I move:
That Seanad Éireann approves the following Order in draft:—
The Adelaide Hospital (Charter Amendment) Order, 1980.
a copy of which Order in draft form was laid before Seanad Éireann on 16th June, 1980.
The Adelaide Hospital (Charter Amendment) Order, 1980: Draft Order.
As indicated in the explanatory memorandum which accompanied the draft order, the application to amend the charter of the Adelaide Hospital was made by the board of management of the hospital. Section 76 of the Health Act, 1970, gives power to the Minister for Health to make an order, on the application of the governing body of a hospital, to amend a charter or private Act relating to that hospital, subject to consultation with the Commissioners of Charitable Donations and Bequests, who have been consulted in this case and who have approved of the proposed amendments to the hospital's charter, and also subject to a draft of an order which it is proposed to make being laid before each House of the Oireachtas. The section stipulates that the order shall not be made until a resolution approving of the draft has been passed by each House.
I considered the amendments in the charter put forward by the hospital's board of management and agreed to make an order incorporating the amendments in their existing charter, which was granted to the hospital in the year 1920.
The main purpose of the amendments is to remove certain restrictions in the existing charter, particularly in clause 5 and clause 20, and also to bring up to date certain other clauses that are regarded as outmoded. The memorandum circulated with the draft order explains the various amendments.
I believe that the House will welcome the removal of the restrictive clauses, but it is only fair to the board of the Adelaide Hospital to say that, generally speaking, the restrictive clauses have not been applied in practice for many years past.
I wish to take this opportunity to thank the board of the Adelaide Hospital, and also the medical, nursing and other staff of the hospital, for the good work they have performed over the years in treating many thousands of people who attended the hospital as in-patients and outpatients. I feel sure that this good work will continue and we can look forward to the day when the services at present provided in the Adelaide Hospital will be transferred to the new hospital that is to be built at Tallaght. Representatives of the Adelaide Hospital will be included on the board that will be appointed soon to plan the development of the new Tallaght hospital.
I ask the Seanad to approve of the draft Adelaide Hospital (Charter Amendment) Order, 1980 which has been laid before the House.
We support this draft order concerning the Adelaide Hospital. The original charter was apparently granted in 1920. There has been much water under the bridge in the past 60 years. Obviously the Minister is wise to accede to the request of the board of management of the hospital to remove certain restrictions, particularly in clauses 5 and 20. We support this fully and wish them well when they eventually get the new hospital.
I welcome this order. It seems to be heading towards an even speedier passage in this House than it had in the other House on 16 October. However, I believe we should pause before we consider it merely as a slightly minor matter which can go straight through. Apparently on the surface there is nothing dramatic about this, merely a regularisation of something which has been a fact for some time. In doing so it is relevant to consider the implication of the kind of religious control which is now being relinquished in the case of this order we are discussing and the implications of religious control in any hospital situation.
I believe that the modern hospital system and the modern health care system of a country require that it is the State, and only the State, which has a right and a duty to legislate in areas which it considers to be of public concern and concerning the common good. Therefore, the Adelaide Hospital order which we are discussing today is indeed a step in the right direction. After all, the medical services of all the hospitals of Ireland cost the taxpayers of the country an enormous amount of their hard-earned money, amounting to many millions of pounds. Therefore, it seems to me that it is only the State, acting in the name of those taxpayers, who should be controlling what happens inside the hospital for which the State is paying.
I can give a case to point where religious control in a hospital like the Adelaide has implications. We know, for example, that the State has a clear law concerning the question of abortion. It is quite clear what the State's position is on that. It is quite clear to every hospital what their own positions must be on that as a result of State law. There are other areas for example, in relation to contraception where the State law, in fact, has no brief and where religious controlled hospitals may act according to ways with which the taxpayers may not agree. For example, in the whole area of male and female sterilisation procedures, hospitals which are religious controlled may take into their own hands matters which are, strictly speaking, matters for the State. Different churches have different views on what should not happen inside hospitals. They have a perfect right to hold these views, the taxpayers have a right to hold their own views and the State must legislate.
The order we are discussing today is not of such minor relevance as it might have seemed from the very rapid debate in the Dáil. I would like to quote a remark by Deputy Boland in his reply to the Minister in Dáil Éireann. The Deputy was discussing the old-fashioned ideas behind these regulations. I quote from column 161 of the Official Report of 16 October:
They laid down certain conditions governing the manner in which the hospital would be operated. Such conditions were restrictive and not in keeping with modern thinking. I do not think they are acceptable to the vast majority of the people of any religion.
I believe that was a correct statement. I can only say I am sorry it was not further developed on that day.
