This motion addresses the growing challenge of unemployment facing the country. We are all aware that the global community is grappling with an economic and financial crisis but that we have our own domestic strain of that crisis. We face an uncertain future and it is clear that growing levels of unemployment will be one of the major challenges for this and future Governments. If the unemployment trend continues we will see greater pressure on welfare systems and growing levels of social unrest throughout the European Union. That is undeniable. It is imperative that, as policy makers and as members of Government, we give the growing unemployment levels top political priority.

I propose to look at initiatives taken by the governments of five other member states, Spain, France, Germany, Austria and Denmark, to see what we can learn and rapidly implement in Ireland.

In Spain there has been the same kind of collapse in the construction industry as we have experienced. This downturn has been responded to through increasing public building programmes, initiating energy efficiency programmes such as retrofitting housing and providing land for public building purposes. Some 80 measures were introduced to improve employment between 2008 and 2009 and there have been different extensions to unemployment benefit. A local investment fund worth €8 billion and a special fund for the promotion of the economy and employment worth €3 billion have been established. Of them, €500 million is dedicated to environmental projects, €500 million for research and development and €400 million to upgrade police and civil guard stations. The Spanish Government has also allowed local governments to increase their permitted budget deficits from 0.05% of GDP to 0.5% of GDP, thus facilitating the injecting of a further €5.8 billion into the economy. A royal decree extended benefits to workers in special situations. Those temporarily laid off will be able to collect unemployment benefit, subsidies will be provided for companies which hire an unemployed person, as well as lower social security payments for companies which reduce employees’ working hours instead of dismissing employees. Incentives will also be provided by the Spanish Government to companies which hire workers on a part-time basis, as the incidence of part-time work is still low in Spain.

In France, €11.4 billion has been allocated to reimburse companies in order to improve their capital and cash situation and to give them the resources they need to invest. This includes the early reimbursement of the research tax credit or value added tax from the start of 2009. The State will invest an additional €11.1 billion in a public investment programme which will include support for housing, with a two-fold increase in zero interest rate loan amounts, in addition to welfare support. A total of €4 billion will be invested by large public companies to modernise and develop the railway and energy infrastructure and the postal services. In addition, President Sarkozy has taken up a trade union proposal and announced the creation of a social investment fund which could allocate up to €3 billion for employment and vocational training.

In Germany, among the new policy measures adopted is the Pact for Employment and Stability in Germany: Safeguarding Jobs, Strengthening the Forces of Growth and Modernising the Country. A supplementary budget was also adopted to implement the pact. The focus is on safeguarding jobs and businesses’ capacity to invest. The measures will markedly increase investment in future oriented sectors, with educational infrastructure at the forefront. It is also intended to supply credit to healthy competitive companies and further empower the workforce to gain qualifications. The total volume of the package of measures in the German public sector budgets in 2009 and 2010 will be almost €50 billion. Together with steps adopted in 2008, this represents total funding of approximately €80 billion to support the economy. Financial assistance has been provided by the Länder with particular focus on educational infrastructure, especially nurseries, schools and universities which make up two thirds of overall planned expenditure, and other infrastructure, particularly hospitals, urban development and information technology. A €100 billion programme of loans and credit guarantees will be implemented by expanding existing measures directed at small and medium enterprises and introducing a comparable loan programme for larger companies. The funding available to support small and medium enterprises and research and development projects will be extended in 2009 and 2010 with about €450 million in additional funding being provided per annum. The spread of broadband networks will be accelerated, guided by a comprehensive broadband strategy. Extra funds of approximately €2.5 billion will be provided by the German Government for activation, support and training measures for jobseekers, as well as short-time and agency workers, and 5,000 additional posts will be created at federal employment agency offices to improve placement of and provision of support to jobseekers. Income tax will be reduced. The statutory health insurance contributions paid in equal parts by employers and employees will be lowered. At the same time, a sustainable fiscal policy and a budget rule to put consolidation back on track has been adopted by the German Government, which will mean that new legislation on the lines of the EU Stability and Growth Pact will be adopted to impose a constitutional limit on net borrowing.

In Austria, the short-time working rules have been amended. In 2009, the Austrian Parliament endorsed an amendment to the short-time working rules with the aim of making them more flexible. This is due to a continuously growing demand by employers for short-term working arrangements to cope with the current economic downturn. Employers and trade unions have largely welcomed the decision. Under short-time working arrangements, working hours may range from at least 10% to a maximum of 90% of normal working hours. The introduction of a new short-time working scheme in combination with further training allows employers to receive a special training subsidy if they offer their employees, during the hours not worked, training course intended to improve workers’ future employability in the labour market.

