Check against Delivery
I move that the Health (Regulation of Termination of Pregnancy) Bill be read a second time.
As legislators in our national parliament, we hold a privileged position, and never more so than when we are acting on the instruction of the people in a referendum.
On May 25th, the Irish people gave us a very clear message to legislate for the introduction of abortion services in this country.
Today, we begin the job they have given us of making the law that follows the repeal of the Eighth Amendment and, after 35 years in our constitution, in so doing we are also making history.
Of course, history is not made only in this House. This history was made on streets, in homes and in ballot boxes across this country.
By people, including colleagues here, who have campaigned steadfastly for many years. By young people who had never had a say on an issue they cared deeply about and who were galvanised by a movement of equality. By everybody who thought deeply and felt strongly on this subject, in their different ways, and came out on May 25th to make their decision known in the ballot box, resulting in an emphatic majority to repeal the Eighth and for us to legislate.
It was a resounding affirmation of respect and support for women and their right to make choices about their own lives. It was a reaffirmation of the primacy of equality in our modern democracy. And it was a call on us all to do more. On women’s health. On women’s equality. On continuing to shape an inclusive and more equal society.
As Minister for Health, after all we heard during the campaign, after all I’ve learnt since I took this role, after everything we know of the dark past, I am determined we can begin a new chapter on women’s health. A chapter in which women are valued, their decisions are respected and they are cared for without judgment. This will be a priority for me in the time ahead.
I turn now to the legislation before us.
Purpose of the Bill
The main purpose of the Health (Regulation of Termination of Pregnancy) Bill is to set out the law governing access to termination of pregnancy in this country.
The legislation permits termination to be carried out in cases where there is a risk to the life, or of serious harm to the health, of the pregnant woman; where there is a condition present which is likely to lead to the death of the foetus either before or within 28 days of birth; and up to 12 weeks of pregnancy as set out in Head 13.
Overview of the Bill
I will now take you through the Bill to clarify its provisions.
I want to note, from the outset that, while the Bill is now arranged slightly differently, its key provisions are the same as those of the draft General Scheme approved by Government which I published in March ahead of the Referendum, and of the updated Scheme approved by Government and made public in July.
The Bill is now divided into three parts.
Part 1. Preliminary and General
The first part of the Bill has sections on definitions, regulations, offences under the Bill, repeals and transitional provisions.
Section 1 of the Bill makes standard provisions setting out the short title of the Bill and arrangements for its commencement.
Section 2 deals with definitions. It defines the meanings of some of the terms used for the purposes of the Bill, including foetus, medical practitioner, medical procedure, and termination of pregnancy.
Section 3 deals with Regulations, allowing me as Minister to make regulations to bring the legislation into operation and other such procedural matters. Any such regulations will have to be laid before the Houses of the Oireachtas for approval.
Section 4 allows that approved expenses associated with the administration of the Bill may be paid for from public funds.
Section 5 sets out the substantive offences under the Bill. It 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.
These provisions will not apply to a pregnant woman who has ended or attempted to end her own pregnancy.
It is further an offence for a person to aid, abet, counsel, or procure a pregnant woman to intentionally end or attempt to end the life of that pregnant woman’s foetus otherwise than in accordance with the provisions of the Bill.
The penalty in the Bill for intentionally ending the life of a foetus otherwise than in accordance with the provisions of the legislation is, on conviction, a fine or imprisonment for up to 14 years, or both.
It should be noted that nothing in the Bill will prevent or restrict access to services lawfully carried out outside the State – this means that, for example, a doctor referring a patient to services abroad, or a person paying for flights or accompanying a woman to another jurisdiction to access the procedure will not be committing an offence under the legislation.
Section 6 of the Bill provides for the offence by a body corporate.
Section 7 repeals certain laws which are in contravention with the principle of the Bill. In particular, it repeals the Information Act and I hope to be in a position to commence this particular part of the legislation when the law is enacted. This will allow doctors here share information with doctors abroad, which will of vital assistance to women.
Section 8 puts arrangements in place to cover situations where a review committee has been convened under the Act of 2013 and is ongoing at the time the present Bill comes into effect. It also obliges the HSE to prepare and submit a final report on reviews to me as Minister, not later than 6 months after the commencement date of the present legislation.
Part 2. Termination of Pregnancy
Part 2 of the Bill covers the grounds on which terminations of pregnancy may be lawfully provided under the legislation, arrangements for conducting reviews, and provisions on certification and notification of procedures under the legislation.
