The Irish Catholic Bishops have seen fit to clarify the church’s view on gynecology given Savita Halappanavar’s death from sepsis at 17 weeks in her pregnancy and the concern that evacuating her uterus was delayed because the fetus still had a heart beat. The full statement is here, but this is the excerpt I find most troubling:
– Whereas abortion is the direct and intentional destruction of an unborn baby and is gravely immoral in all circumstances, this is different from medical treatments which do not directly and intentionally seek to end the life of the unborn baby. Current law and medical guidelines in Ireland allow nurses and doctors in Irish hospitals to apply this vital distinction in practice while upholding the equal right to life of both a mother and her unborn baby.
I spent quite sometime trying to understand how one could possibly translate this statement into medical care. I’ve been a doctor for 22 years and an OB/GYN for 17 years and I admit that I am at a bit of a loss. My three interpretations are as follows.
- Terminating a pregnancy is “gravely immoral in all circumstances.” All circumstances includes 17 weeks and ruptured membranes. Unless I misunderstand the meaning of “all,” then Irish Catholic Bishops also view ending a pregnancy at 17 weeks with ruptured membranes and sepsis, either by induction of labor or the surgical dilation and evaluation (D & E), to be “gravely immoral.” They must also view ending a pregnancy for a woman who previously had postpartum cardiomyopathy and a 50% risk of death in her pregnancy as “gravely immoral.” So if you have a medical condition that is rapidly deteriorating because of your pregnancy, too bad for you if you live in Ireland. Because the mother and unborn baby have equal rights to life, Irish law spares women the anguish of choosing their own life. Neither can be first, so both must die.
- The latest edition of the medical textbook of Irish Catholic gynecology defines “abortion” as elective abortion and “medical treatments that do not directly and intentionally seek to end the life of the unborn baby” as medically indicated abortion. I admit this interpretation is a bit of a stretch. Whether it’s an induction or a D & E at 17 weeks for a woman with ruptured membranes and a runaway infection the intention is to end the life of the “unborn baby” because the infected uterine contents are what is killing the mother. And who defines medically indicated? A physician? A committee of physicians? A bishop? Does Cardinal Grady have a hotline for doctors? And what criteria is used? Risk of death 100%? 50%? 25%? 1%? It’s not always possible to say specifically and the Irish Catholic Bishops do not offer further clarification. The risk of sepsis, a life threatening infection, when a woman presents with ruptured membranes before 24 weeks is 1%. Not everyone with sepsis dies, but many do. I wonder how many Irish Catholic Bishops would get on an airplane if they knew that there was a minimum of a 1% risk the plane would crash? What if the risks were 10%? Or 25%? Hey, not all airplane crashes are fatal.
- The statement is an attempt to distinguish induction of labour from a D & E (you’ll have to bear with me on this one as neither “induction of labor” nor “D &E” are specifically mentioned). “Abortion” could be Irish Catholic Bishop code for D & E (a surgical procedure) and “medical treatments” code for induction of labor. After all, with an induction of labor (medication placed in the vagina or given intravenously to bring on contractions and empty the uterus) the fetus technically dies as a result of the mother getting medication and not by something that “directly” touches the fetus. Sort of in the way that if you tell a lie and your fingers are crossed you’re not really lying. Under this if-you-just-knew-the-secret-code-because-we-don’t-know-or understand-appropriate-medical-terminology interpretation, Dr. Halappanavar could clearly have had an induction of labor at 17 weeks and thus the blame for her death sits squarely on the shoulders of her medical team. However, under this interpretation should a uterus fail to contact with medication (as infected uteri are wont to do) a woman with previable ruptured membranes couldn’t have a D & E on an alive infected fetus with 0% chance of survival, but she could have a far more invasive hysterectomy, because that is “intentionally” destroying the uterus not the fetus.
The statement from the Irish Catholic Bishops is medically nonsensical, contradictory, and immoral and as
it represents a group of men who have never practiced medicine opining on an aspect of medical care that they clearly can’t understand.
The only thing this statement clarifies is how Irish physicians could easily be confused by an Irish abortion law steeped in religion, and thus reinforces the claim that Catholicism contributed to Dr. Halappanavar’s death.
