Protection of Life During Pregnancy Bill 2013: Report Stage

I welcome the Minister for Health to the House. Before we commence, I remind Members that on Report Stage a Senator may speak only once, except the proposer of an amendment who may reply to the discussion on the amendment. Also, on Report Stage each amendment must be seconded.

I move amendment No. 1:

In page 6, line 8, after “treatment” to insert the following:

“but such medical procedure shall be in accordance with current medical practice in Ireland and circumscribed by regulation”.

This amendment arises because of the discussion on Committee Stage with regard to the different types of abortion procedures. The amendment proposes the term “medical procedures” would be interchangeable with “abortion procedures”. Many people found the graphic descriptions of those abortion procedures which operate in other jurisdictions gruesome, barbaric and medieval. Some people were so upset by the graphic nature of these descriptions, that they regarded it as horrific. My hope is that any Member who regarded them as horrific would vote in accordance with the revulsion they felt.

I am grateful the Minister, during a break on Committee Stage, had gone to the trouble of checking the procedures practised in Ireland. He stated:

I have spoken to the master of Holles Street and I am assured, as of this afternoon, that the practices Senator Walsh describes do not take place in this country. In pregnancies of under 12 weeks, while surgical options are available, the procedures used are primarily medical.

I had described both medical and surgical procedures on Committee Stage. For those who want to disassociate themselves from me or criticise me for giving these graphic descriptions, I must point out it was my third attempt to elicit from the Minister what procedures were allowed under this legislation. The first time, he said he did not want to be prescriptive. The second time I asked whether they were surgical or medical procedures, he also did not answer that. At that stage, I spelt out clearly the different abortion procedures that I had researched well and asked if any of those would be allowed under the legislation. The Minister checked and informed me what procedures are in place.

I accept the procedures are primarily medical. In my earlier submissions, I stated the majority of abortions are medical abortions. The Minister, in his reply to me on Committee Stage, stated:

In cases where the pregnancy is more than 12 weeks, the baby is induced and if it is viable, it will be looked after and saved. Sadly, this cannot be done if it is not viable.

We know the overwhelming majority of babies cannot survive because most abortions are done in the first trimester when there is no possibility of the baby surviving.

I also noted that last Friday afternoon, the Institute of Obstetricians and Gynaecologists stated it wanted to allay the fears of the public following statements made in the Seanad. It stated:

The destructive methods described for second trimester termination of pregnancy are currently [note the word “currently”] not carried out in this jurisdiction, nor will they be in the future.

I accept that they are not currently carried out. I certainly hope they will not be carried out in the future but neither the institute nor I nor the Minister nor anybody in this House can guarantee they will not be carried out if we legalise them. The current construction of the Bill legalises each and every graphic procedure about which I spoke in the House.

I went further over the weekend. I am sure some, if not all, Members would have visited the website of the Royal College of Obstetricians and Gynaecologists and, in particular, looked at the section on guidelines on the care of women requesting induced abortion. It is worth putting some of what they say on the record. As one can see, it is quite a tome so I do not intend reading other than a few relevant extracts. It states that "abortion on grounds relating to the physical or mental health of the woman or of any existing children can be performed within the law at gestations up to 24 weeks." We are allowing it for gestations up to 39 to 41 weeks.

The guidelines also state that "at all gestations up to this limit, abortion can be performed using either surgical or medical methods; however, different abortion techniques are appropriate at different gestations." They go on to describe a method I described last week and state that "vacuum aspiration is an appropriate method of surgical abortion at gestations up to 14 weeks." They talk about dilation and evacuation, which the Minister assured us would not take place. I am not contesting his belief that it may not take place. When discussing dilation and evacuation, page 63 of the guidelines state that "surgical abortion by dilatation and evacuation (D&E), preceded by cervical preparation, is appropriate for pregnancies above 14 weeks of gestation." This is from the Royal Institute of Obstetricians and Gynaecologists in the UK.

I am quoting selectively from some of the guidelines rather than reading the full page. The guidelines state that "D&E is a safe and effective method of surgical abortion following specialised training." We should note in this that there is no form of abortion that is safe and effective for the baby, which is my fundamental point. There is none whatsoever. The guidelines also state that "overall, women who underwent medical abortion were significantly more likely to have a complication than women who underwent D&E (29% versus 4%)." It is very significant for women. We are talking about medical abortions which the Minister and the Institute of Obstetricians and Gynaecologists here told us would primarily be the form of abortion used.

