Health Bill, 1947—Committee Stage (Resumed).

Debate resumed on amendment No. 16.

The Minister seems to be banking on the feeling that there is power to require compulsory attendance at school. He ought to look up the decision given by the Supreme Court when the last School Attendance Bill was declared unconstitutional. It was sent to the Supreme Court on a net point in connection with the Bill, but a judgment was given which showed that there was no power under the Constitution to require compulsory attendance at school. It was declared that the only power the Government had under the Constitution was, under Article 42 (3) 2º, to set a minimum standard of education moral, intellectual and social, that these were the only compulsory powers the Government had, that it had no constitutional power to require compulsory attendance at school. If the Minister is banking on a misunderstanding on that matter, to think that he may have compulsory powers analogous to that to operate this section, he would do well to refer to that matter.

I would recall to him that, while only one point in the School Attendance Bill was referred to the Supreme Court at that time, the Bill, although it contained provisions that were considered to be very necessary, has never been brought before the House since then. The Minister suggested that there was very general acceptance of the idea of compulsory school attendance in this country. That is so; and the question of any difficulty in connection with it would never have been raised if undue interference with the rights of people in connection with the schooling of their children was not forced through this House, in spite of general warnings from various Parties in the House. An element of compulsion of a particular kind was brought in, in a way that drove the Supreme Court, when the matter was brought before it, to examine the whole question and to show the constitutional weakness there was in the Bill.

Now the Minister is apparently likely to find himself up against this— that by persisting in a particular type of compulsion in connection with medical inspection, he may find that there will fall from under his feet the authority that would come from a general and harmonious acceptance of a particular position by the people themselves. That may fall from under his feet because he is proceeding to provide a service and to demand that that service be accepted by the people under a compulsion which the Minister may find he has no constitutional power to require.

I rather sympathise with the Minister in the position in which he has got himself. This whole business of compulsion started with Section 87 of the unfortunate Public Health Act, 1945, when, with regard to the medical treatment of school children, in respect of which there was an educational movement, an excellent State service provided and a more extensive and voluntary acceptance of that service and a seeking after that service, the Parliamentary Secretary in charge of that Bill of 1945 brought in the idea of compulsion. Section 87 of the Public Health Bill, 1945, read:—

"(1) The parent of a child shall submit the child to any medical inspection provided for the child or at the child's school pursuant to the Public Health (Medical Treatment of Children) (Ireland) Act, 1919, or Section 85 of this Act.

(2) A person who contravenes sub-section (1) of this section shall be guilty of an offence under this section and shall be liable on summary conviction thereof in the case of a first offence, to a fine not exceeding £5 or, in the case of a second or any subsequent offence, to a fine not exceeding £10.

(3) An offence under this section may be prosecuted by the county authority who provided the relevant medical inspection."

The Minister finds himself asked to handle that particular idea, and, in the new section, he gives just one outlet, that is, that where a person does not wish to submit to it, he is offered the alternative of getting whatever doctor he likes and having his child examined, or his two, three, four or five children examined, perhaps twice a year. But, unfortunately, the original sin is there at the back of the whole idea and the Minister has to extricate himself from it.

That is the position in which he finds himself. He has a legacy of original sin from that section, and however awkward the Minister may find his position in having to endeavour to stand over the idea, I think he will realise, if he stands back from the situation, that much of what has been said here is quite correct, that is, that if the service is provided and the educational work donepari passu with the improvement and extension of the service, there will be more work done in a voluntary way than the service to-day, next year or the year after, can do. He will find that, as the service grows and is capable of doing all the work there is to be done, compulsion will not be necessary and that compulsion introduced to-day will only prevent the voluntary work which could and would be done being done to the extent to which it might be done and will merely walk the Minister up against constitutional difficulties, difficulties with regard to liberty and freedom which the School Attendance Act walked everybody up against, a situation which has never yet been faced and which is accepted only because of the commonsense of the people. The people even acquiesce in the cases brought before the District Court to-day for non-compliance with the School Attendance Act, because quite a number of people feel that it is reasonable and because the people being proceeded against are so poor and so far away from an understanding of things that they do not know that the Supreme Court has decided that there is no constitutional power in the State to compel the attendance at school of any child.

I feel that I must press this amendment. The Minister says that to pass the amendment is to destroy the whole section. I think it would be healthier to destroy the whole section by passing the amendment than to destroy the whole idea by bringing the Minister up against either the reaction of public opinion against this proposal or a declaration by the Supreme Court that what he proposed to do was unconstitutional and that the Legislature had no power to require people to surrender their children for medical examination and treatment in this way.

Question:—"That the words proposed to be deleted, stand"—put.
The Committee divided: Tá, 65; Níl, 28.

  • Aiken, Frank.
  • Allen, Denis.
  • Bartley, Gerald.
  • Beegan, Patrick.
  • Blaney, Neal.
  • Boland, Gerald.
  • Bourke, Dan.
  • Brady, Brian.
  • Breathnach, Cormac.
  • Brennan, Martin.
  • Brennan, Thomas.
  • Breslin, Cormac.
  • Buckley, Seán.
  • Burke, Patrick (County Dublin).
  • Butler, Bernard.
  • Carter, Thomas.
  • Childers, Erskine H.
  • Colley, Harry.
  • Crowley, Honor Mary.
  • Derrig, Thomas.
  • De Valera, Eamon.
  • De Valera, Vivion.
  • Everett, James.
  • Fogarty, Andrew.
  • Friel, John.
  • Gorry, Patrick J.
  • Harris, Thomas.
  • Hilliard, Michael.
  • Humphreys, Francis.
  • Keyes, Michael.
  • Killilea, Mark.
  • Kilroy, James.
  • Kissane, Eamon.
  • Lemass, Seán F.
  • Little, Patrick J.
  • Loughman, Frank.
  • Lydon, Michael F.
  • Lynch James B.
  • McAuliffe, Patrick.
  • McCann, John.
  • McCarthy, Seán.
  • McEllistrim, Thomas.
  • McGrath, Patrick.
  • Moran, Michael.
  • Moylan, Seán.
  • Murphy, Timothy J.
  • O'Grady, Seán.
  • O'Leary, John.
  • O'Loghlen, Peter J.
  • O'Reilly, Matthew.
  • O'Sullivan, Martin.
  • Rice, Bridget M.
  • Ruttledge, Patrick J.
  • Ryan, James.
  • Ryan, Mary B.
  • Ryan, Robert.
  • Shanahan, Patrick.
  • Sheldon, William A. W.
  • Skinner, Leo B.
  • Smith, Patrick.
  • Spring, Daniel.
  • Traynor, Oscar.
  • Ua Donnchadha, Dómhnall.
  • Walsh, Laurence.
  • Walsh, Richard.


  • Beirne, John.
  • Blowick, Joseph.
  • Broderick, William J.
  • Browne, Patrick.
  • Byrne, Alfred.
  • Cafferky, Dominick.
  • Coburn, James.
  • Cogan, Patrick.
  • Commons, Bernard.
  • Coogan, Eamonn.
  • Costello, John A.
  • Dillon, James M.
  • Dockrell, Henry M.
  • Dockrell, Maurice E.
  • Doyle, Peadar S.
  • Fagan, Charles.
  • Finucane, Patrick.
  • Giles, Patrick.
  • Halliden, Patrick J.
  • Keating, John.
  • MacEoin, Seán.
  • Mulcahy, Richard.
  • O'Driscoll, Patrick F.
  • O'Higgins, Thomas F.
  • Reidy, James.
  • Reynolds, Mary.
  • Roddy, Martin.
  • Rogers, Patrick J.
Tellers:— Tá: Deputies Kissane and B. Brady; Níl: Deputies P.S. Doyle and Browne.
Question declared carried.

I move amendment No. 17:

To delete sub-section (8) of the proposed new Section 21 (amendment No. 14).

Sub-section (8) says that an offence under this section may be prosecuted by the health authority which provided the medical inspection. The health authority may be either the county manager, the county medical officer of health, or perhaps some subordinate officer of the county medical officer of health. We have had the position in relation to those who cut turf during the emergency that, in a rather discriminating way, a certain number of valuations were increased here and there throughout the country, without its being done in other parts of the country, entirely on the initiative of some local person. We have had the Minister for Local Government washing his hands of any responsibility in the matter and saying that these people are only carrying out the law.

If compulsion of this particular kind —I have yet to be clear as to the extent of the compulsion and what its effect will be—will be imposed either in particular districts or particular classes of districts or against particular classes of people, under whatever regulations the Minister may make, the Minister ought not to be allowed to wash his hands of responsibility in relation to what is being done under the Act. I think it is not proper that, with so much doubt as to what is going to be done and as to what the effect of it will be, we should relieve the Minister of all responsibility and fix the local manager or the county medical officer of health with complete statutory responsibility for carrying out the provisions of this section, whatever they may be ultimately. Therefore, I move the deletion of the sub-section. The House can consider subsequently who will be the prosecuting authority in this matter, but, whoever the prosecuting authority may be, the Minister for the time being should not be able to wash his hands of joint responsibility.

It is the health authorities who carry out all the provisions of this Bill and they would appear to me to be the proper authorities to deal with this section the same as every other section.

