Sir, – I am not terribly concerned that the State does not own the site for the new National Maternity Hospital but I am concerned that the hospital may become de facto Catholic, even to the extent of deterring people from seeking employment or treatment. I need further assurances, some of which can be provided by amending the draft constitution of the new NMH.
The draft (which is available on the HSE website) states in article three of the memorandum of association that “all clinically appropriate and legally permissible healthcare services” will be provided and this has been approved with the same wording by St Vincent’s Healthcare Group (article 14.7). The question is who decides what is and what is not “clinically appropriate”. The word “clinically” implies that the decision is taken by a doctor or doctors (or perhaps by a medical ethics committee), and we can safely assume that this is what is intended. This qualification on what kind of services are provided in particular cases has serious implications.
Consider a healthy pregnant woman seeking an abortion, as is her right under law, when “the pregnancy concerned has not exceeded 12 weeks”. The only role for the doctor envisaged by the Termination of Pregnancy Act is to decide on the age of the pregnancy. But under the draft constitution a doctor might quite reasonably decide that an abortion would not be clinically appropriate, if it has no specific clinical objective.
The same question might arise when a patient seeks sterilisation, or family planning advice, genetic counselling or IVF. The draft constitution makes it clear that the doctor has the right to decide that these may not be “clinically appropriate”.
Such procedures are often sought by patients for social or personal reasons. The draft constitution should be amended to read “all clinically, socially or personally appropriate and legally permissible healthcare services”.
The constitution does not mention the words “patient” or “ethics”. It is as if a patient has no rights, for example, to request services that are not clinically appropriate (but are legal under the Termination of Pregnancy Act). Nor is there any mention of the central principle of modern medicine, the confidentiality of the doctor-patient relationship. Nor is there any mention of the position of doctors who, under freedom of conscience, may not want to give advice or medical care that is contrary to particular medical ethics, who should be required to explain this to patients and to refer them to colleagues who are not so constrained. The constitution does not make any mention of medical ethics and I am left wondering whether the NMH will be governed by the traditionally religious medical ethics of St Vincent’s Hospital.
Finally, we need more specific assurances than are provided for in article 4.1.2 as to how the board of the NMH will ensure there are a sufficient number of doctors, nurses and other staff who do not have conscientious objections to carrying out medical procedures or giving medical, social or personal advice that are prohibited by Catholic medical ethics.
DAVID McCONNELL,
Honorary President,
The Humanist Association
of Ireland,
Caherdaniel,
Co Kerry.
Sir, – Perhaps it should be renamed the National Eternity Hospital as it seems to be taking forever. – Yours, etc,
BRIAN AHERN,
Clonsilla,
Dublin 15.