Dáil debates

Tuesday, 27 November 2012

Medical Treatment (Termination of Pregnancy in Case of Risk to Life of Pregnant Woman) (No. 2) Bill 2012: Second Stage [Private Members]

 

8:00 pm

Photo of Clare DalyClare Daly (Dublin North, Socialist Party)
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I move: "That the Bill be now read a Second Time."

I propose to share my time with Deputies Collins, Higgins, Healy and Flanagan.

Photo of Michael KittMichael Kitt (Galway East, Fianna Fail)
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Is that agreed? Agreed.

Photo of Clare DalyClare Daly (Dublin North, Socialist Party)
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I am sad and angry to be here again to speak on this issue. We said in April when we introduced legislation on this issue that if the Government did not move on it, we would move on it again, a scenario we hoped would not happen. Sadly, here we are.

We had to listen earlier to the fanfare from the Minister for Health, Deputy Reilly, which was more or less along the lines of the following: "Sure what is the rush? We have the report now - the media had it a week ago - and we will decide what to do about it before Christmas. We do not have to do anything before Christmas, but we will decide what to do and then we can sit around and talk about it for three days in the Joint Committee on Health and Children." This is put forward as some sort of big concession.

We must be clear on this. This issue was on the agenda of the House for discussion this week, but was bumped to next week because of the budget. Now the Minister tells us, framing it as a concession, that it will be addressed next year. The Taoiseach talks about more time and the need for consensus and the need to move forward carefully. The Minister let the word "legislation" slip out in an interview earlier, but he quickly corrected himself. We know there is no certainty coming from the Government on this. The same arguments we have been hearing over past decades are being repeated. We hear the same arguments we heard when we moved our Bill previously: "Give us more time." This is not good enough. The person who does not have time is Savita Halappanavar. How many other cases must we wait for? When we moved a version of the Bill earlier this year, this woman was not even pregnant. Now she is dead. Must we wait for another such case? Almost two years ago, the Council of Europe found Ireland guilty of violating the human rights of women by failing to provide for our constitutional right to abortion where our lives were in danger, including the danger of suicide. This was two years ago. The response to that and to the requests of the Council of Europe for interim measures was that the Government was looking at it. This is not good enough.

The findings of the expert group are no surprise. They are exactly as we knew they would be and as found by the other expert groups and by the Supreme Court. In order to secure a woman's right to an abortion in these very limited circumstances, we need legislation. That is the simple, uncomplicated fact. Our Bill provides a basis for that legislation. We do not say our Bill is perfect, but it is a start. If the Government does not take this start tonight - we are all aware any legislation it plans is only in the commencement stages - the legislative process will not start until at least another four or five months from now. That is not good enough. The only negative opinion expressed by the expert group on legislation was that it might take a considerable period of time to bring it forward. We have saved the House that time by providing the basis upon which to start. That is all we propose. Let there be no doubt about it: against the backdrop of increased austerity, the option of the boat or the plane will not be available for sick women in this country in the intervening four or five months. If we do not begin the process of legislation tomorrow, we will be condemning women and their doctors to the same legal grey area that has been the subject of an outpouring of emotion from women and the medical profession on the airwaves over the course of the past month.

How could anybody say this Bill is rushed? For me, the saddest part of moving this Bill is that it does not even begin to deal with the majority of reasons thousands of Irish women must choose abortions every year. It does not deal with the circumstances of pregnancies arising out of rape or incest, the decisions people must make because they are too young or too old, or many other diverse reasons. It does not deal with the circumstances of women who have contacted all of us because their foetuses had fatal abnormalities and the State had condemned them to carry them to full term or be exported in secret with stigma and shame.

It is a scandal that the House cannot move legislation to deal with this - to deal with simple medical procedures that are, in reality, a private and personal matter between women and their doctors. The reason for this is the eighth amendment of the Constitution. We will champion the call for the repeal of the eighth amendment, but sadly, that is not the subject of today's debate. The first vital step we must take is to legislate for the X case. This Bill is not simply a reintroduction of the Bill we tabled earlier this year. We listened to what the Government said at that time and have made relevant amendments to the Bill which satisfy the concerns aired.

The first thing our legislation does is to remove the validity of the Offences Against the Person Act in the area of medical treatment of women who need an abortion to save their lives. This is a necessary provision. Second, the Bill lays out clear criteria for doctors in assessing the risks for pregnant women so that where two doctors have an honestly held and reasonable belief that as a matter of probability there is a real and substantial risk to the life of the woman, they are legally empowered to carry out an abortion. In the case of suicide, it would require the opinion of a consultant psychiatrist or a clinical psychologist or a combination of both of these to make that medical call. I am aware the expert group has suggested a different combination of medical practitioners, and that is fine. The Bill can be amended on Committee Stage to take into account the best medical decisions. We agree with the expert group that these are medical decisions between women and their doctors. All we can do as legislators is provide the primary basis on which that can be done. Our Bill allows the option, after that, of a further opinion, either from a medical practitioner of her choice or via a referral from the other doctor. It also allows for the establishment of an appeals body, the details of which would rest with the Minister for Health in order to give it validity. That body should operate on a timely basis, coming to its decisions within one day, because we are talking about circumstances in which women's lives are in danger.

As the Minister can see, by accounting for these issues we have provided a primary legislative basis which can be built upon and added to by regulation as recommended by the expert group. This is not really that difficult. Every other jurisdiction manages it.

Section 7 of our Bill allows for a medical practitioner to object conscientiously to participating in these procedures, provided the woman's life is not jeopardised and provided the practitioner provides information and refers the woman on to somebody else who will carry out the necessary medical treatment. Conscientious objection should not apply to a hospital or to somebody not directly involved in the medical procedure.

Two other issues we address in our Bill were ones the Government highlighted earlier as being in need of change, namely the areas of consent and offences.

