Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I refer to amendment No. 80, which I am surprised to see included in this raft of amendments because it does not seek to exclude suicide as grounds for a lawful termination in the State. What it proposes is that where the unborn is potentially viable outside the womb every effort must be made to sustain its life after delivery. The other part of the amendment states: "Notwithstanding anything in this section every attempt shall be made to explore with the woman, by means of counselling and support, alternatives to carrying out the medical procedure referred to in subsection (1).”

I have listened intently to the debate, not only in the Chamber but in my office. I remember that Deputies on all sides of the House raised the issue of cyber bullying and the fact that young girls have taken their lives because they were bullied in this way over a long period. A number of cases in Ireland come to mind, along with that of Phoebe Prince in Massachusetts, who took her life because of cyber bullying. If we genuinely believe that a young girl might take her life because she has been cyber bullied it is possible - and very probable - that a young girl, alone, afraid and vulnerable, who looks at the pregnancy test kit and finds she is pregnant may, because of that vulnerability, decide that suicide is the only way out of her dilemma. That is not something we can dismiss in the abstract - it is real, has happened and will happen again, as night follows day. At present that young girl has a few options. She can continue with the pregnancy, may go to England or may go on the Internet and procure abortifacient pills. In extreme circumstances, however, she may decide that ending her life is the only way to deal with that crisis pregnancy. That is the reality of the situation that confronts a very small number of women in this country.

People referred to the Oireachtas committee which heard that the overwhelming evidence is that a termination is not a treatment to prevent suicide. Every psychiatrist who spoke agreed this was the case because there is no treatment for suicide. This has been bandied about but what was clear in the evidence given is that there is a very small group of people who may, for whatever reason, decide to take their lives because they are in a crisis pregnancy. That is indisputable - it has happened and will happen again.

For all those reasons, therefore, I submitted my amendment in order to talk about the need for support, therapy and counselling in conjunction and in discussions with the girl concerned. If people are genuinely concerned about this Bill, I ask them to think for one moment about this point. If one is a young girl who believes a termination is the only way to address her difficulties, as the law stands she will go to England. I argue that if the girl presented to her GP in Ireland and went through the process offered in this legislation she might realise, given support and assistance, that a termination is not the treatment for her crisis pregnancy. With counselling, therapy and assistance she may very well decide, in conjunction with her GP, her psychiatrist and her obstetrician that continuing with the pregnancy is a valid way to proceed.

People talk as if suicide in this case was something that does not really happen. It does happen and all the evidence presented in the Oireachtas hearings found that it was rare but real. We discussed this issue in January during the Oireachtas hearings and heard further evidence in May during those further hearings. We had Committee Stage and are now on Report Stage. The one area where this matter was discussed twice, however, was with the people - in 1992 and 2002. On two occasions they were asked to delete the interpretation in the X case in respect of Article 40.3.3°. On both occasions they decided it should be retained. People can argue as to whether the Government has an obligation to legislate but what is clear is its obligation to bring clarity to what is now the constitutional right of a woman in this State to procure a termination in the event of her life being at real and substantial risk and termination the only option left. That last is critically important - it must be the only option. In section 9 of the actual legislation it is stated it must be the "reasonable opinion" ...of registered medical practitioners "that risk can only be averted by carrying out the medical procedure".

We trust our psychiatrists in cases where they commit people and take away their freedom. We commit people in this State under our Mental Health Acts on the word of a psychiatrist. We sometimes decide a person is suitable to go to trial on the word of a psychiatrist. In regard to some of the most heinous crimes we take the view of a psychiatrist as to whether a person can stand trial for reason of their mental state. I am convinced that if psychiatrists are obligated to vindicate the life of the unborn, as they are so obligated under Article 40.3.3°, they will do so. They must always take into account what is best because this is a two-patient strategy about what is best for both the woman and the unborn.

When we talk about and refer to England and consider the 1967 Act presented by Lord Steel to the House of Commons and House of Lords, there is no comparison with this country. The United Kingdom does not have a written constitution and there is no obligation there to vindicate the life of a child. In Britain a termination is the intentional destruction of the life of a child. In the context of Article 40.3.3° I have tabled other amendments to this legislation, to make it crystal clear there is an obligation to vindicate the life of a child.