Another area where different churches have different views, and where I believe also it is the State's view as expressed in legislation—and that should be the view that prevails—is the whole question of terminal illness. There is very much debate on that question and the kind of actions that may or may not be taken by doctors in the case of terminal illness. I believe these questions should be legislated for by the State in consultation with doctors, churches, the people of this country and their own consciences.
I do not intend to speak too much longer. I raise these questions because I believe they are very relevant to the kind of money being poured into the hospitals, particularly some of the big voluntary hospitals in Dublin, and which I understand are being controlled by the religious of certain Churches. Therefore, I would like to draw the Minister's attention, as we applaud this order of the Adelaide Hospital, to the very real issues which are being publicly aired about the role and responsibility of the State in terms of what happens inside the Hospitals which are being paid for by the taxpayer.
I, too, would normally welcome this updating and reform of the charter of the Adelaide Hospital. I am, of course, aware that the changes are made on the application of the Governing Body of the Adelaide Hospital, and I am aware that in so far as they concern religious appointments and so on the actual terms of the charter have not been practised for many years. This has been pointed out by the Minister.
Hospitals are for the community as a whole, as Senator Hussey has said, and they are financed by the community as a whole. They should not be in the control of one or other religious group in this situation. But I would point out to the House that this motion comes before it on the same day that the Irish Independent has a banner headline saying “Dr. Ryan Wins on Hospital Ethics,” and it states: “A major victory which ensures that Catholic voluntary hospitals will continue to operate strictly according to ethical principles has been won by the Archbishop of Dublin, Most Rev. Dr. Dermot Ryan,”. Whose ethical principles I will leave it to the House to guess. The order comes before this House on the day after it was announced in the Church of Ireland Dublin Diocesan Synod that the geriatric ward in St. James's Hospital, which was hitherto used virtually exclusively for the use of elderly Protestants who wished to remain together with their co-religionists and who wished to be ministered to by their own religious pastors, is being phased out.
The amendment to clause 5 in the charter, we are told in the explanatory memorandum, is designed to remove a provision which restricts to members of a particular Church the right to hold appointments in the hospital, to vote or to take part in any of its proceedings or, except in cases of emergency, to be permitted access to the hospital, to communicate religious instruction or for any purpose of religion. The Church referred to in the Charter is the Protestant Reformed Church.
As I have said, I know these changes are agreed by the Adelaide Hospital authorities and they are, in my opinion, the right changes to make. However, I am deeply disturbed by the implication that it is right for one religious group to make the voluntary public-spirited ecumenical gesture of getting rid of these clauses in their hospital charter while another religious group is fighting tooth and nail to retain full religious control of other hospitals, other hospitals which are equally financed by the public at large. I am not blaming the Minister for Health for this. I know the size of the guns that were held to his head, but nevertheless I am deeply disturbed by it.
Given this situation, if this sort of change is made in what was a "Protestant" hospital, where the other sort of situation is being maintained in what were Catholic controlled hospitals, the end may well be that I, as a Protestant woman, am constrained to feel, "God forbid that I should have to enter a hospital in this city where I will be treated not in accordance with my medical needs but in accordance with someone else's theology". If this is the direction that our public hospitals are going to take, I am afraid I must strenuously oppose the proposed changes in the Adelaide Hospital charter. I know this went through on agreement, on the nod in Dáil Éireann, but I do not want to see it going through on the nod here for this very reason. I say this so that those numbers of our community who are not Roman Catholics might continue to have a hospital that they can trust, and I make no apologies for these words.
Before the recess of this House, when Senator Hussey was seeking time to have her Bill on rape discussed, we were treated to the spectacle of a number of our fellow Senators standing up to draw attention to the urgency of having a debate on Northern Ireland. I was born and bred in Northern Ireland and I can tell this House for certain that no amount of debate in this House will impress or affect my compatriots one half so much as seeing the Adelaide Hospital pass out of Protestant control on the same day as the Minister for Health accepts that other publicly financed hospitals are to be ruled by Roman Catholic ethics. Oddly enough, Northern people have actually heard of our Lord's saying. "By their fruits ye shall know them".
I am aware that in opposing this motion I am making what might be described as a mere gesture, but I feel that sometime, somewhere, someone has to stand up and be counted in favour of a pluralist society in accordance with our Constitution. I oppose the motion.
I would like to support the sentiments of Senators Hussey and McGuinness because there is a point of principle here and people should be aware of it. The Adelaide Hospital and other hospitals have had a Protestant tradition and in the case of the Adelaide Hospital the legal ties to that tradition are being undone by the proposed amendment. But these hospitals provide certain services that are not generally provided, certainly in the Catholic hospitals, and they may not be provided in the State hospitals. I am not absolutely clear on that. I have more knowledge of the situation in my own area in Cork where the Victoria Hospital provides certain services concerned with sterilisation for example which are not provided in any other hospitals in the South.
