Wednesday, 5 December 2018
Health (Regulation of Termination of Pregnancy) Bill 2018: Report Stage (Resumed)
I am, but I would like the matter to be clarified. Anyone can make a mistake and I am not blaming the Bills Office, but I want to totally repudiate the alarmist attacks directed towards us last night that the amendments were fake, a fraud and all that kind of stuff.
I am not looking for heads; rather, I am looking for respect from the Members who were trying to rubbish us by claiming we had made the administrative errors, that we were responsible for the cock-up and that we did not understand what we were doing.
For the information of the House, the substitute amendment No. 45, which was circulated in substitution of amendment No. 45, from the first substitute list of printed amendments, dated 23 November, corrected an administrative error in respect of cross-references and the processing of amendments.
I must advise the House that Deputies submitted two versions of amendment No. 45 to the Bills Office. The first one was incorrect. The second had the updated numbers contained within it. It was not clear as far as the Bills Office was concerned. All of that has been rectified and clarified.
I want to be clear. There was no substantive change between the two versions. We can now continue with amendment No. 45.
I am speaking on amendment No. 45. There is a difference of opinion on the other. I thank everyone for trying to be helpful. I accept we acted in good faith which we have done at all times. No more, no less. I am not going to be vilified by Members opposite for having a rubbish or fake or fraud amendment. It was called everything. Anyone can make an administrative error. So can we. We are not above making mistakes on this particular issue or any issue for that matter.
I thank the Bills Office, the Ceann Comhairle’s staff and all the other staff for trying to correct it. We were lambasted, however, last night. We were told to take it away, that it was rubbish and to run off with it. It was vitriol of the highest order. We did not put down amendments to be fraudulent, silly, cruel or heartless. All the empathy and sympathy is not on the other side of the House. We are doing what we were elected to do. We are doing no more here than trying to shape this Bill as the eighth amendment is to be removed and put into the hands of the legislators.
The Minister in his indecent haste avoided pre-legislative scrutiny. He rushed into the Chamber on different days with various cut-off times. Today, we have abandoned all business in the House for this Bill. There is nothing else in the country of any importance only this legislation. I cannot believe two items on Private Members’ business were pulled back for this. I will have a different attitude everyday in future when we have demands for more speaking time on different issues. Essentially, the housing crisis, the health crisis and the hospital trolley crisis are not important. This Bill, however, has to be done if nothing else. Clear the decks to rush legislation through to have this when the doctors, nurses and hospitals are not ready. No ultrasound facilities have been rolled out yet. It is a farce and nothing but a farce. It has been a farce since the eighth amendment committee was set up. That was a cabal which could not find a pro-life doctor to address it or meet the women with regrets for having an abortion. Last week, we were told it was makey-uppy regret. I know some have apologised for that. However, we are being vilified for delaying this Bill. We are not delaying or filibustering. We are doing our duty to assess amendments, put them down and speak to them
There has been much said about filibustering. I asked two people to carry out a word count with regard to the contributions from the pro-choice side and the pro-life side. The pro-choice have said 50,000 words so far.
The issue of parental notification is of concern to people. Parents do not want to be kept in the dark. They want to know what is happening regarding their children, and they want to see that provided for in primary legislation. Fine Gael should understand that the majority of parents want to do the best for their kids. We need to trust them with this type of information. It is important.
Last night, a question was asked about whether this would be provided for in the legislation. It is important to understand that the current situation regarding consent and notification is not covered in primary legislation. This Bill could put it into primary legislation. Yesterday, Deputy Butler tried to pin down the Minister on this matter. Let us be clear, in that the Minister cannot cite any statutory basis for the contention that there is a clear legal obligation on a doctor to notify parents if their child is under 16 years of age and decides to go for an abortion. Further problems emerge in light of the relevant sections of the Medical Council's guidelines and the HSE's consent policy. Both documents expressly allow for providing treatment to a child under 16 years of age without his or her parents knowing of the proposed treatment in certain situations. They envisage this arising only in exceptional or unusual circumstances, but the discretion is left with the doctor. That is the difference with the Bill that we are looking for, in which the discretion would not be left just with the doctor.
If any of us heard of an allegation of abuse or suspected abuse, we would have a moral and legal responsibility to go to Tusla. It would be exactly the same for the doctor. The argument on the other side that this would in some way put children in danger is nonsense. That issue is catered for already.
Listen, we will leave it at that and move on. I will say to all Deputies that they should not invite interruptions. This should be an orderly and dignified debate, and we want to ensure that it continues in that way.
Regardless, we are debating the proper amendment with the right sections tonight. Let us debate the merits of the amendment. I have some concerns with it. For instance, the references to parental notifications in respect of sections 11, 13 and 14 can be done away with provided that an application to that effect is made to the High Court. That application can be made by any interested party. The unfortunate thing, or the fortunate thing, whichever way one wants to view it, is that there is no legal definition of "interested party". An interested party could be the State, the father of the child, the rapist, the abuser, the grandfather, the next door neighbour or anyone in this Chamber.
Under the amendment, even if an interested party makes an application to the High Court, the parents would still have to be told "unless the High Court is satisfied that, in the particular circumstances of the case, it may justly proceed to hear and determine the application without" informing the parents. It is very convoluted. The amendment is asking for parental notification and saying that it can be done away with in certain circumstances if there is an application to the High Court, but even if there is such an application, the parents would still have to be informed unless the High Court determined the parents would not have to be informed, and the High Court cannot determine not to inform the parents until there is a High Court hearing. The amendment does not make sense, is not workable and should still be withdrawn.
Deputy Mattie McGrath can thank us later for helping.
In Ireland, the following activities are not legal under the age of 18 years: joining the Army or Garda Síochána; entering into a legally binding contract; registering to vote; changing name by deed poll without parental consent; leaving home without parental consent; getting teeth whitened without parental consent; or using a sunbed without parental consent. Despite that, and unless the House supports the amendment, it could be perfectly legal for someone under 18 years of age to consent to an abortion without parental consent. Deputies might imagine how, unless we support the amendment, their children will be able to end the lives of their babies - the Deputies' grandchildren - without their knowledge, consent or support years before they could even register to vote and enter into legally binding contracts. One of our daughters could consent to risky medical treatment that would end the life of another human being and put her physical and mental health at risk without our knowledge, consent or, more importantly, support years before she could legally use a sunbed or get her teeth whitened. If that is not the kind of Ireland we want for our children, we need to support this amendment. I ask each and every Deputy to consider doing so.
A decision to abort a baby is an irreversible one and our children deserve our support before being asked to make that decision. Our group has tabled this amendment with the intent of protecting the mother of the child going forward, an issue that is of major importance to us. Please, support the amendment so that we can provide our children with that support when they are at their most vulnerable.
I hope not to take the full seven minutes. I also hope to bring some rationality to what is happening. My understanding of the debate is that the proposal is for parental notification to be included in the Bill. If I understand the situation in all similar medical procedures, and given the Minister's response to Deputy Butler last night, parental notification is already in the medical guidelines.
I will let them speak for themselves. I am not referring to the Minister, but to some of the Deputies who were vehemently against parental notification in their contributions. They did not qualify that by saying they would be happy with such a provision in the medical guidelines.
My understanding is that, under the amendment as drafted, one would have to go to the High Court where the "out" of exceptional circumstances was at the discretion of the doctor if there were valid reasons for it in the medical guidelines. Aside from that fundamental difference in the substance of the amendment, the principle is the same. This is the nub of the issue. It appears to me that there are Deputies who do not like parental notification in this case. If that view is pervasive in society, then they could seek to change the medical guidelines and it would never revert to the House.
Therefore, it seems there is an argument for putting parental notification into the Bill à lathe medical guidelines. Unfortunately, we cannot do that here tonight in respect of that wording because it is not-----
Unfortunately, the amendment in front of us does not incorporate the wording that is in the Medical Council guidelines. Of course, if the Minister agreed in principle, that issue could be dealt with very simply. The Minister could give us an undertaking here that when he goes to the Seanad, he will bring forward an amendment that would bring what he says is there, what I accept is there and what most of us know is there and stop it being changed without the will of this House but put in statute law. Otherwise we are at the discretion of the Medical Council, which could change without coming back to the Oireachtas, which the people said was to make the law in this case. The constitutional amendment said that the power to make the law in this case would lie with the Oireachtas, not with the Medical Council. I would favour the withdrawal of this amendment if the Minister gave us an undertaking to bring an amendment to the Seanad incorporating what he said is in the Medical Council guidelines, putting them into statute law and bringing it back for what would effectively be five minutes here once the Bill goes through the Seanad.
As usual, my contribution will be very brief. I echo what the Leas-Cheann Comhairle said, namely, that respect be shown from every side of the House because the people outside would expect that. At no stage, have I spoken twice nor have I used my seven minutes. I would say I have used two to three minutes maximum. That is sufficient for me. Perhaps it is not sufficient for some people but it is certainly sufficient for me. I know the Minister clarified matters for Deputy Butler last night on this issue. I was satisfied with that at the time. Deputy Tóibín seems to have questioned that now. The reason this is a concern to me is because quite a number of parents have expressed concern about this aspect of the legislation. Such concern is very much from a humane point of view. If their daughter was in that type of trouble, they would want to be there to support her and, on that basis, they feel we should allow for that in this legislation. Is parental consent as per the Medical Council guidelines strong enough? Perhaps it is not. If the suggestion from Deputy Ó Cuív that the amendment be withdrawn was accepted, when this Bill goes to the Seanad, the Minister could allow for something to be put in there that would satisfy the people who have concerns about this.
I cannot see the reason in leaving it to the Seanad when we are asking to do the same thing here. Parents are concerned about this. They would like to help their daughter if she found herself in a position like this, and if she wanted to go through with an abortion, they would like to be notified about it. I respect Deputy Durkan very much. He made a contribution last night but I am glad he is here now. I believe there are far more good parents out there who are concerned and would like to help their daughters. I heard Deputy Durkan's concern when he said that it could happen within the family unit or household. It has happened in those instances and we regret that. However, there are far more parents who love their children and want to care for them and it is only right that those parents be notified to give them a chance to help their daughter at a very traumatic time like this. I cannot understand the reasoning behind letting the Seanad decide it. We have a role to play here as well. We are elected by the people. I still support this amendment because I believe it is necessary and fair.
Obviously, this amendment refers to parental consent for girls under the age 16. The reality is that when a young girl like that presents to a GP - it would most likely be a GP in this situation because it is going to be early pregnancy - the GP has a certain number of obligations that are already enshrined in law. First, if a girl under the age of 16 is pregnant, that essentially is statutory rape and there is an obligation on the GP to inform Tusla and most likely to inform the Garda. That is what is required for safety reasons. I know Deputy Coppinger discussed here and at the committee the fact that a parent may be the perpetrator of the pregnancy. That may be the case but it is probably a minority rather than a majority. Nevertheless, it is significant. If a girl under the age of 16 who is pregnant presents to a doctor, the doctor has an obligation to make a report to Tusla and the Garda.
I understand that under the general data protection regulation, GDPR, it is not permitted to discuss the medical condition of a child over the age of 13 with their parent. I am not sure if that is the case but if a pregnancy is involved, the obligation to report trumps the GDPR. I do not think any mother would thank her GP for prescribing abortive medication to a girl under 16 without consulting at least one parent. In many jurisdictions, there is an obligation to inform both parents, while in many others, there is an obligation to inform at least one parent. There are only a few jurisdictions that do not require the doctor to inform a parent.
This is a very important topic to discuss and thrash out here because it is a requirement that if a girl under 16 is pregnant, the law has been broken in some form or other. If it was between two consenting children under the age of 16, the so-called Romeo and Juliet clause kicks in. If the male partner, for want of a better word, is over 16 and the girl is under 16, that is a crime. It could constitute child abuse and it certainly needs to be reported. GPs already have a substantial obligation under the law to make reports to statutory bodies and probably to a parent. I cannot imagine a GP prescribing abortive medication to a young girl under 16 and not consulting her parents provided the GP is happy the parent was not involved in the pregnancy, which could happen in a minority of cases.
A GP has to use his or her judgment.
One of the foundations of medical ethics is that the person has autonomy. Under the Gillick judgment, which relates specifically to the prescription of contraceptives, where a girl under the age of 16 presents looking for contraceptives, her autonomy can trump parental consent in some circumstances. That Gillick competence could be transferred to termination of pregnancy. A pregnant girl could possibly be prescribed the medication without her parents' consent if she exactly understood the situation and was competent and mature. The Gillick competence is a derogation for contraception that could possibly transfer over to termination of pregnancy.
This amendment is too prescriptive. It places an obligation on the parents to be informed and this trumps all else. It also applies time restrictions depending on what section of the legislation is being invoked. Consent is important, but it has to be done in a structured way within the safeguards that are already present in medical ethics and the law to ensure that, if somebody under the age of 16 presents pregnant, the matter is not kept quiet. There has to be a triggering of events. The amendment, well intended as it is, will not advance that any further.
I will return to some of the principles on which the repeal the eighth amendment campaign was fought and discussed by people up and down the country. The reason for bringing in the non-surgical method of taking a pill pre-12 weeks was to allow someone in a crisis pregnancy to have the issue addressed as safely as possible early in the pregnancy without the need for any kind of surgical intervention. That is the way in which termination services are moving worldwide.
If there is a good system of information and sex education in place, people will be conscious of their own physiology and if they become pregnant, they will be able to address it as quickly as possible. For instance, over the past decade, use of the morning after pill in Ireland has been widespread. Somebody who has fears because contraception was not present or failed can avail of this pill. The 12-week principle is, in essence, an extension of that, which we want to see applied as early as possible.
From my experience of legislation, this convoluted amendment is unlikely to be workable in practice. The Minister clearly set out the argument last night, and I am sure he would be willing to do so again, if necessary. Dr. Harty made the point very clearly from a general practitioner's point of view and experience. We are talking here about girls. They are children. Nobody here would not want parents to be involved if the parents are actively concerned about their children, but that may not always be the case, for various reasons. I do not see what this adds to all the notification structures that have been established and set out in great detail in the legislation. A prior requirement broadly exists in Irish law that, if a girl under 16 becomes pregnant, there is in most cases a prima faciecase that she has been the subject of abuse or rape and that this should be communicated to the child protection authorities and the Garda.
Other than frustrating the progress of this legislation and making life almost impossible for doctors who are willing to provide these services, I do not understand this amendment. I will pose again a question I asked last night. Deputies on the other side of the argument have spoken about being loving parents and grandparents. Are we not all loving parents and grandparents? Are there any parents in this House who do not seek to love their children in their own best way? We are all like that. Everybody is like that, regardless of their view on this. Do Deputies want to see circumstances in which the matter of a pregnant 12 or 13 year old who has clearly been the subject of abuse cannot be addressed as the child and her parents wish? This amendment is frustrating the purpose of the Bill and the referendum on which people voted. I ask the Deputies who support it to consider withdrawing it. Perhaps the Minister will restate the advice he offered last night.
As I said last night, this amendment is not about consent but about notification. Parents need to know. The medical, emotional and psychological consequences of abortion are sometimes serious and can be lasting. Parents are best placed to advise in these circumstances as they will know if their child has a mental health issue that the doctor approached for termination may not be aware of. Children are seeing doctors who do not know their history and if a termination goes ahead, there can be serious consequences.
Parents of a minor daughter who had an abortion may be better placed to ensure she receives adequate medical attention after her abortion. If a child has an abortion, who are the best people to ensure she is looked after afterwards? I would appreciate if the Minister would indicate what services will be available after an abortion. We repeatedly asked that question on Committee Stage. We need clarification on it because these are minors.
