Seanad Éireann - Volume 168 - 12 December, 2001

An Bille um an gCúigiú Leasú is Fiche ar an mBunreacht (Beatha Dhaonna le linn Toirchis a Chosaint), 2001: Céim an Choiste (Atógáil). Twenty-fifth Amendment of the Constitution (Protection of Human Life in Pregnancy) Bill, 2001: Committee Stage (Resumed).

  Atógadh an díospóireacht ar leasú a 9:

    I leathanach 9, líne 12, “(nó, i gcás éigeandála liachta agus i gcás ina gcreideann an cleachtóir lena mbaineann gur gá sin ar mhaithe le bainistiú leas a othair nó a hothair, in aon áit eile)” a chur isteach i ndiaidh “fhormheasta”.

  Debate resumed on amendment No. 9:

    In page 8, line 12, after “place” to insert “(or, in case of medical emergency and where the practitioner concerned believes the management of the welfare of his or her patient so requires, any other place)”.

–(Senator O'Meara).  

  Mrs. Taylor-Quinn: We were responding to the Minister's statement that approved places would be maternity hospitals. There are dangers in that because of the distances affecting people in rural areas. I gave the examples of the distances between Loop Head and Limerick and Galway, and spoke of the danger to the life of a woman who was haemorrhaging heavily. Senator Henry clearly explained these dangers earlier when she conveyed the results of the Coombe Hospital survey.

  The other danger is that a GP in a remote rural area must balance taking the actions that he deems necessary against what is in the Bill. If a GP were to perform a necessary medical procedure outside of an approved place, he or she might be open to an action. In such a case, he or she might decide to take the risk of transporting the woman to hospital and she might lose her life as a result. I welcome the Minister's commitment to re-examine this matter overnight and come back with a different proposal tomorrow. I urge him to do so and hope that he takes our concerns seriously.

  Dr. Henry: I take the Minister's assurances on board. I hesitate to use the word “implore” but I hope that he gives serious consideration to this as it is the one dangerous area of the Bill. I regret that this Bill is being denigrated – but I do not blame the Minister – by pausing at 9 p.m. to introduce another Bill, albeit an important one. This Bill was guillotined on Second Stage, Committee Stage and Report Stage in the Dáil, which the Minister, I am sure, did not want. However, we are again showing disrespect by interrupting it. After all, this Bill involves the Twenty-fifth Amendment to the Constitution and women's lives. When I saw the words “Protection of Human Life in Pregnancy” I presumed that the mother's life was of concern also.

  Minister for Health and Children (Mr. Martin): I gave our strong reasons for including the concept of approved places. I agreed to look at it overnight. I have already taken steps to return to certain sources of advice, and I will return here tomorrow.

  Dr. Henry: I thank the Minister.

  Ms O'Meara: In light of the Minister's commitment to consider this matter overnight, I do not wish to press the amendment.

  Tarraingíodh siar an leasú faoi chead.

  Amendment, by leave, withdrawn.

  Níor tairgeadh leasú a 10.

  Amendment No. 10 not moved.

  Acting Chairman (Mr. J. Cregan): Amendments Nos. 11 and 30 are related and may be discussed together by agreement.

  Mr. Norris: Tairgim leasú a 11:

[1505]     I leathanach 9, line 16, “seachas trí fhéindíothú” a scriosadh.

I move amendment No. 11:

    In page 8, lines 15 and 16 to delete “other than by self-destruction”.

Much of the argument on this was made by myself and colleagues on Second Stage and I do not propose to reiterate it. This the crux of the Bill as the intention is to reverse the judgment in the X case, and the people's decision in the 1992 referendum. By excluding the risk of self-destruction, we place the Bill in a dangerous area.

  It is true that the statistical risk of suicide may be slight, but can we afford to take the risk? Of those who threaten suicide, eight out of ten may not do it but two probably will. That is a loss of human life which I am not prepared to risk. I have been involved with a number of counselling agencies and they say that when a person threatens suicide, there is a strong possibility that he or she will not do so, but one must always assume that the person will, otherwise the risk is too high. Yet we are prepared to take this risk with the lives of women, which is completely and utterly wrong.

  Dr. Henry: Senator Norris is correct in saying that this is the crux of the Bill. It is an attempt to reverse the X case judgment which established the legitimacy of the termination of pregnancy where the mother's life is in danger because she threatens suicide.

  It is right to say that this is extraordinarily rare. Dr. John Sheehan, in his address to the all-party committee, said that there are grave difficulties in predicting suicide. The Minister is familiar with Appleby's work which I discussed with Dr. Dermot Walsh, the inspector of mental hospitals. The problem with his work was that it was an attempt to correlate groups of statistics from places as diverse as Finland and the South Sea Islands. They were all retrospective studies. Appleby pointed out that there were cases in which women committed suicide because they were pregnant. He also said that the protective effect of pregnancy – which is real – does not come into play if the reason for the pregnancy lies in rape or incest.

