Dáil debates

Tuesday, 20 November 2012

Supreme Court Ruling in the X Case: Motion [Private Members]

 

8:00 pm

Photo of Mary Lou McDonaldMary Lou McDonald (Dublin Central, Sinn Fein)
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I move:

That Dáil Éireann:

- extends its deepest sympathy to the family of Savita Halappanavar and recognises that news of her death in such tragic and traumatic circumstances has caused distress to people throughout the country and beyond;

- resolves to await the outcome of the ongoing inquiries into all aspects of this tragedy;

- acknowledges that the Oireachtas must legislate to give effect to the 1992 judgment of the Supreme Court (the X case);

- further acknowledges that the absence of the required legislation denies women protection and the right to obtain a termination in life threatening circumstances and it also creates an ambiguous legal situation for clinicians in those same circumstances;

- regrets that successive Governments and Ministers for Health have failed to legislate in this regard; and

- calls on the Government to: - immediately publish the report of the expert group; and

- immediately introduce legislation to give effect to the 1992 judgment of the Supreme Court in the X case, to protect pregnant women where their lives are in real danger and to give legal certainty to medical professionals.
We add our voice to all of those in Ireland and beyond in expressing our deep sorrow and shock at the death of Ms Savita Halappanavar. To her husband, Praveen, and her family we offer our sympathies and support. We do not know as yet the precise series of events that led to this young woman's death and it is crucial the full facts are established. That is the very least owed to Savita. The inquiry into her death must be thorough, timely, independent and have the full confidence and consent of her husband and family, as well as the broader confidence of the general public.

This motion is a straightforward call for legislation to protect pregnant women when their lives are in danger. It is a call for legislation that gives certainty and protection to the doctors who care for women, urging the Government to publish the long-awaited report of the expert group to facilitate debate and the speedy passage of legislation. It is, by any standards, a modest proposal, a reasonable request for a system that has fudged, prevaricated and failed to act in 20 years.

In 1992, the X case determined the very limited circumstances in which a woman might have a termination of pregnancy in the State. That is 20 years ago. At the time, Mr. Justice Niall McCarthy described the failure of the Legislature to enact appropriate legislation governing access to a termination as no longer unfortunate but inexcusable. Some 20 years on, an ongoing failure to legislate is nothing short of scandalous. Multiple court cases, rulings by the Supreme Court and the European Court of Human Rights, two referenda and seven Governments later, we find ourselves here. Pregnant women continue to be left vulnerable as doctors attempt to operate in what they have defined as a "grey area". This is not acceptable by a long stretch.

Pregnant women and the medical profession are being failed by politics and it is cowardly to allow this position to persist. It is now necessary that we as legislators make clear our intentions and that we say, once and for all, that we will legislate to provide safety and clarity to women and medics. This motion provides the opportunity to Deputies of all political parties and none to make this clear.

All of us know the issue of abortion can be divisive, as people feel strongly - even passionately - about the subject. That is to be expected. The opposing views - typically labelled "pro-choice" or "pro-life" - are often pitched in adversarial debate, and that is to be expected too. This motion does not come down on either side of that broader and ongoing debate on the extension of abortion rights: it simply asks that what is already lawful and constitutional be defined and guided by legislation. In the words of Dr. Rhona Mahony, master of the National Maternity Hospital at Holles Street, everybody needs to be protected. The women of Ireland must be protected and the doctors giving health care must know they are also protected in their ability to do the job.

I cannot speak for all of those who served in successive Governments over the past 20 years. I cannot be definitive about why they failed to legislate but I can make an educated guess. I can surmise that they feared what they considered a difficult choice and they hoped it would go away. They presumed their failure to legislate would be consequence-free for women. They were wrong on all three counts. Protecting the health and life of a pregnant woman is not a difficult choice but rather the only civilised choice. The need for this protection will not go away and the failure to legislate has consequences for women and their doctors.

Amendments to the motion tabled by both the Government and Fianna Fáil fall far short of any concrete commitment to legislate, and one must ask why that is so. It seems that 20 years on, there are still within the Dáil people who will not face up to our collective responsibility as legislators to act in the common good. It is 20 years on and the Government's primary first instinct is to run for cover, hide and fudge the issue yet again. Critics of the motion have bandied the words "political opportunism" around, and it seems they are happier to spout political abuse than making the political commitment that the women and medical profession in the country need. That commitment - to obey the findings of the Supreme Court - is 20 years old. The commitment is to legislate for the X case and definitively and finally to protect the lives of pregnant women when on rare occasions their lives are put in jeopardy. The commitment is finally to give legal clarity and assurance required by medical doctors in assisting these women. That is required.

The motion asks that the Government publish the report of the expert group and, with a sense of urgency, move to produce legislation. There has been 20 years of inaction and delay, and that must stop. Every Deputy in the Dáil who believes, as I do, that we must fulfil our role as legislators and protectors of the common interest and good must support this motion. Attempts by the Government or others once again to prevaricate and delay can no longer be tolerated and will no longer be accepted by the women or medical profession in this country.

Photo of Gerry AdamsGerry Adams (Louth, Sinn Fein)
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Across this State and around the world, candle-light vigils and marches have taken place to mark the tragic death of Savita Halappanavar. These occasions are witness to the very genuine and deeply felt outpouring of sadness at the death of this young woman and her baby. I extend to Savita's husband, Praveen, and her family my sincere condolences. As Teachta McDonald has indicated, her death is a reminder of the failure of successive Governments and this Oireachtas to legislate and resolve the issue. Tá sé le tuiscint go bhfuil fearg mór faoi seo.

Sinn Féin believes there should be a full independent investigation into Savita's death.

The manner in which the HSE investigation was established and the initial inclusion of three members from University Hospital Galway, on whom I do not cast any aspersions, without the support of Savita's family was poorly judged. That this decision has been reversed is welcome but it has raised a serious concern about the judgment of the Government. It is crucial that every effort is made to reassure Savita's husband, Praveen, and both of their families and secure their co-operation. They need to be consulted rather than merely notified after decisions have been taken, and this needs to be done quickly.

A public debate is taking place and will continue until legislation is introduced. The expert group report should be released now in order that this debate can be fully informed. Sinn Féin has tabled this motion as our contribution to this essential debate.

Bad government is often a consequence of a bad Opposition, as people in this State who are living with the social and economic consequences of recent history, will know. Despite its flaws, Sinn Féin is determined to be a real and constructive Opposition that supports the Government when appropriate, provides positive alternative positions to those coming from the Government when necessary and puts forward policies in which we believe. In this context, we carefully considered the implications of the motion and crafted it very carefully to attract the widest possible consensus. I reject absolutely the crass party political accusations that our motion is opportunistic; it is nothing of the sort. I found the criticism made by the leadership of the Fianna Fáil Party particularly offensive given that it was in government for most of the past 20 years and its leader, Deputy Micheál Martin, was Minister for Health and Children for four of those years, during which time he did nothing. Instead of seeking to score points on such a serious issue, I urge all Deputies, the majority of whom have been measured and balanced in their response, to step back, set aside party politics, reflect carefully on what has occurred, examine the motion and support it as a genuine attempt to advance the introduction of legislation.

