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Ó Caoláin appeals for compassion and understanding in debate on Protection of Life During Pregnancy Bill

20 June, 2013 - by Caoimhghín Ó Caoláin TD


Protection of Life During Pregnancy Bill 2013 – Second Stage 20 June 2013
Caoimhghín Ó Caoláin TD, Sinn Féin Health spokesperson

Few pieces of legislation in the history of Dáil Éireann have been as widely debated and anticipated prior to their publication as the Protection of Life During Pregnancy Bill.

The issues have been addressed in great detail in the Oireachtas Health & Children Committee of which I am a member. I participated in all the hearings both on the report of the Expert Group and on the Heads of the Bill. While some cynics have dismissed these hearings, I believe they deepened awareness, both in the Oireachtas and in public discourse generally, by giving voice to widespread expertise and to views across the spectrum. It was an exercise in participatory democracy.

Far better to have these complex issues addressed in a calm and considered way, based on evidence and on reasoned argument, than to have the type of hysterical so-called debates on the issue of abortion that we saw too often in the past.

That is not to say that there are not still very strongly and, in most cases, very sincerely held views on all sides on this most difficult issue. Nor is it to ignore the ugly tactics engaged in by some, but by no means all, who are opposed to this legislation. I believe, by and large, the debate has been conducted in a far more reasonable manner than before and that is positive.

For our part, this necessary legislation is welcomed by Sinn Féin.

I commend the Taoiseach and Minister Reilly and the Fine Gael Labour Coalition for their follow through on this issue, despite considerable opposition from church and advocacy voices.

We have stated consistently that legislation in line with the X case judgement and in compliance with the ABC case judgement and the Expert Group recommendations is required. In fact it is long overdue.

We believe there is now a very widely held view, and we would say a majority view, in Irish society that legislation along the lines originally set out in the Heads of the Bill, and now in this legislation, is necessary.

We must safeguard the lives of women. We must provide legal clarity. We must ensure that there are clear guidelines for clinicians. And, let no one forget, we must act at all times in strict adherence to the peoples wishes as laid down in the relevant articles of our Constitution.

For many, and I include myself, this has been and is a difficult issue. I have always been and remain pro-life. Yet I must face the fact that the lives of some are placed at a real and substantial risk due to their pregnancy and that only a termination of the pregnancy, as distinct from a termination of the life of the unborn, though that can be a consequence of the intervention, is going to save her life. This is already accepted practice in Ireland.
It is also the current legal position, as is an intervention where the woman’s life is at real and substantial risk due to the threat of suicide.

The Irish Medical Council guidelines for all registered medical practitioners states, and I quote; “Abortion is illegal in Ireland except where there is a real and substantial risk to the life (as distinct from the health) of the mother. Under current legal precedent, this exception includes where there is a clear and substantial risk to the life of the mother arising from a threat of suicide. You should undertake a full assessment of any such risk in light of the clinical research on this issue”.

As a legislator I have a responsibility, as do all members of the Dáil and Seanad, to evaluate all legislation as it will or might apply in practice, mindful of all the circumstances that do and can present. I must fulfil my role in the interest of all the people and not just those who may share my personal religious, moral or ethical outlook on any given issue. This I have always strived to do.

It is not right that I or any section of Irish opinion should seek to impose our outlook or will on society generally and certainly not where the consequences of doing so could result in the loss of a pregnant woman’s life. That could, in reality, be the loss of two lives.

I have been baffled by the arguments of some who describe themselves as pro-life but who will, in their rigid adherence to a black and white view of the world, countenance the loss of a woman’s life, always some other woman’s life, or the life of another’s wife or partner or daughter. They never contemplate for a moment that it might be their life or their wife’s or partner’s or daughter’s life. But what would their answer be if the woman in the hospital bed was not known by the name Savita but bore their name or the name of someone they loved. Would their position change or would they be prepared to take or to see her take the risk?

I am pro-life. I could not countenance risking the life of the wife I love or our daughters in such circumstances, in any circumstances.

It is beyond me how some can be so sure it will never be about them or those close to them. God grant that that be so.

Make no mistake about it. This Bill is about what it says in the title. This legislation is about protecting the life and lives of women during pregnancy where a real and substantial risk presents. It happens. All too sadly, it happens. And we cannot close our eyes to this fact.

