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

Debate resumed on amendment No. 47:

In page 15 and 16, to delete lines 36 and 37 on page 15, and on page 16, to delete lines 1 and 2 and substitute the following:

“24. (1) A medical practitioner, nurse or midwife shall not be obliged to carry out or to participate in carrying out a termination of pregnancy in accordance with section 11, 13 or 14 to which he or she has a conscientious objection.”.

- (Deputy Michael Healy-Rae)

Deputy Billy Kelleher

This issue has been discussed in great detail. Many people would have considered its discussion in advance of the referendum disingenuous. Until the Irish people adjudicated on the eighth amendment it would have been very difficult for and presumptuous of this House to discuss it. Of course, the decision having been made, it is now up to Members to put forward their views on the interpretation of that decision. In my view, the interpretation is very clear. The proposed detail in heads of the Bill was available to the people and they voted emphatically to support the proposals and the promised services. Those services must now be made available to the people.

Reference has been made to doctors not having been consulted on conscientious objection. The majority of those who gave evidence before the committee on the eighth amendment were doctors or experts in women's healthcare. Similarly, the majority of those who advocated for change to the eighth amendment and to make abortion services available in this country were doctors and representatives of the governing bodies of the various medical disciplines such as the Institute of Obstetricians and Gynaecologists, the Irish College of General Practitioners and many others. I accept that within those bodies there are people with differing views.

Conscientious objection is enshrined in the legislation as proposed. However, its interpretation in Medical Council guidelines is critically important. For us to legislate beyond that would be very dangerous. We would run the risk of being too prescriptive in healthcare. Parliament passes laws and the Medical Council interprets them and puts guidelines in place for its members.

In much of this debate, we seem to have forgotten the patient, the woman.

Deputy Simon Harris

Hear, hear.

Deputy Billy Kelleher

The reason conscientious objection is very important and must not be abused is that women may find themselves in very vulnerable positions and unable to access the healthcare they need. If a doctor fails to refer a woman on, it could leave her in a very vulnerable position. Not every woman has an ordered life. The lives of some are very chaotic, with some women enduring abuse and violence. Some women may not have English as their first language and may feel very isolated in this country. There can be many reasons for seeking a termination. It would be fundamentally wrong not to obligate a doctor to, at least, refer on a woman seeking a termination. The idea that one would just give such women a telephone number and close the door is unacceptable.

Deputy Bernard J. Durkan

Hear, hear.

Deputy Billy Kelleher

Doctors with a conscientious objection should be obliged to refer women to another doctor. To legislate for conscientious objection in the manner proposed in the amendment such that a medical practitioner could decline to assist a woman who presents is against the basic principles of good medical ethics in the view of the professionals who made the case for this legislation at the eighth amendment committee and during the debate across the country before the referendum. I accept that a cohort of medical professionals such as doctors, midwives, nurses, pharmacists and other healthcare providers will conscientiously object.

I have to be honest, however. I have had interactions with them as well. They are people who are conscientiously obstructing the potential roll-out of this service. There is a fundamental difference between the two positions. People are entitled to object conscientiously and not partake but obstructing the rolling out of the services in a way that is against the wishes of the Irish people and, more important, threatening the health of Irish women is anathema to basic, genuine, ethical medical guidelines.

For all these reasons, I do not want us to be too prescriptive in this area. I want the Medical Council, which is charged with regulating doctors and oversees all the registration and the interpretation of medical guidelines, to put what I suggest into effect. It has said at hearings of the health committee and at other fora that it will continually review the guidelines in respect of conscientious objection. As far as I can ascertain, however, conscientious objection has been a fundamental principle in medical guidelines for a long time. I hope it will continue to be. We certainly cannot allow conscientious obstruction, however. I believe some people are now involved in it as opposed to promoting the fact that they are entitled to a conscientious objection.

Let me return to the practicalities. For 35 years, women have had to go abroad for a termination, and their lives were put at risk because of that journey. That is a fact that was presented to the committee on the eighth amendment. Women's lives and health were being put at risk by their having to travel abroad. Our concern was not great, or our conscience was not exactly scratched, when that was happening for many years. At this stage, as we wind down the debate towards the end of our consideration of the legislation, irrespective of whether it finishes tonight, we certainly need to focus on the fact that this legislation is about healthcare for women. Doctors, nurses and others are obligated to comply with the law and medical guidelines. The medical guidelines do enough to ensure conscientious objection is protected and that, importantly, women's lives and health are to the fore in any guidelines that are reviewed or updated from time to time.

Deputy Margaret Murphy O'Mahony

One of the main factors contributing to the success of the Yes campaign in the latest referendum was the introduction of the word "choice". I refer in particular to young girls saying, "My body, my choice." I have no intention of rehashing the whole referendum argument but wish to make a quick point about the word "choice". The word swung the whole debate in favour of a "Yes" vote. Our doctors, nurses and pharmacists are now asking for choice — the choice not to be forced or not to be made feel guilty for not getting involved in something they fundamentally believe to be wrong. I ask the Minister to listen to this point and take it on board. He should give those concerned their choice. Some doctors, nurses and pharmacists do not want to get involved in this in any way, and they should have a choice in this.

Deputy John Curran

I shall confine my comments directly to the amendments. I am conscious that Report Stage is not a rehashing of the referendum debate or Second Stage speeches. It would be remiss of me, however, not to contribute because I, like everybody else in this House, have heard significant numbers of medical professionals, including doctors, nurses and trainee nurses and doctors, raise concerns about this matter. The issue of conscientious objection is not new; it is one that the Minister indicated quite clearly from an early stage. It was in the heads of the Bill and is referred to in section 24. The real question is whether the Bill delivers what it sets out to do.

I was not a member of the committee on the eighth amendment, nor am I a member of the health committee. In my party, much of the information for guidance and discussion comes from our health spokesperson, Deputy Donnelly, who liaised directly with the Minister on what conscientious objection would mean. It is fair to say the Minister fully subscribes to the concept of conscientious objection, and that is why the section is in the Bill. I do not doubt that in any sense whatsoever.

The Minister referred to this matter on a number of occasions. He talked about the 24-7 helpline, the referral line, and to general practitioners being able to opt in and out. I listened to a number of Members speaking tonight on this very issue. They said specifically there will be a referral line and that this is how one will deal with conscientious objection. Deputies O'Reilly and Kelleher referred to the same thing. The key point, however, concerns subsection 24(3), which was referred to earlier. It states: "A person who has a conscientious objection referred to in subsection (1) 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." That is somewhat different from what the Minister is talking about. He is giving an interpretation of what that might mean. My concern is that when the Minister and I pass through here and someone reads this law in time to come, he or she may not have the same interpretation and understanding as the Minister. Will that individual understand that the transfer of care involves the telephone line or another mechanism? I am concerned that when we pass this Bill tonight, the legislation as drafted and presented will mean something different.

I am aware that there are a number of amendments tabled tonight. Since I do not believe they will be carried, my question for the Minister is very specific. He probably cannot answer it tonight and I do not want him to. I want him to reflect on it. I want him to examine subsection 24(3) and become satisfied, with the draftspeople and Attorney General, that it delivers the types of services the Minister referred to without the placing of any additional demands or obligations on medical professionals who have decided they do not want to provide the services. This is important. We will vote on amendments tonight and the Minister knows the probable outcome but I am genuinely concerned that the subsection might not deliver in the way the Minister has interpreted it. The legislation should be drafted in such a manner that it does not depend on my interpretation or that of the Minister. It should be quite clear but I do not believe the subsection is clear.

I share some of the concerns of those in the medical profession, including junior doctors and trainee nurses, who have made up their minds. I have not questioned why they have a conscientious objection. That is their personal concern. My specific concern is that, as we vote on amendments tonight — the Minister knows the outcome — subsection 24(3) will remain. When the Minister brings the legislation to the Seanad, will he satisfy himself, through the Office of the Attorney General, that it will do as he has said it will do without the placing of any additional responsibilities on those who might be conscientious objectors?

Deputy Mattie McGrath

Forcing doctors or other healthcare professionals who have a conscientious objection to arrange for an abortion to be performed is not respecting freedom of conscience. It makes them party to taking the baby's life. The referral obligation forces general practitioners, in violation of their sincerely held convictions, to be involved in a process that destroys that life. Under the Bill in its current form, doctors would not only be entitled, but also obliged, to act in violation of the most fundamental principle of medicine, the obligation to do no harm. They would be penalised for respecting life and exercising their constitutional right to freedom of conscience.

The current proposal has already been opposed by over 600 general practitioners. Many of them have indicated they will not co-operate with a duty to refer for abortion. Indeed, the Irish College of General Practitioners carried out a survey that suggests 25% of general practitioners will not refer. That amounts to between 700 and 800 general practitioners approximately. Therefore, the Minister is heading down a cul-de-sac. He has created a completely unnecessary showdown with doctors over a subsection of a Bill that is, in reality, superfluous. Given the way he treats them, I am aware he does not have great respect for them anyway.

Even as a matter of pragmatism, the country cannot afford to lose a large number of GPs because there are simply not enough of them practising here as it is. If the Minister lived in rural Ireland, he would know this and he should know it given that he represents Wicklow. If he presses ahead with requiring doctors to "make arrangements" for women to access abortion against their deeply held beliefs, a legal challenge seems inevitable as a result of an obvious and easily corrected flaw.

New Zealand law allows doctors with a conscientious objection to abortion not to refer. In US federal law, the Public Health Service Act and the Weldon amendment prohibit the funding of discrimination by public authorities against any "health care entity", which term includes doctors and medical trainees, on the basis that the entity refuses to provide referrals or make arrangements for abortions. We can quote international law when it suits us. In Britain there is no obligation to "make arrangements" to help women avail of an abortion either, and the absence of such an obligation has clearly not impeded access to abortion services there.

The Minister has suggested that the referral obligation is in line with paragraph 49 of the 2016 edition of the Medical Council's Guide to Professional Conduct and Ethics for Registered Medical Practitioners. This is simply wrong. Paragraph 49 states that doctors "may refuse to provide or to take part in the provision of lawful treatments or forms of care which conflict with [their] sincerely held ethical or moral values". The obligation on the doctor in these circumstances is first, to inform the patient that there are options for treatment elsewhere and, second, to give the patient information to allow him or her to transfer himself or herself to another doctor to obtain the treatment. The doctor is only obliged to assist with the transfer where the patient is unable to transfer himself or herself. It is an entirely new departure in Irish law to require someone who objects to the ending of a human life to ensure that that life is ultimately ended by someone with no such objection.

The Government has decided to introduce an opt-in system for the provision of abortion services. There is no basis for mandatory referrals because direct access will be provided. The Minister's scheme will enable women who want an abortion to identify healthcare workers who will provide one, and prospective patients will be able to self-refer. This is quite obvious. There is no rational basis for the argument that respecting conscience rights will prevent access to abortion in Ireland. This amendment would align our law on this point with that of other countries, such as those to which I have already referred.

Amárach Research polling in the wake of the referendum showed that just over 50% of adults, excluding "don't knows", disagree with a referral obligation.

A group of pharmacists recently called on the Minister to specifically recognise the right to freedom of conscience for pharmacists in the practice of their profession in the health Bill before the House. A recent PharmaBuddy poll of pharmacists registered in Ireland showed that 60% of respondents supported the extension of freedom of conscience protection to the pharmacy sector. The Minister knows this better than I do. As a group of healthcare professionals, pharmacists are involved in every aspect of the manufacture and supply of medicines and in the counselling of patients. Pharmacists will therefore play a critical role in the implementation of any future abortion policy. Despite requests from the pharmacists' representative bodies, namely, the Irish Pharmacy Union, IPU, and the Hospital Pharmacists Association of Ireland, HPAI, there has been no engagement whatsoever on the part of the Minister-----

Deputy Simon Harris

That is not true.

Deputy Mattie McGrath

-----on this fundamental change to healthcare ethics and practice. He has displayed a blatant disregard for the rights of dedicated healthcare workers. He will meet any group from the other side that comes up tonight and wants to meet him, but he refuses to meet the professional bodies of our doctors, pharmacists or nurses or anyone else. Such contempt for our healthcare profession is appalling. He listed the groups he has met. He would bring any group from the other side in to meet him so long as there were two or three of them. Such bias is shocking. A spokesperson for the group of pharmacists, Dr. Orla Nolan, a Dublin pharmacist, stated:

Freedom of Conscience is a widely recognised human right. However, there is no explicit acknowledgement in the draft legislation of this right as it pertains to Pharmacists. The legislation denies Pharmacists their right to Freedom of Conscience and compels them to produce, distribute and dispense drugs that they know will be used for the express purpose of ending a life. This is unacceptable, and will place many pharmacists in an untenable position, forced to choose between practicing their profession and following their consciences.

