Hello, it’s Órla Ryan here. Welcome to today’s liveblog of the Oireachtas Eighth Amendment Committee.
The first session will focus on risks to women’s health in relation to abortion.
Today’s speakers are:
Here’s a quick overview of the committee’s schedule today (they’re a little late getting started):
We’ll be sending out an email round-up of what happens at the committee later today.
To sign up, enter your email in the box at the bottom of this article.
Committee member Ruth Coppinger has claimed there are attempts to delay a vote on recommending a referendum to repeal the Eighth Amendment.
In April, the Citizens’ Assembly recommended that the amendment – which gives equal status to the mother and the foetus – be replaced or amended.
The Assembly recommended that abortions should be allowed without restriction up to the 12th week of pregnancy and for “socioeconomic reasons” up to the 22nd week of pregnancy. In cases of fatal foetal abnormality, it recommended terminations be permitted during any period of the pregnancy.
Last week committee members Mattie McGrath TD and Senator Rónán Mullen claimed over 20 groups “pushing for abortion” had been invited to attend the committee’s hearings “while only a handful of pro-life people have been invited“.
Today, they have said “a few token changes” to the list of invitees being brought before the committee will do nothing to balance “the deep-seated bias that exists in the committee at present”.
“There is a deep-seated bias on the committee and its work has been flawed from the beginning, despite early objections from Deputy McGrath and myself,” Mullen said.
“A few token changes will not solve the problem. To cobble together some extra pro-life invitees as a late-stage window-dressing exercise would be cynical in the extreme, apart from being extremely disrespectful to the proposed invitees,” he added.
The committee has just started. Chair Catherine Noone, a Fine Gael senator, has denied the committee is biased. She has asked anyone with concerns to address them to her directly and not to the media.
Mattie McGrath is now addressing the committee, defending a study about poor mental health outcomes following terminations in cases of anencephaly (the absence of a major portion of the brain or skull) he referenced in a previous hearing up session after it was criticised by Senator Jerry Buttimer.
Replying, Buttimer accused McGrath of seeking headlines.
Professor Sir Sabaratnam Arulkumaran, president-elect of the International Federation of Obstetrics and Gynaecology, and author of the HSE report into the death of Savita Halappanvar, is now delivering his opening statement.
“First, I would like to congratulate and praise the maternity care in the Republic of Ireland which has very low maternal mortality ratio for years and ranks six in the whole world.
I greatly appreciate the First Report and recommendations of the Citizens’ Assembly on the Eighth Amendment of the Constitution published on 29 June 2017. I commend the citizens for their work: the report is an impressive achievement by people who are not healthcare specialists or experts, but spent five weekends considering the issues.
“The Citizens’ Assembly members voted on their recommendations for access to abortion for certain medical and other conditions. You are, of course, familiar with the results of the ballots.”
Arulkumaran says abortion is “life-saving in certain health conditions, for example, a mother with chorioamnionitis and severe sepsis, pre-existing severe heart disease, poor mental health with the threat to commit suicide”.
“There are examples of such incidents from the Republic of Ireland. Deaths with these conditions occur due to the difficulty in assessing that the seriousness of the condition meets the legal criteria of “real and substantial risk” that can only be averted by ending the pregnancy, and the fear of legal punishment that prevents the doctor from taking a firm and early decision.”
Continuing his opening statement, Arulkumaran says: “Abortion under optimal conditions has less maternal mortality in developed countries compared with continuation of pregnancy.
“It is 0.7 per 100,0000 with safe abortion care compared with 10 per 100,000 with continuation of pregnancy. These are due to life threatening complications such as thrombo-embolism, hypertensive disease, postpartum haemorrhage, amniotic fluid embolism or worsening of existing medical conditions…
Abortion is not associated with physical or mental health hazards to the mother and it has no impact on future pregnancies.
“Abortions should be permitted for lethal foetal malformation and severe congenital malformation that may have a major impact on life. This is also the position of the Royal College of Obstetricians and Gynaecologists.
“Safe abortion care should be considered as a public health and human rights issue. Despite good contraceptive coverage, about 10% of women get pregnant and seek abortion care. In countries where abortion is legalised the total abortion rates and maternal mortality have declined due to safe post abortion care and post abortion contraception.
“Making abortion illegal has not stopped illegal abortion – for centuries and in different countries – it increases maternal mortality. About 4,800 women in Ireland have their abortions done in the UK. These numbers are reduced by 20% due to availability of medication by post for self-procuring abortion. These have their own complications.
Abortion is a sexual and reproductive rights issue and the decision should be made by individual women after adequate information is given.