Section 9 offers definitions on health, appropriate medical practitioner, medical specialty, relevant specialty, obstetrician, review committee, and viability.
Sections 10 to 12 of the Bill set out the grounds on which termination of pregnancy may lawfully be provided, where there is a risk to life, or of serious harm to the health of the pregnant woman; where there is a risk to life or health in emergency; and where there is a condition likely to lead to the death of the foetus.
Section 13 provides that a termination of pregnancy may be carried out by a medical practitioner who, having examined the pregnant woman, is of the reasonable opinion formed in good faith that the pregnancy concerned has not exceeded 12 weeks of pregnancy. A 3-day period must elapse between certification and the procedure being carried out. This requirement is not unusual; several countries in Europe, including Belgium and Germany, have similar provisions.
The certifying doctor must then make arrangements for the procedure to be carried out as soon as possible once the 3-day period has elapsed.
Sections 14 to 19 of the Bill set out the arrangements for reviews of medical opinions, where this is sought by a pregnant woman or person acting on her behalf. The purpose of the review process is to provide a formal mechanism whereby the woman can access to a review of the clinical assessment made by the original doctor or doctors. I should make it clear that the formal review pathway is in addition to - and not in substitution for - the option of a woman seeking a second opinion as with normal medical practice.
Section 14 states that where a medical practitioner has not given an opinion or has not given an opinion which would certify a procedure being carried out under section 10 or 12, he/she must inform the pregnant woman in writing that she or a person acting on her behalf may apply for a review of this decision.
Section 15 provides for the establishment of a review panel by the HSE, which may be drawn upon to form a review committee.
Section 16 deals with the establishment of the review committee. As soon as possible, but no later than 3 days after receiving a written request from a pregnant woman, the HSE will convene a committee drawn from the review panel, to consider the relevant decision in question.
Section 17 specifies that the committee shall complete its review as soon as possible, but no later than 7 days after it is established. Where certification is made, the committee must then arrange for the termination of pregnancy to be carried out as soon as possible. Where the committee is not of the opinion that that a termination may be carried out, this decision must also be communicated to the pregnant woman and the HSE as soon as possible.
Section 18 sets out the procedures of the review committee.
It aims to empower the review committee to obtain whatever manner of clinical evidence it requires to reach a decision, and to call any relevant medical practitioners to give evidence in person. It provides for the woman herself, or a person authorised to do so on her behalf, to be heard by the review committee.
Section 19 provides that the HSE must submit a report to me, as Minister for Health, not later than 30 June each year on the operation of review committees. Information that will have to be provided in the report includes:
(a) the total number of applications received
(b) the number of reviews carried out
(c) in the case of reviews carried out, the reason why the review was sought and
(d) the outcome of the review.
Any information that might identify a woman who has made an application for a review, a person applying on her behalf, or any medical practitioner involved shall be excluded from the report by the HSE.
This information is required to monitor the implementation of the legislation to ensure that the principles and requirements of the system are being upheld.
Sections 20 and 21 set out requirements under the legislation around certification and notification of procedures carried out under the Bill.
Section 21 also contains a requirement for me, as Minister for Health, to prepare and publish an annual report on the notifications received. This will be done without disclosing the names of the women or the medical practitioners involved.
Part 3. Miscellaneous
The third and final part of the Bill includes provisions covering consent, conscientious objection and provisions for providing universal access to services for persons ordinarily resident in the state.
Section 22 deals with consent, and states that nothing in the Bill will affect the law relating to consent to medical treatment.
The intention is that the provisions of the Bill will operate within the existing legal provisions regarding consent for medical procedures.
Section 23 of the Bill covers conscientious objection. It states that where he/she has a conscientious objection, a medical practitioner, nurse or midwife shall not be obliged to carry out, or to participate in carrying out, a termination of pregnancy. This is in line with Section 49 of the Medical Council's Guide to Professional Conduct and Ethics for Registered Medical Practitioners (2016) which obliges doctors to enable patients to transfer to another doctor for treatment in cases of conscientious objection.
Section 24 prohibits receiving financial or other benefits-in-kind in cases where referrals are made to services providing terminations of pregnancy. It states that a person shall not receive or agree to receive any special benefit or advantage in consideration of a termination of pregnancy within or outside the State, or for making any arrangements for a termination of pregnancy within or outside the State. A person contravening this section shall be guilty of an offence, and liable on summary conviction to a class A fine.
The aim of section 24 is to protect a woman’s interests and to ensure that she receives objective advice and information, uncoloured by any financial or other considerations. It will prevent a counsellor, GP or other service provider from receiving “commission” for referring a woman for a termination of pregnancy either in Ireland or abroad.
