Abortion Discussion, Part Trois

recedite wrote: »

It would not really be within the competence of the brain specialists to pronounce on the viability of the foetus. So I don't think it would be fair to impose that decision on them

Yes but I wasn't saying anyone should do that, I asked why it was necessary to physically send her back to a maternity ward, given that all the medical evidence was that there was no chance that a healthy baby could be born, and that a phone call should have been sufficient for the neurologists to be certain of that.

That, or something similar, is what would happen in other countries, apparently. Certainly there would be no question of keeping a rotting body on life support against the advice of doctors and the wishes of the next of kin. You appear to think it was necessary for some medical reason, but the truth is that it was purely a legal question - nobody thought the baby could survive.

recedite wrote: »

and indeed nobody did try to impose it on them, except possibly the dead woman's family.

That is both nasty and untrue. Why would you feel the need to try to smear them like that?

It's perfectly for the next of kin to be involved in these decisions, and what happened here was that the family simply wanted the doctors to follow through on their own medical evidence. What do you think is wrong with that?

recedite wrote: »

To answer your first question; if there was some doubt, then the woman's obstetrician should have visited the ward in the Dublin hospital. But in this case it would not have made any difference if Dr. Mortell had made that trip because he was obviously keen to maintain the life support as long as it was in any way feasible, and way beyond that too.

There was no medical doubt, just legal doubt about the possible legal consequences for the doctor who gave the go-ahead to switch off life support.

I don't think it's a good thing for doctors to have to juggle with legal constraints that are clearly not in their patients' best medical interests.

recedite wrote: »

AFAIK the undead woman and the foetus were then kept in a private room back at the original hospital, while hooked up to the machine.

Well one would hope that went without saying - presumably she wasn't going to be left in an open ward with visitors coming in and out!

What I meant was, was this room in the maternity unit or in ICU?
It's not especially important I imagine, I'm just trying to envisage what happened and why. It just all seems unclear and illogical in terms of medical care.

recedite

volchitsa wrote: »

It's perfectly for the next of kin to be involved in these decisions, and what happened here was that the family simply wanted the doctors to follow through on their own medical evidence. What do you think is wrong with that?

The doctors who had been treating the brain trauma no longer had a patient. It is your contention, and it was the contention of the family, that the live foetus was irrelevant. But in fact the obstetrician still had a patient, the foetus, and so the woman's body was transferred back into his care in the other hospital.

You are wrong if you are saying the brain doctors should have overridden the decision of the obstetrician.

However, IMO the obstetrician was also wrong not to instruct the brain doctors to switch off the machine in Dublin. And this view is vindicated by the outcome of the hearing, in which Dr. Mortell was criticised by other obstetricians.

I also gave the view on this thread at the time of the Halappanavar case that there was bad medical practice going on, and the 8th amendment was being used by medical practitioners to shield themselves from criticism. Which view was roundly condemned by you and numerous other posters here who contended that the medical staff had only acted as they did because they had been constrained by the law.

And yet we have recently seen Mr. Halappanavar receive an undisclosed "six figure sum" from the state (ie the taxpayer) in an out of court settlement for medical negligence.

Of course if abortion had been fully legalised and liberalised, it is very unlikely that these two cases could have happened. But they shouldn't have happened anyway.

And if abortion was made legally easy, then we would just see a different set of malpractices replacing these ones. Malpractices involving late term abortions, or perhaps allegedly "forced" abortions for mentally handicapped women.

So instead of just railing against the 8th amendment all the time, it would be better to;
(a) demand more accountability from medical professionals who have behaved badly.
(b) recognise the real issues in these cases, whether issues of bad hospital management, bad medical practice, and the issues around what authority/consent is needed for "end of life" treatment/withdrawal of treatment.

recedite wrote: »

The doctors who had been treating the brain trauma no longer had a patient. It is your contention, and it was the contention of the family, that the live foetus was irrelevant. But in fact the obstetrician still had a patient, the foetus, and so the woman's body was transferred back into his care in the other hospital.

You are wrong if you are saying the brain doctors should have overridden the decision of the obstetrician.

However, IMO the obstetrician was also wrong not to instruct the brain doctors to switch off the machine in Dublin. And this view is vindicated by the outcome of the hearing, in which Dr. Mortell was criticised by other obstetricians.

Are you saying that the doctors (obstetricians) looking after the woman once she had been declared brain dead still believed that there was a realistic chance that the baby could be born healthy and if so, was this belief based on any medical evidence from anywhere or was he just parroting the Vatican line?

That's not how I remember the judgment, but perhaps I'm wrong.

Just on the "other patient" being the fetus, this is why the 8th leads to bad medicine. I gave birth in the UK, and during one pregnancy had severe complications, and I remember the Obs. telling my o/h that he had only one patient, me, and that I was his priority.

He said (because we mentioned Ireland) that in his view this was in fact the best way to protect the baby anyway, certainly before viability, because of its complete dependence on the mother, and that allowing a perceived conflict to arise between the two would in almost all cases harm both the baby and the mother.

And yes, I know that Irish law considers that there are two patients, that's my point. Worst outcomes for both, in the end.

I also gave the view on this thread at the time of the Halappanavar case that there was bad medical practice going on, and the 8th amendment was being used by medical practitioners to shield themselves from criticism. Which view was roundly condemned by you and numerous other posters here who contended that the medical staff had only acted as they did because they had been constrained by the law.

And yet we have recently seen Mr. Halappanavar receive an undisclosed "six figure sum" from the state (ie the taxpayer) in an out of court settlement for medical negligence.

