A pregnant woman presents to an Irish hospital with ruptured membranes and cervical dilation at 17 weeks of pregnancy.
This is called an inevitable abortion.
When the mother begins to develop fever and abdominal pain, infection has set in. The treatment – antibiotics and delivery of the baby, no matter what the gestational age or viability of the fetus. Delaying delivery risks maternal sepsis and death.
There is no debate about how to manage this clinical situation. There are clear standards. Even in Ireland.
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, (italics mine) while making every effort to preserve the life of the baby.
(HT to @scanman for finding these Irish regulations.)
An yet, for some unknown, god-awful reason, doctors responsible for the care of Savita Halappanavar decided that in their “Catholic” country, they were required to wait until the fetal heartbeat had stopped before terminating her non-viable, life-threatening pregnancy.
“Savita was really in agony. She was very upset, but she accepted she was losing the baby. When the consultant came on the ward rounds on Monday morning Savita asked if they could not save the baby could they induce to end the pregnancy. The consultant said, ‘As long as there is a foetal heartbeat we can’t do anything’.
“Again on Tuesday morning, the ward rounds and the same discussion. The consultant said it was the law, that this is a Catholic country. Savita [a Hindu] said: ‘I am neither Irish nor Catholic’ but they said there was nothing they could do.
“That evening she developed shakes and shivering and she was vomiting. She went to use the toilet and she collapsed. There were big alarms and a doctor took bloods and started her on antibiotics.
“The next morning I said she was so sick and asked again that they just end it, but they said they couldn’t.”
At lunchtime the foetal heart had stopped and Ms Halappanavar was brought to theatre to have the womb contents removed. “When she came out she was talking okay but she was very sick. That’s the last time I spoke to her.”
At 11 pm he got a call from the hospital. “They said they were shifting her to intensive care. Her heart and pulse were low, her temperature was high. She was sedated and critical but stable. She stayed stable on Friday but by 7pm on Saturday they said her heart, kidneys and liver weren’t functioning. She was critically ill. That night, we lost her.”
Mr Halappanavar took his wife’s body home on Thursday, November 1st, where she was cremated and laid to rest on November 3rd.
What Savita’s husband is describing is medical malpractice, pure and simple, committed by doctors practicing medicine according to the standards of the Pope rather than the profession to which they belong and the country in which they are licensed to practice.
It is tragedy and an abomination.
Were these doctors practicing out of fear and ignorance of the laws, or out of their own religious beliefs? Did they think they had no legal recourse but to ignore clear medical standards, or did they deliberately ignore them?
We will need to await the results of the investigation into this tragic case to learn the answers to these questions, but one thing is clear.
When the Pope plays doctor, women die.
The pope doesn’t care. If she’s a good Catholic she’ll go to heaven, so dying is no problem. Of course since she’s a heathen she’s going to hell regardless. Either way, no problem.
That doctor was an asshat, pure and simple. Charge him with murder.
To #1 Dinosaur on the hell comment: What kind of dumb ass logic? Why bring religion in this context?
All you need to understand is: she was a human with blood like you and would like to be treated with respect like anyone would.
The Pope comes before the Hipocratic Oath ?
The only way to change this outcome for the next woman is “malpractice” ..is there such a thing in Ireland? What this woman was subjected to is hard to believe in this day and age….mind boggling. Stupid religion – don’t get me started. makes my blood boil
I’m Irish and although I’m not a doctor, I heard a very well regarded female obstetrician on the radio today saying she has never in her career known any Irish medical professional to object to a termination on the basis of religion or otherwise when the life of the mother was in danger. I work with health care professionals and it seems the general opinion amongst them is that either a doctor delayed too long out of fear of breaking the law or that it was negligence (not someone’s personal religious beliefs) and they are trying to use the legislation to cover themselves, most likely the latter. I have not heard a single Irish person say that what happened was in any way acceptable, no matter what their religious beliefs.
I think that in Ireland, although the law is rooted in old values, abortion is now a contentious political issue which the politicians don’t want to touch and not specifically one of religion. I know that many Irish women and men wish that women here had the option for abortion so they don’t have to travel abroad for this distressing procedure.
