Friday, November 23, 2012

David Quinn: Leading obstetricians are adding to public confusion

Ireland : IN 2007, Tania McCabe died tragically as a result of sepsis. 

One of the twins she was carrying also died. 

There was little or no public outcry. 

There was no independent investigation, let alone a public one, and staff from the hospital where she died took part in the HSE inquiry.

The 15-page report into her death was published in 2008 and found the hospital had failed to spot that Tania had a ruptured membrane and then failed to recognise she had gone into septic shock following a Caesarean section.

The report did not attempt to claim the law had impeded the proper treatment of Tania. Had the law stood in the way of her proper treatment, it is safe to assume the hospital would have been very quick to say so because it would have absolved them of much of the responsibility for her death.

It is instructive to contrast the reaction to the McCabe case, and the subsequent findings of the report, to the reaction to the Savita Halappanavar case.

When Tania McCabe died there was no attempt by any of our senior obstetricians to demand changes to our law on abortion. This time they are calling for changes even though they admit they don't know the full details of the Savita Halappanavar case, and even though what they are saying appears to be self-contradictory.

Dr Simon Coulter Smith, Master of the Rotunda, told the Irish Independent last week: "This case (Savita's) probably does not have a lot to do with abortion laws."

He said: "What is reasonably clear is that in a position where senior clinicians feel a woman's health and life is at risk then it is permissible in this country to end the pregnancy." (Health?)

Nonetheless, he has called for great legal clarity and that's fair enough if he means giving full legal clarity to what is happening in Irish hospitals.

Or does Dr Coulter Smith want the law changed so that doctors can bring a pregnancy to an end even where there isn't a real and substantial risk to the life of the mother and the foetus is healthy and viable?

In a statement read out on 'Frontline' on Monday night, he seemed to indicate he wants the law changed so that terminations can be performed when the mother's "health" is at risk, as distinct from her life. If so, this would bring us very close to the British situation whereby almost 200,000 abortions take place each year, mostly on very dubious "health" grounds.

If this is not what he had in mind, he needs to make this absolutely clear. Or if it is, he must make this clear as well because it would go much further than even the X Case and would require a referendum.

Dr Peter Boylan, former Master of Holles Street Maternity Hospital, has also been calling for greater clarity and has spoken of a Damocles Sword hanging over obstetricians because they operate in a legal "grey area".

However, if they are operating in a grey area that offers little legal protection, then why hasn't the Sword of Damocles fallen on any of them to date?

And if they have to hold back on providing pregnant women with life-saving treatment because of this legal grey area, why is the number of maternal deaths that takes place here so low?

On 'Prime Time' on Tuesday night, Dr Boylan said that even when a foetal heartbeat is present, as was the case with Savita's baby, doctors can end the pregnancy "if the mother's life is at risk". So again, this would indicate the law was not the problem in the Savita case, any more than it was in Tania McCabe's similarly tragic and awful case.

No one can reasonably object to greater legal clarity being provided to doctors faced with these situations, not even the Catholic Church which does not object to a pregnancy being brought to an end when the mother will almost certainly die otherwise and the intention is not to kill the foetus.

Apart from this, what does Dr Boylan envisage? Does he want doctors to be able to terminate pregnancies where there is a smaller than real and substantial risk to the life of the mother, which is what is currently permitted?

Again, that would require another referendum and would go even further than the X Case.

So our obstetricians seem to be saying on the one hand that doctors can already act to save the lives of women faced with a situation similar to Savita's.

But on the other hand, they seem to want the law to go even further.

The bottom line is our leading obstetricians owe us much more clarity than they have offered to date.

They are only adding to the public confusion.