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Dáil Éireann debate -
Wednesday, 15 Dec 2021

Vol. 1016 No. 2

Health (Regulation of Termination of Pregnancy) (Foetal Pain Relief) Bill 2021: Second Stage [Private Members]

I move: “That the Bill be now read a Second Time.”

I am honoured to stand in the Chamber today with the full support of this Bill's ten co-sponsors. I sincerely thank them all for their support of this Bill. We are here to move the Health (Regulation of Termination of Pregnancy) (Foetal Pain Relief) Bill 2021. It is my understanding that the Government has now submitted an amendment to the Bill, which will deny us the opportunity of it being read again. This is profoundly disappointing, given that it is such a reasonable Bill. I also strongly state that I hope, and it is only reasonable to expect, that the issue of pain relief will be discussed as part of the review into abortion services. It is something that cannot be left out and must form part of that review. I insist on that. I acknowledge the positive cross-party engagement from Deputies and Senators in these Houses. For that reason, and for humane reasons, it is important that pain relief is discussed in the review of abortion services.

The main objective of this Bill is contained in section 3. If accepted, a new provision would be inserted into the 2018 Act requiring pain relief to be administered to an unborn child, where appropriate, in the minority of cases to which that section applies. The section also makes clear that pain relief is not required to be administered in emergency cases where it may not be practicable. I emphasise that we bring this Bill forward in a spirit of constructive engagement. I hope that colleagues will be open to hearing what we have to say and that they will approach this Bill with a view to being guided by the science around foetal pain. More science has come to light in the past few years and, indeed, recent developments have taken place.

In this regard, I will highlight the short report on foetal pain published by the Oireachtas life and dignity group. The report pointed to a major review of the scientific literature on foetal pain that was published in the influential Journal of Medical Ethics in 2020. In the article, Professor Stuart Derbyshire and Dr. John Bockmann state that research indicates unborn babies might be able to feel "something like pain" as early as 13 weeks. It might be noted that the lead author of the review was Professor Derbyshire, who had previously acted as a consultant to the largest abortion provider in the US, Planned Parenthood. In 2006, he wrote in the British Medical Journal that not talking to women seeking abortions about pain experienced by unborn babies was "sound policy based on good evidence that fetuses cannot experience pain." However, on foot of his latest review, he states that "it is now clear that the [2006] consensus is no longer [scientifically] tenable." The authors went on to note that:

Given the evidence that the fetus might be able to experience something like pain during later abortions, it seems reasonable that the clinical team and the pregnant woman are encouraged to consider fetal ... [pain relief].

The life and dignity group report also highlighted the fact that foetal surgeons who perform operations on unborn babies look upon them as their patients. As a result, pain relief medication is routinely administered as standard medical practice. Indeed, one leading children's hospital in the United States performed nearly 1,600 foetal surgeries between 1995 and June 2017. Perinatal medicine now treats unborn babies as young as 18 weeks for dozens of conditions where every care is taken not to inflict pain or cause distress to the unborn baby. In 2019, in a reply to a parliamentary question from Sir Edward Leigh MP, the Secretary of State for Health and Social Care in the UK confirmed that unborn babies receiving recently announced innovative spinal surgery will, as a matter of course, receive pain relief during the procedure.

We are seeking today for the law in this State to reflect a similar precautionary approach, which is reasonable and humane. We already do so in legislation governing animal welfare. In fact, the law demands that this humane approach is reflected in regulatory guidelines dealing with animal welfare. This is only right and proper. For our part, we cannot simply rely on an approach that states it is for medical guidelines alone to deal with such matters. While that position can have some merit, for certain important issues it remains a totally artificial legislative construct that we must overcome. We have all kinds of patient-centred legislation that mandates, where appropriate, how our hospitals and healthcare system should operate. We demand the implementation of certain standards and we make laws to ensure that those standards become a reality. In this light, for us to continue insisting that the Government must have no hand, act or part in shaping a principled approach to medical guidelines is simply not sustainable.

This is particularly true for approaches to dealing with pain relief. Abortions, particularly late-term abortions, are highly emotive issues. We know they are happening already in this State. We know doctors who perform them are highly conflicted and sometimes physically traumatised, as the UCC study made clear. That study was informed by medical professionals.

We must take the lead here. There is a duty and onus on us to do so as legislators who are determined to insert a modicum of compassion into an already sufficiently traumatising experience. We must not abdicate our responsibility as legislators by continuing to insist the issue of pain relief for unborn children is none of our business and will never be our business. How can we maintain that fiction? How long must we wait until our laws in this area are informed by the best available evidence and science? As the Bill's sponsors, we have strong views about that. However, we want to be clear that this Bill will apply in circumstances where the baby has progressed to 20 weeks gestation. In that sense, while the principle of the Bill is critical, it must also be narrow and limited in its terms, approach and application. We hope this warrants widespread cross-party support to enable the Bill to proceed to Committee Stage where the issues can be conscientiously teased out through further analysis. For these reasons and more, I commend this Bill to the House.

As we debate this Bill, some Deputies may be asking or telling themselves that the matter of foetal pain relief is more suited to medical guidelines than primary legislation. I am sure many of my Dáil colleagues remember that when similar amendments were proposed three years ago, the then Minister for Health, Deputy Harris, refused them. He stated:

The purpose of this legislation is not to regulate or dictate the practice of obstetrics. [...] There is a very thin line that we should not cross where we move from being policy makers to being doctors.

However, it is interesting to note that the Animal Health and Welfare Act 2013 mandates "the use of an appropriate anaesthetic... [to animals] to prevent or relieve any pain during... [an] operation or procedure." I wonder whether there have been any concerns about those 2013 legislators? Have any of them moved from being policymakers to being vets yet?

There are other reasons it may not be prudent or ethical to repeat the mantra that we should trust doctors unquestioningly on the topic of foetal pain relief. It is clear that, despite having had three years to do so, there are as yet no guidelines around the administration of anaesthesia during abortion procedures. That is despite the fact we know that late-term abortions are being performed in Ireland, that foetal pain is likely experienced much earlier in pregnancy than previously thought and that two extremely brutal abortion methods are being used during late-term abortions in Ireland, namely, D&E or dismemberment abortions and foeticide involving lethal injection. If anyone is in doubt about why pain relief may be required during a late-term abortion procedure, I recommend they look up what is involved in these two procedures. A good starting point is the report on late-term abortions and foetal pain produced by the all-party Oireachtas life and dignity group. It is easily available for anyone to view at www.lifeanddignity.ie.

In addition to the fact that there is no sign of these medical guidelines, there is another factor that must be considered when suggesting simply deferring to doctors. This was addressed in the 2019 article in the Journal of Medical Ethics entitled "Reconsidering fetal pain". This article is noteworthy because its two authors, Stuart Derbyshire and John Bockmann, came together to address the evidence for foetal pain despite having very different views on the morality of abortion. They noted that it appeared that the only procedures where invasive foetal intervention proceeds without anaesthesia are abortions. The article states:

... all the evidence suggests that surgeons performing therapeutic fetal interventions routinely consider pain relief for the fetus, [while] surgeons performing abortions have their focus on the pregnant woman as their patient. Consequently they more rarely consider fetal pain relief during the preparation and execution of abortion

It is not unreasonable to conclude that, perhaps unsurprisingly, medics who choose to perform procedures intended to end the life of a foetus may have a blind spot when it comes to considering the welfare of the foetus during those procedures.

William Wilberforce stated "you [might be able to turn and] look the other way but you can never again say [that] you did not know.” I ask Deputies to help us to end this injustice and support this Bill. We are discussing a legislative proposal and it is easy to get caught up in the legal jargon and technicalities; however, it is important to remember that at the core of this Bill we are asking whether the House is prepared to support a measure to help to avoid unnecessary pain being inflicted on vulnerable human beings.

If Members care about compassion, humanity and mercy towards the vulnerable among us, or about following the science, which becomes ever clearer that unborn children are likely to feel pain much earlier than previously believed, I ask them to please support this Bill. If they care about cruelty to animals, I ask them to please extend the same protection to unborn human beings and support this Bill.

I am glad to get the opportunity to talk on this important Bill. This baby pain relief Bill is crucial to ensure that any baby with a heartbeat does not have to endure or feel pain while being aborted or killed and denied the right to make their way into this world. There are several other pressing problems and issues we should be highlighting on behalf of communities that are let down and under constant attack from the three Government parties. They concern people who need medical interventions, farmers, hauliers, working-class people whose incomes are diminishing daily and people who cannot even go to work because of Covid.

If we are to be worth our salt in the Dáil, we have to stand up for those who cannot defend or talk up for themselves. We have to stand up at Christmastime, the time of peace and goodwill, for these defenceless babies. They are God's creatures who cannot defend themselves. They have done nothing wrong to anyone. They were conceived naturally, like each of us, but they are not to be allowed to live. To top it all, they have to endure pain while they are being discarded from this life. They are being hurt in the process of ending their little lives.

