woman refused abortion - Mod Note in first post.

SpaceTime

ProfessorPlum wrote: »

Yeah, and all that pisses me off too. But it doesn't have any relevance to the discussion at hand.

Other than it's the entire driving force behind what's at hand.

Why do you think Ireland ties itself in legal knots about abortion?

It's precisely the same reason we'd the symphisotomy scandal, the Magdaline Laundries etc etc.

Or, we can all just revise history and pretend that stuff never happened and has absolutely no relevance whatsoever to the situation that we find ourselves in in terms of anything to do with legalities of reproduction here to this day.

You've had a situation here where the political classes won't or at least wouldn't even debate the issue, never mind change anything about it.

The recent changes to law were probably the first time in the history of the Oireachtas that it's had a proper and open debate about abortion. So, I'm at least hopeful some change might eventually come in a bigger way to at least face reality.

conorh91

Czarcasm wrote: »

a case like this highlights the fact that the medical profession still has a long way to go in this country when according to reports in the media, the obstetrician involved in the case could disregard the opinions of the two other consultant psychiatrists on the case who deemed the woman met the criteria under Section 9 for a termination of her pregnancy.

My understanding is that the obstetrician said "the baby is capable of being delivered alive", not that he or she was in disagreement with the psychiatric opinion on any psychiatric diagnosis.

The narrative on the Irish Times website (updated at 1am) appears to dispute some of the other claims that have been emerging over the weekend. It implies that there was one s.9 request, and that this request was acceded to.

The reason there was no earlier s.9 request is, according to the woman's friend, some authorities, somewhere in the state, did not properly process her request. It does not appear as though a medical team convened more than once.

J_E

conorh91 wrote: »

Good for you. I'm 91. I can claim I know more than you because I claim to have lived longer.

If that's true - fair play to you! :eek:

Not sure necessarily living longer = knows more though.

ProfessorPlum

Czarcasm wrote: »

The face of Irish medicine has definitely overall changed for the better conor, but a case like this highlights the fact that the medical profession still has a long way to go in this country when according to reports in the media, the obstetrician involved in the case could disregard the opinions of the two other consultant psychiatrists on the case who deemed the woman met the criteria under Section 9 for a termination of her pregnancy.

The obstetrician judged that despite the risk of suicide, the woman should continue her pregnancy. Without unanimous agreement among the panel, the woman was denied a termination of her pregnancy under Section 9.

For clarity, and so you might understand that not all posters here are liberal minded whatever so and so, the cognitive dissonance for me stems from the fact that I am a conservative RC, but also I am a humanitarian, and in this instance, you've got a whole lot going on between my religious beliefs, my compassion for the woman in question (I really am struggling to empathise with the medical, legal, and social care professionals involved in this case tbh), my struggle to remain objective despite my experience of some of the elements involved in this case...

As difficult as the discussion on this thread has been for me personally, I can't even begin to imagine the humiliation, pain and suffering that this woman must have gone through, so, so unnecessarily, that could so easily have been prevented if she had been treated as any human being suffering such pain would hope to be treated - with compassion, dignity and respect. None of which is evident in this case.

Where does it say the obstetrician disregarded the opinions of the psychiatrists. Infact I'm pretty sure I read that there was agreement that the woman 'qualified' for a termination of pregnancy. And that is what happened. If there was no s.9 order granted, there was no justification for such and early preterm delivery which obviously has serious consequences for the infant. Why would an obstetrician risk being struck off by delivering so early against all medical knowledge?

Mountainsandh

Gustavo CoolS Quote wrote: »

If you speak to women who've given birth, been on the pill, accessed the MAP, miscarried etc, you might be very unpleasantly surprised at what many people have observed about doctors through their personal experiences.

Gustavo CoolS Quote, it's incredible. In my age group (I'm just over 40, but let's say 35-45 age group) I find that well over 50% of my women friends and acquaintances had a terrible or poor experience giving birth in Ireland. Of those, most ended up with C-sections. Ah but sure, as they say in Ireland, the baby's healthy that's the main thing.

I am French and maybe I just have this extra bit of clarity looking at it from the point of view of someone who grew up abroad, but it has always shocked me how here, in Ireland, this is the number one catch phrase that no one would dare disagree with : "the baby's healthy and that the main thing".

