Belfast Telegraph

Monday 22 September 2014

Might Savita Halappanavar have survived had she live in Northern Ireland

The Republic of Ireland's 'world-class' hospital care failed Savita Halappanavar. But would the outcome have been different north of the border, asks Michael Wolsey

Savita Halappanavar died from suspected septicaemia
Savita Halappanavar died from suspected septicaemia
Nurse Noreen Hannegan arrives for the inquest into the death of Savita Halappanavar at Galway Coroner's Court
Nurse Noreen Hannegan arrives for the inquest into the death of Savita Halappanavar at Galway Coroner's Court
Dr Andrew Gaolebale eaves the inquest into the death of Savita Halappanavar at Galway Coroner's Court
Dr Andrew Gaolebale eaves the inquest into the death of Savita Halappanavar at Galway Coroner's Court

When Savita Halappanavar and her husband, Praveen, walked through the doors of Galway's University Hospital they strayed into a territory where the borders are unknown and there are no written rules – a territory defined by Ireland's non-existent abortion laws.

Ms Halappanavar was in the 18th week of pregnancy and, it soon became clear, in trouble. Her baby was unlikely to be born alive and had no chance of survival if it was. To Ms Halappanavar, a Hindu, this was a tragedy best mitigated by abortion.

She found it extremely upsetting to be carrying a baby who could never live. But the Republic's legal code does not permit abortion, unless there is a substantial threat to the life of the mother.

By the time such a threat was recognised, it was too late. Ms Halappanavar died an agonising death from septic shock and acute respiratory illness.

Praveen Halappanavar's distress at the death of his wife has been compounded by his difficulty in understanding the rules which governed her treatment.

Why did Savita have to carry a child who couldn't live? Why did she have to wait until her own life was endangered to receive a termination that might have saved her?

Mr Halappanavar is not alone in asking these questions. They are being asked by a great many people in the Republic as they listen to disturbing evidence from the inquest into Ms Halappanavar's death. They should also be asked in Northern Ireland, where our approach to abortion is not so very different from the Republic's.

If Ms Halappanavar had gone to a hospital in, say, Derry, instead of Galway, would the outcome have been any different? The answer, like everything to do with abortion on this island, is unclear.

The Halappanavar inquest has undermined one of the arguments frequently used by those opposed to the introduction of abortion legislation in the Republic.

Ireland's maternity hospitals are among the best and safest in the world, they say, therefore there is no need for legislation to underpin the constitutional position that abortion is permissible when there is a substantial threat to the life of the mother.

Doctors, they argue, will always act to save the mother's life and, if the foetus dies as a consequence, so be it. Such practice squares with the teaching of the Catholic Church and, as a Galway midwife told Ms Halappanavar, Ireland is a Catholic country.

Opponents of legislation argue that those who favour it want to open the door for abortion on demand.

The inquest has demolished this argument.

The Republic may, indeed, have some of the world's best maternity hospitals and health staff, but they failed Savita Halappanavar.

The coroner has pointed to "system failures" at the hospital, which began on October 21 when Ms Halappanavar sought treatment for severe back pain.

She was seen by a senior house officer, given paracetamol and told she could go home.

When she came back the "system failures" included failure to recognise that severe shivering was caused by more than the cold and failure to act on the discovery of a "foul-smelling discharge".

Had it not been for these "system failures" Ms Halappanavar might have been diagnosed as needing an abortion to save her life. Or maybe not.

A foetal heartbeat was still detected, so the decision on whether there was a serious threat to the life of Ms Halappanavar would have been left to a doctor or doctors, as indeed it would have been in Northern Ireland.

In 2007, the UN Committee on Human Rights criticised Ireland's failure to clarify its abortion laws. In response the Irish government said that, although legal in the Republic, no statistics were available on the number of abortions taking place.

No statistics are available because no one cares to ask.

Abortions are recorded as some other medical procedure necessary to save the mother's life.

They are lawful, but no one knows who is carrying them out, how many are performed, or which hospitals are performing them.

Northern Ireland has a law on its statute books permitting abortion in limited circumstances, but otherwise the situation is not very different.

Many procedures conducted to save the life of a mother are not listed as abortions.

Our Department of Health, whose minister, Edwin Poots, opposes liberalisation of the law, does not record reasons for the abortions that are listed.

Anecdotal evidence suggests some of these abortions are for reasons of foetal abnormality, which would make them illegal.

On the other hand, many of the women who go to England for an abortion are motivated by extreme mental pressure, which might possibly have justified a legal abortion in Northern Ireland.

Might? Possibly? We are back in that territory where nothing is clear – except that women are not trusted with decisions about their own bodies.

The Irish government has promised to introduce limited abortion legislation this year.

It will, in effect, put the Republic's abortion laws on the same basis as those in Northern Ireland.

So obfuscation will rule throughout the island, women like Ms Halappanavar will still be forced to carry babies that cannot live and their own lives will depend on which clinic they attend and which doctor they see.

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