This meeting has been resumed to consider the Health (Regulation of Termination of Pregnancy) Bill 2018. The purpose of the Bill is to provide for and regulate termination of pregnancy. I welcome the Minister and his adviser to the meeting. I also welcome our members and non-members. We are going to resume where we left off yesterday, at amendment No. 145 in the name of Deputies McGrath, Collins, Michael Healy-Rae, Danny Healy-Rae, Lowry, Fitzmaurice, Fitzpatrick, Nolan, Grealish and Tóibín. This amendment refers to the insertion of a new section and has already been discussed with amendment No. 128.
Health (Regulation of Termination of Pregnancy) Bill 2018: Committee Stage (Resumed)
I move amendment No. 145:
22. (1) A termination of pregnancy in respect of a pregnant minor may only be carried out in accordance with section 10 where a copy of the certification referred to in that section has been served on a parent of the minor at least 24 hours before the termination of pregnancy is carried out.
(2) In respect of a pregnant minor, a copy of the certification referred to in section 11(2) shall be served on a parent of the minor—
(a) before the termination of pregnancy is carried out, or
(b) where it is not practicable to do so before the termination of pregnancy is carriedout, as soon as may be but, in any event, not later than 2 days after the making of that certification.
(3) A termination of pregnancy in respect of a pregnant minor may only be carried out in accordance with section 12 where a copy of the certification referred to in that section has been served on a parent of the minor at least 48 hours before the termination of pregnancy is carried out.
(4) A termination of pregnancy in respect of a pregnant minor may only be carried out in accordance with section 13 where a copy of the certification referred to in that section has been served on a parent of the minor at least 72 hours before the termination of pregnancy is carried out.
(5) Service of any certification required to be served under this section shall be carried out in such manner as may be prescribed and shall be recorded in any notification required to be forwarded to the Minister under section 21.
(6) The High Court, upon application made to it by any interested party, and if satisfied that it is in the best interests of the minor concerned, may make an order dispensing with any requirement for service provided for under this section.
(7) An application under subsection (6) shall be made on notice to the parent or parents of the minor concerned, unless the High Court is satisfied that, in the particular circumstances of the case, it may justly proceed to hear and determine the application without notice to the parent or parents of the minor concerned.
(8) In this section—
“minor” means a woman who has not attained the age of 16 years;
(a) a guardian appointed under the Guardianship of Infants Act 1964,
(b) any other natural or legal person acting in loco parentis in respect of the pregnant minor under any statutory power or order of a court and,
(c) in the case of a minor who has been adopted under the Adoption Acts 1952 to 2010, or, where the child has been adopted outside the State and that adoption is recognised by the State by virtue of any statute or rule of law for the time being in force, the adopter or, where relevant, the surviving adopter.
- Donnelly, Stephen S.
- Durkan, Bernard J.
- Harris, Simon.
- Harty, Michael.
- Murphy O'Mahony, Margaret.
- O'Connell, Kate.
- O'Reilly, Louise.
I move amendment No. 146:
In page 15, between lines 28 and 29, to insert the following:
“Information and informed consent
22. (1) Except in a case of an immediate risk to the life, or of serious harm to the health, of the pregnant woman, where it is immediately necessary to carry out the termination of pregnancy in order to avert that risk, no termination of pregnancy shall be carried out without the voluntary and informed consent of the pregnant woman.
(2) Consent to a termination of pregnancy is voluntary and informed if and only if:
(a) the medical practitioner who is to perform the termination of pregnancy has informed the woman, orally and in person, of the following:
(i) medically accurate information that a reasonable patient in the position of the pregnant woman would consider material to the decision of whether or not to undergo the termination of pregnancy, including:
(I) a description of the proposed termination of pregnancy method;
(II) the immediate and long-term medical risks associated with the proposed termination of pregnancy method including, but not limited to, the risks of infection, hemorrhage, cervical or uterine perforation and danger to subsequent pregnancies;
(III) the medical risks associated with carrying her child to full term; and
(IV) alternatives to the termination of pregnancy;
(ii) the probable gestational age of the foetus at the time the termination of pregnancy is to be performed; and
(iii)the probable anatomical and physiological characteristics of the foetus at the time the abortion is to be performed.
(b) a suitably qualified person has informed the woman, orally and in person, of:
(i) the supports and benefits available for prenatal care, childbirth, and neonatal care;
(ii) the fact that the father of the foetus is legally liable to assist in the support of the child, even in instances where he has offered to pay for the termination of pregnancy.
(3) Where it is intended to perform a termination of pregnancy on foetus who is twenty weeks’ gestation or more, the health care professional intending to perform the termination of pregnancy or a qualified person assisting the health care professional shall, orally and in person, offer information on foetal pain to the pregnant woman.
(4) The information offered in accordance with subsection (3) shall include, but shall not be limited to, the following:
(a) that, by twenty weeks, the foetus possesses all anatomical links in his or her nervous system (including spinal cord, nerve tracts, thalamus, and cortex) that are necessary in order to feel pain;
(b) that a foetus who is twenty weeks’ gestation or more is fully capable of experiencing pain;
(c) the steps in the termination of pregnancy procedure intended to be performed and at which steps in the termination of pregnancy procedure the foetus is capable of feeling pain;
(d) that maternal anesthesia typically offers little pain prevention for the foetus; and
(e) that an anesthetic or analgesic is available in order to minimise and/or alleviate pain to the foetus.
(5) Where it is intended that a termination of pregnancy be performed using abortion-inducing drugs, the health care professional who supplies the drugs to the woman intending to have the termination of pregnancy shall, orally and in person, inform the woman of the following:
(a) that it may be possible to reverse the effects of the abortion-inducing drugs should she change her mind, but that time is of the essence; and
(b) that information on and assistance with reversing the effects of abortion-inducing drugs is available in the printed materials and DVD offered to her.
(6) For the purposes of this section, the phrase “abortion-inducing drugs” means a medicine, drug, or any other substance prescribed or dispensed with the intent of terminating the clinically diagnosable pregnancy of a woman, with knowledge that the termination will with reasonable likelihood end the life of the foetus, other than drugs that may cause such a termination, but which are prescribed for other medical indication.
(7) The Health Service Executive shall cause to be published printed materials and an informational DVD and shall develop and maintain a secure internet website, which may be part of an existing website, to provide the information required by and described in this section.
(8) No information regarding persons using the website referred to in subsection (7) shall be collected or maintained.
(9) The Health Service Executive shall monitor the website referred to in subsection (7) on a weekly basis to prevent and correct tampering.
(10) The materials referred to in subsection (7) shall include:
(a) information to a woman contemplating abortion of public and private agencies and services available to assist a woman through pregnancy, upon childbirth, and while her child is dependent including, but not limited to, adoption agencies;
(b) information as to available medical assistance, supports and benefits for prenatal care, childbirth, and neonatal care;
(c) information on the support obligations of the father of a child who is born.
(11) The materials referred to in subsection (7) shall also include the following statement:
There are many public and private agencies willing and able to help you to carry your child to term, and to assist you and your child after your child is born, whether you choose to keep your child or to place her or him for adoption. The law requires that your health care professional give you the opportunity to call agencies like these before you undergo an abortion.
(12) Nothing in this Act shall operate to create an entitlement by a pregnant woman under the age of eighteen years to consent to medical treatment.
(13) A medical practitioner who carries out a termination of pregnancy in accordance with section 11 shall certify in writing in addition to the matters referred to in section 11(1):
(a) the nature of the medical emergency; and
(b) in cases where the voluntary and informed consent of the woman concerned was not obtained, the reason for its not having been obtained.
(14) The failure to comply with the requirements of this section shall provide the basis for:
(a) a civil action for damages (including aggravated and exemplary damages) by the woman concerned for breach of statutory duty;
(b) professional disciplinary action against the health professional concerned.
(15) In any matter referred to in subsection (14) the court shall, upon application by the woman concerned or of its own motion, allow a woman to proceed using solely her initials or a pseudonym and may make such other protective orders as it considers necessary and appropriate to preserve the privacy of the woman concerned.”.
I made the point yesterday that information was key in any decision a person made and that the more accurate the information provided, the better for the individual in making the decision. I also made the point that I opposed the situation in bygone times where information on abortion was legally withheld from women.
I thought it should never have been the case. Everyone should have full information when making a decision, and that information should be medically accurate. That is the purpose of this amendment. It seeks to ensure there is informed consent. I have had experience of people who have had abortions and who have said to me that there was information they wished they had at the time which would have helped them in making those decisions, which is not to say they would have made different decisions, but it would have improved their ability to make the decisions. That is the purpose of this amendment. The amendment takes into consideration the fact that, because there is an element within the Bill that allows for emergency abortions and other provisions that allow for elective abortions, such consent and information can obviously be impossible to deliver in cases of emergency, such as a risk to life or a serious risk to health.
I am not a big fan of the term "cooling-off period", but it is interesting that the Minister mentioned it yesterday and said it was a disgusting term to use. "Cooling-off period" are actually the words the Tánaiste, Deputy Coveney, used in the campaign, and I do not think Deputy Coveney is disgusting when he-----
That is not what I said.
It is not, but the Minister did say the words the Simon used were disgusting. The point of this is that Simon mentioned at the time-----
Tá brón orm. The Tánaiste mentioned at the time that there would be, as he said, a cooling-off period in order that people could have counselling and full information provided to them to be able to make informed decisions. I do not fully see where this counselling or full information is provided for within the Bill. If it is the case that it is not in the Bill, the commitment the Tánaiste gave was obviously not real and is missing.
Again, this is a pro-choice amendment because a people can decline to have the information given to them if they so wish. They can choose whether to have the information provided to them. Again, the amendment does not restrict access in any way. That is the important point. It is not in any way against the spirit of the heads of the Bill that were provided. In fact, it is a codification of the commitments that senior Ministers and the Tánaiste gave during the referendum campaign.
I thank Deputy Tóibín. I have great difficulty with this amendment for quite a few reasons. The first and the broad reason relates to our good discussion yesterday, which was of considerable length, about the issues of consent and of clinicians fulfilling their duties under the Medical Council guidelines. I struggle to believe that Doctor, or rather Deputy, Tóibín - a Freudian slip - would believe that a doctor would not, before carrying out any procedure, discuss it with the woman, seek her consent and make her aware of her options. In the proposed subsection (2) of his amendment there is the idea that a doctor must give medically accurate information to a woman and describe the treatment and the medical risks. This is what happens today in our health service. We do not feel the need to codify this for any other procedure because this is what doctors do. There is a long-established principle of informed consent whereby doctors set out the facts for Deputy Tóibín or me or a woman when we go to a doctor. The doctor then ensures that the woman is aware of any relevant information and has consented. We had quite a lengthy discussion about this, and I read to the committee from the Medical Council guidelines yesterday regarding the principle of consent. That is the first issue I would raise.
The second issue is that the amendment seeks to change the principle of consent because it specifically seeks to change the age of consent to 18, whereas the medical age of consent in this country is 16. This is another change, and it is quite a significant one, but it was not mentioned in the Deputy's introduction to the amendment. It is a substantive amendment in this regard.
One of the lines in the amendment that greatly worries me is the proposed subsection (2)(b)(ii), which states:
(b) a suitably qualified person has informed the woman, orally and in person, of:
(ii) the fact that the father of the foetus is legally liable to assist in the support of the child, even in instances where he has offered to pay for the termination of pregnancy.
I am genuinely a little confused about this because the statistics collected by the UK Department of Health show that the majority of Irish women who access termination in Britain are in relationships, that is, they are married or have partners. This provision seems to suggest or imply something, and while I am not going to use some of the language I think is behind it, it seems to imply that it is only a certain type of woman who seeks a termination. The reference to the father being liable to support the child's upbringing is quite peculiar. It is also important to note that in certain crisis pregnancy circumstances in which a woman seeks a termination there will be victims of rape and incest and issues of sexual assault. The amendment runs the risk of being quite traumatising in this regard.
I do not wish to be flippant about a serious matter, but the idea that the health service is going to start producing DVDs, handing them out to women before they access terminations and saying, "Go home there now and stick that on and have a look at it," is really offensive but also entirely unnecessary. Women are intelligent human beings who will have researched the issue, consulted their doctors and made informed decisions. The legislation is already quite prescriptive, and in the eyes of some people too prescriptive, in how this deliberative process will be followed. The idea that a DVD would have to be made available to women seeking terminations is wholly unnecessary, to put it mildly.
Similarly, as for the issue of a website being available, as Deputy Tóibín will know, the HSE already runs a number of websites concerning sexual health and well-being. There is also Positive Options and the like. Since, thankfully, it will soon be legal in Ireland to make this information available because we repealed the eighth amendment, information about the options - all of them - available to women will now be made available. Legally, we could not make this information available previously. I appreciate the fact that the Deputy said he did not agree with that position. We will now make that information available.
The Deputy referred to counsellors. I do not think this amendment relates substantively to the issue of counselling but, to be clear about the Government and the Oireachtas fulfilling its commitment, counselling is already available through the HSE's crisis pregnancy agency at locations throughout the country. Doctors and doctors' practices already know, as I am sure Deputy Dr. Harty will be aware, through their engagement with the HSE, how to access crisis pregnancy counselling. We will significantly further increase this provision and invest in it. We are providing a 24-7 helpline that will be operated by healthcare professionals - nurses, doctors and counsellors. We will also regulate counsellors and psychotherapists so they are real counsellors and psychotherapists and not people pushing agendas that are anti-woman, anti-choice and anti-best medical evidence. I hope everyone in this House will support me in this regard.
To return to this amendment, and as I said yesterday on other amendments, the issue of consent is addressed in section 22. I know that Deputy Tóibín and I have different views on this, which in fairness the Deputy acknowledges, and he outlined his view yesterday. Termination of pregnancy should be a part of the public health service like other health services. Therefore, I do not see any reason to differentiate the issue of consent in this legislation relative to any other procedure provided as part of the public health service. The Guide to Professional Conduct and Ethics for Registered Medical Practitioners of the Medical Council 2016, a document I have used and on which I have relied quite a lot in recent days, provides thorough information on the appropriate process to be followed to obtain valid, informed consent for medical procedures. The HSE has also published a national consent policy which includes detailed information as to what constitutes valid and genuine consent and how to obtain it. We had a very good conversation yesterday about the issues of consent, parental notification, what one should do in difficult and horrific situations in which something very troubling, for example, a woman having been abused or a child - a girl - having been sexually assaulted and the like, is brought to the attention of a doctor. Our Chairman, with the benefit of being a doctor, outlined to us the obligations a doctor would have in such a situation, which entirely tallies with what the Medical Council guidelines state.
I am aware that there is sometimes a case to be made for special provision to be made in respect of consent to a termination of pregnancy in the case of an adolescent. This is the case the Deputy has been making in recent days.
I am of the view that issues around consent arise across medical practice and are not limited to this particular issue. As I said yesterday, one could argue that many of these issues also arise in contraception, gender realignment and cosmetic surgery, but we have not changed the laws or codified it in any other way. The issue of consent is dealt with adequately and comprehensively in section 22. Some of these things, intentionally or otherwise, would be viewed as extraordinarily offensive by women who have accessed termination. The idea that women would have to watch a DVD or that someone would need to tell them about the legal requirements for the father of that foetus or baby and explain to them what is going on in their own body, health and well-being nearly seems condescending. It is back to trusting doctors and trusting women and I am satisfied to do both and that the legislation deals adequately with the issue of consent.
I do not support this amendment. It is outrageous. There are a couple of things in it that make no sense. We will put aside the misogynistic and condescending nature of the amendment.
Will people stop calling names? We have had the debate without calling names.
It is not names.
Will Deputy Tóibín let me finish?
It is constant name-calling by certain people and it is an effort to close down debate rather than facilitate it.
May I speak, please? I think I have the floor. Part 4 says that consent to a termination of pregnancy is voluntary and informed only and if alternatives to the termination of pregnancy have been advised. There is only one alternative to the termination of a pregnancy and that is the continuation of a pregnancy. I do not know why that is there. I had a read through it. I note that most of those proposing it will never be in that situation. I am not sure what the intention of this is other than to say to the thousands of woman who have had to have a termination that they did not know what they were doing. It seems a judgmental amendment. I do not mean this in a disrespectful way, but there is something very patronising about deciding that an adult woman who is about to undergo a medical procedure does not know what she is doing and is not able to get the facts. Anyone who has had a termination, or has accompanied a friend or relative to England to access a termination, will know that all of the information that a person requires and needs to know can be accessed. Indeed, the desire to be informed as a woman undergoing a medical or surgical procedure is there, and the information is there. I find it very disrespectful that somebody thinks it needs to be put into law that a woman would be obliged to find out the sort of information that, if she needs it, she will find anyway.
