The State must respect the conscience rights of pro-life hospitals

The Irish Catholic Bishops’ Conference has recently published a long document (The Code of Ethical Standards for Health Care) that gives directions to Catholic health care institutions such as hospitals, nursing homes, hospices, etc. The Code is particularly important now that Ireland has voted to repeal the 8^th amendment.

The document covers a variety of topics and restates that Catholic hospitals must not perform direct abortions: “No healthcare facility or practitioner should provide, or refer a patient for, an abortion, i.e. any procedure, treatment or medication whose primary purpose or sole immediate effect is to terminate the life of a foetus or of an embryo before or after implantation. Such procedures, treatments and medications are morally wrong because they involve the direct and deliberate killing of, or a direct lethal assault on, an innocent human life in the earliest stages of development” (2.24)

The Code makes no reference to the recent referendum that removed the 8^th amendment, or to the law that might follow from it. Nonetheless, the document by the Bishops, which is based on non-negotiable Catholic principles, has been criticised by Minister Harris and other politicians who claimed that there is not such a thing as institutional conscientious objection. Only individual doctors should be allowed to object to perform abortions. Moreover, state-funded hospitals are expected to follow the law, they said.

The ethos of a hospital is the equivalent of the conscience-identity of an individual, as it inspires all their actions and decisions. Indeed, we deem not only individual but also institutions accountable for their choices and acts precisely because we assume that not only individual but also institutions have a moral conscience, a set of principles by which they must act.

The Code says: “The ethos of a healthcare institute has the character of an ‘institutional conscience’. It contributes to the formation of politic and the making of judgements in a manner which is consistent with reason. The ethos of the institution guides the institution in identifying both its operational priorities and the activities in whish it cannot participate with integrity”. (8.19)

When the ethos of an institution is in conflict with the law of the land, there are four possible responses from the institution: act against the law, act against conscience, act according to conscience because the norm can be evaded with some expedient, or act according to conscience because the law allows for exceptions in case of conflict. This last option is the preferable solution for reasons that I am going to explain.

First, a Catholic hospital might decide to intentionally and publicly break the law, as a form of civil legal disobedience, in order to point out the injustice of a norm. This might have some long-term effect but it requires a high level of courage and commitment. This resolution would be appropriate only when other moral options are not available.

Alternatively, some religiously inspired institutions might betray their own mission, act against their ethos, and conform to the new requirements. Obviously, they won’t be Catholic anymore. Acting against conscience, particularly because of interest or pusillanimity, is never right and the state should never push individuals or groups in that direction.

A third option is when the institution finds some way to evade the requirements of the law. This has often a cost, not only for the institution but also for the community that it serves. We can imagine, for instance, that the new abortion law will require only hospitals receiving public funds to perform abortion. In this case a Catholic hospital might decide to refuse public funds and reduce its activities, or to close down its maternity department and continue to offer its services in other areas. Its ethos won’t be compromised but no one will win from this situation. Indeed, what interest has the state in seeing a service that has been proven useful, if not essential, to a community, discontinued? Moreover, if the interest of the state is to make abortion available to women, this won’t happen anyway if the hospital terminates, partially or entirely, its services for the state. If the government will push its policies into this direction, it will only undermine its goal.

This third option is only beneficial to the state if it leads Catholic hospitals to become disloyal to their history and mission, and act against conscience (second option), which is profoundly unjust. Otherwise it creates a situation where both contenders lose.

A fourth, more reasonable and just option, is to grant institutional conscientious objection, i.e. to permit to a hospital or a clinic to continue to provide medical care but without the obligation to offer abortions.

This is a fair solution that balances the rights of religious inspired institutions and the legal duty of the state (post-repeal) to assure that abortion services are offered in Ireland. (Obviously, it is only balanced when those services are offered by other non-objecting hospitals or clinics.)

The current draft of the abortion law does not contain such an opt-out and, as I have already shown, it presents a quite narrow understanding of conscientious objection. See here:

Minister Harris should acknowledge that institutional conscientious objection is internationally recognized. For instance, forty four states in the U.S. allow institutions to refuse to provide abortions. The American Medical Association (AMA) adopted a policy on abortion stating: “Neither physician, hospital, nor hospital personnel shall be required to perform any act violative of personally held moral principles”. (Health Policies of the House of Delegates, “Abortion”, 5.995)

Likewise, in 2010 the Parliamentary Assembly of the Council of Europe approved a resolution stating that “No person, hospital or institution shall be coerced, held liable or discriminated against in any manner because of a refusal to perform, accommodate, assist or submit to an abortion.” Many European states recognize the right to object to abortion not simply to individuals but also to institutions.