Dr. Nolan called on the Minister and the Dáil to amend the legislation to explicitly protect the conscience rights of pharmacists, but he is not listening. He has closed ears and a pure, one-track vision of this. Someone said this is a trophy project. It looks like it, but to undermine and trample over all these professional people is an outrage and a total affront to democracy and the healthcare professionals on whom we depend day in and day out up and down the country. It is ignorant and disgraceful that the Minister will not listen to them.

Deputy Michael Collins

A group of pharmacists has called on the Minister to amend the abortion Bill to protect the conscience rights of pharmacists and other healthcare professionals. The Health (Regulation of Termination of Pregnancy) Bill 2018, as currently drafted, does not provide for the conscientious objections of pharmacists. Pharmacists will therefore play a critical role in any foreseeable abortion regime as all the methods of abortion provided for in the Bill involve prescribing, dispensing and administering medication. Although their conscience prevents them from intentionally ending the life of an unborn baby, they will be required by law to collaborate in this very act. The legislation in its current form interferes with the exercise of pharmacists' professional clinical judgment and denies their right to freedom of conscience. Freedom of conscience and religion is recognised and protected under Article 44.2.1° of Bunreacht na hÉireann and Article 9 of the European Convention on Human Rights. At present, however, there is no acknowledgement in the legislation of this right as it pertains to pharmacists. An alarming aspect of the proposed legislation is that our legislators believe that the only people in the health service who have consciences are doctors and nurses.

The group of pharmacists has called on the Minister and Members of the Dáil to amend the legislation to protect the conscience rights of pharmacists by creating an opt-in system for all aspects of abortion services established under the new law such that those pharmacists who choose not to opt in will not suffer any disadvantage in respect of their employment rights or career progression.

A recent poll revealed that over 60% of pharmacists voted for the right to freedom of conscience in supplying or dispensing medications used to induce abortions.

At this stage, the Minister has made no reference in the legislation as to how his abortion proposals will work in practice. He has proposed a GP-led regime which a majority of GPs oppose and most GPs believe is unworkable. He has failed to consider the most basic practical issue of how the medications used in abortions will be manufactured, provided and dispensed. He has not consulted pharmacists on this fundamental change in healthcare ethics and practice and has, to date, displayed a combination of disregard and contempt for the conscience rights of the dedicated pharmacists and healthcare workers who conscientiously oppose abortion. Pharmacists have a human right to freedom of conscience, religion and belief. Their right to freedom of conscience must be included and protected in the Health (Regulation of Termination of Pregnancy) Bill 2018.

Deputy Carol Nolan

Go raibh maith agat, a Chathaoirligh, as ucht an deis labhairt. The right to conscientious objection is, as has been said a number of times tonight, a fundamental human right. It is one we cannot forget about or dismiss, but that this is what is happening. I fully support the doctors, pharmacists and nurses and all other healthcare professionals who have stood firm on this. They have a right to conscientious objection. GPs are being treated very badly in this whole ordeal, as are other healthcare workers. If they are being more or less forced and bullied into becoming involved in a referral process, that means they are involved in the whole process, in which they want no part. Many of these GPs are dedicated and committed and work long, hard hours. Let us also remember that they are working in difficult conditions because our health service is absolutely disgraceful at present. It is of Third World standard in some areas.

These doctors and nurses are working in difficult conditions every day. They are being told that they have to be involved in a process to which they have a genuine conscientious objection. That is not right and needs to change. We hear much talk in this Chamber about choice, equality, respect and democracy. When it comes to the crunch, unfortunately, none of these is to be seen. This is another example of that.

The group of doctors who organised the petition of more than 640 GPs that led to Sunday's emergency general meeting, EGM, of the Irish College of General Practitioners, ICGP, claimed that several hundred GPs have lost confidence in the ICGP board and that a serious crisis now exists. The Government can longer ignore this crisis in the rolling out of GP-led abortion services. I will read from their press statement after the EGM. I am sure the Minister has a copy. It gives us an insight into what is happening. I, and many other Deputies in this Chamber, met many of these GPs some months ago and they expressed their concerns to us. They are very upset and angry but they also are strong in their resolve. There is no way they will allow themselves to be forced on this issue.

The press statement states: "Hundreds of GPs on the ground do not believe general practice is the appropriate setting in which to deliver abortion services because of lack of capacity in an already overstretched environment, lack of training and availability of ultrasound, and delivering on genuine freedom of conscience protections for doctors who do not want to be involved in overseeing abortions taking place." They do not want to be involved in any part of that process. The first time GPs heard that abortion services would be GP-led was when the Minister announced it on radio. Imagine treating our doctors like that. They work hard every day in a creaking health service. The disrespect they have been shown is appalling.

From that day to this, GPs have not been consulted on the matter. From 1 January, however, the Minister will impose abortion services on general practice. GPs will face the full rigours of the law from the new year if they conscientiously object to becoming involved in any way. That is disgraceful in this day and age when we are talking about the new Ireland and the new republic. It is some new republic if we are to bully and marginalise people simply because they have conscientious objections. Fair play to those GPs for standing firm. They are entitled to do that.

I do not know whether the Minister realises that this crisis will lead to a mass exodus of GPs. It was stated here that there are enough GPs. I and many others do not share that belief and I will explain the reason. In rural counties such as Laois and Offaly, it is getting very hard to recruit and retain GPs in many of our towns and villages. This has been an ongoing issue and many Deputies, on both sides of the debate, have raised the issue of the chronic shortage of GPs in rural counties. The Minister will cause a mass exodus and that will put the health of many people in jeopardy.

Many people are already suffering and languishing on long waiting lists. The Minister will now add to that problem by trying to bully the GPs, pharmacists and nurses who want no part in this process. I stand with those people. They are entitled to their conscientious objection and I support them fully. It is shameful that respect is only given if a certain view is held. That is some democracy in this new republic. As an Irish woman, I am absolutely ashamed at times that we think it is okay to marginalise people and to dismiss their concerns if they do not share our views. That is not right. I stand in full support of those healthcare professionals. I hope the Minister will see sense, see the light and treat them properly.

Deputy Stephen S. Donnelly

Conscientious objection is an important issue, which has been well rehearsed in this debate. I fear we are beginning to stray back into Second Stage speeches. If I may, I will bring it down to the legislation. Conscientious objection is incredibly important and it is fully protected. It is in the legislation. There are two parts to it. There is the right of the medical practitioner not to be involved. It is as clear as day that this right is provided for and I have heard no one, on any side, suggest that it is not. The second issue is what obligations are required in respect of transfer of care. This will apply mainly to GPs. The Minister confirmed to me on Committee Stage that a GP will have met his or her objections on transfer of care by providing the woman with the number for a 24-7 helpline. There may be GPs who believe even that is too much. The vast majority of GPs who will conscientious object and have approached me have said they are satisfied with an obligation on transfer of care which concerns nothing more than giving the woman a 24-7 helpline phone number. That is it. It is very important but it is relatively straightforward.

I will speak briefly now about the amendments. Amendment No. 47 gives medical practitioners the ability to conscientiously object. I agree with this amendment from Deputies Mattie McGrath, Nolan, Tóibín and others but I will not support it because it is almost exactly, word for word, what is already in the legislation. I have checked and double-checked and I can find no difference. I agree with it. The wording in the legislation, however, has been passed by the Office of the Attorney General and professional drafters, and this amendment has not. For that reason, I will stick with the legislation. The amendment is a restatement.

Amendment No. 48 quite reasonably refers to pharmacists and seeks protection for them. Pharmacists must be able to conscientiously object. The Minister might confirm, as he did on Committee Stage, that conscientious objection for pharmacists is fully protected in the legislation and guidelines governing pharmacists.

Amendment No. 49 is my amendment. We discussed this on Committee Stage. I wanted to be certain not only that the right of doctors, nurses and midwives to conscientiously object will be completely protected but that the right of students to do so will also be protected. I have discussed this with the Minister. I acknowledge that he has, in turn, tabled amendments Nos. 52 and 53 to do that. For exactly the same reason as I stated in respect of amendment No. 47, namely, that the Minister's amendments have been passed by the Office of the Attorney General whereas mine has not, I will withdraw my amendment and support the Minister's because that is the version approved by the Office of the Attorney General and the Government. My understanding is that will give full conscientious protection to all students. That is very important.

Amendment No. 50 requires someone who conscientiously objects to notify the Minister for Health that he or she has done so. I do not believe that is a reasonable thing for people to have to do and I will not support the amendment.

Amendment No. 51 proposes to delete the obligation for referral. The ability of a GP, midwife or a nurse to conscientiously object is fully protected. The Minister confirmed on Committee Stage, and he might do so here again, that it is protected in general practice. It is also protected in an acute care setting. A midwife, nurse or doctor can inform his or her employer that he or she is conscientiously objecting and cannot therefore be roistered on or be coerced into being involved. That, too, is very important. Amendment No. 51, however, would delete any obligation of referral. I will not support it for a few reasons. My understanding from the doctors I have spoken to is that it is standard medical practice, here and around the world, that doctors will not simply wash their hands of a patient and leave him or her in a particular situation. As Deputy Kelleher said earlier, while that might not pose too much of a problem for some women presenting in Ireland, there are others for whom it could present a problem. They could be in great distress. They may have been raped or may be under coercion. There are all manner of reasons that women in vulnerable situations will present to a GP. It is not reasonable for any doctor to state he or she is simply not getting involved and off the patient should go. The doctor has an obligation, which in this case requires no more than that he or she tell the patient that there is a 24-7 helpline staffed at all times by qualified medical professionals who are able to talk about counselling and the options available and, if the patient wishes, to direct that patient to a GP who has opted in.

If the only thing the doctor has to do is provide that telephone number, that is absolutely reasonable. I do not believe the referral measure should be deleted. I will be supporting amendments Nos. 52 and 53 from the Minister because they ensure conscientious objection covers students, which is important.

Amendment No. 54 concerns pharmacists and I will not support it. Pharmacists should be protected and I hope the Minister will clarify the legislation under which they are protected. Will he provide clarity on the various pressing issues raised?

Deputy Bernard J. Durkan

I am a little disconcerted by some of the points made about this group of amendments. It appears that in recognising the right of a conscientious objector at all levels, a point with which I agree, it is seen by some as a means of frustrating the purpose of this exercise, namely, compliance with the decision of the people in the referendum. That is a serious matter.

Deputy Ó Cuív made a remark which concerned me a little on the question of two lives being involved. There are, but it should not be forgotten that this is what the eighth amendment was about - equality. History showed that equality when it came to the right to life did not work. Instead, it ended tragically and it has to end tragically for one or other patient. In order to ensure the concept of equality was carried through, practitioners had to wait until such time it was too late and two lives were lost. That did not happen on just one but on several occasions.

I do not have a daughter, but if I did, I would be concerned if I were to come to a conclusion that there would be a debate on the eighth amendment again before action might be taken to intervene in the case of a woman who had presented with a crisis pregnancy. I thought we had had that conversation. I thought our obligation was to comply with the decision of the people. They decided with no force put on them. They made up their own minds clearly.

Deputy Thomas Byrne

This is an interesting debate. When conscientious objection is made into an issue, some are under the impression that there is no conscientious objection clause in the Bill. I have read it and it has been mentioned here, but it is being covered over. The fact is that no doctor, student doctor, nurse, midwife or, as the Minister said, pharmacist will be required to take part in any of the Bill’s provisions. They will not have to take part in an abortion. That fact is being lost. It is a point which is worth fighting for and should be acknowledged. The Bill’s provisions will not apply to any professional who does not wish to take part. That is absolutely clear and I am satisfied that the Bill’s provisions on conscientious objection are broadly based.

Will the Minister set out the position on pharmacists? He gave assurances on Committee Stage that the provisions would apply to pharmacists. Why is he not tabling amendments in that regard? Will he explain clearly why they do not need to be mentioned in the legislation, despite the fact that he says the provisions apply to them? I certainly want reassurance before I vote.

The issue of referral came as a complete surprise to me at the start of this debate. When the 2013 legislation was going through, there were several amendments on the issue. There were certainly some Members on the pro-life side of the debate in the Seanad who put forward straightforward amendments proposing that there be referral to another medical practitioner. Now other Members want in their amendments to delete the obligation to refer. There is a division of opinion, matters move on and people grab on to particular issues.