The guidelines talk about a recent study from the US which involved a retrospective case note review of 242 women between 14 and 24 weeks gestation undergoing either D&E or medical abortion. The guidelines state that "medical abortion (induction of labour) was associated with higher rates of morbidity compared with D&E for both groups of women." We are talking about medical abortion, in other words, induction of labour, which is what the Minister is planning for here and which the Institute of Obstetricians and Gynaecologists is happy to see happen. The guidelines state just as an aside but an aside to which we might return later that "the use of real-time ultrasound scanning during D&E can reduce the perforation rate." There are other aspects in the guidelines, which I have just flicked through, to which I will refer in the debate on other amendments.

What I am asking for is simple. I did not recall it, but I was told on my way into the Chamber today that the Minister had stated at the outset of the debate that he would not accept any Seanad amendment. Will he clarify the position? That decision would horrify me, as the purpose of the Houses is to debate issues. We can debate them as robustly as we wish, but Senators should commit to ensuring the legislation is as good and humane as it can be, regardless of which perspective one has on it. There is no possible way abortion should be allowed under section 9. I fundamentally disagree with that section and will oppose it when we reach it.

This part of the legislation presents a challenge to us all, even those on the Government side who are pro-choice or those who, while being pro-life, have been coerced into supporting the Bill. I use that word advisedly. We must consider what we are doing. "Medical procedure" - the abortion procedure - is defined in the Bill on which Senators voted on Second and Committee Stages as including "the prescribing, by a medical practitioner, of any drug or medical treatment". It does not mention what is excluded because nothing is excluded. The Minister stated he did not wish to be prescriptive. People were so disgusted by my comments because the barbaric practices that I had described were tantamount not just to killing the unborn baby but also to torturing it to death. I am testing-----

On a point of order-----

Is it a point of order?

Yes. It concerns the language we are using in the debate. Once again, I ask that we all be respectful in our language.

With all due respect, that is not a point of order.

I thank the Leas-Chathaoirleach.

On a point of order-----

On a point of order, it is relevant because-----

After mine, perhaps.

Hold on one second. Senator Marc MacSharry had the floor before Senator Colm Burke. Senators should stop interrupting proceedings when they are not raising points of order. Most times, it is not a point of order.

But language is-----

I have ruled on the Senator's comment.

Regardless of anyone's opinion on these issues, Parliament does not have a watershed.

Does the Senator have a point of order to raise?

People are entitled to their points of view.

That is not a point of order, as the Senator knows.

At times, language can be disturbing. Senators should understand this.

People are listening to this debate. I have spoken to people who run medical clinics.

That is not a point of order; it is a statement.

It is a point of order, in that people are being traumatised by the kind of discussion that occurred last week.

Yes, but that is not a point of order.

It was appalling.

I remind Senators not to delay further. As the debate has proceeded, I have become cognisant of flimsy points of order being introduced. In fact, they are not points of order.

Unless Senators want the debate to roll on, they should allow Senator Jim Walsh to conclude. Four other Senators wish to contribute.

I have no intention of sanitising my language on any Stage of the debate so as to facilitate the passage of horrific practices into law. I make no apology for describing them as barbaric.

I wish to test the Minister on what he told us, having conferred with Holles Street. If what the institute claims is correct, namely, that current medical practice is all that we would be allowing, will the Minister accept my amendment? It would clarify that the "medical procedure shall be in accordance with current medical practice in Ireland and circumscribed by regulation". This would not satisfy me on the substance of the Bill, as it would still mean unborn babies would be unnecessarily killed under section 9. I have made my position clear on sections 7 and 8. I have no difficulty with them and no argument to make against any intervention or treatment for a woman whose life is medically at risk.

When it comes to pretending that abortion can resolve and abate suicidal intent when the evidence clearly states it does not but can exacerbate the mental condition and suicidal ideation, it is something we should not be doing.

I am asking that even if the Minister is moving in the direction he is now going, we could at least confine actions to current medical practice, and that would be clearly circumscribed by regulation. If the Minister fails to accept that, it raises questions about his intention. It would also raise serious questions about the practices that may operate in Ireland. I accept that the Minister may subsequently bring in regulations and the Irish Medical Organisation may also introduce regulations and guidelines to circumscribe what can be done. Without us including that in legislation, as parliamentarians we would be saying that we are happy for those practices to be carried out. At the very least we are saying that we are not unhappy and we are not prepared to press the button to try to stop those practices. That is a challenge and we must all reflect on it when it comes to voting.

I stated most of what I wanted to on Second Stage but I will provide some support for the issue raised by Senator Walsh, and perhaps the Minister might give due consideration to it. As Senator Walsh pointed out last week, the Minister was able to check facts and revert, which showed great respect for this House, and I praised him for such action.