In Denmark, the practice of work sharing is growing extensively to help to mitigate the significant increase in redundancy during 2009 arising from the economic recession. The priorities for the Danish Government are enabling faster access to further training by increasing the funds available, establishing a national alert system to offer support as early as possible, increasing the monitoring of the labour market’s development and introducing more flexible rules regarding work sharing arrangements.

The challenge at European Union level is to start examining how the European economy can be strengthened in a way that will increase job creation across all the member states. It is a little misleading to speak about a European economy at present because what we have is a Single Market with a collection of individual, national economies. The concentration at political level now must be on European-wide measures that will stimulate infrastructural projects of a scale that will have job creation benefits for all member states. My colleagues in the European Parliament have called for an EU-wide stimulus programme, a green new deal, to make €500 billion available over a period of five to ten years from both public and private sources. They have large, ambitious infrastructural projects in mind such as an EU-wide electricity grid and an offshore wind farm stretching from the North Sea to the Iberian peninsula. This is the way we should be thinking but political will across all member states is required, particularly in the member states whose economies are stronger and who will probably have to carry some of the weaker economies. We should be working at European level to promote that type of approach so a genuinely stronger European economy can emerge that will deliver much greater benefits to European citizens in terms of addressing the challenge of unemployment.

I second the motion. I welcome the Minister of State to the House. I welcome my party’s Private Members’ motion. As a member of a party that is committed to the whole process of political reform, this motion is very much in keeping with the Green Party’s approach to that issue. On the day after a very difficult budget was announced, if we examine some of the provisions of that budget we can see that a process of political reform, or some of the steps that will lead to what I believe is a significant process of political reform, is in train. I believe the public will recognise that, despite the fact that so many other elements of the budget are causing a great deal of hardship and concern.

The Green Party, as a party of Government, should be an active agent in the process of bringing about political reform. We have had many debates in this House on the issue of Seanad reform. I have no doubt that the Government will leave a legacy of political reform and I hope the Green Party will have made a significant contribution to that.

Regarding the motion before the House, I want to focus on the important issue of gender balance in the way in which public appointments, in particular appointments to State boards, are made. I will begin by outlining the commitments the Government has made in the programme for Government. They include achieving a minimum of 40% representation of women on State boards. In July 2002, all Ministers were asked to review the gender balance composition of State boards and committees under the aegis of their Departments and to take measures to redress gender imbalances where the 40% target has not been reached.

In January 2005, the Government decided all nominating bodies should be required to nominate both male and female options for those appointments to State boards where they are the responsible authority but in December 2007, under this Government, Ministers agreed to take proactive steps to ensure that their nominations, and the nominations made by external bodies to boards under the aegis of their Departments, continue to reflect the Government’s commitment to achieve representation of at least 40% by persons of each gender on State boards to advance the goal of equal participation of women and men in decision making. All Ministers were requested to put in place the necessary procedures to implement the Government decisions. Progress on this issue is reported to Government at six-monthly intervals. However, as I will argue later, there remains a real need for overall reform of the current system of appointments to State boards.

Why should we reform that system? The current system means that places on State boards are filled by ministerial appointment. That is a form of political patronage. It is anti-democratic and unaccountable. Although we tend to hear mainly about the influential boards such as the Dublin Transport Authority or the Broadcasting Authority, there are hundreds of executive and non-executive State boards spread throughout the country.

On the question of gender balance and diversity, despite the Government’s commitment to achieving a minimum of 40% representation of women on State boards, the participation rate currently stands at 34%. In December 2009, the Department of Justice, Equality and Law Reform released the following figures for 2007: total number of State boards included was 278; total number of positions on these boards was 3,804; total number of female members on these boards was 1,293, approximately one third of the members, or 34%; the number of female chairpersons in 2007 stood at 44, or 17%; and during 2007, 1,082 appointments were made to State boards. These included 386 women, representing 36% of new appointments.

The current system also militates against increasing diversity on State boards as candidates are generally drawn from within political and civil society circles. Given the changes in the make-up of Irish society in recent years, it is important that our State boards reflect that. Any new system devised could build both gender targets and general diversity targets. This is the case in the United Kingdom.

On the issue of skills and meritocracy, it appears that although many Ministers try to ensure a good mix of skills and background on State boards, where this is not set down in legislation the process tends to be arbitrary. A new system would ensure that appointments to State boards are filled by those with the necessary skills and background.

