Savita Halappanavar- the thread to actually talk about the case

(106 Posts)
ZombiesAreClammyDodgers Thu 15-Nov-12 16:00:11

Away from the madness of the other thread.

Xiaoxiong Thu 15-Nov-12 16:10:39

Can I just mark my place by repeating from the other thread: if you like me are outside Ireland but desperate to do something, please donate to Choice Ireland - they sent me a lovely note last night thanking me for my donation. It said RIP Savita at the end sad

I have been thinking about this alot, probably because I had a similar experiance.

I wonder if she was given medication that masked the symptoms of infection? For instance steroids for the lungs can mask symptoms of infection. Although I wouldn't think they'd give these as early as 17 weeks.

So can labour. I wonder if they'd induced a few days before if they would have noticed the signs of infection post birth. As it was the infection was probably getting worse the same time as she was induced.

Symptoms of infection such as raised bp, pain, changes in pulse temperature etc may all of been put down to labour when really it was infection iyswim

LeBFG Thu 15-Nov-12 16:18:09

Raised temp is always an infection??? THis is something I can't get my head around. The infection was probably there when she arrived, or at least soon after. Surely she would have had a temp - Were they not monitoring it?

The whole case just makes me feel desperately sad, on just about every level.

RedToothbrush Thu 15-Nov-12 16:20:12

But surely that doesn't explain away the facts that

a) they knew she was miscarrying anyway so even if the infection was masked it didn't make a difference
b) they withheld treatment because she was pregnant and they either feared/misunderstood the law or their religious beliefs affected their decisions.

Either way, it doesn't make any difference. She wasn't treated properly because she was pregnant. Had she been in a situation where she wasn't pregnant different decisions would have been made.

LeBof well no raised temp isn't always an indication of infection, labour can cause an increase in temp as can chronic pain

Of course it makes a difference, if it is the case then if they'd induced her when she wanted 3 days before, labour wouldn't have masked the symptoms of infection. Even so she should have been given antibiotics as a precaution.

ZombiesAreClammyDodgers Thu 15-Nov-12 16:43:55

Isn't it a case of antibiotics not really being to avoid ( just slow the onset of septicaemia down) if the foetus is dead or dying already?

ZombiesAreClammyDodgers Thu 15-Nov-12 16:44:17

being able

Not sure, I've had pprom 3 times and was always told they were giving abs as a precaution even though I showed no signs of infection

LeBFG Thu 15-Nov-12 16:52:41

Moomin - I can see labour will increase body temp like doing sport can. Surely a fever temp (i.e. 38+) would indicate infection rather than just labour?

(I have no idea - just asking. When I went into preterm labour they frequently checked my temp as a common cause of preterm labours is infection).

ICBINEG Thu 15-Nov-12 17:17:13

So the discussion I nearly got into on the other thread was how you can have a definition of when to intervene given that medics are always dealing in probabilities.

If you can intervene when the mothers life is definitely at risk then that is a carte blanche to never intervene as one can never prove life is endangered until it is too late.

If you say potential risk to the mothers life then that includes all pregnancies.

<hopes this isn't one of the banned topics>

That is the think (or one of the things): temperature is routine monitored in labour, antibiotics are routinely given if rupture of membranes has occurred, conservative or active management of miscarriage is offered as a matter of routine.

This woman was not offered what is considered routine medical care in the rest of the Western world (and a fair bit of the rest of the world too btw).

Maybe it would help the discussion about it to refer to 'actively managed miscarriage' rather than the more emotive 'termination'? The pregnancy was terminating itself already, maybe because of infection that was already there.

Having the fetus in utero will have kept any potential uterine infection going.

Curtsey Thu 15-Nov-12 17:29:40

On Irish radio today I listened to a woman describe a miscarriage she underwent at 12 weeks' gestation. A heartbeat was found for quite a long time into the miscarriage despite heavy bleeding and the woman became very ill. The consultant came and explained to her that he would have to do a D and C to save her life. She was confused as she was so ill and said 'but what about the heartbeat' and he said I'm sorry, there's just no way to save the baby and this is the only way to save you.
So this happened in Dublin 8 years ago and the woman was quite clear about the fact that he had saved her life.

LeBFG Thu 15-Nov-12 17:39:17

Clearly pg is inherantly risky.

Defining when mother's life is at risk could mean:

making a short list of conditions which pose strong likelihood of death: pre-eclampsia, ectopic pg are two obvious ones. I think this is how Ireland operates in general i.e. abortions in these cases.

relying on expert obs/gyn assessment of risk of death - with guidelines based on precedent perhaps.

as above, but including other health professionals (I'm thinking of psycologists and suicide risk)

making a long list of conditions that are unlikely to lead to death if untreated but carry a greater risk than an uncomplicated pg: not sure of any (I'm not a medic).

As I said in the other thread, you just draw a line in the sand. Debate will continue around the line but this is inevitable in when you draw lines!

grimbletart Thu 15-Nov-12 17:51:33

Given that Savita was told that foetal death was inevitable and that the pregnancy could not be saved and that she then requested treatment to bring her ordeal to a swifter end, there was absolutely no reason for the doctors not to comply.

