Before I call on Senator Mac Lochlainn to open the debate, I should say I am conscious that this Bill has its genesis in tragic events, the cause of which has been the subject of discussion elsewhere. While I do not want to constrain Members unduly in their contributions, it is very important that Senators should not comment on, criticise or make charges against a person outside the House, as he or she is defenceless against accusations made under privilege. I am confident that we can have a full debate on the proposals contained in the Bill without reflecting on questions of culpability that may arise from the particular tragic case that prompted Senator Mac Lochlainn to introduce the Bill.
Coroners (Amendment) Bill 2016: Second Stage
I move: "That the Bill be now read a Second Time."
This Bill is to be known as "Jake's amendment". On 20 March 2013, shortly after being prescribed the antidepressant, Prozac, 14 year old Jake McGill Lynch ended his own life using a firearm. Jake, who was diagnosed with Asperger's syndrome, was given the antidepressant drug despite research stating that it has no benefit for children with Asperger's syndrome and despite the emerging evidence of harm. The coroner in Jake's case rejected a suicide verdict for Jake. This was due to an email that Jake wrote 24 hours before he took his own life, through no fault of his own. He was writing to a friend and he conveyed his concerns about the medication he was taking, and that he was feeling worse because of it. He said he felt drugged out of his mind and was trying to suppress the bad feelings. Based on those words that were brought to the coroner's attention, the coroner said that this child was not in his right mind and that he would not elaborate on the medication. He asked Jake's parents what verdict they would like, open or narrative. They chose an open verdict. None of the options suited, but it did not really matter to them as long as it was not a verdict of suicide. Their belief is that Jake was not in his right mind due to medication. Jake had no history or diagnosis of depression, suicide ideation or self-harm. That is confirmed by the prescribing psychiatrist.
I welcome Jake's parents, Stephanie and John, to the Visitors Gallery, along with their long-time friends and campaigners, Leonie and Tony. They have worked tirelessly to bring attention to this issue and to campaign for a change to the law. They have said previously that they are trying to make the difference they believe Jake would have made in the world. I think it is fair to say they should be absolutely applauded on making such a real difference on his behalf with this legislation.
Their request is simple. They want the Coroners Act to be amended in order that a coroner can return a verdict of iatrogenic - medically induced - suicide where such is the case. Of course, the coroner will take into consideration the evidence before him or her. This option should be available. It is an issue that must be highlighted. A verdict of suicide, returned in accordance with the provisions of the 1962 Act, must be differentiated from a verdict of iatrogenic suicide. By definition, iatrogenic suicide is the ending of one's own life where the effect of medical treatment undertaken by the deceased, including any prescribed medication, is the primary cause of such an action.
We know that grief is a complicated and harrowing emotion. I can only imagine how much more compounded and how many extra layers of grief are added when the correct cause of death is not attributed to the lost loved one. While this legislation can never relieve Jake's parents and the many others of their pain, it can give them recognition in a formal sense of what happened to their son.
In the midst of their grief, Jake's parents have come to understand that their personal tragedy is one that has been shared by thousands of families whose loved ones have died as a result of antidepressant-induced suicide. Over ten years ago, warnings first began that children in particular needed to be closely monitored when put on certain drugs. For example, a review in the International Journal of Risk & Safety in Medicine in 2004 stated:
Evidence from many sources confirms that selective serotonin reuptake inhibitors (SSRIs) commonly cause or exacerbate a wide range of abnormal mental and behavioural conditions. ... Each of these reactions can worsen the individual's mental condition and can result in suicidality.
There have been more recent studies in the same area with similar results.
It is not the intention of this Bill to scaremonger about, prescribe or influence medical treatment. It is wholly the responsibility of medical professionals, scientists and the Department of Health to advise, monitor and manage health care. The intention of this amending legislation is simply to give this real issue the place it rightly deserves within our legislative process, from the perspective of justice and the reporting of correct cause of death.
The World Health Organization states that countries "need to know how many people are born and die each year – and the main causes of their deaths – in order to have well-functioning health systems". Iatrogenic suicide takes lives each year. We need to know how many. We need to monitor and address it. We cannot and should not hide it. We rightly monitor mental illness rates and suicide statistics and have a suicide prevention office to address this. However, iatrogenic suicide is different, and deserves its own attention and monitoring if we are to have a functioning health system that works on preventing such tragedies as happened to Jake and many others.