  When we consider our figures for infanticide in the past, we have to conclude that this was a way of getting rid of an unwanted pregnancy in place of a termination. Sometimes even now, the bodies of babies are found around the country. Often their mothers are never discovered. I was once asked by a Swedish television company about such a body found beside a canal. I told them that it was an unusual case, but within a few days another was found beside the Shannon and a third in the Phoenix Park. The Swedes rightly asked me what I meant by an unusual case. When we consider the number of adults who are missing, we must wonder about the bodies of new-born children that have never been discovered. In [1506] the rural areas of some countries, infanticide was not as uncommon as we would prefer to think.

  The preventative effect of pregnancy on suicide is important but we must take into account the circumstances under which the person becomes pregnant and her age. Since the X case, the C case has been the only other one where suicide was threatened. As I said on Second Stage, I was much more worried about her than I was about the X case. The X case girl had supportive parents but in the case of the child who had been very violently raped and beaten up there seemed to be grave family circumstances. It seemed to be a disordered family with problems and the man who had raped her was a relation. I feared for that child's life. She was 13 years old. She seemed to be very alone and in the care of the health board. The case went before many courts.

  None of us wants to see these cases. I hope they will be rare. I remember the case in Granard where a child of a similar age, Ann Lovett, went to term but died giving birth in a grotto at the feet of the Blessed Virgin. To see a mother and child lost in that situation must remind us that these circumstances may occur.

  I referred to another type of case in the debate on Second Stage. A woman with very bad post-natal depression told me that if she became pregnant again she would kill herself. Termination of pregnancy is not to be advocated as a cure for post-natal depression but this woman said to me that she would kill herself if she became pregnant again. Bad cases turn up every now and then.

  Since the X and the C cases I have not once heard of any doctor in this country trying to procure a socio-economic abortion or an abortion where the risk of suicide was cited as a defence. This legislation seems to show a lack of trust in the medical profession and I certainly will be supporting Senator Norris's amendment.

  Ms O'Meara: I agree that the issue of suicide is one of the core issues of this legislation. The court judgment in the X case and the subsequent C case is the reason we are dealing with this amendment. I refer to the work of the All-Party Committee on the Constitution and the evidence about suicide in pregnancy which was given by the psychiatric profession and the masters of the maternity hospitals. The rate of suicide among pregnant women is far lower than in the general population of women. This has been referred to by Senator Henry as the protective effect of pregnancy. One can logically see why that would be.

  We are not talking here about a pregnancy which is wanted or planned or even accidental. We are talking about pregnancies which give rise to major trauma. We have the instances of the X case and the C case where teenagers became pregnant as a result of rape, one of which was particularly horrific and has been outlined by Senator Henry.

  One can see how a woman and particularly a child or a teenager who has been raped, beaten, traumatised and dealt with in an awful fashion [1507] would greet a consequent pregnancy. I read this morning in the Irish Independent of a case in England where a raped 19 year old became pregnant. She went into complete denial and did not tell anyone about the pregnancy. She delivered the baby alone in her bedroom and then threw the baby out the window. It landed in the neighbour's garden where it was found two days later. The teenager is in extreme trauma. This happened in a country with abortion quite easily available.

  A pregnancy arising out of a traumatic incident such as rape has to be seen in an entirely different context. Experts cannot totally rule out the possibility of suicide, particularly in the instance of trauma or rape. We have a dreadfully high rate of suicide in Ireland. We should not lessen the seriousness of suicide or potential suicide.

  There is a suggestion that a pregnant woman who claims to be suicidal during a crisis pregnancy should not be believed because she is saying this in order to get an abortion. That is an extraordinarily dangerous suggestion. We should never do so. I hear it sneaking into discussions from time to time.

  It has been said that hard cases make bad law but we have had two hard cases which have informed our law in recent years. These are cases which were foreseen when the 1983 referendum was held. They were nightmares which we hoped would never be visited upon us but they were. We have no reason to believe they will not be again. We have written the right to travel and the right to information in the Constitution. The right to travel is extremely important and arises directly out of the abhorrence of the public at the notion that a child would be forced to continue a pregnancy against her will. Most citizens would not force any woman to continue a pregnancy against her will.

  Let us envisage the situation of a woman who has been raped and beaten to such an extent that she cannot travel but is suicidal. You are then looking at a situation where she is presumably under psychiatric care if she is threatening suicide and she needs medical treatment for physical injuries. If she cannot travel then that woman would be forced to continue the pregnancy. That is a distinct possibility. It cannot be ruled out. This kind of law that we have made in the past has created quite extraordinary dilemmas for us as legislators, for medical practitioners and ultimately for the women affected.

