Amnesty International Report on Ireland's Abortion Laws: Discussion

Under the rules of the Houses of the Oireachtas, mobile telephones should not be used as cameras. If members and guests could put their telephones on silent or aeroplane mode, it would help with broadcasting the meeting and would not interfere with staff.

Our meeting is with members of Amnesty International to discuss its recently published report relating to abortion laws in Ireland which was launched this morning in Dublin. Members have been given opening statements and the report was put in their pigeonholes this afternoon. I welcome Mr. Salil Shetty, secretary general of Amnesty International, Mr. Colm O'Gorman, director of Amnesty International Ireland and Ms Christina Zampas, senior legal adviser. I thank Mr. O'Gorman for assistance in the organisation of the meeting. I also welcome the visitors in the Gallery.

Witnesses are protected by absolute privilege in respect of their evidence to this committee. If they are directed by the committee to cease giving evidence in relation to a particular matter and they continue to so do, they are entitled thereafter only to qualified privilege in respect of their evidence. They are directed that only evidence connected with the subject matter of these proceedings is to be given. They are asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against any person or entity by name or in such a way as to make him or her identifiable. Members are reminded of the long-standing ruling of the Chair to the effect that they should not comment on, criticise or make charges against a person outside the House or an official by name or in such a way as to make him or her identifiable. I ask Mr. O'Gorman to make his opening remarks.

Mr. Colm O'Gorman

We are grateful to the Chairman and members for their kind invitation to discuss Amnesty International’s report on Ireland's abortion law and policy. The report is entitled, She is not a criminal: The impact of Ireland’s abortion law, and was launched this morning in Dublin. I am joined by my two colleagues from our international secretariat. They are Amnesty International's secretary general, Salil Shetty, and Amnesty International's senior legal adviser and the report author, Christina Zampas. The reason for their appearance before the committee is that this is a global Amnesty International report. Ireland is one of the focus countries for our global campaign, My Body My Rights, which highlights the control and criminalisation of sexuality and reproduction by many governments around the world. This is actually the first time Ireland has been the focus of a global campaign. Mr. Shetty will speak to the committee about that while Ms Zampas will then highlight some of the key findings and recommendations in the report.

As members are aware, this is the first time Amnesty International has appeared before this committee on the subject of abortion. We noted the committee's lengthy and extensive hearings on the general scheme of the Protection of Life during Pregnancy Bill in 2013. However, as the ambit of that Bill was narrowly framed on a real and substantial risk to life ground for access to abortion, it fell far short of what international human rights law demands. Of very particular concern is the fact that the new legislation continues to criminalise women and anyone who assists them, including health care providers, so we appreciate this committee was not in a position to debate what a human rights compliant abortion framework would involve and how that could be effected here.

Since that Bill was debated and passed, we have all watched Ms Y's tragic story unfold and the High Court PP v. HSE case cause shockwaves. Both exposed the frightening consequences of the narrow, confused and complicated legal abortion framework that emerged from that Bill. However, as our report shows, there are quieter and more hidden human rights violations playing out daily in the lives of women and girls here in Ireland.

In the aftermath of the historic "Yes" vote on Ireland’s marriage equality referendum last month, members will have heard the renewed pleas by civil society for the repeal of Article 40.3.3 of Bunreacht na hÉireann to finally be put to the people here. Having looked carefully at Irish law and its consequences, repeal of the eighth amendment is one of Amnesty International's report's central recommendations.

Today our key message and appeal to this committee is that it adds to its work programme a review of this issue. As our report shows, Ireland is not just an outlier in Europe and the rest of the world in legal terms – it is denying its women and girls their fundamental human rights and causing them untold harm. This is an urgent and grave human rights issue, one which is now galvanising our members throughout the world. This committee has the power to bring a fresh Oireachtas examination to this issue and place before this Government and the next one a mandate and roadmap for legislative and constitutional reform.

Mr. Salil Shetty

I am pleased to be afforded this opportunity to address the committee on the day we launch our report on Ireland's abortion laws. Amnesty International is a global independent human rights movement. We have no political or religious affiliations. Amnesty's global My Body My Rights campaign works around the world to ensure that we all have the right to make decisions about our bodies and sexual and reproductive lives, which include the right to information and access to services. We work on this in several countries, including Nepal, Burkina Faso, Morocco, Algeria, Tunisia, El Salvador and, now, here in Ireland.

We hope to contribute through this piece of research and this campaign to the entrenched, sensitive and often personal debate on abortion here with a clear human rights perspective and with thorough research into the impact of abortion laws on the human rights of women and girls. Let me be clear. In almost all cases, criminalising abortion and denying women and girls access to safe and legal abortion is a violation of a range of human rights, including the right to life, health, information and to be free from torture and inhuman or degrading treatment. In Ireland, the jails are not full of women and their doctors for having abortions and its maternal mortality rates are low. However, this is partly the case because Ireland effectively outsources its human rights obligations to other countries.

Ireland was chosen as a focus country well over a year ago for this campaign because it has one of the most restrictive abortion laws in the world and we believed it would be important to provide thorough analysis of the human rights consequences of the abortion laws and practices in Ireland after the extremely limited legal reform of 2013. A further impetus for choosing Ireland was the death of Savita Halappanavar. The circumstances of her death unveiled how dangerously uncertain the narrow risk to life ground required by the Constitution was. It still shows today that if the law had provided for a risk to health ground, as required under international human rights law, Savita Halappanavar could be alive today.

Ireland has a very good domestic human rights track record in many areas. Regrettably, it is not so here. I honestly hope that the Irish State does not look short-sightedly at the international interest in and attention to Ireland's marriage equality referendum vote. The very idea of extending civil marriage to same-sex couples was an acutely sensitive, if not controversial, subject in Ireland just a few years ago and yet it managed to get cross-party support for this and 62% of the electorate voted for it. Ireland became just the 20th state in the world to permit civil marriage equality. Ireland has moved so far so quickly on marriage equality but it makes the treatment of women and girls in its Constitution, laws and practices all the more jarring. The eyes of the world are on this Government and also on this Parliament. This committee is the interface between the Government and the electorate at this critical juncture.

The root of the human rights violations, pain, fear and trauma of the women and girls in this report is the 1983 amendment to the Constitution. As the UN Human Rights Committee pointed out to Ireland in July 2014, the State's Constitution is no excuse for these human rights violations no matter what the public mood or vote is. It must be heartening to the committee that in the case of abortion, polling has repeatedly shown that the Irish public is on the side of human rights. Ireland is a noted champion of human rights and indeed on gender equality on the international stage. Amnesty International has worked with Ireland's UN missions in New York and Geneva for many years on women's rights. The Government's review of its foreign policy, which was published in January 2015, reaffirmed its commitment to advancing gender equality and yet Ireland's domestic position on women's and girls' human rights related to abortion is deeply regressive and in violation of international human rights which it works abroad to protect. This is also Ireland's final year on the UN Human Rights Council. Ireland is the co-facilitator of the UN negotiations on the post-2015 development agenda. Is it not time to align its domestic law on women's rights with its global vision for the world's women and girls? This committee can play a crucial role in this and should it take this issue on, Amnesty International stands ready to be of assistance to it.