What about the Mum ??? Did the Mum have a horrible experience ? Is she now depressed, in pain, is the trauma she suffered going to affect the first few years with her baby ?

I have never heard that said in France, the "that's the main thing" part.

This case highlights once again this perspective with the baby in the foreground and the Mum in the background.

strandroad

ProfessorPlum wrote: »

Where does it say the obstetrician disregarded the opinions of the psychiatrists. Infact I'm pretty sure I read that there was agreement that the woman 'qualified' for a termination of pregnancy. And that is what happened. If there was no s.9 order granted, there was no justification for such and early preterm delivery which obviously has serious consequences for the infant. Why would an obstetrician risk being struck off by delivering so early against all medical knowledge?

http://m.independent.ie/irish-news/news/pregnant-woman-refused-abortion-gives-birth-by-caesarean-30512038.html

http://m.independent.ie/irish-news/health/i-am-afraid-ill-be-killed-abortion-case-woman-believed-her-life-was-in-danger-30513878.html

ProfessorPlum

SpaceTime wrote: »

Other than it's the entire driving force behind what's at hand.

Why do you think Ireland ties itself in legal knots about abortion?

It's precisely the same reason we'd the symphisotomy scandal, the Magdaline Laundries etc etc.

Or, we can all just revise history and pretend that stuff never happened and has absolutely no relevance whatsoever to the situation that we find ourselves in in terms of anything to do with legalities of reproduction here to this day.

You've had a situation here where the political classes won't or at least wouldn't even debate the issue, never mind change anything about it.

The recent changes to law were probably the first time in the history of the Oireachtas that it's had a proper and open debate about abortion. So, I'm at least hopeful some change might eventually come in a bigger way to at least face reality.

No, I don't think it is. I think the reason we are tying ourselves in knot over abortion is that our politicians haven't the balls to tackle the situation head on and can only think as far as the next election.
Not because our doctors are indoctrinated in Catholocisim, or even because many hospitals have a religious ethos (which I think is wrong btw) because I think if our doctors had the protection of the law, they would do what their training has taught them to do, and what I am sure the vast majority of them want to do - act in the best interest of their patients and deliver the best care that they can.

Mountainsandh

ProfessorPlum wrote: »

No, I don't think it is. I think the reason we are tying ourselves in knot over abortion is that our politicians haven't the balls to tackle the situation head on and can only think as far as the next election.
Not because our doctors are indoctrinated in Catholocisim, or even because many hospitals have a religious ethos (which I think is wrong btw) because I think if our doctors had the protection of the law, they would do what their training has taught them to do, and what I am sure the vast majority of them want to do - act in the best interest of their patients and deliver the best care that they can.

I don't think it's all religion either. It is likely to be still a part of it though.
It seems to me that doctors already have the protection of the law so I don't understand what you are saying tbh in your last sentence ?

ProfessorPlum

mhge wrote: »

http://m.independent.ie/irish-news/news/pregnant-woman-refused-abortion-gives-birth-by-caesarean-30512038.html

Your link to the report - it doesn't mention the obstetrician disagreeing with the psychiatrist

Morag

http://www.irishtimes.com/news/social-affairs/woman-sought-abortion-at-eight-weeks-1.1899851

strandroad

ProfessorPlum wrote: »

Your link to the report - it doesn't mention the obstetrician disagreeing with the psychiatrist

It says that she was refused abortion. Another one had more details:

Earlier this summer, the woman sought an abortion under Section 9 of the Protection of Life During Pregnancy Act, 2013 as she claimed to be suicidal. Her case was assessed by a panel of three experts, as set out under the legislation passed last summer. The panel was made up a consultant obstetrician and two psychiatrists.

The psychiatrists on the panel determined her life was at risk as she had suicidal thoughts.

But the consultant obstetrician said the baby could be delivered as it was far enough into the pregnancy.

A week after the young woman first presented she was informed she was to be refused an abortion.

http://m.independent.ie/irish-news/health/i-am-afraid-ill-be-killed-abortion-case-woman-believed-her-life-was-in-danger-30513878.html

ProfessorPlum

Mountainsandh wrote: »

I don't think it's all religion either. It is likely to be still a part of it though.
It seems to me that doctors already have the protection of the law so I don't understand what you are saying tbh in your last sentence ?

