Health (Regulation of Termination of Pregnancy) Bill 2018: Second Stage

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.

On Friday, 25 May, the people were asked if they wanted to remove the eighth amendment from the Constitution. There were deeply and genuinely held views on both sides of that question. The debate in people's homes, on the doorsteps and the airways and in Parliament was passionate and, in the main, respectful. We should reflect on this and be proud of it. Around the world, public and political discourse is becoming more extreme, divisive, aggressive and hateful. Bucking that trend in Ireland, a largely respectful debate was held on this most sensitive of issues. Ultimately, the people voted by a large margin to take the eighth amendment out of Constitution. They did so for many reasons. Some believed women should have unfettered access to abortion services. Others believed termination should be available in cases of rape, incest and fatal foetal abnormality. Others believed that, if termination services were available abroad, we must provide them here in order that Irish women would not have to travel. The eighth amendment is gone and it is up to us to legislate. The question now is what form that legislation should take.

Two months before the referendum the heads of a Bill were published, providing much of the detail of what the legislation would look like if the eighth amendment was repealed. It was largely, although not fully, in line with the recommendations of the Oireachtas all-party committee. It stated, for example, that there would be no restrictions on terminations up to 12 weeks. It stated that after 12 weeks terminations would be allowed in specific circumstances, including where there was a risk to the life or serious harm to the health of the pregnant woman. It stated doctors would be able to conscientiously object and much more. The details of the heads of the Bill formed part of the national debate on radio, television and the doorsteps. It is my view that when the people voted to repeal the eighth amendment, they did so with a clear understanding that the legislation that would follow would reflect the heads of the Bill published in March.

Having examined the Bill before us, I believe it reflects the heads of the Bill and, as such, it reflects the will of the people and should be supported by the people's Parliament. I am sure there will be plenty of time on Committee Stage to tease out the details to make sure the legislation is robust, clear and workable.

Given the conversations I have been having in recent days, and which I sure many Members have been having, it is clear that across the spectrum of views on abortion, from those who are pro-life to pro-choice and everything in between, people have many issues with this Bill. I am sure people are approaching every Member of this House about many amendments, changes and tweaks. Some people believe it should be more liberal, some believe it should be more restrictive and some believe it is about right, but that there are technical issues that need to be teased out in the legislation.

There are aspects of this Bill with which I do not agree. For example, I do not agree with the three-day waiting period. It did not form any part of the committee report. It was not included on the basis of international evidence. My understanding is that it was political and that it was included at a time when a certain member of Cabinet was expressing concerns about supporting repeal of the eight amendment.

Regardless of why it was included, it was included and, to my mind, it clearly formed part of what the people voted for and, for that reason, even though I do not agree with it, I will be supporting its inclusion and the inclusion of everything that lines up with the heads of the Bill.

The same approach should be taken with all proposals to amend this Bill. The question we must ask of every proposed amendment is whether it falls within the parameters of the heads of the Bill and, if it does, it is incumbent upon us to reflect upon the merits of the proposed amendment to see if it should be included.

As someone who campaigned for the repeal of the eight amendment, removing the eight amendment was an historic and important day for Ireland and particularly for the women of Ireland, but let us not stop with this important move. Many other areas need attention. We need many more supports in place for women with crisis pregnancies. If we do this and we get it right, we can reduce the number of crisis pregnancies and the number of terminations. That has been achieved in other countries and there is no reason we cannot do it here. We need to see investment in education. We need free contraception. We need free childcare in third level institutions. We need the removal of poverty traps for women who are working and have children. If we do all those things, which we must, we can begin to make great inroads into reducing the number of crisis pregnancies and supporting women, as they must be supported.

If we are going to provide services for the termination of pregnancy free of charge, which I fully support, then we must also provide healthcare services attached to pregnancy free of charge. It would be perverse to make healthcare services related to the termination of pregnancy free while charging for healthcare relating to continuation of pregnancy. Let us make it all free. Let us take this matter very seriously. I spoke to my colleague, Deputy Brassil, this morning and he gave me an example in this context. There is a drug called Cariban which is to help pregnant women who are suffering from extreme vomiting. Between the drug and the potential admission to hospital for intravenous, IV fluids, it can cost somewhere between €1,500 and €3,000 during a pregnancy, and that is not covered by the medical card. Let us remove the costs of pregnancy in their totality. Let us make sure the needed resources are provided more broadly for women's health. We have had CervicalCheck, symphysiotomy, Portiuncula Hospital, the Tuam mother and baby home and the Magdalen laundries. Scandal after scandal in healthcare in this country has related to women's health and, in the main, to women's reproductive health. It must stop.

Let us also look beyond healthcare. We need a comprehensive approach to tackling violence against women, including the issue of consent. We need gender proofing of budgets and of major Government policies.

Repealing the eight amendment was important. Let us make sure that momentum continues as we work to make Ireland a truly equal Republic.

The next speaker is Deputy Kelleher. Is he sharing his time?

Yes. I am sharing the time remaining in this slot with Deputy Thomas Byrne.

I welcome the opportunity again to speak on this topic. I have been speaking on it from this bench for a number of years. It is quite amazing that after the outcome of the referendum we are now here talking about the legislation to enact the will of the people. Reference was made to the fact that the heads of the Bill were published in advance of the referendum. It is an important point to make because we do not want to rerun the referendum.

It is important that the legislation that flows from the heads of the Bill, which we are debating, is in sync with what was published in advance of the referendum. There should not be much deviation from that beyond perhaps technical and administrative reasons, but the principles that were put to the people should remain intact in the context of the legislation. Once we start to move from where we were, we will open up the whole debate again and it could become divisive again. As referenced by Deputy Donnelly, I suggest that in terms of the heads of the Bill, we keep it as it was. I sat on the committee. It was an experience one would draw from in the context of the debate we had during the referendum. It must be acknowledged that, by and large, from my perspective, it was a respectful debate in terms of others who had a very different view, both on the doors, in the streets, in the studios and in this Chamber. I hope it remains that way because we are talking about healthcare for women. That is the principle of the issue. It is about ensuring women have access to healthcare in this State.

Reference was made frequently to people going on a journey, so to speak, in terms of their transition to having different views on the issue of the repeal of the eighth amendment and what should replace it in terms of a constitutional referendum, the wording and now the legislation that is flowing from that. The fundamental issue from my perspective is that we, as a State, should be obliged to provide healthcare for women in this State. In my mind, it was a simple debate, and I believe the people, in adjudicating on the issue in terms of the referendum, distilled it down to that fact. Were we going to continue to export our problems, tragedies, difficulties and our shame to other states or would we be mature enough, as a nation, to deal with them here? The results of the referendum were emphatic in that the people said that we must deal with our problems and challenges in this country and give women the healthcare they need and deserve. In my view, it was a straightforward debate in that context.

With regard to the legislation, as my colleague, Deputy Donnelly, stated, if we are to be honest with ourselves in terms of providing healthcare around the issue of terminations up to 12 weeks for the reasons outlined by the committee and now endorsed in this legislation, and I hope it will be endorsed by this Parliament when the debate is concluded, equally, healthcare should be free for women who do not seek a termination. That is an issue that must be examined very quickly in the context of this debate because from 1 January, the Minister will be providing for abortion services in this country. For the first time, abortion services will be provided in this country free of charge. Equally, all other services for pregnant women should move to be free of charge as well. That makes obvious sense from that perspective.

The other issue raised in the report, which was not debated in great detail during the referendum because what we were talking about was quite specific, was ancillary services. We have a good deal of work to do in the context of sex education and supports for women in crisis pregnancies. That is an area on which we fall down from time to time. We fell down because we knew these issues were being dealt with elsewhere. We kept our head in the sand. There is an obligation on us to ensure that women in a crisis pregnancy have all the supports available to them for them to make up their minds as to how they go forward and the decisions they reach. Until recently, we did not do that very well. We depended on organisations that should not be involved in that.

The State itself should be involved in this through its role of providing healthcare for women. I urge the Minister to look at that issue, and that we would not become dependent on organisations with varying views on this issue that come at it from different perspectives. The State must step up to the plate. We need to start ensuring that we have proper facilities in place with regard to bricks but also supports for women when they are pregnant.

There were a number of reasons we arrived at the 12 weeks but the reasons became very obvious when we listened to the medical evidence. A medical termination could take place up to around 12 weeks, and I accept that it may not always be possible to carry out a medical termination in the community setting up to 12 weeks. The fact that the Minister is talking about medical termination being available from nine to 12 weeks in an obstetric setting is clearly because of medical advice. I also accept this. If, however, we are to provide terminations under an obstetric setting from nine to 12 weeks, I do not want to see a situation where we have difficulties. We need to have enough obstetricians to provide that care and to make sure it is accessible.

On the matter of conscientious objections, I respect everyone's entitlement to object on conscientious grounds, but equally no woman should be put at risk because of conscientious objections.

Many difficult questions were posed in the referendum. There were questions that I, and I suspect many other people, found difficult. One of the easiest questions that I was asked in various media interviews was whether I would accept the will of the people if this referendum was passed. That was the easiest question. Of course we would do that. That is our absolute obligation in this Dáil. This should not even be an issue. It is surprising to me that it was an issue with some people during the campaign, and apparently it is still an issue with some people today. The truth is, and all the evidence shows, that people have different views on abortion and people recognise that others may have different views on abortion. This is clear. The vast majority of people accept that there are alternative positions in this regard. In a democratic society there is only one way to reconcile those views, which is to have a referendum where the country can decide after the people have listened to numerous debates with every side's point of view put forward. I believe that everyone's view was put across fairly in the broadcast and print media, and then the country made its decision. It is now our role in Dáil Éireann, as my colleague Deputy Donnelly has said, to implement exactly the will of the people as expressed in the referendum.

It should be noted that the turnout went from around 50% in previous polls to two thirds of the public turning out, which shows that a large section of the population had thought long and hard about the issue. They may have had contrary views before this referendum and changed those views. Changing a view is one of the hardest things for a politician to do because he or she may be accused of making a U-turn. This, however, is what many Irish voters did and they voted with difficulty. Voters on the No and the Yes sides voted with difficulty.

It was very clear, however, what the outcome of the referendum would mean, that the heads of the Bill, as put forward by the Government at the time would be enacted. My colleague, Deputy Donnelly, who has studied the Bill in depth, and all of us who have read it accept that what is being put forward in the Dáil today is what was put before the people, and it is what the people voted on. We have an obligation to do that with minimum amendment. At this point we are getting so much unfair pressure from both sides of the debate to change things. This is because of the difficulty of the issue, because of the huge national debate the referendum caused, and because of the information that was put out to people regarding what was contained in the heads of the Bill. The debates were listed and the information was listed, so everyone knew what this was about. No one can say that they did not know what they were voting on.

We need to pass this legislation, implement the will of the people and let that happen. We need to concentrate on other important issues also, so let us just do this. We have no other option.

While I support conscientious objection, I understand that the provisions in the Bill for conscientious objection are almost identical to the provisions in the Protection of Life in Pregnancy Act 2013. I had not heard of this being an issue then. In fact, certain amendments that were tabled by certain Senators - I was in the Seanad at the time - would be criticised today because they are not in accordance with today's argument. I do accept that there are people who have serious objections, but the idea that a clinician would stay silent when a person raises the issue is simply not credible. The doctor has the absolute right not to facilitate this, but I do not believe he or she has the right to close the door on a woman thereafter.

