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

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

I am particularly pleased to rise to my feet in the Dáil for this Second Stage debate on the Health (Regulation of Termination of Pregnancy) Bill 2018. For a very long time I did not imagine that this legislation would materialise, much less that I would be a parliamentarian speaking here in the Dáil on it. I welcome the opportunity to contribute to the debate and underscore the importance of the legislation to past, present and future generations of women and their families. That cannot be overstated. For decades, thousands of our women faced a lonely and traumatic journey to England and Wales to access abortion services. The shame imposed on those women and girls by the church, politicians and conservative elements in society was wrong and cruel. Since 1983, a momentum against the deeply oppressive eighth amendment to the Constitution grew in scale and support. In truth, repeal was a campaign decades in the making. As with so many other big social changes, a long and arduous journey is often followed by rapid social adjustment and change. As is often the case when it comes to civil and human rights, the truth is that the people led and the politicians followed.

I take this opportunity to again record my admiration and appreciation of all of those activists, women and men, North, South, east and west, who were to become Together for Yes, to all of those who fought the good fight and who led from the front. This may have been the first big political campaign for young activists. I commend their youthful advocacy and their optimism, energy and vision for their country. I also commend the veterans, if I can use that term, people who for decades had taken a stand for women, for our bodily integrity, right to choice, right to healthcare and right to safety in maternity hospitals. There is no doubt that for a very long time those advocates and campaigners walked a very lonely path. For they and for our youthful advocates the introduction of the legislation is momentous. We divide on many things in this Dáil and I am often rightly a critic of the current Administration but I commend the Government on bringing forward this legislation.

On 25 May this year, 1,429,981 million people voted to repeal the eighth amendment of the Constitution. Yet today women will still travel to Britain for an abortion and their journey will still be unduly harsh despite the collective support expressed to them by the Irish people. Members of the Oireachtas now have a dual responsibility to those women. We must ensure that abortion services are available in Ireland from January next year, and that this legislation will vigorously uphold those fundamental rights the people voted for in May.

We must continue to hear the concerns raised by women, their families and the medical profession on the shortfalls of this legislation. We should to open to a constructive and informed conversation. We should also be open to amendments that will strengthen the Bill in the interests of women and the medical practitioners who care for them. This legislation will shape abortion services in Ireland for decades to come. In practical terms, this is a new strand to healthcare delivery so we must get it right.

This legislation will require very careful thought and deliberation on Second Stage and, more crucially, on Committee Stage. It is my hope that on Committee Stage all Members will have a capacity to listen to, comprehend and translate expert opinion, be it medical or otherwise. I hope that, if it proves necessary or useful and helpful, the experiences of women will again be considered as we craft the legislation. In the course of the debate on repeal, the experiences of women and their families who were faced, for example, with a fatal foetal anomaly, were crucial in setting the tone of the debate and deliberations. It is important that real human experiences do not get lost in a technical exercise of legislative text and amendment.

To get it right we must act in good faith and with goodwill. I know there are different views on abortion across this House, and I respect that deeply, but we also know that the people, collectively, have spoken. When they repealed the eighth amendment, they did not do so in a vacuum of knowledge. The debate was well informed and created light as well as heat. In the course of the debate, Irish public opinion was aware of the general shape of the legislation that would follow. As we debate and deliberate, and as we put forth our view as democratically elected representatives, on our behalf and on behalf of our constituents, I believe goodwill demands that the legislation is allowed to proceed. I ask that we have a full, deliberative and frank debate but I appeal to colleagues not to abuse the rules, regulations and latitude of the Houses of the Oireachtas to delay legislation which already carries the democratic imprimatur and approval of the people.

It is important that we are inclusive of all women. I wish to include trans persons and those who identify as non-binary. For some, those are new concepts and terms, but they describe very real human beings. Regardless of income or where they live, women must be able to access services equally.

There are a number of specific areas within the legislation that demand further attention and I will refer briefly to them.