I call on the Minister and the Government to do everything possible to ensure pain relief is administered to each baby with a beating heart. I do not subscribe to the notion that it should be only those babies over 20 weeks gestation. Every baby with a beating heart should not have to feel pain. There is no difference between a baby over 20 weeks and a baby under 20 weeks. They are all human beings to me. God created them, they are alive and they should not be discounted like this.

This has been asked for since abortion was legalised but there has been a refusal to extend a morsel of compassion to these babies as they breathe their last breath in this world. This is the most forceful and condemning evidence that we are losing our empathy and our way as a society.

Recent scientific evidence concludes that unborn babies feel pain as early as 12 weeks and maybe sooner. To ignore this is reckless. Indeed, unborn babies that are to be born in the natural way and are going to be allowed to live in the normal way are looked on by baby surgeons as their patients and are administered pain relief medication as standard medical practice. So there is medical interventions to stop the pain and to numb the pain.

Pain relief for animals is provided for in primary legislation and properly so. The Animal Health and Welfare Act 2013 provides that veterinarians administer pain relief during any procedures or interventions that would cause pain to the animal. Surely we must ensure that unborn babies with a heartbeat are dealt with in a compassionate way and give them pain relief. If there is any humanity in the Government I ask why it is putting down an amendment to a Bill as harmless as this. Is it just because it wants to oppose ordinary people who want to stop children, little babies, having pain in this way? It is such a small thing to ask. We should be asking that they be let live but at this stage, because of the abortion laws that were passed, this is all we can ask for. We are asking for more heart, that the Government does what we ask and please help little babies that have done nothing wrong to anyone in this world. If the Government does not help these, I cannot see how it will help anyone at all that it is supposed to be helping while its members are in government. There were 6,666 children aborted in the first year after the legislation was changed. These little children are an awful loss to our country and to our community. I had the pleasure of having a young granddaughter, Bríd Healy-Rae, five weeks ago. To think that anyone would harm her or cause her pain would drive me down through the ground. I have five grandchildren and I adore each and every one of them.

We need to do more to help mothers, and fathers, indeed, to ensure there is another way. We are not doing that. Many here were hell-bent on ensuring that the abortion legislation went through. That was their right and for those who voted for it that was their right. But that is not to say that I say it is right. I think that these children, if they grew up, and they do grow up and they are not long becoming men and women, would have been a massive asset to this country. The Government, by its amendment, is looking to delay this. I want to remind the Minister that 18 babies are being aborted daily so they are going to suffer pain. It is 126 weekly and over 6,000 in a year. Surely we should not be wasting time. Is there humanity in the Minister or any of the Government? If there is, now is the time to stand up and do what we ask which is just to administer pain relief in the course of these abortions where we are ending little babies lives.

I move amendment No. 1:

To delete all words after “That” and substitute the following:“Dáil Éireann declines to give the Health (Regulation of Termination of Pregnancy) (Foetal Pain Relief) Bill 2021 a second reading in order to allow for the review of the operation of the Health (Regulation of Termination of Pregnancy) Act 2018 to conclude and for its recommendations to be considered.”

I thank the Deputies for tabling their amendment and acknowledge their legitimacy and genuine views. As for the current approach of allowing this review to progress and make recommendations back to me, the Government, the Oireachtas and the Joint Committee on Health, I would be applying the same approach whether this was a Bill seeking to make the Act more conservative or more liberal. That is important.

I will explain why the amendment is necessary at this time. Following the referendum in 2018, the Health (Regulation of Termination of Pregnancy) Act 2018 was signed into law in late December 2018 and commenced on 1 January 2019. Services for termination of pregnancy are delivered in both community and hospital settings and are designed to provide a safe and effective service for both service users and service providers. The Private Member's Bill before the House today proposes to amend the Health (Regulation of Termination of Pregnancy) Act 2018 to direct the model of care for service delivery. A first reading of the Bill appears to suggest that the obligation on the medical practitioner to administer anaesthetic to the foetus would apply mainly for terminations after 20 weeks' gestation. However, the new section 12A(1)(b) appears to apply to terminations at any stage of pregnancy.

I need not remind the House of the result of the referendum held on the 36th amendment of the Constitution on 25 May 2018. The provisions set out in the Act also reflect recommendations made by the Joint Committee on the Eighth Amendment of the Constitution, based on its consideration of the report produced by the Citizens' Assembly on the issue. No recommendations were made by the joint committee or by the Citizens' Assembly on medical procedures or clinical practice around termination of pregnancy. The purpose of the Health (Regulation of Termination of Pregnancy) Act 2018 is to set out the grounds on which termination of pregnancy is lawful in Ireland. Its purpose is not to dictate clinical practice on the area nor to set out the medical procedures to be used by medical practitioners carrying out a termination of pregnancy.

Detailed work was undertaken by the relevant medical colleges during late 2018 and early 2019 to develop comprehensive clinical guidelines to assist medical practitioners in the clinical decision-making involved in dealing with these cases. This clinical guidance was a key component of the delivery of an integrated service. I am advised that the medical colleges are working on reviewing the clinical guidance documents and where necessary, they will update them according to the latest evidence and international best practice in the area. Care pathways, treatment plans and best medical practice in these sometimes complicated cases are best developed by medical experts and set out in these clinical guidance documents. It would not be appropriate for legislation to dictate clinical practice in a medical or healthcare setting. However, section 7 of the Health (Regulation of Termination of Pregnancy) Act 2018 requires the operation of the Act to be reviewed. I am pleased to be able to tell the House that this review commenced last week on 8 December. The review clause was included in the 2018 Act in order to facilitate monitoring of the impact, operation and effectiveness of the legislation in practice, as well as on the delivery of services in this area. Deputy Nolan asked an important question in the context of this morning's debate as to whether all the issues being raised by her and those tabling this Bill and any of those participating in today’s debate can be considered. I acknowledge these issues are important to the Deputies and all can be raised within the review which is being commenced.

Phase 1 of the review will capture the information on the effectiveness and operation of the Act from the perspective of the women who access the service, health professionals who deliver the service and the public. The latter may also include service users and service providers. The review will be informed by three important streams of information in order to examine whether the operation of the legislation is appropriate and effective. First, and I think most importantly, women's experience of termination of pregnancy services and their views on how the system has operated since 1 January 2019 will be a critical source of information for the review. This stream will draw on the large-scale qualitative research study commissioned by the HSE's sexual health and crisis pregnancy programme. This is to investigate unplanned pregnancy and abortion care. The research is being led by Dr. Catherine Conlon, assistant professor in the department of social studies in the school of social work and social policy in Trinity College Dublin.

The study will generate an indepth understanding of the experiences of women who have accessed unplanned pregnancy support services and abortion care services since the implementation of the Act. Other relevant peer-reviewed research on women's experiences published since 2019 will also be considered.

Second, the review will gather the views of those involved in providing termination of pregnancy services in community and acute settings in Ireland. Independent qualitative research on the service provider perspective was uploaded on eTenders, the Government procurement process, last week. The service providers' research will include input from hospitals and GP services providing termination of pregnancy services. It will include input from individual medical practitioners, medical colleges, midwives, counsellors and other relevant service providers who may wish to partake and be identified. The review will also draw on other relevant peer-reviewed research on service providers' experience of implementing the Act since 2019.

Third, a public consultation was launched to provide an opportunity for members of the public, interest groups or other interested parties to submit their views for consideration in the review. The second phase of the review will be led by an independent chair who will assess the extent to which the objectives of the Act have been achieved, analysing in that regard the findings of the three strands of information on the operation of the Act. The chair will assess the extent to which the Act's objectives have not been achieved and make recommendations to address any barriers identified.

The chair will also draw on the findings of other relevant peer-reviewed research and consult further with stakeholders as necessary before providing conclusions and any recommendations to me later next year. I will share that with the Government. I have already discussed it in detail with the Joint Committee on Health and will share it with colleagues in the Oireachtas too.

In conclusion, I think and hope we can all agree that the best people to make decisions about the most appropriate treatment in healthcare are the treating medical practitioners. Notwithstanding this, as I recently commenced a review of the operation and effectiveness of the provisions of the Health (Regulation of Termination of Pregnancy) Act 2018, at this point, it is necessary to decline to give this Private Member's Bill a Second Reading. We need to allow the review to be completed and for its recommendations to be considered. Let us see what those recommendations may be. They may be operational. There may be recommendations relating to regulation or the Act itself. Those who would seek to change the Act or service provision in any direction, whether to be more conservative or more liberal, need to give the review the space it needs to do its work and report back to us so that we can take appropriate action.

