Seanad Éireann debate -
Wednesday, 2 Feb 1994

Vol. 139 No. 1

Stillbirths Registration Bill, 1994: Second Stage (Resumed).

Question again proposed: "That the Bill be now read a Second Time."

Dr. Henry

I would explain to our visitors that I have been talking about stillbirths. We are to have a stillbirth register which the Minister is introducing, and which I welcome. I hope for a miscarriage register in the not too distant future. I am sorry to load the Minister with more work.

This would not just be a help to the parents but would be extremely important in planning to try to help with future pregnancies. We must not only look at pregnancies in a quantitative manner but in a qualitative manner also. We must value each one; we must not only focus on the outcome of the full-term pregnancy but also look at what has gone astray earlier in a pregnancy.

Funding permitting, the department of obstetrics in Trinity College Dublin is about to undertake a survey of the psychological, psychiatric, psychosocial and familial sequelae of miscarriages from the parents' point of view. Women are to be encouraged to ask questions and demand information. I hope the Department of Health will be able to become involved in this study.

We often have to return to the beginning of pregnancy. We must urgently improve the position regarding genetic counselling. Ireland is the only advanced country without medical genetic resources. They have been delayed for far too long because we have had a loss of confidence in how we would handle them.

Some years ago there was a genetic counselling service in the Rotunda Hospital but lack of finance for the laboratory work caused the consultant involved to resign. Now at last a new genetic counselling service is being set up between Our Lady's Hospital for Sick Children, Crumlin and Temple Street Children's Hospital. One consultant has been appointed but rationally we should have between five and ten consultants in Ireland to deal with the number of cases.

I have some queries about the establishment of this service. Why have two of the children's hospitals in this city been selected and the third left out? Why is the National Children's Hospital not involved? That hospital is being transferred to Tallaght and surely it deserves sessions.

I would also query the lack of involvement of the genetics department in Trinity College which has a worldwide reputation. Retinitis pigmentosa is a serious eye condition which causes blindness in children. The Trinity genetics department has been in the forefront of research in this and many other areas. We should be very proud of them.

No services have been planned for adults, who comprise 50 per cent of the cases needing genetic counselling. There is no provision for advice on multi-factorial diseases, where a genetic predisposition would be made worse by circumstances. Illnesses which involve environmental as well as genetic factors include forms of cancer, psychiatric disorders such as schizophrenia and autoimmune conditions such as asthma. Where are all these people to go for advice? I presume we do not expect them to go to the children's hospitals. The Department of Health will say this will happen in time but the time involved can be quite long. This is an urgent matter because our population is entitled to the best of information and the best help in these serious circumstances.

It appears no training has been set up for general practitioners, who will have to deal with the families at the forefront of any genetic problems which may have led to stillbirths or miscarriages. Many general practitioners may have qualified long before these advances were made and would warmly welcome training in the area.

Another problem with establishing counselling in Crumlin and Temple Street is the involvement of the Catholic Archbishop of Dublin and the religious orders. There are huge moral and ethical questions to be faced in genetics. It is essential that religious views be taken into account but I wonder how wise it is to put either the Archbishop or the religious in a position where they feel they must impose their ethics on the consultant or patient involved.

Obviously there would be an immediate difficulty in prenatal diagnosis. The maternity hospitals, where many of the stillbirths and miscarriages will happen, are not involved in the scheme and will urgently require a genetic counselling service.

There is also the major issue of gene therapy. Quite rightly the churches stress their moral and ethical role in genetics. Gene therapy, which is the treatment of cells of the body by introducing other genes, may be acceptable to the churches in somatic disease, where an ordinary cell in the liver, pancreas or lung is treated.

However I think there will be grave reservations about accepting gene therapy for germ cells. This is where a gene in sperm or an egg cell is affected by a serious disease and may be treated if and when genetic therapy becomes available. I would understand if the Archbishop did not allow any genetic service in his hospital which did not comply with the rules of the church and I would not like to see him embarrassed by having to refuse. Therefore it is important that the Department of Health urgently examines the possibility of changing the circumstances so this embarrassment could not occur.