I stand over the comments I made. This is misogynistic in its intent and there are elements of it that are laughable. The idea of a DVD is a bit outdated. Of course there are not alternatives to the termination of pregnancy. There is only one. A woman either terminates the pregnancy or continues with it. There are a lot of factual inaccuracies in this. I will not support it. I will vote against it because the intention of it is clear, regardless of whether the proposers want to admit that here in this room. The intention of it is crystal clear and, as a woman, a mother and a grandmother, I will not stand over that, nor will I support its inclusion in legislation.
I will be supporting amendment No. 146. Information and informed consent require fair and factual information to be given to a woman before termination. That is all I want to say about No. 146.
The Minister has his mind made up already and I do not think he will move on any of these amendments at all. When the Minister was speaking on amendment No. 146, he referenced a few examples in the UK. Yesterday, when I gave a few examples from the UK, the Minister told me we are not the UK. He cut me off yesterday when I mentioned statistics from the UK and, all of a sudden, it is okay for the Minister. I mentioned the UK yesterday and the Minister cut me straight back.
That was about Irish women.
Let me speak, please. It is okay for the Minister to get examples from the UK but it is not okay for us to get examples from the UK.
In the interests of clarity, I did not give examples from the UK. What I quoted, as the Irish Minister for Health, was the record of Irish women travelling to the UK, which is relevant to this debate. Those were figures compiled about Irish citizens who had to go to the UK because of the pain of the eighth amendment to access healthcare.
I was giving examples of the UK yesterday. What is the difference? I am trying to say that the Minister should listen to us the same way we listen to him.
I am listening very carefully.
I do not think he is. I made two comments yesterday and had to go back on them because the Minister said they were wrong. I would appreciate if the Minister would listen today.
The proposer of the amendment started out by saying information is key, as if they were doing the women a big favour. What is being proposed is forcing any woman who is about to have an abortion to watch a DVD, get a description of the operation and of "the probable anatomical and physiological features of the foetus at the time the termination of the pregnancy is to be performed". I do not intend to keep coming into this debate, as I said yesterday, but I would like the proposers of this amendment to consider how cruel they sound to the public. We have all described to them situations of somebody having an abortion because of a fatal foetal abnormality. The proposers of this amendment want those women to sit and listen to a description of the features of the foetus. "The Handmaid's Tale" is on the television at the moment. We are only a breath away from it with the likes of this and references to foetal pain.
I do not know if it is normal for a man who is going in for a cancer operation to be sat down and shown a DVD of the operation, or have it described in detail by doctors. I do not think that is the case. I am pretty sure it is not. It seems to be only when women want to make up their own minds about what they want to do with their lives.
The abortion pill is mentioned and there is apparently a DVD that shows the woman how to reverse the effects of the abortion pill once she starts to take it. There may be doctors here who can answer that question but, from the studies that I have done of the abortion pill, I do not know what is meant by that. They are proposing an amendment to a Bill that has no medical or scientific basis. It gives the impression that the proposers do not have a clue what they are talking about.
I am particularly interested in this going back to the 1950s when women were pregnant and had to ring around to public and private agencies that might take the child from them. That is proposed in the amendment. That was a golden era in Ireland, apparently, from the point of view of the proposers of the amendment, when women were forced to have their children taken from them and given to public and private agencies. That worked really well.
The proposers seem to be living in a time warp where, according to this, a woman is a single woman who has made the decision to have an abortion because she is not being supported by the father, or he is forcing her to have the abortion and paying for it. It would be great if that was always the case. There are women who make up their own minds without the father of the foetus being the primary focus.
The proposers also do not seem to realise the extent of gender-based violence in this country. There are many women having abortions because the father of the foetus is violent. The proposers want them to be consulted and legally forced into their lives.
Where is that in the amendment?
Deputy Tóibín stated the father of the foetus was liable for this child.
Where is any information on the father?
Will Deputy Tóibín let me speak? Will the Deputy put his hand up?
People have been-----
Deputy Tóibín will be allowed in.
We need to speak to the amendment rather than a made-up amendment.
If Deputy Tóibín has not read his own amendment, it states that the woman is to be told by the doctor-----
At subsection (2)(b)(ii).
Where does it say it?
-----that the father of the foetus is liable for whatever comes along if she continues with the pregnancy. Yesterday, we tried to explain how violence and domestic abuse works in that the person is controlled by the abuser. I am pointing out to Deputy Tóibín that it might not always be a great idea for the father of the foetus to be dragged into the situation. That is, unfortunately, a reality.
The inclusion of a DVD is laughable. The proposers of the amendment might not have noticed but most people do not even have DVD players. I do not know how they will watch this DVD.
This is a continuation of the referendum campaign where people put up posters to try to make women feel guilty. They called women murderers and baby killers. Now those who did that want to induce shame, guilt and upset in women and to delay them having an abortion. That is misogyny. Deputy Tóibín did not like the term being thrown around. It is not name-calling. It is an accurate description of somebody who does not-----
It is not of importance here.
Would Deputy Coppinger stick to the amendment rather than commentary on the debate?
It is a political chamber. We are allowed comment on where amendments are coming from.
These are false allegations. Is Deputy Coppinger calling Deputy Nolan a misogynist?
We are addressing the amendment and we will not rerun the debate.
Women can have misogynistic policies too, yes. I am afraid so.
If they are different than Deputy Coppinger's view.
My point is that if the proposers have such a little view of women that they do not think that they should be able to have such agency over their own lives and they should be subjected to these forms of torture, people could deduce – let me put it this way - that it is misogyny. The proposers of the amendment should just go back to their golden era of the 1950s and leave the rest of us progress.
Following on from Deputy Coppinger, there are a few bits of this amendment to which I would draw attention. There is factually incorrect information, to my mind deliberately designed to cause hurt and pain to not only the women who have been affected but perhaps the men in their lives and their families as well.
Also, there is some wholly irresponsible language in the amendment with reference to the DVD. I tried to not read too much into it when I was reading this last night. The idea that non-medically qualified Deputies would try to prescribe in legislation something that, as a pharmacist, I would say is dangerous, namely, to suggest that women would be given information suggesting that they take a medicinal product somehow to reverse abortion pills that they have taken, in my mind could lead to some very serious consequences. People need to be aware of the irresponsibility and danger in some of these amendments.
It is part of our job and what many of us are trying to do to get the best legislation possible, but by tabling amendments that are deliberately designed to cause pain to women and families, it is almost implied that there is a necessity to put this in because if we did not, all these awful things would happen. In this amendment, we have a very good example of the destructive nature of this grouping of amendments. There are so many parts to it. On the reference to the pain of the foetus, we heard the evidence from world experts at the Joint Committee on the Eighth Amendment of the Constitution that this is not factually correct.
I agree with the previous speakers that it is misogynistic in its essence. It is irresponsible and dangerous. It is an attempt to stigmatise women. As the Minister stated, it all comes down to the notion that the people made a decision to trust women, and these amendments all have that historical contamination of not trusting women. We would all be, as the public would be, very conscious of what is being tried to be achieved in this amendment, but I do not believe it will not be achieved.
First and foremost, our side has never sought to interpret others’ views in any other way than they have presented them, yet on every occasion there is an interpretation given to these amendments that is not the reason for them.
Second, we have never been condescending to anybody with regard to the views that are validly held on the other side of this debate, and we have never name-called or been ignorant in any way with regard to this, because to do so is not in an effort to have debate but in an effort to close down debate. Closing down debate is in nobody's interest in this regard. We are entitled to represent the 34% of the people who voted no on this and the 20% of the people who voted yes but who do not agree with this Bill.
We also have a right to hold the Minister and the Tánaiste and Minister for Foreign Affairs and Trade, Deputy Coveney, and others to account on the commitments that they give on this issue.
The Minister mentioned that abortion is healthcare and is part of the healthcare provisions. Why then is it illegal to have an abortion in certain circumstances with a penalty of up to 14 years’ imprisonment? Is there any other healthcare provision that happens under proper supervision that has a 14 year prison sentence? This issue is different from other issues. We can dance around this point, left, right and centre, if we wish. We have had certain Deputies state that they want the line taken out stating that a termination of pregnancy is the ending of the life of a foetus because they are not comfortable with it, but that line is at the heart of this Bill. To ignore that line would mean we would have a euphemistic conversation about what is at the heart of this Bill. This is also a radical departure from where our health service was in the past. It is a different situation.
Also, the Minister mentioned that in some way we were trying to imply the father's responsibilities legally. We were not trying to imply that at all. It is disingenuous for anybody to seek that. I had a good debate with my colleague, Deputy Jonathan O'Brien, on the parental notification issue for those under 16 years of age where we spoke about the exceptional circumstances that might arise where a minor has been raped by a family member. When we are dealing with Bills, we deal with not only the core majority of the people who will be dealt with in the Bill but with all of the different parameters that could arise.
Deputy Coppinger stated we are trying to force the woman concerned to pull the father in some way into the debate. The amendment does not have any responsibility in pulling the father in. All it does is provide factual information that exists with regard to the responsibilities. The reason being is that the Joint Committee on the Eighth Amendment of the Constitution found that the majority of abortions happen because of socio-economic reasons, because many women feel that they do not have the economic resources to continue with their pregnancy. We want to say that there are responsibilities with regard to those economic resources. Economic resources are important. I have spoken to many women who have said that despite the Minister being pro-choice, they felt they had no choice, because of the economic circumstances that they were in, but to proceed with an abortion. Indeed, 19 women last year who were homeless had babies. These types of economic issues radically affect the decisions that people take.
The Minister talks about DVDs. To be honest, the HSE provides information currently in DVD form. The HSE with which the Minister is involved presents health information now on DVDs. If the Minister did not know that, that is up to himself. We are merely saying that the information should be presented in a way that is easily consumable by people, such as in a digital format, by putting it on a memory stick, etc.
You could mansplain it in person, perhaps.
Deputy O'Connell will be allowed contribute.
Tip around to everyone's house and have a chat.
I am speaking to the Minister.
Deputy O’Connell, please.
On the age of consent issue, I have always tried to explain that we are happy to effect some changes to some of the content in these particular amendments.
The age of consent is 18 for abortion in many countries including Germany, Spain and 21 other countries in the western world. It is not something we would necessarily have a massive difficulty with if a change was sought. This amendment seeks to provide information. Information should be neutral. It should not be determining whether a person is pro-choice or pro-life. Information should be separate from what side a person is on, as long as it is medically factual. If Deputy O'Connell has a particular medical problem with it, we are again happy to sit down to finesse the particular amendments to fix that, if it is necessary.
It has been said that this is an effort to force information. It is an offer of information. It is a choice for a person to accept or decline that particular offer. The logic is if we dressed up the legislation in choice, adding an additional choice to the legislation would also be a positive thing to do.
I do not know where to start with this. I am appalled at the tone of what appears to be an additional part of the Bill that was never flagged to the public at all in the course of the referendum. When the public voted, they certainly did not do so on the basis of these kinds of conditions. I have serious doubts about its admissibility because there was no discussion of this nature, nor could there have been one, without causing serious reaction from all free-minded and free-thinking people. It is extremely old fashioned. If I were a woman, I would object strongly to being in the control of a system over which I had no control whatsoever. Going right back to the 1950s or 1940s, not even then were women relegated to the extent proposed in this additional section to the Bill.
There are references made to a digital video disc, DVD. I presume it is similar to the DVD sent to all Members of the Oireachtas over the past number of years. Perhaps it is and perhaps it is not. If it is, then I object strongly to it because it was obscene in the same way that pornography is obscene. I could not understand why people would want to send that type of material, apart from frightening the life out of the women of the country. I cannot understand why they would want everyone to have a copy of that DVD. If one's own family and children, aged under or over 18, were to receive copies of this kind of material they would be shocked. It would be psychologically damaging to them to feel they had to undergo this kind of propaganda.
There is also another element to this with references to adoption. I support the legitimate adoption societies that have been involved in providing and facilitating adoptions for people for many years. I do, however, object strongly to a woman being coerced into a situation whereby, at a most vulnerable time in her life, she is being fed information stating she will be looked after and she need not worry if she follows the directions of the DVD and its providers. That is the message and it is a dangerous one. It is taking over the souls, hearts and minds of more than 50% of the population. If people think that is alright, then on their own consciences be it. It can and will, however, have serious consequences. It will take the country back 60 or 70 years. I am not finished yet but I will finish shortly.
This amendment then goes on to say that the "the Health Service Executive shall monitor the website referred to in subsection (7) on a weekly basis to prevent and correct tampering".
Does it say that?
Yes, that is amendment No. 146 to section 22(9)(c) on page 23. It also states "that the materials referred to", which I presume are the counter-abortion materials, "in subsection (7) shall include: (a) information to a woman contemplating abortion of public and private agencies and services available to assist a woman through pregnancy, upon childbirth, and while her child is dependent including, but not limited to, adoption agencies."
Let us look at these situations. During the course of the special committee hearings we studied at great length the situation in which many women found themselves. They want support and advice of a non-directive nature that would be fair, even-handed and would help them to make the decision in their own interests. We must remember that they may have a particular medical or mental condition that created an urgency. I fail to understand how it is intended to be helpful to women to put them through this extra trauma at this crucial and vulnerable time in their lives.
Someone made reference or objection to the fact that misogyny was part of this. It may well be or not be intended to be so but it is very anti-women. It is very anti allowing women to have any choice of their own at all. It takes out of the hands of the woman who is pregnant, and may have a crisis pregnancy, the ability to go anywhere other than follow the directions set out in this section. That is appalling. I doubt if that could be applied to any other element, group or anybody else in society. I have strong objections to creating the feeling, notion or impression that society should control women in this fashion. I do not want to go back to the things which we spoke about yesterday but I do want to say this.
Society has to look at itself very carefully all of the time. I thought we had come out of this type of amendment. Society should try to understand situations and make sure that fairness, due process and natural justice apply. It is important that everyone is treated reasonably fairly. I know it does not always happen in society. I mentioned Thomas Hardy's book, Far from the madding crowd, before. It is a great example of where society chooses to ignore and the tragic consequences that occur. Those tragic consequences occur, and will occur, because society has decided to interfere in a clumsy fashion in the life of the individual in a way that is oppressive. I am appalled.
I thank Deputy Durkan. In line of indication then, we have Deputies Mattie McGrath, Nolan, Donnelly, O'Connell and Bríd Smith. I call Deputy Mattie McGrath.
Amendment No. 146 makes provision for information that should be provided to a woman seeking an abortion in all cases except for emergencies. The woman herself decides what treatments or procedures she will have. She must be enabled to choose her treatment with full knowledge of the material facts. The Irish courts, as we know, have emphasised the distinction between elective and emergency procedures. The more elective the procedure, the greater the duty of care on the doctor to warn the patient of potential negative outcomes. It is clear most terminations of pregnancy, as defined in this Bill under section 13, will be elective procedures. The law requires that elective procedures require a high degree of disclosure. The doctor must provide information on benefits, risks and alternatives which will enable a woman to make the best decisions.
In May, the Tánaiste, Deputy Coveney, said he would support the abortion legislation where it allowed abortion for no reason up to 12 weeks. Those are his words. He made that clear after deliberating for some time.
Those were not his words.
Those are his words. What is the problem?
There is always a reason.
There is always a reason for expediency. We know that with the Minister.
That is very offensive to women.
The Tánaiste referred to it being restrictive and spoke of a "cooling-off" period of 72 hours to assure people. The words "cooling-off" are used across legislation, in negotiations with trade unions and even in the insurance industry. These words were used by the Tánaiste, yet the Minister finds them disgusting. I do not know what kind of a Cabinet table they have-----
The Deputy is full of scripts today.
I find Deputy McGrath's comments disgusting. He is comparing insuring a car to a woman accessing an abortion. That sort of stuff is disgusting. He should not say the Tánaiste-----
Nobody takes the Tánaiste seriously.
Deputy McGrath should address his remarks through the Chair.
Am I not allowed to continue? I am being interrupted.
Please continue and address the amendment, please.
Some people in here believe we cannot speak on this issue and we should go away or disappear. The Minister finds different people's words disgusting every day. He should examine his conscience. He said the Tánaiste's words were disgusting and now mine are disgusting.
I will allow robust debate but I will not allow Deputies to refer to other persons either inside or outside the House. I ask the Deputy and everybody else to confine their comments to the amendment.
I am quoting from the record. The quote is from the Irish Examiner.
On a point of order, it is not good parliamentary procedure to personalise a debate.
I made that point.
I am merely pointing out that the Minister said yesterday that the phrase "cooling-off" was disgusting. The Irish Examiner attributed those words to the Tánaiste some time in May. This is a simple matter. We cannot say something today and forget about it tomorrow, even if the Minister would like to do that. Yesterday, the Minister described those words as disgusting. The Tánaiste said that the cooling-off period would involve counselling and offers of alternatives to abortion. We are now trying to ensure that the law reflects what the Tánaiste, the second highest officeholder in the land, said during the campaign. The Minister will express his usual fake outrage and say this is anti-woman and so on but we are trying to ensure that a full range of information is available to women considering abortion, nothing more and nothing less. This not only reflects what the Tánaiste said during the campaign but it is also prudent from a doctor's point of view, as the Chairman would know, to ensure full consent is given to an abortion.
