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Dáil Éireann díospóireacht -
Thursday, 9 Jul 1992

Vol. 422 No. 5

Health (Family Planning) (Amendment) Bill, 1992: Committee Stage.

Section I agreed to.
SECTION 2.

I move amendment No. 1:

In page 2, line 15, to delete "including" and substitute "other than any appliance or instrument which may be used without medical assistance, such as".

It is a Labour Party principle that legislation in the area of contraception should apply only to medical preparations and that we should legislate as little as possible for devices that are simly non-medicines. In my amendment I seek to delete the word "including" and substitute "other than any appliance or instrument which may be used without medical assistance, such as..". Medical criteria should be the only reason for legislating in this area. In seeking to establish that principle, I wish to amend section 1.

The Minister has decided to take spermicidal creams from the provisions of this Bill and to have them regulated under section 65 of the 1947 Act. This contrasts with the Bill published by his predecessor, Deputy O'Hanlon. Therefore, these creams will be regulated in the same way as drugs and medicines. What was the basis for that decision? I believe we would all agree with the approach advocated by Deputy Howlin.

I oppose this amendment because effectively it would render the definition of contraceptives meaningless. For example, if this amendment is passed I could not make regulations regarding the quality standards of condoms, as the amendment specifically states that they are not contraceptives. In fact, should this amendment be accepted much of the remainder of the Bill would cease to have any effect.

The Minister seems to regard it as traumatic that condoms would not be regarded as contraceptives. This is the first time that condoms are to be defined as contraceptives in relation to family planning legislation. The principle I seek to address in this amendment is that we should legislate in relation to the quality and standards of medical preparations that are used as contraceptives, but in relation to devices such as condoms we should have as little legislation and control as possible. Unfortunately, the legislation is in place; therefore, we can only seek to amend that legislation in the best possible way. The question of spermicides has not been addressed by the Minister. Perhaps he would elaborate on that before we withdraw this amendment.

We must apply certain standards. While no standards have been set in the EC in this regard, we must apply certain standards.

Standards can be set under consumer legislation. The Minister is seeking to apply much greater standards and controls to contraceptives than apply to other products. I am seeking to differentiate between products which have a chemical or medical effect, and which should be subject to legislation and control in regard to quality, and other devices which need not be subject to this type of legislation but regulated by normal consumer protection legislation.

I do not agree with the Deputy on this issue.

The Minister has not replied to my query in relation to his decision to exclude spermicides from the Bill although they were included in the 1991 Bill introduced by his predecessor.

I have excluded spermicides from this legislation for the simple reason that they come under medicinal products. They can be purchased over the counter or by prescription, but they do not come under this legislation. To include them in this legislation might create confusion and lead to the supposition that they provide protection against infection, whereas they only protect against conception. They kill nothing but sperm. The suffix "cidal" means to kill; therefore people might think that spermicides could prevent infection. For that reason I thought it appropriate to exclude them from this legislation.

Does that mean they will be confined to restricted outlets?

No. Aspirin and so on are medicinal products, but that does not mean that they can only be bought on prescription; they can be bought over the counter.

Will they be subject to regulation?

If they are, we will ensure that they are over the counter products as they do not cause any ill effects other than, perhaps, a minor allergy.

Amendment, by leave, withdrawn.
Section 2 agreed to.
NEW SECTION.

Amendments Nos. 2, 5, 41a and 45 are alternatives, and Nos. 46 and 47 are related and all may be discussed together.

Are we discussing them together but voting on them separately?

Acting Chairman

They will be taken as a group, but voted on separately.

I move amendment No. 2:

In page 2, before section 3, to insert the following new section:

"3.—(1) Section 2 of the Principal Act is hereby amended by the substitution of the following for paragraph (a):

`(a) provide a comprehensive family planning service,'.

(2) Section 2 of the Principal Act is hereby amended by the addition of the following:

`(c) provide in consultation with the Minister for Education, a Health Education Programme, involving parents and educators, which would seek to promote an understanding and appreciation of responsible sexuality.'.".

Essentially, the purpose of this amendment is to try to bring the 1979 Act into a more acceptable modern context. Section 2 of the 1979 Act provides that the Minister shall secure the orderly organisation of family planning services and provide a comprehensive natural family planning service. The distinction in the original Bill between family planning services and natural family planning services is not appropriate. It can only be interpreted as a sectarian provision in that it indicates a particular view in regard to family planning. My amendment proposes that the Minister should be obliged to provide all types of family planning services that are appropriate and lawful. I believe that principle is supported on all sides of the House. The Minister should take the opportunity in this Family Planning Bill to deal with this issue as it is unlikely that this Bill will be back in the House for many years. I take it that the purpose of the Minister's amendment is along similar lines, but I would like him to explain it.