Will the Minister give the House the benefit of his information as to the individual or individuals who will be responsible for carrying prosecutions successfully to a conclusion? The health authority is a rather vague affair. It would be the manager or the county council. But there is some individual who will have to attend court, who will have to give evidence on oath, who will have to produce records and satisfy the court that the conditions of the Act were complied with, namely, that the parents had due notice of the time and place of inspection. Who will that individual be? There is no member of my profession who has any ambition to find himself a head constable at the end of his days, and that is exactly what you are going to make out of each one of us, because it is obvious that the school medical inspector is the only person who can, with knowledge that will be acceptable as evidence in a court of law, give evidence as to who was or was not medically examined at a particular place at a particular time.

If there is any serious intention behind this particular sub-section, and if it is not just a bluff, then we will spend the rest of our official existence in district courthouses. Anyone who has had any experience of trying to carry a prosecution under any of the recent Acts—the Milk and Dairies Act or any one of those Acts—knows it is easy enough to go to court, but then you find yourself for six or seven weeks going from one courthouse to another. This is what I described before as interfering with a machine that is already going well. The Minister must have had advice on this point and I would like him to tell us what steps will be taken, what procedure will be followed and what instrument will be used in proving these cases before the court.

May I inquire of the Deputy if he has looked at Part IX, which provides for the enforcement of the measure? Whatever the Minister's intentions may be, it is open to the local authority to proceed under paragraph (f) of Section 85 to appoint an officer of a sanitary authority, in writing, to be an authorised officer for the purpose of the enforcement of the Act. That may mean any unemployed warble fly inspector. He may be appointed an enforcement officer, but the Deputy need not be apprehensive, because if the ex-warble fly inspector's qualifications should seem to be inadequate this Bill proposes to give him powers to compensate for the inadequacy of his professional equipment.

The ex-warble fly inspector can proceed to you house and there address a series of questions to you. If you do not answer them to his satisfaction, and produce independent proof of the truth of your replies, he can arrest you and remove you to the local Garda station, there to be detained for 24 hours. Should, however, the offending parent have the impudence not to be in his house when the ex-warble fly inspector arrives, or should the ex-warble fly inspector suspect that, when the parent emerges with six children for display, there is a seventh concealed upon the premises, under Section 88 he can break into the premises, but he must produce for inspection the letter which has transmogrified him from being a warble fly inspector into being an enforcement officer for the purposes of this Act, and he must confine his breaking-in activities to the hours of the day between 9 a.m. and 6 p.m.

If you attempt to deter him from breaking down the door of your house, if you attempt to prevent him, you commit a criminal offence, on summary conviction for which you may be fined £20. If the ex-warble fly inspector finds that his accoutrements are insufficient to grapple with the demands made upon him, he can command the attendance of a Civic Guard, who must, in uniform, at his behest, help to break into your house and, if needs be, to drag you to the police station, there to detain you for 24 hours. That is provided for in Section 89. Section 90 reaffirms that, but do not imagine, if you have got a document expressly exempting you from a demand made upon you by the ex-warble fly inspector, that that will be any protection, because you must prove to him, since the onus of proof is on you, that the document you produce—and this is provided for under Section 91—is genuine and valid.

I do not think Deputy Dr. O'Higgins need apprehend that the medical profession will be troubled with the enforcement of this Bill. There is abundant power to provide a displaced warble fly inspector with compensatory employment. Mind you, we are going to vote for giving a county manager of any county in Ireland power to delegate the powers set out from Section 85 to Section 91 to any authorised servant of the public authority. How in the name of Providence can any rational Deputy of the Fianna Fáil or Labour Party stand for the proposition that any person receiving the primary written authority here provided for shall thereafter be invested with the rights set out in the sections to which I have just referred? It is no use saying, as people so often say, that in theory these things can be done but they will not be done. If they will not be done, this House should not give power to anybody to do them. We have no right to proceed on the presumption that the exercise of these authorities and powers will be prudent, moderate and sensible. We have no right to deliver the people for whom we stand as trustees into the power of any reckless man who would, were he given powers such as these, trespass on his neighbour's liberties. It is perfectly manifest from the terms of Section 85 that the Minister himself does not know who is to be the enforcement officer. What is sinister and evil is that he can consent to the proposition that a competent enforcement officer might be, could be, a displaced warble fly inspector. It is humiliating to think that this Dáil should be a Party to any such enactment.

Deputy Dr. O'Higgins wants to know who will be the enforcement officer. The health authority will look after that matter, in appointing whoever is responsible. The district medical officer in the first instance will be responsible. When this scheme is working properly, he will have a nurse and assistants of that type with him. If this section is to be enforced, the person who goes to court to assist in the prosecution will be, I presume, some person who will have some knowledge of the Bill. I do not think that it should be assumed that there will be any more objection to appearing in court in connection with this section than in connection with any of the other Acts. Medical officers have to appear at the moment in connection with other prosecutions such as those connected with the Milk Acts. I do not think it is worth while following the fantastic arguments of Deputy Dillon because the whole basis of his argument is wrong. The section he quoted deals with premises. There is no use in talking about an ex-warble fly inspector bringing a case to court. That just goes to show that Deputy Dillon cannot make a case against the section except by this fantastic propaganda.

Do you deny that an ex-warble fly inspector may be an authorised doctor?

It does not apply to offences of this kind. The Deputy, of course, by his rhetoric can make it apply to anything but I am not going to enter into fantastic arguments of that kind. I thought, as I said before, that we would settle down to a sensible discussion of this Bill but this type of argument is propaganda.

I think it is distinctly relevant and certainly it is a commonsense attitude towards the Bill——

If that is commonsense, we had better drop commonsense.

Would the Minister not interrupt in the middle of a sentence but keep his interruption to the end? As I was saying it is certainly a commonsense approach to the Bill to inquire what is the human machinery that will be used for court purposes. The Minister says, presumably the nurse or the district medical officer. He goes further and says that the district medical officer or any doctor should have no greater objection to going into court in that type of case than in any other type of case. The Minister apparently missed completely the point I was endeavouring to make. That may be due to my inability to express myself clearly or it may not, but the illustration I gave the Minister was that of a medical officer who was doing a number of schools or one very big school. There is a very large number of children absent. He cannot or should not discriminate as to the parent he will prosecute and the parent he will miss. If he is doing his duty conscientiously he will prosecute the whole lot or prosecute none at all.

We shall say that there are 40 prosecuted in a particular area. A number may employ a solicitor or counsel to represent them. To deal with these 40 prosecutions, we have the district court where a man sits for a day here, a day there and another day 12 or 15 miles away. He will not take any more than three or four of these cases on any court day. He will not take any more than two, if they are adequately and competently defended. To deal with that one group of absentees from one school, you will have that man going from court to court for six months. People may say that that is an exaggeration but I had an experience twice of going to court on comparatively trivial matters in connection with public health. The case was adjourned from one court to another and from one area to another. There were witnesses from one side or the other absent on some of these occasions. Other witnesses were called for and the merry-go-round went on for weeks. Then we found ourselves in the High Court in Dublin, engrossed in conferences with junior and senior counsel and all the rest of it until very late hours at night. That was all over a trivial minor thing. Either we are employed to carry out our professional duties or we are not. There is a waste of public funds if we are paid to do a specialised type of professional work and we are going to become a kind of county prosecutor. I cannot see any other machinery for the prosecution. I cannot see, no matter who else you may have as a prosecuting officer or as a legal officer, anybody but the examining medical officer who can give the type of evidence that would be required in a court of law in order to prove that the person in question was absent from the school medical examination on a particular day. The school teacher does not keep this kind of record. The person that is responsible for keeping the records of those present and those not present is the school medical examiner. I can see immense difficulty in operating that particular section. I can see serious waste of professional time and I cannot see that on the other side there is any commensurate gain. I said before that the scheme is going on well. It may not be going excellently but it is going on well and all this coercion is not going to make it go any better but will create antagonisms and loss of time. It will not improve matters

What does the Minister mean by saying that Part IX of the Bill does not apply?

The Deputy must know that it only applies where it does apply. For instance, where the Deputy talks about breaking into premises, the question of breaking in does not arise unless something is done on or in connection with the premises in connection with which there is a contravention of the Act. It refers to the premises. Something in connection with the premises must be done. That is only an example.

Wait a moment. I will try to find out what the truth is. The enforcement chapter of this Bill lays down the machinery to be employed by the various authorities concerned for the enforcement of the provisions of the Bill. Section 85 sets out the several types of persons who may be appointed an authorised person for the purpose of enforcement of the provisions of the Bill. Section 86 limits him to the area for which he is appointed. Section 87 entitles that authorised person to go to a parent— does not it—who he believes has failed to comply with the requirements of the Act. Is not that true?

And to ask the person his name and address.

You have that already, of course.

If the parent fails or refuses to state his name and address in compliance with that authorised person's demand, states a name or address or produces corroborative evidence which the authorised person has reasonable grounds for believing to be false or misleading, the authorised person may detain the parent and bring him to the nearest Garda station. Is that true or is it false? Is not that there? The authorised person may detain the parent in the Garda station for 24 hours. The authorised person may use force, if necessary, to bring the parent to the station and to keep him there and the parent who refuses to give his name or address or gives, in purported compliance with the requirements of this section, an address or corroborative evidence which is false or misleading, or resists being detained, commits a criminal offence. Is not that also in it?

Now we come to Section 88, under which an authorised person may enter premises for the purpose of ascertaining whether there is or has been on or in connection with the premises any contravention of any provision of this Act, the extent and nature of any such contravention, or whether circumstances exist on or in connection with the premises which would require any action to be taken under this Act or the regulations made thereunder. An authorised officer shall not enter any premises under this section unless he produces for inspection by the person in occupation or in charge of the permises his appointment in writing as an authorised officer. He may not enter except between 9 a.m. and 6 p.m. The section applies to a tent, van, shed, hut, vessel or aircraft in like manner as it applies to premises. He may seek under Section 89 assistance from the Guards. The Guards are required to collaborate with him and he may enter by force.

