Linnea Dunne traces the history of religious involvement in women’s healthcare, and looks at the solution for the new maternity hospital site.
A memory popped up on my phone last month from this time four years ago. A campaigning group I was part of back then had organised a march to demand that the new National Maternity Hospital (NMH) be entirely free from religious involvement. Four years on, not much has changed, as yet another demonstration outside the Dáil, this weekend illustrated. And yet, four years is almost no time at all in the bigger picture of Church involvement in the State provision of healthcare.[restrict]
So how did we end up with the Church running our hospitals?
“There have been inextricable links between Church and State with respect to healthcare provision since the 1860s when the Sisters of Mercy began to take over nursing in the Poor Law Union hospitals. These were important centres of public healthcare provision, particularly in rural Ireland, where dedicated maternity services were few and far between,” says Ciara Breathnach, Associate Professor in History at University of Limerick, explaining that funding was a key factor at the time. “Nuns effectively provided free nursing care.”
When the National Lying-in Hospital at Holles Street was established, it was partly in response to a growing need, but also a result of the Rotunda Lying-in having a Protestant ethos and excluding Catholics from its management structures, Ciara explains. “After a few false starts, the National Lying-in Hospital was re-established at Holles Street in 1894, under very definite Catholic management. While the Poor Law healthcare provisions were being dismantled from the early 1920s, without adequate funding, little changed. Various religious orders continued as managers of nursing and hospital settings, and others were invited by the bishops to establish hospitals, like for instance the Bon Secours. In short, the history of religious involvement in the management of healthcare provision was deeply entrenched and impossible to uproot. Bear in mind also that some 97% of the Irish Free State professed Roman Catholic.”
Religious beliefs, says Ciara, had very real impacts on how healthcare provision evolved, including huge resistance to change, and religious and political concerns about ‘socialised medicine’. “When Minister for Health Noël Browne unveiled his plans for free medical care for mothers and children, at a time when mortality rates were still stubbornly high, he met with major opposition not just from the Irish Medical Association, a professional representative body for medical doctors, but also drew the ire of the Catholic Bishops. They feared that socialised forms of healthcare in secular hands would mean ‘gynaecological care not in accordance with Catholic principles’ – in other words, that birth control and abortion might find ways into the Irish healthcare system.”
What’s the deal with the new National Maternity Hospital?
For years, 100 years – the heart of the debate remains. The relocation of the NMH to Elm Park, a site owned by the Sisters of Charity, was first publicly announced in 2013. This was based on the recommendation that maternity hospitals should co-locate with acute general hospitals, and at Elm Park, NMH patients would also have access to the existing St. Vincent’s Hospital. But the news was never uncontroversial. A dispute around ownership went on for years, and following growing opposition, the Sisters of Charity announced that they would transfer ownership of St. Vincent’s Healthcare Group (SVHG) to a new, private company with charitable status, St. Vincent’s Holdings (SVHs) CLG. This would essentially see the Sisters give up ownership of the land, valued at around €200 million – but at the time of writing, the transfer has yet to be completed.
The current plan is for SVHs to lease the site to the HSE on a 99-year term, with the State required to cover the full costs of both the build and the operation of the maternity hospital. Under this proposal, TD and joint leader of the Social Democrats Róisín Shortall noted in the Dáil on Wednesday, “only the shell of the hospital will be publicly owned, and the State is to have no involvement in the private company set to own the new facility, nor any role in its operations”.
But if the nuns transfer ownership to SVHs, what’s the issue?
The Catholic Church is the largest non-government provider of healthcare services in the world, and a number of existing Irish hospitals are owned by religious orders. But there are two issues at stake here: ownership as well as governance, the former very much informing the latter in direct and indirect ways.
The Sisters of Charity have issued a statement to say that they will have “no role, whatsoever” in SVHG, SVHs or the new NMH, but according to a recent SVHG annual report, the directors of SVHs will be obliged to uphold the values and vision of the founder of the Sisters of Charity, and the Catholic ethos of the original SVHG constitution is to be restated in full in the constitution of SVHs. As Bishop of Elphin, Kevin Doran, told the Sunday Times a number of years ago, Catholic hospitals have “a special responsibility… to Catholic teachings about the value of human life and the dignity and the ultimate destiny of the human person. Public funding, while it brings with it other legal and moral obligations, does not change that responsibility.” What that means in practice is quite clear from the Sisters of Charity guidelines for their hospitals, which state that reproductive health services such as the morning-after pill, IVF, sterilisation and abortion are all forbidden.
During his term as Minister for Health, Simon Harris did his best to repeatedly insist that the new hospital would be independently run, regardless of ownership. But ultimately, no promises seem to change the fact that there’s a huge trust issue at stake. There’s the financial piece and the public investment of what’s grown from an estimated €300 million to now at least €800 million into a hospital that won’t even be publicly owned. When the Sisters of Charity first built St. Vincent’s at Elm Park, it was with public money, and it was agreed that the proceeds from their old hospital if sold, would go directly to the State. The hospital was sold, but no money was ever handed over. Add the fact that the very same order has yet to pay its share towards the redress scheme for survivors of institutional abuse, and you can see why there’s public resistance to going ahead with the current deal.