I will speak to the issue of language and offence caused outside the Houses and so on. We have all chosen to deal with the debate in our particular styles and put forward our points of view as we feel they may be necessary. I appreciate that if some people saw extracts from last week's debate in isolation, it would appal many, but that does not deduct in any way from the fact that it was legitimate to put these issues on the record of the House.

This is Report Stage and I do not want to wander into other sections of the Bill.

I appreciate that and I do not intend to do so. The Leas-Chathaoirleach allowed Senator Walsh to do so and I should be allowed some latitude in the interest of balance, as there was other commentary about the issue last week. It is important that others should be allowed to say a few words. As I could have said with the point of order that was not, Parliament does not have a watershed and it must consider issues that are very grave and serious, and they are many in number.

With all due respect, the Senator is wandering beyond the remit of this amendment No. 1.

I appreciate that.

There may be other areas of the Bill where the Senator can contribute but I do not want him expanding on different views or parliamentary rules.

I know that and I promise I will not speak again, so that might allay the Leas-Chathaoirleach's fears somewhat. The comments are nonetheless legitimate. I have worked with Senators Walsh and Ó Domhnaill in particular over as many as 11 years, and I know it is not their intention to offend anybody. I reiterate that at times in considering matters, some may feel the necessity to quote documentation on medical best practice and journals.

Senator MacSharry, you should understand my position.

The language, at times, may be particularly offensive------

I should have order. If I allow the Senator to wander and digress, I would have to allow the same latitude to others, and I cannot do that. We are on Report Stage.

What the Senator is saying is outside the issue before us. I ask Senator Mullen to speak.

Yes, but the Senator has been digressing. I have ruled on the matter.

I accept the ruling.

If you accepted it, you would sit down.

I am the health spokesperson for this side of the House and at times some level of latitude would be given. I have chosen to speak only once on this Bill, on Second Stage, and anybody would agree that I gave a very balanced view in defence of my issue. In the context of how issues were handled last week, balance would be reasonable.

Senator MacSharry, please.

Sometimes we must deal with variations.

It is unfortunate that you are testing the patience of the Chair. I take it the Senator is not speaking any more on the Bill.

I presume he means this section.

I wish to put on record my concern that we have reached Report Stage yet the Dáil is in recess which is not the first time that this happened in these Houses. To follow on from what Senator Walsh asked the Minister, it illustrates a most profound lack of respect for the parliamentary process but I am not surprised. Obviously there is a profound lack of respect for life in the legislation. On something as serious as this we would be ag feadaíl in aghaidh na gaoithe as we table amendments that we know the Minister does not intend to think about, much less accept and that is not to the credit of the Minister or the Government.

I also wish to express my support for Senator Walsh though he speaks in a very different style to the one that I choose. Ultimately, it is the parliamentarians who stand their ground, not those who run away when it comes to issues of principle, who will be remembered, and with appreciation. On this occasion Senator Walsh deserves credit for insisting that this is a Parliament and not children's television. It is a Parliament, a place where sometimes hard things must be said.

I ask the Senator to confine himself to discussing the section.

I will. I shall speak to the section-----

What Senators have said on Second and Committee Stages is, in many ways, irrelevant because we are debating Report Stage and must deal with 62 amendments. If I allow Senators Mullen and MacSharry to wander in their contributions then others may want to wander or will feel disenfranchised or otherwise when it comes to making contributions.

I have no intention of doing so, a Leas-Chathaoirligh. These are my first comments on Report Stage. I hope that there will be no need to revisit those issues because latitude will be given to Senators to express themselves on the issues as they see fit, and according to their mandate.

I support Senator Walsh's amendment. My concern is about abortion techniques to be used and the related issue of pain killing as arose with Committee Stage amendments, and will arise again. The Minister has fallen back on his line that he does not want to be prescriptive. It makes a lot of sense not to be prescriptive where to be prescriptive might interfere with a doctor's ability to do a doctor's good work. That cannot be what we are talking about here. We are talking about the avoidance of destructive procedures. It is welcome that the Institute of Obstetricians and Gynaecologists has stated:

The destructive methods described for second trimester termination of pregnancy are not currently carried out in this jurisdiction, nor will they be in the future. The procedure currently practised in the Republic of Ireland is induction of labour using medication called prostaglandins. This will not change as a result of the enactment of this legislation. If a viable foetus is delivered, all efforts are made to preserve its life where possible.

