Savita Halappanavar’s death is a tragedy
The death of Savita Halappanavar and her child is a great tragedy for her family and friends. We await the results of the inquiries into the circumstances. Health professionals can face difficult decisions as situations arise and develop. Even with the very best of current medical resources, tragedies will still occur.
It seems helpful to review an understanding of the matter in as objective a manner as possible, recognising that dispassionate reasoning may be difficult in real-life situations. Much is written from the standpoint of Catholic teaching, but it would help to have an approach which does not depend on it.
The report of the expert group appointed by the Irish government to examine the matter is due to be made public. This is in the light of the “X case” of 1992, in which the Supreme Court issued a ruling on whether a pregnant woman was entitled to an abortion in Ireland if her life was at risk because of the pregnancy. Following on this, in the “A, B & C case”, the Grand Chamber of the European Court of Human Rights issued a decision on 16 December 2010. In that case, the Court held there is no right for women to an abortion, although it found that Ireland had violated the Convention by failing to provide an accessible and effective procedure by which a woman can have established whether she qualifies for a legal abortion under current Irish law. The question has also come under public scrutiny with reports of the death in October of a pregnant mother in a Galway hospital; enquiries are being conducted into this case.
A relevant judgment came in October 2011 from the European Court which states, in the context of a ruling on the concepts of ‘human embryo’ and ‘use for industrial or commercial purposes’:
Article 6(2)(c) of Directive 98/44/EC of the European Parliament and of the Council of 6 July 1998 on the legal protection of biotechnological inventions must be interpreted as meaning that any human ovum after fertilisation, any non-fertilised human ovum into which the cell nucleus from a mature human cell has been transplanted, and any non-fertilised human ovum whose division and further development have been stimulated by parthenogenesis constitute a ‘human embryo’. (You can read the full judgement here .)
Clearly, the Court rules that a human embryo exists from conception, even if that is brought into being by means other than natural fertilisation. This has implications for any act which terminates a human life even in its earliest stage.
An International Symposium on Maternal Health in Dublin in September 2012 concluded that abortion is never medically necessary to save the life of a mother, as reported in the Irish Times on 10 Sept. I have seen little other publicity for this Symposium. The addresses at that conference are available on YouTube.
Senator Ivana Bacik, in the Irish Times (Law Matters, 14 May 2012) wrote that her favourite case is from 1884, in which four shipwrecked sailors were found guilty for sacrificing the life of a fifth sailor, the weakest, in order to save themselves. “They were truly in a most difficult situation, in danger of death. Yet they were found guilty of murder by Lord Coleridge, as necessity was no defence … Usually the question of whether necessity can be a defence arises in very extreme situ ations.” Senator Bacik quoted a 1971 judgment, that we must “trust that their distress will be relieved by the charitable and the good.”
The “principle of double effect” is sometimes derided as a kind of double-think; and that, in the case of termination of pregnancy, the church in fact allows abortion, but just refuses to call it abortion. This principle actually operates in a situation where an action for good is morally justified even when it leads to a result which one would normally be obliged to avoid – for example, the death of an unborn child. It is not legitimate, however, to perform an evil act so that good may result.
The principle of double-effect is a normal part of our everyday lives. Medication comes with warnings of possible side-effects. These side-effects are in no way intended by the manufacturer, nor by the person taking the medication, but it is foreseen that they may occur although not intended. In such a case, the non-desired effects are usually exceptional. In some instances, the side-effects may be foreseen as almost unavoidable, as in the case where I want to paint a room: I do not intend to splash paint on my clothes, but I know beforehand that it is almost inevitable.
These kinds of cases are quite distinct from those where the non-legitimate result is the means to the desired good end. I cannot make an omelette without breaking eggs: this is the very means to the end. So to cause the death of an unborn child as a means to saving the life of the mother is not morally acceptable. It is different where, sadly, treatment of the mother, while taking all precautions possible to protect the child, may result in the foreseen but unwanted death of the child. Similarly, treatment of pain in a patient who is terminally ill may result in the unintended shortening of the patient’s life, but the shortening is not the means to the relief of pain.
There will be difficult cases where the application of these principles is costly in terms of love and care and resources. If a member of my family appears to be in a persistent vegetative state, or with advanced dementia, and is incapable to all appearances of any human activity or interaction, decisions must still be guided by love and respect.
