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The facts of Savita’s tragic death are still elusive

The answers will be harder to find if Savita’s husband and her family decide not to co-operate with the investigation

By on Thursday, 22 November 2012

Tributes to Savita in Dublin (Photo: PA)

Tributes to Savita in Dublin (Photo: PA)

There is still no light on what actually happened in the tragic case of Savita Halappanavar, who died of septicaemia following a miscarriage in University Hospital, Galway on October 28. There have been many allegations on the part of the press, predictably hostile to the Church, but until there has been a proper investigation we cannot know for certain what the facts of this case are. I contacted a friend in Dublin yesterday who is a law lecturer at UCD and asked her for her views. She emailed back: “After listening to a range of commentary and reading various statements including one from the husband’s solicitor, I am not one bit wiser as to the facts. Any comment I might make would only be based on general intuition. For example, I find it hard to imagine that anyone living in Ireland today would describe Ireland as a ‘Catholic country’. While a huge majority list their religion in the census as ‘Catholic’, the level of ‘practice’ in many urban areas is tiny.”

The latest news, reported by LifeSiteNews yesterday, is that the official inquiry into Savita’s death has now run into difficulties because the widower, Praveen Halappanavar, has stated that he and the family will not cooperate with it on the grounds that it is being run by the same government agency that he alleges caused his wife’s death. The Health Services Executive has been refused access to his wife’s medical records, “a decision which will cripple the investigation”.

Prior to this, three senior medical consultants from Galway have been dropped from the group of seven physicians conducting the inquest as the dead woman’s family had also objected to them on the grounds that no doctor from Galway University Hospital, where their daughter died, should be included. Despite their removal, Mr Halappanavar still states that he “will not cooperate with the inquiry in any way”. Some of this is probably the result of natural grief as well as anger at what he perceives to be the death by medical neglect of his wife; some of it is also probably driven by his and his wife’s family’s legal team. Either way, it will not help the Irish government in its desire that the investigation should provide answers “speedily, thoroughly and comprehensively”. It has opposed the family’s demand for an investigation independent of the Health Services Executive.

On Tuesday the Irish Catholic Bishops’ Conference issued its own clarification of Church teaching in this area, insisting that “a mother and her unborn baby are both sacred with an equal right to life”. The bishops say that they “share the anguish and sorrow expressed by so many at the tragic loss of a mother and her baby in these circumstances” and go on to explain that “the Catholic Church has never taught that the life of a child in the womb should be preferred to that of a mother”.

They continue: “Where a seriously ill pregnant woman needs medical treatment which may put the life of her baby at risk, such treatments are ethically permissible, provided every effort has been made to save the life of both the mother and the baby. Whereas abortion is the direct and intentional destruction of an unborn baby and is gravely immoral in all circumstances, this is different from medical treatments which do not directly and intentionally seek to end the life of the unborn baby. Current law and medical guidelines in Ireland allow nurses and doctors in Irish hospitals to apply this vital distinction in practice while upholding the equal right to life of both a mother and her unborn baby. Some would claim that the unborn baby is less human and less deserving of life. Advances in genetics and technology make it clear that at fertilisation a new, unique and genetically complete human being comes into existence…”

The bishops conclude by stating that “with many other religious and ethical traditions we believe in upholding the equal and inalienable right to life of a mother and her unborn child in our laws and medical practices. This helps to ensure that women and babies receive the highest standard of care and protection during pregnancy.”

Whether the doctors involved in Savita’s case followed Church teaching, or whether the couple really were told, as is alleged, that “Ireland is a Catholic country” and that therefore they could not intervene as she miscarried, is what the inquiry is all about. For me the most telling detail of LifeSiteNews’s report for Tuesday was the sentence “Irish Health Minister James Reilly has stated there is no evidence that a Catholic ethos prevented responsible treatment.” If this is true, then all the criticisms, allegations and misinterpretations of Church teaching – some of them deliberately malicious – in the media are out of place. The sooner an investigation into the whole sad event publishes its report the better.

  • http://twitter.com/LaCatholicState la catholic state

    It seems to me there is only one goal …..and that is the repeal of the Catholic laws (and yes they are Catholic and let’s stop apologising for that!!) which give equal value to the life of the unborn child as to the life of the mother.  There exists great forces and powers who want ALL rights of the unborn child removed….nothing more and nothing less.