I am pleased to have co-sponsored and to speak today in favour of the Health (Regulation of Termination of Pregnancy) (Foetal Pain Relief) Bill 2021. I strongly believe in the principles of this important legislation. It is rooted in caring principles of avoiding unnecessary pain and suffering. This Bill would ensure that pain relief medicine is provided to unborn babies in late-term abortion situations. This Bill should be judged on its specific merits and not as a replay of the 2018 abortion referendum. At present, the Health (Regulation of Termination of Pregnancy) Act 2018 does not include provisions which ensure that pain relief medicine is provided to unborn children in abortions. Late-term abortions are happening after 12 weeks across Ireland under several circumstances set out in the 2018 Act. This is the primary cause of concern as recent scientific and medical evidence details that unborn children in late-term abortions have developed significantly enough to experience pain. The most recent scientific evidence indicates that unborn babies have the capacity to feel something like pain from 12 weeks of gestation.

As revealed in the 2020 article by Professor Stuart Derbyshire and John Bockmann, there exists significant literature which has long asserted that, from 20 weeks or earlier, unborn babies can feel. Recognising this reality, many countries have introduced foetal pain relief for unborn babies, such as prior to spina bifida surgery. In France, 97% of late-term abortions are performed with the inclusion of pain relief medicine. This compelling scientific evidence has led me to conclude that there is a sufficient basis to claim that unborn babies experience pain during late-term abortions. Scientific arguments debate the exact time at which babies can experience pain. The introduction of precautionary measures to eliminate the potential altogether is a wise provision.

I reiterate that this Bill should be judged on its specific merits and not be a replay of the 2018 abortion referendum. Following that referendum, a clause was inserted in the Constitution that the Oireachtas may legislate for issues relating to unborn children. That compels us to legislate to critically evaluate operations on the unborn. Provisions are lacking and should be amended post-haste. I take this position on humanitarian and ethical grounds, backed up by scientific evidence. This Bill offers genuine compassion. I appeal to all my parliamentary colleagues to join me by voting for this Bill and ensuring that it reaches Committee Stage. Hopefully it will progress beyond that to become law, a Private Member's Bill from the Rural Independent Group entitled an Act to provide for pain relief for the foetus in certain cases of termination of pregnancy; and to provide for related matters.

I hoped that the Minister would not table an amendment to this. By tabling the amendment, he is putting his fellow Deputies and party members under the whip. I want an open, transparent vote on this. I would like the Minister to remove his amendment and to allow everyone in this House the right to vote on the Rural Independent Group's Bill. I ask the Minister to do that and to let every Deputy in this House have an open vote, without producing the whip. I ask the Minister to do that on humanitarian grounds. Let everyone in this House have a voice of their own without the whip. I ask the Minister to withdraw his amendment. Let the Rural Independent Group's Bill go and let everyone in this House answer the people of Ireland truthfully.

I am glad to be a co-sponsor of the Health (Regulation of Termination of Pregnancy) (Foetal Pain Relief) Bill 2021. I was never more devastated or disappointed than when I stood up, on behalf of our group, to table a motion here years ago seeking pain relief when we had failed in our efforts to protect the unborn child, as a last desperate attempt to ensure that they would not feel pain, and a vote was called. We subsequently lost that vote. I thought it was devastating, cold, hard and cruel beyond belief. We live in a society where animals are protected from pain. It is a requirement to administer pain relief to animals and make sure that they are not subjected to cruelty. We have many veterinarians in the countryside, in the parish that I am from, including great people such as Mike O'Sullivan, Brendan Teahan and Leslie Dignam. They are good vets who go around to take care of animals. We now have a situation where we are being denied the right to take care of little unborn babies to protect them from feeling pain.

I find it impossible to believe that the Government is not willing to accept this. It wants to deny that an unborn child is a person. I have always said in this Dáil, and it hurts many people when I say it, that from the moment of conception until the moment of death, a person is a human being. They are the future doctors, politicians and teachers.

They are the people who we want to nourish and who we want to help come into the world to live their lives and to be given the same opportunity as everyone one of us. I believe that in my heart and soul. If I was offered the size of this room in €100 notes, I would burn it to protect one unborn child because I believe in letting these young people come into the world and be given the same right as myself, the Minister or anyone else was.

A vote took place in this country. A decision was taken. We live in a democracy. We were entitled to our opinion at the time. Other people won the vote on that. We are not standing up here today looking to rewrite history or to rewrite that vote because we cannot do that. What we are trying to do is to help a small vulnerable person from feeling pain, and it is a person. It is a human being. That unborn child is a person. They are being denied the right to be born into the world but they are also being denied the right not to have to feel pain.

There are Members who will come in here tonight and be under the whip and vote in accordance with their parties, not with their conscience. I ask the Minister to be a man about this and to go back to the Government and say, "Right, let everybody come in here tonight and vote with a thing called their conscience." God gave us a conscience, but, of course, many Members in this Chamber do not believe in God either. As much dislike as they might have for many things, they dislike God. They hate him being referenced. They hate us being humble about it, blessing ourselves and having our manners about religion. People hate that. There are people who actually hate it. I do not mind talking about God. I do not mind saying that I think it is right that people should be able to come in here tonight and vote with their conscience, and vote for what they believe is right and what they believe is wrong.

How could any human being look me straight in the eye and say with any conviction and with any honesty in his heart and soul that it is wrong to want to stop a little person of feeling pain? Every one of us will have to die and how a person could face God after denying a person the right to pain relief is hard to understand. If I was under any one of their whips tonight, I would crack the whip back at them and I would vote with my conscience.

I plead with the many fine respectable Members who are in this House today - to hell with Fianna Fáil, to hell with Fine Gael, to hell with Sinn Féin, to hell with Labour and to hell with all of their whips - to come in here tonight and vote for what they believe to be right or what they believe to be wrong. On my knees, I would plead with them to come in and vote for the little person, the person who does not have a voice, the unborn little child, the man or woman of tomorrow who will not see tomorrow because he or she has been denied that right. At least, give them the right not to feel pain and hurt and the horribleness that an abortion actually is, and to anybody who would like to forget about it, an abortion is a horrible thing. The Government should offer more support to people who have crisis pregnancies and try to help them, but, for God's sake, should not deny us the right of our motion, which is very important.

I welcome the opportunity to speak on this important issue. I thank the proposers of the Bill for bringing it forward in the first instance and giving us an opportunity to have this debate on this issue.

The language we use and the tone we strike as legislators is important. It matters to women going through a crisis pregnancy, it matters to those families who have received a diagnosis of a fatal abnormality and it matters to those who have had to make that difficult decision to seek a termination in the past. It also matters to all the healthcare professionals who are providing a necessary and professional service to women right across the State, unfortunately, not across the island.

When dealing with this issue as legislators, we must be conscious of the mandate given to us by the Irish people directly through the referendum. It was the Irish people who demanded that we in this House legislate to bring forward safe and accessible abortion services, and that is exactly what we did. A long, and at times fraught, process was put in place that ultimately gave rise to the referendum and subsequently the legislation which, for the first time, put these services in place for Irish women.

As part of that process, the amendment that comes before us as a Bill was thoroughly debated and discussed. To be fair to the proposers of the Bill, nobody here would disagree with its core sentiment. Of course, we support the administration of pain relief. Who would not? Of course, we support medical professionals carrying out these procedures preventing avoidable pain where it is deemed necessary.

I suspect the only difference we have on this matter is that which was articulated before when this issue was last debated and voted on. It is my firm belief that clinical decisions such as this should be taken by clinicians and not by politicians. I trust our doctors and our nurses. I trust our great healthcare professionals to do their jobs without interference from me or from any other unqualified person. I believe that the appropriate place for determining such practice are the clinical guidelines for termination of pregnancy, rather than in primary legislation such as this, and that is a matter for the doctors to decide.

It is our responsibility as legislators to ensure that there are robust legislative frameworks to support the policy decisions of the Oireachtas and the people. When it comes to medicine, it is the responsibility of the medical regulatory institutions – in this case, the Institute of Obstetricians and Gynaecologists at the Royal College of Physicians of Ireland – to set out clinical guidelines within that legislative framework to regulate and make operational, in medical terms, that policy.

In this State, we have an independent medical profession that is free to pursue and implement clinical guidelines, subject to the legislative frameworks and policies set by the democratic institutions, on the basis of the latest medical-scientific research, with ethical practice regulated by the Medical Council. That key principle must underpin the delivery of modern, compassionate healthcare that puts the patient, in this case, the woman, first.

My party, Sinn Féin, supports modern, compassionate healthcare. We must be careful not to cross the line between legislation and clinical guidelines and it is my fear that this legislation does that. We should not infringe on the independence that is so essential to the delivery of modern healthcare. This is an important principle that must underpin access to any healthcare – that we trust doctors to deliver the service in an ethical and safe way. If they do not, there are mechanisms for recourse via the professional and regulatory institutions, such as the Medical Council.

There is nothing prohibiting the administration of pain relief, where deemed necessary by a clinician, in the existing legislation. If there are difficulties in providing such pain relief where a clinician deems it necessary, then that is something which the health service must rectify.

In my view, the fundamental point here is that we must trust our doctors. We must acknowledge that this is a decision for the medical professional who is carrying out the procedure. It is not appropriate, in my view, to mandate compulsory treatments, care pathways or patient treatment plans in legislation. That would not work in any other sphere of healthcare.