We cannot keep parents in the dark. It is important that the Minister accepts this amendment because, as I said, no matter what happens to the child, she will end up with her parents who know best. We have to protect the child. I again ask the Minister to clarify what services will be available after an abortion. It is important to remember that these are children.
I welcome the clarification provided. I presume all the Deputies who attacked and ridiculed us last night and tried to make out that we were misleading in what we were doing will retract the scurrilous allegations they made. I presume they have done that or will do that.
I welcome Deputy Tóibín's contribution in which he highlighted the filibustering of Deputies on the other side who have spoken 50,000 words compared with 45,000 words spoken by those of us on this side. That finally nails the claims that have been going around here for the last couple of days. People, including the Taoiseach, have made accusations against us. This is a worthwhile amendment which is being brought forward for the most sincere of reasons. Deputy Michael Collins highlighted this evening the activities that are allowable and not allowable to a person under 16. All we are trying to do here is protect young people and involve their parents at a time when they most need them.
It is completely scurrilous for people to be trying to give the impression that a majority of parents or grandparents would be mistreating these children. Of course there is a bad egg in every segment of society. I think it is fundamentally wrong if the primary reason for legislating in a certain way is an assumption that the parent or grandparent is the abuser of a child.
I do not question anyone's bona fides in relation to this. As Deputy Burton has said, everybody wants what is best for their children. I am sure everybody shares that view. I am sure we all share the view that everybody wants to make sure children are protected. There is a big and broad debate about the issue of consent across society. It covers a number of areas, including the sexual age of consent and the medical age of consent. I would like to reiterate a point I made last night. The policy on medical consent here is exactly the same as the policy on medical consent for every other part of the health service. Deputy Butler asked me about this last night. It is the same as the age of consent in relation to contraception, gender realignment and cosmetic surgery. The issue of consent actually features on our Statute Book. Deputy Ó Cuív was probably in government when the legislation in question was introduced. He may even have brought it forward.
My apologies. We have more than the 1997 Act. We have the Children First guidelines and the HSE policy on consent. Deputy Harty outlined in the most articulate and eloquent way the reality of how consent works. This is the norm in the health service. In cases involving people under the age of 16, parents are involved unless there are exceptional circumstances. This is not a mystery for anyone in the health profession. There is no reason to do anything differently in respect of this part of the health service. For those reasons, I do not propose to accept this amendment.
There is a difference between the position we are taking and the position the Minister is taking. When we have asked the Minister to do certain things in this Bill, his default position has always been that such things do not have a place in the Bill on the basis that someone somewhere will do something about it sometime. It is good enough for a legislator to take such an approach. These very important issues are of real concern to parents throughout the country. If we think about it, this shows us how far we have travelled in this country and how far out of step with most European countries we will be. Before the referendum, everybody wanted to talk about what is happening in the rest of the world. We are trying to introduce protections that are similar to those that exist in the rest of the western democracies, but we are being told we have to do this our own way. The key element of this is that the consent issue does not exist in primary legislation.
There is a difference that I would like to mention in this context. Under the current consent rules, in exceptional circumstances there can be occasions when doctors do not have to tell parents. We just want to give the power back to parents. I think most people looking in at this would be shocked to think that the national Parliament of this country has decided not to include in primary legislation a safeguard for parents who are seeking to support their children at times of serious crisis in their lives.
John Brassil, Mary Butler, Jackie Cahill, Michael Collins, John Curran, Peter Fitzpatrick, Seán Haughey, Danny Healy-Rae, Michael Healy-Rae, Michael Lowry, Marc MacSharry, Mattie McGrath, John McGuinness, Margaret Murphy O'Mahony, Eugene Murphy, Carol Nolan, Fiona O'Loughlin, Frank O'Rourke, Éamon Ó Cuív, Eamon Scanlon, Peadar Tóibín.
Maria Bailey, Mick Barry, Richard Boyd Barrett, John Brady, Tommy Broughan, James Browne, Richard Bruton, Pat Buckley, Peter Burke, Joan Burton, Catherine Byrne, Thomas Byrne, Shane Cassells, Jack Chambers, Ruth Coppinger, Marcella Corcoran Kennedy, David Cullinane, Michael D'Arcy, Jim Daly, Pearse Doherty, Stephen Donnelly, Timmy Dooley, Andrew Doyle, Bernard Durkan, Dessie Ellis, Martin Ferris, Frances Fitzgerald, Simon Harris, Michael Harty, Séamus Healy, Brendan Howlin, Billy Kelleher, Gino Kenny, Martin Kenny, Seán Kyne, Josepha Madigan, Helen McEntee, Finian McGrath, Tony McLoughlin, Denise Mitchell, Imelda Munster, Catherine Murphy, Paul Murphy, Hildegarde Naughton, Tom Neville, Michael Noonan, Darragh O'Brien, Jonathan O'Brien, Kate O'Connell, Fergus O'Dowd, Louise O'Reilly, Jan O'Sullivan, Maureen O'Sullivan, Eoin Ó Broin, Caoimhghín Ó Caoláin, Donnchadh Ó Laoghaire, Aengus Ó Snodaigh, Thomas Pringle, Maurice Quinlivan, Anne Rabbitte, Michael Ring, Shane Ross, Eamon Ryan, Seán Sherlock, Róisín Shortall, Bríd Smith, Brian Stanley, David Stanton, Mick Wallace.
Amendment No. 46 is in the name of Deputies Mattie McGrath, Carol Nolan, Danny Healy-Rae, Michael Healy-Rae, Peter Fitzpatrick, Michael Collins and Michael Fitzmaurice. It arises out of committee proceedings. Amendments Nos. 46 and 46a are related. Amendment No. 46a is a logical alternative to amendment No. 46. Amendments Nos. 46 and 46a will be discussed together. Will Deputy Tóibín move the amendment?
The Deputy did not table amendment No. 46. Only Deputy Mattie McGrath, Nolan, Danny Healy-Rae, Michael Healy-Rae, Fitzpatrick, Michael Collins or Fitzmaurice may move amendment No. 46.
I move amendment No. 46:
In page 15, to delete lines 32 to 34 and substitute the following:
“Information and informed consent
23.(1) Except in a case of an immediate risk to the life, or of serious harm to the health, of the pregnant woman, where it is immediately necessary to carry out the termination of pregnancy in order to avert that risk, no termination of pregnancy shall be carried out without the voluntary and informed consent of the pregnant woman.
(2) Consent to a termination of pregnancy is voluntary and informed if and only if the medical practitioner who is to perform the termination of pregnancy or another medical practitioner assisting him or her—(a) has informed the pregnant woman, orally and in person, of the following:(i) medically accurate information that a reasonable patient in the position of the pregnant woman would consider material to the decision of whether or not to undergo the termination of pregnancy, including:(b) in the case of a pregnant woman intending to avail of a termination of pregnancy in accordance with section 13, has offered the pregnant woman in person a printed copy of the document referred to in subsection (7),(I) the proposed termination of pregnancy method;(ii) the probable gestational age of the foetus at the time the termination of pregnancy is to be performed; and
(II) the immediate and long-term medical risks associated with the proposed termination of pregnancy method;
(III) the medical risks associated with carrying her child to full term; and
(IV) alternatives to the termination of pregnancy;
(iii) the probable anatomical and physiological characteristics of the foetus at the time the abortion is to be performed,
(c) in the case of a pregnant woman intending to avail of a termination of pregnancy in accordance with section 11or 14, has offered the pregnant woman in person a printed copy of the document referred to in subsection (8), and
(d) in the case of a pregnant woman who expresses a wish to receive the information contained in either of the documents referred to in paragraph (b)or (c)respectively but is unable to read the said document, has conveyed the said information to the woman in an appropriate alternative manner.(3) Where it is intended to carry out a termination of pregnancy on a foetus who is twenty weeks’ gestation or more, the medical practitioner intending to carry out the termination of pregnancy or another medical practitioner assisting him or her shall, orally and in person, offer information on foetal pain to the pregnant woman.
(4) The information offered in accordance with subsection (3)shall include, but shall not be limited to, the following:(a) that maternal anesthesia typically offers little pain prevention for the foetus; and
(b) that an anesthetic or analgesic is available in order to minimize and/or alleviate pain to the foetus.(5) Where it is intended that a termination of pregnancy be performed using abortioninducing drugs, the person who supplies the drugs to the woman intending to have the termination of pregnancy shall, orally and in person, inform the woman of the following:(a) that it may be possible to reverse the effects of the abortion-inducing drugs should she change her mind, but that time is of the essence; and
(b) that information on reversing the effects of abortion-inducing drugs is available in the document referred to in subsection (8).(6) For the purposes of this section, the phrase “abortion-inducing drugs” means a medicine, drug, or any other substance prescribed or dispensed with the intent of terminating the clinically diagnosable pregnancy of a woman, with knowledge that the termination will with reasonable likelihood end the life of the foetus, other than drugs that may cause such a termination, but which are prescribed for other medical indication.
(7) The Health Service Executive shall cause to be published in both printed and digital formats a document containing information as to:(a) available medical and nursing assistance and care, including neonatal palliative care;
(b) available social and counselling supports and services; and
(c) contact details for public and private agencies and services,which may be of relevance and practical assistance for a pregnant woman in a case where a foetus has a condition referred to in section 13, including a pregnant woman who does not wish to avail of a termination of pregnancy in accordance with section 13.
(8) The Health Service Executive shall cause to be published in both printed and digital formats a document containing information as to:(a) public and private agencies and services available to assist a pregnant woman through pregnancy, upon childbirth, and while her child is dependent;
(b) information as to available medical assistance, supports and benefits for prenatal care, childbirth, and neonatal care;
(c) information on the support obligations of the father of a child who is born; and
(d) the information referred to in subsections (5)(a)and 5(b).(9) The Health Service Executive shall develop and maintain an internet website, which may be part of an existing website, on which the information referred to in subsections (7)and (8)can be viewed and from which the documents referred to in subsections (7)and (8)respectively can be obtained.
(10) The document referred to in subsection (8)shall also include the following statement:
“There are many public and private agencies willing and able to help you to carry your child to term, and to assist you and your child after your child is born, whether you choose to keep your child or to place her or him for adoption. The law requires that your health care professional give you the opportunity to call agencies like these before you undergo a termination of pregnancy.”.
(11) Nothing in this Act shall operate to create an entitlement by a pregnant woman under the age of eighteen years to consent to medical treatment.
(12) A medical practitioner who carries out a termination of pregnancy in accordance with section 11shall certify in writing in addition to the matters referred to in section 11(1):(a) the nature of the medical emergency; and
(b) in cases where the voluntary and informed consent of the woman concerned was not obtained, the reason for its not having been obtained.(13) The failure to comply with the requirements of this section shall provide the basis for:(a) a civil action for damages (including aggravated and exemplary damages) by the woman concerned for breach of statutory duty;
(b) professional disciplinary action against the health professional concerned.(14) In any matter referred to in subsection (13)the court shall, upon application by the woman concerned or of its own motion, allow a woman to proceed using solely her initials or a pseudonym and may make such other protective orders as it considers necessary and appropriate to preserve the privacy of the woman concerned.”.
This amendments speaks on informed consent. Before we go further into discussion on the amendment, I wish to draw the attention of Members to subsection 12. The proposed section 46(12) should refer to section 12 and section 12(1) of the Bill, respectively, instead of section 11 and section 11(1). This is because the subsection refers to the section relating to termination in the case of an emergency. I wish to draw the attention of Members to that point.
The amendment makes provision for information that a woman seeking an abortion is entitled to be given. It is designed to ensure that she will have full information on the material facts and that if she is not given that information she may initiate appropriate proceedings for breach of the obligation owed to her in that regard.
The amendment is solely about information. It does not apply to emergency situations. It places no obligation on women. The amendment ensures that women are given information on relevant matters, including risks of the relevant abortion method, risks of carrying the child to term, alternatives to abortion and supports available to assist her. It is obvious that in the absence of this information any consent obtained is not an informed consent.
Consent to a medical or surgical procedure is not true consent unless it is informed consent. Without this amendment women who would elect not to have an abortion if they had complete information will instead go through with it. That must surely be unacceptable to anyone who would label themselves as pro-choice. Yet, curiously, some Deputies of that view have continuously and groundlessly criticised this amendment.
Prior to the referendum, the Tánaiste, Deputy Simon Coveney, assured people that the cooling off period of 72 hours would involve counselling and offers of alternatives to abortion. The amendment ensures that the law reflects what the Tánaiste said during the referendum. The Minister has constantly said that he wants clarity for doctors in the law. Despite this, he rejects amendments from pro-life Deputies as not being necessary in primary legislation. He has said these matters can be dealt with by guidelines etc. This is a contradictory stance. Either we give doctors clarity in the Bill, as the Minister keeps insisting on, or we do not.
At common law the more elective the procedure, the greater the duty on the doctor to warn the patient of potential negative outcomes. It is clear that most abortions under this Bill will be elective procedures. The law requires that elective procedures require a high degree of disclosure. However, the parameters of that obligation are not clear in all situations. Arguments sometimes arise in litigation over whether a given risk was material. Accordingly, for clarity, it is important to include in the Bill a provision specifying what should be disclosed.
Women need to be respected through the provision of full information instead of having information withheld based on some paternalistic assumption. It is highly paternalistic to deny a patient relevant information merely because it could give rise to upset or affect her decision. Such an approach would be entirely an unacceptable approach.
Subsection 12 of the amendment should refer to section 12 and section 12(1) of the Bill instead of section 11 and section 11(1), respectively, as this relates to the section providing for termination in the case of emergency. It is similar to the previous case.
Information is an entity that provides the answer to questions or resolves uncertainty. We can agree in the House that information is a common good and a positive thing.
For years, we have had a culture in the country in which information has been withheld from women. For years, we have had a paternalistic and patronising attitude towards women to the effect that either they are not worthy of information or not strong enough to handle that information.
I had thought we had reached a point in the evolution of the State where we trusted people with information, even if that information was difficult information. Yet, we are in the House in the closing days of 2018 and we are on the verge of introducing an abortion regime in the country that is radical in international terms.
The Bill has at its heart a sentence stating, "The termination of pregnancy means the ending of a life of a foetus or an unborn child." So controversial is that particular sentence that the Deputy sitting beside the Minister argued the point vociferously at the committee that she did not want the sentence in that particular form. That is a fair representation of the discussion in question. Even those on the pro-choice side baulk at the sobering element of that sentence. That is the sentence we must vote on. That sentence will be part of the new regime in future. It reflects a decision that is being made each time an abortion is had.
We had a discussion last week around abortion regret. There are many women in the country who have experienced abortion regret. We had a Deputy in the Dáil today who said that abortion regret was a made-up issue. What if that came from our side of the debate? What if we disrespected individual women who had such difficulties in their lives? I am referring to serious difficulties in their lives. If we said those women were lying or not telling the truth about their experience, then it would be headline news all over the broadcast and print media. This is because it is a shocking thing to say that and to deny a person her feelings with regard to her particular experience.
I have met women who have had abortion regret. They have stated to me that they rue the fact that they did not have all the information at their disposal when they made a particular decision. They wish they could turn back the clock to have the information in question brought to them.
This is a serious issue. Informed consent is a logical and a good thing when people make serious decisions for themselves. The Bill highlights the seriousness of the matter. It states that a person who is guilty of an offence under the section in question shall be liable on conviction on indictment to a fine or imprisonment for a term not exceeding 14 years or to both. The Bill understands the gravity of what we are discussing.
