Not enough

Even a consultant who is critical of the care that Savita Halappanavar received at University Hospital Galway is apparently ok with the refusal to speed up her miscarriage.

Dr Susan Knowles, consultant microbiologist at the National Maternity Hospital at Holles Street in Dublin, was critical of poor documentation at a critical time in Ms Halappanavar’s care at the Galway hospital on Wednesday, October 24th, last.

From 1pm on Wednesday, Ms Halappanavar received a high standard of care, the witness said.

Eileen Barrington SC, for Ms Halappanar’s consultant obstetrician Dr Katherine Astbury, suggested Dr Knowles’s view was that delivery was not called for before the Wednesday.

Dr Knowles said there wasn’t a substantial risk to her life before then. There were “subtle indicators” of sepsis and chorioamnionitis before this, including a high pulse rate on Tuesday. However, this “in and of itself” was not enough for a termination to go ahead.

Nor were her and her husband’s requests, nor was the international standard of care, nor was the fact that the fetus would not survive. Nothing was, because priests.

Fuck that.


  1. karmacat says

    We need a couple of American lawyers go over and tear the defense apart. This kind of case is a lawyer’s dream

  2. otrame says

    It’s only a lawyer’s dream if they have the law with them and nobody in the court is a devout Catholic.

  3. alai says

    Because priests, but also proximately because “no primary legislation the area whatever”. So the law is neither with them, nor against them, it’s simply not there at all. (Admittedly, primary legislation could be enacted and be no more specific or actionable than the existing “equal right” and “real and significant risk”,

    I’d be interested to learn if Knowles had a particular quantifiable risk assessment relating to the time in question, had a quantification of “substantial” in mind (whether the same as Astbury’s, or otherwise), and had an assessment of the prospects for foetal survival. Without those, it’s hard to tell what’s testimony as to medical facts, what’s legal opinion, and what’s general editorialising on her part.

  4. Tâlib Alttaawiil (طالب التاويل) says

    “Ms Halappanavar received a high standard of care, the witness said.”

    …right up until she died. awesome.

  5. Amy Clare says

    I’ve been following the inquest off and on and it just enrages me. The conclusions are clear, if you are a pregnant woman in Ireland you have to be on death’s door before you can expect doctors to do their jobs and treat you, and if it’s too late by the time they start trying then tough. It could not be clearer how Ireland views women.

    A commenter on Jezebel said that if it had come down to a man’s life vs a fetus’s life then the fetus would bite it. I’m inclined to agree.

  6. notsont says

    One has to wonder if they would be so confused what “significant risk” means if it came to someone they loved. Anyone too stupid to understand what that “significant risk” is anything greater than 0 when it involves death, is too stupid to be involved in healthcare.

  7. Amy Clare says

    I remember a consultant advising me against some surgery I was considering because there was a 1% risk of death. (I didn’t have it in the end.) This consultant neurosurgeon considered a death risk of 1% to be serious and significant, but Savita’s doctor didn’t consider 30-40% to be significant. I can’t get my head around it.

  8. alai says

    @notsont: I think since “maternal death” is the precise context of the X Case supreme court decision, it’s not readily arguable that the prospect of such death would modify the sense of “significant”. My personal guess (and usual disclaimers very much apply here) would be the best that could reasonably be hoped for, given the current constitutional position in Ireland, is that “significant” be held to mean “appreciably greater than the baseline risk of death from being pregnant”, or in cases where foetal prognosis is nil, or as Jen Gunter put it, “dismal”, any risk comparable to the probability of foetal survival viability.

    @Amy Clare: when I initially heard Astbury had said “real and significant risk means 51%”, I strongly suspected this was headed towards some sort of volte face “clarification” in the face of mass outcry that this was crazy talk, in an attempt to salvage her career. But not only does there seem to be little overt stir about it, as you mentioned there was her earlier statement in which she said something like “if you consider 30-40% to be significant”. So she seems to be pretty consistent in her (bizarrely high) assessment of what “significant” means.

    Some time ago I encountered a survey study in which people were asked to assign numerical probabilities to various linguistic hedge terms for likelihood (like “impossible”, “possible”, “probable”, “likely”, “certain”, and so forth). To no-one’s particular surprise, the results were wildly inconsistent and variable, even in terms of the relative order of some of the terms. I think that illustrates the futility of allowing the law to rest on unquantifiable terms like “significant”, and letting doctors concoct their own interpretations of what that might actually mean.

  9. Amy Clare says

    As someone else pointed out on another thread, 30-40% would seem extremely significant if the patient was a loved one of the doctor. Surely that’s what medicine is ultimately based on – the fact that we don’t want to die, and we don’t want our loved ones to die, and we accept the same is true for others, so we create a system where doctors work hard to keep people alive.

    I can’t work out whether Astbury has warped views all by herself or whether her views have been warped by working to these twisted legal requirements.

  10. Amy Clare says

    In fact, in what other area of medicine does a ‘significant risk’ of death mean ‘over 50%’?

    “Right, we’re going to try you on this new drug, there’s a 40% risk of death by the way…”

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