Of course if abortion had been fully legalised and liberalised, it is very unlikely that these two cases could have happened. But they shouldn't have happened anyway.

This is the point. The case didn't go to court so the numerous inconsistencies in GUH's evidence were not tested, and I don't propose to go over them here, but I will repeat that if Ms Halappanavar had had a termination when she requested one, she would likely be alive now, and possibly a mother again, and that even if she had had a termination when the law allowed it, i.e. Not before Wed, iirc from Dr Boylan's testimony, she would probably have died anyway.

Sepsis in pregnant women requires terminating the pregnancy ASAP. Not checking and rechecking for a fetal heartbeat.

And if abortion was made legally easy, then we would just see a different set of malpractices replacing these ones. Malpractices involving late term abortions, or perhaps allegedly "forced" abortions for mentally handicapped women.

Any evidence at all for this, or is it just wishful thinking? Does it happen in the UK for example (other than to Irish women who don't manage to get the funds to travel until later on in the pregnancy that is)?

As for "forced" abortions for the mentally handicapped, is that any better than forced birth for them? It's a question of consent, irrespective of the law.

So instead of just railing against the 8th amendment all the time, it would be better to;
(a) demand more accountability from medical professionals who have behaved badly.
(b) recognise the real issues in these cases, whether issues of bad hospital management, bad medical practice, and the issues around what authority/consent is needed for "end of life" treatment/withdrawal of treatment.

It doesn't have to be "either or", you know.

In fact a law removing some of the woman's rights is far more likely to lead to less accountability for medical staff than a legal situation where her consent is always required.

As you implicitly acknowledge yourself, above, in what you say about the Halappanavar case.

recedite

volchitsa wrote: »

Are you saying that the doctors (obstetricians) looking after the woman once she had been declared brain dead still believed that there was a realistic chance that the baby could be born healthy and if so, was this belief based on any medical evidence from anywhere or was he just parroting the Vatican line?

That was the "medical experimentation" part. After he had been forced to accept during the hearing that there was no realistic chance, he agreed (or was told) to terminate the experiment (and the foetus).

recedite wrote: »

That was the "medical experimentation" part. After he had been forced to accept during the hearing that there was no realistic chance, he agreed (or was told) to terminate the experiment (and the foetus).

I thought he was a doctor? How would he need to wait for the hearing to learn that? Was he not aware of the circumstances of the woman's death do you think?

I don't think there's any real reason to think any of the Doctors involved knew from the outset that there was no hope of saving the child; a lot of the evidence presented revolved around the deterioration of the mothers body and a study of outcomes for foetuses where the mother was brain dead, showing a survival rate of 28% in similar circumstances, which demonstrates there was some consideration being given to just how likely survival might be, not that it was a foregone conclusion. Nor is there any reason to think Doctors were 'parroting the Vatican line'; there's nothing in the transcript or any of the reporting to suggest that any of the Doctors wanted to do anything other than their best for their patients, or that they held any religious views on the subject.

In 2013, Marlise Munoz in the US was declared brain dead; she was 14 weeks pregnant at the time. She was somatically sustained for 8 weeks due to the law in Texas, which required that lifesaving measures be maintained if a female patient was pregnant—even if there was written documentation that this was against the wishes of the patient or the next of kin. Eventually, faced with evidence that the foetus wasn't viable (there was evidence of deformity, heart problems and hydrocephaly) a Judge ruled life support should be turned off (on the basis that whilst the law applied to living pregnant women, it didn't apply to dead ones!). That happened before the case in Ireland, so it's readily apparent that other jurisdictions have had similar situations (somatic support is unusual, but not unprecedented in these situations); in the US a number of States have laws which require that a woman must remain on life-sustaining treatment until she gives birth, regardless of any health directive she may have made. That's an indication of what does happen in other countries, should it seem that Ireland might have become some sort of outlier due to the 8th Amendment.

In 2015, Karla Perez in Nebraska suffered brain death when she was 22 weeks pregnant, was somatically sustained for two months and her child was successfully delivered. According to the article, there have been 33 similar cases reported in medical literature worldwide since 1982. So apparently neither Ireland or the US are alone in attempting by extraordinary measures to save the unborn children of mothers who suffer fatal injuries.

There's obviously a big difference between 22 weeks and 14, but it's apparent that as medicine advances children can be successfully delivered earlier, and brain dead corpses can be somatically sustained longer, so I would suggest that given there is an obligation on Doctors to do their best on behalf of their patients, including the unborn ones, that they should at least be considering making an attempt if they believe there may be a chance of success. Some of the Doctors in the Irish case may have been too optimistic initially, but there will come a point where optimism will be rewarded, as it was with the birth of Angel Perez; it's worth pointing out that had doctors not even considered her to be a patient, as some posters consider 'good medicine', she wouldn't be alive today.

Absolam wrote: »

Sure... I don't think I disputed the title of the case? I certainly don't recall discussing it. If you mean my error in referring to P.P as N.P, I'm sure you can accept we all make mistakes (and I did amend it); particularly when you yourself took my reference to "the Doctors engaged in the care of the unborn child at the time" and engaged with it as '"the doctors who were directly involved in N.P.'s care", which is a slightly more egregious rewriting than misplacing one initial...

Ah, Ok I see the source of your confusion. You seem to think that unborn children of 15 to 17 weeks gestation have their own doctors, rather than realise that the doctors who are treating the mother, are also responsible for the foetus. And so you discount doctors treating NP as also caring for the unborn.
However, your point, if you were actually to have one, is moot, since Dr David Mortell was the obstetrician who was 'engaged in the care of the unborn child at the time', and as you acknowledged, he did indeed give evidence in the court.

