Leaders' Questions

Further revelations are emerging in respect of the treatment of women whose smear tests by CervicalCheck - and their treatment at the hands of our health services and legal system - were wrong. We now know that three women at the centre of ten outstanding legal cases against the State relating to incorrect smear tests have died. The State Claims Agency was apparently told by CervicalCheck during the Vicky Phelan case that the women had been told. We now know of course that this was not the case.

In the context of the forthcoming cases - this came across yesterday in a fairly frank exchange at a meeting of the Joint Committee on Finance, Public Expenditure and Reform, and Taoiseach involving the director general of the State Claims Agency and others - that the State may not have a liability and that, in fact, liability may lie with the US companies involved. It seems, therefore, that no guarantees can yet be given to the women involved in those cases to the effect that they will not have to go through the same treatment as Vicky Phelan. Has the Government considered this issue? Will the Taoiseach indicate the steps the Government intends to take to prevent further trauma to women involved in such cases? The director general of the agency said that in cases where the State has liability, they would be dealt with differently. We know that in many instances we are talking about cases involving the actual screening companies. Furthermore, at yesterday's committee meeting, the director general, in response to questions from Deputy MacSharry and others, indicated that if section 32B of the Legal Services Regulation Act 2015 had been commenced, then the approach adopted by the State Claims Agency could have been different.

The section relates to pre-action protocols designed to secure an early resolution in clinical negligence claims by ensuring there is disclosure of all medical and other records in the hopes of reducing the number of cases. Why, then, has section 32B of the 2015 Act not been commenced by the Minister for Justice and Equality? I understand it was signed into law towards the end of 2015. The State Claims Agency and other bodies get attacked all the time in the immediate aftermath of a crisis but we can hardly blame officials if an Act or a section has not been commenced and certain options the Oireachtas intended to provide them with are not, therefore, open to them. Were there consultations between health and justice officials on that issue?

The Taoiseach said yesterday in the House that there were approximately 1,600 cases. These are the 1,600 cases announced by the Minister for Health, Deputy Harris, last Tuesday night which had been notified to the National Cancer Registry but which had not been notified to CervicalCheck. The Taoiseach indicated yesterday that the vast majority of those 1,600 cases would not need to be part of the audit for reasons he set out. Can the Taoiseach state categorically that there are no issues relating to those 1,600 cases? Deputy Kelly made a number of observations last evening in terms of the level of knowledge of the Department of Health on issues between the cancer registry and the CervicalCheck programme in the context of data interchange and all of that. Are the Taoiseach and the Minister aware of such issues? Has the Department been aware of such issues down through the years?

As Deputy Micheál Martin said, new information and revelations continue to become available on this issue. That is exactly why we have established this inquiry, namely, to get to the bottom of this and establish the facts in order that we can put things right to restore confidence in cancer screening. Like other Members, members of the Government are often hearing information that is new. That is why it is right for us to set up the inquiry, which will be able to get to the bottom of all these facts and give people the answers they need.

I understand there are nine outstanding court cases with perhaps one further case where a letter of claim has issued but proceedings have not yet begun. Nobody wants to see sick people or terminally ill women dragged through the courts. The public does not want that and it is in nobody's interest. It is certainly not in the interests of the taxpayer in the longer run, of confidence in our health service or of patients or citizens. I have asked the Attorney General to work with the State Claims Agency to examine the different cases with a view to settling them, albeit it takes two sides to do so, or resolving them by way of mediation as soon as possible in order that they do not have to go to court. I made that request to the Attorney General last week. It may turn out that one or more of these cases is similar or identical to that of Ms Vicky Phelan but it may also be the case that some are very different. We cannot assume that all of these cases are the same. In each case, a medical expert will have to look at the smear or slide and determine what category it falls into. Certainly, the Government's intention is to settle these cases as soon as possible or deal with them by way of mediation if possible. I have asked the Attorney General to work with the State Claims Agency to do exactly that in the short period ahead.

The best thing we can do in the longer term is to avoid these cases going to court in the first instance. That can be done in a number of ways. A whole reform programme has been initiated by the Government over the past couple of years to reduce the number of cases ending up in court or requiring lengthy legal proceedings. The House will be aware of what we have done already around open disclosure by way of putting voluntary open disclosure in the Civil Liability (Amendment) Act, which was passed last year and which will be enacted in law by June.