There will be people in the Chamber who will state that information will be used in an effort to shame individuals or to make their decision more difficult. Such people will find reasons to withhold that information. We had this debate on Committee Stage. People said that the one thing they did not like about amendment No. 46 was the mandatory delivery of information. I sat back and decided to propose taking the mandatory element out of it. I included the word "offer".
We know the whole referendum was dressed up in clothes of choice. The view was that people could make a decision one way or the other. By putting the word "offer" into the amendment several times we have made the information not mandatory but a matter of choice. It is a choice that can be declined if a person does not want the information given to her. Surely in that situation the person can say she was given all the options but chose not to take the information and proceed. Such is the extremity of the position at the moment that even amendments which do not attempt to limit access in any way - they simply ask whether the woman would like information - are not being accepted.
Based on the feedback we are getting from Government Deputies, the amendments are not going to be accepted. Receiving information is positive. It provides answers to questions or removes uncertainty. If one is pro-choice, one will be in favour of offering information and seeking to allow a woman in a crisis pregnancy to have the choice about whether she wishes to receive it. We want to provide factual information that is medically accurate and which allows informed choices to be made.
There are two amendments before us. Before people get really angry about one of them which involves a mandatory provision, they should know that there is a second amendment which does not involve a mandatory provision. It only seeks to ensure the woman involved would be asked whether she wanted to receive the information; it could be declined. How we vote on that issue will show where we are as a country.
Amendment No. 46 would mean that women would be entitled to access all possible information before deciding to end a pregnancy. Seeking to provide for the provision of additional information during a three-day waiting period is not an attempt to shame or pressurise women into not having an abortion, as many supporters of the Bill have claimed. It is simply a measure that might have a small impact in minimising the abortion rate, which surely should be the aim of the legislation. During the referendum campaign the Tánaiste spoke in favour of having measures to provide such information for women. Even now, these completely innocuous proposals are under attack. Surely it is a policy aim of the Government to ensure the number of abortions is kept to a minimum and that as many healthy babies as possible are delivered, but in listening to the Minister on Committee Stage and again on Report Stage in the House and the contributions of some other Deputies, one would almost believe the opposite was the case.
There is nothing in the legislation which seeks to provide alternatives to abortion in the form of additional counselling or financial support, among other things. It is incredible that, after five years of discussion of the issue, countless hours of committee hearings, Oireachtas debates and a constitutional convention, there has been virtually no discussion of such measures. This is the second time in the last hour I have asked the Minister to let the House know what supports will be provided. I asked him this question during the discussions on the previous amendment and I am asking him again now.
I have also asked the Minister what additional counselling services or financial support will be made available. I thought, when he stood to make a speech on the last occasion, that he would tell us the answer to that question, but he said absolutely nothing. Will he, please, confirm what additional supports will be in place?
The Minister has made token nods on the availability of contraceptives as a means of trying to keep the rate of abortion low. In reality, it is a meaningless platitude which ignores the experience of our nearest neighbours in the United Kingdom. Contraceptives have been available almost universally for free on the NHS for decades, as has the contraceptive pill, but in spite of the widespread availability of contraceptives, the rate of abortion in the United Kingdom is through the roof. Some 20% of all recorded pregnancies are aborted. Why does the Minister think the experience will somehow be different in Ireland?
Earlier the Taoiseach said abortion should be rare, that it was not something that would become an easy option. That statement seems to have been abandoned by him and the Government. If they genuinely believe abortion will be rare and a last resort, there is no real measure in the Bill which attempts to advance this public policy aim. Amendment 46 tries to address these issues and I strongly support it. I know, however, that the Minister has made up his mind. It was made up on Committee Stage and it is still made up on Report Stage. He is not going to accept any of the amendments proposed. Will he, please, provide clarity on the supports that he will provide when the Bill becomes law? I am aware that he has serious issues with GPs, midwives and nurses. He has serious problems with everybody. I am asking him to let those who are going to have an abortion know what supports will be in place for them. Will he also, please, stop nodding every time I ask a question? When he nods, I expect to receive an answer, but I am not getting any.
While amendment No. 46 has been tabled by pro-life Deputies, in reality, it is the very model of a pro-choice amendment as it seeks to ensure that where a pregnant woman is considering a termination, she would, before making a final decision on parenting, adoption or a termination, be fully informed of her choices. We know that this is regularly not the case. Many women who have had an abortion or who have considered having one say they felt they had no choice. Many more say they simply were not aware of some of the supports available to them. For these and other women, pregnancy often felt like a crisis because they could see no way out of the difficult situation in which they found themselves. However, many of them say they changed their mind about abortion when they received the information, or that if they had had that information, they might not have proceeded to have an abortion. It seems that, for some women at least, being given access to information on support services has affected their choice. The amendment seeks to ensure pregnant women would be given enough information in order that they could make informed choices about how they would proceed, whether to parent their child, place him or her for adoption or end the child's life prematurely by having an abortion.
The choice to end a baby's life is irreversible. It is often made in desperation and leads to devastation for the baby's parents. Thankfully, the Bill retains, for now, in section 14 the three-day reflection period for elective abortions requested in early pregnancy. However, without a guarantee that pregnant women would be offered information on the supports available and given time to reflect on them, as well as time to seek counselling or more information, the effectiveness of the three-day provision will be weakened and women will not always be able to make the most informed choice possible. It is true that the people voted in favour of having some element of choice, but the only way an informed choice can be made is if one is fully informed.
It is worth taking a look at the type of information the amendment proposes should be made available to women. I find it hard to believe any of my fellow Deputies would object to a woman being offered such information. These are direct quotes from amendment No. 46, subsection (8). Women are to be offered:
...information [on] (a) public and private agencies and services available to assist a pregnant woman through pregnancy, upon childbirth, and while her child is dependent;
(b) information as to available medical assistance, supports and benefits for prenatal care, childbirth, and neonatal care;
(c) information on the support obligations of the father of a child who is born.
If Deputies believe women deserve to be told about supports, they must vote to support the amendment. We would all like to believe all doctors already give women this information when they come to them with an unexpected or challenging pregnancy. However, given the vast array of conditions with which patients come to GPs, it is not reasonable to expect them to be fully up to speed with all of the support services available during pregnancy, especially as the circumstances in which each woman finds herself are often unique and challenging and she may need specialised support. Surely providing such an information booklet for all GPs in order that they can offer women facing an unexpected or challenging pregnancy should already have been a priority of the Government and one would have thought it was the case, given its apparent concern for women. However, to the best of my knowledge, many doctors do not believe they have been prepared to fully inform a pregnant woman of the vast range of support services available to her. It must be remembered that, up to now, many women facing what they considered to be a crisis pregnancy would not have gone to their GP in the first instance, especially if they were considering a termination. Many of them would have gone to a crisis pregnancy agency which was more likely to have detailed information or supports available. The Minister is now doing everything he can to force an overstretched and, for the most part, an unwilling GP service to help women to end the lives of their unborn children.
He is doing everything he can to rush through legislation and introduce medical guidelines and training for GPs on how to perform abortions by 1 January. I have not heard one word from the Minister about how he will ensure that these GPs are also provided with a full list of support services and alternatives to abortion that they can offer when consulted by a woman facing an unexpected or challenging pregnancy. Indeed, this information should be made available to all GPs. I have not heard one word about how the Minister will offer support to women who want to keep their babies but need extra help. The Minister knows that there are many State-run and privately operated support services that will support women through pregnancy.
The Minister says, or at least said before the referendum, that he wants to reduce the number of abortions. However, I do not recall any recent HSE public information campaign reminding women that support is available to them and their babies, that adoption is still an option, that pregnancy and parenting support is available to them, that Government support is available to young parents still in education, or that post-abortion counselling is available. If the Minister really wanted to reduce the number of abortions, it should have been a firm policy of this Government to ensure that women are fully informed of all these support services. Instead we now see the Minister's true colours. He intends to set up a 24 hour hotline to advertise for abortion providers, but he has done nothing to ensure that women will be more aware of the supports that exist for them.
This amendment seeks to ensure that women will be offered information and supports. I implore the Minister to accept it. If he continues to reject amendments that seek to support mothers facing challenging pregnancies, I implore other Deputies to support it to ensure that no woman has an abortion because she does not know what other supports are available to her. I implore Deputies to support women by helping to inform them. I ask all Members to support this amendment.
I, too, am glad to be able to speak to this amendment. Informed consent is one of the fundamental principles underpinning the ethics of medical practice. It is a given that, where possible, the patient or person concerned should be adequately and appropriately informed in such a manner that the nature and gravity of the procedure, not to mention its consequences, are made clear to them. This is an entirely acceptable and long-established medical principle all over the world. Once again, our amendment reflects current UK practice. Indeed the abortion provider known as the British Pregnancy Advisory Service, BPAS, whose representatives gave evidence before the Oireachtas joint committee, clearly states a policy that all women availing of abortion services should have a discussion about their pregnancy options, their decision about whether to continue or to end the pregnancy, and in the latter case, their understanding of the available procedures and associated risks as part of the process of gaining informed consent.
BPAS also highlights, as is directly applicable here, that informed consent is entirely separate from the requirement set out in the Abortion Act 1967 for two doctors to certify that a woman meets the grounds for abortion. Although these principles are often confused, they are totally different. The need for consent in healthcare is founded in common law and the principle of bodily autonomy. For consent to be valid and legal, it must be voluntary and informed. The person consenting must have the capacity to make the decision. These principles apply to all medical procedures, including abortion.
I will now outline the definitions of these terms as explained by the NHS Choices website. "Voluntary" means that "the decision to either consent or not to consent to treatment must be made by the person themselves, and must not be influenced by pressure from medical staff, friends or family". For consent to be informed, "the person must be given all of the information in terms of what the treatment involves, including the benefits and risks, whether there are reasonable alternative treatments, and what will happen if treatment doesn't go ahead". Finally, to have capacity "the person must be capable of giving consent, which means they understand the information given to them and they can use it to make an informed decision".
I note some countries’ different approaches to this issue. In France, the physician must inform the woman about the risks involved and provide her with a guide to the rights and assistance provided by law to families, mothers and their children, as well as informing her of the possibilities for adoption should she decide not to terminate the pregnancy. The Minister has never addressed any of these regimes. In Belgium, the doctor must provide the woman with detailed information regarding the rights, assistance and benefits guaranteed by the law to families as well as regarding the possibilities offered by the adoption of the child. Assistance and advice on resources available to resolve the psychological and social problems posed by the woman’s situation must also be made available. I do not see that anywhere in the Minister's offering, though we spent many hours in the talks on the programme for Government trying to get a commitment to a perinatal hospice. Some Members did not know what that meant at the time. It fell to my daughter and Deputy Harty to explain it to them. We have not seen that rolled out either. Progress has been very limited.
I refer also to the relationship between informed consent and abortion regret. During the Citizens' Assembly this was made absolutely clear by the abortion regret support group Women Hurt. I want to put on the record the points they made in their submission, because they were completely ignored during the course of the referendum debate and have been the subject of mockery during this debate. I have met countless numbers with feelings like that, but they were not listened to at all. They were called fakers, accused of making it up, or called delusional or notional. It was terrible. Deputy Chambers apologised under pressure from others, but I did not hear apologies from other Deputies who said these views were notional, fictitious or airy-fairy. One such Deputy is sitting quite close to the Minister and whispering to him. I did not hear that, and I would like to, because they were totally disparaging remarks.
I quote from the group's submission:
We are writing to you from Women Hurt, a group of women who have all experienced abortion. For us it was the worst decision of our lives and something we deeply regret to this day.
Nobody told us what life after abortion would be like or even what happens in an abortion. Today nobody is talking about what will happen if we repeal the 8th Amendment. All we hear about is the ‘right to choose’ but never anything about the actual abortion itself. If it is such a simple procedure with no drawbacks, why the reluctance to discuss it? Deep down we all know the answer why.
When I took an animated three-minute video to the so-called hearings, no committee members wanted to see it. They would not even look at an animated video. Hear no evil, speak no evil, see no evil. That was intended to inform the members of that committee. The submission goes on:
The published research in this area backs up the evidence that is clear from talking to women. There is a media imposed wall of silence about openly discussing abortion regret. There is no question about that. Almost all of the media focus on the issue is about building the case to justify legalised abortion. There is an unbelievable defensiveness about allowing calm and reasoned debate on the matter, where groups like Women Hurt can contribute without being verbally assaulted.
It is devastating to think of all the women who suffer in silence after abortion, all because those pushing are determined to keep going regardless of the human cost in lives lost or the indescribable human suffering that abortion causes.
Here are some of our stories and experiences. We would gladly present an oral presentation to the Assembly if you intend facilitating such presentations.
The submission then quotes a woman identified as "Lynn":
I aborted my son, Stephen on the 21st September 1980. He would be 35 years old now had he lived. My employer coerced me in to an abortion (which they provided and paid for) giving me the 'choice' in order to keep my job, my income and my home. I had a 'safe & legal' abortion, travelling not more than 10 miles from my then home. In the age of equality, this was meant to make me equal to my male counterpart so that I could continue my career. What nonsense. My male colleague could not become pregnant and therefore would never have to consider abortion. I was not given the facts. No counselling before or afterwards. I suffered from post abortion trauma (PTSD similar symptoms including flashbacks) for a good ten years before I fortunately stumbled across help.
I am glad to speak on this amendment.
We all feel it is important that a woman who finds herself pregnant when she did not intend it should certainly be made aware of all the options and choices, including, of course, abortion, that are now available for women who find themselves in such a state. In times past, girls were frowned upon if they became pregnant outside of marriage and they were shunned and hidden away. That was wrong and we can never go back to that. I believe that there is a change of mindset in the world today about women and girls becoming pregnant and having children. There is no talk about marriage. It is the baby and the mother. Tremendous care, attention and respect is given to the birth of a child all around us now. That is only right because we know of too many women and couples who try to have children and fail. It is a regret throughout their lives that they cannot have a child who would grow up and be with them for all of their lives. Couples have regret when they cannot have a child. To that end, I believe that a girl who finds herself pregnant and who sees no way out other than to have an abortion should at least be made aware that such couples would gladly appreciate a baby. Adoption is another option she should consider.
We know too well of women who underwent an abortion and regretted it and would have chosen another route or option if they had their time back. However, there is no going back after an abortion. It is the end of a life and when life ends there is no magic to get it back again. Certainly, it bothers women and they should be made aware that there can be adverse psychological effects after having an abortion. Women who we met and who told us about it stated they will never forget what might have been and will be regretful to the end of their time for going down that route.
There are so many different types of help out there. There are benefits and supports available. When women or girls find themselves pregnant, they wonder how they will support the child. They should be made aware of all the benefits and supports that are out there because they are available. There is housing and support from the HSE and all the services the State now provides that, regrettably, we did not have in times gone by. There are many different options available to women now that were not there previously. This amendment is important because it is important to give the women advice and make them aware of their choices going forward and also to make them aware of the adverse psychological effects that they may suffer after having an abortion.
I do not know what we would do if we did not have the Rural Independent Group Deputies and other Deputies to give us this amazing information. Women, it seems, do not know that the Internet exists where they can get all this information themselves without us passing it into law. I thank the Deputies for insisting that this be put into the law.
While the Deputies were speaking, I took the liberty of visiting one of the websites they believe all women must be told about. The original amendment, which the Deputies changed slightly since Committee Stage, was that any person who is pregnant and wants a termination, whether due to a diagnosis of fatal foetal abnormality, for health reasons or for whatever other reason, must be subjected to this full-on intimidation procedure. The Deputies have changed the amendment to exclude that requirement because they realised how cruel and callous it looked.
