Bishop John Keenan of Paisley It is essential for the doctors of today to fight for the rights of the doctors of tomorrow, writes Dr Keith Holmes
Several generations past in Ireland, the vast majority of doctors were Catholics who came from Catholic families; if, as students, they wished to go to Trinity College, then various ecclesiastical permissions had to be sought. The Constitution upheld the values of the Catholic Church, clericalism was rife and it was far easier for a Catholic doctor to ‘practice in accordance with his conscience’, because to fail to do so would invite all sorts of consequences.
When the oral contraceptive pill became available, its dual function as a treatment for menstrual irregularities – as well as being a contraceptive – led to something of a grey area which, while creating its own difficulties at the time, now seems almost quaint in hindsight.
Ireland seemed in some ways protected from the horrors of abortion and euthanasia which were increasingly prevalent within wider European society and beyond. The phrase “it could surely never happen here” was implicit.
Fast forward to the current day and the vista is changed utterly, with changes so drastic that it is, in many ways, a different country. In particular, the recent overwhelming vote to repeal the Eighth Amendment caught most people by surprise in its scale, and even more so by the triumphalism which greeted the result.
Some years ago, a group of Irish doctors working in Ireland, who had all worked abroad, came together to set up the Irish Catholic Doctors’ Learning Network (ICDLN). Each of these doctors, having worked abroad, was concerned at the role of the doctor where they practiced in these various countries and could see such changes fast approaching in Ireland.
Reassurance
Nonetheless, there was some small reassurance at the fact that that in other countries, all of which were secular, there was a certain recognition of the belief system of doctors and an acceptance of their conscientious objections.
There was a fear that the creeping secularism within Ireland at the time would result in a “death by a thousand cuts” for the right to practice medicine in line with one’s Catholic Faith.
There was also a growing awareness that doctors with conscientious objections would find themselves isolated, without support and without knowing where to go for support. In addition, there was an awareness that our education in bioethical matters, such as it was, was enormously deficient and could not keep pace with the rapidly changing technology, especially regarding creation and destruction of human life, but not restricted to these.
We now find ourselves in a situation where abortion has become legal, and in a far more permissive fashion than could have been imagined, and indeed doctors themselves seemed to have been very much in favour, although there does remain a sizeable number who are keen for abortion to be available but do not wish to be part of its provision themselves.
The next ethical battleground will inevitably be end-of-life issues. We know from the developments in Britain, with the Liverpool Pathway, that decisions can be taken very readily regarding the appropriateness or otherwise of resuscitation, which can rapidly result in the withholding of food and fluids and the ‘easing of pain’ with morphine which results in a very rapid demise.
While many platitudes are uttered about the importance of end-of-life care, unless it is predicated on an absolute respect for human life, then the slippage, so acutely identified by Pope Benedict as “moral relativism”, results in evermore quickly shifting sands.
There is a wider debate beyond that of being a Catholic doctor, relating to what actually defines Catholic healthcare and whether or not the voluntary hospitals – many of whom are Catholic – can in fact uphold their mission statements in the face of predicted threats of funding cuts.
The role of the voluntary sector within healthcare is currently being examined by an Independent Review Group, which has yet to report, but given the aforementioned level of slippage and the fact that we are currently living in a country which is not merely secular but highly reactionary, one would not be optimistic.
The Consultative Group on Bioethics and the Council for Healthcare of the Irish Catholic Bishops’ Conference has recently published the Code of Ethical Standards for Healthcare, outlining the position of the Church on a variety of aspects, seeking to explore the meaning and significance of health and of healthcare, as well as the appropriate goals of medical interventions and how they are understood in the Catholic tradition.
This is a most welcome and useful document and hopefully will reach a wide audience who will reflect on its contents and engage in the discussion.
It is in this context that the ICDLN is organising its fourth annual conference which will take place on Saturday, December 8 in the Emmaus Retreat Centre in Swords in Co. Dublin, to bring together medical professionals to discuss many of these issues.
Speakers include: former Taoiseach, John Bruton; senior counsel and medical doctor, Dr Ciaran Craven; the bishop of Paisley, Dr John Keenan; former member of the Irish Medical Council Dr Bairbre Golden; and Dr Aisling Bastible.
The issues for discussion include the ethics of conscientious objection in healthcare, delivery of medical care to those in disadvantaged circumstances, implications of the new laws on abortion in Irish healthcare, as well as effecting change in a secular society, among other topics.
It is essential for doctors of today to be mindful of doctors of tomorrow. If we give ground and yield, or indeed if we do not make explicit our objections to the current direction of travel, then it will be all the harder for those coming behind us.
For them, for us, for the patients we serve, and indeed for society as a whole, we must continue to uphold our beliefs, to avoid becoming purely defensive, because what we have is worth standing for and protecting.
Dr Keith Holmes is a consultant child and adolescent psychiatrist.