Thursday, 13 December 2018
Health (Regulation of Termination of Pregnancy) Bill 2018: Report and Final Stages
Before we commence, I remind Members that a Senator may speak only once on Report Stage, except the proposer of an amendment, who may reply to the discussion on the amendment. Also on Report Stage, each non-Government amendment must be seconded. We start with amendment No. 1. Amendments Nos. 1 and 44 to 47, inclusive, are related and may be discussed together. Is that agreed? Agreed. I call Senator Ó Domhnaill.
I move amendment No. 1:
In page 6, between lines 29 and 30, to insert the following:“(2) No public moneys shall be provided by the Oireachtas to pay for the carrying out of a termination of pregnancy other than a termination of pregnancy in accordance with section 9or 10in a case where there is a risk to the life of the pregnant woman.”.
I welcome the Minister for Health, Deputy Harris, back to the House. This amendment is an attempt to give a voice to the majority of people who indicated, in research carried out by Amárach Research, that they were opposed to funding abortions publicly. According to the research, 44% of those opposed to public funding of abortions also voted "yes" in the referendum. This amendment is also an attempt to recognise that, where possible, the State should provide a mechanism for taxpayers to avoid complicity in the funding of procedures specifically designed to end the innocent human life of the foetus, as the Bill puts it. In this sense, the issue is clearly linked to that of conscientious objection.
This is, in turn, an acceptance of the idea that what we are dealing with regarding abortion is an action in a completely different moral and ethical category to anything else. This is where we will disagree profoundly, as Senator Norris said. To my mind, abortion is a deliberate ending of the life of the foetus and is a wrong action upon an entirely innocent party. To then ask those with profound ethical disagreements with that position not only to offer no objection but also to fund the practice is quite bizarre.
The issue of complicity is, in this instance, not just some vague philosophical idea with no real practical implications. We see it in many other areas of our political lives, most notably with respect to the protections ongoing regarding the use of Shannon Airport and the extension of its services. In fact, Deputy Clare Daly, a Member of the other House who ardently opposes the use of Shannon Airport as a violation of our constitutional neutrality, has said that it was "clear by the actions of the Government that-----
We are not on Second Stage. If this goes on, I will rule very strictly on it. It is not a Second Stage speech. The Senator is speaking about a particular amendment and I do not want him to go into a Second Stage speech or a big rigmarole about this or that. I will be fair today but very strict. Senator Ó Domhnaill is going down the road of a Second Stage speech. I will not allow that.
Yes, but the Senator is making a Second Stage speech. If he keeps going down that road I will rule him out of order. I am trying to be fair but Senator Ó Domhnaill is diverging away from the issue and using material for the sake of using it. I ask the Senator to be cúramach anois.
The point with Shannon Airport is critical to this amendment. Deputy Clare Daly in the other House, while making the point about taxpayers funding services to which she objected conscientiously, stated that, "It is clear by the actions of this Government, like its predecessors, that we are complicit in war activities, as promoted primarily by the United States and NATO". I draw the analogy to highlight the perfectly reasonable position we are trying to adopt in this amendment.
There are those, such as Deputy Clare Daly and perhaps Senator Norris and others, who say that it is hypocritical to adopt the position forcefully that we can somehow wash our hands of complicity just because we are not literally taking part in the action with which we profoundly disagree. Amárach Research has confirmed that people are not comfortable with this action. If we take the 44% figure from Amárach Research on the people that voted "yes" together with the people who voted "no", that is more than one million people who are not happy with taxpayers funding abortions. Interestingly, in other countries where abortion is funded, this is also an issue which has been raised and vigorously contested by both sides of the argument.
In his budget analysis and Department's press release following the budget the Minister announced funding in the region of €12 million for abortion services from January. The figure is irrelevant, but if €12 million is to be made available next year, I note that no regulatory impact analysis outlining where or how the money would be spent was published with the Bill.
It is when there is an impact on the taxpayer. Good laws are made when we are clear on their implications. For instance, I have looked at some of the figures in the United States where the carrying out of abortions is widespread. The taxpayer covers roughly 24% of abortion costs, which is in stark contrast with what is being proposed here. It has been proposed that the taxpayer cover all of the cost. There are arguments that can be made in that regard. For instance, the vast majority of services available within the health service are based on ability to pay. The medical card system protects those who are not able to access services by allowing them to access care when they cannot afford to pay for it. The Minister is proposing a universal service to be funded by the taxpayer, irrespective of a person's income or financial status.
According to the information I could find, in the United States the cost of an abortion in the first trimester is about $400. In the second trimester it is around $850. Interestingly, the American taxpayer has the protection of legislation. The Hyde amendment which was adopted in 1997 allows the federal government to fund abortion services through Medicaid but only in cases of rape, incest and life endangerment. It tightens the life endangerment exception to permit payment only when a woman's life is threatened by a physical disorder, physical injury or physical illness, including a life-endangering physical condition caused by or arising from the pregnancy. It is quite restrictive and not universally available. In short, the Hyde amendment has never imposed an absolute ban on the provision of federal government funding for abortion services. However, without the amendment, Medicaid would be liable for the cost of an estimated 300,000 to 500,000 additional abortions every year. Only a small fraction of the cost of the 15.6% of abortions financed by Medicaid is paid with federal dollars. In 2010 the federal Government paid for 331 abortions through Medicaid, while states funded 113,000.
The Guttmacher Institute, a pro-abortion institute in the United States, has provided research. We cannot be accused of bringing research to the floor of the House from the pro-life side of the argument only.
According to the Guttmacher Institute's survey of self-reported reasons for abortion, only 1% of abortions are carried out owing to rape. A further 0.5% are carried out owing to incest. Some 12% are carried out as a result of mothers reporting problems with their physical health, although, according to the Guttmacher Institute, probably only 2.8% of cases involve life-endangering conditions. Its conclusion was that the vast majority of abortions in the United States, or more than 95%, would not meet the stringent Hyde amendment standards. Therefore, the publicly funded system in the United States does not support the cost of 95% of abortions. Here, we are trying to introduce a system under which all abortions will be funded.
I am. There is nothing in the Bill that would prevent the HSE from opening a tendering process for private providers or concluding a service level agreement with them. Therefore, we could end up with a cartel industry funded by the taxpayer.
I continue to be an ardent supporter of the right to life. I am proud to stand with my colleagues to contest an attempt to abridge laws that protect the unborn in our society. I want to reflect on a letter. It is very short.
It is very short and includes just two paragraphs. It is from Dr. Jarlath Deignan and was recently published in The Irish Times. He wrote:
The HSE, at the behest of the Department of Health, has offered GPs like myself a fee of €450 to provide a termination of pregnancy service to an eligible patient.
This fee is over twice that payable to GPs for providing seven antenatal visits to a pregnant woman (€215), and almost twice the amount payable for an emergency delivery (€230).
Furthermore, the GP care of a newborn child up to the age of six years costs the State a mere €125 per annum.
One wonders if the Department of Health has suddenly become generous after years of cuts, or is simply buying GPs to provide the service.
Either way, it appears that our Government values the destruction of life far more than its protection and care.
This is exactly what I am talking about. People have a fundamental objection and feel unease at the way the entire agenda is being financed. Surely it is not beyond our wit to devise something along the lines of an opt-in revenue mechanism for the publicly funded provision of abortion services. Those who wish to opt in could apply to Revenue which would allow a calculated percentage of their taxable income towards the cost of provision of abortion services. At least, that would avoid forcing those who object-----
I cautioned the Senator earlier. He keeps wandering from the subject and quoting. If he sticks to the topic, I will be fair to him, but I have already admonished him on at least three or four occasions. He is spreading out the debate as if he was making a Second Stage speech, but I will soon pull the plug on him and it will also affect his colleagues.
I will conclude soon. I have outlined an alternative mechanism that could be used. It would at least not force individuals who conscientiously object to abortion to pay for the service. More than 1 million people agree that this is a serious issue.
The abortion service is being packaged here as healthcare but I have yet to see where the practice of healthcare can be packaged by killing an unborn baby. That is what this health service amounts to in reality and it is being funded by the taxpayer.
An allocation of €12 million will be provided for abortion services next year, although given the way the Estimates work, additional funding could be provided. Let us take the first trimester figures from the United States and those published by the Department here. I am being generous with the figure. I know the Department has quoted a lower figure than this, but let us say the cost is €500 per abortion procedure and the allocation for the service next year is €5 million. That gives a figure of 10,000 abortions. That is why there is no regulatory impact analysis with this. The Minister does not know the number of abortions, or maybe he does and does not want to tell the public. Will there be 5,000 or 20,000 abortions? How many will there be?
I thank the Cathaoirleach and apologise to Senator Ó Domhnaill for interjecting. I take this opportunity to welcome to the Public Gallery the students of Breifne College in Cavan town, formerly known as Cavan vocational school, which I am proud to have attended. The students are accompanied by their teachers, Ms Aileen Connolly McGettigan and Ms Dolores O'Reilly. Among the students is a young man who sent me an email a number of months ago, Andrew McDermott, whose grandfather I know very well. On behalf of myself and my colleague, Senator Joe O'Reilly, who cannot be here because he is attending the Council of Europe, I very much welcome the students to this House, this place of legislation. They are listening to a very important debate today. Senators regularly debate very important issues here.
We have with us the Minister for Health, Deputy Simon Harris, who is not a school student, although he is not long out of school. He shows what education can do. I request the father of the House to come out and have his photograph taken with us.
I am anxious to conclude. I want to add to what Senator Wilson said about the lovely pupils from Cavan. I hope they have a wonderful day. Senator Wilson was right that the Minister probably does resemble an elder schoolboy. He still has his youthful good looks. I think that was the point the Senator was trying to make. That is a compliment in case the Minister thinks we are attacking him here all the time.
The point we are trying to make is that the amendment is worded to ensure no taxpayer provision would arise. We were not able to word it any other way because of the restriction on tabling amendments that would impose a cost on the Exchequer. Opposition Members cannot introduce amendments that would cost the Exchequer and we cannot tier it. The reality here is that, unfortunately, we do not know how many abortions there will be given that abortion will be unrestricted up to 12 weeks. We are dealing with scarce resources and competing demands. The taxpayer is not left liable for all of the services under the American model. Even if we look at the care provided, as I mentioned, and was outlined by the doctor's letter which I read, it appears that the funding provided for abortion services is much greater than the funding provided for the care the State extends to children who are born. That raises grave questions and would lead us to believe the Government is funding the termination of children to a greater extent than who are born.
I have seconded the amendment. The amendment arises out of a discussion on Committee Stage but it was not the subject of an amendment on Committee Stage. I raised the issue of the funding of abortion from taxpayers' funds on Second Stage. It is one of the many aspects of the Bill which has very little support among the electorate, with 60% opposing this proposal according to recent research. The amendment provides: "No public moneys shall be provided by the Oireachtas to pay for the carrying out of a termination of pregnancy, other than a termination of pregnancy in accordance with section 9 or 10 in a case where there is a risk to the life of the pregnant woman."
The amendment would provide funding in situations where the procedure is carried out to save the life of the woman in line with what has always been best medical practice in this country and in line with the basic principle that, where life is at risk, the State and the health service should do everything possible to avert that risk. I remind the House that Dr. Mary Holohan and others stated before the referendum that doctors were in no way impeded from addressing physical conditions of women arising from the eighth amendment. This amendment only prohibits State funding of elective abortions, that is, those carried out arising out of a choice as opposed to bona fide medical treatment.
When we say abortion is an elective procedure in all cases, it is to say that, other than in cases of emergency situations not covered by this amendment, it is a procedure which is optional and not medically indicated. There are only a very small number of situations where abortion is an acute procedure, in other words, where intervention is required in an emergency situation to save the life of the mother. There were just 13 such terminations in Ireland in 2017 compared with an estimated total of at least 4,000 abortions in 2017, either from those travelling abroad or importing abortion pills. Statistically speaking, about 99.97% of abortions performed on Irish women every year have been elective procedures carried out as a matter of choice.
In future, each of these procedures is to be entirely funded by the State. What other elective procedures are performed entirely at the expense of the taxpayer and the State in all cases? Perhaps the Minister can answer that question. I cannot claim to be familiar with the full range of procedures available in our public hospitals but I certainly cannot think of any. Representatives of the Irish College of General Practitioners, ICGP, and the Institute of Gynaecologists and Obstetricians were asked the same question at the Joint Committee on Health on 19 December. I think they said they could not identify another elective procedure which is funded entirely by the taxpayer. Will the Minister please address this point? Why is abortion to be the only elective procedure funded entirely by the State? Is the termination of pregnancy a more important procedure in his view than acute, life-saving procedures which are in need of public funding? This is why I do not believe the Minister when he says that he wants abortion to be rare. He is making an exception of abortion in wanting all abortions to be fully funded by the State. How can this be justified when other elective procedures will still be paid for by the person receiving the treatment, provided he or she can endure lengthy waiting lists?
As abortion is being rolled out as quickly as possible and free of charge, according to the HSE, the number of other elective procedures being carried out in our hospitals has fallen from 187,000 in 2012 to 86,000 in 2017 due to mass cancellations as a result of the chaos in our health system. Apparently, no elective orthopaedic procedures have been performed in Tralee General Hospital for much of the past six months. Meanwhile the Seanad sat until 2 a.m. on Wednesday, not to allocate funding to remedy that situation but to bring in a procedure for which funding will be fully allocated even while funding is not available for the situations about which I am talking. Members of Fianna Fáil, Sinn Féin and the Labour Party, who stand up in this House and the other House every day to complain about the lack of funding in the health system, have no objection to public money being spent on abortions at a time of dire funding needs for treatments that will save lives rather than end them.
When the Oireachtas Committee on Health discussed this matter on 19 September, Deputy O'Connell objected to the description of abortion as an elective procedure and launched into what has now become a trademark personalised attack when she said that to class women seeking an abortion as attempting to access elective services is to try to diminish women and is totally disrespectful of them. She attacked the Chairman of the committee, Deputy Harty, saying that the Chairman is a medical doctor and did not pull the member up on the usage of the phrase "elective services". If she had done any research on the point beforehand, she would have found that mariestopes.ie, the Irish website of the largest and most profitable abortion business in the UK, describes abortion as "an elective procedure". The website of the Irish Family Planning Association does likewise. Are they also diminishing and demeaning women? That would come as-----
That is not a point of order. Sometimes the enthusiasm of people who oppose Senator Mullen for whatever reason encourages him to expand his theories or views. I will chastise Senator Mullen in a fair way but I would like to allow him to conclude his point. He should not be interrupted. Members may not agree with his point but he is entitled to make it.
I am trying to say that there seems to be a doubt about whether abortion is generally an elective procedure. This amendment is about why taxpayers' money should not be made available in a blanket way for what are mostly elective procedures so it is entirely on point. We have just been through five years of gnashing of teeth about the right to choose and now that it is on the cusp of being introduced, we are effectively being told that it is offensive even to refer to it as a right to choose. This is just more of the Orwellian language that pervades the debate or so-called debate on this issue. It is the latest in a long line of words and arguments that involve words being used to do something other than what the dictionary says.
To return to the text of the Bill, abortions are to be carried entirely at the expense of the taxpayer and the terrible figure of €12 million has been put aside in the recent budget for the introduction of these services. A figure of €450 per abortion has been mentioned. I understand this to be way in excess of the money made available to doctors to accompany women through pregnancy in the normal course, and that raises questions.
This is a very important point. During the Bill's passage to date, the Minister has used the referendum result to bat away any and all criticism of the Bill, using it as a retrospective rubber stamp on its most extreme aspects, but he cannot do so in respect of the proposal to fund abortions from taxpayers' funds because it is a matter of public record that the Government made no such proposal in advance of the referendum. The proposal only emerged after the referendum. Writing in The Irish Times, Sarah Bardon, who I understand now works as an adviser to the Minister-----
In fairness, Senator Mullen should be very careful not to name any person who is not in the House and draw him or her into this debate. If the person writes professionally, that is a matter for him or her. I would be careful there.
As I was about to say, I mentioned a Mr. Winters the other night who wrote another article in The Irish Times. I am merely quoting The Irish Times, not criticising the writer. On 10 July, which was after the referendum, Ms Bardon wrote that "it is understood Mr Harris is examining whether services can be provided under the Maternity and Infant Scheme". The article went on to state that "that programme allows for maternity services free of charge when provided by a family doctor and a hospital obstetrician but this could be expanded to women who may require a termination of their pregnancy". The fact that it even crossed anyone's mind to use the maternity and infants scheme to pay for abortions does not even require comment. I must genuinely ask the Minister how he can look at himself in the mirror and not be even slightly perturbed or bothered by the notion that funding that is used to care for pregnant women and their babies will be diverted or that the budget will be expanded to pay for the ending of babies' lives.
An extraordinary aspect of this is the proposal that the service be extended to women in Northern Ireland. I do not believe this proposal has fully filtered down to voters but, if it did, I would imagine that public opposition to the State paying for abortions would increase even more than the 60% opposition that exists at present.
Those resident in Northern Ireland enjoy a better health service than we do in the Republic of Ireland or, at the very least, there is no evidence that the chaos that has wracked our health system for the past decade is in any way replicated north of the Border. In these circumstances, one can see how much this proposal could rankle with a great many people. I know that Deputies Michael Collins and Danny Healy-Rae have been running buses from Cork and Kerry to Belfast for cataract surgery and hip replacements in recent years.
I do not think that has anything to do with the current topic. Senator Mullen is starting to meander slightly, like the colleague I admonished earlier. I am trying to be fair but Senator Mullen should not draw me into making a decision he may not like.
I understand and I do not wish to, but the point I am making is that we have many inadequacies and deficiencies in our health service and what is being done here with public money is an unjust procedure that ends life. That contrast is important for the understanding of the amendment. This is what people are saying. My office received an email from a woman in Wexford who asked why there was such a terrible fuss about the fact that not every hospital in the country would have abortion on 1 January. She said that maybe somebody should point out that if her father had a heart attack, he could not go to Wexford Hospital but would have go to Waterford. I am getting that kind of correspondence as well. Even the poorest people in our society face certain fees for treatments and medication despite having medical cards, yet abortions are to be available for free even to the wealthy.
I am happy to leave it at that. There is more I could say but, as I have said on previous occasions, I do not want to repeat myself. I want to say no more and no less than what must be said. I remind my colleagues that this is the first time this amendment has been presented and I look forward to hearing what the Minister and others have to say about it.
I will be very brief. This is a disgusting and contemptible amendment that is directed specifically at the weakest and most vulnerable sections of our community. I would be ashamed to have my name attached to such an amendment and I call upon the proposers to withdraw it. The figure of €12 million is a piddling amount of money. It would not fill a pothole in Mayo and the Senator is bellyaching about it.
I will be very brief. I know the Minister will be able to respond in greater detail regarding most of the issues. There are so many inaccuracies that I will not attempt to address all of them. One that is key is the fact that it was made clear that it was intended to be publicly funded. I saw a billboard attacking the Minister for that very proposal during the campaign. At the time, I remarked on it as being an extraordinarily negative billboard.
It was very much part of the scaremongering at the time that this was going to be a hugely profiteering industry. In fact, the exact intention of the provisions of section 25 of this Bill, which directly prohibits profit in this area, when taken with the universal access provisions, is to ensure this service is provided on the basis of need and no inappropriate incentive is attached to it for any company. It is very important that these services are publicly delivered. The many people who campaigned in favour of the repeal of the eighth amendment made it very clear that they were doing so on the basis that there would be free, safe and legal access to these services. I believe most people share those aspirations for all aspects of our health service. They believe it should be free, legal and safe. In light of the deep and cruel inequities in the American system, where people are having contraception removed from their cover, it is extraordinary to hear similar measures being proposed as some kind of alternative here. Such proposals are disrespectful to a country which has a national health service, and where people know the value of having a national health service which is a national health service.
I remind those who have spoken about the taxpayers of Ireland that it is clear from all surveys of Irish taxpayers that people want public services. They want a health service that is delivered publicly. I applaud this positive aspect of the Bill. We should not be challenging it in any way. In that context, I would like to note briefly that there is a rebranding attempt in section 12. It is not a matter of what is elective. Senator Mullen has used the word "elective" in respect of section 12, which relates to the period of early pregnancy when people access these services on the basis of need, for example following rape or incest. We are trusting the woman to know it is necessary. The committee found that it is neither possible nor feasible to determine rape or incest within the applicable time period, and therefore we are not seeking to provide for that. I remind those who are concerned about safety - again, the phrase "free, safe and legal" comes to mind - that this approach is being taken because these matters are time-sensitive. We do not want to move into a time period that might cause people to unnecessarily have procedures or surgical interventions that are less safe. An attempt has been made to add a layer of extraordinarily expensive, medically unnecessary and deeply distressing procedures to the proposed regime. This proposal is somewhat hypocritical because it would add not only to the cost involved, but also to the difficulty and distress of these procedures.
I want to make it clear that throughout the referendum campaign, Senator Bacik and I were among the many people who argued that these services should be free, legal and safe. There should be no misunderstanding in that regard.
I reiterate that I am here all day. I might even be here all night. I am ready to face any charges that people might wish to level at me. I do not wish to see the names of members of my staff dragged onto the record of the House. I do not want to see points made about them when they are not in a position to defend themselves. I am very lucky with the people I have working with me. Perhaps Senators should pick on people who are here to defend themselves.
In light of the points made by Senator Higgins, I find it bizarre that certain Senators would suggest that this aspect of what we are proposing has come as a great surprise or shock. Certain Senators who campaigned on the "No" side constantly told the electorate that if the referendum were passed, the Minister would try to make these services free in this country. I saw the billboards with my name on them that were erected around the country as part of very personal attacks and said I would ensure this service would be funded by the taxpayer. Op-eds were written in newspapers. Press releases were issued. Those who campaigned for a "No" vote made it very clear what my intentions were. I thank them for doing so. In bringing forward this service in my role as Minister for Health, I have always been very clear that it should be free, safe and legal, as Senator Humphreys has correctly said. If it is not free, we will end up preventing certain sections of our society from accessing safe and legal services
In such circumstances, vulnerable women, in particular, will end up continuing to have to use illegal abortion pills that are purchased online, or indeed continuing to travel. If we want people to be able to access new services that are safe and legal, it makes sense to make those services available on a universal basis. Those of us who are in favour of caring for women in our own country in terms of abortion care and healthcare find the word "elective" offensive because, as Senator Higgins has said, those who use it are judging women's reasons for accessing these services and pretending they know those reasons. There is always a reason. No woman gets up in the morning and decides she would like an abortion. The connotation that accompanies the word "elective" suggests that a kind of light-hearted decision is being made. That is why it is constantly used. Senator Mullen might not use it in that way, but that is the way many women to whom I have spoken consider that it is being used. There is always a reason for an abortion - it is just that the woman involved does not need to tell the Senator that reason. We trust each woman to engage with her doctor. We do not need anyone to judge their decisions. If we are going to continue to quote other countries' legislation as fact in this country, it will be a very interesting day. I thought we were a sovereign Republic. We should really debate the legislation that is before the Houses of Parliament of our Republic, rather than saying "in another country they have this law" and applying figures from that country as fact to the Republic of Ireland.
It is a bizarre way of operating. I am sure some of the €12 million that has been mentioned will be spent on some of the things that Senators Mullen and Ó Domhnaill do not seem to have a problem with. I acknowledge that they do not have a problem with providing funding where there is a risk to a woman's life. That is the first point. The second point I would make is that €12 million out of a budget of €17 billion works out at 0.0007% of the 2019 health budget, by my calculations. I am not sure about what Senator Norris said about filling a pothole in County Mayo, but he is certainly correct when he suggests that it is a very small sum of money. It grates on every bone in my body when people point to other challenges in the health service as a reason not to do this. They seem to be suggesting that when everyone in Ireland has had a cataract operation or a hip operation, maybe we can come back and talk about women's reproductive health. They seem to think that a woman must wait until that point has been reached. I heard the debate that the Seanad had to celebrate 100 years of women's suffrage in this country. The suggestion that we might get around to women's sexual health in another 100 years, after we have sorted out cataracts, is a terrible sort of backdrop against which to be celebrating and commemorating that anniversary. Of course we are going to sort out cataracts. Senator Mullen rightly pointed out that it is a cause of great frustration to me as Minister and to citizens in this country that our citizens sometimes travel for healthcare. I remind him that this Bill is addressing that. It is stopping women having to travel for healthcare. The Senator has a difficulty with a man getting a bus from Cork to Belfast for a cataract procedure - I am not happy that this needs to happen - but he has no difficulty with a woman and perhaps her partner having to get the plane or the boat to Liverpool. There is an irony in that situation.
In this country, we already provide free healthcare for pregnant women. I think that is one of the successes of past Governments. It is something that enjoys widespread support across the political spectrum and across society. We provide free healthcare for pregnant women. The Senator is suggesting we should provide free healthcare for certain pregnant women only. He is saying that free healthcare should not be provided to a pregnant woman unless we like the decision she has made. Under his approach, two women sitting in a GP surgery would be treated differently. The woman who decides to continue with her pregnancy would be told that it is no problem and the State will meet the cost of her healthcare. The woman who decides for her own reasons - there is always a reason - that she cannot continue with her pregnancy would be sent a bill. The particularly offensive aspect of these amendments is that they exclude fatal foetal abnormalities. I am sure that is not accidental. The Senator has gone through the legislation and chosen certain sections that he is happy to exempt from his non-universal provision of service. Unless he tells me otherwise, he has made a conscious decision to exclude fatal foetal abnormalities. Maybe he is saying that after a family has gone through the most horrific situation - we have all heard these stories from the Termination for Medical Reasons Ireland group - we should send them a very hefty bill for the use of the hospital bed and for all they have gone through. I do not believe that is something the citizens of this country support.
