Thursday, 15 March 2012
At the outset I wish to explain to the House precisely what symphysiotomy is and to give some context about its use as a medical procedure and specifically its use in Ireland. Symphysiotomy is a medical procedure that was used primarily before the advent of safe caesarean sections. The procedure was carried out in Ireland from approximately 1920 until the early 1980s. It was gradually replaced by caesarean section as the preferred method of delivery in childbirth where required. It is clear that the procedure continued to be used in Ireland for some time after it had been all but discontinued in other developed countries. In this regard within Ireland it continued to be used for a longer period, most notably in Our Lady of Lourdes Hospital, Drogheda.
I am conscious of the distress that symphysiotomy has caused to a number of women and recognise the pain that this issue has caused to those affected by it. The Government is committed to dealing with it sensitively, so that if at all possible, closure can be brought to those affected by it. This practice has resulted in long-term distress and pain, problems with urinary continence, problems with bowel function and difficulty walking to perform day to day duties within the home. It has had a serious effect on a number of women who have had the procedure performed.
My first priority is to make sure that the health needs of those who have had a symphysiotomy are met quickly and effectively. With this in mind, I am committed to ensuring that the greatest possible supports and services are made available to women who continue to suffer effects of having undergone this procedure. The women concerned continue to receive attention and care through a number of services which have been put in place including the provision of medical cards to all who requested them; the nomination of a liaison officer for a patients' group comprised of women who underwent a symphysiotomy procedure; the availability of independent clinical advice for former patients; the organisation of individual pathways of care and the arrangement of appropriate follow-up for women, including medical assessment, gynaecological assessment, orthopaedic assessment, counselling, physiotherapy, reflexology, home help, acupuncture, osteopathy and fast
tracked hospital appointments; the refund of medical expenses related to symphysiotomy in respect of medication and private treatments; the establishment of a triple assessment service for patients at Cappagh Hospital, Dublin, in January 2005; and a support group facilitated by a counsellor which was set up in 2004 in Dundalk and Drogheda for women living in the north-east region.
The provision of these necessary support services for women is monitored and overseen by the Health Service Executive which is committed to being proactive in seeking out and offering help to women who underwent a symphysiotomy and who may wish to avail of the services offered by the HSE.
It has been suggested that some 1,500 symphysiotomies took place during the period 1944 to 1992, giving a rate of approximately six symphysiotomies per 10,000 births. While there was a large variation, even in the hospital with the highest rates, the maximum rate appears to have been six per 1,000 births in one year. Thus, it was a rare intervention in comparison with caesarean section, for example, which rose steadily in the same period from three per 100 births in the early 1940s to now over 20 per 100 births. This is not in any way to minimise any serious effects and suffering it had on the women concerned, but it does indicate the procedure was quite rarely carried out in Ireland overall.
We need to act on the basis of the best evidence that is available on this issue, as in all aspects of our health services. To this end the Chief Medical Officer of the Department of Health commissioned an independent research report last year into the practice of symphysiotomy in Ireland. The aim of the report is to provide an accurate picture of the extent of use of symphysiotomy in Ireland, and an examination of the Irish practice relative to other countries. It is to include an assessment of the circumstances in which the procedure was carried out, what protocols or guidance existed at the time to guide professional practice and details of when the practice changed and why.
The specific terms of reference the researcher has been given are to document the rates of symphysiotomy and maternal mortality in Ireland from 1940 to date, by reference to available data, including annual and other reports; and to assess symphysiotomy rates against maternal mortality rates over the period. The researcher has also been asked to critically appraise international reviews of symphysiotomy practice and associated rates in a number of comparable countries in the world and in Ireland, to review any guidelines and protocols that applied in Ireland on symphysiotomy over the time period and to write a report based on the findings of the analysis providing an accurate picture of the extent of use of symphysiotomy in Ireland and an examination of the Irish experience relative to other countries. The academic researcher concerned was formally appointed on 1 June 2011.
On a point of information, she experienced unforeseen difficulties in accessing information sources and, as a result, submitted the report behind schedule in late January 2012. She informed the Department this was due primarily to the challenges associated with accessing historical data from a time when records on the procedure were not routinely kept. Subject to legal advice, I propose to make the draft report available for consultation and will further engage with the relevant patients' representative bodies concerned and through them the women who underwent symphysiotomy. My Department will also consult with the Institute of Obstetricians and Gynaecologists in Ireland. When these consultations have been completed satisfactorily, the draft report will then be finalised by the academic researcher, taking account of the consultative process and any legal considerations, and presented to me. Informed by the outcomes of the consultation process, I will then consider the final report thus produced by the researcher and decide on the steps required to address this situation.
Ireland is now one of the safest places to have a baby. We have one of the lowest maternal mortality rates and perinatal mortality rates in the world. Ireland is a now a very safe place to have a caesarean section and we should be proud of the fact that we are recognised internationally as leaders in the field of obstetrics. Recent legislation requires doctors to maintain and update their competence. These new requirements for doctors to maintain their professional competence are a significant step and a concrete assurance that medical practitioners are appropriately qualified and competent to practise safely. With the advent of new clinical programmes and directors, there is now much greater monitoring across each specialty.
The national clinical effectiveness guidelines published last year provide a framework for national endorsement of clinical guidelines and audit to optimise patient care. These guidelines will contribute to improving health outcomes, by reducing variation in practice, improving quality of clinical decisions, influencing health service policy and informing service users and the public about the service they should be receiving. These and many other developments ensure that the health system is striving to fulfil the vision of the Commission on Patient Safety and Quality Assurance - knowledgeable patients receiving safe and effective care from skilled professionals in appropriate environments with assessed outcomes. In other words it aims to empower patients more to know what is safe, to what they are entitled and what they should expect and to empower them to complain when that does not happen or they do not receive that care.
The new clinical programmes being developed and implemented in the HSE are one of the most important developments in this regards. These are currently led in the HSE by the directorate of clinical strategy and programmes which was established to improve and standardise patient care throughout the Health Service Executive by bringing together clinical disciplines and enabling them to share innovative solutions to deliver greater benefits to every user of HSE services. Very often we have excellence in practice in an area which can be translated to a different discipline. The interaction that now occurs between the clinical programmes is already yielding great benefit. The clinical programmes are a multidisciplinary initiative between the HSE and the various faculties and generally include patient representatives. Each programme is led by a clinician. The clinical programmes are a sea change in the way we provide health care in Ireland. This new approach utilises key proven drivers of success in improving disease management and is aimed at improving patient care.
The obstetrics and gynaecological clinical programme is led by Professor Michael Turner. The aim of the programme is to improve health care choices for women. Its initial work aims to implement key guidelines, establish local programme implementation groups to facilitate change, develop national models of maternity care, develop a standard approach to capturing and reporting audit and performance metrics, develop solutions and guidelines to reduce the number of multiple pregnancies requiring neonatal intensive care, develop workforce planning and training models and strategy and investigate the numbers of women attending for antenatal care in early pregnancy.
More generally, there has been considerable progress in the options of maternity care available to expectant mothers in Ireland. They now have a number of choices they can make in respect of the obstetric care they choose. Women may opt for a combined care package with their GP and the hospital, under the maternity and infant care scheme which provides a number of free GP and maternity hospital visits to all eligible expectant mothers. There are also a number of midwifery-led units nationally which offer the opportunity to expectant mothers to give birth in a uniquely designed birth room cared for by a team of experienced midwives. These units are located close to hospitals should an emergency arise that requires specialist intervention.
I commend developments in the south of the country, which I would like to see extended, where the maternity service is delivered entirely in the community, with GP and consultant visits being held in the local primary care centre. This is the practice in Mitchelstown, for example.
While these developments can bring further improvements to maternity services in the future, I am committed to addressing the issues that have arisen from the legacy of past practice in relation to symphysiotomy. The Government is also committed to dealing with this whole issue, with all the sensitivity which is undoubtedly required, to help do whatever can be done for those affected by it. I have outlined the supports that have been provided to the women affected and the progress in finalising the research report, but I am aware that much remains to be done. I know there is cross-party support for this group of women who have suffered as a consequence of this procedure. It is the role of the Government and of this House to support them in reaching closure on this matter and to ensure that they receive the service they require to help them recover and lead as normal a life as is possible.
I hope to bring this matter to a satisfactory conclusion as soon as possible and I firmly believe that the women who have had this procedure deserve nothing less.
I thank the Minister for his reply. The Minister, as a medical practitioner, will have dealt with these sensitive issues on a confidential basis. As a lay person, however, when I met survivors of symphysiotomy in the AV room last evening I was very disturbed by their sad stories, as were many other Members. Their stories were emotive, disturbing and upsetting for non-medical people. Anyone who was present last night must acknowledge that deep hurt and pain has been borne by these women for many years with great grace. They simply got on with their lives and suffered urinary tract infections, bowel difficulties, difficulty in walking and psychological difficulties as a result of this procedure.
I am not here to be judge or jury or to apportion innocence of guilt, but I have the capacity to know what is right and what is wrong. The issue of whether or not medical practice at the time was in support of symphysiotomy on some occasions could be debated for evermore. Some medical practitioners will go to their graves stating that the practice was carried out for the right reasons at the time. Equally, the women on whom the procedure was carried out say it was often done for the wrong reasons. They told me last night that there was an undercurrent of religious ethos in medical practice and that use of the procedure was concentrated in some areas of the country, in certain hospitals and among some individuals
Given what we heard last night and what the Minister and Members of the House are aware of, we owe it to the women to have a full and frank discussion on this matter. The report will be published in the near future, and I look forward to its being discussed. This will not be an end in itself, however. While we can continue to provide care and support, the women and their families believe they were wronged. I too believe they were wronged. This is not simply because they suffered a medical practice that was accepted at the time but because alternatives were available and were being practised in hospitals in the same vicinity. Across Europe Caesarian section was used in preference to symphysiotomy.