    It is up to Catholics everywhere to pray for and demonstrate for the protection of Catholic Ireland, its laws and its children.  And that this type of case, tragic and rare as it is, will not undermine this.  Our Lady of Guadalupe….pray for us in this battle. 

  • Caroline Farrow

    The most irritating aspect is that campaigners insist on referring to her miscarriage as an “abortion” in order to deliberately muddy the waters.

    Though press reports have conflicted, what is clear is that Savita was understandably distressed and asked for her child to be delivered or surgically removed upon learning that the child would not survive. She believed this to be the best course of action for her – her husband Parveen has testified how traumatised she was on hearing the heartbeat of her child in distress.

    The question is whether or not she received the best possible treatment and care, not whether or not she was denied an abortion. Pro choicers believe that because Savita asked for an abortion she should have received one, regardless of whether this was best medical practice or in her best interests.

    We do not know whether there was obstetric mismanagement or if prompt intervention would have saved her, which is why it is vital that her husband co-operates.

    I wonder whether the refusal could have something to do with the HSE’s investigation of FPA clinics which have been discovered giving dangerous advice to women seeking abortion.

  • Caroline Farrow

    And of course I fell into the trap too. Savita was not asking for her baby girl to be aborted in order to deprive her of life. She was asking for her medical condition to be alleviated which would have resulted in the death of her child.

    When we are in considerable pain and distress we are often blind to the medical sensibilities, in short we want our ordeal swiftly ended. The thing is that no-one has a right to determine the exact nature of their treatment, be it surgical or medicinal. Ultimately the medics have the final judgement call.

  • Stephen Curran

    i suggest the comments by dr peter boylan, former chief of holles st maternity hospital, where he described the current situation as a “sword of damocles” for clinicians, must be taken into account in any rounded discussion of this tragic case.  

    it’s been 20 years since the X case showed the need for legislation to clarify the situation in the republic & allow doctors to be certain as to when they would not be liable to prosecution under the 1861 ofences against the person act.  the medical council guidelines doctors have had to go by are not 100% definitive in borderline cases.  yet the politicians have strenuously avoided legislating for this for 2 decades.  rather than harvesting statements that confirm a priori assumptions, many might be better off reflecting as to why legislating for the X case has been made too toxic for irish public representatives & what role they have played in that. 

  • paulpriest

     Will you please clarify that under no circumstances can a mother directly or indirectly kill a healthy, viable unborn child on the grounds that either labour or delivery risks their life but not their child’s?
    You repeatedly seem to imply otherwise.

  • Andrew

    It appears from The World Bank’s ‘Maternal mortality ratio’, that the more Catholic a country is, the safer are its mothers.
    I think if anyone in the West needs to look at their obstetric protocols, it’s the UK and the US who are at the top of that queue…..

    (Nice try though)

  • Farrow Caroline

    I have implied no such thing but I await an impassioned lengthy screed, liberally peppered with capitals, use of the words “ontological, paradigm and telos” informing me otherwise and proclaiming my wilful ignorant evilness to the whole world. You’ll probably mention “Vin, Smiffy and CVeebies” too for good measure and maximum dramatic impact.

    I’ll leave you to it, enjoy :-)

  • Stephen Curran

    world bank maternal mortality rates, ’07-’11:
    sweden 4 per 100,000 live births
    finland     5
    ireland     6
    israel       7
    malta       8
    portugal  8

    andrew, are you suggesting that sweden & finland are more catholic than ireland?  that israel is more catholic than malta? than portugal?

    even if you are right, association is not causation. the better maternal mortality rates in ireland compared to the UK can be better explained by the practice of active management of labour in the republic rather than by the religious affiliation of the population.

    but the fact that catholic ireland has better maternal mortality stats that the UK is of little consolation to Savita Halappanavar.  her maternal mortality was 100%.

  • paulpriest

    Nice try, but not an answer.

  • TreenonPoet

     You write

    The most irritating aspect is that campaigners insist on referring to her miscarriage as an “abortion” in order to deliberately muddy the waters

    . It is very important to agree on definitions when discussing these matters, though I do not know that the failure to do so has sinister motives.

