woman dies for want of a abortion

[Eamonnca1]

My approach to a subject like this is usually that it's okay to discuss the underlying issues.  I don't accept the "let's keep quiet while people are grieving" argument.  The gun lobby has been using that old trope to squelch all discussion about gun control in the USA for decades, always arguing that it's always a bad time to discuss it.  No, it's always a good time to talk about these issues.  Maybe hold off on the specifics of one particular case before the facts are in, that's fair enough. But it's okay to talk about the rights and wrongs of hospitals feeling that they have to put a woman's life at risk because of an unclear law.

[cadence]

a little bit of censorship goes a long way eh? what a crock.

as far as i can make out, because the baby still had a heartbeat, they couldn't terminate, despite the fact that the mother had septicaemia. there is another suggestion that the hospital missed the septicaemia, and hence this was the reason there was no termination, not because of the law. doctors are hardly going to be experts on this type of situation in pregnancies when they don't get to actually practice on real live patients.

http://www.guardian.co.uk/world/the-womens-blog-with-jane-martinson/2012/nov/14/abortion-should-remain-legal?intcmp=239

to pitch pro-abortion in 'liberal' agendas terms is way off the mark. there are serious human rights and health equality issues here. even further than the echr ruling that article 8 of human rights were breached, this woman's right to life has been breached. despite being told by the echr that its law and procedures for terminations, when there is a risk to the mother's life, breached article 8 of human rights, ireland has persisted with the same law leading to this case. a woman has died because ireland has not changed its law.

[AQMP]

I've been doing a wee bit of research on this.  First of all while I have a great regard for The Manchester Guardian as a newspaper it is very much pro-choice and strongly anti-Catholic Church and most of its "debate" is founded on this.  Not that there's anything wrong with this but it's worth bearing in mind.  Going by its most famous editor C P Scott's adage "Comment is free but the facts are sacred" what I've been able to glean on the medical side (I'm no expert and this may not be 100% accurate...doctors have opinions too!)

Would earlier intervention have resulted in Ms Hallappnavar's death being avoided?  Impossible to say, though it could have increased her chances of survival.  As we know, no medical procedure, from an ingrown toenail up to brain surgery, is 100% risk free or 100% guaranteed to succeed.

Could Ms Hallappnavar have presented already infected with septicaemia and Ecoli?  Haven't been able to get a clear answer on this but it appears that leaving the cervix dilated for 2.5 - 3 days (as reported) certainly would have been detrimental to her health.

The reported comment about "Catholic country".  Was this not the opinion of an individual doctor/nurse rather than government policy or state law?

Moving on, again I'm certainly not an expert on The Constitution but is it the case that the Constitution supersedes legislation (or the lack of it) and offers citizens protection and rights in an area where law does not exist or is unclear?  In other words does the Constitution not provide for a termination in cases and therefore protect the doctor from any possible legal proceedings?

Reading through the Medical Council's guidelines and comparing those with what has been reported it would appear to me (a non-expert) that the issue here is not the lack of a legislative framework or any alleged backwardness of Ireland as a country (read some of the below the line comments in the Guardian pieces) or any pernicious influence the Catholic Church may have on society but human error.

So, what we actually need to hear in this case is what the doctors say happened.  Now if as reported this is going to take 3 months then that's unacceptable for all involved.

[cadence]

I've been doing a wee bit of research on this.  First of all while I have a great regard for The Manchester Guardian as a newspaper it is very much pro-choice and strongly anti-Catholic Church and most of its "debate" is founded on this.  Not that there's anything wrong with this but it's worth bearing in mind.  Going by its most famous editor C P Scott's adage "Comment is free but the facts are sacred" what I've been able to glean on the medical side (I'm no expert and this may not be 100% accurate...doctors have opinions too!)

Would earlier intervention have resulted in Ms Hallappnavar's death being avoided?  Impossible to say, though it could have increased her chances of survival.  As we know, no medical procedure, from an ingrown toenail up to brain surgery, is 100% risk free or 100% guaranteed to succeed.

Could Ms Hallappnavar have presented already infected with septicaemia and Ecoli?  Haven't been able to get a clear answer on this but it appears that leaving the cervix dilated for 2.5 - 3 days (as reported) certainly would have been detrimental to her health.

