Ciarán Cannon (Progressive Democrats)

I welcome the Minister of State, Deputy John Moloney, to the Chamber, congratulate him on his appointment and wish him well in his role. It is unfortunate that several other Members were not here to listen to his contribution. He spoke with an in-depth knowledge of the challenges that lay ahead for him, and with a passion to resolve those challenges quickly and effectively.

I congratulate my Green Party colleagues on bringing forward this amendment to the Mental Health Act 2001. This Act already includes a range of safeguards to ensure the rights of people who are admitted involuntarily for care and treatment are protected and that Irish law conforms to the European Convention on Human Rights. The amendments proposed this evening set out to further safeguard those rights and to ensure that very invasive treatment procedures are not administered without a patient's consent. The amendments are most definitely inspired by a desire to protect people with mental health difficulties and they offer us an opportunity to discuss a number of important issues in this Chamber.

I agree with the thrust of these Green Party amendments and what they set out to achieve. It is important also to state how this treatment emerged and to set out its history. The concept of having electricity pass through one's brain is daunting enough to frighten even the most well-informed and well educated people. It is broadly accepted that the apparent effectiveness of ECT results from the long-term brain damage it causes.

In 1941, Dr Walter Freeman, the psychiatrist who introduced ECT to America, wrote:

The greater the damage, the more likely the remission of psychotic symptoms ... Maybe it will be shown that a mentally ill patient can think more clearly and more constructively with less brain in operation.

In 1942, another US psychiatrist and proponent of ECT, Dr. Stainbrook, wrote:

It may be true that these people have ... more intelligence than they can handle and that the reduction in intelligence is an important factor in the curative process.

He went on to say:

Some of the best cures one gets are in those individuals who one reduces almost to amentia [a term used to describe total imbecility.]

During the following 30 years, hundred of thousands of patients of all ages across the globe received electroshock treatments for every type of disorder, including depression, mania, schizophrenia and even homosexuality and truancy from school. By the end of the 1960s, ECT treatment had almost vanished from the psychiatric scene. However, it has undergone a makeover in the past 20 years and has regained a huge degree of respectability in some quarters. Many psychiatrists now consider it an efficient way to relieve severe depression or to break a manic cycle for the manic depressive. According to ECT advocates, it can restore a severely depressed or manic patient to health in half the time it takes medication to do so.

Critics of ECT argue it is primitive and outdated. They also believe that positive results are short-term and that patients who undergo ECT suffer cognitive problems, including significant memory loss and the ability to learn. They believe what looks like relief is really just the effect of a head trauma. What is incredible is that doctors still do not know for certain why ECT works to fight mental illnesses. This often makes the decision to have ECT even more difficult for a patient. The leading opponent of ECT, Dr. Peter Breggin, a psychiatrist and author, believes that the price is too high. He describes ECT as playing Russian roulette with your brain. He believes that the procedure is no more sophisticated than hitting someone over the head with a club.

It is obvious that there are very divergent opinions within the field of psychiatry, both from doctors and patients, on the effectiveness and the appropriateness of ECT. There is little information on the use of ECT in Ireland and research is badly needed. Most recent figures reveal that in 2003, 859 persons in the South had treatments and that 628 people in the North of Ireland had treatments. Among other problems, there is no information on gender breakdown, age distribution, the number of people to whom ECT was forcibly applied, and, most importantly, the number of fatalities.

The amendments proposed this evening to the Mental Health Act 2001 do not purport to settle the argument but instead set out to allow the patient the right to decide whether or not to avail of the therapy. In particular, the concept of informed consent is introduced in this new legislation. Under the "informed consent" protocol, permission to administer ECT comes following a careful review of the treatment with the person providing consent. The psychiatrist explains what ECT involves, what other treatments might be available and the benefits and risks of treatment. The person consenting to the procedure is kept informed of progress and may withdraw consent at any time. A psychiatrist may not force a patient to have ECT or decide for the patient that it is the appropriate treatment. He or she must obtain written consent from the patient, or if the patient is too ill to make decisions for himself or herself, from a court-appointed guardian.

At a time when there is such divergence of opinion on the effectiveness of ECT, even within the field of psychiatry here in Ireland, it is most appropriate to begin a discussion of the issue of informed consent in Seanad Éireann. The amendment proposed in the Private Members' Bill would remove the provision whereby ECT may be administered to an involuntary patient who is "unable or unwilling" to consent, if two consultant psychiatrists certify that it is required. Impairment of a person's judgment may be a factor in severe mental illness. It is reasonable to expect that at some point in the patient's history he or she would have had the mental capacity to decide whether to subject himself or herself to ECT. I believe that patients should at that time be allowed to avail of the opportunity to make an informed decision on whether they would ever avail of ECT and that that decision should be fully respected by their doctors.

Again, in a situation where this cannot take place, the informed consent of a court appointed guardian should be sought. In the USA, for example, the Surgeon General's report on mental health requires a judicial proceeding at which patients may be represented by legal counsel prior to initiation of involuntary ECT. It states:

As a rule, the law requires that such petitions are granted only where the prompt institution of ECT is regarded as potentially lifesaving, as in the case of a person in grave danger because of lack of food or fluid intake caused by catatonia.

What is paramount here is the inalienable right of a person or his or her guardian to decide whether to subject that person to a procedure that is invasive, traumatic and bereft of utterly conclusive research as to its benefits or otherwise.

Despite my lack of expertise in this area, my instinct in regard to ECT is that given the inconclusive research in terms of its benefits and having read about and listened to the negative experiences of those who have had this treatment administered, I believe we should seriously consider following some of our European neighbours and severely restrict its use or, following in-depth research and discussion at committee level, as suggested by Senator Fitzgerald, consider banning its use completely as has been done in Slovenia.