Ireland is safe, despite the propaganda

David Quinn, in the Irish Independent. On the Independent's site here. 

IN the debate about abortion we are constantly dealing with what can only be described as 'asymmetrical hysteria', that is we are only ever outraged by anti-abortion laws and their consequences and never by the consequences of pro-abortion laws.

The result of this 'asymmetrical hysteria' is that public opinion is constantly being pushed to favour more liberal abortion laws rather than more restrictive ones.

Indeed, we are conditioned to believe that laws against abortion are the result of irrational dogmas that are placing women's lives at risk.

Thus we now think that if only we were more like our more 'rational' next-door neighbour, Britain, Savita Halappanavar would be alive today.

In fact, it is impossible to know that, and certainly not before the completion of the investigation into her death.

In the meantime, what we do know is that the Irish maternal death rate is one of the very lowest in the world at roughly three women per 100,000. The British figure is four times higher at 12 per 100,000 and the US figure is eight times higher at 24 per 100,000.

How is it that Ireland without abortion is so much safer for pregnant women than Britain and America, which both have highly liberal abortion laws?

The above data has been obtained from 'Trends in Maternal Mortality: 1990 to 2008', which has been developed by the World Health Organisation, the UN and the World Bank.

However, thanks to the highly tendentious coverage of the tragic case of Mrs Halappanavar, particularly by RTE, most Irish people probably believe that Ireland is a particularly dangerous place for women to have a baby.

This notion, now commonplace and gaining worldwide traction, is actually a gross calumny against our country.

Our politicians ought to defend the medical record of this country and point out that our maternal healthcare system is superb at bringing babies to full term without compromising the lives or health of their mothers.

We would also do well to point out how the dogmas behind the abortion laws of other countries cost lives.

For example, in Britain, how many babies are unnecessarily aborted because a doctor erroneously imagines that the only way to save the mother is to abort the baby?

What kind of dogma makes some of us think that 190,000 abortions in England and Wales each year is 'normal', meaning that one pregnancy in every four ends in a termination?

What dogma leads abortion clinics to think 'gendercide' is okay, namely the killing of an unborn child simply because it is the 'wrong' sex, usually a girl?

The 'Daily Telegraph' discovered in a sting operation earlier this year that sex-selective abortions take place in UK abortion clinics.

What kind of dogma thinks it is okay to abort a child simply because the child has Down's Syndrome or cystic fibrosis?

In Ireland, a service is now on offer which allows couples to have their embryos screened to ensure they are in no way 'defective'. This is eugenics and it is common practice today.

None of the scandals just listed ever causes anything like the outrage generated by the hard cases an anti-abortion law will cause from time to time.

There are two reasons for this. The first is that they do not attract anything like the same publicity and so most of us are completely unaware of them.

The second reason is a dogmatic attachment to the ideology of 'choice', which causes many of us to simply turn a blind eye to the innumerable scandals caused by abortion laws.

We must not allow ourselves to be conditioned by ceaseless one-sided propaganda into thinking our law on abortion is inhumane and unjust.

The truth is that our law with respect both to mother and child is far more humane than in other Western countries, including Britain, and we should be very proud of that.

Rotunda head: No confusion

A report in the Irish Examiner. 

A senior consultant has said he sees no evidence of confusion in medical ranks in Ireland over whether or not a woman can have an abortion if her life is at risk.

Dr Sam Coulter-Smith, master of the Rotunda Hospital in Dublin and consultant in obstetrics and gynaecology, said it would be preferable to have legislation to bring clarity.

But he said that in his experience he has not seen confusion among doctors on whether a woman is entitled to an abortion on clinical grounds.

“No. Not in relation to where a mother’s health is at risk,” he said.

“I think most of us who work in obstetrics and gynaecology, there may be individual differences, but the majority would be of the view that if the health is such a risk that there is a risk of death and we are dealing with a foetus that is not viable, there is only one answer to that question, we bring the pregnancy to an end.”

Dr Coulter-Smith is also clinical professor of obstetrics and gynaecology at the Royal College of Surgeons in Dublin and has headed the Rotunda for the last three and a half years.

“It’s a complex area. There are a whole series of issues that need to be resolved,” he said.

Dr Coulter-Smith said he could not discuss Mrs Halappanavar’s death directly but that introducing laws would offer further clarity.

“This case probably does not have a lot to do with abortion laws,” he said.

“It is a clinical scenario – someone in the process of miscarriage and had infective complications as a result of that process, whether or not if the situation had been actively managed in the 24-36 hours proceeding the tragedy of the baby’s death, would that have changed anything? No-one can answer that.