Our report is the result of research and interviews carried out by Amnesty International between September 2014 and April 2015 in Ireland and England. It includes the testimonies of women, health care providers and civil society organisations. We are indebted to all who contributed to the report. It reviews the compliance of Irish law and policy on abortion with international human rights standards. It finds both seriously wanting.

Ms Christina Zampas is the principal author. She wrote the report, is our senior legal adviser at Amnesty International Ireland and is a noted legal expert in this field. In that capacity, she has conducted research into the legal systems on abortion across the world, particularly in Europe, and she is best placed to speak on what she found in Ireland.

Ms Christina Zampas

I thank the members for inviting us today. Across the many testimonies in this report from women, health care providers and civil society organisations about the impact of Ireland's restrictive abortion regime, there are significant recurrent themes that bear emphasising. First, regardless of the law, women in Ireland have and will continue to have abortions. The World Health Organization estimates confirm that restrictive abortion laws do not reduce the number of induced abortions as women will undergo abortions regardless of its legal status and lawful availability. Ireland is no exception. The eighth amendment and the 2013 abortion law have not stopped women from having abortions. Every year, approximately 4,000 women travel to get abortions outside of Ireland. Restricting access to safe and legal abortion in Ireland instead invariably leads to rights violations and disproportionately impacts those who are already marginalised or vulnerable, compounding the human rights violations they experience.

The story of Ms "Y" is a tragic example of how the legal regime in Ireland is harming women. She was raped in her home country and as an asylum seeker, she sought a safe haven in Ireland or so she thought. When she attempted to get an abortion here, she was unable to do so because of the ban on abortion even in cases of rape. She tried to go to England but was turned back at the border because of her migrant status. In protest at her inability to get an abortion, she stopped eating and drinking. She was suicidal. She was then entitled to an abortion on the only ground available under the law in Ireland, the life exception, but even so, she still could not get an abortion. She was coerced into continuing the pregnancy despite her desperate pleas. She underwent a caesarean section and her lawyer told us that the caesarean section scar is, and will continue to be, a constant reminder of the rape she endured in her country and the brutal treatment she received in Ireland. Under human rights, such treatments can constitute torture.

The second theme that arose was that without exception, every woman Amnesty International spoke with, whether she travelled abroad for an abortion or remained in Ireland, experienced a violation of her right to physical and-or mental health. In speaking of their choices to travel or to procure an illegal abortion in Ireland, almost every woman we spoke to made repeated reference to the death of Savita and the impact it had on them, some fearing for their lives should they need to undergo a lawful abortion in Ireland. It is critical to note that the situation faced by Savita is not an isolated incident. Any woman who is in the process of having a miscarriage could easily be her. In fact, we spoke with several such women and I can speak to specific cases in our discussions following this presentation.

The third theme that arose was that women consistently emphasised that having to travel abroad for an abortion made them feel like a criminal, regardless of the reason they were having abortions. They all discussed the increased stigma and isolation this made them feel for making decisions that women in almost every other European country, with the exception of Malta, can make. Women told us of their need to lie to their family, friends and employers; to arrange for child care; and to beg for money from friends in order to afford travel; and the fear they had of returning to Ireland with complications and needing health care but instead being labelled as a criminal. As one doctor I spoke with said: "Our Constitution is profoundly hypocritical and that it protects women to go abroad for something that is outlawed here."

The final theme that arose concerns the Regulation of Information (Services outside the State for Termination of Pregnancies) Act 1995. Most health care providers and counsellors we interviewed expressed frustration at this Act which essentially censors the provision of information on abortion and compromises the relationship between health care provider and patient.

The law’s ban on advocating and promoting abortion has created a climate where women are denied full information on the abortion procedure in Ireland, and doctors could be held criminally liable for referring women to abortion providers. This denies women their right to information and goes against all good practice, including that recommended by the World Health Organization.

One woman’s statement embodies the sentiments of many interviewed for this report. A woman identified in our report as Roisin told us:

I’m hoping [access to safe and legal abortion in Ireland] will happen in my lifetime. So my daughter, when she is older and she needs to have an abortion, doesn’t need to travel to the UK in secret, in [secret and in] silence.

Amnesty International’s calls are simple. We know they will take courage on the part of legislators to see through. However, as our report clearly shows, women's and girls’ health and lives are at stake and Ireland’s human rights record is tarred. This Legislature has a responsibility to ensure that the Republic’s laws are in line with its international human rights obligations. In order to achieve this, it is essential that the Constitution’s eighth amendment be repealed; that abortion be decriminalised; that the Protection of Life During Pregnancy Act be repealed and replaced with a legislative framework that ensures access to abortion both in law and in practice, at a minimum, in cases where the pregnancy poses a risk to the life or to the physical or mental health of a pregnant woman or girl, in cases of severe and fatal foetal impairment, and in cases where the pregnancy is the result of rape or incest. These are the requirements of Ireland's human rights obligations. We are also calling for the repeal of the regulation of information legislation.

I thank the witnesses for their presentations.

I welcome the witnesses and thank them for publishing the report. I have read the summary, the recommendations and some of the conclusions and findings. The individual testimonies certainly highlight some of the trauma people have to endure. Mr. Gorman referred to a call by civil society to repeal the eighth amendment. I cannot recall a time when we ever had a civil debate on this matter, to be quite truthful. Perhaps from now on, we will try to ensure it is civil and cordial and that we will reach some consensus in addressing it.

This issue has been debated in the Dáil on numerous occasions recently. Deputy Daly introduced a Bill on a couple of occasions, as have other members. There is no point in our trying to simplify this debate; it is quite complex and society has very strong views on it. There is a deeply conservative element and those in this category have very strong objections to any form of liberalisation of abortion. They talk about abortion on demand and the move towards that. Theirs is certainly one view. I have always said I believe there is a middle ground. The matter of fatal foetal abnormalities is one on which there might be broader consensus. Having said that, there is a strong body of opinion reflecting concern over this.

The eighth amendment is what anchors all the legislation and the interpretations by the Supreme Court in the context of the X case. We have a very tangled legislative framework hanging off the eighth amendment. The key question is alluded to in the recommendations. The first recommendation is the repeal of Article 40.3.3°. To write this in black and white is quite easy but to reach a point where we could have a rational debate on it would require, in the first instance, a debate in the Parliament with a majority favouring the putting of the proposal to the people for debate.