Speaking of institutional abuse, the very fact that the Sisters of Charity ran their own residential schools and Magdalene laundries has been fuelling much of the outrage around their involvement with the NMH. “100 years ago, we handed over the care of our women, our children, of everyone to religious orders, we handed over our education to religious orders, and they have proven decade after decade after decade that they have no interest in supporting people, of providing for people what they need,” says Linda Kelly, an activist involved in the Better Maternity Care campaign. “They are insistent on implementing their own agenda, and it’s time we said enough. Any new hospital, any new school, should be free from any religious influence, given everything that we know about what these religious orders have done.”
Mary McAuliffe, Assistant Professor in Gender Studies at UCD, specialising in Irish women’s history, echoes this sentiment. “Its been scandal after scandal. We know that the majority of healthcare was carried out under a Catholic ethos for the first seven or eight decades of the State. If you look at what’s happened because of symphysiotomies, and in mother-and-baby homes – it all stems from the same intersection of Church and State and an ideology that sees the pregnant female body as governed by the rules of the State, which means policies developed under the Catholic Church,” she says. “The pregnant female body is not seen as having any agency.”
But is the fear still warranted? Back in 2005, the Mater Hospital stopped lung cancer patients from participating in cancer trials that required female patients of reproductive age to take contraceptives for the duration of the treatment. This, a statement said, went against the Catholic ethos of the hospital. Eventually, the ethics committee was heavily criticised and the clinical trial went ahead. It remains a concern, however, as stated in a petition by the Campaign Against Church Ownership of Women’s Healthcare, that:
“… private hospitals cannot be forced to provide services that conflict with their ethos. They cannot even be compelled to submit to independent inquiries into patient safety, as a High Court case taken by the […] National Maternity Hospital against the Minister [for Health] shows. The hospital recently won its case, blocking a HIQA inquiry following the death of a 34 year old woman during surgery at the hospital.”
Even for Sandy Connolly, a doula and mother who has experienced first-hand just how desperately unfit-for-purpose the current NMH is, moving forward with “this religious institution as the de-facto owner and patron of our state maternity hospital” is not the solution, “not acknowledging the harm, trauma and impact the Catholic Church has played in women’s and pregnant people’s health in our lived history.” She calls for the new NMH to provide “current, evidence-based, non-biased, trauma-informed care to all people on their reproductive journeys”.
So what’s the solution?
In a declaration adopted in 2018, the Campaign Against Church Ownership of Women’s Healthcare makes three demands: that the National Maternity Hospital be taken into public ownership as a condition of public funding; that the €350 million earmarked for the new build be conditional on the change of ownership; and that the new maternity hospital be governed by a new, secular charter fit for the 21st century.
At this stage, even the Tánaiste, Leo Varadkar, has expressed concern about the fact the hospital board won’t be appointed by the State, admitting that the ideal solution would be for the State to own the freehold of the land. Many people now believe that a Compulsory Purchase Order, while it comes with its own difficulties as well as an additional cost, is the only way out of an already drawn-out, costly process. One of them is Donna Cooney, Green Party Councillor for Clontarf and one of the founders of the aforementioned campaign. “We know Canon Law prevents the Sisters from transferring land to an organisation breaking the rules of the Church. We don’t expect them to do otherwise, but if you’re running a Catholic hospital and people know that’s the ethos, that’s fine – but it shouldn’t be a national hospital, and it certainly shouldn’t be paid for by the State,” she says. “Also, there’s discussion of the lease being extended to 150 years, but it would still be up for review after 49 years. We’ve seen similar in the US – what if there’s a shift to the right and the Church comes down with a doctrine that’s more strict, and they hold the lease?”
Jo Tully, Chair of the campaign, also points to the fact that the board members of the relevant companies would be clerical appointees, and that their ethos can be enforced through, for instance, employment contracts. “St Vincent’s University Hospital is currently recruiting theatre nurses. The advertisement makes it clear that compliance with the hospital’s ethical codes of practice is a legal requirement. Such employment contracts have no place, post repeal, in the new maternity hospital,” she says.
Is it time for restorative justice?
Ciara Breathnach stresses that Catholicism can and should be respected in its own right, “but the women of and in Ireland are entitled to reproductive healthcare independent of any and all religious ethos. There are deep historical and cultural resonances, and in this case, we cannot ignore the fact that the Sisters of Charity formed part of the carceral system of so-called mother-and-baby homes, which punished unmarried mothers in the recent past. Sexual and reproductive rights are basic human rights that have been hard-won in this country. I see the continuation of the Catholic Church involvement in the National Maternity Hospital as a retrograde step in 2021, and it is incumbent on us to voice opposition.”
Mary McAuliffe agrees that a Compulsory Purchase Order might be the best solution at this stage. “It must not be governed by faith-based ideologies,” she emphasises, adding that she believes it could take some time before a solution is found. While she seems sceptical about the likelihood of it, she describes the option of starting over and finding a new site as possibly cheaper and more ethical. “They haven’t turned any sod at St. Vincent’s yet. Think of the ethics of it, think of women’s lives. We’re worth something, and we’ve been having these discussions for a very long time,” she says.
“I also think there’s something to be said for the Sisters of Charity, who did run institutions like Magdalene laundries, handing over the site at St. Vincent’s as part of restorative justice for women,” Mary continues. “I think that’s something they should think deeply about. I think it would be the Christian thing to do.”