“But from the medical point of view it would be nice to have clarity – what is and isn’t possible and feasible.

“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.

“There isn’t legislation but the issues that have been judged on have set a precedent. It would be nice if there was legislation.”

Ireland’s Medical Council regulations on abortion state that the procedure is illegal unless there is a real and substantial risk to the life (as distinct from the health) of the mother.

The Rotunda is one of the three main maternity hospitals in Dublin alongside Holles Street and the Coombe.

The Medical Council's Guide to Professional Conduct and Ethics for Registered Medical Practitioners, states:

“Under current legal precedent, this exception includes where there is a clear and substantial risk to the life of the mother arising from a threat of suicide. You should undertake a full assessment of any such risk in light of the clinical research on this issue.

“It is lawful to provide information in Ireland about abortions abroad, subject to strict conditions. It is not lawful to encourage or advocate an abortion in individual cases.

“You have a duty to provide care, support and follow-up services for women who have an abortion abroad.

“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, while making every effort to preserve the life of the baby.”

Ireland's abortion laws: we need to get the facts straight

Dr. Tim Stanley writing in the Telegraph. Click here for the article on the Telegraph's site. 

This post is neither for nor against legalised abortion – it’s simply about laying out the facts of a very tragic story.

On October 21, Savita Halappanavar visited Galway University Hospital, Ireland. The 31-year-old dentist was 17 weeks pregnant and suffering terrible back pain. Savita was told that she was having a miscarriage, so she requested an abortion. The doctors denied her request because they said that they detected a foetal heartbeat and that Irish law ruled out a termination. Savita’s pain continued for three days and she eventually died of septicaemia.

Inevitably, this awful story has prompted demands for a rethink of Ireland’s abortion laws. That’s understandable and will almost certainly happen. Ireland has been liberalising for decades; Irishness and Catholic conservatism are no longer as synonymous as they once were. The European Court of Human Rights 2010 ruling on abortion gives Taoiseach Enda Kenny good legal grounds for a review of the law, and Kenny has branded himself as a critic of the privileged status of Catholicism in Ireland. Change will probably come.

But some would dispute whether or not Savita’s death is an appropriate catalyst for that change. In Ireland, it actually is legal to induce a birth when a mother’s life is at risk. Eilís Mulroy notes the following:

The decision to induce labour early would be fully in compliance with the law and the current guidelines set out for doctors by the Irish Medical Council. Those guidelines allow interventions to treat women where necessary, even if that treatment indirectly results in the death to the baby. If they aren't being followed, laws about abortion won't change that. The issue then becomes about medical protocols being followed in hospitals and not about the absence of legal abortion in Ireland.

Because Savita's case is under investigation, Mulroy asks questions but, wisely, avoids inferring answers: why, in this instance, did the hospital not induce (as it could and should) and is its decision not to induce reflective of a wider institutional failure?

It is possible that new legislation is necessary to clarify the existing medical consensus. But it does not logically follow that Ireland needs a total rethink of its entire approach to abortion that brings it in line with Europe’s essentially pro-choice culture. Aside from the specific medical case for abortion in Savita’s situation, inducing labour to save her life would not necessarily have conflicted with Catholic moral teaching, either. In 1951, Pope Pius XII explicitly ruled that such a procedure “can be lawful.” If it is true, as the Halappanavar family claims, that the Galway doctors said they would not provide a termination because "this is a Catholic country", then they got their theology unforgivably wrong.

Savita Halappanavar’s death demands investigation and answers. Aside from giving justice to her family, the implications of any investigation for the wider abortion debate are so wide-ranging that it is crucial that we get the facts unbiased and 100 per cent accurate. Alas, such objectivity is not always applied when it comes to media reporting of the Irish and/or Catholic approach to abortion. Indeed, much of it is misleading and unhelpful.

Media rushes to judge but we don't know facts

The British media, in tandem with the Irish, is running with the 'woman dies because she was denied abortion' story headline.

It's not surprising that the likes of 'The Guardian' would give the story prominence because 'The Guardian' is fiercely pro-abortion.

In Britain it fits in with a certain stereotype of this country to believe that women are dying here because of our lingering adherence to Catholic medical ethics.

However, even the more pro-life 'Daily Telegraph' and 'Daily Mail' have given the story prominence.That would be justified if we knew that Savita Halappanavar did indeed die because she was denied an abortion, but that is not why she died.

We know this because if there was a need to end her pregnancy in order to save her life, then the hospital was free to do that. Nothing in law was preventing the hospital from doing so.

And to be absolutely clear, ending a woman's pregnancy prematurely is not necessarily the same thing as abortion.

