Copyright the Houses of the Oireachtas. Reproduced under the Oireachtas (Public Sector Information – Open Data) Licence. Links, comparative tables and annotations added by the Protection of Conscience Project.

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[P. 184]

Senator Lynn Ruanne

We have tabled five amendments in this group which all relate to access to terminations in early pregnancy. My main concern is the three-day waiting period and the way in which pregnancies will be dated. . . Amendment No. 33 would allow for the three-day wait period to be waived where the woman had already met a barrier to her care from a conscientious objection. . .

. . . Conscientious objection is a barrier to care. The amendment would ensure that the three-day waiting period does not apply to a woman whose first appointment with a doctor resulted in an objection to her care. . .

[P. 185]

. . . For example, there is one bus going from Mosney per week. It is a major issue as there is usually only one or two doctors, some of them provided by Safetynet Primary Care personnel operating in the likes of Mosney. What if the doctor is a conscientious objector and a person might have to wait for five or six days before being able to leave Mosney and accessing another doctor? What will happen in rural Ireland if a local doctor objects and a person must travel to another town? . . .

[P. 189]

Deputy Simon Harris (Minister for Health)

 . . . The amendments refer to conscientious objection I was more than a little frustrated that all of the talk about conscientious objection was from the perspective of the doctor because, while doctors have a right to conscientious objection, so do nurses and midwives and I defend that right. However, it also has to be looked at from the perspective of the woman. Nobody voted for the scenario where a woman would have to go from doctor to doctor in the hope of finding help. The 24/7 helpline will not just be a telephone line; it will have instant messaging in 2019 because it is a more convenient way for people to contact services The website which will be launched and the MyOptions service that is being put in place will provide women with the information they need in order that they will not have to go to a local GP in the hope of finding help. Instead, a woman will go secure in the knowledge that the medical professional wants to help her and has signed up to provide help for women in such a crisis. . .

[P. 259] 

Senator Rónán Mullen

I move amendment No. 47:

In page 15, lines 7 to 9, to delete all words from and including “Subject” in line 7 down to and including “or 12” in line 9 and substitute the following:

“A medical practitioner, nurse or midwife shall not be obliged to carry out or to participate in carrying out a termination of pregnancy in accordance with section 9, 11 or 12 ”.

Bill text	Amendment 47
Conscientious objection 24. (1) Subject to subsections (2) and (3), nothing in this Act shall be construed as obliging any medical practitioner, nurse or midwife to carry out, or to participate in carrying out, a termination of pregnancy in accordance with section 9, 11 or 12 to which he or she has a conscientious objection. (2) Subsection (1) shall not be construed to affect any duty to participate in a termination of pregnancy in accordance with section 12. (3) A person who has a conscientious objection referred to in subsection (1) shall, as soon as may be, make such arrangements for the transfer of care of the pregnant woman concerned as may be necessary to enable the woman to avail of the termination of pregnancy concerned.	Conscientious objection 24. (1) Subject to subsections (2) and (3), nothing in this Act shall be construed as obliging any medical practitioner, nurse or midwife to carry out, or to participate in carrying out, a termination of pregnancy in accordance with section 9, 11 or 12 A medical practitioner, nurse or midwife shall not be obliged to carry out or to participate in carrying out a termination of pregnancy in accordance with section 9, 11 or 12  to which he or she has a conscientious objection.
[Protection of Conscience Project comparison]

On Committee Stage in the Dáil on 6 November, the Minister, Deputy Harris, stated:

The Medical Council regulates our doctors, not me and not the Oireachtas. It tells our doctors how they are to behave and also provides for serious sanctions if our doctors do not behave in that way.

This is an extraordinary statement, considering what section 22 does as it stands. Under

[P. 260]

section 22 as it stands, it is the Oireachtas, or rather the Minister and the Government by diktat, which tells doctors how to behave. It is the Oireachtas which will compel doctors to choose between performing or participating directly in an abortion, or participating indirectly by referral onwards. This is explicitly what is provided for in the legislation.

The Medical Council did not seek this provision. The Minister and the Government did. As such, for the Minister to say, as he did in the committee proceedings, that the Medical Council tells doctors how to behave is just doublespeak. I listened to the Minister's contributions in the Dáil on freedom of conscience. He seems to contend that the law on conscientious objection is not being changed here because a similar duty to refer exists where all other treatments and procedures are concerned. However, that conveniently ignores the fact that the procedures and treatments that are legal in this country are changing radically. It makes no sense to state the law on conscientious objection has not changed when the context in which it is to apply has changed hugely. We are no longer talking about medically beneficial procedures. We are talking about procedures that kill innocent human beings in the early stages of their lives.

This is the first legal procedure by which a patient's life can be deliberately ended. In the words of the Bill, the procedure is designed to "end the life of a foetus", or the unborn child. This ends the two-patient model which has operated so successfully in Ireland for decades.

The 2016 edition of the Medical Council's Guide to Professional Conduct and Ethics for Registered Medical Practitioners states, at clause 48.1: "You have an ethical duty to make every reasonable effort to protect the life and health of pregnant women and their unborn babies." This statement could not be any clearer. Doctors have an ethical duty to protect the lives of women and their unborn children. The Medical Council told the health committee last October that it is revising these guidelines in light of the referendum and the legislation. I do not envy it that task.

 . . .  

I do not envy the Medical Council in its task of revising guidelines. It has said the process will take some time. It will certainly take skilled draftsmen to amend these guidelines without making it obvious that a doctor's ethical duty to unborn children is effectively being abolished by the Oireachtas. Interestingly, the guidelines go on to point out that it is "legally permissible"

[P. 261]

to perform abortions under certain circumstances under the law as it currently stands but it makes no statement as to the ethics of this. Therefore, the Medical Council guidelines implicitly draw a distinction between what is ethical and what is legal. It is also worth noting that the section of the guidelines dealing with abortion, clause 48, is immediately followed by the section on conscientious objection, clause 49. The two issues were clearly linked in the mind of the Medical Council when it originally drafted the guidelines.