It will ensure that the person or body cannot derive any benefit from recommending that a termination be procured – with benefits to include financial incentives as well as any other types of advantages or benefits in kind, e.g. holidays, cars, etc.
Sections 25 to 27 of the Bill provide the legislative basis for providing universal access to termination of pregnancy services for persons who are ordinarily resident in the State.
Section 28 of the Bill amends the Schedule to the Bail Act 1997 to include an offence under the Bill.
Service Delivery
I would now like to turn to what the service would look like, should the Bill become law.
The Bill allows the service to be provided in the primary care setting. It is my intention that termination of pregnancy services should be provided as part of the continuum of women’s health services. This would mean that in the future, women would be able to choose to have this service from their own GP - from a person with whom they are comfortable and familiar.
The international evidence and advice I have received shows that most women can have their care provided safely and effectively in the community setting.
This is particularly the case where the service is carried out in early pregnancy.
The evidence shows that the earlier in a pregnancy that a woman seeks the service, the safer it is to provide it without recourse to hospital treatment and with minimal complications or other risks to her health.
Officials in my Department and the HSE are at an advanced stage in drafting contract proposals to allow for as many members of the general practitioner community as possible to participate in providing this service. I look forward to a high rate of participation among general practitioners, so that women’s access to the service at the stage in pregnancy when it is safest can be facilitated.
So, up to 9 weeks gestation it is envisaged, as I have said, that most terminations will take place in the community setting and without recourse to referral to hospital or ultrasound scans.
I do understand that not every woman will present early in pregnancy and during the first 9 weeks.
In situations where women present between 9 and 12 weeks of pregnancy, the international evidence and advice I have received indicates that GPs should refer women to the care of consultant obstetricians in hospital environments.
Terminations after 12 weeks of pregnancy will only take place on the grounds of a risk to the life or health of the pregnant woman; a risk to the life or health of the pregnant woman in an emergency; or where there is a condition likely to lead to the death of the foetus before birth or shortly after birth. These will occur in the hospital setting.
I understand that detailed work is ongoing under the auspices of the relevant medical colleges to develop more detailed clinical guidance to assist practitioners in the clinical decision making involved in dealing with these women. My Department has provided financial assistance to the colleges to enable them to complete this work as a key component of the delivery of an integrated service.
I was pleased yesterday to welcome the appointment of Dr Peter Boylan to assist with the HSE’s preparations for the implementation of arrangements for termination of pregnancy and related services. Dr Boylan is a leading figure in obstetrics and gynaecology and we are so pleased to have him assist in this work.
Following similar models in other countries, I have directed the HSE to make arrangements to put in place a medically-staffed national telephone helpline to be available on a 24-7 basis once the expanded termination of pregnancy services are in place.
My Department and the HSE are collaborating on developing a comprehensive plan for communicating with the general public and with stakeholder groups for use in introducing expanded and new services. Messages to the general public will highlight the pathways to accessing services, sources of crisis pregnancy counselling and information where the woman may wish to access them, and medical information on the procedure at different stages of gestation.
The importance of attending services early will be one of the key messages of the communications plan.
I want to reiterate that the Government is also committed to working to reduce crisis pregnancies by improving sexual education and ensuring cost is not a barrier in accessing contraception.
Conclusion
Ceann Comhairle, it has been a long road to get this to juncture. I think today of the many people who have fought this battle over the past 35 years.
I think of the women who shared their private, intimate experiences with the public in order to seek change. I think of the women, and their families, who have endured hardship as a result of the Eighth Amendment but felt unable to share their stories. I hope the work we begin today and the referendum result sends them a message of solidarity and support they were long without.
So in closing, I would ask that we continue to be constructive and not obstructive and ensure we are respectful of each other and of the views of the people of this country as we start the debate on the Health (Regulation of Termination of Pregnancy) Bill.
I hope that we can all work together constructively on this legislation so that we can put services in place for women who need them as soon as possible.
The voices of women who spoke up so movingly during the referendum campaign earlier this year cannot be unheard. Their stories cannot be untold.
If, as I believe to be the case, the people decided they could no longer countenance women being denied care in their own country then we have to make that change. It’s time to end the lonely journeys.
Time to finish lifting the shame and stigma that have cast shadows on so many lives. Time to ‘stop punishing tragedy’.
I look forward to a future where any woman facing a crisis pregnancy can be assured that she will be treated with compassion and will be able to access all the care she and her family need in this country, supported by those who love them.
Thank you.