In terms of the kind of new system we should establish, there are many models we can examine, including the UK, the system proposed in the Green Party Private Members’ Bill published in 2006 and the system established by the Minister for Communications, Energy and Natural Resources, Deputy Eamon Ryan, in the Broadcasting Bill 2008. However, any new system must be based on the following principles: merit; transparency; equality; and diversity of skills and background. The new system should be independent, efficient, proportional, flexible and fair. It should be able to administer appointments to all types of boards, executive and non-executive, prestigious and less prestigious.

In the light of current financial pressures, however, we must be careful that any new system we devise is efficient and not too costly. Some proposals might include that the Oireachtas, either through the Dáil and the Seanad or through committees, could have a role in the process. For example, it could draw up guidelines and procedures or have a reviewing role. For the more important boards, such as the Dublin Transport Authority, the Oireachtas could be given the power to nominate candidates. A special unit could be set up within the Public Appointments Service or the Standards in Public Office Commission which could establish, monitor, approve and carry out appointments procedures and codes of practices. It would advertise positions publicly. A system similar to that in Britain and Northern Ireland could be established, where a commission provides the framework, guidelines and training to Departments, which then carry out the appointments process, including advertising. The commission also has a monitoring function, ensuring that diversity targets are met and the independent process is adhered to. It would be possible to devise a system which incorporates many of the features I have outlined in a way that is efficient, not too costly and independent. It could also ensure a role for the Oireachtas.

There is a danger that a certain amount of fatigue has set in on balanced gender representation in all areas of public life, particularly in State appointments. Just because the political challenge has existed for many decades does not mean that we should not tackle the challenge with renewed vigour. The Green Party is calling today for the Government, of which it is a part, to adopt a new reforming approach to ensuring gender balance in appointments to State boards and commits itself to achieving the targets set out in the programme for Government as speedily as possible.

The economic cost of such a system has been considered and little funding would be needed to establish such a system based on the recommendations made today. We need a new system for public appointments and if the Government achieves that it will be an enduring legacy for which the State will thank us.

The insufficient supply of microloans is a major issue, in particular where business founders are unemployed persons, women or part of ethnic minorities. Supporting the supply of microloans is, therefore, not only an issue of entrepreneurship and economic growth, but also of social inclusion.

In Europe 2 million enterprises are created every year, 90% of which are microenterprises with fewer than five employees. Many reports note the success of microlending around the world. Nearly 70 million individuals are served by microfinancing institutions, MFIs, worldwide. A European survey in 2001 found that 93% of the 2.5 million European SMEs are also microenterprises.

Within five or six years of the collapse of the Berlin Wall, microfinance institutions in central and eastern Europe and the new independent states had attracted more than 1.7 million borrowers and 2.3 million depositors with an average client growth rate of 30% per year. In addition to the involvement of MFIs and NGOs in providing microfinance in eastern Europe, commercial banks also became increasingly interested in downscaling to provide microloans for the poor. In those years the microfinance sector expanded and became more highly structured.

In western Europe microfinance is regarded as a tool for economic growth and social cohesion, and many small businesses and families that lack access to financial services, in spite of our banking network, tend to turn to microfinance services. Micro and small enterprises form the core of the western European economic system, representing 99% of the 2 million start-up enterprises created every year. Traditionally one third of these enterprises have been launched by the unemployed. We should take on board that important point as we face into a number of years when we can expect EU unemployment levels to grow considerably. These businesses have both an economic and a social impact and the ability of the traditional banking system to reach and serve such small entities is vital to the achievement of general socioeconomic improvement. Exclusion from banking services generally constitutes a major obstacle to the launch of new business activities.

The European Microfinance Network report 2007 on the status of microfinance in western Europe noted:

Demand for microfinance in western Europe is less strong than in less developed countries. Yet [this is difficult to understand] the share of micro enterprises – enterprises with less than ten employees – amounts to 93% of all European enterprises. Small and microenterprises account for 65% of the European GDP. A recent European survey among existing companies noted that sufficient access to capital is still a huge constraint for about 20% of European MSMEs.

The European Microfinance Network report 2007 also noted:

Microfinance programmes in western Europe are not and possibly will not become profitable, but make economic sense. The average costs for someone supported within a microfinance scheme – particularly since the monetary support is interest bearing and repayable – are often below the cost for one year of support within the traditional social welfare system, where costs thereby incurred are “lost” subsidies.

