Seanad Éireann debate -
Wednesday, 16 May 2012

Vol. 215 No. 8

Symphysiotomy: Statements

Minister of State at the Department of Health (Deputy Kathleen Lynch)

I thank those Senators who called for this debate which deals with a subject that is not only emotive but very pertinent and which needs to be dealt with. I will start by explaining precisely what symphysiotomy is, to give some context about its use as a medical procedure and specifically its use in Ireland. Symphysiotomy is a medical procedure that was primarily used before the advent of safe caesarean sections. The procedure was carried out in Ireland from about 1920 until the early 1980s. It was gradually replaced by caesarean section as the preferred method of delivery in childbirth where required. It is clear the procedure continued to be used in Ireland for some time after it had been all but discontinued in other developed countries, most notably in Our Lady of Lourdes Hospital in Drogheda.

The Minister, Deputy Reilly, and I are conscious of the distress symphysiotomy has caused to a number of women and recognise the pain this issue has caused to those affected by it. The Government is committed to dealing with it sensitively, so that if at all possible this issue can be brought to an appropriate and fair conclusion for all the women affected by it. Our first priority is to ensure the health needs of those who have had a symphysiotomy are met quickly and effectively. With this in mind we are committed to ensuring the greatest possible supports and services are made available to women who continue to suffer the effects of having undergone this procedure.

The women concerned continue to receive attention and care through a number of services which have been put in place. These include the provision of medical cards to all who requested them; the nomination of a liaison officer for a patients' group comprised of women who underwent a symphysiotomy procedure; the availability of independent clinical advice for former patients; the organisation of individual pathways of care; and the arrangement of appropriate follow-up for women, including medical assessment, gynaecology assessment, orthopaedic assessment, counselling, physiotherapy, reflexology, home help, acupuncture, osteopathy and fast-tracked hospital appointments. Also included is the refund of medical expenses related to symphysiotomy in respect of medication and private treatments. A triple assessment service was established for patients at Cappagh Hospital in Dublin in January 2005, and support groups, facilitated by a counsellor, were established in 2004 in Dundalk and Drogheda for women living in north-east region. A national lead officer for symphysiotomy was nominated. In addition, five designated regional liaison officers are in place across the regions of the HSE. The provision of these necessary support services for women is monitored and overseen by the Health Service Executive which is committed to being proactive in seeking out and offering help to women who underwent a symphysiotomy and who may wish to avail of the services offered by the HSE.

A figure of 1,500 symphysiotomies has been suggested for the period 1944 to 1992, giving a rate of approximately six symphysiotomies per 10,000 births. While there was a large variation, even in the hospital with the highest rates the maximum rate appears to have been six per 1,000 births in one year. Thus, it was a rare intervention in comparison with caesarean section, for example, which rose steadily in the same period from three per 100 births in the early 1940s to more than 20 per 100 births now. This is not in any way to minimise any serious effects and suffering it had on the women concerned, but it indicates the procedure was quite rarely carried out in Ireland overall.

We need to act on the basis of the best evidence that is available on this issue as in all aspects of our health services. To this end the chief medical officer of the Department of Health last year commissioned an independent research report into the practice of symphysiotomy in Ireland. The aim of the report is to provide an accurate picture of the extent of use of symphysiotomy in Ireland, and an examination of the Irish practice relative to other countries. It is to include an assessment of the circumstances in which the procedure was carried out, what protocols or guidance existed at the time to guide professional practice, and details of when the practice changed and why.

The researcher was given the specific terms of reference to: document the rates of symphysiotomy and maternal mortality in Ireland from 1940 to date by reference to available data, including annual reports and other reports; assess symphysiotomy rates against maternal mortality rates over the period; critically appraise international reviews of symphysiotomy practice and associated rates in a number of comparable countries in the world and in Ireland; review any guidelines and protocols on symphysiotomy that applied in Ireland over the time period; and write a report based on the findings of the analysis providing an accurate picture of the extent of use of symphysiotomy in Ireland and an examination of the Irish experience relative to other countries.

The academic researcher concerned was formally appointed on 1 June 2011. The researcher experienced unforeseen difficulties in accessing information sources and, as a result, submitted the report behind schedule in late January 2012. The researcher informed the Department that this was due primarily to the challenges with accessing historical data from a time when records on the procedure were not routinely kept. In line with best practice, the Minister, Deputy Reilly, has initiated a peer review process of the draft report and he proposes to make the report available for consultation with relevant individuals and bodies this month. Following the consultation process and taking into account the outcome of the peer review, the report will be finalised and published. The Minister will then consider the final report and decide on the next steps required to address this situation.

Ireland is now one of the safest places to have a baby. We have one of the lowest maternal mortality rates and perinatal mortality rates in the world. Ireland is a now a very safe place to have a caesarean section and we should be proud that we are recognised internationally as leaders in the field of obstetrics. Recent legislation requires doctors to maintain and update their competence. These new requirements for doctors to maintain their professional competence are a significant step and concrete assurance that medical practitioners are appropriately qualified and competent to practise safely.

The national clinical effectiveness guidelines published last year provide a framework for national endorsement of clinical guidelines and audit to optimise patient care. These guidelines will contribute to improving health outcomes by reducing variation in practice, improving quality of clinical decisions, influencing health service policy, and informing service users and the public about the service they should be receiving. These and many other developments are ensuring that the health system is striving to fulfil the vision of the commission on patient safety and quality assurance of what has been termed "knowledgeable patients receiving safe and effective care from skilled professionals in appropriate environments with assessed outcomes".

The new clinical programmes being developed and implemented in the HSE represent one of the most important developments in this regard. These are currently led by the HSE directorate of clinical strategy and programmes which was established to improve and standardise patient care throughout the Health Service Executive by bringing together clinical disciplines and enabling them to share innovative solutions to deliver greater benefits to every user of HSE services. The clinical programmes are a multidisciplinary initiative between the HSE and the various faculties, and generally include patient representatives. Each programme is led by a clinician. The clinical programmes are a sea-change in the way we provide health care in Ireland. This new approach utilises key proven drivers of success in improving disease management and is aimed at improving patient care.

The obstetrics and gynaecology clinical programme is led by Professor Michael Turner. The aim of the obstetrics and gynaecology programme is to improve health-care choices for women. Its initial work aims to implement key guidelines; establish local programme implementation groups to facilitate change; develop national models of maternity care; develop a standard approach to capturing and reporting audit and performance metrics; develop solutions and guidelines to reduce the number of multiple pregnancies requiring neonatal intensive care; develop workforce planning and training models and strategy; and investigate the numbers of women attending for antenatal care in early pregnancy.

