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Seanad Éireann díospóireacht -
Thursday, 24 Jul 1924

Vol. 3 No. 16

PUBLIC BUSINESS. - MEDICAL BILL, 1924—SECOND STAGE.

This Bill, though apparently a simple, unimportant and harmless measure, introduces a principle which should be very carefully considered by the Seanad. I understand the object of this Bill is one with which every member of the Seanad, and probably every member of the Dáil, agrees. It is to enable universities and medical schools here to continue to train men successfully who will be sent across or who will be able to find positions on the other side as doctors. I am told by a leading doctor that a very large number of our students go across to the other side, and I am quite certain it is not the desire of the Seanad, certainly it is not my desire, to do anything which will make it difficult for such students to find places. At the same time, I think this Bill as it at present stands, is one which should not be passed. In the first place, I am satisfied that it does not do what it is intended to do. In the next place, even if it did, I think the principle underlying or involved in the Bill is one which it is extremely doubtful, constitutionally, we should be able to pass. In the Bill we give powers over persons and over matters connected with the profession to a committee or body which is appointed in England, which is directly and absolutely subject to the British Parliament, and which would have to obey any law which might be passed at Westminster in spite of the fact that our Constitution provides that the Oireachtas is the only body which can pass laws for the good government of the people of Saorstát Eireann. That being the case, it seems to me extremely doubtful whether it is right to give a body which is directly subject to another Parliament, powers which you would not give to that Parliament itself. This Bill gives to the General Council, which, I understand, is called the General Medical Council of the United Kingdom, certain powers over medical practitioners and their customs and practices, and it gives certain lesser powers to a body called the Irish Branch Council. Now, it seems to me that the difficulty in this matter would be met if the Bill were so amended— and I intend to raise the matter on the Committee Stage, but I am raising the general principle now—as to give the actual power to the Irish Branch Council.

If they, in their wisdom, decide to obey an order of the General Council because it is convenient, and in the interests of the medical profession here, I am perfectly certain we will all be pleased, and will have no objection to it whatsoever. I think a way out of it may be found. But I would like to point out that if you give all the power that this Bill proposes to the General Council, I am not satisfied that you are giving the guarantee to future members of the medical profession which we want to give, because you leave them absolutely at the mercy of the General Council, and if at any time they choose to make different regulations for our schools from those of the English schools there is nothing in this Bill to prevent them, and there will be no check other than new legislation. I suggest that if such a step as that were taken it would be almost impossible to get the reciprocal, friendly arrangement that I believe could be got now. I have consulted some of my friends in the medical profession, some of the most eminent, and one prominent doctor told me that he was very doubtful, indeed, as to whether this Bill would be really satisfactory. He stated that what was wanted was something that would carry over the temporary period until a reciprocal arrangement between the two Medical Councils could be made, which I am perfectly certain can and will be made after some time elapses, if it is made clear that the Oireachtas is not prepared to hand over complete power to a body which has no control over persons in Saorstát Eireann.

AN CATHAOIRLEACH

Are there not two matters? First of all, is it not urgent that something should be done, because in the meantime an impediment may be placed in the way of the existing students?

I think that is quite so, but it is my desire to keep strictly within the Standing Orders. I have not gone into what I propose to move on the Committee Stage, which I believe will give something better. As it stands, I think the Bill is objectionable.

AN CATHAOIRLEACH

The duration of the Bill is limited to one year.

I quite appreciate that. I have been informed that under this Bill doctors who would infringe some of the regulations will have to go to Westminster to answer their case. However, the main point I had was that I feel it would be a mistake to allow the Bill to go through the Second Stage without some protest, and on the Committee Stage I propose to move an amendment which will raise the whole principle of the way in which it could be done.

