James Reilly (Dublin North, Fine Gael) | Oireachtas source

As Deputies Regina Doherty and Peter Fitzpatrick said, Article 40.3.3 includes the words "as far as practicable". They have to stay and I cannot accept that amendment.

The test must be met. The test concerns the risk to the life of the mother, not suicidal ideation. It is not about meeting the need but averting the risk to the life of the mother. I am not able to accept the amendments on all counts.

Several members referred to the proposed section 9(7), but one cannot be prescriptive in law about medical practice. It would be a dangerous place to go for politicians and I speak both as a politician and a doctor.

I refer to the issue raised by Deputy Éamon Ó Cuív regarding amendment No. 10. I have some sympathy for it, but I cannot accept it, as currently worded.

I intend to table an amendment in this area on Report Stage. The Deputy would be surprised at how complex this area is and on how the balancing of rights within the Bill must be carefully adjudicated. There has been much discussion with the Attorney General on this and we are probably coming near to an agreement on a wording that could satisfy the sentiment here. That said, I am not in a position to accept any of these amendments.

Amendments Nos. 6, 7, 10, 27, 31 and 45 seek to strengthen the Bill's provisions relating to the right to life of the unborn. The use of the phrase "as far as practicable" in legislation reflects the wording used in Article 40.3.3°. I am aware that concerns have been raised around the need to insert a gestational limit on carrying out medical procedures covered by the Bill. In this regard it is important to stress again that the proposed legislation only covers situations in which there is a real and substantial risk to the life, as distinct from the health, of a pregnant woman which may only be averted by termination of the pregnancy. To be clear, it will only allow a pregnancy to be terminated in situations where it is expected that a woman would otherwise die. It must equally be stated that a woman has a right to a termination but neither she nor anybody else has a right to terminate the life of a child or a viable child that is born.

With regard to the Deputy's other amendments, it is very clear that the life of the child, once born, must be sustained if it is at all viable. It should also be clarified that in such situations while a woman has a right to have the pregnancy brought to an end the provisions in the Bill intend to ensure that in circumstances where the unborn might be potentially viable outside the womb, doctors must make all efforts to sustain it after delivery. It has been suggested that the legislation should include a clear provision to that effect and an explicit reference to viability. As currently drafted the Bill prohibits the killing of a viable foetus and including a reference to viability would not provide any further clarity in that respect as different pregnancies become viable at different points in their development and a clinical foetal assessment would still be required, as it is now. To put it in common parlance, nobody has a right, be they the mother, obstetrician, a doctor or any citizen of this State or other, to end the life of a newborn baby that is viable.

In circumstances where the unborn might be potentially viable outside the womb doctors must make all efforts to sustain its life after delivery. However, that requirement does not go so far as to oblige a medical practitioner to disregard a real and substantial risk to the life of the woman on the basis that it will result in the death of the unborn. Essentially, the decision to be reached is not so much a balancing of the competing rights, rather it is a clinical assessment as to whether the mother's life, as opposed to her health, is threatened by a real and substantial risk that can only be averted by a termination of the pregnancy.

In addition, the Bill makes it clear that only medical practitioners on the register established under section 43 of the 2007 Act can make the relevant medical assessment. These provisions were made to ensure that the medical practitioners who will implement the Bill will follow best medical practice. In the Bill "registered medical practitioner" means a doctor registered by the Medical Council under the Medical Practitioners Act 2007. This definition refers to a person permitted by law to practise as a medical practitioner in the State. In the performance of their professional activities all such medical practitioners are, as a matter of law, subject to the ethical and professional control of the Medical Council. This is a key point. Practice will change and evolve as modern technology improves and changes. We cannot prescribe in law for something that could change next month in the prescriptive manner being suggested.

With regard to the second proposal, the Bill makes it explicitly clear that a medical procedure in the course of which or as a result of which an unborn life is ended is only permissible if the risk to the pregnant woman's life can only be averted by such a medical procedure. This is the critical point. If alternative options are available to the medical practitioners and they go ahead with such a procedure, they will be in breach of the proposed legislation. Therefore, I urge members of the committee not to support the amendments.