David Cullinane (Waterford, Sinn Fein) | Oireachtas source

I welcome the opportunity to speak on this important issue. I thank the proposers of the Bill for bringing it forward in the first instance and giving us an opportunity to have this debate on this issue.

The language we use and the tone we strike as legislators is important. It matters to women going through a crisis pregnancy, it matters to those families who have received a diagnosis of a fatal abnormality and it matters to those who have had to make that difficult decision to seek a termination in the past. It also matters to all the healthcare professionals who are providing a necessary and professional service to women right across the State, unfortunately, not across the island.

When dealing with this issue as legislators, we must be conscious of the mandate given to us by the Irish people directly through the referendum. It was the Irish people who demanded that we in this House legislate to bring forward safe and accessible abortion services, and that is exactly what we did. A long, and at times fraught, process was put in place that ultimately gave rise to the referendum and subsequently the legislation which, for the first time, put these services in place for Irish women.

As part of that process, the amendment that comes before us as a Bill was thoroughly debated and discussed. To be fair to the proposers of the Bill, nobody here would disagree with its core sentiment. Of course, we support the administration of pain relief. Who would not? Of course, we support medical professionals carrying out these procedures preventing avoidable pain where it is deemed necessary.

I suspect the only difference we have on this matter is that which was articulated before when this issue was last debated and voted on. It is my firm belief that clinical decisions such as this should be taken by clinicians and not by politicians. I trust our doctors and our nurses. I trust our great healthcare professionals to do their jobs without interference from me or from any other unqualified person. I believe that the appropriate place for determining such practice are the clinical guidelines for termination of pregnancy, rather than in primary legislation such as this, and that is a matter for the doctors to decide.

It is our responsibility as legislators to ensure that there are robust legislative frameworks to support the policy decisions of the Oireachtas and the people. When it comes to medicine, it is the responsibility of the medical regulatory institutions – in this case, the Institute of Obstetricians and Gynaecologists at the Royal College of Physicians of Ireland – to set out clinical guidelines within that legislative framework to regulate and make operational, in medical terms, that policy.

In this State, we have an independent medical profession that is free to pursue and implement clinical guidelines, subject to the legislative frameworks and policies set by the democratic institutions, on the basis of the latest medical-scientific research, with ethical practice regulated by the Medical Council. That key principle must underpin the delivery of modern, compassionate healthcare that puts the patient, in this case, the woman, first.

My party, Sinn Féin, supports modern, compassionate healthcare. We must be careful not to cross the line between legislation and clinical guidelines and it is my fear that this legislation does that. We should not infringe on the independence that is so essential to the delivery of modern healthcare. This is an important principle that must underpin access to any healthcare – that we trust doctors to deliver the service in an ethical and safe way. If they do not, there are mechanisms for recourse via the professional and regulatory institutions, such as the Medical Council.

There is nothing prohibiting the administration of pain relief, where deemed necessary by a clinician, in the existing legislation. If there are difficulties in providing such pain relief where a clinician deems it necessary, then that is something which the health service must rectify.

In my view, the fundamental point here is that we must trust our doctors. We must acknowledge that this is a decision for the medical professional who is carrying out the procedure. It is not appropriate, in my view, to mandate compulsory treatments, care pathways or patient treatment plans in legislation. That would not work in any other sphere of healthcare.

There is nothing preventing the medical profession from coming to a view and setting requirements in guidelines that they continue to review and reformulate in accordance with a medical scientific approach. That is the approach we support for delivering any necessary pain relief because the appropriate place for regulating such practices are the clinical guidelines for termination of pregnancy, not legislation. On that basis, I will support the Government amendment.

I want to take this opportunity to set out Sinn Féin’s all-island position on abortion services. Sometimes misleading and inaccurate statements have been made in this House and by Members of this House in the media to distract from Government failures to fully commission services across the State.

Sinn Féin is committed to delivering the same services, North and South. We want to see the alignment and delivery of abortion services across the island, and the services available in this State implemented in the North.

We want to deliver modern, compassionate healthcare North, South, east and west. We want to deliver a system that removes the need of any pregnant person to travel to England or elsewhere for an abortion they need. We want to keep the operation of these services under review to ensure they are compassionate, appropriate, patient-centric, and informed by the best available medical advice.

In the Executive and the Assembly, our Ministers and MLAs will continue to push for the immediate commissioning of abortion services in the North and the alignment of services with this State. It is now more than a year since the law changed to legalise abortion in the North. It is totally unacceptable that the commissioning of services continues to be blocked by the DUP and UUP. Our amendments to deliver these services have been rejected time and again by the DUP and the UUP. All of us in this House have a responsibility to recognise the blocks that have been put in the way of people in the North seeking access to abortion services. We will table a motion in the Assembly in the new year to push back against this obstructionism. I hope that political leaders in this State, from all parties, will add their voices to this call and help to deliver these services for people across our island.

