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

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

I wish to thank the Technical Group for facilitating me with speaking time on this important matter. It is indeed a pleasure to be afforded an opportunity to exercise my freedom of speech within the national Parliament. The raison d'être of this debate for both sides is to object immediately to the other person's position. It is the position on either side merely to oppose. There has been a general failure to engage with the fundamental first principles of either side of the debate. Many on the pro-life side of the debate have as their fundamental starting point a profound respect for human life and believe that life starts at conception. It is unsurprising that people holding this belief cannot yield in respect of their resistance to the proposals in this legislation. Many on the pro-choice side of the debate have as their fundamental starting place a profound respect for the liberty of the individual and the right of a woman to autonomy over her own body and believe the unborn is not, up until a point in its development, of sufficient moral status to override the individual liberty and the right of that autonomy and the autonomy over one's body.

Both of these views are sincerely held but it is rare that either side recognises the sincerity of the other person's position, preferring instead to ascribe motives that are unacceptable about the other's. Pro-life people are not motivated by a desire to control women or to impose a theocracy on the State. Pro-choice people are not motivated by a desire to murder babies, nor do they suffer a callous indifference to human life. It may be, given the different starting points of both sides in this debate, that no reconciliation of both positions is possible and this is an explanation I can only offer. It has become clear to me that this debate has become a dialogue of the deaf. It is marked by invective, insults and a reluctance to even understand the other side's position or views. It is an explanation but not an excuse. Passions have run hot in this debate and rightfully so. However, some restraint is needed and ought to be governed by an acceptance of the motivations of the other side, respect in the debate - and indeed within this Chamber - for a civil discourse in this Republic.

The Government has had its hand in encouraging a respectful debate on some occasions. However, since coming into office, it has become increasingly clear that it is disconnecting from the debate. I have argued that the Government has read Naomi Klein's, The Shock Doctrine, not as a warning but as a standard operating procedure. I argue that it is using the current crisis, where many in society are distracted by the economic circumstances and their struggle to secure the welfare of their children, to alter our society in a way that would not be tolerated in less fraught times. It has sought to engage in this debate by attacking the character of those who oppose it. This pattern is typical not just on this matter, but of its general approach. As a result, it has degraded public discourse, stripping back the status of persons and groups in society and making electoral might the only measure of status. Is this how civic discourse ought to be conducted in a secular society, a republic or even in any republic worthy of its name? I do not believe so.

Other Members have entered into the debate in a way that emulates the Government's approach by attacking the character of their opponents, rather than engaging with the arguments. In the recent past there was a disgraceful attack on one faith community here that, if it had been directed at another faith community, most likely would have been condemned by the very people and Deputies making that attack.

Many parts of this Bill are to be welcomed. They provide legal clarity for the medical professionals who are faced with a situation where a woman's life is at risk and action is necessary to save her life that may result in the unintended consequence of the death of the unborn. However, I would argue that the Bill contains some serious flaws. Once again we find ourselves in the mystical belief of Irish exceptionalism. We somehow believe that we alone, as a jurisdiction, have an opportunity to approach this legislation in a way that is different from any other jurisdiction in the world. Both the United Kingdom and California believed that in the 1960s. They never envisaged, in the introduction of their legislation, that they would reach a situation where thousands of crisis pregnancies would arise in their systems.

We have not learned from other jurisdictions. In this and many other areas we have been determined not to learn from their mistakes, but rather to copy them and fail to learn. As a society we chose to learn the hard way. That determination flows from our odd belief in Irish exceptionalism; it may have happened in another country but we will do it differently. I do not believe we will do it differently. The current economic calamity we are enduring was caused by that same odd belief. We were told that property prices would continue to rise as the fundamentals here are different. They were not. It is truly said that the six most expensive words in the English language are that "It will be different this time". I do not believe it will be different.

Section 9 of the Bill will lead to abortion becoming far more widely available than its supporters, some of them disingenuously, now claim. Many of the supporters of the Bill should be honest, first to themselves and then to the public. Some supporters of the Bill know and hope - we heard it earlier in the Chamber - that things will change in the context of progressing further legislation. Perhaps they are being honest to themselves but they are failing to be truthful with those they represent.

I raised these objections frequently in the past. The usual response to people who critically analyse legislation was to attack them with the slogan, "I don't trust women". In general, people are trustworthy. People occasionally lie to achieve a purpose. Some people are women, and I am sorry to have to reduce the discussion to this ridiculous level to spell out that but I am forced to do so.

We have all seen interviews with Lord David Steel, who introduced the Abortion Act of 1967 to the UK Parliament, in which he expressed regret at the way the operation of that Act eventually worked out. He has stated that if he had known then what he knew now, he would not have proposed it. Lord Steel has some excuse; he did not know then what we know now. Twenty years from now many of those who intend to support this Bill will make a similar statement. They will express regret for their support and it will be too late. It will leave them feeling guilty - some may be foolish - for not looking at the evidence around them or, even worse, dishonestly lying about it in this Chamber.

The rhetoric being deployed by supporters of this legislation contains much that is dishonest. I hope those people who continue making the utterings to which I referred earlier are aware of their dishonesty. For example, this is not a pro-life Bill, and Ministers who state that it is know that. I am old fashioned enough to believe that those of us in this House have a duty to be truthful. Opinion polls ask people if they support legislation to protect the life of the mother during pregnancy and then present the result as if it is indicative of support for all aspects of the Bill. It is not. Most people would say, as I would say, that they support the legislation.

It is important that medical professionals have legal clarity on the circumstances in which they can intervene to save a woman's life, even when such interventions may result in the unintended death of the unborn baby.

What would be the answer if people were asked in an opinion poll if they support legislation that allow for abortion in the case of suicidal ideation, knowing that in every other jurisdiction where that has been brought in, it has led to abortion on demand? What would people's answer be if they were asked in an opinion poll if they supported legislation that provided for abortion up to the final week of a pregnancy? What would be their answer if they were asked in an opinion poll if they supported legislation that provided for a baby to be prematurely delivered into disability and pain and a lifetime of State care? I must ask myself about the kind of society in which we want to live. Do we want one that mandates and supports these types of actions? I have a concern about significant aspects of the latter observation in regard to the State having any hand, act or part in the precipitation of the conclusion of a pregnancy where a baby would be born prematurely, without any benchmark in terms of pain, hurt or our responsibility as a State for that child.

I know of many people who would describe themselves as pro-choice who would oppose abortion without time limits as there is no other civilised society on earth that allows for abortion up to delivery. There is little doubt that the majority of Irish people would oppose that.

The Bill is a matter of significant national importance. It concerns many important issues with respect to the welfare and health of a mother, a matter that has been subject to lively and ongoing debate for more than 20 years and one on which there is still division within Irish society. Only one of the four large parties committed to legislation in this area in their manifestos, namely, the junior party in Government. Neither the Government nor the House has a mandate to pass this legislation. It is my firm belief that the only appropriate course of action is that outlined by Deputy John Paul Phelan earlier, namely, to put this Bill before the people in a referendum to ascertain their point of view. Opinion polls with loaded questions are not sufficient in this respect.

We have been lumbered with a vast volume of rhetoric on the need for a new way of politics and the need for reform. We were promised a democratic revolution. We need to see evidence of that with respect to this Bill.

I welcome the presence of the Minister in the Chamber. I have outlined my views with respect to section 9, many of which are on public record. However, I refer to a matter that was brought to my attention recently by the Irish Independent legal correspondent, Dearbhail McDonald, who wrote questioning the way the Bill, if enacted, would interact with the Mental Health Act 2001. The Minister has given many reassurances that the belief that the numbers making use of section 9 of the Bill would be, to use his words, only a handful. We might quibble on why he believes that but I ask him to give the House some assurance that it is not envisaged that any women seeking to have an abortion under section 9 would be automatically involuntarily admitted under the Mental Health Act. I would like the Minister to give that assurance to the House tonight. Under the Mental Health Act, persons may be involuntary admitted where they are suffering from a mental illness and where there is a serious likelihood that they may cause immediate and serious harm to themselves or to others.

Only one medical practitioner will be obliged to make such an assessment in order for someone to be involuntarily admitted to a hospital.

Under section 9, two psychiatrists will be required to certify that a woman's life is at risk from suicide and that an abortion is required as part of her treatment. This standard appears to exceed the provisions of the Mental Health Act 2001. I ask the Minister to clarify how the latter and the Bill before the House will be reconciled.

There are many who describe themselves as pro-choice and many others who describe themselves as pro-life. Both groups hold genuine views. It is important that in this debate we should respect each other's positions. As legislators, we must try to reconcile both position in this very challenging legislation.

I would be grateful if the Minister would comment on the provisions in the legislation under which a woman who attempted to secure an abortion in this country outside of the provisions of the legislation could potentially be liable to serve 14 years in prison. I ask him to reflect long and hard about the prospect of visiting further damage upon a woman who might find herself in a crisis situation and who would be living in fear of the threat of the State pursuing an action against her. I am of the view that the provision in this regard is unacceptable and that it dates from a bygone era. It is a punishment and the legislation before the House should not set out to punish.

I welcome the opportunity to contribute to the debate on the Bill, which deals with a very sensitive and complex issue. There is a wide range of views, which we earnestly respect, on this issue. Such views have been expressed both inside and outside the House. Members have received correspondence in respect of the legislation and I defend the right of people to express their views to us in any way possible. I would, however, have reservations about the small number who would put forward those views in a fashion that is more robust than just seeking to make a few strong points. A number of speakers indicated that they have been inundated with representations. However, I will defend the right of people to make such representations and I respect them for making them. Deputies have read very carefully the letters, e-mails and messages they have received with regard to this matter.

The legislation relates to saving lives, namely, those of the mother and the child, where possible. It upholds the equal rights of mothers and children as outlined in the Constitution. Termination is very difficult and there are intense ethical, religious, social, political and intimate personal issues surrounding it. Over 20 years have passed since judgment was handed down in the X case. That judgment allows for a child to have a termination in the rare and difficult circumstances experienced by the 14 year old to whom the case related. In 2009, the European Court of Human Rights found that an existing constitutional right was identified in the Supreme Court's decision in the X case and that it is legal and rational that this right should be available and enforceable.

I do not wish to repeat a great deal of what has already been stated by others. However, under the Constitution as interpreted by the Supreme Court, there is a right for termination in circumstances where a woman faces a real and substantial risk to her life and in circumstances where there is serious suicidal intent as a result of pregnancy. I use the word "intent" rather than that of "ideation". Deputy Lawlor expressed it well when he stated that, as psychiatrists will indicate, ideation is quite common. Ideation moving to intention is, however, a different journey altogether. We are, therefore, concerned with suicidal intent and not just suicidal ideation. Referenda held in 1992 and 2002 to remove suicide as a ground were both defeated. It has been stated that a difficulty could arise where, as a result of a tragic predicament, a termination on grounds of suicide might cause extreme controversy as a result of there not being a regulating case. The decision in the X case is the law of the State. That law was declared by the highest court in the land and it is binding on all lower courts.

I wish to deal now with the issue of suicide and I will then discuss the Bill. In that context, I refer to some research published in the British Medical Journal by Professor Louis Appleby in 1991 which indicates that the rate of suicide among pregnant women is lower than that among their non-pregnant counterparts. He also indicated that pregnancy protects against suicide but does not prevent it. US studies also show this trend in the context of levels of self-harm and suicide. However, these studies were undertaken in areas where relatively liberal abortion regimes exist and where termination is available for pregnant women in instances involving a real and substantial risk to their lives in the context of suicide. It is worth noting this research which indicates that there are lower levels of self-harm in pregnant women and that admissions to hospital for self-harming are lower among such women. This is international research and I am unaware of any such research which has been carried out in Ireland on this matter. I merely wish to draw attention to the research in question.

People have real concerns about this issue. The advice given to psychiatrists is that they should not make impulsive decisions. Some research shows that up to 50% of pregnancies are unplanned and that there is distress involved. However, these pregnancies are not unwanted. There is a difference between a pregnancy being unplanned and being unwanted. As one individual put it, a woman can move from saying, "Oh my God, I am pregnant" to being happy that the situation has arisen and being prepared to move on. Any decision in respect of someone's mental condition must be evaluated very carefully, particularly as people can change their minds. Professor Veronica O'Keane of Trinity College Dublin is on record as stating:

It is an accepted fact that suicide during pregnancy is a rare event in the western world. This is because maternal death during pregnancy is a rare event overall. Nonetheless, suicide is a leading cause of death during pregnancy. The causes of all maternal deaths in relation to childbirth are examined and published every three years in the UK. There were four deaths attributed to suicide in the latest report where it is stated that the last three inquiry reports found that maternal suicide was more common than previously thought and was a leading cause of maternal death. This indicates that suicide is an important cause of death during pregnancy, even where abortion is available.

A study conducted in Ireland for a similar period reports that there were two maternal deaths from suicide during the perinatal period similar to the deaths rate from cancer which was also two.

Professor O'Keeffe maintains that one of the established risks of suicide during pregnancy is an unwanted pregnancy. This is particularly true for teenagers. In the UK, teenagers are at an increased risk of suicide if pregnant. Overall, a pregnant compared to a non-pregnant teenager in the US is more than twice as likely to die by suicide. We have no statistics on pregnancy and suicide in Irish teenagers, although suicide is a cause of 20% of deaths in teenage girls.

I have been involved with and have knowledge of psychiatrists for more than 20 years since I was involved in campaigning to decriminalise suicide from 1990. I have great respect for the competency and the professionalism of the psychiatric profession. I have issues about psychiatry but not their competency and their professionalism. I have previously outlined those difficulties I had with some psychiatrists which relate to their involvement and communication with carers and their families. However, that is a separate issue from their competency in conducting a decision on the treatment of mental ill-health and suicide intent.

The chairman and secretary of the Irish Association of Suicidology are eminent psychiatrists and we have had eminent psychiatrists on the board in the past. My contact has been real and I am on the advisory board of the Irish Association of Suicidology. I wish, if I may, to say something about the competency and professionalism of the psychiatric profession. Psychiatrists are competent in conducting clinical practice within legislative structures. All consultant psychiatrists are trained in the operation of the Mental Health Act 2001. In this context they are practised in the assessment of medical problems and the legal restrictions within which they manage these problems. They attend tribunals for all patients detained under this legislation and present their rationale for treatment within a legal framework. Psychiatrists are accustomed to working with legal professionals.

Much has been said about suicide. I wish to dwell for some time on the issue of suicide. Recent figures published by the Central Statistics Office show that for 2012, some 507 people died by suicide, the majority of whom were men. However, there were a further 82 undetermined deaths. In other jurisdictions these would be included in the official statistics. There are also some unidentified deaths. We have heard about single occupancy vehicular road traffic accidents, some of which are suicide. I do not wish to overstate that but international research would suggest there are between eight and 12 such deaths. I do wish to overstate or exaggerate the numbers. Those figures combined suggest 600 people died by suicide last year while 161 people died on our roads. For comparative purposes I congratulate the Road Safety Authority for the excellent work it has done in this area.