We are very satisfied with these areas this time around. In relation to the woman consenting, the normal basis in other laws exists. We had a problem last time around with pregnant girls under the age of 16 whose lives were in danger but whose parents did not want them to have abortions. As a result of the Government's success with the children's rights referendum, an emergency provision now allows the State to act as guardian to a child who is threatened. We think that overcomes the problem in our Bill the last time. The treatment in this Bill of the final point - offences such as the harassment of people who have secured abortions or facilitated somebody else in securing an abortion - is rooted in the Non-Fatal Offences Against the Person Act 1997.

This legislation is quite straightforward. It is not complicated. It is a simple piece of primary legislation. It can be built upon and added to by regulation. We are appealing to the Government not to oppose it. I am not engaging in cheap political point-scoring when I say that. Although this Bill has my name on it, the reality is that it is a joint effort with Deputies Mick Wallace and Joan Collins. It has the full support of the United Left Alliance. A number of our staff were involved in drafting it. If we all take ownership of this Bill so that it belongs to the House as a whole, we will send a signal to our colleagues in Europe, to whom the Minister will have to report next week, on what this country has done to protect the lives of women in this State. If we move this Bill onto Committee Stage, we can assure the women and the doctors of Ireland that we take their concerns seriously, that these grey areas will not continue for another four or five months, that we have heeded their calls, that we have taken note of what happened in the tragic case in Galway and that we have expedited a situation which we religiously and studiously ignored for 20 or 30 years. It is the Government's choice. It is really in the Government's court to do something to salvage the reputation of this country and vindicate the rights of women.

8:10 pm

Photo of Joan CollinsJoan Collins (Dublin South Central, People Before Profit Alliance)
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I will follow on from what Deputy Clare Daly has said. A point that has been made many times needs to be registered in the Dáil. It is an absolute disgrace that the last six Governments have failed to legislate on the X case. This Government has not exactly been enthusiastic about introducing legislation. I believe the establishment of the expert group was a stalling measure. The Government's grudging acceptance of the need for action came about after a majority of the Irish people demanded action following the tragic death of a woman in Galway. We know that Irish society has changed dramatically in the last 20 years. Those attempting to stem the tide of a more liberal, more human, more secular and more tolerant society have to accept that we are in the 21st century.

This is the fourth time that a review group has called for legislation. As Deputy Clare Daly said, the Labour Party should take this opportunity to begin the legislative process. Many eminent doctors have stated clearly in recent weeks that legislation is needed. In a recent article, Dr. Peter Boylan made the point that doctors need to be able to say with confidence that they can intervene to save the life of a mother. If the current equivocal position is retained, doctors will continue to be in a difficult position when making 50:50 calls. Legislation is needed to protect doctors in such circumstances.

The claim that there is no need for any action because our maternity hospitals are among the safest in the world for women is true to a point. We have a very good record. Unfortunately, the anti-abortion lobby has been using very misleading figures on this and other issues. It persistently uses a CSO figure that underestimates by half the official maternal death rate. The figure in the Irish maternal death inquiry, which was funded by the HSE, is much more accurate. It is twice the size of the CSO figure. It is closer to the British figure at that point.

Anti-abortion groups have been deliberately trying to move the discussion away from the real issues by focusing on the issue of suicide and abortion. A perinatal psychiatrist, Dr. Anthony McCarthy, said clearly on the radio yesterday that when the risk of suicide is small, it is nonetheless real and must be addressed. The view of two eminent psychiatrists is that this is a very serious issue. We have to remember that this issue was at the core of the X case, which involved a 14 year old girl who had been raped and made pregnant. She was denied the right to travel to Britain for an abortion. That right was given on the basis of suicide. The Supreme Court, under pressure from a huge movement, took the Government of the day off the hook. Rather than acting by introducing legislation, two Governments attempted to overturn the Supreme Court decision by means of referendum. Both referendums were defeated when the people voted to uphold the Supreme Court decision in the X case.

An anti-abortion lobby group has tried to mislead people by arguing that having an abortion contributes to mental health problems. While this has nothing to do with the X case, I want to make an important point about it. A key conclusion of a comprehensive review that was commissioned by the UK Academy of Medical Royal Colleges last year was that the mental health outcome for women who have an abortion is the same as the outcome for those who go on to have a baby. When the American Psychological Association undertook a similar survey, it found no evidence that having a single abortion causes mental health problems. Unbiased reports, as opposed to those with a clear anti-abortion stance, have found there is no evidence that women who have had abortions are at increased risk of suicide. However, there is evidence that suicide is associated with unwanted pregnancies where abortion is not available.

I am proud to be associated with this Bill. Deputy Clare Daly has gone through it in detail. I will not repeat what she said. I remind Labour Party Deputies that this Bill proposes the abolition of section 58 of the Offences Against the Person Act 1861, which is one of the most draconian of the Victorian Acts. It provides that a woman who seeks to procure or bring on a miscarriage herself can be jailed for life, and that any person who assists in the procurement of a miscarriage can be jailed for up to five years. The same Act was repealed in India in 1971. It is mentioned in the report of the expert group:

The Court emphasised the legal uncertainty caused by current provisions arising from the fact that the 1861 Act had not been amended or clarified, following the adoption of Article 40.3.3° of the Constitution... The judgment stated that the criminal provisions still in force would have a significant chilling effect on both women and doctors during the medical consultation process because of the risk for both parties of criminal conviction and imprisonment.
It is important for the 1861 Act to be dealt with.

As I said, Irish society has changed fundamentally in recent years. The United Left Alliance is committed to campaigning alongside all of those who now support a position where issues relating to the health of women should not be matters for the Constitution, but matters to be discussed between women and their doctors. The evidence of a 2010 YouGov opinion poll is that 78% of respondents - almost eight out of ten - agreed that the termination of a pregnancy should be permitted if the pregnancy is the result of sexual abuse, rape or incest and 62% of respondents - almost two thirds - agreed that the termination of a pregnancy should be permitted if there is evidence of a profound foetal abnormality. We will be campaigning for the repeal of the Eighth Amendment to the Constitution. That is no justification for not taking immediate action at the end of this debate. As the Tánaiste has said, inaction is not an option. By voting in favour of this Bill, the House can start the legislative process. I hope Labour Party Deputies will support this Bill.