Suppose he has reasonable grounds for believing that a parent, on being called upon to produce her children to give corroborative evidence of some kind or another, has concealed some material fact in the house, has not an enforcement officer, under Sections 88, 89 and 90, power to break into her house if he believes it necessary to do that in order to get the information he requires? Has not he? What is the point of denying to the House what is in the Bill when Deputies, if they care to read it, can read it for themselves?

The meaning of Section 91 is not easy to determine, but surely it is without precedent to say that if a person produces a permit, licence or exemption under this Act, its production is insufficient and that the onus is on him to prove that it is a valid and genuine document? That is just put in for good weight. I have never seen the like of that section in any other Act passed in this House.

What I am directing the attention of the House to is that every word I have said to describe what an authorised person may do for the enforcement of the provisions set out in Sections 18, 19, 20 and 21, is strictly true and it is not at all outside the bounds of possibility that, on the county medical officer of health or the dispensary doctor pointing out that it will be physically impossible for him to examine the children and to attend at the district court in order to prosecute defaulters, the county manager will appoint persons of the general standard of warble fly inspectors and attach them as sort of clerks to the examining doctors and constitute them authorised persons for the purpose of the Act and to do the kind of police work that Deputy Dr. O'Higgins has referred to and which he rightly suggests doctors in rural Ireland would bitterly resent being called upon to do.

I challenge the Minister now to deny that, if the county manager did deem it desirable to appoint a person like an ex-warble fly inspector as a sort of pseudo-clerk, just for the purpose of sparing the doctor the chores outlined by Deputy Dr. O'Higgins in the event of a prosecution, he would have all the powers I have described in Part IX of this Bill. Maybe the Minister did not mean that but that is certainly what the Bill says and, if this Dáil enacts that, this Dáil is daft.

Question—"That the words proposed to be deleted stand"—put and declared carried.

On the section, Sir——

We have amendment No. 14, which will substitute that section.

Amendment No. 14 has already been passed.

No. It has been moved.

The position was that we accepted amendment No. 14 as replacing Section 21 and that I moved amendment No. 17 to delete sub-section (8) of the new section.

Amendment No. 14 has not been accepted yet, Deputy.

The process is all the same.

That is a ministerial amendment.

We discussed amendments Nos. 15, 16 and 17 as an amendment to amendment No. 14.

Amendment No. 14 was discussed with 15, 16 and 17.

When No. 14 is put in to replace No. 21, will No. 14 be open for general discussion? If not, I want to speak on No. 14.

I think I would prefer to let the Minister or the Deputy speak on Section 21 as it stands. Amendment No. 14 is before the House.

In the event of that amendment being carried, do we then proceed to discuss the section which has been inserted in the Bill in lieu of 21?

Section 21 goes then. Amendment No. 14 is before the House at the moment. It does not become a section until it is carried. It is an amendment at present.

On a point of order, once that section is passed will you not then have to put it as a section to the Bill?

I am putting it to the House as amendment No. 14, Deputy, and, as a consequence of the acceptance of that amendment by the House, Section 21 falls and the other moves automatically into its place without any discussion.

To get us all out of the difficulty in which we are at the moment we will discuss amendment No. 14 as if we had not heard of it before and as if it was before us now as a section. The position now is that we are back where we were at the beginning of last year when dealing with Public Health Bill, 1945, and that we are really back into the spirit in which we were forced to discuss that Bill. The Minister tells us now that there is going to be compulsory inspection of children from the age of one plus to 16 years of age, that a State medical service will be set up for the purpose and that if people resist sending their children to the doctors on the State medical service for this twice a year examination they must provide a medical certificate from some other doctor for each child concerned—probably every six months, the Minister says—to the effect that the child has been examined by some other doctor. This is not a proposal put forward in the interests of public health. This is a proposal put forward in the interests of the personal health of the individual. In the uncompromising spirit in which the Minister puts it before us now this is a dictatorial, totalitarian approach to the individual which is utterly contrary not only to the spirit but to the letter of the Constitution.

Hear, hear!

There is not a proposal to invade for personal health purposes the privacy of the life or of the person above 16 years of age but there is a proposal to make parents responsible for subjecting their children either to the examination of State medical officers or to the examination of some private medical officer whom they will select, twice a year. It is an outlandish and a fantastic position. I sympathise to some extent with the Minister for the position into which he has slipped from the brutal foundations of the Public Health Act of 1945. I think the Minister should stand back from that situation and face the situation which is now disclosed. He has indicated that he has already set up an Advisory Council of Health. He has indicated for what purpose such a council has been set up. I can quite imagine that it is intended to advise the Minister on various matters in relation to public health but I also think it is quite conceivable that he intends it to advise him with regard to matters referring to personal health generally. I would like to ask the Minister if he has in any way consulted the members of the medical profession whom he has already asked to act on that body with regard to the provisions of this amendment or of this section. I feel that if he has not it would be an economy of Parliamentary time in the first instance and it would be an economy of something more. It would be an economy of that which enables us to have clear understanding and harmonious discussion here among ourselves. There would be that economy if the Minister would report progress on this Bill until he has had some discussion with the Advisory Medical Council he speaks about. Early to-day he indicated on my amendment No. 15 that he did not think the medical profession generally would give a certificate of the kind which I suggested might be given, that is, a certificate from a doctor in respect of a child to the effect that the child was under his general care and supervision. The Minister may be expressing that as an opinion of his own or he may have been in consultation with the advisory council on the matter but I plead with him to step back a little from the atmosphere that has been created by the things that have been elucidated in the discussion here to-day and face what he thinks could be done for the personal health of the individuals in the community through the basis of the medical inspection and treatment of children. But to proceed in the spirit in which the Minister has suggested he is proceeding is to bring us into a very disastrous position from the point of view of this very excellent service and of the very necessary work that requires to be done in an educational, advisory and service way for the public health of individuals in their earlier years.

An Ceann Comhairle resumed the Chair.

The arrogant impudence of bureaucracy is an interesting study. Can you conceive the mentality of a man in our community who seeks to establish by law that, unless parents submit their children to a medical examination when they are told to do so by the county manager of the district in which they live, they are to be fined and imprisoned? There is no imprisonment provided in the Bill, but suppose you cannot afford to pay your fine, what is going to happen? There is no "tick" provided by the criminal courts in this country and you go to jail. It leaves me inarticulate——

——when I see a man like Deputy Butler, of Dublin, declaring that he subscribes to the view that unless a parent in this country submits his child to be examined twice a year——

I do not think the Deputy has spoken on this matter.

No, but he has voted on it and trotted out like a man.

The Deputy is purporting to quote what he said.

I said that he subscribed to the proposition that a citizen of this State, unless he submits his child to a medical examination by an officer appointed by the local authority or approved by him twice a year, or more frequently as the county manager may from time to time determine, comes within the description of a person who constitutes, for the purposes of the Constitution, an exceptional case where parents, for physical or moral reasons, fail in their duty towards their children. That is what you are asked to accept.

That is pulling the long bow.

That is what staggers me. The Minister for Health rose here in this House and said that it was under that provision in Section 42 that he proposes to reconcile this Bill with the provisions of the Constitution. Is that not so? The Deputy knows that the Minister made that case on the floor of the House to-day. Well may the Deputy raise his eyebrows. It is daft; it is crazy. I do not believe that the Minister himself believes in it. It is the child of the power-crazed bureaucrat. Who can conceivably imagine that this Dáil would declare that the county manager of the county in which we live has the right to take from us the discretion as to when and how the health of our own children should be protected?

There is no suggestion in connection with this section that the child is suffering from an infectious disease and that it is, therefore, necessary for the protection of his neighbours to impose certain requirements upon him. That is all attended to in another part of the Bill. This section is designed not for the protection of the child's neighbours but for the child himself, so that the man and woman who brought the child into the world are now to be set aside in favour of the county manager.

For the protection of the community.

No. I want the Deputy to face the facts. Chapter IV of this Bill is devoted to infectious diseases. It deals with the dangers that arise from a person who is a victim of an infectious disease and will not submit voluntarily to the rational precautions necessary to ensure that he will not communicate the disease to his neighbour. That is another question which we can discuss on its merits when we reach it, but that has got nothing to do with Part III, which deals with the mother and child service. Its purpose is to provide free of all charge ante-natal and post-natal care for the mother, and medical attention for the child of every parent in this country up to the age of 16. Now, it is one thing to make certain amenities freely available and to say to the community at large, that anyone, rich or poor, wise or foolish, can avail of these services if they want them free of all cost and free from all charges. That is not what we are asked to do. We are asked to provide the service and then we are asked to authorise the county manager——

The Deputy is repeating himself.

Even if I am, Deputy Butler does not know it.

That does not matter. There is a rule against repetition.

We are asked to authorise the city manager of this city to go into Deputy Butler's house and order him to submit his children under 16 years of age to such medical examination, not that Deputy Butler thinks it necessary but that the city manager does. Originally, it might have appeared to many of us that these sections were designed to enable a county manager of a public health authority to deal with tinkers and vagrants and people like that, who through ignorance or eccentricity could not be expected to understand the value of the public health service; but when we came to the penalty sections which provided for a penalty of £5, Deputy de Valera intervened and said that he wanted the penalties raised. He wanted to ensure that they would be equally coercive on the rich and poor alike—a sound general principle. I asked him then: "Do you envisage the use of these powers against a person who is rational, educated, fully competent to understand——"

If the Deputy asks that twice, he is repeating himself.

