Although we have a quorum, we want to wait for a few members to arrive. We have started, but I propose that we suspend for a few moments to allow them to turn up. Is that agreed?
Health (Regulation of Termination of Pregnancy) Bill 2018: Committee Stage (Resumed)
I thank the Minister and his officials for attending.
I move amendment No. 59:
In page 9, line 33, to delete “having examined the pregnant woman” and substitute “following a medical consultation with the pregnant woman”.
This amendment relates to the risk to life or health in an emergency. There is a subtlety in this regard. If there is a risk to life or health in an emergency, it is obvious that there must be a physical examination.
We have discussed that before, including during our meetings last year. The matter was raised at the time of a consultation that would be of greater depth than would normally happen during a medical examination, for example in the event of there being a possible pre-existing condition or to determine whether there is a risk to the health of the woman which could in turn lead to a risk to her life. The amendment is well placed. It covers two issues, namely, the need for a medical examination and for a discussion with the patient to take into account all of the circumstances and past history.
While I fully accept that and while I agree with the Chairman on the subtleties in terms of the differences involved, my response is the same. I am very much in favour of trying to use more inclusive language when it comes to the word “consultation”, while having to recognise, as Deputy Durkan said, the fact that in an emergency situation, one could, for example, find a woman unconscious. I am trying to come up with the appropriate wording. As I said yesterday, I will be looking at how we can improve this by working with colleagues before Report Stage.
I think the amendment is a good one but I do accept that the Minister has said he is going to revisit the language. The view has clearly been taken by some people outside the Houses and in this committee room that the person involved is not central in the current wording, although I know that was not the intention. I think the language that is currently used is a bit unfortunate but the Minister has indicated he will come back to us. I echo what Deputy Donnelly said last night in requesting that we have those suggestions in a timely manner and that we would have the Minister’s revised wording in enough time to enable us to table amendments if necessary.
I support the amendment. When the Minister is considering what consistent wording to use, for me there are two tests. One is that the voice of the woman is put front and centre in the various sections. It is potentially more nuanced and complex in this section because it provides for an emergency case and the woman may not be conscious. That can be reflected by means of terms such as “where possible” or “appropriate”, or whatever the right language is such that the woman’s views are ascertained. We will come to an amendment I have tabled for a later section which provides that a termination be actually requested by the woman. That is missing from various sections. It is more nuanced because, in an emergency situation under section 11, or indeed in the case of a risk to life under section 10, although it may be the case that the woman may not be in a position to give her views, in many cases she will be. When the Minister is considering the wording, these are the two tests I would like to see met - namely, that the voice of the woman be placed put front and centre and, where it is practicable, that a termination be requested by the woman.
On the suggested amendment, as I said yesterday, a medical consultation usually includes an examination. It also includes a discussion with the woman about what course of treatment is the most appropriate. Therefore, "medical consultation" is an all-encompassing term. It includes taking a history, an examination and a engaging in discussion. In the context of what Deputy Donnelly stated, it takes into account the wishes of the woman, which would be paramount in the context of any decision. "Medical consultation" is a wider term for what happens than "examining" the pregnant woman. Would Deputy O'Connell like to come in given that this is her amendment?
Yes. I apologise for being late. We discussed this yesterday and I completely agree with the Chairman. It does not seem right that we would prescribe in legislation what a doctor would do. For example, if somebody was five weeks' pregnant as a result of a rape, we would not want a doctor to think that he or she would have to tick a box to say a physical examination had happened in order to ensure compliance with the law. The doctor and the woman together can make this decision in a consultative, two-way process.
This is an area in respect of which we can make improvements. Going back to one of our many conversations yesterday, there is a question as to how much we include in the legislation. I very much take the point that while the word "examination" is in the legislation, there is a sense that there is a more appropriate phrase and I am very committed to delivering that. Where we go beyond adding more words, we have to make a judgment call, as a committee and as an Oireachtas, regarding whether that helps or hinders doctors.
Going back to the conversation as to where some of this should reside, there is an argument that it should reside in clinical guidelines and in the fact that the Medical Council is already the regulator of doctors. Deputy Donnelly has rightly said that there is nuance. If the woman is unconscious and it is an emergency, the principles of consent already apply. How we get that balance right is one of the tests I will have to apply so there is not an accidental lack of clarity for doctors. We all know where we want to get to. We do not like the concept of the word "examined." Deputies O'Connell, Donnelly, Durkan and O'Reilly have all referred to the voice of the woman and I am fully in agreement with them in that regard. My officials and I think we can improve the wording.
I am catching up here.
Are we discussing amendments Nos. 42, 47, 49 to 60, inclusive, and 63 to 65, inclusive?
No, we are just discussing amendment No. 59, which is the first proposed amendment to section 11 regarding the risk to life or health in an emergency.
I am not seeking to speak on that.
I move amendment No. 63:
In page 9, line 35, to delete "of serious harm".
I move amendment No. 64:
In page 9, line 36, to delete “woman, and” and substitute the following:
(b) the foetus has not reached viability, and".
We do not have any professional draftsmen on our side so if our amendments need redrafting, I am happy to consider that. My understanding of the section might need some direction as well. During the referendum campaign, the Minister indicated that he would not allow a situation where there would be an abortion where an unborn child had reached viability. In this section, we are discussing the risk to life or health in an emergency. That is a very serious situation and nothing should be done in such situations to put the life of the mother in danger in any way. However, as we discussed yesterday, in many cases it is a tragic situation that arises and in most instances the mother would seek the survival of the child. The section states, "Notwithstanding the generality of section 10, or any determination made or pending pursuant to section 17 of an application under section 14(2), a termination of pregnancy may be carried out in accordance with this section by a medical practitioner ...". The definition of a termination of pregnancy is the ending of the life. My instinct is that it might be necessary to add that the child has not reached viability. What is the Minister's view?
As I said during the campaign - I will continue to say it because it is the truth - doctors in hospitals always endeavour to deliver babies where possible and they always endeavour to save both lives in doing so where that is possible. I do not believe any of us, regardless of our perspective on this, would know or be able to find an obstetrician working in our maternity services who would say he or she would do anything else. I appreciate that the Deputy has referred to the fact that women in these situations will rightly and understandably also wish to see their babies delivered. We have doctors who wish to save the life and women who wish to have their babies delivered, so the issue is how to deal with an absolute emergency. This is the emergency provision in the legislation in respect of circumstances where there is an immediate threat to the life or risk of serious harm to the health of the woman. If the procedure is not carried out straight away, the woman may die and, as the Deputy said, nobody wishes to see that happen. I am not being pejorative in that regard.
In these situations it would not be appropriate to stipulate that the procedure may not be carried out in cases where the foetus is viable. Doctors often have to make decisions in an instant in such situations. This is not a policy deviation. If we accepted this amendment, the emergency provisions would be more restrictive than those in the Protection of Life During Pregnancy Act. That Act does not include the viability test in the emergency provisions, and that law was drafted to comply with the eighth amendment to the Constitution. Now that the amendment has been repealed the idea that we would introduce legislation that would be more restrictive in its emergency provisions than the Protection of Life During Pregnancy Act would not make sense. I understand what the Deputy is trying to do, but I believe it happens in hospitals in any event. It is what doctors do and it is what women want. In an emergency situation such as this, however, doctors must be allowed to use their clinical judgment on how best to deal with the situation.
We oppose this amendment. It is not necessary. I do not believe it will deal with a real situation because I do not believe what it seeks to prevent is happening. We will oppose it if there is a vote. It would also be opposed by the majority of Members of the Dáil, but we will see what happens.
I will withdraw the amendment and see if a redrafting for Report Stage could facilitate the concerns of the committee.
Section 12 refers to conditions likely to lead to the death of a foetus.
I move amendment No. 67:
In page 10, line 10, to delete "having examined the pregnant woman" and substitute "following a medical consultation with the pregnant woman".
I will withdraw the amendment based on previous conversations.
I move amendment No. 69:
In page 10, line 10, after “woman” to insert “and ascertained her views”.
Deputy O'Reilly might wish to speak on the amendment but I am happy to withdraw it on the basis of the same principle we discussed previously, and which applies here, that the woman's voice must be front and centre and that she must express a wish, where applicable, for the termination to occur.
Being a woman, I will use my voice as well in the spirit of the amendment. We have had a lengthy discussion with the Minister. If there are any changes, he should refer back to us in time to allow us to table amendments. I am happy to withdraw the amendment.
Amendment No. 70 was discussed with amendment No. 36.
I move amendment No. 70:
In page 10, line 12, to delete "either before, or within 28 days of, birth".
This amendment was not formally grouped with the others, but we have had the conversation. Having reflected on the matter, I will await what the Minister will say. I still disagree with him on this and I believe he is wrong. The Minister thinks he is right and that is fine. We have had the discussion so we will not rehash matters. My position is that the Minister has got this one wrong, but let us see what we can come up with.
I move amendment No. 72:
In page 10, to delete lines 19 to 24.
In the interests of getting this done, I will withdrawn the amendment.
I move amendment No. 73:
In page 10, to delete lines 19 to 24 and substitute the following:
"(4) The obstetrician referred to in paragraph (a) of subsection (2) shall make such arrangements as he or she shall deem to be necessary for the carrying out as soon as may be of the termination of pregnancy to which the certification referred to in subsection (3) relates.".
This amendment is the same as that proposed in respect of section 10. It relates to the same point I made to the Minister yesterday and, on the basis of what he said then, I will withdraw it.
Amendment No. 74 was discussed with amendment No. 57.
I move amendment No. 74:
In page 10, to delete lines 19 to 24 and substitute the following:
"(4) The obstetrician referred to in subsection (2)(a), or the medical practitioner referred to in subsection (2)(b) shall make such arrangements as he or she shall deem to be necessary for the termination of pregnancy as certified in subsection (3).".
This amendment deals with the conditions likely to lead to the death of the foetus, an issue we discussed at length yesterday.
Amendment No. 75 was discussed with amendment No. 58.
I move amendment No. 75:
In page 10, lines 23 and 24, to delete "subsection (2)(a)." and substitute the following:
"subsection (2)(a), or
(c) by an appropriate medical practitioner, if the medical practitioners referred to in subsection (2) are not available.".
I argue that, in terms of a fatal foetal abnormality, it is probably even more important operationally that other doctors be available because obviously in an emergency one would not be dealing with the same doctor. It could easily be the same GP in early pregnancy, but in the case of a fatal foetal abnormality surgery could be scheduled. The idea that it would have to be the same surgeons certifying and carrying out the termination is inoperable.
The clinicians agree on that point too.
Section 13 deals with termination in early pregnancy. There are 22 amendments to the section, the first of which is amendment No. 76 in the names of Deputy Mick Wallace, Clare Daly, Joan Collins and Louise O'Reilly. Amendments Nos. 76 to 79, inclusive, and amendments Nos. 81 to 97, inclusive, are related. Amendments Nos. 77 to 79, inclusive, are physical alternatives to amendment No. 76. Amendment No. 78 is a physical alternative to amendment No. 77. Amendment No. 84 is consequential on amendment No. 81. Amendments Nos. 83 to 88, inclusive, are physical alternatives to amendment No. 82. Amendments Nos. 86 to 88, inclusive, are physical alternatives to amendment No. 85. Amendments Nos. 87 and 88 are physical alternatives to amendment No. 86. Amendment No. 88 is a physical alternative to amendment No. 87. Amendments Nos. 90 and 91 are physical alternatives to amendment No. 89. Amendment No. 91 is a physical alternative to amendment No. 90. Amendment No. 94 is a logical alternative to amendment No. 92. Amendments Nos. 96 and 97 are physical alternatives to amendment No. 95. Amendment No. 97 is a physical alternative to amendment No. 96. Therefore, amendments Nos. 76 to 79, inclusive, and 81 to 97, inclusive, will be discussed together, the reason being they all refer to section 13.
Before members move and speak to their amendments, I would like to point out that, from my reading of them, amendments Nos. 76 to 80, inclusive, reference the substitution of the word "examined" with "medical consultation" or "woman" with "pregnant woman", to which my response will be the same as in the substantive discussion we had yesterday.
They all refer to section 13(1).
I move amendment No. 76:
In page 10, line 27, to delete ", having examined the pregnant woman,".
On the basis of the Minister's remarks and in the interests of making progress, I am happy to withdraw the amendment, while reserving the right to resubmit it on Report Stage if the Minister does not propose an alternative wording.
We are dealing with early pregnancy and a woman's interaction with her GP. Am I correct in saying that yesterday the Minister said that, regardless of what new wording he proposed, there would still have to be a physical meeting? In other words, they would still have to meet face to face?
I move amendment No. 77:
In page 10, line 27, to delete "having examined the pregnant woman" and substitute "following a medical consultation with the pregnant woman".
At this stage there is broad agreement that "consult" would be the preferred term.
I move amendment No. 81:
In page 10, lines 28 and 29, to delete all words from and including “that” in line 28 down to and including line 29 and substitute the following:
(a) the pregnancy concerned has not exceeded 12 weeks of pregnancy, and
(b) a termination of the pregnancy concerned is not being sought because of the sex or race of the foetus concerned or because of any condition or disability affecting the foetus concerned.".
This amendment deals with a very contentious and difficult issue which featured in the debate during the referendum. It seeks to encode equality in the abortion legislation. The Minister and the Tánaiste and Minister for Foreign Affairs and Trade, Deputy Coveney, are on record many times as stating the legislation will not allow for abortion in the case of a disability. We note that where abortion is used in the case of a disability, it has a shocking effect. For example, in Britain 90% of babies diagnosed within the womb as having Down's syndrome are aborted. I do not think anybody wants to see that happen. Countries such as Norway which has a liberal abortion regime, as well as Denmark and Iceland are analysing what is happening among their populations on this issue. In Britain there is an organisation called Don't Screen Us Out which was set up by people with disabilities following their realisation that people with similar disabilities were not being born to the same extent as elsewhere. We know that where abortion is allowed up to 12 weeks, a person can have a non-invasive pregnancy test. In Ireland this can be achieved within three days. The test is 99.9% accurate in determining whether the unborn has a disability such as Down's syndrome. I understand this is leading to certain hospitals having high rates of abortion in cases of Down's syndrome. The purpose of the amendment is to provide that it would not be a legal ground on which to have an abortion and that, to use the words used by the Minister during the referendum, it would explicitly not be a condition within the regulation for an abortion.
The other aspect is gender selection. There are approximately 100 million women missing from the world owing to gender selection abortion, foeticide and infanticide because certain cultures do not value unborn baby girls to the same level as unborn baby boys. It is shocking to us in this part of the world to see that happen, but it is happening at a phenomenal rate. It is also distorting populations. We are fooling ourselves if we believe it does not happen in Ireland also. I have spoken to a woman who, as a result of pressure exerted by her family, had an abortion in Britain because her unborn baby was a female. In Britain the Labour Party is bringing about amendments to make gendercide illegal. In other words, they are to make it illegal for an unborn baby girl to be aborted because of her gender. In developing legislation we look at best practice internationally. Given that other countries that some people would consider progressive on these issues are rowing back from these two situations, logically, in our legislation we should seek to prevent those situations from occurring.
I thank the Chairman for allowing me the opportunity to speak. I wish to do so because, like many others in the room, during the years I have had the privilege of seeing many of my close friends having children with Down's syndrome. I have known these children since they were small babies and had the pleasure of being in their company on family occasions and at other times. Every time I meet them they bring such brightness and happiness to the occasion. That is why I wanted to ensure this amendment would be discussed by me and my colleagues in front of the Minister. It has been tabled with the very best of good intentions.
I have studied what has happened in places like England where it seems there seems are selective births. If a person knows there is trouble with a pregnancy and a child could have Down's syndrome, that child could be denied the right to life. I want to see the amendment discussed and voted on in order that we can protect such babies and give them the same right to be born as I or anybody else in this room has had. It is a serious and important matter. Every one of the people who have signed their names to the amendment has done so for nothing but the very best of genuine and heartfelt reasons. That is why I would like to hear what others have to say about it. I would certainly like to hear what the Minister has to say about it. I remind him that when the campaign was ongoing, he made absolutely clear statements indicating that such children would be protected as the referendum was not about being selective on grounds of gender and disability or abortions being allowed in such cases. I would never get up in the morning and set out to wrong anybody or put something in a person's mouth that he or she did not say. If I am wrong about what I believe he said during the campaign, he should, please, tell me and I will stand corrected. My understanding is that at the time the Minister gave very clear commitments which I appreciated during the debate, despite him being on one side and me being on the other. When he made that statement, I was very happy and thought it was great because at least if the process went ahead, this category of children would be protected. That is what I was sure of and understood. It is what I am now worried about, with my colleagues who have signed their names to the amendment.
As I do not want to take up any more time, I thank the Chairman for allowing me to speak.
I thank the Deputies who tabled the amendment and do not question their bona fides, although I fundamentally disagree with the need for the amendment. With everybody who campaigned for a "Yes" vote, I said during the referendum campaign - it is true - that in Ireland disability would not be a ground for termination. Many of the people in the room, including Deputy Mattie McGrath, sat on the all-party committee that had to make a decision on whether as a country we wanted to include disability as a ground for termination or whether we wanted to limit it to fatal foetal abnormalities. I read the report again yesterday and the committee's view was very clear that in this country fatal foetal abnormalities, not foetal abnormalities, would be grounds for termination. There are no grounds in the legislation related to disability.
As always, Deputy Michael Healy-Rae's contribution was courteous and respectful in tone; therefore, I do not mean the following in a provocative sense, but I was struck by the comments of Down Syndrome Ireland during the referendum campaign when its members asked us all not to politicise or weaponise their children in the debate. That is an important point. Women have children with disabilities for many reasons, not just because the eighth amendment stopped them from having a termination. It is a mindset around which I find really difficult to get my head. I do not intend to reopen the discussion which took place during the referendum campaign, as the amendment might do, that children with Down's syndrome had only been born in Ireland because of the eighth amendment. That is so disrespectful to the parents of those children who, as Deputy Michael Healy-Rae correctly said, have brought such joy, but there is the idea that those children, many of whom have grown into adults, could witness this debate and think the only reason they are alive is the eighth amendment. That is not true and it is not fair to the parents of children with disabilities.
I said the following so many times during the referendum campaign and may as well say it again. Comparing our law with the law in Britain is not fair game. I do not wish to criticise the law in Britain because for a very long time legislators in these Houses were happy enough for Irish women to be exported to Britain to use British law to access a termination during a crisis pregnancy. The law in Britain is very old and has a much broader range of terms and grounds. When we drafted our law and the committee was drafting its proposals, it was not the British system that we were trying to emulate. There are heads and grounds allowed in Britain that are not allowed and specifically banned in our legislation. It is proposed that in Ireland in early pregnancy a woman with her doctor can be trusted to make the decision on the continuation of her pregnancy. That was done because the members of the special committee had considered the matter at great length. If we had tried to be overly prescriptive, we would have got into all sorts of difficulty with respect to matters related to rape, sexual assault, etc. There is no specific indication in early pregnancy up to 12 weeks.
I should be clear that the Bill, as drafted, does not provide for termination of pregnancy to be carried out on the grounds of sex, race and disability. It provides for termination of pregnancy to be carried out in cases where there is a risk to life or of serious harm to the health of a pregnant women in an emergency. It provides for it where there is a condition present that is likely to lead to the death of the foetus and where the pregnancy has not exceeded 12 weeks. We had a discussion during the referendum campaign and will have it again today. Members will suggest this law is trying to do something it is not; not only is it not trying to do it, but it explicitly goes out of its way in listing grounds to ensure the reason in question will not be one of those grounds. It will not come as a surprise to Deputies to hear that I do not intend to deviate from what we told the public through the general scheme. Therefore, I do not intend to accept the amendment.
The members indicating are Deputies Mattie McGrath, O'Reilly, Durkan, Michael Collins, Tóibín, Murphy O'Mahony and O'Connell.
This is a straightforward amendment which intends to include anti-discrimination provisions in the legislation. During the referendum campaign the Minister made numerous commitments to the people that discrimination against people with disabilities would not be permitted in the legislation. During the course of the campaign numerous consultant obstetricians argued that so-called non-invasive pregnancy tests, NIPTs, consisting of blood tests in the ninth week of pregnancy, could be used to detect a baby's DNA and indicate the sex of the baby and whether he or she had a condition such as Down's syndrome. These tests are available in Ireland. When the Minister criticises us, he chooses to say we exported Irish women to England, but when we want to ensure a safe process and hold him to commitments he made during the campaign, he argues that we are bringing British law and that of other countries into the debate. Why would we not compare ourselves with other countries such as Finland, as the practice has indicated that in some countries Down's syndrome will be eradicated? These countries boast that they will be 100% free of Down's syndrome by 2020. It is very important that we hold the Minister to his comments. Can he be held to anything he said? He made those statements clearly on numerous occasions, but he is now seeking to wriggle out of them when dealing with the Bill. He is demonising us for tabling the amendments, but we are trying to hold him to something to which he committed. That is despite him changing his attitude throughout his career. I have letters on my phone that prove it.
Having listened to clinicians, I am proud that I changed my view.
The Minister cannot change it every day, depending on the weather and whatever else. Surely he has some standing somewhere. This is a red-line matter for us.
I listened to the evidence-----
I did not interrupt the Minister.
I am sorry, but the Deputy cast a slur on me.
As I did not interrupt the Minister, perhaps I might be allowed to finish.
I have one quote here. The Minister for Health, Deputy Harris, was quoted in The Irish independent on 14 May 2018 as saying that the Government "specifically excluded disability for grounds for abortion in the legislation”. He stated that disability, including Down's syndrome, would be excluded as a ground for abortion in any legislation. That was just a couple of months ago, but there is absolutely nothing in the Government's Bill ruling out abortion on these grounds. I rest my case. We all know what is going on here. We cannot believe anything that comes out of this Minister's mouth.
Deputy Mattie McGrath cannot say that.
That is my belief.
The Deputy cannot say that.
I have just said it. That is the fact.
The Deputy should not say it.
I have said it. I know it from experience. We know it from his record. I have no intention of withdrawing it. Is the Chairman chairing the meeting, or are the cheerleaders on the other side telling him what to do?
Excuse me, Deputy McGrath. I am chairing the meeting.
The Deputy's comments were out of order, and I am entitled to believe that.
I do not think they were, because it is fact.
We are going to move on to the next speaker.
I suspect the purpose of this session is not to do any great service to persons with disabilities but rather to get a couple of people onto the news. This issue was discussed at length-----
I am not going to take that.
If I could continue without interruption that would be great.
That is very unfair.
I ask Deputy Michael Healy-Rae for order.
I am sorry. I apologise.
That is very unfair. We came in here to make a contribution.
I ask Deputy O'Reilly not to provoke other members.
That is not fair. Deputy O'Reilly can laugh all she likes, but that is not a nice thing to say. People come in here wanting to make a contribution.
In the spirit of the debate I was expressing a very heartfelt opinion.
That is a slur. That is not fair.
Please allow Deputy O'Reilly to speak.
I have my manners, but I would not laugh at somebody else. I would not come here and cast a slur on anyone. I would not do that.
If Deputy Healy-Rae has a problem with a member he can sort it out outside this chamber.
That is not a nice thing to say.
He may not sort it out in here.
I am sorry, Chair, but that is not a nice thing to say.
As I have said, this amendment is wholly unnecessary. We had huge discussions at the Joint Committee on the Eighth Amendment of the Constitution. We came to a conclusion and we had a vote. There is absolutely no suggestion that the scenario the Deputies are seeking to prevent will actually happen. I personally find it objectionable that the men here seem to think that the women of Ireland would only progress with a pregnancy where a child had a disability because of the eighth amendment. That is a disgusting attitude to women, but it is what it is. This is unnecessary. The Chair used the word "provoke". This amendment is designed to restart a debate. For the avoidance of doubt, more than 58% of people in Kerry voted "Yes", as did 69% of people in Meath. The result was two to one in Cork and the "Yes" vote was more than 59% in Tipperary. I do not necessarily agree with every line in the Bill, but the people gave us their answer. They want us to get on with the job. They do not want-----
Then why should we have any amendments at all?
-----us to be distracted. They want to ensure that the services are safe and available for women, and that they are available as soon as possible. That is what people voted for and that is certainly what I am here to do. I do not believe this amendment is in any way constructive. It is an issue that was dealt with at length by the aforementioned committee and considered by the Citizens' Assembly.
We are discussing an issue that we dealt with last year in the special committee. In fact, the committee specifically excluded Down's syndrome. We have qualified that on the basis that everybody knew people with Down's syndrome and that they were not a burden on society. As they were everybody's friends, there was no reason to introduce any particular threat to them.
This is a serious issue. Insofar as is possible, we need to avoid making suggestions that are not accurate, because they scare people. They will scare pregnant women who may be facing a crisis pregnancy. We should avoid that, particularly when those circumstances do not exist. The suggestion that an unborn child might be discriminated against on the basis of sex or colour is outrageous. It is totally and grossly unfair to women, to the medical profession and to everything we have spoken about in the last year. We need to dwell on that for a moment. To make that suggestion is to suggest that women treat this in a frivolous fashion, that it is a sort of social add-on.
The committee also excluded socio-economic circumstances as a ground for abortion, termination of pregnancy or whatever we want to call it. We need to have some consideration for the circumstances that prevail where women seek a termination of a pregnancy. We have talked about the health issues, the threat to health, life and their mental and physical condition. Those are serious issues that can have very serious consequences for everybody involved and for their families. To suggest that we did not have that debate last year and to avoid altogether the discussions we had is unfair. It is unfair to the committee that sat for a very long period last year, it is unfair to the discussions in the Citizens' Assembly which devoted a considerable amount of time to the subject, and to all who were involved in those discussions.
What most impressed me during the hearings was that women clearly did not wish to seek a termination of pregnancy as some kind of social add-on. That was not their consideration. Their considerations were much deeper than that. They felt genuine worry and fear for their situation and their health. It was to address those issues that the committee spent so much time talking over the possibilities, what might happen and what has happened in the past.
The last point I want to make is simply this. That was all done against the backdrop of some tragic situations that have developed over the years, of which we are well aware and have read about and discussed at length. In those circumstances, certain suggestions are unfair to women who might seek a termination of pregnancy in the future, to the medical profession whose responsibility it is to assist in those situations, to Members of this House and to the very large body of people who discussed the issue both inside and outside of this House. We need to treat those women with a great deal of seriousness and acknowledge that they have responsibilities they know about and want to exercise. They only approach this kind of situation when they have genuine concerns.
In order of indication I will call on Deputies Michael Collins, Tóibín, Murphy O'Mahony, O'Connell and Donnelly.
This amendment is very simple. We are protecting children with disabilities as was promised by the Minister and others during the campaign. It looks as if others here can move dozens of amendments to this Bill, but when we move a few that we feel could lead to the protection of a child with disabilities we are talked down to. I would like to ask the Minister where in the Bill children with disabilities are specifically mentioned. That is a very important aspect of this. The feedback I get indicates that this protection is not in the Bill. There are a lot of words, but specifically mentioning children with disabilities is hugely important for a lot of people. Down Syndrome Ireland may have spoken, but I have spoken to dozens, maybe hundreds of parents of children with Down's syndrome who have had major concerns since the referendum and before it. Down Syndrome Ireland certainly was not speaking on behalf of all those people, and if it was, it certainly did not speak to them before making its statements.
I will obviously be supporting this amendment, simply because I do not see mention of children with disabilities and their protection anywhere in the Bill. To satisfy me, we must add that wording to the Bill.
Many people on various sides of the issue will find many aspects of the Bill objectionable. We should do our damnedest not to close down debate but, rather, to facilitate it even if we find it very difficult to accept the views of others on this issue. Minorities have the right to have a voice in this forum. An exit poll conducted by RTÉ on the day of the referendum indicated that a majority of voters, even those who voted "Yes", did not agree with abortion on the grounds of disability. It is patronising to say that people with a disability have a uniform view on this issue and that one organisation can speak on all their behalf. People with a disability, like any other people, hold a diversity of views. Similar to Deputy Michael Collins, many disabled people have told me that they want abortion on the basis of disability explicitly precluded in the Bill. On 14 May 2018, the Minister stated that disability had specifically been excluded as a ground for abortion in the legislation. There is no specific mention of the preclusion of disability as a ground for abortion in the Bill.
Thankfully, there is a great culture in this country and parents love their children and want to see them survive and thrive. We know legislation is a significant element of social norms. When legislation changes, so do social norms. We are not making up these statistics. They are flashing warning signs from all over Europe. Such countries are beginning to row back on the idea that disability should be a ground for abortion. The Minister stated that it is not included in the Bill. However, the Bill allows for it and that is the key element. Abortion on the ground of disability is facilitated by the availability of abortion up to 12 weeks for no indication. If one allows abortion on request up to 12 weeks, one facilitates abortion on the basis of disability. We are suggesting an amendment to specifically preclude that. The amendment would be very difficult to implement, but it would send a wonderful message to people with disabilities that we, as a State, want to ensure in the best way we can that we will not allow for abortion on the basis of disability.
On gender selection, which is discounted by some but is happening all over the world, the British Labour Party stated that non-invasive pregnancy tests should not be allowed to check for gender because it is morally wrong for abortions to be carried out on the basis of gender. If the Government wanted to address this issue, it would take a practical step to prevent it, rather than stating that it is not providing for such grounds for abortions even though they will be possible under the Bill.
