I move: "That the Bill be now read a Second Time."
As legislators in the national parliament, we hold a very privileged position, never more so than when we act on the instruction of the people in a referendum. On 25 May the people gave us a very clear message: to legislate for the introduction of abortion services in this country.
Today we begin the job they have given us of making the law that follows the repeal of the eighth amendment. After 35 years of having the amendment in the Constitution, in so doing we are also making history, but, of course, history is not made only in this House. This history was made on the streets, in houses and ballot boxes across the country. It was made by people, including colleagues here, who had campaigned steadfastly for many years. It was made by young people who had never had a say on an issue about which they cared deeply, who were galvanised by a movement of equality and everybody who had thought deeply and felt strongly on this subject, in their different ways, and who came out on 25 May to make their decision known in the ballot box, resulting in an emphatic majority to repeal the oppressive, repressive eighth amendment and for us to get on with our jobs and legislate. It was a resounding affirmation of respect and support for women and their right to make choices about their own lives. It was a reaffirmation of the primacy of equality in our modern democracy and a call on us all to do more on women’s health and women’s equality and in continuing to shape an inclusive and equal society.
As Minister for Health, after all we heard during the campaign, after all I have learned since I took this role and after everything we know about the dark past, I am determined that we will now begin a new chapter on women’s health; a chapter in which women are valued, their decisions are respected and they are cared for without judgment. That will be a priority for me in the time ahead.
I turn to the legislation before us. The main purpose of the Health (Regulation of Termination of Pregnancy) Bill is to set out the law governing access to termination of pregnancy in this country. The legislation permits a termination to be carried out in cases where there is a risk to the life or serious harm to the health of the pregnant woman; where there is a condition present which is likely to lead to the death of the foetus, either before or within 28 days of birth and up to 12 weeks of pregnancy, as set out in section 13 of the legislation.
I will take the House through the Bill to clarify its provisions. I want to note from the outset that, while the Bill is now arranged slightly differently, its key provisions are the same as those in the draft general scheme approved by the Government which I published in March ahead of the referendum and those in the updated scheme approved by the Government and made public in July. That is important because these schemes provided the people of Ireland with an opportunity to make an informed decision knowing what our intentions would be in terms of the law if the referendum was passed.
The Bill is divided into three Parts. The first Part of the Bill includes sections on definitions, regulations, offences under the Bill, repeals and transitional provisions. Section 1 makes standard provisions setting out the Short Title of the Bill and arrangements for its commencement.
Section 2 deals with definitions. It defines the meanings of some of the terms used for the purposes of the Bill, including "foetus", "medical practitioner", "medical procedure" and "termination of pregnancy".
Section 3 deals with regulations and allows me, as Minister, to make regulations to bring the legislation into operation and for other such procedural matters. Such regulations will, of course, have to be laid before the Houses of the Oireachtas for approval.
Section 4 allows approved expenses associated with the administration of the Bill to be paid for from public funds.
Section 5 sets out the substantive offences under the Bill. It provides that it shall be an offence for a person, by any means whatsoever, to intentionally end the life of a foetus, otherwise than in accordance with the provisions of the Bill. These provisions will not apply to a pregnant woman who has ended or attempted to end her own pregnancy. We never criminalise the woman. Further it is an offence for a person to aid, abet, counsel, or procure a pregnant woman to intentionally end or attempt to end the life of that pregnant woman’s foetus, otherwise than in accordance with the provisions of the Bill. The penalty in the Bill for intentionally ending the life of a foetus, otherwise than in accordance with the provisions of the legislation, is, on conviction, a fine or imprisonment for up to 14 years, or both. It should be noted that nothing in the Bill will prevent or restrict access to services lawfully carried out outside the State. This means, for example, that a doctor referring a patient to a service abroad or a person paying for flights or accompanying a woman to another jurisdiction to access the procedure will not be committing an offence under the legislation.
Section 6 provides for the offence by a body corporate.
Section 7 repeals certain laws which are in contravention of the principle of the Bill. In particular, it repeals the Information Act. I make it clear that I hope to be in a position to commence this Part of the legislation as soon as the law is enacted in order that women who have to travel while we are waiting to introduce the new services in January can at least have the opportunity for their doctors to share information with doctors abroad. From talking to women and women's groups, I know that this will be of vital assistance in the interim.
Section 8 puts arrangements in place to cover situations where a review committee has been convened under the Act of 2013 and is ongoing at the time the Bill comes into effect. It also obliges the HSE to prepare and submit a final report on reviews to me, as Minister, not later than six months after the commencement date of the legislation.
