Dáil Éireann díospóireacht -
Wednesday, 26 Apr 1989

Vol. 389 No. 2

Private Members' Business. - HIV-Infected Haemophiliacs: Motion (Resumed).

The following motion was moved by Deputy Howlin on Tuesday, 25 April 1989:

That Dáil Éireann recognises the particular position of haemophilia sufferers who are HIV positive and who have contracted AIDS. Dáil Éireann considers that the State has a particular responsibility to all AIDS sufferers and that the State must take into account that many haemophiliacs were infected with the HIV virus through blood products supplied, albeit unwittingly, by State agencies. Dáil Éireann therefore, calls on the Government to establish a trust fund of £400,000 per annum for HIV infected haemophiliacs. Dáil Éireann also calls on the Government, and particularly the Minister for Health, to ensure that every public health facility is made available to all AIDS sufferers.

Debate resumed on amendment No. 1:

To delete all words after "Dáil Éireann" and insert:

"rejects any proposals which would inherently result in discrimination between individuals suffering from AIDS or the AIDS virus; Dáil Éireann further considers that all such persons should be treated with sensitivity and understanding and notes in this respect that a Working Group under the Chairmanship of the Minister of State at the Department of Health is to report to the Minister for Health next week on any difficulties which persons suffering from AIDS or HIV may have in gaining access to health services appropriate to their condition; Dáil Éireann notes also the offer of the Minister for Health made to the Irish Haemophilia Society to provide £50,000 for counselling services and his willingness to make a contribution towards a Trust Fund which may be established by or on behalf of AIDS sufferers.".

—(Minister for Health).

An Ceann Comhairle

The Minister for Health was in possession and I should like to advise him that he has some 20 minutes left of the time allotted.

Minister for Health (Dr. O'Hanlon)

As I said last night before I moved the Adjournment, it can be seen that the Department and the Blood Transfusion Service Board acted to protect the blood as the first priority in relation to AIDS and acted at all times to introduce newly discovered protective measures, as soon as it was possible to do so towards achieving this end.

The State, and its agencies, have a statutory involvement in relation to the medical treatment received, but the determination of that liability, if any — which is a cricial issue in this case and indeed of others who were involved — is a legal issue, and one which is a matter for the legal process to adjudicate upon and one which would have to take cognisance of the roles, responsibilities, rights and inter-relationships of and between others involved.

The Labour Party motion calls on Dáil Éireann to recognise the special position of haemophilia sufferers who are also AIDS victims and to agree that the State has a particular responsibility to all AIDS sufferers. Similarly, it calls upon the Minister for Health to ensure that every public health facility is made available to all AIDS victims, irrespective of income. On this theme also, it has been represented to me, and argued in the Seanad, that the State, and in particular the Minister for Health, has an obligation to provide especially for the haemophiliac group of AIDS sufferers on the basis that they are a finite group and that they contracted the infection through no fault of their own.

As the Minister for Health, I have a statutory responsibility to provide health services for all persons who require them. My responsibility and that of the State in fulfilling the statutory duty of care towards treating all persons equitably and uniformly should not, and cannot, involve considerations of differentiation between one group over another, on the basis of the nature of their illness, the finiteness of their numbers, the possible source of their infection or their lifestyle.

Many families are and will continue to be affected by the AIDS virus, the effects of which are direct and immediate not only for haemophiliacs but for intravenous drug abusers, homosexuals, and bisexuals.

To date, a total of 88 cases of full-blown AIDS have been reported to the Department of Health, as follows:—

Homosexuals-bisexuals	34
Intravenous drug abusers	30
Homosexual-bisexuals who are alsointravenous drug abusers	5
Haemophiliacs	10
Heterosexuals	3
Babies born to intravenous drug abusers	4
Undetermined	2
	88

Of these, a total of 36 have died, as follows:—

Homosexuals-bisexuals	11
Intravenous drug abusers	7
Homosexual-bisexuals who are alsointravenous drug abusers	4
Haemophiliacs	6
Heterosexuals	3
Babies born to intravenous drug abusers	4
Undetermined	1
	36

Over 20,000 persons have been tested for HIV and, of these, over 800 have tested positive.

The House will be aware that over half of the intravenous drug abusers who have tested positive for the virus have families and 53 of their babies have tested positive. In this context, I am happy to be associated with the research project on paediatric AIDS launched yesterday by my colleague, Mr. Terry Leyden TD, Minister of State, which is being undertaken by the AIDS Fund and funded to the extent of £30,000 by the Department of Health.

Dealing with one group in a special way, for what is an extremely sensitive condition, would have the effect of setting apart other groups of sufferers from the same illness and of attributing guilt and thus discrimination against these groups. It was with interest, therefore, that I noted the recent comment made on radio and television by the chairman of the AIDS Action Alliance highlighting the plight of other groups, if special arrangements were made for one particular group of AIDS sufferers. The Irish Council for Civil Liberties have made a similar statement.

The complexities involved in this issue are shown by the conflicting positions which are being taken. These show the difficulties involved and the consideration that arises from a fragmented approach which was correctly described as a "nightmare" by my predecessor Deputy Desmond, as quoted in an article in The Sunday Tribune on 12 February 1989. It is interesting that in the same story he stated that no decision had been taken by the previous Government to do anything for AIDS sufferers or for haemophiliacs specifically. It has also been put to me by some of those particularly concerned with the rights of those suffering from AIDS that:

The claim by haemophiliacs will impose a considerable strain on the co-operation between different groups — some will feel that they are now about to be left out in the cold as "guilty" victims while the "innocent" victims attract support.

The Eastern Health Board having considered all the issues voted recently against introducing special measures for haemophiliacs and Dr. David Nowlan former medical correspondent in The Irish Times, in an article in the Irish Medical News on 30 January 1989 spoke of the implications involved in making distinctions of any kind between particular groups in society on the basis of the source of their illness or condition. He referred, in particular, to the submission of the Irish Haemophilia Society to the Government, as follows:

The sweet reasonableness of the document and the extent and depth of the anxiety and misery that it reveals in the most temperate of tones make it very difficult to resist its conclusions and recommendations. Why should not these innocent victims of one of the gravest pandemics the world has met this century not be comforted and cosseted to the limited extent that is possible? They are, above all, surely not to blame for their condition. They sought only lifesaving care to protect them against bleeding and yet they were dealt a death-dealing virus. Surely they deserve recompense.

Of course they do, and I hope that they will receive at least some of what they seek. But if they do, then something pretty similar is going to have to be offered to a great many more people who also currently carry the Human Immunodeficiency Virus in their blood, for there is no way that any society can make distinctions between "innocent" and "guilty" victims of disease.

How innocent or how guilty are those infants who contracted AIDS from their infected mothers? How innocent or guilty is the wife who was unknowingly infected by an errant husband? How guilty, exactly, were the first victims of this previously unknown disease, whether they were homosexuals in America or Ireland, or travellers in Central Africa, or whoever or whatever they were?

He goes on to say—

The whole notion of guilty and innocent in the context of disease or injury is a profoundly dangerous one. Shall we ask casualty officers to distinguish between the driver whose actions contributed to the road accident and the passenger who was travelling in the car at the same time? Will we refuse treatment to the emphysematous patient whose life-long smoking habit may have caused the illness? Have we not only recently heard of an apparently successful liver transplant programme for alcoholics with terminal cirrhosis?

It requires a greater omniscience than the average human community can provide to make distinctions of any kind between allegedly innocent and allegedly guilty victims of the kind of society we live in. It is neither humanly nor humanely possible to draw distinctions between those victims who call for succour. Does someone grappling with heroin addiction need less help than someone coping with haemophilia? Is not the burden of AIDS devastating to both of them? They all need everybody's help.

In my view in those passages Dr. Nowlan outlines the dilemma quite accurately.

The Government strategy on AIDS has been developing since 1982, and all along it has been monitored and adjusted as appropriate in line with current developments in other countries. It compares very well with strategies adopted elsewhere, including the USA.

Since the commencement of the strategy, care has been taken to ensure that the potential for discrimination or stigmatisation does not arise. AIDS is a life threatening condition which can be contracted in a variety of ways — through a sexual and/or drug-taking lifestyle, by foetal transmission to the babies of infected mothers or, in the case of haemophiliacs, by their medical treatment. Other conditions of illhealth are serious and also life threatening, such as cancer, heart disease and some infectious diseases which are also associated with lifestyle. These do not have the same stigma attaching to them as AIDS although each of them requires the same broad preventative and management strategies. It is important that the AIDS virus is seen, debated and considered in the context of all life threatening conditions and that sufferers are not made to feel as if they were outcasts in our society.