I thank Deputy Tóibín. Does the section of the amendment referring to "any condition or disability affecting the foetus" conflict with the previous section, which provides for terminations in cases of fatal foetal abnormality?
The amendment provides that "a termination of the pregnancy concerned is not being sought because of the sex or race of the foetus concerned or because of any condition or disability affecting the foetus concerned". If the committee sought to exclude life-limiting conditions or fatal foetal abnormalities from the amendment, I would be open to that. The amendment simply seeks to encode equality in the legislation and to give effect to the explicit commitments made by the Tánaiste, Deputy Coveney, and the Minister, Deputy Harris, during the referendum campaign.
The explicit commitments given by me, the Government, and all Members of the Oireachtas and those in civil society who were campaigning for a "Yes" vote were to provide for the regulation of termination of pregnancy on the grounds as set out in the general scheme, which were the same fundamental grounds set out by the Oireachtas committee. I take the point made by Deputy O'Reilly in that regard, although she might not agree that every word or line was transposed. This is an attempt to have a "gotcha" moment. Everything in the Bill is lawful. Everything not allowed for in the Bill is unlawful. One does not list in the Bill everything which it does not permit. One lists in the legislation those measures which are lawful. We had a very robust debate yesterday about offences and so on and what is not lawful. We do not want to list everything that is not lawful. The Bill states what is lawful and everything else is unlawful. Following extensive debate and consultation with the people of Ireland, the Oireachtas decided that abortion would be available without specific indication in early pregnancy up to 12 weeks. That was the decision we made.
Would it be possible to have an abortion on the basis of disability under the Bill?
No. The ground is no specific indication. The Deputy gave a little hint of from where this amendment is coming. It aims to make a section of the Bill inoperable. The Deputy acknowledged that the amendment could not be enforced. It would force doctors to second guess women. I refer to its phraseology, such as "sought because of". I disagree with the way in which the Deputy is approaching the decision-making process which women go through with their doctors. Leaving aside the fact that the amendment is unnecessary, how would it be operable? I believe it is a subtle attempt to render the key "no specific indication" provision inoperable.
Disability is not a ground in the legislation. The committee on the eighth amendment had the opportunity to specifically include disability as a ground for abortion. It rightly decided not to do so, which means that the situation here in that regard will be very different to that in the United Kingdom. Deputy Tóibín and I will not agree on this and we are, to some extent, reopening the debate of the referendum. On several occasions, he referred to the commitments I made to the Irish people. I committed to introduce a law along the lines of the general scheme published in March. The Bill does not deviate from the grounds of that scheme.
I will ask one more supplementary question and go no further because I am unsure that we will make any progress on the amendment. The Minister stated on Thursday, 1 February, that abortion on the grounds of disability would be confined to cases of fatal foetal abnormality. I asked the Minister would it be possible and he stated that it would not. The Minister's view in that regard contradicts all of the scientific evidence that has been put forward.
Members have tabled amendments left, right and centre. I have approached this process with the view that they did so for their stated reasons. The amendment seeks to codify the Minister's commitments and ensure equality within the Bill. It would be a shocking message for the country if we were unwilling to put that into legislation.
That is not the message the Deputy is trying to send. I fully respect his point on minority views and his right to bring forward amendments is beyond reproach. However, the Deputy stated that he did not believe the amendment would be operable.
Yesterday, the committee discussed the transgender community and the importance of words. The Minister stated that he would meet representatives of the transgender community to seek their input on the wording of the Bill because words are important. The same level of importance is not being given to these words which would allow for the preclusion of abortion on the grounds of disability.
I cannot allow that to stand. It is an unfair portrayal of my position. Of course, words matter. Yesterday, I outlined the difficulty that the wording of the Bill could cause for the transgender community. I will meet representatives of that community to discuss the Bill and explain the wording to them. The Deputy's amendment is unnecessary. However, in terms of impact it is an attempt to make the legislation inoperable. There is no intention to allow or any ground for allowing termination on the basis of disability in the Bill. No matter how many times the Deputy says that it will be possible, I will continue to restate that point. We made a conscious decision to exclude disability as a ground for termination.
The next speakers are Deputies Murphy O'Mahony, O'Connell and Donnelly.
The Minister must admit that during the campaign he stated that disability would not be a ground for abortion, but that has not been explicitly dealt with in the Bill.
I ask the Minister to say again, categorically, that the intention is that disability will not be grounds for abortion. The Bill states, "where abortion will be allowed", but because disability is not mentioned, it means that disability is not grounds for abortion. I ask the Minister to say directly to me that this is his intention.
If disability is brought in, it would weaken the legislation. Who defines "disability"? Some parents might not be able to cope while others will. There are different levels of disability. In that context, it would be better to leave it out because its inclusion would weaken the Bill. That said, I want the Minister to look me in the eye and say that the intention is that disability is not a grounds for abortion.
I can say that because it is the truth. It is not that I need to admit anything. Deputies Donnelly and Kelly, who are sitting on either side of Deputy Murphy O'Mahony and I, as well as everyone else on this side said the same during the referendum campaign because it is the truth. In the general scheme that we published, based on the Oireachtas committee's report, we specifically took a conscious decision to exclude disability, unlike the British law which uses language that most people in this room and in society at large would find offensive, in terms of how it describes people with disabilities. We took that decision to exclude it.
The Bill lists what is allowed and by virtue of disabilities not being on that list, it is not allowed.
Correct. There are lots of things that are not in the Bill. The only things in the Bill are the things that are lawful and allowed and-----
Everything else is unlawful.
Yes, everything else is unlawful.
I thank the Minister for his clarity.
I will not support the amendment. The Minister has just outlined the position clearly. It is disrespectful to suggest to those who have family members with Down's syndrome that such members are only here because the eighth amendment protected them. It is not the preserve of those on the opposite side to appreciate the joy that somebody with a profound disability can bring to a family. I would not like the impression to be given that it is only one side at this committee that is standing up for people with Down's syndrome. There are many people who voted "Yes" in the referendum and who campaigned for a "Yes" vote who have family members with Down's syndrome.
The UNCRPD states that the right approach is not to have a disability group in the legislation as it is stigmatising to that group. It also holds that the law should not specifically preclude a group because it would grossly interfere with access to abortion. Under the 12-week provision, the pregnant woman would have to be interviewed, tested and examined, with the foetal DNA present in maternal blood after nine weeks being tested and re-tested. An ultrasound would have to be conducted to confirm a disability, whether physical, genetic or otherwise. This amendment undermines the "without indication" aspect of the under 12-week provision. It is deliberately designed to inflame the situation and to re-run the referendum in this committee. I find it quite difficult to listen to some of the commentary this morning. While I understand that minorities need to be represented, I would like to remind all present that the women of Ireland are a majority, not that one would know it sometimes. It is about time that the 52% of us stand up and not take the sort of rhetoric and language that is being used with regard to this issue this morning.
I will also oppose the amendment. As has been laid out, it would make the section inoperable. It would make early term terminations impossible. Including a list of prohibitions, be they intellectual disabilities, physical disabilities, Down's syndrome or whatever, would weaken the protections. Such a list is essentially a hierarchy of reasons and conditions, which would cause confusion. The legislation is black and white. It is an offence to be involved in a termination, except on specific grounds and those grounds do not include disability of any type.
There is communication work to be done and this conversation is part of that work. People have contacted me, including legislators, who have said that they were told that disability would not be a ground for abortion but that when they read through the legislation, they could find no reference to it anywhere. In that context, they are asking what is going on. I have explained that disability is not referenced in the Bill because everything is prohibited, except for the exceptions laid out in sections 10 to 13, inclusive. People have to understand the legislation to understand that point.
I accept Deputy Durkan's point that for members of the Oireachtas Joint Committee on the Eighth Amendment of the Constitution and of this committee, it is frustrating to keep hearing this but in reality, the public were not on those committees, were not in attendance at the Citizen's Assembly and are not as familiar with the legislation as we are because they have lives and other things to do. It is our job to understand the legislation. It is not crystal clear to the casual observer, for whom disability not being a ground for abortion is important. If such an observer does a keyword search for "disability" in the Bill, he or she will not find it and will worry. Many people have genuine concerns but those concerns are met through the legislation by following a logic that holds that everything is exempt, including disability, except what is on the list. It is worth our while, as legislators, to reflect on that. The protections are rock solid. However, one has to understand how the legislation works to see that. There is a job to be done with regard to communication in order that the casual observer who has better things to be doing than poring over detailed sections of a Bill understands what is being done here.
Does the Minister wish to respond?
No, I have said all that I need to say on this.
- Donnelly, Stephen S.
- Durkan, Bernard J.
- Harris, Simon.
- Harty, Michael.
- Kelly, Alan.
- Murphy O'Mahony, Margaret.
- O'Connell, Kate.
I move amendment No. 82:
In page 10, to delete lines 30 to 34.
Can I make a suggestion? It is connected with what has happened on the other three days here. They are all part of the same thing. I wish to speak to amendment No. 89 as well. The amendment is tabled on its own but they are linked. It is a question of either-or with our amendments. They all relate to the mandatory waiting period. Perhaps we can discuss it with the later grouping.
Our amendments are a question of either-or. Amendment No. 82 deletes the mandatory waiting period in its entirety. The reason is that it was a feature of the deliberations of the Joint Committee on the Eighth Amendment of the Constitution that timely access to abortion is key. We want to avoid any scenario where a waiting period might be used as a barrier. All the evidence provided by all the organisations supports this approach. I was particularly struck by the observations of the Guttmacher Institute and the evidence-based research behind the associated deliberations. They showed that the costs go higher the longer a woman waits. The number of available option providers tends to decrease as the pregnancy progresses. Delay in any sense is not good.
All the evidence shows that women spend a good deal of time on this and make the decision carefully. It is a little patronising to assume that they need additional mandatory time to be sure to be sure. Anyone who makes the decision has thought about it. In many instances, women have made up their minds when they consult their medical practitioners. In other instances, they consult them as a sounding board because they may want extra time, but they will make that decision for themselves and we do not need to force them to do that in legislation.
Providing for a mandatory waiting period was not something that came out strongly in the committee hearings. It is in place in other jurisdictions. I have been struck by countries like Netherlands, which people may have been a little surprised about. We should note that the Netherlands waiting period is provided for in the context of open accessible abortion provision. It is different because we are coming from a different stance.
Our preferred option is to remove the three-day period altogether. Our second option is amendment No. 89, which is also in this grouping.
Which amendment is it?
Sorry, it is amendment No. 88, which is in this grouping as well. That would delete the date of certification as the starting point of the three days and substitute it with the date upon which an appointment with the medical practitioner referred to in section 13(1) is requested. This is an absolute minimum. We would prefer its removal entirely, but if the Government is hell-bent on having a waiting period, then it should be constructed from the date the person makes the appointment rather than the date of certification. This is in the context of ensuring that there is no possibility that the waiting period could act as some sort of arbitrary barrier to care. The WHO has stated that mandatory waiting periods are a barrier. We should be careful about putting one in. We need to ensure the period will not be used as a barrier. That is a key point. The best way to ensure that such a period is not a barrier is that it forms part of the protocols and guidance developed by professional bodies rather than be provided for in legislation. Such guidelines represent a better way of dealing with a waiting period. It could be dealt with as part of the care pathway and so on. Again, if the Government is saying that three days is the absolute minimum, then it must begin from the date of the woman's request for an appointment with a medical practitioner if it is to be workable at all. We do not want someone who is at nine or ten weeks being dragged into a scenario where she is suddenly over the 12-week period and out of it. We think it is very important.
I wish to clarify something that arose before Deputy Daly arrived. Amendments Nos. 83 to 88, inclusive, are related and are physical alternatives to amendment No. 82. Amendments Nos. 86 to 88, inclusive, are physical alternatives to amendment No. 85. Amendments Nos. 87 and 88 are physical alternatives to amendment No. 86. Amendment No. 88 is a physical alternative to amendment No. 87, which is what she has said more or less.
I share the concerns expressed by Deputy Daly. The rationale behind amendment No. 88 is based on the fact that we have been told repeatedly that the three days has to be provided for. It bears repeating that three days was not recommended by the Joint Committee on the Eighth Amendment of the Constitution. We did not view it as necessary. It was a political construct and was not looked for by doctors. It was not looked for by that committee but it made its way into the public arena. On that basis, we chose to concentrate on how, in the context of the three days being a matter of public discourse, we could ensure access. For example, let us consider the position of a young woman in direct provision. She may not be capable of visiting a doctor twice. It is a barrier. The more barriers we put in place, the more likely we are to not do what we have set out to do, which is to ensure that women can be cared for at home. In fact, the more barriers we put in place, the more attractive we make it for women to self-medicate.
We have all agreed that while abortion tablets are safe, it is not ideal that they would be taken without medical supervision. Equally, I refer to access for women living in the North. The Minister has given a commitment that the North will be next, which is fine. It is a great phrase; one can put it on a piece of cardboard and hold it up. However, it has to have some meaning. We cannot keep saying "The North is next" or "There has to be access for women living in the North." The requirement to visit a doctor twice will serve as an unnecessary barrier. I am not suggesting the Minister put the phrase on a piece of cardboard, but it was put on one. That is what I am saying. The idea of a requirement to make two visits to a doctor where one lives in rural Ireland or is in a situation of domestic violence is one we considered at the committee where we took the view that access was paramount. Ultimately, the test of this legislation will be whether we reduce the numbers of women accessing terminations via tele-medicine and who are forced to travel. If we put unnecessary barriers in place, we will fail that test.
I accept that the three-day period formed part of the public discourse in the run-up to the referendum campaign, albeit I would like to see it removed. In that scenario we need to consider how best we can maximise access for those who need it. The only way to do so is to minimise the requirement to physically attend a doctor. By the time a woman comes to see the doctor, she has made the decision. She has deliberated. The idea of a cooling off period is associated with insurance, which is not right. It has been referred to, not by me but by others as a cooling off period and I do not think that is right. However, making two visits to a doctor, even where they do not have to be paid for, is still a requirement to obtain an appointment and attend physically. The clock should start ticking from the moment the appointment is made. Where a woman has had the opportunity to deliberate and talk to her partner or friends and come to the decision on her own, like a grown-up, making two visits is unnecessary.
Does the Minister wish to respond or is he happy to hear other comments?
I am happy to hear comments.
I hold a different view as expressed at the committee hearings. I am not at all convinced that the three-day waiting period is an obstacle to a woman receiving the necessary service at the time she wants it. My grounds for so saying formed the basis on which I campaigned during the referendum. I spoke on the same basis at the committee hearings where it was generally accepted. I cited Germany and the Netherlands as two countries which had waiting periods which were a little longer. That waiting period was included for a purpose. The medical practitioners from the Netherlands who appeared before the committee pointed this out. That is where consultation comes in and it is very important. As this is a serious matter, consultation is required. The woman is entitled to receive the best possible advice which is non-directive to meet her particular circumstances. The practitioners from the Netherlands said that in some cases the woman changed her mind and sometimes did so more than once, as she is entitled to do and may be prone to so doing in the circumstances, depending on her situation.
We also found in the course of the hearings that women did not go out to seek an abortion just for the fun of it. In fact, they treated the issue very seriously, even and particularly where there was a disability. I forgot to mention this earlier. They went out of their way to be conscious of the need to care for, nurture and do everything possible to bring the child to a natural birth.
We spent a lot of time at the committee discussing the issue of counselling. After the referendum somebody mentioned that counselling was not part of what was being provided, but it needs to be. That is a fact which was illustrated clearly during the course of the hearings. There is a lack of adequate counselling and education, including sex education in schools and elsewhere. There were some very interesting issues brought to our attention where people found themselves alone without advice and left to fend for themselves. To whom does a woman turn who finds herself fending for herself alone? She needs to talk to someone who will give her non-directive advice. That is the least we should expect and something we need to do. One of the practitioners who appeared before the committee said the first decision was not always the one with which the woman proceeded. We also need to keep that in mind. It may well be that she simply wants to seek and access advice. The three-day waiting period is necessary to allow that to happen. It is in place in other countries for a reason. It does not prevent access to the service the woman ultimately seeks. It does not prevent access to it in the Netherlands, Germany or other European countries. Some Irish women travel to the Netherlands and Germany for a termination and are confined to the same procedures, including the three-day waiting period. As such, the three-day waiting period or a derivative thereof must be retained in such a way as to show the people that what we felt we were doing at the committee has substance and that we stand over it.
In order, the following Deputies have indicated, namely, Deputies Kelly, Coppinger, Danny Healy-Rae, Fitzpatrick and Bríd Smith.
Amendment No. 86 in my name is similar to amendment No. 83 proposed by Deputy Donnelly and amendment No. 88 proposed by Deputy Clare Daly and others. It is about the time at which the clock starts to tick regarding the three-day waiting period. My party firmly believes the construct of the three-day waiting period and the proposal for its inclusion happened after the debate. However, it is included in the discourse and we must, therefore, look reluctantly at leaving it there, given that the people voted in a certain way. That is obvious. The rigidity of the construction of the three-day waiting period in the legislation is, however, something at which, at a minimum, we need to take a look. My amendment proposes the following wording:
a period of not less than 3 days has elapsed from the date on which the pregnant woman made arrangements to attend the medical practitioner for the purpose of the examination referred to in subsection (1).
It refers to contacting the medical professional to make arrangements for this pathway. In that regard, we must, at a minimum, come up with a wording. I am not necessarily locked into my version of the amendment over the wording proposed by one of my colleagues. It is whichever one works best for the Minister or a variant of all of them. At a minimum, however, the Minister will have to do something. This is an issue that will be voted on if there is not some format by which the Minister can propose to deal with this issue. It is something about which a lot of people feel strongly for the right reasons. I hope the Minister will be able to come back to us on it. If not, we will be voting on the issue today and, possibly, on Report Stage also.
We have established in previous discussions that this was not sought by the committee on the eighth amendment and that it is not supported by doctors in Ireland. Doctors have come before the health committee and said it is unworkable and will create problems. It is not necessary because it is patronising, patriarchal and involves the idea that women need a second visit. It is what used to be called a "cooling-off period".
People are not using that terminology but that is essentially what they are saying, namely, that women need a chance to change their minds. The problem with it is that vulnerable women and young girls, whether in direct provision or otherwise, as well as women who are victims of violence, be it physical or psychological, find it difficult to get out to a doctor's surgery twice. This is also the case for ordinary working women. Let us look at the practicalities. They would need half a day or a day off work for a visit to a GP because they could be sitting in the surgery for two to three hours, certainly in an urban area, although I cannot speak for other areas. They have to organise childcare for that if they have children, which the majority who have abortions do. They then have to organise the same thing again, which means another day off work. If the woman is a nurse or a teacher, that will be extremely difficult, so there is a practical problem.
The other practical problem is that this will add unnecessary expense to the health service. Some of those who spoke yesterday were concerned about taxpayers having to pay, yet they are also extremely concerned to build in all of these extra things.
Obviously, people can change their minds but they can do that without having a three-day waiting period. If a woman goes for a consultation with her GP, she then has a chance to go home. She is may be given a prescription, for example, for the medical abortion pill, and she has a chance to change her mind before she takes that. If it is a referral for a surgical abortion, she will also have time to change her mind. We do not need to build in a second visit. This is a problem because it has been found by studies internationally that where these have been imposed, they actually lead to delays of more than three days. If the woman's appointment with a GP is on a Wednesday and she is told to come back after three days, how will that work? The surgery is closed on Saturday and Sunday, so, presumably, she comes back on the Monday, which is a five-day delay. These are serious issues. People think this does not matter but it will cause a lot of practical problems.
Although some people get all hazy when we talk about these issues, the way the pregnancy is calculated is not from conception; it is actually from one's last menstrual period. Therefore, the woman will be under even more pressure to fit into the 12 weeks.
The other problem in busy cities, urban areas and towns is that people can wait up to a week to see a doctor, certainly to see their own doctor. They should be able to see their own doctor to discuss something like this. The way it works in the surgery near me is that there are seven or eight doctors and it is rare for anyone to see the same doctor twice. If a person wants to see her own doctor, she will have to wait perhaps two weeks. That is the reality. To discuss something as important as this, there will be a time delay in any case. It is very important that people do not think this does not matter because it will inflict unnecessary delays on people.
We have to give women credit that they will have thought about this before they pick up the phone. Most people usually find out they are pregnant through a pregnancy test that they buy and they do not need to go to the doctor for that. They have time to think and they think about nothing else. We have to take people's word that they are able to make up their own mind before they ring.
I support both amendments. I support the deletion and I also support it being applied in a way that does not create these problems. However, the way the legislation has been phrased is not that when the person rings, the clock ticks. It has been phrased in a way that is really strict, and people are very surprised by that.
On the idea that this formed a major part of the debate on repeal, I challenge that view. While some may say this is the big thing they used on the doorsteps, it certainly was not for me or for many other people and groups I was canvassing with. We talked about the issue and why the change was necessary. I do not think the three-day waiting period was foremost in the minds of voters when they went to the polls. Some may have relied on something like that but it certainly was not a big thing. I agree it does not need to be in the legislation. This is being nailed into law and it will make matters extremely difficult. The Minister could have put into the medical guidelines that doctors would be asked to try to have a three-day delay during which people could consider their options.
It was one of the parts of the "Yes" campaign that there would be a three-day waiting period where the woman would go to the doctor and get professional advice in regard to her pregnancy. This was part of what the people of Ireland understood they voted for. It was in the legislation proposed by the Minister and the Government. To take this out now, or to reduce or minimise it, would be seen as disingenuous by the people who voted. I do not think three days is that much to wait to get professional advice. It is reasonable to let it stay in the Bill as I feel it is what the people voted for.
A three-day cooling-off period is very important. Am I right in saying Deputy Coppinger said yesterday that 92% of abortions are within the 12-week period?
That is 92% of people who have already made the decision. It was said that we cannot put pressure on women. Ending the life of a human being is a very important thing and is something the woman will have to live with for the rest of her life. I have met women in my constituency who had an abortion and regretted the decision. I have also met women who had an abortion and were happy with the decision. I am pro-life so I presume that is why people speak to me of their regret, and I see a lot of regret. The biggest regret they have is that they did not talk to someone beforehand. If they feel that all they have is 12 weeks to make up their minds, we have to consider the amount of pressure that puts on them. I am not a woman and I am not going to pretend I know how a woman feels, but I have made a lot of pressured decisions in my life and I sometimes regret those decisions. The biggest regret I have in my life was not talking to someone about the decisions I made.
The Minister will play a very important role in this regard. I sat through the whole of the eighth amendment committee hearings and the thing I got out of it is that there is not enough help out there for people in making decisions, before and afterwards. I plead with the Minister in this regard. I was told at the committee hearings that this would be dealt with by the HSE and so on, but there is no one out there to help. It is a massive decision for someone to end the life of an unborn child and no one is going to make it lightly. Can the Minister please put something in place for those who want to keep the child and do not know what options are out there, as well as for those who want to get rid of the child? It is important both ways. That decision cannot be reversed. If a person has an abortion, that person cannot turn around and change their mind. At least when the person has the baby, there are options.
There is no way I am going to be the judge and jury of any woman. I will respect any woman who makes a decision as it is a very hard decision. However, as a Government, and with the Minister as head of the health system, it is important that provision is made to have consultants or agencies available. We are talking about investing €50 million for abortion. How much will go towards helping people to make the decision and to make the right decision?
I accept the bona fides of the men in the room who are pro-life and who speak of a three-day cooling off period. I resent the term "cooling-off" because it suggests that a woman facing a crisis pregnancy is somehow hot under the collar and needs to calm down, and that there is some kind of overheating going on in her head, body, decision-making or life. This is not the case. A woman who faces a crisis pregnancy faces the decision that she is about to make or has made every day. It is something with which she wakes up, goes through the day and goes to bed. Once the decision is made, it is of utmost importance not just for the woman but also in terms of the procedure, that the procedure takes place as early as possible. With all due respect for those who are pro-life, I do not understand why they want to elongate that period because their ethos and beliefs are that the foetus is a baby. If it is nine weeks old, it will be possibly ten or even 11 weeks old if we allow this mechanism to stay in the legislation.
As I stated yesterday, we have a crisis in general practice care because there is a shortage of general practitioners. The Minister knows that because he has spoken about his efforts to hold on to GPs and recruit new ones. There is always a queue to see doctors and women will be left waiting in any event. If a woman has to wait for three days after seeing her doctor before seeing her doctor again, the wait will be longer again. It will not be for three days because the period will be dragged out.
A point was made to me on the date of certification. This could require a scan, depending on the circumstances and the woman's knowledge of her body, for instance, the date of her most recent period and so on. If she has to wait for a scan, it will cause another delay of one week or possibly two weeks. The procedures that members are arguing should be included in the legislation will delay the time by which a woman can have an abortion. The logic of this is that the termination will take place later than is necessary. This will cause great distress to the woman and flies in the face of medical science indicating that abortions should take place as early as possible.
We should drop the idea that a cooling off period is needed and the view that women are not individuals with an intellect who can engage in a decision-making process or are somehow so distressed that they need to be talked to or given loads of information. Where a woman needs information, it should be available. The 24-7 helpline is a brilliant idea which I fully support, but the proposal to have a woman wait for three days after seeing her doctor will not help matters. On the contrary, it will hinder the whole purpose of the legislation and of repealing the eighth amendment.
If we cannot remove this proposal from the legislation because it was in the heads of the Bill, we should apply the model used in the Netherlands under which the clock starts ticking - I prefer the use of the term ticking clock to a cooling-off period - when the woman lifts the phone and makes an appointment with her doctor to request a termination. That is when the ticking clock should start. The amendments are very important because they provide for a crucial and fundamental part of delivering proper services for women's health in the case of terminations of pregnancy. I repeat that if a woman has to wait for a scan or to see her GP a second time, the waiting times will be incredibly destructive and difficult for both the woman and the outcome, which is to have a termination. I plead with members to think about that carefully and drop the idea that women need to cool off. They should consider the objective conditions in this country with our shortage of GPs and the problem we have with delivering health services. This could create a bigger burden than may appear on paper.
I will also speak to this group of amendments. The reality is, as Deputies Smith and Coppinger have said, that it can take a period of time to get an appointment to see a general practitioner. It is very important that a discussion in respect of a termination of pregnancy should be a face-to-face consultation with a GP or medical practitioner as defined in the Bill. That is when the clock should start. I do not agree with the three-day rule but I agree that a woman must and should have a face-to-face consultation with a medical practitioner, preferably her GP.
We are not arguing the opposite of that.
In that consultation, there will be an in-depth discussion and exploration of the reasons a termination is needed or not.
A woman might change her mind in the process.
Of course, and there may also in that consultation be a confirmation of the gestational period. If a doctor is to prescribe medication, the dosage of medication will change after nine weeks. There needs to be an in-depth consultation with a medical practitioner to decide on the next step. The three-day rule is unnecessary but there may be a period of time between the initial consultation with the medical professional and when the woman starts the process of terminating the pregnancy because there may need to be confirmation of the gestational period. Other diagnostic procedures may also be needed to confirm the gestational period and may take a number of days. The three-day period is unnecessary but the consultation with the GP should start the process.
I will speak to my amendment No. 87. Although I disagree with it almost in the same vein as the Chairman, given that the three-day waiting period formed part of the discussion leading up to the referendum, I am reluctant to remove it outright. We have to stick with the type of access we told people would be available before the referendum. However, with respect to the Minister, I suggest that we change the phrasing used because it is impractical in the real world. The phrase used in the Bill is "a period of not less than 3 days has elapsed from the date of certification". The word "elapsed" means to have passed or been completed. That indicates to me that, in practice, from the point of certification three full days must have passed. I am afraid the current phrasing may lead to a period of more than three days elapsing, which would lead to all of the things previous speakers referred to. I propose in amendment No. 87 that we use the phrase "the third day from the date of certification referred to in paragraph (a) has been reached" rather than "elapsed". This would not take away from what we told people before the referendum. It also addresses the issue to which Deputy Smith referred of time building up, depending on the availability of appointments, scans and so forth. The amendment might make the provision tidier.
Practically speaking, if a woman presents at a GP's clinic on a Monday morning and the doctor is a conscientious provider of termination of pregnancy and certifies, at that point, that the woman's pregnancy is definitely under 12 weeks and definitely under nine weeks and can use the pills with medical supervision, the three-day wait would then begin. We have to be very careful about saying when the tablet should be taken. A woman could present on a Monday but could be working all week. Anyone who has had a termination or miscarriage will know that it is not something a woman would go through during the working day. While I cannot speak for all women who have had miscarriages, one definitely needs between three and five days off. Depending on one's job - ironically a hospital doctor who was off for four or five days would be unable to meet a patient who had been in three days previously - from a practical point of view and for family reasons and so on, one cannot be haemorrhaging for a week just because one has to swallow a tablet in front of a doctor.
Those are the practical issues. We should not put down in legislation that women should have to swallow tablets in front of people. Supervised consumption of medication is not something that we should introduce. The Bill states somewhere that the first dose of medication is to be taken in the GP's surgery.
That is not in the law.
That is fine.
