Is amendment No. 9 withdrawn?
Nurses Bill, 1984: Committee Stage (Resumed).
Debate resumed on amendment No. 9:
In page 17, subsection (2), line 26, after "nurse" to insert ", but the training schools shall select their own candidates for Nurses Training."
—(Senator Fallon.)
No, it is certainly not withdrawn. Just to recapitulate, we dealt with this matter at length at the last meeting. The Adjournment time came on top of us before we could take a vote. But our position is quite clear; we spelled out our position in regard to the Central Applications Bureau and the question of the employer-employee relationship and between the trainee nurse and the hospital. We feel that the training hospitals should have an input into the selection of the trainee nurse. They should be allowed to interview the applicant and assess his or her flair for the nursing profession. Generally this is something that is basic to the whole nurse training situation. We outlined our view last week and, certainly, it has not changed in the week.
We are still on the amendment to section 35. I will probably repeat some of the things I have already said. I am going to say them again anyway. Maybe eventually the Minister will realise that I have said them for the second time. The impression has been given that the INO and all the nurses' organisations and all the nurses in this nation agree with the CAB but I know that it is true that the nurses' organisations and the nurses do not agree with the second part of that section, that is, that the training hospitals would have no say whatsoever in who they take in to train. The Working Party on General Nursing recommended that the hospitals would have a say. I want to ask the Minister one direct question this evening and I hope he will give me the kind of answer I would expect. The Minister is proposing in this section to give no say whatsoever to the hospitals in what nurses or students they take in to their training corridors. Why is he so convinced that by this section he should change the situation? This to me is more important than some of my colleagues have realised; and I hope they will realise its importance before we vote later on this evening. What is so wrong that he should change a system that has worked well and has turned out the nurses that we all praise when we see them at close quarters?
The Minister made a statement here last week. I do not know how he got away with it. He virtually said that every nurse in our hospitals was put there by political influence or political pull. That is a dreadful statement. This, he said, was why he had this section in this Bill. That is a dreadful slur on the nurses who have served this country well. Speaking for myself, in my long number of years I might have got one nurse sent to a hospital. I failed with the rest of them. I am not saying I did not try. I do not know why the Minister is so convinced that the hospitals should have no say at all. There is no use comparing this with students in universities. The Minister told us last week he was lucky to get into a university because it was at a time when only "big shots" got into universities. This is not a school-person thing. This is an employer-employee situation because from day one the student nurse is an employee. The Government of which the Minister is a Member, have done nothing but lecture us —"the culchies" who have our heads in the sand — about rights since they came to power. Why is it that you are taking all rights from certain hospitals in regard to whom they take in to train? Is it true also that the first 30 names to come out of a computer next spring will be the 30 students who will go to hospital A or hospital B? If I am wrong, please tell me. I am deeply concerned about this. I have seen a system that worked well. People have entered politics who should never have done so. People became teachers who should never have done so. Ninety-nine point nine per cent of trainee nurses recruited under the present system of the hospitals, and their tutors having a say in whom they take in, have served the country well. Why is that system being changed? I am not hassling the Minister because he belongs to a different party than I. Surely the Minister will have to agree here this evening that the nurses have been appointed on merit and not through political influence, as was insinuated here last week. Other Senators and Members of the other House felt strongly about other clauses and sections but this is the one I am concerned about. I have even refrained from referring to cutbacks because I try to keep politics out of my contributions in this House. I would ask the Minister to look at section 35 (2) to see if there is any way he can give some say to the training hospitals or to the people who were on the boards who interviewed these applicants and who appreciated what was needed to produce the great nurses we have.
If this were a Fianna Fáil proposal I would have challenged it at a much earlier stage. I do so now absolutely outside party politics. I do so because it is wrong. I do not think the Minister will convince me that it is better not to give a say to the sister tutors or to the hospitals regarding the trainees they take on.
The Minister also gave the impression — perhaps I am wrong — that the nursing organisations have approved of this section. That is not the case. The nursing organisations and the individual nurses while they want to try to stop the abuse of 1,000 or 2,000 girls going along to eight hospitals do not support the Minister by suggesting that the hospitals should have no say. This is the most important thing here this evening. We are not talking about just a job; we are talking about a vocation. In my private life at the moment I see it again first hand: I see commitment; I see dedication; I see everything that I believe I should fight for, I believe that we have the right nurses on the corridors and why would we put into legislation something to change a system that has worked well?
First of all, let us put this section and the amendment to it into context. Many of us who have served on health boards over a long number of years are aware of the problems of applicants for nurse training. Under the present system there are approximately 2,500 applicants for possibly 25 vacancies in the only nurse-training hospital in the south-east — Ardkeen. Those 2,500 applicants also have to apply to seven other health boards in Ireland and attend for interview at various places to get an opportunity of having their names even on a panel. For that reason I would welcome the injection of some sanity into the selection of applicants for interview for nurse training. Otherwise, people who want to become nurses have to travel all over the country to get an opportunity of being interviewed. Some health boards set down different criteria and different qualifications and some nurses do better in one than in the other. We have this anomaly where people have to go vast distances to even apply for interview. Secondly, as I understand it — and the Minister can clarify it — he has said that in the event of the Central Applications Bureau being set up there would be consultation between the private institutions and the hospitals that will go through this process. I would remind Senator Honan, through the Chair, that section 35 and the whole Bill is about setting up a nurses board and that section gives that board the option, if they so determine, to establish a Central Applications Bureau. The nurses on the board might decide that they would not have it. At least, we are suggesting to them that changes should be made. We are giving them the option to actually make the change if they so determine. There is no statutory requirement here that the board shall establish a Central Applications Bureau. We should clear our minds on what we are talking about. The board are allowed options and the board will include a majority of nurses. Surely nurses who have come through the process or are involved in the service know best how their profession should be conducted. That is what this board is all about. It has nothing to do with the Minister or politics or Fianna Fáil or Fine Gael or Labour. It is setting up a board for nurses for their own profession.
In respect of what Senator Ferris has said it is clearly implied in this legislation that the board will set up a Central Applications Bureau. In the Minister's statements he has made it absolutely clear that this is what he requires and that this is what he intends shall emerge. Basically what is being set up is an extension of the central applications office which applies to third level education which has manifestly failed the students and the educational establishments of this country because all it takes into account is the educational standard of the pupil for a particular place in a particular school at a particular time. It does not take in the necessary qualifications that they should have in terms of their mentality in terms of their psychological and physical make-up to do the job and to take up the studies for which they actually qualify under the CA rules. The nursing profession is a profession which requires a very, very careful selective process. As has been said by many speakers, this selective process has been successful, and more succesful in this country than in many other countries in the world where nurse trainees are not taken in willy-nilly. They go through a very intensive interview process and their psychological ability to do the job as a nurse is taken into account. The people who have done this assessment throughout the years have gained a lot of knowledge about what is required. One of the problems is that if you have a Central Applications Bureau the psychological assessment cannot take place. As a result it will take away the commitment that the health board people have had in the past in selecting the proper type of person. Due to the very good assessments made up to now we have a nursing profession which is capable of going anywhere in the world and of doing a caring and professional job there. I would be extremely worried if we should set up another bureaucratic sector which will not do anything for the nursing profession or for the patients for whom the nurses will eventually have to care.
Senator Ferris has mentioned that there are 2,500 applicants for nursing in the south-east. I am a member of the health board in that area and I do not consider that they are my applicants. They are South Eastern Health Board applicants. I would suggest that a large number of the people who have applied would not be suitable for nursing. It is another option: they put their names down saying: "We will try for nursing." Quite a number of these people would not be capable of taking up the profession from many many points of view.
That is a matter for the interview.
Not for computer now.
I would suggest that the interviews that have taken place in the past have been extremely successful. The standard of nursing in both the private and public hospitals has been extremely good and has been acknowledged no matter where these nurses have gone. I suggest to the Minister that this section, as amended, is more appropriate to the nursing profession than is the section as is in the Bill at present.
I want to speak briefly in relation to this section and to say that Senator Ferris has summed up the points I was going to make. I agree with him. A lot of unnecessary meat has been made out of this section in relation to the approach to it — the genuine approach — made by Senators. I simply do not agree with their points of view. There are certain aspects of the section which cause me certain concern. First, subsection (1) of the section states that the board may determine the minimum educational requirements necessary for entry for training as a nurse into a hospital.
It is amendment No. 9 we are on now, not on the section.
I cannot speak on the section then?
No, but the Senator will have an opportunity when we clear the amendment.
I share the view that the training hospitals should have an input into the selection decision for training nurses. I work in a university. I am familiar with the operation of the central applications office in the selection of students for third level. The CAO system is objective and fair, though in certain respects quite inadequate especially where personal characteristics are important to the profession being pursued. In other words, in our universities I would like to see in the case of medicine or veterinary medicine supplementary selection criteria in addition to the points system.
In the case of nursing, we are talking about a career with a highly vocational content. The personal suitability of trainee nurses for their profession is absolutely vital in practice. Those who have experience of the performance of nurses and the work they do in hospitals will know there is a whole range of personal characteristics which are not necessarily related to an A in honours maths. I would argue on the grounds of the necessity for personal characteristics to match the vocational requirements of nursing, that the training hospitals themselves should have an input and that there is a logical basis for this. I would also argue that the entire employee relationship in the case of trainee nurses is, of course, quite different from the teacher-student or professor-student relationship in third level. The Minister, with his vast experience of trade union affairs will know that good employer-employee relationships are essential to co-operation and to satisfactory work. On balance I would think that the training hospitals themselves — I think there is a compelling case to support this — should have an input into the selection decision though not perhaps the role right to do just that.
The Minister last week referred to the fact that the Central Applications Bureau would eliminate representations and so on by politicians, and it would. I do not see anything wrong with a politician from either side of the House making a case on the basis of a character reference on behalf of a young girl who might seek a position in a training nursing school. I think there is nothing in the world wrong with it. It is something that the Minister has become paranoid about. I see very little wrong with it. The big point here is this — and we want to stress it very clearly — there is nothing wrong with the idea of a Central Applications Bureau on its own to receive all the applications. But at the end of the day the basic thing is that, because it is an employer-employee relationship and because we pride ourselves on the fact that our Irish nurses in the Third World or wherever they go, in missionary fields or elsewhere, are the finest in the world — and they are — why change a system that has produced such fine, competent nurses? Leave the training hospitals the right to interview the applicants and to select their own trainee nurses. It is that kind of an occupation or profession that requires a chat in front of a selection group to find out if, for example, the sight of a nose bleed would cause one of them to faint.
