In an era of emerging moral and scientific questions, Ailbhe Jordan assesses the historical and ongoing influence of the religious faith on the practice of medicine and implementation of health policy in Ireland
Claims made in the BBC documentary This World that Catholic Primate Dr Seán Brady helped conceal the allegations of abuse made by some of the victims of Fr Brendan Smyth, and his defiant reaction to the calls for his resignation following the broadcast, has reignited the continuing debate about the Catholic Church’s power in this country.
In few areas has this power been more keenly evident than in healthcare and medicine, where the Church has stamped its mark on health policy, medical education and training, and the implementation of emerging new surgical interventions and medical treatments.
In 1950, Minister for Health Dr Noel Browne infamously attempted to introduce free maternity care for mothers and free healthcare for children up to the age of 16, regardless of income, under the proposed Mother and Child Scheme. The proposal faced fierce opposition, led by the Roman Catholic Archbishop of Dublin John Charles McQuaid, who argued that the State had no right to interfere in how families supported their children and claimed the legislation would lead to the introduction of contraception and abortion.
The debacle led to the collapse of the Fine Gael government and the minister’s resignation in 1951.
The Church’s objection to the use of contraception, which was enshrined in the 1968 Papal encyclical, Humanae Vitae, delayed the legal availability of condoms and the contraceptive pill for decades.
The Catholic Church in Ireland fought tooth and nail against the legalisation of condoms and the contraceptive pill. It was not until 1979 that then health minister Charles Haughey introduced the Health (Family Planning) Bill which allowed doctors to prescribe contraceptives for “family planning purposes or for medical reasons”. Only in 1985, under an amendment to this Act, did condoms become legally available without prescription in Ireland.
In February 2011, Ireland became one of the last countries in Europe to make the morning after pill available over the counter following the Irish Medicines Board’s (IMB) approval of the sale of NorLevo without prescription.
The Church has also been at the forefront of the pro-life campaign against legislating for abortion in this country, even under the strictest of circumstances.
A Supreme Court ruling in 1992 resulting from the X Case, allowed for women to be legally entitled to an abortion in Ireland if the mother’s life is in danger. However, successive governments have been reluctant to challenge the Church-led, pro-life lobby and transcribe this ruling into law, inspite of pressure from the European Court of Human Rights.
Just last month, a Private Members’ Bill by TDs Clare Daly, Joan Collins and Mick Wallace calling on the Government to legislate for the X Case was rejected by 109 votes to 20.
The Catholic Church is also a central player in the debates around assisted reproduction, euthanasia and, more recently, stem cell research. In spite of the scandals that have emerged in recent years, the institution remains a strong influence in Irish life, with 84 per cent of the population describing themselves as Catholic in the last census.
Its influence on our health system, and many working within it, is still evident in many surprising ways.
Craniotomy
A grim example of the power wielded by the Catholic Church over the medical profession is currently the subject of much debate and recrimination as the 150 or so women still alive today who were subjected to symphysiotomy during labour seek a full State inquiry into why a procedure abandoned in most developed countries in the 18th Century was carried out on them in Irish Catholic hospitals late into the 20th Century.
However, the symphysiotomy scandal is not the first example of how the Catholic Church in Ireland used its influence to suppress the dissemination of medical developments that were making childbirth safer for mothers.
In the late 19th Century, the Church became alarmed at the increasing use of craniotomy in obstetric practice.
“That meant if the mother’s life was in danger, you would crush the skull of the baby being born. The baby died, but the mother was saved. The alternative to that was that both died, or at least the mother died,” explained Greta Jones, author of Captain of all These Men of Death: A History of Tuberculosis in Nineteenth and Twentieth Century Ireland and co-author of Medicine, Disease and the State in Ireland, 1650-1940.
“It was a practice that was taught in the Rotunda, textbooks in Ireland mentioned it and the man who was in charge of the Rotunda at the time, a man called Henry Jellett who was quite a famous specialist obstetrician, defended it in his textbook and described how to do it. In Queen’s University, it was routinely part of medical education but the Catholic Church took a very strong line against it. The Irish Ecclesiastical Record, which was the big Irish journal for the priesthood, had articles attacking the whole practice,” Ms Jones told the Medical Independent (MI).
