Abortion/ *Note* Thread Closing Shortly! ! !

MagicMarker

Deleted User wrote: »

If the doctors erred they erred, the law is irrelevant. It's all still "if"s at this point.

Is surgical intervention always the preferred method in cases like this? "The model" works fine when people are sensible, same with any "model".

If they change the rules and some doctors err what should they change them to then?

There was no need for surgical intervention, when it was discovered that she was miscarrying her pregnancy could have been induced, but this was refused as the doctor said, according to reports, he couldn't do anything until the foetal heartbeat had stopped.

I think any sensible person, in a case whereby a woman who is miscarrying and is in absolute agony, would choose to expedite the pregnancy. However when the law and the constitution doesn't allow this to happen because there isn't a "real and substantial" risk to the woman in question, then the law and the constitution need to change. In this case, "the model" did not work fine, "the model" cost someone their life.

Bannasidhe

Bannasidhe wrote: »

Is the fact that the Irish people made a choice 20 years ago and that we still do not the the required legislation in place also irrelevant?

What difference would it have made?

MagicMarker wrote: »

There was no need for surgical intervention, when it was discovered that she was miscarrying her pregnancy could have been induced, but this was refused as the doctor said, according to reports, he couldn't do anything until the foetal heartbeat had stopped.

Such cases occur on a regular basis it seems without being reported.

I think any sensible person, in a case whereby a woman who is miscarrying and is in absolute agony, would choose to expedite the pregnancy.

I agree but the law isn't the issue here. There's a couple of degrees of separation and one is the most important, that the doctors apparently didn't recognise that she was in danger of losing her life.

However when the law and the constitution doesn't allow this to happen because there isn't a "real and substantial" risk to the woman in question, then the law and the constitution need to change. In this case, "the model" did not work fine, "the model" cost someone their life.

There quite obviously was a real and substantial risk to her that the doctors didn't recognise.

Bannasidhe

Deleted User wrote: »

What difference would it have made?

Such cases occur on a regular basis it seems without being reported.


I agree but the law isn't the issue here. There's a couple of degrees of separation and one is the most important, that the doctors apparently didn't recognise that she was in danger of losing her life.

There quite obviously was a real and substantial risk to her that the doctors didn't recognise.

Simple question.

Do you believe abortion should be permitted to save the mother's life?

Yes or No.

Bannasidhe

Bannasidhe wrote: »

Simple question.

Do you believe abortion should be permitted to save the mother's life?

Yes or No.

Yes. And it is.

recedite

Bannasidhe wrote: »

Is the fact that the Irish people made a choice 20 years ago and that we still do not the the required legislation in place also irrelevant?

It is in this case. Constitutional law always trumps statute law.

MagicMarker wrote: »

there isn't a "real and substantial" risk to the woman in question

Obviously there was.

Bannasidhe

Deleted User wrote: »

Yes. And it is.

Since the Dept. of Health and the HSE do not keep any records as to when/where/how often this has occured- an issue that was highlighted by the European Court of Human Rights in the A,B,C case- we have no proof of that.
If you (or anyone) have proof - I would very much like to see it.

What we have is anecdotal evidence from the DoH/HSE that it does happen but they don't know when or how often and anecdotal evidence from women who say they were refused and had to travel to the UK.

Bannasidhe

Bannasidhe wrote: »

Since the Dept. of Health and the HSE do not keep any records as to when/where/how often this has occured- an issue that was highlighted by the European Court of Human Rights in the A,B,C case- we have no proof of that.
If you (or anyone) have proof - I would very much like to see it.

What we have is anecdotal evidence from the DoH/HSE that it does happen but they don't know when or how often and anecdotal evidence from women who say they were refused and had to travel to the UK.

First you asked if it should be allowed and now you're commenting as if you asked if it happens. It is allowed.

drkpower

Deleted User wrote: »

I agree but the law isn't the issue here. There's a couple of degrees of separation and one is the most important, that the doctors apparently didn't recognise that she was in danger of losing her life.

There quite obviously was a real and substantial risk to her that the doctors didn't recognise.

What is required is a real and substantial risk to her life, as distonct to her health. The assessment of that risk can change over time, and that is one of the problems here.

For instance, the developing sepsis could, at one point in time, have been considered to be a risk to her health, as oppposed to her life; but the doctors cannot terminate in those circumastances.

For instance, the developing sepsis could, at one point in time, have been considered to be a risk to her life; but the doctors cannot terminate unless that risk was real and substantial.