More generally there has been considerable progress in the options of maternity care available to expectant mothers in Ireland. They now have a number of choices they can make in respect of the obstetric care they choose. Women may opt for a combined care package with their GP and the hospital, under the maternity and infant care scheme which provides a number of free GP and maternity hospital visits to all eligible expectant mothers. There are also a number of midwifery-led units nationally which offer the opportunity to expectant mothers to give birth in a uniquely designed birth room cared for by a team of experienced midwives. These units are located close to hospitals should an emergency arise that requires specialist intervention.

While these developments can bring further improvements to maternity services in the future the Minister, Deputy Reilly, and I are committed to addressing the issues that have arisen from the legacy of past practice regarding symphysiotomy. The Government is also committed to dealing with this issue, with all the sensitivity which is undoubtedly required, do whatever can be done to help bring this issue to appropriate finality as far as is possible for those affected by it. I have outlined the supports that have been provided to the women affected and the progress in finalising the research report. We hope to bring this matter to a satisfactory conclusion as soon as possible — the women who have had this procedure deserve nothing less.

Senator Marc MacSharry

I welcome the Minister of State to the House and our guests in the Visitors Gallery who are survivors of symphysiotomy. I am entirely unqualified to in any way accurately verbalise how the victims of symphysiotomy must feel given the many challenges and difficulties they have had to endure throughout their lives as a result of this procedure. As we sadly often say in these Houses on a variety of issues relating to health as well as other disciplines, there are many reasons for failure but there are no excuses.

The Minister of State's speech is welcome in many respects. The ladies present today, many of whom were here for the Dáil debate, will note that her speech is almost identical to what the Minister, Deputy Reilly, said in the Dáil some months ago. While it is welcome that various steps were taken in terms of services being made available to the people in question, it does not provide the necessary redress and closure which the Minister mentioned in her speech. I am not a qualified person in this field but I am aware of the pain and trauma, as it was explained to me by women such as those who have taken the time to attend this debate today.

The report mentioned by the Minister has come in for some criticism in terms of the independence of the people preparing it and the suggestion that the terms of reference could potentially compromise its outcome. That is a worry. It is something the Minister must address as quickly as possible. It is certainly a worry that it was commissioned some time ago and appears to have been with the Government since Christmas or shortly afterwards. I appreciate that advice was sought from the Attorney General and so forth as to what the legal implications might be. Governments must consider these things. However, it was then due to be put out for consultation with all the relevant people and concerned stakeholders. One of the briefing notes from one of the groups representing some of the survivors, Survivors of Symphysiotomy, SOS, alleges that it has heard nothing from the Minister at this time. It appears ridiculous in the extreme that a process to consult with all stakeholders would appear to exclude the single most important stakeholders, the people who have been affected by this.

The Minister referred to closure as soon as is possible. What is the hold-up? When will some form of apology be put to the people who should not have undergone this procedure? When will there be suggestions as to what form of redress and compensation can be given? Nothing of monetary value can bring back one's health after so many years of pain and difficulty and the issues that have had to be endured as a result of these procedures, but the one thing we can do is speed up the process. Indeed, I sat where the Government's spokesperson is currently sitting for 70 hours, with just toilet breaks, to ensure the National Asset Management Agency legislation was passed by the Houses. Now we are dealing with an issue that is important to a relatively small number of people. They have spent their lives enduring the pain and trying to get some answers, in the first instance, and trying to secure an apology to which they are entitled and some level of redress.

That is not to take from some of the important services highlighted by the Minister which have finally been made available. However, we appear to be going around in circles. Can the Minister put a final time-frame on when this report will be published so all of us can see it? What is in that we are so afraid to let people know? It is over a year since the report was commissioned and several months since it was made available to the Government. Some of the stakeholders, including the most important stakeholders, have not been consulted about it. Nobody is getting any younger, and the demographic of the people concerned demands that progress be made much more quickly.

I do not wish to delay the House but the single most important issue is closure. Closure as soon as is possible sounds a little like the never-never. When it is necessary these Houses are able to legislate within a matter of hours, not days. Why can we not turn this around more quickly, in the interests of the people who have suffered? Why cannot the Government apply a deadline for itself? It is now mid-May. Can it not pledge to publish this report by 1 June and publish the recommendations it intends to implement within a week or so of that?

Even when I was sitting on the Government side of the House I often criticised these woolly reports and speeches. That is no disrespect to the Minister of State, Deputy Kathleen Lynch, or the Minister, Deputy James Reilly, because I know they did not draft these speeches. However, they say things such as "there were unforeseen circumstances". What does that mean? If somebody is commissioned to produce a report, they must do it. If there were unforeseen circumstances, does that mean people blocked certain information being made available to the person who is preparing a report on behalf of the State? If so, that is a criminal matter. What were the unforeseen circumstances? When will the report be published? When will the recommendations on foot of the report be published? When will the people affected by this ultimately gain some level of redress, to which they are entitled? Indeed, most of them have spent most of their lives waiting for it.

Senator Colm Burke

I welcome the Minister and thank her for her comprehensive overview of this issue. I thank the Labour Party for bringing forward this important debate. It is necessary that the House recognises the pain and distress which have been suffered and continue to be suffered by women as a result of symphysiotomy procedures which were carried out in Irish hospitals.

It is interesting to read a Supreme Court judgment which offers a one line definition that sums up the grotesque procedure. It states that a symphysiotomy is the cutting of the cartilage that binds the two pubic bones, thus permanently enlarging the pelvis. This was in the case of Olivia Kearney v. Ethna McQuillan and the North Eastern Health Board. The pain of sufferers was described by the report of Mr. Clements in that case, when he stated: “as a result of [the procedure] Mrs. Kearney has suffered 35 years of pain, discomfort, loss of sexual amenity and loss of opportunity for further children. The operation was wholly improper and unjustifiable. That it was done without consent or explanation, in clear contravention of the hospital’s own ethical guidelines, adds to Mrs. Kearney’s grief and anger”.

It is deeply regrettable that symphysiotomy procedures were carried out in Ireland for some time after the practice had been discontinued in other developed countries. It is especially regrettable given that the preferred alternative delivery method of caesarean section had become the standard for difficult births from the 1930s in most other parts of the developed world. The practice of symphysiotomy was allowed to continue in Ireland because of deep regulatory failure. The women who underwent the procedure were in some cases used as clinical training material for staff bound for developing countries, because the practice was a low cost surgery. This almost undoubtedly led to the procedure being used in cases where it was wholly inappropriate.

However, as the Minister said, it is suggested that some 1,500 symphysiotomies took place in Ireland during the period 1944 to 1992, that is, six symphysiotomies per 10,000 births. The maximum rate appears to be six per 1,000 births per year. It was therefore a rare intervention in comparison with caesarean sections, which rose from three per 100 births in the early 1940s to over 20 per 100 births now. These figures are not presented to minimise the suffering of the women concerned, but to indicate that the procedure was rare in Ireland overall.