I was about to point out when you intervened, sir, that this Bill was of a temporary character. The Minister, I think, emphasised that point in introducing it, but at a later stage, in response to a statement by a Deputy, he expressed the hope that even after the expiration of one year no change might be necessary, and that it would be merely necessary to carry on the provisions of this Bill by another short Bill. Nobody wants to interfere with the freedom of the medical profession in deciding what Council or Society they will belong to, but I think it is desirable that statutory power should be given to the Irish Branch of this Medical Council to discharge all the functions that the General Council has hitherto discharged. I believe that it will be within the powers of the General Council to make such arrangements as will comply with such statutory powers. We had on the Railways Bill a suggestion that certain Boards would be recognised, and one of the objections made by the Minister was that they were people living outside the Saorstát and catering for areas outside it. He expressed the opinion that to give them recognition would be raising a big constitutional question which, under the circumstances, it would not be desirable to raise. The very same circumstances apply here. The General Council, to which the Irish medical profession is attached, has members all over Great Britain and Ireland, and, nevertheless, it is to be given statutory recognition by this Bill, so that there seems to be some lack of consistency in the arguments that have been adduced on the debate during the Railways Bill, and in connection with this. Probably the Minister may have some very good line of difference to draw, but I fail to see what it is, and I should like to know where the difference is now, as compared with the position that arose in connection with the Railways Bill.

I desire to support Senator Douglas's point of view in this matter. Personally, I am very much afraid of these temporary Bills. They have a way of becoming more permanent than we like, and as we are discussing the Second Reading of this, perhaps there is no harm in saying something about the general principle. What is really wanted is a reciprocal arrangement, as has been pointed out. This exists already between South Africa, Canada, and Great Britain, and also between certain Continental countries and Great Britain, and is provided for in the Medical Act of 1886. Under such an arrangement the British Medical Council can register any person belonging to those countries and desiring to practise in England without his passing any examination, and on the payment of a nominal fee. While I recognise that something has to be done of a temporary nature, I am afraid that this Bill may become permanent, and, therefore, I shall support Senator Douglas.

Is not the chief object of the Bill to get something done to bridge over this difficulty which affects medical schools here more than medical practitioners? The medical schools in Dublin are supposed to be the best in the world, because they attract to themselves the greatest doctors, and they have a great reputation. But if the students who work in them cannot practise in any other country but Ireland, it will stop the flow of students coming in, and the schools would then disappear.

I think it ought to be clearly understood that doctors are not at all agreed on this matter. If one is to judge from some of the propaganda that is going about it would be supposed that the medical profession were unanimously in favour of the Bill. That is altogether untrue. A certain number of them have been writing letters to the Press pointing this out. One very eminent doctor, who was a member of the Dáil, but who retired from it, had a letter of a column and a half in the Irish Statesman strongly opposing it, and, as Senator Douglas has stated, a number of other doctors, whose names are very well known and who are most influential in the profession, are also against the Bill, and think that in its present form it ought not to go through. We are all agreed that some arrangement must be made as to the government of the medical profession and as to the future of the persons who want to go abroad and practise in England or anywhere else, but this Bill in its present shape does not meet this problem, and I, for one, shall vote against it.

Senator Douglas has urged certain objections to this Bill, and he prefaced these with a very brief outline of the urgency of the matter. The urgency is as he stated, but it is something more than that. He stated quite vaguely that a number of our students go abroad. Of those who obtain their medical qualifications in this country 65 per cent. do not practise in this country. That is the normal thing. Sixty-five per cent. practise outside the Twenty-Six Counties. The fact that has emerged recently as regards medical practitioners is, that it was thought on this side that a certain article of the Constitution, plus the Adaptation of Enactments Act passed in the earlier period of the Dáil, did carry over the General Medical Council with its powers and with the privileges which it gave to Irish practitioners. It then became clear that, on the other side, certain action had been taken which really knocked out of gear and disturbed the whole Constitution and the whole power of the General Medical Council. The position which then faced the medical profession in this country was that students who had thought they were registered since 1922, were, in reality, not registered, and something had to be done immediately to validate the registration of those qualified and supposed to be registered since the date of the passing of the Treaty. It was obviously unfair that students should be deprived of their professional privileges simply because something unknown to the people here had happened on the other side, which had defeated the whole Constitution and the whole purpose of the General Medical Council which was a United Kingdom body, and which, remember, we purported to carry on in this country under the Adaptation of Enactments Act. It is said that in this Bill we are doing something new. We are not. We are simply doing by positive act, by a special piece of legislation what, it was thought, had already been done by the cumulative effect of the Constitution and the Adaptation of Enactments Act. The position, therefore, is that certain students qualified and believed to be registered since 1922 find themselves not legally registered under the General Medical Council and with no registering authority in this country to give them any power. We are faced with a further addition of students qualified this Spring and about to qualify in the Autumn, and there is anarchy in this country with regard to the registration of medical practitioners. There is no time to set up a separate council. There is no use in doing what Senator Douglas suggested—taking advantage of the Branch Medical Council, because whatever objections apply to the General Medical Council apply equally to the Branch Medical Council. There are nominees of the Privy Council on one as well as on the other. The constitution is under the Medical Acts which we purport to carry over here, and any objection urged against the General Medical Council can be urged against the Branch Irish Medical Council. Are we going to take some steps to register or validate retrospectively the qualifications of those who passed examinations since 1922, and to continue it for a year until a decent solution can be found for this problem? That is all that is required in this Bill.

