Post-the-nuns, will a pro-life or pro-choice ethic govern the St Vincent’s hospitals?

The Sisters of Charity have just announced that they are quitting their three Dublin hospitals. They say from now on the hospitals will be governed by “national and international best practice guidelines on medical ethics and the laws of the Republic of Ireland.” (What does this imply about what is happening now?)  This begs a very big question; what is the best kind of medical ethics? There is no medicine without ethics. Hospitals don’t need to be under church or religious influence but they cannot exist without an ethos.
Medicine has three main purposes: to prevent and cure diseases, and to take care of patients. It is not simply a science but also a practice inspired by ethical values. So, what is the difference with the other sciences? Take for instance mineralogy. It is the description of the chemical and physical properties of minerals. Medicine, instead, aims not simply at describing what a human body is but it is also based on the assumption that there is a natural order, which we call health, and the purpose of the medical practice is to keep or to restore this order. There is an intrinsic good (health) that we discover through science and we preserve and reestablish through practice.
For instance, anatomy and physiology tell us what is the proper function of the eyes, i.e. to see. This is not simply a description but it also contains a prescriptive element because the ideal eye is also the normative model that the doctor uses when she acts to keep the patient’s eyes healthy or to prevent their diseases.
This understanding of medicine doesn’t require a particular religious faith but it is nonetheless intrinsically ethical. It is inspired by a certain conception of the good (health) that we find in human nature through the correct use of reason. The principle of “do not harm”, which has guided health care since ancient times, has the form of an ethical imperative.
Not everything that happens (or might happen) in a hospital or a clinic is medicine, unless it aims at preventing and curing diseases, and also at the same time at taking care of patients. Not all interventions that alter our bodies surgically or chemically are medicine, even if a scientist (medical expert) might be involved. Getting your facial features surgically changed to look more like your music idol is not medicine. Killing the unborn because she was unplanned or is disabled is not medicine. Augmenting your muscles through drugs to win a weightlifting contest is not medicine. Removing a perfectly healthy organ to adjust your body to your perceived gender is not medicine. Facilitating suicide is not medicine.
In all these examples a certain level of scientific knowledge is necessary but they lack what makes medicine more than a science: the ethical value of health. They might involve someone who has a proper knowledge of the human body but his purpose, in these examples, is not to restore or preserve the good of the functioning body. They are instances of scientific techniques without good and true medical ethics.
There is a growing pressure by certain ideologies to transform medicine, which is necessarily led by an objective good that we call health, into the satisfying of the subjective requests and choices of the patient. If bodily autonomy (my body, my choice), rather than health, is the ultimate value then there is no reason why doctor should not amputate a healthy arm or leg, when requested, or administer a dangerous substance, for recreation or self-harm or death. Without the guiding principle of health, practitioners become simply the executors of someone else’s desires. Obviously, people can do what they want with their bodies but this is not medicine.
There is no good medicine without ethics. Hospitals don’t need to be under church or religious influence but they cannot exist without an ethos, without values. When their core value is not health – an intrinsic good indicated by human nature- they don’t serve medicine anymore but trends, ideologies, business.
To return to the question at the top of this article, what will be the governing ethos of the St Vincent’s Healthcare Group now that the nuns are quitting the three hospitals they founded and that come under this group? 