There does not appear to be specific reference to iatrogenic suicide in the legislation of other English-speaking jurisdictions. Therefore, Ireland has a chance to be a leader on this issue by passing this amending legislation and recognising the difference between suicide and iatrogenic suicide. As the scientific evidence for the link between some medications and suicidal tendencies grows, countries will need to legislate for this. Ireland has a chance to be quick off the mark in being an example in this regard.
We understand that the publication of this Bill is symbolic. It is obvious that the Coroners Act 1962 is no longer fit for purpose and should be repealed and replaced with an amended version of the Coroners Bill 2007 as a matter of priority. The amended version of the 2007 Bill should contain a comprehensive list of verdicts open for a coroner or a jury, as the case may be, to return. When it is finally amended, this list should provide for a verdict of iatrogenic suicide to be made.
I hope the Government and everyone in the Chamber will support the Bill.
Whispers from senior civil servants about unintended consequences reach my ears at times. This legislation could not be more straightforward - it gives a coroner another option. The Minister will appreciate that a coroner will examine all the evidence before him or her and attempt to make as accurate as possible an adjudication on or assessment of what caused the person's life to be lost. For the reasons I have stated, it is vital for the sake of accuracy that the Government supports this amendment to the Coroners Act and allow it to continue through the Houses and be debated on Committee Stage and afterwards. For the loved ones in the Gallery today and for many more watching on, the main point is that we should have a society that reflects accurately the cause of death, does not turn a blind eye to the issues at hand and protects other families from suffering what Jake's family suffered. I appeal to the Minister to support this amending Bill and allow it to proceed through the Houses and the debate on it to develop. This is an important matter and I hope to have all of the House's support for allowing the Bill and the debate to progress and for justice to be done by these families.
I second the Bill. It will open up the options afforded to the coroner to include iatrogenic suicide, or suicide as a direct result of the effects of medication. I appeal to the Minister to allow this to be the coroner's responsibility. Let coroners do their job. They are professionals and will make prudent decisions about unintended effects. Please allow the Bill to progress through the Houses.
This legislation follows tough campaigning and Trojan work by parents Stephanie and John and other avid campaigners, who are in the Gallery. Jake, their baby of 14 years, died tragically by iatrogenic suicide in 2013. During my experience as a psychiatric nurse of more than 30 years, I encountered many people - not necessarily young ones - who felt a deterioration in their mental health after being put on antidepressants. One size does not suit all. They questioned why dark thoughts were causing them greater difficulties than when had they not been on these medications. When we titrated the medications down in a safe way, those thoughts cleared and we could deal with the other effects of depression.
Many people placed on these medications experience suicidality, initial or increased self-harming and an exacerbation of depression. These effects are written in the world renowned British National Formulary, BNF, as adverse effects of Prozac, especially on people aged between seven and 17 years.
We have lost thousands of young people throughout the world. Stephanie and John have been warriors struggling in the four and a half years since their tragedy to protect the children of the future. This country has a dubious medication policy. Perhaps that is an argument for another day, but everyone needs to accept that iatrogenic suicide is real and needs to be addressed. The coroner needs to have that option available.
We need to question risk assessment. Was any risk assessment carried out on Jake or the several thousand other young people who have been lost? What about the contra-indications of Prozac? The adverse side effects are too stark to ignore. Having previously showed no suicidal ideation or self-harm, the damage caused to these young people's mental health as they grow up is tragic, as it was in the case of Jake.
The length of prescriptions, their dosage, reviews, re-assessments and monitoring for clinical deterioration and other unusual changes need to be at the forefront. These factors will be taken into account in the coroner's ruling if he or she believes that a death was iatrogenic suicide. I have been in the coroner's court several times following tragedies. I saw coroners repeatedly refuse to rule misadventure. It is the open verdict that Stephanie and John accepted with a view to pushing the option of ruling iatrogenic suicide.
Stephanie and John are pleading with the Minister. They ask him not to stop now. Having done this for four and a half years, they say that he needs to put this measure into action. They write:
We are not just looking for someone to blame. Antidepressant-induced suicide is in actual fact a worldwide problem and there is a mountain of evidence and academic support backing this up....
Most changes that are brought in with new legislation are due to tragic circumstances, [we] are not trying to change the world. We are simply trying to get legislation updated to allow Jake to have the correct verdict that fits his death.
I ask the Minister to please listen.
I welcome Jake's family to the Gallery. I understand well the objective of Senator Mac Lochlainn and his colleagues in introducing this Bill. The background sets a tragic picture of what happened to this young man. I also understand a family's passion to make a difference and effect change after such an experience.