The second part of my amendment calls on the Minister to provide, in consultation with the Minister for Education, a health education programme, involving parents and educators, which would seek to promote an understanding and appreciation of responsible sexuality. It is clear that many young people are coming under peer pressure to enter into sexual relationships at a very young age without a proper understanding of what is involved in the commitment they are making. Therefore it is appropriate, when we are introducing legislation to liberalise the availability of condoms, that we should at the same time put down a marker that we want to see our young people much better equipped coming out of the education system — as I said yesterday, equipped with the ability to say "no" to sexual advances if they do not want to make such a commitment. If we can promote greater self-respect and respect for partners we could also be tackling the public health problem which the Minister and all Members are so keen to address. I hope the Minister will accept that we do not have an adequate programme to equip our young people in this vital area of their lives. We should, at this juncture, avail of the opportunity to provide a legislative framework under which the Minister for Health, with his colleague, the Minister for Education, would put together an effective programme that is appropriate to the age of the children. That is the purpose of this amendment.

I wish to speak to amendments Nos. 45 to 47, inclusive, in my name.

Acting Chairman

The Deputy will be called.

I welcome the Minister's amendment, No. 41a, which to some extent supersedes a number of the amendments I tabled. The purpose of the amendments I sought to make to the Principal Act was to broaden the concept of family planning services and to eliminate the sectarian definition which obliged the Minister only to support so-called natural family planning methods. The Minister's amendment seeks to delete sections 2 and 3 of the Principal Act which essentially eliminates the reference to natural family planning methods and I welcome that.

In amendment No. 4, in my name, I sought to include tubal ligation and vasectomies as part of the services which would be provided under a family planning service. When the Minister seeks to replace sections 2 and 3 with a reference to being obliged to organise in an orderly way the provision of comprehensive family planning services, has he in mind the provision of services such as vasectomies and tubal ligation as family planning methods? I am aware that hospitals in some health board areas provide tubal ligations but, as I understand it, in most cases, they are provided only on medical grounds and not for the purposes of family planning. Does the Minister have a definition in mind for "comprehensive family planning" because it is not defined in the Bill?

This is an important group of amendments setting out the obligations of the Minister in regard to the whole issue of family planning. We seem to be making an improvement on the position that pertains to date. Under this amendment the Minister is required to "secure the orderly organisation of comprehensive family planning services". What exactly does that mean? It sounds like a traffic policeman. Will he be required to provide family planning services and ensure that they exist or will he organise those that exist by way of regulation?

The import of the amendments I tabled is to amend the Principal Act in a number of ways. Amendment No. 45 seeks to provide — not to organise — a comprehensive family planning service; a point I hope the Minister will clarify when replying. Amendment No. 46 seeks to appeal the licensing requirement for family planning services. That is now being done by means of the Minister's amendment No. 41a which repeals sections 2 and 3 of the Principal Act. Amendment No. 47 in my name reads:

In page 4, before section 7, to insert the following new section:

"7.—In section 3 of the Principal Act, the words `that do not relate to the use of contraceptives' are hereby repealed.".

There is a misprint in amendment No. 47 which should read, "section 9 of the Principal Act" rather than, "section 3 of the Principal Act". The import of that amendment is to change section 9 of the Principal Act to broaden the terms of the Minister's ability to fund research into the use of contraceptives and not simply into areas of so-called natural family planning. That is an area on which the Minister had expressed views and I hope he will clarify the methodology he will use to ensure there will be adequate research to the use of contraceptives generally in the country.

I support the notion in the amendment put forward by the Fine Gael Party in relation to the provision of adequate education programmes. Certainly, a parallel education programme should be available. A comprehensive family planning service is a euphemism because the whole issue of family planning is not only relative to families any more, it is relative to anybody who is sexually active and who does not want to have children. The education is extremely important and should be addressed in a Bill and a debate of this type.

When responding to his amendment No. 41 (a) perhaps the Minister will outline clearly what he proposes to put in place. I am a little taken aback by the phrase, "The Minister shall secure the orderly organisation of comprehensive family planning services". That does not strike me as being an obligation on him to provide comprehensive family planning services. As Deputy De Rossa said, the definition of "comprehensive family planning services" needs to be elaborated on. Can the Minister assure me he will have powers to fund research into contraceptives and that he will not be confined to funding research into natural family planning methods alone.

I should like to refer to amendment No. 2 which seeks the provision of a health education programme. When I spoke on a similar Bill in the Seanad in 1984 I emphasised the relevance of a sex education programme. I have repeated time and again the importance of a proper sex education programme both in primary and post-primary schools. Nothing has happened to any great extent regarding the provision of sex education programmes in our schools. If anything the reverse is the case and we have not as many sex education programmes in our schools as we had in the early eighties. Health education programmes in our schools are almost non-existent for a number of reasons. They are being squeezed out because of pressures from exam subjects. There is no time for programmes on sex education, on substance abuse, alcohol abuse, smoking and so on.

If the Minister wants an effective Bill, if he wants to prevent unwanted pregnancies and if he wants to control the level of sexually transmitted diseases it is of the utmost importance that this Bill be accompanied by proper well thought out sex education programmes in our schools. I appeal to him to discuss the matter with the Minister for Education and to make it a priority.

A sex education programme should be part of a general programme on health education and on human relationships. As my colleague, Deputy Bruton, said it is very important nowadays to impress upon young people that they must respect each other. The traditional respect that existed has diminished. One of the reasons we have unwanted pregnancies is the lack of respect people have for each other. Through my experience as a teacher I am convinced that young people can be educated to be more responsible. However, in this country we are not doing anything about that. There is no national commitment and it is left to principals and teachers, who appreciate the benefit of sex education and health education, to implement programmes. Teachers and boards of management are not encouraged to make provision for sex education programmes in their schools.

