Seanad debates

Wednesday, 23 March 2011

Mental Health (Involuntary Procedures) (Amendment) Bill 2008: Committee Stage (Resumed)

 

5:00 pm

Photo of Paul BradfordPaul Bradford (Fine Gael)

I welcome the Minister of State, Deputy Kathleen Lynch, to the House.

Certainly and perhaps fortunately, I am not an expert on this matter. I have listened with interest to my colleagues. This is a very difficult issue on which to make a firm adjudication. It is absolutely impossible for most laypersons to determine the appropriate route to travel in regard to these amendments.

When I first saw the amendments presented by Senators Bacik and Prendergast, I believed they struck a reasonable balance and would address the issue in a fair fashion. However, having read further correspondence from those lobbying for a fundamental change, and who are supportive of the Bill produced by Senator Boyle, I must ask the Minister of State to clarify the definitions of "unable" and "unwilling". I believed initially that deleting the word "unwilling" would solve most of the problem. Where does the word "unable" come into play? In what circumstances would medical personnel deem a patient unable to make an informed choice? From the layman's perspective, it seems easy to determine whether one is willing to accept treatment. A person who breaks his leg is either willing or unwilling to have a pin inserted, and a person with pneumonia is either willing or unwilling to receive certain types of medication. However, where people with mental or psychiatric difficulties are concerned, we must ask whether they are fit to determine whether they should avail of a certain treatment. Who declares whether one is willing or unwilling? If a patient refuses to accept ECT, can a consultant or other medical personnel state that patient is unable to make that decision?

From what Senator Harris and others have said, I understand there is a weighty body of evidence suggesting ECT may be very appropriate in certain circumstances and, most important, that it does work. I am certainly not in a position to dismiss that type of medical analysis. The other side of the argument points to damage done through the use of ECT. Medicine, be it general or psychiatric, has moved on tremendously in recent years. Although laypeople may have visions of a One Flew Over the Cuckoo's Nest approach to medicine and mental illness, I hope we have moved well beyond it.

In the Minister of State's response, to which I am sure we will be responding, will she try to draw a line in the sand regarding the definitions of "unable" and "unwilling"? This will allow me to think further about the amendments. The Bill represents our striving to find an appropriate solution, rather than an appropriate compromise. We are trying to produce the best possible legislation and the best possible treatment for people who suffer from mental illness. While drugs, counselling and therapy have improved dramatically, there could still be a requirement in some cases for ECT. We just need a proper framework for its provision. I am sorry for being so long-winded and for adding confusion to confusion. Will the Minister of State try to explain the core argument about the difference between "unwilling" and "unable"?

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