  Ms Keogh: I am completely opposed to excluding the threat of suicide. We all acknowledge the points that have been made about the preventative or protective effect of pregnancy. The risk of suicide by a pregnant woman would be extremely small. I hate hearing that hard cases make bad law. When somebody is in such an appalling condition that she would threaten suicide, that is a very hard case. One of the most fundamental things anybody who has ever had train[1508] ing as a counsellor is told is never to ignore the threat of suicide. Although it is a long time since I trained as a counsellor, this has always stayed with me.

  I think the people are just as compassionate now as they were at the time of the X case. Nothing has changed. During the time of the X case I stood on the other side of the House and said that if my 14 year old daughter were pregnant as a result of rape and suicidal, I did not know what I would do. I am not in favour of abortion as pro-choice people are said to be. I would much prefer that women would be given every support in bringing their pregnancy to fruition, but I could not say to my daughter that I would take the risk with her life. That would be reprehensible.

  In the intervening years nothing has changed. There was a notion that the floodgates would open and there would be queues of women at psychiatrists' doors pretending to be suicidal because they did not want a baby. Even though women could have done that for the past nine years, it has not happened. Women would not take human life in that way. In my experience as chair of the Well Woman Clinic, which gives non-directive counselling, women agonise over the decision. I have not heard of any women who take this decision lightly.

  A particularly unfortunate phrase was used by the Taoiseach in answering Deputy Noonan's question when he said:

    The legislative vacuum must be filled and if legal provision were made for a suicide risk, a system of psychiatric assessment and court supervision would almost inevitably follow. If that were to happen, even if it were initially to be done on a narrow basis, the scene would be set for a gradual introduction of social abortion in Ireland.

What is the basis for that? There is no evidence to suggest it. Despite the disgraceful fact that we have not legislated on foot of the X case, our organisation, in acknowledging it is very difficult, put forward a suggestion that could be developed. However, the Taoiseach's response shows complete lack of trust in women and lack of compassion for their predicament. Thank God there are a few women in the Oireachtas who have spoken very vehemently on this. It is wrong that there are so few women involved in formulating our laws. We could disagree on the principle of things, but there are issues that relate to life and death that women understand better because their lives are on the line.

  Why are we rowing back on the X case when the compassion has already been shown by the people? I do not anticipate there will be large numbers of cases like that and I sincerely hope there would not be. To make a giant leap from discussing a pregnancy caused by rape to saying there will be a queue of women waiting to have an abortion goes beyond credibility. I do not [1509] accept it. If the referendum comes about, the people will not accept it either.

  Mrs. Taylor-Quinn: The law in Ireland is fairly straightforward. It is covered by the Offences Against the Person Act, 1861, and by article 40.3.3º of the Constitution, which was passed in 1983 following a heated debate in both Houses and outside. It was one of the most controversial times in modern politics. This guarantees the unborn a right to life equal to that of the pregnant woman.

  Following the referendum in 1992, which came about as a result of the X case, if due to physical, psychological or mental conditions there is a real and substantial threat to the woman's life if she continues the pregnancy, then she is protected under the Constitution. In effect, the Government is attempting to withdraw the psychological, the suicide element. That is extremely serious. The people voted on this matter a decade ago and made a very clear decision. The Government has not taken that on board and successive Governments have failed to introduce legislation. The people are now being asked to decide again and withdraw constitutional rights that currently exist for women. It is a seriously regressive step.

  Following the X case in 1992, the law protects the life of a woman who may be in danger of losing her life as a result of suicide. How many cases have arisen? How many cases are documented by the Department of Health and Children? Women are not by nature interested in playing games with something so fundamental. Women do not go around pretending to be suicidal nor do psychiatrists fake certificates claiming them to be so. To bring in legislation is effectively saying that women abuse this facility. There is no recorded evidence of such a trend in the past decade.

  Why does the Government feel the need to restrict further the rights of women as they currently exist in the Constitution? It is an extraordinarily regressive step. It is particularly extraordinary that the Progressive Democrats and a Progressive Democrats Attorney General are the main architects of this legislation, given the platforms on which they pontificated since 1987. It has already been put on the record what the Minister of State at the Department of Foreign Affairs, Deputy O'Donnell, and the Tánaiste, Deputy Harney, said at various times during the debate in recent years. It shows their total hypocrisy and it is an appallingly cynical political manoeuvre in relation to women's lives. It is unfortunate they have gone down that route.