I would like to make a final point. I have heard continuous references in this House and in the other House to an opinion poll. I am not going to go back through what I heard in the other House. God almighty, are we going to start quoting opinion polls? If opinion polls were always right, Brexit would not have happened and Hillary Clinton would be the American President. By the way, we had a referendum and not an opinion poll. Senators keep quoting opinion polls. I thought that as politicians, we do not pay any attention to opinion polls. We had a poll. Lots and lots of people voted. More than 1.4 million people voted for us to get on with this. Today, we are going to get on with it.
I will start on the last point around opinion polls. The opinion poll in question is the only one to have been taken on this issue since the referendum.
If the Minister has so little faith in opinion polls, then why is the Government spending so much money on all sorts of internal polling to find out what people think and then issuing a policy based on what people think? That is what happens within Departments and Government. We saw how the Taoiseach had to calm down his spin unit, which was effectively a polling spin unit carrying out polls to find out what people think and basing policy around it.
The Minister should not be disingenuous. He should at least acknowledge this is the only credible poll, with plus or minus 3% accuracy, that has taken place since the referendum. The question in the poll relating to taxpayer funding was whether people were in favour of or opposed to taxpayers funding unrestricted abortion up to 12 weeks. The results found that 88% of "No" voters did not favour taxpayer funding with the same view held by 44% of "Yes" voters. Overall 59% of all adults who were surveyed opposed the taxpayer funding model of abortion. That is in line with our amendment.
According to the World Health Organization every year in the world there are 125,000 abortions. It is a lucrative industry worldwide, whether people want to acknowledge that. It would be wrong and complicit of the Government to enter into the policy in this Bill that would allow that industry to flourish in future. That is essentially what is happening here. Taxpayers are entitled to conscientious objection on a moral issue of life or death. This is a life-or-death Bill. The amendment does not include sections 9 or 10.
The World Health Organization document on technical and policy guidelines for health systems makes it absolutely clear in the recommendations that financing of abortion services should take into account costs to the health system while ensuring that services are affordable. However, "affordable" is far from being universal. That is the point I am making.
I would not like to fall into a pothole that would cost €12 million to repair - that is for sure. The Minister's argument that €12 million is only small change in the overall expenditure of the Department and that it represents only a small percentage simply does not wash. A total of €12 million is not small change. We live in the real world and €12 million is a great deal of money. We are setting out with €12 million but, based on this Bill, if passed, the figure will increase substantially.
Reference was made to the campaign issues around billboards and people who campaigned to say that it should be universally available. That may be so for campaigners on the pro-choice side but the Government position was clear. It has since changed or the truth has been revealed. On 31 January this year, the Taoiseach attended the launch of the referendum campaign. He said that abortions would be safe, legal and rare. That is not what is in this Bill. There is nothing about rarity in this Bill. The taxpayer is going to fund universal abortions up to 12 weeks irrespective. The dishonest language, the spinning of this issue and the tactics being used are disingenuous. The perception that it is only a small amount of money adds to the vacuum that has been created around this area and the dishonesty that has been attached to it. Unfortunately, what will happen is that, as Deputy MacSharry, a good colleague of mine, said in the other House, abortion up to 12 weeks will become the contraception of choice for some people.
That is a major worry. The research I quoted from the survey results points to how the public are not satisfied that this would be a universally-based system universally funded through the taxation system. It simply does not fit well with the public. The danger always runs that this will spiral. We have seen every year how politicians applaud the increase in funding to our health service. Has the system become any better? No, it has not. In fact, it has got worse. This element of funding will be like a runaway train, like the HSE funding. The figure of €12 million will continue to increase. That is where the concern lies. That is why we wanted to have a real debate on this issue. Clearly, the Minister has made up his mind and is not willing to engage on this or any other issue. That is regrettable.
As fewer than five Members have risen, I declare the question defeated. In accordance with Standing Order 61, the names of the Senators dissenting will be recorded in the Journal of the Proceedings of the Seanad.
I would be very grateful for the indulgence of the House. I wish to thank colleagues who earlier spoke on the Vótáil 100 motion to mark the centenary of women's suffrage. In my very short speech on the motion, I omitted to thank the Oireachtas communications unit led by Mr. Derek Dignam and Mr. Liam O'Brien for its amazing work over the course of the year in organising the programme of events. I wish to put on the record my sincere thanks, those of the committee and all other Senators for its great work in making the centenary events and Vótáil 100 programme such a success.
I will explain the position to the Minister.
The amendment has been moved and seconded and the Senator does not wish to speak on it. Since no other Senator is offering to speak on it, the Minister may respond when ready.
I provided a briefing yesterday for Senators through the Seanad Office. A number of the Senators attended. There was an opportunity to hear from the Chief Medical Officer, from Dr. Peter Boylan, former chairman of the Institute of Obstetricians and Gynaecologists, and from Dr. Mark Murphy, a general practitioner involved in the rolling out of the service.
Explained very clearly at the meeting was the rationale behind the use of the word "examined" rather than "consulted with" or variations thereof. The logic was that the word "examined" had a degree of legal and medical clarity that variations did not have. Even in our exchanges yesterday, it became apparent that sticking additional words into the legislation would have placed, for entirely unintended reasons, additional barriers and tests in the way of a doctor trying to provide a service to a woman. Based on the very strong legal advice I have received and the reasons outlined by medical professionals, including the Chief Medical Officer, to Members of the Seanad, including a number of sponsors of this amendment, I strongly urge the House to reflect on the matter. For that reason, I oppose the amendment.
I concur with the Minister. I have not spoken on the Bill at any Stage up to now. I was involved with the Acting Chairman, Senator Noone, and other Members in the work of the health committee dealing with the legislation on the protection of life during pregnancy.
For us, it is now important to reflect on what the Minister said given what the amendment could bring about. I genuinely understand the motivation behind it. All of us who were members of the committee, including Senator Gavan, will realise it is a matter of ensuring no unintended consequence or, indeed, intended consequence that could have ramifications that are not desirable. Those of us who campaigned, offered support and worked in this area recognise the importance of what the Minister said about medical advice. It is a question of ensuring we do not place obstacles in the way of the woman. That is the important point. It is about the doctor and the woman. From talking to people in the medical profession after the referendum, I know the important point, which is related to the central point that was confused and clouded for a long time, is that we must bring clarity and certainty to the matter. I ask the Members who are proposing the amendment to reflect on it and, if they can, not push it to a vote. It is a matter of ensuring this Bill provides what we all want and that we do not put a barrier in the way of women. I ask Members to reflect on that.
I welcome the Minister to the House. As one of the proposers of the amendment, I was delighted to be able to attend in full the briefing yesterday that the Minister held so helpfully with Dr. Peter Boylan, Dr. Mark Murphy and others. I found it really instructive. As one of the proposers of the amendment, and as I explained at the meeting yesterday, I had also taken the view that "consulted with" was more inclusive and less paternalistic than "examined". However, having listened to the briefing, particularly to the explanation of Dr. Boylan and Dr. Murphy, I was persuaded that "examined" is preferable. Senator Devine spoke very powerfully from her professional experience about the use of the word. Therefore, I am happy with the word. Notwithstanding that I have co-signed the amendment, I would be happier to see it withdrawn and not put to a vote.
Amendment No. 3, in the name of Senators Norris, Craughwell, Ruane, Bacik, Higgins, Kelleher, Grace O'Sullivan, Black, Conway-Walsh, Devine, Gavan, Mac Lochlainn, Warfield and Ó Donnghaile arises out of Committee proceedings. Amendments Nos. 3 and 19 are related and may be discussed together, by agreement.
As Senator Gavan said, these reasons were well aired and argued in the course of the work of the committee on the eighth amendment. The risk or threat of harm to a woman should be a high enough threshold for her to get access to the abortion she needs — full stop. I know, however, that the Minister is not for turning on this matter on foot of legal advice. He set that out quite clearly yesterday and I appreciate where he is coming from. I also accept the focus now is on the guidelines for doctors and practitioners, and that the matter is rightly in their hands, not the Minister's.
I am encouraged by the draft guidelines for general practitioners issued by the Irish College of General Practitioners. They are good, clear, sensible and enabling guidelines. I hope the Institute of Obstetricians and Gynaecologists will follow suit with similar enabling guidelines for its members and not allow any conscientious objectors to hijack those guidelines. I ask the Minister to ensure his departmental officials will ensure good guidelines are in place for doctors of all kinds, including general practitioners, obstetricians and gynaecologists. I will not be pressing the amendment but, since it is sponsored by a group, I obviously have to take cognisance of what colleagues might wish to do.
I tabled this amendment because I was concerned that "serious" is a vague qualifier and might require doctors to delay access to health-preserving treatment where a woman's health deteriorates, even in emergencies. I have been briefed by a series of female doctors who say the current wording sets a very high threshold for access to abortion in all circumstances after 12 weeks. Once the 12-week protective period has passed, lawful abortion will be available only for reasons related to a serious health risk. This is unlikely to serve the needs of pregnant people in Ireland, some of whom will seek abortion after 12 weeks for other reasons. These are serious considerations. However, I understand from my colleagues who attended the briefing that the evidence given by individuals such as Dr. Peter Boylan was so persuasive that they have decided not to push this. Therefore, as the proposer of the amendment, I am happy to withdraw it.
As a member of the committee, and although I respect Dr. Peter Boylan and should have gone back over his contributions at the committee hearings, I definitely feel there was enough medical advice given during the hearings by various medical practitioners that the word "serious" is not necessary and is, in fact, a problem. If the amendment is to be pressed, I will definitely be supporting it.
I genuinely appreciated the meeting yesterday and the genuine attempts made to reach agreement. We were not persuaded fully by the case made. All members of the committee heard that one cannot grade risk in terms of pregnancy because it changes so quickly. Therefore, Sinn Féin wishes to continue to support the amendment and press it.
I take Senator Kelleher's view on this. I am a co-sponsor of the amendment with my Labour Party colleague. Many of us felt the word "serious" would elevate the level of risk and operate as a barrier to women. I found the briefing very persuasive yesterday regarding why the word is included. It is important for any of us on the pro-choice side who have concerns to examine the full text of the test set out in section 9 and examine in particular the test set out in paragraph 9(1)(c).
Having listened to Dr. Boylan and Dr. Murphy, I am satisfied it is a test that is operable for doctors and does not pose any additional barriers to women's access other than what was set out in the campaign on the deletion or repeal of the eighth amendment. I would prefer a different basis or framework on which women might have access to abortion, and one that might set the bar lower, but that is my personal view. I am, however, very cognisant that this was the framework on which we campaigned for repeal and on which there was a general consensus in the repeal movement that we should campaign. Doctors have told us it is an operable framework that does not pose a barrier that is too inaccessible in the provision of safe and legal abortion. This is my overriding concern, along with my previously expressed concern that I want to see the legislation brought into effect so we can ensure women have access to the abortion services we so badly need from 1 January.
I do not have much to add but I will make some quick points. I understand the value of teasing out, as we did in the other House, what is harm, serious harm and risk. My first point is similar to Senator Bacik's. This wording has not changed since the publication of the draft wording and this is very much the framework on which we campaigned. As the Senators know, it is something I am holding to as we take the legislation through the Oireachtas.
Senator Kelleher is entirely right and it is appropriate that these matters are teased out in guidelines written by clinicians who will be operating under the law, as opposed to people like me being overly prescriptive. I do not mean to be pejorative but we, as legislators, may accidentally interfere in the work of clinicians getting that right. I fully agree with Senator Kelleher that it is very important we have good guidelines. There is much work being done by many really dedicated clinicians to ensure that is the case. I have consciously taken the decision, as has the Government, not to define the word "serious" in the legislation. If we did so, we would tie the hands of doctors. This must be about clinical judgment, which is important. I imagine the concerns of the people would be more heightened if the word "serious" was defined. I would not have brought in legislation in that regard.
Senator Bacik made the important point that we need to read section 9(1) in totality as all the words matter. If we pick just one word, such as "serious", but do not consider the likes of the word "appropriate", we might miss the context. On the basis of the legal advice and the clinical information we heard yesterday, Seanad Éireann should not amend the section.
Colm Burke, Jerry Buttimer, Maria Byrne, Martin Conway, Frank Feighan, Anthony Lawlor, Tim Lombard, Gabrielle McFadden, Michelle Mulherin, Catherine Noone, David Norris, Kieran O'Donnell, Marie Louise O'Donnell, John O'Mahony, Diarmuid Wilson.
Amendments Nos. 4 to 6, inclusive, 8, 9, 21 and 22 are related and may be discussed together, by agreement. Amendment No. 5 is a logical alternative to amendment No. 4 and amendment No. 6 is a logical alternative to amendment No. 5.
I wish to speak to my amendment No. 6. There is a very serious concern over the word "avert", which we have discussed at length and on which I understand there has been commentary from different sides. It was aired on Committee Stage in the House so we do not have to go into too much detail on it. "Avert" is an absolute word which is generally construed as meaning to "stop" or to "turn aside", and this was the language used by the Minister on Committee Stage.
The concern is that putting in a requirement to avert could be highly burdensome. An action may have been clinically shown to be likely to reduce a risk from 60% to 20% but not to fully avert that risk. My amendment is not in perfect English but it is an attempt to respond to the Minister's point on Committee Stage that it was the word he had put to the public. I have suggested "avert or substantially avert" to indicate there is scope in the word "avert". In yesterday's briefing, we were told that "avert" related to the increased risk and not to serious harm. It would be impossible to say we can avert serious harm. We can diminish the risk of serious harm or mitigate it but, if an action results in harm, could there be a vulnerability in its interpretation in this context? In the expected implementation of this provision, did the Minister say this was to avert an increase in risk, but not serious harm? I think many doctors would be very reluctant about this provision in the context of variable clinical settings and medical conditions that move very quickly across the spectrum. Can the Minister clarify this?
My amendment suggests "mitigate" instead of "avert". It is about interpretation and states that nothing is absolute. Unnecessary stuff happens. I seek to eliminate the wrong interpretation of what happens in the medical context. Mitigating means reduction, in order to protect the health and safety of the mother if a termination of pregnancy occurs. It applies where pregnancy substantially increases the risks associated with pre-existing medical conditions.
The word "mitigate" will bring it back to where it was before, while the word "avert" will mean that it is null and void, has gone away completely and been eliminated. That is the wording and interpretation we will be pushing for.
I found yesterday's briefing with the doctors very helpful in understanding how this test in section 9(1) will work in practice in terms of the clinical decision making about the appropriateness of carrying out a termination "in order to avert the risk". That is the wording in section 9(1)(c).
It is a matter of reading the words all together in their context. Like Senator Higgins, I would like the Minister to clarify, as we heard yesterday at the briefing, the nature of that clinical decision-making test. It is important that we do not just take one word in the test out of context and that we consider how the test will operate in clinical practice and how it will be operated by doctors. It was very useful to hear the practical illustrations given to us by doctors yesterday to explain how this would work in practice, and how it will work to enable women to access abortion in the sort of life-saving or serious harm-averting circumstances envisaged in section 9.
I have heard from the Attorney General and the chief medical officer and from our clinical adviser, Dr. Peter Boylan, that their preference is for the wording to remain as it is, legally and clinically. Several Senators had an opportunity to hear from clinicians yesterday in that regard too.
I really welcome Senator Higgins's amendment, not because I am in a position to support it but for the exact reason that she outlines, because it does provide me with an opportunity to correct what had been a misinterpretation or a discussion that has not been formed in fact, in terms of what the words in the legislation say. Senator Bacik is right; we should read all of the words. To take this sentence as an example, it states "it is appropriate to carry out the termination of pregnancy in order to avert the risk". The phrase, "serious harm" is not even in that sentence. We have been having a discussion in the other House about whether it is better to avert or mitigate the serious harm but that is not in the legislation. The question is does it "avert the risk". I want to be crystal clear, and it is easy to be because it is there in black and white, that this legislation talks about averting "the risk", not about the test being to avert the serious harm. They are substantially different and are legally and clinically understood to be substantially different.
In response to the amendments tabled by Senator Devine and her Sinn Féin colleagues, I would make the same point and add one more. We need to be very careful about putting additional words into legislation, particularly on Report Stage, rather than reading the section of the Bill in its totality, which has been so robustly legally tested and scrutinised by the Attorney General. I worry when we start sticking in the word, or anything, that we are applying another test or another thing a doctor has to consider. We saw yesterday that there is great clarity among those working to roll out this service on what "avert" and "avert the risk" mean. This is very much also in line with the draft general scheme published in advance of the referendum. I propose not to accept these amendments but to welcome the opportunity to provide that clarity, that it is a question of averting the risk not about averting serious harm.
Ivana Bacik, Colm Burke, Ray Butler, Jerry Buttimer, Maria Byrne, Lorraine Clifford Lee, Paudie Coffey, Martin Conway, Frank Feighan, Anthony Lawlor, Tim Lombard, Gabrielle McFadden, Michelle Mulherin, Gerald Nash, Catherine Noone, David Norris, Kieran O'Donnell, Marie Louise O'Donnell, John O'Mahony, Neale Richmond.
I move amendment No. 6:
In page 8, line 25, after “avert” to insert “or substantially avert”.
The Minister indicated that this was to avert risk. Is he saying that it refers to averting the risk of a continuing pregnancy, not the risk of serious harm but the risk that a continuing pregnancy would add to serious harm?
Amendment No. 7 in the names of Senators Conway Walsh, Devine, Gavan, MacLochlainn and others arises out of committee proceedings. Amendments Nos. 7 and 12 are related and may be discussed together by agreement. Is that agreed? Agreed.
I move amendment No. 7:
In page 8, to delete lines 33 to 38 and substitute the following:“(4) The obstetrician referred to in subsection (2)(a)shall make such arrangements as he or she will deem necessary for the carrying out as soon as may be of the termination of pregnancy to which the certification referred to insubsection (3) relates.”.
Colm Burke, Ray Butler, Jerry Buttimer, Maria Byrne, Lorraine Clifford Lee, Paudie Coffey, Martin Conway, Frank Feighan, Anthony Lawlor, Tim Lombard, Gabrielle McFadden, Michelle Mulherin, Catherine Noone, David Norris, Kieran O'Donnell, Marie Louise O'Donnell, Neale Richmond.
I will simply put on record the content of the briefing I received from doctors as that would be the most economical use of my time. It states the following.
This section is intended to enable access to abortion for those people who find themselves in the distressing circumstances of having received a diagnosis that their pregnancy is not likely to lead to a positive birth outcome. In contrast to the wording of the General Scheme published in March 2018, the section now specifies that the foetus must have a condition likely to lead to death within 28 days of birth. While diagnosis of foetal anomaly involves high levels of certainty, prognosis does not. While it may be possible to predict that death soon after birth is likely, it is not usually possible to set out the exact time frame within which it will occur. Timelines of this sort are not currently used in clinical practice as part of the prognosis for a particular condition. The legislation clearly excludes cases where life expectancy after birth is short, and potentially burdensome and painful for the recently delivered foetus. This means that parents who receive diagnoses of serious and fatal anomalies, but where a life expectancy of less than 28 days cannot confidently be predicted, will still be required to travel abroad for abortion care if they decide they cannot continue with the pregnancy.
There is nothing to suggest that the 28-day time limit excludes invasive and intrusive measures to keep the newly born foetus artificially alive, but possibly in great pain and with little or no prospect of independent, pain-free survival. The 28-day time limit has not been scrutinised ... There is no need to specify a timeline for foetal death in the legislation; instead the wording as proposed in the March 2018 General Scheme [should] be restored. This clearly limits access to lawful abortion to situations of fatal diagnosis for the foetus, but better supports parents who decide it would best to access abortion care in Ireland where an exact life expectancy cannot be clinically predicted.
I thank Senator Norris for tabling this amendment. To be clear, the reason the word "shortly" needed to be replaced with a defined period was primarily legal advice, but also inquiries from clinicians as to what exactly the Houses of the Oireachtas meant by "shortly". There was a fear that if the word "shortly" were put into the legislation, it would not provide direction or clarity as to what we mean as an Oireachtas. While the Senator is entirely correct that the word "shortly" appeared in the original scheme published in March, on the basis of the Attorney General's legal advice there was a view-----
I apologise. I was making the point that while Senator Norris is entirely correct that the word "shortly" appeared in the general scheme published in March, it was on the basis of the Attorney General's advice that we needed to define what was meant by that. When I spoke to clinicians, they told me there is really a choice of two timeframes from a clinical perspective, either seven days or 28 days. The latter is known clinically as the neonatal period. We opted for the 28-day period.
I will make two points in direct response to Senator Norris's amendment. First, what about protection for a doctor? Sometimes things are not an exact science. I contend, as would the Attorney General, that the phrases "of the reasonable opinion" and "formed in good faith" provide a clinical protection because what we are asking our clinicians to do is to arrive at a viewpoint in their reasonable opinion and in good faith. I think this gives our clinicians protection in that we are trusting them to make the appropriate decisions.
The Senator also raised a very important issue about viability when he asked whether there would have to be very intrusive measures. I refer him to the definition of "viability", which is in a different section of the legislation, which states "without extraordinary life-sustaining measures".
Of course, any baby born in a hospital should be given all the supports of a neonatal unit. This is "without extraordinary life-sustaining measures".
For these reasons, and based on my engagements with some clinicians working on the roll-out of this service, the legal advice of the Attorney General and the other definitions in the Act, I do not propose to accept the amendment.
This amendment is effectively a consequential amendment that relates to section 12 abortions. As the Minister will recall, it was our desire to get the Minister to follow through on a pre-referendum commitment he gave that abortion would be specifically excluded where the certifying medical practitioner formed the reasonable view in good faith that it was being sought on the grounds of diagnosed disability. Our amendment also would have protected unborn children where abortion was sought on grounds of sex or race. Section 12 is the section in which abortion, the termination of pregnancy, the procedure intended to end the life of the foetus, is available without reference to grounds of medical necessity. It is very sad that only earlier today the Minister sought to cast scorn, as did others, on my use of the term "elective" to describe such abortions when I had already pointed out in my speech that the term "elective" is used by organisations such as the Irish Family Planning Association and Marie Stopes abortion providers, which it can be said do not care very much about the life of the unborn child. For the Minister to-----
For the Minister to employ another verbal device is to engage again in the politics of casting odium rather than engaging in specificity and honest and truthful analysis of what the various sections present. Clearly, what we have seen in this legislation is the elevation of a certain ideology of choice over the welfare of unborn children and, at the same time, a medicalisation of claims for abortion that are not in keeping with time-honoured bona fide medical healthcare for women, including where such bona fide medical care would adversely affect the unborn child, which has never been opposed.
That was the reason the amendment on taxpayers' money was so important. Although the Minister in his analysis of our amendment sought to confine the issue to cases he could speak about in emotive terms, the reality is that the vast majority of cases of abortion, and I gave the figure of 99.97% in Britain, do not have anything to do with what one could call medical grounds. That is why it is such a corruption of medicine and is so wrong and unjust.
It is worth quoting from O'Flaherty J, in the case of McKenna v.An Taoiseach, where he stated: "The public purse must not be expended to espouse a point of view which may be anathema to certain citizens who, of necessity, have contributed to it." This Bill goes much further than that by expanding the public purse to take countless innocent lives, something that is clearly anathema to at least hundreds of thousands of citizens. The taxpayer funding scheme is contrary to the will of the majority of adults in Ireland, as we pointed out was correctly shown in an Amárach poll. With so much polling taking place, sometimes at taxpayers' expense, to test the waters on what can be successfully promoted and pushed, I found it interesting that when serious opinion poll evidence emerged, including in the exit poll after the referendum, which was a very professional affair, this Government, which is so reliant on polls, cast doubt on the information we were deriving from polls. This is another example of the politics of rhetoric over substance.
I might say in passing that it was interesting that I was criticised earlier by both Senator Higgins and the Minister for pointing out that the Minister was not truthful or forthcoming before the referendum about his intention that abortion would be made available freely and paid for by the taxpayer. It is interesting also that while Senator Higgins said that several of my comments were inaccurate, she did not manage to point to one. The one she attempted to point to was that there were billboards attacking the issue and making this claim. The Minister then said that we should almost be glad that he was following through on his promise. What he is basically saying is that he was very clever in keeping shtum, whereas we who campaigned against abortion were worried about and feared it so we cannot complain now that he has pulled this rabbit from the hat after the referendum. That is a very dishonest way to do politics. What the Minister has failed to contradict is our statement that there was no-----
With respect, the Senator is wandering into the area of funding and the referendum. I acknowledge that his amendment is very technical and I do not want to be unfair to him, but I cannot allow the Senator to rake over old coals in terms of what the Minister said or what was said before and after the referendum.
We have before us legislation that is current and live and that is what we must deal with. The Senator is entitled to criticise and oppose it all he wants but I have to be fair. I will not allow him to use time on Report Stage to unduly delay the passage or non-passage of the Bill, as the case may be.