I will give some other significant facts on the microlending sector in western Europe. It is a relatively young sector and there is plenty of room for it to expand and grow. Some 70% of the microlending organisations in the then EU 15 have been established since 2000 and 17% of those have begun lending since 2005. In the EU 25, 41% of micro-loan clients are women, 7% are ethnic minorities, 7% are immigrants, 7% are youth and less than 1% persons with a disability. Most microfinance institutions focus on start-up business or registered businesses with fewer than five employees. A significant number also assist businesses in the pre-start up phase by financing feasibility studies and the like.

In 2005, 27,000 microloans were disbursed in the EU 25. By country, the greatest coverage was in Poland, France and Finland. In France and Finland, single organisations disbursed 95% to 100% of all microloans and, similarly, in Poland one organisation made 80% of the loans reported in the new member states.

In Europe loans worth €25,000 or less are considered to be microloans. The maximum size of microloans provided ranges from €25,000 to €37,000. The average loan size across Europe is approximately €7,700. In the EU 15 the average loan value is €10,240 and in the new member states it is €3,800. The average maximum interest rate is 10% and the average minimum rate is 4%. This varies greatly according to the regulations in each country, with the UK having the highest rates in western Europe and Poland having the highest rates in the new member states.

The provision of support and advice is also a crucial aspect of microfinance in western Europe. Some 70% of microlenders offer training and counselling on a range of related subjects. Only 20% of microlenders offer financial services other than loans for microenterprise, development and self-employment. Those other financial services which are provided include consumer personal loans, savings products, transfer services and insurance.

The repayment rate on average is 92% and the average portfolio at risk is 11%. Microlenders have widely varying operational performances across Europe demonstrating a need to agree common performance indicators and a focus on capacity building.

I emphasise that the Green Party believes the model of microfinance needs to be promoted and mainstreamed to a much greater extent in the current economic situation in which we find ourselves. We will see large numbers of people becoming unemployed over the coming years and the microfinancing model seems to offer an opportunity for those who become unemployed to avoid long-term unemployment, to start up their own enterprises and to promote their social inclusion and also the economic cohesion and stability of member states.

In Ireland, by comparison, while research on adult stem cells is legal and some of the research has been publicly funded, the legal position regarding embryonic stem cell research is not clear. We do not have legislation to deal with, for example, embryos left over after IVF treatment. The Medical Council produced guidelines in 2004 that forbid the “deliberate destruction of embryos in addition to the creation of embryos specifically for use in research, therapeutic cloning.” However, those guidelines do not apply to scientists. The importation of embryonic stem cell lines created in other countries is not illegal in Ireland. We have a vacuum and, as legislators, we must respond to that. The start of the process is to have a comprehensive debate and this Private Members’ Bill will facilitate that.

Stem cell research is an important area of research because stem cells are immature cells that have the potential to develop into any one of the 216 different cell types that make up the human body. In effect, they are a repair kit for the body and they are found in humans at all stages of life, from embryonic through to adulthood as well as in umbilical cords and placentas. Great strides have been made in this area.

Other speakers referred to the great day for medical science when there was a successful replacement of a damaged windpipe with a donor organ treated with adult stem cells. That line of scientific research shows immense potential for development in the fight against disease and in preventing the rejection of organ transplants. There are great hopes for its use, in particular with patients with Parkinson’s disease and Alzheimer’s disease.

The issue that is particularly relevant to us as legislators is the use of public funding, namely, taxpayers’ money, for stem cell research. Irish scientists and researchers deserve to be given the maximum financial and other support to play a leading role in this field. However, ethical issues intrude on any funding policy and they are ones which we as legislators must take seriously. The protection offered to the life of the unborn in the Constitution makes clear that Irish people have a deep sense of the value of human life and a particular understanding of when human life begins. Others may have different views but the matter will have to be clearly defined when it comes to embryonic stem cell research. For some, what they would see as the destruction of embryos would be completely unacceptable ethically.

We heard a geneticist speaking at a briefing session today for Members of the Houses of the Oireachtas who said that as far as he was concerned he does not regard an embryo in the first 14 days of its existence as early human life. It is only after that that he believes the cells develop the properties he would consider as the early stages of human life. As legislators, we have serious questions to debate and on which to seek greater clarity so the public can be informed also.

I do not speak on behalf of the Green Party per se because our party has had difficulties in the past with arriving at a party policy position on abortion. We deal with such issues by permitting them to be a matter of individual conscience. I could not enunciate a position on behalf of the party on embryonic stem cell research because one would find the same divisions among the party membership as one would find among the public.

