I welcome the Minister of State at the Department of Health, Deputy White, back to the House. Senator Mullen's amendment was seconded by Senator Healy Eames.
Protection of Life During Pregnancy Bill 2013: Report Stage (Resumed) and Final Stage
Debate resumed on amendment No. 8:
In page 9, to delete lines 4 and 5 and substitute the following:
“(b) that medical procedure is carried out at an appropriate institution by—
(i) an obstetrician, or
(ii) a medical practitioner of a medical speciality in respect of which he or she is registered in the Specialist Division of the register, and which is relevant to the care or treatment in respect of which the risk of such loss arises, not being a psychiatrist or a general practitioner.”.
I will pass on this.
I have nothing further to add. If I am not mistaken, I spoke on this amendment already.
No, not on this one.
The amendment proposes widening the list of medical practitioners permitted to carry out the medical procedure at issue in the legislation. However, other than in an emergency, a termination of pregnancy should only be carried out by an obstetrician or gynaecologist. This strict provision is to ensure that the procedures are carried out by highly-skilled and qualified relevant medical personnel only, in order to secure the best possible care for the woman whose life is at risk and for the unborn. I cannot, therefore, accept the amendment.
Amendment, by leave, withdrawn.
Amendments No. 9 and Nos. 18 to 21, inclusive, are related and will be discussed together. Is that agreed? Agreed.
I move amendment No. 9:
In page 9, between lines 5 and 6, to insert the following:
“(c) where the unborn is sixteen weeks gestation or older, an effective anaesthetic for pain relief shall be administered to the foetus before the medical procedure is commenced, provided this does not increase the risk of the loss of life of the pregnant woman.”.
I second the amendment.
I spoke about the issue of foetal pain on Committee Stage last week. A large body of evidence supports the fact the foetus feels pain in the womb during a termination or abortion, particularly if the foetus is over 20 weeks. Professor Glover, a pro-choice advocate in the United Kingdom, says this is the case from 17 weeks onwards. My amendment requests that an anaesthetic be provided for the unborn at terminations at 16 weeks, provided there is no ill effect for the mother.
I have looked widely at research in this area. In neonatal units in the United Kingdom, surgery on foetuses over 23 weeks is performed with the unborn child under anaesthetic. It is medically accepted that unborn babies feel pain and some people argue they feel pain from 17 weeks. There have been several attempts to highlight this in the United Kingdom. In 2008, a motion was put forward to reduce the abortion time limit to 20 weeks, on the basis of pain research on unborn children. In the US, some 11 states now recommend an anaesthetic at the time of an abortion, because of the evidence on pain. The evidence is so strong that last month the US Congress passed the Pain-Capable Unborn Child Protection Act, limiting abortions to 20 weeks, due to the pain experienced by the unborn child during abortions of foetuses over 20 weeks. The common ground on this issue is that where abortions are performed on any unborn child over 20 weeks, there is broad agreement on the experience of pain by the unborn.
As Members know, the situation here is that a termination is allowed, legally, up to birth. I know the Minister has said that babies will be induced, but the Bill does not state that abortion cannot be carried out. I was struck by evidence that in the later stages of pregnancy, the placenta thickens to protect the unborn child from maternal viruses, HIV, alcohol and other toxic substances. In the process, it also protects the foetus against maternal anaesthesia. Although the mother may be under anaesthetic, that anaesthesia does not pass on to the unborn in the later stages of pregnancy. For this reason, since approximately 2000, a separate anaesthetic is given to the infant in perinatal surgery as it has been proven that infants feel pain quite intensely.
Can anybody here name one Senator or citizen who would deny an unborn baby an anaesthetic if its life must be ended, if that would give some relief to the unborn child? I hope the Minister of State accepts this amendment. We are trying to be humane. It is a pity we have to go down this road, but if we do, let us end that life in as pain free and humane a manner as possible. If an animal has to be put down, that is done in a pain free manner. Let us not think a child's life is any less.
This is my request. I have a large body of information on foetal pain. I understand I will be able to come back on this, as I am the proposer of the motion. Is that correct?
That is correct.
I will leave it at that, because I know others want to speak.
From reports I have come across on foetal pain, it is happening earlier than the 24 weeks indicated by the Minister of State yesterday. I would like to refer him to a report by the Royal College of Obstetricians and Gynaecologists in England, which strongly recommends that women should routinely be offered pain relief during surgical operations. It is part of their recommendations that this would be done. I cannot find where it states that pain relief should be given to the baby, but from the information we have, which is medically underpinned, everything that Senator Healy Eames says is factual. If we are even half interested in being humane, to me it would be a logical step that this would be done, especially given the fact that our abortion legislation is unique in that there are no effective time limits on it. It behoves us as legislators at least to have that level of compassion and include in the Bill provisions that avoid foetal pain.
Former US President Ronald Reagan was the man who introduced abortion in 1967 in California, so he did not come to the subject without some knowledge and perhaps some regret for what he had done. He later said that "Medical science doctors confirm that when the lives of the unborn are snuffed out, they often feel pain, pain that is long and agonizing". I support the amendment from Senator Healy Eames. I do not think it requires any great pressing from our point of view. Anybody who has a humane approach to this topic, even though we may have different perspectives on the substantive issue, would certainly not want the unborn baby to be suffering pain as a consequence of the procedure being carried out.
It is important to understand - many of us keep emphasising this - that this Bill is about the protection of life of the mother and the child. Every effort is made by all of the medical people working in this area in Ireland to do that in all circumstances. Not every case is the same. Each case must be approached in a different way, and managed in a different way. I have spoken to a number of consultants in the past two days and they all advised me that it is not physically possible to apply an anaesthetic in the way proposed by the amendment. In some of the amendments being put forward, we are trying to restrict what doctors can and cannot do.
On a point of order-----
I did not interrupt the Senator.
Senator Burke without interruption.
The point of order is very clear. Yesterday evening we passed a Bill that legitimises all the procedures of operation that were described as so disgusting and barbaric when I quoted medical doctors who gave this evidence in open session in the US Congress. We legalised that yesterday, so what the Senator says is incorrect.
I did not interrupt Senator Walsh. He has dominated about 70% of the speaking time in this debate, and I would appreciate it if he would not interrupt me. If he wants to come back and reply to me, he is more than welcome to do so. I am telling him as it is, and it is from Irish consultants.
What also intrigues me during this debate is the quoting from American consultants. Why can people not go and talk to Irish consultants? They spend time in here during the two public debates, gave their evidence and gave clear accounts of how they manage their patients, and why they required-----
On a point of order-----
I did not interrupt anyone else. I have spoken very rarely in this debate. I am fed up with people interrupting me when I am trying to make a point. Senator Healy Eames has spoken for a large amount of time in this debate and I have not interrupted her. I wish to finish the point I am making, and if she wants to come back, she can do so.
If it is a point of order, I have to take it.
Thank you. Let us be accurate on the record.
That is not a point of order.
Irish consultants carry this out at the moment. There is a very simple reason for it. Thank you.
With respect, you can respond again, but please do not interrupt. Senator Burke, without interruption.
We had consultants in here during the public debate who gave up their time freely to assist us in the drafting of this Bill. They gave their point of view. I am concerned that we are now extensively quoting from the UK and from America. The last quote from Senator Walsh went back to 1984. We have moved on in respect of medical practice and procedure in 30 years. We have a committed number of medical people in this country who are providing maternity care. We have over 75,000 deliveries in this country. We have the lowest maternal mortality rate and the lowest perinatal mortality rate across Europe. I have no doubt whatsoever that this will continue.
This amendment and some of the other amendments are trying to put restrictions on what doctors can and cannot do. They work with the sole purpose of trying to protect the life of the mother and the life of the unborn. All of the consultants who are working in this area spent five or six years in college, and another 11 or 12 years before they reached consultant status. Here we have people coming in who are reading papers and who have not got their expertise and who are now trying to put restrictions on what they can and cannot do.
The Constitution is quite clear on this matter. Article 40.3.3° sets out quite clearly that the life of the mother and the life of the unborn must be protected at all times. It is only when there is a risk to the life of the mother that certain procedures can be carried out in order to save the mother. These proposals are unimplementable, are not feasible and that is the medical advice that I have received. Therefore, under no circumstances can the proposals as set out here be accepted.
Senator Burke has given a very clear reason to oppose these amendments. This reason comes from seeking advice from Irish consultants. It is very important that we look at Irish medical practice. We need to trust doctors in this country. I was present in the Chamber yesterday when the Minister for Health gave a very full explanation as to why these particular amendments would not be accepted. We had a very full debate on similar amendments on Committee Stage. We did not get to a number of other amendments on Committee Stage that would be worth debating, and I hope we can do so. The debate on this has really been gone over quite a number of times, and we have heard very clear reasons for opposing them. It is unfortunate that the debate has been dominated by a small number of individuals and by quoting from US practice and US research. We need to look more closely and focus on the Irish Constitution, which sets out the parameters within which we must legislate, and look also at Irish medical practice and trust our doctors.
I support the amendments, especially amendment No. 9 which we are currently debating. Senators are asking why we are quoting American and British consultants and not Irish consultants. Part of the answer to that conundrum is the following.
The Irish medical model, the two-patient model, has a very different idea of care from the one that will arise from the passing of this legislation. We need therefore to look at the countries that are already down the road which we are now about to travel. Britain and America are two countries which many years ago introduced what they felt at the time was exceptionally limited abortion, to be used in very few cases, yet we know that is not what transpired.
Amendment No. 9, in the names of Senators Healy Eames and Mary Ann O’Brien, states that the proposal would be implemented, "provided this does not increase the risk of the loss of life of the pregnant woman". That is a very plain statement providing for an anaesthetic where there is no increase in the risk of the loss of life of the pregnant woman. The Minister debated this with us at some length on Committee Stage and said he would come back to Senator Healy Eames on the matter. I think he gave a partial answer yesterday. He quoted statistics, not from Ireland but from Britain. We can consider all the evidence available but I find it difficult to come up with any reason one would oppose the request that, where it absolutely would not in any way increase the health risk to the mother, the anaesthetic would be provided.
The argument has been made that we listened to consultants here in this room during the hearings of the Oireachtas Joint Committee on Health and Children. Those hearings were very useful but this particular issue was not addressed. Why not? It was not addressed because until now we had a very different model of health care provision from the one we are about to introduce. We also listened to medical consultants stating on the record that in other jurisdictions they would not have to participate in termination procedures if they had a conscientious objection to them. Now we will introduce a regime where such medical procedures will have to be provided.
What Senators Healy Eames and Mary Ann O’Brien are proposing is that we would at least try to do so in a humane fashion. I support the amendment. I heard the Minister's partial response yesterday and I have heard the response of the Minister of State at the Department of Health, Deputy White, which go back to what we were told in the early stages of the debate, namely, that there could be no substantive amendments and nothing other than the original Bill would be accepted. Maybe that is the problem. The gate has been closed and we have been told that even reasonable amendments simply will not be accepted. I find this amendment very reasonable and the public would find it very difficult to oppose.