There has been a debate in the Dáil on the ancillary recommendations and on sex education, but that was a very short Private Members' motion. There has been extensive debate around sex education provision in schools at the Oireachtas Joint Committee on Education and Skills. Having looked at the evidence as it has been put before us, I have no doubt that there is a major problem in the provision of sex education and who might provide it. The Department of Education and Skills does not regulate anyone who comes into schools in that regard, be it for sex education or sports clubs and so on. The Department plays no role in setting out who can come into our schools to teach children on a range of issues, not just for sex education. That has to change but it cannot be done simply as an attack on the ethos of the school. It can be combined to ensure that children are taught in a non-ethos way about fact-based sex education. That has to happen. This needs resources primarily. One of the problems we have with education currently is the constant pressure that schools and teachers can do that. The responsibility for this type of education is not just on schools. Our entire society, and especially families, has a responsibility to inform young people. If we ask schools to do it then they need to be resourced. It is not enough that we make laws and motions in Dáil Éireann and put the burden onto schools. That cannot be done and they need to be resourced properly.

This legislation has to pass. The people are sovereign in this State. The Dáil is not sovereign. This Dáil is not like the House of Commons. It is a very different system. People who are pressurising us at the moment about changing the Bill need to recognise that the people are sovereign.

It is with great pride that I speak on behalf of Sinn Féin on this historic legislation. I intend to raise points in the spirt of co-operation and I wish to be as constructive as possible regarding the legislation because it is incredibly important that we get this right. The reason it is so important is that right across the world we have seen that, once abortion laws are passed, it is sometimes very difficult to revisit them. We need to pass this legislation quickly but we must also make sure it works and delivers for women. The legislation in front of Members today will go down in the history of the State as some of the most important legislation that we will ever pass. That cannot distract us from our duty to get it right for those who will need to avail of abortion services as well as for clinicians who will provide these services. We are here with a mandate from the people, which was cemented with 1,429,981 votes. Today those people are willing us to do our job, to work constructively, and to get this right.

The public discourse during the referendum campaign reflected people’s understanding of abortion as a healthcare issue that should be addressed through progressive patient-centred legislation, not criminal sanctions. The general scheme of the Bill had offences and criminal sanctions at section 19 at the end of the Bill. When the Bill was published, I was shocked and surprised to see offences and criminal sanctions moved to section 5 at the very front of the Bill, which was right in the front window. I told the Minister that I did not believe this was the appropriate place. In legislation to regulate for the provision of abortion we are confronted with the crimes for carrying out an abortion outside of the scope of the Bill before we ever see mention of the provision of abortion. I find that shocking and I would like to know and understand the motivation of the drafters in doing that. This has perpetuated the chilling effect felt by clinicians and the continuation of the stigmatisation of abortion.

Throughout the hearings we had at the Oireachtas Joint Committee on the Eighth Amendment almost every single clinician who gave evidence spoke about the chilling effect of the amendment on their ability to provide healthcare for women, yet here we are with a Bill to legislate for abortion and we see the rewriting of the eighth amendment into legislation. Professor Fergal Malone and Dr. Rhona Mahony were very clear on this issue at the committee. They said doctors could not even pick up the telephone and make a referral. If we cement this chilling effect into the legislation by telling doctors that they are specifically not allowed to do this before we even tell them what they are allowed to do, we will do just that. I ask the Minister to move the offences and criminal sanctions section to the end of the Bill.

It would be remiss of me not to say that, while I use the word "abortion" and the Bill is to legislate for abortion and access to it, there is not a single mention of the word in the Bill. Furthermore, there is just one reference to access and that is in the offences section. Therefore, in legislation to provide for access to abortion there is only one mention of access and no mention of abortion. "Abortion" is not a dirty word. It was not a dirty word in 1983 when the eighth amendment entered the Constitution and it is not a dirty word in 2018. Over three years ago Her.ie published a fantastic article entitled, We Need To Stop Treating Abortion As A Dirty Word. The opening paragraphs stated: "it's rare that the word abortion is said in anything other than an apologetic, hushed tone" in this state. It went on to state abortion had been "treated by the majority of women in this country as a dirty word, heavy with stigma and representative of an act that must be covered up and denied at all costs". While the referendum campaign changed that fact and now abortion is not viewed by so many in those terms, there is the residual effect of that stigma, which is evidenced in the drafting of the Bill. Will the Minister consider ensuring a reference to abortion and access to it is contained in the legislation because if we do not try to challenge the residual effects of the eighth amendment in legislation, there is the possibility that they can live on and grow in our society?

When we met previously to discuss this legislation, I said I had been asked by many stakeholders; lesbian, gay, bisexual, transgender and intersex, LGBTI, groups and by Repeal campaigners to ensure reference would be made in the legislation to "pregnant persons" to cover people who could get pregnant but did not identify as, or were not, women. It was apparent that the LGBTI and trans communities had played a huge part in the referendum campaign. They did so in Fingal Together for Yes and across the State. Trans people, particularly trans women, are an inextricable part of the feminist community and it would be remiss of us if the legislation providing for the provision of services was to leave them out. We have to refer in it to people and persons who can become pregnant. I have spoken to the Minister about this and hope we can sort it out by way of an amendment.

On the three-day waiting period, we must listen to the medical experts. That is one thing the referendum taught us, that on issues such as this, we must listen to women and medical professionals. Many medical professionals have expressed concern that such a measure will restrict access to abortion services. It is a little paternalistic to claim that if a person attends a general practitioner to avail of an abortion she has not thought it through, that she has not given it full consideration and that she is unsure about what she wishes to do. The Minister knows as well as I do that no woman takes a decision such as this lightly and this measure will restrict access in general, but it will also restrict access for marginalised groups, women in abusive relationships, those with a disability and those in direct provision accommodation, among others. It will also affect women in regional, less populated areas, where they may not want to attend their local GP, who will have to travel to Dublin, Cork or another large town or city. This will place additional burdens on them, in time, travel and other costs.

My colleague Megan Fearon, MLA, who is leading our campaign in the North on this issue is watching this debate. For women in the North who may need to access abortion services, the waiting period will act as a significant deterrent. I extend my best wishes to my Northern comrades who are still fighting for access to abortion service; I assure them of my help and support, as well as that of Sinn Féin, in this fight.

It seems that the 72-hour provision was a political decision because it was not part of the committee's report, as stated recently at a committee meeting by one of the members, which seemed odd to me. It was not part of our deliberations and not part of our report. Reference has been made to how it may have got into the legislation. That is fine; it is a matter for the Minister, but it was not done so on the advice of clinicians, many of whom have spoken out against it. We, in Sinn Féin, will be guided by doctors and other medical professionals on the matter. I have completed several stakeholder meetings and will have many more on the legislation.

The conscience clause in section 23(3) of the Bill is appropriate and will protect those who, for whatever reason, do not want to provide this service, but, first and foremost, it will protect women. For the avoidance of doubt, we do not agree that medical professionals who invoke the conscience clause should be exempt from referring a patient for the necessary medical treatment they seek. Women who need medical treatment must be protected and at the centre of this provision. I am glad of the Minister's commitment that the services will be provided free of charge. It is important that there be no barriers to access in that regard. We need to be sure services can go live in January 2019. To do this, medical and healthcare professionals must be engaged with intensively. It is they who will deliver the services and it is important that they be involved and that their input be reflected in the services to be provided.

I welcome the announcement that Dr. Peter Boylan will assist in the implementation and preparation of abortion services. I congratulate him on his appointment. He is an eminent and accomplished clinician who has been at the forefront of women's healthcare in the State for many years. As a consultant obstetrician, a former chairman of the Institute of Obstetricians and Gynaecologists and a former master of the National Maternity Hospital, he is exceptionally well qualified for the role. He played a prominent role in the campaign to remove the eighth amendment from the Constitution and provided excellent evidence and information for the Oireachtas Joint Committee on the Eighth Amendment prior to the referendum. I look forward to working with him to ensure the health service will provide world class abortion care and that the ancillary recommendations made in the report of the committee are implemented in full. It is only by implementing them, with the other recommendations made, that we will do justice to women who are seeking services. Once we have passed the legislation and implemented what I hope will be world class abortion services, it is important that our focus turn to implementing the ancillary recommendations made which include up-to-date, objective sex education and free contraception. I do not think I was the only one on the committee who was surprised by the sex education our kids received in school. It was an eye-opener, but not in a good way. That it is not regulated is very worrying because we are storing up more problems. We have to be able to provide kids with objective information, just information, not judgment or moralising. That came out very strongly during our hearings. If we are to do this justice, we need to do all of it.

We will also need to see improvements in maternity care for those who wish to have a child. This means the full roll-out of the national maternity strategy, with funding, not just announcements and paper, including investment in midwives and increasing their numbers. We need to invest in increasing the number of obstetricians and gynaecologists. We also need to ensure we have affordable childcare and mandatory paid maternity leave. That is, however, a debate for another day and we will have it at some point. We will be submitting amendments to the Bill in order to ensure it is in line with the recommendations of the Oireachtas Joint Committee on the Eighth Amendment and the Citizens' Assembly. We must ensure the legislation respects the result of the referendum and that it will deliver for those who will need access to abortion services. I know that the Minister is committed to doing this, as are we, in Sinn Féin. We will work with him efficiently and constructively to make it a reality.

I thank my comrades and friends in Sinn Féin because they debated, listened, voted and participated fully in an open and democratic way at our Ard Fheiseanna. It was not easy for them. It was an extremely emotive and difficult topic for many to wrestle with, but they took some guidance, listened to evidence and came to a decision. We will back that decision of our members at every opportunity to vote.

I thank those who worked hard to repeal the eighth amendment, including people like Ailbhe Smyth who gave their whole lives to it and the men and women in Fingal Together for Yes. We did a lot of campaigning together. We wore out many shoes. The Minister came to one of our events. We tired out our voices but we got there in the end and achieved over 77% which is really a tribute to those who gave their hearts and souls to it.

I know I have often mentioned my parents but they had extremely good foresight on this issue with regard to how they viewed what would happen in 1983. They campaigned against the insertion of the eighth amendment and brought their two daughters up to believe that one should never ever apologise for standing up for women's rights. I know my mam is watching this and I say to her that we are nearly there. I got very emotional coming in here, which is not like me but this is very important. Sinn Féin will work with the Government. We will not pull against it. We are in opposition. We know that but we want to get this done. We want those services ready for 1 January 2019.

It is a very historic day for this House. I am delighted to be here on behalf of the Labour Party to welcome and support this legislation. All of us who were involved in the referendum know that this is legislation which we have to get right. We will work collectively with the Minister to ensure we get it right because we have to get it right. It is a hugely historic occasion for my party, which as a political entity has a long track record on this issue, dating back to 1983, of fighting against this amendment, with the current Uachtarán na hÉireann Michael D. Higgins, leading the campaign, supported by the previous President of Ireland, Mary Robinson, the lady who has just walked into this room, Deputy Joan Burton, Eamon Gilmore, Senator Ivana Bacik, Deputy Jan O'Sullivan and many more. Today is very important for my party, dating back to 1983. I want to remember all of those who have gone before us who fought against this in 1983 on behalf of the Labour Party and may not be around to see this day. I want to remember them.

