Tragic case to reopen abortion debate in Ireland

[Alatar]

20 years after the guidelines prompted by the "X Case" were published, this tragedy will certainly result in a fresh look at our abortion laws.

THE heartbroken husband of Savita Halappanavar has spoken of his torment at the loss of his wife and the unborn daughter she had already named.

An international storm has erupted over abortion laws here after the death of Mrs Halappanavar (31) from septicaemia a week after she began to miscarry and asked for a termination at University College Hospital in Galway.

Speaking from her hometown of Belgaum, in southwest India, her husband, Praveen (34) told the Irish Independent:

- His wife had already chosen a name – ‘Prasa’, a combination of Praveen and Savita – for the baby girl she had longed for. They learnt she had been expecting a baby girl after losing the child.

- In his last conversation with his wife in the ICU, she asked him to check her parents had arrived back in India safely, after paying a happy visit.

- He believes his wife would still be alive if a medical termination had been carried out, as she had repeatedly requested.

- How, even as her condition deteriorated, he believed she would pull through as she was "full of life".

- Their entire family are questioning how such a death could occur in 21st-Century Ireland.

- How she asked a number of times for a medical termination after a doctor found her foetus would not survive.

- How Savita's grieving mother Akkamahadevi had wanted her daughter to return to India for her pregnancy.

Mr Halappanavar, an engineer with Boston Scientific in Galway, brought Savita's remains home to her parents in India, where she was cremated.

But he plans to return to Ireland in the coming days to put pressure on the "whole system and change the law".

The devastated engineer told how he wants to ensure no other family ever has to endure their devastating loss.

Pressure continued to grow last night as more than 1,000 people staged a demonstration outside the Dail, with more gathering outside the Irish embassy in London.

Tanaiste Eamon Gilmore vowed the Government would take action to provide "legal certainty and legal clarity" on abortion in the wake of the tragedy.

But the Coalition is at odds over the issue of abortion, with Labour TDs demanding legislation and Fine Gael TDs saying they would wait to see a report from an expert group.

The HSE national incident management team confirmed it would interview Mr Halappanavar as part of its review.

And staff at the hospital were interviewed yesterday as the internal investigation stepped up a gear.

It is understood one of the areas the hospital Risk Review Group will be examining is the experience of the consultant who dealt with the case.

Staffing levels at the Galway hospital's maternity unit during Mrs Halappanavar's stay, including the bank holiday weekend, were normal, according to a hospital spokesman.

Mr Halappanavar said the entire family, many of whom are medical professionals, were questioning how this death could occur in a hospital in the 21st Century in Ireland.

"We had heard Ireland was a good place to have a baby. Most of our friends there had babies there and they're all fine."

He added: "You wouldn't have thought about it. How could they leave a womb open for two days?

"The chance of infection is really high and they could have terminated. The way people think here (in India) is different; they are not able to accept the fact it is just a Catholic thing."

Savita's mother also spoke out – saying how she asked her daughter had come back to India for her pregnancy.

"We told her to come back to Belgaum for her delivery, but she felt that treatment in Ireland would be safer.

"But she's gone and I just cannot believe that she is no more with us. . . Had she come back to India, she would be living with us now."

Akkamahadevi and her husband were visiting Savita when their daughter broke the news that she had conceived.

"We were very happy. We were very eager to see our grandchild. However, tragedy struck and we are not in a position to explain our grief."

Mrs Halappanavar longed for a daughter, her brother Yalagi said. "She always wanted to have a girl so that child could be like her."

Happy

Mr Halappanavar painted a happy picture of the days before his wife was admitted.

"Everything was normal. We were told she was perfectly all right," he said.

"Savita was on top of the world. We were so excited and always talking about the baby."

Mrs Halappanavar was 17 weeks pregnant when she arrived at the hospital on October 21 complaining of back pain.

The couple were then told the baby would not survive, as her cervix was already dilating and she was miscarrying.

However, it was not until Wednesday, October 24 that the foetus was removed.

Mrs Halappanavar's condition continued to deteriorate and she died from septicaemia at 1.10am on Sunday October 28 – a week after being admitted.

Her husband told how they "kept on pushing" medics to carry out a medical abortion. However, they were told it was a Catholic country and it was against regulations.

Asked if he thought his wife would be alive if a termination had been carried out, Mr Halappanavar replied: "Yes. Of course, she was a very strong person."

[JewelSong]

This is awful. Just...unspeakable. And medically irresponsible.

I have no words.

[axordil]

I saw this story. I cannot formulate a response that is acceptable here.

[Frelga]

How about we start with "barbaric."

No, that won't work. Barbarians were pagans for the most part.