I agree with Deputy Smith that the cooling-off period gives a sense that women are irrational and incapable of making decisions. We have to make sure that GPs are protected in the sense that they must prescribe within the licensing guidelines of the medication and if there is a borderline issue involving a gestational period of eight weeks and five days, the GP will want to have the facility to guarantee the gestation time.
I suggest that my amendment does not materially change the heads of the Bill but it makes clear that we will not keep women waiting three days plus part of a day either side of that.
Does the Minister want to contribute now or does he want to complete the brief?
I am happy to complete it.
I was in the Oireachtas hearings as well and we had evidence from other countries where there is a waiting period. "Cooling off" might be the wrong term and no one is attempting to describe women as irrational or emotional. It is certainly a difficult time but I had private discussions with the Chairman on this and I found out that the first appointment could be on a Monday evening at 6 p.m. with the follow-up appointment on Wednesday morning at 9.30 a.m. In such circumstances, the three days would have elapsed so we are playing with words.
There certainly needs to be a time of reflection after the first consultation. I have met many women who, having got counselling and discussed the issue with family or others, changed their minds on having a termination because of the time that elapsed. The passage of time allowed them to think clearly and have the benefit of advice and counselling. I am, therefore, opposed to the amendment.
"Liveline" just tweeted the following:
Jane was sent home sick from work today. Jane's GP retired last week and she can't get another doctor to take her on.
There is a shortage of GPs and there is a difficulty accessing them, as the Chairman knows. That tweet makes the case for others who are not GPs to be involved in this. We had the discussion about other medical practitioners possibly having a role in this previously. Given the constraints that exist within general practice and the difficulty that many people have in accessing a GP even once, making people see a GP twice as outlined in this section is an unnecessary barrier. People are talking about a shortage of GPs outside this room, so it would be silly of us to pretend in here that a service can be delivered where additional responsibilities are being introduced in an area where demand is already high. We are potentially doubling the period a woman would have to wait. I cannot be convinced that two visits to the GP is necessary.
A visit to the GP and an opportunity to consult one's doctor, if that is needed, is absolutely the right thing to do but a woman has already made up her mind by the time she has picked up the phone to make an appointment. We have all said that a woman does not choose to have an abortion lightly but that has to have some meaning. We cannot then act as if she might make the decision and put in checks and balances based on that. From the outside looking in, putting those barriers in place makes it seem as though women would engage in a glib decision to have an abortion when it is not a glib decision. General practice is operating under heavy constraints and we know there are many doctors who are ready, willing and able to provide this service conscientiously. However, we have to live in the real world and acknowledge that the service must be fit for purpose.
I have said before and I say again that the test by which we judge this legislation must be that women choose to use this service, choose not to go abroad and do not choose to use telemedicine without supervision. We will let women down from the start if we try to put unnecessary barriers in place.
On that point, I refer to my experience as a general practitioner. If there is to be one face-to-face consultation to start the process and a test is needed to confirm the gestation, that will undoubtedly require a second visit. A third visit will also be needed to confirm that the process has been completed because in normal maternity care there is a post-natal check in any case. To try to minimise the involvement of a general practitioner to only one visit is to minimise the safety and quality of the service that we will provide. I believe three visits to a doctor will be required from start to finish to have safe and proper maternity care or termination of pregnancy care. I apologise for having interrupted again.
I echo what Deputy Smith said. I fully accept the bona fides of all those Deputies who do not agree with my view on this. Deputies Smith and O'Reilly are correct that the GP system is in chaos and at breaking point around the country. On my drive to Leinster House this morning it struck me that when abortion services are carried out in this country, they will reflect the dysfunction of the rest of the health service. We are talking about this service as if it will operate as outlined in this Bill but we are fooling ourselves if we think that is the case. The abortion service in this country will operate in the same manner as the health service in general operates in this country. It will have exactly the same difficulties and problems and it is my honest view that in a number of years abortion will be provided through abortion clinics. There is no doubt in my mind about that.
Much of this could have been worked out if the Minister had met and consulted doctors before the Government decided that this would be a doctor-led abortion service.
The three-day rule was central in the referendum. Some say it was brought in to placate the Tánaiste and Minister for Foreign Affairs and Trade, Deputy Coveney, and get him over the line on the issue. I know of many women who have had abortion regret. It is a big issue and one that does not get the airtime it deserves. I know of a woman who went to have an abortion in Britain and in the waiting room of the abortion service in London she decided not to have the abortion and she now has a 13-year-old girl. It is a life and death issue and it is irreversible. Whatever gender a person is, given the magnitude of the decision involved, it is good that consideration is taken with that decision.
I did not expect to get an opportunity this morning to bring up the issues facing general practice with the Minister but if he would like to start discussing it, that is fine.
We are moving in that direction alright.
We will discuss it on another day, next Wednesday perhaps.
We can encourage Deputy Murphy O'Mahony to bring up Bantry General Hospital.
For a change.
This is the Minister's opportunity to respond.
There is much to respond to and I acknowledge that people have very sincerely held views on this matter.
On the issue of how many times a woman needs to visit a GP, I take the point that Deputy O'Reilly made in the context of those visits having to be mandatory so I am parking the three-day waiting period while I make these comments. I agree with the Chairman that we should resource general practice for up to three visits and we will do so, in the same manner as he correctly said that the mother and infant scheme will provide pregnant women with a number of free GP visits. That is not to say they are mandatory visits but it is important in providing for all of the woman's needs and giving her all the advice necessary that we adequately resource general practice for this and make sure that if the woman wants or needs to go to her GP two or three times, she must be enabled to do so and the GP must be supported in providing that service.
I do not believe anyone has a difficulty with that. I clarify that is my thinking in terms of our engagement with GPs on this matter.
I thank the Chairman for giving us the benefit of his knowledge of the practicalities of being a GP in that on many occasions a natural period will elapse between seeing a doctor, a procedure taking place and medication being administered. That shows that unless it is an emergency situation, it is unlikely these situations take place instantly in the doctor's room. I have never used horrific phrases such as "a cooling-off period" in this context. A natural time period often elapses between having a consultation and having a procedure, whatever that procedure may be. This is a hard one regardless of the personal views any of us have on this matter but, as a number of colleagues said, it was put to the people as part of the referendum. I have heard Deputy Coppinger make the point, and I know she has done so sincerely, that she does not believe it was a big part of it, but I certainly felt, when a number of people were asking why 12 weeks had been decided and how the 12 weeks would work, that it was a significant enough part of the debate. There is a responsibility to bring forward legislation that tallies with the general scheme that was published in March. My opponents during the referendum said we should show them what we were going to do. They said also, as did perhaps even one or two people in this room, that we cannot trust the politicians and that they will say they will put in place these measures but once one votes "Yes", they will go off and do something different. Those words still ring in my ears. It is important we are consistent with what we said we were going to do.
On the reverse of that, there is an element of hypocrisy with respect to people who are not in favour of the legislation at all cherry-picking the bits they like out of it. Those people would like a period of about nine or ten months to elapse before a woman could access a termination, if the members get my point on this. There are people who are against abortion in all circumstances and I ask them not to try to align themselves in any way with my views on this issue. This legislation needs to be seen in the round. It needs to be seen as legislation that seeks to provide access to termination of pregnancy services that were not available in our country previously. It also needs to be seen in the space where we are moving beyond a situation where it is effectively illegal for a woman to have a comprehensive conversation with her doctor about all her options and be advised and referred. We see benefit in a woman and her doctor having that conversation with the woman being imparted with information. It is not about being paternalistic but about the woman being given professional medical information and then having an opportunity to consider that information and making her choice, as that woman is well able to make that choice.
We have somewhat changed what we said in the March legislation without deviating from the fundamental principle. Members will recall that we referred to a period of 72 hours in the general scheme of the Bill. We have clarified that this is three days. We did that for practical reasons. A number of colleagues, including Deputy O'Connell, have asked, for example, that if one sees a doctor at 5 p.m. on a Monday, is the 72 hours from 5 p.m. that day? We have clarified that is not the case and it is three days. It will deal with the way that three days will work. I need to point out something that did not come up during the course of this debate. Obviously, there are emergency provisions in the legislation and they trump all the other provisions. When people talk about difficult situations, which Deputy O'Reilly raised, which I am sure will materialise, and I have discussed this with doctors, the emergency provision enables doctors to use their clinical judgment and perhaps that is something on which we can seek more clarity to provide an assurance for people.
A number of people referenced the fact this is not an Irish-specific requirement and that this is in place in law in a number of European countries. I believe it was Deputy Clare Daly who implied they were not necessarily countries that are considered very conservative, namely, Belgium, the Netherlands, Germany and, I believe, Italy. A number of countries have a waiting period requirement.
A number of members asked when does the clock start, which is to what the issue boil down. Some members would like to remove this requirement but I believe they are asking that if that cannot happen, when does the clock start and how will it work practically? There is an element with respect to somebody not having to discuss their medical details with a person who is not their doctor. That is genuinely something we need to tease out. One should not have to tell the receptionist why one is going to see the GP. We do not have an electronic booking system in this country, which perhaps is the norm in the Netherlands where one makes an appointment by email. That is my understanding. We do not necessarily have the systems in place that other countries have in terms of how they have dealt with it. That is something we need to tease out.
Deputy O'Connell asked about a lapse regarding the waiting period and her amendment specifically refers to that point. I checked this out legally. Section 18 (h) of the Interpretation Act deals with how periods of time should be understood, which I did not know about. It states: "Where a period is expressed to begin on or be reckoned from a particular day, that day shall be deemed to be included in the period and, where a period of time is expressed to end on or be reckoned to a particular day, that day shall be deemed to be included in the period". Section 13 of this Bill provides that three days must elapse from the date of certification and, in accordance with the Interpretation Act, the day of certification is included. If one saw a doctor at 5 p.m. on a Monday, that Monday is included.
I was not aware of the Interpretation Act.
Nor was I in that context.
For the sake of argument, if a person saw a doctor at a minute to midnight on a Monday-----
The whole day of Monday is included.
-----the whole of Monday has more of less passed, but the day is still included.
That is it.
If there is a necessity for a follow-up day, that could happen technically at a minute past midnight and if that was on the Monday, it would be on the-----
Yes. It does not have to be 72 hours. The whole day is included regardless of it being an evening appointment.
It was one of the changes I made because regardless of an ideological perspective on this, and I know there are different ideological perspectives on it, there is also a practical element involved. Members have all talked about having booked GP appointments. In terms of 72 hours, three days provides greater clarity and a degree of flexibility in the way GPs schedule their appointments.
What happens if the appointment is on a Thursday morning?
Is that in terms of the GP not being available on a Saturday?
Or a Sunday.
There is a broader aspect in that it is an operational rather an a legislative matter. If one is certifying a person to provide them with a service and one knows when one can provide that service, one would want to make sure that one is in a position to deliver that service.
Does the Minister envisage in that second visit that one would have to wait in the surgery to have another full consultation with the GP?
The GP would-----
Many people had envisaged that the Minister meant that the person has a consultation and then three days later the person would come back and collect a prescription or get a referral letter if the person had not changed their mind, but the Minister seems to be-----
That is not clear in the legislation, as in it is not included in it, and that is probably a good thing. The person would have to go back to the GP to have the prescription dispensed. Again, that is not included in the legislation but the intention of those getting ready to operate the service is that the prescription would be dispensed by the doctor rather than the pharmacy, cutting out an additional visit, an additional conversation and an additional potential obstacle or hurdle. One of the benefits of what we are doing here is that the dispensing will be done by the GP rather than the person having to go to a pharmacy. I understand the challenge involved. It was reflected also in some of the discussion we had yesterday and some of the correspondence we had from obstetricians yesterday on the whole issue of certification. Some of that will come up again shortly. As a period of time elapses what if a particular obstetrician is no longer rostered that day? There are operational issues regarding how the three days will work and when the clock starts, which I am happy and eager to tease out. It is not the easiest area to tease out because we have to make sure that it is very clear as to how it will work. I am happy to work with people on this between now and Report Stage. If we are going to have an engagement on it, we should engage both legally and operationally on it because we need such engagement with both sides to get this right. We have already seen the challenge with the certification element.
I would respectfully ask people not to push their amendments today. To assure people that I am not being in any way disingenuous on this, my position on this is that the legislation published in March referred to a period of time elapsing. It referred to 72 hours and I have modified that to three days for reasons of clarity and a degree of flexibility.
I do not intend to deviate from that because that is what we said we would do. I would be willing to engage with colleagues with regard to when the three days start.
Referring to what Deputy Peadar Tóibín said, if this process is to be delivered through general practice and through clinics, which I have no doubt that it eventually will be, if the three day waiting period starts on a Thursday, as Deputy Coppinger suggested, it could be accommodated within a clinic system which would probably operate for seven or six days a week. It would circumvent the gap in the three days if it was to occur over the weekend.
I am not speaking for them but we already know of organisations such as the Irish Family Planning Association, Well Woman Centre and others that I imagine could play a significant role in helping the roll-out of these services but that is not to in any way pre-empt those discussions.
I move amendment No. 83:
In page 10, between lines 30 and 31, to insert the following:
“(a) a termination of pregnancy is requested by the pregnant woman,”.
This is a separate issue. Does the Chairman want to get into that now or deal with the other amendments just discussed?
We will deal with Deputy Donnelly's amendment now.
We have had some of this conversation before. I do not want to withdraw this amendment. It is specific to section 13, on early pregnancy. The same argument we had before applies. Amendment No. 83 would insert as a condition of termination of pregnancy that it is requested by the pregnant woman. That is partly for the reasons we have already discussed. The woman's voice and wishes must be at the centre of this. There is more to it than that in the early pregnancy section. One could see a situation where a vulnerable woman comes under pressure. It could be a very young woman or a woman in an abusive relationship. I can see many situations where the woman may not want a termination or may want to wait but she could find herself in a vulnerable situation. Nothing in section 13 says the woman must request the termination. The section states:
A termination of pregnancy may be carried out in accordance with this section by a medical practitioner where, having examined the pregnant woman, he or she is of the reasonable opinion formed in good faith that the pregnancy concerned has not exceeded 12 weeks of pregnancy.
It states it shall not be carried out unless the medical practitioner has certified that and that there must be a three day wait. It is essential that an explicit condition is inserted that a pregnant woman requests the termination, to protect women. It is in a different category from other amendments. In sections 10, 11 and 12, the woman's life is at risk or there is serious threat to her health. We have agreed that the Minister will take away the views of the committee and hopefully, between us all, we can come up with some agreed wording. This is different. It is specific to section 13. It is essential, reasonable and legally robust. I ask the Minister to accept the amendment.
I fully understand what Deputy Donnelly is trying to do here. The strong view of my team is that it is unnecessary. Who else, other than the woman, can request the termination under existing law? Doctors have to operate under medical consent already. I take the Deputy's points seriously and I referred to it yesterday when we were talking about offences. Forced or coerced abortion is something that we should all be concerned about. I do not mean any disrespect but I think this is somewhat superfluous. One cannot carry out any medical procedure in Ireland without a patient consenting. As the Deputy quite rightly says, in this case, the woman would visit her general practitioner to request the termination. It is not because she would have a risk to her health or she has a different opinion on her health to her medical team. While I appreciate what the Deputy is doing, I genuinely do not see the need for it.
This is probably a unique medical situation. I cannot conceive of anyone pressuring a woman into taking aspirin or having some orthopaedic or orthodontic procedure done. Other medical procedures are not situations in which significant social pressure could be brought to bear. It does not really arise. In a situation where if a man or a woman has a medical issue and drugs need to be prescribed or surgical intervention is required, it goes without saying that the patient is agreeing to it. This situation is unique. A very young woman could be under pressure from a parent, guardian, her peers or people she knows who have strong views on the subject. A woman may have become pregnant with a man who is not her partner and he could be putting her under serious pressure. A woman could be at a vulnerable time of life. This amendment makes it clear that when the doctor is consulting with his or her patient, he or she should explicitly seek the patient's request. As such, I think it is essential to have this in the legislation. It is a unique situation.
I agree with Deputy Donnelly. There are situations where women, particularly young women but potentially women of any age, can be put under pressure to have a termination which is effectively against their will, but they feel powerless to resist. It is a real situation. It is a very worthwhile amendment which I agree with.
I do not want to disagree with the Chairman - never mind disagreeing with Deputy Donnelly - because of his background. When the morning-after pill was made available over the counter in the community pharmacy setting, while I cannot remember the law exactly, one was not allowed to give it to the woman's partner. Even if one knew the woman well, one could not provide it. I am not familiar with the medical guidelines on this but I assume they are mirrored. One had to have a consultation with the woman, be satisfied it was for her and that she was comfortable with the situation and not being coerced. I understand that this would already be dealt with in the patient-doctor relationship. I do not think it is required. Including it might have effects on other parts of the Bill. It is a practical issue. There are other physical surgeries for which partners can put pressure on people, not just terminations, such as enhancement surgeries. It is not a unique situation. Sometimes women can be pressured.
Enhancement for the man or woman?
I suppose it depends on which angle one is looking at them from. I do not think it is necessary. I ask for clarification on it. I know about it from a pharmacist's point of view and imagine that medical guidelines are similar.
I see what the Deputy is trying to do. I thought it would be covered in the first sentence by the medical practitioner having examined the pregnant woman. We had a discussion about this yesterday. The phrase "consultation with" might be better than the word "examined" but I think it is covered. The question is whether it creates any problem. Will the Minister comment on that?
I know Deputy Donnelly feels strongly about this. I also accept what the Chairman says. I would like to check with the Medical Council and, I give the Deputy my word, I will support it if there is a sense that this will in any way assist. The Deputy's bona fides are entirely accepted. I am just looking at page 15 of the Medical Council's Guide to Professional Conduct and Ethics for Registered Medical Practitioners on consent. It is very strong on consent, capacity to consent and on what one needs to do in terms of making sure a patient is making a voluntary choice and that the patient knows consent is not just a formality or cannot just be deemed as a signature on a page. Consent is required by law. It is a respect for a patient's autonomy. It goes through information. I can certainly share it with the Deputy. I genuinely feel it is already covered but I also think the Deputy is entirely correct to make sure it is robustly covered. I know the Deputy does not wish to withdraw his amendment but I suggest he consider withdrawing it and submitting it again on Report Stage and we will clarify the matter in the meantime. If the Medical Council or the people drawing up the clinical guidelines do not see a difficulty with it, I have no difficulty accepting it but I would like to check.
I will meet the Minister half way. I will not withdraw it and I will accept we can delete it on Report Stage if the Medical Council comes back and tells us it is in its way. We have a GP in the room. It is a unique situation. I have great respect for my colleague, Deputy O'Connell, but I do not believe this is in the same realm as people being put under pressure to enhance themselves or, dare I say it, give themselves full heads of hair or whatever.
It is a different type of healthcare.
The pressures people are under in this situation are different. In particular, it could apply to very young and vulnerable women. I will leave it in. I would like the Minister to accept it. I will make him the same offer. If the Medical Council comes back and says it is in its way, I will support the Minister in removing it on Report Stage.
I will come back to Deputy Donnelly on what he has just said because there is a technical problem with it.
I am mystified as to what is motivating this. My reading is that it is catered for already. If, for any reason, it is not then clearly we should put it in. Nobody wants to see a situation in which anyone is coerced into having any procedure at all. It strikes me as somewhat unnecessary. I am inclined not to take any view on it on the basis that I think it seeks to fix a problem that does not exist but a problem which should be fixed if it does exist. I do not think it exists. That is my reading of it.
The motive behind this is confusing. I have listened to what has been said here but I am mystified as to why it is needed. I am not sure why it is needed in the first place. It is almost as if it has been put in for a reason that has not been outlined. I am not very clear why it is needed, which makes me nervous. I would tend not to support it because of the fact I do not see the reason it is needed in the first place. Perhaps we should go to a professional body and get some guidance on it before we make a decision. It is always harder to take something out than to put it in later.
Does Deputy Donnelly wish to explain himself?
I already have done twice.
I did not mean it in that way. We are in an unusual situation.
I have explained it. There is nothing else I can say to Deputy Kelly. I hope he understands there is no reason that is not being voiced. The reason is protection of vulnerable women in the situation. As the Deputy stated, this is a unique situation that requires extra protection for the women involved.
The technical issue is the question whether the amendment be made. Will the Deputy press the amendment?
We know if one aids, abets or counsels a woman to procure an abortion, one is open to criminal sanctions. To get some clarity, let us just say, for argument's sake, if I was an abusive partner and I was forcing my partner to procure an abortion, I am open to criminal sanctions. If we put this in and then it is very clear it is at the request of the woman, does that have an impact? I am not saying people will do this but I could easily say I did not put any pressure on her and that she asked for it herself. Are there implications for people who aid, abet, counsel or try to coerce women into procuring an abortion?
"I do not know" is the honest answer but these are the sort of reasons I would like to make sure there are not those sort of consequences before putting it into the legislation. Consent is already in law. A doctor can be struck off if he or she breaches the law. A doctor has to be satisfied the patient is consenting and consenting voluntarily. I accept the Chairman's point. He is familiar with this. If somebody goes to see a doctor, the doctor has to be satisfied the person is looking for the treatment in a voluntary capacity and is not being coerced into looking for it. That is already in law.
I am not really sure about it if it does not cause a problem. The issue is this: if somebody is being coerced by an abusive partner or parents, she is going to be told to go in and say she wants the abortion. That could be something they insist on. It could be a get-out-of-jail card. If the pregnant person is not saying anything, it could be a better indication. I do not want to delay this. It seems like a small thing. I think the words "having examined" mean it is covered whereas insisting the person says it could result in it being something that could be brought about abusively.
Prior to suspending, we dealt with amendment No. 83. Amendment No. 84, which deals with a grammatical change, cannot be moved because amendment No. 81 fell.
I move amendment No. 85:
In page 10, lines 32 to 34, to delete all words from and including “, and” in line 32 down to and including “paragraph (a)” in line 34.
I move amendment No. 86:
In page 10, to delete lines 33 and 34 and substitute the following:
“(b) a period of not less than 3 days has elapsed from the date on which the pregnant woman made arrangements to attend the medical practitioner for the purpose of the examination referred to in subsection (1).”.
In light of our previous conversation and the consideration given by the Minister, I will withdraw this amendment. I feel strongly about this matter. We have to find a solution that works.
I move amendment No. 87:
In page 10, to delete lines 33 and 34 and substitute the following:
“(b) the third day from the date of certification referred to in paragraph (a) has been reached.”.
I will withdraw this amendment. As Deputy Kelly stated, we have to work with the people delivering this service to make it practical and woman-centred. I am conscious of women having to explain their circumstances to too many people and that creating barriers.
Of the Deputies proposing amendment No. 88, Deputy Coppinger is present.
We have not discussed this one yet.
Did we not discuss it with amendment No. 82?
Does this amendment, which reads, "date on which an appointment with the medical practitioner referred to", not relate to referrals and conscientious objection?
No. It refers to section 13(2).
I move amendment No. 88:
In page 10, line 33, to delete “date of certification referred to in paragraph (a)” and substitute the following:
“date on which an appointment with the medical practitioner referred to in subsection (1) is requested”.
I will withdraw this amendment with a view to resubmitting it.
The next grouping is amendments Nos. 89 to 94, inclusive, all of which refer to section 13(3).
I move amendment No. 89:
In page 10, lines 37 and 38, to delete “as soon as may be after the period referred to in subsection (2)(b) has elapsed but”.
This amendment suggests the deletion of the phrase "as soon as may be" in the context of conscientious objection. Many people have major problems with the issue of conscientious objection. I will make some general points because I do not intend to speak several times. In principle, people feel that others should be allowed to conscientiously object. For example, I agree that someone should be able to conscientiously object to having to join the Israeli army. People should have a right to object to participating in world wars with which they do not agree. When it comes to medical care, one could argue that some people may have qualified as doctors in an era when there was no abortion in Ireland. Someone made the point that it could be argued that a time limit should be placed on the conscientious objection provision so that it is not there forever and future medical students who enter the system know that termination of pregnancy is part and parcel of the health service.
Does this refer to conscientious objection?
Yes. This amendment relates to referring someone "as soon as may be" if a medical practitioner objects.
Within early pregnancy.
Yes. I will just speak once on the issue of conscientious objection because I do not want to keep contributing on it.
In including a right for doctors to object, all of the emphasis in the debate has been on health professionals rather than the serious impact on pregnant people. In rural, conservative areas of Italy, for example, doctors feel that they cannot participate because of pressure from within the culture by which they are surrounded.
This leads to a situation where women have no access at all.
On the amendment, many people are shocked at the loose wording used in the Bill. The provision that a doctor must refer somebody must be retained. If somebody wants to object, that is fine. However, the woman involved must be referred to another doctor. That is current law and practice and it should be maintained. The phrase "as soon as may be" is loose - as soon as someone gets a chance, he or she might refer somebody rather than ensuring that he or she must do so promptly because time is an issue in the case of this medical procedure. The phrase should be deleted. It would be good if the Minister agreed to that. There are later amendments which suggest placing a time limit on it and with which I agree. Surely 24 hours is enough time for somebody. If a person comes to see a doctor, said doctor might be busy for the rest of the day. I can appreciate that but by the end of the working day, he or she should be able to make a referral. I would have serious worries about this in some rural areas in particular. This could lead to delays for pregnant women in terms of getting access in a timely manner so I think the phrase "as soon as may be" should be deleted.
I want to tease this out with the Minister. We are referring to section 13(3), which then refers to section 13(2)(b). If a doctor has an objection, surely that doctor should state it when the woman arrives in the surgery on day one instead of waiting until the three days have elapsed to say that he or she has an objection to carrying out the procedure or administering the medication and must refer the woman on. I agree with Deputy Coppinger regarding the objection and the fact that there should be no delay. We are talking about early pregnancy. It seems that if a doctor has an objection, he or she should make that very clear on day one. Surely, by day three, he or she should have referred that patient to another doctor who will carry out the procedure. Could the Minister talk us through that because what is being suggested here is that somebody could invoke their conscientious objection on day three and then have to refer somebody? That should be invoked on day one so that by the time the three days are up, the doctor would refer the patient to somebody who will administer the medication. Can the Minister provide some clarification on this?
The section states that the medical practitioner referred to in subsection (1) shall make such arrangements as he or she shall deem to be necessary. What does the term "arrangements" mean? Does it mean making an appointment or a referral or writing a letter? I think the Irish Medical Council would indicate that it should involve giving sufficient information rather than making an arrangement.
I will begin with a few general comments because Deputy Coppinger is right - all of the discussion about conscientious objection has been about the medical practitioner, not about the woman. Let me be very clear. Medical practitioners have a right to conscientiously object. Deputy Coppinger is saying that perhaps this should be time-limited but it is not. It is not so in the law and Medical Council guidelines. A person has the right to conscientiously object as a medical practitioner. Can we have the conversation with regard to the way Deputies Coppinger and O'Brien and the Chairman raised the question of what it looks like from the woman's perspective because it is much more illuminating and informative? After we have changed the law significantly, had a referendum and made these new services available in the Irish health service, the last thing any of us wants is a woman, and I do not mean to be in any way flippant, going from GP practice to GP practice in the hope of finding a doctor who is not conscientiously objecting. Let us be honest about that. If that happens, it will result in women not accessing the service and either continuing to travel outside our jurisdiction or to access medication illegally purchased online. We need to stop just talking about conscientious objection as though the only person it impacts upon is the doctor. I thought the way the entire health service was meant to be run was with the patient - in this case, the woman - at the centre.
The next issue is outside of the legislation but it is very relevant to our consideration of the legislation. I have been working on devising the 24-7 helpline that will be manned, or "womanned", by nurses, midwives and councillors. We have been working to ensure that this helpline can also be a source of information for a woman to find out where the nearest service is located. To be clear, it is not mandatory for a doctor to sign up for his or her information to be given to that helpline. However, a number of doctors, agencies and organisations that operate in our health service have come forward that may be willing to give their details. This means that if a woman in County Clare contacts the helpline next January, not only will she be able to be given all the information, all of her options and all of the supports, she will also be able to state that she lives in County Clare and those operating the helpline might be able to tell her that there is a doctor in Ennis who has signed up to provide this service. Alternatively, and I do not expect that this will be the case, she might be told that there is no such doctor in said county but that there is a doctor in Dublin who will perform the service.
Conscientious objection is not about trying to catch doctors out. Doctors have a right to conscientiously object. It is not about trying to find the doctor and put them in an awkward position. Much more importantly, it is not about the woman having to go around until she lands on a doctor's surgery that will provide the service. I want to say this because there has been a lot of concern, some of it genuine and some of it made created to become a bit of a frenzy, about conscientious objection being this extraordinary burden on a medical practitioner. What I have tried to do is lessen that burden, although I do not think "burden" is the right word. I have tried to lessen that obligation by making sure there is a source of information that works for the woman and will also enable doctors to know that is there. That is an important point. In practice, no woman in crisis will be wandering around hoping to find the right doctor. Let us give women credit here. That is not the way the world works. The 24-7 helpline will assist in that regard.