It is very important that the Assembly in the North does exactly what it should do. We have to take our responsibilities in this House very seriously. We supported the legislation that enabled the services to be put in place in the South. Ministers in the North from the DUP and the UUP are blocking any attempts by Sinn Féin and others to get this through the Executive. We need to ensure by any means possible that no matter what part of the island they live on, women have access to exactly the same level of abortion services. Sadly, that is not the case. We in Sinn Féin will come at this again with vigour and energy in the new year as best we can.

I also raise the matter of the review of the provision of abortion services in this State. The review process itself is central to the amendment the Minister tabled. We had a very lengthy discussion at the Joint Committee on Health a number of weeks ago and since then we have had a chance to review the terms of reference for the review process. The appointment of an independent chair needs to happen as soon as possible. The Minister has given a commitment to expedite that and has gone through a procurement process. We all hope that will happen very quickly. I reiterate my view that the chair should have been in place at the start of the process and should have had a role in overseeing the outreach and public consultation process. The quicker we get the independent chair in place, the better for everybody.

We need to get this review fully under way. The Government must ensure the widest possible stakeholder engagement with those who accessed or sought to access the services, those who have provided the services and those who felt unable to provide them, as well as the views of organisations helping people who need these services. We need to hear from women who were able to avail of the services but we also need to hear from women who were unable to do so, for whatever reason. Wherever that takes us, so be it. We have to hear the experiences of everybody.

The Minister has clearly said that the review will not start from the point of view of policy but that of the operation of the Act. Those are the terms of reference for the review. There is going to be a very obvious crossover in some of that, as he has acknowledged, and it may be the case that the review process will then make recommendations that are policy-based. We will have to wait and see what comes from that. The review must include the needs of any hospitals that have been unable to fully commission services. It must be explicit in the reasons any public healthcare facility that could provide the services is not doing so. We had a discussion on this issue at the committee. Many maternity hospitals are not providing a service. There may be a reason for that in some instances because of the scale of the hospital, as it might be a level 2 or level 3 hospital, but we need to understand why that is the case. We need to get to a point where these services are available in every maternity hospital. There are also issues in some rural areas with access to GPs providing the appropriate service. All of that will be critical to the review process.

While the purpose of the review as set out in the legislation is to examine the operation of the Act, that does not constrain it from accepting evidence on, and including an analysis of, the impact of different aspects of the legislation on access to services and whether women feel the services are compassionate. It is important that the review does not narrowly focus on the operation of the Act, as prescribed in the legislation. We have to be as open, transparent and generous as we can in this review process to capture all the experiences and make sure none of them are limited or prevented from making their way into the final conclusions of the process. That would be problematic and would undermine its integrity. The review may be limited in what it can recommend but it is a unique opportunity to gain insight into the real experiences of patients accessing these services and clinicians delivering these services, or not delivering them, as the case may be. It can, and should, provide an evidence base for us, as legislators and policymakers, to review the impact of the previously decided policies. We must ensure that decisions made previously have delivered a fair and fit-for-purpose system. This review cannot be blinkered and its output, at least in the collection of testimony and evidence on experience, must be examined in its totality. That means all experiences.

Only half of the maternity units in the State deliver abortion services, meaning half of maternity units are falling short on their obligations and are not providing a service. This is exacerbating the serious geographical discrepancies in access to a GP who will provide services. The Minister has acknowledged those geographical discrepancies. We do not need to wait for the review to paint a picture or signpost the way forward. Where we know there are gaps under the existing legislation and the operation of the Act, we can already move if necessary. We can support those maternity hospitals and make sure we have sufficient capacity in primary care across all areas so women are not travelling 70 miles or more to get to a GP, as we know is happening in some cases. They have to ring multiple GPs, in some cases seven or eight, until they can find one who will provide them with the service and access to information. That is problematic.

This is a matter of trusting doctors as those best placed to advise and support those seeking to access services. It is about recognising that they are best placed to determine the clinical needs and treatments required. It is about recognising that abortion services must be fit for purpose and implemented fully right across this island. It is about supporting women and pregnant people and addressing their medical needs. I do not believe a single Member is against compassionate services that administer any necessary pain relief. Everybody in the House would want that to be in place but the point is that it is in place already. Doctors and clinicians can provide that pain relief if and when it is deemed necessary. The place for determining that is in the clinical guidelines and not in primary legislation. For all those reasons, I will support the Government amendment.

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