Dáil debates

Thursday, 15 November 2012

10:30 am

Photo of Niall CollinsNiall Collins (Limerick, Fianna Fail)
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We welcome the appointment of the independent external expert in obstetrics to strengthen the incident management team's investigation into the tragic death of Savita Halappanavar. Yesterday the Taoiseach said he would not rule out an independent inquiry into Savita's death and this is an option that could and should still be pursued. There have been calls from the medical profession for a legislative framework to be introduced along the lines of the Medical Council guidelines. Two days ago the Minister for Health, Deputy James Reilly, received the expert group's report. The expert group was set up to assess what had to be done following the judgment of the European Court of Human Rights in the A, B and C cases. He will obviously be studying it, but will the Tánaiste outline when it will be published? Surely it will be published as soon as possible. It has already been reported in the media that the export group does not recommend the introduction of specific legislation but discusses a number of options and it will be left to the Government to decide whether primary or secondary legislation is required.

Obviously, this issue brings out different opinions in people and communities across the country. Debates will, unfortunately, be heated, personal and, at times, irrational. As we know, every Deputy has been lobbied from all sides. I hope the tragic death of Savita will allow the expert group's report to be debated in an open, sensible and mature manner. We do not need to create more division. In this regard, we have three questions for the Tánaiste. Will he outline when the report will be published in order that it can be debated in the House? When will the Government be in a position to respond to it? Does it intend to refer it to the Oireachtas Joint Committee on Health?

Photo of Eamon GilmoreEamon Gilmore (Dún Laoghaire, Labour)
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First, I take the opportunity to express my own deepest sympathy to the family of Savita Halappanavar. This is an appalling loss which has, rightly, touched the hearts of all Irish people. It is, of course, true to say we do not yet know the full circumstances of what happened, but anybody who listened to Savita's husband yesterday has to be deeply concerned having heard his very dignified and moving account of what happened to Savita. I thank Deputy Niall Collins for the tone with which he raised the issue this morning. It is one of those issues on which we are all reminded of our duties, as legislators. It is not a moment for shrill voices but for respect for a grieving family, dignified discussion and determined action.

We have to await the outcome of investigations under way into Savita's very tragic death, but there are issues we have to address and to which we need to bring legal clarity. Essentially, it centres on what happens in a set of circumstances where a woman's life is at risk and medical professionals may not be entirely clear on where the lines of their responsibilities and duties lie. These were the issues addressed in the cases which went before the European Court of Human Rights and it was to address these issues that the Government decided, on its formation, to establish an expert group, chaired by a High Court judge and made up of medical and legal experts, to bring to the Government recommendations on what steps we could take. That group has now reported to the Minister for Health. I understand the Taoiseach and I will receive the report some time today and it will be considered by the Government. It will, of course, be a decision for the Government as to whether it will be published. There is a timeline with which we have to comply, as we are required to make a further report to the Council of Europe by the end of this month. We will comply with that requirement. Therefore, the steps will be as follows: the report is in - the Minister for Health obviously needs time to consider it and judge what issues arising from it he will bring to the Government; it will be considered by the Government; a decision will have to be made on its publication; and a decision will also have to made on how it is to be dealt with in the House.

We all need to be clear on this issue. It is 20 years since the Supreme Court made its finding in the X case. It is time to bring legal clarity to the issue. It was to that end that we set up the expert group and we will now deal with the recommendations in the report made to us.

Photo of Niall CollinsNiall Collins (Limerick, Fianna Fail)
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I thank the Tánaiste for his reply. I agree with him that it is a very sensitive issue and it behoves all of us, as parliamentarians and public representatives, to engage in an open and honest debate. The people are demanding that this debate take place as soon as possible. The Tánaiste has outlined some of the timeline in regard to the reply that has to be given to the European Court by the end of this month or early in December. However, we have to engage with the political process. Let us be honest. There are varying views within all political parties and all sections of society.

It is incumbent on the Government to publish the report and have a full and open debate. Will we have a debate in this House on the State's response to the judgment of the European Court of Human Rights prior to the Government reporting in December? Our obligation and commitment to report back in December is the only timeline the Tánaiste has indicated. What will happen after that? What steps does the Government intend to take in order to arrive at consensus that will bring as many people as possible along the journey? Will the Tánaiste please outline the situation and provide more detail?

10:40 am

Photo of Eamon GilmoreEamon Gilmore (Dún Laoghaire, Labour)
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I agree that we should discuss the issue in the House. It should be discussed in a reasoned and informed way. I hope I did not give the Deputy the impression that the report will not be published. It is simply the case that the Government must make a formal decision to publish the report. I accept that the debate must be fully informed. We must examine the group’s recommendations. The group was set up to examine the various options that could be progressed and to view the issue in its totality and complexities. The discussion we will have will be based on the report. The report has just been submitted and the Government must consider where we go with it.