Presumably, the statement should have said "his or her life where possible". That is all very well. The institute does not make law and it does not, ultimately, decide what could be lawful, or not. It cannot even tie its own hands into the future and has no authority to do so. It is slightly less than reassuring when it says that the procedures to be carried out "will not change as a result of the enactment of this legislation." Nobody is saying that it will. We are saying that the legislation, as it currently stands, leaves open the possibility that the procedures could change in a way that would not be desirable from the point of view of respecting the dignity of the unborn child in this situation.

I shall raise an issue that I have raised before, namely, the use of an intracardiac potassium chloride injection into the heart muscle for late-term abortion or termination of pregnancy at 22 weeks onwards, as recommended by, among other people, Dr. Arulkumaran in his scholarly article that I quoted on Committee Stage. This is the gentleman who was bizarrely put in charge of the HSE's investigation into the tragic death of the late Savita Halappanavar.

Perhaps the Minister for Health can assist me, and us, by saying whether he regards the injection as being permissible under the legislation should the relevant doctor or medical organisations decide that it was appropriate for some reason. Does he regard the injection as part of a surgical or medical procedure? What is intended by an intracardiac injection? I would find it helpful to know the information. It is not inappropriate of me to ask my questions given the profound nature or tromchúiseach of this legislation.

It is not enough to say we will not tie doctors' hands. We should not tie doctors' hands where they are doing good work but doctors sometimes do bad things and they certainly do so in abortion jurisdictions. There is no doubt but that we have a culture which is changing. Culture always changes and will change into the future. Therefore, it is very much the responsibility of legislators to shape the circumstances in which medical treatments are carried out.

I support the amendment put forward by Senators Walsh and Wilson and would be very grateful if the Minister would respond because my fear is that by not being prescriptive when one should be, one ends up with a scoundrel's charter and that must be prevented. I would be grateful for a response on the potassium chloride issue.

This legislation comes into play where the life of the mother is at risk. The amendment fails to recognise that medical procedures change, as was clearly evident from the description given last week of something which went on 25 years ago. Procedures have changed and moved on.

There is a huge commitment among the medical profession to the life of the mother and the unborn but we are losing that in this debate. The commitment given by all the hospitals and maternity units and by medical consultants, junior doctors, nursing staff and support staff is unquestionable. People are committed to maintaining that.

I welcome the clarification given by the Institute of Obstetricians and Gynaecologists in which it clearly set out that the procedures described here last week are not carried out in this jurisdiction, nor will they be in the future. The procedures described would open up the whole area of medical negligence. Any doctor going down that road would put himself or herself at risk of being sued civilly and in terms of breaching all of the guidelines. The institute clearly set out that where there is a difficulty and the life of the mother is at risk, medication comes into play.

The amendment restricts any new developments because it refers to current medical practice. Some 15 years ago, a baby delivered at 28 weeks had a very good chance of survival but did not if born between 24 and 28 weeks. However, that has changed and a baby born between 23 and 24 weeks has a very good chance of survival which goes to show how medical procedures have changed in that time. Medical procedures will continue to improve but this amendment would restrict any future development in regard to the care of the mother and the unborn and, therefore, I do not support it.

I am very interested in getting some information from the Minister. I will make one short contribution and will listen respectfully to his reply. The amendment refers to such medical procedure being in accordance with current medical practice in Ireland and so forth, but there are people who have to go abroad. What reply can the Minister give to something sent to me by a constituent? It refers to a newspaper story about a situation in England. The article included the revelations of leading cancer surgeon, Professor Meirion Thomas, who bravely blew the whistle on the massive and escalating problem of thousands flying to Britain for free treatment, including expectant mothers and sufferers of cancer, HIV, liver failure and kidney failure.

The UK Government is about to introduce new laws to the effect that one must be resident in the UK for 12 months or, where one is a foreign student or seasonal worker, for six months and pay a charge of £200 per year to avail of health services. I am unsure where this leaves Irish females seeking abortions. Does the Minster have information on this matter or could he get some and communicate it to me privately? This matter relates to the amendment in some way and was raised by someone who was concerned. Will the new legislation, which has been introduced to inhibit the number of Irish people seeking free treatment of various kinds in England, presumably including abortion, have an effect on those who go there due to fatal foetal abnormalities?

I welcome the Minister to the House. I am sure that he will respond to Senator Norris. From my knowledge of women who have travelled to England, many availed of abortion through private clinics rather than via the NHS. I believe that the rule in question only relates to the NHS.

For the reasons set out by Senator Burke, I oppose the wording of amendment No. 1 in principle. It is also legally and technically unsound, in that it refers to current medical practice without stating from when the time is measured. Would it be current at the date of enactment, the date of debate or the date at which it is to be interpreted in two, three, four or five years' time? For many reasons, it is a problematic amendment.