Section 13 provides for a consideration or waiting period of three days from when a medical practitioner certifies a woman for a termination to when she can have it. I am conscious that last month doctors, in evidence to the Joint Committee on Health, described the three-day waiting period as unnecessary and told us that it did not have a medical rationale. The decision to impose this provision within the legislation is, therefore, perhaps more political than medical. Perhaps we might reflect on the fact that it is a product of a paternalistic mindset of Governments and legislative drafters of old, a mindset that we had hoped had been set aside. This provision must be considered carefully. We must ask ourselves whether it will prove to be a barrier for women living in rural Ireland or the North of Ireland who will have to access services for the time being across the Border. The Minister and his Cabinet colleagues know that many women will not feel comfortable in seeking medical care close to home. The people may have voted to repeal the eighth amendment, but let us be realistic: there is still stigma. I want this provision to be considered and weighed very thoughtfully.

I draw attention to the offences section at the front of the Bill. I note that it features ahead of the sections dealing with medical care and that bothers me. The offences section can and will create a chilling effect. The message to women's doctors is that criminal sanctions must be their first concern and perhaps the care of the women merely secondary. That cannot happen and any impression to that effect must be set to rest. I cannot imagine that this sits well with the Government. My colleague, Deputy Louise O'Reilly, has outlined Sinn Féin's view. We do not agree that medical professionals who invoke a conscience clause can be exempt from referring a patient to receive the necessary medical treatment they seek. Those involved in the medical profession have raised a number of additional concerns with the Minister about the legislation and they must be listened to.

We now have an opportunity to redress associated areas of medical care. I welcome the Minister's commitment that abortion services will be provided free of charge. This commitment must be extended to women living in the North of Ireland who continue to be denied fundamental rights that have been secured here in Ireland and Britain. It is also time to consider equitable access to contraception for women and girls. This, too, must be free of charge. The Committee on the Eighth Amendment of the Constitution recommended the introduction of a scheme to provide contraception free of charge for all persons who wish to avail of it within the State. Committee members voiced a particular concern that personal costs of contraception could be prohibitive. They acknowledged a finding of the Central Statistics Office's general population survey in 2010 in which 18% of respondents had found the cost of contraceptives to be an issue.

The discriminatory language used in the legislation must be addressed. The trans community played an important role in the repeal campaign, as did non-binary people. As communities who campaigned alongside each other for the varied rights the State has historically denied us, our struggles are interwoven. The language used in the Bill needs to reflect the diversity of society and must be absolutely inclusive in its intent. I, therefore, urge the Minister to reflect on the demands made by transgender and non-binary activists and medical professionals for the inclusion of gender neutral language. If this matter is not addressed now, we know that it will be addressed in the future after long campaigning for a right to which we already know the people concerned are entitled.

I commend the appointment of Dr. Peter Boylan to assist in the implementation of arrangements for termination of pregnancy and related services. Dr. Boylan has been a tremendous champion for women's healthcare and I am sure undertook this role during the repeal campaign at some considerable personal cost. We are eternally grateful to all of the medical practitioners who campaigned alongside us, the Irish abroad who supported us, the women who shared their deeply personal stories in order that wider society could truly understand the cruelty of the eighth amendment and the new generation of activists who have emerged. The final Bill must reflect the rights secured by the people earlier this year.

Deputy Mick Barry is in the next slot. I understand he is sharing time with Deputy Paul Murphy.

It is welcome that we are debating legislation aimed at providing for abortion rights in Ireland. I thank the 66.4% who voted "Yes" on 25 May for making this possible. I also thank the 64% who voted "Yes" in my constituency of Cork North Central for helping to make it possible. In particular, I thank all of the campaigners, including women's rights campaigners, repeal campaigners and left activists, who campaigned in the years and months leading up to 25 May for making it possible.

I do not have time to give all of my views on the proposed legislation, but I will make a number of points which I will preface by saying I am a supporter of free, safe and legal abortion services for all women and pregnant people who need to avail of such services. I will continue to campaign until such time as this is the full legal position in the State. While welcoming the arrival of the legislation, I have some criticisms of it. Unfortunately, I do not have time to go into all of the detail. Instead, I will concentrate on two important shortcomings of the legislation and the associated changes that I believe need to be made.