In shaping this motion Sinn Fein's focus was twofold. First, we set out to provide legislative protection for women whose lives are at risk during pregnancy and, second, we sought to ensure that clinicians have clear legal guidelines within which they can carry out their work. Tá a fhios agam go bhfuil a mhalairt de thuairimí laidre agus dáiríre ar fud shochaí na hÉireann faoi deireadh a chur le toircheas ar bhun liachta.

Sinn Féin is not in favour of abortion and I personally am not in favour of it. Notwithstanding my strongly held view on the issue, I am not mandated to come to the House to legislate for myself. The people spoke in a referendum and firmly placed responsibility on the Oireachtas to deal with this issue by means of legislation. In his remarks to the Dáil in April, the Minister for Health acknowledged that no action had been taken by six successive Governments and he did not want this Government to be the seventh. The Government needs to move beyond rhetoric on this issue. Sinn Féin has made its position absolutely clear, having debated it as recently as at our Ard-Fheis in May. We believe all possible means of education and support services should be put in place in order that the difficult choice to terminate a pregnancy can be avoided by as many women as possible. We are against any attempt to criminalise or to be judgmental of women who have had abortions. No woman wants to be in such a position.

I am very conscious that I am a man by accident of birth. However, this could have been my mother, wife, sister, aunt or any of my woman friends. Sinn Féin believes that in the case of rape, incest or sexual abuse or where a woman's life and mental health is at risk or in grave danger, the final decision rests with the woman. It is time for legislation to be enacted that will protect the rights of women, as decided by the Supreme Court in 1992. As legislators, Members of Sinn Féin stand ready to do this, which means facing up to the reality highlighted by pregnant women confronted with life-threatening illnesses who have to cope with this awful dilemma. Mar reachtóir, caithfidh mise déileáil leis an bhfíric go bhfuil ar an phroifisiún leighis measúnú sláinte a dhéanamh gan cosaint dlíthiúil do dhochtuirí. We must ask ourselves, as elected representatives and legislators, if we want to leave Irish women or the medical profession in the awful predicament caused by the current absence of legislation. I and my party do not wish to do so.

While the context for this debate is the death of Savita Halappanavar, the background is the X case. In 2010, the European Court of Human Rights ruled that this State violates the rights of pregnant women by refusing to allow them to receive a lawful termination when a pregnancy could threaten their life. The decision by the European court has made clear there is an onus on the State to legislate under the terms of the 1937 Constitution and the decision in the X case. The Government must respond to the Council of Europe on this issue by the end of the month. I call on it to produce and consult on its proposed response in a reasoned, tolerant and considered manner which secures maximum cross-party consensus.

Tá sé tábhachtach go rachaidh muid i ngleic leis an gceist seo sa chomhthéacs shóisialta. There is a concern that the Government will put this issue on the long finger, which must not be allowed to happen. There is a firm onus and responsibility on Members of this Oireachtas to ensure this generation of Irish women will not face the prospect of doing what many have had to do in recent days, namely, take to the streets. I urge Teachta Dalaí to consider their response to the motion carefully and vote in favour of it.

8:10 pm

Photo of Dessie EllisDessie Ellis (Dublin North West, Sinn Fein)
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Táim an-bhuíoch as labhairt ar an ábhar seo, go háirithe mar gheall ar cad a tharla do Savita Halappanavar i nGaillimh le déanaí. Savita Halappanavar is not the first person to lose her life as a result of the failure of Irish law to protect the health of women. In 1983, shortly after the passing of the supposed pro-life amendment, Sheila Hodgers died having been taken off her cancer treatment after becoming pregnant. At the time, her husband, Brendan, stated the following:

I went to see Sheila one night and she was in absolute agony. She was literally screaming at this stage. I could hear her from the front door of the hospital and she was in a ward on the fourth floor. I saw the sister and she produced a doctor who said nothing that made any sense.
It does not make sense that 30 years after the agonising death of Sheila Hodgers in Our Lady of Lourdes Hospital in Drogheda and 20 years after the scandal of the X case, we still find ourselves in this position. Despite all that has happened in the past week and the needless death of a vital and promising young woman, Savita Halappanavar, nothing has changed. We still have elected representatives, people who claim to be leaders, buckling in cowardice at the fear of an anti-woman rump in society which for far too long told us what we could and could not do. There is no justification for the absence of legislation to bring the law into line with the judgment in the X case. To do so would simply be to give a basic recognition of a woman's right to live as an individual and human being, rather than as an incubator who is less important than a few more days of gestation for a hopeless pregnancy which cannot run its course.

The story of the X case shamed all but a brave few. I have held the same view on this matter for a long time and I have been unswerving in holding it. I have never denied my position and I have taken part in marches and campaigned on the issue in my own way. I regret not doing more and that I did not give the issue greater priority. I cannot deny that the extreme reactions of groups such as Youth Defence and the Society for the Protection of Unborn Children were off-putting and created conditions in which many good people stayed silent for fear of being shouted down in the most vicious of ways. Last Saturday, I marched again through the streets of Dublin with thousands of people unified in their desire to see a woman's right to health care realised and respected.

I stood with people who were born after the X case and who were children when we last voted in a referendum to uphold the X case ruling against a cynical attempt to roll back the rights it defined. I stood with people who had campaigned in 1983 and who had seen all of this lying ahead. I stood with people who had ridden the trains from Belfast to Dublin, their pockets loaded with condoms in defiance of another archaic law that had been upheld for far too long. I stood with the best people in this country, those who had fought and would fight for real change for the betterment of everyone's life and who will not bow down to those who seek to control them as children who cannot be trusted to know what is for their own good.

I was moved by their frustration, grief and anger at the death of Savita. I share their feelings. In that crowd of people who had never met her or anyone connected to her, their feelings were palpable and were only equalled by their determination not to accept failure, equivocation or bargaining. They are determined to win their rights. For them, this is not an abstract or lofty debate on life or morality. This is their right not to die because they become less equal when they become pregnant.

In the crowd were Savitas, Sheilas and, God forbid, Xs, As and Cs. There were the 12 women who travel to the UK every day, the one in approximately every ten women whom everyone knows, who had abortions. They were the women of Ireland with their husbands, partners, brothers and fathers in tow. I cannot help but consider the many baby girls who are born today. Women are still not equal in our society. Those girls will have it harder than boys born today, even if that difference is less than what it was between their grandmothers and grandfathers.

Like others, I am in this Chamber to end that inequality and to ensure that men and women can lead good lives in a country of which they can be proud. I am ashamed that a girl born today is born into a country where women die after being refused proper treatment. I do not want that to be the country in which the next generation grows up. Many of us have had our children and raised them. Let us do something for those who follow us, who are starting families or who are only meeting their families for the first time. Let us give them peace of mind from knowing that, in Irish hospitals, women's health is never compromised. This is a country that values women's health and welfare cheaply, where a mere €15,000 fine is incurred for rape or a €5,000 fine is incurred for beating one's girlfriend until her face is irreparably scarred. Can we be surprised that appropriate health care is not available to all women in all circumstances?