The key question, which I cannot ask the witnesses to answer today, concerns whether the Irish people are ready to repeal the amendment without knowing what is to be put in its place. Would they trust the Legislature to bring forward proposals? The constitutional provision was made, in the first instance, in 1983 because the people were not of the view that they could trust that the move towards abortion on demand across Europe, the United States and elsewhere would not occur here.

There should be a debate on this issue. We must confront it and we cannot deny the fact that ten to 12 Irish women will board a plane every day seeking an abortion for various reasons. Irrespective of the reason, they feel they have a crisis pregnancy and that a termination is their option. Very often, they travel under considerable pressure with a crisis pregnancy.

The report goes into some detail regarding the recommendations. We received it only today so it certainly merits further discussion by this committee.

Let me return to the key issue, that of engaging civil society. Mr. O'Gorman should be very clear that there are varying views in civil society. There is a liberal civil society and a conservative one. To have the debate will be exceptionally difficult. There is no point in my pretending, in the face of a general election, that these issues cannot be very easily moved off the agenda for electoral reasons. Unfortunately, that is what has happened regarding this issue for the past 30 years. It has been avoided, to say the very least.

The tragic case of Savita Halappanavar brought the Protection of Life During Pregnancy Act into being. Many of the testimonies here regard the Savita Halappanavar case as an issue of concern. Is what happened in Galway sometimes used to generate discourse without actually taking into account that it may not have been entirely a question of legislative problems and constitutional inhibitors? If we are to structure an argument or debate, it should be grounded entirely on factual positions, both of those opposing the repeal of the eighth amendment and those proposing an amendment thereto. The case of Savita Halappanavar was very tragic. We had long discussions in meetings of this committee on the Protection of Life During Pregnancy Bill and there was a pre-legislative scrutiny element also. This resulted in a variety of opinions. It is not that every member agreed on how to move forward. If we are to engage with broader society, we cannot deny the fact that 11 Irish women travel abroad for an abortion every day for many and various reasons.

The witnesses have made recommendations. How do they envisage our bringing about a discussion to address the recommendations in a debate, making reference to the equality referendum? The key issue with that referendum was that there was broad political consensus. I doubt this will feature in the case in question. There is potential for a very divisive debate. Perhaps the committee will have to examine this. I raised this in the Dáil previously. We must try to come to some arrangement whereby we can actually have a proper debate, something like that which took place during the pre-legislative scrutiny of the Protection of Life during Pregnancy Bill. Otherwise, this report will gather dust. While it is gathering dust, another 12 women will go abroad every day of the week for a termination in England or Wales. I assume this estimate is conservative in view of the fact that women also travel elsewhere for terminations. One should not pretend it is easy to move this debate on because it is not. Accepting that it is difficult would be the first step in trying to have a more inclusive debate representing all views in society.

I welcome Mr. O'Gorman and his two colleagues from Amnesty International to the committee.

I thank them for the contribution they have made and for the publication of the report, She is not a criminal: The impact of Ireland's abortion law, and confirm that is a view the party I represent has held throughout my political activism over many years. It is the case that Irish opinion has evolved slowly on many matters, and most especially on the critical focus of the witnesses' address this evening, and is likely to take some little time still to get to a point where, I agree, we need to see the repeal of the eighth amendment. Article 40.3.3° denies the opportunity for women to make an effective choice where they are challenged by real and serious decision-making in their lives on their health, physical or mental well-being, the reality of the backdrop to their pregnancy, such as rape or incest, and where fatal foetal abnormalities have been confirmed and are clearly present. In all of these situations the woman most certainly should have the right to decide in full consultation with trusted medical advisers and support. This is not the case, and despite the good intentions of many regarding the Protection of Life During Pregnancy Act, it proved to be deficient when particular cases have presented in the period since.

I mentioned that societally Irish opinion moves slowly. My party has also taken its time in coming to terms with recognising and realising there are circumstances which present and are real and we must face up to this. I speak quite specifically about fatal foetal abnormalities. We only came to a firm decision, by a majority and not unanimously, in March this year at our annual Ard-Fheis, which is our policy formulation vehicle. The time it took frustrated many and others are discommoded by the decision taken. In some way it is reflective of the broad range of opinion which makes up Irish societal opinion today. We made a decision and have given effect to it with regard to opportunities that have presented in the Dáil since. Recently, we supported a Bill proposing the repeal of the eighth amendment. In the context of our policy on this matter we most certainly will support efforts to bring about a repeal.

Deputy Kelleher raised the issue of how the debate is progressed with regard to trying to address the legislation which would follow, because legislation must follow when the Constitution is changed. My sense is the greatest prospect for success would lie in a pre-signalled construction for the legislation which would follow. Leaving it for a debate that would immediately follow, or follow at some point in time subsequently, would leave many people greatly unnerved. If we are to make progress and see repeal of the eighth amendment, we need to be able to spell out for people what it is we as legislators are prepared to present subsequently. This would help enormously in progressing the project for all the good and right reasons, namely, understanding, compassion and the realisation that we cannot, to all intents and purposes, continue to banish women from our shores to access a right that should be theirs here at home. This is the position we hold.

I do not intend to pose a series of questions but I will point to one matter in Ms Zampas's closing remarks on the conclusions and recommendations. I suspect Mr. O'Gorman knows as well as I do that when something new comes into the conversation, the Irish make-up is to say the position has moved. I know about fatal foetal abnormalities because I led the argument and made the proposition. Amnesty's document mentions severe and fatal foetal abnormalities. I know immediately what this use of language will produce, and I ask the witnesses to take on board all of the difficulties many of us have had to get to where we are, never mind where many of us would like to be, believing it to be the correct place to arrive at. I want to be a part of it for all the right and good reasons, none other. The referencing used opens up the matter because where would one make this determination? It would all become another cul-de-sac and I am concerned and worried in this respect. I sincerely thank the witnesses for their contribution to what I have no doubt will be, as it always has been, a very intense debate and discussion which will go on for some time yet.

I thank the representatives for coming before the committee. We are not in a position to ask very developed questions on the report but it certainly appears to be a very important and considered body of work which we will find useful and we will analyse it over the next while. The witnesses mentioned it is part of Amnesty's global campaign, My Body My Rights. Is Ireland the only European country featured in it? Presumably this reflects the fact that we are significantly out of kilter on this issue vis-à-vis other European countries. Deputy Kelleher said it is a difficult issue to grapple with and it is, but everybody else seems to have managed it considerably better than we have. From Amnesty's point of view, was Ireland ever part of another international Amnesty campaign or is this the only issue on which Ireland has been singled out? If it is, I am not surprised, because it reflects Ireland's attitude to women. Would it be fair to say in terms of Amnesty's research into Ireland's abortion laws that it reflects a situation which the former Minister for Justice and Equality articulated very well when he said that our Constitution means not all citizens are equal and that as a result of the eighth amendment pregnant women have a qualified right to health and bodily integrity, a scenario which does not apply to men?