    The Wikipedia article on abortion lists thirty different definitions of ‘abortion’ in a footnote. To its credit, a statement issued from the Standing Committee of the Irish Catholic Bishops’ Conference in Maynooth did include its definition of abortion: ”the direct and intentional destruction of an unborn baby”. The trouble with this definition, however, is that it is ambiguous, so the waters remain muddy.

  • Andrew

    You deliberately forgot to mention those other Catholic countries with the best maternal care too:

    Greece  3

    Italy  4

    Belarus  4

    Poland  5

    Spain  6

    Germany  7

    (obviously included alongside those of Ireland, Malta, and Portugal.)

    But then, of course, you make an about face, and state that maternal care has nothing to do with religion, which undermines, if not negates, the whole innuendo surrounding this case in the first place.

    Strange.

  • Rizzo The Bear

    It grieves me to say this… I think this tragic woman’s husband and family have something to hide from the investigation – something which would shed a brighter light on this awful situation.

    If they have any respect for their deceased wife and child – and if anything good and positive is to come out of this inquiry – then at least the medical profession will have something to go on and to prevent this tragedy happening to another woman.

    And leave the Roman Catholic Church alone!

  • Stephen Curran

    no, i fear you misunderstand; i deliberately focused on non-catholic countries with maternal mortality rates lower than some catholic counties -including the republic of ireland- to show it is oversimplistic to argue that catholic counties are safer for mothers.

    i did not re-define the prevailing religion of entire counties: the predominant religion in belarus is not catholicism but eastern orthodox; in greece it is not catholicism but greek orthodox; & the largest religious group in germany is that of those who have no religion.

    & i still keep to my original point: since the X case in 1992, legislation has been needed so that irish doctors can tend to their patients & know where the line is, but the issue has been made so toxic irish politicians will not touch it. i make no innuendo whatsoever.

  • Farrow Caroline

    I agree with the Bishops here. The pro-choice lobby tend to use the term ‘abortion’ to cover both spontaneous natural miscarriages and any necessary resulting D&C procedures (which the Guttmacher Institute use in their abortion statistics) whereas “abortion” in the case of Savita Halannavar was about the removal of the baby once it had died.

    My point is that she understood her baby to be in the process of dying and to be behind the cause of her physical pain and discomfort. We don’t know whether that is true or not, but the way in which she requested “abortion’ was in the context of what she felt to be the correct treatment for her miscarriage.

    It is far from clear that this would have been the correct medical treatment for her, but it does need to be stressed that it wasn’t abortion in the commonly understood sense and as used by the pro choice lobby

    I agree that expediting the delivery of the unborn child at 17 weeks is problematic in terms of Catholic teaching, however we do not know whether this would have been the correct treatment in this situation, it seems that aggressive management is often the safest option. We don’t know whether or not Catholic teaching did contribute to Savita’s death, it seems unlikely.

    There is much we don’t know, so we need to be careful about talking about various treatments. If Savita was miscarrying then her wishing the hospital to hurry that process up, is not the same as the request for an abortion, although it could have resulted in similar treatment and outcome.

    What I think we do need to guard against is condemning the potential treatments mooted by the pro-choice lobby as being un-Catholic because we don’t know whether or not they would have been the most appropriate or would have saved her life. If it turns out that Savita’s life could have been saved by a premature induction then we need to look at the facts of the case, before making a comment as to the desirability or appropriateness of the treatment. I suspect that there would be a suitable alternative. But what we must not do is anything that suggests that a mother should be compelled to sacrifice her life for that of the unborn child and we must refute the misinformation and terminology that frames this tragic death as being about a dearth of abortion as it plainly isn’t.

  • Andrew

    …..Austria, France, Lithuania, Slovak Republic, Switzerland.

    Still, like you say, it’s ‘oversimplistic’ to suggest religion has anything to do with it. Unless it’s Ireland we’re talking about, in which case it’s all down to the evil Catholics.

    ‘Oversimplistic’? Quite…..

  • NewMeena

    The single most important factor in determining maternal mortality ratios, as detailed in The World Bank’s figures on this issue, is the “contraceptive prevalence rate”.