Many will argue that we must take time to determine the steps forward based on the expert group's findings, but this is not the first expert group. Nor is it 1993. We have not rushed - we have been dragged kicking and screaming into the light and made to stare cowardice in the face 20 years on. If we need an expert group to tell us what is plainly the right action to take or which way is up, we can come to no other conclusion than that we are lost. The Government may be lost, but the people are not. They are more and more certain. They are also certain that we will not revert. They will not relent until justice is won. This is not the right action to take simply as a matter of responsibility for closing the gap between constitutional and legislative rights. Rather, it is the right action to take because it recognises a woman's right to be treated properly and to have her life saved and because it is what the people want.

Do not get distracted by issues not covered by the X case ruling. To reject this call because the Government is opposed to the liberalisation of abortion would be to disregard the State's constitutional reality and to refuse the people their right to decide what is in their best interests. It would be undemocratic, wrong and a dereliction of the Government's duty to legislate for the good people of Ireland and their will.

An important point has to do with how the Savita case is being dealt with and the way we find out the exact circumstances of her death. Her widower, Praveen, was justified in his misgivings about the original set-up. It would have constituted a conflict of interest on the part of the Galway hospital staff appointed to the board. I welcome the HSE's recognition of that fact and its statement that Praveen's concerns were serious. Praveen has rightly called for a full and public investigation into what is a credible case of grave mistreatment by Savita's medical team and potentially by the negligent State that failed to give doctors sufficient guidelines to prevent such circumstances arising.

I call on the Government to do all in its power to ensure an independent investigation into Savita's death that is only interested in revealing the truth of what occurred. Government Deputies, Fianna Fáil Members and reluctant Independents should support this motion and the legislation that would flow from it. Do not cop out and support the gutting amendment to wait and see. Do not fear the backlash of a right-wing rump that is long past its prime and rapidly becoming a spent force. That rump has opposed every progressive step that this State has taken and held our people back through fear, hatred and misinformation. Its time is over. Vote with us and maintain the momentum towards a change in the law so that we can give women peace of mind from knowing that they will be cared for during their pregnancies.

It is our duty to legislate. This is not cynical or opportunistic. The way that the Government has avoided this issue for the past 20 years has been cynical.

8:20 pm

Photo of Martin FerrisMartin Ferris (Kerry North-West Limerick, Sinn Fein)
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As a father of six and a grandfather of 11, ten living, I am opposed to abortion on demand. I believe this to be the majority view in the country and I share the concern that whatever legislation is introduced should strictly limit the circumstances in which terminations can take place. In light of the 1992 judgment, the legislation would need to be restricted to circumstances in which a pregnant woman's life was in danger.

The key issue is that the Legislature must act to address the issues that have been tragically highlighted once again by the death of Savita Halappanavar. Unfortunately, her death has brought attention to the fact that successive Governments have failed for 20 years to act upon the 1992 Supreme Court's X case judgment. Therefore, there is a clear imperative on the current Government to act quickly and to put legal measures in place to ensure that the life of a pregnant woman is protected in so far as is possible.

As highlighted by RTE yesterday, similar situations have arisen. There is a likelihood that more will arise. I appreciate that many problems are connected with this issue and that there are genuine sensitivities and strong feelings on all sides. Every Deputy will have received numerous telephone calls, e-mails and personal contacts on this issue. Those contacts will intensify when concrete proposals are made.

While some people oppose our motion on the basis of a fear that any legislation will open up the possibility of abortion being widely available or, indeed, make it a certainty, the opposite argument can equally be made. Currently, it is essentially left to medical practitioners to decide whether to allow a termination. It could be argued that there is scope for a more liberal approach to allowing abortion than is strictly defined in legislation. This was attempted in the proposed Twelfth Amendment of the Constitution, which was put to the electorate in November 1992. The proposal was to allow abortion in circumstances where there was a threat to a woman's life, not including the danger of suicide. The proposal was overwhelmingly rejected.

It could be argued that there is no basis to put a similar proposal now and it is understandable that the State might not wish to take the chance, given the possibility of a similar defeat. On the other hand, Savita's tragic fate may have focused minds and attitudes may be different.

One thing is clear - the option of not doing anything is no longer open to us. There are strong feelings in the country, and the Legislature needs to address the issues as a matter urgency. Indeed, before this tragedy, a Sunday Times poll in September found that 80% of those polled supported the option of termination in circumstances where a woman's life is in danger. There are strong grounds for believing that legislating to give effect to termination in those strictly defined circumstances could win a majority approval. One thing is for certain - the State must act with urgency to address the current situation and attempt to ensure no more situations, such as that which has given rise to this current issue, can reoccur.

I appreciate there will be an inquiry into the death of Savita Halappanavar and our motion states that final judgment must wait until that inquiry report is forthcoming. However, that must not be an excuse for again putting resolution of the doubts that exist in this area on the long finger.

I stated at the outset that I had 11 grandchildren. In the case of my first grandchild, my son and his wife were told when she was six months pregnant that the child would have no independent life and that most of the brain had not developed. It was suggested to them that they had two options. One was to go outside the jurisdiction to terminate the pregnancy and the other was to go through with it and to see what happened. They took the latter option. The child was born but died moments after birth. My daughter-in-law was very ill. I speak from a personal perspective.

We have an obligation as legislators. We are elected to legislate. For 20 years, those elected to legislate, successive governments, have refused to do so on this issue. If we continue to refuse to legislate, we are putting the lives of more women in danger. We must legislate for a pregnant woman's right to live.

8:30 pm

Photo of Seán CroweSeán Crowe (Dublin South West, Sinn Fein)
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I also wish to place on the record my deepest sympathy to the husband and family of Savita Halappanavar. We cannot even begin to comprehend the grief and heartache that they are now experiencing. While we acknowledge that the HSE is going to conduct an inquiry, I am conscious of the fact that her family are deeply unhappy with that inquiry. What seems to have happened is that in its usual blundering and insensitive manner, the Government and the Minister announced an inquiry without any real consultation with the family of the deceased. Have we learned nothing about dealing with tragedies and victims in this country?

The Supreme Court judgment in the X case in 1992 said very clearly that a pregnant woman had a constitutional right to a termination if there was a real and substantial risk to her life. The details of that case were extremely upsetting. Here was a 14 year old girl who was pregnant as a result of rape by an older man. A senior clinical psychologist provided testimony in the High Court that she was suicidal not because she was depressed but because she had reached the conclusion that death offered the best solution to her problems.

