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The Irish Healthcare System: A Morality Tale

Published online by Cambridge University Press:  22 May 2019

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Abstract:

A country’s healthcare system—the protection and healing of some its weakest people, its sick and injured—could be considered to be one of the most definitive expressions of its national morality. In recent decades, Ireland has experienced profound cultural changes; from a mostly monocultural and religious society to a multi-ethnic one, where secular ideas predominate. Economically, it is largely neoliberal, with one of the world’s most open economies, and one of its lowest corporate tax rates; though there is also a welfare state. Its healthcare system has reflected these cultural changes. The system has evolved, gradually, from being run almost exclusively by religious groups, to becoming essentially secular in nature (though religious groups are still involved at the ownership level). Overall, the system is run according to the two competing secular ideologies which currently predominate; it is a two-tier system, with a mix of a neoliberally oriented (though government subsidized) private system, and a public system. The latter has been starved of resources in recent decades; so to achieve good, or at times adequate healthcare, it is almost essential to have private health insurance (which about half of the population have).

This two-tier system has led to significant concerns and occasional scandals; for example, patients dying while on waiting lists for public treatment, who could have been treated and possibly saved if they had health insurance. A purely ethical approach to healthcare—with the aim of healing the sick—has been mixed with competing motives, such as the desire for profit in the private sector, or for short term savings and box-ticking in the public system. Thus, good healthcare practice and best moral practice are being undermined by competing agendas.

In this article, I describe and reflect ethically on the Irish healthcare system, and how it has evolved to its current state. I also discuss how dysfunction in the healthcare system, leading to the death of a pregnant woman, Savita Halappanavar, was a major factor in a constitutional ban on abortion being overturned.

Keywords

Irish healthcare systemIrelandmoralityethicsabortion referendumSavita Halappanavarneoliberalismhealth insuranceCatholic Church
Type
Special Section: Health, Morality, and Moralism
Information
Cambridge Quarterly of Healthcare Ethics , Volume 28 , Issue 2 , April 2019 , pp. 276 - 302
Copyright
Copyright © Cambridge University Press 2019 

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References

Notes

1. Wren, MA. Unhealthy State: Anatomy of a Sick Society. Dublin: New Island; 2003, at 16.Google Scholar

2. Barrington, R. Health, Medicine and Politics in Ireland 1900-1970. Dublin: Institute of Public Administration; 1987, at 3.Google Scholar

3. O’Connor D. Children’s hospital apologises over death of baby. RTE News, July 27, 2018; available at https://www.rte.ie/news/courts/2018/0727/981466-crumlin-childrens-hospital/ (last accessed 9 Sept 2018).

4. McEnroe J, O’Cionnaith F. 3,000 women may be caught up cervical cancer scandal. Irish Examiner, 2 May 2018; available at https://www.irishexaminer.com/ireland/3000-women-may-be-caught-up-in-cervical-cancer-scandal-470157.html (last accessed 3 Sept 2018).

5. Ryan O. Doctors say emergency departments are ‘death zones’ due to overcrowding. TheJournal.ie, 18 July, 2018; available at http://www.thejournal.ie/imo-sláintecare-4135483-Jul2018/ (last accessed 3 Sept 2018).

6. O’Regan E. Water withheld as ‘punishment’ from patients at Mayo mental health facility. Irish Independent, 24 Aug 2018; available at https://www.independent.ie/irish-news/health/water-withheld-as-punishment-from-patients-at-mayo-mental-health-facility-37247058.html (last accessed 3 Sept 2018).

7. O’Regan E. ‘It was really upsetting and stressful’ – Cancer patients chased by debt collectors. Irish Independent, 1 Sept, 2018; available at https://www.independent.ie/irish-news/health/it-was-really-upsetting-and-stressful-cancer-patients-chased-by-debt-collectors-37272278.html (last accessed 9 Sept 2018).

8. O’Regan E. Summer nightmare for patients as 8,000 are forced to wait on trolleys. Irish Independent, 1 Sept 2018; available at https://www.independent.ie/irish-news/health/summer-nightmare-for-patients-as-8000-are-forced-to-wait-on-trolleys-37272281.html (last accessed 9 Sept 2018).

9. O’Regan E. ‘Our hospitals will be war zones once winter comes’ – Nurses’ warning about A&E chaos. Irish Independent, 8 Sept 2018; available at https://www.independent.ie/irish-news/health/our-hospitals-will-be-war-zones-once-winter-comes-nurses-warning-about-ae-chaos-37294966.html (last accessed 10 Sept 2018).

10. Cullen P. Doctor refuses to be silenced on Tallaght Hospital trolley cases. The Irish Times, 4 Nov, 2015; available at https://www.irishtimes.com/news/health/doctor-refuses-to-be-silenced-on-tallaght-hospital-trolley-cases-1.2416738 (last accessed 3 Sept 2018).