I am not repeating myself, Sir, on this section. I have not mentioned this matter before on this section.

On the amendments to which the section refers.

We are dealing with the section itself now and I am entitled to make this case. I asked him: "Do you mean that the county manager would be entitled to go to a person of the intellectual equipment and experience of the Minister for Industry and Commerce and order him to submit his children and, if the Minister for Industry and Commerce replied: ‘I have heard ample medical opinion on the desirability of having these children medically examined and, having weighed all the opinion carefully in my mind, with the special knowledge I have of my own child, I have decided to reject the advice of having the child examined at the present time and postpone it; the child is a bit nervous at the present time and I think better to postpone it'; under this Bill the Minister for Industry and Commerce commits an offence and can be prosecuted, fined and, if he does not pay the fine, put in jail?"

The Deputy is not suggesting that he should have some advantage over the tinker, the tailor, the soldier or the sailor?

No, but I am suggesting that it is fantastic to go to a parent who is well able himself to weigh up intelligently, rationally and competently medical opinion and, when in the light of that opinion he has taken his decision as a responsible parent, to authorise the county manager to overrule him and to go into his house and have the child examined in spite of him.

Suppose Deputies do believe that that is desirable—and I cannot conceive any Christian man or woman believing such a thing—suppose in aberration they do believe so, I ask them to look at the Constitution:

"The State recognises the family as the natural, primary and fundamental unit group of society, and as a moral institution possessing inalienable and imprescriptible rights, antecedent and superior to all positive law."

What are the rights referred to in that section? If that section means anything, it must refer to some rights. What are they? Surely the first right of the parents is to raise their own children—to feed them, to clothe them and to protect their health. Is it or is it not? If it is, how are you going to reconcile these provisions in this Bill with paragraph (1) of Article 41 of the Constitution?

I asked the Minister for Health that question and he charged those of us who dwelt upon those Articles with seeking to mislead the House by asuppression veri and he said we had forborne from reading on down to paragraph (5) of Article 42, which reads:

"In exceptional cases, where the parents for physical or moral reasons fail in their duty towards their children, the State, as guardian of the common good, by appropriate means shall endeavour to supply the place of the parents, but always with due regard for the natural and imprescriptible rights of the child."

Does Deputy Butler contend that if, in the circumstances outlined by me, the Minister for Industry and Commerce, in the exercise of his own informed discretion, decided that it was in the best interests of his own child not to submit him to the medical examination prescribed by the city manager, he would thereby be a person who failed in his duty towards his child and for that reason should be excepted from the general rules governing the relations that exist between the State and the family in Ireland?

I am not in the least apprehensive of the consequences on us as individuals of the passing of this section, because it will not survive an hour's inspection by the Supreme Court. It will be declared unconstitutional. The only effect of leaving this section in the Bill in its present form is that the whole Bill will be condemned. What I am solicitous about is this—that I hate to see this Dáil acquire the reputation, in one statute after another, of breaking the Constitution in its letter and in its spirit. I dislike, and I know it is bad, to have this Oireachtas rebuked in stern, incisive and commanding language by the judiciary for having sought to take from the people——

I mentioned to-day that a certain case wassub judice. The Deputy said to-day that the matter was not sub judice. It is.

The matter is on appeal to the Supreme Court but, wherever it is appealed to, the words of Judge Gavan Duffy's judgment stand and I submit to you, Sir, with respect, that these words, recorded words, are not to be blotted out by the consequences of any appeal and, however the appeal goes, every citizen of this State is entitled to quote these words with veneration and respect.

The Deputy wants to go beyond all precedent by quoting from a judgment which is being appealed. Those are the facts.

Is there a precedent established that the terms of a judge's judgment, which is the subject of an appeal, may not be referred to? I know of none.

I think the Deputy understands quite well what the Chair said.

I am making the submission that there is no precedent.

So far as I can see, the least submissive Deputy in this House is Deputy Dillon. There is a case before the courts which has been appealed and I submit that, following precedent, that case might be left without reference.

If Bunreacht na hÉireann was not in existence, tattered document though it is and fraudulent as most of its provisions are, I would be more deeply concerned about the intentions of the Minister under this Bill, but, wretched and fraudulent as it was the day it was drafted and as it is to-day, flatulent and deceptive as most of its provisions are, such as it is, I believe it is adequate to prevent the outrage contemplated in this section. For that reason, it is not necessary to exhaust the resources of this House for the purpose of holding up the passage into law of this detestable proposal, but if this fraudulent derelict were not available, we might have longer and more tedious work to do. They say that if you keep any rubbish for 100 years it turns out useful. Fortunately, we have been constrained to keep this bit of rubbish, and, with the help of God, we will turn it to use in due time.

In spite of the style of speeches to which we have listened from the Opposition, I should like to make an appeal for consideration of this section and of the Bill in a calm and reasonable way. I thought, as I said before, Deputies opposite would try to consider a Bill like this, dropping this political propaganda, at least while dealing with this Bill. This is an amendment which I brought in as a result of an appeal made by Deputy O'Higgins on Second Reading and I am called dictatorial, outlandish and fantastic. These are the expressions used by Deputy Mulcahy. I suppose I have learned a lesson. I was deceived by the speeches on Second Reading and thought that the Party opposite intended to deal with this Bill in a reasonable way. I tried to meet them as well as I could, but I see now that, in expecting that attitude, I was only wasting my time. Deputy Mulcahy says we are back to the old atmosphere. I am very sorry to hear that, but we have to go on as best we can.

How is this section going to work? What is the meaning of the section? It was amended, as I have said, so that it now can be applied to a particular county or county borough and, in fact, if it is not necessary, it need not be applied at all. I do not believe it will be necessary, but I may be wrong. There is one thing, however—I have no intention of applying it for some time because there is no organisation in existence to undertake the working of a section of this kind. Another point is that if it is applied and if it is found after some time that there is no longer a necessity for it, it can be withdrawn and we can go back again to the voluntary method. How will it work? If it is applied, I need not tell Deputies—I suppose they have sense enough to know, although they may feel it would suit them better to say otherwise—we are not going to send warble-fly inspectors and policemen to knock down people's doors. What will happen, as every sensible Deputy knows well, is that the district medical officer will carry out his school inspection. He will have with him a nurse under the new organisation and he will find on inspection certain children are missing. He will tell the nurse to call on these children and to find out if there was any reason for their absence, and if they would agree to come for examination on another day, or if for any reason the children are not able to leave their own homes, to arrange for the doctor to call to see them. It will be possible for the district medical officer to call on certain of these people as, the district being so small, he will be passing their houses. It is only where the nurse meets with persistent refusal that she will report refusal and then the question of prosecution will be considered.

There is no use in Deputies saying that the system is satisfactory as it is. It is not satisfactory and it could not be satisfactory because the machinery was not there. As a matter of fact, in most counties at the moment, a school is not examined more than once in every two or three years, and if certain children are absent on the occassion of that examination, they may go through their whole school career without being examined at all. There will be more frequent examinations as time goes on, as soon as we get our organisation built up, but there is no use in putting forward the argument that things are satisfactory, because they are not. The most extravagant statements have been made about this section and Deputy Dillon threatened to become inarticulate if certain Deputies voted for it. If Deputy Dillon ever becomes inarticulate, I shall have to re-examine the position, because I would have to admit that I had done something terrible, if that were to occur.

Why can you not try it with the full equipment but without compulsion? We will all be with you then and there need be no heat nor anger.

We will try it, but we will apply the section if it is considered necessary.

Why ask for the compulsory powers until you have given the voluntary method a chance?

Why refuse them to us? They are not being put into operation unless required. The whole thing is referred to by Deputy Dillon as daft and crazy, and he painted a most exaggerated picture of what will happen. The Deputy uses extravagant language and arguments in his effort to make a case when he cannot make the case in ordinary temperate language.

Take out the compulsion.

Take out what Deputy Dillon wants out and everything will be all right. I do not agree with Deputy Dillon and he does not agree with me, but I do not see why we cannot argue the case on its merits, without painting these terrible pictures of what will happen. Deputy Dillon knows that, when he leaves this House to-night, he may meet a child in the street outside with a deformed spine. That may happen in ten years' time. Deputy Dillon's rhetoric will not cure that child—this clause may. It may at least prevent it —I do not say it will—because, as everybody knows, there are careless parents who will not submit their children unless they are told they have to do so. It may be sufficient to tell them that they must do so under the law, and I believe it will be sufficient in practically every case, but there are these careless parents who have no thought for, and perhaps no belief in, these medical inspections, and, because they do not bring their children for inspection, a latent deformity is not discovered in time. They may perhaps become blind or lose their teeth, if defects are not discovered in time. All these things may happen because they do not submit their children for medical inspection. If through this section we save the health of some of these children, we will have done something if we succeed in doing that.

Let us drop this talk about battering at doors and that sort of thing, because I think it will be quite obvious to anybody when we come to one of these later sections that that question of breaking in refers to an offence committed on a premises; that means an offence, say, under the food regulations or one of those offences which relate to premises. But when we are talking about school medical inspection and infectious diseases, we are not talking of premises but of persons. This question of breaking in does not refer to an offence by a person but to an offence on a premises. If that is not clear, we can make it clear when the time comes.