Having worked in the coroner's court as a solicitor, it has a limited function and cannot consider issues of criminal or civil liability or attribute such to an individual. I understand from the Minister that the Attorney General has given legal advice on this matter, which we must take on board. Essentially, the advice is that there is a risk of what Senator Mac Lochlainn is proposing being interpreted as apportioning some liability to the medical practitioner who prescribed the medication in the first place. This is not to say that liability is removed, only that it cannot be considered, and it does not mean that liability cannot be considered in another forum, for example, the courts. This is the Attorney General's opinion on the verdict of iatrogenic suicide and I understand that it is in this vein that the Minister is proceeding. On that basis, I am in the Minister's hands where this matter is concerned, but I understand the Senators' objective. There is a legal obstacle, but it cannot be readily dismissed. There rests the matter as far as I am concerned.
I welcome the Minister to the House. I also welcome Jake's family, who have campaigned tirelessly. It is not the first time that this issue has arisen. I remember raising a similar matter a number of years ago after a teenager shot himself while he was under the influence of one of these drugs.
We should pause a little as regards the question of culpability and liability. Could this be a wake-up call for doctors? Jake was prescribed Prozac despite the fact that he had Asperger syndrome, which is contra-indicated for the prescription of Prozac. I am not making any accusation against this doctor but, as a matter of principle, if there is medical negligence, then there is medical negligence and there should be recourse through the courts. I have no difficulty in facing that. If someone misprescribes a drug and, as a result, a young person takes his or her life, the person who misprescribed must face the consequences. That is the reality.
Jake was 14 years old and in the run-up to his junior certificate examinations when he was prescribed Prozac. Apparently, as a result of this, he became depressed. While he had never before shown any suicidal ideation, he obtained a gun and killed himself. A verdict of suicide might have been returned but for the fact that Jake's parents discovered a note in which he described himself as being drugged out of his mind. No teenager should be put in that situation. This happens not only in Ireland but across the globe. Jake's parents have been in touch with a family in New Zealand whose 17 year old son died by hanging after 17 days on Prozac.
This is an excellent Bill, which I will be supporting. I commend Sinn Féin on its production. The Bill is short, simple and clear, comprising only one page. Even though I taught English, I was not 100% sure what iatrogenic means. Iatrogenic suicide is defined in the Bill as "the ending of one’s own life where the effect of medical treatment undertaken by the deceased, including any prescribed medication, is the primary cause of such an action." Why, in such circumstances, should this verdict not be returned? A verdict of suicide is inappropriate. Where it has been determined that the suicide was the direct result of inappropriate medication, that should be recorded. The recording of a death by iatrogenic suicide should, I believe, be permissible. There may be some details that need to be tidied up but I am sure the Minister and his advisers are capable of coming up with a formula of words that would obviate any difficulties.
I hope that this important Bill, which deals with only a small minority of people but which, for them, is absolutely vital, will be passed by the House.
I, too, welcome Stephanie and John to the Seanad and offer them my condolences on the passing of their son. I also have a 14 year old son. What they have been through is unimaginable.
There are some questions which arise. In normal circumstances, business taken in Private Members' time has cross-party support and so our assumption was that this Bill would receive such support. I commend my colleague, Senator Mac Lochlainn, on never letting go of this matter. In all of my time as a Member of the Seanad, he has been dogmatic about having this Bill progressed through the Oireachtas. Should it choose not to support the Bill and allow it to progress to Committee Stage - where it could be teased out or, if necessary, reviewed with medical experts and others who have experience in this area - my question to the Government will be: what is it afraid of? We should not be afraid of that process. By the same token, where medical negligence occurs, those responsible must be held accountable. We should not do anything here that would prevent those people being held accountable, both for the sake of those who have lost their lives and others who may do so into the future. If there are valid reasons that need to be explored, this can be done on Committee Stage. I could not under any circumstances condone the cover up of something or the cutting off of something without it having been properly explored.
As Senator Norris indicated, this is a short, simple and straightforward Bill. If the Government or the Attorney General believe it will open up certain issues or that it will give rise to too great a cost, then let us have that debate on Committee Stage in order that we might tease out the relevant matters. Let us do the right thing. It is obvious that the right thing has not been done in many cases in the past but it must be done in the future. It is our responsibility to ensure that it is done.
I plead with the Government and Fianna Fáil - I note there is no member of Fianna Fáil present - to allow this Bill to progress in order that we might have further debate on the matter and analyse the Attorney General's opinion in a way that Jake, his parents and others in this awful position deserve.
