Amnesty International demands compulsory referral for abortion
Irish Times (Letter to the Editor)
Colm O’Gorman (Executive DIrector, Amnesty International Ireland
Sir, – Dr Andrew O’Regan (April 14th) has firm views on when health practitioners should be allow to refuse participate in abortion procedures if the referendum is passed. However, the limits he considers a trespass on practitioners’ rights are in fact how conscience-based refusal should be regulated in order to safeguard the patient’s rights too.
There is an important difference between conscientiously objecting to something – we all have a human right to thought, conscience and religion – and being allowed to act on that objection in a way that negatively impacts on others. . .
. . . So, yes, a health professional exercising conscience-based refusal should still have a duty to make a timely referral to another who will provide the service. . . . [Full text]
Halappanavar death a watershed moment, pro-choice GP campaigner says
A significant majority of general practitioners now favour repeal of the Eighth Amendment, marking a significant change in doctors’ views over the past 15 years, according to long-time campaigner for abortion services Dr Mary Favier.
She says the death of Savita Halappanavar in 2012 proved a watershed moment for GPs, as much as for the general public.
“The death of Savita Halappanavar: that was the watershed moment – as much for GPs as for society at large,” she said. “There were just so many people upset, right-minded people who just said: ‘Oh my goodness, that’s dreadful, how could this possibly happen?’ ”
Ms Halappanavar died at University Hospital Galway a week after she presented with back pain and was found to be miscarrying, 17 weeks into a pregnancy. Although the pregnancy was not viable, her requests for termination were refused because there was a foetal heartbeat. She then contracted sepsis and died of multi-organ failure and septic shock. . . [Full text]
Staff at Galway University hospital given limited sanctions for role in death of Indian dentist who was refused an abortion
Nine members of the Irish medical team that treated an Indian dentist who died after being refused an abortion have been disciplined.
Galway University hospital said the nine were part of a larger medical team looking after Savita Halappanavar before she died from blood poisoning in October 2012.
Halappanavar had demanded that her pregnancy be terminated after fearing the foetus was dead and likely to give her sepsis. Her request was turned down after medical staff said they detected a foetal heartbeat. She was 17 weeks pregnant and miscarrying when she fell ill. [Full text]
Issues arising from the death of Savita Halappanavar in Ireland in October 2012 include the question of whether it is unethical to refuse to terminate a non-viable pregnancy when the woman’s life may be at risk. In Catholic maternity services, this decision intersects with health professionals’ interpretation of Catholic health policy on treatment of miscarriage as well as the law on abortion. This paper explores how these issues came together around Savita’s death and the consequences for pregnant women and maternity services worldwide. It discusses cases not only in Ireland but also the Americas. Many of the events presented are recent, and most of the sources are media and individual reports. However, there is a very worrying common thread across countries and continents. If further research unearths more cases like Savita’s, any Catholic health professionals and/or hospitals refusing to terminate a pregnancy as emergency obstetric care should be stripped of their right to provide maternity services. In some countries these are the main or only existing maternity services. Even so, governments should refuse to fund these services, and either replace them with non-religious services or require that non-religious staff are available at all times specifically to take charge of such cases to prevent unnecessary deaths. At issue is whether a woman’s life comes first or not at all.
The Protection of Life During Pregnancy Act 2013 will permit abortions when there is a “real and substantial risk” to the life of a woman by reason of physical illness or suicidal ideation. In the former case, two medical practitioners must certify the risk. In the case of threats to commit suicide, three medical practitioners, including two psychiatrists, must certify the risk. In all cases, they must also certify that the risk can only be averted by abortion. In emergencies, when there is an immediate risk of the mother’s death and the abortion is necessary to save her life, a medical practitioner may provide an abortion without prior certification.
Protection of Conscience Provision
The Act includes a protection of conscience provision that is limited to medical practitioners, midwives and nurses. A provision that denied freedom of conscience to institutions has been dropped. However, no conscientious objection will be allowed in emergencies when the mother’s life is in immediate danger.
One third of Irish psychiatrists signed a letter to the government asserting that abortion is not a treatment for suicidal ideation, so it is not clear how the part of the Act dealing with threats of suicide will function in practice.