There is no use in trying to defeat a section like this by holding out the most terrifying pictures of policemen battering down doors and taking a person off to the police barrack for 24 hours to investigate and to get names and addresses, etc., because these things, as every Deputy knows, will not occur. Every Deputy knows that what will happen if this section has to be enforced is that the nurse will call on the people and reason with them first. She will know their names and addresses. There will not be any difficulty about that, because the nurses will know their district. It will be part of their job to know the district well and everybody in the district. The nurse will call on the parents whose children have not appeared for inspection and she will get their names. If her entreaties prove to be a failure, then she will report the case. In such a case the health authority may, if they so think fit, issue a summons and have the case tried in the District Court.

Let us at least have the argument kept on a fair level. I can understand Deputies objecting to it even if nothing worse is to happen. But let us argue the case on that without exaggeration. Let us make up our minds as to what we intend to do about the section. I believe the section will be useful. Some Deputies may think that we would get on better without it. The only way to decide it is to let the Dáil decide it.

Might I make a correction in regard to myself? I do not mind being told I am in the wrong, when I am in the wrong, but I object to being put in the wrong by a repetition of inaccuracies. For the third time since we came to this particular section the Minister said that that was what I asked for on the Second Reading. If the Minister will look up the reference, he will find that what I urged was, if it was necessary to have compulsory powers at all, that they should be adoptive.

Yes, that is right.

We are in agreement for once. That is, that they would apply where there was a request made from an administrative area. It is the other way about here. They will apply where the order from on top directs. There is no question of their being adoptive or asked for down below. What is here is exactly what I did not ask for. Will the Minister quote——

I am not disputing what the Deputy says.

My understanding of what is meant by an adoptive Act may be a misunderstanding. But what I had in my mind was that an adoptive Act was an Act that could be used on the request of the local authority or the local council, but not otherwise. This section empowers the Department to make an Order applicable to any part or parts of the country whether the people in the area ask for that Order to be made or not. That is a very different thing; in fact it is the very opposite to what I urged.

I would not say it is the opposite. After all, the Deputy is not objecting to compulsion.

I explained already that I object to the general principle of compulsion, but, if there is a specific case of urgency, of gravity, where the health of the people is affected, then that must be an exception.

If you have the proper machine, if you have properly qualified men conscientiously carrying out their work, the best judges as to what is required in any area are the people working in that area; not the people working one hundred miles away. If these powers are wanted in any particular area and are asked for, then I am agreeable that the machinery should be available to the Minister and to those local authorities to give all the powers that are there, but only when they are asked for locally. I have longer experience of the Department of which the Minister is now the head than the Minister has. I know very well that powers will be forced on us and that we will be forced to use instruments that we find highly objectionable, if it is not adoptive, that is asked for down below. If the Minister did seriously intend to meet my objections by this particular section, I apologise for not having made my mind sufficiently clear, because I think we are approaching some common ground. The Report Stage has still to come and, with that laboured effort at clarification, I leave it to the Minister for his consideration between this and the Report Stage.

I should like to say to the Deputy that I certainly have no desire to misrepresent what he said. What I said was that it was as a result of the appeal of the Deputy on the Second Reading that I brought in this amendment. I do not want to argue the matter again at this stage. I think the Deputy agrees that compulsion might be tolerated under certain circumstances anyway. I am afraid it might happen, at least in some cases, that the county that would need this most would be the county very much against it, because the work might not be done in that county as well as in many other counties. That is a point to be kept in mind.

When talking of a county, I presume the Minister is talking of a county council?

If it is urgently or specially required in an area, surely the county manager or the county medical officer of health would be as conscious of the urgency of the requirement as anybody in Dublin. If the request comes from them, then put the machinery in motion.

It would be a woeful thing if we all got into one another's wool as a result of a misunderstanding. I know no valid argument to advance against power to confer compulsory powers in the event of an epidemic or an emergency. Everyone admits that the public weal may, in certain circumstances, overrule certain individual rights and I think there is a good deal to be said for the argument that, if there was an outbreak of smallpox, typhoid or diphtheria in a particular area, the county medical officer of health should have, for the time being, until the epidemic was effectively disposed of, very wide powers indeed for the express purpose of stamping out the epidemic or, indeed, any endemic condition such as had to be grappled with in certain parts of Connemara.

But that is quite a different cup of tea from giving the power as an ordinary part of the mother and child scheme. The Minister has said that he feels that a good deal of the nonobservance may have been due in the past to inadequate equipment—the personnel was not there, the machinery was not there—and that he would not contemplate putting these compulsory powers into operation until he had given the fully-equipped machine and the new personnel that he has in mind an opportunity of proving itself. What in the name of heaven is the point of having a stand-up row across the floor of the House about powers which the Minister says he thinks it is quite likely he will never have to use and which he would prefer not to use?

If he comes here and says: "I want authority to equip the service properly, to provide the personnel to get this job of mother and child attention properly attended to, and I warn the House that if this step fails I will come back and we will argue the toss about compulsory powers", so far as I am concerned and so far as I can hear from other sides of the House, I believe we will all endorse his proposal and provide him with every facility he wants. I am more than willing, I am extremely anxious, to postpone or eschew altogether this fundamental argument about compulsory powers. This is the kind of thing in regard to which it would be much better that we should have no difference at all. Let philosophers argue it out; it would be an-interesting discourse in academic circles, but we here with a practical job to do should avoid it.

The Minister may never use these powers and, therefore, what is the purpose of having exchanges across the House in order to acquire powers that the Minister does not believe he will be ever called upon to use? Let him drop the compulsion. If he notifies us that he wants every scintilla of Part III of the Bill, I will undertake to give every conceivable help I can down the country, to encourage my neighbours to co-operate with the local authority. I will do anything I can to persuade people to exhort the country people or anybody who can help to make this thing succeed. I will most gladly do that and I venture to say every other Deputy will do the same. Why, then, does the Minister think it expedient to start a stand-up row about our rights under Article 41 of the Constitution?

This Bill can go through with cordiality on every side of the House, albeit we are notified that, if it does not work on a voluntary basis, the Minister intends to come back with an amending Bill to inject compulsory powers. We will fight that battle another day. But is not that an unreasonable position to take up? Is not that provoking unnecessary controversy? Is not that obstructing legislation in a spirit of mischief? I do not give a fiddledee-dee what any member of the Fianna Fáil Party says about me. The more abuse they hurl at me, the more votes I will get.

But, from the point of view of public health, I believe the Minister is anxious to do a useful job and I will help him in every way I can. I assure him that if he will reconsider the decision to insist on the incorporation of that portion of his proposal at this stage, he will be amazed at the difference of the atmosphere in which he will have to do his work, and I imagine that he will come to see that it would be much better to try it out on a voluntary basis first and that the necessity for the compulsory part of it will never arise.

I have seen such an extraordinary advantage resulting from medical examination in the schools, that I was quite overjoyed when I read this Bill. I have an experience going back practically 40 years, and for a great part of that time we had no school medical inspection, and I am perfectly certain that many lives were lost simply because we had not a school medical inspection. When the medical inspection was first carried out in my district I saw cases of heart disease diagnosed—it was spotted in a few moments by the visiting doctor. Sometimes there are children who, to all appearances, are perfectly strong and healthy, but I have seen defects in their eyesight spotted straight away and rectified. I have seen stupid children transformed into quite bright and clever children by a little nose or throat operation.

Or a pair of specs.

I have seen children who were declared to be suffering from lung trouble or who would be liable to lung trouble and one would never suspect they had any trouble or any tendency to trouble in that direction. I always felt that if we could have a yearly examination or an examination every six months of every child in the schools, the results would be almost miraculous—they would be something wonderful. We have not the organisation there; we have not the necessary personnel to carry out these things. When I saw this Bill I was convinced that it travelled a very great distance in the right direction but even with a sufficient personnel, without some element of compulsion we shall never derive full advantage from medical inspection of the family. Very many children object to being examined. Some parents object to having their children examined. For instance boys, I find, are very shy of being stripped and examined by a lady doctor, and I presume that in the case of girls they would simply hate to have to submit to examination by a man. Sometimes, too, through pride, parents will not have their children examined. Possibly their underclothing may not be very good and the parents have a certain pride or objection to having their children stripped and examined. Sometimes a parent might know that a child possibly was verminous. The parent might be trying to remedy that but, fearing that the child might bear the mark of vermin, the parent would keep the child at home on the day of inspection. These children then slip through the net, as it were. I do not think we shall ever get anywhere unless we have compulsory powers. I think it is drawing a very long bow to say that these powers would be used in the way Deputy Dillon seems to fear they may be used.

They could be used.

They could but I think it is altogether unreasonable to think that they would be used wrongly or in the exaggerated way which has been suggested.

That has not been suggested. What is suggested is that they could be used.

They could possibly be used. The Constitution has been cited against what is being done here. The Constitution is there, showing respect for parents, respect for the family and is the guardian of the rights of the family. Mind you, I think one of the primary rights of the members of any family is to have a chance in life, a chance of being healthy, and think the Constitution, if it is properly interpreted, would support what is being done here—the protection of the family. Sometimes people have to be protected against themselves. That is very understandable, is it not?

So had the people in Belsen, Dachau and every other concentration camp.

Deputy Dillon said he could understand this sort of compulsion applied to the tinker class.

Rubbish. I said no such thing.

