Health (Assisted Human Reproduction) Bill 2022: Second Stage

Minister of State at the Department of Health (Deputy Anne Rabbitte)

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

I am standing in for the Minister, Deputy Stephen Donnelly, who is unwell and unable to attend in person. He is disappointed not to be present for this critical and historic legislation, which will introduce for the first time a regulatory framework for assisted human reproduction, AHR.

AHR is a complex, innovative and fast-moving area of medicine and this legislation will support thousands of people who wish to have children to do so safely through AHR. It will clarify the legal position of children born in Ireland as a result of AHR and will provide an ethical framework for research on new reproductive technologies. Ireland is very much an outlier internationally. The State is not funding advanced AHR treatment and we do not have a specific regulatory framework in place in respect of this area of healthcare. This means that individuals are availing of complex and sometimes risky procedures in what is effectively a legal vacuum. The new rules, regulations and provisions under this legislation will help bring guidance, clarity and peace of mind. First and foremost, the legislation will support prospective parents undergoing AHR treatment at what is usually an incredibly stressful time. That stress can be financial, psychological, physical or a combination of all three.

Importantly, these legislative measures will support the health and well-being of all children born as a result of AHR treatment. The Bill fills a legal vacuum in respect of domestic surrogacy. Significantly, children born through surrogacy will, under this legislation, have the right to access information on their gestational and genetic origins. The commencement of this legislation will also support the advancement of our plan to provide advanced AHR treatments, including IVF, in our public health service.

The Bill will build on the excellent work that is being done by the Minister, the Department of Health and the HSE in the area of women's healthcare. As Deputies will appreciate, this legislation will mean a great deal to many and I look forward to working with Members of both Houses on progressing it as swiftly as possible.

The Bill itself has been long in gestation. I acknowledge the ground-breaking work undertaken by the Commission on Assisted Human Reproduction. More recently, the Joint Oireachtas Committee on Health's pre-legislative scrutiny process and last year's report of the special rapporteur on children have been of great assistance.

They have helped to inform the underlying principles and policies of the Bill. We have had very welcome and constructive input from various civic groups, including but not limited to, the National Fertility Support and Information Group, LGBT Ireland, Irish Families Through Surrogacy and Equality for Children. I thank all of them for their work in this area.

The Bill comprises 11 Parts, 161 sections and seven Schedules. This underpins the complexity involved, but also demonstrates the substantial considerations and work done to develop a policy and legislation for the first time in this field. A more detailed section by section analysis of the Bill can be found in the accompanying Explanatory Memorandum, but I will now briefly outline some of the important features of each Part.

Part 1 covers standard provisions, including definitions, regulations, expenses and commencement. Part 2 primarily sets out certain general criteria which need to be fulfilled prior to the provision of AHR treatment, including in respect of minimum age limits, the safety of any child born as a result of such treatment, the provision of appropriate information and counselling and the obtaining of all required consent prior to the commencement of treatment. As recommended by the Joint Oireachtas Committee on Health pre-legislative scrutiny report, upper age limits for women undergoing AHR treatment will now be set in secondary legislation in line with the principles and policies set out in section 11(2) of the Bill. There is also a general requirement that prior to the provision of AHR treatment a reasonable expectation must exist that at least one intending parent will live until any child born as a result of such treatment reaches adulthood.

Part 3 covers a broader range of matters relating to gamete and embryo donation than the issues of parentage and non-anonymous donations addressed in the Child and Family Relationships Act 2015. Provisions in this Part outline the conditions and restrictions relating to an individual or couple donating gametes and embryos for use in the AHR treatment by others. It also covers its use in research. It outlines specific requirements relating to people wishing to access AHR treatment involving donated material. For instance, there are specific requirements relating to the prohibition of the donation of embryos other than supernumerary embryos, which are embryos created and stored for the use as part of a person's own AHR treatment and which remain unused following the completion of that treatment, and the prohibition of commercial gamete and embryo donation whether for the purpose of providing AHR treatment to others or for use in research.

Part 4 allows for a person under the age of 18 who is due to undergo medical treatment which is likely to cause a significant impairment to his or her fertility to be provided with AHR to facilitate the subsequent storage of his or her gametes. Also, in this Part, there is provision for the Minister to make regulation to specify a maximum period for the storage of the gametes and embryos, but in the meantime a period of ten years is applicable. This can be extended with the express permission of the assisted human reproduction regulatory authority, which will be established. I would like to acknowledge that the last two provisions outlined were raised by the Joint Oireachtas Committee on Health as part of its pre-legislative scrutiny process.

Part 5 outlines the circumstances under which an AHR treatment provider will be permitted to offer posthumous assisted human reproduction. This is an application of the AHR technology to achieve a pregnancy using the gametes of a deceased person or an embryo created using the gametes of a deceased person. The 2017 general scheme set out that a deceased person would be only considered a parent of a child born through the use of his or her gametes or embryos where the child is born within 36 months of a parent's death. This provision was inserted to facilitate the orderly administration of a deceased's estate. Importantly, and as advised by the Joint Oireachtas Committee on Health, this has been removed. Instead, there is an emphasis on those contemplating posthumous AHR obtaining detailed relevant legal advice prior to consenting to it.

Part 8 provides for the establishment of the assisted human reproduction regulatory authority, outlines its powers and lists its functions, which include the licensing of AHR treatment providers and research facilities; promoting, monitoring and enforcing compliance with the legislation; collecting and publishing information in respect of AHR procedures and gamete and embryo donations carried out in the State; preparing and approving codes of practice for the guidance of licence holders; establishing and maintaining the national surrogacy register; and taking on the function of maintaining the national donor-conceived person register.

The Minister, Deputy Donnelly, is committed to having regard, alongside our colleagues the Minister for Justice, Deputy McEntee, and the Minister for Children, Equality, Disability, Integration and Youth, Deputy Roderic O'Gorman, to work on a newly established special joint Oireachtas committee on international surrogacy, as this Bill progresses through the Houses of the Oireachtas. I strongly believe that this legislation will support and benefit all of those using assisted human reproduction, AHR, treatment, as well as the children born as a result of it. I commend the Bill to the House.

Deputy David Cullinane

I welcome the Minister of State, Deputy Rabbitte. This is very important legislation for the Minister for Health, Deputy Donnelly. I wish him well and I am sure he would have wanted to be here to move this legislation today. I acknowledge the work he has done in this area, and the fact that he is bringing forward the Bill. I wish him a speedy recovery.

I welcome the introduction of the Health (Assisted Human Reproduction) Bill 2022, and the opportunity it provides to us to speak on this and related issues. It has been a long time coming. It has been too long for some families and it is important that we get it working as soon as possible.

Sinn Féin will be supporting the Bill at this Stage, as it provides for a much-needed regulatory framework for assisted human reproduction treatments and related research, which we have sought for a number of years. Importantly, it provides for domestic altruistic surrogacy arrangements, which will help many families in the State avail of surrogacy where they require it, without needing to travel abroad or engage in complex, non-standardised agreements, which may or may not protect the rights of the child and the rights of parents.

The Bill does not at this stage deal with the difficult question of international surrogacy arrangements. This is an area we need to give serious consideration to, and we must get it right. As the Minister of State said, a special committee of the Oireachtas is to be established. I also understand and appreciate there are very complex moral and ethical issues that arise from international surrogacy that need to be dealt with in a more sensitive way. It is also a service that many people have used, for their own benefit and for the benefit of the children they now have. There are very real issues that need to be addressed. It must be a rights-based approach that protects those involved and does not lend itself to permitting exploitation of any kind, but which fundamentally recognises the situation that some families have, unfortunately, found themselves in. Hopefully, the Bill will provide an effective alternative by providing this framework for domestic altruistic surrogacy arrangements. There are, however, many families who exist in the here and now, and others who may come into being between now and the commencement of each of these sections, to whom this Bill may not apply once enacted. It will take some time for the regulatory authority to be up and running, and we must be conscious of the needs and experiences of families in the meantime.

Sinn Féin will work constructively with the Government, with the Ministers in government, and with other parties through the special committee, which will be established. I hope we can come to an all-party agreement on how to deal with the difficult legal and ethical problems the issue poses, with a solution that protects the rights of children, parents and surrogates. It is essential that we do not ignore the use of international surrogacy and the likelihood of this continuing between now and the availability of domestic surrogacy arrangements, and that we regulate it appropriately thereafter.

For me, the biggest potential omission from the Bill is the rights of parents and children who, in the here and now, are having issues with securing full parental rights. I have met with many of them over the past months. Many of them I am sure will welcome the Bill but they have their own concerns which, unfortunately, will not be addressed in the context of this Bill. The Government must ensure all of the rights that will, hopefully, be enjoyed by future parents through surrogacy are available to those parents and children who need certainty now. As it currently stands, for an intending mother of a child born through surrogacy, there is no route to legal parentage other than adoption, even if she has provided the egg from which the child was conceived and is the child’s genetic mother. There are many cases affected by this issue and I have spoken with families who are looking to the Government and the Minister for Health to solve the problem. Perhaps the issue will be addressed in the context of the special committee to be established. I certainly hope so. I would have hoped, however, that in some way it would have been addressed in the Bill. It is unfortunate that it is not addressed.

A case I remember in particular is that of Antoinette and her husband Barry from County Offaly, whose children Eanna and Doireann were born in Kyiv. Antoinette and Barry’s story was told last summer in the newspapers and I heard them speak on radio of their experience. The law, as it stands, means that when those children arrived in the State, Antoinette was not legally the mother, despite the fact she is recognised as the mother in Ukraine. This is because the law in Ireland only recognises the person giving birth as the mother. The Bill, in section 62, provides for the recognition of parentage only in the context of permitted surrogacies subsequent to the Act. That will not help the many mothers and parents in a similar situation, and it is not clear if it is the Government's intention to provide a pathway for all of those left in a legal limbo due to the current system. It means that mothers of children born through surrogacy between now and the commencement of domestic surrogacy arrangements, which could take years to be enacted and to work, will not be entitled to maternity leave, yet the father will be entitled to paternity leave. It will mean that they cannot travel alone with the children, cannot take medical decisions for the children, and are not seen as the parent. If something was to happen to the father, in these instances, there could be very serious difficulties for families stuck in this situation. We must ensure full rights for both parents, and I hope the Government will be able to move on this, and perhaps clarify whether or not these issues will be dealt with comprehensively when the special committee is established.

I hope the Minister of State will agree that we must ensure the rights of these parents, and that the Government must provide for the retrospective or retroactive recognition of their rights where it can. I am sure we will get legal opinion and legal advice on all of these matters in due course, and obviously we must take on board that legal opinion. It is heartbreaking to listen to the stories of families who are in this situation and in this legal limbo. We need to regularise the situation and make sure the rights of the mother in these circumstances are upheld, are protected and are in place. Unfortunately, that is not the case at the moment.

One of the most important aspects of the Bill is the establishment of an assisted human reproduction regulatory authority. I thank the Minister for Health for taking this approach. I believe it is the right approach. This authority will regulate and provide information on the range of AHR treatments and services open to patients across the health sector. Importantly, its principal function is to ensure the health and well-being of children born as a result of AHR treatments, persons undergoing treatment, and intending parents. It must be a holistic approach, and the fact that an authority is to be established signals that intent. It is welcome that there will be such an authority to safeguard their rights, and which can provide information to prospective patients. This must be established as quickly as possible, with its board and CEO appointed as soon as possible, allowing for the appointments process to take its course. Staffing and resourcing this authority is a key concern, and I would welcome any additional information the Minister of State can provide on the resources it will need, and on when the Minister or the Minister of State can expect those resources to be put in place.

In the final part of my contribution I will focus on public provision of services. We need to make sure opportunities for assisted human reproduction treatment are available to everybody, and not just to those who can afford it. As the Minister of State will be aware, families who need access to fertility treatments, IVF, and other services to aid in having children, must access this privately. It costs a lot of money. It can cost from €10,000 to €20,000 or €30,000. Sometimes, families must get two or three rounds of treatment before there is a success. Many cannot afford to do it. It is heartbreaking for them when they spend all of that money, it does not work out, and they do not have the money to try again. This is wrong. While there is a huge cost to this, we must look at expanding this out as a public service. While the Bill and the regulatory authority will bring some cohesion to the sector, and ensure higher quality services and more certainty, many families will simply not be able to afford the cost.

Once this Bill is enacted, I ask the Minister of State and the Government to make it a priority to develop the public services available to families who cannot meet the cost of going private.

While the Minister of State is in the Chamber, I would like to meet her about children's disability services and the recent High Court judgment about assessment of needs. I am sure she will agree it was a very important judgment. We want to make sure children get the services they need, as I am sure the Minister of State does as well. I would welcome an opportunity to meet on that issue.

Deputy Patricia Ryan

I also welcome this Bill. As my colleague Deputy Cullinane has said, it will ensure AHR practices and related areas of research are conducted in a more consistent way and with the oversight of a new watchdog, the AHR regulatory authority. Under the legislation, this new regulatory authority will be responsible for regulating treatments such as IVF and licensing and regulating domestic altruistic surrogacy, pre-implantation genetic diagnoses and other embryo screening procedures, as well as posthumous assisted human reproduction. Regarding research involving embryos and stem cells, the legislation sets out which practices are prohibited and which are allowed, and how they should be regulated.

According to experts, the UK's legislation combined with the Netherlands' financial legislation section is the most effective hybrid model of best practice for this area in Ireland. It has been five years since the drafting of this legislation began and more than 15 years since the Commission on Assisted Human Reproduction called for new laws to govern practices in this area of great ethical complexity. It is clear that this legislation is long overdue. The role of the new regulatory authority will be essential to embedding safe and appropriate clinical AHR practices in this country. The new authority will also maintain a new national surrogacy register and the existing national donor-conceived person register.

We need strong protections to ensure adequate oversight of this fast-moving area of medicine. We must ensure adequate protection for the thousands of people who wish to have children safely through AHR and must clarify the legal position of children born from AHR. We must also ensure research around new reproductive technologies is carried out within a prescribed ethical context.

It is disappointing that the legislation does not contain provisions in respect of international surrogacy. I understand a special joint committee is being set up to examine all aspects of this complicated issue and I hope its recommendations will be addressed swiftly.

It is over five years since the current Tánaiste announced the Government would introduce publicly-funded fertility treatment. It is almost three years since the Government announced funding for IVF and fertility treatment and publicly committed to funding a model of care for infertility as part of the public health system. There are thousands of people who need support in order to access consultations and diagnostics for both men and women experiencing fertility difficulties. We need an urgent roll-out of the public model of care for infertility. Those who need IVF can expect to pay between €4,000 and €4,500 for one course of treatment. The costs can escalate, depending on what treatment is necessary, as Deputy Cullinane has said.