  It would be better to delete the phrase at the end of section 1(2) as it does not serve any purpose. It is an insult to women and to the psychiatric profession. It is saying that medical practitioners with physiological expertise are more credible than those with a psychiatric or psychological qualification. No one in the House, the other House, or the Department is in a position to adjudicate on that matter or to introduce legis[1510] lation to so adjudicate. I ask the Minister to accept the amendment.

  Mrs. Jackman: I agree with the other speakers. Does the Minister consider it to be discriminatory to provide that a real and substantial threat to the life of the mother as a result of mental illness is not as important as her physical health?

  We would have liked legislation introduced after the X and C cases. Senators Taylor-Quinn and Keogh referred to that. The people would be equally horrified if 14 or 15 year old children were faced with this type of situation as a result of rape or incest. The Minister is ruling out any situation where that problem could arise. There were ways open to the Minister to tighten up the legislation if he had wanted to do so. He could have included a provision to get a second and third opinion from psychiatrists and he could have established a panel of psychiatrists to deal with the threat of suicide. That would be detailed and controlled procedure. Why were those options not considered? I thought that would have been the first thing the Minister would have done. The X and C cases were treated as if they did not happen or as if they should be forgotten. I hope such cases do not happen again.

  We do not know if issues of suicide were brought to the Minister's attention. As women, we are concerned about that issue. The Mental Health Bill was introduced and there was much talk about bringing mental health into the 21st century. We are ignoring the fact that people can suffer from mental illness and be suicidal. We are talking about young girls who may be in this situation as a result of rape or incest, which are both horrific acts. This may happen to them at a time when their hormones are not properly developed. That child will be left in limbo. We will be hypocritical and tell the parents to let her go to another jurisdiction. It is all right in another jurisdiction. We are not interested in what happens year after year in rape cases before the courts. I am flabbergasted.

  The legislation could have been tightened up. We are not talking about idle threats. The Minister could have included controls, such as a panel of psychiatrists to assess the risk of suicide and make a decision. They have been written out of the legislation. As Senator Taylor-Quinn said, they are in a different category to the physicians who look after the physical health of the mother. I am shocked that something has not been done.

  Mr. Martin: This issue deserves to be considered with compassion and consideration. The amendments go to the core of the Bill in terms of wanting to remove suicide or self-destruction as a basis for the termination of a pregnancy or an illegal abortion within the country. The Government has taken a view, notwithstanding the X and C cases and having considered the process which led to the Green Paper and the evidence from the Oireachtas committee dealing with this issue, that the evidence did not lend itself to a view that suic[1511] ide should continue as a basis for facilitating the termination of a pregnancy.

  It is instructive to reflect on why the Oireachtas did not legislate for the X case. People here have put forward a view that it is only a matter of doing A, B, C or D.

  Mrs. Jackman: Nobody said that.

  Ms Keogh: I said the opposite.

  Mr. Martin: Senator Jackman said it would have been relatively easy to tighten it up.

  Mrs. Jackman: When I said easy, I meant when it was ignored. I did not mean easy in that sense.

  Mr. Martin: A different Government was in power between 1994 and 1997.

  Mrs. Jackman: I understand that. No one pointed the finger at that Government.

  An Cathaoirleach: The Minister should be allowed to reply without interruption.

  Mr. Martin: I did not interrupt any speaker. I have a number of points to make.

  Mrs. Jackman: The Minister misinterpreted what was said.

  Mrs. Taylor-Quinn: The Minister is a gentleman.

  Mr. Martin: The valid point I am making reflects on the debate. An attempt has not been made to legislate for the X case.

  Mrs. Jackman: We agree.

  Mr. Martin: The Senator agrees now.

  Mrs. Jackman: I did not criticise any Government.

  An Cathaoirleach: Please allow the Minister to reply without interruption.

  Mr. Martin: An attempt was not made by the Oireachtas or by successive Governments since 1992 to legislate for the X case. We should ask why that was the case. Was it because it was politically impossible to get such legislation through the Houses? Was it because the composition of the parties in Government, whether it was Fianna Fáil and Labour or Fine Gael, Labour and Democratic Left, meant it could not be done?

  Mrs. Taylor-Quinn: There were not enough women.

  Mr. Martin: That is an important point which I will deal with later. That should be acknowledged. The deduction I make from that is that it was not an easy or a politically possible task. The [1512] argument has been made here that we are discriminating against psychiatry or questioning the judgment of psychiatrists. We are not doing that.

  Mr. Norris: What else is the Minister doing? He should explain it to us.

  Mr. Martin: I will explain it to the Senator.

  An Cathaoirleach: We must have an orderly debate. The Minister must be allowed to reply without interruption.

  Mr. Martin: The eminent psychiatrists at the Oireachtas committee said on the record that there was no fail safe test for suicide.

  Mrs. Jackman: We understand that.

