Savita Halappanavar: why we need science based health policies

Sadly last week was not a good week for women’s reproductive rights. Savita Happenavar died in Ireland though what we be regarded as medical negligence in many countries. Cases of medical malpractice  are unfortunately, not that uncommon, and physicians and nurses do sometimes make mistakes that result in fatalities. This is the reality of modern medical practice, and these events are a favourite item for the media; only to be trumped by news of the outbreak of war, political sex scandals, or such items as “gorilla runs amok at zoo” it seems (try googling the latter and you will find it occurs unnervingly frequently).

However, the well publicized tragic case of Ms Happenavar appears to be the direct result of an archaic belief based policy, and resulting medical indifference to the mothers rights compared to those of the unborn child. Although the exact details are unclear the following events seem substantiated:

1) The 17 weeks pregnant Ms Happenavar was admitted at University Hospital Galway on 21 October

2) She complained of back pan was found to be miscarrying her baby.

3) As her condition deteriorated she asked medical staff several times over a three-day period to terminate the pregnancy, and was advised this was not possible as Ireland “is a catholic country” and the foetal heart was still beating. Halappanavar objected that she was neither Irish nor a Catholic, but to no avail.

4) She died of septicaemia on Sunday 28 October. due to complications which seem to have arisen directly from the ongoing miscarriage.

University Hospital Galway is to carry out an internal investigation, and the Health & Safety Executive  has launched a separate investigation. Also, Taoiseach (Prime Minister) Enda Kenny indicated there could also be an external inquiry into the death.

As Roger noted a few months back, science generally has little to say about what is right and wrong in the world, as that falls under the domain of human ethics. However, here we have a case where there was a known diagnosis, clear evidence of the likely outcome, denial of the patients wishes, and her eventual death on the basis of religious argument. At the very least this case seems a clear breach of the hippocratic principle of “do no harm” as the obvious outcome of death of both the mother and unborn child without intervention would have seemed inevitable to any physician with experience in this area.

What is interesting is how how Irish catholic physicians have interpreted the scientific evidence to suit their own beliefs. The absurdity of the Irish anti-abortion law is well documented and includes such nonsense as technically not considering ectopic pregnancies as abortion (as the foetus has not implanted in the womb). This is, presumably, because if they did they would have 1% of all pregnant women regularly dying which would probably be beyond even the catholic public’s tolerance. In 2010 the European court of human rights ruled against the Irish state in favour of a woman who had to travel to the UK to terminate a pregnancy while undergoing chemotherapy, and in 1992 the supreme court ruled that a suicidal teenage rape victim did have the right to an abortion. Recently Irish medical experts speaking at a major International Symposium on Excellence in Maternal Healthcare held in Dublin concluded that ‘direct abortion is not medically necessary to save the life of a mother.’ This was based on the argument that such occurrences are incredibly rare. Well, even if they are exceedingly rare (excluding ectopic pregnancy) there would still be the odd case where the only option to save the mother’s life would be termination of the foetus. Anyone who has worked in an acute care area and cared for septic patients would understand the risk. If in Ms. Happenavar‘s case a termination was unnecessary, we have to ask then what medical treatment should she have had in order to save her, and why didn’t the doctors do these life-saving procedures; as termination was “unnecessary?”

Tragically, the results are the death of a healthy young women, and impact on her family. The scientific medical evidence would likely have resulted in the termination of the pregnancy to save the mother in most other western nations, and this seems like another clear example of womens reproductive rights being dictated by a religious minority of mainly men. To my mind this is a prime example of why we need health policies based on scientific evidence based practice, rather than metaphysical belief.