I wish to make a number of points on the question of health. The Committee on the Eighth Amendment of the Constitution supported the right to a termination where the life or health of a woman was at risk. However, the Minister's proposed legislation states something quite different. It states a termination can take place where there is a risk to the life or a risk of serious harm to the health of a woman. I put it to the House that there is a significant difference between permitting abortion on the grounds of serious harm to health and permitting it on grounds of health. This represents a significant watering down of the committee's proposal and what people voted for on 25 May. This watering down flies in the face of expert medical advice heard by the committee. The expert medical advice indicated that the person best placed to decide on the level of risk she was prepared to take during a pregnancy was the pregnant person based on medical advice and personal circumstances.

Applying a legal standard of risk to a medical determination of actual risk is neither practical nor in the best interests of the pregnant person. Furthermore, what constitutes "serious harm" is open to interpretation. Given the potential for criminal sanctions under the legislation, it is more likely to be open to a conservative interpretation in the hands of medical professionals. The tragic instance that put the issue of abortion rights and health into the national conversation – the death of Savita Halappanavar – shows the dangers of a conservative interpretation of rigid law-making.

All references in the proposed legislation to risk of serious harm to health should be removed and replaced with the words "risk to health".

I want to deal with the proposed three-day waiting period. According to the World Health Organization, there is no evidence that waiting periods are medically necessary. The evidence indicates that they will not change people's minds because they have already made up their minds but will create practical and psychological hardship for women. That is the reason France decided in 2015 to remove the waiting periods that had applied up to that point. They had had no impact, other than a negative one on women and pregnant persons. As I said, opposition to waiting times is the position of the World Health Organization and was also the position of the Citizens' Assembly that considered the issue.

I raise a question to which I would like the Minister to respond because it is unclear to me in reading the legislation whether the limit of 12 weeks includes the three-day waiting period. Is it the intention of the Minister that the window in which a woman or pregnant person can have a termination is 12 weeks minus the three-day waiting period or is it 12 weeks and three days, minus the three-day waiting period, in other words, a total of 12 weeks? I will be concerned and opposed to it if it is the case that that waiting period effectively makes it eleven and a half weeks, rather than the 12 set out in the legislation.

This is positive legislation and it is welcome that it is being debated. It is down to the campaigning work done by many over many years, in particular, the women and young people of Ireland and all those who came out and voted "Yes" on 25 May. It is not, however, without significant shortcomings. The issues of health and the three-day waiting period need to be debated and the legislation amended and changed to make it better.

I will be brief in following my colleague, Deputy Mick Barry. This will be the last speaking slot to be taken by Solidarity-People Before Profit in the Second Stage debate because we are very anxious to see the legislation progress and take effect as soon as possible, particularly in the light of the Government's precarious position.

I will make a few brief general points and two specific points to complement what Deputy Mick Barry said. I register the historic nature of the legislation we are debating and the victory it represents, not for any of the establishment parties but for a movement and all those who fought for decades and, in particular, since the death of Savita Halappanavar, for large elements of it. Those who did it are the ones who marched, organised, mobilised, canvassed, distributed and made accessible abortion pills which showed that the existing legislation could no longer hold, as well as all those who came out to vote. The scale of the victory is seen in contrasting what has happened with the debate that would have been taking place a year or two ago which would have seen this legislation as completely unrealistic and the legislation of radicals, whereas it is legislation that is far more in line with international norms than the restricted legislation anticipated in the earlier stages of the debate. Until a year ago, all of the discussion was about fatal foetal abnormalities, rape and what, possibly, was seen as the most developed position, health only grounds. Those of us who were fighting for the right to choose were seen as off the wall and jeopardising the possibility of repeal of the eighth amendment. This really is an historic victory and a very important step towards the full right of women to choose. On the one hand, it is a victory for those sections of the population which mobilised, in particular women, young people and LBGTQ people, but, on the other, it is a defeat for the conservative forces in the State who believed or liked to pretend to believe they had a silent majority on their side, which clearly they did not. It is a defeat for the Catholic Church and leads to all of the other struggles that are needed to have full separation of church and State, take the church out of the areas of education and health and provide them as public services free of church influence and control, while respecting the right of every persons to practice whatever religion he or she wants.