While a lack of statistical information makes it difficult to estimate the number of women who may have died as a result of being denied craniotomies during labour, Ms Jones says it was a major issue for Catholic doctors as recently as the foundation of the Irish Free Sate in 1922.
“There was a Catholic student in Queen’s who graduated around 1918. He went on to become a Doncaster GP and he left a memoir of his education,” she told MI.
“There was an exchange during a discussion in an obstetrics class about craniotomy, about what you should do if your religion forbids you to do this. And one of the students made a joke and said, ‘I’ll fetch the nearest Protestant doctor’.”
During this same period between the 1860s and 1922, according to Ms Jones, the Catholic Church became intent on creating a denominational higher education system in Ireland so that it could control how Catholic university students were taught. The cause was strongly bolstered by the creation of the Catholic University (now UCD) in 1851, which was financed through a series of highly effective public campaigns and with the help of sympathetic politicians.
This drive, she said, was particularly effective in medical education; so much so that between 1860 and 1910, the number of denominational institutions teaching medicine had jumped from 16 per cent to 48 per cent of all medical education institutions.
“This was about Catholics being educated in schools that were predominantly Catholic and it was increasing in the late 19th Century,” she explained.
“There were still medical schools which were mixed; the RCSI in Dublin, the Queen’s colleges were still mixed, but with the rise of the Catholic medical school which was to become the medical school of UCD in 1908, they were increasingly encouraging their medical students to be educated in a Catholic environment. The reasons were a lot to do with the transmission of the Catholic medical ethos and, of course, this was very strongly connected with obstetrics.”
Around this time, the same sort of segregation was being promoted in hospitals, according to Ms Jones.
“There were lots of Catholic hospitals in the 19th Century,” she said.
“There were lots of Protestant foundations too, but there was an increasing number of
Catholic hospitals and in a way this also increased segregation. It was usual for people of the two main denominations to have medical education and training in a hospital which was also of that denomination and that was disappearing in Britain, but in Ireland it was actually increasing in the late 19th Century.
“Also, the religious orders were in the hospitals and that caused tension in the medical profession between Catholics and Protestant doctors. Because if you were a nun you had certain devotional duties and responsibilities which sometimes took you away from nursing and also there were certain things that they disapproved of nuns doing; things to do with men’s bits and things that could be embarrassing for a nun. It did create a degree of tension throughout the whole medical profession because there were issues there around the doctor’s authority. Secular nurses were firmly under the control of the doctors, but religious ones wouldn’t do certain procedures.”
Children’s hospital
The Catholic Church’s increasing influence on the administration of hospital care lasted well into the 20th Century and during the 1930s, the Roman Catholic Archbishop of Dublin Edward Byrne, demonstrated the extent of the Church’s power.
When he discovered that there were plans to merge Harcourt Street Hospital, which was under Protestant management, with St Ultan’s, a multi-denominational hospital for infants under one year, established by GP and political activist Kathleen Lynn in 1919, he “saw red”, according to Dr Margaret O’hOgartaigh, author of Kathleen Lynn: Irishwoman, Patriot, Doctor.
“He was convinced that they were up to something because they were not, for the most part, Catholic and he wanted a Catholic hospital,” she told MI.
The Archbishop informed John Charles McQuaid, who, at that time, was President of Blackrock College but would go on to become his successor, and together they led a campaign to sabotage the merger, paving the way for the establishment of a Catholic-run children’s hospital in Crumlin.
“They said that you couldn’t trust Dr Lynn, and that they [doctors in St Ultan’s] were in communication with doctors in Germany. They accused them of sterilisation, that kind of nonsense,” according to Dr O’hOgartaigh.
“And they also had powerful friends in the government, including people like Sean T O’Ceallaigh, who was Minister for Local Government and Public Health. In the 1930s and early 1940s it was one department and he was basically an ecclesiastical minister. He wanted Catholics in the top jobs and it was about getting your own people in to crucial places. So they got at people and it worked.”