For all those reasons, we owe it to these women to have a discussion on foot of the report. I hope it can be published as soon as possible. I say this because many of the women concerned are in the latter stages of their lives. The way they spoke last night indicated the urgency of this matter. I was shattered last night when I left the AV room. I compliment Deputy Ó Caoláin for pursuing this issue vigorously and in an all-party and non-partisan way.
We should publish the report quickly. It should not sit around. Let us have a genuine discussion, in parliament and in society, and see how we can formally make redress to the women who feel so aggrieved and are in such distress. While the report will document the number of symphysiotomies carried out from 1940 to the present and will contain other detail, the real issue is the higher incidence of the procedure in some hospitals and by some individuals. Was this because some doctors genuinely believed it was the only possible medical intervention or were there other reasons? This is an important factor. People told me last night that symphysiotomy was used because the view at the time was that one could have only a limited number of Caesarian sections, in which case family planning would have to be discussed. A woman who had a number of Caesarian sections would have to use birth control to avoid a further pregnancy. I do not know if that is the case but it is what was said to me last night in the AV room.
Let us consider what has happened in the lifetime of these women and what we have today. While we argue across the floor of this House about hospital waiting lists, lack of services and people on trolleys in accident and emergency departments, we can be very proud of our maternity services, our infant mortality rates and levels of care in gynaecology, obstetrics and paediatrics. We can be proud of what we have achieved and that we provide the best care to women during pregnancy and birth and to mothers and children. However, the issue we are discussing this morning is not something we can be proud of.
The Minister acknowledged the distress of these women and that they deserve whatever we can do for them. There are individual care packages. They can access medical cards, if requested. Physiotherapy and other supports are available. Some of the women tell me that does not always happen. The decision was made some years ago that it would happen. If it is not happening, the Minister should make sure the women get what they are entitled to under agreements made previously.
However, that is not enough. The women deserve an acknowledgment of what was carried out. I am not here to apportion guilt or innocence. I vehemently opposed the referendum to establish committees of inquiry in the Oireachtas. I do not have the competence or skill set to apportion guilt or innocence but I have the ability, as a person and as a parliamentarian, to say what I feel is right or wrong. It is right that these women deserve an apology. They deserve all the supports possible and they certainly deserve a full investigation - which this report may provide - of the reason this procedure was carried out more frequently over and above all the various comparable medical statistics in other hospitals in Ireland and across western Europe.
I have acknowledged Deputy Ó Caoláin's deep, profound commitment and interest in this issue and there has been no partisan party political attitude to this issue from any side. I hope the report can be published soon as this would allow it to be discussed in committee or in another plenary session. As was discussed with regard to the Bill on the blood clotting factor, people aggrieved by their treatment by the State deserve to be involved in all aspects of the decision-making process, either as individuals or collectively.
Once the report is published we need to move quickly because some of these procedures were carried out a long time ago and some of the women who spoke to me last night are now in their early 80s. They described openly the impact of this procedure on their lives, and on the lives of their families and their siblings. It was a very harrowing story of distress. Most of these women just got on with their lives, rearing their families and working in very difficult times in the 1940s, 1950s and 1960s. For all those reasons, they deserve whatever we can do for them.
The Institute of Obstetricians and Gynaecologists is concerned about any revisionism in the context of health practices and procedures, medical technology and medicines of the time. I accept that the practices of the past cannot be fairly compared with modern practices and we should not judge people who applied the standards of the time by the standards of our time. However, it is a fact that the incidence of symphysiotomy was higher in some areas and in some hospitals and I cannot understand why this was the case until the early 1980s. I cannot understand why there was not some form of peer review of practice which might, at least, have sounded the alarm.
We must make every effort to support the victims and survivors of symphysiotomy with regard to their medical needs and with emotional and psychological issues which need to be addressed as such distress can never be fully assessed but the women should be entitled to support.
Some of the women were concerned by what the Minister said but today's statement is more measured. This is not intended as a criticism but rather I am a lay person and I do not have expertise in that area. However, it is important that this report is seen to be a completely all-party report. I hope consensus can be achieved in this regard and I will be fair and reasonable in my response because the people who are in the Gallery are those who deserve a fair and reasonable response. I remember also those who were unable to attend today because of the difficulties associated with their age profile.
I ask the Minister to consider how the women affected can be best helped in a practical way so that they will all receive the full care and attention to which they are entitled and this is an all-party policy. I ask the Minister to give priority to the publication of the report because some people cannot wait and nobody deserves to wait to hear about this very difficult and sad episode. The country has wonderful health facilities with caring and attentive staff who are dedicated to the care of their patients. I would not want this emotive issue to diminish the confidence of mothers with regard to maternity facilities. I urge the Minister to bring this difficult episode to a conclusion as speedily as possible.
I will share time with my colleague, Deputy McLellan, and I will take ten minutes.
This is both a sad and an historic occasion, the first time that the Dáil has had statements on the use of symphysiotomy and pubiotomy, that barbaric practice which inflicted so much pain, distress and disability on so many Irish women. Our debate today is tinged with sadness as we think of those women victims and survivors of symphysiotomy who are no longer with us, suaimhneas síoraí dá n-anamnacha go léir. It is sad also to realise that it has taken so very long for this human rights issue to be acknowledged by the Dáil in a substantive manner.
I extend a very warm welcome to the women who are with us today in such significant numbers in the Gallery, with an overspill of numbers in the audiovisual room, and who have survived symphysiotomy, living with the legacy for many years. We salute their courage in coming forward to tell their stories and to demand justice and truth. Tá fáilte romhaibh uile anseo linn inniú agus táimíd libh i gcónaí sa bhfeachtas chun an fhírinne agus chun cothrom na féinne a fháil.
The infliction of symphysiotomy on women in Ireland is one of the greatest medical scandals not only here but on an international scale. Symphysiotomy is a clinical scandal on a par with the clerical scandals we have seen exposed in the past two decades. It may not be on a par in terms of scale but it is certainly equivalent in terms of the suffering inflicted on the women victims and on their families and there is one very important and crucial parallel, that is the effort by the medical establishment and by previous Governments to conceal the true nature and extent of this abuse of the bodies and of the rights of Irish women. I regret to say that this effort to conceal or deny the truth continues to be an objective of some.
I listened carefully to the Minister's contribution at the outset of these statements. Promises of consultation with victims and their representatives are all very well. However, after all these years, it is not enough. It is not unreasonable that we would have expected more from the Minister this morning. That said, hopefully, we will see an early breakthrough leading to a resolution of this long-standing issue and truth and justice for all the women concerned.
The Minister said that subject to legal advice, he will see the draft report referred to patient representative bodies and through them, the women who underwent symphysiotomy. Surely that is something that could have been addressed before today and that we would know with certainty there would not be another obstacle.
The Minister also said that he would then, following consideration of the final report, decide the next steps required. Make no mistake about it, the next steps required have been articulated by the women here and the women who cannot be here today ad infinitum, year after year, going back many years. The next steps are well and clearly documented. All that we need is the political will to pursue them. I urge the Minister to do exactly that. He will have the 100% support of all elected voices in this Chamber and he will indeed have our commendation if he commits to doing that.
Exactly one month ago on 15 February in the Dáil, I questioned the Minister on symphysiotomy and asked him if he agreed that this barbaric act should never have been carried out in the first place. We need to have a meeting of minds because the Minister replied: "I reject the Deputy's contention that this was a barbaric act, although its use in certain circumstances may well transpire to have been utterly inappropriate." That was a very regrettable statement on the Minister's part. I have challenged him to ask any of the surviving victims if they agree with this contention that symphysiotomy was not barbaric. A barbaric act is defined as something cruel and primitive. Symphysiotomy was both cruel in its infliction and its effect and because it was medically unnecessary. It was primitive because it arose out of an attempt to impose on the bodies of women an ultra-conservative version of Catholic teaching.
Only yesterday the Dáil passed the Criminal Justice (Female Genital Mutilation) Bill. This legislation, which I wholly supported and endorsed, will outlaw another barbaric attack on the bodies of women arising out of a form of extremism which degrades women and girls and asserts male domination over them. Symphysiotomy shows that such mentalities are not confined to Africa and this State is in no position to look down on countries where such practices are common while we deny the full truth of symphysiotomy and deny justice to its victims.
In that exchange with me on 15 February, the Minister went on to state: "It was a standard procedure at one time and it was reintroduced to certain Irish hospitals in the 1940s as a clinical response to the limitation imposed by specifically Catholic religious and ideological circumstances." I contest that statement. The evidence shows that even in more remote times, symphysiotomy was not a standard procedure. It was always controversial from the time it was initiated in Paris in 1777. It had been rejected in most countries at the time of its reintroduction in the Ireland of the 1940s. This reintroduction was not, as the Minister stated, a clinical "response" to the limitation imposed by what he called "Catholic religious and ideological circumstances". Symphysiotomy was the imposition by clinicians in Irish hospitals of a certain Catholic ideology that saw the role of women solely as the bearers of Catholic children, a role to which their bodies and their rights were to be wholly subsumed. It was also imposed for reasons of clinical training and we heard the testimony of women again last evening who suffered this procedure in the presence of large groups of medical students.
