Now that Ireland has repealed its constitutional ban on abortion in favor of “pro-choice” policies, the definition of “choice” appears to be evolving. Prime minister Leo Varadkar told the Dáil that individual doctors and nurses will be allowed to opt out of participating in surgical abortions, but that hospitals — including those with a “Catholic ethos” — will not be allowed to opt out:

“It will not, however, be possible for publicly-funded hospitals, no matter who their patron or owner is, to opt out of providing these necessary services which will be legal in this state once this legislation is passed by the Dáil and Seanad (senate),” he added.

“I’m happy to give you that assurance.”

Mr Varadkar added: “That legislation will allow individuals to opt out based on their consciences or their religious convictions but will not allow institutions to do so.

“So, just as is the case now in the legislation for the Protection of Life During Pregnancy Act 2013, hospitals like for example Holles Street, which is a Catholic voluntary ethos hospital, the Mater, St Vincent’s and others will be required, and will be expected to, carry out any procedure that is legal in this state and that is the model we will follow.”

That brought a prompt response from one well-known Catholic voice:

Yes, indeed — but there’s a bit more to that, too. Varadkar did stress that this would apply to “publicly funded” facilities, which means … pretty much every hospital and clinic, Catholic or not. Ireland has a single-payer health-care system run by the government; while some of the providers are independent, such as those cited by the Taoiseach, they get paid by the government. In other words, he who pays the piper calls the tune — a point that Ireland’s voters should have considered when voting for abortion, considering that these Catholic-“ethos” hospitals may end up closing their doors if push comes to shove, forcing the government to take over the operations and the costs.

As for Americans, it’s another point to consider when Democrats begin running for government-run health care in the US. Hundreds of hospitals and clinics run by Catholics, and more run by other Christian denominations, might similarly close down if forced to provide abortions. And it doesn’t end with abortion in either country, Wesley Smith points out:

Forcing every institution that receives public funds to perform any legal medical service means that if Ireland legalizes euthanasia — under discussion post referendum — Catholic hospitals will be required to allow sick patients to be killed in their wards.

Sex-change surgeries will also have to be provided. Ditto sterilization, not to mention abortion.

Medical conscience” looks to become one of the most contentious civil-rights issues of the current era as secularists impose their values on the entire health-care system by transforming “mere legality” (my term) of controversial procedures into a positive right to receive them. Once “equitable and equal access” becomes legally guaranteed, the government must ensure accessibility to everyone.

That means coercing heterodox religiously oriented institutions and individual practitioners to violate their own consciences as the oppressive price of medical licensing.

Interestingly, Varadkar plans to use an opt-in system for individual practitioners. The numbers involved suggest that approach won’t last long, though:

The Government is expected to design an opt-in system for medical professionals willing to provide abortion services and allow doctors conscientiously object to providing the care.

The legislation to regulate the termination of pregnancy, in line with the decision made in last month’s referendum to repeal the Eighth Amendment, is being considered by the Attorney General Séamus Woulfe’s office.

It will allow doctors refuse to provide or to take part in the provision of the lawful treatment, if it conflicts with sincerely held ethical or moral values. …

The association estimates that as many as eight in 10 GPs would choose not to opt-in under such a system.

If that is the case, then it’s tough to see how such a system would be sustainable in the long run. Ireland’s population is widely dispersed, so a 20% opt-in rate could mean a very long drive to get to a practitioner willing to participate in abortion. It wouldn’t be long before it transformed into an opt-out, and then into mandatory participation. The repeal combined with the single-payer system will eventually combine to drive out practitioners and organizations of religious faith from the health-care market.

Therefore, it’s more than a little ironic that Varadkar chose the same moment to scold the “socialists” who want to run people of faith from the public square:

He said that, while he believed in separation of Church and State: “I do not believe in the socialist ideology, which is to push religion out of the public space and force people who are religious to be ashamed they have religious convictions.

“The policy of socialists is to take away that funding because they do not just believe in the separation of Church and State – they want to turn religious people into pariahs, put them in a corner and hide them and take away funding from institutions.”

He said they wanted to “hide” religious people “in a corner and to defund bodies and take public funding away from bodies such as the Vincentian Partnership for Social Justice, the Society of St Vincent de Paul, Crosscare, Trócaire and Concern”.

The difference between words and actions here are striking. Put simply, Varadkar doesn’t want to demonize people of faith, but he also wants to use the government to force them to act counter to their religious principles. Varadkar may find out the hard way that it’s impossible to eat your cake and have it too, and that the attempt to do so might make it a lot tougher for people to get ordinary medical care.