Ireland and Lithuania remain the only EU countries not to offer state funding for assisted reproduction, even thought the World Health Organization recognises infertility as a medical condition. This Bill is a step in the right direction but there is a long road ahead. The Government is lagging behind private companies, which often get a bad rap in this House. I commend Vodafone, which recently announced that it would extend its fully-paid 26 weeks of maternity leave to those who become parents via surrogacy. It also offers 16 weeks of paid leave for non-primary caregivers, whether they become a parent through birth, adoption or surrogacy. On top of that, it announced ten days' paid leave for employees who experience pregnancy loss before 24 weeks, whether it happens to the employee, their partner or their surrogate. It also offers flexible and hybrid working options and ten days' paid leave each year for those undergoing treatment, with two days for their partners. Meanwhile, Bills on similar policies at governmental level continue to stutter their way through the legislative process. Let us not forget the constitutional crisis caused when the Minister for Justice, Deputy McEntee, decided to take the standard six months of maternity leave. She was the first Cabinet Minister to do so in Irish history. It is time to catch up.

Deputy Mark Ward

In November, Sinn Féin and other parties stood in solidarity with families and parents as they presented letters to all three Government parties outlining their concerns at the lack of progress in delivering appropriate assisted human reproduction legislation. I join my colleagues in welcoming that this legislation has progressed. Sinn Féin supports this Bill in principle. We welcome a regulatory framework for assisted human reproduction, which will standardise access to and rights around IVF, surrogacy and related research.

However, there are two major omissions from the Bill, namely, international surrogacy arrangements and retrospective recognition of parentage. I am aware that the issue of international surrogacy arrangements will be dealt with by a special committee, which has now been established. I wish that committee all the best in its endeavours as it sets about that task. This special committee is being set up to examine all aspects of this very complicated issue with a view to issuing recommendations within three months, including on international surrogacy arrangements. Failure to address international surrogacy means this legislation will not be fit for purpose for Irish parents who have either used the services of a surrogate in another jurisdiction or are considering it. It is incumbent on the special committee to issue strong recommendations to support parents who are in this position. I am calling on the Minister of State and the Government to give the strongest message possible to parents who have used the services of a surrogate in another jurisdiction that their concerns will be listened to, and acted on, within the three-month timeframe set out. The Government has been found wanting on this issue in the past and is playing serious catch-up in the ever-changing and evolving family creation environment in Ireland.

We have all heard from mothers who, two and three years down the line, are not considered their child’s legal guardian while fathers, just because of the biological nature of their relationship with the child, are immediately deemed to be the child’s legal guardian in the eyes of the law. This needs to change and it needs to change immediately. The Government has to listen to families about their concerns and experiences and must deliver the changes that are needed.

On the retrospective recognition of parentage, it is not clear from the Bill that the parental and guardianship rights for children born through surrogacy will apply to families that already exist. We must ensure that these children and each of their parents, where there is more than one, have full rights. This is particularly important in the event of the death of the parent with guardianship rights, where the other parent may not have completed the legal process of also becoming a parent or guardian of the child. Would-be parents of surrogate children can spend years battling in court for basic parenting rights.

Currently, the mother or second parent is not entitled to those rights and has to settle for guardianship, which expires when their surrogate child reaches 18. This legal limbo means, for example, that until the mother of a surrogate child is granted guardianship rights, she cannot give consent for her child to go on a school trip, open a bank account, or even apply for their first passport. Once that child reaches the age of 18, he or she would also have no legal standing when it comes to making important health decisions about the parents. If the mother or second parent dies, the child would have the same legal status to their parent’s estate as a complete stranger. These are the things I am hoping this legislation will resolve. On this issue, Irish Families Through Surrogacy has said:

Our children are Irish citizens and deserve to be afforded the same provisions as every child in Ireland and have a legal relationship with both parents. At the moment, Irish children are being left in legal limbo as they can often wait years to be granted parental rights to one parent before guardianship proceedings can even take place for their second parent.

The Bill is also very important from the perspective of non-surrogacy assisted human reproduction, such as IVF. As has been said already, the Minister of State needs to ensure that IVF services will be made reasonably available through the public health system. Currently, the only option for parents who require IVF is to go private, which means only a certain demographic of people are able to access it. That must be ruled out.

A regulatory framework that upholds the rights of children born through surrogacy is paramount.

We need to ensure it prevents children born from surrogacy being left in legal limbo or being stateless.

Deputy Duncan Smith

I welcome the Minister of State, Deputy Rabbitte. As was articulated by Deputy Cullinane, I want to note that the Minister, Deputy Stephen Donnelly, has done an awful lot of work to bring this complex Bill to the House so I am sure he is sorry to be missing out on this debate. It is not lost on us that he has done an awful lot of work to get this long overdue Bill before us.

It is a long and complex Bill but it is not one that resolves everything. It is a foundational Bill that we hope will provide regulatory certainty around this area. The arrival of this Bill on Second Stage today will provide an air of relief, not that we have reached the finish line as we are far from it but because it is an important moment now that this AHR Bill has finally reached the Dáil. There is a desire from the Government and the Opposition to move the Bill through as expeditiously as possible, while also being as careful as possible. It will require and be subject to a number of amendments and suggested amendments because we are not dealing with an area that is simple or straightforward. The sheer length of the Bill is testament to that and we welcome this move towards finally regulating AHR in Ireland. The word "laggards" is used an awful lot in other areas and we certainly have been behind our European sisters and brothers in regulating this area. There are people all over this country who have been waiting for this Bill for many years. For many it has come too late and we need to recognise that but there are those who hope that we will be able to move it forward and that, in line with the model of care for infertility, which the Government is pushing and funding and which will need to be scaled up dramatically, we are on the cusp of a proper, publicly-funded and well-regulated model of fertility care in this country. That is somewhere that the vast majority want and need us to be.

The establishment of the assisted human reproduction regulatory authority, AHRRA, is welcome and it is the foundational element of this Bill. It is the right approach to take. The AHRRA will have to adjudicate, decide and provide certainty on a lot of complex issues. One area the Bill deals with is posthumous AHR, which is complex and which has ethical and moral questions. People are suffering from the lack of regulation on this. Anyone going through assisted reproduction has been doing so without the regulation that this Bill will provide through private clinics, many of which operate different standard operating procedures. The clinical care has been good, it has been paid for and it is expensive. However, there are different models of operating procedures in different clinics.

People go for AHR for many different reasons. Some go because they have life-limiting conditions and because they are looking to start a family before their health deteriorates. There are others who are otherwise in perfect health who need assistance with fertility. If a tragedy befalls these people and one of the prospective parents unexpectedly and tragically passes, then all that is left in any physical form might be this gamete, this embryo which is now in a clinic. The clinics have different operating procedures and when you go to a clinic and you are in good health and you do not have a life-limiting condition, your headspace is not about what will happen if you or your partner loses their life. It is about creating life so when a tragedy occurs and one prospective parent is left, he or she is subject to the small print of the many forms he or she will have signed and the vagaries and rules of that particular clinic. This Bill and the AHRRA will need to make provision for the people who are dealing with that situation now.

There is also a provision in the Bill that a surviving partner will be unable to access posthumous AHR for a year. I am sure that provision is in place because of grief and having to deal with same but we are often dealing with people whose clocks are running down. Time is very important to these people so there needs to be a provision to deal with that because a year is really important at a certain stage in life. There are no easy answers to this and we may not be able to capture this in legislation. It might be possible to capture this in the practices of the AHRRA and it is something I would like to see discussed further.

There is no doubt that the Bill is a huge and positive step in the right direction. Delivering this framework and regulating for assisted reproductive care is beyond a necessity at this stage. There are many different elements to this issue and we want to work towards a public model of assisted reproductive care. There are workers' rights issues and the Labour Party brought forward a Bill on this in the Seanad on the back of the great work of our Lord Mayor of Dublin, Councillor Alison Gilliland and the Irish National Teachers Organisation, INTO, in terms of leave for people who are going through fertility treatment. That is another important and practical part of this debate that needs to be discussed. We have talked about the costs of this Bill and that issue will have to be met with a proper model of public care. We will need strong workers’ rights on leave to ensure that people are able to take the time they need to get their treatment and deal with the consequences of same, be they positive or negative. There is a Bill in place that has all-party support and that should be progressed.

This Bill will also help to tackle what has been quite a stigmatised area over the years, as people have felt that if they have had to go through assisted reproductive care, they have somehow failed. They have sometimes had to go through that journey in silence without the support or knowledge of their close friends or family. It is totally untrue to suggest that these people have failed. In recent years we have seen people come out to share their fertility journeys, whatever those journeys may be. They should be applauded and while an awful lot of their work has been soft in the sense that it has not been direct engagement in pre-legislative scrutiny, for example, it has created the environment in which this Bill has finally been brought to the Houses of the Oireachtas. I want to acknowledge those individuals around the country who go on social media and tell their social networks that if they have a question about the process they can ask them. People in my life have put their hands up and invited me to ask them about their fertility journeys and offered to answer any questions I might have. That is not an easy thing to do and the people who do it have played an important role in getting us here. They are not part of any particular group but they need to be acknowledged.

The Bill speaks to domestic and altruistic surrogacy, which is long overdue. International surrogacy has been put into the remit of the time-limited all-party committee. That is good if it works and if it is progressed but it is not good if it is seen as something that is being kicked down the road. I do not think that is the case and that is not the sense I am getting; there is a desire and energy to deal with this. Ukraine is another example of why we need to deal with this.

To see that progress and to deal with the difficult issues, it is to be hoped that a way through them will be found because the reality on the ground is this is happening. Judgments can be made and we need a rights-based approach to this but at the end of the day, if I get a call from my childcare provider that my child needs Calpol, because he is running a slight temperature, I can give that permission but there are parents in this country who cannot do so because they had their child through international surrogacy. These are the practical problems encountered. Who loses out in that situation? It is the child.

It has been more than 15 years since the publication of the report by the Commission on Assisted Human Reproduction in 2005, which called for new laws, and five years since the general scheme was published in 2017. I have mentioned that we are way behind internationally in regulating this space, unlike other EU countries, and that is why this Bill is welcome. There are cost barriers to IVF and assisted reproductive therapies at present. This is where we need to get to in this country. While this is a foundational regulatory Bill, the real proof of its success will be if we have an egalitarian and properly democratic public system that is not just open to those who have the means and the many thousands of euro that are required. Many people do not necessarily have that money on tap. They have to get loans that have to be paid back with interest. That is where we need to be. In the UK, the NHS funds IVF treatment. As we have seen in recent years that it has become harder to access for couples, it is important that the model of care we roll out is robust and future-proofed.

Part 6 of the Bill covers the complex ethical area of pre-implantation genetic diagnosis and sex selection. This is an area of concern for many people and it must be closely regulated. It is important to differentiate between pre-implantation genetic diagnosis, most commonly associated with cases in which there is a known family history of a genetic mutation such as cystic fibrosis or Huntington's disease, and the broader case of pre-implantation genetic screening that often presents other ethical issues due to age or parental concern in which embryos are checked for sporadic mutations or chromosomal abnormalities. We can remark how important this area is for so many families and how it is a chance to address the great burden many families face where there is a known history or genetic risk of devastating inherited diseases, such as cystic fibrosis, Huntington's disease, haemophilia, or fragile X syndrome, to ensure their children do not carry the condition where pre-implantation genetic diagnosis is deemed acceptable and applicable.

Critical to the regulation of pre-implantation genetic diagnosis, PGD, however, is ensuring there is a publicly funded option for IVF, as I discussed, and funding for necessary screening. I ask the Minister of State to confirm that the HSE will fund pre-implantation genetic screening for embryos where it is deemed ethically applicable, and that there would be a system in place to support families. Will the Minister also confirm what approach will be taken for families who decide to pursue the screening of their embryos where there is not a known family history or specific genetic disease, for example, if they decide to screen for chromosomal abnormalities or sporadic genetic mutations where the age barrier may not apply? Again, they are important, difficult questions that we need to nail down.

Human leukocyte antigen, HLA, typing of embryos is provided for in the Bill in order that the child's HLA matches that of a sick sibling, often for stem cell donations or treatment of specific genetic diseases or leukaemia, and are often called saviour siblings. This would avoid the rejection of the stem cells by the sick child's immune system. This is, again, a very sensitive issue in which there are concerns about the possible exploitation of the child, but the Bill does provide clear criteria. As this is a constantly evolving area of medical practice, it should be kept under constant review. I urge the Minister of State to consider specifying in the Bill that the board of the AHRRA establishes an ethics committee, as recommended in the pre-legislative scrutiny, and that the resources are put in place for the funding of genetic services, including geneticists and genetic counsellors, and the provision of pre-implantation genetic diagnosis where it is deemed to be necessary by the board. I will finish on that point.

The international commercial surrogacy issue will go before the special Oireachtas committee and that has to go in tandem, inasmuch as possible, or at least follow on as quickly and expeditiously. There are other related issues, as I mentioned, such as the Organisation of Working Time (Reproductive Health Related Leave) Bill. However, the model of infertility care needs to be properly funded and properly rolled out. If this Bill works and we have a regulatory framework that is trusted and is up to the international standards that we strive for, and that we have a public model of infertility care that would be open to all coming behind it, we will finally be able to catch up and provide the healthcare that we need and have a responsibility to provide for the people in this country who are looking to create life, to nurture life, to love life, and to provide life. I look forward to what the Minister of State will say in summing up this Stage, as well as to seeing this Bill progress through the subsequent Stages.

Deputy Emer Higgins

I am delighted to have the opportunity to debate this Bill today. It has been a long time coming for an awful lot of families. I will begin by acknowledging the service that Ukrainian surrogates have provided for many Irish families. An estimated 400 Ukrainian women have given birth to Irish surrogate children, with 46 Irish surrogate babies born in Ukraine in the past year alone. At least four Irish surrogate babies have been born in a hospital in Kyiv since the outbreak of the war, and we know a number of other babies are due to be born for Irish parents in the coming months through surrogacy in Ukraine. It is an especially terrifying time for those Irish families and their Ukrainian surrogates and their families.

The tragedy of the situation in Ukraine emphasises why this legislation we are debating today is so crucially important. We do not have laws around commercial surrogacy. Ireland is one of the only European countries without any form of specific regulation around assisted human reproduction. The lack of legal footing leaves parents and surrogates in limbo especially in situations such as the current war in Ukraine. Offers have been made to many Ukrainian surrogates to come to Ireland but Irish Families Through Surrogacy has reported surrogate mothers being afraid to accept offers to come to Ireland in case their name ends up on the birth certificate after the baby is born here, in case they become legally responsible for that child, which is obviously an unacceptable situation for both parents and the surrogates.

As I said, this legislation has been a long time in coming and I give huge credit to the parents, families and organisations such as Irish Families Through Surrogacy, which have kept this matter on the political agenda. They have campaigned tirelessly. They have stood outside this building, and I have stood with them, and they have shared their private stories ever so publicly. I acknowledge all the work my Fine Gael colleague, Senator Seery Kearney, has done in this space for her leadership and advocacy for parents through surrogacy. The irony is that many men, women and couples who I have met have already completed their families. They have gone through the struggle of infertility, of IVF and of surrogacy, yet here they are fighting to be legally recognised as their children's rightful parents. They are also fighting to improve the process for future parents who will embark on these journeys, and I believe that is really quite selfless.

