Seanad debates

Wednesday, 17 January 2018

Report of the Joint Committee on the Eighth Amendment of the Constitution: Statements

 

2:30 pm

Photo of Keith SwanickKeith Swanick (Fianna Fail) | Oireachtas source

Ag tús an díospóireacht seo ba mhaith liom buíochas a ghabháil le gach ball den choiste, na Teachtaí agus na Seanadóirí, go háirithe Seanadóir Buttimer, Seanadóir Gavan, Seanadóir Mullen, Seanadóir Noone, Seanadóir O’Sullivan agus Seanadóir Ruane. I rith na Nollag bhí seans agam staidéar a dhéanamh ar an tuairisc dheiridh.Ach tá go leor ceisteanna agam agus tá imní orm. Tá an ceist seo an-chasta. It is as I said, a complex issue, despite the attempt by many to simplify it into a binary issue.

The opportunity over Christmas to study and reflect on the report of the Joint Committee on the Eighth Amendment of the Constitution was one I took very seriously. It is a profound question and a profound decision to attempt to remove the rights of unborn children from the Constitution, irrespective of what law or laws might be proposed here in the Oireachtas. One could, for example, be in favour of repealing the eighth amendment to Bunreacht na hÉireann in the mistaken belief that it removes the constitutional and legal protection to the unborn, thereby paving the way for abortion. There are some that believe that the unborn child is not a human. That is not my view, both personally and professionally as a doctor. When an overjoyed or indeed anxious expectant mother presents to a doctor to confirm a pregnancy or to review their health status during pregnancy, the doctor will carry out two sets of clinical tests and observations. A doctor will conduct a clinical assessment of the mother and carry out an ultrasound of the baby, to ensure that it is developing in a healthy manner.

Repealing the eighth amendment to Bunreacht na hÉireann is unlikely to guarantee abortion without restriction, because as the Attorney General has advised and indeed other constitutional lawyers have pointed out, there are other parts of the Constitution that protect the right to life of the unborn. This is something that An Taoiseach outlined yesterday, when he addressed this complexity. He said: "Because we would find ourselves in a very strange situation if we repeal the eighth amendment only to find out there are other rights to life that exist in other parts of the Constitution, that might then make any legislation we pass unconstitutional." He may be right, I do not know, but I look forward to hearing other speakers, or indeed the Minister, address this question that the Taoiseach has raised.

I will move away from the constitutional aspects of this issue, because we have yet to see the referendum Bill and the proposed legislation that would be used if the referendum were to pass. One of the fundamental issues I have with the current unrestricted proposal up to 12 weeks, and I say this is in the absence of a referendum Bill or draft legislation, is that it appears to equate fatal foetal abnormalities with unlimited access to abortion. The issue of the protection of life is somewhat linked to a highly relevant issue I raised earlier today in this Chamber regarding the effective rationing of intensive care unit, ICU, beds in our public health system. In an earlier contribution I referred to the fact that the absence of an acute ICU bed, for example, should never be the reason that somebody dies. No doctor ever wants to be in this position. It runs contrary to our Hippocratic oath, the guidelines from the Medical Council, and as I told the Minister earlier, contrary to the reason I decided to get into medicine.

The protection and preservation of life is complex and it can also be tragic. As a doctor, I routinely have to sit down with family members and loved ones and say that in my professional opinion, having reviewed and assessed all of the options, the likelihood of survival is slim. I have given this bad news hundreds of times in my career. It never gets easier. In all those conversations I never thought that one of these reasons might be that an ICU bed was not available. However, following the logical thread of what is proposed here in the report from the joint committee, there could be a situation of the availability of abortion on economic or lifestyle grounds, for example, and that this could be given the same status as abortion arising from horrific cases of rape or incest, or indeed fatal foetal abnormalities.