“If abortion is not made legal it will promote illegal abortion. Those women with influence and financial resources will get it performed in a safe environment. Those who are poor with less influence will resort to unsafe methods.”
Dr Peter Boylan, chair of the Institute of Obstetricians and Gynaecologists, and consultant obstetrician and gynaecologist at the National Maternity Hospital, is now addressing the committee.
He states: “Article 40.3.3 (the Eighth Amendment of the Constitution) gives rise to significant difficulties for doctors practicing in Ireland and has caused grave harm to women, including death. The two outstanding examples of which I have direct experience are the death of Savita Halappanavar in 2012 and the case of Miss P in PP v HSE in December 2014.
I suggest that in 2017 the Eighth Amendment is unworkable. When it was enacted 34 years ago, neither the world wide web nor the abortion pill had been invented. You heard evidence last week that the rate of women accessing the pill from online service providers is increasing. Importation of the pills into Ireland is illegal, in reality though, there are many services that facilitate people living here with a means of securing delivery to a designated address, which means they can legitimately use a virtual address to access these type of items.
“The genie is therefore out of the bottle in respect of online access to the abortion pill. The grave concern that doctors have as a consequence of this reality is the potential for harm caused by the use of unregulated medication by Irish women and girls. I believe it is a matter of priority for the Oireachtas to address the reality of this situation.
“The Citizens’ Assembly vote result clearly recommends that the Oireachtas deal with the question of termination by legislation rather than through the constitution. I entirely concur with this conclusion, but I would add that legislation needs to be supported by regulation with regard to clinics and hospitals, and by the Medical Council and An Bord Altranais.”
Speaking about viability of pregnancy, Boylan states: “In Ireland, viability is currently considered to occur at approximately 24 weeks gestation. When obstetricians deliver a baby at the margins of viability, it is standard practice in this country to have a full neonatal team present at the birth to make an immediate assessment about viability and institute intensive care in every case where appropriate.
“I cannot envisage a scenario whereby any doctor in Ireland would support any proposal that termination of pregnancy would be contemplated beyond 23 weeks. I hope this is reassuring to the committee in respect of the uninformed discussion that regrettably occurs in respect of so-called late-term abortion.”
Boylan states: “Under current legislation doctors have to make judgment calls as to when a risk to health becomes a risk to life. If the judgment is wrong either the mother will die or the doctor will be guilty of committing a criminal offence.”
Boylan says pregnancy as a result of rape “could be dealt with in a straightforward way by legislating for the legal prescription of the ‘abortion pill’ which I have previously described”.
“Pregnancy tests are now so sensitive that they are positive just before a missed period and so the pills would be 99% successful if taken within the first eighth weeks. There is no diagnostic test to confirm rape and so I would strongly recommend that a woman who has undergone the trauma of rape should not be forced to ‘prove’ rape if she chooses to terminate a resulting pregnancy. Women should be taken at their word, hardly a revolutionary concept.”
Discussing fatal foetal abnormalities, Boylan states: “For those [women] who continue [the pregnancy], hospice care for the newborn with little or no chance of survival outside the womb has, in my experience, been a long-standing practice in this country in our hospitals. It is simply incorrect to state that this care is not available.
“I have considerable experience of couples who have had the misfortune of receiving diagnoses of foetal abnormalities. In some cases, the parents have chosen to continue with the pregnancy and have been much comforted by having some time, however brief, with their baby.
In other cases, couples have been unable to continue with the pregnancy, and have travelled abroad for termination. However, what is not so well understood is that some couples experience a diagnosis of foetal abnormality on subsequent pregnancies. My experience has been that in the vast majority of these sad cases, on the second or subsequent occasions the couples choose termination.
“I also have experience of couples who, prior to screening for an abnormality declare confidently that they would not seek termination in the event of a serious abnormality being diagnosed, only to change their minds when confronted with the reality of serious fetal abnormality. I think most people in Ireland would sympathise with this.”
Discussing terminations due to socio-economic reasons, Boylan tells the committee: “Throughout the European Union, 99% of women have access to termination of pregnancy without restriction up to 10 weeks of pregnancy. The remaining 1% are those who live in either Ireland or Malta. The method used in these cases is by using medication. which as we know is increasingly used by women in Ireland.
“Of the citizens who voted for termination without restriction, 92% voted to limit gestation to 12 weeks (as part of the Citizens’ Assembly).
“It is well-documented that in countries where abortion is banned, the rate of women dying remains high. Approximately 70,000 women die each year from complications relating to unsafe abortion. You heard testimony last week that Irish women today are attempting self-abortion with potentially fatal consequences.
“It is equally well-documented that countries with liberal laws, and easy access to contraception, have lower rates of abortion than those with restrictive laws.
