Mark Ward (Dublin Mid West, Sinn Fein) | Oireachtas source

I want to speak about the speed at which the Bill has progressed through the House. It has been quite difficult for people to engage in the process. On Committee Stage we heard people felt they were excluded from the process, particularly people with disabilities who felt the speed of the process excluded them. Nobody wants the Bill delayed but we want to get it right. The 90-minute guillotine being imposed on us today is another example of a rushed process. When will the Bill go to the Seanad? Will it be in the next couple of weeks? Will it be in the autumn? I have heard that it will be in the autumn. The rationale for getting the Bill through so quickly was a judicial challenge. If it will be the autumn when it goes to the Seanad, what happens with regard to the judicial challenge in the meantime?

Amendment No. 2 seeks to allow people detained under the Mental Health Act to have their advanced healthcare directives adhered to in the same way as anyone else. The amendment relates to removing section 85(7) to allow advanced healthcare directives to be extended to those involuntarily detained under the Mental Health Act. People who have a long history of mental illness know better than anybody what treatment works best for them. They have the real lived experience. In layman's terms what the Bill means if passed unamended is that people who are involuntarily detained under the Mental Health Act will be discriminated against. If a person goes to the trouble of doing an advanced healthcare directive and is then subsequently detained under the Mental Health Act their wishes may not be adhered to. No other group in society is excluded in this way. Keeping this section is discriminatory towards those with mental health difficulties and does not allow parity of treatment for all Irish citizens.

Every citizen in the State must be afforded an equal right to exercise their will and preference. This must apply to mental as well as physical health. As I have said to the Minister previously, I am a member of the Oireachtas Subcommittee on Mental Health and Oireachtas Joint Committee on Children, Equality, Disability, Integration and Youth. We are going through a review of the Mental Health Act 2001 but it could be a couple of years before it is enacted. This will create a lacuna whereby people with mental health difficulties will be discriminated against under Irish law. The Mental Health Commission and the Decision Support Service support the extension of this right for people under the Mental Health Act. On average 2,500 people a year could be subjected to forced psychiatric treatment, the administration of forced medication or forced electroconvulsive therapy, ECT, without the protection of a legally binding advanced healthcare directive.

Amendment No. 36 relates to the inclusion of 16- and 17-year-olds. At present those aged 16 and 17 can consent to or refuse physical healthcare decisions but this right does not apply to mental healthcare decisions. Those aged 16 and 17 do not have any right to consent or refuse mental health treatment. I have tabled a Bill to address this, and that Bill is on Second Stage. This will be discussed and I hope it will be reviewed under the Mental Health Act but that is several years down the line. At present those aged 16 and 17 cannot refuse admission to hospital. Guardians can decide to admit them without their consent. Those aged 16 and 17 cannot refuse a particular course of therapy such as ECT. We need to make sure everybody is covered including those with mental health difficulties and those aged 16 and 17.

Amendment No. 34 removes language regarding the deleterious effect on the unborn and this is welcome. As Deputy Cairns said, I did not submit amendments because I accepted the Minister's bona fides that he would address this. I am concerned that the Minister is imposing in amendment No. 35 a specific requirement on directive makers to clarify whether they intend their advanced directive to apply during pregnancy.

We believe that in general, the directive makers would have a reasonable expectation that their wishes regarding medical treatment would continue to apply in the event of pregnancy, even if this is not specified within the directive. Such an amendment singles out pregnancy as a specific medical event different to all others, which is not warranted.

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