Rónán Mullen (Independent)

As the Green Party has withdrawn certain aspects of its original proposals in this Bill, I will confine my comments to what remains, essentially whether ECT should be permitted in the absence of the patient's consent. I admire the animating spirit behind this initiative and believe it is right and proper that we think long and hard in terms of human rights and dignity when we consider any kind of medical procedure.

Without wishing to sound patronising, it is because people care so much that important issues are brought before us. Nonetheless, the question of consent raises a core philosophical issue. Our society correctly lays a strong emphasis on rights and that leads to our thinking about patient autonomy which is important most of the time. Rather like anti-discrimination provisions they are always right except when they are wrong. There may be circumstances in which, if we viewed this issue through a communitarian lense, or within the concept of paternalism, which is not desirable in itself because its language is wrong, it may remain a fact that in certain cases society must on occasion act in the best interests of some of its members. Therefore an untrammeled appeal to a doctrine of patient autonomy could end up operating not just against the common good but against the good of individuals in particular circumstances. That is what animates my contribution, with great and sincere respect for what the Green Party proposes.

We all agree that ECT is the last resort. It is often prescribed for patients who are involuntary, unlikely to be willing or able to consent. That goes without saying. The question is whether the treatment is effective and whether the safeguards ensure that ECT is sparingly used only in cases where it is deemed to be necessary. I understand that in practice if the legal representative of the patient objects to the treatment the matter would go to the tribunal which safeguards the rights of the patient in whose best interests it acts.

In Ireland today ECT is reserved for certain circumstances, such as catatonia, treatment resistant depression or severe depression with stupor, which would likely lead to a person's death by starvation, and in cases where the person would die if not given ECT, especially if he or she is elderly or frail. Could this be an important and essential treatment backed by some kind of evidence base? I need to think about and research it more before ruling it out completely. The patients most in need of ECT, whether those in a catatonic state or depressive stupor, are generally unable, by virtue of their condition to give consent. Therefore, changing the law so that it can be given only with consent may result in deaths.

While I am open to debating this issue I am concerned that the Bill, although well meaning, could be counterproductive and I wonder whether the opinion of the medical community has been sufficiently taken into account. Starting with Hippocrates medical treatment has the best interests of the patient at heart. This occasionally involves the use of treatments such as this or, in rare cases, psycho-surgery. Insisting that patients who are often not in a position to act in their own best interests should have a veto over ECT treatment could be a dangerous and counterproductive measure. In the words of one medical contact, if a person was capable of acting in his or her own best interests he or she would not need ECT.