I know the case, for example, in so far as the university central applications bureau is concerned of a young man who on receiving fine results from his leaving certificate was offered a position in medicine and he flatly refused because, as he said himself, the sight of blood would knock him flat. He is going to be a teacher. He wants to be a happy teacher. What is wrong with that? You have the same situation here where it is even more important, because you have that type of young girl or young man who has the flair for nursing and who wants more than anything else in the world to be a good nurse. If the training hospitals who have proved themselves in the past are not allowed to have a say and an input into the selection, then I think we are doing a disservice to these training schools.
If the Minister thinks that this section or any part of this section will do away with any political influence, so be it. I would not feel like Senator Fallon here. My worry here is that screening of students for nursing is something that computers or certain people have not the ability to do. I will just stick with the girls because somebody may take me up and say that boys become nurses as well. I want to get my point across in a nonpolitical way to the Minister so that he would not feel in any way he is giving in to me on this — he probably will not anyway. I still feel that I must say what I feel so strongly about. You cannot make a nurse out of a daughter if she does not want to be a nurse. No matter what ideas parents have about making a priest of one son or a doctor of another, you cannot make a good nurse out of somebody because the father and mother want it. That is my worry. Computers will not turn out the nurses that we have in our hospitals. They have served this country well; they have served us well and our families. I do not know why we are here agreeing to a section that will change that. All I am saying is that the individual training hospitals should have some say in who they employ. We are talking about hospitals that specialise in major heart surgery, brain surgery and so on. If a girl makes the grade she could be working in the intensive care unit of the Mater Hospital.
I am asking the Minister before Report Stage to listen to my plea because I think this is a mistake. I totally accept CAB — and the nurses accept it — but I am worried. In the Minister's Second Stage speech he talked about a progressive step. I do not know how long we will be colleagues together. I do not think I could stand by him and say that this is a progressive step. The particular part of this section about which I am deeply concerned is, I think, a mistake. I hope the Minister will look at it before Report Stage and that the hospitals will have some say in who goes into their training schools.
Perhaps the Minister might clarify something for me. Am I right in saying that the Central Applications Bureau will, in effect, be a first step in processing applications for people who will ultimately be admitted for training as nurses and that there will be at a subsequent stage an interview to assess the type of suitability which cannot be assessed by computer or by other "nonman" means? Secondly, am I also right in saying that the new Nursing Board will include among its members at least nine people who are involved in education, five nurses engaged in the training of nurses, three registered medical practitioners engaged in the practice of medicine in hospitals and one other person approved of by the Minister for Education? With that type of composition the procedure which would ultimately be established by the board — and it is a procedure that the board does not have to establish, because it is a discretionary power that they have under this Bill if they choose to exercise it — should be exercised in a way that would be unsatisfactory both educationally and vocationally.
The Senator mentioned that the board would have among its membership five people who would come from training establishments. That need not necessarily have anything to do with the bureau that would be set up by the board. It could be that the board would set up a central applications bureau and there might be no nurses on it. There is nothing in this Bill which says that the board will be the bureau. You could have a separate bureau set up.
Section 3 of the Bill mentions that if the board establishes a central applications bureau, hospital institutions may accept only a person who is appointed with the consent of the board. It does not give the training hospital any say in not taking on somebody whom the board would have sent to them as being a suitable person. It could happen that the training hospital might decide that the person sent to them by the central bureau would not be suitable for that particular hospital. There is nothing here to say that they will have any control in that sort of situation.
There are some fears and amazing misconceptions about this section of the Bill. I hope to allay these fears and dispel the misconceptions. First of all I want to assure Senator Honan as regards my contribution of last week that I did not say what was attributed to me. I ask Senators to read the record. That is all I will say about that.
enactment of a recommendation which has come before Government and come before the body politic for a number of years. My predecessor, Mr. Brendan Corish, set up The Working Party on General Nursing. It took a long time to do its work inevitably because of the complexity of the issues it had to face. It was set up in 1975 and in March 1980 the report was finally published. The report was welcomed by the then Minister, Deputy Michael Woods, and he said it was apparent from the report that the members of the working party gave long and serious consideration to the many issues which came before them. He pointed out that inevitably it took some time for them to reach their conclusions.
A central recommendation and a unanimous one in this working party report was that there should be a central applications bureau. I would stress that that came from the profession and from the health sector exclusively. There was a departmental input into it. The principal tutor of St. James's Hospital was the chairperson and another principal tutor subsequently took over as a continuing chairman. One had the major trade unions involved, the ITGWU, the FWI and the Local Government and Public Services Union. There were members of the INO and the other nursing organisations such as the matrons side.
All these were unanimous on this recommedation. There was the matron of the Mater Hospital and the director of nurse education in UCD, I would remind Senator Hillery. There were the public health nurses from a variety of health boards, and the secretary manager of St. Vincent's Hospital. They were unanimous that the Minister of the day should do this. There were matrons from hospitals such as Castlebar, a nurse tutor from Our Lady's Hospital in Cork, a superintendent public health nurse from the north Eastern Health Board, the Assistant matron of the James Connolly Memorial Hospital, the Matron of St. Lawrence's Hospital, the Limerick Regional Hospital — I would remind Senator Honan — programme managers from health boards responsible for special hospitals, the Matron of the Meath Hospital, nursing officers from the Department and so on right down the line and then all the medical personnel involved in that working party were equally of the unanimous view that there should be a central applications system established.
All this Bill does is to devolve on the profession the statutory entitlement, an enabling power to set up a central applications bureau. It does not purport to dictate to the hospital system how it should be done but the working party itself, and it is the only model we have, does say how it should be done if it is to be done. It is not a statutory requirement on An Bord Altranais. This working party clearly envisages a major role for the training schools in the selection of students and it does so at three separate levels. First of all, it recommends that the CAB should be as representative as possible of all nurse training schools. That is a central part of this working party report. It is earnestly recommended that Senators should read it in full. Chapter 5 states:
The committee of the CAB should have approximately twenty members appointed by An Bord Altranais,
It is recommended that 15 of the 20 would be on the nomination of the nurse training schools, coming directly from the system. An Bord Altranais envisages that those members will represent the teaching side, the administrative side and the service elements of the schools themselves. Then the second part of the Central Applications Bureau comes into operation as recommended here. It is the only document we have, there is no other model recommended; it is the only one I can go on and I will put in an enabling power here. I will not attempt to spell it all out statutorily because it would be quite impossible; the Bill would never end. Anyway if we are going to give an Bord Altranais the professional right to run their own profession and, in the process, to supervise the selection process for nursing then we should not have to spell it all out statutorily right down the line because the situation can change, as inevitably happens over the lifetime of any Bill.
There is a second provision proposed by the working party, namely that, having determined centrally the suitability of educational qualifications, screening interviews and indeed the aptitude tests and the psychological tests, these would be carried out on a regional basis. The interview teams for each centre will be appointed by the CAB from a central list containing the nominees of all the training schools. That is the way it would work.
The final stage comes when the applicants have been assigned to the schools. Of course it is still open to a hospital to pursue the question of the suitability of the list of people submitted to the hospital on a regional basis. It would conduct its own final assessment by way of interview with a view to determining actual suitability for employment. All that is recommended in this report. Ministers are supposed to act expeditiously but it was five years before somebody decided to do something about it and I was the first Minister, with respect to my predecessors, who said: "What is happening to this report?"
It is ten years since the working party was set up, and five years since it reported. It is about time we had a new Nurses Bill and I have worked very hard to get a new Nurses Bill through and I am doing it strictly in accordance with the recommendations of the working party and I can assure the House that the drafting of the Bill was very carefully monitored departmentally and governmentally and indeed every other way. I am not aware of any objections. I have not met anybody who has objected to this section personally. Many people have come to me, including members of the INO, and they have been worried about the section. We have explained the import of it, and explanations have been accepted. There are perhaps some hospitals where some boards and some matrons will say: "Nobody, I do not care who they are, is going to hand any recommendations to us. We will decide whom we are going to interview, we will decide whether we will give them a job as a student nurse or not and nobody interferes. Frankly this is a national profession. Trainee nurses too have their rights. It is a question of balance between employees, employers, the educational system, the needs of health throughout the country and that is the purpose of this operation. I have every confidence in the capacity of an Bord Altranais, its current president and its chief executive officer to introduce a responsible and sensitive system to the overall framework. I will quote from page 82 of the Report of the Working Party on General Nursing:
The Working Party was concerned at the lack of uniformity in processing these applications. In some hospitals, panels of selected candidates may be set up to fill places for some years ahead resulting in long waiting lists. The Working Party was also aware that many individual applicants apply to several nurse training schools. The multiplicity of applications creates a lot of work and expenditure as each school separately advertises, screens and interviews candidates who apply to that school for training. Under the present system, candidates who are successful in obtaining places in more than one school delay in making their choice and when they finally decide which school they will enter, "last minute" vacancies are left in other schools which the school may not be able to fill, or may only fill with difficulty, in time for commencement of training. Applying to different schools, travelling for several interviews, repeated psychological and medical tests is an unwarranted expense to the individual and does not always result in getting the best candidates into nurse training. It may be off-putting to quite suitable candidates who may not persevere in their efforts to become nurses. Repeated rejection by different schools can be demoralising to young persons whether or not they pursue a career in nursing.
They are the reasons why the eminent nursing personnel, overwhelmingly nurses and matrons, members of religious orders and health boards, came down strongly in favour of a Central Applications Bureau.
Senator Fallon is adamant that the training schools should have an input into the selection of students. Of course they will have an opportunity of assessing the suitability of those who come through the screening process by interview.
One Senator indicated that if the selection process is left to a centralised body people from Donegal will be getting jobs down in Cork and so on. That shows that there is not an appreciation that the working party is quite definite that the interviewing of candidates will be done on a regional basis by a panel of interviewers for the CAB. Senator Lanigan suggested that you would finish up with non-nursing personnel on the Central Applications Bureau even at central level or at local level. That simply cannot happen. I cannot imagine in a body of 29 persons where there would be about 19 nurses that they would be so lacking in their preoccupation and concern that they would allow a Central Applications Bureau either at central level or at local level to be formulated on that basis. Of course candidates can still indicate their choice of schools. This would be part of the operation.