We must have a comprehensive health education programme. It is not good enough to bring an expert into schools one day of the year to address the whole school in the assembly hall, perhaps using a few slides; sometimes it is the local priest who does this. This area must be treated in a totally different fashion. There must be a continuous education programme beginning in primary school and going through post primary schools. It must be part of everyday education. It must be continuous and it must be reinforced. Only then will we get results.

It is appropriate that we are discussing this Health Bill here today because yesterday the Department of Health in England launched a White Paper on health and improving the status of health of the British people. Health education is one area on which they put major emphasis. It would be a good initiative if the Minister, together with the Minister for Education, were to bring forward a new White Paper on the improvement of the health status of Irish people which would deal with the type of education programmes I speak of.

I know the Minister is listening. I realise there are certain constraints upon him in regard to what he can do, but this is one area that will prove most beneficial for young people and the health of the nation in general if progress is made.

I also want to address amendment No. 2 (c), which is extremely important. It brings much needed balance into this whole debate about family planning. One cannot legislate for morality, but one can certainly educate for it and that is what this amendment seeks to achieve. The amendment seeks to put an onus on the Minister to provide, in consultation with the Minister for Education, a health education programme involving parents and educators which would seek to promote an understanding and appreciation of responsible sexuality.

Deputy Deenihan has covered adequately the situation as it exists. In most schools, because of examination pressures, there is no space whatever in the curriculum for sex education/life skills studies. There have been pilot schemes and individual health boards introducing their own programmes, but there is no mandatory curriculum space for education in life skills, sex education and so on. There are people out there watching this debate who are convinced that the only solution this Chamber has to unwanted pregnancies is to throw condoms at the issue. This amendment brings much needed balance to the whole debate. Condoms are only a part of the answer. This legislation is but a safety net for people whose sexual activities are probably at variance with what would be deemed by society to be desirable. This amendment provides for education for morality and I appeal to the Minister to accept it.

I intend to have discussions with my colleague, the Minister for Education, on the whole area of sex education. I quite agree with the Deputy that there is an urgent need for this and it has been overlooked and neglected for far too long. It should not be a once-off thing. It should commence in primary schools and continue right through into post-primary schools and it should be part of the curriculum.

In regard to AIDS specifically, my Department are already involved in promoting AIDS awareness in schools. If this programme were to be changed or widened it is only natural that this should be done in consultation with the Minister for Education and also involve parents and educators. This section simply describes normal policy making progress and nothing can be gained by adding what is in effect simply a statement of intent to review existing policy. It would be most unusual to include such a statement of intent in legislation, but the House can be assured that I will initiate discussions as quickly as possible and will come out with a proper policy for full sexual education in the schools. This is important and this is what I will be impressing upon my colleague, the Minister for Education. I feel he would be at one with me on this. It is apparent that the Dáil in general feels there is an urgent need for this to be done.

In regard to the other amendments. I very much agree with them. I am very pleased that Deputy De Rossa adverted to these. As Deputies will know, I am bringing in my amendment here. A number of Deputies have asked that the words "shall secure the orderly organisation of comprehensive family planning services" be included. The health boards may not be the only ones providing this. The lead was taken by private family planning organisations in this country. I would like them to have a place in providing this family planning service. I phrased the section like this purposely to allow them to also participate in providing a family planning service. Otherwise these people could be left out and, as everybody knows, they have done great pioneering work in this field and a tribute is due to them on the work they have done — against all odds, if I may say so.

I am disappointed with the Minister's clarification of his amendment. A number of questions arise. First, he makes no reference to section 9 of the Principal Act, which he is not proposing to repeal and which confines the making available of money for research to natural family planning methods. It would seem the Minister's new section cannot supersede section 9 unless he deletes that section or accepts our amendments. The other issue is that he is proposing to provide by regulation the making available of a comprehensive family planning service and remove the very archaic licensing procedure that was here. Perhaps the Minister could outline to the House what precisely he has in mind by way of his new regulatory framework for the provision of family planning services. He is taking unto himself the right to make regulations but he has not given the House much of an inkling of his thinking in this area. I fully accept the need to give non-health board agencies a role in this area. As the Minister correctly said, they have often had to provide services in the face of considerable adversity. The Minister should give recognition to that role and be in a position to fund the work carried out by them.

The Minister appears to be neglecting our amendment which proposes giving him a new general duty in relation to education. He seems to dismiss this amendment by saying there is nothing to be gained from a statement of intent. I contend that the general duty section of any Bill is a statement of what the Legislature wants the Minister to do; it is a statement by this House as to what his duties are. It is appropriate that such a statement should be included in this Bill, particularly when, as he accepts, there has been great neglect in this area. An assurance by the Minister that the normal system of policy-making will rumble on is not very reassuring to the House when he accepts that there has been neglect in this area. While it was encouraging to hear that he will meet the Minister for Education, I do not think it removes the desire of the House to see a legislative duty imposed on him in this area.