That a child would have to go through that is shocking in itself but what struck me about the case at the time was the cold contempt with which the victim and her family were treated by the State and its institutions. Her parents contacted the Garda asking if DNA evidence would be helpful in the prosecution of the rapist. This reasonable request eventually filtered back to the Attorney General's office. Her distraught parents were told that the child was to be brought back to Ireland without having had an abortion, as if she and her body were the property of the State. Had the political, legal and medical establishment a more humane attitude to this girl in 1992, we may not have found ourselves in this situation today. Some 20 years on, seven successive governments have failed to introduce any legal framework that will protect a family and a child facing this awful dilemma.

We are left with a situation where women have no idea of the circumstances under which they may be legally entitled to a termination and it seems the members of the medical profession have no clear idea of when they can perform one. They are left to make a judgment call as the watchful eyes of the political establishment forces them to gamble with women's lives. If they make the wrong decision, they could be subject to prosecution under the Offences Against the Person Act of 1861. A woman who attempts to induce her own miscarriage, and it is only a woman in the most desperate of situations who would attempt this, could end up sentenced to life in penal servitude.

People who are opposed to the introduction of this legislation have been very vocal in saying that we do not know the full circumstances in the Savita case and we need to wait for the outcome of the HSE investigation. This is true but the finger of blame should not be pointed anywhere other than at this Government and past Governments which have failed to provide legislation for this issue. There is the potential that there was medical negligence in the Savita case but how long do we have to wait to legislate to protect women and girls? There should be no martyrs for law reform in this area.

Thousands of people took to the streets across Ireland and the rest of the world to demonstrate their genuine grief and utter shock at what happened. Two passed referendums and thousands of people out on the streets should make absolutely clear to the Government that the people of Ireland will not wait any longer for legislation for the X case. Our job as Deputies is to legislate and to give leadership and we must ensure no more families and children are abandoned as in the X case.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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I move amendment No. 3:

To delete all words after "Dáil Éireann" and substitute the following:

"extends its deepest sympathy to the family of Ms. Savita Halappanavar and recognises the very strong feeling of the Irish people in the wake of her death;

awaits the outcome of the investigation into Ms. Savita Halappanavar’s death to be chaired by Professor Sir Sabaratnam Arulkumaran;

welcomes the submission to the Minister for Health of the report of the expert group to address the judgment of the European Court of Human Rights in the A, B and C v. Ireland case and recognises that this group was established on foot of a commitment given in the programme for Government;

notes that the terms of reference of the expert group were as follows:

— to examine the A, B and C v. Ireland judgment of the European Court of Human Rights;

— to elucidate its implications for the provision of health care services to pregnant women in Ireland; and

— 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;

acknowledges the complexity and sensitivity of the issues involved and supports the Minister for Health’s decision to bring the report to Government on Tuesday, 27 November and his recommendation that it be then published immediately; and agrees that the report of the expert group should be discussed in the Houses of the Oireachtas over the coming weeks in advance of a Government decision on the matter and that the Whips should meet to make the arrangements for such discussions at the earliest opportunity."
First, I would like to extend my deepest sympathy once again to the family of Ms Savita Halappanavar on their loss. We all recognise the very strong feelings that her death has caused in Ireland and abroad. I have been struck over the past week by the outpouring of grief and sympathy from people all over this country on this tragic death and yet I know this can only be a fraction of what the family must feel.

As I mentioned many times before, my aim and the role of my Department is to improve the health and well-being of people in Ireland in a manner that promotes better health for everyone, fair access, responsive and appropriate care delivery and high performance. In particular, our focus is to ensure the provision of a safe, quality assured patient-centred and efficient health service. Nationally, we are focused on ensuring patient safety, quality and excellence in our health care system. It is important, therefore, that we have systems in place to minimise risk of occurrence and to detect and respond appropriately to them when they occur.

The internal HSE procedures for dealing with serious adverse events and incidents have improved and strengthened in recent years. Important developments in this area included the establishment of the directorate of quality and patient safety in the HSE, the enhancement of clinical governance and the ongoing development of the clinical care programmes in the HSE. Important contributions to patient safety have been made through HIQA reports and the safer better health care standards published in June this year will also enhance patient safety.

As reported widely in the media, the Department of Health was advised by the HSE of a maternal death in UCHG on 28 October 2012. The incident was escalated directly from the hospital for the attention of the HSE's national incident management team on 1 November. This was done in accordance with its risk and incident escalation procedure which outlines the steps that must be taken by each manager to escalate risks and incidents, as appropriate, that occur within their own service. This procedure is to be used in circumstances where a national or integrated response is required.

The HSE has established an investigation into the death of Ms Savita Halappanavar. The purpose of the investigation is to establish the factual circumstances leading up to the incident; identify any key causal factor that may have occurred; identify any of the contributory factors that may have caused the key causal factors; and recommend actions that will address the contributory factors in order that the risk of future harm arising from these factors is eliminated or, if this is impossible, reduced as far as is reasonably practicable. The period covered by the investigation will be from the patient's admission to University Hospital Galway on 21 October to the patient's death on 28 October. I have been assured that the investigation will be conducted in the shortest timeframe necessary to achieve its purpose. That purpose is, first, to get at the truth and not to leave her family in doubt any longer than is absolutely necessary about what happened and, second, to reassure the many women in this country who use the health service that any practice that might not be safe has been addressed. I have been informed that, through the chairperson, the investigation team will be afforded the assistance of all relevant staff and other relevant personnel and will have access to all relevant files and records, subject to necessary consent and data protection requirements.

The HSE's national incident management team, NIMT, will oversee and support the investigation into the circumstances of Ms Savita Halappanavar's tragic death. University Hospital Galway has committed to co-operating fully with the team to ensure the investigation can be completed as quickly as possible. Sir Sabaratnam Arulkumaran, an independent expert in obstetrics and gynaecology, will chair the investigation team into Ms Halappanavar's death. He is professor and head of obstetrics and gynaecology and deputy head of clinical sciences at St. George's University of London. He is also president of the International Federation of Gynaecology and Obstetrics.

The investigation team will comprise a number of experts in the relevant disciplines, including anaesthesia, midwifery, obstetrics and gynaecology, to review the full range of clinical care provided for Ms Savita Halappanavar. The team also includes an independent patient representative and an expert in infectious diseases. I am aware that Mr. Halappanavar has raised concerns about the membership of the investigative panel in respect of three consultants employed in University Hospital Galway and about the investigation in general. As regards the inclusion of three hospital consultants from Galway, having reflected on the concerns raised by the family, the HSE has agreed that these three consultants will step down. It is in the process of identifying suitable replacements in the relevant clinical disciplines. As per HSE policy, the investigation team will work closely with the family at all times and keep them fully informed of the terms of reference of the investigation. The chairperson is now seeking to meet Mr. Halappanavar to address his concerns and update him on the new membership of the investigation team. It is hoped he will obtain Mr. Halappanavar's co-operation with the inquiry.

