The 8th amendment(Mod warning in op)

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drkpower

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I said a few pages back myself that there is no doubt that patients in all sorts of medical contexts (male or female) perceive that they have no choices in various situations. And i tried to give some reasons why communication failures are more prone to happen in medical situations, especially obstetric. Bad communication definitely happens - very frequently. I agree with that; i think doctors need to get better at how they communicate; i think they need to be given more training, and crucially more time (where practicable) to communicate with patients; i also think patients, all patients, need to take more responsibility for their own healthcare and to research and understand more about what can go wrong, so that they are forewarned and prepared for such eventualities. And i also agree that there is a small cohort of simply bad practitioners out there.

But what has been suggested by this thread (and by the likes of AIMS) is that practitioners are actively making a choice not to seek consent, and to force treatment on people, because of the 8th. That is utter nonsense. They point to various bad experiences of patients and with patently bad reasoning, link it to the 8th without any intervening evidence of same [1. People have bad experiences; 2. The 8th exists 3. The 8th is the reason]. The far more likely explanation for those experiences is plain old miscommunication with a sprinkling of bad practice.

In an attempt to garner support for repeal of the 8th, some are seeking to blame the 8th for anything they can tenuously link it to. This is a perfect example. But that is likely to be counterproductive; there are loads of good reasons to get rid of the 8th; making up false ones only risks your ultimate aim.

There are definite areas where the 8th impacts on obstetric practice; read the submissions of Rhona Mahony and the other Masters to the Oireachtas committess to understand what they are. Nowhere in there at all will you see any reference whatsoever to they type of allegations that are being propogated in places in this thread, and by AIMS.

drkpower

AIMS Ireland are aware of many cases in which heavily pregnant women have been threatened “with the guards coming to get them” if they don’t turn up for their scheduled induction. In fact a cohort of women reported such statements are regular commentary at antenatal classes at one particular hospital

Even at the worst reading of the 8th, intervention by the Gardai is simply off the reservation. Even in the few cases where High Court cases have been brought in respect of women who refuse interventions that pose a potential risk to the foetus, there was never a question of calling the Gardai. So this type of allegation simply doesn't make any sense. At all. Now, i cant discount the possibility that some ignorant practitioner somewhere said something like that some time. Of course that is possible.

But this is the thing; if that happened, it is about as egregious a practice as i could think of. It would warrant the practitioner(s) being sacked. Then being struck off. Then being criminally investigated. AIMS say they know of 'many [such] cases'. So can anyone give an explanation as to why they not reported this mater to the Medical/Nursing Council, to the HSE, to the Gardai, to anyone? Are they not a group dedicated to the improvement of maternity services?; yet in respect of this fcuking awful practice, they stand idly by.

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drkpower

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There is a lot wrong in such a short post.

- I am not a medical professional (any more).
- I have never denied that the 8th impacts on consent; it does, but it is only in a very small cohort of cases
- The evidence here is limited to various patient's experiences; they do not show that the 8th caused the patient's experiences. There is a gaping chasm between the two positions.

Can i ask you a genuine question?; the likes of Rhona MAhony and the other Masters have been very open in their concerns on the impact of the 8th on medical care; its one of the reasons we are about to vote; why do you think she - and they - have not raised the issues you and AIMS have? Genuinely, think about it.

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drkpower

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Genuinely, can i ask you i to go back and read what i have said? I have always said that the 8th impacts on consent; i lecture on it. I advise about it. I think it is bloody awful; the key point that i have been saying is that the 8th impacts on the 8th in a fairly narrow cohort of cases but it does not have the wholescale impact that you are suggesting. Now don't get me wrong, im not defending it - i want it gone. But what i dont want to do is for the repeal campaign to lose ground by propagating false arguments.

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I am not dismissive; i accept they happen. I have tried to explain reasons why; i have tried to offer solutions. All i am questioning is the link between the 8th and those experiences, because that link has neither been proven nor does it make much sense..

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Rhona Mahoney and others have raised this and other concerns in their submissions and elsewhere. Its one of the main reasons we are about to have this vote, and hopefully repeal. And then you throw it back in their faces and question their motivations? Really?

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Less of the attitude; that's not going to help you. Im actually on 'your side' of the argument yet you cant resist having a pop.