I acknowledge that, a Chathaoirligh. While I am very conscious of that, I am also conscious that this debate is to some degree an elegy for the unborn child. Ireland is changing for the foreseeable future in its definition of care for the most vulnerable human beings.
I am concluding. A better day is coming, as I will say later, but it is not thanks to this Government that there is hope in the future for unborn children and their mothers who, as we know, often suffer after abortion.
This amendment is consequential to an amendment that sought to make the Minister carry through on his promise that disability would be specifically excluded. He will be fairly but critically judged in the future for not having been upfront on that issue because, unfortunately, disability is not excluded. In the same way, he will be critically judged for never engaging in honest debate about the consequences of such wide-ranging abortion, namely, opening us up, sadly, to the risk of abortion rates similar to those in Scotland which, with a similar population, has approximately 11,000 abortions a year.
The Minister attempts to portray opponents of this legislation as being somehow opposed to healthcare, but nothing could be further from the truth. In this amendment in particular, we want bona fide quality healthcare for women and their unborn children, as we have always wanted. Dressing up elective abortion as healthcare is a dishonest tactic. It is easy to see why it is employed. It is about making something that is deeply unjust look somehow respectable and good. It is the politics of absolute untruthfulness. It is a tragedy for everybody involved, including those who engage in that type of politics.
The effect of my amendment would be to delete the requirement for a three-day waiting period. This has been discussed so I will not go into it in any great detail. We run up against cases where some pregnant women will have to attend multiple meetings with doctors. A case was also instanced on Committee Stage where a woman was refused an abortion because the doctor had a conscientious objection. She came up against that hurdle and that lengthened the time. I am seeking the deletion of the three-day waiting period.
Two of my amendments are to this section, namely, amendments Nos. 17 and 18. I welcome the few hours we spent with the Minister and doctors yesterday. This is one of the areas on which I have been persuaded a little, whereas I was not convinced by the argument against deleting the word "serious". It is important that these important points are not debated in rooms elsewhere. It is better to have them on the record of the House. Amendment No. 17 deals with how a threat to a woman's life or health might arise from her living circumstances and the possibility that she may have to see a doctor on two or more occasions to access the healthcare she needs. We got to a point yesterday where there was an acknowledgement that some women do not believe they have the ability to advocate for themselves, their healthcare and their rights, perhaps because they are members of a minority group or another group or for reasons of low educational attainment. It is all well and good talking about a public campaign and helplines but these do not always reach everyone. The important point for me was how these women would know that they would come under an emergency provision or even that they could inquire of their doctors about an emergency provision. What became apparent to me is that in regard to all health inequity, a certain amount of awareness training is needed for doctors who work in areas of deprivation to ensure they understand the social context in which they work.
It is about being able to understand the situation of a woman in poor living circumstances and, in a primary care setting, to be able to make that woman aware that there are provisions available to her, rather than expecting that she would already know about them and be able to advocate for access to them. We had some discussions on this yesterday. Perhaps the Minister might comment on that in respect of amendment No. 17. Programmes exist to train GPs to work in areas of deprivation and it would be helpful to know whether the provision of terminations and the related services will also be included in this training for that group of women.
On amendment No. 18, it is something on which we have never had a clear answer. Where a woman's first access to a doctor results in a conscientious objection, having waited for an appointment and visited the doctor only to be told that an abortion would not be provided for her, I want to ensure that once she had subsequently found a provider who would give her the service she needed, that she did not have to wait a further three days. Awareness campaigns do not always reach every community. Will the Minister justify why we would not allow for the three-day period to begin from the first doctor's appointment, even if it resulted in conscientious objection?
I refer to amendment No. 17, on which we are co-signatories. As Senator Ruane said, we did discuss this at length with the Minister yesterday and we debated it at length on Committee Stage. It is critical that section 12's three-day waiting period does not become an insurmountable barrier to some women. It is critical that in guidelines, doctors are given great clarity as to the linkage between section 12, the early pregnancy section, and section 10, that of the risk to life or health in an emergency. As Senator Ruane noted, the question of how this will work in practice with doctors is crucial. We must ensure that doctors, and everyone else, understand that section 10 applies at any point in the pregnancy before the end of the 12-week period, so that it will work in parallel with section 12. That is very important for those of us with concerns about the three-day waiting period. We would prefer if it was not in the legislation but we are trying to do the best we can to ensure that it does not become an insurmountable barrier to some women in the sort of circumstances that Senator Ruane so eloquently described.
When we come to amendment No. 14, Senator Norris has asked that I withdraw it on his behalf.
This is one area where we have effectively been asked to put our trust in the training that might be provided for doctors, in terms of clinical guidelines and how things unfold. I want to mark the real concerns in this area. It is not merely the case that the guidelines are there but there must be engagement on how the practice unfolds. We must ensure that, for instance, the word "serious" is not interpreted in such a way that it does have a chilling effect in practice. We must ensure we monitor what happens and that we listen, because it took a long time as a nation to listen to the stories of women, and doctors, as to how things tend to unfold in reality. Either these will go forward and be successful or we will have to revisit these issues. If "serious" is interpreted in a way that it was in symphysiotomy, and I hope that never happens, whereby something would be regarded as not serious so long as a woman could continue reproducing, it will be an issue. That has happened in Ireland and many of these issues are almost cultural. I accept that we may not want to deal with all of these in legislation but they are matters of practice.
We should be watchful of a pattern emerging in which people attend a first appointment but do not follow up three days later. There is concern that visiting the doctor can be a great effort for people in difficult living situations, particularly in situations of violence, insecurity or in which their attendance anywhere is attached to the care of many other vulnerable persons of whom they may be the carer. We should be careful that people need not look to alternative routes because this serves as an obstacle. I accept that the emergency provision in section 12 may serve in that regard but we may need to revisit it. There may be measures such as time-delay prescriptions or phone consultations. We may need to examine this in different ways to see that it is working. While I might not wish for a three-day delay, I understand that the principle is being enshrined in the legislation but we must monitor it carefully so that it does not block access to the most vulnerable.
I support amendment No. 13, which is a consequential amendment. Its objective, and that of the other amendment on section 12, which we discussed in detail on Committee Stage, was to mitigate or remove the unintended and potential consequences for disability discrimination contained within the Bill and ensure that there would not be abortion based on sex, ethnicity, or disability grounds.
Earlier, when referring to section 12, I raised how abortion could become the contraception of choice. I do not want to be misrepresented due to the earlier interruptions. Some people are determined to misrepresent what I said outside the House. I was referring to various reports in England, including one put out by the abortion providers, the British Pregnancy Advisory Service, in an article published on 7 July 2017. It would be remiss of me not to draw attention to issues like this if we are to have a healthy debate but it is also only fair that in a democracy, people would not set out to intentionally misrepresent my remarks and put their own spin on them.
I will be very brief as amendment No. 13 is a technical amendment that would have been consequential on a previous amendment, which was either defeated at Committee Stage or ruled out of order for Report Stage.
On the other amendments in this section, we have had a very good engagement through both Houses, including the last day, on this subject. I know and very much respect that there are different views on the three-day waiting period but it is sensible that people are discussing how it will operate and work in practice.
It may seem obvious but something that should not be lost in this debate is that this is not the only ground on which someone can access a termination legally in our country under this legislation. It is one ground - a wide ground - to support women in early pregnancy without them being obliged to give their reason and that trusts the woman to make the decision that is best for her and for her family at that stage of early pregnancy. There are obviously other grounds beyond that. The one that has come most into focus in discussions on groups living in disadvantaged areas, vulnerable groups and so on, as Senator Ruane so eloquently made the point, is the emergency head, which is an important provision in that regard. I take very seriously, as do the clinicians who met the Senator and her colleague yesterday, the importance of ensuring that GPs and medical professionals more broadly are trained in the advocacy to which Senator Ruane referred and of how women know of the emergency provision and how it operates. I will raise it in my engagements with the medical colleges as they prepare both their training programme and clinical guidelines. I very much welcome Senator Ruane's ongoing support and engagement on this issue.
I cannot accept the amendment regarding conscientious objection for several reasons but primarily because the legislation states clearly that the certification needs to take place before the three-day period commences.
I worry about the consequences it would have, therefore, throughout the legislation beyond this amendment. We have taken every effort to minimise conscientious objection being a barrier, while respecting the right of people to hold it. Let me be clear on that on the record of the House.We know, however, that women do not operate in the way in which some people have tried to characterise them during this debate. Women will not be going around from doctor to doctor in the hope of finding medical assistance. There will be the 24-7 helpline, thewww.myoptions.iewebsite and advocacy groups will have to be informed of these new provisions. That is to minimise the possibility of a woman ever having to come across the awfully undesirable situation for her where she is asking for help and the doctor states that he or she is not in a position to do so or is not willing to do so. I believe we can significantly overcome the issues, from an access point of view, in respect of conscientious objection through the measures we have taken and the measures our medical community and clinical leaders are actively taking.
I move amendment No. 15:
In page 10, lines 5 to 9, to delete all words from and including “from—” in line 5 down to and including line 9 and substitute the following:“from the date on which the pregnant woman made arrangements to attend the medical practitioner for the purpose of the examination referred to in subsection (1).”.
Colm Burke, Ray Butler, Jerry Buttimer, Maria Byrne, Lorraine Clifford Lee, Paudie Coffey, Martin Conway, Frank Feighan, Anthony Lawlor, Tim Lombard, Gabrielle McFadden, Michelle Mulherin, Catherine Noone, Kieran O'Donnell, Marie Louise O'Donnell, James Reilly, Neale Richmond.
I move amendment No. 16:
In page 10, between lines 9 and 10, to insert the following:“(4) Subsection (3)shall not apply to a woman where it is deemed to constitute a significant barrier to access to a termination of pregnancy under this section, including because it may contribute to her exceeding the 12 week limit referred to in subsection (1).”.
I move amendment No. 17:
In page 10, between lines 13 and 14, to insert the following:“(5) Subsections (3)and (4)shall not apply where the medical practitioner referred to in subsection (1)is of the reasonable opinion, formed in good faith that, during the time period referred to insubsection (3), the pregnant woman is likely to be subject to a threat to her life or health, arising from her living circumstances.”.
Ivana Bacik, Frances Black, Rose Conway Walsh, Maire Devine, Paul Gavan, Alice Mary Higgins, Kevin Humphreys, Colette Kelleher, Pádraig MacLochlainn, David Norris, Niall Ó Donnghaile, Lynn Ruane, Fintan Warfield.
Colm Burke, Ray Butler, Jerry Buttimer, Maria Byrne, Lorraine Clifford Lee, Paudie Coffey, Martin Conway, Frank Feighan, Anthony Lawlor, Tim Lombard, Gabrielle McFadden, Michelle Mulherin, Catherine Noone, Kieran O'Donnell, Marie Louise O'Donnell, James Reilly, Neale Richmond, Diarmuid Wilson.
I move amendment No. 18:
In page 10, between lines 13 and 14, to insert the following:
“(5) Subsections (3)and (4)shall not apply where the pregnant woman concerned has previously been the subject of arrangements for the transfer of care in accordance with section 22(3)in respect of the pregnancy concerned.”.
This is another amendment consequential on an amendment that has not been allowed. We did, however, discuss the issue at some considerable length on Committee Stage. Again, it refers to the grounds for abortion in section 9 and the use of the word "appropriate". As I pointed out on Committee Stage, the word is not to be found in the relevant Medical Council language. It is to be contrasted with the use of the word "necessary" in section 10. I have spoken a good deal about the corruption of medicine. I have also said part of the corruption of medicine is an attempt to cloak access to abortion services on an elective basis in medical terms, thereby seeking to undermine opposition to it. This fudging between what is elective, on the one hand, and what is necessary medically, on the other, is unique to the story of campaigning for access to abortion. It is highly irresponsible to see the Government bend to that political tendency by choosing language that masks the distinction between procedures one could reasonably contemplate on legitimate medical grounds, on the one hand, and, on the other, the importation of an unusual level of subjectivity into assessment to allow abortions which, by definition, are harmful and fatal for the unborn baby to take place, even though there is no bona fide medical basis for them. That is part of the corruption of language and politics for which the Government is responsible, as exemplified by this legislation. On Committee Stage I pointed to the absence of the word "appropriate" in other medical circumstances. It is clear that there is a desire to introduce abortion here, ostensibly on medical grounds but, in fact, where it is not judged to be necessary.
It also departs from what I believe are the wishes of the people. Apart from the 34% who opposed repeal completely because they wanted to protect both mothers and babies, many were reluctant "Yes" voters who did not want to see clever masking of access to abortion services by inappropriate medicalisation of the subject. That is harmful and not the way to do politics. It does a disservice to the women and unborn children in question. It also does a disservice to the medical profession and all those who see a clear distinction between authentic care for mothers and babies, on the one hand, and decisions that are choice-based to avail of an elective procedure, on the other.
I do not expect the Minister to accept the amendment. It would not make sense for him to do so in the context of the substantial amendment not included for discussion today. On that basis, I am not pressing the amendment, but I highlight the injustice, the dishonesty and sheer wrongness of departing from the legitimate and effective term of "necessity" and it does not have to be 100% or absolute, as the Minister claimed previously. Again, it is an example of the use of political language. The simple word "necessary" has always been effective and doctors have used it. They are in a position to make reasonable judgments on necessity without having their hands tied. "Necessary" is the word that should be used.
Without this amendment, an abortion can and will be performed right up to the point of viability on the basis of risks that can be averted in other ways. It can happen simply because a doctor considers the abortion to be "appropriate", even though it is in no way necessary. That is where subjectivity enters into this issue. The word "necessary" brings objectivity rather than subjectivity to this element of the legislation under the review committee in section 16. That is why the amendment is so important.
Amendment no. 23 is consequential, although it precedes amendment No. 26 which relates to parental notification. In moving amendment No. 23 I am addressing both issues. This amendment was discussed thoroughly on Committee Stage, although it was not put to a vote. Colleagues may recall that I said I would prefer not to press the amendment on Committee Stage because I wanted to adjust the wording of subsections (6) and (7). The key point is that the amendment would recognise the life-changing event that abortion certainly is for the unborn baby – it is a life-ending event. As we know, the legislation provides for this life-ending event to take place without time limits in some cases and, potentially, late term in several cases. I have pointed to the dangers of this legislation and my distress in recognising that some abortions could conceivably be late term or take place at an advanced stage of pregnancy. Moreover, there is no provision for proper care in terms of pain relief, etc. or any requirement, where needed, where a baby is born alive, to sustain his or her life in a context where he or she is subjected to a procedure intended to end his or her life under the law. It is clear that this is a grave matter from the perspective of the welfare of the unborn baby who is never spoken about by the Government.
Of course, abortion can also be a life-changing event for women. I have said that while no one should ever try to claim that all cases are the same, it is a fact that in some cases abortion regret is a reality for women. This is often denied by abortion supporters as if it would somehow lessen their campaigning strength to admit the truth. Also, I have pointed to the dangerous lack of clarity in the definition of "health". The legislation exposes women to situations where procedures could take place, although there is no medical evidence that they would be therapeutic. I also have pointed out how the science in this area shows that while there is no evidence to show abortion is therapeutic in the context of a mental health challenge, there is some evidence, albeit conflicting, to show when and how it might have negative or adverse sequelae or negative mental health effects.
One has to careful to be honest and honourable in pointing out what the best available research shows. What the research shows is that abortion is more likely to be associated with elevated risks to mental health where women are young and unsupported. It seems to me that it is precisely in situations where women are young and unsupported that the issue of whether and how parents are notified comes to be a relevant consideration.
I have made it clear already and will make it clear again that this is not about seeking parental consent. It is about recognising the horrendous and extensive nature of this legislation and these amendments simply seek to make a bad and evil situation better and more humane. I have pointed out that it is appropriate that parents would be notified where it is intended to carry out an abortion procedure on their child who is a minor.
I have also pointed out, and this amendment makes clear in subsection (6), that where one could be dealing with a situation where the parents are abusers and where it would not be in order to notify them, upon application being made to the High Court by an interested party, the court may make an order dispensing with any requirement for service of notice to the parents if it is satisfied that this is in the best interests of the minor concerned. While an application of that nature should be made on notice to the parents, given that it is normally the case that an application sought in court would be made on notice to the other side, as it were, in other situations I referred to, this amendment allows for the possibility that the High Court, where satisfied in the particular circumstances of the case, may justly proceed to hear and determine the application without notice to the parents of the minor concerned. Therefore, please let there be no talk of this amendment being burdensome on a child who might be subject to abuse or in situations where the pregnancy may have resulted from abuse in the home.
It was interesting that during the discussion on Committee Stage about situations where the pregnancy resulted from a situation of abuse, or perhaps a situation of a criminal nature, it was also acknowledged implicitly that in some cases it might not be criminal activity that led to the pregnancy of the minor involved. We spoke about how challenging it can be, even for parents who would regard themselves as very attentive and vigilant, to know everything that is going on. We hear every day about situations going on that are not in a child's best interests and of which their parents, who consider themselves to be responsible parents, are really unaware. Parents need support in carrying out their primary duty under the Constitution, which the Constitution acknowledges that they have. It is not acceptable, in legislation of such far-reaching significance, simply to rely, as the Minister and others have said, on other guidelines without setting out what ought to happen as a general principle.
My friend and colleague, Senator McDowell, and perhaps Senator Norris to a lesser extent if I recall correctly, spoke in terms of how onerous it would be to notify parents in this situation where it is sought to carry out an abortion procedure on a minor. I did not recall it at the time, and the Minister will correct me if I am wrong - and I will happily accept correction if I am wrong - but I understand that, under the Children First guidelines, the child protection guidelines, if a child becomes pregnant and if Tusla is involved, it is mandatory that parents are told. That did not occur to any of us the other evening, it must be said, neither to Senators McDowell and Norris nor to myself. It puts my amendment in a much better light than my colleagues might have thought it deserved. There is only one exception to that, which is if it is thought the child would be in further danger as a result of telling the parents. As the Minister can see, that context is also recognised in my amendment.
Why would Senators or Government go against the spirit of the Tusla child protection guidelines? This is legislation that for the first time permits the direct and intentional taking of innocent human life outside of it occurring in the context of bona fide medical necessity. It is simply not acceptable to resort to guidelines and to say that, generally speaking, there will be a discussion about whether parents know and all of that soft law when what is needed in legislation that is far-reaching enough to permit the direct and intentional taking of innocent human life is the recognition of the particular and primary responsibility that parents have for their child's welfare in all but exceptional circumstances, and it should require that they at least be notified of this life-changing event.
An abortion can be very emotional and can have long-lasting psychological consequences that can be serious. When the immaturity of a child is taken into that realm, then those consequences can be even more extreme, given that the girl will not have reached full emotional and mental maturity. That is why Senator Mullen outlined the Tusla rationale. That is important and it establishes the State's recognition of our amendment.
In addition to that, we outlined in some detail on Committee Stage that other European countries also recognise this in the area of abortion. I understand that according to the World Health Organization, 21 other European countries which responded to a 2016 World Health Organization survey confirmed that legal access to abortion is only available to minors under 18 with parental consent. Across the Atlantic in the United States, 40 state parental involvement laws are in effect. I understand that 26 states require parental consent for minors seeking abortions and that ten states require parental notice for minors seeking abortions.
Our amendment is grounded in best international practice and we feel that it is important. There are obviously difficulties with the issue, as mentioned by Senator Mullen, in cases where a child may have been abused by a parent and that is dealt with in the amendment. This amendment is considered, it is important and I encourage the Minister again to accept it. So much of the abortion debate in this country on the pro-abortion side was fuelled from international practice, but it seems that same international practice is being ignored when it provides for more humane elements to be brought into the law. That is regrettable.
I thank the Senators. As Senator Mullen said, we had a lengthy discussion on this on Committee Stage, although not a vote. I want to be clear that the normal medical principles on consent will and must apply in relation to termination of pregnancy. Consent to medical treatment by minors over the age of 16 is governed in the Statute Book, so this idea that we are entirely leaving it to guidelines is not actually correct. It is governed by section 23 of the Non-Fatal Offences against the Person Act 1997.
Furthermore, consent to medical treatment for minors is also governed by significant case law. The issue of parental notification is comprehensively dealt with in the HSE's guide to consent for young people and in the national consent policy, part 2 of which is wholly concerned with issues around consent for children and minors, including detailed sections on the age of consent and the role of parents and guardians. Page 54 of the national consent policy specifically states: "It is only in exceptional circumstances that, having regard to the need to take account of an objective assessment of both the rights and the best interests of the person under 16, health and social care interventions would be provided for those under 16 without the knowledge or consent of parent(s) or legal guardian(s)." The policy then goes on to set out the details of what an assessment in such circumstances should cover, including the need to assess the maturity of the minor and any welfare, protection or other considerations, such as the Children First guidelines to which Senator Mullen rightly refers.
The provision on consent in section 23 of the Bill does not include any special provisions or requirements around consent for any particular group, and I do not intend for this to change as I do not believe it needs to change for the legislative and guideline reasons I have already outlined.
I certainly did not mean to suggest that the guidelines in question are not based in statute. The Minister will recall that I went into detail on Committee Stage about the provisions of section 23 of the Non-Fatal Offences against the Person Act 1997 and the consent guidelines. My point has been that we are in a new situation here. We are in a situation where the direct and intentional taking of innocent life is contemplated. This is such a life-changing event, a life-ending event for the unborn child and potentially a life-changing event for the young mother in question, that it is not enough to rely on the porous provisions of section 23 of the Non-Fatal Offences against the Person Act 1997 and the consent guidelines. I went through the exceptionality, if the Minister will accept my use of the word, of all of that on Committee Stage. Nothing the Minister has just said is news to me, nor is the situation I am outlining covered by the existing statutory and guideline-based apparatus.
I repeat, it is a matter of justice and child welfare, not just the welfare of the unborn child but the welfare of the young mother in question, that parents must be notified. The law should specifically require it in the very new situation of abortion being legal in our country while allowing for the necessary exception where the child's welfare would not be served by the parents being notified, which the court could determine accordingly. I will be pressing this amendment.
I move amendment No. 24:
In page 14, between lines 22 and 23, to insert the following:“(d) any information required to be included in the notification under section 14(4);”.
This amendment does not have to do with parental notification but with notifications. We are left with amendments that are consequential on an amendment that was pressed on Committee Stage but which has not been included for discussion here today. Therefore, I wish to reiterate first of all that what was sought on Committee Stage was something very reasonable, something that is essential for good health policy formulation, namely, information. The phrase "knowledge is power" is familiar to most of us. "Power" is a harsh word to use when one is talking about the welfare of women and their unborn children. Knowledge is competence. Knowledge is foresight. Knowledge is good planning. Knowledge is good citizenship. Knowledge is good patient welfare.
We argued, as colleagues may recall, that the information which must be gathered under section 20 is paltry. It refers to the Medical Council registration number, which is important, but far from exhaustive of what is necessary: the section of the legislation under which the deliberate and intentional ending of the life of the foetus takes place; the county of residence, which I do not find to be of particular relevance or importance, though I am open to being found mistaken; and the date on which the termination of pregnancy is carried out.
None of the other data which are required under the British abortion regime is included. We demonstrated briefly the other night just why some of that data could be very relevant. For example, an issue was made about the inclusion of the ethnicity of the woman. The attempt has been made to suggest that somehow there was racist intent. That did not happen so much in the Seanad as the Dáil. It was actually the equality people in Britain who sought the gathering of that data so as to ensure that women from different minority groups were able to access abortion at the same level as others.
There are all sorts of other reasons. One does not have to be able to foresee exactly why specific data could be helpful for health policy and legislative formulation. It should be enough to follow normal practice in this area, which is to gather information that researchers, medical experts and statisticians will need. I have pointed out that I believe, regretfully, that the deliberate exclusion, the deliberate opting for ignorance that characterises the Government's failure to include the categories of information that are sought in Britain, is ideologically motivated. The fear that underlines it is that if people knew more about what goes on with abortion they might be less likely to support it. That is to put the welfare of unborn children and the welfare of mothers in this situation beneath the ideological push of the abortion industry and abortion activists in priority. This industry has come to the heart of Government in this country. That is very irresponsible. It is very unjust. It is in breach of human rights. It is an abandonment of responsible policy formulation.
I greatly regret that the Government has not accepted it to date, but I foresee a time in the future when legislation will be brought forward to require the gathering of information of the same kind that is gathered in Britain. The Minister is bringing about a situation where his worst fears do not have to be realised. He was never willing to talk about whether abortion rates would go up as a result of the introduction of abortion in this country. The cat was never let out of the bag even though the figures were there. Between 4,000 and 5,000 Irish women travel for abortions every year. Scotland, with a similar population, has at least 11,000 abortions every year. There was no talk though, no willingness to explore the consequence of legalising abortion; future lives lost, for which the Minister will be very directly responsible and which would not have been lost otherwise. That also applies to his colleagues and all of those who worked with him to push for this unjust law.
Of course, one way to avoid publicly taking responsibility is to say that we do not have the information. In fairness, the information about how many abortions take place will be available. I have to correct myself on that and I willingly do so. However, we will not be able to look at how our situation has evolved by comparison with Britain, because a strategic and very cynical option of ignorance has been taken. In light of that, I foresee a day when legislation will seek to re-establish British-style gathering of statistics, no more and no less.
