Abortion Discussion

lazygal

I'm just waiting for a ten page analysis from a certain poster about the use of the term brinksmanship now......

drkpower

volchitsa wrote: »

The thing I just can't understand wrt your point 3 though is that it simply isn't true that there was no monitoring : the fetal heartbeat was repeatedly and intensively monitored. What on earth was that about, and doesn't that fact alone make it impossible to believe that the failure to terminate was "just" negligence?

Of course it wasn't 'just negligence' or just a failure of monitoring.

There were two key factors at play. The failure of monitoring and the decision not to / ambiguity as to when u can terminate.

There were also two key things to monitor. The foetus heartbeat; that was the easy bit. AND the maternal condition to determine what treatment was indicated ( including a termination).

volchitsa

drkpower wrote: »

Of course it wasn't 'just negligence' or just a failure of monitoring.

There were two key factors at play. The failure of monitoring and the decision not to / ambiguity as to when u can terminate.

There were also two key things to monitor. The foetus heartbeat; that was the easy bit. AND the maternal condition to determine what treatment was indicated ( including a termination).

No, sorry, I still don't see it (not accusing you of avoiding the question or anything, just trying to get a precise medical view of this) How was the fetal heartbeat easier to monitor than the clinically observable maternal condition? We know she had a fever (are we really to believe they just thought she needed an extra blanket when her husband was in the same room and wasn't complaining of cold?) accelerated heartbeat etc - surely there was enough clinical evidence to identify a real problem?

(And that's without suspecting that the person who is known to have accessed the blood results on the computer system was someone involved in her care or who passed the results on)

The only conclusion I can come to is that there wasn't in fact a failure to monitor, there was a refusal to monitor/record the results of monitoring because there was a refusal/inability to terminate. It seems to me that a lot of otherwise inexplicable events all make sense when interpreted in that light.

Or am I showing my ignorance of something essential here?

drkpower

I think you may not have followed the case in detail (and I'm not having a go with that statement either!).

Monitoring of an infection, it's extent and progression are not straightforward. Failure to adequately diagnose and treat patients with sepsis happens every day ( and not necessarily as s consequence of poor care).

There is far more to it than measuring one parameter like temperature. You can be grossly septic with no temperature. There are a multitude of factors and the various reporting of, verdict and recommendations public ally available record the difficulties/failures of monitoring in this case.

But failure of monitoring was not the only factor at play here as discussed.

drkpower

There is no evidence of a refusal to monitor. Anywhere.

volchitsa

drkpower wrote: »

I think you may not have followed the case in detail (and I'm not having a go with that statement either!).

Monitoring of an infection, it's extent and progression are not straightforward. Failure to adequately diagnose and treat patients with sepsis happens every day ( and not necessarily as s consequence of poor care).

There is far more to it than measuring one parameter like temperature. You can be grossly septic with no temperature. There are a multitude of factors and the various reporting of, verdict and recommendations public ally available record the difficulties/failures of monitoring in this case.

But failure of monitoring was not the only factor at play here as discussed.

Okay, but surely the opposite scenario (high temperature during a prolonged miscarriage) is one that should ring all alarm bells without the need for specialized monitoring techniques?

volchitsa

drkpower wrote: »

There is no evidence of a refusal to monitor. Anywhere.

There was a problem with the blood tests (anonymously accessed but not recorded/acted upon) and claims that other relevant information was not passed on/recorded. One of the main conclusions of the third report (the HIQA one?) was that more observation would have been needed in order to identify the treatment she needed - I was referring to that claim. I can't see that more monitoring was needed, myself. It seems to me that all the necessary information as available, and all that was missing was the will to act on that. I won't speculate as to why that might have been.

But as I say, maybe I'm missing something important.

drkpower

volchitsa wrote: »

Okay, but surely the opposite scenario (high temperature during a prolonged miscarriage) is one that should ring all alarm bells without the need for specialized monitoring techniques?

A temperature can be caused by a wide variety of different sources, most harmless. Various parameters from clinical symptoms, to signs, to vitals, to laboratory results, to radiological tests and more need to be monitored depending on the infection, and it's extent.

A high temp during pregnancy should certainly be investigated. But it doesn't necessarily ring alarm bells in the sense I think u mean ( ie. That we have a very serious life threatening clinical situation).