11. See, for example, O’Cionnaith F. Doctor: A&E abuse will come back to haunt us. Irish Examiner, 2 Oct 2017; available at https://www.irishexaminer.com/ireland/doctor-ae-abuse-will-come-back-to-haunt-us-460088.html (last accessed 3 Sept 2018).

12. MerrionStreet.ie twitter. Sláintecare Implementation Strategy, 8 Aug 2017; available at https://twitter.com/merrionstreet/status/1027129168981622784; (last accessed 3 Sept 2018).

13. One example of unjust media coverage (I could give many ); a 2015 headline in The Irish Times read: Irish health outcomes are among the worst in the West. The article reported an OECD publication which examined the performance levels of a number of national healthcare systems. The report’s conclusions did not match the headline; for while Ireland did fare very extremely badly in certain areas, being in the bottom third of OECD nations in many key indicators, it fared reasonably well in others. The headline gave a false impression of the report, choosing instead to feed the dominant narrative. See: Cullen P. Irish health outcomes are among the worst in the West. The Irish Times, 5 Nov 2015; available at https://www.irishtimes.com/news/health/irish-health-outcomes-are-among-worst-in-the-west-1.2417462 (last accessed 3 Sept 2018); and: Editorial staff. Health at a glance: Where Ireland stands in the OECD. Irish Medical Times, 15 Nov 2017; available at https://www.imt.ie/news/health-glance-ireland-stands-oecd-15-11-2017/ (last accessed 3 Sept 2018).

14. Irish Medical Organisation (IMO). News & Press Release: New IMO president warns of “crisis of morale” in health services, 12 Apr 2015; available at https://www.imo.ie/news-media/news-press-releases/2015/new-imo-president-warns-o/index.xml (last accessed 2 Sept 2018).

15. Gantly D. IMO unashamed over ‘vested interest’ in public health system. Irish Medical Times, 30 Mar 2018; available at https://www.imt.ie/news/imo-unashamed-over-vested-interest-in-public-health-system-30-03-2016/ (last accessed 2 Sept 2018).

16. Irish Medical Organisation (IMO). News & Press Release: New IMO president warns overcrowding emergency depts. “costs lives,” 8 Apr 2018; available at https://www.imo.ie/news-media/news-press-releases/2018/new-imo-president-warns-o/index.xml (last accessed 2 Sept 2018).

17. Crown J. Ireland has the worst managed healthcare system in the developed world. TheJournal.ie, 27 Feb 2013; available at http://www.thejournal.ie/readme/column-ireland-has-the-worst-managed-healthcare-system-in-the-developed-world-810328-Feb2013/ (last accessed 3 Sept 2018).

18. Health Consumer Powerhouse. Euro Health Consumer Index 2017. Marseillan, France: Health Consumer Powerhouse, at 14; available at https://healthpowerhouse.com/media/EHCI-2017/EHCI-2017-report.pdf (last accessed 3 Sept 2018).

19. Kerrigan G. There’s no mystery about hospital chaos. Sunday Independent, 14 Jan 2018; available at https://www.independent.ie/opinion/columnists/gene-kerrigan/theres-no-mystery-about-hospital-chaos-36485621.html (last accessed 10 Sept 2018).

20. See note 19, Kerrigan 2018.

21. See note 1, Wren 2003, at 139–75.

22. See note 18, Health Consumer Powerhouse 2017. See also: Ni Aodha G. Ireland’s health system: What exactly are we doing wrong? The Journal.ie, 19 Feb 2017; available at http://www.thejournal.ie/irish-healthcare-system-3242479-Feb2017/ (last accessed 2 Sept 2018).

23. Organisation for Economic Co-operation and Development (OECD). Health Policy in Ireland. Paris: OECD; 2016; available at http://www.oecd.org/ireland/Health-Policy-in-Ireland-February-2016.pdf (last accessed 3 Sept 2018).

24. Harvey B. Evolution of Health Services and Health Policy in Ireland. Dublin: Combat Poverty Agency, 2007; available at http://www.combatpoverty.ie/publications/EvolutionOfHealthServicesAndHealthPolicyInIreland_2007.pdf (last accessed 10 Sept 2018). See also: note 1, Wren 2003.

25. Brazier, M and Cave, E. Medicine, patients and the law, 4th edition. London: Penguin; 2007, at 3.Google Scholar

26. This is a very brief overview. For a detailed description, see note 2, Barrington 1987; and note 1, Wren 2003.

27. Varadkar L. Speech of An Taoiseach, Leo Varadkar, on the occasion of the Visit of Pope Francis, 15 Aug 2018; available at https://www.taoiseach.gov.ie/eng/News/Taoiseach’s_Speeches/Speech_of_An_Taoiseach_Leo_Varadkar_on_the_occasion_of_the_Visit_of_Pope_Francis.html (last accessed 8 Sept 2018).

28. See note 24, Harvey 2007.

29. Browne, N. Against the Tide. Dublin: Gill and Mac Millan; 1986, at 154–5.Google Scholar

30. Department of Health. Proposal for a Mother and Child Health Service under Part III of the Health Act 1947. In: Whyte JH. Church and State in Modern Ireland, 1923-1970. Dublin: Gill and MacMillan; 1971, at 377–98. This is the full text of the government’s proposed legislation.

