Savita Halappanavar and the Long Shadow of the X-Case

by Kieran Healy on November 14, 2012

The Irish Times reports the death of a 31 year-old woman last month in Galway, as a result of being denied an abortion:

Savita Halappanavar (31), a dentist, presented with back pain at the hospital on October 21st, was found to be miscarrying, and died of septicaemia a week later. Her husband, Praveen Halappanavar (34), an engineer at Boston Scientific in Galway, says she asked several times over a three-day period that the pregnancy be terminated. He says that, having been told she was miscarrying, and after one day in severe pain, Ms Halappanavar asked for a medical termination. This was refused, he says, because the foetal heartbeat was still present and they were told, “this is a Catholic country”. She spent a further 2½ days “in agony” until the foetal heartbeat stopped. The dead foetus was removed and Savita was taken to the high dependency unit and then the intensive care unit, where she died of septicaemia on the 28th.

A statement from Galway Pro-Choice notes, in part:

Under the X Case ruling, women in Ireland are legally entitled to an abortion when it is necessary to save their life. However, legislation has never been passed to reflect this. It is the failure of successive governments to do so that led to Savita’s death. … Rachel Donnelly, Galway Pro-Choice spokesperson stated: “This was an obstetric emergency which should have been dealt with in a routine manner. Yet Irish doctors are restrained from making obvious medical decisions by a fear of potentially severe consequences. As the European Court of Human Rights ruled, as long as the 1861 Act remains in place, alongside a complete political unwillingness to touch the issue, pregnant women will continue to be unsafe in this country.”

In 1992 I was in my second year of college at UCC. Beginning early in that year a string of social and political crises and scandals broke that, in retrospect, marked the beginning of the end of the public power of the Catholic Church in Ireland, especially with respect to sexuality. I’ve written before about how the events of that year are a kind of bookend to the autumn of 1979, when the Pope came to Ireland and the country was filled with a revivalist fervor focused on the country’s youth. Chief amongst the social crises of 1992 was the X-case. A fourteen year-old girl, pregnant as the result of rape by a neighbor, sought to leave the country to have an abortion in England, as thousands of Irish women did and still do. Her parents asked the police whether it would be possible to collect any DNA evidence during this process, which brought the matter to the Attorney General’s attention. He sought, and was granted, a court injunction preventing her from traveling for the abortion under Article 40.3.3 of the Irish constitution, which had been passed in 1983 as the “Pro-Life amendment” and which prohibited abortion in Ireland. The resulting constitutional crisis saw the Supreme Court issue a hasty ruling permitting the girl to travel, but under a strained interpretation of the law. So in November of 1992 the Government introduced three new amendments meant to clarify things. The result was that things reverted much to the status quo ante, which essentially allowed Ireland to export its abortion problem to the United Kingdom while leaving it unclear what doctors facing a medical emergency during pregnancy were in a position to do.

And so things have stood, more or less. When I followed the X-case in 1992, and when I wrote an MA Thesis about it in 1994, I honestly thought that some minimal legal provision for abortion in Ireland would be fairly soon in coming. But that was twenty years ago.

{ 123 comments }

1

Anderson 11.14.12 at 1:52 am

Thankfully, I live in enlightened, uh, Mississippi.

2

Mise 11.14.12 at 2:00 am

The Bishops’ Conference have launched a public campaign, asking Catholics to lobby their local politicians, to prevent legislation for abortion to save a mothers’ life. They contend such circumstances don’t exist.

Bishop John Fleming wrote in the Irish Times yesterday that;

“Ireland, without abortion, is recognised as one of the safest countries in the world to be a pregnant mother … Clearly, if the life of the mother is threatened, by illness or some other medical condition, the care provided by medical professionals will make sure that she receives all the medical care needed.”

I don’t have much hope that this death will change anything at all, unfortunately.

3

Ronan Delaney 11.14.12 at 2:12 am

The Irish Government’s observations before the European Court of Human Rights in CASE OF A, B AND C v. IRELAND (http://hudoc.echr.coe.int/sites/eng/pages/search.aspx?i=001-102332#{“itemid”:[“001-102332″]}), Section 189:

“As to the precise procedures to be followed by a pregnant woman and her doctor where an issue arose as to such a possible risk, it was the responsibility of the doctor and a termination could occur when the risk was real and substantial. If the patient did not agree with that advice she was free to seek another medical opinion and, in the last resort, she could make an emergency application to the High Court.”

This is how the Government thinks a woman in this case should proceed… You ask repeatedly for a termination which is likely lawful given the X case, and are refused. The State says to seek alternative advice or go to the High Court. Apparently you should do this when you are bleeding and losing consciousness during a 3 day miscarriage with no legislation to back you up. The ECHR rejected the Irish state’s observations due to “the absence of any implementing legislative or regulatory regime providing an accessible & effective procedure by which the 3rd applicant could have established whether she qualified for a lawful abortion in Ireland”

It’s barbaric that this is the state of the law in our country. In this case, however, it may be the case that the absence of legislation did not preclude the doctors from acting and I hopefully that will be addressed:

The Irish Medical Council’s Guide to Professional Conduct and Ethics For Medical Practitioners would appear to leave space to act:(http://www.medicalcouncil.ie/News-and-Publications/Publications/Professional-Conduct-Ethics/Guide-to-Professional-Conduct-and-Behaviour-for-Registered-Medical-Practitioners-pdf.pdf) would appear to have allowed the doctors to act:
21 Abortion
21.1 Abortion is illegal in Ireland except where there is a real and
substantial risk to the life (as distinct from the health) of the
mother. Under current legal precedent, this exception includes
where there is a clear and substantial risk to the life of the mother
arising from a threat of suicide. You should undertake a full assessment
of any such risk in light of the clinical research on this issue.
21.2 It is lawful to provide information in Ireland about abortions
abroad, subject to strict conditions.4 It is not lawful to encourage
or advocate an abortion in individual cases.
21.3 You have a duty to provide care, support and follow-up services
for women who have an abortion abroad.
21.4 In current obstetrical practice, rare complications can arise where
therapeutic intervention (including termination of a pregnancy)
is required at a stage when, due to extreme immaturity of the
baby, there may be little or no hope of the baby surviving. In these
exceptional circumstances, it may be necessary to intervene to
terminate the pregnancy to protect the life of the mother, while
making every effort to preserve the life of the baby.

4

MPAVictoria 11.14.12 at 2:16 am

Barbaric.

5

The Raven 11.14.12 at 2:17 am

Nah, man. You know how this works. The court makes a decision because it has to. The legislature avoids a decision because it can be voted out.

Humans like to feed the corvids.

6

P O'Neill 11.14.12 at 2:52 am

allowed Ireland to export its abortion problem to the United Kingdom

To Britain, until very very recently.

7

between4walls 11.14.12 at 3:28 am

The Bishop’s article is disgusting.

Having relatives in India who have had safe, legal abortions there, I found it striking that even though India has horrible maternal mortality rates and Ireland is a much safer place to go through a pregnancy, with universal healthcare and everything, if she had been in India the doctors would have helped her, while in Ireland they let her die.

Not only do some people contend circumstances where the mother’s life is endangered don’t exist, they also act like the health of the mother is some sort of made-up excuse rather than an actual issue. The doctors here must have know her health would be endangered, and that she was in agony, and still they did nothing.

And what life were they supposedly protecting? There was no way to save the fetus anyway.

This interview with Savita Halappanavar’s husband is pretty painful reading.

““Every time they kept telling me: ‘She’s young. She’ll get over it’. But things never changed, they only got worse….It was all in their hands and they just let her go….What is the use in being angry? I’ve lost her. I am talking about this because it shouldn’t happen to anyone else. It’s very hard. It has been a terrible few weeks, very hard to understand how this can happen in the 21st century, very hard to explain to her family. If it had happened in the UK or India, the whole thing would have been over in a few hours.”

8

ezra abrams 11.14.12 at 3:33 am

This sterile wire coathanger is provided to you by Mitt Romney and Paul Ryan free of charge for emergency contraceptive use.
Warning: misuse may cause permanent sterility and internal bleeding.

have a nice day

9

between4walls 11.14.12 at 3:38 am

Obviously though the people really responsible are the cowardly politicians who choose leave doctors in that uncertain legal position and risk more women dying than actually do their job and pass legislation.

10

Sumana Harihareswara 11.14.12 at 3:47 am

Her family is in Karnataka, which is where my family is from. She looks like she could be my cousin or my sister. She looks a little like me and so I feel even worse at her death. You know how it is.

It is truly awful that, despite Savita Halappanavar’s painful death, I have no reason to believe that the laws will change to protect women’s health in Ireland. And so there will be another Savita.

11

Anderson 11.14.12 at 3:57 am

“Bishop John Fleming wrote in the Irish Times yesterday”

Doesn’t he have a child molester to go shelter?

Really, I am boggled sometimes that any hierarch of the RCC dares open his mouth in a public forum.

… Not derailing thread I hope; just overcome by their hypocrisy. How dare they profess their wicked “morality” that places a zygote or fetus over a living woman or an abused child?

12

john b 11.14.12 at 4:19 am

Anderson: quite. At least in the case of the child rape scandals, you could just about argue that the RCC was in a similar place as other bureaucratic institutions of the time, in terms of wider cultural failings that aren’t inherent to the organisation’s existence or doctrine. Secular care homes, and so on.

