thehighhorse
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thehighhorse

The long labour of Ireland’s National Maternity Hospital

Photo by Gareth Chaney Collins

As far back as 2013, the Irish government announced plans to replace the existing national maternity hospital in the centre of Dublin with an entirely new one on the campus of St. Vincent’s Hospital, a large general hospital located in Elm Park in the southern suburbs of the city.

Built in 1894 as a stand-alone maternity hospital, the existing national maternity hospital in Holles Street is greed by all to be outdated and no longer fit for purpose. The efficiency and care quality benefits of co-locating the new maternity hospital with a major general hospital are another important reason for building the new facility on the St. Vincent’s campus.

Planning permission for the new hospital arrived in 2017. As is the way of things in Ireland, it is not foreseen that the new hospital will be built and operational before 2030. But last month, the political and chattering classes were convulsed in argument about whether the government should finally press the “start” button on the implementation phase of the project or take the slow moving train in a different direction altogether.

The argument wasn’t even as serious as two bald men disputing ownership of a comb because there isn’t even a comb to argue over, only a blueprint for one.

St. Vincent’s Hospital was first established as a 12-bed hospital in 1834 in a house in St. Stephen’s Green in Dublin by the Religious Sisters of Charity in response to a cholera outbreak in the city two years previously. It transferred to Elm Park in 1970 where it now has 600 beds, managed by the St. Vincent’s Hospital Healthcare Group.

As far back as 2009, The Irish Times reported that there were then only 264 Sisters of Charity. Their average age was 74. So one has to imagine their numbers have fallen in the meantime and the capacities of the remaining sisters likewise.

Last month’s argument, which had been simmering for five years, was about the extent of the Order’s influence over the running of St. Vincent’s Hospital itself and whether such influence would extend to the new National Maternity Hospital. The Sisters have retreated from any direct role in the running and indeed the ownership of St. Vincent’s. But the order’s website states that care in St. Vincent’s is provided:

in an atmosphere of Christian love and compassion operating according to the values of the Sisters of Charity…

The “smoking gun” that purports to leave room for continuing influence was that the two hospitals on the St. Vincent’s campus will be connected by more than simply being located adjacent to each other. The state will not own outright the land on which they hospital will be constructed it but will occupy it on a lease of 299 years at the end of which the land and any buildings on it will revert to St. Vincent’s. Both the Government and St. Vincent’s say that this leasehold rather than freehold relationship is simply a mutually satisfactory structuring arrangement, that the net effect will be for the state to have full control of the site and building.

This thread of connectivity gives rise to three lines of argument.

The first is encapsulated in the slogan “a public hospital on public land” with the implied directive that the Government should acquire the land outright, by compulsory order if necessary or, worse case, just build the hospital somewhere else. This suggestion is a bit like the response that locals purportedly sometimes give to visitors seeking directions: “If I were you, I wouldn’t start from here”. “Here” is where we are and trying to restart the process from somewhere else would almost certainly extend the already leisurely timeline for getting the hospital up and running.

The second line of argument is that any religious ethos at all in the hospital would be unacceptable, however apparently unthreatening it might be. For example, in St. Vincent’s, there is a chapel in which Mass is said. There are religious statues on display. The principle of separating church and state should prohibit any such ceremony or iconography in the new hospital because they are the visible trappings of an implicit Catholic ethos. But, if such an ethos is visible in St. Vincent’s, how can we be sure, it won’t permeate the new maternity hospital?

Maybe so, maybe not. I don’t see this point as worth arguing a great deal about either way. Visible trappings of religion are one thing. The range and quality of care are a separate thing. It seems a stretch to argue that the former necessarily shapes the latter.

The most important argument is that unless the state owns outright the land on which the hospital is built, there is always some level of risk that women might be denied health care such as abortion and IVF that are legal in Ireland but not sanctioned by the Catholic Church. That suspicion persists and is loudly articulated despite the assurances of both the Government and the medical staff in Holles Street that all procedures currently being carried out in the existing hospital will continue to be carried out in its successor. The Board of the existing hospital is an enthusiastic supporter of the move.

The Catholic Church has demonstrable historic “form” in prioritising moral imperatives (as it perceives them) over medical concerns in its provision of care to women and not just in the dimmer, more distant and dark past. Writing in the journal.ie, historian Dr. Sarah-Ann Buckley spoke from contemporary personal experience.