With regard to her amendment concerning the words "as soon as may be", Deputy Coppinger argued that this means whenever a doctor gets the chance. I can understand why she would read it like that. I would also read it like that. I am advised legally that there are approximately four categories in terms of the degree of urgency one wishes to attach to somebody having to do something. The first is "forthwith", the second is "as soon as may be", which is where we have gone-----
The Deputy made a helpful contribution whereby she pointed out that the doctor may not be there that very second. Those are the circumstances to which the word "forthwith" relates. The second category is "as soon as may be", "as soon as possible" is the third and "without delay" is the fourth. Legislation is interpreted by courts, lawyers and legal experts who work for the Irish Medical Council and others in terms of enforcing this. We have opted for the period that makes it very clear that the doctor is meant to identify their conscientious objection at the very earliest stage.
We must live in the real world. I do not think it is in the interests of any doctor who does not want to provide the service to not tell the woman until the end. Why would a doctor do that? It is certainly not in anyone's interest to have women going around trying to find doctors willing to provide the service. In terms of the operation of the legislation, we must try to provide information sources that can direct women to services. We cannot remove - and I am not willing to remove - conscientious objection from legislation because if we believe, as I believe, that this is to be a normal part of the Irish public health service, which I think people voted for, the obligation and duty have to be the same for this as they are for anything else. With regard to conscientious objection, we are applying the same standard - no more and no less - that we would apply to other treatments and procedures in the health service. That is largely where we are going with it. I suggest that leaving in the phrase "as soon as may be" is genuinely more helpful legally than taking it out. That is the legal advice I have received.
The limits to the rights of one person are where they infringe on the rights of another. In liberal democracies, that is generally understood as to where we draw the line on the rights of an individual. This Bill states in clear language that termination is an operation that ends the life of a foetus. I appreciate that some people do not see it as that, which is fine. Some people want access for women and I understand the point that the Minister is making. Many medical practitioners, however, will read the Bill in the language in which it is actually written and understand it in that fashion. To force them into an act where they feel culpable is not a good thing.
Were I to arrange for the end of the life of Deputy Simon Harris, I would be in part culpable under the current law, as well as morally. It is perfectly reasonable that doctors around the country would say they do not want to get involved. This should not have happened. There should have been consultation with doctors in advance of this Bill. The Government would then have realised the dangerous space into which it is moving. The Government cannot force people to do this and, indeed, doctors will not do it. Doctors will then be in conflict with the State as a consequence. Doctors and general practitioners are already radically demoralised by the state of the health service and their own profession. Should one seek a way by which to further demoralise doctors, forcing them to make arrangements for a transfer for an abortion would be the way to do it. It also will mean that many people like me will no longer choose those professions at any level, whether doctors, midwives, pharmacists, if they believe their profession will force them to carry out an act that they cannot get their head around morally. If the Minister wants to provide for abortion, I would say this is not the way to do it. It is the method of most conflict to achieve that goal. Within the past week, 650 doctors have signed a letter saying they will not proceed with this. The Minister ought to sit down with them and try to work it out.
Last night I spoke to an obstetrician who told me that Dr. Peter Boylan is doing a tour of hospitals, and has been to Kilkenny, Letterkenny and Cavan. Medical professionals had met prior to this and said that they would not participate in the Government's planned abortion provision. These are consultants and medical professionals, including midwives, who say they will not proceed with this. Two immovable objects now face each other on conscientious objection. There must be a solution whereby medical professionals who are at ease with the provision of these services are clearly identifiable to those who want to access them, and a method to join the two.
I will try to be helpful. When doctors, nurses or midwives want to know whether they are in compliance with the law and their professional code, they do not dust down statutes passed in the Oireachtas but they turn to the regulator. In the case of nurses and midwives it is the Nursing and Midwifery Board of Ireland, NMBI, and for doctors it is the Medical Council. It is the job of those bodies to outline the contentious objection requirements. I have before me a document which has proved useful in recent days, namely, the eighth edition of the Guide to Professional Conduct and Ethics for Registered Medical Practitioners, published in 2016. Section 49, on page 35, outlines conscientious objection. We are not doing anything different here; there is no new standard or barrier.
Will the Minister tell us the wording?
This is the correct interpretation of the law by the Medical Council. They take our law and interpret it into wording, against which they regulate.
To what legislation specifically does this refer? Is it the Protection of Life During Pregnancy Act?
No, it is the issue of conscientious objection.
Yes, in general.
That is fine, I just wanted to check.
That is the point, there is no difference. One cannot have more or less of a conscience on different medical issues. Conscientious objection is a person's right to object if something is in conflict with his or her religious or personal beliefs. Section 49 of the Medical Council guidelines state:
You may refuse to provide or to take part in the provision of lawful treatments or forms of care which conflict with your sincerely held ethical or moral values.
If you have a conscientious objection to a treatment or form of care, you should inform patients, colleagues and your employer as early as possible.
That was the point that Deputy Jonathan O'Brien asked about. It continues by stating:
When discussing these issues with patients, you should be sensitive and considerate so as to minimise any distress your decision may cause. You should make sure that patients’ care is not interrupted and their access to care is not impeded.
If you hold a conscientious objection to a treatment, you must: ... inform the patient that they have a right to seek treatment from another doctor; and ... give the patient enough information to enable them to transfer to another doctor to get the treatment they want.
If the patient is unable to arrange their own transfer of care - as we know, people can be very sick - you should make these arrangements on their behalf.
In an emergency, you must make your patient’s care a priority and give necessary treatment.
We are not changing the wording in this law to the wording that already exists in other legislation in respect of conscientious objection.
The Medical Council refers to giving the patient sufficient information, whereas the legislation says "make arrangements".
That is right, but that can be the making of the arrangement.
An arrangement is active. It is an action whereby a person is then therefore part of a process. It is not passive.
It is giving the patient the name of somebody else.
They will not do it.
Then they would be breaking the law.
From the perspective of myself and of the Minster, it would be logical to resolve this in order to achieve a Bill that functions. A significant proportion of the medical professions in this country, including those in Cavan, Letterkenny and Kilkenny, have already said that they will not proceed with this.
Deputy Tóibín should be very careful about unilaterally speaking for three of our maternity units.
I am very careful.
I am the Minister for Health and I have not received any advice that those three hospitals are not in a position to provide those services.
As of yet.
As of yet. Consequently, I do not think the Deputy should make statements that have not been established.
I had the pleasure of debating and engaging with some of those obstetricians who work in those hospitals over the course of the referendum. Many of the complex cases about which they expressed concern during the referendum are ones that they do not care for anyway as they are already transferred to our main maternity hospitals. I refer to fatal foetal abnormalities and so on. People are also transferred to our tertiary hospitals. We must be very careful. Dr. Boylan is doing an excellent job in engaging. There will be people who will conscientiously object, I do not dispute that in any way. Institutions, however, do not have the right to conscientiously object. Institutions do not have conscience. The only people who think that is the case were the bishops in that unhelpful intervention. It was the repetition of very similar arguments to those made during the passage of the Protection of Life During Pregnancy Act, where some of the same individuals stated that services would not be provided and even if a woman was about to die in one of their hospitals, they would not intervene. I am delighted to say that has not been the case in the practical implication of the Protection of Life During Pregnancy Act because doctors do what doctors do. They intervene and look after people.
I wish to return to the amendment itself. We will deal with conscientious objection later but while it does have an impact on this, we are currently discussing early pregnancy exclusively in this amendment.
Section 13(1) states: "A termination of pregnancy may be carried out in accordance with this section by a medical practitioner where, having examined the pregnant woman, he or she is of the reasonable opinion formed in good faith that the pregnancy concerned has not exceeded 12 weeks of pregnancy." Later, in the event of a medical practitioner having a conscientious objection section 13(3) provides the practitioner must "make such arrangements as he or she shall deem to be necessary for the carrying out of the termination of pregnancy as soon as may be after the period referred to in subsection (2)(b) has elapsed". The Minister has stated it is very unlikely that a doctor who has an objection would wait until the three days had elapsed to invoke that objection. However, under the legislation as it is currently worded, that is possible. It says the medical practitioner shall make arrangements “as soon as may be after the period referred to in subsection (2)(b)", namely, the three-day period.
The three-day period will elapse and then the doctor can invoke the objection. The practitioner must make the arrangements "as soon as may be after" the three-day period has elapsed. For me, if the doctor has an objection, he or she should make the arrangements as soon as the woman indicates she wants to have an abortion. The woman should not have to wait until after the three-day period elapses before arrangements are made to transfer her. That is my reading of it.
I understand why the Deputy is reading it like that. We have just had a lengthy discussion about conscientious objection. In fairness to everyone, that piece of the legislation, and what Deputy Coppinger is trying to do, does not relate directly to conscientious objection. This is section 13(1) of the Bill. It states: "A termination of pregnancy may be carried out in accordance with this section by a medical practitioner where, having examined the pregnant woman, he or she is of the reasonable opinion formed in good faith that the pregnancy concerned has not exceeded 12 weeks of pregnancy." It then details what needs to happen in section 13(2) and section 13(3) actually refers to the doctor carrying out the procedure and not conscientious objection.
At this stage, I should signal that I am likely to seek to tighten up that language on Report Stage. At the moment, it states that the medical practitioner, that is, the doctor who has certified that he or she is going to carry out the termination, should then move to do so as quickly as possible. That is, effectively, what it means. That is for all of the reasons people have outlined for the importance of early access to the service and not waiting until the 12-week limit approaches or expires. It is an instruction in law that, once the three days have elapsed and certification has taken place, the doctor should move to provide the procedure as quickly as possible, which is not a legal phrase, in accordance with the legislation. I am going to tighten up section 13(3) slightly on Report Stage because I think the phase "shall make such arrangements as he or she shall deem" is a bit wordy. I decided to wait until Report Stage to do that because I am coming back to the certification issue anyway. That section, therefore, does not relate to the issue of conscientious objection directly.
The amendments we are discussing on section 13 really speak to the timing for the woman.
That is right
I will bring the discussion back to that and perhaps we can step through it for clarity. A pregnant woman meets her GP, tells him or her that she is pregnant and gives her estimation as to how far the pregnancy has progressed in weeks. The GP consults with and examines his or her patient and then the GP will do one of four things. He or she will state that he or she is conscientiously objecting and there is a conversation about what happens. The second thing the GP might do is state that he or she is not willing to certify because, based on the dates given, he or she believes the patient is above 12 weeks and so is not willing to certify. The third thing the GP might do is certify that it does seem the patient is within 12 weeks and she should come back to the GP in three days to get, essentially, a prescription.
The other thing that can happen is not in the legislation but it has been part of the conversation. That is what happens between nine and 12 weeks. A GP might state that his or her opinion is that his or her patient is 11 weeks pregnant. There is then a question as to whether the GP has to refer the woman to hospital for ultrasounds to try to get a more exact determination of dates and when does the three-day period start. Will the Minister walk us through that? We will start with the scenario where a woman goes into a GP on a Monday. The GP may say that he or she is conscientiously objecting, will arrange the transfer and then have a more in-depth conversation about that. Does the three days start there nonetheless? As the legislation is written, I would say that it does not. It could then, however, take another two or three days, or more, for the woman to access a GP who has opted in, as we might say. It could take four days to find another GP and then the three-day clock starts. Will the Minister confirm that is the case and whether he agrees with that? It does not sound right to me.
We are pretty clear if the doctor believes the pregnancy is less than nine weeks. The doctor certifies and asks the patient to come back in three days. Will the Minister walk us through two situations? One is where the doctor conscientiously objects. What happens there in respect of the timing for this three days? The second case is where the doctor believes the pregnancy may be between nine and 12 weeks. What happens there? Critically, what happens in regard to the timing and in respect of what medical practitioner may be required to make the arrangements?
I will. The first part of the Deputy's question brings us back to when does the three days start. We have agreed to work on that between now and Report Stage. At the moment, Deputy Donnelly is entirely correct in his reading of the legislation. The three days starts when the doctor has been seen and he or she has certified that legally and medically, which is more important, it is appropriate and legal for his or her patient to access a termination. Where I would differ slightly from the scenario Deputy Donnelly gave is that I hope if we get this right - and as he said this is in the operations space rather than the legislative space - we will not have a situation where women are walking into doctors' surgeries hoping they will find one. I need to emphasise that. I met many doctors, as did Deputy Donnelly. I refer to Southern Taskgroup on Abortion and Reproductive Topics, START, doctors, members of the Irish College of General Practitioners, ICGP or Doctors for Choice.
A number of doctors have made the point to me, including START doctors, that we need to help signpost services for women. Rather than a woman walking into a surgery on a Monday hoping she will be seen by the doctor, I hope that woman - either through word of mouth, because that is the way the world also works, conversations with fellow women in her life or picking up the telephone and ringing the 24-7 medically staffed helpline - would know that is what is going to happen. On the first point, therefore, Deputy Donnelly is right. The woman needs to see the doctor and be certified before the three days start. That is how it is currently construed in the legislation but we might decide, as a collective, to revisit that.
I thank the Minister. We have agreed we are all going to meet up before Report Stage. Whatever is the purpose of the three days - we all have different views as to why it is in there, it was not in the report to begin with but it is there and was in the Heads of the Bill - and whatever the period is, for many people it is a period of reflection. I also agree that this idea of calling it a "cooling off" period is wrong. Whatever is the right language, it is around a period of time between first meeting a doctor and a termination. When the Minister is considering Report Stage, will he reflect on whether that period will require the certification of a doctor? We are trying to create a three-day time period. I agree we do not want a situation, for the doctor or the woman, where someone is conscientiously objecting but it can happen. If a woman goes to a doctor that should also count as the start of a three-day period. The Minister might reflect on that. I am sorry, the Minister was going to go on to the second scenario where the doctor believes the pregnancy is between nine and 12 weeks.
Yes, I am. Legally in Ireland, as a result of this Bill and following on from the referendum, there will be no specific indication needed to access a termination up to 12 weeks. My understanding when it comes to the licensing of the medication is that once nine weeks is reached, it is medical best practice that the woman is referred to a maternity hospital. That is currently the situation, at least, accepting that licensing and practice can evolve. During the referendum campaign, everyone, including myself, spoke about zero to 12 weeks in the community setting. It has now transpired that nine to 12 weeks is likely to take place in the hospital setting. The doctor will refer the woman to the hospital setting. I am not endeavouring to hold any information back but how that will work is the job of the development of the clinical guidelines and, crucially, the model of care, being currently devised by the ICGP, the Institute of Obstetricians and Gynaecologists and the Royal College of Physicians in Ireland. I can tell the committee that good progress is being made on referral pathways. I am cautiously optimistic that those clinical guidelines and models of care will be agreed by the end of this month.
I will be happy to arrange for members of the committee to be briefed on it. I am also more than happy to take them through my understanding of it now, but it is being written and devised.
To reply to the Deputy's question, the doctor will refer the woman to the maternity hospital. Obviously, she would have to have a way of accessing the hospital in a timely manner because of the 12 week cut-off point and how best to do this is being worked out in the model of care. A huge amount of work is also being done to ensure there will be adequate access to ultrasound scans and so on during that timeframe.
As to when the three-day timeframe will commence, it is at the point at which the woman is certified in the hospital. As written, she has to be certified by the doctor who will carry out the procedure.
This issue needs further consideration. If a woman goes to her doctor on the Monday and he or she confirms that she is between nine and 12 weeks pregnant, he or she will then refer her to a maternity hospital. Let us say it takes three days for her to get to it, which means that she would be in it on the Thursday. Admission will not necessarily always be on the same day or the next. Let us say it is the Thursday before the woman is admitted for an ultrasound scan which is carried out by a nurse and there may or may not be a doctor present. We have to assume that there is a doctor present to confirm that the woman is 11 weeks pregnant and certify. It is at this point that the three-day timeframe will commence, which will take us through the Friday, Saturday and Sunday, but nobody will be available on the Sunday, which will bring us to the Monday. That does not sound like the intended consequence of the time period. I do not know what the right phrase is, but it seems to be that the three-day period is a pause. In that case, the law is not differentiating between an eight and a ten week pregnancy in terms of the three-day pause, but operationally there would be a world of difference. For example, the three-day period could increase to seven or eight days. Should we not be seeking to provide for this differential in the legislation?
It does provide for it. There is a challenge in getting this right. In looking at this issue, as we should be, from the woman's perspective the pathway on which the Deputy has taken us sounds like a fair description and we should absolutely work to improve it. The other piece at which we have to look is the doctor's pathway. In fairness, I am not sure how one could do anything different in this situation. The legislation provides that a doctor has to make medical decisions "in his or her reasonable opinion and "formed in good faith". We have to ensure the doctor will also be satisfied that he or she is acting in accordance with the law. That is where we are hitting a challenge because, as the Deputy rightly pointed out, it is hard to start the clock before the woman sees the doctor because he or she also has to be protected and satisfied that he or she is acting in accordance with medical regulations and the law. Marrying the two pieces is the challenge between now and Report Stage.
That is reasonable.
I am not saying there is not a better way to do it.
That is all perfectly reasonable. I think a reasonable way for it to be crafted is as follows. The woman goes to her doctor on the Monday and he or she is of a reasonable opinion formed in good faith that the pregnancy is between nine and 12 weeks. I imagine he or she could certify same but with the caveat that there is to be a referral to a maternity unit to check it. The certification could begin at this point. If the woman is in a maternity hospital on the Thursday and it is confirmed that the doctor's certification is correct, it seems that at that point the three days would have passed. That is how I would like to see it worded.
What the Deputy is trying to do, with which I agree, is to minimise the challenges and difficulties caused by the three-day period for the woman and the doctor. It is a challenge, as is evident from the length of time we have explored the issue today. Abortion will be legal in Ireland up to 12 weeks without a specific indication, as provided for in the Bill. Earlier we discussed the importance of communicating this legislation to the public, women and doctors. Communication, in terms of our best roll-out of the service, by which I mean doctors and the HSE, as opposed to the Minister and the Department, will be in line with the best medical advice. It will be on the importance of accessing services early in pregnancy. We already know that women do not need a communications plan to know this. We know from the statistics that the overwhelming majority who currently have to travel to the United Kingdom are accessing a termination before nine weeks. One does not see any reason that will change. One hopes the ratio will improve further because women will not have to travel because they will access the information they need through a 24-7 helpline. I make that point because the nine to 12-week piece and how the primary care community setting will interact with maternity services in terms of access to ultrasound scans and so on will definitely be a challenge. These are all operational matters on which Dr. Boylan and others are working. I would not like people watching this debate, or anybody else, to think it will be a significant number of women because if we get the service right in the interests of women, we will be providing the vast majority of terminations in the community setting as early as possible in pregnancy.
Following on from what Deputy Donnelly said, if a woman presents to a GP, he or she can confirm the pregnancy on the first visit.
Yes, the doctor can confirm that the woman is pregnant.
The certification that the woman is pregnant can be made at that point.
The doctor is required to confirm that the pregnancy is less than 12 weeks.
That is the piece on which we are working.
The certification could be made on the first visit, pending confirmation. The three-day timeframe could commence from the first visit, with the pregnancy to be confirmed with the ultrasound scan.
That is the concern I have raised. A doctor can certify on day one that the woman is pregnant, but he or she may not wish to carry out a termination. However, according to this provision, as worded, the doctor does not have to make arrangements for the carrying out of the termination until after the three-day period has elapsed.
Medical Council guidelines provide that the doctor should indicate to the woman on the first visit that he or she is a conscientious objector.
What the Chairman said is correct. The conscientious objection piece is in section 23 in Part III.
It references "as soon as may be", not the first day.
The Medical Council's guidelines interpret the law.
I know, but this is the law.
The Medical Council's guidelines are already in place.
Which is stronger - the primary legislation or the guidelines?
If somebody went to court and presented the guidelines as opposed to the primary legislation, what would be the court's position?
Primary legislation always trumps guidelines, but-----
If there was a doctor who wanted to frustrate, he or she could do so.
He or she could do so.
He or she could. On the issue of being a conscientious objector, where a doctor objects to the law and wants to frustrate, he or she will not be obliged to take any action until after the three-day period. There are doctors in Clonsilla in Dublin West who will and probably still do not prescribe contraceptives.
We must move on.
I will withdraw the amendment, but this issue needs to be examined.
It does. What the Deputy is seeking to do is not related to this section.
Section 13(3) is, I think, where the Deputy is placing her amendment. This is not about conscientious objection at all, but it has been good to have the discussion about it because it will come up. Under 13(1), the doctor has certified that the woman is opting in and will carry out the procedure. Subsection (2) describes what he or she must do before the procedure is carried out. Subsection (3) is just telling him or her, once the actions outlined in subsection (2) are taken, that he or she can proceed. Conscientious objection, genuinely and truthfully, does not arise under this section, but I take the general point.
I take the point because the Minister says legally "as soon as may be" is stronger than "as soon as possible".
It is legally stronger.
I am taking that point on board, but if nobody has read the conscientious objection bit, it could also be used in this instance to delay.
I will withdraw the amendment.
The Deputy cannot do so yet because we are discussing amendments Nos. 89 to 94, inclusive, together.
This is an important element of the subject matter of the legislation. We all recognise and accept that there has to be provision for conscientious objectors, whether they be consultants, GPs, nurses or other medical staff, but we also have to recognise that the State has a duty to let it be known, by one means or another, that certain practices will not deal with the full range of maternity services in the event that particular issues arise. One situation that worries me is where a woman presents - this has nothing to do with the three-day waiting period but with an emergency - to a GP or at a hospital and may have a condition that has the propensity to accelerate very quickly. Does the conscientious objection-----
We are not discussing the issue of conscientious objection yet.
I know that we are not, but we have been talking about it for the past hour.
If we can return to the amendment, we will get to the issue of conscientious objection eventually.
If the Chairman had said that an hour ago, we might have saved ourselves a lot of breath.
I did say it.
We have to be absolutely clear in what we are doing that we do not want to put women's lives at risk in a situation where an emergency can arise. There is not much sense in telling a woman afterwards that she should not have gone there because all of the staff were conscientious objectors. That could well happen. It is Murphy's Law that if something can happen, it will. Pregnant women have a right to know what circumstances prevail and the extent to which they can gain access to services. That does not take away from the right to have a conscientious objection. We need to deal with the issue urgently because I can think of cases in which an emergency did arise. While I do not know the cause of the problem, we do not want it to happen again.
We are still in early pregnancy.
I thought that we were discussing all of those amendments together. I did not realise that we were not.
To be fair to Deputy Durkan, he was only joining in where the rest of us were-----
-----which was further on in the Bill than where we actually were. The Deputy is entirely correct - conscientious objection is important. It has and will continue to have a legal basis, but it cannot ever trump the requirement for a medical practitioner to intervene in an emergency. I point to section 23(2) which states: "Subsection (1) shall not be construed to affect any duty to participate in a termination of pregnancy in accordance with section 11". That is the emergency treatment clause. It is very similar to the situation in the Protection of Life During Pregnancy Act.
I will not discuss the issue of conscientious objection. The discussion has deviated into the role of care pathways and clinical guidelines. While I do accept that some of the situations could occur where the issue of the nine to 12-week period arises, it is the doctors in the community who know what the relationship is with the universal maternity service. It is a waste of time for the committee to discuss woman Z who goes in and finds that she is over nine weeks pregnant. That is the job of the people delivering the service, be they in the community or the acute setting. It is at that point where the woman, potentially, as Deputy Donnelly said, will end up in a clinical setting due to not being able to confirm in the community whether she is nine or ten weeks pregnant, we will have to consider not sending her from Billy to Jack but letting her choose to go back to her GP or stay in the clinical setting, even though she is only seven or eight weeks pregnant, as opposed to hopping backward and forward between services. I referred to the woman who had to continue to tell her story. I know that the Minister is working with the medics.
I know that this matter is being discussed and will assist the Minister in any way possible to find the right pathways. Yesterday morning we discussed the definition of termination of pregnancy. Here again it is stated it ends the life of a foetus. I highlight that this will be a constant reference point and it is my considered opinion that it is a problem. It was also said - I wrote it down verbatim - the doctors would be clearly identifiable to those who wanted access. I counter that by saying the list of doctors will be clearly accessible to those who want to frustrate the provision of abortion services. I suggest anybody who is particularly interested in this area-----
Are they my words?
No, somebody else said it, not the Minister. I think it was Deputy Tóibín who said it. This afternoon we will head into the realm of Roe v. Wade in the United States. One of the clear strategies of the American pro-life wing is to frighten women, put undue barriers in their way and isolate and intimidate them. Another strategy is to intimidate doctors. Even those who genuinely believe in termination of pregnancy and a woman's right to choose are left in the difficult position in their personal life where it is not worth it to get up in the morning to find blood on their car or a barrier in their way or their families being abused. It is important that people be conscious of the similarities here with the methods used in the past in the United States. We need to try not to repeat those situations. I do not believe we will, but we need to be conscious of it now and in the future.
I want to speak about the issue of conscientious objection. Will I wait?
Even though everybody else has done so.
They should have asked for permission.
We strayed into dealing with it in error. Perhaps the Deputy can hold on.
I will not go back over the conscientious objection stuff, other than to say a suggestion was made that somehow institutions were involved in an objection, but we all know that an institution cannot conscientiously object.
It is silly to suggest that some might object.
It is probably more correct to say they should not, but we need to make sure that they do not. I do not want to talk about conscientious objection. My amendment is No. 94.
Yes, and it is included in this group.
It is included in this group. It is a very practical amendment designed to allow doctors the facility not to be in work on occasion. I have spoken to people who will be providing the service and they say there might be a conscientious provider - a person who wants to do the best for the women in his or her care - who might only work one day a week or one week in three. For whatever reason, he or she may have flexible working hours. This amendment simply means that care can be passed on. I bet the Minister a fiver that there will be objections to it but I cannot imagine what they might be because to my mind it is a simple and practical amendment.
Does the Minister want to come back in on that amendment?
I would not like to call it an objection. The principle here is the same discussion we had about the certifying doctor needing to be the same doctor, so I accept it is the same piece we are trying to rectify that the Deputy has identified here. I think we accepted yesterday that we have to try to find the best way of rectifying it, so it is in the same space.
It is. I want to get confirmation that we will have information-----
The Deputy will.
-----and the Minister's proposals in time for us to table amendments, if necessary, on Report Stage.
Absolutely. I believe I indicated that yesterday. Of all the areas we have discussed, which have been many, this is the one I am hearing about the most from the clinical community, and that this committee is hearing about, that needs to be clarified. The piece the Deputy is on is very important, and I take that point.
I thank the Minister.
I will make two brief points. The Medical Council guidelines do not require for arrangements to be made. They require that information be made available. There is a significant difference in that regard. The issue of abortion is highly contested, not just in Ireland or the United States. It is contested internationally. I do not agree in any way that any person who is seeking such an operation, or the person who will provide it, should be interfered with.
There is no need for Deputy O'Connell to be smart over genuinely articulated views being expressed here. If we want to have a reasonable conversation, we can do that without members trying to cut across each other. It is the case that most doctors do not want to get involved in this particular issue because of the nature of the operation, not necessarily because of how people see them or the difficulties it causes for them.
I have a right to reply.
No. The Deputy had an opportunity to speak. I will call her again.
I cannot see how the view of most doctors internationally, in the entire world-----
I said most doctors to whom I have spoken.
The Deputy did not say the doctors to whom he spoke.
It is clarified now. It is a limited number who have spoken directly.
A total of 650 GPs will not perform abortions. I would not say there is a person in this room who did not thank a GP or medical practitioner for the good work they have done over the years. They save lives. We all have family members whose lives a doctor did their best to save and it did not work out. These people signed up-----
Deputy Fitzpatrick, we strayed into the area of conscientious objection. We will try to speak to the amendment-----
The Chairman gave other speakers an opportunity. I will come to the point I want to make shortly. Is that okay?
Yes, but I ask the Deputy to speak to the amendment because-----
I know things can be done in different ways and, in fairness, the Chairman is chairing the meeting very well. He gave everybody else an opportunity to speak. I am not trying to make an issue of this but I am asking for one or two minutes to make my point.
I do not want to make any headlines over this because the Chairman is doing a fantastic job.
On those grounds-----
That is a ground for conceding, Chairman.
Flattery does work.
What I am trying to say is that medical practitioners should have the right either to agree or not agree to carry out abortions. When we go home from here tonight we will have a conversation with our spouses or partners. When I go home I will have a conversation with my wife, and my family is split down the middle, so to speak, in terms of pro-life and pro-choice. To be honest, I probably get the best education when I go home because I listen to both sides of the argument. I am pro-life, but I agree with certain aspects in terms of pro-choice as well.
The biggest problem we have currently is the shortage of GPs and we are doing nothing to deal with that. I know abortion will be legalised in Ireland. I mentioned earlier that Dr. Peter Boylan is travelling around the country to try to see which hospitals are available. We should be doing everything we can to recruit as many junior and other doctors as possible. I heard of an organisation last week that went to Australia for five or six days to try to encourage Irish people to return here to work in IT. We should be out there trying to encourage GPs, consultants and so on to return here. The recession is over now. If we are going to legalise abortion and are to do an average of nine, ten or 11 abortions a day throughout the country, our hospitals will not be fit for purpose to do that. We will then have abortion clinics throughout the country. I said from day one that Ireland is one of the safest countries in the world in which to have a child and I would like that to continue to be the case. We should be doing our best to recruit as many GPs as possible to work in this country.
I move amendment No. 90:
In page 10, lines 37 and 38, to delete “as soon as may be after the period referred to in subsection (2)(b) has elapsed but before the pregnancy has exceeded 12 weeks of pregnancy” and substitute “within 24 hours”.
