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Report of the Expert Group on the Judgment in the A, B and C v. Ireland Case: Statements (Resumed) (Continued)

Thursday, 6 December 2012

Dáil Éireann Debate
Vol. 785 No. 3

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(Speaker Continuing)

[Deputy Liam Twomey: Information on Liam Twomey Zoom on Liam Twomey] If there is one thing for which I can give credit to those gentleman, it is that they know how to discuss law. That is where we are heading and there has been much discussion around the legal issues.

  The Supreme Court has ruled that termination of a pregnancy where there is a real and substantial threat of suicide by the mother is lawful in Ireland. However that came about - whether we messed up amendments or discussions - that is the way the law currently stands. The European Court of Human Rights has upheld the position and we must legislate for it. We are discussing two issues: the matter of A, B, C v. Ireland and the matter of Irish Medical Council guidelines, and both of them can be dealt with conclusively with legislation.

  With a very emotive issue like this I can understand perfectly why many Members may not like to spell out their position as clearly but we have no choice but to legislate. We must make regulations for how the medical profession assesses the risk of suicide so as to look after the best interests of mother and child. Legislation will come first but we also need regulations, as it will be up to the Irish Medical Council to give doctors guidelines. The doctors will include obstetricians, psychiatrists and general practitioners, and the council is well up to ensuring those guidelines are to the satisfaction of Members in these Houses and people in the communities.

  In the United Kingdom the mental health of the mother is the basis of whether an abortion can be sought. The expected Irish law will concern the risk of suicide, which is vastly more restrictive than what is evident in the United Kingdom. People are discussing comparisons between the United Kingdom and Ireland but it is chalk and cheese: there is no comparison with what we will legislate for. All the other issues being discussed, including abortion on demand, pregnancy associated with rape and incest or unviable pregnancies that could go to full term, are emotive and sensitive but would require a referendum. That would be completely different from what we wish to deal with here, which is legislation and regulations dealing with Irish Medical Council guidelines and the X case, as has already been decided upon by the Supreme Court.

  As the legislation stands, it does not protect doctors or give the confidence needed by pregnant women. Aside from that, the care in our hospitals is world class and women have absolutely nothing to fear. Obstetric care in our hospitals is fantastic and patients are very well looked after and highly respected. I do not know what will come of the inquiry in Galway but I ask people to hold their counsel: I have worked in obstetrics and I know how fraught cases can become. If we had more time I would give examples of what I experienced working as a junior house officer in obstetrics. People would see the issue differently if they saw the human side of work in our health services.

  A patient may present to her general practitioner and state she is suicidal due to her pregnancy. The first responsibility of the GP is to ensure the risk is assessed properly, and if necessary, the patient can be placed in an appropriate care unit. Ideally, this should be like any other medical emergency, and a case where an obstetrician, GP or potentially a psychiatrist has to make a decision over one or two hours is wrong. A decision could be made over days as long as the appropriate level of care is given to the patient in the mean time. This must be taken into account when framing legislation. We do not need to rush into a decision making process and much time can be given to how we work this out.

  Some people feel there will be no limit to when an abortion can be carried out. At this time, a child in a neonatal unit at 25 weeks gestation has a great chance of surviving because we have moved on so far in neonatology. A full-term baby would be approximately 40 weeks. I have no doubt that we could push this further. If we had proper guidelines for behaviour and medical practice, we could continue to keep a person in appropriate care while the most appropriate action is decided. Many people fear this debate because they know we need very good checks and balances with guidelines and regulations. The legislation can do this, and this may be the most closely monitored piece of legislation or regulations we have. That is why we must work really hard to ensure we get it right.

  Everybody must remember that this is what the people of Ireland want us to do and not about Members' personal beliefs. The people want us to face up to our responsibilities and deal with this very sensitive issue. I am delighted this debate is taking place but nobody is baiting opponents to get views on record. The discussion has been very measured and people are treating it with the respect and sensitivity that is due to it. I am glad to see that.

  The idea that one of my patients would feel she had to have an abortion would upset me greatly but we all strive to be as human as possible and not pre-judge people. I would be the first to admit that it is probably easier to do this as a doctor than a politician. Others might rush to judgment, taking their own ideology on board. We have a very open-minded health care system and we have always been very fair with people having their own consciousness in dealing with issues. I know of doctors who would not prescribe and pharmacists who would not dispense morning after pills, contraceptive pills, the Mirena coil and, even up to a number of years ago, condoms. This was because of their personal beliefs. The law existed but nobody prosecuted these people, took away licences or reported them to the council. People have a human understanding of how our culture works, and it is not the same as that in the United Kingdom. We should stop making those comparisons.

  I have written medical reports when a young woman has told me she was going for a termination in the United Kingdom. I would not want that woman to go to the United Kingdom without doctors being fully aware of her medical condition; I would be putting her life at risk on the back of my own beliefs otherwise, which would not be right. The woman may need to return to my practice because of complications after the termination, and I have had women return with quite advanced complications arising from a termination. They feared that if they came to me sooner, I would have reported them to the Garda. We do not need that kind of environment or fears that people will be treated like that in the Irish health care system. It is not the way they would be treated, and people are seen with the utmost humanity. We must continue to aspire to that.

  Over the past 30 years, as I went through secondary and medical school and progressed to being a doctor, I saw the strong divisiveness of what we call the abortion debate. In the past weeks and months I have been amazed at how ordinary people in this country are engaging in the debate in a fashion not seen before. We need to encourage that behaviour when we discuss the issue. There will be no choice but to have legislation and we should be discussing what will be in that legislation, how the guidelines will be considered and how doctors should act.

  Suicide is subjective. If I perform a CAT scan I could see a tumour in a bowel and remove it but because suicide is subjective, the opinion of a psychiatrist would be needed before a final decision can be made. We should be moving the debate in that direction.

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