I have not heard a complaint about practice in the past five years from some doctors who feel there was a breach of their right to conscientiously object. If there has been a problem, will somebody set it out? No doctor has been obliged in any circumstance to take part under the 2013 legislation, just as they will not be obliged to do so under this legislation. No problem in that regard has been demonstrated. I stand to be corrected, but I have no evidence which shows that there has been a problem. I wonder how great an issue this will be in practice.

Not every doctor will be happy with the final legislation. However, the Minister has given assurances that the mere provision by a doctor of a helpline number to patients will mean that he or she was fulfilling the requirement to refer. My understanding from talking to doctors is that the majority who conscientiously object will be satisfied with this. I wonder just how many will think it is a step too far for them. If I were a doctor, I would probably conscientiously object. However, I would certainly have no difficulty with referral. It is for others to deal with their consciences. This is not a matter on which one individual in the medical profession or the Dáil can dictate to anybody else, particularly in the light of the referendum result.

We need to be absolutely clear with the public as there is much confusion. Yesterday an upset nurse rang me. She was worried that she would have to take part in abortions when she would conscientiously object to it. As a lawyer and a legislator, I gave her my assurance that in no circumstance would she have to take part in abortions. She was reassured by me. However, there is so much misinformation on what people will be obliged to do or not to do that we need to keep going back to what is actually included in the law, not what people might fear might be in it.

I will reserve my position on voting until I listen to what the Minister has to say. For the majority of doctors who conscientiously object, the Bill will be satisfactory.

Deputy Joan Collins

I was not going to intervene in this debate because I had made a conscious decision to let it go through, even with some of the comments made by anti-choice Deputies in the Chamber. However, I want to make the important point that a referendum was held and that one of the key issues was trusting women. The people were clear that women should not have to travel abroad to have an abortion, as well as on the periods of 12 weeks, 24 weeks and fatal foetal abnormalities.

Savita Halappanavar’s husband said in his evidence that one of the nurses or midwives in the theatre had said they could not perform an abortion on his wife because we were living in Catholic Ireland and that it was illegal. Let us take as an example an emergency in dealing with a pregnancy at 2 a.m. and three of the emergency team are conscientious objectors. If amendment No. 51 were to be accepted, we could have a situation where those three medical practitioners would be able to say they did not have to pass the case to anybody else. Then what happened to Savita Halappanavar would happen again. That would be the logical conclusion of accepting the amendment.

The potential consequences of amendments that are not thought out or do not reflect the essence of what the legislation is trying to achieve must be taken on board. There are major problems with our health service. I am the first Deputy every week to raise in the House the crisis in our health service. For example, I have challenged the Minister of State, Deputy Finian McGrath, about services in the community healthcare organisation, CHO, 7 area. The crisis is the reason I am an advocate of Sláintecare. In that context, what this amendment could mean must be considered.

Deputy Eamon Scanlon

I will not delay the debate and will only make a few comments. Like many, I have listened to the debate for the past 18.5 hours. In that time, everyone who has spoken on both sides has done so from the heart. Some of the cases raised are not what I would like to see happening, but the people have spoken.

A number of amendments have been tabled, most of which I have supported. Regarding this amendment, we have discussed doctors, consultants, midwives, trainee nurses and so on, but the other hospital staff, for example, hospital porters, should also be considered. It is only fair. People have asked us to make provision for conscientious objection because they do not want to work in that situation. Those of us who have spoken, particularly on the pro-life side, have been asked to make their feelings known. The House has dealt with 46 amendments, many of which have been voted down. There are a further 19 to go, and they will be voted down. As politicians who have been elected to the House to represent people's views, we are obliged to make their feelings known. That is what is happening. It is only right that we have that opportunity. I have listened to everyone respectfully. Everyone who has contributed has said what he or she believes. I am doing the same. People with a conscientious objection should have the option of opting in. That is what I believe. I will not go on for any longer because we do not want to delay the debate unnecessarily.

Deputy Michael Fitzmaurice

I will not speak for long. I just want to make a few points. In recent weeks, many Deputies have met doctors, nurses, midwives and others in the health care sector. We are used to listening to different scenarios. Some of the people we met have stated that they may have to leave work. That happening in any country would be sad.

We could have done this in a way that allowed people to opt out completely while we still ensured that the service was provided in every part of the country. Even pharmacists have expressed deep concern about this legislation. We must ensure that people are not pushed into situations against their firm beliefs. People on different sides of the House have their views on various issues and respect the other sides. I ask that the Minister take that concern into account in the context of this amendment.

Deputy Michael Harty

Conscientious objection is an important issue and this section of the Bill is vital, as shown by the number of Deputies contributing on the debate. Doctors' individual rights and beliefs are not absolute. They should not trump the legal rights or beliefs of others and certainly should not trump the beliefs of doctors' patients. That also goes for all nurses, midwives and allied health professionals. Doctors do not have an absolute right to object. This is the central issue.

The Medical Council is clear on the question of conscientious objection and its medical guidelines have not changed, nor will they. They read:

[A doctor] may refuse to provide or to take part in the provision of lawful treatments [...]

If you have a conscientious objection to a treatment or form of care, you should inform patients, colleagues and your employer [...]

You should make sure that patients' care is not interrupted and their access to care is not impeded. [This aspect is important to our debate.]

If you hold a conscientious objection to a treatment, you must:

inform the patient that they have a right to seek treatment from another doctor; and

give the patient enough information to enable them to transfer to another doctor to get the treatment they want.

If the patient is unable to arrange their own transfer of care, you should make these arrangements on their behalf.

In an emergency, you must [prioritise the patient above the doctor's own objections] and give the patient all the necessary treatment.

The relevant section in the Protection of Life During Pregnancy Act 2013 is the mirror image of the section in this Bill. It reads: "A person who has a conscientious objection ... shall 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 medical procedure concerned." I am not aware of this provision in the 2013 Act having caused any problem and I cannot see how it would cause a problem if this Bill were enacted.

Thus, the obligations of those who have a conscientious objection to the termination of pregnancy have not changed. What has changed is the fact that the termination of pregnancy will be provided in Ireland and will no longer be transferred to another jurisdiction. What has also changed is the fact that medical professionals will now have to face this reality in Ireland and work out how best to accommodate the new, lawful termination of pregnancy. This new reality will take some time for people to accommodate and for the medical profession to develop the accommodation that the new law will introduce. The conscientious objection requirements have not changed. They are not going to change. However, the reality of the provision of termination of pregnancy in Ireland is changing, and the medical and nursing professions will have to accommodate that. The Medical Council guidelines allow them to do so. Now that terminations will take place in Ireland, doctors must ask themselves the question. They cannot avoid the medical guidelines laid down by the Medical Council, as their beliefs do not trump those of patients who access a legal service.

Some general practitioners, GPs, will provide this service, but it will eventually be delivered in clinics or hospitals. GPs are self-employed. They have a contract with the General Medical Services, GMS, scheme. The provision of termination of pregnancy services in general practice will have a separate, opt-in contract. If a GP wishes to provide the services, he or she will take out the contract. If he or she does not wish to provide them, the GP does not take out the contract. If a GP is a conscientious objector, the GP places a notice in his or her waiting room saying that he or she is not participating in the service. A GP does not need to include an explanation if he or she does not want to, but the GP should inform patients that he or she is not participating in the service. If a patient should seek the service from the GP, though, he or she is obliged to help the patient and give that person information on where to access the service, be that by directing the patient to a helpline, a HSE website or a colleague. Conscientious objection does not absolve a GP of that requirement. In summary, GPs have an opt-in contract and the only requirement on them is to provide information.

The Minister says that arrangements can be accommodated by just providing information. It will soon become quite obvious to people who is providing the service and who is not. People will not subject themselves to the humiliation of going to a doctor knowing that the doctor is not going to assist them but the doctor does have an obligation to provide them with information.

However, there is an issue relating to employees of the HSE. They are in a slightly different situation because there is the possibility that they could be forced or pressurised to participate or assist in abortion services. This must be clarified by the Minister. It should not affect their employment, employment prospects or promotion prospects. The Minister must make it clear that should a conscientious objector be an employee of the HSE, it will not affect his or her career in any way.

To go back to my fundamental point, the rights of a doctor do not trump the rights of a patient. The beliefs of a doctor do not trump the beliefs of a patient. The doctor must assist his or her patient and I believe the Medical Council guidelines on conscientious objection cover that.

Deputy Joan Burton

Since this debate began a very long time ago, it has always been clear on the part of people who objected to the eighth amendment and believed it put women's lives at risk and was not in the best interests of women and indeed children and Irish people that the right of conscientious objection was always recognised and given freely and generously. What I would say to people here who have taken a conscientious objection position is that this is their right but it is also my right to be a conscientious supporter of proper facilities being available to women when they need that support. Staff in medical institutions, hospitals and practices throughout the country have the right to conscientious objection, but they should acknowledge the right of conscientious supporters. This is not an easy subject. It is a subject where people agonise and weigh decisions as to what is best for them, their families and their future. We do not have absolute insight into everybody's decision but those who righteously profess conscientious objection should also look at the righteous right of other people to support conscientiously this legislation and the changes it brings.

I was a member of the Government at the time of the 2013 Act. Deputy Fitzgerald, the former Attorney General, Máire Whelan, and I were the only women there and, obviously, were the only people with experience of giving birth to children and all the joys, risks and difficulties that involves. We came at it from a practical point of view. How many of us who read the story of what happened to Savita Halappanavar and her husband and thought if only someone had indicated to them to get in the car and drive to Dublin where someone would possibly look after them, rather than the endless confusion and contortion of events that happened which resulted ultimately in her dying when I believe she need not have died had a better path been open to her?

Yes, people have the right to conscientious objection, but from everything I understand about people in the medical and health services, that does not mean that one can then abandon the patient. All that is being asked here is that the patient would be able to be referred to people who conscientiously can address their needs. That referral is a just referral. It does not undermine the conscience of the person who has an objection. That is and was accepted by everybody on this side of the debate from day one years ago. I am so glad that it has been included so positively in this legislation.

In respect of the different grounds that are contested here, I do not agree that when a woman's life is in danger during pregnancy she should be left to die. I am talking based on my personal experience of living in Africa where every year, hundreds of thousands of women die in childbirth. They die from situations in childbirth that are no longer a problem here such as breech births or the lack of midwives or trained doctors. Do people who work in medical services in those countries really say that given all their skills, they will stand by and let every woman who is at risk die? We are in a very special situation in Ireland where we have fantastic doctors, nurses and staff in all our hospitals who are available to people who want home births as well, but what if something goes wrong and the woman's life is in danger? One can even talk to people who are very religious. What if that woman has other children? That is often the situation in Africa. What if she has other children? Are they saying let her die and let those other children go motherless?

I do not think a lot of the people who have put the argument this evening personally believe that because these are complex decisions. They are not easy decisions for anybody but what we are seeking to do in this legislation is put in place a framework where women and their partners and families can be assured that in the relatively rare cases where something goes wrong, they will get the proper attention. That is what we are talking about. We are not talking about some ideology. We are talking about real women and possibly children whose lives are under threat in a situation of pregnancy. We must address that core question.

I recognise conscientious objection but, equally, I recognise the right of women to get treatment that is appropriate to their situation. The people voted for that, which is what gives us our authority to come into the Chamber and say this with all due care and consideration to the people who think differently from us. There are very simple and easy procedures to pass on records and make the information available. We should remember that way back during the time of the eighth amendment, the judges decided in a Supreme Court case and the people decided in a referendum on the right to information and the right to travel. If someone decided on the right to information and travel, he or she had actually decided to allow people to proceed but to do it in another jurisdiction. This Bill simply brings it back home and provides for it here.

Deputy Peadar Tóibín

I will address the points made by Deputy Donnelly and Deputy Harty. I know they put questions out there.

Acting Chairman (Deputy Declan Breathnach)

Address the Bill.

Deputy Peadar Tóibín

The reason this is considered yellow pack conscientious objection is because the Bill states that there is nothing in the Act that will be construed as obliging any medical practitioner to carry out or participate in an abortion. That only means that there is nothing in the Act. It does not mean that there will be nothing anywhere else that will influence a person to carry an abortion, so it is a very weak form of conscientious objection. Our amendment says there will be nothing in the Act and everywhere else within society that will force a person to participate in an abortion.

The other point that was mentioned was that the Protection of Life During Pregnancy Act contains the guidelines. That Act is of a different order. That Act looked to legalise abortion in the case where there is a threat to the mother's life. This Bill is of a totally different order.