There is nothing preventing the medical profession from coming to a view and setting requirements in guidelines that they continue to review and reformulate in accordance with a medical scientific approach. That is the approach we support for delivering any necessary pain relief because the appropriate place for regulating such practices are the clinical guidelines for termination of pregnancy, not legislation. On that basis, I will support the Government amendment.

I want to take this opportunity to set out Sinn Féin’s all-island position on abortion services. Sometimes misleading and inaccurate statements have been made in this House and by Members of this House in the media to distract from Government failures to fully commission services across the State.

Sinn Féin is committed to delivering the same services, North and South. We want to see the alignment and delivery of abortion services across the island, and the services available in this State implemented in the North.

We want to deliver modern, compassionate healthcare North, South, east and west. We want to deliver a system that removes the need of any pregnant person to travel to England or elsewhere for an abortion they need. We want to keep the operation of these services under review to ensure they are compassionate, appropriate, patient-centric, and informed by the best available medical advice.

In the Executive and the Assembly, our Ministers and MLAs will continue to push for the immediate commissioning of abortion services in the North and the alignment of services with this State. It is now more than a year since the law changed to legalise abortion in the North. It is totally unacceptable that the commissioning of services continues to be blocked by the DUP and UUP. Our amendments to deliver these services have been rejected time and again by the DUP and the UUP. All of us in this House have a responsibility to recognise the blocks that have been put in the way of people in the North seeking access to abortion services. We will table a motion in the Assembly in the new year to push back against this obstructionism. I hope that political leaders in this State, from all parties, will add their voices to this call and help to deliver these services for people across our island.

It is very important that the Assembly in the North does exactly what it should do. We have to take our responsibilities in this House very seriously. We supported the legislation that enabled the services to be put in place in the South. Ministers in the North from the DUP and the UUP are blocking any attempts by Sinn Féin and others to get this through the Executive. We need to ensure by any means possible that no matter what part of the island they live on, women have access to exactly the same level of abortion services. Sadly, that is not the case. We in Sinn Féin will come at this again with vigour and energy in the new year as best we can.

I also raise the matter of the review of the provision of abortion services in this State. The review process itself is central to the amendment the Minister tabled. We had a very lengthy discussion at the Joint Committee on Health a number of weeks ago and since then we have had a chance to review the terms of reference for the review process. The appointment of an independent chair needs to happen as soon as possible. The Minister has given a commitment to expedite that and has gone through a procurement process. We all hope that will happen very quickly. I reiterate my view that the chair should have been in place at the start of the process and should have had a role in overseeing the outreach and public consultation process. The quicker we get the independent chair in place, the better for everybody.

We need to get this review fully under way. The Government must ensure the widest possible stakeholder engagement with those who accessed or sought to access the services, those who have provided the services and those who felt unable to provide them, as well as the views of organisations helping people who need these services. We need to hear from women who were able to avail of the services but we also need to hear from women who were unable to do so, for whatever reason. Wherever that takes us, so be it. We have to hear the experiences of everybody.

The Minister has clearly said that the review will not start from the point of view of policy but that of the operation of the Act. Those are the terms of reference for the review. There is going to be a very obvious crossover in some of that, as he has acknowledged, and it may be the case that the review process will then make recommendations that are policy-based. We will have to wait and see what comes from that. The review must include the needs of any hospitals that have been unable to fully commission services. It must be explicit in the reasons any public healthcare facility that could provide the services is not doing so. We had a discussion on this issue at the committee. Many maternity hospitals are not providing a service. There may be a reason for that in some instances because of the scale of the hospital, as it might be a level 2 or level 3 hospital, but we need to understand why that is the case. We need to get to a point where these services are available in every maternity hospital. There are also issues in some rural areas with access to GPs providing the appropriate service. All of that will be critical to the review process.

While the purpose of the review as set out in the legislation is to examine the operation of the Act, that does not constrain it from accepting evidence on, and including an analysis of, the impact of different aspects of the legislation on access to services and whether women feel the services are compassionate. It is important that the review does not narrowly focus on the operation of the Act, as prescribed in the legislation. We have to be as open, transparent and generous as we can in this review process to capture all the experiences and make sure none of them are limited or prevented from making their way into the final conclusions of the process. That would be problematic and would undermine its integrity. The review may be limited in what it can recommend but it is a unique opportunity to gain insight into the real experiences of patients accessing these services and clinicians delivering these services, or not delivering them, as the case may be. It can, and should, provide an evidence base for us, as legislators and policymakers, to review the impact of the previously decided policies. We must ensure that decisions made previously have delivered a fair and fit-for-purpose system. This review cannot be blinkered and its output, at least in the collection of testimony and evidence on experience, must be examined in its totality. That means all experiences.

Only half of the maternity units in the State deliver abortion services, meaning half of maternity units are falling short on their obligations and are not providing a service. This is exacerbating the serious geographical discrepancies in access to a GP who will provide services. The Minister has acknowledged those geographical discrepancies. We do not need to wait for the review to paint a picture or signpost the way forward. Where we know there are gaps under the existing legislation and the operation of the Act, we can already move if necessary. We can support those maternity hospitals and make sure we have sufficient capacity in primary care across all areas so women are not travelling 70 miles or more to get to a GP, as we know is happening in some cases. They have to ring multiple GPs, in some cases seven or eight, until they can find one who will provide them with the service and access to information. That is problematic.

This is a matter of trusting doctors as those best placed to advise and support those seeking to access services. It is about recognising that they are best placed to determine the clinical needs and treatments required. It is about recognising that abortion services must be fit for purpose and implemented fully right across this island. It is about supporting women and pregnant people and addressing their medical needs. I do not believe a single Member is against compassionate services that administer any necessary pain relief. Everybody in the House would want that to be in place but the point is that it is in place already. Doctors and clinicians can provide that pain relief if and when it is deemed necessary. The place for determining that is in the clinical guidelines and not in primary legislation. For all those reasons, I will support the Government amendment.

I am glad to contribute on behalf of the Labour Party and to set out why we cannot support this Bill. We will support the Government amendment. There is no care or compassion for women's health conveyed throughout the Bill, nor would it do anything to enhance or improve the health of women or our access to reproductive healthcare. As previous speakers have said, language matters in this debate. It is very important that we all speak on issues relating to women's reproductive health, abortion and crisis pregnancies with compassion, empathy and understanding for the many women in this country who face the awful prospect of a crisis pregnancy and who are faced with considerations and choices to make. We have to be conscious that for far too long in our very recent history, the language of foetal rights and that of the life of the unborn was used to devalue the lives and the health of pregnant women.

It was used in such a way as we saw in 1983 with the eighth amendment to the Constitution and the consequent litigation on that. We saw terrible consequences for the health and lives of pregnant women.

Until the repeal of the eighth amendment in 2018, our fundamental law and Constitution placed undue priority upon the protection of foetal life, placing the right to life of the pregnant woman and the foetus in direct conflict with the appalling consequences that are well known and have been well documented. We might recall the tragic death of Savita Halappanavar in 2012 and the dreadful case of PP in 2014 in which a pregnant woman was kept alive on life support against her family’s wishes and against the clinical judgment of her medical team because of the eighth amendment. We might recall the women who took their cases to the European Court of Human Rights, known as A, B and C, and the women like Amanda Mellet and Siobhán Whelan who took their cases before the United Nations. We might also remember the many more women, whose stories are untold but all of whom suffered under the eighth amendment and the approximately 160,000 women who were forced to travel abroad, often in dire circumstances, to access terminations of pregnancy, in many cases placing their health at risk.

It was the recognition of that reality and of the real consequence of the eighth amendment, including that undue priority that was placed on foetal life that caused the Irish people to vote by a 66.4% majority in 2018 to delete the text that equated the right to life of the foetus with that of the pregnant woman from the Constitution. We should not forget that the referendum followed extensive debate on measures such as those proposed in this Private Members’ Bill, as well as extensive consultation through the Citizens’ Assembly process and the Oireachtas committee process. We might recall that the Joint Oireachtas Committee on the Eighth Amendment of the Constitution recommended repeal for three key reasons. It did so because of the impact the amendment had on the provision of services for pregnant women; the continuing and ongoing breach of Ireland’s international human rights obligations; and the practical reality of thousands of women being forced to travel every year or to import the abortion pill.

It was those considerations and the compassion and empathy for women in crisis pregnancy that brought about the holding of the referendum in 2018 and that remarkable result in repealing it by such a strong and clear majority. That majority voted in clear knowledge that the legislation which had previously been published would provide for legal abortion in Ireland consequently. This was progress and a huge step forward for the rights of women and girls. None of us in this House really wants to go back to those days pre-2018 when those of us who had daughters – and I have two – would face the prospect of those girls growing up under the chill of the eighth amendment, as so many of us did. I speak as somebody who was taken to court 32 years ago and threatened with prison for giving information to women in crisis pregnancy in my role as president of the Trinity College Students' Union. I will never forget the calls we got in the students union every day and every week in those dark years of 1989 and 1990 from women and girls in crisis pregnancy who were desperate to get the phone number of a clinic in England because they felt they had no choice but to terminate their pregnancies and we failed them in this State for far too long, for the 35 years the eighth amendment was in place. Let us not go back to those dark days. I am proud of the role the Labour Party played during those years; of the role my party played in the repeal campaign; and of my party as a pro-choice party. The activists of Labour Women and of the party were at the forefront of the repeal campaign.