Women in Ireland with financial resources have access to termination of pregnancy, primarily in the UK. However, women who are poor, in the care of the state, or refugees for example do not have such access.
“Without access to abortion in the UK it is inevitable that Ireland would have an epidemic of illegal abortions and a massive increase in maternal mortality.”
Dr Meabh Ní Bhuinneáin, consultant obstetrician and gynaecologist at Mayo University Hospital, is now reading her opening statement.
“Globally, restrictive termination of pregnancy legislation contributes to maternal mortality and significant morbidity, disproportionately in vulnerable women and girls as supported by the witnesses from the WHO [World Health Organization] last week…
“If the introduction of woman and girl-centred safe termination services is the desire of the Irish electorate, it should be considered as just one element of a comprehensive reproductive health programme.
Engagement with women and girls, men and boys is required to develop formal and informal reproductive health education programs, to strengthen peer-education as a delivery method for life-skills learning, to develop responsive, acceptable, affordable, and locally accessible services while also facilitating bypassing of local services, especially in rural areas, where anonymity and distance from home is preferred. Delays and barriers in access to safe reproductive health services, including termination of pregnancy, are influenced by distance, institutional reception, cost and bypass behaviours.
“Healthcare workers in women’s health in Ireland are guided by the legislative framework of the country, the professional standards of the registration authorities, their professional bodies and their personal value systems whether conscious or unconscious.”
Ní Bhuinneáin continues: “If in due course there is legislative change, then the new service would be commissioned and provided. Regulatory codes of practice would be revised and the professional bodies would revise their competence standards and training curricula and assessment tools.
“Quality assurance and suitable designation of centres that provide termination of pregnancy would be required – centres may include certain primary care services, family planning and sexual health clinics, infectious disease clinics, maternity units, and general hospitals with gynaecology departments.
“The logistical challenges are those faced in the development of any new health service. The process would involve a multi-dimensional approach to include biomedical health system strengthening, informal health system strengthening, woman and family engagement in addition to the actual service development.”
“In other jurisdictions, initial restrictive termination law has evolved into more liberal practice. In addition, members have noted that overly proscriptive categorisation of foetal anomaly may prevent the evolution of matching of options with health technology advancement.
“Therefore, they recommend that the detail is provided for by initial legislation and subsequent regulation rather than by constitutional amendment. Some gynaecologists have expressed potential personal moral distress at the dual challenge of providing extraordinary life-saving interventions for one foetus/infant at borderline viability while also providing foeticide for a potentially normal fetus at the same gestation.
“Those members who wished to contribute gave general support for the provision of termination for fatal foetal abnormalities. Some members view the current law as excessively restrictive for crisis pregnancy,” Ní Bhuinneáin concludes.
Responding to a question from Louise O’Reilly, Sinn Féin’s spokesperson on health, Professor Sir Sabaratnam Arulkumaran says it can be hard to judge if a medical situation is low, moderate or high risk.
Arulkumaran says risk is “something we can sometimes predict” but that this is very difficult to judge in pregnancy as a situation can escalate in minutes or hours, such as in the case of Savita Halappanavar.
Dr Peter Boylan adds: “Some women will risk anything for a baby”, saying a woman who has been undergoing IVF treatment and currently has no children may risk more during pregnancy than a woman who already has children.
Senator Ronan Mullen is now asking the speakers about their ethical stance on abortion.
Arulkumaran tells Mullen people who don’t support legal abortion support illegal abortion, adding Ireland is “lucky” that women and girls can travel to the UK for abortions.
Boylan notes that some people disagree with terminations in all circumstances, even if the woman’s life is at risk. He says “every person’s viewpoint has to be respected” but adds: “The most important person in all of this is the woman herself.”
Boylan tells Mullen it is “inappropriate” to ask him if he has every carried out an abortion himself. Mullen says people can make their own judgements about his response.
Dr Peter Boylan tells Mullen: “No woman goes out in the morning and says, ‘Ah sure I’ll have an abortion today’”, adding it’s a very stressful decision and not one that is taken likely.
Fergal Malone, master of the Rotunda Hospital in Dublin, last week told the committee a woman died on a flight home from the UK after undergoing a termination.
When Mullen asks Arulkumaran about this case, the professor says the “root cause” of the woman’s death was that abortion services are not provided in Ireland.
Mullen is criticising the amount of time committee members have to question and debate statements made by the speakers. Chair Catherine Noone says Mullen often receives more time to question speakers than other members.
Mullen is not impressed, again accusing the committee of bias.
Dr Meabh Ní Bhuinneáin says a decision regarding a termination should take place through a partnership between the doctor and the patient, with the woman or girl making the final decision.