Suicide is a very complex issue but we can easily identify two contributory factors, the neglect of the mental health services and the lack of suicide prevention programmes in past decades. Bearing in mind that up to 80% of those who die by suicide suffer from a mental health difficulty, the historical neglect of the mental health services is nothing short of scandalous. In the two recent budgets the Government allocated €70 million towards the development of the mental health services. It is vital that the allocation is spent as intended by developing community based multi-disciplinary services. Some 1,414 were allocated in 2012 and more than 400 in 2008. I do not wish to discuss this in detail but I would like the opportunity to do so because I have problems in regard to how it is implemented. Some €75 million was allocated this year but recruitment is only starting. For the first €35 million allocated, the first people were appointed towards the end of last year. I have been asking where did the other money go but that is a separate issue and is not one for debate on this Bill.

One in four will suffer a mental health problem at some stage of their lives. The demands, pressures and expectations of modern life can increase levels of anxiety and depression and it is felt even more intensely at times of recession. Suicide has affected too many families and communities across the country, yet a level of denial persists about the real and serious public issue. The stigma and lack of understanding around mental health problems and suicide must be overcome.

There are many misconceptions surrounding incidents of suicide. One of the hardest realities for the bereaved is the admission that a loved one found life too painful and came to the conclusion that suicide was the only option. People often say of some somebody who dies of cancer or heart disease that they really wanted to live but that the disease got the better of them, yet they wrongly say that somebody who dies by suicide wanted to die. Nothing could be further from the truth. People who complete suicide want to live as much as anyone else but living becomes too painful. Those who take their lives do not want to die, they just cannot bear the incredible pain their illness is causing them. It is very important for people to hear that message. Suicide is not a cop-out from life. People who complete suicide have reached the end of their tolerance. There is nothing shameful about someone who dies by suicide. They have fought the valiant battle and they have lost the battle through their illness. Society's attitude must change and we must involve the State in comprehensive suicide policies. In a five year period, Australia reduced its death by suicide by 25%.

I welcome the Minister to the House. It is fair to say that no issue has come before the House which has caused such controversy or which causes the manifestation of such extreme views in our society. It is difficult and personal for women affected and their families. It is difficult for individuals as members of political parties and as legislators to introduce legislation and when legislation is introduced it is very difficult for medical practitioners dealing with life or death cases to have to make the call in a given situation.

It is remarkable and confusing at times to witness, as we did at the two hearings of the Joint Committee on Health and Children, the fundamentally opposing views of the professionals, both medical practitioners and lawyers, on issues of interpretation and practice in respect of the issue of abortion, often given in complex "medicalese" and "legalese" which does not make it any easier. As we debate this legislation we must try to make sense of the evidence to arrive at the best position for a mother in a life threatening situation and for the unborn child.

No pregnant woman, because she met the wrong doctor on a given day or night, should be left without all necessary treatments, including a medical intervention to save her life which may result in the termination of the life of her unborn child. I welcome the aspect of the Bill which seeks to bring a formal process for a pregnant woman to invoke when her life is at risk, owing to a physical threat, and which brings clarity for herself and her medical practitioners.

This responds to the obligation which the A, B and C v. Ireland judgment of the European Court of Human Rights placed on the State. However, much impatience has been expressed in some quarters about years of delays in introducing X case legislation to include the recognition and regulation of a pregnant woman's right to a termination where there is a real and substantial risk to her life from suicidal ideation, in the same way that a physical threat is recognised.

At this stage, there are people who wish to see us sprint over the line and put legislation in place once and for all. Notwithstanding it being over 21 years since the X case judgment, the truth is that tentative discussion and debate in middle Ireland and mainstream politics has only begun in the past year, with the Bill only having being published under two weeks ago. Previously, the debate has been the domain of extreme views on the issue, with most people in the country not really that comfortable speaking about abortion. Most of the media seems to be preoccupied with the politics of who will lose the party Whip on the issue rather than examination and illumination of the issues of concern.

Many of those pressing for legislation on the X case cite polls conducted indicating that a majority of Irish people are seeking legislation in line with it but given the complexity of the matters, how reliable can such a simple question for such a poll be? Much of the sentiment and support on the face of the poll stems from the people's upset - rightly - at what happened in Savita Halappanavar's tragic case, which does not have a correlation with the substance of the X case, which provided for suicide as a grounds for termination of pregnancy. In doing this, the X case did not provide a sufficient exposition and examination of the medical evidence which might support the creation of such a ground. After all, the assessment of the risk to the life of a woman and appropriate treatment is a medical matter.

Many lawyers are uneasy about, or at least acknowledge, this unsatisfactory aspect of the X case judgment. Many proponents of this legislation and an abortion regime more liberal than permitted by our current Constitution want to conveniently gloss over this unhelpful fact. It would seem there is general agreement among psychiatrists that abortion is not a treatment for a pregnant woman who is suicidal. Notwithstanding this, there are some medical practitioners who indicate that on very rare occasions, a termination would be required on suicide grounds, but they can point to no clinical evidence to support this proposition. The medical statistics tell us that a pregnant woman is less likely to commit suicide than a woman who is not pregnant. To compound matters, Irish citizens voted in two separate referenda not to exclude suicide as grounds for termination, so to say the issue is complex is an understatement.

Of great concern is the recent revelation that six young girls - minors in the care of the State - have been taken to the UK for the purpose of termination of pregnancy. This has been given as a reason to introduce X case legislation. What are we really looking at and could we please have some answers to some of the following issues? Four of these cases entailed an application to the courts, with all six having been seen by a psychiatrist. We have been told that a suicidal pregnant woman who would require a termination is a rare event, with the numbers possibly at one in 500,000. The odds for a young girl in State care seem to be much higher so why is that? What treatment did these girls receive for suicidal ideation and why did these young girls get pregnant while in State care and protection? Who does it suit that there should be no pregnancy? Is it those responsible for the girls?

We know that in the D case the girl in question subsequently claimed she was told by the authorities to say she was suicidal. Could these cases possibly expose a culture within the HSE and among some psychiatrists that a young girl in the State's care who gets pregnant through rape should ultimately receive a termination? If it is the case, we are not acting within the boundaries provided for by the Constitution as it stands and the questions must be answered. Why did all of these cases not go before the courts? There is nothing in the Bill stipulating that the HSE will be prohibited from arranging travel for a procedure in a foreign jurisdiction, as in these cases, and the right to travel is restated in the legislation. What has happened to these women since? Surely these questions should be answered in the public interest and considering the import of the legislation which we are on the brink of introducing.

In the legislation we are challenged with balancing the protection of the life of a pregnant woman with the right to life of an unborn child, which we guaranteed to vindicate in accordance with the Eighth Amendment to the Constitution, which was voted upon and inserted by the citizens of this country. This is the blueprint by which we create laws on this issue in accordance with the will of the people. Looking at the Bill, I am concerned with the suicide ground that the correct balance is not being achieved and on account of the lack of medical evidence to support its use as grounds for termination of pregnancy and its possible abuse if included.

I am concerned that the regulations pursuant to this legislation have yet to be published. The Bill sets out a framework but does not give detail which may help in assessing how workable it is. Moreover, it is objectionable that we should be debating and required to vote on this Bill in the absence of the draft regulations which have been promised. I have met with the Minister on this and other issues with the Bill as drafted and I am waiting for him to revert to me about my concerns, which include the following.

The standard of "good faith" placed on medical practitioners is not sufficient and is a subjective test. I contend that it should be explicitly stated that the decision should be objectively reasonable on the part of the medical practitioner, and it should be made in reliance on some objective standards and meet at the very least a standard required in medical negligence cases. For example, the Medical Council guidelines of 2009 refer to an objective standard stipulating to psychiatrists as follows: "You should undertake a full assessment of any such risk (i.e. suicide) in light of the clinical research on this issue." It should be stated that the three medical practitioners referred to in section 9 should be required to examine the pregnant woman separately before certification.

We have been assured that a suicidal woman will be afforded all treatments and termination would be a last resort. This has been offered by way of comfort for those of us concerned that treatments should be explored. However, the Bill does not actually state this but simply sets out a procedure for a woman to establish whether she qualifies for a termination. So what if a woman is suicidal and at risk but has no mental illness and refuses treatment, which she is legally entitled to do? At least one of the psychiatrists at the Oireachtas health committee hearings stated that she did not see her role as treatment in that scenario and rather that she would be simply certifying the medical grounds for legal eligibility. What are of particular concern are the differing views of psychiatrists as to their function in this scenario as set out at the hearings, and that is unsatisfactory to say the least.

A required cooling-off period or a pause of at least a week to ten days for a decision on a section 9 certificate should be included where a woman does not have a mental illness from the time a formal request is made and a medical assessment is conducted. This would accord with medical evidence given at the hearings that no decision should be made in haste when a woman presents as suicidal because with the right supports given to her, such heightened states of distress can pass.

How is the right to life of the unborn vindicated in accordance with the right of representation and fair procedures set out in "Dellway & Ors v. NAMA" 2011? What is provided for in this Bill is the making of a medical decision with legal implications for the unborn as a constitutional person and as a third party to the process which is covered by the Dellway case but which does not appear to be addressed by this legislation. I know this is an issue raised by many of the speakers in the House. There are no term limits and why is no reference made to viability? The X case makes no distinction and this continues to be the case. The Government has maintained that no viable foetus will be aborted so why not state the obligation to deliver such a viable foetus explicitly in the legislation?

It is easy to conclude that we have attained a state of enlightenment or sophistication - if the two are different - so much as to determine the course of our lives. Today, as distinct from days past and days synonymous with ignorance from our point of view, is defined as the era of self-awareness which translates to self-ownership or possession.

We believe we have come to that point where individually we can say "this is my life to do with as I choose. I determine the course of my life. I need no God or external authority to be accountable to." Is this the truth? In the era of the black box of technology, all that matters is what the thing does. We leave the concern for "how" to the few who know its architecture. What makes the gizmo in our hands tick is rocket science for the majority of its users and we trust the few to know what we want. According to this viewpoint, since we determine the course our lives take, what we want is paramount and what we want are tools to live as we please. This ignorance of what is inside the solid state of the black box extends, by default, to what makes us tick as individuals and as a community of humans and how we are created.

In that regard, we deliberately choose not to know the price others paid to make our lifestyle possible but there is no escaping the fact that many gave their lives for our existence. We are not the source of our own existence. Nobody wants to know the price parents, particularly women, the local community and every generation before us have paid for the environment and supports that make possible the peaceful and healthy transition from foetus to young adulthood to what we then call "my life". So many before us and around us have been servants to make reality the singular gift that says "my life". Who then can speak for that life and propose its termination? It is a subject we must surely approach with awe and humility, not impatience or cynicism.

I have many issues of concern, as have many other speakers. I hope the Minister can bring clarity to these issues in his summing up on this Stage this evening.

I am sharing time with Deputy Tóibín at ten minutes each.

Is that agreed? Agreed.

I welcome the opportunity to speak on the Protection of Life During Pregnancy Bill 2013. I have no doubt that everyone in this House agrees that pregnant women in Ireland should be entitled to the very best medical care available. In so far as the Bill provides clarity in respect of the interventions that are lawful where there is a physical threat to the life of the mother, no one has any problems with it. Essentially, what is currently the medical practice in our hospitals is being given a statutory underpinning and clarity, as requested by some medical professionals. If that was all the Bill provides for, I would be happy to support its contents but, unfortunately, it does much more.

Section 9 of the Bill is a real problem for me. It concerns risk of loss of life from suicide. In my opinion, this section is not required in the legislation and is completely unworkable. At the recent Oireachtas Committee on Health and Children hearings, barrister Paul Brady stated:

First, it is clear that head 4 marks a change in the law. It is not accurate to say otherwise. It creates, for the first time, a statutory basis in Irish law for what may be a direct and intentional termination of an unborn child's life.

Section 9 provides for the ending of the life of the unborn where three doctors certify that there is a real and substantial risk that the mother will commit suicide and that this risk can only be averted by the termination of her pregnancy. Essentially, it gives statutory effect to the X case decision of 1992 and the Bill goes on to put in place procedures to facilitate abortions on grounds of a threat of suicide. At the hearings, Dr. John Sheehan of the Rotunda Hospital stated:

If head 4 is enacted, psychiatrists will be asked to determine if there is a real and substantial risk to the life of the mother in order that she may procure a termination of pregnancy. This is a role in which Irish psychiatrists have not been involved to date. Many will not see this as their role as medical practitioners. The role could be construed as making psychiatrists the gatekeepers to abortion. Psychiatric practice relates to assessment and treatment of patients, not assessment and adjudication. Psychiatrists are not judges.

For the very first time, we are stating in statute law that it is ok to deliberately and intentionally take the life of the unborn - direct abortion. This signals a real and significant cultural change in the practice of our hospitals and I have a real problem with this.

It was stated at the health hearings by various legal experts, including Dr. Maria Cahill, that the Government is not constitutionally obliged to legislate to introduce abortion on the grounds of suicidal intent. In a newspaper article, Dr. Cahill stated:

The Constitution gives permission to the Dáil and the Seanad to legislate, rather than imposing such an obligation on them. There are examples dating all the way back to 1965 of the court establishing that various rights exist, only to have 14 successive governments decline, in the lawful exercise of their discretion, to legislate to provide an express statutory footing for these rights.

The former Supreme Court judge, Mrs. Justice Catherine McGuinness, stated that "as regards to the question of the Oireachtas having acted unconstitutionally in the past, I do not think that can be said". She also said "it is free not to legislate"

When the X case was decided 21 years ago, no psychiatric evidence was considered by the courts. Over the course of two sets of hearings conducted by the Oireachtas Joint Committee on Health and Children, we were presented with the evidence - compelling evidence - that the courts did not hear. That evidence is quite clear. Abortion is simply not a treatment for suicidal intent and, in fact, it may even contribute to it. Dr. Sam Coulter Smith, the Master of the Rotunda Hospital, has stated that termination is simply not a treatment for suicidal ideation and that Bill is not evidence based. Dr John Sheehan, consultant perinatal psychiatrist at the Rotunda Hospital said: "However, it is true to say there is no evidence base to indicate that abortion prevents suicide."

I am also very concerned by an aspect of this raised by Professor Kevin Malone in his comments at the hearings. He stated:

By foregrounding a theoretical risk of suicide in women, and enshrining "suicidality" in Irish law, the proposed legislation runs the risk of further invisibilising. normalising, and at worst exacerbating the much more real and volatile threat of increased suicide risk in Irish men, and potentially accelerating suicide risk in young women also.

The various reassurances given by supporters of the Bill that section 9 will be rarely, if ever, invoked, that terminations will not be allowed late in pregnancy, or that viable babies will be delivered early rather than killed give me little comfort when I consider what the Bill actually says and what are the scientific facts.

No one knows how many abortions will result from this legislation. We are not talking about the one in 500,000 women who commit suicide during pregnancy, usually due to mental illness. They can be treated if they are identified in time. We are talking instead about an unknown percentage of the women who travel abroad for abortions and about girls in the care of the State. Crucially, no supporter of the Bill has suggested what would be an "acceptable" number of section 9 direct abortions.

In respect of late term abortions, if one accepts the premise of the X case, on which the Bill is based, a threat of suicide is no less a real and substantial threat to the mother's life whether it arises in the first trimester or at eight months. If the mother says she is suicidal due to the very existence of the baby rather than simply due to the fact that the baby is inside her, the only way the cause of her suicidality can be removed is by killing the baby. Both the X case and the Bill speak explicitly about ending the life of the unborn.

