The inquest into the death of Savita Halappanavar concluded in Galway last week with a verdict of medical misadventure. The day of the verdict would have been her 5th wedding anniversary.
The inquest opened on the 8th of April and concluded on the 19th, hearing two weeks’ worth of evidence from the staff involved in caring for Savita; those who did her post-mortem; her friends and relatives; and external experts.
“This is a Catholic country”
Midwife Ann Maria Burke admitted that it was her who said this to Savita and her husband Praveen when they requested a termination, a remark that was quoted repeatedly in news coverage of Savita’s death. She said it was intended as an explanation of the legal situation in Ireland, not a condemnation or criticism of Savita’s expressed preference for a termination:
It does sound very bad now but at the time I didn’t mean it that way. It was the law of the land and there were two referendums where the Catholic church was pressing the buttons. [Irish Times]
However, Dr. Katherine Astbury, the obstetrician in charge of Savita’s treatment, repeatedly denied saying anything of the kind, despite testimony from Praveen.
The inquest also found that there were deficiencies in the care given to Savita, including:
- not monitoring her vital signs adequately.
- not following up on abnormal blood test results in a timely way.
- missing symptoms of worsening infection, such as shaking chills (the nurse gave her an extra blanket and told her that the heating wasn’t working in her room).
- the antibiotics she was given – while acceptable according to international standards – were ineffective against the type of infection she had.
Many of these mistakes were known before the inquest and have been used by anti-choice activists to explain Savita’s death as solely due to medical mistakes and not Ireland’s abortion laws.
Abortion would have saved her life
However, expert witness Dr Peter Boylan (former Master of the National Maternity Hospital and currently Clinical Director there) made it clear that the law was to blame: the single factor with the biggest impact on her care was that she could not get a termination of pregnancy before becoming fatally ill:
The real problem was the inability of doctors to terminate her pregnancy at an earlier stage”¦ By the time her condition worsened and this became possible, it was too late to save her life. – [Irish Times]
Terminating the pregnancy as soon as a diagnosis like this is made is best practice internationally:
Less than 24 hours after admission, Savita had a white blood cell count of 16.9 and ruptured membranes. She also had pain. This would be enough to prompt every OB/GYN I know in the United States and Canada to discuss evacuating the uterus”¦
By Tuesday evening Savita had shaking chills and an elevated heart rate…. At this point my colleagues and I would be panicking about Ms. Halappanavar’s health. Not so in Galway.
“¦the standard of care with chorioamnionitis is to recommend delivery as soon as the diagnosis is made, not wait until women enter the antechamber of death in the hopes that we can somehow snatch them back from the brink. (emphasis mine)
Dr. Boylan testified that had Savita gotten the termination she requested when she requested it, she would likely be alive today, but her doctor was legally not allowed to perform one:
“It is highly likely she would not have died” if she had been given a termination earlier, he added. (emphasis mine)
However, terminating her pregnancy was not a practical proposition for the doctors treating her at this time because of the legal situation in Ireland, he said.- [Irish Times]
Her wishes would’ve been taken into account in any other country… Whatever it is that they [Savita and Praveen] wished would have been undertaken. In any other country.
“¦these are the only circumstances in obstetric care where a woman’s wishes are not taken into account, where she has no input into her care… If you think of any other sort of situation like that, you end up thinking about the Taliban. Where else are women denied an input into their care? In what other clinical situation? I can’t identify one.
– Dr Boylan speaking on Irish radio on April 21st.
Praveen has said that if he had known that not terminating the pregnancy could result in fatal septicaemia, they would have done everything possible to get the care she needed.
“I was not told her temperature was high, even. She was chattering and now I know it was a symptom of sepsis.” [Irish Times]
“We were always kept in the dark. If Savita would have known her life was at risk she would have jumped off the bed, straight to a different hospital. But we were never told.” [Irish Times]
The coroner made nine recommendations, which were fully endorsed by the jury, including protocols to manage sepsis, and a call for clearer Medical Council guidelines on when termination of pregnancy is warranted based on risk to a woman’s life.
Praveen has hinted that he may take a case further on the basis that Savita was denied her human rights to health and life by the medical staff and Irish law:
“You lose your rights basically when you are pregnant here I think. You lose your rights to get necessary healthcare. Savita and me, we knew that abortion was illegal in Ireland but not”¦when you can’t save the baby and the mother may die if you don’t do something like terminate.” [Irish Times]
This was also the point made by Minister for Justice Alan Shatter in parliament in X-Case debates last year:
“There is no impediment to men seeking and obtaining any required medical intervention to protect not only their life but also their health and quality of life”¦ it can truly be said that the right of pregnant women to have their health protected is, under our constitutional framework, a qualified right as is their right to bodily integrity.”
Pro-choice groups have been calling for immediate legislation for the X-case since Savita’s death, and legislation is due by the end of July. However, even immediate legislation for the X-case may not prevent another case like Savita’s: the X-case makes a distinction between a woman’s life and a woman’s health: only where the former is at risk is a termination allowed.
Unless and until we repeal the 8th Amendment giving equal right to “the unborn,” women’s rights to life, health and bodily integrity will continue to be compromised, with perhaps more fatal results.
Be sure not to have a septic miscarriage in Ireland anytime soon, won’t you?
Note: an inquest in the Republic of Ireland is held after a sudden, unexplained or violent death in order to establish the facts surrounding the death (if a post-mortem cannot provide these fully). It is presided over by a coroner and sometimes a jury – if the latter, the jury delivers the verdict, which can be any one of: accidental death, misadventure, suicide, open verdict, natural causes and unlawful killing. No civil or criminal liability is assumed as a result of this verdict. More details here.