They have the protection of the law in very limited circumstances. For example, they weren't at liberty to comply with this womans request at 8 weeks when it would have been the most reasonable thing to do. They couldn't comply with Savita Halanppanaver's request until they were sure that there was a real and substantial risk, rather than acting according to best practice standards and terminating the pregnancy when it became clear that the abortion was inevitable, a decision that ultimately cost her her life. In that and similar cases they must wait until the balance tips - rather than acting earlier when the health of the mother may be seriously at risk, but not the life. They can't grant requests for abortions for women who are carrying babies with fatal foetal defects. That's kind of what I mean.

conorh91

mhge wrote: »

I
The psychiatrists on the panel determined her life was at risk as she had suicidal thoughts.

But the consultant obstetrician said the baby could be delivered as it was far enough into the pregnancy.

In other words, the obstetrician agreed to a termination of the pregnancy… where is the disagreeing obstetrician?

A week after the young woman first presented she was informed she was to be refused an abortion.

The language matters here.

The Indo claims she was told she would be refused an abortion, but it doesn't say by whom. Was it a HSE employee? An RIA employee? A GP? Who?

The Irish Times implies the woman was not given the adequate information to seek a s.9 termination earlier in her pregnancy. We don't seem to know who is alleged to have neglected to pass on this information.

SpaceTime

ProfessorPlum wrote: »

No, I don't think it is. I think the reason we are tying ourselves in knot over abortion is that our politicians haven't the balls to tackle the situation head on and can only think as far as the next election.
Not because our doctors are indoctrinated in Catholocisim, or even because many hospitals have a religious ethos (which I think is wrong btw) because I think if our doctors had the protection of the law, they would do what their training has taught them to do, and what I am sure the vast majority of them want to do - act in the best interest of their patients and deliver the best care that they can.

Roughly 50% of the 'voluntary hospitals' are under religious patronage in Ireland. That would include at least two of the very major ones in Dublin : Mater and St Vincent's.

The Catholic Archbishop of Dublin is still Chairman of Crumlin Children's Hospital and Holles Street National Maternity Hospital

http://www.nmh.ie/corporate/about-the-hospital.202.html

(just in case you didn't realise)

If you're in Cork, the public system (other than the Mercy) is very secular. CUH and the Cork University Maternity Hospital are direct HSE run.

ProfessorPlum

SpaceTime wrote: »

Roughly 50% of the 'voluntary hospitals' are under religious patronage in Ireland. That would include at least two of the very major ones in Dublin : Mater and St Vincent's.

The Catholic Archbishop of Dublin is still Chairman of Crumlin Children's Hospital and Holles Street National Maternity Hospital

http://www.nmh.ie/corporate/about-the-hospital.202.html

(just in case you didn't realise)

Yeah, I do. Unfortunately I know all about it:(
That's not to say they employ great doctors who have no qualms about doing the best for their patients - such as terminations when the life of the mother is substantially at risk (NMH) and salpingectomy for ectopic pregnancy when necessary (MMH), both which are very much contrary to their ethos.

Czarcasm

conorh91 wrote: »

My understanding is that the obstetrician said "the baby is capable of being delivered alive", not that he or she was in disagreement with the psychiatric opinion on any psychiatric diagnosis.

The narrative on the Irish Times website (updated at 1am) appears to dispute some of the other claims that have been emerging over the weekend. It implies that there was one s.9 request, and that this request was acceded to.

The reason there was no earlier s.9 request is, according to the woman's friend, some authorities, somewhere in the state, did not properly process her request. It does not appear as though a medical team convened more than once.

So either it was incompetence, or it wasn't? If there's one thing I know about the HSE, it's that they will bury you in bureaucratic procedures and paperwork. They love their paperwork, in triplicate copies and double signed, so the idea that her request got lost under the photocopier or whatever nonsense they're going with this time, it's simply inexcusable given everything else they put this woman through.

You really are defending the indefensible at this stage conor, and clutching at straws to do so.

takamichinoku

Mountainsandh wrote: »

electro~bitch, it's incredible. In my age group (I'm just over 40, but let's say 35-45 age group) I find that well over 50% of my women friends and acquaintances had a terrible or poor experience giving birth in Ireland. Of those, most ended up with C-sections. Ah but sure, as they say in Ireland, the baby's healthy that's the main thing.

