Joe Higgins (Dublin West, Socialist Party)
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I move amendment No. 2:

In page 5, line 5, after "pregnancy;" to insert "to make provision for lawful abortion where there is a risk to maternal life;"

Michael Kitt (Galway East, Fianna Fail)
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Amendment No. 3 in the name of Deputy Mattie McGrath has been ruled out of order and cannot be moved because it depends on other amendments. I think the Ceann Comhairle has written to the Deputy about this.

Mattie McGrath (Tipperary South, Independent)
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I wish to seek clarification.

Michael Kitt (Galway East, Fianna Fail)
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The Deputy will have to be brief.

Mattie McGrath (Tipperary South, Independent)
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This morning I received a letter in which the Ceann Comhairle stated he regretted that he had to inform me that amendment No. 3 would have to be ruled out of order as it was declaratory in nature. Will the Leas-Cheann Comhairle explain what that means?

Michael Kitt (Galway East, Fianna Fail)
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The amendment does not arise as a consequence of any other amendment proposed in the Bill. It must be related to another amendment.

Mattie McGrath (Tipperary South, Independent)
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The amendment relates to the Title which is false and erroneous in the extreme. It should be called what it is.

Michael Kitt (Galway East, Fianna Fail)
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That is the Deputy's opinion.

Mattie McGrath (Tipperary South, Independent)
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It is not about the protection of life during pregnancy. It is about the deliberate killing of unborn children.

Michael Kitt (Galway East, Fianna Fail)
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The Ceann Comhairle has ruled the amendment out of order. We must move on.

Mattie McGrath (Tipperary South, Independent)
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It should be called the termination of pregnancy Bill.

Michael Kitt (Galway East, Fianna Fail)
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The amendment is declaratory and does not arise as a consequence of any other amendment proposed in the Bill.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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I move amendment No. 4:

In page 5, line 14, after “of” to insert “maternal”.

Joe Higgins (Dublin West, Socialist Party)
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I move amendment No. 5:

In page 5, line 14, after “Life” to insert “and Health”.

Catherine Murphy (Kildare North, Independent)
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I move amendment No. 6:

In page 5, lines 15 to 17, to delete all words from and including “on” in line 15 down to and including “provisions” in line 17 and substitute “not later than 30 days following enactment”.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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We believe such legislation should be enacted quickly and not left in the hands of the Minister. We have waited too long already.

Alex White (Dublin South, Labour)
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The absence of a specific commencement date is due to the fact that operational issues will require to be addressed before the Bill can be commenced. For example, under section 11, the Health Service Executive, HSE, needs to establish a panel of medical practitioners for the purpose of the formal medical review provisions in the Bill. This process will entail contacting the relevant bodies seeking and receiving the relevant nominations and appointing the identified medical practitioners.

In addition, under section 12, the HSE must put in place the required administrative facilities that will be necessary to enable the review committee, drawn from the review panel, to perform its functions.

I wish to reassure Members that this is not some sort of delaying tactic as has been suggested by Deputy Boyd Barrett but a necessary provision to ensure all the requirements of the Bill are in place to enable its implementation when it is commenced. For that reason, I do not propose to accept the amendment.

Mattie McGrath (Tipperary South, Independent)
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Obviously, the Bill is rushed and could not be done fast enough. The Minister is going to stay here all night but now we find out that the arrangements for the institutions are not even made. I know that from my hospital in south Tipperary. No one knows what is happening but the general threat is that hospitals which do not conform to and perform the Bill’s provisions will be starved of cash and dealt with. It is appalling.

Billy Timmins (Wicklow, Fine Gael)
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Will there be a requirement for physical infrastructure changes in any of the approved centres?

Alex White (Dublin South, Labour)
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I am not aware of any issue arising as to physical structures requiring to be altered.

As for Deputy Mattie McGrath's contention, the argument could not be possibly sustained that this Bill is being rushed. The opposite is manifestly the case.

Mattie McGrath (Tipperary South, Independent)
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Of course it is being rushed.

Alex White (Dublin South, Labour)
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There is no basis for alleging this legislation is being rushed.

Mattie McGrath (Tipperary South, Independent)
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This morning the Taoiseach said he wanted to get rid of the Bill before tonight. What does the Minister call that?

Clare Daly (Dublin North, Socialist Party)
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We have been waiting 21 years for it.

Michael Kitt (Galway East, Fianna Fail)
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Amendments Nos. 7, 72 and 97 are related and will be discussed together.

Joan Collins (Dublin South Central, People Before Profit Alliance)
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I move amendment No. 7:

In page 5, between lines 24 and 25, to insert the following:“ “appropriately qualified practitioner” means a general practitioner, medical practitioner, midwife, obstetrician, gynaecologist, as defined in this Act;”.

Having three medical personnel determining whether a woman is suicidal is, however, a disgrace. The provision in this regard in Deputy Clare Daly's Bill was much more appropriate. The cases of young women in HSE care who were sent to Britain for terminations were determined by one psychiatrist. I believe there should be only one psychiatrist dealing with a woman in a suicidal situation. This amendment aims to broaden those qualified personnel who should be able to deal with certification and not just confine it to an obstetrician. For example, an obstetrician may only meet a woman once or twice during a pregnancy. Her general practitioner, GP, would be much more aware of the woman's overall medical condition and history.

Mattie McGrath (Tipperary South, Independent)
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These amendments are using words lightly and glibly. We were told by Women Hurt by Abortion, a group which was not allowed to give its evidence at the committee hearings on the Bill, that they would have lied and claimed they were suicidal. This is just playing with words and semantics. I think it is very distasteful.

Clare Daly (Dublin North, Socialist Party)
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This is primarily a health matter and concerns a medical opinion. The status and qualification of the medical practitioners is particularly relevant. The amendments seek to broaden the remit as to what defines an appropriate medical practitioner.

Given that it is a relatively routine procedure in terms of termination and where suicide is a risk, it is a medical opinion which in any other scenario would be dictated by a psychiatrist and the person’s doctor. Who knows one’s medical condition better than one’s GP? They are eminently qualified to have an insight into one’s mental health and physical well-being. We make points about how great our maternity services are here. However, the chances of a pregnant woman meeting a gynaecologist or an obstetrician when accessing our public maternity services are few and far between.

If a pregnant woman meets them at all, she will be lucky. The idea that those people know the woman and her physical or mental health or well-being is an absolute joke. Her GP will be much better qualified to do that. The inclusion of an obstetrician to deal with mental health, an area in which such a person has no qualifications whatsoever, is actually an obstructionist clause inserted by the Government to make it more of an obstacle course for women who are suicidal. In that scenario, the last thing a woman needs is more barriers put in her way. The support services should be there to assist women and not to inhibit them. The purpose of our amendments is to make them more accessible.

It should be pointed out that the expert group, which was the Government's own idea, recommended that two medical practitioners were sufficient and that they should come from a broad pool of specialities, including both physical and mental health. Our amendments are in line with that. It broadens out the provision to give a better mix of medical practitioners to adjudicate on what are health and medical matters. We think they are eminently qualified.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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I would like to follow on from the points that were made and also speak about amendment No. 97, which relates to the requirement to have an obstetrician on the review committee. Why the hell is there a requirement for an obstetrician when dealing with the threat of suicide? To be crude about it, the Minister of State or I or anybody else in here is as qualified as an obstetrician to certify whether somebody is suicidal or not. In other words, none of us is qualified. Unless one of us happens to be a psychiatrist, we are not qualified to assess suicidal ideation, so why is the obstetrician included? It is simply inexplicable and no justification has been provided for that inclusion. Many psychiatrists, including one I heard interviewed on the radio a few days ago, as well as Doctors for Choice, have questioned the objective of including a requirement either to have an obstetrician to certify suicidal ideation that might be a risk to the life of the mother or to have an obstetrician on the review committee in those cases. There is no reason for it, so one would have to draw the conclusion that it is a blocking requirement. It simply increases the possibility that a woman who is suicidal, with a consequent risk to her life, could have that risk certified by two psychiatrists, but then have it blocked by an obstetrician who has no qualification whatsoever to make any assessment of whether there is a risk to that woman's life due to her suicidal feelings. I would like the Minister of State to explain all that, but I do not think there is an explanation. I think it is unacceptable.

Joe Higgins (Dublin West, Socialist Party)
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The intent of the amendment is to make very slightly less onerous a massively onerous provision affecting a woman who presents in this acute situation. We should call on the Minister of State to recognise that the provisions in his Bill for three practitioners at the first stage, and three again at the review stage, present an obstacle course to women in a very difficult and traumatic situation which will not be faced by the vast majority of people. Women in a dreadful, traumatic mental predicament in respect of a crisis pregnancy will not be able to find a remedy in this State. That is the reality of the situation and the Minister of State should be honest and admit that. It is a mechanism to ensure that a woman suffering in this situation will be forced out of the country rather than face the barrage that is provided in this legislation, which is simply inhuman and the complete opposite to compassion for somebody in this very difficult situation.

Alex White (Dublin South, Labour)
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I cannot accept the Deputy's amendments. Under the terms of the Bill, a "medical practitioner" means a doctor registered by the Medical Council under the Medical Practitioners Act 2007, which indicates a person permitted by law to practise as a medical practitioner in the State. In the performance of their professional activities, all such medical practitioners are subject to the ethical and professional control of the Medical Council. It is not intended that it should be possible for a person other than a qualified doctor to undertake the procedures involved in this Bill. Other than in emergency situations, doctors who can certify in regard to a real and substantial risk to the woman of loss of life that can only be averted by a medical procedure as a result of which unborn life is ended must be registered by the Medical Council in its specialist division.

The Bill also requires that the medical procedure, in order to be lawful, must be carried out by an obstetrician or gynaecologist rather than by any other registered medical practitioner. This stricter provision is to ensure the procedure is carried out by highly skilled and qualified medical personnel only, in order to secure the best possible care for the woman whose life is at risk and for the unborn.

Finally, the Bill refers to medical practitioners with a "relevant speciality". This is defined with reference to specialist knowledge to ensure that doctors involved in the certification process have a high level of knowledge and skills. However, it is not limited any further, in order to ensure that all clinical specialties that might be relevant may be included in the definition.