I reiterate that this accusation of being misogynistic is an absolute disgrace. I take grave issue with it because it appears that a woman has to be pro-choice in order to be treated fairly and to get respect in this Chamber. I take great exception to that, and I will follow up on it. It is disgraceful. Tens of thousands of women are of the same view as me. Just because I have a different view from the pro-choice view does not make me anti-woman; far from it. I take exception to that accusation. It needs to stop here and now because neither I nor my colleagues will be stifled, and I will not allow the debate that needs to take place here to be stifled because we hold a different view. I am a woman and I am clearly seen as being on the wrong side, and perhaps a threat to a pro-choice agenda. I am entitled to my view.
Nobody is threatened by the Deputy. She is not a threat to anybody.
The Chairman is not giving us fair play. Can I continue, please?
Please allow the Deputy to continue without interruption.
The purpose of this amendment is to give information should the woman wish to avail of it. It needs to be stated clearly and strongly that no woman would be forced to avail of such information. During the campaign, and in this Chamber, we heard a good deal about women needing to have choices and options. That is all the amendment is doing. We are not making any assumptions but simply saying that the information should be made available and that no woman would be forced to avail of it. I ask again-----
It does not say that.
Is the Chairman chairing the meeting?
I am not being allowed to speak.
I have never interrupted-----
I did not cut across the Deputy when he was speaking yesterday.
This is scandalous.
It is absolutely disgraceful.
I do not interrupt people.
I ask Deputy O'Brien to allow Deputy Nolan to finish. He will have an opportunity to speak.
I will do so but the Deputy should be accurate because the amendment states very clearly that the consent to a termination of a pregnancy can only happen-----
This is ridiculous.
It is not fair.
-----if the woman is given the information.
It is a sham.
It is not voluntary.
The Deputy should indicate when he wishes to speak.
I will allow everybody to speak.
It appears some of us cannot speak and must be interrupted.
There is no limitation on speaking.
We are being shouted down.
Deputy O'Brien and Deputy McGrath, please-----
Deputy McGrath and his colleagues are the ones shouting.
We are shouted down every time we speak. The same was done in the joint committee on the eighth amendment and this is nearly as bad.
I ask Deputy Nolan to continue.
I am surprised at the Chairman.
To conclude, this is about giving options and choice, nothing more. Those are the words that we have heard over and over again. No woman is being forced, and that needs to be said.
I will speak directly to the amendment because it forms part of a pattern where seemingly reasonable proposals are being put forward that then undo themselves. Informing parents is a reasonable goal but not in the way proposed for all the reasons we have discussed because it would include informing a father who raped his daughter and made her pregnant. Ultrasound scans are a reasonable idea but we should not force every woman in the country to have them when they are not necessary. Pain relief in an operating theatre is a reasonable idea but legislation does not reach into operating theatres and dictate which instruments, drugs and procedures our surgeons use in any operation in any hospital or in any general practice. Informed consent is a good idea but that is not what this amendment does. This amendment states exactly what needs to be printed on brochures. I doubt there is any other legislation that determines such matters. This amendment specifies the technology and platforms to use. It specifies an IT maintenance programme and security for websites. As the pharmacist in the room stated, this amendment specifies what she believes could be substantively dangerous medical and pharmaceutical advice. Yet again, we have the kernel of a reasonable proposal, which is informed consent, brought forward in a way that no legislature anywhere in the world could pass in primary legislation.
I want to speak specifically to the start of the amendment because it has been claimed by several of those proposing it that the amendment is nothing more than an offer of information. That sounds very reasonable. They are saying they just want to offer women information and who could argue with that? The amendment states that "no termination of pregnancy shall be carried out without the voluntary and informed consent of the pregnant woman". It then states that consent to a termination of pregnancy "is voluntary and informed" only if all the following happens and then sets out a list of mad stuff. That is not an offer.
We are being asked to address the amendment. The amendment is mandatory and forces women because it tells them they will have no access to termination of pregnancy unless we sit them through all of this, unless we tell them things the pharmacist in the room tells us are medically dangerous and unless websites have a weekly security protocol attached to them. That is what this amendment provides. I believe some of the proposers are putting it forward in good faith. However, for what it is worth, it is also my view that others who are putting it forward have enough experience in this House to know-----
The Deputy cannot impute motivation to the proposers of the amendment.
No, but I can speak to my understanding of it. There is no Standing Order that says I cannot do that.
I do not think the Deputy can interpret what is in the minds of others.
That is correct, but I can tell the Chairman what I have concluded. I may not be correct but my conclusion is that there are people in this room-----
New Fianna Fáil.
-----who have the experience to know that no legislature could ever accept this amendment.
Old Fianna Fáil.
This country has a dark history of not trusting women. Scandal after scandal has been attached to maternity care, childbirth and women's reproductive rights. Last night, we heard about a case before Mr. Justice Peter Kelly involving a doctor working in a maternity hospital. What a surprise.
Comments have been made about misogyny. I am not making an allegation if misogyny but my understanding is that it is a reaction to the fact that these amendments are based on a lack of trust in women and their doctors. I am not suggesting what is or is not going through anybody's head. In my view, this amendment will be pushed to a vote and will be voted down, as it must be, after which the members who voted against it will be accused of refusing to offer women information. That is partly what is going on here. For all these reasons, I will vote against the amendment.
Deputy Donnelly made a very good point about the framing and wording of these amendments. They are framed in such a way that allows us to be asked how we could be against them. When I returned home last night, as if I had not had enough of this subject after yesterday's proceedings, I thought about the amendment relating to "dignified disposal". The wording of that amendment was carefully designed, as Deputy Donnelly observed, to make it sound as though we were in favour of undignified disposal. We made very clear yesterday that is not the case.
Deputy Tóibín referred to interpretation of an amendment. I am not sure if he meant my interpretation but if so it was not interpretation. I have the text before me in black and green. It is, in my view, an attempt by the anti-choice people to act the victim. On Tuesday, the first day of these proceedings, we spoke about representing those who voted "No". We should remind people what the people who voted "No" voted for. Their vote meant in effect voting "Yes" to people with diagnoses of fatal foetal abnormality travelling abroad and bringing home the remains of their much-wanted children in the boots of their cars. Their vote was against victims of rape and incest, often minors, being able to access termination. They voted to maintain the position where nine women per day would travel abroad and for the continuation of the pain and suffering inflicted by the eighth amendment.
It was also said that some of us were unhappy with the definition because we were not comfortable with it. That is completely inaccurate. I am not happy with it because I believe it is inaccurate and not fully comprehensive. The Minister has assured us that we will work on this together and I have been working on it to come up with appropriate language.
Today, we heard further references to socio-economic factors and the elective nature of the procedure. This is another attempt to make it sound as though "on demand" would see a woman having an abortion one afternoon because she had nothing else to do. The language in this is an attempt to demean women.
There was a reference to information being medically neutral and factual. The text of the amendment is not medically neutral or factual. It was suggested that we could finesse it. The finesse that I would suggest would be to take a big black marker and score through the lot of it.
The only thing anyone is attempting to tamper with here is the bodily autonomy of the women of Ireland, once again. That is what this amendment is designed to do.
I am watching what is happening here very carefully. It is as anyone could have easily predicted, namely, amendments that are full of bigotry and misunderstanding are being presented to us in long texts - reading some of them is like reading War and Peace - and we then bicker and fight over them, thereby delaying what we are here to do, that is, legislate for the result of a democratic referendum that was decisively won and which provided that women should have choice and access to abortion in this country. That is the issue on which we must focus. People are arguing back and forth over what the Tánaiste did or did not say. That does not matter because the Irish people spoke in favour of the heads of Bill which were published by the Minister for Health. That is what we are trying to deal with and this amendment and many other amendments have absolutely nothing to do with those heads of Bill.
We should not give the amendments much oxygen because they are full of what we heard over and over again during the referendum campaign and what people of my age have been hearing for 35 years. I am sick of it at this stage. I want to move on and I know the women following the progress of this committee want this legislation to move on. We have been waiting to put legislation through for a long time and each day we waste is another day on which women will be forced to leave this country or, in the privacy of their own homes, to put their health at risk by taking pills without supervision. I appeal to everybody to remember the outcome of the referendum. It was decisive and clear and it was the people who spoke, not the Deputies who are having a go at each other in this room, as we have done repeatedly. The people have spoken and we should give effect to the referendum outcome in legislation that can be brought before the Dáil.
The Minister wished to contribute again.
I largely agree with Deputy Bríd Smith. We are at risk of rerunning the campaign here, which would not help any woman in crisis today. We have had two long days of debate and I am sure we will have another intense day of debate today. There is a duty on us to proceed through the amendments, give them consideration and move this legislation forward.
I will recap quickly on a number of points relating to the amendment. The title of the proposed new section is "Information and informed consent". Deputy Donnelly is entirely correct that implicit in that is a suggestion that without this section, there is no information or informed consent. That is not true. As I outlined, informed consent is long established medical practice, which is enshrined in Medical Council guidelines, the Medical Council being the regulator of doctors which can strike off a doctor. Informed consent, consent and information exist. What the Deputies are trying to do is rewrite what the term "information and informed consent" means to suit a particular viewpoint. While they are absolutely entitled to hold it, that view is not objective. Our medics know what to do to comply with the law and their duties under Medical Council guidelines.
Several speakers referred to commitments given by various people. I gave a straightforward commitment that in the event that the people of Ireland voted "Yes", I would move ahead with legislation in line with the general scheme that was published in March. There may be ways of technically improving that, and we have discussed this from many perspectives over the past two days, but that was the commitment I gave and the reason I am here today is to move it forward. We debated the general scheme intensively during the referendum campaign. I heard it debated on radio programmes when people texted in questions and we had head-to-head debates on it, including one between me and Deputy Tóibín. The debate took place very much in the context of the general scheme and the section proposed in amendment No. 146, or anything resembling it, did not appear in the general scheme for good reason.
Deputy Nolan stated the amendment was about giving women choice. Apart from the irony of that comment, it is also not true. Amendments matter and, as our President says, words matter. The words of this amendment are very simple. It uses the phrase "shall be carried out" and refers to consent to a termination of pregnancy being voluntary and informed "if and only if". Let us not in any way suggest there is any choice as to whether a woman or her doctor would go through the detailed protocol that those who signed the amendment wish to insert in the legislation. The amendment does not provide for choice. If this section is inserted in the Bill, any woman in crisis seeking to access a termination of pregnancy will have to comply with all the various tests set out.
To be clear, there is no choice.
I have made my points about the reference to the father of the foetus, and how I genuinely believe that represents a misunderstanding and suggests there is only a certain type of woman who needs to access termination. That is not borne out by the statistics. That is my interpretation of it and it is my job to outline how I interpret it. It is also factually incorrect, because it refers to situations "where [the father] has offered to pay for the termination of pregnancy". As we have already discussed at great length, termination of pregnancy in Ireland will be provided for universally as part of the public health service, so no woman will need any man to pay for it. Let us put that where it belongs.
I really believe that no woman ever wants to find herself in a crisis pregnancy, and the more I have met women in these situations, the more I believe it. No woman would want it for herself and I would never want it for a woman in my life. No one wants to be in that situation. However, if a woman finds herself in that situation for whatever reason, and there is always a reason, we need to make sure the system we put in place is compassionate, sensitive and effective in how it operates. I do not attach any value judgment to the Deputy's perspective, but I genuinely believe this does not help in achieving that.
As much as I oppose every element of this amendment, I am particularly disappointed that when those who drew it up decided to exclude certain groups from having to go through this rigorous protocol, they still chose to include parents of unborn babies with fatal foetal abnormality. That is particularly cruel. Subsection (4) of the amendment refers to a "suitably qualified person" - we will get to that point in a moment - sitting down with the mum and going through the features of that foetus and its state of development. These are people who have experienced fatal foetal abnormalities. They have probably gone through their 20-week scan, with the great excitement of seeing their baby and looking forward to its arrival, only to find out that their baby does not have a brain or a heart. It is a particularly cruel aspect that parents like those I have met from Terminations for Medical Reasons Ireland, TFMR, would have some suitably qualified person sit down and explain the features to them in great detail. I am sure it was not intentional, but it is in the amendment.
The amendment references a "suitably qualified person". I am not sure who that is. The idea here was that a woman and her doctor would have a conversation, a period of time would elapse and the procedure would take place. Does the phrase "suitably qualified person" mean we are now making it mandatory for a woman to see another person? She has already sat down and discussed her intimate private life with a doctor. Does she now have to discuss it with someone else? I am not quite sure who the suitably qualified person is. Who Deputy Tóibín would deem to be suitably qualified and who I would deem to be suitably qualified may not be the same.
It is true the HSE produces things on DVDs. The HSE does a great job promoting lots of things about the Healthy Ireland initiative, positive health and vaccination. Regrettably some people, although not Deputy Tóibín, have opposed the human papillomavirus, HPV, vaccine. I do not care about the modality of the information. Whether it is on a DVD, stored on a memory stick or uploaded to Netflix, I think it is offensive. My problem is not the method by which the information is to be communicated.
Finally, one of the reasons people in this country voted "Yes" was to make sure that when a woman made a choice she could access the service safely. During the referendum campaign I heard, as I am sure many committee members did, men and women saying that if it was their daughter they would want her to have support and to be able to talk to her doctor. They said they would want to know that she was not going on the Internet, ordering an illegal abortion pill and taking that pill in the loneliness of her bedroom or bathroom. The more hurdles are put in front of women, the more likely it is that the issue of illegal abortions will continue in this country. I respect all the Deputies here while fully disagreeing with them on this issue. I do not think any of us can argue it would be a good outcome for illegal abortions to continue and for women to continue to travel. Deputy Tóibín should note that 113 women from Meath travelled last year. We do not want to place challenges in front of these people and I am sure he does not want that either. We cannot continue to put onerous and unnecessary barriers in front of a service people have told us get on with introducing. Whether the Deputy agrees or disagrees, I know he respects the will of the people. We have a duty to make sure it works and is effective, and this amendment simply will not allow that to happen.
I thank the Minister. We have now been discussing this amendment for one hour and 15 minutes.
I will not take long. I will be very brief on this.
We have three contributors.
People have said that the referendum has passed and that we are simply seeking to introduce the legislation to implement it. However, I note that there are 180 amendments. Of those, 16 are substantially pro-life. Most of the amendments seek a deviation from the Bill itself. During the referendum, much of the debate was consumed by the commitments made by senior members of the Government, as would be expected. We had a commitment from the Tánaiste that counselling and information would be provided. They are important things to say. We cannot discount commitments in that regard.
People have also mentioned their interpretations of this measure. I sometimes think these interpretations can be strategic. We have spent about three hours talking about other people's interpretations. We may take it as read that we do not agree with each other's interpretations and simply discuss the content.
Another Deputy, I think it was Deputy Donnelly, said that these are good things in essence but that someone, somewhere, can do something about them at another stage. If we look at international comparisons, many of these issues are dealt with in the legislation dealing with abortion. It is not unrealistic for us to seek some kind of primary legislation guaranteeing that these elements would be provided for.
The last thing I will say is that information is not offensive. Information is not the enemy. Information is not a hurdle, and we need to trust women with information.
I fully agree that if women want information they should receive it, but this amendment does not say that. It does not say it is their choice. Anyone who has spoken on the amendment has said it is up to the women and that they will not be forced to receive this information. However, what its proponents are talking about and what is written seem to be two different things. The wording "if and only if" is very strong. It indicates that the procedure can only be carried out if the woman receives information from all these sources.
It is written there in black and white.
The word "offer" is repeated throughout the amendment. In each of those situations, the offer can be declined. For example, the DVD does not have to be consumed in any way whatsoever. It is offered.
It says "if and only if" before listing the provisions. What the Deputy is speaking about and what is written there are two different things.
I call on Deputy Durkan to conclude.
The Chairman is encouraging me. I wish to refer to two things. I repeat what I said yesterday. I believe that the people who tabled these amendments to the Bill did so in good faith. I do not think they constructed the amendments. I have no doubt about that. I believe they were constructed by other people with other agendas. We need to know and acknowledge that. A deep distrust of women emanates from what is before us. It is as though one has to watch women. We have to be careful of what they might do when they are let off on their own. That is what the agenda says.
Information is not-----
This is about information. If Deputy Tóibín listens for a minute he will get a bit of information. It was alleged at the time of the Protection of Life During Pregnancy Act 2013 that the proposal in that legislation would lead to the floodgates opening and women going for abortions on a daily basis as if in an amusement arcade.
We said it would lead to this type of legislation.
The Deputy was totally wrong. If people had studied the submissions made at the special committee they would have seen that. The public have acknowledged that. That is what they voted on, namely, a recognition that women did not have abortions for the fun of it. As they saw it, a parental, maternal bond, unique to women was being violated.