I welcome that the Bill will put Irish surrogacy on a legal footing and will make the dream of starting a family more achievable for many people. Sending people abroad for a service that we do not offer in Ireland sends a twisted message that is somehow wrong, however, it is anything but. We should be celebrating the advances in science and medicine, and the advances in society that allow us to create families in all kinds of ways. The fact that we are now legislating for assisted human reproduction is exciting and is something I am very proud we are doing in the Oireachtas.

I am a proud member of the Oireachtas Joint Committee on International Surrogacy and we had our first meeting today. I look forward to the work ahead of us in considering and making recommendations on the measures to address issues arising from international surrogacy. It is important that this committee has been formed and that it has been given such a wide-reaching and important agenda, yet such a specific timeframe to do our work. I know that all members are extremely dedicated to improving the experience of international surrogacy for all parents, children and surrogates concerned. With that said, we are asking the Minister of State to consider holding off on bringing this legislation to Committee Stage until the Joint Committee on International Surrogacy has concluded its work in order that it can be incorporated into the Bill.

We will be writing formally to the Minister of State to request this.

I appreciate that there are considered challenges with making this legislation work retrospectively, but I feel we must address the guardianship issue for parents who have already availed of instructional surrogacy. It is such a long difficult road for these families. When they are out the other side of it and have their babies, they enter into a whole new arena of identity complications. There are biological parents who have no legal rights over their child, cannot legally advocate or sign for them in medical situations and cannot even sign school permission slips. There are fears about what will happen if the relationship between a mother and the biological father of a child born through surrogacy breaks down. In this situation, there is, sadly, potential for a mother's lack of parental status to be weaponised against her and her child. While I hugely welcome that we are finally moving to establish surrogacy laws of our own, it is so important that we do not leave the parents and children who have already gone through international surrogacy in the dark. We cannot and I do not believe we want to forget about them.

As I said, apart from that is a more challenging situation for which to legislate. I accept that but it can, of course, be overcome. I know the Minister of State and all Government parties are committed to finding a solution to this. The report that was published last March by the special rapporteur on child protection, Professor Conor O'Mahony, contains excellent work on how we can develop a pathway to legislate for international surrogacy. I am really looking forward to working more on this at the joint committee and to presenting our recommendations to the Minister of State.

It is important to acknowledge the role this Bill will play in terms of access to IVF. Regulating treatments like IVF is something we should have done a really long time ago. Many couples throughout this country struggle to conceive. Many people feel that their families are incomplete without a baby and for so many of them, IVF will make their dreams come true. Regulating that and allowing better access - I believe the plan is eventually to allow for more public access to IVF - is so important for so many couples who otherwise may not have the option of having a baby.

I thank the Minister of State for all the work she is doing in this area. I know she is doing much work along with officials from the Department of Health. I wish her well on this journey. I also give our support do what she is trying to do and achieve in this Bill. I ask her not to forget the surrogates to whom I refer.

Deputy Louise O'Reilly

Sinn Féin will be supporting this Bill in principle. We welcome the regulatory framework for assisted human reproduction, which will standardise access to and rights around IVF surrogacy and related research. This is a piece of legislation on which people have been waiting a very long time. The Minister of State and I can agree on this. People who have been in this Chamber much longer than us have been having these debates for a long time. It is very welcome, therefore, that we have reached this point.

Notwithstanding that, the Bill is not perfect and amendments will need to be made. I hope the Minister of State will be open to amendments and to listening to people. There are those for whom the struggle to start a family or complete their family is very real. Just because it might not be in her personal experience or mine, we should really listen to and be led by them. They are the ones really who are at the coalface in the context of this matter. It is estimated that one in six couples in Ireland is affected by infertility. It is a condition that can cause considerable social, emotional and psychological distress. When one meets with the families, which I know the Minister of State has, that is very real and evident. It is something people do not really understand because, for many, it is a simple thing and they do not think about it. Maybe not thinking about it is the reason it happens in the first place. It is not a struggle everybody faces but the fact is that one in six couples do. We do not talk about it very much. We talk about it more now than when I was younger but we do not talk about it enough because there is still something of a stigma attached. The message can and should go out from this Chamber that we are willing and open to have that conversation.

Alongside that, access to IVF treatment it is not currently available publicly and the private costs are absolutely extortionate. People get themselves into the most awful crippling debt just to be able to start or complete their family. It is really important that any decent health system would provide for compassionate services for women who experience infertility, including assisted human reproduction and IVF. Those services should include full cycles of IVF for qualifying couples as well as access to a full range of treatment options and counselling. The counselling and mental health aspect is absolutely essential; it is important to acknowledge that. There is a clear recognition of the need to adapt to modern requirements and modern methods and approaches to family creation.

There is a fear that the Bill will not go far enough, which is why I absolutely welcome the Minister of State's willingness to engage. Stakeholders told me they believe this Bill does not address the issues, such as a lack of route to legal parentage other than adoption for an intending mother of a child born through surrogacy. We must ensure that there are full rights for both parents. However that is done, we will work with the Minister of State to make sure it happens.

Deputy Róisín Shortall

I would like to send good wishes to the Minister, Deputy Stephen Donnelly, for a speedy recovery.

The Social Democrats support this legislation. I hope there will be an open approach on Committee Stage and on Report Stage in terms of taking on board proposals and suggestions from the Opposition.

For far too long, assisted human reproduction practices in this country have remained unregulated. That has been very problematic. Responsibility for the provision of services has, in effect, been outsourced to the private sector. It has been 17 years - a long time - since the publication of the report of the Commission on Assisted Human Reproduction, which, among other things, recommended that a child born through surrogacy should be presumed to be that of what are termed the commissioning parents. In the intervening years, there has been no legislative response at all, making Ireland the only EU state with no specific legislation governing the area.

This abdication of responsibility has forced many heterosexual couples, LGBTQ+ couples and single people into the commercial fertility sector. It has also meant that many couples and single people can no longer aspire to parenthood. A public model of fertility care is really long overdue but the roll-out of this has been dogged by a delay after delay. This lack of urgency has meant that Ireland remains what many people have referred to as a laggard in this regard and reinforces the perception that such treatments are reserved only for those who are better off.

From a legislative perspective too, though, I will make the point that it is highly unsatisfactory that there has been such a long gap between the heads of the Bill being produced, pre-legislative scrutiny taking place and then the draft Bill being published. It is really unsatisfactory. That goes back so many years that very few people who will be dealing with the Bill now in this Dáil would have been involved in the pre-legislative scrutiny. That is completely unsatisfactory and goes completely against the whole intention of the greater scrutiny and pre-legislative scrutiny process itself.

From the outset, we all recognise the most glaring omission from this legislation, which is the issue of international surrogacy. Section 50 states that "a surrogacy agreement is a permitted surrogacy only where the surrogacy is a domestic surrogacy", thereby failing to recognise international commercial surrogacy arrangements. I fully appreciates that the new all-party committee has been established to look at the whole issue of international surrogacy and make recommendations. The reality is that many parents and children have been left in a legal limbo. Understandably, when there was the option to participate in international surrogacy, many people availed of it but they have been left now in a legal limbo. In many ways, that is unforgivable and has raised some of the most fundamental issues and questions for those families concerned, both for the parents and also for the children. I certainly urge the new committee, while wishing it well and hoping it will complete its work in the timeline outlined, to acknowledge it is really important that as well as making recommendations on policy with regard to international surrogacy going forward, there is a real urgency about addressing that legal limbo in which so many existing parents find themselves along with their children.

Those legal gaps need to be addressed as a matter of urgency. Section 50 states that "a surrogacy agreement is a permitted surrogacy only where the surrogacy is a domestic surrogacy". As I said, that fails to recognise the whole question of international commercial surrogacy arrangements. I completely accept the legal and ethical difficulties associated with this matter. It is regrettable that we are debating this legislation in the absence of provisions relating to international surrogacy. Like other speakers, I would ask the Minister of State to give a commitment. While this is urgent and while we need to see this Bill passed as quickly as possible, it just will not work for us to take Committee Stage in the absence of the report from the all-party committee that has been established. I would like confirmation that we will await the report from that committee and that we will take its recommendations on board. That is important. It will obviously be a further delay. Again, people will have to remind themselves of all the issues involved. It is by no means the ideal way to progress legislation. However, I would like a commitment that as soon as the all-party committee has completed its work that we will then proceed to schedule the Committee Stage debate relating to this legislation. As stated previously, the gaps in the legislation have been well flagged. They could not have taken the Government by surprise. The special committee was needed to consider this issue and to make recommendations. This should, of course, have been done long before the Bill began its passage through the legislative process, and not concurrently with it. Notwithstanding this peculiar situation, I would like to make some points in respect of international surrogacy. I am in favour of the altruistic model provided for in the Bill, but that does not mean that we can ignore the reality of commercial surrogacy in other jurisdictions. Even if we provide for domestic surrogacy, it is widely accepted that some people will continue to seek services outside Ireland. Whether we agree or disagree with practices in other jurisdictions, we must protect the rights of children who are born in this way and we must protect the rights of parents. The whole area of children's rights is a major element in this. It continues to be a major consideration. In 2020, the Government requested that the special rapporteur on child protection, Professor Conor O’Mahony, would examine the implications of donor-assisted human reproduction and surrogacy for children. This report, which was submitted in December 2020, recommended immediate and comprehensive surrogacy legislation to deal with both domestic and international surrogacy. Notwithstanding this recommendation to provide for both instances, Professor O’Mahony raised a caveat by stating that domestic arrangements should be incentivised. I support that. He also recommended that international surrogacy should involve a genetic link between the child and at least one intending parent to act as a safeguard against the sale and trafficking of children. That is sadly a reality in a number of different countries. There are indications that the trafficking of children is even on the increase. As a result, we always have to bear in mind that there is huge potential for the sale and trafficking of children, which must be avoided at all costs. These recommendations were made on the basis of two principles: first an acceptance of the reality of surrogacy as an international phenomenon and, second, the best interests of the child. In respect of the first principle, he pointed to Ireland’s legal obligations to comply with the minimum requirements of the United Nations Convention on the Rights of the Child and with the European Convention on Human Rights. For example, Article 8 of the European Convention on Human Rights requires states parties to provide a pathway to legal recognition of parent-child relationships arising from international surrogacy in all cases that involve a genetic link between the child and the parents. This is an obligation that we have yet to honour. With regard to the second principle, which is the best interests of the child, he points to certain inalienable rights. These include a child's right to family life, identity and non-discrimination. These rights must underpin this debate. We may want to prohibit commercial surrogacy, and we should certainly do that domestically. However, it would be remiss of us to ignore the availability of international surrogacy. The best interests of the child should be our primary consideration, as should the special joint Oireachtas committee. I have no doubt that it will be. Other concerns have been raised regarding the proposed provisions relating to domestic surrogacy. Section 62 only provides for the regulation of gestational surrogacy where the surrogate mother is genetically related to the child. It does not provide for traditional surrogacy where the surrogate's egg would be fertilised. While I appreciate the fears that traditional surrogacy could be more unstable than non-genetic arrangements, it seems to be the case that international evidence does not support these concerns. In the UK, for example, more than 50% of surrogates carry using their own eggs. In New Zealand, the figure is 60%. Research has shown that these arrangements are not any more unstable than non-genetic arrangements. Crucially, though, the omission of this approach from the legislation would exclude single people and couples who cannot produce sperm or eggs from surrogacy. These are important questions that need to be addressed. I hope that the Minister will address these issues on Committee Stage, because many people find it difficult to understand why that particular form of surrogacy has been omitted. The exclusion of traditional surrogacy is somewhat perplexing in light of the provisions in sections 63 and 64. My understanding is that traditional surrogacy arrangements are not provided for in the proposed regime. That is my understanding of it. I would like clarification on the matter. The reason for that is to ensure that surrogates have no genetic connection to the child. However, the Bill states that at birth, gestational surrogates will be the legal mothers and that the intended parents will need to apply to the court to seek a parental order. The assumption is, therefore, that the woman who carried the baby will be the legal mother. Then action must be taken on the part of the intended parents, who have to apply to the court to seek a parental order. The surrogate mother must consent to this transfer. This can only be waived if she is either deceased or cannot be located. This process would be completely understandable in the case of traditional surrogacy where the surrogate is the genetic mother, but it is less so in respect of gestational surrogacy. As the lecturer in child and family law, Dr. Brian Tobin, recently wrote in the Irish Examiner, one would be forgiven for thinking that this regime had been designed to make domestic surrogacy as perilous an undertaking as possible for Irish intended parents. While the international evidence indicates that the vast majority of surrogate mothers do not see themselves as the mothers of the children they have gestated, I am not certain that this provides sufficient reassurance to intended parents. This restrictive approach and the degree of risk certainly raises questions about this entire approach. It could result in disincentivising intended parents from availing of surrogacy in Ireland and, in turn, incentivise the very thing the special rapporteur on child protection warned against, which is international surrogacy.

Part 8 deals with the establishment and role of the assisted human reproduction regulatory authority. One of its most important functions will be the approval of surrogacy arrangement applications. This is a vital and much-needed role, primarily to ensure the proposed surrogate is suitable and not subject to any form of exploitation. A point made in some submissions on the general scheme of the Bill is that the surrogate is the most vulnerable party in any arrangement, bearing the negative emotional, physical and lifestyle risks of pregnancy. Therefore, her health and well-being needs to be central to any decision. Separately, given the pace of change and development in assisted human reproduction practices, it will be crucial that this authority be adequately resourced and staffed, not only to ensure the appropriate ethical and scientific oversight of proposed research and services but also in order that it will have teeth to intervene in disputes and handle complaints. Finally in respect of the regulatory authority, I urge the Minister to ensure that patient voices be represented strongly. Integrating the lived experience of people who have undergone fertility treatment into the regulatory process will be important, not least in the early days of the authority.

Aside from the provisions of the Bill, I raise one further issue with the Ministers of State. As I have previously said, the introduction of these services needs to be accelerated and I hope this legislation will be enacted speedily. It has been almost five years since the previous Cabinet approved the draft legislation. It took a further two years for the current Minister's predecessor, Deputy Harris, to publish details of the model of care for fertility, yet little progress has been made for many people. This is despite an assurance from the then Minister that publicly funded IVF services would be available in 2021. Not even the first phase of the three-stage model-of-care plan has been completed. While it is certainly welcome that four of the six regional fertility hubs are now operational, these hubs do not provide IVF, sperm donation or surrogacy services. They deal only with tests, diagnostic surgery and some non-invasive forms of assisted reproductive technology, thereby excluding single women, female couples and male couples. For those who can avail of fertility services in these hubs, the HSE's target maximum wait time is six months. In view of the current staffing situation and waiting lists throughout the health service, it is difficult to see how this target can be met. Furthermore, many female patients simply do not have time to wait because time is of the essence, as we know, particularly if they want to avail of less invasive or complex fertility services.