Therefore, it is not just a matter of the reaction, which is a perfectly legitimate reaction on my part, towards the element of privilege. There has always been an element of privilege in this country, only an element of privilege, as regards people who get into nurse training. Unquestionably people have got in for reasons other than education, for reasons other than merit, for reasons other than what one might call objective assessment and entitlement. That is not to say that that applies to nurses at large. I never inferred that. It always happens, when one raises those issues, that one gets a global reaction. I am simply saying that to the extent that there is and has been unquestionably an element of special privilege in the selection process of nurses in a number of schools, that, to a very considerable extent, will be diminished. The system of assessment will become more equitable. It will become fairer. I have the statutory responsibility and I think I am the first Minister for Health in the history of the State to exercise that responsibility to see that the 6,000 people who go into nurse training and the 25,000 or 30,000 who would be contemplating making efforts to become part of that number, will all have equality of opportunity in so far as there will be central educational criteria set down, there will be a sensitive system of assessment of suitability and each of the training schools will find themselves getting a rational, publicly acceptable list of persons who will have an opportunity of entering such a distinguished profession.
I have no record of the Irish Nurses' Organisation objecting to this section. They have been very concerned about it. They are not opposing it as such. I have no record of the transport union who organise nurses, particularly on the psychiatric side, or the Federated Workers' Union of Ireland or of the Local Government Public Services Union, objecting to it. All of these are in the nursing areas. None of them is opposed to this on a trade union basis. I would be amazed if they were. I do not have any acknowledged opposition from any health board or from any programme manager responsible for recruiting of nurses. None of them has said to me, that this is a bad proposition and I have every support from the current Bord Altranais, which is an elected body on which there are a large number of nurses including the President, Sister Columba, of Bord Altranais and the Chief Executive Officer. They are entirely supportive of the need for this section. Therefore, I think there is no need for an amendment and I hope the fears and the misconceptions which have abounded in relation to this area have been dispelled and that the House will agree that we should permit the section to stand as it is formulated here and I have no doubt that we will be doing a good day's work.
That was a grand flowery speech by the Minister and I did not expect anything else from him. On 18 October the INO, the Irish Matrons and the Irish Guild of Catholic Nurses still objected to this section and still asked that training schools should reserve the right to interview and select their own staff. I did not say at any stage and I have never said, either last week or today, that anybody objected to the Central Applications Bureau, but I still hold that the nurses do not support the proposal that they should not have the right to select students for their training schools.
They do not own the training schools.
The Minister said he did not make reference last week to certain students getting in back doors through political influence. You did say it, Minister.
I did, yes. I said that.
When the Minister leaves the Ministry for Health he will have been the first Minister who did a lot of things. I ask him again to give the right to the training schools to have some input into who goes into their corridors to train. The Minister claimed he has everybody with him. It sounded great and it sounded as if we on this side were talking rubbish. The training schools should have the right reserved to them to select who will go into their training schools. The Catholic Guild of Nurses, The Irish Matrons, the INO and myself and every nurse that I have talked to support absolutely and totally what the Minister is doing in the Central Applications Bureau. I agree with Senator Ferris that the carry-on was crazy but I am asking the Minister to give them some right. The Minister is saying that the nurses will have sufficient representation on An Bord Altranais.
I do not believe in somebody getting preferential treatment. I am not interested in preferential treatment for the children of people who have money. I am asking that we continue to have the type of nurse at present in the hospitals and that we continue to have the present system of interviewing. That is all I am asking. I am totally with the Minister on the Central Applications Bureau.
There are a couple of questions I would like to ask the Minister. One of the things he mentioned was that because of this report the number of people running around the country to every health board area looking for interviews would be cut down and that this would cut down the expense incurred by applicants for nursing training. He mentioned that regional interview boards were to be set up. If the Central Applications Bureau is going to be a reasonable body which will select the proper people at the top of the list in order of merit, those people will be sent to regional interview boards for the particular hospitals in the region. If they do not get jobs in that region and if they have been the tops in the CAB, surely those people are going to go along to the next interview board wherever that is held, perhaps 100 or 150 miles away? Therefore, you are not going to stop people running from one end of the country to the other looking for jobs unless you are going to suggest, as is done in the Central Applications Office, that if somebody wants to do a B. Comm. he can select Galway, Cork, UCD or Trinity. Somebody going for nursing would be mad not to keep their options open in terms of the regions.
This report is nearly 15 years in preparation, and a lot of things can happen in 15 years. It may be that many of the recommendations that are in that report are now out of date. Of course, educational and nursing requirements can equally change very fast. Mention has been made of all the people who stated in that report that they were in favour of centralising the system. But, of course, centralisation has become one of the problems of this and of other countries. Decentralisation is what is necessary in many cases. I feel that the over-centralisation of the educational testing has not been successful in the selection process for third level education. Equally, I do not think that it will be successful in a situation where jobs will be available throughout the whole spectrum of hospitals and throughout the country as a whole.
I would like to support my colleagues. There is no argument on the question of the Central Applications Bureau. Everybody is agreed that we should have a central system whereby we would cut out the nonsense and the repetition of candidates applying to each hospital for trainee nursing positions. What is at stake here is the degree to which the training hospitals regionalise systems and what happens in regard to the recruitment for training of nurses by the training hospitals themselves.
The Minister accords to the central selection system a degree of infallibility which I find unusual. I want to tell the Minister that that very system to which he accords this infallibility resulted in the mid-west region in a doctor, or an alleged doctor, in a hospital performing operations while he was not actually a doctor at all. What I want to say to the Minister is not to try to tell us that any system — central, local or whatever — is infallible. So what we are trying to do here is to bridge this gap. First, let us eliminate the nonsense that is going on with regard to students applying to every hospital. After that we must see if we can come up with a sensible system which gives a degree of selection to the training hospitals and at the same time is fair and equitable to all concerned. The Minister is being too intransigent in wanting to have a full central applications bureau and selection procedure, which to me at least looks like being based in Dublin and which, perhaps. will not take into account the regional emphasis we on this side of the House want to accord to it.
Amendment put.
The Committee divided: Tá, 17; Níl, 26.
Tá
- Cassidy, Donie.
- Ellis, John.
- Fallon, Seán.
- Fitzsimons, Jack.
- Kiely, Rory.
- Lanigan, Mick.
- Lynch, Michael.
- McGuinness, Catherine I.B.
- Mullooly, Brian.
- Hanafin, Des.
- Hillery, Brian.
- Honan, Tras.
- Hussey, Thomas.
- O'Toole, Martin J.
- Ryan, Eoin.
- Ryan, William.
- Smith, Michael
Níl
- Connor, John.
- Conway, Timmy.
- Cregan, Denis (Dino).
- Daly, Jack.
- Deenihan, Jimmy.
- Dooge, James C.I.
- Durcan, Patrick.
- Ferris, Michael.
- FitzGerald, Alexis J.G.
- Harte, John.
- Higgins, Jim.
- Hourigan, Richard V.
- Howard, Michael.
- Howlin, Brendan.
- Kelleher, Peter.
- Lennon, Joseph.
- Loughrey, Joachim.
- McAuliffe-Ennis, Helena.
- McDonald, Charlie.
- McGonagle, Stephen.
- Magner, Pat.
- O'Brien, Andy.
- O'Leary, Seán.
- O'Mahony, Flor.
- Quealy, Michael A.
- Ross, Shane P.N.
Tellers: Tá: Senators W. Ryan and M. O'Toole; Níl: Senators D. Cregan and J. Harte.
Amendment declared lost.
Amendment No. 10 not moved.
Question proposed: "That section 35 stand part of the Bill."
There is one point I would like to make on subsection (1) of the section which says that "the Board may determine the minimum educational requirements necessary." I would ask the Minister to re-examine that subsection between now and the Report Stage. This is certainly a welcome provision but it should be a mandatory duty on the board to determine the minimum educational requirements necessary. That follows through and indeed, it would appear to be envisaged in relation to section 36 of the Bill. It is provided that the board shall, from time to time and not less than once every five years satisfy itself as to various aspects of the training of nurses. That is a mandatory obligation on the board. On the other hand, the requirement in subjection (1) of section 35 is purely discretionary. The education and training of nurses which we have been talking about here for the past hour is something which concerns all Senators. Minimum educational requirements is something which the board should have to determine. It is not something where any discretion should lie. I would ask the Minister between now and Report Stage to consider changing the word "may" to "shall" and to impose a mandatory duty on the board.
I would agree with all this education for trainee nurses. I would make one comment. It is that a trainee with a seven or eight honours leaving certificate may not be the best nurse when she comes out of training. If that is what determines — whether it be "may" or "shall"— who becomes a nurse that may not be the best formula for getting the best nurses.
I accept and totally agree with Senator Durcan in his concern about the standard of education for our nurses. I accept that biology and chemistry and all these subjects, even with honours, should be in their leaving certificates, but I would worry that we may, as legislators, decide that somebody should have to have a certain number of honours, that that code would be the deciding line and that anybody with even an honour less would not even go through this famous screening and this computer selection which the Minister is convinced is going to come right out at the other end of all these machines. Some of my colleagues in the vote that has just now taken place have taken away the right of any hospital to decide who will go into their training schools.
Question put and agreed to.
Sections 36 to 38, inclusive, agreed to.
SECTION 39.
Question proposed: "That section 39 stand part of the Bill."
Section 39 reads:
(1) Where a nurse has been found, by the Fitness to Practise Committee, on the basis of an inquiry and report pursuant to section 38 of this Act, to be guilty of professional misconduct or to be unfit to engage in the practice of nursing because of a physical or mental disability, . . .
In that situation the board may decide that the name of such person shall be erased from the register. Two or three points occur to me on that section. It is wrong to lump together the question of being guilty of professional misconduct with the question of being unfit to engage in the practice of nursing because of a physical or a mental disability. This is an area which might lead to some problems in the future. A nurse can be injured at work or in a car accident, or whatever, and can suffer a nervous breakdown. What is the situation in regard to that? There is much talk these days of the work for the disabled and the physically-handicapped. If an accident did happen, it may mean a nurse being absent from work for a year or so on a temporary basis and on her return the nurse should be guaranteed her job back. If it was found that her disability was of a permanent nature, perhaps somewhere within the system work of a less strenuous nature might be found for her. Perhaps the Minister would comment on these points. With regard to the other point of the lumping of the professional misconduct with the physical or mental disability problem, perhaps the Minister might define what is "professional misconduct". Is it something that would happen at work, or is it something in the private background of a nurse or a drug problem or a drink problem? Perhaps the Minister would comment briefly on some of the points I raised.