We have also announced this week that we will put in place mandatory open disclosure through the patient safety Bill in cases of serious incidents.

There has also been a programme of law reform. For example, the Mediation Act has been enacted and is now a reality. The Act will allow mediation to occur in more circumstances. In the past couple of weeks, some cases have already been settled through mediation. We would like to see more. There are also periodic payment orders. The legislation for those has been passed in order to ensure that we do not have the same situation we have had for years in the context of very big settlements of €10 million or €13 million being made when it would be better to have settlements over a period that could be increased as needs be. Other new legislation we introduced is the Legal Services Regulation Act, which the Deputy mentioned. It provides for pre-action protocols to speed up cases so that they are not continually being referred. That has not been commenced yet because the Legal Services Regulatory Authority, which is the body that will deal with it, has only been established in the past few months.

The Legal Services Regulatory Authority. These are new laws.

They are not. That was in December 2015. We can keep announcing and passing laws in the Chamber and saying that we will do great things next month or the month after. When we pass such laws, however, they are not commenced and nothing changes. We need a satisfactory explanation as to why section 32B of that Act, which was designed to prevent the trauma people have experienced in taking on the State, has not been commenced. We particularly need that explanation given that the Taoiseach referred to the Act at the end of his long reply.

The Taoiseach said that he has asked the Attorney General to talk to the State Claims Agency. The agency said yesterday that in cases involving the State and in which the State has liability, it would prevent any trauma. I am referring to the majority of cases which could be against the US companies involved. How does the Taoiseach propose to prevent trauma in those cases? Has the Government considered that point? That is what I asked originally. Can the Taoiseach give a specific answer on that? Has he considered it at all?

Will the Taoiseach respond to the third question I asked regarding the level of knowledge in the Department of Health in respect of potential issues between the National Cancer Registry and the CervicalCheck programme and reconciliation of their respective numbers regarding people who have died from cancer?

There is a legislative process which must be undergone and everybody understands that. Legislation must go through the Houses, be enacted and then be commenced. Often a law is enacted and it takes a couple of months, or even longer, for it to be commenced into law.

Three and a half years.

In this case, it was part of a major reform introduced by this Government to provide for matters such as pre-action protocols, the Mediation Act, periodic payment orders and-----

It is not happening.

It is the responsibility of the Minister, not the authority.

The Taoiseach, without interruption.

With regard to that particular aspect of the reforms brought in by this Government, and I should note that it was not done by previous Governments-----

It was the previous Government actually.

-----the new body established to regulate our legal services, the Legal Services Regulatory Authority, is still in its infancy.

That has nothing to do with this.

It has to be established, a chief executive officer must be appointed and a premises needs to be found. In some cases-----

The authority is not required for the purposes of section 32B.

-----when it comes to commencing a law, guidelines have to be produced as well. When it comes to voluntary open disclosure provisions, for example, the guidelines-----

Read the Bill.

The authority is not required for the purposes of section 32B.

-----have to be developed beforehand.

Mr. Tony O'Brien told a meeting of the Joint Committee on Health earlier today that he will not be standing down as director general of the HSE. While Mr. O'Brien was making that declaration, I received a call from Emma Mhic Mhathúna from Kerry. She asked me to raise her case with the Taoiseach. Emma is 37 years old and is the mother of five children aged between two and 15 years of age. She received a clear result from a smear test in 2013 but she now knows that the result was, in fact, a false negative. She received a diagnosis of cervical cancer after a routine smear test in 2016. She only learned of the false negative for the previous test as this scandal has unfolded.

She wants the Taoiseach to know that she is terminally ill, that she will present on Friday for a medical assessment at which she expects she will be given an estimate of how long she is expected to live. Emma wants the Taoiseach to know that she has been told to get her affairs in order and to make provision for her five children. Emma is extremely angry. She says her faith has been shaken to its core. She tells me that her anger outweighs even her fear of dying. She wants the Taoiseach to know that she wants accountability. She has asked me to tell him that she cannot understand why he is sitting on his hands. She cannot wrap her head around why he has not done the very first thing that is needed to ensure the start of accountability. I told the Taoiseach yesterday, as I have said before, that people outside of this place see two Irelands: they see a well-paid senior public executive sitting in a committee room brazening things out and then they see a terminally ill woman in her living room who knows she does not have much time left, who knows - or at least suspects - that it could have been very different and who is left wondering how her children will cope.