Photo of Joe HigginsJoe Higgins (Dublin West, Socialist Party)
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The presentation of the Medical Treatment (Termination of Pregnancy in Case of Risk to Life of Pregnant Woman) (No. 2) Bill 2012 is a call to action on an issue of crucial importance to women in this State. That action is needed to replace 20 years of inaction since the Supreme Court ruled that a pregnancy can be terminated legally when its continuation poses a threat to the life of the pregnant woman. The report of the expert group that was established to examine the implications of the European Court of Human Rights judgment of 2010 was published today. It should have been published when it was delivered to the Minister for Health two weeks ago. Instead, it was cynically leaked to the media in recent days. It is clear that the report favours legislation. Tonight, the House is dealing with draft legislation to deal with the issue. Those who are serious about advancing the needs of women in these circumstances should accept the legislation and move forward with it.

It is important that we deal with the issue now as a matter of urgency. The courts have spoken on the matter and found that termination is lawful where a woman faces a real and substantial risk to her life. On two occasions the public supported this view in referendums. The court case took place in 1992. The late Mr. Justice Niall McCarthy said at the time that the failure by the Legislature to enact the appropriate legislation was no longer just unfortunate, it was inexcusable. Some 20 years later it is much more than inexcusable that the legislation has not been placed on the Statute Book. There is no case for further delay. The Oireachtas must take its responsibility seriously and legislate on the basis of the Bill before the House.

The Bill would provide interim legislative arrangements, as required by the Council of Europe, for a termination of pregnancy where, as a matter of probability, there was a real and substantial risk to the life of a pregnant woman and make provision for the prevention of any curtailment, hindrance or preclusion of such treatment, again where there was a probability that the life of the mother was at risk. The legislation might need refinement, but that is something that could be done as it proceeded through the House, particularly on Committee Stage. There is no doubt that a majority are in favour of introducing such legislation. The Bill is in accordance with the view of the expert group, the report of which has been published today. I welcome the opportunity to speak on the Bill and affirm my support for it.

8:20 pm

Photo of Luke FlanaganLuke Flanagan (Roscommon-South Leitrim, Independent)
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I congratulate Deputy Clare Daly and the members of the Technical Group that has brought forward the Bill. It is what is needed. It is an improvement on what was brought forward in April as the advice of the Minister has been taken on board. One would imagine, therefore, that he would vote for it.

I also welcome publication of the report of the expert group. As someone who is relatively new to the Dáil, I wonder why we are the last to hear about such matters. Why do employees of multinational media organisations get to see a report before we do? I could also ask why the Minister does not listen to Members when they speak, but that is nothing new. As Members elected to represent the views of the people, we should have got to see the report before anyone in the media. I do not believe there was a leak but rather that the report was deliberately made available. The minute there was word of a leak we should all have been contacted and sent a copy of the report. If one were to do this, it would show respect for us, but obviously the Minister does not have respect for us because if he did, he would have sent a copy of the report to us.

The atmosphere outside Leinster House last Wednesday night and the previous Wednesday night was intense. I had never experienced anything like it previously. It clearly said people needed the Oireachtas to act. It was clear that they wanted us to act quickly.

I will not go through the details of the Bill as that has already been done. Its essence is to provide a framework to make sure what happened to Savita Halappanavar will not happen again. Pregnant young women have contacted me who are scared at the prospect of going into the specific hospital in Galway to have their child. The Minister must do something quickly to give pregnant women the confidence they need that they will be safe in our hospitals. It is difficult to see how they can have such confidence.

This is the fourth report to be produced. How many does the Minister need? He knows what needs to be done. My worry is that there is something else igoing on; that there is an ideology that says we cannot go down this road because we would be seen as pro-choice or not caring about the life of the unborn. The reality is that in an area such the one from which I come which is considered to be socially conservative people are in favour of addressing the issue. One woman who goes to mass every day of the week – I question why she does, but I respect her for it – voted on two occasions in such a way as to make the Government legislate on the issue. Public opinion has moved on. In fact, it had moved on 20 years ago. This begs the question of what the Government is afraid of in voting for the Bill which provides solutions. It means that one would not have a situation where someone who was raped would be forced to have the child of the rapist, which is not on. Fox News, the most extreme right-wing television news station I have ever seen, is criticising us for being too conservative. If that is not a message that open one’s eyes, that makes one wake up and listen to what people are saying, I do not know what is.

At the core of the issue is the fact that there is not enough respect for women in this country. That one would force someone who was raped to go through with having the child of the rapist proves that fact. One would think we have moved on at this stage. I remember my mother telling me that on the day I was born she was in agony, as many pregnant women are, and the nun who had helped to deliver me told her that she had had her little bit of fun and that it was time to take the pain. some 40 years later I had hoped we had moved on, but the events of the past month show that, ideologically, we are still in the same place. When I say “we”, I mean many Members in this House. The general public has moved on and the Government must wake up to this fact. It should not have to follow the public like a weather vane. Tony Benn put it very well - the government is meant to be a signpost to lead the people, but it has failed in that regard. Now the people are leading the Government and I beg it to follow them. What happened in the past four weeks was shameful, but if we were to have a repeat, I would not be a proud man come 2016.

Photo of Alan ShatterAlan Shatter (Dublin South, Fine Gael)
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I thank Deputy Clare Daly for the work undertaken by her in the preparation and publication of her Private Members’ Bill which is before the House. The debate on the Bill, as Deputies have noted, coincides with the publication today of the full report of the expert group on the judgment of the European Court of Human Rights in the case of A, B and C v. Ireland. It is unfortunate that we are debating the provisions of the Bill before Members of the House have had an opportunity to reflect on the report published today and before some Members have had an opportunity to read the full report.

