I am pleased to have the opportunity to make a statement on the report of the expert group on the judgment of the European Court of Human Rights in the case of A, B and C v. Ireland. I first wish to put on record my appreciation for the work of the expert group and in particular, that of Mr. Justice Seán Ryan, for the commitment, sensitivity and consideration the group has given to this complex issue. Anyone who wishes to speak on this issue really ought to read the 55 pages in this report for its preface, the summary, the legal provisions, its clarity in respect of the cases that have arisen thus far and its summary of the key principles. It has been done very well.
The European Court of Human Rights accepted that Article 40.3.3° of the Irish Constitution provides it is lawful to terminate a pregnancy if it is established as a matter of probability that there is a real and substantial risk to the life, as distinct from the health, of the mother, which can only be avoided by a termination of the pregnancy. This remains the constitutional position today, unaltered by the decision of the European Court of Human Rights. The constitutional obligation also on the State is, by its laws, to respect and as far as practicable defend and vindicate the right to life of the unborn and these provisions must of course be borne in mind in the mode of the implementation of the judgment.
In the A, B and C v. Ireland ruling, the European Court of Human Rights requires us to give practical effect to our constitutional position. The report of the expert group recommends a series of options on how to implement this judgment, taking into account the constitutional, legal, medical and ethical considerations involved in the formulation of public policy, as well as the overriding need for speedy action. The report provides a range of options that must be considered carefully. In theory, Members present today should agree on at least one thing, namely, the Irish Legislature has grievously failed in its duty in respect of abortion. It should be easy to agree on that as a first principle. The European Convention for the Protection of Human Rights and Fundamental Freedoms is an international agreement that Ireland has signed and ratified and which, in consequence, is legally binding. This duty to comply with the judgments of the European Court of Human Rights is an integral part of the scheme of the convention. Although these Houses have failed to legislate on this issue for more than 20 years, the reality is that over the past two decades, few Deputies or Senators have been idle on the matter or uninterested or without conviction. Members stand today at yet another infinitely painful point in a two-decade sequence of difficult and painful cases, Irish and European case law, reports, Green Papers, deliberations by an Oireachtas constitutional committee and periods of intense public debate.
Some of my colleagues in this House are young enough not to know much about the campaigns and debates of the 1980s and 1990s but both were impassioned. It was often the level of passion which rendered problematic, if not impossible, the task of legislating.
We must now repair the gap, the lack of trust and the uncertainty that has now developed between the people, their legislators and the maternity hospitals with regard to pregnancy. We must make explicit the standards and regulations guiding the delivery of one of the best maternity services in the world. We must, in short, act as the Government pledged it would in the light of the advice of the expert group. How we act will have a powerful if indirect effect on the confidence of women, their partners and families in the consistency and high standards of care provided by Ireland's maternity services.
Let us also face another reality for Irish women. As of this year, more than 4,000 women travel annually out of Ireland for terminations. These are daughters, wives, partners, sisters, mothers, friends and work colleagues. They range in age from the very young - some 11% are teenagers - to the 37% who are aged 30 or older. They are ordinary Irish women who for many different reasons face a pregnancy they believe they cannot continue. Some have sought counselling or support before making the decision but many know that despite the support and promotion of counselling and related services, there is an underlying Irish code of "Don't tell, just go."
The people involved in such cases frequently find themselves ridden by internal contradictions. One woman told me she voted "pro-life", as she termed it, in the 1983 referendum, and she also told me her daughter had a very serious crisis pregnancy, and she had taken her for an abortion. She said, "I voted pro-life to stop irresponsible demands for abortion". That makes sense and it makes no sense, that is, just as it makes sense to say Ireland does not have abortion, it makes no sense when we know Irish women travel to have terminations in our neighbouring jurisdiction. It makes sense to be fearful of change and it makes no sense to brand women as being duplicitous and untrustworthy, likely to claim suicidal thoughts and pull the wool over the eyes of the medical profession in an effort to seek the option of an abortion.