It is also part of a global women's struggle that has emerged particularly strongly in the past few years which had its counterpart in massive protests in Argentina in fighting for abortion rights, where, unfortunately, the conservatives held on and won the vote in the Senate. However, that movement is regrouping, will grow again and, ultimately, will win a victory in that country. It also has a counterpart elsewhere in Latin America, in Brazil, where there is now an all-out struggle by women, workers and left organisations to try to defeat the possibility that the far-right candidate, Mr. Bolsonaro, will come to power in the presidential election. We express our solidarity with all those involved in that struggle.

I want to raise two specific issues for the Government to which I would like it to respond. They relate to the more oppressed sections of the population that will be seeking to access abortion services under this legislation. The first which seems in reading the legislation to be very problematic concerns transgender men and non-binary people who will be seeking to access abortion services. The word "woman" is used throughout the Bill in referring to who can access abortion services. The Bill states: ""Woman" means a female person of any age". When read in conjunction with the Gender Recognition Act, it seems that this will create a real problem where transgender men have the capacity to become pregnant, as do non-binary people, who under a restrictive Bill will be unable to access abortion services. I would like to hear the response of the Government on whether it accepts that this provision presents a legal problem. Even if it states there is no such legal problem, that the matter will be covered, etc., to use transgender and non-binary inclusive language, it should simply replace the word "woman" with "pregnant person" throughout the Bill.

The second issue is criminalisation because a 14-year prison sentence for those who assist persons in accessing abortion services outside the framework of the Bill will remain in place. This is contrary to the recommendation of the committee on the outcome of the Citizens' Assembly on the eighth amendment and international best practice for two reasons, one being that the existence of a draconian 14-year prison sentence, a hangover from the eighth amendment and the Protection of Life During Pregnancy Act, will have a chilling effect on doctors operating even within the framework of the legislation.

They might be very concerned, for example, that they are going over the 12 weeks limit and this will inhibit them in their actions. The second reason is that it will criminalise those such as friends or relatives who are assisting someone in a crisis pregnancy to access an abortion outside the framework of this legislation. Only reckless or dangerous abortion should be criminalised, just as a reckless medical procedure or whatever would currently be criminalised. It seems to be very dangerous to maintain this provision it currently stands. The Government should follow the advice of international experts and the Joint Committee on the Eighth Amendment of the Constitution and have decriminalisation of abortion and whatever new law is necessary in that regard.

The next slot belongs to Independents 4 Change. Deputy Wallace is sharing time with Deputy Connolly.

A number of Deputies in their Second Stage contributions have claimed that the people voted in the referendum earlier this year with the heads of this Bill in mind and that, therefore, we should stick to the draft legislation that was published before the referendum. While some, or even a majority of people, may have voted with the heads of the Bill in mind, we have no idea to what extent this is true. What we do know for certain is that the people voted overwhelmingly to repeal the eighth amendment. We also know that in doing so, they gave elected Members the power to legislate on behalf of the people. Our job now is to scrutinise the Bill, as initiated, and to propose and defend amendments as we see fit. I do not want to delay this legislation, but we would not be doing our jobs properly if we did not address some of the serious problems that we see in the Bill in its current form. It is important that we get it right.

One of the main problems with the Bill is that it does not fully decriminalise abortion. In fact, it creates a new offence in section 5(4) of helping another person to have an illegal abortion. The Bill also retains a 14-year prison sentence for performing an abortion "otherwise than in accordance with the provisions of this Act". As such, doctors will still worry about prosecution. This fear of prosecution will inevitably cause doctors to interpret the legislation conservatively and will have a negative effect on facilitating access to abortion, which is surely not what the Bill should be about. This means that the serious historical problems we are trying to move away from will, in fact, be replicated.