This caused delays in building the hospital which, exacerbated by shortages of building materials throughout the 1940s, meant that it was 1956 when Our Lady’s Children’s Hospital, Crumlin finally opened.
“The sad thing is that they had money in the 1930s for a large children’s hospital. They had funding from the hospital sweepstakes so that wasn’t a problem,” Dr O’hOgartaigh said.
“It was stymied by people like John Charles McQuaid and Edward Byrne and it was mainly because they didn’t trust members of the Church of Ireland. And there were other factors too, that the Church of Ireland would have controlled its own hospitals like the Meath Hospital, Baggot Street and, most particularly, the Adelaide, and they had a policy really of not employing Catholic doctors. This was known and it was resented.”
She believes that many children died as a result of the delay in building the hospital at Crumlin.
“It’s as stark as that – politics triumphed over compassion,” she said.
“Children did die. They died in the 1930s and in the 1940s because they didn’t have a hospital. The 1940s was a time where the State was really moving into public health. There were vaccinations. It had become the cutting edge area and children lost out.”
TB control
The re-emergence of tuberculosis in Ireland during World War II caused considerable public health concern. In 1942, a year when 4,300 people died from the condition, a childhood tuberculosis expert Dr Dorothy Price, who was working in St Ultan’s Hospital, decided to take action and establish Ireland’s first anti-tuberculosis league.
The group held a public meeting in March 1943 to launch the league and invited a number of public figures whom they hoped would help promote the public health campaign, including the Roman Catholic Archbishop of Dublin, John Charles McQuaid.
The league was non-religious and its committee comprised both Catholic and Protestant members. However, Archbishop McQuaid was alarmed that the Protestant Trinity College-educated Ms Doherty was seen to be spearheading such an important initiative.
“He went to enormous lengths to go behind their backs, to actually subvert them,” explained Dr Anne Mac Lellan, who recently completed a PhD in UCD on tuberculosis in Ireland between 1930 and 1960.
“He went to huge lengths behind the scenes to ensure that this would work. He approached the head of the Irish Red Cross. He even went as far as approaching Eamon de Valera, who was Taoiseach at the time. He approached Sean McEntee, the Minister for Local Government and Public Health. He got in touch with the Minister for Defensive Affairs who would have been in charge of the Red Cross. There were activation letters and phone calls going around, making sure that this happened.”
The Archbishop refused to attend the meeting, instead sending his representative Monsignor Maloney who read out a letter stating that he believed the Irish Red Cross [at the time an association with a strong Catholic ethos] should assume responsibility for any anti-tuberculosis campaigns. The Archbishop’s public snubbing of the group had the desired effect; his letter garnered huge media coverage, undermining public confidence in the group. It also set Catholic committee members into conflict with McQuaid’s wishes. The campaign eventually faltered and was subsumed into the Irish Red Cross, ensuring that Ireland remained one of the few developed countries at that time without a national anti-tuberculosis league.
The campaign became the function of the Irish Red Cross which, Ms Price claimed at the time, set tuberculosis prevention back a decade in Ireland.
“I think that’s a little bit strong, but certainly things didn’t start to happen for may-be another five years that might have got going sooner,” Dr Mac Lellan said.
Dr Mac Lellan believes that the Catholic Church’s interference “hugely diluted the effect that might have been achieved by the group. It meant that an awful lot of the things they said they were going to do simply didn’t happen, a lot of the medical interventions and so on,” until the State assumed responsibility for tuberculosis later in the 1940s.
Needle exchange
In the 1980s, following the discovery of AIDS, intravenous drug misusers were quickly identified as a high-risk group, leading to the introduction of needle exchange programmes in many countries. Dr Colm O’Mahony, from the Department of Genitourinary Medicine (GUM) and HIV at the Countess of Chester NHS Foundation Trust, diagnosed the first AIDS patient in Ireland in 1985 and was instrumental in campaigning for needle exchange programmes to be introduced here.
“At the time I went over to Merseyside and I was working in the Royal Liverpool Hospital from 1986 and they had a needle exchange in [place] from the late 1970s,” Dr O’Mahony told MI.
