Wait until the woman is on the edge of death

Let’s look at a little more

Some Catholic hospitals, contrary to the opinion of leading Catholic ethicists and theologians, apply the Directives to prohibit doctors from providing any treatment to a woman having a miscarriage if there are still fetal heart tones, even when a doctor has determined that nothing can be done to save the pregnancy and the woman’s health is placed at risk by delaying immediate treatment. These hospitals will require that doctors withhold treatment until there are no fetal heart tones, or there are specific indications that a woman’s life is at risk, such as the onset of a serious infection.

You see? Or there are specific indications that a woman’s life is at risk, such as the onset of a serious infection. That’s what happened in Savita’s case. There were specific indications, and by that time it was too god damn late.

Catholic hospitals shouldn’t be making that decision; the patients should. No hospitals should be making that decision. No hospitals should be prohibiting doctors from providing any treatment to a woman having a miscarriage if there are still fetal heart tones. Their patient is the woman and it’s their job to treat her.

Some hospitals will transfer the patient elsewhere for medical treatment if the woman’s life is not yet at risk, despite the current threats to her health. As shown in the Study, some hospitals will allow treatment only after doctors perform additional unnecessary viability tests, despite doctors’ existing medical certainty that the fetus is not viable. In these cases patients are being denied emergency care to which they are legally entitled, as further described below.

No hospital has any business doing that. That’s not what hospitals are for. They’re not there for the purpose of making a display of their religious morality, they’re there to treat patients.

In the US Catholic hospitals are buying up secular hospitals at an increasing rate. This is appallingly dangerous.


  1. Karen Locke says

    In the US Catholic hospitals are buying up secular hospitals at an increasing rate. This is appallingly dangerous

    No Kidding.

  2. says

    With mergers between Catholic and secular hospitals taking place across the country, the problem isn’t going to go away soon. The health of women and girls is at stake if Catholic hospitals merge with non-Catholic ones.

    MergerWatch, an organization that monitors such mergers, can offer more information and resources on the problem.


  3. Claire Ramsey says

    Women’s lives mean nothing to those doctors. I wonder how often they are sued for malpractice? If often, who is paying their malpractice insurance premiums? I hate this.

  4. otrame says

    I want there to be a campaign to warn people that women do not get what is called “standard of care” at Catholic hospitals.

    As I stated here, I was nearly killed by malpractice in a Catholic hospital almost 45 years ago. I can not prove that the malpractice was caused by any directive to ignore a possible ectopic pregnancy, but I believe it was, since I now know how egregious the malpractice was.

    And that is a perfect example for why we need to start yelling. Too many people are like I was, ignorant. We need to warn people to keep their women out of Catholic-controlled hospitals and if they can’t do that because there are no other hospitals in the area, then they need to understand that they cannot trust the doctors in a Catholic hospital when it come to women’s reproductive medical issues. They need to be wary.

  5. says

    I live directly between a Catholic hospital and an Adventist hospital. (Well, and a secular one, but they don’t have a maternity ward, so they didn’t count for this purpose.) I could have chosen a doctor who delivered babies at the Catholic hospital but I said (more or less, pun intended) “Over my cold, dead, and lifeless body.”

    I delivered two babies at the Adventist hospital and got my tubes tied there with no fuss. I’ve heard a few horror stories from the Catholic hospital.

  6. alai says

    I’m a bit uncomfortable with one thing here: the post is juxtaposing (if not necessarily equating) two different things: refusal to provide terminations in similar particular medical circumstances, in on the one hand, Catholic hospitals in a secular country, vs on the other, a secular hospital in “a Catholic country”. (That last in quotes because it’s not de jure the case, even though the religious demographics and history are very much the driver here.)

    Savita Halappanavar didn’t die in a hospital run by a Catholic organisation, being treated (or failing to be treated) by a doctor citing refusal to perform procedure on grounds of individual conscience. She died in a public teaching hospital, and her principal physician is citing legal constraint from acting, not a religious choice. Whether rightly or wrongly is another massive headache in itself, and illustrates the absurdity of expecting doctors in time-critical situations to play constitutional lawyer, absent any statute law, while their representative body declaims “sure, ’tis grand, carry on”.

    The problems may indeed be similar, at root, but the solutions are clearly very different.

