Wednesday, November 14, 2012

"Woman 'denied a termination' dies in hospital"

Woman 'denied a termination' dies in hospital

This article is currently making the rounds. The movement to remove all protection from the unborn in Ireland is having a field day, and their siblings across the pond are making waves, too. The scuttlebutt is that all of this has to do with a woman being denied a life-saving abortion.

Savita Halappanavar was admitted to an Irish hospital on October 21, complaining of back pain. They found that she was suffering a miscarriage.

The Irish Times relays the story that her husband,  Praveen Halappanavar, told them.

 Mr Halappanavar said an internal examination was performed when she first presented.

“The doctor told us the cervix was fully dilated, amniotic fluid was leaking and unfortunately the baby wouldn’t survive.” The doctor, he says, said it should be over in a few hours. There followed three days, he says, of the foetal heartbeat being checked several times a day.

“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. (italics mine)

“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.”

I'll leave aside the revolting way the paper referred to Savita's baby as "womb contents." Let's move along.

Since they're quoting the grieving father and husband, I'm not going to call into doubt the veracity of the paper's story.

Note what I put in italics. Savita had already been dilated, with her water broken, when she was admitted on Sunday, October 21. If her husband is recalling correctly, it wasn't until Tuesday evening, when Savita's condition rapidly deteriorated and she collapsed, that anybody gave her any antibiotics. What kind of care was she being given in the mean time?

I've looked at a few sites trying to find what a competent physician would do with a patient like Savita. If her husband is recalling correctly, there were a lot of failures in diagnosis, counseling, and treatment -- including failure to attempt to save a baby that clearly had a strong, healthy heart beat. The doctor appeared to have decided that Savita's baby was doomed based solely on the results of a single physical examination.

It sounds as if, had Savita been given appropriate care from the beginning, there would have been no issue. Proper diagnostics, pain management, and antibiotics administered in a timely manner would likely have provided both Savita and her baby with the necessary treatment.

However, let's go ahead and assume that, in spite of how tenacious of life Savita's baby turned out to be, he or she truly was doomed, that a miscarriage was completely inevitable.

Let's look at what the “Ethical and Religious Directives for Catholic Health Care Services," by the US Conference of Catholic Bishops, has to say. I'm sure that the directives for Catholic hospitals worldwide are similar; correct me if I'm wrong  I'll bold the parts I'll be looking at more in-depth:

45. Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted. Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion....

47, Operations, treatments, and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child.


49. For a proportionate reason, labor may be induced after the fetus is viable.

If Savita was in the throes of an inevitable miscarriage, suffering from an infection originating in the uterus, inducing labor would be permissible for any Catholic, since the intention of the induction would be to address the infection of the uterus, not to kill the child. That premature delivery would hasten the child's already inevitable death would be a sad but unavoidable side effect.The same could be said of a forceps-assisted delivery. What what would be forbidden would be an actual direct abortion -- reaching into the uterus with forceps and removing the child in pieces so that he or she dies of dismemberment.

I don't think you have to be Catholic to not want to be party to that.

Savita's death isn't the first instance I've heard of in which a woman was reportedly denied "termination" of a miscarrying pregnancy until fetal heart tones were absent. I'll address that in a later post.


Suzanne said...

Why didn't removing the fetus remove the infection? Why did she grow WORSE after the operation, and not better?

Christina Dunigan said...

Once an infection like that takes hold it's very difficult to get under control. That's why it's important in an obstetric infection to get the baby out as quickly as possible.

I could see the ban on doing it while there's still a fetal heartbeat if you're doing an extraction abortion, which involves dismembering a live baby in-utero. That's unspeakably cruel to the baby -- and I can't see how it could help the mother to have the baby's body converted to lots of sharp bone shards to scratch up her uterine walls and give the infection an even quicker way to get into her bloodstream.

Inducing labor or doing a forceps-assisted delivery makes perfect sense. It removes the baby from what is, essentially, a toxic environment of infected amniotic fluid, and gives the child the chance to know being held and loved before he or she dies.

So this whole thing strikes me as just utterly bizarre.

I think a lot of prolifers want to just shy away from the whole topic, just dismiss it as pro-abortion hysteria, and move on. But that's grossly irresponsible and flat out wrong. If it happens to even one woman, that's one too many.

I find it disgusting when prochoicers put their heads in the sand about safe-n-legal abortion deaths. It's just as disgusting if the prolifers are putting their heads in the sand about preventable obstetric deaths caused by fear of even appearing to look like you might be considering approving of an abortion.

L. said...

I agree with your last paragraph above!
Apparently there was a delay in giving her antibiotics, and I can't imagine why -- also, surely she could have some narcotic pain relief to ease her suffering.

Christina Dunigan said...

First of all, welcome back, L! I'd been missing you and it really perked me up to see that you'd left a comment.

You really caught me! I had been so focused on the issue of labor induction that I hadn't even noticed that they hadn't done the simplest and most obvious things: antibiotics and pain relief!

L. said...

I never left! I just haven't been commenting much -- there are a few blogs (across the spectrum) where I engage in a spirited argument now and them (and same on Facebook), but for the most part, I'm a lurker these days. I've even discontinued my own blog.
But I'm still around!

Christina Dunigan said...

Are you still in Japan? Because I'm in Korea now. That's practically neighbors.

L. said...

I am indeed in Japan - so close, and yet so far!

I am wondering, since antiobiotics can cause birth defects, did the hospital have some protocol in which very strong antibiotics/narcotic pain relief can't be given to pregnant women, with no exceptions? If so, this controversy isn't just about abortion, but about the protocol for treating women with non-viable pregnancies, which SHOULD, by definition, absolutely, be very different from treating a woman pregnant with a baby with a chance of survival.

John Barry said...

Thank you for such a fine analysis of this tragedy. The international news media could learn from it.

Christina Dunigan said...

L, there are a lot of antibiotics that are safe in pregnancy, especially in later pregnancy. Not to mention in this case they were going on the assumption that the fetus was doomed anyway.