It has always been the norm in our society that persons who may have contracted an illness continue to work as long as they are able to do so and as long as they are no threat to those working with them. Against this background it is difficult to understand how a national daily paper could describe as charitable the continuation of this practice as it relates to those with the AIDS virus who work in one of our semi-State bodies.

In relation to treatment I have mentioned the priority which was given to protecting the blood supply and the measures introduced to achieve this. Prevention, through public information programmes and the AIDS telephone service, is being augmented by public information and education aimed at target groups such as intravenous drug abusers and pupils attending secondary schools. A feature of this strategy is the Outreach Programme aimed at intravenous drug abusers and currently being developed by the Eastern Health Board. Health professionals continue to be educated and informed about AIDS and in-patient and community based services continue to be developed. In this regard I was very pleased to note the opening this week by the Eastern Health Board of the new walk-in facility in Baggot Street, Dublin. It is proposed to open a second such facility in the north side of the city in the near future.

These are some of the new measures being developed by the Department of Health in conjunction with the statutory and voluntary agencies. They are supported by finance made available from the Department through special allocations from the national lottery, which are over and above the normal financial allocations. In 1988, a total of £450,000 was made available from the lottery and a similar amount is being made available in 1989.

The following grants have been made specifically for haemophiliacs who have contracted the virus; a direct grant of £5,000 to the Irish Haemophilia Society in respect of AIDS services, including provision of support, counselling and services; the EHB grant of £12,000 to the Irish Haemophilia Society was increased to £30,000 in 1989 with my approval; a grant of £15,000 was made available to St. James's Hospital in 1988 for counselling. I have arranged for a grant of £30,000 this year to enable the service to continue in 1989, and I am happy to announce a further grant being made to St. James's Hospital to enable it to recruit a dietitian and a nurse for the haemophiliac unit there, as soon as possible. This funding is in addition to the funding made available to St. James's Hospital to run the national haemophiliac and AIDS unit which is of the order of £700,000 each year.

At a meeting with representatives of the society on 10 February last, I offered a grant of £50,000 from the Department's allocation towards counselling and support services. I understand that the society will be submitting proposals as to how this money should be spent. The offer of this grant is, of course, separate to any consideration of the substantive issues raised by the society with the Government.

It is, of course, necessary to ensure that the health services available to all AIDS sufferers are appropriate and accessible. Towards this end, as I already mentioned, I established a working group to review the accessibility to health services of all AIDS suffers. The working group are chaired by Deputy Terry Leyden, my colleague and Minister of State, and includes representatives of the Irish Haemophilia Society, the Department of Health, the Virus Reference Laboratory, UCD, the Eastern and Southern Health Boards and the Drugs Treatment and advisory Centre.

The group have already met with a number of relevant persons and organisations including St. James's Hospital, the AIDS Action Alliance and the Haemophilia Society. The submissions made to the group by the organisations and individuals give, I understand, an extremely useful picture of the appropriateness, adequacy and accessibility to health services for AIDS suffers. The group are finalising their report and following their consideration I will decide on an appropriate course of action.

The position taken by Governments abroad has been quoted to support the submission made by the Irish Haemophilia Society and in particular the establishment in the UK of a £10 million trust fund by the Government there. I understand that, to date, only £700,000 of the £10 million has been disbursed in two years from the fund, due mainly to the unwillingness of infected haemophiliacs to come forward for fear of recognition and stigmatisation. As I said earlier, legal action is being taken in the UK despite the establishment of the trust fund there.

Apart from the UK, only Denmark of the 12 EC countries has introduced a special scheme of payments, although France is said to be considering the matter. West Germany has a general drugs related injury scheme. The Department of Health are keeping in close touch with the situation in the EC member states. The different approaches being taken throughout the Community reflect the complexity of the issue and demonstrate that there is no simple solution to the problem. All of the issues need to be explored thoroughly and objectively. The implications of dealing with haemophiliacs in a special and distinct way, need to be examined and understood.

The position in the Netherlands is particularly interesting. There is no official scheme of payments there, one of the reasons being that the standard and essential medical treatment was given in good faith at the time. However, in the Netherlands a private foundation exists which helps to meet the financial needs of haemophiliacs.

As I stated on coming into the House last night, the AIDS Fund were prepared to set up a trust. Since then officials of my Department have met representatives of the AIDS Fund and we have made an offer to the fund recognising their objective role in caring for AIDS sufferers, and the board are going to consider the offer that was made to them. I believe we have made a reasonable compromise. The Government are prepared to provide £250,000 in the current year towards such a fund when it is established. As regards future years, there is nothing to stop the trust, like other voluntary bodies, making an application for consideration. It would be considered in the normal way in the light of the situation as it exists at that time.

According to their motion the Opposition want us to provide money every year, with no limit on the number of years. I understand, however, that they are prepared to reduce the number of years from four to three. I am sure they appreciate that a Minister must behave in a responsible way. We would look at this trust fund in the light of the prevailing circumstances in other years. It would be most unreasonable to expect the Government to commit themselves. I certainly would not commit the Exchequer to funding a trust each successive year. When the trust is established it will attract funding from a lot of other sources including financial institutions, pharmaceutical companies and the general public. We can look at it in another year.

I appeal to the Opposition to see how reasonable our position is. We are providing £250,000. If a trust fund is established I have no doubt that it will rise to over £400,000 in the current year due to subscriptions from others. The case can be looked at each year.

Mr. Yates

A Cheann Comhairle, you will be aware that 40 minutes of the debate have been lost and there is agreement to terminate it by 8.30 p.m. I propose to take 15 of my 30 minutes and to give ten minutes to Deputy Harney and five minues to Deputy Garret FitzGerald.

An Ceann Comhairle

Is that satisfactory? Agreed.

Mr. Yates

It is regrettable that it has been found necessary to seek to resolve this issue on the floor of Leinster House. Other Governments across Europe have responded spontaneously with compassion, humanity and understanding to the problem of haemophiliacs infected with HIV. The Minister for Health, both in Dáil Questions on Thursday, 9 February and in a subsequent Seanad debate on 1 March, has refused to acknowledge the unique circumstances of haemophiliacs with the HIV virus and AIDS and has rejected the establishment of a trust fund. The campaign of the Irish Haemophiliac Society commenced a year ago in April 1988 without clear success to date. The facts are unfortunately all too tragic. Of 300 haemophiliacs in this country, 106 are HIV positive. Over ten have developed full blown AIDS. Several have died and more will die.

The unique circumstances of haemophiliacs are fourfold. First, they have to cope with two diseases, each of which involves an enormous strain and adjustment to a normal healthy life. Second, it was through the medical treatment of haemophilia that they contracted the HIV virus and AIDS. Third, unlike any other category of AIDS patients, the number infected is finite. The last diagnosed case relates back to 1986 and further cases will not recur due to pre-heat treatment of blood products. I was at the AIDS fund launch yesterday and we heard that AIDS numbers in total are doubling every nine or ten months. The number of haemophiliacs infected in this way will not increase. They are a defined limited group. The fourth point is that haemophiliacs with the HIV virus are the only category of such sufferers who have a potential case for litigation against components of the health services. It has never been argued that drug abusers and the gay community would have any potential case for litigation. The four points I have made single out the haemophilia group.

I wish to make it quite clear from legal advice I have obtained and from other precedents established by previous Governments that allocations of State finance can be made on a strictly without prejudice basis to any legal defence that might be submitted in the future relating to a legal claim against the health services for compensation. In fact, I have been advised by senior counsel that the courts could well dismiss a legal compensation claim in the future if adequate compensation or financial arrangements had already been made available to them.