It’s hard to deny looking at the evidence that the RCC was among the worst offenders, but at least it didn’t *formally mandate that its followers should rape children*. Whereas it does formally mandate that its followers cause women to suffer preventable deaths in horrible agony.

Abortion where the life or health of the mother is in danger is legal in Iran and Saudi Arabia, incidentally.

13

Barry Freed 11.14.12 at 4:32 am

How is this not criminally negligent (or gross negligence – I don’t know the correct terminology for Ireland) manslaughter? At the very least these doctors should lose their licenses to practice medicine.

14

Allen Hazen 11.14.12 at 6:30 am

The practice of medicine inevitably involves making “judgment calls”: there’s no algorithm for determining what the best treatment is. A law, like the Irish one in question, which allows abortions under restrictive conditions (“if the life of the mother is in danger”) makes this even worse: the attending physician has to make the judgment “Is this mother’s life endangered?” before proceeding. And I think it would be a brave doctor (or one culpably lacking in insight) who could claim confidently “My judgment as to whether continuing the pregnancy would endanger the life of the mother was in no way influenced by my beliefs about the morality of abortion.”

15

JamesP 11.14.12 at 6:30 am

The Talmud explicitly says that if the woman’s life is in danger, then the foetus can be “cut apart piece by piece” if necessary. The RCC is not only reactionary, it’s reactionary even by the standards of other faiths on this issue.

16

Meredith 11.14.12 at 6:34 am

This reminds me of seeing my own mother, in 1957 (I was 6 going on 7), writhing in pain, sweaty and naked on her bed, the bed of my mother and father, with the flu. She was also just over three months pregnant, but not for long. The baby (I’ll call this baby just that because my parents both wanted it to be a baby) died, as my mother almost did, from septicemia.
Thing is, had the baby still been living when my mother was rushed to the hospital, and a decision had had to be made about aborting the baby to save my mother’s life, an abortion would have been perfectly legal and uncontroversial in 1957 NJ, US. In fact, anywhere in the US. Roman Catholics would have been supposed not to opt for the mother’s over the baby’s life, but that was their choice, not something imposed on them, much less on non-RC’s, by the state. And my mother would have chosen herself and me and my siblings over this other, however much she mourned his loss. (My father, same.)

Cannot believe this is still an issue in Ireland, or that it even gets discussed in the US. But in the US, this is not just some crazy right-wing fundamentalist Protestant thing. The RC church, to the great credit of many fine nurses and doctors, provide a great amount of the hospital services in this country. But that also puts women patients in the clutches of the RC hierarchy, often without realizing it. Some of the greatest hospitals in Boston, for instance, might greet a Savita Halappanavar with the lack of choice she faced in Ireland. (The narrow defeat of the physician-“assisted” suicide measure a week ago was due chiefly to under the radar, RC-sponsored efforts.)

17

Kevin Donoghue 11.14.12 at 10:23 am

Barry Freed,
IANAL but I’d guess a manslaughter charge is quite consistent with Irish law. However I don’t expect the DPP will prosecute and I doubt that a jury would convict medics in a case like this. The jury would feel that the politicians are to blame for putting doctors in a difficult situation.

18

Tim Worstall 11.14.12 at 11:47 am

“The Talmud explicitly says that if the woman’s life is in danger, then the foetus can be “cut apart piece by piece” if necessary. The RCC is not only reactionary, it’s reactionary even by the standards of other faiths on this issue.”

To a certain extent it’s the Irish Church which is even more reactionary than the RCC. The actual (Canon, not legal) law is that treatment necessary to save the life of the mother is allowed. If that leads to the death, abortion, of the foetus then so be it. Treatment which is specifically designed to cause the abortion or death of the foetus but which is not necessarily to save the life of the mother is not allowed.

An awful lot weighs on that second “necessarily”.

I wouldn’t expect anyone around here to agree that that’s the way things ought to be: but that is what Il Pappa etc. have stated that the religious law is.

19

Kevin Donoghue 11.14.12 at 12:24 pm

Kieran on the X case: “The resulting constitutional crisis saw the Supreme Court issue a hasty ruling permitting the girl to travel, but under a strained interpretation of the law.”

I don’t think that’s quite right. The judgement was that, since her life was in danger, she could obtain an abortion; if it had been performed in Ireland it would have been lawful.

20

Niall McAuley 11.14.12 at 12:50 pm

Allen Hazen at #14 writes: A law, like the Irish one in question, which allows abortions under restrictive conditions (“if the life of the mother is in danger”) makes this even worse

Just to clarify a bit, we don’t really have a law about abortion at all. We have the 1861 act (inherited from the UK) which makes abortion a crime. Then we have the Constitutional amendment, which makes that law unconstitutional.

So the only legal thing we’ve got is the Constitution itself, which states:

3° The State acknowledges the right to life of the
unborn and, with due regard to the equal right to
life of the mother, guarantees in its laws to
respect, and, as far as practicable, by its laws to
defend and vindicate that right.
This subsection shall not limit freedom to travel
between the State and another state.
This subsection shall not limit freedom to obtain
or make available, in the State, subject to such
conditions as may be laid down by law,
information relating to services lawfully available
in another state.

Kieran says that the X case judgment was a strained interpretation but I don’t think so. The first paragraph was put in by Pro-Lifers trying to copper-fasten the 1861 act against any attacks from European courts, but the plain language they inserted instead invalidates that act, which does not have due regard for the life of the mother, it is a blanket ban on abortion.

The 13th and 14th amendments certainly did not restore the status quo ante the X-case, since abortion is now legal when the life of the mother is threatened, specifically including the risk of suicide quoted by the rape victim in the X case.

However, everyone (especially the politicians) has been pretending this is not so, doctors are afraid of being dragged into a quagmire which would require the Supreme Court to sort out (justifiably, given the actions of the Attorney General in the X case), and some of the Hospitals with a “Catholic Ethos” are happy to let on this is the law.

The bolloxology in that article by the Bishop is standard issue: “Abortion is always wrong except when I say it’s not abortion, and I only do that for my favourite exceptions, not yours, and don’t anyone dare try and write this into law, because slippery slope, also Hell.”

21

Doctor Science 11.14.12 at 2:33 pm

The article mentions that she was told repeatedly “this is a Catholic nation.” Do you Irishpeople think things would have been different if she had been Catholic? If she’d been ethnically Irish?

I don’t understand why we’re not seeing more civil disobedience by medical personnel, in Ireland and in the US.

22

Doctor Science 11.14.12 at 2:35 pm

curses, can’t edit — I don’t mean civil disobedience, really, I mean doctors and other medical personnel saying “No, you can’t order me to kill someone by withholding necessary medical care.”

23

mollymooly 11.14.12 at 2:53 pm

Abortions are legal in Ireland, but in such rare circumstances that it’s not clear whether hospitals have the expertise and equipment to perform one. The government doesn’t bother keeping statistics for abortions performed.

It’s not clear whether “this is a Catholic nation” was intended as a smug put-down or an eye-rolling commiseration; nor whether it was said by a Catholic. (Many junior doctors in Irish hospitals are in fact from South Asia; many nurses are also immigrants, though often from Catholic countries like the Philippines. Meanwhile many Irish doctors and nurses go abroad to earn more.)

24

rf 11.14.12 at 3:15 pm

“The article mentions that she was told repeatedly “this is a Catholic nation.” Do you Irishpeople think things would have been different if she had been Catholic? If she’d been ethnically Irish?”

Well I definitely think the fact that she was a ‘non white foreigner’ had something to do with it. A lot of Irish people seem to be in denial at how difficult it is for non white immigrants (which it seems by the stories she was) to be taken seriously by any number of institutions (local councils, courts, HSE etc)

25

Sarah Carroll 11.14.12 at 3:37 pm

The death of Savita Halappanavar should provoke outrage in anyone truly concerned about the health of women.

Hopefully the investigation will shed some light on why Mrs. Halappanavar was refused treatment for miscarriage, when this treatment is regularly administered in this country, and is allowed for by the law and by the Medical Council.

The treatment she needed was legal, so there is no question that a change in the law is what is needed here. It is medical negligence that she was not treated urgently.
In cases where the fetus is still alive, the Medical Council in part 21.4 of its guidelines for medical doctors states that treatment is allowed EVEN if “there is little of no hope of the baby surviving”.

The treatment that Mrs. Halappanavar should have received is legal in this country. In fact, it is standard medical procedure in cases like hers. That she wasn’t treated is a failure of the hospital and medical team, not a problem with the law.
I suspect that the medical council will strike off one or more people because of this and rightly so.

The greatest thing we can do to honour Savita’s life is to insist on obstetric excellence – that is what saves women’s lives, not abortion.

26

Uncle Kvetch 11.14.12 at 3:58 pm

Doesn’t he have a child molester to go shelter?

You know, in just about any other context I can think of, this kind of remark would constitute trolling, and particularly repellent trolling at that. And yet in this particular context, it’s pretty much spot-on.

27

bianca steele 11.14.12 at 4:08 pm

Surely human flourishing requires involves preserving the lives of mothers. Surely there was something they could have given her, which under normal circumstances they wouldn’t give a pregnant woman, because its safety for the fetus is dubious, which they could give her, for her pain and for the infection. I don’t understand this at all. If she had been an unmarried teenager, or a rape victim, at least they might say she’s being punished, or she’s well out of it. A married woman, and a productive member of society, doesn’t fall into either of those categories.

