She must be Madden

A 'lay woman' with no family lineage in law or medicine, the odds are stacked against Deirdre Madden in her bid for chair of the contentious Medical Council ethics committee. Justine McCarthy profiles the UCC law lecturer.

She is a woman, she is young-ish, she is a liberal and she is not even a medical doctor. So who does she think she is, vying for one of the most contentious and influential jobs in the conservative, paternalistic world of Irish medicine? Some say she must be mad.

Dr Deirdre Madden, a full-time law lecturer in UCC and author of the official inquiry report on the retention of children's organs, is a candidate in the Medical Council's midterm elections on 18 October. The hot-seat Madden is after is the chair of the landmine-strewn ethics committee, where words like "abortion" and "consent" and "embryos" get tossed around as explosively as grenades in a cold war. The adjective her admirers most commonly reach for to describe her is "feisty", though she demurs. "Opinionated maybe?" she offers as an alternative.

As if the odds were not sufficiently stacked against her in a contest for the hearts and minds of the medical elite, she has also earned the moniker "the minister's woman", having been appointed to the Medical Council by Micheál Martin to represent the public interest for a five-year term. What one would call "a lay woman" – uttered with a distinct, nasal hint of superiority – were one a member of the increasingly siege-fearing medical fraternity.

Madden has a breathtaking CV. After secondary school in Christ King, Cork she got her law degree from UCC in 1987, her master's in 1988 (with a thesis on surrogate motherhood), was called to the bar in 1989 and completed her PhD in 2000, with a doctorate on the legal dimensions of assisted human reproduction. Devoid of a family lineage in either law or medicine – once a veritable prerequisite – her career advancement has been rapid. She has been lecturing in UCC (where she chairs the university's research ethics board) since 1992 and was a visiting lecturer to Colby College, Maine in 2001. The following year, she wrote a landmark medico-legal book entitled Medicine, Ethics and the Law. She is the external examiner in medical law for student solicitors with the Law Society.

She was on the Commission on Assisted Human Reproduction and has been a member of the Irish College of General Practitioners' research ethics committee.

Further afield, she was part of the Expert Evaluation Panel on Bio-ethics for the European Commission, as well as the Gabriel Project, an EU-funded study of the links between genetics, the environment and asthma. It involves 150 scientists in 14 European countries.

"She's a workaholic," confirms Gary Finnegan, managing editor of the Irish Medical News, to which Madden has been a frequent contributor. "The report of the Commission on Assisted Human Reproduction was fairly liberal and she endorsed it. That paints her as a liberal among the more conservative members of the profession. That sort of thing is relevant because, for instance, the abortion issue is always leaking around the ethics committee. It could also go against her that she isn't a doctor. One guy told me off-the-record he thinks it'll be a major sticking point."

The "lay membership" issue is a current hot potato. Health minister Mary Harney has espoused a strong non-doctor presence in the profession's self-governance. The publication of the heads-of-bill for the new Medical Practitioners Act has re-ignited that debate and some wary doctors fear that the election of Madden as chairwoman of the ethics committee would be the first crack in the edifice.

Perhaps it is an inherited talent for calculus (her mathematician father taught in Cork's Presentation College for 40 years and co-authored the Holland & Madden standard school textbook) that emboldened her to attempt to woo a majority of the Medical Council's 25 members in the election. "She'll make it, I'd say," predicts a medical source. "She's held in high regard."

That is borne out by the comments of Charlotte Yeates, administrator of Parents for Justice, the group still lobbying for a full statutory inquiry into the retention of human organs after expressing dissatisfaction with the Anne Dunne-Deirdre Madden inquiry. The group concluded that the report, which found that nobody profited from the retention of human organs, was "flawed" from the start because of its restrictive nature.

"There were no findings in Madden's report, only recommendations. She did what her terms of reference required her to do. She had to write a report based on what Dunne had done. It wasn't her fault that the terms were too narrow. She's a very nice, approachable woman and very focused in her work. She's easy to talk to."

Madden is currently chairing a working group, set up on her own recommendation in that report to implement standards for organ retention in cases of still-births, miscarriages and the deaths of adolescents and adults, all categories excluded from her first inquiry.

Apart from the heavy workload involved, the myriad banana skins scattered around the field of medical ethics would be enough to deter most people from seeking chairmanship of the Medical Council's ethics committee.

The ongoing High Court case involving an estranged couple and their frozen embryos will spark yet another emotive debate when a decision is handed down. Similarly, the recent court decision to give a new mother a life-saving blood transfusion despite her religious objection was a reminder of the divisiveness of medical ethics issues. So why does Deirdre Madden want the job?

"The ethical guide that the Medical Council has published is criticised for being vague and ambiguous," she answers. "I would rewrite it to support the doctor. There are lots of issues I'd like to see developed, such as consent, refusal of treatment, the doctor-patient relationship. I have reservations about the blood transfusion case. It raises legal and ethical questions about the right of a competent adult to make decisions for his or her self. I think their decision should be respected."

She believes that Ireland must debate issues related to assisted human reproduction in order to establish a legislative code of practice. "I'd like to see a regulator to deal with a code of conduct or guidance to clinics in how to deal with these very difficult decisions," she says.

A medical source, describing Madden as having "a young person's appetite for transparency and accountability", regards her candidacy for the ethics committee chair as a potential turning point for the medical profession at a time when it is under the microscope. "We have the consultants' contract being re-negotiated, the minister trying to bring more lay people in at a regulatory level and we've had the Harding-Clarke report on Neary and the Monaghan report on the death Pat Joe Walsh.

"This election is going to be a test of the old-school tie." p