Joan Collins (Dublin South Central, People Before Profit Alliance)
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As far as I am aware, GPs are covered under the Medical Council in respect of ethics and so on. Why is the obstetrician there? Just being registered with the Medical Council is not a good enough reason to explain why an obstetrician is included and a GP is not included. I do not accept what the Minister of State is saying and I do not see why he cannot accept the amendment.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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It would be helpful if we could get an answer from the Minister of State on that point. Our argument is that the Bill is too prescriptive in respect of the medical professionals required in the first instance and on the review committee. In the case of a threat of suicide, why would one need an obstetrician? An obstetrician's qualifications have no bearing whatsoever on the assessment of whether there is a real and substantial threat of suicide by a woman. Can the Minister of State explain why this is so prescriptive? We are arguing that it should not be so prescriptive. The bar is being set higher for a woman whose life is threatened than would be the case if there was no pregnancy at stake. In any other circumstances, one doctor rather than three would be required to make an assessment of whether somebody's life is under threat. Therefore, the Government is setting a higher bar here and consequently jeopardising the safety of women.

Alex White (Dublin South, Labour)
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The suggestion that we are jeopardising the safety of women is completely unsustainable in the context of what we are doing.

Deputy Daly quoted the expert group in support of her argument, and I have heard her do this before. If we are invoking the export group report in support of the argument, it is important to read all of the report. I read it into the record before for Deputy Daly when she made the same point. I do not have the report with me, but I will have it later in case this arises.

Clare Daly (Dublin North, Socialist Party)
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I have it and I will read it out in a minute.

Alex White (Dublin South, Labour)
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The expert group is very clear about the case for having a different approach in the case of a physical threat to the life of the mother from that in the case of a threat of suicide, and the report mentions the lack of objective clinical markers in that respect. It is very clear in the narrative of the report and in one of the options it outlines.

It makes the case for a different approach in the context of a threat to a woman's life arising from suicide. It is interesting that amendment No. 72 does not reduce the number of doctors required to make the assessment under section 9 from three to two. It simply states that the doctors should include a GP or some other doctor with a relevant speciality rather than an obstetrician. The amendment does not do what the Deputies claim for it.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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We have tabled a different amendment on that issue.

Alex White (Dublin South, Labour)
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I reject Deputy Boyd Barrett's suggestion that the mother's safety is being endangered. This legislation has to address the life of the unborn child and the life of the mother in the context of Article 40.3.3° of the Constitution. A compelling case can be made for including an obstetrician in the assessment provisions in sections 7 and 9. It is likely that a foetal assessment will be required in a particular clinical situation arising under sections 7 or 9. It is entirely proper and prudent to involve an obstetrician in such a setting. That is not to say individual professionals would not draw on their own specialties when making their assessments, but the expert obstetrician or gynaecologist should be involved in making an assessment. We do not propose to change those provisions.

Michael Kitt (Galway East, Fianna Fail)
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Deputy Boyd Barrett has spoken twice already.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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I am one of the movers of amendment No. 97.

Michael Kitt (Galway East, Fianna Fail)
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Only Deputy Joan Collins is regarded as the mover. She may speak again if she so wishes.

Joan Collins (Dublin South Central, People Before Profit Alliance)
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We would like to reduce the number of practitioners to two or one but we know that would never be accepted. We hoped the Government might at least accept this amendment. An obstetrician could refuse a termination to a woman with suicidal intent on the basis of suicidal ideation. Many people do not believe an obstetrician is in a position to make that decision when a psychiatrist is already involved. I ask the Minister of State to accept the amendment. A GP or other medical practitioner can play that role and the GP is probably in the best position to assist a woman making that decision.

Clare Daly (Dublin North, Socialist Party)
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I am glad to be able to assist the Minister of State because, unlike him, I have access to the expert group's report.

Alex White (Dublin South, Labour)
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I ask the Deputy not to quote it selectively as she did previously.

Clare Daly (Dublin North, Socialist Party)
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Section 6.4 of the report, on the number and role of doctors, states: "it was generally considered that two doctors with the relevant training and expertise appropriate to the case would be sufficient for making a clinical decision as to the risk to the life of the woman, whether the risk arose because of a physical or mental health condition." I appreciate that obstetricians can play a role in carrying out a foetal assessment, but assuming that we are not arguing the foetus is suicidal, I do not know how his or her opinion is relevant in assessing the suicidal ideation of a woman whose life is in danger and whose life we are legislating to protect. That is the purpose of these amendments. The points are valid and they stand.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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On a point of order, I understand that movers of amendments have the opportunity to speak again.

Michael Kitt (Galway East, Fianna Fail)
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I understand that when amendments are grouped it is the proposer of the first amendment who speaks again.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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That is not what I have been given to understand. May I speak on the amendments?

Michael Kitt (Galway East, Fianna Fail)
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I will have to check that but I will allow the Deputy to speak if the House agrees. Is that agreed? Agreed.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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The Minister of State made an alarming admission on the issue of the obstetrician. Section 9 provides that if there is a real and substantial threat of suicide, the woman is entitled to a termination of her pregnancy. He is arguing that her right is qualified because an obstetrician who can make a foetal assessment but is not qualified to assess the threat to life of the mother as a result of suicide will have a say on her right to a termination. That is a shocking dilution of her right to protect her life or the right of the psychiatrists who assess the threat to her life to make the decision to allow a termination. We are getting a heavily qualified protection of the woman's life in such a way that her life is threatened by the qualification. It is disingenuous of the Minister of State to say the amendments do not deal with the issue of three doctors versus two doctors. They deal with the issue in so far as an obstetrician is required in addition to two psychiatrists or, as we propose, one psychiatrist and a GP. His insistence that an obstetrician should have an input into the process increases the number of doctors to three, places more hoops for the woman to jump through and endangers her life.

Alex White (Dublin South, Labour)
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I do not propose to add much to what I have already said. The expert group stated:

the role of the psychiatrist is key where a termination of pregnancy is prescribed as appropriate treatment in case of suicidal ideation/intent. There are recognised clinical challenges in correctly diagnosing expressed suicide intent, for instance, the absence of recognised clinical markers. Therefore, it could be argued that this is a more subjective process and requires more safeguards to be put in place for the protection of both the woman and the unborn. The need to keep up to date with clinical research on this issue is highlighted in the Medical Council Guidelines referred to in section 3.6.3 with a view to ensuring that the decision is evidence-based.

to require that one of the medical specialists responsible for the decision-making process is an obstetrician in all cases, even when this expertise is not strictly relevant to the diagnosis. This option gives the obstetrician, as the health professional who is going to carry out the procedure, the capacity to acquire confirmation that the medical treatment is appropriately recommended.

Michael Kitt (Galway East, Fianna Fail)
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For clarification, under Standing Order 133, even when amendments are grouped it is only the mover who has the third contribution.

Amendment No. 8 in the name of Deputy Tóibín is grouped with amendments Nos. 8, 20, 23 and 24, Nos. 55 to 58, inclusive, Nos. 69 and 70, Nos. 70 to 80, inclusive, Nos. 86 to 89, inclusive, Nos. 93, 98, 102, 114, 115, 120, 133 and 140, Nos. 142 to 144, inclusive, and Nos. 148, 149 and 156. Amendments Nos. 148, 149 and 156 are related. Amendment No. 24 is an alternative to amendment No. 23. Amendment No. 62 is an alternative to amendment No. 56. Amendments Nos. 71, 73, 74, 99 and 100 are related to amendment No. 62. Amendments Nos. 87 to 89, inclusive are alternatives to amendment No. 86.

Amendments Nos. 8, 20, 23 and 24, Nos. 55 to 58, inclusive, Nos. 62, 69, 70, 71, 73 and 74, Nos. 77 to 80, inclusive, Nos. 86 to 89, inclusive, No. 93, Nos. 98 to 100, inclusive, Nos. 102, 114, 115, 120, 133 and 140, Nos. 142 to 144, inclusive, and Nos. 148, 149 and 156 will be discussed together. I call on Deputy Tóibín to move his amendment.

Peadar Tóibín (Meath West, Sinn Fein)
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I move amendment No. 8:

In page 5, lines 26 and 27, to delete "section 9 certification".

We should put medical evidence at the centre of this Bill. We know, first and foremost, that abortion extinguishes the life of the unborn child. It is often damaging to the health of the mother and it increases maternal suicides. The most up to date in-depth analysis and longitudinal surveys carried out internationally on this have come to this conclusion. We are told that the provision in the Bill will not open the floodgates to abortion, but nobody in this Chamber knows how many abortions will be carried out on the basis of this legislation. All we know is that where countries have legislated in this area, there has been a radical increase in the number of abortions over a period of time. Even if there is not a radical increase in the number of abortions, how many medical evidence free abortions are tolerable in our society?

We have been told over and over again that this Bill will only provide for a situation where a woman will commit suicide and both the mother's life and the child's life would be lost. In fact, the Bill does not provide for that, because the system it uses to predict the probability of suicidal intent, as we heard repeatedly at the oral hearings, has only a prediction accuracy level of 3%. Therefore, current figures indicate that on 97% of the occasions where a psychiatrist identifies a patient as likely to commit suicide, the psychiatrist gets it wrong.

I can wholeheartedly support the part of the Bill that provides for treatments founded on medical evidence, but when this Chamber reaches a state where it legislates and composes policy for areas outside of medical evidence, we are in trouble. We need to ensure that both the legislation and medical evidence are fully orientated towards each other and do not take different directions.

Éamon Ó Cuív (Galway West, Fianna Fail)
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I tabled amendments Nos. 20, 55, 58, 89, 98, 133, 140, 142, 144, 149, and 156 and they are all connected because basically, what they seek to do is to remove the suicide provision from this Bill, the so-called suicide clause. Substantially, this relates to section 9. I propose the deletion of section 9 of the Bill and the making of the necessary consequential amendments.

When we examine this, what we must decide is whether section 9 is compatible with the Constitution and the principle therein that all human life is worthy of protection. As I said on Second Stage, a human rights approach to this issue leaves a choice as to whether unborn human life is human life and if it is, whether it deserves the same basic protection as born human life. Not only do I think unborn human life is human life, but the Irish people in referendum after referendum have confirmed that simple principle in Article 40.3.3o.

