Fergus O'Dowd (Louth, Fine Gael) | Oireachtas source

Amendment No. 142 is particularly important. It deals with the question of outlawing chemical restraint. The amendment states:

Nothing in this Act shall be construed as authorising any person to administer to a relevant person any medication for the purpose of controlling or modifying the relevant person’s behaviour or to ensure that a relevant person is compliant and not capable of resistance when no medically identified condition is being treated; where the treatment is not necessary for the condition; or the intended effect of the medication is to sedate the relevant person for convenience or for disciplinary purposes ... Notwithstanding [the above], the appropriate use of drugs to reduce symptoms in the treatment of a medical condition does not constitute chemical restraint but the administration of such medication should be clearly documented on the relevant person’s file and the reasons for the administration of such medication specified.

Article 3 of the European Convention on Human Rights applies specifically to chemical restraint, and I will repeat it. It states: "No one shall be subjected to torture or to inhuman or degrading treatment." This right is an absolute right, with no exceptions, as distinct from the exceptions present in article 7. Chemical restraint is inhuman and degrading, and should be prohibited. Medication should only be used if there is a medical or therapeutic necessity and not for any other purpose. I understand the Law Society submits that this definition should be set out in the Bill.

I draw the attention of the Minister of State to the Department of Health policy document, Towards a Restraint Free Environment in Nursing. It states:

Chemical restraint is the intentional use of medication to control or modify a person's behaviour to ensure a person is compliant or not capable of resistance, where no medically identified condition is being treated; where the treatment is not necessary for that condition; or the intended effect of the drug is to sedate the person or for convenience or for disciplinary purposes.

I understand that when the Minister of State replied to Deputy Mac Lochlainn on an earlier amendment, she said she was prepared to introduce amendments.

I welcome what she has done and I support the legislation, and obviously as a Government Deputy I will vote for it, but this amendment is critical because it goes to the heart of abuse of elderly people particularly, and people with dementia or other medical conditions, who are unable to speak for themselves and who may display very challenging behaviour. The use of chemical restraints solely for the purposes of the convenience of the staff or other non-medical reasons should be outlawed by the legislation, where chemical restraint is used as a first resort, including where people with dementia are admitted to acute hospitals, and is not confined to situations where there must be a clear medical reason where medication must be required The distinction between the administration of medication for therapeutic reasons and the administration of medication simply to control behaviour must be clearly understood and provided for. I appreciate this is Report Stage and the Minister of State will bring the Bill through the Seanad.

I note the draft guide to professional conduct and ethics for registered medical practitioners at paragraph 18.2 provides, "If patients lack capacity to make a decision about treatment or examination, you may use appropriate physical or chemical restraint". I find this absolutely shocking and unacceptable. This applies to people who lack capacity, and it states a medical practitioner can use physical and chemical restraint. Chemical restraint is inhumane and degrading treatment and should never be used. The drafters of the guide to professional conduct and ethics for registered medical practitioners do not seem to understand the issue.

There is clear evidence, internationally, on the abuse of patients by using chemical restraint and behaviour-calming drugs and I direct the Minister of State to a recent article in the British Medical Journalby the University of Michigan medical school and Johns Hopkins University, which reviewed two decades worth of research to reach conclusions on antipsychotic and antidepressant drugs and on non-drug approaches which help care givers address behavioural issues in dementia cases.

I am aware of and acknowledge the interest and concerns of the Minister of State in this area. I urge her in her reply to give serious consideration to the amendment. I accept she may not be in a position to accept the amendment today, but I ask her to look at it again seriously for the Seanad. At the end of the day, it is about training staff and caregivers and recognising the fundamental human rights of people who can never speak for themselves because of the medical condition from which they suffer, because of advanced dementia or other medical problems. It is never acceptable that they would be drugged to facilitate understaffed nursing homes, which happens regularly. This goes to the very heart of the quality of care for people in institutions who cannot speak for themselves. Now is the time and this is the opportunity for us to fundamentally state the abuse of elderly people or citizens by using antipsychotic drugs for the sole purpose of facilitating staff, and there is understaffing in many of these institutions, is entirely and absolutely unacceptable and is an appalling abuse of the human rights of the people concerned.

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