Ireland is now putting itself on the world stage as being the ambassador of equality, and correctly so, in terms of same-sex marriage, but in terms of health, half our population, or slightly more than that, are unequal in terms of health provision. Does Amnesty International's research vindicate that viewpoint?
We should move forward on all these issues. Everyone knows we must repeal the eighth amendment. Deputy Kelleher spoke about having a rational debate, but on the number of occasions we have had a debate on this issue in the Dáil during the lifetime of this Dáil, every Member from every party who spoke said that there is a problem with the eighth amendment. That, to me, must be our starting point. They may have very different views on what happens next but everyone is agreed on that point. I would challenge anyone to check the record on that and they will find that people said that something must be done about that. That is something on which we can all find commonality. Let us get rid of the eighth amendment because, clearly, we all agree it does not work. Would our guests agree that for us to be human rights complaint, we need to do that?
We should not have this conversation in a vacuum. We know that representatives of non-governmental organisations from Ireland are appearing before the UN Human Rights Committee. We should know that figures were published today which show that 3,735 women of Irish addresses travelled to Britain to access abortion last year. From our guests' findings and interviews with people, is it the case that the research leads them to believe that the consequence of the State's failure to provide access to safe abortion in Ireland does not change the Irish abortion rate, rather it just means, as was said, that we are outsourcing our human rights and health responsibilities, and to overcome that, we need not only to repeal the eighth amendment but also to provide for safe and legal abortion in all the circumstances they have outlined? In fairness, the majority of people in Ireland have repeatedly stated in opinion polls that they agree with that in all those circumstances. I do not see it as being a huge problem. Have our guests come across a similar scenario anywhere else where human rights and access to health care was outsourced in a similar fashion? It seems a peculiar abdication of the State's responsibility to put into the Constitution that people can access the health treatment of abortion but they cannot access it in Ireland and have to leave the country to access it. That seems a very peculiar set-up.
I would consider myself a feminist and would be pro-choice but it is fair to say that Amnesty International is not those things. I am not criticising our guests for that. It is a different type of organisation but its stance on this issue has been dictated not by those motivations but very much by an analysis of human rights concerns, international human rights standards, international standards in terms of citizens' rights to exercise health care and their rights to bodily integrity.
In terms of the issue of criminalisation, I believe it was Deputy Kelleher who mentioned that he hopes we could have a thorough scrutiny of any new legislation like we did for the Protection of Life During Pregnancy Bill. I sincerely hope it is dramatically better than that because that legislation criminalises people. From the viewpoint of Amnesty International's international human rights defenders or observers, is it the case that Amnesty International is saying that criminalisation is a violation of people's human rights in all circumstances? I think it is saying that and that certainly would be my view. I will leave it at that.

Deputy Conway, our Vice Chairman, and Senator Crown have indicated they wish to speak. I call Deputy Conway.

I thank the speakers for their contributions. I have not got to read the report in great detail today but I welcome the opportunity to discuss this issue with them. I have some specific questions about the pieces I have read. With respect to the closing arguments that were made about repealing the eighth amendment, that abortion be decriminalised and that the Protection of Life During Pregnancy Act would have to be repealed, and Deputy Daly picked up on those, none of this can happen unless we repeal the eighth amendment. That is the quandary in which we find ourselves. That must be the launch pad for any conversation around this. There will be differences of opinion about how and what comes after that, but none of this can happen unless we can repeal the eighth amendment. I believe we should do that.

It is worth noting that the World Health Organization's figures show that throughout the world approximately 800 pregnant women die every day. As a young woman and a legislator, it jars with me that our development policy is far more progressive than our domestic policy. Those 800 women a day who die in pregnancy due to childbirth, as per the WHO figures, live in developing countries. Thankfully, childbirth here is relatively safe. There are always difficulties, but relatively and most strikingly, that was not the case for Savita Halappanavar in Galway. It is not correct to say that legislation in terms of the Protection of Life During Pregnancy Act, as restrictive and as difficult as it is, happened because of Savita's case. Her case completely changed public opinion. That is what it did. That legislation was trying to catch up with something that happened 21 years previously. That shows that this legislation was hard fought for by many people over many years but society, opinion and circumstances have moved on considerably in that time.

On the issue of decriminalisation, one of the speakers made a comment about the procurement of illegal abortions in Ireland. I would like to know a little more about that. Was the speaker saying that the procurement of illegal abortions in Ireland is happening through people buying medication online, or that backstreet abortions are being carried out by unqualified people, or that qualified people are participating in abortions? We know that women in Ireland have abortions every year but they have to travel to the UK.

I welcome again the publication of Amnesty International's report but it is shameful that this is the focus of it, that women are treated like this. My position as an individual is very clear but, as other Deputies have said, we have to work to the middle ground in terms of repealing the eighth amendment. That must be the first step. None of the other things we want can happen unless we remove this amendment. As a young parliamentarian, I would like the opportunity to vote on an issue like this because I am probably one of a very few number of people physically who could be in this position in the next ten years. I also want to thank the very brave women and their partners, husbands and boyfriends who came forward and spoke about the issues around fatal foetal impairment and the treatment, if it could be called that, they have to go to Liverpool to get. There has also been a seismic shift in public opinion on this issue and, to be fair, among legislators as well when they have heard these stories of these very brave families and the really awful way in which they are treated. We need help from civil society. We need to work together to make sure we get over the first hurdle of repealing the eighth amendment. The committee has said it will give more time to this in its work programme following on from the commission report the Labour Party published under the lead of Senator Ivana Bacik. I look forward to that.

I thank the witnesses for attending and for the report. I have a position on abortion that makes everyone maximally unhappy.

While it may not have been hijacked, the debate is being driven by people at the two extremes, and a logical, considered, temperate, thoughtful, scientifically informed and unsentimental middle ground has not been allowed to develop. The position that a two-cell, four-cell, eight-cell, 16-cell or 32-cell foetus, or a foetus a month or two old, with no working brain and no consciousness, movement or any of the characteristics that make a person a person, is a person with the same and equal rights as the mother who is its host is not logical. It may be a good basis for a theological definition of when life begins and for an individual's personal morality, but it is not a good basis for public law or policy. However, currently, it is the basis for the public policy we have, which is effectively that from the moment of conception, a two-cell or eight-cell foetus - although this has been interpreted by the courts as being only at the time of implantation, which can occur very quickly and with very few cells - assumes the full individual rights of a citizen. This is not logical, and as a society we do not behave as if we believe that. Even people who have an anti-abortion or pro-life position do not behave as if they believe that. Otherwise, why, if we know that ten or 12 women are committing murder by travelling to England, would we not put police road blocks in place at all our airports and ports to stop them from travelling for abortions? Why are we not carrying out mandatory pregnancy tests? If in any other situation ten, 12 or 14 murders a day were taking place, people would be up in arms about it. It is quite obvious that we do not believe this. We believe that whatever abortion is, it is something different. Therefore, if for no other reason than that, the case for repealing the eighth amendment is very strong.

