A statue of Our Lady at St Vincent's Hospital in Dublin. Since their foundation, the Irish State hospitals were under the supervision and operation of Church orders which provided care grounded in an ethos dictated by Catholic social teaching.
Throughout the 19th and 20th Centuries, many of Ireland’s hospitals were established by religious orders, specifically orders of nuns.
But as the issue of hospital ownership becomes the focus of culture wars, with certain medical practitioners and politicians warning that the remnants of religiously held ownership of hospitals constrains the ability to provide care, it calls that more secularisation has grown rampant.
Yet, as the religious orders withdraw themselves from the operation of healthcare, many problems related to duty of care, or lack thereof, within Irish hospitals persist with warnings of religious ownership, appearing to act as a red herring.
Infections
A recent study highlighted the preponderance of healthcare-associated-infections (HAIs) within the Irish health system.
According to the European Centre for Disease Control (ECDC), over 40,000 patients pick up infections annually at Irish hospitals, with over 900 affected each day.
The report highlights how Ireland has one of the lowest levels of masking in Europe, with only 20% of hospitals continuing to wear medical masks, however hospital hygiene, or lack thereof, is a perennial problem in Irish hospitals.
While masking may contribute to infections as it relates to Covid-19, the basics of hygiene are not being adhered to in Irish hospitals.
From as far back as 2008, the Health Information and Quality Authority (HIQA) was encouraging patients and visitors to inform hospital staff to wash their hands. The report highlighted how 20% of Irish hospitals studied received a poor hygiene rating, with only 11 hospitals obtaining a positive rating.
Indeed, a similar report carried out in 2013 found that poor hand-washing practices in several hospitals was putting patients at risk of acquiring a HAI.
A HIQA inspection in 2014 of 49 hospitals, found over 20% presented serious risks to infection related to hand hygiene.
A recent inquest into the tragic death of 16-year-old Aoife Johnston in December 2022, who died in University Hospital Limerick (UHL) due to overcrowding and a bacterial infection, encapsulates the contemporary neglect of patients in modern healthcare settings.
That inquest found that neglect was a major factor in her passing, including failure to provide Johnston with antibiotics.
Almost 15,000 people contact sepsis every year, with almost 3,000 deaths recorded as a result with 60% of overall hospitals deaths related to sepsis”
This isn’t the first time a patient died in care due to tragic circumstances related to hospital malpractice.
When Savita Halappanavar tragically died in 2013, an inquest concluded that her cause of death was due to “septic shock from E. coli bacteraemia” and medical malpractice.
In response to her tragic death, Ireland repealed the Eighth Amendment to the Irish Constitution, which guaranteed the equal right to life of both mother and child, yet sepsis continues to kill patients in Irish hospitals every year.
According to the Royal College of Surgeons (RCSI), almost 15,000 people contact sepsis every year, with almost 3,000 deaths recorded as a result with 60% of overall hospitals deaths related to sepsis.
Nurses
Some have argued that the transition away from the cleanliness exhibited by the nuns might help to contextualise the issue of patient neglect further with an understanding of the duty of care offered by nuns gaining renewed impetus and analysis.
According to Dr Therese C. Meehan, who has formed generations of nurses in University College Dublin (UCD), “medical nuns are really the founders of modern nursing.”
“The nuns were intelligent and most well educated. Their deep Christian faith inspired them to love the Holy Trinity and all human beings as Jesus loved them. They were predisposed to respond immediately to the desperate human need that existed in Ireland at the turn of the 19th century. They were astute, had great initiative and determination and lived Caritas in its original meaning.”
“Nurses today find themselves powerless to implement their professional values in some healthcare settings”
Dr Meehan, who runs a website called Careful Nursing which aims to inform the medical community of 19th Century Irish nursing practices to provide a relevant foundation for contemporary nursing practice, fears that nurses today find themselves powerless to implement their professional values in some healthcare settings.
“There is not by any means a complete lack of care in Irish hospitals,” she says, however, “Many hospitals – besides Careful Nursing hospitals – provide very good care… but they are controlled by Department of Health and Health Service Executive (HSE) structures that even the best historical nuns would have trouble facing down.
Primarily, nurses run hospitals, despite career managers ongoing efforts to change this.”
Citing the UK Mid Staffordshire Public Inquiry, which exposed the neglect of patients at Stafford Hospital in which patients were left in their own urine by nurses, she mentions that, “Career managers running hospitals leads to widespread death of patients.”
“There have been similar scandals and inquiries in Ireland in hospitals where nun-like nurses were not employed”.
