Will Ireland’s Catholic hospitals defy Varadkar?

Leo Varadkar: hospitals cannot opt out (Getty)

When Pope Francis visits Ireland this August, he will find a nation changed beyond recognition since Pope John Paul II visited in 1979. The country that 40 years ago looked like an outpost of traditional Catholic life has seen a spectacular collapse in the faith and an exodus from a scandal-hit Church. The recent landslide vote to repeal the Eighth Amendment to the constitution, which underpinned the country’s strict abortion law, demonstrated this change in the most dramatic way.

Pope John Paul’s visit saw enormous crowds responding to his charisma, though in retrospect it looks more like the swansong of the old Catholic Ireland than the revival many hoped for at the time. Pope Francis will face a very different environment. The crowds will be large, though on nothing like the scale of 1979. But also, while John Paul enjoyed almost universal deference, Francis – despite his personal popularity – will be loudly admonished by Irish politicians and media for being “behind the times” on sex and gender issues.

Even though Leo Varadkar’s government was keen to get the abortion referendum out of the way before the papal visit, the result has not taken the issue off the table. Instead, it has opened up new questions as the government moves to clarify its proposed legislation.

While answering parliamentary questions on June 12, Varadkar was pressed by the Socialist Party’s Mick Barry to state that under the proposed legislation Catholic hospitals would be required to perform surgical abortions.

Varadkar replied: “The model we intend to follow for the abortion legislation … will allow individuals to opt out based on their consciences or religious convictions but will not allow institutions to do so.

“As is the case under the Protection of Life During Pregnancy Act 2013, hospitals such as Holles Street, which has a Catholic voluntary ethos, the Mater, St Vincent’s and others will be required and expected to carry out any procedure that is legal in the state.”

He added: “Conscientious objection provisions will apply to individual doctors, nurses and midwives who do not want to participate in providing abortion services, but it will not be possible for publicly funded hospitals, no matter who their patron or owner is, to opt out of providing these necessary services, which will be legal in the state once the legislation is passed by the Dáil and the Seanad [the lower and upper house].”

Varadkar went on to attack those small hard-left parties that believe there should be no Catholic institutions in public life. But, as Mick Barry pointed out, this was beside the point. The question is what the government will do about abortion provision, and its proposal has two parts. The first is that there will be no right to opt out of the new provisions for institutions receiving state funding. The second is that individual medical practitioners may conscientiously opt out of direct involvement in abortion procedures, but would be obliged to refer a patient for abortion if she requested it.

This is especially important in Ireland because of how strong the Catholic influence in healthcare is. The Church established hospitals and schools in the 19th century because there was no state provision at the time. In Ireland these institutions were much more dominant than in Britain or North America, both because the population was so heavily Catholic, and because the state itself was perceived as hostile by Catholics.

After independence, the impoverished Republic had no money to establish a British-style welfare state, and so it outsourced many public services to religious orders, which could provide them more cheaply than a workforce of lay professionals.

But today’s Ireland is far removed from the Ireland of 1951, when the bishops could bring down the government over mild healthcare reform. In recent decades, direct Church involvement in the health sector has been declining, with many hospitals now run directly by the state’s Health Service Executive. However, the Catholic share of the sector is still very significant, and this is bound to cause tensions in an increasingly post-Catholic Irish society.

Even without Ireland’s distinct political controversies, it has become more and more difficult to sustain Catholic involvement in healthcare or other public services when society keeps moving further away from Catholic norms. This isn’t a question of expecting public policy to conform to Catholic doctrine – it’s about whether observant Catholics can even participate in the health sector or should simply opt out of employment in this areas.

This has been a live issue in other countries in recent years. In 2014 the UK Supreme Court ruled against two Catholic midwives in Scotland who had argued that they could not in good conscience provide support to other staff who were carrying out abortions, while their health trust had argued that exempting them from direct participation was enough to respect their conscience rights. At the same time, the Obama administration was taking US religious orders to court to compel them to buy contraceptive cover under the Affordable Care Act.

The complicating factor in Ireland is that the Catholic Church has been so thoroughly discredited by clerical abuse scandals. This means that, even if the bishops speak up on a controversial issue, they would probably damage their cause. This explains why they kept a low profile during the referendums on gay marriage and abortion. It also means there is a strong constituency in Irish public opinion, well beyond Marxists like Mick Barry, which would like the Church out of public life entirely, with no right of conscientious objection. It’s that constituency that will be piling the pressure on Leo Varadkar. Anyone who voted No in the referendum is still too shell-shocked to try to push the government into a more conciliatory stance.

The options for Catholic hospitals in Ireland are limited. They could short-circuit the government’s plans by opting out of public funding and joining the private sector. But that would place such a financial burden on them, and hamper their ability to provide care for the general population, that it is extremely unlikely. But it’s also impossible to see how they could comply with the new legislation while maintaining their Catholic ethos. Either they would have to change their Catholic character voluntarily, or the Vatican would have to intervene.

There is a precedent for an intervention from Rome. In 1998, the Vatican overruled the German bishops’ conference on participation in a state pregnancy counselling scheme. German law required a woman presenting for abortion to have a certificate saying that she had received counselling, and even though Catholic centres were advising against abortion, certificates they had issued were still being used to access abortion services. Rome’s view was that this counted as moral complicity – essentially the same as accepting a duty to refer. If that could not be fudged as compatible with Catholic medical ethics, direct participation certainly cannot be.

The Irish government has given notice that it intends to introduce legislation quickly to liberalise the abortion law.

So the clash between the legal duties and the religious ethos of Catholic hospitals is going to become unavoidable very soon. And although Ireland has not been high on Pope Francis’s agenda, his visit is fast approaching and it’s almost certain that the media will ask him to comment on the hospitals issue. There is a risk that, whatever happens on the issue, a conflict between Rome and anti-clerical Ireland is now inevitable.

Jon Anderson is a freelance writer

This article first appeared in the June 22 2018 issue of the Catholic Herald. To read the magazine in full, from anywhere in the world, go here