I would like to refer briefly to subsection (4). Could I recommend that "registered post" be substituted for "prepaid-post". I am making the point because of the uncertainty of our postal system at times and notification might not reach those people who are affected. I would urge the Minister to give consideration to this.
The joining together of the causes for erasure from the register, under section 39, is largely to help to concentrate the particular reasons in the one section so that people would not be under any illusion as to the precise areas, namely, (1) professional misconduct, (2) being unfit to engage in the practice of nursing because of physical or mental disability, or (3) failure to pay the retention fee. Those are very specific reasons. The assessment of professional misconduct will be entirely a matter of definition by the Fitness to Practise Committee. One must bear in mind they will be acting in a very statutory, legal framework because of the prospect of appeal to the High Court. Therefore, the board will have to be, of course, extraordinarily careful in the procedures they set up in determining that a person is or is not guilty of professional misconduct. This is an enabling section. Again, the board will have to exercise very exceptional care and give due consideration to natural justice in terms of definition of physical or mental disability. These sections are very important. They are rigorous. They are onerous. This section has been the subject of considerable examination at many levels prior to it being regarded as being an apropriate, acceptable provision. There has been a lot of litigation under those sections in relation to other Acts. I would assure Senators that there is no equation of professional misconduct, physical or mental disability with failure to pay the retention fee. It is simply joined together in section 39.
Question put and agreed to.
Sections 40 to 48, inclusive, agreed to.
SECTION 49.
I want to explain that amendment No. 12 is consequential on amendment No. 11. Nos. 11 and 12 may be discussed together.
I move amendment No. 11:
In page 25, lines 32 to 35, to delete subsection (2).
The purpose of amendments Nos. 11 and 12 is to provide that a prosecution may be brought in a court of summary jurisdiction in respect of any offence under this Act, within the period of two years from the date of the commission of the offence. The normal statutory period is six months. The Bill has the effect of extending the period to two years only in respect of one offence which the Bill creates. The purpose of the two amendments is simply to allow a prosecution to be brought in respect of any of the three statutory offences which the Bill creates, within a period of two years from the date of the commission of that offence. Normally, this is the kind of section and the kind of amendment that I, as a solicitor, would never introduce. Lawyers are frequently annoyed when they find that summary matters come before the court and that there is a clause allowing the prosecution to prosecute for a period beyond the normal six-month period. By virtue of the nature of this Bill and by virtue of the nature of the offences which this Bill creates, they are the type of offence which should be prosecutable for a period of two years after the date of the commission. I say that because the offences in question may be difficult to detect and yet they are very serious offences. I would ask the Minister to consider the two amendments. We introduced a similar amendment in relation to the Dentists Bill. I would ask the Minister to provide that offences may be prosecuted for two years after their commission rather than the lesser period.
I take it that the effect of those amendments is to remove subsection (2) from section 49 and insert a slightly broader provision in section 59.
That is correct.
The Senator presumably feels that it is unduly restrictive to confine the petty sessions provision to offences under section 49. Frankly, I have difficulty in accepting those amendments because the parliamentary draftsman's general advice to me on the matter, and the advice from the Attorney-General's office as well, is to the effect that no great purpose would be served by broadening this provision to cover any section of the Act rather than just section 49.
As the Senator has rightly pointed out, the normal period prescribed by section 10 (4) of the Petty Sessions (Ireland) Act, 1851, within which proceedings may be instituted in a summary manner is, of course, six months. However, the nature of offences under section 49 is such that they might not come to light within six months of commission and this provision is associated with section 49 to enable proceedings to be instituted up to two years after the offence is committed.
Other offences under the Act may be prosecuted by the board. These arise under sections 38 (8) and 58 (2). These offences relate, respectively, to unlawful behaviour of a person called before the Fitness to Practise Committee and unlawful attendance on a woman in childbirth. The parliamentary draftsman's view is that the nature of those offences is not such they they might not become apparent within six months and as such they need not be exempted from the provisions of the Petty Sessions Act. I am sure the Senator would agree that an offence against the fitness to practise provisions would be immediately detected. As regards attendance by an unlawful person on a woman in childbirth, this offence would presumably have to be witnessed in order to be proved.
That is the general view. In relation to the Dentists Act, which the Senator referred to, it is equally restricted to offences under section 51 of the Dentists Act and it does not extend to the Act as a whole. I make those points to the Senator. I am glad he brought them to my attention because it forces us to have another look at it.
The only point I would make is that certainly in relation to the fitness to practise provisions and the offence created by section 38 (7) I agree with the Minister that an offence under that section would normally become immediately apparent, but I cannot agree with the Minister that an offence under section 58 would necessarily become immediately apparent. I do not agree with him that such an offence might not be witnessed. Indeed, there are many views now being expressed which would suggest that offences under section 58 might be committed and I am not satisfied at all that such an offence could be easily detected. Certainly, if the provisions of section 10 of the Petty Sessions (Ireland) Act, 1851, are to be extended in relation to the improper use of the title nurse or midwife then the extension should also apply in relation to an offence under section 58 (2) of the Bill.
The improper use of the title nurse or midwife is an offence which normally and more usually would become more evident than an offence under section 58. I do not propose to press my amendment but I would ask the Minister to look at the point I have raised between now and Report Stage particularly in relation to section 58 of the Bill.
Amendment, by leave, withdrawn.
Section 49 agreed to.
SECTION 50.
Question proposed: "That section 50 stand part of the Bill."
The section states "The Board shall, as soon as may be". What does the phrase "as soon as may be" mean? There is a phrase which the parliamentary draftsman has inserted into the Road Traffic Act, 1978. That is the Act which deals with the current breathaliser procedure. In that Act the parliamentary draftsman uses the phrase "as soon as practicable". That would be a preferable phrase and preferable terminology in this section — the board shall as soon as practicable. I have not got an amendment down in relation to it but I wish to make the point to the Minister generally on Committee Stage so that he might consider providing for the inclusion of such an amendment on Report Stage.
"The Board shall as soon as may be" is a rather pie in the sky pious type of phrase. Boards may often have very good reasons for finding and deciding that "as soon as may be" should be deferred. I ask the Minister, while giving flexibility to the board in providing a report, that nevertheless the report should be furnished as soon as practicable rather than as soon as may be.
I will have a look at that.
I would like to support Senator Durcan if that suggestion that "practicable" should be substituted for "as soon as may be" because I am sure the Minister can remember times when the reports of different Departments and various bodies could be three and four years in arrears. While I am not suggesting that the board would necessarily do this they should be encouraged to bring out reports in good time. The phrase "as soon as practicable" has been well defined in various case law and it is understood what it should mean. It would be a good idea to do this.
I will have a look at it although I think the parliamentary draftsman regards it as being standard procedure or a standard phrase. Far be it from me to intervene between lawyers.
People frequently do.
Question put and agreed to.
SECTION 51.
I move amendment No. 11a:
In page 25, lines 42 to 44, to delete subsection (2).
This amendment will be seen — and I see it — as interfering in some way with the rights of hospitals in so far as the ethos and character of the hospital is concerned. It is true to say that it is contrary to the aspirations of the Hospitals Federation and Amalgamation Act 1961, which in a way set out to protect the ethical rights of hospitals.
There has been far more emphasis on this problem in recent weeks than when the Bill was going through the Dáil, clearly as a result of the decision in the Galway Regional Hospital to prevent a gynaecologist from performing sterilisation operations which were contrary to the beliefs of the nurses. This situation in Galway has, in fact, highlighted this problem for nurses. I find that there is more talk and correspondence circulating about it than at any other time since the Bill was circulated. Nurses are aware that this question of a conscience clause is something that for the future they should consider. While many think of conscience clauses as something purely for family planning matters, that now is not the case. As we know, at the moment we have the advent of surrogacy, we have the problems for the future of test tube babies and whole new areas of medical technology which almost certainly will appear in the future. There are many areas of nursing with us presently that involve the conscience of nurses. Apart from the family planning area, what might the attitude be of even one nurse in relation to people who are on life support machines, the ethical problems dealing with organ transplants or the problems of euthanasia? These will be real problems in the future for nurses. It is not just a Roman Catholic problem. It is a problem for the conscience of the young Protestant nurse the same as it is for the Roman Catholic nurse. It is for all nurses. As we all know, one's conscience is one's own.
The Minister will say to me that he has gone out of his way to make this Bill a real Nurses Bill. It was his own amendments that extended the number of nurses from 75 to 170. The position is well controlled by the nursing profession. The Minister will say: why not have faith and confidence in the nursing profession? I would like to stress very forcefully that I have. Since the Galway Regional Hospital problem the code for nurses, which is prepared by the Nursing Board, has been shown to me by a number of nurses — I do not know whether they had not seen it in the past or did not read it until this issue developed — and they certainly felt that the board should be the final arbiter as to whether any such objection falls within the scope of clause 1.11. They are worried. Even that particular section of the code for nurses is a worrying feature for them. The big problem is that in this Bill there are excessive powers for the Minister.
The Minister has gone out of his way to make it very much a Nurses Bill. Nonethe less, those powers exist in many areas of the Bill. For example, section 15 has the power to discharge the board. Section 53 has the power to assign new functions. In the knowledge that the present Bill is with us since 1950, 35 years, this Bill we are discussing will surely be with us for another 40 to 50 years. Who knows that in 25 years time a Minister, let it be a Fianna Fáil Minister, might decide that he could direct the Nursing Board under section 53 on an ethics matter, which would be totally acceptable to the public and to the whole nursing profession. If the board did not agree he could then invoke section 15 to abolish the board and to nominate his own administrator in their place to advise on such matters as ethics. I am not saying that this Minister would dream of doing that, but it is a possibility. For that reason section 51 (2) should be deleted. I stress that we have faith in the good name and the good work that the nursing board, the selected 17 nurses, and the rest of the people will do.