31. A promotional booklet had an emotional, beautiful cover illustration of a mother holding her child, with a traditional Irish cross (St Brigid’s cross) in the background. See: McCord R. The mother and child scheme—The role of Church and state. The Irish Story, June 19, 2013; available at: http://www.theirishstory.com/2013/06/19/the-controversy-of-womens-health-the-mother-and-child-scheme-the-role-of-church-and-state/#.W5Rb4tQrKt8 (last accessed 8 Sept 2018).

32. McKee E. Church-State Relations and the Development of Irish Health Policy: The Mother-and-Child Scheme, 1944–53. Irish Historical Studies 1986;98:159–94.

33. See note 24, Harvey 2007.

34. They are restricted to those earning less than €184 per week for a single person in 2018, along with people over 70, and some other special groups. See: Health Services Executive (HSE). Cards and schemes: How much you can earn and still qualify; 2017; available at https://www.hse.ie/eng/cards-schemes/medical-card/how-much-you-can-earn/ (last accessed 3 Sept 2018).

35. See note 24, Harvey 2007.

36. See, for example: Allen, K. The Corporate Takeover of Ireland. Kildare: Irish Academic Press; 2007.Google Scholar

37. See note 1, Wren 2003, at 281–98.

38. Wall M, Hamilton P. Health insurers considering new strategies for growth. The Irish Times, 22 Dec 2017; available at https://www.irishtimes.com/business/financial-services/health-insurers-considering-new-strategies-for-growth-1.3335614 (last accessed 9 Sept 2018).

39. Weston C. Latest health cover cost hike hits one million VHI members. Irish Independent, 17 Mar 2017; available at https://www.independent.ie/business/personal-finance/latest-news/latest-health-cover-cost-hike-hits-one-million-vhi-members-35539247.html (last accessed 9 Sept 2018).

40. Health Service Executive. Hospital Charges, 2017; available at https://www.hse.ie/eng/services/list/3/acutehospitals/hospitals/hospitalcharges.html (last accessed 16 June 2018).

41. In Dublin, a GP consultation is typically €60 (it can vary somewhat between doctors and between locations). Admission to a public hospital normally requires an initial payment of €100; if kept in, a patient pays €80 per day, up to a maximum of €800 in any year. There is another primary care point of contact; private clinics, run by insurance companies or other business groups, which have appeared on the scene in the last decade or so. Their fees are slightly higher than public hospital consultations; and they allow the queues of public hospitals to be avoided, but only treat relatively uncomplicated issues.

42. Economic and Social Research Institute (ESRI). Maev-Anne Wren, 2015; available at https://www.esri.ie/person/?userid=134 (last accessed 3 Sept 2018).

43. See note 1, Wren 2003, at 139–40.

44. O’Cionnaith, F. Patient given 2024 hospital visit date. The Irish Examiner, 21 Feb 2018. https://www.irishexaminer.com/breakingnews/ireland/patient-given-2024-hospital-visit-date-829055.html (last accessed 3 Sept 2018).

45. Ryan P. ‘National scandal’ – Almost one million patients are on health service waiting lists. Irish Independent, 8 Aug 2018; available at https://www.independent.ie/irish-news/health/national-scandal-almost-one-million-patients-are-on-health-service-waiting-lists-37194846.html (last accessed 10 Sept 2018).

46. See note 18, Health Consumer Powerhouse 2017, at 16.

47. Viberg, N, Forsberg, VC, Borowitz, M, Molin, R. International comparisons of waiting times in health care – Limitations and prospects. Health Policy, 2013;112(1–2):53–61. https://doi.org/10.1016/j.healthpol.2013.06.013CrossRefGoogle ScholarPubMed

48. Clarke V. HSE ‘totally dysfunctional,’ says Blackrock Clinic founder. The Irish Times, 8 Feb 2017; available at https://www.irishtimes.com/news/health/hse-totally-dysfunctional-says-blackrock-clinic-founder-1.2968005 (last accessed 3 Sept 2018).

49. RTE News. 45% of people had private health insurance at year end. 2 Aug 2018; available at https://www.rte.ie/news/business/2018/0802/982585-45-had-private-health-insurance-at-year-end/ (last accessed 9 Sept 2018).

50. See note 1, Wren 2003, at 99.

51. See note 1, Wren 2003, at 99.

52. The Bismarck system is named after Chancellor Otto von Bismarck, its architect. See: Health Matters: The Bismarck Model, 2 Jan, 2011; available at http://healthmatters4.blogspot.com/2011/01/bismarck-model.html (last accessed 3 Sept 2018).

53. The Beveridge System is named after lawyer/economist William Beveridge, who proposed the NHS. See: Physicians for a National Health Program (PNHP). Health Care Systems—Four Basic Models: The Beveridge Model, Undated; available at http://www.pnhp.org/single_payer_resources/health_care_systems_four_basic_models.php (last accessed 3 Sept 2018). See also: BBC History. William Beveridge (1879-1963), 2014; available at http://www.bbc.co.uk/history/historic_figures/beveridge_william.shtml (last accessed 3 Sept 2018).