As somebody who frequently has to make life-and-death decisions and have discussions with patients and their families about the level of intervention they would like in the event they become incapacitated or their prognosis becomes poor, I am very conscious that in general people are very comfortable with regard to doctors making decisions on when life ends. This is historically true in jurisdictions all around the world. However, they have not been as comfortable with allowing us decide when life begins. Part of this problem is that this is our fault as a profession, because there has been a fair deal of moral cowardice. People have brought their own pro-life and pro-choice prejudices into the debate with them and do not want to appear to be disloyal to their own intellectual or philosophical base by taking a position which may be at some variance with it. For this reason, the part of my position which makes me unpopular with pro-choice people, having already burned my bridges with the pro-life people, is that while I believe it is absurd, medieval and theological to assume that a two-cell organism is a person, I also believe it is absurd, medieval and unbelievably inhumane to think that a 22-, 24- or 26-week-old foetus, which can move, has a nervous system and must be anaesthetised before it can be dismembered in the course of a late-term abortion, is not a human. The ultimate logic of the pro-choice position, a viewpoint I have heard articulated, is "It is my body and I can do whatever I want with it at any time, up to and including 40 weeks." If there is a campaign to repeal the eighth amendment, I will support it, because I believe it is a bad amendment that ties the hands of legislators. In the highly likely event that I am still in Parliament at that stage, I may well support some other kind of replacement legislation, which will make me massively unpopular with many other people.

I have a question for the three witnesses. As representatives of Amnesty International, a premier human rights organisation, when do they believe a foetus becomes a person who should enjoy the protection of Amnesty International? At what stage do they think should Amnesty become involved? Would Amnesty International ever go into a country where abortions are legal at 34 or 36 weeks, where children can be removed from the womb and after they have moved and made noise be allowed to die on a table? Would they ever think it is their job, as part of Amnesty International, to defend their rights? I would like to hear Amnesty International's position on this, because I need to inform how I will think about this in the future.

Two other members have indicated that they wish to speak. We will take their contributions now rather than going back and forth with questions.

Most people have said what I would like to say, so I will not repeat what has been said. I support the repeal of the eighth amendment because I do not believe this issue should have a place in our Constitution or that it is a constitutional issue. Deputy Kelleher said earlier that the difficulty in any referendum campaign is that it is rarely about what we are asking the public. We need to be very clear about what we want in place of what we have. We would probably all find difficulties with any legislation on this, based on what has been articulated. The issues Amnesty International has highlighted are issues I would support, but I also agree with Deputy Ó Caoláin's questioning in regard to terminology surrounding severe and fatal foetal impairment. That is new wording as far as we are concerned in this debate.

An issue that has not been raised is one I became very conscious of during the debate on the Protection of Life During Pregnancy Bill. In our debate, we talk about the number of women who travel daily to Britain for abortions, but we do not talk about children who end up in the care of the State and who do not have that choice. That protection is not there for them. These are often children who have been raped by a family member. What choices and rights do these children have? Regretfully, I have come across cases involving these children whom we have totally and utterly failed. These children are put into the care of the State because we as legislators cannot come together and make laws in this area.

I appreciate what has been said about the Protection of Life During Pregnancy Act. However, while I believe the debates and hearings we had were a good model, our debate was restricted by the Constitution. If we could have a wider debate, it would be useful for us to tease out the issues. Before we had our debates, I was not clear on my position, but the debate helped me to become comfortable with my position. We need to find a forum that is not focused on one or the other end of the spectrum, where one feels one has to apologise for standing in the middle and for not being strongly in favour of one end. We must try to see how many people we can bring to the centre to try to work out how they feel about this. We know how people at each end who are shouting out on this issue feel, but we must work out how we feel.

I apologise for having to leave the meeting for a few minutes. While I was out, I heard Amnesty International being called a de facto lobbyist for abortion on the news report. I would see that as the start of a non-cordial or non-respectful conversation.

I am afraid of my life of this topic, but that has nothing to do with votes. Before I came to this House, I was clear in my head - or so I thought - that I did not agree with abortion in any shape or form. My attitude was "No way, José," in any circumstances. I acknowledge that this was a result of my upbringing and faith and that this had been drilled into me. In the past number of years that view has been challenged at many levels and in many circumstances, but I am still afraid of the issue. I know that may sound stupid, but I do not know what the world will look like after we have had this conversation. I acknowledge, however, that we need to have the conversation.

We need to tease out what is acceptable to Irish people if the eighth amendment is repealed and under what circumstances abortion should be permitted. We have had proposal after proposal put forward that abortion be permitted in cases of rape, for example, but we have never had a proper conversation with middle Ireland on what people believe is acceptable and agreeable or on how far we should go. Now, in 2015, it is time for that conversation. I believe we should have that conversation before we have a referendum to repeal the eighth amendment, because we cannot ask people to repeal it without knowing what will be in its place afterwards. I do not know whether this is something we should put to a special constitutional convention, but it should be put to people who are reflective of Irish society, not just the extremes on both sides. With respect, we all know what they feel. As Senator van Turnhout said, we need to capture the feelings of everybody else. We must acknowledge the fears that exist, but have the conversation. I am ready to have that conversation now. I was not ready before, but I acknowledge that we need to have it now. This is as good a time as any to start, so I thank the witnesses for coming in today.

I have no questions, but would like to thank Amnesty International for its presentation. Reading a document like this takes time and needs thought and reflection. Others have spoken about the Protection of Life During Pregnancy Act, and it was mentioned in the report.

As a Member of the Dáil for a number of years, I found it an intriguing - I use that word with the greatest respect - time in my political career to be part of such a process and to listen, learn and debate the issue.

I find myself in the same position here again. Ireland is changing. We have all recognised that in recent weeks. For what seems like a very long time under successive Governments, this topic was not spoken about openly. It may have been discussed but certainly not in the context in which we are doing so now. Starting the conversation is very important in light of what has happened in recent weeks.

