Derek Keating (Dublin Mid West, Fine Gael)

I welcome the opportunity to comment on Deputy Twomey's Bill which, I understand, he produced 18 months ago. The Bill deals with patients' end of life care and with their medical treatment, wishes and management. It will allow people to deal with those issues before they lose the capacity to make known their views.

I have discussed this issue with a number of people, who work in hospices for example. They tell me the general practice at present is that an advance health directive, given through a proxy or next-of-kin who has had a conversation on the matter with the patient, is generally respected by doctors and families.

I am reluctant to mention assisted suicide or euthanasia. I had no intention of doing so this morning, but I feel compelled to do so following Deputy Kelleher's contribution. He said he did not see those issues as part of the Bill but that many other people would. Given the number of times he mentioned the issues in his contribution, there is now more likelihood that people will raise them. We can see the forces at work here. The Bill refers to health care. I will say no more than that, for now.

Deputy Twomey is concerned that Ireland is lagging behind and that patients may be unable to communicate their care decisions to care givers if their wishes are not formally recorded. The current practice is that people who are dependent, unwell, have life-limiting conditions or are terminally ill have available to them a care plan which their care suppliers work out in detail with them or with their next-of-kin or proxy. The Bill, however, is directly related to situations where a person has a life limiting condition or is terminally ill and is being kept alive indefinitely by life prolonging treatment because a medical practitioner has, without consultation, decided to do so.

I do not want this matter to become another marketplace for the legal profession, who may seek to capitalise on the Bill. In the past, the legal profession have benefited handsomely from new legislation. That must not happen in this case.

I welcome Deputy Twomey's efforts to progress this issue. We need to clarify the management of people's wishes. We also need to acknowledge that a person is making an informed decision and is not acting emotionally. Sufficient safeguards, checks and balances must be in place to ensure a person receives sufficient support in making such an important decision.

An article in the Irish Examiner of 5 October 2009 was headlined, "Doctors who ignore living wills are breaching patients' rights". The article went on to say that "doctors who ignore a living will by forcing a patient to receive life saving care against their wishes could potentially be taking part in medical assault, it has been claimed". It is worthwhile raising issues of extremes in this situation and how a patient's wishes will be communicated. The Bill deals with this in some depth.

The Minister for Health has one of the toughest jobs in the country. The Government intends to get on with the legislative process. We should get on with this Bill. We should allow for full consultation. A number of issues will arise during the debate on later stages. It would be helpful to establish a working committee of officials from the Departments of Health and Justice and Equality, because the legislation will have implications for both Departments. That process would provide an opportunity for joined-up thinking. I would welcome the Minister's view on this suggestion. I believe it would be helpful in progressing the Bill.

I support Deputy Twomey's efforts and I welcome the Bill. The Government will support it and I urge the Government to find ways to enact it. The joined-up thinking to which I have referred would be helpful.

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