Savita Halappanavar- the thread to actually talk about the case

[ZombiesAreClammyDodgers]

Away from the madness of the other thread.

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.

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.

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.

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?

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.

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.)

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?

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!

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.

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

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

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?

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.

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?

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?

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 :(

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

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"

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

"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.