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Apr 17 2013

Savita Halappanavar would probably be alive now if she had had that termination

That’s what Dr Peter Boylan, the former master of Ireland’s National Maternity Hospital, told the inquest today.

Dr Peter Boylan said that if Ms Halappanavar had been given a termination on the Monday or Tuesday, one or two days after she was admitted last October 21st, she would “on the balance of probabilities”, still be alive.

“It is highly likely she would not have died” if she had been given a termination earlier, he added.

However, terminating her pregnancy was not a practical proposition for the doctors treating her at this time because of the legal situation in Ireland, he said.

Before reading more, I wonder – is it possible that that’s why there was so much apparent neglect and incompetence? That that’s why doctors failed to treat her deteriorating condition as an emergency for so many hours? Is a woman with a stalled miscarriage just an obvious scary liability in Irish hospitals, and do such women as a result get even more neglected because doctors can’t stand to confront the reality?

But really that’s beside the point, because if they’d done the termination earlier there probably wouldn’t have been any emergency to neglect. They created their own damn emergency and then neglected it, thanks to Irish law. Fuck you, Irish women, says Ireland.

Dr Boylan said there were a number of deficiencies in the care provided to Ms Halappanavar, including the failure to note and review her initial – abonormal – white cell count and a conflict of evidence between a midwife and doctor who treated her early on the Wednesday morning.

He said University Hospital Galway’s guidelines on sepsis were “not particularly helpful”. The particular antibiotics administered to Ms Halappanavar early on the Wednesday could also be regarded as deficient but were in line with international recommendations, he said.

The real problem was the inability of doctors to terminate her pregnancy at an earlier stage, Dr Boylan said. By the time her condition worsened and this became possible, it was too late to save her life.

Ok next question. A stalled miscarriage is not a terribly rare event. I don’t know the statistics but I gather from what Jen Gunter says that it’s something an obstetrician expects to see on occasion. It happens. It’s not like a two-headed calf.

Dr Boylan said obstetricians were working in a legal “vacuum” as to when a mother’s risk of dying was high enough for them to be legally allowed to terminate a pregnancy. Under cross examination he told Eugene Gleeson, SC for Ms Halappanavar’s husband Praveen, that the legal position was that there had to be a “real and substantial” risk to the life of the mother, but that there were no guidelines on what constituted the real and substantial risk.

And how fucking insulting is that? The position in law that if the risk is not “substantial” enough then the woman must be forced to take it.

Mr Gleeson referred to the Medical Council guidelines which state: “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.”

Mr Gleeson asked Dr Boylan whether the risk posed by severe sepsis satisfied this standard. Dr Boylan said the standard had not been reached, according to Ms Halappanavar’s medical notes, until 6.30 am on Wednesday 24 th.

That is just disgusting. Just utterly disgusting. “Sorry, hon, you have to get a lot sicker than this before we can end your pregnancy.”

Asked whether it was reasonable to wait until there had been a 51 per cent risk of death, as had been suggested by counsel for Dr Katherine Astbury at the inquest last week, Dr Boylan said medicine was “not like that”.

He said in his opinion a risk of 20 per cent to 40 per cent risk of death was sufficiently “real and substantial” for a doctor to terminate a pregnancy. “I wouldn’t agree with 51 per cent”.

He said doctors from abroad working here could not understand the restrictive law on abortion here. “But we have to work within the law,” he said. “Had intervention occurred on 22nd or 23rd , Savita would be with us?,” asked Mr Gleeson. “Yes,” said Dr Boylan.

Doctors from abroad have it right. The law is an outrage.

 

13 comments

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  1. 1
    notsont

    I’m dumbfounded by this, how can a doctor spout such idiocy, 20-40% is what he would consider “substantial” are all doctors in Ireland such idiots, or is it only when it comes to the life of women that they can so casually disregard reality.

    His low number is a 1 in 5 chance of dying!

    I would have been appalled if he had said 1% is where he would consider it substantial, but 20%, is he insane? There have been assassination plots with less than 20% chance of success.

  2. 2
    Ophelia Benson

    I don’t think he’s endorsing it, I think he’s saying that’s what the law is.

  3. 3
    notsont

    The law does not seem to make mention of a number, I would assume its left up to the doctor to determine what a substantial risk is. My doctor has in the past warned me about medications with a .0001% risk of serious side effects not even death so i’m guessing most sane doctors would think that a 20% risk of death was far more than just “substantial”.

  4. 4
    Claire Ramsey

    A legally imposed waiting game, with the hope that someone who can do something will be on hand when the patient arrives at the invisible line between “sick enough” and “dead.”