We all accept that a number of complex medical, ethical and legal considerations are associated with the provision of assisted human reproduction services. This issue raises difficult questions, but many people have suffered significant emotional and financial turmoil while successive Governments have grappled with the issue. Some have been forced to find services elsewhere, suffering losses abroad, while others have accumulated substantial debts. This cannot be forgotten, and I urge the Minister to expand supports for those who have fallen between the cracks. Given the costs and the emotional toll associated with assisted human reproduction, simply covering the costs of medicines falls far short of what is needed. We cannot continue to ignore and export our problems. Ireland has changed and our systems must respond. Women are spending longer in education and pursuing careers in far greater numbers. Same-sex marriages have been legal since 2015. The Gender Recognition Act was passed in that same year. These are just some examples of the changes that have occurred while our system has lagged behind. It is time it caught up with the realities of modern life. While an improvement in bringing forward this legislation is heralded, it does not address the entirety of the issues concerned. I hope the Minister will have an open mind when it comes to enhancing the legislation, not only in terms of incorporating the recommendations of the cross-party committee but also by having an open mind in listening to the proposals from the Opposition and taking on board amendments.

Deputy Jennifer Murnane O'Connor

I welcome any legislation that seeks to provide a framework for regulating surrogacy and addressing the gaps in the Children and Family Relationships Act 2015. It is good that the Bill will provide, for the first time in Ireland, regulation of this wide-ranging and technology-centred area of healthcare. Nevertheless, it is sad that the time spent waiting for this legislation to pass has no doubt seen many couples pass the age when they could have had a child via AHR. Almost none of the recommendations of the Government's special rapporteur on child protection have been included in the Bill, such as those relating to the pre-birth transfer of the parentage of a child born through AHR treatment or the ability of those under the age of 16 to access their birth information even through their parents, although it is good that those over the age of 16 will have that ability. Furthermore, there is nothing in the regulations regarding international surrogacy arrangements. It is a big issue that the legal recognition of children already born through AHR treatment is tied into the delicate issue of international surrogacy. They are very separate issues, with one much less complicated than the other, but we seem to be treating them the same and that is a big concern for me.

The current legislation governing the legal relationship that children born through AHR treatment can establish with their intended parent includes the Children and Family Relationships Act 2015 and the Adoption (Amendment) Act 2017. Some children born through AHR treatment procedures can establish legal parent-child relationships with their intended parents. Children born in Ireland using IUI, IVF or reciprocal IVF who were conceived in an Irish fertility clinic can be recognised as the legal child of their intended parents. The same cannot be said, however, for those born through surrogacy. I was happy to attend the inaugural meeting of the first Oireachtas Joint Committee on International Surrogacy today. There are so many issues we can talk about and, I hope, sort out in our important discussions as a surrogacy committee. The committee membership is really good and it is important we address all the issues that need to be addressed.

We have all seen the pictures emerging from Ukraine of babies who were born through surrogacy being cared for in shelters in the war-torn country because their legal citizenship is in question. Several couples who have had a child born through surrogacy in Ukraine had to be assisted by the Department of Foreign Affairs at the outset of the war because of the complications in the country. I have met families with experience of surrogacy who have told me of being forced to sit in a car while they waited for their child to receive treatment alone in the hospital, alone because they were not viewed as the legal guardian of their child who had been born through surrogacy. That does not serve the best interests of the child and the law here lets down such children. This is a big issue that has been raised me when I have met groups and it has to be addressed.

I regret that we have sidestepped this issue with this legislation, although I welcome the opportunity to tease out the issue in committee and I commit to working on the issue on behalf of the groups I represent. I welcome the changes that have been made to this legislation since the general scheme was published in 2017. It is welcome also that, for the purposes of the Bill, an adult is deemed to be anyone over the age of 16 and, therefore, as I mentioned earlier, surrogate and donor-assisted children will be able to access birth information. That issue of access is something I have spoken about in the context of many other types of legislation. I welcome also the removal of mandatory counselling for donors, but this was removed in order to enable donations from abroad. It gives me pause that we have not addressed international surrogacy in a similar way. We have removed only the language causing confusion about those who wish to seek legal advice about international surrogacy. This issue and others I have been reading about are ones for the committee to consider.

It is vital we develop a model of care for infertility to ensure the provision of safe, effective and accessible services through the public health system.

Fertility treatment is currently not available to public patients in Ireland although the tax relief for medical expenses scheme can be availed of. An attempt at IVF costs up to €5,000. Usually, there are many attempts. I have been speaking to parents who have come to me and they just cannot afford it. It is not one attempt. This is something that we need to address urgently.

In addition, there is the heartbreaking issue of a cancer diagnosis coupled with a man or woman seeking to have cancer treatment but also preserve his or her fertility. The issue becomes a larger one. Funding for the fertility preservation services for those with a diagnosis of cancer is currently €259,000. This has been in place since 2003 without increase, despite a growing demand for the service. If there is a real possibility of State funding for fertility treatment, which is important so that there is an equal chance for all families to try fertility solutions that suit their circumstances despite the odds, the provision of fertility preservation needs to be seen as part of these services.

For a female, up to the age of approximately 45, one of the first issues that will be thought about in the event of a diagnoses of cancer is future fertility, particularly for those who do not already have children. More and more women and men are surviving cancer and having their own biological child should not be denied to them if there is any way we can help. That needs to be another commitment from the committee. We need to make sure that we give everybody that chance. We must not continue to ignore the needs of society. Families cannot afford it.

This legislation could be so good but there are significant concerns. The biggest concern is money. Money is a major issue here.

Children born through fertility treatment or preservation are children who are wanted and loved long before they are born and will grow up to contribute to society.

To see this Bill progress, the Government's plan to introduce the provision of advanced assisted human reproduction, AHR, treatment, including IVF, in the public health system, specifically through the final phase of the roll-out of the model of care for infertility is really good news for me. I raised this issue when I was a Senator and have been passionate about it ever since.

Timing is crucial. We need to do what we can and get it done as quick as we can with everybody working together to make sure nobody is left behind.

Deputy Martin Browne

I welcome the fact this Bill has been published and that progress has now been made on setting standards around accessing rights when it comes to IVF, surrogacy and the complex matters connected to them. This is a positive development and is welcome for many families. We must ensure it is subject to careful examination as it makes its way through the Oireachtas in order that we do full justice for many families out there.

An important point to note here is that while the Bill does not deal with international surrogacy arrangements, this will be examined by the recently established Special Joint Committee on International Surrogacy. The work the committee will undertake is of vital importance to many families and I trust that when the committee issues its recommendations, those recommendations will be listened to and the witness accounts the committee hears will be acted on. We must not see a repeat of what we have seen with the recommendations of other committees in which lip-service is paid but preconceived ideas are followed through instead.

Sinn Féin has always stressed the need for a regulatory framework which upholds the rights of children born through surrogacy. This is a move in the right direction.

While this Bill will assist so many families, we need clarity that the parental and guardianship rights of children born through surrogacy will apply to families which already exist. We cannot allow any more inconsistencies or shortcomings in the areas of rights to continue into the future. As I said, certainty from the Minister is needed in the area of retrospective parentage. Any such shortcomings can have consequences down the line, both foreseen and unforeseen.

This Bill is also important from the perspective of non-surrogacy AHR, such as IVF. Ireland is the only state in the EU that does not offer publicly-funded IVF treatment. As a result, the high costs couples are faced with are a matter of great concern and can mean the difference as to whether they can plan to have a family of their own or not.

In 2017, the cost of a single IVF cycle in Ireland was between €4,100 and €5,900 and the cost of an intracytoplasmic sperm injection, ICSI, treatment was between €5,200 and €6,400. The Minister knows precisely the cost facing parents who find themselves facing this challenge.

In publishing the Bill, the Minister for Health, Deputy Stephen Donnelly, said, "The commencement of the AHR legislation will also allow us to progress the ... plan to introduce the provision of advanced AHR treatment, including IVF, in the public health system, specifically through the final phase of the roll-out of the Model of Care for Infertility." We, therefore, need certainty that the Government will fully implement the model of care for infertility and a timeline through which we can ensure patients always receive care at the appropriate level of clinical intervention. This assurance needs to be provided for those who require and are eligible for advanced treatment, such as IVF, and are able to access the same through the public health service.

Deputy Paul Murphy

I wish to share time with Deputy Barry.

I welcome the Bill and the establishment of the authority as a late and small step towards tackling the reality of Ireland as being in the Wild West when it comes to fertility care. The problem is that the Bill does not do anything in terms of the public provision of fertility care, in particular IVF, and, therefore, does not really address the key issue that Ireland is, according to a report launched by a Fine Gael MEP no less, Ms Frances Fitzgerald, the fourth worst in all of Europe in terms of the provision of fertility care and the only country in the European Union which does not provide any public funding for the provision of IVF.

This is not a new issue. This is not a new procedure. IVF was included in the list of universal healthcare entitlements to be introduced under Sláintecare. According to the 2017 Sláintecare report, a universal health system means one that is "accessible to all on the basis of need, free at the point of delivery (or at the lowest possible cost)." Therefore, this should clearly apply to IVF as a universal healthcare entitlement. Nothing has been done to progress this despite Sláintecare nominally being a policy that everybody across politics supposedly agrees to.

Since 2016, when the Tánaiste and Minister for Enterprise, Trade and Employment, Deputy Varadkar, first promised public funding for IVF, we have heard repeated promises from successive health Ministers to publicly-fund IVF but nothing has happened over the past five years and no timeframe for public funding of IVF has yet been provided by the Department of Health. What does that mean for people? The impact is immense on many people. One is not talking about a small group of people here. One-in-six couples experiences fertility issues. On a yearly basis, it looks like 11,000 IVF cycles are carried out, which would probably translate to approximately 5,000 or 6,000 couples on a yearly basis. That is those who can afford it in the context of the current unaffordable and astronomically-high prices for that fertility treatment.

For many people, this is something personal. It is in their relationship. They are struggling to have a child and they do not necessarily want to speak out publicly about it. They do not want to speak to reporters about it or whatever, and also, for some, there can be a certain residual stigma. It is a situation where people should not have to speak out but, unfortunately, in this situation where the Government ignores this issue and refuses to provide the funding as part of the provision of a proper publicly-funded national health service, people have had no choice but to speak out about their experiences to make this real. A number of people, for example, spoke to the noteworthy investigation at the end of last year. I commend them on speaking out about their personal experience to make this real and to explain what having a cost of tens of thousands of euro, the debt, the stress on their relationship, etc., means for them.

I want to add my experience and the experience of my partner to that list of experiences. We have been going through IVF for more than a year. Even putting the money aside, it is a significant stress on people. Above all, it is a significant stress on my partner. She is the one who has to get all the hormone injections. She is the one who has to go through the disappointment when it does not work at the end of a cycle and then there is a discussion about whether to go again and continue with the cycle of raised expectations and lowered expectations.

There is disruption in terms of work, due to the time that has to be taken to go to the clinic again and again and the disruption to life on a daily basis. Throughout different parts of the cycle, my partner has to be stuck with a syringe by me twice a day. It is a huge burden on her, in particular, but on couples as a whole, in general.

Then we come to the issue of money. It is hard enough for people to have to go through that in order to be able to give themselves the best chance of having a child, but then there is the associated cost. I have heard many people talk about the level of costs and, to be honest, they have not looked into it enough because they are talking about the average costs being €4,000, €5,000 or €6,000. That is the average cost on the price list to have IVF, but what people do not realise is that they have to do a whole bunch of other stuff that is also on the price list in order for the IVF to work. Already, we are talking about significantly more money. We have already spent probably €12,000 and we could end up spending more money and it may or may not work at the end of it. We must remember that for many people who want to have kids, they simply cannot afford to do it. Therefore, by not having public provision of IVF, the Government is saying to them there is unequal access to them having the best chance they can of having a child. It is morally wrong that it is determined by how much wealth someone has. Other people get into significant amounts of debt, which adds extra stress to their lives and relationships. It is simply not acceptable to continue with the current situation. What we need is free public provision of fertility healthcare as part of a national health service, up to and including IVF.

When the Government has spoken about it, it has talked about having public provision through the public system rather than being outsourced to private clinics. However, for example, the clinical director of Merrion Fertility Clinic, Professor Mary Wingfield, said there is no infrastructure or trained staff to provide the complex treatment of IVF or intracytoplasmic sperm injection, ICSI, in our public facilities. In her opinion, "it would most likely need to be outsourced to private clinics." That continues with the problem. I accept we will have a regulatory authority, but the problem of having for-profit medicine, especially in such an area where people are encouraged to pay for all sorts of stuff that is not medically proven to add anything, is an horrendous situation. By the public simply paying for this outsourcing, there are significant extra costs from the point of view of ordinary people because of the impact of profit. If we take the current under-resourced health system and say it is going to provide IVF, we are going to run into trouble because then we will have two-tier access, which is bad in all sorts of medical circumstances where time is of the essence, which is the case here. We will have a situation where, in theory, people could sign up for IVF, but they will be on a list for two or three years or for however long. As people who are going through it know, the chances of having a child successfully at a certain point, just drop precipitously in a year or two, makes a very big difference. Again, unless we provide for it properly and employ the proper staff and bring the knowledge in-house into the public system, then we are going to perpetuate a two-tier system.

This is linked to the question of the separation of church and State. It is not an accident that Ireland is the only country in the EU without public provision, considering the church dominance of our hospitals. The Catholic church remains completely opposed to IVF, yet the Government continues to want to effectively hand over ownership of the new national maternity hospital to the church. There needs to be separation of church and State and the building of a properly funded national health service, free from any church influence whatsoever. We must ensure that sufficient resources are put in so that everyone can have equal access. We are all born differently. That can create problems for certain couples, which means it is more difficult for them to have children than others, but with the benefits of modern medicine, we can go a significant way to helping people overcome those difficulties. We add an extra burden when we say people must have a lot of money or be able and willing to go into debt in order to do it. That is wrong. The Government can and should address it but, unfortunately, it looks like significant campaigning will be necessary to put pressure on the Government to do so.

Deputy Mick Barry

I am speaking to bring a socialist feminist analysis to this debate. Socialist feminism opposes cynical attempts to commercialise and make private profit out of the heartbreaking fertility issues prospective parents face. It opposes all attempts to profit from the systemic sexist and homophobic inequality rife in capitalist society. This includes recognising that infertility is a common and significant health concern that should be addressed via the public health service. Socialist feminism means standing for a totally secular state-of-the-art comprehensive public health service, free at the point of delivery, that actively seeks to eliminate the well documented, systemic medical misogyny.

Socialist feminism rejects patriarchal and backward views of the family that propagate rigid gender roles. It recognises that all sorts of diverse carers can make excellent parents, including same-sex couples, those who play a parent role who do not have a genetic connection to the child, single parents and gender non-conforming parents and actively seeks to bring men into caring roles equally. Socialist feminism seeks to make care something that is central to society, not something that is denigrated, undervalued, underpaid and also commercialised, as it is in capitalist society.

On the question of IVF, the current situation is a disaster for the vast majority of prospective parents who have to individually navigate an unregulated private system often with prohibitive costs involved. People get plunged into significant debt. Despite promises in 2019, there is still no access to IVF through the HSE. Meanwhile, successive Governments have essentially facilitated profiteers at the top of private industries. A number of companies that own private fertility clinics in Ireland reported profits in the millions, according to thejournal.ie in December. Access to IVF and other treatments as part of the national health service is the norm across Europe. In Scotland, for example, in the national health service, patients are offered up to three free cycles of IVF. This should be immediately brought in here without any further delay.