For example, inducing labour where it is necessary to save the life of the mother is not the same as abortion and Irish hospitals induce labour in these circumstances on a regular basis.

From the available facts, we know that Mrs Halappanavar was miscarrying and that she died within days of being admitted to hospital from septicemia and E Coli ESBL.

We do not know for certain whether ending the pregnancy upon her arrival in the hospital would have saved her life, but to repeat, if medical staff needed to do that they could have done it.

Therefore the 'woman dies because she was denied abortion' storyline is simply not true. The 'woman dies because of Catholic opposition to abortion' is also not true.

We simply do not know for certain at this stage whether Mrs Halappanavar would have died no matter what was done. This is what the investigation into her death will ascertain.

And we must also repeat for the umpteenth time that Ireland has one of the lowest maternal death rates in the world. It is lower than the British rate where abortion is available on demand.

In addition, it is necessary to remind ourselves that sometimes women die because of botched abortions in legal settings. Indeed, last year a doctor – Phanuel Dartey – was struck off in Britain because he nearly killed an Irish woman while performing an abortion on her in a Marie Stopes Clinic in the UK.

This story received remarkably little publicity here in Ireland. RTE did not cover it at all, whereas it has given the Savita Halappanavar story wall-to-wall coverage. Why this discrepancy?

And by what journalistic calculus did RTE decide to give so little coverage to the revelation by this newspaper that some staff at pregnancy crisis agencies in Ireland are giving women dangerous and illegal advice? It would be good to know.

There has been a tremendous and unseemly rush to judgment in this case.

It is being used to advance the argument that Ireland must change its law on abortion before we know the full facts.

It is also being used to falsely and unjustly give the impression that Ireland is an unsafe place for pregnant women when the opposite is true.

The bottom line is that we cannot draw any decisive conclusions about what happened in this tragic case until we do know all the facts.

We won't let women die, says professor

Eilish O'Reagan, Health Correspondent of the Irish Independent. You can read the article on the Independent's website by clicking here. 

A LEADING obstetrician has said doctors do intervene to save the life of a pregnant woman, even if it means the loss of a baby.

Prof Fionnuala McAuliffe said obstetricians who were caring for pregnant women in life-threatening situations were working without specific legislation – but there was "no evidence they are letting people die".

She said obstetricians believed they had the freedom to intervene to save a woman's life, even if it meant the loss of the foetus.

Prof McAuliffe, who works in the National Maternity Hospital in Holles Street, Dublin, said from time to time doctors came across pregnant women who had uncontrollable blood pressure or severe pre-eclampsia, which can lead to severe complications.

"If uncontrollable blood pressure continues, the woman could have a stroke, a brain haemorrhage or die. The only effective way of (avoiding) that is to deliver the baby," she told theIrish Independent.

"If it happens after 24 weeks there is some chance the baby could live. If it is under 24 weeks it will not survive."

Prof McAuliffe, who is spokesperson for the Institute of Obstetricians and Gynaecologists, said obstetricians would welcome legislative clarity.

While the Medical Council's code of ethics states that doctors can intervene to terminate a pregnancy to protect the life of the mother, the institute has not provided any specific guidelines.

Most patients who come to a maternity hospital with threatened miscarriage would want to do everything they could to continue the pregnancy, Prof McAuliffe said.

She said: "the outcomes for pregnant women in Ireland are among the best in the world. We have excellent maternity services. There is no evidence that we are letting patients die to prolong the pregnancy."

Another leading obstetrician, who did not want to be named, said it was his view that doctors were legally protected if they intervened to save the life of a pregnant woman.

Referring to a report that pregnant Savita Halappanavar developed septicaemia, he said a woman could appear relatively well and collapse quickly.

"An infection can creep up on you very quickly without showing great signs. Infection is something that used to kill large numbers of women. It was the greatest cause of maternal mortality.

"It spreads from the vaginal tract up into the womb where the baby is and that is an ideal place for bugs to grow because it is warm and moist."

Rare

A case where a mother developed septicaemia was quite rare and even big maternity hospitals would only see maybe one every two years.

He added: "In my view it is very clear if the mother's life is at risk due to pregnancy continuing you have a choice to bring it to an end. It's very difficult to create guidelines for every individual scenario."

Asked how doctors would respond in the case of a woman who was miscarrying and was in pain, he said that she would be given pain relief.

Dr Peter Boylan, a former master of Holles Street, said doctors would welcome more guidance on when to save the life of a pregnant woman in grey areas where the threat was not dramatic.

