Billy Timmins (Wicklow, Fine Gael) | Oireachtas source

I cannot support this Bill as it requires me, as per sections 9 and 22(4) to legalise the intentional destruction of unborn human life where there is a real and substantive risk of loss of a woman's life by way of suicide. In other words, if a woman is in such a difficult place that she is contemplating suicide as a result of her pregnancy, this Bill will legalise the direct and intentional killing of the unborn child. This is in spite of the fact that almost 100% of medical practitioners have given evidence that abortion is not a treatment for suicide and, in so far as it can be established, it is more likely to cause long-term damage to the woman and certain death to the unborn. If these sections are removed I have no difficulty in supporting the remainder of the Bill, and I hope the Minister will remove them or give a commitment to remove them in the next few days.

Some Members have spoken about the vitriolic material they have received. We all received this. It is inexcusable. It happens on several issues. Some members of the public are angry at what they see as a break in trust as many Deputies and Senators gave commitments and played on the beliefs and fears of the people. In so far as I can establish, I did not send out any letters at election time or issue press releases in support of any pressure groups on this issue and I am not aligned to any pressure group.

However, the most worrying material I have received is that which has come from certain medical professionals who, with a few rare exceptions, are totally opposed to legislating for the threat of suicide as a grounds for abortion. I have all the material to hand, to which very few Members have referred. We heard from 11 psychiatrists on 13 December; 120 psychiatrists in a petition, some representatives of whom came into the Chamber to inform Members; 12 gynaecologists on 9 December and only yesterday from 39 GPs from Cork and Kerry. That is what worries me, not the material that threatens me and dooms me to hell or otherwise, but material from the medical professionals who are the people who will have to implement this legislation and who, almost to a man and a woman, are totally opposed to section 9 of the Bill.

I have heard many fine speeches in the Oireachtas on the issue of human rights since I was first elected to this House. While in the Army, I served with the United Nations in Lebanon and saw at first-hand how important and difficult it was to defend human rights. Many Irish people lost their lives in doing so. Speeches come easily, but deeds are a little harder. This legislation is primarily about human rights because it proposes to violate the most basic human right, namely, the right to life, of the most vulnerable section of our society, unborn citizens. Whether one is a Catholic, Hindu, an atheist or Jewish, the core issue is the same. If the Bill was run through a computer programme, it would fail to pass. It is built on sand and history will show that to be the case.

There are many similarities between the approach the House and the public are taking to this legislation and to the bank guarantee and the economic boom. There seems to be broad support from the media and those with a different view are painted as being out of step or having an ill-founded basis for opposition. The collapse of the economy and recent revelations on the bank guarantee clearly show how ill served the public was by the herd mentality, but we learned nothing. I will rehearse what the mainstream media had to say in late 2008 about the economic boom and the banking crisis. An editorial in the Irish Examineron 1 October 2008 headed "€400bn bailout - A welcome and decisive move" stated: "It was a brave positive move, the government has acted on a national scale with the financial future of all of us in mind". On the same day the Irish Independentstated: "Lenihan's masterstroke has bought us time to sort out our own problems ... Finance Minister Brian Lenihan has made a wise choice". The Irish Timescautioned, however: "While Taoiseach Brian Cowen and Minister For Finance Brian Lenihan are being commended for their leadership and the template of the solution provided, the devil, as always, will be in the detail".

Dealing with serious social issues during economic difficulties is not good practice. I propose to break my contribution on the strangely named Protection of Life During Pregnancy Bill 2013 into two parts. First, I will speak about the Bill and its flaws and, second, discuss the process of the policy decision.

The core of the Bill is section 9 and the risk to life of the pregnant woman from suicide. In seeking to understand and deal with the Bill I attended the Oireachtas hearings in January and May and met many groups and individuals inside and outside the Oireachtas. I respect all of the views held on this most emotive of issues and many of those to whom I have spoken have experienced great tragedy and suffering. However, it is clear from reading the Bill that for the first time an Irish Government is proposing to introduce a law that provides for the direct and intentional targeting of the life of the unborn child. This is clear from sections 9 and 22.

