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Dáil Éireann debate -
Wednesday, 29 Jun 2022

Vol. 1024 No. 4

Assisted Decision-Making (Capacity) (Amendment) Bill 2022: Report and Final Stages

I move amendment No. 1:

In page 6, between lines 6 and 7, to insert the following:

“(e) section 93;”.

I thank the Leas-Cheann Comhairle. I move amendment No. 1 to repeal section 93 of the 2015 Act, which provides for a separate review of Part 8 of the Act

I will move a separate amendment to ensure that Part 8, which is related to advanced healthcare directives and designated healthcare representatives, will form part of the overall review of the Act under section 146. This was raised by Deputies Ward and Sherlock on Committee Stage. I am happy to have been able to have the amendment proofed and drafted by the Office of the Attorney General to give effect to the desired policy.

Amendment agreed to.

Amendments Nos. 2, 34 to 36, inclusive, 38 and 53 are related and will be discussed together.

I move amendment No. 2:

In page 6, between lines 6 and 7, to insert the following:

"(e) section 85(7);"

I express my opposition and concern about the speed and inaccessible nature of the Bill. It will have far-reaching consequences for disabled people, older people and individuals experiencing mental health difficulties. At all stages it has excluded them. There has been no meaningful engagement with disabled people and disabled persons' organisations. There is still no easy-to-read version of the Bill. The amendments are coming so quickly we do not have time to interrogate them properly. Not alone is this bad lawmaking, but it is contrary to the principles and requirements of the UN Convention on the Rights of Persons with Disabilities, UNCRPD. Now we have just 90 minutes to discuss more than 60 amendments, many of which we saw for the first time on Monday afternoon.

The original rationale for rushing through the legislation was the ending of wardships. Some of the amendments tabled by the Minister will extend wardships. Will the Minister clarify whether it is still his intention to have the Bill progressed through the Oireachtas by the recess in two weeks' time? If not, why is important and complex legislation being pushed through? To whose benefit is it to do so?

The amendments I have tabled address concerns about respecting advanced healthcare directives for individuals engaging with mental healthcare. An advanced healthcare directive is a statement someone can make on the type of medical or surgical treatment they want or do not want. It is an established instrument for individuals to outline their will and preference if they are unable to make these decisions in future. Under the 2015 Act people detained in hospital for mental health treatment are specifically excluded from legally binding advanced healthcare directives. The Act intentionally removes their right to have their advance wishes respected even though they had capacity to make decisions about their mental health care and treatment at the time of making the directive. It is shocking this was included in the original Act. It is even more reprehensible that it is not being removed by the Minister now. To be clear, this exclusion is not applied to any other group of people. It is wrong and harmful and further stigmatises mental health. On Committee Stage the Minister conceded this area would have to be addressed but located in terms of the reform of the Mental Health Act. However, this is still a way off and the Bill could resolve this human rights issue much sooner. I cannot comprehend why there is not action to preserve people's rights.

I welcome that amendment No. 35 reflects the changes brought about by repeal but the Act still singles out pregnancy as a specific medical state different from all others. It imposes a specific requirement on directive makers to clarify whether they intend their advanced directive to apply during their pregnancy rather than presuming they would have a reasonable expectation that their wishes regarding medical treatment would continue to apply in the event of pregnancy even if this is not specified in the directive. Other Deputies and I did not submit amendments on this, in good faith, because the Minister committed to addressing the issue. On Second Stage the Minister of State, Deputy Rabbitte, stated the Government would repeal this provision of the 2015 Act. The Government has not done so. Will the Minister clarify why not? The pre-legislative scrutiny report called for repeal of section 85(6) of the 2015 Act. This is the amendment I would have submitted and the one we should be discussing.

I want to speak about the speed at which the Bill has progressed through the House. It has been quite difficult for people to engage in the process. On Committee Stage we heard people felt they were excluded from the process, particularly people with disabilities who felt the speed of the process excluded them. Nobody wants the Bill delayed but we want to get it right. The 90-minute guillotine being imposed on us today is another example of a rushed process. When will the Bill go to the Seanad? Will it be in the next couple of weeks? Will it be in the autumn? I have heard that it will be in the autumn. The rationale for getting the Bill through so quickly was a judicial challenge. If it will be the autumn when it goes to the Seanad, what happens with regard to the judicial challenge in the meantime?

Amendment No. 2 seeks to allow people detained under the Mental Health Act to have their advanced healthcare directives adhered to in the same way as anyone else. The amendment relates to removing section 85(7) to allow advanced healthcare directives to be extended to those involuntarily detained under the Mental Health Act. People who have a long history of mental illness know better than anybody what treatment works best for them. They have the real lived experience. In layman's terms what the Bill means if passed unamended is that people who are involuntarily detained under the Mental Health Act will be discriminated against. If a person goes to the trouble of doing an advanced healthcare directive and is then subsequently detained under the Mental Health Act their wishes may not be adhered to. No other group in society is excluded in this way. Keeping this section is discriminatory towards those with mental health difficulties and does not allow parity of treatment for all Irish citizens.

Every citizen in the State must be afforded an equal right to exercise their will and preference. This must apply to mental as well as physical health. As I have said to the Minister previously, I am a member of the Oireachtas Subcommittee on Mental Health and Oireachtas Joint Committee on Children, Equality, Disability, Integration and Youth. We are going through a review of the Mental Health Act 2001 but it could be a couple of years before it is enacted. This will create a lacuna whereby people with mental health difficulties will be discriminated against under Irish law. The Mental Health Commission and the Decision Support Service support the extension of this right for people under the Mental Health Act. On average 2,500 people a year could be subjected to forced psychiatric treatment, the administration of forced medication or forced electroconvulsive therapy, ECT, without the protection of a legally binding advanced healthcare directive.

Amendment No. 36 relates to the inclusion of 16- and 17-year-olds. At present those aged 16 and 17 can consent to or refuse physical healthcare decisions but this right does not apply to mental healthcare decisions. Those aged 16 and 17 do not have any right to consent or refuse mental health treatment. I have tabled a Bill to address this, and that Bill is on Second Stage. This will be discussed and I hope it will be reviewed under the Mental Health Act but that is several years down the line. At present those aged 16 and 17 cannot refuse admission to hospital. Guardians can decide to admit them without their consent. Those aged 16 and 17 cannot refuse a particular course of therapy such as ECT. We need to make sure everybody is covered including those with mental health difficulties and those aged 16 and 17.