Her condition and her request for induction IMO overrides any other consideration (unless the doctors thought that induction/termination would of itself actually increase the risk to her life or the risk of infection). That, I find difficult to believe unless we have a doctor on the boards here who would tell us that induction/termination would pose a greater risk in these particular circumstances than allowing the miscarriage to continue naturally.

So, we are left with likeliest explanation given the comments about Ireland being a Catholic country and the existence still of a foetal heartbeat, that it was lack of clarity in the law or doctors' fear of the law that lead to Savita's death.

Extrospektiv Thu 15-Nov-12 18:25:10

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sieglinde Thu 15-Nov-12 18:29:23

Moomins, snap! I had a massive infection after a miscarriage and also after birth of ds1. In the second case it was completely undiagnosed; I myself noticed it because I'd had one before, and I had really obvious symptoms - high fever, sweating, and a stinky discharge.

I don't think many registrars know much about it. I bet they did miss it until it was too late to treat it with antibiotics. My membranes were ruptured and I was not given antibiotics on either occasion. I think this highlights the shocking lack of care for pregnant women in all arenas.

sieglinde Thu 15-Nov-12 18:33:54

Sorry, meant to add that in both cases infection came after the end of the pregnancy/delivery of the placenta. Was the foetus the source of the sepsis? I'm pretty sure with ds1 that he wasn't because he was born alive - think it was a hospital germ introduced with instruments.

CookingFunt Thu 15-Nov-12 18:39:28

I'm so angry at Savita s needless death. It should not have happened.

And as mentioned on the other thread,my mother had a symphsiotomy. I have talked of this before on MN,she did not realise until her doctor told her a couple of years ago. She was given it in 1972.

The more I think about this tragic case, the more I feel that this is not actually about termination and where you stand on the subject, but about bad medical care.

Pregnancy and childbirth ARE inherently dangerous, of course, and nobody who has ever been invovled in the care of a woman who died in that context will ever forget about it or be left unchanged by it. It is a horrible event in any set of circumstances, and people do of course die of septicaemia without pregnancy being a factor.
However, once the membranes have ruptured and the cervix has opened it leaves a rather unique opportunity for bugs to enter a very fertile breeding ground, often with disastrous consequeces, usually for the fetus, but sometimes for the mother.

What stinks about this case is that IMO a)this was never going to be a 'termination; the pregnancy was already ending b)she was not managed in what is accepted normal practice, c)it seems she had actively asked for more intervention and was denied it.

My heart goes out to Savita's husband and family.

<<off to donate to ChoiceIreland>>

BOFingSanta Thu 15-Nov-12 18:48:54

Can I just point out that LeBOF is one of my old names, and I'm not on this thread but Le B F G is? People do tend to mix them up, but we are different posters.

Agree with pacificdogwwod about emotive terms, but my understanding of the law is that it's illegal to procure a miscarriage, however it happened spontaneously so would if she was offered medical management would the doctors have been 'procuring' a miscarriage?

My understanding is that, yes, that is their reasoning. Which I don't follow at all - the fetus was dying, sadly, so potentially a life could have been saved by removing it and possibly saving the mother's life.

pointythings Thu 15-Nov-12 19:08:43

Extro can I just say that posting that link on this of all pages is in the most horrendous bad taste I have ever seen on MN?

I think there are two issues here:

1) The pregnancy could not be saved. That being so, from a purely medical point of view, what should have happened was the minimisation of the risk of infection as far as was possible. Which should have meant immediate termination, to allow the uterus to close, aggressive treatment with antibiotics, and constant monitoring.

2) The Irish government needs to stop dragging its feet and implement legislation and clinical guidelines so that doctors can intervene in cases like this without fearing prosecution.

ZombiesAreClammyDodgers Thu 15-Nov-12 19:22:10

pointy agree. It was a disgusting thing to do when there is a strong case to argue that that lobby's actions have in some ways resulted in this woman's death.
Absolutely disgusting.
Why on this thread??

pointythings Thu 15-Nov-12 19:26:15

Thanks, OP. I am very angry about Extro's insensitivity and so I have reported the post. Though I'll understand if it is not removed.

CookingFunt Thu 15-Nov-12 19:27:35

The government seem to be afraid of upsetting the anti-abortionists and losing votes,than saving womens lives. There is a facebook group called TFMR that is asking for legislation for termination for medical reasons (no chance or quality of life outside the womb). The stories are heartwrenching and a real insight into what women in Ireland are up against.

AnyaKnowIt Thu 15-Nov-12 19:29:47

I still can't understand why they left her in pain for 3 days sad

RIP Savita

AnyaKnowIt Thu 15-Nov-12 19:34:11

I've reported Extros post too

angry

Both the mother's and the foetus/baby's lives are held in equal status under the Irish constitution. So they medical staff could not choose to give her a D+C while there was still a hertbeat, unfortunately without breaking the law. The x case ( where a court ruled that a pregnancy that was the result of a rape put the mothers life in danger, therefore she was allowed to have a termination) has not been legislated for by seven governments. If it had been , theres a strong possibility Savita would still be alive.