With regard to the claim that the HSE would not have investigated the matter had there not been public pressure to do so, all such incidents are investigated routinely. The investigation process in this case had commenced prior to the reporting in the media. As is usual with such cases, the HSE has an internal investigation process which it carries out. There are, sadly, incidents of deaths that occur in the health service that require investigation. This occurs in health services in other jurisdictions in any given year. One of the principal objectives of investigations is to establish the factors relating to a particular case. It is also essential that findings that would help to prevent death or serious injury to other service users are identified. In the vast majority of health care incidents it can be shown that environmental system factors are often a contributory factor. To ensure factors which may contribute to an error prone environment are identified, it is important that staff feel safe and in a position to respond positively to inquiries without fear of jeopardising their rights should future investigations take place.

This is not the first serious incident the HSE has investigated. It has a record of carrying out investigations that are thorough and identify all the safety problems and solutions that need to be identified. When the miscarriage misdiagnosis cases first emerged, there were widespread calls for a full independent public inquiry. The HSE carried out an investigation with an external independent chairperson, the findings of which were uniformly accepted on publication by both the public and the service users. The individual who had raised concerns initially was satisfied with all aspects of the investigation and maintained that if all of the recommendations were implemented, services would be safer for women. The HSE has a record of carrying out investigations that find everything that external independent inquiries would. In the case of the transfer of a young patient for a liver transplant the findings of the HSE investigation were published on the same day as the external independent inquiry report by the Health Information and Quality Authority, HIQA. The HIQA investigation did not find anything that the HSE investigation had not. The final report of the investigation team will be provided for the HSE's chairman and me as Minister. In addition, a coroner's inquest will take place into this sad case, as would be expected.

There is a long history of obstetric audit in this country. Maternal deaths are always intensively investigated and in recent years arrangements have been put in place for Irish maternal deaths to be reported to the UK confidential inquiry system to ensure maximisation of learning and inform future prevention. This country is one of the safest in the world to have a child.

It would be inappropriate to comment further on the circumstances and possible causes of Ms Savita Halappanavar's death until the HSE investigation has run its course. However, it is important to point out that women in Ireland are entitled to legal clarity about what happens in a case where a woman's life is at risk. This issue has been with us for a very long time. As Deputies are aware, the current legal position on abortion in Ireland is set out in Article 40.3.3oof the Constitution as interpreted by the Supreme Court in the 1992 case. It provides that it is lawful to terminate a pregnancy if it is established as a matter of probability that there is a real and substantial risk to the life, as distinct from the health, of the mother, which can only be avoided by a termination of the pregnancy.

In addition, the current Medical Council's Guide to Professional Conduct and Ethics for Registered Medical Practitioners 2009 sets out the position on abortion as follows:

21.1. Abortion is illegal in Ireland except where there is a real and substantial risk to the life (as distinct from the health) of the mother. Under current legal precedent, this exception includes where there is a clear and substantial risk to the life of the mother arising from a threat of suicide. You should undertake a full assessment of any such risk in light of the clinical research on this issue.

21.4. In current obstetrical practice, rare complications can arise where therapeutic intervention (including termination of a pregnancy) is required at a stage when, due to extreme immaturity of the baby, there may be little or no hope of the baby surviving. In these exceptional circumstances, it may be necessary to intervene to terminate the pregnancy to protect the life of the mother, while making every effort to preserve the life of the baby.
These provisions came under scrutiny in December 2009 when the European Court of Human Rights heard a case brought by three women in respect of the alleged breach of their rights under the European Convention for the Protection of Human Rights and Fundamental Freedoms in regard to abortion in Ireland - the A, B and Cv. Ireland case. All of the applicants were women who had unintentionally become pregnant and travelled to the United Kingdom for an abortion. The judgment of the court in the A, B and C v,Ireland case confirmed that Article 40.3.3° of the Constitution was not inconsistent with the convention. It found that there had been no violation of their rights under the convention in respect of the first and second applicants, Ms A and Ms B, and dismissed their applications; there had been a violation of the applicant's right to private and family life contrary to Article 8 of the convention in the case of the third applicant, Ms C. It held that there was no accessible and effective procedure to enable her to establish whether she qualified for a lawful termination of pregnancy in accordance with Irish law. It ruled that "no criteria or procedures have been ... laid down in Irish law ... by which that risk is to be measured or determined, leading to uncertainty..." and held that further legal clarity was required. The third applicant, Ms C, had been treated for cancer for three years. At the time she had unintentionally become pregnant she was in remission and, being unaware of this fact, presented for a series of follow-up tests related to her illness which were contraindicated during early pregnancy.

She was unable to obtain clear medical advice about the effect of the pregnancy on her health or her life or as to the effect of the medical treatment on the foetus, and feared the possibility the pregnancy might lead to a recurrence of the cancer. She decided to have an abortion and travelled to the UK for the procedure.

Ireland has signed and ratified the European Convention on Human Rights, Article 46 of which states that signatories agree to abide by any judgment of the court in any case to which they are parties. Ireland is, therefore, under a legal obligation to implement the judgment of the European Court of Human Rights in A, B and C v. Ireland. Supervision of Ireland's execution of the judgment falls to the Committee of Ministers of the Council of Europe. On foot of the judgment, and to fulfil a commitment included in the programme for Government, the Government established an expert group, drawing on appropriate medical and legal expertise, with a view to making recommendations on how this matter should be properly addressed. The expert group was established in January 2012 and its terms of reference were to examine the A, B and C v. Ireland judgment of the European Court of Human Rights, to elucidate its implications for the provision of health care services to pregnant women in Ireland, and 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 over-riding need for speedy action.

The expert group was made up of experts in the fields of obstetrics, psychiatry, general practice, law, professional regulation and public policy. It was chaired by a judge of the High Court, the Honourable Mr. Justice Sean Ryan. The expert group submitted its report to me on 13 November and I am currently examining the document. The Taoiseach and Tánaiste have also received a copy of the report and I intend to recommend its publication to Government on Tuesday, 27 November.

As I said last April in the House, I am sure Members share my view that it is incumbent upon us as public representatives to take action to deal with a long overdue responsibility. We need to make sure we take the necessary action to protect the lives of women. However, these are extremely complex matters and deserve thoughtful consideration from a clinical and legal perspective. I will be studying the contents of the expert group report and will be discussing it with my colleagues in government and legal advisers. In the meantime, I look forward to a thoughtful and considered discussion on the report in the Houses of the Oireachtas in the coming weeks. The discussion will be invaluable and will assist the Government in formulating proposals to ensure the safety of pregnant women in Ireland is maintained and strengthened and that we can fulfil our duty of care towards them. It is my intention this can be done as expeditiously as possible and I look forward to hearing many views from all sides of the House on a difficult issue that divided not just the country but families over the past 20 years.

8:50 pm

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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There are times when language is inadequate and words cannot express the sentiment we feel in terms of offering condolences to particular families for the circumstances in which they find themselves. We have all been there. Last week, when the news broke about Savita's death, there was a sense of undying sadness that once again we were faced with the death of a young, vibrant mother. We do not yet know the circumstances but we will know because the inquiry will tell us exactly what happened. These things never happen in isolation. Equally, people responsible for her health and welfare at the time are feeling tremendous pressure. To her husband, who will feel her loss more acutely than anyone else, and the family, we must offer our deepest sympathies. We are not certain that saying those words is of any comfort to the person involved but, in the long-term, it probably will be.