They were concerned about it and they expressed that again and again. They were traumatised by it but they found themselves in a situation where they were between a rock and a hard place and they felt that it was the only way they could go.
Reference has also been made to socio-economic reasons for having an abortion. It was already stated that it was discussed at length at that particular time that we were eliminating that particular ground for seeking to have a termination of a pregnancy, so why is it being raised again? That leads me to believe without any doubt that the people who concocted this new section were not familiar with what the committee had done, what the people had voted for, or the legislation in general in this country and were more familiar with the legislation that is effective in other countries such as the US and the UK. We are well capable of governing our own State in every way and we should be left to do that, as we have always done and will do.
I cannot understand why there should be so much concern about a lack of trust in women. Those who predicted the floodgates opening in 2014 said that thousands of women would seek abortions but the average number is between 23 and 24 on an annual basis, and only for reasons that were legitimate and within the law. I dismiss any other speculation that has been put into the ether. This section has nothing to do with the Bill or what the people voted on and is pure surmise as to what might happen in other jurisdictions but has nothing to do with the legislation in this country, incidentally the heads of which were published before the people made their decision. This section was not.
The Minister has constantly said that he wants doctors to have absolute clarity. He said that during the campaign and he has said it here and then he rejects any reasonable amendments we have tabled. We might as well have addressed them all en bloc. It has been said that they are not necessary in primary legislation and that these matters can be dealt with by guidelines. That is a complete contradiction. The Minister keeps insisting that we give doctors clarity in primary law. It looks like he is only interested in clarity when it involves a proposal he is interested in.
As for what Deputy Durkan said today and yesterday about us hiring people in to draft the amendments rather than looking at them ourselves, we studied this and we also studied international comparisons. We do not need any lecture from Deputy Durkan. He needs a cooling off period for being so insulting to us as to suggest that we got the amendments written for us and that we did not know anything ourselves. We were involved. I sat through that quango as well. I will not call it a committee. It was so exploratory that one could not get a pro-life doctor. We do not need any lectures from Deputy Durkan.
On a point of order, Chairman.
We are well able to speak for ourselves and table our amendments as well.
I wish to raise a point of order. The committee was referred to as a quango. Was the decision of the Irish people also the decision of a quango?
They were duped.
I never said that.
I am asking you.
I said it was not. I respect the will of the people. Deputy Durkan said there are responsible people in his party and that people would take the Tánaiste’s word about the cooling off period and the 72 hours as a given and now his colleague in government, the other Simon, is saying that is disgusting. It is a case of two Simons and one is more simple than the other. That is the way I look at it anyway.
Does the Minister wish to comment?
Those comments do not require a response.
- Donnelly, Stephen S.
- Durkan, Bernard J.
- Harris, Simon.
- Harty, Michael.
- Kelly, Alan.
- Murphy O'Mahony, Margaret.
- O'Connell, Kate.
- O'Reilly, Louise.
I want to speak briefly to the section which deals with consent. It states: "Nothing in this Act shall operate to affect any enactment or rule of law relating to consent ...". Therefore, existing legislation applies. I am particularly interested in two case scenarios. One relates to where the pregnant woman is under the age of 16. My understanding is that when a woman is aged 16 or older consent is not required under law from a medical perspective, as the woman is an adult. Will the Minister advise how this will work for women under the age of 16? Will the young woman need to a parent or a guardian to accompany her? Is it expected that forms will need to be signed? Can it be done at the time? How does the Minister foresee that working? My other question relates to the existing law, which is what we are applying here. It relates to the case of a woman who is over the age 16 but may have an intellectual impairment, an intellectual disability. Will the Minister talk us through the way it is envisaged both of those case scenarios will be dealt with?
As the Deputy rightly said, there is nothing new in regard to consent in this Bill that does not already exist in the Irish health service. It will be based entirely on the document, Guide to Professional Conduct and Ethics for Registered Medical Practitioners, because it is the job of the Medical Council to regulate this area. It is not directly my job and it is certainly not the job of this legislation. Page 15 of that document sets out the general consent principles which the Deputy does not need me to go through because he is familiar with them, but under section 10 it specifically refers to the capacity to consent. Obviously, the capacity to consent test, if I may call it that, would be the same. It also contains a section on children and young people and how to interpret consent, which we discussed yesterday, with the basic principle being that if one is under the age of 16, one will need a parent to consent on one's behalf. As the Chairman outlined to us yesterday, there are situations where if there were family difficulties or very difficult situations, that would have to be reported to the appropriate authorities and could be dealt with through those as well. The HSE already has a consent policy, and I would be more than happy to share further details on that with the Deputy in advance of Report Stage. Regarding the principle of consent in the Bill, as the Deputy has acknowledged, there is no difference here other than the normal consent principles that apply.
For example, is one parent enough? If a young woman goes to her GP it is sufficient for one parent to go along with her and orally say, "I consent to this". Is that what is required?
Yes, that is the current consent policy.
Section 23 deals with conscientious objection to which there are 16 amendments. The first amendment is No. 147 in the names of Deputies Mattie McGrath, Michael Collins, Michael Healy-Rae, Danny Healy-Rae, Michael Lowery, Peter Fitzpatrick, Carol Nolan, Michael Fitzmaurice, Noel Grealish and Peadar Tóibín. Amendments Nos. 147 to 163, inclusive, are related, amendment No. 148 is a physical alternative to amendment No. 147, amendments Nos. 150 to 155, inclusive, are physical alternatives to amendment No. 149, amendment No. 151 is a physical alternative to amendment No. 150, amendments Nos. 153 to 155, inclusive, are physical alternatives to amendment No. 152 and amendment No. 160 is a physical alternative to amendment No. 159. As amendments Nos. 147 to 163, inclusive, are related, they will be discussed together.
I move amendment No. 147:
147. In page 15, to delete lines 32 to 35 and substitute the following:
“23. (1) Notwithstanding anything in this or any other enactment and notwithstanding any rule of law, or the terms of any oath or contract (whether of employment or otherwise), no healthcare worker or other person shall be under any obligation to carry out, or to make a certification in respect of, or to participate in carrying out or to make arrangements for the carrying out of, a termination of pregnancy in accordance with section 10, 12 or 13 to which that person has a conscientious objection.”.
Obviously, the Minister is quite comfortable in that he feels there is conscientious objection or freedom of conscience in the Bill as it stands. He knows there is conflict on that view not only in this Chamber but outside it among the medical professionals. This is not something that has been plucked out of the air. This is a real concern among many doctors, nurses, midwives, pharmacists and medical professionals who work in the hospitals. The centrality here is that this Bill seeks to bring in a law that allows for the ending of a human life. That is a very significant thing for anybody to be involved in. The referendum was dressed up as choice. If we are going to fulfil that promise of choice we would obviously make sure that nobody is forced into a situation where he or she has to facilitate or be involved in the ending of the life of a foetus.
Amendment No. 147 states that "no healthcare worker or other person shall be under any obligation to carry out, or to make a certification in respect of, or to participate in carrying out or to make arrangements for the carrying out of, a termination of pregnancy". That only relates to sections 10, 12 and 13, and it does not deal with the case where there is a significant threat to the health of the life of the mother.
There is a desire here not to consider international examples because every time we have suggested an international example we have been told we are special and we should just stick to the Irish situation. Our next door neighbour, the British, for example, have awful problems with this. They have a stronger freedom of conscience element within their legislation than we do. The freedom of conscience states that there is nothing in this Bill that will force anybody to carry out an abortion but it does not look beyond necessarily the horizon of this Bill and, therefore, there could be other contractual arrangements or other unforeseen consequences that forces an individual to participate.
This amendment also broadens out participation in an abortion rather than the narrow definition with which the Minister has identified. It reframes the section and, again, offers clarity. I was involved in the 2012-2013 abortion discussions and clarity was the goal and lack of clarity was the enemy with regard to that. The British, for example, are laden down with regular litigation involving the state because of certain individuals, healthcare workers, who are constantly battling, trying to protect their freedom of conscience.
The case of the Greater Glasgow Health Board v. Doogan and another is an example of this. New Zealand has come to the view it is important to have a gold standard with regard to freedom of conscience and the amendment emanates from its legislation, which states
Notwithstanding anything in any other enactment, or any rule of law, or the terms of any oath or of any contract (whether of employment or otherwise), no registered medical practitioner, registered nurse, or other person shall be under any obligation
(a) To perform or assist in the performance of an abortion ...
New Zealand is a progressive western democracy where access is not sought to be denied to anybody yet it has managed to process this with an allowance for other individual human beings to have their own choice respected. I stated yesterday that the limits of my rights end when they start to infringe on the rights of someone else. I mentioned the 650 doctors who have said they will not participate in the process here.
Will I speak to the other amendments in the group now? I am happy to do so.
The Deputy can proceed.
The other amendments seek to tidy up the elements on freedom of conscience. Amendment No. 148 looks to delete "or midwife" and substitute "midwife, hospital or institution". There is a great argument as to whether institutions have an entitlement to freedom of conscience or conscientious objection. There are many constitutional reasons to state they do because many of them are run by voluntary organisations that under the Constitution have a right to their particular ethos. Some might say Fine Gael has an ethos and the question is whether one can prevent Fine Gael from proceeding with that ethos and can force it onto a certain direction. I would say that should not happen. Even if we forget about what could happen in the future on this, there is a practical element to it. Yesterday, I mentioned three hospitals where the majority of health workers have stated they will not proceed. I will give the Minister more clean information on this today. The general manager of one of these hospitals has told the CEO of the hospital group it will not participate in the process. We have the moral argument I am making and we also have the reality in which we are functioning. To ignore both in the process with regard to institutions would be a folly.
To a certain extent we are all talking about the details of this and how it will work but it will engage with the real-life crisis in every element of the health service. If we are going to create an abortion service we have to make it real-life-proof. Obviously hospitals are opting out from this even before meeting Dr. Peter Boylan so there is a difficulty for the Minister that has to be recognised. This is the desire of amendment No. 148.
Amendment No. 149 proposes to delete a subsection and remove the new obligation in the Bill for a doctor who has an objection to making arrangements. This is one of the most contentious provisions in the Bill for the medical profession. As I mentioned earlier, the GP system is stuffed at present and is under fierce pressure. Nobody can get an appointment with a GP for love nor money. The GPs in my town are not taking on new patients. If I were to ring a GP now for an appointment, I would be lucky to get it for next Tuesday or Wednesday. This is the reality. What will the Minister do to the 650 doctors? This is a real question. What will happen to the 650 doctors if they refuse this? Will they be stripped of their ability to practice medicine? Will they be brought in some way to a court? If they continue to refuse will they end up incarcerated? What penalties will happen to a doctor who refuses to make arrangements? Making arrangements is an activity. It is not a passive element. Other abortion services elsewhere in the world function without it. I will leave it at that as I know other Deputies want to speak on this.
We are all agreed the issue of conscientious objection is very sensitive and held very dearly and reasonably by many medics who are opposed to termination of pregnancy. Many genuine doctors, nurses and midwives throughout the country have been in touch with the Minister, me and all of us to state they have serious concerns about aspects of conscientious objection. It is incumbent upon us to treat these concerns with the utmost seriousness.
I have some questions. The conscientious objection section essentially states two things. It states, "nothing in this Act shall be construed as obliging any medical practitioner, nurse or midwife to carry out, or to participate in carrying out, a termination of pregnancy in accordance with section 10, 12 or 13". The conscientious objection is waived in emergencies, in line with all medical law. Certainly the doctors, nurses and midwives who have been in touch with me do not have an issue with this part of the section. They understand they are being given an exemption and they do not have to participate in any way. I have not had a concern raised with me about this. The second element is the kernel of where people are looking for clarity. Section 23(3) states "A person who has a conscientious objection referred to in subsection (1) shall, as soon as may be, make such arrangements for the transfer of care of the pregnant woman concerned as may be necessary to enable the woman to avail of the termination of pregnancy concerned." I have several questions on both parts of the section, if I may.
The first part exempts from participating in or carrying out a termination and we know from the legislation that it applies to medical practitioners, nurses and midwives. Does it include student doctors, student nurses and pharmacists, either here or in other legislation? As for the transfer of care, the question for a clinician reading this will be what does transfer of care mean. There may be some out there but none of the doctors, nurses and midwives to whom I have spoken have said they will opt out of it and that is the end of the conversation. What they are asking me is what transfer of care means. One interpretation, which we discussed yesterday, is the idea that it is to enable the woman to avail of termination of pregnancy. This could be in a normal case, and not in an emergency case or exceptional case, where a woman is in with her GP who will state he or she will not participate and will conscientiously object but will provide information on the 24-7 helpline staffed by trained clinicians, including doctors, nurses and midwives, give her the phone number and explain there is an opt-in protocol in place for other GPs and that if the woman rings the number, she will be given details of a number of GPs. One therefore is enabling the woman to avail of termination of pregnancy services. We could go to the other extreme, which might be interpreted as stating the GP must contact a colleague, transfer the patient files and discuss the case. Certainly the medics to whom I have spoken have said they are okay with the first of these. They are okay with telling the woman they are conscientiously objecting and giving her the telephone number of the 24-7 helpline and explaining all of the supports that are there. Except in cases where it is medically required, they really do not want a situation where they are heavily involved in transferring case notes and finding colleagues.
Will the Minister address those two points, as it might go a long way to dealing with some of the real concerns that exist?
Does the Minister wish to come back in now or wait until we have some other contributions?
It might be useful for me to come in now as Deputy Donnelly has helpfully outlined the key questions. I have a note I would like to go through as it is important to put it on the record to achieve the clarity that Deputy Donnelly has correctly indicated people want. Before getting to that, I will answer his two questions directly. This includes student doctors and nurses, which is the first point.
Does it include pharmacists?
I will get to that with the note. There is the matter of transfer of care. Section 17 of the Protection of Life During Pregnancy Act 2013 relates to conscientious objection, indicating that "A person who has a conscientious objection referred to in subsection (1) shall make such arrangements for the transfer of care of the pregnant woman concerned as may be necessary to enable the woman to avail of the medical procedure concerned." I make this point because the phrase "transfer of care of a pregnant woman" already exists in Irish law. We have been discussing this quite a bit and when we make law in the health area, the regulators of those professions take the law, interpret it and legally proof what it means from their perspective as regulators before transferring it into guidance. This has already been done with that Act. Nobody in these Houses has the ability to discipline a doctor or strike off a doctor. Deputy Tóibín asked what would happen to a doctor and a doctor would want to know how the regulator is interpreting the law.
The regulator has already interpreted the law on that phrase on page 35 of the famous book, the Guide to Professional Conduct and Ethics for Registered Medical Practitioners. Section 49.1 of the book deals with conscientious objection, stating "You may refuse to provide or to take part in the provision of lawful treatments or forums of care which conflict with your sincerely held ethical or moral values." Section 49.2 states, "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." Section 49.3 states:
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.
Section 49.4, which is the nub of the matter, states:
If you hold a conscientious objection to treatment, you must:
- inform the patient that they have a right to seek treatment from another doctor
- give the patient enough information to enable them to transfer to another doctor or get the treatment they want.
The next point is key. Section 49.5 states, "If the patient is unable to arrange their own transfer of care, you should make these arrangements on their behalf." The Deputy has correctly stated that nobody has a difficulty with section 49.6, which states, "In an emergency, you must make your patient's care a priority and give necessary treatment." That is the totality of the guidelines and it is helpful in answering the Deputy's questions on scenarios.
If a woman cannot arrange transfer of care, and remembering there are many heads and scenarios in this legislation, a medical practitioner must of course arrange the transfer of care. That is likely to happen in a hospital scenario. It relates to a very sick woman, who is perhaps unconscious and whose life could be at risk or who could potentially suffer serious harm to health. To be honest, the bulk of this conversation is coming from the GP community and I accept the legitimacy and bona fides in raising it. With a GP, a patient would be involved with a medical consultation. We have discussed the phrase "medical consultation" a lot. In such cases, the patient will be able to arrange her own transfer of care and the GP is only required to give her that information. I hope that genuinely helps the debate. I have discussed this with members of the Medical Council when I meet them in stakeholder forums and I will meet them again next week as part of a broader stakeholder gathering on the matter.
The Deputy mentioned pharmacists and a 24-7 helpline, and I glad he did. We discussed this yesterday. Everybody has been approaching conscientious objection from the doctor perspective but as the Deputy rightly says, we must also approach it from the woman's perspective. Nobody wants a woman to have to go around trying to find a doctor either. We have done much work on this outside of the legislation on the 24-7 helpline. The idea is that doctors will have the opportunity to opt in and have their information available to that service. A woman needing advice or a service would be able to pick up the phone 24-7, speak to a counsellor, nurse or midwife - a healthcare practitioner - and the woman could be directed to an appropriate place. I do not see a problem from a legal perspective for the reasons I outlined but there is also the practical perspective. This legislation should not, in any way, shape or form, be about discommoding women in accessing a legal service. Nor should it be about catching out doctors who have conscientious objections that they are entitled to have.