The argument put forward by the Taoiseach and the Government regarding Article 40.3.3o is that there is an obligation to legislate for the X case judgment. As time goes on, I believe it is becoming clearer that this is not the case and that it would be open to us to pass this legislation without section 9. The worst case scenario if we did that would be a challenge in the courts. I am certain that if we pass the Bill as proposed, it will also be challenged in the courts as not "protecting the equal right to life of the unborn". In fact, I am certain that the Bill will open up a constitutional and legal mine field.

Why do I believe we are not bound by the X case judgment? The reasons are legal, ethical and medical and are based on all of the knowledge gathered in the intervening years on this subject. It is important to remind ourselves of the simple facts of the X case, a very sad case. A young 14 year old was raped and became pregnant. In the High Court, on the evidence of one psychologist in a case not contested by the State, it was accepted as a matter of fact that there was a real and substantial risk to her life if she did not get an abortion and that an abortion was the only way of avoiding that risk. The Supreme Court in its ruling could not examine the evidence and gave a majority ruling which granted her permission to have an abortion.

We have been told time and again in a mantra like fashion that the ruling in this case created a general obligation on the Oireachtas to legislate for abortion if a pregnant woman had a suicidal ideation. This always seemed to me to generalise what had been a unique set of circumstances in an extraordinary way. I was always wary of this approach, as I had seen over the years how the interpretation of the Constitution had changed according to circumstances and knowledge. This is very obvious in recent years in regard to the interpretation of property rights clauses in the Constitution, where the previous mantra that property rights, including salaries and pensions of public servants, could not be interfered with was subsequently modified. To have no less a person than retired Supreme Court Judge Hugh O'Flaherty say that this point is moot or arguable or as the Irish dictionary says, inphléite, is very significant. As he said, "to say the X case is some giant talisman hanging over us is wrong". That this is arguable is doubly so when we consider he was one of the judges who gave the majority verdict in the X case. Therefore, it seems the Oireachtas would be perfectly within its powers to delete section 9 and pass the Bill.

If it was to do this, the vast majority of people with objections to the Bill would come out totally in support of it. As I said before, I have no principled objection to the rest of the legislation. In fact, I welcome it as it brings clarity to the medical crisis covered in sections 7 and 8.

Section 9 will make bad law that will be open to abuse and will also put doctors in an invidious position in trying to predict the unpredictable. It is generally accepted that, thankfully, suicide in pregnancy is rare. This, however, increases the difficulty which is not addressed in the Bill as to how it is possible to establish a real and substantial risk to the life of the mother as required in condition No. 1 by proponents of the Bill. What we do know is that, even if this could be established with some accuracy, in the absence of biochemical markers, abortion is not a treatment to prevent suicide. This was clearly established at the Oireachtas hearings. That the Oireachtas will legislate to provide for a so-called treatment that flies in the face of all reputable evidence-based medicine is extraordinary. That this is being provided for as the only treatment in these cases is beyond belief. If the Oireachtas was taking a similar approach to any other medical issue, the proponents of the Bill would ridicule them as indulging in bad practice.

As I said, the Oireachtas hearings show abortion is not a treatment to prevent suicide. None of the learned textbooks on psychiatry on the management of mental health issues in pregnancy, even those from jurisdictions in which abortion is freely available, mentions or recommends abortion as a treatment for suicidality in pregnancy. I support the work done by the Minister of State, Deputy Lucinda Creighton, in drafting an amendment which would provide for a care plan for those who experience suicidal thoughts in pregnancy. This seems to be a practical and well based approach to this issue, one likely to save the lives of pregnant women and their unborn.

One of the obligations under the Bill, as drafted, and a constitutional obligation is to seek to preserve the life of the unborn if a termination takes place once viability outside the womb has been reached. How many will be left disabled as a consequence of the unnecessary head 9? The figures are startling and have been provided for me by a well known obstetrician. The fact of the matter is that for babies delivered between 23 and 24 weeks, there is a 50% risk of cerebral palsy; between 24 and 25 weeks, the risk drops to 20%; between 25 and 26 weeks, it is 22%; between 26 and 27 weeks, it is 12.3%; between 27 and 28 weeks, it is 11%; between 28 and 29 weeks, it is 8.2%; between 29 and 30 weeks, it is 8.3%; between 30 and 31 weeks, it is 7%, and between 31 and 32 weeks, it is 4%.

Before we rush willy-nilly into passing this totally flawed legislation, we should picture in our minds some future Dáil that will be confronted by people, men and women, seriously disabled because of this section of the Bill, who will sue the State for introducing a Bill that led to them having lifelong disabilities, based on introducing bad medical practice in our laws. Therefore, I ask the Minister to go to the Taoiseach and ask for permission to accept the amendment. In view of the radically changed position, legally and medically, thrown up by the process that this House and the Government have set in train, it is time to review this section. If the Government accepts the amendment and the other relevant consequential amendments, the Bill will pass with widespread support inside and outside the House.

Greatness is not about sticking to one's tack when new information comes to light that changes the position. It is about recognising new facts and adjusting policy accordingly. The Taoiseach has said time and again that he is pro-life, pro the mother's life and pro the life of the unborn. I ask him to act accordingly. I ask that we support these amendments in order that the whole provision on suicide will be taken out of the Bill and replaced with proper medical evidence-based care paths.

Lucinda Creighton (Dublin South East, Fine Gael)
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Amendments Nos. 58 and 78 are in my name, although I am happy to support the spirit of a range of other amendments tabled by colleagues which deal with the suicide clause in this abortion legislation.

I want to start by saying I very much respect the Members on the Opposition benches who have been at least very honest in terms of what they aspire to achieve in an abortion regime in this country. It is clear that we do not agree, but I respect the frankness and the honesty with which they approach the debate. For me, it is the distortion of facts and, in some cases, revisionism which disturbs me most. I very much support the overall intention of the legislation which is supposed to be about protecting and saving the lives of women and babies, but I cannot support a clause which is essentially built on sand. This issue has already been addressed by Deputies Peadar Tóibín and Éamon Ó Cuív and I am sure others will speak about the litany of medical experts who have contacted us to express their concern about the complete inability to make this section work and their inability to make it work, as practitioners, as we heard repeatedly during the Oireachtas hearings.

I want to talk about the underlying argument which has been made and repeated as a mantra from all quarters, that we have to do this because of the X case. That is fundamental to all of the amendments. I have heard a lot of talk in recent days about people cowering behind the party Whip. People can only examine their own consciences and make up their own minds on the matter. However, what about those cowering behind the Supreme Court? This is a real question that we, as legislators, who function as an organ of the State, an organ which is distinct from the Supreme Court by virtue of the separation of powers, must address.

The first question we must ask ourselves is whether the Supreme Court ordered the Oireachtas to legislate and, of course, the answer is no. Under the Constitution, Bunreacht na hÉireann, the Supreme Court and all other courts have no capacity or authority to direct the Oireachtas to enact legislation. This is borne out in a litany of case law, including Holland v. Ireland, Cummings v. the Director of Public Prosecutions and a range of other cases. The Supreme Court held in these cases that it had no authority to direct the Legislature. Article 15.2.1° enshrines the right of the Oireachtas as the sole legislative authority. We need to understand the responsibility that lies on our shoulders, not on those of Supreme Court justices in making decisions on legislation in this House.

In the X case, while the Supreme Court bemoaned the fact that the Oireachtas had not legislated in this area, it never suggested that it could or should require or instruct the Oireachtas to legislate.

Mr. Justice Niall McCarthy described the failure to legislate for Article 40.3.3° as inexcusable, a comment which has been repeated many times. It is important to note, however, that this was a retrospective observation, albeit a legitimate one and one I share, relating to the absence of legislation. It was not, however, a direction from the Supreme Court to the Oireachtas on whether we should legislate or, much more importantly, how we should legislate, which is a matter for this House and the Upper House.

I will now address the question of obiter dictum. Under Irish law the binding elements of court decisions are known as ratio decidendi, which is the reason or logic behind the decision. This is a principle of law as applied to the facts of the given case and is something any first year law student will know all about. I hope Members of this House are familiar with it. All other statements of law within a judgment are called obiter dicta. These statements are not of direct relevance to the decision and are consequently not binding. They do not have a value in precedent.

In the X case a decision was reached based on certain facts which ultimately did not transpire. Miss X tragically had a miscarriage before an abortion was carried out. While this might appear to be some type of trivial distinction, the reality is that under the Irish legal system, whether or not it suits people's agenda, this has a profound effect on whether a decision is binding in law or is merely persuasive. It has been bizarrely overlooked that one of the judges who made up the majority of the Supreme Court in the judgment in the X case, Mr. Justice O'Flaherty, made the following observation in recent days: "[W]hen it [the Supreme Court, of which he was a member] gives an opinion on a case, [and] that doesn't work out as submitted to it, then it's really an obiter dictum." In other words, it is not binding. Mr. Justice O'Flaherty also said: "They're all talking about the X case, but in effect the X case is moot because the girl didn't have an abortion. She had a miscarriage. To say the X case is some giant talisman hanging over us is wrong." On the question of whether the Government was obliged to legislate for the suicide clause, he said it was not necessarily the case "for the reason that the case wasn't as binding as a different type of case would have been".

Despite this clarification, the terms of the X case keep being dangled over us as justification - for some, particularly in my party, the only justification - for the inclusion of this flawed section in the legislation, which is not evidence-based and which the majority of the medical professionals in psychiatric care and indeed in general practice keep telling us is not workable. We, however, keep telling them we have to do it because of the X case. The Supreme Court did not hear any legal arguments on the issue of whether suicidal ideation could validly satisfy the real and substantial risk test. In fact, the Attorney General conceded the point and, therefore, all the medical, legal and public policy arguments that should have been considered were not considered. Under the doctrine of precedent that governs whether court decisions are binding, a court must rule on the question. If the point has been conceded, it is not a part of the decision of the court. Again, this is known by any law student. If something is not argued before the court, the latter cannot make a decision on that particular point. The Supreme Court itself laid down this rule in the case of the Attorney General v. Ryan's Car Hire Limited, in which Mr. Justice Kingsmill Moore expressly pointed out that where a point has been entirely overlooked or conceded without argument, the authority of the decision may be weakened to vanishing point. According to the Supreme Court's own test, since the point on suicidal ideation was not argued in the X case, this point weakens to vanishing point and is therefore not binding either on the courts, on the Oireachtas or on the Government. There has been no discussion of this very basic legal point. We are being told that we must legislate for X when, in fact, that decision is weakened to vanishing point in the eyes of the Supreme Court.

