The jury in the Savita
Halappanavar inquest has returned a unanimous
verdict of death by medical misadventure.
Savita
Halappanavar (pictured), 31, was an Indian woman who tragically died in Ireland
from overwhelming infection after allegedly being denied an abortion.
Her case has
been seized upon by the pro-choice lobby as grounds for liberalising Ireland’s
abortion law.
Savita was 17
weeks pregnant when admitted to the University Hospital Galway on 21 October
2012 with an inevitable miscarriage.
At that time
a fetal heart beat was detected and doctors opted not to end the pregnancy by
inducing labour but instead waited for her to deliver naturally.
Her baby was born dead three days later on 24 October.
Savita died from multi-organ failure from septic shock due
to an E coli infection on 28 October, four days after her baby’s birth.
The coroner, Dr Ciaran MacLoughlin, said
the verdict of medical misadventure did not mean that deficiencies or systems
failures in University Hospital Galway necessarily contributed to Mrs
Halappanavar's death; these were just findings in relation to the management of
her care.
The chief operating officer at the Galway Roscommon Hospital
Group, Tony Canavan, acknowledged
that there were lapses in the standards of care provided to Mrs Halappanavar
and said that deficiencies identified during the inquest would be rectified by
the hospital.
Leading obstetrician Peter Boylan outlined
a number of deficiencies in her care, but stressed that none on its own was
likely to have resulted in Mrs Halappanavar’s death.
The coroner’s nine
recommendations (summarised below)
were strongly endorsed by the jury.
The key recommendation read as follows:
The key recommendation read as follows:
‘The
Medical Council should lay out exactly when a doctor can intervene to save the
life of the mother in similar circumstances, which would remove doubt and fear
from the doctor and also reassure the public. An Bord Altranais should have
similar directives for midwives so that the two professions always complement
one another.’
The other
eight recommendations involved improving hospital systems and procedures.
There are four
key questions in this tragic case:
If the
doctors had intervened earlier to induce labour when the baby’s heartbeat was
still present would Savita have died? Quite possibly not, but at that stage
there was no suggestion that her life was in danger.
If they had
acted more quickly to diagnose and treat her E coli infection might she have
been saved? Possibly. There were several acknowledged errors and omissions
made in her care but it is impossible to prove that these led to her death.
Did Savita
die because of the Irish abortion law? No, because Irish law already allows
abortion when there is a risk to the life, as distinct from the health, of the
mother. Making this judgement, however,
sometimes requires considerable skill and experience, which is why clearer
guidance from the Irish Medical Council, within
the existing law, is to be welcomed.
Does the
Irish abortion law need changing? No. As I have previously
argued in much more depth on this blog, Savita’s tragic death is not a
reason to change the law.
Ireland remains one
of the safest places in the world to have a baby. Its maternal mortality
rate is just six deaths per 100,000 live births. This compares with 12 in the
UK, 15 in the US and 200 in India.
As there are about
75,000 live births a year in Ireland this means that there is an average of
just four maternal deaths per year from all causes.
Savita’s
death was indeed a tragedy and there was medical misadventure involved in her
care, but we should be very wary of knee-jerk legislation. It is far better to handle exceptional circumstances like this by way of guidance from the Medical Council.
Ending a
pregnancy to save the life of a mother by inducing labour when the baby is too
young to survive outside the womb is sometimes
necessary in extremely rare circumstances.
But this is already legal in Ireland.
Changing the
law in Ireland to that of the UK would not save any mothers’ lives but instead
would lead to around 11,000
more abortions annually.
The baby in
the womb is the most vulnerable of human beings, worthy of wonder, respect,
care and protection. The law should reflect that fact whilst allowing
intervention to save one life (the mother) in cases where not intervening would
mean that two lives (both mother and baby) are lost.
Summary of Coroner’s
recommendations (from the
Independent):
* The Medical Council should say
exactly when a doctor can intervene to save the life of a mother, which will
remove doubt or fear from the doctor and also reassure the public;
* Blood samples are properly followed
up;
* Protocol in the management of sepsis
and guidelines introduced for all medical personal;
* Proper communication between staff
with dedicated handover set aside on change of shift;
* Protocol for dealing with sepsis to
be written by microbiology departments;
* Modified early warning score charts
to be adopted by all staff;
* Early and effective communication
with patients and their relatives when they are being cared for in hospital to
ensure treatment plan is understood;
* Medical notes and nursing notes to
be kept separately;
* No additions or amendments to be
made to the medical notes of the dead person who is the subject of an inquiry.
Dear Mr Saunders,
ReplyDeleteYou state "Ending a pregnancy to save the life of a mother by inducing labour when the baby is too young to survive outside the womb is sometimes necessary in extremely rare circumstances. But this is already legal in Ireland." and "Here we are not saying that the baby's life is less important than that of the mother, but simply (since the baby will die regardless) that it is better to intervene to save one life rather than to stand by and watch two people die". But this is simply a contradiction to the entire pro-life movement. An easy way to see this is to imagine the baby being outside of the womb. Now please tell me when it would be acceptable to hasten the death of a living human child in order to save the life of another? If we work on that basis the logical conclusion would be that terminally ill people could be killed to take their organs to save the life of the person in need. They are going to die anyway, so why allow both to die right?
I've unpacked these arguments in much more detail here - http://bit.ly/ZFRvKq
DeleteGreat article. Thanks once again Peter. Your work is doing a lot of good.
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