Ruth Coppinger (Dublin West, Solidarity) | Oireachtas source

I took "transfer of care" to mean that one must tell the woman that another doctor in her locality - there is no point in referring a woman from Dublin up to Donegal or vice versa- will provide the termination and has the potential to cater for the woman the following day. I thought we would be talking about some kind of referral. The uninitiated among us would read "transfer of care" in that way, so the Minister must explain this. I wrestled with this issue and whether I would oppose conscientious objection completely. There is a case to be made as to whether it should be allowed at all because the way in which it operates in some countries is such that it prevents many people from accessing terminations. We cited examples in Italy, where a culture has been created in the medical community of doctors not participating. One can see how, with political and social cultural shift in a different direction, this could start to happen here.

How onerous is it for a doctor to write a prescription? One could surely argue that it is still up to the woman and that the doctor is not actually participating in the abortion. He or she is giving that choice, that freedom of conscience, to the woman in the situation. I ask the committee to look at it that way. One would think doctors were actively being forced to carry out abortions, which none of us agree should be the case. One is still giving the person affected by the decision that freedom of conscience but one is not carrying out the procedure oneself. All I am hearing about is doctors and nurses. I agree with Deputy Bríd Smith that the majority of doctors will participate in this. Surveys given to the Committee on the Eighth Amendment of the Constitution showed that the majority of doctors, like the rest of the population, were in favour of such provision. I will also be balanced, however. Doctors did not do enough in this country in recent years to actively move the situation forward. Even Professor Arulkumaran said after the inquiry into Savita's death that he was surprised doctors did not do a little more in the intervening years. Be that as it may, doctors are now actively taking part.

I wish to mention some specifics. Some of the amendments basically imply that this should be broadened to all healthcare workers. I myself worked in the healthcare system. If it is broadened, are the Deputies who have tabled these amendments saying a clerical officer could refuse to write a letter of referral for someone or refuse to physically hand a woman a list of doctors in her area? This seems to be what is advocated in these amendments. Not alone that, but what if a receptionist in the surgery has a conscientious objection? There is all sorts of potential here for the matter to be broadened.

The institutions are another matter. I agree that amendment No. 162 should be adopted. We probably should explicitly write this into law and it would be good to do so because there is a serious question mark over it. No one knows what will happen with the national maternity hospital. I would like the Minister to make it clear that he will not accept institutions conscientiously objecting.

Another matter that has come up recently and on which I would like the Minister to give a commitment is the question of an opt-in system. I have been contacted by doctors who are abortion providers in other countries. They have asked me to ensure that such a system is not introduced here because having a list of abortion providers could potentially put certain doctors at risk of attack. We should not be naive. There are people who actively oppose this law and we know they pick on clinics. We know that where they have done so in other countries, doctors and healthcare providers have been attacked and killed. We know they are guilting and shaming women going into abortion clinics in Liverpool today. If we are to have an opt-out system, it must have a limit such that the doctor must ensure that the woman is looked after. Furthermore, we should not have an opt-in system or a list of doctors. I am also worried about this 24-hour helpline, and I mean this for the protection of doctors and staff who work in surgeries too. We do not have an opt-in system for the provision of diabetes services or other healthcare. We should not stigmatise abortion if we can in any way avoid doing so and we should ensure that doctors are protected.

I think there will be enough doctors to provide this service. I will put this in context because I think it was Deputy Fitzpatrick who raised the question of how the healthcare service will cope. We do not know the exact figures, but let us say there will potentially be 5,000 or 6,000 abortions per year, adding up the people who travel and those who order the abortion pill online. We do not know the exact figure for the latter but we have some idea from the two main providers. The current number of doctors will be able to cope, particularly because much of the service, probably up to 80%, would be medical abortion, which simply requires a prescription. I am all for protecting doctors' and other people's rights, but at the same time we must ensure that women, particularly those in rural areas or areas where there are not many doctors, are not left behind.

I wish to raise one last scenario. We had a case two years ago in which a psychiatrist sectioned a teenager who was suicidal and was seeking an abortion. We never heard what happened but this came out in an article in The Irish Timesa year later. Doctors who oppose this legislation have a lot of power to frustrate it, so it is important we write into it the limitations of conscientious objection.