Ivana Bacik (Independent) | Oireachtas source

I wish to speak on amendment No. 9, in particular. It has been tabled by me, my Labour Party colleagues, and colleagues from across the House. As the Minister will be aware, all the amendments in the group seek to do something similar, which is to address the question of the assessment of risk in respect of the various sections. The aim of amendment No. 9 is to insert "or mitigate" after the word "avert". This applies to the test to be carried out under section 9. Some of the other amendments seek to do something similar, by deleting the word "avert" and replacing it with the phrase "substantially mitigate". All the amendments essentially try to address the issue to which the Minister referred. Similar amendments were tabled and debated in the Dáil. "Avert" sets a high bar for risk assessment for a clinician. By inserting the word "mitigate" alongside or as an alternative to "avert", we are seeking to allow for a test that is broader and leaves more room for clinical discretion. We believe this would be more workable on medical and legal grounds. Essentially, we are concerned on our side that there would be too high a threshold of risk prevention in practice if we continued with the word "avert".

I listened with great interest to the debate on the previous group of amendments. I entirely agree with the Minister on holding the line on the word "appropriate" because it protected the exercise of medical judgment. Similarly, we are now saying that inserting the word "mitigate", as an alternative to or alongside "avert", would protect medical judgment to a higher degree and allow for greater discretion in the sorts of cases the Minister describes.

The Minister is quite correct that there will, of course, be different assessments of risk made by the women or their medical practitioners, even in circumstances where the medical condition is the same. During the referendum campaign, there was very powerful and moving testimony from Dr. Peter Boylan and others who described medical circumstances they had encountered in which the same condition had given rise to two different decisions by two different women just because of the context in which they made those decisions. For example, where there is a cancer diagnosis and a resulting threat to health if a pregnancy continues, a woman who already has a number of children might make a very different assessment than a woman who has achieved her first pregnancy, perhaps after many rounds of IVF. Those are the sorts of different decision-making contexts that have to be borne in mind. That is why we say our amendment, alongside the others, would allow for a greater degree of clinical discretion, albeit clearly within the framework of the legislation.

In response to Senator Kelleher’s points on our earlier group of amendments, again on the issue of risk assessment, the Minister indicated it might be possible for us to meet clinical experts between Committee and Report Stages. Speaking for myself and my colleagues, we would like to have that meeting, if possible, between Committee and Report Stages. It would be very useful for us to hear clinical assessments about how these tests would work in practice. Having campaigned on this issue for decades, I believe it is the case that we have been debating legal texts and various words, such as "necessary", "appropriate", "avert" and "mitigate", for so long. It is therefore so important that we hear what the clinical practice will be once the legislation comes into effect.

It is 35 years since the eighth amendment was passed. It had all the legal language. It is strange to hear people who argued very strongly against the Protection of Life During Pregnancy Act in 2013 seeking to defend the test associated with the word "necessary" that was used at the time. That was extraordinary for me to hear having sat through and participated in the bitter debates in 2012. We have been debating these texts for so long - it is seven months from the vote on the amendment - and we want to see how the legislation will operate in practice. That is why it would be useful for those of us who support the Bill strongly but who wish to see it strengthened and improved in the interest of women’s access to meet clinicians.

The point the Minister made in response to earlier amendments about the heads of the Bill having been presented to people is fair, even for those of us who would like to see the Bill made more progressive and who would like restrictions on access eased, as I would. As somebody who is pro-choice, I am clearly very much against some of the aspects of the Bill, including the three-day waiting period, but I am conscious that those of us who campaigned for the repeal of the eighth amendment did so on the basis that the heads of a Bill had been put before the people. I recall, even on doorsteps and in public debates, making the point that there were aspects to the heads of the Bill that I found too restrictive but that I had accepted that was the context in which the referendum was being held.

The Minister pointed out that in January there will be 372 women who will need abortion services who would otherwise be travelling — at a rate of nine per day — or, as was and remains the case, taking the pill at home illegally, at a rate of three per day. There is a hashtag in response to this debate, #WeCantWait. The sentiment is absolutely true. In the seven months since the referendum was passed, I have spoken to the Minister and other Ministers about trying to move more quickly and legislate to decriminalise women and ensure access. Therefore, I make no apology for seeking to do all I can to ensure a service is in place from 1 January. I wish it had been in place before now. The date 1 January is not some magical date that is being held like some sort of threat over anyone but it is the very latest date we owe to women. Our responsibility as legislators, which we are finally facing up to in a post-eighth amendment environment, is such that we do need to be able to provide the service.

I am very heartened that the Minister said there will be health legislation introduced. He indicated it will happen in the new year. It would be useful for those of us who support this Bill and wish to see it strengthened to know when the proposed legislation is to be in the Houses. The Minister indicated that, as with any other legislation, it will be possible for us to propose amendments.Of course, as legislators, we can bring forward Private Members' Bills now that we are in a post-eighth amendment environment. I am very conscious that the legislation we are debating is not set in stone and not a constitutional amendment and I will certainly be working with other colleagues on the progressive, pro-choice side to try to strengthen women's access to abortion services. Even if the Bill is passed as it currently stands, with the issues and concerns we have identified, I will certainly work to ensure we can strengthen it in the coming months through other legislative mechanisms. I take the point, however, that it is not set in stone. Having said that, the amendments would have great merit in ensuring clinicians would have better discretion, that they would still have a framework in which to exercise medical judgment but with a little more freedom within it and, of course, in ultimately ensuring women would have access to services on the terms they so badly need it now and will need it in the future.