Except I misunderstood the Deputy, he said that he could understand compulsion applied in cases like that, in case of people who had not a proper appreciation, and who could not be expected to have a proper appreciation, of hygiene and health matters. Then as against that he seemed to be of the opinion that it was altogether unthinkable that the children of the Minister for Justice or any Minister should be subject to inspection, because he might reasonably be presumed to have knowledge of hygiene and health matters and to know as well as the city manager what should be done. You can have pride in any walk of life or any grade of society; you can have dangerous pride but there should be no discrimination for one class as against another. It is necessary to have compulsory powers if we are going to reap a full and proper advantage from this measure. I believe that and I cannot see that it is antagonistic to the Constitution. If I were persuaded that it was, I would say so honestly. The Constitution points out the respect for and indicates the rights of the family. I believe that this Bill makes for the protection of the family and the protection of the community. I think it is quite unreasonable to assume that the powers granted here would be used in the way suggested from the Opposition Benches.

They could be used—that is the point.

Deputy Butler has approached this question in such a reasonable and persuasive way that one would like to follow his arguments and support him. I feel, however, while there is much in what he said with which I entirely agree, that I cannot accept his conclusions. Deputy Butler said that without compulsion we shall never get a satisfactory service. I am prepared to agree that in this world, where there is nothing perfect, we shall never get a completely satisfactory service but I believe that without compulsion we shall get a more satisfactory service than with it. I believe that this Bill was introduced in a kindly spirit, was well received and that there was an attempt on the part of all Parties concerned to give it a good send-off. I think that that spirit should be followed up right to the end but I suggest that we will get the maximum advantage from this legislation if we leave compulsion aside for the present and develop all the aspects of this Bill which are capable of development.

The Minister for Health admitted that the existing service is not satisfactory, that there is not sufficient organisation and machinery available at the moment and that it is his intention right now under this Bill to provide a more satisfactory service, to provide a better organisation and to ensure that the school inspection service will be more efficient in future. By setting out along these lines I believe we can step up the system very considerably but we might do considerable harm if we were to accompany these improvements in the existing machinery with the threat, the ugly threat, that people who do not avail voluntarily of these services will be penalised. Apart from the increases in staff provided for medical inspection and all the other improvements that are contemplated, we must remember that during the past couple of years there has been a tremendous advance in medical science so far as dealing with disinfestation is concerned. This tremendous advance will have a very important and fundamental bearing on the value and success of school medical inspection.

When parents who do not submit their children for inspection see the advantages derived by other children, they will be more inclined to avail of the service. The improvement contemplated should be given a free trial without the threat of compulsion. The threat of compulsion is bad. It is all right for Deputy Butler to say that there are cranks, and dangerous cranks, everywhere. There are, of course, among parents and among officials, and there is the possibility that some perhaps foolish official will start talking about compulsory powers when he is trying to induce a parent to submit a child for medical inspection. Suppose the doctor, or the nurse, as is more likely, goes to a parent who has failed to present her children for inspection and says, "If you fail to submit your child, you will find yourself in the District Court", that threat would tend to get people up against the medical service and make it unpopular. The whole success of this service depends upon its popularity. It can be made not only efficient but attractive, and that is what we should seek to make it. There may be some counties and districts which have not advanced as much as others but with all the advantages provided in this Bill the service will be improved and expanded, and it is better to leave out compulsion for the moment.

I was one of the few Deputies who on Second Reading forecast that there would be difficulty in regard to the compulsory sections. My forecast has been borne out. The Minister would like to have the wholehearted support for all sections of the Bill of all the members of the House and, therefore, he should be willing to make some little sacrifice in order to get it.

Sub-section (4) of the new Section 21, states: "whenever a medical inspection is arranged under this Act for a child, whether at his home or at any other place...." I would suggest that that should read: "...whether at his home or any other suitable place, suitably equipped for the purpose." I am aware that there are schools in Dublin where it would not be suitable to unclothe a child. I have in mind schools where there is no hot water, where there are stone floors. It would be most unsuitable, for instance, that children should have to stand barefooted on stone floors. Examination might take a long time if a number of children are being examined together. Is it not only right and proper that there should be a suitable room for that purpose to which there would be a supply of hot water, so that instruments could be sterilised and the doctors and nurses could wash their hands?

The case I am putting forward is not my own. A few years ago I was in one of these schools where there was a stone floor, where windows were broken, where there was no water except in the yard. Sub-section (4) does not prescribe a "suitable place, suitably equipped", and I hope the Minister will provide that it must be a suitable place suitably equipped. Where a doctor has to examine, say, six children in half an hour, hot water should be provided for the sterilisation of instruments and for the washing of hands. That case was put to me by a parish manager some three years ago. He complained about the condition of this small school, which was totally inadequate and unfit for the purpose. That school still exists in the City of Dublin, in the condition I have described. It was not built for the purpose of a school, and I would not like that any of my children should be undressed in that stone, cold passage.

I would also suggest that when a doctor finds a backward child or a child who is slightly mentally defective, who is not suitable for admission to any of the homes in the City of Dublin, the doctor should be in a position to recommend——

The Deputy is outside the section now.

I thought I would have the right to refer to the recommendations that the officer might make following the examination. However, I will leave it at that and conclude by saying that I am perfectly satisfied that there is not enough being done for the backward or slightly mentally defective child in the City of Dublin. I rose for the purpose of asking the Minister to assure the House that the words "suitable place, suitably equipped" will be inserted. When the Minister says in the sub-section "or at any other place" what type of place does he mean? If it is not a suitable place for the undressing and examination of children, and if the parents protest on that ground, then the penal sections should not be operated. Perhaps the Minister would reply to the point I have made about the suitability of places for examination.

The Deputy must take it that the most suitable places possible will be provided. As time goes on the Minister for Health will try as far as possible to get the local authorities to provide the most suitable places.

Amendment No. 14 put and agreed to.

Section 21 is now deleted and amendment No. 14 becomes the new Section 21.

I move amendment No. 18:—

In sub-section (1), line 56, to delete the word "may" and substitute therefor the word "shall".

This amendment is a very brief one— that the word "shall" be substituted for the word "may".

I think that the Deputy should consider that the effect of the amendment would be that the health authority would be obliged to inform the school manager in writing at least seven days before the inspection is held. The Deputy will agree that the district medical officer may meet the school manager and tell him that the examination will be held on such a day.

The machinery or, rather, the little glimpses of machinery that are being granted are only becoming apparent in the course of the Bill. There is nothing in the Bill to state specifically that it is the district medical officer.

I have explained that position.

Will that give time to the manager to give the parents notice?

That is provided in the next section.

Amendment, by leave, withdrawn

I move amendment No. 19:—

In sub-section (4), page 13, line 13, to insert before the words "to be given", the words and brackets "(including facilities for obtaining the names and addresses of pupils attending the school)".

This amendment applies to a medical officer who asks the school manager to give facilities for the examination and who also asks him to give the names and addresses of the pupils attending the school. There would not be much use in district medical officers going to the schools unless facilitated by the teachers and told the number of pupils on the rolls, and so on.

Amendment agreed to.
Section 22, as amended, agreed to.
Section 23 agreed to.

I move amendment No. 20:—

To add a new sub-section as follows:—

() Regulations made under this section shall provide for—

(a) freedom of judgment and action for the medical practitioner carrying out the work, and (b) the maintenance of professional secrecy.

This particular amendment was put down by Deputy Mulcahy as a result of a very considerable volume of correspondence from individual practitioners in different parts of the country: The section states:

"The Minister may make regulations applicable to every health authority, every health authority of a particular class or a particular health authority as to the manner in which and the extent to which they are to exercise their powers under this Part of this Act."

Undoubtedly the set-up of that section is giving very, very elastic powers, and rather indefinite and vague powers, as to these regulations that will or may be made by the Minister with regard to the carrying out of the functions and duties. A number of members of the profession are rather uneasy and fear that through regulations a medical man may be instructed as to how to carry out, or in what particular manner he will carry out, his medical functions. Such a state of affairs would be inconceivable. There would be no such thing as a professional conscience if anybody higher up presumed to instruct or direct a practitioner in the performance of his duty. Personally, I do not think that that is the intention in the section, but the amendment is put down because a considerable number of doctors throughout the country are uneasy about this matter.

Further, the question of the confidential nature of medical documents arises. This health service is, of course, a development of the managerial system. The medical examiners will be working under a scheme drafted or designed by the health authority in that area, namely, the manager. The medical person responsible for the health of the mother, the infant, the child and the youth will have to have, if his records are going to be of any value, very confidential information. He must have information not only as to the health of the individual but as to the health of the family—the diseases, ailments and disabilities from which near relatives suffered. It has always been recognised that all that kind of information which passes between a patient and a doctor or between the parents of a patient and a doctor is absolutely secret and confidential which would not be seen by any other eye except another medical eye and then only when there was certain necessity for another medical mind to view those documents. The whole maternity and child welfare scheme would break down utterly and completely if there were any suspicion in the minds of the women that any little weakness which they considered a taint that might be in their family, and which it is important the doctor should be aware of was, within this service, going to be made known to a manager and a managerial staff. Whatever may be said of the professional fears that directed the first part of this amendment a very full and frank statement would require to be made by the Minister with regard to the absolute confidence that will safeguard documents containing any information passed from a patient to the doctor or on behalf of the patient to a doctor. These things cannot be unduly stressed at the present moment because, where medical officers were individuals in the past, they are now becoming part of a great State machine. The chain of command is there from the Custom House right down along to the dispensary district. As a result the people may think, even doctors may think, that the manager has a right to call for one of these registers, for one of these folders or for all of the folders: they may think that a representative of the manager, as other than a medical man, has a right to come along and examine those records, those school cards, those cases.