Senator Douglas urges that the General Council is directly and immediately subject to the British Parliament. That I question. The General Medical Council is not a Government Department. It is a sort of public authority. It has been given certain rights under English legislation. These rights have disappeared. We are now continuing as far as we can and as far as our legislation operates, these powers in the Free State by our legislation, and the British propose this week to introduce some sort of corresponding Bill reconstituting the General Medical Council as far as they are concerned. The General Medical Council is one of those composite bodies which will have powers over the Free State, Great Britain and Northern Ireland. We, on our side, say we will admit this composite body to be given certain privileges here, and to have certain rights here, and they say they will do the same with regard to Great Britain and Northern Ireland. We say, on the other hand, the bargain is that we get representation on that General Medical Council, and that they get representation on that General Medical Council. It is to be noted—the figures I can give later on—that whereas, according to the basis of medicals qualified over a large number of years, we would be entitled to about six per cent. representation on that General Medical Council, we have, in fact, somewhere in the neighbourhood of thirty per cent. representation. That body which the British set up, is to be the only body to have the power to pass judgment upon the medical qualifications not merely of Saorstát doctors, but of doctors of Great Britain and Northern Ireland, and on all those Colonial doctors who come in under the provisions of the 1886 Act. We now, who are an independent country, are given, as far as British legislation can do it, power to sit on a body which will be the compulsory body to register British doctors. That is the quid pro quo in this instance. They give us that right as regards their doctors, and we give them the rights over our doctors that they have over their own. It is not right to say that this body is directly and completely subject to the British Parliament.

As far as these two Bills—the British Bill to be introduced soon, and the Bill we are now passing—are concerned, that body will be completely and directly responsible under both measures. If we want to wipe out the powers of that body, we can do it by withdrawing this Bill. It is further to be remembered, and I hold that it is the best argument—that this is to be an emergency measure, and that we are merely doing by a positive Act, by a specially directed piece of legislation, what we had purported to do by the cumulative effect of the Constitution and the existing legislation taken over under the Adaptation of Enactments Act. It is further stated that the powers of the General Medical Council might be altered in some way unknown to us, and that we might find ourselves left without possibly any representation on the General Medical Council, and that the Irish end or the Saorstát end of the General Medical Council might be weakened considerably, and that we would have passed a Bill, the full advantage of which might be taken away in some way later. I am not disposed to argue here whether or not that could be done. I do not believe it could be done. When corresponding legislation on both sides is passed by agreement, we have to rely on the honour and honesty of the Medical Council that no changes will be made; that when they undertake to continue the General Medical Council's rights and duties for the period of a year, they will certainly not go out of their way to take anything from those powers without our consent. Senator Douglas said: "Why can we not get some measure which will carry over for a limited period until final legislation is arrived at?" He said later that it was a pity a little more time was not given. The Dáil, when I introduced this Bill, hoped to adjourn to-morrow.

I did not refer to time for the Bill, but to time for the doctors.

Under this Bill the doctors are given a year in which to work out a final solution. The whole essence of this Bill is the urgency of it. We in the Dáil had expected to rise to-morrow. The Seanad will, I presume, rise very soon. The British Parliament proposes, I believe, to rise somewhere in the beginning of August. If this legislation is not carried through, all our doctors since 1922 are without proper registration, and we have no registering authority in this country. We cannot set up one in the time. This is really carry-over legislation for a period of twelve months until the doctors have time to hammer out a final solution.

The point has been raised here, and it does definitely show up the weakness of the situation. The position is weak to a certain extent. Senator Douglas said disciplinary cases may arise and Irish doctors may have to go to Westminster, and their cases will be adjudicated there. That is quite true. That is the thing which we are giving in to in this Bill, just as we are giving in to having a nominee of the Privy Council on this body. If it is said that that is derogatory to our status, I admit it— certainly, for the time being. But this is limited to a period of twelve months, and something must be done in that twelve months' period.