Dr. Jen Gunter 
You will be pleased to read this article: http://www.guardian.co.uk/world/2012/dec/18/ireland-legalise-abortion-life-risk
Considering the catholic church’s stance to-date on the value of children, post natal or otherwise; a statement such as “gravely immoral in all circumstances”, can only be taken with a pinch of salt.
In fact, I am totally unable to understand why anyone would even consider the ethical values of institutionalized child rapists as worthy of consideration.
The church’s stance on this is neither here nor there, they are merely stating what there standpoint is which they are entitled to do and they also back it up with a little explanation, just like everyone else seems to be doing in leaving their comments here and elsewhere. It doesn’t really matter if you don’t agree with their view, i mean it doesnt make them wrong it just makes their opinion different to yours.
Clearly by extension, your beliefs (if they are contrary to the church) are eaually abhorrent to them as theirs are to you.
The problem is more the fact that the church’s opinion may have an effect on the states decision to change the constitution. The church and state need to be completely isolated from each other. These days there is no place for the church in law making, the civilised and free world have moved past that. And where religion remains tied to power we can see why the separation is needed.
It is easy to attack the issue when the misunderstanding is on your part. The bishop’s statement is not a medical one. His point is that the woman’s life should not have been endangered and the operation should have been performed to remove the uterus. Furthermore, in the event that it were removed it would not have been an abortion, which in this case is understood to be the direct termination of a pregnancy for the sake of doing just that, i.e., ending a pregnancy. The operation to remove a uterus from a woman who would die if that uterus were not removed — whether or not she is pregnant — is not an abortion. So to blame the Church in this case is in fact a straw man argument, because the Church is not opposed to this type of operation, even if it does result in the termination of a pregnancy. But hey… anything that serves to make the Church look worse is always welcome by some people (typically people who blame others for not using logic) I await your comeback, but wouldn’t it be nice if you could just recognize the point in this case — but you won’t.
At what point did we start considering the removal of the uterus? I’m not sure where you get that from, Biltrix. As far as I can see we have been talking about removing the products of conception FROM THE UTERUS – in order that both the infection and the pain could be treated with the very best of modern medicine.
Why do you want to leave the poor woman infertile just because she’s had a miscarriage? After all, most of us of the female persuasion have had one at some stage.
Remove the uterus? Have you any conception of how major and devastating a piece of surgery that is? Or do you suppose women just can grow another one?
You appear to believe that rather than give the standard treatment to a woman who wants children, desperately wants children but in fact very tragically is about to miscarry this particular pregnancy, which would preserve her own life and the chance of future offspring is in fact to remove her womb for no medical reason whatsoever except that it allows for minor theological hairsplitting about direct or indirect..
If they have nothing medical to say then they should simply shut their pie holes. Theological considerations have absolutely no place in health care.
And this double effect BS is – as noted above – nothing but mental masturbation of the lowest order. The end result exactly the same. The fetus dies. But it’s the height of irresponsibility and immorality to remove a woman’s fertility for absolutely no reason whatsoever.
“If they have nothing medical to say then they should simply shut their pie holes. Theological considerations have absolutely no place in health care.”
Medical science by itself — cannot provide complete answers to “Ought” questions. All ethical considerations necessarily involve questions of value, which are necessarily philosophical questions.
John Hopkins Medicine in the U.S. — one of the top medical facilities in the world — has ethics advisory boards which usually includes a chaplain and an expert in law, and experts in biomedical ethics — none of which involve strict medical credentials.
You might as well dismiss the Hippocratic Oath, The Declaration of Geneva, The Declaration of Helsinki, or the Universal declaration on bioethics and human rights (UNESCO) on the same logic.
If you read the actual Bishops statements closely, there is not one statement that is uniquely “theological” or even uniquely Catholic.
The church does a fine job of making itself look worse. Also, I’m glad you think so little of women that you think it’s okay to mutilate us unnecessary (remove our uterus when it’s not medically called for) but it’s also okay to let us die from harboring a dead, decaying fetus. Freaking Catholics… ghouls.
Reblogged this on herlander-walking and commented:
This idiocy bears repeating because allegedly celibate (and certainly impregnable) men should NOT be making decisions about the lives of women.
Thank you, an interesting medical perspective.
I assume you have seen this study of American Catholic hospitals?
Yes, this is definitely worth reading. Regardless of the people who say, “An induction would have clearly been allowed!” there are numerous anecdotes like these showing that in fact it is not clear what is and what is not acceptable.