Over 50% of the population of this country are female. They are entitled to make the right choices about their healthcare in whatever circumstances they find themselves. The Labour Party has always supported them and will continue to do so today in this legislation to remove the barbaric circumstances that were put into the Constitution in 1983, forcing tens of thousands of women to leave these shores and, in recent times, forcing many women to take abortion pills without supervision. The referendum on 25 May will forever live in the history of Ireland, being passed in such large numbers. It is very important today that we remember those who fought so hard. The civic coming together of people on that day represented an outpouring of relief and compassion. People like to say there was celebration but it was certainly an outpouring of emotion. The Minister played a large role in it and I want to thank and congratulate him on that, along with many other people across politics. I look around this room and see people who have been in opposition for many years, people who were previously in government and, dare I say, people who changed their minds. Many across different parties changed their minds. It is often said that the people are sovereign, and they are, but people are entitled to change their minds and should be congratulated on that. I admire those who have come forward and done so.

We have to acknowledge the Together for Yes campaign across the country, a civic movement incorporating people from all politics and none, people who campaigned with me who I have never seen campaigning before and people who will campaign again in the future. I made many new friends. I am thinking in particular of Anita Byrne and Emma Burns in Tipperary. They are two fantastic women who drove on our campaign in Tipperary to deliver a fantastic result for our county. There was a sense that the people of Ireland were ahead of us on this issue. That is what I got from the off. Maybe there is something to be learned inside these walls, when the people can be so far ahead of a certain number of politicians regarding such a sensitive issue as this.

The people knew what they were voting for. There was a critical decision to publish the heads of this Bill, which I will come back to. Nobody in this House can, with any degree of honesty, accept or put forward the argument that people did not know what they were voting on. They clearly knew what they were voting on and made a definitive decision. The Constitution was never the place to make provisions for such a complex issue. It negated the rights of women to make decisions about their own health under the dark forces of 1983 which still have reverberations around this country in some quarters. There have been some stories in recent times but thankfully they are gone. With the provision of the heads of this Bill, it is critically important, now that we are debating the published Bill, that we do so within the structures of what was decided by the publication of the Bill and the decision of the people. There is no earthly way that we should open up this discussion or debate, or allow it to be opened, because some may like it to be opened up again. Let us work within the parameters agreed by the committee, put forward by the Government and voted on by the public.

I have some commentary on the Bill itself. I read the documentation put forward by various organisations about this Bill, some of which I agree with and some of which I do not. This Bill has to be read in great detail. Every single comma is significant and has to be perfect. The National Youth Council of Ireland, NYCI, asked for a Preamble to be given to the Bill to contextualise the Bill, where it has come from, what went before it, what it is changing, the Bill that came before it a couple of years ago about the previous amendment, and so on. I think that is a good idea and ask the Minister to take it on board. When I read it, it hit something that I was looking for. A Preamble would explain the history of this and maybe contextualise the way in which the Bill sits with other legislation. That would be quite useful. The legislation needs to be clear and unambiguous. It needs to give equal assurance to women and to healthcare providers that we will provide accessible services of the highest quality. We need to ensure that healthcare professionals and workers will have no questions about how to interpret this. We need to leave the floor of this House with that being as perfect as can be. We need absolute clarity.

I know people in this House will put forward amendments. That is everyone's right. We will consider them ourselves. We need to be very careful about the manner in which amendments come forward which possibly would have knock-on effects in the Bill. Terminology and consistency of approach are vital. The Minister has a lead role in bringing forward legislation but in this, his guidance to the House with regard to what he is being advised by the Attorney General is at a different level of seriousness.

We do not want to have unintended consequences for people who are doing something for the right reasons, if the Minister can follow my logic.

I believe the Bill honours the commitments given to provide for universal access and free services for the women of Ireland, but a few issues arise with the drafting of the Bill. I agree with what was said in that regard by a previous speaker. In fairness to the Minister, he acknowledged this when we met him yesterday. It is unfortunate that the offences are upfront. I know that it is unintended, but that is the first thing one comes across in reading the Bill.

Section 19 concerning offences seems to be unusually wide in its scope. The Minister might come back to us on it. Healthcare professionals might be concerned in cases where decisions are required to be made in very narrow circumstances. I refer to the 12 week timeframe. They might be worried about litigation. I urge the Minister to examine the wording. I say this to be constructive. Everything I say is to be taken in that vein.

I understand the need to provide for the offence of aiding, abetting or forcing someone to have an abortion against her will, as well as for the references to abusive partners, pop-up clinics and rogue doctors, among other issues, and the reason the measures have been framed in the way they are. However, I am concerned specifically about the wording "procure a pregnant woman". Is there a better way to word it? Let us call a spade a spade. I know that it deals with coercion and merely pose the question.

Data provision is vital. We need to know when women are having terminations, where geographically, gestation periods and other matters. The records of clinicians who carry out terminations must be tightly managed. The protection of clinicians is also important. Medical data collection is very important in that regard.

Section 24 concerns preventing medical professionals from making a profit or commission from referring women to abortion services. I understand this also, but, again, I wonder if the wording could be tightened a little.

Reference was made to the three-day period following the signing off on the request by a certifying doctor. The issue arose in the course of the committee's discussions. Many of us have different views, but we are where we are and I understand why we have to go about it in this way. However, we must ensure the legislation is clear and that no conflict will arise with the three-day period in the context of the 12 week barrier. From discussions with the Minister yesterday, I understand the three-day period includes the day on which a woman is certified or meets a practitioner.

The term "medical practitioner" is used throughout the Bill and there is only one exemption. Do we need to include a provision to give the Minister for Health or a future Minister the ability to change it without having to amend the legislation in order to include other healthcare providers such as nurses, obstetricians or other practitioners? We now have multi-disciplinary teams I think it is necessary to do so and merely ask the Minister to examine the issue.

I previously raised with the Minister the need to provide for safety zones around hospitals and primary care centres to protect women and practitioners.

In the time remaining to me I wish to deal with the issues of conscientious objection and meeting the timeline for the provision of services. Conscientious objection is not new, but it is very specific in this case. It is incredibly important that while we have processes in place in which to do this, no medical practitioner can cite a conscientious objection which could have a detrimental impact on a woman's health. The issue is that serious. This is very important. Institutions cannot have a conscientious objection. I have a concern about institutions using subtle methods to try to get their clinicians to act in a certain way. We must have strong procedures in place to ensure that cannot happen. We must also ensure such institutions could not try to force women to take the private healthcare route, given the fact that the service is to be universally available publicly. We must consider how and where we manage the lists of those who provide services and those who do not.

Following meetings of the health committee, I have a concern about meeting the 1 January deadline. I have raised the issue with the Minister previously. There must be a 24-hour helpline, a referral system, geographical coverage across the country and within an acceptable timescale in order that women will not have to wait for longer periods than is necessary just because they are based in one part of rural Ireland as opposed to another.

We must consider what will happen to a doctor who refuses to refer and where there are consequences for the health of a woman as a result. I do not just mean from the point of view of the Medical Council. The intention is that the 24-hour service is to provide for referrals, but it must also provide all other supports such as counselling. Midwives and nurses should potentially provide the 24-hour service, but they require training and 1 January is fast approaching. The protocols on referrals must be agreed to, as well as on how the work is to be done. How will that happen? A 24-hour number is to be provided, but how will we ensure the people who take an alternative view do not spend the day blocking the number while women who are in distress cannot access it?

We must protect healthcare providers when it comes to those who conscientiously wish to provide services. There has been a lot of discussion about conscientious objection to providing services. but what about protecting those who conscientiously want to provide them? Respect for self-determination at work works both ways. Respect for the professional integrity and decisions of those who wish to provide services is also paramount. We must ensure there will be processes in place to protect them.

We all know that the GP contract is coming up for renewal. I welcome the update provided by the Minister on the issue at the health committee yesterday. GPs are not set up to provide the services. What extra resources will be provided to ensure they will be adequately resourced?

I have a concern about the phrase "as soon as may be" in section 23(3). The reference is to "shall, as soon as may be, make such arrangements for the transfer of care of the pregnant woman concerned as may be necessary to enable the woman to avail of the termination of pregnancy concerned". To one GP that could mean one thing, but it could mean something else to another.

We must include a reference to contraception in the context of GPs and medical practitioners dealing with pregnancies and terminations. I urge the Minister to deal with that issue.

I am also concerned about the provision of resources in the context of the lack of trained ultrasonographers, obstetricians, in particular those dealing with issues between nine and 12 weeks, midwives and other health professionals.

I congratulate the Minister on appointing Dr. Peter Boylan. He is the right person to liaise with the HSE and the medical colleges on the implementation of this

programme.

We must ensure not alone that the guidelines for these services are put in place through him working with the Minister, but that there is also a plan to ensure that in the coming years we have free services such that pregnant women can rely on the public health system. As I stated, contraception is being dealt with. We need more crisis service provision. We know that many women accessed abortion services abroad. It would not be right to kick that can down the road. We must implement the maternity plan and strategy of which I am very supportive, as the Minister is aware. It is one of the best healthcare provision strategies ever written in Ireland and we must ensure it is implemented.

I wish to conclude by acknowledging on this historic day that in November 2016, having received a letter signed by Deputy Billy Kelleher and me, the Minister met me and Amanda Mellet. On a day such as today it would be remiss of me not to mention Amanda and the women who came after her, such as Siobhán Whelan, who led the fight and ensured that this issue was brought to international attention. I thank her and Siobhán-----

-----and Amanda's husband, James, for their actions in ensuring that international attention was brought to this issue and which has resulted in the changes being brought forward today.

I am sharing time with Deputy Bríd Smith.

This legislation is historic. I refer to the millions of women who live in countries where abortion is illegal and unsafe. Obviously, it is still illegal in Ireland. One in eight deaths of pregnant women worldwide are related to unsafe abortion. Banning abortion never stops it. I particularly send my solidarity to our siblings in Argentina, whose Senate, unfortunately, did not have the guts to do what was needed to legalise abortion there. The struggle for abortion rights there is only starting and those seeking it have lit a flame for all of Latin America.

I wish to characterise the nature of the legislation and comment on some of the points made regarding whether it can be changed. It has been a huge achievement to win legislation that is on a par with international norms. Until a year ago, the legislation being discussed in this country was of a very restrictive nature and related to providing abortion where life was at risk, there was a fatal foetal abnormality or in cases of rape. No other grounds were countenanced. However, the reality of the situation involving people travelling for abortions or taking abortion pills was brought home to the Joint Oireachtas Committee on the Eighth Amendment of the Constitution. The reframing of attitudes was also due to the persistence of a young radical movement which led this campaign, particularly in the past five years, and refused to accept an Irish solution to an Irish problem. The marches in which many people participated in the past seven years in particular, the civil disobedience which was required, the compelling research presented and so on were all critical to winning the referendum and getting to this legislation.

Some Deputies stated that a debate took place on the referendum and the Bill cannot be changed in any way. I do not agree. The scale of the result and turnout show that, if anything, we should be going in a more liberal direction than does the legislation. We got a 2:1 majority which was never anticipated by most of those who have so far contributed to the debate and a massive turnout. The general message was to trust women to make this choice for themselves. In exit polls, choice was the key reason given for voting "Yes". Imagine the discussion we would be having today if the result was a 50.5% majority for "Yes". Deputies would be claiming that people misunderstood the referendum and that we should not have legislation such as that before us.

