The planned move of the National Maternity Hospital (NMH) to the St. Vincent’s University Hospital (SVUH) campus
Some key issues in reproductive medicine, novel therapies and research at the new campus location
- Who is in charge of a patient who is transferred from the NMH to SVUH
- Is that patient to be treated under the Code of Medical Ethics of SVUH or of the NMH
- What are to be the codes of medical ethics of both SVUH and the NMH? Remember that both the SVUH and NMH at present are Roman Catholic hospitals. The term ‘National’ used to describe the NMH is a misnomer given its religious governance.
The structure and composition of their respective boards of governance are set out here:
The RC Archbishop is ex-officio chairman of the Board. Dr. Diarmuid Martin is the present incumbent. Three local parish priests also serve ex-officio.
The governors of SVUH are responsible to the shareholders, the Religious Sisters of Charity, who are the owners of the hospital and its entire campus, including the Elm Park Golf Club, which leases its course from the Order.
We raise here a number of specific concerns to be considered, simply as examples of the ethical complexity of the consequences of the NMH moving to the SVUH campus.
The main question is whether the NMH and SVUH will guarantee that all procedures and therapies legal in Ireland will be available in both NMH and SVUH, if clinically required and following best international practices? It is vitally important that SVUH changes to become like the NMH and not the other way round.
The NMH gradually moved away from strict Catholic ethics under the courageous leadership of Dr. Peter Boylan, and others, but we must be concerned that it might revert to more conservative ethics under the influence of SVUH.
Consider this problem. If a procedure is requested by a patient or next of kin (in an emergency) or a nurse or doctor attending the case, and if it is known that a responsible consultant acting in the best medical interests of the mother might approve the procedure, but the consultant in charge of the patient could not carry out such a procedure because it would be contrary to his or her ethics, will SVUH (and NMH) guarantee that that doctor is required to withdraw from supervising the case?
One can imagine a very sick mother; still carrying her baby, being moved across to SVUH with decisions to be taken about caring for her that might definitely or possibly lead to the death of the baby. The mother’s life may not be immediately at risk but most doctors might decide that the risk of not intervening is too great – this is a matter of judgement. The ethics of SVUH (like those in Galway with the late Savita Halappanavar) may well delay taking such tough decisions and even prevent them. The fear is that SVUH under its present medical ethics code will tend to err in favour of the baby and rather than the mother.
At the moment we understand that SVUH does not offer or perform “elective sterilisation” – that is sterilisation of a man or a woman, requested just for contraception. Nor does SVUH officially give advice on modern contraception in general. So at the moment SVUH does not offer all procedures or therapies that are legal in Ireland and considered to be part of normal medical care in hospitals that are not required to abide by Catholic medical ethics.
Consider a case of a woman who has just had a child with a severe genetic disorder. She wants to have a tubal ligation to avoid conceiving a similar child. She does not need to go to NMH. Will SVUH admit her and perform the procedure? The same question can be posed for the case of a man who carries a defective gene who wishes to avoid conceiving a child.
Now think of IVF, today only performed in the Rotunda and the NMH (apart from private clinics). At present the NMH has the only not-for-profit IVF clinic in the state. IVF is absolutely prohibited by Catholic medical ethics. So it is impossible to imagine that SVUH could approve the setting up of an IVF clinic on its campus. Yet it would be an excellent idea for the NMH, as the largest maternity hospital, to set up its IVF clinic at the new location. There has been silence on this key issue.
Even if the NMH was allowed to set up such a clinic would SVUH allow the use of its laboratories and equipment and health care and technical staff to facilitate an IVF clinic?
The ethical challenges can be very profound. Consider the use of the laboratories and staff of SVUH to facilitate modern methods for avoiding the birth of severely genetically defective children. The procedure is as follows:
- Embryos are conceived in the test tube by allowing the father’s sperm to fertilise the mother’s eggs;
- Each embryo is allowed to grow into a few cells;
- A few cells are taken from each embryo and tested for the genetic defect;
- Embryos without the defect are either implanted or stored for implantation later;
- Embryos with defects are allowed to die. So you can see that we should expect that SVUH would block the setting up of an IVF clinic at the NMH.
One other variation would be the use of surrogate-sperm donors in IVF (when the mother’s partner is infertile)
Another would be the use of surrogate-egg nucleus donors in IVF (when the mother’s own nuclear genes carry a genetic defect, or might even be a cause of infertility)
Yet another would be the use of a surrogate-mitochondrial donor in IVF (when mother’s own egg carries defective mitochondrial genes).
The general point is that SVUH should, by its own rules, inhibit and do its best to block the introduction of any ethically unacceptable advances in reproductive medicine at the NMH that might involve SVUH as an associate through its personnel (consultants, nurses, medical laboratory technologists, etc. with positions in both hospitals), labs, paramedical services etc.
In other words the NMH would not be completely free to take advantage of advances in reproductive medicine because of the deadening effect of the SVUH overarching governance of the medical and nursing personnel working on the campus. This is known in law as a ‘chilling’ effect.
Nor would it be easy for the NMH staff to have access to significant research laboratories and their support services provided at SVUH – such laboratories are essential if staff at NMH are to be able to keep up with discoveries abroad, and indeed to contribute to them. It is a weakness of the Irish maternity hospitals that none of them has significant research facilities – the new NMH on the SVUH campus should be able to use the SVUH research labs. Some of the research undertaken at SVUH is in close collaboration with UCD biomedical scientists. But we must assume that there will be religious ethical restrictions on the kind of research going on in these labs?
26 May 2017