It is to allow for abortions to happen without indication. That is a completely different scenario and has to be understood in that context. Deputies were saying that a person may die in a case of conscientious objection. There is no example in the history of the State of any doctor stating he or she had a conscientious objection to something and a person dying as a result. There is no example of that ever happening.

In a liberal democracy, the right of one person is limited where it damages the right of another person. What the Government is seeking to do is force one person to proceed with the ending of the life of another person at some level. The issue of arrangement is said not to be a big issue. The Bill states that termination of pregnancy is the ending of the life of a human being. If I was to arrange for the ending of the life of another human being, I would be legally and morally culpable and complicit in that action. We can imagine, therefore, that doctors who consider abortion to be what the Bill states it is would feel culpable and complicit if they proceeded in that way.

That pharmacists have not been included is again a case of us saying somebody else can do it but we will not do it. Thousands of health professionals have stated that they do not want to proceed with this. The Minister is on a collision course with the people working in our health service.

Acting Chairman (Deputy Declan Breathnach)

I ask Deputies to stay within the time limits. We are back to the second round of two-minute contributions and I encourage people not to be repetitive.

Deputy Michael Healy-Rae

During the course of the debate on this amendment, I had to leave the Chamber on a number of occasions to take calls from people in the medical profession, both ladies and men, who are watching the debate tonight. They could not believe some of the comments that were made here this evening. We are elected representatives and we can say what we like. People have differing opinions but to say that some of those who called me were concerned, worried and upset would be an understatement.

When this amendment is put to the floor, it is up to people to vote whatever way their conscience takes them. People in the medical profession have made their arguments strongly and eloquently explained why this amendment should be passed and why they wanted us to put it forward in the first place on their behalf. We are not doing this as politicians. We are doing it after consultation. We met groups as individuals and as a group. We listened to their concerns and it would be very remiss of us if, after meeting these people, taking their concerns on board and believing in what they want to achieve for themselves and their work, we did not do what we are doing here this evening.

Deputy Mattie McGrath

Deputy O'Connell asked us to show her the evidence regarding women hurt by abortion. The Fergusson report is a 30-year longitudinal study which shows negative mental health consequences after abortion. The report was done by a well known and respected healthcare professional. Professor Fergusson was actually pro-choice. Those were his words. Deputy O'Connell is not here to hear that, but I hope the Minister will pass on to her that there is ample evidence.

Deputy O'Connell then spoke about Dr. Abigail Aiken, who is also pro-choice and came before the Special Committee on the Eighth Amendment of the Constitution. The Deputy pronounced Dr. Aiken some kind of independent when she was not. Like all the others who were brought before the committee, she was one-sided. Such a shambles and disrespect I never saw the like of. The committee could not get one pro-life doctor. Dr. Aiken, as well as being pro-choice, wrote a submission for Deputy Coppinger seeking to abolish the three-day waiting period which the Tánaiste dreamt up when he was on his journey across the River Lee and back. There is the independent evidence that Deputy O'Connell is telling us about. Dr. Aiken wrote a policy paper for Deputy Coppinger to remove the three-day waiting period. She was supposed to be independent at the committee. The people watching this are aghast.

This is even stranger still. Dr. Aiken's evidence on the safety of abortion pills was directly contradicted by none other than Dr. Rhona Mahony at the committee. It was all over the place. Deputy O'Connell was talking about making things up and the fictional idea of abortion regret. I ask the Minister why did he not meet those people? Why will he still not meet them? He should meet them. He only meets people who back him and hides and cowers away from people who have real issues and are suffering as a result of abortion. It is a case of speak no evil, hear no evil and see no evil. He will not engage with the pharmacists in any way, shape or form. These are professional people and he is treating them with total disrespect. I suppose the Minister is so used to disrespecting everybody in his health services that it does not matter to him anymore. He has no respect for anyone who is struggling to get any kind of service from the health system. His record is abysmal. He will go down as the worst Minister in the history of the State. That is my considered opinion and that of many thousands of people. He can laugh all he likes, but those are the real facts.

Deputy Simon Harris

That is right.

Deputy Ruth Coppinger

The Deputy is over time.

Acting Chairman (Deputy Declan Breathnach)

I have already called time. If people do not show respect for the time, it is a problem.

Deputy Ruth Coppinger

When people are using the maximum-----

Deputy Danny Healy-Rae

I will be brief. We did not dream up these amendments on conscientious objection. It is doctors, midwives, healthcare officials, pharmacists and all the healthcare people, many of whom came to us worried about this. That is why we have put the amendments down and spoken on them. We feel strongly on behalf of these people who are entitled to their rights and are worried they may be forced or bullied into doing something they were never trained to do. That is why we have gone along with these amendments. We feel very strongly about this issue on behalf of those people.

Deputy Peter Fitzpatrick

GPs, pharmacists, midwives and nurses, all medical professionals, are conscientiously committed to both patients and will remain so regardless of sanctions. Nobody should be forced to end life. I do not think the Minister will do that. He should be fair and look at the situation a woman is in. These people are not looking for headlines. They have a conscience. Doctors and nursing staff have paid for their education, trained and put in big efforts. They were trained to save lives, not to end them. Nobody should be forced to end life.

I am a very lucky individual. I have a family that is pretty healthy. People are going away and professionally training to be doctors, nurses or midwives. Sorry, is there a problem here? I am trying to make a speech here and it is not nice when someone on my right-hand side, especially as it is the Minister, is not showing respect. I am not trying to be smart.

Acting Chairman (Deputy Declan Breathnach)

Please allow Deputy Fitzpatrick to continue without interruption. His time is running out.

Deputy Peter Fitzpatrick

I showed the Minister great respect. I have been here all evening and listened to everything he said. Nobody should be forced to end a life.

Deputy Michael Collins

The Minister said that GPs would hold stocks of all abortion drugs so that women would not need to go to a local pharmacy to have their prescriptions filled and therefore pharmacists do not need to be included in the conscientious objection provisions. Do we know that this will be the case? Where does the legislation make this clear? Can the Minister guarantee that no local pharmacist will be expected to stock and dispense these drugs for the purpose of inducing an abortion? What if a GP does not have sufficient quantities in stock? Will he or she expect the local pharmacist to supply them? Hospital pharmacists will, no doubt, need to be involved in abortions, involving a variety of chemicals and drugs from nine weeks onwards.

Why are they not covered under section 24 of the Bill?

Deputy Kevin O'Keeffe

I will be short and brief. I just want to support this amendment. I suppose the Minister will admit that we must try to bring the whole of society along on the issue that is before us today. While there are two sides to the argument, it is only fair for the Minister to give time and to accept this amendment. Maybe things will progress and there will be changes down the road, but we will still have the issue. No one is denying that women's healthcare is at stake here. People like me still believe we are doing away with the right to life of the unborn. I think the Minister should bring such people along as much as possible by accepting this amendment. As we have seen in recent days, it is not about the money. These people work hard at their jobs. We have been told about how much money will be made available to those who perform their duties if they decide to take up this part of their practice. These people are not in business for money. They are looking for the right not to perform a duty where they see that the right to life is being taken. I ask the Minister to consider this amendment.

Deputy Joan Burton

I support this Bill because I think people have to support the health professionals who have a conscientious commitment to caring for people and to providing care. We recognise the objections of the people who object, but equally we have to recognise the conscientious commitment of medical professionals to caring for women.

Acting Chairman (Deputy Declan Breathnach)

The Minister is waiving his entitlement to speak again on these amendments.

Deputy Michael Healy-Rae

I appeal to Deputies to think very seriously before they vote. I thank the Chair for the fair way in which he has been chairing this debate.

Deputy Simon Harris

Hear, hear.

Deputy Michael Healy-Rae

I know it is a contentious issue for many people. I want to thank the Ceann Comhairle, the Leas-Cheann Comhairle and the other Deputies who have chaired these debates. People have to do what their own conscience leads them to do. I certainly hope they will support this amendment. I know that some Deputies who did not support other amendments are going to support this amendment. I am grateful for that. I omitted to speak about the many pharmacists who have grave concerns as well. I have been dealing with them on this issue on a continuous basis over recent months. They are very worried about what is happening in here this evening. I do not want to delay the matter.

Amendment put:

The Dáil divided: Tá, 30; Níl, 75; Staon, 1.

Tá

Aylward, Bobby.
Brassil, John.
Breathnach, Declan.
Butler, Mary.
Cahill, Jackie.
Canney, Seán.
Casey, Pat.
Collins, Michael.
Curran, John.
Fitzmaurice, Michael.
Fitzpatrick, Peter.
Grealish, Noel.
Haughey, Seán.
Healy-Rae, Danny.
Healy-Rae, Michael.
Lowry, Michael.
MacSharry, Marc.
McConalogue, Charlie.
McGrath, Mattie.
McGuinness, John.
Moynihan, Aindrias.
Murphy O'Mahony, Margaret.
Murphy, Eugene.
Nolan, Carol.
O'Keeffe, Kevin.
O'Rourke, Frank.
Ó Cuív, Éamon.
Scanlon, Eamon.
Smyth, Niamh.
Tóibín, Peadar.

Níl

Bailey, Maria.
Boyd Barrett, Richard.
Brady, John.
Broughan, Thomas P.
Browne, James.
Bruton, Richard.
Burke, Peter.
Burton, Joan.
Byrne, Catherine.
Byrne, Thomas.
Calleary, Dara.
Carey, Joe.
Cassells, Shane.
Chambers, Jack.
Chambers, Lisa.
Collins, Joan.
Connolly, Catherine.
Coppinger, Ruth.
Corcoran Kennedy, Marcella.
Coveney, Simon.
Creed, Michael.
Cullinane, David.
D'Arcy, Michael.
Doherty, Pearse.
Donnelly, Stephen S.
Dooley, Timmy.
Doyle, Andrew.
Durkan, Bernard J.
Ellis, Dessie.
English, Damien.
Ferris, Martin.
Fitzgerald, Frances.
Harris, Simon.
Harty, Michael.
Healy, Seamus.
Heydon, Martin.
Kelleher, Billy.
Kelly, Alan.
Kenny, Gino.
Kenny, Martin.
Kyne, Seán.
Lahart, John.
Madigan, Josepha.
Martin, Catherine.
Martin, Micheál.
McEntee, Helen.
McGrath, Finian.
McHugh, Joe.
McLoughlin, Tony.
Mitchell, Denise.
Munster, Imelda.
Murphy, Catherine.
Murphy, Eoghan.
Murphy, Paul.
Neville, Tom.
Noonan, Michael.
O'Brien, Darragh.
O'Brien, Jonathan.
O'Callaghan, Jim.
O'Connell, Kate.
O'Dowd, Fergus.
O'Reilly, Louise.
O'Sullivan, Maureen.
Ó Broin, Eoin.
Ó Caoláin, Caoimhghín.
Ó Laoghaire, Donnchadh.
Ó Snodaigh, Aengus.
Pringle, Thomas.
Quinlivan, Maurice.
Rabbitte, Anne.
Sherlock, Sean.
Smith, Bríd.
Stanley, Brian.
Stanton, David.
Varadkar, Leo.

Staon

McGrath, Michael.

Tellers: Tá, Deputies Mattie McGrath and Michael Healy-Rae; Níl, Deputies Seán Kyne and Tony McLoughlin.

Amendment declared lost.

Deputy Mattie McGrath

I move amendment No. 48:

In page 15, line 37, after “practitioner,” to insert “pharmacist,”.

Amendment put:

The Dáil divided: Tá, 38; Níl, 67; Staon, 1.

Tá

Aylward, Bobby.
Brassil, John.
Breathnach, Declan.
Browne, James.
Butler, Mary.
Cahill, Jackie.
Calleary, Dara.
Canney, Seán.
Chambers, Jack.
Collins, Michael.
Curran, John.
Donnelly, Stephen S.
Fitzmaurice, Michael.
Fitzpatrick, Peter.
Grealish, Noel.
Harty, Michael.
Haughey, Seán.
Healy-Rae, Danny.
Healy-Rae, Michael.
Lowry, Michael.
MacSharry, Marc.
Martin, Micheál.
McConalogue, Charlie.
McGrath, Mattie.
McGrath, Michael.
McGuinness, John.
Moynihan, Aindrias.
Murphy O'Mahony, Margaret.
Murphy, Eugene.
Nolan, Carol.
O'Keeffe, Kevin.
O'Rourke, Frank.
Ó Cuív, Éamon.
Rabbitte, Anne.
Scanlon, Eamon.
Smyth, Niamh.
Tóibín, Peadar.
Troy, Robert.