We must go further than just regulation of private operators. We must have access to free-at-the-point-of-use treatments for infertility. The funding for treatment that the Government has long promised and long delayed cannot just be a funnelling of funds into the private industry. There needs to be training up of staff and massive investment in the public health system so that these essential services can be delivered there. The public health system is already under-resourced. There are currently more than 30,000 adults waiting to see a gynaecologist, 6,000 of them are waiting for more than a year. Ireland is way behind most countries. It is a laggard in these respects. The legacy of the Catholic church and its continued influence in the healthcare system is a key factor. There needs to be cast-iron guarantees that access to IVF and other treatments that are not approved by the Catholic church will be available in all hospitals. This means the removal of any vestige of church influence on hospital boards and a rethink of the Government's decisions and current approach to the new national maternity hospital, which incredibly threatens to put reproductive healthcare back into the orbit of a religious order.

Given the sorry history of the State on matters of child welfare and women's health, I will be tabling amendments for democratic oversight of the assisted human reproduction regulatory authority. At a minimum, there will have to be representation on this board from children's rights advocates, workers in healthcare, human rights advocates and those with a record in campaigning for the rights of women.

I welcome the opposition to commercial surrogacy in the Bill. It is a global industry rife with ruthless profiteering and the exploitation of poverty and desperation in underdeveloped parts of the world. There are many cases of women caught in poverty who sign up to be surrogates often in order to have enough money to feed their children. Meagre pay, withholding of pay if the pregnancy ends tragically early, examples of companies that do not allow the surrogate mother even to touch the baby after it is born, which is incredibly cruel to the baby and surrogate mother, are all widely reported. Callously linking that to people who often have heart-breaking health complications and desperately want to love and care for a child, in order to turn a profit, truly makes this a grotesque industry that profits from and perpetuates gender inequality. In 2020, this global industry was worth more than $4 billion.

I support those aspects of the Bill that will give rights to children born through surrogacy. They should have the right to access information and to have contact with their surrogate mothers. The Bill seeks to protect surrogate mothers and allows some important rights for them that I support. It is important, however, to recognise that even with altruistic surrogacy undue pressure can sometimes be exerted on someone to agree to undertake it. Even if that person enters into it freely, the reality that every single pregnancy is a risk to health and, potentially, a risk to life can have major consequences. For example, the risk of preeclampsia, which is potentially life-threatening for the pregnant person and the baby, is greater for surrogates. The assisted human reproduction Act will be important and any new regime must be regularly and democratically reviewed and checked.

In a capitalist society, pregnancy not only risks a person's health but impacts on his or her income, pension entitlements, job progression and so on. We need to have a new society that protects pregnant people and ensures that the structural injustices built into the system are challenged. Across the board, there must be access to public childcare, full maternity benefits, full pension rights, two years parental leave, a shorter working week - with no loss of pay - to facilitate care and free healthcare. These types of changes are needed for everyone. Furthermore, any altruistic surrogates should not have to depend on expenses being paid by the intending parents. No person having a child should have to be out of pocket in the short term or in the long run.

Capitalism's booming surrogacy industry and the exploitation rife within it is emblematic of how the profit system turns even brilliant medical advancements into an opportunity for private profit, in this instance, in a way that is inextricable from capitalism's systemic gender inequality. A struggle for a socialist society is a struggle to put care at the centre of society and not relegate it to the bottom rung as the for-profit motive consistently does.

Deputy Neale Richmond

Over the past couple of weeks, Deputy Paul Murphy and I have probably spent a lot of time disagreeing with each other. If Deputy Murphy and I are frank, we have spent the past 20 years disagreeing with each other on many issues but there is not a single word he said just now that I cannot agree with 100%. We have to start off from this point. This legislation is so important to so many people outside this House and in it, from all parties and none, that it behoves all of us to add a genuine level of discussion of, and reflection on, what this legislation is seeking to do.

While we welcome the legislation in its current form and we will not stop it going past this Stage, it is woefully inadequate and long overdue. Even in its current form, this legislation still leaves us completely out of the European orbit and completely out of step with similar jurisdictions near us. We need to reflect deeply over the coming weeks during the debate in this House, at the committee on surrogacy and in the Seanad on what we are trying to achieve with this vitally important Bill.

The first area I will address is the costs and supports needed to have a properly funded system of IVF. We do not have any system in this State worth calling appropriate for IVF. We have a private system that very few can afford and genuinely play a part in. Far more people are more willing to take the boat or plane - a dark reference to another part of our chapter in another area of reproductive rights - to Great Britain to seek this service. We have to be honest with ourselves; we are failing the population. When I say "we" I pretty much mean all of us on this side of the House in particular. We have to ensure that we stop talking about a proper, effective, publicly funded system of IVF and just put it in place. It will require a major sacrifice, but it also requires a level of humanity that should not bring any question to the need for that sacrifice.

I mentioned costs but another area is that of the follow-up supports for those going through IVF, which includes the prospective mother and her partner but also the wider society, what happens after the child is born and the ongoing medical requirements that are needed. IVF is not necessarily a one-time go. It might take multiple chances before it is successful and it might require multiple chances for a second or third child, if that is the parents' wish. We have to look at it in that context. This is about allowing people to have the same level of equality of opportunity that so many of us simply take for granted.

The second area that this Bill simply does not address at all relates to international surrogacy. I welcome the establishment of the Oireachtas Joint Committee on International Surrogacy. It is a good thing but I will be honest that when I brought the news of the setting up of that committee to my constituents and family members of mine who had been campaigning on this issue, they were bereft. They asked why they again had to wait and why they had to wait so much longer before this is a reality. Why is it a fact that by sheer stroke of luck and so much else I do not have to go through any administration? My children are my own, no one questions it, there is no legal process and I do not have to wait three or four years before my daughter can legally be called such. Why is that different from so many other people in my life who are still not legally recognised as the parents of their children? It is utterly wrong.

I do not know the reason for the delay. I do not know whether it is an administrative delay from a certain Department, a political misunderstanding, political reluctance or, in fact, something more sinister but it is simply unacceptable. We need to see the committee that has been set up allowed to do its work comprehensively and swiftly to ensure that the next time we come at this Bill, be it on Report Stage or Committee Stage, it includes a genuine aspect relating to international surrogacy that provides those parents, Mums and Dads, Mums and Mums, Dads and Dads, and Mums or Dads the exact same rights that by sheer fluke of genetic luck I am granted and do not have to think about. These are rights that so many of us take for granted and ones for which we have to stand up for others.

Many of us have had meetings with various representative groups, many of us have sat on Zoom calls and many of us have gone out to the gates of Leinster House, but we cannot in any true sense of ourselves go back to those people and say that we have done a little of what they asked for. We have to do absolutely what they have asked for, which is quite straightforward. They have given us examples from other jurisdictions and sound legal advice. They have got assurances, certainly from Fine Gael, and I know other political parties and political representatives have given them the same assurances. We have that duty of care and that ultimate and most precious responsibility to go back to those people and say there is nothing any longer standing in the way of them being recognised as the parents of their children. We have to bring our archaic and utterly cold system, when it comes to surrogacy, up to date and to a level not just of modernity but genuine compassion.

It would be remiss of me not to mention the ongoing war in Ukraine in this context. I must credit the Department of Foreign Affairs and the Department of Justice, which have worked with many families to give them the opportunity to work with their surrogates in Ukraine and to bring their children - they are their children despite what forms might state at present - home to Ireland from Ukraine. There are still a number of people in an extremely worrying situation who are trying to get their surrogates out of Ukraine to safety, not just to have their children but to avoid the violent and oppressive war that Vladimir Putin is waging. On a more practical level, since Ukraine has been the release valve for many of the inadequacies of our State's approach to surrogacy over the past decade or so, many people will now not have the opportunity that others have had over the past couple of years to go to Ukraine to get a surrogate.

We saw this before with changes in international adoption rules over a decade ago in relation to Vietnam, Thailand and Russia. The fact that the opportunity to go to Ukraine and engage a surrogate and have your own child is being removed from so many people or is being put in peril for those already in the process needs to be addressed by the Government in a realistic and compassionate way and should also motivate us to ensure this legislation and the parallel work of the committee is expedited and that we do not use this as a platform to debate other ethical or non-relevant issues. We have to do everything in our power to stand up for the promises made in the last few weeks and to address the failings over decades which were endured by so many of our brothers and sisters.

Deputy Réada Cronin

I am glad to speak on this matter which is of such sensitivity and importance. There is a special onus on the State, given its history on the treatment of women and their babies. We must learn from our history and get things right for the children in order that their rights as citizens are guaranteed. Those of us who have children know what a blessing they are. I hope my children will not mind my saying that they are the loves of my life. However, many of us know the agony and heartbreak of couples who are trying to have babies through IVF. Many of us will have experienced infertility in our extended families. I have seen the weight and the hold of the process physically, mentally, emotionally and financially. That is why, with the opportunity presented in this Bill, as legislators we have the duty to support them. We should do so immediately by making IVF affordable on the public health system and not confined to the private system. We should make every effort to assist people who are trying to start a family and rear the next generation. I want to take the opportunity to wish Deputy Paul Murphy and his partner every good wish in their desire to start a family.

Sinn Féin welcomes the Bill in principle. For the first time there is a specific regulatory framework for all assisted reproduction treatments and associated research. However, there are two omissions. The first concerns international surrogacy arrangements. There is much in the news around Ukraine now and that matter is being dealt with by a special committee. This is vital when there is so much uncertainty about babies born, their legal parentage and citizenship, all against the backdrop of Putin's war. They cannot and must not be left in legal limbo or stateless. It would be a grave wrong to these children who have barely spent a few weeks in the world. We also have a duty of care to the women who are carrying these much-wanted children. Second, there is the retrospective recognition of parentage. We also have a duty to ensure that the child and each of their parents, where there is more than one, have full rights. This is particularly important in the event of the death of a parent with guardianship rights where the other parent may not have completed the legal process of becoming a parent-guardian of the child. We must make every effort to protect and solidify the family arrangement and give the people involved the security and peace of mind that they need.

I started by saying that we have a particular onus on us here because of our history on the treatment of women and their children. I am concerned about profiteering around surrogacy and the protection of the women carrying the children. We must tread carefully. Thinking of what happened with the mother and babies and the debates that we had around abortion, we cannot make mistakes again. We must be very careful.

Deputy Peadar Tóibín

I also thank Deputy Paul Murphy for adding his personal story to the debate. I wish him and his partner the best of luck in their endeavours. The issues at the heart of this Bill are incredibly important and significant. They range from the families which desperately seek to have a child but cannot to the rights of the child to have a family and know their mother and father to the rights that affect the mother who carries to term. There are many examples, unfortunately, of the dark exploitation of surrogate mothers in poor countries around the world. We must be cognisant of that. It is very important that as we develop this Bill that we do so in a balance of all those rights. There will be many different opinions around where the balance lies and there is potentially significant human cost if the equilibrium of rights is not protected. This is an extremely complex moral area. Some would say that it is a minefield.

Many families around the country have been broken-hearted in their efforts over years to have a child. The challenges faced by those families cannot be over-estimated in any way. We, as a country, need to make sure that couples seeking to have a child are given every support possible to have their son and daughter. We also have to make sure that the rights of the child are protected. I believe that the child is probably the most important consideration in this whole discussion. Wherever the balance lies with the competing rights, we need to ensure that the full rights of the child are protected. In relation to what the previous speaker said, we have a long and difficult history in relation to children struggling to find who their biological parents are. I am not comparing assisted human reproduction to what happened in the mother and baby homes or to the shocking history of illegal adoption in the State; they are different in their intent and delivery. However we cannot have a situation where children do not have access to the information about their biological parents or the mother who carried them. We need to ensure that the information is accessible to them in a practical way in order that they can trace their biological parent. We owe it to future generations that we get this right. It would be incredible if we discuss this Bill and the future regime in parallel with discussing the rights of children who have been adopted or who have been born in mother and baby homes and that we do not learn from the mistakes of those years in this respect.

International surrogacy can take place by many ways: an intended mother's egg and the intended father's sperm; the intended mother's egg and donor sperm; the surrogate mother's egg and the intended father's sperm; the surrogate mother's egg and the donor's sperm; the donor egg and the intended-father sperm and the donor egg and sperm or the donor embryo. These are all significantly different levels of surrogacy and complexity and all have different effects on children. Motherhood exists in all these situations but in some, it exists in multiple forms. There can be a birth mother, a biological mother and an intended mother all at the same time for a child. The idea that motherhood is split three ways for a child is potentially a significant difficulty and challenge to a child in their future. There are also different types of surrogacy: there is altruistic surrogacy where the surrogate mother wants to help the couple to try to have their child without getting financial reward and there is also commercial surrogacy, where the surrogate mother who carries the baby does so in exchange for payment. These types of surrogacy arrangements are unregulated in this State. Like many people, I am very concerned with the dangers presented by commercial surrogacy. It can lead to significant exploitation of women in poor countries. Many countries have banned commercial surrogacy due to the threat of exploitation. In India, for example, in one year in one province, €2.3 billion was raised through commercial surrogacy leading to moves to ban the practice there. For-profit surrogacy is banned in Canada, Denmark, New Zealand, Britain and most of Australia. Bulgaria, France, Germany, Italy, Portugal and Spain prohibit all forms of surrogacy. So actually, the legalisation or regulation of the provision of surrogacy would not mean that Ireland was joining the rest of the world on this but rather that it is leaving it. There are only three countries in Europe where commercial surrogacy is legal, namely, Belarus, Ukraine and Russia. There are serious ethical concerns around the surrogacy agencies in Ukraine, Belarus and Russia. There are many examples where safeguards around the sale and trafficking of children have not been put in place.

Any law that discusses surrogacy must ensure that is not allowed in any fashion and is completely prohibited. Ellen Coyne has reported for the Irish Independent on some of these shocking situations. She reported on a woman who was pregnant with a surrogate baby but was not able to flee the war in Ukraine as the contracts signed would not be applicable if that mother left Ukraine. She reported in 2012 that a Californian lawyer was given a prison sentence for her role in what was described as a baby-selling ring involving Ukrainian surrogates. Ellen Coyne has also reported on the BioTexCom surrogacy company that stated on its website that the cheapest surrogacy in Europe is in Ukraine because it is the poorest European country. The same company also advertised a Black Friday sale surrounded by pictures of children. I find it very difficult to raise those shocking situations in the Dáil, especially because it is such a sensitive sector and because there are so many families who want the best for their children and would not tolerate that type of situation but who still want to access a service that provides surrogacy to them. However, it is really important. We have a responsibility to ensure profiteering and exploitation are rooted out completely. It must not be tolerated. To have a conversation and not recognise the existence of it in this sector would be absolutely wrong as well.