The reported comment about "Catholic country".  Was this not the opinion of an individual doctor/nurse rather than government policy or state law?

Moving on, again I'm certainly not an expert on The Constitution but is it the case that the Constitution supersedes legislation (or the lack of it) and offers citizens protection and rights in an area where law does not exist or is unclear?  In other words does the Constitution not provide for a termination in cases and therefore protect the doctor from any possible legal proceedings?

Reading through the Medical Council's guidelines and comparing those with what has been reported it would appear to me (a non-expert) that the issue here is not the lack of a legislative framework or any alleged backwardness of Ireland as a country (read some of the below the line comments in the Guardian pieces) or any pernicious influence the Catholic Church may have on society but human error.

So, what we actually need to hear in this case is what the doctors say happened.  Now if as reported this is going to take 3 months then that's unacceaptable for all involved.

i think the point the guardian are making is valid... ireland being a catholic country in which there is a large part of the population with strong anti-abortion beliefs, formulated to a large degree by said church's own beliefs. legislation around abortion is divisive and successive irish administrations have not dealt with it, either because they agree with the current situation or because they are unwilling to take on the fall out at the ballot box and within their own parties  for dealing with it.

sometimes it's hard to be objective on your own failings. the guardian's fairly clear on it i'd say.

[Main Street]

Also that there were underlying health problems was cast doubt on claims that "want of an abortion" was the cause of death.

Septicaemia was the cause of death,  after nearly waiting for 3 days in extreme pain. Maybe you should investigate a little into miscarriage and septicemia risks?
Can it be determined that her life would have been saved if the pregnancy had been aborted when it was medically obvious that the baby would not survive?  I don't know.
But to allow her to wait that long  when there was medically no chance for the baby to survive  just because there was a heartbeat, and just intervene when there was no longer a heartbeat, is a medical and moral absurdity.

And you are sure that's what happened? With no doubts at all?

I suppose you could go to a dentist with a horrible pain in one tooth, massive swelling and sepsis in the gum and the dentist could miss the connection.  If so that would be a total medical absurdity.
If the reason given for not intervening because the dentist bound by a legal code to wait until the tooth was verified died, then that would be a moral and medical absurdity.
The hospital medics did not offer a diagnosis that they would not intervene because the symptoms did not call for it, it is claimed they quoted the legality of non intervention

Here are the facts
She had a medical diagnosis that her baby would not survive.
She had all the symptoms of septicemia.
Her condition deteriorated by the hour.
The medics waited until the foetal heartbeat stopped, before intervening.
Her death was caused by septicemia.

[deiseach]

Reading through the Medical Council's guidelines and comparing those with what has been reported it would appear to me (a non-expert) that the issue here is not the lack of a legislative framework or any alleged backwardness of Ireland as a country (read some of the below the line comments in the Guardian pieces) or any pernicious influence the Catholic Church may have on society but human error.

I'm pro-choice, but I think using this case as a wedge with which to ram home legislation for abortion is a risky business. What if it transpires that this was something that could not have been foreseen or was the consequence of medical incompetence, things that no amount of legislation could deal with? The pro-lifers will then be crowing that everything is fine and the chances of legalised abortion in this country will be even further away.

[seafoid]

Reading through the Medical Council's guidelines and comparing those with what has been reported it would appear to me (a non-expert) that the issue here is not the lack of a legislative framework or any alleged backwardness of Ireland as a country (read some of the below the line comments in the Guardian pieces) or any pernicious influence the Catholic Church may have on society but human error.

I'm pro-choice, but I think using this case as a wedge with which to ram home legislation for abortion is a risky business. What if it transpires that this was something that could not have been foreseen or was the consequence of medical incompetence, things that no amount of legislation could deal with? The pro-lifers will then be crowing that everything is fine and the chances of legalised abortion in this country will be even further away.

I dunno Deiseach. They were able to get the bank guarantee sorted out overnight.
It's just cowardice in the case of legislating for the X case.

[deiseach]

I dunno Deiseach. They were able to get the bank guarantee sorted out overnight.
It's just cowardice in the case of legislating for the X case.

