What motivates those in officialdom who seek to deny the ethical freedom of choice and services promised for Tallaght hospital, asks Gordon Linney
'I want to make a very clear statement." So said Dr John Neill, the Church of Ireland Archbishop of Dublin, in his address to the Diocesan Synod last week.
He was speaking about the situation at Tallaght hospital, of which he is president, expressing the opinion that a very serious question mark hangs over the future of a meaningful Church of Ireland involvement there. It is unusual for a Church of Ireland bishop to be so direct, but his remarks were solidly supported by a resolution passed later by the 300-member synod.
He emphasised that the issue at Tallaght was not "a Protestant hospital for Protestant people [ or] jobs for Protestant doctors or Protestant nurses", something that would be quite unacceptable to most Church of Ireland people. It was about issues of much greater significance, where solemn agreements given by the Government and approved by the Oireachtas in 1996 are being ignored or frustrated.
Tallaght hospital evolved out of the general reorganisation of hospital services. In that process, several hospitals closely associated with the Protestant community were closed. However, after detailed negotiations it was agreed that three historic Dublin hospitals - the Adelaide, Meath and National Children's Hospital - would jointly move to Tallaght under an amended Adelaide Hospital Charter.
The charter, approved by the Oireachtas in 1996, states that, while the hospital should be "a focus for Protestant participation in the health services", it will have "a multidenominational and pluralist character". In other words, while there is a recognised Protestant presence, it exists only in the context of a greater scheme. No reasonable person could challenge such a provision, given the contribution of that community to medicine in the past and the fact that there are currently sensitive ethical issues in healthcare, with more to come.
The acceptance by the Government of certain public and private denominational hospitals is a fact and they are respected as major contributors to the health service. But there is a need for balance and Tallaght is intended to contribute to that balance.
In the Adelaide charter, there is an obligation "to promote and secure the availability, as a matter between the patient and his or her doctor, of such medical and surgical procedures as may lawfully be provided within the State". The term, "as a matter between the patient and his or her doctor", is important as it protects the confidentiality of the doctor-patient relationship. There is no question of the imposition of an external denominational code of ethics. The same may apply in other hospitals by custom, but in Tallaght it is legal and binding. In this regard Tallaght does not claim to be better than any other hospital, but it is different.
This is not about minority rights, religious or otherwise, but rather the right of every citizen to be treated in accordance with his or her own conscience in so far as that is consistent with the law.
The importance of this was shown when it was recently reported that the treatment of women with a life-threatening disease was interrupted in one of our major Dublin hospitals on the grounds that it breached the ethical code of that hospital. There is simply no way of knowing if this is happening elsewhere in the health service, and while that ought to be a cause for concern it does not seem to bother those who would discredit our position.
The hospital charter envisaged that Tallaght would be a major voluntary university teaching hospital, including children's medicine. The archbishop has expressed concern that it is being downgraded, and that is demonstrable.
When planned in the 1980s, it was intended to have 830 beds, including a 50-bed maternity unit, which was dropped before it opened. When it did open in June 1998 it had just over 500 beds, of which only 385 were available for acute adult services for a population the same as Limerick. According to the report of the project director of the planning board, this reduction in beds "sowed the seeds for many of the difficulties which continue to this day".
A significant expansion of services which was promised never materialised. No new tertiary service has been provided at Tallaght comparable to those which have been given to each of the other four university teaching hospitals in Dublin. In recent bids for radiation oncology and the new paediatric hospital, Tallaght was unsuccessful and the reason given was the lack of tertiary services. The fact is that Tallaght has been denied the capacity or the funding to develop such services; indeed, some services have been removed.
These and other matters combine to diminish the hospital's potential as a leading teaching hospital and vindicate the archbishop's straight-talking. The last straw is the decision to remove the National Children's Hospital - not by any means the first attempt to close it down over a number of years.
This will affect Tallaght in a serious way. Other hospitals may have lost an opportunity for future development; Tallaght and its people will lose a well-established, quality service. Perhaps nothing reveals the mind of officialdom better than the fact that the hospital has never been officially opened.
In June, Dr Neill together with the Archbishop of Armagh, Dr Robin Eames, the Moderator of the Presbyterian Church, Dr David Clarke, and the Rev Desmond Bain, former president of the Methodist Church, met the Taoiseach, who said he regarded the honouring of the hospital charter by the Government as a matter of the highest importance.
While that statement is appreciated and accepted in good faith, it will be meaningless if those who are charged with implementing Government policy choose to ignore it as heretofore.
There are signs that this is happening already.
It is difficult to understand what motivates those who seem determined to ensure that the people of Tallaght and its environs cannot have the hospital they were promised and deserve, and that citizens generally cannot be guaranteed the ethical freedom and choice within the law which they deserve.
Whatever the motivation, the effect is disastrous for Tallaght hospital, its excellent staff and the people they serve, who must feel utterly betrayed and discouraged by what is going on. It is time for serious engagement and dialogue in the context of stated Government policy to sort out the issues and secure an agreed future.
Gordon Linney, formerly archdeacon of Dublin, is a member of the Tallaght hospital board but is writing here in a strictly personal capacity