Determination last week on the part of health minister Mary Harney that the new national children’s hospital be under the direction of a Roman Catholic religious order places a serious question mark over Ireland’s claim to be a pluralist society and threatens the the viability of the children’s hospital at Tallaght– the only general hospital in the state under Protestant management.  If the children’s hospital is lost, the whole Tallaght hospital complex faces the prospect of being down-graded to a district hospital.

To an outsider, the concerns can seem a matter of church politics, but to people seeking treatment the differences in the religious ethos of the hospitals can be vital. The ethos at Tallaght is that best medical practice should prevail and that nothing should interfere in the doctor-patient relationship. The Roman Catholic hospitals have ethics committees which oversee the work of the hospital and which seek to ensure the implementation of Roman Catholic teaching in clinical decisions. There are whole areas of medical practice, particularly in human fertility and reproduction and in medical research where there are fundamental differences about what is permissible.

The loss of Tallaght would leave the bulk of Irish clinical practice subject to the ethics committees, but, as in so much of life, economics has the last say. Even when various procedures were illegal in these islands, there were always people with money who could buy whatever they sought. The legalisation of abortion in England made the termination of pregnancy an option for those who could afford to make the journey; it has become an option exercised by some 6,000 Irish women every year. The existence of ethics committees doesn’t prevent abortion; it simply introduces a price for it.

The situation that applies with regard to abortion would arise in relation to a whole range of other practices if Tallaght hospital lost its ability to provide the full range of clinical care. It wouldn’t mean that practices opposed by ethics committees came to an end, it would simply mean that they would come with a price; the affluent middle classes would be able to choose the British option; the people who would be denied choice would be the working classes and the poor.

I can see an economist I know with the hint of a smile on his face. “You can’t beat the market”, he once told me.

Medical practices considered legitimate by most people may become available only to those with money, but, as has been the case for generations, where there is demand and the cash to pay the price, the services will be provided.