National Maternity Hospital and ethics
Sir, – I would like to support Dr Peter Boylan (April 27th) and others who are concerned about the imposition of the medical ethics of St Vincent’s Hospital on the National Maternity Hospital (NMH) were it to be governed by the board of St Vincent’s. Of course I admire the great contributions made by religious organisations to medical care, as described by Rev Dr Vincent Twomey (May 11th), but we must recognise that times and ethics have moved on. Catholic medical ethics should not be imposed on patients who are being treated in publicly funded hospitals or on doctors or other staff who work there.
Representatives have implied that medical treatment in St Vincent’s is not restricted by the Catholic Church. I am sorry to say I feel this is disingenuous. The fact that St Vincent’s now carries out some procedures that are not approved by the church ignores the lesson that St Vincent’s took more than half a century to come to terms with quite ordinary medicine such as contraception and sterilisation.
In the past, newly appointed staff at St Vincent’s were required to sign a form that in effect required them to adhere to Catholic ethics. I presume some of the current staff signed these forms. Has that process been changed and have the older staff been released from their solemn undertakings? I did not hear of such a change.
Does St Vincent’s have an ethical committee and might we see its terms of reference?
Some years ago, in a very sad case, permission was given by the courts to switch off the life support to a patient who had been in a permanent vegetative state for many years. The hospital did not want to facilitate the courts or the relatives, so the patient had to be moved to Tallaght Hospital.
The impact of Catholic ethics is strong partly because of the personal beliefs of many nurses and doctors, to which they are perfectly entitled. But are they entitled to superimpose these ethics on others who do not agree with them? Is it right that medical cases should be referred to supervisory committees for ethical approval?
I have a friend who had had a baby with anencephaly (a fatal foetal abnormality) who became pregnant again. The chances of recurrence were quite high. She was refused amniocentesis in the Rotunda in 1977 because of a standard objection by nurses. They believed quite reasonably that if such a test showed a second anencephalic baby, the mother might have chosen an abortion. She was told, quite wrongly, that a sonar scan would be as good as a test for alpha-fetoprotein. That was a long time ago but the question arises today – would amniocentesis for prenatal diagnosis, with the implication that the mother might travel abroad for an abortion, be routinely carried out in many circumstances (for example for mothers of advanced maternal age – that is mothers over 35) if the NMH were to be governed by the St Vincent’s board?
Will the NMH be able freely to provide information on abortions abroad? Will the NMH be able to provide after-care to its own patients who have had an abortion abroad? Will the NMH be allowed to develop an IVF service to help couples to conceive or for the purpose of preimplantation genetic diagnosis? Will the NMH be allowed to develop services to help same-sex couples to have children? Or, as Dr Boylan mentions, will the NMH be allowed to carry out surgery related to sexual orientation?
I do not know if such services are provided by the NMH but it would be much more difficult to do so, perhaps impossible, if the NMH were governed by St Vincent’s.
Of course by far the greatest test would be whether St Vincent’s would allow abortion under law to be carried out in the NMH.
At present abortion is only permitted under rare circumstances, which is difficult to facilitate in any Irish hospital, but what happens if the Eighth Amendment to the Constitution is repealed and our laws are changed to allow abortion in more common circumstances? Many Irish people are choosing to have abortions and many more feel that abortion should be legal and publicly available in Ireland in more situations, for example in cases of significant (but not necessarily fatal) foetal abnormality.
St Vincent’s and other Catholic medical organisations, or organisations dominated by Catholic ethics, stood in the way of family planning for many decades.
Today members of the same institutions stand in the way of services in reproductive medicine and medical genetics that are normal in most advanced countries, that are desired by large numbers of Irish people, and that are the subject of discussion within Government and in the Oireachtas.
It is quite important that we move into line with the view that patients should take the ethical decisions about their own healthcare. They should be entitled to receive, in private, lawful medically appropriate treatment of their choice. Their cases should not be referred to ethical committees for ethical supervision.
Public hospitals and their staff should provide such treatment without imposing ethical filters that have no basis in law or more widely in general medical ethics.
If a doctor is restricted by his or her own ethics in ways that are not proscribed by law, then the patient should be told and referred to another.
The governance of the NMH will be an important test of the newly elected Oireachtas and newly formed government, just as the ethical principles of Tallaght Hospital were important in the past.
It would not be wise for a Government considering the introduction of an amendment to the Constitution which could lead to extending the circumstances for lawful abortion to transfer the governance of the National Maternity Hospital to ethical supervision by a board that was bound to prohibit almost all abortions. – Yours, etc,