We are now about to register the stillbirths in Ireland and I hope the numbers will get smaller. We should direct research towards this area. Moral and ethical guidelines will also be needed. We have people with expertise in medicine, genetics, theology and philosophy. Any contribution this country could make on the international stage could only be of the greatest value in the ongoing debate.

Ms Kelly

I have been privileged to listen to one of the most eloquent and well researched speeches I have heard. I congratulate Senator Henry and am most embarrassed to follow her because my contribution is minor in comparison.

I thank the Minister for bringing in this Bill. It is shameful that an organisation had to campaign for 10 years before its voice was heard. It is also a shame that a procedure acceptable in the North of this country 30 years ago and 40 years ago in the neighbouring island could not have been introduced here sooner. There is nothing marking us as special or different which prevented us from introducing this Bill much sooner.

I concur with fellow Senators about the grief and trauma couples suffer on losing a child. Perhaps the grief is greater when the child is older but, as Senator Henry said, even when the child is only a few weeks old the grief is considerable. From the time that a mother knows she is pregnant and especially from the time she feels she is pregnant, which is not always the same, the child becomes a life, a person. The mother can feel the child moving and if she loses the child at that stage she feels grief and guilt.

Like Senator McGennis I am lucky to have had a large brood of healthy children. However I lost a child who was three weeks old. I still remember the grief I felt at that time but it was nothing in comparison to what happened to my sister-in-law, who lost a child at a much later stage. I can understand the feelings of mothers who give birth to babies who are not alive.

This Bill is a means for the State to recognise this life existed. The child is mentioned on the register and has a name. I also welcome the element of retrospection in the Bill. Mothers who have had stillborn children can now officially register that fact. If the compilation of these statistics can be used by the medical profession and the scientists in our universities to reduce the incidence of stillbirths, it would be welcome. Any measure that would enable us to bring healthy children into this world can only be a progressive one.

I concur with Senator Neville's call for counselling. The utmost sensitivity should be shown to women who have had stillborn babies. I have experienced an incident where a mother who had given birth to a baby who had died before birth — she was already aware of this — was put into a public ward with mothers of healthy children. Every time a healthy child cried for attention, that mother ran out of the ward. I thought it was one of the saddest events I had ever witnessed. Every time my healthy baby cried, it reminded her of her loss. It would have been simple to have given that mother a room by herself. Unfortunately, she was not a member of the VHI. She was an unmarried mother who came from a working class area. She was not in any psychological condition to protest about this insensitivity, which continued until the day she was released from hospital.

I welcome the element of confidentiality incorporated in this Bill. While the general statistics are important for the medical profession, the details should only be the business of the parents. When people are grieving, the last thing they want to hear is that someone will be intruding into their case in the future. The element of compulsion is important because when one is going through this trauma, it would be easy to neglect the formality of registration. This Bill allows the medical practitioner or the hospital to do the onerous task for the parents, who otherwise might regret it in years to come not registering the birth.

I thank the Minister for bringing about a change in the registration form, which is contained in the Schedule of the Bill. Including the mother's forename and surname, address and occupation may be a small change, but it was not done in the past. The record of a mother's occupation is as justifiable as that of the father.

I again thank the Minister for initiating this legislation in this House. However, I have one regret. I have noticed that where legislation to do with children is concerned, we often end up with mainly female Senators and few of their male counterparts——

Mr. Norris

Here I am.

Ms Kelly

I did not say no male Senators, but few. It is as if our male counterparts somehow disassociate themselves from any——

Mrs. Taylor-Quinn

They are too shy.

Ms Kelly

——discussion concerning children.

Mrs. Taylor-Quinn

This Bill is long overdue. England and Northern Ireland have had stillborn registers for the past 30 years and this is the only country in the EU which does not have such a register.