Nurses, whether they are Catholics or Protestants, should be able to stop treatment on moral grounds if that is what they feel. I know it will be said that, above all else, medicine is about people who get sick and that should be the main criterion. Of course, it would be at all times; but, nonetheless, that problem is there, will remain there and will be more of a problem in the future. Nurses certainly at this point in time, more than when the Bill was first introduced, have read about it, they are concerned about it and they are thinking about it. They feel that they should have the right to object to medical procedures which are contrary to their moral or to their religious beliefs.
I accept that it would be extremely difficult to draft an amendment. On Report Stage would the Minister consider an amendment dealing with this specific problem? Assuming a vote is called and assuming our amendment is defeated, would the Minister consider introducing an amendment on Report Stage, something to allay the fears of many nurses throughout the country? In regard to the particular problem that has set nurses thinking, has set them writing letters and has set them talking, the problem that arose recently in Galway, could the Minister tell me — I really do not know and there could well have been massive behind the scenes work that I am not aware of on the part of the Nursing Board — if somebody will advise nurses on that specific problem?
I expressed my views on Second Stage with regard to the right of a nurse to conscientiously object to participation in procedures in respect of which she has a moral objection. My views have not changed since then. Having said that, I fully support the section in the Nurses Bill as drafted. I am a little surprised that an amendment has not been put down for the purpose of giving nurses within this Bill the type of rights of which I spoke on Second Stage and which have been the concern of a number of Senators. Subsection (2) of section 51 simply states:
It shall be a function of the Board to give guidance to the nursing profession generally on all matters relating to ethical conduct and behaviour.
The subsection simply states that one of the functions of the board is to give guidance on all matters relating to ethical conduct and behaviour. What are matters of ethical conduct and behaviour? I do not know who will determine what are matters of ethical conduct and behaviour. Will the board determine what are matters of ethical conduct and behaviour or will an individual nurse have the right to apply to the board and say that a particular matter is one of ethical conduct and behaviour upon which the board should give guidance?
That is a more serious view of the subsection. It is a simplistic view of the subsection which simply states that we have got a very paternalistic board who will advise nurses generally. If one looks beyond the word "generally" one is faced with interpreting the meaning of all matters relating to ethical conduct and behaviour. One can use other words not very dissimilar and all of us as politicians realise the concern which other not dissimilar words have caused this Government and perhaps caused other administrations in the past. In using this type of language we are running into tremendous difficulty and danger. It is a subsection that opens a minefield for anybody who has to try to interpret it. Above all, it is a subsection that can give rise to all kinds of applications by people who may wish to use it and who may, for improper reasons, force upon the Nursing Board an obligation to give guidance in circumstances which may not have a constructive validity from the point of view of the nursing profession generally. I am surprised that there is not an amendment down for the purpose of extending the section and that Senator Fallon, who expressed views on Second Stage, also has simply decided to oppose the section.
We have an amendment to delete the subsection.
The Senators are opposing the subsection.
It is on the Order Paper.
I know the Minister expressed very definite views with some clarity when he was concluding Second Stage. I am surprised that the nursing profession, who have expressed considerable concern in relation to this matter are not being given a statutory right to opt out of procedures which they do not wish to participate in. My understanding — I mentioned this on Second Stage — is that in Spain, where legislation legalising abortion under certain circumstances was recently introduced, legislation was introduced at the same time to give doctors and nurses employed by the State the right to opt out of procedures which would be available if they had a conscientious objection to participation.
As the Minister is no doubt aware there is considerable concern among the nursing profession that they are not now being given this statutory right. I will conclude by saying that 95 per cent of nurses in this country are employed by the health boards. They are employees who are subject to the strictures of their employment and they may have forced upon them something which they do not have the right to contract out of as it were. I can see the section giving rise to difficulty. Secondly, I am a little disappointed that the positive right that we spoke on on Second Stage is not now being afforded to the nursing profession.
I want to explain that there is some confusion here. Amendment 11a is explained on the Order Paper: "in page 25, lines 42 to 44, to delete subsection (2)".
On a point of order, where in fact in the Order Paper is it explained?
Acting Chairman
It is an additional amendment.
It is of the utmost importance that the right for a conscientious objection be included in this Bill. The Minister for Health has indicated that the code for nurses issued by An Bord Altranais gives nurses adequate protection in this matter. The members do not agree with him as the code does not confer legal protection. The nurses are asking, as in Northern Ireland, England and other countries, for the right to make a conscientious objection if they feel the need to do so. I want — I suppose it will not be my first polite word to the Minister in this debate — to thank him for amending this section in the other House to give extra places to nurses. He stopped dead at professional conduct and behaviour.
There was another part which stated "each hospital shall have the right to establish its own ethical code while making provisions for the rights of conscience of the individual employee". I consider that any Minister of any Government is in this conferring on himself too great a power in the ethical codes of hospitals which would affect the nurses and which the few of us here who are considering this Bill, are concerned about. This is a section on which it suited some people to talk about religions and some of us are more liberal than others. That is not my view on this section at all. As a legislator I want to make sure that section 51 is just right and that it has the right effect when it leaves this House. I ask the Minister to think again about the request made to him by Senator Fallon, maybe for the Report Stage of this Bill.
The Minister spoke about allowing nurses overriding statutory powers in what would be totally undefined circumstances. I do not think the nurses are asking for undefined circumstances. I want again to support Senator Fallon. The Minister knows what we are asking for. The Minister quotes the code for nurses but the nurses organisation do not agree with page 6 of that Code of Nurses and are asking for the right to make conscientious objection if they feel the need to do so. We leave religion and all these things out of it. It is the right of the individual nurse that I am concerned about here. Recent events in any hospital have no bearing on it. I had my notes made on this Bill. I took this Bill at the very early stages and saw all the problems that are only coming to light nine or ten months afterwards.
I oppose this amendment and support the subsection as set out in the Bill. I appreciate greatly what my colleagues have said about nurses' rights to a private conscience. Of course nurses have a right to a private conscience; so have patients the right to private conscience. So have we all rights to private conscience. Senator Fallon has said that this is a difficult problem. Indeed it is a difficult problem. That will have to be solved by trying to create some kind of reasonable balance between the right of the nurse in what she does and the rights of the patient and possibly what the patient's doctor recommends as correct procedure. Naturally I am not talking about any sort of illegal procedure but of perfectly legal, permissible procedures in Ireland. In a sense, to give the individual nurse a right of conscience to opt out of any of these procedures can tend to work towards a situation where the nurses conscience, if it is completely unfettered in the kind of way that seems to be suggested, can override the conscience of the person who is looking for treatment and indeed possibly the doctor who is recommending that treatment. This is an unbalanced situation. I know that it is obviously an easy, more popular and more high-sounding thing to say that nurses must have a right of conscience, that it is a human right and so on. We must remember that, medicine is not just about nurses or about any one particular group but about the interaction, and a very complex interaction, of all sorts of different people — patients, nurses, doctors, paramedicals and so on. I do not feel that one particular nurse or one particular small group of nurses can use their right of conscience in a way which overrides the consciences of other people.
The Bill states that it should be a function of the board to give guidance. The way in which the board is set up in the Bill means that the board will be largely representative in a broad sense of the nursing profession. At the same time, because of its wide representational character and because of the kind of nurses that will be on it, it will possibly have a more profound wisdom and a greater ability to advise in these difficult questions than one nurse deciding by herself or even a small group of nurses in one particular hospital. I think it is showing a great lack of trust in the representational character of the board to suggest that it should not have a function in giving ethical guidance. The individual nurse is well safeguarded by the proposed section in the code for nurses where it allows her to be entitled to make known at the earliest possible opportunity to an appropriate person or authority any conscientious objection which may be relevant to professional practice. This gives her the opportunity to be open to the guidance of the board which can allow her to make clear her objections and to explain why they should exist.
I find it very difficult to believe that a board which is so representative of the nursing profession and presumably, because it is elected, representative of the views of nurses as a whole, will come out with rulings which are going to be so difficult for nurses to swallow. I cannot understand why there is such a fear of allowing the board discretion in this matter. There has been a certain reference to the fact that this has something to do with religion. I agree with Senator Honan. I do not think it has anything to do with religion; I think it has to do with the kind of decisions which patients and doctors need to be able to make.
Senator Fallon said that it is not just about family planning areas. Of course, in theory, it is not just about family planning areas: but it is the experience over a number of years that it is in precisely these areas of female reproduction that ethics appear to arise in our hospitals. We do not have any talk about the ethics of using public facilities for private patients when it means that public patients are pushed to the end of a long waiting list so that these facilities may be used for private patients. I would have thought that that was an ethical matter which might exercise the consciences of nurses or doctors, but that is never the sort of thing that is mentioned. The sort of areas mentioned is precisely the sort of area that has arisen in the regional hospital in Galway and that kind of area has arisen in other areas too. I fear that that is the way in which ethical committees and ethical codes which are set up in hospitals do work. They work to give a particular ethical view of matters which are to do with the reproductive organs of women and not in other areas. It is very seldom that you will find any other area being dealt with. Of course there will be problems about organ transplants and of course there will be problems about the allocation of scarce resources. Again, these are matters of balance, and again one has to apply a balanced approach where the needs of the patients, the requirements of the doctors and the needs of the nurses and so on must be balanced out. I suggest that the board will be the right place to do this rather than a certain group in a particular hospital or a certain nurse who has an ethical objection owing to her private feelings or possibly her religious feelings.
There has been talk of abortion and euthanasia. No one is talking about these, which are illegal procedures. It is not a question like that. A nurse cannot be asked to carry out an illegal procedure. When Senator Durcan spoke about the Spanish situation it is very cogent to note that it was only when abortion was introduced into Spanish law that this particular right of conscience was given because that is the particular area. In Ireland, where abortion is not only illegal but unconstitutional and where euthanasia would certainly also be illegal as being virtually a form of murder, no nurse is going to be asked to carry out things like that and no one is going to have to refer that kind of thing to the board. The problems that are arising are about procedures which are perfectly legal but on which it happens there is a certain religious view. The fact that either ethical committees in hospitals or nurses' individual consciences can be used to prevent women from getting procedures which are perfectly legal seems to me to overbalance the conscience right against the patient and on the side of the nurse. Therefore I would support the subsection in the Bill which would allow the board to make this kind of decision with all the wisdom that will be available to the board and all the people that the board will be able to consult, and that the code for nurses will double the safeguard of the nurse in the sense that she will, through the code, be able to make her feelings clear. I have not the slightest doubt that hospital authorities and the boards will go to all lengths to prevent a nurse having to take part in something that she finds wrong in her own conscience. Nevertheless I feel that this is a matter which should be left to the board and not to the decision of the individual nurse.