It is interesting the Government did not even do this much. Perhaps I should have tabled a more conservative amendment to this effect, although it would have been rejected anyway. Even if there were a category (e) to include such other information as the Minister may from time to time prescribe, it would have been a better and more responsible policy choice. It is a hell of a wonder with all of the people working with the Minister on bringing abortion into Ireland that there was not even that open-ended possibility of the identification of future categories of information that could responsibly and reasonably need to be gathered. That is very disappointing and an example of bad policy formulation in the name of ideology. It makes no sense, therefore, for me to press the consequential amendment No. 24.
I intend to press amendment No. 25 because this creates consequences for those who would certify the operation but not notify the appropriate information as is their duty. It would be easier to see why such offences need to be created for the full range of necessary and responsible categories of information to be provided for, as per the amendment proposed on Committee Stage. It remains the case, however, that it should be an offence not to notify information on foot of something as life-changing and destructive as abortion.
I move amendment No. 25:
In page 14, after line 36, to insert the following:"(7) A medical practitioner who wilfully or recklessly contravenes subsection (1)of this section shall be guilty of an offence.
(8) A person who is guilty of an offence under this section shall be liable—(a) on summary conviction to a class A fine or imprisonment for a term not exceeding 12 months, or both,
(b) on conviction on indictment to a fine or imprisonment for a term not exceeding 5 years, or both.".
I move amendment No. 26:
In page 15, between lines 5 and 6, to insert the following:
"Parental notification22.(1) A termination of pregnancy in respect of a pregnant minor may only be carried out in accordance with section 9where a copy of the certification referred to in that section has been served on a parent of the minor at least 24 hours before the termination of pregnancy is carried out.
(2) In respect of a pregnant minor, a copy of the certification referred to in section 10(2) shall be served on a parent of the minor—(a) before the termination of pregnancy is carried out, or(3) A termination of pregnancy in respect of a pregnant minor may only be carried out in accordance with section 11 where a copy of the certification referred to in that section has been served on a parent of the minor at least 48 hours before the termination of pregnancy is carried out.
(b) where it is not practicable to do so before the termination of pregnancy is carried out, as soon as may be but, in any event, not later than 2 days after the making of that certification.
(4) A termination of pregnancy in respect of a pregnant minor may only be carried out in accordance with section 12 where a copy of the certification referred to in that section has been served on a parent of the minor at least 72 hours before the termination of pregnancy is carried out.
(5) Service of any certification required to be served under this section shall be carried out in such manner as may be prescribed and shall be recorded in any notification required to be forwarded to the Minister under section 20.
(6) The High Court, upon application made to it by any interested party, and if satisfied that it is in the best interests of the minor concerned, may make an order dispensing with any requirement for service provided for under this section.
(7) An application under subsection (6)shall be made on notice to the parent or parents of the minor concerned, unless the High Court is satisfied that, in the particular circumstances of the case, it may justly proceed to hear and determine the application
without notice to the parent or parents of the minor concerned.
(8) In this section—"minor" means a woman who has not attained the age of 16 years;
(a) a guardian appointed under the Guardianship of Infants Act 1964,
(b) any other natural or legal person acting inloco parentisin respect of the pregnant minor under any statutory power or order of a court, and
(c) in the case of a minor who has been adopted under the Adoption Acts, 1952 to 2010, or, where the child has been adopted outside the State and that adoption is recognised by the State by virtue of any statute or rule of law for the time being
in force, the adopter or, where relevant, the surviving adopter.".
I move amendment No. 27:
In page 15, between lines 5 and 6, to insert the following:"Provision of foetal ultrasound imaging and auscultation of foetal heart tone
22.(1) At least 24 hours before the carrying out of a termination of pregnancy in accordance with section 9, section 11or section 12the relevant medical practitioner or a qualified person assisting the relevant medical practitioner shall perform ultrasound imaging of the foetus and auscultation of foetal heart tone.
(2) The active ultrasound image referred to in subsection (1)must be of a quality consistent with standard medical practice, shall contain the dimensions of the foetus, and shall accurately portray the presence of external members and internal organs of the foetus, if present or viewable.
(3) The auscultation of foetal heart tone referred to in subsection (1)must be of a quality consistent with standard medical practice.
(4) Before or during the imaging and auscultation services referred to in subsection (1), the relevant medical practitioner or the qualified person, as the case may be, shall offer the pregnant woman, orally and in person, the opportunity to view the active ultrasound of the foetus and hear the heartbeat of the foetus, if the heartbeat is audible.
(5) At least 24 hours before the carrying out of a termination of pregnancy the relevant medical practitioner shall certify that—(a) foetal ultrasound imaging and auscultation of foetal heart tone have been performed,(6) The relevant medical practitioner shall obtain the signature of the pregnant woman on the certification referred to in subsection (5)verifying that it is factually correct.
(b) the pregnant woman has been offered the opportunity to view the active ultrasound image of the foetus and to hear the heartbeat of the foetus, if the heartbeat is audible, and
(c) the pregnant woman either—(i) requested to view the active ultrasound imaging and hear auscultation of foetal heart tone, or
(ii) opted not to view the active ultrasound imaging and hear auscultation of foetal heart tone.
(7) A medical practitioner who contravenes subsection (1), (4), (5)or (6)shall be guilty of an offence.
(8) A person who is guilty of an offence under subsection (7)shall be liable—(a) on summary conviction to a class A fine or imprisonment for a term not exceeding 12 months, or both,(9) In this section—
(b) on conviction on indictment to a fine or imprisonment for a term not exceeding 4 years, or both."auscultation" means the act of listening for sounds made by internal organs of the foetus, specifically for a foetal heartbeat, utilising an ultrasound transducer and foetal heart rate (FHR) monitor or similar device;
"midwife" means a person whose name is for the time being registered in the midwives division of the register of nurses and midwives established under section 46 of the Nurses and Midwives Act 2011;
"nurse" means a person whose name is for the time being registered in the nurses division of the register of nurses and midwives established under section 46 of the Nurses and Midwives Act 2011;
"qualified person" means a nurse, midwife or medical practitioner who is competent to perform foetal ultrasound imaging and auscultation of foetal heart tone services;
"relevant medical practitioner" means—
(a) in the case of a termination of pregnancy to be carried out in accordance with section 9or 11, the obstetrician by whom the termination of pregnancy is to be carried out, and
(b) in the case of a termination of pregnancy to be carried out in accordance with section 12, the medical practitioner who has certified or is required to certify his or her opinion as to the matter referred to in subsection (1)of that section;
"ultrasound" means the use of ultrasonic waves for diagnostic or therapeutic purposes, specifically to monitor a developing foetus.".
This amendment would insert a new section 22 concerning the provision of foetal ultrasound imaging and auscultation of foetal heart tone and would provide that at least 24 hours before the carrying out of a termination of pregnancy in accordance with sections 9, 11 or 12, the relevant medical practitioner or a qualified person assisting the relevant medical practitioner would be required to perform ultrasound imaging of the foetus and auscultation of the foetal heart tone.
The first thing to notice is that it is in respect of sections 9, 11 and 12 procedures only that this obligation on doctors, not on women, would apply. This amendment could be characterised as obliging the doctor but offering to the woman. The active ultrasound image referred to would have to be of a quality consistent with standard medical practice, should contain the dimensions of the foetus, and should accurately portray the presence of external members, body parts and internal organs of the foetus, if present or viewable. Likewise, the auscultation of foetal heart tone would have to be of a quality consistent with standard medical practice. The requirement in subsection (4) is that, before or during the imaging and auscultation services, the relevant medical practitioner would offer the woman, orally and in person, the opportunity to view the active ultrasound of the foetus and hear the heartbeat of the foetus, if the heartbeat is audible.
Other amendments on informed consent were not accepted on Committee Stage, to my sorrow. If there was a sincere desire on the part of the Minister or the Government that abortions would be rare, as with the question of notification dealt with earlier this afternoon, there would be a desire to see women not manipulatively or coercively informed but fully informed, respectfully and sensitively, of the surrounding facts of their pregnancy.
On the hiding away of ultrasound, I highlighted on Committee Stage how abortion counsellors - I criticised the Irish Family Planning Association, Marie Stopes and others - have had the practice of telling women to turn away while they carry out their routine ultrasound. That is a disservice to women. I do not see how that could be in any way seen as respectful of women's agency. It is paternalistic and goes against the idea that what one should be trying to do here is to give the full informed consent in the way that is normally done with patients for their welfare so that they can have the information they need. As I pointed out earlier, it often occurs that women say: "If only I'd been told. If only I knew that this was what a baby looked like at the stage of pregnancy I was at. If only I knew that there would be support for me if I decided to keep my baby. If only my parents had been notified when I was a minor." Those are all the "if onlys" this legislation leaves us with because, once the request for an abortion is made, the desire is to put the person seeking an abortion on an express train and not to allow the requiring of information that might help them make a life-affirming decision for their own future happiness and certainly for the welfare of their unborn child.
This amendment is about offering women in a respectful way information that may be relevant to the decision. I would be happy were it to be the case that it might cause them to change their decision. Anybody who says they believe abortion should be rare should be happy. Anyone with a scrap of humanity would be happy that a decision would be changed in favour of giving life, but this legislation is a stranger to such feelings, a stranger to such sensitivity and a stranger to such humanity. The amendment, however, was criticised on the grounds that, by definition, if we were to offer a woman a chance to see an ultrasound image, that was somehow requiring an ultrasound and was therefore intrusive. I would have thought that the balance of good could surely be served, as I said, in the provision of information respectfully. These criticisms, which surprised me, caused me to look a little bit deeper at ultrasound. I still have questions because I am not a medical person, some of which I hope the Minister can answer.
It was Dr. Peter Boylan - no friend to the unborn in this context - who talked about the need for ultrasound before the Joint Committee on Health in September. Speaking in advance of that, and this quote is from The Irish Timesof Wednesday, 19 September, he stated: "The operation of abortion services in the State without adequate ultrasound availability will be fraught with risk". If that is the case, that begs the question whether it is known with certainty when ultrasound is needed and when it is not. If a major abortion proponent says the absence of ultrasound availability means that the operation of abortion services will be fraught with risk, is somebody criticising the requirement of ultrasound in each case, saying that we can know with certainty that there is no risk in the absence of ultrasound? I would like a very specific answer to that question from the Minister.
I also want to know whether it can be disputed that there could be a risk to the health of the mother in circumstances where an ultrasound is not used. I would like information. I am not making statements on it because I am not a medical person, but if a woman has an ectopic pregnancy, can that be clinically diagnosed without an ultrasound? I understand how most ectopic pregnancies present, but could it happen that abortions would be sought by women before the presenting symptoms have occurred? I understand that ectopic pregnancies can happen from six weeks or they can be later. Is it possible that an ectopic pregnancy could be involved even though the presenting symptoms have not occurred? Is it possible, therefore, that there could be a danger in that situation because of the non-recourse to ultrasound? I am concerned about women's health as well as the health of the unborn child and, regardless of whether an abortion takes place, I am concerned about women's health. I want a very specific answer to that question. If a woman has been told she could have pain from having had an abortion but, in reality, that pain could be from an ectopic pregnancy rupturing, they might not seek appropriate help. Is there any basis for what I am saying to arise?
I would also like to know whether this question and these related questions have been brought up with medical insurers. Has the Government had contact with the Medical Protection Society or with medical insurers about the question of what arises where abortions might take place in the absence of the use of ultrasound? I raise all these questions because it has been suggested that ultrasound is unnecessarily onerous and intrusive, and I would not want that, but I want the good of the potential saving of the unborn baby's life and the good of leaving absolutely no risk to the mother's life. Has the question of the consequences of not using ultrasound in the case of an ectopic pregnancy that might not yet have presented but does exist, or indeed any other situation, been raised with medical insurers?
Can a pregnancy be accurately dated without an ultrasound? Is there another way of clinically dating a pregnancy aside from asking the woman to clarify the dates? The Minister suggested there was but I understand an ultrasound is needed for accurate dating and that if the doctor wants to know dates accurately, it is good medical practice to do an ultrasound to ensure the pregnancy is not at 14 or 16 weeks, for example, instead of under 12 weeks.
A related question to that, which I would be grateful if the Minister answered, and I will listen carefully for the answer, is that if a pregnancy is later than a woman says and an abortion pill is administered, could that be detrimental to the woman's health? I understand it could be and that she should be under medical supervision if her pregnancy is more than 12 weeks and that she should be in a hospital.
If that is the case, is there absolutely no risk? Is there never a possibility that there could be a mistake which an ultrasound, and only an ultrasound, would allow to be detected? I understand that ultrasound is near-universal, although not entirely universal. This has been the practice in Scotland. I gather that there is a move or a push not to use ultrasound now. I would be interested to hear what the Government has discovered about that. Marie Stopes carries out ultrasound although, as I have said, it does not encourage women to look at it. That has been the experience of women going to abortion-friendly counsellors in Ireland. I would like specific answers to the questions I have asked in the context of this amendment. I stress again that this amendment would not subtract from the legal abortion service. It would not put any duty on a woman to look at ultrasound, but it would oblige the doctor to carry it out and to offer it. I submit that it is not just for the sake of the welfare of the unborn child that it would be appropriate for an ultrasound to be carried out.
I support the amendment, the rationale for it and the points that have been made by my colleague, Senator Mullen. The ultrasound is a soundwave scan. It can determine the gestational age of the baby and can provide clarity for the doctors. Our amendment proposes that it should be necessary for the doctor to carry out the scan, but that it should be entirely a matter for the woman to choose whether she looks at the scan. That is the situation in Canada and, as Senator Mullen mentioned, in Scotland. Section 12 of the Bill, which relates to early pregnancy, provides that a termination of pregnancy may be carried out for any ground up to 12 weeks. Given that we are making such a law, surely we should be able to date the pregnancy accurately. The only accurate way of dating a pregnancy is through the soundwave technology that is readily available through ultrasound scans. Dr. Mary Favier of the Irish College of General Practitioners told the committee that "the need for ultrasound scanning is becoming clearer". She outlined that it is an evidence-based approach. Surely we should be building that into this legislation. Our approach should be based on evidence so that clarity is provided to GPs in particular.
I will read the statement that has been prepared for the Minister in response to this amendment before trying to answer some of the other questions. I will not be accepting this amendment. As the Minister said on Committee Stage in the Dáil, the need for an ultrasound scan will be dealt with in the clinical guidelines in accordance with best practice in medicine. It would not be appropriate to include a provision on ultrasound scans in this legislation, or indeed to prescribe any details of medical treatments, compulsory care pathways or treatment plans in legislation. Such details are best set out in clinical guidelines rather than primary legislation. I assure Senators, as the Minister has previously done, that clinical guidelines for medical practitioners with regard to the termination of pregnancy are in preparation in parallel with the service planning and expansion work that is being undertaken in the Department and in the HSE. The Department of Health has provided a grant to support the development of clinical guidelines and to enable their efficient completion. I assure the House that good progress is being made.
The questions that were asked about doctors are more suited to doctors than to politicians. If a doctor wants an ultrasound, it will be made available. It is better for the doctor, rather than us as legislators, to decide whether an ultrasound can be used. Most women do not need an ultrasound if they are sure of their dates. This amendment would force them to have a test they do not need. An ultrasound is not needed and could act as an extra barrier for the timely treatment of the woman. Dating in early pregnancy is often more accurate than ultrasound. I do not have any other questions that I can answer at this moment for the Senators.
On a point of information, Senator Ó Domhnaill quoted Dr. Mary Favier, who is a member of the START group of doctors in Cork, which said in a position paper it produced in October that "Ultrasound or serum hCG will not be required for the majority" of early medical abortions. Dr. Favier is a signatory to the paper, which makes it clear that "the literature does not support routine ultrasound" prior to termination of pregnancy.
As I have made clear, there are two reasons for the argument in favour of ultrasound. First, it could save a life. One would hope that if people regard human life as having any value before birth, that would be seen as a good reason. Second, it seems to be the case that there should be a requirement for the woman to be sure of her dates. I have not heard clarification on this reason. What happens when mistakes occur, particularly in cases involving people in vulnerable situations? Will people be able to avail of a get-out clause for liability by saying "we did not do an ultrasound, and the mistake was not ours"? I do not think the Minister of State has been well served by the information supplied to her. She did not answer the question I asked about what the medical insurers have said. If there is any information that can be given to me in response to that very specific question, I would be grateful to receive it.
I will repeat the question. I am happy to do so. I asked about the situation of ectopic pregnancy. Could ectopic pregnancy exist before any symptoms present themselves? I asked whether, if ectopic pregnancy symptoms presented themselves in circumstances in which a medical abortion was taking place, there might be confusion if the person in question thought that the symptoms were associated with the abortion. I did not make a statement. I am asking for knowledge here. I asked whether the medical insurers have a view on this situation, on the use of ultrasound in this situation and on the use of ultrasound more generally. I have heard what Senator Kelleher has said about what the literature says, but I have not heard people say that ultrasound can do any harm. I think it is more likely to bring certainty in relation to dates. That was my specific question about what the medical insurers have to say. I also asked whether it could be detrimental to a woman's health if an abortion pill is administered in circumstances in which a pregnancy is more advanced than the woman says it is, and whether such a situation could have been addressed by the use of ultrasound. Those are the questions that are relevant to women's welfare. Indeed, it would have been appropriate for the Minister of Minister of State, and not just for Senator Kelleher, to answer my question about the data on the universality of ultrasound. I am not the only person who is seeking the provision of ultrasound. Dr. Boylan and others have pointed to the dangers of the non-availability of ultrasound. I think we are in a risky situation here. As I have said, we know what will happen to the unborn child. I think there are issues relating to women's health here as well. I have sought clarification on those issues. I would have preferred more precise clarification.
I cannot answer some of the Senator's specific questions, but I will repeat the answer I gave to an earlier question.
I cannot answer some of the specific questions but I will repeat my answer to a previous question. If a doctor believes or understands that an ultrasound is needed, one will be provided. As a mother who has given birth to five children, I hope that a doctor who is unsure of the dates when examining a patient will carry out the wishes of the patient. I believe doctors will do so because the ethos of all doctors is to look after the health and well-being of the woman. I am sure an ultrasound scan will be taken if a doctor has any doubt. We are heading down a path of doubting what doctors do. Doctors take care of their patients, and in this case the patient is the mother.
The HSE is talking to insurers about the issue addressed in the Senator's question, which is not a matter for law.
On ectopic pregnancy, neither I nor Senator Mullen is a doctor and nor are most other Senators. I am sure doctors and general practitioners following this debate know the symptoms of an ectopic pregnancy, which are very specific. I and members of my family have had experience of ectopic pregnancy and how it presents. At all times, as an individual and particularly as a woman, I would put my trust in my GP and the doctor dealing with me in the maternity hospital. In my opinion, doctors know best and when it comes to ectopic pregnancies I am sure they do everything in their power, as medical professionals, to ensure people are safe. To reiterate the point for Senator Mullen, if a doctor is in doubt at any stage, he or she can require that an ultrasound be made available to the patient.
As I was saying, the Minister of State's answers were shaky and porous, not just from the point of view of the welfare of the unborn child but also the welfare of women. I have been told the Government is in some kind of contact with medical insurers but it is not a matter for law. What exactly does "not a matter for law" mean? I would have thought that when bringing in abortion one would be keen and anxious to bring reassurance on all issues of concern to legislators, regardless of whether one likes those legislators or agrees with their point of view. There is absolutely no reassurance in the statement that the Government talks to medical insurers. I am sure it does talk to them but I would love to know what it is talking to them about. I have not been told here and we certainly have not been told what the medical insurers think of the Government's failure to insist that ultrasound always be in place. Instead, we have been told to trust doctors. I have no problem trusting doctors but doctors sometimes get things wrong. What happens when they get things badly wrong and are given false information, not necessarily deliberately? We know some people find themselves in varying and different circumstances. What happens if the fatal consequences for the unborn are compounded by adverse health effects for the mothers involved? Those are the reasonable questions to which I have sought answers and I have not been given them.
I accept that. However, on Report Stage, once the Minister has responded, the only person who can speak again is the Member who moved the amendment. That is the process. I am not in a position to allow any Member other than the Minister of State to respond to Senator Mullen. I am not at fault here.
Senator Mullen referred to the Minister of State giving shaky and porous responses. The Minister of State has had babies. She has experience of this and has empathy and understanding, which is more than other Senators in this House have.
As fewer than five Members have risen, I declared the question defeated. In accordance with Standing Order 61, the names of the Senators dissenting will be recorded in the Journal of the Proceedings of the Seanad.
I wish to touch on some of the points made on Committee Stage. This amendment relates to the role of the pharmacist, in particular. I understand the Irish Pharmacy Union has written to the Minister on the issue and is awaiting a response. I have noted that the Minister's thinking seems to be along the lines that the code of conduct for pharmacists covers this issue. I know that on Committee Stage Senator Reilly referred to the code as providing for a conscientious objection, but that is not the case. I have since been contacted by pharmacists and their representative bodies to clarify a number of points and raise their valid concerns on the issue of conscientious objection.
The first point is that the current code which is the equivalent of the 2009 set of guidelines of the Pharmaceutical Society of Ireland does not reference conscientious objection and/or freedom of conscience, religion or belief. The second point is that the new draft code which was available during the summer for public comment does not reference conscientious objection and/or freedom of conscience, religion or belief. I have with me a copy of the draft code. Pharmacists believe there is no explicit reference to their right to conscientious objection in either the 2009 code of conduct or the new draft code of conduct. Of course, the main issue for pharmacists who have a conscientious objection to the Bill, irrespective of whether it will or will not be mentioned in the code of conduct, is that the matter has not been addressed. Following public consultation during the summer, the 2018 draft code of conduct was published.
It reads: "Always put the patient first and make their health, wellbeing and safety your primary focus". I agree fully with and support such a requirement.
The draft code continues:
Make sure patients' needs are recognised, assessed, responded to and that their dignity is preserved and values respected. Decision making must be evidence based. Apply your knowledge and skills to ensure the patient receives safe and effective care. Recognise that your decisions and behaviour can influence patient care even if you do not work in direct contact with the patient.
The main principle refers to communication and appears to shift in the 2018 draft code is as follows:
Communicate effectively so that patients receive safe and appropriate care. Build successful working relationships with patients, colleagues and other healthcare professionals in order to deliver person-centred care. Ask relevant questions, listen carefully and respect confidentiality. Welcome questions from patients and respond to them.
Pharmacists who have concerns emphasise the shift in care to encourage adapting treatment to suit a person's individual needs. In their view, it blurs the line of who bears final decision-making responsibility for offering or denying a treatment. By way of example, I will outline one of the concerns of pharmacists. Codeine is safe in certain circumstances and a patient may want to take it to treat a cold. However, a professional will tell him or her that it is not appropriate and will refuse to supply it.
The pharmacists outlined additional concerns about the 2018 draft code, which reads:
Work in partnership with patients and members of all healthcare disciplines in order to ensure that the patient receives safe and effective care. Collaborate with your colleagues and other healthcare professionals.
In order to satisfy this principle, you: 1. Must enable patients to make their own choices about their healthcare and wellbeing by involving them and supporting them in decision making ...
5. Must refer patients to an alternative provider if you cannot provide a professional service or medicinal product so that patient care is not jeopardized or compromised.
6. Must work cooperatively with your colleagues and other healthcare professionals and you should respect their skills, expertise and contribution to patient care.
That is a major concern for pharmacists and to completely rewrite the 2009 code of conduct. The new draft code of conduct seems to have been completely rewritten in order to bring this legislation into consideration.
The pharmacists noted that in healthcare the patient was referred to when the practitioner was unable to provide what they considered to be the necessary or appropriate diagnosis of treatment. Where the practitioner does not think a treatment is appropriate, he or she does not refer, which is normal practice. Clearly the new section that has been inserted into the draft code of conduct is all about forcing practitioners to act against their own professional and conscientious judgment and the issue of termination of pregnancy is reinforced. It appears that the draft code is in line with the Minister's thinking as it almost forces pharmacists to act without having the fallback position of conscientious objection. There is nothing in the new code of conduct to protect pharmacists with a conscientious objection. The Irish Pharmacy Union has raised this matter, about which it has written to the Minister, but as of today before coming into the Chamber it has not received an assurance. That leaves them in a very difficult position because they are being forced against their conscience and will to do something in which they explicitly do not want to be engaged.
Our amendments revolve around conscientious objection. I refer, in particular, to amendment No. 28. Amendments Nos. 29 to 31, inclusive, also deal with pharmacists. Amendment No. 32 deals with medical practitioners and doctors who have a conscientious objection. They have been unfairly categorised for having a conscientious objection to the legislation. That is very unfair on medical practitioners throughout the country who genuinely conscientiously object to it. There is a medical doctor seated in the Visitors Gallery who has a conscientious objection to it. It would be very wrong if such persons were forced to undertake something about which they have strong views. Our amendments are merely about respecting their religious and moral beliefs and professional judgment.
In addition, some of our amendments cover student doctors, but I suspect they have been ruled out of order. However, on Committee Stage we talked about student doctors, nurses and midwives and I know that the Minister gave an undertaking to Deputy Donnelly when he raised some of these concerns in the other House. The Minister agreed with him on student midwives and nurses.