On the question of responsibility, I believe serious questions must be asked about the adequacy and timing of steps which were taken by the Blood Transfusion Board and more especially by international drug companies supplying Factor 8 and Factor 9 blood coagulants from potentially infected donors in switching to alternative sources such as an Irish self-sufficiency in these blood products. The first case of AIDS in an Irish haemophiliac became evident in December 1984. I should like the Minister to clarify at some future date his Department's record of events relating to the introduction of heat treatment in both Irish and foreign Factor 8 and Factor 9 products and the substitution of Irish blood products for foreign products. I am not saying indisputedly that the chronological list of events provides that earlier action could have been taken, but it has been strongly suggested to me that this is the case. While I have heard the Minister's defence based on state of the art, I should like to see the chronological list of events to put the matter beyond doubt. The nature of litigation which would ultimately prove these issues is extremely slow and costly. It is so slow as to be of little use to victims who are HIV positive or diagnosed as having AIDS. They are unable to keep appointments with solicitors, let alone be alive by the time cases might be listed for hearing.

Personally I do attach responsibility in the widest sense to international drug companies for obtaining their blood bank from donors at risk. We know the system in the United States where they have paid donors. I call on the relevant pharmaceutical enterprises of Baxter Travenol, Cutter, Armour and Imuno — to name but some — to consider in a similar, without prejudice, fashion contributing financially to a trust fund for Irish haemophiliacs with HIV positive and AIDS. I firmly believe that responsibility and compassion do not rest solely with the Exchequer in this instance and, therefore, non-Exchequer funding must be the objective of any trust fund. I understand that in Spain a royal foundation has been established along these lines which has received contributions not only from the Exchequer but from the pharmaceutical sector. Such an approach should be followed here.

Some criticisms have been voiced concerning the position of other categories of HIV and AIDS sufferers other than haemophiliacs who are allegedly being neglected and discriminated against because of the demand to set up this trust fund. I have to reject this on a number of grounds. However, this criticism would not arise if the Government had a comprehensive health care and welfare plan for all such AIDS patients. The absence of this should not be used as an argument to dismiss the justifiable claims of haemophiliacs. These arguments from the Minister are somewhat hollow and futile. I reject the assertion that, because little is being done for all AIDS victims, nothing extra should be done for haemophiliacs.

In order to set the record straight I call specifically on the Government to provide a means-tested scheme for all HIV-AIDS patients through the Departments of Health and Social Welfare to provide financial allowances for their special dietary needs, heating and electricity expenses, telephone bills and mobility payments. Such a scheme should be provided not just for haemophiliacs but for all AIDS patients specifically to deal with their inability to meet the costs of their illness.

I now call on the Government to act urgently to ensure that discrimination against and the stigmatising of HIV sufferers are redressed. I am referring to legal measures to ensure equal access to employment, housing, public accommodation, the granting of credit and the delivery of services. This is an important area where I believe there can be all party support so that in terms of public education, information and attitudes we can reverse the appalling stigmatisation of HIV.

I publicly commend the work of the AIDS fund and I sincerely hope that National Irish AIDS Day on 20 May will be successful both in terms of fund raising and public awareness. Specifically, I urge the Government to continue issuing lottery funding towards AIDS research and especially the area of paediatric AIDS, as Ireland has the highest number of babies per head of population with the HIV virus.

I have never considered and do not consider the care of AIDS patients to depend on their source of infection, be it through blood transfusions, drug abuse or sexual activity. Therefore, I call on the Minister for Health to ensure that hospital facilities and treatment are the same for all HIV-AIDS patients. Similarly, the allowances I have referred to should be based purely on financial need relating to a means test. I deplore any questions being raised in this debate as to innocence or otherwise of AIDS patients, and all of those who are raising those questions do not come from the Opposition side of the House. These issues of caring services, and hopefully future curing, are entirely separate from the issue of financial resources, a trust fund, compensation and responsibility.

International Government response to this issue has varied from country to country and has been referred to throughout this debate. I believe there is a close similarity between the situation in the Republic of Ireland and that in the United Kingdom and Northern Ireland. I feel, therefore, that it is relevant to quote from the record of the debate in the British Parliament on 16 November 1987 and specifically the comments made by the Secretary of State for Health, Mr. Tony Newton MP:

On a number of occasions I have commented on the difficulty of a compensations scheme. This is not a compensation scheme. That must be made clear. It is a recognition of a special and unique combination of circumstances and I am glad to make that recognition.

This points clearly to the "without prejudice basis" of Government action, and I see no reason we cannot follow suit. I believe also that, within the Irish system, we have previously established State schemes whereby payments have been made on a compassionate basis to individuals. I am referring specifically to payments authorised by the present Taoiseach as Minister for Health further to a vaccination programme and the separate instance of the Stardust Tribunal. Both of these events occurred when Fianna Fáil were in office.

In any context the amounts of money we are talking about are small in comparison to the potential legal costs arising out of High Court and Supreme court litigation. We have only to look at the recent William Dunne case to see how costs can develop, over a very short period, into figures that look like telephone numbers. The figures mentioned in this debate pale into insignificance by comparison.

I referred earlier to the fact that the campaign by the Irish Haemophilia Society has been continuing for a year. As time elapses this matter is becoming clearly more urgent. It is vital, therefore, that the Minister should not only act with good grace in establishing a trust fund of substance but should do so immediately. The UK Government in their allocation of £10 million made it available at once, even though disbursement may necessarily take place over a longer period. The Minister for Health should also ensure through the Council of Health Ministers at EC level that a comprehensive plan for the care of AIDS sufferers as well as research into prevention and cure is effected. It is interesting to note further to a question in the European Parliament from Mr. Tom Raftery that the EC Commission favours "a humanitarian approach" towards these patients by national Governments and considers it desirable that compensation funds should be set in place for haemophiliacs. I believe the EC Commission would be receptive to a political approach for a common Community policy on care and allowances for all Aids suffers.

The practical problems of coping with haemophilia are often not readily understood. Not only do suffers have to curtail their activities due to their bleeding disorder but often they have severe arthritis at an early age. This often results in having their income reduced due to disability and illness. Prior to the outbreak of this HIV virus there were already insufficient benefits for them. Now they find it impossible to secure mortgages and life assurance. There is also the tragedy of the hereditary nature of haemophilia which has obvious consequences for their future family planning. It is interesting to note that the 106 haemophiliacs who are HIV positive reside in 70 families. From all of these factors it is quite clear that they are a singularly disadvantaged group. Once HIV virus has been diagnosed there are obvious practical limitations to a normal lifestyle such as coping mentally with a terminal illness and the question of sexual relations with a spouse.

On the question of who should administer a trust fund, my personal preference is to involve the State as I believe it could exert pressure on external non-Exchequer organisations such as pharmaceutical companies more effectively than private individuals acting as trustees. However, on this point I understand the Haemophiliac Society are prepared to meet the Government's point of view in establishing their own independent trust fund. Similarily, they have requested annual funding from the Government and are prepared to be flexible on this point, with an insistence that this funding be maintained for a period of three to five years. This flexibility should have been matched by Government willingness to respond generously and urgently.

Fine Gael are not interested in playing politics with this issue but we feel that political action has been necessary to get this issue so far to date. Had the Government put forward what we considered to be the minimum to meet this disadvantaged group's needs we were prepared to avoid an unnecessary Dáil vote. Thus the fate of the Government is entirely in their own hands.

Finally I call on the Government to follow a compassionate policy in this area and to follow the Governments of Denmark, West Germany, Spain, Britain and Norway. Regardless of the outcome of the vote tonight, since the die does seem to be cast, I hope that the Minister, subsequent to this vote, will not be in any way churlish in his handling of the Haemophiliac Society and, even if he has not been prepared to meet Opposition demands, deal with them in a compassionate and sincere way.

Miss Harney

This issue is, and should be, above party politics. It is shameful that the Minister for Health, particularly by his comments today, has now politicised this issue. The paltry sum of £250,000 now on offer on a take it or leave it basis is exactly the same sum of money as this Fianna Fáil Government gave last year to Dublin Zoo. I ask where our priorities are.

It is fair to say that all Opposition parties have sought quietly and behind the scenes for a number of months to bring the Minister and Government around on this issue. A number of weeks ago with other Opposition spokespersons and the former Taoiseach, Deputy FitzGerald, I went on a deputation to the Minister for Health. We tried on every possible occasion to have this matter sorted out quietly so that we would not have to take it to the floor of the Dáil. Opposition parties, in framing tonight's motion, worked together. We were conscious that we were dealing with a very sensitive and difficult issue and nobody wanted to score political points.