We are supporting the Government amendment and we want to work constructively with the Minister and the Government on the statutory review process that we are glad to see under way. We have been critical of the apparent narrowness of the terms of reference and I note the concerns expressed today by the National Women’s Council of Ireland on the terms of reference. We want to ensure that reforms will be introduced on foot of the experiential survey the Minister is conducting and I am glad to hear that Dr. Catherine Conlon of Trinity College Dublin will be leading the study into women’s experiences. They must be at the heart of the review. I am also glad that we will see the experiences of service providers and of the operation of the Act in the survey.

It is also important that we look at policy recommendations and changes to enhance and strengthen women’s rights of access. In particular we want to see the lifting of the three-day waiting period, which does not have any medical basis and again the National Women’s’ Council of Ireland has made that point today. We want to see the introduction of safe access zones law to protect from intimidation women who seek to access terminations. Again today I see Together for Safety noting that there are still ongoing intimidatory protests around our maternity hospitals. We are concerned that there are women in this country who, because of geographic differences in services cannot access terminations of pregnancies here and who have to travel still. We know that 375 women had to travel to England in 2020, compounding the crisis of the pregnancies they faced in many cases. We want to make sure we can deliver the reproductive health services we so clearly need to women in this country. For far too long those services were denied to us under that chill of the eighth amendment.

Let us not take so long about the review this time either. Let us not take as long as it took us to repeal the eighth amendment. If I had known as a 21-year old activist that it would take over three decades to repeal the eighth amendment and to deliver healthcare to women in this country I do not know what I would have done. It was such a relief to so many of us of my generation to see the eighth amendment finally repealed in 2018. We do not want to go back. We want to ensure we move forward, build on the services that are available and build on the legislative provisions clearly set out in the 2018 Act. We want to ensure our clinical guidelines deliver doctors and medical professionals the guidance they need to ensure the Act is implemented with compassion, empathy and care for women who are pregnant, who are facing crisis pregnancy and who require terminations of pregnancy. That is the clear pathway forward that my party wants to see and I believe the clear majority of people in Ireland want to see that, as represented by that tremendous vote in 2018. Let us not go back and let us ensure that none of our daughters or granddaughters has to live under the chill of the eighth amendment or endure the sort of terrible consequences that so many women endured in this country for far too long.

This Bill is deeply troubling and morally wrong. It is an attempt to undermine the will of the Irish people. It is trying to legislate on medical best practice. This is not only inappropriate, but also incredibly disrespectful to women and doctors. Ultimately, it is a move to control women’s bodies. We are not going to return to those days. The eighth amendment and all it represented was decisively dismissed by the Irish people. The only question for this House now is how we can ensure best medical and caring practice for women and families.

This Bill is cloaked in language of compassion when in reality it is trying to drag us backwards and to have the debate all over again. All we can say to that is “No”. The people of Ireland, especially the women who have had to endure patriarchal control for generations, will not put up with it. The days of middle-aged men trying to control the bodies of young women are over. We have won our bodily autonomy and we are not giving it up. This Bill is straight from the playbook of anti-choice Americans. It is a commonly used barrier on behalf of those who believe in forced pregnancies. It makes it more difficult for women in traumatic situations to access healthcare. I would have hoped that no one would think of putting forward such a Bill, especially given how clearly the Irish people spoke on this issue. The majority of people voted for free, safe and legal abortion. In my constituency almost 65% of people voted in its favour. I trust women, families, doctors and nurses.

It is highly inappropriate for legislators to intervene in medical practices. Despite our under-funded health service, we have some of the most dedicated and caring medical staff in the world and this Bill is acutely insulting to the care they provide every day. Patients and healthcare professionals should have the freedom to make decisions based on medical science and the best interests of the patients themselves, nothing else. Legislation on particular medical procedures is not just highly inappropriate but it serves to confuse and restrict options available to women and families, often in the most tragic circumstances. Abortions are healthcare and girls and women are entitled to reproductive health. The Irish people have guaranteed those rights.

This Bill is part of a larger anti-choice strategy to treat abortion care as exceptional. Where are the laws on anaesthetics for orthopaedic surgery, or the Bills regulating colorectal procedures or prostate cancer care? They are not up for debate in this House because we trust medical professionals. It appears that the Rural Independent Group believes that healthcare for girls and women needs legislation. This Bill is especially callous and upsetting for women and families who have experienced terminations after 20 weeks. The fact that we are standing here debating this and the inevitable coverage it will receive will no doubt be very distressing to them, and my heart goes out to every individual and family affected. Cases of foetal anomaly are rare, sensitive, clinically complex and altogether heartbreaking.

It is astonishingly disrespectful to try to sensationalise later abortions. They are the most difficult and emotional decisions a woman or family will ever have to make.

The exceptionally courageous individuals and couples involved in terminations for medical reasons were forced to share their personal stories of pain and sorrow during the referendum. Anyone who is willing to listen will know the hurt and agony they endured in situations with no good options. Their choice for termination is always based on love. They are motivated to end or prevent suffering. To suggest these people and their medical professionals need a law to consider foetal pain is particularly cruel. We should be discussing the support we can put in place for these women and their families. Many, mainly those who need terminations for medical reasons, still have to travel abroad to get care that should be available at home.

I will clarify the reality that has been greatly distorted by earlier contributions. Foetal anomaly terminations are carried out in line with best medical practice as part of a larger care plan in ways that are humane and minimise distress. Healthcare practitioners are highly trained and obviously already follow the highest ethical duties of care. These complicated and sensitive cases have to be guided by medical science and ethics, not dictated by anti-choice Deputies or external groups. This Bill is unnecessary, inappropriate and hurtful. Instead, we should be discussing the ways we can ensure compassionate abortion care. Our legislation still falls very far short of international human rights law and medical standards.

Before I move on to the review, which is what we should all be talking about and how we can better the legislation, I wish to refer to Deputy Cullinane's comment and Sinn Féin being determined to ensure women in Northern Ireland can access abortion case, we would all like to believe that. Perhaps the Deputy can explain why Sinn Féin keeps abstaining when it comes to Democratic Unionist Party, DUP, Bills in the North that seek to limit that.

Regrettably, it seems the Minister for Health has chosen to review the operation of the current law rather than the legislation itself. The experiences of women over the past three years cannot be disregarded by the State. The glaring issues, which were identified early on, remain and will remain for years if the Minister remains committed to the status quo. I think we all hope that will not happen.

We must ask the following. Have the Government parties learned nothing from the referendum? Do they still think of this as a subject to be avoided rather than accept the people are clearly in favour of safe and supportive abortion care? The current law does not represent this. It is a shame the Government has not yet been clear on whether it will provide the necessary review.

As I have mentioned, people in the most heartbreaking situations are still forced to travel due to the restrictions under the current law. These restrictions have no basis in medical science. Instead of women, their partners and doctors making decisions based on best practice and compassion, they must get legal advice. This needs to stop. This was a key issue for many voters in the referendum. Never again should a family enduring a traumatic situation be forced onto a plane or a boat.

Similarly, the mandatory three-day waiting period, which is not evidence-based, has a negative impact on those seeking abortion care, especially in rural areas where access to transport and providers is limited. This delay is medically unnecessary and only serves as an additional barrier. It must be removed.

Abortions need to be decriminalised. This is another oppressive tool that creates uncertainty, forcing medical practitioners to make legal rather than medical decisions.

Ireland still does not provide proper maternity and pregnancy care. Earlier routine prenatal screening and perinatal genetic services are still not available. Maternity units are understaffed.

The current law is restrictive and harmful. It puts in place arbitrary barriers, creates uncertainty for medical professionals, and forces women and couples to continue to travel for terminations. It is within the Government's power to change all of this and it must act. The Bill before us needs to be voted down today. I welcome the Government's position to help achieve that, but I will still push for the real review we so desperately need.

This Bill is upsetting for the women and families who have had later abortions. It is also insulting to our healthcare practictioners. Anybody who canvassed during the referendum will remember that when they knocked on doors and talked to people, many of them were voting yes for the people who needed to travel for terminations for medical reasons, and they are still forced to do that.

This Bill represents sensationalism that has no place in any humane system concerned with best medical practice. It definitely has no place in a republic that voted overwhelmingly for free, safe and legal abortion care. The days of this House controlling the bodies of women and girls has passed whether the sponsors of the Bill realise it or not.

I wish to share time with Deputy Barry.

