HIQA Report let government off hook. November 14, 2013Posted by WorldbyStorm in Abortion, Bioethics, Culture, Irish Politics.
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A very welcome post by Brendan Young, member of Action on X. As Brendan notes “‘Action on X’, which campaigned for legislation based upon the ‘X Case’ – but regards James Reilly’s recent abortion law as unacceptably restrictive. Action on X has the support of the National Women’s Council of Ireland, SIPTU, UNITE the Union, the ICTU Women’s Committee, USI, and the African women’s support network AkiDwa.”
Recent comments by Dr Sam Coulter Smith (Master of the Rotunda maternity hospital) about the strains the hospital is under, and the findings in the recent HIQA Report (into the death of Savita Halappanavar) that our maternity hospital records are not systematically centralised and monitored, highlight the deep problems in the Irish health service. But the HIQA Report, while it revealed problems with the medical care given to Savita Halappanavar, avoided the issue of the law. And there is a risk that the Galway University Hospital medical team, who may have made errors, will be scapegoated for Savita’s death. Yet it is Irish law, including Art. 40.3.3 of the Constitution and the recently-passed Reilly Act on abortion, that continues to pose risks to women – including those going through inevitable miscarriage.
Doctor Peter Boylan hit the nail on the head in saying that the state, through HIQA, did not ask the obvious question in relation to the death of Savita Halappanavar. What impact did the law on terminations have on the actions of the Galway medical team? Would an earlier delivery – a termination of pregnancy – have saved her life? In his opinion it probably would have. HIQA didn’t ask. Why not?
Last year’s HSE Report into Savita’s death raised the legal issues. It said ‘concerns about the law … impacted on clinical professional judgement’. It quoted the consultant obstetrician as saying “If there is a threat to the mothers’ life you can terminate. If there is a potential major hazard to the mothers’ life the law is not clear…. There are no guidelines for inevitable miscarriages.” The same consultant also said: “Under Irish law, if there’s no evidence of risk to the life of the mother, our hands are tied so long as there’s a fetal heart (sic).”
The HSE Report’s Recommendation 4b makes clear that the law restricts clinical decisions, and suggests change: “… We recommend that the clinical professional community, health and social care regulators, and the Oireachtas consider the law including any necessary constitutional change and related administrative, legal and clinical guidelines in relation to the management of inevitable miscarriage… These guidelines should include good practice guidelines in relation to expediting delivery for clinical reasons. We recognise that such guidelines must be consistent with applicable law and that the guidance so urged may require legal change.”
It is also clear that the consultant obstetrician considered a termination when Savita asked for it but felt legally bound to rule it out because there was a fetal heartbeat – even though the demise of the fetus was inevitable. Yet the HIQA Report poses the issue exclusively as management of sepsis – making no suggestion that ‘expediting delivery’ could have been done to avert infection / sepsis in its list of 13 ‘missed opportunities’ to intervene.
Flowing from its enquiries, HIQA’s Recommendation N10 says: “The HSE should develop a national clinical guideline on the management of sepsis… This guideline should incorporate an escalation/referral pathway that includes clinical, legal and ethical guidance for staff at critical clinical points …”
HIQA’s ‘escalation/referral pathway’, by definition, assumes the woman’s health is deteriorating due to sepsis. Recommending ‘… legal and ethical guidance for staff at critical clinical points’ is to accept that a woman must reach a critical condition before termination can be considered – the only issue where the law becomes relevant. Why would a woman, her loved ones or her doctors wish to allow sepsis to develop to such a potentially lethal extent? Yet termination of pregnancy to prevent infection is not considered in HIQA’s Recommendations. The HSE Report is commended in passing, but its key arguments to legislators are glossed over.
By placing the blame for Savita’s death on the consultant obstetrician’s failure to manage sepsis and ignoring the legal restrictions upon her clinical choices, the HIQA Report is letting Fine Gael, Labour, Fianna Fáil and Sinn Féin off the hook. They can all comfortably point to the need for better management of hospitals and / or more resources – all of which are needed.
