Consultant 'refused abortion plea'

drkpower

GCU Flexible Demeanour wrote: »

There's a difference between those two statements, but the emerging picture suggests that (similar to the reported outcome of the HSE inquiry) the law wasn't the pivotal issue. The pivotal issue was the condition was undiagnosed (or, at least, that would seem to be what's coming out the testimony.)

I don't see why you see one as the pivotal issue over the other.

Were it not for abortion laws, evacuation of the uterus (one of the treatments for her condition) would definitely have occurred earlier.


We're it not for the delay in the consultant being aware of certain infective indicators, antibiotic treatment (the other treatment for her condition) may have occurred earlier.


Again, I think you can see the difference and it doesn't appear to demonstrate that the delay in making the consultant aware of the infective indicators was the pivotal issue at all.

GCU Flexible Demeanour

positron wrote: »

The figure of 56000 might look big, but when they say India they are talking about over 1.2 billion people, so it might be really tiny in percentage terms.

Ah, come on.

https://www.cia.gov/library/publications/the-world-factbook/rankorder/2223rank.html

India has something of the order of 200 maternal deaths per 100,000 live births. That's about twenty times the rate you'd expect in Europe.

positron wrote: »

Dr Astbury also said she felt constrained by the Irish law to giving an abortion as soon as she knew the fetus was not viable. I am sure everyone would agree there is no point prolonging the agony and risking death in such a case, and it is shocking really that in this day and age a knowledgeable medical team with armed with the right skillset, knowledge, medical equipment and test results, can't proactively act to help someone, due to some conditions setup by a society under the influence of a religious order with no knowledge of the medical procedures, threats or benefits just because they feel they are the guardians of some sort of moral value and feels the need to inflict that upon everyone else irrespective of their own personal belief or the lack of.

She agreed that, in other jurisdictions, an abortion would be offered where a fetus was not viable, and I do agree that there's no point in prolonging a pregnancy in such circumstances (unless there's some genuine medical reason that would make a natural miscarriage safer.)

Nevertheless, the facts suggest that the issue in this case was a failure to identify what the actual problem was. The emerging facts suggest that a different outcome might well have been achieved, if all the individual bits of information had been gathered and assessed.

Changing the law won't address wrong diagnosis. We have to be very clear-headed about this case. There could be very good reasons for changing the Constitutional position with respect to abortion. But that's not, primarily, what this case is telling us.

Almaviva

positron wrote: »

Dr Astbury also said she felt constrained by the Irish law to giving an abortion as soon as she knew the fetus was not viable. I am sure everyone would agree there is no point prolonging the agony and risking death in such a case, and it is shocking really that in this day and age a knowledgeable medical team with armed with the right skillset, knowledge, medical equipment and test results, can't proactively act to help someone, due to some conditions setup by a society under the influence of a religious order with no knowledge of the medical procedures, threats or benefits just because they feel they are the guardians of some sort of moral value and feels the need to inflict that upon everyone else irrespective of their own personal belief or the lack of.

That's democracy for you.

GCU Flexible Demeanour

drkpower wrote: »

I don't see why you see one as the pivotal issue over the other.

Were it not for abortion laws, evacuation of the uterus (one of the treatments for her condition) would definitely have occurred earlier.

But it would only be happenstance if that avoided the outcome; bear in mind, again, that the emerging issue seems to be a lack of organisation around the management of the case.

Can you see what I'm driving at? It doesn't matter what the law is, if cases are misdiagnosed. It doesn't matter if evacuation of the uterus is lawful, if you get sent home with a diagnosis of back pain.

A lot of people have invested a lot of political argument into this case being about the legal position, in advance of the facts being known. I think that's clouding judgments.

drkpower

GCU Flexible Demeanour wrote: »

But it would only be happenstance if that avoided the outcome; bear in mind, again, that the emerging issue seems to be a lack of organisation around the management of the case.

Can you see what I'm driving at? It doesn't matter what the law is, if cases are misdiagnosed. It doesn't matter if evacuation of the uterus is lawful, if you get sent home with a diagnosis of back pain.