I welcome the Minister. I thank the Senators who brought forward the Bill. There is a huge effort involved in drafting legislation for presentation to this House. I also welcome Jake's family. All of us here have been affected by suicide in some way or other down through the years. It is always a very difficult issue in terms of the questions that remain unanswered. In the vast majority of cases, we do not get answers. As I said, this is always a difficult issue for people to deal with, particularly for the families directly involved.
Section 30 of the Coroners Act states that the question of civil or criminal liability shall not be considered or investigated at an inquest and, accordingly, every inquest shall be confined to ascertaining the identity of the person in respect of whose death the inquest is being held and how, when and where the death occurred. In any inquest, it is not the role of the coroner to determine the cause of the event. In the case of a car traffic accident in which someone has died, for example, it is not up to the coroner to decide who caused the accident or who contributed to it. This is extremely important to note.
The Bill creates a problem in the civil and criminal areas in that if medication were prescribed and the coroner held that such prescribing was incorrect, a legal difficulty would be created and that would be a matter for the civil courts. For example, if this Bill were enacted, a coroner's inquest will require experts from both sides to give evidence.
What is wrong with that?
I am referring to medical experts being required to provide evidence as to whether a drug should have been prescribed. There is already a procedure in place for dealing with that. Such matters do not relate to the role of the coroner. For that reason, I have a difficulty with this Bill. It could lead to a situation whereby coroners' inquests could drag on ad infinitum as a result of the requirement to deal with these issues. This is not the way to go. An open verdict, as often returned in these cases, allows the next step to be taken. The making of final determinations on certain issues, as provided for in the Bill, does not fit with the purpose of inquests.
The Minister has already indicated that the legislation dealing with coroners and inquests is under review and that a comprehensive Bill on this issue will be published in the not too distant future. I am of the view that this issue can be best addressed in the context of our consideration of that legislation. The Bill, as currently drafted, is not the best way forward. As I said, I believe it will give rise to issues that could be extremely difficult to handle.
On that basis, I do not believe it is possible to support it. There are questions that need to be answered on prescribing and we need to debate the need for medical people to be careful about prescribing, because of the consequences. I do not believe changing the legislation covering inquests is the way to deal with it at this stage.
I welcome the chance to speak on this Bill. I thank Senators Mac Lochlainn, Conway-Walsh and Devine for bringing such an important issue to the House. I send my thoughts and condolences to John Lynch and Stephanie McGill Lynch, who have worked tirelessly behind the scenes on the Bill based on their own experience of their son Jake's tragic death in 2013. My heart goes out to them and I commend them on their bravery in highlighting the case and speaking out so openly about it.
The Bill is relatively short and would make the verdict of iatrogenic suicide available to coroners when assessing a case. As Senator Mac Lochlainn said, this differs from suicide as we would usually define it in the case of somebody taking their own life in medical treatment or with prescribed medication. Jake's case tragically outlines how this happens. Before the debate, John Lynch and Stephanie McGill Lynch passionately made the case that, at its core, this is about putting a more accurate verdict on a death certificate, one that more clearly reflects the person and the circumstances involved. This matters enormously to them. They have said that, while it may seem unimportant to people who are unaffected, it is extremely important to parents and other families in a situation like theirs.
I know from my own experience of working with families in therapeutic care that we should do everything to support people in these situations. We need to make sure a death certificate does not bring further trauma or make it harder for families already dealing with tragic circumstances. On this basis, I support the Bill going forward to Committee Stage for further assessment and scrutiny, which I hope can answer some of the questions raised in the debate today. The principle is an important one and we should always look for ways to better support families dealing with tragic circumstances. A death certificate can mean so much and it needs to be accurate.
I would like further clarification on the legal implications of the Bill. For example, what is the situation for a doctor who has prescribed a drug when a coroner later makes a verdict of iatrogenic suicide? How does liability work in such a scenario? As the Bill is developed, I will also be looking for clarity on what supports are provided. It is clear that if we had a properly funded mental health service, we would see far fewer tragic cases such as Jake's. This would mean bringing down waiting lists for people seeking treatment and proper screening and assessment before anyone is prescribed medication that may not work for them and may be harmful. Antidepressant medication can be really important in the right circumstances but it can also be the wrong course of action. We need to take this more seriously, particularly when children are involved. We cannot just prescribe tablets and tell people to come back a month later. We have to keep a connection going and provide regular support for people during the process. This, sadly, is not the case at the moment and supports are too often not available. This is particularly true for children and thousands of young people are struggling with mental health problems but cannot access the services they need. Since 2014, demand for mental health services has gone up by almost 30%. However, as of July 2017, almost 2,500 young people are still on waiting lists, many waiting for over a year. If we had properly funded mental health services to care for these young people, there would be fewer situations where children were prescribed drugs that could be harmful.
