Billy Kelleher (Cork North Central, Fianna Fail)

I thank the Minister for his reply. The Minister, as a medical practitioner, will have dealt with these sensitive issues on a confidential basis. As a lay person, however, when I met survivors of symphysiotomy in the AV room last evening I was very disturbed by their sad stories, as were many other Members. Their stories were emotive, disturbing and upsetting for non-medical people. Anyone who was present last night must acknowledge that deep hurt and pain has been borne by these women for many years with great grace. They simply got on with their lives and suffered urinary tract infections, bowel difficulties, difficulty in walking and psychological difficulties as a result of this procedure.

I am not here to be judge or jury or to apportion innocence of guilt, but I have the capacity to know what is right and what is wrong. The issue of whether or not medical practice at the time was in support of symphysiotomy on some occasions could be debated for evermore. Some medical practitioners will go to their graves stating that the practice was carried out for the right reasons at the time. Equally, the women on whom the procedure was carried out say it was often done for the wrong reasons. They told me last night that there was an undercurrent of religious ethos in medical practice and that use of the procedure was concentrated in some areas of the country, in certain hospitals and among some individuals

Given what we heard last night and what the Minister and Members of the House are aware of, we owe it to the women to have a full and frank discussion on this matter. The report will be published in the near future, and I look forward to its being discussed. This will not be an end in itself, however. While we can continue to provide care and support, the women and their families believe they were wronged. I too believe they were wronged. This is not simply because they suffered a medical practice that was accepted at the time but because alternatives were available and were being practised in hospitals in the same vicinity. Across Europe Caesarian section was used in preference to symphysiotomy.

For all those reasons, we owe it to these women to have a discussion on foot of the report. I hope it can be published as soon as possible. I say this because many of the women concerned are in the latter stages of their lives. The way they spoke last night indicated the urgency of this matter. I was shattered last night when I left the AV room. I compliment Deputy Ó Caoláin for pursuing this issue vigorously and in an all-party and non-partisan way.

We should publish the report quickly. It should not sit around. Let us have a genuine discussion, in parliament and in society, and see how we can formally make redress to the women who feel so aggrieved and are in such distress. While the report will document the number of symphysiotomies carried out from 1940 to the present and will contain other detail, the real issue is the higher incidence of the procedure in some hospitals and by some individuals. Was this because some doctors genuinely believed it was the only possible medical intervention or were there other reasons? This is an important factor. People told me last night that symphysiotomy was used because the view at the time was that one could have only a limited number of Caesarian sections, in which case family planning would have to be discussed. A woman who had a number of Caesarian sections would have to use birth control to avoid a further pregnancy. I do not know if that is the case but it is what was said to me last night in the AV room.

Let us consider what has happened in the lifetime of these women and what we have today. While we argue across the floor of this House about hospital waiting lists, lack of services and people on trolleys in accident and emergency departments, we can be very proud of our maternity services, our infant mortality rates and levels of care in gynaecology, obstetrics and paediatrics. We can be proud of what we have achieved and that we provide the best care to women during pregnancy and birth and to mothers and children. However, the issue we are discussing this morning is not something we can be proud of.

The Minister acknowledged the distress of these women and that they deserve whatever we can do for them. There are individual care packages. They can access medical cards, if requested. Physiotherapy and other supports are available. Some of the women tell me that does not always happen. The decision was made some years ago that it would happen. If it is not happening, the Minister should make sure the women get what they are entitled to under agreements made previously.

However, that is not enough. The women deserve an acknowledgment of what was carried out. I am not here to apportion guilt or innocence. I vehemently opposed the referendum to establish committees of inquiry in the Oireachtas. I do not have the competence or skill set to apportion guilt or innocence but I have the ability, as a person and as a parliamentarian, to say what I feel is right or wrong. It is right that these women deserve an apology. They deserve all the supports possible and they certainly deserve a full investigation - which this report may provide - of the reason this procedure was carried out more frequently over and above all the various comparable medical statistics in other hospitals in Ireland and across western Europe.

I have acknowledged Deputy Ó Caoláin's deep, profound commitment and interest in this issue and there has been no partisan party political attitude to this issue from any side. I hope the report can be published soon as this would allow it to be discussed in committee or in another plenary session. As was discussed with regard to the Bill on the blood clotting factor, people aggrieved by their treatment by the State deserve to be involved in all aspects of the decision-making process, either as individuals or collectively.

Once the report is published we need to move quickly because some of these procedures were carried out a long time ago and some of the women who spoke to me last night are now in their early 80s. They described openly the impact of this procedure on their lives, and on the lives of their families and their siblings. It was a very harrowing story of distress. Most of these women just got on with their lives, rearing their families and working in very difficult times in the 1940s, 1950s and 1960s. For all those reasons, they deserve whatever we can do for them.

The Institute of Obstetricians and Gynaecologists is concerned about any revisionism in the context of health practices and procedures, medical technology and medicines of the time. I accept that the practices of the past cannot be fairly compared with modern practices and we should not judge people who applied the standards of the time by the standards of our time. However, it is a fact that the incidence of symphysiotomy was higher in some areas and in some hospitals and I cannot understand why this was the case until the early 1980s. I cannot understand why there was not some form of peer review of practice which might, at least, have sounded the alarm.

We must make every effort to support the victims and survivors of symphysiotomy with regard to their medical needs and with emotional and psychological issues which need to be addressed as such distress can never be fully assessed but the women should be entitled to support.

Some of the women were concerned by what the Minister said but today's statement is more measured. This is not intended as a criticism but rather I am a lay person and I do not have expertise in that area. However, it is important that this report is seen to be a completely all-party report. I hope consensus can be achieved in this regard and I will be fair and reasonable in my response because the people who are in the Gallery are those who deserve a fair and reasonable response. I remember also those who were unable to attend today because of the difficulties associated with their age profile.

I ask the Minister to consider how the women affected can be best helped in a practical way so that they will all receive the full care and attention to which they are entitled and this is an all-party policy. I ask the Minister to give priority to the publication of the report because some people cannot wait and nobody deserves to wait to hear about this very difficult and sad episode. The country has wonderful health facilities with caring and attentive staff who are dedicated to the care of their patients. I would not want this emotive issue to diminish the confidence of mothers with regard to maternity facilities. I urge the Minister to bring this difficult episode to a conclusion as speedily as possible.

See this speech in context