The Bill states that abortions, examinations and certifications must be carried out by a "medical practitioner". However, a "medical practitioner" is defined in section 2 of the Bill as a medical practitioner who is registered with the Irish Medical Council, which lists only doctors. This means nurses or midwives will not be allowed to examine or certify or provide abortion care in early pregnancy. I appreciate that in terms of assessing risk to the health or life of a pregnant person, a registered doctor should be required, but the World Health Organization safe abortion guidelines advise that "abortion care can be safely provided by any properly trained health-care provider, including midlevel (i.e. non-physician) providers." There is no provision in the Bill, for example, for nurses and midwives to certify or provide abortion care in early pregnancy, even though nurses and midwives are perfectly capable of performing these functions.

I also have concerns about the assessment of risk in sections 10 and 11. Given that the report of the Joint Committee on the Eighth Amendment of the Constitution did not recommend the qualification of harm as serious or otherwise, why are we inserting this into the Bill? Previous abortion law created major problems in assessing what constitutes "real or substantial risk" and this Bill repeats the same mistake. We should not define or qualify risk in legislation. Medical risk should be considered in a clinical setting, in real time, by medical specialists. I made exactly the same point in this Chamber when debating the referendum Bill as a reason to repeal the eighth amendment and it is strange to be back arguing the same point again in respect of legislation that is supposed to facilitate abortion services. Have we not learned from past mistakes? Risk can escalate quickly, and because of this it is actually extremely dangerous to qualify risk in legislation.

Experts at the committee warned against using the term "serious". It introduces uncertainty for doctors and therefore creates a chilling effect, and it also creates an access barrier for proper, timely intervention. The committee report specifically states:

The advice to the Committee is that the assessment of that risk is best considered in a clinical setting rather than being fixed in legislation. The Committee accepts this.

The report also accepts that it is especially difficult to grade or assess risk in the case of women who present with mental health issues. We need to amend the relevant sections of the Bill or more women may die.

Section 12 refers to a "condition likely to lead to the death of the foetus within 28 days". There was no mention of 28 days in the heads of the Bill and the committee report makes no such suggestions. Surely this kind of clinical or medical specificity has no place in legislation. Again, this will create a problematic lack of clarity for doctors. How can a doctor be expected to come up with such an exact prediction? Problems like this in the Bill will have a debilitating effect on doctors instead of empowering them to provide a proper medical service to women who need it. These problems in the Bill still frame and present abortion services in a negative way.

Many Deputies have referred to the 72-hour waiting period. This provision should be removed. The World Health Organization has said that waiting periods like this demean women as decision makers. Waiting periods will only lead to delays in accessing treatment. The UN Committee on the Elimination of Discrimination against Women has also recommended the elimination of medically unnecessary waiting periods for abortion as they pose a barrier to access. This legislation is supposed to facilitate access to abortion services. There is no medical basis whatever for this waiting period. It will particularly hit poorer people, isolated people, people living in rural areas and also people who are in abusive relationships.

Section 13 provides that a pregnant person must be examined prior to certification. This requirement was not part of the draft legislation and was not recommended in the committee report. Where is the medical evidence for such a requirement? Does it specifically mean a physical examination? Presumably it does, and it will have to be conducted in person, rather than over the phone. Again, like so many sections of this Bill, this is yet another barrier to care. We should replace the phrase "having examined the pregnant woman" with "having consulted the pregnant woman", which would facilitate a telephone consultation. We should be clearing the pathway to care and eliminating delays, but instead the Bill seems to be creating some obstacles. There also seems to be a poorly concealed moral or ethical distrust of abortion in its drafting.