    Where contraception usage rates are high, the aforementioned mortality ratios are small, and vice-verse.

     http://blogs.worldbank.org/health/node/554

  • NewMeena

    “If they have any respect for their deceased wife and child”

    IF !
    What an outrageous thing to say.

    CH for pity’s sake remove that comment. 

  • http://www.facebook.com/people/Ashetalia-Staatz/100001792695528 Ashetalia Staatz

    There is a contradiction here. Catholic bishops state that “a mother and her unborn baby are both sacred with an equal right to life,” then state that “the Catholic Church has never taught that the life of a child in the womb should be preferred to that of a mother.” If the mother and the fetus have an “equal right to life,” then the fact that the mother and the fetus both have heartbeats means that a hospital is faced with an impossible choice. It is the lack of clarity created by such statements that probably killed this woman.

  • Rizzo The Bear

    Just. Shut. Up.

  • Rizzo The Bear

    As if what you contribute to these message boards is anything LESS outrageous!

  • JR

    Perhaps,, Rizzo, you could engage your brain before putting your virtual mouth in gear. The facts aren’t “elusive” at all; it was medical mismanagement. It beggars belief that the unfortunate deceased was not appropriately treated with antibiotics earlier that she was. There is no doubt that she would have required a curette eventually ( even if they’d dilly-dallied around until the inevitable abortion took place). Once the amniotic sac has been breached ( and it was) she should have been treated immediately for prevention of sepsis. It was a totally preventable death. I cannot imagine what  her medical attendants were thinking-and as for trotting out the “this is a Catholic country” line, for God’s sake, it wouldn’t have mattered whether she was a Hindu,a Catholic or a Calathumpian  she was not appropriately managed.  Never mind the foetus ( safely in God’s hands with its mother); the outlook for it was hopeless.

  • josephmatte

    Let us imagine the outcry if the person to head the inquiry into the tragic death is pro-life. But as he is pro-abortion, there has been no media fury.The current maternal mortality rate in Ireland is 6 per 100,000. In India it is 253.8.

  • Stephen Curran

    world bank maternal mortality rates expressed as deaths per 100,000 live birth: ’07 – ’11:

    austria               4
    france                8
    lithuania             8
    slovak republic   6
    switzerland         8

    but also…

    sweden                4
    finland                 5
    greece                 3 (main religion: greek orthodox)
    belarus                4 (main religion: eastern orthodox)
    israel                    7

    yes, i do suggest it is oversimplistic to claim that catholic countries are safer for mothers.

  • Andrew

    So it’s the combined populace of Greece, Italy, Belarus, Poland, Spain, Germany, Austria, France, Lithuania, Slovak Republic, Ireland, and Switzerland

    vs Sweden, Finland, and Israel?
    I think I’ll claim victory here.

    But like you say, religion plays no part in it. Which makes me wonder, again, what your point was in the first place?

  • Andrew

    Your link does not attest to the conclusion you claim here. 

    In fact, you’re blatantly lying. The report goes out of its way to say:

    ‘Given different regional and country contexts, it’s a challenge to find a one-size-fits-all explanation.’

    Although, as I’ve said, the more Catholic a country is, the greater the maternal outcomes for mother are.

    Alas, the World Bank survey could never bring itself to say this. But we know it’s true.

    Ask yourself, from the statistics alone, where would you rather give birth? Ireland, or the UK?

    (And that is a serious question. And I’ll repeat: from the statistics alone, where would you rather give birth? Ireland, or the UK?)

  • Parasum

    Greece is culturally Orthodox – not Catholic. STM that any country is in danger of being defined as Catholic, if its stats about maternal care prove the point.

    Funny how countries count as Catholic in this instance, when they don’t count as Catholic on some other issues. 

    All these stats are dust in the eyes, to make people forget a woman has died, & needlessly at that. As even the Irish bishops admit:

    “- Where a seriously ill pregnant woman needs medical treatment which
    may put the life of her baby at risk, such treatments are ethically
    permissible provided every effort has been made to save the life of both
    the mother and her baby.