I am not satisfied that the Minister has addressed my amendments; he certainly has not addressed amendment No. 47. I ask him to give us an assurance that his amendment will place a responsibility on him to ensure that a comprehensive family planning service is provided by the health boards, private individuals and private concerns. I do not think any of the amendments which have been put down would preclude individuals, doctors or private groups from organising a family planning service. That is certainly not the intention of any of the amendments. I ask the Minister to give us an assurance that his amendment No. 41a will place a responsibility on him to ensure that a comprehensive family planning service is provided throughout the country.

I ask the Minister to comment on amendment No. 47 which deals with his ability to fund research into the use of contraceptives. The Minister did not address this issue in his initial comments — maybe this was an oversight. I welcome the deletion of the licensing procedures. I sought to change these procedures in my amendment No. 46. I welcome the repeal of this section by the Minister.

With regard to the education aspect, we accept the Minister's bona fides in relation to the ongoing discussions. I think everyone in the House accepts the amendment but it may not be necessary to include it in primary legislation if we accept the Minister's assurance that an educational programme in our schools will be an intergral part of the provision of comprehensive family planning services.

The Minister proposes to delete sections 2 and 3 of the Principal Act. I do not think it should go unremarked by Members on this side of the House that in many respects this is a quiet revolution in terms of attitudes to contraception. The question of the type of family planning service which should be provided gave rise to much argument in the past. It was contended that the Minister was obliged to support so-called natural family planning methods by way of finance and research but was not obliged to support any other form of contraception. That position derived specifically from the view of the Roman Catholic Church that contraception is wrong, any deliberate act which prevents conception is sinful and wrong. It is disgraceful that this House ever incorporated that view in legislation; it was wrong for us to do that as a national Legislature. The Minister should be congratulated by all concerned on this quiet revolution.

Hear, Hear.

We did not receive any notice that he was going to do this — the amendment was only circulated this morning. He may have his reasons for putting down this amendment. I hope it was as a result of the strength of the arguments made by Members on this side of the House and some of his backbenchers on related issues during the course of the Second Stage debate. This is a watershed in our dealings with this extremely controversial issue.

Subsection (1) of the Minister's amendment obliges him to secure the orderly organisation of comprehensive family planning services. Family planning services are defined in the Principal Act as services for the provision of information, instruction, advice or consultation. It does not refer to the service itself. I referred to vasectomies, tubal ligation, the pill, etc. I am concerned that the amendment does not extend the definition of family planning services and seems to delete the obligation on the health boards to provide the service. Section 3 of the Principal Act specifically provides that the health boards are obliged to provide a service. As a former member of the Eastern Health Board I know that section was particularly important in terms of getting over the reluctance which existed among some members of the boards to get involved in that area. I know that the majority of members in some other health boards would not be anxious to get involved in this area. It is important for the Minister to clarify that his amendment will not provide an escape hatch for health boards who do not wish to get involved in this area.

The Minister's amendment No. 41a proposes that he shall secure the orderly organisation of comprehensive family planning services. This is the same as the wording in the 1979 Act. The Minister said he recognises the role of the voluntary agencies in this area. I wish to point out that a number of these agencies are in dire financial difficulties. The agency in Tralee provide a very comprehensive service. However, they could be forced to close down because of a debt problem and lack of adequate funding. The Minister when replying might state whether he will make provisions in this Bill to help those agencies survive and to maintain their current level of services. If these voluntary agencies, who are performing such a valuable service, are forced to close that will defeat the purpose of this Bill. It is important that we have responsible voluntary agencies to provide essential counselling services and they must get greater financial resources. Does the Minister envisage increased support to those agencies?

I did think the provision that the Minister "shall secure the orderly organisation of comprehensive family planning services" would enable the Minister to deal with a case where the health boards were not complying with the obligation to provide such facilities. If, for example, the health board could not provide the service in a particular area, the Minister would be enabled to ensure that a comprehensive family planning service was organised in the area by other organisations. I am very much opposed to paying grants for research into natural family planning methods only. I would be prepared to accept the amendment on that. As regards funding, I will have to look into the matter.

I welcome the Minister's willingness to accept later amendments.

What amendments is he willing to accept?

Amendment No. 6.

Amendment No. 6 is linked to amendment No. 31. This is a positive move which will remove a sectarian element from the Bill. The Minister has chosen to abandon the original phraseology which stated in respect of natural family planning that the Minister "shall provide a comprehensive service". It would have seemed simpler to approach this by way of my amendment or Deputy De Rossa's amendment, stating that the Minister "shall provide a comprehensive family planning service". This makes it clear that there is a statutory obligation on the Minister without any provision which would enable the Minister to sidestep the health board if necessary. It would be quite possible to contract that job to voluntary agencies or health boards, but it is his responsibility to ensure it is done. The Minister's formulation does not impose that clearcut responsibility on him or his successors. He uses the old phraseology relating to securing the orderly organisation of a service. This provision was in the old Bill and did not deliver a family planning service across the country. I should like to be reassured that the obligation to secure an orderly organisation of this service means more now than it did under the old Bill.

The Minister did not touch upon the regulations he had in mind to replace the licensing scheme. It would be of interest if he had some approach in mind.

