Charles Flanagan (Laois, Fine Gael) | Oireachtas source

I thank Senator Mac Lochlainn and other Seanadóirí for initiating this important debate in the Seanad. I too welcome Stephanie McGill Lynch and John Lynch and other members of Jake's family to our Visitors Gallery and our debate. On my own behalf and on behalf of the Government, I offer my sincere condolences and sympathy to the family on the tragic loss of Jake. They are very much in our thoughts this afternoon as we debate this issue.

The Bill contains three sections. Its main provision, from my reading of it, is contained in section 2, which would insert a new section into the Coroners Act 1962 which would, first, provide for the possibility of a verdict of iatrogenic suicide as defined by the Bill; second, offer a definition of iatrogenic suicide; and, third, provide a safeguard clause to ensure that a verdict of iatrogenic suicide does not contravene section 30 of the 1962 Act in the apportioning of civil or criminal liability, which is important. The Bill, as Senator Mac Lochlainn would readily testify, does not seek to address any related or substantive issues with regard to suicide or suicide prevention. I have listened closely to Senators' comments on this issue and acknowledge their experience in this regard, particularly in the context of her professional activities, Senator Frances Black, my colleague, Senator James Reilly, and Senators Burke and Mulherin, both of whom have engaged on numerous occasions in the process that is our coroner's court. Senator Mac Lochlainn himself notes in the explanatory memorandum that his proposal "symbolically amends the Act of 1962". The sole objective of the Bill, then, is the introduction of a new verdict, namely, one of iatrogenic suicide, or medically induced suicide, to be available to a coroner at an inquest.

The term "iatrogenesis" can be interpreted to mean an event or outcome brought forth by a healer. It could refer to both good and bad outcomes of a medical intervention or procedure. The Private Members' Bill seeks to define "iatrogenic suicide" as the ending of one's own life where the effect of medical treatment undertaken by the deceased, including any prescribed medication, is the primary cause of such an action.

Senators will very much appreciate that it would not be appropriate for me to comment in any way on any individual cases in which persons taking antidepressant medication have taken their own lives, suffice it for me to offer sincerely my sympathy or condolences. However, my role as Minister for Justice and Equality, a public representative and a legislator acknowledges the undoubted tragic cases that are coming before us as a society. In circumstances such as those in the case that has given rise to our debate this afternoon, our hearts go out to the families involved. However, I as Minister for Justice and Equality, and we as legislators in this Chamber, must be careful about assuming there is a causal link. Coroners have arranged for expert medical advice to conduct a review of the research regarding the medication involved and suicidal ideation or suicide. In at least one case, such a report found that no clear association linking death by suicide and use of the medication can be made.

I listened very carefully to the points Senator Norris raised about the matter of medical negligence, according medical negligence in individual cases and apportioning liability in cases. I am not sure whether we should make decisions about this issue in the manner in which it is intended we do so under the Bill. Medical matters should be for medical people, medical negligence through the various fora we have set up to deal with it. As Minister for Justice and Equality, I acknowledge that many of the issues we have been discussing are primarily for my colleague, the Minister for Health. This is not in any way to abdicate responsibility on my part, and I intend to discuss many of these issues, or all of them, with my colleague, the Minister for Health, Deputy Simon Harris. I refer specifically to the very important issues raised by Senator Black, and I acknowledge her expertise and the good work she continues to do in this area, but in this instance I am acting under the remit of my brief as Minister for Justice and Equality. Of course, it is open to any individual to pursue a civil action through the courts if he or she is unhappy with medical advice and the consequences of that medical advice in terms of the administration of any substance, be it prescribed or otherwise. That will not change under this legislation, nor should it.

In recent years, there has been considerable discussion in Ireland on suicidal and homicidal thoughts or impulses as potential adverse effects relating to the use of the medications known as selective serotonin reuptake inhibitors, SSRIs. These are antidepressant medications available by means of prescription only. They are authorised for use in Ireland and across the European Union for the treatment of depressive disorder and some anxiety-related conditions. Again, I agree with Senator Black's comments in this regard, and I am not in a position to contradict, nor would I, any aspect of the submission or the observations of Senator Reilly. What I do know, however, is that depression may well be associated with an increased risk of suicidal thoughts, self-harm and suicide. This risk may persist in the early stages of treatment when a patient starts to take an antidepressant until significant remission of his or her depression occurs. Health care professionals are advised of this risk through the so-called summary of product characteristics, which specifically highlights the need for monitoring of the patient following initiation of therapy. There are public leaflets accompanying these products advising patients and their care-givers to be alert for any deterioration of condition, suicidal behaviour, thoughts or impulses or any unusual changes in behaviour, and to seek medical advice immediately if these symptoms become evident.

The Irish Health Products Regulatory Authority, in conjunction with other EU medicine agencies, continuously monitors the safety of medicines. Case reports and other safety data are reviewed and evaluated in terms of their potential impact on the known safety profile of a medicine and any need for any regulatory change to support their continued use. The decision to use a particular medicinal product for an individual patient rests solely with the health care professional involved in his or her care, taking account of the professional's assessment of that patient's current clinical condition, the medical or medication history, any relevant, underlying risk factors, the condition to be treated and many other related issues. These are health issues, and again I acknowledge the comments of Senator Norris and others, which I regard as being well intentioned, as I accept that the intention of Senator Mac Lochlainn is well founded in proposing this Bill. I acknowledge his work in this area. He previously introduced it in the other House. However, I am not in a position to accept the proposed Bill and I wish to explain why.Acceptance of the proposed definition of a verdict of iatrogenic suicide would risk its use by a coroner at inquest being interpreted as apportioning some liability on the medical practitioner who may have prescribed any form of treatment or medication to the deceased person prior to taking his or her own life. The coroner's inquest is, by definition, an inquisitorial process. It is not permitted to consider questions of civil or criminal liability. Section 30 of the Coroners Act 1962 specifically prohibits consideration of civil and criminal liability. For the purposes of this debate, it is worth quoting from that section. It states: "Questions of civil or criminal liability shall not be considered or investigated at an inquest and accordingly every inquest shall be confined to ascertaining the identity of the person in relation to whose death the inquest Is being held and how, when, and where the death occurred." While Senator Mac Lochlainn proposes a safeguard clause, I am of the firm view that it would be unwise to proceed with the Bill given the significant prohibition against any consideration or apportioning of liability at an inquest.

Moreover, I would advert to a second consideration arising from the Senator's Bill, one perhaps not intended by him, namely, the risk of engaging the criminal law on assisted suicide. A verdict returned at inquest of iatrogenic suicide, as defined in the Bill, could engage the provisions of the Criminal Law (Suicide) Act 1993 and, in particular, section 2 thereof, which provides: "A person who aids, abets, counsels process the suicide of another, or an attempt by another to commit suicide, shall be guilty of an offence and shall be liable on conviction on indictment to imprisonment for a term not exceeding fourteen years."