It is not true that we must remain within the parameters agreed by the Joint Oireachtas Committee on the Eighth Amendment of the Constitution, as stated by one Deputy. Many matters addressed in the legislation were not agreed by the committee. We have now established that the 72-hour waiting period was not agreed by the committee and was not in the report. Several Fine Gael members tried to claim that it was. When it was debated at the committee, it was pushed back by experts. It is important to bring that out. The case regarding decriminalisation is similar. We are here to legislate and it will probably be many years before we get a chance to change the legislation once it is enacted, so we must do it right and speak about what we believe is right.

The 72-hour waiting period is unnecessary, patronising and patriarchal. Research from countries where it has been implemented shows it acts as a barrier to poor or vulnerable women accessing abortion. It will mean that a working person seeking an abortion will have to take a second day off work in order to make a second trip to the doctor. It could prevent people approaching the end of the permitted 12-week period from accessing abortion. In France, there was a seven-day reflection period but that law has been dropped and midwives are now permitted to perform abortions. The waiting period must be debated. Some may argue that it formed part of people's thinking when casting their votes. I do not know many people who voted one way or another because women were to be made to wait for three days. Rather, people voted based on issues such as the 12 week period for abortion and other key points in the legislation.

I ask the Minister to comment on the change from what was agreed by the Committee on the Eighth Amendment regarding the circumstances in which abortion is permitted. The committee proposed that abortion would be allowable where there is a risk to life or health. The legislation provides for abortion where there is a risk to life or serious harm to health, which raises the threshold. The terminology is very different. That is very important because the case of Savita Halappanavar, in particular, was one of the reasons why people went out and voted in droves. They can relate to how subjective such changes in terminology can be.

Another concern with the legislation relates to who decides to grant an abortion. The legislation provides that the decision is made by two doctors, one of whom must be an obstetrician. It makes no reference to the pregnant woman having any say in the granting of the abortion or the decision being made in consultation with her. That is a betrayal of what people voted for in the referendum because the position put forward by most people campaigning for a "Yes" vote was that the pregnant woman would make the choice for herself in consultation with her doctors, not that her doctors would decide, which is what the legislation provides. The criminalisation of illegal abortions may have a chilling effect on doctors, who may be afraid to make a decision based on a risk to the woman's health for that reason. Two years ago, a teenager was sectioned by a psychiatrist because she was suicidal and wanted an abortion. To put the power to grant an abortion into the hands of doctors and take it away from the person affected is wrong.

On criminalisation, the legislation will maintain a 14-year jail sentence for anyone other than the pregnant person convicted of carrying out an abortion outside the scope of the law. It will be maintained as an offence for doctors, but anybody who aids, abets, counsels or procures an intentional abortion or attempted abortion for a pregnant woman is also liable to conviction. The mother or friend of a pregnant woman who helps her to get an abortion pill at 13 weeks - it is perfectly safe to take an abortion pill up to 14 weeks with supervision - could be arrested. Somebody who is refused within the law, the mother or a friend of a woman refused a legal abortion who tries to help her to access an abortion pill online, could face sanction. Obviously, the judgment of a doctor relating to the risk to a woman's health may also be called into question under that provision.

Abortion should not be a criminal offence. In all countries, people are moving to decriminalise abortion.

Conscientious objection is a difficult issue because nobody wants to take on the idea that we must force somebody to take part in a procedure. However, I am shocked by the emphasis being placed on doctors having a conscientious objection. The woman affected is almost taking second place in the discussion. Conscientious objection is used as a mechanism in other countries to act as a barrier to abortion. In parts of Italy pregnant women cannot access abortion because doctors refuse it. I agree with the point that the wording seems to be extremely loose in that it provides that doctors must refer onwards when they have a chance. The emphasis is on the medic.

I cannot understand the transgender exclusive nature of the legislation because the issue was raised by many people before the Minister had the law written. Transgender, LGBT and non-binary people fought very hard in this referendum and in many ways played a leading role in it. The Minister is reviewing the Gender Recognition Act 2015. Transgender people genuinely fear they could be refused an abortion under the legal definition provided here, which makes clear the person must be a woman. This could be changed very simply by replacing the word "woman" with either the word "person" or the words "pregnant person" or inserting the words "and pregnant person" in the legislation.

I will also mention those who are omitted from the legislation. Clearly, many people will still have to travel, specifically those who have been given a diagnosis of severe, but not fatal, foetal abnormalities. Such case are very difficult and the Citizens' Assembly recommended that they be catered for. Unfortunately, the politicians on the committee did not do so and people did not get to have a say on the matter. That is very unfortunate.

I apologise in advance if my voice sounds a little "gappy". I have a chest infection. We should celebrate today because it is historic. It is amazing to be here and to be involved in helping to shape this legislation. I saw both the Minister, Deputy Harris, and Deputy O'Connell, at the March for Choice last Saturday. It was a celebratory event and even months later, winning the referendum felt really good. Tens of thousands of young people attended the march. We should recognising their role in this and celebrate that we have achieved a huge amount.

This time last year, we were sitting on the Oireachtas joint committee hearing the evidence and going through the detail. We had the referendum at the end of the May, and the outcome was decisive. It was not close, with 52% for and 48% against, but decisive. There is no argument about that. However, the process has been held up because there are organisations and individuals who will never stop contesting a woman's right to choose to control her own body. It is important that this legislation does not leave any hostage to fortune in terms of those who might use their wealth and even risk losing their homes by remortgaging them to continue to take High Court and Supreme Court cases, as they did during the summer months, to try to obstruct the outcome of the will of the people.

The tone and language adopted from start to finish in this legislation are important. We have to put women and the choices they make in their lives at the heart of it. I very much agree with Deputy Louise O'Reilly's point that upfront and loaded in the Bill is the question of criminalisation. The Bill states: "It shall be an offence to intentionally end the life of a foetus ...". The use of the words "... to intentionally end the life of a foetus" rather than the word "abortion" smacks of the eighth amendment all over again and the life of a foetus versus the life of the woman, etc. The language used is very important as we will otherwise leave the door open to legal challenge. There is nothing in the legislation providing that it will be a crime to intentionally obstruct a woman seeking to have an abortion. I will return to this issue when I discuss the conscientious objection clause.

This time last year, we were examining the nuts and bolts of the issue and now, a year later, we are legislation for abortion. That is fantastic, but we need to watch out for banana skins. The chill factor that hangs over the medical profession because of the upfront loading of the offences in the Bill has to be dealt with. I know we will have many more chances to do that in the coming weeks.

We need to be careful about including in the Bill provisions that were not part of either the Citizens' Assembly or the deliberations of the Oireachtas joint committee. Whatever about leaving out proposals made by the Citizens' Assembly, we should not insert provisions that did not form part of the deliberations. I refer, for example, to the three-day waiting period when women are to go back and think about their decision. It is important that we do not do that. I believe that was a political decision - the Minister will nod his head - to insert this provision in the Bill because it does not comply with best international practice. While such periods are provided for in some countries, as the Minister told us yesterday, in the Netherlands, where a three-day waiting period applies, the clock starts ticking from the time the pregnant person picks up the phone to her doctor to ask for an appointment on the termination of a pregnancy. If that were to apply here, it would be grand because it will take at least three days to get a general practitioner, GP, appointment in any case. As I have said previously, I wait a week to see my GP, even if I have a chest infection. While GPs do their best to facilitate people, clinics in Ballyfermot and other large urban areas are very busy. We have a ratio of general practitioners to citizens that is far below the European average. We also have many problems in general practice and I am sure Deputy Harty, as a doctor, can speak about the way GPs are paid. Fewer doctors are staying in the profession and many are leaving the country as soon as they qualify.

I am delighted the Minister has appointed Dr. Peter Boylan to oversee this. When it comes to accessing abortion services, particularly medical abortion, we have a major problem with our health service. At the heart of this issue is women's health and our health service is creaking at the edges. Given the problem with the delivery of ordinary GP services, such as prescribing an antibiotic for a chest infection and being able to see people quickly, delivering a proper choice for women will be a real problem. We have to look at that issue very carefully. I am sure many amendments will be tabled on the three-day waiting period, which I believe was inserted for political purposes.

The definitions in the Bill are important, particularly, as Deputy Coppinger stated, the definition of the pregnant person. A pregnant person may not be a woman but could be somebody who is transgender. We need a sentence referring to that somewhere in the Bill to ensure that when we refer to "woman", we refer also to transgender and do not exclude anybody.

The definition of health should be inserted in the Bill also. The World Health Organization recommends that the definition of health include not only physical and mental health but also social health. In this country, that is extremely important because there is a serious social exclusion, specifically in respect of young girls, women in direct provision and women Travellers. That definition should be included.

A medical practitioner is defined as somebody listed on the register. It would help if we changed that because it would assist in dealing with the access question. There are midwives and nurses who have more experience than most doctors in dealing with pregnant people. They should be included in the definition of medical practitioner, particularly for medical abortion. What would be the big deal about seeing a nurse or midwife in the Ballyfermot clinic to procure and take the abortion pill under his or her supervision, instead of having to see one of the doctors?

Last week, a friend of mine had to have the abortion pill. I helped her procure it, but I did not help her through it. She helped herself through it. She told me afterwards that the only reason she was able to get through the experience without serious distress was that she has two children. She understood what was happening to her body and that she was beginning to go into a sort of soft labour, with early contractions, and she expected heavy haemorrhaging. She said she could not imagine what it would be like for a young woman on her own going through that. It is timely, therefore, that we have this legislation before the House. We need to extend the idea of who is and is not a medical practitioner when it comes to giving people access to medical abortions.

On conscientious objection, I have friends who are doctors and they tell me that the Medical Council provides that there is conscientious objection for all sorts of reasons. I have often wrongly attributed a belief to the Mormons - I believe it is another church but I have forgotten its name - by which they often refuse to do blood transfusions. Deputy O'Connell tells me it is the Jehovah's Witnesses. The conscientious objection clause exists but we need a much stronger impetus whereby objecting doctors must refer on. That referral must be immediate and must never be denied. There has to be a criminal sanction for refusing to do so. If we are going to sanction practitioners criminally for helping women to make the choice, we must criminally sanction those who refuse to help them make that choice. I would like to see a body that polices that operation so that if I live in Glenties in Donegal, for example - I have no particular reason for picking it only that I like it - and there is one doctor in the village who conscientiously objects and will not tell me where to go, meaning it will be very difficult for me to get access elsewhere, I would like to think I have a place to go to say I was treated terribly by that doctor. There should be a body that would deal with my complaint immediately, not the Medical Council because that is for doctors but an independent body that has the health and concerns of women at its centre, almost like a feminist body, that would say we are not having that and that would carry out some kind of policing of the way it is done.

There is another thing that is not in the Bill, although I hope there is no need for it because it is widely accepted in this country, as the referendum showed, that we trust women and want them to have a choice. That said, if we had people standing outside hospitals during the referendum with 30 ft high banners that were frightening, humiliating and disgusting, then we may need to have safety zones for women and practitioners. We may need to have a look at that.