The whole debate around this then promised Bill was of course thrown into sharp focus by the tragic death of Savita Halappanavar. The HSE report on her death was published last week on the same day as this Bill and because of its direct relevance to this legislation I wish to comment on it.

I take this opportunity again to extend deepest sympathy to Praveen Halappanavar and all the relatives and friends of Savita.

Like the outcome of the inquest, the Report is a damning indictment and has far-reaching implications.

It is extremely serious and distressing that the Report found that Savita’s death resulted from inadequate assessment and monitoring of her condition, failure to offer all management options to her, and University College Hospital Galway’s non-adherence to clinical guidelines relating to the prompt and effective management of sepsis, severe sepsis and septic shock from when it was first diagnosed.

The Report does not identify individuals involved in the care of Savita but there will be a justifiable public expectation that if serious lapses by individuals, as well as systems, occurred, then individuals should be held to account. The HSE has pointed to the forthcoming HIQA report in this context.

A crucial question that needs to be answered by that HIQA report is whether the hospital was adequately staffed and resourced to provide the standard of care required by this dangerously ill pregnant woman. That is a crucial question for all pregnant women in this State, including those who will be directly affected by the passage of this legislation.
Indeed, we may ask, how workable will the legislation be if adequate staffing, management and resources are not in place?

In looking at the HSE Report in the context of the Bill before us, the key recommendation is that which highlights the need for clear legislation and guidelines on termination to save the life of a woman.

We will never be able to say definitively that this Bill, if enacted at the time of Savita’s hospitalisation, would have saved her life. However there are good grounds, based on expert evidence, for believing that this would indeed have been the case as a termination would have been regarded as a life-saving option to which Savita should have had timely access.

As the HSE Report states:
When the patient and her husband enquired about the possibility of having a termination, this was not offered or considered by the clinical team until the afternoon of the 24th October, due to their assessment of the legal context in which their clinical professional judgement was to be exercised.

Some have argued that the clinical team could have provided a timely termination within the current law. But the point is that there was an uncertainty and a lack of clarity which, combined with the identified serious lapses in the care of the patient, led directly to her tragic death.

That uncertainty, that lack of clarity provides a very strong argument in favour of this legislation. The gap in the law has been long identified and it is long past time it was rectified.

The Judgment of the European Court of Human Rights in the A,B, C case confirmed that there is an imperative to put into legal effect the judgment of the Supreme Court in the X case. The European Court of Human Rights found that there was no accessible and effective procedure to enable Ms C to establish whether she qualified for a lawful termination of pregnancy in accordance with Irish law.

Why is this so? Because, as the European Court of Human Rights accepted, Article 40.3.3 of the Constitution, as interpreted by the Supreme Court in the X case, provides that it is lawful to terminate a pregnancy in this State if it is established that there is a real and substantial risk to the life, as distinct from the health, of the mother, which can only be avoided by a termination of the pregnancy. Therefore this State is in breach of the European Convention on Human Rights in failing to give effect to the right identified by the Supreme Court in the X case.

The Expert Group Report recited the sorry saga of the 1983 amendment and the later legal battle that had to be fought to establish the right to travel and the right to information, culminating in referendums and legislation which provide for those rights.
‘X’ was a 14 year old girl, pregnant as a result of rape, and put through the additional trauma of a High Court injunction to restrain her from leaving the State for a termination of the pregnancy. The Supreme Court judged in the X case that if it were established as a matter of probability, that there was a real and substantial risk to the life, as distinct from the health, of the mother and that this real and substantial risk could only be averted by the termination of the pregnancy, such a termination is lawful. Crucially also, the Court found that the threat of suicide constituted a real and substantial risk to the life of the mother.

The immediate result of that case was the lifting of the injunction so the young girl could travel abroad. I believe that any other outcome would have outraged the vast majority of people in this country, not to mention the likely international reaction.
The 1992 referendum followed, allowing for the right to travel and to information. In 1992, and again in 2001, the electorate in referendums rejected proposals to exclude the risk of suicide as a ground for lawful termination.

Thus, over a decade ago, and long before the A,B and C case was initiated, the clear obligation for the Oireachtas to legislate in line with the X case judgment, including the threat of suicide as a real and substantial risk to the life of the mother, was confirmed.
As well as the referendums there was the 1996 Constitution Review Group, the 1999 Green Paper on Abortion and the All-Party Oireachtas Committee on Abortion which reported in 2000. Following the defeat of the 2001 referendum there was legislative inaction as successive Governments again failed to face up to their responsibilities.
The A,B and C case begun in 2005 with judgement delivered in December 2010, effectively reaffirmed the Supreme Court judgment in the X case.