A lot of people have invested a lot of political argument into this case being about the legal position, in advance of the facts being known. I think that's clouding judgments.

Had there been no legal obstacle, an evacuation of the uterus would have occurred well before any issues of misdiagnoses became relevant and well before systemic sepsis would have developed.

If there is a pivotal issue, there you have it.

animum

mle

GCU Flexible Demeanour wrote: »

But it would only be happenstance if that avoided the outcome; bear in mind, again, that the emerging issue seems to be a lack of organisation around the management of the case.

Can you see what I'm driving at? It doesn't matter what the law is, if cases are misdiagnosed. It doesn't matter if evacuation of the uterus is lawful, if you get sent home with a diagnosis of back pain.

A lot of people have invested a lot of political argument into this case being about the legal position, in advance of the facts being known. I think that's clouding judgments.

I completel agree, I have 2 friends that had to endure proceedures that ended with legal teminations. I have spoken with a surgeon who claims that every hospitalin the country carry out legal terminations every week. He claims that this is nothing but complete neglegence on the hospitals behalf, but it woiuld be very difficult to prove. He compared the Surgeons proffessional body (dont know the name) to the Mafia....no-one will 'rat' on anyone. my father in law sufferd a 'botched' surgery and was advised to travel to the uk for an assessment, as willnever get the full story here. Its terrible.

Flier

http://www.irishtimes.com/news/health/timeline-savita-halappanavar-s-last-days-1.1357554

Above is a useful 'timeline' of the salient events as heard at the inquest.

There was a clinical diagnosis of chorioamnionitis by the SHO at 6.30am.
The consultant diagnosed sepsis (but not severe sepsis) and probable chorioamnionitis on her rounds at 8.25am.
I wonder what was the delay in evacuating the uterus at this point, if it wasn't waiting for there to be a perceived 'substansial risk' to life. If the law allowed termination for less than a 'substantial risk', would there have been a delay at this point.
I accept that there were mistakes made (I would be surprised if errors were not found to be made in any random sample of clinical cases), but the situation in law was the main reason for delay in instigating proper treatment.

April O Neill

In the defense of the person who said "This is a Catholic country", they may just have been trying to explain why their hands were tied. Carrying out an abortion could have had them struck off or prosecuted, they couldn't perform it even if they wanted to. Of course they could have handled it better.

GCU Flexible Demeanour

drkpower wrote: »

Had there been no legal obstacle, an evacuation of the uterus would have occurred well before any issues of misdiagnoses became relevant and well before systemic sepsis would have developed.

If there is a pivotal issue, there you have it.

You've missed the point. It that was the solution, it would only be through happenstance. The issue is about stuff going un-noticed, or at least all known facts not being brought together. If that's the situation, it means that any complications arising from any action might not be picked up. I'm only repeating the point already made here, as you haven't engaged with it.

Flier wrote: »

I accept that there were mistakes made (I would be surprised if errors were not found to be made in any random sample of clinical cases), but the situation in law was the main reason for delay in instigating proper treatment.

That's not sustainable on the basis of the evidence presented. It's just showing a desire to extract from the case whatever is useful from a political perspective, while ignoring the significant points actually emerging.

Flier

GCU Flexible Demeanour wrote: »

That's not sustainable on the basis of the evidence presented. It's just showing a desire to extract from the case whatever is useful from a political perspective, while ignoring the significant points actually emerging.

I disagree. Given the clinical evidence which I've presented, which is what was known at the time by the treating medical team, what do you think would have been the appropriate course of treatment, and did the law interfere with the appropriate course being taken?

Shint0

Flier wrote: »

http://www.irishtimes.com/news/health/timeline-savita-halappanavar-s-last-days-1.1357554

Above is a useful 'timeline' of the salient events as heard at the inquest.