I regret very much that the Government, by their attitude to this issue, have sought to set AIDS victim against AIDS victim. I now understand that even the offer being made at the eleventh hour by the Minister for Health has been rejected by the AIDS fund people who are not prepared to participate in the trust fund as announced by the Minister last night. Last week, in the face of another Government defeat, the Government Chief Whip sought to set an all party committee to deal with this issue. We all know from our experience with the national lottery what the all party committee did when the Government were faced with defeat. The attitude of the Government has been to avoid political defeat at all costs, to avoid political embarrassment. They have not taken this issue seriously. They have not dealt with it as a medical and financial crisis but have tried to avoid political embarrassment at all costs.

AIDS represents the single biggest medical threat which this country has had to face and, although the actual number of full-blown AIDS cases, at 90, is relatively small, the disease is now spreading with frightening rapidity. Three years ago there were just nine AIDS cases in Ireland and all of them had been contracted outside the country. However, in the past 14 months the number of cases has trebled and one of our leading experts, Dr. Fiona Mulcahy, estimates that she is seeing up to five new cases each week. Thirty-eight people in Ireland have died from AIDS, including four children and seven haemophiliacs. It has also been confirmed that over 800 people are carrying the AIDS virus and this figure is doubling every nine months.

These alarming statistics, however, do not show the true picture. The national AIDS co-ordinator, Dr. James Walsh, a very courageous and forward-looking public servant, has said that not all AIDS deaths are being reported and he is now going to monitor all death certificates of people in the 20 to 40 age group who have unexplained deaths. Given that it is estimated internationally that for every one case of AIDS there are between 30 and 50 people with the virus, there are up to 3,000 people with the AIDS virus who remain undiagnosed in this country.

The latest figures available also suggest that at least 50 per cent and possibly as high as 80 per cent of HIV carriers will go on to develop full-blown AIDS. With Scotland, we have the highest incidence of AIDS and the AIDS virus among babies found anywhere in the world. At present we have 54 babies with antibodies to the virus and six of them have developed full-blown AIDS. Other peculiarities of the disease which have shown up here in Ireland are that in one area, the Mid-Western Health Board area, one-third of those with the virus are women.

The first geriatric case of AIDS has also turned up in Ireland. a man over the age of 70 who was admitted to a geriatric assessment unit of a Dublin hospital was diagnosed as having the disease. It was apparently the first such case of AIDS reported to the World Health Organisation.

One good sign, however, is that among those who develop full blown AIDS, life expectancy is longer in this country than anywhere else — a tribute perhaps to the standard of nursing care they receive.

To date the Government's response to this growing problem has been, to put it mildly, unco-ordinated and ineffectual. There is a real danger that this will continue to be the case until we have reached a crisis.

Anyone who attempts to deal with the AIDS threat must face up to the reality that no cure will be found for the disease in the foreseeable future. Our efforts must be based therefore on preventing the further spread of the disease by every means at out disposal and making sufficient financial resources available to ensure the highest possible standards of medical care are available for those suffering from the disease.

It is an appalling reflection that almost half of the staff in the national sexually transmitted diseases centre at St. James's Hospital are paid out of voluntary funds. The voluntary groups who work under the auspices of the national AIDS fund deserve our praise for the courageous way they have filled the vacuum left by the inaction of the Minister for Health.

It would be wrong if tonight's debate did not allow us to focus our attention on the kind of public policy approach which is now urgently required if we are to contain and prevent the further spread of this disease. There is no point in a public health policy of simply telling people not to engage in casual sex. We have to face up to the realities of today's world, however unpalatable it may be to do so. The promotion of the use of condoms, if casual sex is to take place, must become a central plank of the public health policy advocated by the Minister for Health.

Given that 60 per cent of those carrying the AIDS virus in Ireland are now intravenous drug users, we must also develop a needle exchange programme for intravenous drug users. Other countries have long recognised that the AIDS crisis is far more serious than any drug problem they may have and we need to do so too. The national AIDS co-ordinator has courageously sought for this to be part of our public health policy. It is a shame that he has not been able to convince the Minister to advocate this. I understand he does not believe that these measures are necessary.

It us understandable that proposals like these will be highly unpopular but what we are dealing with here is a matter of life or death. As an alternative to doing nothing, these measures are very definitely the lesser of two evils. While every AIDS victim is a particularly tragic story, it is wrong for anyone to seek to talk of guilty and innocent victims. Nobody sets out to develop AIDS.

Unlike any other group of AIDS victims, however, the group of 106 haemophiliacs with the disease developed it from the State's health services. To argue that the State has no legal responsibility to this particularly vulnerable group may or may not be technically correct but it is most definitely morally wrong. To say that there are other innocent victims of AIDS is true. It is also true that there are no grounds for finding one AIDS victim more morally guilty than any other. The issue is not a question of moral guilt on the part of the victim but rather it is the moral responsibility of the State health service which unwittingly gave them the disease. Already handicapped with one major illness, haemophiliacs suffering from the virus have had to endure the most traumatic experiences trying to cope with this killer disease.

Deputies who have met the Irish Society for Haemophiliacs have been very impressed at the courageous manner in which they have sought to help the victims of this tragic killer disease. They have touched everybody who has met them, listening to their heart-rendering stories. It is a pity that we will tonight divide on this issue because we are going to ensure that for a very long time those 106 people, for as long as they may live, will have to continue to live in the most appalling circumstances. Their heating, dietary and housing needs will not be looked after unless a special trust fund is established. I would again call on the Minister for Health not to pursue in dividing this Dáil and not to use as an excuse the fact that other parties have not accepted his very mean offer indeed. As I said earlier, if Dublin Zoo got £250,000 last year surely haemophiliacs suffering from the AIDS virus deserve to be treated a lot better. What are our priorities in this country? Do people with this most dreadful disease come first or do they not?

Dr. G. FitzGerald

The issue in the debate on this motion is the moral responsibility of the Government. It is a responsibility which, as the Leader of the Government at the time these events occurred, I accept. The Minister today is trying to slough off the responsibility of this Government as the successor in office of the Government I led and under whose authority the steps were taken at official level which inadvertently led to the infection of those concerned. Throughout this debate and in all the discussions held previously the Minister has consistently evaded this question. In his speech today he has once again, as a member of the Government, refused to address this issue. He has spoken of the moral responsibility of the Minister for Health to provide the best possible health service for all sufferers and nobody is questioning that. Nobody is raising the question of the role of the Minister as administrator of the health services. The Minister said he cannot be more accountable for one person than for another and that it is his duty to treat each person on the same basis. Is he talking as a doctor or as a health service administrator? He is certainly not talking as a member of the Government. The motion on this issue of the trust fund is addressed to the Government and not to the Minister who has refused to face the issue and accept his responsibility.

The Minister went on to say that the determination of liability is a legal issue, a matter for the legal process to adjudicate upon. Is the issue one of determining liability? Is it the case that the Minister is disputing liability and that on behalf of the Government he is saying there was no responsibility for what was done. We are not talking about blame, nobody is adducing blame; we are talking about responsibility which is quite a different issue. Is the Minister disputing liability? Is he going to drag this issue through the courts so that these people, many of whom would be dead by the time the issue was settled, would have to face that ordeal without getting any compensation or any assistance with their problems while they are still alive?

Surely the Minister must accept the liability. That is not in dispute. It is not a case for lawyers. The money must not be spent on arguing through the courts, right up to the Supreme Court, for years to come as to the exact amounts of money. We know the liability is there. Let the Government discharge that liability honourably as we would have done if I had still been in office. When servants of the Government act in a manner which inadvertently and through no blame of theirs causes hurt or damage, each successive Government must take responsibility for the acts of those continuing officers under their control.

I note that over one third of the Minister's speech is devoted to a totally disingenuous attempt to suggest that the Opposition and the various speakers have sought to discriminate between the innocent and the guilty, as he described them. No one in this debate has raised this issue except the Minister. He is the only one who has attempted to make this distinction. The whole case rests on the discharge of the moral responsibility of the Government for actions taken inadvertently under their authority. The Minister should ignore the advice of officials who in this matter must naturally have difficulty in accepting responsibility lest it imply blame though no blame is implied. He should act as a politician, take his responsibilities as a Minister and not act as a bureaucrat.