I am French and maybe I just have this extra bit of clarity looking at it from the point of view of someone who grew up abroad, but it has always shocked me how here, in Ireland, this is the number one catch phrase that no one would dare disagree with : "the baby's healthy and that the main thing".

What about the Mum ??? Did the Mum have a horrible experience ? Is she now depressed, in pain, is the trauma she suffered going to affect the first few years with her baby ?

I have never heard that said in France, the "that's the main thing" part.

This case highlights once again this perspective with the baby in the foreground and the Mum in the background.

I guess what I'm saying here is gone off topic but going up a generation it definitely applies too, my mam had a really bad experience with my younger brother's birth. It was very clearly a situation that could traumatise a mother and as far as I'm aware there was nothing offered to her afterwards.
Thinking right now about how much that (coupled with a lack of aftercare following my own messy birth, there's noticeable shifts in her personality after each for the worse) may have impacted our lives is actually infuriating me. Extremely embarrassed I've never thought to ask her about it in detail before but I will be doing so, think in my head I was putting the responsibility on her to have sought help out.

ProfessorPlum

mhge wrote: »

It says that she was refused abortion. Another one had more details:

Earlier this summer, the woman sought an abortion under Section 9 of the Protection of Life During Pregnancy Act, 2013 as she claimed to be suicidal. Her case was assessed by a panel of three experts, as set out under the legislation passed last summer. The panel was made up a consultant obstetrician and two psychiatrists.

The psychiatrists on the panel determined her life was at risk as she had suicidal thoughts.

But the consultant obstetrician said the baby could be delivered as it was far enough into the pregnancy.

A week after the young woman first presented she was informed she was to be refused an abortion.

http://m.independent.ie/irish-news/health/i-am-afraid-ill-be-killed-abortion-case-woman-believed-her-life-was-in-danger-30513878.html

That doesn't say that the obstetrician vetoed the decision. it implies that the pregnancy was far enough progressed to make the foetus viable, and the obstetrician then had to balance the woman's right to life with the now viable foetus' right to life, and decided that delivery was the best option in this senario.. I can't blame him, it must have been an awful decision to have to make, knowing that the doctor knew well the difficulties that such a premature infant would face.

efb

Remember of course, when the first child was sacrificed to make way for subsequent children through Symphysiotomy:

http://www.historyireland.com/20th-century-contemporary-history/the-murder-of-infants-symphysiotomy-in-ireland-1944-66/

Not so pro-life then...

SpaceTime

Mountainsandh wrote: »

electro~bitch, it's incredible. In my age group (I'm just over 40, but let's say 35-45 age group) I find that well over 50% of my women friends and acquaintances had a terrible or poor experience giving birth in Ireland. Of those, most ended up with C-sections. Ah but sure, as they say in Ireland, the baby's healthy that's the main thing.

I am French and maybe I just have this extra bit of clarity looking at it from the point of view of someone who grew up abroad, but it has always shocked me how here, in Ireland, this is the number one catch phrase that no one would dare disagree with : "the baby's healthy and that the main thing".

What about the Mum ??? Did the Mum have a horrible experience ? Is she now depressed, in pain, is the trauma she suffered going to affect the first few years with her baby ?

I have never heard that said in France, the "that's the main thing" part.

This case highlights once again this perspective with the baby in the foreground and the Mum in the background.

I think to be honest, that's a lot more to do with the way that Irish consultant-led healthcare tends to work for absolutely everything.

You go into hospital and the person you're dealing with deals with that one thing. It could be giving birth or having treatment for cancer, they deal with the mechanics of it and often only their very specific area and then you're sort of dumped back to your GP or left to your own devices.

I've seen very ill relatives of mine basically having to coordinate all of their own paperwork, files, make appointments with departments in hospitals that were totally unaware of why they coming, their case history etc etc.. and this was one of the very large Dublin Voluntary teaching hospitals.

Going way off topic here, but I think patients need to be assigned a non-consultant doctor or a nurse who is responsible for a group of patients. They should be looking after how they're dealt with and managing their care.

That's not what happens here at all. Often the services are there, the technology's there but there's absolutely no coordination or interaction with the patient and the patient and their GP are expected to be able to figure out how the whole thing should fit together and neither's really able to do it.

