Sir, – I would like to reply to the letter (May 27th) from Drs Benson and Crowley as to how medical ethical questions would be decided were the National Maternity Hospital (NMH) to be governed by the board of St Vincent's Hospital (SVH).
One point concerned the tragic case of a patient who had been in a permanent vegetative state for 23 years. In 1995 the High Court and the Supreme Court gave permission for life support to be withdrawn. I specifically did not name the hospital, because I did not and do not know it. I am sorry if Drs Benson and Crowley assumed, wrongly, that it was St Vincent’s. My original reason for mentioning the case was to show that a medical institution was not willing to allow a patient in its care to die, even though permission had been granted by the courts. That point stands.
The case was held in camera. It emerged in a lengthy article written anonymously by the patient's mother in The Irish Times in 1996 that the patient was being cared for by an institution run by an order of nuns in Dublin. The institution was not willing to carry out the decision of the court, so the family had to make alternative arrangements. The mother told of the wonderful care provided by the nurses who had looked after her daughter for such a long time but many of her experiences of medical institutions and the medical profession were shocking. Reportedly, the Irish Medical Council decided not to amend their ethical guidelines and doctors and institutions withdrew offers to help the family; the patient had to be moved discreetly to the family home (not Tallaght Hospital as I said) where a doctor and eight nurses volunteered to care for her in the last eight days of her life, risking "censure by their various medical ethics bodies".
St Vincent’s is governed by a board on behalf of the owners, the Religious Sisters of Charity. The board undertakes to develop “the hospital and its services in accordance with the principles and ethics of the Congregation of the Religious Sisters of Charity”. It runs the hospital “subject to such directions, if any, that may be given from time to time by the Provincial Superior”. Its objectives are qualified by “the continuance and furtherance of the ethos, aims and purposes of the Congregation of the Religious Sisters of Charity” in accordance “with the Health Care Philosophy and Ethical Code of the Religious Sisters of Charity”. No one can possibly doubt that St Vincent’s is required to adhere to the medical ethics of the Catholic Church. I wrote that “In the past newly appointed staff at St Vincent’s were required to sign a form, which in effect required them to adhere to Catholic ethics”. I wondered if that was still the case. Drs Benson and Crowley say they were not asked to sign (in 1993 and 1994), and say that the practice has been ended. It is clearly not necessary – it is the rule.
I greatly admire SVH. I have been a patient there, so were my mother and friends, and all have been wonderfully cared for. Friends and colleagues are members of staff. We can all be proud of SVH and grateful for all who work there.
But it is more difficult for SVH to maintain its commitment to observe strictly the medical ethics of the Catholic Church. This will become more difficult if maternity services are placed under the governance of the Religious Sisters of Charity. Reproductive medicine and related areas such as medical genetics pose special difficulties for Catholic medical ethics. I wonder if SVH has carefully considered the problems that it would face if it absorbs the NMH.
I do not know the ethical rules of the NMH. It is a Catholic foundation of great distinction and doctors from the NMH have been leaders in their fields. The Archbishop of Dublin is chairman of the board. It has 84 members, including three parish priests who are ex-officio. I understand that the governance structures are under review.
Should the governance of either or both hospitals be decided in discussions between the hospitals or should there be some guidance on their ethical policies by the Government? These are matters of national significance, and it might be opportune for the Government to address them as part of the reorganisation of maternity services. The Government should consider whether it is appropriate that the medical ethics of the NMH and SVH be determined by a single religious denomination, whose medical ethics are likely to be at variance with what is permitted under law, with medical practice both in Ireland and abroad and with the opinions and behaviour of a large number of Irish people. In particular they are not consistent with the widely held principle of personal autonomy according to which patients take ethical decisions within the law about their own healthcare – without the direction by a medical ethics committee or any other third party.
To take the point made by Gary Bury in his letter of June 1st, I am sure that some of us who do not accept the ethics of St Vincent’s (and presumably the NMH) do feel disadvantaged in using their services. – Yours, etc,
DAVID McCONNELL,
Blackrock, Co Dublin.