This Bill governs surrogacy that occurs in Ireland, not-for-profit surrogacy and surrogacy where there is a genetic link between one of the intending parents and the child but it has nothing to say about the continuing practice of international commercial surrogacy. That is a problem and a difficulty. I am on the committee that met for the first time today to discuss international surrogacy. I am learning a lot about it and would say much, if not most of the country has a lot to learn about this whole area and all the difficulties and complexities that exist in it.

I am also concerned about the increasing practice there is to screen out people with disabilities via prenatal diagnostics. We live in a very harsh world at the moment. We celebrated World Down Syndrome Day this week yet in countries such as Iceland and Denmark no children are born with Down Syndrome anymore due to non-invasive pregnancy testing that leads to the screening out of children in most cases, and they are aborted before they make it to term. In the last week, the parties in the North of Ireland voted for abortion for children with Down Syndrome right up to birth - an incredible situation. This Bill will allow for prenatal diagnostics, I understand, of embryos of children with disabilities. As we know from science, an embryo is a living individual human being and this Bill will allow for the regulation of those embryos being discarded and destroyed.

For many people living with the complexities involved in assisted human reproduction it is important we have an honest, frank and open debate here. We must ensure that at the heart of this conversation and this Bill we recognise the real need of many couples to have a child and the real difficulties and challenges that process holds for them. However, we must also ensure the rights of the child are central to this. Those must be the pre-eminent rights in this whole process. We cannot make the mistakes of previous generations in this country with respect to identity, access to biological information and access to information about mothers and fathers and mothers who carry the child. That information must be available to children. I also believe very strongly that if we create a situation where commercial surrogacy is allowed in this State, that will allow for situations of profiteering, exploitation and for the difficulties I have mentioned to exist in the future.

I hope the Minister will be able to take amendments. We have very regularly seen Bills go through this House where there has been a very strict adherence to the letter of the original drafted Bill and no amendments allowed through. On a Bill of this importance, the Government has a responsibility to listen to the collective wisdom, if you can call it that, of the elected representatives here.

Is Bille uafásach tábhachtach é seo agus tá go leor cearta ag baint leis. Tá cearta na máthar agus an athar atá ag iarraidh páiste ach nach bhfuil in ann páiste a bheith acu iad féin i gceist. Bíonn deacrachtaí ag na tuismitheoirí sin agus caithfimid a bheith ag smaoineamh orthu mar níl sé éasca. Tá brú uafásach ar na clanna sin de bharr na ndeacrachtaí sin. Caithfimid smaoineamh freisin faoi chearta na bpáistí. Tá go leor rudaí mícheart déanta sa tír seo go stairiúil mar gheall ar pháistí a tháinig trí na hionaid máithreacha agus páistí agus iad siúd a bhí adopted in aghaidh an dlí. Caithfidh go mbeidh rochtain ag na páistí seo ar eolas faoina dtuismitheoirí, faoi shláinte a dtuismitheoirí agus faoin máthair a d’iompair iad le linn an iompair chlainne freisin. Caithfimid smaoineamh ar na máithreacha sin. Níor cheart go mbeadh siad ina n-íospartaigh san earnáil seo. Tá go leor fianaise ann thart timpeall na cruinne faoi mhí-úsáid na mban seo, brabús a bheith déanta as an tseirbhís a thugann siad agus an easpa cearta atá acu. Tá fadhbanna ollmhóra sa tír seo, agus sa domhan seo, mar gheall ar dhaoine atá trafficked. Nuair a bhíonn brabús i gceist agus nuair a bhíonn na dlíthe lag i dtíortha atá bocht de ghnáth, bíonn deis exploitation ann. Sin an fáth go bhfuil go leor tíortha tar éis dlíthe a thabhairt isteach a chuireann cosc ar an tseirbhís seo. Caithfimid smaoineamh ar an rud céanna a dhéanamh sa tír seo.

Deputy Pádraig O'Sullivan

Aontaím leis na cainteoirí a labhair níos luaithe. Bhíos ag éisteacht leis an díospóireacht thuas staighre. Is rud coimpléascach é seo. Ag an am céanna, tá sé an-tábhachtach agus aontaím leis an mbéim atá na cainteoirí eile tar éis a chur ar an tábhacht sin. Is annamh an rud é le feiscint go bhfuil beagnach gach duine ag aontú faoi na prionsabail sa Bhille seo.

I welcome that this legislation is finally making its way through the Houses. It is much-needed and long awaited. For the first time, all forms of assisted human reproduction will be regulated, including IVF, embryo screening and surrogacy. It has been five years since legislation began to be drafted and more than 15 years since the commission on assisted human reproduction called for new laws in this area. I agree with the comments made by the Minister, Deputy Stephen Donnelly, when putting the legislation before Cabinet that it will finally "ensure assisted human reproduction ... practices and [other] related areas ... are conducted in a ... consistent and standardised way and [very importantly] with necessary oversight".

The new legislation will provide for a new assisted human reproduction regulatory authority that will be responsible for regulating treatments, licensing and regulating surrogacy, pre-implantation genetic diagnosis, embryo screening procedures and posthumous assisted human reproduction, which is where pregnancy is achieved using the gametes of a deceased person. This new regulatory authority will be crucial in providing appropriate clinical care and ensuring appropriate clinical practices in the State for the first time. Most importantly, children born as a result of assisted human reproduction will be at the centre of the process. This legislation will assist thousands of people who wish to have children through AHR and will finally provide legal clarity for families at the centre of it.

The area of real concern I see is that by the Department of Health's own admission, the new legislation focuses entirely on this jurisdiction and does not necessarily address international surrogacy. In this respect, I welcome the establishment of a special Oireachtas committee to examine further issues like these as this legislation continues to progress through the Dáil.

I understand that the committee will make its recommendations within three months.

My other main concern with the legislation is that I am not sure that it makes domestic surrogacy as attractive as commercial surrogacy in other jurisdictions. What is provided for in the Bill is definitely not more attractive than going abroad for surrogacy purposes. While I respect the motivations and intent behind the Bill to make services more accessible for prospective parents, I am not sure that it goes far enough in providing them the necessary legal protections. I would appreciate it if, in his closing comments, the Minister of State, Deputy Feighan, made some remarks about the difficulties faced by parents and their new babies when they return to Ireland. Will he clarify whether returning mothers will be entitled to, for example, maternity leave?

I broadly welcome the Bill and this debate. In recent years, I have been contacted by many parents who have faced the heavy financial burden of undertaking AHR, the mental consequences and stresses the process can cause, and the legal limbo that many have found themselves in for a long time. I welcome this conversation because it is finally an attempt to do the right thing in what is a complex area.

Deputy Martin Kenny

It goes without saying that this legislation is welcome. It is a move in the right direction and long overdue. Assisted human reproduction is an area that badly needs a regulatory authority. That one will now be put in place is welcome.

For many years, I have been in contact with a number of people who have experienced fertility issues. They have gone through considerable anguish and problems and incurred great expense. In some cases, it was all for nothing at the end of it. It is a difficult and torturous process. Anything that can be done to ensure better outcomes and journeys for these individuals is something that all of us should try to achieve.

Surrogacy is a key issue that needs to be addressed. I welcome the new committee, which I understand met for the first time today. It has a large volume of valuable work to do to try to unlock a difficult and complex area. I understand that this Bill will deal with non-commercial surrogacy in Ireland but will not recognise anything beyond that. For many families in this country that now have children who were born to surrogates in other countries, particularly Ukraine, achieving recognition and trying to find a way through the crossword puzzle that has been put in front of them is poses a difficult situation. If we try to find a way to accommodate their right to parentage, it poses another problem because how can we have one child with that right now but another who is born in similar circumstances in the future without it?

In fairness to the parents in such situations and who are lobbying to see a change that should rightfully happen, they recognise that there is no simple or easy fix. This is a difficult area for us to work through. If possible, the Dáil should do this necessary work as co-operatively as possible. We all need to work together and try to use every possible means to devise solutions that will fix this problem for the mothers and fathers of young people who, having been born to surrogates abroad, are now growing up in our schools and will one day be our country's future. We also need to find a way of dealing with this issue for others in similar circumstances who will work through non-commercial surrogacies in this country.

Clearly, this issue will not be sorted out quickly. Instead, it will develop and evolve as we move forward. This Bill and the related moves are welcome, but we have a long way to go.

Deputy Richard O'Donoghue

I welcome any Bill that brings regulation to practices in Ireland for its citizens. I understand that the number of treatment cycles in 2020 was 9,878 and that no particular treatment procedures have been in place. As such, I welcome the clarity that the Bill will bring. I also understand that the Government is planning to put in place a model of care for infertility treatment. The Bill probably does not go far enough, though, in that it does not cover international surrogacies. A special Oireachtas joint committee has been set up and had its first meeting today.

I commend the Minister for Foreign Affairs and his team on their work in bringing home from Ukraine children born by surrogacy and their mothers. Speaking as a father of four and as a grandfather, there is no joy in life like seeing a newborn, healthy baby in the world. Those teenagers who were born by surrogacy in Ukraine or who were adopted from there – I know a fabulous 18-year-old girl who was adopted from there when she was three – are feeling for what they see happening in Ukraine.

I have friends and know others who have gone through years of trying to have families – fertility treatments, IVF etc. – and have had beautiful babies. I was recently at the christening of a young boy conceived through IVF. After that six-year journey, it was fantastic to see that family unit.

I welcome any legislation that protects children who will be born through surrogacy or IVF in this country, but I hope that we can go further and protect children who have already been, or will be, born through surrogacy and who come to this country from abroad, for example, Ukraine. I thank the people who have created such joy by allowing loving mothers, fathers and partners who, for whatever reason, could not have children themselves to become family units.

I also thank those who provide foster care for many children. They have protected young children in difficult circumstances.

I welcome the Bill and any protection that is provided to children.

Deputy Danny Healy-Rae

I welcome the Bill. Many parents of babies born through surrogacy have contacted me about anomalies that occurred when they brought their babies home. Many couples are unfortunate, in that they cannot have children of their own. For one reason or another, they have been deprived of this. They then do the next best thing, which is surrogacy.

Some years ago, a lady I was very close with lost her life trying to have the baby that she and her husband so dearly wished for. They went through many IVF treatments. This lady was young. She jeopardised her own health and lost her life. She went through so many intense treatments that the family believe they played a part in her death.

I have been contacted by a number of couples who are having problems becoming legal parents. Usually, the man can become a legal parent but the mother or second parent cannot even become a guardian until after the child is two years old. There are laws in Ireland governing surrogacy. As a result, biological fathers of children born through surrogacy have more rights than the child's intended mother or second parent. The following issue was brought to our attention by spokespersons for the Irish Families Through Surrogacy advocacy group. Once a child reaches 18 years of age, these women have no standing as a guardian and up to two years of age they cannot make any decisions regarding the health of their beloved babies. This can only be done by the father. This is a slap in the face to these mothers who care for their children and want to help them in every way possible. That needs to be rectified. As we do not have availability of surrogacy in Ireland, these women have to travel abroad and this is resulting in that discrepancy. I welcome the Bill if it is going address these issues.

There is another issue in that when the child reaches the age of 18, if the mother wants to transfer her assets or whatever to that child, because she is non-related, the tax exemption is only €16,000. If she was legally deemed to be the child's mother the tax exemption would be €335,000. We all know the value of a house today. If that mother wanted to leave a house to a son or daughter, it is wrong that the difference in tax would be payable to the State.

Surrogacy is not a choice; it is a last resort. It can be couples only opportunity to build a family due to debilitating infertility and medical conditions after a long difficult journey. Many parents who undergo surrogacy are married couples where one or both contribute genetic material to have the maximum possible biological input to their child. The number of emergency travel certificates issued by the Irish Consulate in the Ukraine for children born as a result of surrogacy arrangements have been illustrated in many tables, but they do not include the number of children born in the USA and Canada who also need emergency travel certificates. The figures indicate an upward trend in international surrogacy and the need for international surrogacy to be acknowledged and provided for in legislation.

As I said, I support the Bill. I thank the Government for bringing it forward. Much of the time in this House, we are critical of Government, but this is legislation we asked for following this issue having been brought to our intention. We are glad that Government has responded. I hope that the Bill goes through without any major difficulty.

Deputy Denise Mitchell

I welcome this Bill, which has been a long time coming. I commend those who have campaigned to put this issue on the table. I am sure the Bill will be welcomed by families and potential parents who have been waiting a long time for proper regulation in the area of assisted human reproduction. Many have had to travel abroad to access surrogacy having not been able to conceive themselves. The fact that this option will now be available domestically is a significant development for those in need of assistance.

The HSE estimates that one in six couples experience infertility. This gives us an idea of the number of people who may seek assisted human reproduction services in the future. We all know that treatments can be very costly. A single IVF treatment costs between €4,000 and €6,000. In order to have a successful pregnancy, it could cost tens of thousands of euro. Sinn Féin wants the Minister for Health to make IVF available through the public health system. We want to see these options made available to as many people as possible. Cost cannot be a barrier.

One of the concerns with the Bill is that families who have already availed of surrogacy abroad will not have the same rights as those who have children by means of surrogacy after the legislation passes. We cannot create a two-tier approach to parental rights. This will need to be addressed and clarified on Committee Stage. As it stands, the Bill gives rise too much uncertainty. We need to make sure we get this right. Previous Governments have been found wanting on the issue of assisted human reproduction. This Bill is a step forward. I welcome the establishment of the authority to oversee assisted human reproduction and advise people on it. I hope the authority can to get work as soon as possible.

My colleague, Deputy Cullinane, will seek to amend this Bill on Committee Stage, as I am sure will many other Deputies. Sinn Féin is committed to working constructively with the Minister to address the concerns raised by stakeholders.

Deputy Catherine Connolly

Fáiltím roimh an deis a bheith páirteach sa díospóireacht seo. Tá sé thar a bheith casta. Tá sé deacair na téarmaí, agus níos mó ná sin, na hábhair a thuiscint. Tá gá le bheith i d'fhealsamh i ndáiríre.

I welcome the opportunity to take part in this debate. It is quite difficult to get one's head around all of the medical concepts, what is possible and what is not possible. In addition to being a Deputy, one would want to be a philosopher, a doctor and many other things besides. I welcome that I have adequate speaking time in regard to this matter.

I have before me a report done by the members of the commission that was set up by the current Taoiseach when Minister for Health in March 2000.

Some 22 years ago in 2000 he set up a commission, which then took five years to deliberate. It is interesting what it said. I will come back to its 40 recommendations. The chairman of the Commission on Assisted Human Reproduction said in the report:

In being asked to advise on the social, ethical and legal factors, the Commission did not attempt to act as the arbiter of public morals. The members were conscious of the strongly held and diverse feelings in the public at large. A broad interdisciplinary approach was taken that allowed recommendations to evolve as a result of informed open debate. It was evident that there exists a broad spectrum of cultural and ethical positions. [...]

The report is intended to reflect the richness and variety of the debates that took place both in the Commission itself and in the work groups. [This was back in 2005] If I may presume to attribute an overall philosophical position to the Commission I think it could be encapsulated in the form of a question: should science do everything that science can do? There was widespread recognition of the benefits of advances in this specialised area of medical science but this was tempered by a note of caution, that society as a whole and not only scientists, must take responsibility for the management of major scientific change, especially in areas that are concerned with the dignity of human life.