After the Phoenix incident, I no longer go to Catholic hospitals.
You can see the exact same distinction in the US Conference of Catholic Bishops’ Ethical and Religious Directive, which is supposed to “govern” treatment in all Catholic hospitals. (Bishops decide medical treatment! What an appalling arrangement.) ERD 47 is what the Bishop of Phoenix tried to force St Joseph’s hospital to agree never to disobey again. I just happen to have it handy…
47. Operations, treatments, and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child.
See? It’s tricky. “as their direct purpose the cure” – that rules out abortion, even when it’s the pregnancy that is killing the woman, because the “direct purpose” of abortion is killing the fetus.
remember….the us bishops guidlines aka Ethical & religious Directivs say, no induction either, UNLESS there is an infection, so they cn preend they are just treating the infection, not inducing a fetus, bc inducing a previable fetus DOES count as an abortion…
But the catholic strategy is quite clear:
Issue verrrrry vague and unclear policies
Let people wonder and make up their minds themselves
Punish those who do heavily
Shrug your shoulders in public and declare that it’s not your fault if those stupid doctors let the woman die, it was clearly allowed!
I’m not a physician, just a lay IT guy with in interest in the issues. I was interested in the question, “how many fertalized ova (“Innocent human babies” in pro-life terms) naturally fail to result in live babies.” What I found was horriffically shocking and rarely seems mentioned.
Aproximately 70-78% of fertalized ova never become live babies. Roughly 31% fail to implant in the uterus, another 30% spontaneously self-destruct before the woman even knows she’s pregnant (post-implantation but pre-clinical). The remaining 12-14% spontaneously abort, most commonly due to genetic or developmental defects.
Facts from the studies:
* 5-20% of human sperm and eggs carry significant genetic defects.
* ~95% of first trimester pregnancy loss is due to genetic abnormalities.
* There are peaks in the miscarriage rate in the 12th and 20th week, with the rate of miscarriage dropping below 1% after the 26th week.
* Even at 20 weeks, 5-13% of pregnancy failures are attributible to genetic defects.
Pregnency and miscarriage doesn’t show use the ‘hands of a loving god’; but rather an enormously complex bio-mechanical process, which often ends up breaking down. Spontaneous abortion and miscarriage, especially early on, is most often natural quality control. It’s a good thing.
This is not to belittle the pain women feel at the loss of a child, nor the preciousness of newborn life. It is hard for us, however to face the naked facts of a process when our feelings are involved.
Article: Human pre-implantation embryo development
Authors: Kathy K. Niakan1,2, Jinnuo Han3, Roger A. Pedersen2,4, Carlos Simon5 and Renee A. Reijo Pera
Ref: doi: 10.1242/dev.060426 March 1, 2012 Development 139, 829-841
Date: March 1, 2012
Source: http://dev.biologists.org/content/139/5/829.full
Article: Conception to ongoing pregnancy: the ‘black box’ of early pregnancy loss
Authors: N.S.Macklon, J.P.M.Geraedts and B.C.J.M.Fauser
Date: 2002
Source: http://humupd.oxfordjournals.org/content/8/4/333.full.pdf
Article: Genetic and Nongenetic Causes of Pregnancy Loss
Authors: Simpson, J, Carson, S, Glob. libr. women’s med.,(ISSN: 1756-2228) 2011; DOI 10.3843/GLOWM.10319
Date: Updated Dec 2011
Source: http://www.glowm.com/index.html?p=glowm.cml/section_view&articleid=318
Thank you for sighting sources for the stats in your comment, and for “speaking” calmly and rationally about this most polarizing topic: it’s positively refreshing. I am highly annoyed with how frequently people throw around phrases like “most people”, “everyone knows” etc without ever sighting where the stats are proving those sweeping statements.
How terrible, that women are getting emotional about threats to our lives based on superstitious mumbo-jumbo.
Thanks SJ. I want to be clear here, and partially in response to Origami’s (MsDaisyCutter’s) response. Savita’s death is a tragedy and a crime. That a majority of women world-wide are so abused is horrific on an epic scale.
One of the proofs to me that religion is man made, is the way it follows dominant hetero male ‘gut’ instincts so often.