There was a clinical diagnosis of chorioamnionitis by the SHO at 6.30am.
The consultant diagnosed sepsis (but not severe sepsis) and probable chorioamnionitis on her rounds at 8.25am.
I wonder what was the delay in evacuating the uterus at this point, if it wasn't waiting for there to be a perceived 'substansial risk' to life. If the law allowed termination for less than a 'substantial risk', would there have been a delay at this point.
I accept that there were mistakes made (I would be surprised if errors were not found to be made in any random sample of clinical cases), but the situation in law was the main reason for delay in instigating proper treatment.

Then would the grey area not rest with the doctor's own clinical judgement?

Electric Sheep

HondaSami wrote: »

This is the only time i am in favour of it, save the mother always imo.

I'm for it in rape/incest cases also, just to be clear but never on demand.

Considering the length of time it takes for a rape case to get to court, let alone to secure a conviction, don't you think you are being disingenuous? How would one prove rape in the very short window of opportunity to terminate a pregnancy?

drkpower

GCU Flexible Demeanour wrote: »

You've missed the point. It that was the solution, it would only be through happenstance. The issue is about stuff going un-noticed, or at least all known facts not being brought together. If that's the situation, it means that any complications arising from any action might not be picked up. I'm only repeating the point already made here, as you haven't engaged with it.

I'm not sure what you mean by happenstance.

If there was no legal obstacle, the uterus would have been evacuated on the patients presentation. It is that simple. The issues regarding the possible delayed diagnosis of sepsis are highly unlikely to have ever arisen.

Loafing Oaf

animum wrote: »

mle

I completel agree, I have 2 friends that had to endure proceedures that ended with legal teminations. I have spoken with a surgeon who claims that every hospitalin the country carry out legal terminations every week. He claims that this is nothing but complete neglegence on the hospitals behalf, but it woiuld be very difficult to prove..

This doesn't ring true to me. If the UCHG staff were generally lazy and incompetent, wouldn't the easiest thing to do have been to terminate the pregnancy right away, if only for the sake of a quiet life. Everything I've read about the case strongly suggests to me that Dr Astbury genuinely believed she was striving to comply with the law.

Loafing Oaf

drkpower wrote: »

I'm not sure what you mean by happenstance.

If there was no legal obstacle, the uterus would have been evacuated on the patients presentation. It is that simple. The issues regarding the possible delayed diagnosis of sepsis are highly unlikely to have ever arisen.

Indeed, GCU talks about issues around diagnosis being the most salient thing about the case, but in this alternative scenario the only diagnosis involved would be that of the miscarriage itself, which presumably even a competent GP or nurse could do...

Kiwi in IE

GCU Flexible Demeanour wrote: »

Ah, come on.

https://www.cia.gov/library/publications/the-world-factbook/rankorder/2223rank.html

India has something of the order of 200 maternal deaths per 100,000 live births. That's about twenty times the rate you'd expect in Europe.She agreed that, in other jurisdictions, an abortion would be offered where a fetus was not viable, and I do agree that there's no point in prolonging a pregnancy in such circumstances (unless there's some genuine medical reason that would make a natural miscarriage safer.)

Nevertheless, the facts suggest that the issue in this case was a failure to identify what the actual problem was. The emerging facts suggest that a different outcome might well have been achieved, if all the individual bits of information had been gathered and assessed.

Changing the law won't address wrong diagnosis. We have to be very clear-headed about this case. There could be very good reasons for changing the Constitutional position with respect to abortion. But that's not, primarily, what this case is telling us.

I completely disagree. If the pregnancy had been terminated as soon as it was identified as unviable, it is probable that there would have been no condition to misdiagnose. Sepsis develops in miscarriage due to the uterus being open and bacteria free to enter. We do not know at what point the bacteria that caused the sepsis entered, but the longer the miscarriage goes on the higher the probability of infection. The fact she was left in this condition for several days, because of the influence of Catholicism in Irish law, cannot be overlooked due to focus on subsequent medical errors. To do so would be a further injustice to Ms Halappanavar and an injustice to all women living in Ireland.

