woman dies for want of a abortion

[Hardy]

By the way, on reading her post, that Ob/Gyn's offering can be dismissed, as she ignores the most likely explanation in offering her "only three plausible explanations" for the outcome.

Which is?

It's close to her first explanation, but without the propagandist rhetoric.

The medical team had no law to follow, as the X case judgement modifies interpretation of the 19th century law, but this modified interpretation has not been defined in legislation and therefore the medical team considered themselves having to act as lawyers and interpret a supreme court judgement in making a medical decision.

can you post up the judgement of the x case that modifies interpretation of the offences against the person act 1861 please? the only modifications i can find are the uk ones to S58...

http://www.supremecourt.ie/supremecourt/sclibrary3.nsf/(WebFiles)/5D058A7C2C1824738025765E003C5631/$FILE/McKinley%20v%20Min%20Defence_1992.rtf

I was basing my opinion on media reports and articles that state that this ruling effectively modifies the 1861 legislation, which apparently simply banned abortion without qualification, to state that "termination of pregnancy was permissible only when it was established as a matter of probability that there was a real and substantial risk to the life of the mother if such termination were not effected". Not that it matters in anything other than legal niceties, but this judgement was, it seems, not directly a re-interpretation of the 1861 act, as I stated, but an interpretation of the eighth amendment to the constitution which wrote the ban on abortion into the constitution.

By the way, I now understand there are Medical Council guidelines in this area and it appears there are fault lines within the medical profession based on whether you consider these guidelines adequate or you believe legislation is needed to provide protection for medical practitioners and mothers alike.

The following is anecdotal, but one gynaecologist I know of thinks (1) that there is no problem with the current guidelines (2) that he is in a large majority within the profession in this belief but (3) that there is a minority of medical people (some or all of whom are not necessarily gynaecologists, but more junior in the ob/gyn hierarchy) who disagree and some who take it upon themselves to police the situation on the basis of their own moral viewpoint, to the extent of warning others that they believe procedures about to be undertaken are in breach of the constitutional ban (as interpreted by the X judgement) and threatening to report such procedures to the authorities.

I have a difficulty in reconciling the two positions that (1) the adequacy of guidelines makes legislation unnecessary (2) the absence of legislation seems to create grey areas that allow some to dispute the decisions of the practitioners.

On the other hand, it may be that the introduction of legislation will not eliminate all grey areas and that there is more to the calls for legislation than a desire for legal clarity. A medic, introduced as "medical advisor to the Pro Life movement" was on Morning Ireland today and stated that doctors interpret the law daily in their medical decisions in all areas of medicine and ob/gyn is no different. While I would be wary of the views of a protagonist on any side of the political debate, that may make sense.

I don't know if this sheds light on the debate. I just offer it as a (second-hand) story from the wards, as it were. 

[AQMP]

A piece on the "legal" situation in the North (which appears to be broadly similar to the South).  My emphasis in italics.

http://www.bbc.co.uk/news/uk-northern-ireland-20353104

Savita death leads to call for clearer NI abortion law.

One of Northern Ireland's leading obstetricians has said the law on abortion could be given greater clarity if politicians were willing to act. Professor Jim Dornan was speaking after the death of Savita Halappanavar at University Hospital Galway.  Her family said she asked several times for her pregnancy to be terminated because she had severe back pain and was miscarrying.  Her husband said this was refused because there was a foetal heartbeat.  She died on 28 October.

News of her death led to a series of protests against Ireland's abortion laws. The Republic of Ireland has had strict laws on abortion for more than 100 years. The country's constitution has been amended to allow for an abortion when a woman's life is at risk - but the issue is very complex.

In Northern Ireland, medical staff operate in uncertain circumstances. There is no legislative law regarding abortion, only case law.

Despite the fact that between 30 and 40 medical terminations are carried out by the NHS in Northern Ireland every year, the exact circumstances in which is it is allowed remain vague. Doctors, nurses and midwives can opt out on the grounds of conscience. But medical staff who are willing to carry out abortions are often fearful of legal action. Revised official guidelines initially drafted in in 2010 have still not been completed and published. Prof Dornan, who sits on the Global Health Board of the Royal College of Obstetricians and Gynaecologists, said the current legislation on when a termination could be carried out in Northern Ireland was confusing.

"We would like to feel that our Department of Health and our paymasters - our political masters -and our legal masters are supportive of us," he told the BBC.  We need to have that guidance because we have been working on a guidance document that is sitting in an in-tray somewhere and we would love to see it coming out. I appreciate there are problems, but let's address those problems and get it sorted out."

Meanwhile, the Health Service Executive (HSE) in the Republic is expected to announce details later of its planned inquiry into Mrs Halapanavar's death.  Mrs Halappanavar, 31, was a dentist and was originally from India.  The terms of reference and the membership of the inquiry team are due to be finalised later. The team will include an independent expert in obstetrics and gynaecology.  The Irish minister for health James Reilly said the inquiry would be thorough but he also wanted it to take place quickly.  About 2,000 people gathered outside the Dáil, the lower chamber of the parliament, in Dublin on Wednesday evening calling for the reform of the Republic's abortion laws.  Speaking in the Dail on Thursday, Tanaiste (Deputy Prime Minister) Eamon Gilmore said it was time to bring "legal clarity" to the issue of abortion.   Mr Gilmore said the Irish government "is going to deal with this issue".