Amendment No. 34 removes language regarding the deleterious effect on the unborn and this is welcome. As Deputy Cairns said, I did not submit amendments because I accepted the Minister's bona fides that he would address this. I am concerned that the Minister is imposing in amendment No. 35 a specific requirement on directive makers to clarify whether they intend their advanced directive to apply during pregnancy.

We believe that in general, the directive makers would have a reasonable expectation that their wishes regarding medical treatment would continue to apply in the event of pregnancy, even if this is not specified within the directive. Such an amendment singles out pregnancy as a specific medical event different to all others, which is not warranted.

I have not really been involved in this debate, but Mental Health Reform, at a meeting of the Joint Committee on Disability Matters a couple of weeks ago, asked me to put forward amendments to support Deputies Cairns and Ward from the point of view what they went through on Committee Stage. I really want to support amendments Nos. 2, 36, 37 and 53.

I will make an appeal to the Minister. The Mental Health Commission, the Decision Support Service, the Irish Human Rights and Equality Commission, IHREC, the Centre for Disability Law & Policy, NUIG, the Department of Health, Ministers, Opposition Deputies and Government Deputies are in agreement that the discriminatory exclusion addressed in amendments Nos. 2, 38 and 53 must be addressed. If we have to wait for the Mental Health Act 2001 to be reformed, what protections will those involuntarily detained have in the meantime? It has taken seven years to get to the point of commencement with the Assisted Decision-Making (Capacity) (Amendment) Bill 2022. People involuntarily detained will be the only cohort receiving any sort of treatment who will not have their will and preference respected.

An advance healthcare directive is a statement set out by someone when he or she has capacity to make decisions about his or her will and preferences for care and treatment in the future. An advance healthcare directive will come into effect if and when the person becomes unwell and no longer has the decision-making capacity. People can make advance healthcare directives about a broad range of issues, such as the type of medication they prefer, the type of therapies that work best for them and the refusal of treatments such as ECT.

Under the Assisted Decision-Making (Capacity) Act 2015, people detained in hospital for mental health treatment are specifically excluded from legally binding advance healthcare directives. They have no legal right to have their advance wishes respected even though they had capacity to make decisions about their mental healthcare and treatment at the time of making their directives. There is no other group of individuals that is specifically excluded from this legal right. The exclusion is contrary to international human rights standards, including those outlined in the UNCRPD.

While advance healthcare directives can be made for mental health treatment care decisions under Part 8 of the 2015 Act, they are not legally enforceable for persons involuntarily detained under the 2001 Act. Amendments Nos. 2, 38 and 53 relate to removing section 85(7) and section 136 in order to allow advance healthcare directives and decision supports to be extended to those involuntarily detained under the Mental Health Act.

With regard to amendment No. 36, people aged 16 to 17 cannot consent to or refuse physical healthcare decisions. However, this right does not apply to mental healthcare decisions such as those dealt with in the Non-Fatal Offences against the Person Act 1997. People aged 16 to 17 do not have any right to consent to or refuse mental health treatment. Under-18s cannot refuse admission to hospital and guardians could decide to admit them without consent. People aged 16 or 17 cannot refuse a course of treatment, such as ECT, even if they wish to do so. The World Health Organization has criticised the use of ECT on children and young people and has recommended that its use should be prohibited under legislation. There is currently no national advocacy service for people under the age of 18 who are accessing mental health services. As a result, there is a risk that young people are not having their voices heard regarding their mental healthcare and treatment.

Part 8 of the mental health (amendment) Bill is set to provide for 16- and 17-year-olds to give or withdraw consent to treatment and mental health services if they are deemed to have capacity. The heads of that Bill state that the Assisted Decision-Making (Capacity) Act 2015 would apply for the purposes of conducting the necessary capacity assessments. However, the Act does not provide for decision supports for under-18s. Mental Health Reform has raised this with all relevant Ministers and in relevant submissions and briefing notes to date. The omission of a 16- and 17-year-old from decision-making rights is contrary to our obligations under the UN Convention on the Rights of the Child.

I will speak to amendment No. 2 first. Deputy Collins is right that there is agreement among everyone that there must be parity between physical healthcare and mental healthcare in the operation of advance healthcare directives. I reiterate what I and the Minister of State, Deputy Rabbitte, said on Second Stage. The Minister for Health, Deputy Stephen Donnelly, and I, our respective Departments and the Government are in absolute agreement that this is an issue which has to be addressed as soon as possible. However, I have stated at all points that this is a technically complex issue, from both the legal perspective and the healthcare policy point of view. In light of the current work to reform the Mental Health Act 2001 in a comprehensive fashion, I am not, at this point, able to support the complete deletion of sections 85(7) or 136.

The application of the 2015 Act to persons whose treatment is regulated under Part 4 of the Mental Health Act 2001 is being considered by the Department of Health. It is appropriate that full and proper consideration will be given to this issue within the context of the ongoing reform of the 2001 Act and with the input of the clinical and policy expertise of the Department. The Minister for Health and I are in full agreement with Deputies about the need for parity of care. I will be very clear that there is no question of not addressing this issue. Government will address the gap that exists. However, it is important to ensure that the changes we are bringing forward to make sure that gap is addressed are properly sequenced in terms of changes to the 2015 Act, on foot of this legislation, and the 2001 Act. If we do not properly sequence these issues, we risk putting something on the Statute Book that risks leaving somebody lacking legal or clinical certainty at a point in their lives when they are particularly vulnerable and need the full protection of the legislation.

The amendments call for outright deletion. I am not in the position to support them at this time. However, my officials and officials in the Department of Health are continuing to engage on this issue. If we are able to devise a policy solution that can be implemented in this legislation, I will bring forward an amendment on Committee Stage or Report Stage in the Seanad. Engagement is continuing. We are still trying to find a solution here. I cannot guarantee that will happen because this matter is complicated. It is very much dependent on the wider reforms and how the reforms of the 2001 Act will apply.