I am a mother and a grandmother, and I regard my children as the greatest gift ever given to me. I went through a time in my life when I had a number of miscarriages and felt the devastation that caused. I agree with Deputy Regina O'Doherty that it is frightening to think of what is happening outside this House, but without all the information, the figures and the stories, which have been well reported, it is difficult for somebody like me to ask any questions of the witnesses. Along with most people in the room, I would like to be able to debate this issue and listen to those stories. This is not about decisions. It is about believing that what we do here as legislators gives everybody equal opportunities and so on. We have restarted this conversation and we should not let it flitter away.

Like many other members, I have met people in my constituency office who had experienced the trauma of foetal abnormality, and on many occasions following those meetings I went home deeply shocked and upset by their stories. Some of them were very close to home. As legislators we have to have all the facts and information but, above all, we must be compassionate in our decisions, because that is what this is about. It is about compassion, putting ourselves into other people's shoes and listening to what they have to say.

I have nothing further to add. I do not have questions but I agree with the previous speakers that this is about human beings. In fairness to Senator Crown, whom I do not always agree with, he speaks with great knowledge about the medical aspects. When he talks about cells and so on it is difficult for me to take it in because I am not an expert on that, but what he said at the end of his contribution about his medical work is profoundly important when decisions are being made on legislation like this.

Deputy Ó Caoláin has apologised for having to leave to attend another meeting with the Taoiseach. Deputy Neville had to go to another meeting also. I should have recorded at the outset apologies from Senator Imelda Henry and Deputies Sandra McLellan and Peter Fitzpatrick. I call Mr. O'Gorman, who can co-ordinate the responses.

Mr. Colm O'Gorman

Mr. Shetty wants to make some general comments first, and then we might try to move on to deal with some of the specific questions.

Mr. Salil Shetty

I thank all the members of the committee. Every single contribution was authentic and reflected many of the tensions in this society which they have to deal with. Ultimately, they must face the electorate and people in their own constituencies, so I thank them for engaging and for taking our contributions seriously.

We met yesterday with people from the Executive branch, the Minister for Health and the Tánaiste, and raised many of these issues with them, but we believe the meeting with this parliamentary committee is probably the most important one. The questions members asked us today as to the process from here on and what replaces the eighth amendment are relevant, but who will give the answers to those? We have some thoughts, but this committee has to move the process forward. It has to come up with a framework and a process which will help us to move forward, because nobody is saying there is not a problem. Everybody accepts there is a real challenge here. If there is one thing this report can do, it is that it will contribute to the process moving forward, not in an open-ended way but in a time-bound manner in that it has a clear end date. Elections come and go, but this is affecting 4,000 women every year. It is a very serious issue and I hope the committee can find a concrete way in the coming weeks to take it forward. I hope an action plan of some sort will come out of it.

I want to restate what we said earlier, because it is important when we are asked what will replace the eighth amendment, etc., and what is our position on the issue. Our position is essentially in line with international human rights standards, and those are clear. Abortion should be decriminalised in all circumstances. The criminalisation of a woman who is already going through such suffering does not make sense. Very few countries criminalise, and we would not expect Ireland to be in that group of countries. Beyond that, we say clearly that it is not only the risk to life but the risk to mental and physical health that must be taken into consideration. Abortion services should be available for women who become pregnant from rape, incest and sexual assault. In the case of foetal impairment, we can come to the question of severe and fatal, which Ms Zampas can clarify. That is our position. We hope it can inform the discussion when members consider what happens next. That is our contribution.

Ireland is in a unique position on this subject, but in terms of the international stage, if the Irish ambassador or representative was sitting on the Human Rights Council and one of the countries which came up for review said that in that country freedom of expression is not allowed because there is a constitutional provision which prevents that, the Irish representative would say it is time it changed its constitution. Similarly, if we were told by a country that the death penalty was very much in our faith and culture, that would be challenged by an Irish representative to the effect that that is not acceptable.

On both counts I would appeal to this committee to think about the way forward and the next steps because I suspect there is no other body which can make that happen.

I put it to Mr. Shetty that the committee itself cannot change the Constitution-----

Mr. Salil Shetty


-----so that, therefore, is a matter for the people.

Mr. Salil Shetty

Of course.

What exactly is Mr. Shetty calling for in the context of the report? From reading the report I am unclear as to what he wants.

Mr. Salil Shetty

We made specific calls, which are the repeal of the eighth amendment; the repeal of the regulation of information Act-----

I accept that, but in terms of the issue of abortion, is Mr. Shetty saying that abortion should be allowed per se or in specific circumstances? I heard his earlier comments but I am still confused as to what he is actually saying in that regard.

Mr. Salil Shetty

Amnesty International's position on that is very clear. It is along the lines of international human rights standards. First, decriminalisation of abortion under all circumstances. Second, at a minimum, we are calling for abortion in the case of physical and mental risks to the health of the woman; Ireland already has the risk to life provision. We are calling for it to be available in situations of incest, rape and sexual assault and in the context of foetal impairment, severe or fatal. That is what we have said in the report. I will pass over to Mr. O'Gorman.

Mr. Colm O'Gorman

I will try to address some of the broader questions and, as she is the legal expert among the three of us, I will hand over to Ms Zampas, who will deal with some of the more drilled-down legal questions.

In the spirit of open acknowledgement of how slowly many of us have come to this debate, and given what Deputy Ó Caoláin said in responding to Deputy Daly's comments, I should acknowledge that Amnesty in Ireland has been an outlier within Amnesty International on this issue. When our global movement adopted this policy position in 2007, Amnesty International in Ireland voted against it. When it was adopted we accepted that was the position of our international movement, but our members made it clear that we would not work on this issue at that point. We have been on our own journey on this as well.

Amnesty International's position on access to abortion as adopted in 2007 was not a particularly progressive position. We have elaborated on and moved that position forward in significant ways since that time.

We are a part of all of that. One of the important statements that Amnesty Ireland needs to make is that, as members of Amnesty International who work with the organisation in Ireland, we are part of a society that has been described by former Ministers for Health at various times as pathologically incapable of having a rational, objective conversation about an issue like abortion. We need to own this. It references much of what Deputy Kelleher discussed.

I wish to address a question that he also raised about the case of Savita Halappanavar. Ms Zampas might discuss this matter. As all of the reports established, Savita's death was the result of medical negligence. However, we are clear in our view that, if Ireland had had a human rights-compliant framework of abortion in law and in practice, Savita Halappanavar could have been alive today. The issues that led to the grave risk to her life and that resulted in medical negligence becoming a factor would likely not have arisen had she been granted a termination at the point when she requested it and when it was clear that she was experiencing an inevitable miscarriage. It is worth pointing out that her death moved public opinion. It also empowered public opinion to be articulated in a way that it had not been previously.

