Candles in the Dark S I N

C A N D L E CANDLES IN THE DARK S I N T MEDICAL ETHICAL ISSUES IN NORTHERN IRELAND DURING THE TROUBLES CANDLES IN THE DARK H E D A James McKenna, Farhat Manzoor and Greta Jones MEDICAL ETHICAL ISSUES IN NORTHERN IRELAND DURING THE TROUBLES R K This report tells the story of how medical care was dispensed during the period of the recent civil conflict in Northern Ireland. Based on interviews with medical professionals who lived and worked through the Troubles as well those with whom they came into contact, it highlights the strains and ethical tensions that the Troubles in Northern Ireland placed on the medical profession. Based on the experiences of those in hospitals, surgeries and prisons within the province, Candles in the Dark is both a significant record of the issues faced and a testament to the integrity and dedication of the vast majority the medical professionals involved. This report is based on the Nuffield Trust’s 2002 Rock Carling lecture by Dr James McKenna, former Chief Medical Officer for Northern Ireland, and is augmented by additional research and interviews carried out by Farhat Manzoor and Greta Jones of the University of Ulster. It will be of interest to health leaders, researchers and all those interested in medical ethics or the recent social history of Britain and Ireland. The Nuffield Trust 59 New Cavendish Street, London W1G 7LP Email: [email protected] www.nuffieldtrust.org.uk CANDLES IN THE DARK MEDICAL ETHICAL ISSUES IN NORTHERN IRELAND DURING THE TROUBLES James McKenna, Farhat Manzoor and Greta Jones The Nuffield Trust The Nuffield Trust is a charitable trust carrying out research and policy analysis on health services. Its focus is on the reform of health services to improve the efficiency, effectiveness, equality and responsiveness of care. The Rock Carling Fellowship was established in memory of the late Sir Ernest Rock Carling. It is awarded to a distinguished individual who is invited to review the current state of knowledge and prospects in his or her field in a monograph published by the Trust and at a public lecture given by the author. This report is based on the 2002 Nuffield Trust Rock Carling given by James McKenna, augmented by significant further research and analysis by the three authors. Published by The Nuffield Trust 59 Cavendish Street London W1G 7LP Telephone: 020 7631 8450 Facsimile: 020 7631 8451 Email: [email protected] Website: www.nuffieldtrust.org.uk Charity number 209201 © The Nuffield Trust 2009 ISBN-13 978-1-905030-32-3 Typeset and printed by Winstonmead Print, Loughborough, Leics LE11 1LE Telephone 01509 213456 Contents About the authors . iv Acknowledgements . v 1. Introduction . 1 2. Background . 9 3. Family Doctors . 29 4. Hospitals and Community . 43 5. Professionals in Interrogation Centres and Prisons . 65 6. Prison Protests . 89 7. Conclusion . 115 Appendix 1 . 131 Appendix 2 . 137 Appendix 3 . 138 Bibliography . 139 About the authors James McKenna is former Chief Medical Officer of Northern Ireland; he also formerly led on public health for the Northern and Eastern Health Board and Social Services Boards in Northern Ireland. He is a fellow of the Royal College of Physicians of London, Edinburgh and Ireland and a Fellow of the Faculties of Public Health of the UK and Ireland. He is a recipient of the Alwyn Smith Medal of the Faculty of Public Health (UK) and was appointed Companion of the Bath in 1994. Dr McKenna was the Nuffield Trust Rock Carling Fellow in 2002. Farhat Manzoor is a former Nuffield Trust Associate Fellow and research associate at the University of Ulster. She has worked at the Centre for the History of Medicine at the University of Warwick and is an associate member of the Centre for the History of Medicine in Ireland at the University of Ulster. She is the author with Dr McKenna and Professor Jones of ‘ “How could these people do this sort of stuff and then we have to look after them?” The Ethical Dilemmas of Nursing in the Northern Ireland Conflict.’ (Oral History vol. 35, no.2, 2007). Greta Jones is Professor of History and co-Director of the Centre for the History of Medicine in Ireland at the University of Ulster. She is the author of books on Darwinism and the history of medicine including ‘Captain of all these men of death’: The History of Tuberculosis in Nineteenth and Twentieth Century Ireland. Amsterdam, New York: Rodopi (2001). iv Acknowledgements The authors are grateful to the Nuffield Trust whose financial support was vital to this project. John Wyn Owen was the original inspiration and Matthew Batchelor was indispensable in bringing it to fruition. Iwan Morus helped in its early stages. Elizabeth Gurley gave essential secretarial support. We are indebted to all those who gave time to the interviewers and whose testimonies form the basis of this work. The help of various agencies in locating interviewees was important and, in this context, we would like to thank WAVE Trauma