The debate will be resumed on amendment No. 86.
Committee on Finance. - Public Health Bill, 1945—Committee (Resumed).
SECTION 18.
We were discussing a wide range of amendments when we adjourned last night.
Amendments Nos. 93, 105 and 106 seem to deal with the same point.
I think that we were discussing nearly all these amendments in a general way.
Yes.
It was understood that, having had a roving discussion over a wide group of amendments relating to this sub-section, the question would later, if so required, be put without debate in respect of any of them.
We had reached the point last night at which we were discussing whether we should rely on the word "knows" or whether that word should be taken out and replaced by some such words as are contained in amendment No. 87. We were considering what a person ought to do if he thought he had been in contact with infectious disease and it was felt that it was a pity we had not a statement from the Parliamentary Secretary as to the whole intention of the section, so that we would have a clearer background to all the amendments. Deputy Byrne asked what a woman was to do if a case of measles occurred in her family in a house in which a number of families were living. Would it be taken that members of other families who assisted the family in question were to be regarded as probable sources of infection and open to all the penalties implied here? The House was very anxious last night to have information from the Parliamentary Secretary as to what was likely to be expected of a person in such a case. Measles and whooping cough are of fairly frequent occurrence and are oftentimes treated at home. They are likely to bring people within the danger of penalties under these proposals.
I do not think that I can give the House any more assistance on this matter than I gave it last night. I contributed a fair share to the debate by way of explanation and I do not think that anything I can say to-night will help it further. The meaning of the section is clear. If a person knows that he is a probable source of infection from infectious disease, he must do certain things. A statutory obligation is being placed on a person who knows that, having become a source of infection from infectious disease, the health or lives of his neighbours are in danger if he does not take certain precautions. The precautions that are to be taken to prevent the spread of the disease will be prescribed by regulations. We come back to the fundamental point—that a person who does not know he is a source of danger to his neighbours is in no danger whatever under this section.
Various amendments have been suggested. Amendment No. 86 suggests that, instead of inserting in the section the provision that a person "knows" he is a probable source of infection, we should say "has been notified by a competent medical authority". That would not get us anywhere. No medical authority, competent or otherwise may be aware that a person has become a probable source of infection from infectious disease.
The greatest difficulty confronting public health authorities in the matter of the control of infectious diseases arises out of the fact that in many cases the presence of infectious disease about a house is not disclosed at all. I do not believe there is a Deputy listening to me who is not aware that that is so. If the people concerned are not particularly scared as to the possible domestic or family consequences, they will not call in a doctor but, if they do call in a doctor, he is not under any obligation, that has so far been successfully enforced, to see that the necessary precautions are taken for the protection of the community. Let us consider a family where a case of scarlatina, a case of diphtheria, a case of any infectious disease for that matter occurs. The members of the household know at any rate that they are in close contact with a dangerous infectious disease. Is it right and proper that we should say to the members of that household: "Look here, you have an obligation to the community; you have no right to endanger the lives of the community or the health of your neighbours by suppressing or hiding the fact that there is infectious disease about your house. By establishing contact with your neighbours, in an innocent but really in a treacherous way, you are endangering the lives of your neighbour's family". Let Deputies apply the thing to themselves. Would any of you like to have a dangerous infectious disease brought about your house, to have members of your own family, perhaps, struck down by that disease or perhaps to have the lives of people who are dear to you sacrificed? I venture to say that if you bring it home to yourself, if you picture that occurring in your own family, you will agree with me that a person who is a danger to his neighbours ought to be compelled to take precautions.
This is a serious matter. During the Second Reading I stated to the House that in the year 1944 there were 54,000 cases of infectious disease in this State and that over 6,000 people died. We will all agree that that is a very serious problem. It is as certain as I am addressing the House to-night that if we do properly organise public health services with all the necessary statutory powers enforceable and enforced, we can at any rate make a very substantial inroad on that death rate from preventable diseases. I do not know why Deputies will not support me in this matter. It does not seem to me to inflict any undue hardship on people to ask them to exercise reasonable care to ensure that, if they are unfortunate enough to contract infectious disease themselves, they will not transmit it to anybody else.
So far I have been discussing contacts. There is another type of difficulty —where the person knows that he is a source of infection and, knowing that he is a source of infection, yet does not take the necessary care to ensure that he does not convey the infection to anybody else. That is the case of the carrier. A person knows that he is a carrier, say, of typhoid, of infantile paralysis or of other diseases which I might mention were it necessary. He knows he is a carrier. He is not in any doubt about it. Yet he mixes around with the community as if he were not a danger to anybody and perhaps takes a physical part in the manufacture, distribution or handling of food intended for human consumption. What are we to do about it? Is it right that that condition of things should continue to obtain or should we in this section—we have other provisions to try to solve that problem later on—say to these people: "If you knowingly endanger the lives of the community by failing to take the precautions set out and any other reasonable precautions, you will incur a certain penalty"? I think that is a reasonable proposition; I think it is right and proper we should do that. I hope I shall have the support of all Parties in the House on this. There is nothing about which we can have any misunderstanding. It is as plain as noonday to me and I think it must be clear to everybody who has devoted any attention to it.
Other amendments relating to the same matter have been tabled. There is an amendment by Deputy Martin O'Sullivan who wants to substitute the phrase: "if a person has reason to believe he has an infectious disease" for "if a person knows he has an infectious disease". I realise that there may be great difficulty in proving that a person actually knows and, if it will meet the wishes of the House, I am prepared to accept Deputy O'Sullivan's amendment. I cannot believe that every section of the House objects to the wording in the section as it stands, but there is an obvious objection to the wording that is proposed here but if I could secure unanimity upon Deputy O'Sullivan's amendment it would satisfy me.
The Parliamentary Secretary says he is trying to get the support of the House. I think what the House is trying to find out is what is in the Parliamentary Secretary's mind. It seems to me that on this and some of the subsequent sections the field is so big that one can be digging at one end of the field while the Parliamentary Secretary is digging at the other. We have only to approach each other. I should like to approach it in a realistic and practical way and to ask the Parliamentary Secretary a couple of questions. He has given us a list of diseases which is a help, but I should like to give him a hypothetical case.
