Following the sad and unnecessary passing of Savita Halappanavar, Mick along with a number of other Deputies raised their concerns over the lack of action by six consecutive Governments to legislate for the X case findings. Under a topical issue debate Mick pointed out that if the Government took action when the Medical Treatment Bill was put forward in April, Savita would have lived. You can watch the full debate here.
Acting Chairman (Deputy Michael McCarthy): Deputies Patrick Nulty, Mick Wallace, Clary Daly, Joan Collins, Richard Boyd Barrett, Joe Higgins and Catherine Murphy have 14 minutes in total to make an initial statement, and the Minister has four minutes to reply. Deputies have two minutes each and I will call them in that order. The first speak is Deputy Patrick Nulty.Deputy Patrick Nulty: I express my condolences to the family concerned on the passing of Savita Halappanavar. My comments do not relate to any specific case but to the need to legislate for the X case. The fact that 20 years after a Supreme Court ruling the Oireachtas has absolutely failed to vindicate the rights of citizens, or ensure that where there is a real and substantial threat to the life of a mother a pregnancy can be terminated, is a damning indictment of this country and of the legislators who have served in successive Dáil terms since then. It is simply unacceptable for us to allow that situation to continue on our watch. I understand the report of the working group was on the desk of the Minister for Health last night, according to the Taoiseach. Has the Minister read the report? Previously in the House the Minister has stated that he would act. Will the Minister give a commitment now to the people, especially to Irish women who are looking on with shock and disdain for the Oireachtas because of our failure to legislate on this crucial public health issue? Will the Minister bring forward the necessary legislation to provide for the protection for women throughout the duration of their pregnancy? Will he ensure that where their lives are at risk all procedures will be available in our hospitals including, where necessary, a termination to protect the life of the mother? The Minister will be judged on how he acts on this issue and on whether he fails to deal with it or whether he has the courage to act on it. The thousands of people who have contacted us and who are in shock because of this issue want answers and an explanation about how this has been allowed to go on. Deputy Mick Wallace: Savita Halappanavar would most likely still be alive if she had chosen any 44 of 47 European countries. Sadly for her and all those belonging to her she chose Ireland. We have just held a referendum on the rights of children. It was passed and now we will proceed to legislate for it, rightly so. There have been two referendums on the Supreme Court judgment of 1992 which ruled that abortion was legal in Ireland where a woman's life was at risk, including where there was a threat of suicide, but we have not yet legislated for it. Six Governments have failed to legislate despite the people having spoken on two occasions. Why is this? When I challenged the Minister for Health in the Dáil in November last year about the Government's failure to prioritise the issue, he replied that the Government has many priorities. Clearly, this is not at the top of the list. When asked about abortion in an interview with Time magazine in September the Taoiseach stated that he thought the issue was not a priority for the Government at the time. The failure to pass the Bill, which we introduced last April, to legislate for the X case is damning. Would Savita Halappanavar be alive today if we had done so? The people expect us to legislate in their best interests. Did we fail to do so? Did a majority of Deputies here on that night last April believe it was right to vote "Yes" to legislate for something six Governments had failed to do? Instead, they decided to play politics with us, set up yet another group to examine the matter and in the process the Government become the seventh to kick the can down the road. Many people must dearly wish that vote result had been different. In recent days Ms Halappanavar's husband said that if this had happened in the United Kingdom or India the whole thing would have been over in a matter of hours. He also said that the matter was altogether in the hands of those in the hospital but that they simply let her go. How could they let a young woman go to save a baby who would die anyway? Savita Halappanavar could have had many babies. It is difficult to understand how this could happen in the 21st century. Deputy Clare Daly: When myself and Deputies Wallace and Joan Collins moved our Bill earlier this year, supported by the United Left Alliance, Savita Halappanavar was not even pregnant, now she is dead. The situation that we warned about at that time, and hoped would never happen, has happened. I am boiling mad that this has occurred in this country. It would appear that this beautiful young woman is dead as a result only of political cowardice. The failure of successive Governments, including this Government, to provide for a woman's constitutional right to an abortion where her life is in danger is absolutely outrageous. Today we have been inundated by the world's media about this situation and by citizens of every age, gender and class. They have asked how this could happen in