The consultant obstetrician may have made errors, but she should not be made the scapegoat for Savita’s death. A fundamental problem in dealing with inevitable miscarriage is that Art. 40.3.3 of the Constitution, and its interpretation by the Supreme Court, effectively preclude termination of pregnancy during miscarriage if there is a fetal heartbeat – until a woman’s life is at risk. This legal restriction on clinical action contributed to Savita’s death and politicians have a responsibility to deal with it.
If the HIQA Report is used to inform the medical guidelines accompanying James Reilly’s abortion law, its focus on management of sepsis will entrench a perverse situation where medical conditions due to pregnancy that are not in themselves life-threatening (eg inevitable miscarriage) must be allowed become life-threatening before it is legal to perform a termination of pregnancy – on a fetus that will die anyway. The same legal restriction that allowed sepsis to develop in Savita Halappanavar will remain.
James Reilly’s abortion law, based upon Art. 40.3.3, codifies this restriction by giving legal protection to the ‘unborn’ from the moment of implantation in the womb until delivery. Such restriction on doctors, which HIQA did not examine, must be removed so that women’s lives can be protected. At minimum, the HSE Recommendations must be acted upon. Both Art. 40.3.3 and Reilly’s abortion law must be repealed.
Got to admit… May 7, 2013Posted by WorldbyStorm in Bioethics, Culture, Feminism, Irish Politics.
Jacky Jones in the Irish Times,former HSE regional manager of health promotion, is a voice of reason on a range of issues from private schools through to reproductive rights.
Unfortunately the Protection of Life during Pregnancy Bill 2013 will not protect or vindicate women’s reproductive rights. The name change – removing the word “maternal” from the title – means there is still ambiguity about whether the woman’s life or that of the foetus is prioritised. It is only a matter of time before another Irish woman asks the European Court of Human Rights to protect and vindicate her right to terminate a pregnancy because her health, as distinct from her life, is not protected by the proposed legislation. In the meantime, Irish women will have to rely on the kindness of strangers in the UK.
Some more thoughts on that Red C Poll… December 4, 2012Posted by WorldbyStorm in Bioethics, Economy, Irish Politics, The Left.
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A few days have passed since the SBP Red C poll was released. And that offers time to work through the reasons that it may have seen such significant changes for at least one of the parties. The headline figures were as follows:
Fine Gael 28% (down 6%), Labour 14% (up 1%), Fianna Fail 20% (up 1%), Sinn Fein 17% (NC), Green Party 3% (up 1%), Independents, United Left Alliance and Others 18% (up 3%).
And while all others were broadly within their pre-existing levels of support, it is the FG figure which is most striking. In the space of a month it lost 6 per cent and in doing so dipped below 30 per cent for the first time in a Red C poll. As Pat Leahy put it:
A month ago Fine Gael was untouchable – miles ahead of everyone else on 34 per cent. Not today. Unbelievably, having dropped by six points to 28 per cent, Fine Gael now sees, approaching in the rear view mirror, its old enemy: Fianna Fáil.
That may be overstating it, and yet, and yet, both parties are now 8 per cent apart. That’s the thing with Irish politics, the closeness of FF and FG in terms of what they offer to voters is such that there is some (not a huge amount) interchangeability in that vote. Leahy argues that the death of Savita Halappanavar is a motive force in all this. I think it is to a considerable extent. But it’s very difficult not to believe that a broader dissatisfaction with FG over various issue, plus more immediately the travails of the Minister of Health, have also fed into this and that the abortion issue was in part a means by which this dissatisfaction could be activated.
Leahy makes a further crucial point:
It’s also clear from today’s numbers that the public is a good bit less conservative than Fine Gael on the abortion issue.
It’s arguable that the rather vociferous ‘pro-life’ FG TDs have done their party no good at all and it will be instructive if they moderate their tone in the next while. I put up an interview with Harvey Milk at the weekend where he noted that often a perception of greater strength of right wing attitudes than actually exists can prevent progressives from acting. In the case of abortion that seems to be the case. It is true that the death of Savita Halappanavar brought home the realities facing women in this state for many, but it is also difficult to believe that there had not been a slower shift in public opinion on the matter, and I think purely on an anecdotal level from my own perspective of hearing people on the matter – with all the necessary caveats – I would see that as being probably accurate.