I move amendment No. 93:
In page 10, after line 38, to insert the following:
“(4) If the medical practitioner referred to in subsection (1) is not available, another appropriate medical practitioner may make such arrangements as are specified in subsection (3).”.
I move amendment No. 94:
In page 10, after line 38, to insert the following:
“(4) Nothing in this section shall prevent a medical practitioner from transferring care for the carrying out of the termination of pregnancy to another competently trained healthcare practitioner.”.
The next group of amendments also relate to section 13 and are the final amendments to this section. Amendments Nos. 95 to 97, inclusive, refer to section 13(4).
I move amendment No. 95:
In page 11, to delete lines 1 to 3.
This amendment seeks to delete lines one to three in page 11, which define 12 weeks of pregnancy. As to the reason we are proposing to delete those from the legislation, I never thought I would see the day when we would have legislation in which women's menstrual periods are included. Why is this necessary? Presumably we have established medical practice as to how a pregnancy is dated, be it gestation or whatever, and it seems ludicrous to insert something like this into a law. This should be dealt with in medical guidelines.
There is a touch of "The Handmaid's Tale" to this. It is like something out of an episode from the TV series. We are in a parliamentary committee talking about women's periods being put into law. We should delete the reference. We trust doctors to have a conversation with a woman and to establish the duration of the pregnancy.
There are a couple of other things to back it up. Every day, people take abortion pills they have ordered online that they get from whatever source, one hopes from safe sources such as Women On Web. They are certifying themselves on a website as to how far they are into the pregnancy. We presume they are doing so honestly because we have not had reports of ill effects. The surveys that have been done by Dr. Abigail Aiken, who testified before the Joint Committee on the Eighth Amendment of the Constitution, that appeared in the British Medical Journal and The Lancet show that follow-up treatment was required in less than 3% of cases.
The reason I make the point is that there is a touch of paternalism here. We should trust women. That was the message of the referendum. I have spent the entire day listening to it being said that we cannot do anything because we talked to people about it during the referendum. My view is that we should learn from the referendum result. For six weeks we had a dialogue with the population. I and many others in the room knocked on thousands of doors and spoke to thousands of people. By the end of the conversation something more progressive and radical had emerged than what we thought previously. People told the exit poll that they trusted people and that they wanted people to make a choice.
It is very insulting putting that measure into a law. If the reason for it is to appease people who are opposed to abortion, I do not see why we should do that. We should delete the measure. Let doctors have a discussion with women to decide how far pregnant they are without the Legislature specifying measures relating to periods in the law.
I will speak to amendment No. 96, which I tabled. It is in the same vein as Deputy Coppinger's amendment. I support everything she has just said. I do not understand why we need the words "last menstrual period" or any reference to women's menstrual bleeding in the legislation. It is crass and inappropriate.
Currently, the Bill states the dating of pregnancy shall be construed in accordance with the medical principle that pregnancy is generally dated from the first day of a woman's last period. There are those who believe that life begins at conception, but the Bill suggests that life could begin ten days before one has sexual intercourse. That is a fundamental issue if one uses a date when a woman is not actually pregnant. We discussed this at considerable length in the committee. Because I asked for it, we got a document from somebody and it is in the file. It showed what way European countries date pregnancies. Some do it from the point of implantation and others from the first day of the last missed period. We need to look at what we are trying to achieve here and what the measure is trying to achieve. I cannot find a reference in any legislation to menstrual bleeding or women's periods. I cannot understand this obsession with women's periods and menstrual bleeding.
Could we simply alter the wording to say that dating a pregnancy shall be construed in accordance with current medical principles? If the Medical Council adopted the idea that pregnancy was from the point of implantation then we would have to amend the current wording. It throws up problems. I am trying to be helpful. The measure would be future-proofed against medical advancements in the event that we would be able to track the fertilised egg down the fallopian tube. Technically, one could argue that, pre-implantation, one has the genetic material to make a person in nine months. My suggestion covers medical advances but we must also consider irregular cycles and that cycles and ovulations are based on averages. This will cover people who might have a six-week menstrual cycle or who throw out two eggs a month. I am not an expert in this area but I know about it. All sorts of individual cases arise and I do not think what is proposed is fit for purpose or future-proofed and my amendment addresses those issues to some extent. I object to the fact that women and their private bodily functions would be prescribed in legislation. Women comprise 52% of the population, although I accept they would not all be menstruating. As a woman, I find the measure offensive.
I agree with the other Deputies. I do not think it is appropriate that the day of a woman's last menstrual period should appear in legislation. That is crass and unnecessary. To be fair, three women have spoken and we have made our views known. There has been much talk of speaking to this and that group, but I cannot imagine the Minister spoke to any group that was cheerleading for this measure. Deputy O'Connell's amendment makes sense and it does not use such language, which I do not think is necessary. I do not think it exists in other legislation-----
Perhaps it does, and it should not be there either given the views that have been expressed. I do not understand where the cheerleaders or proposers of such a measure would be coming from. Deputy O'Connell's amendment makes eminent sense.
I concur with Deputy O'Connell. From a practical point of view it can be quite difficult to determine the first day of a last period. First, it may not be remembered or it may not be accurate. Quite often when women present for ultrasound scanning, the date of delivery is altered on the basis of the scan because the date given as the approximate date of the last menstrual period was incorrect. There often has to be an adjustment on the expected date of arrival. Current medical practice is much more encompassing from a practical point of view.
I thank Deputies O'Connell, Coppinger and O'Reilly. This does appear in other laws. I will get the details of where that is for the sake of completeness. Although I take very seriously the points made by the three Deputies, and the points made in the letter the committee received yesterday from the Institute of Obstetricians and Gynaecologists' foetal medicine guideline development group, which has sought absolute clarity as to what is 12 weeks, members will recall that I had conversations with people in this room in advance of and during the referendum campaign on how we define 12 weeks of pregnancy. We do not need to reopen the entire debate again but we discussed whether it was ten weeks plus two or 12 weeks plus two or if it was 14 weeks. I genuinely take very seriously what the Deputies say in terms of the language being crass, but it was done in consultation with medical practitioners with a view to providing them with clarity as to what 12 weeks mean. I will read the note that has been prepared for me. I do not think the phone that is interfering with the sound system is mine.
Does somebody have his or her phone on, which is not allowed, or is it near the microphone?
It is not my telephone. I will read my briefing note as opposed to me explaining this. Twelve weeks of pregnancy has been defined in accordance with the medical principle that pregnancy is generally dated from the first day of a woman's last menstrual period, LMP. Given that termination of pregnancy is to be permitted where a pregnancy has not exceeded 12 weeks, it was considered important, including by medics, and we heard this again from them in the letter yesterday, that a definition would be included in the legislation that was clear and unambiguous. That is what Deputies O'Connell, Coppinger and O'Reilly want to achieve as well. It is essential that legislation would be clear, particularly for medical practitioners providing services and obviously for women. We do not want a situation where doctors are wondering if something is legal or to have the chilling effect of doctors being uncertain as to whether they can or cannot enable a woman to access a termination. The definition in the legislation accords with the definition of 12 weeks of pregnancy that is commonly used and understood in medical practice. It does not endeavour to deviate in any way from normal medical practice but to be a definition that is readily understood by both medical practitioners and women.
In light of the serious views expressed by the three Deputies and the section on gestation that we received in the letter yesterday from the IOG's foetal medicine guidelines development group, I will engage further on this. We must arrive at a point where the language is acceptable and where there is absolute clarity as to what is 12 weeks. The people voted for 12 weeks, but 12 weeks plus two weeks is 14 weeks. I do not wish to rerun the referendum campaign but I must stay honest to the principle of 12 weeks while taking on board what the Deputies said.
We discussed this at length in the committee on the eighth amendment. The Minister said "generally dated". Yes, in Ireland pregnancies are generally dated as the Minister described, but I imagine that is because the eighth amendment was in place. Perhaps it was not, but I argue that it was. Jurisdictions date it differently, and I believe there is scope there to move without compromising the ten to 12 weeks or eight to ten weeks.
It is highly embarrassing to put something like this in legislation. It is the element of control of women that we should have broken with from the past. With regard to the referendum, I do not recall many conversations on the doorsteps in which I discussed menstrual periods-----
-----but there were a few in which I tried to explain that 12 weeks are really only ten. One saw elderly males on the doorsteps who were flummoxed by what we were saying. That refers to the claim that the people fully grasped that. The reason I proposed deleting it is the reference to current medical practice. What does that mean in legal terms? Does it mean it keeps changing or is it current to when we vote? I agree with Deputy O'Connell. Dating a pregnancy from one's last period, given what the doctors and the Chairman said, is highly unscientific in some ways, and there could be an advancement next week whereby we can exactly date a pregnancy. If we insert something like that, we are inhibiting any advancement. In addition, we do not go into details about men's health in such a way in legislation and we should not do so about women's either.
Members will recall that one of the issues before and during the referendum campaign was how one can definitely and categorically date a pregnancy. We got into what I considered a very unhelpful conversation about how every woman who wanted to access a termination was going to be obliged to have a scan, which is not medically necessary and not best practice. There was a need to land somewhere that provides clarity as to what 12 weeks are. Through the committee we decided to provide in legislation for no specific indication as a ground and we capped it at 12 weeks. There was a need to try to capture what 12 weeks were and, without scanning every woman accessing a termination, the sense was that using the LMP provided clarity. I have heard what the Deputies have said and I will reflect on it, but in doing so I cannot deviate from the fact that there is a 12-week limit on the no specific indication. I do not believe anybody is asking me to do that but that is the challenge we must try to address.
I move amendment No. 96:
In page 11, lines 2 and 3, to delete "with the medical principle that pregnancy is generally dated from the first day of a woman's last menstrual period" and substitute "with current medical principles".
I hope we can fix this. I believe it is possible.
We resume in public session. When we suspended, we had completed our consideration of section 13. We now move on to amendment No. 98 which proposes a new section 14.
I move amendment No. 98:
In page 11, between lines 3 and 4, to insert the following:
“Protection of infants born alive
14. (1) In this section, “born alive” means the complete emergence of a foetus from the body of the woman, regardless of the state of gestational development, who, after emergence, whether or not the umbilical cord has been cut or the placenta is attached, and regardless of whether the emergence occurs as a result of natural or induced labour, caesarean section, termination of pregnancy or otherwise, shows any evidence of life including, but not limited to, one or more of the following:
(b) a heartbeat;
(c) umbilical cord pulsation; or
(d) definite movement of voluntary muscles.
(2) In this section, “infant” means a foetus who has been born alive as a result of the carrying out or attempted carrying out of a termination of pregnancy under this Act.
(3) A medical practitioner shall take all steps as may be appropriate and practicable to preserve the life of an infant.
(4) For the avoidance of doubt, the fact that the infant has been born alive as a result of the carrying out or attempted carrying out of a termination of pregnancy under this Act shall not be a relevant consideration for a medical practitioner when determining what constitutes an appropriate and/or practicable step under subsection (3).”.
During the campaign, I met a woman who told me she was the survivor of an abortion. At that stage, I did not realise there was such a thing as people who survived abortions. She told me that in her situation, thankfully, a medical practitioner who was at the location of the abortion intervened after it to provide her with comfort and sustenance. I was shocked that this had happened. I carried out some research after that and found that in Canada between 2000 and 2010, there were 491 occasions on which an unborn child survived an abortion but was significantly injured and was allowed to expire. In those cases, doctors did not provide any medical assistance to the child so that it could survive. In any given year in Britain, there can be up to 66 not unborn but born children in this situation who have survived an abortion but are injured and allowed to expire. This amendment is neither a pro-choice or pro-life amendment. It does not do anything about access to abortion. All it means is that we ensure that a person born in that scenario is protected. My own instinct is that it would surely never happen in Ireland and that if a person made it through, all necessary medical help would be provided. However, I have indicated two international examples which suggest that we should clarify the position and go forward by ensuring that in those cases lives are protected.
Failed abortions happen. When I spoke on Second Stage in the Dáil, it was suggested to me that they did not, but that is not correct. Deputy Tóibín has given the examples of Canada and England and Wales. This amendment provides clarity and guidance for doctors by creating a duty to act to save the life of a child born alive after an attempted abortion. The amendment identifies criteria such as breathing, a heartbeat, umbilical cord pulsation or the movement of muscles which should be taken into account to oblige a doctor to act to protect the life of the child. Over the course of the hearings, the Minister said the biggest problem he had in relation to abortion was the lack of clarity for doctors. This amendment clarifies the action for doctors. Importantly, it does not dictate to the medical profession what steps might be appropriate in any given care scenario.
It is routine in countries with legalised abortion that doctors in one part of a hospital are doing everything possible to save a premature baby born at 23 weeks while in another part of the same hospital a baby at 24 weeks' gestation is having its life ended by abortion. The only difference between the babies in that scenario is that one is wanted while the other is not. We cannot allow this to happen in Ireland. Amendment No. 98 ensures the scandal of children being left to die in other countries will not happen here. The amendment does nothing to prevent access to abortion or to stop a woman availing of legal treatment, but it will avoid the gross human rights abuses which take place when the law fails to clearly protect babies who survive abortions. In the course of hearings here and during the referendum campaign, the Minister has often used the word "compassion". This amendment is all about compassion and care for one of the most vulnerable people in our society, namely, a tiny baby who has just survived the trauma of abortion.
It would be unbelievable if the Minister rejected an amendment which did nothing to prevent access to abortion and which is all about saving lives. We cannot create a situation in Ireland where doctors in one part of a hospital are doing everything possible to save a premature baby born at 23 weeks while in another part of the same hospital a baby of 24 weeks, born after surviving an abortion, is left without life-saving care for whatever reason. The amendment is sought to provide clarity and certainty to doctors as to how to proceed when an abortion does not result in the death of a baby. It makes it clear that where there are indications of life, there is a duty to act to save that life. Nothing could be more compassionate and clear. The amendment will assist doctors significantly in the carrying out of their duties. We must also be cognisant of the human rights abuses of children who survive abortions and are then left without care. We have plenty of evidence of this problem from England, Canada and elsewhere where babies born alive after botched abortions are left alone in hospitals to die without care from medical staff. We cannot license human rights abuses here. Abortion in Ireland will be legal up to six months into a pregnancy in some cases and we can only hope the number of children who experience the cruel after-effects of failed abortion procedures will be few and far between. However, we must ensure at the same time that those children are cared for. That is what this amendment is all about.
We have felt it necessary to table this very important amendment. A year ago, I met a lady downstairs in Buswells Hotel, which is across the road, who had been aborted herself but was now 39 years of age.
She explained what happened. Her grandmother insisted that her mother abort and her mother duly had the abortion. A nurse who was passing by heard a little groan or moan from the baby in a bucket and asked the matron if the baby was still alive. The matron told her to carry on, that the baby was dead but she came back and it proved that, when the baby got attention, it lived. It is worrying that babies can feel pain much earlier in the pregnancy than 21 or 22 weeks. To go on with the story, the baby was seen afterwards and survived. We are asking that if a baby lives after coming out of the womb, it should get every intervention that is medically possible to ensure it gets the same chance at life as everyone else. As the previous speaker said, one could have a scenario where, on one side of the hospital, a mother, for one reason or another, has to have an early birth at 21 or 22 weeks and everything is done to ensure her baby is kept alive. We do not want a scenario where, just because a baby has been aborted, it does not get the same attention.
A few weeks ago, I had the good fortune of seeing a baby who was born at 22 weeks, weighing a little over 1 Ib. He was a lovely little boy and is now six months old. He is small but he is coming on and will live. It is sad, in one way, that we lose babies, but if the baby arrives and is still alive outside the womb, I am asking the Minister to please ensure it gets every possible medical intervention and every help and assistance possible to be allowed to live. That is what this amendment is about and I fully support it.
I am supporting this amendment, which states:
A medical practitioner shall take all steps as may be appropriate and practicable to preserve the life of an infant... For avoidance of doubt, the fact that the infant has been born alive as a result of the carrying out or attempted carrying out of a termination of pregnancy under this Act shall not be a relevant consideration for a medical practitioner when determining what constitutes an appropriate and/or practicable step under subsection (3).
This amendment provides badly needed clarity, to which the Minister often refers, in guidance for doctors in creating a duty to act to save the life of a child who is born alive after an attempted abortion. Like Deputy Danny Healy-Rae, I have met a number of survivors of attempted abortions. The amendment identifies criteria such as breathing, heartbeat, umbilical cord pulsation, movement of muscles, etc. The Minister, over the course of the hearings, has said that one of the biggest problems with the law on abortion in the past year was a lack of clarity for doctors. We might disagree about that point but if the Minister has indicated a lack of clarity, this amendment is an opportunity to make it clear.
It is important to note that the amendment does not dictate to medical practitioners what steps might be appropriate to take in any given case. It will obviously vary with circumstances, including in particular the stage of gestation of the foetus and into infancy, and different considerations will naturally apply. For example, if the infant is born alive after the point of viability, the amendment clarifies that the fact that a termination of pregnancy was sought by the pregnant woman, or certified under the Act, does not per se alter the duty owed by doctors to take appropriate steps to preserve the life of any child born. It is a reasonable amendment and I am hopeful it will be accepted. We have seen evidence and figures from Canada and other countries. Over a ten-year period starting in 2000, 481 babies who survived botched abortions were abandoned by medical staff and left to die alone in the corners of hospitals. It is unbelievable that this would happen.
I hope this amendment will be accepted as it gives clarity to medical professionals. The circumstances in which people survive abortions might be rare but, as others have said, they have met people who survived them and are living proof. I also met the lady Deputy Danny Healy-Rae met and the incredible relationship she now has with her mother is second to none. She was fortunate that, after the abortion, she was seen by a medical professional several times who observed her heartbeat and decided to give medical intervention and save her life. A baby who survives an abortion deserves every right to medical treatment so it can continue to live. The amendment will provide clarity for medical professionals.
I also support the amendment. The first time I met a person who had survived an abortion was when Deputy Mattie McGrath introduced me to a lady who had visited him here in the Dáil. During that conversation, the enormity of what happened to this young person struck me. I looked at and spoke to this lady and the enormity of the way she came into the world was a profound experience for me. I was grateful to Deputy McGrath for introducing me to her because it opened my eyes to what can happen and things that I would not have understood. A doctor would understand them, but people like me would not. That is why I feel strongly about this important amendment. There are sound medical reasons for bringing it forward as it will give clarity to medical practitioners as to what they should or should not do. It would, I presume, be abhorrent to all of us if something was done to a baby who had survived an abortion other than allowing it to live. I hope I am explaining myself properly. I wholeheartedly support this extremely important amendment.
The purpose of this legislation is not to regulate obstetric procedures which do not constitute termination of pregnancy, nor is it to dictate the practice of obstetrics, or medicine generally, to obstetricians. It would not be appropriate for the committee to do so. Medical practitioners are always required to maintain professional standards and uphold medical ethics and are bound through professional regulatory mechanisms to deliver medical services in accordance with best medical practice. However, the detail of best medical practice is always set out in clinical guidelines rather than in primary legislation. The purpose of primary legislation is not to set out treatment plans or compulsory care pathways. That is not our job as legislators. I certainly would not fancy giving advice to the master of a maternity hospital on how to care for or deliver a baby or how to care for a woman. That is the job of highly qualified obstetricians.
Let me be clear: I have not come across one doctor working in our maternity services who seeks this clarity, because they already have it. They care for newborn babies every day they go to work regardless of the circumstances.
One aspect that was not mentioned in any of the Deputies' contributions, perhaps disappointingly, was the woman. The idea that any woman in Ireland would leave a baby in a bucket, which is a reference to a phrase that one of the Deputies used, is a shock tactic. Whether it is intentional or otherwise, it is insulting to doctors and to women. Doctors know how to care for babies. They care for every single new life that comes into the world daily and they do a darn good job. If anybody wishes to take a trip, I suggest going to the neonatal intensive care units in Holles Street, the Rotunda or the Coombe, and I am sure the masters of any of our maternity hospitals would be more than delighted to show how much they care for life at its most vulnerable stages. I would happy for my office to arrange that for any of the Deputies. The idea that doctors would not care is not borne out by reality. The Deputies have all heard multiple times from the masters of maternity hospitals and the Institute of Obstetricians and Gynaecologists. The only people who suggest that doctors would not care are a group of politicians in Leinster House. It is not borne out in medical practice or in the standards to which our doctors adhere. It is a poor reflection the Deputies are trying to cast on women in this situation. While I do not doubt their bona fides, I fundamentally disagree with them and it is has no place in the law. We do not put compulsory care pathways and treatment plans in law. I am not, therefore, in a position to accept the amendment.
The Minister should not blame me for seeking clarity on this. Until now, there have been no abortion clinics in Ireland. We have maternity hospitals - and I know what happens in them - but I wish matters to be clear not only for myself but for all the people who voted in this referendum. I want clarity about whether that baby will get the same treatment, because it was not clear in the Bill until we started discussing it. The Minister can criticise me if he so wishes and say I am this or that for stating the lady's baby was thrown into a bucket, but that is what happened to her and she said it herself. I am not making it up or adding one iota to it. I make no apologies for getting clarity as to what will happen or for asking for every intervention possible for a baby who is aborted and who, in the first place, is not wanted by anyone but who ends up alive for a number of minutes. It is not wrong or unfair of me to ask that that baby gets the same care and nurturing that another baby of the same age delivered in a maternity hospital in some other part of the country would get.
The Minister should not criticise me or say that I am being disingenuous. I have the same regard for mothers and babies. We know the mother will be seen afterwards but it was never clear - and it will not be clear until it is included in the Bill - that the baby will also be seen afterwards. The Minister may think I get enjoyment out of talking about these things but I certainly do not. I was elected by the people and I find myself here making the case and asking questions. We have tabled only 16 amendments, which we found important to put down and put our names to, and we do not want to be criticised by the Minister or anyone else for tabling them. All we wanted was to get clarity and surety that an aborted baby will get the same treatment. The Minister should not criticise us on whatever platform he has. He is the Minister and he is supposed to be the expert.
We all got the job of legislating. The people voted and I will abide by their vote but we must put a fair Bill in place to provide for all eventualities. If an eventuality arises where a baby arrives and he or she is alive outside the womb, I want to ensure that baby will be appropriately seen afterwards. We do not know what happens in an abortion clinic because we have never been there and we have never had an abortion clinic in Ireland. That is what we wish to ascertain and the Minister should not belittle us.
I answered the question when I said that our doctors care for every life born in a hospital. The Deputy asked me a question, which I answered and which I am now answering a second time. Many medics appeared before committee meetings in advance of the referendum outlining why the constitutional change was needed and how much they care for all babies born in their hospitals. To suggest they do not care, therefore, is a slur on our medical profession.
The Deputy claimed that there are not any abortions in Ireland but that is factually incorrect. He may or may not have supported it but the Protection of Life During Pregnancy Act allows women whose lives are at risk to have access to abortion. That law has been in place for a number of years and every year more than 20 take place. It is factually incorrect, therefore, to say that terminations do not take place in Ireland.
The Deputy also referred to abortion clinics. I presume he is referring to our maternity hospitals and maternity units staffed by our obstetricians.
I know we have the best doctors and we depend on them, but it all depends on what the doctors are told to do. I wish to be clear that in the abortion regime if a baby arrives alive, after having gone through the abortion process, he or she gets the same rights and interventions that are available to him or her from the medical services.
There is a dual approach here in the different amendments. At the start of our deliberations yesterday, the Minister stated that he would accept none of the pro-life amendments. However, he is to some extent making an effort to meet or technically facilitate some of the other pro-choice amendments, which is a pity. The Minister said we never referred to women in our discussion, but all the people we mentioned were women.
I said "the mother".
The Minister said we never referred to women. These are both women and mothers and we mentioned them in our opening statement. These are people who have survived due to someone obviously intervening in a medical fashion to protect their lives. There is nothing in the amendment that determines what type of treatment or pathway of treatment is provided or any such thing. Rather, it requires that treatment is provided. This debate often arises when people like me compare and contrast international examples but people say it would never happen in Ireland. The implication is that Irish people are morally superior in some way to those in other countries and, therefore, Irish doctors will not make the same decisions that are made in Canada or Britain. I do not think anyone is superior in any country; doctors are doctors and people are people. We know that when we legislate in this regard, legislation can often change social norms and that is the concern.
It is a genuine worry. It is not an effort to make any difference to the legislation with regards to access; it merely seeks on this occasion to make sure that in a case where a person is born and injured, he or she would be protected. Clarity would be useful in this regard.
The Minister mentioned that nobody is talking about the woman or the mother and that is highly insulting. We are putting forward amendments to protect the unborn, if there is an abortion where the child survives. We are putting forward this amendment merely to ensure protections are put in place for medical professionals.
There will be cases where women will not be medically able to make a decision after having an abortion. Certainly, I am aware, from talking to the lady to whom we spoke, who is the woman I referred to both about her mother and herself and the great relationship they now have after her survival, that we need to put those protections in place and ensure if something like this happens that at least the medical professionals know.
We are not undermining any medical professional. We are going down a different road. The Minister may say abortions are taking place in Ireland but they are rare and they are undertaken in extreme circumstances to protect the mother's life. We need to ensure these safeguards are put in place and this amendment will ensure they are.
I do not like attacking anybody but I feel sometimes the Minister is talking down to us regarding our amendments as if we are here to cause as much disruption as possible; we are not. We have kept our amendments to a minimum. These are sincere amendments. This is a sincere worry among some, which I share, that these safeguards need to be put in place.
I am disappointed in the word the Minister used with regard to terminology that my brother used where he described the fact of something that happened. The Minister accused him of engaging in shock tactics. It is not a shock tactic if one goes in front of people and states a fact that happened in real life. That is not made-up stuff. That is not a politician being sensationalist. It is a politician telling a truth of a life's experience that he and others had and for the Minister to try to put a person down because of stating a fact is not in keeping with his form. The Minister is better than that and he should not engage in that type of activity.
Coming back to what Deputy Michael Collins stated, the Minister gives the impression that it is as though he wants to ridicule us, try to find fault with, and punch holes in our 16 amendments. For the office that he holds and for an intelligent person, that is not a proper way for Deputy Harris to be carrying on. He should listen to what we are saying and take it on board. If he is to beat us, he should beat us but not try to ridicule us for holding firm the views that we have. We are, after all, representing an awful lot of people. We are democrats.
Following the referendum, I was asked whether I would engage in trying to hold the legislation up for as long as possible, and I clearly stated I would not. What we are doing here, as the Chairman will be well aware, is not blackguarding the system. We are not trying to hold anything up. We are not speaking for a minute longer than we have to. We merely want to make our points. That is why I am so disappointed with the Minister's reaction to our amendments.
The way the Minister answered this amendment was to go off on a tangent talking about the protection of the child. We are talking about being inside in a room in a clinic - the Minister can call it whatever he likes - where the purpose is for a baby to be aborted. Then the Minister talked about expecting the emphasis to be on protecting the life. It will not be about protecting the life if one is inside in a room where an abortion is to take place. If one is in that room where the baby is to be aborted and the baby is alive for one reason or another, we want clarity about what will happen it at that stage. That is what we are talking about here.
The Minister replied to something completely different that we never stated in the first instance. We are being clear about what we are talking about. It has been stated by every member on this side that we want to know if that life is to be protected if it is outside of the womb, if the baby has a heartbeat. The Minister did not answer that. He went off on a completely different matter, trying to ridicule it and trying to say that is what doctors do - they save lives. That is what doctors have been doing all along but we are talking here about legislating for ending life. We are looking for protections and measures to be put in place and for there to be clarity for our doctors. There are many doctors, GPs and others, up and down the country who have asked us to raise these matters. The Minister, more than anybody, should appreciate what we are trying to achieve here.
I, too, am disappointed with the Minister in the way that he is talking down to us as if we were trying to hold the legislation up. We have 16 amendments; there are 180 overall. That answers that assertion. We were being accused of intending to filibuster and do God knows what.
For the purposes of clarity, I reiterate that official figures in Canada show that over a ten-year period, starting in 2000, 491 babies who survived abortions were abandoned by medical staff and left to die alone in the corners of hospital. In the UK, the confidential inquiry into maternal and child health revealed that in one year, 66 babies were born alive and left unaided to die after failed abortions in England and Wales. These figures shed a light on the chilling reality of legalised abortion without protections for children who survive an abortion. The fact that these practices are rarely talked about in public does not diminish one iota the horror of what takes place. It is routine in countries with legalised abortion that doctors in one part of the hospital do everything possible to save a premature baby born at, say, 23 weeks, and I am testament to that as I have a grandchild who was born at 23 weeks thanks to the hospital staff and who the Chairman has met, while in another part of the same hospital a baby at 24 weeks' gestation is having his or her life ended by abortion. It is insulting for the Minister to state we do not respect what the staff do in those hospitals and to give us a lecture. In my grandchild's case, I note the work that went on in both Clonmel and at Cork University Hospital, CUH, in the neonatal ward. We are so blessed to have her in school now.
As for the Minister talking down to us, I have visited an abortion clinic. I have been in a maternity hospital. I have eight children and four grandchildren, and am expecting two more. I know the ins and outs of it and respect the work they do. As for the Minister trying to stigmatise us as bashing the doctors, more than 600 of them signed the petition looking for an EGM because the Minister has not consulted them.
I am talking about doctors.
