Comment & Analysis

The Sisters and the State: a scandalous alliance?
Greg Daly asks whether the Religious Sisters of Charity can legitimately host the new National Maternity Hospital

In recent days a story broke in California that the American Civil Liberties Union (ALCU) had filed a lawsuit against a Catholic hospital for denying a hysterectomy last year to a woman who identified as a man, and wanted the procedure as part of a sex reassignment.

Evan Minton, on whose behalf the suit has been filed, had had surgery scheduled with the Mercy San Juan Medical Centre in the Sacramento metropolitan area, but says surgery was cancelled when the hospital learned that Minton was transgender and asked to be referred to as “he”; as a Catholic hospital, the centre does not provide elective sterilisations.

Dignity Health, which owns Mercy San Juan, transferred Minton to one of its Methodist hospitals shortly after refusing the initial procedure.

Claiming Minton had been illegally discriminated against as transgender, the ACLU is seeking a court order that would force the hospital to perform elective hysterectomies in the future.

The story should ring alarm bells for the Religious Sisters of Charity in light of the controversy that has surrounded plans for a new National Maternity Hospital on the grounds of their St Vincent’s University Hospital at Elm Park in South Dublin.

As Elphin’s Bishop Kevin Doran told The Sunday Times against the background of the controversy, “A healthcare organisation bearing the name ‘Catholic’, while offering care to all who need it, has a special responsibility to witness to the presence of Christ and to Catholic teachings about the value of human life and the dignity and the ultimate destiny of the human person. Public funding, while it brings with it other legal and moral obligations, does not change that responsibility.”

That the new National Maternity Hospital would not bear the name ‘Catholic’ is clear enough, but in some ways that’s not necessarily the point. Neither, despite vociferous opposition from a significant portion of the population, are questions about whether or not the sisters would have sole ownership of the hospital, or what this would mean in terms of governance.

Far more pertinent, in practical terms, is the fact that the new hospital is planned to be on land belonging to a religious order, and that the National Maternity Hospital’s board has repeatedly insisted that the new facility will be run independently and will carry out procedures such as IVF, sterilisations and abortions, all of which are opposed by the Church.

The real question, therefore, seems to be whether or not the sisters can legitimately provide land for activities they know are likely to run contrary to Catholic teaching.

In the US, for example, Catholic hospitals operate under the US bishops’ Ethical and Religious Directives for Catholic Health Care Services, a 43-page document, now in its fifth edition, which maps out the theological principles that should guide Catholic healthcare, reaffirms the ethical standards of healthcare behaviour that flow from the Church’s teaching about the dignity of the human person, and provides authoritative guidance on specific moral issues that face Catholic healthcare today.

Banning abortion, sterilisation, emergency contraception and tubal ligations, the guidelines are based primarily on the natural law, and explicitly state that the Church “cannot approve medical practices that undermine the biological, psychological, and moral bonds on which the strength of marriage and the family depends”, continuing, “Catholic health care ministry witnesses to the sanctity of life ‘from the moment of conception until death’. The Church’s defence of life encompasses the unborn and the care of women and their children during and after pregnancy.”

The American guidelines seem especially relevant to the developing Irish situation, and should be considered carefully by the sisters – and by the Archbishop of Dublin – before the deal is finalised.

Noting that abortion is never permitted in Catholic facilities, the guidelines state that “Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion, which, in its moral context, includes the interval between conception and implantation of the embryo.”

They continue: “Catholic health care institutions are not to provide abortion services, even based upon the principle of material cooperation. In this context, Catholic health care institutions need to be concerned about the danger of scandal in any association with abortion providers.”

Material cooperation is at the core of the problem with the National Maternity Hospital, since the planned arrangement, however the details are finally worked out, will in practice be a partnership in which the sisters will facilitate the performing by others of actions contrary to Catholic teaching.


Some may say that this is a problem that religious-run hospitals in Ireland already face, given how 2013’s Protection of Life During Pregnancy Act permits abortions in some circumstances. 

Against this, however, the act, in line with the Constitution, allows for abortions only when there is no other way of saving a mother’s life, and as pro-life doctors and psychiatrists have repeatedly pointed out, there are no circumstances in which abortion is the only way of saving a mother’s life. It should be possible, therefore, for a hospital to act in full accordance with the law without ever performing abortions.

The proposals of the so-called ‘Citizens’ Assembly’ look set to change this, however, and it would be a brave person who would bet against a widening of Ireland’s abortion laws over the coming years.

This is a problem our American cousins have been grappling with for some time, with the bishops observing that “new partnerships can pose serious challenges to the viability of the identity of Catholic health care institutions and services, and their ability to implement these directives in a consistent way, especially when partnerships are formed with those who do not share Catholic moral principles”, adding that “the risk of scandal cannot be underestimated when partnerships are not built upon common values and moral principles.”


While not rejecting partnerships out of hand, the US bishops insist that systematic and objective moral analysis should be undergone when considering whether Catholic healthcare institutions should enter into them.

Advising that “as a rule, Catholic partners should avoid entering into partnerships that would involve them in cooperation with the wrongdoing of other providers”, the bishops warn that decisions that “may lead to serious consequences for the identity or reputation of Catholic healthcare services, or entail the high risk of scandal, should be made in consultation with the diocesan bishop”.

The diocesan bishop, the guidelines note, “has final responsibility for assessing and addressing issues of scandal, considering not only the circumstances in his local diocese but also the regional and national implications of his decision”.

Ultimately, it may be Dublin’s Archbishop Martin, still in law – however reluctantly – the chair of the National Maternity Hospital’s Board of Governors, who must decide what the sisters can do.