James Reilly (Dublin North, Fine Gael) | Oireachtas source

When the Statute Book is silent on matters of life and death, great mischief can occur. We remedy that through this Bill. Twice the Supreme Court confirmed that the X case decision is the state of our law in the baby O case in 2002 and in Roche v. Roche in 2010. If the court wanted to alter or vary the decision in any way, it could have done so but it did not. The Minister for Justice and Equality referred to how the X case was referred to in Cosma v. Minister for Justice, Equality and Law Reform. The decision of the Supreme Court in the X case has never been added to, varied or contradicted by any subsequent decision of the court. It is the law and we are bound by it.

Other issues were raised. I was implored to listen to the psychiatrists. I will quote Dr. Anthony McCarthy, president of the College of Psychiatrists of Ireland:

I will specifically discuss a phrase that is being quoted frequently at the moment that "abortion is never a treatment for suicide". This is true, and abortion is never a treatment for suicide, but neither is counselling, psychotherapy, antidepressants or anything else. There is no treatment for suicide. What society needs to address in general, and what we as psychiatrists have to do specifically, is try to prevent suicide, and this requires looking at the causes of suicide and what can be done to address those causes. The question is not whether abortion treats suicide but is there ever a case where a woman will kill herself because of an unwanted pregnancy, and if so, what can we do to save her life, and would that ever be a termination of pregnancy? This Bill is about legislating for that very small but real possibility.

He further stated:

Suicide in pregnancy is real; it is a real risk and it does happen... Much has been made and will be made about the so-called lack of evidence with regard to abortion and whether it will ever prevent a suicide. I believe there will never be statistical evidence to prove this point one way or other because trying to prove anything statistically for such a rare event is extremely difficult, if not impossible. Only a study involving thousands of women who were expressing suicidal ideation in pregnancy and wanted an abortion, and where half of them had that abortion and the other half did not... could answer this question about statistical evidence. This study will almost certainly never be done, I hope.

I am listening to the psychiatrists. The same psychiatrist on the radio two mornings ago stated that dialectical behaviour therapy is for emotionally disturbed women with a personality disorder. To suggest that should be the treatment for every woman who finds herself in this situation is not logical.

A great deal of work has been done by the crisis pregnancy agency and the number of women travelling from this country to the UK has fallen by one third from 6,000 to 4,000 annually. Much more work needs to be done and I acknowledge that, as does the Government.

I would like to address the issues raised by Deputy Terence Flanagan who contended that the Bill was a change. It is not a change in the law; it is a clarification of existing law. He stated that psychiatrists are not judges and I agree but every day, they must make clinical judgments as part of their work. As somebody else said, they are better positioned to make those clinical judgments than anybody else, including the Judiciary. It was contended that I said on television this law would lead to increased numbers of babies being born with a disability. I did not say that but I acknowledged that it could happen.

Deputy Kirk said the arguments made, particularly by the Minister of State, Deputy Creighton, were compelling but we have seen clearly that not alone are they not compelling, they are deeply flawed.

The Minister of State, Deputy Alex White, the Minister for Justice and Equality, Deputy Alan Shatter, I and others have detailed the reason. He also suggested that taking section 9 from the Bill would be the easy thing to do. However, the right thing is often not the easy thing. As others have pointed out in respect of gestational age, there can be no limit to a right. Are we to say to a pregnant woman in this situation that we can save her life up to 20 weeks of pregnancy but cannot do so after that date, and she has no right?

I refer to issues raised by Deputy Timmins. Would he prefer to leave the right to termination on grounds of suicide unregulated? It is legal now, as the X case has shown. The Deputy might say no such terminations have taken place. I already pointed out I cannot confirm that but I know that as the law stands without this Bill, a doctor anywhere who forms the opinion that the risk of suicide is real and substantial and the only way to avert it is to terminate the pregnancy, is entitled under the law to perform that termination in any institution, with no certification and without referring to any other doctor. It is not unreasonable to go further and state that had this law been put in place in 1992 some lives might have been saved.

A number of speakers have asked how we came to this point, as a Government, and noted it is said that one party in particular wrote a letter, giving certain commitments. In the letter it was stated we would not legislate for abortion. We are not doing so - it is already legal. In our manifesto we stated we would have an all-party committee on the A, B and C case. The programme for Government went further, stating we would form an expert group. That group's report made it very clear to the Government, giving three options, that the safest and best way forward was by legislation and regulation. We know there is no available evidence as a treatment for suicidal intent; I have covered that.

I admire the courage of all, professionals and non-professionals, who have joined the debate. In response to Deputy Daly, I acknowledge that risk of suicide is real. We must trust the mothers of the next generation and must trust our doctors. That should be our starting point. The Deputy spoke of the GP. The expert group had input from GPs and although it did not believe GPs should be involved in certification it believed they should be consulted. That is covered in the Bill.

Deputy Wallace asked why two psychiatrists and one obstetrician would be required. That was one of the options given by the expert group and has nothing to do with any contention on the Deputy's part that certain people on this side of the House believe that women would lie or be manipulative. It has to do with the more subjective nature of assessment of the threat of suicide and the risk it represents. We do not have biochemical markers, imaging X-rays, etc, as we have in physical cases and have to depend on clinical opinion and assessment. We must acknowledge that the outcome of that assessment could be the end of the life of the unborn.

Deputy Naughten contended we are doing this merely because of the Supreme Court. We have covered the importance of the Supreme Court and do not need to return to that. It is not true to say that in the case of a review a woman cannot have somebody with her.

I thank Deputy Kelleher for his contribution. Along with others, I agree that suicide risk is rare but is real, as the Deputy noted. We cannot be prescriptive to doctors doing their work. The Deputy's amendment is already contained in the Bill in that it is stated repeatedly that termination must be deemed the only treatment that can avert this risk. This means that all other treatments must have been explored and considered.

Deputy Conway made her points very clearly and I share her concerns around mental health and some of the comments that have been made.

Deputy Boyd Barrett claimed the Bill does not go far enough. I believe we understand that we are bound by the Constitution, the Supreme Court and the A,B,C judgment of the European Court of Human Rights. As others observed, we cannot selectively choose from any of those. We cannot select bits of the Constitution we like and ignore the bits we do not like. We cannot select decisions of the Supreme Court we like and ignore others. Nor, as some have suggested, can we, having signed up to the ECHR take an àla carte view of that institution.

I accept that some people have a serious problem with this but I reject the contention made by Deputy Walsh that this Bill will in any way normalise suicide. I have addressed the issues the Deputy raised about gestational time.

Deputy McNamara made a point on legal interpretation which is absolutely correct. Deputy Ó Caoláin was supportive, for which I thank him. He stated that I had told the committee I would amend the Bill in regard to treatments available. What I stated, as seen in the blacks in front of me, was that I would return to this and mention it in my speech on Report Stage, which I am happy to do. However, given the lateness of the hour I do not know whether Deputies will want me to go through all of that. If it is their wish, I will do so.

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