  Mr. Martin: To suggest that we are second guessing psychiatrists or questioning their judgment is erroneous. That is not the motivation behind it. There is a difference between the diagnosis of physical and medical issues, as psychiatry and psychiatrists have acknowledged. I acknowledge we can cite different texts as different people made different submissions. In the report Dr. Anthony Clare said:

    I would say that the only reason that I am here, I think, and that you will find psychiatrists involved in this, is, in a way, because, I suppose we have been drawn in to try and get people off the hook over this issue of a danger to the health and life of a woman who is pregnant and wishes to terminate the pregnancy, so who better than to get the psychiatrist to tell you that if this is refused, this woman will kill herself. Well, no such statement can be made with any great safety, whether the person making it is a psychologist, psychiatrist or a general practitioner.

Dr. John Sheehan, consultant in perinatal psychiatry at the Rotunda Hospital, said that suicide is what he and his colleagues call “multi-factorial”. It is not related to a single factor, but to multiple factors, including the presence of psychiatric illness. It can be related to depression, psychosis or alcohol problems coupled to with absence of social supports, socio-economic class or marital status. There is no test or fail-safe way to indicate if a person will or will not commit suicide. Dr. Sheehan also indicated that the medical response to a pregnant woman considered to be at risk of committing suicide is to help and support her while treating her underlying mental condition. Professor John Bonnar, chairman of the Institute of Obstetricians and Gynaecologists, told the Oireachtas All-Party Committee on the Constitution that prior to the introduction of the UK's abortion Act, risk of suicide was grounds for termination and that large numbers of patients used to have terminations on psychiatric grounds linked to risk of suicide. Those cases suddenly disappeared when the abortion Act came in.

[1513]   The problem with risk of suicide and psychiatric indications is that they are clearly different from the physical problems we have been discussing, such as pre-eclampsia, ectopic pregnancy and cancer of the cervix. In practice the psychiatric indications become exceedingly elastic. Legislation to control that has usually been unsuccessful and has been used to achieve abortion. Those are the kinds of submissions that were made and there were others. The Master of the Rotunda, Dr. Peter McKenna, took the different view that one cannot ever rule out the possibility of suicide. Dr. Sean Daly, Master of the Coombe, said he had never come across a case where a risk of suicide was posed. The Psychological Society of Ireland, which is in favour of freedom of information, argued that one can identify a risk of suicide, but psychiatrists say there is no test to do so. A key point is that it is very unlikely a psychiatrist would recommend abortion as a treatment for a suicidal woman.

  Dr. Henry: It is not.

  Mr. Martin: That is what they are saying. I have read it in the Official Report and in work which has come out subsequent to the publishing of this Bill. People have said they are unaware of a psychiatrist recommending a termination as a treatment for suicide. This is by no means an attempt to second guess psychiatry. From the mouths of psychiatrists themselves comes the clear message that there is no fail-safe test to prove a risk of suicide. In other jurisdictions psychiatry has been used for making a more liberal abortion regime a reality. People may throw their eyes up to heaven, but that is a reality.

  Many submissions were made in the drafting of the Green Paper, which came out before the Oireachtas All-Party Committee on the Constitution considered this matter. While there are a number of clinical and social factors associated with suicide, it has proved difficult to predict which women will commit suicide. A thorough assessment of the clinical, social and mental health status of the woman is made before initiating the appropriate therapy. Underlying mental conditions are treated and an attempt is made to resolve any social problems associated with the pregnancy. It is considered important that major life decisions are not made while suffering from acute psychiatric illness.

  I acknowledge that this is a difficult issue and I am not saying there are not many perspectives that can be brought to bear on it. The argument has been made that if there were more women in the Houses there would be a different perspective on the legislation. My experience is that in wider society many women have strong pro-life perspectives.

  Mrs. Taylor-Quinn: We are all pro-life.

  Mr. Martin: I am sorry. I will be more specific. There are as many women out there who would agree with this approach as there are who would [1514] disagree with it. Perspectives on this issue are not bound to gender alone. There is no gender divide whereby women are of one view and men of another. There is a range of views among men to the same extent as there is among women. I have met women who have completely different views from Senators Keogh, Jackman and Taylor-Quinn. We have to be open enough to acknowledge that is the nature of the issue and of this debate on it. If we look at the 105,000 submissions that were made, we will find quite a lot of views, therefore it is not fair to say that one gender takes one view and the other a different one.

  We are not lessening the importance of the issue of suicide. We have done much recently – compared to what was done previously – to provide additional support and improve resources for mental health patients, particularly those at risk of suicide. We have established the Suicide Research Foundation, implemented many of the recommendations of the task force on suicide and created multi-disciplinary, consulant-led teams for child and adolescent psychiatry in every health board. There has been much progress over the past four years on the wider issue of suicide which points to the multi-factorial nature of its causes and to the need for a multi-disciplinary approach to it.