But even in the US there are medicines that can’t be approved to give to women between the ages of twelve and forty, because they might become pregnant, and they might not take the responsibility of ensuring (as all medical professionals would insist they do, if they took the responsibility of informing those professionals) that they were never pregnant and taking that medication at the same time.

28

bianca steele 11.14.12 at 4:10 pm

And what do doctors do, in cases of ectopic pregnancy? If the news report is accurate, by the second day the pregnancy seems to have put her in as much danger as an ectopic pregnancy would.

29

Kevin Donoghue 11.14.12 at 5:02 pm

Tried to find out a bit more about the ethos of the hospital in question. In a way, this page offers a clue as to what the problem might possibly be:

http://www.guh.hse.ie/About_Us/GUH_Management_Structure/

30

Omega Centauri 11.14.12 at 5:15 pm

And how does one deal with dependent statements in law like necessary, when any honest evaluation of the results of a medical proceedure are probabilistic at best? What degree of possible harm constitutes necessary?

31

Kevin Donoghue 11.14.12 at 5:24 pm

Omega Centauri, the X case judgement is pretty specific. Abortion is legal “where it is established as a matter of probability that there is a real and substantial risk to the life of the mother which can only be avoided by the termination of the pregnancy then such termination is permissible. The test of inevitable or immediate risk to the life of the mother insufficiently vindicates the mother’s right to life.”

In practice a jury would be very unlikely to question the judgement of an obstetrician and the DPP would be very unlikely to prosecute unless s/he was really stretching it.

32

Kevin Donoghue 11.14.12 at 5:27 pm

33

Lilypod 11.14.12 at 5:39 pm

During ectopic pregnancies, the death of the foetus is seen as an unintentional by-product of removing the fallopian tube. During all the river dancing on the heads of pins that took place throughout 1992 in Ireland, I remember further controversy about the medical treatment of ectopic pregnancies here. A number of women were distressed that they had been left with reduced fertility due to the removal of the fallopian tube as opposed to the removal of the embryo (in cases where the former hadn’t ruptured). This presumably had been hospital policy where these women had been treated, although a quick Google search shows it may not have been a blanket policy.

On the anniversary of the X Case earlier this year, it did strike me how completely abandoned women have been by the failure to legislate. I can’t see it happening within the next twenty years either.

‘Nighthawks’ satirical advert in 1992: “Are you pregnant? Are you unemployed? Are you a drug user? Are you HIV positive?…Have you considered…England?”

34

Barbara 11.14.12 at 5:46 pm

I am grieving for this woman and her husband. To be caught up in this as a Catholic is bad enough, to be forced to lose your life in service to a belief system you do not share is horrifying. But please don’t think the U.S. is so much better. Were it up to the RCC, this would have played out exactly the same in Catholic hospitals in the U.S. Most of you are familiar with the St. Joseph’s Hospital (AZ) incident, yes? A nun in charge of medical ethics at the hospital authorized obstetricians to terminate the pregnancy of a woman (mother of four) dying of pulmonary hypertension (a condition that is catastrophically aggravated by pregnancy). She was so sick she could not be moved out of the ER, let alone transferred to another hospital.

A bishop excommunicated the nun and decertified the hospital as a Catholic institution. He deemed it morally unsupportable that a Catholic would have authorized the termination of a “healthy pregnancy.” (What kind of disconnection from reality and biology could cause someone to see a a pregnancy that is 100% fatal to the fetus as healthy? What kind of church makes imposing death on women a cornerstone of its theology?) The only thing that saves Catholic hospitals from themselves in this country are the secular impulses of nearly all physicians. I am convinced that if this woman had been allowed to die with physicians forced to stand around and do nothing, its obstetrics department would have vanished overnight.

A few months later, the hospital’s parent, changed its name from Catholic Healthcare West to Dignity Health Care and officially terminated its status as a Catholic institution.

I think the Catholic reasoning is flawed even by its own logic, but there are many women (and men) who don’t even truly understand how much peril women are in when they turn to Catholic institutions for obstetric care in particular. In the aftermath of the Arizona case, legislation was introduced in Congress affirming the right of religious hospitals to deny any treatment that is deemed incompatible with their religion. Anyone who has a choice should boycott Catholic hospitals.

35

ishu 11.14.12 at 5:57 pm

Sad that Savita had to die ………
Crazy law ..these country practice…..
She was not aborting the child ,it was an Extreme medical need .Doctor is suppose to help her not kill her.

SAD!!SAD!!!SAD!!

Motherhood is most valued in India . Last thing a women in INDIA would want to listen Loosing her Child. There life is around there kids. and no religion pressure or guideline for this. Its Plain MOTHERHOOD.

So its extremely sad and barberic to even read stupid protest stuff happening there.
And what justice will serve , a beautiful life lost, her dreams of motherhood gone with her. Family Shattered for ever.

Last thing a world need to teach a Indian Women on “Motherhood and value human life.”

So stop the bullshit!! YOU KILLED HER!!!!

36

Bruce Wilder 11.14.12 at 6:19 pm

Kevin Donoghue: “In practice a jury would be very unlikely to question the judgement of an obstetrician and the DPP would be very unlikely to prosecute unless s/he was really stretching it.”

Right, because with notable exceptions, we have such a surplus of humane reason overwhelming these disputes, that an impasse predicated on a risk of prosecution or loss of professional licenses is simply an unreasonable expectation.

37

Kevin Donoghue 11.14.12 at 7:40 pm

Bruce, I’m not sure what you’re getting at. I was responding to Omega Centauri’s question. (Quite possibly I misunderstood it.) A medic who contemplates performing an abortion in Ireland may have all sorts of reasons to worry about the Matron/Bishop/Ethics Committee looking over his/her shoulder. But so far as criminal prosecution is concerned, the law isn’t at all hazy. If you can convince the jury that you’re doing it because the woman’s life is in danger you’re in the clear. If not, you risk jail.

Any change to the legal position requires a referendum. That’s not on the cards at the moment.

To me, what’s disturbing about this case is precisely the fact that the medics apparently had nothing at all to fear from the law. The patient was obviously in serious danger. There’s nothing in the X-case judgement that says you have to wait for the foetal heartbeat to stop. My fear is that they were thinking in terms of Catholic theology — double effect and all that — rather than the law of the land. Historically, this is a country where obstetrics and theology were always intertwined. Medical students who said irreverent things about St Thomas Aquinas were taking a risk. Now I’m thinking maybe there’s still a bit of that around.

38

Peter Erwin 11.14.12 at 8:09 pm

The article mentions that she was told repeatedly “this is a Catholic nation.” Do you Irishpeople think things would have been different if she had been Catholic? If she’d been ethnically Irish?

(Not an Irishperson, but:)
Later in the article, the quote is given some context:

The consultant said it was the law, that this is a Catholic country. Savita [a Hindu] said: ‘I am neither Irish nor Catholic’ but they said there was nothing they could do.

(I get the impression that “this is a Catholic country” was meant as an explanation/justification for the law, not as a prim way of saying “No terminations for foreign heathens!” )

39

Stephen 11.14.12 at 8:10 pm

Ghastly story.

Sincere query, though, from imperfect understanding of US politics.

Recent pro-Democrat, or at least anti-Republican alliance, is reported as involving
a) women, on account of their being pro-possibility-of-abortion
b) Hispanics, apparently culturally at least Catholic, therefore anti?

Long term prospects for this alliance?

40

Doctor Science 11.14.12 at 8:37 pm

Stephen:

Excellent. A majority of native-born Catholics are already Democrats, after all. Catholics are more common in “blue” states, and tend to have opinions in line with other blue-state residents, even about abortion, homosexuality, and sexual morality.

I can’t find the link at the moment, but the LA Times did a poll in late summer/early fall that showed a gigantic gender gap for Hispanics. Latinos mostly didn’t like Romney, but it was pretty clear that Latinas *loathed* him.

41

bianca steele 11.14.12 at 8:45 pm

@Peter Erwin
I can’t speak for Doctor Science, but the same thing did occur to me. Minorities are often told the equivalent of “this is a Catholic country,” and it usually seems meant to end the conversation: a warning to be more culturally sensitive, or simply that a path of inquiry won’t be successful. A native would know not to ask straight out.

OTOH, an outsider saying, “this is a Catholic country, I wouldn’t be able to get an abortion” (or its equivalent), might get the response that Catholicism (or its equivalent) isn’t really as rigid as all that.

42

rf 11.14.12 at 9:08 pm

I think Bianca’s right. Whether or not the consultant was being explicitly xenophobic is one thing and probably shouldn’t be speculated on. Whether she would have got better care if she was a ‘native’ with a recognisable local name and family etc is another? I would say yes, but I also have no expertise on abortion in Ireland. (I couldn’t imagine the Catholic line being used on a ‘native’ though) You do hear a lot from recent immigrants about dealing with local councils etc and it isn’t good. I’ve heard of friends, ‘ethnic Irish’, being asked to approach local councillors at the behest of immigrants so requests are taken seriously. Worked in numerous low paid jobs in the early 00’s where the unions and employers explicitly scapegoated/took advantage of recent immigrants. Gone out to clubs where blacks were turned away at the door. Got taxis where drivers would block of the ranks from black drivers. So unless the HSE is the one area of live divorced from all of this, and I doubt it, let’s not be under any illusions about Ireland.

