Madam, – Prof Desmond O’Neill’s letter (December 24th), misses the point, indeed misses many points.
The fact is that it is the Charter of the Adelaide Meath Hospital, commonly called Tallaght Hospital, which in legal terms uniquely protects the confidential relationship between doctors and their patients. In the hospital there is no ethics committee to which doctors must refer clinical cases: there is no prescriptive code of religious or denominational ethics to which all clinicians must abide as is the case, for example, in St Vincent’s University Hospital and other religiously controlled hospitals. His attempt to ascribe this factual situation as simply being my views or the views of the Adelaide Hospital Society is rather sad as he is a “senior clinician” in the hospital.
Prof O’Neill’s reference to the joint research ethics committee shared by St James’s Hospital and Tallaght Hospital is quite beside the issues raised by the case of Michelle Harte at Cork University Hospital. Research ethics committees provide oversight for research but not for clinical practice and for specific cases of individual treatment. Prof O’Neill’s references to the value of clinical audit, accreditation, the coroner (surprisingly he does not refer to the Medical Council which provides the ethical framework for doctors) as sources of clinical oversight again obscures rather than enlightens the issues arising in the Cork University Hospital case. The framework for ethical practice in Tallaght Hospital allows both doctors and patients to obtain, and, if they wish, to abide by whatever ethical or religious advice they wish: it is the presence or absence of a prescriptive written code of ethics religiously or denominationally controlled that is at issue. Those of us who respect freedom of conscience and the freedom to practise religion object to the presence of such codes in our publicly provided health services which are there to serve all citizens.
The value of the Charter of Tallaght Hospital is that it facilitates those with divergent religious and ethical perspectives to serve together in a university hospital so long as they abide by their professional codes of ethics and the laws of Ireland. It is apparent from my experience as a board member of the hospital since 1996 that very many people both inside the hospital and outside the hospital, both North and South, see it as a model for an inclusive health service in this regard.
Finally, Prof O’Neill’s rather dismissive reference to my not being a medical doctor shows perhaps that we are not yet past the day when medical consultants were perceived as the fount of all knowledge; medical ethics concern everyone and indeed lay involvement is now seen as central in medical and health governance. I do have a post graduate degree in health services management which involved the study of medical ethics and I have co-edited a valued book on medical ethics, so perhaps Prof O’Neill will allow me to state what is the actual situation in the hospital without such personalisation of any argument he might wish to make. Let us address in a mature way the important issues raised by the Harte case. – Yours, etc,