I would like to refer to Senator Kelly's comments on the fact that few male Senators are present for this debate. While we joke that they may be too shy, people often do not realise that a stillbirth can cause as much anguish and concern to the father as it does to the mother. Perhaps it is an unfortunate part of our culture and conditioning in society that men want to pretend that they are not in any way involved or associated publicly with this issue. That may be reflected here today in so far as few male Senators are prepared to state publicly how they feel on the matter or that they welcome this Bill. Undoubtedly, there are few who have not been touched by a stillbirth or a miscarriage and suffered the grief and trauma associated with such an occurrence. The Irish Stillbirth and Neonatal Death Society has done tremendous work in helping those who have suffered from this.

I am delighted the Minister has presented this Bill, which is a technical one. I am concerned about one part of the Bill. The definition section defines stillbirth as "a birth in relation to which section 1 of this Act applies and "stillborn "shall be construed accordingly." It provides that: "This Act applies in relation to a child born weighing 500 grammes or more or having a gestational age of 24 weeks or more who shows no sign of life. "I wonder why the Minister put that definition of stillbirth in the Bill. I would find that difficult to accept. It should not be defined by the weight of a stillborn child. I have had children and miscarriages and have seen scans of a child at ten, 11 and 13 weeks and I can appreciate that there is a child in formation. The child is real to a mother at that stage and she has a close bond to it. The definition needs further consideration. I know a lot of people who have had still births under 24 weeks. I am not conversant with the technicalities of weights but it should be reconsidered. Personally, I find this section difficult to accept.

The Minister and his Department may have chosen this definition because the possibility of a child surviving after 24 weeks would be greater. We have had this debate in the political arena for many years. When the abortion issue arose, we had wide discussions on the question of pregnancy and when life occurs. This matter should be reviewed, taking into account the fact that any woman who is beginning to feel the signs of pregnancy automatically feels a bond with that child. When there is a miscarriage, there is a great sense of loss. A mother literally moves from a state of expectation of a new addition to a total sense of emptiness and loss. That is difficult for parents to cope with. By identifying and recognising the child and providing the facilities of registering, life could be made easier for the parents concerned. I urge the Minister to reconsider this aspect of the Bill.

Senator Kelly referred to counselling, a point Senator Neville raised earlier in the discussion. I concur with what she said. Many women who go through this experience are very traumatised. Needless to say the level of loss and grief will vary from person to person, depending on their circumstances and emotional state. This should be taken into consideration. While the Minister does not have direct responsibility for that aspect, perhaps the Department of Health in conjunction with the Minister's Department should consider an active counselling service. In the regional maternity hospital in County Limerick, a nurse has done wonderful counselling work. She works in the Mid-Western Health Board area and was recently recognised in the British Isles when she was given an award. We need to develop more of that type of support system for the parents concerned.

I compliment the Minister for presenting this Bill. It is welcome in so far as it provides recognition of the fact that there was a child and that parents had a child. It provides an opportunity for them to have the child recognised through a proper procedure where there is a birth certificate and a death certificate. That is an official recognition and once that is provided, society will automatically acknowledge that there was a child. This is extremely important. Parents move literally from a state of hope and expectancy to a complete sense of loss; instead of having a live birth and a new addition to the family they have a death. It is far more difficult for them if they have to deal with that and grieve in private, as if nothing had happened, without the opportunity for the normal proper procedures of a funeral and State recognition.

I welcome the Bill but I ask the Minister to reconsider the provisions relating to the weight of 500 grammes and the gestational period of 24 weeks. I have strong reservations about them. I cannot go into the professional and technical medical discussions on it but as somebody who has experienced it and knows many people with similar experiences, I believe there is a need to reconsider these aspects.

I compliment the Minister on presenting the Bill.

Mr. Lydon

I welcome the Bill. It is a caring Bill and the Minister means it as such but I have one quibble with it; the definition of a stillborn child is one born dead but viable outside the womb. This a good definition but the Minister goes on to limit it by talking about a child who either 24 weeks or weighs 500 grammes. The Minister said the gestational age was typically 28 weeks but that is now reducing due to the advances in medical science. I know how quickly medical science advances come about so perhaps in a month or a year this definition will no longer be any good and we will have to introduce another Bill. Is it necessary to have these figures? If my wife had a stillborn child and he or she was 23 weeks and six days or weighed 499 grammes, it would take a lot to convince her that she had not had a stillborn child. This should be taken into account.