The Minister deserves the ignominy of defeat in this debate tonight for failing to act as a person with the political authority to take decisions rather than as somebody engaged in a bureaucratic exercise. I would like to add that his threat to ignore the Dáil which, I understand, was stated in the newspapers in any event, if made, was an arrogant one and would demonstrae an unlovely characteristic of the party of which he is a member, the reappearance of which would do no good to that party. The Minister has done himself and his party no service by succumbing to the advice being pressed upon him to adopt this disingenuous and bureaucratic approach. I appeal to him even at this late stage to even once face, listen to and answer the arguments being put. In the private discussions we have had and in this debate he has refused to face the argument and he has never adverted to the question of responsibility. He has changed the subject time and again in a manner that is unworthy of him in matters of this kind.

Dr. O'Hanlon

£250,000.

Dr. G. FitzGerald

The Minister has changed the subject and moved away from the question of the moral responsibility of the Government to deal with his functions in administering the health service which is not the issue. The Minister has failed to face the issue, rather he turned it into a legal dispute and disputed legal liability. I was horrified when he did so. Even at this late stage I appeal to the Minister to save his party from the ignominy of defeat on an issue of this kind.

Dr. O'Hanlon

I would ask the House to allow three of my colleagues to share the half hour: the Minister of State, Deputy Leyden, Deputy Roche and Deputy Fitzpatrick.

Acting Chairman (Mr. Pattison)

Is that agreed? Agreed.

Mr. D. Fitzpatrick

There is no one in this House who does not have sympathy for those afflicted by AIDS no matter how it was contracted. AIDS is the new scourge of society. It is no respecter of persons no matter what their position in society may be. It afflicts both male and female, old and young. It has connotations, both social and medical, that touch a chord deep in every human being. It is a blood-borne infection. The AIDS virus affects a person in such a way as to destroy his or her resistance to infection and leaves a person in such a condition that a common cold can become a major life threatening catastrophe.

That brings us basically to the problem before us here tonight, which can be settled to the satisfaction of those most in need. The Labour Party motion basically wants the haemophiliacs who have contracted AIDS through no fault of their own to be compensated for their undoubted suffering in a way different from all other sections of the community but specifically from all those other people who did not contract AIDS from blood transfusions. Deputy Howlin based his argument on three points, the first of which was the moral and legal responsibility of the Government, the second the special requirements of haemophiliacs, and the third that the Minister for Health should provide services or benefits which do not usually fall within the ambit of the health services.

On the question of moral and legal responsibility, it must be said that the Minister and everybody practising medicine, be they a doctor, nurse or in the paramedical professions, have both a moral and legal responsibility to treat each and every member of the community in an even-handed manner and always with an eye to see that the patient gets the best possible treatment. Over and above this, haemophiliacs because of the nature of their affliction have special requirements peculiar to the disease which at present, as we understand the state of the haematological arts are being relatively adequately dealt with. There is no doubt that haemophiliacs who have contracted the AIDS virus through no fault of their own have had a second and most terrible affliction visited upon them.

The argument being advanced by the Labour Party and the other Opposition parties is that because people contracted the AIDS virus through no fault of their own they should be treated differently, in other words, they want the Minister and the Department of Health to make moral judgments in regard to the contraction of the disease.

Mr. Howlin

Not so.

Mr. D. Fitzpatrick

I think so if one reflects on the motion. The major problem I have with the Labour Party motion and I accept fully their bona fides in this matter——

Proinsias De Rossa

Is that it is not a Fianna Fáil motion.

Mr. D. Fitzpatrick

——is that they want the Minister and his successors to make moral judgments in the treatment and provision of services to patients.

Mr. Howlin

Not so.

Mr. D. Fitzpatrick

I beg to differ on this one but this is the nub of the issue. Before we start to provide services we would have to decide whether a patient contracted AIDS in an innocent manner or not. It would be very unfair to put this burden on anyone engaged in the provision of services.

Miss Harney

All AIDS victims are innocent. No one sets out to contract AIDS.

Mr. Howlin

It is an outrageous suggestion.

Mr. D. Fitzpatrick

Deputy Howlin made the point that those who contracted AIDS as a result of using factor 8 products given to them to help alleviate their haemophilia are innocent sufferers. I agree with and accept that point but then so is the child born of parents afflicted with AIDS. Therefore, where do we begin and finish in the provision of services and in deciding who should get services? That is the nub of the dilemma facing the House tonight. It is a dilemma that will have to be faced up to and a decision taken.

Disagreement arises when we come to decide on how we should deal with the problem. I accept that there is no lack of goodwill towards AIDS sufferers but I maintain both as a Deputy and a practising GP that I cannot discriminate between patients on the basis of how they contracted this or any other disease. All AIDS victims no matter how they contracted the disease require special consideration but we cannot proceed on the basis of this motion. To do so would be to create further strains and stresses in a society already overburdened with them. This would be to the detriment of all AIDS sufferers.

Deputy Howlin also made the point that the Minister for Health is under an obligation to provide other services and benefits which do not usually fall within the ambit of the health services. I would have thought that if they were serious about this the motion would have been put down to the Minister for Finance as it is he who has the statutory responsibility for discharging financial services.

Mr. Howlin

The Government decide.

Mr. D. Fitzpatrick

There is no doubt in my mind that the question of insurance and house mortgages falls within his competence. Finally, I would like to say to the Labour Party that this motion puzzles me, given that the Labour Party have as one of their abiding principles that all people, specifically those suffering from illness, should be treated equally and in an even-handed manner by all State agencies, including the Department of Health.

Proinsias De Rossa

But not equally badly.

Mr. D. Fitzpatrick

It is very surprising that the Labour Party should put forward a motion which seeks to treat people in a discriminatory manner given that the ethos of the party, as I understand it, dictates that people no matter what their station or circumstances are should be treated in an even-handed manner.

Mr. Howlin

The Minister did not oppose the principle. He is giving money but not enough.

Mr. D. Fitzpatrick

That is not the way the Labour Party started out. They gave an open-ended commitment. The Minister has shown himself to be a caring and concerned Minister. He has made an offer of £250,000 to the AIDS trust. These are the best people to decide how money allocated for the treatment of AIDS should be spent. We in this House can and should decide where money should be allocated but in the treatment of AIDS it would be far better to leave it to the professionals working on the ground to decide how the money should be dispensed. I would hope at this late stage that the members of the Opposition would re-examine the wording and thrust of their motion. The offer of an all-party committee was not a very bad one.

Miss Harney

The Deputy knows what happened the last one.

Mr. D. Fitzpatrick

I accept that this motion was put down in the best interests of all AIDS sufferers, not for a specific group within them. That is what we should be aiming at.

Minister of State at the Department of Health (Mr. Leyden)

I would like to say a few words about the amendment to motion No. 45 on today's Order Paper proposed by my colleague, the Minister for Health, Deputy O'Hanlon. The amendment is being proposed to highlight the critical issues which arise for the House in considering the question of dealing with haemophiliacs who have contracted AIDS or HIV on a special and distinct basis. At the outset I would like to put on the record my own personal sympathy for those haemophiliacs who have contracted the virus together with all AIDS sufferers and to reiterate once again the sympathy of the Government for all such persons. It is within this context of the very spread of AIDS and HIV among the population, however, that the issue of making arrangements specific to one particular group within the so-called AIDS population must be considered and, in particular, the implications for individual members of society and for the State, its agencies and others who were — and still are — involved in the treatment and care of haemophiliacs.

The Minister has dealt at some length with the implications inherent in singling out one group of AIDS sufferers for particular treatment on the basis of the possible source of their infection. This would go against the thrust of the Government's AIDS strategy which is designed to cater for all AIDS sufferers on a uniform and equitable basis. AIDS is an extremely sensitive condition and it is crucial, therefore, to adopt an approach which will encourage persons to participate fully in the prevention and control of the disease and will not result in discrimination and stigmatisation.

Regrettably there is evidence, as the Minister said, of unease among the population in relation to AIDS sufferers. There have been problems in the work-place, for example, and it is incumbent on the Government to lead by example and to facilitate a reasoned and unemotive climate which will be beneficial to society and its individual members.