The Southern Taskgroup on Abortion and Reproductive Topics, START, is a collection of general practitioners, obstetricians, public health doctors and psychiatrists. It has highlighted serious problems in a likely path to care based on the legislation due to the requirement in sections 10, 11 and 12 that the termination of pregnancy is carried out by the same doctor who certifies that the pregnancy has not exceeded 12 weeks. START argues that it is not workable in practice if the legislation requires that the same doctor who certifies must be available three days later to facilitate the abortion by prescribing medication in primary care or arranging the termination in hospital. According to START, it is obviously entirely possible that the same doctor will not be available when the mandatory 72-hour period after certification has elapsed. This doctor might be unavailable for various reasons. He or she might work part time, may be on leave of some sort, or may have other work commitments at the time.

Even assuming everything goes well and according to plan and there are no conscientious objections, 12 weeks, which is actually nine weeks in practice, is unlikely to be enough time for many women. It is not clear that the time limit is workable based on the Bill, as initiated, which means we will continue to see women travel or rely on the use of unsupervised abortion pills. This will defeat the purpose of this legislation. There is no medical reason for this requirement and it poses a serious risk to the implementation of abortion services in clinical practice. START argues that there are numerous examples of well-established protocols in primary and secondary care which allow the hand-over of care from one doctor to another so as to ensure continuity of care for patients.

Surely similar protocols could be used for abortion services.

Section 12 states that a termination may be carried out where the pregnancy has not exceeded 12 weeks. This period may need clarification. How are we to interpret it? Does the 12 weeks mean 84 days, full stop, or could it mean 12 weeks plus four, five or six days, but obviously not seven. It might be a simple thing but it may need some clarification.

I am not trying to be critical. I am trying to make it better.

Cuirim fáilte roimh an mBille seo. Táimid tagtha go dtí an pointe seo tar éis turas fada. Le linn an thurais sin, d'fhulaing a lán mná agus fuair cuid acu bás. Is í seo an chéad chéim chun é sin a cheartú agus chun seirbhísí a chur ar fáil do mhná ar bhonn atá bunaithe ar chearta daonna.

I welcome the Bill. It has been a very long journey to get here with unnecessary deaths and suffering, repeated condemnation by various international courts, including the European Court of Justice and the European Court of Human Rights, UN committees and people power on the streets.

It is possible, of course, to start that journey at different significant points depending on one's viewpoint and experience. We could start with section 58 of the 19th century Offences Against the Person Act, the Victorian legislation. As a result of my own experience I will start with the death of Sheila Hodgers. I pick her, as I have done on other times when I have spoken on the subject in the Dáil, because her death on 19 March 1983 happened prior to the eighth amendment being inserted into the Constitution. She died unnecessarily after giving birth to a premature baby who died almost immediately after birth. She died because she was refused treatment for cancer. I will not go into the details of that case. I mention that because that was prior to the eighth amendment and this country then went ahead and inserted that article into the Constitution, using black and white terms, knowing well that it was a complex matter and that difficulties would ensue.

We had the X case in 1992. The Supreme Court judgment laid out exactly the difficulties, almost ten years after the passing of the eighth amendment. Sometimes the facts of that case are lost and I will not go into them. I am sure they are very painful for the family to hear repeated. It is important to say that we are talking about a 14 year old girl pregnant as a result of rape. Those facts were not even discussed in Irish society, as represented by those who took High Court action to prevent her from travelling. That was of more concern to them, rather than the circumstances of the rape.

I am only picking a few of the cases. In 1998 we had A and B v. the Eastern Health Board, Judge Mary Fahy and C. We are talking about a 13 year old girl under the care of the Eastern Health Board who was raped and again prevented from travelling.

I jump to 2011 because there are so many cases where women and children suffered as a result of the eighth amendment and as a result of certain sections of society dealing with complex issues in a black and white manner. In 2011, the A, B and C case went to the European Court of Human Rights, which ruled no effective remedy was available to the women in theory or in practice. As a result of that case, Michelle Harte came forward. She had become unintentionally pregnant when she had cancer. Her doctor quite sensibly recommended a termination but a subsequent hearing of an ad hoc ethics committee in the hospital determined she could not have a termination. She had to be helped onto the plane.

