Rónán Mullen (Independent) | Oireachtas source

I move amendment No. 2:

In page 4, line 19, after “practitioner” to insert the following: “(other than a general practitioner who has notified the Minister that the practitioner does not wish the premises at which he or she provides healthcare services to be deemed, for the purposes of this Act, to be a relevant healthcare premises)”.

This amendment refers to the definition of “relevant healthcare provider” as meaning a general practitioner. It excludes from that definition a general practitioner who has notified the Minister that he or she does not wish the premises at which he or she provides healthcare services to be deemed, for the purposes of this legislation, to be a relevant healthcare premises.

If I were to try to characterise this amendment, I suppose I would call it the “not in my name” amendment. When the abortion legislation was brought in, there was some acknowledgement, as there is now, of the issue of conscientious objection, whereby healthcare practitioners do not need to be involved in the provision of abortions. Why would a healthcare practitioner not want to be involved in providing abortions? Of course, the obvious answer to that is that they have a conscientious objection. What is a conscientious objection? We sometimes think of it as a means through which we can let a religious person off the hook from getting involved in something their faith says is wrong. There is no doubt that situation is included or that it is sometimes the essence of a person's conscientious objection. When it comes to abortion, however, which involves the intentional, procured destruction of human life, there are many people who would not attribute their conscientious objection to any religious motive at all. They would say it is a matter of human decency that everybody gets to have a shot at life. There is always a better solution than that which involves the ending of a life. There is always other help that can be given that will save a life. I am not speaking of the sad and tragic situations where a medical intervention is needed where an unborn baby cannot be saved. That is not at issue at all. I refer to the wilful, voluntary and unnecessary ending of a human life. There are many people, as I said, who would not invoke any kind of religious values. In fact, one atheist friend said to me recently that a person who is an atheist should be more against abortion and should be more pro-life than anybody else because if this world is all there is, what could be meaner than to dispatch another human being into nothingness? This is an interesting philosophical view. The person to whom I refer put it in more graphic terms.

The fact is, however, that in some cases, those who oppose the provision of abortion, do not even ascribe it to a conscience per se. They might refer to it as an ethical objection or as a professional objection because, as I said earlier, abortion is not unconnected to adverse consequences. We know about the adverse consequences for the child who dies, but it is not unconnected to adverse consequences for women as well. It is not unconnected to coercive activities by men. Indeed, one of the issues that I and others have raised with the Minister is the whole problem of telemedicine being used in the accessing and provision of abortions. It can mask coercive behaviour of men towards women, both those who are underage and overage, forcing them to have abortions without having scrutiny over what is going on, etc.

There are many reasons to have a professional objection to abortion and, of course, there are many reasons to have a social objection to abortion. One of the issues is that quite a few medical professionals have an ethical or professional objection to abortion. How many are there? Are they a minority or the majority? I do not know. They are certainly an extremely large minority at the very least because it is actually a very small number of the overall cohort of doctors in this country that is involved or wants to be involved in the provision of abortions. I think that says a great deal.

A small number of people are engaging in this activity, which is called everything from healthcare to abortion care to all of those dishonest, sanitising phrases that mask the idea that an innocent human creature is being snuffed out. Yet, it is probably the case that the great majority of doctors in this country - whether they oppose abortion in every case or not and I do not know that - do not want to have hand, act or part in the ending of an innocent human life. I do not think I am exaggerating there. If the Minister is going to surprise me with some stats on this, I would nearly go up and shake his hand at this stage. An accurate statistic has not been presented to me about anything, but it seems to me that most doctors do not want anything to do with this.

There is a question then about how they are provided for because under existing law, those doctors are required to transfer. This is where a person comes to them seeking an abortion and they have an ethical or professional objection to this, they do not believe it is good healthcare, they think they are being caught up in the killing of an innocent and all of that. They are expected under the law to transfer because this is now legally available and, indeed, State-funded whether the taxpayer in question likes it or not. They are required to transfer to another practitioner or provider.One would think that for something as controversial as abortion the State would not put the burden on somebody who has an ethical or professional objection to it for being responsible for transferring somebody to where the deed would be done. If I believe I am doing something wrong and I am asked do something, and I believe it would be wrong of me to it, if I am allowed to say that, to believe it and to abstain accordingly, the logic of that should be that I would not be forced to just pass the person on to somebody else who will do what is wrong, especially when there are other avenues available to the State to make sure that a service that is legally available should be accessible. I get that point, if it is legally available in the State and given the model the State has chosen where it chooses to endorse abortion as a good thing, to pay for it and not to have any discussion or discouragement of it. That is where we are at. I lament that fact, but if that is the State's position, I can see how it would be the logic of the State to say that it must make sure that anybody who wants it can access it. However, there are other ways to achieve that, for example, by the State advertising a central point of information where a person may access that service.

I know from my involvement with the committee on assisted dying, which is looking at euthanasia and assisted suicide, that in jurisdictions like New Zealand, doctors and other healthcare workers who do not want to be involved in the provision of euthanasia or assisted suicide are not required to pass a person on to somebody who will help them because that is seen as implicating them. It would be a very healthy thing if that thinking from New Zealand in the context of euthanasia were to be explored here in Ireland so that medical people - healthcare workers and others - are not implicated in abortion, even to the extent of having to transfer a person to somebody else who will give that service when, as I said, there are other means available to the State to ensure that the person can get that service.