I move now to the question of checks and balances. Our Constitution gives specific powers to the three branches of government, namely, the Legislature, the Executive and the Judiciary. Each is supposed to act as a check on the power of the others as a kind of corrective mechanism. No one arm can instruct the other. Just as when the Government or the Oireachtas errs as to its powers - which, believe it or not, they can do - the Judiciary steps in to correct it, as we have seen in the past, the reverse can also be the case. In the Oireachtas in recent months we have seen a perfect example of this process in action. The legislative branch, by means of the January Oireachtas committee hearings, has managed to identify the fundamental mistake in the legal logic and the medical science - one might say the complete absence of medical science - accepted by the Supreme Court in 1992. By gathering evidence at the hearings, the Oireachtas has fulfilled its constitutional role and now has a huge volume of testimony that the Supreme Court did not have which shows that the judgment in the X case was incorrect and that it ought to be corrected under the separation of powers principle and the system of checks and balances. That is our responsibility in this House. The Executive, however, has not only chosen to ignore this fact but is now seeking to entrench this decision, which is not binding, by forcing the Oireachtas to compound the error made by a Supreme Court which did not hear any medical evidence. I find that bizarre, to say the least. It sets a very grave precedent for the doctrine of the separation of powers. Not only is one branch of government ignoring its duty to act as a check on another branch, but it is actually seeking to legitimise, entrench and enshrine this error in the law of the land. I consider that to be deeply worrying and something I certainly cannot be part of.

Peter Mathews (Dublin South, Fine Gael)
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Hear, hear.

Lucinda Creighton (Dublin South East, Fine Gael)
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My final point continues this very important underlying thread. We have all been repeatedly told that we must include the suicide clause, against all of the medical evidence, in order to satisfy the X case test. However, this legislation ignores a very recent Supreme Court case and indeed a range of developments in that court in recent times. I draw Members' attention to the case of Cosma v. the Minister for Justice, Equality and Law Reform from 2006, in which a woman sought that her deportation order be quashed on the grounds that if she were to be deported she would commit suicide. She argued that an action by the State should not be allowed to occur because she felt suicidal. The finding in that case is now the binding test laid down by the Supreme Court and I ask Members to pay attention, please, as I outline it.

The court found, first, that the absence of a treatment plan for a psychiatric condition and the fact that the person was not undergoing therapy or counselling were relevant factors in determining how real and substantial was the risk to life. Several Members of this House have proposed precisely the same thing - a treatment plan - to enhance this legislation, but it has simply been dismissed out of hand by the Minister. Second, the court found that the fact that the woman had not even considered removing the risk to life by treatment or some other means was relevant to considering whether the risk could only be averted by the course of action she preferred. The third finding was that the Minister was entitled to take into consideration arguments of public policy, as he had argued very vigorously in submissions that he should be, making the point that "to permit the threat of suicide to act as a stop on the execution of administrative decisions such as deportation would be to open a Pandora's box of potential abuse with possible effects of paralysing administrative activity in any given area of government".

On the Cosma reading of the X case, section 9 would fail to meet the necessary standard because it does not require evidence of a treatment plan or consideration of other means of avoiding the risk to life of the mother, and does not take into account, as the then Minister for Justice, Equality and Law Reform insisted we should, the public policy arguments that are relevant in assessing claims of suicidality.

This is not to mention the medical evidence. If we value the X case so much, which I argue is an obiter dictajudgment, how can we ignore this very specific and refined test urged by the Minister in the case of Cosma v.Minister for Justice, Equality and Law Reform? It is an entirely contradictory position and a position of convenience to suggest that the threat of suicide of a person at risk of deportation, who may be an inconvenience to the State, is not entertained but in other circumstances it is. It is entirely inconsistent, contradictory and hypocritical. Selective constitutional interpretation is happening in the Department of Health.

Peter Mathews (Dublin South, Fine Gael)
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Hear, hear.

Lucinda Creighton (Dublin South East, Fine Gael)
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I am deeply concerned about it and I appeal, as I have done a multitude of times, to the Minister for Health to listen to the evidence put forward by medical experts and the psychiatrists the Minister is asking to administer the flawed section. They say they cannot do it. Please let us listen to them and please let us not enshrine flawed logic and flawed legislation on our Statute Book. The legislation may be reversible but the consequences of the legislation are not reversible. They will change the culture in this country and they will change how we deal with vulnerable women. Why can the Minister not accept the proposal that we put in place a clinical care pathway for vulnerable women feeling suicidal thoughts or feeling at risk of suicide during pregnancy? Why can we not talk about improving services and standards and putting in place the kind of clinical care path accepted as best practice in the United Kingdom? Why must we be the poor relation in terms of the service we provide to vulnerable people? Why are we insisting that abortion, which has no medical grounding, will be enshrined in our Statute Book as the only treatment for women who find themselves in that desperate place? I am lost for words because I cannot understand why this proposal is being insisted upon by the Minister and his Government.

Michael Healy-Rae (Kerry South, Independent)
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It is a pity there are not more like Deputy Creighton.

Michael Kitt (Galway East, Fianna Fail)
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The next speakers are Deputies Terence Flanagan, Mattie McGrath, Séamus Kirk, Billy Timmins, Clare Daly, Mick Wallace, Michelle Mulherin, Denis Naughten, Patrick Nulty, Billy Kelleher, Michael Healy-Rae and Ciara Conway.

Terence Flanagan (Dublin North East, Fine Gael)
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I support the amendments of the Minister of State, Deputy Creighton, regarding the clinical pathway. They should be supported by the Minister as outlined. I tabled amendment No. 56 to remove section 9, which deals with the risk of the loss of life from suicide. Of all the elements in the Bill, this is the most controversial. There would be little or no opposition to the Bill if section 9, the cornerstone of the Bill, was removed. We have repeatedly heard that the Bill is about providing clarity for doctors and protecting the lives of pregnant women but section 9 does not serve these worthy objectives. Its purpose is simply to give statutory effect to the X case decision, which we know is a flawed judgment. It legislates for the direct and deliberate destruction of unborn human life. The desire to legislate for the X case is what has us here today and is reflected throughout the Bill. Unfortunately, it has corrupted other sections of the Bill, which are about ensuring pregnant women in Ireland continue to receive the high standard of medical care to which they have become accustomed. As the Minister of State, Deputy Creighton, stated, retired X case judge, Hugh O'Flaherty stated explicitly that the X case ruling is moot in current abortion debate because the girl did not have an abortion but a miscarriage. The definition of medical procedure used in sections 7, 8 and 9 was devised to meet the purposes of section 9 alone. It reads: "It shall be lawful to carry out a medical procedure in respect of a pregnant woman in accordance with this section in the course of which, or as a result of which, an unborn human life is ended." It is only a medical procedure during, or as a result of which, unborn human life is ended that is made lawful by this Bill. This is at odds with the current medical practice in our hospitals but is being made lawful by the Bill. It has changed sections 7 and 8.

The obstetricians who testified before the Oireachtas Joint Committee on Health and Children made clear, regardless of their view on the Bill, that they do everything possible to save the lives of viable babies. I hope they continue to do so but they will be acting outside the boundaries of this Bill if they do so. That causes major concern. The barrister Mr. Paul Brady stated that section 9 marks a change in the law. He said that it is not accurate to say otherwise and that it creates, for the first time, a statutory basis in Irish law for where there may be a direct and intentional termination of an unborn child's life.

Psychiatrists are very concerned about the change in their role. It is a role they have not had to date and they will be asked to determine whether there is a real and substantial risk to the life of the mother in order that she may procure a termination of pregnancy. Many do not see this as their role as medical practitioners and the role could be construed as making psychiatrists the gatekeepers to abortion. Psychiatric practice relates to the assessment and treatment of patients, not the assessment and adjudication. Psychiatrists are not judges. Dr. Maria Cahill said during the hearings that the Constitution gives permission to the Dáil and Seanad to legislate rather than imposing an obligation on them. The retired Supreme Court judge, Mrs. Catherine McGuinness, said that on the question of whether the Oireachtas has acted unconstitutionally over the past 21 years:

I do not think that can be said. [...] It is free not to legislate.

No one now knows how many abortions will be procured under section 9. I am concerned as Sam Coulter Smith stated that there is no gestational limit in respect of the Bill. Delivering the baby at 25 weeks gestation could lead to death, extreme prematurity or a child with cerebral palsy or significant developmental issues for the future. The Minister for Health, Deputy Reilly, has acknowledged that situation by stating that the Bill will result in more babies suffering damage because of premature delivery.

We know no country has ever been successful in restricting abortion on these limited grounds of suicide.

The State of California introduced therapeutic abortion legislation in 1967. The legislators thought it was a strict, regulated provision which would be very rarely used. Within three years, the number of abortions had risen from 500 to 63,000. For those and other reasons, there is no way I can support section 9 of the Bill. The Government assures us that section 9 will rarely, if ever, be invoked. Clearly, I hope that proves to be the case, but fear that it will not. I am not prepared to be responsible for the deaths of those unborn children who will be killed if section 9 is enacted. As a matter of conscience, I will not be in a position to support section 9.

Peter Mathews (Dublin South, Fine Gael)
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Hear, hear.

Mattie McGrath (Tipperary South, Independent)
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In particular, my input is directed to amendment No. 23. I compliment the bravery, understanding and research of colleagues across the floor who cannot accept the decision based on the X case. It was a flawed judgment. Anybody who sat through our committee hearings understands that. It is the one thing that emerged. The Supreme Court in the X case heard no proper legal arguments on suicide. There was no proper, in-depth hearing. How could the court deliberate properly without hearing the evidence on both sides - for and against? I put down an amendment previously on the Title of the Bill, which is misleading, erroneous and false.

I note that the Minister for Children and Youth Affairs is in the Chamber. The Government has kept going back to a Supreme Court decision from a long time ago but it ignored a recent Supreme Court judgment, which was unanimous, having heard all the facts, on the misappropriation and misspending of money voted by the House in the children's referendum. We can ignore it when it suits us. We can use it and abuse it when that suits us. That is what the Government has been doing. The separation of powers is quite clear for the Legislature, Executive and Judiciary. There was a total absence of medical science at the time of the Supreme Court decision in 1992. We have moved on in so many ways. Great progress has been made in our understanding of medical science and health care. As the Minister of State, Deputy Creighton, has said, the absence of a treatment plan in the Bill illustrates that it is cobbled together legislation involving Fine Gael kowtowing to the Labour Party. I would not even call it the Labour Party, but the takeover Labour Party. It is not the Labour Party I knew.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Please, stick to the amendments.