  7. Maureen Brian says

    Because, Hein, they don’t actually understand their rules – as Dr Astbury is displaying in gloroius technicolor at the inquest in Galway.

    Medical ethics say if there are two patients – which is stretching it a bit in that case but no matter – then where you cannot save both you MUST save the one you can save. Catholic ethics, as practiced by Catholic Ethicists, says much the same but may ask you to double check. The Irish medical authorities say much the same.

    Apply enough mumbo-jumbo, create an atmosphere of terror and somehow all that gets internalised as a Dalek-like “Must not intervene. Must not intervene.” So it all actively encourages a Consultant Obstetrician, a very senior midwife and armies of other medical personnel not to check vital signs, not to look for the seat of infection within the uterus, not to recall the key risk of a stalled miscarriage, not to discuss the case with each other – all in case they should arrive at the point where both knowledge and ethics tell them it’s time for a D&E plus aggressive management of infection.

    All of which is sad, very sad. What puzzles me is that they have managed to forget that even if a 17-week foetus gets out of the birth canal alive and without infection it cannot survive because it cannot yet breathe. Its lungs are not sufficiently developed.

    How you spend your life in obstetrics and manage to forget that continues to bewilder me.

  8. dianne says

    What makes this even worse is that 99+% of pregnancy related complications are completely curable with prompt treatment. A woman who has pre-eclampsia, HELLP syndrome, ALFP, a failed pregnancy with incomplete (spontaneous) abortion, etc in whom the pregnancy is ended promptly, by delivery if practical and by abortion if not, will almost always recover completely and walk away healthy and fertile. Heck, it’s not even expensive or technically difficult medical care. An analogy: You are standing next to a swimming pool. There is a person drowning in the pool. Next to you are 5 life preservers, a phone with a dedicated line to call paramedics, and a lifeguard. You are also an expert swimmer. Not only do you not jump in and help the person, not call the paramedics, and not toss a life preserver or two in the general direction of the drowning person, you tackle the lifeguard to prevent him or her from doing any of the above.

  9. alai says

    @Maureen Brian: I don’t want to prematurely extend too much in the way of sympathy for Astbury, but it’s entirely possible that she’ll end up being thrown under the bus by the anti-abortion lobby and the medical establishment in their attempts to preserve the status quo. (Not through the inquest process, but as the lumbering process of overlapping inquiries and parliamentary followup unwinds.) If she can be argued to have been negligent, have contributed to the hospital “systems failure” (which seems to be the current mantra), or to have applied the wrong threshold (barrack-room legal malpractice?), many would be very happy to see her take the fall for the whole thing, mutter some “Dublin Declaration” hopeful pieties, fudge more “best maternal outcomes in the world” statistics, and declare the frameworld that’s ultimately responsibility for the whole mess to be perfect in every way.

    After all, Astbury is arguing that she was “trying to save both patients”. I appreciate that considering a 17-week foetus as a “patient”, especially without the consent of the “other” patient, is deeply problematic, but that’s essentially the position Article 40.3.3 ends up in. Of course, while she was estimating foetal prognosis to be 12-14% survivability, two other doctors were saying 0%. (And I haven’t heard what the theory is as to a scenario for a positive foetal outcome might be. There are apparently surgical procedures for membrane rupture, but here there was also cervical dilation.) And while she’s asserting that “real and significant risk” means 51%, as far as I can see any other doctor — or lawyer, or supreme court judge, or voter in constitutional referenda — can supply their own personal interpretation there.

  10. Maureen Brian says

    I’ve no wish to see Dr Astbury take the rap for the whole damn crew. From what I know the former Master of the hospital has had massive influence on others’ thinking and certainly questions to answer. Let’s see what he comes up with when he gives evidence.

    We have also still to hear the detail of the autopsy. I have no idea what it is going to say but just suppose it says that Ms Halappanavar cannot possibly have ended up as the pathologist found her post mortem without sepsis building up for however many days. What then?

    Then look at this 51% risk to life. Where does that come from and what formula were they using to determine it? Clearly they miscalculated for the woman ended up dead after her condition had deteriorated during a week. At some point during that week the risk was way beyond 51% and rising fast.

    Do you know whether Irish law allows a verdict of “manslaighter by negligence”?

    I feel we’d be better getting to the truth, however painful, than trying to second guess what this, that or the other pressure group will do with the facts and with the inquest verdict. Don’t you?