Generally, it is not helpful to the debate on Report Stage for proposers of amendments to use graphic or insensitive language in doing so. We need to be respectful in the House in our use of language, particularly when discussing a sensitive topic like abortion. Remarks in this House last week caused offence, as Senator Burke mentioned. We should behave in a professional and respectful manner. This is not children's television, but neither is it Fox News. We are not here to shock or appal people with our language. We are here to have a reasoned, respectful debate with emotion and passion. It should reflect reality as people understand it.

We are debating the definition of "medical procedure". It is from the UK's Department of Health statistics for last year that we derive our information about the majority of Irish women who have abortions. Of the nearly 4,000 women who had abortions, 85% were carried out in the first trimester and a small number were carried out beyond that. There is a sad and disturbing story in today's The Irish Times of a woman who died last year having reportedly had an abortion at 20 weeks gestation. From what little we know, that case illustrates the difficulty-----

The Senator is broadening the debate again.

-----facing women. It is not good medical practice to have obstructions in place that prevent women from obtaining abortions in the first trimester where they would otherwise do so.

Some Senators have sought to portray this debate as being between pro-life and pro-choice groups. I do not pigeon-hole myself into either. If anyone is listening, he or she might remember how I stated on Second Stage that this was not a matter of conscience. The Supreme Court has spoken on this matter.

We are on amendment No. 1.

That is exactly what I will address. As legislators, it is our job to bring the law into alignment with the Constitution in this House. While doing so, we are speaking to each other. We must assume that everyone who has taken part in the debate has fully informed himself or herself of all elements of the debate. As such, the graphic language is clearly not aimed at Senators. It is aimed at a wider audience. To suggest otherwise-----

I have ruled on this.

I am coming straight to the point.

No. The amendment is on medical procedures, not on the language used. The Senator tried to ruin this discussion previously. What he is trying to do in an uncouth way is to expand on the topic, but I have ruled on it and have tried to suppress it.

The Leas-Chathaoirleach has.

The matter is beyond the remit of the section.

The Leas-Chathaoirleach will find how relevant it is to the section in one moment. The section, or the amendment, as Senator Bacik has-----

On the amendment rather than the section.

Yes. I am speaking to both. Senator Bacik has pointed out the technical fault with the amendment's use of the word "current". It must fall on this point alone. As the Minister and others have mentioned, the amendment is also prescriptive. This legislation relates to an immediate and substantial risk to the life of the mother and allows no room for the introduction of the politician, the lawyer or the priest into the argument. I will leave it at that for the time being, although I will say more later. The amendment is technically and ethically incorrect.

In this debate, there is a danger of conveying the assumption that only one opinion is right. It is not true. We must stick to the facts. Sometimes, they are difficult to hear.

We can pride ourselves on the fact that the current practice in Ireland is a two-patient model of care whereby the expectant mother and the child are prioritised. I infer from Senator Walsh's amendment that this is what he meant. I understand that "current medical practice" never sits still - it is always evolving through evidence and improvement. However, we cannot underestimate the importance of emphasising the two-patient model. Doing well under that model is more difficult than under a one-patient model.

At the weekend, I spoke with an OB-GYN practising in Galway city. She used the example of a pregnant mother who had cancer and an emergency situation that might arise under sections 7 or 8. She stated that, under the two-patient model, one knew to give chemo at between 15 and 35 weeks, the safe period for the expectant mother. She also stated that one knew how to shield the baby in the womb from radiotherapy. This is real care.

Also at the weekend, I spoke with a woman who stated that she had Hodgkin's disease 12 years ago. She was pregnant at the time. One gynaecologist told the other person beside her that it would have been better to "get rid of that", meaning the unborn baby. The expectant mother refused and the child is now a fine, healthy 12 year old.

I am sure that the Minister will agree on the importance of continuing to prioritise the two-patient model. I suggest to Senator Walsh that, instead of the phrase "current medical practice", he should have used "two-patient model of health care", under which all efforts are made to save both lives. Let us not forget that, for quite some time, we have ranked in the top five in the developed world in terms of maternal health care. For some of that time, we were No. 1. I see no reason to move away from the current model. Will the Minister address this point? Does he agree that this country is safe continuing with the two-patient model of health care in all circumstances so that both lives can be prioritised?

As regards sections 7 and 8, I accept fully that, where there is evidence that the mother's life is at risk for a medical reason, the child's life may be lost, but it would not have been the intention of the procedure. The Minister knows my opinions on section 9. There is no evidence to move, but we are unfortunately deciding that there is under this section. I look forward to the Minister's reply.