54. The American advocacy group, Physicians for a National Health Program, notes that the world’s healthcare systems can be categorized into 4 models. As well as the Bismarck and Beveridge systems, there is a national health insurance system, and an out of pocket system. In the former, private healthcare providers are paid by nonprofit insurance programs, financed from taxation. Countries that use this system include Canada, South Korea and Taiwan. Costs tend to be much lower than in for-profit insurance systems. In the latter, patients pay for treatment as they need it. If they cannot pay, they remain ill or die. The PNHP note that only about 40 of the world’s 200 countries have advanced healthcare systems; the out of pocket system applies in most of the world. See note 53, Physicians for a National Health Program.

55. See note 18, Health Consumer Powerhouse 2017, at 22.

56. See note 1, Wren 2003, at 281–98.

57. National Treatment Purchase Fund (NTPF) homepage, 2018; available at http://www.ntpf.ie/home/home.htm (last accessed 3 Sept 2018).

58. See note 1, Wren 2003, at 283.

59. O’Dowd T. Letter to the Editor. The Irish Times, 1 Nov 2000. In: Wren 2003, see note 1, at 282–3.

60. O’Toole F. Enough Is Enough: How to Build a New Republic. London: Faber and Faber; 2011, at 165.

61. See note 60, O’Toole F 2011, at 159.

62. Varadkar L. Speech, 10 Nov 2017; available at https://www.finegael.ie/speech-taoiseach-leo-varadkar-leader-fine-gael/ (last accessed 3 Sept 2018).

63. White Paper on Universal Health Insurance: The Path to Universal Healthcare, 2014; available at https://health.gov.ie/wp-content/uploads/2014/04/White-Paper-Final-version-1-April-2014.pdf (last accessed 3 Sept 2018).

64. Centre for Health Policy and Management, Trinity College Dublin. Sláintecare – A Path to Universal Healthcare in Ireland. 2017; available at https://www.tcd.ie/medicine/health_policy_management/assets/pdf/policy-brief-on-the-sláintecare-report-19122017.pdf (last accessed 3 Sept 2018).

65. Houses of the Oireachtas Committee on the Future of Healthcare. Sláintecare Report, 2017, at 16; available at http://data.oireachtas.ie/ie/oireachtas/committee/Dáil/32/committee_on_the_future_of_healthcare/reports/2017/2017-05-30_sláintecare-report_en.pdf (last accessed 3 Sept 2018).

66. See note 65, Houses of the Oireachtas Committee on the Future of Healthcare 2017, at 16.

67. See note 62, Varadkar 2017.

68. Government of Ireland. Sláintecare implementation strategy, 2018; available at https://health.gov.ie/wp-content/uploads/2018/08/Sl%C3%A1intecare-Implementation-Strategy-FINAL.pdf (last accessed 3 Sept 2018).

69. Bardon S. Director of Sláintecare urged to divest stake in private firm. The Irish Times, 13 July 2018; available at: https://www.irishtimes.com/news/politics/director-of-sl%C3%A1intecare-urged-to-divest-stake-in-private-firm-1.3563237 (last accessed 3 Sept 2018).

70. Larkin L. Government reveals radical health reform plans. Irish Independent, 8 Aug 2018; available at https://www.independent.ie/irish-news/health/government-reveals-radical-health-reform-plans-37196109.html (last accessed 3 Sept 2018).

71. Gordon MRM. IMO responds on Sláintecare, 8 Aug 2018; available at https://www.gordonmrm.ie/media-centre/imo-responds-on-sláintecare/ (last accessed 3 Sept 2018).

72. Ryan V. Sláintecare will not transform our health services warns IMO. Irish Medical Times, July 19, 2018; available at https://www.imt.ie/news/sláintecare-will-not-transform-health-services-warns-imo-19-07-2018/ (last accessed 3 Sept 2018).

73. Molloy E. Investment crucial to stop Sláintecare strategy becoming another false dawn. Irish Independent, 18 Aug 2018, at 36.

74. Shortall R. Is the government prepared to face down vested interests for radical Sláintecare health reforms? Roisinshortall.ie, 29 Nov 2017; available at http://www.roisinshortall.ie/2017/11/29/is-the-government-prepared-to-face-down-vested-interests-for-radical-sláintecare-health-reforms/ (last accessed 2 Sept 2018).

75. Doyle K. Taoiseach defends use of private investigators to uncover ‘moonlighting’ hospital consultants. Irish Independent, 12 June 2018; available at https://www.independent.ie/irish-news/health/taoiseach-defends-use-of-private-investigators-to-uncover-moonlighting-hospital-consultants-37002308.html (last accessed 2 Sept 2018).

