As someone whose suffering at the hands of the church was so painstakingly documented in last week's report from the commission of investigation into the Dublin archdiocese, Marie Collins is as well-placed as anyone to critique how it is working now.
Having fought repeated battles down the years to have her story heard, amid deliberate attempts by church authorities to brand her as a liar or to downplay her abuse, she says she is concerned that the level of progress since then is severely limited in nature.
This is despite claims to the contrary by others within the Catholic church.
She points out that the welcome lead provided by Dublin archbishop Diarmuid Martin in his archdiocese is by no means guaranteed to continue should he move on to another assignment.
She adds that Martin can only do a "limited amount", particularly when it comes to his bishop and archbishop colleagues in other dioceses.
"Even an archbishop has no power or authority over fellow bishops. Even Cardinal Brady does not have that. And a lot of people don't realise that individual bishops are all powerful and subordinate only to Rome."
One of the most striking – and disturbing – features of last week's report was the way in which senior clergy sought to move abusers from diocese to diocese, frequently not even informing their fellow clerics about the accusations which had been made against these priests.
Yet Collins, who helped put together the church's landmark 'Our Children Our Church' guidelines on how to deal with allegations of sexual abuse within the Catholic church, is extremely concerned that such actions may occur in the future.
'Our Children Our Church' has since been replaced with a new document, 'Safeguarding Children', which was introduced last February.
Collins believes this has been "watered down" significantly when compared to its predecessor, undoing much of its good work.
The result, she says, is that the type of resistance which she received from church authorities could happen again.
"The one thing we have in the leadership of the church is a total absence of humility or acceptance that they can be wrong. It is the arrogance of power."
Collins is not alone in her criticism of the current church structures. But some look at the problems differently.
Outspoken Augustinian priest, Fr Iggy O'Donovan, says there has been a noticeable centralisation of power towards Rome in recent years. He says many of the reforms of Vatican II have been rolled back, while liberal voices have been quelled.
Yet he notes, as does the commission's report, that the issue of child sexual abuse is a serious crime under canon law.
"Even if the church authorities had followed the church's own guidelines, they could have avoided much of this abuse," he says. "So they failed even by their own criteria."
This was due in no small part to a "misplaced loyalty" to an all-male clerical set-up which was inherently unhealthy, he says. At the time, Irish society itself was locked in a form of "antisexual terrorism".
There is little doubt reform of the current church is needed, he says.
Key to this is an expansion of the role of the layperson, and a rolling back of clerical domination.
But he does not agree that the maintenance of the current hierarchical structures means the abuses of the past will necessarily be repeated.
He stresses that Irish society's deferential relationship with the church has significantly changed, diminishing capacity to cover up abuse.
"The old church as we knew it in Ireland is dying, and we could not bring it back even if we wanted to," he says.
"I don't think the bishops and the church have anything like the power they did have."
Michael Kelly, deputy editor of the Irish Catholic, agrees there is a need for structural reform of the church. Like O'Donovan, he believes the focus should be on an increased role for the laity.
This should extend, he says, to the inclusion of lay people in the selection process for bishops, with a list of suitable candidates drawn up from which an appointment would be made.
"There is absolutely no transparency in how leaders are appointed," he says. "It seems to me the general approach, particularly when appointing bishops… is that they won't rock the boat."
Meanwhile, as the church continues to grow in the developing world and elsewhere, the risks of a repeat of what happened in Ireland must surely be a pressing concern.
Others go even further, suggesting that closer to home, the claims last week by church leaders ring hollow in the face of little real structural change and a policy of reform whose ultimate aim is the self-protection of the existing institution of the church.
"Let's ignore the church officials who use words like 'failure' to describe their deliberate, callous, deceitful and reckless wrong-doing," said Barbara Blaine of the USA-based Survivors Network of those Abused by Priests.
"It's not a 'failure' or 'mistake' that led to the commission and cover up of thousands of clergy sex crimes. It's the willful, intentional short-sighted selfishness of powerful, cold-hearted men masquerading as spiritual figures.
"Our hearts ache for the thousands of kids now at risk in the Dublin Archdiocese because so little has changed in the church hierarchy. In our view, perhaps the main reason so many children were so severely violated and so many Catholic employees hid the crimes can be summed up in just a few words: the rigid, secretive, all-male monarchy that is the church hierarchy. Sadly, despite all these crimes and revelations, that structure and culture remains fully intact," she says.
"It's foolish to assume or believe that what's happened in the past isn't happening now. It's reckless to buy into a false sense of security. While the report said "the structures and rules of the Catholic church facilitated [the] cover-up" of child sex crimes, merely changing church rules is insufficient.
"It's the centuries-old secretive and monarchical culture of the church that needs reforming. Church rules are largely irrelevant, because given the nearly limitless power of bishops, there's rarely any real recourse when bishops break such rules."
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