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freshpopcorn

Edward M wrote: »

A clear majority for repeal and the 12 week limit according to this.
https://www.irishtimes.com/news/politics/clear-majority-backs-abortion-on-request-up-to-12-weeks-poll-shows-1.3368816?mode=amp

I'd be very concerned about the result of this opinion poll and I wouldn't call it a clear majority from my memory most of the opinion polls for the marriage referendum were well in the mid 60% and 70% and turned out to be about 62% and this could go either way being 56%.

drkpower

freshpopcorn wrote: »

I'd be very concerned about the result of this opinion poll and I wouldn't call it a clear majority from my memory most of the opinion polls for the marriage referendum were well in the mid 60% and 70% and turned out to be about 62% and this could go either way being 56%.

+1
The other thing is that the anti-repeal campaign havent started their campaign yet. With a few minor exceptions, they havent come out of the traps. So this poll has been taken after the pro-repeal side have had the pitch to themselves.

I assume that once the referendum wording (and especially the Heads of Bill) comes out, the anti-repeal side are going to come out fighting.

This campaign has a long way to go yet. That is why the Repeal side needs to be careful with the quality of their arguments. Take a leaf from the Equality Ref. A respectful and measured approach is likely to be far more effective.

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drkpower

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drkpower

New poll shows 76% support for same-sex marriage
The details were in the first opinion poll of 2015.
Jan 14th 2015, 9:45 PM

http://www.thejournal.ie/opinion-poll-2015-same-sex-marriage-1882262-Jan2015/

Bannasidhe

drkpower wrote: »

Are those not the figures from May 2015?
If so you are not really comparing like for like. Surely you should be comparing figures from earlier like Jan?

By May, in the last few day before the Ref, the Marriage Equality Campaign was playing a blinder while their opponents had continually shot themselves in the foot with insinuations about what would happen adopted children etc.

Bannasidhe

drkpower wrote: »

http://www.thejournal.ie/opinion-poll-2015-same-sex-marriage-1882262-Jan2015/

Apologies. I don't remember it as being that close.

I must say, having been involved in that particular campaign from the start that they are two different beasties. While Mar Eq did bring out some of the nasty, that was effectively turned into a positive for the campaign because so many 'ordinary' people came out and that turned the mood. The anti side began to be seen as (can't call them) homophobic bullies.

Now - if we hear from the hundred of thousands of women who have been forced to travel for the last 30 years and their stories we might begin to see similarities.

I would also say that the Mar Eq people, myself included, haven't even begun to campaign for Repeal yet - but we will be and we have learned some valuable lessons. The question is - has Iona?

nice_guy80

great to see the RCC coming in with reasoned, rational debate once again...

https://www.rte.ie/news/ireland/2018/0127/936344-catholic-bishop-warns-about-arguments-for-abortion/

"This is the final frontier," the bishop declares. "If we cross it, there will be no easy way back."

I always thought that space was the final frontier. Well that's what Jean Luc said. And I'd listen to him before a bishop.

A Catholic bishop has warned that the same arguments which are now being used to justify abortion will be used to justify ending the lives of frail older people and individuals with significant disability.
this is complete fear mongering

Zubeneschamali

I hope there's a bishop in the paper warning us about abortion every day until the referendum.

All they are doing is linking the 8th to the Catholic Hierarchy ever more firmly.

Annasopra

drkpower wrote: »

I'm not a fan of the 8th (far bloody from it!) but lets not overstate it.

Before 1983, and after 1983, before the X case, and after the X case, abortions were being carried out in Ireland perfectly legally for many medical indications (for ectopics being the classical example).

What the 8th (and the X case's interpretation) did was to legalise suicidality as a ground for abortion. Which is, eh, ironic to say the least! But irony aside, even now, and even post POLPA, i'm not even sure if an abortion has actually occurred under the suicidality ground (though may be wrong on that).

So it might be a little misleading to suggest that the 8th did the complete opposite of what was intended.

There has been 77 (reports from 2014, 2015, 2016) since the Act came into law.

Annasopra

seamus wrote: »

"Official" means recorded, standard medical practice.

I went looking (albeit not for hours) and could find no indication that abortion was standard medical practice in Ireland unless the embryo or foetus had no detectable heartbeat.