I suppose I am generally supportive of the amendment, but I appreciate that when one tries to provide for such a concept in law one's language has to be very precise. I note what Senator Bacik and my party colleague, Senator Colm Burke, have said. The Minister indicated earlier - perhaps it was last week - that the Holles Street people have spoken about the fact that terminations will not be carried out in the way suggested by Senator Walsh last week. Perhaps we need to know exactly what the current medical practice is. It is okay to say what it is not, but we need to know what it is. Obviously, the Minister has the power to introduce regulations. In fairness, he has said many times previously that he will introduce regulations. I think it would be very helpful if we knew now what those regulations are because we are being asked to buy a pig in a poke. I certainly look forward to seeing these regulations as soon as possible.

Colleagues have mentioned, in the context of this Report Stage amendment, the language that was used during last week's debate. While I accept that the language in question upset some colleagues, I cannot get my head around the possibility that the abortion or termination will involve a stork coming to take the baby, as I said last week. When we talk about a termination or an abortion, we are talking about the unborn person's life being ended medically, surgically or through a combination of medical and surgical means. We need to know what the procedures will be when they are prescribed by the Minister by regulation or otherwise, in so far as they can be so prescribed. If he is ruling out some of the methods outlined by Senator Walsh, that is good. I wish it were the case that the use of these methods stopped 15 or 20 years ago, but there is a great deal of international evidence that they are being used as we speak.

We need to know what is happening in Ireland. My colleague, Senator Gilroy, has said these methods are not in use here. I recall one of the experts advising us at the hearings that medical personnel will have to be trained. It is on the record of the hearings. One of the medical personnel advised us that training will be required. If this is being practised in a very limited and necessary fashion already, and women's lives are correctly being saved, why will further training be required? Those are not my words. Those are the words of a consultant as spoken during the hearings that were held in this Chamber. The person in question said that training in these procedures will be required. Could the Minister advise me of the type of methodology that requires such training, according to a consultant who sat on the seats opposite me at the committee hearings some months ago?

I also want to speak about the amendment proposed by my colleagues, Senators Walsh and Wilson. We had a lengthy discussion on medical procedures on Committee Stage. Obviously, it is regrettable that in order to advance an argument, we sometimes have to use language that we cannot sanitise. One cannot sanitise the truth. If the language used has caused upset to any individuals, particularly anyone who would have had a miscarriage, I certainly regret that from my point of view. I know a Member of the House spoke about that last week. I would extend the deepest sympathy because I know-----

The Senator is broadening the debate again. I ask him to stick to amendment No. 1.

Members of my own family and friends of mine have had miscarriages. I know as well as anybody else the difficulties that are experienced in cases of miscarriage. The difference with a miscarriage is that it is a natural death. We are legislating here for the deliberate ending of life. There is a major difference. I want to put it on the record that there is a major difference. There is no direct correlation between the two in relation to what we are saying.

Let us just look at the medical procedures. Senator Colm Burke argued that the Bill is about protecting life. Yes, it is. It is about protecting one life over another. The Bill, by extension, is also about ending life. The medical procedure defined in the Bill is a medical procedure which will end life. If we were having a debate here on capital punishment, we would be discussing a procedure that would end life. Every Member of the House and all the human rights groups outside the House would want to know what the prescribed procedure would be. It appears to be okay to legislate for a medical procedure, without being sure what that procedure will be, simply because it will be performed on a person who cannot speak - an unborn who is not among us but within the womb. I think that is wrong. I think it is very wrong.

At the weekend, I read and researched all the articles on the issue of foetal pain that were given to me after last week's debate. This issue is not something new that has come over the rainbow. As far back as 1984, the then US President, Ronald Reagan, raised the issue of foetal pain in a speech he gave. In support of that speech, 26 of the best medical brains in America wrote to the President and published an article outlining clearly that foetal pain is stronger and more abundant among unborn children after 20 weeks than it is among babies who have been born. The effect of pain on an unborn child of more than 20 weeks' gestation is greater than the effect of pain on a baby who has been born. How can we dissociate ourselves from that?

Is this relevant to amendment No. 1?

I remind the House that Senator Ó Domhnaill is the tenth speaker and none of the previous speakers has seconded the amendment before the House.

I am glad to second the amendment.

It would be better if people concentrated on what is before the House, rather than wandering off the point.

It cuts to the-----

I understand there is an amendment about foetal pain, which I will be happy to support, but it is miles down the line.

It is a different issue.

Yes, I think so.

I will allow Senator Ó Domhnaill to conclude.