Dr. Sam Coulter Smith has expressed serious concern about the idea that an obstetrician might be required to induce delivery of a viable but extremely premature baby under section 9. He stated at the hearings that "the fact that there is no gestational limit in respect of the third scenario relating to suicidality is a major ethical issue for obstetricians". He also said that "delivering a baby at 25 weeks' gestation could lead to death, due to extreme prematurity or it could lead to a child with cerebral palsy or with other significant developmental issues for the future". In effect, a previously perfectly healthy baby, if he or she survived, would have a 50% chance of suffering cerebral palsy as a result and could suffer a range of other disabilities.

The Minister, Deputy Reilly, acknowledged, on the RTE programme, "The Week in Politics", that the Bill will probably result in more babies suffering damage because of their premature delivery.

No country or state has ever been successful in restricting limited abortion legislation on the grounds of suicide. We know for instance that in the US state of California the Therapeutic Abortion Act was passed in 1967 on what legislators believed were extremely strict mental health grounds, yet within three years the number of abortions had risen from 500 to more than 63,000. The UK and other European countries have also seen abortions far in excess of what legislators expected. For these and other reasons, I have serious concerns about the effects of this legislation for as long as section 9 remains part of it.

It gives me no pleasure to dissent from the whipped position of my party but prior to the last general election, Fine Gael gave a commitment to the electorate that it was opposed to the legalisation of abortion. This commitment was given precisely to court the support of those opposed to legislating for the X case. To honour this commitment I may be forced to break my party's Whip. It is not something I do lightly. In deciding how to legislate on such a uniquely life or death issue as abortion, a legislator must have the freedom to follow his or her own conscience on the matter. A free vote on this issue is routinely granted in the UK Parliament at Westminster, to take just one example. We know from recent polling research by Amárach that 86% of the people are in favour of a free vote on abortion. They are right, and I hope, even now, the Taoiseach will reconsider this question before the vote tomorrow.

I do not agree with those who say we should set aside our beliefs and consciences when we deal with so grave an issue. It is precisely by holding true to these beliefs that we best serve those who elected us.

I will defend the right of our doctors and nurses to practice their healing vocation with clear consciences and I will defend the right to life of unborn children and their right not to have their lives deliberately ended when they can and should be saved.

As John F. Kennedy stated in a famous speech on conscience delivered shortly before his election as President of the United States, "I will make my decision in accordance with... what my conscience tells me to be the national interest". Most people would not be impressed with a Deputy who voted for something he or she believed to be fundamentally wrong or for a law he or she judged to be unjust, with no scientific basis, and with foreseeable consequences which most people would not wish to see. It is my belief the misnamed Protection of Life During Pregnancy Bill 2013 is such a law and this is why I will vote against the Bill on all Stages. As a legislator I am constitutionally free to oppose the Bill and I am conscientiously obliged to do so.

Ba mhaith liom buíochas a ghabháil leis an Teachta Flanagan as ucht a chuid ama a roinnt liom ar an mBille tábhachtach seo.

Abortion is a severely difficult issue for most people in the State. The majority of people in the Chamber and in society in general, whether they have a pro-life or pro-choice perspective, come to the issue with justice and compassion in mind. Nobody has anything to fear from comprehensive robust debate. This country has learned to its great cost that there is much more to be feared from groupthink and herd mentality than a civil word of dissent.

I condemn those on both sides of the debate who campaign with disrespect. This is a sensitive issue and it is very important that those who campaign are respectful of all others. I also condemn efforts by some to demonise those who do campaign with respect. In every case a mother's life should be saved, no ifs, buts or doubts. Every medical procedure necessary to save a mother's life should be afforded to every woman whose life is threatened.

There should be no confusion on this point whatsoever in any hospital in Ireland. I wholeheartedly support the sections of the Bill which deal with evidence-based medical treatment. However, this abortion Bill will introduce a radical change from the status quo. For the first time treatment for suicidal ideation or intent in one person will include ending the life of another person. For the first time the law will allow for the direct and intentional ending of life without medical evidence or a basis in science. People need to be very clear. This abortion Bill is not a medical or psychiatric response to suicidal ideation. This abortion Bill is a political response to a flawed medical evidence-free Supreme Court judgment.

If we put medical evidence at the heart of this decision we see that abortion extinguishes the life of the child, often damages the life of the mother and actually increases maternal suicide. For the first time the decision to terminate an unborn child will not be based on objective medical markers but on subjective prediction with an accuracy level as low as 3%.

For me an outcome of this Bill which has not been properly debated is the fact the legislation will allow for abortion until birth. An unborn child, alive and kicking at 21 weeks in Ireland, who would have the protection of the law in liberal abortion regimes in Europe, will no longer have the same protection in Ireland. I am shocked the legislation will allow for a healthy unborn child on the cusp of viability to be brought to pre-term with the likely probability the child will be disabled by the State and possibly institutionalised for life. In fairness to the Minister for Health, on this specific issue he has acknowledged there will be damaged children as a result of the legislation and I hope I am quoting correctly what he stated on "The Week In Politics". Many people on the pro-choice side of the debate have contacted me to state while they want legislation on the substantive issue of the X case, they cannot agree with the fact there are no term limits in the Bill and that forcible pre-term delivery will be possible with the likelihood of disability. There will be a referendum in the autumn on the future of the Seanad. With no burden to the State the issue of term limits could be put to a referendum and the Government could ask the question of the people.

I believe in political accountability. Deputies are responsible for their actions. If a politician cuts child benefit, he or she is responsible for pushing children into poverty. If a Deputy votes for abortion, the Deputy is responsible for what happens under the legislation. The State does not do nearly enough when it comes to mothers in crisis. We rightly talk about a youth guarantee but never about a mother and child guarantee, one whereby society guarantees that all mothers will have all medical and psychiatric support necessary to deal with their pregnancy and beyond, and whereby all woman will have every support necessary to feed, clothe, shelter, educate and raise their children.

Everybody will agree that one of the most shocking outcomes of the Oireachtas hearings on the planned abortion law was the widespread concern expressed by senior medical professionals that our maternity services are significantly under-resourced. If the Government was serious about supporting maternal life, it would be serious about maternity resources. Proportionally, abortion affects more women from poorer marginal sectors of society. Again, if the Government was serious about preventing abortion, it would be serious about preventing the socio-economic causes of abortion.

The 166 Deputies of the House will vote on the right to life of the unborn tomorrow. We will be asked to legislate on this issue and vote on it. At the same time, we will be diluting that same right for the next generation. There has been a debate in the Oireachtas as to whether this Bill will open the floodgates. What is an acceptable number of evidence-free abortions? We are moving from a culture that seeks to save the life of the mother first and foremost and then the life of the child to one that allows for the direct ending of human life. Once we allow for abortion for non-medical reasons, it becomes increasingly difficult to oppose abortions for other difficult reasons. For those in the House who believe that this is the end of the road on the issue, my Labour colleagues will agree that this is only the start. Assurances from the Taoiseach can now be taken as seriously as his pre-2011 promises on the issue.

Many will be conflicted between their party loyalties, careers and consciences. Neither my career nor any Deputy's is worth a jot in comparison with the life of one mother and the life of one child. In articulating my views on abortion, I do not seek to judge anyone. I am in no position to do so. I simply seek a health service whose objective is to save life on each and every occasion.

When I first began examining this issue, I was surprised and perturbed to learn that the X case, as defined by the Supreme Court, was the law of the land. This point was agreed by a number of eminent people during the recent hearings. Regardless of whether one agrees, it is the law of the land. As such, abortion on grounds of suicide is constitutionally possible. It is actually legal, as Bunreacht na hÉireann is the basic law of the land. My difficulty with the current situation is that there are no constraints, qualifications or regulations to control it.

I learned something else recently, although I stand to be corrected if I am wrong - no central records are being kept. We do not know what is happening. We do not know how many terminations are taking place in hospitals, what hospitals or clinics are carrying out abortions or under what circumstances these procedures occur. This is a dangerous situation in the context of the constitutional and legal position under the X case.

We could hold a referendum to change what Deputy Tóibín suggested was the "flawed" X case decision. We had two referendums. In both instances, the people decided to keep the suicide clause intact. We are still left with it.

People have mentioned the Whip system and so forth. I have been in the Oireachtas for 16 years and am of an age at which I may or may not stand for re-election. I do not know, as it is not an easy life. In any event, I have decided not to comment on this matter - I have been criticised for that decision - but to listen to and engage in debate with people. Most have been respectful, but certainly assertive. A small minority have gone beyond that, as colleagues on all sides have mentioned, and have been extraordinarily aggressive, insulting and hurtful.

If I felt strongly - maybe I might yet - that this Bill was wrong, I would vote against it, as the Minister knows. I have thought about it long and hard. I am still thinking about it. I held some meetings on the matter today. I keep coming back to the X case position and wondering whether we can allow it to stand in good conscience without putting some parameters and controls in place.

I have a number of questions about the legislation, but I note that few, if any, women present on grounds of suicide. Some eminent psychiatrists stated that they had not seen any such women in 40 years. Others argue that these women go across the Irish Sea, but I recently came across a research report of the International Symposium on Maternal Health that argued: "Not one Irish woman has had an abortion in the UK in order to save her life since 1992, new research from the Committee for Excellence in Maternal Healthcare (CEMH) has shown." The report goes on to state:

A response to a freedom of information request by the Committee to the British Department of Health shows that, between 1992 and 2010, no abortions were carried out on Irish women under section F of the UK Abortion Act, which requires records to be kept of abortions that were carried out to "save the life of the mother".

Further, the same data shows that no abortions were carried out on Irish women between 1992 and 2010 under Section G of the same Act, which requires records to be kept of abortions conducted to "prevent grave permanent injury to the physical or mental health of the pregnant woman".

It argues:

Irish women have known all along – they do not have to leave Ireland to seek abortions if their life is in danger. In fact, not one abortion has been carried out to save an Irish woman’s life since the X case, despite the frequent and misleading claims of those who support the provision of induced abortion.

I am unsure as to whether this is true, but it is a strong statement. If it is accurate, such abortions do not actually occur.

Suicidal ideation has been mentioned, but it is a continuum, stretching from people with fleeting ideas of committing suicide to people who actually plan it. As a counsellor in a former life, I met people who had planned their suicides and had everything ready. When I asked doctors and general practitioners, GPs, what to do in such instances, they told me not to break eye contact with the people and to get them help as soon as possible, for example, get them into a secure unit if necessary or have them seen by psychiatrists, psychologists or both, people who could help, treat and support them. Sometimes, suicidal thoughts can be fleeting.

If a woman presents under this legislation, she must first engage with a psychiatrist, who must then make an assessment. A short time later - it is not specified in the Bill, but I would expect it to be on a different day or perhaps even a different week - she must engage with another psychiatrist for a second opinion. Both psychiatrists must share a reasonable opinion that the risk of her killing herself can only be averted by carrying out the medical procedure, that is, the abortion. The "only" is important, as it implies that other approaches and procedures can be carried out, for example, psychotherapy, the talking therapies, counselling, medication and hospitalisation. There is a range. In most instances, someone who presents with suicidal intent to psychiatrists will be offered these therapies first.

Some have stated that they have never encountered anyone who was suicidal because she was pregnant. It probably happens in very rare cases. Under this Bill, such women must meet two psychiatrists. That is not currently the case. If these women exist, they take the boat to England.

Much has been made of the English situation and the hundreds of thousands of abortions carried out there, but the English law differs from what is proposed in this Bill. The Abortion Act 1967, which has been widely cited as having opened the floodgates - it probably did - states:

Subject to the provisions of this section, a person shall not be guilty of an offence under the law relating to abortion when a pregnancy is terminated by a registered medical practitioner if two registered medical practitioners are of the opinion, formed in good faith--

(a) that the pregnancy has not exceeded its twenty-fourth week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family.

That is extraordinarily wide and is completely different from what is being proposed here, which is extraordinarily restrictive.

It went on to say that

(b) The termination is necessary to prevent grave permanent injuries to the physical or mental health of the pregnant woman, or (c) that the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated, or (d) that there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.

That is the fatal foetal abnormality, but it does not exist in the legislation before us. We are therefore talking about an extraordinarily restrictive situation which, I feel, tightens up the current law and does not add anything to it. In fact, it makes the current law extraordinarily restrictive.

Much has been said about the role of the church in this. The church has a view and is entitled to it. It is expected to express that view, but I am a member of the Catholic Church as well. If, in conscience, I believe that the current law is wide open and this particular law we are bringing in is to tighten up and restrict the current situation - which can only be changed by another referendum, by the way - then I would like to quote from what Pope John Paul II said in Evangelium Vitae. He stated:

In the case of an intrinsically unjust law, such as a law permitting abortion or euthanasia, it is therefore never licit to obey it, or to "take part in a propaganda campaign in favour of such a law, or vote for it".

That is fair enough, but he went on to say:

A particular problem of conscience can arise in cases where a legislative vote would be decisive for the passage of a more restrictive law, aimed at limiting the number of authorized abortions, in place of a more permissive law already passed or ready to be voted on. Such cases are not infrequent. It is a fact that while in some parts of the world there continue to be campaigns to introduce laws favouring abortion, often supported by powerful international organizations, in other nations - particularly those which have already experienced the bitter fruits of such permissive legislation - there are growing signs of a rethinking in this matter. [That is true]. In a case like the one just mentioned, when it is not possible to overturn or completely abrogate a pro-abortion law, an elected official, whose absolute personal opposition to procured abortions was well known, could licitly support proposals aimed at limiting the harm done by such a law and at lessening its negative consequences at the level of general opinion and public morality. This does not in fact represent an illicit co-operation with an unjust law, but rather a legitimate and proper attempt to limit [what the Pope calls] its evil aspects.

We are in a situation currently where the Medical Council states that "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 exemption includes where there is a clear and substantial risk to the life of the mother arising from the threat of suicide, so it is already in our law. It is already there in our basic constitutional law. We are putting parameters and controls on it. I stand to be corrected if I am wrong, but that is how I see it at this stage.

At the recent hearings, a representative of the College of Psychiatrists said that "suicide is very rare in pregnancy before birth, possibly as rare as one in 500,000 births". Suicidal thoughts and feelings are very much more common and the College of Psychiatrists' submission describes the importance of expert professional assessment and treatment of women in these circumstances. Suicide during pregnancy is, therefore, very rare.

I note that central records will be kept of any terminations on medical grounds. Sections 7 and 8 cite the medical grounds, including medical emergencies and illness. Some people have concerns about those as well but I do not because they are already there. I think we need to tighten up on the suicide issue in a big way.

I would have question marks about the time limits and other colleagues have already mentioned these. I am asking for that matter to be re-examined. Children are viable from 24 weeks, but what about 22 or 23 weeks, or 20 weeks? We should have a debate about that. Article 40.3.3o states:

The State acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right.

I would suggest what is happening there is that doctors will be under an obligation to do everything possible to save both lives all the time. That is the overriding issue here.

