Exit poll: The post referendum thread. No electioneering.

Loafing Oaf

LorelaiG wrote: »

A woman who is 14 weeks pregnant has been denied an abortion on the grounds of an FFA (certified by two consultants) in the Coombe hospital by the board there. They want to wait and see if she miscarries first.

I wonder is there something in the law that would encourage them to adopt this approach.

amcalester

Obvious Desperate Breakfasts wrote: »

I’m going to reserve judgement on this development until we know more.

Really, there’s going to be teething problems. This is a sea change. It’s going to take a while to bed in the new services and work around doctors and surgical staff who don’t want to perform abortions. I’m very confident that all will be well, it will just take a while.

True, but it should have been explained to the woman the reason she was denied an abortion.

Now maybe she was, but somehow I doubt that.

freshpopcorn

ELM327 wrote: »

Yes, what we voted for was to allow the government free reign with regards to abortion.


However in reality given the 2:1 margin of victory and the "hot potato" nature of the topic, it will sit as it is now and not be touched again for another generation at least.

Thanks! That was my understanding.
It's just something I have wondered about with how things/attitudes can change.

LorelaiG

Loafing Oaf wrote: »

I wonder is there something in the law that would encourage them to adopt this approach.

Yes, doctors can still be prosecuted for performing abortions outside of the criteria set out in the legislation so they're worried about being prosecuted.

Obvious Desperate Breakfasts

amcalester wrote: »

True, but it should have been explained to the woman the reason she was denied an abortion.

Now maybe she was, but somehow I doubt that.

We just don’t really have enough information. People can be economical with the truth. I just don’t want to speculate personally.

keano_afc

Obvious Desperate Breakfasts wrote: »

We just don’t really have enough information. People can be economical with the truth. I just don’t want to speculate personally.

Indeed. The sensible thing to do would be to wait until the Coombe comment on this, but try tell that to the likes of Coppinger and Smith.

Igotadose

Obvious Desperate Breakfasts wrote: »

We just don’t really have enough information. People can be economical with the truth. I just don’t want to speculate personally.

Agreed. IMO if she requested the termination and it was refused, that's egregiously wrong. If she was offered the opportunity to miscarry naturally, that's not illegal and sometimes is the best option in terms of impact on the mother's health.

seamus

In this case, I'm cautious to comment because the details of the case are hearsay. The TDs are paraphrasing what they've been told by the woman, who herself is paraphrasing what she's been told by the doctors.

I'm not accusing anyone of lying, but I've lost track of the number of people who've come away from a hospital believing one thing despite the doctors having said the exact opposite.

Hotblack Desiato

nozzferrahhtoo wrote: »

Hope she consented to be named?

She has not been named in any report I've seen. People's personal situations are raised in Dail questions all the time without them being named.

Amirani wrote: »

This might make sense actually, and could be part of the issue here.

It's not. The Coombe already performs abortions under POLDPA where the woman's life is at risk.

retro:electro

“Wait it out and see if you miscarry”

What in the fresh hell.

ohnonotgmail

keano_afc wrote: »

Indeed. The sensible thing to do would be to wait until the Coombe comment on this, but try tell that to the likes of Coppinger and Smith.

The coombe will not comment on the case. They can't.

Igotadose

retro:electro wrote: »

“Wait it out and see if you miscarry”

What in the fresh hell.

I wouldn't be so quick to judge that position without more facts about this case.
It can be better for the pregnant woman, the hormone imbalance undergone during pregnancy will be re-balanced more gradually this way (at least, this is what my US based friends tell me.)

ohnonotgmail

Igotadose wrote: »

I wouldn't be so quick to judge that position without more facts about this case.
It can be better for the pregnant woman, the hormone imbalance undergone during pregnancy will be re-balanced more gradually this way (at least, this is what my US based friends tell me.)

If that was the best option medically why was it put to the board at all?

LorelaiG

If this woman requested a termination and was refused it then that's wrong. The law is that she can request a termination in the case of an FFA. She shouldn't have to be made to wait it out to see if she miscarries. She's carrying a fetus who is not going to survive outside of the womb and has all its organs growing outside its body.

retro:electro

Igotadose wrote: »

I wouldn't be so quick to judge that position without more facts about this case.
It can be better for the pregnant woman, the hormone imbalance undergone during pregnancy will be re-balanced more gradually this way (at least, this is what my US based friends tell me.)