I am sharing time with Deputy Clare Daly. When more than 1.4 million people voted to repeal the eighth amendment in May of this year, they did so after years of thinking about, reflecting on and discussing people's personal stories of abortion. These were stories of relatives, colleagues and friends who had to travel abroad for basic healthcare. The people voted in the context of a campaign that did not hesitate to demand free, safe and legal access to abortion services and an end to the stigma of seeking such services. It was a campaign that demanded that women and any person who can get pregnant can be trusted to make the best choices for themselves in consultation with their doctor. The 1.4 million people accepted that life has grey areas and that dogmatic religious teachings have no place in dictating to anyone what should be a private healthcare decision.

While I broadly welcome this historic legislation as a step towards enacting the result of the referendum, I am a bit concerned that some of the themes in the Bill show that thinking dominated by Catholic social teaching is still contained within some parts of the legislation. There is a theme running through the legislation of refusing to trust those who need the services. There are issues around the use of language and potentially overly own-risk clauses within the Bill presented to us. It is around the question of the three days. If the three days were counted from the point at which the person makes the phone call to the surgery, that would possibly be accepted. Some women are very clear they want to have a termination and should be given the medical abortion immediately, if necessary. Some women may be unsure about what to do and may want a bit of advice. A GP could certainly advise a woman or person where to go to get that advice impartially. That has to be looked at. I am seriously concerned about it.

On the question of language, I would like to flag the use of the definition of "woman." I recognise that "woman" as defined will capture the vast majority of people needing access to abortion services, but clearly there are people - intersex, transgender and other gender identities - who are able to become pregnant and who are very upset and concerned. There is serious concern that they will be excluded from the legislation. It has been recommended by Amnesty that, instead of the current definition of "woman", the term be amended to "a pregnant person of age". I know the Minister said yesterday that "woman" covers everything but I think there should be some reference to it in the legislation or the amending parts of it. Given that we have some of the better legislation in the world in this area, such as the Gender Recognition Act 2015, I do not think there will be much opposition to the proposal when we get to the stage of teasing it out.

A couple of other issues around language and definitions stand out. The use of the phrase "life of the foetus" throughout the Bill raises an issue for me. We risk recreating a right to life of the foetus. I do not need to remind anyone what the referendum in May was about and what the people decided. It certainly was not to create a right to life of the foetus again in legislation to the detriment of people's healthcare access. I propose that instead of "to intentionally end or attempt to end the life of the foetus" or words to that effect, a more suitable wording might be "intentionally ending a pregnancy". I am sure we can tease that out on Committee Stage. We do not want to be in a situation where these definitions are being challenged in the courts by those who do not accept the will of the vast majority of voters in the referendum. The point was made succinctly earlier on as well. In any cases, the focus of the Bill on offences instead of a positive right for pregnant people to seek abortion services in a timely and easily accessible manner is a remnant of that way of thinking from before the referendum. The people have spoken overwhelmingly. They do not want their sisters, aunts, mothers, daughters, or friends to be treated as suspect or criminal or to be unduly burdened for seeking out a health service.

I do not know why the Bill maintains the system that was in place to notify the Minister for Health of every abortion case in the State. The system was taken directly from the 2013 legislation that catered for 20 to 30 abortions per year. Under the present Bill, the 12 women currently travelling each day will be getting care here. That will be thousands a year, plus those who procure the abortion pill and others who would not have been able to access those services abroad or on the Internet but will be seeking their healthcare here. Why should they be treated differently from any other patient in the State? This is a stigmatising measure and I thought we had moved beyond that point. Of course there should be reporting and collection of statistics but it should be carried out in a normal manner, the same as any other health service.

A review clause should be put into the legislation meaning that we regularly assess whether it is meeting goals that those who require abortion services are able to access them safely without barriers or delays. This would also allow us to review it in line with evolving best medical practice and human rights law. Amnesty particularly made the point about the review clause:

In line with recent legislation, including the Gender Recognition Act 2015 (section 7), the legislation should include a provision requiring a periodic review of the substance and operation of the Act. The Act should be periodically reviewed to ensure that women and girls are able to access safe, quality healthcare without barriers or delays; and to address in policy/guidelines any gaps, and new and emerging issues. The Act's substance must also be reviewed, to ensure that it evolves in light of developing international medical practice and human rights law (noting that what is proposed in the general scheme currently falls short of what international human rights law requires).

I further worry that some of the language in the Bill could cause issues for medical practitioners, especially the phrase "serious harm to health". This is a high bar for harm and also somewhat unknowable for a medical practitioner. A person's right to health is not qualified in international human rights. It is also impossible to know in advance how much harm is going to be done to someone's health. The World Health Organization, in its Safe abortion: technical and policy guidelines of health systems, from 2012, had the following to say on best practice around risk to health as regards abortion care:

The fulfilment of human rights requires that women can access safe abortion when it is indicated to protect their health. Physical health is widely understood to include conditions that aggravate pregnancy and those aggravated by pregnancy. The scope of mental health includes psychological distress or mental suffering caused by, for example, coerced or forced sexual acts and diagnosis of severe fetal impairment. A woman's social circumstances are also taken into account to assess health risk.

We should consider taking that on board in the legislation.

It would be better to remove "serious" and just refer to a risk to health in the Bill. To try to quantify the risk to a person's health takes away a person's ability to accept what level of risk they are willing to take. It goes against international best practice and the advice given to the Oireachtas joint committee on legislating on health grounds. We could be going back to a situation where doctors could be waiting for a risk to become substantial and serious before intervening.

We need to tease out on Committee Stage the very important issue of conscientious objection. I accept that people have the right to conscientious objection. As has been said, in countries such as Italy it has been used very frequently, meaning that some women have to travel long distances to find access to healthcare. The submission from the Abortion Rights Campaign stated:

The result of this practice is that, although abortion in Italy is technically legal, it can be practically impossible to access, with more than 70% of providers (rising to 90% in southern parts of the country) refusing to provide abortion care. Indeed, one woman had to visit 23 hospitals in order to obtain an abortion.

We also need to be very careful in this country. In some practices where there is a main GP, the other GPs in that practice could feel the pressure from that particular GP. It would be a shame if we were not to provide that. The submission from the Abortion Rights Campaign also stated:

The Health Bill is no different: it states that a medical practitioner invoking conscientious objection “shall, as soon as may be,” arrange for the patient’s care to be transferred to another practitioner, but does not define “as soon as may be”.

We need to look at that area.

I will be brief because while today is an incredibly important day, in some ways it is a sort of abstract day. It is an important stage in the process in delivering access to abortion to women. People have crusaded for this important day over decades since the insertion of the eighth amendment in the Constitution in the first place. At times I am sure many people thought we would never get here. Now that we are here, we need to leave much of the input to the experts.

What is happening today? Today sees the introduction of the Second Stage legislation in the post-repeal the eighth amendment era. It is incredible that we are still able to say that now and it has not really kicked in. We are in a post-eighth amendment scenario where everything is different, but yet, as it stands, everything has remained the same. As legislators, we have been charged with putting together the best and most comprehensive legislation that gives a voice to our citizens who have engaged in this debate over not just the past year but years in many instances. That is all we have been asked to do.

Last week I attended a press conference by the Abortion Rights Campaign, advertising last Saturday's march. It was attended by the excellent Dr. Mary Favier, a GP who, along with her colleagues, will be at the forefront of service delivery. She made the point that the law is one thing, but implementation is an entirely different matter. Some jurisdictions have perfect law on paper, but in reality women find it difficult to access services. In other instances it is the reverse. The important job is to ensure that Irish women in whatever circumstance have access to abortions where they need them. The people have spoken clearly. What was put before them was access to abortion up to 12 weeks' gestation without any restriction or justification as to reason. Our job is to introduce legislation that facilitates that.

Other Deputies have highlighted some of the shortcomings in the legislation before us today. I do not see any merit in me repeating those points. For some time organisations, such as the Irish Family Planning Association, IFPA, have soldiered on dealing with women's reproductive health issues. They not only provided the services but also had to crusade for legislative change. We now expect those organisations to be at the forefront of service delivery in a post-eighth amendment scenario. If we are expecting that, as we are, we need to listen to what they have to say. They have articulated it and other Deputies have referenced their submissions. It is our job to do that and the Bill as it is tabled does not do that. It is great that is there, but it needs to be changed and improved.

The IFPA made the point that the people spoke clearly about providing access to abortion, but the legislation does not mention the word "abortion" anywhere. I see nothing wrong with including "access to abortion" in the Title. In the previous Dáil Deputy Wallace tabled the first initiatives relating to broadening access to abortion in Ireland. At that time, Alison Spillane worked in Deputy Wallace's office and she has now gone to the IFPA. That organisation has been to the fore and its views have to be taken on board.

The biggest weakness, which needs to be addressed more than anything, is the issue of continued criminality. As the Minister knows, we all sat through the hearings of the Oireachtas joint committee, the Citizens' Assembly and so on. It was very clear that restrictive abortion legislation does not prevent abortion. It just means they happen later or are more unsafe. It is very clear that criminalisation causes stigma and causes harm, and people want to move away from that.

As other Deputies have said section 5(1) continues to make broad provision for criminalising the activity. It is very unusual when compared with other healthcare legislation, which is much more specific in terms of what constitutes an offence. This creates a grey area for doctors. We cannot divorce this from the fact that the HSE has not been women-friendly in terms of providing proper reproductive care for women in the State. Without full decriminalisation, we are getting into problems here. The chilling effect continues. The signal to doctors is that this legislation is just the same as the Protection of Life During Pregnancy Act with slightly broader parameters. If we do not address the issue there, we will have very serious problems. It is not really human rights compliant unless we move to total decriminalisation.

Other Deputies have spoken about the waiting period. The World Health Organization has stated that such a waiting period is a barrier to accessing safe abortion. We heard from the best, including legislators in the Netherlands and so on who were very clear. Deciding to have an abortion, like deciding to have a child, is a very serious decision. No woman makes that decision lightly. I have no problem with time being provided for people to make that decision, but I do not need to tell people that. People already allow themselves as much time as they need to make that decision.

Unfortunately, sometimes people do not have that freedom. They may be in a job with an employer who might make it difficult for them to get time off. They may need to access the abortion pill over the weekend and so on. The time period for thinking about it must be, as in the Netherlands, from the first phone call. I do not think anyone would have a problem like that. When moving into periods of later gestational limits, however, and a doctor then operating on the basis that he or she might be criminalised later on, it is too dangerous unless we tackle that issue. Therefore the section on the waiting period needs to be firmed up.

I refer to what constitutes a pregnant person and a medical practitioner. Other countries, such as the UK, are moving away from a system dependent on nurses and midwives, and the facility is widely available in the early stages in primary healthcare and so on. We cannot restrict and outlaw those providers from being able to provide the facility later on.

I will not repeat points made by others. I see no point in that. The issues have been well flagged by people at the coalface. This is only a symbolic day because the real body of work will be done in committee. There is an acceptance on this side of the House that the Bill needs to be amended. We are very glad it is there. We are very clear about what the people have spoken on. At the moment it needs to be improved in line with the wishes of the people. That is what we will be doing on Committee and Report Stages.

