A conflict over ethics has shaken a 150-year-old Catholic medical institution in London to its core. Two directors have resigned following the adoption of a tighter ethical code and there are growing questions over the hospital's survival under the auspices of the Church in secular Britain
Last year the Hospital of St John and St Elizabeth celebrated 150 years as a Catholic charitable institution. That it will celebrate future anniversaries now seems uncertain. For after months of accusations, investigations and negotiations, the hospital appears to have fallen victim to a clash between two very different cultures. The story of St John and St Elizabeth is one in which the immovable object of a hospital rooted in non-negotiable Catholic morality has collided with the irresistible force of modern enterprise driven by secular interests. Disaster was inevitable.
Sale of the hospital is now being considered, or even its possible closure. For though it has been determined that the Catholic ethics of the hospital are of principal importance, many of the doctors working on the premises are unable to square these with their obligations as medics. Unable to countenance what they see happening to the hospital they have cherished for decades, two members of the board of directors have already resigned. Its chairman, Lord Bridgeman, is understood to be resolved to resign on Wednesday.
Meanwhile, as the current of events gathers speed, the hospital's patron Cardinal Cormac Murphy-O'Connor finds himself struggling to ensure the hospital's survival as a Catholic medical institution.
St John and St Elizabeth was opened as a charity by Cardinal Wiseman in 1856, in Great Ormond Street. Since then the independent hospital has moved to prosperous St John's Wood in north London and hosts one of the most glamorous private maternity clinics in the country. It still operates as a charity, with profits going to the nearby St John's Hospice, for the terminally ill.
However, the story of the decline of the hospital begins two years ago, when it emerged that the Linacre Centre for Healthcare Ethics, which occupied one of the hospital buildings, was to be ousted. Its rooms were to be transformed into a polished medical centre, at a cost of around £13 million. The centre would comprise 27 consulting rooms, two endoscopy theatres and a local NHS practice.
This prompted members of the Linacre Centre to confront questions that had been niggling them. They suspected that the code of ethics, which forbade doctors from involvement in abortion and contraceptive services, was being infringed by some of the dozens of consultants who practised from the premises. More specifically, they wondered how a group of GPs, with obligations under their NHS contract to provide a full range of services to patients, could comply with the rules.
The complaints prompted Cardinal Murphy-O'Connor to order an investigation into the code and infringements were found to include sex-change operations and referrals for abortion. Some of those at the hospital failed to "accept the implications of the tensions and conflicts between Catholic moral teaching and contemporary secular medical practice", wrote the cardinal in a stern letter to the chairman.
Expert advice was taken, and the cardinal instructed that the code must be rewritten to close any loopholes and it must be more strictly enforced. The resulting rulebook not only forbids referrals for direct abortion, but also forbids doctors from referring patients to a colleague who could enable abortion. Contraception and the morning-after pill are proscribed, as are gender-reassignment operations.
What remained was for the hospital's board of directors to decide whether it would accept the revised code and impose it on all doctors at the hospital, including the NHS GPs due to move in next month. The solicitors Capsticks, experts in health-care law, told the board: "Our advice is therefore not to adopt the code of ethics as presently drafted." An independent firm of management consultants warned that implementing the code would have a significantly adverse effect on profitability. The General Medical Council and the Nursing and Midwifery Council also said it was unworkable. On this basis, Cardinal Murphy-O'Connor initially agreed that he must withdraw his patronage to save the future of the hospital, but was persuaded by his advisers to retract.
The hospital board consists of 13 Catholics, five of whom are members of the Sovereign Military Order of Malta, including the Order's president Charles Weld and Prince Rupert zu Löwenstein. These men are uncompromising Catholics who reportedly said they would "prefer to see the hospital become a soup kitchen" than distance itself from its code. The board finally passed a resolution in November, accepting the code by a majority of five to three. The three who voted against were Dr Martin Scurr (the only medical doctor on the board), Lord Mark Fitzalan-Howard and Lord Bridgeman.
The first board member to resign was Dr Scurr, although he has since been persuaded to suspend his resignation until the end of the board meeting due on Wednesday.
In a letter to Lord Bridgeman on 8 November he said: "I am convinced that the cardinal has been badly advised, as so often happens with the Catholic Church."
Clearly upset and angry, Dr Scurr, whose father was a distinguished anaesthetist at the hospital, says he no longer trusts the board. "Expert advisers have been chosen who give the hierarchy of the Church the answers that they wish to hear and in the matter of modern medical care the cardinal has chosen to listen to individuals who have no specific expertise in that arena," he wrote. "The damage to the Church will be worse if the hospital closes, unless he chooses to withdraw his patronage."
Two weeks later, Lord Mark Fitzalan-Howard, director of the hospital and chairman of St John's Hospice, also resigned, saying that he did "not believe that what is being asked of us by the cardinal is in the best interests of this truly wonderful 150-year-old charity".
"I personally believe an ‘amicable disassociation' from certain requirements in our constitution is the preferred solution," he wrote on 22 November. "However, I have also stated that I would not wish to pursue a solution that did not have the approval of the cardinal."
The clash between secular medicine and Catholic values is clear from these letters. As Dr Scurr, who is also chairman of the hospital's ethics committee, points out: "We are now in an era where the Catholic Church must withdraw from involvement in frontline healthcare."
Dr Scurr is a Catholic GP at the private Portobello Clinic in Notting Hill. He managed, against his better judgement, to compose a code of ethics that satisfied Cardinal Murphy-O'Connor. "What I signally failed to do is to persuade the lay members of the committee and the non-medical members of the board of the position of doctors who have to do this work, in a secular culture, under the jurisdiction of the General Medical Council," he wrote.
At a meeting on 23 November attended by the cardinal and hospital trustees, sources say that the possible damage to the hospital and the Church was impressed upon the cardinal, but under pressure from his advisers he continued to insist that the code must be enforced. "Both he and his advisers have become much more zealous in recent months" said one observer. "I see the seeds of fundamentalism being sown at the hospital. The Knights of Malta will see these resignations as a victory because now they can do what they like with the hospital".
After the withdrawal of his two allies on the board, Lord Bridgeman, who is 78, has also decided to resign at the end of the meeting on Wednesday. His involvement with the hospital dates back almost a decade and he has a reputation as a man of strong principles who understands only too painfully the impossibility of the task he was charged with. "He's sweated blood over this," said a friend.
It is a task that may be required of others before long. Already, there are murmurings about other Catholic institutions that may have fallen by the wayside. St Anthony's in Cheam, south London, has no code of ethics, nor does the GPs' surgery at the Passage in Westminster, run by a religious sister. It remains to be seen whether action will be taken to pull others into line. What is clear is that current events add up to some big questions for the future of Catholics working in health care.