Since when has it become permissible to make such bald and dismissive statements about women and people presenting with serious mental health problems? Since when has it become permissible to resist the idea that pregnancy might trigger or could exacerbate existing mental health conditions? Let us not go there or attribute ruthless, uncaring duplicity to women we do not know and who in the distant future may have a crisis pregnancy. We do not progress in that way.
Where we have progressed it has come through respectful responses to reality. Our attempts to reduce the levels of unplanned pregnancy and provide better support and encouragement - there is history in that regard - to women in choosing to have their babies have, I am thankful, made some progress. We have a long way to go and I certainly favour a more determined and intensive level of attention to the work of the crisis pregnancy unit of the Department of Health. That was formerly an independent agency but it is now working as part of an interdepartmental and inter-agency national action plan.
This debate has specifically been about a failure to act in the wake of the X case and in light of the cases which have arisen since. It has resulted in an unacceptably grey area in medical practice. The masters of some of our maternity hospitals and many other health professionals insist that clear law, supported by equally clear regulation, is essential.
As we move to meet this need, we must not segregate women into the selfish majority who are not to be trusted in this area and the tragic few hard cases as to do so would be irresponsible and shameful.
This Government is committed to doing what no Government has done before. We will make the necessary changes to bring clarity to this issue by regulation, legislation or a combination of both. After years of inaction, we will deliver a clear framework for medics and women in their care whose lives are at risk. We must also take some other steps. We must acknowledge in our health statistics information on Irish women who travel to other jurisdictions for terminations.
We must also acknowledge the painful reality for those expectant families who are faced with the news that their baby will not survive outside the womb. These tragic cases of fatal foetal abnormality, as the A, B and C report acknowledges, are generally considered to be outside the principle arising from the X case. I recently met a woman who experienced such circumstances; her story is representative. Sarah and her husband John were delighted to be pregnant in 2009. Scans taken at the Coombe Hospital in the 13th week showed a pregnancy that was progressing normally and later, in the 26th week, that Sarah and John were expecting a daughter. Within days, however, the position changed as a further scan showed a fatal foetal abnormality. The couple's daughter had anencephaly - she was not forming a brain - and would not survive outside Sarah's womb. Sarah suddenly knew that medical treatment which could save her baby was not available and her daughter would not live. She assumed that a Caesarian section would be scheduled because it did not occur to her that anything other than this would happen. However, she then found herself in the twilight zone the Irish health system becomes when such a crisis arises. Sarah's circumstances were not normal and the diagnosis was clear. She was informed she could travel to Britain to be induced in an English hospital. She, her father, who is from the midlands, John and his mother sought and obtained in England the care Sarah needed. Although it was clear to Sarah and her family that her doctors were unable to act in her circumstances, at least they were aware of all the options, which is not the case for everyone. What is evident from anecdotal evidence is that when such circumstances arise, there is no consistency in care, advice or practice.
Some question marks have also arisen about the accuracy of Irish statistics on maternal deaths. We must have accurate data on maternal mortality, the number of diagnoses of fatal foetal abnormalities and the care given to women in such circumstances. We must face reality by gathering statistics in these areas to understand precisely what is happening in our hospitals. We cannot have grey areas on this matter as the position is not fair on the medics and women involved. As I stated, a review is also needed of the crisis pregnancy division of the Department of Health to identify what more we can do about the continuing unacceptably high rate of crisis pregnancy in Ireland.
Whatever guidelines are developed as a result of the events of recent months, they must be enacted in the common good and respect the fact that the people who live here are of many faiths and none. No patient in a State hospital should be ever told his or her care is driven by anything other than our laws and best medical practice. Let us stop the discourse that is based on the illusion that we do not have abortion in Ireland. What we do not have are the hospital services and legislative framework and the reason the current position is sustainable is that our close neighbour provides both.
Can the legacy of recent weeks and our accumulating understanding of our flawed system lead us to holding a national debate which grasps the reality and complexity of crisis pregnancy? I sincerely hope so.