I presume this provision would apply to any pregnant person who visits a general practitioner seeking an abortion within the first 12 weeks. What women will find when they look up the Internet at eight weeks is a foetus the size of a raspberry. At 12 weeks, they will see a foetus two inches in size. What amazing information do the Deputies think these airhead women would find if the amendment was passed? Seriously, this is beyond belief.
I will deal quickly with the amendment. We all know why these amendments are being tabled. It has nothing to do with any concern for women. As soon as I finish, I will meet women who are under real threat and I will listen to Ms Vicky Phelan speak about the life-saving drug which she wants to be made available to all women. As for the idea that anyone going through this procedure would have to be shown the probable anatomical and physiological features and be told about foetal pain, and that a little ring-around would be done of the public and private adoption agencies that might want to take their baby, even if all of these things are done, women will still make the decision to have abortions.
I love the way Deputy Mattie McGrath would find houses for them all. The Deputy correctly stated there is a housing crisis. If only every woman who was pregnant had a house because many of them do not. Amendment No. 46 seeks to have the father of the foetus brought into the equation as well. We have this idea that if only these poor girls had the real information, they would suddenly change their minds and decide not to have an abortion. They can get this information without the Deputies forcing it down their throats. They do not need the Deputies making a law that a doctor would have to subject them to shame, guilt, upset, delay and out-and-out misogyny, which is what this is. There is no need for the Deputies to try to trigger people. All of these amendments are ghoulish. It is difficult to understand how somebody could sit down and write them.
At the committee, I made the point that the Deputies need to move beyond the 1950s and let the 66% of people who voted for this change, and many others who accept their verdict, move on, progress and have done with it. I will not take up any more time but I felt it was important to call that out.
I do not intend to speak on this for long because we spoke on it at great length at the committee and on many other occasions. Members need to be careful with the use of language. I heard the reference to abortion as a women taking the easy option. That is grossly offensive, regardless of anybody's view on the issue. It is never easy. No women gets up and says, "God, I would love to have an abortion today." That sort of language adds to the stigma of women in crisis.
We ought to be careful in using such language. Abortion is not an easy option.
Informed consent exists in this country. Doctors who do not follow informed consent may face the most serious of consequences, including the loss of their livelihood. The Medical Council Guide to Professional Conduct and Ethics for Registered Medical Practitioners has been discussed at great length. It dedicates five pages to the issue of consent, including section 9, consent – general principles; section 10, capacity to consent; section 11, information for patients; section 12, timing of consent process; section 13, responsibility for seeking consent; section 14, emergency situations; section 15, refusal of treatment; section 16, advance healthcare plan or directive; section 17, consent to genetic testing; section 18, children and young people; and section 19, personal relationships with patients. Pages 15 to 20, inclusive, of the Medical Council rule book outline the issue of consent. It is inherent in the amendment that we need to tell a doctor that he or she must provide medically accurate information to a patient and tell her the proposed method for the termination of pregnancy and the immediate and long-term medical risks. However, that is already standard medical practice and there is no need for the amendment.
Members have asked on several occasions what supports will be provided for women in crisis pregnancy who do not wish to pursue a termination. I have not addressed such queries because we are on Report Stage, Members are meant to speak only to the amendments, and that is what I have been endeavouring to do. On this occasion, however, I will expand on that issue. Deputy Michael Collins horrifically described the 24-7 helpline as an advertisement line for abortion providers, which is quite a disgusting, as well as inaccurate, way to refer to it. For the information of Deputy Fitzpatrick, it is a non-directional helpline. Many of his constituents may have experienced a crisis pregnancy and travelled to the United Kingdom, the Netherlands or elsewhere or taken an abortion pill. A significant majority of them voted to repeal the eighth amendment and allow us to pass this law. One of his constituents in a crisis pregnancy will be able to phone that 24-7 helpline which will be operated by healthcare professionals who will provide non-directive information on all of the options. Some Members of the House do not want one of those options to be termination. That is fine. They are entitled to hold that opinion. However, they lost the referendum. Everybody else in the House wants termination to be one of the options available because we take our mandate from the people. The non-directional 24-7 helpline is not an abortion helpline but rather one which will inform a woman in crisis on all of her options, including access to counselling. Deputy Fitzpatrick is correct that access to counselling and support for a woman is important no matter what her decision. It is not for me or anyone else to judge that decision.
I substantially disagree with the Deputy on contraception. By its nature, contraception reduces pregnancy and, therefore, crisis pregnancy. It can play a major role in the reduction of crisis pregnancy rates. In 2019, we will increase the amount of barrier contraception available. I look forward to returning to the House with legislation to expand eligibility to free contraception for women. I have asked my Department to work on the preparation of clinical guidance in that regard. I hope that Members of this House, particularly those who do not support this legislation, will support the expansion of eligibility to free contraception to more women to reduce the number of crisis pregnancies.
I do not intend to accept the amendment, which is very similar to one tabled on Committee Stage. The reference to a DVD has been removed but it is otherwise very similar. The issue of consent is addressed-----
I accept that is also a difference. The issue of consent is addressed in section 23 which clearly sets out that the provisions of the Bill will operate within existing legal provisions. It has been repeatedly stated by some Members that consent does not exist on the Statute Book, but that is factually incorrect. The Non-Fatal Offences Against the Person Act 1997 deals with the issue of consent. I ask Members to refrain from stating that the issue of consent is not addressed in statute. It is dealt with in primary legislation passed by the Oireachtas. Some Deputies may have been Members of the Oireachtas which passed that legislation in 1997.
The proposers of the amendments are asking us to accept that abortion is so substantially different from all other healthcare situations that there must be extra legal obligations on doctors. My position is that the termination of pregnancy should be integrated in a modern healthcare system for women and that the same obligations should apply to doctors as would in any other healthcare situation. As I stated, informed consent is dealt with in the Medical Council Guide to Professional Conduct and Ethics for Registered Medical Practitioners, the Non-Fatal Offences Against the Person Act, and the HSE national consent policy. Although I do not question the bona fides of its proposers, the amendment is unnecessary and it has no place in this legislation.
Reference has been made to abortion regret and the Women Hurt group. It was offered a slot at the Citizens' Assembly but allowed an American pro-life group to take its place. The Joint Committee on the Eighth Amendment of the Constitution, of which I was a member and all meetings of which I attended, heard from an expert on abortion regret, Dr. Abigail Aiken. There is no point having a committee and cross-party agreement on expert witnesses only for Members then to come to the House and disregard the information we were given. Dr. Aiken was asked some questions by Deputy Durkan. A slide on abortion regret, a term that had emerged, was on display. I asked if there was a correlation between the feelings one may have after a termination of pregnancy and those one may have after a miscarriage and for a comparative analysis in that regard. The expert doctor stated, "On abortion regret, the data in front of the Deputy is really the best data we have," and clarified how many women were consulted. She continued:
I think there are as many feelings after abortions as there are abortions because it is an individual and personal thing. However, looking at this graph, [which is available in the information presented by the committee] I do not see much evidence for an abortion regret. I know it is a term that is out there but it does not really exist in the medical literature. I have to emphasise that we really lack empirical evidence - real evidence.
That is real evidence, not anecdotes or fairy tales. She made it very clear that there is no empirical evidence for abortion regret. Deputy Mattie McGrath referred to published research which backs up what the women to whom he referred state about abortion regret. I would like to see that research. I am sure Dr. Aiken would also be keen to see it as it would change her position on the issue. If Members intend to rely on published data, let such data be put before the House.
Deputy Danny Healy-Rae referred to women being put away, and the issue of a perinatal hospice was raised. Like some of the amendments that have been proposed, that initially appears to be a great idea. I have three children. If I had a crisis pregnancy now, was six months pregnant and had an anencephalic baby, who would mind my three children? Where would I be incarcerated? Are we going to open a laundry for these women? Who would stay at home with my husband and three children? These are being put forth as good ideas but in practice they hark back to the 1950s, as Deputy Coppinger remarked.
On abortion regret, women may encounter complicated psychological issues during or after pregnancy or at any other stage in their lives. However, it is wrong to purport that it is a clinical condition and to create such ructions about it in the House. Those claiming that they have been vilified are the only ones using such terminology.
On the word count of 45,000 versus 50,000 as referred to by Deputy Tóibín, my understanding is that 66.4% of the people voted yes. The result of the referendum was not a confidence and supply arrangement. We live in a democracy.
Of course, we will listen to the voices of those opposed to this legislation. I have listened to the voices of such Members ad nauseam. However, we won. If the other side gets the support of 51% or more of the electorate, it will get its way, but we won in May and we will get our way. The Members may use their allotted time of seven minutes and two minutes to discuss published data, although I am unsure whether some would know one end of it from the other. However, they lost the referendum. That must hurt. We will get our way whether we have to sit till midnight tonight or tomorrow night.
To avoid any doubt, I must state we will not support amendment No. 46, based on its content. We do not want any association with it. It states, "Where it is intended to carry out a termination of pregnancy on a foetus who is twenty weeks' gestation or more, the medical practitioner intending to carry out the termination of pregnancy or another medical practitioner assisting him or her shall, orally and in person, offer information on foetal pain to the pregnant woman." Presumably, that will cover a case of a fatal foetal abnormality. I am sure it is not the intention of those sponsoring the amendment to be grossly offensive or hurtful but those affected are already suffering enough.
During a hearing of the committee on the eighth amendment, two lovely, dedicated representatives of Terminations for Medical Reasons shared their story with us. It was absolutely heartbreaking. The Deputies who have sponsored the amendment and call themselves pro-life - I call them anti-choice but one can call them anything one likes - did not turn up to hear from Terminations for Medical Reasons. It strikes me that if they had done so, they would not have included cruel references like what they propose, although perhaps they would.
Subsection (7) of the proposed new section states the Health Service Executive shall cause to be published in both printed and digital formats a document containing information as to "public and private agencies". We have already had discussions about the private agencies. I refer to the lovely people who talk about the non-existent link between abortion and breast cancer and other forms of cancer. I am very disturbed by the content of the amendments but I do not believe they are being tabled to allow for any kind of reasoned debate. They are being tabled just to give certain Members an opportunity to make what I, as a woman, would consider to be very offensive statements, such as the statement that a woman would have an abortion because she simply does not know about the supports available to her. She can, of course, find out. The idea that the lads will be riding in on their white horses to support all these women and the idea that they somehow call this amendment a pro-choice amendment are a little laughable. I do not believe anybody is really fooled by that. The intention is to highlight the shame, judgment and all the other things that go along with this. That is how I feel when I read the amendment as a woman. I find it grossly offensive. I sincerely hope that is not the intention of the amendment's sponsors.
It is very sad that it is being proposed to put a family facing a diagnosis of a fatal foetal abnormality through further hoops. It is very hurtful to them. If the Members supporting the amendments had engaged with them, they might have paused for thought before submitting them.
Subsection (7)(b) of the new section proposed in amendment No. 46 refers to information that should be offered to any woman who is given a diagnosis of a life-limiting condition for her son or daughter. This is a particularly important subsection as we have all heard many stories of parents who received a heart-breaking diagnosis indicating their child might not live long. One horrifyingly common theme ran through many of the emotional testimonies shared by parents who chose termination and parents who chose life. Most of those parents repeated their experience of being told by a doctor in Ireland that their child had a serious condition and was likely to die and that many women in their situation chose to travel to the UK. Parents often report being left alone and heartbroken to process this news. Our doctors did not always ensure, as a matter of course, that the affected parents were informed about perinatal hospice care, palliative care, counselling services, support groups of parents who had received a similar diagnosis or the chance, however remote, that their child might live. These failings of professionals in Ireland to inform women and couples of all supports at an incredibly vulnerable time should break all our hearts and should be a clear reminder just why this amendment is so important to ensure all women and all parents receiving such a difficult diagnosis are given information on all supports available to them.
I hate talking about a Member who has left the Chamber. Every time she makes a famous statement, she runs out the door. I have no choice but to consider some of the issues she raised in her contribution. She was entitled to make it and I have to respect that but I want to explain to her the position on the fairy stories she spoke about last week when we spoke about the Canadian lady who had survived an abortion. The Deputy does not seem to have seen the video during the week about a lady who lives in Ireland who survived an abortion and how insulted she was on hearing her story described as a fairy story, and about how insulted tens of thousands of women right across the world would have been if they had heard their stories referred to as fairy stories. That is a shocking insult by Deputy O'Connell to women of this country who survived an abortion and horrific circumstances. For her to comment on her fellow women like that is appalling.
The consistency of some of the Deputies opposite is incredible. There is regularity, like a clock, in here. This is a very difficult debate on very difficult issues. That Members are calling people names, misrepresenting people and constantly slurring people is just incredible. I cannot believe some Deputies really accentuate the level of offence they find in every single word of these legislative measures, yet they are happy to stand in the national Parliament and dismiss abortion regret as a fairy story. It is breathtaking that offence can be experienced on only one side of this debate. It is unbelievable. I invite the Minister and Deputy O'Connell to come with me and meet women who have experienced abortion regret. That would be a really important exercise for both individuals so they might understand what those concerned are talking about.
Yesterday we were told the ethnicity reference was some kind of racist reference. The fact of the matter was that the British equality authority asked for ethnicity to be included when collecting information. The Guttmacher Institute, the research wing of Planned Parenthood, seeks for research to be carried out on the basis of ethnicity for quality reasons, yet the word "ethnicity" was bandied about yesterday like some kind of trigger word. I actually do not believe the Members here feel the offence they are speaking of, and they do not have any interest in debating with us. What they are looking for are Twitter hits. They are seeking to ratchet up their offence levels so they can in some way appeal to their gallery elsewhere in this debate. They are also seeking to censor Members here. The subtext is, "Conform, conform, conform and make sure you do not disagree with us because if we disagree with you we will seek to shame you on the basis of the language you use."
Information is an entity that provides answers. It is an entity that resolves uncertainty. The Deputies are so maximalist in the demand for abortion access that even information should not be allowed at this stage on the grounds that it might be a barrier to the choice to have an abortion. My amendment asks only for the information to be offered. In one question, it can be declined or accepted.
I wish to speak briefly on the amendment itself. I have not made many contributions on Report Stage but believe it is important that we try to speak to the amendments and keep our focus on what we are doing here, namely legislating for the will of the people, as expressed in May. The issue of abortion regret was discussed at the committee hearings and evidence was presented. The majority of the evidence — that is, evidence that is clinical — shows the majority of women who have had a termination believe it was the right decision.
I am definite that there are women who regret having had a termination. Equally, I know many women who regret having to go to Birmingham or Liverpool to have a termination or who, because they faced a crisis pregnancy, had to take tablets without medical supervision. The point is that this amendment is trying to force-----
-----women and their clinicians into circumstances in which further shame and guilt are heaped on them. That is my reading of it based on my examination of how this would play out in surgeries across the country.
It should be borne in mind that the amendment reads "Except in a case of an immediate risk to the life, or of serious harm to the health, of the pregnant woman". The amendment concerns people who have been pregnant for less than 12 weeks. In the committee we also spoke about the fact that many women will have a termination early in the pregnancy for many reasons. I do not judge them, but there is a certain element in this amendment of judging women and casting aspersions on their decisions. Whatever the reasons they arrive at those decisions, they arrive at them.