Níl

Bailey, Maria.
Boyd Barrett, Richard.
Brady, John.
Broughan, Thomas P.
Bruton, Richard.
Burke, Peter.
Byrne, Catherine.
Carey, Joe.
Chambers, Lisa.
Collins, Joan.
Connolly, Catherine.
Coppinger, Ruth.
Corcoran Kennedy, Marcella.
Coveney, Simon.
Creed, Michael.
Cullinane, David.
D'Arcy, Michael.
Doherty, Pearse.
Dooley, Timmy.
Doyle, Andrew.
Durkan, Bernard J.
Ellis, Dessie.
Ferris, Martin.
Fitzgerald, Frances.
Harris, Simon.
Healy, Seamus.
Heydon, Martin.
Kelleher, Billy.
Kelly, Alan.
Kenny, Gino.
Kenny, Martin.
Kyne, Seán.
Lahart, John.
Madigan, Josepha.
Martin, Catherine.
McDonald, Mary Lou.
McEntee, Helen.
McGrath, Finian.
McHugh, Joe.
McLoughlin, Tony.
Mitchell, Denise.
Munster, Imelda.
Murphy, Catherine.
Murphy, Eoghan.
Murphy, Paul.
Neville, Tom.
Noonan, Michael.
O'Brien, Darragh.
O'Brien, Jonathan.
O'Callaghan, Jim.
O'Connell, Kate.
O'Dowd, Fergus.
O'Reilly, Louise.
O'Sullivan, Maureen.
Ó Broin, Eoin.
Ó Caoláin, Caoimhghín.
Ó Laoghaire, Donnchadh.
Ó Snodaigh, Aengus.
Pringle, Thomas.
Quinlivan, Maurice.
Ring, Michael.
Sherlock, Sean.
Shortall, Róisín.
Smith, Bríd.
Stanley, Brian.
Stanton, David.
Varadkar, Leo.

Staon

Byrne, Thomas.

Tellers: Tá, Deputies Mattie McGrath and Michael Healy-Rae; Níl, Deputies Seán Kyne and Tony McLoughlin.

Amendment declared lost.

Deputy Stephen Donnelly

I move amendment No. 49:

In page 15, line 37, after “practitioner,” to insert “student doctor, student nurse, student midwife,”.

Amendment, by leave, withdrawn.

Deputy Catherine Murphy

I move amendment No. 50:

In page 16, between lines 4 and 5, to insert the following:

“(3) Medical practitioners who refuse to carry out a procedure for the procurement of an abortion on the basis of conscientious objection must notify the Minister for Health in writing within 28 days of the decision being taken.

(4) No corporate body or institution in receipt of public monies may refuse to carry out a procedure in order to procure an abortion on the basis of conscientious objection.”.

I tabled the amendment despite the issue of conscientious objection being covered in other amendments because I wanted specifically placed on record the point that publicly-funded institutions cannot use any loophole relating to the moral ethos of the organisation in question to circumvent the legislation. The United Nations has explicitly confirmed that the relevant regulatory framework must ensure an obligation on healthcare providers to refer women to alternative health providers and must not allow institutional referral of care.

While I understand the need to allow for personal conscientious objections, it must be done in a way that means that conscientious refusals do not lead to access barriers for women in accessing the healthcare to which they are entitled. My amendment stems from a concern that where a publicly funded institution is under the effective control of a religious organisation with a particular ethos, medical practitioners could effectively be advised not to agree to provide this healthcare within their working arrangements within the institution. This could potentially lead to a situation whereby medical practitioners who potentially do not have a conscientious objection to carrying out the procedure could find themselves refusing to carry out the procedure as part of their public health work while simultaneously offering patients appointments in their private clinics to perform procedures.

Such a possibility is not merely conjecture. A similar situation was referred to earlier this evening; abortion services in Italy were pushed almost exclusively into the private medical sector by way of institutional objections. With this amendment to the Bill we can ensure that no such situation arises in Ireland and that institutions are under no illusion as to the fact that legislation takes precedence over their ethos. The amendment will ensure that all patients can access this healthcare procedure via the public health system as intended by the Bill. Indeed, when this issue was debated at committee we wanted to ensure that this would be part of the public system and be GP-led or provided in public hospitals. This amendment seeks to provide for that.

Minister for Health (Deputy Simon Harris)

I am not in a position to accept the amendment for two reasons. We have just had a very lengthy debate about conscientious objection and the obligation to ensure that a woman can access health services. Nobody can obstruct that. Conscientious objection is therefore an accepted part of medical practice and already exists in a number of areas, not just in the termination of pregnancy. I do not see any reason to have a different set of rules. This is the same argument used by those who are against the legislation and who want a different set of rules for conscientious objection. I apply the same principle to this amendment. The rules on conscientious objection should be the same for this health service as any other. That covers the first part of the Deputy's amendment No. 50.

The second part of the amendment raises an important point about institutions. Institutions do not have consciences and cannot conscientiously object. Section 24 of the Bill sets out that persons who may refuse to participate due to a conscientious objection, including medical practitioners, nurses and midwives, have that right, but by not including references to other personnel or to institutions the Bill is clear that that provision does not extend to them. I sought the legal opinion of the Attorney General because of the sensitivities involved in this, and have been informed that one of the first tenets of lawmaking is that the expression of one thing leads to the exclusion of the other. In other words, when certain persons are specified in a law an intention to exclude all others, in this case institutions, from its operation can be inferred. This means that by not including a reference to other personnel or institutions the Bill is absolutely clear that conscientious objection does not extend to institutions. I am very clear on that. The HSE is also very clear on that matter, and indeed has been in contact with all 19 maternity units with a view to preparing an implementation plan.

An Leas-Cheann Comhairle

Is Deputy Catherine Murphy pressing the amendment?

Deputy Catherine Murphy

I will withdraw the amendment on that basis.

Amendment, by leave, withdrawn.

Deputy Mattie McGrath

I move amendment No. 51:

In page 16, to delete lines 5 to 8.

Amendment No. 51 seeks to delete lines which force doctors to refer. This speaks fundamentally to the right of doctors to conscientiously object and to the whole reason we are debating this issue. Doctors should not have to refer against their will. We also must ask what "refer" means. It might mean that the life of one of the two patients a doctor is treating will be ended, which is an important reason for putting this amendment forward. Many doctors have a fundamental issue with this approach, but the Minister has steadfastly refused to meet those doctors. There was a call for an EGM, which was tailor-made to be held after the debate finished last Thursday, but that did not happen. We saw what happened at the EGM. It is not for me to tell the Irish College of General Practitioners how to organise itself, but democracy was shut down in that organisation. Indeed, Dr. Kirsten Fuller, who is an excellent GP from County Tipperary, was one of the people who lead the walkout to fight that provision. Dr. O'Regan from Kerry and many others were also involved. They have not been listened to or engaged with, and conscientious objections have not in any way been dealt with. Any degree of consultation might have allayed their fears and allowed the Minister to find a wording that would have pacified many of those genuine GPs who have taken the Hippocratic oath in the first instance and who strive every day to give a service.

Many GPs work in country areas where there is no Caredoc or out-of-hours service. Those doctors and their families answer calls at all times of the day and night; their duty of care and desire to try to save lives is their motive at all times. They have a genuinely held fear that they are going to be forced to refer, and are worried about what that referral means. If the Minister or his officials had engaged with those doctors in any way we might have had clarity and a better understanding of this Bill, and we would not have 700 or 800 of them threatening not to co-operate in any way with this legislation. There is a scarcity of GPs in urban and rural areas and few GPs are even applying to run a practice. They are dealing with a contract that is almost 50 years old and which has not been renewed. The Minister chose to engage at a senior level with the two doctors' organisations and did not listen to the members of those groups. The organisations did not listen to their members either; democracy has been damaged there as well. Those organisations are able to talk for themselves.

I am here to speak on behalf of the many doctors working at different levels who contacted me about this legislation and to protest at the sheer speed with which it is being rushed through the Dáil. People here are talking about the rights of staff. I am hearing that staff are being told they have to work all night tomorrow if this Bill passes tonight in order to get the Bill through the Seanad. We can cry about workers' rights and complain all we like, but we are now making people work unreasonable hours. We are now making staff here work unreasonable hours because of unreasonable sittings. I do not know if that is definitely happening but that is what I have been told. It shows little care about the staff here and their families who have to stay up working late. I include the Senators, those working in committees, the secretariat, ushers and indeed all the people who attend on the House.

An Leas-Cheann Comhairle

The Deputy should concentrate on the amendment.

Deputy Mattie McGrath

I am concentrating on the amendment. This is the fundamental part of the problem. The Minister might have reached agreement with the vast majority of GPs had the Minister engaged in a modicum of consultation with these doctors and listened to their fears. They are busy in their practices every day of the week. They are not people who are out marching and protesting about this, that and the other. However, this interferes with a fundamental part of their Hippocratic oath, their beliefs and their education. They spent a lot of time gaining their medical degrees and developing their working expertise, and they want to be listened to, which is not unnatural in a democracy. They should have been listened to and engaged with. The Minister went out of his way to meet all sorts of groups with any acronym on the other side but would not meet the GPs at any stage to discuss this legislation. What was he hiding? What was he afraid to debate? Why does he have to run to the populist side and use a bulldozer to drive this legislation through at all costs? It is a trophy project for himself. Those GPs are facing absolute and utter chaos on a daily basis. When they refer people to accident and emergency departments they cannot get an ambulance so people are left in their surgeries.

They go to an accident and emergency department in Tipperary and they are lucky if they get a trolley. They cannot get a pillowcase or a blanket. Then there are early discharges.

The front line is the GP service. It is nowhere else. We have seen all the areas of the free GP care for young people. Now this service is going to be rolled out against GPs' will. They will be forced and coerced to refer against their fundamental beliefs. It is despicable, it is sad and it is disrespectful towards a profession that has served this State well. I know many of them who continue to work long after retirement age because they have a rapport and a sense of commitment to patients, their families and their communities. I am not just talking about rural areas. I am talking about urban areas as well. They are part of the very fabric of what makes it good to live in a community. This Government is shamelessly stripping everything from our community.

My fundamental reason for putting this amendment forward is the lack of clarity on the implications that arise if doctors have to refer. One of the lives they see in a pregnant woman would be taken. That is what they fundamentally disagree with. This could have been worked out if the Minister had the courage or the respect to meet with GPs.

Deputy Simon Harris

We have had a very long debate on conscientious objection, and this is another issue relating to it. It was quite a good and useful debate. The points I made during that very long debate, to which we all contributed, I reiterate here. The Medical Council guidelines are very clear on what the duty to refer comprises. The law on conscientious objection is not changing even though the law on abortion is, and therefore I do not see any reason to accept this amendment.

Deputy Peadar Tóibín

Obviously there have been a couple of debates around conscientious objection. I am surprised this has not been grouped with the other ones.

Deputy Simon Harris

Me too.

Deputy Peadar Tóibín

However, the fact is that it is not, and I wish to make a couple of short points. Points were made about the Protection of Life During Pregnancy Act 2013. The Medical Council guidelines relating to that Act state that doctors must do their utmost to protect the mother and baby. We are told those guidelines will not change. They iterate a very strong pro-life view. The issue that has struck me the most is this. Doctors around the country have stated to me that the very basis of their function, the very reason they are practicing, is being radically undermined by the Government. Doctors have said to me that they invested time, energy and money into studying to become doctors in order to protect, nurture and save lives. They have stated that it is unprecedented in their experience for a Government to change the environment of a group of workers so radically, thereby undermining them in their ability to provide services. We know from experience around the world that when freedom of conscience is not properly provided to doctors and medical health workers it leads to certain people leaving the profession. It also leads to certain workers not entering it. Those who operate under those terms suffer burnout more in the long run, because they are constantly in mental dissonance with the work they are involved in.

The Minister has stated that we are simply talking about arrangements for a doctor to pass a patient on to another individual. The key point is this. If I was to arrange for the ending of the Minister's life in the way that this Bill envisions, I would be seen as morally and legally complicit. The doctors we are talking about see an abortion in those terms. They see the unborn child as a living individual human being and therefore as having the same value and worth as anybody else. The fact that they are being told under this legislation that they have to make arrangements for that unborn child to be aborted is a real difficulty for them. These people are crying out for the Minister to take that into consideration.

I heard Deputies Kelleher and Micheál Martin speak. It seems to me that they are looking to dictate to the conscience of doctors. Why have Deputy Martin, Deputy Kelleher and the Minister not sat down with the thousands of healthcare workers?

Deputy Simon Harris

We have.

