Perhaps if I might just reply to both Senators in this way. It is the last thing I am going to say on the section. It is impossible to say whether there would be sufficient specialists to carry out orthoptic treatment, whether it be by design or by legislation reserved for them, and I could not answer the question, except to say they do not do it at the moment. At the moment, it is the accepted thing—I am speaking on the advice available to me—for a doctor to say that the boy or adult needs orthoptic treatment and that he should go down to the nurse, and in some cases it is the receptionist who does it and, in some cases, an ophthalmic optician.
I feel that, out of justifiable concern, the two Senators, Senators Barniville and O'Carroll, have rather magnified the importance of this thing. It is generally done. In fact, almost without exception, it is done by unskilled persons, and I am advised that you do not find the specialist doing it himself. There is one thing I would ask Senator Dr. ffrench O'Carroll to appreciate and it is this: under the sub-section, the decision, the initial decision, the primary decision, as to whether the treatment will take place and as to who will give the treatment, is not for some poor ignorant person. It is the decision of a qualified medical practitioner. It is he who decides what treatment will be given and who will give the treatment.
Orthoptic treatment cannot be given by an ophthalmic optician, except on the written direction of the patient's doctor, who certifies that he has examined the eyes and directs the ophthalmic optician to give him such treatment. The direction comes from the person who is qualified to know the medical conditions, to know what is to be done for his patient. The particular patient will always remain the patient of the medical practitioner, if he directs an unqualified person to give this treatment and that medical practitioner remains responsible in the eyes of the civil law, and in relation to his own oath as a medical practitioner, for what is going to be done for that patient.
Senator ffrench O'Carroll said that a general practitioner would not be competent to supervise specialised treatment. I quite accept that. That is why we have specialists and that is why we have general practitioners, but, after all, a general practitioner is not a person who can be shrugged aside. The general practitioner represents, I suppose, 75 per cent. of the medical profession in the country, the ordinary family doctor, and surely we can trust general practitioners to know when the conditions of the eyes of a patient require the attention of a specialist. If the conditions of a patient's eyes require the attention of a specialist, the House may be quite certain that the general practitioner, knowing that he is not competent, by reason, perhaps, of lack of experience, to advise on or treat the condition of that person's eyes, will refer him to an ophthalmic surgeon. I have no doubt, if the sub-section remains in the Bill, if it becomes law, that, in the ordinary sequence of events, an ophthalmic surgeon will, as a matter of practice and of habit, if he finds that orthoptic treatment is necessary, direct it to be carried out by an ophthalmic optician.
Therefore, just to summarise, the decision as to whether an ophthalmic optician shall carry out this treatment or not and the decision on the need for it and the type of it will be the decision of a medical practitioner who will be the family doctor and the doctor in charge of the patient in question. That medical practitioner will remain responsible for the consequences of the treatment and for what will be done. He will be responsible in relation to his own conscience and he will be responsible in relation to his liability at law. In these circumstances, I think that to express the anxieties that have been expressed by Senator Barniville and Senator ffrench O'Carroll, while understandable, is, I fear, magnifying the situation and making something more of this than, in fact, exists.
The common practice at the moment is that this kind of treatment is given only by untrained persons. It is necessary. It must continue to be given. Whether this sub-section is removed from this Bill or not, it will continue to be given by young girls, possibly receptionists in doctors' rooms, nurses and a variety of other people except opticians unless the sub-section remains in the Bill.
In relation to Senator ffrench O'Carroll's question, I will consider the matter. I do not want to be unreasonable or to give the Senator any short answer in this connection. However, this represents a ministerial amendment during the Committee Stage in the other House. It was inserted at my request on the Committee Stage and the Dáil, having fully considered it and having been satisfied that it was necessary, felt that it certainly did not contain any of the objections the two Senators felt it did contain.