The Act demands that medical practitioners who do not want to participate in the procedure must arrange “for the transfer of care of the pregnant woman concerned as may be necessary to enable the woman to avail of the medical procedure concerned.” Many conscientious objectors are unwilling to refer patients for morally contested procedures because they believe that by doing so they become morally complicit in wrongdoing.
However, it is far from certain how much difficulty the mandatory referral requirement will cause, since the Act envisions abortion only in circumstances involving a substantial risk to the mother’s life. This is very rare, and in such circumstances there is much less likelihood of conscientious objection, so the provision may not prove to be troublesome in practice.
On the other hand, government comments accompanying the earlier “heads of bill” noted that medical practitioners do not need to be of the opinion that the risk to the woman’s life “is inevitable or immediate.” The more broadly this interpretation is construed, the more likely it is that conflicts of conscience will occur, and the greater will be the surrounding controversy.
While the proposed bill is the product of the controversy generated by the death of Savita Halippanavar in Galway in October of last year, it does not appear to propose anything that would have made a difference to the outcome of that case. Her death was caused by a particularly virulent infection that is not normally found in maternity settings. An emergency induction of the kind contemplated the proposed Act was legal at that time and had been decided upon when she spontaneously delivered a stillborn daughter. (See A “medical misadventure” in Ireland: Deaths of Savita and Prasa Halappanavar)
The general scheme for a new Irish abortion law will permit abortions when there is a “real and substantial risk” to the life of a woman by reason of physical illness, suicidal ideation, or emergency medical conditions. The scheme is called a “heads of bill”, with each “head” corresponding to what is likely to become a section of the final
bill. However, the wording and content of each head are not settled.
Protection of Conscience Provision
The General Scheme for the Protection of Life During Pregnancy Bill 2013 includes a protection of conscience provision that is limited to medical practitioners, midwives and nurses. The commentary states that the provision is derived from a bill passed by the Irish Parliament in 2001 (which ultimately did not become law), but it is narrower provision than the original, which extended protection to all persons.
All hospitals and institutions operated by the state or by persons contracted by the state will be required to provide abortions if they provide maternity or neonatal care. No exemptions are permitted for facilities operated by religious denominations or persons who object to abortion for reasons of conscience.
Section 2 of the protection of conscience provision may deny freedom of conscience to psychiatrists and other medical practitioners who do not wish to participate in panels convened to approve abortions for women who are threatening to commit suicide. One third of Irish psychiatrists have already signed a letter to the government asserting that abortion is not a treatment for suicidal ideation.
Finally, the bill demands that medical practitioners who do not want to participate in the procedure must find someone willing to do so. Many conscientious objectors are unwilling to refer patients for morally contested procedures because they believe that by doing so they become morally complicit in wrongdoing.
It is not clear how much difficulty the mandatory referral requirement will cause, since the bill envisions abortion only in circumstances involving a substantial risk to the mother’s life. This is very rare, and in such circumstances there is much less likelihood of conscientious objection, so it may not prove to be troublesome in operation. On the other hand, government comments accompanying the bill note that medical practitioners do not need to be of the opinion that the risk to the woman’s life “is inevitable or immediate.” The more broadly this interpretation is construed, the more likely it is that conflicts of conscience will occur.
While the proposed bill is the product of the controversy generated by the death of Savita Halippanavar in Galway in October of last year, it does not appear to propose anything that would have made a difference to the outcome of that case. Her death was caused by a particularly virulent infection that is not normally found in maternity settings. An emergency induction of the kind contemplated by Head 3 in the proposed bill was legal at that time and had been decided upon when she spontaneously delivered a stillborn daughter. (See A “medical misadventure” in Ireland: Deaths of Savita and Prasa Halappanavar)
Savita Halappanavar was a 31 year old woman who was 17 weeks pregnant when she presented at the University Hospital, Galway, on 21 October, 2012, with a miscarriage. She spontaneously delivered a stillborn daughter, Prasa, on the afternoon of 24 October, and died from sepsis early on 28 October. The circumstances of her death generated a hurricane of controversy in Ireland and around the world about Irish abortion law. A coroner’s inquest held in Galway in April, 2013 resulted in the classification of Savita’s death as a “medical misadventure.”