I could make all the political reform arguments in the world as to why Tony O'Brien must go; I have made some of them previously. I could make all the good governance and public policy arguments as to why this man needs to go. We could go back and forth on that all day long. However, that all pales into absolute insignificance when one compares it with what a woman like Emma is feeling and articulating today. The buck must stop somewhere and accountability must start somewhere. Emma has no confidence in Tony O'Brien, the public and the women and families affected have no confidence in Tony O'Brien, the Opposition has no confidence in Tony O'Brien and three of the Taoiseach's own Cabinet members have said he should stand down, yet the Taoiseach and his Minister for Health refuse to act.

When the Taoiseach gets to his feet, I do not want him to answer me; I would like him to speak to Emma. I want him to answer Emma Mhic Mhathúna. I want him to explain to her why he is allowing Tony O'Brien to continue as usual, why he refuses to hold him to account and why he is ignoring her voice.

The most egregious aspect of this whole affair is that important information about women's health was withheld from them, and that was absolutely wrong. We all know that the audit did not commence until these women had already been diagnosed with cancer and were being treated, so providing them with that information would not have impacted on their treatment. However, they should have been told anyway. People have a right to know information about their healthcare. Doctors, officials and anyone else involved in managing their cases or looking after them have no basis on which not to pass on that information. As Deputies will know, this has been HSE policy for all staff since 2013 and is in the Medical Council guidelines. Part of the inquiry that is now under way must get to the bottom of why this information was not passed on to women in the way it should have been as they ought to have known. This is absolutely the most inexplicable and egregious aspect of this whole affair.

As I said yesterday, people want accountability. The Government wants accountability as much as the Opposition does. People are annoyed, and I am annoyed, about the way this has been handled in recent weeks, the drip-drip of information and the misinformation from some quarters. We, as politicians, need to ensure we are never part of putting across misinformation because that does a terrible disservice to the women affected. We have seen at least a degree of personal accountability so far, the clinical director of CervicalCheck having resigned and the manager of CervicalCheck being moved aside and replaced by Damien McCallion, head of the serious incident management team. We have an inquiry that is under way and can get to the facts and assess whether more needs to be done and whether more individuals need to be held to account. As I said yesterday, more heads may well yet roll but it is important they are the right heads and that people who are dismissed are dismissed because of something they actually did wrong or failed to do, having known about it. That is something we cannot say with certainty at present.

As I said yesterday, for me and for some of those affected, this is not primarily about looking for a head; it is about establishing the facts, getting to the bottom of the matter and putting it right, restoring faith in our cancer screening system and ensuring it does not happen again.

Mr. O'Brien has approximately eight weeks left before he finishes his term of office, at which point an interim HSE director will be appointed by the Minister for Health. We are already in the process of appointing a new person to take over the leadership of our health service as the chief executive officer, CEO, of the HSE. We will also put a board in place to ensure an additional layer of accountability between the Minister and the HSE.

Nobody wants accountability more than Emma or other women and families in her circumstances. I do not believe the Taoiseach's response, to be blunt. What I see is a person who leads the Government and who knows well what needs to happen and what is the right thing to do. I do not dispute the sequence of events and share the Taoiseach's view that the most egregious offence was the withholding of information. We cannot with all certainty state whether in each case the withholding of that information had a material affect in diagnosis and subsequent treatment. Let others decide on that. What Emma told me is that she sees the Taoiseach, the leader of Government, fail her. Has it occurred to the Taoiseach that women like Emma might not be around to hear the results of these inquiries? Mr. O'Brien has eight or 12 weeks left, depending on when he takes his leave, but who is to say how long Emma has? She has a very simple request of the Taoiseach, and it is a challenge to him as Head of Government because it is something that we do not do in this jurisdiction. The Tony O'Briens of this world do not stand down, and Governments here do not sack them or tell them to clear their desks. She wants to see the start of accountability now. That means the departure of the man in charge of the HSE, the director general with whom the buck stops. It is as simple and clear cut as that.

