Billy Kelleher (Cork North Central, Fianna Fail)

I welcome the opportunity to speak on this issue. The Bill is very detailed and concise. However, the issue merits much broader debate than a debate in this House alone. It should deal with a change to ethics and how society views certain issues. We should think long and hard about this before we rush headlong towards passing the legislation. It is appropriate, however, that the legislation stimulates debate on the issue. Mr. Dermot Gleeson, the former Attorney General, commissioned a report in 2007 but it was never laid before the Oireachtas Committee on Health and Children. Perhaps that committee should discuss further the broader issues surrounding the Bill.

The Bill is detailed, and one could go through it line by line on Second Stage and highlight some of its inadequacies. Its proposer, Deputy Twomey, has already identified one or two inadequacies that were brought to his attention. There is no unanimity among the medical profession or in society with regard to the proposals in the Bill. It contains some fundamental flaws in that people could be put under duress, for example. I see no safeguards in the Bill to prevent family members or others acting on behalf of a patient who may be fully capable mentally but vulnerable in other respects from exerting pressure. However, this issue could be dealt with on Committee Stage if the Bill proceeds that far.

We need to address this issue. We talk about patient care and patient-centred focus. We all believe everybody has a right to his bodily integrity and should be able to make decisions for himself. There is another Bill before the Houses of the Oireachtas, the mental capacity Bill, that could have an impact on this Bill. How does it fit in with the Bill before us?

I welcome the opportunity to speak on this Bill and that its being brought before the House will stimulate debate. The practices to which the Bill alludes occur week in, week out at bedsides in hospitals throughout the country and in family homes. There is no family which at some stage will not be brought into a conference with its GP, consultant and terminally ill loved one to make decisions. Everybody must make decisions about a loved one at some stage in his or her life. One must ask whether the legislation is necessary at all in view of its potential to be too prescriptive.

There is a need for consensus and to have informed, detailed discussions. We should obtain the report by the former Attorney General, Mr. Gleeson, and submit it to the Oireachtas Committee on Health and Children as a basis for discussion on this issue. Some will have very strong views on the Bill. Deputy Twomey stated some of the medical professionals and representative groups have already discussed this issue at various conferences and have set up sub-committees and established ethics committees to consider it. There is no broad consensus.

The legislation leads to the question of compromising medical professionals in carrying out their duties. Deputy Twomey stated quite correctly that an advance health care decision document or living will, if signed, should have the same legal standing as any other legal document. However, this raises the question of the ability of medical professionals - Deputy Twomey is one - to make decisions in the interest of a patient. This matter requires broad discussion to achieve consensus and inform society.

I agree with Deputy Twomey in that I do not accept the Bill is a first step to euthanasia or assisted suicide but there are thousands who believe it is. Where a fundamental issue of life and death is concerned, we should probably put the matter to an expert group. We always shove responsibility for hard decisions into some committee. That said, we should bring in various groups with contrary views, certain beliefs or strong convictions in this area to determine whether we can achieve consensus in society. If we are to tie the hands of the medical professionals in every way, it will compromise them. We have a duty to listen to what they have to say. Let us be quite clear: we put our lives in the hands of medical professionals day in, day out. As matters stand, we sit around bedsides with our loved ones and talk to our general practitioner and consultants and then make decisions about life and death. This happens continually. Deputy Twomey, however, is proposing that an individual of sound mind and with full capacity could decide the types of treatments he or she should not receive in the event of acquiring a certain illness or debilitating disease. A person of sound mind may make a judgment today to the effect that he does not want a certain type of treatment in the event of something happening to him, but medical treatment and technology could advance to the point where the illness could be cured. Surgery that was massively invasive some years ago is no longer invasive and conditions can be treated in other ways.

Rather than being divisive, I am trying to be constructive. We should bring in all groups concerned and have a broad discussion reflecting broader society. In many people's minds, not mine, this is an issue that is moving beyond what is considered the normal medical practice of allowing the family, patient, medical team, general practitioner and anyone else concerned to discuss the pertinent issues when they arise, either in people's homes or at the bedside in hospital. I propose that, rather than being divisive, we park the Bill and submit the report of the former Attorney General, Mr. Dermot Gleeson, to the Committee on Health and Children to have a detailed, informed discussion on the merits, or otherwise, of the Bill and many aspects of end-of-life care or palliative care.