What follows is a chronological account of Savita’s care and treatment from 21 to 28 October, drawn from newspaper reports of the evidence taken at the inquest. [Read more . . .]
The Irish parliament will begin hearings in January on legalization of abortion, and the Irish government promises to have a bill before the Dáil Éireann by Easter. The new law will permit abortion in order to save the life of a mother, including those who threaten to commit suicide if they are denied the procedure [Global News]. In response to the announcement, and reports that Prime Minister Enda Kenny might force objecting members of his party to vote for the bill, Ireland’s four Catholic archbishops have protested the proposed changes, and insisted that the government must respect lawmakers’ freedom of conscience.
. . .on a decision of such fundamental moral importance every public representative is entitled to complete respect for the freedom of conscience. No one has the right to force or coerce someone to act against their conscience. Respect for this right is the very foundation of a free, civilised and democratic society. [Zenit]
The new legislation is meant to clarify Ireland’s stance on abortion when the mother’s health is at risk, but antiabortion groups say it goes too far, and abortion-rights groups not far enough.
Ireland took a step today toward loosening its strict antiabortion regime, as the government announced legislation to legalize abortion in limited circumstances. But a battle lies ahead, as both abortion-rights and antiabortion groups appear dissatisfied with the government’s new prescription. . . [Christian Science Monitor]
According to a BBC report, a survey conducted following the death of Savita Halappanavar in an Irish hospital found 80% of Irish respondents in favour of legalization of abortion to save the life of a mother, including situations in which the mother threatens to commit suicide if an abortion is not provided. In a radio interview, Reporter Kitty Holland, who broke the story, was questioned about why her original article in the Irish Times failed to include an admission made in a later Observer article: that there was no evidence that Halappanavar dies because she was denied an abortion.
Marc Coleman (MC): On the 17th of November, in The Observer, you wrote that there was no evidence, as of yet, that, eh, that Savita had died for want of a termination. Can I ask you why that sentence, that very important sentence. .
Kitty Holland (KH): Hmm.
MC: . . was in your Observer article on the Saturday but not in the original article that you wrote on the 14th of November for the Irish Times?
KH: Well, I suppose throughout the um, the art, the original article, em, I mean it was, it was quoting the concerns of the, husband, Praveen, and, uh, at no point, uh, I mean, there was, uh, it, you know it was hinted at in the headline which obviously I didn’t write, those quotes. .
MC: … Mm hm.
KH: . . you know, refused a termination was in quotes. Ahm, ah, but it, you know, I was reporting the concerns of, the husband and, and what he said he was concerned about and what he said happened in the hospital, whereas my piece in The Observer was a more kind of, background piece from my point of view, so it was obviously important for me to say, quite explicitly, that, you know, and it, there was, it has not been established that . .
MC: . . Sure, sure.
KH: .. that there was a lack of access to a termination.
MC: . . But can you see, I suppose, can you see from the point of view of a lot of people that the contrast between what you wrote in The Observer and the headline on the original story,
KH: .. Mm.
MC: . .and I take your point that you did not write that headline. But it did travel around the world very quickly . .
MC: .. that, the assumption that this woman had died, precisely because of a lack of termination.
KH: Well, I mean, they were, they were what, what I wrote was, was, were the concerns of the husband, and, um, I suppose what readers took, decided to infer from that is, ah, what the concerns were of the husband and what he stated happened, from his recollection of events, em, in the hospital.
MC:.. Mm hm.
KH: Em, whereas I said, the piece in The Observer was, ah, you know, a piece by me about the background. And, ahm, I mean, I suppose, the fact that ah, a healthy, well, as far as we know healthy thirty one year old, ah, woman who was 17 weeks pregnant entered a, hospital in 21st century Ireland and died, was dead a week later
KH: .. is a, tragic story anyway.
