This article appears in the May 2006 edition of the Catholic Medical Quarterly
The Hospital of St. John and St. Elizabeth
Now that the crisis at "John and Lizzie"has been reported widely in the media, it seems timely to review the current situation and speculate as to what may happen in the future. It has arisen as a result of a management decision to invite a local General Practice to relocate its surgery within the hospital premises. A further reconstruction plan is at present under way: the rent obtained from such a plan would help to fund the projected cost of the new scheme. But it quickly became apparent that the practice would be bound by NHS regulations and required to refer patients for abortions and provide the full range of contraceptive services, including prescriptions of the abortifacient contraceptive morning after pill with other abortifacient pills. It is extremely difficult for a NHS practice to opt out of providing these services. The law is laid down as to these contracts in the National Health Service (General Medical Services Contracts), Regulations 2004, Statutory Instrument 2004/291. Moreover, the senior partner of the local practice has stated publicly that he has no intention of not providing these services; `We cannot breach our terms of service'.
The Brampton Trust, which has the Cardinal as ex-officio trustee and four lay trustees all of whom have to be loyal Roman Catholics, owns one third of the hospital site and in particular Brampton House, which it is planned to redevelop. In order to house amongst others the local practice, the Trust has to agree to this project. It is obliged to benefit only Roman Catholic charities. If the Trust does give permission without ensuring that Catholic Ethics are adhered to, a formal complaint to the Charity Commission might be justified.
The Cardinal, following the advice of a confidential report submitted by a four member committee of enquiry headed by Lord Brennan, reacted to the crisis by calling for tighter ethical governance of the hospital. He called for a ‘revision and clarification of the Code of ethics’ in specific ways in order to make impossible ‘referrals for direct abortion, for amniocentesis, for purposes other than safe delivery, for contraception and prescribing for contraceptive intent, particularly when what is prescribed is or may be abortifacient (eg by impending implantation)!
He specifically made clear that ‘anyone who, while in the Hospital, recommends such procedures, arranges for them to be carried out elsewhere’ or ‘does anything with the intention that it be preliminary to or an initiation of the carrying on of the procedure elsewhere’ would be ‘formally and therefore always wrongfully co-operating in the unacceptable procedure or other activity; the Cardinal also asks that `in revising the Code it should be made clear that its requirements apply to any facility within the Hospital, its precincts or its ownership.’
The only response of the Hospital has been:
‘The Hospital of St. John and St. Elizabeth is governed by a Code of Ethics, the General Medical Council's code of practice to which all UK doctors must subscribe, and the terms of registration with the Health Care Commission and the Charity Commission’.
Lord Bridgeman, chairman of the Hospital of St. John and St. Elizabeth, said : ‘We accept Cardinal Murphy O'Connor's recommendations that we renew our Code of Ethics. Any revision of the Code will take into account the Cardinal's views in addition to the hospital's existing legal, medical and charitable obligations.
Our duty of care to our patients remains paramount, and during this review our doctors will continue to work within the existing Code of Ethics.’
This is pretty lamentable. The teachings of the Church, which the Cardinal has expounded, are referred to as ‘the Cardinal's views’ as if they were his optional private opinion. It also suggests that somehow the Hospital is restrained by legal, medical and charitable obligations which might conflict with the teachings of the Church. The management has promulgated the view that the General Medical Council obliges the doctors to make referrals for abortion. This is untrue. What the General Medical Council says on its website is that:
If you feel that your beliefs might affect the advice or treatment you provide, you must explain this to your patients, and tell them of their right to see another doctor.
There have been suggestions from the management in the past that ‘European Guidelines for Auditing Independent Ethics Committees’ could hamper the application of Catholic Ethics. The NHS Central Office for Research Ethics Committees has made it clear that this is not the case.
Gender Reassignment Operations
There has been concern about un-ethical Gender Reassignment Operations (GROs) taking place in the Hospital for years; complaints have been ignored. In July 2005 firm evidence was obtained that these operations were taking place on a regular basis at the Hospital. This situation was reported to the Board, pointing out that, if this was the case, then not only was there a continuing breach of Catholic Ethics but questions must be asked as to how this had been permitted. In August 2005, a surgeon was advertising on the internet that he gave consultations and performed GROs in the hospital. In September a member of the ethics committee found evidence of GROs in the operating theatre records. Another surgeon openly admitted he had performed GROs in the Hospital.
The management eventually agreed to carry out an investigation themselves, but would not agree to the request that an independent observer from the Guild should take part in the inquiry. The inquiry would be conducted in accordance with established procedures to establish which operations were licit or not. Six case histories were selected and sent to an independent consultant in Rome. A report by that consultant was received by the Hospital in late 2005, but was not disclosed to the ethics committee of the Hospital at their January 2006 meeting, It was stated that it ‘needed analysis’ by management.
It has been revealed subsequently that the Roman consultant was Dr. Carlo Bettochi, who together with Mr. D.J. Ralph detailed their results in Pubic Phalloplasty in female-to-male transsexuals on 65 patients [1]
Mr. D.J. Ralph is the surgeon who has openly admitted that he has performed numerous GROs at the Hospital. It is quite obvious that Dr. Bettochi and he are close colleagues. There can be no criticism of Mr Ralph who has been perfectly open about this. However, it does seem that Dr. Bettochi has himself carried out numerous GROs contrary to Catholic ethics; therefore it is extremely doubtful that he could be considered to be suitably independent a suitably independent consultant to conduct this investigation. In conclusion, the pronouncements on gender reassignments of the American and Australian hierarchies should be highlighted:
1. The Ethical and Religious Directives for Catholic Health Care Services US 29
"All persons served by Catholic Health Care have the right and duty to protect and preserve their bodily and functional integrity. The functional integrity of the person may be sacrificed to maintain the health or life of the person may be sacrificed to maintain the health or life of the person when no other morally permissible means is available".
2. Code of Ethical Standards for Catholic Health and Aged Care Services in Australia 3.11
"Interventions should be limited to authentic therapies for pathological conditions. Procedures or interventions that deliberately render a healthy sex organ dysfunctional, mutilate it or remove it, as a treatment for a psychological or psychiatric problem, are not permissible".
References
[1] XV Harry Benjamin International Gender Dysphoria Association Symposium, Pubic Phalloplasty in Female-to-Male Transsexuals, C.B Bettochi*, DJ. Ralph, J.P. Pryor, Institute of Urology, The Middlesex Hospital UCH London, UK
*Cattedra di Urologia, University of Bari, Italy