If Catholic-ethos hospitals conflict with medical practice, who looks out for the patients, asks Eithne Donnellan, Health Correspondent
If you were told there is a hospital in the State with a prayer book on every patient's bedside locker and you had to guess which hospital it was, what one would you say? The answer will surprise some. It's the Galway Clinic.
This is a new private hospital on the outskirts of Galway city backed by one of the founders of the very successful Blackrock Clinic in Dublin, Dr James Sheehan. Both hospitals, says Sheehan, have a Catholic-ethos and he is "not ashamed to say so".
This means procedures such as sterilisation are not carried out in either hospital. Neither are they carried out in other Catholic-ethos hospitals in the public sector, such as the Mater and St Vincent's in Dublin.
The issue of religious influence on hospitals and how it can influence what services a hospital provides resurfaced in the past week, following a decision by the Mater hospital to defer giving approval for clinical trials of Tarceva, a cancer drug. The Mater was concerned that information in a leaflet drawn up for patients participating in the trials ran counter to the hospital's Catholic ethos.
It was said initially this was because artificial contraception had to be used by women taking part, though it later emerged abstinence was also acceptable. Pregnancy had to be avoided by women on the new drug as it could damage an unborn child.
The net result of the decision by the Mater is that patients at five hospitals across the State may, if they are suitable, be able to avail of a drug which can prolong life in people with advanced lung cancer, but patients at the Mater cannot. A clearly frustrated Dr John McCaffrey, a cancer specialist at the hospital, was quoted as saying doctors needed to be able to offer patients the best treatments available. "We can't do that at the moment and it's a disaster," he said.
Maurice Neligan, a heart surgeon at the Mater hospital for many years, said he was surprised in this day and age that something like this should happen.
"This is a Catholic hospital, but at the same time the sick are the sick, and we are meant to be a non-sectarian State," he says. "I would have thought anybody going into hospital would be entitled to receive the treatment they needed, or that the hospital would arrange for them to go somewhere else."
Mary O'Rourke, the former TD who is now leader of the Seanad, said she just didn't understand it in a hospital that was getting "big State money".
Dr John Crown, a cancer specialist who works at St Vincent's Hospital, which also has a Catholic ethos, says he believes there is "a fundamental tension and contradiction" in the owners of a hospital entirely funded by public money trying to impose their ethos on patients of all faiths and none.
The question of whether or not it was permissible for a publicly funded hospital to decline to perform a particular procedure for what amounted to religious reasons was posed by the Constitution Review Group when it reported back in 1996. Answering its own question, it said hospitals with a religious ethos "should not be debarred from public funding provided they do not discriminate on grounds of religious practice or belief, save where this can be shown, in any given case, to be necessary in order to maintain their own religious ethos".
Fr Kevin Doran, secretary of the Catholic Bishops Bioethics Commission, asserts that under European anti-discrimination legislation the entitlement of religious and similar bodies to protect their ethos is confirmed. He says pharmaceutical companies behind clinical trials are in some instances being "over prescriptive in their requirements", requiring women to use contraception which was contrary to Catholic teaching, and "infringing on women's freedom".
Fr Doran, who is also on the board of the Mater, is in the process of drawing up a leaflet which could be given to patients participating in trials where birth control is a requirement, with a form of wording which reflects the hospital's ethos.
A spokesman for St Vincent's Hospital says "it is not saying you have to abide by the teachings of the Catholic Church. It is just asking people to respect its ethos". Therefore, he says, a person turning up at the hospital seeking elective sterilisation, when they know the hospital's ethos, was analogous to a person going into a Jewish shop and expecting to get pork.
Dr Sheehan believes public hospitals such as the Mater "is absolutely entitled" to maintain its Catholic ethos. He points out that the Mercy nuns have been working there for years, they provided the hospital, and only in more recent years started getting significant State funding.
When asked about the issue, the Minister for Health Mary Harney didn't answer the question directly. She said she wouldn't want to interfere with the ethos of any institution.
Consultants working in Catholic-ethos hospitals it seems can't really interfere either. In their contracts they have to agree to abide by the hospital ethos.
The Mater says it fulfils all its obligations in accordance with its contractual arrangements set out with the Health Service Executive (HSE). This entails provision of a very wide range of specialist and general medical and surgical services. But research activity, including clinical trials, is not HSE funded.
It rejects the suggestion it is acting in a "sectarian" manner. The Mater, it insists, cares for everyone irrespective of their faith, beliefs or culture, but says it "reserves the right to alert its patients to procedures that are contrary to the hospital's ethos while also respecting the patients' rights to make informed choices with regard to their medical care".
The Catholic Church has long had an influence on what went on in Irish hospitals, even if less so now than in the past. There are anecdotal stories of doctors being rapped over the knuckles in recent times in one Catholic-ethos hospital for prescribing the pill to young women with acne. And it's said that in days gone by, hospitals with a Catholic ethos carried out symphysiotomies, in which doctors permanently widened the pelvis of some women giving birth. The procedure has left those who went through it in pain and incontinent for life.
The former obstetrician Dr Michael Neary even claimed during hearings into his fitness to practise case, before he was struck off for unnecessarily removing patients' wombs, that the non-availability of sterilisations at Our Lady of Lourdes Hospital in Drogheda, which was run by the Medical Missionaries of Mary, contributed to the high incidence of Caesarean hysterectomies at the hospital.
Kildare GP Dr Andrew Rynne also recalls regular visits from priests trying to dissuade him from carrying out sterilisations in the mid-1980s at Clane hospital. He even incurred the wrath of the former Bishop of Galway Eamonn Casey when he refused to desist. He says now that public money should not be put into hospitals that do not provide services on religious grounds.
The Irish Patients Association isn't prepared to comment on the question of funding Catholic hospitals. "We respect their right to reflect their own ethos," says its chairman Stephen McMahon. But he says it should be a patient's right to access innovation. "We are concerned that patients should make the final decision to participate or not participate in clinical trials if they meet the clinical criteria to participate."
Dr Simon Mills, who is both a doctor and a barrister, says it is possible a patient might try to sue a hospital for not providing a service as a result of its ethos, but felt this would only happen in extreme cases. It might occur if the hospital were the only one capable of providing a particular service which a patient needed but declined to do so on ethos grounds, he suggests.
In the case of the Mater trial that was deferred, a patient would have to be able to prove they would have received the drug in the first place and that it would have benefited them.
He addedthat the Mater wasn't discriminating against people. "It's saying this is the way we do things for everyone, whether patients are Catholic or Protestant."
The issue of the trials at the Mater will be revisited by the hospital board on October 18th. It's likely the go-ahead will eventually be given for the trial of Tarceva, which in any event is due on the market early next year, having been granted a marketing authorisation by the European Medicines Evaluation Agency on September 19th. This means it is now licensed by the Irish Medicines Board, but Roche, the company marketing the drug, says there is usually a few months between approval and getting the drug to the market.