I understand what Deputy Cairns meant when she said she had hoped this Bill would not be before the House and that it is not something we wish to face. Given I am a good bit older than her and been through a life of political activism, all I can say is get used to it. Every time you make one step forward, they will try to grab two steps backwards.

This is not the first time I have seen women's gains in this country being chipped away at and an attempt made to erode them. I have seen the same happen with workers' rights, water charges and very many campaigns we have fought on behalf of communities, the oppressed and, in particular, on behalf of women, because we have a horrible legacy in this country of the oppression of women.

This Bill smacks of an attempt to roll back on the gains of the repeal the eighth movement. People should not forget how earth-shattering that movement and outcome were. It was absolutely groundbreaking stuff in terms of the history of this country and the shape of the future. How it happened was through people power and, in particular, through the massive determination of young women throughout the country to see their rights attained and not to have to live in the dark atmosphere in which their mothers, sisters and all the rest had to live and grow up in, be sexually active in, and be potential mothers in or not at all. That is why I think what is happening here today is straight out of the playbook of American fundamentalism.

One of the most honest speakers here today has been Deputy Danny Healy-Rae because he mentioned the heartbeat several times. It is interesting that, not that long ago, a piece of legislation was brought in in Texas, known as the heartbeat legislation, that basically bans abortion once a heartbeat can be detected in a foetus at six weeks. Most of us would not know we were pregnant at six weeks. They have been chipping away at this for decades since the Roe v. Wade judgment, and the Texas legislation makes it possible for any citizen to sue another citizen for helping a woman procure an abortion. That is dark ages stuff, and this in a country where abortion was once upon a time available and part of the health service. Chipping away at women's rights is something we can expect over the next period.

Last night I read back on the transcript from the debate in the House when the group of Deputies who have put forward this Bill also supported an amendment when we tried to frame the regulations around the termination of pregnancy. It is carbon copy stuff; there is nothing any different.

I, for one, am not surprised this Bill is before the House. I will expect it or something similar to come before the House again whenever time allows because what it is trying to do is to row back on the rights women have won and were long fought for, as has been said by other Deputies, by spreading misinformation, doubt and hoping to create hoops, loops and jumps women will have to go through before they can access abortion. They cannot ban it outright or object to it outright but they will try to chip away at it. The kind of Ireland that would bring us back to is the kind of Ireland that saw mother and baby homes, Magdalen laundries, symphysiotomy and women being absolutely ignored in terms of their medical needs.

We, as Deputies, are not in a position to pass laws that say whether medical procedures require anaesthesia. Abortion care should be a normal part of medicine in this country and treated in the same way as other procedures, so that when doctors need to administer them, they should be able to administer them.

It is precisely that type of right-wing, religiously motivated political interference we have all become familiar with through the A case, the B case, the C case, the X case and the Y case. We have known the sort of pitiless regime that was imposed on women in the past.

I welcome the defeat of the DUP Bill in Stormont last night. I welcome the fact Sinn Féin changed its position and voted against that Bill. It must be said that was a result of the pressure of people power and the activism of young women across Northern Ireland.

I want to make a very clear point about why we take up these moral attitudes about pregnancy, reproduction and women. It is shameful these attitudes are taken in a country where 2,500 children will sleep in homeless accommodation tonight and more than 2,000 children are in direct provision. We know for sure that affects their ability to live a happy life. Growing up in those circumstances affects their mental health. These are children who have been born. They are walking, thinking, breathing and living. I wish I could hear the Deputies who have brought forward this Bill kick up the same amount of fuss as regularly about children who have been born as they do, both inside and outside this House, about those who have not yet been born. The choice of the woman is involved and that is always totally ignored.

We can expect more of this. There are protests outside abortion clinics and GP centres where abortions are being delivered. That is a fundamentalist view. We need to look forward to the review of the termination of pregnancy regulations, to ensure the three-day barrier is removed and we put an end to only 10% of GPs providing services.

What is Fianna Fáil playing at? Here we have a Bill from a group of right-wing Deputies who supported the de facto abortion ban, a policy which forced hundreds of thousands of Irish women to travel abroad for healthcare, and who are trying to copy the playbook of the Trumpian right in the United States who are trying to undermine Roe v. Wade. The Deputies want to roll back the gains made by women in 2018 when the country voted to repeal the eighth amendment. A Fianna Fáil Deputy has co-signed the Bill and is backing up these reactionary arguments without facing any censure or disciplinary action from his party.

More important, we have a Fianna Fáil Minister for Health trying to narrow the three-year review of the legislation and shut out the voices of women who have real issues with the way the Act operates in practice. I am talking about women who rightly feel the three-day wait provision is deeply patronising and who will make more significant decisions in their lives without having to wait three days. Those women also find a powerful point of support for their point of view in no less an organisation than the World Health Organization. I am talking about pregnant people who ask why it is the case that 12 weeks is equal to 12 weeks plus six days in matters generally relating to pregnancy but 12 weeks plus zero days in this case. I am talking about reviewing the question of access to the new services. Why do only one in ten GPs provide the service? Why do nearly half our public hospitals not provide the service? How do we provide safe access and prevent the ongoing intimidation of women accessing services?

Abortion on the grounds of severe foetal anomaly remains criminalised. This needs to be reviewed and changed. To be clear, I support a woman's right to choose and am in favour of removing a far broader layer of restrictions, but if there is to be a review, it should not be narrow. It should deal with the real-life experience of pregnant people in accessing the new services over the past three years and it should be an external, transparent and woman-centred review.

What we have here before us is simply a Bill for the prevention of cruelty. I will, therefore, appeal to all Deputies, including those who support legal abortion, to join in voting for this Bill, which merely shows a measure of compassion for unborn children at a relatively disadvantaged stage in their prenatal development. I can see no legitimate ground for objecting to it. In fact, some will say the Bill does not go far enough. It only requires pain relief where, first, there are reasonable grounds for believing the pregnancy concerned may have reached or exceeded 20 weeks or, second, it is likely that pain could be caused to the foetus arising from termination of pregnancy. I wholeheartedly support this Bill because I recognise it seeks to achieve what seems achievable in the House on the issue of pain relief. Most of all, I support it because it is a positive and unimaginably important step for every unborn child who needs the protection of its providers.

Most of us will know the joy of seeing ultrasound pictures of a son, a daughter, a grandson or a granddaughter of 20 weeks or younger. Just as we cannot deny the humanity of that child, visible before our very eyes, equally we cannot deny how visible and clear is the humanity of another child when seen at the same stage. A 2016 review of the evidence concludes that from the 15th week of gestation onward, the foetus is extremely sensitive to pain stimuli and this fact should be taken into account when performing invasive medical procedures on the foetus.

In answering a parliamentary question I asked in October, the HSE confirmed that dilation and evacuation abortions are happening in Ireland. The gruesome details of those horrific procedures are too graphic to describe during this debate. The use of such procedures only further underlines the urgent need for pain relief.

Some in this House will say this matter should be left to the doctor to decide. They will see the flaws in this view if they consider it. If a doctor were about to perform a procedure intended to take such a Deputy's life without his or her consent, would he or she think the same doctor is well placed to decide whether to give pain relief? Does the Animal Health and Welfare Act leave it to veterinarians to decide whether to give pain relief to animals? It does not. The law does not stop at the hospital door. Doctors are subject to legal duties and prohibitions of many kinds. The past three years of complete failure to ensure pain relief to unborn children have shown that this cannot be left to the medical profession and must be addressed through statute. I call on Deputies to take this opportunity to address it now for every unborn child who desperately needs the protection of this Bill.

I support the foetal pain relief Bill, which I was happy to co-sponsor when it was introduced in May. I continue to support its humanitarian measures completely and I encourage my colleagues to allow this Bill to progress to Committee Stage. The Bill will place an obligation to give pain relief to unborn babies before late-term abortions. Scientific evidence now suggests unborn babies can feel pain before 20 weeks' gestation. This was pointed to in a recent article published in the peer-reviewed Journal of Medical Ethics in 2020. By providing pain relief to unborn babies, we are simply doing the decent thing in light of the growing medical evidence.

It is worth repeating the point that late-term abortions are happening in Ireland. Under the 2018 abortion legislation, three separate sections allow for the provision of late-term abortions under broad and vague terms. In these circumstances, unborn babies are extremely likely to feel pain. The proposals contained within this foetal pain relief Bill would ensure these babies did not have to suffer pain as their lives were being ended.

It is important to note the proposals contained within this Bill are specific and not linked to other aspects of the abortion debate. Providing unborn humans with pain relief is a measure based upon fundamental principles of human rights and ethics. I would appeal to Deputies to approach this Bill on its particulars and judge it on its merits.

The most recent guidelines from January 2020 set out by the Institute of Obstetricians and Gynaecologists in Ireland make no reference to the provision of pain relief medication for babies in late-term abortions. By contrast, extensive protections exist in Irish law for animals to ensure they do not suffer unnecessary pain. If basic animal welfare is considered necessary and good, why is the same principle not applied to humans? This is a legitimate question which should be addressed without any side-stepping of the issue.