Deputy Peadar Tóibín

These people are not making it up. They are not pretending that there is a serious difficulty here. To stand up on this issue in the environment of today's society is actually a really hard thing for people to do. To make the point that this is such a difficulty, to swim against the tide, is a very hard thing for people in their professions to do.

Deputy Ruth Coppinger

It was very hard to be pro-choice for a long time.

Deputy Peadar Tóibín

We hear another point as well. On one side of the debate we are told-----

An Leas-Cheann Comhairle

If there are Members who want to contribute, I ask them to wait and to indicate to the Chair. I ask Deputies to allow Deputy Tóibín to speak, whether they agree with him or not, and to stop interjecting.

Deputy Peadar Tóibín

This is hard to understand. We are told that there are oceans of doctors who are willing to deliver this service. However, we are then told that we have to force certain doctors to make arrangements for it. It is either one or the other. If there are adequate numbers who are happy to provide the service we do not actually need to go down this particular route. As I said earlier, the limits of one individual's rights are where they infringe on another individual's rights. Most people would understand that it is an infringement of a person's rights to force him or her to be involved in a process that leads to the end of another human being's life. This is something that thousands of doctors are crying out for, and I ask the Minister to accept the amendment.

Amendment put:

The Dáil divided: Tá, 27; Níl, 75; Staon, 0.

Tá

Aylward, Bobby.
Brassil, John.
Breathnach, Declan.
Butler, Mary.
Cahill, Jackie.
Casey, Pat.
Collins, Michael.
Curran, John.
Fitzmaurice, Michael.
Fitzpatrick, Peter.
Grealish, Noel.
Haughey, Seán.
Healy-Rae, Danny.
Healy-Rae, Michael.
Lowry, Michael.
MacSharry, Marc.
McGrath, Mattie.
McGuinness, John.
Moynihan, Aindrias.
Murphy O'Mahony, Margaret.
Murphy, Eugene.
Nolan, Carol.
O'Keeffe, Kevin.
O'Rourke, Frank.
Ó Cuív, Éamon.
Scanlon, Eamon.
Tóibín, Peadar.

Níl

Boyd Barrett, Richard.
Brady, John.
Broughan, Thomas P.
Browne, James.
Bruton, Richard.
Burke, Peter.
Byrne, Catherine.
Byrne, Thomas.
Calleary, Dara.
Carey, Joe.
Chambers, Jack.
Chambers, Lisa.
Collins, Joan.
Connolly, Catherine.
Coppinger, Ruth.
Corcoran Kennedy, Marcella.
Coveney, Simon.
Creed, Michael.
Cullinane, David.
D'Arcy, Michael.
Donnelly, Stephen S.
Dooley, Timmy.
Doyle, Andrew.
Durkan, Bernard J.
Ellis, Dessie.
English, Damien.
Ferris, Martin.
Fitzgerald, Frances.
Harris, Simon.
Harty, Michael.
Healy, Seamus.
Heydon, Martin.
Humphreys, Heather.
Kelleher, Billy.
Kelly, Alan.
Kenny, Gino.
Kenny, Martin.
Kyne, Seán.
Lahart, John.
Madigan, Josepha.
Martin, Catherine.
Martin, Micheál.
McEntee, Helen.
McGrath, Finian.
McGrath, Michael.
McHugh, Joe.
McLoughlin, Tony.
Mitchell, Denise.
Munster, Imelda.
Murphy, Catherine.
Murphy, Eoghan.
Murphy, Paul.
Neville, Tom.
Noonan, Michael.
O'Brien, Darragh.
O'Brien, Jonathan.
O'Callaghan, Jim.
O'Connell, Kate.
O'Dowd, Fergus.
O'Reilly, Louise.
O'Sullivan, Maureen.
Ó Broin, Eoin.
Ó Caoláin, Caoimhghín.
Ó Laoghaire, Donnchadh.
Ó Snodaigh, Aengus.
Pringle, Thomas.
Quinlivan, Maurice.
Rabbitte, Anne.
Ring, Michael.
Ross, Shane.
Sherlock, Sean.
Shortall, Róisín.
Smith, Bríd.
Stanley, Brian.
Troy, Robert.

Staon

Tellers: Tá, Deputies Mattie McGrath and Michael Collins; Níl, Deputies Seán Kyne and Tony McLoughlin.

Amendment declared lost.

Deputy Simon Harris

I move amendment No. 52:

In page 16, line 12, to delete “and midwives” and substitute “and midwives, or the midwife candidate division of the candidate register,”.

Amendment put and declared carried.

Deputy Simon Harris

I move amendment No. 53:

In page 16, line 15, to delete “and midwives” and substitute “and midwives, or a division (other than the midwife candidate division) of the candidate register,”.

Amendment put and declared carried.

Deputy Mattie McGrath

I move amendment No. 54:

In page 16, line 16, to delete “2011.” and substitute the following:

“2011;

“pharmacist” means a person whose name is for the time being registered in the register of pharmacists established under section 13 of the Pharmacy Act 2007.”.

Amendment put:

The Dáil divided: Tá, 29; Níl, 65; Staon, 11.

Tá

Aylward, Bobby.
Brassil, John.
Breathnach, Declan.
Butler, Mary.
Cahill, Jackie.
Canney, Seán.
Casey, Pat.
Collins, Michael.
Curran, John.
Fitzmaurice, Michael.
Fitzpatrick, Peter.
Grealish, Noel.
Harty, Michael.
Haughey, Seán.
Healy-Rae, Danny.
Healy-Rae, Michael.
Lowry, Michael.
MacSharry, Marc.
McGrath, Mattie.
McGuinness, John.
Moynihan, Aindrias.
Murphy, Eugene.
Nolan, Carol.
O'Keeffe, Kevin.
O'Rourke, Frank.
Ó Cuív, Éamon.
Scanlon, Eamon.
Tóibín, Peadar.
Troy, Robert.

Níl

Barry, Mick.
Boyd Barrett, Richard.
Brady, John.
Broughan, Thomas P.
Bruton, Richard.
Burke, Peter.
Byrne, Catherine.
Carey, Joe.
Chambers, Lisa.
Collins, Joan.
Connolly, Catherine.
Coppinger, Ruth.
Corcoran Kennedy, Marcella.
Coveney, Simon.
Creed, Michael.
Cullinane, David.
D'Arcy, Michael.
Dooley, Timmy.
Doyle, Andrew.
Durkan, Bernard J.
Ellis, Dessie.
English, Damien.
Ferris, Martin.
Fitzgerald, Frances.
Harris, Simon.
Healy, Seamus.
Heydon, Martin.
Humphreys, Heather.
Kelleher, Billy.
Kelly, Alan.
Kenny, Gino.
Kenny, Martin.
Kyne, Seán.
Madigan, Josepha.
Martin, Catherine.
McEntee, Helen.
McGrath, Finian.
McHugh, Joe.
McLoughlin, Tony.
Mitchell, Denise.
Munster, Imelda.
Murphy O'Mahony, Margaret.
Murphy, Catherine.
Murphy, Eoghan.
Murphy, Paul.
Neville, Tom.
Noonan, Michael.
O'Brien, Jonathan.
O'Callaghan, Jim.
O'Connell, Kate.
O'Dowd, Fergus.
O'Reilly, Louise.
Ó Broin, Eoin.
Ó Caoláin, Caoimhghín.
Ó Laoghaire, Donnchadh.
Ó Snodaigh, Aengus.
Pringle, Thomas.
Quinlivan, Maurice.
Ring, Michael.
Ross, Shane.
Sherlock, Sean.
Shortall, Róisín.
Smith, Bríd.
Stanley, Brian.
Stanton, David.

Staon

Browne, James.
Byrne, Thomas.
Calleary, Dara.
Chambers, Jack.
Donnelly, Stephen S.
Lahart, John.
Martin, Micheál.
McGrath, Michael.
O'Brien, Darragh.
O'Sullivan, Maureen.
Rabbitte, Anne.

Tellers: Tá, Deputies Danny Healy-Rae and Michael Collins; Níl, Deputies Seán Kyne and Tony McLoughlin.

Amendment declared lost.

Deputy Mattie McGrath

I move amendment No. 55:

In page 16, between lines 16 and 17, to insert the following:

"(5) A reference to medical practitioner, nurse or midwife in this section shall include any person studying or training to qualify or work as a medical practitioner, nurse or midwife as the case may be.".

Amendment put:

The Dáil divided: Tá, 30; Níl, 63; Staon, 11.

Tá

Aylward, Bobby.
Brassil, John.
Breathnach, Declan.
Butler, Mary.
Cahill, Jackie.
Calleary, Dara.
Canney, Seán.
Casey, Pat.
Collins, Michael.
Curran, John.
Fitzmaurice, Michael.
Fitzpatrick, Peter.
Grealish, Noel.
Haughey, Seán.
Healy-Rae, Danny.
Healy-Rae, Michael.
Lowry, Michael.
MacSharry, Marc.
McGrath, Mattie.
McGuinness, John.
Moynihan, Aindrias.
Murphy O'Mahony, Margaret.
Murphy, Eugene.
Nolan, Carol.
O'Keeffe, Kevin.
O'Rourke, Frank.
Ó Cuív, Éamon.
Scanlon, Eamon.
Tóibín, Peadar.
Troy, Robert.

Níl

Barry, Mick.
Boyd Barrett, Richard.
Brady, John.
Broughan, Thomas P.
Bruton, Richard.
Burke, Peter.
Byrne, Catherine.
Carey, Joe.
Collins, Joan.
Connolly, Catherine.
Coppinger, Ruth.
Corcoran Kennedy, Marcella.
Creed, Michael.
Cullinane, David.
Dooley, Timmy.
Doyle, Andrew.
Durkan, Bernard J.
Ellis, Dessie.
English, Damien.
Ferris, Martin.
Fitzgerald, Frances.
Harris, Simon.
Harty, Michael.
Healy, Seamus.
Heydon, Martin.
Humphreys, Heather.
Kelleher, Billy.
Kelly, Alan.
Kenny, Gino.
Kenny, Martin.
Kyne, Seán.
Madigan, Josepha.
Martin, Catherine.
McEntee, Helen.
McGrath, Finian.
McHugh, Joe.
McLoughlin, Tony.
Mitchell, Denise.
Munster, Imelda.
Murphy, Catherine.
Murphy, Eoghan.
Murphy, Paul.
Neville, Tom.
Noonan, Michael.
O'Brien, Jonathan.
O'Callaghan, Jim.
O'Connell, Kate.
O'Dowd, Fergus.
O'Reilly, Louise.
O'Sullivan, Maureen.
Ó Broin, Eoin.
Ó Caoláin, Caoimhghín.
Ó Laoghaire, Donnchadh.
Ó Snodaigh, Aengus.
Pringle, Thomas.
Quinlivan, Maurice.
Ring, Michael.
Ross, Shane.
Sherlock, Sean.
Shortall, Róisín.
Smith, Bríd.
Stanley, Brian.
Stanton, David.

Staon

Browne, James.
Byrne, Thomas.
Chambers, Jack.
Chambers, Lisa.
Donnelly, Stephen S.
Lahart, John.
Martin, Micheál.
McGrath, Michael.
O'Brien, Darragh.
O'Loughlin, Fiona.
Rabbitte, Anne.

Tellers: Tá, Deputies Michael Healy-Rae and Michael Collins; Níl, Deputies Seán Kyne and Tony McLoughlin.

Amendment declared lost.

Deputy Bríd Smith

I move amendment No. 56:

In page 16, between lines 16 and 17, to insert the following:

“(5) Nothing in subsection (1) shall be construed as applying to an institution, hospital or medical facility.”.

I speak on behalf of all the signatories to this amendment. I am willing to withdraw it on the basis that the Minister is willing to reiterate the commitment he gave us on Committee Stage, and which I think he gave to Deputy Catherine Murphy earlier, that there will be no chance whatsoever that any institution, hospital or organisation, in particular the promised new maternity hospital, will have a right to conscientious objection.

Deputy Simon Harris

I am very happy to give that commitment to Deputy Bríd Smith. As I said to Deputy Catherine Murphy, institutions cannot have conscientious objection, and the law and the view of the Attorney General in this regard is very clear. One of the first tenets of lawmaking is that the expression of one thing is the exclusion of the other. There is absolutely no place in this law for institutions to have conscientious objection.

Amendment, by leave, withdrawn.

Deputy Simon Harris

I move amendment No. 57:

In page 16, between lines 16 and 17, to insert the following:

“Offences

25. (1) 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 this Act.