Adult stem cell research provides much potential. The advantage of it is that it is uncontroversial. Adult stem cell research does not involve the destruction of embryos. Adult stem cells can be developed from umbilical cord blood and placenta, which are rich in adult stem cell potential. Cord blood banking has already been used to treat more than 80 known diseases and it appears to hold great promise for treating additional diseases and disorders. Cord blood stem cells are used primarily for hematopoietic, or blood forming reconstitution, for diseases such as leukemia and lymphoma. Because every cell in the human body has the same genetic information and approximately 200 programmes for using the genetic information, it is clear that it should be possible to make a stem cell from any cell in the body. As other speakers indicated, scientists have already figured out how to do that from skin cells and induced pluri-potent stem, IPS, cells. The advantage of such stem cells is that they can be made from any human being and thus have the potential to allow a human being to regenerate his or her own tissue. That is the best possible scenario given that our immune system rejects almost all cells and tissues from other humans.

From research carried out it appears that it is possible to reprogramme skin cells to become induced pluri-potent stem cells, a state which is virtually identical to that of embryonic stem cells. There are some disadvantages attached — as there is a limited quantity of such cells, they can sometimes be difficult to obtain in large numbers and they may be more difficult to reprogramme to form other tissue types.

I welcome the fact that Senator Mullen has introduced this Bill and stimulated this debate. I hope we will carry it to a further stage and, in the process, clarify many of the ethical issues that arise for the Irish public.

I congratulate the Senator again because this is bold legislation. It proposes a fundamental change to a system with a presumption in favour of consent to the donation of organs and body parts unless that consent is expressly withheld

I agree with the sentiments expressed earlier by the Minister of State. Based on practice in Spain and elsewhere, it appears that presumption in favour of consent can and does lead to a much greater level of availability of organs for transplantation. Such a fundamental change would require full consultation with the public and for that reason I withhold my immediate support for the proposition. I support what the Minister of State said about public consultation and having a level of support for that fundamental change. It is a very sensitive area and speakers have highlighted this point earlier. I do not believe it would be fair to introduce legislation containing such a fundamental change without the support of the public. Following a public consultation period, I would be happy, and I believe the Green Party would be happy, to consider legislative change to presumption in favour of consent.

The issue of consent is obviously central to this legislation. In this context consent refers in particular to the removal, retention and disposal of human body organs and human tissue. There have been scandals in this country, specifically the organ retention debacle in which hospitals retained organs of deceased children following post mortems and without the consent of their immediate families. The group, Parents for Justice, has done great work in raising awareness of this issue. The Government set up a non-statutory inquiry, the Dunne inquiry, which was followed by the Madden report in 2006 that outlined a series of recommendations.

Reasons for the removal, retention and disposal of organs and human tissue can vary, ranging from diagnostic purposes, teaching and research and transplantation. What is very helpful in Senator Quinn’s draft legislation is the clarification dealing with consent being for “permitted” activities for scheduled purposes. Those kinds of safeguards would be necessary in any legislation because harvesting human organs and tissue is a sensitive issue. Harvesting happens at a time when, typically, people have been recently bereaved and are obviously very emotional and distressed. The circumstances of the deceased person may have been very tragic. It is a difficult time to try to establish consent for a procedure as sensitive as this one and we must have adequate safeguards in place. There is growing public concern about possible trafficking in human body parts and any legislation we may introduce in this area must put safeguards in place to ensure this cannot occur. That would be the greatest fear of many relatives of deceased adults and children. It is possible to imagine a system emerging in which human body parts might be trafficked and we must be very careful that the legislation allows no scope for this to happen.

This Bill touches on a number of important issues, one being the consent of children. It was important to address this issue but I am not sure the Bill has fully resolved some of the dilemmas that would arise in obtaining the consent of children to the harvesting or use of their organs after their decease. A young teenager is in a much better position to give informed consent to procedures such as this while a very young child is not. Perhaps some kind of differentiation between categories of children, based on age, might be useful. I would be more comfortable with that.

A helpful part of the Bill concerns qualifying relationships in the context of withholding consent by children and adults. The Bill raises the need for a much greater level of public awareness and education in the area of organ removal and retention. The public must understand to what uses organs are put and there must be much clearer explanation as to the kind of medical research carried out and what some of its possible benefits might be.

We need improved medical education and training in hospitals with a much greater emphasis on communications skills and on the legal and technical issues. Training must be given to personnel in the area of post mortems. One of the reasons the system in Spain is so successful is that there are adequate support services in hospitals for families who find themselves in a position where their consent might be required. We must ensure that if we are to introduce legislation in this area, resources are made available to ensure that proper supports are available.