DublinMammy Thu 15-Nov-12 19:45:50

I've reported it too.

freddie the point is that under Irish law, it's illegal to procure a miscarriage, in other words to 'bring about' which the medical staff absolutely wouldn't have done even if they managed the miscarriage by medical means. The poor woman was already having a miscarriage spontaneously.

But is this about abortion or medical negligence? I think there's clearly medical negligence but it's about abortion as she wasn't allowed the option which clearly would have been the best way forward.

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pointythings Thu 15-Nov-12 20:06:40

carrot I did not realise that Extro had pulled this stuff on the other thread - am horrified now. angryangryangryangryangry

MNHQ, please act!

Back on point: upthread ICBINEG was asking about when medics can intervene, about balance of probabilities, etc, is it a grey area?

I answered on the other thread but it probably was lost. According to the OBGyn in this article, there is no need to make a judgement call about these questions in a case such as this.

"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. Infection must always be suspected whenever, preterm labor, premature rupture of the membranes, or advanced premature cervical dilation occurs (one of the scenarios that would have brought Ms. Halappanavar to the hospital)."

*"there is no medically acceptable scenario at 17 weeks where a woman is miscarrying AND is denied a termination, *"

So there isn't a single medical reason that would justify denying her the termination in her circumstances.
No grey area. No balance of probabilities. Absolutely categorical.

pointythings Thu 15-Nov-12 20:17:08

You see, that's what I thought too. I just wonder whether the political climate in Ireland is so intimidating that doctors are terrified of prosecution to the point where they are paralysed with it. Which would be a very sad state of affairs indeed, but not surprising.

Agreed. The obgyn who wrote the article concludes

"As there is no medically acceptable scenario at 17 weeks where a woman is miscarrying AND is denied a termination, there can only be three plausible explanations for Ms. Hapappanavar’s “medical care” :

1) Irish law does indeed treat pregnant women as second class citizens and denies them appropriate medical care. The medical team was following the law to avoid criminal prosecution.

2) Irish law does not deny women the care they need; however, a zealous individual doctor or hospital administrator interpreted Catholic doctrine in such a way that a pregnant woman’s medical care was somehow irrelevant and superceded by heart tones of a 17 weeks fetus that could never be viable.

3) Irish law allows abortions for women when medically necessary, but the doctors involved were negligent in that they could not diagnose infection when it was so obviously present, did not know the treatment, or were not competent enough to carry out the treatment."

LeBFG Thu 15-Nov-12 20:24:05

Or, as the OB says in carrot's link, a zealous individual doctor or hospital administrator interpreted Catholic doctrine in such a way that a pregnant woman’s medical care was somehow irrelevant and superceded by heart tones of a 17 weeks fetus that could never be viable.

LeBFG Thu 15-Nov-12 20:24:40

Sorry x-posted

Curtsey Thu 15-Nov-12 20:25:14

Freddie doctors can and do terminate pregnancies/assist miscarriages even when there's still a heartbeat if the woman's life is at risk-see my earlier post. The question is why did this not happen in this case.

Separately but related, the question of why 6 governments have failed to legislate for the X case remains.

Abortion is prohibited in Ireland by sections 58 and 59 of the Offences Against the Person Act 1861:

58. Every Woman, being with Child, who, with Intent to procure her own Miscarriage, shall unlawfully administer to herself any Poison or other noxious Thing, or shall unlawfully use any Instrument or other Means whatsoever with the like Intent, and whosoever, with Intent to procure the Miscarriage of any Woman, whether she be or be not with Child, shall unlawfully
administer to her or cause to be taken by her any Poison or other noxious Thing, or shall unlawfully use any Instrument or other
Means whatsoever with the like Intent, shall be guilty of [an offence], and being
convicted thereof shall be liable, ..., to [imprisonment] for Life ....

59. Whosoever shall unlawfully supply or procure any Poison or other noxious Thing,
or any Instrument or Thing whatsoever, knowing that the same is intended to be
unlawfully used or employed with Intent to procure the Miscarriage of any Woman, whether she be or be not with Child, shall be guilty of [an offence], and being convicted thereof shall be liable, ..., to [imprisonment for a term not exceeding five years].

Ilovemydog - There is no exception there for cases where the mother's life is in danger.
The mother can travel to another
jurisdiction for an abortion in such
circumstances, and the Constitution allows for legislation providing an exception to the
ban in such circumstances, but no such exception has actually been created by legislation in Irish law. The medical staff, imo, are not to blame.