And when making that assessment (of real and substantial), what can a doctor use as guidance, at 3am in the morning, or any other time, to ascertain whether terminating a foetus is likely to be lawful? Well, not much; no detailed guidelines or legislation have ever been produced to deal with these circumstances. So they have to make these assessments with little or no guidance, when the wrong choice might leave them at risk of being struck off, or even imprisonment.

It is little wonder that doctors would only terminate where the risk to the mother has worsened considerably to the point that the risk to the life of the mother is truly grave, rather than perhaps acting earlier when the risk to the life of the mother was present, but perhaps not of such gravity as to meet a very undefined nebulous legal standard.

Delaying such crucial treatment always runs the risk of a tragic outcome to the mother.

Bannasidhe

Deleted User wrote: »

First you asked if it should be allowed and now you're commenting as if you asked if it happens. It is allowed.

Then may I ask you to provide a link to the relevant legislation?

MagicMarker

Deleted User wrote: »

Such cases occur on a regular basis it seems without being reported.

How do you know if it's not being reported? Are you sure these daily cases of induced pregnancies as a result of miscarriage occur when there is still a foetal heartbeat? If they do then great, I'm not complaining. But doesn't this highlight exactly the ambiguity surrounding abortion and the options doctors have in these kinds of cases?

Deleted User wrote: »

I agree but the law isn't the issue here. There's a couple of degrees of separation and one is the most important, that the doctors apparently didn't recognise that she was in danger of losing her life.

Yes, but if doctors were lawfully/constitutionally allowed to abort a foetus that has been deemed nonviable then there's no reason to believe that there would have been any danger posed to the life of Savita Halappanavar.

Deleted User wrote: »

There quite obviously was a real and substantial risk to her that the doctors didn't recognise.

Really, there was? At what point? Was it on the third or the fourth day of having a fully dilated cervix? What about the first day? I'll quote again part of the article from OB/GYN Dr. Jen Gunter...

Since posting this piece I learned that Ms. Halappanavar’s widower reported that she was leaking amniotic fluid and was fully dilated when first evaluated. There is no medically defensible position for doing anything other than optimal pain control and hastening delivery by the safest means possible.

If this doctor had the constitutional & lawful power to act on the FIRST day, then Savita Halappanavar would likely be alive.

Bannasidhe

Bannasidhe wrote: »

Then may I ask you to provide a link to the relevant legislation?

There's no requirement for a law for something to be allowed. There's no law about what colour my bedsheets have to be but I doubt I'll be arrested anytime soon for switching from green to blue ones.
You just thanked the post above talking about risk to the mother's life so you know that it's allowed or you thanked it ironically.

eyescreamcone

drkpower wrote: »

What is required is a real and substantial risk to her life, as distonct to her health. The assessment of that risk can change over time, and that is one of the problems here.

For instance, the developing sepsis could, at one point in time, have been considered to be a risk to her health, as oppposed to her life; but the doctors cannot terminate in those circumastances.

For instance, the developing sepsis could, at one point in time, have been considered to be a risk to her life; but the doctors cannot terminate unless that risk was real and substantial.

And when making that assessment (of real and substantial), what can a doctor use as guidance, at 3am in the morning, or any other time, to ascertain whether terminating a foetus is likely to be lawful? Well, not much; no detailed guidelines or legislation have ever been produced to deal with these circumstances. So they have to make these assessments with little or no guidance, when the wrong choice might leave them at risk of being struck off, or even imprisonment.

It is little wonder that doctors would only terminate where the risk to the mother has worsened considerably to the point that the risk to the life of the mother is truly grave, rather than perhaps acting earlier when the risk to the life of the mother was present, but perhaps not of such gravity as to meet a very undefined nebulous legal standard.

Delaying such crucial treatment always runs the risk of a tragic outcome to the mother.

This is the question indeed.
Where is the border between a serious threat to a mother's health and a serious threat to her life.

Doctors differ patients die.

We need to help the doctors to do their best for their patients, and not create legal hurdles for them. Their job is hard enough.

MagicMarker

MagicMarker wrote: »

How do you know if it's not being reported? Are you sure these daily cases of induced pregnancies as a result of miscarriage occur when there is still a foetal heartbeat? If they do then great, I'm not complaining. But doesn't this highlight exactly the ambiguity surrounding abortion and the options doctors have in these kinds of cases?

It highlights that most doctors and patients are sensible. I don't have evidence other than knowing people it happened with. I know that probably doesn't constitute evidence when it goes against what you want to hear.
Whatever the law is if you have bad doctors you'll have people die who shouldn't. They failed to spot the danger to her life.

Yes, but if doctors were lawfully/constitutionally allowed to abort a foetus that has been deemed nonviable then there's no reason to believe that there would have been any danger posed to the life of Savita Halappanavar.