There is also the issue of false positives, which is quite a concern where suicide, or a suicide decision, is being examined. Quite often psychiatrists might err on the side of caution and may suggest that somebody might be suicidal when in fact they are not, just to be on the safe side. That comes back to what one does first. The first thing one does is to go for counselling, therapies, medication and hospitalisation. As a result of the X case, we have to let in the abortion one. I suggest, however, that because the numbers are so small, if somebody goes through all the other therapies and counselling, what happens at the end will be virtually zero. According to the international symposium on women's health, it does not happen in the UK at all.

Depression tends to come and go in episodes, which is something we must bear in mind. Somebody can be depressed and suicidal today and it might pass in a few days' time, so we must take that into account as well.

Capacity legislation is fast coming down the tracks and is due to be published. There has been mention of people who have a capacity issue to make decisions. It was formerly known as the mental capacity Bill, but will now be called the assisted decision-making Bill. That could have a bearing on this legislation also. Colleagues have cited minors, people with limited intellectual capacity and a limited capacity to make decisions. We need to have clarity around that area. The other Bill is coming down the tracks soon, but it would be useful if both Bills were dealt with together. Many of the instances that were cited involve minors and people in care. The question then arises as to whether they have the capacity to make a decision and the legal capacity which pertains in such a case. We should examine that aspect, so it would be useful if the assisted decision-making Bill was published soon.

I understand that at any stage a judicial review can be sought by a father or others close to the person involved. If I am wrong, however, I stand to be corrected.

Some colleagues have said that we should go to the people on this matter. If there was a referendum in the autumn it would take this House off the hook, but I understand that it is not to be. A decision will be made on it and it could possibly be challenged in the courts. I have no doubt that somebody will challenge the decision in the courts as to whether it is constitutional and the courts will decide on its constitutionality.

I have given a lot of thought to this matter and have treated it with great seriousness. Many people have made representations to me and colleagues in this House on this legislation, more so than any other piece of legislation that I have come across in my time here. As Mrs. Justice Catherine McGuinness said, the decision in the X case is the law of the land and it is necessary to introduce legislation around it.

There has been so much discussion and debate on the Bill that at this stage we are almost all punch drunk from it. Professor Patricia Casey said that "when a person indicates suicidal thoughts or makes threats, whether they are pregnant or not, it is crucial to evaluate these factors". Psychiatrists therefore have to evaluate and listen to what people say. They must also take account of whether what the person plans is lethal or not. This is very often done by interview and I understand that there are very few, or no, biological markers.

One issue of concern is that suicidal intent is not always associated with psychological or psychiatric illness, nor with a wish to die. People can be distressed for all kinds of other reasons, including inter-personal problems, poor coping skills, mental illness or being under the influence of drugs.

Professor Patricia Casey stated that not since 1995 had she seen a pregnant woman for whom abortion was the only or last treatment for suicide. Again and again, it is stated that it is an extraordinarily rare event. What we do not want in passing this legislation is to end up encouraging people to come forward pretending to be suicidal. People have said that suggestion is highly insulting to women. I agree. We must trust in our professional psychiatrists to be able to make a judgment. It is said that it is not possible to predict suicide. Approximately 600 people die by suicide in Ireland every year. The work of Pieta House and others is to be commended. We need to do so much more in this area. When abortion and suicide are linked, as in this instance, it is a serious issue.

I wish to share time with Deputy John O'Mahony.

Is that agreed? Agreed.

I am glad to have the opportunity to speak on this very important Bill, which has been the subject of wide-ranging discussion and deeply, genuinely held views. I think everyone would agree that providing a safe medical environment for both mother and child is vital. We must ensure the integrity and transparency of the legislation and, as stated by the Minister, Deputy Reilly, in his Dáil speech on 20 June, ensure it upholds the constitutional right to life of the unborn.

In the time I have available to me, I wish to approach the Bill on a constructive basis, to look at ensuring its robustness, and where necessary, to enhance and strengthen the framework of the legislation. I thank the Minister for Health, Deputy Reilly, for engaging with me and others in discussions on the Bill. The work of the Minister and his ministerial colleagues, including the Minister of State, Deputy White, who is present in the Chamber, needs to be acknowledged.

I wish to direct my attention today to the broad areas of reporting and good governance in the Bill, the constitutionality of the Bill and other aspects.

The principal reporting and governance sections are section 4, which deals with regulations; section 11, which deals with establishment of review panels; section 15, report by the HSE to the Minister on the operation of the review process; and section 20, dealing with notifications to the Minister of medical procedures carried out under sections 7, 8 and 9, which deal with risk of loss of life of a pregnant woman.

Having studied the legislation in detail, I believe there are areas where the reporting and governance could be enhanced in order to strengthen it. On section 4, which deals with regulations, the Minister for Health stated that he had begun a consultation process with the relevant professional medical bodies to develop clinical guidelines on the implementation of this legislation and the establishment of a multidisciplinary committee to develop these guidelines. I believe this to be a very important aspect of the legislation, in particular section 9, which deals with risk of loss of life from suicide. While I welcome the Minister's initiative, I would like to make two points that I believe would enhance the robustness of the process.

First, nominations to the multidisciplinary committee should be sought from the four relevant medical professional bodies outlined in section 11(3), which relates to the review panel, namely, the Institute of Obstetricians and Gynaecologists, the College of Psychiatrists of Ireland, the Royal College of Surgeons in Ireland and the Royal College of Physicians of Ireland, as well from as the Medical Council and the Irish College of General Practitioners. The medical professions' direct involvement in developing these guidelines is relevant as they have the first-hand knowledge of best clinical practice and research and will be responsible for its implementation. Second, it would make perfect sense for the Bill not to come into operation until the regulations have issued. That is good practise.

On section 11, establishment of the review panel, etc., I welcome, as stated under section 11(3), that the HSE is to request four professional medical bodies to nominate medical practitioners for appointment to the review panel. However, subject to these people meeting the necessary qualifications, their nominations to the review panel should be accepted. This is important for the integrity of the legislation, as they contribute best up-to-date clinical knowledge, practice and research to the process.

I would welcome the same reporting requirements under section 15, reviews, and, section 20, notifications. On the basis of consistency and good governance, the reporting requirements under section 20 should be the same as under section 15. This does not appear to be the case under the Bill as currently drafted. Under section 15(2), an annual report to the Minister provides details of (a) the total number of applications for review received by the HSE; (b) the number of reviews carried out and the reason these reviews were sought; and (c) the outcome of the reviews, while at all times providing absolute confidentiality to the woman involved, which is extremely important. While these measures are to be welcomed, there does not appear to be similar provisions under section 20 for reporting the total number of applications received and refusals under sections 7 and 9. I believe this information should be provided to ensure the Minister has information consistent with that he receives under section 15(2) in respect of reviews.

On the reporting requirements to the Minister under section 20 - notifications, under section 20(3) as currently framed - it would appear the only information currently provided to the Minister in respect of sections 7 and 9, physical illness and the risk of loss of life by suicide, respectively, is the Medical Council registration number for the medical practitioner who carried out the medical procedure under these sections. Specifically, under this subsection, to enhance the governance of the legislation and to ensure the Minister has full information, he or she should be also provided with the Medical Council registration numbers for medical practitioners who carried out the certifications under sections 7 to 9, inclusive, and 13. By ensuring that only the registration numbers of the medical practitioners are provided, the privacy of medical practitioners is maintained. This approach is similar to that under section 20(3) for the medical practitioner who carried out the medical procedure. Furthermore, to provide further assurance on the confidentiality of the medical practitioners involved, under sections 20(4) and 20(5), which are the reports prepared by the Minister, it is up to the Minister to prepare and publish the report in such form and manner as he or she thinks appropriate. The Minister has enormous discretion in this area.

On publication of reports under section 15, reviews, and section 20, notifications, under section 20(4) and 20(5), the Minister prepares and publishes a report in such form and manner as he or she thinks appropriate. For consistency, this publication procedure should also apply under section 15, reviews, and both reports should be laid before each House of the Oireachtas at the time of publication. This reporting process would enhance the integrity of the legislation, while giving the Minister the flexibility to ensure confidentiality is afforded to the woman and medical practitioners involved. It is important this is taken on board to ensure the integrity of the process.

On certification under section 19, section 19(b) of the Bill as drafted relates to the prescribed information to be included in the certificate and may need to be strengthened to ensure the clinical grounds for carrying out the medical procedures are specified. From my reading of the Bill, this may not be the case. For the integrity and transparency of the legislation, it makes sense to ensure this happens.

On the constitutionality of the Bill and other aspects, the Minister made reference to the reasonable opinion definition and specifically stated that the medical practitioner 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 its life. In the interest of clarity, should this point not be explicitly stated in the Bill as part of the definition of reasonable opinion? Furthermore, should the reference to a medical opinion given in good faith - good faith is mentioned throughout the legislation - not also refer to due regard being given to best clinical practice and research, as set out in current medical guidelines in this area?

Since the publication of this Bill, the former Director of Public Prosecutions, DPP, Mr. Eamonn Barnes, has expressed the view that without representation for the unborn under section 9, which deals with risk of loss of life due to suicide, or sections 13 and 14, which deal with reviews, the Bill may be unconstitutional. The constitutionality of all aspects of the legislation needs to be looked at as it may possibly end up before the Supreme Court.

Having studied the legislation in great detail, I raise these points in a constructive manner with the express intention of ensuring the integrity, transparency and effectiveness of the Bill. As legislators, we must test the robustness of the framework underpinning the legislation and ensure it stands up constitutionally because, as I stated, it may end up before the Supreme Court. There is little point in going through the legislative process if we do not do everything possible to achieve this end.

This is a difficult debate for everyone involved. I have proposed reasonable changes which would provide clarity, consistency and transparency in several areas. Above all, they would provide for a safe medical environment for the mother and child, while upholding the rights of the unborn, as provided for in the Constitution.

Since the Government started the process of addressing the ruling of the Supreme Court in the X case by its establishment of an expert group and, in particular, since the group reported its findings, I have had a major concern that the inevitable outcome of this process would be to risk rather than protect human life. My consistent and simple view has been that a mother should always receive whatever medical treatment is necessary to protect her life. Equally, however, the life of the unborn baby should be protected unless and until the life of the mother is under threat. I appreciate that, in practice, the risks and associated treatments cannot always be equally balanced between the life of a mother and that of her unborn child. It is in this context that we are faced with the difficult question of conflict between one life and another. Along the journey of this process, from the report of the expert group to the heads of the Bill to the publication of the text of the legislation, some of my concerns have been allayed, while others remain and will need to be addressed on Committee Stage to allow me to support the Bill on Final Stage.

There are many aspects of the Bill that I welcome and with which I am comfortable. These include the greater clarity and certainty given to the medical profession regarding the legal parameters within which it can take decisions to save the life of a mother in a medical emergency where there is a real and substantial risk to her life. Against this, it is well known that I have an issue of conscience with section 9, which deals with the threat of suicide to the life of a mother if a pregnancy continues. In principle, I cannot accept that there is or should be a right to terminate the life of an unborn child on the ground that there is a risk to the life of the mother where that risk is suicide. This is not a matter of religious belief on my part, but an issue of the human rights of the mother and unborn child.

I have done everything in my power to inform myself and obtain clarity on this issue, including sitting through the majority of the hearings of the Joint Committee on Health and Children in January and May. I met numerous medical, psychiatric and legal experts and politicians, including in other jurisdictions, to hear as many views as possible. I also met women who have had terminations because of suicidal feelings and lived to regret their decision. Last week, l met the Taoiseach, the Minister for Health and the Attorney General to obtain further clarity on this matter. This has informed and perhaps strengthened my view that, in principle, abortion on the grounds of suicidality is not right. These meetings have also informed my understanding of the law and, in practical terms, the changes legislators can make to the Bill before us.

The law was established by the Supreme Court in the X case when it decided that the Constitution permits abortion in circumstances where there is a real and substantial risk to the life of a mother, which risk may include the risk of suicide. While I do not agree with the court's interpretation of Article 40.3.30 of the Constitution, I understand that its decision trumps any desire I or the Government may have to legislate to the contrary. In the more than 20 years since this interpretation of our Constitution has been in force, medical practitioners have taken decisions within the law, as established by the Supreme Court, without having access to legislative guidance or parameters within which to make such difficult and life changing decisions and without specific regulation in this area.

I am aware that Ireland has been criticised by the European Court of Human Rights for failing to clearly outline how the right established in the X case can be accessed. As legislators, we must ask ourselves what can be done to protect as many lives as possible. In doing so, we must distinguish between the law as interpreted in the X case ruling and the proposed legislation. The argument made by those who support the Bill is that in the absence of this legislation, the Supreme Court ruling could, in practice, be interpreted more liberally than section 9, as currently framed. It has been suggested that this view was borne out in the subsequent A and B v. Eastern Health Board case in which the evidence of one psychiatrist was taken to permit termination on the ground of suicide. The obvious question that arises in this context is whether there would have been a different outcome to the case if this legislation had been in place at the time.

It is ironic that the Bill is being strongly opposed by those who campaigned for the 1983 referendum which subsequently resulted in the ruling in the X case. In 2002, people were given an opportunity to remove the suicide ground by referendum and declined to do so. It remains the case, therefore, that a real and substantial threat to the life of a pregnant woman which emanates from suicidality can give rise to a constitutionally permissible termination of pregnancy where that risk can, as a matter of probability, only be averted by such termination. Again, I do not agree in principle that abortion is or should be a treatment for suicide. The decision I have to make, however, is whether the status quo or the framework set out in the proposed legislation will better protect human life. I assure all my constituents and members of the public at large that I will approach this decision with extreme care and seriousness and do everything possible to ensure that whatever scheme is included in the final Bill, regardless of whether I vote for or against it, will protect as many lives as possible. It is only after Committee Stage has been completed that the full picture will become clear in respect of this legislation and at that point I will make a final decision on whether I can support it.

While I do not propose to discuss in detail the amendments suggested by Deputy Kieran O'Donnell, I concur with him on many of the points he raised. At the outset of this process, I stated I did not want my vote on this issue to be taken for granted. That remains the case. In the past nine months, I have read almost 3,000 postcards, 4,500 e-mails and approximately 600 letters and my office has received several thousand telephone calls. I have also met hundreds of people who, for the most part, were respectful in their approach, for which I thank them. However, I object to my staff taking personal abuse, as occurred on several occasions in my offices and at clinics, as they perform an important task that allows me to carry out my work representing my constituents in this House.

There has been much debate as this legislation has come closer to the voting stage about whether a free vote should be given on social and moral issues. Having sat through all the hearings and the debates in this Chamber, the committee rooms and beyond, and having observed that the medical profession, the lawyers, the judges, the psychiatrists and the politicians are split down the middle on the legislation, I am convinced there should have been a free vote on all sides and in all parties. There should not be a conflict between the loyalty to my party and to my conscience. While I respect those who have decided otherwise, I strongly believe that democracy would be strengthened if a free vote was granted. If we are serious about Dáil reform, the opportunity of a free vote on such an extremely contentious and sensitive issue should be addressed as a priority.

I welcome the Minister of State's presence and I welcome the opportunity to speak on this very important Bill, which is about the protection of life.

I am unashamedly a pro-life person who believes in the intrinsic value of human life and who believes that all life is sacred and precious and must be protected. In saying that, I am confident in supporting the Bill. Having listened to all six days of the committee hearings, and having met religious, ethical and medical experts on a one-to-one basis, I am confident that the Bill balances the right to life of the unborn child and the right to life of the mother. Life is not always black and white. It is not always possible, I believe, to save the unborn child and the mother, and I believe the Bill provides for those heart-wrenching situations.