Absolam wrote: »

And (again) I never said it was mentioned in the case, did I? I said the Examiner offered an opinion on it, and that the Doctors had no reason to have any legal concerns based on the 8th since it placed them under no obligation, and subjected them to no penalty. Unlike the POLDPA, which did.
Other than that it was also reported in the news? After all, the Examiner at the time said "Clinicians fear that they will breach their ethical and legal duty to preserve the life of this unborn child if they remove life support from this woman. Indeed, the Protection of Life During Pregnancy Act exposes clinicians to a maximum term of 14 years imprisonment if they “intentionally destroy unborn human life”. Whereas, as I've said, the clinicians had no obligation under the 8th, nor does it express a penalty for their non compliance. If they were concerned about it, it doesn't seem they had any reason to be....

So based on on opinion piece in the Examiner, which appear to have been written before any details of the case were heard (including what the doctors themselves felt to be the source of their legal concerns), you conclude that the 8th amendment was of no concern, or now, that "If they were concerned about it, it doesn't seem they had any reason to be...."
(As a side note, your linked Examiner article also discusses the 8th amendment as being a concern, but you left that bit out).
And you prefer this opinion over the actual testimony of the doctors involved in the case as to what there actual concerns were - to remind you, their concern was the 8th amendment, and not once did any of them (or the judges for that matter) mention the POLDP Act as being of concern.
And despite the fact that the Hospital Legal team felt concern, and the high court sat to debate the application of the 8th, you in your infinite wisdom are sure that they really had no need to be concerned at all.

Absolam wrote: »

And whilst I agreed with Oldrnwisr some time ago that it appears that one of the doctors raised the point that there could be legal issues with discontinuing somatic support, that doesn't preclude the possibility that their raising it was as a result of information provided by their legal team. Does it?

And as I have already explained, the legal team would not have known about any concerns unless they had been raised by the medical team looking after the patient. This is not a chicken and egg scenario! Unless you are saying that a breech of medical confidentially took place?

I'm not really sure anymore what relevance most of this has to that big picture I mentioned, as usual you have gone deep into the rabbit hole.

recedite wrote: »

They were neurosurgeons, and had little or no expertise in obstetrics or the legal implications of the 8th amendment. That's why they sent the brain dead woman with the live foetus back to the obstetrician, instead of switching off the life support.
It seems to have been a very sensible approach.

The neurosurgeons requested legal clarification. There are obstetricians practicing at Beaumont hospital - if they felt that they would have been helpful they would have asked. Maybe they did.
The reason why NP was transferred back to the referring hospital was most likely due to the standard practice: Beaumont is a tertiary referral centre for neurosurgery. Once that expertise has been exhausted in a case, typically patients are transferred back to their referring hospital.

recedite wrote: »

It would not really be within the competence of the brain specialists to pronounce on the viability of the foetus. So I don't think it would be fair to impose that decision on them, and indeed nobody did try to impose it on them, except possibly the dead woman's family.

To answer your first question; if there was some doubt, then the woman's obstetrician should have visited the ward in the Dublin hospital. But in this case it would not have made any difference if Dr. Mortell had made that trip because he was obviously keen to maintain the life support as long as it was in any way feasible, and way beyond that too.

AFAIK the undead woman and the foetus were then kept in a private room back at the original hospital, while hooked up to the machine.

As the foetus was only 15 weeks at the time of the injury, and otherwise it seems there were no health concerns for it, the best people to judge viability of the foetus were neither the neurosurgeons or the obstetrians, but the intensivists at Beaumont. Because for the foetus to reach viability depended entirely on their ability to maintain the brain dead mother in a physiologically functioning state.

recedite wrote: »

However, IMO the obstetrician was also wrong not to instruct the brain doctors to switch off the machine in Dublin. And this view is vindicated by the outcome of the hearing, in which Dr. Mortell was criticised by other obstetricians.

The obstetrician, and I presume you are referring to Dr Mortell here, could not instruct the neurosurgeons to 'switch off the machine'. He was no longer the treating doctor, he had no power at that time. In any case, once the legal concerns were brought to light, there was no option but to wait for a legal opinion.
I also don't see how you have come to the conclusion that other obstetricians were critical of him. I didnt take that from the transcripts or the reporting of the case. He really had very little doing in bringing this case to the point it came to. The patient was transferred to beaumont and from that point he had little to no control over what happened.

recedite wrote: »

I also gave the view on this thread at the time of the Halappanavar case that there was bad medical practice going on, and the 8th amendment was being used by medical practitioners to shield themselves from criticism. Which view was roundly condemned by you and numerous other posters here who contended that the medical staff had only acted as they did because they had been constrained by the law.

And yet we have recently seen Mr. Halappanavar receive an undisclosed "six figure sum" from the state (ie the taxpayer) in an out of court settlement for medical negligence.

Of course if abortion had been fully legalised and liberalised, it is very unlikely that these two cases could have happened. But they shouldn't have happened anyway.

And if abortion was made legally easy, then we would just see a different set of malpractices replacing these ones. Malpractices involving late term abortions, or perhaps allegedly "forced" abortions for mentally handicapped women.

So instead of just railing against the 8th amendment all the time, it would be better to;
(a) demand more accountability from medical professionals who have behaved badly.
(b) recognise the real issues in these cases, whether issues of bad hospital management, bad medical practice, and the issues around what authority/consent is needed for "end of life" treatment/withdrawal of treatment.