The Bill seeks to abolish all of this. It drives a coach and four through the Medical Council's own ethical guideline by forcing the council to force doctors to say that what is now unethical is in fact ethical and that the unborn child is no longer a patient of the doctors, yet this legislation seeks to delete or abolish this ethical duty to the lives and health of unborn babies. I was on RTÉ's "The Week in Politics" last Sunday with a number of others Senators, including Senator Richmond, who raised the interesting point that in his view doctors have a right to conscientiously object but do not have a right to break the law of the land. This raises an interesting question, which I shall pose to Senators who support this legislation. Existing Medical Council guidelines contain an ethical duty to do everything to protect the life of an unborn child. This Bill now seeks to abolish that ethical duty on pain of criminal punishment for doctors. I ask those who support this Bill where we draw the line. What other principles of medical ethics can be overridden by legislation by a future Government and future Oireachtas? I ask colleagues to think very carefully about that. If one principle of medical ethics can be scrapped by the Oireachtas, then none of them is safe. There is no floor to how low we can stoop and nothing we cannot force doctors to do.

We have heard a lot of talk about the right of women to choose but what about a doctor's right to choose? How can one person's right to choose become a right to force somebody else to take part in something against his or her will and become a cog in the wheel, however directly or indirectly? If the State is to have no right to tell women what to do, then why is it in a position to tell doctors what to do where telling them to do what it expects of them goes against everything they have always believed to be true and good, having regard to their deeply held beliefs and best clinical judgment? Just because the law no longer sees the baby as a patient does not mean good doctors will not still hold these beliefs, including where abortion is being sought. Therefore, it cannot be maintained that forcing doctors to refer that invisible patient, that less visible patient, that more vulnerable patient, although both persons involved might well be vulnerable, to another doctor to have their life ended is in accord with respect for conscientious objection. This aspect of the Bill, which forces doctors to refer, simply has to be amended. There will be more than enough doctors who will be willing to carry out these procedures so what is the need to force others to refer? At least 25% of general practitioners have said they are willing to perform the service, I gather. That is approximately 625. Assuming a worst-case scenario and 12,000 abortions per annum, as Dr. Peter Boylan and his colleagues suggested at the Oireachtas health committee, it would mean each willing general practitioner would need to perform a maximum of 20 terminations per year. These are shocking figures, of course, but they at least show that allowing those doctors who wish to participate to do so and equally allowing those who wish not to participate not to do so will still ensure adequate coverage of the service, if that is what the House wishes. I urge colleagues on all sides of the House to support these amendments to show solidarity with doctors around the country who, I am sure, have been in contact with them in regard to this most serious of issues.

We are not just talking about the rights of doctors here. We are also talking about the rights of medical practitioners, nurses and midwives. Senator Norris is proposing, as are we, the in-

[P. 262]

clusion of pharmacists. I spoke to a pharmacist the other day who is terrified of the consequences of being required by law to prescribe a drug that would be used upstairs to terminate the life of innocent child. That person wonders whether he or she has a future in the organisation. He or she wonders whether there will be any reasonable accommodation for their position.

It is important, however, to consider a perhaps even more significant issue than the right to refer. I call the relevant amendment the "Minister Harris amendment" because, on Committee Stage, he said a medical practitioner shall not be obliged to take part, but that is different from what is in the Bill. The Bill states nothing in the Act shall be construed as obliging any medical practitioner, nurse or midwife to carry out or participate in carrying out a termination of pregnancy in accordance with sections 9, 11 or 12 to which he or she has a conscientious objection. The difference is that the Minister said on Committee Stage that a practitioner would not be obliged. That can only mean there is protection or that he was claiming there was protection for a person who might be obliged by his employer, for example, to take part in abortion. The Minister's Bill, however, does not require medical practitioners, nurses or midwives to get involved but it does nothing to protect, in the new scenario he is bringing about, medical practitioners, nurses, midwives and pharmacists from being required by the rules, including the rules of the organisation with which they have a contract to work, to become involved. They could lose their job. The provision of limited protection for conscientious objection is effectively null. While the Bill will not impose an obligation, it does nothing to protect practitioners from the pressure that will be put on them under contract or by their employer. This is how the Minister's provision in this Bill differs from provisions on conscientious objection in other places. That is an important issue he should address here.

Senator David Norris

I support these amendments. I vigorously opposed a number of Senator Mullen's amendments and believed they were shameful but I support these ones. I will not rehearse too much my support for amendment No. 47.

I stated earlier on in this discussion that, although I believe abortion is necessary and justifiable, and morally good in certain circumstances, forcing medical practitioners to refer is the equivalent of them being an accessory. That is my view. People should not be forced to violate their conscience in any way.

It has been said that the Code of Conduct for Pharmacists covers the matter of pharmacists I raise in my amendment. My good friend and colleague, Senator Bacik, has shown me a phrase that she thought fulfilled this requirement. Having read it, I do not believe it does. I have had contact from a number of pharmacists who state that the Code of Conduct for Pharmacists 2009 and the draft code published in June 2018 but not adopted clearly show that pharmacists' rights to freedom of conscience are nowhere mentioned or protected. One of these, who seems to be a rather distinguished woman with a PhD, quotes the Minister, Deputy Harris, as saying that pharmacists are protected and they have their own legislation for a code of conduct. This person states that the same could be said for doctors, nurses and midwives but they are not included. The person said the Minister stated that the conscientious objection clause does not refer to other personnel in institutions for the express purpose of clarifying that those staff in institutions are not entitled to conscientious objection. I wonder if the Minister could confirm that it is, indeed, his view that other professional groups are not entitled to conscientious objection. That is rather serious, particularly in the light of the report from the Irish Human Rights and Equality Commission, recommendation 20 of which states: "The Commission recommends that the provisions of Head 15 be made to apply more broadly than currently outlined in Head 15(1), to provide for the possibility of conscientious objection by the broader range of health and social care profession with whom a pregnant woman or girl may come into contact." That

[P. 263]

is quite clear. It is explicit and makes the point that the commission is independent. It is not campaigning for or against abortion or anything like that. The commission is saying that head 15 should be made to apply more generally to cater for freedom of conscience and the conscientious objection of other professionals within this general range of expertise, and we must take this seriously.