Anti-conscientious objection article in Irish Times very misleading

An article in The Irish Times this week presents Italy as an example of how granting doctors the right not to perform abortions can harm women.  However, the writer bases her case on some very erroneous information, never mind the substance of her argument.
Laura Fano Morrisey, an Italian pro-choice activist, begins her article with the story of Valentina Miluzzo who in 2016 died of sepsis after the doctor, for reasons of conscience, “refused to perform a termination following complication in her twin pregnancy.” This is totally untrue. He did perform an abortion and she died anyway. (See an Italian source here). Morrisey did not inform her readers of this fact.
Fano Morrisey failed to mention that two investigations carried out by the Minister of Health and by the public prosecutor established that the death of the woman was not due to the fact that the doctor was a conscientious objector. The first of the two twins was spontaneously miscarried while the second one was aborted by the same doctor who, in that particular circumstance, did not object to perform an abortion as the life of the mother was in imminent danger. So, an abortion was carried out but it didn’t prevent the death of the woman. Can this be blamed on conscientious objection? Obviously not. So Exhibit A in Fano Morrisey’s case against conscientious objection collapses.
Laura Fano Morrisey goes on to claim that the right to have an abortion “is often denied by the practical impossibility of finding a doctor and a facility what would provide one”.  While it is true that a big majority of Italian doctors will not perform abortions, there is no evidence that any woman has ever been denied an abortion because of conscientious objectors (leaving aside for the moment the fact that abortion is wrong in itself).
Then she mentions the story of a woman from Padua who had to visit 23 hospitals in three different regions before being able to have an abortion. This is also false. An inquest has established that she had an appointment for an abortion but then had an anxiety crisis and made 23 phone calls to around ten other hospitals to find out if she could have an abortion in one of those. (Italian source here) Eventually the abortion was performed as planned and according to the law that prescribes a time limit of 28 days from the first visit. In any event, in this particular region more than 5,000 abortions are performed every year so why would someone have to call so many hospitals to find a suitable one?
Before the inquest established the truth, this story had been used by Italian pro-choice activists to attack conscientious objectors, blaming them for the delay. The author of the Irish Times article should have known that.
Laura Fano Morrisey also claims that abortion doctors are “so overloaded with the number of surgeries that sometimes they cannot keep up”.  However, according to an official report presented by the Minister for Health in December 2016, the average number of abortions carried out by non-objecting doctors is 1.6 per week, in a working year of 44 weeks. Even in Molise, the Italian region mentioned in the article, the number of abortions per week per doctor is 4.7.  Hardly an overload.
In 1983 the average number was 3.3 all over Italy, which is more than twice the current value. The absolute number of non-objectors has not changed significantly since then (from 1607 to 1408, a 12% drop) while the number of abortions went down from 233,976 to 87,639 (- 62.5%). This means that the workload has constantly decreased. 
The percentage of objectors among doctors has increased but this does not affect the general provision of abortion.
Moreover, the official report notes that there is no correlation between the percentage of conscientious objectors and the waiting time for abortion. Which is to say that even in regions with a high number of objectors the waiting time can be high or low, depending on other circumstances. Molise, with the highest percentage of objectors, has a waiting time lower than the national average.  (See Table 21 of the report)
It is not true, as Laura Fano Morrisey says, that there are not enough doctors performing abortions. According to the Minister for Health, 11% of non-objecting doctors are employed in other areas, which means that the abortion service is already fully covered in their hospitals. 
The author of the article mentions a worrying trend in the increase of clandestine abortion, linking this to the growing number of objectors. Again, this claim, which is common among pro-choice campaigners, has no correspondence to reality.
Official data from the National Institute of Health (Istituto Superiore di Sanità) estimates that ‘backyard’ abortions in Italy are decreasing even as the number of conscientious objectors is increasing. In 2012, it estimated that between 12,000 and 15,000 ‘unofficial’ abortions took place among Italian women. The estimate was 100,000 for 1983, 72,000 for 1990 and 43,500 for 1995.
If conscientious objection is the problem here, then why the big decrease in so-called ‘backyard’ abortions?
In her article, Laura Fano Morrisey takes aim at conscientious objection but badly misses the target. Upon close examination of the facts, her case collapses completely.

Atheist Ireland’s secular State would reduce freedom of religion to freedom of worship

Michael Nugent of Atheist Ireland, has presented the usual litany of discrimination allegedly suffered by atheists and religious minorities in Ireland in an article for The Irish Times this week.  He calls a more secular state.  But what kind of secular State? The kind he wants would have almost no place for religion in public life. That would not respect true religious freedom.
Nugent lists various examples of discrimination, real and imagined, including even the innocuous one-minute item on RTE that shares practically nothing with the Angelus apart from its title.
Those issues mentioned in the article – denominational schools for example- have been addressed individually many times, including in the Iona blog, so I will concentrate on the ideological framework that lays behind Nugent’s comments.
In particular, I want to discuss two concepts that are often invoked, with a certain level of confusion, in these debates: the secular state, and the separation between church and state.
We often hear people invoking more separation between church and state in Ireland but are we very different, in this respect, when compared to other European countries?
Detlef Pollack is a distinguished German sociologist who has produced an index of church-state relations according to five criteria: the existence of a state church, theological seminaries in state universities, religious education in public schools, spiritual guidance in the military and in prisons, and tax privileges and financial support of the church by the state.
In a scale from 1 to 8 Ireland scores 5, in the middle. At the bottom of the scale we find France, with 2 points, while at the top (strong church/state links) there are Sweden and Norway, with 8 points, and Denmark and Germany with 7. (Note 1)  Nordic countries have kept a strong relationship between the established (or only recently disestablished) Lutheran church and the state.
Paradoxically these countries, with a long tradition of social democracy are often presented as a model by those who want a more secular state.  Still, in Ireland we have a higher degree of church-state separation when compared to them. It might be more accurate to call the Nordic countries secular societies as distinct from secular states. It should also be noted that church-state relations in these countries makes the Church very much subordinate to the State. So, what is a secular state? What model of secular state do Atheist Ireland want? Is it the one we really need?
It is interesting to note that the degree of church-separation has no statistically relevant correlation one way or the other with frequency of church attendance. Which is to say, a strong church-state relationship doesn’t imply strong or weak religiosity among the population.
Michael Nugent correctly notes that Ireland is changing fast and is becoming more secular but the ‘solution’ he offers is to push religion almost entirely out of public life and the public space. He would reduce freedom of religion to freedom of worship only. Individuals would be allowed to worship and practice according to their beliefs but the state would exercise a direct or indirect hegemony over every aspect of social life that lies outside the private sphere.
In contemporary Europe, laïcité (a strongly secular State with religion relegated to the margins) is not the prevailing model and even in France it has to face the challenges coming from the growing presence of non-Christian religions, particularly Islam.
The defenders of the laïcité model fail to recognize that between the private sphere and the public sphere, which they identify with the state, there is a whole spectrum of intermediate bodies, what it is generally called the civic society. They can be motivated not only by religious values, but also by political ideologies, common interests (sport, hobbies), etc.
It is a normal practice in all the European countries that those intermediate bodies receive state support in terms of funding, tax exemptions, special regulations. It is also a normal practice to favour one religion over the others because of its historical association with the nation. This is especially the case in historically Protestant countries.
In terms of funding bodies with a religious ethos, Ireland is not exception at all.
The radical model of the secularism (laïcité) understands the state as a monopolistic provider of services like education and health care, and only one ethos, its own, is allowed to receive public funds. (Even in France, by the way, church schools receive public funds). Other bodies are tolerated but are considered private.  This model promotes conformity rather than pluralism and choice.
The alternative to laïcité is a model inspired by religious freedom that does not relegate religion to the private sphere but recognises its value not just for the individuals involved but also for society as a whole. The work done by religious charities, associations, congregations, movements, is supported by the state on behalf of society. A diversity of values is not simply tolerated but appreciated.
So yes, let’s have a secular state by all means, but let it be a secular state that permits and appreciates and, in some cases (schools for example) facilitates religious beliefs and values. This is not the type of secular State Atheist Ireland supports, however. Their secular State would be a cold house for religious believers.