I don't think that you can draw from the fact that a settlement was made in the Halappanaver case that doctors are using the 8th amendment to shield themselves from criticism. In fact, it is obvious from that case that the 8th was very much in play, and if there had been no foetal heartbeat, best practice would have ensured urgent intervention in the case, rarther than the 'wait and see' approach that was taken.

You have some points, but it's also true that the existence of the 8th amendment directly leads to bad medical practice, and so as a multifaceted approach to improving treatment, it should go.

oldrnwisr

Absolam wrote: »

I don't think there's any real reason to think any of the Doctors involved knew from the outset that there was no hope of saving the child; a lot of the evidence presented revolved around the deterioration of the mothers body and a study of outcomes for foetuses where the mother was brain dead, showing a survival rate of 28% in similar circumstances, which demonstrates there was some consideration being given to just how likely survival might be, not that it was a foregone conclusion.

Well, actually they wouldn't have had any hope. The key study presented in the hearing is a systematic review of brain death during pregnancy. The study found 30 reported cases of maternal brain death in the 28 years between 1982 and 2010. So before we get to analysing the results, this is such a rare event that any result is going to have no statistical power.
In this study there are only 3 cases which have a comparable gestational age (i.e. 15 weeks or less), although Dr. Marsh, in his analysis expands the relevant cases to those at 17 weeks or less. In this group there are 8 cases. These cases resulted in 5 deaths prior to delivery, 1 death at 30 days and two live births, one followed up with normal growth at 11 months and the other case reports no information beyond live birth.
However, there are several problems in gleaning any information from this study. Firstly, as mentioned previously, this is a very rare occurrence with only 30 reported cases in 28 years. Secondly, as explained by Dr. Marsh in the transcript, negative outcomes are unlikely to be published. This is not an uncontroversial view and is explained at length here by Ben Goldacre. Thirdly, the key takeaway point from Dr. Marsh in raising the study is the paucity of evidence in cases like this. In fact the transcript notes:

"The paper itself made the point that the number of reported cases was too small to determine the rate at which intensive care support for the mother could result in a healthy infant."

So your claim about a 28% survival rate is both misleading and wrong.

Secondly, for all your talk about lack of evidence from the doctors actually treating in N.P. in your posts you seem to know what they were and weren't aware of. Dr. Brian Marsh, the doctor who introduces the study was not involved in the care of N.P. and there is no indication that any of the doctors who were involved in her care were aware of previous research on the issue contrary to your claim that:

"demonstrates there was some consideration being given to just how likely survival might be, not that it was a foregone conclusion"

Even some of the expert witnesses in the trial were previously unaware of the study referenced.

In fact, it is far more likely that rather than having read this systematic review in BMC Medicine or the more obscure individual cases reported in the study, the doctors in this case would have been more familiar with the consensus positions on the issue.
For example in 2007, a study in the Irish Medical Journal on consensus positions on neonatal intensive care viability found that "most would not provide care before 22 weeks."
Also, in the UK, the Nuffield Council Guidelines state:

You'll note the use of the word "experimental" in the "Before 22 weeks" category.

There is a paucity of evidence in this matter and certainly no evidence to suggest that continuing somatic support is anything more than a research experiment. As the court transcript notes:

"The entire medical evidence in this case goes one way only, and that is to establish that the prospects for a successful delivery of a live baby in this case are virtually non-existent.The medical evidence clearly establishes that early gestation cases have a much poorer prognosis for the unborn child than those cases where brain death of the mother occurs at a later stage, usually improving after 24 weeks."

Absolam wrote: »

There's obviously a big difference between 22 weeks and 14, but it's apparent that as medicine advances children can be successfully delivered earlier, and brain dead corpses can be somatically sustained longer, so I would suggest that given there is an obligation on Doctors to do their best on behalf of their patients, including the unborn ones, that they should at least be considering making an attempt if they believe there may be a chance of success. Some of the Doctors in the Irish case may have been too optimistic initially, but there will come a point where optimism will be rewarded, as it was with the birth of Angel Perez; it's worth pointing out that had doctors not even considered her to be a patient, as some posters consider 'good medicine', she wouldn't be alive today.

You say above, that "there will come a point where optimisim will be rewarded". How do you know that? How do you know, for example, that somatic support and prenatal care will continue to improve rather than reach a limit?

As Dr. Peter McKenna explained during the trial:

"In reply to the Court, Dr. McKenna further confirmed that to the extent that a mother is suffering from various problems during a pregnancy, the baby also suffers and will react with distress to adverse developments and will not be unaware or unaffected by them."

From the Heidelberg study the conditions with which clinicians have had to contend during the course of somatic support for brain dead mothers include (but not limited to): thermovariability, diabetes insipidus, panhypopituitarism, pneumonia, urinary tract infection, sepsis, hemodynamic instability etc. It's a given that the earlier the brain death occurs the more likely there are to be complications like these. Furthermore, given the endemic nature of nosocomial infections in Ireland, the likelihood of contracting an infection like MRSA, C. Diff or KPC increases dramatically with the length of somatic support.

There's no reason to think that medical improvements in this area will continue indefinitely. However, there's also no reason to preclude the possibility of such an improvement. Like I said already there's a paucity of evidence on the matter. So the proper course of action is to proceed with what we know to be achievable until sufficient evidence is produced to demonstrate an improvement.

What's striking about the evidence from the posts above is that if the baby had been born (or removed by C-section) around the time of the mother's death, there would have been no legal obligation on the doctors to provide artificial life support for it, because of its dismal prognosis.

The problem only arose because of the special "protection" that the constitution affords the unborn. A born child even several weeks older would have no such protection.

