More arguments over denying Dr. Halappanavar an abortion in Ireland

The death of Dr. Savita Halappanavar in an Irish hospital is provoking a great deal of analysis and argument.

The editor in chief of RH Reality Check, Jodi Jacobson, wrote two insightful articles. Among her observations:

1. The unwillingness of Irish politicians to create clear legal guidelines for abortion in life-threatening situations is unacceptable. In Dr. Halappanavar's case, however, the primary problem was that she was a patient in a Catholic hospital. Given the clear medical needs of Dr. Halappanavar, Catholic doctrine, and not Irish law, was the primary culprit in causing Dr. Halappanavar's death.
2. This is not an isolated case: In other countries with restrictive abortion laws (and cultures), women have died as a result of being denied an abortion.

Could this happen in the United States? One would think, "no," given our relatively open laws and high public support for life-saving abortion care. But consider Jacobson's suggestion: This might have been less a problem of Irish law than a problem of a Catholic institution unwilling to violate Catholic doctrine. 

In fact, wrote Katha Pollitt in The Nation, there has been a case like this in the United States, but with better results, due to the good wisdom of a hospital administrator:

If you think it couldn’t happen in the United States, you haven’t been paying attention. After all, in 2010, Sister Margaret McBride, an administrator in a Catholic Hospital in Phoenix, was fired and excommunicated after she approved a first-trimester abortion for a woman with life-threatening pulmonary hypertension. What happens in Catholic hospitals when there’s no Sister Margaret willing to risk the bishops’ wrath? With conscience clauses expanding to cover not just individual doctors but whole hospitals, a pregnant woman may find her care is being dictated not by standard health protocols but by a religion she doesn’t even follow. Savita was a Hindu, after all. What about her conscience?

On the question of medical necessity, Dr. Jen Gunter, an OB/GYN who blogs, analyzed Dr. Halappanavar's case and concluded that "there is no medically acceptable scenario at 17 weeks where a woman is miscarrying AND is denied a termination. . . ." She also writes, "As Ms. Halappanavar died of an infection, one that would have been brewing for several days if not longer, the fact that a termination was delayed for any reason is malpractice." I think it is going to be very hard for the pro-life movement to continue suggesting that abortions are never "medically necessary." 

The pro-life media has been relatively quiet on this case, perhaps because there is almost nothing to be said that would be to the benefit of the pro-life movement. The author of an interesting article in LifeNews.com, Evelyn Fennelly, suggests that performing an abortion in Dr. Halappanavar's case would not have violated Catholic doctrine and would have been consistent with current Irish Medical Council guidelines. Therefore, Catholic doctrine and Irish abortion law are not to blame for the tragedy-- bad doctoring is.

I'm no expert on Catholic doctrine, but my understanding is that intentionally and directly killing the fetus as the means of addressing a medical complication is not permitted. The death of a fetus is only acceptable when it is the incidental effect of other forms of medical treatment.

So, for example, in the case of an ectopic pregnancy, removing the embryo from the fallopian tube is an abortion and impermissible. Removing the entire fallopian tube, however, which incidentally kills the embryo, is morally acceptable. Semantics? Angels dancing on the head of pin?

In the case of Dr. Halappanavar, if doctors would have hastened her miscarriage by performing a "D&E" (removing the contents of the uterus), wouldn't this have violated Catholic doctrine, as killing the fetus would have been the means by which Dr. Halappanavar's medical condition was resolved?

If readers know more about Catholic doctrine, I invite them to weigh in. Interestingly, one of the articles Ms. Fennelly cites to support her position that an abortion would have been morally justified in this situation (from Catholic.net) appears to undermine it, by making the direct-is-wrong, incidental-is-okay distinction. But another writer cited by Ms. Fennelly, writing at CatholicHerald.co.uk, seems to think that Catholic doctrine obviously would allow direct-yet-life-saving abortions.

So isn't this the point? It does not seem to me clear at all that there is an obvious consensus on what Catholic doctrine allows in cases like Dr. Halappanavar's.

Setting aside Catholic doctrine, the Medical Council guidelines quoted by Ms. Fennelly do seem to allow for abortion as a direct form of medical treatment (the relevant language is on page 21):

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.

Furthermore, Ms. Fennelly quotes a few doctors who seem to say that a therapeutic abortion would have been justified in Dr. Halappanavar's case. Three considerations, however:

1. Jodi Jacobson's point still stands: If Catholic doctrine does not permit abortion in Dr. Halappanavar's case, then Irish law and Medical Council guidelines are irrelevant in a Catholic hospital. 
2. It is not clear that the Medical Council's guidelines are pegged to Irish law. In other words, doctors might think it appropriate to follow the Medical Council's guidelines but be unsure if, in following those guidelines, they are violating the criminal law. Therefore, they might still hesitate to do the right thing.
3. The stated opinion of one or two doctors about what is or is not legally permitted does not indicate if Irish legal guidelines are clear enough for all reasonable doctors to come to the same conclusion.

Links:

Article in RH Reality Check (November 14, 2012): Irish Law, "Conscience Clauses," and Needless Death: Three Questions About Savita Halappanavar's Death

Article in RH Reality Check (November 13, 2012): We Are All Savita Halappanavar: Catholic Hospital in Ireland Denies Woman Life-Saving Abortion

Article in The Nation (November 14, 2012): When 'Pro-Life' Kills

Post at Dr. Jen Gunter's blog: Did Irish Catholic law or malpractice kill Savita Halappanavar? 

Article in LifeNews.com (November 16, 2012): Savita Died Because Doctors Failed to Follow Irish Pro-Life Law

The Medical Council of Ireland's Guide to professional conduct and ethics for registered medical practitioners, 7th edition (2009)

Essay at Catholic.net by Patrick Henry Reardon (2009): Abortion and the mother's life

Article in Catholic.Herald.co.uk (November 15, 2012): The tragic death of Savita Halappanavar should not be exploited to sweep away Irish abortion law, under which she could legally have been saved