And if abortion was standard medical practice when there was a risk to the life of the mother, what happened to Savita? Why was Malak Thawley refused chemical intervention and told surgical was the only option?

Happy to be corrected though.

Where there is a risk to the life of the Mother the hospital must wait until the risk is greater than 50% until they can act.

Bannasidhe

Joeytheparrot wrote: »

Where there is a risk to the life of the Mother the hospital must wait until the risk is greater than 50% until they can act.

And combine that with something fast acting like sepsis..:mad:

Loafing Oaf

Joeytheparrot wrote: »

Where there is a risk to the life of the Mother the hospital must wait until the risk is greater than 50% until they can act.

Is this what happens in practice though? Surely we'd have a much higher maternal mortality rate if it was?

Bannasidhe

Loafing Oaf wrote: »

Is this what happens in practice though? Surely we'd have a much higher maternal mortality rate if it was?

Similar to the difference between HSE 'on trolley figure' and the figure provided daily by the Nurses there is a discrepancy between the 'official' and the 'actual'

The number of maternal deaths in Ireland has risen sharply, and the pregnancy-related death rate is now higher than in the UK, according to a new report.

There was a 22 per cent rise in the number of maternal deaths in 2010-2012, according to the second report of the Confidential Maternal Death Enquiry, based in UCC. The period coincided with a number of controversial deaths of pregnant women, most notably Savita Halappanavar in 2012.

The rate of maternal death picked up by the report from hospitals and other sources is four times higher than official figures gathered by the Central Statistics Office from death certificates. The report, which says this issue is not unique to Ireland, recommends that a question on pregnancy status at time of death be added to the coroner’s death certificate.

There were 38 maternal deaths between 2009 and 2012. Ten were classified as direct maternal deaths, ie due to obstetric causes. Twenty-one were indirect maternal deaths due to pre-existing conditions exacerbated by pregnancy. The rest were attributed to “coincidental causes”; these are not included when calculating the maternal mortality rate.

https://www.irishtimes.com/news/health/new-report-reveals-sharp-rise-in-number-of-maternal-deaths-1.2111831

Firstly - do you really expect that there is a section on death reports that covers 'treatment delayed until risk of life to mother was over 50%' ?
Secondly - Even one death is unacceptable when it could have been prevented by a termination of the pregnancy before things reached crises level.

Added to that do we know how many suicides have occurred due to unwanted pregnancy? Pro-Life Psychiatrist Patricia Casey claims there have been none but as it is not recorded on a Death Certificate if a suicide victim was pregnant unless each post-mortem result was researched and the figure complied from that there is no way of knowing...

We do know that those presented as suicidal are not always treated with sympathy and the system in place is not working - in addition to being a horrific ordeal to put a person in crises through in the first place.

A girl deemed to be at risk of suicide who wanted an abortion was sectioned under the Mental Health Act because her treating psychiatrist said terminating the pregnancy “was not the solution”.

The case is one of 22 reported by the Child Care Law Report Project, published this morning.

In the case, which was before the courts last year, an order was made to detain the girl on the evidence of a psychiatrist who said that while the child was at risk of self-harm and suicide as a result of the pregnancy, “this could be managed by treatment and that termination of pregnancy was not the solution for all the child’s problems at this stage”.

https://www.irishtimes.com/news/social-affairs/girl-sectioned-after-psychiatrist-ruled-out-abortion-1.3116111

Concerns have emerged at senior HSE levels about the failure to always secure a psychiatrist to give a second opinion in cases where a pregnant woman is seeking an abortion on the grounds she is suicidal.

An internal document said in some cases it has meant the two psychiatrists and obstetrician, who are required under law to make an assessment in such cases, cannot be found.

Abortion is allowed in cases of suicide risk under the Protection of Life During Pregnancy Act of 2013, which came into effect in 2014.

The abortion can only be allowed if the doctors agree she is suicidal. If she is turned down, the woman then can apply for a review before another panel.

However, in an internal report authorised by Dr Philip Crowley, HSE national director for quality improvement, the lack of availability of a "second opinion" psychiatrist at the initial assessment means that in some cases the woman's application is going straight to review.

Some consultants "are referring to the review process before exhausting all opportunities to get the required second opinion locally", the document obtained by the 'Medical Independent' revealed.