So one thing we can unequivocally conclude is that this incident was a direct consequence of the 8th amendment.

ProfessorPlum wrote: »

Ah, Ok I see the source of your confusion. You seem to think that unborn children of 15 to 17 weeks gestation have their own doctors, rather than realise that the doctors who are treating the mother, are also responsible for the foetus. And so you discount doctors treating NP as also caring for the unborn.
However, your point, if you were actually to have one, is moot, since Dr David Mortell was the obstetrician who was 'engaged in the care of the unborn child at the time', and as you acknowledged, he did indeed give evidence in the court.

Well, I can see why you think I'd be confused given your preference for restatement over specificity, but don't worry; I knew what I was saying and stuck with it. If Dr Mortell was engaged in the care of the unborn child at the time, it's amazing he had to be informed of it's circumstances by a visiting Doctor who conducted an examination.

ProfessorPlum wrote: »

So based on on opinion piece in the Examiner, which appear to have been written before any details of the case were heard (including what the doctors themselves felt to be the source of their legal concerns), you conclude that the 8th amendment was of no concern, or now, that "If they were concerned about it, it doesn't seem they had any reason to be...."
(As a side note, your linked Examiner article also discusses the 8th amendment as being a concern, but you left that bit out).
And you prefer this opinion over the actual testimony of the doctors involved in the case as to what there actual concerns were - to remind you, their concern was the 8th amendment, and not once did any of them (or the judges for that matter) mention the POLDP Act as being of concern.
And despite the fact that the Hospital Legal team felt concern, and the high court sat to debate the application of the 8th, you in your infinite wisdom are sure that they really had no need to be concerned at all.

Well, let's see; how exactly could the Doctors contravene the 8th, and what would the penalty be?

ProfessorPlum wrote: »

And as I have already explained, the legal team would not have known about any concerns unless they had been raised by the medical team looking after the patient. This is not a chicken and egg scenario! Unless you are saying that a breech of medical confidentially took place?

Why should there have been a breach of confidentiality? You don't think it's at all possible that members of the legal team in the wake of the passing of the POLDPA would have thought it relevant to brief Doctors on their potential liabilities under new legislation? And that such briefings could cause a Doctor to be concerned in this particular situation, resulting in them raising that concern and seeking legal advice?

ProfessorPlum wrote: »

I'm not really sure anymore what relevance most of this has to that big picture I mentioned, as usual you have gone deep into the rabbit hole.

I'm not sure you're demonstrating that you haven't the time, or frankly could not be arsed to 'help' me further very well either, but at least I never claimed that what I was saying was supposed to be relevant to your notion of a big picture; as I said, I don't know why you think it's a 'big picture' kind of thing, or why you're imagining I missed it.

^^^^^Not surprisingly you have difficulty accepting the facts although they are very clearly outlined to you. And I'm not going further into that particular rabbit hole with you.

I hope you don't mind my reducing that truly impressive wall of text to the bits that are actually relevant.

oldrnwisr wrote: »

Well, actually they wouldn't have had any hope.

Sure; we definitely know that. Which is not the same as the Doctors knowing from the outset that there was no hope of saving the child.

oldrnwisr wrote: »

So your claim about a 28% survival rate is both misleading and wrong.

Well, it's not really my claim; the report from the Heidelberg Study showed that of the 7 cases that fitted into the category of 17 weeks or less gestation, 2 survived. That's 28%, even if one did die later. I wasn't claiming that the evidence presented was in any way authoritative, or complete. Only that it was presented.

oldrnwisr wrote: »

Secondly, for all your talk about lack of evidence from the doctors actually treating in N.P. in your posts you seem to know what they were and weren't aware of. Dr. Brian Marsh, the doctor who introduces the study was not involved in the care of N.P. and there is no indication that any of the doctors who were involved in her care were aware of previous research on the issue contrary to your claim that:"demonstrates there was some consideration being given to just how likely survival might be, not that it was a foregone conclusion"
Even some of the expert witnesses in the trial were previously unaware of the study referenced.

Ah... I can help you out quite quickly there. As I mentioned to Prof Plum, I never said I was talking about lack of evidence from the doctors actually treating in N.P.
And with regards to "demonstrates there was some consideration being given to just how likely survival might be, not that it was a foregone conclusion", I was specifically talking about evidence being given in the High Court (by Dr Marsh, as you say), so obviously not referring to the Doctors treating N.P., but the Court proceedings.

oldrnwisr wrote: »

As the court transcript notes:
"The entire medical evidence in this case goes one way only, and that is to establish that the prospects for a successful delivery of a live baby in this case are virtually non-existent.The medical evidence clearly establishes that early gestation cases have a much poorer prognosis for the unborn child than those cases where brain death of the mother occurs at a later stage, usually improving after 24 weeks."

Evidence that was given by experts in the various fields and wasn't available to the Doctors when they initially placed N.P. on life support? I'd go along with that; had they had such evidence, and foreknowledge that N.P.s condition would become so unmanageable so quickly I think they probably would have decided differently.

oldrnwisr wrote: »

You say above, that "there will come a point where optimisim will be rewarded". How do you know that? How do you know, for example, that somatic support and prenatal care will continue to improve rather than reach a limit?

In fairness, it's true, I'm not prescient. But I don't think there's a single area of medicine that has stopped advancing in the last century, and I wouldn't be willing to bet there is one that will in the next.

http://www.thejournal.ie/women-walk-out-church-poland-abortion-protest-2697097-Apr2016/

Women (and men) walk out of church as priest reads anti-abortion letter
The letter was read out as the Catholic Church in Poland launched its campaign in support of proposed legislation to ban abortion.

https://www.youtube.com/watch?v=pYCqRlUtTw8

The message from Poland’s Catholic bishops, presented at churches nationwide, called on lawmakers to back the proposal being considered by Poland’s right-wing government.