I am 37 years of age and I have had the following occur in my lifetime — received inadequate sex education in school (except a fear of becoming pregnant before marriage). Attended a consultant for an investigation of polycystic ovaries syndrome and had the Billings method cited as the best option for family planning. After requesting a DNC, been actively encouraged to consider the damage and possible future pregnancies that may be affected.

The past is not a perfect guide to the future but it is the only one we have. Vigilance is warranted, but paranoia should not be.

Advocates of both positions — that there is both a possibility and a risk of mischief and that there is no risk whatsoever - have recourse to clauses and sections from the governance documents relating to the ownership and operation of the proposed hospital that appear to support their position. Most of us have no expertise in such legal texts — but that does not inhibit people from commenting confidently on their meaning. Doctors and journalists opining on the quality of commercial leases is probably as useful as lawyers offering medical diagnoses.

Anyway, on 17 May, the Government decided definitively to press ahead with the new hospital and the news maelstrom moved on to other things. It’s a long way from today to hospital completion so there may be more bumps, twists and turns along the road.

Some observations at this stage.

First, the recent “debate” was heavily skewed around the bad things that might happen to women rather than the good things that the hospital might make available to them. This perspective was bluntly expressed in The Irish Times by Breda O’Brien:

Listening to objectors to the National Maternity Hospital (NMH) at St Vincent’s one would think that it was actually the National Termination Hospital instead. A historian researching in 200 years’ time would receive the impression from the objectors that the women of Ireland had no particular interest in giving birth but instead were obsessed with securing the right to abortion.

Second, I can speak only of the media sources through which I kept in touch with the “controversy”: RTE, The Irish Times and the journal.ie. Leaving aside the political “chaff” of whether and how the Government would get its way, I would describe the coverage of the issues as fair and balanced in the sense of providing true and thorough accounts of the opposing perspectives: “nothing to see here” versus “Something very large to see here that must be dealt with”.

What was in short supply though was any attempt to rise above the role of faithful recorder to that of authoritative adjudicator. The prioritisation by the mainstream media of “balance” over adjudication is one reason why the weeds of outlandish, wacky and conspiratorial views flourish so well in the garden of so-called “information”. The media will report just about anything. It offers reliable guidance on almost nothing.

Well, I am going to adjudicate here and you can decide for yourselves whether my judgement is authoritative. The controversy was kept afloat by three possible contentions none of which seemed overly plausible to me.

The first is that the mere fact of the tenure on the land being leasehold rather than freehold constitutes a risk of women’s rights to legal treatments being impaired without any further explanation being required as to how it constitutes a risk. There has been much inconclusive parsing of the language in the documentation to the effect that only “clinically appropriate” procedures should be conducted in the hospital, but nothing more substantial than that.

The second is that the Government is in such a hurry to get on with the hospital that it is oblivious to legitimate concerns about women’s rights or, worse, that it is aware that such concerns have a good basis but just doesn’t care enough about women.

The third is the notion that the lease or other governance documentation might contain a landmine provision that is legally explosive enough to allow the Sisters of Charity to enforce Catholic morality in the hospital but so well concealed that neither the Government nor anybody else was able to detect it despite the documentation being made transparently available to the public.

To the conspiratorial classes, there is no limit to the government’s capacity for casual negligence or to religious orders’ enduring capacity for cunning cruelty to women.

It will be many years before we have a hospital at all. But I suspect that when the time comes, the recent controversy won’t be remembered as anything more than a light breeze in a teacup.

In September 1983, the people voted by a majority of two to one to include provision in our constitution effectively prohibiting abortion in Ireland in most circumstances.

In May 2018, the people voted by a similar majority of two to one to repeal this provision and to allow the Oireachtas (Irish parliament) to legislate for the provision of abortion. They voted by a resounding majority to reverse the 1983 referendum in the full knowledge that they were doing more than simply repealing it, but opening the door to the immediate introduction of legal abortion here — because the government had affirmed its intention to introduce such legislation quickly if the referendum was passed.

So the pendulum of public opinion on abortion had swung strongly in the opposite direction between 1983 and 2018.

It is hard to imagine the kind of case the Sisters or their agents might make to the courts that is invisible today but that would force the hospital to abandon the provision of medical services to women that are legal within the state. But, if the climate of public opinion remains as it was four years ago, it is equally hard to imagine that contingency enduring very long if it did arise.

The public would not stand for it.

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Daire O'Criodain

Daire O'Criodain

Former diplomat and aviation finance executive, active now mainly in not-for-profit sector. Living in rural Clare. Weekly posts on Wednesdays.