Curtsey Thu 15-Nov-12 20:27:45

Pointy, I'm not sure that the political climate in 2012 could rightly be described as 'intimidating'. 'Paralysed' is a better description. But as we've seen it doesn't really matter since the outcome is terrible either way.

pointythings Thu 15-Nov-12 20:38:37

But Freddie it is impossible to argue that anyone would have been procuring a miscarriage in this particular situation, since a miscarriage was already happening and had already been confirmed as being irreversible.

So I'm thinking that Curtsey's option 2 or option 3 are probably going to be correct, with the possibility that both were in play.

I suspect the outcome will be that the doctors get done for negligence and that the Irish government will continue to duck its responsibilities in legislating as they have been directed to do by the EHRC. Cowards that they are, each and every one. I wonder how many times this will have to happen again. sad

Hopefully they don't Pointy. I really believe the medical staff feel they were doing what they could within the constraints of the law, and that it wasn't simply for religous reasons.

The gathering of people outside Leinster House last night and the outrage expressed by the Irish public today will, I hope sway Fine Gael and spur them into drafting legislation which will legalise at the very least, abortion where the mother's life is in danger.

freddie that's the point though. It would not have been illegal to medically assist Savita as the illegal act is to procure a miscarriage which had happened spontaneously. This is the tragedy; that what she was asking for was well within the confines of the law.

Agree with pointy that this will probably change nothing in regards to Irish law about abortion and the doctors will be scapegoated with medical negligence.

Freddy: If every doctor knows that denial of termination in these circumstances poses a risk to the health and life of a mother then in Ireland they have a huge conflict with the law and should have been screaming from the rooftops for decades that the law as it stands prevents them from saving dying women.

Instead, too many Irish doctors have been denying what other doctors know to be true.

And if you are right then her doctors should now be saying
"we wanted to give her the termination. We know it is medically what she needed. We know that we did not give her the care she needed because the law prevented us from doing this. She died because the law prevented us from doing our jobs."

And then they should be struck off. Because she had a right to be treated by doctors who actually abide by the hippocratic oath, and any doctor who withholds lifesaving treatment from a patient for fear of their jobs, even for fear of prison is a coward and has no business in medicine.

edam Thu 15-Nov-12 21:30:01

This is such a horrible, horrible tragedy. The Catholic Church has Savita's blood on its hands. As does the Irish government - successive governments that have failed to uphold the European law that demands abortion be available when necessary to save a woman's life. As does the medical profession, which should have been shouting from the roof tops, and the doctors involved in her (lack of care) who, faced with a dying patient, should have fulfilled their moral and professional duty to save her life. As does everyone in Ireland who voted against abortion and particularly the anti-abortion movement.

edam Thu 15-Nov-12 21:32:45

(I wouldn't be quick to defend Irish doctors as being in an impossible situation legally either - firstly, their conscience and professional obligation must over-ride the muddled law or they have no business being in medicine, and secondly there is a long and extremely nasty history of Irish medics doing evil things to women because they were anti-contraception as well as anti-C section, let alone anti-abortion.)

pointythings Thu 15-Nov-12 21:58:14

Very good points, edam. I may have too much faith in human nature.

I have been watching the arguments develop and I am amazingly angry at some of them. Posters on other sites have been at pains to point out cases of women dying from legal abortions, without for a moment pointing out mortality statistics relating to illegal abortions. Then there's Extro with her compassion bypass and more like her. So many people don't seem to want to acknowledge that this was a situation where one life was already lost - and a second was also lost, needlessly.

I have two DDs - they may end up going to university in Ireland if the current situation with tuition fees stays the same. I will make damn sure that if anything goes wrong and they end up pregnant, they will have a termination in the UK if they want it. I am so grateful that I live in a civilised country.

FastidiaBlueberry Thu 15-Nov-12 22:11:59

I just wonder if there was an element of racism which influenced the way Savita was treated.

As I understand it, the law is a bit unclear in Ireland about whether you could abort in the circs they were in - baby was clearly dying and unviable and she at risk of death if termination didn't happen. So they could very possibly have carried out a termination and saved her life and had a reasonable confidence that their action would stand up in court as the baby was miscarrying anyway. Particularly as the EU is on their side - Ireland should be fucking thrown out of the EU if they don't clarify the law the way they're supposed to.

I'm wondering how many cases like this there are and whether there have been any where medics have in fact risked court believing that they could justify it legally. And if so, whether Savita was not just a victim of misogyny but also of racism. That crap "Ireland is a catholic country" sounds to me like someone talking to someone s/he considers not "one of us", not someone talking to a fellow human being in mortal danger, asking for medical care.

I could be completely off the mark but just wonder if anyone knows about this?

pointythings Thu 15-Nov-12 22:16:49

Fastidia we will never get to the bottom of that one, but it wouldn't susprise me <cynical>. Ireland isn't brilliant on inclusiveness for ethnic minorities, except perhaps in Dublin.

FastidiaBlueberry Thu 15-Nov-12 22:19:02

Sorry Curtsey just noticed your post.

So in fact, there are cases where doctors will abort in ireland and know that they won't be dragged before the beak.

So those doctors must have known this.

And they chose to let Savita die.