We also need clearer information for families on the effects of certain drugs and this is also something a proper mental health service could help with. People should not be left googling medication for clarity. We need therapists and counsellors who can help people directly and give thorough advice on the best treatment available, whether it is in the form of medication or other supports. I am keen to listen to the debate today and there are questions that need to be addressed as the Bill progresses. I thank John and Stephanie again for their incredible bravery in highlighting this issue. As legislators, we need to ensure families are not dealing with situations like this and uncertainty over something as important as a death certificate.
Níl fúmsa mórán a rá mar tá cuid mhaith dá bhfuil le rá faoin mBille seo ráite ag mo chomhghleacaithe anseo. I add my voice in support of this Bill. I welcome the parents of Jake, Stephanie and John, to the Visitors Gallery. It is a very emotive issue, one that Senator Mac Lochlainn has been pushing forward for a quite a long time, with the support of campaigners. I urge the Government to at least support the progress of the Bill to Committee Stage. I ask it not to quash it because it is an important subject that is very much worthy of debate in the Seanad. We should not be afraid of such a debate, or a discussion of iatrogenic suicide. There are many other issues around the work of coroners but this Bill is trying to focus specifically on this issue. I commend the work of Senator Mac Lochlainn and urge Government Senators to give this Bill the opportunity to go forward for further debate. It would reflect well on the Seanad if we allowed that to happen. Sin an méid atá le rá agam faoin mBille inniu mar tá an cuid eile ráite, i ndáiríre, ag mo chomhghleacaithe.
I agree with the last speaker that we should be prepared to discuss these issues and I fully accept the good intentions behind the Bill. However, I feel it is my duty as a prescribing doctor to correct some of the statements made by Senator Norris, whom I heard state that Prozac was absolutely contra-indicated in people with Asperger's syndrome. This is not the case. It needs to be prescribed with great care, as is the case with any antidepressant in young people. There is a much higher incidence of younger people, in particular those aged under 18, developing anxiety and they are becoming increasingly depressed when on these medications so prescribing is often done under very strict supervision, often by a psychiatrist.
It is not my intention today, out of respect to the family and the Chamber, to talk about specific instances and my sympathies are with the family who have lost a young man in these circumstances. However, the Coroners Society of Ireland is in discussions with the Department of Justice and Equality on a Bill related to the Coroners Act and the Government has made the passage of a Bill a priority for this Dáil session. The Minister might tell us what stage it has reached.
I believe this Bill is premature and it does not seem appropriate to insert it into a Bill relating to the preservation of documents. This does not mean I believe we should not be discussing this important issue and the issue of suicide. It does not mean we should not discuss the impact it has on families or what we can do to support young people and help them share their worries and concerns. As somebody who practises medicine, I stress that I am not trying to shield doctors who engage in bad practice. We have to have a proper, reasoned discussion and deal with it in a full way as we will do in the new Bill which is coming, and this will ensure that unintended consequences do not follow. It will be dealt with in an appropriate way and in a way that will afford everybody in this Chamber an opportunity to debate it at length. On that basis, I will oppose the Bill but I do so on the clear understanding that this issue will come before us again in the shape of the coroners Bill which the Minister is preparing.
I thank Senator Mac Lochlainn and other Seanadóirí for initiating this important debate in the Seanad. I too welcome Stephanie McGill Lynch and John Lynch and other members of Jake's family to our Visitors Gallery and our debate. On my own behalf and on behalf of the Government, I offer my sincere condolences and sympathy to the family on the tragic loss of Jake. They are very much in our thoughts this afternoon as we debate this issue.
The Bill contains three sections. Its main provision, from my reading of it, is contained in section 2, which would insert a new section into the Coroners Act 1962 which would, first, provide for the possibility of a verdict of iatrogenic suicide as defined by the Bill; second, offer a definition of iatrogenic suicide; and, third, provide a safeguard clause to ensure that a verdict of iatrogenic suicide does not contravene section 30 of the 1962 Act in the apportioning of civil or criminal liability, which is important. The Bill, as Senator Mac Lochlainn would readily testify, does not seek to address any related or substantive issues with regard to suicide or suicide prevention. I have listened closely to Senators' comments on this issue and acknowledge their experience in this regard, particularly in the context of her professional activities, Senator Frances Black, my colleague, Senator James Reilly, and Senators Burke and Mulherin, both of whom have engaged on numerous occasions in the process that is our coroner's court. Senator Mac Lochlainn himself notes in the explanatory memorandum that his proposal "symbolically amends the Act of 1962". The sole objective of the Bill, then, is the introduction of a new verdict, namely, one of iatrogenic suicide, or medically induced suicide, to be available to a coroner at an inquest.