For me the Bill is not about religion, but about life and human rights. I also have a conscience and much has been made in this House and outside about the role of conscience. I have worked to inform my conscience and have listened to mine. With an informed conscience I am making a decision on a personal basis to support the Bill. I will work as I have done with the Minister, Deputy Reilly, and the Ministers of State, Deputies White and Lynch, on amendments to bring further clarity if needed.

The Bill deals only with situations where there is a real and substantial risk to the life of the mother from physical risk to emergency situations and in case of suicide. In all cases the Bill requires doctors to have "regard to the need to preserve unborn human life". This ensures that the rights of the unborn are fully considered and respected in all cases where the Bill will apply. It ensures that Article 40.3.3° of the Constitution is fully respected and adhered to. Nothing in the Bill permits the direct and intentional ending of the life of innocent human beings, as portrayed by some. The Bill ensures that to save the life of the mother it is lawful to carry out any medical procedure.

The Minister has included a number of reporting mechanisms to ensure compliance with both the letter and the spirit of the Bill and importantly to ensure that in practice the Bill remains within the confines of Article 40.3.3° of Bunreacht na hÉireann. This reinforces the clear intention of the Bill to clarify our current legal position - not to go any further or to create any new rights. By having proper reporting mechanisms in place we can ensure that the Bill operates as intended by the Minister, the Taoiseach and the Government. However, I ask the Minister to consider inserting a provision requiring an annual report to be laid before the Houses of the Oireachtas in whatever shape that may be. I believe that would enhance the formality of the report and oblige all future Ministers for Health to carry out this Minister's clear intention for an open and transparent reporting mechanism.

The Bill puts in place controls and regulations for what already is permissible. If we object to the Bill we are continuing to allow a situation that hands all power to individual doctors. The State, the regulators, the people and this House of elected representatives would continue to be sidelined in this most fundamental of issues. The Bill is not just about legislating for the X case, but it is about legislating for Article 40.3.3° of Bunreacht na hÉireann. It is about legislating finally, after 30 years, to ensure the State will be fulfilling its obligations and its guarantee to "respect, and, as far as practicable, by its laws to defend and vindicate" those rights.

Dr. Rhona Mahony made a telling contribution during the committee hearings when she said, "If a woman commits suicide, she dies and her baby dies too." As a country we must be proud of the compassion our courts have shown in dealing with very difficult individual circumstances and human tragedies that have been presented to them. One of the most difficult human tragedies that presented was the X case. It required the court to consider a 14-year old girl, pregnant as a result of rape and presenting with suicidal intent. The court had the task of interpreting Article 40.3.3° as inserted by the eighth amendment to the Constitution.

In that case the then Chief Justice stated that the "proper test to be applied is that if it is established as a matter of probability that there is a real and substantial risk to the life, as distinct from the health, of the mother, which can only be avoided by the termination of her pregnancy, such termination is permissible, having regard to the true interpretation of Article 40.3.3° of the Constitution." There has been much debate recently as to whether the issue of suicide as a ground for termination of a pregnancy is in fact law in this country. If it is not, why were two referenda, held in 1992 and 1993, trying to exclude it as a ground? Why then does the current Medical Council guideline 21.1 state as follows:

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.

In the X case judgment, the issue was specifically addressed. Again I quote the then Chief Justice, Mr. Justice Finlay, in setting out that legal test as being that "there is a real and substantial risk to the life of the mother by self-destruction which can only be avoided by termination of her pregnancy."

It is clear that in this country pregnancies can be terminated when there is a real and substantial risk to the life of the pregnant woman, including a risk from suicide. This test has been consistently upheld. However, there is no regulation or control of any such termination. There is no regulation as to how decisions are made or even on who can take decisions and in what locations a pregnancy can be terminated.

I understand the concerns of many people regarding section 9, which deals with a risk to life from suicide. I also share this anxiety and I have reflected on this deeply. However, I reiterate that current Medical Council guidelines make clear that this is a ground for terminating a pregnancy as I read out earlier. In this context it is important to recall what Dr. Anthony McCarthy told the committee hearings: "Suicide in pregnancy is real; it is a real risk and it does happen." Despite what others have said, part of the professional skill set of a psychiatrist is assessing suicide risk. The College of Psychiatrists of Ireland in its submission confirmed that by stating:

Psychiatrists are trained to assess mental states, mental illness and suicidal risk and if trained to Specialist level are competent to do so. These assessments form part of our everyday work.

Pregnancy is a very vulnerable time for women, both from physical and mental health perspectives. As a State, we must ensure that all possible supports are available, which is what this Bill is doing. The Bill does not prescribe any treatment, but deals with the legal grounds. It provides a framework for decisions but, as in practice today, it relies on our highly trained doctors to appropriately care for a pregnant woman.

If the Bill explicitly excludes suicide as a ground then the legislation could be struck down as unconstitutional as it would be denying access to a right which is permitted by the Constitution. Restricting a "real and substantial risk" to a physical risk would be restricting the availability of a constitutional right and would risk defeat in the Supreme Court for being unconstitutional.

There are two ways of addressing the issue of suicide in this context. One is by referendum, which has already been rejected twice by the people. The other is by robust legislation that regulates and controls access to this existing constitutional right, which is exactly what is proposed in this Bill.

Some people say they would support the Bill if section 9 was not included. If that was the case, we would face other difficulties and perhaps future problems.

We may even find ourselves back here again having the same debate in years to come. If there is no mention of threat of suicide in the Bill then it is still open to a court to continue to interpret the Constitution such that a right to a termination exists. Like today, there would be no control over how this right could be exercised.

Everyone who is uncomfortable with section 9 must seriously consider whether opposing the Bill would actually achieve their overall objective. In my humble opinion it would not. Opposing the Bill does not change the legal position. Suicide will remain a grounds for termination of pregnancy. Why do people who oppose the Bill not object to the current medical guidelines? It is contradictory to oppose to the Bill yet not object to the medical guidelines that neither regulate nor control how existing rights are operated.

In January the Joint Committee on Health and Children, which I chair, held hearings on the Government decision following the report of the expert review group on the A, B and C v. Ireland judgment. We are told that judgments are about what happens in practice. The myth that terminations of pregnancy do not occur in Ireland was dismissed. Dr. Sam Coulter-Smith, master of the Rotunda Hospital, which caters for approximately 12% of births in the country, told us that the Rotunda sees:

....about 40 very significantly sick mothers with life-threatening issues annually...On average, we have approximately five or six cases a year in which interruption of the pregnancy is required to save the mother's life.

Other leading practitioners gave similar evidence. By extrapolation, we have approximately 30 to 40 such procedures each year in our hospitals. We are told that cases of tragic maternal deaths cause heartache for the families involved and distress for medical staff. In discussing the issue, Dr. Rhona Mahony stated:

If one looks back at maternal deaths, one can see there were six deaths arising directly from pregnancy complications but double that number, 13 deaths, arising in women who had pre-existing medical disease. Five of these women had pre-existing cardiovascular disease, two died by suicide and two of influenza, and there were a variety of other medical causes, including liver disease and lung disease.

These are the hard cases that present to our highly-skilled doctors, who do not operate in a vacuum. Dealing with these cases will always be difficult for doctors but, as Members of this august body, Oireachtas Éireann, we have no right to make their task more difficult. We should not place our medical professionals in a position whereby they are unsure of what they can and cannot do. No doctor or medical professional should have to second-guess his or her clinical expertise. The Bill is about giving clarity on what can and cannot be done when there is a real and substantial risk to the life of a pregnant woman. Doctors themselves have called for clarity in this matter. However, this is not only about the doctors. It is about giving clarity to women on what can be done to save their lives if they are at risk during pregnancy. It is also about protecting the unborn child.

Apart from the pressing realities facing doctors and pregnant women there are also legal reasons for acting and legislating. The administration of our democracy is vested in the tripartite of the Executive, Members of the Legislature and the Judiciary, all operating within the parameters set down by the people in the Constitution. Each arm of the State has a distinct role, but each arm must also operate within the parameters defined by the people and as interpreted by the Supreme Court until such time as the people change those parameters.

In the A, B and C v. Ireland case, the European Court of Human Rights held that the lack of legislation providing for rights under Article 40.3.3° has resulted in striking discordance between the theoretical right to allow for abortion in Ireland on grounds of a relevant risk to the woman's life and the reality of its practical implementation. It went on to state that the implementation would amount to rendering effective a right already accorded after the referendum by Article 40.3.3° of the Constitution. The European Court of Human Rights has not asked us to change our legal position. It has said that we should give clarity to rights that already exist but that is not the only court which has called for legislation. Our Supreme Court also did so in 1992. In the X case judgment Mr. Justice McCarthy criticised the Oireachtas stating: "The failure of the Legislature to enact the appropriate legislation is no longer just unfortunate; it is inexcusable".

Some argue that we do not have to legislate and that instead we should have regulations. Leaving aside that our Supreme Court has said otherwise, what issues would arise with mere regulation? Regulations require legislation. They cannot be made without a legislative basis. If basic legislation was passed then it would be left to the Minister to issue regulations which can be done without reference to the Dáil. This could mean each Minister for Health could issue new regulations depending on his personal viewpoint. Some fear legislation because it would make reference to grounds for lawful termination of pregnancy, a proposition with which they do not agree. However, today medical guidelines clearly state that a threat of suicide is an exception to the general provision on terminating a pregnancy in Ireland.

Today the people, through us, their representatives in the House, have no control over how this is implemented or controlled. By putting in place legislation we can control what happens without changing the legal position. The Bill does not legalise anything that is either illegal or unconstitutional today. We are elected to this House by the people. We are elected to uphold the Constitution yet we are also constrained by its terms. The Bill walks that fine line and gives effect to an existing constitutional entitlement and remains within the confines of Article 40.3.3°. Article 40.3.3° has been held out by those who refer to themselves as pro-life as a victory. According to the website of the Pro Life Campaign: "The Amendment protects the right to life of the unborn child and ensures that women receive all necessary medical treatments when pregnant. It is regarded internationally as one of the key pro-life victories of the past 40 years." If the Bill is passed by the Oireachtas the same protection which was sought by and held out as a seminal victory will remain in place. No legislation can go beyond how the Constitution constrains the hands of this House. At the moment Article 40.3.3° is the buttress against the so-called and often-feared floodgates. If this Bill is enacted it will remain the buttress but it will be reinforced. Added protection will be afforded to doctors and women giving them guidance on what they can and cannot do and on how to make decisions within our existing constitutional provisions.

Much has been made of term limits and a major discussion has taken place on the issue. Parallels have been drawn with other countries. I believe there are really legitimate concerns that have been expressed by many. However, in countries where term limits apply there are exceptions such that a pregnancy may be terminated at any stage where it is necessary to save the life of the pregnant woman. The Bill is about taking action when the life of a pregnant woman is at risk. If term limits are put in the legislation, what happens when the woman's life is at risk after the term limit expires? We would be providing that after such a time, a doctor could not intervene to save the life of the mother.

We need to ensure that legislation reflects the constitutional protection afforded to both the unborn child and the mother. We must ensure that every effort is made to ensure the survival of the unborn child who must be delivered early to avert risk to the mother's life. I was that child. I am that person. I was born prematurely to a mother whose life was at risk. I am telling that tale in the House today. The Bill requires that any doctor making a decision in a situation where there is a threat to the life of a pregnant woman must have regard to the need to preserve unborn human life. This reflects our constitutional position and obliges a doctor to make every effort possible to save the lives of both the unborn child and the mother. However, if this can be made more explicit it is something that should be given further consideration on Committee and Report Stages.

I do not buy the argument relating to California, England and other jurisdictions. Simon Mills made the point during the hearings that we have Article 40.3.3° and that it is the bulwark. I do not buy the argument at all.

We must do our business in the House as Members of the Legislature. Like many in the House, I have heard from constituents who oppose the Bill, from some who favour the Bill and from some who oppose it because it does not go far enough. Some have called to my office, others have rung my office, some have protested, others have sent anonymous letters, some have sent e-mails while others have made threats, which I have reported to An Garda Síochána. I thank all those who have engaged in a respectful manner. I am loth to use categories but I am a pro-life person; that is my disposition. As I stated at the beginning, I believe life is precious and I should know more than most in the House tonight about it. I am convinced that a substantial majority of people in the country support the Bill and what the Government is doing.

I have a conscience and I am acting with my conscience to support the legislation to protect the lives of women and their unborn children and to provide clarity to professional medical and nursing personnel. The Bill seeks to address one aspect of this reality: where there is a real and substantial risk to the life of the mother. Doctors will act on their medical experience and deserve to be given legal clarity and protection when so doing.

I commend the Minister on listening and engaging with Members of the House. I look forward to Committee Stage and Report Stage, when he will table amendments with other Members of the House. The Bill is a restrictive piece of legislation. It will not open the floodgates. It will protect life. I am disappointed and upset at colleagues and friends of mine who feel otherwise. I appeal to them again to engage with all of us on the Government side of the House to ensure we can support the legislation, which protects, preserves and promotes life during pregnancy and beyond.

I wish to share time with Deputies Liam Twomey and Pat Deering.

Is that agreed? Agreed.

I am pleased to have the opportunity to speak on this very important piece of legislation. I wish to state at the outset that I will be voting with my conscience and with the Government on this issue, as I do on every other issue. I wish to set out some facts which I hope will explain my reasons for doing so. However, before I do that I wish to say that a great deal of misinformation is in the public domain in respect of the Bill. Over the past year, I have met men and women both in Offaly and in Leinster House who have sought to discuss this issue with me. I have returned phone calls, e-mails and letters. In all cases, people outlined their genuine fears and I answered their questions truthfully and to the best of my ability, and was happy to do so. However, I have been disappointed by the actions taken by some individuals and groups opposing the Bill. Putting emotive slogans above photos of Fine Gael Deputies on posters along national primary and secondary routes, taking out full-page dramatic advertisements in local newspapers exhorting readers to contact local Fine Gael Deputies, with our names and telephone numbers located under inaccurate headlines and disturbing photographs, and sending bizarre newsletters, anonymous letters and e-mails, a minority of whose content is unspeakable, are just some of the tactics used in the campaign. We live in a democracy and people are entitled to lobby. However, I would imagine they will discover these methods are hardly the best way to achieve their aims. I am sure that in time their campaign strategy will be reviewed and I would be surprised if they did not realise quickly that diplomacy is how lobbying works best. Interestingly, some of their public exhortations worked in the sense that my constituency office telephone was very busy the day the advertisement appeared in the local newspaper. It worked from that perspective; however, the callers were ringing to express their disgust at the content and urge me not to be intimidated by it. Most significantly, every call was from a woman.

The first and most important aspect of the Bill is that it restates the general prohibition on abortion in Ireland. Its only aim is to place a legal framework on an already existing narrow provision created by Article 40.3.3° of the Constitution, which was interpreted by the Supreme Court in 1992 to allow for the lawful termination of a pregnancy where it is established as a matter of probability that there is a real and substantial risk to the life of the woman and that risk can be averted only by the termination of her pregnancy. The Bill remains strictly within the parameters of the Constitution and will not create any new rights. The medical termination of pregnancy will be permitted only under three circumstances in which there is a medically determined need: a real and substantial risk of loss of life from physical illness; a real and substantial risk of loss of life from physical illness in an emergency; and a real and substantial risk of loss of life from suicide. In each of these situations the doctor or doctors involved in the assessment will have to unanimously certify that a termination is the only treatment that will save the woman's life.