It is difficult, but you have to try to avoid applying hindsight to this case. We now know she died and from what infection. When she presented, things were very different.

drkpower

All of the information was available, but wasn't accessed. To suggest that that was a deliberate act is to be honest just silly.

lazygal

Would the fact she was admitted on a weekend be any factor at all? I certainly noticed a difference in staffing on the Saturday and Sunday when I was having my babies. Sunday especially, we were waiting an age when we had to bring our baby back to be checked by a paediatrician. I'm not an expert at all, I'm just wondering. Before this gets picked apart word by word.

volchitsa

lazygal wrote: »

Would the fact she was admitted on a weekend be any factor at all? I certainly noticed a difference in staffing on the Saturday and Sunday when I was having my babies. Sunday especially, we were waiting an age when we had to bring our baby back to be checked by a paediatrician. I'm not an expert at all, I'm just wondering. Before this gets picked apart word by word.

There's definitely evidence (in the NHS) that post-operative deaths are higher at weekends. Not sure about A and E. And really not sure that anything that happened to Savita H on her admission was a factor in her death - but I may not be remembering the details well enough to be sure of that.

volchitsa

drkpower wrote: »

All of the information was available, but wasn't accessed. To suggest that that was a deliberate act is to be honest just silly.

It isn't true that it wasn't accessed : the highly significant blood results were accessed, but the hospital refuses to say whose password was used. (How likely is it that no password was in place to protect access to results which are presumably covered by rights to privacy regulations? We use logins and passwords in my work, which is far less security sensitive than medical results.)

ProfessorPlum

The intensive and repeated monitoring of the foetal heart rate suggests to me that the medical team knew that the 'right' course of action - from a medical best practice pov in any case, was to evacuate the uterus. The difficulty was the ambiguitity in law as to when this course of action was legal. Once there was no foetal heartbeat, there was no issue, so repeated monitoring was used to pinpoint the earliest time possible to intervene, without haveing to invoke the 'substantial risk to life' clause. They were waiting for the foetus to die so that they wouldn't be constrained by the law in their course of action.
The other scenario which would have made evacuation legal was if the points in the 8th amendment were fulfilled - that there was a real and substantial risk to the mother's life. That criteria is much more nuanced. Given the lack of guidelines for doctors, I can understand the reluctance to act on the basis of what really is little more than an aspirational statement in the constitution. With the benefit of hindsight, it becomes very easy indeed, but unfortunately in real life it is never so clear. Speak to any doctor in clinical practice and they will tell you of the many cases where patients have gone off rapidly and unexpectedly - and not through negligence or lack of care. Equally, they will have stories of patients who were never expected to recover who remarkably did, or had a much better outcome than expected. The cancer patient 'given' six weeks who last 18 months. The fact is that it is not an exact science. Usually there is no test that will give a black and white answer. In most cases as in this, it is a case of balancing the probabilities, but without having all of the information. And you never have all of the information. Every patient is different. How will they react to an infection? Will they mount a strong immune response? (Will that response be too strong and detrimental), Will they develop the classic signs and symptoms, or not? How will they respond to treatment? Do they have any underlying condition, that may be hidden, that will affect their reactions?
I find it hard to believe that the team would deliberately not act if they truly felt the conditions of law were filled, and that they were legally able to terminate. It just doesn't make any sense. Although all or most of the information may have been accessed (although if memory serves, the fulminancy of the e.coli was not recognised until after the fact)it seems that it was not properly collated, and perhaps chances were missed because of this. To be fair, it's a common problem, and is more of a system failure than a medical failure per say. Results or comments or observations often get mislaid or buried in the notes. Mostly it doesn't adversely impact on outcomes. The staffing levels are another factor. Iirc, the HSE/minister said at the time that staffing levels were not a factor, but I would be very sceptical. The hospital was not EWTD compliant. There seemed to be no proper handover from the on call team.
One last point. Medical mistakes do not equal negligence. It is possible to have one without the other.

volchitsa

ProfessorPlum wrote: »

The intensive and repeated monitoring of the foetal heart rate suggests to me that the medical team knew that the 'right' course of action - from a medical best practice pov in any case, was to evacuate the uterus. The difficulty was the ambiguitity in law as to when this course of action was legal. Once there was no foetal heartbeat, there was no issue, so repeated monitoring was used to pinpoint the earliest time possible to intervene, without haveing to invoke the 'substantial risk to life' clause. They were waiting for the foetus to die so that they wouldn't be constrained by the law in their course of action.
The other scenario which would have made evacuation legal was if the points in the 8th amendment were fulfilled - that there was a real and substantial risk to the mother's life. That criteria is much more nuanced. Given the lack of guidelines for doctors, I can understand the reluctance to act on the basis of what really is little more than an aspirational statement in the constitution. With the benefit of hindsight, it becomes very easy indeed, but unfortunately in real life it is never so clear.
....