The establishment of the group and the publication of this report fulfil an important commitment in the programme for Government. For too long successive Governments have failed to address this issue properly. Over a period of 30 years, since the 1983 referendum, this failure has resulted in a series of difficult court cases for our domestic courts, and also before the European Court of Justice and the European Court of Human Rights. It is the judgment of the latter court which held this State to be in violation of the Convention on Human Rights and starkly detailed both our obligations and our failures as a State. It is important to place where we stand at present in context, following which I intend to detail what must be done having regard to the conclusions contained in the expert group's report. I will then address Deputy Daly's Bill and some other matters.

As other Deputies noted, our law in this area starts with section 58 of the Offences against the Person Act 1861 which criminalises "a woman...and whosoever...who unlawfully administers any poison or noxious thing, or unlawfully uses any instrument or other means to procure a miscarriage". The issue is constitutionally addressed in the amendment to the Constitution, adopted by the people in a referendum in 1983. The article states: "The State acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect as far as practicable, by its laws to defend and vindicate that right". In the X case the Supreme Court prescribed that under this constitutional provision, where it is established on the balance of probability that there is a real and substantial risk to the life, as distinct from the health, of the mother, and that such risk could only be averted by the termination of a pregnancy, such termination is lawful. That case involved a 14 year old girl who had become pregnant as a result of rape and was suicidal. The court deemed the threat of suicide a real and substantial risk, justifying a termination of her pregnancy. In the referendums held in 1992 and 2002 propositions were put to the people to exclude a threat of suicide as granting a real and substantial threat to the life of a mother, permitting a termination. It is right that we recall that both propositions were rejected.

No action was taken at any stage by this House to prescribe the procedure applicable for determination as to whether the continuation of a pregnancy posed a real and substantial risk to the life of the mother, nor was any legislation enacted to amend the 1861 Act to ensure its compatibility with Article 40.3.3° of the Constitution, as interpreted by the X case, nor to update its content to take account of modern medical techniques and pharmaceutical advances. The truth is that for three decades we have had a deeply dysfunctional and obtuse legal architecture that is badly in need of reform. This is well articulated in the judgment of the European Court of Human Rights in the C case. The applicant, C, had been treated for cancer for three years and while in remission became unintentionally pregnant. She went for a series of follow up tests related to her illness which were contra-indicated during early pregnancy. She could not obtain clear medical advice as to the effect of the pregnancy on her health or her life, or as to the effect of the medical treatment on the foetus. She feared the possibility that the pregnancy might lead to a recurrence of cancer and travelled to the United Kingdom for an abortion. In its judgment the court held that there had been a violation of Article 8 of the European Convention in respect of C. Referring to Article 40.3.3° of the Constitution, the court stated: "While a constitutional provision of this scope is not unusual no criteria or procedures have been subsequently laid down in Irish law, whether in legislation, case or otherwise, by which that risk is to be measured or determined, leading to uncertainty as to its precise application".

While this constitutional provision, as interpreted by the Supreme Court in the X case, qualified sections 58 and 59 of the earlier 1861 Act, those sections have never been amended and remain in force with their absolute prohibition on abortion and associated criminal offences, thereby contributing to the lack of certainty for a woman seeking a lawful abortion in Ireland. The court continued: "Against this background of substantial uncertainty the court considers it evident that the criminal provisions of the 1861 Act would constitute a significant chilling factor for both women and doctors in the medical consultation process regardless of whether or not prosecutions have in fact been pursued under that Act".

Both the third applicant, that is C, and any doctor ran a risk of serious criminal conviction and imprisonment in the event a decision taken in a medical consultation that the woman was entitled to an abortion in Ireland given the risk to her life was later found not to accord with Article 40.3.3° of the Constitution. The court found that the lack of an effective procedure in Ireland, which meant the applicant could not determine her entitlement to a lawful abortion in Ireland, caused considerable suffering and anxiety to C, who was confronted with the fear that her life was threatened by her pregnancy. The court awarded her €15,000 in damages.

The conclusions of the expert group derive from the A,B,C judgment and are clear and unambiguous. They are detailed in paragraph 47 of the report, which states:

Arising from the judgment Ireland is under a legal obligation to put in place and implement to legislate a regulatory regime providing effective and accessible procedures whereby pregnant women can establish whether or not they are entitled to a lawful abortion in accordance with Article 40.3.3° of the Constitution, as interpreted by the Supreme Court in the X case and, by necessary implication, access to abortion services in the State.
It would obviously be insufficient for the State to interpret the court's constitution as requiring only a procedure to establish entitlement to termination without also giving access to such necessary treatment. A pregnant woman essentially now has a recognised constitutional right to have a pregnancy terminated where continuation of the pregnancy poses a real and substantial risk to her life. This right has existed since 1983 and is the effect of Article 40.3.3° of the Constitution, as interpreted by our Supreme Court. What the State is obliged to do is to put in place measures to enable a woman to exercise such a right and, in the words of the expert group, "regulate and monitor that right to ensure the general constitutional prohibition on abortion is maintained".

Any measures put in place must not act as an obstacle to any woman legitimately entitled to seek a termination doing so. The expert group report proposes a variety of procedural options to be put in place for determining entitlement and access to a termination of pregnancy, providing for an initial determination and a review process. It also addresses the position of the conscientious objector. It further discusses how to implement the European Court of Human Rights judgment under the procedures chosen. It gives the options of guidelines, regulations, legislation or a mix of legislation and regulations. These are the proposals to be considered and discussed by Government and Members of this House.

It was decided by Government today that discussion on the expert group report would occur in the House next Tuesday and that further time would be made available. The Government also decided it would make a decision on the option to be pursued to implement the judgment of the European Court before the Dáil goes into recess. It is the intention of the Government to make the necessary decisions to provide the architecture required to fulfil our human rights obligations.