(2) It shall be an offence for a person to prescribe, administer, supply or procure any drug, substance, instrument, apparatus or other thing knowing that it is intended to be used or employed with intent to end the life of a foetus, or being reckless as to whether it is intended to be so used or employed, otherwise than in accordance with the provisions of this Act.

(3) Subsections (1) and (2) shall not apply to a pregnant woman in respect of her own pregnancy.

(4) It shall be an offence for a person to aid, abet, counsel or procure a pregnant woman to intentionally end, or attempt to end, the life of the foetus of that pregnant woman otherwise than in accordance with the provisions of this Act.

(5) A person who is guilty of an offence under this section shall be liable on conviction on indictment to a fine or imprisonment for a term not exceeding 14 years, or both.

(6) A prosecution for an offence under this section may be brought only by or with the consent of the Director of Public Prosecutions.

(7) Nothing in subsection (4) shall operate to prevent or restrict access to services lawfully carried out in a place outside the State.”.

Amendment put:

The Dáil divided: Tá, 90; Níl, 16; Staon, 0.

Tá

Aylward, Bobby.
Brady, John.
Brassil, John.
Breathnach, Declan.
Broughan, Thomas P.
Browne, James.
Bruton, Richard.
Burke, Peter.
Butler, Mary.
Byrne, Catherine.
Byrne, Thomas.
Cahill, Jackie.
Calleary, Dara.
Canney, Seán.
Carey, Joe.
Casey, Pat.
Chambers, Jack.
Chambers, Lisa.
Collins, Michael.
Corcoran Kennedy, Marcella.
Coveney, Simon.
Creed, Michael.
Cullinane, David.
Curran, John.
Donnelly, Stephen S.
Doyle, Andrew.
Durkan, Bernard J.
Ellis, Dessie.
English, Damien.
Ferris, Martin.
Fitzgerald, Frances.
Fitzmaurice, Michael.
Fitzpatrick, Peter.
Grealish, Noel.
Harris, Simon.
Harty, Michael.
Haughey, Seán.
Healy-Rae, Danny.
Healy-Rae, Michael.
Heydon, Martin.
Humphreys, Heather.
Kelleher, Billy.
Kelly, Alan.
Kenny, Martin.
Kyne, Seán.
Lahart, John.
Lowry, Michael.
MacSharry, Marc.
Madigan, Josepha.
Martin, Micheál.
McEntee, Helen.
McGrath, Finian.
McGrath, Mattie.
McGrath, Michael.
McGuinness, John.
McHugh, Joe.
McLoughlin, Tony.
Mitchell, Denise.
Moynihan, Aindrias.
Munster, Imelda.
Murphy O'Mahony, Margaret.
Murphy, Eoghan.
Murphy, Eugene.
Neville, Tom.
Nolan, Carol.
Noonan, Michael.
O'Brien, Darragh.
O'Brien, Jonathan.
O'Callaghan, Jim.
O'Connell, Kate.
O'Dowd, Fergus.
O'Keeffe, Kevin.
O'Loughlin, Fiona.
O'Reilly, Louise.
O'Rourke, Frank.
O'Sullivan, Maureen.
Ó Broin, Eoin.
Ó Caoláin, Caoimhghín.
Ó Cuív, Éamon.
Ó Laoghaire, Donnchadh.
Ó Snodaigh, Aengus.
Quinlivan, Maurice.
Rabbitte, Anne.
Ring, Michael.
Scanlon, Eamon.
Sherlock, Sean.
Stanley, Brian.
Stanton, David.
Tóibín, Peadar.
Troy, Robert.

Níl

Barry, Mick.
Boyd Barrett, Richard.
Collins, Joan.
Connolly, Catherine.
Coppinger, Ruth.
Daly, Clare.
Dooley, Timmy.
Healy, Seamus.
Kenny, Gino.
Martin, Catherine.
Murphy, Catherine.
Murphy, Paul.
Pringle, Thomas.
Shortall, Róisín.
Smith, Bríd.
Wallace, Mick.

Staon

Tellers: Tá, Deputies Seán Kyne and Tony McLoughlin; Níl, Deputies Ruth Coppinger and Bríd Smith.

Amendment declared carried.

Deputy Simon Harris

I move amendment No. 58:

In page 16, between lines 16 and 17, to insert the following:

“Offence by body corporate

26. (1) Where an offence under this Act is committed by a body corporate and it is proved that the offence was committed with the consent or connivance, or was attributable to any wilful neglect, of a person who was a director, manager, secretary or other officer of the body corporate, or a person purporting to act in that capacity, that person shall, as well as the body corporate, be guilty of an offence and may be proceeded against and punished as if he or she were guilty of the first-mentioned offence.

(2) Where the affairs of a body corporate are managed by its members, subsection (1) applies in relation to the acts and defaults of a member in connection with his or her functions of management as if he or she were a director or manager of the body corporate.”.

Amendment put and declared carried.

An Leas-Cheann Comhairle

Amendment No. 59 in the names of Deputies Mattie McGrath, Nolan, Danny Healy-Rae, Michael Healy-Rae, Michael Collins, Fitzmaurice and Grealish has not been discussed.

Deputy Mattie McGrath

I move amendment No. 59:

In page 16, between lines 16 and 17, to insert the following:

“Dignified Disposal of Foetal Remains

25. (1) The bodily remains of a foetus who has been the subject of a termination of pregnancy carried out by surgical means shall be disposed of only by way of:

(a) burial in a burial ground for the purposes of section 44 of the Local Government (Sanitary Services) Act 1948; or

(b) cremation carried out in a crematorium, being a building fitted with appliances for the burning of human remains which is lawfully used for that purpose as its primary function.

(2) The Minister shall make regulations to provide for the dignified disposal in accordance with subsection (1) of the bodily remains of a foetus who has been the subject of a termination of pregnancy carried out by surgical means.

(3) The woman who has availed of a termination of pregnancy carried out by surgical means shall be entitled to choose the manner of the disposal of the bodily remains of the foetus subject to subsection (1) and regulations made by the Minister under subsection (2) and the said regulations shall provide for the manner of disposal in the event that no such choice is made.

(4) A person who disposes of the bodily remains of a foetus who has been the subject of a termination of pregnancy carried out by surgical means otherwise than in accordance with subsection (1) shall be guilty of an offence.

(5) A person who disposes of the bodily remains of a foetus who has been the subject of a termination of pregnancy carried out by surgical means otherwise than in accordance with regulations made by the Minister pursuant to subsection (2) shall be guilty of an offence.

(6) A person who is guilty of an offence under subsection (4) or (5) shall be liable on summary conviction to a class A fine.

(7) A person who sells or offers to sell a foetus or the bodily remains or any part thereof of a foetus who has been the subject of a termination of pregnancy shall be guilty of an offence.

(8) A person who carries out any experiment or procedure not authorised by this Act on the bodily remains of a foetus or any part thereof who has been the subject of a termination of pregnancy shall be guilty of an offence.

(9) A person who is guilty of an offence under subsection (7) or (8) shall be liable on summary conviction to a class A fine or imprisonment for a term not exceeding 12 months or both.

(10) In this section—

“termination of pregnancy carried out by surgical means” means a termination of pregnancy which involves carrying out a procedure other than or in addition to the administration or self-administration of a drug or drugs to the pregnant woman in order to end the life of a foetus.

(11) Subsections (4), (5), (7) and (8) shall not apply to the woman who has availed of the termination of pregnancy concerned.”.

I want to speak to this amendment. The content of the amendment covers two distinct related areas, namely, the disposal of foetal remains and the protection of such remains from sale or unlawful experimentation. Before people start attempting to undermine us-----

(Interruptions).

An Leas-Cheann Comhairle

Deputy Mattie McGrath, without interruption.

Deputy Mattie McGrath

What we might call the first half of this amendment introduces a statutory and regulatory requirement to provide for the dignified disposal of bodily remains of foetuses which have been the subject of termination of pregnancy, including the dignified disposal of ashes generated by the cremation of such remains in accordance with section 25(1)(b). It also proposes that the bodily remains of a foetus which has been the subject of a termination of pregnancy shall be disposed of only by way of section 25(1)(a) via "burial in a burial ground for the purposes of section 44 of the Local Government (Sanitary Services) Act 1948" or section 25(1)(b) "cremation carried out in a crematorium". The amendment is absolutely clear that the pregnant woman who has been the subject of the relevant termination of pregnancy "shall be entitled to choose the manner of the disposal of the bodily remains of the foetus subject to" regulations made by the Minister. In the event that the woman declines to choose the manner of the dignified disposal of the remains in question, the Minister, pursuant to section 25(1), shall provide for the manner of a dignified disposal of the bodily remains of the foetus. As the proposers of this amendment, it is our hope that these provisions achieve a sensitive and appropriate balance between the rights of the woman to determine the manner of a dignified disposal with the right of the unborn child to a dignified resting place.

This amendment seeks to bring the legislation close to that in the UK. It is, in fact, milder than the legislation in the UK. It is all about the dignity of the remains. I do not know why there would be any controversy about this but there was before Committee Stage. We were accused of hijacking the Bill and everything else by the media. We merely sought to have a dignified and respectful ending of the life of the baby and a dignified disposal. We saw all of the different allegations during the referendum about how distressing it was for mothers to have to bring back their babies in a box etc. All we want is to have respectful disposal. It is no more and no less. We are not trying to impose anything on anyone or debase or undermine anyone. I could not understand why there was such a frenzy in the media and on the part of some Members as well. That was headline seeking. All we wanted was a dignified disposal and resting place for the unborn child.

We had such controversy, such costs and rightful disgust at what happened in Tuam and elsewhere. I could not understand why, with this amendment, we could be accused of seeking to undermine and so on. That goes to show the intolerance of the so-called tolerant people. All we are asking for in this amendment is something very similar to what is in the UK. It is a tad milder than what they have over there. I make no apology for tabling it. Like the other amendments we put down, it was tabled in good faith. We did not hog the proceedings and we did not table a large number of amendments.

I am not criticising the Bills Office: that is the way it has to operate. However, it added to the numbers of amendments because some of our amendments were divided up into two, three or four. We were very mindful of the need to have a short and concise debate so we kept the amendments to a minimum. Many of us spoke to a minimum. Deputy Tóibín stated earlier that 50,000 words had been spoken by the people who were saying we were filibustering. Those on the pro-choice side turned out to be filibustering themselves.

Deputy Noel Grealish

I will be very brief. The remains of a foetus which has been the subject of a surgical termination should be disposed of in an appropriate setting. There is legislation in place which requires the appropriate disposal of clinical and biological waste. I am of the view that we should legislate so that the remains of foetuses should also be disposed of appropriately and in a dignified manner. This is not unreasonable. Given that it applies only to medical terminations carried out surgically, there is no extra stress or burden on the woman involved. This amendment provides clarity and certainty to doctors on how to proceed when an abortion does not result in the death of a baby. It makes it clear that where there are indications of life after birth, there is a duty to act to save that life. The amendment does not try to dictate what steps should be taken by the medical professionals. It leaves it to those involved to take the appropriate steps.

Deputy Danny Healy-Rae

I support this amendment. The dignified disposal of deceased persons has been a time-honoured tradition in this country. This amendment deals with the disposal of the remains of a foetus - a baby - which has been the subject of a surgical abortion. It proposes that these babies will be disposed of appropriately whether by burial or cremation. The woman concerned does not have to make the decision as to how the remains are to be disposed of. This amendment makes it clear that she is entitled to make that decision if she wishes. The section introduced by this amendment would also guard against forms of shocking mistreatment of foetal remains which have occurred in other jurisdictions. The offence provisions in the section would not apply to the woman concerned. The amendment simply seeks the dignified disposal of the remains of the baby concerned.

Deputy Simon Harris

I made my views known about a version of this amendment on Committee Stage, as did the Select Committee on Health when it voted in significant numbers to reject it. I am conscious that there are people watching this debate who will have been through tragic circumstances where they lost much loved babies, particularly in the cases of fatal foetal abnormality. I do not wish to use any emotive language which could in any way add to their pain.

I do not believe there is any woman out there in a crisis pregnancy who needs a ministerial regulation to tell her how to grieve or how to act in a dignified manner. I do know, however, what a woman has to experience currently in bringing back the remains of her beautiful and much-wanted baby in a box or through a courier is not dignified. I think this amendment is wholly unnecessary, has no place in legislation and should be rejected.