I said yesterday that I do not believe it is right for any politician or party leader to seek to appoint him or herself as the spokesperson for all the people affected, whether it is the 209 women who are part of this audit, their families or the many hundreds of thousands of women who are concerned about the accuracy of their smear tests. I do not think it is right for any politician to appoint him or herself as the sole spokesperson for all these people. I have been in contact with some of them too. They have different views but many concerns and the main thing they want is answers. They want the truth, which is why we have established a scoping inquiry in order that we can get as many answers as quickly as possible for the women affected and their families. We will move on to a statutory commission of investigation after that to answer any unanswered questions. We have gone for a scoping inquiry in order that we can get answers quickly. I appeal to Deputy McDonald and all Members of this House to avoid saying things that may not be factually correct or putting out misinformation. It is not fair to the 209 women who were subject to this audit to have additional fears and concerns. They have enough to worry about as it is without misinformation being propagated.

Those are disgraceful remarks. The Taoiseach is dodging the question.

On the questions which Deputy Micheál Martin asked earlier, which I tried to answer between interruptions, the case against the laboratories is something that we very much have under consideration. If there is not a case against the State and the case is against the laboratory-----

That is the Taoiseach's answer to Emma?

-----a third party or a private body, that creates a difficulty for us, as the State cannot settle or extinguish a case against a third party.

Go raibh maith agat.

He does not want to answer. He is shamefaced.

That is something that we are examining now to see what options are available to us.

Today we saw Google's announcement that it would stop accepting all advertisements relating to the eighth amendment in order, as it said, to protect the integrity of the process. This follows Facebook's announcement that it will only accept advertisements from Ireland on its platform, although this will simply mean that linked organisations will be exposed in Ireland and organisations will have to register here and may then continue to advertise.

There are no spending limits in respect of the referendum anyway, so it will make little real difference. However, it is imperative that we as politicians act to regulate the information included on posters and in online advertisements to ensure that the information given out to the public is based on facts and not on outright lies, myths or emotive untruths. We have all seen cases around the country where posters have been placed near schools and outside churches. These posters use imagery and information that is clearly wrong, that cannot be checked and that is not verifiable at all. We must act to ensure that the use of such posters cannot continue. It is vitally important for both sides of the campaign, the yes side and the no side, to put out accurate images and information in order that people can make a decision based on what they feel themselves.

We have seen the posters held up outside the hospitals. We have seen all that. We have seen the fake statistics and factually incorrect responses that also have been used in respect of the campaign. This is all wrong. These are things on which we can act and make a decision. The announcements from Google and Facebook are welcome but we can also be proactive and ensure that posters carry respectful images and images which will sway the argument one way or the other rather than those which are just used as a shock tactic. That is vitally important. I know it is probably too late to do it for this campaign, but what are the Taoiseach's plans to do this in order to ensure that referendum campaigns will be carried out in a proper manner and that proper images will be used on posters? This is something which we in this House can directly control. We do not have to rely on Facebook or Google or anybody else to do it for us.

First, I join with others in welcoming the decision taken by Facebook not to allow advertisements relating to the referendum that are paid for by foreign bodies or foreign entities. That is a welcome measure on its part. While Google has gone a bit further and is not accepting advertisements to do with the referendum altogether, I think Facebook has made the right decision to not accept advertisements paid for by bodies from other countries. Whether advertisements are for a yes vote or a no vote, we all hold by the principle that foreign money should not be used to influence elections and referendums in this country. The decision Facebook has made in that regard is very welcome. Perhaps it could have come sooner but it has come and is very welcome.

I share Deputy Pringle's concerns about some of the posters we have seen around the country, some of which are extraordinarily inaccurate in the claims made on them and some of which are, frankly, quite grotesque. I have often spoken to parents on the campaign trail whose children have asked them to explain the images on the posters and what the posters mean. For people who purport to be concerned about children, putting parents in a position where they have to explain these things to children based on the images on the posters says a lot about their true motivations and hearts.

It has never been the case in Ireland that we have regulated people's posters. If we were to regulate people's posters we might also argue in favour of regulating literature because the same kind of images that appear on posters can also be put on literature put through doors. We need some consideration of the issue, perhaps on an all-party basis, but it would be a big move to give any authority to ourselves, or even to an electoral commission or referendum commission when established, to decide what sorts of posters and literature are allowed and what sorts are not. It could start from very good intentions but move on to become a restriction on democracy and freedom of speech. If we do anything like that we would need to do it on an all-party basis. Perhaps the Joint Committee on Housing, Planning and Local Government, which covers electoral matters, could give some consideration to the issue after this referendum.