modern-day Ireland. When we moved the Bill in April we were informed that it would not happen, that our Bill was unnecessary and that a woman's life was always protected in Ireland. The people who said that were wrong. The people who asked us to wait for the expert group to produce its report in July - I understand the Minister of Health received it last night - were wrong too. Death and loss are always tragic but when a death occurs for no reason it is truly and utterly heartbreaking and it enters the realm of being a crime. The Taoiseach told us this morning that Savita Halappanavar could not be brought back and that nothing we could do would undo that fact and that is clearly true. However, we can provide her family with answers and give citizens in this country an assurance that it will never happen to any other woman again. We can only do this if we act now. Will the Minister assure us that there are no similar cases in existence? Will he instruct a full investigation of all maternity hospitals? I understand there were two deaths in the Coombe Women and Infants University Hospital recently. Will the Minister act now on secure independent review procedures for maternal deaths in our maternity hospitals? Will the Minister legislate now? Acting Chairman (Deputy Michael McCarthy): Thank you, Deputy. Your time is up. Deputy Clare Daly: He did not listen to us in April but I hope he listens to us now. Deputy Joan Collins:We must consider this from the point of view of Ms Savita Halappanavar's husband, Praveen. He has come out publicly because he does not want this to happen to any woman ever again. He does not want any other woman to endure the tragedy he has had to face in recent days. On 21 October Savita Halappanavar presented at the University Hospital Galway with back pain. She was informed that she was miscarrying and that it would be over in two and a half to three hours. On Monday morning, in severe pain, she asked for a termination of the pregnancy. She was refused and told it could not be done. When she was in more pain on Tuesday morning, she and her husband asked the same question and again she was refused and told it was not going to happen until the foetal heartbeat stopped. She became terribly sick on the Tuesday night, suffering from fever. When the foetal heartbeat was checked on Wednesday, it had stopped. The medical personnel removed the foetus from the womb, but in the next few days Savita became extremely ill, eventually dying of septicaemia. From the time her cervix was dilated, she was open to serious infection - it was similar to having an open head wound - and Savita was left without proper care and without immediate action. If our Bill had been accepted by the Government, we could have prevented this, as the doctors in that hospital would have been protected by legislation in assisting Savita. It is a damning indictment of six successive Governments that they have refused to take matters into their own hands and make a decision on it. It is a shame that we have allowed this to happen. The European Court of Human Rights has found that successive Governments have failed to vindicate the Constitution. We must hear the Minister's comments today on the following two matters. There should be an independent public investigation into this incident within a specific timeframe, and the Minister should allow time for our Bill to become through. He can propose amendments to it, but let us bring it into the Dáil immediately. Deputy Richard Boyd Barrett: It is truly incredible that it is 20 years since the terrible and tragic circumstances of the X case, which led to an enormous public outcry about the Supreme Court judgment and to referendums that concluded that abortion must be allowed where there is a threat to the life of the mother. Twenty years on, after nothing but political cowardice and dithering, we have been led to a situation in which tragic and terrible circumstances have caught up with us and forced us to recognise the abysmal failure and political cowardice of successive Governments. The late Ms Savita Halappanavar, a 31-year-old woman, was the victim of that political failure and cowardice. A woman in agony, begging for a termination of her pregnancy in order that she could be treated and possibly have her life saved, was denied such a procedure, according to the reports, because of the law that successive Governments have refused to change despite the will of the people and despite the terrible circumstances of the X case 20 years ago. This is a tragedy resulting from political failure and cowardice. Will the Minister do something about this to ensure that it never happens again, that there is justice for the late Ms Halappanavar's family and that there is an investigation that will establish how this awful tragedy could have happened? Deputy Joe Higgins: The tragic death of Ms Savita Halappanavar at Galway University Hospital followed the denial of a medical termination of an unviable pregnancy. According to her husband, when Ms Halappanavar requested a termination she was refused and allegedly told, "This is a Catholic country." Medical commentary today suggests a termination in Ireland under these circumstances would normally happen. This raises the following questions. Is there, in University Hospital Galway, a so-called ethos of opposition in principle to abortion to save a woman's life? Are there other hospitals that demand a young