A similar amendment to the Health (Regulation of Termination of Pregnancy) Bill was tabled in 2018 but was rejected, unfortunately, before the new abortion law came into force. I hope the passage of time and the presence of new evidence which has since come to light will impact on Deputies and encourage them to consider this Bill today with a fresh perspective. It is extremely unfortunate that pain relief was not included within the abortion legislation from the outset. That would have avoided the issue surfacing again now. The best time to rectify this issue is now rather than later.

Providing pain relief medication for unborn babies undergoing surgical procedures for spina bifida and similar ailments is widespread general practice. However, during abortions, the same measures are not applied. This is an unfair inconsistency that is not based on any ethical or scientific consideration but is based simply on whether a baby is wanted or unwanted. Irrespective of a person's views on abortion, this inconsistency should be addressed and a provision set in place to ensure unborn babies are spared the pain inflicted upon them in an abortion.

Although this Bill concerns abortion, it does nothing to impact on the operation of abortion in this country.

It simply addresses an easy fix to a problem. The problem is increasingly being considered internationally in countries such as France, where 97% of late-term abortions are provided with pain relief medication as humane measures. This can be done in Ireland as has been done abroad. In context, the current three-year review of the abortion legislation is important. The issues raised within the Bill should be taken seriously by the Minister for Health. We need this issue to be taken seriously.

In the first two years of abortion in Ireland, 13,243 babies had their lives ended by the State abortion services. By the end of this month, 20,000 individual living, human beings will have their lives ended by the State. That is an incredible situation on the basis of legislation passed by the Minister of State’s party, the Labour Party, Fianna Fáil, Sinn Féin and People before Profit. That is 127 babies a week that are losing their lives in this State because of this particular law. It is equivalent to the total to 850 classrooms of children who will never make it to school, who will never get to live and grow up, like the Members who were sitting here at a number of minutes ago. In the North of Ireland the Sinn Féin MLAs voted against children with disabilities being able to make it to full term. They voted for abortion right up until birth for a child with disabilities.

When it comes to this law, these same political parties will argue that the State imposes in legislation rights for animals. Indeed we have those rights for animals in law in this State. It states "A person shall not ... perform an operation or procedure ... involving interference with the sensitive tissue or bone structure of an animal ... without the use of an appropriate anaesthetic". Yet, the same right is not being afforded to individual living human beings during late-term abortions in this State. There is a cruelty. There is a lack of compassion. There is a lack of sympathy in the ideology that forces these political parties to ignore completely the humanity of these living individual human beings. I urge the Government parties to make sure they vote for this particular Bill and to make sure that they are not remembered for generations for their lack of compassion.

Deputy Pringle is sharing time.

I start by taking a moment to acknowledge and commend those who shared their personal stories and experiences of late-term abortions. I understand that, for many, dedicating so much unnecessary time constantly rediscussing this topic can be incredibly triggering. In reality, that is what this discussion and this Bill are: completely and wholly unnecessary. The best argument for this comes from Deputy Nolan herself. When introducing this Bill, she stated that doctors administer pain relief as a matter of course. She knows well, as does the whole Rural Independent Group, that doctors will administer pain relief when required. They do not need to be legally obliged to do so. Any suggestion this is not the case is completely disingenuous and Deputy Nolan herself has confirmed this is the case.

Most instances of late-term abortions occur due to high-risk or emergency situations, so this Bill is attempting to address an issue that does not even exist. It is a made-up issue and a made-up Bill with the sole purpose to mislead the public. Let us call this what it is. This is nothing but an attempt to rally anger and cause outrage. I am not naive enough to think that the Rural Independent Group does know what it is doing by introducing this Bill. This Bill has nothing to do with good medical practice. This is a blatant attempt to create confusion and upset and nothing more. I emphasise that technically this Bill does nothing. The sole aim of the Bill is to confuse and to divide the public. It is malicious, disingenuous and a massive waste of time, to be frank.

The Rural Independent Group is against all abortion at any stage or by any means, and while that is fair enough, I refuse to indulge in this hidden agenda to obsess over what women do with their bodies, dressed up as a Bill. Some 66.4% of this country’s electorate voted to repeal the eighth amendment in 2018, yet this group is still forcing conversations about abortion care. It is clear what our citizens want, and we would do well to respect this vote rather than trying to undermine it at every given opportunity.

Instead of participating in this time-wasting exercise, I would instead like to use my time to address the important issue of the repeal review. When abortion legislation was passed three years ago, we were told that issues with this legislation would be addressed in the repeal review. Yet now the Minister for Health, Deputy Donnelly, has stated the review would look at its operation but is not intended to examine policy on terminations. This review is important and we must use it as an opportunity to address problems with this legislation. It needs to be a wide-ranging review that is not just limited to the procedure itself. It should address with the current system and ensure people do not have to travel to get their rights.

The Abortion Rights Campaign has stated that participants found the mandatory three-day waiting period demeaning and induced undue stress and anxiety. The three-day waiting period must be removed. It places extra barriers in the way of women, and the delay is medically unnecessary. I also call for the review to ensure free, universal abortion care for everyone in Ireland, including those without a PPS number and those in Northern Ireland. I commend the MLAs in the North who rejected the DUP Bill to stop terminations for non-fatal disabilities yesterday. Such a Bill would have been a massive step backwards for this island. I urge the Irish electorate to support those fighting for abortion rights in the North. We must make sure abortion is free, safe and legal across the island of Ireland and that nobody is left behind on this.

I strongly criticise the Rural Independent Group for its intention to deceive the public and rally anger. I ask its members to put showmanship aside for once and use their time to address issues that actually exist rather than using every chance they get to induce a shouting match for media coverage.

The Minister said earlier the issue of foetal pain relief in the termination of pregnancy can be dealt with in the upcoming review. I would like some clarity on this. Will the terms of reference allow it? Will it be part of the review? That is an important question. The Minister determines the terms of reference, so he has the answer. We need a policy response on this issue.

To be honest, I was not even aware of this issue until a few months ago. In my ignorance I assumed a foetus, an unborn child, would automatically be provided with some form of pain relief, analgesia or anaesthetic before an abortion procedure. It never occurred to me this might not be the case. I have spoken to many others and they have the same opinion as me. I am not sure what is going on here and I will come back to that issue in a moment. In some ways I wonder what I am doing making a request in the Dáil for a foetus about to be aborted to be treated humanely. I know the vast the majority of healthcare workers are decent, humane people who dedicate their entire lives to saving lives and to ensuring quality of life.

I thought maybe it is not the role of politicians to draft primary legislation on this and that maybe we should leave this to our healthcare professionals. However, I was wrong because I looked at the Animal Health and Welfare Act 2013, which obliges vets to administer pain relief during any procedure carried out on animals where they are likely to feel pain. Some colleagues say guidelines are sufficient, but is this in any guidelines? Is this a choice for healthcare professionals? I very much want to hear some clarity on this situation.

I have heard other colleagues speak about what this Bill does not do. They are right. Like any amendments to legislation, it deals with a specific issue only and that does not negate its value. The abortion debate is over. The people decided. Our role is to ensure the legislation in place works for all concerned. That is why we are having a review, and the issue of foetal pain during termination needs to be part of that.

I have heard comments from colleagues that this Bill is proposed by anti-choice public representatives, by right-wing Deputies. That is divisive language. We have managed to negotiate a way forward in Ireland because many people - not all but many - were careful with their language on both sides. Many people looked at the complete picture and not just the bits and pieces they supported. That is why I believe all of these issues, such as access to services for women, compassion and care for women and for the foetus to be aborted, is all part of the picture. We do not need to revert to the debates of the past. We heard some of them here this morning. We need to move forward in the most humane way possible. As legislators, we need to look at all aspects and not leave out any aspect.

It is widely accepted that unborn babies over 20 weeks, and very possibly younger, can experience pain. Even if that is just a possibility and if it is only one in 100 cases, we cannot ignore that. In my opinion nobody loses if we require the administration of pain relief to a foetus before and during abortion. Nobody loses.

I thank the Members of the Dáil who contributed to the debate on this Private Members' Bill. The Minister and I recognise there are deeply held views on all sides of this Oireachtas on the Health (Regulation of Termination of Pregnancy) Act 2018 and we must respect them all. What Deputy Harkin said about the choice of language used on all sides is also very important.

The 2018 Act enables women who need it to have access to termination of pregnancy services in a safe manner in our own community, where possible, and to have this service free of charge. The legislation provides for termination to be carried out in cases where there is a risk of serious harm to the health of the pregnant woman, where there is a condition present which is likely to lead to the death of the foetus either before or within 28 days of birth, and without restriction up to 12 weeks of pregnancy.

Termination of pregnancy is a medical procedure. It involves a medical treatment. It is therefore best carried out by medical practitioners in a safe and regulated medical environment, which can ensure the best possible outcome for a woman's health.

