Eilis O’Hanlon
Why is it so hard to do the right thing?
THE parliamentary meeting of Fine Gael TDs last week heard that one reason for their abject election result, which saw them finish third in a threehorse race to be the largest party, may have been a comment by then senator Catherine Noone about Leo Varadkar being “autistic”, for which she later apologised.
Are they for real? The idea that voters turned against FG because of something inappropriate that was said in passing by some senator is almost touchingly preposterous. FG has now lost more than half of the seats it won in the historic 2011 election, a decline which is rooted squarely in the party’s repeated failure to understand the continuing public malaise.
Nothing crystallises that more than the CervicalCheck scandal, which saw hundreds of women who’d originally been given the all-clear years earlier subsequently discovering that they’d had cervical cancer all along. Many have since died. Rather than hold up its hands and humbly admit wrongdoing, the government continued to fight the women at every turn in the courts, including Ruth Morrissey, who recently passed away at the age of 39, leaving a young daughter.
Ministers fulsomely praised the Limerick woman, but, less than two weeks later, two more women whose test results were misread have now had their cases listed in the High Court. These actions will in turn be contested vigorously by the HSE.
There are legal issues which need to be clarified in all these cases. It’s not unreasonable for the Government to seek to prevent the State being liable for every misdiagnosis. Cancer screening programmes can’t get it right every time, but they are essential, nonetheless. Officials also need to be careful with public money, though it’s worth asking why it’s women with terminal cancer who are made to bear the brunt of this sudden interest in fiscal prudence when millions of euro vanish down the government drain annually.
Ministers still need to find a way to speak about these issues without giving the impression that human understanding must be dragged out of them under duress.
The Tanaiste even added insult to injury by insisting that the cervical cancer screening programme will now be improved because of Vicky Phelan’s intervention in these pages last Sunday, when, roused by the death of her friend and fellow campaigner, she called for action rather than fine words.
Leo Varadkar didn’t even seem embarrassed to be making that promise. He was Taoiseach for the last three years. He has served previously as minister for health. What took so long? It shouldn’t be Vicky Phelan’s job as she battles cancer to micromanage the Government’s health policy.
Not everything that Vicky Phelan is asking for may be achievable. That includes her call for the reintroduction of the 2015 Dying With Dignity private members’ bill. The legalisation of euthanasia seems like the compassionate and progressive thing to do, and has the consistent backing of a majority in opinion polls. The experience in other countries suggests, however, that any such move can have unsettling consequences.
‘Doctors need a new partnership of equals with their patients’
Up to a quarter of deaths in the Netherlands in 2017 were ‘induced’ in some way, including people with dementia who’d lost the ability to communicate continued consent, and young people struggling with mental health issues.
It’s possible to draft legislation strict enough to minimise abuses, but the risk of that infamous slippery slope is not imaginary.
It’s still outrageous that Vicky Phelan should need to be calling for mandatory open disclosure, nearly two years after it was recommended by Dr Gabriel Scally’s report into the cervical cancer scandal. Things will always go wrong in medicine. When they do, the patient has the right to know, promptly, and in as much detail as they request. The paternalistic relationship between heath professionals and ordinary patients needs to be replaced by a partnership of equals.
Open disclosure in both public and private healthcare is a central plank of the Patient Safety Bill, which was published last December, but it remains in draft form.
Until it’s implemented, campaigners can be forgiven some lingering suspicion. The bill names certain “identified patient safety incidents” which would be covered by the new legislation, but they’re not comprehensive by any means. The Minister of Health would have the power to add other incidents to the list, but there will be some cultural resistance from the medical establishment.
One paper published in the UK in 2014 by the government-funded National Institute for Health Research found, for example, that there was “strong support for the basic principle of being honest with patients or relatives when someone was seriously harmed by health care”, but that “in practice... the issues are complex”.
It concluded: “Health care reforms are often difficult to enact and the changes that policy makers envisage and aspire to may not translate into practice, or change may take longer because working practices are institutionalised.”
It’s in that gap between expectation and reality that campaigners may end up being marooned.
Doctors need reassurance that they won’t be scapegoated for deeper institutional failures, but what the aforementioned report calls the “protective agenda” in medicine must be challenged. Are ministers up to the task?
It remains to be seen what the new Taoiseach and new Health Minister, both Fianna Fail, are planning to do to change the closed culture of the Department of Health, but the stark truth is that there’s no point having a new government if it simply repeats all the arrogant, complacent errors of the previous one. What’s worse is that the new, or maybe not so new, Government might be laying the groundwork for future tragedies.
Up to 40,000 smear tests are normally carried out every month. They were suspended because of Covid-19, along with breast and bowel checks. Shops and restaurants are widely open, but it will be at least September before breast checks return in a limited capacity. They’re already back up and running in Northern Ireland.
If FF doesn’t want to be sitting in a parliamentary party meeting in four years’ time, puzzling over its own defeat, it could do worse than start reaching out to women who’ve been wronged by the healthcare system before, like Ruth Morrissey, it’s too late for them, too. The Government should be these women’s champion, not their adversary.