Liam Twomey (Fine Gael)

I ask the Minister of State to comment on the issues I will raise. I am probably the only Member of this House who has administered ECT. It is a truly barbaric procedure but so too is major surgery. We should consider the outcome of the treatment in asking whether it is necessary. I have witnessed the recovery of people who were incredibly depressed after they were treated with ECT but I was too inexperienced at the time to know whether they would have benefited from alternative treatments. We should discuss the Bill from the perspective of whether we are for or against ECT. I am not convinced that advanced directives would be as effective as some presume because nobody decides to embark on ECT before trying all the alternatives. Patients may not have the opportunity of considering advanced directives on ECT.

If we are not going to ban the treatment, we should examine the effectiveness of the protocols governing its application. Anecdotal evidence strongly suggests that ECT is being used inappropriately and too often. Perhaps we should restrict the treatment to a limited number of institutions and consultants. When I was a senior house officer, consultants directed me to go to a ward, with an anaesthetist, to carry out ECT treatment on a patient. That was maybe too loose a way to carry out the treatment. When the Minister of State responds he may need to examine within his Department the protocols and procedures for carrying out ECT, by limiting it to certain institutions and tightening up the way it is carried out, who is informed or who allows it to go ahead.

I do not know that advanced directives will work. Advanced directives for ECT should be the same as advanced directives for any form of treatment, for example, for someone involved in a car accident or who gets a serious illness and is left comatose. The advanced directives should kick in for anybody who no longer has the capacity to decide his or her own future. That could apply to dealing with someone who has Alzheimer's disease. None of us would decide to write an advanced directive on what should happen if we get Alzheimer's disease. We simply get it and then it is too late. This situation is similar. We should consider whether we abolish ECT or allow it to continue in a very rigid way. The Minister of State needs to bring forward proposals on that issue and that may be what we should debate on later Stages.