43

PlutoniumKun 11.14.12 at 10:08 pm

I’m surprised more hasn’t been made about the link between the Professor of Obstetrics in Galway NUI and the ‘Dublin Declaration on Maternal Health’, which seems to have been made by a group of pro-life medical professionals.

http://www.irishtimes.com/newspaper/ireland/2012/0910/1224323797477.html

It was developed at this conference – the 3.10 talk seems significant – the author is known for claiming a connection between abortion and poor mental health outcomes according to Wikipedia.

http://www.symposiummaternalhealth.com/programme/

http://en.wikipedia.org/wiki/Priscilla_K._Coleman

This letter from a well known pro-life doctor refers to it:

http://www.aaplog.org/get-involved/letters-to-members/dublin-declaration/

Incidentally, the end of that letter seems to indicate that inducing an early miscarriage in some circumstances is not considered abortion even by some of the most extreme pro-life groups.

I’ve heard plenty of anecdotal stories indicating that the obstetrics profession and midwifes in Ireland is strongly dominated by very conservative catholics. Quite deliberately I think, organisations like Opus Dei have often seen womens health issue as a key area for control.

Having said all this, I don’t think it can be ruled out that the decision to ‘let nature take its course’ might well have been a genuine medical judgement. And neither is it clear that the septicaemia was directly related to the failure to terminate.

44

bjk 11.14.12 at 10:43 pm

Here’s some barbarism for you. You can google at your leisure:

“Katrina Effert was 19 on April 13, 2005, when she secretly gave birth in her parents’ home, strangled the baby boy with her underwear and threw the body over a fence into a neighbour’s yard…

Effert will have to abide by conditions for the next three years but she won’t spend time behind bars for strangling her newborn son.”

But don’t worry, she won’t get off without punishment:

“Regarding the conditions of the probation that goes along with a suspended sentence, Veit agreed Effert should take counselling as directed, inform her supervisor if she is pregnant and perform 100 hours of community service.”

100 hours of community service, alrighty then. She’s paid her debt to society.

45

taj 11.14.12 at 10:59 pm

…hence it was sad but necessary for Savita to die, implied bjk.

46

derrida derider 11.14.12 at 11:10 pm

Not to excuse politicans or bishops here at all, but those doctors were definitely gutless. Any humane or sensible doctor would have put a stethoscope to the poor woman’s belly as soon as she was diagnosed and declared that they couldn’t hear any foetal heartbeat. That others have failed in their duty to your patient doesn’t entitle you to.

47

umami 11.14.12 at 11:10 pm

That is barbaric, bjk. It is absolutely horrific that that poor kid couldn’t get an abortion and ultimately resorted to that.
Thank you for highlighting another case which demonstrates the massive importance of easily accessible abortion.

But I think you have to be careful. Although your intentions were good it could seem like you’re distracting from the discussion of Savida’s death and callously ignoring the horror of that when you bring up other unrelated cases in the comments about her death without even briefly acknowledging the tragedy that is the topic of this thread.

48

gordon 11.14.12 at 11:29 pm

So, collateral damage in warfare against the Devil is terrible, but collateral damage in warfare against the Taliban is fine?

49

ckc (not kc) 11.14.12 at 11:38 pm

Here’s some barbarism for you.

…if your hope was to point to the content of your post, rather than your act of posting it in this thread, it was in vain

50

gordon 11.14.12 at 11:45 pm

And of course collateral damage in warfare against Hamas is positively wonderful:

“GAZA CITY, Palestinian Territories (AFP) – A top Hamas commander was among at least eight Palestinians killed in more than 20 Israeli air strikes on Gaza on Wednesday [14/11/12] as Israel began an operation targeting militant groups… Israel pounded the Gaza Strip with another 20 air strikes, killing five more people, two of them children, Hamas health minister Mufid Mukhalalati said in a televised press conference at Gaza City’s Shifa hospital….The Palestinian envoy to the United Nations put the death toll at nine and said the number would likely rise.

Hospitals and medical centres across Gaza were put on high alert after the initial strikes as Israel warned the hit on Jaabari was only “the beginning” and said “a significant number” of arms dumps were within civilian and residential areas…”.

http://au.news.yahoo.com/world/a/-/world/15384476/top-hamas-commander-killed-in-israel-strike/

51

leederick 11.15.12 at 12:14 am

“But so far as criminal prosecution is concerned, the law isn’t at all hazy. If you can convince the jury that you’re doing it because the woman’s life is in danger you’re in the clear. If not, you risk jail.”

Surely the onus is reversed, the prosecution has to convince the jury that you did it even though you didn’t think the woman’s life was in danger?

52

JohnR 11.15.12 at 12:24 am

I’m not entirely sure why Gordon’s comment is on-topical, but in a sense, the Palestinian situation should be familiar to the Irish here. After all, in both cases (the Irish Problem and the Palestinian Problem) the problem is the continued existance of the subhumans. The solution is their extirpation or absorbtion. cf also the Abo Problem in Australia, the Redskin Problem in the Americas, etc, etc., etc. It’s ironically amusing that the Irish have now apparently decided that there is a NonCatholic Problem; locally, admittedly, and in practice rather than by national decree. I suppose this is a kind of step forward, as it marks an advance on the former Non-Catholic/Non-Protestant Cooperative Problem, but the the essence is still there. I’m not smugly superior, mind you; I’m from the US, which is like that, only with four or five factions where the Irish have just a couple. Clearly both sides are correct in the ongoing, world-wide ‘Evolution Isreal’ debate. Some of us have evolved from our simple primate acestors, while some of us appear to have the social and cultural elements of baboons, but with the outward appearance of humans. Clearly these latter must have been created by the same loving Moloch that decreed the life of this yong woman should be ended slowly and painfully, as a sacrifice to the Holy Church of Death.

53

Kevin Donoghue 11.15.12 at 12:49 am

leederick,
As noted IANAL. But yes, of course the burden of proof is on the prosecuter. Practically speaking s/he would need to get expert witnesses to testify that no obstetrician could reasonably believe that the risk to the mother’s life was such as to justify an abortion.

I’ll sign off now. It’s late and some comments are appearing which I suspect will be deleted when the management looks in.

54

ChrisTS 11.15.12 at 12:58 am

God, what a horror story. It’s difficult to find anything more useful to say.

55

Salient 11.15.12 at 2:58 am

@bjk — Here’s some barbarism for you.

State barbarism != individual barbarism.

(It works both ways, mind you. Considerate persons wouldn’t bring up war massacres at the funeral of a murder victim, either.)

But don’t worry, you won’t get off without excoriation. What’s impressively repellent about your comment is that you decided not to mention the deteriorated psychiatric condition of the mother, which was, explicitly, the principal reason her murder conviction was overturned and replaced by a higher court. Most folks reading along probably aren’t going to go look up the details, since it’s only weakly tangential to the thread, but they might well be sympathetic to judicially credible assessment that the mother was suffering from severe psychiatric distress. (She was hospitalized for it, the court had access to clinical documentation, etc.) Withholding that crucially relevant tidbit, despite its superlative relevance, is basically just an indirect way of slandering her for no reason on a thread about someone from a different country suffering from a different fate under different circumstances. Alrighty then.

56

purple 11.15.12 at 3:38 am

Another reason to excommunicate religion from any role in public life.

57

Alan 11.15.12 at 3:54 am

From the original post: “Yet Irish doctors are restrained from making obvious medical decisions by a fear of potentially severe consequences.”

Is this a variety of the Nuremberg defense, that they justifiably react in some supposed compliant way to inflexible authority? Then such physicians are moral cowards at best (they know what’s right but lack courage resisting the authority) or moral deviants at worst (they fully embrace the horror of that authority) or pitiable moral nihilists if they are nothing at all (if they are charitably self-reflective moral skeptics who adapt a moral pragmatism of self-interest against the powers of the authority or simply don’t care).

In the face of such prima facie abject evil of their inaction whatever the motivation, none of these is a proper defense.

I wish there were such a fate as to underwrite “To Hell with them”.

58

ckc (not kc) 11.15.12 at 4:21 am

@salient 55
…you have more patience for explication/excoriation than I, but yes, this!

59

Harold 11.15.12 at 4:23 am

I suppose bjk thinks that poor mother deserves the death penalty. Pro-life, indeed!

60

Thers 11.15.12 at 5:08 am

As a recommendation, Sandra McEvoy’s “Before Cadden: Abortion in Mid-Twentieth Century Ireland” in Ireland in the 1950s: The Lost Decade provides an excellent overview of abortion in the Irish state from the 1920s-50s.

61

Meredith 11.15.12 at 6:07 am

I don’t know enough about the details or the people to judge the individual physicians and other medical professionals involved in this story. Nor can anyone say for sure that Savita Halappanavar would have lived had the abortion she requested been performed (though surely her chances of survival would have been better).

We do know that organized groups are advocating, above and beneath the public radar, policies that will ensure there will be more Savita’s. Barbara@34 discusses a notorious case here in the US. My son, doing rotations in Boston hospitals, was quite amazed to discover a very active network of Catholic doctors (ob/gyn’s) and nurses dedicated to extreme positions like this. Fine practioners — “the best” — and good and decent people, by most measures — that is what so threw him for a loop. They meet. They organize. Quietly. And not to rag on Catholics: plenty of fundamentalists Protestants are promoting the same things these days.

