Jillian van Turnhout (Independent) | Oireachtas source

Maybe if Senator Walsh checks against the Bill when I am talking about a section, he will see I am talking about section 68(7). I am speaking to amendment 203.

I believe the provision is unfortunate because it is precisely when people are treated under the Mental Health Act 2001 that people will wish an advance health care directive to take effect. The use of differential standards for treatment decisions during involuntary detention perpetuates stigma and limits the use of advance health care directives in mental health care settings. Stigma and discrimination have been identified as the greatest barriers to recovery. Even if advance health care directives are legally binding during voluntary admission, the threat of coercion limits the impact of decisions.

A national study by Irish mental health service users has found an urgent need for legally binding advance heath care directives during involuntary detention to promote respect for treatment preferences. Many clinicians assume that if advance health care directives are made binding in the mental health context that hundreds of people will make blanket refusals of all medical treatment, yet there is no evidence to support this. Advance health care directives can actually increase treatment engagement rather than increase refusals. In an Irish national survey the majority of mental health service users stated they would be more willing to adhere to treatment if they had an advance health care directive, suggesting the measure may lead to an increase in treatment engagement rather than refusals. The international evidence also suggests this. The fear that individuals would refuse all treatment, or be left untreated, often results in limitations on advance health care directives during involuntary detention. The research suggests that mental health service users are more interested in using advance health care directives to express a preference for a particular treatment over others, rather than using the directive to refuse all treatments. To make a blanket denial of these preferences and concerns when a person is involuntarily detained, at precisely the moment such directives become important, is unjust. This is why I suggest amendment No. 203.

I will now turn to amendment No. 201. I am very surprised and concerned that an informed and considered decision to end life sustaining treatment should be viewed as equivalent to a suicide attempt. To put these situations together is unbelievable and, having worked on the Joint Committee on Health and Children's Report on End of Life and Palliative Care in Irelandand having looked at the issue extensively, I find it objectionable.