I'd say it's more like : baby delivered, job done... I only do deliveries.. if you want after care, that's somewhere else, here's a phone book!

ProfessorPlum

I think a huge part of the reason for the high numbers of women who have C sections is the threat of litigation. 20 years ago the maternity hospitals prided themselves on the low rates of c section - it was about 10% in Ireland compared to over 25% in the US. Since then medical indemnity fees for obstetricians has sky rocketed and any complication or delay in labour is likely to be met with a recommendation for a c section.



but I think patients need to be assigned a non-consultant doctor

Ah comeon, they'll never manage to be EWTD compliant if you do that!

efb

ProfessorPlum wrote: »

I think a huge part of the reason for the high numbers of women who have C sections is the threat of litigation. 20 years ago the maternity hospitals prided themselves on the low rates of c section - it was about 10% in Ireland compared to over 25% in the US. Since then medical indemnity fees for obstetricians has sky rocketed and any complication or delay in labour is likely to be met with a recommendation for a c section.



but I think patients need to be assigned a non-consultant doctor

Ah comeon, they'll never manage to be EWTD compliant if you do that!

My link may also explain Ireland's low CS rate

Mountainsandh

And incompetence. My own first C-section was as a result of blatant incompetence and very poor care in/at several "stages".

pq0n1ct4ve8zf5

Looking at the Irish Times article, it seems like the panel were pretty well hamstrung by the law the time she got to them. Someone cocked up earlier though, seeing as it appears that she got an examination at eight weeks, decided immediately that she wanted an abortion, and then three months elapsed before she was referred to a panel.

Even if one thinks the PLP legislation is adequate, things were not operating as they should have been even within that very restrictive framework. It also shows up the PLP for the crock of shít that it is, at eight weeks and as a rape victim, surely to god a GP should have been able to deal with the situation at their discretion. In combination this means that a woman who could have taken a few tablets in a doctor's office ended up on hunger strike and undergoing surgery to delivery a horribly premature child who will now (if they survive, and that's a pretty big if) be taken into care. Anybody who thinks that's right needs to... I don't even know what they need to do.

SpaceTime

ProfessorPlum wrote:

Ah comeon, they'll never manage to be EWTD compliant if you do that!

it's for another thread but that's down to mismanaged resources and lack of funds in the right places.

Czarcasm

ProfessorPlum wrote: »

Where does it say the obstetrician disregarded the opinions of the psychiatrists. Infact I'm pretty sure I read that there was agreement that the woman 'qualified' for a termination of pregnancy. And that is what happened. If there was no s.9 order granted, there was no justification for such and early preterm delivery which obviously has serious consequences for the infant. Why would an obstetrician risk being struck off by delivering so early against all medical knowledge?

I genuinely don't know Professor, but it was one of the first questions I asked myself when this case came to light. It simply makes no sense whatsoever to perform a cesarean section on an otherwise healthy woman, and given her condition where she was considered at risk of suicide, there are also questions surrounding her capacity to consent to such an invasive medical procedure unless there was some immediate concern at that point for the welfare of the unborn child.

I simply can't get my head around it and am at a loss to understand why this woman was put through such rigorous procedures legally and medically in order to have her give birth to a child prematurely at that stage of her pregnancy, and that was before the HSE were again to go to the High Court to compel the woman to undergo the procedure.

This case if anything has shown that the current legislation is wholly inadequate for the purposes of which it was intended, or, depending on your perspective, it is precisely adequate for the purpose for which it was intended. I would hate to think like that though tbh, and would actually prefer to believe that this was one catastrophic snowball effect that was never intended to see the light of day.

Now that it has though, I'm not so sure it can be so easily contained any more. There are some difficult questions to answer, and someone had better start taking responsibility before indeed all faith is lost in the medical profession and the various agencies of the State in this country.

SpaceTime

I think we need a new thread on healthcare systems and hospital management!

ProfessorPlum

efb wrote: »

My link may also explain Ireland's low CS rate

Not since 1966. Im talking 1990's. Nobody was doing symphysiotomies then.

efb

ProfessorPlum wrote: »

Not since 1966. Im talking 1990's. Nobody was doing symphysiotomies then.

Up to 1984

efb

The ethos of discouraging CS as it reduced further child birth would be another reason for it's low take up in Ireland