We were very clear in the committee that this would be done in conjunction and in discussions with their GPs. We were very concerned that women should be able to go to their GPs, surgeries and local doctors and have these discussions. There are ethical obligations on GPs in the medical guidelines such that they must outline and discuss with a patient all the issues surrounding any treatment. That is already enshrined in basic medical ethics and has been a long-established practice.
I am only offering my opinion but, having listened to the evidence at the committee and perused a lot of evidence outside the committee, most women, after having a termination, still believe it was the right decision for them at the time. Some women will regret having a termination. Equally, some women will regret for many reasons having got pregnant in the first place but they feel they must have a termination for whatever reason. This concerns pregnancies of up to 12 weeks' gestation only, and the idea that one must talk about the physiological and anatomical characteristics and size of the foetus etc. is, in my view, again an effort to shame women and hurt them more in advance of a decision they do not arrive at lightly.
The Minister constantly says he wants clarity for doctors in the law. Despite this, he has rejected amendments from pro-life Deputies as not necessary in primary legislation, saying these matters can be dealt with through guidelines etc. This is a contradictory stance. Either we give doctors clarity in the Bill, as the Minister keeps insisting, or we do not. This amendment ensures that women would be given information on relevant matters, including the risks of the relevant abortion methods, the risks of carrying the child to term, alternatives to abortion and supports available to assist them. I will repeat what I said about supports. There is nothing in the Bill about providing an alternative to abortion in the form of additional counselling or financial supports. We had five years of discussions. Women need to know that supports are available. The Minister keeps using the word "clarity". Women need clarity, and supports should be provided for in the Bill.
I mentioned abortion rates in the UK earlier. They have gone through the roof. There have been 8 million abortions since 1967, and 20% of all recorded pregnancies are aborted. The Minister talks about contraceptive pills. Contraceptive pills have been free in the UK for decades. Does the Minister think the experience in Ireland will somehow be different? Given these statistics, will the Minister explain to me why he thinks the contraceptive pill will sort this problem out? Women need clarity on supports. Doctors need clarity.
I cannot understand why there is such objection to this amendment we are putting before the Minister for inclusion in the Bill. I see nothing wrong with it whatsoever if, by giving information to a woman or a girl, one baby will be saved. I cannot see what is wrong with that. All kinds of advertisements, advice and information are available. Why not ensure that this information is available to women in the hope we might save a life or many lives? Why must abortion be the only choice? I hear what the other Deputies are saying, and they are entitled to their views, but I am entitled to my view. What is wrong with ensuring we might save a life or a number of lives? Whether it is four, six, 12 or 22 weeks, if the baby got a chance and was allowed to arrive into the world naturally, the hope would be that he or she would live out a full life like we are trying to do today. However, if it is the case that we deny all the information and do not give the woman the options-----
-----what is she going to do only have an abortion?
Women in such a state can have dark days and down days, but what if the information and supports were given to them? What if advice were given to them as to the supports available, the things they could have or the other roads they could go down? There are so many advertisements here about smoking, road safety, mental health and suicide prevention, and this could be a part of it. After having aborted a child, we know for a fact that women become very upset and suicidal. No one can deny that because I have learned it from people who had abortions themselves. What is so wrong about saving one life or a couple of lives? I say to the Minister and any other Deputy who is trying to say otherwise that I do not see anything at all wrong with it.
I made a number of points earlier but ran out of time. I made them very honestly. I had done my research and I have my evidence. It is not makey-up evidence. For the reasons I gave and others, it is vital we have robust protections with informed consent and do all we can to ensure that the consent is real, genuine and based on the best available evidence.
Deputy O'Reilly mentioned that we are sitting until midnight tonight. I did not think the House had amended its sitting times. It is amazing how some people know these things. I do not think we have passed any vote here-----
Deputy O'Connell, who has since left, talked about Abigail Aiken, who appeared before the committee. Yes, she is an expert. I am not questioning her expertise on this but I am questioning her bias coming before us and the abject refusal to allow women hurt by abortion before the committee, to listen to them or to watch an animated video of an abortion. There was just a closing of eyes and a locking out of the whole situation. The term "makey-up" is out there now. Deputies still will not get away from the term "makey-up" when talking about abortion regret. Abortion regret is more than a term. It is well known. If Deputy O'Connell chose to do so, she would meet plenty of women who have experienced it. There are many of them. I refer to the videos that went around at the weekend and the one brave woman out there. Deputy O'Connell said we had no empirical evidence. We have plenty of published evidence. It is there to be seen if she chooses to look at it, but no, she would get no headlines out of that.
As for the language used, the question was asked where we are going to incarcerate the woman. We are not talking about incarcerating anyone. There is no mention of it. We are talking about looking after people who are ill and avoiding mental health issues. Trying to go back to such language, as I said last night, is an effort to be as wicked as possible to get headlines.
I could say the same for the committee. The Deputies who are constantly attacking, name-calling and so on were on the winning side. Where is the aggression and the anger coming from, and why?
It is our democratic right. We hold a different view and so do 723,000 people in our society. It is our right as democratically elected representatives to put forward other views, make sure the legislation is done properly and that it is not as extreme and harsh as it is. Our concern is that it is over the top in being extreme and harsh. I know time will prove that and prove it to the Minister. He might not see it now but he will have questions to answer in the future. Let it be, because he does not want to listen to any other view.
This amendment that we put forward seeks to ensure that before a woman makes any final decision, she is fully informed, because the decision she makes can be a life-changing one. We are all aware and can appreciate that it is a very serious decision to make, given that it brings about the end to life of the unborn child. That is a point that needs to be made here again. This is all being treated in such a casual manner, with the whole life of an unborn child, which is about to end, being dismissed. It is pertinent that women are made aware of the supports available and also of other options that could be pursued if they wished to pursue them.
Abortion should never be the only option made available to any woman. Women should not feel pressurised into having an abortion. It is vital, therefore, that women are fully informed when comes to such a decision. It appears that this House, and indeed the Minister, wants to push abortion. He wants push it as hard as he can and hopes it is taken up by as many as possible. As a woman, I find that disgusting.
Bobby Aylward, Maria Bailey, Mick Barry, John Brassil, Declan Breathnach, Tommy Broughan, Richard Bruton, Peter Burke, Mary Butler, Catherine Byrne, Jackie Cahill, Joe Carey, Pat Casey, Lisa Chambers, Catherine Connolly, David Cullinane, Michael D'Arcy, Clare Daly, Regina Doherty, Stephen Donnelly, Paschal Donohoe, Timmy Dooley, Andrew Doyle, Bernard Durkan, Dessie Ellis, Damien English, Frances Fitzgerald, Simon Harris, Seán Haughey, Séamus Healy, Martin Heydon, Brendan Howlin, Heather Humphreys, Billy Kelleher, Gino Kenny, Seán Kyne, Marc MacSharry, Josepha Madigan, Michael McGrath, John McGuinness, Joe McHugh, Tony McLoughlin, Mary Mitchell O'Connor, Margaret Murphy O'Mahony, Catherine Murphy, Eoghan Murphy, Paul Murphy, Hildegarde Naughton, Tom Neville, Michael Noonan, Darragh O'Brien, Jonathan O'Brien, Jim O'Callaghan, Kate O'Connell, Fergus O'Dowd, Fiona O'Loughlin, Louise O'Reilly, Frank O'Rourke, Jan O'Sullivan, Maureen O'Sullivan, Eoin Ó Broin, Caoimhghín Ó Caoláin, Éamon Ó Cuív, Donnchadh Ó Laoghaire, Aengus Ó Snodaigh, Thomas Pringle, Maurice Quinlivan, Shane Ross, Eamon Ryan, Eamon Scanlon, Róisín Shortall, Bríd Smith, Robert Troy, Leo Varadkar, Mick Wallace.
I move amendment No. 46a:
In page 15, to delete lines 32 to 34 and substitute the following:“Information
23. (1) Except in a case of an immediate risk to the life, or of serious harm to the health, of the pregnant woman, where it is immediately necessary to carry out the termination of pregnancy in order to avert that risk, no termination of pregnancy shall be carried out without the offer of information to the pregnant woman.
(2) Consent to a termination of pregnancy is voluntary if and only if the medical practitioner who is to perform the termination of pregnancy or another medical practitioner assisting him or her—
(a) has offered the pregnant woman, orally and in person, information on the following:(i) medically accurate information that a reasonable patient in the position of the pregnant woman would consider material to the decision of whether or not to undergo the termination of pregnancy, including:(b) in the case of a pregnant woman intending to avail of a termination of pregnancy in accordance with section 13, has offered the pregnant woman in person a printed copy of the document referred to in subsection (7),(I) the proposed termination of pregnancy method;(ii) the probable gestational age of the foetus at the time the termination of pregnancy is to be performed; and
(II) the immediate and long-term medical risks associated with the proposed termination of pregnancy method;
(III) the medical risks associated with carrying her child to full term; and
(IV) alternatives to the termination of pregnancy;
(iii) the probable anatomical and physiological characteristics of the foetus at the time the abortion is to be performed,
(c) in the case of a pregnant woman intending to avail of a termination of pregnancy in accordance with section 11 or 14, has offered the pregnant woman in person a printed copy of the document referred to in subsection (8), and
(d) in the case of a pregnant woman who expresses a wish to receive the information contained in either of the documents referred to in paragraph (b) or (c) respectively but is unable to read the said document, has conveyed the said information to the woman in an appropriate alternative manner.(3) Where it is intended to carry out a termination of pregnancy on a foetus who is twenty weeks’ gestation or more, the medical practitioner intending to carry out the termination of pregnancy or another medical practitioner assisting him or her shall, orally and in person, offer information on foetal pain to the pregnant woman.
(4) The information offered in accordance with subsection (3) shall include, but shall not be limited to, the following:
(a) that maternal anesthesia typically offers little pain prevention for the foetus; and
(b) that an anesthetic or analgesic is available in order to minimize and/or alleviate pain to the foetus.
(5) Where it is intended that a termination of pregnancy be performed using abortioninducing drugs, the person who supplies the drugs to the woman intending to have the termination of pregnancy shall, orally and in person, inform the woman of the following:
(a) that it may be possible to reverse the effects of the abortion-inducing drugs should she change her mind, but that time is of the essence; and
(b) that information on reversing the effects of abortion-inducing drugs is available in the document referred to in subsection (8).
(6) For the purposes of this section, the phrase “abortion-inducing drugs” means a medicine, drug, or any other substance prescribed or dispensed with the intent of terminating the clinically diagnosable pregnancy of a woman, with knowledge that the termination will with reasonable likelihood end the life of the foetus, other than drugs that may cause such a termination, but which are prescribed for other medical indication.
(7) The Health Service Executive shall cause to be published in both printed and digital formats a document containing information as to—
(a) available medical and nursing assistance and care, including neonatal palliative care,
(b) available social and counselling supports and services, and
(c) contact details for public and private agencies and services,
which may be of relevance and practical assistance for a pregnant woman in a case where a foetus has a condition referred to in section 13, including a pregnant woman who does not wish to avail of a termination of pregnancy in accordance with section 13.
(8) The Health Service Executive shall cause to be published in both printed and digital formats a document containing information as to—
(a) public and private agencies and services available to assist a pregnant woman through pregnancy, upon childbirth, and while her child is dependent,
(b) information as to available medical assistance, supports and benefits for prenatal care, childbirth, and neonatal care,
(c) information on the support obligations of the father of a child who is born, and
(d) the information referred to in subsection (5)(a) and subsection 5(b).
(9) The Health Service Executive shall develop and maintain an internet website, which may be part of an existing website, on which the information referred to in subsections (7) and (8) can be viewed and from which the documents referred to in subsections (7) and (8) respectively can be obtained.
(10) The document referred to in subsection (8) shall also include the following statement:
There are many public and private agencies willing and able to help you to carry your child to term, and to assist you and your child after your child is born, whether you choose to keep your child or to place her or him for adoption. The law requires that your health care professional give you the opportunity to call agencies like these before you undergo a termination of pregnancy.
(11) Nothing in this Act shall operate to create an entitlement by a pregnant woman under the age of eighteen years to consent to medical treatment.
(12) A medical practitioner who carries out a termination of pregnancy in accordance with section 11 shall certify in writing in addition to the matters referred to in section 11(1):
(a) the nature of the medical emergency; and
(b) in cases where the offer of information to the pregnant woman concerned was not made, the reason for it not having been made.
(13) The failure to comply with the requirements of this section shall provide the basis for:
(a) a civil action for damages (including aggravated and exemplary damages) by the woman concerned for breach of statutory duty;
(b) professional disciplinary action against the health professional concerned.
(14) In any matter referred to in subsection (12) the court shall, upon application by the woman concerned or of its own motion, allow a woman to proceed using solely her initials or a pseudonym and may make such other protective orders as it considers necessary and appropriate to preserve the privacy of the woman concerned.”.
Bobby Aylward, John Brassil, Declan Breathnach, Mary Butler, Jackie Cahill, Seán Canney, Michael Collins, Michael Fitzmaurice, Peter Fitzpatrick, Seán Haughey, Danny Healy-Rae, Michael Healy-Rae, Michael Lowry, Marc MacSharry, Mattie McGrath, John McGuinness, Carol Nolan, Frank O'Rourke, Éamon Ó Cuív, Eamon Scanlon, Peadar Tóibín.
Maria Bailey, Mick Barry, Tommy Broughan, Richard Bruton, Peter Burke, Catherine Byrne, Joe Carey, Lisa Chambers, Catherine Connolly, Simon Coveney, David Cullinane, Michael D'Arcy, Clare Daly, Regina Doherty, Stephen Donnelly, Paschal Donohoe, Timmy Dooley, Andrew Doyle, Bernard Durkan, Dessie Ellis, Damien English, Frances Fitzgerald, Simon Harris, Séamus Healy, Martin Heydon, Brendan Howlin, Heather Humphreys, Billy Kelleher, Gino Kenny, Seán Kyne, Josepha Madigan, Michael McGrath, Joe McHugh, Tony McLoughlin, Mary Mitchell O'Connor, Margaret Murphy O'Mahony, Catherine Murphy, Eoghan Murphy, Paul Murphy, Hildegarde Naughton, Tom Neville, Michael Noonan, Darragh O'Brien, Jonathan O'Brien, Jim O'Callaghan, Kate O'Connell, Fergus O'Dowd, Fiona O'Loughlin, Louise O'Reilly, Jan O'Sullivan, Maureen O'Sullivan, Eoin Ó Broin, Caoimhghín Ó Caoláin, Donnchadh Ó Laoghaire, Aengus Ó Snodaigh, Thomas Pringle, Maurice Quinlivan, Shane Ross, Eamon Ryan, Róisín Shortall, Bríd Smith, Robert Troy, Leo Varadkar, Mick Wallace.
Deputies, please. There are some people who want to do work.
Amendments Nos. 47 to 49, inclusive, and 52 to 55, inclusive, are related. Amendments Nos. 48 and 49 are physical alternatives to amendment No. 47. Amendments Nos. 47 to 49, inclusive, and 52 to 55, inclusive, will be discussed together.
I move amendment No. 47:
In page 15 and 16, to delete lines 36 and 37 on page 15, and on page 16, to delete lines 1 and 2 and substitute the following:“24. (1) A medical practitioner, nurse or midwife shall not be obliged to carry out or to participate in carrying out a termination of pregnancy in accordance with section 11, 13 or 14 to which he or she has a conscientious objection.”.
