Protection of Life During Pregnancy Bill 2013: Report Stage

The nub of this legislation rests in sections 7 to 9, in inclusive, which detail the physical threat to health, emergency situations and suicidal intent. The debate, particularly in recent weeks, has focused on section 9, which deals with suicidal intent. The suggestion from some is that hordes of suicidal pregnant women will suddenly come forward and these will run rings around professional psychiatrists. There is also a suggestion that these women may only “think” they are suicidal and that they should be locked up for their own protection. The reality is that women in crisis pregnancies, whether suicidal or not, will continue to do what they have always done when this legislation is passed, as I hope it will be. They will go to England. To stay in Ireland and subject themselves to the process we are putting in place means they would be suicidal when finished with it if they are not when they begin.

What application will section 9 have in that regard? The evidence suggests it will apply to one in 500,000 cases, meaning the issue is very rare but it exists. How many of those cases are likely to happen after 20 weeks gestation? I suggest there would be none. The main concern, which I understand, has been that there is no gestational limit. Everybody understands it and nobody would be happy with terminations of almost viable foetuses. If suicidal intent occurs with a pregnant women, it may come about due to her pregnancy and particularly in the early weeks after the discovery. A woman would not suddenly become suicidal five months after learning she is pregnant; that is a very unlikely scenario. If the overall instance of such cases is one in 500,000, the likelihood of an instance occurring after 20 weeks gestation is virtually zero, and it would come about only when there is no other treatment available.

The only application of section 9 will be for women or girls already in care and where assessments for determination are sought by the HSE. The irony is that the HSE is already obtaining terminations in England with no restrictions such as the assessment of three doctors, certifications or reports to the Minister or these Houses. The only effect of section 9 will be to circumscribe the circumstances in which terminations can be obtained. Nevertheless, we seem to be pointlessly convulsing about the matter, as it will have little application in reality. Section 9 exists because it forms part of the Supreme Court judgment, and omitting it would be unconstitutional. We cannot, as some would have us think, pick and choose decisions of the Supreme Court and neither can we be so arrogant as to argue that it is wrong. By definition, the Supreme Court cannot be wrong and its decisions are the law.
Terminations required in emergency cases are also quite rare but we know, tragically, that they exist. Section 7 deals with the physical threat as grounds for a termination and it will have a greater application; these cases will not be as rare as the other two examples. We do not have precise figures for affected women but the anecdotal evidence is that the section may apply to a considerable number of sick women, where as a pregnancy progresses the threat to life would increase. Such women are travelling to Leeds, Liverpool and London and they may have cancer, high blood pressure, kidney diseases or other chronic conditions. After discussions with doctors, these women have no alternative in trying to save their lives but to travel to England.

This is really very minimal legislation and my only hope for it is that these sick women will no longer have to travel. I know that is the intent in the legislation and the Minister has reiterated the point. I am concerned that the legislation does not articulate it nonetheless, and specifically that doctors are covered by this legislation even where the threat to life is not imminent or inevitable. I hope the legislation works and I know its purpose is to provide clarity, so we should take the opportunity to give such clarity by writing it into the legislation. Doctors must be absolutely clear they are covered.
It became quite clear that some doctors thought it only applied in emergencies or where the threat was imminent. It is important for GPs to have clarity around this situation because, in most cases, when women first become pregnant, they see their GP first and they do not see an obstetrician until much later. If a decision such as that has to be made, it is better made earlier than later. The Minister is not minded to accept amendments to insert this in the legislation but I ask him to consider this for guidelines later. What is often lost in this debate is that these sick women desperately want to have babies but they cannot if their lives are to be saved. It is only this cohort of women to which this legislation has any relevance or application.

Many people think the legislation does not go far enough while others think it goes too far. The truth is it is neither; it merely reiterates existing law and clarifies it. I commend the Bill to the House.