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Confronting complexities

The Irish health system is confronted by a range of challenges, both emerging and recurring. In order to address these, it is essential that spaces are created for conversations around complex ethical and legal issues. This collection aims to provide a basis for ongoing engagement with selected issues in contemporary Irish health contexts. It includes contributions from scholars and practitioners across a range of disciplines, most particularly, ethics, law and medicine.

The focus of the collection is interdisciplinary and the essays are situated at the intersection between ethics, law and medicine. Important issues addressed include admission to care homes; assisted suicide; adolescent decision-making; allocation of finite resources; conscientious objection; data protection; decision-making at the end of life; mental health; the rights of older people; patient responsibilities; stem cell research; the role of carers; and reproductive rights. From these discussion, the collection draws out the following interlinking themes, addressing difference; context and care; oversight and decision-making; and, regulating research.

The essays are theoretically informed and are grounded in the realities of the Irish health system, by drawing on contributors’ contextual knowledge.

This book makes an informed and balanced contribution to academic and broader public discourse.

The case of Universal Health Insurance – by competition
Cliona Loughnane

9 Cliona Loughnane Governing healthcare: the case of Universal Health Insurance – by competition Introduction One of the defining features of the Irish health system, since the establishment of Voluntary Health Insurance (VHI) in the 1950s, has been a heavy reliance by those who can afford it on private health insurance. Thus the Irish health system, which is three quarters funded by taxation (Wren, Connolly and Cunningham, 2015), is a strange mix of a national health system with high levels of private insurance cover (with up to 50% of the population holding

in Reframing health and health policy in Ireland
The Emergency Hospital Services in Second World War Northern Ireland
Seán Lucey

which were to receive ordinary medical cases from hospitals in the first and second groups. The final group of hospitals included four voluntary hospitals that would only be called upon in exceptional circumstances. 43 Such hospital groupings indicated the influence of ‘hierarchical regionalism’ in Northern Irish health planning; a term coined by the comparative health historian

in Medicine, health and Irish experiences of conflict 1914–45
Introducing the governmentality turn
Claire Edwards and Eluska Fernández

, 2016, and for a critique see Porter, 1996). We believe this to be a significant absence for a number of reasons. First, like many developed countries in the Western world, Ireland is witnessing the emergence of a number of health and healthcare dilemmas: the (disputed) emergence of obesity as a public health issue, the increasing visibility of dementia, and concerns regarding the mental health of the population, to name but a few. In such a context, there is a need to critically analyse how, or why, certain 2 Reframing health and health policy in Ireland health

in Reframing health and health policy in Ireland
David Bolton

their precipitants any violence related issues’ (Curran and Miller, 2001 : 75). Their audit of 2191 persons affected by acts of terrorist and criminal violence found that only 2% were admitted for in-hospital psychiatric care, while 13% were referred to out-patient mental health services or counselling services. The Northern Ireland Health and Social Wellbeing Survey: 2001

in Conflict, peace and mental health
Claire Murray

about carers and engages with different theoretical approaches to recognising the caring relationship and the implications of this for those involved in such relationships. In particular the chapter considers an approach grounded in the ethic of care and one based on relational autonomy. The chapter then moves on to examine an area of Irish health law where carers are clearly excluded from the legal framework­– ­the mental health system. The mental health system is a useful case study as it illustrates the complexities around this issue. Ultimately this chapter

in Ethical and legal debates in Irish healthcare
Abstract only
Mary Gilmartin

care workers, such as doctors, social workers, nurses’ aides and care assistants. Yet, in the UK the association of nursing with Irish women remains strong, and is being reconstituted again. The ongoing public sector recruitment ban in Ireland means that many newly trained nurses now move to the UK in order to access work and gain experience. Just as Irish-trained nurses continue to migrate to the UK and elsewhere for work, nurses trained elsewhere continue to work in Irish hospitals. A combination of increased investment in the Irish health care system, population

in Ireland and migration in the twenty-first century
Editors: David Durnin and Ian Miller

Medicine, Health and Irish Experiences of Conflict, 1914-45 is the first exploration of Irish medical and health experiences during the First and Second World Wars, as well as during the Irish revolutionary period. It examines the physical, mental and emotional impact of conflict on Irish political and social life and medical, scientific and official interventions in Irish health matters. The volume asks: What made Irish medical and health experiences unique? Did the financial exigencies of war impact detrimentally on Irish health care provision? How were psychological and emotional responses to war managed in Ireland? Did Ireland witness unique disease trends? And how did Irish medical communities and volunteers partake in international war efforts? The authors suggest that twentieth-century warfare and political unrest profoundly shaped Irish experiences of medicine and health and that Irish political, social and economic contexts added unique contours to those experiences not evident in other countries. In pursuing these themes, Medicine, Health and Irish Experiences of Conflict, 1914-45 offers an original and focused intervention into a central, but so far unexplored, theme in Irish medical history.

A governmental analysis

Recent years have witnessed a burgeoning international literature which seeks to analyse the construction of health and health policy through an analytical lens drawn from post-Foucauldian ideas of governmentality. This book is the first to apply the theoretical lens of post-Foucauldian governmentality to an analysis of health problems, practices, and policy in Ireland. Drawing on empirical examples related to childhood, obesity, mental health, smoking, ageing and others, it explores how specific health issues have been constructed as problematic and in need of intervention in the Irish State. The book focuses specifically on how Jean Jacques Rousseau's critical social theory and normative political theory meet as a conception of childhood. The 'biosocial' apparatus has recently been reconfigured through a policy framework called Healthy Ireland, the purpose of which is to 'reduce health inequalities' by 'empowering people and communities'. Child fatness continues to be framed as a pervasive and urgent issue in Irish society. In a novel departure in Irish public health promotion, the Stop the Spread (STS) campaign, free measuring tapes were distributed throughout Ireland to encourage people to measure their waists. A number of key characteristics of neoliberal governmentality, including the shift towards a market-based model of health; the distribution of power across a range of agents and agencies; and the increasing individualisation of health are discussed. One of the defining features of the Irish health system is the Universal Health Insurance and the Disability Act 2005.

Abstract only
Mary Donnelly and Claire Murray

Introduction Mary Donnelly and Claire Murray At the heart of the Irish health system, there is an interplay between ethics, law and medicine. Every day in Irish hospitals and clinics, decisions are made which have profound effects on individual lives, and deaths. More broadly, these decisions and the manner in which we make them are the building blocks for the kind of healthcare system we operate, which in turn reflects the kind of society we have constructed. Yet, beyond the ‘headline’ issues, our understanding of how decisions in healthcare are made is partial

in Ethical and legal debates in Irish healthcare