76. Whyte JH. Church and State in Modern Ireland, 1923–1970. Dublin: Gill and MacMillan; 1971.

77. Whyte JH. Church and State in Modern Ireland, 1923–1979, 2nd edition. Dublin: Gill and MacMillan; 1980.

78. Journal of the Irish Medical Association 1951;28(168):91. See note 2, Barrington 1987, at 222.

79. Kirwan, L. An Unholy Trinity: Medicine, Politics and Religion in Ireland. Dublin: The Liffey Press; 2016; at 32–3.Google Scholar

80. The editors, Encyclopaedia Britannica. Fabian society. Encyclopaedia Britannica, undated; available at https://www.britannica.com/topic/Fabian-Society (last accessed 3 Sept 2018).

81. See note 79, Kirwin 2016, at 36.

82. See note 29, Browne 1986, at 175.

83. Minutes of a meeting between the minister for health and IMA representatives, 24 Oct 1950. Cabinet Files S14997A. Dublin: State Paper Office. See note 2, Barrington 1987, at 206.

84. See note 2, Barrington 1987, at 176

85. See note 1, Wren 2003, at 38.

86. Letter from the Bishop of Ferns to the Taoiseach, 10 Oct 1950. See note 76, Whyte 1971, at 404–5.

87. See note 76, Whyte 1971, at 404–5.

88. See note 29, Browne 1986, at 160.

89. See note 29, Browne 1986, at 160

90. See note 1, Wren 2003, at 38.

91. Dignan J, Bishop of Clonfert. Social Security: Outlines of a scheme of national insurance. Sligo, 1945, at 36. See note 2, Barrington 1987, at 149.

92. See note 1, Wren 2003, at 40.

93. Deeny J. To Cure and to Care: Memoirs of a Chief Medical Officer. Dublin: The Glendale Press; 1989, at 74. See note 1, Wren 2003, at 32.

94. See note 76, Whyte 1971, at 404–5.

95. See note 1, Wren 2003, at 38.

96. See note 1, Wren 2003, at 38.

97. See note 29, Browne 1986, at 169.

98. On his resignation, Browne released all correspondence between the government and bishops on the issue; it was published in three major national newspapers on 12 Apr1951. See note 76, Whyte 1971. Appendix B: Correspondence released by Dr. Noël Browne on his resignation as minister for health, 1951, at 399–428.

99. Irish Catholic Bishops’ Conference. Please click on your diocese, 2011–2018; available at https://www.catholicbishops.ie/dioceses/ (last accessed 3 Sept 2018).

100. See note 29, Browne 1986, at 170.

101. See note 29, Browne 1986, at 160.

102. See note 29, Browne 1986, at 208.

103. The Irish Times, 13 Apr 1957; see note 76, Whyte 1971, at 257.

104. Irish Catholic Directory, 1952, 714–5; see note 77, Whyte 1980, at 271–2.

105. Semple P. Previous generations would be astounded at attitudes to churches in Ireland today. The Irish Times, 18 Nov 2014; available at https://www.irishtimes.com/news/social-affairs/religion-and-beliefs/previous-generations-would-be-astounded-at-attitudes-to-churches-in-ireland-today-1.2004480 (last accessed 3 Sept 2018).

106. The bishops’ arguments are addressed and largely repudiated in Kirwan’s historical account. See note 79, Kirwan 2016, at 46–77.

107. See note 29, Browne 1986, at 155.

108. See note 29, Browne 1986, at 177.

109. Finlay F. I was 65 yesterday. I feel the same as ever, but Ireland has changed. Irish Examiner, 2 June 2015; available at https://www.irishexaminer.com/viewpoints/columnists/fergus-finlay/i-was-65-yesterday-i-feel-the-same-as-ever-but-ireland-has-changed-334050.html (last accessed 3 Sept 2018).

110. See note 2, Barrington 1987, at 215.

111. Dáil Eireann Debate - Thursday, 12 Apr 1951; available at https://www.oireachtas.ie/en/debates/debate/dail/1951-04-12/41/ (last accessed 17 Feb 2019).

112. The National Archives. The Cabinet Papers: Origins of the NHS. Undated. Available at http://www.nationalarchives.gov.uk/cabinetpapers/alevelstudies/origins-nhs.htm (last accessed 2 Aug 2018).

113. MacPherson G. 1948: a turbulent gestation for the NHS. British Medical Journal 1998;316(7124):6. https://doi.org/10.1136/bmj.316.7124.6

114. See Wren 2003, note 1, at 334–9.

115. It is worth comparing the American situation with the Irish one. In the same time period, President Harry Truman attempted to establish an American national health service. He intended that since many parts of the country were poor and had inadequate health services, and doctors found it hard to make a living there, the government should construct a national healthcare infrastructure that served all. He proposed that healthcare should be free, and compensation paid to those who were sick and couldn’t earn; also that the government should invest in medical research and medical education. The American Medical Association (AMA) fought against it. They and their political allies described the plans as being a communist plot which would turn doctors into slaves. They took out full page ads in approximately 10,000 newspapers, advertised across approximately 16,000 radio stations, and distributed 55 million ‘red scare’ pamphlets. The pamphlets published a quote attributed to Lenin, that “Socialized medicine is the keystone to the arch of the Socialist state.” The proposals were defeated. Truman responded to the accusations made against the plan: “I put it to you, is it un-American to visit the sick, aid the afflicted or comfort the dying? I thought that was simple Christianity.” For “Christianity” here, one could substitute any mainstream religious or secular ethical thought; to deny this seems to invert the whole concept of morality. See: Greenberg J. Give ‘em health, Harry. The New Republic, 11 Oct 1993; available at https://newrepublic.com/article/141319/give-em-health-harry (last accessed 12 Sept 2018).