The Minister, Deputy Reilly, is a very strong advocate of patient-centred care. I fully support that, as does everybody. There are areas of vulnerability in the Bill in that patients and other individuals could be put under duress. There seem to be no safeguards whatsoever in the legislation in this regard. Family members could put an elderly person of sound mind under pressure to be prescriptive regarding the types of treatments he or she would allow in end-of-life circumstances.

The Bill is well crafted and goes to the heart of decisions that doctors and families make day in, day out. Therefore, rather than accepting or rejecting the Bill today after discussion, I propose we take a proactive approach thereto. We should allow the Committee on Health and Children to discuss the concept of the Bill and have informed, detailed discussions. We do so every day in Oireachtas committees in respect of many subjects that do not entail life and death. One might say the reason people might oppose this Bill or support it is they have stronger views on end-of-life care. Many Members on all sides of this House would expect and support the idea that a person has a fundamental right to the most intricate and expensive medicines, and to have the best technology available to him or her, right to the end to keep him or her alive. Equally, Members might say persons have a right to determine the types of treatments they will receive in the event of them finding themselves with a debilitating disease or a terminal illness. We probably all accept that, but there are difficulties in trying to get those two arguments and two sides to meet without conflict and division and without putting fear in the minds of some.

Rather than rehashing my views, I suggest we park this Bill as is and make a commitment in the House to bring forward the report to which I have referred, have detailed discussions on it, and use it as a basis to try to bring about a consensus and a really informed debate. If we are being honest, there are persons watching this debate who will believe this is a first step to assisted suicide and euthanasia. People will believe that. People believe many things when they are not informed. We must inform the public about this proposal, and the best way to do it is through constructive broad discussions where everybody can have his or her view represented. We would then have a final report and recommendations, and if the recommendations are broadly in support of this Bill, let that be the case.

There are the views of the Irish Council for Bioethics and there are other views. The Labour Relations Commission has made recommendations as well in the context of the need for legislative support in the area of advance health care decisions, living wills or testaments or whatever one wants to call them. The bottom line is the commission asks some fundamental questions as to what medical professionals can do in terms of assisting a patient to live longer and more comfortably and whether the patient always has the right to decline medical intervention in advance of he or she knowing what may be the outcome of such interventions.

Deputy Twomey has strong views on this. This legislation was presented previously but ran out of time and had to be resubmitted. There are many, not only Members of this House but in broader society, and members of the Deputy's profession, who have strong contrary views, and rather than being divisive on it, we should bring about some sort of informed discussions and bring society with us on whatever road we are thinking of travelling.

People will have major concerns about this. Vulnerable persons, quite rightly, will have concerns about it as well. If one looks through the detail of the Bill, and this is an issue we could probably discuss on Second Stage because it goes to the heart of the Bill, there is no provision, because it requires one or two witnesses, to deal with a situation where families or the guardians of an individual could bring pressure to bear on such persons to make signed advance health care decisions recommending no intervention in certain cases which could bring about a shorter life expectancy or a quicker death by natural means. This is a matter about which many would have concerns.

I propose we would not move this Bill on to Committee and instead have an informed discussion on the matter on the basis of the Gleeson report which we would present to the committee. It would be discussed and in the event of the committee coming to the same conclusions as are in this Bill, we could discuss it at a later stage or indeed whatever legislation would be recommended by the committee.

We should not be divisive. I do not want to fan flames of concern that exist. I do not agree this is a first step to assisted suicide or euthanasia, but there are many who believe it is. We should not instil fear unnecessarily. Every day of the week decisions are made in consultation with patients which I do not want to discuss and which we all have had. Every family will have them at some stage in their lives. It will be either about oneself or about one's loved ones, but at some stage we all will have these discussions as to whether invasive surgery is required in terms of the treatment of cancer or the person being allowed, without any more invasive surgery, to avail of palliative care and end life naturally. These matters are discussed continually.

On the necessity for this legislation, one could argue whether it complicates matters and makes front-line decisions difficult for medical professionals. Such persons make life and death decisions daily and we are potentially tying their hands. With the advances in technology as well, persons could be making decisions today about treatments which may be more advanced in a number of years to the point where they could have an impact on quality of life.

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