Fintan O’Toole: Church control of hospitals maintains myth of charity

Maternity hospital debacle a symptom of public services as favours, not rights

In 1990, my second son was born in the Rotunda Hospital in Dublin. Of the women in the ward with my wife, one was 42 and had just had her seventh child. She was desperate to be sterilised. Another woman was younger – somewhere in her mid-30s – and obviously poor. She had just given birth to her fifth child. She, too, did not want any more children. She wanted, as she put it, “to have my tubes burnt”. The curtains were drawn around her bed but everyone in the ward could hear the conversation with the doctor to whom she put this request.

The doctor, a woman, was professional and sympathetic. But she was also emphatic: “This is not a decision for you and it is not a decision for me. It is a decision for the ethics committee of the hospital. If you wish to make a request, your file will be sent to the ethics committee. They will read your file and on the basis of the file they will decide whether or not you can have a tubal ligation. But I must warn you that even if they rule in your favour, the procedure will not be covered by your medical card. It will be separately means-tested.”

We were ashamed to be listening in on this poor woman’s humiliation, but even more ashamed of her absolute powerlessness. There was nothing about it that we did not know already, but that knowledge of how Irish society worked for women – and especially for women without money – took on a brutal reality and a stark clarity: This is not a decision for you. The “this” was her body, her future, her self, her supposed status as a citizen of a free republic. It was what women were told all the time.


This kind of humiliation wasn’t just about whether the women got their sterilisations or not. It wasn’t about whether the secretive ethics committee would be made up of nice, humane, decent people. (I’m sure it was.) It was about the creation and maintenance of a culture in which people did not have rights. They asked for favours which might be graciously granted or dismissively refused. Our clientilist political system was built on this principle – and so were our public services. We came as suppliants, not citizens.

It still seems natural even to a politician of Simon Harris's generation that basic public services should be provided as a matter of charity, not of right

I thought of this powerless woman when I heard the otherwise almost inexplicable decision to hand the new National Maternity Hospital into the ownership of the Sisters of Charity. It is the culture that made her powerless that explains why a Minister for Health, who was scarcely more than a baby himself when she was having her place in the world made so clear to her, would not see the problem with this decision. Cultures are not just about what people think – they’re also about what they don’t think. They are most powerful in their unexamined assumptions, the things that seem quite obvious and natural. And it still seems natural even to a politician of Simon Harris’s generation that basic public services should be provided as a matter of charity, not of right. The point of the ownership arrangement he agreed to was that a key piece of public infrastructure, paid for by taxpayers, would remain a charitable institution. Not for nothing do the nuns involved have Charity in their title.

Corrosive myth

Nothing corrodes civic democracy in Ireland quite so badly as the myth of charity. It has a long reach because it has deep roots. It comes in part from the history of colonisation. But its most insidious form is the belief that the Irish would have had nothing were it not for the Catholic Church. The truth is that the church fought ferociously to prevent the development of any form of public education or healthcare that it did not control. It destroyed and then took over the non-denominational national school system in the 19th century. It blocked the extension to Ireland of the sickness and maternity benefits introduced in the UK by Lloyd George's pioneering National Insurance Act of 1911. It stopped the mother-and-child healthcare scheme in 1951.

These key victories shaped and kept alive the idea that Ireland could never fully create a culture in which we as citizens and taxpayers owned our own public services. We evolved a half-baked welfare state, a chaotic and enormously inefficient mix of public, private and charitable provision. And many parts of the political and bureaucratic systems are not unhappy with this. The difference between having rights and receiving charity is accountability. Charity is unaccountable – it speaks to the goodness of the heart not the good of the citizens. And having this unaccountability at the core of so much of our system of public provision doesn’t just suit the church – it suits all those whose lives are made easier by not having to answer to the people they supposedly serve.

Ownership is not just a legal concept – it’s a state of mind. If we don’t own our own hospitals, we don’t own our own bodies. And if we don’t take ownership of our own State we will always be hearing those words: This is not a decision for you.