The issue of disposal of retained organs is very important. The period of retention can often be quite long and we should have very clear protocols around this. The principle of observing the wishes of the family concerning the disposal of organs, and how they should be disposed of, should be established very clearly in any new legislation. There have been difficulties in the past where families have discovered that their children’s organs may have been incinerated in the same way that general hospital waste is incinerated. Very often the wishes of families are that these organs would be re-buried with the child’s body. While it would be important to establish this principle in any legislation, I wish to conclude by again congratulating Senator Quinn on a timely and welcome item of legislation and by expressing the hope that the Government will follow up with its own legislation as quickly as possible, based on a full public consultation process.

I also welcome the Minister of State to the House.  On behalf of the Green Party, I am very happy to move this Bill.  It is quite limited in its scope, which is deliberate.  There is a much wider debate about the appropriateness of certain psychiatric practices and the model that underpins them.  Those of us who have been involved in the mental health services are very aware that the traditional biological or medical model is increasingly being challenged in the field of mental health.  There is a very strong call for its replacement by a much more comprehensive bio-psycho-social model.   This debate is very important because of the treatments prescribed by each model of mental health disorders.  The focus of the Bill is on a couple of procedures that are currently on our statute books and which the Green Party wishes to see amended. 

The scope of our Bill relates to  involuntary procedures that are prescribed under the biological or medical model.  We specifically refer to the practices of psychosurgery and ECT.  Section 1 of the Bill seeks to amend Section 58 of the Mental Health Act 2001, which concerns use of psychosurgery.  Most of us became familiar with the treatment of psychosurgery – commonly known as lobotomies – through the famous film starring Jack Nicholson, One flew over the Cuckoo’s Nest.  Public awareness of the procedure has meant that over time, its use has almost completely died out.  It does not appear to have been used in this State over the last 20 years.  However, it is still left on our statute books and the option to use it still remains.  We are attempting to delete this section in section 1 of our Bill, and to introduce on Committee Stage a prohibition on its use. 

Section 2 of the Bill seeks to amend section 59 of the Mental Health Act 2001, which allows for the involuntary use of ECT in certain circumstances.  We are looking for this section to be deleted and replaced with the following wording.  “A programme of electroconvulsive therapy shall not be administered to a patient unless the patient gives his or her informed consent in writing to the administration of the programme of therapy.”  The issue of consent and informed consent is central to the amendment proposed  today.  The Mental Health Commission rules for 2006, governing the use of electroconvulsive therapy, are very specific on the issue of consent.  These rules state that a patient must be considered capable of giving informed consent for ECT, including anaesthesia, unless there is evidence to the contrary.  They also state that capacity to consent must ensure that the patient can understand the nature of ECT, understand why ECT is being proposed, understand the benefits, risks and alternatives to receiving ECT, understand the broad consequences of not receiving ECT, retain the information long enough to make a decision to receive or not receive ECT, make a free choice to receive ECT and communicate the decision to consent to ECT.  Consent must be received in written form. 

However, in part 2, section 4 of the guidelines entitled “Absence of consent”, it is stated that where a patient is unable to give consent or is unwilling to give consent, Section 59 (1) (b) of the Mental health Act 2001 applies.  This section states: 

Where the patient is unable or unwilling to give such consent, the programme of therapy is approved (in a form specified by the Commission) by the consultant psychiatrist responsible for the care and treatment of the patient and the programme of therapy is also authorised (in a form specified by the Commission) by another consultant psychiatrist following referral of the matter to him or her by the first mentioned psychiatrist. 

A form 16, entitled “Treatment without consent Electro Convulsive Therapy Involuntary Patient (Adult)” must be completed by both consultant psychiatrists and placed in the patient’s clinical file. 

Our Bill seeks to prohibit the involuntary administration of ECT to a patient.  We will propose on Committee Stage that during a period before he or she becomes unwell, and following a full and comprehensive explanation of the procedure of ECT, a patient will be asked to sign an advanced directive, giving or refusing consent for the ECT procedure on them at any stage in the future.  We accept that the advanced directive could contain a provision where the patient is empowered to name an individual to make a decision on his or her behalf, in the event that he or she was likely to become unwell.  However, this safeguard would deal with the issue of consent and ensure that the patient was consenting in a situation where he or she understood the implications of the decision, and was not under the influence of heavy doses of anti-psychotic or anti-depression drugs while making the decision. 

