Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

That is something one learns very quickly in politics.

I welcome the opportunity to contribute to this debate and articulate my support for the Bill. This legislation is not about suicide, which I will address in detail in due course. Rather, it is about protecting women whose lives are threatened during pregnancy and assuring doctors that they can do their job without fear of prosecution. If I were asked two years ago whether I believed legislation on this issue was necessary, I would have offered my considered view that it was not and that the current legal position was safe. I might have pointed to the very low pregnancy mortality rates in this country - in many years the lowest in Europe - and that abortions only occurred in Ireland where they were medically necessary. In short, I would have made the case that if the system is not broken we should not seek to fix it.

Various events in the past two years have changed my view on the question of the necessity or otherwise of legislation. The first issue is our discovery that guidelines, circulars and other legal instruments which are not underpinned by legislation will often come unstuck. This occurred most recently in respect of the motorised transport grant and the mobility allowance scheme, where a decision issued by way of circular did not have a legislative underpinning. Likewise, in the case of the Children First guidelines, we have seen the necessity of providing a legislative basis. Going back further, we all know what happened with nursing home charges when they were not underpinned by legislation. The message has gone out again and again that Governments cannot rely on guidelines, circulars or policy documents in the absence of a legislative framework. It seems clear in the case of the issue we are discussing that guidelines or anything of that sort are not an alternative to legislation.

Another factor in changing my position on the need for legislation was the judgment of the European Court of Human Rights. "C" was a real woman who was recovering from cancer when she became pregnant and sought advice as to whether a termination was in her best interest. She could not get an answer to that question from the medical profession in Ireland. It went back and forth between ethics committees but nobody would give her an answer.

Events have occurred in the past two years that changed my view on the question of the necessity or otherwise of legislation on this issue. our experience in regard to guidelines and circulars and other legal instruments that are not underpinned by legislation subsequently coming unstuck. The most recent example is the motorised transport grant and mobility allowance which was based on a circular that had no legislative underpinning. We are now obliged to address the lack of legislative basis for the Children First guidelines. We know what happened in regard to nursing home charges when they were not supported by primary legislation. The message comes across again and again that Governments cannot rely on guidelines, circulars or policy documents which are not underpinned by legislation

Subsequently she had to go to the United Kingdom and have a surgical abortion at a later stage when she could perhaps have been told either that she did not need one at all or that she could have had it done as a medical abortion earlier on. That was not done because of the absence of a proper procedure to determine whether somebody's life was at risk and needed a termination. That is one of the reasons we have to change this situation. We also know from the testimony given by the Masters of the various maternity hospitals that 20 or 30 terminations occur in Ireland every year on medical grounds because they are necessary to save the life of the mother.

The Savita case changed things a lot for people in this country. The case was not handled well. There was a catalogue of errors and many things went wrong. This woman died of multi-organ failure secondary to septicaemia, secondary to a septic miscarriage. Everyone knows in medicine that when somebody is ill from an infection, the things one tries to do are, first, to treat with antibiotics but always to try to remove the source of the infection. The doctors in that case should have done so and should have done so early or, at the very least, should have had that conversation with the patient, but they did not. The patient and her husband requested a termination and were probably right in their diagnosis that a termination was necessary to save her life. Under this legislation what would happen at the very least? Under this legislation, if somebody requests a termination, a second obstetrician will be brought in to give an opinion and, at the very least, that second obstetrician might make the case go differently. Had this law been in effect at the time Savita Halappanavar might well have survived. The truth is that terminations are sometimes required to save the lives of pregnant women in cases of sepsis, cancer, PET, malignant hypertension and others and we need to ensure our laws provide for and facilitate this and to ensure there is no delay in performing such a procedure, where it is necessary.

Some people try to say this is not an abortion. They talk about it being "indirect" or "dual effect", the kind of things I have never seen in my medical textbooks. The reality is that the procedure is the exact same as it would be if it was a social abortion. It is interesting that many of the people who argued vociferously, with conviction and all the arguments behind them to support the view that these were not real abortions, no longer make that argument because it is not valid. I may not have been able to attend all of the hearings, as other Members did, but I am a qualified medical doctor; I have a degree and higher diploma in obstetrics and did study psychiatry at least as part of my degree. Therefore, I do know something about these areas, even though some may think they know better.

