Keith Swanick (Fianna Fail) | Oireachtas source

I welcome the Minister of State to the House.

I commend Senator Devine on her work on this area and the Bill that she is bringing forward and also commend Senator Freeman on the vast amount of work she has done in this area. I welcome Deputy Pat Buckley to the House and commend him on the work he does in the Lower House with my colleague, Deputy James Browne.

As a general practitioner, GP, I am delighted to support this Bill. Fianna Fáil will be supporting this Bill which seeks to ensure involuntary patients in hospitals for mental health treatment will have their advance healthcare directives respected. Currently, involuntary mental health patients is the only group which is excluded from having a living will fulfilled. It is important to ensure that involuntary patients have a voice in their treatment and have their will and preference for mental health treatment fulfilled and respected.

I welcome the changes that have come about over the past number of years. As a young fellow growing up in Castlerea where there was a large mental institution, St. Patrick's Hospital with 400 inpatients, in which my father worked as a plumber, I often played up in its playing fields. They had a farm. In thinking of that time and the time from when I was a medical student working in Grangegorman to when I was a psychiatric registrar working under the medical director, Dr. Blennerhassett, in Portrane, the developments must be welcomed. On a day to day basis in the surgery, I am delighted to be treating patients in the community, keeping them in the community and not having to rely on these dreadful institutions where people were locked up inappropriately for many years. The situation is improving and it is great that we are having this debate here tonight.

The Assisted Decision-Making (Capacity) (Amendment) Act 2015 provides laws for advance heathcare directives. The Act was signed into law on 30 December 2015 but it is not yet in effect. A living will may be valid and enforceable. By making such a statement, one may have withdrawn one's consent to the specific medical or surgical treatment, for example, as Senator Devine mentioned earlier, a do-not-resuscitate request. It is not possible to state with absolute certainty that such a directive would be enforced because this depends on exactly what it says and whether it addresses the precise circumstances.

In some countries, it is possible to appoint someone else to make decisions on one's behalf if one is not capable of making them for oneself. In Ireland, this power is granted via an enduring power of attorney. I see this in my role as a GP but also as a medical officer in a small district hospital. An enduring power of attorney, however, does not specifically allow for the making of healthcare decisions by another person and while one may suggest to one's doctor or hospital that the wishes of certain persons may be considered, one cannot give anyone else any legal right to make decisions about one's healthcare. People can make advance healthcare directives about a broad range of issues, such as the type of medication they prefer, the type of therapies that suit and work for them best and, most important, to treatment refusals - treatments that they do not want - such as electroconvulsive therapy, ECT.

Under Irish law, people who are detained in hospital for mental health treatments are specific excluded from legally-binding advance healthcare directives. As a doctor, I find this deeply upsetting and deeply troublesome. That is why I am supporting this Bill today. This exclusion is contrary to international human rights standards, including the UN Convention on the Rights of Persons with Disabilities.

The Government has recognised that it is necessary to update the 2015 Act for Ireland to be compliant with the UN Convention on the Rights of Persons with Disabilities, which was ratified by the Government in 2018. In June 2016, the then Minister of State at the Department of Health with responsibility for mental health, Deputy McEntee, publicly stated that the draft legislation to reform the Act would be completed by the end of that year. I understand that delays happen with legislation but since then, numerous dates have come and gone. Numerous dates have been given for publication of the draft legislation and none of them have been met. These delays are problematic given the lengthy duration of the review of the Act and the seriousness of the gaps in human rights protections, both for adults and children, receiving inpatient and mental health treatment.

As a GP and as a member of Fianna Fáil, I am happy to support this Bill to ensure that the most vulnerable who often do not have a voice - involuntary patients in mental health institutions - will have their wishes respected. As I stated, it is a basic human right. My party is happy to support this. Once again, I commend my colleague on her work in this area.