Dr Boylan says the doctor ultimately decides if the woman’s life is at risk. Boylan adds that women and girls who take abortion pills without professional support may experience additional bleeding, which can be very stressful and dangerous.
Replying to Senator Jerry Buttimer, Sir Sabaratnam Arulkumaran says the Eighth Amendment is not working. If it was, why would 4,800 women be travelling to the UK for abortions each year, he asks.
The two other speakers agree that the Amendment is not fit for purpose.
Arulkumaran adds that research shows termination rates actually go down once abortion is legalised in a country.
When asked about what the situation would be if nothing changes in terms of Ireland’s abortion legislation, Dr Boylan says it will be “Groundhog Day”, telling the committee: “You’ve got to do something now … You need to legislate.”
Boylan says the Eighth Amendment has caused “enormous problems and huge distress to women”.
Referencing the potential 14-year prison term tied to having an abortion, Arulkumaran adds: “Can you imagine putting 4,800 women behind bars every year?”
Dr Peter Boylan tells the committee: “I don’t think the Constitution is the place to regulate medical practice … [The Eighth] has caused endless problems.”
Replying to a question Senator Lynn Ruane asked about the Savita Halappanavar case, Dr Boylan says there is “no question” that there were deficiencies in her care. He said if she received a termination when she first asked for it, she would have not developed sepsis.
“We would never have heard of her and she’d be alive today,” he states.
Dr Meabh Ní Bhuinneáin says termination of pregnancy is part of basic emergency obstetric care.
Bringing up the Miss P case, where a brain-dead pregnant woman was kept on life support in 2014 due to the presence of a foetal heartbeat (before the High Court ruled the machine could be switched off), Dr Boylan says this was “appalling”.
Clare Daly TD is asking whether midwives, nurses and GPs could be allowed to dispense the abortion pill. The speakers note this may happen in the future.
Dr Boylan says: “Ireland is a very safe place to give birth,” but adds that the maternal morbidity rate would “shoot up” if women and girls didn’t have access to terminations in the UK as they would go down the illegal abortion route.
Responding to Ruth Coppinger, Professor Sir Sabaratnam Arulkumaran says legislators need to consider “what is best for the women of Ireland”.
“If those 4,800 [women and girls who travel to the UK for abortions annually] can access the same care they can get in England … that would be the best outcome for Ireland or the women of Ireland,” he says.
Dr Peter Boylan says if abortions were legalised in Ireland, he believes over 90% of terminations would be carried out before 12 weeks.
He adds that post-23-week abortions would make up under 1%, noting many such cases are due to fatal anomalies that only show up later in pregnancy.
Kate O’Connell says legislators need to be “brave” and do what is best for the women of Ireland, rather than act based on concerns for their own political career.
“Anyone who is ignoring this is putting their head in the sand.”
O’Connell says the idea of the “floodgates opening” if abortion is legalised is “humorous”, conjuring up an image of gates behind which “there are loads of pregnant women and if we open [the gates] they’re just going to run wild”.
She says women who can’t access abortion through healthcare professionals here instead visit aerlingus.com or ryanair.com, calling this “An Irish solution to an Irish problem.”
Responding to Bernard Durkan about the gestational limits recommended by the Citizens’ Assembly, Professor Sir Sabaratnam Arulkumaran says nearly 90% of terminations in the UK are carried out before 12 weeks.
Both he and Dr Boylan say they’re not aware of any women in Ireland who’ve been prosecuted for using abortion pills.
Boylan says if the Eighth Amendment is repealed the Protection of Life During Pregnancy Act would still stand and new legislation dealing with abortion in a wider set of circumstances would be needed.
Dr Meabh Ní Bhuinneáin says research shows abortion rates fall in jurisdictions where abortion is legalised, but that this doesn’t always happen immediately. She adds that a better sexual education programme – both formally and informally in the youth sector – is needed.
Responding to Peter Fitzpatrick, who asked how safe abortion is for unborn babies rather than for women, Dr Boylan notes that many people have “sincerely held” beliefs that abortion is wrong in all circumstances.
Fitzpatrick asks if a baby should have the same rights as any other patient a doctor is caring for, given that a foetal heartbeat can be detected from three weeks.
Boylan says you can detect a heartbeat from very early stages in the pregnancy but that “a huge amount of very complex development” is still yet to happen. He says the heartbeat detected in the very early stages is a “tube which is pulsating” and “not the heart as we know it”.
Boylan says a doctor has two patients “if a woman opts to continue the pregnancy”. Fitzpatrick says the unborn should have the same rights as any other patient.