[magpie seanie]

I am dreading what is coming on this. There are so many crazies out there talking complete rubbish on this issue.

My standpoint and I think that of the vast majority is the terminations should be allowed when the life of the mother is at risk.

It's a tough issue and I wonder if a "one size fits all" legal solution is available. The best we can hope for is to get to a legal situation where we the medical profession make the calls and do their job ethically and professionally. If they are found to provide a termination in circumstances where the threat to the life of the mother is found to be minimal or non-existant then they face the rigours of the law. Let some of the anti-abortion groups have representation on a statutory body that investigates cases to keep them happy that there's no cover ups.

What happened with that Indian lady is a scandal and reflects terribly on our country. God help her and her husband and family. We are a disgrace but with the so-called leadership we've had to endure in this country for decades it's no surprise unfortunately.

[screenexile]

I know a few doctors and have asked them about the situation. Basically they have said that the Media Circus around this hasn't helped and people are just jumping on the issue to serve their own agenda's.

1. Full details of the exact situation have not been released as you can't release any medical information about the patient until the inquiry has been completed.

2. While there is a foetal heartbeat all is not lost and there can be no degree of certainty that the patient would have miscarried.

3. There has been no clarification on when the patient started showing signs of septicemia and when treatment was administered.

Basically what I'm saying is we need the facts of the case before jumping to conclusions. Aside from that there is no doubt that the need for legal clarification around medical abortion should be sorted sooner rather than later!!!

[cadence]

By the way, on reading her post, that Ob/Gyn's offering can be dismissed, as she ignores the most likely explanation in offering her "only three plausible explanations" for the outcome.

Which is?

It's close to her first explanation, but without the propagandist rhetoric.

The medical team had no law to follow, as the X case judgement modifies interpretation of the 19th century law, but this modified interpretation has not been defined in legislation and therefore the medical team considered themselves having to act as lawyers and interpret a supreme court judgement in making a medical decision.

can you post up the judgement of the x case that modifies interpretation of the offences against the person act 1861 please? the only modifications i can find are the uk ones to S58...

http://www.supremecourt.ie/supremecourt/sclibrary3.nsf/(WebFiles)/5D058A7C2C1824738025765E003C5631/$FILE/McKinley%20v%20Min%20Defence_1992.rtf

I was basing my opinion on media reports and articles that state that this ruling effectively modifies the 1861 legislation, which apparently simply banned abortion without qualification, to state that "termination of pregnancy was permissible only when it was established as a matter of probability that there was a real and substantial risk to the life of the mother if such termination were not effected". Not that it matters in anything other than legal niceties, but this judgement was, it seems, not directly a re-interpretation of the 1861 act, as I stated, but an interpretation of the eighth amendment to the constitution which wrote the ban on abortion into the constitution.

By the way, I now understand there are Medical Council guidelines in this area and it appears there are fault lines within the medical profession based on whether you consider these guidelines adequate or you believe legislation is needed to provide protection for medical practitioners and mothers alike.

The following is anecdotal, but one gynaecologist I know of thinks (1) that there is no problem with the current guidelines (2) that he is in a large majority within the profession in this belief but (3) that there is a minority of medical people (some or all of whom are not necessarily gynaecologists, but more junior in the ob/gyn hierarchy) who disagree and some who take it upon themselves to police the situation on the basis of their own moral viewpoint, to the extent of warning others that they believe procedures about to be undertaken are in breach of the constitutional ban (as interpreted by the X judgement) and threatening to report such procedures to the authorities.

I have a difficulty in reconciling the two positions that (1) the adequacy of guidelines makes legislation unnecessary (2) the absence of legislation seems to create grey areas that allow some to dispute the decisions of the practitioners.

On the other hand, it may be that the introduction of legislation will not eliminate all grey areas and that there is more to the calls for legislation than a desire for legal clarity. A medic, introduced as "medical advisor to the Pro Life movement" was on Morning Ireland today and stated that doctors interpret the law daily in their medical decisions in all areas of medicine and ob/gyn is no different. While I would be wary of the views of a protagonist on any side of the political debate, that may make sense.

I don't know if this sheds light on the debate. I just offer it as a (second-hand) story from the wards, as it were.

cheers, i didn't know that it was written into the constitution and those andecdotal discussions do shed some light onto the grey areas of statute... health and social care professionals interpret and apply the law within those grey areas. they also just as importantly apply the ethics of the professions they've signed up to daily. but if the law is silent on a particualr area, those professionals have to reach an interpretation within the spirit of that legislation. and since i've mentioned them, i'm not so sure that those concerned followed the ethics/codes of practice of the profession that they've signed up to either. their first consideration seems to have been protecting themselves from prosecution, not the life of their patient.

i have sympathy for the medical staff, terrible situation to be in. can't see new legislation making it any clearer myself whilst terminations are allowed only in very exceptional circumstances. those exceptional circumstances will always be a battleground fought on by anti and pro camps. + some medics will do the right thing as they see it and others will make a political decision and back off to live to fight another day as they say.