A hetero-male watching two men kiss elicits a gut-disgust reaction (I know, I am one) – so the holy book says it’s an abomination. A hetero-male fears losing control if women gain power – so holy books say women should be silent baby makers and property.
These gut reactions are instinctive and ‘feel’ right, but aren’t rational. Just because I’m wired Hetero, doesn’t mean that all males have to be too. And gut reactions can be controlled and desensitized by exposure. Likewise emancipated, empowered women are our partners and friends in building a better world, and have proven themselves capable of great good (and sometimes great idiocy, just like men).
Emotion gives us energy to fight, but reason must give us direction. If we only use our reason to rationalize our emotional directions, we, like the dominant heirarchs, run the risk of doing far more harm than good.
So, yes! Get emotional, this was a tragedy. Organize and work until law and state are independent of religion and male dominated perspectives. Ultimately I believe abortion of any sort is a woman’s perogative; your life, your risk, your decision.
Why, Kevin, thank you SO much for mansplaining to me how I should go about agitating for my own rights! My fwuffy widdle girwy-bwain would never have been able to figure it out without your magnanimous mansplanation!
…Seriously, you have no damn idea what I do or don’t do offline, so stuff your lectures up your ass, kthx.
Kevin, I’ve seen that stat used by Howard and Georgeanna Jones, MD’s who do IVF. They used the stat to justify discarding human embyos who failed preimplantation genetic diagnosis. I always wondered how they came up with the idea that 7 out of 10 human ova fertilized in the body naturally are “aborted” naturally. Is there a scientific study that resulted in that conclusion? Who performed it? Where and when was it performed? And, who were the test subjects?
All human life is precious, whether born, or unborn.
One of the reasons Dr. Savita’s death is getting so much attention is that it is not common for women to die in childbirth in Ireland and elsewhere and the abortion lobby are grasping at justification for their goal of overturning Ireland’s laws against elective abortion. Where is the abortion lobby’s outrage over the ever-increasing numbers of healthy women dying as a result of elective abortions.
It’s rare for women to die from pregnancy because most of the time things go right and even when they go wrong most of the time the doctors can fix it up.
In this case, though, the doctors didn’t/weren’t allowed to fix it and she died.
*I’m* outraged at the number of “ever-increasing number of women dying as a result of elective abortion” which is why I’m strongly in favour of legal, destigmatised abortion offered in the context of an overall women’s health system which also includes sensible sex education in schools for both sexes from an early age and ready access to free or cheap contraception. Because if a process – even a technically legal process – is under-resourced, under- or badly-taught, hedged around with restrictions that means it’s undertaken later than it ideally should be, if preventatives such as Plan B are made unavallable or hard to obtain then any and all of the above factors are likely to increase the number of abortions and of healthy women dying from them, and anyone campaigning for the above restrictions (including restrictions on contraception, sex education and morning after pills) is in fact a campaigner for more abortions and more women dying in the process of having them.
AJ, Surely you realize, surgical abortions are one of the causes of ectopic pregnancies.
No, because as a statement it’s a load of bollocks. Pelvic inflammatory disease is an enhanced risk factor, as are the factors given here: http://www.nhs.uk/Conditions/Ectopic-pregnancy/Pages/Causes.aspx but there’s no link specifically to abortion, same as there’s no link between abortion and breast cancer.
Catherine asked, “Is there a scientific study that resulted in that conclusion? ”
There are three studies referenced above, with hyperlinks.
Catherine, I’m sorry this is so late. I was ill this week and had a lot of catching up to do.
You ask a significant question. There is not one but many studies that have contributed to the 70-78% figure.
The earliest study I could find that addressed overall pregnancy loss was “Where have all the conceptions gone?” by Roberts and Lowe in 1975. It is a study of live births in England and Wales in 20-29 year old females vs. opportunities for conception. Unfortunately this study is behind a pay-wall at the Lancet so it’s difficult to get to.
Roberts and Lowe were prompted to study conception failure after noting a large number of aborted fetuses were malformed. Per Roberts and Lowe “in the world of early embryos, malformation may be the norm rather than the exception” and “product rejection by way of implantation failure and spontaneous abortion is (Nature’s) principal method of quality control”. They state that 50-75% of all conceptions spontaneously abort during the first Trimester.
