It could be worse, we could be in Ireland

[Otta]

http://www.independent.co.uk/news/world/europe/this-is-a-catholic-country-woman-dies-of-septicaemia-after-being-refused-an-abortion-in-irish-hospital-8315609.html

Shocking

[LondonMix]

That's horrific. Even the most ardent pro-life activists in the US agree that abortions should be allowed if the mother?s life is in danger. This is probably the most extreme position I?ve ever seen on the issue and such a tragic death.

[Otta]

I suppose the other side of the coin is when you have a mother who requires a blood transfusion but won't have it due to religion http://www.dailymail.co.uk/news/article-491791/Jehovahs-Witness-mother-dies-refusing-blood-transfusion-giving-birth-twins.html but at least that is their decision even if it must be awful for the doctors who want to save them.

PS. Sorry for the Daily Mail link, it was the first one I could find.

[Carbonara]

Shocking and tragic.

That Galway hospital is notorious for bad treatment of women. I saw something linked by Ben Goldacre - the professor of Obs and Gyn is very old, 85 I think, was educated by the Brothers, and has published a paper asserting that there is no circumstances under which it would be necessary to terminate a foetus to save the life of the mother. His name is Prof Eamonn something.

Is it wholly true that in Ireland it is not legal for doctors to carry out an abortion in order to save the life of a woman? Or was this bad medical negligence prompted by or compounded by over-zealous observance of the 'no termination' laws?

The woman was already miscarrying, why did they continue to check for a heartbeat before removing the foetus, in order to remove the source of infection?

Poor woman. Sympathies to her devastated husband.

[StraferJack]

Words can't hope to convey how awful this is

On plus side, hopefully a watershed moment for that sometimes backward nation

[Dudley]

Hi,

I don't think you should be so judgmental in relation to Ireland. I am lawyer qualified in both Ireland and England and I think you should buy today's Irish Times for a full and accurate report on the tragic death Savita Halappanavar and legal landscape in the Republic of Ireland.

1) It is simply NOT known yet whether Savita Halappanavar's life could have been saved by a medical termination of her pregnancy, earlier in her miscarriage, and not relying on the miscarriage to come to its natural end.

It MAY be the case that a termination of her pregnancy earlier could have saved her life but lets be clear - we do not know that yet. She died of septicaemia poisoning due to e-coli. She was administered antibiotics.

It is not yet clear whether carrying out and earlier termination would have saved her life, or indeed at least increased the chances of her life being saved.

If it is the case that a termination should have been given to save her life then, there is nothing in Ireland's constitution which prevents this treatment from being given, as medical abortions are permitted in Ireland to save the life of the mother. This is absolutely clear in article 40.3.3 of the Constitution and as per the X case.

2) The Royal College of Obstetricians and Gynaecologists in the UK notes that between 2003 - 2005 there were 5 deaths from sepsis related pregnancy complications prior to 24 weeks gestation in Britain.

3) Ireland is 6th safest place in the world to have a baby. The UK is 23rd, behind Albania, Slovakia and the Czech Republic.

http://www.guardian.co.uk/news/datablog/2010/apr/12/maternal-mortality-rates-millennium-development-goals

https://docs.google.com/spreadsheet/ccc?key=0AonYZs4MzlZbdHp2SWFHbFJtcnpISk5ic3Z0S0l6clE#gid=0

4) IF it is shown that Savita Halappanavar's treatment was influenced by anything other than the best medical care and expertise then, and only then, should the hospital and staff be held responsible and answerable to the law, and their respective professional bodies.

5)The hospital staff are not permitted to comment on this story or indeed defend themselves from what is turning into a witch hunt and trial by media.

[Otta]

Fair enough, but I thought I might get in trouble if I called the thread "it could be worse, the doctor could be catholic" ;-)

[Dudley]

Indeed,

Ask yourself how that sounds if you replaces Catholic, with Jewish or Muslim.

[StraferJack]

About the same?

[Otta]

Not sure this would have happened

"Judaism does not forbid abortion, but it does not permit abortion on demand. Abortion is only permitted for serious reasons."

"Muslims regard abortion as wrong and haram (forbidden), but many accept that it may be permitted in certain cases."

Dudley, I was trying to be lighthearted. I am not having a go at Ireland, and I am not having a go at Catholics. I am however having a big go at the fact this woman died and it MAY WELL have been avoidable.

