This chapter argues that debates about conscientious objection in health care would benefit from distinguishing clearly between two distinct sets of issues 1) who qualifies for conscientious objection and 2) how conscientious objection ought to be limited in order to prevent harm to others. It argues that institutions (e.g. hospitals) and indirect participants (e.g. pregnancy counselors) ought not qualify for conscientious objection but for different reasons. Institutions ought not qualify because they do not have the kind of critical moral consciousness which is necessary to ground a right to conscientious objection. Indirect participants ought not qualify for two reasons: first, denying someone pre or post abortion care is harmful in discriminating against receivers of lawful abortion care and is more than is necessary for the protection of objectors’ moral integrity and secondly, information about pregnancy and abortion care will not necessarily lead to an abortion and after care cannot prevent abortion. In this way the chapter proposes that Irish debates about conscientious objection in a healthcare context need to move beyond a consideration of the powers of religiously run hospitals and towards a rights based method of assessing conscientious objection in light of the need to recognise moral integrity and prevent harm.

Examines the citizen’s experience of FOI. It begins with a basic ‘how to’ guide to making an FOI request and details citizens’ usage of the Act since its inception. Following an examination of significant Information Commissioner rulings that, it is argued, have shaped the evolution of the Act, the chapter assess a sample of citizens’ experiences making FOI requests. The chapter is co-authored by former journalist and current academic, Tom Felle, and Gavin Sheridan, investigative journalist and citizen activist for FOI; both of whom have quite different citizen experiences to relate. Utilising the reported experiences of personal and non-personal FOI requests, this chapter details quite different levels of satisfaction with the two FOI processes.

This chapter gives particular consideration to the political culture in which Irish approaches to governmental secrecy and freedom of information evolved and developed. It notes that openness and transparency in government institutions were not high priorities for the fledgling Irish state. Fresh from fighting the War of Independence and in the midst of Civil War, the Free State government that was established with Irish independence was driven by an expedient imperative to maintain control. From these beginnings, many have noted that the Irish state system that subsequently evolved was characterised by a centralised and secretive approach to government – governed more by pragmatics than principle. It is from this starting point that Chapter 2 documents the political and administrative culture of the Irish state as it evolved throughout the last century, demonstrating that once institutional norms are established, they take a great deal of effort and directed political intention to shift them. The chapter looks at Irish attitudes to FOI and illustrates the unevenness of reform efforts over the years, as well as the prospects for a future re-orientation.

This chapter considers two high profile Irish inquiries: the Lourdes Hospital Inquiry on the Neary case and the Health Information and Quality Authority (HIQA) Report on University Hospital Galway and the care of Savita Halappanavar from an organisational ethics perspective. The chapter outlines the significance of systemic factors in both cases and draws on literature from organisational clinical ethics and business ethics to provide a framework for thinking about the wider ethical responsibilities of healthcare organisations. It outlines how organisational structures are directly implicated in the facilitation of ethical actions by members of the organisation.

The chapter considers the ownership of newborn screening cards (also known as Guthrie cards) and the blood spots retained on them, the role of consent to the use of these cards and relevant data protection provisions which have resulted in challenges to their retention. The issues raised here also have relevance for biobanks and other existing archives of retained biological samples in hospitals and research facilities as similar questions arise in relation to those collections. The chapter recommends that legislation be introduced to exempt the newborn screening card collection from data protection legislation and to put in place a clear and robust governance framework to ensure that individual rights are protected to the greatest extent possible. These recommendations are also relevant to other collections of biological samples in which a strong argument exists for their retention for diagnostic purposes as well as for public health.

This chapter asks whether the language and idea of the doctor-patient partnership, which embraces the notion of patient autonomy, is one which also places responsibilities on patients as well as on healthcare providers.This chapter outlines the duties and responsibilities of doctors and the development of the understanding of the doctor-patient relationship as one of partnership. It analyses the implications of this, looking at the legal responsibilities of the autonomous patient in the context of an action for medical negligence.

This chapter discusses the legal and ethical issues that arise in regulating embryonic stem cell research in Ireland. It outlines three approaches Irish policy makers may take to the difficult ethical debate: a restrictive approach, a permissive approach or an intermediate approach. The chapter analyses the current status of embryonic stem cell research in Ireland. It argues that although the Irish courts seem to support the intermediate approach, the lack of legislative guidance has left the embryo without legal protection. The chapter advocates a national discussion on the status of the embryo in order to develop a regulatory framework that both protects the embryo and accommodates embryonic stem cell research.

This chapter provides an analysis of the main ethical issues which arise in the debate about assisted suicide, with particular attention to the role played by the concept of autonomy in the discussion. The concept of autonomy plays a prominent role in justifying claims that a terminally-ill person should have a right to determine the point at which his or her life should end. However, opponents of assisted suicide argue both that such claims distort the meaning of autonomy and that autonomy should not be prioritised when its exercise threatens the rights or interests of healthcare professionals, family members or others. The chapter attempts to determine whether the concept of autonomy is capable of supporting the arguments on both sides of the discussion which rely on it. It examines briefly the evolution of the concept of autonomy in healthcare generally and analyses the role played by arguments from autonomy in support of, and against, the permissibility of assisted dying/suicide. It provides a critique of the use of the concept of autonomy on both sides of the debate and examine the implications of this critique for the validity of the concept of autonomy in healthcare more generally.

The book concludes with some summary insights offered by the editors and Nat O’Connor, who was responsible for setting out the international and comparative context of Irish FOI legislation in the first chapter. In his initial contextual chapter, Nat suggested that FOI legislation typically follows one of two alternative implementation types: a narrow and primarily administrative Introduction interpretation that is focused on citizens’ access to personal records; or a broader and much more substantive interpretation, which sees FOI as but one building block in the creation of a more open and transparent system of governance. The chapter draws together the evidence presented by the various contributors – pointing out the evidence that exists for both the narrower and broader interpretations of FOI in Ireland. On balance, it is fair to conclude that thus far the Irish FOI regime is closer to the former, narrower, interpretation of FOI than the latter, broader prescription for open government. Whether this is a stage in the evolution of Irish FOI, or the intended end point, is a judgement left to the reader.