Most of the Deputies seem to have fastened on to the point as to whether a person knows or does not know, or has reason to believe, or has been advised by a registered medical practitioner, and so on. I want to see how far the Parliamentary Secretary intends the ramifications of this section to go. I could sympathise with what the Parliamentary Secretary says about some of the infectious diseases mentioned, but I suppose that most family people are aware that when one child in a family gets a rash or a cough, it is almost negligible —during the summer months it is looked upon merely as a severe cold and as something not worth talking about—but when the rest of the members of that family become infected, it is of a most virulent type. I am sure the Parliamentary Secretary has that in mind.
With regard to a person who is in contact with such a child, how far are the provisions to extend? Suppose one child in a family gets an infectious disease, such as measles, whooping cough or scarlatina, and suppose the house is large enough for that child to be isolated—in the instance quoted by Deputy Byrne last night, that would be quite impossible, but I will come to that later—I am speaking only of children's diseases because it will serve to obtain clarity in regard to even one part of the section—the mother of that child or the guardian looking after the child is probably quite aware that the child has an infectious disease. Are the parents of that child to go into quarantine? We could all agree that if there is accommodation available in the house, that child should be put into some sort of quarantine and isolated so far as circumstances permit.
That is quite all right in a house where that separate accommodation can be provided, but are the parents and the other children in that house to be regarded as potential carriers of the disease? Perhaps I should not use the word "carriers", because a carrier is in quite a different category and requires separate treatment. Are the parents to consider themselves as being liable to infect other people or children with that disease? Are they supposed to remain in quarantine? That, quite obviously, is impossible for the humbler sections of the community who live in tenement houses, but if that is to be carried to its logical conclusion, as soon as a child is diagnosed as suffering from an infectious disease, are these parents to be whisked off to a fever hospital or some place of isolation? That is what I should like to get from the Parliamentary Secretary—how far the ramifications of the section go when people know or become aware that there is infection in a house. That is quite apart from the very long discussion which has taken place on the question of how a person is to know or to become aware.
Before we finish this fireside chat and get back to the amendment, I should like to thank the Parliamentary Secretary for circulating the information he has circulated as to the diseases he proposes to declare infectious diseases under the various sections. I should like to ask him, in view of the use this list will be, to verify if it is correct, because, as bearing on Section 19, it opens a very serious situation of which we ought to take cognisance before we decide on this amendment. The first sheet the Parliamentary Secretary has circulated contains a list of diseases to be declared infectious by Order of the Minister under Section 18 (1) and at the bottom there is a footnote: "All the foregoing will be declared infectious diseases for the purpose of Section 19."
Section 19, when the Parliamentary Secretary has done with it, having inserted therein the amendment he proposes, will contain a provision, under Section 3, that a person who knows that he is a probable source of infection shall not expose himself in any street, public place, club, hotel or shop. In the list of diseases which are infectious and which would apply under the section as finally remodelled, we find whooping cough, tuberculosis, ringworm, mumps and two types of venereal disease. Does the Parliamentary Secretary really suggest that if a person has ringworm, or, ringworm being a contagious disease, has been in contact with a person who has ringworm, that person is not to go out in the street or into a public place, shop and so on, because if the position we are shaping here is that the person who has ringworm or mumps cannot go into the public street, I am very glad that we got the Parliamentary Secretary's list? I ask him if his list is correct.
The Parliamentary Secretary intended, for certain reasons of policy, not to have venereal disease classed as a notifiable disease, but surely if a person is not able to stir outside the house, his neighbours may very well ask why he is afraid to come out. The same applies to tuberculosis, because, in the light of the information now provided by the Parliamentary Secretary, a person with tuberculosis cannot come out into the public street. If that is some of the background to this general section which we asked to have elaborated before we came to some of the decisions involved in the amendments, I do not know what to say with regard to any of the amendments.
Perhaps I can help the Deputy. So far as tuberculosis and venereal disease are concerned, under Section 18 there is power to declare certain stages of the diseases to be infectious. In regard to certain venereal diseases, anyhow, the stage of infectivity is comparatively brief. In the case of both of these diseases, it is the stage of infectivity that matters. These are not in the infectious diseases category at the present time and it is proposed to bring them in by Order.
It may be very alarming, and apparently is a cause of wonderment to most Deputies, that this list should be put before the House, carrying with it all the restrictions and penalties to which Deputy Mulcahy has referred. The fact of the matter is that these are infectious diseases and have been so regarded for many years. In order that Deputies may understand in some brief way the statutory provisions in relation to infectious diseases of the present day, I would refer to Section 142 of the Public Health (Ireland) Act, 1878, which up to to-day governs this particular matter and which would continue to govern it if we did not propose to repeal that section in this Bill and enact Section 19.
Would the Parliamentray Secretary read Section 142 of the Public Health (Ireland) Act, 1878, and let us see if it is re-enacted?
Yes, I am not running away from it. It is very hard to get me to run, unless the Deputy is in front of me. Section 142 reads:—
"Any person who—
(1) While suffering from any dangerous infectious disorder wilfully exposes himself without proper precautions against spreading the said disorder in any street, public place, shop, inn, or public conveyance, or enters any public conveyance without previously notifying to the owner, conductor, or driver thereof that he is so suffering, or
(2) being in charge of any person so suffering, so exposes such sufferer, or
(3) gives, lends, sells, transmits, or exposes, without previous disinfection any bedding, clothing, rags, or other things which have been exposed to infection from any such disorder, or
(4) exposes or conveys without proper precaution the body of any person who has died of any dangerous infectious disorder, or
(5) wakes, or permits to be waked, in any house, room, or place over which he has control, the body of any person who has died of any dangerous infectious disorder,
shall be liable to a penalty not exceeding five pounds and a person who, while suffering from any such disorder enters any public conveyance without previously notifying to the owner or driver that he is so suffering, may be summarily ejected therefrom and shall in addition be ordered by the court to pay such owner and driver the amount of any loss and expense they may incur in carrying into effect the provisions of this Act with respect to disinfection of the conveyance.
We have further references in Sections 62 and 63 of the Public Health Acts Amendment Act, 1907. I submit to the House that these provisions are fairly sweeping and I think, if I were taking this verbatim and inserting it in this Bill, I would get the same type of criticism as I am getting on the provision I have made there.
I do not know if the Parliamentary Secretary is under the impression that he has made an impressive speech, but he sat down as if he had.
I never get the impression that I have impressed that side of the House.