I am disappointed that the Minister has not indicated a willingness to accept our extension of the general duties of the Minister in the area of education. The House would be much better served by a statutory obligation in this area rather than relying on the policy approach that has failed in the past.

The Chair heard the Minister indicate that he would presently accept amendment No. 6. The Chair also heard Deputy Bruton indicate the Minister's acceptance of amendment No. 31. I note that the Bills Office regard amendment No. 31 as an alternative to amendment No. 6. Could we clarify whether they are alternatives or whether the Minister made any reference to amendment No. 31? The Chair did not hear him do so.

They are identical.

Can I add to the confusion? We are dealing with a group of amendments which includes amendment No. 47. That amendment is identical to amendment No. 6. There is a misprint: "section 9" should read "section 3".

The Chair, as exhorted by that great man Shakespeare, would rather deal with problems we have than fly to those of which we know not. I want to have clarified whether, in reply to what Deputy Richard Bruton had said, the Minister indicated he was accepting amendment No. 31. The Chair did not hear that.

I will accept amendments Nos. 6, 31 and 47.

I note the Minister has now indicated that he is accepting amendments Nos. 6,31 and 47.

It is the same amendment.

I am glad we have had that sorted out.

This was the question of research.

Yes, that is important. I was going to suggest that we defer discussion——

Deputy De Rossa, perhaps we should now confine ourselves specifically to what arises out of amendment No. 2.

I want to impose somewhat more on the Minister's generosity in his amendment No. 41a. In reply to my question with regard to the obligation on a health board, the Minister indicated his purpose in proposing a new section 7, subsection (1), which reads:

The Minister shall secure the orderly organisation of comprehensive family planning services.

This was with a view to ensuring that if health boards did not provide, were unwilling or unable to provide such services, others could provide them. That is not really an acceptable position in that the various health boards are the statutory bodies responsible for public health. They are responsible for organising the delivery of services in a whole range of areas, particularly for people who cannot provide a service from their own resources. It seems to me that if private organisations — no matter how good they may be in terms of the services they may wish to provide — are asked to pick up the slack because X health board for policy reasons decides not to provide a family planning service, it would be virtually impossible for private organisations to substitute for a health board.

Let me cite the example of the Eastern Health Board, who have been very good in terms of providing services within the Act as it has obtained to date; that is why I have chosen them rather than identifying others that have not been so good. But if a health board decide not to provide a service — as they may well decide to do under the Act as we now propose to amend it — then it would be extraordinarily difficult for the Minister to secure a service in the Eastern Health Board area through private organisations, general practitioners and so on, and it would be extremely expensive. A way out of this dilemma I foresee arising would be to add a number of words to the new section 7 (2), which would then read:

For the purposes of section 2 of this Act, the Minister may, without prejudice to the generality of this section, provide by regulations for the purposes of this section for the making available of a comprehensive family planning service by health boards and others.

That would clarify that there would be an obligation on the health boards to provide this service and would also include others in that area.

Yes, I would be very much in favour of that. But the Minister does not provide a comprehensive family planning service. This would augment any family planning service that would be provided by a health board. I think the addition of the words "by health boards and others" would meet Members' wishes and ensure that a comprehensive family planning service is provided.

The Chair appreciates what appears to be the co-operative mood of the House. On the other hand, the Chair knows that ordinarily friendly ad hocery does not withstand the test of time. May we determine precisely what are the words it is intended to add?

I just wanted to clarify a point. The Minister says he does not provide any service whereas in the original Act it is quite clear that he did in that it says: "The Minister shall provide a comprehensive natural family planning service". The formulation there is absolutely clearcut. Even with Deputy De Rossa's addition, there is room for confusion as to whether there is a clear statutory responsibility on the health board or whether it is an enabling provision only — that a health board might do it if they so chose.

As I see it, in respect of the Minister's amendment No. 41a, what the Minister has indicated in response to what was proposed by Deputy De Rossa is that the new section 7 (2) shall read:

For the purposes of section 2 of this Act, the Minister may, without prejudice to the generality of this section, provide by regulations for the purposes of this section for the making available of a comprehensive family planning service by health boards and others.

Before that is agreed I want the Minister to clarify the point I raised in that, to my mind, this does not place such a clearcut statutory obligation on a health board to provide this service. The subsection still contains the phrase: ".... the Minister may provide by regulations". I take it that a health board may or may not choose to take action under those regulations. Therefore there is still some slight confusion as to whether the new formulation imposes a statutory obligation on health boards.

I thank the Minister for accepting the amendment across the floor of the House because it does help to clarify the obligation which will be on health boards by way of regulation. I take the point Deputy Richard Bruton is making. However, the subsection, as amended, would still read:

...... the Minister may, without prejudice to the generality of this section, provide by regulations for the purposes of this section for the making available of a comprehensive family planning service by health boards and others.

It would be nonsense for the Minister to introduce a Bill, provide for regulations and then not provide a service. I would be satisfied with the Minister's acceptance of the inclusion of the words "by health boards and others".