As part of his statutory duty of care to all persons who require health services, the Minister for Health has in place a range of health services for persons suffering from AIDS or HIV. These are monitored and reviewed regularly and, to ensure that there are no difficulties in relation to accessibility to health services for the persons concerned, the Minister established a review group, under my chairmanship on the subject. The members of the group are Professor Irene Hillary, Margaret King, who represents the Irish Haemophilia Society, Dr. Jimmy Walsh, Mr. Michael Lyons, Department of Health, Mr. Hickey, the chief executive officer of the Eastern Health Board, Mr. John Hurley and Dr. John O'Connor. Our first meeting was on 9 March, and we met on 15 March, 6 April and 13 April and we are now finalising our report. We met all the groups concerned — as far as we are aware — in this issue. I will be submitting the report of this group to the Minister very shortly and it will present a concise overview of the health services as they relate to AIDS patients which, apart from a number of matters, is quite satisfactory. I approached my task with an open mind and we are looking at the situation, not just from a health point of view, but at the impact of the disease in relation to social welfare, environment as far as housing is concerned and other matters. Indeed, it would have been appropriate if the Opposition parties had given us an opportunity of presenting this report to the Minister and the Government for consideration. The motion is politically motivated.

There is always room for improvement and the particular needs of AIDS sufferers are also being met by the Minister through special funding from the national lottery, the details of which were set out earlier by the Minister. In this context, the Minister has responded to the requests made by St. James's Hospital and by the Irish Haemophilia Society during their submissions to the review group by approving the recruitment of a dietician and a nurse for the haemophilia unit at St. James's Hospital in advance of the receipt of the report of the review group. Those issues were highlighted in the submission from St. James's Hospital and have been brought to the immediate attention of the Minister who has rightly approved the additional funding for staff.

The Minister, Deputy O'Hanlon, has offered £250,000 to the AIDS fund to supplement those raised from industry, banking and insurance companies and which are used to relieve stress and suffering in persons who have contracted AIDS. The fund will consider the offer at a board meeting soon. I want to deny the statement made by Deputy Harney that the board have rejected the Minister's offer. They could not have done so as they have not yet met.

Mr. Howlin

The Minister only made the offer an hour ago.

Mr. Leyden

The board will meet to consider the offer. I have great confidence in the ability of the group to administer this fund and I hope that the Opposition parties will support them in relation to its distribution.

Some weeks ago the Minister made a special grant of £50,000 to the Irish Haemophilia Society to assist in providing counselling services which I am aware are of special concern to the society. In these circumstances, the Minister has clearly indicated his great and personal concern in relation to this matter. The motion before the House is divisive and at this stage it would be a responsible approach by Opposition parties to withdraw it and to approve the amendment put forward by the Minister. We should all be mature in relation to this problem instead of trying to score points in the House. This situation is deeply serious and requires the support of all Members and parties in assisting AIDS sufferers.

It is our greatest single health problem at present and will continue to be so for the foreseeable future because there is no light at the end of the tunnel as far as a cure is concerned. Research is being carried out throughout the world but there is no breakthrough in sight. In the circumstances, I sincerely feel that this debate is not constructive as far as the well being of AIDS sufferers is concerned. The Opposition parties should reconsider the situation in the light of the Minister's concern, his support for the Irish Haemophilia Society, his announcement of the allocation of £250,000 to the AIDS Fund and the report which will be coming to the Minister and the Government very shortly from the committee which I chair.

I am anxious, as chairman of the committee, to ensure that the recommendations which we will make will be carried out. Indeed, some have already been carried out in St. James's Hospital.

Mr. Yates

The Government's last report on the dental services was never put into force.

Mr. Leyden

Deputy Yates referred to discriminatory measures which denied jobs to AIDS sufferers. However, everything he said in support of a special deal for haemophiliacs suffering from AIDS is divisive. I should also like to refer to Deputy FitzGerald's remarks. He was Taoiseach when this problem arose and, as far as I am aware, he did not indicate any great public concern at that stage. The Minister at the time, Deputy Desmond, did not set up a fund. However, that is history. We are now in Government and it is our responsibility to support AIDS sufferers and to have particular concern for those who are also haemophiliacs.

I appeal to all parties to support us in this field and I assure the House that we will continue our work after the vote, irrespective of the outcome. We have work to do for AIDS sufferers and it will be carried out. I wish to compliment the Minister for Health who has been fair and caring in his attitude. It is because of his deep concern about this problem that he is not prepared to yield to the proposals made. The usual simple remedy has been put forward, that we should throw money at it in the hope that it will be solved. We are more concerned about the longer term strategy. I can assure the House that the Minister is deeply concerned about this problem. I reject the innuendo that he is not concerned. As a medical practitioner he is aware of the problems involved. The Labour Party are using this motion for political reasons.

Mr. Howlin

That is insulting.

Mr. Spring

That is absolute nonsense and typical arrogance by the Minister of State.

Mr. Leyden

It is wrong that the Labour Party should use an issue like this for their selfish purposes.

Mr. Spring

That is nonsense and the Minister of State knows it.

Mr. Leyden

I appeal for support for our amendment.

Mr. Roche

The truest words spoken tonight were those uttered by Deputy Yates who said that the die was cast and that this was simply a numbers game. That is a distressing fact. This issue should never have come to a vote in the House. Rather than scoring points and arguing as to each other's bona fides in this matter, we should address the serious issue involved. There is no question that any one side of the House possesses an absolute monopoly of wisdom. Wisdom is what is needed in regard to this issue. I should like to quote from an article on this issue that has touched me greatly. The article was published in the Irish Medical News dated 30 January last and was written by David Nowlan. The heading of the article was “Haemophilia and AIDS”. I should like to draw the attention of Members to the final paragraph which states:

It requires a greater omniscience than the average human community can provide to make distinctions of any kind between allegedly innocent and allegedly guilty victims of the kind of society we live in. It is neither humanly nor humanely possible to draw distinctions between those victims who call for succour. Does someone grappling with heroin addiction need less help than someone coping with haemophilia? Is not the burden of AIDS devastating to both of them? They all need everybody's help.

No truer words than those have been spoken or written, They all need everybody's help.

I agree also with the comments made by Deputy Barry Desmond, as reported in The Sunday Tribune of 13 February last. In the course of an article, written by Gerald Barry, Deputy Desmond suggested that the issue was basically a public health one and the solution lay in specialised services for haemophilia sufferers from AIDS. He said they should be brought within the categories covered by the long-term illness scheme. According to the article the former Minister went on to say that the principle of trust funds for specific categories of sufferers could turn into a “nightmare”.

Mr. Spring

The Deputy is always lecturing the House.

Mr. Roche

That is not meant to be a lecture. I am stating facts, as reported in The Sunday Tribune. That remark has not been withdrawn by Deputy Desmond. I do not wish to suggest that the mover of the motion is intentionally engaging in an excercise which is cynical. I do not believe that is the case and if I did believe it I would say so. However, the approach being adopted is wrong. While the mover of the motion may not accept that, others on the benches opposite — I specifically cite Deputy Desmond in regard to this — whose knowledge is based on experience know that the proposals before us are wrong. They are not intended to do any harm but the reality of them is that they draw a distinction between “innocent” and “guilty” victims of this pandemic.

Dr. Nowlan, in the course of the article I quoted, referred to the horrific human tragedy. He referred to families with infected members being shunned in their neighbourhoods. He said that people have been dismissed from work or not offered jobs at all when either their anti-body status or the fact that they are haemophiliacs have become known. He stated that affected patients have been stigmatised in hospitals and some have had to deny their haemophilia publicly and forced to lead a kind of double life to avoid being singled out. Doctor Nowlan painted a very chilling picture. He would seem to argue the case in favour of the Labour Party motion but he went on to make the point that the type of action proposed here would inevitably make distinctions between people who contact AIDS in one way and people who contract it in another way.

The precise problem, and the probable unintentional aim of the motion, is that the motion draws distinctions between the origin of the malady. The motion is wrong not because the movers want to do something which is not laudable but because it is going the wrong way about achieving their aims. The Minister for Health said last night that much was being said and much was being written about the moral responsibilities of the Minister and the moral responsibilities of the State. He said that this issue of moral responsibility was a complex and relatively simple thing. The role of the Minister, and the State, is to provide the best possible health services for all sufferers regardless of their ailments or how those ailments were acquired. That is the indisputable fact. The Minister said that the State cannot, and the Minister must not, be placed in a position where he, and the State, become more accountable for one sufferer as against another sufferer. David Nowlan asks in the article I quoted what of the innocence or guilt of the child of an infected mother; what of the innocence or guilt of the wife of an errant husband.

The issues raised here cannot be resolved by parliamentary debate and that is what is wrong with what is going on here tonight. Rather than dividing and scoring ill points against each other we should be combining to seek a solution to this horrific problem. It will not be resolved tonight and it certainly will not be resolved by the kind of arguments we hear across the floor from people like Deputy Harney.