Not with any argument, as the Parliamentary Secretary has produced no argument. If he did not want anything more than already existed in Section 142 of the Public Health (Ireland) Act, 1878, why did he not leave it where it was? It has been there since 1878, there has been no public outcry, and no drastic steps have been taken in reference to it.
I have been urged to coordinate the law.
Well, put it in as it stands. Why change it? I am perfectly certain that whatever change is here is a change from the point of view of the Minister, in order to do something he is not able to do under the existing law.
For the control of diseases.
The Parliamentary Secretary wants to know why he is not getting the support of the House on measures of this kind. We certainly will not support anything we do not understand, or where we have no idea as to what the scope will be. I must say that, when I saw the list of diseases which are to be declared infectious diseases for the purpose of this section, I was rather astonished. The Parliamentary Secretary says they were always so. If they were, there is nothing to be alarmed about, that is, if things are going to remain as they were. What is alarming is this: are they going to be left as they were? We are perfectly certain they are not.
What we are afraid of is the intention of the Administration. We want to know definitely where we stand. We have not been told and we will not support the measure until we are told. Looking at the Bill and listening to the Parliamentary Secretary's explanations, I have got the impression that he has got a strong view that he can achieve, by an Act of Parliament passed by the Oireachtas, far more than the safeguards and precautions provided by nature against the spread of disease. We are trying here to do something which nature can do more effectively than any Act of Parliament.
Better give her a hand.
There has been no serious epidemic in this country for years. I see here that whooping cough is an infectious disease. Presumably that has been so always, under the Act of 1878, but has that kept the children in from the streets, from the parks, from the seaside? I know that with Dublin people there has been a kind of notion—I suppose the Parliamentary Secretary, as a medical man, would call it a superstition—that one of the ways to cure whooping cough was to bring the sufferer for walks around the gas works in Ringsend. That has been the Dublin cure for it, and I think it has been as effective as any palliative the medical profession has been able to produce. The medical profession have not been able to cure whooping cough, but the Dublin mothers have at least been able to alleviate the sufferings of the children by giving them walks around the gas works. That is going to be stopped by this Bill. It is that sort of thing that makes us suspicious.
There should be more than the children in the gas works.
If there were some people in a gas chamber——
That is going too far.
I would like the Parliamentary Secretary to treat serious problems seriously. Is the person who has tuberculosis to be prevented from taking the only step likely to give him any hope of recovery, namely, fresh air? Is he to be prevented from walking, or taking fresh air? Is the person who has ringworm on his finger or his nail, that can be covered up with a glove, to be prevented from going to school or walking in the street? Perhaps the Parliamentary Secretary will tell us what he really means by this section and then, if we approve of it, we will give him as much support as we are capable of giving; but so far as we are concerned, at all events, we are not going to give him a blank cheque to exercise his inventive medical skill on the public. We have had no serious epidemics in this country. Nature provides a considerable amount of remedy against those things. It is well known—if I may go back again to a homely illustration—that the children whose parents coddle them and keep them in, who watch every draught and who will not let them out on the street, get everything that is going; but let the child run round and get hardy and then he has a better chance than the other fellow. That is what the Parliamentary Secretary and his Party want to do. They want to make the children of the people like robots, to act at the dictation of the gentlemen in the Custom House.
A final word on the amendment. The amendment before the House is No. 86, in the name of Deputy Beirne. He seeks to delete the word "knows" and substitute therefor "has been notified by a competent medical authority". A question arose as to what a competent medical authority might be and, therefore, as between that amendment and amendment No. 87, in the name of Deputy McGilligan, which seeks to replace the word "knows" by the words "has been given notice by a registered medical practitioner", I think, as between the ordinary individual who may suffer from, or be in contact with, any of these infectious diseases, and the pains and penalties included in this section—or that will be by the time the Bill is remodelled— the House must put the onus of the notification on the registered medical practitioner. I do not think anybody should be made subject to these penalties unless he is in the position that he has been warned by a registered medical practitioner that he is suffering from one of the infectious diseases likely to bring him under the section. He must have formal and official warning from a person competent to give it before I would be prepared to risk the Minister getting after him with the pains and penalties of the section.
I am concerned also because of an amendment of mine which appears later and which is linked up with this whole question. I think the Parliamentary Secretary must realise that the section, if there is not some amendment of it, is capable of a great deal of confusion and is capable of defeating the very purpose he has in mind. It seems inconceivable, in the circumstances in which the section has been framed, that any penalties could be enforced in certain cases. There are cases where isolation will clearly be necessary, and I think the only authority that can settle a matter of that kind is a medical authority. The serving of notice, the formal intimation to the person concerned, by the responsible medical authority, seems to me to be the only manner by which you can get the spirit of the section enforced.
On the other hand, there will be clearly a number of cases of what may be termed minor infectious disease where it would be ludicrous to enforce the penalties contemplated in the section. I think the Parliamentary Secretary must realise that this whole position is very unsatisfactory, that the wording of the section is likely to defeat the whole purpose in mind if it is not altered, and that there can be no possibility of securing the enforcement of the penalties if the position is left as loose as it is. It seems to me that if there are provisions of this kind in the legislation going back to 1878, they were almost unheard of so far as any attempt to enforce them went, and unless there is a more sensible approach to this Bill before it leaves the House, I believe it will be equally ineffective.
Although Deputy Mulcahy intimated that we were dealing with amendment No. 86, actually amendments Nos. 87 and 88 are in line with that amendment. When my colleagues and myself were examining the Bill, we agreed that the word "knows" in Section 19 carries too wide an implication and is capable of being administered in a dangerous form. We were at a loss to find suitable words in substitution, but we found them eventually, as in amendment No. 88—"has reason to believe". We go further in amendment No. 105, in Deputy Murphy's name. That amendment gives our explanation of the words "has reason to believe", the governing factor being that the protection to be taken should be the certificate of a medical officer. Incidentally, may I say that the words "has reason to believe" are used by the Minister in amendment No. 103 (5)? So far as we are concerned, it would meet the position if the substitution was made along the lines of amendment No. 88, carrying with it the explanation offered in amendment No. 105.
I am faced with a difficulty in this matter. Notwithstanding what Deputy O'Sullivan has said, I cannot see that "has reason to believe" would protect the individual better than the word "knows". I do not see how it would be more difficult for the authorities to prove that a person "has reason to believe" that he has had contact with the disease, rather than that he "knows". I think the word "knows" gives more protection. With regard to the medical practitioner, I have somewhat the same difficulty. I cannot see why there is any fuss about that. I cannot imagine any court deciding that a person knew unless there was medical testimony given, and it can be shown that medical advice had been given. Perhaps some of my legal friends will clear that up.