How the medical profession and civil law can deal with these matters, and whether full clarity is achievable, present other levels of difficulty. Decisions in individual cases have to be made by the people concerned. Civil law and medical ethics can help provide context so that those concerned can make good decisions without a cloud of uncertainty leading to fear of consequences. As I understand it, current medical practice in Ireland does in fact offer necessary medical treatment for the mother, even when it is foreseen that the child will not survive on account of the treatment. It would be sad if such treatment were to be refused because of lack of clarity in civil law, or because of a mistakenly perceived “Catholic ethos” restriction.
The “GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS” issued by the Medical Council in Ireland, states at 21.4:
In current obstetrical practice, rare complications can arise where therapeutic intervention (including termination of a pregnancy) is required at a stage when, due to extreme immaturity of the baby, there may be little or no hope of the baby surviving. In these exceptional circumstances, it may be necessary to intervene to terminate the pregnancy to protect the life of the mother, while making every effort to preserve the life of the baby.
The language used in dealing with these matters can be manipulated. For some, the word “terminate” from the Medical Council would be seen as “abortion”. “Termination of pregnancy”, however, is the conclusion of a pregnancy, whether by natural birth, or by induction, or by Caesarian section, or by any other intervention. To use “pro-choice” only for those in favour of easily available abortion would imply that those not of this mind are “anti-choice”. To use “pro-abortion” casually as a label would seem to ignore the deep personal anguish faced by many in crisis pregnancy.
If it is true that abortion is never necessary to save the life of a mother; and even if it seems necessary in a most difficult situation, if we do accept the principle that “necessity is no defence”, then these matters must weigh heavily in any decision our government makes on the question of abortion. Having voted, despite an embarrassing government breach of the law, for an amendment intended to protect our children, we can find ways to ensure that in difficult cases “distress will be relieved by the charitable and the good.”
As best as I can judge it, we need our government to introduce clarity in law in the matter, and this would best be done by explicitly recognising the current medical practice from the Medical Council as the way. In this way we can respect our excellent tradition of caring to the utmost of our resources for both mother and child. This is my reflection on an important topic. I hope the debate in the coming months will be conducted without diatribe, but with respect and reverence for human life at all its stages.
There have been claims that a “Catholic ethos” is responsible for this tragedy. On the contrary, the Catholic church holds that an expectant mother should be given any treatment necessary to preserve her life, even if, sadly, it is foreseen that it is unlikely that the child she is carrying will not survive.
“Clearly, if the life of the mother is threatened, by illness or some other medical condition, the care provided by medical professionals will make sure that she receives all the medical care needed. In a small number of cases, however, the treatment given may unintentionally result in the death of the unborn child. But in such cases the life is never directly and intentionally taken and everything is done to save the child.”(Bishop John Fleming in the Irish Times on Tuesday 13 November, the day before the story broke in the media).
Most pregnancies terminate, thankfully, in joy at the birth of a living child, whether or not at full term. If it is necessary to intervene to terminate the pregnancy earlier because of the health of the mother, medical guidelines and practice in Ireland are that every effort is made for the survival of both mother and child. Decisions on such intervention are made in each case between the mother and the medical practitioners.
“The Church has never taught that the life of a child in the womb should be preferred to that of a mother. By virtue of their common humanity, the lives of both a mother and her unborn baby are sacred… It is never necessary to target the life of the baby in the womb to save the life of the mother” (Day for Life message of Irish bishops, 7 October 2012).
Abortion – termination of a pregnancy for the purpose of ending the life of the unborn child – is never necessary for the survival of the mother. Legislation which permits intervention for the purpose of ending the life of the child would be contrary to human and Christian values, and contrary to the reverence and respect due to each human being, before and after birth. Any intervention which terminates a pregnancy must always do all possible for the life and health of both mother and child. This is the policy stated by the Medical Council.
If it is determined that law as it stands at present creates an uncertainty which inhibits a medical professional from acting according to those Medical Council guidelines, this must be considered by the Oireachtas and Government, in order to bring as much clarity as legally possible for the health and life of mother and child and for the vital work of those in the medical profession.