GCU Flexible Demeanour

Flier wrote: »

I disagree. Given the clinical evidence which I've presented, which is what was known at the time by the treating medical team, what do you think would have been the appropriate course of treatment, and did the law interfere with the appropriate course being taken?

Look, you don't even need to go there.

http://www.rte.ie/news/2013/0412/381029-halappanavar-inquest/

Dr Knowles <...> agreed that it was clear that the GUH protocols for dealing with sepsis infection had not been adhered to.

Dr Knowles said the antibiotics recommended as part of those guidelines had not been administered until around 1pm on Wednesday 24 October.

Dr Knowles is the consultant microbiologist at the National Maternity Hospital in Dublin.

Now, unless you are suggesting both that the GUH protocols for dealing with sepsis are unlawful and that the the consultant microbiologist at the National Maternity Hospital doesn't know that there's a conflict between the law and appropriate action, your point seems to fall.

drkpower wrote: »

I'm not sure what you mean by happenstance.

If there was no legal obstacle, the uterus would have been evacuated on the patients presentation. It is that simple. The issues regarding the possible delayed diagnosis of sepsis are highly unlikely to have ever arisen.

I've tried to explain twice why your statement isn't dealing with the point. I'm afraid I can't put it any clearer - I can't see any reason for confusion.

I'm not saying the point is irrefutable - maybe someone has something to say that would make me re-assess it. But, unfortunately, you're just not addressing it.

GCU Flexible Demeanour

Kiwi in IE wrote: »

I completely disagree. If the pregnancy had been terminated as soon as it was identified as unviable, it is probable that there would have been no condition to misdiagnose.

Ditto as for drkpower.

Kiwi in IE

GCU Flexible Demeanour wrote: »

Ditto as for drkpower.

I think you are missing the point completely.

If Ms Halappanavar had recieved the appropriate treatment as per any other First world country, where law is not influenced by religious principles, there would in all probability, have been no sepsis. Therefore the Sepsis policy of GUH and whether or not it was followed, would have been irrelevant.

It seems Ms Halappanavar could have been saved twice; firstly if she had recieved appropriate treatment for the miscarrying of an unviable feotus, this the law prohibited, and secondly if the medical team had dealt appropriately with the sepis that resulted from the law preventing best practice in the treatment of her primary condition.

GCU Flexible Demeanour

Kiwi in IE wrote: »

I think you are missing the point completely.

If Ms Halappanavar had recieved the appropriate treatment as per any other First world country, where law is not influenced by religious principles, there would in all probability, have been no sepsis. Therefore the Sepsis policy of GUH and whether or not it was followed, would have been irrelevant.

No, I've understood and responded to this point. The issue is that yourself and drkpower haven't grasped that this would just be happenstance, if the situation is one of misdiagnosis. I repeat

GCU Flexible Demeanour wrote: »

It doesn't matter what the law is, if cases are misdiagnosed. It doesn't matter if evacuation of the uterus is lawful, if you get sent home with a diagnosis of back pain.

A lot of people have invested a lot of political argument into this case being about the legal position, in advance of the facts being known. I think that's clouding judgments.

opinion guy

You are all missing the point.

Savita, the woman who endured horrible pain and ultimately death, requested a termination as soon as she was told the child was not viable. The religiously biased laws denied her this. Her wishes were ignored and she endured horrendous suffering and a likely avoidable death when there was no possibility the child would survive. Then she died. The end. No semantics or clever debate points - this is what happened.

You all need to grow up and take a cold hard look at what your superstitious beliefs resulted in.

Kiwi in IE

It does matter if uterine evacuation is lawful however when miscarrying over several days because it is unlawful results in sepsis. And that, in combination with medical error treating the sepsis, ultimately results in death.

Kiwi in IE

opinion guy wrote: »

You are all missing the point.

But I am making the same point as you!

