Colette Kelleher (Independent) | Oireachtas source

I agree with Senators Gavan and Marie-Louise O'Donnell. Much more needs to be answered.

Why do we need to put the word "serious" before "harm"? I find it puzzling and difficult to understand, and I have not heard anything to convince me otherwise. I understand the Minister is not for turning on it and, therefore, it is good that it will not be closely defined in the legislation if it must remain there because it is a ticking time bomb and it will be only a matter of time before it explodes and harms women.

If we are to rely on guidelines, they must be written in a progressive and enabling fashion, but I have seen some guidelines which worried me. One section, for example, relates to assessing the severity of risk to maternal health, which means that we have moved from "harm" to "serious harm" and to "severity" and "severe". The guidelines I saw recommended that each patient will need detailed individual assessment of risk and, in assessing the severity of risk to maternal health, practitioners may find it useful to refer to publications such as the annual report on severe maternal morbidity in Ireland, produced by the National Perinatal Epidemiology Centre, or international publications such as the Centre for Disease Control and Prevention's, Severe Maternal Morbidity in the United States. These publications provide context for discussions about severe risk to maternal health, but there is no mention of a woman and her self-assessment therein, which is most concerning.I want to refer to an article in which Professor Louise Kenny was quoted. While the article referred to a different regime, the questions it raised are the same. Professor Kenny, who had to make the call “was involved in the care of the late Michelle Harte, who had to travel to Britain for an abortion while terminally ill with cancer.” In 2010, after Michelle Harte became unintentionally pregnant while suffering from a malignant melanoma, doctors at Cork University Hospital advised her to terminate her pregnancy. Professor Louise Kenny was quoted in the article saying that the treatment of cancer had “advanced considerably in the last decade” with many of the newer options involving drugs that target the immune system rather than the traditional chemotoxic agents. She was further quoted as saying:

At the current time, many of these promising treatments are only available by participating in large randomised controlled trials. For obvious reasons, a woman who is pregnant or who becomes pregnant cannot participate in clinical trials.

Professor Kenny further said that in the case of Ms Harte, who was in the first trimester of her pregnancy when she presented, a termination could have been performed but she [the doctor] was “hamstrung” by an absence of clear guidelines and confusion and uncertainty about the legal interpretation of the risk to her patient’s life. The hospital’s ethics committee concluded there was no immediate risk to Ms Harte’s life and advised against performing a termination. Ms Harte died in November 2011 shortly after receiving substantial compensation from the State.

Much good that was to her. I am really concerned we are walking into the same trap by having the word "serious" in the legislation and by guidelines not being sufficiently enabling. I am concerned that doctors will be looking over their shoulders with the threat of 14 years’ imprisonment hanging over their every move and decision.

Will the Minister consider these amendments? There is a good chance that we will return to this on Report Stage unless we are given considerable reassurance on the matter.