I understand part of the position taken by my friends with whom I do not agree because there is a judgment from the European Court of Human Rights that: "States are obliged to organise the health services system in such a way as to ensure that an effective exercise of the freedom of conscience of health professionals in the professional context does not prevent patients from obtaining access to services to which they are entitled under the applicable legislation." That freedom of conscience should not frustrate the operation of the legislation is an interesting and important point that must be taken into account but given the numbers of doctors who are prepared to be engaged in this and have no difficulty with it, I do not believe that allowing doctors the complete freedom of conscience and extending this to cover pharmacists would inhibit the implementation of this legislation.

Senator Catherine Noone

How would it work in practice?

Senator David Norris

How would what work in practice? . . .

How it would work in action is by giving pharmacists the right of freedom of conscience, the right not to dispense these matters. I believe they would be very widely available, even in circumstances where this was registered.

Those are my views and I will stand with them. I will license my friend, Senator Bacik, to withdraw on my behalf my amendment about pharmacists with the intention of resubmitting it on Report Stage.

Senator Ivana Bacik

I fundamentally disagree with these amendments, in particular, with amendments Nos. 47 and 50, which effectively create a skewed balance between the rights of conscientious objection which are respected in this section 22 and the right of women to access medical services. Senator Norris is correct, of course, that there is European case law on this. There is, indeed, a useful report, published in October of this year, from the European Parliament on conscientious objection law and sexual and reproductive health rights which makes clear that the right to conscientious objection is not absolute, it must not be a barrier to accessing sexual and reproductive health services and that this is the case across the EU and also in Ireland.

[P. 264]

Indeed, I would support section 22 because it strikes that careful balance between respecting the rights of conscientious objection of medical practitioners, nurses and midwives, and, indeed, students, as per an amendment in the Dáil, and the rights of women to access services. That is, as I say, a careful balance that is well struck and, of course, does not affect the duty to participate in a termination in accordance with section 10, which is the emergency section.

Unfortunately, given how much debate there was on this issue in the other House, what we have seen is, as the Minister put it, not so much conscientious objection as conscientious obstruction being carried out in the shape of some of these amendments. Anyone who looks objectively at section 22 will see that it strikes this careful balance. In particular, subsection (3) ensures that there is an obligation to make arrangements for the transfer of care. It merely puts it at that. That is fair.

Finally, in terms of the pharmacy point raised by my friend, Senator Norris, the Pharmaceutical Society of Ireland has in its Code of Conduct for Pharmacists an obligation that where they are unable to provide prescribed medicines or pharmacy services, they must take reasonable action to ensure that those medicines or services are provided to patients and that their care is not jeopardised. That is rather similar language to the sort of balancing act struck in this section.

Finally, much of the debate around this Bill and the provision of services focused on the medical practitioners, the doctors etc. I was disappointing that the Coombe hospital, where I had a happy experience having my own babies, indicated it would not be in a position to provide services from 1 January. It is unfortunate that the debate has been so focused upon doctors and not upon women.

Senator Marie-Louise O'Donnell

Hear, hear.

Senator Ivana Bacik

It is important in our contributions, particularly on this issue of conscientious objection, that we bear in mind that the key aim here in this legislation is to ensure that women will have effective access to the services we so badly need.

Senator Brian Ó'Domhnaill

I support this group of amendments and acknowledge what Senators have said.

As for the rationale for these amendments, first, amendment No. 47 endeavours to reframe section 22(1) so that it provides a positive and substantive protection of freedom of conscience. The current section 22(1) states that nothing in the Bill obliges a doctor, nurse or midwife to participate in carrying out a termination under section 9, 11 or 12. However, the concern is that this leaves a serious gap in protection because it merely states that the Bill does not force doctors, nurses or midwives to participate. It, therefore, does not prevent the imposition of such compulsion by an employer or professional body, and there is where the difficulty arises.

A situation, which I referred to on Second Stage, arose in Norway where a doctor who was not willing to perform an abortion was removed from his position by the public health service because of his conscientious objection. The individual concerned took a case to the Norwegian Supreme Court.

11 o'clock

In mid-October of this year he won the case on the basis that he deserved to make a conscientious objection. If this matter is not addressed in this Bill then we run the same risk of

[P. 265]

exposing the taxpayer here to a case. We and other countries should learn from what happened in Norway. Accordingly, the amendment at issue improves the protection by closing the gap and ensuring that no-one can lawfully be forced into carrying out a termination other than in an emergency as provided for under section 10.

This amendment also reflects international best practice models for recognising the right to conscientious objection. It is based on section 46(1) of the New Zealand Contraception, Sterilisation and Abortion Act 1977, which provides:

Notwithstanding anything in any other enactment, or any rule of law, or the terms of any oath or of any contract (whether of employment or otherwise), no medical practitioner, nurse, or other person shall be under any obligation —

(a) to perform or assist in the performance of an abortion.

The UK Abortion Act 1967, which has been referred to here many times, also provides for a substantive protection at section 4(1), which reads: "Subject to subsection (2) of this section, no person shall be under any duty, whether by contract or by any statutory or other legal requirement, to participate in any treatment authorised by this Act to which he has" [or she has] "a conscientious objection." There is a similar provision in US federal law. For instance, the "church amendments" ensure that an individual or entity who receives a grant, contract or loan does not entitle a public authority to require the individual to perform or assist in the performance of an abortion if that would be contrary to his or her religious beliefs or moral convictions. In addition, it does not entitle a public authority to require an entity to makes its facilities available for the performance of any abortion if the performance of such an abortion in such facilities is prohibited by the entity on the basis of religious beliefs or moral convictions. The "church amendments" also provide protections against discrimination in the context of employment and medical training based on whether or not someone has a conscientious objection to abortion. Additionally, there is international expert opinion in medical literature that supports the view that denial of conscientious rights is a cause of disillusionment and burnout in doctors, and disengagement from particular areas of practice. I am sure that is something that the Minister would not like to see happen here.