According to Dr Angelo Bottone, “Nuns have played a foundational role in the history of nursing, dating back to early Christianity.”
“Their tradition of ‘careful nursing’ began with figures like Phoebe, mentioned by Saint Paul. Throughout history, religious sisters provided organised healthcare within monasteries and later established some of the first hospitals.”
Nuns
Dr Bottone, who lectures in philosophy at UCD and Dublin Business School, mentions that, “During the Crimean War, nuns such as the Sisters of Mercy were pivotal, working alongside Florence Nightingale. This tradition influenced the professionalisation of nursing, underscoring the significant contributions of religious sisters to modern healthcare practices.”
When a cholera epidemic hit Dublin in the 19th Century nurse Mary Clare Moore worked with Catherine McAuley, the founder of The Sisters of Mercy, in caring for the sick in impoverished tenements.
The munificence of Irish nuns transcends even the borders of Ireland, with US President Abraham Lincoln commenting that The Sisters of Mercy showed a “benevolence seen in the crowded wards” of a “most efficient” kind during the US Civil War.
The Irish Sisters of Charity led by Mary Aikenhead established the first hospital run by nuns in 1834, St Vincent’s hospital originally located in St Stephen’s Green.
There has been a huge decline in hygiene standards in hospitals that coincided with the decline in the number of nuns managing hospitals”
The hierarchy of importance placed on cleanliness was evident in the early days of Irish healthcare.
In 1873 nursing was described as the ‘employment of the strictest decency, cleanliness and morality’ and in 1883 the Board of Superintendence of Dublin Hospitals described nursing as the ‘preservation of cleanliness.’
Even when there was no facility for hand washing in the Rotunda hospital prior to 1877, a doctor, midwife or pupil would lubricate their fingers with a napkin before examining a woman.
Yet, in recent months, hand washing compliance has dipped.
A recent report from the Health Protection Surveillance Centre (HPSC) found that national compliance of hand washing in hospitals last year dropped from 93.2% to 92.6%.
Yet, as hospital hygiene dips with a resultant rise in infections, public figures have sought to scapegoat the work of religious orders with the health issues within present day healthcare going largely ignored.
Over 40,000 patients pick up infections annually at Irish hospitals with over 900 affected each day”
Recently, plans to transition the new National Maternity Hospital (NMH) from Holles Street to the grounds of St Vincent’s Hospital was met with outrage from politicians and medical figures fearful that a Catholic ethos would dictate the service of care.
“It is clearly not possible for the Government to make any commitment or promise that Catholic ethos will not govern”
In 2017, protestors took to the streets demanding secularised care free of religious dictation.
At the time Dr Peter Boylan, a former master of the NMH on Holles Street and campaigner for repealing the Eighth Amendment to the Irish Constitution, mentioned that, “It is clearly not possible for the Government to make any commitment or promise that Catholic ethos will not govern” the new hospital given the Sisters of Charity then owned the land where it was to be located.
Sinn Féin’s health spokesperson David Cullinane said: “There must be absolute, cast-iron guarantees, in black and white, that all legally permissible services will be available to those who want them.”
Eventually, the Sisters of Charity transferred its shareholding in St Vincent’s Healthcare Group to a trust which will lease the land on which the new hospital will be built for close to 300 years.
The gifting of the land to the State received Vatican approval.
At time of writing, the hospital has yet to build, with an initial price tag of €300 million increased to €800 million.
Scapegoats
The culture war stoked by opponents of care offered by religious orders has managed to foment a perception that such care was detrimental to overall healthcare but in particular healthcare for women.
However, for Dr Eugene Jordan the scapegoating of nuns speaks to a wider weaponising of history by bad faith actors seeking to exploit the past.
There must be absolute, cast-iron guarantees, in black and white, that all legally permissible services will be available to those who want them”
He says that, “Not all religious institutions were well managed, at times, the same as the hospitals of today… but their failings are today blown out of all proportion.
“The nuns of the past mainly looked after patients in the highest risk categories with predestined poor health outcomes”, he says before adding that, “What little statistics were recorded has provided a fertile ground for present day bad actors to exploit for their own ends.”
Dr Jordan, who is an expert in the field of historical medicine and science, says that there has been a huge decline in hygiene standards in hospitals that coincided with the decline in the number of nuns managing hospitals.
He mentions that nuns were highly cognisant of the risks associated with infections in hospitals: “The nuns managed their staff in regimented fashion, where hygiene standards were applied meticulously. This is noted in several government inspectors’ reports.”