Medical Malpractice and Treating Tragedies as Political Footballs

The horrific news last night that a 31-year-old dentist, Savita Halappanavar, died from septicaemia a fortnight ago following a miscarriage in Galway University Hospital looks almost as perplexing as it is tragic. I'm glad that two investigations are currently taking place into what exactly happened, because the whole thing mystifies and appalls me.

Seemingly Savita presented at hospital seventeen weeks pregnant and in extreme pain, and was told she was miscarrying; the following day she asked for the pregnancy to be terminated, but was denied one on the basis that the child was still alive, with somebody saying 'this is a Catholic country'; she remained in pain for two-and-a-half further days until the foetal heartbeat stopped. 

The Irish Times goes on to say that the third day Savita was in hospital she asked if labour could be induced to end the pregnancy, but the consultant refused, again apparently saying it was the law and 'this is a Catholic country'. Savita remained in agony all that night and into a fourth day, but the hospital refused to end this. Eventually the foetal heartbeat stopped, and Savita was taken to ward.

Two days later she died.

Obviously this is horrible, sickening, and tragic. 

I hope those investigations get to the bottom of what happened. I'd hope too, that appropriate action be taken if anyone claimed that the hospital couldn't help Savita as it would be against the law for it to do so, especially on the spurious grounds that, as was supposedly said, 'this is a Catholic country'. And if the hospital's negligence veered into the realms of the criminal, then I really hope there are suitable consequences.

The thing is, assuming that the reporting is accurate, and given the Irish Times' recent record on life issues, it may not be, this doesn't make sense. As far as I can see, Galway University Hospital would have been fully within its legal rights to have induced a preterm delivery -- or foetal evacuation -- in an attempt to save both mother and child. Indeed, not merely would it have been within its rights to do so, doing so would have been normal medical practice. 

This is exactly the sort of thing that Dr Berry Kiely talked about back on what was an uncommonly good Vincent Browne show back in the Spring -- you induce a preterm delivery, thus saving the mother, and you do everything you can to try to save the child. You almost certainly fail, but you try. 

In 2000, Professor John Bonnar, then chairman of Institute of Obstetricians and Gynaecologists, which represents 90%-95% of Ireland's obstetricians and gynaecologists, explained the situation to the All Party Oireachtas Committee's Fifth Report on Abortion as follows:

'In current obstetrical practice rare complications can arise where therapeutic intervention is required at a stage in pregnancy when there will be little or no prospect for the survival of the baby, due to extreme immaturity. In these exceptional situations failure to intervene may result in the death of both the mother and baby. We consider that there is a fundamental difference between abortion carried out with the intention of taking the life of the baby, for example for social reasons, and the unavoidable death of the baby resulting from essential treatment to protect the life of the mother.'

In other words, for the hospital to have induced labour of the foetus with the intention of saving Savita, would, surely, have been in accord both with Irish law and normal Irish medical practice. It seems that such situations have nothing to do with the X Case, for all the well-meant cries that the failure of the Oireachtas to legislate for that is to blame here.

Bonnar elaborated on such situations as follows:

'We have never regarded these interventions as abortion. It would never cross an obstetrician’s mind that intervening in a case of pre-eclampsia, cancer of the cervix or ectopic pregnancy is abortion. They are not abortion as far as the professional is concerned, these are medical treatments that are essential to protect the life of the mother. So when we interfere in the best interests of protecting a mother, and not allowing her to succumb, and we are faced with a foetus that dies, we don’t regard that as something that we have, as it were, achieved by an abortion.  

Abortion in the professional view to my mind is something entirely different. It is actually intervening, usually in a normal pregnancy, to get rid of the pregnancy, to get rid of the foetus. That is what we would consider the direct procurement of an abortion. In other words, it’s an unwanted baby and, therefore, you intervene to end its life. That has never been a part of the practice of Irish obstetrics and I hope it never will be.'

Despite having no shortage of friends who are medical practitioners of one sort or another, including embryologists, obstetricians, and midwives, I'm obviously not one myself so I'm not qualified to judge, but it seems to me that at least on the basis of the facts as reported, this was a straightforward and stomach-churning case of shocking -- possibly even criminal -- medical malpractice with a tragic outcome.

After all, section 21.4 of Ireland's Guide to Professional Conduct and Ethics for Registered Medical Practitioners seems to be unambiguous about this sort of situation, saying exactly what Professor Bonnar said to the Oireachtas Committee:

'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.'

This is indeed the standard by which this affair should be judged. The problem here wasn't with the law.

The problem wasn't with religion either, for all that people are leaping to blame Galway's religious ethos, or the stupid and bizarre claims that 'this is a Catholic country'. Leaving aside how Ireland is not legally defined as a Catholic country, Catholic teaching allows for the normal Irish medical practice in this case, just as Irish law does. 

The problem seems to have been solely with somebody -- for whatever reason -- failing to obey both the law and the medical profession's own code of conduct, and attributing their failure to Ireland being -- supposedly -- a Catholic country. If that's what's happened then people should be bloody furious about this.

But while anger's one thing, it makes no sense to talk of how this tragedy means we should change the law to make sure that this doesn't happen again. Law isn't magic: if doctors can disregard law and medical practice now, then they can do so in the future, regardless of what the law says.

At least based on the facts as reported, I don't see how new legislation would help here. There are clearly people who think Ireland's laws, which require that human life be respected and protected from conception to natural death, are barbaric and oppressive. I understand that, but regardless of what they think, it really seems that Ireland's laws weren't at fault here. I may turn out to be wrong, but as far as I can tell, this has nothing to do with the X Case.

There are investigations that need to run their course. There'll be a time for anger, and we should make sure it's the right kind of anger, and directed at the right target. In the meantime, I think it'd be best if Savita Halappanavar weren't treated as a political football.


Update: It's been pointed out to me that according to the reports, Savita was admitted to hospital with a miscarriage underway, her cervix being open from Sunday, but that antibiotics were only brought into play on Tuesday night, a full two days later; it's as though she spent two days there with an open wound. Again, I'm no doctor and would appreciate if someone could clarify this, but given that this was a case of death from infection,  it seems to me to have been utterly egregious medical negligence from the start, and nothing whatsoever to do with the law, medical guidelines, or religious principles.