The term "iatrogenesis" can be interpreted to mean an event or outcome brought forth by a healer. It could refer to both good and bad outcomes of a medical intervention or procedure. The Private Members' Bill seeks to define "iatrogenic suicide" as the ending of one's own life where the effect of medical treatment undertaken by the deceased, including any prescribed medication, is the primary cause of such an action.
Senators will very much appreciate that it would not be appropriate for me to comment in any way on any individual cases in which persons taking antidepressant medication have taken their own lives, suffice it for me to offer sincerely my sympathy or condolences. However, my role as Minister for Justice and Equality, a public representative and a legislator acknowledges the undoubted tragic cases that are coming before us as a society. In circumstances such as those in the case that has given rise to our debate this afternoon, our hearts go out to the families involved. However, I as Minister for Justice and Equality, and we as legislators in this Chamber, must be careful about assuming there is a causal link. Coroners have arranged for expert medical advice to conduct a review of the research regarding the medication involved and suicidal ideation or suicide. In at least one case, such a report found that no clear association linking death by suicide and use of the medication can be made.
I listened very carefully to the points Senator Norris raised about the matter of medical negligence, according medical negligence in individual cases and apportioning liability in cases. I am not sure whether we should make decisions about this issue in the manner in which it is intended we do so under the Bill. Medical matters should be for medical people, medical negligence through the various fora we have set up to deal with it. As Minister for Justice and Equality, I acknowledge that many of the issues we have been discussing are primarily for my colleague, the Minister for Health. This is not in any way to abdicate responsibility on my part, and I intend to discuss many of these issues, or all of them, with my colleague, the Minister for Health, Deputy Simon Harris. I refer specifically to the very important issues raised by Senator Black, and I acknowledge her expertise and the good work she continues to do in this area, but in this instance I am acting under the remit of my brief as Minister for Justice and Equality. Of course, it is open to any individual to pursue a civil action through the courts if he or she is unhappy with medical advice and the consequences of that medical advice in terms of the administration of any substance, be it prescribed or otherwise. That will not change under this legislation, nor should it.
In recent years, there has been considerable discussion in Ireland on suicidal and homicidal thoughts or impulses as potential adverse effects relating to the use of the medications known as selective serotonin reuptake inhibitors, SSRIs. These are antidepressant medications available by means of prescription only. They are authorised for use in Ireland and across the European Union for the treatment of depressive disorder and some anxiety-related conditions. Again, I agree with Senator Black's comments in this regard, and I am not in a position to contradict, nor would I, any aspect of the submission or the observations of Senator Reilly. What I do know, however, is that depression may well be associated with an increased risk of suicidal thoughts, self-harm and suicide. This risk may persist in the early stages of treatment when a patient starts to take an antidepressant until significant remission of his or her depression occurs. Health care professionals are advised of this risk through the so-called summary of product characteristics, which specifically highlights the need for monitoring of the patient following initiation of therapy. There are public leaflets accompanying these products advising patients and their care-givers to be alert for any deterioration of condition, suicidal behaviour, thoughts or impulses or any unusual changes in behaviour, and to seek medical advice immediately if these symptoms become evident.
The Irish Health Products Regulatory Authority, in conjunction with other EU medicine agencies, continuously monitors the safety of medicines. Case reports and other safety data are reviewed and evaluated in terms of their potential impact on the known safety profile of a medicine and any need for any regulatory change to support their continued use. The decision to use a particular medicinal product for an individual patient rests solely with the health care professional involved in his or her care, taking account of the professional's assessment of that patient's current clinical condition, the medical or medication history, any relevant, underlying risk factors, the condition to be treated and many other related issues. These are health issues, and again I acknowledge the comments of Senator Norris and others, which I regard as being well intentioned, as I accept that the intention of Senator Mac Lochlainn is well founded in proposing this Bill. I acknowledge his work in this area. He previously introduced it in the other House. However, I am not in a position to accept the proposed Bill and I wish to explain why.
