DURING HIS 40 years of being an obstetrician in Ireland, Peter Boylan has had a shadow looming over him – as he puts it in the title of his new memoir, it’s the shadow of the Eighth Amendment.
It’s part of why he became such a huge proponent for the amendment’s repeal in 2018′s referendum – he believes it prevented doctors and obstetricians from making healthcare decisions that could save women’s lives.
In his memoir, In The Shadow of the Eighth, the Dublin-born former Master of Holles St dwells only briefly on his personal life. What he wants to concentrate on is the relationship between women, healthcare and the State in Ireland.
We do get a sense of the real Dr Boylan at the beginning of his book: he tells us he grew up in a happy home, one where his parents mixed in a cultured set. He learned how to sail (he still sails to this day), played rugby at school, and set his mind on working in the healthcare system.
But the book is less about this and more about Boylan casting an eye over his 40 years in medicine and assessing it for what it is now. He adores his role, and he has a deep respect for all those who work in the medical industry. But he is not blind to the the issues, and to him one of those is religion’s abiding role in Irish hospitals.
“From the beginning of the last century and before that, in fact, the church has had a huge role to play – the Catholic church has had a huge, huge role to play in the provision of health care and education in Ireland,” says Boylan when we meet in TheJournal.ie‘s offices. “And in many ways they’ve done an absolutely superb job.”
He says that religious ethics are generally of “no consequence in things like say orthopaedics or neurosurgery or neurology or any of those specialties”.
“But it only becomes a problem when it’s women’s reproductive health care.”
He explains that it is usually only an issue where there’s a maternity unit or gynaecology unit in a general hospital which is run by a religious order.
Yet in his book, he has examples of how a maternity hospital might be affected. For example, as Master in Holles St he tried to introduce tubal ligation as a form of family planning.
It was being requested by women, but was only being used in “exceptional circumstances” in the three maternity hospitals. After he decided to introduce it, Boylan was called to see Archbishop Des McConnell.
“There was an ocean of misunderstanding and difference of opinion between us and they almost regarded us as a sort of a separate species,” he recalls of the meeting. The atmosphere in the room was “extremely frosty”.
“They basically told me: Look, you can’t be doing this. That it’s not justified surgery, and it’s effectively an assault on women without, you know, just reason. So I said, Well, look, I’m the doctor and you’re not; and I’m responsible for the observations, responsible for running the hospital, and we’re going to keep doing it.”
After he left, he “never heard any more from them”. (Incidentally, female sterilisation, has fallen off “in a huge way in the last few years” he says, because of the mirena coil, which is as effective as a sterilisation but reversible.)
It’s just one example of how Boylan has stood firm in his beliefs throughout his career, not allowing himself to be swayed by others.
Termination for medical reasons
It was on the issue of terminations, and the repeal of the Eighth Amendment, that he became a household name as part of the Together for Yes campaign.
Boylan says that termination of pregnancy raised its head because of more diagnoses of foetal abnormality, which occurred due to improvements in ultrasound.
He first came across terminations when he was training in London. While working as Associate Professor of the University of Texas in Houston, he got exposed to the developments in foetal medicine. The ‘shadow of the Eighth’ started to appear over his work after it was introduced into the Irish Constitution in 1983.
It loomed even larger for Boylan after the death of Savita Halappanavar, in 2012.
“The medical care she got wasn’t to the highest standard towards the end. But because of the Eighth Amendment, they couldn’t intervene and deliver her and she requested [delivery], which is what would have happened in any other European country,” he says. “Apart from Malta.”
In his book he outlines the details of Savita’s hospital experience, death, and the subsequent inquest. He also tells the story of what happened to Miss Y, (an asylum seeker who became suicidal as a result of rape – he describes the case as “an absolutely Kafka-esque episode”) and also Miss P, who was pregnant and had died, but “the doctors felt they had to keep her going because of the 8th Amendment”.
These women’s cases serve to demonstrate the chilling effect the Eighth Amendment had on women’s healthcare in Ireland, writes Boylan. When speaking about the cases now, it’s clear that he’s still struck by the tragic detail to them.
“The problem with Miss P was that the doctors were looking at the Constitution of Ireland in the intensive care unit, figuring out whether or not they’d be able to turn off the machines,” says Boylan.
“She had already been declared brain-dead because there was no blood going to her brain and her brain was liquefying. Because that’s what happens when the brain dies. And it ended up in the High Court in the days before Christmas.”
So that was one of the most distressing – the most distressing experience of my life, because I was asked to give evidence on it by the solicitor representing the family, so I had a very good insight into what was going on. And how distressing it was for her children to be brought in to see her body.
He felt the judgment in this case “was a bit kind of Jesuitical, you know, because they said it had nothing to do with abortion and therefore it had nothing to do with Eighth Amendment but the whole reason we were in the court was because of the Eighth Amendment”.
By some strange coincidence, as I am talking to Boylan the news breaks that Miss P’s family had received an apology from the HSE for what happened to her. We now know that ‘Miss P’ was Natasha Perie, a 26-year-old mother who died as a result of a ruptured brain cyst that had gone undetected. Her family described what happened to her as “nothing short of a nightmare”.
Boylan was asked by Justice Nicholas Kearns during Miss P’s hearing, whether any guidelines would be helpful in interpretation of the Eighth Amendment.
“I just said, ‘look, we need to get rid of it’. That would have been better.”
