Simon Harris (Wicklow, Fine Gael) | Oireachtas source

That is an important point. One of the reasons it is so particularly important relates to what we discussed yesterday and even the day before about certification. If an obstetrician certifies a woman for a procedure but goes on leave and the covering obstetrician has a conscientious objection, it demonstrates the importance of rectifying what the Deputy, I and others discussed over recent days. We will do that between now and Report Stage or we will certainly endeavour to work together to do it.

Regardless of a rostering or staffing position in a hospital, the right to conscientious objection should not be infringed. We must work together with the HSE and Dr. Boylan to ensure the service is operable but we must also ensure we do not attach disproportionate concerns to some matters. It is highly likely, based on the trends that we know relating to abortion in Irish women so far, that approximately 80% of Irish women who access terminations will do so in the community setting.

We should park the issue of the nine to 12 week period, which I accept is different from what I am about to say. Other than the nine to 12 week period, the women whose medical well-being the Deputy is discussing are very sick in terms of the risk to their health or life and may well have to be transferred to one of the larger tertiary maternity hospitals. I do not mean this disrespectfully, but I heard some obstetricians in smaller units in the country campaigning for a "No" vote during the referendum campaign and saying, "The eighth amendment has never prevented me from providing care for such a woman." However, that is because such individuals would have transferred their patient to Holles Street hospital, the Rotunda Hospital or the Coombe hospital. Therefore, it does not really arise in the case of a fatal foetal abnormality.

The point the Deputy makes is serious and legitimate. As the HSE rolls out this system, it has a responsibility to work with hospital management to ensure the staff will be consulted, informed and briefed in order that they will be aware of what conscientious objection means. There cannot and will not be any pressure on staff to in any way negate their conscientious objection which they absolutely have a right to have.

I am somewhat concerned about Deputy Tóibín's comments. I do not doubt his words, but I will not cast a slur on any hospital CEO, anonymised or otherwise, because I need to verify the facts. A hospital CEO in any voluntary or HSE institution cannot say, "My hospital is not participating," because it is my clear advice that institutions do not have a conscientious objection. No hospital will have the right to opt out; certainly no hospital CEO will have the right to say, "My hospital is not doing it." I need to ensure we will not exaggerate the significance of this issue. Prior to the introduction of the Protection of Life During Pregnancy Act, we heard many people say, "My hospital will not participate." In fairness to the doctors and medics involved, that largely was not the experience.

I will read my note for the purposes of the records of the committee. I do not want to take too long, but I want to be clear. This is an important issue on and about which we have all had discussions and questions. Section 23 of the Bill covers the issue of conscientious objection. It states that where he or she has a conscientious objection, a medical practitioner, nurse or midwife shall not be obliged to carry out or participate in the carrying out of a termination of pregnancy. In the event that a doctor, a nurse or a midwife has a difficulty in undertaking the required medical procedure, he or she will have a duty to ensure another colleague takes over the care of the patient. This is in line with section 49 of the Medical Council Guide to Professional Conduct and Ethics for Registered Medical Practitioners 2016 which I have read in full. That section obliges doctors to enable patients to transfer to another doctor for treatment in cases of conscientious objection. It has clarified how it is interpreted by the Medical Council.

Similarly, the Nursing and Midwifery Board of Ireland Code of Professional Conduct and Ethics for Registered Nurses and Registered Midwives, published in 2014, states:

If you have a conscientious objection based on religious or moral beliefs which is relevant to your professional practice, you must tell your employer and, if appropriate, tell the patient as soon as you can. If you cannot meet the patient’s needs because of this objection, you must talk with your employer and, if appropriate, talk to the patient about other care arrangements.

Even if you have a conscientious objection, you must provide care to a patient in an emergency where there is a risk to the patient’s life.

Therefore, both the Medical Council and the Nursing and Midwifery Board of Ireland, NMBI, have mechanisms to address non-compliance with their guide or code by doctors, nurses and midwifes. I am often asked if I am going to sack all of these doctors. Apart from the fact that it is not my function in law, it is not how the Medical Council or the NMBI discharges its duty. These things are only said to shock or create a problem; there is not that sanction.

I have discussed the fact that the HSE is developing a helpline to assist women to navigate the service for a termination. It is intended that medical practitioners will voluntarily consent to have their names released to women who are seeking a termination through this helpline. That will ensure women will be directed to medical practitioners who do not have a conscientious objection to termination of pregnancy.

Both the Bill and the existing medical guidelines make it clear that conscientious objection cannot be invoked when the risk to a pregnant woman's life or health is immediate. Any individual's right to conscientious objection is not absolute and obviously has to be balanced against the competing rights of a patient, particularly the right to life in the case of an emergency. I agree with Deputy Donnelly - I do not believe doctors or nurses have a difficulty in that regard.

I have also outlined what the duty is in non-emergency cases. There are some amendments tabled by Deputies Bríd Smith and Coppinger to this section which we discussed yesterday, perhaps by accident. They are focused on the definition of "as soon as may be" and my decision based on legal advice that it provides for a greater degree of urgency and immediacy than other phrases that laypeople such as those of us around the table might think are more urgent. The phrase "as soon as may be" attaches a significance to informing the patient as quickly as possible.

There is no need to make references to the Protected Disclosures Act 2014, as covered in one of the amendments. The right to conscientious objection is clearly set out in section 23 and does not require a reference to, nor interrupt the interaction of, the Protected Disclosures Act which is already on the Statute Book and will continue to operate independently of this legislation.