The purpose of the legislation is not to regulate obstetric procedures which do not constitute termination of pregnancy, nor is it to dictate the practice of obstetrics or of medicine more generally. Medical practitioners are always required to maintain professional standards and to uphold medical ethics. They are bound through professional regulatory mechanisms to deliver medical services in accordance with the best medical practice. However, the detail of best medical practice is set out in clinical guidelines rather than in primary legislation. It is not appropriate to insert compulsory care pathways or treatment plans in legislation. A review of the Health (Regulation of Termination of Pregnancy) Act 2018 is under way. This review will assess if the termination of pregnancy services provided for in the legislation are being delivered and will identify any barriers or issues with the effectiveness of these services. Women who use the service, our health professionals who deliver the services, members of the public and members of stakeholder groups can input into the review and outline any concerns they have with the operation of the 2018 Act. The review will allow a detailed examination of the provisions of the Bill to be undertaken, receive expert evidence and make recommendations on the operation of the 2018 Act. When the review is concluded a report will be submitted to the Minister for Health for consideration. He plans to submit the final report on the review to the Government with a request it be referred to the Oireachtas for discussion.

Therefore, it is recommended by the Government to urge the House to decline to accept this Private Members' Bill to be read a Second Time and allow time for the review of the Health (Regulation of Termination of Pregnancy) Act to conclude.

I am proud to be a co-sponsor of this Bill. I questioned the Government Chief Whip, the Minister of State, Deputy Chambers, yesterday to find out what was happening with regard to this Bill and I was disappointed the Government decided at such a late hour to oppose it. It would not even give it an airing to be read a Second Time. I am very sad this Bill is even necessary but today’s debate is not about opening a wider discussion. It is about trying to find some common ground and ensuring, at a minimum, no baby is ever forced to die from abortion while suffering excruciating pain. The Minister did not reassure me of that in any make, shape or form. He said pain relief can be included in the review. It is not a matter of "can”. We have it for animals. It should and must be included in the review.

Regardless of where colleagues in the House stand on the issue of abortion, I call on them to treat this Bill separately, to look at the scientific evidence coming to light with regard to foetal pain and to support this small but compassionate proposal that will achieve one thing and one thing only, namely, it will ensure unborn babies do not have to endure unnecessary pain and distress during late-term abortions. That is all it is about. I will not even reply to other Deputies’ attacks about it. I do not mind being called right-wing or anything else if it means we get humanity and pain relief for a human being. If we cannot stand for that, where is our moral fibre?

Since the abortion legislation was passed in 2018, new research has been published confirming the reality of foetal pain from 20 weeks' gestation and suggesting unborn babies likely feel pain even much earlier than that, as Deputy Danny Healy-Rae said. As legislators, we cannot ignore what the scientific research is saying. The evidence is becoming clearer each day that unborn babies feel pain, but even if some colleagues remain to be convinced of that, that is not a reason to oppose the Bill. If there is even the slightest possibility an unborn baby could suffer pain and distress during a late-term abortion, that should be a sufficient reason to back this Bill in terms of humanity.

The truth, however, is that the situation is not as vague or unclear as some might suggest. The facts are clear that unborn babies do feel pain and we should act to alleviate it wherever possible. I would strongly urge colleagues to look at the expert testimonies from medical consultants and sonographers before congressional hearings in the US on the issue. The testimonies of women and parents at the same hearings whose babies were aborted without receiving pain relief make for particularly difficult viewing, but they tell a story that cannot be ignored if we want to face the truth and act in a humanitarian way. In one of the Senate hearings in the US, Dr. Gary George, a senior radiologist at Miami Valley Hospital in Dayton, Ohio told the hearings:

While doing my first ultrasound rotation, I observed my first "selective reduction" procedure, of one of the triplets at about 14-18 weeks. I observed while the ultrasonographer scanned the three babies and provided live images so that the obstetrician could aim a long needle through the mom’s uterus into the chest of one of the baby’s hearts in order to make the lethal injection. As the sharp needle touched the baby’s chest, the baby immediately withdrew and started to rapidly move his arms and legs. The needle was unable to penetrate the chest. The mother started crying when she saw the horrific live images on the screen. Her husband told her not to look and the obstetrician instructed our ... [technical team] to turn the screen away from the mother’s view to hide the reality of what was happening.

Dr. George’s testimony continued in that way. I will refrain from giving the House any more of the graphic details of what he went on to describe, but it is awful stuff. Over and over again, similar testimonies have been given to various public hearings. We cannot turn a blind eye to what is happening. We must acknowledge the reality of foetal pain and do something about it. I salute Deputy Nolan, my colleagues and other Deputies who put their name to our legislation and will support it.

In England right now, a woman who had an abortion at 23 weeks is pursuing a legal challenge on the grounds she was not informed her baby could potentially feel pain at the stage in pregnancy the abortion took place. Are we going to wait for that to have to happen here?

In addition to ensuring unborn babies are given pain relief before late-term abortions, those considering late-term abortions are entitled to be informed about what the science says with regard to fatal foetal pain.

When we shroud the whole issue in secrecy, we do an enormous disservice to women and unborn babies. I would add that 100 healthcare professionals have recently issued a statement in support of this Bill. We are not alone in our concern and we know that there is compassion among those working in the health service as well. It would be much better to be open and honest about this. Why can we not be open and honest about what is happening? We know it is happening and there is no point in hiding it.

It is now routine practice for unborn babies receiving spina bifida operations in the womb to be given pain relief. The Dáil passed legislation in 2013 placing an obligation on vets to administer pain relief to animals, even during minor procedures, to ensure no animal has to suffer unnecessary pain or distress. How can we possibly treat unborn babies less humanely than animals? I remind the House that in Northern Ireland last year, a vet was prosecuted under similar legislation for not administering pain relief. Have we lost our humanity completely? Where is our moral compass? We have it for animals but not for babies.

We got lectures here about the homeless. The Independent Deputies and other colleagues who signed this legislation care deeply about the homeless and we will not be lectured by Deputies Cairns and Bríd Smith. They will argue that they have compassion. They are also interested in animal rights but they are opposing the most basic humane, medical treatment for unborn babies. We are talking about lives, not foetuses as they like to describe them.

The suggestion that the issue of administering pain relief should be left to clinical guidelines is not satisfactory by any yardstick. We introduced primary legislation in Ireland in 2013 to ensure that animals are given pain relief. Why should the provision of pain relief for unborn babies not be given the same recognition in law? A child in kindergarten could answer that question because it is a no-brainer. Leaving it to the guidelines that will be introduced is a sure-fire way of guaranteeing that nothing will happen. Guidelines were promised three years ago when the Government introduced the abortion legislation. Three years on, there are still no guidelines which is scandalous. Ensuring that babies receive pain relief before late-term abortions is not something that can be left to chance. We have to guarantee that it happens. It belongs in primary legislation, despite what others might say. Deputy Pringle accused those bringing forward this compassionate Bill of time wasting but one must ask where is his moral compass and that of other Deputies. This debate belongs in this House and we are entitled to propose legislation when the Government has not issued guidelines.

This is not a medical issue and it is most certainly not a political issue. It is a humanitarian issue. It would be terrible to acknowledge the need for pain relief to be given in every situation involving animals and humans, except for unborn babies. Why would we single out unborn babies and deny them the right to basic pain relief before their lives are ended by abortion? I cannot get my mind around it. We have an opportunity with this Bill to ensure that unborn babies enduring late-term abortion are shown at least a modicum of respect and are not made to suffer unnecessary pain and distress during the abortion.

I urge my fellow Oireachtas colleagues, particularly members of the Government, not to engage in delaying tactics on this issue. Let us, for once, do something that needs to be done. We want to do nothing more than alleviate unnecessary pain and suffering. That is all we are asking for. In other jurisdictions they have found a way to administer pain relief to unborn babies. Why not in Ireland? If we come together on this issue we can find a way. This House brought in abortion legislation that some of us opposed. We accept that legislation but we want to make it humane and to cut out distress for unborn babies. What this Bill seeks to achieve, and manages to achieve, is a compassionate, humane and practical response to a very tragic situation. It deserves the full support of this House and I wholeheartedly urge colleagues to vote in its favour today.

There were 6,666 abortions in the first year. What a figure. We know what 666 signifies. Now the total is over 20,000 and is growing, with approximately 128 per week. My goodness, our future doctors, scholars, politicians, scientists and entrepreneurs are being denied the right to life but worst of all, they are being denied any bit of dignity or pain relief before the horrific procedure that takes place. I appeal to the compassion of the Government. I am very disappointed that the Government has proposed an amendment referring to the review. The terms of the review have not been finalised and everybody is arguing over them. The Minister said this morning that this might be included in the review. Pain relief for unborn babies must be in the review. It should be the top priority for all of us in every review but three years later, there is no sign of it. Where is our compassion?

Amendment put.

In accordance with Standing Order 80(2), the division is postponed until the weekly division time this evening.

Sitting suspended at 11.57 a.m. and resumed at 12.01 p.m.
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