  11. alai says

    There’s an offence of “criminal negligence manslaughter”, as in English law. Indeed, it’s not Irish (or English, come to that) statute, but common law developed in the latter tradition and “inherited” by the RoI. But that would be a matter for a subsequent criminal trial, not for the inquest. It is able to return a verdict of “unlawful killing” (if it feels that someone is criminally responsible, identified or not, in some combination); a “narrative verdict” if it wishes to identify specific contributory factors, or to make specific recommendations to various parties; and various other possibilities. Or that’s my understanding, at least: I am not a lawyer (nor a medic, while I’m disclaiming away).

    I’ve no idea where the 51% comes from. I commented on my surprise, in several respects, at this statement, at the previous post in this tag thread, so I’ll try not to duplicate that too much here: http://freethoughtblogs.com/butterfliesandwheels/2013/04/wednesday-at-the-inquest/#comment-522282
    (Sorry, having problems with formatting links, so just leaving this one “bare” and hoping things work out one way or another.)

    If it’s common practice, it certainly doesn’t seem to be common knowledge — the RTE health correspondant seemed to convey a certain amount of surprise himself, though there seems to have been very little followup on that matter. It might be derived from the “equal right to life” thing, but even that would have to take into account the foetal prognosis, which she seemed to think it wasn’t possible to do. If you’ll permit me some more second-guessing, I don’t think she’ll get a lot of backup on it. The “Dublin Declaration” types don’t want to admit any possible conflict between prognoses at all, much less specify threshold and tradeoffs. The explicitly “Catholic ethos” lot want to deal with absolute prohibitions of “intent”, which which transfigure into refusal of entire procedures, in broad ranges of circumstance.

    One of the midwives that’s already given evidence said that she’d never seen a patient “deteriorate” so fast (in reference to one particular period of about two hours). So it may be that they have their own “timescale” of how and when to intervene, and were caught on the hop by the alleged “atypicality” of this case. I certainly don’t see that as any sort of excuse for their apparently systematic departure from international best practice, but to try to square the circumstances of this case with that they’re not killing off women by doing this on a regular basis.

    I think the second-guessing started some time ago, and it’s hard not to be drawn into comment on it. And the inquest verdict is just one piece of the picture: there are also several inquiries at various stages of completion, and crucially, the “X Case” primary legislation, which is still in preparation, is already being opposed by the doctor’s union, but is the only real hope of bringing clarity that could benefit women in similar circumstances in the future. (Though beyond that, actual substantive change to the constitutional position is pretty key.)

    That’s the crucial difference between the US and RoI circumstances. In the former, inquests finding negligence on the part of doctors following a “Catholic ethos” instead of best practice may serve to persuade those hospitals to change that (or else for women to stop using those services, with the same eventual result). In the latter, legal change is what’s essential.

  12. says

    I’m not sure I think there is much difference between the US and RoI circumstances in practice. The law is different, but the practice isn’t so much, because the law is not enforced. The Feds don’t enforce the fucking law. They look the other way.

    There has been no Savita Halappanavar case here, that I know of. The closest was the St Joseph’s hospital case and that wasn’t very close, because it cut the other way – there the Catholic ethicist approved the life-saving abortion.

    The US badly needs a Praveen Halappanavar.

  13. alai says

    That seems a pretty clear practical difference, if the “Catholic ethos” in the US gets squared away on a “just in time” basis. (Except in the cases it doesn’t, that haven’t necessarily been brought to light, presumably.) Surely the law acts as at least some sort of incentive to square “ethos” and “not being hauled up criminal charges or civil suit”, whether or not this has actually happened yet.

    For the Halappanavars, it’s possible that if they’d been “in the know”, they’d have been able to find another doctor with an entirely different interpretation of the “real and significant” clause of the X Judgement. But that would have been unrelated to advertised hospital “ethos”, the medical profession here seems to show no inclination to be seen to break ranks, and have someone come forward to say they’ll perform terminations on some other basis than “51% risk of maternal death”. And as well as professional groupthink, the law must act as a disincentive to doing so, as someone saying “I think that 0.1% risk of death is ‘real and significant’, and would provide a termination in such circumstances” would be to invite the anti-abortion campaigners to take them to court. So I don’t personally know how they’d have set about finding such a person, even had they taken an active decision to do so.

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