GOOD AFTERNOON. AFTER a distracting few days in Leinster House the Oireachtas Committee on the Eighth Amendment is getting back to its business.
The committee met today, and will again tomorrow, to hear more medical evidence.
Some important decision were also made.
This is what happened.
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Committee chair Senator Catherine Noone is beginning the meeting by outlining how votes are to be taken from next week ahead of the drafting of the final report.
It’s envisaged that this will happen next week but some members are unsure about their availability because of long-standing commitments.
Jonathan O’Brien TD says he wants a debate next week on module 2 of the committee. Module 2 is based on medical evidence and is due to conclude today.
“I’ve over two folders of information now relating to module two,” he says.
Bríd Smith TD wants a vote ahead of next week on the “substantive issue” of whether they are to recommend that the referendum will include a vote on repealing the eighth amendment.
The committee has already decided that the don’t want the Eighth Amendment to remain as it is, but whether it is to be completely repealed is still in question.
Jan O’Sullivan TD says first of all that “it’s good to to be back here”.
There were concerns that an election could scupper the work of the committee.
Those concerns have been averted, but here’s a summation of the worries committee members had and what would have happened had there been an election.
There’s some debate about when the report will be written
Noone says the votes will be taken on 13 November and then the report “will be turned around as quickly as we can”.
Legal advice will need to be taken but all members are agreed that the shorter the report is, the better would be.
Noone says the committee wouldn’t be doing its job properly if the report wasn’t presented in a concise way.
The committee will now hear evidence from Dr Peter Thompson, consultant in maternal fetal medicine, Birmingham Women’s and Children’s Hospital.
He is to address termination in cases of foetal abnormality.
Thompson thanks members for the invitation to him to appear and he says they are to take a “critical decision with regard to women’s rights”.
He says he has worked in the maternal hospital in Birmingham since 1999 and has also been the lead clinician for women with cardiac disease in pregnancy.
He tells the committee he addressed the Citizens’ Assembly and although he does not propose to repeat the evidence he delivered there, he is open to answering questions on what he told the assembly.
Addressing the issue of fetal abnormalities, Thompson says that, out of 185,596 terminations in England and Wales in 2016:
Of all these abortions however, only 3208 were performed under clause E, ie where there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.
“Although, as in the Republic of Ireland the main fetal anomaly ultrasound is performed at approximately 20 weeks gestation, it can be seen from the table below that only 507 of these abortions were performed after 22 weeks gestation. In 2016, 141 terminations were selective terminations of pregnancy, involving multiple pregnancies and over three quarters of these were under clause E. As can be seen from one of the case studies attached these procedures can have significant benefit for the co-twin.”
He continues:
One of the issues that you face is the decision regarding which, if any, fetal abnormalities will be compliant with the new legislation for termination of pregnancy. With regard to this I would urge you not to make a list, as with the ever changing progress in medicine, conditions would need to be added and removed from the list on a regular basis.
I would also strongly advise against being prescriptive and using the term lethal abnormality. The problem is there is no agreed definition as to what lethal actually means, is it that all fetuses with that condition die before birth, that they die either before birth or in the neonatal period despite supportive therapy, a baby that usually dies in one of these two periods of time or is it that it has been noted that there is an association between the condition and death.
Termination of pregnancy in England and Wales is presented as one of the options available to women if their fetus is at substantial risk of significant handicap. Parliament has not defined either substantial or significant but have purposefully left it to the medical profession to make these decisions in good faith.
Thompson is now answering questions. First from Fianna Fáil TD Billy Kelleher who asks about Thompson’s urging that Irish politicians do not make a “list” of fatal conditions.
In response, he says he would be concerned that you would be “constantly” updating the list because of both the classification of abnormalities and improving medical practices.
“Some people would argue that everything is fatal and some people would argue that nothing is fatal, because it doesn’t lead to you dying in every case, because you may live for a short time after,” he says.
Thompson notes that under the NHS in the UK, pregnant women are offered a free scan on 12 weeks that can point to some abnormalities while a more detailed anomaly scan at 20 weeks is also offered.