Mr. Howlin

With the permission of the Chair I should like to share the first five minutes of my time with Deputy De Rossa.

Acting Chairman

Is that agreed? Agreed.

Proinsias De Rossa

I should like to thank Deputy Howlin for giving me an opportunity to say a few words on this issue. I welcome the conversion of the Fianna Fáil Party, and the Fianna Fáil Government, to the concept of no fault, to the concept of the absence of guilt in various situations. I can recall the arguments put forward by the Fianna Fáil Party against the concept of no fault divorce where it was felt that that would be a fundamental move away from the question of justice. I argue strongly that the motion is not a question of who is to blame in terms of the sufferers, but who is to blame for the injections which the haemophilia sufferers got. There is a clear analogy between the position of the haemophiliacs and those children who suffered side effects as a result of receiving three-in-one injections. Those children suffered very serious physical and mental handicaps as a result. In their case the State acknowledged and accepted its responsibility and provided a special fund for the victims. That is what we are about here.

This is not a question of whether AIDS sufferers, or particular categories of sufferers, are guilty or innocent in terms of the disease they have but who was responsible in the first place for them being in that position. In the case of haemophiliacs the State is indirectly, though perhaps innocently, responsible. It is on that basis that we are arguing in favour of the motion which represents a compromise. The four parties on the Opposition benches have compromised on a variety of points in order to achieve an acceptable motion. Indeed, the fact that the Minister sought to compromise yet again on that motion is indirectly an acknowledgement of the case being made by the Opposition. The fact that he was not able to reach an agreement with the Opposition is another matter, but even the terms of his amendment acknowledge the case which the Opposition are making in relation to haemophilia sufferers.

The fact that it is extremely difficult to reach a wise decision on this has been referred to by a number of Fianna Fáil Members. We have been told that a former Minister for Health found it difficult to come to a conclusion on this. That is no fault of that person but it is an indication that a difficult decision has to be made. The majority in the House, represented by the Opposition parties, have come to the conclusion that this is the best way forward in these circumstances. If the Minister had come into the House tonight with a package which would deal comprehensively and effectively with the problems of all AIDS sufferers there would be no question of this motion being pressed to a vote, but the Minister has not done that. All he has done is come in here and promise that a report will be available to the Government next week and, presumably, a decision will be made at some stage. Indeed, if this motion has no other effect than to force an early decision in relation to that report, we will have done a job fairly well.

I would argue that the Government have up to now failed completely to acknowledge the reality of the major problem which faces this society, as indeed it faces virtually the whole of the world in terms of how AIDS is developing. They have failed to acknowledge the reality of this problem because until now they have failed to put in place any attempt whatsoever to deal with the problems of AIDS sufferers. To come in here and argue, having failed to reach a compromise with the Opposition, that we are trying to allocate blame or guilt to one sector or another is utter nonsense. To quote statements from various doctors on the basis that there is a very human problem is all well and fine but the reality is that if the Minister's amendment is carried tonight the vast bulk of AIDS sufferers will still not be dealt with by this Government. The Government's amendment refers to discrimination in this motion. The reality is that our health services are full of discrimination between public and private health provisions and the Government are failing completely to deal with this problem.

Mr. Howlin

This is not a political debate. We are not divided on party political grounds on this issue in this House and it is sad that we face a vote in ten minutes time. There has been ample time, ample discussion and ample goodwill on all sides of the House and it is sad that all that goodwill and positive feeling could not result in the achievement of a consensus across all the parties in this House in regard to this important matter.

What divides us now? Why are we going to have a division? Why are Deputies going to troop through separate lobbies in ten minutes time? The Minister is prepared to make £250,000 available to haemophiliacs and a further £50,000 for counselling. The Minister said tonight that the fund could apply again next year for further funding from the national lottery or his Department. So what divides us? It is a unwillingness by the Minister to give either long-term commitment or alternatively an adequate initial grant to enable this group of people to face a horrific tragedy with some semblance of personal dignity. Why has the Minister chosen to call a division on this issue when agreement was at hand and within this grasp?

The amendment the Minister has put forward has been rejected by all the Opposition parties in this House and by each of the Independents. Are we all out of step and out of touch? One of the Fianna Fáil backbenchers said that no one party in this House is the repository of all wisdom. On that basis the motion put on the Order Paper in the names of the Labour Party Deputies was agreed with the other Opposition parties. It is the consensus view of the majority in this House and it was agreed by the Irish Haemophilia Society who represent those who are the focus of our concern here tonight.

The Minister in his speech quoted various people and he brought in an odious concept of innocence and guilt. Nobody from the Opposition benches mentioned innocence or guilt. There are no innocent or guilty victims as such — all who suffer from this horrendous disease are innocent. The Minister said it is important that sufferers are not made to feel as if they were outcasts in our society. That phrase would stand up to better scrutiny if the situation in St. James's Hospital, as outlined by another Deputy last night, was not as it is. The Minister tonight announced a grant for an extra dietician and nurse for the haemophilia unit of the hospital. The Minister is aware that in the unit which treats AIDS victims there is one consultant, one junior hospital doctor, one nurse, one counsellor and one social worker paid by the State. There are other ancillary staff who are funded by private sources. Our treatment of all AIDS sufferers is inadequate.

The Minister stated that there is an intention to serve legal proceedings against the State by the Irish Haemophilia Society. It is important to state that no such intention exists. Individuals have indicated their intention to take legal proceedings, but not the society. The Minister has stated that in the United Kingdom £10 million sterling, roughly IR£12 million, was made available by way of a fund but that only £700,000 has been drawn to date. There is a reason for this, and the Minister knows it. The reason is that it took a long time to identify those in the United Kingdom who are haemophiliac and who have contracted the HIV virus. No such difficulty will exist in this country — they are already identified — and the society are willing to give them relief, sustenance and help immediately the Minister provides the resources to do just that.

In response to my quoting the international precedents the Minister said he is keeping in close touch with EC member states. Why must we always be the last? Why must we be dragged screaming to do what is morally right instead of leading the van? An offer was made by the Minister last night to fund £250,000 through the AIDS fund and the Minister for State tonight said that they were considering this. The offer was freshly made this evening to them and obviously the board have not had time to consider this offer but I understand that the people who met the secretary of the Department are disconcerted, to put it mildly, to be put in this position because the offer made in good faith yesterday was to be, to use their phrase, a conduit whereby funds could be transferred to haemophiliacs. They are disconcerted to find themselves put in an invidious situation whereby they are expected to arbitrate between the conflicting demands of various AIDS sufferers. The reasonable compromise the Minister wants us to accept tonight is £250,000, assuming it does go to the haemophiliacs who are infected in this way. On a once-off basis £250,000, or roughly £2,500 for each individual will be made available to the sufferers, which I suggest is enough to pay their funeral expenses but little else.

This debate has focused well beyond the limits of haemophiliacs who are HIV positive or who have contracted full blown AIDS, and I welcome that. This Dáil and nation have now accepted that the Government have a responsibility to haemophiliacs who have become infected with the HIV virus and have suffered doubly from the two crippling diseases of haemophilia and either AIDS or HIV infection. We have discussed at length during the past two nights the inadequacies of the measures taken to tackle the problem of AIDS which affects this country and all countries in the world. Those methods we have put in place to fight this scourge are inadequate and this debate is important in highlighting that fact. There is no national strategy, or at least none that I have found, disclosed yet. I welcome the discussion on that aspect of it and may be we can have a comprehensive answer to all those who are suffering from AIDS and that we can have a campaign that will stop the exponential growth in AIDS victims in this country. But the issue that we focus in on now at 8.30 p.m. is clear.

The former Taoiseach, Dr. Garret FitzGerald, has put the matter succinctly to the Minister, to this Government and to all the Fianna Fáil Deputies behind him. The Government of the day, not any individual Minister, not any individual bureaucrat in any Department have an inescapable responsibility to haemophiliacs who were infected by human immuno deficiency virus through their contact with the health services. That is an inescapable fact and I appeal to the Minister and to the Government assembled here to recognise that fact now. In no political sense of victory and in no point scoring way I humbly beg the Government to reconsider, to withdraw the amendment, not to put it to a vote and allow this House to act in a moral consensus to treat people who have been so cruelly treated and so cruelly infected.

Amendment put.

The Dáil divided: Tá, 69; Níl, 72.