The last clause, I think, answers the only objection Senator MacLysaght has to the Bill—that temporary Bills had a tendency to become permanent. This measure cannot become permanent without definite action by the Oireachtas. The Bill will expire in twelve months. The Bill says that on its passing it "shall continue in force for twelve months thereafter and then expire." The case for urgency cannot be made twelve months hence. If it is urged then, most of the force will have gone from it. The doctors will have had twelve months to consider the situation and to put their house in order.

Senator O'Farrell asked me where is the consistency in my attitude in objecting to the setting up of a body under the Railways Bill to have representation of an area outside our jurisdiction and setting up a body such as this. My attitude is not completely consistent, but if I were bringing in a final Bill to set up a General Medical Council and giving it power over Saorstát doctors, then I would admit the charge the Senator has levelled against me. But we are doing this for twelve months only, as an emergency measure. If in the end we do get full reciprocity from the British, and they say on condition that a composite and joint body be set up, you will be given these powers, and we will have these other powers given under this Bill, that is, by agreement. Under the Railways Bill it was a case of doing something by way of a bait to the others to come along. My answer to the Senator is that this measure is for twelve months to meet a sudden emergency, and I have no other answer than that at the moment.

Colonel Moore referred to the fact that the medical profession are not unanimously in favour of this Bill. The medical profession are almost unanimous in holding that something must be done in the next seven days to get medical people registered and to set up some registering authority. If any other registering authority can be set up—if Senator Moore or Senator Douglas can show me how any other authority can be set up in the next seven days and assent got to it before the British Parliament dissolves—all I can say is that I will see what can be done in the matter. I do believe this is the only course. It is not sure that assent will be given to certain clauses of this measure. It has been pointed out to us that we are purporting to legislate in this Bill for England, and certain clauses are objected to. Then I am told, here, that what we are doing is not legislating for the Free State so much as legislating to give Great Britain power in the Free State. That is a sort of Kilkenny-cat argument. I will let one argument swallow the other.

I would like to point out that two wrongs do not make a right, even in the case of Kilkenny cats. I have to thank the Minister for his very full and frank statement on the question, and I think it is probably better to postpone further consideration of the points until the Committee Stage comes up. The issue really hangs on the question as to whether the Irish Branch Council, being given the power, would not meet practically all the desires of the medical profession and meet all the points raised by the Minister without, at the same time, having a somewhat unsatisfactory principle introduced. I further believe that one of the dangers of this Bill is that despite differences of opinion amongst the Medical Council, at the end of the year we shall find that nothing has happened.

I do not want to be regarded as such an extreme Nationalist that I am opposed to co-operative arrangements between different countries. Exactly the opposite is my view, but I do believe that where you have arrangements of this kind the respective Parliaments should give power to their own Branch Committees, allowing them to consult and co-operate, so far as the central body is concerned. My case briefly is that it is our own Committee and the members of it who are subject to this Parliament and subject to its laws, and no matter how they are nominated, that is the body to which I think the powers ought to be definitely given. The Minister believes that there is no difference between the two bodies, and that any argument against the General Council is an argument against the Branch Council. My answer to that is, that if an Act dealing with any question of the medical profession were passed through the Parliament of Westminster, it would be binding on the General Medical Council, as far as the vast majority of its members are concerned, whereas an Act passed here would not be binding on the vast majority of them.

I think what most of us have been turning over in our minds is the question of which way we are going to give our votes as regards the Second Reading of this Bill. I do think the Minister has made it perfectly clear that we will do a great deal more damage, without knowing what we are about, by refusing to give a Second Reading to the Bill, than if we passed it now and discussed these matters more in detail when we come to the Committee Stage. I have not heard a single word said that would induce me to give a vote against the Second Reading of the Bill. Without having much knowledge of the subject, I think Senator Lady Dysart was perfectly right when she said that we would probably do much injury to a great many students who have got to a certain stage in their examinations if we refuse to give a Second Reading to the Bill. If they are held up for another year, the Seanad may be injuring some of the most intelligent young men in the country, without gaining anything whatever for the medical profession. I do not see why we should not pass the Second Reading.

Question—"That the Bill be read a Second Time"—put and declared carried.
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