I genuinely believe the balance is right. What we are introducing in conscientious objection in this legislation is not new or a different construct. It is not more or less onerous than what has existed. It is exactly what has normally been done. I am concerned a little about some of the commentary from some medics raising the issue of conscientious objection because doctors know it is the regulator - the Medical Council - that makes the interpretation and they should be very familiar with what I have just read. I hope that answers the question.
The matter relating to pharmacists has come up a bit. In the primary care setting from an operational and service perspective, the intention is for the doctor to dispense medication to the woman, thus removing the need for the woman to have to make another trip to another healthcare professional, which would be the pharmacist in this case. In the hospital setting, I am sure pharmacists would be involved with dispensing and, in some cases, supplying the medication to the doctor. In that sense there is a role that pharmacists would have. They already have a code of conduct and it states that pharmacists must "ensure that in instances where they are unable to provide prescribed medication or pharmacy services to a patient, they must take reasonable action to ensure these medicine services are provided and that the patient's care is not jeopardised". Information is available on the Pharmaceutical Society of Ireland's website with respect to referendum in May and the next steps, stating:
The statutory code of conduct for pharmacists sets out the principles for professional practice and behaviour which patients, members of the public and other health care professionals and society generally require and expect of pharmacists who are registered with the PSI. The code of conduct is intended to provide support and guidance to pharmacists as they discharge their professional duties. The code requires pharmacists to ensure that in instances where they are unable to provide prescribed medicines or pharmacy services to a patient, they must take reasonable action to ensure those medicines and services and provided and that the patient's care is not jeopardised.
These are similar principles to what we have just discussed with respect to doctors.
I thank the Minister, as that is really helpful. Many pharmacists will ask if they will be in a position where a woman could comes to the pharmacy seeking an abortion pill that they could conscientiously object to providing it.
Yes. Their code of conduct already states that they can do it but need to take reasonable action. In other words, they might need to identify where the service may be available. The following may not be well known but it is important for pharmacists from a services perspective; we are discussing the law and this is somewhat separate in that it is the operation of the law. It is not envisaged that woman will be walking into a pharmacy to access medication, as it is envisaged she will get it through her doctor.
I thank the Minister and that is really helpful. We have discussed general practice but in the acute setting, doctors, nurses and midwives will be able to opt out and conscientiously object. It is not covered in legislation and I imagine it should not be as it is an operational matter. Will the Minister speak to the concerns that some may have about concerns relating to rostering, for example? In a smaller hospital, for example, there may be a very limited number of obstetricians or midwives. How are they protected in ensuring they are not rostered into a situation if a colleague is on leave, sick or whatever? Is it possible they may end up being asked to participate in a termination?
That is an important point. One of the reasons it is so particularly important relates to what we discussed yesterday and even the day before about certification. If an obstetrician certifies a woman for a procedure but goes on leave and the covering obstetrician has a conscientious objection, it demonstrates the importance of rectifying what the Deputy, I and others discussed over recent days. We will do that between now and Report Stage or we will certainly endeavour to work together to do it.
Regardless of a rostering or staffing position in a hospital, the right to conscientious objection should not be infringed. We must work together with the HSE and Dr. Boylan to ensure the service is operable but we must also ensure we do not attach disproportionate concerns to some matters. It is highly likely, based on the trends that we know relating to abortion in Irish women so far, that approximately 80% of Irish women who access terminations will do so in the community setting.
We should park the issue of the nine to 12 week period, which I accept is different from what I am about to say. Other than the nine to 12 week period, the women whose medical well-being the Deputy is discussing are very sick in terms of the risk to their health or life and may well have to be transferred to one of the larger tertiary maternity hospitals. I do not mean this disrespectfully, but I heard some obstetricians in smaller units in the country campaigning for a "No" vote during the referendum campaign and saying, "The eighth amendment has never prevented me from providing care for such a woman." However, that is because such individuals would have transferred their patient to Holles Street hospital, the Rotunda Hospital or the Coombe hospital. Therefore, it does not really arise in the case of a fatal foetal abnormality.
The point the Deputy makes is serious and legitimate. As the HSE rolls out this system, it has a responsibility to work with hospital management to ensure the staff will be consulted, informed and briefed in order that they will be aware of what conscientious objection means. There cannot and will not be any pressure on staff to in any way negate their conscientious objection which they absolutely have a right to have.
I am somewhat concerned about Deputy Tóibín's comments. I do not doubt his words, but I will not cast a slur on any hospital CEO, anonymised or otherwise, because I need to verify the facts. A hospital CEO in any voluntary or HSE institution cannot say, "My hospital is not participating," because it is my clear advice that institutions do not have a conscientious objection. No hospital will have the right to opt out; certainly no hospital CEO will have the right to say, "My hospital is not doing it." I need to ensure we will not exaggerate the significance of this issue. Prior to the introduction of the Protection of Life During Pregnancy Act, we heard many people say, "My hospital will not participate." In fairness to the doctors and medics involved, that largely was not the experience.
I will read my note for the purposes of the records of the committee. I do not want to take too long, but I want to be clear. This is an important issue on and about which we have all had discussions and questions. Section 23 of the Bill covers the issue of conscientious objection. It states that where he or she has a conscientious objection, a medical practitioner, nurse or midwife shall not be obliged to carry out or participate in the carrying out of a termination of pregnancy. In the event that a doctor, a nurse or a midwife has a difficulty in undertaking the required medical procedure, he or she will have a duty to ensure another colleague takes over the care of the patient. This is in line with section 49 of the Medical Council Guide to Professional Conduct and Ethics for Registered Medical Practitioners 2016 which I have read in full. That section obliges doctors to enable patients to transfer to another doctor for treatment in cases of conscientious objection. It has clarified how it is interpreted by the Medical Council.
Similarly, the Nursing and Midwifery Board of Ireland Code of Professional Conduct and Ethics for Registered Nurses and Registered Midwives, published in 2014, states:
If you have a conscientious objection based on religious or moral beliefs which is relevant to your professional practice, you must tell your employer and, if appropriate, tell the patient as soon as you can. If you cannot meet the patient’s needs because of this objection, you must talk with your employer and, if appropriate, talk to the patient about other care arrangements.
Even if you have a conscientious objection, you must provide care to a patient in an emergency where there is a risk to the patient’s life.
Therefore, both the Medical Council and the Nursing and Midwifery Board of Ireland, NMBI, have mechanisms to address non-compliance with their guide or code by doctors, nurses and midwifes. I am often asked if I am going to sack all of these doctors. Apart from the fact that it is not my function in law, it is not how the Medical Council or the NMBI discharges its duty. These things are only said to shock or create a problem; there is not that sanction.
I have discussed the fact that the HSE is developing a helpline to assist women to navigate the service for a termination. It is intended that medical practitioners will voluntarily consent to have their names released to women who are seeking a termination through this helpline. That will ensure women will be directed to medical practitioners who do not have a conscientious objection to termination of pregnancy.
Both the Bill and the existing medical guidelines make it clear that conscientious objection cannot be invoked when the risk to a pregnant woman's life or health is immediate. Any individual's right to conscientious objection is not absolute and obviously has to be balanced against the competing rights of a patient, particularly the right to life in the case of an emergency. I agree with Deputy Donnelly - I do not believe doctors or nurses have a difficulty in that regard.
I have also outlined what the duty is in non-emergency cases. There are some amendments tabled by Deputies Bríd Smith and Coppinger to this section which we discussed yesterday, perhaps by accident. They are focused on the definition of "as soon as may be" and my decision based on legal advice that it provides for a greater degree of urgency and immediacy than other phrases that laypeople such as those of us around the table might think are more urgent. The phrase "as soon as may be" attaches a significance to informing the patient as quickly as possible.
There is no need to make references to the Protected Disclosures Act 2014, as covered in one of the amendments. The right to conscientious objection is clearly set out in section 23 and does not require a reference to, nor interrupt the interaction of, the Protected Disclosures Act which is already on the Statute Book and will continue to operate independently of this legislation.
On the issue of conscientious objection, the Minister quoted from the Protection of Life During Pregnancy Act 2013. Will it be repealed?
That is correct, but the wording is the same.
Is the wording used anywhere else? If that Act is repealed, are there other areas where the wording is the same?
I would not imagine so.
The point I am making is if that Bill is repealed, the wording is also repealed.
I apologise; the wording is included in section 23 of this Bill.
If the 2013 Act is to be repealed, is it included in any other legislation?
Not that I am aware of-----
In other words, could one change the wording because this is a new Bill?
Yes, one could.
The Bill states, "make such arrangements". Does that include the provision of information?
I believe this is the point Deputy Donnelly or one of the other contributors made. It is a much stronger requirement to refer to the making of arrangements than providing information. I do not believe anybody with a conscientious objection wants to obstruct, impede or delay the provision of treatment for women. However, they object to having to actively participate in the making of arrangements. If making arrangements means the provision of information which is a less onerous task, does it fulfil the obligation to make arrangements?
I have referred to the 2103 Act because that is the law today. The wording is the same as what the law will be when we pass this legislation. Therefore, it is being operated today in a way that reflects Medical Council guidelines which state practitioners can meet the test set out in law once they either make the information available if the woman is in a position to make her own arrangements, or, if she is not in such a position, arrange the change.
That is the caveat. The provision in respect of making an arrangement is only invoked if the woman is unable to make the arrangements.
The test is satisfied in giving the woman the information, subject to her being-----
Is directing her towards the website sufficient to fulfil that requirement?
The Medical Council, working with the HSE, will need to decide whether that is appropriate. Is it a leaflet or a website? That bit is, rightly, not for me. However, I have heard some doctors suggest that if a woman comes into a GP practice and the doctor is conscientiously objecting, he or she will have to telephone another GP to transfer the woman into his or her care. That is not the requirement. The requirement is as set out in the existing Medical Council guidelines to give the patient enough information to enable her to transfer to another doctor. Of course, the Medical Council will update its guidelines, as appropriate, to reflect the reality of the changes made in Ireland.
Will "making such arrangements" refer to what the Medical Council decides?
That is the case.
Deputies are offering in the following order: Deputies Fitzpatrick, O'Reilly, Durkan, Paul Murphy, Bríd Smith, O'Connell and Coppinger.
I will speak to the amendments generally first and then move them individually later.
The Minister appears to think the Bill protects freedom of conscience, but that is not true. Conscientious objection appears to be provided for in the Bill, but on closer inspection, it disappears completely. Freedom of conscience is a vital human right according to the European Court of Human Rights. A person's conscience claims can be religious or non-religious. What matters is that his or her conscience may lead him or her to object or refuse based on his or her deeply held religious, moral, ethical or philosophical beliefs to do or assist in certain things. The best known example is conscientious objection to military service. During the years many people have objected to serving in the armed services or fighting in wars owing to an objection to taking human life.
Many doctors, if not most, are guided by the principle to first do no harm. The idea of intentionally taking human life will be abhorrent for them. Furthermore, the assisting in taking a human life is essentially the same as directly taking it. In the case of abortion the process involves the ending of a human life - there is no ambiguity in this - and after more than 50 years of abortion practices in the UK we see that it clearly involves the intentional destruction of a developing life.
In the Bill the Minister, Deputy Harris, states: "A person who has a conscientious objection [...] shall, as soon as may be, make such arrangements for the transfer of care of the pregnant woman concerned as may be necessary to enable the woman to avail of the termination of pregnancy concerned." In effect this obliges the doctor to ensure that an abortion is carried out by requiring him or her to make arrangements with another doctor who will perform the abortion. The fact that the conscientious objector is obliged by law to set up an arrangement to enable a woman to obtain an abortion has been overlooked in the discussions on the Government's abortion plan, as discussed with the Chairman earlier.
The Minister for Health, Deputy Harris, has made no intent to engage or consult with general practitioners prior to publishing the legislative plan. Clearly, however, he now wants the new abortion services in Ireland to be GP led. Abortion is not healthcare in any meaningful sense. The intentional destruction of an unborn child is not a therapy, nor is it a recommended treatment for any complication that may arise in pregnancy. Many GPs will be deeply uncomfortable with the ending for no reason of an otherwise healthy pregnancy. Many Irish people will be deeply uncomfortable with the idea that the local GP practice has developed into an abortion clinic on abortion referral services.
Irish doctors should not be forced by law to choose between their job, their business and their reputation on the one hand, and their conscience on the other. These amendments reflect the concerns expressed to us by more than 600 GPs in recent days. We can look at each amendment individually but the key point is that without removing the obligation to make arrangements for abortions we will find ourselves engaged in a massive attack on the rights of our doctors.
I thank Deputy Fitzpatrick. Next is Deputy Louise O'Reilly.
Will the Minister address the issue around the obligation?
I did talk about that in great detail but I would be happy to revisit it.
I feel that it is not in the Government's abortion plan. I am aware it was asked earlier on, but I believe the Government has left this out and overlooked it. Perhaps the Minister can tell me-----
I heard reference to wars here and obviously there is no reference to sending anybody to war. The only thing that is continuing here is a war on women's rights, which needs to end. Earlier I spelled out very clearly how conscientious objection will work. I will state it briefly but clearly again for Deputy Fitzpatrick, and it is the same thing I said to Deputy Donnelly. The provision for conscientious objection exists in section 23 of the Bill. No "medical practitioner, nurse or midwife" need participate in any such procedure based on their own views. They have absolutely every right to hold those conscientious objections and I respect that. The Medical Council guidelines interpret that. The council is the regulator, not me. Section 49 on page 35 of the Medical Council guidelines states this. I have heard from many doctors also, and I accept there are genuine concerns and practical operational questions. I am sure the Chairman will be aware of these from his own colleagues also. I hope that the information I have put on the record of this committee can help to allay those concerns.
I thank the Minister. I remind members that we are discussing amendments Nos. 147 to 163, inclusive. If a member has amendments within that grouping then please refer to the amendment when speaking. I believe that Deputy O'Reilly has an amendment in that group.
I do indeed. My amendment No. 157 refers to the issue of conscientious objection. I believe that we already have comprehensive provision made for any person who wishes to conscientiously object. I do not hold with the notion that the provision of this specific form of healthcare for women should cause a whole additional layer. Notwithstanding that, we believe it needs to be codified that there would be consequences for those doctors who refuse care to women. Asking a doctor to participate in a procedure is not the same thing as asking that he or she ensures that a provision is made for the procedure to happen.
Our amendment asks for a referral to the Medical Council for appropriate sanction in the event that a physician refuses to make arrangements for the transfer of care of the woman who is pregnant. There should be a sanction because we do not believe there should be an opt out and that Ireland should continue to do what it has done for decades, which is to look at women in crisis pregnancy situations and fold our hands, throw our eyes up to heaven and say, "No, sorry love we are not helping you." That is not good enough. There has to be an obligation to make a referral for the transfer of care. I do not believe telling a doctor to make a referral is the same as forcing a doctor to participate in any procedure. Any Deputy who comes in to the committee and tries to claim this is being somewhat disingenuous.
The amendment provides for a referral to the Medical Council for appropriate sanction. Although I may have had my own views about whether or not a criminal sanction would be appropriate, the amendment does not say that. It states, "shall be referred to the Medical Council". We are having this debate following on from the referendum, and all of the discussions we had where everybody said there should be no more shame and no more stigma or forcing women to go abroad. It is about putting the woman at the centre and ensuring she gets the care. It is about ensuring that if the doctor or physician in front of whom she is sitting does not wish to provide that service then that physician will make a referral onwards. As I said earlier, I do not believe this constitutes participation in any way, shape or form. It simply lives up to the obligations to provide care.
The Deputies have called themselves pro-life - the opposite of which is anti-life, which is silly - and I do not hold with their notion that this part of healthcare should be separate or different. We believe there should be a sanction on any doctor who refuses to make arrangements for the care to be provided if he or she is not willing to do it themselves.
This is a very important element of the legislation and we have to respect the rights of conscientious objectors in all parts of the profession. We must recognise they have concerns that are entitled to be catered for, and we must cater for them. I note the 650 doctors who have signed the petition to the effect that they do not propose to participate. In his reply perhaps the Minister will give some indication of the impact this is likely to have on the overall service available to women in the State.
Other branches of the medical service such as midwives, nurses, trainee doctors - to which the Minister has referred - are also important enough to be provided for in the primary legislation for two good reasons. The first reason is to observe the spirit of the letter of what has been said and promised before. The second reason is to ensure that it is possible to provide alternative readily available services so that women may be able to know where to go without having to make phone calls or do a check. They may have to go in an emergency. They should know before they travel to a particular GP practice if they will or will not receive a service. They should not have to do two or three journeys to find that out. I am aware that the helpline will eliminate some of that. Envisage, however, a situation where a woman might have multiple emergencies - for some reasons outside of her control - and her ability to surmise may be compromised. At this stage it would be better to have a simplified system; a belt and braces system whereby in the first instance the woman would be able to gain access to a medical practice where she knows she will receive the treatment first hand and where she knows she will not put pressure on the conscientious objector or put her own life - or her baby's life - at risk.