This morning, it was sobering to hear Dr. Mahony make it clear in her presentation when we launched the report that the Act did not address the circumstances surrounding Savita's death. I am sure that Ms Zampas will discuss cases. One case mentioned in the report arose three months after Savita died in the same hospital and involved the same circumstances. Many medical experts gave information as part of the research to make it very clear to us that we are still, as Dr. Mahony stated this morning and as Senator Crown, with his expertise, would speak to, playing medical roulette with women's lives and health. Doctors are forced to sit back and not intervene. They can see that a woman will inevitably become ill, then seriously ill and finally gravely ill, but they must wait for the moment in which they can make a determination of a real and substantial risk to her life. As Dr. Mahony asked, does that mean a 10%, 20%, 50% or 80% chance of death? All the time, the doctors must remember that, if they act and a clinical view is arrived at in future that there was not a real and substantial risk, the woman and the practitioner will face up to 14 years in prison. We are still operating in this context.

We must be clear about what we are saying about Savita's case, but we must baldly state that it is likely that she would still be alive if Ireland had had a human rights-compliant framework for abortion at the time that she presented at the hospital in Galway.

On the question of what would replace the current set-up and how to carry the debate forward, I noted Deputy Doherty's comments about some of the comments being made because we have published this report, for example, presenting Amnesty as a pro-abortion lobby group. I will ask those who respond in that way to read the report and to engage with the testimony, evidence and research presented therein. We are not going to engage in a vitriolic shouting match with those who may have previously created a heat around this debate that has caused all of us to run away from it since. The human rights violations that we have identified in this research require that we do not do so. I am encouraged by the nature of how this debate has developed politically and the responses that we have received from the committee at this meeting on the clear need for this debate.

Let us be clear. This is a controversial, complex and difficult issue. In Ireland, our major difficulty is our fear of how this debate went previously rather than of where we might go in the conversation. We have been frightened and cowed out of having the conversation because of the heat and vitriol that often accompanies it. As executive director of Amnesty International in Ireland, I want to make it clear that Amnesty will be a part of ensuring that we have this conversation. We will not be shouted down or intimidated away from it. The lives and human rights of the women and girls who spoke to us and of those who will face grave violations as a consequence of Ireland's law on abortion require that we do so. We are a human rights organisation. We are not a lobby group or a pro-abortion group. Unless those who would present that view also want to accuse all of the treaty monitoring bodies of the United Nations of being pro-abortion lobby groups, their position on this point has little depth or merit.

As everyone has mentioned, opinion in Ireland seems to be strongly on board with the minimal obligations required by international human rights standards, which were adopted and written by states and legislators and are binding. We are asking states, including Ireland, to respect those obligations.

I will ask Ms Zampas to answer the question on severe and fatal foetal impairment, as it was an important one that we want to address properly.

To answer Deputy Daly, Ireland is the only country in Europe that features in the My Body My Rights campaign. We agree with Deputy Shatter, the former Minister for Justice and Equality, that gender discrimination is at the heart of the violations that are under discussion. We believe that Ireland is outsourcing its human rights obligations, which is unacceptable.

The other country that we examined in respect of this issue is El Salvador. I was there last September for the launch of a similar report. In some ways, El Salvador is Ireland without access to England - that is unless women have money. Its abortion law is even stricter, with abortion banned in all circumstances, including risk to life. Poor, rural and, often, young women experience the impacts of El Salvador's approach whereas those who have money travel.

We agree with Deputy Conway that nothing can happen until after we have repealed the eighth amendment, which is why that forms one of our overarching recommendations. On the broader question of the political process that needs to happen, though, that is a matter for legislators. We are available to support and inform the process in any way that legislators believe is appropriate. We will be a part of the public debate that must follow to support the work that legislators will need to do. It makes obvious sense that, in tabling a proposal to amend the Constitution, legislators need to be clear about its impacts. It seems sensible to suggest that a clear framework be decided, developed and delivered. Consistent with international human rights law, Amnesty's position is that abortion should be decriminalised and instead addressed through the civil code and medical regulation. This is a discussion that we might develop at some point.

I was struck by Deputy Conway's comment about how, as a young woman, she had a particular interest in this. I recently made the point - others have made it also - that there are few people directly affected by the eighth amendment who voted on it. Those most affected by it have never had their say. This is something that we need to address.

I appreciated Senator Crown's input. I will hand over to Ms Zampas so that she can deal with his question on how and where states should begin providing protection for prenatal life.

To be clear, I understood that Senator van Turnhout was referring to the situation of children in the care of the State who found themselves in crisis pregnancies. Our understanding is that there are circumstances in which the State provides for children in care to travel to access terminations.

It is not necessarily a consistent practice.

Mr. Colm O'Gorman

No. The Senator is pointing out something that the research and our report made clear, in that it is marginalised women and girls who are most at risk of grave human rights violations as a result of our particularly restrictive framework.

I have answered everything, so Ms Zampas might address some of the legal questions. We can then continue the discussion further.

Ms Christina Zampas

I will go through them as they were raised. I will not repeat what Mr. O'Gorman stated, but I want to say something about the Savita situation and the case of Lupe, who is mentioned in our report.

She was in a very similar situation. She had a wanted pregnancy and she was miscarrying. She went to the hospital for a scan which indicated that there was no foetal heartbeat but they told her to come back the following week just to make sure. She ended up carrying a dead foetus for two months. At one point she realised that she could get an infection and she could be Savita. She went back to Spain, her home country, and doctors there could not believe that she had not been given an abortion. Dr. Mahony referred to how it does not make clinical sense to equate the constitutional protection of the unborn with the right to life of the pregnant woman. To repeat what Mr. O'Gorman has said, the distinction between health and life is not a distinction for the law to make. It is a distinction to be made in a clinical setting by a pregnant woman, in consultation with her doctor.

Severe foetal impairment is a very difficult issue. The easy answer is that human rights bodies recognise that the human rights implications of denying women who have had pregnancies which are severe could be that women will seek abortions anyway, but I think it is much more difficult than that. We have a story of a woman who wanted to be called Laoise's mother. She had a very wanted pregnancy. She and her husband were very happy about it. The pregnancy was diagnosed with a severe foetal impairment. Her decision to terminate her pregnancy was not an easy one. When we were drafting the report, it was very difficult for her to include it in the report. Finally she agreed and she came out and thought it was very important. She took part in a recent meeting with stakeholders where she said she was happy it was in the report. It is not up to Amnesty to make the call on what is severe or not. We are not a medical organisation. We would never want to see a list of what is severe. It is a clinical decision to be made between a patient and her doctor. These are judgments to be made in a clinical setting. We are a human rights organisation. We are not going to list the grounds on which women can have abortions for severe foetal impairment, but we will follow international human rights standards.