Mattie McGrath (Tipperary South, Independent)
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A further contradiction is that where a person facing deportation claims suicide, it is to no avail. A person that is suicidal needs treatment. Abortion is the last treatment any pregnant woman needs. It is not a treatment in any shape or form for a person suffering stress and trauma. A woman needs to be treated and to have a health care plan worked out. In the fullness of time, everything should be dealt with when the person is able to make a decision. I have heard from women who were hurt by abortion, who were not allowed to attend the committee hearings. To a woman, they told us they felt more suicidal after the fact than before.

Séamus Kirk (Louth, Fianna Fail)
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I am glad to have the opportunity to add my voice to the comments and observations of a number of people who have moved amendments, including my party colleague, Deputy Éamon Ó Cuív, and the Minister of State, Deputy Lucinda Creighton. In many ways, their contributions anticipate what other Members have to say generally on the issue.

Section 9 is where the real problem exists in the Bill. If the Government agrees to remove section 9 from the Bill, its passage will be relatively easy. That is what is needed. The arguments against the provisions in the section are compelling. We have heard them in the past half hour. There was no psychiatric evidence provided in the context of the original Supreme Court decision. A decision was taken in the X case without the benefit of necessary psychiatric evidence. The reflections and review of the decision by retired Supreme Court judge, Hugh O'Flaherty, are very interesting in the context of today's discussion. Section 9 is not required to be included in the legislation. If the motivation and spur to bring forward the legislation is the unfortunate case of Savita Halappanaver in Galway, the old principle that hard cases make bad law should be remembered. Section 9 provides for no time limit on abortion within the gestation period, which is horrendous. I hope the House will not come to regret its decision if the section is voted through tonight. It will provide in law for something we may regret for a very long time in terms of its impact on humanity.

It has been interesting to read and reflect in recent times on the observations of Lord David Steel, who introduced abortion legislation in the United Kingdom in 1967. If he were brought in as an adviser to the Government, he would give advice which would be contrary to the provisions in the Bill. I will not traverse the ground which has been covered more than adequately by previous speakers on the section. I simply exhort and encourage the Minister to reflect on what he is providing for in section 9. I hope he will. If the debate and the decision on the legislation were postponed to allow for an 11th hour Government meeting on the removal of section 9, the Irish people would be very grateful.

Peter Mathews (Dublin South, Fine Gael)
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Hear, hear.

Lucinda Creighton (Dublin South East, Fine Gael)
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Hear, hear.

Billy Timmins (Wicklow, Fine Gael)
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Amendment No. 56 is the last to which I will speak. I will be pressing the amendment. I concur with much of what has been said by previous speakers. This is a profound moment for the Oireachtas and for the State. This is the most barbaric section - the suicide clause - that has been put before the House since the foundation of the State. I was in the Nutley wing of St. Vincent's Hospital at lunch time to visit a friend on St. Anne's ward. I had time to read at the back of the nurses' station a notice to the effect that they strive to provide care based on the best available medical research. To paraphrase my good friend, Deputy Mathews, who often talks about the banking difficulties, I can understand how the last Government got the financial crisis and bank guarantee wrong based on the information it had. I cannot understand this Government, which has the correct information in front of it, making an incorrect decision.

Peter Mathews (Dublin South, Fine Gael)
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Hear, hear.

Billy Timmins (Wicklow, Fine Gael)
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Based on the suicide clause, the Bill is unconstitutional. I would like the Minister for Health to tell me whether the Attorney General and Cabinet are satisfied that it is constitutional. Do they have doubts about its constitutionality?

Many Members will come in here tonight and vote for this Bill, and will vote against amendment No. 56, on the basis they believe they have no other choice because of the judgment in the X case. I concur with the points made by earlier speakers and I will not re-plough the ground on the issue of whether it is binding or not. I believe it is not.

Looking at Mr. Justice O'Flaherty's comments at the weekend, it appears the Supreme Court was saying we need to legislate for the constitutional Article 40.3.3°, not for the X case.

Peter Mathews (Dublin South, Fine Gael)
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Correct.

Billy Timmins (Wicklow, Fine Gael)
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That is what is required. I believe that most people would concur on that because the equal right to life is impossible to implement. It is a flawed article; I acknowledge that. However, we have laboured under a false illusion in this House and many Members going to vote tonight will labour under a false illusion by voting to retain this clause based on the X case judgment because it is wrong. I believe this will end up in the Supreme Court and I ask those who sit on that court to take cognisance of the fact that many of the Members who vote on this will do so on that basis.

I have a few points that are also important to raise with respect to the amendment. With respect to the psychiatrist, Deputy Creighton raised some issues to which the Minister will reply.

We can all selectively quote from the expert group but there are a few points I want to make. We all look at this through our own eyes. I realise on my left-hand side here there are many genuinely held views and, while I do not agree with them, I respect them. However, I have a difficulty with what is my own side of the House when matters are purported to be what they are not. On one simple issue, legislating for the X case is not in the programme for Government . How often must we repeat that? I have heard Minister after Minister come out and state it is. One should check the programme for Government. It is not in it.

With regard to the psychiatrists, virtually every psychiatrist who is in favour of the legislation happened to be at the hearings. We had a number who are opposed to it. When making his submission, Dr. McCarthy - this is important for historical record - stated that "we know that among our 864 members there will be a wide range of opinions with regard to the sensitive issue of abortion, reflecting the deep divisions in society ... about this issue.", and, therefore, the council of the college was confining its comments to the general scheme of the heads of Bill rather than any overall comment about abortion. It is important to remember that. When Dr. McCarthy gave his evidence, he did so in the context that the Bill was before him and it was how best to deal with the Bill. He made the same point at the earlier hearings in January.

With respect to the 864 members, that evidence was given on the Monday of the hearings held in May last. On the Friday, when the gynaecologists were giving evidence, Dr. Boylan, in his submission, referred to his understanding that the Council of the College of Psychiatrists of Ireland, the elected decision-making body representing more than 864 members, had made a single submission on behalf of all members. I note that Dr. John Sheehan, who is a psychiatrist and member of the college of psychiatrists, when he gave evidence on the Monday, had not seen the submission from the college of psychiatrists and was not familiar with it, and yet the gynaecologist who gave evidence on the previous Friday was. It is important to put that on the record.

During the evidence of the expert group, from which the Government widely quotes, on the day the three gynaecologists from the main hospitals appeared before the committee, two of them from Holles Street were asked if their evidence was personal or made on behalf of the institute of Holles Street. They did not answer, perhaps by default. If they had answered, they would not have been able to answer that it represented Holles Street because when evidence was given at the earlier hearings in January a number of gynaecologists from the greater Dublin area and elsewhere wrote into the committee. I do not know whether it is on the record of the hearings, but a written submission - an email was sent in and circulated - stated that they disagreed that there was a requirement for any legislation on this, be it threat to either the physical or mental health - I am not saying I agree with them - whereas when Dr. Sam Coulter-Smith was asked, and he had alluded to it in this speech, he stated his submission to the committee was based on his own views and the views of his consultant colleagues at the Rotunda following their consideration of the draft heads of Bill. For historically reasons, it is important to put that on the record.

While dealing with Dr. Coulter-Smith, I want to make a few points. I made them on Committee Stage, which was held down in the basement, a matter with which I disagreed, where 150 or so Members could not submit amendments which is unusual for such important legislation. I made a couple of points with which the Minister disagreed and I want to read them into the record. First, I have mentioned Dr. Coulter-Smith speaking on behalf of the institution. I will extract some of his quotes. He stated, "there is currently no available evidence to show that termination of pregnancy is a treatment for suicidal ideation or intent and, as obstetricians, we are required to provide and practice evidence-based treatment." He went on to elicit concerns they have about the gestational period, which was well covered by Deputy Shortall at the hearings. I will not go over that ground again. When the issue was put by Mr. Seán O'Rourke on "The Week in Politics" on Sunday night to the deputy leader of the Sinn Féin, she asked him not to present it in such fashion. I will not do so here, but that was the fashion that was presented by Dr. Coulter-Smith and these are the doctors who will have to implement this legislation. At the end, Dr. Coulter-Smith stated:

This outcome would be entirely iatrogenic and the responsibility of those clinicians who have agreed to be involved in the process. This is a source of serious concern for myself and my colleagues.

that the inclusion of suicidality within the legislation may ... in the long term lead to an increased demand for termination in this country. We currently do not have any real understanding of how big that demand may be.

On Friday last, when I put it to the gynaecologist in Portiucula, Ballinasloe, I stated that ultimately the implementation of this legislation will end up in front of him and I asked him what he would do. He stated that he would not implement it. He stated that he could not implement it because his whole medical well-being and medical ethical background is to do good and he would not do something that he believed to be bad and that was not evidence-based for good. The Minister will respond that there is a conscientious objector clause in the Bill that will cover that doctor, but it is poor legislation where one of its defences is that the Minister has the conscientious objector clause as a strength of the section in the Bill in the first place.

Perhaps this legislation will codify the law. We can use whatever terms we like, but it will change the practice and ethos in this country. I raised the issue of the six minors in the care of the HSE who, in so far as I can establish from the Minister for Children and Youth Affairs, went abroad for abortions based on the X case decision on the suicide clause. Four of the cases went to court; two did not - I do not know why that differentiation existed. I asked the legitimate question: if this legislation is about saving women's lives, why did these minors in the care of the HSE have to go abroad for the treatment? I have not read "the Blacks", but the Minister stated one of the reasons was that this legislation would give clarity to those where there might have been uncertainty. Is he saying now that in future they will be able to get the terminations here at home? If so, to state that this legislation does not change the practice is inaccurate. We cannot have it both ways, and let us be honest about what is happening here.

History will show that the College of Psychiatrists of Ireland has failed the profession. I have got to admire the courage of individual psychiatrists. I understand 120 consultant psychiatrists made a submission stating that they would not participate in this process because it was not evidence-based. With respect to the 864 members who were circulated by the college of psychiatrists, it went to consultants, trainee psychiatrists, etc., my understanding is that somewhere in the region of 30 of them responded to the president of the college.