Part 2 of the Bill covers the grounds on which terminations of pregnancy may be lawfully provided under the legislation, arrangements for conducting reviews and provisions on certification and notification of procedures under the legislation. Section 9 offers definitions of "health", "appropriate medical practitioner", "medical specialty", "relevant specialty", "obstetrician", "review committee" and "viability".
Sections 10 to 12, inclusive, set out the grounds on which a termination of pregnancy may lawfully be provided, including where there is a risk to life or serious harm to the health of the pregnant woman; where there is a risk to life or health in an emergency; and where there is a condition likely to lead to the death of the foetus.
Section 13 provides that a termination of pregnancy may be carried out by a medical practitioner who, having examined the pregnant woman, is of the reasonable opinion, formed in good faith, that the pregnancy concerned has not exceeded 12 weeks. A three-day period must elapse between certification and the procedure being carried out. This requirement is not unusual. Several countries in Europe, including Belgium, Germany, the Netherlands, Italy and Luxembourg, have similar provisions. The certifying doctor must then make arrangements for the procedure to be carried out as soon as possible once that period has elapsed.
Sections 14 to 19, inclusive, set out the arrangements for reviews of medical opinions where this is sought by a pregnant woman or person acting on her behalf. The purpose of the review process is to provide a formal mechanism whereby the woman can access a review of the clinical assessment made by the original doctor or doctors. I should make it clear that the formal review pathway is in addition to, not in substitution for, the option of a woman seeking a second opinion as in normal medical practice. Section 14 states that where a medical practitioner has not given an opinion or an opinion which would certify a procedure being carried out under section 10 or 12, he or she must inform the pregnant woman in writing that she or a person acting on her behalf may apply for a review of this decision.
Section 15 provides for the establishment of a review panel by the HSE, which may be drawn on to form a review committee.
Section 16 deals with the establishment of the review committee. As soon as possible but not later than three days after receiving a written request from a pregnant woman, the HSE will convene a committee drawn from the review panel to consider the decision in question.
Section 17 specifies that the committee shall complete its review as soon as possible and no later than seven days after it is established.
Section 18 sets out the procedures of the review committee. It aims to empower the review committee to obtain whatever clinical evidence it requires to reach a decision and to call any relevant medical practitioners to give evidence.
Section 19 provides that the HSE must submit a report to me, as Minister for Health, not later than 30 June each year on the operation of review committees. Information that will have to be provided in the report includes the total number of applications received; the number of reviews carried out; in the case of reviews carried out, the reason the review was sought; and the outcome of the review. Any information that might identify a woman who has made an application for a review, a person applying on her behalf, or a medical practitioner involved shall be excluded from the report by the HSE. This information is required to monitor implementation of the legislation to ensure the principles and requirements of the system which this House will, I hope, vote to put in place are being upheld.
Sections 20 and 21 set out requirements under the legislation for certification and notification of procedures carried out under the Bill. Section 21 also contains a requirement for me, as Minister, to prepare and publish an annual report on the notifications received. This will be done without disclosing the names of the women or the medical practitioners involved.
The third and final Part of the Bill includes provisions covering consent and conscientious objection, as well as provisions for providing universal access to services for persons ordinarily resident in the State. Section 22 deals with consent and states nothing in the Bill will affect the law on consent to medical treatment. The intention is that the provisions of the Bill will operate within the existing legal provisions on consent for medical procedures.
Section 23 covers conscientious objection.
It states that, where he or she has a conscientious objection, a medical practitioner, nurse or midwife will not be obliged to carry out, or to participate in carrying out, a termination of pregnancy. This is not new because it is in line with section 49 of the 2016 Medical Council’s guide to professional conduct and ethics for registered medical practitioners which obliges doctors to enable patients to transfer to another doctor for treatment in cases of conscientious objection.
Section 24 prohibits receiving financial or other benefits-in-kind in cases where referrals are made to services providing terminations of pregnancy. It states a person will not receive or agree to receive any special benefit or advantage in consideration of a termination of pregnancy within or outside the State, or for making arrangements for a termination of pregnancy within or outside the State. A person contravening this section will be guilty of an offence and liable on summary conviction to a class A fine. The aim of section 24 is to protect a woman’s interests and ensure she will receive objective advice and information, uncoloured by financial or other considerations. It will ensure the person or body cannot derive any benefit from recommending that a termination be procured, with benefits to include financial incentives, as well as any other advantage or benefit in kind.