In recognising the pain and needless suffering caused to the women who underwent the symphysiotomy procedure it is important to ensure that a situation like this can never arise again. I welcome the commissioning of an independent report by the chief medical officer of the Department of Health into the practice of symphysiotomy in Ireland.

By compiling an accurate picture of the use of the procedure and protocols of the time relative to other countries, it will be possible to formulate guidelines for the future. I also recognise the attention and care services that already have been put in place, including the provision of medical cards, the availability of independent clinical advice, the organisation of individual pathways of care and the arrangement of appropriate follow-up. The Minister for Health has also stated his intention to have in place a named person to deal with all queries in respect of symphysiotomy, which will make it easier for women who have suffered the procedure to obtain the services to which they are entitled. I note the Minister of State has already referred to this measure. The provision of these services is monitored and overseen by the HSE, which is committed to offering help to women who underwent the procedure.

I hope the recommendations of the report that is due to be published will be implemented and together with the support services already in place, a holistic care and support structure will exist for women who have suffered long-term side-effects to their health and quality of life as a consequence of a symphysiotomy procedure. It is through the creation of co-ordinated initiatives that scenarios such as that which arose in Drogheda, where Our Lady of Lourdes Hospital continued with the practice of symphysiotomy after it had been discontinued in many other Irish hospitals, will not happen into the future.

I refer to a decision of the High Court in the aforementioned case of Olivia Kearney v. Ethna McQuillan and the North Eastern Health Board. Ms Kearney’s case initially was dismissed by the High Court on the grounds of undue delay, thereby creating a further hurdle for her in receiving justice for a gratuitous and improper procedure carried out on her. I believe it is unfortunate the courts have been the route to justice for those who have suffered as a consequence of the procedure. The Supreme Court decision was delivered on 26 March 2010. It is important that on publication of the report, the recommendations will be implemented at an early date.

I am glad to note the circumstances in which women give birth have changed significantly. Ireland now is one of the safest places in which to have a baby. We have one of the lowest perinatal mortality rates in Europe and have set up a number of procedures to which the Minister of State has referred. As recently as 1998, only 14 years ago, maternity hospitals were not inspected on a regular basis but this practice is now in place. There is a new national clinical director, Dr. Michael Turner, who, as a former master of the Coombe Women and Infants University Hospital, has considerable experience. Guidelines are issued and updated on a regular basis on all obstetrical and gynaecological procedures. Moreover, each maternity unit carries out its own internal reviews when errors arise and I acknowledge errors will arise in any hospital, regardless of the area of medical care. However, reviews are put in place immediately to ensure the mistake does not arise again. There is in place a medical competency assurance scheme for all medical consultants that is overseen by the Medical Council and each maternity unit must produce an annual report setting out the figures for each procedure performed in that unit. These six measures set out clearly the focus on ensuring the mistakes that occurred in this regard for many years will never arise again. Moreover, it may be necessary that such procedures be reviewed and updated on a continuous basis. Taken together, this new guidance and regulatory structure should be robust to prevent a situation similar to that which arose and to ensure similar mistakes are never made again. I look forward to the report's publication and to the full implementation of its terms. I again thank the Labour Party for facilitating this debate and the Minister of State for her attendance and for giving Members the time to deal with the matter.

Senator Jillian van Turnhout

I welcome the Minister of State to the House. I also thank my Labour Party colleagues for providing the opportunity to Members of Seanad Éireann to make statements on the scandalous medical malpractice of symphysiotomy, which was performed in Ireland at least 1,500 times between 1944 and 1992. I also extend the warmest of welcomes to the survivors of symphysiotomy who are present today in the Visitors Gallery and elsewhere in Leinster House. I commend the dignity, bravery and honesty they have shown in sharing their personal traumas with Members during a number of Oireachtas briefing and information sessions. I thank them for opening Members' eyes to the at best utterly inappropriate and at worst barbaric treatment they suffered at the hands of trained medical professionals in Irish hospitals.

I followed the statements on symphysiotomy in the Dáil last March with great interest and I agree with the comment by the Minister, Deputy Reilly, which was echoed today by the Minister of State, that we should be proud that Ireland is recognised internationally as a leader in the field of obstetrics. We also should be proud that with only one maternal death per 100,000 live births, Ireland has one of the lowest maternal mortality ratios in the world. However, as is evident from the statements being made today, Ireland has a far from unblemished record in the area of maternal health care. Between 1920 and as recently as 1992, many women suffered serious maternal morbidities under the care of trained medical practitioners in Irish hospitals. Maternal morbidity is defined as an illness or disability in women caused directly or indirectly by factors relating to pregnancy, childbirth or the post delivery period. The vast majority of maternal morbidities are preventable and as such, their prevalence constitutes a serious violation of women's fundamental rights to life, liberty and security, as well as to health, dignity and freedom from cruel, inhuman and degrading treatment.

In common with many others, I am extremely frustrated by the delay in the publication of the report into the practice of symphysiotomy in Ireland. Extremely serious concerns must be addressed for the survivors to receive the acknowledgement, truth and justice they deserve. Chief among them is the contention by the Institute of Obstetricians and Gynaecologists in Ireland, upon which it appears the Department of Health is content to rely, that the practice of symphysiotomy was carried out due to medical necessity and only until consensus regarding caesarean section changed and it was deemed safe. It is my hope that in carrying out a critical appraisal of international reviews of symphysiotomy practice and associated rates in comparable countries in the world, as well as an examination of the Irish experience relative to other countries, this report will refute this contention once and for all.

Senator Ivana Bacik

Hear, hear.

Senator Jillian van Turnhout

The Minister, Deputy Reilly, himself acknowledged last March that symphysiotomy continued to be used in Ireland for some time after it had been all but discontinued in other developed countries and continued to be used for a longer period in particular hospitals, most notably in Our Lady of Lourdes Hospital, Drogheda. Rather than a procedure arising out of medical necessity, the evidence suggests symphysiotomy was the preference of some senior doctors in keeping with their conservative Catholic belief systems, whereby caesarean section had a safe birth limit of up to four children, while symphysiotomy would allow women have an unlimited number of children despite the horrendous cost to their health and well-being.

While the last thing anyone wants is another institutional abuse scandal, if there is one, and I believe there is, it must be met head on. The culture of secrecy, collusion and cover-up that surrounded institutional and clerical child sex abuse cannot be allowed to flourish again now as, otherwise, what has been learned? I cannot help but discern a parallel between the recent calls for Cardinal Brady's resignation and this issue. Something that was not illegal at a particular time or indeed which was accepted practice within an institution or discipline but which in hindsight is found to be utterly inappropriate and morally wrong, cannot and should not be immune to a contemporary and robust response.