There have been large gains in the ability to detect very early pregnancy since this study was done, resulting in the ability to detect by blood serum testing implantation of the embryo to within a day. Further studies have confirmed and refined the findings by Roberts and Lowe.
The best summary, I’ve found to date, is cited in my first post: “Conception to ongoing pregnancy: the ‘black box’ of early pregnancy loss”, N.S.Macklon, J.P.M.Geraedts and B.C.J.M.Fauser. It’s really not that hard to read and the full text is available online. (Just Google any words you don’t know; there’s a wealth of information out there.) It not only goes back citing many other studies over the past 50 years, but does a good job of explaining the genetic causes of early pregnancy loss. Their refined estimate is 70% (pg 335, para1, bottom). The 78% figure was garnered from the graph of the Modified Roberts and Lowe on page 339 of the same study.
I have to disagree with you about “all human life is precious, whether born, or unborn”. This is a heartfelt statement prompted by lack of knowledge and misrepresentation by authorities (Church and Political) on the complexity of the issue. Nature doesn’t value embryos and discards a large majority of them. We do a harm to real people in our communities when we avow to support public policy based on bad evidence and advice. Conception is NOT a reasonable place to put infinite value on life.
This prompts the question “If at all, where should we rationally begin to consider fetal rights?” 99% of elective abortions occur before the 23rd week. This is before nerve development is complete, before the frontal lobe of the brain has formed, before there is even a chance of pain or consciousness. If at all, perhaps here.
Ultimately, I still feel that this should be an area where the government should abstain from a concise decision and should instead support a woman’s personal liberty. As long as the issue is so contentious with arguments on both sides, public policy should support women in getting the medical care they desire with fully informed consent, and require medical professionals to act in the best interest of their patient. Its a woman’s body, their conscience, their risk, their decision.
Article: WHERE HAVE ALL THE CONCEPTIONS GONE?
Authors: C.J. Roberts , C.R. Lowe
Reference: The Lancet, Volume 305, Issue 7905, Pages 498 – 499, 1 March 1975: doi:10.1016/S0140-6736(75)92837-8
Source: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(75)92837-8/fulltext
Kevin, I’m sorry to read you were sick. I hope you’re feeling better.
Regarding your last post. I took a quick look at Conception to Ongoing Pregnancy; the “black box”. Did it bother you as much as it bothered me that this “study” used a chart from the other study you cited, and the chart used these words, “estimated”, “assumed”. Also, while the ages of the female subjects were on the chart, there was no information on the males.
I still don’t see how anyone can conclude with any amount of certainty that 70-78 percent of all those who are conceived naturally are aborted naturally, not from what I read in “Ongoing Pregnancy….” a lot of guesswork, estimates, and assumptions. .
But, the topic is Dr. Savita. Recently the world learned there’s more to the tragic story about the recent death of mother and child in a hospital in Ireland than what was told by the reporter who now admits she left a significant fact, or two, out of her report.
Kevin,
Thank-you for posting all that information. I think the number of twin pregnancies that do not last may make the number of failed conceptions even higher (Google disappearing twin).
On one point, however, I do have to disagree. We cannot expect people to base their moral views on the actual numbers. If every fertilised egg is a human person, then it is. If that leads to very strange actions (baptising tampons?) then it does.
This article is based on a basic mistake in reading comprehension. The distinction being made is between “direct and intentional destruction” (in first sentence) and “medical treatments which do not directly and intentionally seek to end the life” (in second sentence). Notice the contrast between the “intentional” and the non-intentional. The distinction being drawn is one of motivation and intention–a basic consideration in jurisprudence, just war theory etc. An intentional crime cannot be condoned, but an unintentional one may have mitigating circumstances. This is what is obviously being referred to here: the intentional destruction of fetal tissue /baby/unborn person is “gravely immoral in all circumstances” but there may be cases when the destruction is not intentional, and when it is done under force of circumstances, e.g. to save the life of the mother. This is analogous to the Catholic teaching on just war: killing human life (and all life) is wrong per se, but there may be circumstances when the destruction of war is warranted and justified, to prevent greater evil. Again, the distinction is between the mode and spirit in which the action is done — i.e. intention. Again, this is a basic ethical distinction which this article wholly seems to miss and the technicalities of the “analysis” really only cloud the issue and read into the short passage what is not there… Worse, it really is just a matter of reading the two sentences together, and having the generosity of spirit not to leap to judgment immediately. Basic reading comprehension!!!