“I remember writing to the Minister saying ‘this is what you have to do, Merseyside has hardly any HIV positive drug addicts now because of the needle exchange programme in the 1970s, whereas Dublin is decimated’.”
However, the proposal faced fierce opposition from the Catholic right-wing lobby and Dr O’Mahony was even informed by the Minister for Health in the 1980s that introducing such a programme would be seen as ‘condoning immoral behaviour’.
Furthermore, he recalls a leaflet being distributed by the Children’s Protection Society around the time entitled ‘67 Reasons Why Condoms Spread AIDS’.
As recently as 1991, Dr O’Mahony was still campaigning for a needle exchange prog-ramme after returning to Dublin to do some locum clinics, where he was seeing “hundreds of HIV-positive drug addicts”.
After contacting RTE to highlight the issue, he appeared on television alongside then Minister for Health Mary O’Rourke, but recalls feeling that she “wasn’t interested in talking about needle exchange. That was hugely disappointing”.
Speaking at the Irish Society of Gastroenterology conference last month, Dr O’Mahony quoted statistics that speak volumes about the impact this delay had. He said there are 40,000 regular drug injectors in Merseyside and a HIV population of around 2,500 to 3,000, but only 50 HIV positive drug users. In Dublin, almost 50 per cent of all injecting drug users are HIV positive.
“The Irish response was pathetic and disgraceful; there’s no other way to put it. Any politicians who had any part in that should hang their heads in shame,” he said.
Legacy issues
Even today the legacy of the power once held by the Catholic Church over the medical profession is still very much in evidence. Gay Doctors Ireland (GDI) were recently forced to go before the Dail and the Seanad to demand the repeal of Section 37.1 of the Employment Equality Act which specifically empowers religious “medical institutions” to discriminate against persons deemed “undermining” of its “religious ethos” or to give “more favourable treatment” to persons where “it is reasonable to do so in order to maintain [that] religious ethos”.
“Any employee working in Irish hospitals with a religious ethos or charter can be affected by S37.1, especially in terms of their initial recruitment and subsequent promotion,” GDI Chair Dr Leslie Hannon said.
“It could be argued that no doctor has actually been dismissed because of their sexuality, beliefs (non-Christian, atheist, etc.) or say, public outspokenness against the Church. However, the weight of laws like these impress upon gay doctors the type of self-censorship and discretion that enable and propagate homophobia in general, simply because they serve to downsize us and make us invisible.”
Even within the profession, a small but significant number of practitioners consider Catholic teachings in some of the decisions they make. The Irish Catholic Doctors’ Association is an active group of around 60 members which meets two or three times a year and which recently hosted the European Board Meeting of the Federation of the European Catholic Doctors Association in All Hallows College.
Chairman and Naas GP Dr John Kehoe believes that doctors should not impress their beliefs upon patients.
“The last thing I’d like to be as a Catholic, whether it’s as a parent, as a husband, a doctor or a member of society, is finger-waving,” he told MI.
“If someone wants to chat to me about religion I would rather convince them by saying ‘it’s such a great way to be’ as opposed to saying, ‘you shouldn’t do this, you shouldn’t do that’. That’s just a disaster; no-one likes being told what to do, we like to think it out for ourselves.”
As a practising Catholic, however, Dr Kehoe objects, as one might expect, to procedures such as abortion, artificial contraception and euthanasia. However, there are other, less obvious medical issues that can also cause conflict for Catholic doctors.
“The Catholic Church teaches that sex outside marriage is not good. It would be better within marriage,” he said.
“So, if a man comes to me and he has a problem with erectile dysfunction, he needs Viagra or something like that, and I know he’s not a married man, while I’m not saying I’ll refuse it outright, it’s not black and white. Some doctors would say, ‘Oh no you shouldn’t’. In that situation I’m not breaking a working system by helping him. If he’s truly impotent, then I’ve helped him restore his bodily function. My gut instinct is to say it’s quite a different thing from issues like contraception. It’s an area I don’t lose a huge amount of sleep over, but I do sometimes ask myself, ‘Could I have advised that man better?’
The Catholic communications office was invited to contribute to this feature. However, at the time of going to print no response had been received.