Reference has been made to the gestation period and I have thought long and hard about this. I listened to the evidence that was presented at the Oireachtas Joint Committee on Health and Children hearing. That evidence, the interpretation of the X case and the legislation before us concern saving the life of the woman, not more or less. If there is a threat to a woman's life, be it physical or mental, regardless of the stage of gestation of the unborn, there is an obligation on medical practitioners to save the life of the woman and equally to save the life of the child. If the child is born at 23 or 24 weeks there is a chance that it may not survive or may be born with disabilities. That is a medical fact but if the alternative is to allow the woman die then both woman and unborn die.

We need to keep to the facts before us in the context of this legislation. I supported the Bill on Second Stage and I tabled some amendments on Committee Stage which the Minister considered and he is bringing forward some to ensure an obligation to make every effort to save the life of the child. I welcome that. We are being asked to adjudicate on legislation that is already a constitutional right for a woman, to have access to a termination where her life is in substantial danger. We should speak to that area.

I spoke earlier about psychiatrists. At the hearings of the Oireachtas Joint Committee on Health and Children all agreed that termination is not a treatment for suicidal intent. Some people said that it should not be countenanced in any case. The strong body of opinion was that people do commit suicide because of crisis pregnancies in very rare circumstances. Equally, they have confidence in their professional ability to assess and adjudicate on who is and is not suicidal. Reference was also made to the fact that in diagnosing suicidal intent there is a 3% accuracy rate. For every 100 women who may be suicidal three will actually commit suicide. If my wife was going into an operating theatre tomorrow morning, or my brother, or my neighbour, or anybody else and they were told that they had a 3% chance of dying because of a procedure I would consider that an exceptionally high risk rate. We would not want to dismiss the fact that the rate is 3%.

Another interesting observation made during the hearing was that all these people being assessed for suicidal ideation or a threat of self-destruction are in therapy, which proves that with treatment, counselling, therapy and supports people who are suicidal can be treated. That is the important point. It is not as if the 100 women were not treated and we found out that three destroyed themselves. All these women were being treated, which proves that with psychiatric supports, counselling and therapy, people who are suicidal or have self-destructive intent can be treated.

I am not speaking to the amendments that support the deletion of section 9. I am speaking to my own amendment No. 80, which I think is very fair and reasonable. The Minister should consider it, for all the reasons I have stated because, as I said on Committee Stage, my concern is that the panel for assessment and adjudication is not just a box-ticking exercise for a girl or woman, who has presented to her GP in crisis, threatening self-destruction or self-harm and believes that the only solution to her difficulties is a termination. We are talking about a human being, a girl who is vulnerable. There should be an obligation for a patient-clinician type of relationship whereby every support and assistance would be given to that girl to deal with her threat to destroy herself. It is important to make the point that it is not just a clinical decision or box-ticking exercise, yes or no.

I do not believe that an avalanche of girls will present themselves as suicidal. There are several reasons for this. First, I believe that the threat of self-destruction is rare but real in pregnancy. We also have to believe and trust the women and girls in this country. We have to believe and trust our medical professionals. We trust our obstetricians and gynaecologists and our anaesthetists every day of the week. Why are we not willing to trust our psychiatrists, the professionals who deal on a daily basis with people with mental health problems, people who threaten to destroy themselves and other mental health issues and psychoses? We already take into account their views on taking freedom from people when committing them under the Mental Health Act and in the context of a court of law. That is why I said I would be clear about my amendment.

We cannot just dismiss the threat of suicide. We must be humane and understanding and believe because the evidence is there that girls who are vulnerable and in crisis have killed themselves. Others have accessed termination of pregnancy in Britain and others procure abortifacient tablets from the Internet. That is real life. That is what happens in the outside world. This legislation, as drafted and crafted, is restrictive. Some say it is too restrictive. I do not. I believe it is right, it is balanced, proportionate and it is there to assess a real and substantial risk to the life of a girl or woman in the context of section 9 and I welcome that. There should, however, also be some obligation not only to assess but to support and treat a girl in a crisis.

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