In my second speech I asked the Minister to include a conscience clause in this Bill mainly because it is a Nurses Bill that is coming in and will be in operation for many years. I did so also on the basis that medicine is changing. I gave the example that there are experiments going on with embryos at the moment. While I accept a lot of what Senator McGuinness has said, there is always the danger that there are new trends coming in that some people may accept and even an ethics committee may accept but which one individual may not feel in his or her conscience are right. I would accept completely what she says that no individual should be able to overrule the right of a patient to treatment. I got an assurance on the last occasion from the Minister that the ethics committee will deal with these problems. I am quite sure that he has dealt with this in the Dáil already and if he is not willing at this stage to accept the conscience clause I hope he has weighed up all the arguments and that the result will be for the good of everybody and that the ethics committee will deal with any conscience clause or objection which may come in with the nurses later on.
I think that the debate has taken a change now in that Senator McGuinness has brought in a red herring by equating nurses' rights to a private conscience with patient's rights to a private conscience. Why should a nurse have to equate her conscience with somebody else's conscience. I cannot equate my conscience with anybody else's conscience. If my conscience says I should or should not do something, that is my business. I should not have to take anybody else's conscience into account.
The situation simply as stated here, is unworkable. How can a board give guidance in a particular situation, in an emergency situation in a hospital where a nurse is confronted with a case which has to be dealt with on the spot? Senator McGuinness mentioned that the whole emphasis is on women's reproductive organs and that this is the only area of concern. It is not the only area of concern. There can be occasions when because of religious, ethical or moral beliefs by particular doctors or hospitals a nurse might be asked under circumstances to carry out procedures which would be totally against that person's conscience. I cannot see how a board can give guidance then. How can you call a board together when an instant decision has to be made by a nurse? The nurse has no right if she does not go along with what she is asked to do in the hospital. She is employed by the board, not by the hospital, and then she will come in for disciplinary procedures.
The patient has every right to get whatever type of care is needed in any circumstance but that does not mean that a particular nurse has to perform the operation or administer the drug which that type of operation requires. There is grave concern — not alone among the nursing profession — about the fact that nurses may have moral and constitutional rights taken away from them.
Many of these nurses now employed here came back from service abroad; many of them came back from service in England, and through the years they have always had the right to opt out of surgical or medical procedures in which their consciences would not allow them to take part. There was never any question of them not having that right. They come back to Ireland and are not allowed the same freedom of conscience. I do not think it would be as disruptive to patients as is suggested by Senator McGuinness. There would be certain disruptions if there was one nurse only involved in a medical or surgical procedure but if the patient is undergoing an operation, surely the hospital should be able to arrange for somebody whose conscience would allow them to do so to be present or to take part in that operation.
Patients have the right in that sense and the hospital has the right to organise their surgical practices but the nurse does not now have the right to opt out. She should have that right. It has been said that it is only in cases of women's problems that we are perturbed. It is not. You could have the case where life-support machines might need to be turned off. A nurse might be asked to turn off a life-support machine. Why should she not have the right to opt out of that situation if her conscience did not allow her to do so? That situation can arise for a nurse. Even though it could be said that the doctor in consulation with parents or relatives would have decided that a life-support machine should be cut off, if the individual nurse who is asked to do it does not want to do it by virtue of her conscientious objection, she should be allowed not to do it and let somebody else go along and do it.
The suggestion was made by Senator Fallon that the Minister change his mind on this item and that when we come to Report Stage he should amend this subsection or eliminate it so that the nurses who have a civil right at present to opt out of any procedure would have that right in the future.
Section 51 (2) relating to the function of the board to give guidance to the nursing profession generally on all matters relating to ethical conduct and behaviour is a section I raised on the Second Stage and I was pleased with the Minister's response to my suggestion that there should be an ethical clause written in. Not alone was I pleased with the response but I was pleased with the explanation which proved that there was no necessity whatsoever on this occasion for writing a clause in this legislation giving nurses the opportunity to opt out on moral grounds, simply because this legislation does not ask nurses to do anything that is immoral. The Minister in his reply assured this House that if the legislation contemplated that there was a question of morals involved in a nursing procedure, then naturally there would have to be written into the legislation the right of opting out on moral grounds.
We have drawn comparisons with Britain and elsewhere where they have legislation that allows particular surgical operations and interventions to take place. They have legalised abortion there and it is correct when a country has such legislation on the statute book that people who have moral objections to that type of surgical intervention should have the right to opt out. This legislation sets up a nursing board which, as I stated earlier, will comprise between 18 and 20 nurses out of a total membership of 29. All this legislation empowers them to do is to initiate guidelines about ethical behaviour and ethical conduct. That covers a whole range of activities in their private life, whether they spend all night out drinking, whether they turn up drunk on the job, which as we know no nurses do, but it does give the board the right to set down certain standards of behaviour outside of the whole area of the moral code.
It is only right that a nursing board which would have this responsibility to register nurses as being suitably qualified to be members of this admirable profession, this vocation which we all talk about, should have the right to set down for themselves a certain code of behaviour. Every right thinking professional person and nursing person and indeed patient will realise that it is imperative that the board would have the right to set down guidelines for the behaviour of their members. There is nothing whatsoever in this legislation that says that nurses, if they still have a moral objection to a particular medical procedure, could not in fact on moral grounds opt out. Of course they can and do regularly. But you can bring morality down to the level of a laugh if you consider that in the area of blood transfusion, which all of us accept as a necessary part of life in all our hospitals every day, there are religious people who disbelieve that blood transfusions are morally justified. They think that it is immoral and they would advocate that none of their members if they were nurses would participate in blood transfusions. I think we should be honest with ourselves in assuming that a board which is going to be set up for the profession to set down their own code of behaviour will do so on a proper basis and if 18 or 20 members from a board of 28 or 29 should set down some sort of an immoral code of conduct, certainly all the Members of this House would be coming back requesting the Minister to bring in a ministerial order to stop them from doing so. We have a just system and it does not need legislation to uphold it. We had a recent example in Canada which did affect some people's consciences and a lot of people wore other people's consciences on their sleeves at the time. Nobody in that legislation advocated that people would by law have to be involved in the sale or provisions of contraceptives and there was a moral clause written into the legislation to allow for that simply because the legislation was putting certain statutory obligations on people who did not hold the same moral beliefs to provide a service, and it was appropriate that in that legislation such a moral clause would be included.
This legislation, I would respectfully suggest, does not do any such thing. I have had lengthy discussions with many nurses and nurses' organisations and representatives in my constituency and I am arranging further meetings with them to explain what this legislation is about. I do not know where the idea has come from but there is some idea in people's minds that this Minister is now bringing in legislation that would make people do something that is not morally in keeping with their own beliefs. Nothing could be further from the truth. It is an unfair reflection on the Minister for this to have been said or for it to be suggested that in some way nurses who refused on moral grounds to participate in anything would ever lose their job because that would be the subject of action in the Labour Court by way of a claim for wrongful dismissal. I would assure my friends on the other side of the House that they do not have anything to worry about in this area. The nurses are well able to look after themselves and the nurses are being given the power by this House of the Oireachtas to set up their own board. I do not know why the people on the other side of the House feel that it is imperative to put in a conscience clause when in fact the legislation does not require that anything immoral would be carried out. It is to set up a board to set out the code of ethics and conduct for the members of the profession. That is how I look at it. I think that was the Minister's response to the Second Stage debate. That was the subject of my contribution originally because if it was possible to have it written in naturally we would like to do so, but it is silly to write in sections in legislation that are totally and completely unnecessary. Let us hold them for the day when they are necessary. Then I will support them.
I am concerned about the conscience clause for the individual nurse. I suppose we must admit that this springs to some extent from religious conviction in every case, but we have all been approached and circularised by people with vested and special interests in this Bill. My understanding of the objections is that this section 51 would deny the rights of individual hospitals to empower their own ethical committees to formulate ethical guidelines and standards for observance in their hospitals. I believe this would be overcome and there would be general agreement if the board only had power to stipulate guidelines of professional conduct for nurses but that each hospital would reserve the right to establish its own ethical code while making provision for the rights of conscience of individual nurses.
I want to repeat that I find nothing objectionable in the section as it stands but what I do worry about is this, and perhaps the Minister might answer a simple question for me: does a nurse currently have the right to opt out of the procedure which she or he — not to be sexist — is directed to participate in as an employee? Does a nurse as an employee have the right currently to opt out of a procedure to which he or she has a conscientious objection to participating in? That, as far as I can see, is the nub of the matter. If the Minister can satisfy me that a nurse currently has the right to opt out of something within the current terms of employment as a health board employee then I have no worries in relation to this matter. But if I cannot be satisfied that a nurse does have the right to opt out, bearing in mind the fact that nurse is an employee, then certainly I have worries, then certainly the numerous nurses who have come to me individually and in groups and who have had other people making representations to me on their behalf would also be very worried. I would like the Minister to answer that simple question.
If the Minister answers Senator Durcan in the way Senator Durcan hopes my worries will be over also. I cannot understand why Senator Ferris decides to come in here this evening and give us on this side of the House a lecture. Is it because we have delayed this legislation going through? I am concerned with the Bill before me this week and last week and that is the Nurses' Bill. I do not understand why there is not a conscience provision in it for the individual member of the nursing profession. If the Minister answers Senator Durcan's question then that will probably satisfy me also.
If we could have a reply from the Minister?
May I say in reply to Senator Ferris, in fairness we did not. I certainly did not and none of our side did infer that the Minister would do anything that would be contrary to our wishes, as it were. What we said, and what I said is, that perhaps in 25 years' time — and I even said it might be a Fianna Fáil Minister — a Minister might decide under section 53(1), the section with powers to assign new functions, for whatever reason to direct the nursing board on an ethical matter contrary to the belief of the public and of the nursing profession and if they did not agree he could invoke section 15, which is the section giving the power to discharge the board and put in his own administrator. That could happen. It is a possibility in the future. That is the point that I think we made.
Just to make a very brief comment on what Senator Lanigan said, first of all I must congratulate Senator Lanigan on the fine Protestant statement he made at the beginning of his speech about the fact that his conscience was his own and nobody could tell him what to do with it and that that is the way we should behave. I am glad to find that Senator Lanigan is coming around to my point of view in these matters.
