James Reilly (Dublin North, Fine Gael)

I thank Deputy Liam Twomey for raising this important issue. All Deputies will acknowledge that there are serious deficiencies in this area which must be addressed. I also thank him for sharing his personal and professional experience with the House.

There is increasing recognition that advance health care directives can empower patients by giving them greater control over their treatment and care decisions. They are also regarded as an important instrument in fostering a patient centred health care model and strengthening partnerships between individuals and their health care providers. In this respect, I recently attended an informal meeting of European Ministers for Health in Denmark at which the issue of patient empowerment was the main focus of discussion. This morning I launched a new service by a public-private tri-partnership, if one likes, of the Mater Private, Charter Medical and Third Age, a voluntary group which is determined to ensure that as people grow older, they are allowed to continue to reach their full potential.

I propose to respond to some of the comments Deputies have made. Deputy Billy Kelleher who raised a number of issues is correct about the potential for the intent of the Bill to be misinterpreted. For this reason, we all have a duty to ensure we inform people about its true intent, that is, to empower patients or, in my view, citizens. It is not necessary to wait until one is ill to avail of an advanced health care directive and people should not do so because they can be revised at any time.

I take issue with the arguments made by Deputy Billy Kelleher. There will always be concern about people being placed under duress and stress. However, it should be borne in mind that the current legal position permits a will to be made with a single witness present. There are many people more likely to put somebody under pressure if or she has some property or other wealth to leave behind, so I do not think that argument can be carried in the same way as it was presented today. However, we need lots of time to discuss this. I know I have Deputy Twomey's agreement that we need time for a full debate to let everybody understand precisely what this Bill is about, because that is very important.

The Medical Council's ethical guidelines in 2009 state that doctors should take into account an advanced care directive made by a patient. Therefore, there is already a broad consensus among the medical profession that these instruments are useful as a guide to the patient's wishes. I agree with those who say - Deputy Daly alluded to it - that patients, as citizens, have a right to determine what they want. As a doctor, my belief has always been that we are there to advise, but it is up to the individual to take that advice or not. It is not up to us as professionals to impose our will and our values on the patient or the citizen.

Deputy Ó Caoláin claimed that the Minister of State, Deputy Lynch, opposed this. That is incorrect. She does not oppose it. The Department has been working on this for quite some time. Much work has been done and it was intended that this would be part of the mental capacity Bill. There will be serious difficulties with this Bill in its current format, and I know that Deputy Twomey accepts that. We will explore the possibility of making changes to rectify that on Committee Stage, but if it becomes impossible to do that for technical reasons, we will revert to our original intention, which is to put it in the mental capacity Bill. I commend the Deputy for bringing this Bill forward. It is an important and emotive point that touches all our lives. I agree with Deputy Kelleher that these are the things that the committee should be exploring in great detail.

Advance directives are not aimed at allowing people to request actions which are currently illegal in this country, such as euthanasia or assisted suicide. I would like to make that clear, because I was door stepped this morning coming out of that launch in Smithfield. I was asked whether this Bill was about assisted suicide. It is absolutely not about that. It is about allowing patients make decisions, when they have the mental capacity to do so, about what they want at the end of their day, such as whether or not they want to be resuscitated, whether or not they would like to be administered particular types of medication like chemotherapy. Thankfully, none of us knows what the future holds for any of us. I sat with a good friend of mine on Sunday morning and this afternoon I am going to his funeral. He was 55 and died of lung cancer, due to smoking. My views on tobacco are well known, so I will not go into that today.

Ireland currently has no specific legislation on advance health care directives. This has led to uncertainty about the legal status of people's health care preferences documented in advance health care directives, and whether or not they will be adhered to. It has become apparent that Ireland needs a legislative framework in this area. We are way behind many other jurisdictions and we need to catch up. Consequently, the area of advance health care decision making is one in which my Department has been actively engaged. We will offer all assistance possible to the Deputy, and I appreciate the support of others as well. This is an issue where we can put party politics aside.

I also agree with Deputy Ó Caoláin's comments on being afraid to talk about death. There has been a change in approach over the last few decades. There was a time in this country when TB was seen as a disgrace, and nobody would know that somebody in the family had it. That changed with the efforts of Dr. Noel Browne and the sanatoria and new drugs. Then the taboo issue became cancer. People did not want anyone to know that they had cancer, but now they are not afraid to talk about it because we know that it is not a death sentence and that we can often cure it. We also need to talk about death. I have always felt it is important that patients know the reality. I do not necessarily think that doctors should be giving them precise timelines, but they need to know the situation. As a GP, I could never live with the fact that I was not supposed to tell the patient he was gravely ill but the patient knew he was gravely ill anyway, the spouse knew but was not supposed to know because the patient was not supposed to know, and nobody discussed it. That is not to the good in my view. We need to prepare for death and we need to acknowledge it as an inherent part of life.

The purpose of the mental capacity Bill is to put in place a comprehensive framework to support persons lacking the mental capacity required to exercise their legal capacity in some or all respects. The Bill will reform the law in respect of adults who are vulnerable in the sense that they may lack some or all capacity to make important decisions for themselves. It will modernise the law on capacity, some of which dates back 200 years, and will bring Irish capacity legislation into line with current thinking and modern legislative frameworks worldwide. Given that advance directives are a tool for allowing individuals to make decisions regarding the kind of treatments they may or may not wish to receive in the future when they do not have capacity, the mental capacity Bill was considered to be an appropriate vehicle for providing a legislative framework for advance health care directives. Officials within my Department have been working closely with their counterparts in the Department of Justice and Equality in this regard.

I already mentioned the Minister of State, Deputy Lynch. She would be here today but she is at her daughter's wedding and I wish them all well.

Members will appreciate that the issues involved are complex. Detailed consideration of a number of topics, such as the role of the proxy decision makers, the definition of medical treatment, and how those with mental ill health can be accommodated, is required as part of any legislative solution in this area. Given that Deputy Twomey has now brought forward his Advance Healthcare Decisions Bill 2012, it is my intention to support it. Undoubtedly, all of the complex issues mentioned will have to be addressed as the Bill progresses. I look forward to a comprehensive discussion on Committee Stage. Should it become apparent that for legal and ethical reasons, the mental capacity Bill represents a more efficient and practical way of consolidating the law in this area, then this option may be pursued. I know that Deputy Twomey agrees with this.

I thank him for introducing this important Bill, which will undoubtedly touch the lives of many citizens and allow them to realise their health care preferences and values at a time when they may not be in a position to express those wishes. It will also be a helpful guide to the professionals who care for people in their time of distress towards the end.

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