Clare Daly (Dublin North, Socialist Party) | Oireachtas source

I welcome the Bill and I am glad it will provide assistance - to a certain extent - to those who need it in terms of exercising their decision-making capacity. I am also glad that we are ratifying the Convention on the International Protection of Adults. I am sure we would all welcome the inclusion of the UN Convention on the Human Rights of Persons with Disabilities in the legislation, if that were possible.

I wish to deal with a couple of issues. A number of people have been in contact with me - I am sure the position is the same for other Deputies - about the legislation. Some of them raised concerns in respect of the power of attorney provision and the fact that the rights of the individual may be undermined. In fact, the legislation is actually designed to enhance the rights of individuals. How we will achieve a balance in this regard on Committee Stage will be important. Some very good points were made by organisations such as Age Action in respect of the issues of restraint, detention and deprivation of liberty, particularly in the context of elderly citizens. Of course, if we all live long enough, we will become elderly too and we will require the protections that will be available under this legislation.

The Bill is a step in the right direction in the context of protecting people when they are at their most vulnerable. However, there is a need for balance. It is not just a question of legislating, we must also examine the position with regard to the provision of the relevant resources. The idea of appointing public guardians is good, provided the process in this regard will be open to scrutiny and accountability. We must be honest and state that transparency and accountability are not things which we in Ireland do well. As a result, the necessary safeguards must be implemented in a rigorous manner. I welcome the change in language incorporated in the Bill. It is good that we are moving away from stigmatising people, which was the case with the language used in previous legislation.

Our guiding principle must be that decision making is not a straightforward issue. Degrees of assistance may be required at different times and the Bill must allow for flexibility in this regard. We must strive to support people in their decision making at each stage in their lives. Mechanisms such as advanced health care directives are very good and eminently sensible. Everyone thinks that it is totally logical to make a will in order to decide what happens to our goods and property after we die. Deciding in advance what will happen to our bodies if our health deteriorates thereby leaving us in a position where we will not be able to make the necessary decisions is eminently sensible, as long as it truly reflects a people's actual decisions. The difficult issue is how to achieve a balance. In Britain, horrendous cases have been exposed whereby, in essence, patients were condemned to early deaths as a result of do-not-resuscitate orders being signed on their behalf but without their permission. Institutions in this country were shut down by the HSE as a result of a lack clarity in respect of the permission given in the context of such orders. There is a need to investigate this matter.

If we are serious about protecting vulnerable and elderly citizens, we must consider protecting them in the community and in their homes. In that regard, there is a discrepancy between some of the Bill's lofty aspirations and the cutbacks to home help provision, etc. There is a great deal of evidence which indicates that people's health and decision-making capacity can deteriorate when they are removed from their family homes and placed in care settings. People tend to do better in the family home so if we are to assist them in their decision making, we should begin by protecting them in their homes and facilitating them in remaining there for as long as possible.

Age Action has highlighted the disconnect between legislation and reality. This is an issue about which we must be extremely careful in the context of the Bill. Some existing legislation did not protect service users such as, for example, people in nursing homes. I refer here to the scandals relating to the Mulross and Leas Cross nursing homes. Many such nursing homes were found wanting. The HIQA report into Mulross nursing home cited persistent failings in respect of the Health Act 2007. The concerns of Age Action are, therefore, well founded. It could be stated that at least those who operated Mulross nursing home were found out and that the facility was closed down. However, there is a need for constant attention in respect of this matter.

One of the other issues I wish to highlight relates to restraints, etc. I was recently contacted by a constituent regarding the manner in which her elderly aunt was treated in a unit linked to the Mater Hospital. The woman in question is not mentally incapacitated and she was in possession of her full faculties at the time. However, she was placed in a locked ward and could not leave. In that instance her liberty was taken from her as a result of the fact that the control for the automatic door was located behind the nurses' station. She was obliged to ask permission to leave if she wanted to vacate the unit. Her family were of the view that this was demeaning to her dignity, that it limited her contact with them and that her liberty was curtailed. In essence, they were of the view that it was an environmental restraint. The woman made inquiries to the HSE about the matter and we did too. However, we did not receive a satisfactory response. We were informed that although a restraint-free policy is adhered to, as much as possible, at the Mater Hospital, the facility in question is not officially a nursing home and - although linked to the Mater - is not covered by that policy. Account must be taken of this issue. A restraint policy must cover all health care settings and not just care homes. The rules should also apply to persons residing in the community as well as to those residing in nursing homes.

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