Joan Collins (Dublin South Central, Independent) | Oireachtas source

I am sharing time with Deputy Clare Daly. When more than 1.4 million people voted to repeal the eighth amendment in May of this year, they did so after years of thinking about, reflecting on and discussing people's personal stories of abortion. These were stories of relatives, colleagues and friends who had to travel abroad for basic healthcare. The people voted in the context of a campaign that did not hesitate to demand free, safe and legal access to abortion services and an end to the stigma of seeking such services. It was a campaign that demanded that women and any person who can get pregnant can be trusted to make the best choices for themselves in consultation with their doctor. The 1.4 million people accepted that life has grey areas and that dogmatic religious teachings have no place in dictating to anyone what should be a private healthcare decision.

While I broadly welcome this historic legislation as a step towards enacting the result of the referendum, I am a bit concerned that some of the themes in the Bill show that thinking dominated by Catholic social teaching is still contained within some parts of the legislation. There is a theme running through the legislation of refusing to trust those who need the services. There are issues around the use of language and potentially overly own-risk clauses within the Bill presented to us. It is around the question of the three days. If the three days were counted from the point at which the person makes the phone call to the surgery, that would possibly be accepted. Some women are very clear they want to have a termination and should be given the medical abortion immediately, if necessary. Some women may be unsure about what to do and may want a bit of advice. A GP could certainly advise a woman or person where to go to get that advice impartially. That has to be looked at. I am seriously concerned about it.

On the question of language, I would like to flag the use of the definition of "woman." I recognise that "woman" as defined will capture the vast majority of people needing access to abortion services, but clearly there are people - intersex, transgender and other gender identities - who are able to become pregnant and who are very upset and concerned. There is serious concern that they will be excluded from the legislation. It has been recommended by Amnesty that, instead of the current definition of "woman", the term be amended to "a pregnant person of age". I know the Minister said yesterday that "woman" covers everything but I think there should be some reference to it in the legislation or the amending parts of it. Given that we have some of the better legislation in the world in this area, such as the Gender Recognition Act 2015, I do not think there will be much opposition to the proposal when we get to the stage of teasing it out.

A couple of other issues around language and definitions stand out. The use of the phrase "life of the foetus" throughout the Bill raises an issue for me. We risk recreating a right to life of the foetus. I do not need to remind anyone what the referendum in May was about and what the people decided. It certainly was not to create a right to life of the foetus again in legislation to the detriment of people's healthcare access. I propose that instead of "to intentionally end or attempt to end the life of the foetus" or words to that effect, a more suitable wording might be "intentionally ending a pregnancy". I am sure we can tease that out on Committee Stage. We do not want to be in a situation where these definitions are being challenged in the courts by those who do not accept the will of the vast majority of voters in the referendum. The point was made succinctly earlier on as well. In any cases, the focus of the Bill on offences instead of a positive right for pregnant people to seek abortion services in a timely and easily accessible manner is a remnant of that way of thinking from before the referendum. The people have spoken overwhelmingly. They do not want their sisters, aunts, mothers, daughters, or friends to be treated as suspect or criminal or to be unduly burdened for seeking out a health service.

I do not know why the Bill maintains the system that was in place to notify the Minister for Health of every abortion case in the State. The system was taken directly from the 2013 legislation that catered for 20 to 30 abortions per year. Under the present Bill, the 12 women currently travelling each day will be getting care here. That will be thousands a year, plus those who procure the abortion pill and others who would not have been able to access those services abroad or on the Internet but will be seeking their healthcare here. Why should they be treated differently from any other patient in the State? This is a stigmatising measure and I thought we had moved beyond that point. Of course there should be reporting and collection of statistics but it should be carried out in a normal manner, the same as any other health service.

A review clause should be put into the legislation meaning that we regularly assess whether it is meeting goals that those who require abortion services are able to access them safely without barriers or delays. This would also allow us to review it in line with evolving best medical practice and human rights law. Amnesty particularly made the point about the review clause:

In line with recent legislation, including the Gender Recognition Act 2015 (section 7), the legislation should include a provision requiring a periodic review of the substance and operation of the Act. The Act should be periodically reviewed to ensure that women and girls are able to access safe, quality healthcare without barriers or delays; and to address in policy/guidelines any gaps, and new and emerging issues. The Act's substance must also be reviewed, to ensure that it evolves in light of developing international medical practice and human rights law (noting that what is proposed in the general scheme currently falls short of what international human rights law requires).

I further worry that some of the language in the Bill could cause issues for medical practitioners, especially the phrase "serious harm to health". This is a high bar for harm and also somewhat unknowable for a medical practitioner. A person's right to health is not qualified in international human rights. It is also impossible to know in advance how much harm is going to be done to someone's health. The World Health Organization, in its Safe abortion: technical and policy guidelines of health systems, from 2012, had the following to say on best practice around risk to health as regards abortion care:

The fulfilment of human rights requires that women can access safe abortion when it is indicated to protect their health. Physical health is widely understood to include conditions that aggravate pregnancy and those aggravated by pregnancy. The scope of mental health includes psychological distress or mental suffering caused by, for example, coerced or forced sexual acts and diagnosis of severe fetal impairment. A woman's social circumstances are also taken into account to assess health risk.

We should consider taking that on board in the legislation.

It would be better to remove "serious" and just refer to a risk to health in the Bill. To try to quantify the risk to a person's health takes away a person's ability to accept what level of risk they are willing to take. It goes against international best practice and the advice given to the Oireachtas joint committee on legislating on health grounds. We could be going back to a situation where doctors could be waiting for a risk to become substantial and serious before intervening.

We need to tease out on Committee Stage the very important issue of conscientious objection. I accept that people have the right to conscientious objection. As has been said, in countries such as Italy it has been used very frequently, meaning that some women have to travel long distances to find access to healthcare. The submission from the Abortion Rights Campaign stated:

The result of this practice is that, although abortion in Italy is technically legal, it can be practically impossible to access, with more than 70% of providers (rising to 90% in southern parts of the country) refusing to provide abortion care. Indeed, one woman had to visit 23 hospitals in order to obtain an abortion.

We also need to be very careful in this country. In some practices where there is a main GP, the other GPs in that practice could feel the pressure from that particular GP. It would be a shame if we were not to provide that. The submission from the Abortion Rights Campaign also stated:

The Health Bill is no different: it states that a medical practitioner invoking conscientious objection “shall, as soon as may be,” arrange for the patient’s care to be transferred to another practitioner, but does not define “as soon as may be”.

We need to look at that area.

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