Still the Governments in power took no action. It took another death in my city, that of Savita Halappanavar, a 31 year old woman who was 17 weeks pregnant and died on 28 October 2012. I accept there was a basic lack of care in that hospital, which continues to have serious issues with the service it gives. One of the major issues was a refusal to consider a termination for her. That tragic death, which should not have happened, led to the introduction of the 2013 legislation. That legislation was to implement the Supreme Court judgment of 1992. It took the deaths of those women and that suffering to introduce that limited legislation where we still persisted in criminalising women who had an abortion or those who helped them. Unfortunately we are still doing it in this Bill.

It continued right up to 2016 with Amanda Mellett going to the UN Human Rights Committee, followed by Siobhán Whelan in 2017 and still we did not learn. It took people power on the streets with people of every age coming forward to force us into holding the referendum on 25 May of this year when 2 million people cast their votes. There was a landslide victory for "Yes" with a majority of 66.4% to 33.6%. However, all the while women have had to continue travelling outside this country. It must be remembered we help people onto a plane, including in the case I mentioned, to go over to England because we have refused to provide those services. Most significantly all of those women are excluded from the health service and continue to be excluded from the health service. Therefore, this Bill is extremely important because for the first time we have been forced to bring it forward.

I thank the Minister of State present and the Minister, Deputy Harris, for introducing this Bill. Finally we are at the stage of doing our job as legislators and this Bill is the first step in that important process. We have a duty to ensure that the legislation enacted is robust, fit for purpose and actually capable of dealing with the myriad of challenges and problems facing a pregnant woman at any given time. These include a woman suffering from cancer and a pregnant woman with a diagnosis of a fatal foetal abnormality.

It is, of course, essential to highlight that no woman takes a decision to terminate a pregnancy easily. It is also vital to recognise that the Bill is to provide a health service. We need to move away from the patronising and patriarchal language, and we need to trust women. If we have learned anything from the cervical smear scandal and all the other scandals, it is to trust women and give the maximum information to empower them, to put them at the centre of every decision-making process. With that we will have a much healthier society.

I generally welcome the Bill. However, a number of problems need to be teased out. I hope they will be teased out on Committee Stage. I do not sit on that committee, but I will certainly keep a careful eye on the Bill and look at amendments. It has to be woman centred. There is a contradiction in a Bill providing a health service while at the same time providing for penalties. I do not believe offences or penalties have any place in the Bill. If the Government insists on providing for penalties, it should be in separate criminal legislation and not in a health service Bill. It gives contradictory messages and does not help. The woman needs to be at the centre of the decision-making process.

The definition of health must be as broad as possible. I would recommend, as the organisations on the ground have asked us to recommend, the very comprehensive definition provided by the World Health Organization.

As has been mentioned, the waiting period has no medical rationale other than a patronising, patriarchal attitude that a woman really does not know her own mind and that we need to give her more time so that she comes to her senses. I do not hold with that type of logic. If the Government insists on putting in the three-day waiting time, it is very difficult to know when that begins. If it begins from certification, what about the delay in getting that certification?

What about the delay if the initial doctor refuses that certification? These are practical problems on the ground that need to be teased out.

The storage of information and the right to access information in regard to a decision made or not made by a medical practitioner, as well as the review of that, is an issue that has to be looked at. With regard to the early pregnancy section, whereby one is allowed to have a termination up to 12 weeks, if a doctor refuses, what is the position and what are the consequences for that doctor? Does the pregnant woman have to go from doctor to doctor to try to get a doctor who will give her permission? The make-up of the review panel has to be scrutinised and a much broader range of professions and experience brought into it. I have no difficulty with conscientious objectors but the result and consequences for a doctor refusing must be tied down.

We also need to clarify who is entitled to this service. I welcome that it is free, although I should not say "free" because everybody pays taxes for services, one way or another. Nonetheless, I welcome that the service is being provided as a universal service without extra cost. In regard to medical guidelines, like others, I welcome the appointment of Professor Peter Boylan because we are going to need robust medical guidelines in regard to many of these issues, which will be dealt with better under medical guidelines rather than in legislation.