We speak about what the opinion polls tell us but we should never be led by opinion polls. Some of my colleagues love to quote polls saying 80% or 90% of people want this or that judgment. If one asked the Irish people in an opinion poll do they feel that an unborn child, whose life is about to be ended, should at least be provided with the dignity and the pain relief of an anaesthetic, there would not be 70% or 80% in favour, there would be 100%. We should at least be reasonable in responding to that. I accept that the Minister will not accept any amendment whatsoever but it is important that we put on the record this request from at least a minority of this House. I think the majority of Irish people would want this amendment to receive fair consideration. How can anybody say "No" to pain relief? How can anybody say "No" to humanity? How can anybody say to "No" to giving at least some degree of dignity at the end of life to an unborn child? As a society, if we say "No" to this amendment we are making a very profound and negative statement about the values or lack of values in our country.
This amendment deserves every support.
Hear, hear.
It is an attempt by humanity to stare ideology in the face. I would also like to note the paternalism of Senator Burke’s suggestion that we have listened to doctors and therefore we have no business here setting out the rules for what should or should not happen. That is a complete misunderstanding of the role of a legislature and it is quite bizarre that he should suggest that, given how scant was the treatment at the hearings of the Oireachtas Joint Committee on Health and Children of many issues.
This issue was not dealt with at all. To suggest, as he and Senator Bacik are doing, that we should have regard to the Irish context and not look to the international scene is a denial of every good practice, particularly in a situation like this where we are changing the culture so dramatically. We are introducing an abortion regime, the extent of which may be disputed but there can be no disagreement about the fact that something completely new is going to happen here, namely, that doctors are expected to intervene in healthy pregnancies and in some cases destroy the lives of unborn children, and in other cases expose them to the risk of severe injury or disability.
That is not section 7.
That is the reality of what section 9 provides for. Now, for the first time, we have to have regard to whether pain relief would be appropriate because under the sections 7 and 8 procedures, which are necessary interventions to save life in a situation of physical illness, there is no doubt but that every effort is being made to preserve the life of the child. We do not credibly believe that will be the case in the section 9 situations, precisely because, to all intents and purposes, the departure of the unborn from this world is what will be sought and there is a heightened need to have regard to the welfare of the unborn. That is what is at the heart of this amendment. It is no argument to say we should trust doctors. Of course we should trust them but we should legislate to make sure that those who would not care for two patients would be circumscribed in their actions.
This is a very compassionate amendment which Senators Healy Eames and Mary Ann O'Brien have tabled. If we cannot have compassion for the unborn, for those who cannot speak for themselves even though they are being cruelly deprived of life as a result of this legislation, at least let it be compassionate. I am not sure why there is this apparent reluctance to entertain this amendment. Irrespective of where the medical evidence comes from, whether from the moon, America, Russia or Ireland it does not matter, because we are all human beings and we should all be concerned with the well-being and welfare of our fellow human beings. That is exactly the reason for this amendment.
We have heard Senators Colm Burke and Bacik on foetal pain and we do not question in any way Irish obstetricians or medical practices about this but where is the report by the Department of Health which confirms that foetal pain does not exist after 20 weeks? That report should accompany this Bill if this amendment is being rejected. We can only learn from other jurisdictions because this is the first time in the history of our State that abortion is being introduced where the rights of the child are being violated in respect of the Constitution under section 9 of this Bill.
On a point of order.
This from a man who says he does not interrupt.
I thought Senator Colm Burke did not interrupt people.
The Senator has alleged that we are interfering with the rights of the child as protected in the Constitution.
Absolutely.
We are not.
I stand by that.
We are not.
I stand by that. I will reiterate the point for the purposes of clarity. Section 9 of this Bill violates the rights of the unborn child and it tears up the constitutional protection for the unborn child.
The Senator should read the Bill.
I do not have to read the Bill because it is abundantly clear-----
That is exactly what has happened.
Clearly, the Senator has not read it.
That is exactly what has happened.
-----in section 9. The Senator can be as vague as she wants-----
I was not vague about it.
-----but the reality is that the rights of the child protected under Article 40.3.3° will be violated if this Bill is passed.
Why is the legislature in Texas introducing legislation for children who are going to be aborted post 20 weeks and accepting an amendment similar to that which Senator Healy Eames is trying to promote here?
Texas.
Reference was made to President Reagan's statements in 1984. Twenty-six leading health professionals in the United States wrote to the President and outlined that it is an established fact that the unborn, the prematurely born and the newborn of the human species is a highly complex, sentient, functioning individual organism. That the human unborn and newly born respond to stimuli is also established beyond any reasonable doubt. According to Senator Burke and others, these professionals were not telling the truth in the letter they wrote to President Reagan.
Please stop misquoting me.
The final line of that letter stated, "Mr. President, in drawing attention to the capacity of the human fetus to feel pain, you stand on firmly established ground". I refer to President Reagan's comment, "When the lives of the unborn are snuffed out they often feel pain, pain that is long and agonizing". What has changed since 1984? In 2012 the sub-committee on the Constitution, the US House Judiciary Committee held a hearing on this issue. Colleen Malloy is an assistant professor of neonatology at the department of paediatrics, Northwestern University school of medicine. She stated that there is ample biological physiological hormonal and behavioural evidence for foetal and neonatal pain. Professor Malloy told the committee that by 20 weeks post-fertilisation, or 22 weeks LMP, the foetal brain has the full complement of neurons present in adulthood. When questioned she confirmed that the ability of the foetus to feel pain was the majority view of those in the field. It has been suggested that an Irish report shows that this view is rubbish, even though this view is held all over the world, including in Britain. Speakers can quote from such reports. Senator Fidelma Healy Eames has researched this topic. She has drawn the attention of the House to this issue, for which I compliment her. I was not aware of this topic until this amendment was tabled. She and Senator Mary Ann O'Brien should be applauded for bringing forward a compassionate amendment which tries to ensure that if a child is to be aborted, gruesome and barbaric as that it, that at least the pain is minimised during the process. How can anyone argue with that? The only reason for not accepting this amendment would be if a scientific report - an Irish report would be acceptable - shows clearly that foetal pain does not exist. I do not believe such a report exists but perhaps the Minister of State can prove the contrary.
I remind Senators that there remain more than 50 amendments to be dealt with and we have less than two hours in which to do so.
We should keep going for the night.
The House has ordered the business.
It is most dispiriting to have to listen to this level of debate. This is the third time we have been through it.
Hear, hear.
The people whom Senator Ó Domhnaill dismisses as quacks or whatever he calls them, include the Royal College of Obstetricians and Gynaecologists in the UK and the American Association of Obstetricians. These are the most renowned people working in the field. They state very clearly -----
(Interruptions).
Senator Gilroy without interruption.
There is constant cackling when a speaker says something that others do not agree with or do not accept. We are all looking for some respect in dealing with this matter rather than playing havoc-----
Hear, hear, respect.
Senator Ó Domhnaill, please have a little bit of respect for other Senators.
We are constantly playing the ad hominem argument in this House. Speakers play the man when they cannot think of something to put up as a reasonable argument. Does my point need proving? We are making the very best case for the abolition of this House, no question about it. I go home from these debates-----
The Senator voted for it this evening.
Is it any wonder that I would vote for it? This is the sort of nonsense that passes for debate in this House. There is scant regard being paid to any evidence. We are talking about foetal pain which is a terrible and awful concept. We are being accused of not having compassion. Yet, the word, thalamus-limbic has not even been mentioned, which the highest authorities in the field of research dealing with obstetrics says is responsible for the perception, conception of pain and it does not develop in the foetus until at least the 23rd week.
Rubbish. We placed this on the record. The Senator is not entering new information. He is contradicting it.
Senator Gilroy without interruption.
If a foetus cannot feel pain for 23 weeks and Senator Burke has said that it is impossible to administer anaesthesia to a foetus at 16 weeks, why are we talking about an amendment that proposes 16 weeks? It might be reasonable to propose an amendment to administer anaesthesia at 22 weeks but it is preposterous to talk about 16 weeks. It is illogical, even by the Senator's own argument. If we are to be taken seriously as a House, let us have some regard to the facts and to the logic of our own arguments.
I welcome the Minister of State to the House. I am aware that yesterday, the Minister, Deputy Reilly, referred to two reports from two respected medical journals which stated that the unborn do not experience pain until post-29 weeks in one report or 24 weeks gestation in the second report. I have done a lot of research on this topic since we first tabled the amendment. I have 22 pages of information from the British Medical Journal, The Lancet, and doctors from all over the world who have given different opinions and different scientific views. There is disagreement with some of the research science stating 18 weeks while others state 20, 22 or 16 weeks. While I accept the Minister's words as being said in good faith, those words suited his argument. This is definitely an area of uncertain science. I have listed equally respected reports that contradict the two reports which the Minister cited. I will accept that given the various range of views on the topic, depending on whether one is classed as pro-life or pro-choice, this area is uncertain. When it comes to a burden of proof, one would have thought that the mature and civilised action would be to provide anaesthesia to the unborn at 20 weeks. Our whole argument is for the protection of the mother's life and this amendment will not hamper that in any way. Even if there is the slightest chance that some of my 18 pages of medical reports are correct, and that there is the slightest chance that the baby may feel pain, what is wrong with making this small amendment that will have an anaesthetist present to ensure the unborn baby does not feel pain?
If the Minister of State cannot accept the amendment for any reason, I propose that we introduce a Bill very similar to the Pain-Capable Unborn Child Protection Act, which was passed by the House of Representatives on 18 June 2013 in the most liberal abortion regime in the world, namely, the United States. We should do so this autumn if he cannot see his way to accepting this provision. I had predicted that the Minister, Deputy James Reilly, would protest, in respect of the amendment, that we cannot be prescriptive in the legislation. It is clear, however, that we can be prescriptive enough to ask two doctors to make a decision, quite rightly, in cases in which a mother is suicidal. I am asking the Minister of State to consider that perhaps my science is correct and we should insist on an anaesthetist being present in the circumstances I have indicated. It is the least we can do.
Hear, hear.
Well said.
These amendments broadly concern the issue of viability. In making reference to a medical practitioner's reasonable opinion, the Bill places a statutory duty on each practitioner forming an opinion to have regard to the need to preserve unborn human life as far as practicable. This imposes a clear duty on doctors to make every effort to preserve the life of the foetus where possible. We had a discussion last night on what is meant by "where possible". A failure to do so would place a medical practitioner in breach of the proposed legislation and subject to its penalties.