They are not obstetricians.
The only difference between the two babies I have described in that scenario is that one is wanted and the other is not. We cannot allow this to happen in Ireland. This amendment makes sure that the scandal we have seen in other countries of children being left to die will not happen here.
This amendment is clear. It does not hold up anything or try to stop the abortion process. It will do nothing to prevent access to abortion or to stop a woman availing of a legal treatment but it will avoid the gross human rights abuse that happens when the law does not clearly protect babies who survive abortions.
I have met a number of people. The Minister could have met them too as they asked to meet him but they were not allowed in and he referred them back to the committee. They could not get a pro-life doctor, we were told, to address the committee. That answers that.
I had nothing to do with the committee.
The Minister stated that the committee heard from obstetricians and doctors. We were told by the secretariat and the Chair we could not get a pro-life doctor, which was totally untrue.
The Minister has often used the word "compassion" during these hearings and during the referendum campaign. This amendment is all about compassion and care for one of the most vulnerable persons in society, a tiny baby who has just survived the trauma of an abortion.
It would be unbelievable were the Minister to reject this amendment. I reiterate there is nothing to prevent access to abortion but it is all about saving lives. We cannot have a situation where doctors in one part of the hospital are doing everything possible to save a premature baby born at 23 weeks, for example, while in another part of the hospital, a baby born after 24 weeks, born after surviving an abortion, is left without life-saving care. Doctors need to know what to do. They cannot be tied. This is why this amendment has been put down. We trust doctors, of course. This amendment has been sought to give clarity and certainty to doctors on how to proceed when an abortion does not result in the death of a baby. It makes it clear that where there are indications of life there is a duty to act to save that life. Nothing could be more compassionate. It is clear that this amendment will significantly assist doctors to carry out their duties.
We must also be cognisant of human rights abuses for children who survive an abortion and are left without care. This is not a theoretical problem, as we have plenty of evidence of such cases in England, Canada and elsewhere where babies born alive after botched abortions are left alone to die in hospitals without care from medical staff. We cannot allow such human rights abuses to happen here. Perhaps we can, according to the Minister. We met that lady from America, and her story was just riveting. It was wonderful to see her alive and telling her story. Abortion is going to be legal in Ireland until six months into a pregnancy in some cases. We can only hope that the number of children who experience the cruel after-effects of failed abortion procedures will be very low. At the same time, we have to ensure they are cared for. This amendment not about grandstanding. We have 16 amendments in total. Other amendments are described as very important, but ours are ridiculed and rubbished. It is not a good way to proceed. The Minister is talking down to us about hospitals. I have been in more maternity hospitals than the Minister will ever see. I wish the Minister well. I know plenty about what goes on in hospitals and the excellent work by the nurses, doctors and others. I have been in abortion clinics in America - perhaps the Minister has not - and have seen the horror of what goes on there. We are not backward people. We have a right to be here and have been elected to be here. I seek fewer lectures, please.
This amendment is all about the protection of infants who are born alive. I have been present for most of the last two days, and we have mentioned women many times. We have said numerous times that we have nothing but respect for women. The Minister is clearly under pressure because what he said was a cheap shot. The Minister always says that he is looking for clarity. We are looking for clarity. Is the Minister aware that babies are left alive after botched abortions, lying in corridors? Is the Minister aware that the confidential inquiry into maternal and child health revealed that 66 babies in one year in England and Wales dies without medical aid. Is the Minister aware of that?
I am not the Minister for Health in Canada. I am introducing Irish legislation in Ireland.
I asked the Minister a question. Is he aware of these things?
I will respond when the Deputy is finished.
The Minister is constantly talking about compassion and clarity. It is only a matter of time before this becomes an issue, and our hospitals will not be able to cope. If abortion takes off and there are thousands of abortions every year, our hospitals will not be fit to look after these abortions. Therefore, there will be abortion clinics coming to Ireland and all I seek is clarity as to whether doctors or whoever carries out these abortions in clinics are fully aware that if an abortion is botched and the child survives he or she must look after the child. I might not have mentioned women in my last speech, but I mentioned the Minister's name many times. The reason I mentioned his name is that I want him to make sure that this amendment is carried. He is looking for clarity, and we are providing clarity. We are asking the Minister to listen to us. Has the Minister made up his mind? Will he throw aside all of our amendments? Are we all wasting our time coming here today? He is the Minister for Health, and we have asked him to listen to us. He has mentioned that he has one or two favourites on one side of the committee. Has he no favourites on this side?
That is not relevant to the amendment.
The Minister stated that he has favourites on one side of the committee room. I do not mind if he has no favourites over here. We are only seeking a fair hearing. The unborn child deserves protection, and the Minister of Health has no intention of providing that protection.
That is not a fair comment at all.
That is what it looks like. The Minister has his mind made up already.
I thank the Deputies for their contributions. I always try to engage respectfully on this matter. Deputy Michael Healy-Rae has a depth of feeling and passion but so do I. I am thinking of the many women who have experienced human rights abuses in our country because of our current legislative situation. We are trying to change that. Deputy Mattie McGrath has spoken about human rights abuses. Many human rights abuses have been perpetrated on women. Deputy Kelly and I have sat in rooms with some of these women, as have others, while they outline the human rights abuses they have suffered in this country. Passions are running high on both sides of the argument.
It is not a matter of having made my mind up yet or not. I have a right - indeed, an obligation - to try to respond to the questions I am asked. The Deputies can call it lecturing if they like, if they do not like the answers. They have the right to describe it however they wish. I will answer the questions to the best of my ability based on the information available to me and on my perspective on this issue. My perspective has been endorsed overwhelmingly by the people of Ireland in the recent referendum. The Deputies can call a vote on any amendment here or in the Dáil if they wish; that is how parliamentary democracy works. It is not a matter of my mind being made up. My mind is made up. I intend to pass the Bill in line with what I promised the people I was going to do. We are testing amendments here. I was concerned by the lack of reference to the woman in this situation because it is highly relevant. The Deputies have referenced women who survived abortion, but-----
Some Deputies have telephones, which are interfering with the recording.
The amendment refers to "infants born alive". Infants born alive are cared for in our maternity hospitals already. This amendment suggests that there is some doubt about that. There is a suggestion that if this is not included a doctor will hear a crying baby and not care for it. We are talking about situations where the baby has reached viability and is alive. I agree with Deputy Mattie McGrath that viability cannot be defined by the number of weeks. We have not done that in this legislation, because viability moves and changes depending on the pregnancy, the woman, whether there are multiple births, and indeed modern medicine.
The Deputy is correct when he says that we have not defined viability, and that babies can sometimes be viable at a younger age. However, we are talking about situations of viable pregnancies, where the woman has wanted to have her baby, and one of three things has happened: the woman is about to die; the woman is about to experience a risk of serious harm to her health that could result in her death; or she has had the devastating news of a fatal foetal abnormality. Perhaps the baby has no brain or no heart. I accept the bona fides of the Deputy, but it should be remembered that these are wanted babies and a terrible situation or tragedy has occurred. Our laws are very clear, unlike laws in other countries. I can tell Deputy Fitzpatrick that I do not know what Canadian law is like, but I am familiar with the Irish law and it is very clear as to viability. Abortion is not allowed in Ireland where a pregnancy has reached viability. I do not make the point about visiting maternity hospitals flippantly but the doctors who run our maternity hospitals sat in these rooms and made it clear that every single intervention is provided in those situations. Of course people want to save the life of any baby. A number of Deputies have suggested that hospitals have two wings, and that in one wing babies are looked after and in the other, babies are put into buckets. I believe that many people watching this at home can understand how I find that very hard to engage in. I find it quite upsetting. I cannot accept these amendments.
I will talk briefly about my locality. I sought the figures for the time since the introduction of the 2013 Act and, although somewhat delayed, I received them. They are small. There is talk about the wing of a hospital but we are not talking about Dallas. I am speaking about South Tipperary General Hospital where there are two cubicles. They are not at either end of the hospital; they are right beside each other in the same place. It is very caught for space and overcrowded. I have been there. Thankfully, everything was successful each time and I cannot praise the staff enough. Both procedures took place in the same labour ward. We are not speaking about a wing of a hospital; we only have a small hospital. God knows it has suffered enough but they do an excellent job in maternity care there. They are excellent at all other care but especially maternity. It is not as cold and bleak as that. No one asked the Minister to be Minister for health in Canada but surely when we are making legislation we are obligated to look at best practice and worse practice.
If the Minister wants to read through my notes, what I said was it is routine in countries with legalised abortions that doctors in one part of the hospital do everything possible to save a premature baby born at 23 weeks while in another part of the same hospital a baby at 24 weeks gestation is having its life ended by abortion. I said it is routine in other countries where abortions are legalised, which is why I keep mentioning Canada, the UK and Wales. I also said Ireland is one of the safest places in the world to have a baby. I said all of this. I do not want Ireland to become the same as Canada, the UK or Wales. The Minister has an opportunity to protect the unborn baby. We want the Minister to state that the child who survives an abortion will be given as much medical aid as possible. That is our suggestion, which is simple. The Minister keeps asking for clarity. I am speaking about countries that have legalised abortion. Currently, abortion is not legal in Ireland. Before this happens, I am giving the Minister an opportunity to protect the child that survives an abortion.
I thank the Deputy. The question is-----
Will the Minister answer that? He mentioned earlier on-----
I can answer it one final time. This is not about the unborn child; this is about the child that is born, and the Deputy is asking whether a child born in a maternity hospital regardless of the circumstances in which he or she came into the world will be looked after by our medical professionals and receive all of the medical support and treatment that is appropriate and, yes, he or she will.
- Donnelly, Stephen S.
- Durkan, Bernard J.
- Harris, Simon.
- Harty, Michael.
- Kelly, Alan.
- O'Connell, Kate.
- O'Reilly, Louise.
I move amendment No. 99:
In page 11, between lines 3 and 4, to insert the following:
"Administration of anaesthetic or analgesic to foetus
14. (1) A medical practitioner who carries out a termination of pregnancy shall take all steps as may be appropriate and practicable to avoid causing pain to the foetus.
(2) Where the medical practitioner who is carrying out a termination of pregnancy is of the reasonable opinion formed in good faith that the gestational age of the foetus is 20 weeks or more, he or she shall administer or ensure the administration of an anaesthetic or analgesic to the foetus prior to the carrying out of the termination of pregnancy.
(3) Subsection (2) shall not apply where—
(a) 2 medical practitioners certify that they are of the reasonable opinion formed in good faith that the administration of an anaesthetic or analgesic to the foetus would pose a risk to the life, or of serious harm to the health, of the pregnant woman in respect of whom the termination of pregnancy is being carried out, or
(b) a medical practitioner proposes to carry out a termination of pregnancy in accordance with section 11 and it is not practicable to comply with the obligation in subsection (2) because of the particular circumstances of the case.
(a) an anaesthetic or analgesic is administered to a foetus in accordance with subsection (2), or
(b) subsection (3) or (4) applies, the medical practitioner who carries out the termination of pregnancy shall include this information in the notification forwarded or caused to be forwarded to the Minister under section 21(1).".
This amendment is proposed from a humanitarian perspective. There is a lot of research that shows babies in the womb are seen to have a physical and biochemical response to injury and pain from as young as a foetal age of 20 weeks and for definite from a foetal age of 24 weeks' gestation. The amendment does not in any way seek to restrict access to abortion and does not change one iota of the heads of the Bill that were published before the referendum. It is not a pro-choice or pro-life amendment in any way. It simply states that in the case where there is a potential for pain to be experienced by an unborn baby in the womb during abortion that we take a precautionary perspective and ensure no operation is undertaken that allows for pain to be experienced.
If I lived forever, I could never understand why anybody would not want to support this amendment. As Deputy Tóibín has stated, we are not looking to change anything or water down anything. If there is a possibility of an unborn child feeling pain the Chairman, who is a doctor, will know more than any of us that something should help alleviate the pain that might be suffered otherwise. Which one of us can say clearly that pain would not be suffered? Who here can state that he or she is 100% sure and certain the unborn child would not feel pain? If we thought they were to feel pain, surely to God this is a very human thing to seek to do. There is nothing wrong with seeking this amendment. I would be extremely surprised if the Minister or anyone else had a problem supporting it. I would have to have it explained to me as to why anybody would be against this. I am more than willing to listen to somebody with a differing viewpoint. If there is somebody, I would love to hear what he or she has to say because I cannot understand it. I cannot understand why somebody would be fundamentally against this because to me it seems like a very ordinary decent human thing to want to protect an unborn person from suffering or feeling pain.
I support the amendment. We are told abortion is an invasive and violent procedure for the unborn child. All we are asking is that whatever anaesthetic or pain relief is to be had, that it be administered in the course of the abortion to ensure the little babies suffer the least pain possible in the last seconds of their time in the world. It is a small request. When we meet people in pain, and elected representatives meet many of them every day, we try our best to see what can be done to minimise or reduce it and relieve them of whatever pain they have.
It would be remiss of us as elected Members if, when discussing the Bill, we did not ask for whatever pain relief is possible to be had to help the poor baby not suffer pain.
This amendment imposes a duty to minimise pain to the foetus where appropriate and practical. Medical science has shown that babies in the womb respond to injury and pain. We have a duty to ensure compassion and humanity for the child and to apply the precautionary principle that pain should be prevented wherever possible. Surgeons recognise unborn babies as patients and anaesthetic is routinely used for babies undergoing surgery in the womb. Surely the same should apply in the case of surgical abortions. It would be horrifying and unnecessary for Irish unborn children to suffer needlessly during an abortion. To prevent this, the Government must accept the amendment requiring unborn children to be given pain relief before an abortion procedure wherever there is a reasonable possibility of pain being experienced. I hope the Minister has a good look at this.
I was quite shocked to see the extreme nature of the Bill. We are dealing with a human life, whether the Minister wants to accept that or not. The fact this has not been factored in is beyond belief. Like others here, I am acting according to the wishes of the electorate, more than 723,000, including "yes" voters, who would like to see this put into the legislation. Nobody wants unnecessary suffering or to inflict any unnecessary suffering. It is clearly the duty of compassionate and humane doctors to act on the precautionary principle of prevention of pain if there is any risk. Scientific research from around the world has shown that babies in the womb feel pain before 20 weeks. All we are doing with this very reasonable amendment is asking the Minister to show compassion for the unborn baby by accepting the amendment.
The people inherently recognise the humanity of the unborn child. We need to acknowledge this humanity by obliging medical professionals to minimise the pain of abortion procedures. Surgeons recognise unborn babies as patients and anaesthetic is routinely used for babies undergoing surgery in the womb. Surely the same should apply in the case of surgical abortions. It is not too much to ask. The Bill envisages surgical abortions in certain circumstances beyond 12 weeks’ gestation. Clearly there is a possibility that some of these unborn children are capable of feeling pain, yet the Bill as it stands has no requirement that unborn children are given appropriate protection from pain during abortion procedures.
There are differing views on this. In April 2018, the master of the National Maternity Hospital, Dr. Rhona O'Mahony, said a foetus does not feel pain until 26 or 27 weeks. A 2010 Royal College of Obstetricians and Gynaecologists report on foetal awareness inferred the foetus has the capacity to feel pain at 24 weeks. Experts observed in a recent paper that a common precautionary principle is imposed whereby the absence of possible damage must be demonstrated before giving, or in this case before withholding, a potentially useful treatment that we would expect to be used.
We are pleading for humanity. I am sure nobody in the room wants to inflict pain on anybody. This is why I have proposed the amendment and I plead with the Minister to accept it.
Medical science has shown that babies in the womb respond to injury and pain. We have a duty to ensure compassion and humanity for the child and apply the precautionary principle that pain should be prevented where possible. I fully support the amendment. The Bill envisages surgical abortions in certain circumstances beyond 12 weeks’ gestation. Clearly there is the possibility that some of these unborn children would be capable of feeling pain, yet the Bill as it stands has no requirement for unborn children to be given appropriate protection from pain during the abortion procedure. I fully support the amendment.
I cannot accept the proposal to include a separate section in the Bill that provides for the administration of an anaesthetic to a foetus. The purpose of the legislation is not to regulate or dictate the practice of obstetrics. Medical practitioners are bound through their professional regulatory mechanisms to operate in accordance with best medical practice. The requirements in sections 10 to 13, inclusive, for medical practitioners to be of a reasonable opinion formed in good faith emphasise that doctors must maintain professional standards and uphold medical ethics.
It is simply not appropriate to include detailed medical treatments, compulsory care pathways or treatment plans in legislation. We do not do this even for the woman in the legislation, such as detailing what medication must be prescribed to her. The type of detail is best set out by our clinicians in their clinical guidelines rather by politicians in primary legislation. I have assured my colleagues, and I am happy to do so again, that in parallel with service planning and expansion work, clinical guidelines for medical practitioners on termination of pregnancy are also in preparation. That work is being undertaken by the Institute of Obstetricians and Gynaecologists, the Royal College of Physicians in Ireland, and the Irish College of General Practitioners. The Department has provided financial grant aid to support this work to enable their timely and efficient completion. These clinical decisions and how clinicians operate belong in the clinical space decided by clinicians in their guidelines. It is not for us to prescribe medication or treatments in the Oireachtas.
It is amazing that we have to fight for pain relief for an unborn living individual who is at least likely to or does experience pain. It is an issue for politicians to decide upon whether they should or not. We had a correct conversation earlier where Deputies from the other side said if something is in primary legislation, it is much stronger than if it is in medical guidelines. This is an ethical and moral situation and question. It is not a guideline or a pathway decision. Any of us should have the confidence to state that we oppose an operation that causes pain to any individual and that we will use the tools that we have, politically and democratically, to ensure that it does not happen. Passing the buck to somebody else to do this is incredible. This is the mildest and most unifying of all the amendments, and the fact that we have to fight for this is amazing.
I am the same. I just cannot understand it. The Bill envisages surgical abortions in certain circumstances beyond 12 weeks’ gestation. Clearly some of these unborn children are capable of feeling pain, yet the Bill as it stands has no requirement for unborn children to be given appropriate protection from pain during an abortion procedure. What is the resistance? Surely all of us know what pain is like and understand it. It would be horrific and unnecessary for Irish unborn children to suffer needlessly during an abortion. To prevent this, the Government must accept the amendment requiring that unborn children be given pain relief before an abortion procedure wherever there is any reasonable possibility of their experiencing pain. It is a human right. It is about our respect for the dignity of all human beings. They must be pain free where they can be and where medicine is there to make something pain free or less painful.
The Minister made the point that it is up to clinicians, but surely he as Minister for Health can advocate for pain relief and ensure something is included or some commitment is made to ensure that unborn babies do not suffer needlessly. That is all we are asking him to do.
The position is not one of having to fight for anything. It is a question of where it is appropriate to deal with various issues. It is appropriate for the legislation to set out policy parameters of how a regulation of termination of pregnancy service will work, and the most appropriate people to talk about the administration of anaesthetics are medically qualified people and not politicians. I have never administered an anaesthetic in my life and I am not sure that anyone in the room has. Perhaps the Chairman has done so. The appropriate place for these issues to be decided is by clinicians in clinical guidelines.
It is important that clinicians do their job and legislators do theirs and that we not get in each other's way in that regard. Clinicians will decide appropriately what medications, treatments and care pathways to put in place. We will provide them with the parameters of the grounds on which termination is legal in Ireland. It is not the job of this Bill to regulate obstetrics. It is simply the Bill’s job to outline how termination of pregnancy services will be regulated.
As a Deputy, does the Minister personally support pain relief being provided to individuals in an operation that causes pain?
I trust our clinicians to know what is appropriate to do.
I am asking for the Minister's personal view.
That is not the question the Minister was asked.
That is my view.
The Minister is saying that he will not answer the question.
If I am asked a question, I can answer it. The Deputy gets to ask it and I get to answer it. He asked me what I believed. I said that I trusted doctors to make the appropriate decisions regarding this matter. Deputy McGrath cited evidence from the master of the National Maternity Hospital, Dr. Rhona Mahony. I attach a great deal more weight to what she has to say about this than what I have to say. I am not qualified to answer that question.
The Minister has given an answer to a question that I did not ask. When I asked him whether he personally had a perspective on this, he said that he would defer to other people's perspectives. That does not negate his opportunity to have a perspective himself in any way at all. He has refused to answer the direct question about his opinion as an individual regarding seeking pain relief for individuals in an operation that could cause pain.
I am not here in the personal opinion space. I am here as the Minister for Health in Ireland and as a Deputy for County Wicklow. In both roles, I decide to allow those qualified to make the appropriate decisions. My constituents and the people of this country would much rather decisions about the administration of anaesthetics and medication be made by people who know how to administer them and what is appropriate rather than by politicians like me, who are in no way qualified to make those calls. The way I arrive at my opinions is evidence-based.
Next I will call Deputies Fitzpatrick and Danny Healy-Rae.
I am seeking guidance. I am not a doctor either, but am I correct in saying that the first injection in an abortion is to paralyse the foetus?
I cannot tell the Deputy.
This matter arose at the eighth amendment committee. The first injection paralyses the foetus and the second injection stops the heart. That seems cruel and is the reason I am seeking guidance. All we are looking for in this amendment is some pain relief. The Minister mentioned how he would take medical advice. He should ask them what sort of pain a foetus feels.
This is cruel. I am not going to discuss the graphics of abortion, as this is day-time television, but will the Minister please speak with the people from whom he will get medical advice and then revert to us?
I am horrified to think that it was too much to ask of the Minister to accept our amendment, which would ensure that, in an abortion, the little baby would be administered pain relief for its last few seconds in this world. It is difficult to expect that the Minister would prevent people in Kerry from roaring with the pain of hip or knee operations for four or five months-----
That has nothing to do with the amendment.
Deputy Danny Healy-Rae, that has nothing to do with the amendment.
It would be very-----
Deputy Danny Healy-Rae's comments are all about politics.
-----when the Minister would not do this for a small, defenceless baby about to leave the world. I will make no apologies for saying it.
There is no need to make an apology. Does Deputy Michael Collins wish to comment?
Staon: Deputy Margaret Murphy O'Mahony.
- Donnelly, Stephen S.
- Durkan, Bernard J.
- Harris, Simon.
- Harty, Michael.
- Kelly, Alan.
- O'Connell, Kate.
- O'Reilly, Louise.
I move amendment No. 100:
In page 11, between lines 3 and 4, to insert the following:
“Provision of foetal ultrasound imaging and auscultation of foetal heart tone
14. (1) At least 24 hours before the carrying out of a termination of pregnancy the relevant medical practitioner or a qualified person assisting the relevant medical practitioner shall perform ultrasound imaging of the foetus and auscultation of foetal heart tone.
(2) The active ultrasound image referred to in subsection (1) must be of a quality consistent with standard medical practice, shall contain the dimensions of the foetus, and shall accurately portray the presence of external members and internal organs of the foetus, if present or viewable.
(3) The auscultation of foetal heart tone referred to in subsection (1) must be of a quality consistent with standard medical practice.
(4) Before or during the imaging and auscultation services referred to in subsection (1), the relevant medical practitioner or the qualified person, as the case may be, shall offer the pregnant woman, orally and in person, the opportunity to view the active ultrasound of the foetus and hear the heartbeat of the foetus, if the heartbeat is audible.
(5) At least 24 hours before the carrying out of a termination of pregnancy the relevant medical practitioner shall certify that—
(a) foetal ultrasound imaging and auscultation of foetal heart tone have been performed,
(b) the pregnant woman has been offered the opportunity to view the active ultrasound image of the foetus and to hear the heartbeat of the foetus, if the heartbeat is audible,
(c) the pregnant woman either—
(i) requested to view the active ultrasound imaging and hear auscultation of foetal heart tone, or
(ii) opted not to view the active ultrasound imaging and hear auscultation of foetal heart tone.
(6) The relevant medical practitioner shall obtain the signature of the pregnant woman on the certification referred to in subsection (5) verifying that it is factually correct.
(7) A medical practitioner who contravenes subsection (1), (4), (5) or (6) shall be guilty of an offence.
(8) A person who is guilty of an offence under subsection (7) shall be liable—
(a) on summary conviction to a class A fine or imprisonment for a term not exceeding 12 months, or both,
(b) on conviction on indictment to a fine or imprisonment for a term not exceeding 4 years, or both.
(9) In this section—
“auscultation” means the act of listening for sounds made by internal organs of the foetus, specifically for a foetal heartbeat, utilising an ultrasound transducer and Foetal Heart Rate (FHR) monitor or similar device;
“midwife” means a person whose name is for the time being registered in the midwives division of the register of nurses and midwives established under section 46 of the Nurses and Midwives Act 2011;
“nurse” means a person whose name is for the time being registered in the register of nurses and midwives established under section 46 of the Nurses and Midwives Act 2011;
“qualified person” means a nurse, midwife or medical practitioner who is competent to perform foetal ultrasound imaging and auscultation of foetal heat tone services;
“relevant medical practitioner” means—
(a) in the case of a termination of pregnancy to be carried out in accordance with section 10 or 12, the obstetrician by whom the termination of pregnancy is to be carried out, and
(b) in the case of a termination of pregnancy to be carried out in accordance with section 13, the medical practitioner who has certified or is required to certify his or her opinion as to the matter referred to in subsection (1) of that section;
“ultrasound” means the use of ultrasonic waves for diagnostic or therapeutic purposes, specifically to monitor a developing foetus.”.
There are two critical elements to this. First, at least 24 hours before the carrying out of a termination of pregnancy, the relevant medical practitioner or qualified person assisting the relevant medical practitioner should perform an ultrasound imaging of the foetus and auscultation of foetal heart tone. The Minister stated that this would not be necessary medically at that stage. His view contradicts that of a large number of medical professionals, not least Dr. Peter Boylan, chair of the Institute of Obstetricians and Gynaecologists, who explicitly informed the Joint Committee on Health on 19 September 2018 when it was discussing the clinical guidelines for the introduction of abortion from nine to 12 weeks that it would be necessary to have an ultrasound as a dating mechanism in that respect. He told the committee: “Figures vary but in Scotland, for example, about 30% of women will require a scan for uncertain dates and it will probably be something similar here.” He spoke about the risks of introducing a termination of pregnancy service in this State without adequate scanning facilities and how there were infrastructural deficits in the provision of access to ultrasound in pregnancy in Ireland. That deficit raises concerns regarding this process. When giving evidence at any level to us regarding this procedure, the first thing that many doctors indicated was that they did not have ultrasound machines in their offices and they were not skilled in their use.
There is also an issue with ectopic pregnancies in this scenario. There is a danger, if an abortion pill is prescribed and consumed, that that abortion pill will not have an effect on an ectopic pregnancy. If that ectopic pregnancy is not discovered, that can be a threat to the mother's health, which is a major issue. The issue of allowing for an ultrasound scan to be taken has been discussed by many senior medical professionals. The medical professionals the Minister has tasked to run this particular service have said it is necessary. Certain doctors are concerned that if they are involved in the delivery of a treatment that does not fully understand the dangers with regard to ectopic pregnancy, it could be a threat to the mother's health and could also be a threat to them in the future. The threat to the mother's health is the primary concern there.
The second element of this amendment is information. I have been pro-life for a great number of years, although I was not always. In all that time I never denied that information should be offered or provided to people. I have always been of the view that access to information is really important for people to be able to make proper choices. Informed consent is based upon access to information. I have been struck by a number of women who have come to my constituency clinics and said that they had had abortions but that they did not realise how developed the unborn child was at the age gestation that the child was. They did not have that full information and they regretted that that information was not provided or at least offered to them.
The amendment only seeks to offer this potential to a woman who is pregnant. It does not seek to coerce, even though I know some people have said it does. It just seeks to offer. In that case it is a pro-choice amendment because it gives the choice to a person to accept or decline that offer. Given that the Minister is in favour of choice, surely this choice should also be offered to the woman in that circumstance.
I support the amendment for the reasons that have been stated. I do not want to be repetitive. Deputy Tóibín has made the salient points I would have made and I support his comments.
I support the amendment and thank the other speakers. I wish to clarify something that has been misquoted elsewhere. A pregnant woman is offered the opportunity to view an active ultrasound imaging and hear auscultation of foetal heart tone. She can opt not to view the active ultrasound imaging or the auscultation of foetal heart tone. Some people have tried to twist this in different ways that were never intended. The Chairman and I know that ultrasound equipment is available in very few GP surgeries. The Minister knows of one place where it is available in Clonmel in County Tipperary. They offered it to the HSE to be used for south Tipperary and west Waterford but after long meetings - the Minister visited to see it himself and I thanked him - they were offered a contract for only ten days and it was pulled after eight. That is more mismanagement in the HSE, but that is not why we are here.
I am just reminding the Minister that he was there and saw it. Very few surgeries have it. That is a massive medical centre - a wonderful practice - with up to 11 or 12 doctors, but most GPs will not have such facilities in their surgeries, nor would they have the broadband in many remote areas to work it or have the experienced people to read it.
Do we want to have the best possible assessment? The Chairman is a GP and I had discussions with him in private, which I will not divulge. As regards pregnant mothers, there is a different gestation for different reasons. It is not deliberate; they just might not be sure. This would be one way of telling. In the case of a termination of pregnancy to be carried out in accordance with sections 10 or 12, we have the reasons behind this and it is all about being accurate about dates and times, and what the best treatments are. The Chairman or somebody else said earlier that certain medications can be administered at certain stages of pregnancy and not after certain stages.