Of course it is. But if this case turns out as I suggested, they'll be able to take the cowardly way out.

[Hardy]

Guy Crouchback has already decided that it was the lack of an abortion that caused this poor woman's death according to the title of the thread.
Is he/she suitably medically qualified to make such a judgement from one newspaper report?

I'm not medically qualified to make any decision, and I'm only going on what has been reported throughout the day and on the interviews with the woman's husband. i have started this thread  because this is turning into a massive story that at present is being reported all over Europe and by tomorrow will be world wide.

this story is different because the reason it is a story at all comes back to the failure of politicians to implement  necessary legislation for over twenty years.

according to the woman's husband they were told by a member of the medical staff that a termination was not possible as ireland was a ''catholic contry''. now this may have been said as an expression of exasperation with the status quo or as an explanation of why  the status quo was the way it was.

either way it seems to point at the fact that the reason for not preforming the procedure earlier was not based solely on medical considerations.

The "Catholic country" quote is what makes this story. It contextualises what happened, places it at the centre of the culture war and has extra resonance because this poor woman was Indian.

But it's an unattributed quote. We don't know who said it, when it was said, in what context it was said, nothing. The media have created a storm that will sell many papers but right now we know nothing about what happened other than the fact that a woman has died who need not have died.

Would a termination have saved her? What were the steps that were taken to save her? What steps weren't taken? I am fairly sure that these decisions between the life the fetus and the life of the mother are made all the time in difficult pregnancies. Naive to think they're not. This was one that went wrong and we don't yet know why it went wrong. But not everyone wants to know why it went wrong, because could waste a potentially excellent weapon in the culture war.

Once this snowball gets rolling it could bring the government down, with fissure developing in both parties. Amazing to think it, but very far from impossible.

I'd say "this is a catholic country" was said sarcastically by whoever.

Irish abortion policy is a joke. It takes a tragedy like this to show it up for what it is.

Thought it's not clear that the original allegation that Praveen Halappanavar was told this is a Catholic country comes directly from himself, I heard him assert the allegation last night in an interview on one of the UK TV news programmes (I can't remember which, as I watched a lot of different news channels last night, but I think it was Channel 4). The relevant part of the conversation was as follows (in paraphrase):

Reporter - And can you confirm that the medical staff <not sure if that was the exact phrase> told you "this is a catholic country"?
PH - Yes.

[AQMP]

I've been doing a wee bit of research on this.  First of all while I have a great regard for The Manchester Guardian as a newspaper it is very much pro-choice and strongly anti-Catholic Church and most of its "debate" is founded on this.  Not that there's anything wrong with this but it's worth bearing in mind.  Going by its most famous editor C P Scott's adage "Comment is free but the facts are sacred" what I've been able to glean on the medical side (I'm no expert and this may not be 100% accurate...doctors have opinions too!)

Would earlier intervention have resulted in Ms Hallappnavar's death being avoided?  Impossible to say, though it could have increased her chances of survival.  As we know, no medical procedure, from an ingrown toenail up to brain surgery, is 100% risk free or 100% guaranteed to succeed.

Could Ms Hallappnavar have presented already infected with septicaemia and Ecoli?  Haven't been able to get a clear answer on this but it appears that leaving the cervix dilated for 2.5 - 3 days (as reported) certainly would have been detrimental to her health.

The reported comment about "Catholic country".  Was this not the opinion of an individual doctor/nurse rather than government policy or state law?

Moving on, again I'm certainly not an expert on The Constitution but is it the case that the Constitution supersedes legislation (or the lack of it) and offers citizens protection and rights in an area where law does not exist or is unclear?  In other words does the Constitution not provide for a termination in cases and therefore protect the doctor from any possible legal proceedings?

Reading through the Medical Council's guidelines and comparing those with what has been reported it would appear to me (a non-expert) that the issue here is not the lack of a legislative framework or any alleged backwardness of Ireland as a country (read some of the below the line comments in the Guardian pieces) or any pernicious influence the Catholic Church may have on society but human error.