The Minister in that exchange on 15 February unfortunately repeated the mantras we have heard from those in the medical establishment who seek to defend symphysiotomy, for example, that the safety of repeat caesarean sections in the period was unproven. Remember we are talking here about the period from the 1940s to the 1980s. It was as if medical science had not moved on in 40 years.
In a letter to the Department of Health and Children in May 2001, the Institute of Obstetricians and Gynaecologists claimed that the danger of sepsis from caesarean sections was the main reason for the carrying out of symphysiotomy. Again, this was an attempt to muddy the waters. Anyone who doubts the real motivation for the carrying out of symphysiotomy need only refer to the published writings of Dr. Arthur Barry and Dr. Alex Spain. The former referred to caesarean section as leading to the "improper prevention of pregnancy".
Of course, the most compelling condemnation of symphysiotomy is not in academic studies but in the testimony of the victims themselves. Not only was the operation cruel and unnecessary, its victims were kept in the dark about what was being done to them. They received no aftercare or support. That was the case for a significant number of women we have listened to. They were effectively abandoned by the medical establishment and by the State.
When the victims spoke out, it took a long time for them to be listened to. Some of us in the Oireachtas, including my former Dáil colleague, Arthur Morgan, as well as a number of Deputies from other parties and Independents, raised the issue with a succession of Ministers for Health. The Minister was among those voices when in opposition. We helped to keep the plight of the victims on the agenda but again it was the women themselves speaking out bravely who elevated the issue to national attention.
In February 2010, RTE's "Prime Time" carried out an investigation into symphysiotomy. I said at the time, when I secured a Dáil Adjournment debate in the wake of the programme, that an inquiry into this practice should already have been held, reported and acted upon.
One of the most extraordinary pieces of evidence on that programme was one that did not need a great deal of research. It was on the number of symphysiotomies actually carried out. The Department of Health and Children was asked for a figure - I had repeatedly sought this information - and it gave one which it said was incomplete because it did not have all the relevant health board reports. However, a reporter from "Prime Time" was able to go to the National Library, which had the relevant reports, and find the correct figure. It was three times the Department's estimate. This was a very sorry and embarrassing state of affairs for the Department to find itself in.
In the wake of the "Prime Time" programme, it was announced on behalf of the then Minister, Mary Harney, that she had asked the Institute of Obstetricians and Gynaecologists to prepare a report for her on the practice. That was unacceptable. She was asking the institution whose members were responsible for the abuse in the first place to investigate itself. It was not a proper inquiry, although its establishment came about as a result of pressure on the Minister to act.
Similarly, the report currently in the hands of the Minister was not the outcome of a transparent and public investigation. We will reserve judgment until we see the contents of the Walsh report but whatever it concludes, the need for a proper inquiry remains.
I thank the Oireachtas support group for victims of symphysiotomy, because it is only correct that I do so, and reaffirm that we will continue to work together on this issue. I acknowledge the sincere intent and support of voices from all parties and Independents in this Chamber and on that basis, we intend to go forward.
I welcome the opportunity to speak on this issue today. I would first like to acknowledge the fantastic resilience and commitment of all those survivors, victims and campaigners who actively campaign for justice for the victims of this barbaric procedure. As the Minister is aware, these groups consist of survivors of both symphysiotomy and pubiotomy. They have been actively campaigning for an independent inquiry into these covert operations for the past ten years. This State has failed these women. The demands for a public inquiry, for full medical supports and for the right to pursue these cases through the courts must be facilitated.
I am honoured to be one of the Sinn Féin Party representatives on the Oireachtas all-party support group. Many of the victims of symphysiotomy are permanently disabled, incontinent and in pain. I aim to highlight the anguish and unnecessary suffering these women endured. I find it astonishing that no person or agency has ever been held accountable for these cruel and unnecessary procedures.
The admission by the Minister that symphysiotomy may occasionally have been wrongly performed did not go far enough. We in Sinn Féin rebut any suggestion that symphysiotomy was generally an appropriate intervention. It was never a standard operation in any country at any time and was a maverick practice that should never have been performed. As studies have shown, both symphysiotomy and pubiotomy carry more risk than caesarean section. This brutal surgery unhinged the pelvis and often led to long-term walking difficulties, bladder problems and chronic pain. One of the starkest statistics shows that one baby in ten died when this practice was performed. Ireland was the only country in the western world to practise these 18th-century operations in the mid to late 20th century. The consequences for mothers of symphysiotomy were horrendous. The long-term physical effects only tell half the story. Many mothers had great difficulty bondingwith their children and, as a mother of three, I find this one of the most heart-breaking consequences of this unnecessary procedure. The brutality of the practice of symphysiotomy turned what should be the most memorable and joyous occasion of childbirth into a nightmare.
These women were generally not informed in advance about their surgery. Neither the risks nor the benefits had been explained to them nor had the existence of a safer alternative, caesarean section, been mentioned. The failure of some hospital staff to inform women of their surgery was even more disturbing. Even general practitioners refused, on occasion, to tell women what had been done to them. Several decades had elapsed before many women finally understood that their pelvises had been broken. It was as though these were secret operations, not to be disclosed to the patient. The sinister role of the medical profession continues to this day as many patients have been unable to get access to their complete files. Last night we heard from victims who could access all their records apart from those relating to the birth of their children. It was as if it had never happened. This is a disgraceful attempt to defend the medical profession from gross injustices perpetrated on patients. It is something we have seen before and it is absolutely shameful. A large percentage of women who underwent the procedure of symphysiotomy decided against having more children due to the emotional and physical attack they had undergone without their consent and because they feared this procedure would once again be forced upon them.
We need to ensure that all the victims of symphysiotomy receive justice. This draconian operation left women with horrific physical and mental effects. As has been stated, many women still experience severe side effects due to the procedure of symphysiotomy and these severely impact on their quality of life. The women who were subjected to this abusive surgery in childbirth have repeatedly reiterated their call for the statute that bars them from redress to be set aside. As elected Members of Parliament, we have a duty to ensure that these women, whose constitutional and human rights were violated by these pelvis-breaking operations, finally receive justice.
Some people got in late on the act. Like previous speakers, I acknowledge the visitors in the Gallery and pay tribute to the women who have courageously pursued this issue for many years. It is a humbling experience for us to be present today. I was sorry I could not stay for the full presentation last night but we had to speak in the Chamber.
Nobody could say they were glad to be present today for that is impossible, but it is a recognition of what went on. It is an important acknowledgment by the State of the crimes committed against many of the women present today, crimes which led to the suffering endured by them and their families for decades. It is important that the Dáil acknowledges this. It was the butchering of women's bodies, without their consent, for no medical reason. It is truly horrific even to stand in this Chamber and talk about it. Marie O'Connor described it as a life sentence without remission. The procedure was the severing of one of the main pelvic joints, the sundering of pubic bones and the unhinging of the pelvis. It occured before, during and after labour and women were expected to endure it. It is horrendous that people were put through that.
It is important that we acknowledge the wrong done to these women but that is not good enough. People have endured this for decades. They have put up with it and have campaigned for justice in its regard. Today, we must do much more than acknowledge that a crime was committed, important though that may be. People need answers about why this happened to them. They need those responsible to be identified and called to account. They need the State to acknowledge it failed in its duty of care to prevent this from happening. Crucially, they need measures put in place so that all victims can get redress and have access to benefits and entitlements they should have as of right. That is not happening.
I noted the Minister's speech and the reports he commissioned. I asked him about the matter before Christmas - it was delayed. Today, the Minister told us he is awaiting further legal advice before he consults with the groups. I must agree with Deputy Ó Caoláin that this is a little disappointing. The issue has been discussed in this House for more than ten years yet even today half-truths are being put about. The first thing this debate must achieve is a full acknowledgment of what happened. The Minister must stop peddling a certain half-truth, namely, that symphysiotomy was a normal procedure that happened at the time and that although what happened to the victims was shocking and terrible we have moved on from that now and things are better. It was just a routine that happened in order to deal with difficult births.
We must nail that lie. That is not true. Unless we address that issue we will not get any nearer to dealing with the issue. Symphysiotomy was never medically necessary. Information that verifies this is available from medical experience throughout Europe. It was deemed to be too dangerous, a barbaric act, a mutilation. The Minister stated it continued until the 1980s but there were cases even in the early 1990s. This is part of our modern history and the women in the Gallery are living testament to it. We have a chance now to do something about it.
As historical records show, it was not a procedure used in emergencies but in many instances was a scheduled procedure by medical staff. It was not the case that caesarean sections were not practised or were not safe during the 1940s and 1950s. They were. That is a false statement. The reality of what happened was far worse than those half-truths which are being put out on the advice of the Institute of Obstetricians and Gynaecologists, which has a vested interest because its members were guilty of the acts in the first place. The reality is this was a practice, found in Catholic hospitals in the main, which affected 1,500 women. In essence, medical staff abused their position of medical power to carry out and deform women. It was part of an ethos that sought to control the reproductive rights of women. Women were seen as child-bearing vessels and because caesarean sections might limit the number of children they could have it was considered permissible to break their pelvis, in particular on the first child, and for young women, to enable them to have many children. As we have heard, in many cases this took place without consent being sought. People were sent home after major surgery and were not even told what had happened to them.