  Mr. Norris: I do not want to be tedious as it is rather tiring that we have been in here all day. I do not know if we have generated more heat than light, but this House was abominably hot during the afternoon. My eyes were closing at times.

  The Minister addressed a couple of questions to the House. He asked why Government did not legislate on this matter after the X case. It should have and it was told that by the Supreme Court. The Oireachtas has been reproached by the Judiciary for not legislating and the reason it did not was that there was complete moral cowardice in all parties. They shied away from this issue. The proposed referendum is another cynical manoeuvre caused by four independent Deputies.

  An Cathaoirleach: The debate is being broadened. The Senator must address the amendment.

  Mr. Norris: I am answering the Minister's question. The cynical manoeuvre is the context of this Bill. The Minister referred to psychiatrists and said there was a difference of opinion and that people refused to be hard and fast in their pronouncements. That demonstrates how very honest the psychiatrists are and should give us confidence in them. Are we expected to believe that people who are prepared to give evidence with such clarity and without being self serving will dishonour their professional standards by signing chits at the drop of a hat? There is a contempt for the psychiatric profession in that attitude, though it may not be intended or realised. We must be prepared to trust psychiatrists. Everything the Minister has said about the evidence [1515] they gave revealed how complex the issue is. I agree.

  Not many young women are going to commit suicide simply because they are pregnant. We heard evidence from Senator Henry that the woman's instinct for survival is increased by pregnancy as there is a natural maternal wish to protect the infant in the womb. We are talking about cases the Government has failed to address in this legislation, such as rape and incest and in which there is obviously confusion in the mind of the young person involved. In such cases a young person who has been brutally assaulted is sentenced by our uncaring society to an involuntary nine months of penal servitude, during which she is host to an invading organism. This is so complex that I believe a young person would take the awful step of taking her own life.

  The Minister introduced evidence from various people, including Professor Bonnar. The Minister should have put on record that he is by no means a disinterested party in this.

  Mr. Martin: I said that.

  Mr. Norris: The Minister did not say it.

  Mr. Martin: We can quote selectively

  Mr. Norris: He is a very fine doctor.

  Mr. Martin: I quoted others who had a different point of view.

  Mr. Norris: He is an extremely fine and rather pleasant person. I used often see him in the common room in Trinity College. He is partisan on this issue and was the mind behind the first referendum. He has been against abortion for many years. He is not a disinterested critic looking at it with fresh eyes. Late as it is and suffering from a certain degree of linguistic confusion as I am—

  Mrs. Taylor-Quinn: That is very unlike the Senator.

  Mr. Norris: —I will still press the amendment. In response to Senator Taylor-Quinn, I will have to get a double-barrelled name. I will be Senator Fitzpatrick Norris from now on. It might give me the same degree of rationale as the Senator.

  Mrs. Taylor-Quinn: Absolutely.

  Ms Keogh: I will not prolong the argument much longer. We all agree with much that the Minister said. We have accepted that the threat of suicide is minimal. We have acknowledged that there has not been a queue of women claiming to be suicidal and demanding abortions, even though it was legal to do so for the past nine years.

  What would the Minister do if it was his 13 or 14 year old daughter who had been raped and [1516] traumatised? Who can be absolute about this? I cannot put my hand on my heart and say I would put her on a flight to England and ensure she had an abortion. If she were that traumatised and I was genuinely convinced she was suicidal, I probably would because I would do what was best for her. I believe the Minister in his heart of hearts would too.

  Dr. Henry: Dr. Sheehan, with whom I work, was correct in describing suicide as a combination of many factors. Abortion is not described as a good treatment for psychiatric disease. Psychiatrists must be the advocates of their patients. Many psychotropic drugs are contra-indicative during pregnancy. Someone with a serious psychiatric illness who is pregnant because of rape or incest which may be the basis of her illness may have to have her psychotropic drugs on which she is dependent withdrawn because of their effect on the developing foetus. It is a very difficult problem and I am glad it is the Minister's, not mine. We must point out these various difficulties to him.

  Mrs. Jackman: We would have preferred that something be done about this in 1992 by the then Government. I do not blame the current Government. It is just that the position has been left unaltered since that time.

  I can understand, if there had not been the X and C cases, why psychiatrists would have come to the conclusion the Minister said they did when he was in discussions with them. However, those were cases where young teenagers were obviously suicidal and the X case precipitated a referendum. The Minister ruled out the psychiatric element as if psychiatrists had not discussed the X case and the fact that legislation had not been introduced to deal with it. I am sure they must have had an opinion on the X and C cases. The Minister gave the impression they were not discussed in the detail I would have liked them to have been.