The submission on behalf of the council represented, in theory, the views of those 30 members. Some of the members who responded have claimed that the submission did not represent their views. I do not think, therefore, that it is built on very firm ground.

I wish to make two points in conclusion. Many Members have had difficulty with this legislation and I appreciate these difficulties. However, they have been given assurances from members of the Government - I do not mean to be flippant or cynical and I raised this point on Committee Stage - but I do not see anywhere in the definitions in the Bill the status of an assurance from the Taoiseach, the Minister for Health or the Attorney General. What is the legal basis of an assurance given by a Minister? In my view, it is no better than Willie the Crow's assurance; it makes no difference and has no legal status whatsoever. Let us be honest - if we want to include a ministerial assurance in the Bill, let us give it a status. Let us not hide behind such language.

I do not believe the sky will fall in tonight if this legislation is passed. Neither do I believe it will fall in tomorrow night. However, I do believe, as sure as night follows day, that there will be a time when people will come into this House and ask, "How did the Oireachtas of 10 July 2013 pass the suicide clause, which not based on a lack of knowledge?" We can talk about the Magdalen laundries and the abuse of children and hide behind the fact that we did not know. I want to state clearly that we do know, as the evidence is there in bucketfuls. They will ask how did we pass this legislation. I believe in life that I can generally find the answers to most questions, but I cannot understand how people will support this section. I will be pressing the amendment which goes to the core of the Bill. This provision is built on sand.

Clare Daly (Dublin North, Socialist Party)
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The previous speaker has given a very good illustration of why this matter should be left out of the hands of politicians and treated for what it is, a health matter that should be adjudicated on between women and their doctors. We should remind ourselves of why we are here and why we are in this mess. It is precisely because the Constitution equates the life of a woman with that of an unborn. If they were two independent lives, perhaps one might have an argument about this but because the life of an unborn is intrinsically linked with that of the woman; when there is a conflict, there has to be an adjudication. The Supreme Court adjudicated on the matter in the X case and determined that in the event of a conflict where the life of the woman was in danger, including from a risk of suicide, she was legally entitled to an abortion in Ireland. While it did not direct us to do anything about it, in fairness, it made its opinion abundantly clear. Mr. Justice McCarthy has been quoted here already. He said the failure to enact appropriate legislation was not just unfortunate or inappropriate but that it was inexcusable.

This very narrow Bill is based on the premise of protecting a woman's life if in danger, including from a risk of suicide. Inevitably, that means we are talking about a tiny number of the thousands of Irish women who have abortions every year. We do not know, but it may be 40 or 50. A very small number will be affected by the provisions in this Bill, but a very small number nonetheless is still not none. There are people who are pregnant and suicidal. The Deputy gave as examples the cases of six young women in State care. A psychiatrist adjudicated that it was best for their mental health that they should have an abortion. Unfortunately, these young women were taken out of the country for that treatment. Presumably, the purpose of the Bill means precisely that these young women would not have had to travel. The point has been made previously that women who are not in the care of the State, where they, their parents or partners have the means to travel, if they are suicidal, will continue to do what they do now; they will get on a Ryanair aeroplane or a boat and travel to England because they certainly will not put themselves through the Star Chamber that is envisaged by the Government. We need to be very clear on this matter. We know for a fact that suicide in the case of pregnant women is a reality.

Speakers made a point this morning about the high level of maternal care and the excellence of Irish maternity services. They are not bad, but they are not the best. They are nowhere near the best; they are probably average at best. We can say this with certainty because the method of calculating such figures in Ireland is at variance with that used by some of our European peers. The latest figures show that out of the 25 maternal deaths in recent years, two were women who had committed suicide. I do not know if an abortion would have saved the lives of these two women; nobody knows. I do not know the circumstances, but perhaps it might have done. If it would save the life of even one person, I would be glad to see such a provision in the Bill.

I take great offence at Deputy Peadar Tóibín's talk about medical evidence. He dismisses the issue of mental health and the risk of suicide as if it was spurious and not really an issue at all. That is what lies behind a great many of the contributions to this debate. It is a fundamental assertion that women would scheme and lie, pretend to be suicidal, hoodwink their doctors who are so cowardly and ridiculous that they would go along with it to enable themselves to have a termination here. Lads, they will not; they will travel to England and do what they are doing already. It is disgustingly disrespectful and I find it quite offensive, not only to women who make these difficult decisions but also to the many victims of suicide and their families, that people would seek to trivialise mental health issues. People slag off medical opinion produced by the College of Psychiatrists in Ireland, the expert body when it comes to mental health. They throw that opinion out the window and then lean on the medical opinion of obstetricians. One might as well get the medical opinion of vets on issues of mental health. It is ludicrous. The psychiatrists are the ones who make the decisions in this regard and they are medical decisions.

There was the derogatory use of the word "floodgates" with reference to other states which had legislated on this issue, as if this was an easy decision for any woman in any circumstance. Examples were given from Britain and America. I fully respect everyone's individual opinion which he or she is entitled to express. I remind Deputy Terence Flanagan that to express an opinion and state it as fact and back it up with studies, some of which are spurious, having been the beneficiary of a trip to America and welcomed by these bodies which purport to stand over these scientific studies, is not to engage in a scientific analysis. He should declare his vested interest in these matters.

Terence Flanagan (Dublin North East, Fine Gael)
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What are the Deputy's vested interests?

Clare Daly (Dublin North, Socialist Party)
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I refer to the facts given about Britain because they have been used and bandied about in the media. The argument is that the 1967 Act allows abortion under the suicide clause. That is not the case. Under the 1967 Abortion Act, 90% of the abortions are on the basis of ground C which deals with pregnancies under 24 weeks, where the continuation of a pregnancy involves a risk greater than if the pregnancy was terminated, of injury to the physical or mental health of the woman. Because it is always safer to have a termination in the early stages of pregnancy, rather than later, most abortions are granted using these criteria. It is not that people pretend to be suicidal as Deputies who are making the point are clearly implying. Suicide is a very tragic reality in our society and the issue should be adjudicated on by medical staff, not unqualified politicians.

Factual evidence, rather than just opinion, has been given indicating that where no abortion is permitted, 10% of women who commit suicide are pregnant at the time. Where there is not an option of abortion, evidence seems to suggest that the rate of suicide among pregnant women is higher.

Other issues have entered into the debate that are purely spurious. The idea that there would be a time limit is such an idea. This legislation is founded on the basis of medical intervention necessary to save a woman's life. If it is necessary to save the woman's life, that is the only show in town, the only decision to be made. Anything else is irrelevant. It is highly derogatory for Deputies to believe that women would go through the latter stages of pregnancy and then, at a whim, decide to pretend to be suicidal because they have suddenly changed their mind. This has no relationship with reality or the tragic, hard decisions that women who often choose abortions must make.

For all these reasons, the amendments are seriously unfounded, and we have stated why. I do not believe the way in which the Minister has dealt with this is ideal. He has put far too many restrictions in the legislation. There are amendments in this grouping that touch on the points we made on why the opinion of only two medical practitioners should be sought. A woman's general practitioner is eminently qualified to make the decision. This was included in our Bill last year. It is a psychiatrist that will make the determination, not a gynaecologist, obstetrician or other such practitioner. For all these reasons, I am vehemently opposed to not dealing with the issue of suicide. It is not because of anything the Supreme Court said, however. If one is unsure about this, one should note that the people had a choice to remove the suicide provision in 2002 but they decided to keep it, that it was valid and that suicidal ideation is certainly a threat to life that should be dealt with.

Mick Wallace (Wexford, Independent)
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The Minister says Ms X tragically miscarried but I would say she was tragically raped. Given that she wanted to terminate her pregnancy, I do not believe the miscarriage was her greatest misfortune. Nobody is saying that abortion is a treatment for suicide. Although a woman can become suicidal during a crisis pregnancy, are we supposed to tell her, “Listen, woman, an abortion won't cure your problems.”? Dealing with an unwanted pregnancy through abortion may deal with the woman's problems. It could be that she has been raped. Perhaps continuing with pregnancy could prove too much to bear.

We proposed that one obstetrician and one psychiatrist is sufficient. The Irish Family Planning Association has stated:

The diagnosis of expressed suicide intent is a routine process for psychiatrists and the requirement of a second psychiatrist when this does not occur when a pregnancy is not involved has no justification. Imposing a different standard of decision-making in cases where the risk arises from threat of suicide risks stigmatising mental health conditions.

Michelle Mulherin (Mayo, Fine Gael)
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The amendments, as proposed, seek to address the many concerns I have in regard to the nature of the suicide provision and how it will operate. The ultimate responsibility for whether a pregnant woman has an abortion lies with that woman. How restricted, or otherwise, her ability to have an abortion is constitutes a matter for the State. Our Constitution sets out the parameters within which this Oireachtas must work in passing our laws. The eighth amendment to the Constitution, as inserted by the citizens, guarantees that the State will defend and vindicate the right to life of the unborn, with due regard for the life of the mother. This legislation could be drafted in a more prescriptive way in order to respect this constitutional provision and strike a fairer balance between the legal rights of both the mother and unborn child.

In view of this and the fact that the Taoiseach has stated that only Government amendments or amendments tabled through the Government will be accepted, I wrote to the Minister for Health setting out my concerns and suggestions for the draft legislation. I am very disappointed that there is very little accommodation of the legitimate concerns expressed by me and many others, not least within the Chamber, in the Government amendments, as published. I met the Minister, Deputy Reilly, for an hour last night, and the Taoiseach for nearly an hour and a half. I am now faced with either supporting the Bill or being booted out of the party, my party. I am not going to allow myself to be booted out so I am supporting this legislation.

Denis Naughten (Roscommon-South Leitrim, Independent)
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I support the amendments tabled. Much has been said about the issue of suicidal intent and suicide. The reality is that suicide in pregnancy is a reality, and there is absolutely no doubt about that. The issue is the scale. As I stated on Second and Committee Stages, suicidal ideation is quite frequent in pregnancy. Between one in eight and one in three women experience suicidal ideation at some stage during pregnancy. This is up to a third of all pregnancies and, therefore, the phenomenon is quite common. I am thankful that the number of women who act on their ideation is very small. All possible supports need to be put in place to ensure the rate is reduced.