Objections

https://www.independent.ie/irish-news/health/suicidal-women-struggle-to-get-second-opinion-when-seeking-an-abortion-36532604.html

Calina

Bannasidhe wrote: »

Similar to the difference between HSE 'on trolley figure' and the figure provided daily by the Nurses there is a discrepancy between the 'official' and the 'actual'

https://www.irishtimes.com/news/health/new-report-reveals-sharp-rise-in-number-of-maternal-deaths-1.2111831

Firstly - do you really expect that there is a section on death reports that covers 'treatment delayed until risk of life to mother was over 50%' ?
Secondly - Even one death is unacceptable when it could have been prevented by a termination of the pregnancy before things reached crises level.

Added to that do we know how many suicides have occurred due to unwanted pregnancy? Pro-Life Psychiatrist Patricia Casey claims there have been none but as it is not recorded on a Death Certificate if a suicide victim was pregnant unless each post-mortem result was researched and the figure complied from that there is no way of knowing...

We do know that those presented as suicidal are not always treated with sympathy and the system in place is not working - in addition to being a horrific ordeal to put a person in crises through in the first place.

https://www.irishtimes.com/news/social-affairs/girl-sectioned-after-psychiatrist-ruled-out-abortion-1.3116111

https://www.independent.ie/irish-news/health/suicidal-women-struggle-to-get-second-opinion-when-seeking-an-abortion-36532604.html

Access to relevantly qualified personnel in assessing how suicidal or not a candidate for abortion was was highlighted as a major risk in particular for women who were dealt with the health system outside Dublin. It doesn't surprise me that there is some suggestion that there are now issues with that.

Ralf and Florian

How stupid is this? It's the likes of this wan (Steph F) who will swing the undecided towards voting in favour of the 8th.



https://twitter.com/Stephanenny/status/956885048044769280

pitifulgod

Hmmm, posting random tweets that are pretty reasonable overall but outraged you, so you must tell the world. :P

Water John

Just to be clear, any sign of sepsis and medical will and should act, with medical intervention. Anything less is very poor practice, irrespective of the 8th.

Ralf and Florian

pitifulgod wrote: »

Hmmm, posting random tweets that are pretty reasonable overall but outraged you, so you must tell the world. :P

You find the tone of that tweet reasonable?

Pherekydes

Ralf and Florian wrote: »

How stupid is this? It's the likes of this wan (Steph F) who will swing the undecided towards voting in favour of the 8th.



https://twitter.com/Stephanenny/status/956885048044769280

Should have posted a few more of the answers:
https://twitter.com/samrboland/status/956894224879947781

Bannasidhe

Water John wrote: »

Just to be clear, any sign of sepsis and medical will and should act, with medical intervention. Anything less is very poor practice, irrespective of the 8th.

In the gap between should be and will be lies death.

From the H.S.E Report into the death of Savita Halappanavar:

Our investigation established that hospital guidance assumes four-hour monitoring of patient observations for patients with premature rupture of membranes. However, in this case monitoring of the patient who had prolonged rupture of membranes was less frequent (See Appendix F). There was inadequate assessment and monitoring that would have enabled
the clinical team to recognise and respond to the signs that the patient’s condition was deteriorating due to infection, together with non adherence to guidelines for the prompt and effective management of sepsis, severe sepsis and septic shock when it was suspected or diagnosed. The modified Obstetric Early Warning Score (mOEWS) observation chart was not in use in some hospitals at the time of this incident for pregnant women on gynaecology
wards.
We considered that the patient’s condition involved prolonged rupture of membranes, which is associated with increasing risk of infection with the progress of time. In this case, the patient’s condition was rare and serious. There was a lack of recognition of the gravity of the situation and of the increasing risk to the mother which led to passive approaches and delays
in aggressive treatment.
This appears to have been either due to the way the law was interpreted in dealing with the case or the lack of appreciation of the increasing risk to the mother and the earlier need for delivery of the fetus.
When the patient and her husband enquired about the possibility of having a termination, this was not offered or considered possible by the clinical team until the afternoon of the 24th of October due to their assessment of the legal context in which their clinical professional judgement was to be exercised.

http://cdn.thejournal.ie/media/2013/06/savita-halappanavar-hse-report.pdf