Not totally.
I would just say that when I expressed concern that these ethical questions always seem to be about womens' reproductive organs of course you can say there might arise the question of a life-support machine. So there might. There might arise questions of experiments on embryos and so there might. I would just like to ask Senator Lanigan, or anybody else, if they can give me a concrete example of any hospital in this country in the last ten years where an ethical issue arose which was not about something that was to do with family planning or womens' reproductive organs generally. There is the present controversy about sterilisation. Why is it that sterilisation is available in so very few hospitals except that this kind of ethics is imposed?
It is fine to talk in generalisations of what might happen and what might not happen, but what I am worried about from the point of view of the patient is what does happen. I would refer to an interview recently given by Dr. Mary McEntaggart, who is a member of the ethical committee of the Irish Medical Union. She pointed out that in her experience there had been at least a number of women who underwent hysterectomies, which is a major surgical intervention and which is quite dangerous, because they were not allowed to have tubal ligation or sterilisation as it is more popularly called. If your conscience is going to make a woman have a major operation which carries considerable risk instead of a minor operation which carries practically no risk, it seems to me that there is something funny about a conscience that makes people do that.
I think that Senator Durcan's question is a fair and a relevant one but I do not think it is as significant as it would appear at first because, first of all, we are talking of a situation within the structures of this Bill. My understanding at the moment is that individual hospitals have the right to establish their own ethical code. The committees can do that and they have that power. So at the present time I do not think there is any situation where a nurse would be asked to do something which in conscience she would feel she could not do. I feel that the answer to Senator Durcan's question, while it is relevant to an extent, is not all that significant. We are talking of a situation which will be completely different. At the present moment, as I understand it and I am subject to correction, those individual hospitals can determine their own guidelines and in that situation no nurse would be asked to do something which in conscience she would feel she could not do.
I have come a little bit late because I had to be somewhere else during the early part of the afternoon. I am a little concerned about this cry for a conscience clause and an opting out. We must remind ourselves of the fact that our health care profession, both doctors and nurses, operates within the law of the land. Secondly, they operate within the guidelines of the ethical codes of their own professions, both doctors and nurses, and in some hospitals they have ethical committees, though I feel that this is an unnecessary icing on the cake given that you have the law of the land and the professional and ethical guidelines of the different professions. So that if, in addition to that, you want to throw in an individual conscience clause, it strikes me as being something that is in fact superfluous. We all know the fears that many of us have in relation to this extra procedure or process that is being looked for and it is that the people who are behind the wishing to have ethical committees are going to apply yet more leverage to ensure that the rights of so many patients which are currently being denied are effectively going to be denied and that is the concern that I have. I would hope that when the Minister replies he could make some reference to how he thinks this would operate and I would also like him to give reassurances along the lines that health care professionals in this country today operate conscientiously within the law of the land and within the guidelines of their professions and whether he feels that there is a need to have a conscience clause for good measure.
I think that Senator McGuinness and Senator Bulbulia effectively stated the position, and one can summarise it this way. A nurse in the performance of her duties in the first instance can claim unquestionably not only on conscientious grounds but on statutory criminal law grounds, if for example she was asked to perform an abortion procedure, that she would have absolute entitlement to refuse to commit a criminal act. It is only when one gets to the specifics of questions that this question can arise. There is not in existence in this country a global overriding all-embracing statutory right of conscientious objection. It does not exist. It is undefinable in that framework. That is why in relation to abortion, which is a criminal act of itself under our law, we know exactly the position in terms of the work of a nurse. In relation to family planning, for example, there is a specific conscientious clause written into that specific piece of legislation and we know where we stand there. We know, for example, that in relation to tubal ligation or sterilisation as it is called, it is not an illegal criminal act. It is not and, therefore, if a nurse and doctor in a theatre, with the consent of the patient, decide to perform the procedure they are not performing a criminal act or an illegal act. That is the position.
Therefore, a nurse has several constraints and responsibilities in the performance of her duties. First of all, she has to give due regard to the statutes of the country that she works in, and I have seen many variations of statutes. I have met Irish nurses working in Saudi-Arabia and they are subject to the laws of Islam in a very emphatic way — and you should see some of the conscientious decisions which have to be taken there. I have met nurses working in Iraq. I have met nurses working in the UK. There is in the UK a conscientious clause in relation to abortion. There is a specific conscientious clause written into that legislation. But there is no universal conscientious clause in the UK nor indeed in Northern Ireland as has been inferred. It does not exist in terms of operation. So, therefore, the law of the land comes first in terms of the ordinary day-to-day work of a nurse.
Secondly, there is the professional code of the particular professions. Indeed, the profession most under scrutiny is obstetrics and gynaecology. Senator McGuinness is quite correct when she points to the obsession, invariably on the part of male politicians, who relate all issues of conscientious objection in terms of the practice of nursing to those areas and virtually nothing else. That is the reality and it is a grim, disturbing reality. I must confess I have always had that view and it speaks volumes of what we Irish men are like. But her professional code as a nurse and the doctor's professional code as a doctor, subject to the codes of their professions, come into play in balance with the law of the land.
Then there are the conditions of employment, because invariably a nurse is an employee of a particular health board or a hospital. No nurse, for example, can claim on conscientious grounds that she does not wish to wash a patient. We would not try to uphold that. No nurse has a global right to say on conscientious grounds "I do not propose to permit a particular clergyman to go to that patient". We would not tolerate that. Therefore, we do not confirm global conscientious entitlement, but we do so in relation to specific aspects of specific legislation. We have done so in relation to family planning. It is not possible to write into this legislation such an all-embracing right of conscientious objection because one would have to fill 25 volumes of definition in terms of procedure. Therefore, the question is asked of me whether a nurse has the right to opt out of a procedure on conscientious grounds. If the particular procedure demanded of her is illegal of course she has the right to opt out. She has a statutory entitlement as a citizen, not to be obliged to commit a criminal act. But she does not have a global right. She does not have a statutory entitlement of a global nature. That has never existed and no hospital or institution would confer a right automatically on any nurse or any doctor of total, personal, absolute conscientious objection. I am taken aback at the attempt to remove section 35 (2) because this is a protective mechanism. It is to the benefit of nurses. We have here, for example, the first addition by An Bord Altranais, all eminently sane and sensible people——
So say all of us.
Admittedly they were appointed by the Minister of the day, following the democratic electoral procedure of An Bord Altranais. There is a protective mechanism, a definition of responsibility to patients. The code for nurses reads:
It is the responsibility of the nurse to be aware of and to take appropriate action in circumstances of incompatent, unethical or illegal practices.
Therefore, the nursing profession, in whom we are to repose responsibility and to devolve professional authority, will decide the code and so on. There are a group of people in this country — mostly male, mostly paternalistic — who resent giving and who are reluctant to give nurses that authority. They do not want to see them have it; they would prefer to tell them. I am a democratic parliamentarian. I want to have the nursing profession, who will be overwhelmingly represented from all of the grades of the profession on An Bord Altranais, to sit down without ministerial interference and without being browbeaten in any way by anybody and decide the code of conduct for their fellow nurses. Nurses have a right to have that responsibility. Some people do not want to give them that right. I know a few people around who would not give it to them, be they medical or otherwise, because nurses have always been treated as: "After all, she is a good nurse; she will do what she is told". That is why I want to turn this argument around from what I regard as a perverse removal of this section. It is protective of nurses. I mean that in all earnestness.
There are very unusual arguments put up as to why this should be changed. They are arguments which are not tenable. Senator Lanigan maintains that nurses, if I may recall his words, will be losing their moral and constitutional rights. There are lots of things I could say, but I do not say these kind of things. I never advance that kind of argument. But I say, in fairness to our colleagues, that it would be quite impossible to set out comprehensively what such matters are. We could not set it out comprehensively in legislation. Matters alleged to be unethical can be reported under this Act. Any citizen, high or low, male or female can go to An Bord Altranais and say that in their view nurse X is committing an unethical act. He or she has perfect authority to do that. The board will then judge or adjudicate on whether this is unethical or unprofessional conduct. As such the person will then be judged by her or his peers. If the fitness to practise committee feels that they cannot adjudicate, they can seek outside advice from anybody they like. An Bord Altranais are perfectly free to go to any Church, any barrister or any committee, any Deputy or Senator, and seek their views as to whether the practice in question was or was not an unethical practice. But if we give An Bord Altranis the right to decide that a particular action is unethical then we must have the parallel right to say: "We will give you guidance as to what is ethical". You have to have it in both directions; otherwise the legislation is meaningless. If this section is taken out the fitness to practise committee can be taken out, because there is no point in having a fitness to practise committee if in the first instance they cannot lay down criteria as to what is fitness to practise. Therefore, the legislation must stick together. That is why I have had to keep it together in spite of some very unusual interpretations as to what I am having imposed.
The board, therefore, are empowered to determine fitness to practise on grounds of professional conduct and on grounds of physical and mental ability and they have power to prosecute for offences under the Act. It, therefore, follows that the board must also have the power to set down guidelines generally for the practise of the profession. This power must be clearly established in the legislation. I was very pleased to see An Bord Altranais come out with this. Individual hospitals have their own publications and conditions of employment. They do not cut across it. Various practices exist in a variety of individual hospitals and nurses taking up employment in those hospitals are subject to various conditions of employment which they either accept or do not accept. They are not being diminished in any way. But An Bord Altranais must be a board. In my view this is one of the critical functions of An Bord Altranais and I am very much in favour of it. My general explanation is offered in an effort to clarify the thinking behind it. We cannot put everything into legislation. That is the best effort I can make at explaining the situation. On those grounds I would urge Senators to permit the section to stand. I have spoken to a lot of senior nursing personnel and they see the sense in this section.