The Bill does not impose any time limits on carrying out the medical procedure at issue with reference to the gestational stage of a pregnancy. The approach adopted provides protection for the unborn at all stages of pregnancy. This is because the legislation only covers situations in which there is a real and substantial risk to the life of a pregnant woman which can only be averted by termination of pregnancy. The limit of potential viability is subject to change as developments in medical treatments progress. It would be incorrect to legislate for a particular gestation limit as to do so could have the effect of depriving unborn life which has not reached that limit of protection.
Amendment No. 21 makes proposals regarding civil and criminal liability for negligence. As it is not the purpose of this Bill to regulate obstetric procedures such as the delivery of a viable premature infant or to change the law of negligence in regard to the practice of obstetrics, I cannot accept the amendment. It should be noted that normal cover for medical practitioners, through their professional regulatory mechanisms, will apply in such situations. Standard medical practice will provide appropriate mechanisms for the assessment and treatment of both the woman and the unborn. It would not be appropriate to include this or other details of medical treatments in legislation.
I have reviewed the information from Senator Fidelma Healy Eames on the matter of foetal pain and have consulted my own medical advisers and officials in that regard. Having done so, I am satisfied with the position put forward in the Bill. To reiterate, it is not intended that the legislation will be prescriptive in regard to clinical practice. Clinical decisions, including the provision of pain relief, will be taken by the clinical team involved in line with evidence-based international practice. For these reasons, I do not propose to accept the amendments.
If colleagues consider it helpful, I will reiterate the response the Minister gave to Senator Healy Eames yesterday in respect of the various studies she quoted in the course of the debate. I am happy to do so.
There is no point unless the Minister of State has something new to say.
There is often a tendency - I concede that it is not confined to one or other perspective in this debate - to quote from experts and expertise which tend to support or validate the argument one is putting forward. That is perfectly allowable and is a legitimate form of debate. There is no difficulty about it. We are all inclined to reach for studies that tend to support the case we wish to make. What the Government must do, however - and, I would respectfully suggest, what the Oireachtas must ultimately do, having considered the broad sweep of evidence - is to come to a conclusion on the matter at hand. I make no criticism of Senators in observing that we have heard all the arguments at great length. I would not presume to say how this House should approach its business, but the Government certainly must have regard to more than one particular perspective.
Senator Rónán Mullen referred several times to doctors having particular ideologies. It may be reasonable to use that word but the reality is that one person's ideology is often matched with an ideology on the other side of the argument. It is not proper or prudent to rely on selective quotation; we must have regard to all the evidence and studies. The Minister referred yesterday to multidisciplinary, systematic and peer-reviewed studies, not just reaching to one or another study here or there but looking to see what is the broad sweep of opinion. In fairness to Senator Mary Ann O'Brien, she made the point that there is a great deal of controversy about this issue. Those of us who have occasion to follow the debate in the United States can observe that it is a hugely contentious topic in that country, as indeed it is elsewhere.
The study published in the Journal of the American Medical Association in 2005, as referenced by the Minister yesterday, looked at a range of different studies, concluded that the evidence regarding the capacity for foetal pain is limited and indicated that foetal perception of pain is unlikely before the third trimester. The article observed that the capacity for conscious perception of pain can arise only after the thalamocortical pathways begin to function, which usually occurs at around 29 or 30 weeks' gestation. The Minister went on to refer to the study in the United Kingdom undertaken by the Royal College of Obstetricians and Gynaecologists following recommendations by a House of Commons committee in 1997. That study, published in 2010, reviewed all the evidence, including the recently published literature. This is the type of broad-ranging review that is required. It is no good simply accessing a study that takes one particular approach. It is still possible to come to a particular conclusion on one or other side of the argument, but it should not be done based on a flow of studies or arguments from one particular perspective. I would respectfully suggest that this is not good law-making. It is not what we mean by evidence. When we talk about an evidence-based approach, it does not mean looking for a study that tends to support what we want to do. That is not my understanding of the proper marshalling of evidence in a legislative pursuit. It is about looking at all the evidence in the round. Senator Ivana Bacik made a fair point when she referred to the tendency to be overly reliant on medical opinion from the United States. The reality is that even in that country, medical opinion is not universally taking one particular perspective on this issue, as even a cursory look at the reporting will show.
Senator Paul Bradford is putting a negative characterisation on the position we have taken in this debate in claiming that we were never willing to accept amendments. After the heads of the Bill were published and debated in the committee hearings process and the legislation was brought to the Dáil, we made clear our willingness to consider amendments which improved the operation of the Bill. What has happened, however, is that we simply were not in a position to accept many of the amendments brought forward. There is no arguing with Members' rights to bring forward proposals; it is perfectly legitimate to do so. There can be no denial, however, that the majority of amendments - not all, perhaps, but certainly a lot of them - reflected colleagues' basic objection to section 9. I understand Senator Jim Walsh conceded that point last night; if I am wrong, he will correct me. Senators have adopted lots of different ways to attack that section, as is their right. That, essentially, is what most of the amendments have been about. The bottom line, however, is that the Government is not amenable to removing section 9. We will not agree to any amendments which seek, whether directly or indirectly, to undermine the operation of that section. That is our position and it is for the Seanad to make its own decisions.
I wish to make clear that the Government was open to amendments which might assist in improving the operation of the Bill. However, it was not interested in those which seek to drive a coach and four through its provisions. We are not prepared to accept such amendments. That is what we meant when we indicated that we would accept amendments which improved the operation of the legislation. For those reasons, it is not proposed to accept the amendments in this group.
I agree with considering all the evidence in the round. My background is in research and I am aware that one does not just examine one item of evidence and draw a conclusion from it. To deny that there is no up-to-date medical evidence which shows that an unborn baby feels pain is to completely mislead the House. I will identify some patterns from the information available. There is broad agreement that after 26 weeks the unborn feels pain. Some new evidence is emerging which indicates that the unborn feels pain from 17 weeks onwards. It is for this reason that - as a precautionary principle - I included the phrase "where the unborn is sixteen weeks gestation or older" in amendment No. 9. The precautionary principle suggests that there should be no doubt that the unborn may feel pain. As a result of the uncertainty - and just in case - surely the humane and compassionate course of action would be to provide for relief at that moment of the ending of life of an unborn baby. That is what we are doing here.
I spoke to two obstetricians yesterday, one of whom informed me that from 17 weeks onwards the procedure to end the life of a baby involves injecting potassium chloride into the heart. Those who perform such procedures are guided by ultrasound. Within one minute, this causes the baby to have a heart attack. It is the very same lethal injection that is used in executions.
Not in Ireland.
What I have just outlined is how an Irish obstetrician described to me the way in which these procedures are carried out elsewhere.
Who is the person to whom the Senator refers?
I would be happy to provide the Minister of State with his name after the debate.
No, the Senator should place it on the record.
I would be happy to give it to the Minister of State afterwards.
Put it on the record.
Many names have been offered in this House and they have been rejected by the Cathaoirleach. I am, therefore, going to adhere to Standing Orders on this matter. However, I would be more than happy to supply the name to the Minister privately.
On a point of order, the Minister of State is smirking. However, Senator Healy Eames is showing respect for someone whose permission she may not have in the context of revealing his name.
That is not a point of order.
Plenty of obstetricians-----
On a point of order-----
Excuse me, who has the floor here?
-----it is somewhat astonishing that the Minister of State, the leader of the Labour Party group and the health spokesperson of the Fine Gael group-----
That is not a point of order.
-----would openly ask a Senator to abuse privilege.
Hear, hear.
Senator Healy Eames, without interruption.
It is disgraceful.
Hear, hear.
I really must-----
I will allow the Minister of State to respond at the end of the debate.
This is an issue of order. There was no request to ask anybody to abuse privilege.
The Minister of State called on Senator Healy Eames to name the obstetrician to whom she referred.
There was no allegation made against anybody. No adverse statement was made in respect of a single person. If so-called evidence is being put on the record so late in the debate, then it is not unreasonable to request the source of that evidence.
Perhaps Senator Colm Burke might reveal the names of the medical professionals he consulted.
Under Standing Orders, I am allowed to make an intervention if the person in possession permits me to do so.
As long as I can continue. Is that acceptable to the Acting Chairman?
Senator Walsh is not permitted to do so on Report Stage.
Guidance from the Royal College of Obstetricians and Gynaecologists recommends that babies over-----
Senator Walsh should please-----
-----23 weeks who survive abortion should have their hearts stopped by lethal injection-----
That is not a point of order.
-----but that this can be a difficult procedure for doctors.
Here we go again. More of this nonsense.
The Royal College of Obstetricians and Gynaecologists said that and I wanted to point it out in support of Senator Healy Eames and in answer to-----
Senator Walsh should please respect the Chair.
-----the Minister of State's question.
The Minister of State indicated a few moments ago that it is important to consider all evidence. He has presented some evidence and I have done likewise. What the Minister of State is saying is that there is no openness on his part and that the Government is only acknowledging one view. In that context, I say "Shame on you" to the Minister of State.
We must listen to everything the Senator says and we do so. However, if she is putting forward some additional evidence which she says she was informed about by an Irish obstetrician today, it is not unreasonable to ask the identity of that individual.
I am not objecting to supplying the Minister of State with the name in private. However, I will not put it on the record without the person's permission.
That makes it much more difficult to rely on the evidence.
The Minister of State will not even-----
I am not going to be-----
This is hypocrisy.
-----ballyragged by the Minister of State.
I merely asked the Senator to supply the name. Asking someone a question is not ballyragging.
The Royal College of Obstetricians and Gynaecologists in the UK and the Royal College of Midwives have stated that after 24 weeks a foetus feels pain. What I completely object to is the condescending tone being used by some Members who cannot listen to the evidence. I am not just referring to the Minister of State in this regard, I am also referring to a number of Senators. The tone to which I refer is unacceptable. If people cannot bear hearing about the pain, why do they want to legislate in respect of it?
I return to my basic point regarding the precautionary principle. If there is any doubt, then let us, at the very least, be humane and provide for an anaesthetic to be administered to the unborn whose little life is being ended. If the mother is already being given an anaesthetic, what is wrong with providing the baby with one? This beggars belief. Why can we not accept that it is okay to be wrong? What is wrong with the Government? Is it the case that it does not want to recall the Dáil from recess? It is our job to provide - if we must go there at all - for the most humane ending of life. Let us have open minds. If we must end life, then let us do it humanely and let us operate, at the very least, on the basis of the precautionary principle. I included the term "sixteen weeks gestation or older" but I am very open to reaching agreement on the timeframe involved. Let us not deny, however, that foetuses feel pain, particularly after 20 weeks.
I again ask the Minister of State to think carefully before he rejects the amendment. If necessary, I will press the matter to a vote but I would rather not be obliged to do so.
I have not spoken on the amendment.
Unfortunately, and due to the fact that the Minister of State had responded, Senator Healy Eames's was the final contribution. I must, therefore, put the question.