The risk of loss of life from suicide has caused much debate and it is worth pointing out that the Government has taken great care to introduce new safeguards in this area. Under the proposed legislation, four doctors - if the woman's GP is included - will be required to take part in the assessment process. Currently, the opinion of just one doctor is sufficient, as evidenced by the Medical Council's Guide to Professional Conduct and Ethics for Registered Medical Practitioners, published in 2009. The guide states:

21.1 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.

This area is completely unregulated by legislation at present. It is also worth pointing out that termination of pregnancy could be achieved by the safe delivery of the baby and not the termination of its life. I welcome the fact that the Bill also contains provisions to allow for conscientious objection by medical and nursing personnel. As an additional safeguard, the Bill contains review provisions to ensure the law is faithfully followed in this area.

I absolutely reject the suggestion made by some that women will pretend to be suicidal to obtain terminations. As a woman I find this suggestion objectionable. For many this Bill does not go far enough, particularly in the area of fatal foetal abnormality and pregnancies as a result of rape or incest. I sympathise sincerely with those who have experienced such trauma; however, as An Taoiseach clarified in the Dáil last week and again today, it is outside the scope of this legislation to deal with such issues.

As a woman and a parent, I am confident that the Bill will give legal clarity, which has been absent to date under Irish law, to women and their doctors. An unfortunate feature of this debate is that it is being argued in stark black and white terms. Having a baby is the most natural thing in the world but, as I know only too well, pregnancies can go wrong. In what are thankfully a small number of circumstances, that can pose a risk to the mother's life. The reality is that sometimes medical intervention is required to save a woman's life in pregnancy. A woman may have other children waiting for her to come home. She will mourn the loss of a much-anticipated baby and she may go on to have other children. The Constitution permits that. What the Bill seeks to do is to ensure clarity for women and medical professionals in respect of these existing rights. This strict legislation and regulations will outline the circumstances in which a medical termination is permissible - that is, where there is a real and substantial risk to the life, as opposed to the health, of a woman as the result of a pregnancy - and it upholds the equal right to life of both the mother and her unborn baby under the Constitution. I firmly believe that this Bill will protect the lives of both mothers and their unborn babies in the future.

In years to come, when we look back on this legislation and see current practice, we will realise that putting it on the Statute Book may have been historic, but the content of the legislation will not be so controversial. My expectation on reading the legislation for the first time was that groups and individuals who support a more pro-choice regime would have been the ones who were up in arms. It seems that when it comes to matters relating to the uterus of a pregnant Irish woman the political response can often be utterly unpredictable. The controversial aspect of the legislation relates to suicidal intent. I would have expected the support of the pro-life lobby for the highly restrictive nature of the legislation, coming as it does from the Supreme Court judgment, but in fact the opposite has happened. That does surprise me.

During the course of the debate in recent months the most throwaway remark ever must have been “to open the floodgates”. It is important to put on record the political and legislative history of women’s reproductive rights in this country. When Mr. C. J. Haughey was Minister for Health, one could only get the pill to regulate one’s cycle. This country had an enormous number of women with irregular cycles. In fact, one had to get a prescription to buy a box of condoms, and one had to be married in order to get such a prescription. That was the situation in my lifetime. That was when po-faced elderly men who saw themselves as the guardians of a woman’s cervix lectured to me when I was a teenager. I found it absolutely ridiculous. That is not that long ago.

It is interesting how quickly a situation can evolve. Three things happened. A woman could get a tubal ligation or the morning-after pill, or have a coil inserted into her uterus, all of which prevent implantation. According to the purists, they are all abortifacients, yet there was little if any controversy around those issues. In fact, it has now got to the stage at which the morning-after pill will soon be available without prescription. It is certainly more accessible than people think. Unfortunately, there are also concerns, about which we must be vigilant. There is an abortifacient pill, known as RU-486 when I was in medical school – I am not sure of the current medical name for it – that women can now buy over the Internet. My concern is that younger women who are not aware of the complications that can arise are buying it. There is a need for us to be open-minded about this type of debate in order that we can genuinely protect women and not just pay lip service to that aim. Much of what was done in terms of tubal ligation, the morning-after pill and the prescription of oral contraceptives to women helped to save their lives.

Women with large families who had one birth after another experienced untold morbidity. They had problems with incontinence and poor health and some women also lost their lives. Irish society has changed quite dramatically, much of it for the good. In the meantime, we have witnessed the ultimate double standard, in that we have put into the Constitution the right to travel to Manchester for termination. However, were one to do the same for any woman in Ireland, one would be told it would lead to a fall in the standards of care to pregnant women in Ireland. This sort of doublespeak and doublethink actually puts the Taliban in the ha'penny place with regard to talking about women's reproductive rights. Moreover, it also is highly insulting to the doctors and midwives in the health care system.

Members also should bear in mind that on average, each general practitioner, GP, encounters two women in his or her practice who seek a termination outside this jurisdiction each year. Ireland is evolving. We have had terminations in this country for years and we have a health care system that allows women to have much greater control over their reproductive lives. Members should consider how the system is evolving. They are not opening floodgates and in fact are doing very little in this regard. While they may think they are doing a lot, very little is being done. Members are way behind the curve as to how patients and women think about themselves. I am bringing that experience as a doctor to the debate. I am pro-life and do not like the idea of terminating a pregnancy. However, I also respect the right of every woman with regard to how she wishes to live her life. Moreover, I do not wish to be judgmental towards women or anyone else because I have seen people at their weakest and I know how frail is human nature. This spirit also should be brought into this debate with regard to how Members legislate and look after people in this society.

First, I thank the Leas-Cheann Comhairle for giving me an opportunity to speak on this issue. It is important that all Members get an opportunity to explain their position on the matter. In speaking on this Bill, I am highly conscious that this issue has divided Irish society over the past three decades. It is a highly sensitive, emotive and difficult issue for each Member present. At the outset, it is important to recall what is the main purpose of the Protection of Life During Pregnancy Bill 2013. Its main purpose is to restate the general prohibition of abortion in Ireland, which all Members obviously will welcome, and to regulate 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 proposes to confer procedural rights on a woman who believes she has a life-threatening condition, in order that she can have certainty as to whether she requires this termination. It also is important to point out that nothing new is being introduced here and it is strictly within the Constitution.

In discussing this issue, Members must not lose sight of two very important issues that have been the subject of very little discussion in this debate thus far. First, approximately 30 terminations take place in Irish hospitals annually without any regulation and this is now being restricted. The fact that women with an issue can enter a hospital and can avail of a termination without regulation or protection is an important point to bear in mind. Second, approximately 3,000 women travel abroad each year and as my colleague, Deputy Twomey has noted, there is doublespeak in this regard. In some cases, the terminations take place in back-street clinics without any regulation and in some cases, they have a detrimental effect on the women's health thereafter. It is for these two reasons that I believe the Bill deserves support because of the protection it gives to women during pregnancy.

As I already have stated, approximately 30 terminations take place in Irish maternity hospitals each year without any regulations. It is for this reason that Members must ensure legislation is put in place to protect the mother and medical professions. At the same time, Members must ensure it is highly restrictive. It must be so restrictive that it ensures the so-called floodgates are not opened. In this case, I believe the Minister for Health has achieved the required securities in this Bill under the three headings in Chapter 1, sections 7, 8 and 9. In section 7, which provides for a risk to life from a physical illness, two medical practitioners will be required to examine a pregnant woman and certify, in good faith, there is a real and substantial risk of life and the only way this can be avoided is by carrying out a procedure. In section 8, where there is the risk of life from a physical illness in an emergency situation, one medical practitioner's assessment will be required. This provision is completely new. Obviously, sections 7 and 8 are the two straightforward sections, while section 9 contains the provision that creates difficulty for all Members. However, under section 9, which deals with a risk from suicide, three medical practitioners will be required, namely, an obstetrician and two psychiatrists and the fact they will be obliged to decide unanimously to agree restricts this provision greatly. It is so restrictive that I believe what will actually happen in this case is that a pregnant lady will end up making a decision to take the aeroplane or boat abroad to have a termination, rather than putting herself before a board to be assessed. On Committee Stage, Members must ensure that all anomalies within the Bill are addressed to ensure the so-called floodgates, if they exist, remain closed.

The other element in the Bill I wish to mention is the notification stage and I refer to the point I mentioned earlier regarding the 30 terminations that take place annually in hospitals around the country without any regulation, without anyone being notified, with no one knowing precisely what happens or to whom and without the Minister being notified. I welcome this provision in the Bill, which states that not later than 28 days after a medical procedure having been carried out, the appropriate information must be forwarded to the Minister. As Members are aware, this information is to include the Medical Council registration number attached to the medical practitioner who carried out the medical procedure, whether the procedure was carried out under section 7, section 8 or section 9, as well as the location of the procedure. While this reporting mechanism is welcome, I seek an opportunity whereby there can be a meaningful review on an annual basis to ensure that no abuses take place and this might be addressed on Committee Stage.

In conclusion, this is an issue I did not address earlier during the debate in January and I was not involved in detail at the different hearings but only from a distance. However, after much consideration - like my colleagues who spoke previously, I also have a conscience - and as a practising Catholic who would consider himself to be pro-life, I believe it is important that this Bill be passed. It is important that every safeguard possible is put in place to ensure that no abuses take place. It may have been suggested earlier that someone might take advantage of this Bill by suggesting she may be suicidal. However, that suggestion must be knocked on the head straight away. This Bill brings certainty and clarity to the medical practitioners in this country and gives the women of Ireland the safety they require to ensure they are protected during pregnancy. For this reason, I commend the Bill to the House.

I thank the Leas-Cheann Comhairle and am delighted to have an opportunity to speak on this most important legislation. Like him, I have been around this House for similar discussions over many years. My earliest recollection of a similar debate was as a very small child, when legislation was brought through the Houses by the late Dr. Noel Browne, namely, the famous mother and child scheme. That was a long time ago and there have been many debates in this Chamber in the intervening years. The issue was revisited in the 1980s when a debate arose in which it was considered necessary to, in the phrase used at the time, enshrine in the Constitution the protection of the life of the unborn. Moreover, there was no general disagreement with that. However, the issue became really difficult at the time of the formulation of the wording. At the time, two Attorneys General advised the pro-life movement to the effect that the proposed wording would arrive at a situation whereby abortion in some shape or form would actually be permissible. This is what happened and it happened rather more quickly than people had anticipated. Incidentally, like the Leas-Cheann Comhairle and many other Members of this House, I have been the recipient of thousands of e-mails, letters and postcards, all indicating a particular preference. In common with everyone else, I have tried to respond, in so far as I could.

Like many Members of this House, I am a Catholic. I am sure I am not the best one in either this House or country and I certainly do not propose to judge any of my peers. I do not have the moral right to judge, except in a court of law, where that kind of judgment can take place. I wish to refer to a court of law because it has featured repeatedly in the course of this debate over the past six months. It has featured on the basis that the Supreme Court was wrong in its determination regarding the 1983 amendment to the Constitution.

That was on the basis that it did not hear all the evidence, but that is not the job of the court. The court heard all the evidence given to it and made a decision based on the evidence. Members have since reiterated that the judges made a judgment on the case presented before them. If they had not done that they would have been delinquent in their responsibility, but they did.

The problem was the equality of the right to life of the mother and the unborn. It was always understood that the medical profession and the State would do all in its power to try to ensure that was observed. However, a situation arose whereby a decision had to be made in favour of one or the other. That may seem to be a violation of what was decided by the people but the only way that could have been done at the time was to do nothing and observe both die, and that was not an option. I believe the Supreme Court was correct.

I would remind people inside and outside this House that one always disputes the decisions of the courts but whether we like it, when a case goes up along the line to the Supreme Court we must accept its decision. That is a sad fact of life, but that is the way it is. We may have our personal views but as the Supreme Court remains the supreme court in this country, there is nothing else to do other than appeal to a higher court elsewhere such as the European Court of Justice or whatever. That was always available to people. People could have done that if they wanted to, but they did not.

I turn now to the case presented and the recent events that took place. I attended the hearings in January and in May held in the Oireachtas and I compliment my colleague, Deputy Jerry Buttimer, on his chairing of those meetings. I compliment also all those who made submissions and appeared before the committee. One thing is certain, and I want to emphasise this point, depending on the person to whom one speaks outside this House the automatic response will be that the hearings determined clearly and unequivocally on one side or the other, but they did not. On the medical grounds the determination was quite clear. On the case of suicide, it was not clear; there was a debate about that.

I am in a quandary as to how to determine what was meant in some of the arguments made. It has been suggested to me that 130 psychiatrists made a submission to the effect that it was impossible to determine whether suicide was inevitable in certain circumstances. That may be the case, and that may be their view, but we must not forget that psychiatrists have addressed the courts and decisions have been made on the basis of their evidence, which was deemed to be good, sound, professional evidence. They did that in good faith.

Regarding the sequence of events leading to the situation in which we now find ourselves, we had the 1861 Act, which prohibits abortion. We had the Health (Family Planning) Act of 1979, which recites the prohibition on abortion. We had the 1983 Eighth Amendment of the Constitution, which acknowledged the right to life of the unborn with due regard for the equal right to life of the mother. It is that equal right to which I have already referred in regard to the X case. We then had the X case, which sets out the criteria for lawful abortion or termination of a pregnancy. I have referred to that already.

We then had the 1992 Thirteenth and Fourteenth Amendments of the Constitution, which ensure the right to travel for an abortion outside this jurisdiction. Questions have been asked as to the reason young women in care should be allowed travel outside the State for such services. It is simply because the State is obliged to ensure that whatever right or entitlement is available under the Constitution is made available to such persons. To do otherwise would leave the State open to a legal challenge.

Similarly, I do not agree with those who say there is no obligation on the Oireachtas to legislate for the X case. The European Court has already referred to that. There may not be a legal obligation but in the event of the Oireachtas being unwilling or unable to provide a legislative base for the 1983 amendment to the Constitution, as interpreted by the Supreme Court, it could leave the State open to a serious legal challenge and consequential costs. I am not a legal practitioner. The Minister of State is, and he has considerable knowledge in that area. I do not wish to argue a case one way or the other at this juncture but I assure the House that from what I have read there is considerable ground for believing that could happen.

Much has been spoken about suicide being a ground for abortion but we always forget that the people of this country decided twice on this issue by way of referendum. We can view that any way we like, and there is no sense in saying that those in the different lobbies did that for contradictory reasons. That is not the issue; the issue is the final outcome.

At the same time people suggest we should have another referendum. I would have a concern about that for a different reason. I would seriously worry about using a referendum to bypass the Supreme Court in any country. It is a dangerous route to take and in other jurisdictions where that has been used as a means of dealing with the decision of a court that some people did not like, it had disastrous consequences.