If I can bring myself within that category of the Deputy's legal friends, he anticipated the remark that I was going to make bearing upon Deputy O'Sullivan's suggestion. There is no doubt the amendment proposed by Deputy O'Sullivan would be harder on the private individual and easier on the State prosecutor than the word "knows". That is the reason why the Parliamentary Secretary was so blandly agreeing to accept Deputy O'Sullivan's amendment when I interjected. Deputy Sheldon is quite right. The word "knows" is a far greater protection to the individual than the words "has reason to believe".
It has the same connotation as the amendment in the name of Deputy McGilligan.
I do not think so. Whether it has or not, I will deal with Deputy McGilligan's amendment when we come to it. I think what Deputy McGilligan means by his amendment— if I may anticipate—is that he is deleting "knows" and is not putting in "has reason to believe". He is only making the point that an offence is deemed to be committed if a registered medical practitioner gives notice. I am warning those Deputies who may be taken in by the Parliamentary Secretary's bland acceptance of their amendment, that the word "knows" is a far greater protection for the individual than the words "has reason to believe".
How is a man to know? Is he going to be his own doctor? The man who is his own doctor has a fool for a patient. How can he decide? It is only a doctor who can decide.
On a point of order, I think Deputy Beirne said last night that he was prepared to take Deputy McGilligan's amendment.
I would point out to the Deputy that the word "knows" occurs in each of the amendments. I am putting the question in the form that the word proposed to be deleted stand.
There are people who might prefer the word "knows" with the words "notified by a competent medical authority", and who would throw down the word "knows" if put in opposition to the words "given notice by a registered medical practitioner".
I am putting the question: That the word "knows" proposed to be deleted, stand.
The Committee divided:—Tá, 69; Níl, 24.
Tá.
- Aiken, Frank.
- Allen, Denis.
- Bartley, Gerald.
- Beegan, Patrick.
- Blaney, Neal.
- Bourke, Dan.
- Brady, Brian.
- Brady, Seán.
- Breathnach, Cormac.
- Breen, Daniel.
- Brennan, Martin.
- Brennan, Thomas.
- Breslin, Cormac.
- Briscoe, Robert.
- Buckley, Seán.
- Burke, Patrick (Co. Dublin).
- Butler, Bernard.
- Carter, Thomas.
- Colbert, Michael.
- Colley, Harry.
- Corry, Martin J.
- Crowley, Honor Mary.
- Derrig, Thomas.
- De Valera, Vivion.
- Everett, James.
- Flanagan, Oliver J.
- Flynn, Stephen.
- Fogarty, Andrew.
- Fogarty, Patrick J.
- Gorry, Patrick J.
- Harris, Thomas.
- Healy, John B.
- Humphreys, Francis.
- Kennedy, Michael J.
- Killilea, Mark.
- Kilroy, James.
- Kissane, Eamon.
- Lemass, Seán F.
- Little, Patrick J.
- Loughman, Frank.
- Lydon, Michael F.
- McCann, John.
- McCarthy, Seán.
- McEllistrim, Thomas.
- Moran, Michael.
- Morrissey, Michael.
- Moylan, Seán.
- O Briain, Donnchadh.
- O'Connor, John S.
- O'Grady, Seán.
- O'Loghlen, Peter J.
- O'Reilly, Matthew.
- O'Rourke, Daniel.
- Pattison, James P.
- Rice, Bridget M.
- Ruttledge, Patrick J.
- Ryan, James.
- Ryan, Mary B.
- Shanahan, Patrick.
- Sheldon, William A. W.
- Sheridan, Michael.
- Skinner, Leo B.
- Smith, Patrick.
- Spring, Daniel.
- Traynor, Oscar.
- Ua Donnchadha, Dómhnall.
- Walsh, Laurence.
- Walsh, Richard.
- Ward, Conn.
Níl
- Anthony, Richard S.
- Beirne, John.
- Bennett, George C.
- Blowick, Joseph.
- Browne, Patrick.
- Coburn, James.
- Cogan, Patrick.
- Commons, Bernard.
- Coogan, Eamonn.
- Corish, Brendan.
- Dockrell, Henry M.
- Giles, Patrick.
- Halliden, Patrick J.
- Keating, John.
- Keyes, Michael.
- McGilligan, Patrick.
- Mulcahy, Richard.
- Murphy, Timothy J.
- O'Donnell, William F.
- O'Driscoll, Patrick F.
- O'Reilly, Thomas.
- O'Sullivan, Martin.
- Reidy, James.
- Roddy, Martin.
Tellers:—Tá: Deputies Kissane and Kennedy; Níl: Deputies Cogan and Commons.
Question declared carried.
Amendments Nos. 87, 88 and 89 not moved.
I move amendment No. 90, standing in my name and that of Deputy Costello:—
In sub-section (1), line 19, to delete the word "probable".
I want to ask the Parliamentary Secretary what is the reason for putting in this word? The House has now voted that in order to constitute an offence under this section there must be knowledge on the part of the alleged offender, but what is the knowledge to relate to? One could say that there is something in the nature of objective tests in regard to a person being a source of infection, but if you are now going to saddle that person with the added burden of proving that he is not a probable source of infection, that is very vague, and I suggest, accordingly, that the word "probable" should be dropped.
If the restrictions were only to apply to a person who knew that he was a source of infection, then the section would not effect its purpose because, by the time it could be established that he was, in fact, a source of infection, the harm would have been done. I presume that a court would hold that a person was a probable source of infection if he had been in close contact with another person who had been suffering from an infectious disease, but I do not know at what stage of the outbreak we could hope to get it under control. If the person concerned were not under any obligation to show when he had ceased to be a probable source of infection, I do not know how this thing would work out at all. Deputy McGilligan says that he sees no reason for the inclusion of this word, but I am still at a loss to know why there is any difficulty about a provision such as this, when we bear in mind the purpose of the powers that we are seeking in this Bill, and when we relate the purpose to the actual facts—notwithstanding what Deputy Costello said to-night, to the effect that we have not had any serious infectious disease here for a long time. When we relate the problem to the magnitude of the number of deaths from infectious diseases in the last year for which records are available, namely, 6,000, I think that the House will concede that any steps we can take to prevent that are in the interests of the general community. I think it would be conceded that even though it means imposing restrictions on certain individuals, the interests of the general community must come before the interests of the individual.