This is a tragic story and let us hope in the future neither pregnant women or doctors in Ireland will have to face such an awful situation.
This is just one example of the type of tragedy we’d see if Paul Ryan and friends had their way, right here in the U.S..
I would also like to say, Margaret, that I really enjoy reading your blog, but I really don’t like this post. I think it distracts from the real issues and as an Irish woman who wishes to have children in this country it is of great concern to me. Changes need to be made to avoid future occurrences and your religious references and your ‘pope playing doctor’ statement is sensationalist and unhelpful.
Irish hospitals are NOT run by the Catholic church, they are run by the state.
You have taken your information from the Irish Times newspaper article which focused on the ‘Catholic’ comment. It mentions nothing about chronic understaffing, how overstretched the medical staff were or the reluctance of the Irish government to tackle the abortion issue. The big problems are that the legislation is not clear and is insufficient, and that the government keep cutting funding for Irish hospitals. Under these circumstances it seems inevitable that negligence cases like this will occur. It seems too black and white to just blame the doctors.
The pope has nothing to do with this. When Irish hospitals were under the control Catholic church the life of the baby was always prioritised over the life of the mother (no matter if she had 10 children at home who would be left without a carer). Thankfully we have at least moved on from that.
Thank you, Meabh, for your perspective.
This news struck a chord in the U.S., where abortion is legal but is under a huge and organized effort to restrict access, and ultimately to make the procedure illegal in all circumstances.
Dozens of laws have been passed in an effort to make abortions hard or impossible to obtain; and to de-fund contraceptive and preventive and screening services provided by women’s health organizations that also sometimes provide abortions (with totally separate funds). Now abortion opponents are even going after access to hormonal contraception (which they wish to define as abortion-inducing). One big recent fistfight is over the new health care act, which requires contraceptive coverage; Catholic hospitals (among others) want to be able to opt out of that coverage, even though contraceptive services *save money* and help ensure the health of women.
There are also efforts to define life as beginning at conception — giving greater protection to an embroyo than to the woman carrying it, and feeding the attacks on hormonal contraception. Politicians made various statements during our recent elections; one was that abortion is *never* necessary to save the life of the mother; another, that women cannot become pregnant (and thus need an abortion) following “legitimate” rape.
So, that is some of the recent context in the U.S. I am in my mid-50’s, and really, it is horrifying to me that in this day and age, women are considered unworthy of making their own decisions about family planning and personal health care.
I do not understand why one of the major U.S. political parties — the one that sees itself as favoring “small government” — nonetheless insists that the religious beliefs of other people be forced on citizens of the female persuasion, and their doctors. (And that is exactly how I see this set of problems. The joke version is: “small enough to fit in my uterus.”) I strongly believe in the separation of church and state, which is a constitutional protection in the U.S., but nonetheless under assault.
All that said, it is a small comfort to hear that this horrible tragedy is regarded as a violation of the standard of care for Irish doctors. No matter where we live, we need to be sure that patient safety and patient health comes first. “First, do no harm,” right?
P.S. — You are correct that we are relying on news accounts, and in particular the account of Savita’s husband. He says he and his wife were told that the doomed pregnancy (a slow-motion miscarriage in progress) could not be terminated while there was a fetal heartbeat, under the law. (The part about Ireland being a Catholic country is more or less icing; although historically, that was true.)
The actual medical records may or may not reflect those conversations. They are almost certain to reflect, however, Savita’s terrible and deteriorating condition. Whether this was a hosital-wide misunderstanding of the law, or an individual doctor making an untenable assessment of the law due to personal beliefs, or an issue of understaffing and/or ignoring the problem — it sure smells like malpractice.
Thanks very much for your comments Kathy and it is sad to hear that there is such a strong anti-abortion movement in the U.S.
I am desperately sad for this man who has needlessly lost his wife and am sure that it was a case of negligence.
I suppose it upsets me that half the world seems to think that there is a possibility that an Irish doctor would stand by, deliberately break the law and allow a woman to die for his or her personal beliefs. I cannot believe that this is what happened.