This is why, underlying a lot of what has gone on here in recent years, there is intolerance. It is not enough that abortion would be available or that the taxpayer, whether pro-life, pro-abortion, pro-choice or whatever you want to call it, have to bankroll it. Dissent must not be allowed. The people, the third of the voters who voted against this because it is unjust, are effectively expected to go under a rock, but they are not under a rock, they are out there. They still believe that abortion is unjust, and many of them are medical and healthcare professionals. There is an issue that needs to be addressed about the way in which their ethical and professional conscientious objection is addressed. At the very least, it adds insult to injury, or would add insult to injury for these people. Let us say they are in a clinic that is providing abortions or somebody within the clinic is providing abortions, but unlike the Government, they respect that there are two sides to it and that they have people perhaps within their GP clinic who do not agree with abortion. They might say that some staff may provide this service, but we do not want our provision of this service to be used as the means or the instrument to preventing another person from having their say on the matter, 80 yd from here. That is what this amendment seeks to do. It seeks to facilitate the genuinely liberal person who, whether they are providing abortions or not in their GP service, do not want their location to be the means of preventing another person from communicating their ideas about abortion, for or against, wherever they like.

This amendment only applies to GPs, not to obstetricians or hospitals. Even though paragraph (b) of the Bill's definition of "relevant healthcare premises" does not use the term "relevant healthcare provider", this amendment should prove effective even for shared premises because paragraph (b) of that definition is effectively built on paragraph (a). The proposed provision uses the phrase "his or her" and this cannot reasonably be objected to and is very common in statutory provisions.

In a situation where two or more GPs practise at the same premises, and at least one of them does not want an opt-out, my interpretation of the amendment as I have worded it is that the opt-out would not take effect. The reason I interpret it that way is that if there is at least one GP at the premises who does not want an opt-out, then there is at least one "relevant healthcare provider" providing healthcare services at the premises, meaning the premises is a "relevant healthcare premises" within the meaning of the Bill.

This is quite a minimalist proposed amendment and I hope that would make it more palatable to the Minister and to other Senators who are not pro-life. It effectively allows a veto on opt-out where any person is a relevant healthcare provider in the premises in question.

However, because of what I have just said and because in some places there could possibly be another GP practice within 100 m, one could have situations where a particular GP would have opted out but his or her premises would still be in a so-called safe access zone. Therefore, the prohibitions would still apply, but because the GP who had opted out would not be a "relevant healthcare provider", he or she would not be protected by the current section 3(3) of the Bill, which might also protect pro-life doctors advising a woman against having an abortion, or at least protect them against being in breach of section 2(2).

On the other hand, I do not think the phrase "section of the public" should be interpreted as including just one individual, in this case a woman considering abortion, at least insofar as concerns private communication between a doctor and herself, so I am inclined to think section 3(3) is a largely redundant protection anyway.

The objections or questions about this amendment might be as follows: How are people to know whether or not a particular premises is a safe access zone if there can be these opt-outs? Would the opt-outs be publicised, and if so, how? Would publication of opt-outs require a specific provision in the Bill?

Of course, the promoters of this Bill do not seem to mind that, even without opt-outs, there is a huge difficulty with knowing whether or not one is in a safe access zone. The proposed amendment is less problematic than the Bill itself in that regard, because it would reduce the number of safe access zone areas and so, instead of people falling into the trap of unlawful conduct, as they could under the Bill, or at least be subject to a warning by a garda, it seems to me, moreover, that since commission of an offence under the Act depends on Garda intervention, it would be sufficient for the Minister to notify local Garda stations of the opt-outs, rather than wider publication, so that deals to large extent with the above mentioned likely objection or question.

Even better in that regard would be to change the wording of the proposed amendment to: "(other than a general practitioner who has provided a notification, to the superintendent of the Garda Síochána for the district in which the premises at which the practitioner provides healthcare services is situate, that he or she does not wish that premises to be deemed, for the purposes of this Act, to be a relevant healthcare premises)". I did not go for that because it is a bit wordy. I have been inclined to go for something quite minimalist but I put the House on notice that we might consider it at a later Stage, depending on how the debate goes.

In addition, at a political or psychological level there is something that does not sit well with GPs who want to opt out having to tell the Garda. It almost makes it seem as if such GPs are quasi-criminal, even though of course that is not what it would mean. I would like it if there was another opportunity to consider further the wording of the amendment on the opt-out issue, but it seems that any wording of such an amendment is likely to be rejected. I regret that. I would like to hear what the Minister has to say on it.

I think even many pro-life GPs might be concerned that an opt-out would draw unwanted attention to them from the Minister if it were the case that they had to notify the Garda. They might also be concerned about unwanted attention from pro-abortion groups and activists if the opt-out became publicly known. Although in my view, the Bill is very wrong, it does provide protection from pro-abortion pressure within the safe access zone as well, that is, pressure on doctors to provide abortions. I grant that is the case in regard to this Bill. I look forward to hearing what the Minister has to say.