I shall read the prepared note that the Minister put on the record during Committee Stage in the Dáil. He said the following about section 24, which was possibly numbered section 23 but I may be mistaken. He said: "Where he or she has a conscientious objection, a medical practitioner, nurse or midwife shall not be obliged to carry out or participate in the carrying out of a termination of pregnancy." In line with this confirmation of the intent of the section, this amendment revises section 24(1) so as to give it the effect that the Minister told the Select Committee on Health that it would have.

A conscientious objection goes further than just the medical practitioner or the doctor. It extends to those people who would be expected to assist or perform, and I mean other healthcare workers, including midwives. I can categorically state the following. I have spoken to a large number of GPs and midwives who are extremely concerned and frightened at the concept of having to perform an abortion from 1 January. One of those midwives wrote to me and I assure Members that I will not identify her or the hospital where she works. The midwife is highly concerned, which will be evident when I read her letter into the record. She explained everything from her standpoint. I shall not read her full letter, just the main parts. I confirm that I know the lady. She said:

[P. 266]

[P. 267]

An Cathaoirleach

I have listened very carefully to the Senator and I thought that he would be selective in what he said or did not say.

Senator Ivana Bacik

Hear, hear.

An Cathaoirleach

I take it from what Senator Ó Domhnaill has said, the midwife objects to the entire Bill and not the section. I do not dispute the sincerity of the person who wrote the letter. I understand that the entire Bill does not suit her, and she is entitled to her view. We are debating a particular section here. When I allowed the Senator to read the letter I presumed that it would just be a few paragraphs. He has been reading for almost five minutes and I hope he is near the end of the letter.

Senator Brian Ó'Domhnaill

It is indeed, a Chathaoirligh, and I thank you.

An Cathaoirleach

I have to be fair to everyone. I was told earlier that we will probably be sitting until 2.30 a.m. I do not mind. I am quite happy to stay here, but others may not be.

Senator Brian Ó'Domhnaill

This letter relates to conscientious objection in its totality. The person who wrote it is setting out her views. I am trying to air them. I have received hundreds of letters about this issue. I felt that this letter deserved particular attention by being read into the record of the House. It will stand the test of time. I hope it will protect the unspoken voices of midwives out there who are concerned. The letter continues:

On the point often made of what happens in other countries, we are unlike any one of those other countries. We had a referendum - they didn't. The citizens were asked "Yes" or "No". I appreciate we live in a democracy, but surely those of us who voted "No" for the reasons we did cannot now be expected to be able to set those reasons aside and get on with it as some are telling us to do. I am concerned that among some political circles, including some who are members of the select committee, my colleagues and I are now being referred to as "anti-choicers". We are not; we are conscientious objectors. As I have said before, I respect the democratic result of the repeal amendment, but "pro-choice" was a term we became very familiar with during the campaign.

She is quoting that. She goes on:

I sincerely hope that midwives like myself and other healthcare professionals who are now pro-choice of the abstaining ourselves from any procedure that will bring about the death of an unborn human life will have that respect reciprocated.

I think that is very fair. There is much more to the letter. I will not go on.

An Cathaoirleach

With all due respect, a letter is a letter but that is like an epitaph. I have to be very careful in allowing it to be read because somebody else could come in and keep us here all night by reading ten such letters onto the record. As I said earlier, with all due respect, the letter broadly says "No" to this legislation and does not refer exactly to the amendment before us. I cannot allow it. I have to be very fair.

Senator Brian Ó'Domhnaill

While I appreciate that, I would not like to devalue the authenticity or genuineness of the letter.

An Cathaoirleach

I am not doing so.

[P. 268]

Senator Catherine Noone

Nobody is.

Senator Brian Ó'Domhnaill

Many members of staff in the midwifery section of Letterkenny General Hospital and many other hospitals have conscientious objections and are highly concerned about the introduction of this legislation. Like midwifery staff, pharmacists, who have been mentioned during this debate, have raised their conscientious objection to the provision of the services they will be expected to provide under this Bill. It is alarming that the Minister does not appear to be willing to concede to meet the doctors, midwifery staff and pharmacists who are advocating for conscientious objection to discuss these issues with them. I know for a fact that the Hospital Pharmacists Association of Ireland wrote to the Minister about the conscientious objection issue recently. The Irish Pharmacy Union wrote to the Minister to outline its grave concerns about the same issue on 28 February last. These concerns have not been addressed. The code of conduct of the Pharmaceutical Society of Ireland, which has been referred to as a way of protecting pharmacists, does not refer to conscientious objection or freedom of conscience, religion or belief. It is worth noting that Principle 4 of the current code of conduct was updated earlier this year. It was completely rewritten in a way that allows the patient to have the choice and removes the choice from the pharmacists. The pharmacists are being left in a situation where they do not have a conscientious objection under their own code. They have no protection under the legislation. The code was rewritten quite recently. They have articulated this in writing to the Minister.

The conscientious objection we have outlined is available in other jurisdictions. It should be available here. It is a reasonable request. It does not in any way dilute the effectiveness of the Minister's Bill from his point of view. It provides a way out to people who have a religious, humanitarian or moral conscientious objection. They should not be forced to partake in a practice about which they have such strong feelings of objection. It would be wrong to force them to do so. The Bill does not provide for conscientious objection. It relies on codes of conduct elsewhere. Conscientious objection is enshrined in the legislation in the UK and in New Zealand and it should be enshrined in this Bill as the only way to protect GPs. There are GPs who do not have a conscientious objection, and that is fine, but there are many GPs who do have a conscientious objection. There are hundreds of them up and down the country. They deserve the same respect. If we are talking about choice, then they should have a choice as well. One cannot level choice one day, and then the next day remove the choice. If one wants to purport that this is all about choice, one must accept that choice is a two-way street. If it is all about choice, so be it. That is great, but pharmacists, midwives and doctors must be given the same choice and respect. Choice must be reciprocated. That is what these amendments are about.