This is about people in the medical profession who have a difficulty. They want to carry out their functions, but if they have a conscientious objection to participating in a termination and they are forced to do so or to make a referral, then one is as bad as the other. I have visited hospitals in recent days and met people who have been at the coalface working in maternity wards for many years. They are genuinely concerned about what will happen to them and their jobs when this legislation is passed. We must think of these people. I do not know of people in any other sector in society who could have a conscientious objection on an issue and still be forced to participate in something that they did not want to do.
Of all the amendments that are being tabled, this is one that Deputies should consider. They should think of the people involved and who have come out and spoken. More than 500 nurses and midwives working in maternity services have signed a petition calling for this amendment to be examined closely and supported by Deputies, who should take in account their views when voting.
That is all I wanted to say. I will leave five minutes for the people who are accusing us of doing something we are not.
As a practising pharmacist and healthcare professional, I believe that if a person wants to opt out, he or has has the conscientious right to do so. I will break my contribution into three parts.
I will deal, first, with the pharmacy issue. I know that the Minister is very well aware of the duties and responsibilities of a pharmacist. Dispensing drugs is not like handing out chips in a chip shop; rather, it is an issue of professional responsibility, particularly in hospitals. I am informed that the drug potassium chloride may be needed at a later stage during pregnancy. As it is highly toxic, it is highly controlled in its prescription, dispensing and administration to avoid inadvertent toxicity or death. The role of the pharmacist in its dispensing, if it is to be used in an abortion, is extremely important and we really need to establish whether pharmacists can exclude themselves from the process. I, therefore, ask for clarification on the issue. On Committee Stage the Minister referred to the code of conduct of the Pharmaceutical Society of Ireland, PSI. Unfortunately, to my knowledge, the code does not explicitly mention freedom of conscience or conscientious objection for pharmacists. Therefore, I would really like to receive clarification on the issue. If further legislation is needed to protect pharmacists - I believe they deserve protection - it needs to be progressed immediately.
The legislation states a doctor shall make such arrangements as may be necessary for the transfer of care of a pregnant woman to enable her to avail of a termination. What exactly does that mean? I would like to receive a specific explanation on the floor of the Dáil. Some doctors might regard the giving of the number of a helpline as not including them in the process, while others would. If those doctors deem it to be against their beliefs and judgment, they should be protected and not subject to a legal challenge. They deserve to be protected. The same goes for midwives.
I want to refer to a few scenarios because this issue is worrying. The majority of abortions will be carried out with the use of an abortifacient, a pill which consists of Mifepristone and Misoprostol. The research tells me that the earlier the drug is given, the more effective it is. It is 98% effective in the first eight weeks, 96% effective between eight and nine weeks and 93% effective from nine to ten weeks on; therefore, it is not 100% effective. A situation may arise where somebody in the ninth or tenth week of pregnancy avails of this tablet or a set of tablets and they do not work. She then enters the next scenario because up to nine weeks, she will be dealt with at GP level, but between nine and 12 weeks, she will avail of a different route. I am concerned that some woman in seeking to avail of an abortion service will move from the GP service to the hospital setting. I will use County Kerry as an example. Is the service in County Kerry set up for this? Are there enough obstetricians in the county opting in because if there are not, we have a situation that we need to deal with? I would hate for a situation to develop where somebody seeking a termination starts the process before 12 weeks but cannot have a termination before 12 weeks expire. The last thing we want to do is bring about a situation where somebody will finish up in tragic circumstances, as happened when the eighth amendment was in place, and a new debate erupts. It is extremely important that we receive clarification on the issues raised. I firmly believe that if a healthcare professional wants to opt out of the process, he or she should be allowed to do so without fear of a legislative or legal challenge.
Among some elements in the House, there is a rush to get this legislation over the line. There is an old saying - "act in haste, repent at leisure". I do not want to see a situation develop where somebody seeking a termination will finish up in a scenario similar to those that developed after the introduction of the eighth amendment into the Constitution. We need to know how many doctors, hospital obstetricians and midwives are available to take part and whether all 11 hospitals that provide pregnancy care are suitable to take on this role.
The drug mentioned is to be provided by a doctor. Right now most doctors do not have the facility to order it. They must use the pharmacy. They do not have licences or contracts with manufacturers. Today is 5 December. If this legislation is to be in place by 1 January, we are really beginning to push things out.
I add my voice in support of the amendment. This legislation is flawed. On the issue of conscientious objection, it is a real ask of the medical professionals to whom I have spoken, be they nurses, pharmacists, midwives, obstetricians or clinicians. When they qualified, they took an oath to protect life - in this case, the lives of the mother and the unborn child. If they want to opt out of providing this service, they should be given that right. I do not think that, as legislators, we or this House should force anyone to go against his or her morals, ethos or beliefs. That is what we are doing in enforcing this provision. I, therefore, ask the Minister and the Government to reconsider. Nobody should be forced to do something he or she does not want to do.
Last week I received a telephone call from an obstetrician in St. Luke's General Hospital in Kilkenny. He told me that a vote had been taken in the hospital and that two obstetricians, four clinicians and 82 nurses had said they did not want to take part in any act connected with abortion. We should respect their decisions. If a woman presents for an abortion in St. Luke's General Hospital, is it safely guaranteed if that number of individuals object to taking to part in the process and is it morally right to force them to take part in it? I was told by the same obstetrician that a vote had also been taken in two other hospitals. He named them, but I will not do so here because it is up to them to talk about the matter. The obstetrician told me that the results were the same. It is morally wrong. We all know that the proposal that the eighth amendment be deleted from the Constitution was passed by the people and we must respect that decision.
Conscientious objection is something we must take on board. Each person, male or female, should be given that right. I ask the Minister and legislators in this House to consider this and not to force people to do something they do not want to do, that is against their principles, and that they believe is against their oath, morals and ethical beliefs. I ask that to be taken on board here. I, for one, could not support that.
A group of more than 640 GPs have signed a petition seeking conscientious objection. Over the weekend, up to half a meeting of doctors in an emergency general meeting walked out, leaving the meeting in disarray.
Hundreds of GPs on the ground do not believe that general practice is the appropriate setting in which to deliver abortion services for many reasons, not least because of the lack of capacity in an area that is already overstretched, the lack of training for what is involved and the lack of availability of ultrasound. There is also the very serious issue of delivering genuine freedom of conscience, protecting doctors who do not want to get involved in this.
How this has happened is mind-blowing. The first that GPs heard about abortions being GP led was when the Minister announced it on radio. That is the first time these GPs stated they heard of it. From that day to this, this group of GPs has never once had a chance to discuss the matter with the Minister. He is imposing abortion on that particular sector.
Despite requests from pharmacists' representative bodies, the Irish Pharmacy Union and the Hospital Pharmacist Association of Ireland, there has been no engagement with the Minister for pharmacists who have conscientious objections.
It is also important to realise that more than 500 nurses and midwives on the Nursing and Midwifery Board of Ireland, NMBI, register have signed a petition to call on the Minister to protect freedom of conscience and support the amendments relating to it. Nurses and Midwives for Life Ireland has claimed the Minister, Deputy Harris, and the leader of Fianna Fáil, Deputy Micheál Martin, have refused to meet them to discuss their concerns with conscientious objection legislation. If the Minister were to introduce a Bill on hedge cutting, he would take about a year's worth of consultation within that sector before he brought the legislation through. It is phenomenal. For such a Bill, the stakeholders of that particular sector would be consulted for a year and yet these doctors, nurses and pharmacists have all been denied access to discuss directly with the Minister the issues that they have. These are the people on whose shoulders the health service sits. These are the people who are filling the gaps created by the disastrous funding in the health service at the moment. Despite this, the Minister, who has spoken about little else in the past two years, is pointing to them and asking them to take the weight on this particular issue.
I spoke to a few of those nurses and midwives and they told me a values clarification workshop is being rolled out in the hospitals, asking the nurses and midwives to reassess their own particular values with regard to the introduction of this service. There is an Orwellian feeling around this, when we are going to people who studied, strove and worked to protect and save life to reassess and re-evaluate their values on such an important issue.
The Minister has been a unifier in many ways. There are 750,000 people on hospital waiting lists, 10,000 people on hospital trolleys last month, 2,500 children waiting over a year for their first mental health appointment and now the people working in that sector are also being attacked by the Minister. He was on the radio today and said that these people had conscientious obstruction, not conscientious objection.
It is incredible that the people who are working in the health service, who want to do a day's work, save and protect people, are being attacked in such a manner.
This is a terrible accusation to level at a doctor or nurse as they seek to defend a conscientious objection and we have to remind ourselves of the import of what they are being asked to do. The Bill states that termination of pregnancy is the ending of a life of a foetus. It shocks me that we have not had that level of consultation at all. If something is built without that level of consultation, I guarantee there will be problems in it. The purpose of consultation is to iron out the difficulties that could arise in future.
I know the Minister is hungry to get this through. He has probably staked a bit of his reputation on the timescale of this being pushed through. This is surely more important than the reputation of a Minister and whether it happens on 1 January or 1 February. Surely the outcomes and potential pitfalls are the important issues that we, as Deputies, should be focusing on.
This amendment that we seek to provide here reframes the Bill so that there is a positive and substantive protection for the freedom of conscience. The current section 24(1) states that nothing in this Bill obliges a doctor, nurse or midwife to participate in carrying out a termination under sections 11, 13 or 14. However, it leaves a significant gap in the protection of those people because it merely says the Bill itself does not force doctors, nurses or midwives to participate. It therefore does not prevent the imposition of such a compulsion by an employer, a professional body or even an individual seeking to get promoted, or get through a particular piece of work. Accordingly, the amendment that we have tabled fills that particular gap.
The Minister should never say we do not listen to him because we do. The way we have framed this amendment is by using the direct words he used at the Committee on Health. He said that what he wants to see this level of protection for doctors, nurses and midwives included in the Bill. We decided that, rather than go for the yellow pack conscientious objection that exists in the Bill, we would lift the Minister's words from the blacks of the committee, put them into the amendment and slot them into the Bill itself.
I will tell the Minister one thing. This is the most dangerous aspect of the implementation of his Bill. As a number of other Deputies have stated here, there are a large number of healthcare professionals who will not implement this as laid out. They will refuse to implement it. The problem here is that the abortion service that the Minister seeks to provide will be as chaotic as the health service over which he presides.
I would be the first to recognise the rights of people with a conscientious objection. We have always recognised that, through the debate that took place a year ago in the Joint Committee on the Eighth Amendment of the Constitution and the debate that took place in the health committee a week or ten days ago, and I think we have all listened carefully and sympathetically.
Unfortunately, I received an email the other day to the effect that I was being accused of turning a deaf ear to expressions of concern from pharmacists and doctors. That is not the case. I would be the first to recognise their rights.
We need to recognise something else, including Deputy Tóibín, who is now leaving. We need to recognise that the women in a crisis pregnancy also have rights. In the event of a woman in a crisis presenting at a particular time, as has happened in the not-too-distant past, and a decision has to be made as to whether that woman is entitled to the provision of services as envisaged under the heads of the Bill that were published before the referendum, what do we say to that woman? What do we say to her family? Do we apologise, and tell them nobody is around to provide the services that she now requires? Do we say we are sorry that she has a terminal illness and tell her we cannot do anything about it, nor advise her where to go?
I presume that people with genuine conscientious objections will recognise that, in those circumstances, the hippocratic oath prevails and that woman has a right to the provision of services to support her life as well. It is very simple. We need to put ourselves in the position of that woman.
Incidentally, the very interesting coroner's report in the Savita Halappanavar case goes into great detail in setting out the exact circumstances as they unfolded. The members of last year's committee will remember this. I know the Minister has committed to recognising and acknowledging the rights of people who have conscientious objections.
All of that being said, there must be somebody somewhere who will provide these services, as envisaged and approved by the people when they voted with the heads of the Bill on the horizon. What do we do? Do we say to women who may find themselves in a crisis that we are very sorry, but there is a little problem and we cannot help them? I sincerely hope nobody intends that this will occur. I sincerely hope we do not have a repeat of that kind of situation, which we have had in the past. I sincerely hope there is a general recognition that a woman who has a crisis pregnancy needs to find some solace somewhere and should be guaranteed to get services. Somebody should refer her to a place where she can avail of the services she requires. We must remember that any pre-existing conditions she may have, like high blood pressure or diabetes, will be at the back of her mind. The clock turns very quickly in such circumstances. Within a very short period of time, it may be too late for her, and for everybody else as well.
We all have to examine our consciences in this respect. We have to acknowledge the rights of people with a conscientious objection and provide for those rights. We also have to acknowledge the rights of the people of this country who voted in the clear knowledge that certain legislation would be passed. It was not by a hair's breadth or a narrow majority that they approved the referendum proposal. It was a clear decision. It can be presumed that the people who voted knew what they were voting about. I hope we can justify the confidence they expressed in us when they made their decision by making provision to allow for conscientious objection while also making adequate provision to ensure women in these circumstances are not ignored.
There are quite a few amendments in this grouping. I want to try to deal with a number of issues. I noted the comments that were made yesterday by Dr. Peter Boylan, who is a former chairman of the Institute of Obstetricians and Gynaecologists and a former master of the National Maternity Hospital. Along with the HSE, I appointed Dr. Boylan to lead the roll-out of these services. As Dr. Boylan pointed out on national radio yesterday, his view is that many doctors are ready and willing to provide this service. I share that view. While all the media attention at the weekend was on the minority of doctors who walked out of a meeting they had sought, the overwhelming majority of doctors stayed in the room, asked questions and worked their way through it.
I note that many of the doctors who are now leading the charge on some of the issues referenced by Deputy Tóibín were among those who led the No campaign, and that is fine. It is not a criticism; it is just a fact. They do not want abortion in this country because they do not support it. That is their right as citizens. I will defend forever the right of a doctor or healthcare professional to object conscientiously, but I will not stand over conscientious obstruction. I have spoken about the fundamental difference between the two. It is beyond doubt that every medical professional has the right to object conscientiously.
I do not think there is anybody in this House who disagrees with that. Are we going to continue to talk about conscientious objection as if we had a referendum on doctors? We had a referendum on women and on women's healthcare. Maybe we should actually think about the woman. Are we going to have a situation in which a woman who has been raped turns up at her doctor's surgery and is shown the door, given the cold shoulder and told "out you go"?
Despite the Deputy's best efforts, we have moved very far away from that in Ireland, thankfully. I am very proud of that.
I would like to be very clear in response to the legitimate questions that have been asked by people right across this House, including Deputies Aylward and Brassil. The law on abortion is changing, thankfully. The law on conscientious objection is not changing. Deputy Brassil asked me for clarification on the wording that is being used in relation to the transfer of care, etc. It is the same wording that was used in the Protection of Life During Pregnancy Act 2013. When wording like this is put into legislation, the Medical Council, as the regulator, transposes it into guidelines based on how it interprets it. Doctors are not regulated by me, by the Government or by the Oireachtas, but by the Medical Council. I referred at the committee on many occasions to page 35 of the Guide to Professional Conduct and Ethics for Registered Medical Practitioners, which defines what conscientious objection is and what the obligation is. It reads:
You may refuse to provide or to take part in the provision of lawful treatments or forms of care which conflict with your sincerely held ethical or moral values. If you have a conscientious objection to a treatment or form of care, you should inform patients, colleagues and your employer as early as possible. When discussing these issues with patients, you should be sensitive and considerate so as to minimise any distress your decision may cause. You should make sure that patients’ care is not interrupted and their access to care is not impeded. If you hold a conscientious objection to a treatment, you must:- inform the patient that they have a right to seek treatment from another doctor; and
- give the patient enough information to enable them to transfer to another doctor to get the treatment they want.If the patient is unable to arrange their own transfer of care [perhaps he or she is unconscious], you should make these arrangements on their behalf. In an emergency, you must make your patient’s care a priority and give necessary treatment.