[Voronwë the Faithful]

Like Ax, I'm not even going to try.

[Lalaith]

Well, I'd like to see the exact medical details, honestly, before taking up arms.

Was the fetus already dead? If not, when did it die? (Allowing a dead fetus to stay in the uterus is asking for infection.) Did they administer pitocin to speed labor along? Did they give her prophylatic antibiotics? When "the foetus was removed" (meaning delivered? or did they do a D&C?), did they do a thorough job of making sure all of the fetus and placenta were removed from the uterus?

At first glance, it seems like this case might not have been handled properly from a basic medical standpoint irrespective of the abortion issue. In that case, by all means, they should face some repercussions. However, I will say that sometimes, no matter what is done, women (and babies) die in childbirth (or related to childbirth). It sucks, but it happens.

This is very sad, and I feel very bad for this family.

[River]

She arrived at the hospital, 17 weeks pregnant, complaining of back pain with her cervix dilated. They couldn't stop the labor and it was too early for any chance of saving the fetus. But it took a couple days for the fetus's heartbeat to stop, which is why they left her lying around with her womb open to infection. Who knows why they didn't start antibiotics sooner.

Whole thing makes me wonder what Irish law has to say about the whole practice and concept of triage.

[Primula Baggins]

If the fetus had been dead, they would have been willing to remove it. But it still had a heartbeat, so they would not try to speed the miscarriage in any way, even as the mother's condition deteriorated. They let her die rather than remove a doomed fetus.

[Lalaith]

If that is true, then, yes, this was wrong. They should have been administering antibiotics, and they should have been giving her pitocin (or something) once the labor went on for too long. There is a window of time where they will let a mother labor on her own; I think it's about 24 hours or so.

[narya]

I remember 28 years ago, when my neice was born, that women were allowed to labor on their own no more than 24 hours after the water broke, then they went to C section. The risk of infection was too great to wait any longer. My sister-inlaw had a C section after 24 hours yet both she and her baby were in the hospital on antibiotics for weeks because they got infected anyway. The bugs (staph, I think, leading to meningitis) are resident outside the cervix just waiting for a chance to get in and multiply. So I can't understand why Savita was treated so negligently.

[Alatar]

Some more info for those interested

The British media, in tandem with the Irish, is running with the 'woman dies because she was denied abortion' story headline.

It's not surprising that the likes of 'The Guardian' would give the story prominence because 'The Guardian' is fiercely pro-abortion.

In Britain it fits in with a certain stereotype of this country to believe that women are dying here because of our lingering adherence to Catholic medical ethics.

However, even the more pro-life 'Daily Telegraph' and 'Daily Mail' have given the story prominence.That would be justified if we knew that Savita Halappanavar did indeed die because she was denied an abortion, but that is not why she died.

We know this because if there was a need to end her pregnancy in order to save her life, then the hospital was free to do that. Nothing in law was preventing the hospital from doing so.

And to be absolutely clear, ending a woman's pregnancy prematurely is not necessarily the same thing as abortion.

For example, inducing labour where it is necessary to save the life of the mother is not the same as abortion and Irish hospitals induce labour in these circumstances on a regular basis.

From the available facts, we know that Mrs Halappanavar was miscarrying and that she died within days of being admitted to hospital from septicemia and E Coli ESBL.

We do not know for certain whether ending the pregnancy upon her arrival in the hospital would have saved her life, but to repeat, if medical staff needed to do that they could have done it.

Therefore the 'woman dies because she was denied abortion' storyline is simply not true. The 'woman dies because of Catholic opposition to abortion' is also not true.

We simply do not know for certain at this stage whether Mrs Halappanavar would have died no matter what was done. This is what the investigation into her death will ascertain.

And we must also repeat for the umpteenth time that Ireland has one of the lowest maternal death rates in the world. It is lower than the British rate where abortion is available on demand.

In addition, it is necessary to remind ourselves that sometimes women die because of botched abortions in legal settings. Indeed, last year a doctor – Phanuel Dartey – was struck off in Britain because he nearly killed an Irish woman while performing an abortion on her in a Marie Stopes Clinic in the UK.

This story received remarkably little publicity here in Ireland. RTE did not cover it at all, whereas it has given the Savita Halappanavar story wall-to-wall coverage. Why this discrepancy?

And by what journalistic calculus did RTE decide to give so little coverage to the revelation by this newspaper that some staff at pregnancy crisis agencies in Ireland are giving women dangerous and illegal advice? It would be good to know.

There has been a tremendous and unseemly rush to judgment in this case.

It is being used to advance the argument that Ireland must change its law on abortion before we know the full facts.