The move would tighten what are already some of Europe’s most restrictive laws on pregnancy termination. Current legislation, dating from 1993, already bans all terminations except when pregnancy results from rape or incest, poses a health risk to the mother, or if the foetus is severely deformed.

Pro-life activists support even tougher legislation but the move has sparked a backlash and thousands of marchers took part in a protest outside the country’s parliament in Warsaw yesterday, as well as in several other cities.

Elderly and middle aged virgin men telling women what to do with their bodies, its utterly pathetic

On a slightly different issue, that is what I thought should have happened on several occasions in Ireland, and in particular every single time Cardinal Sean Brady said Mass after his alleged "resignation" was refused by the Vatican.

The Poles appear to have a lot more moral courage than the Irish.

ProfessorPlum wrote: »

^^^^^Not surprisingly you have difficulty accepting the facts although they are very clearly outlined to you. And I'm not going further into that particular rabbit hole with you.

Lets just say I think your preoccupation with having others accept your personal interpretation of the specifics doesn't lend itself to the appearance of a 'big picture' perspective.

And that constant obsessing over rabbit holes... is a little odd.

Absolam wrote: »

I don't think there's any real reason to think any of the Doctors involved knew from the outset that there was no hope of saving the child; a lot of the evidence presented revolved around the deterioration of the mothers body and a study of outcomes for foetuses where the mother was brain dead, showing a survival rate of 28% in similar circumstances, which demonstrates there was some consideration being given to just how likely survival might be, not that it was a foregone conclusion. Nor is there any reason to think Doctors were 'parroting the Vatican line'; there's nothing in the transcript or any of the reporting to suggest that any of the Doctors wanted to do anything other than their best for their patients, or that they held any religious views on the subject.

oldrnwisr wrote: »

So your claim about a 28% survival rate is both misleading and wrong.

Just to add to your point oldrnwisr, Absolam's assertions of a 28% survival rate are wrong for all the reasons you've given, but also because the case before the doctors was in no way similar to any that were described in the literature. As we recall the disturbing testimony from this case, NP was not only brain dead, but she had an infected open wound to her brain, and with no circulation of blood to the brain, there was no possibility that that infection would every be brought under control. She was in effect decaying before their eyes.

Absolam wrote: »

That's 28%, even if one did die later. I wasn't claiming that the evidence presented was in any way authoritative, or complete. Only that it was presented.

And you were also claiming that the cases were similar. They weren't.

Absolam wrote: »

And with regards to "demonstrates there was some consideration being given to just how likely survival might be, not that it was a foregone conclusion", I was specifically talking about evidence being given in the High Court (by Dr Marsh, as you say), so obviously not referring to the Doctors treating N.P., but the Court proceedings.
Evidence that was given by experts in the various fields and wasn't available to the Doctors when they initially placed N.P. on life support? I'd go along with that; had they had such evidence, and foreknowledge that N.P.s condition would become so unmanageable so quickly I think they probably would have decided differently.

Why would you think the evidence was unavailable to the treating doctors - it's freely available on the internet -I'm sure the doctors could have found it. They also could have simply asked their colleagues (such as the experts who gave their opinions in court)

You think they would have decided differently? How do you come to that reasoning?
I don't think they would have decided differently. Firstly, it was several days before brain death was declared, so by that time, they would have had a pretty good idea of the way things were going. In this case, because they felt they couldn't do an apnoea test as part of that process, they did a cerebral angiogram to confirm the brain stem death. The angiogram showed that there was no blood flow to the brain. That and the fact that there was an open wound, (which was likely showing signs of infection at this point as it would be an inevitable consequence) made the situation hopeless. So they had every reason to know that NP's situation was unmanageable.

volchitsa wrote: »

On a slightly different issue, that is what I thought should have happened on several occasions in Ireland, and in particular every single time Cardinal Sean Brady said Mass after his alleged "resignation" was refused by the Vatican.

To be fair people did walk out of church's,
ok not everyone but people do walk out during the time when the church read out those sex abuses letters from the pope and also when the church read out its marriage equality hatred text.

The Poles appear to have a lot more moral courage than the Irish.

Perhaps but I think that depends which morals I guess.
They have a anti-gay party who won in elections, no such party's exists in Ireland as far as I'm aware and certainly none that would do any good in elections.

So morally I guess they do have alot more morals if those morals are in keeping with the catholic church teachings.

oldrnwisr

Absolam wrote: »

Well, it's not really my claim; the report from the Heidelberg Study showed that of the 7 cases that fitted into the category of 17 weeks or less gestation, 2 survived. That's 28%, even if one did die later. I wasn't claiming that the evidence presented was in any way authoritative, or complete. Only that it was presented.

OK, just to clarify here. You said that there was a 28% survival rate. The term 28 percent is not used in the paper. That is your calculation based on information presented therein. It is also wrong and misleading.

Firstly, it is wrong because there are in fact 8 cases in the sub-17 week group.

