Enda Kenny (Mayo, Fine Gael) | Oireachtas source

I acknowledge the sensitivity of the issue we are debating and thank colleagues for the generally respectful tone of the debate to date. The purpose of the Bill before the House is the protection and preservation of life - the lives of women and the lives of their unborn children - and the provision of certainty to medical personnel. This legislation is important but it is not radical. It will regulate existing constitutional rights but will not create any new rights. It will not lead to the introduction of abortion on demand in Ireland but it will clarify the very rare circumstances in which doctors can intervene where there is a real risk of a woman losing her life during her pregnancy.

As Members will recall, in late 2010 the European Court of Human Rights in its judgment in A, B and C v. Ireland required this country to provide legal clarity to women on the circumstances in which they are entitled to a medical termination of pregnancy where there is a real and substantial risk to her life which can only be averted by termination of pregnancy. This entitlement was determined by the Supreme Court in 1992 in its judgment in the X case. It is a constitutional right, but one which has existed since then in a completely unregulated way.

As stated in the programme for Government, an expert group was established to examine the judgment and set out the options for addressing it. The group undertook very detailed work and presented its report to the Government in November last year. It is crystal clear from the report the only realistic way of achieving the necessary legal clarity is through primary legislation backed up by regulations, and the Government decided last December to implement this option. Given the sensitivity and complexity of the issues raised by this decision, the expert group report and the draft heads of the Bill were referred to the Oireachtas Joint Committee on Health and Children for oral hearings involving medical and legal experts and advocacy groups. I thank the Chairman of the committee, Deputy Buttimer, and the committee members for the manner in which they carried out this very important work which has greatly contributed to the preparation of the legislation being debated in the House.

The Bill is underpinned by a number of important principles which I will outline. It provides legal clarity by way of legislation and regulation on the circumstances where a medical termination is permissible where there is a real and substantial risk to the life as opposed to the health of a woman. The legislation is strictly within the parameters of the Constitution and the Supreme Court judgment in the X case. It will cover existing constitutional rights only and will not create any new rights. The equal right to life of the unborn will be upheld and the obligation on the medical profession to save both lives where possible will be confirmed. Medical termination of pregnancy can only be legally permitted in situations where all doctors involved in the assessment process have jointly and unanimously certified it is the only treatment which will save the woman's life by averting the real and substantial risk to it. The subjective nature of the assessment of suicide risk means the legislation provides for a demonstrably more rigorous process of assessment in such cases. The Bill before the House is consistent with these principles.

The general prohibition on abortion in Ireland is restated and severe penalties will apply to any person or body responsible for the unlawful termination of unborn life. Processes are set out to establish the circumstances in which there is a real and substantial risk to the life as distinct from the health of a woman and where the only treatment which will avert this risk is the termination of her pregnancy. In the case of a medical emergency where the risk to the woman's life is immediate, one doctor may make the decision. In such emergencies the doctor involved will be required to certify the reasons for his or her actions within 72 hours. In the case of a real and substantial risk to the woman's life arising from a physical health condition, the assessment process will require the obstetrician and gynaecologist and a second relevant specialist to jointly agree and certify that the termination of pregnancy is the only treatment which will save the mother's life. Where feasible, the woman's general practitioner will be consulted.

In the case of real and substantial risk to woman's life arising from self-destruction, additional safeguards will be put in place. The assessment process will involve three specialists, one obstetrician and gynaecologist and two psychiatrists, who must jointly and unanimously agree and certify that the termination of pregnancy is the only treatment which will save the mother's life. In such cases also, the woman's general practitioner will be consulted. A new requirement has been included that at least one of the psychiatrists involved must have direct experience of providing mental health services to women with regard to pregnancy, childbirth or post partum care.

In all cases, other than emergencies, medical termination of pregnancy, where legally permitted, can only be carried out in public hospitals with obstetric units and mental health services. Only doctors registered on the specialist division of the register of medical practitioners of the Medical Council can be part of these processes. As a person's GP often has the best knowledge of medical history, he or she will be consulted during the process wherever possible. In cases where the assessing doctors jointly and unanimously certify a termination of pregnancy is permissible, it will be a decision of the woman concerned whether such a termination should proceed. In cases where any of the assessing doctors decide not to certify that a medical termination is permissible, the woman will be entitled to a review of the decision and the composition of the review panel will mirror that of the original assessment. The decision of the review panel must be unanimous before an intervention is permissible.

Reporting and monitoring requirements will be put in place to ensure the availability of full and transparent information about the number and nature of medical terminations. All procedures must be notified to the Minister within 28 days. An annual report will be published which will detail the number, nature and location of any terminations which have been certified. The Minister for Health will also be given powers to suspend a service in any hospital if he or she believes the provisions of the Bill are not properly adhered to. This is an important safeguard which has been added to the Bill since the committee hearings.

