Bernard Durkan (Kildare North, Fine Gael)
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I thank Deputy Gino Kenny and his colleagues for coming before the committee and giving us their views. I do not have any vested interest one way or another. Deputy Boyd Barrett mentioned pain, which is the crucial and most significant element in this debate. Having had a condition that involved a lot of pain and having been referred to pain management in the past, I can speak with some experience. One of the things I discovered was that management of the pain does not necessarily treat the cause of the pain. My question follows from that. To what extent did the witnesses's research go into the cause of the various forms of pain and the treatment of those conditions?

I am also talking about severe pain - the kind that involves contraction of the muscles, the clenching and breaking of teeth and a series of frightening degenerative effects. People have different pain thresholds so when a person with a high pain threshold reaches to that stage, it is getting serious and they will do virtually anything to alleviate the pain, including beating their head off a wall. I looked at all the options and discovered a person who told me that treating the condition that caused the pain was the most important thing and that individual was right. That is only my personal experience. I am fully aware that it does not apply to everybody. I put that out there as a particular experience and would be very conscious of people with conditions that involve severe pain as a result of those conditions, be they children or adults. It is an appalling situation to be in and something we need to spend far more time dealing with in order to get to grips with it. I am not in any way dismissing the rest of the argument. I emphasise that point and I want to know as much about the research into that area as possible.

The HPRA has advised against what is proposed, with the exception of a limited number of conditions. The only exceptions are where the consultant and the GP are involved and approve, on prescription, with full authority. The reason for that is simple. If we do not do that, a serious problem exists and there is a liability. Who accepts liability? If one or other of those people is removed from the chain of command, and we say it is not going to work in every case, who will accept responsibility in the event of there being a serious liability and from where will the insurance to cover that liability come? Will the liability be so serious as to deter the provision of insurance cover and could it proceed without cover? I am talking about matters relating to the State as well.

The general idea would be to protect the patient as much as possible. Is that accepted in so far as the witnesses are concerned? Is it agreed that the patient's interests, not ancillary issues or advice, are the most important considerations? Will the lifting of the ban, for want of a better description, protect the doctor or consultant? Do the witnesses envisage changes that will protect the doctor, consultant or whichever person prescribes?

Could the patient have grounds to ignore the advice of the consultant? That is a serious question. Could evidence the witnesses might put forward be of such a nature that the patient or the patient's relatives feel it necessary, advisable or possible to ignore the advice of the conventional medical consultants and, as a result, bypass the GP and consultant and operate on the basis of a licence? To what extent will that licence protect the patient, those prescribing or providing the drug or both, as well as the State, in the event of there being a claim?

In respect of insurance cover and in the event of a conflict, we have the HPRA on one hand and the removal of the ban on a particular product on the other. Who protects the patient, society and the State in the event of a conflict? The witnesses say that this is no worse than any other drug, that the procedure is no worse than any other and that it is hugely helpful in respect of particular conditions. We know that and the HPRA has said it as well, but it has also specified instances where it should not be utilised under any circumstances. It has also drawn attention to the limited access in other countries in Europe and the rest of the world. I know the witnesses will tell me that this has been very effective in the US. I am going through a hiatus in respect of the US. I do not think it necessary to follow all the experience the US has had in recent times.

Am I correct in stating that cannabis-based products are already available and in use? I think there are two.