I have not yet got any explanation of the intention of the Government in bringing in the word "probable" into this matter. Perhaps I might be able to get more clarity on the matter if I were to put it in this way. The Parliamentary Secretary does not seem to be able to see any half-way house between "actual" and "probable". If you take out this word "probable", it would appear, from what the Parliamentary Secretary says, that there is no other alternative, but I do not think that there is no other alternative. If that was what was aimed at- and, of course, it was not—then it would apply to a person who knew he was infected with an infectious disease. Let us pass on from that to the case of a person who felt that he was infected up to the point where he might cause infection amongst other people. There is the further point here that, not only could he give rise to infection, but he might have been placed in circumstances which might be the cause of infection. That is the extent of the knowledge which must be imputed to the person before an offence can be committed. I suggest that is not what is required. Is there in the Parliamentary Secretary's mind much difference between saying that a person is a source of infection, and saying that he infects? Surely a person could be a source of infection without actually infecting other people?
He could.
And it would be easier to prove that a person was capable of infection than to prove that he knew he was likely to and probably would infect others. There are three points on which we could follow that. To say that a person knows that he is a source of infection is harder on an individual than to say that he knows he is a probable source of infection.
I prefer to take it the other way.
That means you are not satisfied.
I would like to think over what the Deputy said.
Amendment, by leave, withdrawn.
I move amendment No. 91:—
In sub-section (1) to delete all words after the word "shall" in line 20 to the word "precaution" in line 22, inclusive, and to substitute therefor the words:—"take the precautions specifically provided for, by, or under this part of this Act".
The effect of my amendment would be to delete the reference "take every other reasonable precaution" other than those specifically provided for by or under this part of the Act. It would be difficult to know what precautions a person is required to take under this part of the Act, without throwing in a general provision that he must take every other reasonable precaution. I should like to ask the Parliamentary Secretary if he could indicate what are the precautions specifically provided for under the Act, so that knowing what these are, we might be able to allow our imagination to see whether there is anything reasonable in requiring anything else.
The precautions to be taken under this Act are set out clearly in the sections that follow. In Section 20, as Deputies will observe, power is given the Minister to make regulations providing for the prevention of the spread of infectious disease. The precautions that a person will be under statutory obligation to take, in addition to those set out under this part of the Act, will be set out in the regulations. Deputies will ask me if that is not sufficient to set out in this portion of the Act, to set out the very far-reaching precautions that a person suffering from an infectious disease must take.
That is in the Schedule.
In this part of the Act apart from the Schedule.
The Minister may by regulation go beyond the Schedule. He may, under Section 20?
He may.
There is power to regulate by the Schedule and to regulate by regulations beyond the section. You want "every other" precaution.
It may seem very far-reaching to insert in the section a provision covering every other reasonable precaution, other than the precautions set out in the Bill, and provided for under Section 20, and it may be argued that we have given ourselves scope enough to cover every possible contingency. We have not, for the reason that it is not possible to include in any set of regulations that could be constructed all the precautions that ought reasonably be taken.
Give a sample.
I shall try. I realise that in giving any sample I am providing further material for debate, but I am agreeable to that.
I would think that you would provide material for regulations.
The material for regulations will come later. Up to the present we are not under any obligation to include them. That is another day's work. Take a typhoid carrier. It is very difficult to define in any regulations the precautions that a typhoid carrier ought to take, in order that he may enjoy his liberty without endangering the community. Yet it would be possible, if he obeyed the instructions of his medical advisers, and of the public health authority, for such a person to enjoy his full freedom. The same would apply to a carrier of infantile paralysis. I do not think the type of detailed precautions necessary under one or other of these headings could well be incorporated either in legislation or regulations. Let us take trachoma. It is difficult to devise regulations that would adequately protect the community, if people suffering from trachoma are to enjoy freedom, and not to be under an obligation to take reasonable precautions to protect the community. Suppose a person suffering from trachoma goes into a public lavatory and uses a towel there. That is only one example that will be criticised and pulled asunder, but I suppose that is what it is for.
You can deal with it by regulations.
It is not so easy to cover a matter like that in regulations. I submit that that is the type that is very difficult to define. These are only examples. Many others could be devised. The same line of argument could very well be adopted in relation to venereal diseases. In certain stages of these diseases they are highly infectious and innocent people in an innocent way can contract them. Make no mistake about it. Again, the use of a towel can certainly convey ophthalmia of a very serious nature. Deputies may say you can deal with all these things by regulation. We can go a long way but I still submit to the House that people who are suffering from these diseases ought to take reasonable precautions——.
Known to them.
——to protect others. In addition to all the precautions that we set out and that they are bound to take under the law, they should also be bound to take what would be deemed in a court "every other reasonable precaution". After all, who is going to decide ultimately the reasonableness or otherwise of the precautions? It is not the Minister this time; it is not the dictator; it is the court. It ought to be safe enough, I think, to leave these matters to be determined by the court. If a person is brought into court on the charge that he did not take reasonable precautions against the spread of any particular infectious disease, that he did not take every reasonable precaution, I think the court will not act in any hasty or harsh way. I do not think that there is any great hardship being inflicted on any section of the community or any individual or that any great hardship will arise under this provision, but I do think that it is necessary in order to ensure that hardships will not arise for innocent people.
I take the phrase, "innocent people in an innocent way can contract the disease." Would the Parliamentary Secretary take the other case of an innocent person who innocently may give another person a disease? Is that case to be met? The Parliamentary Secretary says the court is going to decide this. That is not so. What is the court going to decide? Has the person taken every other reasonable precaution? Who is going to give the court evidence about what the reasonable precaution is? Certainly no judge is going to decide that on his own. It is going to be given by people of the public health variety, medical officers of health, and so on. Remember, it is not stated that he is to take "every other reasonable precaution known to him". This quite avoids the point as to whether the person who gives the disease knows of the precaution. Let somebody get infection and, even although the Department were not able to put into a regulation a particular precaution, let it be proved to a court that there was a reasonable precaution, then it does not matter whether it is imputed to the person that he knew it or not, he has committed an offence. The Parliamentary Secretary also tries to mislead the House.
Oh, oh.