[P. 269]

Senator Diarmuid Wilson

. . . Like my colleague, Senator Brian Ó Domhnaill, I want to read an extract from a letter. The letter to which I refer was written by Dr. Fiona O'Hanlon, who is known to myself, to Senator Robbie Gallagher and to our colleague in the Lower House, Deputy Brendan Smith. Rather than going off on a tangent, I want to read as clearly as possible an edited section of the letter, which was published in a national newspaper.

It really states what I want to say myself:

I want to briefly refer to Baroness Nuala O'Loan, the former Police Ombudsman for Northern Ireland, who is well known to all of us in this House. She recently gave a first reading of a

[P. 270]

piece of legislation in the House of Lords. Some of the detail that I have before me has already been alluded to by Senator Ó Domhnaill and I do not intend to repeat it. However, it is important to make three or four points from her contribution on that legislation. She points out that conscientious objection was first provided for in the United Kingdom in 1757. We celebrated the 100th anniversary of the end of the First World War a couple of months ago. During that war, 16,000 men were excused from conscription to military service on grounds of conscience. They included Quakers, who did not believe in fighting on religious grounds, and others. This is most interesting for some of my colleagues in this House who are most anxious to get this legislation through. Baroness O'Loan says: "Others, such as radical socialists, did so out of political principle." These were conscientious objections. I suggest that those radical socialists were every bit as well meaning in their conscientious objection as the radical socialists we have in this House and the Lower House.

I also want to refer to what Senator Bacik mentioned about the Council of Europe Parliamentary Assembly adoption of Resolution 1763. I think that is the one to which Senator Bacik referred.

Senator Ivana Bacik

No, I talked about the European Parliament.

Senator Diarmuid Wilson

This is the Parliamentary Assembly of the Council of Europe adoption of Resolution 1763, affirming the right of conscientious objection for medical professionals. The resolution is worth putting on the record. It states: "No person, hospital or institution shall be coerced, held liable or discriminated against in any manner because of a refusal to perform, accommodate, assist or submit to an abortion." That is Resolution 1763, recently adopted by the Parliamentary Assembly of the Council of Europe.

We thank the Minister for listening to us. People who are fundamentally opposed to implementing procedures which will result in death should not have to beg for conscientious objection. It is a human right, the same as I believe it is a human right of a child to be born.

Senator Robbie Gallagher

. . . Following on from the comments of my colleagues, I think it is important that, when we discuss healthcare, we always keep in mind the person at the centre and in this case that is the young woman. We always have to keep that in mind.

Having said that, it is important that we genuinely acknowledge that some people will have an issue with conscientious objection. A number of GPs have been in contact with me, particularly about the phrasing of section 22(3) and the inclusion of the phrase "make such arrangements". There seems to be a degree of confusion there, I hope the Minister will agree, as to what exactly that means. It might be helpful and I would welcome it if the Minister could bring clarity to that. I understand there is some degree of urgency to push this through and everybody had 1 January 2019 in their sights as the date when they would like this to be up and running. It is important to put legislation through both Houses as quickly as possible but it is equally important that, when we do so, we tread carefully and try and bring as many people with it as we can. The phrase "make such arrangements" in section 22(3) deserves clarity that I hope the Minister will bring.

We have constantly been told that there are enough GPs to do the necessary work and, if that is the case, I wonder is there a need for this at all. Perhaps it is something that could be revisited

[P. 271]

at another stage. We have to be conscious that all GPs, throughout the country, do magnificent work and many of them are under severe pressure.

Many patients in places like the place where I come from in rural Ireland have to queue up to get access to general practitioners. Senator Bacik talked about the Coombe Hospital having difficulties in having the service in place by 1 January. As I said earlier, it is important that we progress matters but it is important that we do so while ensuring that any step we take is sound.

At a time when we are talking about choice and equality it is unfortunate that this impasse has arisen. I hope that common sense will prevail and that we will strike a balance to accommodate the rights of all those who genuinely have reason for conscientious objection.

Senator Paul Coghlan

. . . I agree with what has been said by Senators Wilson, Gallagher, Ó Domhnaill and Mullen on these matters. Conscientious objection is fundamental, as are freedom of conscience, freedom of expression and a free vote. We recognise this in so many different ways as politicians. It is important in our democracy that we follow through on it.

Like many others in the House I have had contact from doctors, pharmacists, nurses and midwives. I feel for them because they do not want to be locked in or to have to perform what may be required of them. No one should be forced or required by law to perform or assist in something that conflicts with his or her conscience. As I have said, I believe that much is basic. With me, it boils down to the point that I am totally opposed to any deliberate, wilful extinguishment of life in any make, shape or form. I will leave it at that.

Senator James Reilly

. . . There are 23 sections to the Bill and only one relates to conscientious objection and those who must provide care to women in these circumstances. I staunchly defend the right of any medical, nursing, pharmacy or other professional who has a conscientious objection to performing a termination. That is their right and it is enshrined in the Bill. It is clear. Other Senators have talked about recent changes in pharmacy. I have the relevant changes before me. Point 5 of principle 4 on page 9 of the proposed code of conduct makes provision for conscientious objection. It is clear. The Bill provides for it too.

On Second Stage I mentioned my concern about who practises in this regard. On the one hand, the Bill makes it easier for a doctor in a practice who conscientiously objects to refer the matter to someone else in the practice. Equally, we have to guard against bullying of junior doctors by senior doctors, who might have a different view. I am very much opposed to that.