woman's life to be criminally sacrificed for a Catholic so-called ethos? If so, the Minister should name these hospitals. This is a monstrous, medieval, obscurantist imposition on the Ireland of the 21st century. We must have a directive forthwith from the HSE to all hospitals that necessary termination of pregnancies is provided for in any eventuality in which a woman's life is in danger. Will the Minister insist that such a HSE directive issues immediately? The Taoiseach's response this morning to the tragic death of Ms Halappanavar was pathetically deficient. Like a scared rabbit caught in headlights, he counselled that there should be no rush to make a judgment on legislation for the X case. Would somebody tell this out-of-touch Taoiseach that it is 20 years since legislation was demanded? I support the introduction of legislation on the X case judgment, but I must say as well that counterposing the health and life of a woman against those of her unborn child is unacceptable. The health and life of women are paramount. Therefore, we need to provide free, safe and legal abortion facilities, to avail of which is the choice of the women concerned. Lastly, people power - the power of women and men united - must be brought to bear immediately on this laggardly Government. That is why everybody should support the Garden of Remembrance demonstration on Saturday in Dublin at 4 p.m., to ensure there is no further delay. Deputy Catherine Murphy: It is appalling even to consider that a tragedy like this was allowed to happen. There can be no argument with the assertion by the late Ms Halappanavar's husband, Praveen, that what happened to her cannot be allowed to happen in this country again. Earlier this year, I supported the Bill introduced by Deputy Clare Daly that might have prevented this tragedy from occurring, but unfortunately that Bill was defeated by the Government. While action is now too late for Savita and her family, it is not too late to protect other women from this horrific experience. The equal right to life for the mother and the unborn child must be acknowledged, and for that to happen we must take action immediately. The Offences Against the Person Act 1861 is the law that governs this area. It imposes a penalty of penal servitude for life on a woman who procures an abortion, and provides that a medical practitioner who provides an abortion is guilty of a misdemeanour. There would of course be potential professional sanctions, up to and including being struck off. We are putting the patient and the practitioner in an impossible position by acknowledging the equal right to life but completely failing to create a mechanism to determine how that right can be vindicated. The European Court of Human Rights has categorically concluded that it cannot be left in the hands of the individual medical practitioner, guided by only Supreme Court judgments, to determine what does and does not constitute a real and substantial risk to the life, as distinct from the health, of the mother. I emphasise "as distinct from the health", as the difficulty lies with where one draws that line. We cannot even seek best international practice on this because it is widely acknowledged throughout the world that it is an extraordinarily difficult distinction to make. Nothing can bring this beautiful young woman back to her family, but what we can do is to ensure no other woman suffers the same fate. Minister for Health (Deputy James Reilly): I extend my sympathy to the family of Ms Savita Halappanavar on their loss. My aim and the role of my Department is to improve the health and well-being of all people in Ireland in a manner that promotes better health for everyone, fair access, responsive and appropriate care delivery and high performance. In particular, our focus is on ensuring the provision of a safe, quality-assured, patient-centred and efficient health service. Nationally, we are focused on ensuring patient safety, quality and excellence in dthe health care system. It is important, therefore, that we have systems in place to minimise the risk of occurrence of such incidents and to detect and respond appropriately to them when they do occur. Deputy Mick Wallace has made a serious allegation before the full facts are known when he stated that this tragedy would have been avoided if treatment had been given elsewhere. Deputy Clare Daly is prejudging the outcome of the coroner's report, which will be an independent report. Important developments in recent years in the area of health and safety include the establishment of the directorate of quality and patient safety, the enhancement of clinical governance and the ongoing development of clinical care programmes in the HSE. Important contributions to patient safety have been made through HIQA's reports and the Safer Better Healthcare Standards, published in June this year, will also enhance patient safety. I am as concerned as others about recent maternal deaths. The death of Savita Halappanavar in UCHG on 28 October 2012, as reported widely in the media today, is a cause of great concern and was notified to my Department by the HSE. The incident was escalated directly from the hospital for the attention of the HSE's national incident management team, NIMT, on 1 November, in accordance with its risk and incident escalation procedure, which outlines the steps that must be taken by managers to escalate risks and incidents, as