A revised Code of Ethics and a new “ethical governance framework” are the key demands contained in a 6 March letter from the Archbishop of Westminster, Cardinal Cormac Murphy-O’Connor, to the Chairman of the Hospital of St John & St Elizabeth.

The letter to Robin Bridgeman follows a confidential report submitted to the Cardinal by a four-member committee of inquiry headed by Lord Brennan. The Cardinal ordered the inquiry last year after the hospital - popularly known as “John and Lizzie's” - decided to allow GPs to operate NHS practices from its premises in St John's Wood, north  London.

In the letter the Cardinal thanks Lord Brennan and his Committee for “having looked in some depth at a difficult matter and for having given me succint and well-founded advice.”

The Cardinal writes:

“It is clear that everyone involved with St Johnand St Elizabeth wishes it to continue successfully with a Catholic ethos, that is, in accordance with the spiritual and ethical principles of Catholic teaching and tradition.”

But he adds: 

“What is less clear however is that all involved accept the implications of the tensions and conflicts between Catholic moral teaching and contemporary secular medical practice (and the expectations and attitudes of many non-Catholic and Catholic patients).”

“In fairness to healthcare professionals, patients, and benefactors,” the Cardinal continues, “there must be clarity that the Hospital, being a Catholic hospital with a distinct vision of what is truly in the interests of human persons, cannot offer its patients, non-Catholic or Catholic, the whole range of services routinely accepted by many in modern secular society as being in a patient’s best interest.”

The Archbishop of  Westminster has legal responsibilities in relation to the Hospital both as its Patron and as Adjudicator on differences of opinion regarding ethics and their implementation.

Cardinal Murphy-O’Connor tells Viscount Bridgeman: “Differences of opinion have arisen about how the Code’s provisions about consultation apply to referrals for direct abortion, for amniocentesis for purposes other than safe delivery, and for contraception, and to prescribing with contraceptive intent, particularly when what is prescribed is or may be abortifacient (e.g. by impeding implantation).”

The Cardinal goes on to call for “a revision and clarification of the Code of Ethics” in specific ways in order to make clear that “the kinds of referral and prescription mentioned above are inconsistent with the Code because they are inconsistent with Catholic ethical teaching and therefore with adherence to the governing objects of the Hospital.”

The revision should make clear that “anyone who while in the Hospital recommends such procedures, arranges for them to be carried out elsewhere” or “does anything with the intention that it be preliminary to or an initiation of the carrying out of the procedure elsewhere” would be “formally and therefore always wrongfully cooperating in the unacceptable procedure or other activity”, he says.

The Cardinal also asks that “in revising the Code it should be made clear that its requirements apply to any facility within the Hospital, its precincts or its ownership.”

The second part of the Cardinal’s letter calls for a tightening of the mechanisms for implementing the revised Code. 

“A hospital which is Catholic in name and ethos must invest time and energy in its ethical as well as in its clinical governance,” he tells Viscount Bridgeman. “It is therefore particularly important that the Hospital institute effective structures and procedures of ethical governance so that the application of the revised Code is audited in ways analogous to modern best practice in relation to financial and medical governance.” 

He then spells out a series of mechanisms for ensuring more effective compliance, emphasising the need to make both consultants and patients aware of the Code, and calling for a “periodic review” and “regular monitoring” of its application.

The Cardinal acknowledges in his letter that the Hospital will need a “period of adjustment” to meet the two demands and says he will be asking Lord Brennan’s Committee to review the progress made after a specific time.

The Cardinal’s letter concludes:

“Achieving clarity inevitably involves some discomfort and some commercial risk, but these are challenges which if accepted, will secure the Hospital of St Johnand Elizabeth as a Catholic Institution in the tradition in which it was founded.”