Bastards.

I think we'll have to agree to disagree pointy, carrot and everyone(!) until the independent report comes out and James Reilly gets up off his arse and reads it.

Pointy - have you ever been to Galway? It's probably the most open-minded, culturally diverse city in Ireland.

edam Thu 15-Nov-12 22:47:43

Curtsey, I'd missed your post because of the unfortunate juxtaposition with extro's bizarre and unpleasant contribution. That testimony is a very important point - that at least one doctor DID act to save a woman's life when she was miscarrying, so these doctors could have done the same, had they any conscience or competence.

Haven't clicked on extros link but am pretty sure that it does not add to the discussion.

This article in the Times today may explain what I've been trying to say a little more eloquently. No clear legislation for medical staff in these circumstances means they face a grey area where they have to use their own judgement. And in this case they made the wrong call and a woman died unnescessarily.

Freddy - legally perhaps, a grey area.
Medically, a black and white choice. Do your job, or fail to do it. Their job was to save her life.

I understand they faced a risk in doing their jobs. But to accept that position and treat that woman knowing they would fail her medically is still reprehensible.
If you can't do your job you can only either shout that you are being forced to risk lives and try to change things, and then be prepared to defy an unjust law
or leave the profession entirely.

If I was a builder being forced to build unsafe buildings that would collapse on people's heads I would leave the job rather than have a death on my hands. Claiming "they made me do it" (whilst continuing to stay in the paid employment of that profession) is no defence.

I get where you're coming from Carrot - but it ultimately boils down to the govt. avoiding drafting legislation after the judgement in the X case. If they had legislated, then no grey area would exist in the first place.

I do wonder if the HSE could have in this case attempted to gain a court order to do a D+D, thus 'terminating' the pregnancy? The HSE have done so in cases where life saving treatment was needed, such as the AB case and (rather unnescessarily) in the & CW case (See page 21 for an overview of the case)
. Interestingly enough, both of those cases involved going against the religous beliefs of Jehovah's Witnesses in order to provide medical treatment. I wonder if the same would be done in the case of Catholics. Probably notsad

madwomanacrosstheroad Thu 15-Nov-12 23:52:07

Fastidia, it seems that there may well have been an element in the treatment or rather lack of treatment of Savita. I was talking to a friend earlier at one of the protests and she was talking about her niece miscarrying last week in a dublin hospital. It was a totally different case in that it was much earlier in the pregnancy and the cervix was closed, so not the same risk of infection but it seems that while the embryo had stopped developing and growing there still was a suggestion of a possible heartbeat. The woman was offered an appointment for a d&c.
The issue re Savita is not directly about women's right to choose. However the gouvernment's persistent refusal to legislate for the x case has created a grey zone where the treatment Savita suffered could happen easily. As there is no legal definition, prioritising prolonging the life of a nonviable fetus over that of the mother depends on the judgement of the doctor. Women here are beginning to ask if the same would have happened had Savita been white.

ZombiesAreClammyDodgers Fri 16-Nov-12 00:00:38

Certainly "Ireland is a Catholic country" seems like patronising twaddle to a woman in agony and almost on her deathbed.

ZombiesAreClammyDodgers Fri 16-Nov-12 00:02:52

freddie the irony is nothing in her personal faith or beliefs presumably conflicted with what her request. Yet that was disregarded.
Dammit, she wanted to life! They had a duty to help her do that.

ZombiesAreClammyDodgers Fri 16-Nov-12 00:03:31

to live

madwomanacrosstheroad Fri 16-Nov-12 00:04:28

I was watching the english language el jazeera news channel there and they had a report in which Savitas widower announced he would do whatever it takesto change the status quo in ireland.
The taboo around abortion has been broken and there is international attention.

ZombiesAreClammyDodgers Fri 16-Nov-12 00:20:57

Mr. Kenny:"'A child has been lost, a mother has died and a husband is bereaved,' said Mr Kenny. 'That is a tragedy.'"

Even now all he can begin with is "a child has been lost"?!? angry

I certainly hope it had nothing to do with race, fastidiasad

Zombies,I would like to think the 'Ireland is a Catholic country' comment would have been someones clumsy attempt to explain the (slowly diminishing) stranglehold the catholic church has had on every aspect of Irish society, particularly the right to life of the unborn child. Maybe not thoughsad.

And Enda Kenny has been known to speak out against the church. An unfortunate turn of phrase, but no doubt calculated in order no to alienate the old guard who still vote Fine Gael.