The whole foundation of medicine in this country will be undermined and blown up if there is any uneasiness anywhere with regard to the degree of secrecy maintained in relation to any information passing between the patient and the doctor.

While this is an amendment that we might agree with in principle, the Deputy, I think, will see the difficulty there would be in putting it into the Bill. There will, of course, be freedom of judgment and action where there is room for freedom. The first thing a doctor will have to do under this is to examine the school children. That will be done under a fairly routine system. I have never done it myself, but the doctor has to certify that the child is free from all the various things that may be wrong. There is freedom of judgment there. As regards treatment under this Part of the Bill, where there is room for a choice of treatment the doctor will be free. It might happen, on the other hand, that the Department would prescribe a certain type of vaccine for prevention. I do not think it would be wise to allow freedom in that case.

Surely the Department would not prescribe it. It might suggest it.

I am just saying that it might happen that the Department might suggest it. I am not sure that it would be necessary to order it. The Deputy must remember that at present we are dealing with something like 34 or 35 county medical officers who are better qualified for this work than the ordinary medical man. Under the new system we may be dealing with 900 or 1,000 medical men, some of whom may not be very up to date in their methods. I think it will be agreed that it may be necessary to point out that certain diagnostic tests or certain methods of immunisation must be used if we want to immunise against infectious diseases. It would be impossible to do that in the case of pneumonia. That would be a matter for the medical practitioner himself, but there would be cases where certain directions would be given. I think they would be very few.

I think the Deputy will agree that no Minister for Health could possibly prescribe a certain vaccine for diagnostic purposes or for immunisation purposes unless it was freely recognised by the greater part of the world as being the best. That is as far as freedom goes. I have given a lot of thought to the question of secrecy. I have discussed it with a number of my officials. I think they have succeeded, in the diagrams which they have shown me, in meeting that position. The doctor who examines the children will put their names on the margin of a sheet. He puts the numbers and all the particulars on an extension of the sheet. When he has finished his work, the sheet tears down and the names are put into a locker. It is only the particulars and the reports that are sent up by him. Nobody knows who the children are except the doctor himself and he has the key of the locker. These particulars will be necessary for the Public Health Department in the building up of statistics. We can hardly hope to get rid of some of those very intractable diseases like diphtheria, measles, enteric fever, typhus, unless we have all the statistics and know where the diseases are likely to be found. As far as our statistical department goes, it is only the particulars and the numbers that come up to it, so that nobody there can identify any particular person. I am sure that secrecy can be maintained as far as this mother and child welfare service is concerned.

That is true, provided the scheme works in a manner suggested by the Minister. Under the section, however, there is nothing to prevent the manager asking the doctor to supply him with the names of particular patients.

That did not occur to me.

I imagine, however, that that would not happen except in very rare cases. Suppose a dispute arose between the parent of a child and the county health authority and that proceedings ensued, the manager, in that case, might ask the medical officer for particulars of the case and might wish to identify the person not merely by a number but by name. I think some precaution should be inserted in the Bill so that the doctor who examined the child would be in a position to refuse to supply the manager or any other official with particulars, beyond setting out the fact that the patient was examined in accordance with the regulations. The doctor should not be obliged to supply the name of the patient. While I can see that it would be highly undesirable if doctors administering the scheme or the local medical officer were to use out-of-date methods, or a vaccine other than that in current use, at the same time it must be remembered that in many cases doctors may differ as to the suitability of a particular vaccine for a particular disease or for a particular type of immunisation.

While it would be reasonable to expect that whatever particular vaccine or immunisation standards were favoured by the Department the medical officers would adopt them, it is undesirable where professional experience and practice are concerned, that any compulsion should be adopted. I would suggest to the Minister that if the Health Council adopted or suggested a particular vaccine or method of immunisation, it might be satisfactory as in no way infringing on the professional independence or liberty of choice of the doctor concerned.

I can well see doctors differing on the type of vaccine which one man would use as against another and while, in general, agreement is usual in these matters, if a particular doctor did not wish to use the vaccine which the Department suggested, it might involve him in a dispute with the Department. I have no personal experience of the ordinary methods adopted by doctors in these cases, but I think that, with few exceptions, liberty of choice and freedom of opinion as exercised by doctors is not merely something most cherished by them but something which they regard as being their peculiar right. Any suggestion that that should be regulated by control from the Department or from the county manager would, in my view, be most obnoxious.

A debate such as this on this kind of question is going to be read very closely by a great number of members of the medical profession and I am only intervening a second time in order to give the Minister an opportunity to see the full implications of some of the observations he made when he was last speaking and to see that he is treading in a very dangerous direction. If any doctor or group of doctors in this country or in any other European country presumed to take to themselves the authority to direct other doctors even what specific immunisation agent they must use, a question of that kind would go to the medical council for that particular country and would have to be ruled on by them.

The most rigid discipline prevails in armies, the chain of command is most continuous in armies, but the medical authority on top would never lay down in a flat-footed manner what particular treatment or preventative would be used for any particular disease. The procedure is laid down and must be adhered to, the routine is laid down and must be adhered to, but a certain choice of agencies is left there for the practitioner down below. It is strongly urged that (a) rather than (b), (c), (d), or (f) be used, but beyond that it does not go.

The Minister might have been informed that an issue of this kind appeared to be arising a couple of years ago between the Department of Local Government and Public Health and certain medical people down the country. An instruction or a circular was issued. I do not think the intention behind that circular was exactly or clearly expressed in the circular itself, but there was a danger at that time that misunderstandings might arise with regard to the functions and responsibilities of medical men in the Department and the functions and responsibilities of medical men working down below. Catholic teaching in association with the practice of medicine lays it down very firmly and very emphatically that a doctor is not entitled to treat any human being in a way that he is not, by conviction and conscience, convinced is the proper line of treatment. Arising from that, it is very clear that no one of us, no matter what our rank or position, can be the keeper or the director of the professional conscience of another.

I am quite with the Minister that it is the function of people in a medical headquarters to give assistance and guidance, to give advice and to make recommendations and suggestions, to place at the disposal of those below all the available information which they can get with regard to the success of one particular product rather than another. That is the way the matter must be approached and those down below, whether very experienced or only with slight experience, would each one of them only be delighted and relieved to get that particular form of assistance and advice from the Department; but anything in the nature of a direction, instruction or order with regard to the practice of medicine, whether on the treatment side or the preventive side would not, should not and could not be tolerated by any member of the Minister's profession and mine.

In connection with the remarks concerning the confidential nature of documents, when we were discussing it we were doing so with the hangover of having been some hours dealing with school medical inspection only; but these regulations referred to in Section 24 refer to all the duties under Part III of the Bill. In other words, they apply to the treatment for every illness and defect of the mother and the children up to the age of 16. So it is not just a matter of designing a card with a number instead of a name. That might meet it in the case of school records, but the rules and regulations will apply to and govern all the relevant documents relating to any and every illness suffered by the people coming within the service. It must contain the most intimate details of family life and inter-family relations.

It must contain the most confidential information with regard to illnesses in that family, perhaps back for one or two generations and in respect of near relatives in the present generation. It would be unthinkable that any information of that kind should be available to anyone but a medical man, and only available to that medical man under a rule of the most stringent secrecy.

I agree with much, and practically all, of what Deputy O'Higgins has said with regard to the freedom of the doctor. He will have complete freedom, so far as his clinical work is concerned, and, so far as his administrative work is concerned, he will be under the direction of the county medical officer of health, and I suppose we can assume that things will work out fairly smoothly between them. If the county medical officer of health complains that the man is not doing his work properly, it will be for the health authority to deal with the position.

With regard to the secrecy point. I should have said that the system I outlined refers to everything under this part of the Bill. The expectant mother goes to the doctor and the doctor puts on one side of a sheet of paper or a card her number, and on the other, her name and fills in whatever details are necessary. He will then tear off the part with the name and lock it away. He will, of course, lock the other away, too, except that, from time to time, these cards or sheets may be required at headquarters for the purpose of statistics. They would not be required for any other purpose. It is hoped to get machines which will be capable of dealing with these cards for the purpose of preparing statistical returns. There is one point which did not occur to me until it was raised by Deputies opposite, that is, that the doctor might think he was obliged to give information to his civilian manager, the county manager or anybody else. I think we had better make that clear and I will try to bring in an amendment on Report to cover the point with regard to professional secrecy.

That is satisfactory.

There is one point which occurs to me—the matter of the treatment that the medical officer may recommend. If it is hospital treatment, somebody must know the name of the patient. There is no use in calling the person S.9. He cannot be removed to hospital merely with a number.

We will remember that in our amendment.

Amendment, by leave, withdrawn.
Question proposed: "That Section 24 stand part of the Bill."

This is the last section of this Part dealing with the mother and child service. It is the general provision empowering the Minister to make regulations covering all the matters dealt with and I want to avail of it, before passing from this Part, to renew the most earnest appeal to the Minister to enable us to give him that measure of cordial and unfeigned co-operation in making this Bill a success which he could do if he would proceed on the basis of completing his personnel, providing the equipment necessary to realise his ideal and allowing the voluntary principle to be tried out with the co-operation of all those who are ready and willing to help him to make the voluntary scheme 100 per cent. successful. He can do that without prejudice to his own view on the question of compulsion, even making a specific reservation that, if the voluntary practice falls short in future of what he desires, he reservesin toto his right to come back to the House and to inject into the Act, as it then will be, the compulsory principle in a new Bill, when the merits of that principle can be debated independent of the general purpose of this code of law. I understand that, in the acceptance of the amendment to Section 21, we are not to abandon hope that between now and Report Stage the Minister might consider that aspect of the situation, with a view to determining whether, consistent with his own purpose, it would be feasible to meet the views of some of us on this side in regard to that detail of compulsory powers.