Sections 25 to 27, inclusive, provide the legislative basis for providing universal access to termination of pregnancy services for persons ordinarily resident in the State. This is important because we cannot have a situation where a woman cannot access the service owing to cost. We want to provide it as an integrated part of the health service.
Section 28 amends the Schedule to the Bail Act 1997 to include an offence under the Bill.
The Bill allows the service to be provided in the primary care setting. It is my intention that termination of pregnancy services should be provided as part of the continuum of women’s health services. This will mean that in the future women will be able to choose to receive this service from their GP, a person with whom they are comfortable and familiar. The international evidence and advice I have received shows that most women can have care provided safely and effectively in the community setting. This is particularly the case where the service is carried out in early pregnancy. The evidence shows that the earlier in a pregnancy a woman seeks the service, the safer it is to provide it without recourse to hospital treatment and with minimal complications or other risks to her health. Officials in my Department and the HSE are at an advanced stage in drafting contract proposals to allow for as many members of the general practitioner community as possible to participate in providing the service. I look forward to a high rate of participation among general practitioners in order that women’s access to the service at this stage in pregnancy when it is safest can be facilitated. Up to nine weeks gestation it is envisaged that most terminations will take place in the community setting and without recourse to referral to hospital or for ultrasound scans. I understand not every woman will present early in pregnancy and during the first nine weeks. In situations where women present between nine and 12 weeks of pregnancy, the international evidence and advice I have received indicates that GPs should refer women to the care of a consultant obstetrician in a hospital environment.
Terminations after 12 weeks of pregnancy will only take place on the grounds of a risk to the life or health of the pregnant woman, a risk to the life or health of the pregnant woman in an emergency or where there is a condition that is likely to lead to the death of the foetus before birth or shortly thereafter. These terminations will occur in the hospital setting.
Detailed work is ongoing under the auspices of the relevant medical colleges to develop more detailed clinical guidance to assist practitioners in the clinical decision-making involved in dealing with the women concerned. My Department has provided financial assistance for the colleges to enable them to complete this work as a key component of the delivery of an integrated service. Yesterday I was pleased to welcome the appointment of Dr. Peter Boylan to assist in the HSEs preparations for the implementation of arrangements for termination of pregnancy and related services. Dr. Boylan is a leading figure in obstetrics and gynaecology and we are pleased to have him assist in this work. He has a long track record as a women’s health advocate and expert clinician. I thank him for agreeing to undertake this work.
Following similar models in other countries, I have directed the HSE to make arrangements to put in place a medically staffed national telephone helpline to be available on a 24/7 basis once the expanded termination of pregnancy services are in place. My Department and the HSE are collaborating in developing a comprehensive plan for communicating with the general public and stakeholder groups for use in introducing expanded and new services. Messages to the general public will highlight the pathways to accessing services, sources of crisis pregnancy counselling and information where the woman may wish to access them, as well as medical information on the procedure at different stages of gestation. The importance of attending services early will be one of the key messages of the communications plan.
The Government is also committed to working to reduce the number of crisis pregnancies by improving sex education and ensuring cost is not a barrier in accessing contraception. These important ancillary recommendations of the all-party committee need to be acted on by all Members. We need to help to reduce the number of women who find themselves in a crisis pregnancy, as well as expanding termination services.
It has been a long road to get this to juncture. I think today of the many people who have fought this battle in the past 35 years. I think of the women who shared their private, most intimate experiences with the public in order to seek change. I think of the women and their families who have endured hardship and pain as a result of the eighth amendment but who felt unable to share their stories. I hope the work we begin today and the referendum result send to them a message of solidarity and support that they were long without. I ask that we continue to be constructive, not obstructive, and ensure we are respectful of each other and the views of the people, the people who voted and made their decision, as we start the debate on the Health (Regulation of Termination of Pregnancy) Bill. I hope we can work together constructively on the legislation to ensure we do not rerun the referendum campaign. That argument has been dealt with and the votes cast. Instead, I hope we can work together to put services in place for women who need them as soon as possible. The voices of women who spoke up so movingly during the referendum campaign earlier this year cannot be unheard. Their stories can never be untold. If, as I believe to be the case, the people decided they could no longer countenance women being denied care in their own country, we have to make that change. It is time to end the lonely journeys. It is time to finish lifting the shame and stigma which have cast shadows on so many lives. It is long past time to stop punishing tragedy. I look forward to an Ireland where any woman facing a crisis pregnancy can be assured that she will be treated with compassion and able to access all of the care she and her family need in this her country, supported by those who love and care for them. That is the objective of the Bill which I commend to the House.