Public ownership does not guarantee access to free and safe abortion

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Healthcare is provided by individual healthcare professionals, not by buildings, land or legal documents. When I have a patient in front of me who needs care, it doesn’t matter who owns the building we’re in or who owns the land he’s on. What matters to me is being able to provide the health care he or she needs in a safe and dignified setting.

Anyone interested in the National Maternity Hospital (NMH) moving to its new site, on the campus of St Vincent’s Healthcare Group (SVHG), would also like to see the women in the new hospital still able to get the healthcare they need. need, when they need it.

Unlike hospitals run by the Health Service Executive which are state-owned on public land, the SVHG and NMH are voluntary hospitals, created and established by volunteers under their guardianship. At NMH, our volunteer status is very important to us, and we value it very much, as does SVHG, but why should this volunteer status be important to the public?

There are 19 maternity hospitals in the state. Three of them are voluntary hospitals like us and the rest are HSE hospitals, state owned on public land. Of the 16 HSE units, eight still do not offer a full pregnancy termination service, and women attending these units only have access to abortion in very limited circumstances.

“Complex Reasons”

You may well ask: how can it be so?

My personal opinion is that this is probably due to the fact that some clinicians in these hospitals are unwilling to offer terminations for reasons of conscience. When asked, the HSE told me that the reasons why these services are not offered in some HSE hospitals “are complex and site-specific” and that “the HSE is working towards full implementation in the 19 units”.

Three years after it became legal to do so, this lack of service represents a dismal failure of the “publicly owned on public land” model of care for providing pregnancy termination services. Voluntary maternities all offer a complete pregnancy termination service. What is absolutely clear is that public ownership of public land does not guarantee access to free, safe and legal abortion. If not, what does it do?

The guarantors and advocates for the provision of abortion, sterilization, IVF, gender affirmation services and health services for women in general are the individual clinicians willing to scale up and provide these services, in a enabling environment with appropriate legal support.

The NMH as a voluntary hospital has this enabling environment, we have the clinicians and the legal structure in place.

We will bring this with us when we move to SVHG. While until two weeks ago it was owned by the Religious Sisters of Charity, they have now officially ended their role by divesting their entire stake in the hospital and transferring their entire shareholding to St Vincent’s Holdings CLG, a new secular, not-for-profit corporation with charitable status governed by Irish law.

James Menton, the chairman of the board of directors of St Vincent, confirmed in a letter published in The Irish Times on May 4 that St Vincent is now a “secular organisation” completely free from religious influence.

Unfortunately, the doubt about potential religious influence has not been sufficiently assuaged or trust established enough by the legal assurances given, or the assurances of clinicians like me, to enable everyone to overcome their fears that religious influence may be introduced in one way or another into the legal structure. through the back door.

Legal protections

I may not be able to absolutely allay everyone’s concerns, but I can say that I have spoken extensively with our own legal advisors and am convinced, as are all NMH clinicians, that the legal structure of the accord gives all of us legal protections that we seek and need as clinicians to do our jobs without fear of interference or influence from any religious ethics.

Although the existing NMH is neither state owned nor operated, the state and public interest are protected by our service level agreement with the HSE. For all intents and purposes, we look and feel like a public hospital, but our voluntary status gives us the operational and clinical independence to respond quickly to the changing clinical needs of our patients, without having to refer a management chain to the top of the hierarchy. HSE for major decision making.

This dynamism was illustrated recently during our rapid and effective response to the Covid crisis, and three years ago during the implementation of pregnancy termination, in which we were the first hospital in the State to offer all services.

The now released legal framework gives us the clinical, operational and budgetary independence to operate as a full-fledged voluntary hospital on the SVHG campus in exactly the same way as we currently do on our current site.

The state and public interest are protected in two ways: first, by the 299-year lease at the HSE (longer than the expected operational life of the new building); and secondly with the new service level agreement that we will enter into with the HSE to provide public services.

NMH clinicians are unanimously satisfied that the strong legal protections we need are now in place to allow us to continue to provide, defend and secure the access rights of public patients to get the healthcare they need when they need it.

I call on you to support this project, because the reality of failure, due to well-meaning but ill-informed doubts, is to condemn many generations of Irish women, girls and their children to the provision of health care in establishments universally recognized as being of inferior quality.

Let’s not be the generation to let women down again.

Dr. Roger McMorrow is the clinical director of the National Maternity Hospital

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