Amendments Nos. 1 and 3 are related and may be discussed together.
Stillbirths Registration Bill, 1994: Committee and Final Stages.
SECTION 1.
I move amendment No. 1:
In page 3, line 9, to delete "or having a gestational age of 24 weeks or more".
I will not delay the Minister but some Senators who spoke after me stressed our concern about the limits on the time after which children can be registered. Senator O'Kennedy said that this Bill would have far reaching effects, which I think is true. The Minister spoke most sympathetically at the beginning of his speech about how this Bill was introduced to alleviate the grief of parents whose children were born prematurely and did not live. However, it will also be extremely important in the medical field.
I am anxious about the Department of Health using one definition in one area and another definition in another. This is why I pointed out that since 1988 the Department has been using the World Health Organisation's definition of 500 grammes in the perinatal statistics. I know this refers to a singleton and, naturally, there may be multiple births which are lighter. However, this can be worked out more easily than the gestational age.
Senator Roche used the phrase "a residual pool of grief". Wherever we draw the line there will be a residual pool of grief but having two definitions will mean two residual pools of grief: those who did not make it on the 500 grammes limit or the 24 weeks.
Senator Lydon is right in his comments about the decrease in the number of weeks at which a child becomes viable. Twenty eight weeks was considered the absolute limit until a few years ago and it is now down to 24 weeks. With developments, particularly the development of the lung in the unborn child, we may shortly see it go even lower. The World Health Organisation is considering reducing the weight level to 400 grammes.
It is not wise to have two definitions of stillbirth; it would have been better to have one. I know that, as Senator Roche so eloquently put it, there will be a residual pool of grief but we will be dealing with two rather than one unless we try to simplify the definition.
I am inclined to agree with Senator Henry. The weight can be objectively established and is more relevant than the gestational age which is a matter of conjecture in many cases. There is the additional problem of the age at which a child can survive decreasing. If there has to be a limit it should be the one which errs most on the side of compassion. The Minister has clearly shown that he intends to be compassionate and wants to show a compassionate side of the State. If we must have a limit it should be the one which can be objectively established.
If the World Health Organisation is considering reducing the limit we should set that limit rather than setting one of 500 grammes. If a limit has to be set, only one should be set because we do not want to have a situation of double jeopardy. I am certain that the Minister does not want a situation where people could be hung on one hook or the other. The whole approach which the Minister has adopted here is one of compassion and to open the door.
There will also be a practical difficulty in that the weight and the gestational period may not be noted in any official register when it comes to retrospective registration.
These are alternatives.
I know these are meant to be alternatives. I am simply saying that what we should do — and what the Minister aims to do — is to try and open the door and get rid of pain. The way to do that is to adopt the limit which is the easiest to establish and the lowest threshold. I stand to be corrected because I have no professional knowledge in this area, but I think that the lowest threshold would be the lowest accepted weight level.
I am sure that the Minister will give grave consideration to the points made by Senator Henry. I understand why the two alternatives are given, this is to ease the situation. However, it would be prudent of us to give much consideration to the point made by Senator Henry. Something which is being put into law now to make the way easy could actually make the way hard, which we do not want.
My understanding, unless I am reading it wrongly, is that the Minister is being more free in having the two options. It is either/or; if the gestation age is 24 weeks but the child has not reached a weight of 500 grammes it can still be registered. Therefore, it is giving more openings rather than less.
I would go along with Senator O'Sullivan. I understand that one wants a situation which is as simple and understandable as possible. When I read that section initially I felt, as Senator O'Sullivan did, that a stillbirth could be well under 500 grammes but because there was a gestation of 24 weeks it was acceptable. On the other hand, there could be a gestation of less than 24 weeks but a weight of 500 grammes which would also be acceptable. That was my understanding. Perhaps the Minister would clarify that point.
That is correct. I have given careful consideration to the definition of a stillbirth in the Bill. The stillbirths register is intended to provide comfort for bereaved parents and I have made the definition as wide as possible, consistent with the accepted medical norms. The Act will apply to a child born dead which either weighs 500 grammes or more or has a minimum gestational age of 24 weeks.
There is no universally accepted medical criterion by which to separate a stillbirth from a miscarriage. A weight criterion of 500 grammes is used by the World Health Organisation. For the purposes of the Department of Health's perinatal statistics, weight is regarded as being more definitive than gestational age which can be difficult to assess. Gestational age, on the other hand, more accurately reflects parents' expectations about the outcome of pregnancy than weight which is typically unknown. There is also the possibility that in a multiple birth if weight is the sole criterion used one child might qualify for the registration and the other would not.
The United Kingdom Government, having canvassed views in its Green Paper on Registration, has decided to retain gestational age as its criterion for stillbirths registration. As I said on Second Stage, this issue does give rise to a broad range of varying opinions. Senator Henry's amendment seeks to delete the reference to gestational age and, if I understood the contribution of Senator Taylor-Quinn correctly, she was suggesting that the reverse should be the position — that we should retain gestational age and delete the reference to weight.
