Savita Halappanavar, Ireland, and the false divisions in abortion laws

15 Nov

As most of you reading this probably already know, Savita Halappanavar, a young woman living in Ireland, died last month at a Galway hospital.  The details are not yet fully available, but it appears very likely that she would still be alive had she lived in a country with less restrictive abortion laws.  Savita apparently went into labor at 17 weeks of pregnancy (far too early for the fetus to survive on its own). According to her husband, she requested a termination, but was told that as Ireland was a Catholic country her request could be fulfilled only after fetal heart activity had stopped.  3 days later, the Savita finally got the abortion she requested; however, it was too late to prevent the fatal infection that developed while she was waiting.  She went into septic shock shortly thereafter and died a few days later.

Although I can only speculate, my best guess is that although Ms. Halappanavar’s treating physicians were aware that her condition was serious, they did not consider it life-threatening.  (Abortion is legal in Ireland according to its constitution when a woman’s life is at risk).  Although we doctors are often asked to determine a prognosis and to make pronouncements as to the likelihood that a disease will get worse or even become life-threatening, the fact is that we often lack the data to do so, and in the end it is a matter of opinion.  Highly-educated, highly-experienced opinion, but opinion nonetheless.  There are simply too many factors to take into account, and too few studies upon which to rely, to make any accurate predictions.  (As an example, I am sure all of you know somebody who was told he or she had 6 months to live and survived several years… or vice versa).

It is bad enough that doctors in Ireland are supposed to somehow determine whether a pregnancy is life-threatening or “only” health-threatening, a task which quite frankly is impossible.  To make matters worse, although they face criminal prosecution (and potentially lifetime imprisonment) if they perform a procedure that is not considered justified, no legal framework exists to help them determine in which situations they can legally perform an abortion.  How sick does a woman need to be for the situation to be considered life-threatening?  What conditions must be present?  What laboratory values must be exceeded?  There are no answers to these questions.

This problem is not new.  In fact, two years ago the European Court of Human Rights determined that Ireland had violated the rights of a woman (pseudonym “C”) who required an abortion on medical grounds for precisely this reason and cited “the lack of effective and accessible procedures to establish a right to an abortion” which “has resulted in a striking discordance between the theoretical right to a lawful abortion in Ireland on grounds of a relevant risk to a woman’s life and the reality of its practical implementation.” (Read more here in this excellent fact sheet from the Center for Reproductive Rights)

Unfortunately, even as the Court held that this woman’s rights had been violated, it found that the rights of two other applicants (pseudonyms “A” and “B”) who sought abortion on the grounds of their personal health and wellbeing were not violated. This judgment unfortunately solidifies a false division between types of abortions; those that are required for a woman’s life to be saved, and those that are required for her health to be maintained.  Whose health is most jeopardized by her pregnancy?

1) The woman with 4 children already in foster care, who suffered debilitating depression during each of her prior pregnancies, who might become suicidal in this pregnancy (applicant “A”); 2) the woman who could not afford to be pregnant or raise a child, who might not seek medical attention after complications from her abortion for fear of legal repercussions (applicant “B”); 3) the woman with cancer in remission, whose disease might get worse during pregnancy (applicant “C”); or 4) the woman who went into labor at 17 weeks (Savita Halappanavar)?

Anybody who claims they can answer this question objectively and precisely is fooling herself.  There is no way to objectively determine ahead of time which pregnancies are life-threatening and which pose a serious health threat.  Of course some are more likely to be problematic than others, but very dire-appearing situations often end up fine, and routine pregnancies can turn tragic in the blink of an eye.  In the end, the seemingly logical and ordered way countries go about restricting access to abortion (some allow abortion only to save a woman’s life, others to preserve her health, others for socioeconomic grounds, and still others without restriction as to reason)  no longer make sense, and the only reasonable thing to do is to leave the decision to the woman whose life is affected.

In response to the European Court of Human Rights’ judgment, the Irish government formed a committee  that was tasked to report back to the Committee of Ministers by the end of October of this year.  Clearly this was too late for Savita.  Let’s hope they have gotten some work done and it’s not too late for the next woman who needs an abortion in Ireland.

5 Responses to “Savita Halappanavar, Ireland, and the false divisions in abortion laws”

  1. anonymous November 19, 2012 at 4:45 pm #

    Many questions surrounding this story. How long had membranes been ruptured? Already sick when she came to hospital? Shameful exploitation going on here.

    NYPCMD – would an abortion cure septicemia? (hint – the answer is no)

    • NYCProchoiceMD November 23, 2012 at 11:58 pm #

      Anonymous, I don’t know where you went to medical school, but had an abortion been provided upon request, when requested, it is quite likely sepsis would have never occurred. Although I don’t know the full story any more than anyone else, the scenario appears to be that Ms Halappanavar went into predicable preterm labor (assuming this because of husband’s report of back pain). I don’t know when her membranes ruptured, but it was likely soon after. Once membranes are ruptured and labor is continuous, the risk of infection if the fetus is not delivered is extremely high. Which is why when Ms Halappanavar requested an abortion, she should have had one right away. In waiting 3 days to deliver the fetus (in this instance, by performing an abortion), her treating physicians dramatically increased her risk of infection. The abortion is part of the treatment for infection. Untreated infection is the cause of sepsis. Therefore an abortion, which would have treated the infection earlier, would almost certainly have prevented the sepsis.

      Even if she was septic upon arrival (which seems unlikely, as she would have been much sicker and required ICU level care earlier), providing the abortion when she requested it would likely have helped save her. Treatment of sepsis is a combination of treating the infection that led to the sepsis (in this case, treating the chorioamnionitis, or infection inside the uterus during pregnancy) and providing supportive care, such as IV fluids. So the answer to your question is, yes, in this case abortion would have been part of the treatment for sepsis. More importantly, however, an abortion provided immediately likely would have prevented sepsis from ever occurring.

  2. Eve November 19, 2012 at 10:48 pm #

    ‘In response to the European Court of Human Rights’ judgment, the Irish government formed a committee that was tasked to report back to the Committee of Ministers by the end of October of this year.’

    This report was delayed, and delayed until ‘mysteriously’ the day before Savita’s story broke, it found it’s way to the desk of the minister for health. The abortion debate has been going on in Ireland for 30 years; politicians just want to ignore it. We voted TWICE for legislation on the issue, but they ignored us. Kinda like the Lisbon treaty – vote until you get it right etc etc. The island of Ireland is far from a democracy.

    • NYCProchoiceMD November 23, 2012 at 11:59 pm #

      Thanks for clarifying this, Eve.

Trackbacks/Pingbacks

  1. What We’ve Been Reading & Watching « Politics Power Sex - November 16, 2012

    […] And, from the Abortion Gang, read a pro-choice MD’s take on what it must be like for doctors living under such a vague and restrictive legal framework.  Lisa or I will write soon with more on […]

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