We still don't know at what point sepsis set in etc. and in this case they were allowed to abort the foetus.

Really, there was? At what point?

She died, are you arguing there wasn't? Anyway without being a doctor and having the casenotes I wouldn't be confident of pinpointing when her life was in danger.

Was it on the third or the fourth day of having a fully dilated cervix? What about the first day? I'll quote again part of the article from OB/GYN Dr. Jen Gunter...

If this doctor had the constitutional & lawful power to act on the FIRST day, then Savita Halappanavar would likely be alive.

He had the power to act after that and almost certainly still in time. Just to go back to your "one death is too many" idea, if one person in the last 20 years had died from a legal abortion, whether surgical or medical, in Ireland would you want change?

drkpower

Deleted User wrote: »

Anyway without being a doctor and having the casenotes I wouldn't be confident of pinpointing when her life was in danger.

This is precisely the point. Even doctors with experience in this area can find it difficult to pinpoint when there was a real and substantial risk to her life. Especially so when there are zero guidelines out there as to what a real and substantial risk to her life is. And when an erroneous assessment can end with the doctor being struck off or even imprisoned.

MagicMarker

Deleted User wrote: »

It highlights that most doctors and patients are sensible. I don't have evidence other than knowing people it happened with. I know that probably doesn't constitute evidence when it goes against what you want to hear.
Whatever the law is if you have bad doctors you'll have people die who shouldn't. They failed to spot the danger to her life.

Would you want most doctors to break the law when it suits them because they think they're being sensible? We have laws and the constitution for a reason, if a doctor can make a bad decision and then point to the constitution and say "but I was right as far as the constitution says" then that means there's a fundamental flaw in the constitution which needs to be addressed.

Deleted User wrote: »

We still don't know at what point sepsis set in etc. and in this case they were allowed to abort the foetus.

She died, are you arguing there wasn't? Anyway without being a doctor and having the casenotes I wouldn't be confident of pinpointing when her life was in danger.

She was admitted to hospital on a Sunday, according to her husband she wasn't physically ill ("shivering, shakes & vomiting") until Tuesday evening. That's 3 days of agony where, if we did not have a fundamentally flawed constitution, a doctor could have acted on the FIRST day to expedite the pregnancy meaning this woman would likely have lived.

Deleted User wrote: »

He had the power to act after that and almost certainly still in time. Just to go back to your "one death is too many" idea, if one person in the last 20 years had died from a legal abortion, whether surgical or medical, in Ireland would you want change?

He didn't have the power to act on the first day, this is my point. This is where "the model" is broken. If her doctor had the power to act immediately, then it is likely that she never would have developed an infection in the first place.

Regarding someone dying from a legal medical procedure, all procedures carry risks. There's nothing you can do about that so long as all protocols are are strictly adhered to. In Savita's case, the doctors were powerless to act immediately, and there is too much ambiguity as to when they can act.

recedite

drkpower wrote: »

Even doctors with experience in this area can find it difficult to pinpoint when there was a real and substantial risk to her life. Especially so when there are zero guidelines out there

If a doctor at the scene cannot make that call, do you really think a politician sitting in the Dail (maybe an ex barman or an ex teacher) will be able to? Its probably best to let the medics decide. When doctors get it badly wrong, they get sued for malpractice. That's why they always carry insurance.

drkpower

recedite wrote: »

If a doctor at the scene cannot make that call, do you really think a politician sitting in the Dail (maybe an ex barman or an ex teacher) will be able to? Its probably best to let the medics decide.

Politicians can be informed by eminent medics as to what guidelines are appropriate to enshrine in law. Then individual doctors have smething useful to inform their practice.

recedite wrote: »

When doctors get it badly wrong, they get sued for malpractice. That's why they always carry insurance.

Do they carry insurance to protect them against being struck off or even imprisoned?

Let me ask you this: if, in your job, you had to make decisions which could risk your livelihood or your freedom, would you welcome guidelines to help you make that assessment? In fact, wouldnt you demand such guidelines? And if such guidelines were not in place, wouldnt you err on the side that protects your livelihood/freedom perhaps to the detriment of your clients?

robp

MagicMarker wrote: »

Would you want most doctors to break the law when it suits them because they think they're being sensible? We have laws and the constitution for a reason, if a doctor can make a bad decision and then point to the constitution and say "but I was right as far as the constitution says" then that means there's a fundamental flaw in the constitution which needs to be addressed.



She was admitted to hospital on a Sunday, according to her husband she wasn't physically ill ("shivering, shakes & vomiting") until Tuesday evening. That's 3 days of agony where, if we did not have a fundamentally flawed constitution, a doctor could have acted on the FIRST day to expedite the pregnancy meaning this woman would likely have lived.