The right to freedom of conscience is a fundamental right protected by the Irish Constitution and the European Convention on Human Rights. No person should be required by force of law to take innocent life. Irish doctors, nurses and midwives entered their professions to protect life, not to take it. For the first time in Irish history, a Minister for Health is proposing to force doctors to refer women for abortions. Forcing doctors to become involved in the abortion process against their conscience is deeply unjust. There is growing anger among nurses, in particular paediatric nurses, doctors, midwives and pharmacists because they were never consulted. It was said wrongly that this was GP-led. However, there was a GP poll and of the 900 GPs who responded, 75% said they do not want to participate. Theatre staff and gynaecology ward staff will be forced, and bullied, I believe, to do this job when they never entered the profession thinking this was what they would have to do. How can a nursing staff manager take over a 12-hour shift where the nurse leaving says there are three terminations of pregnancies going ahead, when the second nurse does not want to be involved in that? She is going to be forced into it. Indeed, two Scottish nurses lost their jobs for the same reason in 2014. I can see this is what will happen in our country down the road and we are not addressing those issues.

Most GPs have no ultrasound service available to them and most of them are not trained to operate an ultrasound machine. If a girl presents and says she is nine, ten or 11 weeks pregnant, how can he be sure it is not 14, 15 or 20 weeks when he does not have that ultrasound service available to him? Where a girl presents up to 24 weeks on mental health grounds, and something happens with the father of the child and she is in a very bad state, what is the definition of "mental health grounds"? This will allow for the abortion of a 24-week old baby. Only the other day I had the pleasure of seeing and meeting a baby who was born at 22 weeks, and he is perfect, a lovely little boy. The people I am talking about came into the profession to save lives, not to kill.

What happens the babies who are born alive? Are they going to be saved once they are outside the womb? I met a woman of 39 years of age across the road from here last year. She was aborted and thrown into a bucket, and a conscientious nurse heard her moaning and saved her. She was perfect last year, 39 years later, across the road from here.

With regard to foetal abnormality, we understand the case of the baby that has no hope of surviving outside the womb. To be honest, everyone felt for that situation, as I did. That should have been addressed on its own, aside from any abortion Bill. The Bill refers to a foetal abnormality up to nine months. How much of a disability are we talking about? This has never been explained or defined. Is it some child with a cleft palate? Who is going to decide that? If a baby that is in the womb for nine months is going to be aborted for no good reason, to me, that is murder and it should not be allowed. There are many Deputies here who have an awful rush on them to get this Bill through the Dáil. I believe the Taoiseach does not want to allow pre-legislative scrutiny, which is wrong because this is very serious.

An awful lot of people around the country will be very hurt when they see and understand what is happening in the case of an abortion, and what happens to a little baby. I believe that once a baby is in the mother's womb, it is alive. Although it is constantly being referred to as a foetus, I refer to it as a baby. We are talking about this happening up to nine months. A couple of days later it is a baby outside the womb whereas a couple of days before that, or even hours before that, it is called a foetus and can be aborted. It is very wrong.

Our abortion laws will be the most liberal in Europe. I respect the vote of the Irish people but they relied on us in this House to do what is right. If we are going to rush this Bill through the Dáil, I do not think that is right. On every little aspect I have raised here, I had only ten minutes to speak. This should be gone through in minute detail, not rushed through. The people out there are depending on us to legislate properly for abortion. We must ensure the doctors, midwives and paediatric nurses, who were never consulted, are consulted and talked to in order to see how this will be carried out. It is all right for the Minister to say, "There is €12 million there. Do it." That is not the way it should be done. We should go through it properly and ensure plenty of legislative scrutiny is given to the matters I have raised here tonight because it is very important.

Many healthcare professionals have called on the Government not to force doctors to refer women for abortions. The legislation must be amended to remove the obligation on doctors to refer women for abortions.

Debate adjourned.