The absence of legislative implementation of these judgments has created very dangerous grey areas in which, as we now know all too well, women can die. The European Court of Human Rights judged that there is a “striking discordance between the theoretical right to lawful abortion in Ireland on grounds of a relevant risk to a woman’s life and the reality of its practical implementation”.

It was against that background that we in Sinn Féin developed our policy on abortion which I would like to refer to briefly. Like all parties and all sections of society we have members with varying and strongly held views on the issue and we respect those views and their right to hold them. However, we have a policy, democratically decided and we as elected voices of Sinn Féin have a duty to articulate and uphold party policy irrespective of our own personal positions.

Over many Sinn Féin Ard Fheiseanna we have debated this issue and reached an agreed policy position. It is the members of our party, as democratically delegated, who decide policy and all organs of the party and, as I have already said, all elected representatives are bound by those policies.

The policy as reaffirmed by our 2008 Ard Fheis states that Sinn Féin is not in favour of abortion nor do we believe that the 1967 British Abortion Act should be extended to the Six Counties.

We believe that all possible means of education and support services should be put in place to prevent crisis pregnancies. We believe that Irish society has a responsibility to not only address the issue of abortion but also address the fact that at least 5,000 Irish women travel to Britain each year for abortions.

When the abortion issue was discussed in the Northern Assembly Sinn Féin placed on record our very firm opposition to the extension of the British 1967 Act to the north. We supported an amendment that this complex matter should be referred to the Assembly Health Committee.

Following a discussion by the Health Committee, and the recommendations made to her by all of the parties, including the SDLP, the Women’s Coalition and the Alliance Party, the then Sinn Féin Minister for Health, Bairbre de Brún, extended the availability of the morning-after-pill.

Sinn Féin believes that the way to reduce the number of women seeking abortions is by way of State provision of comprehensive sex education, full access to safe birth control options, full access to child-care and comprehensive support services, including financial support for single parents.

Sinn Féin believes that full information and non-directive pregnancy counselling should be freely available. Sinn Féin is opposed to the attitudes and forces in society which compel women to have abortions, and that criminalises those who make that decision. We accept the right of a woman to seek a termination of the pregnancy where her life is at risk or in grave danger, and in cases of rape or incest.

Sinn Féin believes that women in crisis pregnancy situations have the right to receive accurate information by means of counselling that is impartial, non-directive and non-intimidatory.

We support the introduction of legislation to ensure this standard is met by all agencies providing crisis pregnancy counselling.

Our assessment of the Protection of Life During Pregnancy Bill, informed by our party policy as outlined above, is that it does offer greater protection for women and clarity for frontline practitioners and, accordingly, we will be supporting its passage through both Houses of the Oireachtas.

It is not perfect legislation. Far from it. It diverges from our policy in a number of respects but judged in the round and taking into account the pressing need for long overdue legislative certainty, it is, we believe, worthy of our support.
We have, of course, concerns about certain sections of the Bill.

The issue of fatal foetal abnormalities is a very serious and complex aspect of the abortion issue and one that requires the most careful consideration. The definition of the unborn in Section 2 of the Bill is relevant to this question.

We stated previously that the woman’s voice must be at the centre of the process and that no undue obstacles or delays must be put in the way of necessary treatment. We will assess Sections 7, 8 and 9 in light of these requirements.

The criminalisation of women who have terminations outside the scope of this legislation, and the threatened imposition of a prison sentence of up to 14 years as penalty, is also a serious concern, as is provided for in Section 22 of the Bill.

We may address some or all of these and other matters in the course of Committee Stage.
As I stated last December in the debate on the Expert Group Report, we are obliged to legislate.

All Teachtaí Dála have an obligation to address this need and to step up to the mark as legislators.

We have to approach this Bill with compassion and understanding and respect.
I believe that now, more than ever, the majority of people know the complexity of this issue and know that simple black and white attitudes are inadequate and insufficient to address what is involved.

We have to face up to our responsibilities. This Bill, flawed in some respects though it may be, does exactly that and for that reason Sinn Féin will support it. ENDS

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