I was disappointed by the limited terms used by the Minister, Deputy Reilly, during the Dáil statements in March in referring to the experience of the survivors. He spoke of pain and distress but it is clear to me, having listened to the women's personal testimonies, that such descriptions are totally inadequate in the face of the devastating impact symphysiotomy had on their lives and those of their families. In addition to the horrendous physical injuries they suffered as a direct result of the procedure, which sustained and worsened in the absence of appropriate aftercare, the serious emotional and psychological suffering they endure must be acknowledged. The birth of a child — for many of the women affected this was the birth of their first child — should be the most joyful time in a woman's life. Instead, for the survivors, of whom there are currently a little over 150, the birth of their child was the beginning of a nightmare. This was a nightmare as a result of a medical procedure to which they did not consent, of which they were not informed of after they had it, in respect of which they did not receive medical treatment and aftercare, and the evidence of which suggests was not medically necessary. Shockingly, there are women who, despite having presented to doctors for treatment for various medical ailments over the years, only realised following the RTE "Prime Time" investigation into symphysiotomy in February 2010 that they were survivors. These women still present as survivors in 2011. Sadly, as time passes survivors are dying. We know that at least four survivors have passed away since the Walsh report was commissioned.

The women are the primary victims here. We have heard testimonies from women who could not lift or attend to the needs of their newborn babies due to the pain they were in and of the helplessness, guilt and shame they felt as a result. We heard from those who could no longer play beloved sports, to those who could no longer walk, of how their quality of life was irrevocably altered. We also know that there are secondary victims. They, too, must be acknowledged. One in ten babies died during symphysiotomy births. Children lost the love and nurture of mothers so traumatised by their experiences that they could not bond with their baby and subsequent babies. Likewise, husbands suffered as a result of the effects on their wives.

I note the Minister of State's comments today and those of the Minister, Deputy Reilly, in March in relation to the provision of medical care to the survivors, which I welcome. However, having also heard from the women, I am concerned that they are having difficulty accessing services. I am particularly concerned about the difficulty some are facing accessing their medical records. Some women have been told there records no longer exist and others have simply been denied access to them. I presume this is the same "unforeseen difficulty" which the Minister of State, Deputy Lynch, mentioned Dr. Walsh was experiencing in explaining the delay in the submission of her report? I accept that records get lost over the passage of time, in isolated instances but when it seems to be systemic my antenna goes up.

I heard from one woman that her doctor had requested a hospital in Dublin to carry out an X-ray to establish whether symphysiotomy had been performed on her. To establish or indeed rule out symphysiotomy the doctor had referred the woman to the hospital for a stand-up X-ray, specifically. The hospital refused to carry out the X-ray in this manner. The Minister of State, Deputy Lynch, spoke about addressing the legacy of the past. What I have just outlined happened last week, not in the past, which makes me question whether the system is trying to protect itself.

Will the Minister of State send out a clear message today that it is totally and utterly unacceptable for the medical profession to frustrate in any way the right of these women to redress and remedy?

Senators

Hear, hear.

Senator Jillian van Turnhout

I would like to put on the record my full support for the setting aside of the statute bar to allow these women seek judicial redress. There is solid precedent in terms of this having been done in respect of clerical sex abuse.

Senator Mary Moran

I welcome the Minister of State, Deputy Lynch, to the House. I am grateful for the opportunity to lead Labour Party Senators in this Labour Party motion on symphysiotomy. I welcome the many survivors in the Visitors Gallery today and those who contacted me in recent weeks and months, who could not be here today but are following the proceedings on the Internet. The response I have received on this issue from many different people and the media has been fantastic, which shows how important everyone takes this issue.

It is almost one year since I was elected to the Seanad. During the past year I have taken a keen interest in the plight of victims of symphysiotomy and have attended many meetings where I have been over-awed by the courage, bravery, resilience and quest of those involved to attain natural justice for what happened to them. As we have heard already, symphysiotomy was a dangerous childbirth operation performed in Ireland from approximately 1920 to the early 1980s. It involved severing the symphysis joint or in the case of pubiotomy, cutting the pubic bone. Up to 1,500 of these operations were performed in Ireland between 1944 and 1992, with approximately 150 known survivors. As a result of symphysiotomy many of the women involved are living their lives in constant pain, suffer from incontinence and many have suffered serious psychological affects, as evidenced from the many briefings we have had throughout this year from the victims.

I read yesterday of a case of symphysiotomy carried out in 1992. Our Lady of Lourdes Hospital has been regularly mentioned as a hospital which carried out this procedure. Four of my five children were born at that hospital, two of them by 1992 and one in 1993. My fourth child was born in Louth hospital which also carried out this procedure. It is frightening to hear this procedure was being carried out only a short time ago. Symphysiotomy procedures were, it appears, performed in some hospitals more than others. It appears to have been favoured in some hospitals run by religious orders. One woman told me yesterday of how she was told she was having a symphysiotomy because she was a Catholic and was then advised to have at least ten pregnancies after it, following which she would be okay.

It has also been reported that symphysiotomy, despite the fact that it had been discontinued in all other European countries, was preferred to caesarean section as that would have meant giving family planning advice. Symphysiotomy was regarded as preferable to that. I welcome the support and services that are in place. I know having spoken to women in the north-east region that there are many such services in place. I acknowledge and commend these services, including the provision of medical cards for all those who have requested them, the appointment of a liaison officer and access to medical assessment, gynaecological assessment, counselling, reflexology, physiotherapy, osteopathy and acupuncture. However, I call on the Minister of State to do everything possible to ensure all the victims of symphysiotomy are aware and availing of these services.

What struck me most, having spoken to many of the women concerned, is that the majority of the women concerned are in the latter years of their lives. They may not perhaps be aware that as survivors of symphysiotomy they can access medical cards. I ask that everything be done to ensure they are looked after. I also ask the Minister, who I know has taken a keen interest in the proceedings to date, to seek publication of the Walsh report. I welcome the comment today that the report will be with the stakeholders at the end of the month, which is great news. I look forward to publication of the report and hope that, following its publication, we can have a further comprehensive debate in the Houses on the matter.

We owe it to the women concerned to do everything we can to ensure they receive adequate redress for what happened to them. I hope the report will provide a full and comprehensive response on the reason this procedure was performed more frequently in Ireland that in any other country in western Europe. I found it deeply upsetting to learn that the practise of symphysiotomy was often performed in Irish training hospitals. These hospitals were training doctors to perform the procedure in Third World countries as an alternative and cheaper solution to caesarean section in a difficult childbirth. I ask that the Minister consider how best we can ensure these victims achieve natural justice, be it by lifting the Statute of Limitations for a year or by setting up a redress board. It is important that justice is attained for these women who have suffered all their lives.