I would like to say, first of all, that it is a very sad state of affairs where we have Catholic and Protestant hospitals, Catholic and Protestant schools, where we cannot just have hospitals and schools but the situation is that that is the case. What worries me is that these services which are now provided by the Adelaide Hospital may be ruled out by an agreement on hospital ethics which is imposed on the new hospital in Tallaght, such as the agreement that Senator McGuinness has referred to, which is receiving a good deal of prominence in today's edition of the Irish Independent. I would like the Minister to assure us that the full range of services that the Adelaide Hospital now offers in all aspects of medicine will be available in the new hospital in Tallaght and that when the Adelaide staff transfer to the new hospital in Tallaght we will not suddenly find restrictions imposed on the medical practitioners, the nursing staff and on the options available to the patients.
It is right that this point should be nailed down and made absolutely clear because it seems to me that while on the one hand we have a situation in which a former denominational hospital is giving up its denominational ties, on the other hand we have a tightening up on the other side of certain practices which I myself could not accept as a patient and I know that my co-religionists are not prepared to accept them. They feel that services which they enjoy should be widely available and certainly they feel that if there is to be a transfer of the Adelaide to a new site all the services now provided by the Adelaide must be offered by the new hospital. I would like the Minister to make this absolutely clear when he replies to the debate.
While welcoming the usual courage which is demonstrated by Senator Hussey when she addresses herself to any of these subjects, I do not think it is altogether unreasonable that a Senator should be permitted to protest at Senator McGuinness calling on us to stand up and be counted when all that Senators can be expected to know is that they are asked to approve of an order in draft with regard to the Adelaide Hospital and not expected, I should have thought, in the contemplation of anything they might subscribe to such a debate to bear in mind what the Irish Independent might choose to put on its headlines for today relative to an entirely different matter.
If I understand the matter before the House, it is a proposal from the Adelaide Hospital, a voluntary hospital, for a change that they want in its legal situation. I would have thought that all we had to consider was whether or not what the Adelaide Hospital proposed to the Oireachtas was reasonable for us to grant. For my part I concluded that it was reasonable. I should be tempted to consider any application from a voluntary body, which had been and was dependent on the Houses of the Oireachtas for its legal operations, provided the proposal came from that body and was in accordance with our general laws, one which we should grant on the general principle of the desirability of encouraging voluntary enterprise and activity of this social and charitable kind.
I commend the Adelaide Hospital not merely for what it is now proposing but for all those who in the past served in the Adelaide Hospital. When I was young it was said that all the surgeons and doctors of the city of Dublin wore scapulars to make quite sure if they were taken ill in the street that they would be brought to a Catholic hospital. I hope that the spirit in which that remark has just been offered will be taken by those to whom it is addressed in the same spirit. In other words, that was a joke.
The matter which Senator Hussey raised is beyond the scope of what is before us. It would be worthy of a general debate, but there is much more to it than merely the question of the relationships of religious institutes with the State. There are also these fundamental questions of the relationship of the State to any voluntary body to which the State on the application of that voluntary body gives money. Take, for example, the universities. The two Senators who have spoken are elected by the graduates of two universities. These institutions receive substantial sums of money from the taxpayer. Is it to be said that because they receive substantial sums of money from the taxpayer anything the taxpayer in any given mood on any day of June decides he wants will be imposed upon the voluntary bodies because they have chosen to take taxation from this community?
I would suggest that the answer to the question put by Senator McGuinness is to be given on another day in another debate. That debate would be worthy of attention. I can see all our third level educational institutions getting into serious problems unless we face up to what is implied in the financing by the taxpayer of their needs. I would argue from a point of view which is already close to Senator McGuinness on the ecumenical side if I understand her correctly; I should have thought that it is outrageous that by virtue of the provisions of the charter of the National University there is not, and cannot be, a department of theology in the university colleges, if that is the correct view of that law which has been understood as being the meaning of the charter. It has been a great deficiency in the education of people that there has not been a department of theology. I do not say a denominational department of theology. I say a department of theology, and I would have thought that Senator McGuinness might be in agreement with me on that.
If she were in agreement with me on that, the implications of her agreement might have to be considered in relation to the other matters which have been raised. I do not happen to know what is Dr. Ryan's great victory. I do not happen to know what matters of ethics have been imposed as an agreement on the voluntary hospitals. It is worth noting that these are voluntary hospitals, that these hospitals existed for many years without any State money, that they represent acts of charity persisting over a long period of time by very noble people. I do not accept that we must turn our backs on all of that. I do not think that their usefulness is now spent.