I am happy to accept what has been said. My comments are relevant to the issue of medical procedures. If the Minister and the Institute of Obstetricians and Gynaecologists are saying that certain procedures do not occur here, there is a simple solution. It is staring us in the face. The Minister should simply legislate for the procedures that will be carried out by listing them in this Bill. Alternatively, he could show us the money - the regulations - now so that we know by law and by statute that none of those procedures will be carried out here. If we are saying that, and if we are genuine and honest about it, we should have no difficulty legislating for it.

The danger is that if we do not legislate prescriptively here, we cannot be sure that in a few years' time, when we have a new Minister for Health - perhaps the Minister, Deputy Reilly, will have become Taoiseach or there will be a new Government in place - and medical procedures have evolved, the procedures we have mentioned that are used in other countries will not come here. Nobody can predict the future. The only way to define the future is to legislate to define exactly what we want to happen in the future. No Member of this House can say that this will not happen next year, the year after or the year after that. If we do not legislate to prevent it, we cannot say it will not happen. I think that is the point Senator Walsh is trying to articulate. I fully support him. This issue is the kernel of this legislation. If we are the human rights activists that some of us proclaim to be, surely those human rights should not apply after birth only - they should apply pre-birth as well.

First, let us get the record straight. The idea that a foetus at 21 weeks could feel more pain than a newborn child is utterly unfounded. I know that is not part of this discussion, but several Senators have raised it. In 2005, a multidisciplinary systematic review of evidence in the Journal of the American Medical Association concluded that "evidence regarding the capacity for fetal pain is limited but indicates that fetal perception of pain is unlikely before the third trimester". It went on to state that "the capacity for conscious perception of pain can arise only after thalamocortical pathways begin to function, which may occur in the third trimester around 29 to 30 weeks' gestational age". When the Royal College of Obstetricians and Gynaecologists in London examined this matter in 2010, its main findings were that the foetus cannot feel pain before 24 weeks because the connections in the foetal brain, between the periphery and the cortex, are not yet fully formed.

There is some evidence that suggests that the foetus, while in the chemical environment of the womb, is in a state of induced sleep and is unconscious. Therefore, the report concluded that because the 24 week old foetus has no awareness or cannot feel pain the use of analgesia is of no benefit.
I want to quickly address some of the issues raised. I find it regrettable that Senator Walsh has engaged in the dramatic and very upsetting - what some people would describe as offensive - description of procedures that do not take place in this country, and will not take place in this country. He said that we cannot guarantee that they have not taken place. He implied that.

He is absolutely right that I cannot guarantee that, by the very lack of the Bill being in the Legislature we have no notification of the terminations that have taken place even though they are legal since 1992. We have no certification. We have no need for a second opinion. He also acknowledged that they do not take place. The Senator talked of torture but that implies the wilful infliction of pain which this Bill is not about. He also mentioned the ability to experience pain and to suffer as a consequence, which I clearly outlined would not be the case.

Senator Mullen talked about a profound disrespect for life and I utterly reject his claim.

The Minister would.

The legislation is all about respecting life, respecting the life of a woman and her unborn child and an attempt to save one rather than lose two.

His respect is somewhat focused.

The Minister has no respect for life and this legislation proves it.

Again, the Senator mentioned the scoundrels' charter seeking to denigrate the medical profession and carried on his theme from last week. I find his claims objectionable.

Some deserve to be denigrated.

Senator Norris asked me some questions on the health services. As Senator Bacik has said, many people go privately but I can revert to him with more information.

Senator Bradford mentioned the regulations but they were published last Thursday evening. Perhaps he meant the guidelines of the institutes that are still under consideration. They are the Institute of Obstetricians and Gynaecologists, the College of Psychiatrists of Ireland and the Irish College of General Practitioners. Notwithstanding what the medical profession may have said in this Chamber over the course of the hearings, it is part of routine training and there is no need for additional training. This is part of routine training. Members will have heard Senator Ó Domhnaill describe how friends of his and members of his family have had miscarriages. Part of normal training is being able to deal with miscarriage and the complications that arise. Sometimes a woman does not have a complete miscarriage. There is a real threat to the life of the mother if retained placental parts are left inside the womb so they must be dealt with.

I do not propose to accept the amendment. As I stated during Committee Stage, it is intended that medical procedures, under the terms of the Bill, will be carried out in line with current medical practice. It is neither desirable nor appropriate to enshrine clinical practice, which constantly evolves and changes, into primary legislation. What is best practice today could change next year and each time practice changes and improves we would have to return to the Legislature to re-legislate. To me, that would be a very bad place to go and, to be honest, would be impractical and unworkable.