The same applies in the context of amendment No. 36, which I am also not in a position to accept today. My officials will, however, continue to engage with their counterparts in the Department of Health on this. As the Deputies know, this falls within Part 8. That is a matter of responsibility for the Minister for Health. The proposed amendment from Deputy Ward seeks to allow minors who have reached the age of 16 to make valid advance healthcare directives and this would allow minors to make decisions with regard to their own treatment.

The 2015 Act was designed with respect to adults because it is about capacity in terms of decision-making. It was not designed, originally, to apply to those who are under 18. I am aware - and I have stated this before in the context of healthcare - that 16- and 17-year-olds have legal capacity to consent to surgical, medical and dental treatment. However, there is a body of family law that regulates their capacity to refuse treatment in certain circumstances. More examination is ongoing in respect of that. If I am able to bring forward a resolution regarding 16- and 17-year olds, I will do so in the form of an amendment in the Seanad.

I am bringing forward two amendments, Nos. 34 and 35, both of which need to be read together. As recommended in pre-legislative scrutiny and as I committed to in early stage, amendment No. 34 proposes to delete section 85(6) of the 2015 Act. This amendment has been drafted with the Attorney General. The Office of the Attorney General identified a need for a related amendment to section 89 as well. It is important to state that section 85(6), which was originally included to qualify and limit the application of advance healthcare directives in the context of pregnancy, was required by the then constitutional provision. As we know, that constitutional provision was wrong.

Now section 85(6) will be deleted if the amendment is passed.

Amendment No. 35 applies to section 89 of the principal Act, which includes provisions on the role of the High Court when considering an application on the validity of an advance healthcare directive in respect of life-sustaining treatment. The sole change there is that we are substituting the term "her pregnancy" for "the unborn". It is the sole change in that provision. It is important to state the provision we discussed that caused so much concern in terms of the maintenance of the approach that followed the repeal of the eighth amendment, section 89(6), is to be deleted.

We all have much to say in response to the Minister's comments but given we have 90 minutes for 60 amendments, there is no point in continuing the discussion on these. The Minister seems set on them. I really hope there will be a change to these in the Seanad.

I welcome that the Minister will seek a resolution in the Seanad and I will watch that intently. I am happy the Minister did not use the language he used on Committee Stage in saying people detained under the Mental Health Act 2001 could be a risk to themselves and others. That language caused upset and it was a generalisation that stigmatised people detained under the Mental Health Act. Today's stance continues to discriminate against those whose rights are incredibly restricted due to detention under the Mental Health Act.

There is a significant body of research on the failures of predicting risk of harm posed by psychiatric patients. We also know people with experience of mental health services, including those detained under the Mental Health Act, are more likely to be victims of violence than perpetrators of such violence. People contacted me to say people would already be detained in an approved setting so the potential to cause harm to anyone in such an environment is incredibly low. I bring that language used during Committee Stage to the Minister's attention because I was asked to do so. It caused people particular upset and concern.

Amendment No. 35 would still single out pregnancy as a specific medical event different from all others, which is not warranted. Why is it in there? I know it is not part of these amendments but I asked about the processing of the Bill. When will it go to the Seanad? Will it be in the autumn or the next couple of weeks?

Amendments Nos. 38 and 53 relate to removing sections 85(7) and 136 to allow an advance healthcare directive and decision supports to be extended to those detained under the Mental Health Act. Leaving these sections in is discriminatory so I expect the Minister will move very quickly and certainly to address those matters. We should not have it brought in under the mental health legislation and leave people waiting another seven years with a lacuna. I defer to the other Deputies on amendment No. 36 and it being dealt with in the Seanad. I hope the Minister can bring something positive forward there.

Amendment No. 35 relates to section 89 of the Act. We are replacing the reference to "the unborn" with "her pregnancy". This means that where there is an application to a court to clarify a matter with regard to an advance healthcare directive, the healthcare needs of the woman's pregnancy will be considered, not those of "the unborn". There is no instruction regarding the rights of the unborn, meaning the advance healthcare directive will apply to a pregnant woman in the same manner as any other person.

On the progress of the Bill, I hope to bring it to Second Stage in the Seanad next week or the week after, if possible. At all times I have wanted to get the Bill passed swiftly. We have waited far too long to remove wardship. We have had this legislation there since 2015 and nothing has been done with it. I have indicated that. There is a constitutional challenge and a risk in our continuing maintenance of wardship, which we know is in breach of the Constitution and the UNCRPD.

I have listened closely to the matters raised by Deputies Ward and Cairns and others throughout this. I am endeavouring to address those and I am addressing some of them with some of the amendments before us today. These are complex amendments, particularly those we have just discussed. If this involves the final Stages of the Bill being pushed into the next term, it is a consequence of wanting to get the best result in this Bill. There were two sessions taking in Second Stage of the Bill and we had a planned four-hour session on Committee Stage that we got through in three hours. I understand what Deputies are saying but I do not set the timetable, which is set by the Business Committee. I have been happy to engage with the matters raised by Deputies at all stages.

If this may go past the recess, why is the legislation being rushed through? The Minister told us before it was because of the need to end wardship but now there are amendments to extend that. Nobody has any clarity on why it is being rushed through if it is okay to continue deliberations after the recess.

Amendment put:
The Dáil divided: Tá, 54; Níl, 73; Staon, 0.