It has been suggested to me that a pregnant woman has never committed suicide in this country. I do not wish to go into the particular details but that statement is untrue. For whatever reason women who were pregnant have felt suicidal and in those circumstances there is an obligation on all of us to ensure, in the event of that arising at any stage of their pregnancy, that they receive treatment. It cannot be treatment that excludes one type of treatment or another. It must be whatever treatment will deal with their particular situation. That is my view, and if we did not recognise that as legislators we are not doing our job.

In the past women here did not always receive the highest quality treatment. I have spoken about that previously. It is a fact of life that some of the procedures offered to or forced upon women in the past 50 years were unpardonable. We should never allow ourselves to even venture into an area whereby we determine the extent of the lack of facilities, services or treatment that might be made available to a woman or a girl in the event of becoming pregnant.

I am pro-life, as I am sure is the Leas-Cheann Comhairle and everybody else in this House. I am certainly not pro-death, as suggested to me in some e-mails I received recently. However, despite the best intentions, cases will arise whereby the life of the mother and the life of the unborn are in the balance. Two situations then arise. The first is the pre-viable state in which case a serious risk to the health of the mother will warrant, even more now under this legislation than under the previous amendment to the Constitution, that an intervention is required. The theory as put forward by some people is that the intention is to kill the unborn child. That is not true. It is not permitted under our Constitution, and there can be no doubt about that.

The second situation, and this was referred to obliquely and unfairly recently, is the post-viable stage of the unborn where a pregnant mother may find herself with a health condition that requires an intervention. It has been suggested that the intervention at that stage could lead to brain damage in the unborn child or whatever, and so it could, but so could a normal birth in normal circumstances. One thing is certain, however. In the event of the mother suffering from a condition that will ultimately lead to her death, there is no doubt in my mind that inducement is required.

I ask those who suggest inducement should not be allowed in such circumstances to give careful consideration to the matter. Ultimately, not allowing inducement would result in the willful death of the pregnant woman. It follows that if nothing was done in a scenario such as that to which I refer, the pregnant mother and her unborn baby could both die. In the past, both mother and baby have died. This matter must be addressed. Therefore, I strongly urge people to give careful consideration to all of the implications involved.

It must be acknowledged that pregnant women cannot always be entirely in control of the situations in which they find themselves. We all accept that unborn babies are very vulnerable. That is true and some of the situations which arise can be extremely difficult. However, expectant mothers can also be vulnerable and if they have particular medical conditions, they may not be in a position to offer advice on what should be done. However, it should not fall to a group of experts - regardless of whether they are men or women - to determine the treatment to which an expectant mother in circumstances such as those to which I refer is entitled. One can visualise what would happen if a male member of the public found himself requiring specific hospital treatment and he was left wondering whether the provision of such treatment would be approved by a particular body, group or court or at a public meeting. There would be a very understandable reaction from members of the male population to such an eventuality and they would be right. Similarly, women who find themselves in vulnerable positions should have the right to expect the protection of the State as laid down in the Supreme Court's interpretation of the 1983 amendment to the Constitution.

Another interesting matter to which I wish to refer is that which relates to conscience and conscientious objection. What the Government is proposing to do via the Bill is to try to ensure pregnant women will, within reason, have an expectation of standard or universal treatment when they present in hospital with particular conditions. This means that it will not be the responsibility of one or other body, institution or ethos to determine the extent to which a woman's condition will be addressed. This is critical and it was referred to by various individuals who contributed to the hearings of the Joint Committee on Health and Children. It is hugely important that a person going into hospital to receive treatment, particularly a woman with a problem pregnancy or who is facing an emergency as a result of such a pregnancy, will be catered for. I accept that most pregnancies are trouble-free, but it must be recognised that where difficulties arise, the woman involved is entitled to expect a certain response. The nature of that response must be laid down by the State. The entitlement of a woman to such a response is determined in law by the Supreme Court, regardless of whether her predicament arises on foot of a physical or mental condition. I do not believe we are in a position to second-guess the decisions of the Supreme Court in such matters. If we begin to do so, we will be faced with a problem. The Bill will, to a huge extent, eliminate variations in the treatment a pregnant woman can expect to receive when she presents with a particular condition.

Various references have been made to the separation of powers and the fact that the courts have no function in determining what the Oireachtas might do. However, the courts have the right to identify deficiencies in the extent to which the Legislature addresses issues which have arisen as a result of the evolution of the law or society over a period. That is what is being done in this instance. Avoiding identifying such deficiencies would be a dereliction of duty.

This is good legislation, it is sound, pro-life and sets out the parameters within which the terms of the 1983 amendment to the Constitution, as interpreted by the Supreme Court, should be followed. A tremendous job has been done in addressing that issue in the Bill which I hope it will be passed. I will certainly be voting in favour of it. I would have preferred if it included a provision in respect of rape and incest, but I recognise the reasons this could not be done. I have had some very interesting discussions with people who are strongly opposed to my point of view in this regard. I am sincere in my opinion on this matter and, as stated, I do not propose to sit in judgment on others and I do not propose to allow them to sit in judgment on me. I am not God and neither are they. Those who want to assume the position of a deity will be obliged to wait for the afterlife in order to do so. When and if that time comes and if we are to be judged, I hope we will be judged mercifully.

I met a large number of individuals and groups to discuss this issue and the proposed legislation. It is clear that the vast majority of people whom I met were very sincere and exercised in articulating their concerns about the content of the legislation. There is no doubt that many individuals who would define themselves as being either pro-choice or pro-life will be unhappy with the final legislation passed in this House. Ultimately, however, the Government has a responsibly to enact laws which are consistent with the views of the people as set out in the Constitution and interpreted by the Supreme Court. The Government is also obliged to provide clarity in the law under the terms of the judgment handed down in the A, B and C v. Ireland case. Many of the pro-life individuals I met would like to another referendum to be held in order to narrow the definition of a lawful termination to exclude a termination where the main risk factor to the life of the mother is based around a risk of suicide. Many others are quite clear that everything should be done to save the life of a mother where there is a real and substantial risk to her life, regardless of whether that risk is physical or psychological in nature. The vast majority of people I met who personalised the matter in order to include their own loved ones were very clear in stating everything should be done primarily to save the life of their loved one, regardless of from where the risk emanated.

A substantial number of people expressed the view to me that a termination should be available for the victims of rape or incest or where a foetus had a fatal foetal abnormality and would not be viable outside the womb. They will not be satisfied with this legislation, but in the absence of a referendum, the Government simply cannot act on their wishes. If it were to do so, it would be acting in an unconstitutional fashion. I met very few people who said they wished to see abortion on demand introduced in this country, either now or in the future. A substantial majority of the people are of this view, as has been consistently shown in opinion polls during the years. This reflects the view of the vast majority of the people that every life is precious and that a termination of pregnancy should only be lawful in the very restrictive circumstances I have outlined.

The people have given their views on this issue in three previous referendums. Some speculate that the people were confused about what they were voting on in the two referendums held in the aftermath of the decision handed down in the X case. The fact remains, however, that on two previous occasions the people rejected amending the Constitution to remove a real and substantial risk of suicide as a legitimate ground for obtaining a termination in Ireland. The country was fairly evenly divided on the most recent occasion. I am not convinced that the result would be any different on a third occasion. Given the opinion polls and changes in societal attitudes during the past decade, I would conclude that the margin to retain the status quo would be much wider than in 2002.

I will now focus on the text of the Bill as it stands. I have engaged in discussions with the Minister for Heath, Deputy James Reilly, on how the legislation will operate in practice. He has articulated to me his understanding, based on legal advice he has obtained on section 9(1)(b), that in a situation where a woman with no history of mental illness presents as suicidal and refuses alternative treatments, a medical practitioner cannot certify in good faith and his or her reasonable opinion that said risk can only be averted by carrying out a termination. That is of critical importance as it contradicts some of the testimony at hearings held by the Oireachtas Joint Committee on Health and Children.

I would interpret this as meaning that a medical practitioner who did certify in these circumstances would not be able to avail of the exemption contained in section 22(4) of the Bill and would be committing an offence. He or she would be committing the offence of intentionally destroying unborn human life and would be liable if found guilty to a fine or imprisonment up to a maximum of 14 years. This is a severe penalty. I believe that, if applied as envisaged, this will ensure the legislation will be extremely restrictive. It illustrates that the Taoiseach, the Minister for Health and the Government take their obligation to protect the life of the unborn child, with due regard to the equal life of the mother, as contained within Article 40.3.3° of the Constitution, very seriously.

I have discussed with the Minister for Health certain aspects of the Bill, particularly sections 2, 3, 4, 7, 8, 9, 10, 12 and 19. I have done this because I believe additional safeguards would be helpful in reassuring people who are concerned about the Bill and have real reservations that unintended consequences cannot and will not result from the passing of this Bill. It is crucial that all efforts are made to accommodate the views and very real concerns of as many Members of the House as possible.

I ask the Minister, on obtaining the advice of the Attorney General, to bring these possible amendments to the attention of his Cabinet colleagues prior to Committee Stage. I will also forward them to the Chairman of the Joint Committee on Health so that members may discuss and consider adopting the amendments. The first suggested amendment is to section 2(1): in the definition of "reasonable opinion", to insert at the end of that definition, immediately after the words "as far as practicable", the words "and where such opinion is formed on substantial medical grounds having carried out an assessment of any real and substantial risk to the life of the woman in light of clinical research and having regard to the necessity, proportionality and justification for any medical procedure in the clinical circumstances prevailing at that time". This amendment would enshrine in the Bill the test currently set out in the Medical Council guidelines, which state:

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.

This amendment would also ensure that any reasonable opinion is based on medical grounds alone and not on any other extraneous non-medical consideration. It ensures compliance with the terms of Article 40.3.3° of the Constitution.

The second proposed amendment is to section 2(4). It seeks to insert a new subsection (4) as follows:

(4) Any medical practitioner involved in the treatment of a pregnant woman is obliged, subject to the provisions of this Bill and the right to life of that pregnant woman, to safeguard the unborn and, where it is potentially viable outside the womb, to make all reasonable and practicable efforts to sustain its life after delivery.

This amendment would explicitly give effect within the terms of the Bill to the assurances given by the Minister for Health in his Second Stage speech, during which he said:

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 third proposed amendment is to section 2(5). It seeks to insert a new subsection (5) in section 2 as follows:

(i) Notwithstanding the provisions of sections 7, 8 and 9, where in the reasonable opinion of a medical practitioner a course of treatment or course of action could reasonably and practicably be offered to the pregnant woman which would avert the real and substantial risk of loss of the pregnant woman's life but which would not require the carrying out of a medical procedure in the course of which, or as a result of which, an unborn human life is ended, they may not conclude that the risk in question can only be averted by carrying out that medical procedure,

(ii) For the avoidance of doubt, a medical practitioner may not conclude that a course of treatment or course of action could not reasonably and practicably be offered to a pregnant woman merely because of the refusal of the pregnant woman to accept, permit or consent to the course of treatment or course of action in question.

The purpose of this amendment is to give effect to the requirement of the ruling of the Supreme Court in the X case that a termination of a pregnancy is permitted where there is a real and substantial risk to the life of a woman which could only be removed by terminating the pregnancy. It ensures that a medical procedure in the course of which, or as a result of which, an unborn human life is ended is only carried out as a last resort and where no other reasonable or practicable treatment is available.

The fourth proposed amendment relates to section 3(1), which defines appropriate institutions for purposes of the Bill. I propose the deletion of the words ", or by another person pursuant to an arrangement entered into under section 38 of the Health Act 2004". The reason is that the Schedule to the Bill designates 25 hospitals as appropriate institutions under the Bill and this section permits the Minister to add further hospitals to that Schedule. The amendment ensures that private clinics cannot be added to the Schedule by the Minister, and would explicitly give effect within the terms of the Bill to the assurances given by the Minister for Health in his Second Stage speech, during which he said:

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. ... 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 38(1) Health Act 2004 reads:

The Executive may, subject to its available resources and any directions issued by the Minister under section 10, enter, on such terms and conditions as it considers appropriate, into an arrangement with a person for the provision of a health or personal social service by that person on behalf of the Executive.

Such a wide scope could extend the provisions of section 3 outside the close parameters outlined by the Minister. The Minister would retain the power to specify further institutions for the purposes of section 3 where those institutions are managed by the HSE. The specification of a private clinic would, however, not be permissible without an amendment of the Act.

The fifth proposed amendment seeks to amend section 4 by inserting a new subsection (4) as follows:

(4) For the avoidance of doubt, any regulations made under this section must be consistent with and acknowledge the right to life of the unborn and, with due regard to the equal right to life of the mother, respect, and, as far as practicable, defend and vindicate that right.

This proposed amendment would explicitly limit the regulations that could be created to those that comply with the provisions of Article 40.3.3° of the Constitution as inserted by the Eighth Amendment in 1983.

The sixth proposed amendment relates to a number of sections. It proposes to add the words "in their unanimous reasonable opinion" at section 7(1)(b)(i) and section 9(1)(b) immediately before the words "there is a reasonable and substantial risk of loss of the woman's life"; to add the words "and in his or her reasonable opinion" at section 8(1)(b) immediately before the words "believes in good faith"; and to add the words "in its reasonable opinion" at section 13(3)(a), immediately before the words "there is a reasonable and substantial risk of loss of the pregnant woman's life". This amendment would explicitly give effect within the terms of the Bill to the assurance given by the Minister for Health in his Second Stage speech that doctors would be required to conclude that in their reasonable opinion there was a real and substantial risk to the life, as opposed to the health, of the pregnant woman arising from a physical illness that could only be averted by carrying out that medical procedure." The Bill as initiated does not require doctors to certify that there is a real and substantial risk of loss of the pregnant woman's life in their reasonable opinion; this amendment would fix the omission.

With regard to applications for review of a medical opinion, a new section 10(3) could state as follows: "(3) The three medical practitioners who make a section 9 certification shall forthwith make an application to the Executive for a review of the relevant decision and the said section 9 certification shall have no effect or standing until and unless it is upheld by a review committee under section 13(3)." Ancillary amendments could be as follows. In section 12(1), to add the words "or section 10(3)" after "section 10(2)" and in section 9(1) to add the words "Subject to section 10(3)," at the beginning of the subsection. Such an amendment would ensure a fair and independent assessment of the decision to terminate an unborn life on grounds of suicidal ideation and ensures the constitutionality of section 9 by ensuring an impartial balancing of the equal rights of the pregnant woman and the unborn life. It merely invokes the same procedures that are available to the pregnant woman in the event of a refusal of certification under Chapter 2 of the Bill to have the decision of the medical practitioners in question independently reviewed. The reasons given for the following amendment also substantially apply to this amendment.

My last amendment is to section 19, which deals with certification. In paragraph (b) I seek to replace the word "may" with the word "shall". The reason for this is that the current text does not require the certification issued by medical practitioners to include the clinical grounds for carrying out the medical procedure to which the certification relates. The current text merely states that it may include those clinical grounds. The fact that the Bill as initiated refers to certification on clinical grounds in this section is not reflected elsewhere in the Bill. In fact, this is the only section in the Bill that refers to "clinical grounds". This draws attention to the lack of a requirement for the decisions of medical practitioners to be made on medical or clinical grounds, with the Bill currently merely requiring decisions to be made "in good faith" without any requirement for substantial and objective medical or clinical grounds to exist.