That is what conscientious objection is. It is not the convoluted thing that some people have tried to make it out to be.
We have gone further by providing for a helpline that will be staffed by healthcare professionals 24 hours a day, seven days a week. Here is another bit of interesting information. Women do not want to be going from doctor to doctor as they try to find someone to help them. As functioning intelligent people, they would like to be able to pick up the phone or go on the Internet and find out where they can legally access legal and safe healthcare services in this country. The 24-7 helpline will provide non-directional information and will signpost in a way that significantly lessens the situations in which doctors will find themselves and, much more importantly, the crisis situations in which women will find themselves.
Two amendments in this group are in my name. As Deputies will be aware, I am defending the right of conscientious objection for doctors, nurses, midwives, student doctors, student nurses and student midwives. Student doctors were already covered because they are registered with their council. I am proposing amendments Nos. 52 and 53 to be absolutely certain that student nurses and student midwives also have a right to conscientious objection.
Deputy Brassil raised some issues with regard to pharmacists. As a pharmacist, he is very well informed on all of these issues. I remind the House that the code of conduct for pharmacists provides that "in instances where they are unable to provide prescribed medicines or pharmacy services to a patient they must take reasonable action to ensure these medicines/services are provided and the patient’s care is not jeopardised". The Pharmaceutical Society of Ireland, which regulates pharmacists, put information about the referendum that was held in May on its website to outline how its statutory code of conduct for pharmacists will work in this regard.
Can we dismiss the idea that I do not interact with GPs? Deputies do not have to take my word for it. Perhaps they will take the word of the clinical director of the Irish College of General Practitioners who debunked that myth on RTÉ's "Morning Ireland". I have met representatives of the college on several occasions to discuss this issue. Deputy Tóibín is right when he says I have not met individual groups of doctors who have different views on these matters.
I have met representatives of the training college that trains our GPs. I think that is what my responsibility as a Minister is.
I want to make it clear that conscientious objection is a long-established and important principle in this country. I will defend the right of a healthcare professional to object conscientiously and I would expect an overwhelming majority of Members of this House to do likewise. I will also defend to the death the right of a woman to access healthcare in our country. We need to make sure those two rights do not trump each other. Under the system of conscientious objection we are providing for, those who opt out will need to provide information. We are setting up a 24-7 helpline to help them to do that. This is reasonable. There are some people who want to stymie and delay it and prevent it from coming in. They are going to throw the kitchen sink at their efforts to prevent this from happening. Conscientious objection is fully respected. Conscientious obstruction of the democratic will of the people and of healthcare for women will never be tolerated.
The Minister has quite usefully read the pharmacists' guidelines from the Pharmaceutical Society of Ireland. Like Deputy Brassil, I am a registered pharmacist. I would like to explain the normal procedures for GPs getting medication into their surgeries. It is normally done by means of stock-order dispensing from a pharmacy of the GP's choice. This should not arise, in the sense that the arrangement will be there.
If for some reason a doctor who wants to conscientiously provide for a termination of pregnancy encounters a dispensing chemist who will not do it, there are plenty of others to go to. Therefore, I do not see it arising.
With reference to the hospital pharmacist's role, in practice misoprostol has been used for years in the dilation and curettage process after miscarriage. I understand a licensed drug has come on the market in the past week.
On supply issues, if a company has sought a licence for a drug, it is more than likely that in the interests of the bottom line it will have it on the market. Therefore, I do not see it as a concern. As the Minister said, it is about access to termination of pregnancy, not the denial of a service. It is about enabling doctors to act in the best interests of their patients, while also protecting themselves in the process.
There was some commentary about the Minister not meeting stakeholders. The stakeholders are the women of Ireland, all 52% of us, and the men in our lives. The Minister engaged and showed great leadership on that front. I do not believe the comments about his reputation. It has never been to the fore. If it was the case, it would have been easier for him not to have done this.
Comments were made about the service being GP-led. It came directly from the committee, nowhere else. I speak as one member of the committee. It was done in order that there would be no targeting of abortion clinics, as happens in other jurisdictions. Instead of copying the methods of other jurisdictions, we set out to have an Irish method - a bespoke method - that would be suitable for the year and which would apply the learning from processes in other countries. There is nothing rushed about it. Deputy Fitzgerald who is sitting beside me has reminded me that it has been 35 years. I doubt that she sees it as being rushed. I clarify and confirm what the Minister said. This is a change to the law on termination of pregnancy. There is no change to the law on conscientious objection. Many of the emails which many of us have received, some of which appeared to be very reasonable, are designed to obstruct because there is no need for the amendment.
I received a well worded tweet from a person who asked when conscientious objection was expanded to mean that only the consciences of the objectors were to be considered in preference to those of the rest of us. It is a very poignant way of putting the argument. As has been pointed out, the question of conscientious objection is dealt with in medical regulations. In including it in the Bill we would just be restating what is already in place. What is being inserted into the Bill is the requirement to refer onwards, but it is not worded in that way. It states, "shall, as soon as may be, make arrangements for the transfer of care of the pregnant woman concerned as may be necessary to enable the woman to avail of the termination". That could mean referring her to the 24/7 helpline.
It is absolutely essential if we are to give structure, legislation and rights to people following the repeal of the eighth amendment, that all women have access to the choice to terminate a pregnancy. That may mean a woman in an isolated rural village, a woman in a direct provision centre, a woman who does not have good command of the English language or a terrified young woman who has been raped. It could mean anyone. Anybody who paid attention to the deliberations of the Citizens' Assembly and the committee will remember the many hundreds of cases in which a woman or girl may have sought an abortion and the circumstances they faced. I may be wrong, but the kind side of me cannot imagine that there are hundreds of doctors who do not want to provide abortion advice or for referrals, who would turn away women or young girls who are absolutely desperate and not give them information to allow them to access an abortion service through another doctor or the helpline. I find it hard to imagine that there are 600 or 700 cruel professionals who do not give a damn about their main patient, the patient who is alive and kicking. That patient is often working and has problems or a crisis. She may have other children. Most of the time she has other children she has to attend to and also has a job and a life. I cannot imagine that it is the case that when she finds herself in a crisis, she will be told by these 600 or 700 cruel and inhumane doctors to go to Hell, that they do not care about her, that she is one of their two patients, that they care more about the other and that they will not refer her onwards.
I refer to the statement that the Minister would take longer to deal with a Bill on hedge cutting. Give me a break. Was the Deputy comparing women's lives to the cutting of hedging?
Is it becoming that ridiculous and inhumane? We need a reality check and to think about what we are saying.
My final comments will be on waiting lists. Waiting lists in the creaking and crumbling health service are being used as an excuse not to provide women with what is rightfully theirs and what they deserve. It is what is rightfully theirs according to the outcome of the referendum. I will make a plea to the Minister about the plight of doctors. There are some areas, particularly in rural Ireland and some working class areas in the cities of Dublin and Cork, where the average number of public patients per doctor is more than 1,200. It is too many for a decent health service to function. If we add the women and girls who may try to access abortion services, we are asking a lot of doctors. As a result of the FEMPI legislation, during the years of austerity their payments were cut by up to 25%, although there are disputes about how much. This needs to be taken into consideration. Austerity cuts have hit GP services and made some GPs bitter about the way they have been treated. This may add to the numbers who say they will not buy into the scheme because they have too many patients. They are stuck in poor working class areas of Dublin or rural areas of County Laois or County Offaly and nobody notices what they have to go through. It illustrates a danger in the 72-hour waiting clause and a return visit being absolutely necessary in law. In addition to the strain on GP services, we are adding in the requirement to make a second visit within three days. It needs to be extended to include midwives and nurses being able to administer the abortion pill, which is a medical abortion rather than a surgical abortion.
There are lots of flaws in the Bill. If there are flaws in it, it is because it is not universal enough to deliver the health service women need. I recognise the existence of conscientious objection in medicine, but, as the women who tweeted me said, conscientious objection does not extend to the objectors being able to have their way over the consciences of the vast majority. The vast majority have said in no uncertain terms what their consciences tells them. They tell them whether they would choose to access abortion services. They tell them not to stand in the way of every woman and girl being able to make that decision for herself. Therefore, the services we deliver should not stand in her way.
I express my abhorrence of the vilification, disrespect, disparaging and name-calling during this debate in the House. When I came into the Chamber, I had freedom of conscience in how I voted on whether a referendum should be held. In that vote one third of those who voted, 32 out of 110, were not in favour of holding the referendum. When it was held, one third of the people voted in a different way and were in the minority. These figures suggest that at least one third of those involved the medical profession have a conscientious objection. If we base it on the numbers in the vote in the House and the referendum, we can expect a similar figure in the medical profession.
The Minister went some way towards clarifying certain points in his earlier intervention by providing confirmation and guarantees. However, I am keen to push him further on these points. He referred to the code of practice of practitioners. I imagine there are numerous codes of practice in other areas of the health profession. The Minister has gone some way in this regard already, but will he reassure me that conscientious objection will apply to all junior, trainee and student doctors as well as student nurses and pharmacists? This point has been alluded to already. I refer in particular to rostering, especially in acute settings. Some staff might be rostered on shifts. Will they be able to conscientiously object? Will provision be made for them as well?
On the issue of the call helpline, our experience with the 24-hour service provided in the health services in recent years has been good. People can contact this service anytime. I know it might be a little nitpicky on my part but I am seeking clarification from the Minister on whether the helpline will be completely separate from the call-out services currently available in the system.
We all have to respect that there may be people who have serious issues. We have serious people on both sides of the divide and I imagine it is no different in the medical profession. No one should be embarrassed in this situation. Many people, especially nurses and doctors, have written to me since the result of the referendum seeking to ensure that conscientious objection would be included. I am satisfied that it is, but I am unsure about circumstances in which people, for reasons of religion or otherwise, do not necessarily want to deal with this. It is important that the 24-7 call line would be almost a first port of call for a person who might feel embarrassed in the knowledge that her general practitioner is a very religious or concerned person who would not want the embarrassment of having to refuse. The helpline may not necessarily be a first port of call but it could be a special port of call if a woman was in doubt about her GP. I am seeking clarification on that point.
This is probably one of the areas on which I have received most representations. I remind Deputies that these representations have been made by eminent doctors, nurses and midwives. It is not simply a question of me asking a "What if?" question and setting out what I believe. I know many of these people personally. They are eminent people who have looked after people very well for many years.
The Minister has explained a good deal to us about this amendment but we should explore the implications for doctors, nurses and all other healthcare professionals if their right of conscience is not respected in law. Every person has a right to freedom of conscience. No person can be compelled to perform or facilitate an action that he or she believes to be morally wrong. The right to freedom of conscience acknowledges that we are responsible for our free actions and the associated consequences inasmuch as we can foresee them. It acknowledges that we cannot disclaim responsibility for our free actions simply because we are obeying the will of another person. Freedom of conscience is respected in a democratic society. There is the right to refuse to perform or participate in an action with which the person in question does not agree. We must accept that many doctors have profoundly held convictions about the right to life, and we must acknowledge that. It goes very much against their conscience to be involved in the practice of abortion.
It is disingenuous to imply that because a doctor, midwife or nurse does not wish to participate in abortion, he or she is a blocker or some type of obstructer. The Minister did not imply as much but maybe others have done so. It is a matter of conscience for the person.
Abortion information should be in the public domain and perhaps not restricted to medical personnel. Deputy Breathnach spoke about information helplines being available and people being aware of them. As healthcare professionals, doctors, nurses and others, as far as I can establish, wish to provide compassionate care for all patients. Often, they try to give positive alternatives to abortion. We cannot claim to be a pluralist society if professionals believe they are being coerced into facilitating something they do not believe in.
Has the Minister considered the implications for the health service if a high number of GPs and nurses believe they are unable to practise and leave the profession? That suggestion has been made clear to me. I am not being alarmist. I have spoken to a husband and wife GP team who are abroad at the moment. They were talking about coming back to the west of Ireland in the coming months to practise there and raise their young family. Given elements of this particular legislation, however, they are having second thoughts.
What will the Minister do for patients who are left behind without a GP? That is an important question as well. We must understand the situation for many doctors. We must have freedom of conscience. It is a fundamental part of living in a democratic society. Routine general practice is not an appropriate place for this service if it could be easily provided by family planning groups instead. Doctors should be afforded the choice to opt in or opt out. That approach works well in New Zealand.
I hope the Minister can clarify some of those points for me and take on board the points I have made. By the way, many of these points have been made to me by female professionals. Fewer representations were made by male professionals.
I too am glad to get the chance to speak on this important matter. I have met midwives and nurses. Doctors have spoken to me, including GPs, who are highly concerned about this. It is clear that the Minister is rushing through this Bill with no pre-legislative scrutiny. We have been criticised in the House for talking about all the various amendments, including some of the amendments we had earlier. I imagine we will get criticised for talking about this amendment as well.
I will explain what I see wrong with it. The Minister is saying that the medical profession will have to refer on people. That is where the bother lies. If he was so sure that GPs could provide the service and that there were enough GPs, midwives, nurses and other healthcare officials signed up to provide the abortion service, there would be no need to force or bully people into doing something they conscientiously object to doing.
I met some midwives in Buswells Hotel who came in to meet us. They were crying. There were two of them together. I picked a particular day. They said they loved their job.
All of a sudden they are being forced to turn around because the Minister has not taken the time to organise teams throughout the country that will carry out abortions without being forced to refer people onwards. That is wrong.
It is right and the Minister should not shake his head because what I am telling him is correct. He should have taken time to talk to doctors. A week ago he had not spoken to many of them. I do not know how many to whom he has spoken since. He has left it very late to start a service at the beginning of January. Your Taoiseach was trying to blame healthcare officials-----
-----and trying to deny them their right to have time off during the Christmas period. Christmas is coming and people generally take a number of days off. They are entitled to do so after working for the whole year. It minimises the amount of time available in which to create a functioning service by 1 January. The Minister is in a bind because people have not signed up to this proposal. He has not had enough conversations with them. That is the truth and the Minister should not shake his head. We have met doctors and nurses. Two nurses told me that they were really worried about refusing to participate. They will go to work on a Wednesday morning. There might be a number of normal births and perhaps two or three terminations of pregnancy. The nurses are given their tasks for the day-----
-----and if they refuse to take part in terminations of pregnancy, they believe they will be treated like the two nurses in Scotland who were forced to leave their jobs because they would not do what they were being forced to do. That is how serious the matter is for them. They were brought up and taught how to protect life, save it and bring it into the world and all of a sudden they are being made to do what they do not have a mind to do.
The current proposal has already been opposed by over 600 GPs, many of whom have indicated that they will not co-operate with a duty to refer for an abortion. The Minister has created a completely unnecessary showdown with doctors on a subsection of the Bill that is, in reality, not practical. As a matter of pragmatism, the country cannot afford to lose a large number of GPs, midwives, nurses and other healthcare officials. As it is, we do not have enough of them and we do not want to lose any more. The health service is a disaster in County Kerry. It has emerged today that people have died because of the neglect of the HSE which has failed to provide a proper service in County Kerry, in particular at Kerry General Hospital.
The Minister is forcing people to press ahead and requiring doctors to make arrangements for women to access abortion services against their deeply held beliefs. A legal challenge is inevitable. It is very obvious that there will be a challenge if this matter is not corrected in the Bill, which will delay the legislation further. It is very possible that it will happen. I am again asking the Minister to set up a team, if he believes he can, to carry out the service without bullying or forcing doctors, midwives, nurses and other healthcare officials to do something they were never trained to do in the first place, that they do not want to do and that they will never will do.