Many of the issues to be dealt with in the report fall under the aegis of my colleague, the Minister for Health, Deputy James Reilly, and the Department of Health. However, the Department of Justice and Equality also has an important role. The context of the European Court judgment is clear that in the criminal law area legislation will be required because of what is described as a "significant chilling effect" of the criminal law provisions in the 1861 Act which impact on both women and doctors during the medical consultation process because of the risk to both parties of criminal conviction and imprisonment.

With regard to section 58 of the 1861 Act and the related provisions of section 59, the expert group states:

The provisions are arguably unclear as to their scope and content. It is not clear from reading the section what sort of conduct would be liable to criminal prosecution and what would not. Nor is it clear whether the scope and content of the prohibition on abortion is coextensive with the constitutional prohibition on abortion. It should be borne in mind that the 1861 Act predates the Constitution. Its provisions are only in force in so far as they are consistent and in so far as they are not inconsistent with the Constitution. The provisions fail to provided specific protection for the right to life of a woman whose life is at risk due to her pregnancy. This has been the subject of sustained criticism by the Irish courts and was impugned in the judgment in A, B and Cv. Ireland.
The expert group also states it can be argued that the section does not effectively protect the right to life of the unborn. For example, under current Irish law the life of a baby who is in the process of being delivered is not clearly protected, under legislation pertaining to the offences of murder or of abortion. The expert group stated this lacuna should be addressed by changing the 1861 Act. I believe it is absolutely clear that the only appropriate action to take is to repeal and replace the 1861 Act, using modern language which does not criminalise the termination of a pregnancy where its continuation poses a real and substantial risk to the life of the mother.

In her Bill, Deputy Daly attempts to provide a legal architecture to fulfil our human rights obligations and to give statutory expression to the judgment of the Supreme Court in the X case. The Bill is well intended but unfortunately is substantially defective. It fails to maintain the necessary constitutional balance and does not address in detail a number of important issues dealt with by the expert group. While it seeks to provide protections for a woman whose life is at risk it absolves medical practitioners from any duty to consider whether the life of the foetus is also capable of being preserved.

This appears to be a significant flaw in the Bill, which goes to its constitutionality in that Article 43.3 requires the right to life of the foetus to be vindicated if it is possible or practicable to do so without compromising the right to life of the mother. In seeking, understandably, to protect a medical practitioner from criminal prosecution under the 1861 Act should he or she provide medical treatment to woman where there is a real and substantial risk to her life, section 5 provides a blanket immunity to any such medical practitioner from civil liability should he or she be negligent in the provision of said medical treatment and should such negligence result in either the death or permanent incapacity of the woman involved. That is a very serious matter which must be addressed.

The provisions in the Bill relating to decision-making processes as to whether a termination should occur are, unfortunately, confused and inexact. For example, section 5(2) confers an entitlement on a woman to obtain a further opinion from the medical practitioner or practitioners of her choice but does not explain the relevance of such second opinion or what action might be taken pursuant to it. In addition, the provisions in the Bill which deal with the establishment of an appeals body are either flawed or unclear. In cases of medical emergency, they could represent a failure to vindicate a pregnant woman's right to life. By simply conferring a broad power on a Minister to establish an appeals body by order and saying nothing further, this provision is also open to constitutional challenge. Deputy Clare Daly's Bill also fails to adequately deal with the reforms necessary to sections 58 and 59 of the Offences Against the Person Act 1861.

Now that the report of the expert group has been published, we have a clear insight into the issues which need to be addressed. There is also now a clear statement from Government that the necessary decisions will be made before the Christmas recess and that appropriate action will be taken to implement those decisions without undue delay. The debate on Deputy Clare Daly's Bill affords Members an initial opportunity to commence discussion on the expert group's report. In view of the fact that this report has been published and that a commitment has been given by the Government that it will do what is required to address these very important issues, I ask the Deputy to seriously consider not unnecessarily dividing the House by putting her Bill to a vote. I also ask her to consider withdrawing the Bill and to afford to Members the further time they require to debate the expert group's report. On the understanding that decisions will be made by Government before the Christmas recess, it is not reasonable that Deputies should be asked to vote on a Bill on a Wednesday having first received a report that was published at 3 p.m. the previous day.

The Government is now committed to doing what no previous Administration has done in the 30 years since Article 43.3 was incorporated into the Constitution. The steps to be take are within the confines of that constitutional article and its interpretation by the Supreme Court. I hope everyone in the House will be able to discuss these matters in a common sense, rational and sensitive way, both during the course of the debate on the Bill before us and when the formal debate on the expert group's report commences next week. In addressing this issue, Members should ask themselves what they would do or what would they want to see done if it were their wife, mother, sister, granddaughter, niece or, for those Deputies who are women, themselves who were confronted with the dilemma of being informed that to maintain a pregnancy would result in a real and substantial risk to life.

It is the real and substantial risk to life that is the central issue here. Regardless of whatever action the Government takes, Ireland will still have one of the most restrictive laws in Europe with regard to the termination of pregnancies. The Government and I believe that women and medical practitioners are entitled to know where they stand and what procedures are available to address the circumstances in which a pregnancy is terminable under our constitutional code. In debating this issue it is of crucial importance that Members do not resort to extreme language. We should be conscious of the impact of what we say, both in the House and outside, on women who have miscarried or who have had pregnancies terminated where their lives have been at risk.

We should also be clear on what we are not doing. We are not considering, in any shape or form, abortion on demand as is alleged by some outside this Chamber. We are not even addressing - nor can we under the current constitutional provision - issues which many outside the Houses believe should be addressed. For example, whatever decision is taken by Government, we cannot provide in this State for the termination of a pregnancy resulting from rape in the absence of the victim being suicidal. Neither can we provide for the termination of a pregnancy where there is a foetal abnormality which will, as a certainty, result in the birth of a baby unable to survive. I personally believe that this is an indefensible cruelty. The expert group's report documents cases of rape victims and mothers with babies which suffered foetal abnormalities such as encephaly or Edwards syndrome going to Britain in order to effect terminations. In the absence of constitutional change, there will continue to be a British solution to this Irish problem. It is also the position that a pregnancy which poses a serious risk to the health, as opposed to the life, of a woman - even where such risk could result in permanent incapacity - does not provide a basis for effecting a termination in this State.