I acknowledge the time and effort all of the witnesses who attended the Oireachtas hearings put into their contributions. Some have received more coverage than others. One of the witnesses at the January hearings who strongly supported the legislation spoke about saving women's lives and sought reassurance that she and her colleagues would not go to jail. I am confident that everyone in the House would support any measure to address such concerns. However, the following correspondence was subsequently sent to the Chairman of the Joint Committee on Health and Children:

Dear Mr Buttimer,

I would be grateful if you could present the enclosed statement to your committee tomorrow, Thursday. It goes as follows:"We the undersigned obstetrician/gynaecologists see no obstetrical advantage in changing the current law on abortion.

We are concerned that legal intervention could interfere with Irish obstetricians being able to treat pregnant women to the best of their ability."

The letter was signed by Dr. James Clinch from Dublin, Dr. John Monaghan from Ballinasloe, Dr Michel Brassil from Ballinsloe, Dr Eileen Reilly from Galway, Professor Michael Foley from Dublin, Dr. Eamon McGuinness from Dublin, Dr Trevor Hayes from Kilkenny, Professor Dermot MacDonald from Dublin, Professor Michael Foley from Dublin, Dr. Hugh O'Connor from Dublin, Dr Naveed Kwaja from Ballinsloe and Professor Colm O'Herlihy from Dublin. Prior to the hearing in May, I contacted one of the signatories of the letter who did not give evidence and he expressed the view that the legislation would not clarify the matter because the medical practitioner would ultimately have to make a clinical judgment call. I ask the Minister to show me where in the legislation are women's lives saved.

I am happy to support the Bill, with the exception of section 9. I have received countless representations from members of the medical profession on the provision on suicide and section 9 and who have been almost unanimously opposed to this measure. One of the more profound examples was the evidence presented by Dr. Sam Coulter-Smith, the Master of the Rotunda. I will rehearse his submission in the hope commentators will read it before making glib comments in the media. I ask them to deal with the issues he raised rather than accusing me and others who hold similar views of ulterior motives. He stated:

My name is Dr. Sam Coulter-Smith. I am master of the Rotunda Hospital in Dublin. My submission to the committee today is based on my views and the views of my consultant colleagues at the Rotunda Hospital following consideration of the draft heads of the Bill ... In respect of loss of life from self-destruction there are a number of issues that need to be raised. First, this is an extraordinarily rare situation with the incidence of suicide in pregnancy of the order of one in 500,000 pregnancies as per United Kingdom figures. Second, our psychiatric colleagues tell us that there is currently no available evidence to show that termination of pregnancy is a treatment for suicidal ideation or intent and, as obstetricians, we are required to provide and practice evidence-based treatment ... It, therefore, creates an ethical dilemma for any obstetrician who has requested to perform a termination of pregnancy for the treatment of someone with either suicidal ideation or intent. Third, this legislation, I am sure, is designed to create clarity and reassurance for both health professionals and patients alike.

The fact that there is no gestational limit in respect of the third scenario relating to suicidality is a major ethical issue for obstetricians. I will illustrate this with two scenarios. First, let us consider the case of a patient who is 25 weeks' gestation. If she is deemed to be sufficiently suicidal to require a termination of pregnancy by one or more psychiatric colleagues, an obstetrician who is tasked with dealing with this situation is faced with an enormous ethical dilemma. Delivering a baby at 25 weeks' gestation could lead to death, due to extreme prematurity or it could lead to a child with cerebral palsy or with other significant developmental issues for the future. This outcome would be entirely iatrogenic and the responsibility of those clinicians who have agreed to be involved in the process. This is a source of serious concern for myself and my colleagues.

Another clinical scenario which provides a difficult ethical dilemma is a situation whereby at a woman's 20 week anatomy scan a significant but non-lethal malformation is discovered. The patient, for a variety of reasons, may decide that she cannot continue with the pregnancy and it is causing her significant mental health issues with risk of suicide. The obstetrician is left in the unenviable position of, by law, having to look after the best interests of the baby but also the understanding of the mother's issues. It would, therefore, seem appropriate in a case where there is a risk of self-destruction that there is no gestational limit applied in this situation as this creates a major ethical dilemma for us.

My overriding concern, however, in relation to the whole area of self-destruction and termination of pregnancy to prevent same, relates to the lack of evidence to show that termination is of any assistance in this scenario and that we as obstetricians and gynaecologists must be able to stand over the decisions we make as being based on good medical evidence.

