Ms Maeve Taylor:

Ms Spillane and Dr. Henchion also wish to come in. I thank the Senator for her questions. She asked about the definition of foetal anomaly and the 28-day limit. Professor Keelin O'Donoghue and her colleagues would be the best people to talk about this. They have done some really important research on it. Regarding the review of provisions within the legislation, Deputy Colm Burke pointed out earlier that it is extremely odd that only one review of a decision about foetal anomaly had taken place and asked whether that was functioning. That is not unrelated to the definition and the ticking clock that we have repeatedly talked about.

Our director of counselling, Róisín Venables, who is in the Gallery, has spoken about the decision-making process of people who have received the diagnosis of foetal anomaly. The clock starts ticking. Doctors need to do scans to determine the diagnosis and to make a determination of whether a foetus is likely to survive more than 28 days. That is not at clear-cut diagnosis, and very often there are multiple serious anomalies. In some cases, women or couples have travelled to the UK and a doctor there has said that it fell within the definition of foetal anomaly. That is extremely difficult for people.

This point was made to the Oireachtas joint committee and the citizens' assembly many times. It is putting a bright line into law where clinicians are looking at a statute rather than following the normal professional guidance on how to treat a case. That determination must be made in line with the law rather than in consultation with a pregnant woman about her views because her views do not come into that determination. That is critical to the determination of risk in any other circumstances. The reason more people may not be looking for reviews under the law of decisions on the nature of a foetal anomaly is because the clock is ticking and they need to make a decision to travel to the UK for an earlier intervention rather than wait and potentially be told it will not happen here.

The WHO advocates for abortion on request for all the reasons we have heard. The law gets in the way of timely access. It gets in the way of good exercise of medical ethics, informed consent and clinical discretion. It stigmatises women. As Dr. Henchion said, there is no other procedure in respect of which the law gets discussed so much. It keeps abortion at the margins of healthcare in ways that are not good for health. It makes things more difficult for women and forces providers to police and be gatekeepers of the three-day waiting limit, to police and be gatekeepers of the gestation limit, to police and be gatekeepers of the definition of foetal anomaly and risk to health which is also very limiting and we see very few cases reported under that ground.

Having a criminal provision in the background simply makes it difficult and cumbersome. It creates added time burdens and added administrative burdens. It uses up healthcare resources on the part of the provider. It causes stress, anxiety, delay and stigma to women for no health benefit. It does nothing to change the picture of abortion access. We know this from all the previous discussions. When the law is in the picture it forces difficult decisions on women on where and how they will access abortion, not whether. It forces women into later abortions by waiting.

The WHO guidelines set out that the approach to law should not start with criminal sanctions and then work in enabling provisions, which is essentially what the Act does because it was based on the Protection of Life During Pregnancy Act, which was the enabling provision of the eighth amendment. We are using that model, which was published in March 2018, before the extent of the public support for repeal of the eighth amendment was made clear through the referendum. The WHO is advocating that laws should be based on principles of rights and access and they should place responsibilities on the State, which already exist. They should be reflecting the responsibilities that already exist on the State.

Deputy Hourigan mentioned that the UN Committee on Economic, Social and Cultural Rights had raised the issue of abortion in Ireland in its list of issues. There are obligations on the public sector in Irish law. There are obligations on healthcare providers according to their duty and their ethics. The WHO believes that the law should be enabling access and should be protecting access to the service. We need to protect the good elements which we mentioned in the opening statement of funding by the State for abortion and abortions on request without requirement to justify a decision, which are really important principles. The law should be like the laws in places like the state of Victoria in Australia, which has one of the model laws and which starts with rights-based provisions.

The law in Spain similarly starts with the rights-based provisions and then goes into the fact that the law is designed to enable access rather than to restrict and criminalise. That only causes harm, delay, stress and stigma.