Protection of Life During Pregnancy Bill 2013

Despite the considerable controversy we have had around this debate, I am very happy to be a member of the 31st Dáil that will at last legislate to protect the lives of women when their life is threatened by their pregnancy. I think it is to our shame that we have waited until we were forced by the international community to take action in this area. It is to our shame that we forced sick, distressed and often heartbroken women onto boats and aeroplanes to find elsewhere the compassion that was not available to them here at home in their own country.

When I say it is to our shame, I mean it is to our shame as legislators. It is not, and has not been for a long time, the will of the Irish people that sick women should be treated like this. In successive referenda they told us what they wanted and those views have been confirmed in successive opinion polls, opinion polls which have shown the people to be far ahead of we politicians in both compassion and understanding.

I am happy, however, to now be a part of the process which will begin to leave those dark days behind us. Having said that, I know there will always be what we euphemistically call “crisis pregnancies”, and I know women and young girls will continue to travel in numbers to England for terminations. I know, whatever the reason for travelling, they will be distraught, lonely and frightened.

When speaking on what I regard as a very positive development, I do not want to be carping and argumentative, but I do feel I have to say something about remarks made during the debate around accusations that this would open the floodgates and lead to abortion on demand in this country. The assumption underlying this accusation is, of course, that somehow women cannot be trusted. No girl, no woman, seeks a termination lightly. It is simply not in our nature to do so. Since time began, women across the world, across religion, across class boundaries, have loved and cherished their children, and have done so instinctively, not because anyone has legislated for it. In war and in famine, they have gone to the extremes to protect and feed their children. They have sacrificed their health and often their lives for their children. So, if women make that awful decision that they must have a termination, they do not do it lightly or without a great deal of thought, and they do it in great distress. They certainly do not do it for lifestyle reasons, as has been suggested. For me, the most distressing thing about this whole debate has been how many people think the worst of women and attribute the worst motives to them, when all of the evidence is around the selfless devotion of mothers. When women go against what is their most basic, primal instinct to protect their young, they do so for very good reasons.

While this legislation will not apply to those women who will continue to travel, I hope that the passage of the legislation and the open and, for the most part, constructive debate we have all participated in, as a society, will make that journey a little bit easier, less traumatic and less secretive for them. It is the need for secrecy, more than anything, and the absence of someone to confide in or a GP to consult, that can often make those journeys not just distressing for women but downright dangerous, both from a psychological and physical perspective.

I am sorry to say one part of the legislation also displays this lack of understanding or compassion, namely, the sanctions that apply in the Bill. I hope the Minister will reflect on the inappropriateness of the extreme penalty of 14 years in jail applying to a woman who procures an abortion, or has a self-induced one. It seems to be wholly inappropriate and Dickensian to treat a distraught woman in the same way as one would a back-street abortionist, operating for profit. Applying these sanctions, apart from being harsh, is also dangerous as the threat of such a sentence hangs over the woman and would deter her from seeking treatment should there be post-termination complications, which is not uncommon.

It is particularly dangerous in the case of use of abortifacient pills, which are now much more widely used and are freely available and advertised online. I believe these will, as time goes on, become just as common as people taking the boat to England, albeit they are really only suitable in the early weeks of pregnancy. These pills have to be used within a prescribed timescale and ideally under medical supervision, but the reality is their most likely users are young girls who perhaps cannot afford to travel and who are afraid to consult either their parents or their doctors. Adding the chill of a 14-year jail sentence to the medical and psychological trauma they are already undergoing only reinforces the need for secrecy and makes it very unlikely they will seek medical treatment, thereby possibly endangering their lives.

I suppose 14 years is slightly more humane than the legislation currently on our books, which sentences women to penal servitude for life, but it is just as chilling. I believe there is a strong possibility the 14-year sentence will not comply with the requirements of the ECHR judgment.

I welcome some changes that arose from the hearings, particularly the change of language. The original phrase in the heads of the Bill that “it shall not be an offence” has been changed to “it shall be lawful”. I welcome this because language does matter. Last weekend a former Director of Public Prosecutions suggested legal representation for the foetus should be introduced in cases of suicidal intent because the woman had “two chances to have the life of the foetus terminated.” I prefer to describe this as the woman has “two chances to save her life,” which is the purpose of the legislation and a far more humane description of her dilemma and mental state. The suggestion the Attorney General should have a role in the delivery room in this case is nonsense, superfluous to what is needed to vindicate the right to life of the foetus and bizarre. The purpose of the legislation, including all of its arcane and complex procedures and requirements, is to protect and vindicate the right to life of the foetus. To do this we are compromising women’s health and happily legislating to do so. If it were only the mother’s life being considered, there would be no hoops to go through, no requirement to have three specialists, no monthly reports to the Minister and no 14 year jail sentences. There would be no legislation. Were it not for the constitutional imperative to vindicate the right to life of the foetus, the only consideration would be the mother’s health, never mind her life. This is the standard medical criterion in treating any patient, except pregnant women.

