Liam Twomey (Wexford, Fine Gael)

I move: "That the Bill be now read a Second Time."

I thank Members for coming to the House this morning and in advance for the contributions they will make to the debate on the Bill. I also thank a classmate of mine, Dr. Simon Mills, who is also a senior counsel, for the great help he has given to me and party colleagues in drawing up this legislation, as well as Dr. Siobhán O'Sullivan from the Department of Health who has been working on advance health care directives in the Department. I was unaware of her work on this issue. The fact that so much work is being done behind the scenes by so many committed people may help this legislation to see the light of day. Organisations outside the Oireachtas such as the Irish Hospice Foundation, Amnesty International and a host of committed organisations in the mental health and elderly advocacy field have helped us to focus on what needs to be done for patients in the health care system. I appreciate their support in drawing up this legislation.

When my father was diagnosed with advanced bowel cancer in 2005, he decided he would undergo limited surgery. He did not want to undergo the radical surgery proposed by his consultant and decided instead to avail of palliative chemotherapy, a less stressful form than the radical chemotherapy many patients undergo. He also decided not to avail of radiotherapy. If he was suffering from Alzheimer's disease or dementia at the time, as a family, we might have disagreed on what was best for him. The doctors treating him might also have disagreed with him on what was the best course of treatment for him. That is what this issue is all about - keeping the wishes of the patient at the centre of the decision-making process in the health care system.

An advance health care decision is nothing more than what any of us could make if diagnosed with a significant illness. We would decide what treatments we would like or would not like to receive. That is all what an advance health care decision plan would allow one to do. It would allow a person to keep control when he or she no longer had the necessary capacity.

I want to make something clear. This is not about euthanasia, the deliberate taking of somebody's life when he or she decides life no longer has a value, nor is it about assisted suicide or refusing life saving treatments such as blood transfusions. This is about having the power to decide what treatments one would like to receive in the event that one receives a serious life limiting diagnosis at a time when one does not have the capacity to decide on the treatment options available.

It may sound straightforward, but there are complexities involved in this issue. The biggest question is what is capacity. Who can or cannot make these decisions? The heads of a Bill on this issue will be published by the Department of Justice and Equality in the coming weeks.

There are flaws in the Bill I have presented. I am not precious about it and would like the Chamber to decide on the best legislative route for patients. Some of the weaknesses have been identified for me in the discussions I have had with people inside and outside the House. I have been told the Bill is too prescriptive in terms of basic medical care needs. I agree. We should say basic medical care needs should be provided for at all times. This issue can be decided at a later stage. We do not need to be too prescriptive in the legislation in that regard.

I have provided that a doctor should read through an advance health care decision made on behalf of a patient. That comes from my background as a doctor in that I have been asked to read through patients' living wills. However, someone asked me why a doctor, no more than a solicitor, should read through it. This is a decision for the patient to make on what treatment he or she wants to receive. If he or she has the capacity to make the decision now, I do not see why I, as a doctor, should interfere in that decision-making process or why he or she should need to obtain a solicitor's or a legal opinion on it. This is about empowering patients to make decisions for themselves. That is the ethos to which we are moving towards in the health service. We are moving towards putting the patient at the centre of the service and that is the thinking behind this provision.

Another weakness identified is that the legal standing of an advance health care decision is not strong enough in the legislation. It is important that we give it the strongest legal standing possible. I have been asked to amend section 8 to make it clear that there can be no opt-out clause for doctors to say they will not accept an advance health care decision for whatever reason. If this provision is to mean anything, it must have the same legal standing as any other document. Therefore, there should be no opt-out clause for any of those treating a patient. An advance health care decision should be treated as a legal document and one should only be able to opt out if there was a serious flaw in it.

Decision-making in the health service should be patient centred. There should be no waffle and we should not pay lip service to the notion that the health service should be patient centred. It has been pointed out to me that there is a provision which has been left out of the legislation. We must create a role for proxy health care decision-makers, whereby one could assign somebody to stand over an advance health care decision. The person concerned would not have to be a doctor or one's solicitor; he or she could be a family member or a trusted friend who would understand what one wanted in the event that one could not make the decision. If this legislation proceeds to Committee Stage, it is important that such a provision be included in it.

The Minister for Health and the vast majority of Members of the House support the sentiments expressed in the legislation and believe we must give patients as much power as possible in the health care system. However, this could be tricky. The Minister and I are members of the medical profession and I know there will be significant resistance from the medical profession in the same way as there is always resistance in changing the status quo. This is very useful legislation and will be very important in helping people to make decisions about how they plan their health care. The legislation is simply about empowering patients to become involved in decisions on their health care needs, both now and in the future when they may not have the capacity to make a decision. I ask for the Members' support for the legislation.

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