Late on Tuesday night I read a lengthy letter from a midwife who works in Letterkenny University Hospital. Not everyone agrees with them, but the values and rights of the persons in questin should be respected.
The Irish Pharmacy Union has written to the Minister outlining its concerns. Pharmacists, some of whom are based in Senator Reilly's constituency, have raised concerns with me about this issue. Their rights also deserve to be respected and they are not having a go at anyone. They are professionals who have a conscientious objection to the manner in which the legislation has been structured. All we are looking for is to have their conscientious objection respected in the legislation. We have structured our amendments in such a way as to facilitate and rubber stamp this.
The Minister has referred to the code of conduct for doctors and midwives. I have raised the concerns of pharmacists about their code of conduct. As I have a copy of the new draft code with me, I know that it does not deal with a pharmacist's conscientious objection. In fact, it infers that a pharmacist must refer. That means that when the legislation comes into effect on 1 January, in line with the aim of the Minister, pharmacists will be placed in a position where they will have no right to hold a conscientious objection, which is very wrong. In tabling the amendments my colleagues and I have provided the Minister with an opportunity to address the matter.
Amendments Nos. 28 to 32, inclusive, are to section 22 that deals with conscientious objection. As we debated the principle at length on Committee Stage, I will be brief.
Like most of my colleagues on the pro-choice side, I have sat in a very dignified and respectful silence through many hours of debate on Monday, Tuesday and today, but it is important that I outline some of my objections to the amendments. If one looks at the international human rights context of conscientious objection law, one will see that conscientious objection is recognised internationally, but the right is not absolute.
The Committee on Economic, Social and Cultural Rights has held that the exercise of conscientious objection must not be a barrier to accessing sexual and reproductive health services and the UN Committee on the Elimination of Discrimination against Women, CEDAW, has called upon state parties to establish an effective mechanism of referral if health service providers refuse to perform reproductive health services for women based on conscientious objection. Furthermore, relevant European Court of Human Rights rulings establish that governments are obliged to ensure that the exercise of freedom of conscience does not block patients from accessing services to which they are legally entitled.
That is the international human rights framework in which we approach legislating on this important issue and as I said on Committee Stage, this Bill sets that balance correctly. Section 22 gives a right of conscientious objection. Many of us might take a view that this should not be necessary in legislation on abortion as it is not necessary in other healthcare provision legislation, however, I accept that it is here and that there are international legal principles dealing with conscientious objection but where conscientious objection rights are recognised in law, they must be balanced by a duty to ensure that patients can access services and that is critical here.
I have been contacted by pharmacists and I am listening to what those who are putting forward amendments on pharmacy have said. I should also say that my mother worked as a pharmacist for many years so I am very familiar with the pharmaceutical working environment because I have even worked in a pharmacy myself, albeit just as a shop assistant. It is important to note that the current code of conduct for pharmacies about which I spoke on Committee Stage, which was developed by the Pharmaceutical Society of Ireland, already states that where pharmacists are unable to provide prescribed medicines or pharmaceutical services, they must take reasonable action to ensure the services are provided and patient care is not jeopardised.
I know a redrafted code being drawn up to take account of the new legislation and I know the Minister will speak to that but the pre-eminent point in any statement around conscientious objection for any professional, is that pre-eminent duty to ensure that patient care is not jeopardised. That is there in section 22 as it applies to students, nurses and midwives, as well as to other medical professionals and it is there in the pharmaceutical code of conduct.
It is very important that conscientious objection principles are not used as a vehicle to try to undermine patient right of access. I fear that in the lengthy debate on Committee Stage we saw this idea of conscientious objection as conscientious obstruction. I accept that is absolutely not the motivation of some colleagues in putting this forward but we have to be careful that it does not become obstructive of the main purpose of this legislation and the main purpose of this legislation and of the 66.4% of people who voted "Yes" in May was to ensure that women would have access to abortion services in Ireland, not medical professionals, and we need to ensure the debate focuses and remains focused on the women who need the services.
I will also be brief. If a principle of conscientious objection is allowed, it should extend pretty generally, unless there are specific circumstances that militate against that and that is the question that was instanced by my distinguished colleague Senator Bacik when she talked about conscientious obstructionism. I do not believe for a second that we are at that stage in Ireland. There would not be sufficient people citing conscientious objection to obstruct. I believe in being balanced so I put on the record of the House the judgments of the European Court of Human Rights which said that conscientious objection was perfectly fine except in circumstances where it militated against people obtaining relevant services. An international report on human rights has been cited by my colleague but I would also point to the Irish Human Rights and Equality Commission, which has very clearly said in one of the recommendations I put on the record the other day that it should be extended to other health service workers and that includes pharmacists.
It is a question of balance and we are not at the stage where people would be prevented from having access but if the Minister can produce information on that which shows that access to these kind of services would in fact be seriously obstructed by the operation of this clause, then that is a reason to think about it again. I believe strongly in this Bill. It is an important social advance and I congratulate the Minister on it so I am certainly not seeking to be obstructive but I respect the right to freedom of conscience.
I was not going to contribute because I do not want to delay the passage of this Bill any longer than is necessary. We have had a respectful debate and I appreciate the honesty of Members of this House when they speak honestly, but I cannot attribute that character to Senator Ó Domhnaill. I read directly from the Bill the other day and I read directly from the pharmaceutical code of conduct and I will read it again for the record of the House. Before I even do that, the problem is that the Senator demeans and diminishes everything he has said, some of which was valid, when he tells mistruths in the House because people cannot trust anything he says. That is a real difficulty.
The Senator mentioned pharmacists in my constituency to me. I wonder if he even knows the name of a pharmacist in my constituency. Perhaps he will tell us or he will Google and find out before he responds. The point is that no pharmacist in my constituency has been in touch with me to express concern.
The core point, which Senator Bacik has eloquently put, is that conscientious objection is fully covered in this and on Committee Stage I already made it very clear that I am a staunch defender of that and would defend younger doctors from older doctors in group practice who might be bullied about that. I clearly state here in the House that anybody who has that experience anywhere in the health service, should come to me, anonymously or giving their name, and I will happily defend them here in this House, because that is not something that I would countenance or allow to happen and, as a public representative, I would feel duty bound to highlight it were it to happen. I know the Minister is nodding in assent and I know that he shares those values.
I do not want to delay any further but I refer to part 5 of principle 4 of the new guidelines on page 9 of the proposed code of conduct which makes provision for conscientious objection subject to the pharmacist referring the patient to an alternative provider if the pharmacist cannot provide a professional service or medicinal product so that patient care is not jeopardised or compromised. That is crystal clear to me and to anybody who has an honest interpretation of what is on a page in front of them.
With respect to the House, I want to support this Bill and reject these amendments. I fully respect the right of Members to filibuster, prolong and delay as much as they feel they need to and I absolutely respect those 34% of people in this country who decided to vote against the referendum and I have no issue with them whatsoever, but I do have issues with Members who would seek to mislead the House.
As the House would reasonably expect, I will confine myself to grounds not covered by Senator Ó Domhnaill but I will just say that the question of conscientious objection and people's need to express or act in line with their conscience can only be understood in this area by reference to the question of what people believe is legitimate healthcare. The conscientious objection issue arises for people who believe that what they are being asked to be involved with, goes against their deepest beliefs about what is good and true. Whether it is pharmacists, doctors, midwives or students in any of those areas, in the end, they also deserve to be trusted about where they believe they can or cannot get involved.
Senator Reilly's comments will not be of any consolation to many of the people who have been in touch with me because it is a paternalistic approach that says we will decide how much latitude people shall get if they have a conscience problem in this area.
The problem with this is that people who see themselves acting in a context where the State has all the power and all the money, and is in a position to ensure these services will be provided in a way that is widespread, are a million miles away from being what some people would like to call conscientious obstructors even if they wanted to be. It simply has no reality. They are people who for professional and ethical reasons, which may be rooted in faith or, as I said before, in their outlook on life or the simple human rights beliefs they hold that there are two human beings to be cared for and cherished here, do not want to become a cog in a wheel of a corrupt and corrupting process. That is their concern. They are not out to block the State from securing access to what the State now permits. They are people who want to go their own way peacefully and live, work and act professionally according to their values about how they want to care for other people in accordance with the training they received.
Many of them received training at a time when these procedures were unconscionable from a human rights and human dignity point of view. For 35 years, the Constitution had a noble protection of human rights for two patients. Under the guidance of the Government this has now gone but the people who want to care for others remain and they include people who are now in the process of training. We are speaking about doctors, midwives and pharmacists. The Minister himself gave a commitment as I understand it. It is not the only promise he has not kept on this legislation. This was that people who were studying or training would also be protected. This is not there in the legislation. Those of us presenting these amendments could have, and perhaps should have, extended our definitions on those studying or training to include student or trainee nurses, midwives and pharmacists.
On a point of information, an amendment was made in the Dáil to include student midwives and nurses. I referred to it in my contribution. The Minister pointed it out on Committee Stage. We have been over this ground several times already. It is there in black and white.
I found Senator Bacik's comments interesting. She stated many might take the view there ought not to be any provision for conscientious objectors while acknowledging it is a human right. This goes to the heart of the problem and the heart of the fears that many people have, that there is something about the abortion movement that is not content to let people go their own way peacefully. It wants to co-opt and draw everybody into approval. This is why we have to be very careful to give specific legal protection to those with a conscientious objection.
One person expressed concern to me that the Minister has reassured pharmacists their conscientious objection is provided for in their code of conduct, and averred it is a set of guidelines subject to the law that can change at any time. This person said pharmacists are not satisfied that they are not specifically named in the legislation alongside doctors, nurses and midwives and would like the Minister to clarify why he is deliberately denying pharmacists legal protection under the Bill. It is not enough to say to pharmacists that they are covered by their code of conduct. Doctors, nurses and midwives have similar provisions in their codes of conduct but they are specifically named in the legislation. Senator Ó Domhnaill referred to how they make the point that their code of conduct has no reference whatsoever to the words "conscientious objection" so I will not labour it. This is the principle the Minister is using to imply there is some protection under Principle Four on work with others, and he quoted the fifth point.
Can I just point out this is a load of nonsense? Senator James Reilly put on the record of the House the words of the document. I was misinformed and I understand Senator Mullen was also misinformed. I stick by my wish to include pharmacists but there is no point in just simply talking nonsense and putting stuff on the record of the House that is simply not true. Senator Reilly, who is a qualified medical practitioner, has put on the record of the House what the guidelines state and they state, rather to my surprise and I accept this, there is provision for conscientious objection. That is the fact. Could we please move on a bit?
Everyone is allowed to speak once. I take the point Senator Norris is trying to be helpful but I am trying to keep the debate going. People can speak once except the proposer of the amendment and that is it. I ask Senator Mullen to conclude if he can.
-----but when it comes to relying on people I have more respect for the professionals who have got in touch with me, who are so worried about this, who have done their homework and who have asked the few in the Dáil and Seanad who share their concerns to represent their point of view, than to allow them to be dissed and dismissed, whether it be by Senator Reilly despite his medical expertise or others in circumstances where there has been so much evasion and misinformation in the Dáil and Seanad.
On a point of order, at no point have I ever said anything that disrespects colleagues, medical, pharmaceutical, nursing or otherwise. I have the utmost respect for them. I am equally happy if the Senator or his colleague-----
I thank the Acting Chairman and I appreciate it. I will be very quick. Anybody who has an issue who is in my constituency, as alleged by the Senator, who wishes to write to me directly and identify himself or herself as a medical professional, pharmacist or otherwise I will be very happy to engage with that person.
The trouble is that many people in the constituency in which Senator Reilly resides, and indeed in other constituencies, would not feel comfortable approaching Government figures at this stage because they do not feel listened to or appreciated.
At least Senator Norris has a track record of surprising people with his independent thinking on occasions, even if he is - in my view - completely wrong-headed on this issue. What we have had from the Government has been a culture of arrogance and spin right from the get-go.
Senator Bacik stated earlier that she and her colleagues had listened in dignified and respectful silence. At the point when she said that, it was mostly true. There had been just a few eruptions over the preceding days. However, there have been more eruptions in the past few minutes, as we are coming to the end of this debate, than there were in all of our debates up to now. I have just one more substantial amendment to present to the House. We are coming to the end of the debate on this far-reaching legislation. I appeal for respect. I am very happy to stand corrected, as I did on a point of legislative detail when it was pointed out by Senator Bacik. I wish other people had been as open to the errors and flaws in their arguments and their legislation. I have repeatedly pointed out those errors and flaws over the past couple of days. I would like to think I have set a standard.
-----that regardless of whether the pharmacists who have been in touch with us are correct in their fears, at least it can be agreed that the legislation does not specifically protect them in the way that it protects other professionals? That is why I will support Senator Norris's amendment if he puts it to a vote and that is why we will advance our own amendment. It is important that we respect people's right not to become a cog in the wheel. The Minister was in error when he told the Dáil that there were specific protections to ensure people would not get in trouble arising from their conscientious objection. As I pointed out on Committee Stage, his legislation falls short of that. It provides protection against being victimised by this legislation, but there is no protection in this legislation, as things stand, for people who are made subject to sanctions other than sanctions pursuant to this legislation for wishing to exercise their conscientious objection. That is the problem. The Minister said one thing, but his legislation is doing another. I do not believe Senator Bacik or others can contradict me on that.
Most of the comments we have heard were made in response to a very strong misrepresentation of certain individuals. Their statements were misrepresented, as was their relationship with their own constituency, their profession and those they represent. When people are misrepresented and words are put into their mouths or paraphrased, it is appropriate for the record of the House to be corrected. Unfortunately, in this last debate it became necessary for a number of individuals to do that. When Senator Mullen proposed one of these amendments, I was pleased to hear him speaking about "people who want to go their own way" without interference. I presume that when we bring forward legislation in respect of buffer zones to ensure that those who "want to go their own way" quietly can access these services in what might be difficult situations for them, the Senator will be similarly strong on the important principle of allowing them to do so.
The Senator also spoke about people not being "comfortable approaching Government figures". We have had a period of time in history when women were not able to approach almost anybody to talk about the reality of the situations they were in. Now we are bringing in legislation that will bring them some comfort in approaching their doctors to talk about these matters and engage with them. It is clear that what is being spoken about here is not about approach, or freedom, or going anywhere. It is about the obstacles that can or cannot be put in the way. When we considered the last section of the Bill, we heard about proposals to put difficult obstacles that are not medically necessary in the way. I do not wish to go back to that section. In this regard, conscientious objection is clearly provided for. Nobody is saying to any doctor or nurse that he or she must be the person who delivers this service. The point is that the doctor or nurse cannot be an obstacle in the path of somebody who is trying to access an essential service.
Student doctors and nurses are also covered by this section. To be clear, it covers pharmacists as well. I know this because I have campaigned on this issue previously. Right now, there is conscientious objection in respect of the morning-after pill. Young researchers have charted the many obstacles that many young women have faced in trying to access the morning-after pill because there is a right of conscientious objection. Conscientious objection exists and is working. It is already being used. Many of those who object to access to the morning-after pill are among those who may become conscientious objectors in this area as well. My colleague has read into the record the simple requirement that exists right now. They do not have to dispense - they simply need to refer onto another pharmacist. This ensures the path being taken by a woman is not blocked. It ensures an arrow is provided so that she can take another direction and go to a different pharmacist. As my colleague has made clear, students are covered in this legislation. It is really important to note that we need to monitor this measure to ensure undue pressure is not put on young junior doctors in the opposite direction. In Italy, for example, conscientious objection was almost a badge that one was expected to wear to make progress up the ladder within medical institutions. I think we are getting the right balance in this Bill. If we are giving people their freedom of conscience, it is very important that we ensure we do not bring about a situation in which there is de facto pressure on them to sign up to conscientious objection in order to make progress within an institution. This comes back to the wider issue of management and progression in our institutions, which I will not open up now. It is a key concern.
On the other side I would want to ensure that any decision on conscientious objection is made by the individual and is not an expectation of his or her working situation.
The issue of conscientious objection is dealt with comprehensively in the Bill but as Senator Bacik has said, if we are to envisage a situation where a woman is in a room with a doctor, and she is distraught and in clear need of a service available as legislated for, and as voted for by the people of this country, are we really going to focus our attention on what the doctor is feeling rather than on the woman? Is that the intent of these amendments? Surely at this stage in our development as a republic, in that very troubling, traumatic and deeply distressing situation the woman and her needs should first and foremost be our focus.
I find it ironic in the extreme that a facade of Christianity is placed over this whole idea of conscientious objection because it is coming from the same stable that would refuse the rights of teachers to conscientious objection when they are asked at interview will they uphold the religious ethos of the school. We can be very sure that their chances of advancement in the teaching profession will be really stunted if they were to suggest that they have a conscientious objection to what they are being asked by a board of management or a principal.
The child to which Senator Mullen referred is mine. I will say this much about my daughter, thank God she has been born in this year so that in years to come she will live within an ideology of care and compassion for women and not the judgmental views of Senators such as Mullen and Ó Domhnaill which would send her across the waves for the care that she needs, feeling like a criminal. Thankfully, in this year we have had a referendum and we are passing legislation that brings her closer to being an equal citizen in this Republic and not a second-class citizen which those Senators would have her remain.
I will explain why I will speak in this case. I am not participating, except on this section, for a particular reason. I believe a conscientious objection is an honourable thing to have and I will explain why. I take that view in respect of pharmacists, doctors and attendants who bring the patient to the operating theatre. They can conscientiously object and say they will not do that.
I will speak on my own position and want a bit of indulgence here because I did not take time at all.
It might be Senator Norris's problem too. I fully support the idea of conscientious objection because 35 years ago I voted for the eighth amendment. Senator Norris should not be sniffy about it. That Bill was an effort to save the lives of the unborn. Some 139 Deputies voted in favour and 11 voted against. Only six Members of that Dáil are still there and only one Member of the Seanad who voted then is still a Member. I think I should have a small bit of flexibility on this because at least I participated in that particular regard.
Thirty five years later I feel very privileged to be a Member of Seanad Éireann and to uphold the objectives of the eighth amendment to prevent abortions, only in accordance with the wording then agreed. What was lacking in that Bill was that guidelines should have been issued and ministerial orders should have been prepared to assist the work of the medical profession in that regard. That was not provided at that time. It left doctors in a very precarious situation when it came to the question of the equal right to life of the mother or the unborn. I want to make that point clear.
If I voted against abortion then and am against abortion now, and if I was a pharmacist, I would not and could not participate in providing abortion in this country. I would either lose my professional position or go against my conscience.
Let us deal with the amendment. It is conscientious objection. Is that correct? What if a pharmacist or a young porter working in a hospital has a conscientious objection to participating? Has my microphone been turned off?
He is a complete misogynist. He said that women who speak in this House should not get emotional. I will not take that. He has not read the Bill. He has no idea what he is talking about. He should go out and actually read the Bill and come back and say something with substance.
Acting Chairman, you will have to delete some of these comments which are very unsuitable. The greatest human right is the right to life of the unborn. I made those observations when I was a member of the Council of Europe and I voted against a proposal put forward for a similar proposal to be put into that Bill. I am voting against Report Stage and against the Bill.
I am too emotional. I am emotional actually and I will not apologise for that. Conscientious objection is something that some Senators do not seem to understand. I understand that certain Senators have a sincerely held view and differ from many of us in this House when it comes to this issue.
However, coming into this House and boasting about having put the eighth amendment into the Constitution in the first place when it has been repealed by 66.4% of the population is difficult to take at this point in the debate, especially when somebody is completely disconnected from the discussion taking place. It is an insult to the House to behave in that way. We are sitting here-----
I think what I referred to were comments that were condescending and mysoginistic, and I do not believe we should have to put up with them. I am wasting time talking about this because I will never change the views of people who speak in the way they do. I have no personal axe to grind with Senator Leyden. I have always got on very well with him. I know he has a very good relationship with his daughters.
He is a decent man in many ways but we just differ on this particular point. It is exasperating to sit here and listen to some comments when all of us have been here for many hours debating this Bill. Certain people then come into the House and delay it further by speaking incorrectly about many of the issues we have been discussing. That is frustrating and exasperating at this stage in proceedings.
To be fair to Senator Leyden, and I am trying to be fair to everybody in the Chamber, he cannot be accused of taking up much of the time in the debate today, Monday or Tuesday, relative to many Members on all sides of the House who made valid and not so valid points. However, in terms of the analysis of the time Members took, I do not believe Senator Leyden took anywhere near the same amount of time taken by the Members who were the largest contributors in that regard. He is more than able to defend himself. Equally, I have been trying to defend everybody's right to speak. I have given latitude to Members on all sides of the House. I cannot allow a Member who has already spoken to contribute again. Senator Marie-Louise O'Donnell has not spoken but she can do so now if she wishes.
I might have my own conscientious objection to what Senator Leyden says at times but it is a cheap shot to start calling people mysoginistic. I am sick listening to it if somebody makes a comment that people do not like or that they find emotional or passionate. I do not believe Senator Leyden is mysoginistic. Many of his arguments may be unfounded and he may not have scrutinised the Bill in the way we did, but he is not mysoginistic. In the same way, we are not all emotional. Sometimes our thought process or sense of projection takes over but I believe it is a cheap shot to call someone mysoginistic. I agree with Senator Leyden. He is not mysoginistic, and I would like to withdraw the aside I made a few minutes ago-----
This is so serious. I have three daughters and a granddaughter. Senator Noone is accusing their father and grandfather of something very grave. I am sorry, but I regard that as one of the most offensive comments made about me in all my time in public life. I thank Senator O'Donnell very much for her comments but what the Senators are doing now is harming my family.
If she makes that statement outside the House, I will sue her. I will take her to the courts. I challenge her now, as a solicitor, to make that statement outside Seanad Éireann and I will take her to court, and I will prove she was wrong. I will not stand for this. I have three daughters and a granddaughter and she made the most hurtful, hateful and spiteful comments about their father and grandfather. The Senator knows the respect I had for her in the Council of Europe and in this House over all the years we have been Members. I appeal to her to, please-----
In light of our friendship over the years and the fact that I respected her on every occasion, including in the Council of Europe and elsewhere, I ask Senator Noone to withdraw her comments. She knows that what she said is very hurtful to me personally.
Let us bring this to a conclusion. I did not intend to make a personal attack on Senator Leyden. It was the comments that I found to be in that manner. There is no need for this. There is no intention on the part of any of us to fall out here. We are trying to get through this legislation.
To get back to the amendments, Nos. 28 to 32, inclusive, I do not have anything useful to add other than to refer to my comments on Committee Stage in which I clearly outlined the way conscientious objection is protected in this Bill. We are at an impasse in terms of people's viewpoints on that and I propose that Seanad Éireann rejects the amendments.
To conclude, and to keep to the amendment, I seek clarification from the Minister. Will he indicate where protection is explicitly provided in the Bill for student doctors?
I want to make a number of points and observations about what has been discussed. The first factual point is that more than 650 GPs have signed a petition to the effect that their rights are not being protected in this Bill. One hundred and sixty-five pharmacists have signed a petition outlining the way their conscientious objection rights are not respected in this legislation.
I want to refer briefly to what Senator Reilly said. It is misleading to suggest that pharmacists' conscientious objection rights are in some way dealt with in the 2009 code of conduct and in the new draft code of conduct, which I have before me. They are not dealt with-----
I will speak through the Chair. They are not dealt with. The document makes no mention of conscientious objection. It merely states that the pharmacist must refer. That is the reason 165 pharmacists have raised their concerns and the reason the Irish Pharmacy Union has written to the Minister but, as of today, it has not received a response. Some of the pharmacists, including pharmacists who have raised this issue with me, would find it a lonely, hollow place if they were to raise those issues with Senator Reilly. That is why I am sure they have raised them with people who are willing to express their concerns in this House.
Furthermore, 500 nurses and midwives have raised concerns about it, while there is a grounding in legislation argument, a 2014 High Court judgment on the issue of conscientious objection and Article 44.2.1° of the Constitution. It was Albert Einstein who once said, "Never do anything against conscience even if the state demands it." We are not following the words of that famous quotation in this Bill.
We have acknowledged the fact that I amended the Bill in Dáil Éireann to include student nurses and student midwives. Senator Bacik outlined for Senator Mullen where this had been done in the legislation and he has accepted this. As for medical practitioners, including student medical practitioners, the advice I have received indicates that the definition included in the Bill provides assurance that all medical practitioners who might be asked to carry out or participate in any way in a termination of pregnancy are covered by section 22. Therefore, no further amendment of the wording set out in that section is necessary to provide the protection Senator Ó Domhnaill is seeking.
-----I accept what Senator Noone said to me. I accept that she has not accused me of saying things that might be taken in the way she has described. I respect everyone in the House. I respect their views and the will of the people. The Minister had to do his duty, for which I respect him. I apologise to anyone who I said was emotional, but these are personal comments. They do not reflect the views of anyone associated with me.
Catherine Ardagh, Ivana Bacik, Colm Burke, Ray Butler, Jerry Buttimer, Lorraine Clifford Lee, Rose Conway Walsh, Martin Conway, Maire Devine, Frank Feighan, Paul Gavan, Alice Mary Higgins, Kevin Humphreys, Colette Kelleher, Anthony Lawlor, Pádraig MacLochlainn, Gabrielle McFadden, Gerald Nash, Catherine Noone, Marie Louise O'Donnell, Niall Ó Donnghaile, Aodhán Ó Ríordáin, James Reilly, Neale Richmond, Lynn Ruane, Fintan Warfield.