Centre, Prisoners Aid and Post Conflict Resettlement Community, Restorative Justice Ireland, North Belfast Prisoners Aid, East Belfast Prisoners Aid, Prisoners Enterprise Project South Belfast, Prisoners Aid Lisburn, Greater Shankill Community Council, Greater Shankill Alternatives Programme. v 1. Introduction This publication tells the story of the Troubles from the viewpoint of health professionals. The focus of the book is on the various venues – general practice, hospitals and prisons – in which medical care was dispensed during the period of the recent civil conflict in Northern Ireland, and on the doctors, nurses and patients who were involved. It is a record, not of the broader organisational or administrative issues connected with health, but of the more personalised accounts of reaction to the turmoil which engulfed Northern Ireland in the late 1960s. The work is based on interviews with health professionals who lived and worked through the period and, to a lesser extent, those with whom they came into contact, including patients, hospital administrators, chaplains and politicians. The purpose of these interviews was basically to elucidate the strains and tensions which the Troubles in Northern Ireland placed on them, and to give an account of how they coped. The framework within which these interviews were conducted was to identify what the key issues were considered to be for those dispensing health care during the period. It deals with the obstacles, both physical and emotional, placed in the way of the health professions. Also framing a large part of the interviews was the question of how far the ethical codes governing medical practice were affected and to what extent these were delivered successfully, even under the strains of intercommunal strife and conflict. The narrative is based primarily upon personal testimony, although the political background to the Troubles, and many of the main events, are sketched out. This is done in order to provide some explanation of the events described and to contextualise the individual narratives. The period covered encompasses the political upheavals in Northern Ireland from 1969 until the second ceasefire in 1998, but it is not a political history. Indirectly, considerable light is thrown upon the impact of politics on the medical profession and also upon the everyday life of the Northern Irish community. However, its chief objective is to ask the 1 CANDLES IN THE DARK following question: how difficult was it to conduct medical work in the circumstances of Northern Ireland during this period, and to maintain the medical codes of ethics governing health care? Doctors and nurses are governed by a set of professional ethics which are conveyed in training. However, until the publication of the Report ‘Tomorrow’s Doctors’ by the United Kingdom General Medical Council (GMC) in 1993, there was no formal or mandatory provision for training in medical ethics in place in British medical schools – certainly not at Queen’s University Belfast, which continued to supply the majority of Northern Ireland doctors in practice during the period. Following on from the GMC report, special provision for ethical training began to be introduced into medical education. In the Republic of Ireland, from where doctors in Northern Ireland often were recruited, medical ethics courses were more common. In both jurisdictions the ceremony of taking the Hippocratic Oath was an important part of graduation. Students were required to take the oath and usually this was the moment when doctors would be addressed on the wider issues of their duties and responsibilities to their patients. However, in the oldest school of nursing in Northern Ireland at the University of Ulster, a full module on nursing ethics was taught from 1977 onwards. This contrasted somewhat with the rather sparse teaching on the subject given to doctors. Therefore, for doctors, a great deal of medical training in ethics was through contact with teachers and colleagues. It is not suggested that this was not an effective and meaningful source of ethical training. All the professionals who operated in the Troubles were clear about the values that they were expected to display. As one doctor said: I don’t remember very much about ethics training…but I do remember a very strong informal ethos, which was that we were doctors, we were Health Service and we would treat everyone with respect – and regardless of who, why, where, their involvement, non-involvement and what part of the community. (D 500) In the absence of formal training, the understanding of what was required of them was gained by osmosis, absorbing the general ambience of medical practice. These values were to save life, to dispense care without favour or discrimination, to treat the patient with consideration, to minimise suffering where possible, and to act only with the patient’s benefit in mind.

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