116. Public Statement by the Hierarchy on the Health Bill, 14 Apr 1952. See note 2, Barrington 1987, at 237.

117. See note 1, Wren 2003, at 41.

118. See note 79, Kirwan 2016, at 49–50.

119. See note 1, Wren 2003, at 44, 51, 53, 75, 85, 135, 359.

120. The Council for Justice and Peace of the Irish Episcopal Conference. Caring for Health in Ireland. Dublin: Veritas, 2012, at 21; available at: https://www.catholicbishops.ie/wp-content/uploads/2012/02/caring-for-health-in-Ireland.pdf (last accessed 3 Sept 2018).

121. Health Consumer Powerhouse (HCP). Ethical Values. Undated, available at https://healthpowerhouse.com/about-us/#contact (last accessed 16 June 2018).

122. Rawls J. A Theory of Justice. Cambridge, MA: Harvard University Press; 1999. See also: Barnard Health Care – Medical Ethics. Contractarianism. 7 Feb 2012; available at https://www.barnardhealth.us/medical-ethics/contractarianism.html (last accessed 10 Sept 2018).

123. See note 1, Wren 2003, at 69.

124. See note 1, Wren 2003, at 68–70.

125. Preston A. ‘I couldn’t sit back and let this happen’—mum had to pay for operation to save sight after hospital delay. Irish Independent, 3 Sept 2018; available at https://www.independent.ie/irish-news/i-couldnt-sit-back-and-let-this-happen-mum-had-to-pay-for-operation-to-save-sight-after-hospital-delay-37276505.html(last accessed 3 Sept 2018).

126. See note 125, Preston 2018.

127. Grice A. I’ve watched the deterioration of the NHS at first hand. Trust me when I say as a political reporter, this is our country’s biggest issue. The Independent, 4 July 2018; available at https://www.independent.co.uk/voices/nhs-70-anniversary-social-care-crisis-hospital-discharges-elderly-care-homes-a8430611.html (last accessed 3 Sept 2018).

128. O’Toole F. Why is Ireland unable to solve basic problems? The Irish Times, 18 Aug 2018; available at https://www.irishtimes.com/opinion/fintan-o-toole-why-is-ireland-unable-to-solve-basic-problems-1.3597198? [behind paywall] (last accessed 3 Sept 2018).

129. Farrell, R. The world-famous buildings that cost the same (or were cheaper) to build than the new National Childrens’ Hospital. Irish Independent, 10 Feb 2019; available at https://www.independent.ie/irish-news/news/the-worldfamous-buildings-that-cost-the-same-or-were-cheaper-to-build-than-the-new-national-childrens-hospital-37795742.html (last accessed 17 Feb 2019).

130. European Commission—Press Release. State aid: Ireland gave illegal tax benefits to Apple worth up to €13 billion. Brussels: European Commission, 30 Aug 2016; available at http://europa.eu/rapid/press-release_IP-16-2923_en.htm (last accessed 10 Sept 2018).

131. Burke C. The government isn’t saying when the €13 billion from Apple will be recovered. TheJournal.ie, 30 Nov 2017; available at http://www.thejournal.ie/apple-tax-close-to-agreement-official-3725384-Nov2017/ (last accessed 10 Sept 2018).

132. Another example: in the housing market, recent governments have almost ceased building social housing for the (relatively) poor, and have allowed a significant portion of the current social housing stock to be sold off at a discount to tenants. Governments have been encouraging a private rental market that is largely owned by foreign corporations. After the housing crash of 2008, the government bought distressed properties from builders, and sold them, via a ‘bad bank’ set up specially to deal with the crisis, to these corporations at discounts of approximately 70 percent. Laws were passed that require little or no income or capital gains tax to be paid by the corporations; while they tax small locally based landlords very heavily, many of whom have been forced out of the business. The various governments since the crash have also been allowing vulture funds, largely American, to buy distressed mortgages at great discounts (the mortgagees are not allowed to buy their own loans at a discount). Vulture funds have bought most of the country’s shopping centers, and they are gaining effective ownership of many farms with distressed loans (agriculture has been the mainstay of the Irish economy for centuries). The government has cultivated a very powerful corporate sector which exerts a great degree of control on Irish life; albeit in the background. In the case of foreign ownership of housing, farms, loans and business premises, it is akin to a new colonialism. See, for example, Connolly F. NAMA Land: The Inside Story of Ireland’s Property Sell-off and the Creation of a New Elite. Dublin: Gill Books; 2017. See also: Rudd J. The great Irish selloff. RTE TV documentary, 9 Jan 2017; available at https://www.dailymotion.com/video/x580tvq (last accessed 10 Sept 2018).