Catherine Ardagh, Ivana Bacik, Colm Burke, Ray Butler, Jerry Buttimer, Lorraine Clifford Lee, Rose Conway Walsh, Martin Conway, Maire Devine, Paul Gavan, Alice Mary Higgins, Kevin Humphreys, Colette Kelleher, Anthony Lawlor, Pádraig MacLochlainn, Gabrielle McFadden, Gerald Nash, Catherine Noone, David Norris, Marie Louise O'Donnell, Niall Ó Donnghaile, Aodhán Ó Ríordáin, James Reilly, Neale Richmond, Fintan Warfield.
I move amendment No. 31:
In page 15, line 25, to delete "2011." and substitute the following:"2011;
"pharmacist" means a person whose name is for the time being registered in the register of pharmacists established under section 13 of the pharmacy Act 2007.".
Catherine Ardagh, Ivana Bacik, Colm Burke, Ray Butler, Jerry Buttimer, Lorraine Clifford Lee, Rose Conway Walsh, Martin Conway, Maire Devine, Paul Gavan, Alice Mary Higgins, Kevin Humphreys, Colette Kelleher, Anthony Lawlor, Pádraig MacLochlainn, Gabrielle McFadden, Gerald Nash, Catherine Noone, Marie Louise O'Donnell, Niall Ó Donnghaile, Aodhán Ó Ríordáin, James Reilly, Neale Richmond, Lynn Ruane, Fintan Warfield.
I move amendment No. 32:
In page 15, between lines 25 and 26, to insert the following:""medical practitioner" means a medical practitioner who is for the time being registered in the register or a person who is studying or training to qualify or work as a medical practitioner.".
Catherine Ardagh, Ivana Bacik, Colm Burke, Ray Butler, Jerry Buttimer, Lorraine Clifford Lee, Rose Conway Walsh, Martin Conway, Maire Devine, Paul Gavan, Alice Mary Higgins, Kevin Humphreys, Colette Kelleher, Anthony Lawlor, Pádraig MacLochlainn, Gabrielle McFadden, Gerald Nash, Catherine Noone, Marie Louise O'Donnell, Niall Ó Donnghaile, Aodhán Ó Ríordáin, James Reilly, Neale Richmond, Lynn Ruane, Fintan Warfield.
I move amendment No. 33:
In page 15, between lines 25 and 26, to insert the following:"Dignified Disposal of Foetal Remains
23.(1) The bodily remains of a foetus who has been the subject of a termination of pregnancy carried out by surgical means shall be disposed of only by way of:(a) burial in a burial ground for the purposes of section 44 of the Local Government (Sanitary Services) Act 1948; or(2) The Minister shall make regulations to provide for the dignified disposal in accordance with subsection (1)of the bodily remains of a foetus who has been the subject of a termination of pregnancy carried out by surgical means.
(b) cremation carried out in a crematorium, being a building fitted with appliances for the burning of human remains which is lawfully used for that purpose as its primary function.
(3) The woman who has availed of a termination of pregnancy carried out by surgical means shall be entitled to choose the manner of the disposal of the bodily remains of the foetus subject to subsection (1)and regulations made by the Minister under subsection (2)and the said regulations shall provide for the manner of disposal in the event that no such choice is made.
(4) A person who disposes of the bodily remains of a foetus who has been the subject of a termination of pregnancy carried out by surgical means otherwise than in accordance with subsection (1)shall be guilty of an offence.
(5) A person who disposes of the bodily remains of a foetus who has been the subject of a termination of pregnancy carried out by surgical means otherwise than in accordance with regulations made by the Minister pursuant to subsection (2)shall be guilty of an offence.
(6) A person who is guilty of an offence under subsection (4)or subsection (5)shall be liable on summary conviction to a class A fine.
(7) A person who sells or offers to sell a foetus or the bodily remains or any part thereof of a foetus who has been the subject of a termination of pregnancy shall be guilty of an offence.
(8) A person who carries out any experiment or procedure not authorised by this Act on the bodily remains of a foetus or any part thereof who has been the subject of a termination of pregnancy shall be guilty of an offence.
(9) A person who is guilty of an offence under subsection (7)or subsection (8)shall be liable on summary conviction to a class A fine or imprisonment for a term not exceeding 12 months or both.
(10) In this section "termination of pregnancy carried out by surgical means" means a termination of pregnancy which involves carrying out a procedure other than or in addition to the administration or self-administration of a drug or drugs to the pregnant woman in order to end the life of a foetus.
(11) Subsections (4), (5), (7)and (8)shall not apply to the woman who has availed of the termination of pregnancy concerned.".
I always admire Senators from whatever side who come in here and spend hours debating, as I myself used to in the old days, and contribute, whether one agrees or disagrees, but when Senators turn up occasionally, once in 26 hours, for ten minutes and cause trouble, it is difficult to assess their sincerity towards the Bill. Ar aghaidh leat.
Amendment No. 33 was discussed the other evening. It has to do with the dignified disposal of foetal remains.
On the other evening here, I dwelt on our tradition of respect for the dead and how important that is and always has been in the human experience. In many ways, this amendment is made necessary in the tragic situation of a law that excludes a vulnerable and invisible cohort within the human community from the protection of law in society, departing from time-honoured traditions of inclusivity and particular focus on the needs of the vulnerable.
This was one of what I termed on Committee Stage "the mercy amendments", which do not undo the indignity and the wrong and the injustice of abortion but at least guarantee that a little human creature who may or may not - depending on the circumstances - have somebody to grieve for him or her but in any event is not generally anywhere in the world, in particular, in the western world, afforded respect for his or her human dignity in death and in burial, and we talked about what happens in other countries.
We also talked about the abuses, the instrumentalisation of the human bodies for research, even if in pursuit of goals that one would want to see achieved in medicine and advances in care. The instrumentalisation of another human being, the use of a human being as a means to an end, has always been fundamentally against the best traditions in ethics. It is an unbreakable law that we should not use one another as means to an end. That is why it was particularly important, in the context of this amendment about the dignified disposal of foetal remains, that we would include prohibitions on the carrying out of any experiment or procedure not authorised by the Act on the bodily remains of a foetus or any part of the bodily remains of a foetus, and provide also that a person who would engage in the sale or trafficking of or who offers to sell a foetus or the bodily remains or any part thereof which had been the subject of a termination of pregnancy, the procedure intended to end his or her life, would be guilty of an offence.
At one level, it seems amazing that one has to even think about tacking on such amendments but it is made necessary by the brutal reality of the legislation itself.
I want to point out, for the avoidance of doubt and controversy, that this refers only to surgical abortions. I also want to point out that the provisions of this amendment do not create any responsibilities or carry any consequences for the woman involved. They carry consequences for medical personnel and institutions which would not treat the remains of aborted children in a dignified way where those children are aborted surgically.
That is the amendment. I know what will happen to it but it is important. It is one of those amendments that would attract the support of a majority of people, including many who voted "Yes" in the referendum.
Catherine Ardagh, Ivana Bacik, Colm Burke, Ray Butler, Jerry Buttimer, Lorraine Clifford Lee, Rose Conway Walsh, Martin Conway, Maire Devine, Paul Gavan, Alice Mary Higgins, Kevin Humphreys, Colette Kelleher, Anthony Lawlor, Pádraig MacLochlainn, Gabrielle McFadden, Gerald Nash, Niall Ó Donnghaile, James Reilly, Neale Richmond, Fintan Warfield.
Amendments Nos. 34 to 43, inclusive, are related. Amendments Nos. 35 to 43, inclusive, are physical alternatives to amendment No. 34. Amendments Nos. 38 to 41, inclusive, are physical alternatives to amendment No. 37. Amendments Nos. 39 to 41, inclusive, are physical alternatives to amendment No. 38. Amendment No. 41 is a physical alternative to amendment No. 40. Amendments Nos. 34 to 43, inclusive, may be discussed together by agreement. Is that agreed? Agreed.
I will speak to all the amendments together. They deal with decriminalisation, and the fact that the criminalisation of doctors and those who assist women has been retained in the Bill, and is straight out of the Protection of Life During Pregnancy Act. We cannot talk about protecting and supporting women in this regard. Do you want me to wait, a Chathaoirligh?
I am speaking to the group of amendments concerning criminalisation. The amendments all deal with criminalisation given that the criminalisation of doctors and those who assist women has been retained in this Bill, and is straight out of the Protection of Life During Pregnancy Act. We cannot talk about protecting and supporting women without calling out the barriers that this legislation has placed in the way of access. Decriminalisation was a central part of the discussions in the Joint Committee on the Eighth Amendment of the Constitution and the term "chilling effect" was used countless times. I fail to see how we are reducing that chill with the legislation as it is currently drafted. It is as though the Government now feels that limited access is okay. In fact, it seems to think it is better than okay.
Many academic papers, service providers and doctors clearly set out what the decriminalisation of abortion means. In simple terms the decriminalisation of abortion means removing specific criminal sanctions against abortion from the law and changing the law and related policies and regulations to achieve the following: not punishing anyone for providing safe abortion; not punishing anyone for having an abortion; not involving the police in investigating or prosecuting safe abortion; not involving the courts in deciding whether to allow an abortion; and treating abortion like every other form of healthcare. This legislation does not meet all those criteria. Women will still be criminals and so will those who support or aid them, just as it is in the Protection of Life during Pregnancy Act. There are small instances whereby decriminalisation is carved out, and just like the chilling effect of the Protection of Life during Pregnancy Act and the eighth amendment, doctors, women and those who support them will err on the side of caution. The Minister referred to women being coerced and how our laws must ensure the protection of women. While we agree on that, this legislation is not the way to achieve that.
To allow for the law to still have a role in instances the Minister envisages, we have tabled these amendments in an effort to meet him half way. That is not speaking to the first amendment, which would delete the section, but further amendments. In the Dáil, the Minister consistently made the case that he has retained criminalisation in the area due to the Attorney General's advice that some form of criminal sanction needs to be maintained to protect women and to encourage access to legal abortion services. However, what the Minister has done is implement a blanket criminalisation of all actions not done in accordance with the Bill, which is far broader than what is required to protect women. On Committee Stage, he said that we are talking about serious and violent attacks on women, a violent attack on a woman and her autonomy and situations where women may be intimidated or forced into illegal terminations of pregnancy in dangerous circumstances. However, we do not see these specific offences in section 23. Instead, blanket criminalisation is maintained, which will only serve to have a chilling effect on medical practice and the people who may assist a woman in procuring an abortion because she is a few days beyond the 12-week limit. That is what we are proposing in the former amendment No. 54, which is now amendment No. 35. It would explicitly outline specific crimes that the Minister clearly has in mind when he thinks of this section and remove the chilling effect of the current blanket criminalisation where offences are made for violent attacks on women to administer anything to a woman to end her pregnancy against her will. Amendments Nos. 42 and 43 would make it a specific offence to coerce a woman into terminating her pregnancy with the later amendments. The Minister has regularly cited the joint committee's report as justification for this blanket criminalisation. We recommended that where a termination was carried out in an appropriate medical setting and where a woman procured an abortion for herself, no criminal sanction should apply. We did not recommend that criminalisation should be applied to every situation and did not specifically call for decriminalisation. It is a misrepresentation of both our report and our deliberations to say that we did.
What we are proposing will achieve what the Minister wants but without the chilling effect on all abortion service provision and will make sure such offences would not apply to the pregnant woman herself. We have listened very closely to the Minister's comments and have matched our amendments as a result in an attempt to be constructive and find a middle ground where, if criminalisation must be retained, we make it specific to the need to protect the woman and not chill the work of our doctors as they provide abortion care.
I feel very strongly about this section. My colleague has spoken about the wider issue of the inclusion of criminal sanctions in this Bill. We would all prefer if it was a health Bill and if issues such as criminal sanctions were dealt with in other areas, for example, in amendments to the Offences Against the Person Act or in other locations. This is why there is such strong opposition. It is because for far too long, there has been an attitude of threat and sanction. We have spoken about the shadow of the eighth amendment, which has been felt. In terms of bringing light to this area, it would have been better if we were able to resolutely say that women and women's health constituted the centre. I acknowledge they are strong in this Bill because I believe people voted to support rather than to police women and their health.
I will address the very serious concern I have. As Senator Ruane noted, during the debate in the Dáil, we were told that some of the provisions in this section in terms of offences were to deal with situations of coercion with terms such as "serious and violent", "intimidated" or "forced". One of my main concerns here is that aiding, abetting or counselling a person - actions that may be done from a positive perspective, perhaps done without full knowledge of the law or taken by a family member with good intent in trying to support another family member - are offences but coercion is not an offence under this Bill and is not covered. Regarding the terrible situations we described, I believe this is the case in a very small minority of situations, but where undue pressure is being applied, I do not see where it is properly dealt with in this Bill. Section 23(1) talks about carrying out a termination but in a situation of intimidation or pressure, the termination is not being carried out by the actor. Section 23(4) again uses the terms "aid", "abet", "counsel" or "procure". The Minister said that this is language taken from the 1997 Act regarding accessories. Again, we have a problem. While the woman may not be guilty of a crime, those who support her are treated as accessories to a crime so there is an implied crime in the actions of a woman that are happening outside the terms of this Bill in that section through choosing the 1997 Act.
The other issue is the fact that "aid", "abet", "counsel" and even "procure" are actions that a person takes for someone. It is that person's intent that is being supported. In the case of coercion, intent is being forced upon somebody and the action is being pressed upon somebody and it is not an action of that person's will. We have very clear legislation that we passed in this House regarding coercion. Coercion is not an abstract word. We debated the meaning of words up and down over the course of this debate. Coercion is something for which there is a very strong, clear and recent legal precedent in the legislation on domestic violence. As it sets out what it is to intimidate, press and force somebody to act in a way to which he or she has not consented in the sense of freely given and informed consent, we have the legal precedent in this regard. With respect to the Minister and the Attorney General, I would say that when we put in new legislation, we should endeavour to ensure that our legislation does not simply go back to the 1997 Act or other Acts but reflects the realities, situations, legislation and social concerns such as coercion that have been recognised since and have been given legal recognition since.
I will not press all of these amendments. I recognise that there may be legal complexities with regard to some of them because of the intersection with the 1997 Act, which is the choice and base. However, I am extremely concerned that we could see a situation arise under this Bill whereby a family member, friend or classmate who gives advice, shares medicine in the wrong way or who tells somebody what she did because she had a termination at a time when it was illegal and gives advice that is wrong or inappropriate could find themselves prosecuted in this context while an abusive partner might not. If the person was to find him or herself in such a situation, I would find it very concerning if the same case law was to generate in respect of both.
I have strong concerns about this. I realise there are issues with a couple of my amendments in terms of their legal intersection with the language of the 1997 Act. Could the Minister clarify where coercion sits in this? I seek an assurance about what the interpretation of the word "counsel" is in this regard, because I know the Minister is taking it from the Act relating to accessories. I am very concerned that it could be very widely interpreted whereby innocently given advice or people talking about their own experiences could be misconstrued in this regard and could be regarded as an offence under this section. I am particularly concerned about the term "counsel" in this regard.
I will be supporting amendment No. 36 from our colleagues across the House. It is very important that we are clear, as we are in other parts of the Bill, that when a medical practitioner is acting in good faith, that should be recognised in respect of sections 23(1) and (2). As we already have very clear tests in respect of good faith, I will support that also.
I will speak generally to the group of amendments first and then address some of them specifically. My Labour Party colleagues and I are co-signatories to amendments Nos. 37, 42 and 43. Senator Norris has asked me to formally move and withdraw amendment No. 34 on his behalf. Broadly, all these amendments seek to address our concern to ensure, as expressed by Senators Ruane and Higgins, that the chilling effect of criminal law will not continue to operate as a barrier to women's access to abortion after enactment of this legislation. That is the fundamental concern behind this group of amendments. We all acknowledge and very much welcome the clear provision in section 23(3) that the woman herself will not be criminalised. That is crucial for me. The pregnant woman herself is not criminalised and subsections (1) and (2) will not apply to her, which is very important. Our concern arises from the sorts of prosecutions we saw in Northern Ireland in recent years where, for example, a mother was prosecuted for assisting her daughter in purchasing abortion pills over the Internet. We do not want to see that kind of support for a young woman by a parent being criminalised here. I understand, of course, that the other provisions of this Bill, particularly section 12 and the legal access to early term abortion should mean that people will not have to purchase pills illegally anymore over the internet. Clearly, in the interests of patient safety, we do not want that to remain the practice here. We know that currently three women are ordering these pills every day illegally. That was one of the key motivations behind the Oireachtas committee in recommending repeal of the eighth amendment and the introduction of this sort of legislation. We accept the need to ensure patient safety but there are residual concerns about whether we need to go as far as section 23 does in terms of the criminal law. On the other hand, we must also ask if section 23 goes far enough to deter the coercion of pregnant women. These amendments seek to address both concerns.
To turn to the individual amendments, amendment No. 37 and related amendments deal with the issue of "aid, abet, counsel or procure". As many will be aware, that is a formula taken from common law and now enshrined in section 7 of the 1997 Criminal Law Act, which applies generally in criminal law to anyone who assists a principal offender in carrying out an offence. It is known as the accomplice provision and the four words, "aid", "abet", "counsel" or "procure", should be read in that light. We currently have two offences of coercion. The offence of coercion is provided for under section 9 of the 1997 Non-Fatal Offences against the Person Act, which I read carefully in the context of this legislation. We also have the new offence of coercive control coming in under the Domestic Violence Act 2018, which we worked so hard to achieve in the Seanad. The Minister has expressed the view that the issue of coercion of a pregnant woman is addressed through the operation of section 9 of the Non-Fatal Offences Against the Person Act. The relevant part of the Act reads, "A person who, with a view to compel another to ... do any act which that other has a lawful right to do ... (a) uses violence to or intimidates that other person ...". It has been argued that this would cover some offences, some case of coercion of a woman and that the provision in subsection (4) is aimed at covering cases of coercion which are not covered by the section 9 offence. As the Department's very helpful briefing note points out, subsection (4) is in place to ensure that a person will be deterred from aiding and abetting, counselling and procuring a pregnant woman to act outside of the law and in the course of that, to expose her to procure an unsafe termination of pregnancy. I see the link with coercion and understand why subsection (4) is there. Essentially, it is to cover more subtle or more insidious forms of coercion than those which might be covered under the section 9 offence. Clearly, there will be some forms of coercion that would amount to assault, where a termination is carried out against a woman's will. We need to be sure that the criminal law is sufficient to protect women against coercion but not so extreme as to criminalise a person who, in good faith, assists another to procure pills, for example. That is the difficulty that we face with these amendments, particularly amendments Nos. 37 and 42. The latter also seeks to address the question of coercion.
Amendment No. 43, which we have also co-signed, seeks to create an offence of obstruction of access. The Minister has said that he will deal with that through separate legislation to be introduced in the new year and, as I said on Second Stage, that certainly offers my colleagues and I some comfort. The legislation will be health legislation and will deal with safe access. It will, one assumes, create criminal offences where there is obstruction of access. It might be timely when that legislation comes before the House in the new year for us to reflect on whether a better approach can be taken to the issue of coercion, with which we are all struggling. We need to ensure that women will be protected against coercive control or coercion specifically in the context of pregnancy and forced terminations while also ensuring that we are getting the balance right and not unduly criminalising those who should not be criminalised at all, such as a parent who, in good faith, helps his or her daughter.
In terms of the medical practitioners acting in good faith, they may well be protected by the wording of section 23(1) because "intentionally end the life of a foetus otherwise than in accordance with the provisions of this Act", means that a doctor who, for example, thought a woman was under 12 weeks pregnant when in fact she was not, would be protected. The bigger concern is about the well meaning friend or relative who assists a girl or a woman, knowing that the assistance provided is outside the provisions of the Act. These are the issues with which we struggle.
It is reassuring to know that legislation will be introduced in the new year with which we can all work to ensure that it protects women adequately, if these amendments are not agreed to at this stage. Again, I do not want to see this legislation delayed. I want to see women having access to legal terminations as early as possible. I am really glad that the Bill, if passed as it is, even with our concerns about section 23, will provide for free, safe and legal abortion for women. That was the promise and that was the premise on which we campaigned. Many of us, myself included, campaigned on the basis that we would like to see a less restrictive regime in place. We had concerns, in particular, about the three day waiting period, the criminalisation and so on. This was the framework presented to the people. This is not an unrestricted access to abortion law that we are debating here and that was not the basis on which we went to the people in May. That is an important point. Furthermore this law, whatever about our difficulties with the three day waiting period and section 23, is infinitely more progressive than the current situation for women in Ireland and the British Abortion Act of 1967, under which more than 160,000 Irish women have had abortions. That Act requires two doctors to certify reasons, even at the earliest stage of pregnancy. In that context, I take great comfort from the fact that section 12 of this Bill will enable women to access abortions on much less restrictive terms than is currently the case, particularly when they have to travel and work under the provisions of the aforementioned 1967 Act.
I have expressed my concerns, which are shared with my Labour Party colleagues, about the criminalisation provisions but I recognise that we will have other opportunities, not only with the Minister's new Bill in the new year but also through the mechanism of Private Member's legislation, to address those concerns.
I too will speak generally on the group of amendments and then refer specifically to amendments Nos. 36, 39 and 43. Before doing so, I want to point out that this will be only time that I will be speaking this evening. I want to say that Sinn Féin, as a team, is very proud to support this legislation. We have worked constructively at all stages. I am very proud of the fact that every member of the Sinn Féin team has been present for every vote in the House today. Our record shows that we support the legislation but are trying to make it as progressive as possible. We are very proud to do so. Of course, we operate on a 32-county basis and we will ensure that we have equality of choice for women across this island.
We commit to that.
I want to speak on the issue of criminalisation this evening, on which I also spoke on Committee Stage. It is an area about which I feel particularly passionate, as do my party colleagues.
I was a member of the Oireachtas committee and we were very clear about the need for decriminalisation. While I commend the Minister on many of the things he has done in the Bill, he has not fully honoured what we requested in that respect. That speaks specifically to amendment No. 36 where we used the phrase "good faith" which came from the committee recommendation. With that amendment we have tried to ensure that medical practitioners as well as people acting with the explicit permission of the pregnant person are excluded from offences. Medical professionals need to be assured that if they do their job in good faith, they will not be exposed to prison sentences for administering healthcare.
The Joint Committee on the Eighth Amendment of the Constitution heard about the chilling effect this has had on doctors and how such sanctions inhibit them from carrying out their work in good faith. If we do not explicitly protect doctors we will continue to see a chilling effect on doctors and this could end up endangering women's health. I appeal to colleagues across the Chamber to recognise this is a significant addition we should all be able to agree on and support when we vote in a few minutes.
Amendment No. 39 seeks to ensure that in cases where a pregnant woman explicitly requests someone to help her to obtain abortion pills from the Internet or in another manner she will not be guilty of an offence. Again, we will press the amendment to a vote. As Senator Bacik mentioned earlier, we do not want to have cases such as the one in the North of our country recently where a woman who was helped by her mother to obtain abortion pills is now under investigation and could possibly be jailed. It is unbelievable that this is happening in our country. For that reason alone, amendment No. 39 deserves our full support.
On amendment No. 43, throughout the referendum debate we witnessed what can only be described as targeted harassment and protests outside maternity hospitals and other healthcare facilities. Let us call it what it was, shameless intimidation. These individuals were also outside Leinster House, but my main concern is for women and doctors. We have seen the tactics of the anti-abortion cabal in the US and other countries where they try to intimidate women to prevent them getting an abortion. They have tried to intimidate doctors to stop them carrying out abortions. They have tried to intimidate those in healthcare facilities. Needless to say, they will start to do that here once we start delivering these services.
Recently, at an education meeting about abortion services in my home city of Limerick, doctors were threatened and nearly had to cancel their meeting. I spoke about it on radio in Limerick the other day. I was surprised to hear that the radio station had contacted other politicians who refused to come on and talk about the topic. I excuse my colleague, Senator Byrne, because she told me she was tied up with a previous engagement. However, it is poor form that elected representatives are not prepared to speak out against this level of intimidation.
We cannot wait for this to be done through other legislation and doing it through this legislation would send a powerful message to those who plan to threaten the women who need these services and the doctors who provide them.
I wish the Minister well with the rest of the Bill. I congratulate our colleagues on all sides who have worked constructively on the legislation. Let us hope we can finish the Bill in a way that makes it as strong and progressive for women as we can.
I thank Senators for their contributions and the work they put into the drafting of these amendments. They have put a lot of work into what is a very sensitive and important area that we are all determined to get right. As Senator Bacik said at the start of her contribution, I am conscious that while we are talking about the issue of criminalisation in the final grouping of amendments - that is just the way the sequencing works - those who are following the Bill closely should not forget that the Bill is about access and ensuring women can access lawful termination freely and safely in our country in a way they cannot do today. The Irish people instructed us to get on with it and ensure it happens and I am determined it will happen in this country from 1 January.
