David Stanton (Cork East, Fine Gael) | Oireachtas source

When I first began examining this issue, I was surprised and perturbed to learn that the X case, as defined by the Supreme Court, was the law of the land. This point was agreed by a number of eminent people during the recent hearings. Regardless of whether one agrees, it is the law of the land. As such, abortion on grounds of suicide is constitutionally possible. It is actually legal, as Bunreacht na hÉireann is the basic law of the land. My difficulty with the current situation is that there are no constraints, qualifications or regulations to control it.

I learned something else recently, although I stand to be corrected if I am wrong - no central records are being kept. We do not know what is happening. We do not know how many terminations are taking place in hospitals, what hospitals or clinics are carrying out abortions or under what circumstances these procedures occur. This is a dangerous situation in the context of the constitutional and legal position under the X case.

We could hold a referendum to change what Deputy Tóibín suggested was the "flawed" X case decision. We had two referendums. In both instances, the people decided to keep the suicide clause intact. We are still left with it.

People have mentioned the Whip system and so forth. I have been in the Oireachtas for 16 years and am of an age at which I may or may not stand for re-election. I do not know, as it is not an easy life. In any event, I have decided not to comment on this matter - I have been criticised for that decision - but to listen to and engage in debate with people. Most have been respectful, but certainly assertive. A small minority have gone beyond that, as colleagues on all sides have mentioned, and have been extraordinarily aggressive, insulting and hurtful.

If I felt strongly - maybe I might yet - that this Bill was wrong, I would vote against it, as the Minister knows. I have thought about it long and hard. I am still thinking about it. I held some meetings on the matter today. I keep coming back to the X case position and wondering whether we can allow it to stand in good conscience without putting some parameters and controls in place.

I have a number of questions about the legislation, but I note that few, if any, women present on grounds of suicide. Some eminent psychiatrists stated that they had not seen any such women in 40 years. Others argue that these women go across the Irish Sea, but I recently came across a research report of the International Symposium on Maternal Health that argued: "Not one Irish woman has had an abortion in the UK in order to save her life since 1992, new research from the Committee for Excellence in Maternal Healthcare (CEMH) has shown." The report goes on to state:

A response to a freedom of information request by the Committee to the British Department of Health shows that, between 1992 and 2010, no abortions were carried out on Irish women under section F of the UK Abortion Act, which requires records to be kept of abortions that were carried out to "save the life of the mother".

Further, the same data shows that no abortions were carried out on Irish women between 1992 and 2010 under Section G of the same Act, which requires records to be kept of abortions conducted to "prevent grave permanent injury to the physical or mental health of the pregnant woman".

It argues:

Irish women have known all along - they do not have to leave Ireland to seek abortions if their life is in danger. In fact, not one abortion has been carried out to save an Irish woman's life since the X case, despite the frequent and misleading claims of those who support the provision of induced abortion.

I am unsure as to whether this is true, but it is a strong statement. If it is accurate, such abortions do not actually occur.

Suicidal ideation has been mentioned, but it is a continuum, stretching from people with fleeting ideas of committing suicide to people who actually plan it. As a counsellor in a former life, I met people who had planned their suicides and had everything ready. When I asked doctors and general practitioners, GPs, what to do in such instances, they told me not to break eye contact with the people and to get them help as soon as possible, for example, get them into a secure unit if necessary or have them seen by psychiatrists, psychologists or both, people who could help, treat and support them. Sometimes, suicidal thoughts can be fleeting.

If a woman presents under this legislation, she must first engage with a psychiatrist, who must then make an assessment. A short time later - it is not specified in the Bill, but I would expect it to be on a different day or perhaps even a different week - she must engage with another psychiatrist for a second opinion. Both psychiatrists must share a reasonable opinion that the risk of her killing herself can only be averted by carrying out the medical procedure, that is, the abortion. The "only" is important, as it implies that other approaches and procedures can be carried out, for example, psychotherapy, the talking therapies, counselling, medication and hospitalisation. There is a range. In most instances, someone who presents with suicidal intent to psychiatrists will be offered these therapies first.

Some have stated that they have never encountered anyone who was suicidal because she was pregnant. It probably happens in very rare cases. Under this Bill, such women must meet two psychiatrists. That is not currently the case. If these women exist, they take the boat to England.

Much has been made of the English situation and the hundreds of thousands of abortions carried out there, but the English law differs from what is proposed in this Bill. The Abortion Act 1967, which has been widely cited as having opened the floodgates - it probably did - states:

Subject to the provisions of this section, a person shall not be guilty of an offence under the law relating to abortion when a is terminated by a if two registered medical practitioners are of the opinion, formed in --(a) that the pregnancy has not exceeded its twenty-fourth week and that the continuance of the pregnancy would involve , greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family.

That is extraordinarily wide and is completely different from what is being proposed here, which is extraordinarily restrictive.

It went on to say that

(b) The termination is necessary to prevent grave permanent injuries to the physical or mental health of the pregnant woman, or (c) that the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated, or (d) that there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.

That is the fatal foetal abnormality, but it does not exist in the legislation before us. We are therefore talking about an extraordinarily restrictive situation which, I feel, tightens up the current law and does not add anything to it. In fact, it makes the current law extraordinarily restrictive.

Much has been said about the role of the church in this. The church has a view and is entitled to it. It is expected to express that view, but I am a member of the Catholic Church as well. If, in conscience, I believe that the current law is wide open and this particular law we are bringing in is to tighten up and restrict the current situation - which can only be changed by another referendum, by the way - then I would like to quote from what Pope John Paul II said in Evangelium Vitae. He stated:

In the case of an intrinsically unjust law, such as a law permitting abortion or euthanasia, it is therefore never licit to obey it, or to "take part in a propaganda campaign in favour of such a law, or vote for it".