Somewhere I saw a brief video of Savitha, with her husband, dancing. The other children she and her husband might have danced into being, the dances they might have danced together! I will remember her dancing.

62

Thers 11.15.12 at 6:40 am

Dammit, McAvoy, I meant.

63

PaulB 11.15.12 at 9:34 am

I’m not a Roman Catholic, but my understanding is that its teaching on abortion is laid down not in Canon Law, as TimW#18 says, but in the Catechism, particularly number 2271

…Direct abortion, that is to say, abortion willed either as an end or a means, is gravely contrary to the moral law…

The RCC has however developed the teaching that abortion is permissible as an unintended but foreseen side effect of treatment necessary to save the life of the mother – the doctrine of ‘double effect‘.

The example of an ectopic pregnancy in a fallopian tube is instructive: it is permitted to remove the tube, and the embryo with it, but not permissible to abort the embryo leaving the tube intact: this is because in the former procedure the death of the embryo is inevitable but not willed. Thus in the case of a woman with only one intact fallopian tube, the RCC teaches that sterilization is the only acceptable way to save her life.

Thus the teaching of the RCC would seem not to have permitted an abortion in Savita Halappanavar’s case.

64

ajay 11.15.12 at 10:34 am

Sincere query, though, from imperfect understanding of US politics.
Recent pro-Democrat, or at least anti-Republican alliance, is reported as involving
a) women, on account of their being pro-possibility-of-abortion
b) Hispanics, apparently culturally at least Catholic, therefore anti?

Following up on Dr Science’s comment: there’s an error, I think, in part b. The bishops are anti. It doesn’t necessarily follow that all or most of their flock is.

Also fascinated by Niall McAuley at 20: I didn’t realise that the Holyhead Ferry Compromise was actually written into the Irish constitution!

65

Niall McAuley 11.15.12 at 12:00 pm

ajay, you should see what we nearly got in response to the X case:

It shall be unlawful to terminate the life of an unborn unless such termination is necessary to save the life, as distinct from the health, of the mother where there is an illness or disorder of the mother giving rise to a real and substantial risk to her life, not being a risk of self-destruction.

That would have been the 12th amendment, but lost 65-35.

66

Eimear Ní Mhéalóid 11.15.12 at 12:06 pm

Even more crazily, some of the so-called prolifers were against that last because it wasn’t extreme enough.

67

ajay 11.15.12 at 12:07 pm

Ugh. Thanks.

I am coming to the conclusion that the Church of England is right in banning women from becoming bishops – indeed, they should go further and ban men from becoming bishops as well.

68

ogmb 11.15.12 at 1:50 pm

Shorter abortion deniers: If it’s a legitimate abortion, the female body has ways to shut that whole thing down.

69

Eli Rabett 11.15.12 at 1:53 pm

Where are the names of the physicians and administrators responsible for this, their names and addresses, so that at a minimum the first thing anyone finds when they search on line is this tragedy? Can they, perhaps, be charged in the International Court of Human Rights? Made to stand in the dock in shame?

70

MPAVictoria 11.15.12 at 4:54 pm

“Thus in the case of a woman with only one intact fallopian tube, the RCC teaches that sterilization is the only acceptable way to save her life.”

Fuckers.

71

Substance McGravitas 11.15.12 at 5:36 pm

Fuckers.

And they’re not supposed to be doing that either.

72

Mise 11.15.12 at 5:58 pm

As a woman in Ireland it is great to see light being shed around the world on our draconian abortion laws.

I’d ask you all to please share this story as widely as you can. The Irish government has not listened to its people for twenty years on this question. Perhaps international shame might have more of an impact.

Thanks for your support.

73

Kevin Donoghue 11.15.12 at 6:18 pm

Mise, international shame won’t have anything like the same impact as a zero-tolerance policy come election-time. Just take a look at how Todd Akin and Richard Mourdock were roasted in the US elections and think about how the recipe might be modified for Irish palates.

74

Kevin Donoghue 11.15.12 at 7:01 pm

It seems that anti-abortion campaigners in Ohio also attach particular significance to a foetal heartbeat, so as other commenters have remarked upthread, this issue may have quite a bit of relevance in the US. This is worth a look:

http://www.balloon-juice.com/2012/11/15/might-be-time-to-start-talking-about-this/

75

Harold 11.15.12 at 7:19 pm

I know from personal medical experience with fetal loss that unless a monitor is attached directly to the fetus’s scalp, the fetal heartbeat is not all that easy to detect or monitor accurately by stethoscope, especially when the mother’s heart is beating rapidly from emotion or exertion.

76

Harold 11.15.12 at 7:20 pm

Stethoscope or ultrasound, I should have said.

77

STH 11.15.12 at 9:34 pm

I think there’s something important that many discussions of the Catholic Church miss: that the church really, really doesn’t care about life here on Earth. From their perspective, the only thing that’s important is “saving souls.” You aren’t going to find the church (and I mean the hierarchy here, not individual priests, nuns, or lay Catholics) working seriously to alleviate poverty or end wars, because their theology teaches that what really matters is the health of souls, not physical health. They don’t care that forbidding contraception or abortion has dire effects on their followers. As far as they’re concerned, abortion puts your soul in peril, so it’s serious, whereas poverty is not because it only affects your short time on Earth. Child molesting is sad, but it’s much less important than continuing the work of the church, so they’re going to cover it up to protect the church. If a priest is saving souls, what he’s doing to kids he’s raping is small potatoes.

78

Katherine 11.15.12 at 9:47 pm

Eli @ 69, alas there is no such thing as the International Court of Human Rights. The is the International Criminal Court, but that deals with war crimes and crimes against humanity, so no.

It would be interesting though to see the execrable position of the Irish state being put to the European Court of Human Rights.

79

rf 11.15.12 at 10:12 pm

I thought it was a couple of years ago and we were found in breach (Not something I know a lot about so Googled it and found this – apparently at the next stage to be reported on soon)

http://www.forbes.com/sites/womensenews/2012/08/27/abortion-law-decisions-coming-to-catholic-ireland/

80

gordon 11.15.12 at 10:17 pm

Meredith (at 61), thanks for your Boston story. It reminded me of a film I saw a long time ago where a good young doctor (Hugh Grant) discovers an evil old doctor (Gene Hackman, I think) doing illegal things not with pregnancies but with body parts. Your story struck me as a good theme for a sequel.

81

ChrisTS 11.16.12 at 12:41 am

@Salient #55:

Thank you. I do think evil trolls should be confronted with facts. I admit this story made me too ill to bother.

82

Meredith 11.16.12 at 5:55 am

US commenters here may have our own preoccupations — sorry. The recent election campaign has focused the attention. We in the US are often not so different from Ireland:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2636458/

83

Adrian Kelleher 11.16.12 at 10:13 am

Ireland is the most reflexively conservative developed country even though the Irish politicians who actually campaign for conservative causes are tiny in number and have never wielded significant power. They are therefore not directly to blame for this horror. Responsibility instead lies with the mainstream political class who bear little resemblance to conservatives elsewhere in tone or emphasis and seldom promote conservatism directly but have nonetheless created an extremely restrictive set of laws on reproductive rights. Interestingly, they are the same people that nowadays attack the Catholic Church with the same integrity and vigour that they had once defended it.

Ireland’s conservatism certainly reflects that of its citizens. Its many peculiarities however, which set it aside from that in other countries, reflect the absence of any underlying values whatsoever among its politicians. The issue is awkward, there are no votes in it and so it gets buried.

This precise issue and its attendant cruelty had been publicised just recently, so there’s simply no excuse.

84

sarah 11.16.12 at 9:45 pm

I haven’t read all the comments here but there is a poor understanding of clinical practice in Ireland.
The fact is that pregnancies are terminated here frequently when the mother’s life is in danger. The classic ones are ectopic (and no, the tube is not removed as some comments have claimed – the embryo itself is removed). Pre-eclampsia is another- where only delivery is the cure. Heavy bleeding will also result in a termination. Doctors don’t mess around – the life of the mother is always the priority. If the baby can be saved too – well and good.
Savita’s case will probably turn out to be a medical negligence issue. It had a little to do with the law but more to do with poor clinical practice and bad management of miscarriage.
As any pregnant woman knows if your waters break and you don’t go into labour, two things happen as a matter of course -
1. you are put on antibiotics automatically – even if there is no sign of infection
2. labour is induced within 24 hours, but certainly not longer than 48
These two things are done precisely because the risk of infection when the cervix is open is so high.
Savita presented, miscarried, got a D&C on the 3rd day, then got the infection and died on the 7th day.
There is no way she should have been left 72 hours with an open cervix and without antibiotics. If she was in a major hospital with different doctors, this might not have happened. But we don’t know the details yet. She could’ve been on antibiotics but the infection was a superbug.

We do need the legislation but in the absence of it, Ireland has one of the lowest maternal death rates in Europe – lower than England where there is abortion on demand up to 24 weeks. Of course, Irish women can just go England for abortion, but those who develop dangerous medical conditions in Ireland are treated and their lives saved.