I say that on the basis that people may not have made up their minds about what the procedure should be at this stage, and may change their minds. The provision of this service is critically important. I note what the Minister has already said, but it would do no harm to refine it a little to take into account the points I have just raised, with a view to ensuring that the service is available in every region so that the woman does not have to travel 100 miles in order to access basic services. Some medical practitioners in any given practice might have conscientious objections, but others may not. I presume that a situation of co-existence will prevail, whereby those who wish to offer access to abortions can and those who have conscientious objections are not forced into providing it.
There is a great depth of feeling about this issue. It is probably the part of the Bill that has been spoken about most. With my heart and soul I can fully understand why someone would not want to be part of this. There are many reasons for it. Some people might be pro-life. People should not have to explain themselves. I know that the Minister is aware that the depth of feeling on this issues applies not only to the medical staff but also to the general public. Everyone believes that nobody should be forced to do something that is against what he or she believes in his or her heart and soul. The mental health of medical staff is suffering because of the thoughts of what may be, so it is very important that this is clarified very quickly. Many medical professionals have suggested to me that they would resign if they were forced to do something that they believe to be wrong. We are facing a potential loss of good, experienced medical staff. I cannot reiterate enough the trauma that people feel they will go through if they are forced to do something they fundamentally believe is wrong.
One of the main things that helped the "Yes" campaign succeed was the word "choice". I know of many people who were going to vote "No", but when people started to argue for a "my body, my choice" approach their feelings and attitudes to it changed. We must give medical staff the choice if they fundamentally believe that they should not have to do something they do not wish to do.
Unlike Deputy Murphy O'Mahony I am not concerned that there will be mass resignations because of this. I have great faith in the doctors of this country and their ability to deliver this service, and I want to ask the Minister some questions about the doctors who are publicly and vocally objecting. In the Irish medical profession there is a great tradition of being on the side of women, when it has been allowed. In Ballyfermot in the 1960s, 1970s and 1980s there was a notorious doctor called Paddy Leahy, who has now passed away, who was absolutely brilliant at breaking the law and giving women with 12 or 14 children access to contraception when it was totally illegal. Dr. Andrew Rynne also faced down the law on the question of condoms and the contraceptive pill. Doctors for Choice played an amazing role in delivering the result of the recent referendum. In the 1990s, when it was not popular or profitable to promote abortion services, other doctors really stuck their necks out. I am not worried at all that we are going to lose medical practitioners over this.
I agree that the idea of choice was a key factor in the referendum, and that doctors and nurses should have the choice. The issue arises as to what happens if a medical practitioner says that he or she conscientiously objects and what happens next. That is an important issue because transfer of care could mean that doctors will simply provide the phone number for a 24-7 helpline. It should mean that an employee of the HSE or someone who works on behalf of the HSE who meets a woman in a crisis pregnancy asking for the appropriate help has an obligation, because of the contract the HSE has with that employee, to ensure that the woman seeking help gets the care she needs. Ultimately it is the responsibility of the HSE. The way that is provided for in law really matters.
I want to leave open the possibility of putting in a different kind of amendment at the next Stage on the question of the ultimate responsibility lying with the HSE itself rather than the doctor. However, I can foresee hard cases here, and the law as it is written at the moment may not deal with those cases. Transfer of care might be interpreted as merely providing a freephone 24-7 helpline but will do nothing for a young woman from direct provision or from a marginalised community who only knows about a doctor's clinic. She may be impeded by the use of language, her inability to speak English, or a lack of money to make phone calls. There may be many reasons a young woman could not independently look for help outside a doctor's clinic.
We have to be careful not to create hard cases. Having said that, I am pretty confident that most of our medical practitioners would not be that hard-hearted or so cruel to let somebody walk away in a desperate state. There may be some such practitioners out there, and we should allow for the possibility of that. We have to look at how we frame this provision. We have inserted a clause to say that those doctors must refer the woman on to someone who will treat her. We do not quite use that language, but it is clear that the transfer of care is the duty of the doctors. I want to look at inserting an amendment in the future which will make it the ultimate responsibility of the HSE.
As a corollary to the amendment introduced by Deputy Tóibín which seeks to allow an institution access to conscientious objection, we have submitted amendment No. 162 which would insist that an institution does not have access to conscientious objection by inserting into subsection (1) that, "Nothing in subsection (1) shall be construed as applying to an institution, hospital or a medical facility". We could leave that out, but we believe it would be better in the legislation as an absolute guarantee that there will be no chance that a place like St. Vincent's Hospital can refuse to provide abortion care because it has a Catholic ethos. Some people are terrified that our future national maternity hospital might have that facility. We want it to be written into abortion legislation that it does not. I believe that is a reasonable request. I take the Minister's point that the legislation includes institutions, hospitals and clinics in good faith.
I have heard that many of the approximately 600 doctors kicking up about this legislation are unhappy because it raises a question about the GP scheme and the payment of GPs in general. Dr. Carthy would know about this. GPs lost a lot during austerity; it has been suggested that there were pay cuts of between 26% and 36%. Those payments have not been restored. I can imagine that a cohort of GPs would be annoyed that they are now being asked to take on extra work without proper remuneration. Can the Minister tell us whether that is correct or not? I do not imagine that there are 600 doctors who are saying that they will not give out the abortion pill. It makes more sense that there would be 600 people who are discontented about pay.
Deputy Bríd Smith is entirely correct. GPs will obviously have to be remunerated. There is a broader issue concerning general practice into which I am not going to get today, but the Chairman and I are very familiar with it. It relates to the ongoing GP contract talks between my Department and the Irish Medical Organisation, IMO, with the end of the year agreed as the date of completion by both sides. The talks are to address the issues the Deputy has referenced, including the sustainability of general practice, where we want it to be in the future and how we are going to resource it. On the specific issue of resourcing, with GPs to provide the specific new service, I note that in the coming days we will be in a position to issue a contract for the service. It will be very clear for all to see that we are adequately resourcing general practice to provide the service properly, comprehensively and safely. I cannot say any more than that today,
The conversation on this amendment has included a reference to the belief that abortion is the ending of a human life and that people will be forced to facilitate the ending of a life. We have come back to the use of inflammatory language. Perhaps that is the view, but it is not really the place we are in right now. Previously, people spoke about reasons or offering clarity in reference to these amendments. The Minister has been very clear. The amendment is completely unnecessary and already provided for. As a registered pharmacist, I concur with the Minister's reading of the Bill to the effect that pharmacists have always been allowed to conscientiously object. During the years I personally have had concerns about the idea that anybody in receipt of State payments has had that option, but that is my personal view.
Some years ago I had experience in a town where there was a pharmacist who was a known conscientious objector and did not stock barrier or oral contraceptives and refused to stock Cytotec, that is, misoprostol, for the completion of a miscarriage. My understanding is there was no active referral. However, it was very well known among girls in the town that one did not go to that pharmacy for the contraceptive pill because one would not be given it. Happily, there were nine other pharmacies in the town that could facilitate. There is something like 1,800 retail pharmacies in Ireland and I do not imagine this will pose any problem. However, I do not mean to womansplain anything here, but as the Minister said, one of pharmacist's roles in the community is to complete stock orders for GP surgeries. As such, a dispensing process will be involved. In the hospital environment the pharmacy will dispense for prescribing doctors.
I was not going to go there, but there was also a reference to New Zealand. It is really easy to selectively pluck elements of other countries' legislation and bamboozle committee members as if we would not look it up, but I did. Under the Contraception, Sterilisation, and Abortion Act 1977, in New Zealand abortion is available on health grounds up to 20 weeks; therefore, the risks of delay are not as great as under the Bill here. What happens in New Zealand is not at all relevant to the situation here. A doctor in New Zealand can refuse to consider a woman but must inform her of her right to seek healthcare elsewhere. The comparison with New Zealand, therefore, just does not work. It has been statistically proved - it is not merely my opinion - that terminations in New Zealand tend to happen later in the first trimester owing to that longer period.
Let us remember that at the start of the week we spoke about women being at the centre of our discussions. We have to imagine a woman with a crisis pregnancy who is looking for a medical professional's help and how she might feel if she was shown the door. I am of the understanding one can conscientiously object to treatment but not to a person. That is a very important point to consider.
The discussion has proceeded as though conscientious objection is a black and white issue. There is actually a spectrum. Suggesting an institution could be a conscientious objector represents a complete misunderstanding of the degree of objection within the medical profession. Let us consider an institution such as a hospital that is in receipt of State funding. It would be bizarre if it could organise as a collective so as not to provide services for which the people clearly voted.
To my mind, we are yet again seeing a sinister strategy to stigmatise the care required, that is, the procedure of termination of pregnancy; to demean and reduce a woman by suggesting she needs more information; to target the medical professionals who want to be conscientious providers of this service; and to drive willing medical professionals to simply give up.
As somebody who has worked in late night pharmacies at weekends and on Christmas Day for several years, I would like to make a point that the Minister has perhaps considered. There is a need for a book of guidelines for community pharmacists to cover situations where a patient, whom one knows, presents on Christmas day or at 8 p.m. If we cannot get hold of a GP, pharmacists should know the cascade of options to which we refer if we are caught in a situation with a vulnerable woman. Obviously, referring her to a maternity hospital seems to be the logical choice, but that is fine for me as a person in Dublin. A booklet would be helpful for those pharmacists who want to hold it. I am not saying they should be forced to hold them, but there should be some guidelines for community pharmacists in order that we will not be gazing at women in a crisis not knowing what to do with them.
I hear a lot from a lot of Deputies today, as well as in a lot of the motions, about freedom of conscience and how absolutely vital and important it is, but for umpteen years I have not heard from any of them about the absolute right to freedom of conscience where people like me are concerned. I did not hear about freedom of conscience for people like me when the Dáil prayer was forced on us and we were forced to stand for it, or with reference to the statue of the Virgin Mary one sees in hospitals. We do not have full freedom of conscience.
I am becoming a little concerned as the debate goes on. Yesterday I said I was not going to come in, but I am becoming quite worried. It is being suggested doctors, nurses and, as some would love to have it, everybody else will be able to object to providing abortions. All they will be required to do is tell somebody about a website or a 24-hour helpline. That is not what I understood by "transfer of care". The Minister needs to be a little more specific. He was very specific when he wanted to include periods and dates in the law, but he is not being as specific in this instance. I accept the point he made yesterday that "as soon as may be" means a little earlier than we all thought. However, a specific time should be outlined. It should be 24 hours, as proposed in one of the motions. The wording "as soon as may be" is a little too vague. Notwithstanding all of the great doctors in the country, there are some who will actively frustrate women and pregnant people in seeking to have an abortion in this country. They certainly will. Some nurses and midwives will too. They just do not agree or accept that it is a freedom of conscience issue for the woman having an abortion. They accept freedom of conscience only in their case. I have visions of women being passed from Billy to Jack.
If one goes to a doctor and is told there is a website and that is the doctor's duty done, that is not enough. We need to be a little more specific.
I took "transfer of care" to mean that one must tell the woman that another doctor in her locality - there is no point in referring a woman from Dublin up to Donegal or vice versa - will provide the termination and has the potential to cater for the woman the following day. I thought we would be talking about some kind of referral. The uninitiated among us would read "transfer of care" in that way, so the Minister must explain this. I wrestled with this issue and whether I would oppose conscientious objection completely. There is a case to be made as to whether it should be allowed at all because the way in which it operates in some countries is such that it prevents many people from accessing terminations. We cited examples in Italy, where a culture has been created in the medical community of doctors not participating. One can see how, with political and social cultural shift in a different direction, this could start to happen here.
How onerous is it for a doctor to write a prescription? One could surely argue that it is still up to the woman and that the doctor is not actually participating in the abortion. He or she is giving that choice, that freedom of conscience, to the woman in the situation. I ask the committee to look at it that way. One would think doctors were actively being forced to carry out abortions, which none of us agree should be the case. One is still giving the person affected by the decision that freedom of conscience but one is not carrying out the procedure oneself. All I am hearing about is doctors and nurses. I agree with Deputy Bríd Smith that the majority of doctors will participate in this. Surveys given to the Committee on the Eighth Amendment of the Constitution showed that the majority of doctors, like the rest of the population, were in favour of such provision. I will also be balanced, however. Doctors did not do enough in this country in recent years to actively move the situation forward. Even Professor Arulkumaran said after the inquiry into Savita's death that he was surprised doctors did not do a little more in the intervening years. Be that as it may, doctors are now actively taking part.
I wish to mention some specifics. Some of the amendments basically imply that this should be broadened to all healthcare workers. I myself worked in the healthcare system. If it is broadened, are the Deputies who have tabled these amendments saying a clerical officer could refuse to write a letter of referral for someone or refuse to physically hand a woman a list of doctors in her area? This seems to be what is advocated in these amendments. Not alone that, but what if a receptionist in the surgery has a conscientious objection? There is all sorts of potential here for the matter to be broadened.
The institutions are another matter. I agree that amendment No. 162 should be adopted. We probably should explicitly write this into law and it would be good to do so because there is a serious question mark over it. No one knows what will happen with the national maternity hospital. I would like the Minister to make it clear that he will not accept institutions conscientiously objecting.
Another matter that has come up recently and on which I would like the Minister to give a commitment is the question of an opt-in system. I have been contacted by doctors who are abortion providers in other countries. They have asked me to ensure that such a system is not introduced here because having a list of abortion providers could potentially put certain doctors at risk of attack. We should not be naive. There are people who actively oppose this law and we know they pick on clinics. We know that where they have done so in other countries, doctors and healthcare providers have been attacked and killed. We know they are guilting and shaming women going into abortion clinics in Liverpool today. If we are to have an opt-out system, it must have a limit such that the doctor must ensure that the woman is looked after. Furthermore, we should not have an opt-in system or a list of doctors. I am also worried about this 24-hour helpline, and I mean this for the protection of doctors and staff who work in surgeries too. We do not have an opt-in system for the provision of diabetes services or other healthcare. We should not stigmatise abortion if we can in any way avoid doing so and we should ensure that doctors are protected.
I think there will be enough doctors to provide this service. I will put this in context because I think it was Deputy Fitzpatrick who raised the question of how the healthcare service will cope. We do not know the exact figures, but let us say there will potentially be 5,000 or 6,000 abortions per year, adding up the people who travel and those who order the abortion pill online. We do not know the exact figure for the latter but we have some idea from the two main providers. The current number of doctors will be able to cope, particularly because much of the service, probably up to 80%, would be medical abortion, which simply requires a prescription. I am all for protecting doctors' and other people's rights, but at the same time we must ensure that women, particularly those in rural areas or areas where there are not many doctors, are not left behind.
I wish to raise one last scenario. We had a case two years ago in which a psychiatrist sectioned a teenager who was suicidal and was seeking an abortion. We never heard what happened but this came out in an article in The Irish Times a year later. Doctors who oppose this legislation have a lot of power to frustrate it, so it is important we write into it the limitations of conscientious objection.
Our next three contributors are Deputies Tóibín, Nolan and Mattie McGrath.
It is interesting how best practice internationally is being solidly ignored in this scenario. I cannot understand why. I gave the examples of New Zealand and Britain. In both countries doctors do not have to make arrangements but abortions happen. Access is not reduced, the law on conscientious objection does not prevent it, etc. We can get lost in ourselves on this issue when, in fact, there are systems functioning, not that I agree with them, in a way that people from the other side of the debate would want them to function without forcing other people to get involved in them. The conscientious objection of a doctor and a cleaner are equal.
A cleaner could have to go into an abortion facility - for example, in the case of a surgical abortion - and ensure that the facility is cleaned, etc. He or she may not want to do that because of conscientious objection.
The cook as well?
Chairman, is there any way we can have a little-----
No. It is a question.
Deputy Coppinger had a clean opportunity without any interaction at all from other members. Workers at all levels are equal and should be treated equally. We should not be saying certain workers should be allowed conscientious objection and other workers should not. That is a really important point.
We have been having this back and forth on guidelines and primary legislation for the past three days. This is one area the Minister needs to relinquish. The opposition is not just from what people would call the pro-life side of the debate. There is fair opposition around the country, left, right and centre, on this issue. Primary legislation trumps medical guidelines. Furthermore, this is a change to the medical guidelines. The Minister mentioned the medical guidelines in respect of the Protection of Life During Pregnancy Act. That was a requirement in respect of abortion in cases in which the life of the woman was under threat and had to be protected. For a start, the level of conscientious objection that would exist in such a case is zero. Second, the position would be that the guideline would be deleted if that Act were repealed.
The Chair was very close to nailing it in this situation.