However, by using both criteria the existing definition will allow — and this is my intent — the greatest possible number of stillbirths to be registered. Senator Henry's definition would have the effect of narrowing the definition and reducing the number of registrable stillbirths. It could prove particularly problematic for retrospective registration as gestational age was the traditional criterion used in the past. Bearing in mind the therapeutic rationale for the scheme, I believe the definition used should be as inclusive as possible. Senator Henry's definition would deny registration to some who would be afforded this comfort under the existing definition. With regret, therefore, I am unable to accept Senator Henry's amendment.
I assure the Minister that it is not due to lack of compassion that I am trying to point this out. We are going to have a perinatal statistic in this country detailing stillbirths at one figure and a stillbirth register giving another figure, and both within the Department of Health.
Or in the Department of Equality and Law Reform.
By that stage it will be in the Department of Health, which is odd. I am not going to push the amendment to a vote but I am sorry that it was not accepted.
Amendment, by leave, withdrawn.
Section 1 agreed to.
SECTION 2.
Government amendment No. 2:
In page 3, between lines 11 and 12, to insert the following definition:
"‘commencement date' means the day appointed under section 13(3) of this Act to be the day on which this Act comes into operation;".
This is purely a technical amendment to introduce the definition of "commencement date" which is referred to later in the Bill. It is purely a drafting amendment.
Amendment agreed to.
Section 2, as amended, agreed to.
SECTION 3.
Question proposed: "That section 3 stand part of the Bill."
What is the Minister's view on registration of miscarriages? This has been discussed throughout this debate. This section formalises the registration of stillbirths. I would welcome hearing the Minister's approach to the possibility of establishing a register for miscarriages in the future.
There is an acknowledged difference between a stillbirth which is a child born dead but viable outside the womb and a miscarriage. It is not the intent of this Bill to introduce a register for miscarriages. There is a very clear distinction to be drawn there.
A number of Senators, Senator Roche in particular, asked if there should perhaps be a register of miscarriages. That is a matter that would have to be considered. It would be quite an extension of the intention of this Bill which is not to provide for registration of miscarriages. That could cover a broad range of positions at an early stage of pregnancy. It could be considered but it does not apply to this Bill.
Question put and agreed to.
Sections 4 and 5 agreed to.
SECTION 6.
Question proposed: "That section 6 stand part of the Bill."
Can this section be interpreted as saying that both parents can register the birth rather than one parent? Can both sign the register?
Either parent can sign.
Either, so both cannot.
Both can. Either or both.
Either or both.
I would think it is either or both. Either parent may do it.
It is a small point and maybe not important but when it comes to registering, one parent will have to decide to register the stillbirth rather than have the parents do it jointly. Could we consider allowing them to register it jointly rather than just have one do it?
It is probably the same position that applies in the ordinary registration of a birth. I think either may do it. The important point is not who does it but the fact that it is done, that the registration is recorded and the certificate issues. The standard practice is that one parent does it.
Question put and agreed to.
Sections 7 to 13, inclusive, agreed to.
SCHEDULE.
Amendment No. 3 not moved.
Question proposed: "That the Schedule be the Schedule to the Bill."
Would the Minister inform me why it is important to put a person's occupation on any recorded register?
It is an important aspect of identification. The purpose of the register is to give full information regarding the parents. Name, address and occupation is a standard legal description in all legal documents.
It seems outdated that somebody must be identified by their occupation.
I do not think so. It is standard legal practice.
I know it is standard legal practice but with 300,000 people unemployed, is it right?
The fact that they may be unemployed does not stop them having a trade.
An occupation.
Yes, if they are unemployed; that is a fact of life and can be recorded.
It is very important that it be recorded because, as I pointed out earlier, there is an appalling stillbirth rate among unemployed people and unskilled manual labourers. It is three times the rate among the professional and salaried people. From a socio-economic point of view, it is very important to look at these factors. As I said, perhaps reducing our unemployment rate could do far more for the stillbirth rate than many medical advances.
The same provision applies to live birth registers. This is a legal document and in legal documents it is proper, good and standard practice that when a person is designated, the necessary basic information concerning them is given and that refers to their full name, address and occupation.
Question put and agreed to.
Title agreed to.
Bill reported with amendment and received for final consideration.
Question proposed: "That the Bill do now pass."
I thank Members for their contributions and help in getting this important matter through all Stages today. I express my sincere thanks to my officials, Margaret O'Connor and John Hurley who have worked so hard in the assembly and research that was necessary to prepare this Bill and bring it before the Seanad so quickly. It means that we can now send the Bill to the other House and have it enacted as soon as possible. Members of ISANDS and the people they represent have waited too long for this measure. It is good to be able to let them know that the time has come and this legislation will be enacted before long.
Question put and agreed to.
Sitting suspended at 5.10 p.m. and resumed at 6 p.m.