- I hope the international attention will sway FG, madwoman. Labour had outlined that they would take action in their election manefesto, hence the appointment of the expert group, but I'd hazard a guess that FG were putting that on the long finger, hence James Reilly being too busy and important to read the damned thing and present his findings.

cartimandua Fri 16-Nov-12 00:36:46

But the poor woman didn't need an abortion. That's a complete red herring. She was miscarrying and the foetus was non-viable at 17 weeks. What she needed was clinical management of the miscarriage. The law on abortion in Ireland, or lack of it, has nothing to do with the case, except as a smokescreen for these cruel and incompetent doctors to hide behind. Of course if Ireland had civilised laws on abortion, like the rest of the Western world, the medical staff wouldn't have anything to hide behind.
The medical staff knew that the foetus had no chance of survival, they knew that in managing the miscarriage properly they would not have been performing an abortion, so how they could stand there for three days and watch a fellow human being die in agony is utterly beyond me.

sieglinde Fri 16-Nov-12 07:41:16

Oh, gods, we're back to this.

For a while there was a rational conversation going on about the way misogynist ideology was a reason for the crap medical care pregnant women face, all the time and with or without the separate issue of Irish abortion law, and now we are back to ranting.

FFS. I despair.

ZombiesAreClammyDodgers Fri 16-Nov-12 07:49:45

sieglinde that is indeed the key issue but it doesn't mean any comment on any other aspect is "ranting". I find the reaction of the government to an incident such as this to be germane.

sieglinde Fri 16-Nov-12 08:47:18

It is indeed, zombie, and it wasn't you I meant - friendly grin.

Sieglinde - I believe that Savita died as a result of many factors, the most pertinent being:

-the influence of the Catholic Church on Irish society -particularly the church's role as a social provider and the influence of the Catholic Church in the Irish political sphere for example, the preamble to the Constitution (upon which all Irish law is based...)

^"In the Name of the Most Holy Trinity, from Whom is all authority and to Whom, as our final end, all actions both of men and States must be referred,
We, the people of Éire, Humbly acknowledging all our obligations to our Divine Lord, Jesus Christ, Who sustained our fathers through centuries of trial,
Gratefully remembering their heroic and unremitting struggle to regain the rightful independence of our Nation,

And seeking to promote the common good, with due observance of Prudence, Justice and Charity, so that the dignity and freedom of the individual may be assured, true social order attained, the unity of our country restored, and concord established with other nations,
Do hereby adopt, enact, and give to ourselves this Constitution"^

-Political mishandling and avoidance of discussion on abortion and legislating for abortion in Ireland.

I feel that discussion of these factors and focusing our energies on the failure of 7 successive governments to act upon legislating for abortion is where our energies should be focused, as legislating for abortion (the best we can hope for is abortion in limited circumstances, to begin with, but this will hopefully open the debate on abortion) will lead to change.

If you don't believe these issues were a factor in the case or warrant discussion, then feel free to discuss misogynist ideology. I won't accuse you of 'ranting' simply because you wish to discuss a different topic.

chipmonkey Fri 16-Nov-12 10:08:30

Fastidia, I doubt if there was a racist element, I hope not. FWIW a lot of the doctors and nurses in the Irish health service are from India themselves and usually very highly regarded. The vast majority of Irish people are not racist.

LeBFG Fri 16-Nov-12 10:46:45

Somebody has already asked but not sure if there was a reply: when will we know the outcome of the investigation?

ZombiesAreClammyDodgers Fri 16-Nov-12 11:01:37

LeBFG- they said three months in the online news last night.

KRITIQ Fri 16-Nov-12 11:29:31

Just a quick point about infection. I would have thought it standard practice after someone is admitted with the history and symptoms that Savita had that a full range of blood tests would have been ordered immediately. It would have been possible to spot quite early on signs of infection from the white cell count, and soon after, from blood cultures.

In any case, when someone presents with clinical signs that they are at high risk of infection (e.g. leaking amniotic fluid, fully dilated cervix, etc.) the standard practice would be to order strong intravenous antibiotics prophylactically - that means as a precaution, before it is 100% clear that infection is present.

Years ago when I was briefly in hospital with sever abdominal pain, they put me immediately on iv broad spectrum antibiotics as a precaution while they did a battery of tests. In the end, they couldn't find anything amiss and I went home - fine since then.

In Savita's case, the presenting symptoms and history showed that she was at extremely high risk of infection, yet no treatment was given for 3 days, until the infection had caught hold and spread.

On the other thread, I explained why removal of the products of conception was also crucial. Even where there remained a faint heartbeat in the foetus, in cases like this, the tissues supporting the foetus have started to die - providing an excellent medium for bacteria to feed, grow and spread from. Treating with antibiotics, would be less effective so long as the necrotising (dead and dying) tissue was left in the body. For the same reason, that's why gangrenous toes are removed. The tissue is dead, is cultivating infection that could spread systemically, and amputating the dead and dying tissue is the best way to be sure that is halted. Antibiotics alone won't have enough effect.

It will be interesting to see the findings of the enquiry (although I'm not expecting much - such enquiries rarely turn up anything very radical.)

It is clearly medical negligence as any licensed physician should have had adequate knowledge and skill to diagnose and treat her condition appropriately. That didn't happen.

The additional factor here, however, that can't be ignored, seems to be that the negligence wasn't the result of the medics being incompetent per se. It was the result of them choosing not to act because they either feared the risk of a law suit because treatment could be seen as "procuring a miscarriage" (but it wouldn't be,) or they had personal qualms about administering treatment about which they had "moral" concerns. Maybe it was both.