I do not accept that as the State gives a great deal of money for health services that necessarily means that the State is adequately providing for health services. You have only to read the recent issue of Magill magazine to see the horror of our mental hospitals. Let us deal with those things that we are responsible for and turn our eyes away until we have dealt with them from these other institutions. Take, for example, the provision for the old. Is it seriously being said that there is to be a control exercised from the Houses of Parliament on the voluntary institutions established to take care of the old for which there is an increasing need? There are many other examples where voluntary activity of charities has paved the way for social developments which the State has very properly implemented but which for a long time they have equally properly left on a subsidiary level. If Senator McGuinness wants to stand up and be counted I would like to be counted with her on most things but I cannot be counted in a curious opposition to a charter which I approve in relation to a theme which the Seanad has not properly debated.
I had not intended to contribute to the debate on this draft order but I have been provoked in a welcome way by the contributions of Senators Hussey and McGuinness in raising the broader issues which lie behind the motivation of this draft order. That does not lead me to the same conclusion as Senator McGuinness, though I have a great deal of sympathy for her justified anger. It does not lead me to oppose this order. The order is a genuine step forward by the Adelaide Hospital. It is wanted and put forward by the hospital itself but I can understand and I see the relevance and the connection.
I understand the anger of Senator McGuinness in being asked to approve this order today and seeing and reading the article in the Irish Independent relating to the apparent victory in relation to an ethical code which appears to be going to be part of the contract for consultants in the voluntary hospitals which are under the general auspices of the Archbishop. There is a relevance, and even though this matter is not before the House and it may not be fair to Senators who did not read the article in the Irish Independent, the Minister has been involved. He has approved the adoption of this code and it will be incorporated, as I understand it, in the contract of the consultants.
I would ask the Minister to give a full and clear explanation to this House of precisely what has been agreed, precisely how it was agreed, what its effects will be in relation to the voluntary hospitals, and also to give the kind of assurance looked for by other Senators, including Senator West, relating to the future of the Adelaide Hospital now that it has voluntarily taken what I regard as an important step. This may be a sensitive and difficult area.
The Minister's opening speech did not make it clear what was in the proposed draft order. He seemed to go out of his way to be oblique by referring to the earlier explanatory memorandum, which had been circulated. We need not be oblique. We need to be very open, very clear and very honest. I share a great deal of the concern and anger expressed by Senator McGuinness. It does not lead me to the same conclusion. I approve of this draft order but I think that there is a direct relevance. It is not the first time in this House that a matter which has come before us by way of draft order or draft Bill has been related to something that happened on the same day or the day before or has been commented on in the daily newspapers.
The House is entitled to an explanation from the Minister. It is not a question of purely voluntary activity by purely voluntary bodies. The State is directly involved. The State will be negotiating these standard contracts. The State will be paying these consultants, and we are entitled to know in detail what the negotiations were, what the agreement was in relation to this ethical code, what its impact will be and in what way it is to be adopted in the voluntary hospitals.
I would like to support this draft order. It is an excellent move on the part of the board of the Adelaide Hospital, which we should all welcome. This is a very old hospital. It has a very great and deserved reputation in this city, and indeed abroad. We are privileged to have in Dublin the calibre of the consultants, the resident staff, the nurses, the students and the many people associated with the Adelaide Hospital, and not least the community concerned which has given so much support down through the years to the Adelaide Hospital. Nonetheless I am somewhat disappointed that there should be a reaction to this very worthy order in the very best sense of the word, the very worthy move by the Adelaide Hospital which we are simply and quite rightly supporting and that this should have been coupled to these rather unfortunate comments which could well have been brought up in a totally separate and different manner entirely. I feel that this move on the part of the Adelaide Hospital is something which we should welcome in an open spirit.
I would like to answer some of the points which were made. There is some misunderstanding about what exactly is being done. We would want to bear in mind that the charter of the Adelaide Hospital held certain clauses which were regarded by the hospital as being particularly restrictive and something which they wanted to get away from. Some of these—I will just paraphrase them—were that unless one was a Protestant one could not hold an appointment, one could not vote at meetings or take part in a meeting, one could not even be admitted as a patient without being a member of the Protestant Reformed Church, one could not communicate religious instruction or any purpose of religion. There are some other changes then which are of a more minor nature. Another one was:
That our United Kingdom of Great Britain and Ireland becomes Ireland.