Minister Harris said that state funded hospitals are expected to follow the law. Of course they are but at the same time there is no reason why the law should not contemplate conscientious objection for individuals and institutions, as it happens in other countries.

Denying this right would be unjust because it would force religious institutions to act against the principles inspiring their healthcare, but it would also be detrimental, because it would deprive communities of certain health services now provided by Catholic hospitals.

What really reduces teenage pregnancy; social media

British abortion provider, BPAS, have just produced a survey of teenagers dealing with the decline in teenage pregnancy rates. It turns out the big factor, despite all the hype, isn’t sex education at all, but social media and the fact that, as a result, teenagers spend a lot more time in the family home rather than meeting such other face to face. Our policy-makers should take note. The fact that the findings are from BPAS should doubly cause them to take note.

The UK has always had the highest rate of teenage pregnancy in Western Europe but over the last twenty years those rates have experienced a rapid decline. In 1969, the conception rate per thousand women aged 15-17 was 47.1. It reached 18.9 in 2016. (p. 3)

Unfortunately, in the same period there was no similar drop in teenage pregnancies leading to abortions. In fact, the abortion ratio among teenagers has increased from 31.6% all of conceptions in 1995 in England and Wales to 51.4% in 2016. (p. 4)

So, fewer teenagers are now getting pregnant but, among those, the percentage who choose to abort their child has gone up.

The report acknowledges that there is no clear consensus as to what factors have driven the decline in teenage pregnancy rates. Social policies like sex education may play some role, but a growing and now dominant factor is the internet and its impact on socialisation.

Teenagers spend a significant amount of their time in the family house or with family members. An average of almost five hours a day is devoted to online activities for non-work or non-study purposes. Between 60% and 90% of social interaction with friends is conducted online, according to the study.

This profound shift in the way young people communicate and socialise with their peers is the major factor in the decline of teenage pregnancies. Young people who socialise more face to face with their friends are also more likely to be sexually active, while the growing time spent online is now reducing their opportunities for sexual interaction that could result in a pregnancy.

For the same reasons, alcohol and drugs consumption has fallen dramatically among young people. Compared to the previous generation, current teenagers present lower levels of alcohol consumption and of binge drink because they socialise mostly on the internet. As alcohol and drugs are linked to riskier sexual behaviour, the decline in their use has significantly contributed to reducing the pregnancy rate.

High-quality (but what is ‘high quality’?) sex and relationship education (SRE) might be another factor in the diminution of teenage pregnancy rate but the respondents to the BPAS survey had an overwhelmingly negative view of the SRE they had received. (p. 31)

Of significance is that the efficacy of contraception in reducing teenager pregnancies is generally overestimated. Indeed, the decline in teenage pregnancy has coincided with the closing of contraceptive services in parts of Britain.

As the report states: “Teen conception rates have declined despite the closure of contraceptive services across the country which may in turn be hampering young people’s ability to access contraceptive advice and support when needed. Therefore, while the uptake of long-acting methods of contraception will undoubtedly have had an impact, our research indicates that this alone cannot be responsible for the ongoing and significant decline in teenage pregnancy rates.” (p. 22). (In 2015/16, 30% of women aged 16-18 who attended contraceptive clinics reported using long-acting contraception methods.)

Commenting on this, Prof. David Paton has highlighted elsewhere that the biggest reductions in teenage pregnancy have happened after significant cuts to government programmes, questioning their effectiveness. (See here and here)

Our policy-makers have a naïve faith that school sex education will do wonders for our young people. The evidence for this is thin, to put it mildly.

It is somehow comforting that even the report by BPAS confirms our scepticism.

Marriage breakdown in Ireland: higher than we think

We often hear that Ireland has a low divorce rate compared to the rest of Europe and particularly to the UK. This is correct, but we can’t afford to be complacent because for every four couples who marry in Ireland each year, roughly one couple go their separate ways. That is probably higher than many people realise.

In order get a clear picture of marriage breakdown in Ireland we need to add together the number of people who applied for divorce to the number who applied for a judicial separation. There will be some overlap between the two because some people who apply for divorce in a given year might have previously been legally separated, but it brings us closer to the true situation than looking at divorce only.

In 2016, there were 4,179 applications for divorce, 1,353 applications for separation and 33 applications for nullity. 5,565 applications overall.