That is fair enough, but he went on to say:

A particular problem of conscience can arise in cases where a legislative vote would be decisive for the passage of a more restrictive law, aimed at limiting the number of authorized abortions, in place of a more permissive law already passed or ready to be voted on. Such cases are not infrequent. It is a fact that while in some parts of the world there continue to be campaigns to introduce laws favouring abortion, often supported by powerful international organizations, in other nations - particularly those whish have already experienced the bitter fruits of such permissive legislation - there are growing signs of a rethinking in this matter. [That is true]. In a case like the one just mentioned, when it is not possible to overturn or completely abrogate a pro-abortion law, an elected official, whose absolute personal opposition to procured abortions was well known, could licitly support proposals aimed at limiting the harmdone by such a law and at lessening its negative consequences at the level of general opinion and public morality. This does not in fact represent an illicit co-operation with an unjust law, but rather a legitimate and proper attempt to limit [what the Pope calls] its evil aspects.

We are in a situation currently where the Medical Council states that "Abortion is illegal in Ireland except where there is a real and substantial risk to the life, as distinct from the health, of the mother". Under current legal precedent this exemption includes where there is a clear and substantial risk to the life of the mother arising from the threat of suicide, so it is already in our law. It is already there in our basic constitutional law. We are putting parameters and controls on it. I stand to be corrected if I am wrong, but that is how I see it at this stage.

At the recent hearings, a representative of the College of Psychiatrists said that "suicide is very rare in pregnancy before birth, possibly as rare as one in 500,000 births". Suicidal thoughts and feelings are very much more common and the College of Psychiatrists' submission describes the importance of expert professional assessment and treatment of women in these circumstances. Suicide during pregnancy is, therefore, very rare.

I note that central records will be kept of any terminations on medical grounds. Sections 7 and 8 cite the medical grounds, including medical emergencies and illness. Some people have concerns about those as well but I do not because they are already there. I think we need to tighten up on the suicide issue in a big way.

I would have question marks about the time limits and other colleagues have already mentioned these. I am asking for that matter to be re-examined. Children are viable from 24 weeks, but what about 22 or 23 weeks, or 20 weeks? We should have a debate about that. Article 40.3.3^ostates:

The State acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right.

I would suggest what is happening there is that doctors will be under an obligation to do everything possible to save both lives all the time. That is the overriding issue here.

There is also the issue of false positives, which is quite a concern where suicide, or a suicide decision, is being examined. Quite often psychiatrists might err on the side of caution and may suggest that somebody might be suicidal when in fact they are not, just to be on the safe side. That comes back to what one does first. The first thing one does is to go for counselling, therapies, medication and hospitalisation. As a result of the X case, we have to let in the abortion one. I suggest, however, that because the numbers are so small, if somebody goes through all the other therapies and counselling, what happens at the end will be virtually zero. According to the international symposium on women's health, it does not happen in the UK at all.

Depression tends to come and go in episodes, which is something we must bear in mind. Somebody can be depressed and suicidal today and it might pass in a few days' time, so we must take that into account as well.

Capacity legislation is fast coming down the tracks and is due to be published. There has been mention of people who have a capacity issue to make decisions. It was formerly known as the mental capacity Bill, but will now be called the assisted decision-making Bill. That could have a bearing on this legislation also. Colleagues have cited minors, people with limited intellectual capacity and a limited capacity to make decisions. We need to have clarity around that area. The other Bill is coming down the tracks soon, but it would be useful if both Bills were dealt with together. Many of the instances that were cited involve minors and people in care. The question then arises as to whether they have the capacity to make a decision and the legal capacity which pertains in such a case. We should examine that aspect, so it would be useful if the assisted decision-making Bill was published soon.

I understand that at any stage a judicial review can be sought by a father or others close to the person involved. If I am wrong, however, I stand to be corrected.

Some colleagues have said that we should go to the people on this matter. If there was a referendum in the autumn it would take this House off the hook, but I understand that it is not to be. A decision will be made on it and it could possibly be challenged in the courts. I have no doubt that somebody will challenge the decision in the courts as to whether it is constitutional and the courts will decide on its constitutionality.

I have given a lot of thought to this matter and have treated it with great seriousness. Many people have made representations to me and colleagues in this House on this legislation, more so than any other piece of legislation that I have come across in my time here. As Mrs. Justice Catherine McGuinness said, the decision in the X case is the law of the land and it is necessary to introduce legislation around it.

There has been so much discussion and debate on the Bill that at this stage we are almost all punch drunk from it. Professor Patricia Casey said that "when a person indicates suicidal thoughts or makes threats, whether they are pregnant or not, it is crucial to evaluate these factors". Psychiatrists therefore have to evaluate and listen to what people say. They must also take account of whether what the person plans is lethal or not. This is very often done by interview and I understand that there are very few, or no, biological markers.

One issue of concern is that suicidal intent is not always associated with psychological or psychiatric illness, nor with a wish to die. People can be distressed for all kinds of other reasons, including inter-personal problems, poor coping skills, mental illness or being under the influence of drugs.

Professor Patricia Casey stated that not since 1995 had she seen a pregnant woman for whom abortion was the only or last treatment for suicide. Again and again, it is stated that it is an extraordinarily rare event. What we do not want in passing this legislation is to end up encouraging people to come forward pretending to be suicidal. People have said that suggestion is highly insulting to women. I agree. We must trust in our professional psychiatrists to be able to make a judgment. It is said that it is not possible to predict suicide. Approximately 600 people die by suicide in Ireland every year. The work of Pieta House and others is to be commended. We need to do so much more in this area. When abortion and suicide are linked, as in this instance, it is a serious issue.

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