Speech by An Taoiseach, Enda Kenny TD Protection of Life during Pregnancy Bill 2013 (Second Stage)

At the outset, I would like to acknowledge that sensitivity of the issue we are debating and I thank colleagues for the generally respectful tone of the debate to date.

The purpose of the bill before the House today is the protection and preservation of life – the lives of women and the lives of their unborn babies.

This legislation is important, but it is not radical.

It will regulate existing constitutional rights, but will not create any new rights.

It will not lead to the introduction of abortion in Ireland, but it will clarify the very rare circumstances in which doctors can intervene where there is a real risk of a woman losing her life during pregnancy.

Background

As members will recall, in late 2010 the European Court of Human Rights in its judgement in the ABC case required Ireland to provide legal clarity to women on the circumstances in which they were entitled to a medical termination of pregnancy where there is a real and substantial risk to her life that can only be averted by the termination of her pregnancy.

This entitlement was determined by the Supreme Court in 1992 in its judgement in the X Case. It is a constitutional right which has existed since then in a completely unregulated way.

As stated in the Programme for Government, an Expert Group was established to examine this judgment and to set out the options for addressing it. This Group undertook very detailed work and presented its report to the Government in November 2012.

It is crystal clear from their report that the only realistic way of achieving the necessary legal clarity is through primary legislation, backed up by regulations and the Government decided last December to implement this option.

Given the sensitivity and complexity of the issues raised by this decision, both the Expert Group Report and the draft heads of this bill were referred to the Oireachtas Committee on Health and Children for oral hearings involving both medical and legal experts, and advocacy groups.

I want to take this opportunity to thank committee chairman Deputy Jerry Buttimer and his committee for the manner in which they carried out this very important work which has greatly contributed to the preparation of this legislation.

Principles

This bill is underpinned by a number of important principles.

-To provide legal clarity by way of legislation and regulations of the circumstances where a medical termination is permissible where there is a real and substantial risk to the life, as opposed to the health, of a woman.

-That this legislation is strictly within the parameters of the Constitution and Supreme Court Judgement in the X Case. It will cover existing constitutional rights only, and will not create any new rights.

-That the equal right to life of the unborn will be upheld and that the obligation on the medical profession to save both lives where possible will be confirmed.

-That medical termination of pregnancy can only be legally permitted in situations where all of the doctors involved in the assessment process have jointly and unanimously certified that it is the only treatment that will save the woman’s life by averting the real and substantial risk to her life.

-That, because of the subjective nature of the assessment of suicide risk, the legislation provides for a demonstrably more rigorous process of assessment in such cases.

Main features of the bill

The bill before us today, is consistent with these principles:

-The general prohibition on abortion in Ireland is restated and severe penalties will apply to any person or body that is responsible for an unlawful termination of unborn life.

-Processes are set out to establish the circumstances in which there is a real and substantial risk to the life, as distinct from the health, of a woman and where the only treatment that will avert that risk is the termination of her pregnancy.

-In a case of a medical emergency, where the risk to the woman’s life is immediate, one doctor may make the decision. In such emergencies, the doctor involved will be required to certify the reasons for his or her actions within 72 hours.

-In a case of a real and substantial risk to a woman’s life arising from a physical health condition, the assessment process will require that an obstetrician/gynaecologist and a second relevant specialist must jointly agree and certify that the termination of pregnancy is the only treatment that will save the mother’s life. In addition, where feasible, the woman’s General Practitioner will be consulted.

– In a case of a real and substantial risk to a woman’s life arising from self destruction, additional safeguards will be put in place. The assessment process will involve three specialists; one obstetrician/gynaecologist and two psychiatrists must jointly and unanimously agree and certify that the termination of pregnancy is the only treatment that will save the mother’s life. In such cases also, the woman’s General Practitioner will be consulted.

In addition, a new requirement has been included that at least one of the psychiatrists involved must have direct experience of providing mental health services to women in relation to pregnancy, childbirth or post-partum care.

-In all cases, other than emergencies, medical termination of pregnancy where legally permitted can only be carried out in public hospitals with obstetric units and mental health services. Only doctors registered on the Specialist Division of the Register of Medical Practitioners of the Medical Council can be part of these processes. As a person’s GP often has the best knowledge of their medical history, they will be consulted during the process wherever possible.

-In cases where the assessing doctors jointly and unanimously certify that a termination of pregnancy is permissible, it will be a decision for the woman concerned whether such a termination should proceed.