So, what we actually need to hear in this case is what the doctors say happened.  Now if as reported this is going to take 3 months then that's unacceaptable for all involved.

i think the point the guardian are making is valid... ireland being a catholic country in which there is a large part of the population with strong anti-abortion beliefs, formulated to a large degree by said church's own beliefs. legislation around abortion is divisive and successive irish administrations have not dealt with it, either because they agree with the current situation or because they are unwilling to take on the fall out at the ballot box and within their own parties  for dealing with it.

sometimes it's hard to be objective on your own failings. the guardian's fairly clear on it i'd say.

As I say I'm a big fan of the Guardian but in this case some of its reporting of the facts has been selective and in some cases inaccurate.  What we need is the hospital's version of events before we can judge who was responsible?

[AQMP]

Reading through the Medical Council's guidelines and comparing those with what has been reported it would appear to me (a non-expert) that the issue here is not the lack of a legislative framework or any alleged backwardness of Ireland as a country (read some of the below the line comments in the Guardian pieces) or any pernicious influence the Catholic Church may have on society but human error.

I'm pro-choice, but I think using this case as a wedge with which to ram home legislation for abortion is a risky business. What if it transpires that this was something that could not have been foreseen or was the consequence of medical incompetence, things that no amount of legislation could deal with? The pro-lifers will then be crowing that everything is fine and the chances of legalised abortion in this country will be even further away.

I agree with you here deiseach, there's an old saying in legal circles "law made on the hoof is generally bad law"

[seafoid]

Guy Crouchback has already decided that it was the lack of an abortion that caused this poor woman's death according to the title of the thread.
Is he/she suitably medically qualified to make such a judgement from one newspaper report?

I'm not medically qualified to make any decision, and I'm only going on what has been reported throughout the day and on the interviews with the woman's husband. i have started this thread  because this is turning into a massive story that at present is being reported all over Europe and by tomorrow will be world wide.

this story is different because the reason it is a story at all comes back to the failure of politicians to implement  necessary legislation for over twenty years.

according to the woman's husband they were told by a member of the medical staff that a termination was not possible as ireland was a ''catholic contry''. now this may have been said as an expression of exasperation with the status quo or as an explanation of why  the status quo was the way it was.

either way it seems to point at the fact that the reason for not preforming the procedure earlier was not based solely on medical considerations.

The "Catholic country" quote is what makes this story. It contextualises what happened, places it at the centre of the culture war and has extra resonance because this poor woman was Indian.

But it's an unattributed quote. We don't know who said it, when it was said, in what context it was said, nothing. The media have created a storm that will sell many papers but right now we know nothing about what happened other than the fact that a woman has died who need not have died.

Would a termination have saved her? What were the steps that were taken to save her? What steps weren't taken? I am fairly sure that these decisions between the life the fetus and the life of the mother are made all the time in difficult pregnancies. Naive to think they're not. This was one that went wrong and we don't yet know why it went wrong. But not everyone wants to know why it went wrong, because could waste a potentially excellent weapon in the culture war.

Once this snowball gets rolling it could bring the government down, with fissure developing in both parties. Amazing to think it, but very far from impossible.

I'd say "this is a catholic country" was said sarcastically by whoever.

Irish abortion policy is a joke. It takes a tragedy like this to show it up for what it is.

Thought it's not clear that the original allegation that Praveen Halappanavar was told this is a Catholic country comes directly from himself, I heard him assert the allegation last night in an interview on one of the UK TV news programmes (I can't remember which, as I watched a lot of different news channels last night, but I think it was Channel 4). The relevant part of the conversation was as follows (in paraphrase):

Reporter - And can you confirm that the medical staff <not sure if that was the exact phrase> told you "this is a catholic country"?
PH - Yes.

Based on mass attendance I'd say Ireland is more of a post catholic country .How many couples follow church teaching on contraception, for example? Abortion is like the last stand of a culture that once ran the country. 
Accusing the Guardian of anti catholicism is very poor form as well.

[Hardy]

It's not a Catholic (or indeeed catholic) country. Nevertheless, this is the major point of the story that's going out worldwide.

[seafoid]

It's not a Catholic (or indeeed catholic) country. Nevertheless, this is the major point of the story that's going out worldwide.

Not for the first time the legal system is way behind the times. Does Ireland have a bank resolution law yet ?