Perhaps that is a matter to which we could give consideration in the context of the Standing Orders of the House. I intend to support Senator Healy Eames. I must inform the Minister of State that I received a detailed briefing from somebody in Trinity College - I will communicate the name to him privately - in respect of this matter, about which I am concerned. What Senator Healy Eames has stated is reasonable. I deplore the fact that during the hearings of the Joint Committee on Health and Children and on Committee Stage here appalling language was used about children being dismembered, etc. That was absolute rubbish. However, I agree with Senator Healy Eames in respect of the issue of pain.
Is the amendment being pressed?
Those in favour say "Tá".
Those against say "Níl".
Níl.
Níl.
Shame on ye.
Let us be respectful in this debate.
The question is lost. Amendment No. 10 arises out of Committee proceedings.
Vótáil.
The question-----
I said I was pressing the amendment.
The Senator did not-----
The Senator did not do so.
I said I was pressing the amendment. That is what it means.
The Acting Chairman has already declared the result.
Yes, that is correct.
Sorry, vótáil.
Amendment put:
The Seanad divided: Tá, 14; Níl, 34.
Tá
- Bradford, Paul.
- Crown, John.
- Healy Eames, Fidelma.
- MacSharry, Marc.
- Mooney, Paschal.
- Mullen, Rónán.
- Norris, David.
- O'Brien, Mary Ann.
- Ó Domhnaill, Brian.
- Ó Murchú, Labhrás.
- Quinn, Feargal.
- Walsh, Jim.
- White, Mary M.
- Wilson, Diarmuid.
Níl
- Bacik, Ivana.
- Brennan, Terry.
- Burke, Colm.
- Clune, Deirdre.
- Coghlan, Eamonn.
- Coghlan, Paul.
- Comiskey, Michael.
- Conway, Martin.
- Cullinane, David.
- Cummins, Maurice.
- D'Arcy, Jim.
- Gilroy, John.
- Harte, Jimmy.
- Hayden, Aideen.
- Henry, Imelda.
- Higgins, Lorraine.
- Keane, Cáit.
- Kelly, John.
- Landy, Denis.
- Mac Conghail, Fiach.
- Moran, Mary.
- Mulcahy, Tony.
- Mullins, Michael.
- Naughton, Hildegarde.
- Noone, Catherine.
- O'Donnell, Marie-Louise.
- O'Keeffe, Susan.
- O'Neill, Pat.
- Ó Clochartaigh, Trevor.
- Reilly, Kathryn.
- Sheahan, Tom.
- van Turnhout, Jillian.
- Whelan, John.
- Zappone, Katherine.
Tellers: Tá, Senators Fidelma Healy Eames and Mary Ann O'Brien; Níl, Senators Paul Coghlan and Aideen Hayden.
Amendment declared lost.
Amendments Nos. 10 and 13 are related and may be discussed together, by agreement. Is that agreed? Agreed.
I move amendment No. 10:
In page 9, line 26, to delete “is ended” and substitute “may be lost”.
One remarkable aspect of this debate has been that when seeking to reassure Members, the various Ministers present talk about the necessity of procedures that involve the termination of a pregnancy. However, the legislation provides for the lawfulness of procedures in the course of which or as a result of which an unborn human life is ended. Not only has the Government resisted taking a precautionary approach to the possibility that the unborn, in the context of the termination of a pregnancy, might feel pain but Members have also seen a refusal to take on board a direct duty to protect the life of an unborn who is viable, as well as the rejection of specific language that would require this where it was practicable to so do. This is extremely troubling. As I stated, the issue is that instead of using the word "ended", that is, in the context of the lawfulness of procedures leading to the ending of life, one should be talking about the possibility of life being lost.
As was stated on Committee Stage, I seek to protect and provide for situations where it is clear to medical personnel that they are at no disadvantage from the perspective of civil or criminal law in the event that they perform the procedure in question but the child does not die and that, in fact, it is desirable that the child not die where that is avoidable. The Government has been talking out of both sides of its mouth because, on the one hand, it has been stating it is desirable that the child should not die where it is possible to provide for this, but there is nothing in the language used in the legislation to give comfort on that point. It appears that the word "lost" would be more appropriate if what the Government intends doing in any of these sections pertains to ending the pregnancy but trying to save the life where that is practicable. Ideally, instead of talking about when, in the course of which or as a result of which "an unborn life is ended", wording stating "a pregnancy would be ended and the life of the unborn endangered or lost" should be used. The idea that the life would be lost really honours more what the Constitution requires, which is respect for the equal right to life of the unborn. Therefore, it appears that the word "lost" would introduce no ambiguity but bring much reassurance that where it was practicable to so do, the life of the child would always be saved.
There are two dimensions to the amendments. The first is the more desirable language of loss, implying that the intention is to save life, if at all possible, and that it is a regrettable fact that the child's life is to be lost, not a sought end in itself. The second aspect is the use of the phrase "may be" instead of the word "is" in the context of the life being lost or ended because that would make it clear that such procedures would not necessarily end in the death of the child in post-viability situations and that doctors were both fully protected and fully expected to protect life in that context.
I second the amendment.
I am unsure whether I understand fully the rationale for this amendment, even though I have listened carefully to Senator Rónán Mullen. In the first instance, I will give a general response and will then seek to consider precisely what he has said in support of his amendment.
As was stated on Committee Stage, the Bill, as drafted, reflects the policy requirements to implement the judgment in A, B and C v. Ireland which pertains only to effective and accessible procedures being available. However, the change proposed by the Senator would have the effect of bringing a greater number of medical procedures under the Bill. For example, medical procedures which are currently carried out but which may pose a risk to the unborn such as amniocentesis or the administration of a general anaesthetic do not require legal certification, apart from clinical indication, and it would not be desirable for them to so do. There would at least be a risk that this would be the effect of what the Senator has proposed. However, having examined the words proposed by him, I am still somewhat at a loss as to what is the rationale for this proposal. I believe he will agree with me that irrespective of one's perspective on what is proposed in this legislation, the Bill must provide clarity with regard to what is protected. As a result, sections 7 to 9, inclusive, particularly sections 7 and 9, begin with the phrase "It shall be lawful". In addition, the phrase "it shall be lawful" appears on the second line of section 8. The Bill is making it clear what is lawful and regardless of whether one likes it, the clear intention of the sections is that it shall be lawful. Therefore, there must be clarity in respect of what is lawful.
When the baby dies.
May I have the protection of the Chair?
The Minister of State to continue, without interruption, please.
It is what is lawful that is protected and it must be clear in what one is doing.
If one uses language such as "may be ended" or "may be lost" so that, for example, section 8, from the middle of the second line, would read, "it shall be lawful to carry out a medical procedure in respect of a pregnant woman in accordance with this section in the course of which, or as a result of which, an unborn human life may be lost", it introduces at least an uncertainty as to what is protected here, and that would be unacceptable. Either it is being done in legislation or it is not. Some of the Senators opposite believe it should not be done. I respect that, although I disagree with it. Given that it is being done, it must be clear.
In what the Senator proposes, there may be, at least to some extent - I hope he will excuse me in this - a point being made by him. I am not taking from his right to introduce this amendment - I hope he will not react to this, as it is getting late - but there is a polemical element to what the Senator proposes. He is entitled to introduce such an element, but for it to be adopted in legislation would be most undesirable because it would undermine the protection that it is intended to give to the various persons who would be protected throughout sections 7 to 9, inclusive, by the use of the phrase "it shall be lawful".
I thank the Minister of State for his response. I assure him that this is a substantive amendment which would make the following substantive difference. There would be absolutely no doubt that in a pre-viable situation the unborn child's life would be ended. However, in a situation at viability onwards, it would make clear that the intervention was not designed to take the life of the child but to end the pregnancy. There is no ambiguity or danger introduced by the words "may be lost". It simply encapsulates the reality that, depending on the stage of pregnancy at which the intervention is made, the outcomes from the point of view of the unborn child may differ. There is no prejudice to the woman's welfare here. This is not opposing section 9, which I certainly do oppose. I am saying, accepting for the moment that section 9 is in the Bill, that section 9 should make clear that any such intervention on foot of section 9 is not designed to end life. It is designed to end pregnancy, which, depending on the stage of pregnancy, may or may not end life. That is the entire purpose of the wording that I have proposed and I do not see how there is any danger imported by the use of the words "may be".
Furthermore, and this is where I am afraid I must accuse the Minister of State, the Government and perhaps the officials advising the Minister of being polemical and perhaps being-----
It is not fair to introduce the officials into the matter. These decisions and proposals are made entirely politically by the Government, not by officials.
Not true.
I hear what the Minister of State says-----
Senator Mullen should accept it.
-----but I am saying that only a contorted reading of the proposed amendment could view it as including procedures such as amniocentesis. This line was trotted out by the Minister, Deputy Reilly, at Committee Stage as well. I take the Minister of State, Deputy Alex White's, implication that he himself came up with the idea. It certainly is not a credit to him because subsequent subsections clearly establish that the only categories of medical procedure contemplated by the Bill are those which respond to a real and substantial risk of loss of maternal life as a necessary means of averting such risk and to introduce amniocentesis there as a reason not to make this change - bearing in mind, of course, that it would do no mischief, because the Minister of State is not pointing to any mischief that the use of the word "lost" would import, but is saying, rather, that it might introduce what are, at worst, irrelevancies - or to even claim that, is contorted. It is perverse and I would say it is even a corruption of debate.
I repeat that my key objection to this amendment is that it would risk undermining the protection that it the section is intended to give. If one has a doubt - if there is a phrase that talks about protecting something that is lawful in circumstances where something "may" happen - one must have protection-----
That is inclusive.
Whether one agrees with it or not, if one is going to have protection, it must be protection where something actually happens. To start introducing language such as introducing protection for something that "may" happen-----
That is simply not logical.
-----introduces a complete lack of clarity and, in my mind, doubt.
Question, "That the words proposed to be deleted stand," put and declared carried.
Amendment declared lost.
I move amendment No. 11:
In page 9, lines 31 to 33, to delete all words from and including "(being" in line 31 down to and including "practicable)" in line 33 and substitute the following:
"(being an opinion which respects the equal right to life of the unborn, and which has regard to the duty to deliver the viable unborn alive where practicable)".
Is there a seconder?
I second the amendment.
Question, "That the words proposed to be deleted stand," put and declared carried.
Amendment declared lost.
Amendment No. 12 arises out of Committee Stage proceedings. Amendments Nos. 12 and 15 are related. Amendment No. 14 is an alternative to amendment No. 12. Amendment No. 31 is related to 14. Amendments Nos. 12, 14, 15 and 31 may be discussed together by agreement. Is that agreed? Agreed.
I move amendment No. 12:
In page 10, to delete lines 4 to 39.
This goes to the core of the Bill. The Minister of State pointed out that we are against the substantive issue of section 9, and that is true. We have made no secret of that. However, that does not mean that issues such as foetal pain and trying to confine the procedures that are allowed for abortion should not been have favourably considered, as they would not have changed the substantive issue. Anyway, so be it; that has not been done.