Question put and agreed to.

Amendment No. 21 is an amendment which governs several other amendments of similar type.

I move amendment No. 21:—

To add a new sub-section as follows:—

() Regulations made under this section shall be subject to the approval of the national health council.

This amendment is put down for the purpose of giving a real function and a real existence to the proposed national health council. A similar amendment is put down to other Parts of the Bill. What the amendment aims at is that the approval of this health council should be secured for any regulations which may be made under the Act. I think the Minister will agree, and the discussion is making it very clear, that this Bill is really an empowering Bill, an authorising Bill, a Bill which, when passed, will give authority to the Department of Health, and, through the Department, to the various health authorities throughout the country, to get certain very important health services established and functioning. That will be done, not through the Bill, but, arising out of the Bill, through the regulations. This House, although it is passing the Bill, will have no voice with regard to the regulations. I know that the usual clause appears here and there that regulations under this Part of the Act shall be tabled for so many days. The Minister is a member of this House for greater length of time than I, and he knows that that provision is worthless. He knows very well that there may be a very important regulation containing from ten to 50 sections and that it cannot be amended. It can only be scrappedin toto or swallowed in toto. The person who thought of that device of laying regulations on the table was clever enough to avoid any interference by Parliament, because they are not subject to alteration or amendment; they can only be completely wiped out or completely accepted. That is no safeguard.

We have established a new Ministry of Health as a special Department of State and the first work undertaken by that Department is a new Health Bill. Out of that new Health Bill will arise new health services which every one of us hope will show very great benefits in the course of time. Under that Bill you are appointing a national health council, with so many members nominated by the Minister, so many nominated by the Medical Association and other medical and nursing bodies. Apparently the Minister has not yet made up his mind as to the complete design of the council. But it will be a council of specialists specially elected or selected. Surely, neither the Minister nor his Department need be afraid of laying it down that regulations under the Act, or at all events regulations under certain portions of the Act, should get the approval of that body. Nobody would think of suggesting that a health council of that kind would be out to sabotage or interfere with or impede the health work of the State. They will be a body whose mere participation in the responsibilities of such a council will be evidence of the fact that they will be helpful and not obstructive.

I would regard it as evidence of lack of confidence on the part of any Department of Health if they were afraid of or had any objection to having any of the regulations approved by a council such as that. If a council of that type disapproves of the regulations drafted or suggested by the Health Department it could only be because those regulations were not suitable and would not carry out the work in the best interests of the health of the nation as a whole. If I were in the Minister's position, I would welcome a suggestion that a body such as that should approve or disapprove of suggested regulations. I certainly would not like that there should be any suspicion that my Department would issue a type of regulations in respect to which there was any risk that the council would not approve.

Everybody fancies himself at his own particular job, but pooled minds are better than the single mind and the experience of many is much better than the experience of a few. People immersed in the atmosphere of a great State Department are not always the best judges of what is required away down the country or how things should be done at the periphery. But the pooled minds of those from the periphery and those from the centre would be invaluable, and on this national health council you will have the pooled minds of departmental medical chiefs, medical men from the provinces and experts specially elected or selected from a group of teaching institutions or clinical hospitals.

It would be impossible to imagine that a body constituted in that way would hold up any regulations that would be of benefit to the people and in the best interests of the health of the people. I therefore strongly urge on the Minister that the wise course is not only to accept the suggestion contained in the amendment, but to welcome it.

I indicated earlier that I would have to oppose this and similar amendments with regard to getting approval of the council. This consultative council, as Deputy O'Higgins says, will be composed of medical men, some of them sent forward by their organisations, representatives of nurses and dentists and, in all probability, some members of health authorities. They will be people who will be giving their services free and they can hardly be expected to meet more than once every two months. I have a lot of experience of consultative councils in another Department and they found it hard to meet more than twice a year. I admit that a health council like this will probably be prepared to meet fairly frequently for a while until we get things straightened out. But it might happen that we would wish to add some disease to our list and we could not possibly expect the council to come together for the sake of ratifying that. It would be unfair to ask them, and the circumstances might not allow us to wait until they would meet. Deputy O'Higgins will probably say that that could be provided for, that they would sanction it afterwards. That is true. The principal work of the health council will be to give advice on regulations of all kinds. It would be my intention to submit all the regulations as they are drafted or ready for publication; they would be circulated to the members. In the case of the principal regulations that will be made in the beginning, we will call the members together, having given them time to read those regulations, and then we will ask them for their views on the regulations. I have no fear that we would meet with any sort of destructive criticism from such a body. I am sure they will be as helpful as they can be.

Of course, it might not be possible to get them together when we want them, and that is the first reason. The principal reason that I have to advance is that in my view the Minister must take responsibility for what is done, because the Minister is responsible to the Dáil. Deputy O'Higgins does not think there is very much use in submitting regulations to the Dáil, but I have always found that the House is rather jealous about having that inserted in every Bill. I know that there are disadvantages in that the regulations must be either rejected or approved, but at any rate Deputies will have an opportunity of bringing them forward for discussion and perhaps pointing out that the regulations were good in many respects but that there were one or two things to which they strongly objected. Anyhow, it will give them an opportunity to express their views. The regulations will be laid before the House and provision can be made to have them discussed if Deputies so desire.

Is that provision contained in this Bill?

It is—that they must be laid on the Table of the House. I think we should follow that procedure—that the Minister should take responsibility for his Department, that he should be responsible to the Dáil and not to any health council. I have a great belief in consultative councils. I had them when I was in the Department of Agriculture and I met them very often on various subjects. I very seldom had to disagree with or reject any advice they gave me —I do not recollect any occasion when I had to do so. I think the Minister should be free to do it, if he feels that way. He seeks advice, but he must be free to accept or reject it, because he is responsible. I am afraid I shall have to oppose this amendment.

Dr. Lynch

By whom will the Minister be advised in the first instance?

The Department, and then the health council.

Dr. Lynch

By what officials in the Department?

That depends. To a great extent the Minister is advised on administrative proposals by the administrative staff and on professional matters by the medical staff.

Where is it in the Bill that the regulations are to be laid on the Table?

In Section 5.

Would it be possible to prescribe, in regard to regulations laid upon the Table under this section by the Minister, that the opinion of the consultative council would be taken and made available to Dáil Éireann by the same procedure as the Order itself is communicated to the House? That is to say, that annexed to each Order, either contemporaneously or subsequent to its being laid on the Table, there should be a note to the effect that "the medical advisory council agrees with the regulations," or "the medical advisory council has submitted the following comments to the Minister in relation to these regulations," thus enabling Deputies, in the event of there appearing to be a difference of substance between the Minister and his medical advisory council, to raise the matter in the House, to have it discussed and to afford the Minister an opportunity of informing the Dáil of the grounds on which, in a particular case, he overrode the advice tendered to him by the medical advisory council.

There are two objections to what the Deputy suggests. One is that sometimes a rather trivial regulation is made and it would be hardly fair to ask the council to come together to give their views on it. Of course, it would be rather difficult to interpret what is trivial and what is not. The second objection is that I do not think the Deputy should tempt the Minister to select a council to tender advice in such circumstances. He should allow the Minister to get a council that would be really helpful to him in important matters.

Amendment, by leave, withdrawn.
Question proposed: "That Section 25 stand part of the Bill."

The Minister will remember that, in reply to questions put last year, certain information was given with regard to particular diseases. Does the Minister intend classifying infectious diseases, or will he say if any change has taken place?

If the Deputy puts down a question on that subject, I will be quite prepared to give him the information.

Question agreed to.


Question proposed: "That Section 26 stand part of the Bill."

I would like the Minister to give some explanation as to what the powers in this section are required for and the extent to which they are required.

This section puts an obligation on a person who knows he is a source of infection to take reasonable precautions. I think it would be impossible to state in an Act what reasonable precautions are. The court will have to decide, and I think that Deputies will agree that, as a rule, the court will give every consideration to the person in a case of this kind. There is no strictly comparable provision in existing law, but there are certain limited requirements in various Acts. For instance, in Section 142 of the Public Health (Ireland) Act, 1878, and Sections 52 and 62 of the Public Health Acts Amendment Act, 1907, there are provisions that may not altogether coincide with this, but they are of a somewhat similar nature and this codifies them.

Does the Minister realise that if he brings an unfortunate person into court, charging him that he did not take reasonable precautions, that he did not take every reasonable precaution to prevent the spread of infection, he may involve that person in a very serious problem as to how he will make a defence? The Minister will have the whole machinery of his Department to make a case against that man, but the man will not know what particular point of human imagination he has to be prepared to make his defence against.

I think it would be very difficult to lay down all the various contingencies this Act will refer to. Section 142 of the Public Health (Ireland) Act, 1878, gives a lot of details, but it leaves out a lot of equally dangerous situations. I think, on the whole, it would be better to leave it in a general way and let the courts decide.

I believe, if the Minister consulted the Attorney-General as to the fundamental principles involved if this Bill were law, the Attorney-General would tell him that one of the very first essentials of any penal enactment is that it should be clear, so that the person who wishes to abide within the law may know with certainty what he is required to do and what he must refrain from doing. Now, time brings about changes in circumstances. I move to report progress.

Progress reported; the Committee to sit again.
The Dáil adjourned at 10.30 p.m. until 3 p.m. on Thursday, 12th June, 1947.