Deputy Daly referred to other countries in Europe. Malta is the only other country in the EU that has a stricter law than Ireland. In the 47 Council of Europe member states, the only other countries that have stricter laws are the micro states of Andorra and San Marino. Malta, Andorra and San Marino have a total ban on abortion. In regard to pregnant women having a qualified right and how the eighth amendment works, our report describes how pregnant women in non-abortion related settings are being treated in maternal health care settings, so it is not just related to abortion. That could be the topic of a whole other report. There is one story that stands out, to which we wished to dedicate more time in terms of the report, but we want to make it clear that the eighth amendment impacts on all pregnant women, not just those seeking abortion.

In regard to the criminalising of abortion, we follow human rights standards. Human rights bodies have called for the decriminalisation of abortion in all circumstances, to take it out of the criminal code and not punish women and doctors. We know what happens when there is a criminal law governing abortion. It stops women from seeking care, even post-abortion care, it hinders providers from making decisions that are in the best interests of their patients and it reinforces a stigma and treats women as outcasts. That is why we also call for decriminalisation, and we believe there are other ways to regulate. There are professional sanctions which can be imposed on doctors; their licences can be removed, etc. Some of the doctors to whom we spoke were concerned about the criminalising of abortion hovering over them, but they also spoke about professional sanction, and to some that is almost worse: to have their licence taken away or to be ostracised by their peers in the medical community.

Deputy Conway asked about how illegal abortions happen in Ireland. This is dealt with towards the end of our report. Women who cannot travel, usually the most vulnerable women and asylum seekers, spoke to us about how they considered suicide. One woman spoke about how she calculated throwing herself in front of a truck or jumping off a bridge. It appears that women are taking the medical abortion pills here. Sandra's story, which is on page 94 of the report, tells how she procured the pills online. We want to be clear that medical abortion is very safe. The WHO has it on the essential medicines list for abortion. It is extremely safe and it is the safest methods of illegal abortions, safer than any other method. Around the world, especially in countries where women cannot travel and where abortion is prohibited or extremely restricted, like in Latin America, taking the pills have actually saved women's lives and have reduced maternal mortality. However, that is not an answer to changing the laws. The pills should be taken with medical supervision but we think that is probably one of the ways in which women are having illegal abortions here.

Reference was made to gestational limits. Amnesty's policy is that states could put reasonable limits on abortion and that could be the licensing of doctors, regulating of facilities that provide abortions, and gestational limits. Most countries have gestational limits. No country in Europe allows abortion on request to the end of pregnancy. It allows abortion until end of pregnancy when women's lives or health is in danger. Late term abortions do not happen because a woman makes a conscious choice to delay having the abortion. There are reasons they happen late. In the US less than 1% of abortions are late term abortions, but we see those who oppose abortion use this as a way to discuss the issue. They have co-opted the language of "partial-birth abortion" etc. Viability would be a reasonable gestational limit so we support those limits. Amnesty believes the best way to protect pre-natal life is to provide maternal health care services. In Ireland, the best way to protect pregnant women and those seeking abortions would be to repeal the eighth amendment.

Ms Zampas outlined that there were more than 60 interviews. Did that include clinicians with a pro-life disposition or members of the pro-life movement in this country? Deputy Regina Doherty mentioned that some of them had made comments already.

Ms Christina Zampas

No. Most of the testimonials come from women and their partners. We also interviewed the mother who travelled to England with her 15-year old girl to get an abortion. In this report as with Amnesty International's reports across the board, we document the human rights violations and we speak to people who are trying to support the human rights of women. It is really not that helpful to speak to those who oppose it or try to stop women.

Are there any other questions before we conclude?

While I am open to correction, I do not believe any finding of medical negligence has been made against any doctor with respect to-----

I agree. I do not believe so either.

----- Ms Savita Halappanavar. That is very important. I say quite firmly that there has been gross administrative negligence on the part of successive Governments that let this unit be so understaffed and under-resourced in common with all the other obstetric, medical and surgical units throughout the country.

Mr. Colm O'Gorman

I am very happy to have that matter clarified by Senator Crown.

I thank the committee members for meeting us at such short notice having had the report. In the context of a hearing like this it is very difficult to articulate much of the testimony of the women and girls we interviewed. I know it is challenging for members to get through everything they are given to read. However, if they have time at all it would be incredibly valuable for them to read some of that testimony.

Ms Zampas spoke of Lupe, a woman who was required to return to a hospital in Ireland for repeated scans before she finally gave up and travelled to Spain to access an abortion. I do not intend to be too graphic here, but we need to be blunt about this. When she travelled she was bleeding all the way and frightened about the impact of a pregnancy that she knew could not possibly continue because she knew that the foetus had died. That took place three months after Ms Savita Halappanavar died. That is one of the cases I particularly ask members to pay attention to.

I have a request to make of the committee. Earlier Deputy Conway indicated that the committee may have plans to look at foetal impairment at some point. If at all possible we would like the committee to begin this conversation in a way that seeks to move it forward. Hopefully this evening's hearing will be a start to that and we really value the opportunity to appear before the committee. We need to begin the process of both the political and public conversation that needs to happen if we are to move the issue forward.

We would be incredibly grateful to the committee if in deciding its work programme in coming weeks it could open up a discussion on reviewing the eighth amendment and Ireland's legal and policy framework with regard to abortion. That would be an incredibly valuable contribution in seeking to move some of this forward. I do not underestimate the challenge involved in that. However, for those of us, including many members of the committee who have made it clear, who are understandably committed to finding a way to move some of this process forward, we cannot continue to wait until we have another tragedy. It is certain that if the committee, the Government and the Legislature do not act, at some point - it could be at any moment - we will be facing into another crisis, another tragedy where another girl or woman has lost her life or we face another macabre horrific situation on par with the one we faced towards the end of last year.

I thank members of the committee for giving their time and we look forward to engaging with them on the matter in the future.

I thank Ms Christina Zampas, Mr. Colm O'Gorman and Mr. Salil Shetty for their presence and testimony this afternoon, and for the report that is before us. I also acknowledge the presence in the Gallery of members of Amnesty International and other organisations. I thank them sincerely for being here.

Any change in our laws can only be done by the people through referendum. As Deputy Kelleher has rightly said it is an issue that has polarised Irish society for over 40 years. We have been able to show that we can debate the matter in this committee in a civilised manner and I hope we will continue to do that in future deliberations. The committee will at a future date as part of our work programme discuss what, if anything, we will do. I have made my view clear that it is important for us to have a national conversation along the lines of the Convention on the Constitution, of which I was a member and which did sterling work. It would be a very important forum within which to bring together the different viewpoints within civic society. It is important that we had the conversation this afternoon.

The joint committee adjourned at 7.06 p.m. until 9.30 a.m. on Thursday, 11 June 2015.