The contribution of religious orders to the provision of hospital services in Ireland dates back to 1834 when the nuns established St. Vincent’s Hospital in Dublin. In general, the role of religious orders has been viewed positively by Irish Catholics, but in the past two decades public opinion has changed radically.
This became evident in 2017 when plans to move the National Maternity Hospital from Holles St. to St. Vincent sparked an outcry. Why such an attitude change? To answer this question it is necessary to refer to historical developments.
When the Irish Free State was established in 1922, the religious administration of health services was well established. Church involvement in health, education and social services has given the Catholic Church tremendous power over public policy and medical practice in Ireland.
The Catholic ethos has prevailed. The Hospital of Our Lady of Lourdes (Drogheda), which was under the Missionaries of Mary until 1997, banned – like all other Catholic hospitals – all forms of artificial contraception. The only birth control method approved in the hospital was the highly unreliable billing method, based on calculations of the infertile phase of the menstrual cycle.
Fallopian tube ligatures (female sterilization procedures) were prohibited – even if a new pregnancy was dangerous. Catholic ethical guidelines, however, allowed “indirect sterilization”. It was permissible to remove a diseased organ, such as a uterus, even though the woman would not be able to have a baby. In such cases, the goal was to maintain the patient’s health – not to prevent future pregnancies.
In her Lourdes Hospital Inquiry Report (2006), Judge Maureen Harding Clark found “a lot of evidence” that the ban on sterilization in hospitals with Catholic ethos led to the practice of “compassionate hysterectomies” – “an unspoken Irish solution to an Irish question. “The surgeon’s clinical judgment has not been challenged in such cases.
Tubular ligatures were a different matter. Rigid adherence to conservative Catholic teaching led to sterilization through hysterectomy when tubal ligatures would have been more appropriate. The hysterectomy was far more invasive and traumatic for the patient. Even so, religious ideology outweighed clinical judgment and best medical practice – the well-being of women was of secondary importance.
The subject of symphysiotomies also damaged the reputation of Catholic moral teaching. Pubic symphysiotomy is a surgical procedure to increase the delivery capacity of the mother’s pelvis when the baby is too big to pass through. This procedure was sometimes viewed as an alternative to caesarean section, but it was rarely chosen. When it was chosen, some patients suffered from side effects.
Irish obstetric practice was constrained by a legal framework, which in turn was influenced by Catholic values. Pope Pius XI’s encyclical, Casti Connubii (1930), condemned artificial contraception, abortion and sterilization and almost certainly influenced Irish lawmakers to pass the Criminal Law Amendment Act 1935, which banned the import and sale of contraceptives. Artificial contraception was illegal until the Health (Family Planning) Act 1979, and even then it was restricted to married couples requiring a prescription.
The frequency of symphysiotomy operations must be seen against the background that multiple births were the rule and repeated caesarean sections (especially until the early 1960s) posed serious dangers to the health of the mother. The symphysiotomy appeared to allow some mothers to have safer afterbirths and was performed more frequently than would otherwise have been the case.
In recent years, awareness of the subject of symphysiotomy has helped increase opposition to any expansion of Catholic moral teaching that might impede access to health services related to reproductive medicine.
In a broader context, the moral authority of the church has been undermined by an unstoppable torrent of scandals.
In parallel with all of this, public opinion about reproductive choices and sexual morals had radically changed, as evidenced by the referendums on divorce (1995), same-sex marriage (2015) and abortion (2018). The law changed to reflect radical changes in public opinion, but Catholic doctrine remained the same. A striking gap developed between the institutional church and the church as a community of believers.
In the late 20th century, the decline in the Church’s influence over health services became increasingly evident. The decline in callings resulted in the Church’s inability to place brothers and nuns in key positions to influence politics and the training of doctors and nurses. Sterilization procedures (tube ligatures and vasectomies) became available in the 1980s.
The power of the institutional church was no longer what it used to be – but it was not negligible. Hundreds of millions of euros in health care facilities in Ireland have been controlled by religious orders, notably the Sisters of Bon Secours, Religious Sisters of Charity and Sisters of Mercy. Ireland was not unusual in this context.
The Roman Catholic Church was the largest non-governmental health care provider internationally, and questions of public concern were sometimes raised as institutional decisions had to be made against a backdrop of aging and shrinking membership. Religious orders were less and less able to directly administer the hospitals founded by their predecessors. New management structures were required.
Dr. Peter Boylan, a former Master of the National Maternity Hospital, noted that Catholic orders around the world in recent years have transferred their assets to Vatican-approved charities to uphold the Catholic ethos. Transfers in Ireland include the Mater Hospital Group (2016), Mercy Hospital in Cork (2016), the Bon Secours Group (2017) and St John of God’s (2019).
The Sisters of Charity also saw themselves forced to adapt to the changed conditions. In 2003 St. Vincent’s Healthcare Group Limited (SVHG) was founded and St. Vincent’s University Hospital was transferred to the company. The Religious Sisters of Charity became shareholders and the SVHG constitution required the hospital to function in accordance with the Catholic ethos.
The government’s plans to relocate the National Maternity Hospital (NMH) sparked angry protests in 2017 – not only because a hospital built at the taxpayer’s expense would be privately owned, but also because some services, such as tube ligatures, were not provided due to Catholic ethics would principles.
In addition, the historical legacy of the Sisters of Charity has been tainted by the scandalous abuse and exploitation of women in the Magdalene laundries. This was exacerbated by the refusal of the Order and three others to contribute to making amends for several hundred survivors.
In May 2017, the Religious Sisters of Charity announced that they had transferred their ownership of SVHG, which would now become St. Vincent’s Holdings CLG – a privately held company. They would not play a role in the new LMWH. This did not address concerns that religious influence could affect the management of the new NMH.
Hospitals built on church property are owned by the Church and are subject to canon law and Catholic ethics. The St. Vincent’s Holdings CLG constitution made no reference to Catholic ethics or canon law and was committed to providing healthcare services in accordance with international medical ethics best practices and state law.
On May 27, 2020, the company assured the Ministry of Health through its lawyers that canon law “must have no effect on the company”.
It remains to be seen, however, whether the Catholic ethos will be set aside so that contraceptive services, fallopian tube ties, abortions, and assisted fertility treatments are offered in accordance with secular law and the welfare of women. Even if such services are provided, one question remains of fundamental importance to be resolved.
Why should a state-funded hospital with enormous costs (at least 500 million euros) be 100% owned by a private company?
- Dr. Don O’Leary is the author of Biomedical Controversies in Catholic Ireland (Eryn Press, 2020), available through Amazon, Paperback, and Kindle e-book; or directly from www.erynpress.com