But, the reason this state of affairs was allowed to happen was due both to the opacity of the law in Ireland on this issue and the general believe amongst many leaders in the medical establishment there that anything which in any way could be seen as "taking the life of an unborn baby," must be rejected, full stop.

What I can't work out is what the doctors thought the outcome would be of their failure to treat her. Did they genuinely think that she would get better on her own? Really baffles me that.

sieglinde Fri 16-Nov-12 11:41:06

Exactly, Kritiq. Thanks for this clear and level-headed exposition; I will stop nagging now as you have said everything I wanted to say. But in relation to your last question, I was left like this twice, and only got treatment in both cases by demanding it.

LeBFG Fri 16-Nov-12 11:41:34

KRITQ: your post sums up my position and questions exactly.

That's been my experience too Chip. There were protests outside my local hospital when the excellent Indian consultant who delivered DS had to leave because the HSE wouldn't give him a permanent contract.

squoosh Fri 16-Nov-12 13:50:12

I'll be interested to read Breda O'Brien's Irish Times column on this matter. Breda is an extremely conservative, right wing Christian who also classes herself as a feminist (!). She has written some pretty jaw dropping articles over the years. Below is an excerpt from one on the subject of the 9 year old Brazilian girl made pregnant by her step father.

'Despite some awful dilemmas, abortion is not an option'

Here's the link if you wish to read it in full scroll halfway down the page

Otherwise here's an excerpt:

However, even though the mother’s decision to choose abortion for her daughter was absolutely understandable, I knew it was not one I could go through with. I am well aware that our culture has moved to a place where it is impossible to envisage that denying a child an abortion might ever be motivated by compassion.

I know that for some people it would simply put me in the same category as Josef Fritzl forcing his daughter to go through incestuous pregnancies. I don’t feel like Josef Fritzl. I feel like someone desperately trying to decide what would be best for all three lives in a situation where all of the alternatives were truly appalling.

Children should not have to have children, especially after rape. But the younger a child, the less likely she would be to be able to rationalise an abortion, no matter how great the initial relief. Even a rapist does not receive the death penalty. Could a little child cope with 20 more weeks, in order to possibly save two lives?

This is a woman with a weekend column in the Irish Times. She is continually spouting these extreme views. Any normal person can she sees an absolute crazy loon. Not in Ireland though. She's given a column in the broadest of broad sheets.

KRITIQ, that sums it up excactly and is entirely my position.

Agree with KRITIQ but OMG what sort of parallel universe are we in whereby a doctor even contemplates medical negligence rather than saving the life in front of them? shock sad

I think it's the other way round: medical staff might have got so caught up in the 'Am I procuring a miscarriage here, thereby leaving me open to prosecution?' that they did not see that there was no case to answer. A miscarriage was in progress which they had to manage; and by all accounts manage more actively than they did.

Having said that, more and more drs are considering how vulnerable they are to being sued and are chosing their specialties accordingly. Because childbirth is such a minefield, there is a growing trend, certainly in the States, to do Gynaecology only and no obstetrics. That of course has nothing to do with this case.

LaVolcan Fri 16-Nov-12 15:37:23

Being sued may apply in the general case, although I think it's a bit of an excuse myself - however, I can't see that it would have been an issue here.

(I say I think it's a bit of an excuse - my grandmother died, we felt, after negligent treatment. We didn't sue in the end; we weren't interested in money, but we wanted to try to make sure that someone else didn't suffer. So it came down to poor communication - which is what I suspect is behind a lot of cases, and may even be partly to blame in Savita's case.)

FastidiaBlueberry Fri 16-Nov-12 16:19:28

I dunno, I just think on the whole doctors are fairly intelligent, well-educated people and if you work in the field of obstetrics in Ireland, surely you can't be unaware of the very tenuous position the Irish govt is in vis the EU and its demand that Ireland clarify its abortion law?

Unless the Irish govt wants an all-out collision with the EU there's no way it would want to take any case like this one to court in the event of abortion taking place to save a mother's life - no way would it go on the offensive because it was lying low on the issue of abortion law clarification.

How can a doctor in the field not have known this? How could there have been anything like a reasonable fear of court action?

crookedcrock Fri 16-Nov-12 17:07:39

Squoosh, re Breda O'Brien, whatever your views on her might be and many will disagree with your characterisation of her, what do you mean by the phrase "not in Ireland though"? Is she not entitled to express her "extremely conservative, right wing Christian" views?

damibasiamille Fri 16-Nov-12 17:09:41

Two small points about double standards:

Following on from Squoosh's post, I have been told that when some nuns were raped (in Nigeria, I think) they were allowed abortions; one rule for nuns and another for 9-year-old girls, apparently!

The anti-abortion people tend to base their position on "the sanctity of life", but strangely, they don't often identify as pacifists! And none of the mainstream churches have ever opposed war as such, in spite of the fact that wars undeniably kill people!