One last point. Medical mistakes do not equal negligence. It is possible to have one without the other.

Yes, all of this makes sense to me. The first and last parts seem particularly significant - the fact that evacuation of the uterus was the normal thing to do from the PoV of best medical practice and that this is what they were hoping to do, but weren't sure if they legally could until the heartbeat stopped.

And yes, there were mistakes made, but the term medical negligence is lot more specific than that, and I'm very unwilling to accuse the team at GUH of negligence when they actually did a great deal - just not what was needed to save Savita Halappanavar's life. Something else was going on that was preventing them from doing that. Uncertainty about the legal situation seems to be the most plausible explanation.

Brian Shanahan

lazygal wrote: »

I'm just waiting for a ten page analysis from a certain poster about the use of the term brinksmanship now......

Without even getting within one parsec of what brinkmanship actually means at that.

Absolam

lazygal wrote: »

I'm just waiting for a ten page analysis from a certain poster about the use of the term brinksmanship now......

Brian Shanahan wrote: »

Without even getting within one parsec of what brinkmanship actually means at that.

I imagine if you were able to muster such illuminating insight into what posters posted, rather than what you imagine they'd post, the discussion would be immeasurably improved.

lazygal

Come now Absalom, no one mentioned any names did they? Are you making the mistake of reading something into posts that the posters didn't actually say? Because that wouldn't help the discussion, would it?

pauldla

^^^

<braces himself for ten pages of discussion clarifying 'come now Absalom'>

Absolam

lazygal wrote: »

Come now Absalom, no one mentioned any names did they? Are you making the mistake of reading something into posts that the posters didn't actually say? Because that wouldn't help the discussion, would it?

You don't think it would be the case for any poster you directed it at? Tut tut. But I'm afraid I read no more into it than was written all the same.... perhaps it's your guilty conscience telling you otherwise

obplayer

This is where the "pro-life" fanatics would lead us. All in the name of Catholicism.

Raped 10 Year Old Won’t Be Allowed An Abortion

The Black Oil

There was an SDLP rep (Alasdair McDonnell, I think) on BBC NI earlier today. He was concerned that fatal foetal abnormalities would lead to women being 'coerced' into making decisions...but didn't elaborate on what he meant.

Absolam

obplayer wrote: »

This is where the "pro-life" fanatics would lead us. All in the name of Catholicism. Raped 10 Year Old Won’t Be Allowed An Abortion

How do you mean 'would lead us'? An abortion in these circumstances is already illegal in Ireland, unless there is a risk to the life of the mother. And not in the name of Catholicism; in the name of the right to life of the unborn child.

recedite

It seems a similar situation to the x-case in many respects.

obplayer

recedite wrote: »

It seems a similar situation to the x-case in many respects.

Except this case involves a 10 year old. Forced to go to term.

Lingua Franca

Here's a more similar case: http://en.wikipedia.org/wiki/2009_Brazilian_girl_abortion_case

PopePalpatine

What's the odds that those nutjobs at "Family & Life" are going to hound this girl?

lazygal

PopePalpatine wrote: »

What's the odds that those nutjobs at "Family & Life" are going to hound this girl?

I'm surprised Cora Sherlock hasn't told us about there always being a better solution than abortion.

Absolam

obplayer wrote: »

Except this case involves a 10 year old. Forced to go to term.

Or prohibited from killing another child? Matter of perspective I suppose.

PopePalpatine wrote: »

What's the odds that those nutjobs at "Family & Life" are going to hound this girl?

What are the odds that they have the facility to 'hound' someone in Paraguay? Have they ever undertaken any activity outside the British Isles?

pauldla

Absolam wrote: »

Or prohibited from killing another child? Matter of perspective I suppose.

What are the odds that they have the facility to 'hound' someone in Paraguay? Have they ever undertaken any activity outside the British Isles?

Given Paraguay's severe anti-abortion laws, it would seem that the local nutjobs have the situation well in hand. Family & Life can rest easy on this one.

qo2cj1dsne8y4k

A woman's body, therefore a woman's choice. Not all women want to be mothers and not all bodies are fit enough to be put under the strain of acting as an incubator for almost 10 months.

You can be pro life or pro choice but only as far as the decision over your own body. You have no say over whether or not a woman terminates her pregnancy, the same way as nobody could force a pro life to have an abortion against their will.

The law needs to be changed - and will be soon I am sure. And along with that Youth Defence and any other crazy organisations should be disbanded, because they're a disgrace to the side they are supporting