[Carbonara]

In the UK standard practice would have been to remove the foetus once a miscarriage was underway, the cervix was open and the waters had broken, specifically because of the risk of infection and sepsis.

And why did the doctors repeatedly check for a heartbeat, given that miscarriage and certain death of the foetus was underway, and only conduct the removal of the foetus once the heartbeat had stopped unless the status of the foetus was relevant to the decision to remove the contents of the uterus? And why was the husband told 'this is a catholic country', if that fact had no relevance to the decisions being taken?

[Dudley]

Carbonara,

Thank you for clarify UK practice.

The initial decision seemed to be 'cautious wait and see'. I believe that is also UK practice in some cases, but I am willing to be corrected on this? Perhaps it is only the case with first and not second trimester miscarriages?

Second, if as I said, their were factors other than best medical care influencing the decision, such as Catholic ethos, then the hospital should be answerable. But at this stage they are not in a position to confirm or deny this.

Finally, if the doctors were under the impression the presence of a foetal heartbeat prevented them from terminating to save the life of Savita Halappanavar, they are wrong legally, ethically, and morally.

[LondonMix]

I know we shouldn't jump to conclusions but if she did in fact ask for an abortion because the slow miscarriage was causing her agony as her husband has suggested, I'm not really sure on what grounds they could deny even that request.

If the pregnancy is not viable, is there a legal requirement in Ireland to wait until its clear the mother might die. What is the watershed? Is it justifiable to take any action that might even marginally increase the risk to the mother under these circumstances?

[Saffron]

Dudley Wrote:

-------------------------------------------------------

> Hi,

>

> I don't think you should be so judgmental in

> relation to Ireland. I am lawyer qualified in both

> Ireland and England and I think you should buy

> today's Irish Times for a full and accurate report

> on the tragic death Savita Halappanavar and legal

> landscape in the Republic of Ireland.

>

How barbaric to force any woman to endure a painful miscarriage at any stage of pregnancy, when medical interventions could be made.

A woman is now DEAD. People are going to judge.

[Ruth_Baldock]

Abortion on demand? eh? Whats that when it's at home?

[Cyberia]

"How barbaric to force any woman to endure a painful miscarriage at any stage of pregnancy, when medical interventions could be made.

A woman is now DEAD. People are going to judge."

I think the issue is, people are implying that such a thing couldn't happen in other parts of the UK. Completely wrong. Look at a couple of recently reported cases:

http://www.standard.co.uk/news/midwife-simply-laughed-at-my-torment-over-stillborn-baby-7303668.html

http://www.metro.co.uk/news/909281-hospital-payout-over-baby-delivery-heartbreak

Usually these stories don't even make it into the broadsheets.

Then there's the depressing story about the baby who died through overfeeding (I mean, seriously, how could 210ml per hour even be an option in a specialised machine like that? I would have thought there would be strict parameters... or is such a high dose ever appropriate?) Slightly OT but like the NI story, it made me cry.

http://www.bbc.co.uk/news/uk-wales-south-east-wales-20323497

I think Dudley is 100% right that (a) we just don't know the facts here and (b) it is a media witchhunt. Mistakes and lack of judgement happen everywhere. This should not have happened, but it didn't happen because of the law in NI, whether we agree with that law or not (and I don't).

[StraferJack]

Mistakes and lack of judgement are bad (especially so in fatalities) but forgivable

But from what has been reported so far, if true, suggests something far worse

Why am I included to believe reports? Because I know too many Irish people who would support what the nurse said. It's plausible in a way that it wouldn't be here. Mistakes will happen anywhere. Entrenched backward belief systems take something else (Ireland on abortion or Uganda on homosexuality to name two recent cases)

[Saffron]

Cyberia Wrote:

-------------------------------------------------------

> "How barbaric to force any woman to endure a

> painful miscarriage at any stage of pregnancy,

> when medical interventions could be made.

>

> A woman is now DEAD. People are going to judge."

>

> I think the issue is, people are implying that

> such a thing couldn't happen in other parts of the

> UK.

I was not implying such.

[Saffron]

StraferJack Wrote:

-------------------------------------------------------

> Mistakes and lack of judgement are bad (especially

> so in fatalities) but forgivable

>

> But from what has been reported so far, if true,

> suggests something far worse

>

> Why am I included to believe reports? Because I

> know too many Irish people who would support what

> the nurse said. It's plausible in a way that it

> wouldn't be here. Mistakes will happen anywhere.