What does this say about our attitude to women who were denied the basic right to control or have a say about surgery being carried out on their bodies? A moral attitude was imposed on people by some medical practitioners in spite of best medical practice in place at the time. That is a crime. It is an abuse by those who were in position and people must be called to account for it. There is documentary evidence which links this practice to an over-zealous Catholic ethos that was promulgated by the likes of Archbishop McQuaid in order to impose a certain moral viewpoint on society, the health and well-being of women notwithstanding.
Anything that prevented birth had to be opposed and the rights of women were secondary. I find that abhorrent and it was a violation of human rights. If we acknowledge that point, we must acknowledge that corrective action must take place. Therefore, out of today's debate we need a number of corrective actions to be taken. We need an absolute commitment to lifting the statute bar to allow women to seek redress for the crimes perpetrated against them. It is urgent given the age profile of the women and their need to access it quickly. That is not onerous; it is a reasonable demand proposed by symphysiotomy survivors. The idea of an independent commission of inquiry is crucial. There is too much reliance on the opinion of professional medical people to advise the Minister in this regard and we need to step back. It is not good enough that these people investigate themselves. It is inadequate that no person or agency has been held accountable for this. It must stop if we are to move on.
The special Survivors of Symphysiotomy medical card should be available to all but it is not. Documented evidence available to the Minister and Members shows that many women have spent tens of thousands of euro trying to access medical assistance while they are receiving inadequate home help. They should have these benefits as a right, including a doctor of their choice, home help and more liaison officers. These important practical issues are the least these people deserve and while they do not undo the wrong they make the lives of these women easier. We have a chance to play our part, to reward the efforts of these women who have campaigned for justice over the decades. We can say that this crime ended today and that justice and redress began. We can be a part of changing modern Irish history, where we put it behind us on the correct basis.
In one and a half years in the previous Dáil and one year to date in this Dáil, I have come across a number of forgotten groups in society. These include the post-polio survivors, survivors of thalidomide and women who lived - or, rather, existed - in the Magdalen laundries. This is another group that has been forgotten by society. I acknowledge the work of Deputy Caoimhghín Ó Caoláin in bringing this matter to the Chamber, where it deserves to be, and in setting up the all-party group on the topic.
The facts of the procedure are chilling and disturbing. These include unhinging the pelvis, severing joints and sundering pubic bones. I acknowledge that 180 women still survive. Some of them have ended up permanently disabled, incontinent and in pain. Some faced the anguish of losing their babies doing the procedure. It is a very sad issue. In talking about it, can we do justice to the stories in the way these women can? Some of the women were unaware of what they were going through, which is frightening, because it was not spoken of until recently. I acknowledge the work of Marie O'Connor and her book, Bodily Harm: Symphysiotomy and Pubiotomy in Ireland 1944-92. She pays tribute to the women and speaks of their courage, tenacity, determination and indomitable spirit. It must be difficult for them to sit here and go through it all again.
The procedure was described as widening the pelvis but it really severed the pelvis. It was carried out by doctors at the same time as they were withholding the procedure of caesarean section. It was dangerous for mothers and babies and some procedures were performed in the aftermath of the caesarean while others were performed during labour. It is too cruel to think about it. Women in labour for many hours could have had the operation forced upon them without warning in the labour ward or in theatre and sometimes without anaesthetic. One can imagine the pain of women trying to give birth with an unhinged pelvis and then discharged with a broken pelvis with no medical treatment and no painkillers. The idea of patient consent or discussion with the patient of the implications and consequences of the procedure was a non-event. Options were not discussed and a lot of time elapsed before the women understood what had happened. It belongs to a time when women, their dignity and their rights were a non-event. We have seen examples of the failure of care during surgery and afterwards when people with walking disabilities were in chronic pain. The disability benefits were inadequate, as was access to services. These women suffered and their health was affected and they deserve to be looked after by the State. I note that the Minister mentioned the range of services but these are not getting through to all of the women. Like many of the ladies in the Magdalene laundries, their advancing age is a factor and they should have justice before their time is over. Caesarean section was a safer alternative yet dangerous operations such as symphysiotomy and pubiotomy were continued. This must be seen as an example of medical negligence and breaches of the constitutional rights of women, their right to dignity, the right to make decisions about their own bodies and the right to medical care and treatment. It was a violation of human rights and is linked to a male-dominated medical profession, the male-dominated Catholic Church and decisions made about women to which they were not party. Many of our institutions were involved in that. One lady called it a daily crucifixion.
I support the calls made and the questions that must be answered. We must acknowledge the physical and psychological disabilities. The questions include why there are no medical records, why they are not receiving the care they need, why medical staff did not give them information about the procedure prior to it and why women were discharged with pelvic injuries without providing adequate care. There is no doubt it is barbaric.
I do not have anything new to add to what has been said. It is very hard to talk about this. It is so horrific. It is clearly another example of men trying to control women's bodies. We have a male-dominated Parliament doing little about this, just as it failed to legislate for the 1992 Supreme Court judgment in the X case, which ruled that abortion is legal in Ireland where a woman's life is at risk, including through the threat of suicide. This is a moral attitude driven by a warped religious thinking and has led to bad things happening to good people.
We need a temporary lifting of the statute bar to enable women to seek redress through the courts. Justice demands that the statute of limitations be set aside for at least one year. We need to set up an independent commission of inquiry that is not controlled by vested interests and the access to the health benefits and entitlements promised by the Government in 2003, many of which were subsequently withdrawn or never granted, to be placed on a statutory basis. Fairness is all people ask and accountability, transparency and acknowledgement would go a long way.
I propose to share time with Deputy Regina Doherty. I welcome the survivors of symphysiotomy present in the Gallery to witness an historic and momentous occasion. Today represents an emotional occasion for them, their families and their friends. The women had to endure tremendous suffering for over 40 or 50 years in many cases due to the practice of symphysiotomy. It is of great significance that this is being debated in Dáil Éireann. Symphysiotomy was carried out on more than 1,500 women in Ireland between 1944 and 1992. It is said that it was used in exceptional circumstances and its use declined from the mid-1960s on, except in the case of Our Lady of Lourdes Hospital, Drogheda, where it remained in practice until 1984.
It is extremely disturbing to know that at a time when symphysiotomy was not being used elsewhere, it was still in practice in Ireland until 30 years ago. Serious questions must be answered in that regard and it is my hope that the draft report currently before the Attorney General will start the process of answering some of those questions.
I met with a number of members of the Survivors of Symphysiotomy last night, as did other Oireachtas Members, and one can only sympathise with the huge trauma they have experienced. This procedure, carried out in many cases without the permission of the patient, has left many women with permanent issues relating to mobility, incontinence, pain and depression. I read one extract in which a woman stated that after a symphysiotomy she had to be taught how to walk again. That is an example of the ordeal some of these women faced.
I listened last night, as did others, to horrific personal accounts of the way women were treated during childbirth and when I heard that women were shown a saw before it was used on them, I was horrified. I want to commend the women who came forward and told their stories last night because each time they tell them, they relive again the horror of what they went through. It was an awful experience for them.
I am a mother of two children who were both born by caesarean section and when I heard the stories last night of the way women were restrained, their arms pulled back and held down for the procedure to take place, I felt physically sick and ashamed that women could be treated in such a barbaric way in this country. The stories we heard were like something we would have heard happen in a remote part of the Third World in an almost ritualistic way.
Having a child should be a joyous occasion for any family but the sad reality is that this procedure has left women mutilated for life, to the extent that it has impacted on the quality and enjoyment of their lives. It has affected women from across the country, including in my own constituency. There was a telephone call to my office yesterday evening from a lady who had a symphysiotomy carried out in Drogheda. I understand she is unable to be present here today but she informed my office that she would be watching proceedings closely at home.
It is an important point, and other Deputies have alluded to it, that for the vast majority of women this procedure was carried out over 40 years ago. Some of them are now in old age and have been campaigning for justice all their lives. I hope that fact will be taken into consideration to ensure this matter is progressed as a matter of urgency.
As we are all aware, we are living in extremely difficult financial times and I am fully aware that the Government's strong focus is on improving our economic position. However, it is critically important that sensitive issues such as the one before us today are given the due consideration they deserve and not simply brushed aside, as has been the case in the past.
This is an issue which has cross-party support. I commend my constituency colleague, Deputy Ó Caoláin, who convened the all-party Oireachtas group and who I know has put a great deal of work into this issue. I pay tribute also to Marie O'Connor and to the groups that have provided many of the women with somewhere to turn to and ensured their voices are heard.
I reiterate my support for this issue. I want to impress upon the Minister to fully investigate it and to consider temporarily lifting the statute bar to enable women seek redress through the courts. Women have been treated with appalling disrespect. What they experienced was a form of institutional abuse. There must be an independent inquiry into this matter to ensure the pain and torture these victims of symphysiotomy endured can be publicly recognised, which would give them closure on the matter. I again impress upon the Minister that every effort should be made to ensure that finality is brought to this matter as soon as possible and that the women affected are given satisfactory closure also.
I am grateful for the opportunity to speak on this matter but I do so with a genuinely heavy heart. I welcome all of the ladies and their families to Dáil Éireann but I wish their visit was under different circumstances.
Nothing in the year I have been a Member of this House has affected me as much as this matter. I have huge respect for the courage and bravery shown by the women we have had the privilege to meet in recent months but when we consider the suffering, pain and trauma they have been put through for practically their entire adult life and the effects of that trauma on their husbands, children and, in some cases their grandchildren, I am devastated by it. I cannot even begin to imagine the pain and suffering each of those ladies have gone through in the past 40 or 50 years.
