After Tragedy, Irish Abortion Laws Come Under Fire

The death of a young pregnant woman has thrust the issue of abortion center-stage in Ireland, with pro-choice campaigners blaming the country’s ban on abortion for the woman’s death. However, even a quick perusal of the facts reveals a much more complex scenario. Pro-life advocates insist the tragic case is being used by those trying to overturn Ireland’s pro-life legislative framework. There have even been accusations that Catholic health-care ethics led to the death.

Savita Halappanavar—a native of India who moved to the west of Ireland some years ago—was 17 weeks pregnant when she went to the hospital on October 21, complaining about back pain. The 31-year-old was admitted to Galway University Hospital. According to her husband, doctors determined she was having a miscarriage. Little else is known officially, apart from the fact that a week later, Halappanavar had died from septicaemia, a blood infection.

The only account of the events leading up to her death come from Halappanavar’s distraught husband, who claims his wife asked for a termination of her pregnancy when it became clear that she was miscarrying. He insists that doctors refused because of the presence of a fetal heartbeat. His wife would be alive, Praveen Halappanavar says, if doctors had induced labor and ended the pregnancy as she requested. He told the Irish Times that his wife died because Ireland is a Catholic country and follows Catholic medical ethics.

Cue a torrent of anti-Catholic commentary on social media sites and from prominent journalists and commentators. Despite a lack of facts, the collective outcry was that this tragic incident had occurred because the hospital acted with a Catholic ethos. The country’s Minister for Health, Dr. James Reilly, intervened to warn against prejudging the situation before the conclusion of two independent investigations surrounding the death.

“I am privy to certain facts but I am not privileged to share them,” Dr. Reilly said.

He said that the question of a Catholic ethos preventing or inhibiting medical personnel from carrying out proper medical treatment, as defined by the Medical Council, had been raised. “I have no evidence of that, but, again, I am not going to preclude what a coroner’s court will find, and I want to await that independent investigation that a coroner always undertakes,” Dr. Reilly told the Irish parliament, in response to questions about the incident.

While no one wants to intrude on Mr. Halappanavar’s obvious grief over the death of his wife, medical experts and bioethicists have been quick to express their view that Ireland’s ban on abortion had nothing to do with Mrs. Halappanavar’s death. They insist that guidelines from the Irish Medical Council are perfectly clear that pregnant women must be given all necessary medical treatment.

The Pro-Life Campaign, the country’s largest anti-abortion lobbying group, described as “deplorable” calls for new abortion legislation in the wake of the tragic case.

PLC spokesperson Dr. Ruth Cullen said, “We extend our deepest sympathies to the husband and family of Ms. Savita Halappanavar, who died from pregnancy-related complications.”

“It is deplorable that those who want to see abortion available here are exploiting Mrs. Halappanavar’s tragic death when the Medical Council Guidelines are very clear that all necessary medical treatment must be given to women in pregnancy,” Cullen said.

She said the PLC welcomed “the fact that a thorough investigation to establish what went wrong is taking place.”

“It is also vitally important to acknowledge at this time that Ireland, without induced abortion, is recognized by the UN and World Health Organization as a world leader in protecting women in pregnancy and is safer than places like Britain and Holland, where abortion is widely available,” she insisted.

Cullen’s contention is backed up by one of the country’s most senior obstetrics practitioners. Dr. Sam Coulter-Smith, head of the Rotunda Maternity Hospital in Dublin, has said he sees no evidence of confusion in Irish medical ranks over whether or not a woman can have a termination if her life is at risk.

“I think most of us who work in obstetrics and gynecology—there may be individual differences, but the majority would be of the view that if…there is a risk of death and we are dealing with a fetus that is not viable, there is only one answer to that question, we bring the pregnancy to an end,” he said.

Coulter-Smith is also clinical professor of obstetrics and gynecology at the Royal College of Surgeons in Dublin. “This case probably does not have a lot to do with abortion laws,” he said. “It is a clinical scenario—someone in the process of miscarriage [who] had infective complications as a result of that process. Whether or not if the situation had been actively managed in the 24-36 hours preceding the tragedy of the baby’s death, would that have changed anything? No one can answer that.”