I might revert to the very first point I made in relation to the Minister's amendment. I am not satisfied with the first form of words to which he has reverted, and I said so. I consider the words "shall secure the orderly organisation" are less clear than they should be. While I accept that it would be the intention of the present Minister that such would be the case, I would prefer that the statutory imperative were included as clearly as it was for a natural family planning service in the original Act. We are caught in a cleft stick here. We know what are the intentions of the present Minister, but when drafting law we should ensure that it would be there in the long term because we do not know who may be the incumbent of that great office in the future. I do not think we can push the point any further. I would hope that the regulations the Minister will draw up will provide that the type of service required will be available to all citizens across every health board area.

The regulations will provide the obligation on them to do that. But under the 1980 regulations there is an obligation on health boards to provide a family planning service. I propose that this obligation should continue under the provisions of this Bill.

I take it that amendment No. 2 is not being pressed.

If we have those words added at the end.

We must take the amendments seriatim. We must dispose of amendment No. 2 in the names of Deputies Richard Bruton and Creed.

In deference to other Members who are happy with the new formulation — although in my view it is a bit of a camel — I am willing to withdraw my proposed new section 3 (1). But I will press my new section 3 (2) in relation to a health education programme.

This amendment relates to matters appropriately dealt with outside the field of legislation. However, it will be addressed.

I do not agree. We are providing for comprehensive family planning. We all recognise that an integral part of this is not just the provision of a service or the provision of drugs or condoms, but that we are endeavouring to provide health education back-up to the legislation.

All Deputies recognise that this has not been done in the past and, therefore, to place an obligation and a duty on Ministers is eminently reasonable. I simply cannot accept the assurance from Ministers that this will happen because it has not occurred before, despite having had similar assurances, and we cannot refer to a statutory obligation on Ministers.

This amendment refers to education. It does not relate to family planning. Sexual education does not necessarily involve family planning. It is a totally different issue. It is part of the education of young people and they are not taught sex education simply for family planning purposes. We teach them to have a broader, responsible and mature attitude to sex.

In supporting the amendment we do not doubt the bona fides of the Minister when he says he will initiate discussions with the Minister for Education, but we now have an opportunity to place a statutory obligation, through legislation, on the Minister to provide that educational service. It is an opportunity we cannot afford to miss. As I mentioned earlier, we have had pilot programmes carried out by individual health boards but there has never been a comprehensive, nationwide, obligatory health education programme. This is a useful amendment and it is appropriate to include that obligation on the Minister in the legislation. I accept that the Minister would personally intend to proceed with developing policy on this issue but this is a legislative opportunity which cannot be ignored.

The Deputy is totally wrong. Education is a matter for the Minister for Education. The Minister for Health cannot be bound to undertake education programmes which may bring his Department into conflict with the Department of Education. We are addressing two totally separate issues and whilst both are equally important, one comes under the aegis of the Minister for Health, that is the supply of family planning devices etc., but the education of children is a matter entirely for the Minister for Education. I do not understand how a Minister for Health can be made responsible for ensuring that sex education is provided in schools. One cannot bring young children to clinics and offer them a sex education class.

I understand what Deputy Briscoe is saying but he would have to recognise that the HIV programme was drawn up by the Department of Health and is being used in schools. We are not creating a precedent because the precedent has already been established. Deputies will be aware of occasions in the past when legislative provisions were made and enshrined in our Constitution, commitments of a nature that were never followed up with an adequate policy response subsequently. The pro-life amendment, in particular, was never backed up with proper pro-life provisions from this House. We now have a golden opportunity to implement that which all of us wish to see, that we do not simply provide for the liberalisation of the availability of condoms but also provide a statutory obligation for the more important task which will match the reform in our laws. This is the only opportunity this House will get to provide for such an obligation and it is not breaking new ground because the Minister for Health already provides education programmes for schools.

I am a member of the Eastern Health Board and I realise these programmes are provided in schools with the permission and under the auspices of the Department of Education.

That is provided for in our amendment, so perhaps the Deputy will support it.

No, as I understand it the Deputy is asking the Minister to supply educational services in schools. I am not talking about people not in school.

In consultation with the Minister for Education.

This teteà-tete must terminate.

I have no objection whatsoever to the intent of the amendment. Given the short time available to debate other amendments we should not spend too much time on this one. We should try to move on because there are other substantive issues in the Bill which require to be addressed and we have only one and a half hours left. Therefore, I would appreciate the Minister's acceptance of the amendment or for the issue to be challenged.

This is a fundamentally important amendment. My party are seeking to provide adequate education and that must be undertaken in consultation with the Department of Education and the Department of Health. As one of the younger Deputies in this House, the sex education that I received on leaving secondary school left a lot to be desired and I am not aware whether it has improved very much over the last number of years.

The Deputy is still learning.

I am, thankfully.

Desires were not allowed.

An Leas-Cheann Comhairle is putting me off my point. The Minister should accept the amendment because it would give to both the Department of Health and the Department of Education an initiative to introduce a proper education system, which is fundamentally important.

I do not disagree with the sentiments of what the Deputy is saying. However, I feel that it cannot be done in this Bill. It is a priority which must be addressed without delay but it cannot be contained in this Bill.

Is Deputy Bruton pressing the amendment in total?

I accept the Minister's formulation in respect of (a).

Does the Deputy wish to amend his amendment?