I have been interested in this issue for as long as I can remember. I have always known we would have an incident like this and, whatever the circumstances, there will be another. I appeal to the Members who tabled the motion. It is unusual for me to do this and for a Government backbencher or Minister of State to say these words. I second the Government amendment. I appeal to the Deputies who tabled the motion for calmer heads to prevail. The anger they now feel was anger we felt over the years. When we now know that there is a solution in sight and that action will be taken, the anger dissipates. The anger on the streets, not just in Cork, Dublin, Galway or in Ireland, but all over the world is very understandable.

However, now that we are within sight of doing something concrete about it, and now that we have the solution within our power, I appeal to Deputies to let wiser heads prevail. Let us be calm about this and let us do it properly. My major worry is that we will rush into something that will present us with greater problems. That happened in the past and we need to take time – not to prevaricate or to take too long – but to do it properly and to ensure the eventualities that could arise are covered. I appeal to people to be calm. Now that we have a solution in our sights, we should do this properly. We can shout and roar and be as angry as we like but that will not give us a solution. The solution is within our grasp and we can do this properly. Maybe some people have not been involved in this issue for as long as others. We need to do this properly and we need to act because, as the Tánaiste said, not acting is not an option. We now have the opportunity but we also have the responsibility to do this properly. I appeal to Members to let wiser heads prevail and to do this properly. At long last, we have the possibility of doing it right.

Photo of Ciara ConwayCiara Conway (Waterford, Labour)
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I offer my condolences to the family of Savita and particularly her husband in the aftermath of such a tragic case in Galway University Hospital. The country is shocked and grieving since we learned this tragic news. We have been told that Savita died in agony after begging the doctors for help but was refused the necessary treatment while the foetus had a heartbeat. When the news of the story broke, every woman in the country thought that it could be her. Never has the inhumanity of our abortion law been so starkly exposed. While quite shocking and infuriating, I am sad to say it is not surprising. Many of us who are advocates of women's health have always expected that our restrictive and inhumane abortion regime would someday result in the death of a woman. Although we await the outcome of the HSE investigation, we have been told that Savita asked for intervention by the hospital to terminate her pregnancy and that this was allegedly denied. This ambiguity or grey area is avoidable. The blame for this, the circumstances in which vulnerable pregnant women find themselves, and the solution lie solely in this House. Last week, I listened to the story of a woman who was told to read between the lines and to head to England when she found out that her much wanted baby would not survive and that her health was deteriorating. The heartbreaking stories of the shame, lack of support and coldness with which women find out that their babies may have a fatal foetal abnormality and the way they are treated in the Irish health system is unacceptable in this day and age.

As legislators, we have spent 20 years colluding in making already difficult circumstances unbearable. We have colluded in making the country inhumane for women. We have colluded in taking the dignity and limiting the access to safe health care for women in the country.

Deputy McDonald states that we should no longer prevaricate on this issue. I invite her and her party colleagues to examine their own inaction on the matter over the past 20 years. A party that prides itself on being an all-Ireland party, and is in power in the North under the leadership of Martin McGuinness, has resisted attempts to bring any part of the UK abortion law to Northern Ireland. Five of the Sinn Féin Deputies abstained on the vote on Deputy Clare Daly's Bill.

The Labour Party is the only party to have asked for legislation to end this inequality and mistreatment of women's health. We did so in our general election manifesto of 2002 and in every subsequent manifesto. We have often been targeted by other parties. It is perceived by them as a weakness to be exploited for their own political gain. We, the candidates and grassroots members of the Labour Party, went door to door. We stood our ground on the need for legislation on this issue. We were right then and we are right now. For the first time in this debate, which has stretched over two decades, a Government has put in writing its commitment to make a decision on this issue. I welcome that.

The report of the expert group will be published on Tuesday, 27 November and I understand that, with the agreement of the Whips, a debate will ensue shortly after that. I ask every Deputy to read the Government amendment. For the first time, a Government is committed to dealing with this issue.

9:00 pm

Photo of Olivia MitchellOlivia Mitchell (Dublin South, Fine Gael)
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This debate takes place in the aftermath of a case that, from what we know of it, is shocking beyond words. I preface my remarks by saying we do not yet have an independent account of what actually happened. Nevertheless, from the debate that has ensued since that tragic death in Galway, we now know one thing for sure that we did not know before. We know there is, indeed, a grey area. There are circumstances where it may be necessary to intervene to terminate a pregnancy to save the life of the mother.

It appears from the circumstances of Savita Halappanavar's death that this was one such example. There have been others. Such terminations take place in Ireland, for instance where there is an ectopic pregnancy. Of course, we do not call them abortions, in order to preserve the myth. We call them terminations. In other cases, because the risk to life is not imminent, there cannot be a termination in Ireland. Perhaps because of a heart condition or high blood pressure, the threat may not be imminent but likely to manifest later in a pregnancy. In many such cases, the mother is forced to travel to England for a life-preserving termination.

Whatever the outcome of the two investigations that are going on, we now know for certain that there are circumstances that require life saving terminations. Among the considerable correspondence we all received was a document from a group called the Life Institute, containing "three important facts the expert group cannot ignore". The first of these three facts is that "abortion is never necessary to save the life of the mother. Leading Irish medical experts have already confirmed this fact". We now know that is wrong, wrong, wrong. Terminations are sometimes required.

Many speakers have referred to how the international media have reported this and how embarrassing it is for Ireland. It is embarrassing but it is, much more, a cause of annoyance. What happened to Savita does not reflect the will of the Irish people, what is in our Constitution or the Supreme Court interpretation of it. There is not a single person in the country, whether pro-choice or pro-life, who believes that what happened in Savita's last days, if what we hear is true, is acceptable, is in line with our Constitution or should ever happen again.

There is, perhaps inevitably, a desire to lay blame somewhere. We hear the doctors, the hospital and the church all being blamed in the media. The only truly culpable people, however, are ourselves, the present and past members of the Oireachtas, who failed over many years to give legislative expression, or any other kind of expression, to a right guaranteed by our Constitution and voted for in successive referendums by the people of Ireland. If Savita's husband's account of what happened is correct, her death is at our door and nobody else's. I do not want any more deaths at my door.

It is not in anybody's interest that, due to fear of legal circumstances, we have the appalling prospect of highly qualified and highly trained medical staff finding themselves forced to hover and hesitate around the beds of sick patients, maybe for several agonising days, and to prevaricate, procrastinate and postpone action until there is a virtual certainty that the patient is slipping away and that death is almost inevitable. We cannot leave our doctors in a position where they feel they have no option but to treat living, sentient human beings in a way a vet would not treat a dog.