“What is reasonably clear is that in a position where senior clinicians feel a woman’s health and life is at risk then it is permissible in this country to end the pregnancy,” he said.

Catholic health-care ethics do allow for actions to be taken to save the life of the mother, even at the risk of ending the life of the unborn child. Pope Pius XII in 1951 told the Italian Union of Midwifes that, “if, for example, the saving of the life of the future mother, independently of her pregnant condition, should urgently require a surgical act or other therapeutic treatment which would have as an accessory consequence, in no way desired or intended, but inevitable, the death of the fetus, such an act could no longer be called a direct attempt on an innocent life.”

“Under these conditions the operation can be lawful, like other similar medical interventions,” Pope Pius insisted.

It is unclear if inducing Halappanavar’s labor would have saved her life. What is clear is that—contrary to the reported comments from her husband—Catholic teaching would not have stood in the way of such an operation.

The case has provoked rage in Halappanavar’s native land. The Times of India has accused Ireland of “murdering” her, while atheist Richard Dawkins stated on Twitter, “Irish Catholic bigotry kills woman.”

There are serious questions to address, not least of which is establishing when doctors should have realized that Halappanavar had a life-threatening infection.

Eilis Mulroy, who works with the Pro-Life Campaign, says the question that needs to be asked is: “Was Mrs. Halappanavar treated in line with existing obstetrical practice in Ireland? In this kind of situation the baby can be induced early (though is very unlikely to survive). The decision to induce labor early would be fully in compliance with the law and the current guidelines set out for doctors by the Irish Medical Council.”

“Those guidelines allow interventions to treat women where necessary, even if that treatment indirectly results in the death to the baby. If they aren’t being followed, laws about abortion won’t change that,” she says.

Mulroy said, “This terrible situation should not be used to push an ideological agenda to introduce abortion. Any debate on the issue of abortion should be carried out in a reasonable manner. It does no service to Savita’s memory to use her tragic death as an impetus for legislation that is bad for both women and their babies.”

While Ireland is recognized as a worldwide leader in maternal health, the two inquiries into Halappanavar’s death take place against the backdrop of another investigation into the practices of Irish health professionals when dealing with pregnant women.

As a result of an undercover investigation published by the Irish Independent last month, the government has launched an inquiry into crisis pregnancy counseling services in Ireland that were found to be giving illegal and life-threatening advice. The undercover investigation was carried out at 11 state-funded crisis pregnancy counseling services and revealed that some pregnancy counselors were giving women dangerous and illegal advice, such as telling them they could hide their abortions from their doctors, which could endanger their lives. Some counselors advised women how to smuggle illegal abortion pills into Ireland and take them without medical supervision.

As Savita Halappanavar’s death continues to focus the world’s attention on Ireland’s abortion laws, David Quinn, director of the religious think-tank the Iona Institute, sees something sinister in the media coverage.

“There has been a tremendous and unseemly rush to judgment in this case,” he said.

Quinn believes Halappanavar’s death “is being used to advance the argument that Ireland must change its law on abortion before we know the full facts. It is also being used to falsely and unjustly give the impression that Ireland is an unsafe place for pregnant women, when the opposite is true.”

“The bottom line is that we cannot draw any decisive conclusions about what happened in this tragic case until we do know all the facts,” says Quinn.

The ban on abortion predates Irish independence in 1922, and goes back to an 1861 British law that has remained in force. This was strengthened by a 1983 constitutional amendment that recognized the equal right to life of the mother and child. Controversially, however, the country’s Supreme Court ruled in 1992 that this created a right to abortion where there was a substantial risk to the life—as opposed to the health—of the mother. This has never been legislated and pro-life campaigners have considered the ruling deeply flawed.

The government is expected to publish the report of an expert group on the issue within weeks. The group has been given the task of advising the government on how it should respond to a 2010 judgment of the European Court of Human Rights (ECHR) concerning the country’s abortion legislation. While the case found that Ireland has a right to ban abortion, it found that the country must clarify the 1992 Supreme Court judgment.