Boylan says he doesn’t advocate for patients to have terminations, rather present them with all the facts so they can make an informed decision, stating: “You leave your views at the door.”
When Mattie McGrath says there are differing opinions about whether or not the Eighth Amendment was responsible for Savita Halappanavar’s death, Dr Boylan says it was.
He adds that Professor Sir Sabaratnam Arulkumaran, author of the HSE report into her death, agrees with him.
“I had the opportunity of reviewing her notes forensically,” Boylan tells McGrath, noting he may be better placed to make a call on this.
Boylan says he can’t think of any other cases “off the top of my head” where the Eighth led to a woman’s death.
Replying to Sinn Féin’s Jonathan O’Brien, Dr Peter Boylan says the Eighth Amendment needs to be repealed, not replaced or amended as he believes the Constitution is not the place to deal with medical care.
Professor Sir Sabaratnam Arulkumaran notes that a ‘cooling off’ period in terms of deciding to have an abortion is not generally recommended but that the woman can of course request time to consider her options.
Dr Boylan says the current situation leads to “panic and emotional pressure” as women may need to make the decision quickly and borrow money to travel to the UK.
Dr Meabh Ní Bhuinneáin says best international practice is to not introduce measures that cause delays, adding: “Ultimately the electorate will decide how liberal the result is.”
Responding to Fianna Fáil TD Anne Rabbitte, Arulkumaran says he doesn’t believe that legalising abortion would lead to a spike in terminations in the cases of disability. Ní Bhuinneáin says we can’t know if abortions in such cases would increase, noting we don’t have a full pre-natal diagnostic service.
The committee meeting has been suspended until 6pm, meaning proceedings are an hour behind schedule.
For the last hour, the committee has been meeting in private session to discuss taking a position on repealing, replacing or amending the Eighth Amendment.
Sinn Féin’s Jonathan O’Brien purposes the question that Article 40.3.3 of the Constitution (the Eighth Amendment) should not be retained in full.
Senator Ronan Mullen says he opposes the taking of the vote, Mattie McGrath seconds this.
Mullen, again referring to the committee’s proceedings as “a farce”, wants to propose an amendment to the motion. McGrath goes one further, calling the situation “farcical in the extreme”.
They want the vote to be deferred until all witnesses have been heard.
After McGrath suggested the committee discussed the issue in private session because some members wish to hide something, chairperson Catherine Noone said it is standard practice to discuss such issues in private session.
She said legal advice was sought during this period, and is pushing for the vote to take place.
A lot of back and forth between members now.
Senator Lynn Ruane is unhappy, asking why Mullen and McGrath didn’t raise their concerns during the private session.
And we’re back.
The committee has voted to recommend that the Eighth Amendment should not be retained in full, meaning it will recommend a referendum be held.
The final vote is as follows:
Committee members are now discussing the six options available to them, which include a straight repeal; entrenching legislation in the Constitution so that it couldn’t be amended without a referendum; or replacing the Amendment with specific grounds for abortion.
The three No votes were Mullen and McGrath (both independent) and Fine Gael’s Peter Fitzpatrick. The two abstentions were Fianna Fáil TDs James Browne and Anne Rabbitte.
Ruth Coppinger thinks a straight repeal is the best option, as do the Sinn Féin members. Fine Gael’s Bernard Durkan is leaning towards option five: repealing and replacing on broad grounds.
His Fine Gael colleague Kate O’Connell believes options two, four and five are “off the table”. She favours option one, a straight repeal, or option six: repealing and replacing with a provision conferring exclusive power on the Oireachtas to legislate.
Quoting a phrase Dr Peter Boylan used earlier today about the availability of abortion pills, TD Mattie McGrath says “the genie is out of the bottle” in terms of the committee’s pro-choice bias.
He said the committee refused to hear from certain pro-life groups including women who regret their abortions.
Fianna Fáil’s James Browne, who abstained from the vote on whether or not the committee should recommend the Eighth Amendment not be retained in full (the vote passed), says he agrees with a referendum being held so people can have their say.
He says he’s undecided as to what the wording of that referendum should be.
Sinn Féin’s Louise O’Neill says today is an important day, noting the committee has said “the status quo” cannot continue.
O’Neill says she’s very proud of her parents for campaigning against the Eighth Amendment in 1983.
“The only way is forward,” she adds.
The committee has adjourned for the night and members will meet in public session again on Wednesday afternoon.
We’re wrapping up the liveblog now, but thanks for staying with us throughout the day. We’ll be back next week.
We will be sending out an email round-up of what happened at the committee later. To get the weekly round-up, just enter your email in the box at the bottom of this article.
Goodnight.
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