Acceptance of the proposed definition of a verdict of iatrogenic suicide would risk its use by a coroner at inquest being interpreted as apportioning some liability on the medical practitioner who may have prescribed any form of treatment or medication to the deceased person prior to taking his or her own life. The coroner's inquest is, by definition, an inquisitorial process. It is not permitted to consider questions of civil or criminal liability. Section 30 of the Coroners Act 1962 specifically prohibits consideration of civil and criminal liability. For the purposes of this debate, it is worth quoting from that section. It states: "Questions of civil or criminal liability shall not be considered or investigated at an inquest and accordingly every inquest shall be confined to ascertaining the identity of the person in relation to whose death the inquest Is being held and how, when, and where the death occurred." While Senator Mac Lochlainn proposes a safeguard clause, I am of the firm view that it would be unwise to proceed with the Bill given the significant prohibition against any consideration or apportioning of liability at an inquest.
Moreover, I would advert to a second consideration arising from the Senator's Bill, one perhaps not intended by him, namely, the risk of engaging the criminal law on assisted suicide. A verdict returned at inquest of iatrogenic suicide, as defined in the Bill, could engage the provisions of the Criminal Law (Suicide) Act 1993 and, in particular, section 2 thereof, which provides: "A person who aids, abets, counsels process the suicide of another, or an attempt by another to commit suicide, shall be guilty of an offence and shall be liable on conviction on indictment to imprisonment for a term not exceeding fourteen years."
That is another section that needs to be reformed.
Allow the Minister to continue without interruption.
Any use of this new verdict contemplated in the Bill would be capable of ascribing criminal liability to a person or persons who would be readily identifiable. While suicide is not a crime, as the Seanadóirí will know, assisted suicide continues to be a crime. Assisted suicide could well include iatrogenic suicide, as defined in the Bill.
It could not.
The Senator cannot interrupt the Minister.
Somebody prescribing Prozac would not be deliberately aiding or abetting. They would be trying to keep the person alive.
Allow the Minister to conclude.
That would be open to interpretation and I am not saying the Senator's interpretation would hold in the manner in which he might intend.
It is a red herring.
My Department has received the advice of the Office of the Attorney General on the Bill and reference to the Attorney General has been well made by my colleague, Senator Mulherin. It is the firm view that to introduce a verdict of iatrogenic suicide at inquest would be legally unsound.
The Coroners Society of Ireland is a body that has not been mentioned during the course of this debate. It is important that we would acknowledge the role played by that society. Its members are engaged on a daily basis in the conduct of inquests. The society and its members have indicated they are very much opposed to this proposal, not least given that it might require coroners to reach verdicts that would infer liability on a medical practitioner.
I believe that a sufficient range of verdicts is available to coroners to draw on in the context of the cases envisaged by the Bill, including those of suicide, open or medical misadventure. I wish to inform the Seanad that I intend to widen the scope of the coroner’s investigation at inquest along the lines of that proposed in the Coroners Bill 2007, which was referred to by Senator Mac Lochlainn. This will help to better fulfil our obligations under the European Convention on Human Rights. The coroners (amendment) Bill 2017 is being urgently drafted by the Office of the Parliamentary Counsel. I hope to be in a position to seek Government approval in the near future to publish this Bill.
I very much agree with those Senators who said that where a medical misdiagnosis or prescription occurs, action might then be taken against the medical practitioner. Provision for that is contained in a process under our civil law. However, such an action must be followed in the appropriate forum and I am not sure that forum is a coroner's court, on the basis that it is not a court of law. The coroner cannot consider or determine the liability of any person in any circumstances. This situation is one of long standing with regard to the coroners not only in this jurisdiction but across all common law jurisdictions. It is not the intention to change the nature of the inquest procedure or to change the role and function of the coroner or the coroner's court in as radical a fashion as is envisaged under the Bill. I should mention that our courts have in the past ruled against liability being ascribed at an inquest, and that is a problem here. It is one that I would ask Senators to appreciate in the context of debating this legislation further.
I acknowledge the work Senator Mac Lochlainn has done not only in drafting this legislation but in highlighting the importance of the issue, giving rise to this debate where people like Senator Black and others have made important contributions in terms of the response of the Government to mental health issues. I am sure there will be further opportunities, as there have been in the recent past, for this issue to be discussed in this forum. In commending Senator Mac Lochlainn, however, I must reiterate that the context in which he places the Bill is not appropriate in my view. He raises no wider issues in the Bill that might inform our ongoing debate on suicide. Rather, he proposes what he describes as a symbolic change to the Coroners Act 1962. However, it is my view, in short, that the effect of the change would be anything other than symbolic. It would give rise to consequences or changes in the law of a very fundamental nature. It would risk significant disruption to our coronial system by seeking to introduce determination of liability into the inquest process. The Government, as it works towards immediate and longer-term reform of the coronial system, will not at this point in time support such a change.