The Government seems to maintain that the freedom of conscience provision in the Bill is operating. That is patently false, as evidenced by the simple fact that huge numbers of doctors have publicly said there are not enough of them. This also applies to pharmacists, midwives, nurses, carers and all other healthcare professionals. The Minister should be aware of what happened at the EGM of the Irish College of General Practitioners at the weekend. A large number of GPs walked out at the meeting because of the attitude of those conducting it. There are photographs and videos of the event that show an almost empty room while the issues were being discussed because a majority of GPs had left in protest. The Government must listen to GPs on this issue. There are huge concerns about how it is being dealt with.
For decades medical professions have operated a two-patient model. In treating a pregnant woman a GP has two patients - the mother and her baby. Under the proposed legislation, GPs will be forced to refer both patients to another GP in order that one of them - the baby - will have his or her life ended. Surely it is not difficult to see why so many GPs have a problem with this. How can be it a surprise to the Minister or anyone else that doctors might object to having to refer a patient to another doctor to have his or her life ended?
There is a very disturbing truth at the heart of this issue. The Minister and other pro-abortion campaigners will not admit that they think doctors should have the right in the first place to object to involvement in abortions. Pro-abortion campaigners view abortion as good, a right to which women are entitled and think any doctor who cannot see this is clearly in the wrong and should be brought to heel. That is the attitude that has pervaded the abortion debate in many countries in recent decades. Legal actions have been mounted against the rights of medical professionals to opt out of abortion services. In the United States there have been concerted efforts to dump such doctors out of the profession. This has resulted in a huge drop-off in the level of interest among young people who are thinking about entering the medical profession owing to their fears that they will be pressurised into taking part in an abortion. Are we going to see a similar pattern here? Thankfully, the tide may be turning on this issue internationally. Recent decisions of the Supreme Court in the United Kingdom and Norway were strong rulings in favour of the right of healthcare professionals to refuse to participate in abortions.
The very notion that GPs should be forced to provide abortion services in their practices is reprehensible. Why can we not operate an opt-in system, as is the case in New Zealand? Under this method, the approximately 25% of GPs who wish to provide a service could do so. It would surely give enough coverage in each county for the service to be carried out. The National Association of General Practitioners has already called for the introduction of an opt-in system and has stated the provision of abortion services should not become a standard part of GP practice. It seems that the Minister and the Government want to ignore both positions. An opt-in system for GPs is operated in other areas. For example, GPs can choose to opt in or out of the medical card scheme. Some 1.6 million people have a medical card, yet GP practices can opt in or out of the service. The Government has estimated that 12,000 abortions will be performed per year, yet all GPs are being forced to either provide a service or make a referral. Allowing GPs to opt out of the medical card scheme has not led to its collapse. Why is the Government persisting with the notion that abortion services will be untenable unless all GPs provide them? What is the reason for the difference in treatment?
It seems that the Government is trying to prove a point. The Minister and the Government view the introduction of abortion services as being so important and vital and such a great advantage in the provision of healthcare that GPs must be brought to heel from day one. We should provide for the introduction of an opt-out system in order that the public at large would know which GP will and will not provide a service. This would prevent the need for a fundamental attack on a doctor's freedom of conscience by forcing him or her to refer. The Oireachtas Joint Committee on Health is frightened by this matter because it exposes how unprepared the health system is for the introduction of abortion services on the scale envisaged. Representatives of the medical profession were in unanimous agreement that the health system was totally unprepared for the introduction of abortion services in January.
Medical facilities are lacking in training, resources, equipment and so on. We read in The Irish Times this morning that regulations governing this area will not be ready for January's deadline either. Why on earth is this legislation being rushed through in these circumstances? Would we rush in any other medical treatment or programme without the proper personnel, equipment and resources being in place? Let us say, for argument's sake, that a new screening programme for a form of cancer was to be introduced. Would we do this without having adequate personnel, equipment, training and monitoring in place? The very notion is ridiculous. To operate health policy in this way would amount to gross negligence and would expose women to danger. In rolling out abortion services in such a hurry, that is exactly what we are doing. I strongly support the amendment. The Oireachtas needs to trust the judgment of doctors in all cases and must not compel them to act against their conscience.
We are discussing several amendments. I welcome the Minister's amendment extending the right to conscience to the candidate division of the registrar, in other words, to students. That is a small step in the right direction. I listened with great care to my colleague, Deputy Brassil. Having listened to the Minister's explanation, I do not think he dealt with the issues raised by Deputy Brassil.
Conscientious objection is the nub of the issue. Over my lifetime, I have known many medical people - nurses, midwives and doctors - who had a total commitment to the protection of human life. In the case of a pregnancy, they have always seen two human lives to be protected as far as practicable. I do not want to be provocative, but I have to take issue with what Deputy Durkan said on a number of grounds. Any medical intervention required to save the life of the mother was traditionally carried out by good medical practitioners. I have known people who were totally committed to the concept of two patients but would never have hesitated to intervene if the mother' life was at risk. It is interesting to ask whether that constitutes termination within the terms of this Bill. The purpose of such an intervention is to save the life of the mother. The definition of a termination in the Bill is as follows: "“termination of pregnancy”, in relation to a pregnant woman, means a medical procedure which is intended to end the life of a foetus". As such, the purpose in those cases is not to save the life of the mother.
It is on lines 12 and 13 of page 6. That was what I always understood it to be. It was traditionally the practice of good medicine in Ireland, and anyone who says anything to the contrary does not know what really good medical practice was about. This goes to the core of the dilemma facing medical practitioners, midwives, nurses and doctors. Are there two patients or one? As I have said from the very beginning, there are people here who believe that there is only one patient and the other human life does not count. Some people believe it counts in some way but not really. One of the Deputies here this afternoon - I admire her honest and her integrity on this - referred to the "main patient". Others believe that in human existence that is a very slippery slope to start down. When one starts differentiating between people and talking about main patients and not-so-main patients we know where that kind of thinking leads.
The Bill provides that a doctor must refer a case on. Many medical people, particularly the doctors who are tasked with referring on, know from medical science that there are two human beings. Referring on the so-called care of one of these human beings is to refer the other to certain destruction. If one does not believe there are two human beings, that is not a dilemma. If one believes that one totally has control over the right of the other and that the other has no right - in other words, the unborn has no right - that poses no problem. Most of these cases concern people who do not have any medical conditions that require a treatment of that kind, because the whole Bill provides for abortion for no reason. We know the vast majority of abortions are carried out-----
The interruptions lasted for closer to a minute. Doctors do not want to be forced to act against their conscience. This is the only issue here. I accept the result of the referendum. I have always said so. I also accepted the result of the referendum in 1983, which some people boast about not accepting, but that is as it may be. To force medical people to act against the interest of one of their patients, as they see it, is in itself an unethical provision. Many fine people who went into medicine in the past, among them some of the most caring people I have known, will find this a very chilling medical discipline in which to be involved.
I will also speak to the amendments, as I have done all week. Section 24(3) states: "A person who has a conscientious objection referred to in subsection (1)shall, as soon as may be, make such arrangements for the transfer of care of the pregnant woman concerned as may be necessary...". Deputy Brassil raised the issue of what exactly the transfer of care is. Deputy Donnelly raised it several times on Committee Stage and I am still not satisfied with the answer. This is the nub of the issue. Does the transfer of care mean the handing over of a telephone number by a receptionist or does it mean a doctor handing over the files of his patient? What exactly is transfer of care? I am not satisfied with the answer I have been given so far.
I have spoken in person to many doctors, nurses and midwives who have grave concerns. As Deputy Ó Cuív put it, when they look at the patient they see two patients. Not everyone does but that is the reality. The reason they find it very difficult to refer this person on is that they know another life will be ended.
I am aware that the people have spoken. They spoke strongly in large numbers. The eighth amendment no longer exists within the Constitution and abortion is a reality in this country. At the same time, there are serious issues in the health services with recruitment and retention, and if these medical practitioners are not listened to, the situation will get worse.
Recently I met a midwife who told me that she will no longer carry on as a midwife in the new year but she has asked to be transferred to the care of the elderly because she has a serious conscientious objection. She is pro-life. She feels that, through no one's fault, she may find herself in a position one day where she may be asked to participate in an abortion or that she may be in a room where a baby is being born and another baby may be being aborted in the room next door, and she just cannot put herself in that situation. She is a nurse of 14 years but she has decided, because she cannot put herself in that situation, to opt for the care of the elderly. Others will follow her.
I welcome the clarity in relation to the student doctors, student nurses and student midwives. It was an important amendment I had worked on with Deputy Donnelly.
The Minister stated that he believes he has been in consultation with the GPs, but all through this referendum, I believe, from day one, there was no consultation with the GPs. That is regrettable. Their voices were not listened to. It does not matter whether they heard it first on Committee Stage, on the radio or in the media. At the end of the day, they should have heard it first from the Minister or from the Department of Health. They should have been consulted.
The right to freedom of conscience is a fundamental right and it is protected by the Constitution and the European Convention on Human Rights. No person should be required by force of law to take an innocent life. I believe that these medical practitioners, these nurses, doctors and midwives, have genuine concerns. It is very important that they are listened to. As I stated last week when speaking about older people, we face a winter of discontent in the health service and we certainly do not want to lose any more health workers. It is very important that their voices are heard in this.
Last night, in Limerick, a group of doctors who want to provide the service - perhaps they are conscientious providers rather than conscientious objectors - and want to provide healthcare for women were hounded out of the original venue for their training. The good news is that they found a place. That emphasised the need for us to include exclusion zones, if not as part of this legislation then as part of legislation that must follow, because there are people, not necessarily Members in this Chamber, who cannot understand or accept the result of the referendum. They are just not quite there yet. We need to provide protections for those doctors and healthcare professionals who wish to provide the healthcare for women for which we voted.
With regard to a comparison that was made between legislating for hedge cutting and legislating for women's healthcare, I do not think any offence was meant but it was an unfortunate turn of phrase. It is not true to say that this debate is being rushed. We have been having this debate for 35 years. All of my adult life up until recently, I was on the losing side of that debate and I had simply to suck it up and deal with it, or regroup and keep campaigning. No one could say that this is rushed or that there are arguments that have yet to be rehearsed. We have made all of those arguments.
I have been contacted, just as other Deputies have been, by doctors and healthcare professionals who may be seen on social media using the hashtag #wewillprovide. What they say, to women, legislators and their colleagues, is that a significant majority of doctors and healthcare professionals are willing to provide terminations and access to terminations and abortion healthcare for women, which is a good and positive development. One of them contacted me. I will not use his name but he asked me to state that saying nothing does not meet professional standards, and that while doctors are perfectly entitled to hold a conscientious objection for religious, moral or other reasons, they also have a duty of care. That duty of care is to ensure that those sitting in front of him get access to the healthcare that they need. In that regard, conscientious objection provides for them not to be the provider of that service but they must refer on. Anything less - this comes from a doctor, not me - will fall below what is required by professional standards.
I have heard that no GP will be compelled to provide this service. We need to make clear that no person will be compelled to provide that service. There is already a facility for conscientious objection in place. I do not know the purpose of the amendment because the facility to object conscientiously already exists.
I do not believe that there is a significant majority out there who do not want to provide this service. The majority of doctors and healthcare professionals want to provide it. In any event, nobody will be compelled to provide it. We need to ensure that where there is a conscientious objection, that is respected but that the person who requires healthcare can access that healthcare. As it was said to me, saying nothing does not meet professional standards.
I will start off be alluding to the meeting of pro-choice doctors that took place in Limerick last night that was harassed and hounded and had to change venue. There is a boycott campaign being waged against the Savoy Hotel. I just want to put on the Dáil record that is not the hotel where the meeting took place, if the anti-choice people could stop boycotting it. The reason I mention those tactics is that if one listened to some of the recent speakers, one would think doctors were being forced and coerced into carrying out abortion whereas, in fact, under current medical guidelines they can conscientiously object, and that is not being changed.
We are hearing a great deal about the rights and freedom of conscience of medics, but I want to put the other side of it, that is, the impact of this conscientious objection provision on women and those who are pregnant. I weighed up whether I would completely oppose conscientious objection being allowed at all because it is not allowed in public health in Sweden, Finland and Iceland. If somebody does not want to provide abortion, he or she can go into the private sector and work in whatever sphere he or she likes. There is a reason for that. The Deputies can all be clear: this applies only to women's health and reproductive rights and not to any other area of medicine. We do not hear Deputies railing about the rights of doctors to object conscientiously to anything relating to male health.
It applies only to women's reproductive rights. Conscientious objection is not allowed in countries which have a long-established high threshold for women's rights because they will not allow those rights to be subordinate to religious beliefs, which is what is being proposed. Although we will be able to cope with conscientious objection in Ireland because there will be enough doctors to provide services, I ask Members to spare a thought for women in countries such as Mexico, which introduced abortion in the first trimester but has a shortage of doctors because it is a poor country with a low ratio of doctors to the general population. The National Action Party, a conservative right-wing political party there, began a campaign to pressurise doctors to opt out. It stated that abortion might be guaranteed in law but it would ensure it does not happen in practice. A similar situation pertains in Italy. The stigmatisation of abortion in a manner similar to that which we have heard from some in the Chamber over the past few hours forces doctors to opt out and conscientiously object. A campaign by right-wing forces in Italy has led to it being very difficult for women to access abortion across swathes of the country, resulting in some women travelling abroad for a termination. I would like to hear a little more about the vote we mobilised in May which was about women's individual right of access to abortion and right to choose, whether some Members like it or not.
There has been reference to a showdown with doctors. A similar situation arose on the legalisation of contraception. It was well known that a doctor in general practice for a long time near where I lived in Blanchardstown would not provide contraception to women who needed it. The idea that doctors will suddenly be forced to provide services does not stand up.
It is important to send the message that there will be enough doctors to provide services. What one hears in this Chamber is rarely representative of the views of the majority of society, but it certainly has not been for the past few hours. There will be enough doctors to provide the services. A survey of doctors carried out in the summer of 2012 was presented to the Joint Committee on the Eighth Amendment of the Constitution. Some 76% of GPs surveyed were willing to provide terminations in all or most circumstances. One would imagine that those attitudes have moved on since the summer of 2012, which was pre-Savita Halappanavar and the repeal movement.
The Minister is not currently present. Women in Ireland are finding out that they are pregnant. They may be in their bedroom or bathroom and faced with a crisis pregnancy. Some Members may not like it if such people choose to have an abortion but the people voted to change the law and allow them to make that decision. It is imperative that they have access to such services in January as was the impression they were given. We should prevent any delay in that regard. The Minister must ensure that the necessary training takes place such that doctors feel sufficiently trained to provide these services, that ultrasound facilities are available where required and that the 24 hour phone line is in place.
Deputy Fitzpatrick asked why we cannot ask doctors to opt in. The country did not vote for that. The majority of the people did not vote to stigmatise abortion as strange and outside normal healthcare. The discussion very clearly revolved around healthcare as a right of women and for that reason we must ensure that we do not have an opt-in policy. Can one imagine, given the harassment that has already been experienced in hospitals, what would happen to doctors who opted in? They would be absolutely hounded by some of those who have spoken tonight and it would be quite dangerous for them to opt in. If doctors wish to opt out, that is fine and they can do so, but it is very important that we do not have a list of doctors who opt in as an exception.