Eilís Mulroy: Pro-choice side must not hijack this terrible event

THE case of Savita Halappanavar should make us all stop and reflect. Anyone who shares a concern for the protection of life extends their deepest sympathies to the Halappanavar family.

The question that needs to be asked is: was Ms Halappanavar treated in line with existing obstetrical practice in Ireland? In this kind of situation the baby can be induced early (though is very unlikely to survive). The decision to induce labour early would be fully in compliance with the law and the current guidelines set out for doctors by the Irish Medical Council

Those guidelines allow interventions to treat women where necessary, even if that treatment indirectly results in the death to the baby. If they aren't being followed, laws about abortion won't change that.

The issue then becomes about medical protocols being followed in hospitals and not about the absence of legal abortion in Ireland.

Professor John Bonnar, then chairman of the Institute of Obstetricians and Gynaecologists, spoke about the matter to the All Party Oireachtas Committee's Fifth Report on Abortion, saying: "In current obstetrical practice, rare complications can arise where therapeutic intervention is required at a stage in pregnancy when there will be little or no prospect for the survival of the baby, due to extreme immaturity.

"In these exceptional situations failure to intervene may result in the death of both the mother and baby. We consider that there is a fundamental difference between abortion carried out with the intention of taking the life of the baby, for example for social reasons, and the unavoidable death of the baby resulting from essential treatment to protect the life of the mother."

With this medical practice Ireland, thankfully, has one of the lowest death rates of mothers in pregnancy anywhere in the world.

Our generally excellent record on maternal care doesn't of course help Praveen Halappenavar, who is today dealing with the loss of his beautiful wife and the baby they expected together. Yet this terrible situation should not be used to push an ideological agenda to introduce abortion. Any debate on the issue of abortion should be carried out in a reasonable manner. It does no service to Savita's memory to use her tragic death as an impetus for legislation that is bad for both women and their babies.

Any investigation into the circumstances surrounding Savita's death will happen against the backdrop of another investigation into the practices of health professionals when dealing with pregnant women in Ireland.

As a result of an undercover investigation published by the Irish Independent last month, the HSE has launched an investigation into crisis pregnancy counselling services in Ireland that were found to be giving illegal and life-threatening advice.

The Oireachtas Committee on Health and Children has also asked for answers from the HSE. The undercover investigation was carried out at 11 state-funded Crisis Pregnancy Counselling services and revealed that some pregnancy counsellors in certain services, including the Irish Family Planning Association, were giving women dangerous and illegal advice, including telling them they could hide their abortions from their own doctors -- a practice that can endanger lives.

Incredibly, some counsellors advised women how to illegally smuggle an abortion pill into Ireland and take it without medical supervision.

A prompt investigation must take place into the death of Savita Halappanavar to best serve her memory and ensure a tragedy like this does not reoccur. The investigation into the dangerous practices being employed by some state-funded crisis pregnancy counsellors must also happen.

See this article on the Independent website here. 

Death as a result of infection during miscarriage rare

Dr. Muiris Houston, writing in the Irish Times. Article on the Times' website here. 

Background: A death as a result of an infection during a miscarriage is a rare event in the developed world. Referred to as a septic abortion or miscarriage, most cases are due to infection with bacteria such asE.coli or streptococci.

In a more severe form that spreads to the wall of the uterus, the patient will usually have a fever and a raised pulse.

The initial management of a suspected septic abortion involves taking a swab from the vagina and the neck of the womb. If the woman’s temperature goes above 38.4 degrees Celsius then blood is taken and sent to the laboratory to see if the bugs have spread to the bloodstream.

A combination of antibiotics is started even before the results of these tests are available. However, it is possible that despite the treatment the patient will go into medical shock, their blood pressure drops and a serious complication called disseminated intravascular coagulation (DIC) may ensue.

In this situation it is normal practice to wait until the patient has stabilised before surgically removing the contents of the uterus.

On rare occasions, a hysterectomy may be needed if the infection remains uncontrolled.

A miscarriage is defined as loss of pregnancy in first 24 weeks of gestation.

There are different types of miscarriage including:

* a threatened miscarriage with mild symptoms of bleeding and usually little or no pain. The neck of the womb remains closed;

* an incomplete miscarriage occurs if either the conception sac or the placenta remains in the womb;

* an inevitable miscarriage occurs with heavy bleeding, and the neck of the womb is now open. If the bleeding is severe the mother may slip into medical shock.

In an inevitable miscarriage, even though a foetal heart beat is present, the pregnancy cannot continue to term.

With the neck of the womb already open, the woman’s body prepares to naturally evacuate her womb.