Author | Gestation weeks at maternal death | Outcome | Follow-up
Bernstein et al. (1989) | 15 | Live birth at 32 weeks | Developing normally at 11 months
Antonini et al. (1992) | 15 | Intrauterine death | N/A
Anstotz (1993) | 13 | Spontaneous abortion at 19 weeks | N/A
Wuermeling (1994) | 14 | Intrauterine death | N/A
Spike (1999) | 16 | Live birth at 31 weeks | None
Beca et al. (1999) | 17 | Intrauterine death | N/A
Lane et al. (2004) | 13 | Intrauterine death at 14 weeks | N/A
Mejia et al. (2008) |17 | Premature birth at 25 weeks | Candida infection on delivery, died at day 30

Secondly, it is misleading because each of the cases above represented different causes of maternal death (e.g. traffic accident, intracranial haemorrage, Cerebral venous sinus thrombosis, traumatic brain injury etc.), different medical complications (thermovariability, infection, pneumonia, UTI etc.) so they cannot be reliably compared to each other.

Finally, just because 2 out of 8 in the group survived (or 25%), doesn't mean that a future case would have a 25% chance of survival for reasons outlined in my last post and by ProfessorPlum above. There is nowhere near enough evidence in the literature to draw conclusions with any kind of statistical power.

ProfessorPlum wrote: »

Just to add to your point oldrnwisr, Absolam's assertions of a 28% survival rate are wrong for all the reasons you've given, but also because the case before the doctors was in no way similar to any that were described in the literature. As we recall the disturbing testimony from this case, NP was not only brain dead, but she had an infected open wound to her brain, and with no circulation of blood to the brain, there was no possibility that that infection would every be brought under control. She was in effect decaying before their eyes.

ProfessorPlum wrote: »

And you were also claiming that the cases were similar. They weren't.

I'm not claiming to be an expert on the evidence presented, I'm just going by what evidence was presented; "The study took in a 30 year period and involved about 30 cases in all. Only 7 fitted into the category of 17 weeks or less gestation at the death of the mother. Of those there were two survivors, one of whom died at 30 days post delivery. " So they were similar enough to be grouped together in the transcript. Two of the seven survived initially. 28%.

ProfessorPlum wrote: »

Why would you think the evidence was unavailable to the treating doctors - it's freely available on the internet -I'm sure the doctors could have found it. They also could have simply asked their colleagues (such as the experts who gave their opinions in court)

Happy to rephrase as 'evidence that they may not have been aware of when they initially placed N.P. on life support' if you like? There certainly seems to be nothing to say they had had that evidence presented to them by those experts at the time, particularly since the context of the substantially deteriorated condition of N.P. that had occured by the time of the Court hearing wasn't available at that stage.

ProfessorPlum wrote: »

You think they would have decided differently? How do you come to that reasoning? I don't think they would have decided differently. Firstly, it was several days before brain death was declared, so by that time, they would have had a pretty good idea of the way things were going. In this case, because they felt they couldn't do an apnoea test as part of that process, they did a cerebral angiogram to confirm the brain stem death. The angiogram showed that there was no blood flow to the brain. That and the fact that there was an open wound, (which was likely showing signs of infection at this point as it would be an inevitable consequence) made the situation hopeless. So they had every reason to know that NP's situation was unmanageable.

I can come to it because there is nothing to show that they did have the evidence presented by the expert witnesses in Court at the time they were making the decision to place the corpse of N.P. on somatic support, nor did they have foreknowledge that N.P.s condition would become so unmanageable so quickly ( somewhat different from your restatement as having every reason to know that NP's situation was unmanageable). There's no mention of their feelings on doing apnoea tests in the transcript, but Dr Marsh asserts the angiogram carried out on the 3rd confirmed she was brain dead, and there's no indication in the transcript that inevitability (at least as regards the future of the unborn child) was a predominant feature of Doctors thinking on the 3rd; even on the 17th a tracheostomy operation was carried out in an attempt to attain foetal viability. I'd regard that as evidence that even by the 17th the Doctors thought they could attain foetal viability, would you not?

Once again, I'm seeing a plethora of authoritive looking information here, so I hope you don't mind that am again reducing it to the bit that is actually relevant. I am impressed though, it looks great.

oldrnwisr wrote: »

You said that there was a 28% survival rate. The term 28 percent is not used in the paper. That is your calculation based on information presented therein. It is also wrong and misleading.

Yes it's my calculation. As I said, the transcript shows "The study took in a 30 year period and involved about 30 cases in all. Only 7 fitted into the category of 17 weeks or less gestation at the death of the mother. Of those there were two survivors, one of whom died at 30 days post delivery."
2 out of 7 is 28%. Whether you feel the information that was in the transcript was factually incorrect, or misleading because of how it was compared, makes no difference to the fact that it was in the transcript. As I said (and you quoted), I wasn't claiming that the evidence presented was in any way authoritative, or complete. Only that it was presented.

Whether or not Doctors may choose to use the literature to draw conclusions with any kind of what they think is statistical power, or even simply use what they can learn from the literature to try and make decisions that may increase the possibility of viability of unborn children in similar circumstances, I can't say; I'm not one of them.
But I can (and do) hope that every time Doctors fail, despite their best efforts, to save a childs life in similar circumstances, something will be learned and medicine will advance, bringing us closer to a point where more lives can be saved.

At the very least, the case allowed the High Court to draw parallels with judgements where life support was withdrawn from born persons, both adult and child, demonstrating a parity with and consistency in similar judgements with regards to the right to life for both born and unborn, insofar as in all cases the right to life does not necessarily entail that life must be preserved and prolonged at all costs no matter what the circumstances (re a Ward of Court (witholding medical treatment) (No. 2) [1996] 2 I.R. 79), so Doctors may, at their discretion, decide to withdraw somatic support whether the patient is born, or unborn (Re A (A Minor) [1993] 1 Med L Rev 98).

