What disturbs me is the process surrounding maternity hospital

On the basic issues of property and profiteering, it seems the Sisters are doing some good, writes Gerard Howlin

What disturbs me is the process surrounding maternity hospital

Arguements about religion, power, and conflict of interest swirling around the proposal to build a new national maternity hospital on the grounds of St Vincent’s Hospital, which is owned by the Sisters of Charity, ignore the elephant in the room. The essential conflict of interest, one almost unmentioned, is money.

In the gust of outrage about a new €300m maternity hospital being built on land owned by nuns, something essential is overlooked. That new hospital will be a gleaming money-making machine for private medical practice. It will be entirely paid for by the taxpayer. The site is currently owned and will remain in the hands of the Sisters of Charity. In a prevailing mood of anti-clericalism this sticks in the craw of many most vocal in the public conversation.

In fact co-location with a general hospital is essential. To work best, that co-location should be contiguous. A suggestion that nearby, but not attached, lands being sold by RTÉ should be used is amusing. That part of the RTÉ campus is currently home to Fair City’s Carrigstown. I’ll leave the rest to comedy. The real issue, however, is an intervening motorway.

On the basic issues of property and profiteering, it seems the Sisters are doing some good. They are effectively sterilising an immensely valuable site for as long as the new hospital sits there. It is on associated issues of ethics, however, that there are legitimate questions of public policy as to where there motives lie between charity and proselytising. Those issues, however, are primarily ones for the State.

The net concern on medical ethics is whether all procedures legal in the State now and in the future can be provided at the new hospital, capacity allowing. The new hospital will have four board members, from the two hospitals, and an independent, internationally authoritative chair. This guarantees creative tension at best, not a guaranteed outcome. The plain speaking of the Roman Catholic Bishop of Elphin, Dr Kevin Doran, last weekend, was strangely disquieting for some. It seems to me entirely appropriate in a liberal democracy that religious institutes propagate their values. The onus to ensure legal procedures are available in a national maternity hospital is on the State, not the Sisters of Charity.

In his Irish Examiner column yesterday, Fergus Finlay pointed out there is an almost total absence of documentation in the public domain. I second that pertinent point, and extend it. This is a serious public policy issue. It is one the minister must have clarity on to categorically assure the Oireachtas. My extension to Finlay’s point is that relevant documentation is what is arrived at by the end of the process. It is the process itself which disturbs me.

In fairness, there is no hugger-mugger about it. It is hiding in plain sight. The State is proposing to build a new national maternity hospital and transfer its existing functions to an enhanced facility. It presumably transfers and potentially enhances income streams from existing private practice to the new taxpayer-funded facility.

If it is a legitimate policy concern to break the nexus of religious institutes and control of medical ethics, surely at this juncture the need to break the link between public hospitals and private practice is as acute or greater? The paucity of information in the public domain extends beyond agreements reached by the two hospitals.

The public has a right to know, and the Oireachtas has a duty to ask: Who profits from private practice in the national maternity hospital now? Are any of them decision-makers on this issue? If so, has consideration been given to the appropriateness of this? Critically, what are their expectations, if any, in regard to private practice at the new hospital, if it goes ahead? Will those expectations be enhanced because of massive State investment?

A cornerstone of the Irish narrative is sex. It covers a multitude. Priest-ridden prudery made us ashamed of ourselves, and made us what we are. Hypocrites, we institutionalised non-conformity on an industrial scale. The reported non-availability of procedures such as female sterilisation in religious-run hospitals is the carry-over of that controlling carry-on. In one last heroic push, we can get the last rosary off a fertile Irish ovary. Then Repeal the Eighth, and we’re home and hosed. The codicil is while there is truth to this narrative, it is only partial. And because it’s partial, it’s misleading.

Money, not sex, drove a lot that’s wrapped up as an all-purpose, moral-cum-clerical narrative. Illegitimacy was shunted into institutions to protect ‘legitimate’ interests. Stigma was as much instrument as cause. The catastrophic mistake of the Catholic Church was allowing itself to be instrumentalised by the social and economic agenda of an emerging Catholic middle-class. It’s hardly surprising. Clergy were largely recruited from it. But the payback has been appalling. The furore behind the Mother and Child Scheme debacle was partly about the Church being used as a catspaw by doctors. There was a symbiotic relationship between the higher echelons of the medical profession and the Church historically. Followers of the Nazarene embraced private medicine in preference to State control, to better exercise control themselves. Now in full retreat, they are largely repudiated by their former proteges. As they age and wither, the golden calf is shamelessly worshipped in their institutions.

It is no accident that St Vincent’s Hospital and UCD left adjoining sites on St Stephen’s Green and Earlsfort Terrace in the same generation for essentially the same purpose. They were to be pillars of an emerging and assertive Catholic middle-class in south Dublin. It was a Faustian pact. The national maternity hospital on Holles St fits fully into the malformed history of Irish hospitals. The priests of Baal roam in white coats, reciting their ethics. The State has essentially replaced the Church now in the same Faustian pact. It is dependent on income from privately insured patients to subsidise public hospitals. In order to shake down money from private patients in public beds, it has to allow doctors treat them there. For things to remain the same, everything must change. Hence the move. Everything will be new, but the same.

What the Government, Sisters of Charity, and hospital consultants, of whom they are some committed exclusively to public work in public hospitals should do, is reflect. The ultimate issue around a coalition of different hospitals on the St Vincent’s site is not specific medical procedures, though they are important. It is not about the ownership of the site, per se. Purely as a property play, concerns can be addressed. It is that a newly arrived and consequently entrenched model of care is a Frankenstein version of the gargantuan vision of John Charles McQuaid. He, in fairness, would be appalled by the mutation. My concern is not that this is a new maternity hospital for nuns, but that it is a partly for-profit franchise for hospital consultants, which the Government is investing in as minority partner.

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