I am not saying it is deliberately done, but he does put this suggestion which is in fact misleading to the House, that it is the court which will decide whether the court thinks the precaution is reasonable or not. That is not in the section. That could be put into the section. It could be put in this way—that he shall take every precaution which it appears to a court to be a reasonable precaution for such person to take, or to have taken. That is not in the section. The section is quite impersonal with regard to the court. It is one of these matters that is put in as the point of view of the law. The mentality of the individual does not enter into it at this stage—although the "knows" is in the early part—it does not enter into it at all. There is no question of having a mens rea—a guilty mind—in this matter. It is simply, is there proved, completely outside this person's knowledge, some precaution which some witness whom the court will believe suggests to be a reasonable precaution and, if the person has not taken that, whether he knew of it or not, he may be adjudged eventually to be guilty of a contravention of this section. I do not suppose that is meant, but I suggest that that is in the section and that it should not be there. I cannot still see the difficulty about these regulations. Under Sections 21 and 22 certain specified matters are set out. Under Section 20, the Minister is given power to make regulations about the prevention of the spread of infectious disease. He is given power to make regulations which, in particular, refer to all the variety of matters set out in the Second Schedule, but the use of the words “in particular, provide for any of the matters mentioned in the Second Schedule” clearly means that he can make regulations beyond the matters set out in the Second Schedule so long as they come within the general cloak of “preventing the spread of infectious disease”. Then the Minister can change and amend and vary his regulations and he can get a whole code and test it and change it from time to time. The Parliamentary Secretary takes this position, that there may be precautions which it will not be possible for him to reduce to a formula, but it will be possible to have alleged as an offence against a person that he did not take these precautions.
I do not think that is fair. If the specialist people in the Department cannot frame regulations to cover the variety of precautions which they are empowered to cover then it should not be possible to allege as an offence against a person that he did not take some of these unnotified precautions. I do not see the Parliamentary Secretary's difficulty and I suggest that this phrase is far too wide and requires redrafting, apart altogether from any difficulty the Parliamentary Secretary may see as between himself and other members of the House as to their attitude towards imposing good health upon the people whether they like it or not. Leaving that point of principle aside, there is too wide a fling in this section. I do not think it could have been intended that a man must take precautions, even though they could be considered reasonable precautions, that he did not know of, and I do not think it was intended, not content with the precautions scheduled by these regulations, that he must also take another or a few other reasonable precautions, and further. anything that the Department can think of after the event as being a reasonable precaution and, if there is a single one of these that he does not take, he could be landed into court and charged. Surely the intention was never to be as wide as the language at present used carries out.
Deputy McGilligan has put down amendment No. 93 in which he is proposing to add certain words, so that the part of the sub-section would read: "In addition to taking the precautions specifically provided for by or under this Part of this Act take every other reasonable precaution of which he has been advised by such registered medical practitioner". The "such" arose from a former amendment. Would the Parliamentary Secretary accept the amendment the Deputy has there, leaving out the word "such"?
The registered medical practitioner might not know anything about his condition at all.
"By a registered medical practitioner who did know something about his condition"— would the Parliamentary Secretary accept that?
Leave it alone.
In that connection, leave out the word "reasonable" and make it "every precaution of which he has been advised by a registered medical practitioner".
Does not the Deputy see that a registered medical practitioner might not be aware of his condition at all?
If he disobeys a regulation he is caught. We want to find out what is the area beyond that in which he may not live freely. Surely he ought to have some warning from somebody.
I have tried to show you that.
Is the amendment withdrawn?
No, Sir. We are asked to accept that a person may be fined £50 for doing something or neglecting to do something to cover which the whole machinery of the Department of Local Government, sitting down over this measure, with all their experience of infectious disease, is incapable of framing words.
Amendment put, and negatived.
Amendment No. 92 not moved.
I move amendment No. 93:—
In sub-section (1), line 22, to insert after the word "precaution" the words "of which he has been advised by such registered medical practitioner".
Deputy Mulcahy has already spoken on that, and I want to have it put to the House.
Amendment put, and negatived.
Amendment No. 94 not moved.
There is a series of amendments, Nos. 95 to 102, which are counterparts in relation to sub-section (2) of the words discussed in sub-section (1).
That may be, but you are not suggesting that they fall because of the other suggestion?
No, I want to know if they are being moved. The principle has been established.
This is sub-section (2). Sub-section (1) dealt with what a person does in relation to himself. This sub-section deals with what he does in regard to people under his charge.
Amendment No. 95 not moved.
I move amendment No. 96:—
In sub-section (2), line 25, to delete the word "knowing" and in lieu thereof to insert the words "having been given notice by a registered medical practitioner".
I move this for the sake of having the amendment put.
Amendment put and negatived.
Amendments Nos. 97, 98 and 99 not moved.
I move amendment No. 100:—
In sub-section (2) to delete all words after the word "shall" in line 27 to the word "precaution" in line 29, inclusive, and substitute the words:—"take the precautions specifically provided for by or under this part of this Act".
We moved a similar amendment to this in regard to the previous sub-section. We were moving it then in relation to a person's own acts. Sub-section (2) says: "A person having the care of another person and knowing that such other person is a probable source of infection with an infectious disease shall, in addition to the precautions specifically provided for by or under this part of this Act, take every other reasonable precaution to prevent such other person from infecting others with such disease by his presence. . ." The Parliamentary Secretary had a difficulty in feeling that his imagination was equal to describing what precautions a person might take in relation to himself. But he ought to be able to define what are the precautions that a person in care of another person ought to take to prevent the person in his care from infecting others. It is an entirely different type of case and no doubt simpler, and the Departmental imagination ought to be able to deal with this matter under regulation.
I could not rise to it. I cannot say any more than I have said. I cannot accept the principle.
Amendment put and negatived.
Amendments Nos. 101 and 102 not moved.
I move amendment No. 103:—
To delete sub-section (3) and substitute the following sub-sections:—
(3) A person who knows that he is a probable source of infection with an infectious disease shall not expose himself in any street, public place, club, hotel or shop.
(4) A person having the care of another person and knowing that such other person is a probable source of infection with an infectious disease shall not permit such other person to expose himself in any street, public place, club, hotel or shop.
(5) The parent of a child shall not send the child to any school, or permit the child to attend any school, if he has reason to believe that the child is a probable source of infection with an infectious disease.