Ha ha ha! Surely you jest! The paragraph makes no sense medically and contains no valid medical terminology, ergo it is worthless dogma.
I disagree: I don’t think it’s worthless, merely infantile. I think she should go away and try to find some doctors who perform abortions without good motivation and intentions (such as the intention and motivation of helping a woman deal with a very difficult problem) and remonstrate with them.
No, I went to a Catholic school and I’m pretty sure Lisa’s right. I agree it’s dogma — what else do you expect from bishops? It’s like this: if a man is threatening to kill me, I can kill him in self-defence. There’s no sin if my intention is merely to save my own life. His death is an indirect consequence of my intention. But if I’m thinking “great, he threatened to kill me so I’ve a perfect excuse to kill him” that’s a sin. In that case his death is a direct consequence of my intention.
If you think this is a load of shite you’re not alone. But Lisa is reading it correctly IMHO.
More intellectual masturbation from people who put their imaginary friends above the wellbeing of humans.
Has the irony of accusing Dr. Gunter of poor reading comprehension in a comment that demonstrates your own occurred to you?
If it’s that simple, why couldn’t Savita’s doctors figure this out?
Lisa, the article actually does deal with the distinction between intentional and unintentional termination of a pregnancy. The author points out that a “treatment” which unintentionally results in the death of the baby is ok according to the Bishop’s statement and gives the example of the removal of an infected womb to save the mother’s life – the unintended side effect of which is the death of the baby inside. The author then goes on to say that removing only the baby is directly and intentionally killing the baby and therefore must be wrong as the intention is clearly to remove the baby from the womb effectively killing it. A doctor who has deliberately removed a baby from the womb cannot claim to have unintentionally harmed the baby. This distinction is precisely what the author takes issue with. If the deliberate and direct act of ending the baby’s life by dilating the cervix and scraping out the foetal tissue is always wrong then what is a doctor to do if the pregnancy is killing the mother? Seeking to find a treatment that does not involve directly and intentionally killing the baby only delays treatment and compromises medical care. The Bishop’s statement says that this is the better course of action even if it compromises the life, health or future fertility of the mother and despite the fact that whether intentional or not the end result of any treatment in such a situation will be the death of the baby. Should we not allow the doctor to do this in a manner that best saves the life, health and future fertility of the mother? It is the distinction between deliberately and directly ending the baby’s life and unintentionally and indirectly ending the baby’s life that the author refers to as “medically nonsensical, contradictory, and immoral”. I have to agree. Both result in the death of the baby. The latter risks the life and health of the mother as well.
Unfortunately the Bishops’ statement is a reflection of Irish society or at least of how we govern ourselves. In 1983 the 8th Amendment added the following line to the Constitution of Ireland:
“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.”
There you go. An “unborn” (whatever that means) has equal rights to the life of the mother.
Since the 1993 Supreme Court ruling that allows for an abortion if there is “a real and substantial risk” to the life of the mother. (A further proposed Constitutional Amendment that same year proposed to remove suicide as a reason to justify a risk to the mother’s life but thankfully was rejected). Since then there have been abortions carried out in Irish hospitals when the circumstance calls for it. However we as a society prefer not to acknowledge these. They are not even counted: http://www.irishtimes.com/newspaper/opinion/2012/0904/1224323574371.html
It may help you to read this comment dated November 15. Bishops and ethicists get their facts from doctors, not the other way round. If you want a little enlightenment about what the Irish bishops are talking about, just say so. You have my email. David
“Dr. Sam Coulter-Smith, Master of the Rotunda Maternity Hospital in Dublin,(a Protestant hospital since founded in 1745) has said he sees no evidence of confusion in Irish medical ranks over whether or not a woman can have a termination if her life is at risk.
“I think most of us who work in obstetrics and gynecology—there may be individual differences, but the majority would be of the view that if…there is a risk of death and we are dealing with a fetus that is not viable, there is only one answer to that question, we bring the pregnancy to an end,” he said.
Coulter-Smith is also clinical professor of obstetrics and gynecology at the Royal College of Surgeons in Dublin. “This case probably does not have a lot to do with abortion laws,” he said. “It is a clinical scenario—someone in the process of miscarriage [who] had infective complications as a result of that process. Whether or not if the situation had been actively managed in the 24-36 hours preceding the tragedy of the baby’s death, would that have changed anything? No one can answer that.”