Is the House agreeable to Deputy Bruton amending his amendment? Agreed.

The Minister could agree to the amended amendment without accepting it.

That would take time, Minister, if one wants to comment on that.

What I am saying is that I cannot accept Deputy Bruton's and Deputy Creed's——

That is it precisely, Minister. You could accept his right to have the question on the amended amendment put, which I will be putting.

Yes, of course, by all means.

Amendment, as amended, put and declared lost.
NEW SECTION.

Amendment No. 3 in the name of Deputy De Rossa. Amendment No. 43 is an alternative so I suggest that they be taken together.

I move amendment No. 3:

In page 2, before section 3, to insert the following new section:

"3.—Section 1 of the Principal Act is hereby amended by the deletion of ` "family planning service" means a service for the provision of information, instruction, advice or consultation in relation to any one or more of the following;' and by the substitution therefor of the following:

` "family planning services" means a service for (i) the provision of information, instruction, advice or consultation, or (ii) the supply of devices or drugs, in relation to any one or more of the following:'.".

This amendment seeks to amend section 1 of the Principal Act of 1979, which defines family planning services. I already referred to this in my earlier remarks on the question of the precise meaning of a family planning service. My amendment seeks to expand the definition of family planning services beyond the provision of instruction, information and consultation to include the supply of devices or drugs. My amendment No. 4 also seeks to extend the definition of contraceptives, and amendments Nos. 3 and 4 should be seen together, although they are not being taken together.

The import of my amendment No. 43 is the same. It also seeks to broaden the definition section of the Principal Act with regard to family planning services to include the provision of contraceptives. Anyone who goes to a family planning service would expect more than information, instruction, advice and consultation. They might also expect to be provided with contraceptives.

This is a very sensible amendment. Anyone providing a family planning service should either be able to provide contraceptives or provide a prescription on which contraceptives can be obtained. This is a commonsense legislative change.

I do not propose to accept these amendments. A family planning service is defined in section 1 of the 1979 Act as:

a service for the provision of information, instruction, advice or consultation in relation to any one or more of the following; (a) family planning, (b) contraception, (c) contraceptives.

The supply of drugs and medical provisions is being removed from this legislation by the Bill. These continue to be the subject of medicines legislation. I thought there was agreement in the House on this course of action. The supply of medicines will continue to be subject to the normal doctor/patient relationship. While the Bill does not provide for the supply of contraceptives, there is provisions in sections 3 and 4 of the Bill for the widespread sale of contraceptives. There is also provision for their supply other than by way of sale. It is not necessary to amend the Bill here.

I regret that the Minister is not accepting the amendment, because the 1979 Act defined a family planning service as a service for the provision of information, instruction, advice or consultation in relation to family planning, contraception or contraceptives. A health board which would provide the service will not be able to provide the services on contraceptives or other forms of family planning if we do not define the family planning services in the way I am suggesting.

The Minister said that in the Bill there is provision for the sale of contraceptives. However, there is no provision in it for other forms of family planning or other forms of contraception — for instance, tubal ligation and vasectomy, which are mentioned specifically in my amendment No. 4. In many cases they would be the most appropriate form of contraception. The condom is not always the most appropriate method. There are many circumstances where because of the nature of the relationship the woman would not be in a position to oblige her husband to use condoms and she may already have perhaps seven or eight children. Tubal ligation might be the only effective way for her to avoid a further pregnancy. It is important, if we are going to provide a comprehensive family planning service, to have a means whereby a health board would be in a position to provide for family planning purposes the services to which I refer. That is why it is important to more broadly define family planning services in a way which obliges health boards to provide a service which is not simply confined to information, advice and consultation.

Will the Minister clarify what he said in rejecting this amendment? The Minister indicated that the Bill already provides for the supply of contraceptives by way of sale or otherwise. This came up yesterday and the Minister, in very hurried words at the end of his Second Stage speech indicated, that the Bill provided both for the sale or gift of contraceptives and that it did not, for example, debar a health agency from deciding that they would provide condoms as a matter of public policy to certain "at risk" groups without charge. That should be an option under the Bill. There has been some doubt as to whether "supply" as interpreted allows supply by any means other than sale. I would like the Minister to clarify that point.

This is provided for. Under regulations contraceptives will be provided free to certain sections of the population such as drug abusers with AIDS as we do not want them to spread infection. There is provision for that.

Where, in the Bill?

In section 3 (2). The 1979 Act does not refer to tubal ligation or vasectomy on the basis that they should be dealt with on the basis of surgical procedures. There is no prohibition on that in the Bill, but it is a different procedure within the hospital context.

I fully appreciate that they are not prohibited, but to a large extent unless one has the money one will not get them. As far as I understand it, tubal ligation will not be provided in hospitals in some health boards except for specifically medical purposes unrelated to family planning needs. I am seeking to ensure that it will be regarded as a contraceptive method and therefore cannot be refused by a health board on the basis that there is no specific medical prognosis involved, that there is a family planning need, a contraceptive need.

We might make some progress if we realise what the Minister is trying to do. This is not family planning legislation, it is a "condoms" Bill. The Minister is trying to sort out the Irish solution to an Irish problem, even though this is not a solution for any problem. The Minister is simply seeking to regulate the availability of condoms. The Minister has not dealt with any of the issues that have been raised so far such as sex education, or family planning services other than the supply of condoms.