I do not know if this Bill applies to the child after it is born or just before. As the Minister is aware, the unborn child has rights under our Constitution and is protected. We may be discriminating in some way by stating a time or an age at which a person is either viable or nonviable. It is sad when we come to measure the worth of a person, no matter how small, by her weight or age. By having a cut off point, we are automatically devaluing that person. At some future stage, this may pave the way for abortion legislation to which I would be opposed and which I hope will never enter this country.

At the moment my concern is not with abortion but with the mother who has a child who weighs 499 grammes or the gestational age was 23 weeks and six days. It might be better if the Minister could consider leaving the definition as it is, that a stillborn child is a child born dead but viable outside the womb. I am not asking the Minister to change the legislation completely but to consider that definition and perhaps leave it a little broader. Senator Henry asked for a register of stillbirths and a register of miscarriages. There may be no need for two; perhaps one could cover all. It is concern for the mother that preoccupies me at this stage. Perhaps the Minister would look at that.

Mr. Norris

I too will be brief. As Senator Kelly said, it is important that male Senators should show some concern in this area. This is a caring Bill and recognises the fact that it is important for the parents of a stillborn child to be allowed the official grieving ritual and period and the acknowledgement that a child is born. It is for this reason that the Minister has wisely chosen to introduce this caring legislation.

I was listening in my office to some of the other speeches and I found them very interesting. One Member referred to the fact that it has taken 30 years to catch up with the North of Ireland and that there was a curious discrepancy. Things and attitudes change and there may be something in the cultural climate, in the ethos and even in the religious climate that may have affected it. I am old enough to remember when, for example, limbo was in existence and it was assumed in the major Christian denomination in this country that children who were not baptised spent a period in this ambiguous state of suspended spiritual animation before they were sufficiently purged to be allowed into heaven. In that, as in medical science, we have also advanced.

I listened with great interest to Senator Henry's contribution. I thought a number of her points were extremely valuable. In particular, I was impressed by the argument that we should, in this legislation as in other legislation, adopt the terminology and standards of the World Health Organisation. I am not sure if the Minister is prepared to concede on this in the matter of definition.

I was also interested in and impressed by the first point my colleague, Senator Lydon, made about the advances in medical science and the difficulties of giving a stable definition that will last. However, I differed from him in a linguistic sense when he spoke about the person. It is difficult to describe either a stillborn child or a miscarried foetus as a person in the fullest sense. If one looks at the word personality, which derives from the noun person, it assumes a much wider range of behaviour and capacity than a human embryo is capable of. I say that not in any sense wishing to demean the status of the foetus, embryo, stillbirth or miscarriage but to suggest that there is, when looked at rationally, a difference between a stillbirth, miscarried foetus and a fully realised child who has a personality. It is only entities which have personality that can be properly described as persons. I do not wish to labour this point.

I was also glad that my colleague, Senator Henry, broadened the scope of the discussion — and that this was permitted because it is appropriate on the Second Stage of a Bill such as this — to include ethical committees, the Medical Council, etc. To a certain extent we are in an area of ethics. A number of Senators spoke movingly about the desire of parents to have children and to have the fact that they have had children recognised. This is a strong human desire. It is not one which I share, certainly not with the strength of some of my colleagues, which is perhaps fortunate because it would present some biological difficulties for me.

Listening yesterday to Marion Finucane on RTE radio, I heard an extraordinarily patronising male medic who persisted in referring to her as Miss Finucane. They were discussing the question of in vitro fertilisation. I draw this to the Minister's attention because this is an important area where I believe the Medical Council is making a ham fisted approach. This gentlemen was obdurately rejecting any right of persons not religiously or civilly married to become parents, using——

An Leas-Chathaoirleach

I suggest to the Senator that he is going beyond the terms of the Bill. I ask him to come back to the Bill.