“What is reasonably clear is that in a position where senior clinicians feel a woman’s health and life is at risk then it is permissible in this country to end the pregnancy,” he said.
Reply
“Whether or not if the situation had been actively managed in the 24-36 hours preceding the tragedy of the baby’s death, would that have changed anything? No one can answer that.”
Yes we can.
We can look at similar cases and statistics and then make a very reasonable prediction. As a clinical professor. this shouldn’t be news to Dr. Coulter-Smith. And from what OB/Gyns all over the world have said it was agross misshandling
We await the findings of two investigations about what the doctors in Galway treating Savita H. did or didn’t do. How can anyone, obstetrician or non-medical, make a judgement about the medical staff at Galway hospital who have had to remain silent until the reports are completed, and read about the wild accusations in countries where the rate of maternal mortality is twice that of Ireland? Still less, how can anyone know what might have been different when we don’t know what strain of E. coli caused her death? Savita H. was not a statistic, and no one case is identical with another. Isn’t a wee bit of caution in order?
The key point in her medical care is the delay in evacuating her uterus. This should have been offered as soon as ruptured membranes were diagnosed at 17 weeks. There are also signs from her husband’s description that match a developing infection (these have been detailed in articles that looked at the timeline). Pathogenicity of of E.coli is not typically reported by strain. Perhaps you mean the serotype or the antibiotic susceptibility profile? Those things may have a bearing in how her illness progressed, but in every medical scenario earlier intervention is the standard of care. There is no scenario where a 2-3 day wait while the fetal heart tones are being checked is acceptable. The “wee bit of caution” should have been considered with her wide open cervix and ruptured membranes, caution that she had a high risk for infection.
Excuse my ignorance of biology. My source was Dr James Clair, a consultant microbiologist at Mercy University Hospital, Cork city. He believes that the main problem in Savita H.’s death may be missed in the public controversy over abortion or the lack of it. In his own words, the “most likely” cause of her death was “ESBL, or Extended Spectrum Beta-Lactamase positive gram negative bacteria”, in short, “ESBL E.coli strain”. This “organism” is far more dangerous than MRSA and is rapidly spreading in the general population of Ireland. Read his full comment at:
http://www.irishexaminer.com/opinion/savitas-death-may-have-been-due-to-resistant-bacteria-strain-214431.html
“early intervention” is the standard routine in Ireland, according to an eminent obstetrician I have consulted. Most obstetricians, like Coulter-Smith and others, cannot understand how the Galway doctors waited three days, if that is what they did. Was there an inexcusable delay in giving Savita H. standard treatment? Before leaping to judgement on the Galway medics and basing it solely on Mr Halappanavar’s narrative, we should wait for the doctors’ side of this sad event.
Dr Rhona Mahony, the Master of Holles St Maternity Hospital, does not agree with Dr. Coulter-Smith.
“If we think is a woman is going to die, we can terminate the pregnancy – and we do – and there are no issues surrounding that,” she explains.
“But there are areas where we are not sure how to quantify the risk to life, and indeed the risk to health, and there is an overlap between the two – when does the risk to health become a risk to life?
“It can be difficult in practice to make a clinical distinction between threat to life and threat to health, therefore there is a degree of legal uncertainty.”
….
“Do I have to wait until she is unwell, critically ill – at what stage can I make provision to offer her good, sensible healthcare? I do not want to wait until she is dying before I intervene, I want to protect her.”
http://www.irishtimes.com/newspaper/health/2012/1127/1224327139941.html
I agree that the distinction between risk to life and risk to health is impracticable, and goes back to a badly thought-out X case judgement, written by four judges of Ireland’s Supreme Court in 1992. It is foolish for legislators and judges to make clinical judgements; that is for the medical practitioner, and it is a task where there are often unknown knowns and a certain outcome can never be guaranteed. So, what is the law to do? To make abortion a private matter between a woman and her doctor, as in Canada, or to ban it [almost] entirely, as in Ireland?
In the aftermath of Dr. Halappanavar’s death, I noticed that many Irish “pro-lifers” tried to establish a distinction between “abortion” and “medical termination.” We’d find it laughable, were the circumstances less tragic. The pretense was transparent: yes to “medical terminations” where married, honest women were at “legitimate” risk, but beware of those sluts who want to open the door to, God forbid, “abortions.”