We welcome this strategic landmark. That is what it is and we should be glad to recognise it. It is a long time coming in a country that has not treated women appropriately in terms of childbirth and so on. I welcome that the Minister has brought it to the floor of the House and I look forward to working constructively to make it better and fit for purpose when it emerges from Committee and Report Stages.

I welcome the opportunity to speak on this issue. The Bill we are due to "debate", and I use the term very loosely, represents a moral, political and humanitarian catastrophe. It is now absolutely clear we have decided to anchor our understanding of human dignity in a culture of vicious political supremacy of the strong over the weak. We have done so fully aware that wherever legislation such as this is introduced, it soon generates a momentum that makes further liberalisation almost impossible to resist.

We have seen that process begin already. Yesterday morning the abortion lobbying and taxpayer funded National Women’s Council of Ireland sent all Members of the Oireachtas an email urging them to submit amendments deleting sections 5 and 6 from the Bill before us. These are the sections that deal with offences either by individuals or by corporate bodies or institutions. Let us be clear about what the National Women’s Council of Ireland finds so offensive. The very first line of section 5 states: “It shall be an offence for a person, by any means whatsoever, to intentionally end the life of a foetus”. According to this logic, it is a sign of intolerable restriction to have the Bill make any provision whatsoever for offences to be committed. The National Women’s Council of Ireland and its supporters clearly want the practice of abortion to be removed entirely from the scope of legal penalties. This is a scandal. It is also a clear sign that the provisions of this Bill will be absolutely resisted by abortion rights extremists.

I am sorry the Minister has left the Chamber. In his usual doublespeak, he pleaded with us, the Members of this House, to make life as easy as possible for him, and not to resist the Bill or seek to amend it. Despite this, he could not wait to hear my contribution, which tells us how tolerant he is. He sent a rather embarrassed Chief Whip to the Business Committee last week with a demand that we waive pre-legislative scrutiny on this Bill. I was shocked and I resisted that to the best of my ability as a member of the Business Committee on behalf of the Rural Independent Group. Yet, that very same morning, he was reported in the Irish Examiner as saying there is a duty on all of us who are honoured enough to sit in the Dáil and Seanad to scrutinise and ask questions on the legislation. I would have thought that was a prerequisite for any legislation. We have had a pre-legislative scrutiny process for some time and it has proved very successful. On that issue, we absolutely agree we have to scrutinise and examine legislation, ask questions and put forward amendments, which is our duty. However, unlike the Minister, I believe that Bills of the nature and gravity of the one being proposed must be rigorously subjected to the parliamentary process of pre-legislative scrutiny. That is what the process is for and it ensures we avoid the pitfalls. His fear and his unwillingness to submit the abortion Bill to in-depth scrutiny speaks to an implicit acceptance that the Bill is fundamentally flawed on several levels. As I said, the people have spoken and he has a job of work to do, but why would he try to rush that, despite the fact some Members wanted to sit late tonight and tomorrow to rush it through? We must make haste slowly. It is very serious legislation. I cannot fathom why the Minister was afraid to submit this legislation to pre-legislative scrutiny. All summer was spent drafting it and building on the heads of the Bill, which were put before the people. Why would he not want to have in-depth scrutiny of this Bill, like many other pieces of legislation? We have had enough bad legislation and legislation with loopholes that is then brought before the courts and challenged constitutionally, as well as the other negative impacts of legislation which did not have proper impact analysis. I believe pre-legislative scrutiny is necessary.

This makes a mockery of authentic conscientious protection rights and it tramples over the many professional concerns that exist around the absence of ultrasound technology to determine gestational age. It makes a mockery of it, as GPs up and down the country know. They know how limited they are and how much pressure they are under, with the FEMPI cuts and the whole issue of GPs leaving the country. I will return to these issues shortly.

An exhaustive analysis performed by the Oireachtas Library and Research Service last year clearly showed that pre-legislative scrutiny has a “proven record of influencing a Bill’s content before it is entrenched, and providing a locus of guidance for parliamentarians, demonstrating its value as a significant contributor towards the development of better legislation.” Goodness knows, there are enough faults in the HSE and enough clamour and serious scandals of huge proportions, including the latest one concerning cervical cancer. Surely, for this sensitive legislation around healthcare for women, young and old, though mainly young, we would have pre-legislative scrutiny and ensure that every parliamentarian had a chance, so we would enact robust legislation that was not flippant. I cannot understand the Minister's doublespeak when he is reported in the Irish Examiner as saying he wants full and protracted scrutiny and, then, he sends the Chief Whip into the Business Committee to ask us to bypass or do away with pre-legislative scrutiny on this very important legislation. In light of that statement, it is impossible to tell why the Minister and the Government sought the waiver on pre-legislative scrutiny. The explanation might be that he wants his legislative trophy more than he wants good law. That question has to be put to him as that must be the true situation. We have had enough bad law for many years across our economy. Given we now have a system to scrutinise law, we should use it and not try to bypass it.

I want to be absolutely clear. To my mind, this is a Bill that ignores fundamental freedoms, annihilates the first principles of medicine and levies upon the conscience and purse of a nation unjust taxes to support it. We are all worn out at this stage from pre-budget lobbying and meetings, and we see how difficult it is and how scarce resources are in healthcare and across all walks of life, yet there is no problem with finance for this. People out there know all about it. There are people with cataracts waiting four and five years for treatment while they are going blind. People are waiting for hip operations and for orthodontic treatment for their children, there are adolescents who cannot get into CAMHS, despite the level of mental health pressures that exist, not to mention the trolley crisis. Those people know the real situation. However, to question this Bill, to seek to amend it or to seek parliamentary scrutiny of its provisions is to mark oneself out as an enemy of progress. I want to state I am no enemy of progress. We must listen to the people who have voted. However, if accepting the erosion of fundamental rights is “progress”, then I want no part of it. There is no doubt this Bill will live long in the memory as the chief political legacy of a Minister for Health and a Government that gleefully offered up the protection of the smallest and most vulnerable in return for their entry to a dehumanising and debasing ideological cartel.

There are widespread problems with the Bill. There is the terrifying definition of the unborn child as “an embryo or a foetus during the period of time commencing after implantation in the uterus of a woman and ending on the complete emergence of the foetus from the body of the woman”. Where does this definition or this understanding exist in the real world? Does anyone here seriously believe that this is not setting the legislative groundwork for late-term abortions? It could not be clearer to me. Of course it is. From the briefing the Minister gave yesterday, which I was unable to attend although my parliamentary assistant attended, I understand there is absolutely zero possibility of real and meaningful conscientious protection, either for medical personnel or for medical institutions, coming into force.

This is guaranteed to create a major conflict within the GP and hospitals system.

I worked very hard during the talks on the programme for Government, assisted by my staff and, indeed, my own daughter. I hoped to have a perinatal hospice service introduced. I hope there is as much zeal to support women who face a crisis. I want all supports necessary to help them keep their babies and to carry on with their pregnancies. Supports such as perinatal hospice care nationally were promised in the programme for Government but we have seen very little introduced in the two and a half years since the Government was formed. Also promised were housing supports for lone parents, supports for families with children with disabilities and improved maternity services, which are badly needed.

I salute the staff of the paediatrics ward in Tipperary who are receiving an award tomorrow night, as are maternity services staff. They are under huge pressure and they are very short-staffed. Nurses are leaving the service which cannot attract new recruits and that is having a hugely negative impact on what the hospitals do every day, notwithstanding their excellent track record.

Just last week, we heard about the huge extra costs faced by families of children with life-limiting conditions. Children with autism and many other health issues have little or no support. As a pro-life Deputy, I will continue to fight for these supports and hope the Minister and the Government will be open to supporting fully all women who need extra help to get through whatever crises they face.

From the briefing the Minister gave yesterday, however, the possibility of meaningful change looks like zero, which is guaranteed to create a major conflict with GPs and our hospital system. Regardless of the weasel-worded definition used in the Bill, the legislation will trample over the sincerely held belief of doctors who do not want to play any hand, act or part in the destruction of innocent life. Yesterday, we all received an email from Doctors for Conscience. It contained a copy of the letter sent to Mr. Fintan Foy, CEO of the Irish College Of General Practitioners, and was signed by 203 Irish medical doctors. It was not two, 12 or 50 but 203. Many more were afraid to sign because their contracts are up for renegotiation with the implicit threats that go with that. The email included the following:

We are writing to express our profound concern that the ICGP has not made the issue of freedom of conscience a central part of its consultation with GPs regarding the Government's proposed new legislation on abortion. There is no question but that this is the standout issue for GPs and the ICGP board knows this to be the case.

I discussed this with the IMO last week during a pre-budget meeting. However, the IMO does not want to talk about it and wishes simply to take whatever diktat comes from the Minister and run with it. That is no solace to the hundreds of GPs who are fiercely conflicted about what is being foisted on them. The email continues:

The Minister for Health is tasking GPs with the provision of an abortion service without first asking GPs on the ground if they think their surgeries are an appropriate setting. Neither was the question asked in the recent ICGP online survey.

What are we afraid of? Why do we not deal with the real issues? We have issue after issue being foisted on GP practices. such as health care for the under sixes and under 12s, which already have queues out the door because hospital emergency departments are so full. New patients cannot be taken on by most GPs and people have to wait a week to eight days for an appointment. I salute GPs who are working under awful pressure. One of them is sitting behind me, namely, Deputy Michael Harty, who knows the pressures more than anyone. The pressure is greater on rural GPs whom we are trying to keep. I thank the Ceann Comhairle for selecting my Topical Issue matter later on a rural practice in County Waterford in my own parish.

This question was not asked in the ICGP's recent online survey. Why did it not ask? Is it afraid of getting the wrong answer? The Minister and Minister of State are no doubt fully apprised of recent online surveys, including the one on GPBuddy.ie where 75% of the 936 registered GPs who took part were opposed to a GP-led abortion service. It was not 10%, 15% or 25%. It was 75% of the 936. Is that not a message? Nevertheless, the Government continues to bulldoze this along without any consultation or meaningful interaction with GPs.

Does this letter from more than 200 doctors not give the Minister cause for concern or pause for thought? Does it not suggest the need for pre-legislative scrutiny and a need to make haste slowly with this serious legislation? Does it not provide the Minister with a moment's hesitation about the nature of what he proposes to force upon dedicated men and women who have given their professional lives to the Irish people and the Irish healthcare system? We see that 24-7 in rural GP practices where doctors live in the community and are part of it. Indeed, Deputy Harty was elected on the slogan "No doctor, no village". That is very true. If the Minister cared to go out from the leafy suburbs to the country, he would see what goes on. It is wrong to treat professionals like GPs like this and to foist issues on them, of which this is the third or fourth in recent times, when they are suffering from financial emergency measures in the public interest, FEMPI, cuts of almost 40%. They have been decimated. Clearly, it has not given the Minister any pause. I beg the Minister and Minister of State, Deputy Byrne, to pause for reflection and to treat GPs, practice nurses and all other healthcare providers who have a conscientious objection with the respect and dignity they deserve having qualified, followed their vocations and provided decades of service.

It is horrifying that the Minister is even contemplating removing parental consent before a child obtains an abortion. I remember that we tried to bring up the age limit for children in the context of cyberbullying and everything else. This flies in the face of all that. As I understand it, the Minister did not rule this option out at the briefing yesterday. I ask if he will rule it out today, although he is not in the House to answer right now.