Online abuse
Being one of the major faces of the Repeal the Eighth campaign meant that Boylan was appearing on TV screens and radios across Ireland. The period leading up to the referendum date was an intense and for some people uncomfortable time. There were calm and civil discussions, but there were also highly-charged public moments and barbs thrown back and forth on social media.
How did he deal with any abuse that came his way?
“Well, from my own personal point of view, the abuse and so on really didn’t bother me all that much to be honest with you. Because I’m a big boy,” he says. “I mean, a lot of it I just ignored, like the online stuff, and the social media stuff. A lot of them are bots. So they’re not real people at all. There are real people running them, obviously.”
There were several letters written, trying to get him to resign as chairman of the Institute of Obstetricians and Gynaecologists. At a public event in Donegal, he was the target of shouts of “murderer”.
But he says: “When you look at the hurly burly of say what politicians go through that of was very minor stuff really.”
I mean, people have a point of view: they’re perfectly entitled to express it. So I didn’t have a problem with people writing letters and trying to get me to resign. I wasn’t going to resign.
A number of Holles St consultants signed a letter calling on him to resign from the hospital’s board. He says now that a number contacted him to say that they didn’t want to sign it but did. “So, you know, that’s what goes on in the background. And all of that is fine. All is fair in love and war.”
He says rugby has taught him how to deal with such scuffles. “One of the features of rugby is that you often will know the opposing team very well. You may have been in school with them, where you go out and tear strips off each other and it’s all no holds barred stuff. But when the whistle goes, you shake hands and you go back to a normal relationship and you’re friends again and so on. So that’s kind of the attitude I’ve brought to all of these encounters, that I don’t take it personally.”
This also applies to his relationship with his sister-in-law Rhona Mahony. The pair are on opposing sides of the argument when it comes to the National Maternity Hospital at Holles St re-locating to a new building at St Vincent’s Hospital.
“I mean to draw on the sporting analogy, again, the whistle hasn’t gone yet. Yeah, because the Vatican haven’t given their decision. We’re still on the pitch,” he says.
Hospital wars
The issue of the Holles St move to the St Vincent’s Hospital campus takes up a chunk of the book. This is because of Boylan’s concerns about religious ethos in the new NMH.
“The design of that hospital is superb. It’d be wonderful if it happened. But I raised the issue of potential problem with religious ethos in the hospital,” he explains. “Because it was going to be built on land owned by the Sisters of Charity. Now, the original plan was that the Sisters of Charity would actually own the hospital and own the land, own the company that was set up to run it.”
His stance has put him at odds with some colleagues, a family member (his sister-in-law Rhona Mahony, Master of Holles St), and led to him resigning from the board of the NMH.
But he stands firm in his opinion.
The latest news on this is that the Sisters of Charity have asked the Vatican for permission to pull out from the site before any substantial building works take place.
The religious order announced almost 30 months ago that it was ending its involvement in they St Vincent’s Hospital Group and would therefore have no involvement with the new National Maternity Hospital.
The move came after the discussion and controversy over the religious congregation’s involvement in the new NMH.
Boylan says that this has all arisen “because proper due diligence wasn’t done. Way back when you know, in 2016.”
“They just bulldozed head and effectively I was closed on every time I brought it up,” he says. “So I’ve been proven to be right at the end.”
But he says that throughout everything, he has had “massive support from people with in Holles St”.
There’s only a small number of people who thought that I was out of order, if you like. Whenever I went to Holles St, which I do regularly, I’m welcomed back.
“I just feel sorry… that I resigned from the board because of what was going on. It was impossible to stay on board.”
He says that should “due diligence” have been done on the consequences of building on religious-owned land, it would have been “obvious that there was a major problem, and that should have been sorted out years ago”.
“And that’s what really annoys me.”
He claims that there is “a lot of denial, self denial, in it and thinking it will be alright on the night, we just go ahead and build a hospital there”.
Separation of church and State
After the repeal of the Eighth Amendment, Boylan agreed to be an advisor to the HSE for the implementation of abortion services. The services were rolled out in January of this year. They weren’t without their speedbumps.
“And there were a couple of hairy moments that I described in the book, for example, the availability of the drugs and difficult with ultrasound services, that sort of thing, which were the most difficult to resolve,” he says.
Currently, he says that the GPs are providing the majority of the service, “and they’re doing a phenomenal job”, though he acknowledges GPs across the country aren’t all providers.
“My understanding is that the hospitals are not as busy as they anticipated they would be but more hospitals need to get involved.”
He says that it is up to the CEOs of the hospital groups to ensure that the service is implemented around the country. “They need to do [that] you know, and I’ve found them pretty disappointing to be honest with you.”
Boylan believes we need “proper protection for women’s healthcare because oftentimes the gynaecology ward is the first one that gets cut, or gynaecology beds”.
He wants to see maternity units stand alone, not as part of general hospitals.
“They need to separate them out the same way that they did with the cancer service.”
“There’s no problem with it, with the religious running hospitals. They’ve run excellent hospitals. St Vincent’s is run extremely well. and it’s a very good hospital.
“But in the future, any new hospitals, it should be absolutely crystal clear.”
He says that St Vincent’s might end up being “a landmark decision which will clarify things”.
“Definitely, the church has its place and people have to be allowed to practice with their religion.
“But when it comes to the provision of state services, then sorry, I mean if you want to have a maternity hospital also that’s, you know, purely Catholic maternity also. Fine.
“But you’ll have to finance it yourself. You can’t ask the State to finance it. It wouldn’t be fair.”
In The Shadow of the Eighth, by Peter Boylan, published by Penguin Ireland, is out now.
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