    - Whereas abortion is the direct and intentional destruction of an
    unborn baby and is gravely immoral in all circumstances, this is
    different from medical treatments which do not directly and
    intentionally seek to end the life of the unborn baby. Current law and
    medical guidelines in Ireland allow nurses and doctors in Irish
    hospitals to apply this vital distinction in practice while upholding
    the equal right to life of both a mother and her unborn baby.”

    http://www.zenit.org/article-35997?l=english

  • Parasum

    Switzerland’s population by religion:

    Religion in Switzerland – 2010 Census[2]
      Roman Catholicism (38.8%)
      Swiss Reformed (30.9%)
      No religion (20.1%)
      Islam (4.5%)
      Other (5.7%)

     
    http://en.wikipedia.org/wiki/Religion_in_Switzerland#cite_note-Press_release-2

    ## What’s that about Switzerland being a Catholic country ?

  • Andrew

    You might need to re-read what you’ve just posted, and see if it contradicts the claim ‘the more Catholic a country is, the safer are its mothers.’

    Take your time.

  • Jonathan West

    I think it is worth examining the Bishops’ statement in detail.

    The Catholic Church has never taught that the life of a child in the womb should be preferred to that of a mother. By virtue of their common humanity a mother and her unborn baby are both sacred with an equal right to life.The logical consequence of this is that it is never permissible to take an action which will end the baby’s life in order to extend the mother’s.Where a seriously ill pregnant woman needs medical treatment which may put the life of her baby at risk, such treatments are ethically permissible provided every effort has been made to save the life of both the mother and her baby.This is in flat contradiction of the previous paragraph. It is known as having your cake and eating it.Whereas abortion is the direct and intentional destruction of an unborn baby and is gravely immoral in all circumstances, this is different from medical treatments which do not directly and intentionally seek to end the life of the unborn baby. Current law and medical guidelines in Ireland allow nurses and doctors in Irish hospitals to apply this vital distinction in practice while upholding the equal right to life of both a mother and her unborn baby.This “vital distinction” seems to depends on nothing more ot less than what the church arbitrarily chooses to call and “abortion” or a “direct” or “intentional” desctruction of the baby’s life. I suggest that chemotherapy to save the mother from cancer which would have just as definite and certain effect on an unborn baby’s life, and is therefore is just as direct and intentional an action as an abortion to prevent an ectopic pregnancy. Therefore there is no moral difference between them and both are actions whose intention is to save the bother and whose foreseeable and inevitable effect is to kill the baby. The death of the unborn baby must be regarded as much a direct and intentional consequence of the action as saving the mother.This is only morally justifiable if you regard the unborn baby’s death as being less or a moral issue than the death of the mother. The cure must not be worse than the disease.Some would claim that the unborn baby is less human or less deserving of life. Advances in genetics and technology make it clear that at fertilisation a new, unique and genetically complete human being comes into existence. From that moment onwards each of us did not grow and develop into a human being, but grew and developed as a human being.And now the bishops are going back to the idea that the mother and baby have equal moral worth, which would rule out medical interventions which shorten the life of the unborn baby in order to save the mother’s life.I have never seen a more morally or logically incoherent statement.

  • Jonathan West

    Apologies for the lack of paragraphs in that last – I had them in the comment as edited but they didn’t come through in the published version. Text in italics is a direct quote from the bishops’ statement, non-italic is my response.

  • Dr. Jon Brownridge

     Jonathan, thanks again for your insightful examination of this vexing logical problem. No one pretends that this is a simple matter. On the contrary, there are some very fine conceptual differences to be taken into account, but they are differences with huge implications for the matter at hand.

    As I have said before, I think your account, though very well expressed, fails to distinguish between “effect” and “consequence”. This is the principle of two-fold effect, not two-fold consequence. The bishops’ statement obviously depends on this distinction to make their position viable. I can see no logical fallacy in what they say, but I respect the fact that you do.

    Effect refers to the immediate action and it is part and parcel of the action itself. To open a window is an action, and the effect of that action is an open window. There may be multiple consequences of the action as well, either foreseen or not. In the DMB case, a single action has two effects, one desired and one not desired. It is morally permissible because of the desired, good effect – saving a person’s life. That is what the bishops are trying to say, though not very clearly I’m afraid.