Atlantis50

GCU Flexible Demeanour wrote: »

Ah, come on.

https://www.cia.gov/library/publications/the-world-factbook/rankorder/2223rank.html

India has something of the order of 200 maternal deaths per 100,000 live births. That's about twenty times the rate you'd expect in Europe.She agreed that, in other jurisdictions, an abortion would be offered where a fetus was not viable, and I do agree that there's no point in prolonging a pregnancy in such circumstances (unless there's some genuine medical reason that would make a natural miscarriage safer.)

Nevertheless, the facts suggest that the issue in this case was a failure to identify what the actual problem was. The emerging facts suggest that a different outcome might well have been achieved, if all the individual bits of information had been gathered and assessed.

Changing the law won't address wrong diagnosis. We have to be very clear-headed about this case. There could be very good reasons for changing the Constitutional position with respect to abortion. But that's not, primarily, what this case is telling us.

Spot on.

Some on this thread are still desperately clinging to the idea that Ireland's abortion laws caused her death despite the catalogue of medical errors outlined in evidence at the inquest.

Kiwi in IE

Atlantis50 wrote: »

Spot on.

Some on this thread are still desperately clinging to the idea that Ireland's abortion laws caused her death despite the catalogue of medical errors outlined in evidence at the inquest.

Interesting. I think the opposite. It appears to me that some are in complete denial of the pivotal role that the law played because they don't want it blamed.

Atlantis50

Kiwi in IE wrote: »

Interesting. I think the opposite. It appears to me that some are in complete denial of the pivotal role that the law played because they don't want it blamed.

You're the one in denial Kiwi.

The media are gradually come around to accepting and reporting the fact that medical errors played "the pivotal role" in Savita's tragic death:

Three-hour test delay 'could have made all the difference' - Herald.ie

Shortcomings in Halappanavar care identified - RTÉ News

Missed chances by staff raise yet more questions - Independent.ie

Savita Halappanavar inquest: 'Shortcomings in treatment'- BBC News



Savita should have been given stronger antibiotics, inquest told- Irish Times

Nodin

Atlantis50 wrote: »

Spot on.

Some on this thread are still desperately clinging to the idea that Ireland's abortion laws caused her death despite the catalogue of medical errors outlined in evidence at the inquest.

...it has been deemed a contributory factor by the report into the matter, if you care to recall.

Neyite

Atlantis50 wrote: »

You're the one in denial Kiwi.

The media are gradually come around to accepting and reporting the fact that medical errors played "the pivotal role" in Savita's tragic death:

Three-hour test delay 'could have made all the difference' - Herald.ie

Shortcomings in Halappanavar care identified - RTÉ News

Missed chances by staff raise yet more questions - Independent.ie

Savita Halappanavar inquest: 'Shortcomings in treatment'- BBC News



Savita should have been given stronger antibiotics, inquest told- Irish Times

Because the media don't have a political agenda at all...

Loafing Oaf

Atlantis50 wrote: »

Spot on.

Some on this thread are still desperately clinging to the idea that Ireland's abortion laws caused her death despite the catalogue of medical errors outlined in evidence at the inquest.

You're playing semantic games. The 'cause' of Savita's death was sepsis, the question is whether and how it could have been prevented. Would she have survived if the relevant medical procedures had been conducted properly? Yes, probably. Would she also be alive if the consultant had been legally permitted to carry out delivery/termination in the early stages of the miscarriage, as is standard pratice in most other countries? Almost certainly, and this approach can be applied in almost all cases of miscarriage, irrespective of specific details of infection etc.

animum

Loafing Oaf wrote: »

This doesn't ring true to me. If the UCHG staff were generally lazy and incompetent, wouldn't the easiest thing to do have been to terminate the pregnancy right away, if only for the sake of a quiet life. Everything I've read about the case strongly suggests to me that Dr Astbury genuinely believed she was striving to comply with the law.

And I believe that she is hiding behind the law to cover her own mistakes.

Its my opinion I know, but as a Catholic Irish person, I can not believe that a medical professional, stood back and let a woman die before thier eyes, because of the Catholic Religion and the laws of our country. There are laws to protect women in instances like this. And terminations are carried out all the time.