Mr. Norris

It is in the finest traditions of the House, and I know that with your customary generosity, a Leas-Chathaoirligh, having embarked on this point you will allow me to conclude, which I promise to do.

An Leas-Chathaoirleach

Senator, you are stretching the patience of the Chair.

Mr. Norris

I am speaking about the interest of parents in having children and I believe it is important. It may be my only chance for some time to address this point with the Minister present.

In the absence of divorce, which has hit a hurdle, it appears to me that unmarried people——

An Leas-Chathaoirleach

With respect, Senator, the House is not discussing divorce.

Mr. Norris

I am.

An Leas Chathaoirleach

The House is not, nor is it considered under the Bill.

Mr. Norris

Unmarried people in a stable relationship ought to have the same right to have children as people in a legally recognised marriage. I believe that the recognition of this is as important as the recognition of stillbirths. I promised to be brief, but I have not been successfully terminated, despite your interventions, a Leas-Chathaoirligh.

I wish finally to congratulate the Minister on introducing what I believe to be a sensitive, caring and important Bill which permits the parents that period of grieving from which they were previously disbarred. I believe that for both parents, and especially for the mother, because for biological reasons the mother carries the child for this period of months, to officially deny the existence of this experience, or to attempt to obliterate it is offensive. It is offensive to women especially, but also to caring men.

Mr. Wall

I welcome the Minster to the House and thank him for this eagerly awaited legislation. There are few sadnesses that can compare with the grief of parents at the death of their child. We see cases all too often where there is a tragic loss of a young life and no consolation for the parents. The same applies to parents whose children die while still in the womb. They mourn the child they never got the chance to know and they grieve for the future that such a child will never have.

Current legislation makes their anguish all the greater. In the case of stillborn babies the law fails to acknowledge that this tiny person existed. It obliges nobody to record the all too brief life and parents are grief stricken and heartbroken.

Medical staff in the hospitals do their best to comfort the families by taking photographs of the stillborn child and attempting to handle the tragedy with great compassion. However, the problem remains that there is no formal acknowledgement.

When there is no way to bring the child back to life, it is possible to give dignity to childbirth and that is what this Bill is about. A stillbirth certificate will be available to bereaved parents lending formality and legal status to their loss. A register of stillbirths will be kept, but will not be publicly accessible. Legal provision is already in place to allow for the recording of the father's name on the register, whether or not the parents are married to each other.

For the purposes of the Bill, a child born weighing 500 grams or more, or having a gestational age of 24 weeks or more who shows no sign of life is regarded as stillborn. The Bill also gives parents of a stillborn child the option to notify the local registrar of the stillbirth. If they do not choose to do so the, the hospital or the midwife is obliged to notify the registrar. Parents of stillborn children, whose deaths occurred before now and up to the time when this legislation becomes law, will be able to obtain a certificate of the stillbirth on request.

I congratulate the Minister for Equality and Law Reform, my colleague Deputy Taylor, on bringing this legislation before the Houses of the Oireachtas. He will be thanked by many parents all over the country, whether they have experienced stillbirth at first hand or not. It is only right and fitting that our law should recognise stillbirths. Continuing to deny that a life begins, even though it ends in the womb is not acceptable.

Ms Honan

I also welcome the introduction of this Bill and congratulate the Minister for bringing forward what I believe everybody acknowledges to be a caring piece of legislation.

As the Minister remarked, the provisions of the Bill was one of the recommendations of the Second Commission on the Status of Women. It is a measure which is welcomed by the Irish Stillbirth and Neonatal Death Society. The society is to be commended for its efforts over the past number of years to have this legislation brought forward. As the society has said in its correspondence, after ten years of negative discussion on the register at its annual conference, it can look forward this year to welcoming the enactment of the Bill at its conference in April if, following our work today, the Bill makes rapid progress through the Houses of the Oireachtas.