  • Andrews, Chris.
  • Boyd Barrett, Richard.
  • Browne, Martin.
  • Buckley, Pat.
  • Cairns, Holly.
  • Canney, Seán.
  • Carthy, Matt.
  • Collins, Joan.
  • Collins, Michael.
  • Conway-Walsh, Rose.
  • Cronin, Réada.
  • Crowe, Seán.
  • Cullinane, David.
  • Daly, Pa.
  • Doherty, Pearse.
  • Donnelly, Paul.
  • Ellis, Dessie.
  • Farrell, Mairéad.
  • Funchion, Kathleen.
  • Gannon, Gary.
  • Guirke, Johnny.
  • Harkin, Marian.
  • Healy-Rae, Danny.
  • Healy-Rae, Michael.
  • Howlin, Brendan.
  • Kelly, Alan.
  • Kenny, Gino.
  • Kenny, Martin.
  • Kerrane, Claire.
  • Mac Lochlainn, Pádraig.
  • McDonald, Mary Lou.
  • McNamara, Michael.
  • Munster, Imelda.
  • Murphy, Catherine.
  • Murphy, Paul.
  • Mythen, Johnny.
  • Nolan, Carol.
  • O'Callaghan, Cian.
  • O'Donoghue, Richard.
  • O'Rourke, Darren.
  • Ó Broin, Eoin.
  • Ó Laoghaire, Donnchadh.
  • Ó Murchú, Ruairí.
  • Ó Ríordáin, Aodhán.
  • Pringle, Thomas.
  • Quinlivan, Maurice.
  • Ryan, Patricia.
  • Shortall, Róisín.
  • Smith, Bríd.
  • Smith, Duncan.
  • Stanley, Brian.
  • Tully, Pauline.
  • Ward, Mark.
  • Whitmore, Jennifer.

Níl

  • Berry, Cathal.
  • Brophy, Colm.
  • Browne, James.
  • Bruton, Richard.
  • Burke, Colm.
  • Cahill, Jackie.
  • Calleary, Dara.
  • Cannon, Ciarán.
  • Carey, Joe.
  • Carroll MacNeill, Jennifer.
  • Chambers, Jack.
  • Costello, Patrick.
  • Coveney, Simon.
  • Cowen, Barry.
  • Creed, Michael.
  • Crowe, Cathal.
  • Devlin, Cormac.
  • Dillon, Alan.
  • Donnelly, Stephen.
  • Donohoe, Paschal.
  • Duffy, Francis Noel.
  • Durkan, Bernard J.
  • English, Damien.
  • Farrell, Alan.
  • Feighan, Frankie.
  • Fitzpatrick, Peter.
  • Flaherty, Joe.
  • Flanagan, Charles.
  • Fleming, Sean.
  • Foley, Norma.
  • Griffin, Brendan.
  • Harris, Simon.
  • Haughey, Seán.
  • Heydon, Martin.
  • Higgins, Emer.
  • Kehoe, Paul.
  • Lahart, John.
  • Lawless, James.
  • Leddin, Brian.
  • Lowry, Michael.
  • Madigan, Josepha.
  • Martin, Catherine.
  • Matthews, Steven.
  • McAuliffe, Paul.
  • McConalogue, Charlie.
  • McEntee, Helen.
  • McGrath, Michael.
  • McHugh, Joe.
  • Moynihan, Aindrias.
  • Moynihan, Michael.
  • Naughton, Hildegarde.
  • Noonan, Malcolm.
  • O'Brien, Darragh.
  • O'Callaghan, Jim.
  • O'Connor, James.
  • O'Donnell, Kieran.
  • O'Dowd, Fergus.
  • O'Gorman, Roderic.
  • O'Sullivan, Christopher.
  • O'Sullivan, Pádraig.
  • Ó Cathasaigh, Marc.
  • Ó Cuív, Éamon.
  • Phelan, John Paul.
  • Rabbitte, Anne.
  • Richmond, Neale.
  • Ring, Michael.
  • Ryan, Eamon.
  • Smith, Brendan.
  • Smyth, Niamh.
  • Smyth, Ossian.
  • Stanton, David.
  • Troy, Robert.
  • Varadkar, Leo.

Staon

Tellers: Tá, Deputies Mark Ward and Holly Cairns; Níl, Deputies Jack Chambers and Brendan Griffin.
Amendment declared lost.

Amendments Nos. 3, 62 and 65 are related and may be discussed together.

I move amendment No. 3:

In page 6, after line 34, to insert the following:

“(2) A court shall construe this Act in a manner that gives effect to the Convention on the Rights of Persons with Disabilities done at New York on 13 December 2006, and for this purpose the court shall have regard to the provisions of the Convention, including its preamble.”.

Now that Ireland has ratified the UNCRPD, embedding an explicit requirement for courts to interpret the Act in a manner that gives effect to the convention strengthens the potential for the Act to be interpreted in manner compatible with the human rights obligations within that convention. The Act was continually referred to by successive Ministers during its development as being an essential part of Ireland’s preparation to ratify the UNCRPD. Adding this amendment recognises that best practice in this field is continually evolving and reaffirms Ireland’s commitment to refine and reinterpret our law in a manner consistent with our human rights obligations. Introducing this amendment signals Ireland’s commitment to a progressive and evolving interpretation of this law in light of emerging understandings of human rights law.

On Committee Stage, the Minister said it would not be possible to accept an amendment such as this due to Ireland’s dualist legal system and that full incorporation of the UN convention in separate legislation would be required, similar to the European Convention on Human Rights, ECHR. The Minister noted that courts are free to have regard to the UN convention already, following Ireland’s ratification. However, evidence from legal cases where the UN convention has been put forward by counsel in support of a claimant's constitutional and ECHR rights shows that courts are not willing to consider it until it is incorporated, see C. O’C v. An Bord Pleanála, for example. However, incorporation of principles from other UN conventions has occurred in different Irish legislation without full incorporation of the convention of the whole. For example, legislation on children’s rights, including the Children and Family Relationships Act 2015 and the Domestic Violence Act 2018 have codified rights enshrined in the UN Convention on the Rights of the Child, such as non-discrimination and the rights of children to be heard.

Since the term "will and preferences" in the principal Act is taken directly from Article 12 of the UNCRPD, and has no precedence in any other domestic legislation, it is entirely appropriate that domestic courts interpreting this provision would have regard to the primary text from which this term derives, that is, the UNCRPD. Therefore, this amendment has been resubmitted. I would urge the Minister to reconsider accepting it. In addition, the Minister mentioned on Committee Stage that full incorporation of the UNCRPD into domestic law will be an option, similar to the manner in which the ECHR was incorporated. We would welcome the suggestion and will support the Minister if he comes forward with such a proposal for such incorporation.