He says that a ‘cutoff point’ at 12 weeks after which termination may not be lawful in cases of fatal abnormalities would not be useful because not all abnormalities could be picked up at 12 weeks.
Louise O’Reilly TD is worried about the availability of scans in Ireland and wonders if it is possible to identify women who may be more likely to be in need of a scan early in pregnancy.
Thompson says it is possible to identify women who may be more likely to have a pregnancy with a fetal abnormality, such as women with conditions such as diabetes. but that it even if a scan was carried out early abnormalities may not be identified.
He says the most accurate way to detect abnomalities is to ensure that all women have a scan at 20 weeks.
“I think that is something we can all agree on,” O’Reilly says.
Kate O’Connell TD is asking Thompson about the mental stress that may be placed on families and partnerships following a diagnosis of a fetal abnormality, fatal or otherwise.
“We don’t have the 20 week scans outside of Dublin rolled out,” O’Connell notes, following up on O’Reilly’s question.
Thompson says it’s quite a difficult thing to come to terms with risk and why some women are at a greater risk of a pregnancy with an abnormality.
He said it can be difficult to quantify. For example, he says it is often said that older mothers are more at risk of having a child with Down syndrome.
“But most babies with Down syndrome are born to younger women and that’s because more young women have babies,” he says.
Thompson says that in the hospital in which he works it is almost unheard of that a fetal diagnosis is made and a termination is agreed on the same day.
“We like to make sure that people go away and think about it,” he said.
O’Connell is asking about feticide.
Thompson says feticide a procedure that is carried out after 22 weeks gestation.
He says it involves stopping the heart of a foetus using potassium. He says before this takes place “it is important that you paralyse the foteus in a same way that you would during anaesthetic”
He says that it is not something that doctors like to do, as their job is to save lives, but that “it is something that is necessary to do on rare occasions”.
Bríd Smith TD is asking additional questions about feticide and wants to know if it can be said that the foetus experiences pain.
Smith is also asking whether Thompson feels Irish women are “particularly disadvantaged” by being denied access to terminations in Ireland.
In response to Smith’s question about of foetal pain, Thompson says it is unclear.
He notes that the Royal College of Obstetricians and Gynaecologists recently said that the evidence for foetal pain is less convincing.
He says that analgesia may not be necessary but may be administered to cover all eventualities
Committee member Ruth Coppinger TD on Twitter:
Senator Lynn Ruane is asking about the rate of abortion in women who are beyond 24 weeks gestation and whether the rate has increased and declined.
Ruane also wants to know about cases where a termination in the UK in lawful under ‘clause D’, which relates to the effect of a pregnancy on existing children.
This is clause D:
Where the pregnancy has NOT exceeded its 24th week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of any existing child(ren) of the family of the pregnant woman.
Thompson says in his experience it is likely that a termination may be lawful under more than one condition.
For reference, here are the other reasons.
A. The continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated
B. The termination is necessary to prevent grave permanent injury to the physical or mental wellbeing of the woman
C. The pregnancy has NOT exceeded its 24th week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman
E. There is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped. It is important to note that only clauses C and D are gestation dependant.
Thompson says that his main concern for Irish women who travel for the UK for a termination is that they may not have the appropriate aftercare if required.
He says that in his hospital in Birmingham most Irish women try to stay over in the city “but there is always an awareness of cost”.
“Most Irish women used to go to Liverpool, and now it’s London. Some come to Birmingham but it’s less than the other two. And I do think it’s difficult for them,” Thompson adds.
Peter Fitzpatrick TD asks thompson if he thinks a diagnoses of Down syndrome “is enough to deprove a baby of its right to be born.”
“I would be concerned I think it’s okay to abort babies if you think the baby is going to be disabled,” he says.
Thompson says he believes that in such conditions termination is lawful because the baby may be born with physical or mental abnormalities so as to be seriously handicapped.
Fitzpatrick is asking Thompson about his lecturing of younger students.
“My problem at the moment here is I don’t want to repeal the Eighth Amendment and it seems to me from everything you’re saying that you want to repeal the Eighth Amendment,” Fitzpatrick says to Thompson.
At this point Chairperson Catherine Noone interjects.