[hmmm]

Good article here from a leading OB/GYN:
http://drjengunter.wordpress.com/2012/11/14/did-irish-catholic-law-or-malpractice-kill-savita-halappanavar/

This is what is known. Savita Halappanavar was 31 years old and happy to be pregnant with her first child. Then, at 17 weeks, tragedy struck and she was "found to be miscarrying." Her husband reports that she was in "severe pain" for three days at the hospital and a termination was requested. He says this request was denied because Ireland is "a Catholic country." He and his late wife were led to believe that the law would only allow her to be delivered when there was no fetal heartbeat.

What does the standard of medical care say about this treatment? Without access to the chart, "miscarrying" at 17 weeks can only mean one of three things"

A) Ruptured membranes

B) Advanced cervical dilation

C) Labor (this is unlikely, although it is possible that she had preterm labor that arrested and left her with scenario B, advanced cervical dilation).

All three of these scenarios have a dismal prognosis, none of which should involve the death of the mother.

The standard of care with ruptured membranes (scenario A) is to offer termination or, if there is no evidence of infection and the pregnancy is desired, the option of observing for a few days to see if the leak seals over and more fluid accumulates. If no fluid accumulates and by some chance the pregnancy manages to go beyond 24 weeks (the vast majority of pregnancies with ruptured membranes delivery within a week), survival is unlikely given the lungs require amniotic fluid to develop. I have seen the rare case where a woman with no infection (and no fluid) elects conservative management in the hopes that might make it to at least 24 weeks in the pregnancy, however, I have never heard of a baby surviving in this scenario. Regardless, if at any point infection is suspected the treatment is antibiotics and delivery not antibiotics alone.

The standard of care with scenario B involves offering delivery or possibly a rescue cerclage (a stitch around the cervix to try to prevent further dilation and thus delivery) depending on the situation. Inducing delivery (or a D and E) is offered because a cervix that has dilated significantly often leads to labor or an infection as the membranes are now exposed to the vaginal flora. Many women do not want wait for infection. A rescue cerclage is not without risks and is contraindicated with ruptured membranes or any sign of infection. Rescue cerclage is a very case by case intervention and well beyond the scope of this post. These decisions are difficult and the mark of good medical care is that all scenarios are discussed, all interventions that are technically possible offered, and then the patient makes an informed decision. All with the understanding that if infection develops, delivery is indicated.

Not only do I know these scenarios backwards and forwards as an OB/GYN, I had ruptured membranes in my own pregnancy at 22 weeks, a rescue cerclage, and then sepsis. I know how bad it can be.

As Ms. Halappanavar died of an infection, one that would have been brewing for several days if not longer, the fact that a termination was delayed for any reason is malpractice. Infection must always be suspected whenever, preterm labor, premature rupture of the membranes, or advanced premature cervical dilation occurs (one of the scenarios that would have brought Ms. Halappanavar to the hospital).

As there is no medically acceptable scenario at 17 weeks where a woman is miscarrying AND is denied a termination, there can only be three plausible explanations for Ms. Hapappanavar's "medical care" :

1) Irish law does indeed treat pregnant women as second class citizens and denies them appropriate medical care. The medical team was following the law to avoid criminal prosecution.

2) Irish law does not deny women the care they need; however, a zealous individual doctor or hospital administrator interpreted Catholic doctrine in such a way that a pregnant woman's medical care was somehow irrelevant and superceded by heart tones of a 17 weeks fetus that could never be viable.

3) Irish law allows abortions for women when medically necessary, but the doctors involved were negligent in that they could not diagnose infection when it was so obviously present, did not know the treatment, or were not competent enough to carry out the treatment.

What we do know is that a young, pregnant, woman who presented to the hospital in a first world country died for want of appropriate medical care. Whether it's Irish Catholic law or malpractice, only time will tell; however, no answer could possibly ease the pain and suffering of Ms. Halappanavar's loved ones.

****

Since posting this piece I learned that Ms. Halappanavar's widower reported that she was leaking amniotic fluid and was fully dilated when first evaluated. There is no medically defensible position for doing anything other than optimal pain control and hastening delivery by the safest means possible.