(6) Where a registered medical practitioner attending a child, or attending a person in a dwelling where a child resides, is aware that the child is a probable source of infection with an infectious disease, he shall so inform the district medical officer for the district in which the child resides.
(7) Where a school medical officer finds, on inspection of a child, that the child is a probable source of infection with an infectious disease, he shall so inform the district medical officer for the district in which the child resides.
(8) Where a district medical officer becomes aware, whether from information given under sub-section (6) or (7) of this section or otherwise, that a child residing in his district is a probable source of infection with an infectious disease, he shall serve notice on the parent of the child prohibiting the attendance of the child at any school until such district medical officer gives a certificate (for which no charge shall be made) that the child is fit to attend school.
(9) Where a notice is served on a person under sub-section (8) of this section, he shall be deemed conclusively to have, during the period between the service of the notice and the giving of the certificate referred to in the said sub-section (8), reason to believe that the child to whom the notice relates is a probable source of infection with an infectious disease.
(10) A person who contravenes sub-sections (1), (2), (3), (4), (5) or (6) of this section shall be guilty of an offence under this section and shall be liable on summary conviction thereof to a fine not exceeding fifty pounds.
The object of the amendment is to incorporate in Section 19 the provisions dealing with the question of the precautions to be taken by a person who knows that he is a probable source of infection and also by a person having the care of another person and knowing that such person is a probable source of infection. This amendment also enables Section 21 to be devoted solely to dealing with persons who are verminous. The new sub-sections (3) and (4) prohibit persons who are sources of infection from being present in any street, public place, club, hotel or shop. Corresponding provisions—I mentioned them already—are in Section 142 of the Public Health Act, 1878, which is being repealed.
Will the Parliamentary Secretary define "public place"?
Is this amendment in order? There is a considerable enlargement, of course, of the measure passed on Second Reading. The only part that is in any way comparable with what we are discussing is the old Section 21, which is entirely related to sending children to various places. This is referring the whole substance of Section 21 to individuals themselves. I suggest that it is a considerable enlargement of what was discussed on Second Reading.
The Bill is very wide already.
I am asking for a ruling.
I am ruling that it is not out of order.
I suggest that a ruling has already been given that, unless matters of a very substantial enlarging kind were mentioned on Second Reading, such amendments are not permitted.
It is only a reconstruction.
A reconstruction of Section 21?
Sections 19 and 21.
We have Section 19 as it stood, with this exception, that it is proposed to cut out sub-section (3) which is merely providing for the fine for an offence. Instead of that, it is proposed to put in eight other sub-sections, one of which is the equivalent of the one which is being cut out. It means, therefore, that we are inserting seven completely new sub-sections relating to individual matters and it is, so to speak, borrowed from Section 21, which so far has dealt with children, not with individual matters. It is an amazing enlargement of what was discussed on Second Reading.
Is it on the drafting that the Deputy is raising the point of order?
No, on the substance, which is entirely different.
If we put in a new section, will it meet the Deputy?
Not at all. It is a completely new provision and a very wide and definite enlargement. I do not remember one word being said about this on Second Reading. There was no indication given about it. The ruling so far has been—I have suffered under it many times—that a Deputy is not allowed to put down an amendment which very definitely enlarges the scope of a measure discussed on Second Reading unless the material point was made on Second Reading. This was not made. We are keeping almost the whole of Section 19 as it stood. We are substituting sub-section (10) for sub-section (3) and we are putting in all contained in sub-section (3) down to sub-section (9). Whereas we had this under Section 21, previously, referring only to children, it is now referring to adults.
The objection raised by the Deputy might be sustainable on Report Stage.
The ruling has been given over and over again on Committee Stage. An enlargement of a measure in a substantial way beyond what was discussed on the Second Reading, except the points have been raised and a forecast made of the enlarging provision, is not permissible. No such forecast was made in this case.
I do not think that this amendment enlarges the general scope or principle of the Bill.
To supplement what Deputy McGilligan has said, this new sub-section (3) says: "A person who knows that he is a probable source of infection with an infectious disease shall not expose himself in any street. . . ."
Is the Deputy discussing the sub-section?
I am adding to the point of order.
I have ruled that the amendment is in order.
May we have that ruling reduced to a point of principle? I suggest that it is a departure from all previous rulings. The ruling just given includes the principle that a measure may be enlarged after Second Reading although no forecast of the enlargement was made when the Bill was being discussed on Second Reading.
That would apply on Report Stage, but not on Committee Stage.
Being in Committee, I am discussing a very definite enlargement of the measure we had before us on Second Stage. You have ruled that that is in order. I am taking that as establishing the principle that enlargement of a Bill, even to a substantial extent, is to be permitted on Committee Stage, even though the subject matter of the enlargement was not raised on Second Stage.
I am not accepting what the Deputy says. I hold that this is not an enlargement of the general principle of the Bill.
Is it not an enlargement of the measure, having heretofore said that it would be an offence to allow children to go to various public places, now to say that an adult may not expose himself in any street, public place, club, hotel or shop, that matter not having been mentioned on Second Reading?
Will the Deputy read the title of the Bill?
Am I to take it that anything within the title is permissible?
I do not say so, but I hold that this is not an enlargement of the principle of the Bill.
I want to oppose the amendment on the ground that it is far beyond anything of which we were given an outline on Second Reading. Secondly, I want a certain amount of information. What is a "public place" for the purpose of this section? A great deal of comment was aroused in a number of circles because it was stated, and very vigorously contended by those who ought to know, that Section 21 is, in fact, a breach of morals, as they are understood in this country. You do not avoid that breach by taking out the word "church" or the words "place of public worship" and putting in "public place". You may be attempting to get away with it but I suggest that it is not a proper performance in face of the attitude adopted by certain clerical circles in this whole matter.
I have not heard of it.
One can turn a blind eye to certain things, and I suppose it is equally possible to turn two deaf ears to them. But these objections have been audible to those who wished to hear the comments and contentions. We are now asked to say that a person will be guilty of an offence if he goes in a certain condition to a public place. I take that to include a place of worship. There was an old slogan that cleanliness was next to godliness. We are reversing that order of things so far as the Department of Public Health is concerned. I assume that "public place" includes a place of public worship. Am I right in that assumption?
I could not tell you.
The Parliamentary Secretary does not know whether "public place" covers a place of worship?
I do not know whether or not the Deputy is right in his assumptions.
Is "public place" intended to cover a place of worship?