85

ptl 11.16.12 at 10:27 pm

If she was in a major hospital with different doctors, this might not have happened.

It was University College Hospital Galway.

86

Kevin Donoghue 11.16.12 at 11:09 pm

ptl is correct. As a teaching hospital with over 500 beds, UHG is a major hospital, certainly by Irish standards.

87

Maria 11.17.12 at 11:27 am

Sarah, the whole issue has arisen because there are quite evident grey areas in medical and medico-legal practice in this area. It would be nice it if were as cut and dried as you say, across every hospital in Ireland – except, oddly UCG which you seem to think is a cottage hospital – but that just isn’t the case. The absence of legislation is one factor leading to different clinical practices and outcomes; another is simply which consultant happens to be in charge (and not their expertise, but their religious beliefs). That is simply not good enough.

One thing I’ve learnt from this is that if I’m ever so lucky as to be delivering a child, and I happen to be living in Ireland, it will NOT be at UCG hospital, and probably not in Holles St. either, though that’s where all my siblings were born. The Rotunda is emerging as one of just a few hospitals that routinely protects the mother’s health, whether or not a foetal heartbeat can be found.

(Harold’s comments above are illuminating, on that hearbeat point.)

But should it be up to an informal grapevine of information that women find out where they know they will be treated as fully fledged humans, and not as good little Catholic incubators?

88

Maria 11.17.12 at 11:30 am

And honestly, that old canard about Ireland having the lowest maternal mortality in the universe since history was begun…

Honestly, do you really think providing good pre-natal care (the main determinant of maternal mortality) excuses us of allowing a perfectly healthy young woman to die in agony because of our refusal to deal with and legislate for difficult moral dilemmas?

89

P O'Neill 11.17.12 at 4:03 pm

FWIW, the Corner has an ethicist opine on the case –

“The lack of precise medical details included in media coverage of the Savita Halappanavar case does indeed make it difficult to offer a cogent moral analysis of what transpired,” Reverend Tadeusz Pacholczyk, director of education at the National Catholic Bioethics Center cautions. “If it were the case, for example, that she suffered from a serious placental infection unable to be controlled by other remedies, it would have been allowable to induce labor under a proper application of the principle of double effect. Such an action would not constitute a direct abortion, but maternally directed therapy to remedy the infection, with the secondary, unintended effect that the life of the child would be lost.”

90

Niall McAuley 11.17.12 at 6:39 pm

Yo, Reverend Thomas? Fuck you and your allowable double effect bullshit.

91

They offered you no resistance 11.17.12 at 7:51 pm

Contrary to what is asserted here and by the Irish Times, Savita Halappanavar did not die because she was denied an abortion, she died from chronic infection. Sarah (above) has taken care to present an illuminating chronology with these facts.

Those of you who seek to distort these facts and rush to judgement, in the words of a former Australian Prime Minister, wish to “maintain your rage”.

And as for the comments here regarding the Catholic Church, and the ad hominem regarding observant Catholics, you confirm my suspicion that liberals cannot tolerant dissenting opinion.

92

sarah 11.17.12 at 10:25 pm

@ Maria
– what evidence do you have that the Rotunda protects mothers better than Holles St?

(Declaration: I’ve had 3 children in Holles St. They don’t mess around as far as I can see)

- I did not say Ireland has the lowest maternal death records. Here are the European records

http://www.indexmundi.com/map/?v=2223&r=eu&l=en

We’re no. 6.
The UK (with abortion on demand until 24 weeks) is 12.
One of the major causes of MMR is infection.

@Everyone

Please just bear in mind – we actually don’t have ANY facts yet about what really happened. Was she put on antibiotics when she came in? Was it an antibiotic resistant strain? When did the infection take hold?

We should have legislation (personally I think the whole lot should be deleted from the constitution – it’s ridiculous trying to legislate for any of these circumstances). But the way people are confidently asserting why Savita died without the facts isn’t fair. I honestly think this will turn out to have more to do with medical negligence + horrible bad luck.

93

Belle Waring 11.18.12 at 1:28 am

THANK YOU Maria.

94

Mise 11.18.12 at 2:14 pm

@sarah The figures on maternal mortality in Ireland are an over-used unreliable argument.

Pointing to our maternal mortality rate ignores the countless (and uncounted) women who travel abroad every year, at the covert whispered advice of Irish doctors, to safely terminate their pregnancy. It’s a safety valve that, yes, thankfully, lowers our maternal mortality rate. But its not the Irish state that should claim credit for saving those lives. Like the 16 year old who, pregnant, started bleeding and was advised by her doctor to get on the next plane to England because he could not guarantee she would receive the appropriate treatment in Ireland.

And even leaving that aside, Ireland collects maternal mortality data differently to most other European countries, and is accused of under-reporting for various reasons – details in the Medical Independent here – http://www.medicalindependent.ie/page.aspx?title=maternal_death_%E2%80%93_into_the_great_unknown

95

js. 11.18.12 at 5:50 pm

Just read this over at the Guardian. Unspeakably horrible this. But at least it’s good to see that there’s public outrage. (10,000 marchers seems like a fair bit, but do people with greater knowledge of local conditions have a sense of how widespread this outrage is?)

And here’s hoping that the family manages to hold the doctors and/or hospital accountable.

96

Lilypod 11.19.12 at 3:45 am

sarah, you cannot emphatically state that women have not experienced the removal of a fallopian tube as a treatment for ectopic pregnancy in Ireland when some women have experienced precisely that, and may well still do, depending on the religious beliefs of the doctor treating them (I am not talking of cases where a fallopian tube has already ruptured and there’s a medical reason for removal). My honest answer is that I have no idea how often it happens for non-medical reasons because nobody is looking for that information. So, yes, we all have poor understanding of clinical practice here.

A woman presenting with cancer at six weeks pregnant may find herself talking to a doctor who will advise fully on all choices and potential outcomes and mention a termination in England amongst them; another may find herself talking to a doctor who informs her that drug or radiation treatment will need to be postponed until after delivery. If the latter dies a year after giving birth because the cancer spreads so aggressively in the months during pregnancy that treatment when finally commenced proves ineffective, her death will not be classed as a maternal death. Again, we don’t have information on how many such women there have been, or how their care or the choices offered in Ireland differed from what they would have received elsewhere. We have only the occasional awareness filtering through, when women or their surviving loved ones have been sufficiently angry to think it mattered enough to be spoken of publicly instead of feeling that secrecy, guilt or shame were the appropriate reactions. So, as always, the voices absent from the discussion are those of the women who have actually had terminations.

Visiting family on Friday evening meant having to sit through the ‘Late Late Show’, which debated the issue with a lawyer, a consultant psychiatrist, a politician, and a barrister. Caroline Simons wanted first to send her commiserations to the Halappanavar family. The second thing she rushed to do was express her sympathy to the family of Rory Staunton “who had a similar experience” in New York. Because there is always the danger we might think we should be discussing a) women b) abortion or c) Ireland. Simons, an anti-abortion lawyer, and concerned about scaremongering, was reassured that the Taoiseach would not be “rushed” into legislating after twenty years (no need to have worried, successive governments have confirmed it’s “not a priority”), then went on to claim that doctors would be “hogtied” by legislation, and that it would put women’s lives at risk. That be the level at which the debate is still at.

97

rf 11.19.12 at 4:44 am

“but do people with greater knowledge of local conditions have a sense of how widespread this outrage is”

Imo, Irish society is very settled in the middle. (Uncomfortable with abortion, yet hostile to, primarily, Catholic extremists) I’m with the pro-choice group (but conclusively only very, very recently)
I came back only a few days ago for a funeral and from what I’ve seen it’s gone (relatively) unnoticed. So as K O Donoghue says above (I think) whoever makes the other look worse (if there’s a referendum) will win.

98

Meredith 11.19.12 at 4:46 am

I wish Maria could talk with a woman, early 30’s I’d guess, whom I met when I was canvassing for Elizabeth Warren here in MA, US, a couple of weeks ago, in a solidly working-middle class neighborhood. A regular voter and registered dem (why she was on my list), she answered the door with a darling 3- or 4-year-old daughter in tow. Her only child, I gathered. At first she was inclined to brush me off, but then she decided she wanted to engage. I heard about how she had experienced numerous miscarriages (I think she said 19), and about her parents’ having raised many foster children. I listened intently — there was something important she was saying to me despite the flaws in her implicit argument, and I couldn’t help but be very sympathetic. When she finished, I was a little non-plussed. I mustered the observation that Scott Brown (Warren’s opponent) is (nominally) pro-choice. Yes, she said (this woman was certainly well informed), but in the end, he would vote for a Supreme Court justice who would overturn Roe v. Wade. QED. To which I could only respond (quite sincerely), well, despite our differences of opinion and whoever wins, we both agree that we all need to do everything we can together to work for the interests of children.

I don’t think this woman had imagined that the interests of the mother, or of her other child(ren), or of the father, could ever be in competition with one another. That particular lack of imagination is both moving — at the heart of good parenting? — and, obviously, blinkered. Savita. Anyway, I thank Maria for most of any good that came or might come of my exchange with another woman in MA.