The idea that the Legislature would have a say over the actual mechanism of how doctors practice, as opposed to what they should be doing, was raised last week. We are prescribing what they are to do. We are not prescribing how they are to do it because that would be wrong, in my view. As I said, the medical and nursing professions in this country and across the world have a reputation for care and compassion that has been built over centuries.

Not in Britain, they do not.

Virtuous in Britain? Nonsense. Qualified obstetricians in Britain are killing children.

For all Senator Mullen's talk of respect he has interrupted me a number of times. I have not interrupted him once since I came to this House.

The Minister has shown no respect for this House or for the unborn.

I am extremely disappointed with the Minister's response but I am not surprised as it is consistent with the manner in which the Bill was drafted. First, it totally ignored all of the professional evidence presented over six days of health committee hearings. Second, a significant number of amendments were tabled in the Dáil but they have been ignored. Third, we have only reached the first amendment so far today. I guarantee the Leas-Chathaoirleach that when we reach amendment No. 62, or No. 86 as it was numbered for Committee Stage, every amendment will have been ignored by the Minister. He is in a rush to introduce legislation that will not advance the protection of women in any shape or form and will probably have an adverse affect on many women who will have abortions under this legislation. Obviously we all know the effect that it will have on unborn babies.

With regard to some of the points made by the Minister, at 18 to 21 days a baby has a heartbeat and at around 41 days professionals and research have shown that a baby has brainwaves. I have read into the record here that babies at 11 weeks have a placenta around them to supply food and oxygen. They can make complex facial expressions and can even smile. All bodily systems work at 11 weeks. At 16 weeks the child can use its hand to grasp which ultrasound can prove and he or she can swim and do somersaults. At 18 weeks the child is active and energetic, flexing muscles, punching and kicking. Any woman who is pregnant will be well aware of the child's movements at that stage.

We have the scenario where what I described is regarded as disgusting and, by some people, language that we should not have used. There are people who would love to see this language sanitised to the extent that people are unaware of the barbaric effects of abortion. That is how the evil abortion industry has survived and grown across the globe.

I applaud the Minister for stating the reality of the tobacco industry. A relative of his died from smoking and my mother died from smoking. The tobacco industry prevented the disclosure of medical research and information that could have saved many lives. The industry sat on that information because it was motivated by profit and has shown a total disregard for humanity and its fellow human beings.

With no disrespect for Senator Walsh, might I ask for information about proceedings?

The industry that I am talking about today is worse.

I am not attacking Senator Walsh and just seek some information.

I ask Senator Norris to resume his seat, for the moment. Senator Walsh please. There have too many interruptions.

The abortion industry is evil. All one has to do, when the industry is uncontrolled, is look at what happened in the Gosnell case. Can anybody here raise his or her hand to say that Gosnell was a paragon of virtue and he or she supports his practices?

The Senator is right. No one would say it.

I accept that. I do not think that anybody would.

Why did the Senator mention it?

There are other minor Gosnells who operate in the same way and deal in the abortion procedures which I described here and, I admit, do not take place in Ireland.

Why did the Senator announce them?

Senator Walsh to continue please, without interruption.

The Bill allows all of those procedures because they are simply not circumscribed. I want to put the following on the record, I did it the last day, I did it during the health committee hearings and I would do it again. I agree with Senator Colm Burke that there is a great commitment to the life of the mother and the baby here. We have a proud tradition in the two-patient model that Senator Healy Eames referred to and our excellent maternal health record is on a par with the best international comparators. We are about to change the culture of our medical profession by introducing abortions where they are not necessary and there is no evidence that they will, in any way, contribute in the context of mental illness or the suicidal intent of the mother.

I wonder if Members have read my amendment. I know that there have been attempts at obfuscation regarding the issue. Many Members may be challenged personally, with their conscience, on what he or she is doing but many may not.

The Senator's comments are not in the context of the amendment.

As it is now 5.30 p.m., I ask Senator Walsh to report progress.

I report progress.

The Leas-Chathaoirleach indicated that he would entertain a point from me.

Not now that the House is being-----

I am sorry but I want to say that I cannot take any further part in this debate.

Senator Norris-----

The Leas-Chathaoirleach indicated that he would deal with this.

Senator Norris, on a point of order.

My point of order is that I very much regret I cannot take part in the debate as far as the amendment I wanted to debate, which was amendment No. 57. We have spent an hour on one amendment.

That is not a point of order.

I would have stayed, although I am exhausted. However, I will not stay because we are not going to reach amendment No. 57.

That is not a point of order.

I have stayed as long as I can.

Sitting suspended at 5.30 p.m. and resumed at 7 p.m.