I thank the Minister and colleagues for their contributions to this debate. I appeal to the Minister and his Government colleagues not to oppose this Bill and to allow it to go to Committee Stage today in order that we can further develop the issues of concern the Minister raised, try to find a way to address the concerns of families like the McGill Lynches and also address some of the concerns the Minister raised. It has been said that this Bill is premature and that the Coroners Act is being looked at and reviewed as we speak. That Act dates back to 1962, it is archaic and radical reform of it is long overdue.
I introduced this Bill in the Dáil two years ago but no reform of the Coroners Act has been put before these Houses by the Government in those two years. Therefore, it cannot be premature for me to introduce this Bill again here today having waited patiently for two years. The reason this Bill is being debated in this House is that I understood it had all-party support and that it would not be challenged. The family are in the Gallery on the basis that the Bill would progress today and the debate on it would continue through the Houses. That was what I understood happened between the Whips.
I ask the Minister and his colleagues to allow this Bill to move forward. He has put his concerns on the record. All that would happen today is that this would progress to Committee Stage. Those concerns would be put on the table and addressed through the Houses as the Bill progresses through the different Stages. I ask the Minister to allow this debate to continue and the Bill to progress through the Houses.
The Minister might not be aware that I co-chaired a meeting of what was formerly known as the Joint Committee on Public Service Oversight and Petitions and the Joint Committee on Justice and Equality during the lifetime of the previous Oireachtas. The meeting was about the responsibility of our Government under Articles 1 and 2 of the European Convention on Human Rights. I will quote exactly what I said on that day:
Articles 1 and 2 of the European Convention on Human Rights, when read together, require a proper and adequate official investigation into deaths resulting from the actions of State agents, both from the use of lethal force and also in situations arising from the negligence of agents that leads to a death.
The purpose of the meeting in question was to explore those issues and those present heard from a range of witnesses. One was a coroner who talked about the limits of what was available. As the Minister knows, a coroner can, in the course of an examination, refer a matter to a public inquest. In the case that led me to draft this legislation, the matters were examined and debated. One of the other Senators referred to medical experts having to come and debate the issues. They were debated in this case. That already happens in coroners' courts, where issues are thrashed out and relevant experts are brought in.
It is not beyond the capacity and goodwill of Members of the Seanad to allow this Bill continue its passage through the Houses. That could happen in tandem with the Minister's wider review of the Coroners Act 2013. I am asking that we do not divide the House on this issue and that we do not ignore the fact that we have a real societal challenge with which to deal. I again refer the Minister to his responsibility, my responsibility and our responsibility in these Houses, under Articles 1 and 2 of the European Convention on Human Rights, to ensure that families have the right to the whole truth. The Minister talked about civil cases. God help any poor family that has to go through a civil case. Can the Minister imagine the level of their financial exposure? They would become impoverished as a result of taking on the full weight of the medical establishment. It is a huge burden. The responsibility falls on us, as legislators, to change the law in order to make it as accountable as possible and to ensure that people receive the right answers.
I appeal to the Minister not to divide the House. He has put his views and concerns on this issue on record. Even in light of all the reservations the Minister expressed, it would be a noble thing to allow this Bill to proceed to Committee Stage. Let us develop the conversation about how we can collectively meet our responsibilities under Articles 1 and 2 of the European Convention on Human Rights.
- Black, Frances.
- Conway-Walsh, Rose.
- Devine, Máire.
- Gavan, Paul.
- Higgins, Alice-Mary.
- Mac Lochlainn, Pádraig.
- Norris, David.
- Ó Céidigh, Pádraig.
- Ó Clochartaigh, Trevor.
- Ó Ríordáin, Aodhán.
- O'Sullivan, Grace.
- Warfield, Fintan.
- Burke, Colm.
- Burke, Paddy.
- Buttimer, Jerry.
- Byrne, Maria.
- Clifford-Lee, Lorraine.
- Coffey, Paudie.
- Coghlan, Paul.
- Daly, Paul.
- Feighan, Frank.
- Gallagher, Robbie.
- Lawless, Billy.
- McFadden, Gabrielle.
- Mulherin, Michelle.
- Noone, Catherine.
- O'Donnell, Kieran.
- O'Donnell, Marie-Louise.
- O'Mahony, John.
- O'Reilly, Joe.
- Reilly, James.
- Richmond, Neale.
- Wilson, Diarmuid.