    I hope Savita Halappanavar’s family is awarded a huge settlement and that the doctor who permitted this to happen goes to prison.

  5. 5
    sheila

    I wonder what would count as a real and substantial risk to the life of the Pope? Somehow I suspect it might be lower than 20%.

  6. 6
    sonderval

    So, world war II really was a piece of cake, then. According to Wikipedia, only 24 Million out of 168Milion people died in the USSR, and only about 10% of the Germans. Nice to know that a world war like that is not a substantial risk.

  7. 7
    kevinalexander

    I hope Savita Halappanavar’s family is awarded a huge settlement and that the doctor who permitted this to happen goes to prison.

    What the doctors did was, in Ireland, legally not malpractice so I don’t see how the family can get anything but more grief.

  8. 8
    SallyStrange

    I really fucking hate the Catholic Church.

  9. 9
    sc_770d159609e0f8deaa72849e3731a29d

    My doctor has in the past warned me about medications with a .0001% risk of serious side effects

    I think you’re confusing two ways of expressing probability here: 0.0001% is one chance in a million- so small statistically that it is probably undetectable in tests on medication. A risk- a probability- of 0.0001 is one in ten thousand- still small but detectable, and expressed in percentages is 0.01%.
    The frightening thing here is that the law required doctors to leave a woman untreated until there was ‘real and substantial risk’ of her death- however defined- even though there was no chance whatsoever of the foetus being viable. It wasn’t a question of ‘saving’ the foetus but intervening to save Ms Halappanavar’s life. There was no ethical problem except to an obsessional casuist. The law wasn’t just an ass but a murderous ass.

  10. 10
    Markita Lynda—threadrupt

    In other countries, such as Nicaragua and Guatemala, it has been the practice with an ectopic pregnancy to wait until the Fallopian tube bursts, destroying it and creating a medical emergency, before aborting the embryo, which is 100% doomed anyway.

  11. 11
    Pteryxx

    Markita Lynda – that’s sometimes the practice in the US, too, at Catholic-run hospitals. See the report cited here:

    http://freethoughtblogs.com/butterfliesandwheels/2012/11/its-not-just-ireland/

    One doctor in the study reported several instances of potentially fatal tubal ruptures in patients with ectopic pregnancies at her Catholic-affiliated hospital. She said that her hospital subjected patients with ectopic pregnancies to unnecessary delays in treatment, despite patients’ exhibiting serious symptoms indicating that a tubal rupture was possible. These patients, therefore, were denied emergency care to which they were legally entitled.

  12. 12
    alai

    My strong suspicion here is that there’s a series of “judo” arguments going on here. I’ve seen a doctor from the “Pro Life Campaign”, Kiely Berry, argue that in the described circumstances, a termination would be legal, ethical and “not abortion”. Meanwhile, Boylan and Astbury assert the reverse. Why? Well, my inner cynic asks “who gains what?” Boylan evidently wishes explicit clarification of the law, and may be “highballing” his estimation of what the threshold is, on the basis of making case for reform more clearcut. That, and not wanting the forcedbirthers to be calling for him to be fired and prosecuted under 19th century anti-abortion law. (Yes, the operable legislation is actually significantly older than the country it’s operating in.) Astbury seems to be talking up the threshold to fend off criticism that she didn’t act sooner, by constructing the theory that she was legally unable to, which requires that she argue that the actual probability of maternal death was much lower than the theshold of permissibility.

    Conversely, of course, Kiely, faced with an actual maternal death, would find it in her interests to “talk up” what would and could have been possible to treat Halippanavar, in order to prop up the PLC and their like’s sweeping statements about maternal safety in Ireland, and the “Dublin Declaration” nonsense about coincidence of maternal and foetal prognoses, and most importantly, to try to minimise the case for clarifying legislation — much less, any change to the constitution’s “equal right to life” provision.

    Meanwhile, Irish doctors don’t publish statistics on how many terminations are actually carried out, and in what circumstances. Irish lawyers have offered no definitive interpretation of what “substantial” means. Good luck working out who’s actually doing what, and what it or isn’t (or would or would not be deemed) legal.

  13. 13
    dianne

    There is almost no chance that Ms. Halappanavar would have died if she’d been treated appropriately. She was a healthy young woman and had a completely reversible medical problem. Heck, she MIGHT have survived if they’d simply taken her condition seriously and put her on antibiotics and ICU monitoring while waiting for the heartbeat to stop. This was incompetent management on so many levels. It indicates a more widespread problem than just the abortion laws, although the abortion laws are a major part of the problem.

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