I acknowledge the Minister's commitment to bring closure for these women. I ask that we do not lose the opportunity to do so. We must stand up and commit to that which has already been agreed. The women concerned deserve an acknowledgement of what happened to them. It is only right and proper that they receive an apology in that regard. They must also be made aware of and have access to all the supports and services they need. I welcome the formation in recent months of the cross-party Oireachtas group in support of symphysiotomy. I welcome also the opportunity to be an active member of this group and acknowledge the support of all members of the Oireachtas on this issue. It is hoped that in calling for this debate today we have again highlighted the pain and anguish and need for redress for these women. I hope we can continue to further engage with the victims whom I stress must be at the heart of all our efforts. I ask that the Minister of State do all in her power to ensure that it is the victims who remain the first priority, that they are listened to at every stage and are consulted as a priority in every development. The practice of symphysiotomy has been tied up in secrecy for years. It is now time responsible groups came forward and acknowledged the wrong done to these ladies. Very often these victims were not told what had happened to them and many continued to live their lives in pain only to discover in recent years what has been done. I pay tribute to the "Prime Time" programme, which opened this up for us. There have been many disturbing stories of patients' records going missing or getting lost and we need to address this.

We must strive to attain closure for these brave and outstanding women who were so wronged by our country, many of whom I have met and who are from my own area of Louth-Meath, where symphysiotomy procedures were carried out in the Lourdes hospital. I repeat that many of these ladies are elderly and time is not on their side. We are talking about approximately 150 survivors. I know the Minister of State will not let these women down. The youngest survivor, who has come forward to date, is 47 years of age while the eldest is in her 90s. Many of these ladies are now frail and vulnerable and it is imperative that the Government does everything it can to ensure these victims receive acknowledgement and redress.

I pay tribute to the many victims we have met and who continue to support each other and who have provided invaluable help to each other over the past ten years. People in my own area, Olivia Kearney and Kathleen Naughton — I think Senator Burke referred to Mrs. Kearney earlier — have campaigned tirelessly to bring closure to this issue. To these and all the victims of symphysiotomy, I thank them for their bravery, courage and ongoing battle to ensure they attain the justice and closure they richly deserve.

Senator David Norris

The Minister of State, Deputy Kathleen Lynch, is a good Minister; she is a decent woman and she was obviously extremely embarrassed by what she had to parrot out today. It was the worst speech I have ever heard her deliver. I will protect her reputation by saying that it was headlined "Speech Material for Kathleen Lynch". I do not believe she would have come out with this drivel. She started by saying she would like to explain precisely what symphysiotomy is but she did not do so. She never mentioned anything about the cruelty, the barbarity and the veterinary practices that were visited upon the unfortunate women, so why hold out the promise and not do so?

A number of things have not really been touched on, although Senator Burke quoted a Supreme Court judgment which gave a very short definition of symphysiotomy. Let us know what symphysiotomy is: it is a cruel and dangerous child birth operation that unhinges the pelvis severing the symphysis joint or, in the case of pubiotomy, which is an even greater aggression, sundering the pubic bones. This was the only country in the civilised world for the last 60 years of the past century to do this.

There was a vested interest in it. The medical profession protected itself. I remember I spoke on this issue on the Prevention of Corruption (Amendment) Bill 2008, which was about whistleblowers. People were terrified to speak out on this issue. I remember in 2010 when I raised it again — I have raised it repeatedly — I was told there was going to be a report and that it was going to be referred to the Institute of Obstetricians and Gynaecologists, the very people who were involved in it. I put on the record two years ago that I was not impressed by the representative of the Institute of Obstetricians and Gynaecologists. Some years ago, it was asked by the same Minister for a report. It gave one page which was as contemptuous as the way in which this House was treated last night. It dismissed everything and it was incorrect to do so. It was the old boys network protecting itself. This was an unnecessary and dangerous operation that had been impugned since 1777 and it was still practised here.

Let us ask why it was practised. I do not often speak well of journalists these days but Marie O'Connor wrote a book about it after she wrote in the Sunday Independent. I gather she is in the Visitors Galley and I would like to salute her because it is a wonderful book. She had the courage to say in this book what lay behind it. A sectarian, religious clique dominated and dictated. The Roman Catholic Church, in particular, always demands the right to interfere in people’s sexual and reproductive lives and in a democracy, it should not have that right. I put on record some of what Marie O’Connor stated. Religious beliefs appeared to be central to the latter day practice of these operations in Ireland. Prominent practitioners of symphysiotomy were at the centre of an informal network that included Archbishop John Charles McQuaid and several were members of Catholic action groups such as the Knights of Columbanus, the Guild of Saint Luke, the Society of Saints Cosmas and Damian, a medical association dedicated to put Catholic teaching into clinical practice. The writings of leading symphysiotomy revivalists at NMH, such as Dr. Alex Spain and Dr. Arthur Barry, are indicative of moral not medical difficulties with caesareans. While they accepted its safety, they saw it as morally hazardous. In other words, birth control, which was against the teaching of the church, might be practised and the church would be left without the control it had taken to itself in people’s very personal lives.

I was terribly moved by the television broadcast two or three years ago. The impact of this decision by men without consultation with the patients — this often happened without them knowing it was being done to them — meant they were left unable to walk properly, they were not given proper nursing attention afterwards and some of them were permanently incontinent, and all for what? It was for the pursuit of the imposition of the narrow sectarian moral views of one group upon a group of victims — women who, in many cases, did not even know what had happened to them.

I have a description of what it is like, which is worth putting on the record.

Some symphysiotomies, particularly those performed in the aftermath of a Caesarean section, [They did both; these people were unbelievable] were more hideous than others. Those carried out during late pregnancy were almost equally unprecedented. However, even the more usual symphysiotomies, those done during labour, were cruel in the extreme. Women found the experience utterly traumatising: after being left in labour for many hours, they were generally operated upon without warning, in the labour ward or in theatre, under local anaesthetic. And after the surgery, there was still a baby to be born: they were still in labour. [Can we imagine this?] The pain of pushing a baby out with an unhinged pelvis was followed by the agony of walking on it. Instead of immobilising the pelvis, hospital staff further destabilised it by requiring women to walk. Discharged home with a broken pelvis, women were left to sink or swim, without medical advice or painkillers.

That is the most shocking indictment. It was not only the pelvises of those women that were unhinged, the doctors who practised it were unhinged. What did they think they were about? What is the medical profession for? There is primum non nocere. Yes, I dare to speak the classical tongues in search of ancient wisdom. The first rule is, do as little harm as possible. That was not followed. That goes back as far as the Greeks. People 2,000 years ago knew that was the first duty of a doctor.

Forget producing reports, setting up these commissions and investigations and all the rest of the blather. Give the women what they want which is the temporary lifting of the statute bar, as was said by I think Senator van Turnhout. Why not do so? Some of these women only learned 20 years or 30 years later what had been done to them when someone was able to explain their difficulties to them. Let us try to do that. We will support the Minister of State, who I believe would like to do that. It is a limited number of people.