133. For a brief biography, see: Holland K. Savita Halappanavar; The early years. The Irish Times, 19 Oct 19 2013; available at: https://www.irishtimes.com/life-and-style/savita-halappanavar-the-early-years-1.1565736 (last accessed 3 Sept 2018).

134. Bunreacht na hEireann/Constitution of Ireland; available at https://www.taoiseach.gov.ie/eng/Historical_Information/The_Constitution/Bunreacht_na_h%C3%89ireann_October_2015_Edition.pdf (last accessed 10 Sept 2018).

135. McDonald H, Graham-Harrison E, Baker S. Ireland votes by landslide to legalise abortion. The Guardian, 26 May 2018; available at https://www.theguardian.com/world/2018/may/26/ireland-votes-by-landslide-to-legalise-abortion (last accessed 3 Sept 2018).

136. Callaghan D. Abortion referendum turn-out is the third-highest ever for a referendum in Ireland. Irish Independent, 26 May 2018; available at https://www.independent.ie/irish-news/abortion-referendum/abortion-referendum-turnout-is-thirdhighest-ever-for-a-referendum-in-ireland-36949137.html (last accessed 3 Sept 2018).

137. Minister for Health, Simon Harris. Dáil Éireann debate Friday 9 Mar 2018; available at https://www.oireachtas.ie/en/debates/debate/dail/2018-03-09/5/ (last accessed 13 Sept 2018).

138. Brunet R. Abortion laws vary significantly across the EU. France 24, 25 May 2018; available at http://www.france24.com/en/20180525-abortion-laws-vary-eu-ireland-malta-poland-termination (last accessed 3 Sept 2018).

139. Government of Ireland 2018. Health (Regulation of Termination of Pregnancy) Act 2018; available at http://www.irishstatutebook.ie/eli/2018/act/31/enacted/en/html (last accessed 19 Feb 2019).

140. See note 134, Bunreacht na hEireann/Constitution of Ireland, 2015, Articles 46 and 47.

141. Department of Taoiseach. 2015. Constitution of Ireland – Bunreacht na hEireann: Ammending Acts. Available at https://www.taoiseach.gov.ie/eng/Historical_Information/The_Constitution/ (last accessed 10 Sept 2018).

142. Carolan E. Article 40.3.3° and the law on abortion: A history. Citizensassembly.ie, undated; available at https://www.citizensassembly.ie/en/Meetings/-Art-40-3-3-and-the-law-on-abortion-a-history-Eoin-Carolan.pdf (last accessed 4 Sept 2018).

143. See note 134, Bunreacht na hEireann/Constitution of Ireland, 2015, Article 40.3.3°.

144. Bacik, I. Legislating for Article 40.3.3°. Irish Journal of Legal Studies 2013;3(3):18-35, at 24; available at http://ijls.ie/wp-content/uploads/2013/07/IJLS_Vol_3_Issue_3_Article_2_Bacik.pdf (last accessed 4 Sept 2018).Google Scholar

145. Protection of Life During Pregnancy Act 2013; available at http://www.irishstatutebook.ie/eli/2013/act/35/enacted/en/pdf (last accessed 3 Sept 2018).

146. See note 145, Protection of Life During Pregnancy Act 2013, S.22(2)

147. O’Hanlon E. This government must be the one to face facts. Sunday Independent, 18 Nov 2012; available at https://www.independent.ie/opinion/analysis/eilis-ohanlon-this-government-must-be-the-one-to-face-facts-28902772.html (last accessed 3 Sept 2018).

148. A more detailed summary of the events is given in: O’Carroll S. Savita Halappanavar: Her tragic death and how she became part of Ireland’s abortion debate. TheJournal.ie, 29 Apr 2018; available at http://www.thejournal.ie/eighth-amendment-4-3977441-Apr2018/ (last accessed 3 Sept 2018).

149. Crawford C. Savita died from ‘rare infection.’ Irish Independent, 29 Apr 2013; available at https://www.independent.ie/irish-news/courts/savita-died-from-rare-infection-29207124.html (last accessed 3 Sept 2018).

150. Shannon J. Learning lessons from Savita. Irish Medical Times, 28 Apr 2017; available at: https://www.imt.ie/features-opinion/interview-features-opinion/learning-lessons-from-savita-28-04-2017/ (last accessed 6 Aug 2018).

151. St. George’s, University of London. Research Profiles A-Z: Professor Sir Sabaratnam Arulkumaran; available at https://www.sgul.ac.uk/research-profiles-a-z/sabaratnam-arulkumaran (last accessed 3 Sept 2018).