  • Jonathan West

    The point I am trying to make is that the difference between “effect” and “consequence” is a matter of wordsmithing. It seems to me that if an action has a foreseeable probable outcome (to use a word that is neither” effect” nor “consequence”), and that you take that action in the knowledge of the probable outcome, then you are morally responsible for that outcome.

    In deciding to take one course of action rather than another, you weigh up the totality of the foreseeable outcomes, and you choose the one which gives you the best result overall. I don’t see how you can maintain your moral integrity and ignore  a foreseeable aspect of an outcome by saying “that’s an unintended effect” or “that’s an indirect effect” and so decide that it doesn’t count in the moral calculus.

    It seems to me that you can arbitrarily choose to ignore just about any unwanted outcome of any action if you allow yourself that much moral wriggle room.

    If you’re going to accept that it is morally acceptable to take an action whose foreseeable outcome is to end the life of an unborn child in order to save the life of the mother, then it needs to be done honestly by saying that the death of the unborn child is the lesser of two evils, in essence that in such a difficult circumstance the death of the unborn child is preferable to that of the mother.

    Personally, I have no difficulty in openly stating that moral principle. But then, I’m not trying to maintain a hard line against all abortion.

  • Ditty

    We want rights for unborn children to be commensurate with rights for other semi-sentient creatures, and commensurate with a wise respect and foresight for the nature of the ecosystem that we all depend on. We aren’t on a satanic vendetta to harm babies wherever we see them, we just want the lunacy of privileging them so much more than all the other things we could privilege removed.

  • http://twitter.com/LaCatholicState la catholic state

    Who is ‘we’ pray tell.  Don’t dare include Catholics.  Humans rank higher than animals.  Jesus Christ God Himself said so.  God loves us so much more than His other creatures..

    And whether you know it or not you will be used by Satan to advance his evil anti-Child plans.  But remember….those little ones you condem on earth….will condem you on the Last Day.  Fair is fair.  All human beings are equal…..but not all creatures.  .

  • Jon Brownridge

     Try the logic this way: The situation is the same as before. A pregnant woman will die unless her pregnancy is terminated. If she dies the unborn child will certainly die too. Some kind of medical intervention is called for.

    The child’s only chance, however remote, is to be removed from an environment that will ensure its death. It is so removed either by inducement or by surgery. That is the action and it has two effects: 1. The child escapes from  an environment of certain death; 2. The mother is relieved of a situation that will kill her. The consequences of all this will not be known immediately, but there are four possibilities. Both mother and child may die; the mother may live and the child die; the child may live and the mother die; both mother and child may live. The surgeon’s moral responsibility is to achieve the fourth possibility.

    That is the way Catholic moral theology presents it. That is what the bishops’ statement is meant to convey.

  • TreenonPoet

     This ‘Jesus Christ God’ character believed that children who dishonour their parents should be put to death. That seems rather ‘anti-child’ to me. Happily, we know that the Bible contains many falsehoods, so it is not to be trusted.

    How do you know that humans do not “rank” higher after being born than before being born, but do “rank” higher than other animals?

  • Stephen Curran

    andrew, if you want to claim “victory” based on classing greece, belarus & germany as catholic countries when they are not, & on responding to examples of non-catholic counties with maternal mortality rates as good or better than catholic countries by pointing out there are more people in the catholic countries, then you are welcome to it.  my original point?  for the 3rd time: legislative clarity has been required in ireland for 20 yrs in the wake of the X case so that doctors don’t have this sword of damocles hanging over them, but the issue has been made too toxic for the legislature to touch. those who have engineered this regrettable situation should reflect on their role.

  • Jonathan West

    What you have described is a somewhat different situation from the one that has been presented in the case of Savitra Halappanavar and about which the bishops made their statement.

    The situation we had there was that the known and certain consequence of the medical intervention to save the mothers life was the immediate death of the unborn child.Now, it is also true (so far as that facts are known to us) that a miscarriage had also already started, so there was nothing that could be done to save the life of the unborn baby in the long term. However, as far as I understand it, catholic moral theology does not allow you to count the days of probable life when assessing the moral value and sacredness of that life, and so an action to deliberately bring an immediate end to that life is not morally permissible if you apply catholic moral teachings consistently.