KH: Ahm, I would have been a big story anyway. A maternal death is very rare. And, and, but it’s, it’s the husband’s, ehm, recollection or take on
KH: .. the events, and his concerns that he was, wanted to talk about
KH: You know, I, that, that, that took it off around the world.
MC:..Okay. And can we just, in fact, point on one fact of confusion between the Irish Times and RTE. Because on RTE’s website there’s a timeline, ah, attributed to the hospital itself. .
KH: Mm hm.
MC:.. Which states that, and, and it is the only date the timeline gives, the timeline gives for which Savita was given antibiotics, and it states that she was given antibiotics on a Monday. However, ah, in your original article, it, it clearly says that she was given antibiotics on a Tuesday. But then in the interview you did with Praveen H. which was up on the Irish Times website, he says in the first four minutes of that interview that the antibiotics were administered on a Sunday. Eh, for those of us who are very confused by all of this, do you think you could help to reconcile those three different versions of events?
KH: Ehm, well I mean the, the the HSE timeline is the HSE’s timeline, ahm, which, ah, um, was Monday. Ahm, he said, said to me that it definitely was on a Tuesday and as I, as I recall, during that interview, ahm, that, in the original interview I did with him when he was in India he said he’s had to choose days.
MC: .. Right
KH: That she was started on antibiotics when she collapsed. Ehm, when he says she collapsed. .
MC:.. Which was on a Tuesday, originally.
KH: On a Tuesday evening and she was getting very ill.
MC: .. Fine.
KH: Um, now, he did, he said to me in the interview when I spoke to him back in Galway that there was then, ah, was this the recorded one?
MC: .. This is the recorded one on the Irish Times website
KH: .. that was just audio or was. . (talked over)
MC: . . where he clearly says it was a Tuesday, ah, sorry, Sunday. He says that the, on this interview he says, “The antibiotics were administered on a Sunday.”
KH: And was that the audio, or was
MC:.. It was the audio.
KH: . . it the video? Okay. There were two. Eh, ehm, the audio, ehm, I mean the, all one, one can surmise is that his, his recollection of events is, is, you know, that, that the actual timeline, ehm, and days that may, may be, a little muddled. I. .
KH: Just. Ahm, I mean he said to me at one point that she was given paracetimol and not antibiotics, at one point in interview as well, not given antibiotics at any point, so, I mean, but one assumes she was given antibiotics.
KH: When she was that ill.
MC: .. And I suppose this leads to the, to the final question, in that, eh, what, to what do you attribute the disparity between, ah, Praveen Halappananvar’s ah, assertion that the family asked for termination, and the fact that the hospital records contain, aa, they contain notes of requests for tea and toast . .
MC: .. and many other things but they contain no request, aaa, for a termination?
KH: And again we only have Praveen and his solicitor’s take on what was in or not in the notes, so, I mean, what, what, we’re relying all the time on, ehm, on their take on, on what happened. Ehm, I don’t know. That’s a huge gap and if, if that is the case, ehm, and, and it is the case that she, a termination was requested and Praveen says that there were witnesses to these requests . .
MC: ..Mm hm.
KH: .. ehm, so that would all come out in the inquiry. If there, if that’s not in the notes, as they say it’s not in the notes, well then that is obviously a huge gap and I suppose one may even wonder, are requests for terminations recorded at all
KH: .. in Irish maternity hospitals (unintelligible)
MC: .. But you’re absolutely satisfied, despite saying that his recollection might have been muddled to a certain extent, you’re satisfied that he did request a termination?
KH: Oh, I’m not satisfied of anything. I mean, I’m, I’m satisfied of what he told me, but I mean I, I, I await as much, as much as anyone else, ehm, the, the, the inquiry and what the findings. I mean, I can’t tell for certain, I mean, who knows what commissions of inquiry may say, you know, they, they may come back and say, you know, she came in with the disease she caught from something outside the hospital before she even arrived in, and
MC: .. Sure
KH: . . that there was no request for termination, and, ehm, that. Ehm, we, we await with bated breath the (unintelligible)
MC: .. Okay
KH: (unintelligble). .as recounted to me, and recounted to many other people quite reasonably consistently by her husband. . .