“The witness isn’t here to comment on the Eighth Amendment, he’s here to give evidence, to be fair to him,” she says.
Fitzpatrick also asks Thompson if he feels the almost 190,000 abortions in England and Wales in 2016 was high. (The number is 185,596)
Thompson says he is not present to give his opinions and adds that he’s there to give evidence about terminations in cases of fetal abnormality.
In 2016, 3,208 terminations were carried out in these cases and Thompson notes that it is low compared to the overall number.
“Roughly how many abortions have you carried out under clauses C and D?,” Rónán Mullen asks of Thompson.
Thompson declines to give a number.
Bríd Smith asks Mullen to justify his line of questioning but the chair lets Mullen proceed.
Mullen is now talking about about children with Down syndrome.
He asks whether Thompson accepts people “will be chilled to the marrow” about his descriptions of feticide.
He also asks him to accept if he has different world view to thousands within his own country.
“I do not believe that all children with Down Syndrome should be terminated, but I do believe that in cases of serious abnormality that women should have choices, ” he says.
There’s a short tense exchange between Mullen and Noone in which Mullen suggests he wishes to talk to the chair at a later date.
After Mullen asks Thompson about his own career and Noone interjects saying that he does not have to answer.
Mullen: But I’m allowed to ask.
Noone: Senator, I interject when various members are speaking.
Mullen: And we’ll talk about that.
Fianna Fáil TD Lisa Chambers says “we don’t have consensus clearly in the country about how we should proceed”.
Chambers is saying that she has heard claims that a woman who has had an abortion is at a greater risk of breast cancer. She is seeking from Thompson whether there is any evidence of this.
“I think there’s a strong link with pregnancy, but I’m not aware if there is any link with termination,” he says.
The committee has now moved on to its second session of the day where it will discuss the ancillary recommendations of Citizens’ Assembly report.
Officials from the Department of Education and Skills and Officials from the Department of Children and Youth Affairs will be speaking to the committee members.
Olive McGovern, principal office at the Department of Children and Youth Affairs is making her opening statement.
“One of the main objectives of the National Youth Strategy is that young people enjoy a healthy lifestyle, in particular with regard to their physical, mental and sexual health and well-being,” she says.
Eamonn Moran, principal officer in the Curriculum and Assessment Policy Unit in the Department of Education and Skills:
Access to sexual and health education is an important right for students. Schools have a responsibility to provide for this, in consultation with parents, having regard to the ethos of the school. Social, Personal and Health Education (SPHE) is a mandatory curriculum subject in all primary schools and in post-primary junior cycle. Relationships and Sexuality Education (or RSE) is required at all levels, from primary through to senior cycle.
The department has set out the content for each of these programmes in SPHE syllabuses and guidelines. The primary level SPHE curriculum currently used in schools was published in 1999.
Its purpose is to foster the personal development, health and well-being of the individual child, to help him/her to create and maintain supportive relationships and to enable children make safe and healthy decisions now and in the future.
At post-primary level, the SPHE curriculum framework for junior cycle was published in 2000. It provides students with the opportunity to develop the skills and competence to take care of themselves and others and to make informed decisions about their health, personal lives and social development.
The reasons the two officials from the departments are here is because of the ancillary recommendations of the Citizens’ Assembly. (The full report can be read here)
Here are the ancillary recommendations:
1. Improvements should be made in sexual health and relationship education, including the areas of contraception and consent, in primary and post-primary schools, colleges, youth clubs and other organisations involved in education and interactions with young people.
2. Improved access to reproductive healthcare services should be available to all women – to include family planning services, contraception, perinatal hospice care and termination of pregnancy if required.
3. All women should have access to the same standard of obstetrical care, including early scanning and testing. Services should be available to all women throughout the country irrespective of geographic location or socio-economic circumstances.
4. Improvements should be made to counselling and support facilities for pregnant women both during pregnancy and, if necessary, following a termination of pregnancy, throughout the country.
5. Further consideration should be given as to who will fund and carry out termination of pregnancy in Ireland.
“The department is developing a policy on wellbeing which will be published in early 2018. The policy, which will cover both primary and post-primary schools, will set out a number of actions which will enhance the physical, mental, emotional and social wellbeing of students and enable them to build life skills,” Moran says.
