16Nov 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.
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.

7 Responses

  1. Con Carroll

    Let us be honest and respectful. Have the ability to listen. Be compassionate.
    I was watching Vincent Browne. tv 3 from Tuesday night, 13 November. I was raging with anger, having listened to Vincent. Reading Irish Times headlines. I am pro choice.

  2. Sarah Gorman

    Thank you for this piece. I am a recently married woman of child-bearing age and Savita’s death has upset and angered me.

    The main point in all of this is that Savita was not asking to be induced in order to kill her baby. The baby seemed to be much wanted, and she would have been devastated to learn that she was losing it 4 months into the pregnancy.

    But the child did not stand a chance of survival. The membranes had ruptured, the cervix was fully dilated, leaving her open to infection. All the international guidelines that I have read say that immediate induction and antibiotics are recommended in such instances.

    I cannot believe that it would have been wrong for the doctors to induce the birth and potentially save her life. The baby was not going to live, and its parents no doubt grieved for it. But Savita wanted to live. To be a wife, a daughter and hopefully a mother. Was it so wrong for her to ask to be saved from the physical and emotional agony that she was enduring?

    I am a moderate on this issue. I absolutely do not wish to see abortion on demand, but I do want to see women’s lives protected. When a miscarriage is already happening and nothing can be done, I would like doctors to be able to induce birth and save the life of the mother.

    I feel so so sorry for Savita and her family. This is the most terrible tragedy and it could have been prevented. I also – selfishly – feel worried that the same thing could happen to me someday.

    Please tell me that I am not being unreasonable.

  3. Sean (Derry)

    Con @no.1, when you say you are ‘pro-choice’, don’t you really mean that you are pro-abortion?

  4. Rory Connor

    There is a Wikipedia article entitled “Death of Savita Halappanavar”
    Included under the heading “Political Response” is the following:
    Dr James Reilly, the Minister for Health, said we “could not pre-judge” the situation and that he was waiting for the results of the investigations, adding he had no evidence to suggest a Catholic ethos at the hospital prevented the pregnant woman’s life from being saved by a medical termination.[25]
    Galway West Fine Gael TD Brian Walsh said that Galway University Hospital had carried out terminations in recent years in accordance with the Supreme Court judgment in the X case and Medical Council guidelines. He said it was not managed by any religious order and did not have a Catholic ethos.[27]

    And there is another heading “Reaction” that includes this:
    According to an Irish Times report on 16 November, staff and users of University Hospital Galway were keen to dismiss suggestions of any Catholic ethos influencing treatment decisions. Sources close to the hospital stressed that not only was there “no particular ethos” at the hospital but it was very well resourced with a high level of specialist care. “This is why it’s such a shock,” said Cllr Catherine Connolly (Ind), a member of the HSE West’s regional health forum. “As someone born and reared in Galway, I can say it [a Catholic ethos] never came to my attention. There is a huge waiting list and there is a big issue around cutbacks but once you get into the hospital the treatment is second to none.” Cllr Michael Crowe (FF), also a member of the HSE forum, said the hospital operated on the basis of “patient first”. “My belief is if there’s any threat to life, regardless of the context, the medical people would protect the patient. There is no other issue at play. I can say that as a patient, a visitor, and a member of the [forum],” he said. Medical sources similarly downplayed any suggestion of a particular religious ethos at the hospital. [17]
    I hope this helps to calm the people who believe that the Catholic Church is responsible for all evil in Ireland- but this is probably too much to hope for!

  5. Gene Carr

    Rory: You seem to be implying that if the hospital had been run by a religious order and had a Catholic ethos, then Savita might have been denied treatment including early enducement. Correct me if I am wrong but I understand that such treatment is perfectly compatible with Catholic medical ethics.

  6. Neil Addison

    In the Indian Newspaper “The Hindu” November 16, 2012

    Gynaecologist Hema Divakar, president-elect of the Federation of Obstetric and Gynaecological Societies of India (FOGSI) for 2013-2014, (so clearly a senior and respected Gynaecologist) said

    “Based on information in the media, in that situation of septicaemia, if the doctors had meddled with the live baby, Savita would have died two days earlier.” “Delay or refusal to terminate the pregnancy does not in itself seem to be the cause of death. Even if the law permitted it, it is not as if her life would have been saved because of termination,” she said.

    “Severe septicaemia with disseminated intravascular coagulation (DIC), a life-threatening bleeding disorder which is a complication of sepsis, major organ damage and loss of the mother’s blood due to severe infection, is the cause of death in Savita’s case. This is what seems to have happened and this is a sequence which cannot be reversed just by terminating the pregnancy.” “Based on available information, Savita would have reported pain and infection and doctors would have indicated a miscarriage as the 17-week foetus may not have grown as expected. Its growth would have been deteriorating because of the infection. Having understood that the baby was not going to make it, the couple would have asked for termination. But as Savita’s infection may have required aggressive treatment at that stage, doctors must have felt the need to prevent complications. The usual [practice] is to meddle the least till the mother is stable.”

    There are other medical opinions expressed in the Article but this opinion is by the most Senior Indian Gynaecologist. Even if the only point is that there is a difference of opinion in medical circles that of itself is significant. The doctors and nurses in Galway and the Irish Constitution are being villified as the facts in case were certain and the Demonstrators in Dublin were accusing Ireland of having Blood on its Hands. I am not Irish I am English but I dislike the way Ireland is allowing itself, its Constitution and and its medical staff to be subjected to all this unjustified criticism

  7. Sean (Derry)

    Neil Addison @no.6, well stated. It’s good to see that at least an Indian newspaper has presented a balanced piece of journalism in this case, unlike the hysterical outcry from every pro-abortion advocate attaching themselves like parasites to this sad death with the intention of furthering only their own pathetic cause. No medical reports have been made available on this particular case but it’s amazing how so many people can suddenly overnight become experts in obstetrics whilst all headlines scream ‘Woman dies after being refused an abortion’.
    As we know from experience facts and truth don’t matter when an opportunity arises to push forward an agenda of death that is dependent upon false information for its very survival.
    Unfortunately the medical staff involved have already been tried and found guilty of having no consideration for the life of the mother.
    It would be interesting to know how many women die as a result of having an abortion.