And I am afraid that this focus on religion will distract from the crux of the matter – that our laws mean that if a woman is pregnant with a baby that will not survive outside of the womb, or if they have been raped, are too young to be a mother, or are miscarrying but the baby is still alive, Irish doctors are powerless to help.
I am so proud that my gynecologist is speaking out to prevent another Savitas.
There are several states considering laws that would require this kind of care here in the USA. Somehow we must reach our citizens to show them what is obvious to us, that a woman’s rights to life and health must be valued over those of the nonviable fetus. Savitas might have lived to have children and been there to raise them!
These are some of the reasons we all must become more active to protect women’s rights.
Susan — absolutely correct, about the need to actively protect women’s rights and health.
Meabh — It isn’t directly the pope who is a problem in the U.S. (although the bishops have been outspoken); it is politicians — and the rabid anti-abortion ones inevitably turn back to their own religious beliefs to defend their positions. People holding elected office are in no better a position than the pope to assess and rule on the particular medical needs of others. But, religion is horribly tangled up in this issue.
This case needs to be spoken about, because of idiotic fact-free public statements like, “with modern medical advances, an abortion is never necessary to save the life of the mother.” But it bothers me that we are reduced to framing a discussion about abortion on the most stark and deadly scenario. Imminent death should not be the only situation in which a pregnancy can be terminated, with all other pregnancies then considered mandatory, no matter the individual circumstances.
Sorry for rattling on. I’m a mother; I love babies. But all babies should be wanted; and their parents should be ready and able to care for them. Pregnancies carry large health and emotional risks for the mother. Some fetuses have abnormalities incompatible with life; or that will make life painful, difficult, and/or short. Illegal abortions tend not to be safe abortions. Birth control is tremendously important, so I am fearful about efforts to curtail access; as a society, we spend a lot on prisons, but have cut public spending on basics that children need (food; education; health care; services). Children who are not loved and properly cared for have bad outcomes.
Here is a column by an Irish journalist, calling for clarifications in the law — and taking responsibility for not speaking out more herself: http://www.guardian.co.uk/commentisfree/2012/nov/15/ireland-medieval-abortion-law-savita
And here is a report about a longitudinal study of women denied abortions, finding adverse outcomes in carrying an unwanted pregnancy to term: http://io9.com/5958187/what-happens-to-women-denied-abortions-this-is-the-first-scientific-study-to-find-out
This is a tragic story. It is horrifying that this kind of thing can happen. I hope this story makes it clear to people (like that idiotic congressman Joe Walsh) that there are times when abortion is medically necessary, not that this should be a requirement for an abortion.
This death is indeed tragic and needs to be reviewed and well understood.
I do not see however, the proportional outcry here in the U.S. where the CDC reports over a dozen deaths from legal abortions (clearly preventable) and the indictment of at least 4 abortion providers over the last two years. Clearly the local OB-GYN community is aware of the doc who is a bit loose with the dates and will handle certain terminations with “discretion”.
While we lament the unnecessary death an ocean away and have the temerity to even blame the Pope, we sit idly by while deaths resulting in indictments happens in those medical backwaters known as Philly and Baltimore, where the ruling class is the medical community. Google “Kermit Gosnell” who stands as Exhibit A.
Because when docs do not police docs, women (and born-alive viable children) die.
Mr. Kane — Nobody here is advocating sloppy abortions in horrid circumstances. Nobody.
The example you give is, indeed, a horror story. No woman in need should be so out of options that she ends up there — on this, we agree. But “out of options” is exactly where the anti-choice and anti-contraception movement wants to put more women.
One of the sources that Dr. Google turned up argues that this particular provider’s terrible, substandard, life-threatening practices are about poverty: http://healthland.time.com/2011/01/20/why-the-pa-abortion-docs-case-is-about-poverty-not-roe-v-wade/
I believe that doctors need to adhere to the standard of care, which this one doctor did not. But the kinds of regulations that certain lawmakers have pushed are NOT aimed at providing safe care, to the medical standard of care — they are aimed at preventing access to quality care. A forced vaginal ultrasound before an early termination, for example, does zero zip nada to improve the standard of care; it only serves to humiliate and coerce the patient who does not want to see that — and does not need to see that for any legitimate medical reason.
