Roderic O'Gorman (Dublin West, Green Party) | Oireachtas source

Amendments Nos. 1 and 2 provide for the inclusion of new subsections that simply reflect how the Credit Union Act 1997, the National Disability Authority Act 1999 and the Mental Health Act 2001 shall be construed following amendments made to those Acts in the Assisted Decision-Making (Capacity) (Amendment) Bill. I wish to speak also to amendment No. 58, which is a Government amendment in the group.

Amendment No. 58 proposes changes to the application of the 2015 Act, including decision support arrangements and the validity of advance healthcare directives, AHDs, to persons whose involuntary mental health treatment is regulated by Part 4 of the Mental Health Act 2001. This matter was raised in the pre-legislative scrutiny report back in April and has been raised throughout the various Stages of this Bill, including by Senators in the Second Stage debate. I am pleased to be able to introduce these amendments today and show the commitment my colleagues in government and I have to making progress on this matter.

I stress that the amendments being introduced today are not the final word on this matter and acknowledge that more is needed to achieve full parity of care. While it remains the case that fundamental reform of involuntary care under the 2001 Act is a matter for the reform of that Act under the Department of Health, the amendments being introduced today signify an important move away from a paternalistic, best-interests approach and extend supports to cohorts previously excluded from the supports under the 2015 Act.

Persons whose involuntary treatment is regulated under Part 4 of the Act must meet the definition of "mental disorder" within the 2001 Act. I am using the terminology used in the Act. Nowadays we would regard it as inappropriate, but, with regard to what I am talking about amending, I have to use the definitions contained in the Act.

Under the 2001 Act, a person may be treated under Part 4 if there is an immediate and serious likelihood of that person harming himself or herself or another person or where, in the opinion of the relevant clinicians, treatment is required to improve the condition or a condition would deteriorate without treatment. Reforming treatment considerations where a person may be likely to cause harm is a more complex undertaking than can be achieved in this Bill, despite all the efforts that have been made. Therefore, I cannot, at present, extend decision support arrangements to the A category spoken of, nor can I extend it to persons whose detention arises from a referral from the criminal justice system, due to several complex technical and legal issues. However, along with Senators present and advocates, I remain committed to continuing to move towards parity in this area. I look forward to the fundamental reforms that the Minister for Health will bring to the 2001 Act, which I know Senators are involved with and will address the necessarily more fundamental reforms related to how the law should address the issue of possible harm.

In dealing with the amendments before us, I must address the 2001 Act as it stands. Unfortunately, it is not possible to extend the Act's provisions in their entirety in that regard. Notwithstanding this, amendments I am introducing today will extend the provision of assisted decision-making supports to those treated under the B category. This will ensure a clinical view of a person's best interest will no longer, by itself, be placed above that person's own will and preference and that a person's will and preference will prevail. This represents a significant extension of the provision, and I hope it will benefit the treatment of those whose treatment has not to date been within their control.

On the question of a significant extension of the application of advance healthcare directives, I acknowledge there is more work to be done. With regard to our very extensive engagement with the Department of Health over the summer, we believe this is as far as we can go in this legislation. The remaining elements may be addressed within the reform of the 2001 Act, which I am aware has been subjected to pre-legislative scrutiny. I hope to get a full draft of the associated Bill from the Department of Health shortly.