I have a long speech but I will not read it out. I just want to say that for the vast majority of their lives these women have been hiding their hearts from the people who love them the most. The vast majority of the people in this country do not know what a symphysiotomy is, let alone what any of these women have experienced. The commitment we can give is to ensure that the respect and the redress they are entitled to will be their reward. They deserve to be given their lives back but that is not within our gift. I urge the Minister to give these ladies the justice they so richly deserve and to do so as speedily as possible.
I cannot say I am happy to be participating in this debate but I value the opportunity to contribute on a matter that should have been dealt with many years ago. Like other speakers, I acknowledge the presence in the Gallery of the women and their families who have been affected by this travesty that has been needlessly visited on them.
My first exposure to this issue was in 2009 when, as Chairman of the Oireachtas Joint Committee on Health and Children, we heard a presentation in which Deputy Ó Caoláin was involved, as was the Minister, Deputy Reilly. I welcome the fact that the Minister remained in the Chamber for this important debate. In that presentation we heard reports from women that were harrowing. As a man, the thought of my mother, my sisters or my daughter experiencing the appalling, barbaric brutality these mothers experienced filled me with horror. What struck me most forcefully, however, was the dignity of the women and their families and their determination to work towards a solution to this problem in so far as any solution can be reached.
I acknowledge also that at that period the then Deputy Kathleen Lynch was very much to the fore in promoting awareness of this issue. I am conscious that as she is now a Minister of State in the Department of Health with the Minister, Deputy Reilly, who has an appreciation of the problems, we can all have a realistic expectation that this matter will be prioritised and action taken on it.
I compliment my colleague, Deputy Ó Caoláin, on his recent initiative in bringing together the all-party group. As he stated last evening in the AV room, the idea of us acting in a collegiate way can do a great deal to resolve issues. I am minded of the Deputy's former constituency colleague, Dr. Rory O'Hanlon, who had major experience in this area, both as a practitioner and as Minister for Health. He often stated in this House, and to me, that adversarial politics is very bad for public health. If we could have a more collegiate and collaborative approach to many of the issues on the health agenda we could work towards a solution for many of them in a more efficient and effective manner.
Like my colleague, Deputy Kelleher, I have no more than a layman's understanding of symphysiotomy. I accept it is a legitimate medical procedure but one that can be used in exceedingly rare medical circumstances. I understand for medical practitioners that in those exceedingly rare circumstances it has, on occasions, saved the lives of children and mothers. The problem we face is that in this country, most notably in three maternity hospitals, namely Holles Street, the Coombe and Our Lady of Lourdes Hospital, it was not used in very rare occasions, rather it was used with considerable frequency.
The Minister said symphysiotomy is not a barbaric act. In strict terms, he is correct. Amputation is not a barbaric act but the amputation of a healthy limb by a medical professional would be a barbaric act. What was perpetrated on these women needlessly, unnecessarily and with their knowledge was barbarism by medical professionals. It shocks us to the core to think it could have happened.
We commend the Minister for bringing in Dr. Oonagh Walsh and conducting a study. He indicated there are some legal difficulties in publishing it. We urge him to publish it as quickly as possible and ask the Attorney General to get on with the job of perusing it. We need another debate in the House immediately following its publication. It may well be that the solutions to the problem and the next steps are contained in the report. If they are, we will come together on an all-party basis and support the Minister in implementing them. If the report does not recommend the necessary actions, we will have to consider that.
Some reference has been made to the Catholic church and its possible influence on what happened. Any Catholic zealot who pursued these practices was no servant of the church and was not acting in a Christian manner. He or she should consider his or her position in terms of his or her view of Christianity and the church. The basic tenant is "Do unto others as you would have them do unto you".
Given that the church has been brought into the debate, we should also consider whether the procedure was a feature of the medical arrogance and godlike authority that was given to people in the senior echelons of the Irish medical profession. The attitude was doctor knows, doctor says, doctor is always right and doctor cannot be challenged. One would hope we have moved a long way from that situation.
We have to openly and unambiguously say to the women that they were brutalised by the State and the State apologises unambiguously to them. In 2003 SOS met the then Minister Deputy Micheál Martin. Attempts were made in the aftermath of that meeting to provide a comprehensive suite of medical supports for the women affected.
A very good job appears to have been done in the north east. I have heard many positive comments about Ms Joanne White, the liaison officer in the area, and the manner in which she assists women to gain access to treatment, even alternative treatments which have been chosen by many women. Liaison officers should be available across the country, similar to the service available in the north east. Medical cards and access to all the necessary clinicians, clinical support, aids and equipment should be made available.
The issue of compensation inevitably arises in case like this. I live in a constituency where Army deafness claims were a major issue. I know many people who took games against the State arising out of its negligence and that of the military authorities in providing them with the safeguards they needed in order to not damage their hearing by gunfire. I compare what happened to those men and women with the invasive and brutal experiences of the women who underwent symphysiotomy. The problem arose not from negligence but was deliberately perpetrated upon them.
When one compares the two situations, one has to say the State has to offer a compensation package to the dwindling group of women who now need compensation to live out their lives in comfort. I understand €321 million was spent on the Irish Army deafness cases. A tiny fraction of that figure is required to address, in some small way, the suffering these ladies continue to experience on a daily basis. The Army deafness cases were obvious. The suffering of these women is somewhat invisible and not known to the public. It is to be hoped that after today's debate it will be known and understood.
This debate should be one of the final steps towards finding a solution to this challenge. I have confidence in the Minister. He has been fairly clear in his understanding of the issue, although we might disagree on some of the details. He knows the suffering people have endured. It rests with him and I am sure he will be encouraged by the Minister of State, Deputy Kathleen Lynch, to move the situation towards the sort of resolution we need. I urge him to do that as soon as possible and ensure we can have, at the earliest possible date, a follow-up debate in the House on the issue in order that the matter does not rest until the measures that meet the needs, demands and rights of the people affected are put in place.
I am glad to have the opportunity to speak on this issue. I raised it a number of times when I was a Member of the other House.
As a society, in the past number of years we have lifted many flat stones, shone light into several dark corners and looked in horror at the scandals that lived beneath our notice. Just as no person can be completely sane without coming to terms with past traumas, no society can be healthy that is afraid to look at and heal its past.
Lifting stones and seeing horrors serves us by comforting the victims, punishing the perpetrators and preventing future disasters. All of us here are aware of the symphysiotomies that were performed in Irish hospitals from 1944-83. The previous Minister for Health announced a partial inquiry into one hospital, Our Lady of Lourdes Hospital Drogheda. I ask the current Minister for an inquiry into the practice in all hospitals.
This operation was simply the cutting in two of the cartilage that holds the hips together in front to widen the passage during childbirth. That description makes the process sound clinical, normal and even medical. The surviving women want answers, and I want them too. While the operation was simple in surgical terms, the reasons for its use in place of caesarean sections, the after-effects of the women involved and the role of a perversion of religious doctrine are far more complex.
Symphysiotomy was first advocated in 1597 by a French carpenter and became a rare and odd operation until better hygiene, anaesthesia and clinical practice made caesarean sections safer. In the developed world the operation fell completely out of use. Why was it reintroduced to Ireland in 1944? Why did Irish obstetric practice diverge from Britain and the rest of Europe in 1944? For what reason were Irish women condemned to endure a procedure that was genital mutilation and banished from the developed world? Symphysiotomy was described in 1951 by the then Nuffield Professor of Obstetrics, the finest obstetrics surgeon of his time, as medicine from the Dark Ages. He described it thus for good reasons. One clear and single reason led to caesarean section supplanting symphysiotomy when medical practice made caesarean sections safe. Symphisiotomies damage babies in childbirth. There is a 10% mortality rate, making symphysiotomy a high-risk procedure, even in skilled hands, for both the infant and mother. How many children were affected in terms of health and how many lost their lives because of the operations carried out in Ireland between 1944 and 1983?
Why did so many women who had symphisiotomies tell us of incontinence, walking problems and terrible chronic pain? Could there be a connection between the horrendous consequences for women and the after care they received? Women tell us of having been taken from their beds and made to walk within hours, despite textbooks requiring five to seven days of bed rest.
Serious questions must be asked about the manner in which the operation was performed and the after care women received. "Savage cruelty" is a mild term for the way in which the affected women were treated. Worse, it seems this savagery was visited on the most vulnerable. Women who were detained, often illegally, in the so-called Magdalene homes, including single mothers and the poor, may have been doubly victimised through being subjected to bush-clinic obstetrics in a modern country.
I am a practising Catholic but believe the use of the procedure to avoid family planning sought by women was a disgusting perversion of Catholicism. However, this may have been a motivation for inflicting the procedure on women. We need to know whether this was the case.
We know from recent times that tribunals can be lengthy and costly. An inquiry into symphysiotomy can be done simply and cost effectively. A legal and medical expert should be employed to conduct such an inquiry.
For women trapped in incontinence, immobility and constant pain, symphisiotomies are not history. What do numbers matter when one baby killed leads to a lifetime of grief and sorrow, inflicted for no reason? Now is the time to give answers to those alive to hear them. A relatively cheap, simple inquiry would provide such answers and would be some recognition of the misery misguided medicine has inflicted. It would go some way towards giving closure on foot of the pain of the affected women.