I will defend absolutely the right of medical and nursing professionals and others to be conscientious objectors. I see nothing in the Bill that does not enshrine or protect that. At the same time, the Bill is about patients and women in trouble who wish to have a termination and who are entitled to it. We have had a referendum on the matter. Women cannot be obstructed because people refuse to give them information on others who are prepared to act or help in the practice or in the town or village in question. A nurse's letter was read out. She acknowledged that in an emergency she would act. Nowhere else in the Bill is there provision for an onus on her to do otherwise or to prevent her from being a conscientious objector or obliging her to act.

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People have views but the reality is that the Bill is clear. I commend the Minister on the Bill. Certainly, I will not support the amendments.

Deputy Simon Harris (Minister for Health)

I thank the Senators for their contributions. A total of six amendments to this section are grouped. I too am a defender of conscientious objection. I believe in it. People have the right to conscientiously object. It is a long-standing principle in medicine and has long been enshrined in the way we run our health service.

Senator Bacik and, to some degree, Senator Gallagher both hit the nail on the head when they talked about balance. It is about balancing the right of medical professionals to conscientiously object from this or other services in respect of which they have a conscience issue with the right of a woman to access a service that will be a legal part of the Irish public health service from January. What we are trying to do here is attain balance. I believe we have achieved that balance because section 22 states that where a medical practitioner, nurse or midwife has a conscientious objection, he or she shall not be obliged to carry out or to participate in carrying out a termination of pregnancy. The provisions set out are in line with section 49 of the Medical Council guide for professional conduct and ethics for registered medical practitioners. The provision obliges doctors to enable patients to transfer to another doctor for treatment in cases of conscientious objection.

Senator Gallagher asked the reasonable question of what that means and whether I could provide clarity. I am pleased to do so and I did so in the other House as well. It is described on page 35 of the Medical Council guidelines. Section 49 of the document relates to conscientious objection and states:

If you hold a conscientious objection to a treatment, you must:

- inform the patient that they have a right to seek treatment from another doctor; and

- give the patient enough information to enable them to transfer to another doctor to get the treatment they want.

I am keen to make another point. No one wants a situation whereby doctors who are conscientiously objecting are coming into contact with women looking for a health service. That is not desirable for anyone. It is not desirable for the doctor and it is certainly not desirable for the woman. We have taken several measures. In particular we have provided for the 24-7 helpline. The first port of call for many women in a crisis pregnancy will be to pick up the telephone. Later in 2019 we will have an instant message service. Women will be able to check out websites like www.myoptions.ie, which will go live when this law passes and is enacted. Women will be able to receive all of the information about all the services available to them in a crisis pregnancy that are legal in Ireland, including termination, in a non-directional manner. The helpline will be able to signpost a woman to where those services are available. This should minimise the situations that no one wants to see, such as conscientiously objecting medical professionals coming into contact with women. It is not desirable and I have no wish to see women going from doctor to doctor in an effort to seek help, especially women who, by virtue of being there, are in a crisis pregnancy situation.

Balance could completely go out the window and the situation could become completely unbalanced if a woman presents in a crisis – it could be a difficult and traumatic situation for the woman – and is simply shown the door without being at least given the information to access the service. That is what transfer of care means. Everyone has acknowledged that it would

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be different in an emergency situation or in a situation where a woman is not in a position to transfer her care – perhaps she may be unconscious. The law is clear on this point. The Medical Council guidelines have been clear on it too. I am clear on this point. We need to avoid over-egging what is being done in the Bill. The bar is low here. We are simply asking that women are actually given information to access legal services in the country, no more and no less. Similarly, the Nursing and Midwifery Board of Ireland code of professional conduct and ethics in 2014 states:

If you have a conscientious objection based on religious or moral beliefs which is relevant to your professional practice, you must tell your employer and, if appropriate, tell the patient as soon as you can. If you cannot meet the patient’s needs because of this objection, you must talk with your employer and, if appropriate, talk to the patient about other care arrangements. Even if you have a conscientious objection, you must provide care to a patient in an emergency where there is a risk to the patient’s life.

Others have alluded to the fact that in the Dáil I brought forward amendments to ensure it was absolutely clear that student nurses and midwives would have the right to conscientiously object as well. Moreover, section 13 provides a specific duty on a treating physician who refuses certification to inform the woman that she has a right to apply for a formal review of this decision.

I have already mentioned that I have directed the HSE to put in place a helpline to help women navigate the services for termination of pregnancy. It is intended that medical practitioners will voluntarily consent to have their names released to women seeking the service so that women ringing the helpline will be assisted in contacting medical practitioners who do not have a conscientious objection to termination of pregnancy.

As I have already said, the Bill and existing medical guidelines make it clear that conscientious objection cannot be invoked in an emergency situation where there is a risk to a pregnant woman's life or health and where there is an immediate risk in that regard.

As has been stated by some colleagues, the current code of conduct for pharmacists states that pharmacists must, "Ensure that in instances where they are unable to provide prescribed medicines or pharmacy services to a patient they must take reasonable action to ensure these medicines/services are provided and the patient's care is not jeopardised." The council of the Pharmaceutical Society of Ireland, PSI, which is the regulator for pharmacists in this country, has approved a new code of conduct for pharmacists. Part five of principle four on page nine of the proposed code of conduct makes provision for conscientious objection subject to a referral of a patient to an alternative provider if a pharmacist cannot provide a professional service or a medicinal product so that patient care is not jeopardised or compromised. A footnote to principle four also makes a specific reference to a pharmacist transferring the care of a pregnant woman availing of services in the termination of pregnancy, so it has already taken action as the pharmacy regulator in this country.

The approved code of conduct is required to be submitted by the PSI to the Competition and Consumer Protection Commission for approval before being submitted to the Department for ministerial approval. Conscientious objection is in place. It is about getting the balance right between making sure women can access legal services and providing for medical practitioners who do not wish to partake and conscientiously object. It is also about making those rights respect each other. We have taken a number of measures outside the legislation in terms of the roll-out of services, most particularly the 24-7 helpline, to support women and medical practi-

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tioners in this new reality.