As time is running out, we might as well accept that this is a simple "condoms" Bill and therefore we should address the question of who should have access to them and where they should be available. I presume other amendments will be required to deal with the family planning services that are required. I think the Minister should get straight to the point and say what his intention is.

Let me say to Deputy Mac Giolla that we have advanced some way in this Bill and that it also provides for family planning services. We have agreed to reform some aspects of the 1979 Act — I am almost tempted to refer to it as the iniquitous Act.

Deputy De Rossa said that tubal ligation and vasectomy operations are not available for those who cannot afford to pay but sterilisation and tubal ligation operations are carried out when considered necessary. Indeed I can list the hospitals: St. James's, The Rotunda, the Adelaide, The Coombe, Holles Street, and the service is available in the Midland, Mid-Western, North Eastern, Southern and Western Health Boards. I agree with the Deputy that we have a long way to go yet, but it is only through the process of education and enlightenment that this will come.

The Minister has given a list of hospitals and health boards that have the capacity to provide the service but the issue that arises in this amendment is the availability of the service. Could the Minister direct his attention to that question? He is in a better position than most to know that while the capacity exists in hospitals to provide services it is definition of the circumstances and the lack of means that prevent people who need the service gaining access to it. As I understand it, this is the point the amendment addresses.

The Deputy slipped in there unnoticed. The Deputy's presence certainly adds colour to the scene. The point he raises is covered under the doctor-patient relationship and it is a hospital matter which is totally different from the question of family planning. Where the doctor advises that this is necessary for the patient, the person goes to hospital to have the operation.

The Minister referred to my being unnoticed in this area, although indeed I have been highly noticed in this area for many years. Yesterday the Minister referred to the fact that I was silent in the Dáil in 1985; in fact I was in the Seanad and spoke vigorously on related legislation.

In amendment No. 3 I seek to extend the definition of family planning services to include the supply of devices or drugs. In other words the health board would be obliged by ministerial regulation to provide information, and consultation as presently defined as well as being obliged to supply devices or drugs. I tried to hasten the discussion by referring to my amendment No. 4 which deals with tubal ligation and vasectomy as they are important methods of contraception. It would be a mistake to assume that the condom is the only method other than the contraceptive pill which is available.

As I said earlier in many cases a vasectomy or tubal ligation are the only appropriate methods of contraception. I accept the Minister's point that they are surgical procedures and must be carried out in a clinic or hospital. As this requires the intervention of a doctor, the doctor-patient relationship comes into play. However, certain hospitals and health boards are reluctant to provide this service. As Deputy Michael D. Higgins said, while hospitals have the capacity to provide this service, the service is not provided except in certain circumstances. The Minister said that this procedure would be provided where appropriate but the question is what are the appropriate circumstances? It seems to me that is where the problem arises. Some people would consider sterilisation of men or women as inappropriate except in the most grave circumstances where there is a threat to the health of the man or women. I am trying to establish that tubal ligation or a vasectomy as a form of contraception would be available through our health boards for family planning purposes and not simply for other medical reasons. I am seeking an undertaking from the Minister that he will ensure that each health board will provide that men and women can avail of a vasectomy or tubal ligation for family planning purposes and that people who cannot afford to pay for this will be able to avail of them under the normal criteria.

Where tubal ligation or vasectomy is considered necessary for medical reasons, the operation is provided. One cannot allow a tubal ligation operation to take place without proper consultation or where the operation may not be justified for medical reasons; but where it is deemed necessary for medical reasons, it comes under hospital policy, like any other surgical procedure, and the same criteria with regard to eligibility apply. I will list the public hospitals that perform these operations, the Rotunda, St. James's, the Adelaide, the Coombe, Holles Street, Portlaoise, Mullingar, Limerick, Monaghan, Cavan, Letterkenny, Sligo, Cork, Tralee, so the operation is widely available. When either is considered necessary it is provided under the same eligibility criteria.

I seek further clarification of the term "necessary". If a man or woman attends a consultant at St. James's Hospital and tells him or her that as they have six children and they do not wish to have any more and the only realistic way they can achieve this for a variety of reasons is that the husband has a vasectomy or the wife has a tubal ligation, will the service be provided on that basis?

We do not want everyone going around the country to get a snip. There would have to be proper justification, otherwise anyone could opt out and say that no other method suited. If that happened all the beds in our public hospitals would be occupied by people having a vasectomy. A certain amount of wisdom will have to be applied.

Doctors playing God.

Vasectomies would not be freely available but could be provided when considered medically necessary. That is an important point. Again the consultant-patient relationship would be involved. It may be that the various options would be explained to the patient. A vasectomy might be carried out when a doctor, in consultation with his or her patient, feels that the usual methods of contraception are not available. I hope Deputies will believe me when I say that the final word on vasectomies has not yet been written — I speak from a medical point of view. Due regard must be had to all other methods available and to whether a vasectomy is medically necessary. It might not be the best thing to leave it to a patient to say that he will not consider any other method of contraception.

Progress reported; Committee to sit again.
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