I could stand here and try to persuade the Minister that the very humanity of the unborn child should be reason enough to cry halt to this truly barbaric legislation. However, it is clear that such an approach would be utterly pointless. The Minister and his supporters have been totally captured by a vicious logic which pays no heed to the most vulnerable in our society, namely, the unborn child. If such heed had been paid, this legislation would not be as desperate as it is. The Minister has closed his ears and eyes to the reality of the unborn child as a member of the human family, fully deserving of our protection and our care. I will propose various amendments to this Bill, just like many other Deputies who indicated that point to the Minister at the briefing yesterday. I hope we will have time in the House to deal with those, notwithstanding the eagerness to rush this through and to bypass pre-legislative scrutiny. I hope we will have a proper discussion and that the amendments will be considered and not scoffed at as coming from backward people.

I will continue to try to sanitise the brutal tool that we have before us and to give some help to the many doctors and the hundreds of thousands of people who voted no in the referendum. We cannot just forget about them because one side won. While it is clear that side won, a sizeable proportion of our population are very concerned. Many of those who voted yes did so with huge reluctance. I have been contacted by quite a number recently, as have we all. They did not expect this to be as serious or for the package to be as it is. Many of them will be horrified when they see what the Minister and Government have done with the mandate provided. It will be a salutary lesson in respect of future referenda, legislation and elections. People voted in good faith, as they always do when they go into the polling booth.

We must have respect, however, not only for the people who elected us, but also the people who elected other people and the people who voted for other situations. I look forward to debating this under the stewardship of Deputy Harty in the Committee on Health and back here on the floor of the Dáil. I hope we will have a meaningful and respectful debate and that we will be able to pass some amendments.

We now move to Deputy Catherine Murphy, who is sharing time with Deputy Catherine Martin.

Let me first say how glad I am that we are finally at this stage and that we are commencing the legislative process on this issue. It is a testament to the dedication of campaigners, some of whom have been fighting this fight for decades, that we are finally on the cusp of delivering comprehensive maternal and abortion healthcare in Ireland.

The strength of the mandate given on 27 May leaves no doubt in our minds as legislators as to the will of the people. It was a two thirds majority, with just one constituency not voting in favour of the amendment. The process leading up to the vote was very robust, from the Citizens' Assembly to the all-party Oireachtas committee, of which I was a member. The very fact that a very comprehensive report was delivered and that the public had full sight of it in advance of the referendum was incredibly mature and incredibly important. It was very much a product of new politics that the make-up of that cross-party committee could be so broad in coming to a consensus.

I have been involved in committee work on pre-legislative scrutiny in respect of other issues. It is not the case that pre-legislative scrutiny goes to the detail of writing the legislation. It writes the broad script. This is precisely what the all-party committee did. It did the work of what would normally be seen as pre-legislative scrutiny. I therefore believe there is no deficiency in the legislative process in respect of this legislation. If anything, it was more robust than what one would usually see, and the work of the committee was very public in that it had a very wide audience.

While today is an achievement of massive proportions, it would be remiss not to mention some shortcomings in the Bill. We welcome the fact that the Minister has allowed the amendments to be tabled. It is important that this was possible. I understand that the Attorney General's office is responsible for the drafting arrangements of the Bill. I must, however, echo the sentiments of those who expressed concern about the framing of the Bill. Following a mandate which overwhelmingly sought to remove the stigma and criminalisation of women in this country, it is a shame that the entire first half of the Bill is preoccupied with a listing of offences and penalties which may be faced. Experience and research both show us that perpetuating a fear of criminalisation of the medical profession results in a chilling effect and makes medical practitioners fearful of their actions. This is not the environment in which we want our medical practitioners to operate. I am very glad to hear that Dr. Boylan will take the clinical lead on the implementation strategy, and I hope this will address some of these concerns, but I certainly favour reframing the Bill so it does not lead off with the offences.

The basis of the Bill must be access for women who need abortions. Many interest groups have spoken about the ambiguity caused by the reference to serious health risks or serious harm. This potentially leaves definitions open to the subjective opinion of individual practitioners and therefore makes things still somewhat uncertain for women. Similarly, we need absolute clarity as to how the three-day waiting period will operate. I understand from briefings with the Minister that the clock will start ticking when the doctor certifies the pregnancy, but we must factor in the potential difficulties this may cause. I remember asking questions of the witnesses from Holland as to when a pregnancy is counted from. We were all trying to figure out how this would work for people travelling to Holland from this jurisdiction, for example. The witnesses said a pregnancy is counted from first contact. There is much humanity in the thinking surrounding this when one considers someone who may present with, say, a fatal foetal abnormality. What they wanted to do was give people time, for them not to feel they were under duress or pressure. If this is to be included, then it must be included in a way that reflects the experience.

The Bill allows for conscientious objection. It must be taken into account that women, particularly those in rural or isolated communities, for example, may have difficulty sourcing a doctor who will certify a pregnancy. Given that we are trying to ensure that abortion is not only rare but also performed as early as possible in the pregnancy, it is important to manage this aspect of the legislation properly. It is imperative that the legislation takes account of the particular difficulties that may be faced by those in non-city or non-urban locations, those with disabilities and those who are in other ways already marginalised in society. I have a particular memory of Professor Veronica O'Keane talking about someone who had bipolar disorder coming into her office. This person was very stressed and Professor O'Keane wondered how she would make her way home, never mind make the arrangements to go to another jurisdiction. We must keep in mind, therefore, that there can be a broad range of people in different crisis scenarios and that there may not be only one crisis but multiple crises.

Regarding the proposal for conscientious objection, my office has also raised concerns about the possibility of certain medical institutions opting out. While the Minister has assured me that there can be no conscientious objection on the part of institutions, it would be remiss of us to ignore the fact that certain boards of management potentially could instruct staff to adhere to internal regulations. We must ensure the legislation covers such eventualities. Other jurisdictions have also encountered the problem of doctors in public hospitals refusing to carry out a procedure where it will be free to the patient yet offering the same procedure in private practice for which the patient would have to pay. The legislation must be robust enough to ensure this scenario cannot develop.

While I know it has been raised ad nauseam, I must add the Social Democrats' voice to the calls for the definition of "woman" within the Bill to be clarified so as to be fully inclusive of all who identify as female or who have a uterus. This must also take account of adolescent women and girls, and the Minister must examine the potential conflict between the age of medical consent and the age of sexual consent. The World Health Organization is clear about the need for children's voices to be heard in the medical process where their bodies are subject to any abortion procedure. I believe this area needs more thought and clarity in the final legislation and I have no doubt that this issue will be raised on Committee and other Stages. We in the Social Democrats look forward to working with all groups and parties throughout this legislative process to ensure that the final Bill, when passed, provides a best practice example of abortion healthcare in a modern, progressive society.

Is lá cinniúnach é seo do mhná na hÉireann, dóibh siúd atá torrach nó a bheidh amach anseo, agus do na daoine agus na grúpaí ó cheann ceann na tíre a bhain éacht amach i mí na Bealtaine seo caite. Today is an historic day. Today, for the first time since 1983, we commence the process to legislate without constitutional constraint to bring compassionate healthcare to pregnant people in Ireland. We owe this day to the people who campaigned tirelessly over the past 35 years and to all those who shared their very personal and traumatic experiences. As we have much work yet to do on this proposed legislation, I will be brief in outlining some concerns the Green Party has about it.

First, I am concerned about the language used in the section concerning offences and, as other Deputies have mentioned, the location of this section within the Bill, but I will bring those concerns to Committee Stage.

The Bill also outlines that three days must elapse from the certification of the person seeking termination by a medical doctor before a termination is carried out. The Minister has pledged that people from Northern Ireland will have access to abortion services here. I and my Green Party colleague and Member of the Legislative Assembly in Northern Ireland, Clare Bailey, have brought our concerns about this specific issue to the Minister's attention. How would that access to abortion services be feasible if two appointments with a doctor may be required? For some travelling across the Border this would mean a three-hour round trip. That is just to get across the Border. It could be longer depending on where the nearest medical practitioner who will assist them is located. That is two three-hour round trips and two days off within a week. This does not represent a feasible option for many given the time required and the expense of travel. How is this compatible with the pledge made to those in Northern Ireland?

There are also concerns for people in rural Ireland who may have to travel significant distances to find a medical practitioner who is willing to help. It is also a concern for people who lack the financial resources or ability to travel or to take time off work. We must put ourselves in the shoes of those who find it difficult to take the time to visit a doctor and we must ensure the legislation does not put more barriers in front of them. There have been suggestions of changing this provision to allow the three-day waiting period to commence from the time of booking the appointment. We must again tease out how this would work in practice. How would we ensure the confidentiality of the patient? To ask for an appointment three days out may allow the person taking the call to infer the purpose of the visit. How is a doctor to know when the appointment was made without first asking those at the front desk? I ask the Minister to provide clarification on these concerns and to ensure that, if a three-day waiting period is included, it supports decision-making without creating arbitrary barriers.

The Bill constantly refers to the “pregnant woman”. I have spoken to the Minister on this matter before and he has been receptive to changing the phrase to “pregnant person” to be inclusive of trans and non-binary people. While I appreciate that legalistically speaking the phrase “pregnant woman” can be interpreted to mean someone of another gender and does not represent a barrier to accessing services, a simple change of language is symbolically important. It would be an important gesture of recognition and inclusivity. There is much work to be done on this legislation over the next few months but I remain hopeful that we in this House can approach that work in a considered and thorough manner.

Do I have until the end of debate, until 5 p.m.?

The Deputy has 20 minutes.

Every time a speaker has contributed here today he or she has said, as has been said many times, that this is an historic day. I could not help but grin every time because it meant so much each time it was said. It is a long road that has no turning. There are many people in here who never thought we would get here. We are on the cusp of legislating for free, safe and legal bodily autonomy and healthcare that puts women at its centre, not at the margins like a forgotten and irrelevant host. Along the journey to today there have been moments that shook this nation and that sent waves of emotion across the country. The bitterness and misogyny that led to the eighth amendment being enshrined in our Constitution may be a distant memory for some, yet there are so many echoes of it every day in our policies, in our hospitals and in our legislation. We must be careful not to repeat these mistakes and, where possible, to try always to remember what we are trying to achieve in here. I fundamentally believe that we are trying to make people's lives better. I believe we will make people's lives better today.

No doubt many of us have had our inboxes flooded with emails in recent weeks. I know mine has been. I have been told what people voted for and what people wanted to vote for when they voted yes. Fair play to those people contacting me because, if they can look inside their hearts and know what the people are thinking, they may have more in common with our forebears than we know. We should not presume to know why people voted yes in such enormous numbers. We can only assume that, like the Together for Yes slogan, their private decision in the privacy of the ballot box needed public support. They certainly received that. I thank those who voted yes. We now have to deliver the best legislation possible to honour that resounding yes vote.