So it looks as if the "sanctity of life" argument is just a smokescreen for something else, and I suspect that something is patriarchal power. War is a men's thing, after all, so of course, different rules apply!

Maybe it's time to join the Quakers! smile

squoosh Fri 16-Nov-12 17:18:26

crookedcrock I mean that having Breda O'Brien and John Waters both writing for the Irish Times is overkill. The woman is to the right of the far right. I can't believe the IT continue to give her a weekly platform for her extreme views. But that goes along with the anti abortion bias throughout all Irish media.

squoosh Fri 16-Nov-12 17:19:27

She used to be my teacher too so my opinion of her isn't purely based on her columns.

<waves at the Dominicans>

sieglinde Fri 16-Nov-12 17:51:00

Ilovemydog, let me just say again that i had two infections, both neglected by docs. I think this is sadly pretty commonplace.

FastidiaBlueberry Fri 16-Nov-12 19:54:27

Yes I agree, they don't actually believe in the sanctity of life as such, because they suspend that doctrine every time their support is needed for a war.

I'd like to know what the actual theological approach is to human life now, thinking about it. There used to be the doctrine of the just war, I don't know if it's still doctrine. Any theologians about?

edam Fri 16-Nov-12 20:38:29

Good point re. sanctity of life only applying when they want to oppress and kill women. Not when it's war. And not when it's a murderer who wants the services of a priest either.

I hope the doctors ARE sued - by Savita's husband and family. I hope he sues their arses off, I hope those weaselly evil toerags are bankrupted. Maybe then Irish doctors will realise they can't save their own skins by killing pregnant women.

LeBFG Fri 16-Nov-12 20:49:55

Bally crappy state of affairs where religion has apparently spread its influence to a profession that world-wide is seen as one motivated by a deep rooted desire to help human beings...

Why haven't the irish doctors been shouting about this from the roof tops?

lotsofcheese Fri 16-Nov-12 21:17:32

I think the main issue here is that the doctors failed in their duty of care. However, what motivated their decision-making?

I would hope that the Hippocratic Oath & professional standards of practice would guide practice, rather than religious/personal ideology.

Surely the medical staff would have been equally scared about being sued for failure to intervene, as much as lack of intervention?

I cannot understand (as a healthcare professional myself) how the medical staff could possibly justify their inaction, within the context of their code of conduct?

Or were they more motivated by fear of prosecution for ending the pregnancy?

HoleyGhost Fri 16-Nov-12 21:24:56

I expect that incompetence will be at the root of this.

Also a clash of cultures. Asking for an abortion might have made inadequate staff dig their heels in. Insisting on a second opinion, that 'something' be done may have worked. Or maybe not.

She was a dentist, she understood about infection sad

juule Fri 16-Nov-12 21:46:08

I know Wikipedia not always reliable bit apparantly there is no legal requirement to swear the Hippocratic Oath.
"While there is currently no legal obligation for medical students to swear an oath upon graduating"
From here

HoleyGhost Fri 16-Nov-12 22:04:17

Juule, I have just learned from that page that the Hippocratic oath contained the line
"I will not give to a woman an abortive remedy"

juule Fri 16-Nov-12 22:52:50

shock I didn't read it all. I will do now though.

LaVolcan Fri 16-Nov-12 23:09:51

"I will not give to a woman an abortive remedy"

But still - offering treatment to a woman who is having a miscarriage which can't be prevented and will result in a baby which will not be able to survive, is not the the same as what most of us think of as an abortion.

I see I have had my first post deletion on five years of mumsnet! Given the circumstances though, I am unrepentant.

madwomanacrosstheroad Sat 17-Nov-12 02:06:08

Belfast Telegraph tonight has an interview with a woman who was in a very similar situation in the Royal Victoria Hospital in 1990 and only survived because her husband put up a massive fight for medical staff to induce. Staff at the time said they could not legally authorise an abortion even though there was no chance for the baby at 17 to 19 weeks. She was showing signs of infection and only after her husband brought in their 2 year old SN child and basically screamed the place down that this child needed his mother was she given treatment. She just about made it.

pointythings Sat 17-Nov-12 17:59:37

verylittlecarrot you're right not to be repentant, you were right. I'm amazed I wasn't deleted too, given my response to your deleted post.

madwoman I just hope Savita's husband doesn't feel he could have saved his wife if he had screamed the place down sad.

And the original Hippocratic Oath dates back to before Christianity, medicine has moved on since then. The oath is not relevant in and of itself. The principle of medical practice should be 'First do no harm'. Going by that principle, the doctors treating Savita failed dismally in their duty of care.

squoosh Sat 17-Nov-12 18:17:41

An estimated 20,000 people marched through Dublin this afternoon in protest.

edam Sat 17-Nov-12 18:21:21

Very glad to hear it. Hope the politicians and medical profession were listening.

Morloth Mon 19-Nov-12 07:59:38

What was done to that woman was pure evil.

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