When compared with the number of marriages in the same year (21,570), we see one application every 3.87 marriages. Roughly, more than one marriage breakdown for every four new marriages. This is definitively not a good sign.  The ratio was 4.06 in 2004 and 4.14 in 2010, which means that family breakdown is growing, and it has never been so extended.

The crude marriage rate (number of marriage per 1,000 persons per annum) for Ireland was 4.8 in 2016. It was 5.2 in 2004 and 4.3 in 2011 when, during the recession, it reached its lowest level on record. Even if fluctuating, the overall trend shows a continuous reduction of the number of people who are getting married. In the early 1970s the figure exceeded seven at one point.

The crude divorce rate is calculated on the number of people who get divorce in a year out of 1,000 persons, and it was 0.6 in 2013. If you add in separations the figure moves closed to 1.0.

Let’s now compare Ireland to our neighbours.

In England and Wales in 2014 (latest available figures) there were 113,296 petitions for divorce or nullity, and 247,372 marriages. A ratio of 2.18. This means that for every two new families which are started, one is broken. That is twice the Irish figure, but the British figure is very high indeed.

The crude marriage rate in 2013 was 4.3 per 1,000 persons, and this is not significantly different from Ireland where, in that same year, it was 4.5.

The crude divorce rate (number of divorces in a year out of 1,000 people) has decreased from 2.8 in 2004 to 2.0 in 2013 but this trend is a necessary consequence of the fact that less people are getting married and more are cohabiting.

Ireland is becoming very much similar to our neighbours in terms of number of people who get married, which is to say, the marriage rate is low. On the other side, marriage breakdowns have not reached the British levels by any means but, as mentioned, there is zero room for complacency. In absolute terms, a lot of people in Ireland are suffering broken marriages.

Sources:

Eurostat

Office for National Statistics

Central Statistics Office

Marriage in Ireland compared with other EU countries

In 2013, 2.1 million marriages and 943,000 divorces took place in the European Union. This is the equivalent of 4.1 marriages and 1.9 divorces for every 1,000 persons.

How does Ireland compare with the rest of Europe?

In the same year, the crude marriage rate (number of marriage per 1,000 persons per annum) for Ireland was 4.5. This was 6.4 in 1980 and it is expected to decline to 4.0 in 2030, according to a recent study. 

Instead, the crude divorce rate (number of divorces in a year out of 1,000 people) was 0.6 in 2013. This does not include the number of Irish people who separate without divorcing. (More here: https://ionainstitute.ie/marriage-breakdown-in-ireland-higher-than-we-think/ )

When analyzing cohabitation, marriage, separation and divorce, Europe can be divided in three parts: North-West, Southern and Eastern. In North-West Europe cohabitation is more prevalent and marriage happens often after the birth of a child. While in Southern and Eastern Europe marriage remains more common, even if the number of children born out of wedlock is increasing. The age at marriage is higher in North-West Europe, compared to the rest, but the age of women’s first union, which includes cohabitation, is lower. Informal unions tend to be rather fragile and their breakdown is not recorded, as it happens with marriages and divorces.

Marriage rates have never been so low in Europe. It went from 7.8 per 1,000 in 1965 to 4.3 in 2015. This represent almost a 50% decline. The divorce rate went from 0.8 to 1.9 in the same period. We need to remember that divorce was introduced after 1965 in countries such as Ireland, Italy, Spain and Malta. These figures don’t show the percentage of marriages that break down but, rather, the proportion of divorced people in the general population.

The highest crude marriage rates in 2013 can be found in Cyprus (6.4) and Lithuania (6.9). The lowest in Slovenia and Bulgaria (3.0). The EU rate was 4.1 and Ireland’s rate was 4.5, somewhat above the average but far lower than a few decades ago.

In 2013 the lowest crude divorce rate could be found in Ireland (0.6), in Malta (0.8), where divorce was introduced only two years earlier, and in Italy (0.9), which also had a low marriage rate (3.2).  Low divorce rates have always been more prevalent in Southern and Eastern Europe, while the highest could be found in Latvia (3.5), and Lithuania or Denmark (3.4).

In recent years some countries have provided more rights and sometimes even legal recognition to non-marital unions (civil partnership, same-sex “marriage”). This makes more difficult to compare countries with a variety of different legislations but also to match past figures with current ones. If we also take into account the growing rate of cohabitation, which is not officially recorded, one could say that statistics about marriage and divorce do not really present the complex reality of romantic unions and their dissolutions.