This is an emotive debate and a complex issue. All sorts of red herrings are being thrown in our path. Some fear this tragic episode will be used to leverage the introduction of abortion on demand. Others would like to see the entire Judiciary brought into the labour ward. Some people may well want abortion on demand, although they are few. More, including myself, feel we should look in the future at the situations of rape, incest and extreme youth. None of those issues is on the table today, however. They cannot be, because the Constitution does not allow them to be. The only issue before us is to safeguard the lives of women by giving expression to the Supreme Court judgment in the X case, so that medical people know, when they are treating a woman, that they have a responsibility to act to save the life of the woman before the threat to life is so immediate that death is almost inevitable.

I do not care how that is done. I am delighted to hear the Minister's personal commitment to ensure it will happen quickly. I do not care if it is done by guidelines, regulation or legislation. I simply want it to happen as quickly as possible. I understand that we have to look at the recommendations of the expert group, but I want the light shone, at last after 20 years, into this grey area where there is no clarity as to the point at which the threat to health becomes a threat to life.

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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With the agreement of the House, I will share my time with Deputy Michael McGrath.

It is with regret that, once again, I rise to express sympathy with the family of Savita Halappanavar. Last April, we debated a Private Member's Bill, introduced by Deputy Clare Daly, to legislate on the X case. At that time, most Deputies said we would await the report of the expert group chaired by Mr. Justice Sean Ryan and, on foot of that, would have a calm, rational, reflective and respectful debate to try to find a solution to the difficulties in which we now find ourselves. The death of Savita Halappanavar has charged the atmosphere in an emotive way and many people are expressing views more forthrightly than in that previous debate. People are conscious of the sensitivities that exist.

We face the difficulty presented by Article 40.3.3o of the Constitution and its interpretation by the Supreme Court in the X case. The views of Deputies are already showing serious divergence as to what we can, must or should do. No matter what we do, any regulation or legislation must comply with Article 40.3.3o, as interpreted by the Supreme Court in the X case. Anything beyond that will require a decision of the Irish people. We must be conscious of that. We cannot accommodate everyone's view within the confines of this debate. It will be very difficult to come to a final conclusion. Legislation must not only be sensitive to the views expressed in this House, but must also be enacted in the context of a society that is divided on this issue.

Let us be clear, it is divided. As a young lad I observed the 1983 campaign, wondering what all of this was about, and I have seen the effects of the 1992 and 2002 campaigns. Some people might say nothing was done but while nothing was achieved, we tried to do things. They may not have met with universal approval in this Chamber and they certainly did not meet with universal approval outside it but efforts were made and unfortunately they did not succeed in addressing any of the concerns that are being expressed in the context of what is required now to bring clarity to the issue. We also have to take note of what has been said by eminent obstetricians and masters of some of the maternity hospitals around the State, who say clarity must be brought to bear and the only people who can do this are the people in this Chamber.

The next question is how we bring about that clarity. The Minister of State mentioned legislation but often people react by being defensive. Others are open about the need for broader based legislation to accommodate fatal foetal abnormalities and other issues such as rape and incest. Clearly, these are well beyond the remit of what we are being asked to do by the Grand Chamber of the European Court of Human Rights when it found we were in breach of the women's human rights in the A, B and C case, and by the Supreme Court to deal with the issue of the X case.

That is where we are and over the next number of weeks we must have a calm debate. I say to Deputy McDonald and the other sponsors of this debate that I felt that we should not have moved the motion at this time, a week in advance of getting an expert report that would give an opportunity to evaluate the informed opinions of experts in obstetrics, gynaecology and the law and that might be able to give us a solution that will address this issue. Even within Sinn Féin, within Fianna Fáil, Fine Gael and within the Labour Party, there are differing opinions on the issue. If we cannot reach some form of consensus that accommodates the very broad views, which will be difficult, we could be back here again and again. This does the people of the country a disservice and, more importantly, its does a disservice to those depending on maternity services while those providing them will find it difficult to operate. That is the challenge for everyone in this Chamber tonight and in the coming weeks.

If the report is published and we have an informed debate, we can deal with this. There is no point in our introducing other issues unless people are willing to say we must repeal the eighth amendment to the Constitution and overrule the X case with a constitutional referendum because otherwise we are broadening the debate beyond our remit.

I do not want to be critical at this time but I was concerned at the announcement there would be an investigation into the tragic death of Savita Halappanavar, that it would be carried out by people closely associated with the hospital and the HSE and that it would not be fully independent. I do not, however, mean to cast any aspersions on the integrity and competence of those who were named on the inquiry. There are staff in the Galway hospital who are distraught at this tragic death. They feel they are the scapegoat or are being forgotten about in the broader discussion. I spoke to some people who are shattered about what has happened. We must be conscious of that but first and foremost we must be conscious that a woman died in a maternity hospital in Galway and we must ensure her family are consulted about the inquiry. There are protocols about the investigation of deaths in maternity hospitals but this was poorly handled and there should have been broad consultation with the family and engagement at an early stage. We now need a fully open inquiry that is independent and can get to the truth.

This issue can be used by both sides to be more divisive. We need an informed debate and whatever the circumstances and the reasons why Savita Halappanavar died must be brought into the domain to ensure we are not apportioning blame wrongly. We must find the truth of the matter. We must also instil confidence that our maternity services are, by and large, the safest in the world. We must say that consistently because of the negative publicity around the world. We have a safe maternity system and its integrity must be protected. That is why an independent inquiry is so necessary.

I urge the Minister to publish the report that is being overseen by Mr. Justice Ryan. The longer there is a vacuum and the longer we assume what is in it, the more the debate can become acrimonious, convoluted or complicated. I urge that when the Cabinet meets, the report is published immediately. Let us have the debate and if we can find some way to address this issue and give clarity that addresses the A, B and C cases in the European Court of Human Rights and provides guidance for those who provide services, we will have done some good in this Chamber. While people bring other issues into the debate, it will make it more complex and difficult to reach a consensus to ensure women can be confident that when they go into a maternity hospital, they will be treated with respect and dignity and are afforded all treatment unhindered to ensure their lives are protected.

The Government must publish the report and ensure the investigation into the death of Savita Halappanavar is fully independent and worked though as expeditiously as possible while getting to the truth of the matter. Those are two crucial issues that will inform us as to what we should do to address this divisive and sensitive issue.

9:10 pm

Photo of Michael McGrathMichael McGrath (Cork South Central, Fianna Fail)
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At the outset, I extend my own personal sympathies to Praveen Halappanavar and his family, and the family of the late Savita, on what can only be described as a tragic loss for all of the family. It is indescribable, I agree with the Minister of State in that regard. We all agree the family deserve answers and to get to the truth. We need an investigation that pursues the truth and identifies it. Whatever the truth is and however uncomfortable it might be for everyone concerned, the truth must be established, the facts nailed down and the conclusions drawn therefrom.

