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Dr Peter Boylan: The National Maternity Hospital deal is dead in the water, it's time for Plan B

The former Master of the National Maternity Hospital says the Catholic ethos will never meet with that of the State and it’s time to move on.

Dr Peter Boylan

WITHOUT WANTING TO make light about what has become a very serious national issue, there has been something of the undead for the last four years about the project to relocate the National Maternity Hospital on Holles Street to the Elm Park campus of St Vincent’s Healthcare Group (SVHG).

We have been told repeatedly that legal documents – “more complex than originally anticipated” – are close to being agreed, that the Sisters of Charity are close to fulfilling their May 2017 commitment to departing, that fears about religious ethos impacting the provision of the full range of women’s reproductive healthcare are baseless, just “ideological”.

Everything, it seems, is close to being resolved, but reality tells us that nothing has actually been resolved. And so on we go, one public furore after another, no nearer to a new hospital.

Today, more than eight years after the project was announced, there are still no agreed legal documents, the Sisters of Charity still own SVHG 100%, and fears about inappropriate religious ethos in the €800 million publicly funded new maternity hospital have not been allayed. In fact they have sharpened.

I suggest that it is time now to put a metaphorical stake through the heart of this misconceived project, acknowledge that the issues are intractable and move forward for once and for all and actually build the state of the art new maternity hospital that the women and infants of Ireland deserve.

Let me explain first why this project has today run out of road and secondly, suggest a workable solution and way forward.

Catholic power

Over four years ago, I resigned from the board of the NMH, deeply disturbed after its members agreed to the terms of the Mulvey report which recommended that the hospital where I spent most of my career would be handed to the 100% ownership of the Religious Sisters of Charity.

Decades before, I and previous masters had won battles with earlier conservative Catholic board members on the question of providing sterilisation and contraception to women who considered their families complete. I could clearly see the insanity of handing the hospital into the ownership of a Catholic religious order, given the absolute prohibition in worldwide Catholic healthcare directives.

I wrote at the time that I could no longer be a member of a board “so blind to the consequences of its decision to transfer sole ownership of the hospital to the Religious Sisters of Charity and so deaf to the disquiet of the public it serves.”

I was able to make change at Holles Street in the 1990s because there is no Catholic ethos in the Royal Charter of 1903 which governs the hospital, nor in the amended Charter of 1936, nor in the bye-laws.

People are sometimes surprised to learn that the Archbishop of Dublin of the day is the titular chairman of the board, and priests from Westland Row and Haddington Road churches sit on the board. This is a historical hangover: when the original hospital opened back in 1894 the catchment area was largely Catholic and their representation was seen then as desirable.

However, it is the 100 independent governors of Holles Street who own the land, the building, and the operation of the hospital, which is why there are no problems with providing the full range of women’s reproductive healthcare there today.

At the time I resigned, I posed a simple question: Give me just one example, anywhere in the world, of a hospital built on Catholic-owned land that provides abortions, IVF and gender reassignment surgery and other procedures absolutely prohibited worldwide by the Church’s universal healthcare directives. Four years later, no one has been able to give me an example, because no such hospital exists.

Together with the obvious public interest in the State owning the land on which it wants to build a hospital entirely funded by €800 million of public money, this explains why the issue of the ownership of the land is so crucial.

With the all-party consensus today on the Social Democrats Dáil motion that the State must own the land on which the new maternity hospital has been built, I now believe that the relocation project is dead in the water.

It won’t happen

Why? Because as we saw yesterday SVHG issued a statement confirming that the shareholders of the group – the Sisters of Charity – will not sell the land to the State.

It is clear to me that in fact they cannot sell the land, even if they wanted to. Why not? The rules for all Catholic religious orders who want to sell assets are clear.

If the value is more than around €4.3 million they must apply to Rome for permission, specifically to the Congregation of the Institutes of Consecrated Life and Societies of Apostolic Life, headed by Cardinal Joao Braz de Aviz. SVHG holdings were valued at €661 million in 2018.

They went through that process a couple of years ago to secure permission for the straightforward transfer of their shareholding of SVHG to their successor company, the private charity St Vincent’s Holdings. Archbishops Eamon Martin and Diarmaid Martin, and the Papal Nuncio Archbishop Jude Okolo, provided the required letter of “Nihil Obstat” or No Objection. A blind eye was clearly turned to the issue of the NMH.