In relation to the infrastructure and resources it is my view, and that of many of my colleagues, that the inclusion of suicidality within the legislation may, and I stress may, in the long term lead to an increased demand for termination in this country. We currently do not have any real understanding of how big that demand may be. Currently in excess of 5,000 women a year go from Ireland to the UK to have termination procedures performed. We cannot be certain how many of these women would decide to use this current legislation as a means of obtaining a termination in this country and even if unsuccessful in obtaining a termination in this country, a huge amount of time and resources will be spent on the assessment of these patients ... In conclusion, I welcome this draft legislation, particularly in the area of real and substantial risk to the life of the mother which pertains to physical illness. I think, however, that there are significant concerns in all areas of the medical profession in relation to this Bill when it comes to suicidality. Our overriding concern relates to the lack of evidence to show that termination of pregnancy is an appropriate treatment for women who are deemed to be at risk of suicide. As obstetricians we are expected to practise evidence-based interventions and first and foremost to do no harm. This legislation should help in providing clarity and reassurance to professionals and patients alike. To enact and underpin the idea that termination of pregnancy is a solution or a treatment for a patient at risk of committing suicide when there is no evidence to support that intervention creates an ethical dilemma for our profession.

To make matters a little more difficult there is no gestational limit mentioned in the draft at which this termination might happen. This opens the possibility for iatrogenic prematurity with all the risks of infant morbidity and mortality. Who will be responsible for these interventions? I also confirm to the committee that we as a profession, and particularly in my hospital, have concerns about the potential for increased demand for termination services in this country as this may be an unintended consequence of this legislation in its current form.

Those remarks were made by Dr. Sam Coulter-Smith, who is the master of the Rotunda Hospital, rather than by Deputy Billy Timmins or any spokesperson for a pro-life group. I hope the Minister can address those concerns. I did not hear them addressed at the close of the hearings.

I have listened to some speakers who have questioned the suggestion that "abortion is not a treatment for suicide" and expressed weariness at its continuous use. Surely this is the issue at stake. By allowing abortion upon a threat of suicide, the Government would be legislating for a treatment that is not evidence-based. It is impossible to predict suicide accurately. Abortion exposes some women to mental health issues. Section 9 of this proposed legislation will potentially put women's lives at risk. If this section was not in the Bill, I would happily support the remainder of the legislation. I will do so if the Minister removes this section on Committee Stage or Report Stage. International experience has shown that the inclusion of such a measure results in a liberal abortion regime. It is difficult to understand the nuances of this issue, particularly when one hears two psychiatrists arguing from different sides. However, there is widespread opposition from psychiatrists to the inclusion of suicide as a ground for abortion. Professor Kevin Malone stated in his submission to the Joint Committee on Health and Children: "By foregrounding a theoretical risk of suicide in women, and enshrining "suicidality" in Irish law, the proposed legislation runs the risk of further invisibilizing, normalizing, and at worst exacerbating the much more real and volatile threat of increased suicide risk in Irish men, and potentially accelerating suicide risk in young women also." Ms Sunniva McDonagh SC said: "I want to mention what was decided in the X case because we cannot leave out of the picture the fact that the Supreme Court formulated the test without the benefit of medical evidence or best psychiatric practice". Dr. John Sheehan, who is a consultant psychiatrist at the Mater Hospital, said "[T]here is no evidence base to indicate that abortion prevents suicide". Professor Malone, who is a consultant psychiatrist at St. Vincent's Hospital, has said "I wonder how [abortion] can overnight become a recommended psychiatric treatment in Ireland".

In their submission to the Joint Committee on Health and Children, three Irish perinatal psychiatrists with over 40 years of combined clinical experience said they had not seen a single case in which termination of pregnancy was the treatment for a mental disorder. However, since 1992, the HSE has assisted six minors who were in State care in travelling abroad for abortions on the grounds of suicide. A psychiatrist was involved on each occasion. How can this conflict be resolved? As many other speakers have said, the judgment of the European Court of Human Rights in the case of A, B and C v. Ireland does not require Ireland to legislate for abortion. It merely requires us to clarify what the law is. Equally, there is no constitutional duty to legislate for the Supreme Court decision. The judgment in the X case, with respect to the permissibility of abortion as a treatment for suicidality, is not a formally binding precedent. It is not binding because the issue was conceded without argument and therefore does not form part of a binding precedent. At the hearings, Mr. Paul Brady, who is a barrister, and Dr. Maria Cahill of the UCC faculty of law quoted Mr. Justice McCarthy and Mr. Justice Brian Walsh in support of this argument. Mr. Brady said:

It is well established that neither a constitutional provision nor even a statutory provision can be construed on the basis of a concession if it were to be binding in rem. It is unfortunate that .... legislators should feel under some strait-jacketed legal obligation to bind themselves to what was a concession in that decision.