Deputy Peter Fitzpatrick

I support this amendment which would allow us to show some dignity to the remains of the unborn child after a surgical abortion has been carried out, which is a violent and gruesome procedure. The amendment guarantees that unborn children who have been aborted will have their remains treated properly either by burial or cremation. It places no burden on the woman to have a role in this, as has been falsely alleged, unless she chooses to. The amendment would safeguard against those horrifying stories in other jurisdictions where the remains of unborn children have been treated as medical waste or, as in the case of one shocking practice which operated in the United States, were sold for profit for the purpose of medical experiments. We need to ensure there is no way this could ever happen in Ireland. Much has been said in the House about the treatment of human infants’ remains in the Tuam mother and baby home. Surely we never want to see this happen again. We need to pass this amendment to ensure that.

As a matter of international law and of human practice going back thousands of years, the remains of all human beings are entitled to be treated with dignity and respect. By rejecting this amendment, the Government is stating that unborn children who have been aborted are not entitled to this respect. This will be a truly shocking indictment of the House and shows total hypocrisy, particularly in the wake of the scandal of the treatment of the remains of babies in Tuam. This amendment simply guards against inhuman and barbaric practices which happened in Ireland decades ago and have happened in other jurisdictions in recent years. For this reason, I strongly support this amendment.

Deputy Carol Nolan

This amendment applies only in the case of surgical abortions. It inserts a new section which ensures that the remains of a foetus that has been the subject of a surgical abortion will be disposed of appropriately through, for example, burial. The remains of all human beings should be treated with respect. I do not know how anyone could honestly dispute that.

The woman concerned does not have to make the decision as to how the remains are to be taken care of. However, this amendment makes it clear that she is entitled to make that decision should she wish to.

The section introduced by this amendment also guards against forms of shocking mistreatment of foetal remains which have occurred in other jurisdictions. We could turn a blind eye but I do not believe that would be appropriate or fitting. Unfortunately, we have heard of too many examples of this mistreatment. The offence provisions in the section do not apply to the woman concerned. They merely ensure that, in the case of surgical abortions, the remains of unborn children are treated in a manner consistent with respect for their dignity. They are after all human. This is a matter of basic human decency.

It also makes clear that a woman who has had an abortion under the Bill is entitled to decide which of the methods she wishes to be used. However, since many women may not wish to enter into that question, the amendment provides for the remains of unborn children to be treated with respect and dignity.

This amendment protects against the kind of appalling practices which have been brought to public attention by official inquiries in the United States involving the sale of organs and other human tissue from aborted unborn babies. In the UK, the bodies of thousands of aborted and miscarried babies were incinerated as clinical waste, with some of them used to heat hospitals. We do not want that practice here. There is an obvious need to ensure that such shocking practices are never repeated.

Remarkably, the Minister has termed this amendment distasteful. Clearly, the undignified disposal of human remains and the abuse of those remains are extremely distasteful. Accordingly, it is precisely the practices which this amendment seeks to prohibit that are distasteful. Therefore, far from being distasteful itself, this amendment guards against distasteful practices. To contend that requiring human remains to be treated with proper respect is distasteful is evidently absurd. Will the Minister take this into consideration? It is a serious matter. It is not a point I like raising but it needs to be said. We have to make sure there is respect and dignity at all times.

Deputy Michael Healy-Rae

This is a sensitive subject. I, like many others, have friends who sadly lost unborn children for different reasons. It is probably one of the most traumatic things that could happen to would-be parents. The signatories to this amendment are tabling it only for the best motivated and good intentions.

Again, I take issue with the way it has been portrayed. It has been put out in an erroneous manner by certain sections of the media which have tried to turn it into something it was never intended to be. That was wrong. The people who have put forward this amendment have done so in a sensitive and proper fashion that is becoming of respect for a person who is no longer with us, no matter what age that person is.

Deputy Mattie McGrath

I do not know how the Minister could be so offended by the terms of this amendment. It is sensitive in the extreme. We all know people who have had miscarriages, cot deaths and whatever. We know the sensitivity around them. We also see children born with life-limiting conditions who might live minutes, hours, days, weeks, months or even 12 years like one of the girls in Cavan.

Let us face it - there have been horrific practices in America and elsewhere, with body parts being procured and sold for research. All we are trying to do is ensure that the remains of the aborted child are treated with respect and dignity. The Minister might think this amendment is unnecessary and appalling, but it is frightfully appalling that he will not accept it. Is he in hock to the abortion industry? Some of those people get their hands-----

Acting Chairman (Deputy Declan Breathnach)

Speak to the Bill, please.

Deputy Mattie McGrath

I will. Will there be scope for those greedy people to get their hands on this and make financial gains on such a sensitive and delicate matter? Why is the Minister objecting so much to the amendment? Why was it spun in the media by people who are against it that we were being savages? We were only speaking about surgical and late-term abortions. I will not repeat the other issues that the spin went into, but it was disgusting in the extreme. Why can the Minister not accept this amendment? Why is he afraid to place safeguards that will allow for a dignified and safe resting place for the remains with the consent of the mother? The "if" and "where" would be her choice. I cannot understand why the Minister is set against it.

Acting Chairman (Deputy Declan Breathnach)

Is the amendment being pressed?

Deputy Mattie McGrath

Yes.

Amendment put:

The Dáil divided: Tá, 10; Níl, 89; Staon, 0.

Tá

Canney, Seán.
Collins, Michael.
Fitzmaurice, Michael.
Fitzpatrick, Peter.
Grealish, Noel.
Healy-Rae, Danny.
Healy-Rae, Michael.
Lowry, Michael.
McGrath, Mattie.
Nolan, Carol.

Níl

Barry, Mick.
Boyd Barrett, Richard.
Brady, John.
Brassil, John.
Breathnach, Declan.
Broughan, Thomas P.
Browne, James.
Bruton, Richard.
Burton, Joan.
Butler, Mary.
Byrne, Catherine.
Byrne, Thomas.
Cahill, Jackie.
Calleary, Dara.
Carey, Joe.
Casey, Pat.
Cassells, Shane.
Chambers, Jack.
Chambers, Lisa.
Collins, Joan.
Connolly, Catherine.
Coppinger, Ruth.
Corcoran Kennedy, Marcella.
Cullinane, David.
Daly, Clare.
Donnelly, Stephen S.
Dooley, Timmy.
Doyle, Andrew.
Durkan, Bernard J.
Ellis, Dessie.
English, Damien.
Ferris, Martin.
Fitzgerald, Frances.
Harris, Simon.
Harty, Michael.
Healy, Seamus.
Humphreys, Heather.
Kelleher, Billy.
Kelly, Alan.
Kenny, Gino.
Kenny, Martin.
Kyne, Seán.
Lahart, John.
MacSharry, Marc.
Madigan, Josepha.
Martin, Catherine.
Martin, Micheál.
McEntee, Helen.
McGrath, Finian.
McGrath, Michael.
McGuinness, John.
McHugh, Joe.
McLoughlin, Tony.
Mitchell O'Connor, Mary.
Mitchell, Denise.
Moynihan, Aindrias.
Munster, Imelda.
Murphy, Catherine.
Murphy, Eoghan.
Murphy, Eugene.
Murphy, Paul.
Neville, Tom.
Noonan, Michael.
O'Brien, Darragh.
O'Brien, Jonathan.
O'Callaghan, Jim.
O'Connell, Kate.
O'Dowd, Fergus.
O'Loughlin, Fiona.
O'Reilly, Louise.
O'Rourke, Frank.
O'Sullivan, Maureen.
Ó Caoláin, Caoimhghín.
Ó Cuív, Éamon.
Ó Laoghaire, Donnchadh.
Ó Snodaigh, Aengus.
Pringle, Thomas.
Quinlivan, Maurice.
Rabbitte, Anne.
Ring, Michael.
Ross, Shane.
Scanlon, Eamon.
Sherlock, Sean.
Shortall, Róisín.
Smith, Bríd.
Stanley, Brian.
Stanton, David.
Troy, Robert.
Wallace, Mick.

Staon

Tellers: Tá, Deputies Peter Fitzpatrick and Carol Nolan; Níl, Deputies Seán Kyne and Tony McLoughlin.

Amendment declared lost.

Deputy Louise O'Reilly

I move amendment No. 60:

In page 16, to delete lines 17 to 34.

We have concerns about the manner in which special benefit or advantages are defined because it would appear that it will prevent organisations such as the IFPA from paying counselling staff or others. I believe the Minister may be in a position to address that.

Deputy Simon Harris

I am continuing to engage with the IFPA and Dublin Well Woman to make sure those concerns do not come to pass. I very much want to see both organisations carry on their excellent work in counselling. We need more such excellent work from organisations like them rather than rogue agencies, which we are moving to regulate against. The aim of this Bill is to protect the woman's interest by ensuring she receives non-directive and objective crisis pregnancy advice and information on termination of pregnancy and that the provision of such information or advice is not influenced by any financial considerations. I am very satisfied that this will not adversely impact the work of the IFPA, Dublin Well Woman or similar organisations but I will continue to engage very closely to ensure that is the reality.

Deputy Louise O'Reilly

In that case, I will withdraw the amendment.

Amendment, by leave, withdrawn.

Deputy Carol Nolan

I move amendment No. 61:

In page 17, lines 6 and 7, to delete “section 11, 12, 13 or 14 of the Health (Regulation of Termination of Pregnancy) Act 2018” and substitute the following:

"section 10 or 11 of the Health (Regulation of Termination of Pregnancy) Act 2018 where there is a risk to the life of the woman".

Amendment put:

The Dáil divided: Tá, 9; Níl, 101; Staon, 0.

Tá

Canney, Seán.
Collins, Michael.
Fitzpatrick, Peter.
Grealish, Noel.
Healy-Rae, Danny.
Healy-Rae, Michael.
McGrath, Mattie.
Nolan, Carol.
Tóibín, Peadar.

Níl

Aylward, Bobby.
Bailey, Maria.
Barry, Mick.
Boyd Barrett, Richard.
Brady, John.
Brassil, John.
Breathnach, Declan.
Broughan, Thomas P.
Browne, James.
Bruton, Richard.
Burton, Joan.
Butler, Mary.
Byrne, Catherine.
Byrne, Thomas.
Cahill, Jackie.
Calleary, Dara.
Carey, Joe.
Casey, Pat.
Chambers, Jack.
Chambers, Lisa.
Collins, Joan.
Connolly, Catherine.
Coppinger, Ruth.
Corcoran Kennedy, Marcella.
Coveney, Simon.
Cullinane, David.
Curran, John.
D'Arcy, Michael.
Daly, Clare.
Doherty, Pearse.
Donnelly, Stephen S.
Dooley, Timmy.
Doyle, Andrew.
Durkan, Bernard J.
Ellis, Dessie.
English, Damien.
Ferris, Martin.
Fitzgerald, Frances.
Fitzmaurice, Michael.
Harris, Simon.
Harty, Michael.
Haughey, Seán.
Healy, Seamus.
Humphreys, Heather.
Kelleher, Billy.
Kelly, Alan.
Kenny, Gino.
Kenny, Martin.
Kyne, Seán.
Lahart, John.
Lowry, Michael.
MacSharry, Marc.
Madigan, Josepha.
Martin, Catherine.
Martin, Micheál.
McConalogue, Charlie.
McDonald, Mary Lou.
McEntee, Helen.
McGrath, Finian.
McGrath, Michael.
McGuinness, John.
McHugh, Joe.
McLoughlin, Tony.
Mitchell O'Connor, Mary.
Mitchell, Denise.
Moynihan, Aindrias.
Munster, Imelda.
Murphy O'Mahony, Margaret.
Murphy, Catherine.
Murphy, Eoghan.
Murphy, Eugene.
Murphy, Paul.
Neville, Tom.
Noonan, Michael.
O'Brien, Darragh.
O'Brien, Jonathan.
O'Callaghan, Jim.
O'Connell, Kate.
O'Dowd, Fergus.
O'Loughlin, Fiona.
O'Reilly, Louise.
O'Rourke, Frank.
O'Sullivan, Maureen.
Ó Broin, Eoin.
Ó Caoláin, Caoimhghín.
Ó Cuív, Éamon.
Ó Laoghaire, Donnchadh.
Ó Snodaigh, Aengus.
Pringle, Thomas.
Quinlivan, Maurice.
Rabbitte, Anne.
Ring, Michael.
Ross, Shane.
Scanlon, Eamon.
Sherlock, Sean.
Shortall, Róisín.
Smith, Bríd.
Stanley, Brian.
Stanton, David.
Troy, Robert.
Wallace, Mick.

Staon

Tellers: Tá, Deputies Carol Nolan and Mattie McGrath; Níl, Deputies Seán Kyne and Tony McLoughlin.

Amendment declared lost.

Debate adjourned.

Dáil Éireann debate - Wednesday, 5 Dec 2018