I also welcome the fact that this legislation is retrospective. As the Minister said, this is rare. This is especially welcomed by the society, because this registration will be the only evidence that members of the society have of the existence of their babies. Many of us who have had children of our own can appreciate, as other speakers have said, at a time of joy and hope, the loss and sense of grieving that is felt by the parents of stillborn children. Not having it officially recognised must be difficult, especially in the country where there is so much talk about the unborn child. In such instances it must be particularly difficult for a parent that they have had no formal recognition of their child's birth. For that reason, and as a woman, I especially welcome the legislation.

The Second Commission on the Status of Women went further in their recommendations. It talked of the need for maternity hospitals and units to adapt hospital practices to the needs and wishes of their patients. This is especially relevant in the case of women who have a miscarriage or a stillborn child. The psychological well-being of women and their partners at a time of grief must be of primary concern to all of us.

In this respect I would like to see the implementation of the recommendations of the Second Commission regarding the provision of separate accommodation in maternity hospitals for women who have had a miscarriage or a stillbirth. Appropriate follow up counselling for women and their partners should also be offered.

As Senator Neville has said, it is in the natural order of things that parents die before their children and I believe it is difficult for people to commence the grieving process until there is an acknowledgement that there has been a death. Official acknowledgement, as will be possible after the enactment of this Bill, is vital to the commencement of the grieving process. However, follow up counselling is essential. Certain measures tend to be postponed because of the lack of funding. We have over 300 stillbirths a year and it behoves us all in this House to ensure that funding is provided for counselling in this area.

I also welcome the suggestion by Senator Henry that adequate funding for genetic counselling should be provided. Hitherto it has been difficult for women, who have had to travel to Northern Ireland and Britain for genetic counselling. This is unacceptable. The women of Ireland have put up with it for long enough and they are now demanding better services.

In this respect we are relying on the Minister. I congratulate him on his efforts since taking over this Department and on the efforts made on behalf of women. I urge him to continue with these efforts and I would like to see the Minister pressing at Cabinet for funding for genetic and other counselling facilities to be made available to women.

I also congratulate the Minister on the Schedule to the Bill. Regarding the information to be recorded in the stillbirths register he has again taken note of the recommendations of the Second Commission on the Status of Women. The information in the stillbirth register will be ahead of the information that is required in the registration of birth. For the first time, the forename and surname of the child will be recorded and the mother's forename, surname and occupation will also be recorded. This is a welcome development.

I would like the Minister to move forward in this area and to implement this change in the registration of births. There are some administrative difficulties and, as Senator McGennis said, a general review is taking place on the registration of births, deaths and marriages. I encourage the Minister to continue his efforts and to ensure these changes will be applied to the registration of all births. As other Members said, this is caring legislation and people have campaigned for it for many years. I am pleased to welcome it to the House.

Mr. O'Kennedy

I join with my colleagues in giving a warm and enthusiastic welcome to this legislation. The introduction of this Bill and the Minister's Second Stage speech are evidence of his sensitivity to the trauma which parents, particularly mothers, suffer in circumstances of stillbirths and neonatal deaths. This trauma is deeply embedded. If we want proof of that, we would find it in the fact that these parents have campaigned for a register for a long time. That is underlined by the degree of retrospection — an unusual move in legislation which the Minister acknowledged in his speech. The Minister said he was conscious of the fact that the suffering of bereaved parents of stillborn children can last for a long time, even for decades, and it does.

The fact we have not taken action before could be an over-extension of the legal principle de minimis non curat lex— the law is not concerned with very small matters. These may seem details to the majority of the population because only a small proportion is directly affected. Although it does not affect society or parents at large, it is a measure of the attitudes and values of society that the small number affected are an integral part of our society and warrant this kind of action. I am happy the Seanad has the privilege and the opportunity to introduce this legislation.

Over the years I have been in contact with parents of stillborn children and I have been touched by the fact that it is a constant preoccupation with them, it is a matter of tension and psychological trauma. For that reason, it is surprising we did not address this issue earlier. It is a unique issue which, in my experience in both Houses, has received total and enthusiastic endorsement from all sides. There will, of course, be points of detail and technicalities which will need be considered. Having regard to the contributions made, I am sure the Minister will take them on board.