With regard to my objection to section 9, I am objecting fundamentally to suicide as a ground because there is no medical evidence in this regard. Even with regard to the last discussion, in which I think the Minister of State missed the point that was being made, where the phrase "it shall be lawful" was used in the context of when unborn human life has ended, what happens if the baby survives? It is silent as to whether that procedure is lawful or not. We do know that this will happen, particularly in that period post-viability in which babies can be seriously disabled.
There is a point I want to develop on this. There are a number of points, and this probably will be my last time to get in because I imagine there will be quite a bit of discussion of this group of amendments and this section. I will quote from something I came across which articulates, maybe better than I can, my point of view in its regard and to which I referred at Second Stage, which was to do with the principle of the inviolability of human life. It reads:
If we abandon the principle which teaches that innocent human life is inviolable, which is to say, that is it is sacred and must be protected by law, if we relinquish that principle, and begin to allow for the deliberate and direct destruction of human life, what basis will we have to object when the situation shifts further and other categories of vulnerable human beings are under threat? We will have none or very little, because we will have sacrificed the foundation, the basis, the principle: every human life is to be respected, because it is of inestimable value. This recognition is at the origin of every human society and community. It is not per se a religious truth; it is a human truth.
I would go further and say that this is an objective truth. It is not merely any ordinary truth; it is an objective truth. Because it is an objective truth, it is accessible. It is accessible by every Member of this House. Through our knowledge, through the research that we have done on the issue, through our intelligence and through our reason and conscience, we can arrive at what the truth is. I would argue that, on every issue, every decision and every Bill that comes before this House, there is a duty on us to seek out the truth. It is not always as easily accessible as it is, in my opinion, in this context.
I quote Pastor Martin Niemöller, who spoke about the atrocities committed during the last century. He wrote:
First, they came for the socialists,
and I did not speak out because I was not a socialist.
Then they came for the trade unionists,
and I did not speak out because I was not a trade unionist.Then they came for the Jews,
and I did not speak out because I was not a Jew.
Then they came for me,
and there was no one left to speak for me.
Interestingly, something of which I was unaware, which I came across only within the past number of days, is that after the war the war crimes tribunal indicted ten Nazi leaders for encouraging and compelling abortions, which at that time was classed as a crime against humanity. I would argue that it is as big a crime against humanity today as it was at that time.
I am well aware, under this heading, that suicide is a major issue for society generally.
I covered that on Second Stage. If there were any medical evidence suggesting a woman who is suicidal could be relieved by giving her an abortion, we would be challenged in making our argument. There is no such evidence. This was clearly enunciated at all the health committee hearings. Unfortunately, we continue with our approach. I said yesterday in the presence of Minister for Health, Deputy Reilly, that the abortion industry is evil. It is a multi-million dollar industry and absolutely corrupts the thinking of people, including medical professionals.
I did some research on abortions since the practice was legalised in the 1960s.
What is the relevance?
Once we bring it in with the suicide clause, it will open the door. This has happened in every country. The number of procedures carried out is in the order of 600 million in four countries, namely China, the United States, Britain and India. If one accounts for the rest of the world, the number is in excess of 1 billion. I could give statistics from many countries.
A document I saw recently indicated our maternal health rate is the second highest on a list of 150 countries. Countries with liberal abortion regimes are well behind us in that regard.
Let me quote Deputy Brian Walsh on Second Stage in the Dáil. He made a comment that resonated with me and, I hope, the Minister and others. He said we are now poised to perpetuate in legislation the absurd principle that the suicidality of one human being can be abated by the killing of another.
I have been particularly uncompromising in the language I have used and have made no apology for that because I believe the unborn have neither a voice nor a vote. If those of a pro-life ethos are not prepared to articulate the innocent, vulnerable status of the unborn, their cause is totally conceded. That would be to the shame of humanity.
On the suicide issue and the mental health issue in general, research in New Zealand, with which the Minister and his Department will certainly be familiar, shows the rate of mental disorders among women who have had an abortion is approximately 30% higher than among other women. The research was produced by Professor David Fergusson, who is pro-choice.
I came across information on a commission on abortion headed by Lord Rawlinson in 1992. The commission found that 80% of women who responded to a survey suffered from the long-term effects of abortion.
I tried to articulate three areas in my Second Stage speech. One was concern for women faced with a medical emergency and who need every treatment available to save their lives. I have no dispute with this and fully support the argument. The second area concerns the women who are badly affected by having the procedure of abortion. The third area is obviously the devastating effect for the unborn.
I have come across information from 2007 or 2008 that indicates that botched abortions mean scores of babies are born alive and left to die. It was revealed in an official record.
On a point of order, how is this relevant? I have sat through Senator Walsh’s quotations yet again-----
Can I make a point?
He is giving another Second Stage speech. It has no relevance.
This group of amendments proposes to delete almost two sections of the Bill.
He has already quoted at length-----
The amendments propose physiotherapy and counselling services. Therefore, they cover everything being said by Senator Jim Walsh.
He has already said a lot of this at least once. It is poor chairing that is letting him get away with it.
That is an outrageous statement to make.
I know the Senator does not want to hear the hard facts but I would like her to listen to them and, perhaps, re-examine her conscience. A total of 66 infants survived NHS termination attempts in one year alone. Rather than dying at birth, as intended, they were able to breathe unaided. Approximately half were alive for an hour while one survived for ten hours. Once born, no medical help is offered. The statistics are contained in the small print of an official report by the confidential inquiry into maternal and child health commissioned by the British Government.
Senator Brian Ó Domhnaill was criticised for referring to disability. Perhaps it was a little unfortunate that his point got tangled up with the issue of foetal abnormalities, which is really challenging for us, but the point he made was no less valid. This report says that there is concern that babies with problems such as cleft palates or clubbed feet are being terminated because they are not perfect. Is this not reminiscent of anything from the 19th century?
How is this relevant to the amendment of suicide risk, or the amendment on section 9? I appeal to the Chair.
Amendment No. 15.
I accept the amendment would delete all of section 9. However, how is a discussion about abortion generally relevant to the amendment?
Amendment No. 15 refers to psychiatric treatment, physiotherapy and counselling services.
Senator Walsh is talking about an amendment to delete section 9. The amendments are directed at section 9.
May I be allowed to continue without disruption?
There is nothing relevant. There is no limit.
These deformities may be corrected during childhood. The findings follow evidence to MPs this week that foetuses feel pain before 24 weeks.
We have debated this already.
The Senator should stick to the amendment.
I am sticking exactly to it.
Women will feel suicidal when, in fact, through the modern techniques of ultrasound-----
His amendments are about suicide risk.
-----they will feel suicidal when they are told and many will actually obtain abortions under these headings because of that.
A baby born alive after a botched abortion at 21 weeks is among the worst cases reported in Britain. A little girl with Down's syndrome lived for three hours after being delivered.
The Senator has been given some latitude. I ask him to stick to the amendments.
Her parents claim they were coerced into a termination by staff at Macclesfield District General Hospital. The 44-year-old mother said:
If I had been given any idea that the baby would be born alive after an abortion I would never have gone through with it. They coerced me.
Coercion is a huge factor.
I ask the Senator to stick to the amendment.
I am sticking to the amendment. I am seeking the deletion of section 9 and making no bones about it.
It is about suicide risk.
I am raising this because suicide will-----
We are not on section 9.
My amendment is to delete section 9.
On the issue of suicide, many women in other countries have been advised to go down the suicidality route because it fast-tracks the abortion. It is the only mechanism in the Bill to facilitate abortion and, therefore, I believe it will be widely used. Therefore, I am seeking the deletion of the section.
There are various risks attached to abortions for women, and that is my concern. Risks are fewer when abortions are carried out in the early weeks, which I accept, but there is a greater chance of serious complications further into a pregnancy and a greater risk of dying. There was a report on this in one of yesterday's newspapers. While people might try to use that case, which was sad and unfortunate for both the lady and her family, it must be noted it is not that uncommon. One death from abortion occurs in every 530,000 cases where the period of gestation is eight weeks or fewer. This increases to one death per 17,000 for pregnancies between 16 and 20 weeks, and one death per 6,000 at 21 weeks and more.
What is the relevance to the suicide risk?
I ask the Senator to stick to the amendment.
I am.
The Senator is moving away from the amendment.
I am not. I am actually talking about why I want the section deleted. I seek to have it deleted because of its effects on women. Women who will have abortions under this provision will suffer, as I outlined on Second Stage and as distorted in one of the daily newspapers last Friday. The article had no substance at all and what I said was misrepresented. The actual effects are identified by medics.
One of my main objections to the section is that it has the effect of widening the abortion regime and bringing about the liberalisation of abortion. That has happened in Colombia, where there has been extensive-----
Could the Senator stick to the amendment?
I am sticking to the amendment.
This is Ireland, not Colombia.
Stick to the Irish constitutional framework.
I am sticking to the amendment. The Irish Constitution and procedures will have no effect once we pass this legislation because we are liberalising abortion.
That is rubbish.
Senator Walsh is being repetitive.
No, I am not.
On a point of order, Senator Walsh has brought this House into disrepute through his use of inappropriate and insensitive language already in this debate. I appeal to you, a Chathaoirligh, to exercise a firm hand by stopping repetition, digression and inappropriate language.
I have asked Senator Walsh to stick to the amendments and not to be repetitive.
Let us speak on the amendment and be respectful in our deportment.
I am asking Senator Walsh not to be repetitive.
I am not.
You are being repetitive.
No. I have referred briefly to some of the things I said on Second Stage without going into any detail. The Cathaoirleach should allow me to conclude without interruption, if he does not mind.
You have been going on for the last ten minutes.
I am going to finish.
We will interrupt if Senator Walsh keeps saying things that are not true.
I am seeking that this section be removed because it is a practice where women deny their natural role. Many for various reasons feel distressed and suicidal as a consequence of the distress they suffered. I recognise that that is a real situation, but abortion harms women, it does not actually cure their suicidal ideation.
Four thousand a year.
That is my point.
Four thousand women a year.
Please allow the Senator to continue without interruption.
As we have seen, women have died as a consequence of this.
What is the point?
Women suffer trauma as a consequence of having an abortion in these cases.
Senator Walsh has made these points already.
Even women who are suicidal-----
Senator Bacik's interventions are not helpful.
How do you know?
We know that women suffer post-abortion trauma because of guilt afterwards. That is medically proven.
How is this relevant?
Senator Walsh is being repetitive.
I am not.
He should conclude.
Many women - and we have had examples of it - suffer not just increased mental illness as a consequence of abortion, which is what this is about, but in fact some become suicidal as a consequence and have actually committed suicide as a consequence of it. So I am asking the Minister, in the interests of these women,-----
Irrelevant and repetitious.