That is not where the concern arises in connection with the Bill. It arises, in particular, in connection with the provision on suicide. Many Members of the House are concerned that the provision might be misused, that psychiatrists and obstetricians might certify abortions where they are not necessary to save the life of a mother and that they may be afraid not to do so because if a case does arise where they do not sign off or certify a termination and the woman goes on to kill herself, they may be blamed. That is the other chilling effect. We have talked a lot in recent weeks about the chilling effect. Members are concerned that we may introduce a whole new form of chilling effect, whereby psychiatrists and obstetricians may sign off on a termination inappropriately for fear that they might get it wrong. That is the reality where medicine combines with the law.

I can certainly understand the genuine concerns of many Members about the suicide provision in the legislation. That, however, ignores the fact of where we are now and the current legal position, as a result of the deeply flawed 1983 amendment to the Constitution and the Supreme Court's interpretation thereof in the X case. The current law in Ireland is that even a psychologist, someone who is not a psychiatrist, who is not even a doctor, can certify that a termination is necessary to save the life of a suicidal woman in the State. Thankfully, that does not happen or, at least, we do not think it happens. That is the current legal position in Ireland. The Bill is much stricter. It is much stricter than the current situation. It requires two psychiatrists and an obstetrician to certify that an abortion is necessary. They certainly cannot do it on the basis of suicidal ideation or tendencies. It has to be suicidal intent. They can only do it if they are convinced that this is the only means by which the woman's life can be saved. If the woman's life is not saved, it is a certainty that the life of the unborn will go too.

This is not pro-life legislation. I am not going to pretend that it is, but it is certainly more pro-life than the existing legal position. There are Members in this House who are legitimately concerned that this provision will be misused. This provision and this legislation are much tighter than the status quo. If the status quois not being abused, why do these Members believe a law that is much tighter and stricter than the current legal position will be abused? Any law can be abused, but this law contains more safeguards than other laws and the existing legal position and on that basis it is much safer to legislate as we are doing than to allow the situation to continue as it is.

We must also consider the alternatives. This legislation will be tested in the courts which will decide on it either on the referral of the President or through a challenge to its constitutionality. Those who would not like to address the issue of suicide in the Bill must understand that can only be done by a third referendum on deleting self-destruction as a ground for abortion in the State. We have had two referendums on that issue. As is always the case in referendums, people vote all sorts of ways for all sorts of extraneous reasons, but they did vote "No" on two occasions in these referendums. I do not think it would be possible to ask people to vote a third time on that issue without asking other questions also, such as their view on allowing terminations on the grounds of rape, or alleged rape, or incest or the health of the mother or a foetus not compatible with life. People within and outside the House who are pro-life and who are calling for referendums should be careful what they wish for because they do not know, for example, exactly how big a Pandora's box they would open if this went back to a referendum. Public opinion has changed a lot and changed dramatically, even in the short number of years I have been in this House and that needs to be reflected in the strategies people put forward.

It is important to mention, too, that there are many very good colleagues in the Fine Gael Party who have deep concerns about this legislation. I would certainly not like to see my party lose anyone from its ranks over legislation that I do not believe will substantially change what is happening about abortion in Ireland. I do not believe this will open new floodgates or that huge numbers of terminations will occur on Irish soil that are not occurring already. I would really hate to lose colleagues on the basis of legislation that will be shown in two or three years time, when we face the next election, to have been safe and not to have been grounds to depart from a party which we all love. I appeal to people thinking of doing so to reflect on this and consider whether they really want to take a stand on legislation which will have been shown to be safe long before the next election takes place. We will know it is safe because for the first time we will have a reporting mechanism. We do not have this now. We know how many people have transmissible diseases, how many cases there are of certain infectious diseases because a doctor has to report them and fill in a form to do so. A good innovation and an advance the Minister has inserted in this legislation is a proper reporting procedure which I believe is very important as it will allow us to monitor where terminations are occurring and why. He has said he is willing to act should there be any unusual pattern or good reason to believe the legislation is being misused in any way. That is extremely important, too.

This is an emotive issue that is difficult for many people, but we need to reflect on it and be very careful not to repeat the mistakes made in the past, the biggest one being the 1983 amendment which was so flawed that it managed to offer a life to the unborn without defining "unborn" and to offer protections to pregnant women and the unborn but not to men or women who were not pregnant. In addition, it did not deal with the obvious conflict that was certain to arise when one gave an equal right to the unborn as to the pregnant woman because, as we all know, the unborn cannot survive without the mother.

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