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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 Caoimhghín Ó Caoláin: Information on Caoimhghín Ó Caoláin Zoom on Caoimhghín Ó Caoláin] We in Sinn Féin believe that those formulations of the State's obligations and the principles for implementation are sound. We have long held that legislation in line with the X case judgment is necessary. The challenge before the Oireachtas, in particular this Government, is to summon the political will to legislate and to legislate in the best possible manner.

This brings us to the core of the report. Chapter 6 addresses the procedures to be applied for determining entitlement and access to termination of pregnancy. It notes that where there is a real and substantial risk to the life of the mother, it is not necessary for medical practitioners to be of the opinion that the risk is inevitable or immediate. The options for procedures in terms of numbers and types of doctors involved in these decisions and the form of review process to be adopted need careful consideration.

Two factors are essential. First, the woman must be at the centre of the process and her voice must be heard and heeded at all times. Second, the process must not be so cumbersome and complex that vital time is lost, thus creating further dangers. For this reason, we would advocate the medical model of review rather than the legal model.

It is clear from chapter 7 of the report that regulations alone will not suffice and that primary legislation is essential. Likewise, legislation alone will not likely be sufficient to meet the requirements. A combination of robust primary legislation and regulations, in careful balance, would seem to be the optimum approach.

It is a pity that the review group was not mandated to produce recommendations rather than options. This forces us to read between the lines, especially in chapter 7, which I have cited. I would urge that the review group members be permitted to appear before the Oireachtas Committee on Health and Children to address us and to answer questions when we sit specifically to carry out that function in the second week of January.

We must legislate. This is the task that the Oireachtas must face up to. All Teachtaí Dála, without exception, have an obligation to address this need and to step up to the mark as legislators. As I have stated previously, there is no selfish political advantage in this for any party. This is not 1983, it is 2012. We must approach this issue with compassion, understanding and respect, conscious of the strong and sincere views held on all sides of this debate. Now more than ever the majority of Irish people know the complexity of this issue and that simple black and white solutions do not exist.

We have a task before us. We should face it together.

Deputy Dan Neville: Information on Dan Neville Zoom on Dan Neville I welcome the opportunity to contribute to this debate on a sensitive issue that causes extreme difficulties for many people. The decision of the Supreme Court in respect of Article 40.3.3° provided in law that the State must facilitate a termination where there is a real and substantial risk to the mother. This is the judgment of the highest court in the land and, therefore, is binding on all courts.

The Supreme Court stated that it was lawful to terminate a pregnancy if it was established that there was a real and substantial risk to the life, as distinct to the health, of the mother that could only be avoided by termination of the pregnancy. According to the X case judgment, no matter how high the probability that the mother will die, it is not and never can be a certainty. This point has already been discussed.

In 1996, a review group recommended legislation that would include definitions, protections for appropriate medical intervention, certification of real and substantial risk to the life of the mother and a time limit on the lawful termination of pregnancies. The 2009 Medical Council guidelines stated that abortion was illegal except where there was "a clear and substantial risk to the life of the mother" including suicide, in which event it directed medical professionals to "undertake a full assessment of any such risk in light of the clinical research on this issue". This is one of the clearest statements on the matter. Clinical research is a developing area in which new information is coming to light.

The European Court of Human Rights legally obliges Ireland to put in place a legislative or regulatory regime to provide procedures to establish whether a pregnant woman is entitled to a termination if there is a real and substantial risk of suicide that can only be avoided by that termination. We must establish criteria and procedures for measuring real and substantial risks to life that can only be removed via terminations. This is key to the situation. There should be some type of risk index that consultants can examine to ensure that there is a real and substantial risk to a mother's life. We accept that a medical diagnosis is not always a clear-cut process and does not exclude differences of opinion.

The constitutional obligation to defend and vindicate, as far as practicable, the right to life of the unborn must also be recognised and included in any consideration of the issue and the dignity of the foetus must be protected. As recommended, all of the steps involved in reaching a decision on a real and substantial risk to a mother's life must be documented clearly. Extra regard should be given to suicide risks, given the clinical challenges involved in diagnosing suicidal behaviour. It has been suggested that two psychiatrists and perhaps an obstetrician should form the team that would make the decision, with the backup of other professionals, such as psychotherapists, and the involvement of the woman's general practitioner, GP, who may have a great deal of knowledge about her. It will be argued that since two team members are sufficient for a medical situation, having three in a potential suicidal situation is discriminatory. While there is a case for this argument, we should accept that the team to decide whether there is a real and substantial risk of suicide should comprise two psychiatrists and one obstetrician, given the clinical challenges involved in diagnosing suicidal behaviour. There has been a great deal of debate on this issue.

It is understood that motherhood and pregnancy are protective influences against suicide, as borne out by studies in the UK and the US. One UK study shows that the rate of suicide among pregnant women is one sixth of the rate among women who are not pregnant. There are no figures to indicate whether suicides resulted from a real and substantial risk owing to their pregnancies, only that they died while pregnant. No figures are given for the number of terminations completed. Abortions are available under the liberal regime that pertains in the UK.

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