However, with the neck of the womb open, there is an opportunity for bugs such as E.coli to travel from the vagina into the womb before multiplying and infecting the inside wall of the uterus.

Infection can then spread to the woman’s bloodstream, leading to shock and the onset of DIC, which occurs when the normal functioning of blood cells is progressively impaired, leading to multi-organ failure.

Medical teams focus first on pregnant woman's health, obstetricians say

Paul Cullen, Health Correspondent of the Irish Times. Read the article on the Times' website here. 

The main focus of medical teams treating a seriously ill pregnant woman is on maintaining the health of the mother, according to leading obstetricians.

Although there are no fixed rules governing practice in such cases, interventions to deal with the cause of the illness are not considered a therapeutic termination of pregnancy, one Dublin-based practitioner told The Irish Times.

In his hospital, intervention took place in cases where a mother’s life was in danger such as was required by the maternal interest, he said.

The cause of this intervention could relate to an independent condition such as cancer or a condition arising during pregnancy but in either case this intervention was not considered a therapeutic termination of pregnancy.

In all cases, the medical options would be discussed in detail with the mother where this was possible.

Septicaemia was an unpredictable event which could happen acutely and prove devastating for the affected person, he said. The existence of a foetal heartbeat could lead to a situation where it might not be considered that septicaemia was a possible complication.

Voluntary hospital 

Another obstetrician working in a voluntary hospital said that in situations where a pregnancy would never attain viability and the mother was critically ill, the main concentration of the medical team treating the woman would be on maintaining her health.

“In such situations, you expedite delivery,” he said. However, problems such as septicaemia could “creep up” very quickly and have devastating effects. Infection was one of the major causes of maternal death, he added.

“Decisions like this are usually clinically led. It’s easier in voluntary hospitals with clear clinical leadership. Where governance is more complex and bureaucratic it can be harder to get decisions.”

Under the Constitution, as interpreted by the Supreme Court in 1992, it is lawful to terminate a pregnancy if it is established “as a matter of probability” that there is a real and substantial risk to the life, as opposed to the health, of the mother.

The Medical Council advises doctors to undertake a full assessment of any risk “in light of the clinical research on this issue”.

According to its guidelines: “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, while making every effort to preserve the life of the baby.”

Maternal death is defined by the World Health Organisation as the death of a woman while pregnant or within 42 days of termination of pregnancy.

Death is due either to indirect causes or to a cause that can be directly linked to the pregnancy.

Ireland’s rate of maternal death, at six per 100,000, is extremely low by international standards.

Abortion in Ireland - Pro Life Submissions far outnumber opposing side in public consultations

For a number of years now Government backed bodies have sought public submissions on life-related issues hoping to boost their claim that their recommendations are in line with public demand.     The public have responded in massive numbers, and encouragingly, the majority of submissions have been pro-life, with most people wanting human life in its most vulnerable stages protected by law, matching the findings of professional polls commissioned yearly by the Pro-Life Campaign.
However, it's been disturbing how often the recommendations of these bodies have gone the opposite way, raising the question how come the government who appoints most members of these bodies picks people unrepresentative of the majority view in the general public?

It points to a need for democratic oversight of such appointments to clarify why people with views differing sharply from the majority are appointed more often than those who share the commonly held pro-life views.

And in the run up to legislation in relation to frozen embryos the pattern has been repeated in the Commission on Assisted Human Reproduction and the Irish Council for Bioethics.

For example, in the report of the Irish Council for Bioethics published in 2008, Council members were unanimous, 13 to 0, in recommending allowing that human embryos to be destroyed to extract stem cells for research, but 77% of the members of the public who responded to their question on this issue took the opposite view*

Another recent example of a preponderance of public submissions being pro-life now seems to have been the Medical Council’s advertising for public submissions in its preparations for the seventh edition of its Ethical Guide.  Recently, in preparing an article for the Irish Medical Times, Dara Gantly discovered that the Council received “more than 6,500 submissions from members of the public”, “the overwhelming majority” of which were pro-life. You can read this article which includes some analysis of the Pro Life Campaign’s submission here.

In the run up to the publication of government proposals following R v. R, it is politically significant that the preponderance of pro-life submissions mirrors Pro-Life Campaign poll findings that most people support Dáil legislation to protect human embryos.

Or to look at it the other way round, the fact that the majority of submissions match what the majority of the general public think bespeaks a political energy and organisational commitment in the pro-life community likely to translate into a political dividend for election candidates supporting legislation protecting embryos and a political cost for those who don’t.

* Ethical Scientific and Legal Issues Concerning Stem Cell Research: Opinion (2008), (p. 94)