He didn't have the power to act on the first day, this is my point. This is where "the model" is broken. If her doctor had the power to act immediately, then it is likely that she never would have developed an infection in the first place.

Regarding someone dying from a legal medical procedure, all procedures carry risks. There's nothing you can do about that so long as all protocols are are strictly adhered to. In Savita's case, the doctors were powerless to act immediately, and there is too much ambiguity as to when they can act.

Induced labour is not always an automatic procedure for predicted miscarriages. There are very good reasons for this. As Minister Reilly said in some cases the risks associated with intervention may be greater than no-intervention. A second reason is the problem of misdiagnosis. In this country misdiagnosed miscarriages is a documented problem. In the UK a trigger happy approach to induced labour for predicted miscarriages has led to an estimated 400 healthy babies pointlessly perishing every year.

There really are many possibilities here so caution is needed. Professor O'Dywer seems to be predicting a malpractice scenario based on the information he has. Yet the story still has a long way to run.

recedite

drkpower wrote: »

Let me ask you this: if, in your job, you had to make decisions which could risk your livelihood or your freedom, would you welcome guidelines to help you make that assessment? In fact, wouldnt you demand such guidelines? And if such guidelines were not in place, wouldnt you err on the side that protects your livelihood/freedom perhaps to the detriment of your clients?

Yes, but such guidelines are going to be very vague, and of limited use; each individual case is different. It will always be up to the doctor at the scene to make the call. In the case of Savita, as in any other case involving possible negligence, the doctor/s have endangered their livelihood/freedom precisely because they failed to adequately protect the patient. It was not "an either/or" situation.

As was said earlier though, there is a need to remove the legal "protection of the unborn" in these cases where the foetus is doomed anyway. That would allow termination to happen earlier, even before the life of the mother was threatened. Such a law would require another referendum to that effect to be passed first.

Bannasidhe

robp wrote: »

Induced labour is not always an automatic procedure for predicted miscarriages. There are very good reasons for this. As Minister Reilly said in some cases the risks associated with intervention may be greater than no-intervention. A second reason is the problem of misdiagnosis. In this country misdiagnosed miscarriages is a documented problem. In the UK a trigger happy approach to induced labour for predicted miscarriages has led to an estimated 400 healthy babies pointlessly perishing every year.

There really are many possibilities here so caution is needed. Professor O'Dywer seems to be predicting a malpractice scenario based on the information he has. Yet the story still has a long way to run.

Would this be the same Eamon O’Dwyer, professor emeritus of obstetrics and gynaecology at NUI Galway who was one of the organisers of a symposium on maternal health in Ireland in September which concluded

“As experienced practitioners and researchers in obstetrics and gynaecology, we affirm that direct abortion is not medically necessary to save the life of a woman.
“We uphold that there is a fundamental difference between abortion and necessary medical treatments that are carried out to save the life of the mother, even if such treatment results in the loss of life of her unborn child.
“We confirm that the prohibition of abortion does not affect, in any way, the availability of optimal care to pregnant women.”

http://www.irishtimes.com/newspaper/ireland/2012/0910/1224323797477.html

by any chance?

Hardly an 'independent' view if it is...

In fact, if one were cynical one would conclude that as a vocal pro-'lifer' and staunch defender of the view that there is never a medical need for an abortion - plus the fact that he teaches at GUH - he would say that now wouldn't he...

drkpower

recedite wrote: »

Yes, but such guidelines are going to be very vague, and of limited use; each individual case is different. It will always be up to the doctor at the scene to make the call.

There are guidelines covering thousands of areas of medical practice (especially obstetrics); most are quite specific. So clearly the profession feels guidelines to be of some use. Im sure we could debate of exactly how much use they would be, but i think we can agree that they would be of some use. Thus ending that mini-debate.

recedite wrote: »

In the case of Savita, as in any other case involving possible negligence, the doctor/s have endangered their livelihood/freedom precisely because they failed to adequately protect the patient. It was not "an either/or" situation.

It is 'either/or'. Doctors expose themselves to malpractice actions, fitness to practice investigations and even criminal prosecution no matter which way they act in this type of situation. That is precisely why guidelines are so important.

Back to my question to you: if, in your job, you had to make decisions which could risk your livelihood or your freedom, would you welcome guidelines to help you make that assessment? In fact, wouldnt you demand such guidelines? And if such guidelines were not in place, wouldnt you err on the side that protects your livelihood/freedom perhaps to the detriment of your clients?

