It is recklessness with regard to women’s lives, and those days are long gone.

I commend the Bill to the House.

I welcome the opportunity to speak on this important legislation. This is an extremely difficult and contentious issue, and everyone’s view should be respected. It is estimated that around 5,000 Irish women avail of abortion services in Britain each year. We should not be judgmental of the thousands of women who travel to the UK for terminations. Each is a woman who has had a difficult situation to decide on. Without being in their shoes, no one should judge what they have done. It is not an easy decision for them to take that journey and it is imperative that proper supports are put in place for their after-care.

This legislation broadly covers three clinical scenarios: when a woman’s life is at risk in an emergency situation due to a complication of pregnancy; when the urgency of the situation may not be immediate but its severity relates to co-morbidity such as cancer, significant heart disease or some other related illness; and when there is a risk of death from suicide or self-destruction. We must provide clarity and must act on best medical practice. I do not have a principled objection to a law that clarifies and restates current medical practice in favour of protecting the lives of pregnant women. In fact, it may address concerns expressed to me about regulatory creep within the Medical Council as a result of the way the guidelines in this area are drafted. I have been informed that the elections for Medical Council positions are based on the candidates’ positions on abortion. Accordingly, there is always a conflict when drawing up the next draft of the Medical Council’s guidelines. It is not good that those who are not directly accountable to the people should dictate policy in this regard.

The best approach is to bring in enabling legislation with regulation. This seems to have been the Government’s decision after the publication of the expert group report. Such a mechanism could have provided the clarity required, including the legal certainty, and allowed for term limits and silence on the issue of suicidal ideation, thereby not contravening the Supreme Court judgment in the X case. In the first two categories of medical emergency or a medical threat to the life of a mother at some stage during pregnancy, a pregnancy will be terminated early where there is a significant threat to the life of the mother and she has an underlying illness. However, under the third category of suicidal ideation, it will only be legal to avail of a termination where there is no underlying illness. In this case, we are talking about mental illness. Where there is an underlying mental illness that is treatable, a woman will not be legally entitled to a termination under this legislation. Does this not undermine the argument made by those in favour of the suicide provision that they are treating mental illness as a physical illness? Pregnant women with suicidal ideation and no underlying mental health issues are the only women who can practically avail of this particular provision.

It was interesting to hear the evidence given by Professor Kevin Malone to the Oireachtas hearings on the Bill. He expressed concern that the provision of termination based on a 20 year old risk assessment excluded consideration of 50% of the population, namely, males. While some might believe it is an abomination to mention men during this debate, the fact remains that men die by suicide and suicide rates among young men remain stubbornly high. In Professor Malone’s evidence, he expressed his concern that this legislation could accelerate the already high rates of suicide among young Irish men by legitimising it for women and girls who suffer crisis pregnancies. Overall, he believed the provision of the suicide clause could actually cost more lives than it could potentially save.

At the same set of hearings, Dr. Sam Coulter-Smith, the master of the Rotunda Hospital, said: "My overriding concern, however, in relation to the whole area of self-destruction and termination of pregnancy to prevent same, relates to the lack of evidence to show that termination is of any assistance in this scenario and that we as obstetricians and gynaecologists must be able to stand over the decisions we make as being based on good medical evidence." It is important that all Members read Dr. Coulter-Smith’s evidence before they make a decision on this legislation.

The incidence of suicide during pregnancy came up as evidence at the committee. Suicide in pregnancy is a real risk. The committee was informed that one in 500,000 pregnant women will - not may - die by suicide. That fact is misrepresenting the situation, however. The key question is how many women are suicidal during pregnancy. In the western world, recent epidemiological research has demonstrated that suicidal ideation may be detectable in a range of between one in eight and one in three pregnant women. That means that up to one third of pregnant women may have suicidal ideation at some stage during their pregnancy. It is therefore more than probable that a large proportion of women travelling to the UK for terminations would be eligible for a termination here under this legislation.

Much focus has been put on a UK study which suggested that predictions of suicide by psychiatrists were accurate in only 3% of cases. The question is which 3%. Psychiatrists are competent in assessing intent and risk factors. It is impossible to predict when and whether intent will actually be acted upon.

There is no scientific data on women who are suicidal because of a pregnancy rather than because of an underlying mental illness. There are clinical markers for people with mental health difficulties. These can be treated and there are alternatives to termination. However, if a woman is suicidal with no mental health issues other than being pregnant, then the psychiatrist has no choice and there is no alternative treatment available. The Mental Health Act 2001 makes it clear that it is not permitted to impose treatment on a patient who is not mentally unwell. The X case test, therefore, is unworkable in psychiatric terms as it requires a prediction that a woman will die by suicide unless her pregnancy is terminated. That test does not require the risk to be inevitable or immediate.

Debate adjourned.
The Dáil adjourned at 10 p.m. until 10.30 a.m. on Thursday, 27 June 2013.