Amendment No. 62 would create an obligation on IHREC to engage meaningfully and directly with disabled people in order to obtain information and advice on how the rights of disabled people are being impacted at grassroots level. IHREC has already taken steps to achieve this, including through the creation of the disability advisory committee. However, further direct engagement with disabled people would be more appropriate in this context. The Joint Committee on Children, Equality, Disability, Integration and Youth has called for such an amendment to ensure wide consultation with the disability community. The Minister acknowledged on Committee Stage that IHREC is an independent monitoring mechanism appointed by the State under Article 33 of the convention and, as such, already has a clear monitoring function and a strong track record of consulting with disabled people, as evidenced through its creation of the disability advisory committee.

However, some groups of disabled people are currently not represented on this advisory committee, including people with experience of mental health services. As numbers on this committee are limited, it will never be able to represent the full diversity of the disability community in Ireland. IHREC has never claimed that its obligation to engage with disabled people can be solely or even primarily achieved through its disability advisory committee, as other forms of engagement are necessary and ongoing.

Therefore, we have resubmitted this amendment, not to undermine the work in this area, but to strengthen it and give a stronger legislative basis to IHREC's designation by the State as an independent monitoring mechanism under Article 33 of the convention.

I want to speak to amendment No. 65. The Disability Act 2005 takes an overly medical model approach to the definition of disability as compared with the conceptualisation of disability under Article 1 of the UNCRPD. The UN's understanding of disability is broader than that covered under the Disability Act and is more inclusive of and reflective of different experiences, including for people who have experience of mental health services but who do not identify with any label or diagnosis, and for people who have experienced disability-based discrimination even if they do not themselves identify as disabled people. Given that the function of the IHREC disability advisory group is to support IHREC's work on the UNCRPD, it would be more appropriate to take the UNCRPD's approach to disability rather than the narrow definition of disability in the Disability Act.

Is amendment No. 6 included in this grouping?

No, it is amendments Nos. 3, 62 and 65.

My apologies. In response to Deputy Duncan Smith, while I appreciate the intention behind the amendment, the Government's position has not changed on this provision since Committee Stage. The amendment being proposed is unusual in terms of legislative norms and we would also see it as unnecessary in order to achieve the desired effect of the provision. Following ratification of the UNCRPD in 2018, Ireland is already bound by the obligations contained in the convention by decision of the Executive. The amendment is unnecessary as the State, including Departments and public bodies, is under an existing obligation to honour the requirements of the convention and to act in a manner that is compliant with the convention. The provisions of the 2015 Act and this amendment Bill are progressive and rights-based, and they weave that requirement to identify, respect and act in accordance with the will and preference of the relevant person throughout the entirety of the Act. From that perspective, we do not believe the proposed amendment adds anything that is material.

The amendment is also technically problematic as it appears too vague to work in legal practice. As we know, the convention is a large instrument. It is drafted as a document for international consumption and it does not go into the level of detail or the level of rigour that maybe a piece of legislation would. We would have a concern as to whether its principles could be transposed in the manner the amendment seeks in a way that is legally sound and could provide clear definitions. As such, I am still not in a position to accept this amendment.

With regard to amendment No. 62 we discussed this at committee and, again, whereas I understand the intention behind the amendment, I am not clear why it is being proposed in this particular place. The proposed amendment seeks to alter the section of the Bill dealing with the appointed day for the transfer of status of staff from the National Disability Authority. This part of the Bill provides for the transfer of employment status of employees of the National Disability Authority from being public servants to becoming full civil servants of the State. This process will be provided for by the insertion of a new section 27A to the Act of 2015, to which the appointed day relates. I am unsure of the intention of the amendment in the context of what is quite a specific action within the provisions of the Bill.

Deputy Ward's amendment No. 65 seeks to assign an alternative meaning to disability that is different to that set out in statute under the Disability Act 2015. Again, I understand the attempt to move towards a more social model definition. I would also say that the definition specifically used in the convention is not technically tight enough in terms of a provision being put on a legislative basis to serve as the linchpin for determinations made under Irish statute law. The 2005 definition in the Disability Act is broadly consistent with a social model conception of disability, although I recognise it is an older definition. However, it is important that the legal meanings we assign to terms within the Irish Human Rights and Equality Commission Act 2014 would be consistent with other definitions that are contained within primary law and, of course, the meaning that is assigned to disability within the 2005 Act is well established and is widely known and used. While I acknowledge the intention behind this amendment, I do not believe the term being proposed is suitable for inclusion in primary law. I am not in a position to accept that amendment.

It is my understanding that, since Committee Stage, IHREC has changed its position in its recent recruitment campaign for new members of its disability advisory group by using the UNCRPD's understanding of disability rather than that in the Disability Act 2005. As I said, this is more inclusive and facilitates the participation of more people, including people with experience of mental health services. It is my opinion that if the Minister does not accept this amendment, it could hamper IHREC's efforts to be more inclusive and progressive in its recruitment of future members of its disability advisory committee by embedding a medical model of disability in this legislation instead.

Amendment put and declared lost.

I move amendment No. 4:

In page 6, after line 34, to insert the following:

Amendment of section 4 of Principal Act

5. Section 4 of the Principal Act is amended-

(a) in subsection (1)

(i) by the substitution of “sections 37” for “sections 37, 85(6)(b)”,

(ii) by the substitution of “in which the following persons are residing or carrying on business at the time the application or appeal concerned is made, or have resided at any time during the period of 3 years immediately prior to the making of the application or the lodging of the appeal concerned:” for “in which—”, and

(iii) by the substitution of the following paragraphs for paragraphs (a) and (b):

“(a) the relevant person (including a ward) the subject of an application under this Act;

(b) in the case of proceedings under section 15, the decision-making assistant appointer, whose decision-making assistant or decision-making assistance agreement is the subject of an application or appeal under that section;

(c) in the case of proceedings under Part 4, the co-decision-maker appointer, whose co-decision-maker or co-decision-making agreement is the subject of an application or appeal under that Part;

(d) in the case of proceedings under section 46 or 47, the relevant person, whose decision-making representative is the subject of an application or appeal under the section concerned;

(e) in the case of proceedings under Part 7-

(i) the donor, whose attorney, enduring power of attorney or instrument creating an enduring power of attorney, or

(ii) the donor under the Act of 1996, whose attorney under the Act of 1996, enduring power under the Act of 1996 or instrument creating an enduring power under the Act of 1996,

is the subject of an application or appeal under that Part;

(f) in the case of proceedings under section 88 or 89, the directive-maker, whose designated healthcare representative is the subject of an application under the section concerned;

(g) in the case of proceedings under section 125 or 127, the adult the subject of the measure that is the subject of an application under the section concerned.”,

and

(b) by the insertion of the following subsection after subsection (4):

“(5) Nothing in this Act shall affect the inherent jurisdiction of the High Court to make orders for the care, treatment or detention of persons who lack capacity.”.”.