Senator Máire Devine

I did not want to speak but given my role as nurse and the role of Senator Reilly, we are very well aware that we are catered for in terms of conscientious objection. It is there and is respected. The 24-7 helpline will contain a list of GPs to whom women can go because they will be willing to help them. Will it be the same for pharmacists? I remember the hullabaloo when contraception was legalised in this country. To this day, there are some pharmacists who refuse to dispense prescribed medication such as the contraceptive pill. Will a list of pharmacists be provided by the 24-7 helpline because it would make a woman's journey much easier and get them close to the GP they are visiting? I know we talked about nurse practitioners and their ability to carry out these procedures and prescribe under 12 weeks. Perhaps that is a discussion for another time in a review or an amendment later on.

An Cathaoirleach

I wanted the Minister to hear that because I left him the last time.

Deputy Simon Harris (Minister for Health)

As is envisaged in this legislation, the GP will also dispense the medication, thereby lessening another journey or trip a woman may need to make. With regard to nurse practitioners, the law as currently drafted does not allow for that but the operation of the Act will be reviewed in three years.

Senator Rónán Mullen

The Minister presents it as a reasonable balance but it is not at all reassuring. How could it be when there was so little consultation? The Minister broke the news on radio to GPs that his abortion regime would be GP-led. Before his announcement, he never consulted rank-and-file GPs around the country about turning their surgeries into abortion clinics and forcing them to become facilitators of abortion through referral. Since his initial announcement, he has refused point blank to engage with ordinary GPs and is well aware that more than 640 GPs have signed a petition raising very serious concerns about his proposal and that nurses, midwives and pharmacists have done likewise. I find it extraordinary that the Minister would not afford these hard-working healthcare workers even one minute of his time, yet from 1 January, any GP who refuses to facilitate abortions in line with the Minister's extreme law runs the risk of being struck off the medical register and losing his or her job. There really are no words to describe this travesty.

I know a doctor who felt under intense pressure to abort her daughter when working in England seven years ago. She has first-hand experience of what a conveyer belt abortion system results in - rushed decisions followed by immense regret - but her personal experience counts for nothing under the Minister's new law. From 1 January, she will have to get in line with his abortion law or face being struck off the medical register. I can assure the Minister that she has no intention of being coerced into going against her conscience and there are hundreds of healthcare workers just like her. They are not going to surrender their clinical judgement and lifetime of experience in assisting women with unexpected pregnancies in the sensitive, compassionate and non-judgemental way they do. They feel they are being bullied by this Government and the Minister to do something that goes against every fibre of their being. That should be enough to give the Minister concern, because they are right. They are being bullied. Calling doctors, nurses and midwives rogue practitioners simply because they disagree with the Minister and want to practise evidence-based medicine is outrageous and wrong. Forcing decent, hard-working and conscientious-----

An Cathaoirleach

I do not want to go down this road again. The Minister has replied so, obviously, the Minister is not listening to Senator Mullen or Senator Mullen is not listening to

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the Minister because I am hearing totally different views on this issue of conscientious objection. I would like to facilitate and be fair to everyone. Nobody is withdrawing. This amendment will be put to a vote. I will insist on it. We will let Senator Mullen ramble on for a while but he is making very serious accusations against a Minister on an issue where the Minister believes he is correct. The Senator may disagree but we cannot allow this to ramble on. We have already spent one hour and 14 minutes on this section. I can be fair to the House as well. I will let Senator Mullen continue but I ask him to understand the position I am in. I must be fair to both sides.

Senator Rónán Mullen

I understand the Cathaoirleach's position, but forcing decent, hard-working and conscientious healthcare workers to do something they find morally troubling, even abhorrent, crosses a line. They have received their own legal advice and they know the freedom of conscience protections the Minister claims are in the Bill offer no meaningful safeguards. The Minister is putting many healthcare workers through hell through his refusal to listen to them. I dearly wish that he would amend his Bill, but if he does not, it will not end there. Peacefully but persistently, people will stand united against the injustice of what the Minister is trying to impose. I believe it will give rise to a civil rights and civil disobedience movement that this country has not seen in a long time because people will tolerate a lot of things but they will not tolerate their freedom to object conscientiously being trampled on. I do not think people will tolerate their doctors, who give them so much care, and other medical professionals being bullied in this way.

The Minister says that Medical Council guidelines are going to change in line with the legislation, and we know they will. The same is true of the PSI's guidelines and all relevant guidelines because the law will shape what happens in future. The power of the State is behind the provision of abortion, so the Minister does not need to bully medical personnel to become a cog in the wheel, as they see it, by being required to refer or even participate more directly - not under pain of being punished by this Bill but of not being protected by this Bill from punishment by their employer. That is the point the Minister has either not grasped or has not been willing to engage with. Those conscientious objectors should not be seen as the awkward squad, nuisance people or doctors who would show women the door. They are caring professionals who, for whatever reason, be it a faith-based or philosophical reason or just their clinical judgement, believe they have a duty in justice to the unborn child as well as the mother before them. That is what actuates their concern. Asking them to be involved in transferring for a care they do not believe is care, for a procedure they do not believe is compassionate because it excludes one of the two parties they see before them albeit only one is immediately visible, is the injustice.

It is so unfair because, as I said, the entire power of the State is behind the Minister's abortion proposal. He is going to spend an enormous amount of taxpayers' money making abortion available, including through the use of advertising telling people how they can access this service. He does not need to force doctors, midwives or anybody else to pass on information they believe will be fatal to the well-being of another human being.