No pregnant woman will ever be criminalised under this legislation, which is a very significant difference from the situation today where women are living under the stigma and cloud of criminalisation for accessing healthcare. There will be no more of that. The pregnant woman will never be criminalised no matter how she accesses termination in this country. That is an important point.
We are living in a post-eighth-amendment Ireland and that is why Senator Bacik is so correct. It means this is not the only time we have to discuss and debate these issues. In the new year I will introduce health legislation on safe access zones. As the Senator reminds me - it is an important reminder because I am sure it will happen - Private Members' time in both Houses will allow the Oireachtas to continue to do what the people have now given us the power to do through the enabling provision in the Constitution to regulate this area. Unlike in Britain, where a Bill on this matter was passed more than 50 years ago and the position has been somewhat static since, we will continue to keep these areas under review to ensure the provisions are working as they are meant to work. If they are not working, we can take action to fix that.
In making those comments I appeal to Seanad Éireann, at the final stages of this legislation, not to do anything on the floor of this House that we have not had the opportunity to tease out in the comprehensive way that is necessary. My Department has worked extensively with the Office of the Attorney General over a sustained period to try to get this right. Time will tell if we have done so and Senators will have different views on that. I commit myself on the floor of the Seanad this evening to work with Senators in the new year as we prepare further legislation for safe access zones and to tease through some of these issues at the level of detail that I think is required and which I know many colleagues will think is required.
I have not used my notes much today, but I want to use them for this amendment because I want to take the opportunity to put some largely legalistic information on the record of the House. As Senators know, the Bill provides that it shall be an offence for a person, by any means whatsoever, to intentionally end the life of a foetus otherwise than in accordance with the provisions of the Bill. Officials from my Department and the Office of the Attorney General considered a number of different ways of phrasing this offence, and I am legally informed the wording put forward in the Bill is the clearest formulation possible.
A termination of pregnancy is a medical procedure that can be lawfully carried out by a medical practitioner only. The wording in section 23(1) was necessary to clarify that it is an offence for all persons, whether a medical practitioner or not, other than a pregnant woman in respect of her own pregnancy, to intentionally end the life of the foetus otherwise than in accordance with the provisions of the Bill. It was decided that the wording used in section 23 was the clearest wording to convey the scope of the offences therein.
With regard to the Senators’ proposed amendment which seeks to make it an offence to cause injury or death to a pregnant woman such as to cause the termination of her pregnancy, it is already an offence to intentionally or recklessly assault, with or without injury, any person, and to intentionally or recklessly kill any person.
It seems that this proposed amendment would shift the main focus from protecting the pregnant woman to protecting the pregnancy. I am sure that is an unintended consequence. The Bill as drafted, on the other hand, focuses on protecting both the pregnant woman and the foetus. Furthermore, the offence proposed by the amended subsection (1) would appear to include the actions of a pregnant woman - again I am sure unintentionally - who injures herself so as to cause the termination of her pregnancy.
The second part of this amendment refers to consent or lack of consent by the pregnant woman. It proposes to make it an offence for a person to intentionally or recklessly administer any drug, substance, instrument, apparatus or other thing to a pregnant woman without her consent such as to cause the termination of her pregnancy. Senators have also proposed an amendment which proposes adding the words, "Save in the case where a person is acting with explicit instruction from the pregnant woman".
Since behaviour which the law does not prohibit is permitted, the effect of these amendments is to make it lawful for any person to carry out a termination on a woman at any stage in her pregnancy, for any reason, if she consents. Obviously that is a very significant departure from the grounds allowed in this legislation.
The effect of these amendments would be to make sections 9, 10, 11 and 12 completely redundant, since a doctor who carried out a termination on a consenting woman outside the parameters of these sections would not be committing any offence. Furthermore, the amendments would render it lawful for unqualified non-medical persons to carry out medical or surgical terminations on consenting women, at any stage in pregnancy. Again I imagine this is an unintended consequence which highlights my point about needing to tease these issues through in great detail and my commitment to do that with Senators.
Under section 23(2) of the Bill, it is already an offence to prescribe, administer, supply or procure any drug, substance, instrument, apparatus or other thing which is intended to be used with the intent of ending the life of a foetus or being reckless about whether it might be used for that purpose. The proposed amendment seeks to make it an offence to administer a drug, etc., without the consent of the woman such as to cause the termination of her pregnancy. Any person other than a medical practitioner who administers a drug or instrument, etc., to a pregnant woman such as to terminate her pregnancy will be guilty of an offence pursuant to section 23 of the Bill.
A medical practitioner is the only person permitted to carry out a termination in accordance with the provisions of the Bill. Section 21 provides that nothing in the Bill shall operate to affect any enactment or rule of law relating to consent on medical treatment. We already have had an extensive debate about consent provisions.
I will address the amendment Senators have proposed making reference to prosecutions not being brought against medical practitioners who are acting in good faith. Each section of the Bill dealing with grounds for termination of pregnancy, namely, sections 9 to 12, inclusive, specifies that the carrying out of a termination of pregnancy is lawful where the medical practitioners are of the reasonable opinion, formed in good faith, that certain requirements are met. These provisions have the same effect legally as the effect the Senators seek in their amendment. For that reason I cannot accept it.
I am keen to emphasise one point. Senator Bacik made this point too and it is an important one. We have framed this legislation to ensure that if a doctor is following a reasonable opinion in good faith on the stated grounds and carries out a termination, then the doctor will not be guilty of an offence. That is an important protection for our medical community.
Senators have proposed deleting the subsection that makes it an offence for a person to aid, abet, counsel or procure a pregnant woman to intentionally end or attempt to end the life of the pregnant woman's foetus otherwise than in accordance with the provisions. Senators have also proposed to amend the subsection to include reference to coercion. I am keen to point out that the offence of coercion already exists in law. It is provided for by section 9 of the Non-Fatal Offences Against the Person Act 1997. I sought the view of the Attorney General on the matter following our engagement yesterday and following Committee Stage as well. If it can be proved that a person's behaviour fits the offence, including in the context of termination of pregnancy, the accused can be charged under section 9 of the 1997 Act and may be found guilty of that offence. However, in the context of a woman terminating her own pregnancy it may be difficult to prove the offence of coercion for some behaviour that should be criminalised. For example, a dominant personality, rather than forcibly terminating a woman's pregnancy himself or herself, might induce the woman to terminate the pregnancy herself instead of attending a medical practitioner. The imbalance of power between the woman and the perpetrator in such cases is unclear. That is why it is important to get the balance right in this legislation and to avoid unintended consequences. We need to ensure we protect the woman while providing for a robust offence for coercion.
In situations of abuse it is easy to see how not criminalising those aiding, abetting, counselling or procuring an unlawful termination could be used by abusers to conceal the evidence of their abuse. This could happen under the guise of helping a pregnant woman to end an unwanted pregnancy. To allow such a thing to happen would be to further allow abuse to be perpetrated against a woman or girl. In such a situation, it may be difficult to prove the existence of the constituent elements of the offence of coercion. To capture all such circumstances, the Bill creates the offence of aiding, abetting, counselling or procuring a woman to end her own pregnancy, because that offence will cover situations where a person deliberately procures a termination of a woman's pregnancy for his or her own motives. In this way the Bill seeks to ensure that more insidious or other more subtle forms of pressure or control that do not fall easily within the offence of coercion but that result in or contribute to a pregnant woman terminating her own pregnancy constitute an offence.
I wish to assure Senators that I have thought long and hard about removing this section from the Bill but following the legal advice I have received, which is clear on the matter, we have yet to come up with a formula of words to overcome the issue. Were we to remove the provision, there would be nothing in the Bill, even with the amendments, to deter a person from aiding, abetting, counselling or procuring a pregnant woman to act outside the law. Such a scenario could accidentally and entirely unintentionally expose a woman to procure an unsafe termination of pregnancy that could put her life or health at risk.
I know we are all agreed on this. One of the arguments made by those of us who were in favour of repealing the eighth amendment time and again was that termination is a reality for Irish women. Abortion is a reality for Irish women. The only difference is that either it happens in a foreign country or it happens here illegally, in an unsafe manner and without medical supervision. We cannot say as much only to pass legislation that is blind to or that ignores that fact.
Section 7 of the Criminal Law Act 1997 provides that any person who aids, abets, counsels or procures the commission of an indictable offence shall be liable to be indicted, tried and punished as the principal offender. Again, the Houses of the Oireachtas have made a decision that a pregnant woman would never be committing any offence where she undertakes the termination of her pregnancy. Those normal provisions will not apply and, therefore, they could not be relied upon to charge any person who does aid or abet an offence. From a legal perspective, the phrase is well established and understood in its entirety. Therefore, it is one I was happy to continue to work on with Senators. However, I cannot accept the amendments currently before the House. It is necessary to impose a penalty for this offence, because the offence will cover situations where a person deliberately procures the termination of a woman's pregnancy for his or her own motives rather than those of the pregnant woman.
Those are the main points I wanted to make. I accept that this is an area we need to get right. I accept that people have sincerely held views. I accept that no one wants any unintended consequences and that we all want to the balance right. We have put a great deal of work into trying to get the balance right by never criminalising the woman who is pregnant in any situation regardless of what happens while always ensuring that if there is coercion, violence, abuse or medical negligence, then there are medical protections in place for the woman. This is something we should rightly expect in our country.
Let me be absolutely crystal clear on the question of safe access zones. There will be safe access zones in this country. I deplore what has happened outside some of our maternity hospitals. It was disgraceful to see our maternity hospitals having to tweet to advise pregnant women and their partners that they might wish to use a different way in to the hospital to avoid intimidation. Senator Gavan is entirely right to say that it was intimidation and harassment of people entering a hospital and that it is not acceptable.
To be honest, I had planned originally providing for it in this Bill. Based on the legal advice I have received it makes more sense to do it in separate legislation. I wish to reiterate on the record of the House a point Senator Bacik raised with me a moment ago. I am committed to doing this under health legislation. This is not something that I will make disappear or hand over to the Department of Justice and Equality. The measures will be brought forward in a health Bill in 2019. I have received Government approval for the drafting of these legislative proposals last July. The measures will allow patients, service providers, healthcare staff and members of the public to enter or leave premises without fear of intimidation or harassment and without being subjected to unwanted communications about termination of pregnancy by any means. It will include oral, written or visual displays like those many of us were subjected to during the referendum campaign.
To ensure full consideration of these issues and to ensure the publication of this important Bill would not be delayed, I have decided that the best way forward would be to provide for safe access to health services in separate companion legislation. As Senators have acknowledged, that will provide the opportunity to tease further through some of the issues we have been discussing this evening.
I will be brief in order that we can move on. I am not in any way ignoring how important and crucial this matter is in respect of the decriminalisation of the woman. However, I believe we have criminalisation in place outside of that with regard to doctors. There was equal concern about the criminalisation of doctors because of their ability to be able to provide care to the woman. We were concerned in equal measure about criminalisation for the woman and for those who are able to provide her healthcare.
The Minister referred to aiding and abetting in one of the amendments. For the most part we all agree on the substance of the legal note we read apart from the section on aiding and abetting. The note states that a dominant personality might, rather than forcibly terminating a woman's pregnancy himself or herself, induce the woman to terminate the pregnancy herself instead of attending a medical practitioner. The imbalance of power between the woman and the perpetrator in such cases is unclear. Basically, under that provision we are ensuring that a dominant personality or someone who is an abuser cannot say that he or she was merely helping the woman to be able to get around criminal sanctions. In fact, we should be criminalising coercion and not helping such people. We are trying to ensure safeguards to prevent the abuser manipulating a system. However, we also will have a large majority of people who are trying to help in good faith, whether this involves helping their daughters or family or whoever. We are criminalising such help with the words "aiding", "abetting" and "counselling" on the off-chance that an abusive partner may manipulate the legislation so it looks like he or she was simply helping. The words are not right. Rather than looking towards a Private Members' Bill, it would be preferable to see measures in the legislation that will be forthcoming in the new year from the Minister. We need a commitment from the Minister that he will look at this again. I do not suggest he has not done so to date but I refer to further scrutiny of these provisions and how they would apply in cases of people who are helping others rather than engaging in coercion. Basically, we seek to ascertain whether the Minister will deal with coercion in the legislation in the new year, as well as the safe zones, which counter coercion in themselves. I will leave it at that. I seek a reply. I hope the Minister can come back in on my query about the legislation in the new year on coercion.
Reference was made to the criminalisation of doctors. Doctors are watching this. We need our doctors and we want them to provide this service.
Many doctors are stepping up to provide this service so I just need to reiterate the wording in the legislation which refers to doctors carrying out terminations on the grounds allowed for in the legislation, forming a reasonable opinion and acting in good faith, to have legal protection in that regard. I assure Senator Ruane that I will work with Members of Seanad Éireann who have a particular interest in it. I would be very pleased to work with Senators Kelleher, Higgins, Ruane, Bacik and many others in the new year to further tease out these matters.
Catherine Ardagh, Colm Burke, Ray Butler, Jerry Buttimer, Maria Byrne, Lorraine Clifford Lee, Paudie Coffey, Martin Conway, Paul Daly, John Dolan, Frank Feighan, Robbie Gallagher, Anthony Lawlor, Tim Lombard, Gabrielle McFadden, Michelle Mulherin, Catherine Noone, Kieran O'Donnell, Marie Louise O'Donnell, John O'Mahony, James Reilly, Neale Richmond, Diarmuid Wilson.
I move amendment No. 35:
In page 15, lines 27 to 33, to delete all words from and including “(1) It” in line 27 down to and including line 33 and substitute the following:“(1) It shall be an offence for a person to intentionally or recklessly, by any means whatsoever, cause injury or death to a pregnant woman such as to cause the termination of her pregnancy.
(2) It shall be an offence for a person to intentionally or recklessly administer any drug, substance, instrument, apparatus or other thing to a pregnant woman without her consent such as to cause the termination of her pregnancy.”.
Catherine Ardagh, Ivana Bacik, Lorraine Clifford Lee, Rose Conway Walsh, Maire Devine, Paul Gavan, Alice Mary Higgins, Kevin Humphreys, Colette Kelleher, Pádraig MacLochlainn, Gerald Nash, Niall Ó Donnghaile, Lynn Ruane, Fintan Warfield.
Colm Burke, Ray Butler, Jerry Buttimer, Maria Byrne, Paudie Coffey, Martin Conway, Paul Daly, John Dolan, Frank Feighan, Robbie Gallagher, Anthony Lawlor, Tim Lombard, Gabrielle McFadden, Michelle Mulherin, Catherine Noone, Kieran O'Donnell, Marie Louise O'Donnell, John O'Mahony, James Reilly, Neale Richmond, Diarmuid Wilson.
Catherine Ardagh, Ivana Bacik, Lorraine Clifford Lee, Rose Conway Walsh, Maire Devine, Paul Gavan, Alice Mary Higgins, Kevin Humphreys, Colette Kelleher, Pádraig MacLochlainn, Gerald Nash, Niall Ó Donnghaile, Lynn Ruane, Fintan Warfield.
Colm Burke, Ray Butler, Jerry Buttimer, Maria Byrne, Paudie Coffey, Martin Conway, Paul Daly, John Dolan, Frank Feighan, Robbie Gallagher, Anthony Lawlor, Tim Lombard, Gabrielle McFadden, Michelle Mulherin, Catherine Noone, Kieran O'Donnell, Marie Louise O'Donnell, John O'Mahony, James Reilly, Neale Richmond, Diarmuid Wilson.
I move amendment No. 38:
In page 15, to delete lines 36 to 38 and substitute the following:"(4) It shall be an offence for a person to intentionally coerce or deceive a pregnant woman into terminating her pregnancy against her will or without her knowledge.".
Catherine Ardagh, Ivana Bacik, Lorraine Clifford Lee, Rose Conway Walsh, Maire Devine, Paul Gavan, Alice Mary Higgins, Kevin Humphreys, Colette Kelleher, Pádraig MacLochlainn, Rónán Mullen, Gerald Nash, Niall Ó Donnghaile, Aodhán Ó Ríordáin, Fintan Warfield.
Colm Burke, Ray Butler, Jerry Buttimer, Maria Byrne, Paudie Coffey, Martin Conway, John Dolan, Frank Feighan, Anthony Lawlor, Tim Lombard, Gabrielle McFadden, Michelle Mulherin, Catherine Noone, Kieran O'Donnell, Marie Louise O'Donnell, John O'Mahony, James Reilly, Neale Richmond, Diarmuid Wilson.
I move amendment No. 42:
In page 15, after line 38, to insert the following:“(4) It shall be an offence for a person to intentionally coerce or deceive a pregnant woman into terminating her pregnancy against her will or without her knowledge.”.
I move amendment No. 43:
In page 15, after line 38, to insert the following:(5) It shall be an offence to obstruct, or attempt to obstruct, a woman from accessing a termination of pregnancy under this Act, including by intimidating, threatening, misleading or deceiving her, or by impeding her access to any premises or location where terminations of pregnancy are performed under this Act.”.
Ivana Bacik, Rose Conway Walsh, Maire Devine, Paul Gavan, Alice Mary Higgins, Kevin Humphreys, Colette Kelleher, Pádraig MacLochlainn, Gerald Nash, Niall Ó Donnghaile, Aodhán Ó Ríordáin, Lynn Ruane, Fintan Warfield.
Catherine Ardagh, Colm Burke, Ray Butler, Jerry Buttimer, Maria Byrne, Lorraine Clifford Lee, Paudie Coffey, Martin Conway, John Dolan, Frank Feighan, Anthony Lawlor, Tim Lombard, Gabrielle McFadden, Michelle Mulherin, Catherine Noone, Kieran O'Donnell, Marie Louise O'Donnell, John O'Mahony, James Reilly, Neale Richmond, Diarmuid Wilson.
Amendment No. 44, in the name of Senators Ó Domhnaill and Mullen, was already discussed with No. 1. Is it being moved? I am always telling Senators about the parable of the wise and foolish virgins: be ready just in case.
I move amendment No. 44:
In page 17, lines 8 and 9, to delete "section 9, 10, 11 or 12 of the Health (Regulation of Termination of Pregnancy) Act 2018" and substitute the following:"section 9 or 10 of the Health (Regulation of Termination of Pregnancy) Act 2018 where there is a risk to the life of the woman".
I move amendment No. 45:
In page 17, lines 14 and 15, to delete "section 9, 10, 11 or 12 of the Act of 2018" and substitute "section 9 or 10 of the Act of 2018 in a case where there is a risk to the life of the pregnant woman".
I move amendment No. 46:
In page 17, lines 25 and 26, to delete "section 9, 10, 11 or 12 of the Act of 2018" and substitute "section 9 or 10 of the Act of 2018 in a case where there is a risk to the life of the pregnant woman".
I move amendment No. 47:
In page 17, lines 38 and 39, to delete "section 9, 10, 11 or 12 of the Health (Regulation of Termination of Pregnancy) Act 2018" and substitute the following:"section 9 or 10 of the Health (Regulation of Termination of Pregnancy) Act 2018 where there is a risk to the life of the woman".
There has been much intense and emotional debate on this issue. To be fair to everyone, I will allow some time at the conclusion for Senators to make comments one way or another but I will not allow them time at this stage and then allow them to contribute again when the Bill is passed, or not passed, as the case may be. Senators have a choice. I will be fair to both sides. If Senators want to make a contribution now, I will allow it but I will not allow them to make another long contribution when the Bill is either passed or defeated. One way or another, I will allow Senators to contribute. They may decide whether it should be now or when the Bill is passed, or not.
Catherine Ardagh, Ivana Bacik, Colm Burke, Jerry Buttimer, Maria Byrne, Lorraine Clifford Lee, Paudie Coffey, Rose Conway Walsh, Martin Conway, Maire Devine, John Dolan, Frank Feighan, Paul Gavan, Alice Mary Higgins, Kevin Humphreys, Colette Kelleher, Anthony Lawlor, Pádraig MacLochlainn, Gabrielle McFadden, Gerald Nash, Catherine Noone, Kieran O'Donnell, Marie Louise O'Donnell, Niall Ó Donnghaile, Aodhán Ó Ríordáin, James Reilly, Neale Richmond, Lynn Ruane, Fintan Warfield.
Catherine Ardagh, Ivana Bacik, Colm Burke, Jerry Buttimer, Maria Byrne, Lorraine Clifford Lee, Paudie Coffey, Rose Conway Walsh, Martin Conway, Maire Devine, John Dolan, Frank Feighan, Paul Gavan, Alice Mary Higgins, Kevin Humphreys, Colette Kelleher, Anthony Lawlor, Pádraig MacLochlainn, Gabrielle McFadden, Gerald Nash, Catherine Noone, Kieran O'Donnell, Marie Louise O'Donnell, Niall Ó Donnghaile, Aodhán Ó Ríordáin, James Reilly, Neale Richmond, Lynn Ruane, Fintan Warfield.
Catherine Ardagh, Ivana Bacik, Colm Burke, Jerry Buttimer, Maria Byrne, Lorraine Clifford Lee, Rose Conway Walsh, Martin Conway, Maire Devine, John Dolan, Paul Gavan, Alice Mary Higgins, Kevin Humphreys, Colette Kelleher, Anthony Lawlor, Pádraig MacLochlainn, Gabrielle McFadden, Gerald Nash, Catherine Noone, Kieran O'Donnell, Marie Louise O'Donnell, Niall Ó Donnghaile, Aodhán Ó Ríordáin, James Reilly, Neale Richmond, Lynn Ruane, Fintan Warfield.
I will allow one person from each group to make a contribution. I will not allow a free-for-all. I will be somewhat liberal with the time I will allow but I will not allow Senators to go on forever. Each speaker will have a maximum of ten minutes. Is that agreed? Agreed. I will be strict on time. If all groups want to speak and each takes ten minutes, it will take one hour exactly. I welcome the Minister back to the House. I invite Senator Noone to make some concluding comments for the Government side.
This is an historic and emotional time to be in the Seanad. It is an historic moment for the Houses of the Oireachtas. We have had an intense and sometimes very difficult and emotional year and a half since this process first began in the Oireachtas. I have been contemplating various matters for the past few hours but predominantly my thoughts are with Savita and with all the women who had to travel in times when our laws abandoned women in this country.
I pay tribute to Deputy Enda Kenny-----
-----who started this process of deliberative democracy with the Citizens' Assembly.
At the time, he was much maligned for so doing. We owe him a debt of gratitude for suggesting this process which all Senators will agree has worked well. I also pay tribute to the Taoiseach, Deputy Varadkar, who put this issue front and centre on his agenda from the day he was appointed. I thank the Minister, Deputy Harris. It is fair to say that his contribution has been immense and he has been amazing. I thank those from Together for Yes, many of whom I see in the Public Gallery. I am far newer to this issue than they are. If I start naming names, I am sure to leave someone out. It has been a real privilege to work with so many inspiring people, predominantly women but also some men, on this issue.
Many negative comments have come my way over the past year but this is a proud moment for me and for everyone who has been involved on the issue. It has been the privilege of my professional career to do this work and I am very proud to have been involved in such monumental change. I am happy to know that our laws are now more caring towards women and that we live in a beautiful democracy which listened to the stories of women and the expert evidence given on the issue, particularly by doctors. Thankfully, our decades-old English solution to an Irish problem will come to an end once the President signs into law the Bill which will be sent to him from the Oireachtas today. We repealed the eighth amendment and we legislated to reflect that. I am proud of how we have reached this point.
I will share two minutes of my time with Senator Clifford-Lee. I have not spent as much time on this issue as my colleague, Senator Noone, who I thank for her hard work, time and commitment on the issue. I thank the members of civic society who are here today, including many members of Together for Yes who have put a great deal of time and effort over the past 18 months into making this a historic day and getting us to where we are. I particularly thank the Minister. This is the longest debate to which I have been party and I was glad to listen to Members on both sides of the debate. The Seanad did itself proud and the debate was, in very large part, courteous and contemplative. I am very proud to have taken part in it. I particularly thank the Minister for sitting through the debate, being very eloquent and addressing many of the concerns of Senators, especially in regard to criminalisation and other matters which he was able to clarify. We look forward to the legislation in the new year on exclusion zones. I thank the staff of the Seanad, the Cathaoirleach, the Leas-Cathaoirleach and the Acting Chairmen who facilitated the debate. We owe them sincere thanks. I thank the medics behind the scenes.
I thank my party, Fianna Fáil, and its leader, Deputy Micheál Martin, who made his views on the issue clear at an early stage. I thank my colleague, Deputy Lisa Chambers, who put in significant effort, particularly on Committee Stage of the debate, and was a great champion of repealing the eighth, as well as many other colleagues to whom I will not refer for fear of forgetting someone. I became very emotional when Deputy Micheál Martin made a speech in the Dáil in favour of repealing the eighth. It was a very proud day and a turning point for me. Many members of Fianna Fáil may sometimes feel left on the edge but it was nice to feel that we are on the right team and that there are like-minded people in our party. That speech gave me great comfort as a Fianna Fáil member.
Like Senator Ardagh, I wish to pay tribute to Deputy Micheál Martin. I remember sitting in my car in Malahide, listening to his speech in the Dáil with tears rolling down my face. It reaffirmed my commitment to my party and the republican ethos by which I have lived my life. There are many people to thank for bringing us to this day. It is a very emotional time for us all. We took the bull by the horns and finally dealt with this issue.