appropriate, that occur within their own service. This procedure is to be used in circumstances where a national or integrated response is required. The two investigations referred to earlier are currently underway. In addition, a coroner's inquest will take place into the matter. The HSE investigations are being undertaken to establish the facts in this case and to identify the factors that contributed to this tragic death. The outcome of the investigation reports must be awaited before commenting further. In accordance with HSE policy, the investigation teams will work closely with family members at all times and keep them fully informed of the terms of reference of the investigation. As Deputies may be aware, the current legal position on abortion in Ireland, set out in Article 40.3.3o of the Irish Constitution and interpreted by the Supreme Court in 1992, provides that it is lawful to terminate a pregnancy in Ireland if it is established, as a matter of probability, that there is a real and substantial risk to the life, as distinct from the health, of the mother, which can be avoided only by a termination of the pregnancy. In addition, the current Medical Council's Guide to Professional Conduct and Ethics for Registered Medical Practitioners, 2009, sets out the position on abortion as follows: '21.1. Abortion is illegal in Ireland except where there is a real and substantial risk to the life (as distinct from the health) of the mother. Under current legal precedent, this exception includes where there is a clear and substantial risk to the life of the mother arising from a threat of suicide. You should undertake a full assessment of any such risk in light of the clinical research on this issue. 21.2. It is lawful to provide information in Ireland about abortions abroad, subject to strict conditions. It is not lawful to encourage or advocate an abortion in individual cases. 21.3. You have a duty to provide care, support and follow-up services for women who have an abortion abroad. 21.4. In current obstetrical practice, rare complications can arise where therapeutic intervention (including termination of a pregnancy) is required at a stage when, due to extreme immaturity of the baby, there may be little or no hope of the baby surviving. In these exceptional circumstances, it may be necessary to intervene to terminate the pregnancy to protect the life of the mother, while making every effort to preserve the life of the baby. The Deputies are aware that, on foot of the judgment of the European Court of Human Rights in the A, B and C v. Ireland case and to fulfil a commitment included in the programme for Government, the Government established an expert group, drawing on appropriate medical and legal expertise, with a view to making recommendations on how this matter should be properly addressed. The deliberations of the expert group have concluded and its report was submitted to the Department late yesterday evening. I will consider the content and implications of the report before discussing them with my Cabinet colleagues. In this regard, I have asked my officials to examine the report and revert to me once that work has been completed. Deputy Patrick Nulty: I respect the views of everybody in this House. They are entitled to their views, but what they are not allowed to do is obstruct or undermine the constitutional rights of citizens in this country. Where, as the Minister stated in his reply, there is a risk to the life of the mother and where a termination is feasible, it should be allowed. In this country we have failed to legislate for 20 years. I have one question for the Minister, namely, will he, as Minister for Health, legislate for the X case - yes or no? Deputy Mick Wallace: The Minister quoted the Medical Council guidelines which are relevant but they do not protect doctors. The 1861 Offences Against the Person Act states that the maximum punishment is "penal servitude for life" in the case of a doctor making a call in such cases and he or she can be prosecuted. That law remains in place and there is no protection for a doctor who makes such a call. Legislation can do that and I plead with the Minister not to waste any more time in legislating for the X case. Deputy Clare Daly: The Minister's response is totally inadequate. It is the case that abortion is lawful in Ireland where a woman's life is in danger but this woman's life was in danger and now she is dead. Clearly, something is not right. Clearly, legislation is needed. It is not good enough to say we have to await the investigation. We know enough to know that we can stand over everything we have said. I must point out that we have a different system from that which operates in the UK, whereby we do not have a national independent review, systematically, of maternal deaths or automatic autopsies. The Minister must put in place such measures. He has not assured me that there are no other similar cases to the one we are discussing. What will the Minister do to provide that information to us? Will he assure the House that we will be able to discuss these issues next week when he has considered the report of the expert group? Will he tell us when he is going to introduce legislation? If he does not, we will re-introduce - with the amendments suggested by the Minister - the Bill we moved in April. Deputy Joan Collins: There is a lack of urgency on the part of the Government with regard to what has happened