We are introducing a new law and the language in this particular section is the same language as the particular other law, but it is for a different right, not the right to have an abortion in the case where the mother's life is under threat but the right to have an elective abortion in a scenario before 12 weeks for other reasons, and important reasons they may be. It is a different right. Therefore the guidelines designed by the Medical Council on this particular issue will not have to give the same level of precedence to passing information, etc. In actual fact, I have spoken to a number of barristers on this issue and their view is that the Medical Council could not but develop guidelines that actually reflect the law. They would have to respect the law.
Where the Minister refers to arrangements for abortions up to 12 weeks without indication, the Medical Council would have to implement that. That is where the doctors are having the real difficulty. It is not a replication. It is a completely new situation, under completely new circumstances, where the Medical Council is going to have to follow the law on this. That is why my request would be that this needs to be put into primary legislation to deal with that.
On pharmacies, Deputy O'Connell made a point that I wanted to raise. People do not realise the level of engagement pharmacists have on this. They purchase stock for their localities but pharmacists in hospitals would have to provide for this situation. The Minister said that reasonable action was necessary. Action is not passive. It is an involvement in a process. The Bill is forcing the pharmacists to be involved. We are getting lost in ourselves in a way. All of this can happen as all of the pro-choice TDs want without forcing one individual to do something that he or she does not want to do. That is what we are talking about. We are talking about forcing individuals to do things that are completely against their wishes. In a liberal democracy, surely we should not be doing that.
On a brief point of order, Chairman, as to what the pro-choice TDs want - in fact the people voted in a referendum-----
On a point of order this was-----
-----lest that point has gone astray-----
-----a referendum that was on a constitutional amendment not on a Bill.
-----anywhere - this was not a concoction of Members of this House. This was as a result of a solemn referendum, a plebiscite among the people; one will not get any better mandate than that.
Let us be clear, Isobel Kennedy of the Referendum Commission indicated to people before the referendum that unlike what Deputy Durkan has said, it was on the deletion of the 8th amendment. Furthermore, all of the detailed aspects of the Bill could not be conveyed in a binary question such as a referendum. People voted for this referendum for lots of different issues not on the word "arrangement" or "transfer". In fairness, to suggest so is a nonsense.
I wish to make a correction, Chair. It was a referendum held on the basis of the heads of the Bill being published beforehand and the-----
That is incorrect.
Can we ask the Deputies to stick to the amendments rather than the historical arguments?
When we are discussing a matter and something is thrown out into the ether, I would ask that we be factual.
Let us agree with Deputy Smith there, please.
I am obliged to offer the members a break because we have been here for the best part of three hours. I will be led by the members.
How many more speakers are there on this particular section?
I believe everybody has spoken on all of the amendments in this section.
I am obliged to offer the members a break and I am doing so. I get the impression that we should continue.
There are two more speakers and then we will go for a break.
The next two speakers are Deputies Nolan and Mattie McGrath.
I want to point out that conscientious objection is a major issue. I can see why. I have met a number of GPs and they have genuine concerns. They do not want to have any hand, act or part in the abortion process. It is as simple as that. The legislation as it stands, which my colleague Deputy Tóibín pointed out, does not provide for full conscientious objection. It was not voted on in the referendum, if we are to be honest about that. That 640 GPs have signed a petition suggests that this is becoming a major problem that needs to be dealt with.
It is appalling that the Minister did not consult with these GPs or sit down with them. The doctors' group released a statement, which he may be aware of, stating quite clearly that they felt bullied and disrespected; those are their words not mine. They have been treated in an appalling manner. Everybody has the right to conscientious objection. Let us be straight that it is a human right. These GPs want no hand act or part in this. Their views should be respected. The legislation is a weak form of conscientious objection. It is not given full conscientious objection or respecting their rights.
The GPs have also pointed out that as well as the Government the Irish College of General Practitioners, ICGP, has also acted in an unfair manner in that it refused to call the EGM until after these amendments are dealt with. What that effectively means is that the legislators cannot hear the voices of the GPs directly. We have met them and I know many of the pro-life TDs have had the courtesy to meet them in our clinics and we have been hearing their concerns. We agree that there is a huge issue here.
If these GPs refuse to participate in this process, and I am totally sympathetic to them, what is going to happen? Are their licences going to be taken? Are they going to be locked up? Are we going to have a flood of court cases because that seems to be where we are headed here? All this is at the end of the day is upholding a fundamental right to conscientious objection. If we do not accept this very reasonable amendment here, we are headed to a flood of court cases. Listen to the GPs and respect them. We are talking here about different choices and views. We all have our own views and nobody, whether they be a politician or a GP or a health care worker, should be forced into taking part in a process with which they fundamentally disagree.
We are about to have a vote on one of the most important questions we could ever be asked, as to whether this legislation, as put forward by the Minister for Health, would change everyday medical practice. It is no overstatement to say that the Minister has proposed nothing short of a radical change in the model of medical practice and care provided by maternity services in Ireland. We have been contacted by numerous doctors, as has been said, in everyday practice who are shocked that the draft legislation has been proposed without so much as the slightest consultation with front-line care providers whose patients are pregnant women and their unborn babies.
No guidance has been given on the professional liability for the practitioners that may arise in providing abortions under the legislation. No experts have been consulted on the pathetic conscientious objection clauses that are contained in this Bill which in practice would not protect anything .
Despite what the Minister said during the referendum campaign that the law would protect the right to conscience, the so-called conscientious objection clause in the legislation gives no real protections in law for those who do not wish to provide abortions. It is as simple as that. Doctors were shocked to discover that even in circumstances where they object to performing an abortion or prescribing abortion medication, they must make such arrangements to ensure that women requesting a termination are able to do so, which I am quoting from the legislation. The meaning of this is obvious. Where a doctor objects to an abortion, he or she must still ensure that one is obtained. The Government's proposed abortion law goes far beyond the law even in Britain where there is no requirement to make arrangements for abortion access. The health services are full of doctors who want to care for women and their unborn children equally. Doctors across the country are not willing or able to become abortion clinics for a Government that has no clear plans or budget to radically change our caring patient-centred medical practice.
The Minister cannot even handle the record-breaking delays in accident and emergency departments. This abortion will turn into a similarly badly thought-out mess in court cases, as we have in illness litigation. We are aware the costs of that and the damages involved, with plenty of cases of cervical cancer and God knows what else.
The Minister has rejected protections for disabled babies from abortion and protections for babies born alive. He has rejected provisions for ultrasound and the respectful burial of bodies after surgical abortions.
On a point of order. This is misleading information which the Deputy is trying to reinsert into the debate.
It is an out of order amendment.
Allow the Deputy to continue, please.
I did not interrupt anyone.
Continue please, Deputy.
Is it the gospel according to St. Bernard? Deputy Durkan knows the truth. Goodness, gracious me. I will repeat what I was saying. The Minister has rejected protection for disabled babies from abortion and protections for babies born alive. He has also rejected provisions for ultrasound and respectful burial of bodies after surgical abortions but this is a new low for the Minister. Now he is refusing to listen to hundreds of GPs and is demanding that they turn their practices into abortion clinics.
Continue Deputy, please.
What is the problem?
There is no problem.
There seems to be a problem with some irrational members here who do not want to listen to what I have to say..
Will Deputy McGrath please address the amendment and not-----
-----provoke other members of the committee.
I did not stop until I was interrupted.
The Deputy is responding to yesterday evening's debate.
This is a joke.
This is ridiculous.
The Deputy is constantly being interrupted.
This is pathetic.
It is pathetic. I do not interrupt.
On a point of order, Deputies Durkan and others need to show a bit of respect and allow the Deputy to finish. If they want to say something afterwards, they can do so then. They are all getting a fair-----
We are just getting tired now.
They are getting a good run.
Thank you Deputy.
I want to clarify something.
I will refuse to sit and listen to something that I know to be untrue and which is being repeated again and again. There is no basis in the legislation at all for the conclusion being reached in terms of what is actually happening. The information that is being put to the House at the present time is misleading.
Would Deputy McGrath please stick to the amendment?
I will but I will not take any lectures about misleading anybody from Deputy Durkan. He is the greatest blunderbusster that I ever met in this Parliament. I want to be very clear that I have spoken to these doctors. The Minister has too but he has not listened. They are not going to perform these abortions and are not going to make sure they are performed. If the Minister wants to start stripping licences away from GPs and destroying local healthcare, he will go down in history as the most incompetent Minister for Health in the history of the State.
Deputy McGrath. I am asking you to stick to the amendment. We do not want commentary like that-----
I am sticking to the amendments. I have outlined the reasons-----
Deputy McGrath, you are out of order in making comments like that in this committee.
I am not out of order.
You are in the health committee. You are not elsewhere. I am ruling you out of order in making comments like that.
I have just ruled you out of order for making comments like that. You are being obstructive.
I am not being obstructive. I have carefully written this and I am reading it out.
Yes, but even though you are reading it out, what you are saying is not appropriate for this committee.
Well, I think it is-----
I am telling you it is not so-----
Look at the health service. It is scandal after scandal-----
Deputy McGrath, if you do not address the amendment, I will move on to the next speaker.
I am addressing the amendment. The Chairman did not stop anybody else, no matter what was said. We were called all kinds of names but the Chairman did not stop anyone. The Chairman did not stop any of them.
Deputy McGrath, I would ask you to respect the Chair.
I am respecting the Chair but-----
-----I want respect from the Chair as well, which I am not getting. It is a two-way process. If the Minister starts stripping away licences from GPs or locking them up, as he is threatening if they object, he will go down in history as the most incompetent Minister for Health in this country. Our amendments will ensure that the right to freedom of conscience is protected. They will avoid pointless and expensive court cases but the expense does not matter. They will protect GPs in their work. I am appealing to the Minister but he has set his face against accepting any of them.
The Minister refused to meet the Irish College of General Practitioners, ICGP, and just met the board of directors. A total of 640 GPs have signed a letter calling for an extraordinary general meeting but that meeting has been put off until after all amendments have been dealt with. People can see that it is a total stitch up. They can see what is going on. It is the silencing of doctors, of people who provide care. They do an exceptional job in providing that care.
The Chairman knows how tough it is to be a GP. He campaigned on the slogan, "No doctor, no village". He knows how much people appreciate, need and love their doctors. This is upsetting doctors. A full 640 signed the letter and many more who did not sign it have the same issues with this. Everyone knows how difficult it is to get GPs for rural practices. It is a problem in my own constituency. Are we going to just rubbish them? Are we going to tell them to eat cake and shut up? GPs released a press statement today. They have concerns regarding the total lack of consultation by the Minister and the ICGP board, which is disturbing. Many GPs on the ground do not believe general practice is the appropriate setting in which to deliver abortion because of a lack of capacity in an already overstretched environment. They also cite a lack of training, the limited availability of ultrasound and the need to deliver a genuine freedom of conscience protection for doctors who do not want to be involved in overseeing abortions.
The Deputy just read that out. That is the speech that he read out earlier.
I did not. Is this sideshow going to persist? I am just quoting from a statement issued by the ICGP or rather by 640 doctors-----
You have already quoted it.
Yes, but I am quoting it directly now.
You cannot be repetitious.
What does it matter if people are repetitious? I went through the Oireachtas Committee on the Eighth Amendment of the Constitution, which I called a quango and I know what that was like but I expected that there would be more decorum here with Deputy Harty in the Chair. I expected more respect and manners but it seems that some people cannot help themselves. I call on the Minister to enter into talks with the ICGP because 640 members of that organisation want to discuss these issues with him. We wanted to have discussions with the Minister before we tabled our amendments. Deputy Fitzpatrick and I sought meetings with the Minister. We wrote to him on behalf of ten Deputies but he never replied.
Thank you Deputy McGrath.
Is that it? Are we going to vote on it?
No, not yet. I will call on the Minister to respond.
Deputy McGrath is not going to make the news. We are an hour out.
Did the Chairman hear that comment?
We are all big enough to take a few comments.
I do not think I need to respond to personal insults and I am happy to progress with the legislation.
Okay, the question then is-----
Through the Chair, I think that it is a wee bit unfair.
Of course it is.
In fairness, other Deputies have asked the Minister questions and he has given them long answers. Is there a reason he will not answer us? I cannot understand it. I think the Minister is shying away from us. He should show some kind of decency here.
I will. If I can speak and the Deputies do not heckle me-----
We promise that the Minister will be able to speak.
So far, in the four hours I have been here today-----
So have we-----
No, not all of the Deputies have been here for four hours. Following on from the eleven and a half hours yesterday and the nine hours previously, so far today I have been referred to as simple and as the most incompetent person in the history of the State. There is no decorum here.
Minister, you cannot-----
Let the Minister speak.
If the Deputies would like me to speak, I will speak but I would like to speak in a respectful forum. I have actually answered all of these questions but unfortunately some people have been coming in and out of the room and they want me to answer them again. There is a record of my answers. I have not moved from this chair. I have answered all of the questions but I will answer them again for the Deputies.
There is conscientious-----
That is how committees work, on a point of order.
What? That people walk in and walk out and do not bother to listen to anything?
Deputy McGrath -----
Is that what Deputy Fitzpatrick thinks too?
I left on three occasions because I had to go to the toilet.
Same here. Are we not allowed-----
Deputies. The Minister is going answer the questions again.
He did not respect us-----
I have answered them already. I will answer them again and again. This is a delaying tactic-----
Allow the Minister to speak so that we can proceed to the vote.
Is the Minister summing up on all of our questions?
Yes, for the final time. As Deputy Coppinger knows because she has been here, I have answered all of the questions already.
Conscientious objection is allowed for in section 23. The issues that the Deputies are suggesting have been voted against already. Of course, we have not voted against them but against the amendments as proposed because we are satisfied that the protections and clarity are already in the legislation. This is no different to the conscientious objection that already exists. I have explained in great detail and read fully into the record of this committee the Medical Council guidelines, referencing specifically section 46 of those guidelines that outlines how conscientious objection works. Deputy Mattie McGrath is not going to like my answer, no matter how many times I say it. I am not going to like his position, no matter how many times he reiterates it.
Given the lengthy discussion I suggest that we vote. I have answered all of the questions.
- Durkan, Bernard J.
- Harris, Simon.
- Harty, Michael.
- O'Brien, Jonathan.
- O'Connell, Kate.
I move amendment No. 148:
In page 15, line 33, to delete “or midwife” and substitute “, midwife, hospital or institution”.
As the full membership of the committee is not present, under Standing Orders we are obliged to wait eight minutes or until full membership is present before proceeding to take the division.
- Durkan, Bernard J.
- Harris, Simon.
- Harty, Michael.
- O'Brien, Jonathan.
- O'Connell, Kate.
I move amendment No. 149:
In page 16, to delete lines 1 to 4.
As the full membership of the committee is not present, under Standing Orders we are obliged to wait eight minutes or until full membership is present before proceeding to take the division.
- Durkan, Bernard J.
- Harris, Simon.
- Harty, Michael.
- Kelly, Alan.
- O'Brien, Jonathan.
- O'Connell, Kate.
I move amendment No. 150:
In page 16, line 1, after “shall,” to insert “within 24 hours,”.
I move amendment No. 151:
In page 16, lines 1 and 2, to delete “, as soon as may be,”.
I move amendment No. 152:
In page 16, lines 2 to 4, to delete all words from and including “make” in line 2 down to and including line 4 and substitute the following:
“inform the person requesting a termination of pregnancy that it may be available/availed of from another medical practitioner.”.
I move amendment No. 153:
In page 16, line 2, after “the” where it firstly occurs to insert “prompt”.
I move amendment No. 157:
In page 16, between lines 4 and 5, to insert the following:
“(4) A person who has a conscientious objection referred to in subsection (1) but refuses to make arrangements for the transfer of care of the pregnant woman concerned shall be referred to the Medical Council for appropriate sanction.”.
I move amendment No. 158:
In page 16, between lines 6 and 7, to insert the following:
“ “healthcare worker” includes a medical practitioner, nurse, midwife or pharmacist and any person training or studying to qualify or work as a medical practitioner, nurse, midwife or pharmacist;”.
I will return to this on Report Stage.
I move amendment No. 159:
In page 16, to delete line 12 and substitute the following:
“participate in carrying out a termination of pregnancy” means participate directly or indirectly in carrying out a termination of pregnancy, and includes—
(a) prescribe, dispense, sell, advertise, promote, distribute or otherwise provide medication used for termination of pregnancy,
(b) refer a pregnant woman for the making of a certification in respect of or for the carrying out of, a termination of pregnancy, and
(c) supervise, delegate to, plan or support persons who are participating in carrying out a termination of pregnancy;
“pharmacist” means a person whose name is for the time being registered in the register of pharmacists established under section 13 of the Pharmacy Act 2007.”.
I move amendment No. 160:
In page 16, to delete line 12 and substitute the following:
“participate in carrying out a termination of pregnancy” means participate directly or indirectly in carrying out a termination of pregnancy, and includes refer a pregnant woman for the making of a certification in respect of or for the carrying out of, a termination of pregnancy.”.
