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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

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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).

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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).