There is no impediment to men seeking and obtaining any required medical intervention to protect not only their lives but also their health and quality of life. I do not merely have ministerial responsibility for justice and defence, I am also responsible for equality. It can truly be said that the right of pregnant women to have their health protected is, under our constitutional framework, a qualified right. This will remain the position. This is a republic in which we proclaim the equality of all our citizens but the reality is that some citizens are more equal than others. We should not pretend that the limited measures that must now be put in place to satisfy the terms of the judgment handed down by the European Court of Human Rights ensure true equality for all citizens of the Republic, both men and women. They are, however, the essential measures necessary to ensure that pregnant women whose lives are at risk will have available to them the medical treatment they require and which is their right. The Government is committed to ensuring that action will be taken in this regard. In that context, I ask Deputy Clare Daly to give serious consideration to not putting the Bill to a vote tomorrow evening.

8:40 pm

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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Like the Minister, I also thank Deputy Clare Daly and her colleagues on the work they have done and the effort they have made to ensure that focus has not been lost in respect of this issue. I know how difficult it can be to draft legislation such as this.

The Government shares the concern expressed by Deputy Daly in her Private Members' Bill to the effect that pregnant women whose life is at risk should be able to access appropriate medical care, including lawful termination of pregnancy. As the House was informed last week, the Government is committed to ensuring that the safety of pregnant women in Ireland will be maintained and strengthened and that will be in a position to fulfil our duty of care towards them. The Government's commitment in respect of this issue is clear and is reflected in the agreed programme for Government, which contained a commitment establishing an expert group to examine these issues and to make recommendations to Government on how this matter should be properly addressed. The expert group's report was published today, a fact I welcome. It can be found on the Department of Health's website and will be debated in the House next week. I urge Members to read the findings of the expert group. All Deputies should be afforded the opportunity to study the report in detail before being called upon to vote on any legislative proposals on the matter. A guillotine will not be applied in respect of the Dáil debate and every Member will have an opportunity to add to the discussion. The Oireachtas Joint Committee on Health and Children will also hold three days of public hearings on the report in the new year, prior to the resumption of the Dáil following the Christmas recess.

On the day on which the expert group's report was published, I do not believe it is appropriate to be considering or voting on what is effectively an attempt to prejudge its recommendations. As I stated last week during the debate on the Sinn Féin motion on the Supreme Court ruling in the X case, we now know that there is a solution in sight and that action will be taken. The expert group's report, which is now at everyone's disposal, is a detailed and comprehensive document. It provides very interesting background information on the topic of termination of pregnancy in Ireland. It lays out, with stark clarity, the current legal provisions governing termination of pregnancy in this country and sets out four options for the implementation of the judgment handed down by the European Court of Human Rights judgment in A, B and C v. Ireland case. The report also provides a very clear analysis of the legal, constitutional, ethical, and medical issues to be considered. Further, it lays out - in a simple and concise fashion - the advantages and disadvantages of each option available to us for the implementation of the judgment of the European Court of Human Rights in the A, B and C v. Ireland case. Most importantly, the report is clear, that the option of legislation - with regulations - will satisfy the requirements relating to the implementation process of the judgment of the European Court of Human Rights. In my reading of it, the report provides us with a clear roadmap for action.

As both the Tánaiste and the Minister for Health stated in the House recently, this issue was been with us for 20 years and this is the first Government that has decided to deal with it. Six Governments in this State have failed to act on the 1992 judgment of the Supreme Court; this Government will not be the seventh. However, legislating for the X case is a serious and legally complex issue. As such, every comma and full stop will be subject to intense scrutiny and may be subject to a challenge in the courts. We all know this is very likely. Legislation in this area requires the most careful and expert drafting, appropriately the work of the Office of the Attorney General. While Deputy Daly's Bill is welcome in facilitating debate, it is not appropriate that it should form the legislative basis for this particularly complex issue. Indeed, the expert group report pointed out that: "Due to the nature of this legislation, the process of drafting and democratic scrutiny is likely to take a considerable period of time." This is a sensitive issue and it is proper and right that it be given the attention it requires. Therefore, I support the Government decision to oppose Deputy Daly's Bill.

The expert group report sets out a number of recommendations and weighs the advantages and disadvantages of each option. The report's findings state that the recommendation for legislation with regulations would likely satisfy the requirements of the implementation process of the judgment in A, B and C v. Ireland. According to the report, legislation with regulations "fulfils the requirements of the judgment, it provides for appropriate checks and balances between the powers of the legislature and the executive, and would be amenable to changes that might arise out of clinical practice and scientific advances".

The Oireachtas will have the opportunity to discuss and vote on all the relevant details of any proposed legislation in this area. I hope the Government will be supported by the Opposition, especially by those Members who have been so clear in their desire for action on this issue. The Government is committed to acting on this report, with a decision to be made before the Christmas recess and implemented in the new year. However, it is clear that any proposed legislation for the X case will be a complex task.

The expert group report is helpful in that it discusses the various complex issues than can arise and sets out a number of measures that could be implemented to address each issue. For example, the report states:

The Supreme Court in the X case specifically recognised risk of suicide as a legitimate basis for permitting termination of pregnancy where the other criteria were satisfied. This principle was upheld in two subsequent referendums on the issue.
However, the report deals with and rejects the arguments often put forward that the judgment in Attorney General v. X, establishes a right to abortion at any gestational age. Even from a cursory analysis, it is clear that the report of the expert group provides a wealth of expertise, both medical and legal, and that this considerable resource at our disposal should not be ignored.