I am deeply concerned the investigation that has been established could hit a wall very quickly. The fact it was initially established with three representatives from the hospital concerned was a major mistake. There should have been direct consultation with Praveen Halappanavar himself. His solicitor has stated today that even the removal of those three people from the team will not suffice. If Savita's widower does not co-operate with the investigation, it could run into the sand quickly, which would be a major problem. I urge the Minister of State and the Minister for Health to take personal ownership of the issue and to work in whatever way they can to get Praveen Halappanavar's support for the investigation because that co-operation is essential. If he refuses to extend consent for the medical files to be reviewed, that could open a potential legal minefield. We cannot allow that situation to happen.

On the issue of substance, Deputy Kelleher has got to the point: we are dealing with Article 40.3.3° of Bunreacht na hÉireann, as interpreted by the Supreme Court in the X case in 1992 and, of course, the decision of the European Court of Human Rights on the A, B and C case in 2010. The Government now has the report of the expert group chaired by Mr. Justice Ryan, and I welcome that along with the commitment that it will be considered by Cabinet next week and published immediately.

Apart from the tragic death of Ms Savita Halappanavar, what has really made me sit up and take notice in recent days was listening to the practitioners, including the masters of the various maternity hospitals. When those into whose care we entrust pregnant women are telling us they need greater clarity in the application of the outcome of the X case and the application of our constitutional provisions on the right to life, we have a duty to sit up and take notice. Clearly the existing guidelines are not deemed to be adequate by those practising in this field. When one examines it and thinks about it, one can understand why. The X case deals with a real and substantial risk to the life as opposed to the health of the pregnant woman. One can understand the problem for medics because clinicians will need to decide when a woman's deteriorating health situation becomes a matter of life or death. In some cases, regrettably, it will become a matter of life or death. However, at what point do they feel sufficiently confident to intervene and do what is necessary to save the life of that woman in that situation? That is a real problem. As someone who holds pro-life views - I believe the majority of Irish people would still regard themselves as bring pro-life - I believe there is no question but that practitioners must be given the capacity and whatever legal clarity is required to ensure they can intervene and do whatever is necessary to save the life of the mother. I believe that reflects the views of the majority of Irish people on this issue.

Other issues come into the debate, particularly the issues of suicide as addressed in the X case, which will be more contentious. In particular it will be far more difficult to deal with the safeguards to be provided for in legislation, guidelines or regulations. The other issue raised in this debate but not directly relevant to the X case is the broader set of criteria whereby some people wish to allow for terminations to take place. This is an issue on which we should put politics as normal to one side. We all have our personal views on this and parties are coming from different historical perspectives and have taken different roles in various campaigns through the years. Clearly, when those who are directly involved in the care of pregnant women are telling us that something additional needs to be done, that is good enough for me. Something needs to be done to give additional clarity to the circumstances under which they are legally empowered to intervene and do what is necessary to save the life of the woman. For me that is the fundamental issue. Beyond that we will have a very difficult debate, but let us have that debate and I accept there is a duty for us to do what is required of us as legislators.

9:20 pm

Photo of Michael KittMichael Kitt (Galway East, Fianna Fail)
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I call Deputy Maureen O'Sullivan, who is sharing time with Deputy Catherine Murphy.

Photo of Maureen O'SullivanMaureen O'Sullivan (Dublin Central, Independent)
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As the motion states, there is no doubt that successive governments have failed to legislate on this matter. We have had referenda, Supreme Court cases, papers and Oireachtas groups, but no decision. The dithering, procrastination and kicking to touch must come to an end because failure to legislate has been detrimental. That is not to take from the excellent maternity services, as has been acknowledged. In the majority of cases mothers and babies leave hospitals in good health.

I am basically reiterating what I said during the debate on Deputy Clare Daly's Bill, which I supported. In response to numerous e-mails I received on the topic, I say that I do not agree with abortion on demand. Some people do not like that term, but what I understand by it is an abortion clinic where a woman can go in and have an abortion at any stage in a pregnancy for any reason, and I do not agree with that. However, I am conscious that there are women who have left this jurisdiction to go to another one to have an abortion. I respect their decision while I do not agree with it.

In the real world we know that the intervention, abortion, termination or whatever one wants to call it, is needed. If a woman who has been raped or subjected to incest makes the decision that she does not want to continue with the pregnancy, she needs to be supported. Such women are in a sufficiently traumatic situation without having to travel outside this country for that.

There is a need for legal clarity and legal decisions on the case we are discussing where there is a direct threat to the life of the unborn or the mother so that everybody involved can be protected. I know of a case where a woman went ahead with the pregnancy when she knew she was going to lose her life. Equally that must be protected, as must the other situation. The same is true of the medical teams involved.

The report of the expert group must be published as soon as possible and we need a very frank and candid debate. Regarding the investigation in Galway, serious errors of judgment have been made and it is hard to believe, when there was so much goodwill to find out exactly what happened in a dignified way, that such mistakes were made before the investigation even began. A lovely young woman has lost her life and at the end of the day her husband, parents, family and friends will be without her company for the rest of their lives. We owe it to her and to other women in that situation not to allow that happen again.

Photo of Catherine MurphyCatherine Murphy (Kildare North, Independent)
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Earlier this year I supported Deputy Clare Daly's Bill set within the parameters of the X case. While the Bill had flaws, they could have been ironed out on Committee Stage and had that happened, I wonder if it might have prevented this terrible tragedy from occurring. If there is an equal right to life for both the mother and the unborn, then action is needed to give expression to this. I wish to stress the equal right to life as distinct from the health as the difficulty lies in where to draw that line. We cannot even seek out international best practice on this because it is widely acknowledged throughout the world that this is an extraordinarily difficult distinction to make. I could not find evidence in other countries where they made such a distinction between the life and the health of the mother. I believe we should not make that distinction. It is a medical rather than a political issue. However, at this point we have an obligation to legislate within the parameters set by eighth amendment to the Constitution and the Supreme Court judgment.

The European Court of Human rights has categorically concluded that it cannot be left in the hands of individual medical practitioners, guided only by Supreme Court judgments, to determine what does and does not constitute a probable, real and substantial risk to the life as distinct to the health of the mother. It is very unfair to put that responsibility on individual practitioners. The second issue is that the result will invariably give a wide variation of application and care.

The Offences against the Person Act 1861 is the law that currently governs the offence. It imposes penalties of penal servitude for life for women and a misdemeanour for the medical practitioner. There would potentially be serious other sanctions through the Medical Council up to and including a medical practitioner being struck off. There are very serious consequences. We are putting the patient and the medical practitioner in an impossible situation by, on the one hand, acknowledging the equal right to life and, on the other hand, objectively failing to create a mechanism by which that right might be vindicated. We need to have an open, honest and mature debate on the issue. I acknowledge there are strongly held views on both sides. If we are to have such a debate, the publication of the report of the expert group as quickly as possible is essential. It is also essential that any inquiries are seen to be independent, open and fair, and report in a timely way. Once they report there can be no delay in producing legislation and acting on a matter that should have been acted upon in the past 20 years.

Debate adjourned.

The Dáil adjourned at 9 p.m. until 10.30 a.m. on Wednesday, 21 November 2012.