I had a quite technical speech written but will leave it alone. I will keep my head down because I feel so ashamed about the way the women in question have been treated. I ask the gentlemen in the Chamber to excuse me when I say I feel so strongly about this subject as a woman. Symphysiotomy was still carried out in 1984, only a year after I had a baby. To think I could have been subjected to the barbaric practice, with some sort of religious overtones or undertones, is frightening.
I accept the Minister's statement that it was believed the procedure was good at the time. However, one should consider the after care the women received. The procedure was carried out by intelligent people. My Government colleague has likened it to female genital mutilation. I would liken it to it also. Female genital mutilation, as with symphysiotomy, is a fundamental violation of women's human rights. Their civil liberties are being defiled, predominantly those associated with health, freedom of choice and the right not to be degraded.
A primary reason for the performance of female genital mutilation and symphysiotomy is related to sexual, health and religious concerns. Female genital mutilation is performed in Third World countries but we, who believe we are so modern, should realise symphysiotomy is very similar and was preformed in Ireland until 1984, which I consider to be very much in the recent past. Doctors chose to perform the procedure instead of caesarean sections.
Caesarean sections date from long before Julius Caesar, after whom the procedure is named. I have no idea, therefore, why symphysiotomy was reintroduced in 1944. The medical profession should have known about its dangers. Had practitioners opened their eyes, they would have seen the difficulties experienced by women who had the procedure. It is heinous.
I, too, would like all the answers. I urge the Minister to bring about closure regarding the horrendous practice and the way in which affected women have been left to one side. The Government is committed to achieving closure for the victims of symphysiotomy.
I heard harrowing stories last night, one of which was about a woman who had the operation performed on her when she was only 33. The procedure took away her mental health, her relationship with her husband and the relationship she should have had with her children. I feel really ashamed that symphysiotomy was carried out in what was deemed a modern country. I urge the Minister to do whatever must be done to bring about closure on this awful episode.
I wish to share time with Deputy Peadar Tóibín.
I never heard of symphysiotomy or pubiotomy until a year ago. It was brought to my attention by two very brave women, Ms Olivia Kearney and Ms Catherine Naughton, women of great grace and courage. Since then, I have met many other victims and survivors, and the advocacy groups. I commend them all. I commend an Teachta Ó Caoláin on his leadership on this issue.
Symphysiotomy and pubiotomy amount to institutional abuse. Symphysiotomy involves acts of butchery against female citizens The State should be deeply ashamed about what it allowed to happen to them because of the influence of conservative religious fundamentalism.
Last night, a group of survivors, including Matilda Behan, Ellen Moore, Helen Kennealy and Anne Ward, who spoke on behalf of her mother Mary MacDonogh, gave testimony to the hurt and trauma they suffered. As colleagues have said, the accounts were deeply distressing and upsetting for those who gave them and for us who listened in silence. The 200 or so survivors of symphysiotomy are mainly elderly and some are becoming quite frail. They carry the deep physical and emotional scars.
A woman called Lilly McDonnell called to see me in Drogheda. She was a victim 60 years ago and told me how her child was killed in the course of this procedure and of the physical damage done to her. She showed me the child's birth certificate. Like the other survivor, Lilly lives daily with the harrowing consequences of what was done to her six decades ago.
I do not want to give a history of the practice or of the use of misinformation to deny the victims justice and truth, or of the destruction of records, the shameful use of many of the women as teaching aids in hospitals without their consent, and the denial of proper after care. These details have already been outlined graphically. Our focus as Teachtaí Dála must be to ensure this deep wrong is finally brought to a conclusion in a way that is acceptable to the victims. In a real republic the rights of these citizens would have been protected and the survivors of symphysiotomy would have had justice many years ago. They have campaigned for truth. They have asked one Minister for Health after another to provide the truth through the establishment of a full public inquiry.
I am deeply disappointed by the Minister's statement today, however, even though he was moved by the case of the witness brought here by other colleagues. There is all-party support for these women. In opposition, the Minister for Health, Deputy Reilly, gave his full support to the demand for a public inquiry at an Oireachtas committee hearing in 2009. Now he has the responsibility and the power to finally make it happen. He can say he will authorise a full public inquiry into these events. Nothing else will suffice. Nothing else will do.
I know from my experience in a different area that unless the victims are given satisfaction, the campaigning, but more importantly, the hurt, the anguish, the grief and the bereavement will go on. Given the increasing age of the victims, the chronic pain and constant medical intervention they require, it is urgent the Minister deals with this by giving them support now. I appeal to the Minister to assure victims today that he will hold an inquiry as they have requested. I also appeal to him to ask the Government to agree to the lifting of the statute bar to allow victims to seek redress through the courts.
There are several justice campaigns which can be resolved in this Dáil term. They include Justice for the Maggies, for other victims of institutionalised abuse, including Bethany Home and at Our Lady of Lourdes Hospital, Drogheda, and victims of symphysiotomy. These causes are crying out for justice. We can do something about it. These women as citizens deserve our support, our love and they particularly deserve to have their wrong righted. We as Teachtaí Dála have a duty to make this happen.
All Members who have listened to this debate on symphysiotomy, and the excessive pain suffered by women as a result, have described it as a barbaric procedure. Many of us who met the women who underwent this procedure have learned how their lives were affected and shaped subsequently. Listening to their stories, many of us have been shocked. There have been very few occasions when I have attended presentations in the Leinster House audio-visual room where noticeably people in the audience were moved to tears on what they had heard. I commend the individuals who have fought this campaign through thick and thin. It is not easy for people to discuss their personal lives and what was done to them in such a manner. It takes great courage to do so and I commend the individuals involved.
What sets aside symphysiotomy from other invasive medical procedures is not just its brutal nature but that it is completely avoidable. Alternative treatments could and should have been used. There was no justification for the procedure then and neither is there any justification for the perpetuation of the injustice experienced by these women now. This procedure was performed on approximately 1,500 women, many from my constituency who attended the Our Lady of Lourdes Hospital, a hospital that continued with this procedure up to modern times long after all others had ceased. This again raises an issue about the clinical governance at this hospital through this period.
These operations were undertaken because of a narrow interpretation of a religious ideology and no consideration was given to the views of the mothers. No alternatives were offered or explanations given of the long-term effect of the procedure. Nowhere was the informed consent of the women who underwent this procedure sought. These women entered the care of the State as expectant mothers and left as injured victims.
While for many these events are historical, the outcomes are very much sadly in the present. We still have very brave women who carry the scars of this procedure and have been forced to campaign for justice. No one in this Administration is going as far as they should to hold the individuals to account for what happened to these women. It is true the damage cannot be undone. However, these women are entitled to justice. It is in the Government's gift to recognise that what happened in the past in the name of the State was wrong.
It is also in the gift of the Government to extend the Statute of Limitations to allow these cases to be dealt with and to make public the report on this situation. As the Opposition, it is our job to hold the Government to account. While we may have a different vision, political philosophy and policies to those of the Government, I believe there is a common decency that we all share. It underlines a common morality of what is right and wrong. The Government knows what needs to be done for these women.
In the past they were victims because a system prioritised other considerations above their rights as citizens and mothers. Let us not repeat that mistake. Let us not put legal or financial considerations before ending this injustice. We must finally do the right thing by these women.
Ireland, unfortunately, has seen many abuse scandals but the tale of abuse suffered by the victims of symphysiotomy is a particularly squalid and vicious stain on our national history. I do not use the word "abuse" carelessly for I believe what was done to the women in question, as other Members have stated, was a form of institutionalised abuse. Ireland has failed these women. We failed them when we first inflicted this barbaric procedure on them, long after it had been discontinued in other developed countries. We failed them in 2003 when the then Minister for Health and Children refused to hold an inquiry. We failed them again in 2010 when the then Minister, Mary Harney, again refused an inquiry. The Minister for Health, Deputy Reilly, has commissioned an independent review of the practice of symphysiotomy in Ireland due to be published soon.
The story does not stop there, however. We must be sure not to fail these women again. Some of the language and phrases emanating from professional medical institutions and State officials in the lead-up to the publication of this report has been concerning. Phrases such as "standard procedure for the time" and "emergency surgery only" have been wafted into the air to serve as a smokescreen to cover up some of the deliberate and planned actions in the use of this horrendous procedure which had lost credibility a long time ago. This was not a standard procedure in developed countries. To call it such adds further insult to the injuries suffered by the women in question, many of whom are from my area Louth and Meath.
The procedure was resurrected in Ireland, I believe, to facilitate a perverse and twisted interpretation of religious doctrine whereby women should continue to have children regardless of the impact on their health. Symphysiotomy was rejected by British doctors in 1855 while the French Society of Medicine rejected it as far back as 1798 at a time when the French were guillotining people by the thousands.
Last night some survivors of symphysiotomy came to Leinster House to tell their own stories. One woman spoke of how she was held down by nurses, her arms forced back, while a doctor sawed through her pubis in front of a theatre packed with students. She screamed at him to stop an operation for which her consent had neither been sought nor given. She said it was like she was forced to endure an aggravated sexual assault. This is a woman, a mother, a wife, a sister, a daughter, who is now in her 80s but still cannot sleep at night. She has been incontinent most of her adult life and has suffered a succession of health problems as a result of the injuries inflicted upon her. She was a young woman then when this horror was inflicted on her and occurred at a time when the world was still reeling at the atrocities carried out by the Nazis including their gruesome medical experiments that we know about now. As a young woman, she wondered how something such as that could have happened to her in her own country. An older woman now, she is yet to receive a comprehensive answer.
