Dan Boyle (Green Party)

I thank Members for their contributions. It is important to note we are talking about a limiting of the practice of electroconvulsive therapy. The debate relates to those subjected to the treatment, and whether a majority have been affected in a negative way, rather than helped. The existing law is failing in many respects. The safeguards for patients implemented by the Mental Health Commission are carried out too secretively. The extent to which the patient or his representatives is able to contribute that process is non-existent.

Our process is behind that found in other European countries. ECT is not practised at all in Slovenia. In England and Wales, the practices are quite similar to those in Ireland. However, Scotland has had a separate Parliament since 1999 and the Scottish Mental Health (Care and Treatment) Act 2003 gives patients with capacity the right to decide. Where people in this country have the capacity to decide, that capacity is overruled in the current situation and the treatment is administered regardless. That is a flaw in its own right. The involuntary nature of the practice when people have the ability to refuse is a major flaw in our legislation. None of us can be happy with this.

The Austrian Government tried to overcome the difficulties described by Senator Corrigan by appointing a patients' advocate who would act on a patient's behalf. There is something similar in Belgium, where a person known as judge of peace acts under similar principles. There are laws in Denmark which allow for complaints about the administration of involuntary treatments and involuntary admissions. That is subsequent to the fact, but it has helped reduce the reliance on psychiatric measures in Denmark. Over a 20 year period to 2008, the number of beds in psychiatric institutions in Denmark halved because the Danes took what we would argue is a more humane approach. The balance at state and federal level in Germany is towards a more human rights patient-centred approach over and above what are seen to be the preferred approaches of the medical profession in administering care and attention. Ironically, ECT has been more or less taken out of the psychiatric system in Italy, which was the first country to use the practice. It is now expressly discouraged for schizophrenia and is banned as a means of achieving a rapid remission of symptoms in those who are deemed to be suffering under such psychiatric conditions.

We argue that Ireland does not have the proper balance between the rights of patients and the administration of effective standards. In the renewed programme for Government that was recently agreed, the Government committed itself to making appropriate amendments to the Mental Health Act 2001 to address concerns regarding involuntary committals and procedures. As limited as it is, this Bill is a sincere attempt to do this. It will not happen tonight, but we have edged the debate forward.

Proposals have been made on how we can involve more actors in the debate, and I accept the points made by Senator Fitzgerald. However, Senator de Búrca already pointed out that we have had that in the original debate also. I welcome the formation of an Oireachtas group on mental health, and this is possibly a good forum for such a debate to happen. However, this debate has been dominated too much by the established psychiatric profession. There is a great debate within psychiatry itself and many psychiatrists do not believe this is an effective form of treatment or that it should be administered to the extent that currently occurs. The debate has seen very little contribution on the role and rights of patients. The Minister of State has made several attempts in the ongoing review to change the situation, but this is about where we need to go with this Bill.

Senator Mullen made a point about patients' rights and the threat to wider society. I do not accept that the use of ECT has anything to do with life saving. Psychiatrists might make arguments about mental capacity and personality disorder, but life saving procedures are medical procedures. They relate to the physical condition of the person and I do not see the situation as described by Senator Mullen.

When we are passing Bills, we must avoid legislating for the particular. The legislation in force is based on a mythical set of standards, whereby there is an extreme case in every circumstance for which the law must provide. As our law is predicated on that premise, there are too many innocent victims who fall foul of not being the extreme case, who get treatment that is not necessary but is seen to be the easiest treatment. We should not have a psychiatric system or a philosophy of psychiatry that is based on this. That is why we are moving these amendments and seeking support.

The first amendment tries to take away the debate on psycho-surgery or lobotomy, which I find far more offensive, even though we have not practised it here for 30 years. That will not be the focus of the Bill. The second and third amendments deal with electroconvulsive therapy. I will wait for the contribution of the Minister of State on this, but I welcome the comments made by all Members. While there are reservations about specific aspects of what is being proposed in the Bill, there is a sincere belief there is a need to change the legislation to get the balance right. If there is a means for this House to find a way forward on the basis of this Bill, we will have done well.