  In the context of placing the risk to the life of a mother because of suicidal tendencies brought on by mental illness or whatever alongside the physical risk to her life, I am surprised that psychiatrists did not examine the X and C cases in the discussions because they were concrete examples of where the trauma of incest and rape caused young women to become suicidal. This was especially the case for the young girl in the C case on whose behalf the health boards had to intervene to sort out her position. She was left traumatised by the brutal treatment meted out to her and she had no support. The girl in the X case had the support of caring parents. The Minister gave the impression that the suicide issue was examined but was dismissed and that the reality of the X and C cases did not appear to have been explored, which upsets me.

  Surely the Minister, with the help of psychiatrists, could have legislated for specifics such as where it is proved a woman is suicidal because [1517] of rape or incest. That is ruled out now. What happens if there is another X or C case? Do we forget about that 13 or 14 year old if it happens again? Is the Minister saying it does not matter if she feels suicidal because she can go to England for an abortion? I cannot accept the hypocrisy of that stance.

  Mr. Martin: We have debated these issues, they have been debated in the other House and they have been debated at great length since 1992 in the Green Paper process and by the All-Party Committee on the Constitution which took considerable evidence from psychiatrists and obstetricians organisations and so on. The Government's view and position is that the evidence given did not lend to the maintenance of suicide within the legislation as a basis for abortion. That is the considered view of the Government having examined all the submissions made and having assessed the evidence submitted to the all-party committee. I have dealt with the difficulty in respect of psychiatry articulated by psychiatrists in terms of there being no fail-safe test for the suicide issue.

  Mr. Norris: The Minister quoted Dr. Anthony Clare. Am I to understand that he felt the threat of suicide should not be a ground?

  Mr. Martin: No, certainly not. I did not say that.

  Mr. Norris: That is what I thought.

  Mr. Martin: I did not say that nor did I infer it.

  Mr. Norris: The Minister did not and I do not accuse him of having done so. He is a very honourable person and he has been clear on that.

  Mr. Martin: I do not know what his views on the issue are. He was saying honestly as a psychiatrist that, if we were looking to psychiatrists to try to get us off the hook, there was no fail-safe test.

  Mr. Norris: It was very honest of Professor Clare to say there is no fail-safe, black and white test. However, there is a difference in the medical profession between the treatment of physical illness and mental illness. I doubt very much that any of those psychiatrists who gave evidence disagreed with the X case judgment. I would like [1518] that to be put on the record because the Minister may have given the impression, although I am sure he did not want to, that Professor Clare was washing his hands—

  Mr. Martin: I did not.

  Mr. Norris: I know the Minister did not mean to do so and that is why I am doing him the courtesy of making that clear. I do not believe there was evidence that psychiatrists felt they should be excluded from the process and that they were incapable in certain cases of giving a judgment. They cannot say infallibly that a young person will commit suicide, but they cannot say in most cases that she will not. They can, however, give a balanced, professional judgment and say, “On balance, we believe that this young person will take her own life.”

  While scant respect is paid to the way in which the Supreme Court approached the situation, it examined the evidence quite forensically. Learned judges – the top legal brains in the country – were prepared to accept, in all seriousness, that a particular, specific young woman would in all probability take her own life. The psychiatrists gave clear, concrete evidence that that was their professional judgment. The Supreme Court agreed that, from a legal point of view and having examined and dissected the evidence, this was the case. For that reason it took the serious step of entering the judgment in the X case. The most expert people in the State, both in the psychiatric and legal fields, came to that conclusion, yet we are now saying, “Not at all.” If only one life was saved, it would be worthwhile.

  Ms Keogh: The Minister did not answer my question, although I know it was a hard, virtually impossible one to answer.

  Mr. Martin: I have no intention of subjectivising the debate. If the Senator wishes to do so, that is her prerogative, but I will not do so.

  Ms Keogh: That is what it is all about.

  Mr. Martin: It is not.

  Cuireadh an cheist: “Go bhfanfaidh na focail a thairgtear a scriosadh.”

  Question put: “That the words proposed to be deleted stand.”

    Bohan, Eddie.

    Bonner, Enda.

    Callanan, Peter.

    Cassidy, Donie.

    Chambers, Frank.

    Cox, Margaret.

    Cregan, John

    Farrell, Willie.

    Finneran, Michael.

    Fitzgerald, Tom.

    Fitzpatrick, Dermot.

    Gibbons, Jim.

    Glennon, Jim.

    Glynn, Camillus.

[1519]

Tá–contd.

    Kett, Tony.

    Kiely, Daniel.

    Kiely, Rory.

    Lanigan, Mick.

    Leonard, Ann.

    Lydon, Don.