The timeline is that there is a requirement to make a report to the Council of Europe by the end of the month. We will comply with the requirement. What further steps will be taken, how the issue will be progressed and how we will get the legal clarity we must have on the issue will be based on what is in the report. I would envisage that we will have a discussion in the House, if necessary in the Joint Committee on Health and Children. The issue is currently being discussed by the general public in any event. The discussion must be a reasoned, reasonable, dignified one and it must be focused on what it is we need to do to bring legal clarity to sets of circumstances that have been outstanding for a long period that are very real. Although we will not know the full details until the investigation has been completed, we have heard what Savita’s husband said yesterday and as legislators we have a duty and responsibility to respond, act and deal with the issue.

Photo of Mary Lou McDonaldMary Lou McDonald (Dublin Central, Sinn Fein)
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I too heard the words of the now widower of Savita Halappanavar. His testimony was truly shocking and heart-breaking. Like the rest of the country I was not just upset and moved by what he had to say but I was also very angry. We have debated these matters for 20 years. This is probably the only jurisdiction on earth where urgency is defined by a delay of 20 years. I accept absolutely that there have to be inquiries into the precise circumstances of the death of Savita. We need the medical detail and we need a full account of it. I support that but I fear that we will hide behind reports and inquiries and we will kick the issue down the road yet again.

We do not need a report or an inquiry to tell us that the medical profession is left in legal limbo. We know that. Neither do we need a report or inquiry to tell us that as a result of that, women’s health and lives are left in jeopardy. We know that. It would be easy for us to point the finger at the Catholic Church, the medical profession, a particular hospital or the HSE, but the blunt truth is that the limbo exists because this House has failed to legislate. We now have the seventh Government that has not yet introduced the legislation to give effect to the Supreme Court judgment. The Oireachtas shows itself as a bit farcical when we find ourselves in those circumstances. Successive Governments failed to act.

The Tánaiste has not given the kind of clarity we need. Why has the Government not decided to publish the report? Why can he not say clearly that legislation will be brought forward to give effect to the Supreme Court judgment? He was not nearly so reticent prior to the previous election and for a long time. Our sympathies are with the family and the inquiries must take place, but we need action which must be speedy. No longer can anyone elected to this House or in the Government hide behind the failures of others or reports or inquiries. We need the legislation. I want to know when the Tánaiste will bring it forward.

Photo of Eamon GilmoreEamon Gilmore (Dún Laoghaire, Labour)
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My position on the issue is known for a very long time. I am on public record for more than 25 years as to how this issue should be dealt with. There is no doubt about it. It has not always been a popular position or one that has commanded support across all parties in this House. I was deeply disturbed yesterday by what Savita’s husband said. I do not think we, as a country, should allow a situation where women’s lives are put at risk in this way. We must deal with the issue and bring legal clarity to it.

As the Minister for Health said in the House some time ago, there have been six Governments in this State since the Supreme Court judgment in 1992 and they have not dealt with it. This will not be the seventh. That is why we set up the expert group to guide us. It is not a case of a report on what happened or looking into the matter. Let us look at the terms of reference of the expert group; it was to examine the A, B and C v. Ireland judgment of the European Court of Human Rights to elucidate its implication for the provision of health services to pregnant women in Ireland, to recommend a series of options on how to implement the judgment, taking into account the constitutional, legal, medical and ethical considerations involved in the formulation of public policy in this area and the overriding need for speedy action.

The group has now reported and the report has just been received. Obviously the Government will have to consider what is in the report. As Deputy Niall Collins has said, we must discuss the issue in this House. We must bring legal clarity to the issue as quickly as possible. As the Minister for Health said in a Dáil debate on the issue some time ago, this will not be the seventh Government to neglect and ignore the issue.

Photo of Mary Lou McDonaldMary Lou McDonald (Dublin Central, Sinn Fein)
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I am familiar with the Tánaiste’s public position and that of his party. It is one we wholeheartedly share and support. The problem is that while expert groups meet, reports are drafted and necessary inquiries are held, women and the medical profession remain in a legal limbo. The case of Savita and the tragedy for that woman and her family writes large the failure of successive Governments. The ball is now in the Government’s court. The Tánaiste says he wants to see speedy action. I remind him that his expert group is late in reporting. The report is late coming to Government and now the Tánaiste equivocates. Why is that the case? We have a former and current master of the National Maternity Hospital on the public record stating categorically the dilemma in which medics find themselves. They need legislation.

We know that, and so do the women and families of Ireland. This is not about the broader debate around abortion; this is a specific circumstance in which medical action is required to save the life of a woman. We have no right to equivocate on that matter. The report ought to be published immediately and the Government should make it crystal clear that the legislation required to give certainty and safety will come through speedily.

10:50 am

Photo of Eamon GilmoreEamon Gilmore (Dún Laoghaire, Labour)
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This is neither an issue nor a day on which to score political points.

Photo of Mary Lou McDonaldMary Lou McDonald (Dublin Central, Sinn Fein)
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I am not attempting to score any points.