-In cases where any of the assessing doctors decide not to certify that a medical termination is permissible, the woman will be entitled to a review of that decision and the composition of the review panel will mirror that of the original assessment. The decision of the review panel must be unanimous before an intervention is permissible.

-Reporting and monitoring requirements will be put in place to ensure the availability of full and transparent information about the number and nature of medical terminations. All procedures must be notified to the Minister within 28 days and an annual report will be published which will detail the number, nature and location of any terminations that have been certified.

-The Minister for Health will also be given powers to suspend a service in any hospital if he believes that the provisions of this bill are not being properly adhered to. This is an important safeguard that has been added to the bill since the committee hearings.

Arguments put forward by those opposed to the bill

I now want to refer to some of the arguments that have been made by those who are opposed to this bill.

Some have argued that the Government is not obliged to legislate within the parameters of Article 40.3.3 of the Constitution, as interpreted by the Supreme Court in the X case.

Let me be clear on this point – as head of Government, I am bound to comply with the Constitution of this country. I do not have the luxury of being able to pick and choose which constitutional rights I will comply with or not.

It has also been claimed that this bill will open the floodgates to abortion on demand. I utterly refute this assertion. What is being provided for in this bill is a very restrictive process which will only be applied to very rare, life-threatening situations.

If I, as a person who is opposed to abortion, thought for one moment that this bill would lead to a liberal abortion regime in Ireland, I would not be asking the House to enact it.

In recent years, considerable resources have been devoted to supporting women who find themselves in crisis pregnancy situations. This has resulted in a significant reduction in the number of Irish women opting to travel to Britain for abortions and that it imperative that we continue to support women in these very difficult situations.

Others have suggested that the provisions of this bill which deal with the risk to a woman’s life from suicidal intent should be deleted.

This is not possible, and would, in my view be counterproductive. The reality is, whether people agree with it or not, that the constitutional right on these grounds already exists. If this bill were to ignore this reality, that right would still exist but in a totally unregulated manner.

What we are creating in this bill is a rigorous process around the issue of suicidal intent which will ensure that a termination of pregnancy on these grounds can only happen in the very rare cases where two psychiatrists and an obstetrician have jointly agreed that it is the only intervention that will save the woman’s life.

In practice, this will mean that the certifying specialists will have to satisfy themselves that all alternative treatments have been either attempted or ruled out.

In including this provision, the Government is not in any way validating or endorsing abortion as a treatment for suicide. We are simply recognising the reality that this right already exists, and putting in place a process to prevent this right being abused.

This process, and these safeguards, are far preferable, I believe, to leaving a totally unregulated right which might be open to abuse.

Some people have claimed that this bill will facilitate late term abortions and asked for a limit to be applied to when a medical termination of pregnancy can be allowed in order to save the life of a woman.

This is not correct. This bill will clarify the circumstances in which a woman may have the right to have her pregnancy terminated where that is the only intervention that will save her life.

However, it will not confer on a woman any right to insist that the life of her unborn child be deliberately ended. On the contrary, the constitutional obligation on doctors (which is reiterated in this bill) to save both lives where possible will mean that, in practice, the ending of a pregnancy where the foetus is viable will actually be the birth of a child.

This obligation will also mean that doctors who are assessing a patient where the foetus is close to the point of viability will have to be mindful of their responsibility to both patients – mother and baby.

-Finally, I want to address the accusation that I, as leader of Fine Gael, am breaking a pre-election promise in bringing forward this bill.

I reject this allegation. Before the last general election, Fine Gael made three essential points.

Firstly, we said that Fine Gael would not legalise abortion in Ireland, and we are not and will not.

Secondly, we acknowledged that the European Court of Human Rights judgement in the ABC case would have to be examined and addressed.

And thirdly, we promised that women in pregnancy would receive whatever medical treatments are necessary and the duty of care to preserve the life of the unborn would be upheld.

That is precisely what this bill aims to achieve.

Conclusion

In asking the House to support this bill, I remind members that this bill is not about creating new law or new rights.

It’s about clarifying and regulating existing rights.

To those who fear that this bill is the first step towards a liberal abortion regime in Ireland, I say clearly that this extremely restrictive bill is the only proposal that will be brought forward by this Government on this issue.

I sincerely believe that it is the right thing to do. That it will save the lives of women and their unborn babies.

I commend the bill to the House.