MagicMarker

robp wrote: »

Induced labour is not always an automatic procedure for predicted miscarriages. There are very good reasons for this. As Minister Reilly said in some cases the risks associated with intervention may be greater than no-intervention. A second reason is the problem of misdiagnosis. In this country misdiagnosed miscarriages is a documented problem. In the UK a trigger happy approach to induced labour for predicted miscarriages has led to an estimated 400 healthy babies pointlessly perishing every year.

There really are many possibilities here so caution is needed. Professor O'Dywer seems to be predicting a malpractice scenario based on the information he has. Yet the story still has a long way to run.

I never said induced labour was an automatic procedure and I never said it should be, you're the only one talking about a "trigger happy" approach.

Also, there are misdiagnoses across the medical field, we don't withhold treatment of cancer incase the doctor got it wrong, nor should we withhold treatment of anything else. Misdiagnoses is a separate issue and needs to be dealt with as such.

However, I'd be curious as to how many women who at 17 weeks are fully dilated and leaking amniotic fluid are misdiagnosed as having a miscarriage.

recedite

drkpower wrote: »

It is 'either/or'. Doctors expose themselves to malpractice actions, fitness to practice investigations and even criminal prosecution no matter which way they act in this type of situation. That is precisely why guidelines are so important.

Back to my question to you.....

I already answered Yes to your question.
And you are wrong there; if it was an either/or situation the doctor would be in the clear now, having acted to protect him/her self instead of the patient.

Assuming it is malpractice, there are two possible reasons for this malpractice;
1. Doc failing the patient due to medical incompetence.
2. Doc failing the patient while trying to uphold a particular "ethos."

Either way, we can expect the doctor to be scapegoated, and will probably leave the hospital after receiving a substantial payoff.

If No. 2 the inquiry may or may not disclose this finding publicly. They may just say "the doctor acted within existing hospital guidelines."

My gut feeling is that if she had attended the Rotunda hospital, which operates under the same laws but a different religious ethos, she would still be alive today. I have no proof of that, nor will any proof emerge in the inquiry, one way or the other.
It makes you think though, if the kids were not educated in schools that are subjected to a religious ethos, would the adults they grow into have tolerated publicly funded hospitals being under such influences?

recedite

robp wrote: »

Professor O'Dywer seems to be predicting a malpractice scenario based on the information he has.

Bannasidhe wrote: »

Would this be the same Eamon O’Dwyer....
http://www.irishtimes.com/newspaper/ireland/2012/0910/1224323797477.html

...

In fairness he is also quoted in your link there as saying

no treatment should ever be withheld from a woman if she needed it to save her life, even if that treatment resulted in the loss of life of her unborn child.

which is also where the law unequivocally stands at the moment.

GCU Flexible Demeanour

recedite wrote: »

My gut feeling is that if she had attended the Rotunda hospital, which operates under the same laws but a different religious ethos, she would still be alive today. I have no proof of that, nor will any proof emerge in the inquiry, one way or the other.

I suspect you're right (but, similarly, have no evidence to support that opinion). I even wonder, had they attended any of the main Dublin maternity hospitals, would mother and baby have survived. Obviously, there's too many variables in play to say anything coherent about that. But these are thoughts that I'm hearing people speak.

There's an element of defensiveness in some of the local reaction. After all, this is meant to be cosmopolitan, artistic Galway. And here it is, with suggestions of doctors practicing medieval ethics or simply not having a clue.

I think it's fair to say the investigations will at least verify some facts. But, given the circus that has evolved around the case, it may be necessary to have a fuller inquiry. People will want to know if anyone contests that the husband was told "this is a Catholic country" at any point, and the exact context if it is not contested. Points like that won't have crucial bearing on allegations of malpractice.

The Black Oil

Was at the march in the city centre earlier. As it was moving down O' Connell St, one guy on the path started shouting aggressively about the Old Testament. Fun.

The minute's silence was rather sombre.

The Mad Hatter

The Black Oil wrote: »

Was at the march in the city centre earlier. As it was moving down O' Connell St, one guy on the path started shouting aggressively about the Old Testament. Fun.

The minute's silence was rather sombre.

I wonder if that was Mr Shouty Creationist from the corner of Henry St. I couldn't make it, unfortunately, as I was at work, but I heard there was more than 20,000 there, so I doubt this will be as poorly covered as the march in response to YD a few months back.

Bannasidhe

Today's March in Dublin

Bannasidhe

recedite wrote: »

In fairness he is also quoted in your link there as saying
which is also where the law unequivocally stands at the moment.

Link to the relevant legislation please?

The Mad Hatter

Bannasidhe wrote: »

Today's March in Dublin

My girlfriend was there, and near enough to the front to probably be in that picture - d'you have a higher resolution copy?