Colette Kelleher (Independent) | Oireachtas source

I move amendment No. 6:

In page 8, line 23, to delete “serious”.

The amendment seeks to remove the word "serious" from the provision dealing with the risk of harm to a woman seeking a termination of pregnancy. The Minister stated in regard to the previous grouping of amendments that he does not wish to take a risk on terms that are clinically uncertain or ambiguous. There is quite significant clinical concern about the ambiguity of the word "serious". It is disappointing that it has been retained after Committee and Report Stages in the Dáil. It is to be hoped that today we can move the conversation along a little. A Bill of this historic magnitude has no room for uncertainty or ambiguity, as the Minister stated in regard to the previous grouping of amendments.

Legislation should never hinder the practice of evidence-based medicine or harm women. However, the requirement that there must be a risk of serious harm to a woman's health before the legislation permits a medical professional to help the woman is an odious and unfair restriction being imposed by legislators. Is it fair in the Ireland of 2018 to only help women if there is a level of seriousness to which a woman's health must deteriorate before a doctor can act? That is outrageous. No other healthcare sector would tolerate such a risk. It is not right to have to wait for the health of a patient to deteriorate to such an extent as to become serious before a doctor can help the patient. The restrictive adjective "serious" must be deleted. It should be sufficient for a woman's health to be in jeopardy in any form. Harm is harm.

Dr. Mark Murphy, a general practitioner and lecturer at the Royal College of Surgeons in Ireland and a leading member of Doctors for Choice, stated that the retention of the word "serious" would cause harm to women. Like the phrase "real and substantial risk" arising from the 1992 common law interpretation of the eighth amendment, these words are not reflective of clinical best practice guidelines or evidence.Indeed, Professor Louise Kenny, in the course of the abortion referendum, talked about the effect of interpreting legislation in serious cases such as that of Michelle Harte, where doctors differed and ethics committees differed and she was not given the help she needed because of that ambiguity around legislation. We do not want to create similar situations. As we know, Michelle Harte went on to lose her life and so the doctors were wrong and she was not helped. We do not want to be in this situation again.

Much like "real and substantial", what exactly is "serious" in the context of health? At what point in time does a woman's ill health suddenly meet a legislative definition of "serious" before medical staff can intervene and help the woman? Deputy Clare Daly cited these issues on Report Stage in the Dáil. She said that many of the medical practitioners made the point that risk of the development of serious harm can fluctuate and in that context mothers can slip through the net. We cannot have such a situation pertaining. Other Deputies shared such reservations with Deputies Coppinger and O'Reilly also underlining the undue broadness implicit in "serious harm."

Uncertainties over the word "serious" as a threshold for medical harm were also raised on Second Stage in the Dáil by Deputies Joan Collins, Catherine Murphy, Mitchell and Coppinger - all women interestingly enough. Equally, during the select committee debates, Deputies argued against the use of "serious" to denote what constitutes a level of harm requiring medical intervention. Even during the committee on the eighth amendment, many medical professionals criticised the use of this language, arguing that it is simply not possible to gauge risk in this way.

Today, I and many of my Seanad colleagues are echoing these sentiments. As the Minister said, good legislation is built on clarity. Any threat of any form to the health of women should be taken seriously. We should not put vague limits based on vague definitions and vague thresholds on a statutory basis. Health and ill health are already defined in medicine and in guidelines and, as Senator Ruane reminded us, the World Health Organization defines health as "[a] state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." Why have we placed a limit above ill health, stating a level of seriousness that must be reached? Nowhere in medicine is the word "serious" used as a minimum standard before doctors can act. In the same way Senators in 1983 and 1992 predicted the medical chaos which inappropriate legal language can cause when applied to women seeking healthcare, today in 2018 we are saying again that we are running the same risk by using legalistic, restrictive language which has no basis in defining medical pathways of care.

Legislation should enable doctors to provide excellent healthcare and not impose inappropriate hurdles in the way of women's healthcare. This is all the more important when we think of the shadow of criminalisation which we seem to be determined to hold onto in the context of this Bill. If we are holding onto that and then we are also putting in ambiguous medical requirements that have no clinical basis, then we are causing a potential risk to women down the line. If a woman's health as she and her healthcare professionals define it, is in question, that alone should be sufficient for her to access care. That is why we must remove the word "serious."

If the Minister does not remove the word "serious", and I really urge him to do so, I would like him to then issue non-exhaustive guidelines on what it means. I would prefer that those guidelines come from the Department of Health. I caught sight of some guidelines that were being prepared by the Institute of Obstetricians and Gynaecologists and I was very concerned when I read them because not only do we have "harm" but we also have "serious harm" and in one section it was talking about "severe maternal risk to health." We are now entering into another level and threshold, so I am very concerned about this and I would like the Minister to give this due consideration. If the Minister can reassure me about the guidelines, that will obviously have a bearing on how we proceed on this amendment.