It is important to remember that there is a differentiation being made between physical illness and mental illness. Deputy Daly, Deputy Wallace and a number of others made reference to that. Let met outline the difficulty. A woman with a physical illness resulting in a threat to her life during the pregnancy is entitled to a termination under this legislation but a woman with a treatable underlying mental health condition is not entitled to a termination. That differentiation has been made in the legislation. A difficulty is that where there is no underlying mental health condition other than suicidal ideation or intent, the psychiatrist has no choice but to certify the woman so as to allow her to avail of a termination if she wants it. It is impossible to prove or disprove suicidal intent. When I raised this point with the Minister on Committee Stage, he said, correctly, that a consultant can use his or her professional skills.

A consultant can also identify underlying mental health conditions but Professor Veronica O'Keane, who gave evidence to the joint committee on two occasions, made it crystal clear that if a woman states she is suicidal, she has no other choice but to believe her. As I stated on Second Stage, I recently spoke to a consultant who pointed out that where someone is suicidal, there is no skill set for a consultant psychiatrist to determine whether the intent is there or not. No consultant can make that determination. One consultant pointed out that the hospital electrician is as equally capable of making that determination as anyone and that is the sad reality of suicidal ideation and suicidal intent. It is impossible for anyone. The hands of consultants left in that situation, where there is no other underlying mental health condition and where a woman presents with suicidal ideation, are tied because if they refuse to certify the woman and she subsequently dies by suicide, the consultant faces a significant personal and professional liability for not certifying her.

I refer to another issue teased out on Committee Stage. The Minister made it clear that where a foetus is viable, it is sacrosanct in the legislation that any procedure that would threaten the viability of the foetus outside the womb cannot be provided for and cannot be used to terminate the pregnancy. That will lead to cases where a woman with suicidal intent who obtains a termination of pregnancy beyond the cusp of viability will give birth to premature babies with significant disabilities who will become the responsibility of the State. We are returning to a situation where we could see children in institutions again and surely none of us wants to go down that particular road.

It is also important to recall evidence given by Professor Kevin Malone to the joint committee hearings about his beliefs. He is, sadly, an expert on the incidence of suicide. He firmly believes there is a strong possibility that this legislation could increase the overall incidence of suicide in this State. That needs to be taken into consideration by every Member.

It is argued that section 9 needs to be included because of the X case judgment. If anyone is of that opinion, he or she should read last week's newspaper article by one of the judges involved, Mr. Justice Hugh O'Flaherty. He did not say that. It would be worthwhile for everyone to take time to read it in advance of making a decision on this issue. This was well argued by an t-Aire Stáit, Deputy Creighton, earlier but I do not wish to revisit it. We are told that because we are legislating, we must legislate for the X case. That is not the case and a number of examples have been given. I outlined one example on Second Stage. The Government parties made the argument well on the issue of blasphemy. We introduced legislation at the time, which we knew could never be implemented, because there is a blatant reference in the Constitution that we must provide for a law of blasphemy. Here we are doing it on a supposition based on a Supreme Court judgment in the X case and Deputy Creighton has made the point well about that.

The Government parties argue that their hands are tied and they must legislate for suicide but that is not the case. I tabled an amendment on Committee Stage that would allow us to legislate for the issue before us to protect a woman's life where there is a risk based on medical issues, and leave the issue of suicide silent until there is an opportunity to amend the Constitution.

The Government parties also argue this legislation is about women and protecting their lives. All of us want their lives protected. I acknowledge where the thrust of the legislation is coming from and the vast majority of Members do not have a difficulty with the principle underpinning it but suicidal intent is an issue. I am disappointed that two issues that focus on the women who unfortunately will have to use this legislation have not been addressed in the Report Stage amendments tabled by the Government. One relates to the review mechanism under both sections 7 and 9. Unfortunately, a woman who has to go before a review committee must do so on her own, face three consultants and argue her case without being accompanied by an advocate. She is not legally entitled to an advocate. I do not know how one can say this legislation is pro-women when a woman is not legally entitled to an advocate when appearing before the review committee.

The second issue, about which I have tabled an amendment, is the legislation does not state that the consultants on the committee must review a woman's case at the closest location to her. In other words, a woman who is physically or mentally ill may in certain circumstances have to travel to the other end of the country to see the consultants on her own and advocate on her own behalf while ill. I cannot understand why those issues have not been addressed in this legislation if its focus is on dealing with women in a sympathetic manner when they are faced with serious illness. This provision is more about achieving an objective in the manifesto of one political party than dealing with what should be the focus, which is improving the health of pregnant women in this State and their lives.

Patrick Nulty (Dublin West, Independent)
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I oppose this cohort of amendments. One issue that has been lost in the discussion by those advocating for these amendments is there was a detailed national debate on this issue in a referendum ten years ago when the people were given the specific option to remove the suicide clause, which they rejected. Some Members argue that our citizens would somehow be grateful to us if we supported these amendments and deleted section 9, which deals with suicide but, on the contrary, they would be appalled and ashamed that we would so clearly disregard their opinion on this matter, which was decided by referendum.

There is a bizarre and deliberate attempt to distinguish between a physical risk to life and a psychological risk to life.

All the advocates of these amendments to repeal section 9 have not come either clean or clear about why that section, more than any other, is a problem for them. Surely it is perfectly clear that if a woman is in the tragic situation of being pregnant and suicidal that must be taken as seriously as if there were any other risk to her life during her pregnancy. That seems a reasonable proposition. More important, morally, ethically, philosophically and constitutionally, she has a right to have that pregnancy terminated in this State if that is what is required. While I respect everybody's right to amend legislation, even where I disagree profoundly with it, there is an attempt in these amendments to undermine a person's constitutional right in that respect.

As has been noted, the restrictive nature of the legislation means that if one has the means, wherewithal and financial resources to leave the country to have a termination in these circumstances, one probably will do so. This legislation provides a basic protection for women who face such a difficult situation. One can only imagine the context in which they would be suicidal as a result of pregnancy, which is what this legislation seeks to address.

One of the contributors observed that when the record of this debate is being reviewed and assessed, questions will be asked as to why in 2013 the suicide clause was retained within the Bill. I believe questions will be asked about why this Oireachtas is debating a Bill which I support although it is so minimalist in content that it is totally out of synch with public opinion on this issue. As has been seen in the outcomes of referendums and as has been demonstrated in recent opinion polls, the vast majority of Irish citizens fully support legislation in this regard. It is not contentious for them, being basic public health legislation to protect 50% of our population. As soon as this legislation passes tonight, as I believe it will, comprehensively, if the Second Stage vote is anything to go by, we will need to move straight away to push for a referendum to appeal the eighth amendment as quickly as possible and address the substantive issue of a woman's right to choose overall.

Billy Kelleher (Cork North Central, Fianna Fail)
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I refer to amendment No. 80, which I am surprised to see included in this raft of amendments because it does not seek to exclude suicide as grounds for a lawful termination in the State. What it proposes is that where the unborn is potentially viable outside the womb every effort must be made to sustain its life after delivery. The other part of the amendment states: "Notwithstanding anything in this section every attempt shall be made to explore with the woman, by means of counselling and support, alternatives to carrying out the medical procedure referred to in subsection (1).”

I have listened intently to the debate, not only in the Chamber but in my office. I remember that Deputies on all sides of the House raised the issue of cyber bullying and the fact that young girls have taken their lives because they were bullied in this way over a long period. A number of cases in Ireland come to mind, along with that of Phoebe Prince in Massachusetts, who took her life because of cyber bullying. If we genuinely believe that a young girl might take her life because she has been cyber bullied it is possible - and very probable - that a young girl, alone, afraid and vulnerable, who looks at the pregnancy test kit and finds she is pregnant may, because of that vulnerability, decide that suicide is the only way out of her dilemma. That is not something we can dismiss in the abstract - it is real, has happened and will happen again, as night follows day. At present that young girl has a few options. She can continue with the pregnancy, may go to England or may go on the Internet and procure abortifacient pills. In extreme circumstances, however, she may decide that ending her life is the only way to deal with that crisis pregnancy. That is the reality of the situation that confronts a very small number of women in this country.

People referred to the Oireachtas committee which heard that the overwhelming evidence is that a termination is not a treatment to prevent suicide. Every psychiatrist who spoke agreed this was the case because there is no treatment for suicide. This has been bandied about but what was clear in the evidence given is that there is a very small group of people who may, for whatever reason, decide to take their lives because they are in a crisis pregnancy. That is indisputable - it has happened and will happen again.

For all those reasons, therefore, I submitted my amendment in order to talk about the need for support, therapy and counselling in conjunction and in discussions with the girl concerned. If people are genuinely concerned about this Bill, I ask them to think for one moment about this point. If one is a young girl who believes a termination is the only way to address her difficulties, as the law stands she will go to England. I argue that if the girl presented to her GP in Ireland and went through the process offered in this legislation she might realise, given support and assistance, that a termination is not the treatment for her crisis pregnancy. With counselling, therapy and assistance she may very well decide, in conjunction with her GP, her psychiatrist and her obstetrician that continuing with the pregnancy is a valid way to proceed.

People talk as if suicide in this case was something that does not really happen. It does happen and all the evidence presented in the Oireachtas hearings found that it was rare but real. We discussed this issue in January during the Oireachtas hearings and heard further evidence in May during those further hearings. We had Committee Stage and are now on Report Stage. The one area where this matter was discussed twice, however, was with the people - in 1992 and 2002. On two occasions they were asked to delete the interpretation in the X case in respect of Article 40.3.3°. On both occasions they decided it should be retained. People can argue as to whether the Government has an obligation to legislate but what is clear is its obligation to bring clarity to what is now the constitutional right of a woman in this State to procure a termination in the event of her life being at real and substantial risk and termination the only option left. That last is critically important - it must be the only option. In section 9 of the actual legislation it is stated it must be the "reasonable opinion" ...of registered medical practitioners "that risk can only be averted by carrying out the medical procedure".

