Termination of pregnancy as emergency obstetric care: the interpretation of Catholic health policy and the consequences for pregnant women. An analysis of the death of Savita Halappanavar in Ireland and similar cases
16/01/2013 § Leave a comment
Marge Berer, Editor, Reproductive Health Matters
Below is a summary of the article in full Termination of pregnancy as emergency obstetric care
On 28 October 2012, Savita Halappanavar miscarried at 17 weeks of pregnancy and died in the maternity ward of a hospital in Ireland. Twelve weeks later, articles and blogs about her death continue to be published in many countries. What was iconic about Savita’s death was the fact that it raises questions about whether to terminate a pregnancy as emergency obstetric care, e.g. for inevitable miscarriage, where there are severe fetal anomalies and other non-viable pregnancies, or to save a woman’s life or health. As a committee of the Irish Parliament considers proposals to offer limited legal abortion in Ireland, this paper explores how these questions arose in relation to Savita’s death, how they relate to the interpretation of Catholic health policy and the consequences for pregnant women’s lives.
Part of the treatment required to save Savita’s life, carried out without delay, was to terminate the pregnancy because her cervix was fully dilated, the pregnancy was no longer viable and she was at high risk of infection. This was not, apparently, how Savita’s doctors saw the situation, or at least not what determined the action they took. Based on what was reported in the media, termination of the pregnancy appears to have been delayed because there was still a fetal heartbeat. But why?? What appears to be the answer arises from a statement by the doctors involved in Savita’s case that “this is a Catholic country” and, in the cases of other women reported in the media afterwards, with direct reference to personal or hospital-wide interpretation of Roman Catholic health policy.
A 2009 judgement by the now Chief Justice of the Irish Supreme Court has been interpreted to mean that if a fetus cannot survive beyond pregnancy it does not enjoy the protection granted in the Irish Constitution to the “life of the unborn”. In November 2012 the Standing Committee of the Irish Catholic Bishops’ Conference said: “· 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… 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.”
The requirement “to uphold the equal right to life of both a mother and her unborn baby” is the crux of the problem, however, because in a case like Savita’s and many others, the mother and fetus do not have an equal chance of survival. Catholic policy signally fails to acknowledge this, to women’s great detriment. The fact that the fetus is still alive is what appears to make all the difference ̶ because it forces medical professionals to decide whether the death of the fetus would be “directly intended” or not. This was fatal for Savita and is potentially fatal for other women.
The paper goes on to describe a number of other such cases, including those described by obstetrician-gynaecologists in six Catholic-run hospitals in the USA, individual cases in the Dominican Republic and Costa Rica, and those of other women in Ireland from the past which have emerged. Finally, it describes a US case where a Catholic-run hospital decided to terminate a pregnancy to save a woman’s life and was officially stripped by the Bishop of its Catholic affiliation.
This paper asks: is refusal to terminate pregnancies because the fetus is still alive, no matter what risk they pose to women, the norm in Catholic maternity services? If so, in which countries? Or are these cases exceptions?? It argues that the governments of Ireland and of every other country with Catholic-run maternity services need to answer these questions urgently.
Many of the events presented in this paper are recent or have only just taken place, and most of the sources are media and individual reports. However, there is a very worrying common thread running across countries and continents. These reports invite rigorous investigation of emergency obstetric care provided by Catholic maternity services and Catholic health professionals.
If such research unearths more histories of failure to treat and save women’s lives, as in the cases reported in this paper, urgent action is called for, including stripping any such health professionals and/or hospitals of their right to provide maternity services and emergency obstetric care. At issue is whether the woman’s life comes first or not. This is the crux of what abortion as well as emergency obstetric care is all about.