Our responsibility as legislators is not simply to draft legislation, no matter how well-intended. It is our responsibility to pass legislation which is subsequently enacted. This will require 83 votes in favour of the legislation. Deputy Daly introduced this Bill last April. I spoke on the Bill at the time and I have no doubt of her good intentions. However, only 20 Members voted in its favour. This is a far cry from the required number of 83 votes in favour. There is division among all groupings in this House. Not one political party or group speaks with a unified voice on this issue. Fianna Fáil, Fine Gael, Sinn Féin and the Technical Group are all divided on this issue. The Labour Party has been the only party with a clear and unified voice on the need to legislate on behalf of the X case. We stand ready to legislate now. I am confident this will not be the seventh Government to ignore the need to act on the Supreme Court ruling in the X case. The Government has committed to have a decision before the Christmas recess. There is a commitment to implement that decision early in the new year, following the hearings of the Joint Committee on Health and Children. I have no doubt the report will stimulate an extremely interesting discussion in the House next week. I trust that, following on from the events in recent weeks, we will be able to have a thoughtful and considered debate on this sensitive issue that has divided Ireland for at least three decades. For all these reasons I believe that a vote in favour of this Bill is not appropriate at this time.

8:50 pm

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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I welcome the opportunity to speak on this Bill. However, it is not helpful that the report is not available to aid us in a discussion of the broader issues raised by Deputy Daly's Bill. I wish to express disappointment that the report was leaked extensively over the past weeks. This is a very challenging debate. Many individuals and parties have significant concerns of conscience and concerns on religious or ethical grounds. We are legislators and we are obliged to legislate. We may need to park our individual concerns to debate the broader issues. In my view, the leaking of the report was distasteful and unnecessary. This report was commissioned by the Government as part of the programme for Government and its recommendations were to be made public. I do not understand why it was thought necessary to leak the report to various media outlets. I am not sure what this achieved. The leaking of the report did an injustice to a report which had been supported by all sides in the House.

There is an obligation on legislators to deal with this very difficult issue which has been with us since 1983. Many Governments have been blamed for failing to act on this issue. A referendum held in 1983 inserted Article 40.3.30 in the Constitution. One could argue that this article is the reason we are debating the issue today. The X case referendum was held in 1992 to deal with the right to travel and the right to information but it removed the ground for lawful termination of the threat of suicide to the life of the mother.

Photo of Alan ShatterAlan Shatter (Dublin South, Fine Gael)
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The last one was unsuccessful.

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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I do not think we need to be made aware of that fact. The right to travel and to information was carried but the ground of threat of suicide was unsuccessful. The people decided on the issue of suicide. They believe that the issue of suicide requires a legislative decision. The reason I list these events is because there is a perception that nothing was done in the past. The people were again consulted in 2002 and they again concurred with the view of the Supreme Court. We have an obligation to stand up and be counted and to provide a resolution to this very difficult issue.

The Minister of State, Deputy Kathleen Lynch is correct that many parties have varying views within their membership. This is a matter which will need to be dealt with internally by parties. However, when we assemble here as legislators - whether as members of Fine Gael, Fianna Fáil, the Labour Party, Sinn Féin or Independents - we have a duty to the electorate. We will at times be required to leave aside our personal views - whether pro-choice or pro-life - in an attempt to establish a mechanism that will deal conclusively with the issue of the X case, provide clarification and allow us talk about the other important issues relating to maternity services and access to proper treatments and maternity care for women.

We must deal with this issue as a result of the judgment of the European Court of Human Rights and the case of A, B and C v Ireland. The expert group review has provided a number of options. I have not read the report in detail but we will have an opportunity to speak with some authority once we have studied and digested the report and consulted our party members and other interest groups from both sides and no side. We are being asked to divide the House again on this same Bill which was debated last April. On the night of the publication of the report, we are being asked to debate the issue and to divide the House again.

We must act in the interest of giving everybody an opportunity to determine, on foot of the expert review group's recommendations, what he or she believes will satisfy the majority in the House. Ultimately, it is the majority in this House who will decide what is required, be it legislation or regulations, in the context of the Government's interpretation of the report. For all these reasons, the Bill is divisive at this juncture. I am not questioning the motivation of Deputy Daly, whose views have been made well known publicly. She has said on numerous occasions that she is pro-choice and that even the eighth amendment, inserting 40.3.3°, is restrictive. However, we must deal with what we have. The bottom line is that the public has spoken and insisted that Article 40.3.3° is the basis on which we make decisions in light of the Supreme Court's interpretation in the X case.

Issues such as rape, incest and fatal foetal abnormalities elicit strong views and people argue for entitlement to termination in such cases, but the current position is that we would actually have to have a referendum to address these particular issues legislatively at a later date if we wanted to. We must work within the current narrow focus. The expert review group has, on foot of a cursory examination, arrived at proposals that may meet the needs of the majority in the House. I refer to the introduction of legislation or a regulation, or both. I am not sure exactly what the Government's interpretation will be but I am sure it will more or less make a proposal, based on the four or five recommendations, that could be backed by a majority in the House. Otherwise, we will be debating this issue continually where a matter arises that is contentious, divisive or does not secure the backing of a majority in the House. For all these reasons, the Bill is not timely this juncture.

Deputy Shatter, as Minister for Justice and Equality with access to support in analysing the Bill and as a solicitor, will have identified some of the flaws in the Bill. It is evident that it would require considerable work on Committee Stage even if Second Stage is passed tomorrow evening. We must wait only a few weeks for recommendations from the Government. The recommendations will be presented to the Joint Committee on Health and Children in January and there will be an opportunity for people of all views to make presentations and submissions on the views of the expert group and judgments A, B and C. We can then determine whether we can bring society with us. There is no point in making in the House a decision that has no resonance. People refer to Mr. Tony Benn's view on leadership. We must lead but the problem is that if one leaves a divided society behind one, one is not achieving very much in the context of this very sensitive issue.