We just want the best for both patients at this stage - the mother and baby. We want the offer of viewing an ultrasound or listening to the heartbeat, not enforcement. I repeat that it would not be compulsory. It is the offer of that. If the mother opts not to see it or listen to it, that is her choice; she is entitled to do that. We not about coercing people at all. We want to use the best diagnostic equipment that is available in some areas but not in others. We want that opportunity to be there.
I will speak once on this set of amendments. People are entitled to table amendments, but some people have learned nothing from the debate we have had in society in the past year in particular. Either people genuinely do not understand how offensive some of these suggestions are or they do not care or they do not interact with people who have been in these situations. I had not planned on speaking because there is no point in giving oxygen to some of these things. I was laughing at some of the details in the amendments such as the DVD. On foot of these amendments, I was contacted by a young relative, who was livid and outraged which was triggered by some of this offensive stuff. She has recently been through the trauma of a fatal foetal abnormality with twins, an experience which stretched out for months. It is unforgivable that the six men who just mansplained to the whole population have no understanding of the trauma of people who have to go through a late abortion. They talked about being left alone and so on.
We had a referendum, involving misogynistic posters in which the shaming of women was roundly rejected by the electorate. There is no point rehearsing the discussions we had during the referendum campaign, but I wanted to pass on that people were genuinely upset by these amendments.
Those on the other side failed with their stuff during the referendum and they now want women to be forced to have ultrasound scans, for the HSE to give them written material if they want to take the abortion pill and to be forced to watch a DVD. DVDs went out with the Ark by the way. How offensive it is to require them to listen to a heartbeat. Savita Halappanavar is dead because through the miscarriage she was experiencing, there was still the detection of a foetal heartbeat. These Deputies want to force a woman who is seriously ill to listen to this. As well as that-----
I believe the Deputy's phone is interfering.
Sorry about that.
In addition it is proposed to have a prison sentence for a doctor who does not offer all these things. The only impact of all the amendments is to delay and shame anybody who seeks an abortion. They should go and educate themselves. For example, the number of late-term abortions-----
I ask the Deputy to stick to the amendment.
As has been pointed out, only 0.1% of all abortions are late and they occur in the most tragic situations. The other abortions that are routinely done using the abortion pill take place up to 12 weeks' gestation, which would be the basis of this legislation. Even the thing about the burial, one would be burying a blood-----
We will get to that amendment in a moment.
I do not intend to keep coming in so it is better if I speak on them all.
One would be burying a bloodstained sanitary pad. I hate to be graphic but that is the reality. This shows a lack of understanding of the facts and an insensitivity. I do not want to have a big debate on this but I want to pass on that people feel that some members have learned nothing from the interaction we have had with the population over the last year.
I am delighted to have the opportunity to clear up a few matters. Firstly, the amendment is not misogynistic because I am a woman and I was also involved in tabling it.
That is all right so.
Excuse me but I did not interrupt the Deputy while she was speaking so I am going to continue.
I also want to clear up the issue of misrepresentative reporting of this amendment in the media which is totally unacceptable. We are asking for balance here. There was laughter in here as we discussed pain relief as well and I ask members of the media to convey that because they are here. Laughter is coming from one side of the committee room and I would bring that to the attention of the public. We are in here trying to do our best with an extreme Bill. We respect the will of the people but many "Yes" voters have sent me in here to soften this extreme Bill and that is what I am here to do. I will respect the voice of pro-life people as well because I am pro-life. I am trying to be fair but what has gone on here today is disgusting and disgraceful and many false reports and false statements have been given.
The Chairman might be aware that the Amárach Research survey findings show that eight out of ten people agree with women having "the choice". How many times have we heard that wording of having "the choice" here today? They are not being forced in any way to have an ultrasound scan.
They are not being forced to.
The Minister has talked about the best clinical practice and all of that and I want to make the point to him that many experts in this field - I would not include Dr. Boylan in that but that is my personal opinion - have pointed out that they feel it would be beneficial to have ultrasound equipment available in hospitals. We are asking the Minister to take that on board. I ask for the disgraceful and disrespectful behaviour in here to stop. Laughter while we are discussing pain relief for unborn children is disgusting. We are dealing with human life here, so I ask for it to stop. Since I came in here at 3 o'clock there has been laughter and it is disgusting. The Minister has talked about respect so where is that respect?
None of us in here has a monopoly on education or wisdom and it is not right to have such a personal attack directed at us because we are here to try to lessen the savage impacts of a cruel and heartless Bill, as Deputy Nolan said. I have heard the laughter and scoffing. We had it during the Joint Committee on the Eighth Amendment of the Constitution too and the media overwhelmingly tried to brush it under the carpet because it was coming from the right side. We would say something, there would be laughter and it would be in the headlines, so I ask the media to have some respect for the views of the people we represent.
I accept the will of the people and it is of the utmost importance to stress that. Contrary to the fundamentally misrepresentative reporting that has taken place on this matter, the amendment does not oblige or force a pregnant woman to view any ultrasound image or receive any information on the imaging and monitoring performed. That is a fact and that is what is in the amendment. It was carefully crafted with legal assistance.
Deputy Nolan quoted the Amárach Research but I will give the committee the facts of it. The Amárach Research survey findings, which were published last month, found that almost eight out of ten adults agreed with offering women the choice of seeing an ultrasound image. Excluding those who said they did not know, the survey found that 74% of those who identified as "Yes" voters in the recent referendum also agreed with the statement that women should be offered the choice of seeing the ultrasound. Members all quote polls when it suits them but if the Minister is genuinely sincere in his wish to implement the will of the people, then we can see no reason this amendment should be rejected.
There is no question of women being forced. It is being offered, which I said at the outset, but some journalists chose to run off and have a field day with it. The importance of ultrasounds for determining the gestational age of the unborn child and for protecting the health and life of the woman who is undergoing an abortion cannot be overstated and the Chairman knows that as a GP, particularly in circumstances where there are concerns about dating the pregnancy or where there are ectopic pregnancies.
As I said, Dr. Boylan, who committee members usually laud, was chair of the Institute of Obstetricians and Gynaecologists and he explicitly informed the Joint Committee on Health on 19 September 2018, when it was discussing the clinical guidelines for the introduction of abortion services, that from nine to 12 weeks women will require hospital management, which in turn raises the question of ultrasound as a dating mechanism. According to Dr. Boylan's testimony at that committee, figures may vary, but he referenced Scotland where about 30% of women will require a scan for uncertain dates so it would probably be something similar here. That is from the man members all want to hail.
Dr. Boylan also spoke about the risks of introducing termination of pregnancy services in this State without adequate scanning facilities and how there are infrastructural deficits in the provision of access to ultrasound at present. This deficit raises serious concerns with respect to the intention of the Minister for Health to roll out abortion services nationally as early as January of next year. These concerns were confirmed by Dr. John O'Brien on behalf of the Irish College of General Practitioners, ICGP. In reply to Deputy Donnelly, Dr. Mary Favier of the ICGP informed the committee that the evidence base on the need for ultrasound scanning is becoming clearer. Dr. Favier went on to say that if ultrasound is acquired, rapid access to this facility, including the expert provision and interpretation of sonography will be a critical element of the pathway. A 24-hour helpline staffed by properly trained clinical staff will be required. She further noted that GPs have expressed concerns on capacity and resourcing challenges such as staffing, facilities, training, the potential lack of appropriate specialist support, the possibility of medical complications for their patients and fear of litigation. All those points underscore the necessity of introducing a legal obligation to perform an ultrasound for both the woman and her doctor. Those are not our words in support of this amendment. The taking of medicines and all of that has to be considered as well because doctors need to know what treatments they can administer as the Minister said himself.
This is nothing to be scoffed at. These are people we like to quote and I will take no lecture from Deputy Coppinger or anyone else on how uneducated we are or whatever. She seems to have a monopoly on all this and on respect for democracy. We have to face the people too, and we will. We represent people as well, and we are entitled to do so.
Two doctors who I know well have been referenced in the last few minutes.
Firstly, in the opinion of Deputy Nolan, Dr. Peter Boylan is not an expert in the field of obstetrics. Dr. Boylan was the chairman of the Institute of Obstetricians and Gynaecologists, he was the master of the National Maternity Hospital in Holles Street, he has delivered tens of thousands of babies and he has cared for tens of thousands of women so those are the sorts of experts I like to listen to in working out what is best for women and for babies.
That is the Minister's opinion.
It is not my opinion. That is his CV.
Other medical practitioners who have worked with him would disagree with the Minister.
That is his CV, so privilege or otherwise we should not-----
I suggest that a CV is not the best indicator of a person-----
The Deputy gets very testy. Come on now.
Allow the Minister to respond.
She is trying to instruct the media what to report on and now she is trying to tell me what to say.
No, I am just asking the Minister to-----
Let us say that just because people have-----
This is like "The School Around the Corner."
Is the Deputy ready?
I am ready for "The School Around the Corner."
I thank the Deputy. Maybe he should go back to school.
The Minister should go back to school. It is Tony O'Brien's opinion that he should have stayed there.
The Deputy is sniggering.
They were the best of friends.
I thought laughing was banned in here. I am ready. Can we talk about the issue, namely, that the Deputy wants to subject women to ultrasounds?
Who quoted Dr. Boylan in his defence?
I will not allow anybody to slur the expertise of any medical professional under parliamentary privilege and that is the point I am making.
Dr. Boylan, as a medical professional, is an expert in this field and so too is Dr. Mary Favier. I do not speak for her but I am pretty darn certain she has a different perspective from Deputy Mattie McGrath in respect of this matter. She would not like her name being used in support of or aligning with the Deputy's arguments. Dr. Favier is working extraordinarily hard to facilitate the roll-out of the services for women from January and this can be seen with many of her public comments in recent days.
Deputy Tóibín made a fair point about the importance of access to ultrasound. He also correctly quoted Dr. Boylan, who said there are circumstances in which ultrasound may well be clinically needed. He correctly indicated that from the period of approximately nine weeks - I am quoting Dr. Boylan and others - there may well be need for recourse to ultrasound. Of that there is no doubt. In the drawing up of clinical guidelines and care pathways under way now, our doctors are deciding when a woman needs access to an ultrasound. I am not drawing up the clinical guidelines and nor should I but the Deputy may well be right that it may be the case that the majority of cases from nine weeks on may require this. Of course, that is not what the amendment is about, and it is not just dealing with that period.
This amendment would make it mandatory for every woman to have an ultrasound. I accept the Deputy stating that the screen could be turned away and it would not have to be shown to the woman or the woman would be asked if she wanted to see the screen. The Deputy has incorrectly criticised some journalistic reporting of this because the amendment stipulates that the medical practitioner "shall perform ultrasound imaging" and that the practitioner shall then certify that this has been done. The amendment also stipulates that after the imaging, the pregnant woman must sign to indicate that the imaging happened and that if the practitioner does not do this, he or she could end up serving a jail term of up to four years. It is pedantic and I accept that the Deputy is not saying the woman must look at the ultrasound but he is indicating that the woman must be subjected to an ultrasound. He is stating that a rape victim or anybody in the position, including, as Deputy Coppinger has said, an extraordinarily ill person, must be put through an ultrasound. This would make ultrasounds mandatory and that is a statement of fact. There is no doubt that this is the legal effect of what the Deputy is trying to do with the amendment.
The Chairman will know my next point well and Deputy Mattie McGrath made reference to it. Access to ultrasounds for all pregnant women and other people through our health service is very important. The idea is that we would make it mandatory to scan every woman who needs a termination when there is no medical reason for the scan. No doctor would believe that these women would need to be scanned in some of these circumstances. This could end up depriving women who may need a scan or access to such machinery and diagnostics. It is not a consequence-free amendment. This is as well as being somewhat insulting in that we as politicians would be stipulating that a doctor must scan the patient regardless of medical opinion. Apart from this and the fact that a woman must be subjected to the scan, there is also the concern about the Deputy's constituents who may need a scan but could lose out because of the capacity of the imaging service being occupied by those women for unnecessary scans.
Deputy Tóibín mentioned an important point regarding the role that ultrasound scanning must play in satisfying medical concerns when they may arise and there is no doubt about that. Clinical guidelines stipulate how best to do that. He correctly quoted Dr. Boylan in stating that it is much more likely to be necessary from nine weeks. If we are being honest with each other, that is vastly different from what is being proposed in the amendment, which is to mandatorily scan every woman in every circumstance. This would have a chilling effect on the doctor if he or does not carry out the ultrasound, with the threat of either a fine or imprisonment, and it would make the woman sign her name to indicate the scan has been done. Basically, it amounts to us as politicians telling clinicians that we know better than them as to when an ultrasound is appropriate. For those reasons, unsurprisingly, I am not in a position to accept the amendment.
Tempers are flaring, tolerance is decreasing and perhaps people may be getting tired at this stage. I know there is momentum and people want to see this Committee Stage process happen fast. I have no desire whatsoever to slow it down. It might be useful in the context of people's ability to engage with each other respectfully to take a break at some point. I have never called anybody names in respect of this matter or second-guessed motivation. I have never sought to control somebody else's language on the matter. It is too important for any of that. At the very outset I said I respected people's bona fides on the issue, no matter what perspective they come from. I know the feelings are deep.
People who understand what representative democracy means know that minorities have a voice in this room. Deputy Coppinger stated that the debate and referendum have been had. If only majorities had a voice in these Houses, her party would have to fold because it is a minority party, as such. Minorities have a role in these Houses and at this committee, and that should be respected.
The ultrasound is a medical tool designed to benefit patients. It is not threatening in any way at all. People are second-guessing the provision of it here as being threatening in some way but it is not. It is a medical tool designed to ensure patient safety at all times, with doctors being protected in the delivery of this service. I have no doubt the medical guidelines will go down this route. Everybody I am speaking to medically has said that for this to work properly, there must be an ultrasound involved. What happens if there is an ectopic pregnancy that is missed because an ultrasound is not used? I ask these questions to find out information. It is not the case that we are trying to railroad something through.
The Minister referred to penalties. We cannot create a responsibility in law without creating a penalty and the Minister mentioned that yesterday in referring to the penalty of 14 years in prison. We have applied a class A fine, which is the same as what applies when a person does not pay his or her television licence. We are not talking about extreme and high-level penalties but rather penalties to apply if there are people continuously refusing to accept a responsibility in providing information to others. It is a key point made by others that the vast majority of people asked by Amárach Research stated it is a good idea to offer women this information. Of those who voted "Yes" in the referendum, 74% indicated it was a good idea to offer this information to people before they make a decision.
I understand the Minister's comments about ultrasound imaging but this Bill will give rise to a necessity for increased access to ultrasound. We are not saying that every pregnancy requires an ultrasound but certainly, with reassurance from a doctor's perspective and as the system is rolled out, it would be important that there would be access to ultrasound if it is deemed clinically necessary. It should not be rationed so that somebody in an early pregnancy would get an ultrasound and displace the service for somebody who requires it for a different clinical indication. We must take on board the necessity to make available ultrasound in a very timely manner for those who have a clinical need.
The Chairman is entirely correct and this was the point I was trying to make. There is no doubt that there will be a need for extra ultrasound provision. It is a major part of the preparation ongoing for the introduction of the new services in 2019. The Chairman indicated that this would be used where clinically appropriate or where a clinician believes it to be appropriate. The amendment is not about asking the clinician if he or she believes an ultrasound is necessary but rather it tells the clinician it must be done. At the very best and most benign interpretation of the amendment, it would amount to a waste of capacity if a clinician does not believe an ultrasound is necessary.
I have been accused of misquoting or showing disrespect to Dr. Peter Boylan but I have done no such thing. I used his titles and I quoted from his comments to the health committee as recently as September of this year. According to Dr. Boylan's testimony, the figures vary. I will repeat them. In Scotland, for example, 30% of women will require scans because of uncertain dates. The number here will probably be similar. Dr. Boylan spoke at length. The Minister tried to imply that I was misquoting or doing something damaging to Dr. John O'Brien and he specifically mentioned Dr. Favier. I am quoting from the committee transcript. I do not know Dr. Favier at all. She also informed the committee that the evidence base on the need for ultrasound scanning is becoming clearer. She went on to talk about rapid access for required ultrasound scanning.
I thank the Chairman for his intervention. Rapid access to this facility, including the expert provision of interpretation of sonographs, will be a critical element of the pathway. In our hospital in Tipperary, people have to wait six or seven months for ultrasounds. That is why we lobbied so hard when private providers wanted to fill the gap but the Minister, the HSE and Mr. O'Brien just pulled the plug on it. I made reference to a 24-7 helpline already. I was not impugning anyone's character. I will not allow the Minister to play to the media or misquote me to suggest I was impugning someone's reputation. I merely referred to the fact that we have put so much stake in Dr. Boylan who has been appointed to lead on this, but when he quotes things that are supporting the need for our amendment-----
That is not true.
-----it is rejected out of hand and we are somehow guilty of misquoting or damaging him or in some way tricking a loop. We are being honest and sincere and doing the best we can to try to mitigate the horrors and savagery of this Bill, no more and no less. It is a pity the Minister is setting his face against all amendments we put down, unlike other amendments.
It is not fair comment to describe the Bill as savagery.
It will have savage impacts. That is my opinion.
The Deputy referred to the Bill as being savagery, which is not a fair comment.
This proposed Bill is savage, in my opinion, even without the fact that there is total stonewall resistance to taking any reasonable amendments.
I had not intended to speak again but I am sure Dr. Boylan, who is a clinical adviser on the roll-out of the services, is watching these proceedings. The Deputy said Dr. Boylan's position supports the amendment. The amendment runs contrary to the advice Dr. Boylan is providing to the HSE and me because it would make it mandatory in every single circumstance to scan every single woman. That is not what Dr. Boylan said to the committee. The Deputy quoted him several times and referred to nine to 12 weeks but that is not what Dr. Boylan has said to me, the Department of Health or the HSE. In the interests of fairness, I do not think the Deputy can say Dr. Boylan supports the amendment.
I did not say that.
I said Dr. Boylan's evidence to the committee supports it. I gave the date and the stenographers have it written down, unless they made a mistake. I am only quoting from the Official Report. I do not twist figures or statistics to suit myself, unlike the Minister. I am just saying that is from the transcript of the committee proceedings. I am not saying Dr. Boylan supports our amendment. I am saying what he said is reason to back up the necessity of accepting the amendment.
How stands the amendment?
I am pressing it.
- Donnelly, Stephen S.
- Durkan, Bernard J.
- Harris, Simon.
- Harty, Michael.
- Kelly, Alan.
- Murphy O'Mahony, Margaret.
- O'Connell, Kate.
- O'Reilly, Louise.
I move amendment No. 101:
In page 11, between lines 3 and 4, to insert the following:
“Dignified disposal of foetal remains
14. (1) The Minister shall make regulations to provide for the dignified disposal of the bodily remains of foetuses which have been the subject of terminations of pregnancy including the dignified disposal of ashes generated by the cremation of such remains in accordance with subsection (2)(b).
(2) The bodily remains of a foetus which has been the subject of a termination of pregnancy shall be disposed of only by way of:
(a) burial in a burial ground for the purposes of section 44 of the Local Government (Sanitary Services) Act 1948; or
(b) cremation carried out in a crematorium, being a building fitted with appliances for the burning of human remains which is lawfully used for that purpose as its primary function.
(3) The pregnant woman who has been the subject of the relevant termination of pregnancy shall be entitled to choose the manner of the disposal of the bodily remains of a foetus subject to this section and regulations made by the Minister thereunder.
(4) The regulations made by the Minister pursuant to subsection (1) shall provide for the manner of the dignified disposal of the bodily remains of a foetus which has been the subject of a termination of pregnancy where the relevant woman declines to choose the manner of the dignified disposal of the remains in question as provided for in subsection (3).
(5) A person who disposes of the bodily remains of a foetus which has been the subject of a termination of pregnancy otherwise than in accordance with subsection (2) shall be guilty of an offence.
(6) A person who disposes of the bodily remains of a foetus which has been the subject of a termination of pregnancy otherwise than in accordance with regulations made by the Minister pursuant to subsection (1) and (4) shall be guilty of an offence.
(7) A person who is guilty of an offence under subsection (5) or (6) shall be liable on summary conviction to a class A fine.
(8) A person who sells or offers to sell a foetus or the bodily remains of a foetus which has been the subject of a termination of pregnancy or any part thereof shall be guilty of an offence.
(9) A person who carries out any experiment or procedure not authorised by this Act on a foetus shall be guilty of an offence except in the case of bona fide and lawful medical assessment or treatment of the relevant pregnant woman or foetus by a medical practitioner.
(10) A person who carries out any experiment or procedure not authorised by this Act on the bodily remains of a foetus which has been the subject of a termination of pregnancy or any part thereof shall be guilty of an offence.
(11) A person who is guilty of an offence under subsection (8), (9) or (10) shall be liable on summary conviction to a class A fine or imprisonment for a term not exceeding 12 months or both.”.
I am happy to move the amendment, which covers two distinct but related areas, namely, the disposal of foetal remains and the protection of such remains from sale or unlawful experimentation. There is currently no provision in the Bill for treating the remains of aborted babies with respect and dignity. We know abuses have taken place in other countries where such protections do not exist, including the appalling reality of body parts of unborn babies being sold for research without even the consent of the mothers of those babies.
Some of the amendments are based on research and adapted from precedents that have worked effectively in other countries. There is nothing unusual in that. It happens every day of the week in this Oireachtas on other issues and in parliaments throughout the world. Before I proceed to a detailed deliberation on the content and objectives of the amendment, it is important, with the permission of the Chairman, to address briefly what can only be described as wilful and outrageous misrepresentation to which the amendment has been subjected by some elements of the media and those tasked with co-ordinating the implementation of the proposed abortion legislation. A deliberate and callous attempt has been made to conflate or confuse how we are proposing to address two very distinct and tragic realities, namely, a deliberate termination of pregnancy as defined under the Act and an involuntary miscarriage. We are profoundly conscious of the fact that each year an estimated 14,000 women miscarry spontaneously. Our own loved ones are included among them. We are deeply conscious of the fact that this is often a profoundly traumatic event for the woman and her partner, the family and siblings. We therefore categorically reject the utterly baseless assertion that this amendment is an attempt to impose additional grief on any woman in what is already a time of great distress and sadness. I repeat that we categorically reject it.
This amendment places an obligation on hospital facilities, not women. It does not provide for any power to prosecute or infringe upon the women in question. It applies to the facilities where abortions will be carried out and God knows where that will take us. We are told it will be in our maternity hospitals but whether it is in private clinics or elsewhere, it is the person and the facility carrying it out to which the provisions would apply, not the women.
I repeat that it is not the women. The amendment has been totally misquoted, abused and kicked around.
When the Minister is addressing this amendment, I ask him to answer the question as to where aborted babies will be buried. Will a record of DNA testing be kept? This comes down to whether the Minister respects the fact that we are dealing with human beings here. We are not proposing this amendment in order to cause unnecessary distress to any woman who finds herself in a difficult situation. What we are saying with this amendment is that we want to ensure the right of any unborn baby to a dignified resting place. That is all we want. We want dignity and respect for the rights of the unborn baby.
The amendment is on the dignified disposal of the foetal remains. This is a choice for the pregnant woman, in terms of the manner of the disposal of the bodily remains of the foetus. This is related to the surgical procedure. There should be an obligation on hospitals to dispose of foetal remains in a dignified manner, in accordance with regulations laid down by the Minister.
I support the amendment, about which some in the media have created considerable concern. I wonder why because since time began, it has been important to people to be able, where possible, to choose where to be buried. In the same way, if a mother does not have a place organised or does not wish to decide where the baby will be buried, it is important for the Minister to provide such a place so that the baby can be laid to rest with dignity and respect. It is a very reasonable request because we hear of body parts being sold and other things happening. In that context, some type of burial would be proper. It is up to the Minister and he should say where this place will be if the mother or some other relative of the baby does not want to exercise his or her say on where the baby should end up. It is the responsibility of the Minister, the State and the Government to provide a proper place so that babies are laid to rest with dignity and respect. The amendment is very reasonable and is asking for nothing more than dignity for the baby. It is very important for the people who voted "Yes" in the referendum who are asking where these little babies will end up or be left.
This amendment has caused a bit of excitement in the media in the past week or two. Politicians have commented to the effect that it is barbaric and other nonsense. We are trying to find out where exactly a child's remains will go after an abortion. In many cases where a mother has an abortion, she is under a huge amount of stress afterwards and it might not be the easiest time to discuss the issue with her. In many cases, hospitals will not be able to have such a discussion with a mother. In that context, I would like to know the Minister's plans for the foetal remains. To be fair, we do not want there to be an outcry in ten years' time when we find out that, as happens in other countries, body parts were sold. I sincerely hope it will not happen here and I know the Minister will say that this is Ireland and it will not happen here. I contend, however, that we need to put protections in place to make sure babies are protected. It has been suggested in the past week or so that we have the intention of criminalising the mother but that is absolute nonsense. There will be no criminalising of mothers. The mother needs to be protected here at all costs but we must also have concern for the baby.
I invite the Minister to respond.
First, I accept the word of the proposers regarding their intention but my understanding of the legal reading of the amendment is that it would criminalise the woman in some circumstances because this is applied across all of the definitions and all of the grounds in the Bill. I do not intend to add to anybody's distress or hurt by getting into the graphic and tragic situations in which people can find themselves. In many cases in early pregnancy, from a medical point of view, this effectively has the same impact on a woman as having a miscarriage. How do the Deputies propose that the baby be buried or cremated? It is a foetus but how do they propose that it would be identified? These are very early pregnancies. I am not referring to any individuals when I say that the proposition is quite grotesque in terms of its impact. An abortion at the early stages of pregnancy is, from a medical point of view, like having a miscarriage and I am not quite sure how the Deputies propose to have a burial-----
I am sorry to interrupt but Deputy Fitzpatrick's phone is causing interference.
It is not mine.
I hope it is not my phone.
The next piece is the issue of fatal foetal abnormality and what happens at the moment in this country. At the moment, women go abroad-----
Will everyone check their phones because there is still interference and we cannot hear the Minister?
Is there a phone near the microphone?
Maybe it is the Chairman's phone.
No, mine is off.
After early pregnancy, if we look at the area of fatal foetal abnormality, what happens here at the moment is that women, often with their partners, travel to Liverpool or elsewhere. In terms of the burial of the beloved child that they wanted, whose loss is devastating to them, there is a church and a crematorium near where they travel back from and they often go there. Others send the remains back to Ireland through the postal service or a courier service. We know that in the case of fatal foetal abnormalities, it is not a question of the hospital or the Minister of the day having to dispose of or bury the remains. These are babies that people take home and bury with dignity like anybody would after a stillbirth or a miscarriage and to suggest otherwise is unfair and upsetting.
Regarding the grounds of life and health in early pregnancy, I am not going to describe the process because any woman who has been through a miscarriage knows what it is like. The proposal here is grossly offensive, accidentally or otherwise. Beyond that, one is into the same procedures that we have in our hospitals today. Hospitals already have procedures in place for stillbirth and miscarriage. Our hospitals already deal with these cases sensitively. They work with the families in arranging burials and so forth. Our hospitals know what to do here.
We should not include anything in the legislation which would place the Minister of the day in such a position. I accept the Deputies' assurances that this is not the intention behind the amendment, but, accidentally or otherwise, a woman who, in the early stages of pregnancy, has what is from a medical point of view a procedure equivalent to a miscarriage would be criminalised for not having held a funeral. The amendment is unnecessary and upsetting. I accept that this was not the intention of its proposers but I cannot accept the amendment.
We are playing with figures. I acknowledge that each year 14,000 women miscarry spontaneously. All members are familiar with that but that is not what is under discussion. Rather, we are referring to surgical terminations and the disposal of remains. International best practice supports the amendment. We agree with the guidance on the disposal of pregnancy remains following pregnancy loss or terminations issued by the United Kingdom Human Tissue Authority in 2015 to the effect that in all cases the woman should be made aware that there are options for disposal. According to the UK regulator, the woman should be given written or verbal information about her options and the opportunity to discuss them and be supported in an individual and sensitive manner in order to ensure that she can make a decision that is right for her and her partner. Further information provided should include explanation of how the pregnancy remains will be disposed of if the woman does not wish to make a decision and would prefer the hospital to handle it, as the Minister suggested. It should also explain who to contact to request a particular disposal option and a timescale for that. We are not talking about miscarriages but, rather, surgical procedures. A crucial distinction reflected in the United Kingdom Royal College of Nursing guidance on informed decision-making is that although incineration and cremation both involve the pregnancy remains being burned, the procedures are not the same and take place in very different environments. The incineration of foetuses has been forbidden in Scotland since 2012.
The amendment is not intentionally mischievous. Rather, it is about trying to be respectful to the mother, her family and the body of the baby. Clearly, it is not intended to address miscarriages. We are not trying to muddy the water in that regard, but others are.
The amendment refers to the disposal of foetal remains. The Minister tried to suggest that it does otherwise. I am sure he will agree that we are dealing with two human beings and that there is human life in these situations. We are trying in a sensitive manner to give that little unborn baby the respect of having a burial.