I’m not going to spend a lot of time looking for data. I did find a CDC report of 14 deaths related to legal abortions over a 2 year period. I also found CDC data that there are 300-500 pregnancy-related deaths every year in the U.S. Do the math.
To an extent poverty drives many evils; but Gosnell operated for decades unimpeded. Per the indictment, the PA Dept. of Health as a matter of policy, did not inspect any abortion facility in PA – ever. The Grand Jury wanted to indict the Dept. of Health! All the while regular OB-Gyns quietly cared for complications and the patients in the ER a few died. The findings of the Grand Jury never suggested that the root of the Gosnell circumstance is poverty because it was not.
It took a DEA raid to expose this business and his fetal foot collection – right on his desk freaked them out so bad that they ran from the building.
The fact remains that while we can all be indignant and outraged over this solitary event in Ireland, my point is similar events routinely occur here where abortion is legal. See the 2000+ reported complications of Ru-486 and 14 deaths here http://tinyurl.com/azghxjt.
Mortality data is predictably under-reported but in 2006 the CDC found 15 deaths. See http://tinyurl.com/4cpvuq. Since abortion methodology is pretty stagnant, about a dozen deaths per year is reasonable. NY and CA do not report abortion complications yet provide the most abortions.
My point is visa-vie abortion, one tragic death in Ireland should cause us to look not to Ireland but our own shores.
Probably the single best thing one can do to ensure the safety of women receiving abortion services is to mandate that (1) physicians actually do abortions and (2)the physician providing the abortion have surgical admitting privileges at the local hospital.
I do not know how contraception access and ultrasound contribute to a discussion on mortality, but why cry alligator tears over a single death in Ireland – which we can do nothing about – while ignoring dozens of dead women in the U.S. who are cared for by non-physicians and physicians that lack surgical training and admitting privileges.
Mr Kane –
I will make no attempts to change your mind on abortion.
But just an FYI, I indeed expressed outrage at Gosnell, as did almost every reproductive health expert and advocate I know –
http://www.tbtam.com/2011/01/philadelphia-abortion-doc-charged-murder.html#sthash.n0w5oRmF.dpbs
His reprehensible behavior has gone punished as well it should be.
As for abortion mortality, no pregnancy, whether aborted or carried to term, is risk free. Still, mortality rates from abortion are far lower than morality from pregnancy carried to term. Sadly, malpractice can and does occur in both cases, as do complications that have nothing to do with malpractice.
What makes this case different from just any case of malpractice is that there appears to have been willful withholding of standard medical care for religious reasons, despite laws to the contrary that would have allowed the proper care of this woman to be given.
What makes it even more frightening is that pending legislation in various states in the United States could lead to similar tragedy here in America.
Best,
Peggy
Kathy a – yes it is definitely the politicians here who don’t want to change any form of legislation, mostly the (male!) ones from rural constituencies where there are still strong traditional catholic views.
On news programmes this week in Ireland we have seen pro-choice Irish doctors who say they cannot terminate the pregnancy if there is still a fetal heartbeat unless the mother’s life is at risk. Not her health, her life. It seems unclear as to when risk to health turns into risk to life in some cases. They are saying that the legislation is at fault in this case and are calling it a ‘grey area’ which needs to be clarified. I don’t understand how the life of an unborn fetus who is going to die anyway is equal to the life of the mother. But that’s the law here.
I think maybe people viewing it internationally see it as very black and white as they cannot grasp the concept of it happening in their health care system.
The anti-abortion groups are the ones who are using the argument that the law is clear cut and that this is a case of medical negligence which shouldn’t have happened.
Who knows how many cases like this have happened in the past. This case only became public because Savida’s brave husband brought it to the media. How many times will it happen again?
And how many women having miscarriages will have to wait many unnecessary painful hours for a D&C and heartbreakingly hear their baby’s heartbeat as it is checked over and over again in the knowledge the the baby inevitably will be lost.
Meabh –
Thanks so much for this reasoned and informative comment from Ireland. It shows the climate in which this sort of thing will continue to occur until there is clarity within the healthcare system.