Isn’t it up to her to decide what’s better for her? She requested a termination, and it seems they declined that request and told her to wait it out to see does she miscarry, or go to England. The fact they told her to go abroad tells me they rejected her on the grounds of not wanting to perform the procedure rather than it being out of concern for any health issue. They should have referred her elsewhere in Ireland if they weren’t ready. Again, I could be jumping the gun but the fact she specifically asked for this to be raised in The Dail tells me something is off.

seamus

retro:electro wrote: »

“Wait it out and see if you miscarry”

What in the fresh hell.

I'm going to play devil's advocate here.

We don't know:
- How far along the woman is
- What FFA has been diagnosed
- Whether the consultants have "certified" or merely confirmed the FFA verbally
- Whether board actually ruled on this

So, let's say the woman is not particularly far along (let's say 13 weeks) and an FFA has been diagnosed through blood tests or similar.
For some defects, it would not be appropriate to jump the gun and assume the test is correct, or that the severity of the defect will be enough to confirm compatibility with life.

In this case, the consultants will confirm that the foetus has a given defect, but cannot "certify" that it is incompatible with life.

This is one of the scenarios in which time provides more clarity. When the consultant says, "we will wait four weeks, by which time we should be able to confirm the abnormality. Or as is typical for this defect, you may miscarry by that time", he is not saying, "Let's wait and see if you miscarry".

The woman may request a termination, but the consultants will say, "If we go to the board with this, they will refuse and ask to wait until 18 weeks".

This is how, even when everyone is being honest and trying to do the right thing, the message can become, "My doctors confirmed my child has an FFA, but the board refused and I was told to wait and see if I miscarry".


Ultimately this is an edge case, and I'm amazed it appeared so suddenly. Kudos to that woman for going public about it. It's a prime illustration why limiting later termination to FFAs only, is still a sub-par solution. I'm sure her consultant would have been very willing to allow the procedure if that option were available to them.

Loafing Oaf

retro:electro wrote: »

Isn’t it up to her to decide what’s better for her?

Is that an iron law in all medical cases? What if the patient wants something that endangers their health.

ohnonotgmail

seamus wrote: »

I'm going to play devil's advocate here.

We don't know:
- How far along the woman is
- What FFA has been diagnosed
- Whether the consultants have "certified" or merely confirmed the FFA verbally
- Whether board actually ruled on this

unless the lady in question is lying we do know she has been diagnosed, we know that 2 doctors confirmed the diagnosis and that the board refused her a termination.

pq0n1ct4ve8zf5

I'm interested to see what if any further details emerge, there can be sound medical reasons that a lay audience just wouldn't know about. Though as it was the board that vetoed it I don't know how that'd work. While the serious legal ramifications for carrying out illegal abortions are still there and while there are no precedents I can see why institutions and bureaucracies are going to err strongly on the side of caution. Things will smooth out as we go along, but I doubt this woman or anyone else in her position will draw much comfort from "hey guess what this is great, you're probably one of the last women of many thousands who'll have to go through this!".

Whatever one thinks of Coppinger and Smith's politics they're incredibly hard working and dedicated public servants, they've been banging this drum since long before it was popular or politically expedient to do so. A constituent came to her with an issue, she raised it in the dáil, it's literally her job. And they get attacked for things they didn't do (naming the woman) and for things that won't happen (I don't think waiting until the Coombe issued a statement that they don't comment on individual cases would have made much difference). I'm broadly in agreement with them on a lot of things and not at all on others but I really respect their willingness to keep putting themselves out there despite the uninformed, hateful personal abuse they get.

retro:electro

Loafing Oaf wrote: »

Is that an iron law in all medical cases? What if the patient wants something that endangers their health.

Why would they tell her to go to England then?

seamus

ohnonotgmail wrote: »

unless the lady in question is lying we do know she has been diagnosed, we know that 2 doctors confirmed the diagnosis and that the board refused her a termination.

As per the rest of my post, she doesn't have to be lying. Misinterpretation of what's been said is very common, especially when the situation is emotionally charged and then filtered through several different layers.

Think about the "this is a Catholic country" statement at the heart of the Savita debate. The implication was that it was a very pointed "STFU or go home" declaration made to Savita.

The reality was that it was an off-the-cuff, partially sympathetic remark by an everyday nurse.