That may be what Deputy Nolan is trying to say but that is-----
That is what I am saying. The Minister should not twist my words. I have said it very clearly.
Yes, but the Deputy is factually incorrect.
No, I am not.
The Deputy is incorrect because-----
I am not.
It does not work if the Deputy-----
I have set it out very clearly. It may be distasteful, and I know the Minister is trying to-----
It is very distasteful.
-----dehumanise the issue but it is an issue of concern to many in society-----
-----both "Yes" voters and "No" voters.
I agree that it is-----
I understand that the Minister does not find it palatable and that he wishes to dehumanise the argument.
May I speak uninterrupted? I find it extraordinarily distasteful that, intentionally or otherwise, under the amendment a rape victim who attends her doctor in early pregnancy, perhaps at six or seven weeks or earlier, and is administered the medication would have to bury the foetus. Not a woman in the world would want to have to go through that. Groups such as Termination for Medical Reasons, TFMR, know exactly what to do and how to care with compassion for a beloved baby who could not survive. There is no issue in that regard. Our maternity hospitals know how to care with compassion and dignity for stillbirths and miscarriages. I accept that Deputy Mattie McGrath stated it is not about miscarriages but the same procedures will apply. Our hospitals know how to deal with these situations and for women and their partners. I take the Deputies at their word that the consequences of the amendment are unintentional, but it would apply across all sections of the Bill. For those reasons, we should reject the amendment.
We must learn from past scandals. Subsection (5) of the amendment provides, "A person who disposes of the bodily remains of a foetus which has been the subject of a termination of pregnancy otherwise than in accordance with subsection (2) shall be guilty of an offence". That aims to avoid any possibility of the recurrence of an event which occurred in 2000 at the National Maternity Hospital, Holles Street, when the hospital admitted it may have incinerated the remains of a baby whose mother had been led to believe her child would be buried in the holy angels plot at Glasnevin Cemetery. It was reported at the time that the hospital disputed for several years whether it had dealt with the remains and insisted that it had no record of the location of the body.
The amendment also highlights that our intention is not to place the onus of responsibility on the woman who has been the subject of a termination of pregnancy but, rather, on the facility or hospital where the abortion took place. Although the amendment is silent on how the disposal of foetal remains ought to be monitored, it is our view that service providers should be subject to regular audit of relevant policies and procedures and that inspection of registered providers' termination of pregnancy services should take place. Have we learned anything from the Tuam mother and baby home and other such institutions? This is real life.
I will not address the selling of foetal remains in detail. Subsections (8) and (9) of the amendment would prohibit selling or offering to sell a foetus or the bodily remains of a baby. All present are aware of the corrupt money involved in such trade in other parts of the world. We are not dreaming this up. There is clear international evidence of such trade. We are not trying to criminalise the mother at any stage.
We have clarified that it was never our intention to criminalise the mother. That would never come into this. We must be very protective of a mother who finds herself in such a situation. I have been present for some of the meeting and have followed more of it in my office. I listened to the discussion of each amendment. I have always respected those who table amendments, even if I do not support them. The Minister has stated that certain amendments may be considered at a later stage.
The Minister is lucky to have a legal team at his disposal for this process. He needs such a team and I respect that. We do not have that. All I have is the wisdom of life and listening to people. The Minister has on several occasions stated that our hospitals and medical professionals know what to do. I presume the correspondence he receives from the public reflects that which I receive as a Deputy. Why have hundreds of medical professionals told us that they do not know what is going on with these proposals? They do not agree with much of what is proposed in the Bill and are very annoyed. The Minister is saying medical professionals know everything. Not all of them do. Is the Minister implying that those who do not are not very good medical professionals? He stated that medical professionals know all about it but it is obvious that many are not familiar or do not agree with many aspects of the Bill.
The amendment seeks to clarify where the remains of the aborted baby will end up. We do not want to be looking at this issue ten or 15 years down the road and realising a mistake was made in the legislation.
The Minister for Children and Youth Affairs, Deputy Zappone, talks about respectful burial for babies in Tuam, whereas the Minister, Deputy Harris, does not seem to care about babies being disposed of after an abortion.
That is not what I said.
What did the Minister say?
I do not wish to interrupt the Deputy. May I explain?
The fact is this would mean that a woman who takes the abortion pills in early pregnancy, which effectively results in that woman having a very heavy bleed, would then, under this amendment, be obligated to bury the foetal remains.
I care, and I do not wish anyone to misrepresent my position. I have sat in far too many rooms with far too many women who have lost their much-wanted babies. The Deputy knows me well enough to know that I care about these situations.
I care about these situations. These women do not need the Deputies or me to help arrange the funerals. They know exactly how to grieve. As legislators, legislating to tell a woman how to grieve and how to have the funeral is abhorrent. It is not that I do not care and, in fairness, it is not that the Deputy does not care either; it is a disagreement about this amendment, which I believe, to be polite about it, has significant unintended consequences that will cause pain and hurt.
Can I comment, Chairman?
The Deputy can come back in and there is no restriction on him doing so. I call Deputy Durkan.
I have refrained from intervening for the past two hours, which I found difficult at times. I have been around a few years so I have heard this debate previously, and I was present during similar debates in the 1980s. Nothing new has been said here today that I have not heard before. I do not question the ability of the Opposition or the right to table amendments. I question the people who drafted the amendments as it appears that they had little knowledge of the proposals in the legislation because we have spent a lot of time talking about something that the legislation does not propose at all. That is fundamental to what we have talked about for the past two and half hours.
Abortion at 24 weeks or 26 weeks is not proposed in the legislation. We heard all of that debate in 2013. Some of us have had our posters defaced and the words "Murderer", "Bloodlust" and all other kinds of slogans daubed on them in red paint. There comes a time when one must answer these assertions and that time is now.
I am glad to hear a newfound concern about compassion for babies who are aborted. I am not, and never have been, in favour of abortion. There have existed certain instances where women in particular situations have no other option or see no other way out other than self-harming, and that has been proven to be true.
I wish to draw the attention of the committee to the manner in which babies who were born at full-term were disposed of. Up and down this country I never heard public outcry about it. We are now visiting those sites and talking about exhuming the remains that were disposed of in a pretty cold-blooded fashion. Lest anybody think that I wish to blame the church or churches in respect of this, I do not. I blame society that was alive and well but looked on and did nothing and, by that stance, approved of what was happening. People turned a blind eye and did nothing.
I do not attribute the content of the amendments to the members opposite, but whoever phrased them knows more about English and American law than Irish law. They certainly knew a lot more than they know about what is proposed in the legislation.
Compassion is not the preserve of any one group, body, party or person in the Dáil. Much has been said about the circumstances in which women are subjected to what is seen in some quarters as inhuman and inhumane treatment in the course of the legislation. Women have given birth in some pretty peculiar circumstances in the past and very little was said about it so, regardless, it was something that we took in our stride. It was a classic case of ignoring the obvious, moving on and pretending that it did not happen. We, as a society, have a lot to answer for and we should not pretend to suddenly discover our consciences. I wish to emphasise that this is not a tilt at the people opposite; it is a tilt at the people who produced and drafted the so-called amendments because they were clearly intent on portraying everybody else in the House who does not agree with the agenda, and the sentiments of those who drafted the amendments, as being blood-curdling, heartless, cold and callous. The irony of the issues that we have discussed for the past two and half hours has not gone unnoticed by some of us who have been around before, and I am sure that it has not gone unnoticed by those who are here now. It would be wrong of that time to pass without drawing attention to the fact that some of us were around before and carefully listened to the debate. Those issues that were not discussed or dealt with previously and were pushed under the carpet are still with us. We are still reaping the whirlwind of those today. I do not wish to lecture anybody on the committee but I do not wish to be lectured to either.
I want to state categorically for the benefit of Deputy Durkan and anybody else - and I accept his bona fides and know he has been around for a long time and respect his experience - that all the amendments we are sponsoring are entirely reasonable. It is easy for political opponents to misrepresent them as we would expect some of that to happen. The intent behind our amendments is clear. It is to address the extreme nature of this Bill, to protect women, and treat with respect and give some dignity to unborn babies who have had their lives ended, or are likely to have their lives ended, under the new law. For example, I cannot say it often enough that the specific amendment on the disposal and treatment of foetal remains clearly refers to surgical abortions-----
It does not.
-----and any proposed penalties for not complying with the dignified disposal of remains of babies refers to those carrying out the abortion, the facilities and the clinicians, and clearly not the woman.
Regarding the amendment, I do not say we are infallible. I resent the claim made by Deputy Durkan that we must have been given the amendment by someone. Thankfully, we are free thinkers. As Independents, we do not have to accept the diktat from the Minister, his officials and the public relations or PR people in parties. I was a member of a party all of my life so I know all about them. Ten members sat down in my office and worked hard to draft these amendments. We got legal and medical advice and all of the other advice that was available to us at our own expense. We asked for a meeting with the Minister before we tabled our amendments. Deputy Fitzpatrick approached him and I wrote to the Minister on behalf of ten members, including myself. The Chairman will be aware that the meeting took place. We did not even get a response and now we have been accused of tabling amendments that are ill-thought-out or ill-judged and were fed to us by somebody. My colleagues and I worked hard on drafting our amendments. We discussed them back and forth, made several phone calls and made amendments and changes. We did not submit them lightly or do it for fun as has been suggested. We are not cannon fodder for any political machine either. We represent the people and are entitled to table amendments.
Please speak to the amendment.
If our amendment is to be altered slightly to reflect this more clearly, then we will propose and engage with changes but we could not do so. We wanted to meet the Minister to engage with him before we drafted our amendments to see if we had some common ground. We begged and pleaded with him to meet us. The Minister met his former colleague and told him that he would get back to him that night at 8 o'clock, as he reported to me-----
This has nothing to do with the amendment.
-----and I wrote to the Minister.
None of this has to do with anything.
No, of course it has to do with the Minister. Let me put it on record that we drafted our amendments. They were not fed to us by a political machine, PR people or spin doctors. We humbly put the amendments together to the best of our ability. The Chairman is aware of that and he outlined to us how the committee would work. Then we wrote to the Minister, and Deputy Fitzpatrick approached him, asking him to meet us.
The Deputies were invited to a meeting with me.
We were not. As I have said, we wrote on behalf of ten members. I ask the Minister not to twist everything, please.
The Deputies were invited.
This is fact and I have the letter.
The Deputy should withdraw that.
I have the letter dated. Deputy Fitzpatrick can speak for himself. I am saying that-----
I ask the Deputy to speak to the amendment, please.
I am. We have been insulted by the claim that the amendments were fed to us by somebody. Party members are so used to that culture in their own parties as stuff is fed to them and they cannot say "Yea" or "Nay" but only vote Tá or Níl, or abstain.
I object to that claim by the Deputy.
There is currently no provision-----
I ask the Deputy to withdraw his claim.
I was a member of a political party so I know how it works.
We request that Deputy McGrath withdraw his nonsensical statement-----
We are freethinkers and can think for ourselves.
The Deputy needs a cooling-off period.
-----and stick to the amendment.
We have not received media training.
Deputy McGrath needs a cooling-off period.
Deputy McGrath, we have been very disciplined for three days.
Some of us have been disciplined.
We have put forward the argument from this side. Can I finish please?
No. Will the Deputy please speak to the amendment?
As I said, we are prepared to amend this amendment and to sit down with the Minister before we put down an amendment. We wanted to put it on the record and make it very clear. On behalf of ten of us, I wrote the letter and I have a copy of it. The Minister received it. It is very obvious what we are seeking to achieve here. We are not being pedantic or silly. There is currently no provision in the Bill for treating the remains of aborted babies with respect and dignity. We know the horrendous abuses that have taken place in other countries where such protections do not exist. We have explored that and researched it with our limited resources. We know of the appalling reality of body parts of unborn babies-----
Will Deputy McGrath please speak to the amendment?
I am. I am reading what I have prepared and I am not deviating from it. We know of the appalling reality of body parts of unborn babies being sold for research without even the consent of the mothers of the babies. Some of the amendments are based on research and adapted from precedents that have worked effectively in other countries. We looked at best practice. We made an honest attempt-----
Is the Deputy reading this out?
Please, Deputy Coppinger.
I do not need Deputy Coppinger's intervention at all.
Will Deputy McGrath please-----
They seem to be all schoolteachers here, some of whom would want to learn-----
I will not be lectured-----
Deputy McGrath is being repetitious.
Maybe I am, but I do not mean to be. We went to great effort to put these amendments forward in a reflective and respectful manner-----
We understand that.
-----and we tried our best to engage with the Minister, who practically refused to talk to us-----
Thank you, Deputy McGrath.
-----despite the fact that we were representing-----
The Deputy is being repetitious.
-----more than 750,000 people who voted on this. I want this on the record because it is very important given Deputy Durkan's intervention. We are not cannon fodder for the political machines.
Deputy Fitzpatrick is next. Deputies O'Connell and O'Reilly will be after him. I ask Deputies to be brief.
I want to rephrase what I said earlier. I said this is a choice for pregnant women in terms of the manner of and dignity for the disposal of the bodily remains of the foetus. This is to do with a surgical procedure. I put it to the Minister that we are not dealing with an early pregnancy. We are referring to the bodily remains after later surgical abortions.
Reference was also made to Termination for Medical Reasons Ireland, which was clear that it was arguing for the respectful treatment of remains. That is exactly what this amendment proposes to do. It does not require women to have a funeral. We aim to put an obligation on the hospital to bury or cremate the remains with dignity. The women do not have to get involved unless they want to. I wish to make it clear. If the intention is to limit this measure to surgical abortions, will the Minister consider this amendment?
I think the Deputy should withdraw the amendment and resubmit it on Report Stage.
Is Deputy O'Brien the Minister for Health?
No, I am not but I am just saying-----
Is he a Minister?
He is saying-----
I do not think that is fair.
I was just saying-----
I am talking directly to the Minister.
Speak to the Minister.
I ask if the Minister would consider it.
For the reasons I have outlined, I genuinely do not believe there is a need for this amendment, or any variation of it. I appreciate the fact Deputy Fitzpatrick acknowledges that the amendment currently goes further than his intention. Currently, it includes the full ambit. The Deputy is saying that he would narrow it to surgical terminations. I appreciate that he is trying to change that. I make the point, however, that in our hospitals, we already have procedures to deal with stillbirths and miscarriages. How would this be any different? The hospitals would still have procedures to deal with these sensitively.
I am worried about the phrase "The women do not have to get involved unless they want to". This sounds like a throwback to the very worst parts of this country's history where we had all sorts of burial situations. I am not suggesting that is the Deputies' intention-----
We are not talking about early pregnancy.
I have accepted that-----
In fairness, the Deputy set out-----
The Deputy is asking if I would accept or be inclined to support a variation of this amendment. My honest answer is that I do not believe any variation of the amendment is needed. That is my truthful answer.
As it has been put on the record of the committee, when I met with the Opposition spokespeople on health I invited a representative of the Rural Independent Group in addition to Deputy Harty in his role as the Chairman of this committee. Deputy Mattie McGrath was unable to make that meeting and he sent an assistant. Deputy McGrath is not present but I can also say this when he returns. The only meetings I had in that regard, and the Chairman was there, included representatives of all of the groupings in the Dáil.
Deputy McGrath came to one meeting.
He attended previous meetings.
I thank the Minister. We will conclude with Deputies O'Connell and O'Reilly.
I will be brief. I am conscious that despite the Minister's comprehensive understanding of this topic, as it has been put, it is not clear in the amendment that it refers to surgical termination. Deputy O'Brien's suggestion is quite a good one. In its current state, I read it to mean that it could have consequences for a woman having a late period, which is often an early miscarriage. If a woman is a couple of days late in her period and she has a heavy bleed the product of that situation would be subject to this proposed amendment. That is unacceptable. That is the mildest word I can probably choose. Often in this type of miscarriage situation, it is a much-wanted child. Deputy Fitzpatrick suggested that women may not want to be involved. People before they miscarry are expecting a baby. As the Minister has so rightly put it, there is a grieving process for those of us who have had miscarriages. We expected a baby and we grieved a baby, although those babies were only 13 or seven weeks old. As a woman who has been in this situation, I find the suggestion offensive. I do not want to inform anybody about what I have done with my foetal remains. I do not want to inform the Minister and I do not want it in the legislation. I most certainly do not want people in this House prescribing what I should do with my used maternity pads, my soiled bed sheets and my bath sheets. I want no interference from you guys, and the one lady, in my dignity and in my care.
I thank Deputy O'Connell. I remind members that there is a vote in the Dáil. We probably have five or six minutes. Are members willing to proceed to dealing with this amendment before we depart to the Chamber?
We are all here.
I wanted to make a contribution because I was grossly offended by this amendment. It is not in any way clear that it applies to surgical abortion. For the avoidance of any doubt, it is offensive. It is offensive to any woman who has had a miscarriage and I believe it is intentionally so. The Deputies who have put the amendment forward should reflect on that and have one of the many conversations they allege to have had with all these people. Perhaps they should reflect on the result of the amendment and the hurt they have caused, which I believe was intentional.
There are a few technical issues in the section which are not covered by any of the amendments and which I would like to discuss with the Minister. In respect of the amendments that have been tabled, I would like to believe that the Deputies here are acting in good faith. That is my assumption going in, but I do not believe that those who tabled at least some of the amendments we have been talking about for the past two hours or so are acting in good faith. We have a series of amendments which have the kernel of a soundbite or of something good in them. Protecting babies is good, as are pain relief, diagnostics and dignified disposal. All of these things are good but I put it to those Deputies that they are clever enough and experienced enough to know that the amendments they have put forward are unworkable. Protection of foetuses is, as the Minister said, covered but the amendment the Deputies have tabled would leave us in a situation in which non-viable foetuses would have the same protection. Pain relief sounds like a good thing, but in legislation we do not get into deciding when doctors administer it for any operation, as the Minister has laid out. Of course the Deputies tabling the amendments know this. They know that no legislature would ever pass a provision forcing every pregnant woman to have an ultrasound scan. Disposal of remains, if and when appropriate, and when the mother or parents wish is of course a good thing, but it is not a good thing in every circumstance. I understand that I must move to the section. What we have seen over the past two hours or so is at least some of the Deputies involved tabling amendments which they know are unworkable and which they know-----
Will the Deputy-----
I am finishing with this, Chair. I did not speak to any of it. This is the only thing I am going to say on it. The Deputies then walk out of the room and send political tweets and soundbites. Regrettably I do not believe that at least some of the Deputies involved are acting in good faith. It is very disappointing.
On section 14-----
May I address that please?
No, I am not finished. The Deputy can respond when I am finished. I am addressing the Minister.
I am addressing the Chair.
No, I stayed quiet for two hours.
I am asking the Chair.
I will allow Deputy Fitzpatrick in when Deputy Donnelly has finished. We have gone through all these amendments.
Yes, and everyone has spoken once and now I have spoken. I appreciate that.
It is a showpiece.
Deeply disingenuous politics are at work. It is about soundbites and theatre rather than trying to get this legislation right.
I have uttered no soundbites. I am not in that habit.
It is very disappointing. My comments are not directed at the Deputy.
On section 14, I have two questions. When a doctor says "No" and refuses to certify, this section compels the doctor to inform the pregnant woman in writing that she may make an application for a review. That is essentially what this section is for. I have no objection to anything in the section but I would like some clarity. Section 14(1) states-----
I am sorry, on what section is the Deputy?
Are we not on section 16?
We are speaking to the section.
The Bill states, "Where a medical practitioner, who has been requested to give an opinion in respect of a pregnant woman in the circumstances referred to in section 10(1) or 12(1)...". Section 10(1) refers to a risk to life or health and section 12(1) refers to fatal foetal abnormalities. Is there a reason this has not also been applied to section 13, which refers to early pregnancy? If a woman presents at a GP and her GP decides, for whatever reason, that he or she is not going to certify, the Bill does not state that the GP must inform the pregnant woman of her right of appeal in that case. It is just a question of clarity. Why is section 13 omitted?
That is a good question. We did think about this. The difference between sections 10 and 12 as a group and section 13 is that section 13 does not involve a specific indication. The woman, therefore, does not have to give a reason to a doctor. If the Deputy looks to the review, he will see that it involves looking at the medical case history to decide whether the woman had an entitlement. This is very much a review of the medical opinion, whereas the doctor under section 13 is not giving a medical opinion. Once the doctor is happy that the woman fits the 12-week window, she does not have to give any further specific indication.
Is that not the GP's medical opinion? He or she is certifying that the pregnancy has lasted less than 12 weeks. Would that not also be a-----
It is, but it is not on a health ground. This section is very much about reviewing the health grounds. Different doctors could have different medical opinions about serious harm. That is what this provision is aimed at. Because section 13 does not involve a specific indication and because there will be a 24-7 phoneline and the like, women will be able to be directed to others. Other people will be available to give second opinions through the provision of the service whereas in this situation one might have seen an obstetrician who has decided, in his or her medical opinion, that one does not qualify for termination. In that case, one might wish to have another obstetrician look at the case, if the Deputy gets my point. They are different.
That is the rationale anyway.
So if a woman goes to a GP, in terms of early pregnancy the only reason for refusal of certification that I can think of is that the GP believes the pregnancy has lasted more than 12 weeks.
In that case I presume the GP would tell the woman. Is there a review process for the woman?
No, there is no review process because the law is quite clear that termination is illegal beyond that point unless provided for under another head.
Okay. I thank the Minister. My second question relates to the timing of telling women. Section 14(1)(b) says that "he or she shall inform the pregnant woman in writing that an application may be made ... to review the relevant decision". A doctor may consult with a woman, examine her, and certify that he or she does not believe that the pregnancy poses a risk to her life or a serious risk to her health. My understanding is that the doctor would then have to write to the woman, as the section states, "inform the pregnant woman in writing", to tell her that she may apply for a review. Would it be better to tighten that up in terms of timing because all of this is time-sensitive? In most of the other areas we have given timelines of three, five or seven days. Would it be worth adding such a timeline to this? I was thinking that the woman should be informed at the time of refusal that she has the right to appeal.
Yes, this is largely based on the Protection of Life During Pregnancy Act 2013. It is the situation that the treating physician or clinician would provide the opinion there and then. The Deputy is correct when he refers to writing to the woman, but that does not mean writing to the woman through the postal service. It happens instantly in a sense but the Deputy is arguing that we should put a timeline in.
I am not arguing. It is simply a question.
Deputy Donnelly is posing the question. Let me think about it. My view is that we do not, and we have not up to now, but I will certainly reflect on it and come back to him with an opinion on it. Our sense is that we do not need it, but we will have a look at it.
Okay, that is it.
A total of 180 amendments are listed for the coming day or two. Of these, 16 amendments have been tabled by our group and 144 by others. I did not agree to all of our 16 amendments but I put my name down for most of them. In fairness, we are entitled to do this.
In respect of amendment No. 107, I see no obvious justification for what Deputy Donnelly is seeking and I oppose it. I am not going to start shouting and roaring. Deputy Donnelly is entitled to table the amendment. I am not going to come onto the floor today and criticise the Deputy for that, but he is totally out of order with his comments. I have been a Deputy for the past eight years and I have seen what goes on in the Dáil for the past eight years. I am not happy with a great deal of it but, again, people are entitled to do what they want to do. I have been delighted for the past two days to have had the opportunity to engage with the Minister, when he is listening to me.
I apologise; I was consulting my official.
I am delighted to be engaging with the Minister. I think Deputy Donnelly is totally wrong. I think he should withdraw his comments. I think he is far better than that and should not stoop to that level. Whether we finish today or tomorrow, this is very important. I have constituents who have approached me in recent weeks and months and have asked me to put forward many of these amendments. I am speaking for the people who have asked me to do this. I am being genuine at the moment. I am nearly here the whole time and I am not using Facebook or Twitter. I am using this committee to say what I want to say. Deputy Donnelly is being a little unfair.
If I had been directing my comments at Deputy Fitzpatrick, I would agree that I have been unfair. Others are involved with those amendments. In my opinion, they are being deeply cynical in how they are using this process.
We cannot reopen the debate.
Can I speak?
No, I am going to put the question.
Amendment No. 106 is in the name of Deputy Catherine Murphy. Since she is not present, the amendment falls.
Amendments Nos. 107, 108, 111 and 112 are related and may be discussed together. Amendment No. 108 is a physical alternative to amendment No. 107.
I move amendment No. 107:
In page 12, line 8, to delete “7 days” and substitute “5 days”.
This is a relatively minor amendment. Section 17(1) states: "The review committee shall complete its review of a relevant decision as soon as may be but, in any event, not later than 7 days from the date on which the review committee was established and convened". That is too long. If it was from the point when the woman, or someone acting on her behalf, writes a letter and looks for a review, then it may be fine. As I read it, the review committee would actually have met, presumably with the appropriate files. I would be open to the amendment that proposes three days but I have opted for five days. The period of seven days, given that this is obviously time-sensitive, seems too long. My proposal is that we move from seven days to five days.
My understanding is that the clock on the seven-day period starts when the review committee receives the application. I will go through my note. This is taking the review committee model that has been used in respect of the Protection of Life During Pregnancy Act. I wish to point out that it has worked well. Under the provisions of the Protection of Life During Pregnancy Act, we are dealing with life rather than with the expanded terms in this case, which include serious harm. It is foremost in my mind that the formal review process needs to happen in a speedy manner to safeguard the life or health of the pregnant woman and to ensure that she or her family are not subjected to prolonged suffering. However, there is a practical consideration for the review to be conducted properly. The review process requires several steps. The HSE, as the convenor of the process, needs to take those steps. The application for the review process needs to be assessed to ascertain the nature of the request, whether it concerns a certification under section 10 or section 12, the identification of the relevant medical practitioners, the making of logistical arrangements in respect of the convening of these medical practitioners, their duty to examine the woman, the woman's right to be heard or for someone on her behalf to address the review committee. Reasonable timeframes need to be provided for in the Bill to strike that balance. I get the point that Deputy Donnelly makes and he appreciates that there has to be a period. The question is whether it should be five or seven days.
I am satisfied, based on the operation of the Protection of Life During Pregnancy Act, that seven days is appropriate and that it has not caused any difficulty. I wish to point out that this is the upper limit. It is not that it cannot be completed in less than seven days. Depending on the clinical scenario at hand the review process can and often does take place far more efficiently. I realise I am stating the obvious somewhat but if the woman's medical condition were to deteriorate in any way then there are other provisions in the legislation, including the emergency provisions in section 11.
Thank you, Minister. I wish to remind Deputies Coppinger and Bríd Smith that we are going to discuss your amendment with this amendment.
I wish to clarify that the period is seven days from the time it is established.
That was the point I was going to make.
Yes, it is seven days from the time it is established.
Technically, it could be ten days because it could take up to three days for the review committee to be established and then a further seven days. It seems ten days would be the upper limit.
I wish to make a point in response to what the Minister has said. We have tabled an amendment with a period of three days. There is a point to this and I spoke about it earlier. It is a question of timing. When a woman is in a crisis pregnancy, timing matters a great deal. I know the Minister is talking about the operation of the Protection of Life During Pregnancy Act, but that relates to a far narrower and more restrictive cohort of women who may be seeking abortions. That is not a good ground on which to base the provision. We will now be able to offer to many more women in crisis pregnancies the ability to have a termination at home. This is putting a burden on them. We must try at all costs to avoid a time-limit burden. This is not a serious attempt to avoid that in providing for a period of seven days. As the previous speaker said, the upper limit could become ten days. It is too much.
I wish to clarify that this does not relate to the community setting. Earlier, Deputy Donnelly asked me why not. It does not relate to section 13. It relates to sections 10 and 12. At issue is risk to life or risk of serious harm to health.
In one way I would almost argue the converse. We are broadening the terms and the number of women who may seek reviews. Therefore the seven-day period is even more appropriate than it was in the Protection of Life During Pregnancy Act.
One benefit of having had the Protection of Life During Pregnancy Act in operation for several years is that we can test some of the claims people made about what would happen as a consequence at the time to see whether they arose. We get annual reports and notifications. This has not posed any difficulty. It is very much the upper limit. These review committees can be convened far quicker. It is simply the case that we have to provide for an upper limit and seven days seemed appropriate. Obviously, it is not seven weekdays, it is seven days inclusive of weekends and so on.
Maybe the Minister can clarify how it currently works. I am not sure it is wise to simply transplant something from an old Act that was brought in with a certain criminalising hue.
Let us suppose a woman believes her health is endangered by not being able to have an abortion, but two doctors disagree. The woman can review it but she might have to wait for seven days for a panel to be convened.
Yes, that is correct.
Seriously, if a woman believes her health is endangered, what about the mental suffering and trauma that she will be going through?
There is another issue.
I know the Minister has said the Protection of Life During Pregnancy Act worked hunky-dory but I do not think so.
No, I did not. If I thought it was hunky-dory, I would not have voted to repeal the eighth amendment.
The Minister did not use the term "hunky-dory", but there have been many cases of people who could not get an abortion under that Act, because they lived outside Dublin. Many people had to go to a hospital in Dublin to try to access an abortion.
One can get a second opinion on anything. Presumably if I felt my health was at risk and a doctor disagreed, I could get another opinion. Would I have to go through an entire review process?
No, one does not have to do that. That is entirely correct. The Deputy makes an important point. One is not obligated to go through the review process to access a termination.
Especially not if one is waiting ten days.