All rights are of course limited and even the right to conscientious objection is limited where what is at issue is necessary medical treatment. I would not support the right of any person to object in conscience to bona fide treatment needed by another person. However, the whole point of the Minister's legislation is that it includes an abortion regime that is not connected with medicine, as under section 12 no reason is required to be given. I do not understand why the Minister wants to turn this-----

An Cathaoirleach

I am listening to the Senator's comments very carefully and I have listened to the Minister. I must be a referee and impartial as Cathaoirleach. The Minister dis-

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agrees with the Senator and the Senator does not agree with the Minister. I am not allowing this to drag on. We are nearly one hour and 15 minutes on the matter. The Senator's speech is more like a Second Stage speech. He has made his points cogently and as far as I understand, the Minister is unlikely to accept his opinion. There will be a vote on it and it is the way to resolve the matter. . .

Senator Rónán Mullen

I am coming to a conclusion. I am grateful to the Cathaoirleach. As I said yesterday, I want to say what needs to be said, no more and no less, before addressing the points that are raised. That is appropriate on Committee Stage. The time we have spent on this matter is as nothing to the time I have spent on the phone and in meetings with good and ethically minded professionals who are terrified of what is in this Bill and the implication for their ability to give compassionate care. I have a duty, as do the other Senators presenting these amendments, to be faithful to those decent professionals. These are not the awkward squad, as I mentioned, but rather people who want to keep best medical traditions going where they see those traditions as being attacked by this Bill. I was urging the Minister not to want to turn this into a war between those who agree with abortion and those who disagree with it.

Senator Ó Domhnaill referred to the case in Norway and it was very instructive that the Supreme Court of Norway found just weeks ago that Dr. Katarzyna Jachimowicz had acted within her rights when refusing to follow through with a medical procedure with which she had a moral objection. The court held that health clinics and hospitals could not fire staff who asserted such objections. It is interesting as this law will not require the firing of staff but it will allow it.

Deputy Simon Harris (Minister for Health)

That is an untruth

Senator Rónán Mullen

That is the wrong and injustice in this. Senator Wilson referred to the resolution of the Parliamentary Assembly of the Council of Europe in 2010. I know about it because I was there and involved in the debate. I believe he was referring to the debate on what was known as the McCafferty report. It started as an attack on conscientious objection. Much of what we have heard in recent months claims that the right to conscientious objection inhibits the delivery of care but the report in question turned into a ringing endorsement of people's right to object in conscience to procedures they believed unethical. The buzz phrase in this area is "reasonable accommodation". When the power of the State is behind the provision of abortion and the Minister has access to the purse strings - essentially being able to advertise and provide information about the services that will now, tragically, be legal - the Minister can afford to be much more generous than he is being in allowing people to go their own way peacefully and respectfully.

That is not, as I think the Taoiseach said, giving the cold shoulder to people. It is the continuation of a tradition of caring medicine that has the idea that two people are being cared for. It is about asking a practitioner to refer a patient to somebody who will take away the innocent life that is growing within the patient, and it asks too much of a caring professional. In the end,

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it is not for the Minister, Senator Reilly or anybody else to tell a person what ought or what ought not be in conflict with his or her conscience. That is with the exception of where there is bona fide medical care to which a person is entitled, as conscientious objection cannot prevail over that. Where we speak of elective procedures, it is absolutely wrong and unjust to say to a person that he or she does not have to carry out the abortion, at least not under this law, but it is not the case if the health service or professional organisation requires that person to do so. It is tough if that person does not like or want to be complicit in facilitating the injustice by passing on information about the service.

I know of one case where a person resigned not because that person did not want to do something against that person's conscience but rather there was a reluctance to delegate it to another professional. That person was willing to take a step down in the organisation, allowing another worker to do the delegation. The person was not asked to do the service to which there was a conscientious objection. It was the person's sensitive conscience and that person did not want to be a cog in the wheel. The trouble with the Government's Bill is that this has not been thought through, at best, and at worst it is pretending there is protection for freedom of conscience. It is only there in fig leaf form for the two reasons I have mentioned. It does not prevent a person from being disciplined-----

Senator Kevin Humphreys

We have heard this nonsense over and over again. The Minister has answered the Senator.

Senator James Reilly

It is a personal attack.

Senator Kevin Humphreys

This is getting a little ridiculous.

An Cathaoirleach

The Senator is anxious to conclude.

Senator Rónán Mullen

I am.

Senator Kevin Humphreys

He was ten minutes ago.

Senator James Reilly

There are none so deaf as those who will not listen.

An Cathaoirleach

Allow the senator to conclude.

Senator Rónán Mullen

This does not protect a person from being sanctioned. The legislation does not provide that a person will be sanctioned but it does not protect the person. Senator Reilly mentioned the less powerful people in an organisation, and funnily enough it is those who will come under pressure.

Senator Kevin Humphreys

The women in this are less than powerful.

Senator Rónán Mullen

I say this as somebody who cares for those women and the unborn.

Senator Kevin Humphreys

The Senator has never shown it.

An Cathaoirleach

Does the Minister wish to respond?

Senator Rónán Mullen

May I finish the sentence, as I was heckled? The first problem is the legislation does not protect the person against being sanctioned from above. The second problem is the requirement for the person to be a cog in a wheel. That is not fair and it will be

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resisted, peacefully but persistently in future, regardless of whether the amendment is accepted.

An Cathaoirleach

I am putting the question.

Senator Rónán Mullen

I have not yet pressed it.

An Cathaoirleach

This has gone on for an hour and a half. I have spoken before about anybody who wants to debate this and have two bites of the cherry over an hour and a half and two hours before reintroducing an amendment on Report Stage. I am putting the question.

Senator Rónán Mullen

On a point of order, is the Cathaoirleach permitted to put the question whether I press it or not?

An Cathaoirleach

Yes. Anybody may put the question.

Senator Rónán Mullen

I defer to the Cathaoirleach. All I can say is I want people to have an opportunity to consider what was said tonight. People are tired. Many people and more than just the usual suspects spoke in favour of this amendment. There will be an amendment on Report Stage.

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The Committee divided: Tá [Yea] 9; Níl [Nay] 55;   Amendment declared lost.

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