I will suspend my judgment of the setting up of an independent commission of inquiry. I understand there were some difficulties. It is a year old. It has been submitted but let us have it out as soon as possible in order that we can discuss it here. I will not judge this person whoever it was, I do not know whether it was a man or a woman, but whatever academic did it experienced difficulties in getting statistics and so on over a period of a year. Now it is with the Government. Let us publish it and have it out.

Acting Chairman (Senator Terry Leyden)

The Senator's time is nigh.

Senator David Norris

The third demand was access to the health entitlements and benefits promised by the Government in 2003. Those are the three demands and I support every single one of them. These are dreadful matters but so is the matter I raised in the House the other day and I still await another Senator to take it up. When a 16 year old boy in Holland who reported the fact that he was sexually abused to the police he was taken back to the Catholic institution where he was castrated. An investigation was carried out in that home. That boy would be the same age as me. That is why I feel it so much. It was the same thing, the imposition of a religious doctrine. Eleven teenage boys were accused of having homosexual thoughts and they were castrated medically without the knowledge of their parents. It was the same thing and it should be stamped out.

Acting Chairman (Senator Terry Leyden)

Applause is not permitted in the Chamber but in the circumstances we have to overlook it.

Senator Marie Moloney

I welcome all the survivors of symphysiotomy and those promoting their cause who are in the Visitors Gallery. I welcome the Minister of State who is a regular visitor to the House.

Symphysiotomy was advocated in 1597 and the first procedure on a human being took place in 1797. Given that society was primitive at that stage, one would have thought that medical procedures used in those ancient days would have been left behind in the 20th century. However, it is estimated that 1,500 Irish women, unknowingly and without consent, underwent symphysiotomies during childbirth between 1944 and 1992. Survivors were left with severe lifelong after effects including extreme pain, impaired mobility, incontinence and depression. I cannot understand how such a barbaric procedure was still being carried out up to as late as 1992. Obviously some in the medical profession will say it was a medical necessity, others firmly believe it was a religious ethic.

Senator MacSharry said he was not a medical authority, neither am I, but I am a mother. I gave birth to my first child in 1981. Unknowingly, I could have been one of the victims as I had a very difficult childbirth but, thankfully, I did not have to endure such a procedure. With no disrespect to the men in the House, one must have given birth to understand how vulnerable one is during childbirth, especially with one's first child. It may come as a surprise to some that women were treated by some gynaecologists as if they were imbeciles. I distinctly remember sitting up in bed, the morning after giving birth, when the gynaecologist was doing his rounds with a nurse. He asked the nurse beside me, "How is this woman feeling today?" He simply could not address the question to me in the bed. That was unbelievable.

Having sat and listened to the harrowing and heartbreaking stories of the surviving victims, some of whom are sitting in the Visitors Gallery, it is my duty to make a plea on their behalf. Many of these women, who at a young age believed the procedure they underwent was the norm, carried this secret for many years. They were afraid to speak up and take on the system. They had been dismissed by their general practitioners and told that the procedure was a medical requirement and had to be carried out. We know this was not the case. The consequences for victims who had no choice in the matter are devastating. The women who were victims of this barbaric act have suffered physical pain and mental and social torment for many years. Some have outlined in detail to us personal and intimate details of the consequences of living with the aftermath of symphysiotomy. Some are afraid to go out in public due to incontinence, some have indicated that their sexual lives suffered and, as a consequence, marriages have broken up. Some are experiencing such pelvic pain that, many years later, they are on morphine.

I welcome the introduction of the obstetrics and gynaecological clinical programme, led by Professor Michael Turner, the aim of which is to improve health care choices for women. While I acknowledge that the HSE has put in place facilities and support services to help the victims of symphysiotomy, they are still awaiting the long-promised Walsh report which was due to be published on 1 September 2011. I am pleased to note the Minister of State said the report will be published before the end of the month.

As the Minister of State will be aware many women have only recently become aware of the fact that what happened to them was symphysiotomy. Many are barred by the Statute of Limitations and the issue of delay. As there are only about 200 surviving victims an amendment to the Statute of Limitations would surely be less expensive on the State than a redress board. All victims of such a barbaric act, women who put their trust in their consultant, the doctor who delivered their babies, have a right to access to justice. The Minister of State is one of the most caring I have met. I say that with my hand on my heart. That is evident every day in her work on mental illness. I ask the Minister of State to go back to the Cabinet and make a case on behalf of victims and request the Minister for Health to consider amending the Statute of Limitations for at least a year. These women must be given a right to natural justice.

I commend the women who have spoken out and have highlighted the injustice. In particular, I pay tribute to Olivia Kearney who was the first woman to pursue a case through the courts and to the groups who are promoting the cause of survivors of symphysiotomy.

Senator Darragh O’Brien

As other Members have done, I welcome all the survivors of what can only be described as a barbaric practice who are in the Visitors Gallery. It is as simple as that. Many of my colleagues have expressed in graphic detail the nature of these actions and their effects on women. I commend the Labour Party for using its Private Members' time to bring the matter to the fore.

It is fair to say that successive Governments and Ministers, particularly since 2003, have kicked the issue to touch. While we must look forward to what can be done in real terms, Senator Moloney hit the nail on the head. As a man and a father I cannot fathom the practices carried out on many of the ladies in the Visitors Gallery and others and some, to whom I have spoken, who live in my constituency in north County Dublin who would have had access to Our Lady of Lourdes Hospital. I certainly know what a joy it was to have a child on 11 September 2008 when my daughter was born and what that meant to my wife and our family. That such a joyous occasion was destroyed in the main with the consequent pain that lives on, the knock on effect on women's lives, their husband's lives, and their children's lives, is an issue with which the State needs to grapple immediately.

While I have immense regard for the Minister of State with whom we have discussed many issues, particularly mental health, I am somewhat disappointed, not with the Minister of State, that there is no timeline for the publication of a report. I was elected to the other House in 2007 and met survivors of symphysiotomy in late 2008 and 2009 and would have lobbied previous Ministers for Health on the issue. Nothing further has happened since.