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Notes

1. Motzkin G. and Fisher Y. (ed.), Religion and Democracy in Contemporary Europe, pp. 97-98.

Fintan O’Toole mocks ethos, but he has one too

Fintan O’Toole in his Irish Times column this week ridiculed the very idea of having an ethos and mocked Catholics for having one, but can anyone really live without an ethos?
O’Toole thinks that ‘ethos’ is a Latin word. He has either never read or has forgotten about Aristotle’s Ethics, one the foundational texts of western civilisation. In the second book of this remarkable work the Greek philosopher discusses the two meanings of ethos, i.e. character and habit, and shows how they are the root of ethics. (note 1)
What we do follows from what we are and good habits follow from a good character, according to Aristotle. In the same way, the repetition of bad actions becomes a bad habit, a vice.
Fintan O’Toole, in his article, laments that those who appeal to a religious ethos, in school for instance, have changed their attitudes through time. What is supposed to be, at least in his interpretation, solid and permanent is only arbitrary and contingent.
Had he read Aristotle, he would have learned that in practical matters we deal not only with unchanging general principles but also with particular situations. In practical deliberations the task of the wise person is precisely to translate general rules into specific right actions that necessarily take the whole context into consideration.
Something might be more (or less) tolerated today than in the past not because it has suddenly became right but because the context makes a higher ideal unachievable. (This is different from doing something that straight-forwardly contradicts your ethos, for example, opposing euthanasia yesterday and supporting it today as the Brothers of Charity in Belgium have just done).
“Jesus has apparently changed his mind”, write O’Toole in his mocking way. No, he has not but in different contexts his followers will come to different conclusions even if they appeal to the same unchanged values.
O’Toole derides Catholics for their flexibility with regard to their ethos in schools. Paradoxically, he would like them to be more rigid, less arbitrary, and suggests that ethos is a word that should have no place in public services at all. But is this possible?
Even democracy, which according to him should replace ethos in public discourse, has its own moral character. It is based on the normative principle that common deliberations should be achieved through wide consensus rather than on the will of just one or a few rulers. Democracy has an ethos because everything that is good, everything that is ethically relevant, must be based on some normative principles. But is majority opinion automatically right? And if it isn’t, what ethos do we judge it to be incorrect by?
The Irish Times, where Fintan O’Toole appears regularly, has its own principles among which we find, for example, “The promotion of a friendly society where the quality of life is enriched by the standards of its education, its art, its culture and its recreational facilities, and where the quality of spirit is instinct with Christian values, but free from all religious bias and discrimination” This is part of their ethos.
Ethos is a word for unchanging values in changing contexts. Without a moral character, persons and institutions are subjected to the arbitrary control of those who are in power at the time.
Ultimately, the questions is not if we can achieve any good without an ethos. We can’t. But rather, what values, what principles, what good should lead our evaluations? What ethos? Fintan O’Toole himself has an ethos, a governing principle, his newspaper has one, we all have one.

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Notes

1. In ancient Greek character (ἦθος ) and habit (ἔθος) are very similar words.