In a way, I bring a unique perspective to this issue as I worked as a general practitioner in the UK for many years. Legislation in England, Scotland and Wales, specifically the Abortion Act 1967 and the Human Fertilisation and Embryology Act 1990, allow a woman to have an abortion up to 24 weeks of pregnancy if two doctors agree that it is less likely to cause harm to her physical or mental health than continuing with the pregnancy. Of course we know that the 1967 Abortion Act does not extend to Northern Ireland and that abortion is legal there in very exceptional circumstances. The reason I raise the UK legislation is to point out a serious problem that I foresee with what is being proposed here.

It appears, and again we have no specific legislation to review, that the Government will accept the recommendations from the committee. As I understand it, this will create a regime of abortion on request for up to 12 weeks and this would occur in the GP setting or perhaps in a health clinic. In effect, it is proposed that GPs would prescribe abortion pills and that they would be taken under medical supervision of a GP. I stress this is my understanding of what is being proposed. Is this a way of trying to ensure that there are no abortion clinics in Ireland and that, in effect, the proposal would be to outsource the abortion clinic services to an already underresourced and overstretched general practice setting?

Has the Government, or indeed the Minister or officials, engaged with the GP representative groups on the specific aspect I highlighted, namely, the creation of an abortion clinic within surgeries around the country. Existing Medical Council guidelines require GPs to treat a woman who may have had an abortion. Section 21.3 of the Medical Council guidelines states: "You as a GP have a duty to provide care, support and follow-up services for women who have an abortion." Has the Minister, or any of his colleagues, had engagement with the Medical Council on what is being proposed? I feel this would be crucial.

Currently we are bound by the Guide to Professional Conduct and Ethics for Registered Medical Practitioners. Section 21 of this deals with abortion and section 22 deals with end-of-life care. The proposals appear to go a lot further than the law in the UK, for example, which I referred to earlier, because in the UK a doctor or nurse has the right to refuse to take part in abortion if they do not believe in abortion or have ethical issues about the protection of the unborn. GPs must refer a patient to another doctor or nurse and these rules are set down by the Medical Council in the UK and the Nursing and Midwifery Council. Have there been any discussions on these matters? If not, there needs to be. The law of unintended consequences could be at play here, because Dr. Rhona Mahony, the master of the National Maternity Hospital, has already said that it is her belief that the eighth amendment of Bunreacht na hÉireann is distorting clinical judgments. I cannot agree or disagree with this claim, as I am not on the front line of clinical work in obstetrics. The broader point that she raises regarding the criminal context of abortion in Ireland is an interesting one, when she said:

The issues really are quite medical. We are looking at a requirement for us to determine that a woman is at risk of dying, and that decision is made in a criminal context. It is under the shadow of a custodial sentence of 14 years [...] and I do believe that distorts clinical judgment.

The complexities that I have highlighted are designed to be constructive and the questions I have asked come from a very narrow area of this entire subject, but it is one of which I have intimate knowledge. Throwing labels on people and putting people in a category because of their deeply held views on these matters is very damaging. I know many people who are deeply traumatised by the issue of abortion, from both perspectives. It requires compassion and understanding to deal with a woman who is in a crisis pregnancy situation and to deal with a family to tell them that having reviewed the anatomical scans with the consultants, there is no longer any sign of life from their much wanted child.My wife Aislinn and I are blessed to have two young healthy children. They, like every child, have brought more joy to our lives than we ever could have known. An estimated 14,000 women, however, endure a miscarriage in Ireland every year and it is almost taboo to talk about it. I salute the courage of Kathryn Thomas who spoke recently on the "Late Late Show" about her own experiences.

In conclusion, there are really important aspects of the committee's report that deserve to be praised and I fully support them, specifically that all women should have access to the same standard of obstetrical care, for example early scanning, anatomical scanning, in other words scanning for anomalies, irrespective of their location or socioeconomic status.

The proposal to improve counselling services to support women is one I support, as well as the proposal to have a perinatal hospice service for those who wish to avail of it. The review of sexual health education with a focus on consent is a welcome proposal. I look forward to hearing the response from the Minister of State and Members of the House on this most sensitive personal issue.

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