Although there was doubt about whether the Bill would make provision for voluntary registration for babies born over the years, I am impressed by the fact that it does. The Irish Stillborn and Neonatal Death Society which contacted me and many others, including the Minister, was concerned that such a provision would be included in the Bill. Its inclusion is measure of concern and expedition and I welcome it enthusiastically.

Those who feel they have been left outside the scope of law for some unimaginable reason over the years, will now feel vindicated because their stillborn children are recognised. For each mother this is a fundamental experience.

I join with other Members in welcoming this Bill and I congratulate the Minister on its introduction. This legislation will have consequences beyond what anyone could anticipate at this time because of its effect on parents and on society who see it as the role of the Government and the Oireacthas to be sensitive and caring even to a small group. Although this affects only a small group, and that is what makes it important, it does not lessen their right or entitlements in our society.

Mr. Roche

Like other speakers I warmly welcome this Bill because I have campaigned for it for a number of years. In 19881 took a group from the executive of the Irish Stillborn and Neonatal Death Society to meet the then Minister for Health. Although we did not get a stillbirth register, we got money for the ISANDS booklet. I commend the Minister not only on the Bill but on the fact that he showed more sensitivity than some of the contributors in this House to both parents who are affected by stillbirth. I rise because of a comment made by Senator Kelly. In a frivolous and throwaway remark she made a slight at the hurt which a male parent experiences on a loss and she made a slighting reference to the interest of males in this House. The issue of parenthood and the pain of bereavement are shared by both genders.

The Minister has done a lot in this Bill. Although it is a slight Bill in many ways, it will bring a great deal of comfort to a large number of people. I cannot understand why this Bill has been delayed for years. I campaigned to four Ministers for Health and my correspondence with the present Minister was passed on to the Minister for Equality and Law Reform. Given the size of the State machine, I do not understand why it cannot produce legislation like this which will not be a major consequence in terms of funds or being an imposition on the State. It will be of immeasurable benefit and it will be of comfort to people whose lives are visited by this dreadful tragedy.

I would like to address a number of points in the Bill. Regarding registration and the procedural formalities required, I do not understand why in terms of definition is difficult to deal with this issue. Should we be so precise as to say "500 grammes or more or having a gestational age of 24 weeks"? As another Senator said, what happens where these requirements are not met, where, for example, the child is 23 weeks old or 450 grammes? The pain and the sense of loss will be as great for those parents.

From the moment one knows there is a child to the moment the horrific news comes, there is a bonding with the mother and with the caring father. Perhaps the Minister would consider in his response, or on Report Stage, extending the powers of retrospective registration contained in section 7. I commend the Minister on that provision because it will give a great deal of comfort. I met a lady on the 21st anniversary of the loss of her child. Some 21 years later the pain of the loss was still with her. The Minister has been humane in allowing retrospective registration in section 7. Perhaps voluntary registration could be introduced where a child does not meet the 24 week or the 500 grammes requirement because pain exists across the board in such cases.

I commend the Minister. He has dealt with the issue very sensitively and with speed. I am disappointed this Bill was not introduced five, six or ten years ago. I welcome all its aspects, particularly the retrospective one. I ask the Minister to consider whether it would be possible to introduce a voluntary registration element where a stillbirth occurs before the requirements relating to 24 weeks and 500 grammes are reached. This Bill deals with a need but it may also leave a residual pool of pain and grief which is not addressed. Other than that comment I have nothing but praise for the Bill. I commend the Minister.

Ms O'Sullivan

I also commend the Minister for initiating the Bill in the Seanad. As many Members have said, there has been a long campaign for a register of stillbirths. It has taken a long time for this stage to be reached. We have all welcomed the Minister's giving this issue close and detailed attention which has resulted in the Bill before us.

The Minister indicated that there are more than 300 stillbirths each year. This means that each year over 300 families have to face the great grief and sadness of a stillbirth and need the option of registering it in an official way. Any study of psychology will indicate that it is very important to go through the process of grieving for any death, whether it be that of a stillborn baby or of people at any stage of their lives. This process has not been made official because of the absence of a stillbirth register.