It is also being used to falsely and unjustly give the impression that Ireland is an unsafe place for pregnant women when the opposite is true.

The bottom line is that we cannot draw any decisive conclusions about what happened in this tragic case until we do know all the facts.

Irish Independent

[Frelga]

That second article is a rather textbook case of misdirection. The outrage is not over "Ireland being unsafe for pregnant women." It is that medical professionals apparently put religious dogma above patient's safety.

[Alatar]

Well, we don't actually know that.

[Frelga]

If this is true, we do.

Her husband told how they "kept on pushing" medics to carry out a medical abortion. However, they were told it was a Catholic country and it was against regulations.

[Alatar]

Again, not defending this, but we're getting the reports of a devastated husband as reported by a left wing press.

The facts are that if the doctor feels the mothers life is in danger (and the wording is "life", not "health") then termination is allowed, and according to all reports this happens quite often. In this case, we are led to believe, the mothers life was not considered to be in danger, so the termination was not carried out. That's the current law of the land. I think we're all aware that in medicine, like in all other things, a lot can happen very quickly. I'd be far more inclined to believe that a doctor misjudged, than to think they deliberately let a woman die.

[axordil]

I guess the question becomes, what ingredients comprise a doctor's judgment? Sepsis is sneaky and something you want to stop before it starts. Doctors know that. If they really didn't see any risk, they did a piss poor job of communicating that to the husband, and of explaining that's why they weren't terminating.

Conversely,is there any doubt had the fetus been dead, they would have taken it out immediately, precisely because of the increased risk for sepsis?

[nerdanel]

The facts are that if the doctor feels the mothers life is in danger (and the wording is "life", not "health") then termination is allowed, and according to all reports this happens quite often. In this case, we are led to believe, the mothers life was not considered to be in danger, so the termination was not carried out. That's the current law of the land.

And that law is immoral and illegitimate. The mother here requested termination of the fetus and it was not provided (unless we are to believe that her husband is unable to report this simple detail accurately.) This case is a textbook example of why it should be left to a woman to decide when she will not continue with her pregnancy. Unless her husband is blatantly lying that she made this request, the simple truth is that acceding to her request - as any country that respects the human rights of women is bound to do - would likely have left her alive. The failure should be recognized as murder and condemned by all people whose definition of pro-life includes the lives of born women. The case clearly illustrates what happens when those who place a fetal heartbeat over the heartbeat of a born woman (or those who believe that the law requires them to do so) are allowed to make decisions for women.

I hope to see the European Court of Human Rights take Ireland to task for its blatant violation of the Article 2 right to life, both by imposing a substantial fine to be paid to this woman's husband and more pressingly, directing the country to change its immoral (and more to the point, arguably illegal under supranational/regional) laws, as Strasbourg is entitled to do. Hopefully, the husband brings the necessary lawsuit to effect this long overdue change.

[Lalaith]

And I still think the facts of the case are not clear and so will not rush to judgment about anything. In fact, if I do rush to judgment, it will be that the story is being sensationalized to make Ireland look bad for its stance on abortion.

[nerdanel]

My judgment about the immorality of Ireland's laws was formed years ago and is not specific to this case. As applied to this case: I see no serious factual dispute that she requested a termination that was not provided, and I am prepared to judge the country's laws on that basis alone: the failure to provide a requested abortion was immoral and improper. Ireland should and does look bad for its failure to do so.

Now the immorality is greatly exacerbated by the fact that this woman died, very likely because she did not receive necessary medical treatment in the form of a termination. I understand that you are saying that this has not been proven beyond doubt, although there is certainly substantial evidence to believe this is true. I am saying that I do not need to wait for proof that this woman was murdered by medical staff who refused to provide necessary and available medical treatment on the basis of her gender and pregnant status, in order to (continue with my) be(ing) outraged about Ireland's immoral abortion laws, since my feelings are on behalf of all women whom Ireland barbarically denies fundamental control of their bodies and are not limited to murder cases.

ETA Hearing of the rallies and waves of anger from Irish women is very inspiring. Ireland's laws have been so regressive for so long, and it has been puzzling to me that women have not stood up to assert their rights until now. I'm hoping that Irish women stand up just as American women did on Election Day this month and show very clearly that they are enfranchised citizens who will not permit others to wrest away their lives or control over their bodies.

[nerdanel]

Here is some additional medical information on this case from US doctors: http://abcnews.go.com/Health/irish-abor ... KU5xNmulS8

While obviously not possible for doctors to diagnose or prescribe treatment to a dead patient they never had the chance to meet, the consensus again appears to be that it is substantially likely that her medical problem was treatable and would likely have required swift removal of the "products of pregnancy."