> Entrenched backward belief systems take something

> else

Indeed.

[Cyberia]

If this is true: "There is nothing in Ireland's constitution which prevents this treatment from being given, as medical abortions are permitted in Ireland to save the life of the mother. This is absolutely clear in article 40.3.3 of the Constitution"

And this is true: "Ireland is 6th safest place in the world to have a baby. The UK is 23rd"

Then I object to the heading "It could be worse, we could be in Ireland"

That is all.

[ianr]

Carbonara wrote:

> That Galway hospital is notorious for bad treatment of women. I saw something linked by Ben Goldacre - the professor of Obs and Gyn

> is very old, 85 I think, was educated by the Brothers, and has published a paper asserting that there is no circumstances under which it

> would be necessary to terminate a foetus to save the life of the mother. His name is Prof Eamonn something.

The Goldacre blog is here: http://bengoldacre.posterous.com/irish-miscarriage-case.

According to the Irish Times article he links to, http://www.irishtimes.com/newspaper/ireland/2012/0910/1224323797477.html dated 10 September, Eamon O?Dwyer is a professor emeritus. The article does not mention any paper by him. It concludes:

[start quotation]

Prof O?Dwyer and a panel of speakers also formally agreed a ?Dublin declaration? on maternal healthcare. It stated: ?As experienced practitioners and researchers in obstetrics and gynaecology, we affirm that direct abortion is not medically necessary to save the life of a woman.

?We uphold that there is a fundamental difference between abortion and necessary medical treatments that are carried out to save the life of the mother, even if such treatment results in the loss of life of her unborn child.

?We confirm that the prohibition of abortion does not affect, in any way, the availability of optimal care to pregnant women.?

In a statement, Prof O?Dwyer also said no treatment should ever be withheld from a woman if she needed it to save her life, even if that treatment resulted in the loss of life of her unborn child.

[end quotation]

[StraferJack]

Cyberia: couldn't the first point be both true AND ignored by someone who don't feel bound to a "constitution". Someone who may or may not have used a religious and racial prejudice to scold the woman?

And do you disagree with my assertion that plenty of people in Ireland would have said what was alleged to have said?

[Cyberia]

I've never been to Ireland, so I don't know what they think there - does it show? I would have thought it's more usual to agree with the O'Dwyer statement that "no treatment should ever be withheld from a woman if she needed it to save her life, even if that treatment resulted in the loss of life of her unborn child" than to take the view that the woman's life is unimportant, as you seemed to be implying. I could be wrong - clearly you know more about Ireland than I do!

But wherever you go in the world, you are going to find people who don't follow protocols - I don't think this is unique to Ireland...

Care of women in labour in the UK, for example, often leaves much to be desired and appalling stories crop up with depressing regularity. It just seems odd to leap on this one instance of supposed prejudice and backwardness - though to be fair we really don't have all the facts here - as if it were some sort of institutional or legal failing that just couldn't happen in a 'civilised' country like the UK.

Sorry if that's controversial. I'm not trying to justify some kind of weird pro-life (as long as it's a fetus not a grown woman) approach here.

[shaunag]

StraferJack, this incidence,however tragic, does not give you licence to refer to the Irish as a "backward nation". That is just racist, and as an Irish person I take enormous offence. I also think your alleged insight into the minds of the Irish nation both ridiculous and arrogant. Let's not make this tragedy about your blatant prejudice against the Irish.

[LondonMix]

Mistakes, breaches of protocol, and malpractice do exist everywhere to some degree. I think the reason why this case has garnered so much attention and elicited such a strong reaction is that if the husband is to be believed in even the most basic elements of his claim, there was an ideological / religious component to this tragedy.

Doctors being human beings are sometimes negligent and sometimes make errors and this is always tragic when it leads to someone?s death. However, denying a requested abortion during a painful miscarriage (and potentially endangering the mother?s life) is abhorrent. The idea that someone else?s religious beliefs could lead to unnecessary suffering or even risk of life for a pregnant woman will strike many as shocking. It?s a breach of the most basic trust we have in doctors. Without this sort of reaction from the public, it is unlikely that an inquiry would have been organized so the public outcry is not only totally reasonable but a valuable part of the process.