Tellers: Tá, Deputies V. Brady and D. Ahern; Níl, Deputies Howlin and Pattison.

• Tá
• Barnes, Monica.
• Barrett, Seán.
• Barry, Peter.
• Begley, Michael.
• Bell, Michael.
• Birmingham, George.
• Blaney, Neil Terence.
• Boylan, Andrew.
• Bruton, John.
• Bruton, Richard.
• Burke, Liam.
• Carey, Donal.
• Clohessy, Peadar.
• Colley, Anne.
• Connaughton, Paul.
• Cosgrave, Michael Joe.
• Creed, Donal.
• Crotty, Kieran.
• Crowley, Frank.
• Cullen, Martin.
• Deasy, Austin.
• Deenihan, Jimmy.
• De Rossa, Proinsias.
• Desmond, Barry.
• Donnellan, John.
• Doyle, Avril.
• Dukes, Alan.
• Durkan, Bernard.
• Enright, Thomas.
• Farrelly, John V.
• FitzGerald, Garret.
• Flaherty, Mary.
• Gibbons, Martin.
• Gregory, Tony.
• Griffin, Brendan.
• Harney, Mary.
• Hegarty, Paddy.
• Higgins, Jim.
• Higgins, Michael D.
• Howlin, Brendan.
• Hussey, Gemma.
• Kavanagh, Liam.
• Keating, Michael.
• Kelly, John.
• Kemmy, Jim.
• Kennedy, Geraldine.
• Kenny, Enda.
• Lowry, Michael.
• McCartan, Pat.
• McCoy, John S.
• McDowell, Michael.
• McGahon, Brendan.
• Mac Giolla, Tomás.
• Mitchell, Gay.
• Mitchell, Jim.
• Molloy, Robert.
• Nealon, Ted.
• Noonan, Michael.
• (Limerick East).
• O'Keeffe, Jim.
• O'Malley, Desmond J.
• O'Malley, Pat.
• O'Sullivan, Toddy.
• Pattison, Séamus.
• Quill, Máirín.
• Quinn, Ruairí.
• Shatter, Alan.
• Sherlock, Joe.
• Spring, Dick.
• Stagg, Emmet.
• Taylor, Mervyn.
• Wyse, Pearse.
• Yates, Ivan.

Níl

• Barnes, Monica.
• Barrett, Seán.
• Barry, Peter.
• Begley, Michael.
• Bell, Michael.
• Birmingham, George.
• Blaney, Neil Terence.
• Boylan, Andrew.
• Bruton, John.
• Bruton, Richard.
• Burke, Liam.
• Carey, Donal.
• Clohessy, Peadar.
• Colley, Anne.
• Connaughton, Paul.
• Cosgrave, Michael Joe.
• Creed, Donal.
• Crotty, Kieran.
• Crowley, Frank.
• Cullen, Martin.
• Deasy, Austin.
• Deenihan, Jimmy.
• De Rossa, Proinsias.
• Desmond, Barry.
• Donnellan, John.
• McDowell, Michael.
• McGahon, Brendan.
• Mac Giolla, Tomás.
• Mitchell, Gay.
• Mitchell, Jim.
• Molloy, Robert.
• Nealon, Ted.
• Noonan, Michael.
• (Limerick East).
• O'Keeffe, Jim.
• O'Malley, Desmond J.
• Doyle, Avril.
• Dukes, Alan.
• Durkan, Bernard.
• Enright, Thomas.
• Farrelly, John V.
• FitzGerald, Garret.
• Flaherty, Mary.
• Gibbons, Martin.
• Gregory, Tony.
• Griffin, Brendan.
• Harney, Mary.
• Hegarty, Paddy.
• Higgins, Jim.
• Higgins, Michael D.
• Howlin, Brendan.
• Hussey, Gemma.
• Kavanagh, Liam.
• Keating, Michael.
• Kelly, John.
• Kemmy, Jim.
• Kennedy, Geraldine.
• Kenny, Enda.
• Lowry, Michael.
• McCartan, Pat.
• McCoy, John S.
• O'Malley, Pat.
• O'Sullivan, Toddy.
• Pattison, Séamus.
• Quill, Máirín.
• Quinn, Ruairí.
• Shatter, Alan.
• Sherlock, Joe.
• Spring, Dick.
• Stagg, Emmet.
• Taylor, Mervyn.
• Wyse, Pearse.
• Yates, Ivan.

Tellers: Tá, Deputies Howlin and Pattison; Níl, Deputies V. Brady and D. Ahern.

Amendment declared lost.

Tá

Abbott, Henry.Ahern, Bertie.Ahern, Dermot.Ahern, Michael.Andrews, David.Aylward, Liam.Barrett, Michael.Brady, Gerard.Brady, Vincent.Brennan, Matthew.Brennan, Séamus.Browne, John.Byrne, Hugh.Calleary, Seán.Collins, Gerard.Conaghan, Hugh.Connolly, Ger.Coughlan, Mary T.Cowen, Brian.Daly, Brendan.Davern, Noel.Dempsey, Noel.Dennehy, John.Ellis, John.Fahey, Frank.Fitzgerald, Liam.Fitzpatrick, Dermott.Flood, Chris.Flynn, Pádraig.Foley, Denis.Gallagher, Denis.Gallagher, Pat the Cope.Geoghegan-Quinn, Máire.Haughey, Charles J.Hilliard, Colm Michael.

Hyland, Liam.Jacob, Joe.Kirk, Séamus.Kitt, Michael P.Kitt, Tom.Lawlor, Liam.Lenihan, Brian.Leonard, Jimmy.Leyden, Terry.Lyons, Denis.McCarthy, Seán.Mooney, Mary.Morley, P.J.Moynihan, Donal.Nolan, M.J.Noonan, Michael J.(Limerick West).O'Dea, William Gerard.O'Donoghue, John.O'Hanlon, Rory.O'Keeffe, Batt.O'Keeffe, Ned.O'Kennedy, Michael.O'Leary, John.O'Rourke, Mary.Power, Paddy.Reynolds, Albert.Roche, Dick.Smith, Michael.Swift, Brian.Walsh, Joe.Walsh, Seán.Wilson, John P.Woods, Michael.Wright, G. V.

An Ceann Comhairle

The question now is, "That the motion in the name of Deputy Dick Spring and others be agreed".

Question put.

The Dáil divided: Tá, 72; Níl, 69.

Motion declared carried.

Níl

Abbott, Henry.Ahern, Bertie.Ahern, Dermot.Ahern, Michael. Brady, Vincent.Brennan, Matthew.Brennan, Séamus.Browne, John.Byrne, Hugh.Calleary, Seán.Collins, Gerard.Conaghan, Hugh.Connolly, Ger.Coughlan, Mary T.Cowen, Brian.Daly, Brendan.Davern, Noel.Dempsey, Noel.Dennehy, John.Ellis, John.Fahey, Frank.Fitzgerald, Liam.Fitzpatrick, Dermott.Flood, Chris.Flynn, Pádraig.Foley, Denis.Gallagher, Denis.Gallagher, Pat the Cope.Geoghegan-Quinn, Máire.Haughey, Charles J.Hilliard, Colm Michael.Hyland, Liam.Jacob, Joe.Kirk, Séamus.Kitt, Michael P.

Andrews, David.Aylward, Liam.Barrett, Michael.Brady, Gerard. Kitt, Tom.Lawlor, Liam.Lenihan, Brian.Leonard, Jimmy.Leyden, Terry.Lyons, Denis.McCarthy, Seán.Mooney, Mary.Morley, P.J.Moynihan, Donal.Nolan, M.J.Noonan, Michael J.(Limerick West).O'Dea, William Gerard.O'Donoghue, John.O'Hanlon, Rory.O'Keeffe, Batt.O'Keeffe, Ned.O'Kennedy, Michael.O'Leary, John.O'Rourke, Mary.Power, Paddy.Reynolds, Albert.Roche, Dick.Smith, Michael.Swift, Brian.Walsh, Joe.Walsh, Seán.Wilson, John P.Woods, Michael.Wright, G. V.

An Ceann Comhairle

We will now resume on the Derelict Sites Bill, 1989.

Mr. O'Kennedy

There are some derelict sites around now.

A Deputy

They will be out cleaning the mud now.

Mr. Cowen

You are an historic monument now, Garret.

Dr. G. FitzGerald

I do not need a preservation order.