It is no secret that I personally would favour allowing terminations in cases of rape, incest and particularly where there is a clear fatal foetal abnormality. I congratulate Deputy John Hannigan who spoke very movingly this morning on that issue. I realise this legislation cannot accommodate that change because we must stay strictly within what is permitted under the Constitution, otherwise we jeopardise the passing of this legislation because it would definitely be challenged. It does not stop us, however, having a referendum on that specific matter and I hope that day will come.

For most people, this debate has been a long and difficult journey of conscience. The absence of a time limit on the right to a termination owing to suicidal intent has been and remains a major dilemma for many. Nobody here would be happy with the termination of an almost viable foetus and that includes all of the women and the doctors who have to make that excruciatingly painful decision. I take comfort in the fact that such a situation will arise only where there is absolutely no other treatment possible to save the mother’s life and that without that treatment, both will die, but life is not always straightforward. It is messy and full of difficult decisions. This is one area of legislation in which there are, undoubtedly, moral dilemmas, grey areas and uncertainties, but we, as legislators, have to face up to the responsibility of doing the best we can to provide a framework to ensure clarity and certainty when such very difficult decisions have to be made. It is morally unthinkable that we would let a woman die when it was possible to save her. It is equally unthinkable that, because it is easier on our consciences, we would send them to England to allow someone else to make that life-saving decision for us.

Terminations in the case of emergencies and suicide have received a lot of attention during the debate leading up to this legislation. Although such circumstances are rare, the other circumstance, under section 7, where there is a medical threat to the life of a woman which is not an emergency is of particular interest to me. First, because they are more likely to occur – we heard this morning about some circumstances where they do occur – and, second, because in many cases we are talking about sick women who desperately want to have a baby, this is sometimes overlooked in the debate. It seems incredibly cruel to force such women to take that lonely, difficult and often heart-breaking journey to England. It is my fervent wish that this legislation will end that practice forever. However I have concerns that this is not entirely clear in the legislation.

I was disturbed during the hearings that there seemed to be a lack of recognition among many doctors, particularly GPs, of the application of this legislation to those women not in need of an immediate termination. In other words, the risk to life is real and substantial but not immediate. However, it will increase as the pregnancy progresses. It is precisely to these women that this legislation primarily applies – women with severe illnesses such as cancer, high blood pressure, heart problems or kidney disease. It is vital that it is absolutely clear to the medical profession that under this legislation, it will no longer be necessary for such women to be sent to England. In other words, the threshold for a termination is a “real and substantial threat to the life”, but that threat does not have to be immediate or certain. Unless that is clear, there is a risk that women may continue to be left without treatment until it is too late and death is almost inevitable. This was clearly stated in the Supreme Court judgment and the Minister reiterated it in his contribution, but it is not clear in the legislation. However, it must be made clear by way of an amendment, the guidelines or in regulations. I ask the Minister to clarify this issue because it is vital all doctors, including GPs, are absolutely clear that this legislation caters for precisely these situations.

A related concern centres on the absence of a clear referral pathway from the GP’s surgery to an assessment process. It is normally a GP, not an obstetrician, who sees a pregnant woman first, but the legislation is silent on how the GP should act when there is a perceived threat to life. It is silent on how the referral process should take place and, crucially, the timeframe for that referral. Most people agree that if the need for an intervention is established, is it better it should happen earlier in pregnancy rather than later. This accords an extremely important role to the GP which should be clarified. I appreciate Deputy Micheál Martin’s remarks that the legislation cannot deal with every specific instance, but these instances have been covered by the Supreme Court’s judgment or in the Constitution. Therefore, the position must be clarified because although it has always been the law, it has not been the law as applied. If having clarity is the purpose of the legislation, it should be clearly stated in it.

Another issue of concern is the requirement for each termination to be reported to the Minister, including the registration number of the doctor carrying out the procedure. I can see how it is important to have the facts surrounding all of these cases, but I would worry about the situation, for instance, in a small rural hospital where perhaps there is only one doctor who does not claim a conscientious objection. This leaves that doctor very vulnerable and the hospital open to picketing by protesters. The last thing the staff or any woman who has already been over the hurdles required in the legislation need or needs is to have to run the gauntlet of hospital demonstrating picketers. I ask the Minister to see if there is a way the registration number of the individual doctor is not made public.

My hope for this legislation is that women’s lives will be saved by obviating the need for them to travel to obtain life-saving procedures. For those women in crisis pregnancies who will continue to travel to England, I hope this debate and the fairly reasoned argument we have had will make their journeys a little easier, less traumatic and less secretive.