Peggy
It appears that you had your facts totally wrong Peggy; disappointing that you would accuse the pope of all people. The “story” was non other than from a non-medically educated distraught husband looking for someone to blame.
http://www.lifesitenews.com/news/failure-in-basic-care-caused-savitas-death-not-irelands-former-abortion-law
Savha died from a resistant super bug/septicemia.
Patricia –
Actually, facts were pretty much correct. See this article on the HSE report,
http://www.thejournal.ie/inadequate-care-and-monitoring-were-factors-in-savitas-death-hse-report-949973-Jun2013/
which includes this –
“(The consultant) stated that the patient and her husband were advised of Irish law in relation to this. At interview the consultant stated“Under Irish law, if there’s no evidence of risk to the life of the mother, our hands are tied so long as there’s a foetal heart (sic)”.
The consultant stated that if risk to the mother was to increase a termination would have been possible, but that it would be based on actual risk and not a theoretical risk of infection “we can’t predict who is going to get an infection””
In addition, there were systemic quality issues at the hospital that led to poor management once Savita’s infection became evident. But had she been induced when she had requested it, and which would have been medically appropriate, she never would have gotten infected in the first place.
I actually love the current pope. But the abortion laws of his church, which only allow for pregnancy termination for ectopic pregnancy, put women’s lives at risk. I stand by my post.
Thanks for reading.
Peggy
Thanks for your reply Peggy. The way I read that report, is that she most likely did have sepsis at the time she asked for the abortion, but it was missed clinically. Had the diagnosis been properly made at that time, she would of had the abortion when requested and probably would be fine. The report even lists the guideline for future patients (all clinical, nothing to do with “abortion law” for non-Catholics.
In any case, your headline “When the Pope Plays Doctor, Patients Die,” should read more like, “Patients often die due to lack of proper and prompt medical treatment.” That is clearly more the issue here than a fetus with a beating heart (and more than a bit unfair to the Pope).
Truth be told, I just found your blog after looking for a map of central park yesterday. I found it rather interesting to be honest, and even made your cauliflower soup (thank you very much). Today, while eating my soup, I was sitting in front of my computer and continued reading through your posts.
I just like to think we can all respect each others’ faith, and realize that if we aren’t of that faith, we shouldn’t make assumptions. So, FYI, for anyone who doesn’t “get” Catholicism, the abortion issue has nothing to do with the pope, and everything to do with the teachings of Christ. The Catholic Church is merely the teacher of the fullness of Christ’s teachings; no more, no less.
All said, thanks for the soup recipe Peggy. Despite this initial disagreement, I think you write a pretty cool blog. And FWIW, we have far more in common than that upon which we disagree. I will most likely be a regular reader.
The last word on this, if you have one, is yours.
Thank You Peggy.
Patricia –
Thanks for your kind comments and for engaging.
If you haven’t figured it out by my name (Margaret Mary) I too am Catholic, though I drifted away from the church many years ago due to its stance on women (not to mention the bad modern music). I have to say this new pope could bring me back, but that would also take allowing women to be priests and priests to marry and a more reasonable stance on contraception. I don’t mind at all that the church does not believe in abortion, and I myself grew up believing it to be wrong. But reality of life as a woman and now as a practicing gynecologist long ago changed my opinion on that issue. And when the church’s religious stance becomes institutionalized outside the church and allows folks to feel righteous refusing to induce what is an inevitable abortion that then places a woman at high risk for infection, I get very, very angry. Savita got her infection because they did not induce her when she ruptured membranes at a previable gestational age, which is standard medical care. One does not wait till the infection is so bad that the baby dies and the woman becomes septic to induce labor. And then of course in this situation fault to recognize and treat the infection in a timely manner, which is a separate medical issue and ultimately caused Savita’s death. But she never would have become infected if her labor had been induced when she presented and as she requested. Infection in this situation is not a theoretical risk, it is, with rare exception, an inevitability.
I’m sorry if it offended you, but my post title was deliberately meant to be inflammatory and reflect the anger I felt when I wrote it, and it will stay.
So will the recipes, which I happily share along with my opinions, and which I am pleased you have liked. I too supsect we agree on more than we disagree, and look forward to your continued readership and hopefully, more comments in the future.
Thanks again for reading,
Peggy