Your analysis is excellent. Thanks.
Reblogged this on and commented:
Dr. Jen Gunter has done it again. We get so caught up in the philosophical and ethical discussion of abortion (we’re guilty too), that sometimes it helps to remember that at the end of the day, this is a medical procedure and we need physicians with strong voices like Dr. Jen’s to break it down for us in terms of the real world implications of our philosophical musings.
Nothing surprises me any longer. It just deeply saddens me
I can make sense of it if you look at a broader picture–you can apply other medical treatments to the woman despite their detrimental effects on the fetus (say, chemotherapy or the radiation of a bone marrow transplant) but you can’t target the fetus, period.
It’s theological hairsplitting and nonsense like that that results in the absurd situation where removing an entire fallopian tube (and thus reducing fertility is ok), but just removing an ectopic pregnancy while trying to save the tube is an Evil Abortion.
Just to clarify–I was trying to find a reasonable interpretation of the words, I’m not saying I agree with the theologians. To me this is an attempt to rationalize murder.
Thats the way an ectopic pregnancy is handled in Ireland? That is seriously shocking to me, the reduction in fertiliy would be 50% or am I mistaken? To me that is inacceptable and I guess a lot of women wishing to have a family would see it that way.
@Daisy
It’s not just Ireland, but it’s basically the official position of the Catholic Church. And if you now go “Wait, why does a church have a position on medical matters?” you’d be right.
To be fair, not all Catholic hospitals actually do that, but a certain amount does. And if you are brought there in an emergency or even go to one yourself, you have absolutely no way to know what their regulations are.
@ Steve and Daisy
That is absolutely 100% not how ectopic pregnancies are handled in Ireland.
The amount of not-quite-accurate information that is getting thrown about around this issue is disappointing. To be clear, I am in favour of abortion, embarassed by the situation in Ireland and hoping a change in abortion legislation comes about. I am doubly embarassed as a doctor (not in Obstetrics/Gynaecology, but nonetheless…) who received my medical training in the hospital in question. And this blog post is excellent, as were Dr. Gunter’s previous posts on the topic.
But take a stroll down internet lane and you would be led to believe that Irish hospitals are 100% Catholic-run, that the OBGYN Dept in Galway University Hospital is run by a cadre of god-fearing bigots, that the Irish healthcare system is inherently racist, or that ectopic pregnancies are apparently all treated by removal of the fallopian tube in Ireland. This is patently absurd.
Don’t drown the totally legitimate criticisms of the Irish abortion laws, the medical care of Ms Halappanavar or the ridiculous statements of the Bishop by mixing them with inaccurate hearsay misstated as fact.
Please be a little bit skeptical when you read some of the apparently bonkers behaviour people on the internet are assuring eachother happens in Irish hospitals.
Thanks
Reblogged this on Activism and Agitation.
This column just about says it all. Thank you for your analysis. Your logic seems impeccable.
I couldn’t make any sense of the Bishops’ statement; but then I’m a general surgeon.
But then, trying to explain medical ideas to non-medics is always an uphill task.
There’s another bit in their statement, about never having taught that the life of the unborn child has precedence over the mother’s. This is contrary to received opinion in N Ireland at least; and, thanks to a letter in one of the papers recently, I learnt that the reasoning is that the mother has been baptised, but the child hasn’t.
I’m really grateful for this comment. I never could understand…but of course, how stupid of me not to realise that mothers are baptised and therefore magically protected, or magically part of the blessed communion of — you know, those — well, those special people — so of course it doesn’t matter about their suffering and death. I had always had the impression that it must be because they’re just women, and therefore exist merely to produce babies, which obviously have to be given every priority — I mean, sacredness of life, and all that, and babies are real people, as we know. I’m so relieved that now I know better. But…oh no, surely not!… dare I ask? — what about unbaptised mothers? Or doesn’t Holy Church care about them? No, terrible thought, forgive me for even thinking it…How did I ever get such an impression? I must be so sinful and wicked…
The Bishop said ‘ gobbledegoop ‘ .
Only one thing matters the fetus was in trouble and so was the mother . Her life should have been spared, but as with most Catholic areas they don’t look at it that way shame on them