It is intended to have the meaning it has had in Section 142 of the Public Health Act, 1878.
Does that include a place of public worship?
It has been there long enough, whatever it covers.
Is "church" included in this particular phrase? I am assuming that the phrase does cover a place of public worship, as we have had it previously in Section 21. In addition to a person not being permitted to go to church in the condition described in sub-section (3), it is also forbidden, under penalty of committing an offence, to permit another person to go to a street, public place, club, hotel or shop. "Public place" is an extraordinarily wide term and, in addition to covering a place of worship, will cover practically any place where a considerable section of the public congregate or is allowed to congregate.
In addition, we have a provision which deals with registered medical practitioners. This provision has been condemned as a serious breach in the relations between a confidential medical adviser and his patients. Under sub-section (6), if a registered medical practitioner who attends a person in a dwelling where a child resides becomes aware that the child is infected, then, although he has been called in in a confidential relationship to see the head of the house, he is bound, under this particular sub-section, to inform the district medical officer of his discovery and, if the district medical officer becomes so aware from the information given to him by the registered medical practitioner, he is to serve notice on the individual forbidding him to allow the child to go to school. He is to continue to keep the child from attendance at school until such time as another certificate is given. If there is any contravention of any of these many sub-sections which we now have in Section 19, new form, then there is an offence for which a person may be brought before the most minor court the country has, charged in a summary way and, if convicted, fined £50. That is going to put a serious strain upon the attitude of the medical practitioners of the country, as a whole, towards the public. They will be in a definite state of conflict, so far as their relationships go, once this provision becomes law, because there is a very special intimacy as between the medical adviser who is called in to attend, say, the head of the household and his patient. Yet, he suddenly finds himself turned into a sort of spy. He is not allowed himself to pass judgment on the condition of the child. He must make a report and the district medical officer who gets that report does not even go to visit the house to see whether in his opinion there is any reality in the matter of infection. He must send the notice preventing the parent from sending the child to school.
I say that under those circumstances there is going to be more evasion of the law than was ever practised before. I think it is very well known as a fact —and it has been always held to redound to the credit of the medical profession—that medical men took up a particular attitude during the struggle here against the British. There was a time when, under the British Government, an Order was promulgated that medical men must report any cases of gunshot wounds which they treated. It was supposed to be incumbent on medical men to report such cases. There was any number of medical men at that time who entirely disapproved of the conflict that was going on. Not one of them became a spy for the British Government, no matter how much he disapproved of the particular type of warfare that was carried on. They simply turned a blind eye on such cases. The Parliamentary Secretary in putting this amendment through in its present form is asking the members of the medical profession to turn spies. I would have thought that, before we advanced to this point, we would again have got statistics of some kind. How many epidemics have there been in recent years caused by children sent to school by parents who knew they were a probable cause of infection with an infectious disease? On how many occasions has it come to the knowledge of the Department that resident medical practitioners visiting houses became aware that children were a probable source of infection with an infectious disease and failed either to tell the parent to keep the child from school or failed to give notice to the public health authorities? Before we proceed to brand the members of the medical profession in this country as being guilty of dereliction of their duty we should have some example, some notification of the number of cases in which this very definite dereliction of duty is alleged against them.
I thought that the medical profession would have been at least presented to us by the Parliamentary Secretary as an honourable body of men, not merely honourable but a body with a very definite consciousness with regard to their public duty, who could be relied upon. If, on any occasion medical men are called in by, say, the head of a household in which children are definitely infected and that it is right and proper to keep them from school, I think we can rely on the medical profession to see that they are kept from school. Until some notice is given to us that there has been any serious breach in that regard—I am not referring to the odd breach that might occur because the medical man did not judge the child as being so seriously infected as he turned out to be, but cases where in fact knowing the seriousness of the matter, doctors refrained from doing their duty in telling the parents to keep the children from school—I certainly hold that until we get to that stage, we should not ask the medical people to accept it that their colleagues have been deficient in that way and that we should seek to put this penalty on them.
Remember we make it an offence for a registered medical practitioner to fail to report. That gentleman may be hauled down to the District Court and a fine of £50 possibly may be imposed upon him. I do not think it right to treat a body of men of the professional type in that way and to threaten them with these penalties unless we have a case to make against them. I asked this on Second Reading and I got no reply. I ask it again. I suggest it would be much preferable to have left Section 19 as it was, so that a person knowing that he was a source of infection and failing to take reasonable precautions, would be subject to penalties but when we proceed to drag the registered medical practitioner, the confidential medical adviser of the family into court we, in effect, say to him: "So far from believing that you are going to do your duty, we are going to tell the people publicly through an Act of Dáil Éireann that we think you have failed to do your duty and if we consider that in any case in future you fail to do your duty we shall take you to the District Court and get you fined".
I think the Parliamentary Secretary ought to tell us what he had in mind when he first introduced the Bill and when he left out all these very important provisions. Again I would call attention to the fact that he gave us to-day a list of diseases which were to be declared infectious diseases by his Order, under Section 19. Now under Section 19 a provision is to be made that a person who knows that he is a probable source of infection with an infectious disease shall not expose himself in any street, public place, club, hotel or shop. We find that, by a provision which it is sought to insert in Committee and which was not hinted at when the Bill was introduced, a man suffering from whooping cough if he goes into the street shall be guilty of an offence and shall be liable on summary conviction thereof to a fine not exceeding £50. Does the Parliamentary Secretary intend that?
I shall tell the Deputy to-morrow.
That is what we are here to discuss to-night. If the Parliamentary Secretary is unable to tell us anything about it to-night there is not very much use in going further, and perhaps I might be allowed to report progress.
I could not tell the Deputy in a minute and a half all I have to tell him.
Does the Deputy wish to move to report progress?
I can fill in the minute and a half by saying that the Parliamentary Secretary never intended, when he introduced the Bill, that a person suffering from ringworm would incur a penalty of £50 if he went into the street while suffering from that disease, but under the amendment proposed here now, and as a result of the informatiin provided for us in connection with the Schedules, the Parliamentary Secretary proposes that people suffering from scabies, mumps, impetigo, if they go into the street, are going to be liable to a fine of £50 each. Perhaps the Parliamentary Secretary would explain whether that is one of mic proposals?
I move to report progress.
Progress reported; Committee to sit again.
The Dáil adjourned at 10.30 p.m. until Thursday, 28th March, at 3 p.m.