Madam, - Brian Maurer (July 10th) raises three important points concerning the governance of any new children's hospital, the importance of paediatric services to the Adelaide & Meath Hospital at Tallaght, and the doctor-patient relationship in Irish healthcare. I wish to respond as briefly as possible to each of these.
In relation to governance, the "provision of separate governance and ownership structures" for a new children's hospital is indeed a necessary condition but it is not a sufficient one to "allay fears and apprehensions". It is vital that the precise character of "separate governance and ownership structures" is discussed and agreed. The facts are that any new children's hospital will involve the existing two voluntary Roman Catholic paediatric hospitals and one multidenominational and pluralist paediatric hospital. It is helpful that the Government has decided that the new facility to be built at the Mater hospital site will be governed on a multidenominational and pluralist basis. However, this new hospital will have to relate to, and integrate with, services in the Mater hospital, which is governed by a prescriptive written code of Roman Catholic ethics. It is not unreasonable to seek clarification as to which ethical stance will prevail in these circumstances.
The second point relates primarily to the healthcare needs of the rapidly growing communities served by the Adelaide & Meath Hospital which, alone of the hospitals mentioned by Mr Maurer, has already a National Children's Hospital co-located and integrated with its adult services. Currently it serves more than 70,000 children each year, including 30,000 in its puprpose-built, separate A&E unit, 29,000 outpatients and more than 10,000 in day and inpatient beds. We have a clear responsibility to the families we serve to ensure both access and the character of care they desire. If the hospital were simply to resile from its legal mandate, under the charter, to develop the National Children's Hospital, it would cease to be "a major contributor to Irish healthcare", as it is currently the only paediatric teaching hospital in the Republic not under Roman Catholic auspices.
Thirdly, Mr Maurer raises the uniqueness of the legal guarantee of a confidential doctor-patient relationship contained in the charter of the Adelaide & Meath Hospital, Dublin, incorporating the National Children's Hospital. He asserts that this is not a necessary protection as such a relationship is at "the core of the code of practice and ethics of all medical practitioners".
Mr Maurer must surely know that Roman Catholic hospitals operate under a written, prescriptive code of ethics which enshrines the teaching of that church. Those who work in such hospitals are obliged to adhere to this code and to treatment decisions made from time to time by a separate ethics committee. Under such a code, for example, parents do not have a right to the full range of family planning services which are legal in Ireland.
The ethical code of the Religious Sisters of Charity, who own and govern St Vincent's University Hospital, prohibits in-vitro fertilisation which it considers "not ethically justified". This ethical code states clearly that in respect of "any partnership of co-operation or source of funding that will effect our healthcare mission, the ethical identity and the Catholic ethos of our services must be respected. Our healthcare services will participate and co-operate insofar as our philosophy, mission and ethical code are not compromised".
Why does it become "deeply, though perhaps inadvertently, offensive", to use Mr Maurer's phrase, if Protestant church leaders, and indeed many other citizens, seek for their Christian ethical positions to be similarly respected and not compromised in any new arrangements? The reality is that doctor-patient relationships are always vulnerable to those who wish for a variety of reasons (which may be political or religious) to impose external beliefs systems and/or ideologies on the care provided. The unique protection in the charter of the Adelaide & Meath Hospital, far from being superfluous, is more essential than ever to vindicate citizens' rights in a republic and perhaps public policy should seek to extend it to many other healthcare providers. - Yours, etc,
Dr FERGUS O'FERRALL, Director, Adelaide Hospital Society, Adelaide & Meath Hospital, Tallaght, Dublin 24.