-----what counselling and support systems will be put in place for these women who are going to have abortions. All the evidence we have to date is that there are no backup services. It is all very fine for the pseudo-liberals and pseudo-feminists to argue for the woman's right to choose.
Has the Senator any more that is relevant?
She is exercising that right to choose whether her baby lives or dies.
How is that relevant to this amendment? Let us see some firm chairing.
However, as soon as that woman has had her abortion, they are no longer interested. All they are interested in is asserting the ideology.
The Senator is way out of order. I am asking the Senator to conclude.
I am going to conclude. I am asking the Minister-----
I would like to call a quorum please.
Okay.
Notice taken that 12 Members were not present; House counted and 12 Members being present.
I now ask Senator Walsh to conclude.
I will. In the case of these women who have had abortions - many of whom have often suffered trauma throughout their lifetimes, with no backup support - I am asking the Minister what support systems he is putting in place-----
All this has been said before.
-----as a consequence of this Bill, in order to ensure that those women get the necessary supports to which they are entitled?
Is there a seconder for the amendment?
I second it. Section 9 is one to which, like Senator Walsh, I am absolutely opposed. Senator Walsh has referred to various studies and reports. One of the questions we must ask ourselves is whether abortion reduces the risk of suicide in pregnancy. It is a valid question. Dr. Eleanor Corcoran is an eminent psychiatrist of 27 years' standing who was based in England but now works at Letterkenny General Hospital. She compiled a report examining all the studies, both pro-abortion and pro-life. From her findings she could discover no suggestion in the core text-books of psychiatry, including perinatal psychiatry, that abortion is a treatment on its own or as part of a risk reduction measure for suicidality in pregnancy.
The issue of abortion as an aid to reducing suicide has been examined more directly in a series of studies from Finland. The first of those studies, by Gissler in 1996, linked the individual records of those whose pregnancies ended either by delivery, miscarriage or abortion with the suicide records enabled by a common record number, between 1987 and 1994. In total, over 650,000 women were involved. The suicide rates in these were compared to the national average in Finland. The study showed that with a national average suicide rate for women of 11.5 per 100,000, the rate of suicide after abortion was 34.7 per 100,000. The rate of suicide after birth was only 5.9 per 100,000.
The author suggests that either abortion caused the increase in suicide or there were factors common to abortion and suicide, such as mental illness or poor supports, that led to the increase. One way or the other, this study confirms that abortion does not reduce the risk of suicide, but rather is associated with a several-fold increase.
A similar study covering a longer period-----
All of this was debated on Second Stage.
No. I have not raised any of this. This is new information which has become available to me over the weekend. I have not raised it before.
It is 20 years old.
Another study from 1987 to 2000, replicated these findings. In Finland, in 2005, it showed that accidental death, homicide and suicide all increased after abortion, and were lower after giving birth than the national average. In this study, the authors commented on the protection effects of pregnancy. The study concluded by recommending a post-abortion check-up, as necessary, in order to detect signs of depression and to identify the rare cases of psychosis after an induced abortion. It also recommended that such a check-up be made routine practice in all other countries where it has not yet been included in the current care practice scheme.
In the past few years, some cases of suicidal behaviour occurring after abortion have come to public attention - for example, Ms C and Emma Beck. Ms C was taken from Ireland to Britain for an abortion under the X case decision, which we are referring to here.
Can the Senator stick to the amendment please?
This is to do with section 9. Our amendment seeks to remove section 9, so it is relevant.
In what way?
It is relevant to section 9 because it deals with the whole suicide issue. As we all know, Ms C was taken from Ireland to England for an abortion under the X case decision. She publicly stated, a few years after, that she was suicidal and hospitalised for several months after this.
This is irrelevant.
All of this has been put on the record before several times.
No, no.
It has been on Second and Committee Stages.
But not on this Stage.
Maybe I am mistaken but my understanding is that this is section 9. This amendment aims to delete the section. This section is the kernel of this legislation. It is my responsibility as a legislator to bring these facts to the attention of the Minister. Our role as legislators is to do that whether we agree or disagree with the legislation.
The Senator is being repetitive.
The submission continued, "Emma Beck was an artist who died in 2008-----
We have heard all of this already.
-----by suicide after aborting her twins."
We have heard about this on other Stages.
It continued: "Her mother spoke about her daughter’s grief." Obviously, Senator Bacik does not want to hear what we have to say. This is factual evidence.
I have sat through hours of this already.
The submission stated:
Her mother spoke about her daughter’s grief. Cases such as these would suggest that abortion may have a negative rather than a positive effect on some women’s mental health.
The Royal College of Psychiatrists investigated whether abortion harms women’s mental health in its systematic review in 2011. This is a review of all high-quality studies, the results of which are then collated statistically to provide a total overview. It based its results on four studies. It found that the mental health outcome was the same whether the pregnancy ended in birth or abortion. In other words abortion made no difference to the outcome. Some researchers challenge this.
I am giving a balanced viewpoint as Senators will appreciate.
The Senator has nothing new to say.
It continued:
Fergusson, a pro-choice researcher, has found in his work following 500 children born in Christchurch New Zealand for 30 years that mental health problems do occur post abortion even in those without any previous mental illness history and that abortion increases the risk by 30%.
Other Senators have indicated they wish to contribute. Senator Ó Domhnaill is being unfair to them.
It is not my fault that we are guillotining this Bill.
The Senator is being repetitive.
That is a matter for the Government parties, supported by Sinn Féin. They all want the debate to be guillotined.
The Senator has taken up 70% of the speaking time already.
I will not apologise for that because Fianna Fáil voted against the Order of Business this morning. We do not agree with guillotining legislation. When I am trying to make my point I am spoken down. Will the Chair give me protection? I know the Cathaoirleach has given it in the past. He is a very honourable Chairman.
Will the Senator get back to the amendment?
I will fast-track my presentation. I can see some Senators opposite smiling now. Unfortunately, when one brings in true facts, the people who want to ram this legislation through and guillotine it do not want to hear them.
If the Senator brought in some new facts, then we would listen. He is just being repetitive.
Senator O’Keeffe, please.
Some people never listen.
I beg your pardon, Senator Walsh.
Senator O’Keeffe, please. Senator Ó Domhnaill without interruption.
I will not take abuse from Senator Walsh.
Senator O’Keeffe, you were making charges. Senator Ó Domhnaill has the floor.
Senator Walsh was giving abuse again.
The abuse was coming from the other side of the House. I am in possession.
In possession? I did not know we were playing rugby.
Senator O’Keeffe.
Senator O’Keeffe is the one playing rugby.
You are the one.
Senator O’Keeffe, will you allow Senator O Domhnaill to proceed?
The eminent consultant, Patricia Casey, concluded:
There is no evidence from international studies showing that abortion is a recognised treatment or part of a treatment for a suicidal pregnant woman, nor has it been suggested that this might have prevented the rare cases of suicide that occur in pregnancy. The adequate recognition and treatment of mental illness during pregnancy is what is required.
In an individual case it is claimed that an abortion might be of benefit. The problem is that since suicide cannot be predicted there is no definitive way of identifying an individual woman who, on the balance of probability, is at risk of taking her life. Also, since there are no studies indicating benefits from abortion it will be impossible to tell whether such an intervention will help or harm the woman or what the likely magnitude of either is. The recommendation of the expert group in 2012 is that psychiatrists, in their role relating to the implementation of the X judgment, must ensure that their decision is evidence-based so as to comply with the Medical Council ethical guide, 2009. This is not met in respect of abortion and suicide.
In the event that legislation is enacted allowing for suicide risk as a ground for abortion, psychiatrists will be compromised. This will arise if the woman insists she is suicidal, against the opinion of the examining psychiatrists, who might understandably be tempted to err on the side of caution and accede to her wishes. Questions will also arise as to the role of a psychiatrist in recommending an abortion to a woman who is suicidal but does not have mental illness. Being expected to make decisions of this sort jeopardises their role as medical professionals who treat mental illness.
If legislation for abortion on the grounds of suicide risk is enacted psychiatrists will be expected to propose an unproven intervention - abortion - for a rare outcome, suicide, that is more often incorrectly rather than correctly predicted.
The possibility of abuse of such a law is also a consideration in light of recent comments from the British Pregnancy Advisory Service.
On the implications of the expert group report on the A, B and C ruling, she stated:
Legislation for the X case should not include suicide risk as a ground for abortion in Ireland as there is no evidence that it is necessary and no evidence of benefit. Thus the requirement that treatments must be evidence-based is not met.
Abortion does not cure suicide. All of the international evidence, from both pro-choice and pro-life psychiatrists, supports that. If this Bill is about protecting lives and supporting women, we should provide the adequate care and attention women require during a difficult time in their lives. Will Fine Gael and Labour Senators opposite, most of whom have been respectful during the course of this debate, consider at this late stage voting against this legislation because none of the evidence supports its introduction into Irish law?
Senator Ó Domhnaill eloquently quoted from many reports that abortion does not decrease the risk of suicide.
Reports from eminent consultants.
Senator Gilroy without interruption.
Yes, to support that contention. However, Senator Ó Domhnaill omitted three small words which change the entire complexion of the point and undermines his entire argument and credibility along with it. If we were to add, “Abortion does not decrease the risk of suicide in individual patients”, it would change the entire complexity of the argument. We do not know if it does. There is no evidence.
Senator Ó Domhnaill quoted Dr. Fergusson. I will quote him fully:
I think it would be misleading for anyone to state emphatically that abortion does or does not help suicidal women.
Again, Senator Ó Domhnaill left out five small words which changed the whole complexion of what he said.
Hear, hear.
The Minister of State, Deputy White, asked us to be less selective with our quotations and instead gather the evidence, weigh it and measure it, look at it in the round and make a decision on it. Senator Ó Domhnaill has failed on all of these criteria. I contend that not alone will he not agree with me but he will not even understand me.
Senator Walsh also vigorously opposes section 9. He is entitled to do so but his decision is not based on evidence. It is one based, obviously and as he admitted himself, on ideology. He compares what the Government is trying to do with what the Nazis did during the Second World War.
Genocide.
He uses the words “evil” and “conscience”. He draws on evidence from an individual he called “a renowned authority”, Dr. Pravin Thevathasan, who happens to be an acknowledged quack.
Could Senator Gilroy refrain from putting individual’s names on the record of the House who are not here to defend themselves and, particularly, from describing them as quacks?
I apologise and withdraw the word "quack". This was a man who wrote a professional paper which was not peer-reviewed. It was hardly necessary for it to be peer-reviewed when he cited the Book of Exodus in the references, about which we need to say no more. When people start quoting renowned experts and it turns out that one of them might not be what he claims to be, it undermines the credibility of the argument made by the supporter.
Yesterday evening Senators Jim Walsh, Brian Ó Domhnaill and Rónán Mullen and I agreed that sections 7 and 8 were necessary - horrible, absolutely, but necessary. We said there was a provision in sections 7 and 8 to directly take the life of an otherwise healthy baby and we have agreed to that provision.