   

[Maguire01]

Regardless of the facts of this particular case, the status quo can't remain. There has to some progress - politicians can't keep kicking this one down the road. There is an agenda here that has to be pushed.

[Denn Forever]

If a new referendum which clearly outlined what was and was was not permissable was proposed, I think it would pass.  Would these changes then be written into Law?

Something the ULA (political suicide for the main parties) should be pushing.

[Main Street]

What most of you are missing is that the Supreme Court has already given a definitive ruling, not a complete ruling, but more than enough to allow the doctors to do their job in this case.
From Justice Finlay @ Supreme Court
"if it is established as a matter of probability that there is a real and substantial risk to the life, as distinct from the health of the mother, which can only be avoided by the termination of her pregnancy, such termination is permissible"

The doctors only need to establish a 'probability' of a real and substantial risk to the life before abortion is permissable.
The doctors do not need to have 100% certainty, a diagnosis of a 'probability' is enough.

In this case, they could have ignored evaluating the level of risk because of the (99.9%) probability of the unborn child not surviving.
A diagnosis of a 'probability' is enough for the Supreme Court.

[Hardy]

Probability, though, is a mathematical concept. The range of probability extends from zero (impossible) to 1 (inevitable). So the phrase "established as a matter of probability" has no logical meaning of itself without a definition of the level of probability meant. Likewise, with the definition of "substantial". The definitions in law of terms like these are usually established by case law. But, in this instance, case law will only arise as a result of at least one, if not a series of trials where the action of a doctor in performing an abortion is disputed and I don't think anyone wants that.

On the one hand, I take the point that the majority of practitioners seem comfortable with the situation as it stands, with what they consider to be adequate guidelines. On the other hand, the Halappanavar case shows that these guidelines don't work in all cases (whether that's because of genuine difficulty of interpretation or bloody-minded ideologically-inspired mischief-making). Then again, I can't think of any law or set of guidelines that covers 100% of potential eventualities - otherwise there'd be no need for lawyers and courts. So any interpretation provided by legislation is unlikely to be case-proof anyway.

Nobody, other than the extreme loopers on either side has any difficulty with the moral choices when they are clear cut. But, like most reasonable people, I struggle with the choices at the boundaries, where matters do not so easily fall into well-defined categories. I do envy the certainty of those who can pronounce with assurance on the moral issues in these grey areas.

[Main Street]

Probability, though, is a mathematical concept. The range of probability extends from zero (impossible) to 1 (inevitable). So the phrase "established as a matter of probability" has no logical meaning of itself without a definition of the level of probability meant. Likewise, with the definition of "substantial". The definitions in law of terms like these are usually established by case law. But, in this instance, case law will only arise as a result of at least one, if not a series of trials where the action of a doctor in performing an abortion is disputed and I don't think anyone wants that.

The Supreme Court has already accepted that probability in this sensitive sphere, is  proven/defined by medical diagnosis of probability.

[Declan]

Nobody, other than the extreme loopers on either side has any difficulty with the moral choices when they are clear cut. But, like most reasonable people, I struggle with the choices at the boundaries, where matters do not so easily fall into well-defined categories. I do envy the certainty of those who can pronounce with assurance on the moral issues in these grey areas.

+1

[Puckoon]

http://www.bbc.co.uk/news/world-europe-20768743

The Irish government has announced it will legislate for abortion in circumstances where the mother's life is at risk.

[seafoid]

another  abortion dilemma . Pro life vs the real world. 

http://www.theguardian.com/world/2014/dec/18/irish-doctors-legal-advice-brain-dead-pregnant-woman

Ireland's highly restrictive abortion laws have come under renewed focus after it emerged that doctors in an Irish hospital are seeking legal advice over whether they can switch off the life support machine of a brain-dead woman who is 16 weeks pregnant.
The family of the woman want the medical team there to allow her to die. The woman, who is understood to be in her mid to late twenties, suffered head trauma and a clot to the brain.
But even though there is no chance of revival, doctors at the hospital are reluctant to carry out her family's wishes because she is 16 weeks pregnant. Under the 8th amendment to the Irish Republic's constitution the foetus inside her is as much an Irish citizen as the clinically dead mother.

What a mess.
Bringing abortion into the constitution was ridiculous.

[muppet]

This case appears to be more straightforward legally.

If the above is correct, then the mother's life isn't at risk, sadly.

This is really tough for the family, and the inevitable media attention (along with the horrible prospect of the two extreme groups getting involved) will make it horrible for them. But with the mother gone, surely the medics have to fight for the infant?

[Ulick]

You'd like to believe if the mother was still alive she'd be fighting tooth and nail for the child. You wouldn't think it from the press coverage so far.