I wish to spare a thought for the women who for too long travelled and those who lived with stigma and shame in this country. At last, women can be looked after at home in their time of need and do not have to go abroad alone to face perhaps the most difficult time in their life.
I thank those who embarked on their own personal difficult journeys, engaged on the issue and listened to the debates, experts and the women of Ireland, then had an internal conversation and voted “Yes” in May. They empowered us, as legislators, to come to these Houses and do our jobs and legislate to provide proper healthcare for the women of Ireland. Politicians are much maligned but we took this issue and finally dealt with it. We did not continue to go with the narrative that this was a toxic issue that could never be tackled. Of course, it could be tackled and we could deal with it as mature people. Of course, the democratic will of the people of Ireland could be respected and we could legislate and deal with each other in a courteous manner in these Houses. I am very thankful to be here as part of this process. I hope we can leave the House united, put any disagreements behind us, get on with things and let the women of Ireland have the healthcare they deserve.
With goodwill to all, this is a sad moment for hundreds of thousands of people in our country. It is a moment of great change but it is not permanent negative change. It is a crisis for solidarity with some of the most vulnerable in Ireland. Hundreds of thousands of people are very sorry that this day has come. It could be said that Ireland has not so much caught up with the rest of the world but, rather, lost its lead and the rest of the world has caught up with us in terms of this very sad and despairing way of dealing with a human dilemma.
As we consider how we got here, it is useful to reflect on how past wrongs sometimes lead to counter-reactions and injustices. I think of past injustices of men towards women, the despair of the events of the 20th century internationally and the emergence of Marxism and its focus on the resolution of injustice through conflict between people. It is fair to say that a movement has grown which has driven a wedge between women and men and women and children and chosen to see a conflict of rights instead of a reconciliation of rights in response to many human problems.
I pay tribute to the visionary people who in 1983 established a constitutional principle that cherished all human life. Although it is true that many travelled abroad for abortions, it has always been wrong to say that this was only a matter of whether people had an abortion abroad or at home. There has not been sufficient emphasis on and realisation of how many lives were saved because of the eighth amendment, how many women avoided abortion regret and how many children grew up to be adults, to survive and thrive in our society. There is no easy way to deal with this dilemma but it is always better to take the route that does no harm and does as much good as possible.
One could dwell on politicians, promises given by political parties, promises not kept and people misled and deceived. One could also reflect on the corruption of medicine at home and abroad and on the coercion of people's consciences. They are all issues that flow from unjust law. We do have a problem. In the name of "compassion", innocent lives can be taken away. That is a matter of concern to anybody who sees himself or herself as an inclusive humanitarian. In our topsy-turvy world, this silencing of the invisible vulnerable voice is called "compassion". It is even called "human rights". It is, sadly, a travesty of respect for human rights and human dignity.
There is hope. Advances in science increasingly help us to a realisation of the wonder of life in the womb from its earliest stages. Once more, we will see stirrings of idealism. A new generation will emerge, and is already emerging, that will demand a return to solidarity. Nothing is forever. Much focus was given to the cheering after the result of the referendum, something that many people, including "Yes" voters, found disturbing.
Less attention has been paid to the many young people, not a majority but numerically significant, who see this in human rights terms. Some of them are people of faith and some of them are not. They see it as something that should be of concern to all faiths and none - including the weakest among us. We are at our best as a society when we make room for the weak and the invisible and the powerless. That is never about saying "No" to supporting women in their dilemma. It is a both-and solution, instead of an either-or solution, that has always been at the heart of the pro-life message.
We will arrive at a moment where there will be more education and cultural change in favour of a more inclusive vision of human rights. The Minister may talk about erecting barriers to those who would protest. I would certainly never want to engage in any activity that would stop people from accessing what is a legal entitlement but neither the Minister nor anybody else can ever silence the voices of those who will want, in a loving and respectful way, to offer and to persuade in a better direction in a way that cherishes all human life.
These people I have spoken about, whom I have met, who are texting me today, men and women, younger and older, people in college and people in the working world already, these are the people who will respond in ever more active, kind and vigilant ways to try to create a better future. Today is not the end of the pro-life movement. Today is the beginning of a new phase in its work. There are encouraging signs in other parts of the world. Angela Merkel's successor as head of the Christian Democratic Union, CDU, party in Germany, is pro-life and would wish to take things in a better direction there.
Even when a majority is strongly against, the thing about the pro-life message is that, because it is rooted in something that is good and beautiful, it always has new ambassadors as each new generation comes forward. It is my hope, and something I see in these young people, that they are not out to divide. They are out to bring people together in a search for solutions that are inclusive, respectful of women, men and people born and unborn. There will be civil rights activism in the name of that important civil right that is conscientious objection. I refer to a person's right to go his or her way peacefully, to do no harm to others and not to be caught up in processes that are unjust and do harm to others.
We have reached the end of this phase. We have lost something, noble, good and productive. I am sad to say that, in the short term, we will see the negative fruits of the repeal of the eighth amendment and the legislation that has followed. I already see, however, the early light of the bright new dawn that is ahead.
I wish to share time with Senator Gavan. This is a momentous moment, a momentous decision and a momentous choice. I do not want to get emotional. It will take a while for it all to sink in. I, like many others in the House, can finally let out that loud, deep breath that some of us have held for 35 years and perhaps longer. We can let it out and we can get on with life. I look forward to the next steps. Among the most pressing is the need to protect and provide the safe spaces for women seeking treatment and for the professionals providing that care and treatment.
The landslide referendum, the landslide of 66.4% and the 1.5 million people and their votes must be respected and the safe space must be respected. Today's legislation is a sound foundation that allows reproductive choices that are safe, free and legal. It will contribute further to women's social, economic and political advancement. We know that not having to endure unwanted childbearing has made a critical positive difference to women at all stages of life. From 1 January, Irish women will also benefit from this. That includes women from the young woman who wishes to finish her education, to the woman who is not prepared for children, to the overburdened mother who cannot cope with another child and to the older woman who mistakenly believed she could no longer conceive.
As the legislation progressed, some, a few in both these Houses, attempted to paint a picture portraying women, and the advocates of this legislation, as immoral, inhuman, irresponsible and frivolous. They misunderstand respect and they misunderstand trust. We will continue to cultivate respect for women as moral actors who make their childbearing decisions with profound concerns about their health, the health of their unborn babies, their lives and the lives of their families. I thank the Minister for the commitment he gave when he met Deputy O'Reilly, Ms Megan Fearon, MLA, and the campaign groups in the North. There are many aspects that are unfinished business and this is one of them. The North is next.
I acknowledge and thank the Minister. I thank colleagues from across the Chamber. I thank, in particular, my colleagues on the Oireachtas Joint Committee on the Eighth Amendment, on all sides, who worked so diligently. Above all, though, I want to thank the people from Together For Yes, the tremendous activists who, over many years, made this day possible. The inspiration in Limerick was incredible because it was the left coming together. I refer to Sinn Féin, the Labour Party, the Social Democrats, the Greens-----
I acknowledge the Fianna Fáil Party. I am not scoring points here. I just want to make the point that when we came together, we achieved something fantastic. That is the best way to make politics work. I am thinking of those people who have been campaigning for years and for decades. I was involved in that first campaign in 1983. I made reference in the Oireachtas committee to the fact that back then in Ireland, children on buses just disappeared. There were girls that we never saw again and who were never spoken of again. That is in our lifetime. After 35 years, thanks to the tremendous work of these people I have mentioned, in particular, and thousands like them across the country, we have now made a step towards a real republic. Today is a day of which we can all be proud.
We have waited 35 long years for this day where legislators are no longer hamstrung by our Constitution and can make abortion legal and accessible to women here at home in Ireland. While there are things I would have liked to have included or left out of the law, it is certainly good enough for us to proceed.
In this historic moment, I am thinking of the hundreds of thousands of women who have travelled and made those lonely journeys to England and of the women who slept on my floor in London, as I did what I could in a foreign country to help my fellow countrywomen who made making difficult choices and decisions. I am thinking about the Irish Women's Abortion Support Group, my friends Janet O'Sullivan and Kate Norris and all the others who did what they could to help Irish women. I am thinking of the work of Senator Bacik and the students' union and their bravery. I am thinking of the tireless campaigners like Ailbhe Smyth and Dr. Mary Favier and people who are not so prominent, like my friends Aileen, Moggy and Deirdre who never, ever gave up the fight for this to be real in Ireland.
I am thinking of the Irish Family Planning Association, IFPA, which provided contraception in 1980s Ireland to people like me and which trained us to teach sex education in schools, and provided books and materials. One of the titles I remember was, "Hair in Funny Places" which I bought for my children and they never thanked me for that. I would like to particularly commend the work of Alison Spillane and Maeve Taylor and the role the IFPA has played throughout.
Above all, I am thinking of my daughter and nieces, their friends and their generation who will now have freedom, their reproductive rights and choices respected safely and legally. I remember the march to repeal the eighth amendment in March 2017. I stood outside this House and watched wave upon wave of mostly young women call on legislators to provide for their reproductive rights in their own country. I was so inspired by their passion and determination. I began to dare to dream that we could repeal the eighth amendment and legislate for abortion care in Ireland. After 35 years of waiting, we could pass on a better Ireland to our daughters than the one in which I came of age.
I thank the Minister and all the officials. I thank my colleagues in the Civil Engagement group and all the Senators of like mind. This is not an easy place for Senators Mullen and Ó Domhnaill, but they will now feel some of what we felt for all those years when what we believed in was not heard or upheld.
It has been an honour and privilege. I never expected to be in this House but it is wonderful to have been part of this really important change. I thank everybody.
Senator Kelleher has thanked everybody so perfectly that I will not attempt to match her, but I want to thank my colleagues in the House, the Minister and all of those in the other House and all the people who have championed this issue, but particularly those who have done so in very difficult times and in the streets. I thank those who campaigned in 1983 and those who campaigned, not only on this issue, but on the wider issue of women and their reproductive rights and the idea that a woman's body is important to her and that her decisions, feelings and concerns matter.
I thank all those who campaigned, brought this issue to the agenda and campaigned as part of Together for Yes. Myself and others visited towns across the country during the campaign and sometimes only two or three people came out but they gave that permission to others. They let it be known that this was a thing we could talk about. In particular, I want to thank those who spoke about their experiences, not always in public, but in private, and who shared their experiences with family members with whom they may never have shared before, talked about it and created a more honest relationship.
In particular, I thank the public who chose support over silence. We began today by marking Vótáil 100, a century since women's suffrage, and it is fitting that we are ending the day with something which I believe is another marker of equality in Ireland. We are closer to being a republic that not only respects and trusts women but one which women can trust and which they know they can shape. It is a better Ireland.
I recognise there are fears and concerns for many across the country. There have been many decades of fear around this issue. I hope, when these laws are in action, that everyone with fears about this legislation will see that it is compassionate. It is better to be able to talk, share and support each other and it is, in fact, a step forward. I hope that many more will come to the view of the vast majority who voted in May. I firmly believe they will.
There are still challenges to make sure that women are closer to safe, free and legal healthcare. We need to make sure that women's health and rights remain as central issues. That will be important and it will not always be easy. We must ensure that our institutions truly deliver access to healthcare. We must ensure that all persons who can become pregnant feel that they have the supports and routes to supports that they need. We also really need to make sure that the most vulnerable persons get access in this area and that this is working for them. This is new practice and we will have to make sure that it works. I am confident we will be able to do that together.
We must also not forget the many women still living who are carrying the legacy of a crueller, harder time to be pregnant. We must ensure that, as we move forward, we also address and give justice to the legacy and burden carried by those who suffered in a different and harder time.
I spoke about Vótáil 100. I hope those young campaigners in particular, as my colleague has described, see that their voices can shape Ireland. I hope they are enthused to keep working together. It will not always be possible, but working together when they can to shape Ireland. Ireland is now an ambassador to the world as a way to deal with this issue. We should become champions of good, kind, compassionate human rights practice. In particular, we should give solidarity to those in Northern Ireland and ensure that human rights equivalence is delivered for them and that is something we will move to next. This is an important milestone.
I made a statement here on 17 January to which I am now going to slightly return. There was, in the main, sincerity on both sides of the debate. I offer thanks to all for that because it is important. All get the benefit of the doubt for good intentions. However, having listened to the debate this week and earlier, there was a distinct element of sophistry being deployed in this House. Sophistry is defined as the subtle practice of using clever arguments that sound convincing but are, in fact, false. I particularly refer to Senator Mullen.
Will all due respect, and I have tried to referee all of this, Senators Mullen and Ó Domhnaill, and others who spoke did so from their hearts, whether we agree with them or not. I hope this debate will not become personalised in its conclusion.
That is not my intention. I do not wish to have offended either of the Senators. It was just to be clear.
This issue involves two entities, one absolutely a human being, the mother, and another behind her that is journeying to be life. That entity in the womb that is stretching towards humanity can be described as a person or a baby, but the mother cannot disappear and nor can her pre-pregnancy human status and her continuing human status and the myriad responsibilities with which she so often has to deal.
We will have to return to the issue of voting in conscience in this House and in Irish society to look at whether public representatives and legislators have the right to their own view when they are in a space for the public and common good.
Democracy does settle issues but it does not determine right and wrong absolutely. Democracy simply brings that compromise.
As I come to a conclusion, I want to refer to the issue of trusting women. Every slight advance for women is either dragged out of the system or is a side benefit of something else, for instance, the need for women in the workplace. There is still a long and hard way to go. I was very concerned that the issue of disability and people with disabilities was overused and not rightly or sensitively used at some times in this debate. We will return to this issue soon, given the many developments we expect with regard to the environment, technology, science and people's views. Right now, concerted action is what is needed. There is a solidarity that is required in the sense that every one of us has to make sure there are fewer women on the cusp of that difficult decision. Mine is not in any sense a sense of victory. It is a sense of relief for women and a sense that all, on both the "Yes" and the "No" sides, need to work relentlessly and wisely to dampen the need for any woman to be on the cusp of considering a termination.
Speaking on the passage of this historic Bill, I feel an overwhelming sense of relief, as do many colleagues and others watching the debate. At this historic moment, I am happy to speak on behalf of my Labour Party colleagues in the Seanad, Senators Kevin Humphreys, Aodhán Ó Ríordáin and Ged Nash, and to say I am proud of the role the Labour Party has played over the 35 years the eighth amendment has been in place in our Constitution. My party campaigned against the inclusion of the eighth amendment in the first place, and members and activists of the party have been at the forefront of the repeal movement over many years as a pro-choice party. I want to mention my colleague, Deputy Jan O'Sullivan, who was our representative on the Oireachtas committee on the eighth amendment and members of Labour Women in particular, who have led on this within the party.
I also thank the Minister for Health, Deputy Harris, for his incredible leadership on this issue through the repeal campaign on the referendum and since then, in particular in the last few weeks in steering the Bill through both Houses. I thank his officials who were so committed and who have worked so hard on this. For their work in the last week, I thank the Seanad staff who facilitated such lengthy debates with such good humour.
I thank also the many activists who have played such a vital role in the campaign and acknowledge the presence in the Visitors Gallery of so many of them, including Together For Yes, led so ably by Ailbhe Smith, Grainne Griffin and Orla O'Connor. I was proud to have been a member of the steering group of Together For Yes and to have worked so closely with many of them. There are so many other groups. There is Women's Health in Ireland on which I and Deputies Kate O'Connell and Lisa Chambers worked with Senator Colette Kelleher and others on a cross-party basis to try to achieve a consensual approach to working on repeal. We worked with many other groups too, for example, Lawyers For Choice and the Irish Family Planning Association, which Senator Kelleher is correct to single out as it led for so many years on this issue. Termination For Medical Reasons also deserves a special mention because its members were to the forefront in putting out their very personal, private stories and really helping to change the way the debate was conducted, and always in such a respectful manner.
We also have to think of the process through which this has gone - the Citizens' Assembly, the Oireachtas committee, so ably chaired by Senator Catherine Noone, and, of course, the referendum campaign itself, leading to the historic 66.4% vote in favour of repeal. Certainly, if I had known nearly 30 years ago as a student threatened with prison under the eighth amendment that it would take this long to get to repeal, I would have been devastated. I do not think I would have believed I could have spent all my adult years growing up under the chill of the eighth amendment. I am conscious that, as students, we were affected by this but, of course, I am thinking now, as Senator Kelleher has been, of all the many women who have been so affected by this for so long, the 160,000 women who have had to travel, and the utterly tragic cases of women like Ms X, Savita Halappanavar, PP, the ABC women who took their case so bravely to the European Court of Human Rights, Amanda Mellet and Siobhan Whelan, and so many more unnamed, some of whose stories have been told but all of whom have suffered so much under the eighth amendment.
I am so glad that, at last, we have moved on and that we are passing this law or, rather, that it has passed - I still cannot get used to that - and that we will see services in place for women from 1 January, as promised by the Minister and as we said was our priority. It is important that we can now breathe a collective sigh of relief that we have moved on and passed a compassionate law, one which will at last enable our women to access free, safe and legal abortion where needed in crisis pregnancy. Who thought we would say that here in Ireland? I am so grateful that my daughters and all of our daughters will not have to grow up under the chill of the eighth amendment and that, at last, we are facing up to our responsibility and enabling women to access the healthcare we need here in our own country.
Mar fhocal scoir, bronnaim mo fhíorbhuíochas agus mo chomhghairdeas ar an Aire agus a fhoireann as ucht an Bhille seo a ritheadh san Oireachtas. Is lá an-stairiúil agus an-tábhachtach é seo. I congratulate the Minister on his leadership and courage. I acknowledge on my own behalf and as Leader of the House the staff who have worked with the Minister in the Department of Health and his own staff for their sterling work in ensuring we have passed this very important legislation today. I commend and thank all Members of the House for their participation in the debates during the past week. I thank the Cathaoirleach for his accommodation of the late sitting late and, in particular, I thank Senators Mullen, Ó Domhnaill and Wilson for their courtesy and respectful debate with other Members of the House over the past week. The tone of the debate, in the main, was befitting of the Upper House and in stark contrast to some of the performances in the other House. The Members of the Seanad upheld the dignity of the House with great respect and I thank them all for that.
Many of the points I wanted to make have been made, from the clarity and certainty of protection of life to the liberation of the referendum result on the repeal of the eighth amendment last summer to today's passing of this historic Bill on a day when we commemorated Vótáil 100. Notwithstanding the different viewpoints, this is a day when we can say to Irish women of today and of the future that their healthcare can be delivered safely and legally, and that the veil of darkness and secrecy is lifted from them.
To the former Minister for Health, Senator James Reilly, the former Taoiseach, Deputy Enda Kenny, the former Tánaiste, Eamon Gilmore, the Minister, Deputy Harris, and the Taoiseach, Leo Varadkar, I say that our country has come on a huge journey. We are a Republic which cherishes all equally. We have made gargantuan progress in the past decade, although we have a significant journey to go. I thank the Cathaoirleach for his courtesy and all the Acting Chairmen who chaired proceedings during the week. I thank Senator Catherine Noone for her work on the committee. I thank the Seanad staff, the ushers, the recording staff, the sound staff and the staff who record our votes for their tremendous professionalism and dedication. I wish everyone a safe journey home and I thank them for being here on a very historic day.
It is a momentous day. It is an historic day. It is a day that I am humbled and proud to be a part of. There are so many people I want to thank that it will not be possible to thank them all. I begin by thanking the Cathaoirleach for the way in which he has chaired this debate with fairness and impartiality throughout recent days. I thank the Members of Seanad Éireann for the diligence with which they have gone about their business in scrutinising this law. I have had the pleasure of being through this process twice, both in the Dáil and in the Seanad. It has certainly been an interesting few days here in Seanad Éireann as we teased through many very important issues. I thank Members for their courtesy in how they went about that.
I particularly thank those Members of the Seanad who played a role in the Oireachtas all-party committee, the foundation that really enabled us to put a concrete proposal to the people, not just asking them to vote "Yes" or "No" in a vacuum, but asking them to vote "Yes" and being able to paint a picture of what that new Ireland would look like in terms of caring for women with compassion in our own country.
I particularly thank my colleague and friend, Senator Noone, for her leadership in chairing that committee with the efficiency, courtesy and intelligence with which she goes about all of her business. I thank my officials in the Department of Health who have worked so hard on this issue for such a long period.
-----who is here with me this evening and who has been over so many days. I thank Mr. Ronan Horgan, Ms Aoife O'Brien, Ms Bronwyn Conway and Ms Noelle Waldron for all the work they have done in the Department in making sure that we were well briefed and in a position to brief Members of the Oireachtas as we went through the various legislative Stages. I thank my own team, Ms Joanne Lonergan, Ms Sarah Bardon, Ms Fiona Nugent, Ms Kathyann Barrett and Ms Majella Fitzpatrick, for working with me and putting up with me in what has been a challenging and intense time in Irish politics and in my own involvement with it.
I thank the incredible civic society leadership we saw during the referendum campaign. I particularly thank Together for Yes. I know Ms Orla O'Connor, Ms Ailbhe Smyth, Ms Grainne Griffin and Ms Deirdre Duffy are with us. They represent so many more. They represent an entire grassroots movement. I thank them for their leadership. I want to thank TFMR Ireland and so many other groups that came together in support of a "Yes" vote and to create a more compassionate country. It is really interesting example of what we can achieve when political leaders come together with civic society leaders. There is really nothing we cannot achieve. There is a lesson in that for us as we go forward and debate and consider other challenging issues. I thank staff of Seanad Éireann and the Oireachtas in general for their patience and tolerance regarding what has been a very long period.
The House will understand that I particularly want to thank those who recognise the need for our discourse to be respectful of differing views and of the sensitivities involved, particularly the sensitivities of those who have experienced termination of pregnancy. I can only begin to imagine how the intensity of debate during the referendum campaign and right throughout the legislative process must have felt for the women who travelled abroad in the past. These women felt the cold shoulder of judgment, the sting of shame and stigma at home and the isolation of being alone and vulnerable abroad. They certainly do not forget those experiences, but I hope this referendum result lets a little welcome light into those shadows of the past, shadows that were forced on their lives.
If the past is a foreign country, as L.P. Hartley said, it is barely recognisable from the country in which we find ourselves today. To look back on our political history, starting with the momentous referendum of 1983, requires a brief review of some 35 years in which this debate only rarely punctuated the work of this or the Lower House. In that period, it was the work undertaken by so many, largely outside of here, that moved Irish society to a more equal and more compassionate view of women and of a woman's right to choose. Some women had to go to court, some had to go to the United Nations, others had to go to radio and television studios to share publicly their most private anguish. In doing so, they moved a nation. I must acknowledge the work of a small number of incredible Senators and Members of the other House who campaigned so hard for so long. I think particularly of Senator Bacik-----
-----who did incredible work on this issue over so many years. Despite their small number, these Senators succeeded more than once in putting this matter on the agenda of the Oireachtas when it was not on the agenda of the majority. It is on their shoulders that we stand tonight.
At the end of such a long journey, it is astonishing to reflect on how far we have come in the past year. We pass this Bill just over six months since the people had their say. It is just two years since the Citizens' Assembly had its first meeting on the eighth amendment. This time last the year the Joint Committee on the Eighth Amendment of the Constitution was still deliberating. The Citizens' Assembly proved itself. There was a fair degree of healthy cynicism and scepticism in respect of it at the start but it proved itself to be a very powerful model of participative democracy. It is a model we should retain for the next big social issue that needs to be addressed in an era in which people and their politicians work together because there is still so much work to do. Voting to repeal the eighth does not end the equality agenda, issues of women's equality, or our work to create the inclusive society we wish to have for our children and a real, mature, tolerant republic.
So many people ask what is next. There is so much more to do. A younger generation has been galvanised by the repeal referendum, while knowing that it owes much to those who went before it. Many of them, including myself, were not born in the Ireland of 1983. We certainly do not want to live in that Ireland today.
I thank the campaigners who fought for 35 years to change a nation, to change hearts, to change minds and to break down barriers. I thank the minority who fought a battle in here when it was ignored by the majority. Now that change has been embraced by a majority at the ballot boxes and a majority in the Oireachtas. Like everybody here I am sure, today I think mostly of the hundreds of thousands of women who were forced to make the journey to access care that should have been available in their own country. They are not faceless, nameless women; they are women we know. They are our friends, our mums, our wives, our sisters, our nieces, and our work colleagues. Many of these women, who left under a cloud of secrecy, shame and silence, are still dealing with social stigma from their peers, from their communities and, up until now, from their state. On 25 May, the people of Ireland said "No more".
We cannot turn back the clock on what we did to those women but we can ensure that we enter a new era for Irish women, one in which we value them, respect their decisions and choices and care for them in their own country. I look forward to a time, not very far from now, when we will be able to ensure that women experiencing crisis pregnancies will be looked after here at home by their own doctors and will need not to fear that they will be stigmatised for their choices or that there will be a lack of support for them or their families. I also look forward to being able to assure our doctors, nurses and midwives that they can be confident in the decisions they make in helping their patients and in providing the care they require. I look forward to this Bill going to the President and to continuing my work in the Department of Health and with the HSE and all healthcare professionals who will now come together to provide this new service, which will be free, safe and legal, as we move closer to making that new Ireland a reality. The many women I have met who thought this day would never come can now breathe a sigh of relief. It has finally happened. Today, together, we are making history.