That is one of the best male chauvinistic speeches I have heard in a long time in which the Minister blames the politicians of the male variety for all the pressure in regard to this section. For my part, any pressure that was put on was not because I have anything against the nursing profession or female nurses in the profession but because I have been approached by a large number of people from various elements within the nursing profession. What I am doing here is making explicit what they have said to me. The Minister came to the nub of his argument in his reply when he said that it is the law of the land that comes first. He then mentioned that a nurse who was asked to help to perform an abortion in this country would be helping to perform an operation which was against the law of the land. He mentioned the fact that tubal ligation was not illegal here and therefore a doctor and a nurse who were in the situation could go ahead. I was not too sure why he mentioned that item. He followed that with the statement that conditions of employment would come into effect. Basically what he seemed to be suggesting there was that a clause could be written into the conditions of employment that a nurse would have to perform any operation which was the law of the land irrespective of her objections, conscientious or otherwise. This is implicit in the Minister's statement. I should like to know if there is an intention that conditions of employment will now contain a clause that a nurse must take part in all operations and all surgical practices and in everything which is now the law of the land. The Minister has broadened this debate quite considerably with this statement. He has specifically stated what he means by putting in this clause. If I were a nurse I would hate to think that now the law of the land becomes the conscience of the country. Everybody has to abide by the law of the land but we do not in all circumstances, have to get involved in the niceties of it. I can opt out of performing something which is legal in the country.
I complement the Minister on his approach to the debate and on his line of argument, not that I necessarily agree with what he says. It is quite obvious that somebody cannot be compelled to commit a criminal act. The Minister makes this point rather dramatically in trying to underscore the arguments which some Senators have been putting forward. Nobody can be compelled to commit a criminal act and that is basic. We were talking about specifics. Can a nurse who is employed by a health board be compelled to assist at a sterilisation operation? Having said that, I accept the point that Senator McGuinness raised on the Second Stage that there can be attempts made to deprive people of procedures which they may require. I would be very worried if that were to happen. I would oppose any such situation developing within the country. I made a point, immediately following the Senator in my Second Stage speech that I shared her worry in this regard but that I did not altogether agree that the Galway situation was a good example in relation to this.
Dealing with specifics, if a nurse is told on coming on duty that as an employee of a health board she must assist in a sterilisation operation can she opt out on conscientious or on moral grounds? The code of conduct is not of any help because whoever worded clause 1 (11) of it worded it in such a way as to make it completely inoperable. I shall read it for the record:
A nurse shall be entitled to make known at the earliest possible opportunity to an appropriate person or authority any conscientious objection which may be relevant to professional practice. An Bord should be the final arbiter as to whether any such objection falls within the scope of this clause.
It is quite impossible to put that into operation for the protection of an individual nurse.
In conclusion, I shall summarise what I have said and repeat my question in another way. In the specifice situation which I have mentioned, does the nurse, as an employee of a health board, have the right to opt out currently? If I can be assured that a nurse does have the right to opt out, I will be happy.
With respect to the Minister, he is wrong when he states that this is an area of misplaced male concern. My concern springs from the approaches which were made to me by people in the nursing profession from the lowest level through to the top levels. All these approaches came from women. My views are the views of concerned people within the profession at all levels. The Minister is wrong.
I always think very highly of what Senator McGuinness says but I do not agree with her that when we talk of morals and ethics we immediately think of delimiting the reproductive powers of a woman. This is not so. Nevertheless, with regard to what the Minister stated on sterilisation, the position is, as I understand it, that this is not allowed by the laws of the Catholic Church. We have the situation, for example, where people would want the operation carried out for family planning reasons. This would be against the conscience, as I understand it, of a nurse who is a Roman Catholic. We can also have the situation where the operation might be carried out for health reasons which would be quite in order for a nurse who would be a Roman Catholic.
Senator Durcan asked whether a nurse could opt out of a particular situation at the present time. The situation now is that a nurse in a particular hospital would not be asked to take part in that operation. The hospitals have the power to form their own ethical code and to follow their own ethical values so that situation would not and could not arise at present. In relation to the future, as it will be formulated through the development of the Bill, that situation could arise. That is the significant difference.
I would like to clarify for the record something I said earlier. I believe that people should have the right of sterilisation operations if they so require. In case I said anything that would suggest otherwise, I am making the point now for the record for the purpose of clarifying my position on this matter.
I should like to make one final point. I am not saying that sterilisation is right or wrong. I am not making any value judgment on sterilisation. I am simply stating the situation as it is at the present time and as I understand it objectively. There are many Roman Catholics who have the operation carried out — in conscience they feel they are right. I am not criticising them, I am not condemning them and I am not condoning it. I am taking the situation as it is. In a particular hospital where a nurse is employed she would know whether she would have to take part in that particular operation or not. She would realise that if she is taking part in the operation it is carried out for a particular health reason. This is the point I am making. I am not projecting my value judgement on the situation.
Is it not the intention to adjourn for tea?
It was indicated at the beginning of business today that we should suspend the sitting from 5.30 p.m. to 6.30 p.m. We have had a substantial debate on this amendment and the manner in which the debate has developed indicates that we should not interrupt it, that we should continue on beyond 5.30 p.m. in order to dispose of the amendment. If it has not been disposed of by 6.30 p.m. we can think again.
Is that agreed?
Senators
Agreed.
I thank the House for agreeing to endeavour to dispose of section 51 of the Bill.
Specific hypothetical questions have been put to me. That is entirely appropriate. I will endeavour to answer them as best I can. Before doing so I want to again refer Senators to the specific section. It is in that framework that I will answer the questions. It shall be a function of An Bord Altranais to give guidance to the nursing profession generally on all matters relating to ethical conduct and behaviour. That specific statutory power has been written in because there can develop the type of situation just enunciated by a number of Senators. For example, the question of sterilisation or the performance of the tubal ligation procedure has been put directly to me. My response is that no individual nurse can be compelled to participate in a procedure against his or her personal will. Nobody can be compelled as such. But there does arise a situation in these circumstances where a number of factors come into play. First of all, there are the conditions of employment. Reference has been made to a health board hospital. Automatically the nurse's conditions of employment come into play. Automatically her own undoubted probability of seeking information from An Bord Altranais as to whether her personal action is in accordance with the general ethical views of An Bord Altranais does come into play. Her trade union automatically comes onto the scene in terms of that situation. Therefore, there arises a problem of the continuing protection afforded to her in her day-to-day work as a nurse in terms of taking such personal decisions. That decision is no different from the situation, for example, where a doctor and a nurse or a group of nurses in an intensive care unit would have to take a final decision to turn off a ventilator on a patient when, by all criteria of assessment they had come to the conclusion that there would be no prospect whatsoever of the revival or continued life of that patient and it was a question of the ventilator decision having to be finally taken. I have seen that happen. A nurse's assessment comes in there in terms of her role. Equally, you can have a situation where particularly dangerous drugs are required to be administered, or a case of a terminally ill person with cancer being administered with heroin. Some nurses may object in principle to the administration of a particular drug. There cannot be a compulsion in that regard.
I will sum it up in this way. It is not possible in this legislation to put in a global provision, an all-encompassing provision, in relation to ethical conduct or to a conscientious opting-out. The only legislation where we have that is in relation to the Health (Family Planning) Act. There is a specific provision there. What one cannot devolve in this legislation is a specific statutory conscientious clause being put in. To attempt to do so would be to create a condition of employment or a condition of professional service which in the first instance would be enormously difficult in terms of definition and would be meaningless in practice. It would certainly cause great difficulty in terms of implementation. For these reasons I want to assure Senators that I have endeavoured to give as broad an explanation as I possibly can to the position.
Question put: "That the words proposed to be deleted stand."
The Committee divided: Tá, 26; Níl, 17.
Tá
- Browne, John.
- Bulbulia, Katharine.
- Burke, Ulick.
- Connor, John.
- Conway, Timmy.
- Cregan, Denis (Dino).
- Daly, Jack.
- Deenihan, Jimmy.
- Dooge, James C.I.
- Ferris, Michael.
- FitzGerald, Alexis J. G.
- Fleming, Brian.
- Harte, John.
- Higgins, Jim.
- Hourigan, Richard V.
- Howard, Michael.
- Kelleher, Peter.
- Loughrey, Joachim.
- McAuliffe-Ennis, Helena.
- McDonald, Charlie.
- McGonagle, Stephen.
- McGuinness, Catherine I.B.
- Magner, Pat.
- O'Brien, Andy.
- O'Leary, Seán
- Quealy, Michael A.
Níl
- Cassidy, Donie.
- de Brún, Séamus.
- Ellis, John.
- Fallon, Seán.
- Hussey, Thomas.
- Kiely, Rory.
- Lanigan, Mick.
- Lynch, Michael.
- O'Toole, Martin J.
- Fitzsimons, Jack.
- Hanafin, Des.
- Hillery, Brian.
- Honan, Tras.
- Ross, Shane P. N.
- Ryan, Eoin.
- Ryan, William.
- Smith, Michael.
Tellers: Tá: Senators Cregan and Harte; Níl: Senators W. Ryan and de Brún.
Question declared carried.
Amendment declared lost.
Section 51 agreed to.
Section 52 agreed to.
SECTION 53.
Question proposed: "That section 53 stand part of the Bill."
I would like to ask if it is felt that the new functions of the board should be authorised by the Oireachtas and not by the Minister. Is this section giving too much power to the Minister? Should it not be authorised by the Oireachtas?
I would stress to the Senator that indeed every order made under the section shall have to be laid before each House of the Oireachtas unless a resolution annulling the order is passed. It will then come into force. Unquestionably, there can be no new functions assigned unless both Houses of the Oireachtas agree.
Question put and agreed to.
Sections 54 to 58, inclusive, agreed to.
SECTION 59.
Amendment No. 12 not moved.
Section 59 agreed to.
First Schedule agreed to.
SECOND SCHEDULE
Question proposed: "That the Second Schedule be the Second Schedule to the Bill."
I would like to make a quick comment on that to the Minister. We did discuss the casual vacancies. The Minister has dealt with that previously. I am wondering did the Minister amend the provision on the quorum? The Minister said that the quorum of the meeting of the board shall be nine but that in the case of a meeting of the board for the matter of the erasure of the name of a nurse from the register or any division thereof the quorum shall then be 12. I was wondering was that the quorum when the board was composed of 27 members. Is there a need for an increase?
Senator Fallon is correct in that there has not been a change in the quorum. It is the same quorum as existed when the Bill was first published without taking into account the increase in numbers. By and large, it was felt useful that it should remain at that level because there was only an increase from 27 to 29 members in all and we did not want to get into a fraction.
Question put and agreed to.
Title agreed to.
Bill reported without amendment.
Report Stage ordered for Wednesday, 30 October 1985.
We will suspend the sitting. I do not think there is any reason to go beyond the original hour of 6.30 p.m. for our resumption.
Sitting suspended at 6 p.m. and resumed at 6.30 p.m.