Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I thank the Senators for putting down these amendments on what is an area that was debated extensively at the Oireachtas committee where many different views were expressed and different testimony heard. It was debated extensively also during the referendum campaign and in the other House.

I will start by outlining the importance of making sure that people who are being referred to in the House as vulnerable groups, and rightly so, can access the services. It is for that very reason that I made the decision that this service needs to be free and part of the universal health service. It is for that very reason that I am so determined that these services are introduced in the new year because it is a reality today in Ireland that some women can travel and that other women, especially marginalised women, cannot. That is why I am disappointed to hear comments such as those from the Coombe Hospital today that it will not be in a position to provide the services. We should remember that the overwhelming majority of these services will be provided in the community through a woman's general practitioner. We should remember also that maternity hospitals are already providing, albeit in a limited circumstance, access to termination under the 2013 Act.

There is a time for leadership in these Houses of the Oireachtas but there is also a time for clinical leadership. I do not have any role in drawing up clinical guidelines. That is the responsibility of clinicians. I believe that if everyone puts their shoulder to the wheel, we can make sure that services are in place in January. They will have time to embed and evolve fully, but safe services can commence in the new year. That is the reason I do not believe legislation can be delayed.

I have moved somewhat on this issue since the referendum. It might seem like a small point but it was an important one. The original general scheme referred to 72 hours rather than three days. It was pointed out to me by a number of doctors, and a number of women's organisations, the practical challenges that would have caused.The difference between 72 hours and three days is not insignificant. Asking for the full 72 hours to elapse was going to place a further hurdle for the woman and cause further confusion and inconvenience for GPs. I made the change during the passage of the Bill through the Dáil to clarify that section 18(h) of the Interpretation Act 2005 dealt with how periods of time should be understood where they were included in legislative provisions. It states, "Where a period of time is expressed to begin on or be reckoned from a particular day, that day shall be deemed to be included in the period and, where a period of time is expressed to end on or be reckoned to a particular day, that day shall be deemed to be included in the period". As section 14 of the Bill provides that three days must elapse from the date of certification, in accordance with the Interpretation Act, the date of certification is also included in the three days. It lessens the time, but it does not address all of the issues highlighted by some Senators. However, the emergency does more than Senator Kelleher believes it does. I have taken medical views on this issues, including that of the Chief Medical Officer. There is no reason a doctor cannot use section 10 where it is an immediate and necessary step to protect a woman's health or life.

We need to be careful to point out that the three-day period is only one of the provisions included in the Bill. There are others dealing with accessing a termination and that specifically relate to health and life that have no time period. There is also an emergency provision that has no time period and on which I will engage further with clinicians. If somebody is affected by domestic violence, she may only be able to get to the doctor once; therefore, we have to make sure that, if the doctor believes there is an immediate risk to the woman's health, he or she needs to be able to intervene. I will continue to engage with Senators on this issue.

Senator Devine asked if the time period could start from the moment the telephone call was made. We do not have an electronic booking system, as they do in other European countries where a person makes an appointment with a GP by email or a logged phone service. Our 24/7 helpline will signpost where services are available, but it will not make the appointment for a person. We need to be careful not to allow a third party who is not a medically qualified health professional to interfere in the relationship between a woman and her doctor.

The amendments refer to conscientious objection. I was more than a little frustrated that all of the talk about conscientious objection was from the perspective of the doctor because, while doctors have a right to conscientious objection, so do nurses and midwives and I defend that right. However, it also has to be looked at from the perspective of the woman. Nobody voted for the scenario where a woman would have to go from doctor to doctor in the hope of finding help. The 24/7 helpline will not just be a telephone line; it will have instant messaging in 2019 because it is a more convenient way for people to contact services. The website which will be launched and the MyOptions service that is being put in place will provide women with the information they need in order that they will not have to go to a local GP in the hope of finding help. Instead, a woman will go secure in the knowledge that the medical professional wants to help her and has signed up to provide help for women in such a crisis.

Amendment No. 27 relates to the idea of an obstetrician certifying and carrying out the procedure. I have dealt with this issue extensively and clarified what is meant by the medical procedure and how it is different from aftercare. The outer limit for legal access to a termination is 12 weeks. Some amendments, although they are well intentioned, ask the House to waive that limit, but that is something we have to be careful not to do.

I was also asked about dating the pregnancy. A number of female Deputies vociferously said they found it offensive to talk about menstrual periods in legislation. We looked at whether there was another way of doing this and I accept the medical advice that pregnancy is generally dated from the first day of a woman's last menstrual period. We are keeping the legislation under review, but we need to use language that is very clear and which doctors and women will understand. While there are different views on this issue and I understand why, I believe that, following the referendum campaign, people voted in favour of the 12-week period without a specific indication but with knowledge of the context and how it would operate.

I have heard references, more extensively in the Dáil than in the Seanad, to the Dutch and other systems. This is not the only country in the European Union to propose a law with a waiting period. Many of the countries that do would not be defined by Members of this House as conservative nations but as bastions of liberalism. In the Netherlands there is a five-day waiting period which can be triggered by a woman telephoning the helpline, but section 3(1) of the Dutch Act states a pregnancy shall be terminated not earlier than the sixth day after the woman has consulted the physician and discussed her intention with him. The website of the Dutch ministry of health, welfare and sport states the law imposes a mandatory five-day waiting time in order that a woman can think carefully about her decision, but I do not favour this language. The committee heard from lots of very fine experts and there are waiting periods in many countries. We are bringing forward legislation in which I feel I am mandated to do what I told the people that we were going to do. I have tried to make it as operable and practical as possible, which is why we have made abortion services free and part of the universal public health service. It is why we changed the 72-hour limit to three days and set up the 24/7 helpline and the instant messaging service from 2019 in order that women can be signposted to services. There are also emergency and health provisions in the legislation which are separate and distinct from the early pregnancy section.

I am glad that Senator Lawlor raised the points he did. Many Senators have raised the same issues on a regular basis.. We want terminations carried out in this country to be free, safe and legal, but we also want them to be rare. No woman wants to find herself with a crisis pregnancy. There are a variety of ways to deal with it, one of which is contraception. In 2019 we will increase the amount of barrier contraception, that is, condoms, available through the HSE. We will also bring forward proposals for how we can expand access to female contraception to make sure cost is not a barrier.