We have to let the clinical experts, the doctors and the women involved have the latitude and independence to act in the way they see fit. The chill over medics must be lifted. The isolation, fear, and power over women must also be lifted. What comfort can someone take from placing barriers in the way of doctors or their patients? What sort of individual would take a twisted sense of achievement from the fact that a woman might - just might - be able to make a choice for herself only once sufficient hoops had been jumped through, certain hurdles cleared and certain criteria adhered to? If the idea is that barriers might give people comfort, then we should think about which people we are trying to comfort. Who is most deserving of comfort: a mass of people that we speculate exist or actual physical, visible and credible women, girls or children in need of comfort standing in front of a doctor whether in Tralee, Tullamore or Terenure? In Kerry, over 58% voted yes, in Offaly, over 58% voted yes, and in my constituency of Dublin Bay South, over 78% of people voted yes. Why and how they did that is their own business, but we would do a great disservice to them if we delayed and departed from that which was pledged.

There is a great insight in "Hamlet" when the titular character says that the actions that should be carried out swiftly get delayed so much that they stop being actions at all. We could probably benefit from listening to it a few times in here every day.

Thus conscience does make cowards of us all;

And thus the native hue of resolution

Is sicklied o'er with the pale cast of thought,

And enterprises of great pith and moment

With this regard their currents turn awry,

And lose the name of action.

That is the thing about conscience. We are all supposed to have one, but some people deem theirs much more valuable than others. I have been dealing with this issue for almost nine years. When I, based on my own personal experience, started discussing it within my own party and in wider society, there was an attitude that we had been there before, that no one wanted this, and that the public had no appetite for it. When we started discussing it in here, I listened to many conversations suggesting it was a Dublin issue and that it was not relevant outside Dublin. We then saw the map of Ireland showing all of the women who leave every county in Ireland every year and it was in front of us that it was not just a Dublin issue. We had representatives who made assumptions based on the voices in their own echo chamber and their own people telling them what way people were thinking. Deputy Thomas Byrne referred to the gap between in here and out there and to the fact that we needed to employ or engage a Citizens' Assembly to bridge that gap.

The electorate needs to be conscious of the fact that in here does not necessarily represent what is out there. One of the most significant engagements I had was in Donegal when Dr. Peter Boylan and I went there to launch the Together for Yes campaign. When I looked down the room where we were doing the launch, I saw between 400 and 500 people but only one politician - he was not from my party either - showing leadership. Deputy Thomas Pringle led the charge in Donegal for the Together for Yes campaign when it was not popular to do so. It was difficult for politicians in Donegal because of the way the vote fell in the end. It is interesting how polls seem to have changed people's views more than perhaps evidence.

In Tipperary over a year ago, I assumed when older men approached me about the eighth amendment that I was about to get an earful. Instead, they told me how they had not thought about the women who went missing when they were young men. They just blocked it out. They never considered the girl in their class who did not turn up one week and disappeared. They never considered why a sister went away to England for six months. The accepted it as truth as they grew up and never considered it was a woman in difficulty and Ireland dealt with it in Ireland’s way then.

This is now and it is a fair departure from 2013. Largely due to the political make-up in the House, those of us dedicated to righting the wrong and removing the eighth amendment were able to work together on a cross-party committee and come up with such a comprehensive report. That report did not just land out of the sky. It came from hours of work and dedication from many members of all parties and none. We worked together and trusted each other to have the same purpose at the end. We worked together to get to the end.

We are now in a position where we want to roll out these services. The Minister referred to the number of women who have had to travel from this country to access termination services since the electorate resoundingly voted “Yes”. It is our duty as legislators to enact the will of the people and to stop what we were doing before, namely, torturing women and treating them in a cruel, inhumane and degrading manner in their hour of need. We still have one woman a week who receives a diagnosis of a fatal foetal abnormality having to travel in the most difficult of circumstances. I welcome the Minister's comments earlier about the provision of medical records to hospitals abroad in the interim. I remember the lady to which Deputy Catherine Murphy referred earlier. Some of the evidence we heard at the committee was deeply disturbing. A psychiatrist referring a patient abroad for treatment without her medical records was cruel. The professor who gave evidence to the committee said she would lie awake at night worrying about the welfare of those patients.

Hopefully, come the new year, we will start the process of dealing with women's health in a mature and rational fashion in this country. I agree with many of the speakers that there are issues with the Bill. Some of the language used is not ideal. I completely agree with changing the terminology from “pregnant woman” to “pregnant person”, inclusivity and also the front-loading of the criminality which brings a negative connotation. There could be a change of ordering in the latter case.

We also must ensure everyone is catered for. We do not want a situation where women in the most isolated parts of our country are not able to get timely comprehensive healthcare. There has to be a proper standard throughout. Deputy Bríd Smith spoke earlier about other health practitioners being involved in this. It is my considered opinion that this has to be led by general practitioners and doctors. It was the will of the committee and the expert evidence suggested that should be the case. In time, there might be an opening for that. However, now I would disagree that midwives and pharmacists should be involved in the prescribing and administration of what are called abortion pills.

We have to ensure sonography services are widely available, not just in Dublin but outside the capital. If a person gets a bad diagnosis in a 20-week scan, this would make sure there is no ambiguity and the person would not have to be moved to another centre to repeat the trauma of a bad diagnosis. Bizarre as it seems, if we just have that principle that women should be at the centre of this, and nobody else, then we are probably on a good path.

While we have managed to repeal the eighth amendment and we are in a new dawn, the negative effects the eighth amendment has had on our society and on families are coming down the tracks. Many of us engaged in this have heard many stories about a missing sister, a long-lost nephew, hidden people and the shame in families. My mother, who is 70 years of age, spoke to me about the crime it was to have a child outside of marriage. An unmarried woman having a baby was seen as the worst thing that could happen to someone, particularly when one considers that for most of us it is the happiest time of our lives. We have to think of the knock-on psychological effects on that whole generation who were fed a diet of hellfire and damnation while being preached to about their personal lives from the altar. It will take a couple of generations to wash the stains of all of this out of our history.

There are several people who deserve our thanks. Ailbhe Smyth fought for this for most of her life. The Together for Yes campaign, somehow, got people from all sides of the political divide to canvass together. I doubt in my lifetime I will ever again have somebody from People Before Profit shout at me about which road I should canvass. It was a once-off but it was worth it. We must pay thanks to the medical experts, many of whom gave their time voluntarily, who attended both Fine Gael and Together for Yes public meetings.

They were able to get into their car, travel and take questions in Louth, Meath, Tipperary or whatever part of the country we were in. The medical profession and the activists are the people who have driven this. I refer to those women who told their stories to many people within my party, the women and men who had a diagnosis of a fatal foetal abnormality. That is what changed it for many people within my party. I refer to the barbaric nature of the manner in which we were treating people.

If one were to tell a person in a medical crisis that they had to book a flight or get on a boat, go to a foreign city, deal with a health system with which they were not familiar and bring the ashes of their much-wanted child home, possibly in the boot of their car, it would seem like a made-up story. I am sure that, in time, future generations will wonder what we were at and how we allowed this to happen in our country.

I welcome the fact that this is to be a universal provision. We heard a great deal of evidence regarding barriers to access. Despite a person's means on paper, they may not have the means to have a termination of pregnancy when they want it.

Tribute must be paid to the Minister, Deputy Harris. He has listened and learned and been compassionate and understanding. He listened to the experts and helped us to get to where we are today. I also pay tribute to the members of the Fianna Fáil Party. While Deputy Donnelly is now the party's spokesperson on health, Deputy Kelleher was the party's main man on the committee, and I also pay tribute to Deputy Lisa Chambers. I thank them for sticking with us. I also thank the Sinn Féin members who sat down with me as we worked through the wordings and teased out how we could get to the end with the outcome that we wanted.

I am anxious for this to start in January. It is very important this is done right, that we do not have any errors, that we do not leave anyone out in the cold and that the system we put in place is fit for purpose. I am not going to fall out with the Minister over a week or two, or a month or two, but it is important this is done right. It is important people can have confidence in our health system that they will get the proper care and that they will not be treated as a trial run, because the woman and her family at the centre expect the very best.

Regarding the amendments, I firmly believe that what which we put to the people is that which we should be passing in this House. Deputy Donnelly put it very well in terms of the heads of the Bill. We must be very careful about any discrepancy between what we said we would do and what we are doing. We have to make sure it is as aligned as possible because the people want to be able to trust their politicians.

On this historic day, after 20 minutes of contributing, I thank all my colleagues, particularly my colleagues in Fine Gael, and the people of Ireland for doing what I thought they would do all along.

I call Deputy Tóibín. Is the Deputy sharing his time?

I will start off. I did not initially intend to speak on this very important Bill, but as an opportunity has arisen to do so, I will take it.

May was a very emotional time for the women of Ireland, for women from older generations to younger generations, as we saw a new generation of women out marching, canvassing and voting for this important Bill. I am a little emotional thinking that we are finally getting to this stage. We must acknowledge the women who for years had campaigned, put themselves upfront and centre and who took a great deal of stick from the establishment and from others. It is important we commend those women. It is also important we commend the women who marched having campaigned for 30 years to see this day.

I would like to express special thanks to the members of the committee. They worked tirelessly and sometimes under uncomfortable pressure. As the previous speaker said, everyone came together. The members of the committee listened to the evidence presented to them, they stood front and centre and sometimes they took a great deal of stick, but they did that and got through with it. We need to commend and to thank them again, especially the chair of the committee, Senator Noone, who did so well. We must also commend the Citizens' Assembly because, without those people, we would not be debating this Bill today.

Regarding the legislation published by the Department of Health and the Minister, reference was made to the point that the general scheme of the Bill was published before the referendum. We have some observations about the Bill in terms of the way it has been changed from the general scheme of the Bill. The provision dealing with offences has been moved from section 9 to section 5. That places offences very largely at the front of the Bill. That does not generally happen with any other legislation. That is chilling. We should hold up this part of the Bill as being vitally important. For so many women, having an abortion was an offence for which they faced a penalty. Therefore, that is an important point.

On section 10, which deals with the risk to life, there is no mention of the opinion of the pregnant person in this section and how that would feed into the situation. That section dealing with the risk to life still includes the words "serious harm to ... health". The Committee on the Eighth Amendment of the Constitution was very strong that we cannot grade risk. At our party's Ard-Fheis, our position on that was passed in terms of harm as a risk factor in itself, but not serious harm. We need to examine that with a view to teasing out these parts of the Bill.

Section 12, which deals with conditions likely to lead to the death of the foetus, states that the obstetrician who certifies a risk to life or harm to health must carry out the abortion. For practical reasons of rostering and other reasons, that could not work.

Section 13, which deals with early pregnancy, has the three-day, 72 hours provision. We are meeting stakeholders on that and some medical professionals say it would risk access and can cause problems for those people.

The Oireachtas joint committee had five-hour meetings on the legislation some weeks ago. Many medical experts contributed, including Dr. Peter Boylan and representatives of the Medical Council. Representatives of the Irish College of General Practitioners attended also. On the issue of the 72 hours waiting period, we must listen to the medical experts. That is the one thing the referendum has taught us. We must listen to people on these issues, such as the women and the professionals. We in Sinn Féin will be guided by doctors and medical professionals on this matter. It seems that the 72 hour provision was a political decision because it was not part of the Oireachtas eighth amendment committee report.

We are also worried about the timeframe. We need to see more action from the Minister and the Department of Health in engaging with health professionals to ensure the start date of 1 January can be realised. That is very important.

Debate adjourned.