Recent revelations of the horrific extent and nature of sexual, psychological and physical abuse over decades at schools owned by the Catholic Spiritan order have prompted renewed shock and trauma on the one hand and the standard church response of belated apology and promises of reform on the other.
The horror of clerical abuse has been especially pervasive in Ireland given the extent of the control exerted by the church in this country.
We are familiar with the historical circumstances in which responsibility for and ownership of education and large swathes of health and social care was both ceded to and actively acquired by the church over more than 150 years. I see it as a twin legacy of both colonisation and “Cullenisation”, ie the success of Paul Cullen, the mid-19th century archbishop of Dublin, in fostering and promoting Catholic religious orders in Ireland.
Cullen was instrumental in securing separate and clerically controlled – but state-supported – Catholic education, overturning the aims of the 1831 national school system which envisaged non-denominational tate education. After 1922, the Church’s grip on education increased.
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Today, over 90 per cent of our primary schools are under Catholic patronage but are State-funded. Catholic faith formation is part of the curriculum. Approximately 50 per cent of secondary schools operate under Catholic ethos.
State grant
Archbishop Cullen would surely have applauded the stated aims of the Sisters of Mercy at Dublin’s Mater hospital in 2001 that, in their lay successor organisation, a “Catholic, voluntary, public healthcare can exist, flourish and develop into the future, providing a parallel and alternative option to that of the State system”. The issue is that this parallel and alternative health system, governed by Catholic ethos, is wholly funded by a supposedly secular Irish State. The Mater’s 2020 revenue grant from the State was €355 million.
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Seven of the largest “public” hospitals in Ireland are owned by private Catholic entities and receive more than €1 billion of State funding each year, and more in capital grants.
Catholic control of the private healthcare sector is even greater. Twelve of Ireland’s 18 private hospitals adhere to Catholic ethos.
The five Bon Secours hospitals are owned by the giant American-Catholic conglomerate, Bon Secours Mercy Health. The group aims to increase its annual Irish turnover to €450 million by 2025. The strategy, according to Irish chief executive Bill Maher, is to “partner with the HSE [Health Service Executive] and the Department of Health” as they did during the Covid-19 pandemic when the HSE outsourced hospital capacity to Bon Secours. A core goal of the group is to maintain the “founding vision and values” of the Catholic order.
I would hazard that most government politicians over recent decades believe that, unlike many of their 20th-century predecessors, they no longer take direction from the Catholic Church or serve its interests. I suggest, however, that a new church-State nexus has emerged. This link is based not on faith or deference but on an alignment of the interests of Government economic policy with the church’s ownership of land and valuable health and education assets.
Recent economic policy has been characterised by privatisation of State enterprises and growth in public-private partnerships.
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Maternity hospital
In health, the State says it is introducing Sláintecare. On the ground, however, policy looks more like outsourcing to the private sector, the majority of which is owned by Catholic entities. Construction of new private hospitals and clinics is ongoing while, for example, no progress has been made with the new public elective hospitals promised for Dublin, Cork and Galway. The percentage of the population with private health insurance has grown to 57 per cent at a time when the State’s health budget has never been higher.
The Government seems to have been blindsided last May when the Minister for Health’s plan to bring a memo to Cabinet to advance the National Maternity Hospital project met renewed public furore. Well-founded concerns about the adverse impact of the Catholic ethos of St Vincent’s Healthcare Group on the availability of treatment to women were a key element of the opposition.
But what the Government also seems unable to understand is that its failure to deliver on the assurance given by its most senior members – that the new hospital would be “State-owned on State land” – is also a source of intense public disquiet since it became clear that the new €1 billion publicly funded maternity hospital would be owned by a private company.
The significance of Catholic ethos extends beyond women’s reproductive healthcare. We have started a debate in this country about assisted dying, but Catholic teaching holds that this would be intentional taking of life and never permissible. Should a future dying with dignity Act be passed, Catholic hospitals will opt out precisely as they do today on abortion, IVF and contraception.
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Elsewhere, it is hoped that gene editing will provide a cure for such hereditary diseases as cystic fibrosis. However, where gene editing treatment requires conceiving an embryo through IVF it will not be permissible in Catholic hospitals.
As we debate these issues and plan for the future, we need to understand that the expanding Catholic healthcare system in Ireland will never provide treatment forbidden by the church even if it is legal in the State. Pupils in Catholic schools will be left in no doubt of the church’s opposition to same-sex marriage or abortion, despite both being legal.
The Catholic Church is fully entitled to provide health and education, but if it wants a “parallel and alternative option” to that of the State, delivered according to its ethos, it should not be funded by the State.
- Peter Boylan is a former master of the National Maternity Hospital