I suggest these amendments in the spirit of ensuring that as many Members of this House as possible are satisfied that the legislation complies with the Constitution, and that what is enacted is, in effect, what the Minister and the Taoiseach have previously articulated, protecting the life of both mother and child as much as permissible within the bounds of the Constitution. It would be remiss of me not to bring such proposed amendments to the attention of the House and I hope to participate on Committee Stage.

I thank all the Deputies for their contributions throughout this very good and extensive debate, which was very respectful to all the positions that have been articulated. I did not hear any attacks by any colleagues on the character of others who have taken a different view, as was suggested earlier. All the contributions have been measured and there has been a very good analysis of the Bill and the constitutional context in which we operate. The Dáil has done itself proud in the level, nature and content of the debate. It could not be suggested by anyone that this Oireachtas has failed to debate the issue or consider all the views, and there have been at least four occasions I recall in the past year or so when the issue has been quite rightly debated on the floor of the Dáil. The health committee has also treated the matter on two lengthy occasions, and the issue has been well ventilated, with a good quality of debate. It is important that this is so as that is what we have been expected to do in this Chamber.

As has been indicated since the intention to legislate in this area was first announced, 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 so that she can have certainty as to whether she requires or is entitled to this treatment or intervention. The purpose of the Bill is not to confer new rights for termination of pregnancy but to clarify existing rights. It will make existing rights actually available; there is little point in a constitutional point that cannot be exercised, and it is arguable that the position has been that a right has existed that could not be exercised. This Bill is setting out a procedure for the exercising of an existing constitutional right, and we are doing so within the parameters of the constitutional provisions that pertain, and particularly those as interpreted by the Supreme Court in the X case in 1992 and in order to implement the judgment of the European Court of Human Rights in the A, B and C v. Ireland case.

Legislating for the X case is a serious and legally complex issue but this 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 that safeguards are put in place for the protection of the unborn, where possible, or in the precise terms of Article 40.3.3° where practicable.

I will address some of the main issues raised by Deputies during the debate, although I will not have the opportunity to address all the matters. One of the most common reasons for opposing this Bill is the fact that it includes suicide as grounds for permitting termination of pregnancy. The reality is that these grounds are already included in our law. In the course of the judgments in the X case in 1992, a majority of the members of the Supreme Court specifically recognised suicide as a lawful basis for permitting termination of pregnancy 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 that could only be averted by the termination of pregnancy. This principle was upheld, as many colleagues have stated, in two subsequent referendums on the issue.

The debate has been very interesting and informed in respect of the role of the Oireachtas. There has been much debate on whether the Oireachtas is obliged to legislate and the extent of that obligation etc. Many speakers referred to the issue but many have made the point in an astute manner. For example, Deputy Durkan, who spoke a few minutes ago, considered the role and function of the Oireachtas vis-à-vis the Supreme Court and the people, who are the ultimate arbiters and the owners of the Constitution. The people enacted their Constitution in 1937, amending it in 1983 before a question arose in 1992 as to the precise meaning of that amendment. The Supreme Court, doing its duty, set out what the amendment's provision, with Article 40.3.3° actually meant. The role of the Supreme Court is to interpret the Constitution where there is doubt or a question arising as to the precise meaning of the terms of the Constitution. Neither the Parliament nor the Government does this but where there is an issue of interpretation as to the meaning of a provision in the Constitution, the work is done by the Supreme Court. That is what was done in 1992.

People have often wondered if that was the end of the matter but it is not. If there is unhappiness with the interpretation set out by the Supreme Court, the people can be consulted again. To put it at its simplest, we showed the people what was put in the Constitution in 1983 and what the Supreme Court indicates that it means before asking the people if they want to revisit the issue. The proposal was to re-word the 1983 provision in a manner that might find favour with the people invited to vote on the potential amendment to the previous 1983 amendment. This was done not once but twice; it was done in 1992, shortly after the X case judgment, and again in 2002. On neither occasion did the people decide, in their wisdom, to exclude suicide as a ground for lawful termination of pregnancy in this jurisdiction. The opportunity was afforded to the people to make that decision and they declined to do so.

The position is that with the court having given its interpretation and with the people having decided not reverse what they decided in 1983, we are left with what remains our law, and there can be no doubt in that respect. Whatever other issues we can debate or disagree about, there cannot be any objection to the simple proposition that the Irish Constitution - the supreme and fundamental legal document of the State - allows for lawful termination to occur in circumstances including suicide.

As we heard from many people in the debate and with the evidence so often referred to arising from the health committee, suicide in pregnancy is real. We should all ask a question when the distinction is drawn so often between a physical threat and one arising from suicidality; does not the risk of death by suicide constitute a real risk to life? It is almost crass to put it in those terms but it must be put in simple terms. Somebody's life can be at risk from suicide, and although I respect those who make the point, I cannot understand how people have said in this House and elsewhere that although there is no difficulty with sections 7 or 8 and that the physical risks described therein are real, they cannot bring themselves to see the risk being addressed in section 9 as a risk at all.

That is a fundamental issue to which people have not faced up. Given that we accept that death through suicide constitutes a risk, I do not understand why people can feel there is a rationale for having a different view of that risk from the view they hold of the other risk, which is to allow these circumstances to pertain in our law. I accept that it is rare, but it does happen and when it does, it is always a tragedy.

Many have argued against including in the Bill a risk of suicide on the basis that a termination of pregnancy is not a treatment for suicide, which phrase has come up so many times. We heard from eminent psychiatrists during the Oireachtas Joint Committee on Health and Children hearings who informed us that there was no definitive treatment for suicide and that seems to be so. It is constantly used in the House as an attack line on section 9 that it does not stand up because abortion is never a treatment for suicide. I accept that abortion is not a treatment for suicide. The point is that what we are doing in the Bill is legislating for that very small but real possibility that terminating a pregnancy is necessary to save a woman's life. These circumstances include a risk of death through suicide and must include it.

Deputy Michael McGrath addressed this issue very carefully and closely and finished off with a rhetorical question. I hope I am not misquoting him, but I get the sense of what he said. When he spoke about section 9, he asked whether it was ever the case that a termination of pregnancy was the only way to save a woman's life. I think that is almost precisely what he said and I do not think I am being unfair to him in that regard. It was a rhetorical question to ask whether it was ever the case that a termination was the only way to save a mother's life in circumstances where there was a risk of suicide. With respect to him, the way we must pose that question as legislators is to ask whether we are saying it would never arise or whether it could be concluded that it would never be so.

That is not fair.

This is the end of the debate and I will not be interrupted. I ask for the Ceann Comhairle's protection.

The Minister of State is not allowed to reframe a question.

We have all had our say and it has been a long day.

I was talking about Deputy Michael McGrath, not Deputy Peter Mathews. If we are to be fair and reasonable in this debate, the way the question ought to be phrased is if we are saying it would or could never arise. I remember that Dr. Rhona Mahony made this point in the Seanad.

On a point of order-----

What is the Deputy's point of order?

My point of order is that a Member is never allowed to reframe another Member's question that was framed in a certain way. That is dishonest.

That is not a point of order.

I quoted Deputy Michael McGrath fairly. I have simply said in the course of the debate, as I am entitled to do, that he put that question and that I think the real question to put is the other one. That is a perfectly reasonable point to make in the course of debate. It is very hard to understand why we are having interruptions from a colleague at the very end of the debate. We know that it cannot be said that it would never arise. We simply cannot say that and that is the basis on which we must proceed as legislators.

There is another aspect I have genuinely had difficulty in understanding. This is a genuine objection I have because it has never really been properly explained to me. It is the notion that if, it enacted, section 9 will have the effect of normalising suicide. I genuinely cannot understand how it could reasonably be suggested this would follow. We have a provision in our law that everybody accepts is entirely limited and restricted. I cannot understand how the rare and restricted circumstances covered by a very rigorous process set out in the Bill, whereby a woman who finds that she is suicidal and seeks to have a termination must face the very rigorous requirements set out in section 9 and is or is not certified as having a real and substantial risk to her life that can only be averted by a termination, would have the effect of normalising suicide. I simply cannot understand this. The point has been made and repeated, but it has never been explained to me.

The Government is aware that concerns have been raised about whether it could be possible to insert gestational limits on the carrying out of the medical procedures mentioned in the Bill. It is important to stress 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 put the matter plainly, it will only allow a pregnancy to be terminated where it is judged that a woman may otherwise die. I do not accuse Deputy Peadar Tóibín of this, but others have posited quite grotesque scenarios relating to late term pregnancies that might arise in very rare circumstances and which I think would almost certainly never arise, although there can be no certainty. If they ever did arise, they would be very rare and the Minister for Health was unfairly represented as having a particular view in this regard. He and I are of the same view, as reasonable people would be in any analysis of the Bill, that such circumstances would be extremely rare. If they did arise, let us not forget what also might happen in that circumstance, namely, a woman may die if this procedure is not afforded to her. There is very little reference to this fact when that particular circumstance is being addressed.

I will repeat a point made before, that while a woman has a right to have the pregnancy brought to an end, the provisions included in the Bill are intended to ensure that in circumstances where the unborn may be potentially viable outside the womb, doctors must make all efforts to sustain his or her life after delivery. It is very important to recall the definition of "reasonable opinion". Sections 7 to 9, inclusive, require doctors to give a reasonable opinion. "Reasonable opinion", as defined in the definition section of the Bill in respect of a medical practitioner or a review committee, means an opinion formed by the practitioner or committee in good faith which has regard to the need to preserve unborn human life as far as practicable. Doctors must have regard to the need to preserve unborn life as far as practicable, which is exactly what the Constitution states.

I assure all Deputies that, as drafted, the Bill prohibits the killing of a viable foetus. Including a reference to viability would not provide for further clarity in that respect because pregnancies become viable at different points in their development and the clinical foetal assessment would still be required, as is the case. Let us remember what the test is. There must be a real and substantial risk to the life of the mother that can only be averted by the procedure. I know Deputy Charlie McConalogue raised this question when he, quite reasonably, pointed out that there were gestational limits in other jurisdictions with quite liberal abortion laws. That is precisely the point. They are jurisdictions with liberal abortion regimes, but that will not happen here under this legislation. We will not have a liberal environment on foot of this legislation; far from it. Therefore, we are not comparing like with like.

Some Deputies have expressed concern about the potential criminalisation of pregnant women. I wish to clarify that a woman can be prosecuted for an unlawful abortion under an extraordinary provision in the Offences Against the Person Act 1861 which is still on our Statute Book. If found guilty a woman "shall be liable to be kept in penal servitude for life". The proposed legislation does not create a new offence for pregnant women; it brings the penalty for this offence in line with current parameters, in other words not exceeding 14 years instead of life.

I certainly recognise the potential criminalisation of a pregnant woman is an extremely difficult and sensitive matter, to put it at its mildest, but this provision reflects the State's constitutional obligations arising from Article 40.3.3° and the constitutional protection of the life of the unborn. This is a very grave and important point. To suggest we could do anything other than have a criminal sanction associated with a breach does not face the reality of what the Constitution does. Just as I say to colleagues opposed to the legislation that we cannot ignore the Supreme Court decision in the X case I must also say that I must also respect, and do profoundly respect, the Constitution, although as a citizen I find quite extraordinary and frankly offensive the notion there would be a criminal sanction involved for a pregnant woman in these circumstances. The Constitution is clear on the right to life of the unborn and the protection of the right to life of the unborn, and until such time as this is revisited it remains the position. In so far as there is a statutory provision restating the offence there is no way of avoiding a criminal sanction of the level proposed in the legislation. The sentence to be applied in a particular case is always a matter for the court involved, and in the circumstances we have here, a prosecution may only be brought with the consent of the DPP.

The Bill clarifies existing law and I am conscious of the point raised by many Deputies that it does not address many circumstances which arise too often for pregnant women throughout the country. Many colleagues would like to see other grounds included in the legislation, particularly in heartbreaking cases where there is a diagnosis of a fatal foetal abnormality. With profound regret I must say these provisions cannot be included because the purpose of the Bill is not to confer new rights to termination of pregnancy but to clarify existing rights.

The question of representation or separate representation for the unborn was raised and it has been debated here and outside the Chamber. It is important to be clear about what people must mean by separate representation for the unborn, how it might possibly work and what precisely is being suggested. It is not simply a case of the Attorney General appointing a lawyer just to act in some generalised way. Ours is an adversarial system and what is being proposed, because it can only mean this, is to introduce some type of procedure allowing for a forensic cross-examination of a woman, essentially of her bona fides to establish whether she is making an honest claim. What else could it mean? This is all it could mean. Article 40.3.3° neither requires nor contemplates such a procedure. The Constitution requires the State with due regard to the equal right to life of the mother to respect and, as far as practicable, by its laws to defend and vindicate the right to life of the unborn. If one reads the section closely, the State's obligation is to be carried through in its laws. The requirement on the State is to vindicate the right to life of the unborn in its laws. This is why the legislation before the Oireachtas sets out a rigorous certification procedure by doctors who are expressly required to have regard to the need to preserve unborn life as far as practicable. It would be wholly inappropriate and entirely unnecessary constitutionally to introduce a legal procedure with separate representation for the unborn, and frankly there is no proposal to do so in the Bill.

Some Deputies raised the issue, quite reasonably, of greater supports for crisis pregnancy in general. I reiterate the HSE crisis pregnancy programme funds 15 service providers to provide counselling services in more than 50 locations nationwide. A number of these services also provide access to free post-termination counselling and medical checkups. 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.

The main purpose of the Protection of Life During Pregnancy Bill 2013 is to restate the general prohibition on abortion in Ireland by regulating access to lawful termination of pregnancy in accordance with the X case and the judgment of the European Court of Human Rights in A, B and C v. Ireland. There is much talk about stepping stones and floodgates and what the future will bring. I do not know what the future will bring on this issue. I agree with Deputy Kyne and many others, and Deputy Walsh also made the point perhaps from a different perspective, that this issue will not be finally resolved in this legislation because how could it? No country in the world can draw a final line in the sand under this issue. It simply is not a realistic proposition. Perhaps there will be a future referendum. The case for a future referendum will be made and it has some force, but the requirement on us in this context with this legislation is to give legislative foundation to a right which already exists in our Constitution. We have set out a procedure by which it can be availed of. It is balanced legislation. Deputy Catherine Murphy stated the Bill is the bare minimum and I must agree with her on this. It is a fair assessment. On the other hand, Deputy Clare Daly suggested we could have done much more, and I was surprised to hear her state this because, in fairness to her, the two draft Bills she brought forward made it very clear what the constitutional constraints were.

Two quotes from two colleagues fairly reflect on what is being done here. They are not particularly legalistic, but they encapsulate very fairly and in a very reasonable way what we are doing. Deputy McLellan described the measure as a matter of common decency and Deputy Cowen described it as a good faith measure. I thank both of them for their support for the Bill. I thank all Deputies in the House who have set out their views and for contributing to the debate, whether for or against. This legislation is measured, and it is fair-minded and balanced. I commend the Bill to the House.

Is the question, "That the Bill be now read a Second Time", agreed to?

Question put.

Deputies

Vótáil.

In accordance with the Order of the Dáil on Thursday, 27 June 2013, the division is postponed until immediately after the Order of Business on Tuesday, 2 July 2013.

The Dáil adjourned at 8.10 p.m. until 2 p.m. on Tuesday, 2 July 2013.