99

rf 11.19.12 at 5:18 am

I should add, which is obviously a given, some of the most genuinely compassionate, thoughtful and humane people I know are very torn on this. (We’re back to ethnicity aren’t we, ‘you’re all a pack of…..’)
Arguments win, so let’s win it this time (While showing the opposition to be eh, slightly of kilter (?), if needs be)

100

sarah 11.19.12 at 11:07 am

” woman presenting with cancer at six weeks pregnant may find herself talking to a doctor who will advise fully on all choices and potential outcomes and mention a termination in England amongst them; another may find herself talking to a doctor who informs her that drug or radiation treatment will need to be postponed until after delivery.”

I agree completely – that’s why I said in my initial post that in a different hospital with a different doctor Savita could’ve lived. (but some people didn’t like that). My point was: It’s not always about the law but about which doctor you get, and that’s true for many medical conditions. I think the legislation does need to come in – it’s moronic not having it – BUT I also believe that medical malpractice, bad decisions and unbelievable bad luck are factors in MMR and blaming the law for this case is jumping the gun when you consider that terminations are carried out frequently in Irish hospitals. Therapeutic termination is standard practice.

(btw, I didn’t say tubes are never taken, of course they are, but that depends on all kinds of things like the degree of damage and the attitude of the surgeon. My point was that previous comments indicated that tubes were always taken to fit in with Catholic teaching. From the experience of my friends, this is rubbish. Their cases are treated depending on their conditions so it’s the condition that drives the treatment not catholic teaching).

Look, what I am saying is this: In Ireland, the fact is that clincial practice is such that women are not being left to die in order to “Save” unviable babies. This was an extremely rare case that might have occurred for all kinds of reasons we know nothing about yet. I honestly think we should wait until we have more information, e.g. was everything done correctly, but it was a superbug?

As for consensus in Ireland the consensus pre Savita was:

Oh god, please not another abortion row. It’s too upsetting. Everyone has a sad story. We don’t want to talk about this.

Now it’s:

Sigh. ok, we’re going to have get our act together. Legislate please but would the nutters on each side please stop trying to exploit this poor woman’s death for their own political end…..

101

Katherine 11.19.12 at 11:21 am

but some people didn’t like that

No, I think some people didn’t like the implication that OCG was some kind of outlier in the Irish medical establishment, and that therefore events there were not relevant to Ireland as a whole.

Also, I don’t think you mean MMR.

102

ajay 11.19.12 at 12:10 pm

This was an extremely rare case that might have occurred for all kinds of reasons we know nothing about yet.

Nothing except for the clear and detailed account given to the Irish Times by the dead woman’s husband and quoted above. Which makes it pretty unambiguously clear that the hospital’s decision to commit gross malpractice, whether or not it resulted in her death (and I agree that this isn’t clear yet), resulted in her spending almost three days in extreme pain.

103

Watson Ladd 11.19.12 at 12:53 pm

sarah, the nutters on one side are defending the rights of women to control their reproductive lives. The nutters on the other side are defending child molesters. There is no equivalence.

104

sarah 11.19.12 at 1:44 pm

Or

- the nutters on one side cannot conceal their satisfaction they’ve got a dead mother to prove their point, which is unseemly to say the least
– the nutters on the other side are in a panic because they’re convinced the government wants to introduce abortion on demand (which they couldn’t even if they wanted to and they don’t anyway).

In the middle, a lot of people, like me, would like our legislation without being accused by either side of being in favour of the child molestors or murdering little babies.

And I do mean MMR.
It means maternal mortality rates.
If a refusal to carry out terminations to save mothers lives was regular practice in Ireland our MMR should be higher than in the UK. Instead the UK’s is higher – way higher.

All I’m saying is: this is complicated.

105

Katherine 11.19.12 at 2:09 pm

Wow, you think pro-choice “nutters” are satisfied? That’s a disgusting accusation.

106

ptl 11.19.12 at 2:10 pm

Sarah. As the article Mise cites says, MMR (maternity mortality rate) is calculated differently in the UK. I quote

While Ireland appears to have one of the lowest maternal death rates in the world, experts are concerned that the real figures are vastly under-reported…

According to the 2007 report: “If, as is the case in other countries, the numbers of maternal deaths are restricted to those identified by the underlying cause of death given on the death certificate alone, UK maternal death rate was 7 per 100,000 maternities, half that identified by this much more in-depth enquiry.”

Dr O’Hare said that as Irish obstetric practice is very similar to that in the UK, it is reasonable to assume that the number of maternal deaths here would be similar to those recorded by CMACE in the UK.

I could cite other articles to support the point about the rate in the UK, but I suspect you wouldn’t take any more notice of them than you did of Mise’s comment. And I have little patience, on this issue, with that. I grew up in a mainland Britain where abortion was almost entirely illegal, where dangerous illegal abortion was widespread, and where doctors forced to choose between a woman in labour and her baby would choose the baby, presumably in the name of life. If that is not what you want, if you genuinely want legislative change in Ireland, why do you argue as you do?

107

ptl 11.19.12 at 2:11 pm

My apologies to fellow commenters. Here’s the quotation in full

While Ireland appears to have one of the lowest maternal death rates in the world, experts are concerned that the real figures are vastly under-reported…

According to the 2007 report: “If, as is the case in other countries, the numbers of maternal deaths are restricted to those identified by the underlying cause of death given on the death certificate alone, UK maternal death rate was 7 per 100,000 maternities, half that identified by this much more in-depth enquiry.”

Dr O’Hare said that as Irish obstetric practice is very similar to that in the UK, it is reasonable to assume that the number of maternal deaths here would be similar to those recorded by CMACE in the UK.

108

ajay 11.19.12 at 2:16 pm

ptl, I think you have to put in an italics tag at the start of each paragraph if you want to have several paragraphs of italics. The tag doesn’t carry over from para to para.

109

ptl 11.19.12 at 2:20 pm

Thank you, ajay. I’ll (try to) remember in future.

110

sarah 11.19.12 at 4:12 pm

@ptl

Point taken on the MMR.

“Dr O’Hare said that as Irish obstetric practice is very similar to that in the UK, it is reasonable to assume that the number of maternal deaths here would be similar to those recorded by CMACE in the UK.”

So, in other words, obstetric practice is similar, the MMR is probably in reality similar, so Irish women are NOT at any disadvantage. i.e. catholic teaching is not putting Irish women at higher risk.

111

Katherine 11.19.12 at 4:20 pm

Well, you know, apart from the dead one, Savita Halappanavar.

112

Barbara 11.19.12 at 4:37 pm

sarah, the difficulty with your reasoning regarding “differences in practice” is that it dearly matters where the weight of the law rests — as it stands, it appears that physicians in Ireland are unaccountable when they impose their Catholic views on their patients, whether the law requires that or not — they are protected by its ambiguity. Although this case might also have happened in the U.S. (as I reported above, I have no doubt the RCC in the U.S. would have engineered the same outcome if it could have), it is also the case that even in many U.S. Catholic hospitals the weight of accountability prevents many of the worst outcomes — sometimes because the hospital blinks and sometimes because the physicia blinks. In the case of Catholic Healthcare West, the whole enterprise blinked. That makes the legal status of abortion rights a really important if not always a pivotal factor in determining the outcome for people like Savita. Her husband reports that they BEGGED the physicians to terminate the pregnancy. The issue of superbugs and antibiotics would be a lot easier to understand if the physicians had even tried to act earlier. They didn’t and so far as I can tell they are never going to be held responsible for that fact.

113

ptl 11.19.12 at 5:25 pm

Thank you, sarah, for taking the point about the data

“, in other words, obstetric practice is similar, the MMR is probably in reality similar, so Irish women are NOT at any disadvantage. i.e. catholic teaching is not putting Irish women at higher risk.”

That’s an assumption, of course. The true rate’s assumed.

Your original point — made three times — was that Ireland’s MMR was far lower than the UK’s, which, you said (twice) has “abortion on demand until 24 weeks”. You added,

“One of the major causes of MMR is infection”.

Actually, the UK’s MMR rate is falling despite a rise in infections, and the rate (narrowly defined) remains roughly the same as Ireland’s.

You said

“If a refusal to carry out terminations to save mothers lives was regular practice in Ireland our MMR should be higher than in the UK. “

(as it may be) not really; as commenters here have pointed out, the UK — and others — carry out abortions on your behalf.

Also, if you really do support a change in the law, support the enshrining of some kind of right to abortion in Irish law, why don’t you just support it? Surely the case for that stands independently of the precise circumstances and causes of Savita’s death.

114

Hector_St_Clare 11.19.12 at 5:43 pm

Re: the nutters on one side cannot conceal their satisfaction they’ve got a dead mother to prove their point, which is unseemly to say the least
– the nutters on the other side are in a panic because they’re convinced the government wants to introduce abortion on demand (which they couldn’t even if they wanted to and they don’t anyway).

Sarah,

Good points, I generally agree with you. I do strongly support allowing abortions in case of serious threats to the mother’s life or health, but one must be careful not to empower the yahoos who want to legalize abortion on demand, including for non-therapeutic reasons. I do think it’s unseemly to exploit this woman’s death in that way.

As you point out though, I’m not too worried about that. Ireland is a religious country, fortunately, and it’s not likely to go down the same path of the unborn that we did with Roe v. Wade. Neither are the Latin American countries, for the most part.