In order to sell, or gift, the land at Elm Park, however, the Sisters of Charity would have to make a fresh application to Rome. The problem now is that in the past few days, both the Taoiseach and the Tánaiste have stated with the utmost clarity that the reason they want to buy the land is to build a new hospital, in which they “guarantee” that procedures such as abortion, IVF and gender reassignment surgery will be performed.

I cannot see how the Irish Archbishops and the Papal Nuncio could possibly issue a Nihil Obstat, knowing what they now know. Rome keeps a close eye on these issues. Would it really permit such a global precedent?

Another major problem arose as a consequence of SVHG’S statement yesterday. It has seriously annoyed the Government. The Minister for Health, Stephen Donnelly, TD said as much this morning. When asked about the possibility of the State insisting on issuing a Compulsory Purchase Order, he indicated quite rightly that it is not a good idea to start off on a joint project in the courts.

He might also have said that honesty between stakeholders is an essential requirement. That has been destroyed, in my view, by SVHG’s claim yesterday that abortion, sterilisation and gender reassignment surgery are available today in their hospitals. I cannot have been the only doctor in Ireland whose jaw dropped reading that.

In fact, healthcare at SVHG is today governed by the Sisters of Charity “Health service philosophy and ethical code” which was last updated in April 2010. The Code is often referenced in job advertisements. It states clearly that:

Direct abortion is never permitted since it constitutes the intentional killing of the unborn. Also any procedures, the direct purpose of which is to destroy the embryo at any stage of its development, whether by preventing it from implantation, or removing it from the womb before it is viable, or by any other procedure is not permitted… Direct sterilisation of either men or women is not permitted in our healthcare services when its sole immediate object is to prevent or eliminate fertility. Extracorporeal conception as it is attained, for example, in the process of in-vitro fertilisation, bypasses the marital act, and is not permissable in our healthcare services.

This ethical code is standard in all hospitals around the world, sited on Catholic-owned land. The Constitution of St Vincent’s Holdings retains the Core Catholic Values of the Religious Sisters of Charity and SVHG is on the record as saying that the directors of St Vincent’s Holdings will be obliged to uphold the “values and vision” of the Order’s founder.

The bottom line is that if the State proceeds with the development of the new National Maternity Hospital project at Elm Park, not owning the land, it will have no ability to prevent Catholic ethos from dictating services there. Once again the state will have capitulated to the Catholic Church and, once again, it will be Irish women who will suffer.

That is why I say that, in my view, a Plan B is needed. I suspect that the Government is already thinking along those lines.

Government pragmatism

Last Saturday afternoon, on my way home from my local supermarket, I bumped into Minister Simon Harris shepherding James Geoghegan, the Fine Gael bye-election candidate for Dublin Bay South, around Ranelagh.

Quite naturally, we talked about the hospital. Indeed, Mr Geoghegan has been a member of the Board of the NMH since 2019. When I asked him if he had any up-to-date information, he said that he felt it was now a matter for Government.

As he continued with his canvass, Simon asked me whether I thought Tallaght University Hospital would work for the new maternity hospital. As he said, the State owns the land and the hospital.

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I think this is the most viable solution at this stage. A massive amount of work by my colleagues in Holles St has gone into designing a superb new hospital. There would need to be only minimal change in design were it to move to Tallaght which has all the requisite specialist services, is well served by public transport, and is close to the M50.

The time has come to admit the impossibility of an independent state-owned maternity hospital being built at Elm Park and move to plan B.

[With regard to the provision of abortion services, tubal ligation and gender reassignment procedures at its hospitals, SVHG said: "All medical procedures, in accordance with the laws of the land, are available in SVHG and terminations, tubal ligations and non-complex gender affirming surgeries have been carried out in our hospitals.  Patients requiring complex gender reassignment surgeries are referred, under the treatment abroad scheme to specialist centres in the UK, Belgium and Poland and are supported pre and post-surgery by SVHG consultants." A spokesperson for the group would not clarify whether the terminations and tubal litigations were provided on request from patients.]

Dr Peter Boylan FRCOG, FRCPI is a former Master of the National Maternity Hospital and former Chair of the Institute of Obstetricians and Gynaecologists. He was appointed by the Minister for Health to advise the HSE on the implementation of the Termination of Pregnancy Service in 2019. He was an expert witness at the inquest of Savita Halappanavar in 2013, and an expert witness for the family of Miss P in HSE v PP in 2015. He is the author of In the Shadow of the Eighth: My Forty Years Working for Women’s Healthcare in Ireland (Penguin, 2018) and, with Dr Jennifer Walsh, The Irish Pregnancy Book (6th edition, O’Brien Press, 2020). 

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