I am coming back to fully supporting the Bill as it relates to assisted human reproduction, but there are many other aspects to this area that really need a broad discussion. I will move from the 2005 review to Schedule 2 of this Bill, which sets out what is prohibited. This shows us where the science is at the moment and what is possible, in that we actually have to prohibit "the creation of a human-animal hybrid embryo" and many other things that are prohibited. Scientific knowledge has gone so far that many, many things are possible that are inconceivable to me, morally or in justice, but they are possible. It is not just scientists that are participating or making decisions. It is the Dáil and concerned groups too.

I am also very concerned that the broad discussion that took place between 2000 and 2005 was utterly ignored until today. That commission made 40 recommendations, one of which was very far-reaching. I do not agree with the particular recommendation myself, and it was not taken on board in relation to this Bill. It is that a presumption would be made in relation to the intended parents, that from birth on, the presumption would be that the intended parents are the parents, and that a child born through surrogacy should be presumed to be that of the commissioning parents from birth on. There was a dissenting view on that at the time, which I happen to agree with. My point is that the complexity of what is involved here was fully discussed. Unfortunately, it was ignored. When we fast forward to five years ago, the heads of the Bill were produced and were discussed with only four meetings of the committee with Deputy Harty, who had done a great job. There was only four meetings in relation to such complex matters. The committee produced a report. Some of the recommendations were taken on board in relation to this Bill and some were not. Then we had the report of the special rapporteur in 2020, when he too laid out the state of play.

I must thank the Oireachtas Library and Research Service, which produced two papers, under pressure. Again, I do not know what influence we might have but the Oireachtas Library and Research Service is under constant pressure to inform Members and educate us. The Bill was only produced last week or the week before, coincidentally, in the same week that the rapporteur produced another report, which was on illegal adoptions and the importance of identity. It is ironic that the rapporteur has emphasised the importance of the right to know one's origins and legal identity in a week where legislation is published highlighting the vacuum around the right to knowledge for children born through assisted human reproduction, and the utter fragmentation, in theory, of that identity depending on how the assisted human reproduction is done. I will come back to that point.

As was pointed out by other speakers, in 2020 Professor Conor O'Mahony, the special rapporteur on child protection produced A Review of Children's Rights and Best Interests in the Context of Donor-Assisted Human Reproduction and Surrogacy in Irish Law, in which he said that "Surrogacy is entirely unregulated in Irish law." This was 20 years after then Minister for Health, Deputy Micheál Martin, commissioned the report. So, 20 years later, surrogacy remained "entirely unregulated". Professor O'Mahony goes on: "Children are born and raised in families in which one parent is treated as legal stranger to the child." I had to read this a few times. At the committee the professor said:

Surrogacy is entirely unregulated in Irish law. The result is that children are born and raised in families in which one parent is treated as a legal stranger to the child. This fails to recognise adequately the children's right to family life and their right to identity in some cases of donor-assisted human reproduction and entirely ignores those rights in the case of surrogacy. [This is what I am zoning in on] This is contrary to both the best interests of children and the principle of non-discrimination.

Professor O'Mahony also pointed out at the committee that the Supreme Court has highlighted this issue. In his review Professor O'Mahony said: "The impact of this position on children born following surrogacy arrangements has been repeatedly highlighted, including by the Supreme Court, which has called on the Oireachtas to fill this legislative vacuum."

We are beginning to fill the legislative vacuum with this Bill, and it is a good start. It is important however to give the context on that. Up to now, successive Governments have been pushed and pushed, from the original commission to the Children and Family Relationships Act in 2015, which had some protection for children born through donated sperm or eggs. However, with that Act we had the crazy position where the relevant sections 3 and 4 never came into operation, I understand, until 2020. This was five years after the Act was passed. When those sections did come into operation there is nothing before me to show that the Act, or the operation of that Act, had been reviewed. Separately, the cross-party committee has said that this legislation currently before us is so important that when it becomes law it should be reviewed after one year. The Government has pointed out that this is not necessary because Standing Orders allows for a review. If that is the position, where is the review of the 2015 Act? Do we have it? It has not been referred to anywhere in what I have read. I think that this is very important. When the two sections of that Act came into operation in 2020 there was an obligation to register, but I have no access to information on that anywhere. It also distinguishes between children born through assisted human reproduction, prior to that legislation becoming operational, and post operational. We have a complete mess with regard to rights and identity, and this is just one tiny aspect of this area.

On top of that we have completely ignored international surrogacy. I have my own opinion on international surrogacy. I will place on the record that I believe assisted human reproduction should be publicly provided on a not-for-profit basis. This is absolutely essential and should have been done. I have no time for going down the direction of profit-led development in this area, which is particularly sensitive on so many levels. Of course, this also has not happened but I understand that the Government will look at that aspect sometime in the future. When one reads around this, however, one cannot escape the conclusion that in all of this development - outside of couples and regardless of their standing in needing help, which I fully and absolutely support - there are other aspects. We can see from what has been prohibited, that some aspects are being pushed by a certain for-profit approach in relation to health. This should be completely taken out of the area of assisted human reproduction. It should be gone.

The legal vacuum is bad enough, but we also have an information vacuum. We are utterly reliant on the clinics to tell us what procedures have been carried out and whether they have been successful. We know from the Oireachtas Library and Research Service's paper that the number of treatment cycles has increased and the trend is in an upward direction. We can get those figures but they are not from a central database. We are utterly reliant on the companies that are making a profit for the information and we do not know the outcomes of these procedures. As well as the legislation lacuna, there is an information lacuna with regard to outcomes, such as the number of pregnancies, successful pregnancies, live births and so on. None of that information is there, despite the fact that we have been on notice about this for a very long time.

Some regulation was provided by the Health Products Regulatory Authority, which was designated as the competent authority and has some oversight. However, it has no role in relation to ethics, research or looking at where we are going and in what direction. In all the reports before me, different things were asked of the Government. In a sense, the Government has tried to do its best with the legislation it has produced but this requires further discussion. We have to look at the international component and decide what we are going to do about international surrogacy. Difficult as that is, we need a full discussion on it. At what stage will that happen?

Various committees said not to make counselling mandatory. As I understand it, however, the Bill makes both counselling and legal advice mandatory. That will increase the cost. I have an open mind as to whether counselling should be mandatory. There was so much to take in here. I do my best to take things in and form an educated opinion as best I can but I wonder what the justification is on the Government's side for making counselling mandatory. My background tells me that something being mandatory is not a good way to start a process. It also increases the cost.

There are many other ethical issues around sex selection and pre-implantation genetic diagnoses. I agree with the restrictions that have been placed on these areas. They will only be allowed in very restricted circumstances. The pre-legislative scrutiny of the heads of the Bill took place so long ago, and the report of the commission was so long ago, that not only are we talking about fragmented identities but a fragmented discussion as well. Now we are waiting for the international element to be discussed by the committee. Overall, it is extremely difficult to deal with this subject in any coherent way.

It is quite clear that Ireland is an outlier in this area, having no legislation in respect of it. However, it is not entirely clear where all the other countries stand, based on the research. Some allow for certain procedures while others do not, and so on. Regulation is absolutely essential and that regulation must be kept under constant review.

It is unacceptable, morally and on every other level, that assisted human reproduction is available to rich people or those who have access to money but out of the question for people on a lower income. That is immoral on every level and should not be allowed to continue. It is urgent that we get a public model as quickly as we can. We are doing everything like a jigsaw. We are forming policy in a vacuum without information before us. It has been 22 years since we set up a commission. I am making my comments against that background. I welcome the legislation, and it is important that we begin to legislate.

It is ironic - although ironic might not capture it - that on the one hand, we have the rapporteur's report telling us about the damage caused to children and adults when the State stands by and allows their identity to be taken from them and then, on the other hand, we allow an ad hoc approach to assisted human reproduction in such a way that children born by means of it do not have access to their identity or where they came from. This Bill seeks to rectify that but I would like that to be teased out.

There is also an issue whereby cases from prior to the Children and Family Relationships Act 2015 becoming operational in 2020 are operating under a different system to the ones that arose after that. All I see is a fragmentation of the most basic human right, that is, for children to know who their biological parents are and what their genetic background is. If we are making that point in one report from the special rapporteur, the same logic applies to this. While I embrace medical science, the changes being made and what it can provide us, it must be regulated in a manner that is for the public good and the common good.

I wonder if the same scientific effort could go into making our society more equal in terms of pollution and toxins, which lead to infertility, or other things relating to health generally. What about basic housing? This is separate from assisted human reproduction but I am talking about the application of science for the common good. If such effort was put into other areas, what difference would it make to our society? How many thousands in this country do not have such a basic thing as a house? They have no security. Yet, science can go down a road which is absolutely essential for assisted human reproduction but also makes possible many other things that are now rightly prohibited by this Bill. I will go back to the basic question asked in the 2005 commission report: "should science do everything that science can do?" Should these things be left to scientists? I believe they should not. If not, where is the forum for looking at all these complex issues that we as a society must deal with?

Deputy Alan Farrell

I am pleased to finally see this Bill being brought into Dáil Éireann, having been discussed and awaited for some years now. The Bill and its introduction to the legislative framework is something Fine Gael has been committed to across successive Governments. Today represents progress for thousands of families in Ireland and the tens of thousands of couples who will in future require support when starting their own families. There exist significant gaps in the current legislation that have left many families in legal limbo. While this Bill is not perfect by any means, I believe that if the Department and the Minister approach this issue and this Bill with the sensitivity, understanding and openness this subject matter demands, we can make significant progress for so many families in Ireland and provide the clarity and certainty all people require with regard to their family.

Ireland has long been a European outlier with regard to legislation in this area, as highlighted by my colleague Frances Fitzgerald in a recent report. The lack of legislation has created an unnecessarily complex and vague situation for couples attempting to access supports for IVF or ICSI for surrogates and, ultimately, for the children themselves.

Some one in six Irish heterosexual couples will struggle to conceive during their relationship. This represents a significant number of people in our country. There is no public funding for these couples and the lack of legislation deprives them of the support and information they need to make the best decisions for themselves and their families. The procedures involved in AHR treatments can be risky and costly, and they can be emotionally and physically demanding for all of those involved. There is, therefore, a need for the Government and this House to act in order to provide the regulatory framework that is vital for the provision of treatment in Ireland.

In 2017, the cost of an IVF cycle in Ireland was between €4,000 and €6,000 and the cost of an ICSI treatment was between €5,000 and €6,500. This is a significant burden on the individuals involved and, as most will know, there are no guarantees that a single cycle will be successful. Further rounds may be necessary to allow couples to fulfil their dream of growing their family, something that many people have to date dreamt of but been unable to access. As has been stated, the cost of these services should not dictate a parent or an intending parent’s ambition to welcome a child to their families. This Bill will be a stepping stone to address these issue and I urge the Minister of State and the Department to investigate the avenues in which the State can provide funding assistance in the event that people cannot pay the costs of treatment themselves.

The number of treatment cycles per annum in Ireland grew from 7,500 in 2009 to just over 11,000 in 2018. I note there has been a slight drop in the number of treatments provided since then but I understand that is down to the Covid-19 pandemic. The lack of legislation in the area of AHR in this country has allowed for a vacuum in services and, crucially, information. The development of the AHRRA under this Bill will be a transformative moment for AHR services in Ireland and for the families that will seek these services in the future. As has been said by other Members, research should be conducted by the Department with regard to access to services provided for under this Bill, and how they can be implemented in a regionally balanced way. The AHRRA will provide many services in this area. Notably, it will be in the position to collect data with regard to treatments and outcomes, which heretofore have been unaddressed and only available through private facilities. This has led to an inability to understand the needs and services that should be provided within our health system. This will allow further research to be carried out and to indicate where our funding should be placed in order to provide parents and children the best possible service in Ireland.

The AHRRA will also play a vital role in the provision and regulation of surrogacy in Ireland. The authority will provide for the introduction of a national surrogacy register as well as a register of donors. This, again, is a transformative step the Bill will provide for. The mechanism will allow couples in Ireland the opportunity to engage in surrogacy domestically and not be forced to travel abroad to find the opportunity to grow their family. Travelling abroad for surrogacy can present intending parents and parents of surrogate children with complex legal issues both at home and abroad. As has been mentioned so far in this debate, the Bill leaves some questions with regard to international surrogacy and parentage and so I welcome the development of a special Oireachtas committee to deliver a body of work on international surrogacy. I understand this committee will report back in a number of months. This is a welcome step that I hope will deliver some important recommendations on an issue that is of utmost seriousness and emotion. However, the timing of this process is questionable. The Bill has been published in advance of the committee’s hearings and thus will not, it seems, benefit from this process. I ask the Minister of State to come back to the House in his closing remarks and address this issue, one which a majority of Members have mentioned during the course of this debate.

The issue of parentage in the context of international surrogacy is a key question in this debate. The Minister of State will recall the AHR Coalition, which came before the Fine Gael parliamentary party in recent weeks at the request of Senator Seery Kearney. We heard directly from families across the spectrum of surrogacy about the significant gaps that are present. There are families in Ireland where one parent is not recognised as having parentage rights over their children. This means there are parents in Ireland that lack the legal ability to make simple parental decisions on behalf of their children. The unpredictability of life leaves us with the potential for serious and heart-wrenching scenarios where a parent with legal parentage passes away suddenly and his or her partner does not have the legal equality to parent the child and make decisions on behalf of the child. The resolution to such issues can sometimes take years. This is something that should be addressed and I hope this will form the basis for some of the work to be carried out by the Oireachtas committee on international surrogacy and by the Department. I acknowledge there are serious and sensitive ethical issues regarding the nature of surrogacy and these concerns have been recognised within the Bill, providing for surrogacy for altruistic purposes only and that any surrogacy agreement in Ireland would be certified by the regulatory authority. Importantly, this Bill and the Government recognise the need to avoid coercion into or commercialisation of surrogacy in Ireland. While introducing legislation of this nature we must ensure vulnerable women are not forced into a scenario of carrying a child against their wishes.

I would like to highlight the need for continued support for women who carry a surrogate child. This should not only be limited to the early stages of surrogacy or the term of the pregnancy but it should also be provided in the post-natal period in which the woman may require additional support. This should be a priority for the services provided in this context. I also wish to note that the Joint Oireachtas Committee on Health has completed work on this issue and has made a number of recommendations to the Minister with regard to this Bill. They include some important contributions with regard to international surrogacy and parentage, as I have already discussed, but also with regard to the welfare of the child and the removal of mandatory counselling for anyone seeking to be a recipient of AHR. I hope the Department will, throughout the process of this Bill and in the time subsequent to the passage of this Bill, continue to engage with stakeholders, families and those involved in the sector. I hope it will allow the roll-out of an inclusive, encompassing and progressive service that will make profound impacts on the lives of so many. It has the potential to be a truly life-changing Bill, filling a gap that has been identified for over two decades.