[1520]     Moylan, Pat.

    O'Brien, Francis.

    O'Donovan, Denis.

    Ó Fearghail, Seán.

    Ormonde, Ann.

    Quill, Máirín.

    Walsh, Jim.

Níl

    Caffrey, Ernie.

    Coghlan, Paul.

    Costello, Joe.

    Cregan, Denis (Dino).

    Henry, Mary.

    Jackman, Mary.

    Keogh, Helen.

    Norris, David.

    O'Dowd, Fergus.

    O'Meara, Kathleen.

    O'Toole, Joe.

    Taylor-Quinn, Madeleine.

Tellers: Tá, Senators T. Fitzgerald and Gibbons; Níl, Senators Henry and Norris.

  Faisnéiseadh go rabhthas tar éis glacadh leis an gceist.

  Question declared carried.

  Faisnéiseadh go rabhthas tar éis diúltú don leasú.

  Amendment declared lost.

  Dr. Henry: Tairgim leasú a 12:

    I leathanach 9, línte 18 agus 19 a scriosadh.

I move amendment No. 12:

    In page 8, to delete lines 18 and 19.

  An Cathaoirleach: Is the amendment being pressed?

  Dr. Henry: No, I intend to resubmit it on Report Stage.

  Tarraingíodh siar an leasú faoi chead.

  Amendment, by leave, withdrawn.

  An Cathaoirleach: Amendment No. 14 is an alternative to amendment No. 13 and both may be discussed together by agreement.

  Ms O'Meara: Tairgim leasú a 13:

    I leathanach 9, línte 20 agus 21, na focail go léir i ndiaidh “ata” i líne 20 agus an focal sin san áireamh go dtí “Stát” i líne 21 agus an focal sin san áireamh a scriosadh agus an méid seo a leanas a chur ina n-ionad:

      “a bhfuil a ainm nó a hainm taifeadta sa chlár atá á chothabháil ag an gcomhlacht atá bunaithe in alt na huaire de dlí chun daoine a bhíonn ag gabháil do chleachtadh na míochaine sa Stát a chlárú agus a rialú”.

I move amendment No. 13:

    In page 8, lines 20 and 21, to delete all words from and including “permitted” in line 20 down to and including “State” in line 21 and substitute the following:

      “whose name is entered in the register maintained by the body established for the time being by law to provide for the registration and control of persons engaged in the practice of medicine in the State”.

Amendment No. 13 is designed to amend the definition of “medical practitioner” as set out in the Bill.

  Mr. Martin: I considered this matter at length in the other House. I have also considered it since and, unfortunately, cannot accept the amendment. I think our amendment is broad enough and also has the necessary flexibility given that it is going into the Constitution.

  Tarraingíodh siar an leasú faoi chead.

  Amendment, by leave, withdrawn.

  An Cathaoirleach: Amendment No. 14 has already been discussed with amendment No. 13. Is the amendment being pressed?

  Dr. Henry: The Senator did not get a chance to think.

  An Cathaoirleach: If Senator Norris wishes to speak on amendment No. 14, I will allow him to do so.

  Mr. Norris: That is very kind of the Cathaoirleach whom I thank for his indulgence.

  Tairgim leasú a 14:

    I leathanach 9, líne 21, “ar a n-airítear síciatraithe cuí-cháilithe” a chur isteach i ndiaidh “Stát”.

I move amendment No. 14:

    In page 8, line 21, after “State” to insert “including duly qualified psychiatrists”.

I feel strongly about this amendment and, in a [1521] sense, the Minister made my case when he spoke of the highly responsible evidence given by psychiatrists to the committee. It seems to me that we must respect the view of psychiatrists, particularly in the light of the fact that they were so honourable in the way in which they gave evidence. I refer to the X case. It seems to me that one must accept that the psychiatric profession is an honourable branch of the medical profession whose opinion is worthy of being listened to and that it is unwise and dangerous to discriminate against one branch of the medical profession.

  I would like to put on the record the fact that I received a briefing from the Irish Family Planning Association which posed the question: “When is a medical opinion not a medical opinion?”.

  Mr. Martin: I must go to the other House for about 20 minutes but I will return thereafter.

  An Cathaoirleach: We will be reporting progress in a matter of seconds.

  Mr. Norris: The briefing states that a decision to exclude the risk of suicide is a justification for legal abortion. The Government is saying that consultant obstetricians may lawfully terminate a pregnancy after implantation but before viability on the basis of advice from doctors such as cardiologists and nephrologists. However, they may not do so if that advice comes from psychiatrists. That seems to be totally wrong. I intend to press this amendment to a vote.

  Tugadh tuairisc ar a ndearnadh; an Coiste do shuí arís.

  Progress reported; Committee to sit again.