115

Lilypod 11.19.12 at 7:19 pm

sarah, who are you seeing who “cannot conceal their satisfaction” about Savita Halappanavar’s death? Seriously. Please name them. It’s an utterly offensive projection. (“Finally! We have the dead body we always wanted! Let us crow in unseemly fashion!”) The anti-abortion movement regularly accuses people of “exploiting” a case to bring about change. Then maybe they should direct those accusations to the Halappanavar family who when interviewed have said that they want to believe that their daughter’s death wasn’t in vain and that it will bring about change in Ireland. Just as the husband of Sheila Hodgers may have hoped when he spoke publicly almost thirty years ago.

You keep stating that Irish women are not at a disadvantage to their UK counterparts re maternal mortality rates when part of the reason is that Irish women are availing of medical treatment in the UK to terminate high risk pregnancies. The UK therefore contributes both to its own low mortality rates and ours. If the UK suddenly refused to carry out terminations on Irish citizens, do you think the woman presenting with cancer at six weeks would then be at a disadvantage to her UK counterpart? Do you think she’d be offered a clearcut choice to have a termination here at six weeks? And by termination, I mean abortion. Where you acknowledge fully that a healthy foetus is being removed to minimise the risk to the woman’s life. No fudging. No fuzziness. You keep stating that “terminations” are available here – that “therapeutic termination is standard practice” – when what you actually seem to be referring to are induced early deliveries in later pregnancy, D&Cs in cases where the foetus is already dead, or ectopic pregnancies (none of which the anti-abortion movement itself will actually categorise as abortion): so we have “terminations” but we don’t have “abortions”. Because if actual abortion – what most people understand as deliberately terminating a pregnancy – were standard therapeutic practice in Ireland, the doctors involved could expect to have Youth Defence decorating the footpaths outside their homes or SPUC in its newer incarnations running screaming to the High Court (irrespective of its current qualms about legislation).

116

sarah 11.19.12 at 7:37 pm

@barbara
An independent inquiry led by an international expert (non-Irish) has been ordered into the Galway case. The gardai are involved.

IF the enquiry shows they made a mistake, then doctors will be struck off and a massive law suit is guaranteed. Her death will have major consequences for everyone involved (as it should). Why do you think they won’t be held responsible?

117

Maria 11.19.12 at 7:40 pm

Sarah @92, of course I don’t present *evidence* that the Rotunda is more likely to act in the woman’s interest and not at on the personal beliefs of the consultant. The point I made – quite clearly – is that there is no such evidence to help women choose where to be treated, merely rumour and uncertainty about consultants’ personal beliefs and how they will manifest in clinical treatment, which has been brought about by the refusal of successive governments to legislate. Women should not have to rely on rumour and happenstance to find, in a crisis, hospital care that will choose their health and life over that of a slowly extinguishing foetal heartbeat.

You complain about a rush to judgement on the basis of the known facts, and then confidently claim that “catholic teaching is not putting Irish women at higher risk.” Let’s see about that, shall we?

You imply again that it’s as likely that Savita died of MRSA or similar, a fringe theory designed to distract and obfuscate. There are well understood protocols for identifying and responding to super-bugs, and none of them appear to have been enacted in this case.

You say you want legislation, and then implicitly dismiss the need for it by saying clinical practice on medically required termination is uniform in Ireland – and uniformly supportive of women’s health.

You say such terminations are a standard practice in Ireland, and then imply conversely that UCG is an outlier. And if it is an outlier, you skim right over the central point of everyone’s concern: that Galway hospital staff did not follow accepted medical practice because of religious beliefs or fear of prosecution in ‘a Catholic country’.

At the heart of your various arguments is the idea that it’s just about possible Savita suffered horribly and died because of unusually bad medical luck, and not because she was denied needed treatment owing to the beliefs of those who treated her. Given the facts that are available, this seems an extremely unlikely outcome. And yet you grab at it fiercely and claim that ‘nutters’ are exploiting this woman’s death for political ends. Why?

I find your attempt to portray yourself @104 as the good faith middle ground uncompelling, to say the least, and your characterisation of pro-choice ‘nutters’ as being satisifed by Savita’s death quite revolting.

I can’t decide whether you are just confused, are concern-trolling or think this blog is a place where strangers should line up to sort out your contradictory arguments for you.

Perhaps you are in good faith, but the claims you are making and your appeals to others to recognize or join you in the ‘middle ground’ are exactly the kind of de-railing and disinformation I’ve seen repeatedly over the past twenty years.

There is a middle ground here; one where people try as constructively and objectively as they can to fathom what happened in Galway and stop it from ever happening in Ireland again. But you’re not on it.

118

Mise 11.19.12 at 8:17 pm

Barbara @112
“as it stands, it appears that physicians in Ireland are unaccountable when they impose their Catholic views on their patients, whether the law requires that or not — they are protected by its ambiguity”

I think its important to remember that many doctors refuse to give abortions in Ireland not because they are ideologically opposed but because, despite medical guidelines, there is also a strong weight of law saying abortion is illegal in all circumstances. At the European Court of Human Rights, the government could not point to a single hospital with the required equipment for terminations, or a single recorded termination. Doctors are justificably scared of being brought to court if they carry out terminations because of the legal ambiguity.

That’s why the Masters of a number of major hospitals have been repeatedly calling for legislation: they want to be able to do their job, but their hands are currently tied by the law. I do not want to see a doctor scapegoated for not being able to muddle his way through the mess of abortion law in Ireland. It’s clear its the governments who are at fault.

The “this is a catholic country” comment is potentially a bit misleading – I would suspect it was intended as some sort of explanation for why the hospitals hands were tied – not as a moral judgement.

119

Barbara 11.19.12 at 10:38 pm

Mise, I defer to your greater understanding of what the doctor likely meant. The point, I guess, is that it doesn’t really much matter, does it, whether they refuse abortion out of fear of prosecution or using the fear of such prosecution as a pretext for not doing what they would strongly prefer not to? Who will ever know? Either way, this woman died needlessly.

120

Nathanael 11.20.12 at 5:50 am

“The Bishops’ Conference have launched a public campaign, asking Catholics to lobby their local politicians, to prevent legislation for abortion to save a mothers’ life.”

Surely adovcating medical malpractice and letting pregnant women die of neglect is illegal in Ireland? I know you don’t have such an extreme protection of freedom of speech as the US does.

A point made by someone earlier is that the hospital behavior was medical malpractice — the previous commenter thought this meant the law didn’t need changing. Well, maybe not, *provided* every doctor and nurse and hospital administrator involved with the case is convicted of criminal medical malpractice, jailed, fined, and stripped of licenses to practice medicine.

Is that happening? No? Well, then, the law does need to be changed. For a doctor, nurse, or someone in authority at a medical establishment to refuse to provide a medically necessary abortions needs to be a crime punishable by prison. This would chase the nasty women-killers out of the medical profession in Ireland pretty fast.

121

Stephen 11.20.12 at 8:49 pm

Dr Science, Ajay:

Thanks for the consoling news that US Hispanic Catholics take (what seems to me) a more intelligent and enlightened view of abortion than the remarkable system currently running in Ireland.

I have tried to work out why that might be so. I can imagine several reasons why intelligent Irish Catholics might support their current system:
1) they genuinely agree with the teachings of the Church
2) they have doubts about abortion, but believe the Church can commit them to salvation or damnation in the next life
3) they doubt (2) also but are painfully aware that their professional prospects in this life, if they are doctors, or their future votes if they are politicians, depend on not opposing the Church
4) orthogonally to the above: they realise that if Catholics avoid abortion (and as far as possible contraception) they may eventually outbreed Protestants and other enemies of the faith; after which, in lands lost to the so-called Reformation …

Now, applying these arguments to US Catholic Hispanics who (as you say) are not locked into an anti-abortion mindset, the only factor that seems to me to apply to Ireland but not to the US is (3): the secular power of the Church in the US is inadequate.

Corroborative evidence: look at the legality of abortion in Catholic Latin America (outside Mexico City). Limited to zero.

Awkward consequence: if factor (4) applies, not so much through breeding as through immigration, then the secular power of the Church in Hispanic-majority regions of the US, if not the whole US, might increase to the point where factor (3) also applies.

Of course, by then I (and much of CT) may be past caring.

122

Kevin Donoghue 11.21.12 at 9:58 am

Concerning abortion pills, The Irish Times reports:

The HSE has set up an investigation into allegations that pregnancy counselling agencies it funds provided women with inappropriate advice, the Oireachtas health committee has been told.

It seems there was a sting operation:

According to information gathered undercover by anti-abortion activists, some counsellors allegedly advised women how to smuggle the abortion pill into the Republic. It was also alleged women were told to hide their abortions from their doctors. Since the allegations were published last month, some backbench Fine Gael and Fianna Fáil TDs and Senators have been pressing for an investigation.

I don’t know the legal basis for this. Presumably it’s kosher to buy pills in Hollyhead? Must they be swallowed before the return journey?

123

ajay 11.21.12 at 12:38 pm

Dr Science, Ajay:

Thanks for the consoling news that US Hispanic Catholics take (what seems to me) a more intelligent and enlightened view of abortion than the remarkable system currently running in Ireland.

And here is some actual evidence to back it up, even. Gosh, I feel rigorous now.

http://latinainstitute.org/Latinopoll
http://www.reuters.com/article/2009/07/14/us-usa-hispanics-abortion-idUSTRE56D00Y20090714

Like other Catholics, they’re split on the issue.

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