The "Catholic ethos" is not to blame for what happened at Drogheda Hospital, writes Bishop Donal Murray.
Far from justifying unnecessary hysterectomies, the ethos of Catholic healthcare is the service of the dignity and rights of the patient.
Following the publication of the recent report into the activities of Dr Michael Neary at Our Lady of Lourdes Hospital in Drogheda, it has been suggested in some quarters that the Catholic ethos of the hospital was, in some perverse way, responsible for his behaviour.
The care of the sick and the ministry of healing have been an integral part of Christianity since its very origins. There is no fundamental conflict between the ethos of the Catholic Church and the professional ethos of healthcare. There may be, however, some misunderstanding as to what ethos means.
Many professions have their own unique ethos, which is related to the raison d'etre of the profession. As a matter of principle, journalists do not reveal their sources. If they did, people would not speak freely to them, and they would be unable to carry out their professional responsibilities. Among seafarers it has always been accepted that, in case of an emergency, the captain is last to leave the ship.
The objectives of the healthcare professions can be described in terms of the prevention of disease, the healing of the sick and the relief of pain. Since the time of Hippocrates, healthcare professionals have promoted certain fundamental ethical principles which are intended to ensure that their skills and privileged access to patients are used in a way consistent with the meaning and purpose of healthcare.
The ministry of healing has always been understood among Christians as an expression of the compassion of Christ. In medieval times this ministry to the sick was carried out by the various "Hospitaller orders", among them the Order of Malta. In more recent centuries, within the Catholic tradition, religious congregations were established which specialised in the care of the sick, especially those who could not afford to pay for treatment. Among these were the Brothers of St John of God, the Sisters of Mercy, the Sisters of Charity and the Order of St Camillus.
Like any agency which has worked in a particular field for a long time, the Catholic Church has an enormous wealth of experience in the field of healthcare. Alongside that experience, the church brings to healthcare the wisdom of centuries of reflection on the meaning of human life and the dignity of the human person. While many healthcare facilities were originally established by religious, this wisdom and experience has been developed in partnership with the many doctors, nurses and other healthcare professionals, who were trained and have worked in healthcare facilities inspired by a Catholic ethos.
Any worthwhile ethos is fundamentally positive. A Catholic ethos of healthcare, of its very nature, is focused primarily on providing the best possible care to every person who is sick, or at risk of being sick. For that reason Catholic healthcare facilities must seek excellence in education, in treatment and in medical research. Catholic moral teaching is often presented as if it were simply about saying "no" to all kinds of things.
The church, in operating healthcare facilities, must certainly respect the freedom of conscience of both patients and staff. But respect is a "two-way street". In treating a patient, the doctor does not simply do whatever the patient asks. The health professional brings his/her skill and ethos to bear on the treatment that will be offered.
From the beginning, the Hippocratic Oath forbade doing anything that the physician knew to be harmful to the patient. Healthcare workers and agencies - including Catholics - cannot be obliged to provide facilities or services which conflict with their conscience or religious beliefs. In the final analysis, irrespective of whether religious orders continue to manage healthcare facilities, there will always be a Catholic ethos of healthcare.
At the heart of the crisis of ethics in modern society is the division between those who believe that morality and values are fundamentally related to facts, and those who believe that morality and values only have to do with feeling. How can we talk about how something should be treated - let alone a human being - if we ignore the reality of what it is?
Traditional Catholic morality argues that personal rights derive from the fact of being a person. Where healthcare is concerned, therefore, a Catholic ethos always begins from the position that the fundamental value to be promoted and respected is the patient as an integral person (not simply as a body, an intelligence, or indeed a soul). The ethical evaluation of any healthcare procedure will be determined by its implications for the person as a whole, and not simply by its practical consequences.
Two principles are essential to the Catholic ethos and indeed to bio-ethics in general:
1)The principle that medical interventions require the informed consent of the patient. This means that the patient should, before hand, be clearly informed and understands the reasons for the proposed action, the risks it involves, the consequences and that he or she freely consents. In an emergency situation, when the intervention is urgent and necessary, such consent may be presumed. If the intervention is not truly necessary, then this principle is not fulfilled.
2)The principle of totality is well established in Catholic ethics. Simply stated, this principle holds that, while in general it is wrong to harm the body, it is justifiable to harm the part when this is necessary to heal or save the whole person. Like most ethical principles, it is only common sense.
The removal of the uterus might be ethically justified, for example, if cancer of the uterus was diagnosed, and no other less-invasive treatment was considered likely to be successful. Even under such circumstances, a decision would not be taken lightly, given the implications for the fertility and well being of the woman.
Bishop Donal Murray is chair of the Irish Bishops' Committee for Bioethics.