Of course that doesn’t mean there’s a contradiction in all this. It could well be that despite all that FG remains a lot more conservative on the issue, that it is not tagging along after a perceived public opinion, but that its representatives are genuinely attached to much more conservative positions. It’s certainly telling to see names like Brian Hayes placed in the ‘pro-life’ camp.
The irony is that if the FG vote is a form of political collateral damage in respect of abortion legislation then it is truly a case of a party playing it safe and being undercut by changing public opinion – and a further irony, it is not economically linked.
That said on that latter matter Leahy makes a most interesting observation:
Public opinion has also shifted on the budget. Whereas previous surveys tended to show that the public was more in favour of public spending cuts than higher taxes, today’s poll shows that opposition to cuts in welfare payments, especially pensions, is shared by two-thirds of voters. However, a similar proportion (67 per cent) say that tax increases for higher earners – defined as those with over €100,000 household income – should be the first option for the government.
Voters favour further public sector pay cuts, rather than cuts to welfare and pensions, with a fifth of voters (21 per cent) saying it should be the first option, while over half (55 per cent) say it should be an option considered by the government. Just 20 per cent say the option of “higher taxes for all” should be considered, though a similar proportion say it should not be on the agenda at all.
One could dismiss all that as being a case that ‘anyone but us’ should be taxed or should have their wages cut, on the part of voters. But an appetite to increase higher taxes on those better off is at least moving in the right direction.
And he concludes by suggesting:
Overall, this poll shows not just political support but the political landscape moving away from the government parties. It’s not altogether clear what might replace this. But it does remind us of the underlying volatility that the economic crisis has wrought on Irish politics. The crisis has already changed our politics to an historic degree. That change is not necessarily at an end.
That’s the thing. As was put elsewhere, FF is positioning itself to the right of SF and to the left, marginally, of the Government. That may reap dividends, and already it is six points above where it was in similar polling half a year ago. All FF wants is to recover lost ground, as much and as fast as it can. So it will do literally anything to achieve that end. No more the chatter about FF becoming a niche right wing party that we heard in the aftermath of the election. Their ambitions are much much bigger than to be a PD redux. But it could be that their rather minor gain is because others have made the running in this – indeed a not dissimilar dynamic could explain why SF haven’t improved upon their position, given the very public and rather unusual – for them – apostasy from the party line on this particular issue.
Look at the Independents and Others who are up to 18 per cent. What remains striking is how the supposedly impotent and irrelevant Independents and Others continue to command a vast share of the vote. Yet if anything the recent events have shown how even given near non-existent political power they retain an ability to shape the discourse and in ways that are both positive for themselves and immensely damaging to their rivals. Again it seems reasonable to propose that this is a function of the most recent events, and particularly the high profile of Clare Daly, and Joan Collins and Mick Wallace in matters (a lot is made of the fact that those involved mention each others names a lot, but it would seem to be an approach that is not without merit if one wishes to solidify the Independent and Others vote share).
In a way what all this reminds me of is the way that when the opportunity arrived for voters to turn their backs on the Fianna Fáil and the Green Party during the last government they did so and in droves. It’s as if there is a need for ‘permission’ in these matters, and once it is given, or rather taken, then that’s that. It’s not, as Leahy notes, that ‘these positions are set in stone’. FG could recover though I hesitate to use the word ‘easily’. But with so much bad news still in train… it may be that this is a key moment in the electoral cycle.
And a Budget tomorrow!
A ‘special level of support’… April 25, 2012Posted by WorldbyStorm in Bioethics, Uncategorized.
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In relation to the issue of women who had pregnancies where there were fatal foetal abnormalities it is interesting to note the proposed solution for that issue from one quarter, that being,
…the establishment of perinatal hospices so women could receive a “special level of support”.
Without doubting for a moment that such a facility would be of considerable service to a proportion of those in that situation (and the NYT in this article notes that many of those within these hospices ‘seem free of ideology’ in any respect) for others the prospect of continuing through a pregnancy in this context in such institutions certainly doesn’t appear to come close to addressing their needs.
There’s also the thought that these institutions, in an Irish context have an odd echoes of a harsher and even more profoundly paternalistic time in this society.