Limited access to abortion in Ireland is causing further scandal.
An Indian woman who lived in Ireland, Dr. Savita Halappanavar, died because doctors delayed addressing complications from her miscarriage at 17 weeks of pregnancy. Dr. Halappanavar was in the process of miscarrying. The process of miscarriage introduces the danger of serious infection, with the risk increasing over time. The indicated treatment, then, is to hasten the end of the pregnancy-- i.e., perform an abortion. Dr. Halappanavar's doctors did not, and she died of septicemia.
The first thought that came to mind after reading about this tragedy was that Dr. Halappanavar's sad and avoidable death is direct evidence against the assertion that an abortion is never "medically necessary" to save the life of a pregnant woman.
Given that the Dr. Halappanavar's unborn child, at 17 weeks, was pre-viable and 100% certain to die-- she was, after all, in the process of miscarrying-- why wouldn't doctors speed up the end of the pregnancy? Because the fetus was still alive, and to speed up the miscarriage would constitute an abortion.
There are three explanations for the doctors' behavior.
First, to intentionally kill the fetus, even though its death was inevitable, is against Catholic doctrine. It is not clear, however, that the doctors were motivated directly by their Catholicism-- or even if they are Catholic-- although one doctor did reportedly tell Dr. Halappanavar, "this is a Catholic country."
Second, the doctors did not believe that hastening the end of the pregnancy was medically indicated. This, according to a medical expert interviewed by The New York Times, is implausible:
As discussed in an earlier post, the problem in Ireland is not that it lacks a medical necessity exception to its general abortion ban. It has one, as ordered by the Irish Supreme Court in 1992 and the European Court of Human Rights in 2010. Instead, due to strong social and political pressure, the Irish government has never actually passed laws and regulations to implement the exception, so that Irish doctors and hospitals would have a clear sense of when and how they can legally terminate pregnancies. As a result, I speculate that hospitals do not develop protocols like those suggested by Dr. Houston, because there are no clear legal guidelines to which to peg hospital guidelines.
Furthermore, as a general rule, when the criminal law is unclear-- when one is not sure what is or is not legally prohibited-- it has a 'chilling effect' on behavior. People who might run afoul of a law go out of their way to avoid breaking it. In Ireland, doctors are 'chilled' from performing any abortions because they are worried about being criminally prosecuted and having their medical careers ruined.
Blame in this case, then, should fall on the doctors, who should ultimately have put the interests of Dr. Halappanaver first. But blame also rests with Irish politicians, who have left doctors, hospitals, and, most importantly, women, in legal limbo, with tragic results.
POSTSCRIPT 1: Dr. Halappanavar's death could serve as a catalyst for the Irish government to develop and implement legal guidelines for medically necessary abortions. The government is making noises in that direction, although they have delayed and failed before.
POSTSCRIPT 2: Because Dr. Halappanavar was Indian, the Indian public and government have expressed general outrage, and the Indian government has talked directly to the Irish government. India legalized abortion in limited circumstances in 1972 (life, rape, contraceptive failure, etc.). There has been very little public opposition to abortion in India, so there is likely to be little sympathy for Irish abortion bans rooted in Catholic culture and doctrine.
Links:
Article in The Guardian (November 15, 2012): Irish abortion: external investigator to head inquiry into woman's deathhttp://www.guardian.co.uk/world/2012/nov/15/external-investigator-irish-abortion-death
Article in The Guardian (November 13, 2012): Scandal in Ireland as woman dies in Galway 'after being denied abortion'
Article in The New York Times (November 14, 2012): Hospital Death in Ireland Renews Fight Over Abortion
Article in The New York Times (November 16, 2012): From India, Pressure on Ireland Over Abortion Laws
Article in the New York Daily News (November 14, 2012): Ireland probes death of ill abortion-seeker from India
For a sense of Indian law and culture regarding abortion (and a fascinating discussion of the problem of sex-selective abortion in India), read The Means of Reproduction, by Michelle Goldberg.
An Indian woman who lived in Ireland, Dr. Savita Halappanavar, died because doctors delayed addressing complications from her miscarriage at 17 weeks of pregnancy. Dr. Halappanavar was in the process of miscarrying. The process of miscarriage introduces the danger of serious infection, with the risk increasing over time. The indicated treatment, then, is to hasten the end of the pregnancy-- i.e., perform an abortion. Dr. Halappanavar's doctors did not, and she died of septicemia.