in recent days. The Minister did not respond to Deputy Clare Daly's question as to whether there have been similar cases of maternal death in recent times. I ask him to answer that question definitively - yes or no. We will resubmit our Bill in the near future if the Government does not move on this issue. The expert group set up after the ruling of the European Court of Human Rights was due to report last December. The deadline was then extended to the summer and then to the autumn. At this stage the report is almost 11 months overdue. We want that report in the public domain, that is, circulated among Cabinet members and then to all Deputies. We want to see the report and we want change. We want the necessary legislation introduced quickly. Deputy Richard Boyd Barrett: Given the terrible circumstances surrounding the death of Savita, the Minister's response is grossly inadequate and utterly fails to acknowledge his responsibility and the responsibility of the Government to act to ensure there could be no question of a woman's life being threatened because she could not receive the medical treatment she needed because of the current legal situation in this country. The Minister seems to imply there is no impediment in law to a woman receiving necessary treatment in these circumstances, but there is. At the very least, it is a grey area and we know that in this case, a woman begged, in agony, for treatment that could have saved her life but was denied it because the medical practitioner believed it could not be done within the law. The Minister must act and must take responsibility. Deputy Joe Higgins: Like the Taoiseach, the Minister's response to the tragic death of Savita Halappanavar is utterly inadequate. There is prima facie evidence which makes a powerful case that her life could have been saved with the termination of her unviable pregnancy. The Minister had a prepared script but now I ask him to answer the questions that are being put. Are there hospitals in this State whose ethos denies a termination to a woman in these circumstances, where her life is in danger? Is that the case? What action will the Minister take? Will he instruct the HSE to instruct each hospital, forthwith, to provide all medical procedures, including terminations, where a woman's life is in danger? When will the Minister publish the expert group's report? I ask him to give us a date, now that he has the report. When will he publish legislation providing for this? I again appeal to men and women, young and old, all over this country, to mobilise immediately to secure the necessary action from the Government. Deputy Catherine Murphy: The nightmare for this family is not in the past. The nightmare is only beginning. The have their loss and now they are facing into things like inquests and inquiries. The reality is that she was not even given a chance. This problem arises because we have no mechanism for vindicating the equal right to life of the mother. When will this legislation be brought forward in order that the decision will not be down to individual hospitals or practitioners? Deputy James Reilly: This is a difficult time for the family of Savita in light of the loss it has sustained. I recognise that Deputies wish to discuss broader issues and people have spoken about ministerial responsibility. This Government has many responsibilities, one of which is not to prejudge a situation. One of the Deputies opposite referred to the clinician concerned as "he". Is that Deputy sure the clinician was male? I make this point because while I am privy to certain facts I am not in a position to share them. This is why I ask for time to prepare an independent report which will outline the truth of what happened. Deputies have raised questions about a Catholic ethos inhibiting people from providing proper medical treatment as defined by the Medical Council. I have no evidence of this but I will not pre-empt what a coroner's court may find. I will await the conclusions of the independent investigation that a coroner always undertakes. I am the first to admit that in the past the independence of the HSE in investigating itself has raised questions. However, the new structures we have put in place, with an individual of the calibre of Dr. Philip Crowley being involved in the investigation, give me much greater confidence than I would have had in the past. I want to see a truly independent investigation which does not give rise to any question or perception of lack of independence. This is a terrible tragedy for Savita's family but it is also an emotionally traumatic time for the staff involved. Some of the comments made today would seek to deny them the due process to which these individuals are entitled. That is unfair. My concern is to put the patient first and above everything else. I cannot say one way or another whether there was hesitation because of moral or religious beliefs, although I doubt there was. If there was such hesitation, however, it would be an extremely serious matter. As a doctor, I am aware that in cases where a miscarriage is inevitable medical experts consider allowing it to occur naturally to be the safest option. There may, however, come a point where it is not the safest option and intervention must take place. That is a general comment and it does not relate to the specific case. I again express my deepest sympathy on behalf of the Government to the family of Savita.