No, we have not.
Yes, we did.
We certainly did not agree to it in the terms described by the Senator.
We did.
The Senator should not mislead the House.
Yes, we did and I will explain it.
The Senator is not speaking for me.
If he reads his garbled presentation-----
Senator John Gilroy to continue, without interruption, please.
The record of the House will show that three Senators agreed with me last night.
We are not discussing last night's business.
It is very important.
We are dealing with the amendments.
We have established that there are some circumstances - horrible, hateful and very challenging - where it is necessary. I can point to a particular illness which might jog one's memory. I will not identify the illness because there are people who are possibly suffering from it and, unlike Senator Jim Walsh, it would be offensive for me to nearly name-check them. There is an illness associated with aortic dissection where the root of the aorta is under pressure from an otherwise healthy baby in an otherwise healthy woman. These are the facts.
It is not a healthy pregnancy.
It is a healthy baby in an otherwise healthy woman.
What relevance does this have to the amendments before us?
It relates to the reason section 9 should stand. Despite the fact that Senator Jim Walsh called me an abortionist, he and I agree on this. Despite his mighty rhetoric of being more pure than me, we agree that abortion is sometimes necessary. All we disagree on are the circumstances in which it is necessary.
I will quote from a paper delivered at the public hearings on behalf of Professor Patricia Casey. I spoke to several people on the pro-life side and they agree with me. We are providing for a medical procedure known as abortion - let us call it what it is - in the rarest of circumstances in the most challenging of cases, yet the argument been portrayed on the other side of the House is that we are almost legalising compulsory abortion. It is so dishonest and despicable to go this way. The difference between Senator Jim Walsh and me - we both acknowledge the awful necessity of abortion sometimes - relates to the circumstances involved which I am saying include suicide. The Senator does not agree with this, but he disagrees not from a medical but from an ideological perspective. He is forever shouting about pseudo-feminists-----
That is a distortion. The evidence given at the committee was very clear, even from pro-choice-----
The Senator should speak to the amendment.
It is an ideological argument.
I know the Senator may believe he is an expert because he is Chairman of the committee.
The Senator is entitled to take an ideological view, but he is not entitled to ignore the medical evidence. When she was here, Senator Fidelma Healy Eames made a point on amendment No. 9 and Senator Jim Walsh-----
It is not in order to allude to a Senator who has left the Chamber.
Give us the medical evidence that abortion is a treatment for suicidality.
On amendment No. 9, Senators Brian Ó Domhnaill, Jim Walsh and Rónán Mullen agreed with the proposer of the amendment that we must move towards the precautionary principle. As Dr. Fergusson says there is no evidence for or against it, let us use the precautionary principle here. If we say it will never happen, so much the better. It would be fantastic if it never happened, but let us not try to prescribe events that we do not know will ever happen. If the evidence is not available, are we absolutely sure it will never become available and that this will never happen?
Where is the evidence to support the argument that it is a cure?
Senator John Gilroy to continue, without interruption.
When we descend to this clownish behaviour on the part of my esteemed friend on the far side of the House, we know his argument is beaten.
There are two problems with section 9, if we do not accept suicide as a legitimate reason. One is that we have different attitudes to mental illness. Some people do state mental illness, including suicide, is a very serious problem. Others have a different view. There might be a second argument, which is that we do not trust our doctors. We think there are pro-life and pro-choice doctors, which, of course, raises the appalling vista that the medical profession is not based on sound clinical practice but on some ideology perhaps shared by Senator Jim Walsh. These are the issues we need to examine.
I appreciate the indulgence shown to me by the Chair. If we acknowledge suicide and mental illness as presenting a real risk and if there is evidence, or none - I might be generous enough to say this - section 20 of the Bill offers protection against the ideologically driven doctor in the review to be laid before the Houses. If there is an ideologically driven doctor who suddenly ignores all clinical risk, clinical and professional good practice, the Hippocratic oath, the views of his or her colleagues and peers and just about everyone else because he or she is absolutely adamant that people should be aborted, every year before 30 June we will see the pattern emerging in the review. That should allay the fears about the ideologically driven doctor. The other reason for opposing section 9 is to deny the existence of suicide as a cause of real distress and to deny the existence of mental illness.
I welcome the Minister of State who I know is doing his very best in his portfolio. We will give him another two years and see how he delivers, but I am optimistic that he will deliver in his portfolio.
I believe our duty, as legislators elected in accordance with the Constitution, is to uphold the Constitution. In Ireland, thankfully, under the Constitution there is a separation of church and State and our obligation is to uphold the Constitution. There are two serious issues before us which previous Governments neglected for many years, including those which included my own party of Fianna Fáil. The first is how doctors faced with life or death decisions and in the absence of explanatory legislation are to interpret the constitutional provision that abortion can take place only where there is a real and substantial threat to the life of the mother. Thankfully, the law before us sets out procedures and processes to guide doctors and protect them legally.
In the X case in 1992, some 21 years ago, the Supreme Court held that a threat to commit suicide could constitute a real and substantial risk to the life of the pregnant mother. As the Supreme Court is the interpreter of the Constitution, its finding in the X case remains the constitutional position which we, as legislators, are duty bound to respect. We cannot have an à la carte approach to accepting the legitimacy of judgments of the Supreme Court. We regularly accept as authoritative and binding its judgments on various issues. It is not warranted to set aside its findings in the X case because they do not suit our personal disposition.
Let us not forget that the people have spoken in two referendums on this issue. In 1992 the proposal that the possibility of suicide was not a sufficient threat to justify an abortion was defeated. In 2002 the proposal to remove the threat of suicide as a ground for legal abortion in the State was again rejected by the people. As legislators, we must respect the will of the people as demonstrated in these two referendums. For ten years since the referendum in 2002 successive Governments led by Fianna Fáil failed to deal with these two issues - providing clarification for doctors of the circumstances when abortion was permitted and legislating for the X case judgment.
In a poll in The Irish Times in June 2013 voters were asked several questions about the issue of abortion.
A total of 89% of the people in the MRBI poll on 30 June said it should be allowed where a woman's life is at risk. As I said earlier in the debate, I know I am speaking for the majority of Irish women on this issue. When asked if abortion should be permitted in cases where the foetus is not capable of surviving outside the womb, 83% said it should be.
Hear, hear.
Some 81% of those polled said abortion should be allowed in cases of rape or abuse while 78% were in favour of it in cases where a woman's life is at risk.
I humbly refer to the challenge posed to Senator John F. Kennedy when he campaigned in 1960 to become the first Catholic US President. At a critical point in his campaign on 12 September 1960, he addressed the doubts of many Protestants as to whether his Catholic faith would allow him to make important national decisions as president, independent of the Catholic Church. His response was unequivocal. He said he believed in an America where the separation of church and state was absolute and he would uphold the US constitution. I commend President Kennedy's stance to all my colleagues,
I thank the Government for having the courage to bring this Bill forward and I am confident that I represent the position of the majority of Irish people.
Well said.
The amendments suggest that we should delete section 9. It is important that we go back to why the Bill is going through. It is the result of the interpretation by the Supreme Court of Article 40.3.3°. Mr. Justice McCarthy stated 20 years ago:
I think it reasonable, however, to hold that the people when enacting the amendment [the 1983 amendment] were entitled to believe that legislation would be introduced so as to regulate the manner in which the right to life of the unborn and the right to life of the mother could be reconciled. Failure by the Legislature to enact the appropriate legislation is no longer just unfortunate; it is inexcusable. What are pregnant women to do? What are the parents of a pregnant girl underage to do? What are the medical profession to do? They have no guidelines save what may be gleaned from the judgments in this case. What additional considerations are there?...The Amendment, born of public disquiet, historically divisive of our people [we have seen that 20 years on again] guaranteeing in its laws to respect and by its laws to defend the right to life of the unborn remains bare of legislative direction.
We have not dealt with this issue over the past 20 years but this legislation does. People dispute the X case judgment. When the 1995 Bill was before the Supreme Court, the judges referred to the X case. The court held: "Having regard to the judgment and the decision of this Court, which recognises and emphasises the supremacy of the Constitution, this Court is satisfied that, in the consideration of the issues raised in that case and the conflicting constitutional rights involved, the proper principles were applied in the interpretation of the relevant provisions of the Constitution and in the determination of the issues raised therein." The court set out that there was a need to put in place legislation in order that there would be clear guidance for the courts in dealing with this matter. Guidance is also needed for the medical profession and that is exactly what we are providing in this legislation.
Only one medical report was produced in the X case because the courts had no guidelines. The legislation sets out clearly that three medical experts must come forward to deal with this matter.
They will still die. We all know that.
It is important, therefore, that we move forward with this legislation and that the amendments are not accepted because section 9 is an important part of the Bill. We have done everything possible to take on board everyone's views in dealing with this legislation. In particular, we had three days of committee hearings in January and again in May. The committee took on board the opinions of more than 50 experts after the heads of the Bill were published. The Government has brought forward comprehensive legislation that the House should vote in favour of later.
For one moment, I wish it was admissible to take photographs in the Chamber. I appeal to the acting Leader to voluntarily make changes to the Order of Business. Important amendments will not be discussed and I greatly regret that. I do not mean to be disrespectful to those who have contributed at length on issues they feel strongly about but many Members would be happy for the debate to go on a little longer. Perhaps there should be a voluntary agreement by those on both sides to limit their contributions in order that there would not be an opportunity for an endless filibuster.
The Senator should stick to the amendments.
They can all be taken tomorrow.
I reassure colleagues who are terribly exercised by the issue of suicidality and evidence-based medicine that we are not legislating for guidelines for evidence-based medicine. Such medicine is drawn up by panels of doctors, national steering committees, professional organisations, institutions and faculties within institutions when they have examined the raw data, listened to opinion leaders in the field and read meta analyses. If the weight of evidence-based medicine is that an abortion is never necessary to prevent a suicide, then an abortion will never occur to prevent a suicide. That is the truth. Some Members are assuming that either doctors will ignore evidence-based medicine deliberately or will be so incredibly incompetent that they will not be familiar with the teachings of evidence-based medicine and with contentious issues.
It is not even possible to say that the Senators who are terribly worried are concerned that perhaps one rogue doctor acting "malfeasantly" could make the decision; they are saying that three rogue doctors acting in collusion will make the decision. These are my colleagues and friends they are talking about. These Members are saying they are fighting to protect women and unborn children from the malfeasance of the woman who comes into lie in the first place to say she is suicidal and from the malfeasance and the incompetence of the three doctors who will collude with her in the wilful destruction of her unborn child for some other reason entirely. There is no short cut around that. That is that they are saying and I do not believe it.