The first thought that came to mind after reading about this tragedy was that Dr. Halappanavar's sad and avoidable death is direct evidence against the assertion that an abortion is never "medically necessary" to save the life of a pregnant woman.
Given that the Dr. Halappanavar's unborn child, at 17 weeks, was pre-viable and 100% certain to die-- she was, after all, in the process of miscarrying-- why wouldn't doctors speed up the end of the pregnancy? Because the fetus was still alive, and to speed up the miscarriage would constitute an abortion.
There are three explanations for the doctors' behavior.
First, to intentionally kill the fetus, even though its death was inevitable, is against Catholic doctrine. It is not clear, however, that the doctors were motivated directly by their Catholicism-- or even if they are Catholic-- although one doctor did reportedly tell Dr. Halappanavar, "this is a Catholic country."
Second, the doctors did not believe that hastening the end of the pregnancy was medically indicated. This, according to a medical expert interviewed by The New York Times, is implausible:
Third, and more plausible, doctors were afraid of violating Irish criminal law.During a miscarriage, the cervix is opened, exposing the woman to infection, and the longer the miscarriage persists, the greater the risk, said a prominent medical commentator here, Dr. Muiris Houston. While Dr. Halappanavar’s death was “on the rare end of the spectrum,” and the facts surrounding the case are not all known, Dr. Houston said, she “undoubtedly needed to go to theater,” meaning to surgery.“If she had gone to theater earlier she might still have died, but perhaps not,” he said. “Medicine is now increasingly driven by guidelines, and the question must be, ‘Did the hospital have protocols in place when a woman presented with such a condition?’
As discussed in an earlier post, the problem in Ireland is not that it lacks a medical necessity exception to its general abortion ban. It has one, as ordered by the Irish Supreme Court in 1992 and the European Court of Human Rights in 2010. Instead, due to strong social and political pressure, the Irish government has never actually passed laws and regulations to implement the exception, so that Irish doctors and hospitals would have a clear sense of when and how they can legally terminate pregnancies. As a result, I speculate that hospitals do not develop protocols like those suggested by Dr. Houston, because there are no clear legal guidelines to which to peg hospital guidelines.
Furthermore, as a general rule, when the criminal law is unclear-- when one is not sure what is or is not legally prohibited-- it has a 'chilling effect' on behavior. People who might run afoul of a law go out of their way to avoid breaking it. In Ireland, doctors are 'chilled' from performing any abortions because they are worried about being criminally prosecuted and having their medical careers ruined.
Blame in this case, then, should fall on the doctors, who should ultimately have put the interests of Dr. Halappanaver first. But blame also rests with Irish politicians, who have left doctors, hospitals, and, most importantly, women, in legal limbo, with tragic results.
POSTSCRIPT 1: Dr. Halappanavar's death could serve as a catalyst for the Irish government to develop and implement legal guidelines for medically necessary abortions. The government is making noises in that direction, although they have delayed and failed before.
POSTSCRIPT 2: Because Dr. Halappanavar was Indian, the Indian public and government have expressed general outrage, and the Indian government has talked directly to the Irish government. India legalized abortion in limited circumstances in 1972 (life, rape, contraceptive failure, etc.). There has been very little public opposition to abortion in India, so there is likely to be little sympathy for Irish abortion bans rooted in Catholic culture and doctrine.
Links:
Article in The Guardian (November 15, 2012): Irish abortion: external investigator to head inquiry into woman's deathhttp://www.guardian.co.uk/world/2012/nov/15/external-investigator-irish-abortion-death
Article in The Guardian (November 13, 2012): Scandal in Ireland as woman dies in Galway 'after being denied abortion'
Article in The New York Times (November 14, 2012): Hospital Death in Ireland Renews Fight Over Abortion
Article in The New York Times (November 16, 2012): From India, Pressure on Ireland Over Abortion Laws
Article in the New York Daily News (November 14, 2012): Ireland probes death of ill abortion-seeker from India
For a sense of Indian law and culture regarding abortion (and a fascinating discussion of the problem of sex-selective abortion in India), read The Means of Reproduction, by Michelle Goldberg.
Comments