The possible move of the National Maternity Hospital from Holles Street to the grounds of St. Vincent’s Hospital has caused a fair degree of debate. One of the main debating points is the role St. Vincent’s Catholic ethos may or may not have in governing the National Maternity Hospital if the proposed move transpires. This in turn has led to a debate over the value of the Catholic ethos for the practice of medicine.
A recent contribution to this debate appeared in the letter pages of The Irish Times by David McConnell, professor emeritus of genetics at Trinity College Dublin. McConnell makes a number of arguments representative of liberal secularism against the worth of the Catholic ethos. This blog will deal with them in turn.
“The impact of Catholic ethics is strong partly because of the personal beliefs of many nurses and doctors, to which they are perfectly entitled. But are they entitled to superimpose these ethics on others who do not agree with them? Is it right that medical cases should be referred to supervisory committees for ethical approval?”
No medical institution in the world allows patients to choose whatever course of treatment they desire. Every medical institution has an ethos that restricts the range of options available to patients. A hospital with a Catholic ethos is no different in this regard. The real question is whether the Catholic ethos is in line with good medical ethics, in particular with the principles to do no harm and to improve the health of patients. As to the last point in the section above, every worthwhile medical institution has some kind of ethics committee for dealing, when appropriate, with difficult or controversial cases.
“Today members of the same institutions stand in the way of services in reproductive medicine and medical genetics that are normal in most advanced countries, that are desired by large numbers of Irish people, and that are the subject of discussion within Government and in the Oireachtas.”
In another part of the letter McConnell provides a list of what he means by services in “reproductive medicine and medical genetics”: abortion, IVF services (which, going by the reference to same-sex couples, may include surrogacy), gender re-assignment surgery and sterilisations. None of these really are medical services in the true sense of that term because none of them are designed to improve the health of patients. In fact, most of them involve serious physical harm: the purpose of abortion is to kill the unborn child, gender re-assignment surgery involves the deliberate mutilation of the person’s genitals, and sterilisation involves deliberate harm to the person’s reproductive system. And while IVF may not necessarily involve physical harm to any adults, it is not a medical treatment per se since it does not cure fertility – rather it bypasses fertility problems through the artificial creation of human life (which very often involves the destruction of human beings in the embryonic stage of their life). So an ethos that endorsed these practices could not be doing so from the point of view of the right to physical health: abortion is predicated on the supposed right to choose to terminate the lives of young unborn children, IVF is predicated on both the supposed right to a child and the supposed right to discard embryonic human beings, gender re-assignment surgery is predicated on the supposed right to shape one’s most basic physical reality according to how one feels, and sterilisation is predicated on the supposed right to mutilate one’s reproductive system as a way of avoiding having a child. Even those who believe that each of the above are genuine rights must acknowledge that the rationale for them does not derive from protecting the integrity of the patient’s physical well-being.
“It is quite important that we move into line with the view that patients should take the ethical decisions about their own healthcare. They should be entitled to receive, in private, lawful medically appropriate treatment of their choice. Their cases should not be referred to ethical committees for ethical supervision.”
The Catholic ethos certainly does respect the right of patients to make ethical decisions regarding their own healthcare. This, along with excellence in medicine, helps explain why hospitals with a Catholic ethos are so popular right across the world. The problem that liberal secularists have with the Catholic ethos is that it does not place an absolute value on patient autonomy. There are good reasons for not doing so, however. Patients are capable of making unreasonable demands and also capable of requesting that a serious harm be done to them (or others). Furthermore, any respectable medical ethos should place significant value upon the training and expertise of medical professionals and should not assume that patients always either know best or should have their wants (as distinct from their needs) vindicated.
“Public hospitals and their staff should provide such treatment without imposing ethical filters that have no basis in law or more widely in general medical ethics.”
The “ethical filters” which McConnell views as being “imposed” are better described as ethical principles that guide the conduct of staff in the discharge of their professional duties. These principals include the principle “do no harm” – one of the foundational ethical principals in both medical law and medical ethics. If liberal secularists have a problem with a Catholic hospital refraining from harm, the problem is that of their own ethos.