I thank the Taoiseach for his response. I note there is already regulation of posters in certain areas in this country. For example, Dublin City Council regulates politicians' posters. They have to be submitted to Dublin City Council so that it can have a look at them. It then decides whether they can be put up or not. They cannot be offensive or anything else like that.

It is possible to regulate posters and this begs the question as to why the posters in question have not been regulated. That may be a separate question. It is not enough, however, to share the annoyance and upset of people in respect of this issue. It has to be addressed. Doing so is vital.

The matter is probably more stark in the run-up to the forthcoming referendum. It is a referendum campaign that is dividing people and generating strong opinions on both sides. That is different from what happens during most elections. In most elections, our faces are on the posters. People might find them offensive but that is a different story. We really should be capable of dealing with the images used on posters. If Facebook and Google can do it in respect online patterns, why can we not do it with postering in this country?

I was not aware that Dublin City Council had a role in regulating which posters may be put up and which may not. My local authority in Fingal requires that permission be obtained if one wants to put up a poster advertising a public meeting or such an event outside election time. I had thought it was different during election and referendum campaigns, however, and that all local authorities can do is prescribe where posters could not be located, as on roundabouts or in locations where they obscure road signs. Regulating where posters may be placed for reasons of road safety is different from regulating the content of posters, be it the words or images. This is not something we can resolve over the next couple weeks. We could definitely ask the committee to examine it, however. I will certainly ask the Minister of State with responsibility for local government and electoral reform, Deputy Phelan, to determine, after the referendum, what measures could be put in place for future contests.

As we approach the final two weeks of the abortion referendum campaign, it is becoming absolutely clear that the Government's position is rapidly losing support among the general public. All attempts by the Taoiseach and the Government to convince the people that what he is proposing is a restrictive abortion regime are being exposed as the complete falsehoods that they are. The Minister for Health, Deputy Harris, would know that if he displayed even one ounce of political courage and responded to the numerous requests made to him, by the Save the Eighth campaign and others, to conduct an open debate on this matter. Unfortunately, he is in hiding on this issue.

Despite that fact, we have a health service that is almost in total paralysis. It is in total paralysis as far as I am concerned, yet the Minister takes no responsibility. He is the head appointed to office by the Taoiseach to deal with these issues but he lacks courage and will not take responsibility in this area. Instead, he chooses to spend his time campaigning with individuals and organisations that are in open defiance of Irish electoral law. I raised this matter with the Taoiseach some time ago and he said he had no issue with this. I find that staggering. The Taoiseach has no issue with the fact that the Minister campaigns with people operating outside the law. Where are the Taoiseach standards? A senior Minister in the Government is championing a group that made clear and illegal use of €120,000 but the Taoiseach believes that is perfectly fine. No wonder there is no accountability in the HSE or anywhere else. Not only has the Taoiseach undermined the integrity of his own campaign, he has also insulted the independence and integrity of the Standards in Public Office Commission, which made the judgment against Amnesty Ireland.

That said, I ask the Taoiseach to clarify some issues that have arisen following comments made by the Minister in The Sunday Times last weekend. The Minister mentioned that the general scheme of the Bill, which I have to hand, provides for early delivery and specifically prohibits the possibility of late-term abortions. Where in the heads of the Bill is the prohibition on late-term abortion to be found? I ask the Taoiseach to explain. I have read the Bill, as have others, and we cannot see it anywhere. I ask the Taoiseach to take some accountability for his Ministers. He has appointed them, under seal from the President, yet they can campaign with people who have acted outside the law and blatantly told everyone that they would keep the money and would not pay it back. Everybody in here operates under the Standards in Public Office Commission, and rightly so, and every elected official throughout the country must do so. Will Amnesty Ireland get away with this? Is it okay for the Taoiseach's Ministers to champion this organisation on the streets?