Why is the issue of informed consent by patients to the use of electro convulsive therapy on them so important?  Electro convulsive therapy is a procedure that  is primarily used for patients suffering from severe depression – in some cases psychotic depression.  It is also used for patients with catatonia or mania.  It is certainly a highly controversial treatment, and while it is supported by many in the traditional psychiatric profession, it is bitterly opposed by many patients and their families as well as a growing number of mental health professionals.  

According to a recent article by Dr. Brian O’Shea in Irish Psychiatrist, October-November 2007, the use of electro convulsive therapy in Ireland was first officially reported in 2003.  He refers to a study by Daly et. al., which stated that in 2003 in Ireland, 859 had received this treatment, although the use of ECT had varied per region.  The figure was 38.7 people per 100,000 in the southern health board region compared to 8.4 per 100,000 in the south-eastern health board region.  This issue raises two important questions.  Why is it that, given the controversial nature of electro convulsive therapy, no official records have been available for those investigating and concerned about its use, until 2003?  The second issue that arises is why there is such a level of variability between the different health board regions in terms of the use of electro convulsive therapy.  This is something that must be investigated further by the Department of Health and Children.  I have no doubt that, following our debate today, this type of investigation will occur.  

Most individuals undergo a course of between four and six treatments of electro convulsive therapy, usually two per week.  The procedure is reported to work quickly, although its effect may not last longer than one month.  The literature reports that it is usual to have a memory blank for the time surrounding a course of electro convulsive therapy.  The article I referred to by Dr. Brian O’Shea makes a couple of very worrying remarks about the use of electro convulsive therapy.  It opens with a quotation which basically questions whether electro convulsive therapy should be a treatment of last resort and seems to be encouraging a much more widespread use of it.  There are other comments in the article, however, which should cause concern.  Dr. O’Shea says that dementia per se is not a contraindication to the use of electro convulsive therapy, although confusion among dementia patients after ECT can be severe and prolonged.  He says Down’s syndrome patients can also be given ECT and mentions that psychiatrists do not consider age to be a contraindication in giving electro convulsive therapy.  He refers to a study that predicts an increased use of electro convulsive therapy in elderly depressives.  Another study he refers to stated that electro convulsive therapy might actually be under-used among the intellectually disabled.  

There is a passing reference in Dr. O’Shea’s article to the possible side-effects of electro convulsive therapy.  These are side-effects such as amnesia, fractured limb  bones, dislocated jaw, broken teeth, bitten tongue, myocardial infarction and angina.  There is some reference to cognitive patients who have undergone electro convulsive therapy, and who experienced cognitive difficulties afterwards.  Again, not very much attention is given to that issue in the article.  However, I should like to read a short passage from a psychiatrist who has been a very vocal critic of the practice of electro convulsive therapy, Dr. Peter Breggin.  This highlights why there is a campaign among those who have experienced electro convulsive therapy and object strongly to its involuntary use, in particular, Dr Breggin writes as follows:  

It is impossible to find words that are sufficient to communicate the tragic personal cost to many of the patients who undergo ECT.  In my own experience, spanning more than thirty years, I have encountered dozens of individuals whose lives have been wrecked by the effects of ECT on their mental function…Many have been left with such devastating retrograde amnesia that they can no longer function as professional persons or homemakers.  Years of professional training and other key aspects of their lives have been obliterated.  Even portions of their past that they can remember may seem remote and alien as if they are watching a movie rather than recalling their own lives.  Often they have been impaired in their ongoing ability to focus or pay attention, to concentrate, to make sense out of complex situations, to remember names and places, to learn anything new, to find their way around and to read and think effectively.  Frequently they have become irritable and easily frustrated, emotionally unstable and shallow in their ability to feel.  Often they feel depressed and even suicidal over the loss of their mental function.  In short, they have shown all the typical signs of close head injury, including frontal and temporal lobe dysfunction.  Often their families have been irreparably damaged by their inability to function as wage earners, husbands or wives, mothers or fathers.  A treatment that can cause such devastation, while producing such limited and questionable results, has no place in the practice of medicine.  

Having looked at the research in the area of electro convulsive therapy in preparing for our Private Members’ Bill today, it seems to me that there is a great deal of uncertainty as to why it is that the ECT procedure is effective at all  - where it is effective in some patients.  Given the scientific uncertainty surrounding it, the point that the Green Party is making is that its use without the consent of the patient must be prevented until we have the scientific knowledge that can explain how and why it works and on what patients it can be effective. I move the motion and ask other Members of the House to support it.