We have at present no confirmation that any official certification took place or official decision was made by the board of the Coombe.

I actually have no issue with Coppinger or Smith, they're not outrage merchants like Paul Murphy who would deliberately overstate a position to create furore. But I know that it is incredible how vast the gulf can be, between what patients have heard, and what has actually been said.

Hotblack Desiato

Elisabeth Wrong Stork wrote: »

I'm interested to see what if any further details emerge, there can be sound medical reasons that a lay audience just wouldn't know about.

How is a board with several non-medical members qualified to make a medical decision?

retro:electro

seamus wrote: »

I'm going to play devil's advocate here.

We don't know:
- How far along the woman is
- What FFA has been diagnosed
- Whether the consultants have "certified" or merely confirmed the FFA verbally
- Whether board actually ruled on this .

- she was 13 weeks when a scan determined the organs of the foetus were outside of the body
- two doctors certified FFA
- the board refused an abortion.

pq0n1ct4ve8zf5

Hotblack Desiato wrote: »

How is a board with several non-medical members qualified to make a medical decision?

I don't know, as I pointed out in the sentence directly following the one you quoted, that aspect of it is troubling. You presumably read it before you cropped it from the quote.

Perhaps her medical made representations to the board that in their opinion it was in her best interest to wait for miscarriage. We don't know, we know SFA. I'm glad the issue was raised, I hope it's clarified what happened and on the scant detail and from the perspective we have it looks bad, I'm just reserving full judgement for now.

seamus

retro:electro wrote: »

- she was 13 weeks when a scan determined the organs of the foetus were outside of the body
- two doctors certified FFA
- the board refused an abortion.

Thanks. My headphones aren't working so I can't get the specifics.

This further illustrates what I'm saying. The survival rate for this type of defect is typically around 70%. But at the specific level, it's very much dependent on the severity of the condition and what comorbidities are present.

It's most probable in this case - if we assume that it went to the board - that it was decided the foetus was still too small to accurately verify the severity of their defect, and that by 17/18 weeks it would be possible to say with more certainty.

That is no comfort to the mother. It's also no real comfort for the doctors; they're probably 95% certain that the child is incompatible with life. But the law ties the boards' hands and that 5% is too big.

This is why we need the facts before we start jumping up and down and getting angry with people who are trying to do their best inside tight legal restriction. Get angry about the laws, not the people who are honouring them in good faith.

Obvious Desperate Breakfasts

ohnonotgmail wrote: »

unless the lady in question is lying we do know she has been diagnosed, we know that 2 doctors confirmed the diagnosis and that the board refused her a termination.

Nobody is saying she is lying. But when a person receives shocking news, their ability to absorb anything said in the immediate aftermath of that point can be badly compromised. So she might not have relayed fully correct information to the politicians, simply because she could very easily have picked up the information wrong.

amcalester

Ivan Yates also reporting that she’s being denied access to her medical files.

Igotadose

amcalester wrote: »

Ivan Yates also reporting that she’s being denied access to her medical files.

Interesting that the chairman of the Coombe Board, John Gleeson, also was in charge of CervicalCheck. Denying your records seems like a trend with those on his watch.

This is the hospital board. We don't know which board denied this woman her abortion.

Calina

amcalester wrote: »

Ivan Yates also reporting that she’s being denied access to her medical files.

That has to be illegal, no?

Amirani

retro:electro wrote: »

- she was 13 weeks when a scan determined the organs of the foetus were outside of the body
- two doctors certified FFA
- the board refused an abortion.

Not sure if this is the reasoning but: https://www.irishtimes.com/news/health/no-mention-in-law-of-process-for-reviewing-or-overturning-decisions-of-certifying-doctors-1.3761463

'The Coombe is the only one of the three big Dublin maternity units that has not yet started taking referrals for women seeking abortions. In a statement issued on December 31st, a day before the legislation come into force, the hospital said it was fully committed to providing abortion services under new legislation. “To ensure the provision of safe, high quality, sensitive and compassionate care to women, these services will be provided when the Board and Management of the Hospital are satisfied that the necessary resources have been put in place. In this context, these services will not be available on 1st January, 2019."

I guess they have no obligation to provide an abortion here, but they would have to refer elsewhere if it was deemed to be within her rights (as this does appear to be given the information provided)?