It is important to bear in mind that notwithstanding these changes the charter still states, for example, in Clause 5 (e):
To maintain the Fundamental Principle upon which the Adelaide Hospital was established:— that the Society should be and remain an essentially Religious and Protestant Institution.
It is the words after that which are removed, The words removed are:
and that no person shall at any time be eligible to hold any appointment in connection therewith, or to vote or take any part in any of its proceedings, or except in cases of emergency, be permitted access to the hospital to communicate Religious Instruction, or for any purpose of Religion whatever who is not a member of or does not profess the doctrine of the Protestant Reformed Church.
Those parts from "and" down to "Church" are removed and it just remains that "the society should be and remain an essentially Protestant Institution". It would be wrong to think that the character of the hospital was going to change. These very restrictive clauses were there and under this measure, which we are proposing to take now on request, would be removed.
It is also important to bear in mind that because there was a charter you had very restrictive clauses like this. In the case of the Catholic hospitals you did not have charters and you did not have clauses of that nature, so the comparison directly does not arise in that sense.
Senator FitzGerald spoke very eloquently about the nature of our hospitals In a way he has answered part of what I felt needed to be said. We have voluntary hospitals, some of which are Protestant in character and some of which are Catholic in character. We have health board hospitals and we have a mixed system. That is our practical position at this time. Our voluntary hospitals have given tremendous service to the country and are known to have the very highest standards. That is the position that we have within our society.
It is important to recognise that in going to Tallaght the Adelaide Hospital would then become a part of a major general hospital on which the Minister would appoint the board. The Adelaide would have three out of 14 representatives on that board, Five members would be appointed by the Minister, two by the Eastern Health Board, three by the Adelaide Hospital, three by the Meath Hospital, which is also proposing to participate in the new Tallaght hospital, and one by the University of Dublin, giving a total of 14 board members. That board would control the Tallaght Hospital. That may explain the nature of the development which is likely to take place there. It is towards a hospital which would be controlled by a board. I have also made it clear that the control of the Adelaide Hospital will still remain with the board of the Adelaide Hospital.
The question of the article in today's paper was raised. I was surprised at the article, which to me seemed somewhat misleading. What has in effect happened is that the Irish Medical Association voted by a very narrow margin against participation in the common contract. The figures which were given were of the order of 47 per cent for, and 53 per cent against participation in the common contract. In contrast the Medical Union voted 73 per cent in favour and the balance, 27 per cent, against participation in the common contract. This was the major problem which arose in relation to the common contract. That matter has been discussed for quite some time to try and find what clarifications were required by the Irish Medical Association in particular to finalise the matter. These discussions had been progressing quite favourably. Nevertheless, the time was becoming quite protracted.
The other aspect which was raised then by certain voluntary hospitals and by a spokesman on behalf of certain of the voluntary hospitals was the question of ethics and ethical principles. It is accepted that a voluntury hospital has a right to its own ethical code within that hospital. In that context there have been lengthy discussions on an ethical contract which would apply to a particular voluntary hospital because the character of that hospital would be in the nature of the character which was desired by the board and management of that hospital, whether it was a Catholic hospital or a Protestant one.
Those discussions are still in progress, and we are hoping that they will be concluded shortly and that it will become possible for those hospitals to participate in the common contract. Notwithstanding that I gave the decision only last Friday that the common contract will go ahead one way or the other from 1 April. There are a variety of administrative and other reasons which dictate this date, and they are fully accepted by the union involved. It will go ahead from 1 April. The opportunity is given to those voluntary hospitals—there are only a limited number of voluntary hospitals who have raised these queries—to have them clarified and sorted out before that time. It also gives an opportunity for the Irish Medical Association, if it wishes, to finalise its position. The contract will be a contract with the individual and it will be taken up by the individual. Some of the individual consultants may not wish to participate in a contract in any event, in which case it will not be compulsory on the existing consultants. I hope that makes that position clear.
I would just like to thank the Senators for their contributions. I am not sure if any Senators wish to speak further on the matter. I believe that what the Adelaide Hospital is doing here is certainly a very desirable thing and I have no hesitation in putting it to the House. I hope that the House will have no hesitation in approving of it.
Will anything like the contract situation arise in the health board hospitals?
The health board hospitals are extremely anxious to have the contract. The contract they will have is the common contract. It is only in a certain limited number of voluntary hospitals that the other question was raised. There is disciplinary procedure within health board hospitals which is agreed as part of the contract. There will be a committee of the consultants in the hospital who will manage their own hospital within the board of the hospital. They have their own management structure, which has been discussed for some years. The question was: would this go on inevitably being discussed or would a decision be taken about it? The decision was taken by me as Minister rather than, as might be suggested, by articles in the newspapers.
Question put and declared carried.