In the wake of the Cloyne report last year, the Taoiseach and the Tánaiste rightly condemned the culture of secrecy, evasion and deceit that had characterised the response of the Catholic Church to the issue of child abuse. We cannot allow a similar culture to fester in the corridors of Departments and professional bodies. There are already far too many disturbing stories of women being denied access to their medical records or of their records being conveniently lost. Last night, a woman spoke of how the hospital in which she had given birth to her five children had no record of them. According to the hospital, they did not exist. Elements of official Ireland are seeking to air-brush history. We must have the truth and there must be a day of reckoning.
What practical measures can the House take and what can we, as public representatives, do? Deputies from all parties can begin today by giving the victims a voice, but we must ensure that voice is heard to good effect. There can be no further cover-ups or evasions. There must be access to some form of legitimate redress. A day rarely passes when I knowingly or otherwise do not encounter a friend, family friend, neighbour or member of the community in which I was born and reared who has not been directly affected by the impact of this barbaric procedure.
To facilitate the continuation of this process of redress, we should do as the Deputies opposite suggested and give consideration to a Bill to suspend the Statute of Limitations temporarily. There is a precedent, although the House does not need to be reminded of it. Only approximately 150 victims of symphysiotomy are with us. Many have passed on. We have failed these people too often and must not fail them again.
For several decades, the practice of symphysiotomy has had a devastating effect on women. Barbaric acts were inflicted unnecessarily on women who were in their most vulnerable state. At a time when joy for a newborn was to be expected, women were subjected to a procedure that would alter the rest of their lives.
The procedure was carried out on up to 1,500 women and resulted in a wide range of short and long-term complications, including walking difficulties, haematoma, incontinence, infections and pelvic joint pain among others. I remember well the indignity of having to be shaved, being given an enema and having an episiotomy, all to spare the blushes of the male doctors. Little did I realise at the time that the situation was worse for many women.
Watching the "Prime Time" programme on this matter a short time ago brought home to me the effects of this procedure. The acts were not consented to and amounted to institutional abuse. There is no retrospective justification for them. This 18th century practice was alive and well in the 20th century when other countries were phasing it out. The technique does not form any part of the Irish curriculum of specialist training and is apparently only taught as an emergency procedure. If this is the case, why was this practice being utilised by doctors in this country? Why was it that, in some cases, the procedure was carried out after the baby had been safely delivered, let alone before or during birth? Why on Earth were doctors with saws allowed to perform pubiotomys?
Survivors of Symphysiotomy, SOS, is a group that was formed to answer questions such as these. Like other Deputies, I welcome the many women in the Gallery, in particular a good friend of mine from County Wicklow, Marie and her husband, Billy, who have unsuccessfully lobbied previous Ministers to seek justice on this issue. The women in the Gallery represent only a fraction of those affected by the practice. Many women have passed away and others are unable to make it here today for health reasons.
I understand that the SOS group is seeking resolutions on a number of matters, including the lifting of the statute bar to enable women to seek redress through the courts, the setting up of an independent commission of inquiry, and access to promised health benefits and entitlements to be enshrined in statute. The Minister for Health has received a draft report on the practice of symphysiotomy from an independent academic researcher. I understand that this report has been sent to the Attorney General for her consideration and, subject to her views, will be made available for consultation.
It is important that, in the intervening period and until decisions on what will be done are taken, women have easy access to support services provided by the HSE. This has not been the case to date and some individuals have not even been able to access their own medical records. I urge SOS to press on and to keep up the pressure on politicians to act. Groups such as SOS are fundamentally important in bringing to light the dark side of a society that liked to hide in the shadows. The barbaric acts of the past are brought to the fore when a few people who are committed to seeing justice done come together. This is why the work of a coalition such as SOS should not be underestimated. I am reminded of a saying, "Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has".
I am heartened by the cross-party support on this issue. I thank Deputy Ó Caoláin for convening the meetings and getting everything going. He is to be congratulated. I hope that the justice sought by SOS can be realised and that it will go some way towards addressing the grave wrongs that have been done. In the meantime, we all hold our heads in shame.
I welcome the women to the Visitors Gallery. If anything has united them other than the symphysiotomy procedures performed on them, it has been the powerlessness. Today's debate contributes to some of their power being returned to them and acknowledges that the issue is an important step. However, it is only a step, as we would all agree.
The debate forces those of us contributing to it to carry out research. All of today's contributions have been important. I was not able to attend last night's briefing, but I spoke with colleagues who were there. They were deeply affected by it. Communication is viewed as being primarily about speech, but listening to people is just as important and was the most powerful element of last night's briefing. It was important that Members listened to the women's voices. Some people believe that politicians are less than human. In fact we are very much affected by the types of issue that impact on people, including this one.
I have some knowledge of this issue because my mother had a symphysiotomy in 1952 in Holles Street hospital. She is in her 90th year and still talks about it. In many cases, the practice was intended to ensure that a woman would not have a section. The idea was that a section would limit one's ability to have a raft of children. It worked in my mother's case. By 1956, she had five children and more were to follow. The idea was to deliver a large number of children into a Catholic country.
The question of clusters is interesting. This point has already been made. Symphysiotomy procedures primarily occurred in hospitals with a Catholic ethos. The evidence from other European countries shows that this was not a dominant practice there. One must question the medical aspects to which the Minister referred. If the upcoming report is to be a proper one, we must also question the ethos. This is what has resulted in women's powerlessness for years.
One of the first tasks for most expectant mothers - I have two children - is choosing their hospital. They want to be able to trust the hospital and its professionals to take care of them. A large number of women believe their trust was abused. In the Ireland in the 1950s and 1960s, the church, State and professions thought they knew best. It was not the thing to do for a mere woman to question a consultant.
In most cases this procedure was carried out on women expecting their first babies. Not only were these women less knowledgeable about child birth, but the procedure also made the birth a more traumatic experience because it lengthened the period of labour. In most instances the procedure was carried out during labour. If it was done for purely medical reasons, such as to reduce the mortality rate among women and babies, it would have been accepted to some extent. However, the practice was primarily clustered around hospitals with a Roman Catholic ethos and this was central to its use. Deputy John Paul Phelan asked why the procedure began to be carried out in 1944. I have been asking myself the same question but one only needs to look at the religious control exerted during the 1940s and 1950s for the answer. While I am not religious, I defend the personal right to practise religion. However, it is wrong to allow religion to control society. Large families were the norm in Ireland and as late as the 1970s mothers were questioned if they only had two or three children. Family planning clinics could not charge for artificial birth control in the 1970s. They had to ask for prescriptions because it was illegal to sell contraceptive drugs without them.
Our society was changed by the courage of those who challenged the system. The women who took the train to Belfast and came back with contraceptives were openly defying the State. Similar courage has been displayed by the residents of the Magdalene homes and the victims of industrial abuse. This society has been challenged by their personal stories.
I almost feel sorry for the Minister because I am aware he has to be balanced in his remarks. He adopted a different attitude when he was in opposition, however. The Minister of State at the Department of Health, Deputy Kathleen Lynch, advocated the establishment of an inquiry into this issue. Any report that solely considers clinical issues without addressing the social context will be unable to provide the answers people want. I am concerned by the Minister's comment that the researcher experienced unforeseen difficulties in accessing information. It has been noted by other speakers that some of the medical records no longer exist. It is, therefore, difficult to quantify the numbers involved.
The Minister stated that Ireland is one of the safest place in the world to have a baby. I hope that continues to be the case but it is important that we examine these practices because we will have to contend with a reduction in the number of professionals working in the health service. It is questionable whether there will be adequate staffing to ensure that we continue to be one of the safest places in the world.
It is essential that an independent inquiry be established. The women concerned must be able to get answers as well as the medical treatment they require. Teaching practices at the hospital must be examined because if they have been exported to other, less developed countries I would feel responsible for the impact on women in those countries.
I thank those who kept the matter on the agenda, including Deputy Ó Caoláin for convening the group. It is important that we come to a satisfactory conclusion. We will not be able turn the clock back but the least we can do is ensure that people's questions are answered and their health care needs are addressed. Given the small number of people involved, extending the Statute of Limitations would allow the State to acknowledge a wrong that should be addressed even if it cannot be put right.
I knew nothing about symphysiotomy and pubiotomy until the constituent to which Deputy Anne Ferris referred invited me to a meeting. I listened in horror to the stories being told. Coming from a farming background, I have cared for hundreds, if not thousands, of animals while they gave birth and I would call a vet if I needed help. A vet would be more considerate than some of these people.
As I was tied up in committee meetings, I did not get the opportunity to hear the Minister's speech. I do not want to read a copy of it because I urge everyone concerned to set aside the protective mode and acknowledge the wrong that was visited on these ladies. They were abused for experimental or religious reasons, or simply because of an attitude of medical superiority. Some of those who spoke last night argued that it is too simple to blame the religious ethos of the hospital. Medical experts appeared to take the elitist attitude that they had the right to choose how mothers should plan their families. Given that caesarean sections have been safe since the 1930s, there was no excuse for preforming these procedures in 1944.
At the very least, these people deserve to be told they were treated horrifically by the State and the medical profession. The only way we can deal with the issue is by lifting the Statute of Limitations to allow them to seek redress in an independent and fair manner. Peace and reconciliation commissions have been established in South Africa and on this island. In this case we need a truth and reconciliation commission. We need a forum whereby people who still believe they did nothing wrong for whatever reason meet the people on whom they foisted this abuse and their families. Having listened both last night and previously to these ladies' stories and the stories of their families - husbands, daughters and even grandchildren - it is clear their lives were utterly changed.