This amendment provides for and clarifies the geographical jurisdiction of the Circuit Court so there is no ambiguity as to which circuit should deal with an application made to it. These updates are largely by way of technical amendments but will provide clarity to the Circuit Court system and practitioners.

The amendment also introduces a new subsection (5), which clarifies the inherent jurisdiction of the High Court in matters regarding treatment and detention orders which the court possesses under the Constitution and clarifies that that remains, notwithstanding the provisions of the 2015 Act. While it would be wholly inappropriate for a decision supporter to ever restrain or detain a relevant person, and indeed, as we know, the amendment Bill removes provisions that enable the use of restraints, a legal vehicle for the care and treatment of persons who are in detention outside of the area of capacity is still required. The amendment clarifies that following the abolition of wardship, such matters are proper to the High Court, having regard to the individual circumstances of the case and the protections that are provided within the case law of the Irish courts.

I will bring further related amendments on Committee Stage in the Seanad regarding the review of detention of existing wards under sections 107 and 108.

We will be opposing this amendment as it gives a legislative basis to inherent jurisdiction. Inherent jurisdiction creates a loophole which allows the court to deny a person's legal capacity and makes decisions for them without following the rules of any specific legislation providing a specific basis for appeals or ensuring regular review. It allows the court to determine and forcibly treat people beyond what is permitted under the 2015 Act or the Mental Health Acts. In recent years, inherent jurisdiction has been used to make orders for the detention and transfer of people to other jurisdictions for treatment against their will and preference, including young people in psychiatric treatment and people with eating disorders, and has authorised unwanted surgery on pregnant women in prison.

It is important to state that inherent jurisdiction is controlled by the jurisprudence of the Irish courts. It is important in that context to refer to the case of AC v. Cork University Hospital and the HSE, a very important case that was decided on the whole area of capacity law. It was heard in the High Court, the Court of Appeal and, eventually, the Supreme Court. This case affirmed that constitutional rights cannot be swept away by a piece of legislation, such as wardship. It stated that the law itself must be compliant with the ECHR, and it is not enough for deprivation of liberty measures to be simply lawful in a domestic sense. The Supreme Court judgment forced the legal system to ensure deprivations of liberty in all instances, be they under statute or wardship, but importantly, be they through inherent jurisdiction, must meet safeguards required by constitutional justice.

There is a very recent Supreme Court decision clearly regulating the court's use of inherent jurisdiction in this situation and putting in place very clear case law protections.

There are always alternatives to forced psychiatric treatment which are more compliant with an individual's human rights if the Minister was minded to fund and resource peer-led human rights compliant initiatives. However, this amendment brings the law further from compliance with the UNCRPD.

Amendment put and declared carried.

I move amendment No. 5.

In page 6, after line 34, to insert the following:

“Amendment of section 3 of Principal Act

5. The Principal Act is amended by the substitution of the following for section 3:

“Recognition of legal capacity

3. (1) ‘Legal capacity’ means the ability to hold rights and duties and to exercise these rights and duties.

(2) The exercise of legal capacity may be achieved either:

(a) by the relevant person, acting legally independently, and with decision-making supports and reasonable accommodation as needed; or alternatively,

(b) by the person(s) appointed to support the relevant person in exercising his or her legal capacity; and

(3) Where capacity falls within the purview of paragraph (b) of subsection (2), there shall be a requirement that the decision be guided by the decision-making assistant, co-decision-maker, decision-making representative, attorney or designated healthcare representative’s best interpretation of the relevant person’s will or preferences and how these are to be applied to a specific decision(s).

(4) In applying subsection (3), ‘best interpretation’ means the interpretation of the relevant person’s behaviour and/or communication that seems most reasonably justified in the circumstances,

(5) Decision-making assistants, co-decision-makers, decision-making representatives, attorneys, or designated healthcare representatives must be able to provide a reasonable account of how this interpretation was arrived at.”.”.

This is a really important amendment. It is focused on removing the functional test of mental capacity as a means of determining whether a relevant person can exercise his or her legal capacity. This approach results in substitute decision-making rather than supported decision-making. The functional test of mental capacity has been found to be contrary to the UNCRPD. The UN committee on the Rights of People with Disabilities states in general comment No. 1:

The functional approach attempts to assess mental capacity and deny legal capacity accordingly. Article 12 does not permit such discriminatory denial of legal capacity but rather, requires that support be provided in the exercise of legal capacity.

The retention of the functional test and substitute decision-making means that the Act is not compliant with the UNCRPD. On Committee Stage, the Minister refused to accept this amendment because he said the functional approach to mental capacity is compliant with Article 12 of the UNCRPD and general comment No. 1. He was incorrect and I hope that in the meantime, he and his officials have consulted those documents. General comment No. 1, which I just quoted, clearly states that functional assessment of capacity should not be used to deny someone's human rights and recognises it is an unreliable method of assessing the inner workings of the human mind, it discriminates on the basis of disability and has been recognised as a subjective method of assessment with individuals receiving different results depending on the person conducting the assessment.

Following pre-legislative scrutiny, the Joint Committee on Children, Equality, Disability, Integration and Youth recommended that the functional test of capacity should be removed and replaced with an obligation to acknowledge, interpret and act upon the relevant person's will and preference in line with the UNCRPD. I have tried to be proactive here and put forward an amendment based on the guidance from the Centre of Disability Law and Policy, which undeniably is the expert in this area. The wording is drawn primarily from a draft statutory framework for legal capacity law reform in Canada.