Louise O’Reilly is asking about Relationships and Sexuality Education (RSE) that may take place during religion class and she says this raises “alarm bells” for her.
She speaks about concerns about groups providing such education are not regulated asks: “Is there any form of standardisation?”
Chair Catherine Noone also wants to know if there have been “any complaints about rogue agencies?”
“No to my knowledge,” says Eamonn Doran.
Bríd Smith TD is asking if there is “problem to progress” by the continue dconnection of the Catholic Church to so many schools in the country?
Emer Egan of the Dept of Education says that when teaching RSE in schools, the school must follow the themes as laid out by the programme but that it is up to the school to decide how they provide it
“Schools are allowed take account of that ethos in how that is covered,” Egan says.
She also says that she feels Ireland has ‘come on a long way’ in the last 20 years about how sex education is provided.
Sinn Féin Senator Paul Gavan says the RSE and SPHE programmes as outlined by the officials were of great interest to some of his colleagues who aren’t long out of education.
“It sounds great, but we never got it,” he quotes them as saying.
Eamonn Doran says he has two girls who have been in the education. In terms of RSE and and SPHE: “One said we never got it and the other said we got it in spades.”
Doran says in some cases it could come down to how the teachers deliver the sex education.
“It could be the case that some teachers decided to cover them in different ways,” he says.
Doran also says that he is often asked about why children aren’t taught about contraception in primary school.
He said such questions considered but that:
You don’t want to hit someone with something that they are too young to understand.
“There is a balance to be found,” he adds.
Kate O’Connell TD says she is “very concerned” to hear that the ethos of a school can be considered in how it teaches sex education.
“I’m concerned that the rhythm method or the withdrawal method is being taught to children in this State,” she says.
“I’m really, really concerned about what children are exposed to.”
Emer Egan says that the curriculum states that “all methods of contraception”should be taught to students but that it is up to the school to decide “how far it should go”.
Egan says he feels that system is “absolutely fit for purpose”.
Bernard Durkan TD says he believes that: “the parents need to be involved in the programme of sex education in the school.”
Durkan says he “got a bit of a shock” when he received an answer to a Dáil question about the number of children who reported being bullied online while in school.
In response to Durkan’s comments about parents. Doran says that parents should be kept informed of the programme of sex education in a school and should in fact be involved with the school when it is being prepared.
Catherine Noone asks how many schools don’t have an RSE policy in place?
“About 1% or 2%,” says Doran.
Amanda Geary says “it is very rare” that schools wouldn’t have a policy because if schools are not compliant and were identified by an inspector the school would be found to be non-compliant with child protection standards.
Labour’s Jan O’Sullivan TD is also asking also about outside groups that may be brought in to teach sex education to children.
“In any other subject you also have to be appropriately trained,” she says adding,
I really think that the time has come to not let groups come in unless they are appropriately trained.
“They don’t have to have a teaching qualification?,” O’Sullivan asks
“No they dont have to have a teaching qualification at the moment,” Emer Egan says in response.
Fine Gael’s Peter Fitzpatrick TD is asking two questions about abortion.
He wants to know whether children are taught about adoption as an alternative to abortion.
He also asks whether children are taught about the development of a foetus and whether they are told when an unborn child’s heart begins beating.
He is told that children are indeed taught about families and different familial structures. The officials also say that children are taught about reproduction.
That pretty much concludes today’s proceedings.
The committee is back again tomorrow at 3pm when it will continue discussing the ancillary recommendations of the Citizens’ Assembly. This time with officials from the HSE and the Department of Health.
It’s planned that this will be the final hearing of the committee that hears expert evidence.
Next week it will start voting and scoping out the final report, which is due to be delivered before 20 December.
It was decided earlier that the vote on the “substantive issue” of whether they are to recommend repealing the Eighth Amendment will be taken on 13 December.
If you want a nightly round up of what happened during each day of the committee, just enter your email in the box at the bottom of this article.
Thanks for joining us, we’ll be back tomorrow.
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