With regard to natural justice, one of the striking issues mentioned by Marie O'Connor in her notes is that justice delayed is justice denied. As Oireachtas Members representing the people and citizens of this country, including citizens who have been wronged, the first thing that must be done is the temporary lifting of the statute bar. If the Government will not do it, a redress board must be established immediately. We know about the delays with the report. Last February, the Minister for Health, Deputy James Reilly, made some comments that I disagreed with completely because it was not standard practice and nor should it have been. I know the Minister of State well enough to know that she will drive the matter. She has the full support of my party, my spokesperson this evening, Senator Marc MacSharry, who spoke on it, and me as leader of the Fianna Fáil Party group. I know previous governments have failed these women. They and their families have been failed and it falls to us to address it. At the very least, we need a timeline for the report and a commitment from the Government that it is willing to temporarily lift the statute bar to allow the people affected to move on. I was shocked by what Senator van Turnhout said about the experience of a lady just last week when she tried to avail of an X-ray. We are not talking about thousands of women here. Unfortunately, the other 1,300 women whom we reckon underwent the procedure have passed on and there are about 150 left. We should not be talking about the issue in a year's time. I do not want to debate the matter again in the Seanad Chamber, not to avoid giving a voice to everyone that is here but because I would rather the Government delivered the report, implemented its recommendations, lifted the statute bar and gave a commitment that it will ensure that the needs of the remaining survivors of symphysiotomy are looked after quickly and within a stated timeline.

I have a difficulty with the Minister of State's speech today, although I recognise that she is under some constraints. I am certain that if she was not she would be much more forthcoming. At this stage we need action and not another report or debate. As someone rightly said, it was only after the "Prime Time" report in 2010 that people realised the difficulties suffered by these women emanated from what should have been the joyous occasion of the births of their children. It was ruined. All of us are in agreement on this matter and I want the Minister of State to set a timeline. When will a report reach Cabinet? When will it make recommendations that will be implemented swiftly? The Cabinet can deal with this matter quickly. Successive Governments have made swift decisions on urgent matters for this country. I repeat Marie O'Connor's words that justice delayed is justice denied. Let us set a very strict timeline here and make recommendations. We can discuss them, but I want to know when action will be taken because these women and their families deserve some closure and assistance with this issue.

Acting Chairman (Senator Terry Leyden)

Three more Senators wish to contribute — Senators Tony Brennan, David Cullinane and Ivana Bacik. I request Members to be as brief as possible, although I know that each Member wishes to comment before the Minister of State replies. I call Senator Brennan.

Senator Terry Brennan

Go raibh maith agat, a Leas-Chathaoirligh, agus ba mhaith liom ar dtús fáilte a chur roimh an Aire Stáit go dtí an Seanad.

Like some of my previous menfolk colleagues, I am not qualified to speak on this matter. However, I acknowledge the pain and distress that has been caused and that it will continue to be a great source of continuous pain for the women who suffered this barbaric procedure, not so long ago in some instances.

I welcome the news that the Walsh report will be available within weeks. The Minister and the Minister of State are committed to addressing the issues that have arisen out of the legacy of the past practice of symphysiotomy and that they both hope to bring the matter to a satisfactory conclusion. I hope they do so as quickly as possible. I firmly believe that the women who suffered this barbaric procedure deserve nothing less, as the Minister of State stated earlier, and the sooner the better. I note that 1,400 similar procedures were carried out on women spanning the years from 1944 to 1992. I was born during that period but I cannot tell the Members the year. Thankfully, my mother did not undergo the barbaric procedure. I am happy to say that my three children, and more recently my three grandchildren, were born in Our Lady of Lourdes Hospital. My children were born in the late 1960s and early 1970s and I am pleased that the barbaric procedure of symphysiotomy was not performed on my good wife during the births.

I, too, congratulate my Labour Party colleagues and my colleague from Dundalk, in particular, on tabling the motion. I wish and hope that the report will be published and that we can look after the survivors. Sadly, many of the women who suffered this barbaric procedure have gone to their eternal reward having suffered pain for many, many years.

Senator David Cullinane

It is sad that we are again discussing an issue where the citizens of the State have been badly let down by institutions and the State itself. We are here again discussing an issue where people are seeking truth and justice, but it is important for us to hold this debate. I commend all of the Deputies in the Lower House who conducted a similar debate a number of weeks ago.

A number of Senators quite rightly characterised this practice as barbaric. When one considers the pain and suffering that was inflicted on women because of this practice, no other word can best describe it. Many of the women were left disabled by it. Some of them are in the Chamber today, but, sadly, some of the women affected have passed away. Many of the victims will never have their stories told because they never knew that a symphysiotomy was carried out on them, yet they all struggled through life. These people deserve the truth and justice. I know of one case that was carried out in my city of Waterford at the Airmount Hospital, and I am sure many more such procedures were carried out in hospitals across the country. Many of those victims, as we have rightly described them, have passed away and will never receive the justice they deserved. Last night, I attended the briefing session on the subject in the AV room here, and I attended the previous one held before the Dáil debate, where there were copious amounts of genuine and sincere expressions of sympathy, empathy and kind words. The only way we can move beyond sympathy and get to the truth and secure justice for the victims is to have an open and transparent inquiry into the matter. In any situation where a state fails its citizens, and in this case the State failed women, a responsibility is placed on legislators to ensure that the truth outs. That must happen, and the only way it will happen is if there is an independent, open and transparent inquiry. I know there is great cross-party support, from the Independents and everybody inside the House and the public outside, to work together to ensure redress and justice for the victims. We do not need a report to deliver justice because it is in our gift, as politicians, to deliver it.

A number of people referred to the Statute of Limitations. I want to read briefly from the conclusion to the briefing document that was given to us yesterday:

If the Statute of Limitations is not amended, there is a real danger that many of the victims will be denied access to justice. Furthermore, the inevitable legal dogfight will lead to substantial delays for the survivors' attempt to pursue their claim. All the victims, many of whom are in their 70s and 80s, are getting older. If there is delay, many will not live to see justice done.

I do not believe anybody in this House, through a lack of action, would wish to prevent victims from living to see justice done. I am aware that people from all parties have been working with the SOS group for many years. They have seen people pass away, unfortunately. Those people have not seen justice done. It is in our gift.

I am asking the Minister of State and the Government to do three things. First, it is important for a proper, open and transparent inquiry to be established to get to the truth. Second, the Government should introduce legislation to suspend the Statute of Limitations for 12 months and thereby give people an opportunity to have the day in court that they deserve. It is incumbent on legislators and politicians to ensure these people get the opportunity they need. Third, we need to consider people other than the immediate victims of this barbaric act, who were mentioned by a number of speakers. Yesterday and previously, we heard many accounts from women whose relationships broke up, or whose husbands or children had huge distress inflicted on them. It was truly harrowing to hear about babies who died while this practice was being carried out. I am sure the Minister of State will agree that the time has come to move beyond sympathy and kind words, genuine and sincere as they may be. It is time for action. The only way we can give justice to these women is to do the three things I have asked the Minister of State and the Government to do.

Senator Ivana Bacik

I would like to share time with Senator Hayden.

An Cathaoirleach

Is that agreed? Agreed.

Senator Ivana Bacik

I welcome the Minister of State to the House. I thank Senators for agreeing to this debate at short notice. I welcome the many survivors of symphysiotomy and their representatives who are in the Gallery. I know that more of them are following our proceedings from an overflow room because they cannot be accommodated in the Gallery. I thank the Captain of the House and the ushers for facilitating the visit of such a large group. We are delighted they are here.