Another reason the Minister seemed to be opposed to the amendment was due to the subsequent changes it would trigger. If these changes are necessary to ensure the Act is compliant with the convention, then they must be adopted. Related to this was the excuse that these changes would delay the progress of the Bill and prolong the abolition of wardship. The timeline has shifted and seems now to be a moving thing since Committee Stage. The Minister is now proposing transitional arrangements to continue wardship. There is obviously fresh scope to make the necessary amendments. It is far preferable that these amendments take place now to ensure Ireland is as close as possible to compliance with our international obligations. These issues will arise during the review and when Ireland enters into dialogue with the UN committee in Geneva, this will also be raised. We have the opportunity and the responsibility to ensure the Act is compliant with the UNCRPD.

There has been a shift in focus from deeming a person does not have capacity to an equal recognition of legal capacity. As per Article 12 of the UNCRPD, legal capacity is an inherent right owed to everyone. This is about moving to a recognition that everyone has legal capacity but still holds the understanding that where you may not be able to understand, will and preference decision-making supports may be needed. On Committee Stage, as Deputy Cairns said, the Minister refused to accept the amendment because he said the functional approach to mental capacity is compliant with Article 12 of the UNCRPD and general comment No. 1. This is clearly not the case as the UN committee stated in general comment No. 1, "The functional approach attempts to assess mental capacity and deny legal capacity accordingly". It is often based on whether a person can understand the nature and consequence of a decision and-or whether he or she can use or weigh the relevant information.

The approach is flawed for two key reasons. It is discriminatory and applied to people with disabilities and it presumes that to be able actively to assess the inner workings of the human mind and when the person does not pass the assessment, it then denies him or her a core human right, the right to equal recognition before the law.

In all these approaches a person's disability and-or decision-making skills are taken as legitimate grounds for denying his or her legal capacity and lowering his or her status as a person before the law. Article 12 does not permit such denial of legal capacity but rather requires that support be provided in the exercise of legal capacity. As the UN committee has made clear the functional test of mental capacity has no place in a true system of supported decision-making.

This amendment seeks to replace section 3 of the 2015 Act which sets out the functional capacity model with replacement text on legal capacity. As drafted, the amendment does not fit with the overall architecture of the 2015 Act or the amendment Bill. It would require significant policy drafting to give effect to the proposed amendment. As the functional model is core to what the previous administration tried to achieve with the 2015 Act and what we are trying to achieve with the amendment Bill, that fundamental restructure would make the current Bill unworkable and would prolong the abolition of wardship, which is something we all wish to achieve.

As I said on Committee Stage, the amendment seems to be designed towards a view that the functional model is not compliant with the UNCRPD. I do not accept that position nor does the Government. I do not accept the 2015 Act or the amendment Bill as a whole do not provide compliance with Article 12 of the convention. I wish to be very clear that the 2015 Act and the amendment Bill provide a framework for supported decision-making that will provide the components for legal certainty and for compliance with Article 12. While no single section sets this out, the 2015 Act provides for relevant persons to hold and exercise legal rights, responsibilities and duties. Where higher-tier decision supporters may be the people exercising these rights, interests and duties, they are required to do so in a manner that aligns explicitly with the will and preference of the relevant person and a robust and proportionate oversight regime will be in place to ensure that is how the Act is operated.

Where we are not compliant with the UNCRPD is in our continued reliance on wardship. The place of functional capacity model in the Act is designed to maximise a person's decision-making capacity in a manner that explicitly privileges and provides a framework to enforce and safeguard his or her explicit will and preference. Contrary to the prevailing system of wardship, assisted decision-making will allow a person to hold and exercise legal rights and obligations.

While I appreciate the intent of this amendment, I do not think this model, which would, as I said, fundamentally change and remove a central element of what we are trying to achieve, is helpful in terms of achieving Ireland's overall compliance with the UNCRPD. I have spoken on the guiding principles contained in Part 2 of the original Act on a number of occasions. On the guiding principles, section 8(2) states that it shall be presumed that a relevant person falls within paragraph (a) of the definition of relevant person has the capacity in respect of the matter concerned unless the contrary is shown in accordance with the provisions of the Act. The very centre of the legislation we seek to activate through this amendment legislation is that presumption of capacity.

In terms of general comment No. 1, I would make the point the Deputy is right in her direct quote.

It comes from 2014. It was written prior to our current legislation even being drafted but what I draw attention to is what is currently being said by UN bodies about the Irish legislation. I draw the House's attention to Jonas Ruskus, who is the vice chair of the UN Committee on the Rights of Persons with Disabilities. At the World Congress on Adult Capacity in Edinburgh earlier this month he commended Ireland and the progressive nature of our legislation and praised the introduction of mechanisms for supported decision-making by Ireland. That is not me saying it and that is not the Government saying it; that is the vice chair of the UN committee that oversees the UNCRPD and is responsible for drafting the state reports on each member state recognising the advanced nature of the legislation we have here. However, let us not forget that is legislation that is still not enacted. That is why this Bill is important, that is why the functional test needs to be an element of this Bill and that is why I am not able to accept this amendment.

When the Minister says he does not accept that position, I hope he is aware he is basically saying he does not accept the position of the UNCRPD committee. This issue is very clear. There is no ambiguity. Retaining the functional test makes the Act not compliant with the UNCRPD. We are at risk of repeating ourselves but I am going to because it is important this goes on the record. Paragraph 15 of the UN committee's general comment No. 1 states:

The functional approach attempts to assess mental capacity and deny legal capacity accordingly. It is often based on whether a person can understand the nature and consequences of a decision and/or whether he or she can use or weigh the relevant information. This approach is flawed for two key reasons: (a) it is discriminatorily applied to people with disabilities; and (b) it presumes to be able to accurately assess the inner-workings of the human mind and, when the person does not pass the assessment, it then denies him or her a core human right — the right to equal recognition before the law. In all of those approaches, a person’s disability and/or decision-making skills are taken as legitimate grounds for denying his or her legal capacity and lowering his or her status as a person before the law. Article 12 does not permit such discriminatory denial of legal capacity, but, rather, requires that support be provided in the exercise of legal capacity.

As the UN committee has made clear, the functional test of mental capacity has no place in a true system of supported decision-making. Then the Minister says what is a breach of the UNCRPD is the wardship. Yes, 100%. I think everybody agrees with him. Why then is he introducing amendments to extend that? He was speaking about the vice chair of the UN committee. I would bet money that if the vice chair of the UN committee saw amendment No. 5 he would support it.