152. O Cionnaith F. Author of Savita Halappanavar report says 8th Amendment contributed to her death. Breakingnews.ie, 18 Oct 2017; available at https://www.breakingnews.ie/ireland/author-of-savita-halappanavar-report-says-8th-amendment-contributed-to-her-death-810432.html (last accessed 10 Sept 2018).

153. Health Service Executive (HSE). Investigation of Incident 50278 from time of patient’s self referral to hospital on the 21st of October 2012 to the patient’s death on the 28th of October, 2012; June 2013; available at https://www.hse.ie/eng/services/news/nimtreport50278.pdf (last accessed 3 Sept 2018).

154. Health Service Executive (HSE). Press Release: HSE publishes Report of the Investigation into the death of Ms. Savita Halappanavar; available at https://www.hse.ie/eng/services/news/media/pressrel/newsarchive/2013archive/jun13/savitareport.html (last accessed 3 Sept 2018).

155. Health Services Executive (HSE). Press release: HSE publishes Report of the Investigation into the death of Ms. Savita Halappanavar, June 13 th 2013; available at: https://www.hse.ie/eng/services/news/media/pressrel/newsarchive/2013archive/jun13/savitareport.html (last accessed 3 Sept 2018).

156. Health Information and Quality Authority (HIQA). Investigation into the safety, quality and standards of services provided by the Health Service Executive to patients, including pregnant women, at risk of clinical deterioration, including those provided in University Hospital Galway, and as reflected in the care and treatment provided to Savita Halappanavar, 7 Oct 2013; available at https://www.hiqa.ie/sites/default/files/2017-01/Patient-Safety-Investigation-UHG.pdf (last accessed 3 Sept 2018).

157. Health Information and Quality Authority (HIQA). Executive Summary: Investigation into the safety, quality and standards of services provided by the Health Service Executive to patients, including pregnant women, at risk of clinical deterioration, including those provided in University Hospital Galway, and as reflected in the care and treatment provided to Savita Halappanavar, October 7 2013; available at https://www.hiqa.ie/system/files/Patient-Safety-Investigation-UHG-Summary.pdf (last accessed 3 Sept 2018).

158. Admin. The Savita report confirms worst fears. Irish Medical Times, 18 Oct 2013; available at https://www.imt.ie/features-opinion/the-savita-report-confirms-worst-fears-18-10-2013/ (last accessed 3 Sept 2018).

159. Health Information and Quality Authority (HIQA). HIQA News Update: Patient Safety Investigation Report published by Health Information and Quality Authority (Savita Halappanavar), October 9 2013; available at https://www.hiqa.ie/hiqa-news-updates/patient-safety-investigation-report-published-health-information-and-quality (last accessed 3 Sept 2018).

160. Daly S. This shocking graphic shows 13 “missed opportunities” in treatment of Savita. TheJournal.ie, 13 Oct 2013; available at http://www.thejournal.ie/savita-halappanavar-missed-opportunities-timeline-1121510-Oct2013/ (last accessed 3 Sept 2018).

161. Hynes F. Savita: The truth. Herald.ie, 13 Feb 2013; available at https://www.herald.ie/news/savita-the-truth-29068036.html (last accessed 3 Sept 2018).

162. Halpin P, Humphries C. Ireland quietly comes to terms with dramatic change after abortion vote. Reuters, May 27, 2018; available at https://www.reuters.com/article/us-ireland-abortion/ireland-quietly-comes-to-terms-with-dramatic-change-after-abortion-vote-idUSKCN1IS0IB (last accessed 3 Sept 2018).

163. Holland K. Flowers, notes and messages placed at mural of Savita in Dublin. The Irish Times, 26 May 2018; available at https://www.irishtimes.com/news/social-affairs/flowers-notes-and-messages-placed-at-mural-of-savita-in-dublin-1.3509950 (last accessed 3 Sept 2018).

164. O’Brien B. Abortion legislation will force GPs out of healthcare. The Irish Times, 6 Oct 2018; available at https://www.irishtimes.com/opinion/breda-o-brien-abortion-legislation-will-force-gps-out-of-healthcare-1.3653118 (last accessed 19 Feb 2019).

165. See note 164, O’Brien 2018.

166. Gandhi M. Quoted in Marsden F. Decline in morality has led to animal-human hybrids. The Catholic Herald, 16 Sept 2007, at 7.

167. He said this to a group of Catholic medical missionaries who bring healthcare to very poor people in Africa, who would not otherwise receive it. In: Wooden C. Health care is a right, not a privilege, Pope says. Catholic News Service, 9 Sept 2016; available at http://www.catholicnews.com/services/englishnews/2016/health-care-is-a-right-not-a-privilege-pope-says.cfm (last accessed 16 Aug 2018).

168. Universal healthcare access is also advocated by the World Health Organisation (WHO). See: Wren MA and Connolly S. Challenges in achieving universal healthcare in Ireland. Dublin: Economic and Social Research Institute (ESRI), 2016; available at https://www.esri.ie/pubs/BP201701.pdf (last accessed 9 Sept 2018).