Reference was made to the ‘Prime Time’ programme on the issue of drugs. The message I took from that was that policy makers and politicians need to be courageous in their approach to the problem of tacking drug abuse and substance abuse generally in society because it appears the older prohibition model has its limits. If we are to seriously tackle some of the social and crime related problems attached to substance abuse, we may have to look at a model other than prohibition. It does not always have huge social support and much public education and so on is needed. I hope that in the new drugs strategy that thinking will be reflected. 

I will be quoting from the recommendations of the Merchants Quay Project which has developed much expertise in the area of working with drug abusers. It has welcomed the inclusion of alcohol into a single national drugs strategy. Most members will be aware that a motion was agreed by the Seanad last year on the issue of alcohol abuse in society. It is a good idea to integrate the issue of alcohol. 

Alcohol is the drug of choice for many Irish people. We do not think of it as a drug because we use it so widely in so many social contexts. It is one that needs to be addressed within the drugs strategy in the same way as other substances that are being abused. The point made by the Merchants Quay Project is that appropriate resources and funding need to be provided to facilitate service development and staff upskilling and not to assume that alcohol can be included and that the resources that have been used to tackle other substances can be automatically applied to address the issue of alcohol abuse. 

The submission from the Merchants Quay Project highlights some of the structural and reporting mechanism changes it would like to see. These are sensible suggestions. It seeks clear formal mechanisms for ongoing consultation with drug users and users of drug services. That would be a welcome element of any new drugs strategy. The Minister of State and his predecessor have been involved in the national consultation process which has involved consulting former drug addicts and those using and providing State services, as well as medical experts. The expertise and the experience that substance abusers have of the services is invaluable in terms of ongoing evaluation of the services. That those clear structures would be established as part of the process of implementing the new drugs strategy would be welcome. The timely reporting of data submitted to the national treatment reporting system has been mentioned. Timely reporting is important. It is impossible to assess how the strategy is being implemented and to respond to new trends emerging unless that data are available. 

The Merchants Quay Project has called for needle exchange to be included and counted as a treatment intervention within the national drug treatment reporting system. I hope the Minister will consider that recommendation and also the establishment of a drug trend monitoring system as a matter or priority. The level of cocaine use has exploded in recent years. It appears the profile of people who abuse cocaine is very different from that of those who abuse heroin and so on. Research has identified that it is predominantly the 15 to 34 age group who abuse cocaine. The side effects and the problems associated with cocaine use are different from other drugs. The drug trend monitoring system is a good idea and it is to be hoped that it is one that will be established with the new drugs strategy. 

The issue of funding has also been highlighted by the Merchants Quay Project. This is the key issue. It states that the following are essential in regard to funding. There should be a single funding channel for the national drugs strategy, annual funding for the regional development task force and also the local development drugs task force and funding for projects for three years.  There should be ring-fenced budgets for each pillar of the national drugs strategy, full cost recovery for projects paid in advance and a commitment to multi-annual funding to facilitate proactive service planning and delivery. I realise that in difficult budgetary situations it is not always possible to do that but that is the ideal in terms of funding certainty.  It also seeks regular reporting on the progress of the strategy. I am interested to hear whether the Minister of State has plans in regard to regular reporting. It also recommends that the Oireachtas committee on drugs link in to existing national drugs strategy structures.

In the area of harm reduction, some of the suggestions made by the Merchants Quay Project are interesting. In terms of the new thinking, one of its new proposals is that the new drugs strategy would look at establishing a pilot safer injecting facility or facilities in Dublin city and, perhaps, in one or two other cities with a view to assessing the impact of such a service on drug related harm.  Certainly the “Prime Time” programme, which looked at the issue of drug abuse, featured a number of models of this kind, based in the Netherlands, and which appeared to be successful in terms of harm reduction. While they do not cure the problem or wean the users off the drugs, they are injecting in a much safer way and avoid many of the problems, infections and diseases that go with hard drug abuse.

The Merchants Quay Project is also seeking a full spectrum of outreach services for hard-to-reach groups, better access to primary health care for drug users and more immediate access to mental health services for drug users experiencing acute mental health issues. I hope the Minister of State will take all these points on boards in putting the new strategy together.

The Minister of State mentioned prevention in his contribution. The Green Party believe the targeted Garda anti-drug use programmes in schools and third level institutions are very important.  We hope the programmes will continue and that the Garda will be properly resourced to provide them. We also recommend that the Garda be given search powers along the lines of the new random breath testing model for drink driving to allow for random searches at particular places, times and events where senior Garda believe there is a risk of drugs being present.