I will refer to a number of matters raised in respect of the Bill. Some have argued the Government is not obliged to legislate within the parameters of Article 40.3.3° of the Constitution as interpreted by the Supreme Court in the X case. Let us be very clear on this point. As Head of the Government and one who is privileged to be Taoiseach, I am bound to comply with the Constitution of the country. I do not have the luxury of being able to pick and choose which constitutional rights I will comply with. It has also been claimed the Bill will open the floodgates to abortion on demand. I utterly refute this assertion. What is being provided for in the Bill is a very restrictive process which can only be applied to very rare life-threatening situations. This country, as people are well aware, is one of the safest countries in the world for childbirth and will continue to be so.

In recent years, considerable resources have been devoted to supporting women who find themselves in crisis pregnancy situations. This has resulted in a significant reduction in the number of Irish women opting to travel to Britain for abortions, and it is imperative we continue to support women in these very difficult situations. I support this work very strongly. Others have suggested the provisions of the Bill which deal with the risk to a woman's life from suicidal intent should be deleted. This is not possible and would, in my view, be counter-productive. Regardless of whether people agree with it, the constitutional rights on these grounds already exist. The Constitution confers on the women of this country the right to a termination in very specific and particular circumstances. It is not open to me to deny this right exists. I cannot unpick the decisions of the Supreme Court. It is a matter on which the people have adjudicated twice.

If this Bill were to ignore that reality, if one was to say that that right did not exist, it would still exist within the meaning of the phrase "substantial risk to the life of the mother" in a completely unregulated fashion. Therefore, legislation that would attempt to deny that would in itself be unconstitutional, as determined by what the Constitution actually means.

What we are creating in the Bill is a rigorous process around the issue of suicidal intent that will ensure that a termination of pregnancy on these grounds can only happen in the very rare case where two psychiatrists and an obstetrician have jointly agreed that it is the only intervention that will save the woman's life. In practice, this will mean that the certifying specialists will have to satisfy themselves that all alternative treatments have been either attempted or ruled out.

In including this provision, the Government is not in any way validating or endorsing abortion as a treatment for suicide. We are simply recognising the reality that this right already exists and putting in place a process to prevent this right being abused. This process and these safeguards are far preferable, I believe, to leaving a totally unregulated right in existence that might be open to abuse.

Some people have claimed that the Bill will facilitate late-term abortions and asked for a limit to be applied to when a medical termination of a pregnancy can be allowed in order to save the life of a woman. This is not correct. This Bill will clarify the circumstances in which a woman may have the right to have her pregnancy terminated where that is the only intervention that will save her life. However, it will not confer on a woman any right to insist that the life of her unborn child be deliberately ended. On the contrary, the constitutional obligation on doctors, which is reiterated clearly in the Bill, to save both lives where possible will mean that, in practice, the ending of a pregnancy where the foetus is viable will actually be the birth of a child. The doctor has two patients in these cases, the mother and the unborn child. This obligation will also mean that doctors who are assessing a patient where the foetus is close to the point of viability will have to be mindful of their responsibility to both patients, to mother and child.

May I also address the accusation that, as the leader of the Fine Gael Party, I am breaking a pre-election promise in bringing forward this Bill? I reject this allegation. Before the last general election, the Fine Gael Party made three essential points. Firstly, we said that Fine Gael would not legalise abortion in Ireland, and we are not and will not. Secondly, we acknowledged that the European Court of Human Rights judgment in the A, B and C case would have to be examined and addressed. Thirdly, we promised that women in pregnancy would receive whatever medical treatments were necessary and the duty of care to preserve the life of the unborn would be upheld. This is precisely what this Bill aims to achieve.

I have had quite a deal of contact from different groups about various elements of what is not included in this Bill. While I have understanding, empathy and sympathy for many of these situations, this Bill deals strictly with what is in our Constitution and what our requirement to provide legal clarity entails.

I am asking the House to support the Bill. I remind Members again that this Bill is not about creating new laws or new rights. It is about clarifying and regulating existing rights. To those who put forward the proposition that this is the first step towards a liberal abortion regime in Ireland, I say clearly that this extremely restrictive Bill is the only proposal that will be brought forward by this Government on this issue. I sincerely believe that it is the right thing to do, that it will save the lives of women and the unborn. As somebody who has been through this situation on a number occasions, dealing with legislation of one sort or another related to this, if I had thought for one moment that this Bill would lead to the creation of a liberal abortion regime in this country, I would not ask the House to endorse it. I believe, as one who is privileged to hold this office, that we have a duty to uphold what this book means. What this book, which is our Constitution, our Bunreacht, confers on the women of our country is a constitutional right to have a termination of a pregnancy in certain very specific, very specialised circumstances. We have a duty to see that that right is vindicated and that the constitutional responsibility to uphold the right to life of the mother and the unborn is actually implemented in practice.

Therefore, having considered all of these issues, I am happy that this is the right thing to do and I ask that the Members of the House support the Bill through all its Stages.

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