Podium: The unsung heroes of the Troubles

From an address by the Archbishop of Armagh, Primate of All Ireland, to the British Medical Association conference in Belfast

BEHIND THE smokescreen of our troubled past so much that is good and worthwhile has taken place, and such developments have been and continue to be in no small measure due to the excellence of the service to a violent society by medical practitioners. Together with clergy of all denominations, doctors in Northern Ireland have been the unsung heroes of our troubles.

The quality of their work and the faithfulness of their care and attention to people of all creeds and none has been truly remarkable.

In the course of that service they have developed new techniques and opened up new avenues of research as they have grappled with the consequences of "man's inhumanity to man".

I know that at medical gatherings throughout the world, in journals and in lectures, those techniques have won great admiration. We are rightly proud of the advances that have been made possible in patient care and medical research across the spectrum in this province. Backing up advancements in medical techniques have been the many ancillary services, from ambulance personnel to aftercare, when people often working under difficulties and indeed physical danger to themselves and to others have provided this community with degrees of excellence that have been and are truly remarkable.

The practice of medicine is by tradition one of the great callings. Throughout European history there has been the practice of referring to such disciplines as medicine, the law, teaching and the Church as "callings". Today it must seem to be a slightly outmoded word - "calling."

In these days of accountability, seemingly inevitable answerability to adversarial court action and the perception that the customer, the client, the patient or the parishioner is always right, there are special issues that arise and pose serious implications for the traditional notion of "a calling".

I am aware of the presence in all those great professions of a weariness, at the present time. Questions to do with such elements as appreciation, gratitude and respect today appear often to take second place - and a poor second place at that - to professionalism. Teachers talk to me of having a diminishing amount of time to actually teach. Clergy talk of frustration because of new ways of looking at authority in a secular age.

Doctors belong to a profession that is subjected to apparently endless NHS reforms. The speed of those reforms, just as in the case of education, is breathtaking. Bureaucracy in its many aspects threatens to stifle the real nature of caring for patients. Reforms have so often squeezed out that vital and integral element of personal care that has been for so long the hallmark of what a Dr Finlay would have called the "bedside manner".

Together with the rapidly increasing demands of frequent changes in the NHS, you are aware of the loss of morale among your profession. This is serious and, as it is communicated to the general public, is a dangerous development.

Here in Northern Ireland, as in the rest of the United Kingdom, the reorganisation of the hospital service has become a contentious debate. I recognise that there are many facets to this development, not all of which are recognised by the public.

But I presume to say that ill-informed debate on decisions that have apparently been motivated by commercial considerations as much as medical service efficacy have added to the general perception of crisis for the lay person.

I am equally certain that statements and speeches from government spokespersons have far too often devalued the nature of your traditional calling. I think in particular of the reaction of junior doctors, whose grievances have recently been given publicity.

Behind such issues is the proverbial balance between patients' demands and available resources. That balance is today, I believe, calling into serious question the ability of the NHS to provide a realistic and comprehensive service. The basic question is, surely: what can we afford and what cannot we afford? Perhaps we ought to rephrase the question: what is the reasonable, justified and legitimate expectation of the general public so far as medical care is concerned?

Not all priorities ought to be based on what the media usually calls "commercial efficacy".

From the beginning of the Christian story, healing in its widest sense has been a hallmark of the love of God. The Gospel speaks to us of healing and reconciliation of human kind with God. In that process few callings have such a vision of good, worthwhileness and need than yours.