Clare Daly (Dublin North, Socialist Party)

I will be brief since Deputy Ó Caoláin robbed some of the points I had intended to make in respect of raising the issue of Amnesty International's concerns on mental health aspects of the Bill. I welcome the fact that Deputy Twomey has tabled this legislation. I will strongly support it on Second Stage. It is important that we articulate these issues and begin to discuss them as a society. In that context, this is a welcome Bill which will provide for the polar opposite scenario of that outlined by the Fianna Fáil Party spokesperson. It is disingenuous to suggest this legislation will result in elderly and sick people being frogmarched into signing declarations against their will. Such a scenario is completely contrary to what it is designed to achieve. One cannot achieve consensus on an issue that is about recognising an individual's right to choose and supporting his or her decisions, whatever they may be and regardless of whether one agrees with them. This is a human rights issue related to the right of individuals to dictate what happens to their bodies and lives on condition that their wishes are not detrimental to society as a whole. It is not an issue on which consensus must be achieved. The purpose of the Bill is not to force people to make the decision one wants them to make but to ensure respect for the decisions people make for themselves. I am glad Deputy Liam Twomey has introduced legislation to provide for this welcome outcome.

The weight of legal opinion recognises the right of a competent person to decide on the nature of his or her medical treatment and refuse such treatment to facilitate a natural death. The Bill provides that a person may provide clarity on this issue by making an advance determination of his or her wishes and have them respected in the event that he or she loses capacity later in life. How could anyone disagree with that eminently sensible proposition which is respectful of the wishes of the individual? This is the direction in which society is moving. The legislation gives clarity to the concept of extending the power of attorney by allowing another person to make certain designated health care decisions on one's behalf. This is a welcome and necessary development.

The legislation works on two counts. First, it will assist those who wish to plan their medical treatment in advance, specifically future medical interventions that they may not want, for the purposes of avoiding an undignified death or enduring undesired circumstances. It gives clarity and provides that persons may make such a choice. Second, it will assist health care professionals whose position in this regard is somewhat unclear. This issue needs to be clarified and any decision made should be considered in the wider context of a person planning his or her entire health care provision in a broader context.

I recognise, as Deputy Liam Twomey has done, that the legislation does not address euthanasia or assisted suicide, which are entirely distinct issues. This is regrettable because many others and I would like them to be explored in a rational and comprehensive manner. We are at the start of a debate on these issues. There is a distinction to be made between the narrow focus of the Bill and euthanasia and assisted suicide. The literal meaning of euthanasia is "good death". Currently, it refers to the practice whereby a third party deliberately ends the life of a person with his or her consent. Assisted suicide refers to a person taking his or her life based on the advice or assistance of another party. We must explore these practices because both have a role to play. I respect people's decisions in these matters and while I accept that my view is not shared by everyone, it is an issue of recognising the rights of the individual.

The Bill provides for the introduction of advance care directives in which persons may indicate a refusal of treatment. It does not allow people to refuse basic care. While I am fully supportive of expanding resources and supports in the area of palliative care, in a small minority of cases - perhaps 5% - it is not possible to ease a person's pain and he or she is exposed to a severe, undignified and traumatic death agony. In such circumstances, I understand the reason a person may choose to end his or her life and die on his or her own terms at a time of his or her choosing. This issue must be explored.

An important shift is under way from a paternalistic approach to medicine and health care provision to greater patient autonomy and the full involvement of patients in decision making on their cases. Although the Netherlands was the first country to decriminalise and regulate voluntary euthanasia, surveys have shown that Irish attitudes to voluntary euthanasia are changing. For example, approximately 60% of final year medical students in at least one Irish university indicated they favoured euthanasia. If society does not address these issues, it leaves the door open for practices such as voluntary suicide and euthanasia to take place behind closed doors in an unregulated manner in which duress may come into play. We do not want this to occur.

The issues of euthanasia and assisted suicide may not come within the scope of the Bill, but this debate offers Deputies an opportunity to raise them. The enactment of the Bill will be a welcome step because it moves us one step along the road. It must also be considered in the context of broader reform of overall capacity legislation, including mental capacity legislation. As Deputy Caoimhghín Ó Caoláin noted, Amnesty International has expressed concerns about Ireland's capacity legislation. I do not propose to elaborate on the Deputy's contribution other than to note that last month's issue of Irish Medical News reported that the Department of Health had advised that the heads of the mental capacity Bill did not address the issue of advance care directives. The failure of the Bill to cover people with mental health difficulties must be rectified, either in broader capacity legislation or this legislation.

I welcome the Bill and again congratulate Deputy Liam Twomey on introducing it. I also welcome the opportunity to discuss this issue. All civilised societies should be able to rationally discuss and defend the rights of the individual, provided they are exercised in a manner that does not damage the public good. The legislation is a welcome step forward and I will support its passage to Committee Stage.

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