I will not repeat everything Deputy Cairns just said but the UN committee has made clear the functional test of mental capacity has no place in a true system of supported decision-making. I understand accepting this amendment would require further amendments to the Bill and the principal Act. However, it is preferable these amendments take place now to ensure this State is as close as possible to compliance with international obligations than realising the error of our ways further down the line in the review of the Act following its commencement and seeking to change the course at that stage when it has already been rolled out in its present form.

I regret Deputy Cairns's attempts to put words in my mouth so let me be very clear in what I am saying - I do not believe the 2015 Act is in breach of the UNCRPD. That is my position and the position of the Government. The piece Deputy Cairns quoted was written a year prior to the 2015 Act being drafted and as I have stated, the vice chair of the body that oversees the UNCRPD has complimented our approach to the issue of dealing with capacity. The reason Ireland is seeking to bring this in and is being recognised and regarded is the graduated model of tiered decision-making supports that we are introducing. The Deputy spoke of supports and quoted the issue of supports. We are bringing in those supports in terms of the tiered decision-making within the 2015 Act and we will activate them if we initiate this.

There is also the fact the language in the Bill is disability neutral. Importantly, there is no diagnostic component linking incapacity to a condition. We are moving away from the model that was adopted in wardship. The Bill also moves us away from a "best interests" approach and again centres on the "will and preference" of the individual concerned. That is what this legislation seeks to achieve and what is at its core. That is why members of the UNCRPD committee are recognising the advances the Irish legislation represents.

Amendment put:
The Dáil divided: Tá, 55; Níl, 71; Staon, 0.

  • Andrews, Chris.
  • Bacik, Ivana.
  • Barry, Mick.
  • Boyd Barrett, Richard.
  • Browne, Martin.
  • Buckley, Pat.
  • Cairns, Holly.
  • Canney, Seán.
  • Carthy, Matt.
  • Collins, Michael.
  • Conway-Walsh, Rose.
  • Cronin, Réada.
  • Crowe, Seán.
  • Cullinane, David.
  • Daly, Pa.
  • Doherty, Pearse.
  • Donnelly, Paul.
  • Ellis, Dessie.
  • Farrell, Mairéad.
  • Funchion, Kathleen.
  • Gannon, Gary.
  • Guirke, Johnny.
  • Harkin, Marian.
  • Healy-Rae, Danny.
  • Healy-Rae, Michael.
  • Howlin, Brendan.
  • Kelly, Alan.
  • Kenny, Gino.
  • Kenny, Martin.
  • Kerrane, Claire.
  • Mac Lochlainn, Pádraig.
  • McDonald, Mary Lou.
  • McNamara, Michael.
  • Munster, Imelda.
  • Murphy, Catherine.
  • Murphy, Paul.
  • Mythen, Johnny.
  • Nolan, Carol.
  • O'Callaghan, Cian.
  • O'Donoghue, Richard.
  • O'Rourke, Darren.
  • Ó Broin, Eoin.
  • Ó Laoghaire, Donnchadh.
  • Ó Murchú, Ruairí.
  • Ó Ríordáin, Aodhán.
  • Pringle, Thomas.
  • Quinlivan, Maurice.
  • Ryan, Patricia.
  • Shortall, Róisín.
  • Smith, Bríd.
  • Smith, Duncan.
  • Stanley, Brian.
  • Tully, Pauline.
  • Ward, Mark.
  • Whitmore, Jennifer.

Níl

  • Berry, Cathal.
  • Brophy, Colm.
  • Browne, James.
  • Bruton, Richard.
  • Burke, Colm.
  • Cahill, Jackie.
  • Calleary, Dara.
  • Cannon, Ciarán.
  • Carey, Joe.
  • Carroll MacNeill, Jennifer.
  • Chambers, Jack.
  • Costello, Patrick.
  • Coveney, Simon.
  • Cowen, Barry.
  • Crowe, Cathal.
  • Devlin, Cormac.
  • Dillon, Alan.
  • Donnelly, Stephen.
  • Donohoe, Paschal.
  • Duffy, Francis Noel.
  • Durkan, Bernard J.
  • English, Damien.
  • Farrell, Alan.
  • Feighan, Frankie.
  • Fitzpatrick, Peter.
  • Flaherty, Joe.
  • Flanagan, Charles.
  • Fleming, Sean.
  • Foley, Norma.
  • Griffin, Brendan.
  • Harris, Simon.
  • Haughey, Seán.
  • Heydon, Martin.
  • Higgins, Emer.
  • Kehoe, Paul.
  • Lahart, John.
  • Lawless, James.
  • Leddin, Brian.
  • Lowry, Michael.
  • Madigan, Josepha.
  • Martin, Catherine.
  • Matthews, Steven.
  • McAuliffe, Paul.
  • McConalogue, Charlie.
  • McEntee, Helen.
  • McGrath, Michael.
  • McHugh, Joe.
  • Moynihan, Michael.
  • Naughton, Hildegarde.
  • Noonan, Malcolm.
  • O'Brien, Darragh.
  • O'Callaghan, Jim.
  • O'Connor, James.
  • O'Donnell, Kieran.
  • O'Dowd, Fergus.
  • O'Gorman, Roderic.
  • O'Sullivan, Christopher.
  • O'Sullivan, Pádraig.
  • Ó Cathasaigh, Marc.
  • Ó Cuív, Éamon.
  • Phelan, John Paul.
  • Rabbitte, Anne.
  • Richmond, Neale.
  • Ring, Michael.
  • Ryan, Eamon.
  • Smith, Brendan.
  • Smyth, Niamh.
  • Smyth, Ossian.
  • Stanton, David.
  • Troy, Robert.
  • Varadkar, Leo.

Staon

Tellers: Tá, Deputies Mark Ward and Holly Cairns; Níl, Deputies Jack Chambers and Brendan Griffin.
Amendment declared lost.

The time permitted for this debate having expired, I am required to put the following question in accordance with an order of the Dáil of 28 June 2022: "That the amendments set down by the Minister for Children, Equality, Disability, Integration and Youth and not disposed of are hereby made to the Bill, Fourth Stage is hereby completed and the Bill is hereby passed."

Question put and declared carried.
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