My party will not be supporting the Bill tonight. We await the Government's recommendations. As I stated publicly, including in this Chamber, we want to play a role that will bring finality regarding our obligations in respect of the A, B and C cases, having regard to the reprimand of the Grand Chamber. Thus, there will be clarity such that women can believe their maternity services are comprehensive and safe and that their human rights will be vindicated daily. Where there is a substantial risk to the life of a woman using maternity services, a termination is legal, but clarity is required in this respect. It is necessary on a number of fronts, primarily because of the statement of the European Court of Human Rights. Masters of various maternity hospitals, obstetricians and clinicians dealing with this matter daily are saying legislative and regulatory clarity is required. They seek a definitive statute to give them confidence to work in the maternity services.

With regard to the inquiry into the death of Ms Savita Halappanavar, it is important that we await the outcome. The matter was badly handled. We raised this a long time ago. When we heard about the issue first, we stated the inquiry should be fully independent. There should have been significant discussions with the family, including Mr. Praveen Halappanavar and the extended family. There is now an inquiry that does not have the confidence of the family; it does not really have the confidence of anybody.

I acknowledge the HSE is obligated to carry out its own clinical investigation. Running in tandem with that could have been an independent investigation that would satisfy the needs of the family. Despite this, there was no discussion or engagement. The Tánaiste brought in the Indian ambassador, and the Irish ambassador spoke to the Indian Government, yet no member of the Irish Government spoke to the husband of the deceased until a couple of days ago. To say the very least, this is distasteful. I refer to a high-profile case with a very tragic outcome giving rise to major concerns on the part of the family concerned over the fact that an independent investigation is not being carried out and that instead, an investigation is being carried out by the HSE. I understand the concerns of the family. We should have appointed an independent investigative team that could have carried out an investigation in tandem with the HSE. The HSE has an obligation to ensure that whatever happened in Galway on the day in question will not happen again and it is obliged to address deficiencies.

This debate has done a considerable disservice to maternity services. People highlight the issue of Savita Halappanavar but we do not know the circumstances. However, I do know we have one of the best maternity services in the world. It is staffed by the most eminent and qualified obstetricians, gynaecologists, midwives, nurses and support staff. Women ought to have confidence in the safety of our maternity services and believe they provide the best quality of care for mother and child. We must understand that individuals may use certain tragic circumstances to highlight their particular positions but doing so does not do any justice to the thousands of staff who are working week in, week out, in our maternity services and providing some of the best maternity care in the world. It is important that the language we use to highlight issues be used in a way that is understanding of the concerns of others and what flows therefrom.

The Minister stated we have an obligation regarding the statement of the European Court of Human Rights regarding the A, B and C cases. This is really why we are discussing this issue: let us be honest. I have been a Member for a number of years and believe this matter was pushed on us. It may not have become part of the programme the Government had the European Court of Human Rights not stated quite clearly that there ought to be clarity and that an individual's human rights were not vindicated in respect of her having clarity on whether she was entitled to terminate a pregnancy to save her life. This is the kernel of the issue. Nobody has acted on this issue. Had the European Court of Human Rights not vindicated the human rights of the individual in the C case, we might not have been discussing this at all.

I welcome the fact that, at long last, in the context of the interpretation of the Supreme Court and the European Court of Human Rights decisions, this issue has been brought to the Legislature, where we can make the points and, more important, the decisions that are now required. It is evident that we cannot muddle along anymore and we have to try to be brave in how we deal with this, although we must do so in a way that is sensitive to, and understanding of the fact, that many Members will not necessarily support some or any proposals. My party has not discussed the report because we only received it earlier. However, unless 83 Members are willing to support this, we can continue to debate this issue forever and a day. We must be understanding that some Members have strong views at variance with those expressed by previous speakers and they have as much right to vote against the Government's proposals as others have to support them. Common sense and a consensus may address this divisive issue.

9:10 pm

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Since the tragic death of Savita Halappanavar, the issue of abortion has once again become dominant in Irish politics. It is a double tragedy that it should take the death of a young woman to again focus minds on the requirement to protect women and to address the unresolved legal issues but the need for greater legal clarity has been there for a long time. Disgracefully, that need has been neglected by successive Governments.

This Bill seeks to provide legal clarity. It may not be the required answer but Sinn Féin believes that it should be allowed to proceed to Committee Stage where it can be amended, as appropriate, and we will vote accordingly. Legislation can now be addressed in light of the Report of the Expert Group on the Judgment in A, B and C v Ireland, the publication of which I welcomed earlier. The report reminds us that, in the A, B and C v. Ireland case, the ECHR found that Ms C's right to private and family life had been violated contrary to Article 8 of the European Convention on Human Rights. The court 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. That, in a nutshell, sets out the need to legislate.

The report sets out options for the provision of lawful termination of pregnancy in circumstances where there is a real and substantial risk to the life of the mother which can only be avoided by a termination of the pregnancy. This is the core of the matter on which we have to provide as much legal certainty as possible. From the report’s analysis of the options, it is clear that primary legislation is required and that regulations alone will not suffice. The detail of the report will require careful scrutiny in the days ahead, for example, to assess if a combination of primary legislation and regulations would be preferable to primary legislation alone. A first reading of the report makes clear that what is most likely required is both primary legislation and regulations. A careful balance will have to be struck between making legislation too prescriptive and leaving too much to be dealt with by regulation.

It is absolutely crucial that the Government acts speedily on the report. As an immediate next step, the Government should allow the Bill to proceed to Committee Stage. That is our sincerely held view. It will then be up to the Government to determine when Committee Stage will be taken. This can be done in consultation with all parties and any number of amendments can be brought forward to make the Bill fit for purpose. We are willing to play our part in all of that. We should not have to wait another six months for legislation to present and be enacted. As an Opposition party, Sinn Féin is willing to co-operate with the Government and all parties and voices in the Oireachtas to achieve the best outcome and the stated outcome, which is the protection of women in all circumstances that can present and the provision of certainty for medical practitioners where legal certainty is required.

Debate adjourned.

The Dáil adjourned at 8.55 p.m. until 10.30 a.m. on Wednesday, 28 November 2012.