I am the eldest of eight and my mother is 81. I feel so grateful that she was lucky enough not to have had to endure that. Last night, I listened to one daughter talking about to her mother. My mother taught for 36 or 37 years as a schoolteacher and reared eight children. She is lucky enough to have her health and all her faculties about her. She used to say teaching was getting away from us, which is probably a fair assessment of what she had to do.
Only for the bravery of a very small group of people who are left in bringing this story to our attention, this would have passed us by. The men here are as moved by it as the female Members. I commend Deputy Ó Caoláin. Even though we have enough reasons to divide the House, on this topic we have managed to unite to try to find a resolution to this terrible wrong that was done to these women. They need at least to have faith in the structures of the State that acknowledges it in the first place and tries to deal with it as best we can. While the Statute of Limitations is important, it is not the only part of it. We need some sort of truth and reconciliation forum to allow people meet their demons on both sides.
I thank my colleague for allowing me speak for a few moments on this important issue. In the aftermath as we discuss it here in the calm light of Parliament we must reflect on the options available to women who were subjected to this treatment over a long number of years. Notwithstanding medical science advances over the period, this practice continued on regardless for some reason that I do not know. I have always developed a healthy respect for consultants and also the need to confront consultants and the basis for their opinions, although I do not always get applauded for it. The practice that went on was, to say the least, archaic and savage. It was more in concert with medieval times than with the 1930s, 1940s and more recent times.
My first knowledge of this issue arose from a television programme because it was not a subject matter that was discussed too widely, and understandably so. The women who were the victims of this practice were embarrassed. They were embarrassed socially and would not even tell their families. As a result there was a certain amount of silence. However, that the process could continue unabated notwithstanding the fact that various people raised issues is a sad reflection on how we allow things to happen when we could and should do something about it. It is particularly true in this instance. This practice was carried out by qualified people who should have known better. I do not want to draw inferences from other happenings in the 20th century where people in similar circumstances should have known better. However, at this time we should be clear about one thing. To my mind this is tantamount to criminal negligence - it is a serious matter.
While we are discussing it in the calm aftermath, the people who carried out these practices knew full well the consequences at the time. They could not but have known it and it was brought to their attention on numerous occasions. Sadly, it took until now to get general recognition that a practice continued year after year that, to say the least, was prehistoric. It was a savage and painful practice with a long-lasting negative impact on the individual women concerned. It was totally unnecessary in the light of emerging science. In those circumstances, we need to ask whether we can now put in place restrictions on the carrying out of any similar practices that might be found at a later stage to be detrimental to the health and well being of anybody in any sector of the community. People who are in a vulnerable situation receiving treatment in hospital will automatically draw on the advice made available to them. The presumption is that the best advice and the best attention is about to be given to them. In this case, it was not, and the evidence shows it.
None of my family members was a victim of this practice. In one area of the country this seemed to be an ongoing practice that had become acceptable, which is a sad reflection on the health services in general. I hope that what has been learnt from the discussion that has taken place on this issue will serve us in good stead in remembering not to allow practices such as this to go unabated in future and particularly not to allow them to go unchallenged.
Listening to this morning's debate I am struck by the level of cross-party agreement that this practice is barbaric. The word "savage" has been used on several occasions this morning, which is what it is. I was struck by the contribution of Deputy Ann Phelan, putting herself in that situation given that the practice was ongoing. I compliment Deputy Caoimhghín Ó Caoláin and the former Deputy, Dr. Rory O'Hanlon, on the work they have done in this matter. In particular, I thank Deputy Caoimhghín Ó Caoláin for giving us this opportunity as Oireachtas Éireann to unite in condemnation of this practice.
As we come towards the end of these statements we need to give these people some sense of justice. We need this report to be published. I do not doubt the Minister's personal commitment given that he acted very quickly on coming to office to commission the report. However, I get very weary when I see the Office of the Attorney General involved in anything. The Office of the Attorney General looks after laws and we have to look after justice. As an Oireachtas, we have responsibility to deliver justice. It may be necessary to put a bullet under someone to get moving and get this report issued so that we can see exactly where we go from there.
We need to investigate the issue of clustering and why this was specific to certain areas. There seem to be difficulties in a particular area regarding a range of health issues - I speak about the north east. Many of the issues we discuss seem to come back to the north east area. Perhaps it is time to have an overall inquiry into what was going on there rather than investigating the area topic by topic.
What redress will be given? We can never compensate women for hell they have endured with the complications following this procedure. However, we can give some sort of indication for the financial hell they endured. That also needs to be resolved.
Some people have referred to the wider issue of the faith we place in consultants at a very difficult time. In general, people need consultants at a difficult time when they are not in a very good frame of mind and have some sort of serious medical condition. Many consultants do not respect or understand the position their patients are in when they go to them. They treat patients and their families with a degree of contempt. They do not give them information or lay out the options. A large minority of them believe that a patient is blessed to be in their company - the majority are good decent people. This is symptomatic of what was going on here - the doctor knows best and the patient will suffer the consequences. We must ensure that culture is wiped out of our health system and ensure that the patient is put first, that the patient has rights and that the patient is treated as a citizen of the Republic with dignity and respect. Personal opinions and beliefs and everything else should play second fiddle to the citizen's rights.
In a week when there has been division and rancour in the Chamber I have been struck by the past two hours when there has been unity. I did not make the briefing last night but I understand people who were there were shocked to the core. Last night's briefing and this morning's debate will amount to a waste of time if we have to come back here again in two, three or four months time without a published report or some type of action plan. We have done the talking and the empathy. The Oireachtas will never really be able to understand what the victims of this savage procedure went through and are going through. We must give them justice. Our responsibility as legislators is to provide justice for our citizens. Let us not return here unless we have a report and an action plan in place.
I thank the Deputies who raised the issue in the first instance and I thank those who spoke. All of those who spoke have conveyed not only a great degree of sympathy but also the degree of urgency with which this issue must be addressed. I commend the brave women who have spoken out. I have no wish to dismiss men's experience, which is considerable, but as a woman it is very difficult to speak about something as personal and as debilitating as this procedure. It is not simply about aspects of orthopaedics and so on. In some cases this procedure led to incontinence and this remains an issue. This is something women find remarkably difficult deal with in a social context, as anyone would.
I have taken a particular interest in this area but I admit and I confess that I did not attend the recent briefing, because this is one area which I believe could take a night's sleep from me. The barbarism inflicted and its consequences are unforgivable. I met several Deputies who came from the briefing last night and who were rather traumatised. Some Deputies had only heard about this issue for the first time. They included male and female Deputies. We cannot continue to pretend this did not happen.
I was interested in Deputy Catherine Murphy's contribution. She referred to the inquiry into the Magdalen laundries. We have been left with historical and legacy issues which should have been dealt with several years ago but which were not. We are now coming to grips with these. I have discussed this issue at great length with the Minister and he believes, as do other members of the Government, that these issues cannot simply be left in abeyance. It cannot be a case of deny-until-they-die Government. We trust that this type of governance and Government is a thing of the past and we will deal with this. We sought for a report and a review which, we all agree, must take place quickly. We cannot have the type of delays which occurred the past. This must be done quickly. When the report is before us we will take a clear view of it, in consultation with not only the groups representing the women but with the women themselves, to determine the way forward.
I will not read the official speech which provides a list of what is in place and what services are being provided. We are all aware of the position. Anyone who does not receive the services available should be proactive and determined about accessing them because the Government has provided for them. There is no excuse. No woman who has undergone this procedure should have need of the service but they need to be proactive in any case. We must come to terms with our past. I will not advert to what Deputy Calleary has already hinted at in terms of particular areas of the country and the procedures carried out there. However, we must come to terms with the past. I do not believe it was entirely an matter of ethos. Certain practices were in place and there was a lack of control and administration. A combination of forces came together to allow these things to happen. I hope the code of conduct to be introduced for consultants and medical practitioners in general will ensure that we have safeguards in place against such a thing occurring again.
I am loth to use the term "these women" because basically these women were mothers at the time. They were women who went into what should have been a joyful occasion and came out to the sort of life we would expect. Some were unable to care for their families and had to get certain supports. In some instances these women were not understood and they were unable to explain why they were having particular difficulties. I can only imagine what that was like.
Some women suffer from depression after childbirth. They have a great difficulty in explaining to people why they are not as joyful as others who have had babies. I can only imagine what it must be like for these women to describe and explain something that was far more complicated and far less widespread. We should keep this at the forefront of our mind as well. We must be mindful of the lack of joy that came with having a new baby and the great difficulty not only in looking after that baby but in carrying out the other duties normally expected of them as well. We must also keep in mind the sadness this must have brought about.
We must deal with this. We must recognise our past and we must accept that what took place in the past must be dealt with now. However, this must be about the future and about protecting women who find themselves in this vulnerable position as well. We must ensure that this never happens again with the new code of conduct. We must also ensure that when the report comes before us we act as quickly as we can to determine the future not only for these women but for others who may find themselves in this position. We must ensure we act quickly. The days of putting it off are behind us.
We are in a very difficult position financially but this should not stop us doing what is right and just. A good deal has been put in place but we must do more. I congratulate these women for having the courage to stand up and set out in detail what happened to them.
On a point of order, only one minute remains. We have had great encouragement from the visitors following each of our contributions. Heretofore, it has been the practice that when distinguished visitors join us in the Gallery we show a true welcome. I call on us to reciprocate and give an applause to our distinguished visitors here today.