I strongly disagree with the Deputy. He seems to be assuming that the referendum is over and that the proposition will be defeated. I believe that the referendum and campaign are ongoing. I was on the doors in Clonsilla in my constituency as part of a cross-party canvass, listening to people, hearing their views and answering some of their questions. I believe that this referendum will carry. The people have not spoken yet. When they have spoken, we will count the votes and determine what they have said. It is somewhat arrogant for anyone to assume the outcome of this referendum already. At the start of this campaign, I said something that I really believe, which is that this campaign should always be respectful and should never be personalised. By and large, I am glad that has been the case so far. Unlike previous abortion referendums, this campaign has largely been respectful and has rarely been personalised but I regret the extent to which some people, including Deputy Mattie McGrath, have sought to personalise this against the Minister, Deputy Harris. That is absolutely wrong. The Minister, Deputy Harris, is putting forward a proposal that the Government is making following an all-party committee, following a Citizens' Assembly. The people will have their say on that. I do not think he, or anyone on any side of this referendum, should be targeted personally in any way, whether through posters, demands for one-to-one debates, or anything of that nature. It is wrong and it is not what people want.

Amnesty International's current campaign is registered with the Standards in Public Office Commission, SIPO. It is above board and I do not believe anyone has produced any evidence to the contrary. The Deputy is referring to a different campaign it ran maybe a year or two ago, against which SIPO has made some negative findings. That matter is now before the courts. Its current campaign on this referendum is registered with SIPO just like any NGO campaign of this nature. It is wrong to confuse the two. Perhaps it is deliberate but it is wrong either way.

On the legislation before us, the legislation that the Government has produced allows for a woman to decide to end her pregnancy if she decides she does not want to go ahead with that pregnancy up to 12 weeks into it. That is ten weeks from conception. It allows for the termination of pregnancies after that on the grounds that there may be a serious risk to her life or health, or in the case where the baby she is carrying will not survive as a result of a fatal foetal abnormality. It does not provide for the termination of pregnancies beyond viability and that is in the heads. There is an important point that we need to make and understand, which is that if there is not a yes vote, there will be no legislation at all. If there is not a Yes vote, things will remain exactly as they are now. There will be no legislation. Women who are victims of rape, who are pregnant as a result of incest or who are just children themselves will not be able to get the help they need in this country. Those who are advocating a No vote need to explain why they would turn their backs on those women and give them the cold shoulder. That is what a No vote would mean.

I never mentioned Amnesty International.


I said Amnesty Ireland. Excuse me, listen. I mentioned Amnesty Ireland. It is fine for the Taoiseach. The Minister wants to hide. This is not a personal attack at all but a Minister in the Government proposing this legislation will not debate it. He chose not to answer me on that and I did not assume at all that the referendum was over. While head 4 of the general scheme says that the life of the unborn child cannot be ended once it has reached viability, there is no evidence of where this will be set. To understand that, I suggest that the Taoiseach reads the definitions contained in the general scheme. Even more disturbing is the fact that, directly following head 4, provision is made in head 5 to nullify or cancel out the prohibitions contained in head 4. There is utter confusion. This clearly demonstrates that all of the claims the Taoiseach and his Ministers are making about protecting the child once it reaches viability are an absolute nonsense and are not worth the paper they are written on. The Taoiseach and the Minister, Deputy Harris, know that. The Taoiseach and I know that it is simply one more tactic that is being used by this Government to disguise the extreme nature of the proposal. Will the Taoiseach be honest with the people for once in this debate and admit that post repeal, if it happens, absolutely no guarantees can be given on prohibition of abortion in either six, seven, eight or nine months? That is the fact.

Viability, the point at which a baby is viable outside of the womb, is a clinical judgment.

It is not as simple as just saying a certain number of weeks so that has to be a clinical judgement for the doctors concerned taking into account the gestation, the size of the foetus and the weight. Taking those three things into account, the two doctors - there must be two doctors, both of whom are on the specialist register, to certify a termination beyond 12 weeks - will make the judgment as to whether or not the pregnancy has reached viability. A pregnancy can only be terminated after 12 weeks if two doctors, both of whom are on the specialist register, determine that there is a serious risk to the life or health of the mother and that the pregnancy is not viable. If it has reached the point of viability, a compassionate early delivery occurs and every effort is made to save the life of the baby at that point as well as the life of the mother.

The legislation being put forward by the Government is not extreme. It is considerably more conservative than the situation in the UK or the Netherlands. It is very similar to the law in Germany. One individual I met on the doorstep last night was a woman from Germany who explained to me how it works there. It is very similar to what we have proposed where there is a cooling-off period of 72 hours, which gives the woman concerned a crucial period in which to consider other options and avail of counselling. This is a much better situation than the current one where people acquire the pills over the Internet without medical support or counselling.