I often speak in this House of how our country and society have changed in recent years and decades. We have seen dramatic changes in women’s rights and LGBT rights in Ireland, led by the public and pursued by the Government. This Bill is the latest where successive Governments have sought to build on that progress and deliver real change that reflects more understanding and an equal country. The AHR Bill will allow for more access for families, couples and individuals that seek to achieve one of the most profound and important life events one can have, the welcoming of the birth of a child. Fine Gael has committed to providing legislation in this area and I am pleased to see the Bill before the House today. This Bill will change lives for the better, I look forward to the work of the special Oireachtas committee. I hope the Department will consider the issues of international surrogacy and parentage I have raised, as well as increasing access to services such as IVF.

We must recognise that the country and our lifestyles have changed. We know women are having children later in life than in previous decades. With progress in social equality, we see more same-sex couples living happily in our society and the provision of AHR services and supports will allow loving couples of all different backgrounds to welcome a new family member into their homes. I look forward to the progress contained within this Bill but I urge the Minister of State to ensure the views and recommendations of the special Oireachtas committee be included by the Minister on Committee Stage of this Bill. I would be immensely disappointed if we were to separate international surrogacy from the steps the Government is taking today through this Bill. I ask the Minister of State and the Government to reflect on that.

Deputy Jim O'Callaghan

I welcome the opportunity to speak on this important Bill and I commend the Minister of State and the Department on bringing it forward. This Bill is long overdue; it has been called for and required for more than two decades. We need to appreciate it is complex and complicated legislation. Notwithstanding the delay, I can understand why the Minister of State and the Department have had to put such time into preparing this Bill.

When one reads through it, one can see that it deals with areas of such enormous complexity, ethical issues of significant concern. It is important we get the balance right when the legislation is enacted. The Bill will benefit from being considered by everyone in this House. All parties in the House will have an opportunity to review it. I know that it is a complicated Bill but I believe the Department of Health will benefit from getting the views of the Members of this House.

It was in July 1978 that the first child conceived through IVF was born. It was an extraordinary scientific achievement. It transformed the world in many ways. In particular, it transformed the lives of many people who could not have children. Due to the scientific changes, they were subsequently able to have children. It was a remarkable achievement. In the past 40 years in Ireland and, indeed, throughout the world many couples have been assisted in reproducing children as a result of assisted human reproduction processes. It is surprising that in Ireland to date we have never had it regulated by law. We have never had it licensed by law. Notwithstanding that, it is obviously the case that many couples in Ireland, in the past 20 to 30 years, have availed of the services of providers of services of assisted human reproduction. Even though those services seem to have been provided without too much controversy or public criticism, it is absolutely essential that this issue is regulated by the Houses of the Oireachtas.

When we look at some of the issues in respect of assisted human reproduction and IVF, in particular, we can see the problems that have arisen in the past as a result of the absence of legislation. For instance, in 2009, the Supreme Court considered a case that arose as a result of a couple who decided to go down the avenue of IVF. They had a number of embryos produced, some of which were implanted in the woman and others were frozen. Subsequently, the couple separated and split up. It was a traumatic case that arose as a result of the fact that, after the separation, the woman in the relationship wanted the frozen embryos to be implanted and born, whereas the man did not want that to happen. That was an extremely difficult issue to resolve. It would have been resolved if there was legislation in place stating what should be done in such circumstances.

Ultimately, the matter went to the Supreme Court and it was resolved in a manner that was not, in my opinion, satisfactory because of the absence of legislation. The couple should not have been put through the trauma and uncertainty of not knowing what would occur. For instance, under the legislation being introduced, we know the issue that arose in that case would not apply because the procedure would be available, under section 23, for one of the parents to apply for a revocation of permission that he or she previously granted. We know how that traumatic situation would be dealt with.

It is also important to note that the persons who are providing these services in Ireland as present also want to be regulated. It is important they are regulated. That is why I welcome the fact that under the Bill there will be a new statutory body, the assisted human reproduction regulatory authority. I do not think it will be a statutory body that will need to be staffed by vast numbers of people, but it will be a statutory body that will perform an extremely important function. I am sure there are people around the world who want to come to Ireland, or may already be in Ireland, and are not providing the level of service that is required of assisted human reproduction. I welcome the fact that under section 116, the Minister can declare whether persons are or are not fit to be involved in this business.

Many Members of the House have spoken about ethical issues that have arisen. Obviously, ethical issues arise when it comes to what is to happen to embryos. On the issue of assisted human reproduction, in the case of IVF, generally embryos are implanted in the mother in the hope that the baby is subsequently born. However, in many instances, a number of embryos are produced and they are not all implanted. It is extremely important that those embryos are not used for research unbeknownst to the parents or used for research that we in this House would regard as unethical or inappropriate. I welcome the fact that Schedule 2 to the Bill sets out the types of behaviour that this House regards as unacceptable. Experimentation on embryos is something we do not want to see in Ireland, and I believe Schedule 2 has been very well drafted to ensure that does not occur. I also welcome the fact that in Schedule 2, the provision is available to the Minister for Health to enact by regulation other types of practices that may happen in the future in regard to experimentation on embryos.

On the issue of research, referred to as embryo stem cell, ESC, research, that is dealt with in Part 3 of the Bill. It appears to be the case, and perhaps the Minister could deal with this not in the reply but on Committee Stage, that under section 30 of the Bill, research is permitted on an embryo when the intending parents' consent to that research happening. Obviously, the research must be ethical. It cannot be beyond what is provided for in Schedule 2. It cannot engage in any of those types of activities.

Part 4 deals with the storage of gametes and embryos. There is also an interesting provision contained in section 38. In the tragic situation where a girl of 16 years of age has to undergo treatment for cancer, there is a provision contained within section 38 that would allow for eggs from that child to be stored until after the treatment in the hope that they will be of use to her in her life.

The one issue that many Members have spoken about is the issue dealt with in Part 7, which is domestic surrogacy. We need to be realistic about the extent of domestic surrogacy that will happen in Ireland. I suspect it will be extremely small, unlike the whole area of assisted human reproduction and IVF, a service many people avail of. In respect of domestic surrogacy, there will be very few people who, in practical terms, will avail of it. We saw in the case of MR v. an tArd-Chláraitheoir a number of years ago a very good example of the type of domestic surrogacy that may arise. It is referred to as compassionate surrogacy. It was a situation in which a woman was incapable of carrying a child to fruition, however, her sister was prepared to assist her. The embryo that was created by the woman and her husband was implanted in her sister and the child was born. There was a controversy about it, legally, because the woman who gave birth to the child was regarded as the mother. That is not the type of surrogacy that is common in Ireland at present. We need to be realistic as to the type of surrogacy that happens in Ireland. In general, it involves people from Ireland who are desperate to have children going abroad to countries where surrogacy is legal and having a child there. One of the parents usually provides one of the gametes and the other parent will apply for a step-parent adoption in that country. On return to Ireland, an application is brought before the Adoption Authority of Ireland for the recognition of a foreign adoption. That is how it happens in Ireland and we should not fool ourselves into thinking it happens any other way.

What we do not want to happen is to have two avenues of surrogacy in Ireland: one piece of legislation that deals with domestic surrogacy and another that deals with international surrogacy. We need a mechanism whereby we have a statutory authority, perhaps the one that will be established under the Bill, that will deal with all types of surrogacy. On the issue of surrogacy, we need to recognise that it happens. No matter what legislation we enact, it will continue to happen. As referred to by Deputy Connolly, a very important issue that may not be given enough recognition is the right to identity of the child subsequently born.

Deputy Paul Donnelly

I cautiously welcome the Bill as it is essential to regulate the provision of any treatment or procedure for the purposes of surrogacy and IVF in the State. It is incredulous for this most important medical procedure not to be regulated given that is has been flagged for so many years.

I am sure we all know couples who, through no fault of their own, cannot have a child without the assistance of AHR treatment. The health and well-being of the mother and baby must always be to the fore and it cannot be allowed to become a for-profit procedure. While the not-for-profit section of the Bill would ensure that domestic surrogacy would not be abused for profit, there are concerns, as have been alluded to throughout the debate, about international surrogacy which is not addressed in the Bill. I understand an Oireachtas committee will look at that. It is an extremely important issue because one cannot separate domestic and international surrogacy.

The Bill, of course, does not address the issue of access to surrogacy. It will still mean it will be out of reach for so many people who cannot afford the types of expenses that are allowed for in this Bill if we only look at the expenses for surrogacy alone. In respect of IVF, the chance for couples and individuals is even more out of reach.

I listened to Deputy Paul Murphy's contribution this afternoon. It was really important to hear what he said in relation to his personal experiences of the emotional and physical toll it takes on the woman and the financial costs incurred by couples. On many occasions it can cost tens of thousands of euro because, obviously, it is difficult and does not normally work first time around for most couples and individuals.

It is, therefore, important that this would be available in the public healthcare system, as has been discussed today. There are concerns regarding the recognition of parentage. It is not clear in the Bill that the parental and guardianship rights in respect of children born through surrogacy will apply to existing families. We must also ensure the child and each of his or her parents has full rights. I welcome the commitment given earlier by the Minister of State, Deputy Rabbitte, to look at this further down the line on Committee Stage.

With regard to people born as a result of AHR treatment, we need to make sure there are provisions that provide the rights of a person to access information concerning his or her origins. We have seen far too many times in our recent past the upset caused to people who cannot access their own birth history. This should not happen again. We also need to ensure that anybody who is not fully compliant with the AHR procedures should be held to account. We should be assured they will never be allowed to practice again if they break any of the rules or regulations.

I would like to talk about counselling and the mandatory counselling section. Like many others, I have concerns about mandatory counselling. As somebody who has provided counselling, the concept of counselling is that somebody has an issue and comes to you to work through it. I am always unsure and concerned when we put in a provision, particularly a law, that states a person is mandated to go and access counselling. That absolutely needs to be looked at.

I have gone through the legislation and it is very detailed. It is a start. Having listened to the contributions made today, however, many issues still need to be addressed. My party and I are absolutely up for ensuring this legislation is fit for purpose and that we deal with the issues that have been ongoing, as has been said, for more than 20 years.

Deputy Ruairí Ó Murchú

It has been said by many others at this point that there is an absolute and necessary need for a regulatory framework with regard to assisted human reproduction and the wider issues of surrogacy and IVF. It also been said by many, including my colleague, Deputy Paul Donnelly, that there are significant questions with which we need to deal. A significant amount of due diligence will be required on Committee Stage. Deputy Jim O'Callaghan spoke about the difficulty or, I suppose, the reality with regard to international surrogacy.

We accept that a committee has been established that will deal with this at some point but there is a logic to a single piece of legislation to cover it. Many stated that there is obviously a difficulty in that there is no element of retrospection regarding those people who have already been born through this process and ensuring their identity rights are dealt with. We know the huge difficulties for people perhaps not being able get their entitlements, the difficulties in terms of where the law stands if the father was to die or if there was marital break-up and all the rest. I get that from a human perspective, it is an incredibly complicated situation.

For people who go for IVF or surrogacy, there is a real want and need to have their own children but there are difficulties. It is hugely difficult, not only from a financial point of view. A huge number of people cannot even look at this because they do not have the resources, which is obviously an unfairness and inequality that cannot stand. We need to make sure there is public provision. We are talking about IVF cycles and figures are being thrown around of somewhere between €4,000 and €6,000. That would obviously put a huge amount of people out of the bracket of being to avail of this and that is not okay in any way, shape or form.

On the whole idea of international surrogacy, the initial period of the Ukrainian crisis threw up this particular issue with regard to Irish families that went out there. That once again points out the scenario that this is a reality we need to deal with and for which we need to legislate. As per normal, we have been pretty slow to deal with it. There is no point in being too downbeat in the sense that we are finally arriving at a starting point. It is only a starting point, however. Like I said, we have to do a significant amount of work to ensure we cover all the bases.

I will add my voice to many others before who said that if we are looking at IVF, there must be provision within the public health system. It is absolutely unfair that this is only a resource that can be availed of by those who have the means to do so. That is not to take away from the huge emotional difficulties that face anybody in these particular situations. I accept the difficulties in dealing with retrospective laws and so forth but it is not beyond the possibility of Government and this House to deliver solutions. We know what the problems are. We know a significant amount of work will have to be done on Committee Stage. It is only right that we ensure we have a just system that works for all the people, both those who have been through IVF and surrogacy and those who will go through this system. It also means we must deal with domestic and international surrogacy in the same legislation.

This is, therefore, a good start, or it is a reasonable start. One can be quite uncomfortable with some of it and particularly the for-profit scenario. I can see why people who have the resources do it but it is not available to everybody and that is the piece we must close off, if we are really talking about having a just and equitable society.

Acting Chairman (Deputy Marc Ó Cathasaigh)

That exhausts the list of speakers. I will, therefore, return to the Government slot and ask the Minister of State, Deputy Feighan, to close the debate.

Minister of State at the Department of Health (Deputy Frankie Feighan)

On behalf of the Minister, Deputy Stephen Donnelly, and Minister of State, Deputy Rabbitte, I thank all the Members for their valuable contributions today. As the Minister of State, Deputy Rabbitte, said at the outset, the Minister really would have liked to have been here today to introduce this very important, if not historic, legislation. From listening to everyone, I can hear there is broad support for this long-awaited Bill. I assure all speakers that I will inform the Minister of the numerous constructive observations on the Bill. In addition, the relevant officials from the Department have been taking notes of all queries, comments and issues raised today as they look forward to the passage of the Bill to Committee Stage.

Much reference was made to the issue of international surrogacy by essentially all the speakers. I reiterate that it was the Minister, Deputy Donnelly, who proposed to the Government the establishment of the special Oireachtas committee, alongside the Minister for Justice, Deputy McEntee, and Minister for Children, Equality, Disability, Integration and Youth, Deputy O'Gorman. Much good work has been done on which I want to compliment them.

The Minister, Deputy Stephen Donnelly, has committed to having regard of the work of the cross-party committee as this Bill progresses through the Houses. Many Members also outlined the financial burden, the agony, the excitement, the heartbreak and the joy of IVF. I wish Deputy Paul Murphy and his partner all the best in that significant journey in the coming weeks and months. There were also many broad discussions on the aspects of the Bill. Again, many Members have welcomed the new committee and the difficult deliberations that will happen. It met today. Many issues need to be addressed and clarified on Committee Stage.

In conclusion, I would like to state my agreement with the desire of the Minister, Deputy Stephen Donnelly, to progress this legislation as quickly as possible, as well as with his belief that it will improve the outcomes for and provide certainty to all parties involved in the undertaking of various types of AHR treatment or research. The legislation is important to many people, given that 5,000 or 6,000 couples are going through the personal debt, the stress, the joy and the disappointment of it. This legislation is long overdue.

Again, I want to express my appreciation for a useful debate from all who contributed this evening. I hope that Members across the House can continue to work closely with us in order to potentially improve the Bill and advance it swiftly.

Question put and agreed to.

Dáil Éireann debate - Wednesday, 23 Mar 2022

Health (Assisted Human Reproduction) Bill 2022: Second Stage

Dáil Éireann debate -
Wednesday, 23 Mar 2022