It is very difficult for parents to come to terms with the fact that their child is stillborn. I agree with Members that it is equally sad for the father as for the mother. At least the mother has had the feeling of having carried a child whereas the father has not had the opportunity to relate to the child in any real way. Such deaths may be psychologically more difficult for the father than for the mother.

The Bill is as wide as possible, both in its definition of the stage of the child, whether it be by time or weight, and the way in which the register can be filled, in that the parents can do it if they wish but if they do not do so there is another mechanism by which it can be done. There is no element of compulsion. From the State's point of view stillbirths are registered but parents do not have to take on the obligation. I also welcome the option of retrospection. I do not intend to repeat what other speakers have said. The debate has been wide ranging and very comprehensive. I add my voice to the voices of others in the House in welcoming the Bill.

Minister for Equality and Law Reform (Mr. Taylor)

I sincerely thank all the Senators who contributed for their constructive, sympathetic and understanding contributions to the debate on this important Bill. The establishment of the stillbirths register will not only bring this country into line with other European Union countries but, more importantly, will provide tangible official evidence for parents of the existence of their stillborn child. The big tragedy until now was that there was no official recognition that something very important had happened. The great importance of the Bill is that it will make it possible for the parents of the stillborn child to obtain a certificate giving an official, permanent recognition and acknowledgement of the stillbirth. This has been lacking until now. Parents of stillborn children and, in particular, the Irish Stillbirth and Neonatal Death Society have made it clear to me that they regard this official validation as a matter of extreme importance to their members. I pay tribute to ISANDS for their long campaign. I am more than pleased at this late stage in our history to have been able to meet their very appropriate and essential request.

As I said earlier, I have provided for retrospective registration because I recognise that the grief of parents following a stillbirth can be long lasting, perhaps even for decades. In the absence of retrospection this Bill would have come too late for many people. I was not prepared to accept this situation, notwithstanding that retrospection provisions of this nature are extremely unusual in legislation. I have been contacted by parents whose stillbirths took place a considerable time ago and who continue to grieve. The retrospective provision has no antecedent time limit. This will give all those parents the opportunity to have their stillbirths registered and will help them finally to come to terms with their grief.

As it would not be possible to obtain a medical certificate for many stillbirths which occurred in the past, I have provided for other forms of supporting evidence for registration purposes, such as hospital records. The format of the stillbirth registration will be the same for all stillbirths regardless of when they occurred.

On the question of registration generally, my Department has assumed responsibility for a comprehensive review of the legislation on births, marriages and deaths. The object of the review, which is ongoing, is to see how this legislation, much of which dates from the last century, can be amended to reflect modern needs and conditions. The review will take considerable time to complete because of the age of much of the relevant legislation and the complexity of the issues involved. I was not prepared to await the outcome of that detailed review before providing for registration of stillbirths.

Many of the points made, particularly by Senators Neville and Henry, relate to very important matters. Senator Henry gave a very interesting, illuminating and wide ranging speech. I am sure she is well aware that many of the matters she raised are the responsibility of the Minister for Health and I will bring them to his attention. There was a long comment about the definition aspect of the Bill and I propose to deal with this when we discuss Senator Henry's amendment on this subject. We have to draw a line somewhere. I regard the definition in the Bill as flexible. I wish to confirm to Senators who raised the point that this Bill has nothing to do with abortion. It has been said that advances in medical care mean that the gestational age and weight at which a child can be viable is reducing.

I considered providing for an amendment of the definition by Ministerial Order but decided against taking this power because there is reason to believe that a provision giving such extensive legislative power to a Minister might be unconstitutional. As the House knows, I have had sufficient and unfortunate experiences on such an issue without wishing to undertake another one. I am pleased to have introduced the Bill in the Seanad, which is the appropriate place to have done so. The quality, breadth and sympathetic nature of the contributions made by so many Senators is ample evidence of this. I thank them for their thoughtful contributions and help on all aspects of the Bill.

Question put and agreed to.

Agreed to take remaining Stages today.