We trust our psychiatrists in cases where they commit people and take away their freedom. We commit people in this State under our Mental Health Acts on the word of a psychiatrist. We sometimes decide a person is suitable to go to trial on the word of a psychiatrist. In regard to some of the most heinous crimes we take the view of a psychiatrist as to whether a person can stand trial for reason of their mental state. I am convinced that if psychiatrists are obligated to vindicate the life of the unborn, as they are so obligated under Article 40.3.3°, they will do so. They must always take into account what is best because this is a two-patient strategy about what is best for both the woman and the unborn.

When we talk about and refer to England and consider the 1967 Act presented by Lord Steel to the House of Commons and House of Lords, there is no comparison with this country. The United Kingdom does not have a written constitution and there is no obligation there to vindicate the life of a child. In Britain a termination is the intentional destruction of the life of a child. In the context of Article 40.3.3° I have tabled other amendments to this legislation, to make it crystal clear there is an obligation to vindicate the life of a child.

Reference has been made to the gestation period and I have thought long and hard about this. I listened to the evidence that was presented at the Oireachtas Joint Committee on Health and Children hearing. That evidence, the interpretation of the X case and the legislation before us concern saving the life of the woman, not more or less. If there is a threat to a woman's life, be it physical or mental, regardless of the stage of gestation of the unborn, there is an obligation on medical practitioners to save the life of the woman and equally to save the life of the child. If the child is born at 23 or 24 weeks there is a chance that it may not survive or may be born with disabilities. That is a medical fact but if the alternative is to allow the woman die then both woman and unborn die.

We need to keep to the facts before us in the context of this legislation. I supported the Bill on Second Stage and I tabled some amendments on Committee Stage which the Minister considered and he is bringing forward some to ensure an obligation to make every effort to save the life of the child. I welcome that. We are being asked to adjudicate on legislation that is already a constitutional right for a woman, to have access to a termination where her life is in substantial danger. We should speak to that area.

I spoke earlier about psychiatrists. At the hearings of the Oireachtas Joint Committee on Health and Children all agreed that termination is not a treatment for suicidal intent. Some people said that it should not be countenanced in any case. The strong body of opinion was that people do commit suicide because of crisis pregnancies in very rare circumstances. Equally, they have confidence in their professional ability to assess and adjudicate on who is and is not suicidal. Reference was also made to the fact that in diagnosing suicidal intent there is a 3% accuracy rate. For every 100 women who may be suicidal three will actually commit suicide. If my wife was going into an operating theatre tomorrow morning, or my brother, or my neighbour, or anybody else and they were told that they had a 3% chance of dying because of a procedure I would consider that an exceptionally high risk rate. We would not want to dismiss the fact that the rate is 3%.

Another interesting observation made during the hearing was that all these people being assessed for suicidal ideation or a threat of self-destruction are in therapy, which proves that with treatment, counselling, therapy and supports people who are suicidal can be treated. That is the important point. It is not as if the 100 women were not treated and we found out that three destroyed themselves. All these women were being treated, which proves that with psychiatric supports, counselling and therapy, people who are suicidal or have self-destructive intent can be treated.

I am not speaking to the amendments that support the deletion of section 9. I am speaking to my own amendment No. 80, which I think is very fair and reasonable. The Minister should consider it, for all the reasons I have stated because, as I said on Committee Stage, my concern is that the panel for assessment and adjudication is not just a box-ticking exercise for a girl or woman, who has presented to her GP in crisis, threatening self-destruction or self-harm and believes that the only solution to her difficulties is a termination. We are talking about a human being, a girl who is vulnerable. There should be an obligation for a patient-clinician type of relationship whereby every support and assistance would be given to that girl to deal with her threat to destroy herself. It is important to make the point that it is not just a clinical decision or box-ticking exercise, yes or no.

I do not believe that an avalanche of girls will present themselves as suicidal. There are several reasons for this. First, I believe that the threat of self-destruction is rare but real in pregnancy. We also have to believe and trust the women and girls in this country. We have to believe and trust our medical professionals. We trust our obstetricians and gynaecologists and our anaesthetists every day of the week. Why are we not willing to trust our psychiatrists, the professionals who deal on a daily basis with people with mental health problems, people who threaten to destroy themselves and other mental health issues and psychoses? We already take into account their views on taking freedom from people when committing them under the Mental Health Act and in the context of a court of law. That is why I said I would be clear about my amendment.

We cannot just dismiss the threat of suicide. We must be humane and understanding and believe because the evidence is there that girls who are vulnerable and in crisis have killed themselves. Others have accessed termination of pregnancy in Britain and others procure abortifacient tablets from the Internet. That is real life. That is what happens in the outside world. This legislation, as drafted and crafted, is restrictive. Some say it is too restrictive. I do not. I believe it is right, it is balanced, proportionate and it is there to assess a real and substantial risk to the life of a girl or woman in the context of section 9 and I welcome that. There should, however, also be some obligation not only to assess but to support and treat a girl in a crisis.

Ciara Conway (Waterford, Labour)
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I oppose those seeking the deletion of section 9. In February 2013, a Wexford Coroner's Court heard, very tragically, that ten out of 14 inquests concerned suicides. One person under the age of 17 dies by suicide every month in this country. In 2010, 486 certified suicides were recorded, 386 very tragically were male and 100 were female. Suicide is the leading cause of death. It is a real risk for our citizens, male or female, or a woman, regardless of whether she is pregnant. Some people in this House seek to undo the erosion of the stigma from this issue following campaigning and lobbying to see mental health as an issue that needs to be addressed. Deputies Tóibín and Naughten said they do not consider this a medical issue. They should tell that to the medical doctors, the psychiatrists who have gone to medical school, who treat our citizens who have poor mental health and mental illnesses in our acute and community medical facilities all over the country.

Much legal analysis has been read out in the course of this debate and we have been asked to listen to it. I ask those Deputies to listen to the people. On two occasions the people asked that the X case be legislated for. Is democracy a mere inconvenience for these Deputies? Much has been made in this discussion about the need for evidence.

I stated at the Bill’s committee hearings, on Committee Stage and on other occasions that the evidence they so badly seek that suicide is a threat for women is evidence that should never be collected. It would mean that out of 100 pregnant women who are suicidal, 50 of them would get the treatment they need while 50 would not. I am not prepared to stand over that kind of evidence or that kind of risk to 100 pregnant women in our State. Members should reflect on what they are seeking.

Suicide is real. In 2010, 100 women died in this country very tragically because of suicide. People need to reflect on that. They need to reflect on the damage that is being done to mental health advocacy. For decades we have campaigned to erode the stigma around mental health issues. All of this is being undone by saying it is frivolous and not a medical issue. People need to choose their words carefully when they speak of mental health.

Having worked on a mental health team, I know it is our job, including that of psychiatrists, to reduce risks. We are trained to deal day in and day out with hundreds who present to general practitioners, accident and emergency departments and elsewhere with suicidal thoughts. As a mental health social worker, if a girl presents to me telling me the reason she is suicidal is that she is pregnant, am I to dismiss it? All people who present with suicidal intentions, be they male or female and pregnant or not, must be believed. It is our job as trained professionals - it is not some hocus-pocus, pulling things out of the sky - to assist them. It is so difficult to work in the area of mental health because the risks are so high. Am I not to believe the girl who tells me she is suicidal because she is pregnant? In some cases, the only treatment that will help her is termination.

We must reflect carefully on the kind of language being used when discussing mental health. I for one know the great stigma that is still associated with it. I know how difficult it is for those affected by it and their families to admit they need help. Are we to dismiss this now? Deputies who have spoken so spuriously about mental health in this debate tonight have in the past lauded the idea of removing the stigma. That is now all to be wiped clear if a pregnant girl says she is suicidal.

Michael Healy-Rae (Kerry South, Independent)
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I applaud and congratulate Members such as the Minister of State, Deputy Creighton, and her colleagues on the other side of the House who have gone against this Bill. The only disappointment I have is that tomorrow, as a result of her actions tonight, I will no longer be able to refer to her as Minister of State. That is blatantly wrong. I appreciate when Members speak in this Chamber according to their consciences and from the heart, doing what they believe to be right instead of being dictated to by a party Whip. A very smart man once told me, “The wheel is always going around.” People will be remembered for voting with their consciences. Some Members will be giving up much for themselves because of their beliefs. They do not care what they are sacrificing for themselves. They are putting their principles before themselves, as well as the betterment of their political careers. It is good to see politicians put this issue and their views before their careers. This must be acknowledged and appreciated. I appreciate it because a politician who will not stand for something will fall for everything.

Peter Mathews (Dublin South, Fine Gael)
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Hear, hear.

Michael Healy-Rae (Kerry South, Independent)
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It is good to see a few Members tonight who are willing to stand for something and put it on the record. Time will thank them for it. Tomorrow will not, but time will.

This Bill before us is wrong on the suicide issue. Every Member here is as interested in the protection of women's lives as they are in the lives of the unborn. We want to put the unborn life at the same level as that of the living person. In England, up to 6 million abortions have been carried out since 1967. Is anyone seriously trying to tell me that 72% of the people who had these abortions were suicidal? We are being asked to believe that over 70% of 6 million would have committed suicide if they had not had an abortion. I do not believe that.

The statistics in Ireland show that in our three maternity hospitals, out of 675,000 thankfully successful births, only two people committed suicide. They had other personal issues and it was nothing to do with their pregnancies. Everyone knows that it is natural for a person who is going to have a baby to be more concerned about her health and the protection and nurturing of that child. We are being told, however, that suicide is a massive problem. That is the lie that is being told here.

In 2008, 1.2 million abortions took place in the United States. In 2000, there were 1.36 million. Since the Roe v. Wade case in 1973, there have been 53 million legal abortions in the US. Were the majority of those ladies going to commit suicide? Today, the price of a legal abortion in the USA is €451. That is the price of a life in America. There are 3,500 legal abortions every day in America and 125,000 abortions per day worldwide. In China, over the past 40 years there were 330 million abortions. In Russia, for every ten live births there are 13 abortions. Every one of those people - they are people - denied their right to live is as every bit as good as me, as Deputy Mattie McGrath, as any of the Ministers. They are every bit as good as any one of us. What we will do later tonight is to introduce this into our country. It is wrong and sad, and it will be remembered for a long time that it was the wrong decision. It had to be based on something, so it was based on the suicide issue, which is not an issue. That is the lie. In Ireland, out of 675,000 live births, two ladies committed suicide.

Mattie McGrath (Tipperary South, Independent)
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Two too many at that.