Sir, – So we now have the truth of the matter. Our current legal system in Ireland has operated a flawed system in relation to a pregnant woman’s birth difficulties for far too long.
At present in Ireland, for a woman undergoing the deep trauma of a miscarriage that is leading to the inevitable death of her baby, legally there can be no help from the medical profession to ease her suffering, unless she herself is at death’s door. In actual terms the law is saying: “Too bad about your continuing pain, your own acute anxiety and the coming loss of your baby, we can’t help you; not unless or until you are actually dying can we then try to behave as medical healers who have taken the Hippocratic oath to help save lives and minimise suffering – so stick with it, it will soon be all over”.
To refuse to help the suffering woman whose baby is not viable is morally indefensible and the law as stands is appallingly unjust.
I am sure there are many Irish women who have survived this inhumane waiting treatment while undergoing the acute sadness of a miscarriage, but under our present system there could well be more such casualties.
I speak as a mother of four, plus, sadly, one necessary intervention over 30 years ago, carried out at that time with efficiency and kindness. Please let us Irish women try to ensure that new legal guidelines include the words “the health and welfare of the mother” as well as the word “life”. –Is mise,
NIAMH O DOCHARTAIGH,
Moyola Park,
Newcastle, Galway.
Sir, – Like most doctors, I read about the inquest into the death of Savita Halappanaver with shame and incredulity. According to Kitty Holland (Home News, April 20th), Mrs Halappanavar was given paracetamol to reduce her temperature on Wednesday, October 24th.
I spent most of my professional life looking after patients with leukaemia in St James’s hospital. Almost all patients had a raised temperature at some time during their illness. I never prescribed paracetamol to lower a temperature but always looked for and treated the cause of the raised temperature which was usually sepsis. There never was and never is an indication to give paracetamol to an adult to lower a temperature. The only indication for giving drugs such as paracetamol is in children under the age of two years as they may develop “fits” with a high temperature irrespective of its cause. Judging by media reports today it seems as if our spineless politicians wish to pass legislation which would do nothing to prevent a repeat of recent events.
Incidentally is “system failure” a new expression for a cock-up? – Yours, etc,
SHAUN R McCANN,
Prof Emeritus of
Haematology & Academic
Medicine,
St James’s Hospital &
Trinity College Dublin,
Dublin 2.
Sir, – Praveen Halappanaver is right (Front page, April 20th). It is barbaric – truly barbaric. A foetus that was incapable of surviving was left to die inside its mother’s body. It was left there until the mother’s life was at risk. Only when it looked like she was going to die could it be removed legally. So, Savita Halappanavar died.
When it is known that a foetus cannot survive, remove it, bless it and allow the living to live. – Yours, etc,
LUCY McCAFFREY,
Pakenham Road, Monkstown, Co Dublin.
Sir, – In relation to the legal definition of a “real and substantial risk” to the life of a mother, Harry McGee suggests: “Perhaps this could also extend to accepting the risks presented by a non-viable foetus. Draft legislation written by Dr [Simon] Mills, and presented to the health committee, included such provisions” (Opinion, April 20th)
This suggestion is problematic on two levels. First, a foetus which is diagnosed with fatal abnormalities in the womb presents no greater risk to the life of a mother than a foetus which is fully formed and healthy. Physically, both pregnancies will affect the mother in identical ways before coming to term.
Second, and for that very reason, any legislation allowing for abortion in the case of such abnormalities, including that presented by Dr Mills, would be explicitly outside the terms of the X case judgment and would be struck down as unconstitutional.
To permit terminations in circumstances where there is no risk to the life of the mother would require a referendum, and would therefore represent a radical liberalisation of Irish law on abortion. And yet this proposal is repeatedly presented as some kind of uncontroversial middle-ground proposition which ought to fall naturally within the ambit of legislation on the X case.
The persistent skewing of the debate on this particularly sensitive aspect of maternal care is highly regrettable. – Yours, etc,
BARRY WALSH,
Brooklawn,
Clontarf,
Dublin 3.
Sir, – The recommendations arising from the inquiry into the death of Savita Halappanavar are shocking to me. Naively, I assumed that the procedures and protocols referred to in points two to seven (Home News, April 20th) would be standard: that it is necessary to require such recommendations to be applied nationally is akin to admission of a shambolic health system. It should be unacceptable to our Government that tragedies such as the death of Mrs Halappanavar could be contributed to by these factors.
I consider myself fortunate that, should I require medical care in the near future, it will not be affected by HSE policies – or lack thereof. – Yours, etc,
ELAINA MAGINN,
Davisville Road,
London,
England.
Sir, – There are two facts which have emerged from the inquest into the Halappanavar case which are potentially life-saving: 1. The need for rigorous monitoring of vital signs in cases of potential sepsis and appropriate clinical action (this should already be normal clinical practice but now will be formalised into “protocols”) and 2. The need for medical staff to consider ESBL (multi-resistant) E. coli when deciding empiric antibiotic coverage in a patient at risk for sepsis, especially if the patient is from a country where these are more common(like the Indian subcontinent).
These two facts could and should have been highlighted in a two-day review of this case in November, the relevant public health bodies should have been e-mailing alerts to clinicians and the media headlines should have been: “Killer bug causes tragic death by sepsis of pregnant Indian woman in Galway”. This would not have precluded a more protracted and rigorous inquiry.
In the intervening six months the farcical media and legal bandwagon surrounding the case have conspired to obfuscate these facts with cries for change in abortion law. Your own newspaper has been shamefully agenda-driven in this regard and functions, despite its pretensions, as nothing better than a populist tabloid.
Savita Halappanavar’s death may indeed save lives in the future as long as the lessons learned are the correct ones. – Yours, etc,
Dr THERESE BOYLE,
North Circular Road,
Dublin 7.
Sir, – Referring to the proposed abortion law in relation to the inquest findings on the Savita Halapannavar case (for the moment putting aside the failures in medical care): I find it incredible that the medical person responsible has to wait until the unfortunate mother is almost at death’s door in such a situation, especially when the foetus is not considered to be viable. After rupture of her membranes, Savita Halapannavar was told the pregnancy would not continue “miscarriage was inevitable”.
One of the consultant witnesses spoke of his rare experiences of septic abortion, where the foetus had in all cases died.
Are we going to enshrine in our new law a “rule” whereby the mother must deteriorate in health to the point of near death, carrying a doomed baby who it seems must die in the womb rather than outside it, in order to fulfil some rigid logic of ( legal? political? Catholic? ) correctness? A 51 per cent risk to life? I would not wish such a fate on my daughter – or on any woman. Is such a nit-picking attitude of exactness a truly human response in such a tragic crisis?
I would urge a sense of proportion and balance in framing a more flexible form of legislation, allowing trust to be placed in the attending practitioners to use their judgment in each case. Would any associated human mistakes be worse than those we have already witnessed?
I write this as someone who has some doubts about the wisdom of abortion in suicidal cases, especially in our Irish context where fully functioning multidisciplinary mental health care is not available to young adults suffering emotional difficulties; this is a context which favours the likelihood of a pregnancy exacerbating pre-existent fragile mental stability in some vulnerable women. – Yours, etc,
INGRID MASTERSON
(Former RGN RMN),
ICP Reg Psychotherapist,
Lower Churchtown Road,
Dublin 14.