Photo of Eamon GilmoreEamon Gilmore (Dún Laoghaire, Labour)
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Let us be clear: there is no equivocation here and never has been, as far as this Government is concerned. We made it clear on the day the Government was formed that we were going to address this issue. That is why we set up the expert group, which has looked for additional time to complete its work. The Deputy can make a fuss about all the delays and so on, but the Government is going to deal with this issue. The report must be considered by the Government. I expect it will be published and that we will debate and discuss the issue in the House. I have stated clearly that we need to bring legal clarity to this issue. We must ensure that in this country no doubt can arise in a hospital in a set of circumstances which puts a mother's life at risk. I heard a medical professional speak about this on the radio this morning. We also need to provide clarity for medical professionals who must make judgment calls on these matters in the real-life situation of a hospital, and must hear the concerns they have about making a decision that may expose them to action if some person disagrees with it. We must also take into account the ethical concerns that some medical professionals may have about this issue. A range of complex considerations must be weighed up, and that is what the expert group was asked to do. When we set it up we included both medical and legal people so that they could take a totally rounded view. They have now reported and the report will be considered and taken forward. There is no question of equivocation. We need to bring legal clarity to this situation and that is what we are going to do.

Photo of Thomas PringleThomas Pringle (Donegal South West, Independent)
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I take this opportunity to send my condolences and sympathy to Savita Halappanavar's husband, family and friends. Although these instances may be rare, one life lost unnecessarily is one too many. As matters stand, this is something that could still happen to our wives, sisters or daughters. I join the calls for the report of the expert group to be published without delay so that we can rectify the situation as soon as possible.

Unfortunately, the mistreatment of women under the State's care is nothing new. This week some 150 symphysiotomy survivors travelled to Dublin for the first screening of a documentary that examines this brutal practice. In the case of many of these survivors, the operations were done without their prior knowledge or consent. They continue to call for justice and a recognition of the suffering they have endured as a result of this barbaric procedure.

For too long, this State has failed women. This must end. We must prioritise the welfare of the mother and what is best for women from a medical perspective so that tragedies such as these can never happen again. Will the Tánaiste listen to the calls of the survivors of symphysiotomy and waive the statute of limitations so that these women can be compensated for what was done to them under the watch of the State? There has been cross-party support on this issue but no action on something that has been described as arguably the biggest human rights scandal in Ireland since the foundation of the State. Most of these women are now in their 70s and 80s. They are looking for justice for the most dramatic event of their lives. Will the Tánaiste address and recognise the mistakes of the past? Will he commit to prioritising the well-being of women who find themselves in situations in which their welfare is put at stake?

Photo of Eamon GilmoreEamon Gilmore (Dún Laoghaire, Labour)
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I am conscious of the distress that symphysiotomy has caused to a number of women and I recognise the pain it has caused to those affected. The Government is committed to dealing with the women concerned sensitively so that, if at all possible, closure can be achieved for them. The first priority of the Minister for Health is to ensure that the health needs of those who have had symphysiotomies are met quickly and effectively. The HSE provides a range of health services to women who have undergone symphysiotomies. Patients who underwent this procedure have, on application, been granted full GMS eligibility on medical grounds. Advice with regard to pathways of care is available to women on request through the five symphysiotomy liaison officers in the HSE. Necessary medical expenses related to symphysiotomy in respect of medical and private treatments may also be refunded.

A report has been commissioned by the chief medical officer in the Department of Health. This is an independent research report into the practice of symphysiotomy in Ireland from 1944 to 1984. An independent academic researcher, Professor Una Walsh, was formally appointed on 1 June 2011. The compiling of the independent research report has two stages. The first is the production of a draft report based on an analysis of published medical reports and research. This report contains information about how frequently symphysiotomy was carried out in Ireland and compares rates with other countries. It also provides reasons the procedure was carried out. The second stage of the research is planned as a consultation process led by the researcher, who will seek feedback on the contents of the draft report from those with experience of the procedure, particularly the women concerned, and health professionals. She will then use this material in finalising the report. The final report will be presented to the Minister for his consideration of any actions that may be required to address the issues concerned. The Minister is determined to bring this matter to a satisfactory conclusion for all the women concerned as soon as possible. The Government expects to receive the report shortly.

Photo of Thomas PringleThomas Pringle (Donegal South West, Independent)
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The Tánaiste's response tells us that another expert report is being drafted in respect of a desperate situation. The issue in question is that the State should recognise the wrong that was done to these women. The way to do that and allow them to achieve closure is to waive the statute of limitations to allow them to go before the courts and have their cases heard. There was a recent precedent in the courts in which a person was compensated, so it is the case that the courts can deal with the matter and these women can have their rights vindicated. We do not want to see another report that will drag on perhaps for years before being published. We need this issue to be resolved once and for all. I again call on the Tánaiste to waive the statute of limitations and allow these women to come forward and have their rights vindicated in the courts.

Photo of Eamon GilmoreEamon Gilmore (Dún Laoghaire, Labour)
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The purpose of the report is not to drag out this issue but to enable the Government to make an informed decision about how to deal with it. Professor Walsh has been conducting the research and consultation, including consultation with the women and health professionals concerned. We should allow that work to be completed and concluded in order that we can make whatever decisions are necessary arising from it. I assure the Deputy that as a Government we have decided to deal with this issue. Professor Walsh was appointed in June 2011, in the lifetime of this Government. Her work needs to be completed and when that is done the issue will be addressed and dealt with.