I move amendment No. 161:
In page 16, between lines 12 and 13, to insert the following:
“(5) Refusals of provision of abortion by a medical professional on the basis of conscientious objection must be notified to the Minister for Health by the medical professional concerned within 7 days of the refusal.”.
We have not spoken on this amendment but we may put it back in on Report Stage.
I move amendment No. 162:
In page 16, between lines 12 and 13, to insert the following:
“(5) Nothing in subsection (1) shall be construed as applying to an institution, hospital or medical facility.”.
I wish to make a procedural point. I mentioned earlier that I wanted to leave myself free to put in an amendment that is not in the numbered list at a later stage.
Does the Deputy mean on Report Stage? What is the topic?
She mentioned it earlier.
It related to conscientious objection, the term, an obligation to refer and so on.
I propose that we take a break until 6.30 p.m.
Is the intention to finish tonight if possible?
Can we not just continue to get this over and done with?
We have not had a break. We are here nearly three and a half hours now. We need to take a break.
Do we need a break for a whole hour?
Yes, for a whole hour.
I do not want to be awkward for the staff. I have visions that we can finish this quickly. I am not saying we should go on now if people want a break, but could we make it shorter?
If there was no vote called on section 24 we would be quick.
We will finish at the same anyway.
Yes, but if the break is for one hour it makes a difference.
You have suggested a break until 6.30 p.m., Chairman. It is 5.30 p.m. now.
I am in the hands of the committee. I am simply making a suggestion.
I am here until 6.30 p.m. or I can go until 5.45 p.m. and then take a break.
Amendment No. 163 has already been discussed with amendment No. 147.
I move amendment No. 163:
In page 16, between lines 12 and 13, to insert the following:
“Protection for persons exercising right of conscience
24. (1) A protected person shall be deemed to have all of the same rights, protections, causes of action, immunities and means of redress as are provided for by sections 11, 12, 13, 14 and 15 of the Protected Disclosures Act 2014 in respect of a person who makes a protected disclosure under that Act and, subject to any necessary modifications, the said sections shall be deemed to apply to a protected person and references in the said sections to the making of a protected disclosure shall be deemed to refer to a conscientious refusal.
(2) Nothing in this section shall operate to affect any right or claim that a protected person may have, otherwise than under this section.
(3) In this section—
“conscientious refusal” means a refusal or omission by a protected person to do any act referred to in section 23(1) in relation to a termination of pregnancy in accordance with section 10, 12 or 13 to which that person has a conscientious objection;
“protected person” means any person referred to in section 23 who refuses or omits to do any act referred to in section 23(1) in relation to a termination of pregnancy in accordance with section 10, 12 or 13 to which that person has a conscientious objection.”.
I move amendment No. 164:
In page 16, between lines 30 and 31, to insert the following:
“Offence against medical practitioner or healthcare facility
25. (1) It shall be an offence for a person, persons, or group to expose in any way the name of a medical practitioner, practitioners, or healthcare facility that has, is, or will carry out or participate in the termination of a pregnancy for the purposes of harassment.
(2) It shall be an offence for a person, persons, or group to protest or harass a medical practitioner, practitioners, or healthcare facility that has, is, or will carry out or participate in the termination of a pregnancy.
(3) A person who is guilty of an offence under this section shall be liable on conviction to a fine or imprisonment for a term not exceeding 12 months, or both.
(4) A prosecution for an offence under this section may be brought only by or with the consent of the Director of Public Prosecutions.”.
Amendment No. 165 has been ruled out of order.
Amendment No. 166 in the name of Deputy Catherine Murphy cannot be taken.
Amendments Nos 167 and 168 have been ruled out of order.
I move amendment No 169:
In page 17, line 10, to delete “shall” and substitute “may”.
I move amendment No. 170:
In page 17, line 11, to delete “services” and substitute “and/or out-patient services as appropriate”.
Bear with me for a moment.
Did we not discuss this already?
We did. It relates to services for pregnant people.
I have not discussed it.
Amendments Nos. 170 to 172, inclusive, are in my name. I will discuss them together because they are all about the same issue. One was ruled out of order but the others relate to the same issue.
I will discuss the technical amendment first, which is amendment No. 170. Essentially, this section makes termination of pregnancy services free and they would be provided through the HSE. One of the subsections states that the services referred to shall be provided otherwise than as inpatient services. This might be relatively simple, but as I read it a concern arose for me. The preceding paragraph states that the HSE shall make available without charge medical surgical and midwifery services for the purposes of termination of pregnancy in accordance with sections 10 to 13, inclusive. The paragraph goes on to state that those services should be provided otherwise than as inpatient services. I may be wrong but my concern is that for an outpatient or a patient in a general practice the services would be free but once the woman moves to being an inpatient the services would no longer be free. I wish to clarify whether I am correct in thinking that. I believe the services should be free regardless of whether a woman is an inpatient or an outpatient. Can the Minister give some clarity on that?
I thank Deputy Donnelly for raising the matter. It is absolutely the intention that termination of pregnancy services will be free both in the community and in the hospital setting. The amendments to the Health Act 1970 mirror the provisions of that Act as they relate to services for attendance to the health of women in respect of motherhood. Thus, women in receipt of services in accordance with the Act of 2018 are not discriminated against in terms of eligibility. The proposed section 62A(2) contains identical text to section 62(1) of the 1970 Act. This is to make it clear that section 62A never applies to inpatient services because inpatient services are dealt with in sections 51 to 55, inclusive, of the 1970 Act and the necessary amendments to those sections are contained in sections 25(b) and 25(c) of this Bill.
That explains my confusion. I wish to be absolutely clear. Free services will apply to inpatients, outpatients and across the HSE. Is that correct?
Amendment No. 172 provides for a report on the implementation. If we are to make termination of pregnancy services free - I agree we should and must and I support that being provided for in this section - then we must make all maternity services free at the same time. They are to a large extent, in fairness, but it is not the case across the board. Some drugs that can cost a great deal of money can be prescribed. Sometimes women have to go in and out for intravenous treatment and acute setting services. In some cases the maternity costs to a woman can end up running into the thousands. I hope any cost on the Exchequer of implementing this measure would be limited. Nevertheless, I am keen to see a situation whereby all maternity services are free. It would be perverse otherwise to have termination of pregnancy services entirely free but not pregnancy services entirely free.
There is a second aspect to this that we should grasp as an opportunity. We should make all contraception free as well. For example, some of the longer acting contraceptives are highly effective but can cost hundreds of euro.
There is the morning-after pill. We could, for example, have a situation - that no one would want - whereby the morning-after pill might require a visit to a GP or €50 to get it from a pharmacist but a visit to a GP for an abortion pill would not incur a charge. I am not suggesting those two things are substitutions for each other. Many different opinions on termination of pregnancy have been voiced at this committee. I am going to take a punt and assert that pretty much everybody here would like to see crisis pregnancies reduced-----
-----and the number of terminations reduced. The relatively high cost of some contraception is acting as a financial barrier. I would really like to see, therefore, at the same time as we provide for termination of pregnancy services to be free that all maternity cover and all contraception should be free as well.
I know what Deputy Donnelly is trying to do and his intentions are very good. In respect of the phrase "all maternity" services, people engage in many things during pregnancy that we could never expect the State to cover, such as yoga and well-being classes. The term "all maternity services" would cover a very broad church. On the drugs issue, Deputy Donnelly mentioned a particular drug, Cariban, used for some cases of morning sickness. He did not mention this today but he did reference it in another meeting, I cannot remember which but I think it was the Joint Committee on Health. It costs money - off the top of my head I think on average it is about €30 for a 21 day supply in the pharmacy. That drug, however, is not licensed for the indication for which it is being used and it is being prescribed off-licence.
I always caution against the provision of drugs that are licence-free. We do not often do that in this country. I want to highlight that. Regarding reversible long-acting contraceptives such as the coil and implant, it is untrue to state they cost hundreds of euro. A coil, give or take, costs about €140 on average and there is also an insertion cost. A coil covers contraception for five years, so when the fee is divided by five it is not that expensive. From my experience I have found that the combination of the expense of having a baby coupled with the price of a coil and a doctor's consultation means that sometimes the amount of money required is outside of people's limit in a pressured financial situation after having a baby. I completely support the suggestion of free contraception, as it was my suggestion at the Joint Committee on the Eighth Amendment of the Constitution. That was based on the evidence that we saw which, from memory, was that 44% of people said contraception failure was part of the reason. On the morning-after pill in the community pharmacy setting, I believe that in the early stages the Minister for Health made it available free to medical card holders in the community pharmacy setting at the weekend to avoid people with medical cards being unjustly treated. My knowledge of the morning-after pill is that it is between €20 and €30 on average in the community setting. It is means tested as part of the medical card so it is deemed to be for people who have the means to pay, if the committee understands what I am saying.
I do not want to delay but I will make one brief statement. There are ancillary recommendations from the Joint Committee on the Eighth Amendment of the Constitution. I did not submit amendments to them in the interests of getting this legislation passed speedily. What is being advocated here is straying into that territory. I have no problem with that. This committee has a right to do that. There are, however, things like sex education on which we have a Bill still stuck on Second Stage. The Minister might move it along. I refer also to free contraception. They are all related. Perhaps we can reserve the right to put them in on Report Stage, if only for the historical record. This has to go through the Seanad as well after it comes back here in two weeks or whatever. Perhaps we can get a timeline. We did not put in all of the elements referred to in the interests of getting this Bill passed by December. Can we speed this Bill up in the interests of women and pregnant people who desperately need it?
The point made by Deputy Coppinger is a good one. I can argue, technically, as to whether this should be debated as part of this legislation, but Deputy Donnelly putting these amendments down is important. All of us here are concerned, as Deputy Donnelly correctly said, about reducing crisis pregnancies. Commitments, or certainly, recommendations were given in the all-party committee report on the eighth amendment in respect of ancillary recommendations. I hate the word "ancillary" because it somehow or other seems to suggest they were afterthoughts. They were not. They were fundamental to the deliberations of the committee.
All of us who campaigned for a "Yes" vote stated we were going to legalise termination but we were also going to put other supports in place. I have heard my own position misrepresented on this and I want to be clear. I want to see free contraception in this country. Free contraception for women is going to require changing primary legislation. It is also going to require some clinical advice and guidance for the reasons Deputy Donnelly gave. There are different types of contraception. At the moment, many women, probably over 40%, have access to free contraception through the general medical services, GMS, scheme. Unlike men, women require a visit to their GP, generally, to be prescribed contraception so it is governed under the GMS scheme. We will, therefore, require primary legislation to be changed and a clinical input as to what is the best thing to do for women. I am committed to doing both of those things in 2019. I am also committed to working with the Joint Committee on Health as perhaps the best forum where we can work on a cross-party basis to try to identify how best to progress that.
The Deputies acknowledged the maternity and infant care scheme does largely provide for free maternity services. We went through this yesterday and I will not go through it again. I will just say that there are free visits to the GP, further examinations during pregnancy, free visits to the maternity unit and if a woman has hypertension or diabetes there are additional visits after the birth of the baby. The GP will examine the baby at two weeks and both the mother and baby at six weeks. Mothers are entitled to free inpatient and outpatient services in hospitals in respect of the pregnancy and birth and are not liable for any of the standard inpatient charges that the rest of us experience as we go about accessing the health service. We also have free GP care for under-sixes as well.
The Deputy is right about some drugs. Cariban was mentioned by my colleague, Deputy O'Connell. She dealt with the issue that it is an unlicensed drug. Legislatively, the Oireachtas gave the power to the Health Service Executive to decide on the reimbursement of drugs and not to the Minister of the day in the Health (Pricing and Supply of Medical Goods) Act 2013. The long and the short of it is that what Deputy Donnelly is trying to do is good. It aligns with what I want to do. I do not think we should put in a report about the broader issues in this legislation but I am happy to give a commitment that I will report to the Joint Committee on Health etc. I would rather not put it in this Bill because I do not think it is a good fit. It is, however, important to highlight it.
I thank the Minister.
I move amendment No. 172:
In page 17, between lines 11 and 12, to insert the following:
“(3) The Minister shall lay before the Dáil, no more than 3 months after the passing of this Act, a report on the costs and implementation plan for the Health Service Executive to make available without charge medical, surgical and midwifery services, including provision of prescribed drugs, for the purposes of pregnancy for women who are ordinarily resident in the State.”.
Amendments Nos. 176 to 180, inclusive, have all been discussed with amendment No. 1.
I move amendment No. 176:
In page 5, lines 5 to 11, to delete all words from and including “An” in line 5, down to and including “Act 1997;” in line 11 and substitute the following:
“An Act to ensure that pregnant women may have equitable access to abortion care in a safe and timely manner, and at no cost, and for that purpose to amend the Health Act 1970 and certain other enactments; to make provision for reviews at the instigation of a pregnant woman, or a person on her behalf, of certain medical opinions given in respect of pregnancy;”.
We have had an extensive discussion about this and I have made the views of my party known as to what this legislation should convey and I do not propose to delay it. I withdraw the amendment.
I move amendment No. 178:
In page 5, line 5, to delete “termination of pregnancy” and substitute “abortion”.
I move amendment No. 179:
In page 5, line 8, to delete "termination of pregnancy" and substitute "abortion".
I move amendment No. 180:
In page 5, lines 10 and 11, to delete "; to provide for offences in respect of the intentional ending of the life of a foetus otherwise than in accordance with this Act".
I will address the process very briefly. To the Minister's credit, he has been very open to a substantial number of amendments to various Parts of the Bill. It is to members' credit that they withdrew most amendments. I know we want this Bill passed into law as soon as possible but it must be right. Based on the three days of debate we have just completed, a great deal of work remains to be done and the Minister has agreed that he needs to consider many issues. My understanding of what will happen next is that the Minister will consider the three days of debate. He has offered to provide members with access to clinicians regarding some of the issues and has undertaken to meet the committee informally. That will probably be a long meeting because a significant number of issues need to be discussed. I understand the Minister will provide members with his proposed amendments or set out his detailed thinking and we will subsequently have time to craft and submit our own amendments. As the Minister did not propose amendments on Committee Stage, other than one on reporting, the Committee Stage debate was a little like a pre-legislative scrutiny session in respect of some of the issues. I guess what we are seeking is a mid-legislative scrutiny session. Is that the Minister's understanding? While we want this provided for in law, it must be right.
It is useful to clarify the position and I do not mean this in any way other than to be constructive. Obviously, in amending this legislation, we all want to get it right. Therefore, because of the office I hold, my ability to bring forward amendments will mean that I can have my amendments robustly legally scrutinised in a way that Deputies may not be in a position to do. I hope that we could net out the issues we want to discuss. I will go back through the three days of debate. I ask members to email me their views by close of business tomorrow, if possible, setting out what they consider to be the net outstanding issues. I suggest that I have an informal meeting with members early next week.
This process will have two parts. There will be some things that I am genuinely convinced I cannot change because to do so would undermine the Bill legally or from a policy or operational perspective. I will do my best to have the rationale for that explained by making available my officials and clinicians. I hope colleagues will accept that rationale on some of the issues. There will be other issues in respect of which members have wanted me to bring about change and on which I hope we will be able to work out how we can bring about the change in wording that is proposed. I suggest there will be give and take. I do not believe we will reach unanimity on all of the issues we could not resolve on Committee Stage but I hope we will be able to net them down.
This is about the process and follow-up. One of our amendments was about extending access to women from the North. I understand that it may not be possible to do this in the legislation but I want to confirm that the issue will form part of our discussions.
I welcome the fact that the Deputy raised the issue because the relevant amendment was ruled out of order, which precluded me from saying what I would like to say.
The same applied to me.
To be very clear, women from Northern Ireland will be able to access services in the Republic of Ireland. Of that, there is no doubt. We are not leaving women from the North behind in respect of this. Until the North gets around to rectifying the inequalities in that jurisdiction, we will make sure women in Northern Ireland can access health services here. As the Deputy is aware, there is an issue, which she and I have discussed, about eligibility in terms of cost and whether there is a way of making the service free. It is a complex issue and I welcome the Deputy's invitation to meet a group of advocates from Northern Ireland, possibly next Thursday.
As the Minister knows, none of our group is a member of the committee. Will it be possible for some of us to attend the meetings and discuss some of the amendments we would like to introduce, rather than arguing the whole time in this committee?
I see no difficulty if the group wishes to send a representative. Deputy Fitzpatrick may wish to liaise with my office.
I thank the Chairman for chairing the meetings for the past three days and compliment him on his management of the committee.
As the Bill has now completed Committee Stage, it is recommended that members submit Report Stage amendments to the Bills Office without delay as Report Stage may be tabled at short notice. When does the Minister expect Report Stage to take place?
I would like to engage with the committee membership early next week and revert with a date. I would like to take Report Stage very soon this month.
Obviously, we cannot submit amendments until we see what changes the Minister propose.
I thank the members, the Minister and his officials for attending and completing Committee Stage in an orderly manner.
Thank you, Chairman.