The Labour Party Senators are pleased to have used our Private Members' time to facilitate this debate. We did so at the initiative of Senator Moran, who has been calling for this discussion for some time. It is important that this debate, along with the debate in the Dáil on 15 March last, marks an historic recognition by both Houses of the Oireachtas of the suffering of the survivors of symphysiotomy. This grotesque and barbaric procedure has been likened to female genital mutilation. There is no doubt that it is a form of abuse of women. It is appalling that it was carried out in Irish hospitals into the 1990s.

We have heard the harrowing stories of some of the many women on whom this procedure was performed. I would like to pay tribute to those who came into this House last night and on other occasions to brief us on their real and human stories and on the appalling health consequences they have suffered as a result of a procedure that was performed on them in most cases without any knowledge and in all cases without consent. As we know, it was far from being a standard medical procedure. It was carried out for Catholic doctrinal reasons. It was carried out in hospitals instead of caesareans, which should have been the standard procedure in these cases.

When I researched this issue eight years ago, I wrote that this barbaric procedure was carried out to avoid repeat caesareans, which were viewed by some Catholic doctors as being unwelcome as they might induce women to resort to contraception or sterilisation, given that a woman can deliver a small number of children only by means of caesarean section. Appalling and twisted as it may seem today, symphysiotomy was viewed as preferable in these circumstances. All of us agree that there is a need for action. This debate and the debate in the Dáil two months ago have highlighted the appalling abuse suffered by women who were subjected to this procedure.

I wish to pay particular tribute to Marie O'Connor, Olivia Kearney and the other women who have brought this issue to the fore. All of us are agreed on the need for justice for the women who have suffered. As Senator Cullinane said, there is a need for action. Senator Colm Burke referred to some of the cases that have been taken. We are all conscious that the Olivia Kearney case, which succeeded in the High Court in March, is being appealed to the Supreme Court by the defendants. We know that proceedings have been commenced in a total of 141 cases. There is a real fear that the Statute of Limitations will form a serious legal obstacle to a number of those cases, if not the majority of them.

It is clear that the Walsh report must review the best way for the State to facilitate access to justice for the women who have suffered symphysiotomy. Perhaps we can provide for some sort of temporary lifting of the Statute of Limitations, as was done for the victims of residential abuse. That appears to be a possible and realistic option. Alternatively, the establishment of some sort of redress scheme has also been sought or suggested.

All of us welcome the critical health supports that have been put in place. More needs to be done in terms of a response on the justice side, in recognition and acknowledgement of the abuse and injustice that was done to these women. We know that records were disappeared and have been hard to obtain. That has been one of the reasons for the delay in the publication of the Walsh report. We were all delighted to hear the Minister of State say it will be made available to the stakeholders within the next two weeks. We all want to see a clear timeframe thereafter for the consultation process and the publication of the report. We look forward to action being taken immediately thereafter. I know the Minister of State is committed to that.

Senator Aideen Hayden

I congratulate my colleague, Senator Moran, on organising this debate. As someone who practised as a solicitor in Drogheda and Dundalk for a number of years, I am personally aware of a number of cases that arose from activities at Our Lady of Lourdes Hospital. I refer to this matter and to a number of other matters. It is ironic that we are celebrating and commemorating the 1916 Rising in Arbour Hill today. The culture of silence that existed in this country for many years allowed this practice and a number of other problems to develop. I refer to the laundries, forced adoptions and sexual abuse, etc. This is a particularly sad issue because every woman who has ever had a child knows the fear one experiences in advance of one's first childbirth. It is particularly abhorrent to every woman in this country that medical professionals unilaterally ignored their patients in this way, preferring instead to impose their own views on sexuality and contraception on them.

I would like to make a brief suggestion before I conclude. We are all aware that records have disappeared. Certain medical professionals — they know who they are — should be asked to come forward. Perhaps they could be given some level of immunity that would encourage them to step up to the plate by making the evidence they have available.

Minister of State at the Department of Health (Deputy Kathleen Lynch)

I thank everyone who has contributed to this debate. I welcome the people in the Gallery. I recognise some of them from previous debates on this issue. More than anything else, the contributions we have heard show that we are all of one voice on this issue. We want to ensure that the women who had this horrendous procedure imposed on them get justice. The procedure was not requested. Who would request it? It must be about justice. A great deal of suffering has been endured over the years by those who were subjected to this procedure. In many cases, it has detracted from their enjoyment of their families, which is something we all expect to have. We need to acknowledge the great hurt and damage that was inflicted on them.

Senator Cullinane has called for a sworn public inquiry to be established. I remind him that this country has not had great experience with such inquiries. Given that speed is of the essence, that is not the way we should go. During the 12 months since this Government came to office, we have had to deal with many legacy issues. This is one of the most horrendous issues we have come across. We are desperately trying to grapple and come to terms with other issues like the Magdalene laundries and the Bethany Home.

The Walsh report will be with stakeholders, the most significant of whom are the women involved, by the end of the month. We must then have a two-month period in which submissions or reaction to that report come back to us, which is right as issues may arise with which those involved will not agree and which we will have to tweak or reconsider. When it comes back to us, we will need to take another look at it but there will be no delay from our side — the women have received that assurance not just from me but from the Minister. While they have rightly pointed to the delay that occurred, that was in regard to gathering the information.

If there are people out there who have files, they should please submit them. It has been too long and too tough a road for these people to have further delays now. Was it Joyce who said that too long a suffering makes a stone of the heart? It does. This has gone on for too long. We need to bring it to a satisfactory conclusion in regard not just to the women but to everyone else involved. If there are people out there who have information, my message is "Do not let this die with you, please come forward."

I congratulate the Senators who brought forward the motion so we can debate the issue and I pay tribute to the courage of the women involved. Having spoken to most of those women, I know it was difficult at that time to go home and talk about the details of what happened in childbirth or other private, intimate details. To be able to speak about it openly and honestly takes a great deal of courage — I know that. The fact we are all here today is some sort of reward and recognition but we need to bring this to finality and, hopefully, have a conclusion that will be of benefit to everyone.

The House has my assurance that the Walsh report will not be delayed. The input of the women involved will form part of the recommendations that will come from the report and, for our part, there will be no delay. I hope we can all reach a satisfactory conclusion because the women deserve no less. I do not go to all of the briefings because I have already heard the stories, which I find quite harrowing. I can only imagine what it must be like to have to live with this. Even in my imaginings, however, I do not think I would come anywhere close to it. I assure the women involved that we will bring this to finality as quickly as possible.

An Cathaoirleach

I would like to be associated with the welcome to the members of the SOS group who are in the Visitors Gallery and the AV room.