I believe the legislation before the House may be unconstitutional. Contrary to what many commentators have said, a commitment to legislate for the X case was not in the programme for Government. I ask them to read what the programme for Government says. I have grave reservations about the whole process. I made reference to this in earlier speeches and at the committee hearings. The media has shown little interest in examining the detail. It was clear from the expert opinion presented at the hearings and the correspondence from medical practitioners that legalisation of the threat of suicide as a ground for abortion does not save women's lives. The hands of the expert group were tied, in contrast to the commitment in the programme for Government, which states:

We acknowledge the recent ruling of the European Court of Human Rights subsequent to the established ruling of the Irish Supreme Court on the X-case. We will establish an expert group to address this issue, drawing on appropriate medical and legal expertise with a view to making recommendations to Government on how this matter should be properly addressed.

Some nominations from professional bodies to the expert group were not chosen. Why was this? How were the eventual members selected? While this is very much a secondary issue, it is important nonetheless.

The laws we enact influence our culture and our behaviour. Ireland does not have a culture of abortion. I believe this legislation will change that. The message I received when I spoke to the members of the Women Hurt group was very clear. It resonated with me more than most of the submissions I receive. They referred to the pain and suffering they experienced after they had had abortions. They described their negative experiences and how they felt afterwards. Women from different countries and cultures have this - the mental health consequences of having had an abortion - in common. As women who have been hurt by abortion, they fear this legislation will give rise to a social acceptance of it. Many friends and colleagues who hold sincere and genuine beliefs will support this Bill, but I cannot do so. I have spent many months meeting groups and individuals and reflecting on their views. I disagree with some of them, but I accept that they are all genuine. If there was an easy solution to this problem, it would have been resolved some time ago. While this legislation may pass, I do not think it will address our problems - instead, it will increase them. I remind the House that Norma McCorvey, who was central to the 1973 Roe v. Wade case in the US, sought a judicial review of the decision in her case many years afterwards.

Voting against this legislation will result in my losing the Fine Gael Whip. I deeply regret this. I and other family members have served Fine Gael at local and national representative level for a total of over 100 years. I have knowledge of what is the Fine Gael ethos. When this law is enacted, it will not sit lightly with it. The way this issue has been presented to the public can best be reflected in the following words:

"How we Learn"

Great truths are dearly bought. The common truth,

Such as men give and take from day to day,

Comes in the common walk of easy life,

Blown by the careless wind across our way.


Great truths are greatly won. Not found by chance,

Nor wafted on the breath of summer-dream;

But grasped in the great struggle of the soul,

Hard-buffeting with adverse wind and stream.


Not in the general mart, 'mid corn and wine;

Not in the merchandise of gold and gems;

Not in the world's gay hall of midnight mirth:

Nor 'mid the blaze of regal diadems;


Wrung from the troubled spirit in hard hours

Of weakness, solitude, perchance of pain,

Truth springs, like harvest, from the well-ploughed field,

And the soul feels it has not wept in vain.

I will conclude by giving another example of the many concerns that have been raised with me. Dr. Bernard Nathanson, who was one of the foremost pro-abortion activists in the US, admitted in his 1996 autobiography that he had "helped usher in this barbaric age". He described the four steps that are usually followed by those who want to liberalise abortion law. First, they find a hard case, even if it is not fully relevant. Second, they create fear, doubt and confusion and even grossly exaggerate or lie about the facts. Third, they find a convenient pro-life group that is easy to hate and demonise or scapegoat it. Fourth, they legalise abortion on mental health or suicide grounds. Does this sound familiar to the House? I will conclude by reiterating that I would be happy to support this Bill if section 9 were removed. I remind the House that the questions raised by Dr. Sam Coulter-Smith, rather than by me, have not yet been answered.

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