There has been one tragedy in this country where there was a departure from evidence-based medicine because of legal constraints. We are all aware of the case where a sad outcome occurred and a young woman died. There were multiple factors involved and we will not conduct our own mini-inquest here but on the Monday she went into hospital, ambiguity was introduced into the minds of doctors who, if they were thinking only in terms of medicine-based medicine and were not legally constrained, might have made a different medical decision, which was in accordance with evidence-based medicine. That is the decision that somebody was having an inevitable miscarriage. Somebody's precious first baby could not be saved; it was going to die. Under those circumstances one would induce the labour rather than let the woman run the risk of potentially life threatening infection. The ambiguity was there because there is ambiguity in our law. This is not some hypothetical construct; this happened. People need to be aware of all the issues surrounding evidence-based medicine in this circumstance.
I would also appeal for consideration to be given to some of the other amendments, although I know I am going to be ruled out of order on this. We have a situation in this Bill where somebody who rapes a woman will get a shorter sentence-----
Exactly.
-----than the woman's 15-year old sister might get for-----
That is the outside the scope of those amendments.
-----taking abortion drugs that she has bought online. This may stop that woman, if she is haemorrhaging to death, making her fearful of her life, so that she will not go into a hospital and seek medical attention. If somebody is really pro-life, they would not want that ever to happen to their daughter, their sister, their wife or anybody they even casually know. This is what our law is going to enshrine because we are not able to discuss these amendments tonight. I would appeal to the Ministers, to the acting leader of the House and to the Chair to give this consideration. It does not suit me more than it suits anybody else to spend more hours on this issue-----
The Chair has no involvement in this.
-----but I believe these are critical issues which will go unaddressed. We are going to end up with a law which will be on our Statute Book forever because no one is ever going to want to tackle this again with a barge-pole. We are going to have a situation which I believe next year, next week, next month or in five years time could lead to some haemorrhaging woman being afraid to get medical attention. Let us not leave this House tonight without fixing it.
Well said. They will not accept any amendments because the Dáil is gone off on its holidays.
I welcome the Ministers to the House. I want to make three points in respect of the amendment seeking to delete section 9. First, it would be unconstitutional to delete section 9 because to delete the provision relating to suicide risk would give insufficient regard to the right to life of the pregnant woman and would not implement the X case judgment for the reasons others have already outlined. Second, although abortion is not a treatment for suicide, and nobody has ever said it was, because there is no treatment for suicide, it may sometimes be necessary to prevent the risk of suicide in a woman or a girl, as we saw in the X case and as we heard in the expert evidence.
That is not what is in the legislation.
Third, anyone who is really serious about trying to delete section 9 from the Bill should read again Chief Justice Finlay's judgment in the X case, those compassionate and humane words of a judge who was faced with the very real prospect of a 14-year old girl who had been raped and who was suicidal as a result. They should remember that the psychological evidence was accepted by the State and by the courts, given the very real concern of the court that the girl would commit suicide if her pregnancy was not terminated.
He was a very conservative judge.
That was the issue. It was not a case about treatment or about mental illness. It was a case about a young girl who was suicidal as a result of a crisis pregnancy and for whom abortion was a necessary option in order to avert the real and substantial risk that she would end her life.
I wish, like Senator Crown, that we could legislate for cases of rape and fatal foetal abnormality-----
That is outside the scope of the amendments.
It is outside the scope not only of these amendments but of the Constitution. I believe it is very welcome that this Government is finally, after 21 years-----
On a point of information, I did not advocate legislation for rape. What I am advocating is the amendment of the legislation to reduce the criminal penalty on a woman who-----
I call Senator Mullen.
I would like to speak to amendment No. 14. First, I agree with Senator Crown that this debate should be extended. I would be very happy to have a gentleman's or gentlewoman's agreement that we would make three-minute speeches as a maximum. However, we should at least do this most important of issues-----
The Senator should apply it to his own side.
No, let us have the Leader in the House to make an arrangement.
The Senator should focus on the amendments.
I want to speak to the amendment because it has everything to do with evidence-based treatment. Like my friend and colleague, Senator Crown, I believe in evidence-based treatment. If evidence-based treatment was what we were legislating for, there would not be a problem. Let us look at the reality, however. The reality is that amendment No. 14, which I have proposed, changes the test required for the certifying doctors - those who will have the responsibility of certifying the procedure - from being a subjective good faith test of a kind which is increasingly discredited, to a more objective test that requires them to have regard to the relevant clinical evidence and to then jointly certify. That would be a more objective test and would approach what Senator Crown says he supports, and what I think everybody here supports, which is evidence-based medicine.
He is more of an authority on it than Senator Mullen.
I listened to the authorities very carefully, and I listened to Senator Crown's authority and have shown it great respect. However, I want to make the point that in regard to what is evidence-based medicine, this is our job, as legislators. Senator Gilroy, in a rather convoluted presentation, seemed not to grasp the fundamental idea-----
I am sorry if my lack of articulation offends the Senator.
-----that opposition to this legislation is not based on evidence, it is based on the lack of evidence that abortion is an appropriate treatment or response to a situation where a threat of suicide is deemed to constitute a risk to life.
The Senator is being repetitive. All of those points have been made.
What we do know is that abortion does not in any way improve mental health outcomes for women and is associated with a low to moderate risk of negative mental health sequelae in some women. It has been pointed out that one could not do the kind of study that would allow one to determine exactly whether, in situations where a person presented as suicidal, an abortion would help or hinder the situation. It is the first time I have ever heard the precautionary principle being invoked in favour of the taking of life, when the entire medical tradition is based on primum non nocere - first, do no harm. Far from it being a case, as the Government likes to posit, of "Let us save one life to avoid losing two", where there is an underlying mental health condition, it has been explained to us very clearly that abortion or any sudden life-changing decision could be contra-indicated - we heard that from Dr. John Sheehan, the perinatal psychiatrist. In the context of a situation where there is no underlying mental health illness, on one reading, as I have said here before, one might never have abortion because it would always be within the person's ability to change their mind.
Those points have been made. You are being repetitive.
I certainly am not. I am responding to the amendment. The issue arose on Second Stage and Committee Stage. Senator Crown's concerns in particular deserve a response. He is right in saying we must have evidence-based medicine. We do not have the requirement of evidence-based medicine here. Even though we are being told, on the one hand, it is not medical, the Chief Medical Officer, Dr. Holohan, came in here and told us that all of this was being pursued through a medical model, yet Senator Bacik persists in telling us that, of course, it is not a treatment. The amount of playing with words and doublespeak that is going on defies credibility.
What happened to the three-minute contribution?
So much for the three-minute contribution.
Senator Mullen has made his point.
As to the question of whether rogue doctors exist and whether we should be legislating to prevent, not the collusion of three doctors, but of two psychiatrists, because the obstetrician will not be in a position to gainsay the certification of the psychiatrists that there is real and substantial risk-----
So the psychiatrists are the villains.
It is a two-doctor situation. The third doctor is involved at the level of the mechanics, quite frankly. In response to the suggestion that there might be rogue doctors out there, to use that phrase, I can only quote what Ann Furedi, who is involved in the provision of abortion in Britain, said in the comparable situation of mental health in Britain, which provides the grounds for the vast majority of abortions-----
It is not comparable.
-----that in most of those situations, there is no mental health challenge at all and yet the thing is routinely abused.
Will the Senator stick to the amendments?
It is not comparable.
It is comparable to this extent, namely, it is much easier to prove the existence of a mental health situation than it is to prove the reality that a threat of suicide might actually lead to the act of suicide.
Does the Senator deny that suicide exists?
It is no argument for Senator Gilroy to say we are not respecting mental health. This is all sham argumentation and bogus blustering by Senator Gilroy. We had in the House Professor Kevin Malone, a leading suicide prevention expert, perhaps the leading one. He warned about the possible impact of this legislation in terms of negative attitudes around suicide in the country, in terms of it being a contributory cause of the problem by foregrounding. He talked in particular about the dangers for young men but we can also point to the potential dangers that this imports.
This is bad legislation. It is unjust legislation, not just in terms of the unborn but in terms of a sincere approach to address the real crisis women face in pregnancy. It is certainly a million miles away from evidence-based medicine.
I call the Minister.
On a point of order, it is now 8 p.m.-----
It is not 8 p.m. according to the clock.
It is one minute to eight.
What is the point of order?
If order is restored, I will make my point of order.
It is too late.
As it is 8 p.m., I request that-----
The Senator should stop telling lies.
-----the debate be extended to allow the Minister to reply.
As it is now 8 p.m., I am required to put the following question in accordance with the order of the Seanad of this day: "That amendment No. 12 is hereby negatived; that the Bill is hereby received for final consideration; and that the Bill is hereby passed."
Question put:
The Seanad divided: Tá, 39; Níl, 14.
Tá
- Bacik, Ivana.
- Brennan, Terry.
- Burke, Colm.
- Clune, Deirdre.
- Coghlan, Eamonn.
- Coghlan, Paul.
- Comiskey, Michael.
- Conway, Martin.
- Crown, John.
- Cullinane, David.
- Cummins, Maurice.
- D'Arcy, Jim.
- Gilroy, John.
- Harte, Jimmy.
- Hayden, Aideen.
- Henry, Imelda.
- Higgins, Lorraine.
- Keane, Cáit.
- Kelly, John.
- Landy, Denis.
- Mac Conghail, Fiach.
- Moran, Mary.
- Mulcahy, Tony.
- Mullins, Michael.
- Naughton, Hildegarde.
- Noone, Catherine.
- Norris, David.
- Ó Clochartaigh, Trevor.
- O'Donnell, Marie-Louise.
- O'Keeffe, Susan.
- O'Neill, Pat.
- O'Sullivan, Ned.
- Power, Averil.
- Reilly, Kathryn.
- Sheahan, Tom.
- van Turnhout, Jillian.
- Whelan, John.
- White, Mary M.
- Zappone, Katherine.
Níl
- Bradford, Paul.
- Daly, Mark.
- Healy Eames, Fidelma.
- Leyden, Terry.
- MacSharry, Marc.
- Mooney, Paschal.
- Mullen, Rónán.
- Ó Domhnaill, Brian.
- Ó Murchú, Labhrás.
- O'Brien, Darragh.
- O'Brien, Mary Ann.
- O'Donovan, Denis.
- Walsh, Jim.
- Wilson, Diarmuid.
Tellers: Tá, Senators Paul Coghlan and Aideen Hayden; Níl, Senators Brian Ó Domhnaill and Diarmuid Wilson.
Question declared carried.
When is it proposed to sit again?
Ag 10.30 a.m. maidin amárach.
Is that agreed?
I object. This is a very bad day for democracy. I voted in favour of the Bill reluctantly, but the fact approximately 40 amendments were not reached, that we put significant effort and time into it and that we had the guillotine again is appalling.
That was decided by the House this morning. I will put the question.
Question, "That the House stand adjourned until 10.30 a.m. tomorrow morning", put and declared carried.