I'd imagine many people in the rest of the UK are surprised and disgusted with the sentence handed down to this women in Norther Ireland, http://www.bbc.com/news/uk-northern-ireland-35962134

Woman who bought drugs online to terminate pregnancy given suspended sentence

She had been unable to raise enough money to travel to England for a termination

A defence barrister told Belfast Crown Court that had his client lived in any other region of the UK, she would "not have found herself before the courts".

The 21-year old bought two types of drugs online, took them and then miscarried on 12 July 2014.

She cannot be named because of a court order.

She was left with little choice due to her financial circumstances and the backwards laws that exist in Northern Ireland,

Personally I'd like to see the "pro-life" lobby for prosecutions to happen in Ireland like this,
In addition I'd like to see them lobby to ban pregnant women traveling for abortion. But they won't, because they are scared of the one thing I want to see happening in Ireland, that such cases and bans will finally lead to a referendum and no before time.

Until then they'll claim Ireland is abortion free while being totally happy and content with exporting abortions and doing nothing to stop these abortions, the same as basically all so called "pro-lifers". It seems they can't even stand up for what they believe in.
:rolleyes:

Cabaal wrote: »

Personally I'd like to see the "pro-life" lobby for prosecutions to happen in Ireland like this,

You want pro-life to lobby for people to be prosecuted for breaking the law? Why would they bother; the DPP hasn't given any indication that they wouldn't prosecute if they could prove someone broke the law have they?

Cabaal wrote: »

In addition I'd like to see them lobby to ban pregnant women traveling for abortion. But they won't, because they are scared of the one thing I want to see happening in Ireland, that such cases and bans will finally lead to a referendum and no before time.

Or they won't because they don't think legislating against travelling for abortion is likely to reduce abortions? Or that Ireland has no business legislating for what happens in States with different laws? I think your 'because' is much more contingent on your own opinion than that of 'the pro-life'. It's funny how the only posters ever to advocate this course are not pro life. Actually, it's funny how often the poster advocating it is you.

Cabaal wrote: »

Until then they'll claim Ireland is abortion free while being totally happy and content with exporting abortions and doing nothing to stop these abortions, the same as basically all so called "pro-lifers". It seems they can't even stand up for what they believe in.
:rolleyes:

Or what you say they should believe in :rolleyes:

Absolam wrote: »

Or what you say they should believe in :rolleyes:

They believe abortion is murder or do you dispute this?

If you believe murder is wrong then logical extension then regardless of where it occurs then surely you are against an Irish citizen traveling to commit murder?

Or is it the case that they are ok with murder once it doesn't happen in Ireland?, in which case thats a pretty messed up viewpoint to have esp if you then continue to claim abortions = murder.

Cabaal wrote: »

They believe abortion is murder or do you dispute this?

Yes I do dispute it. Or at least, I identify as Pro Life and don't believe abortion is murder, so I dispute it on my own behalf. I don't think I can speak on behalf of anyone else any more than you can, but I think probably some do and some don't.

Cabaal wrote: »

If you believe murder is wrong then logical extension then regardless of where it occurs then surely you are against an Irish citizen traveling to commit murder?

I don't believe it's illegal to travel to commit murder. It's illegal to conspire to commit murder. It's illegal to attempt to commit murder. But travelling to commit one in and of itself? I don't think so. Which obviously begs the question... Are you currently lobbying to ban travelling to commit murder, or do you hold yourself to a different standard from Pro Life people who believe abortion is murder but aren't lobbying to ban travel for it?

Cabaal wrote: »

Or is it the case that they are ok with murder once it doesn't happen in Ireland?, in which case thats a pretty messed up viewpoint to have esp if you then continue to claim abortions = murder.

I suppose we can apply the same standard to your good self, and when you find a Pro Life proponent who agrees that abortion is murder, you could keep each other company lobbying against travel? You could maybe take turns covering each others lobbying, while the other one nips off for a cuppa or suchlike?

Absolam wrote: »

I'm not claiming to be an expert on the evidence presented, I'm just going by what evidence was presented; "The study took in a 30 year period and involved about 30 cases in all. Only 7 fitted into the category of 17 weeks or less gestation at the death of the mother. Of those there were two survivors, one of whom died at 30 days post delivery. " So they were similar enough to be grouped together in the transcript. Two of the seven survived initially. 28%.

"So they were similar enough to be grouped together in the transcript." It was a review of case literature - the only criteria for inclusion was somatic support for pregnancy and brain death. Using a percentage 'success' is meaningless. For instance, the review doesn't include the two other cases from Ireland that we know about (Waterford 2001 and Galway). Infact, no one would know about them except an application to the courts for direction was made. There are no doubt other cases in Ireland that we don't know about as they were neither written up as cases reports, or made it as far as the courts. So statistics are meaningless unless all cases are reviewed.

All of that aside, none of the cases were similar to the case under discussion - that is the point which you seem to be missing. I accept your admission that you are not an expert, and of course you therefore can't be expected to see that one simply can place no significance on any statistic you have arrived at.

Absolam wrote: »

Happy to rephrase as 'evidence that they may not have been aware of when they initially placed N.P. on life support' if you like? There certainly seems to be nothing to say they had had that evidence presented to them by those experts at the time, particularly since the context of the substantially deteriorated condition of N.P. that had occured by the time of the Court hearing wasn't available at that stage.

Regardless of weather they did or didn't (and it would be usual for clinicians faced with unusual cases that they might not be familiar with to do a bit of research), the evidence would have been of limited use, as the case in front of them was significantly complicated by an open wound to the brain and a lack of blood flow to the brain.

Absolam wrote: »

I can come to it because there is nothing to show that they did have the evidence presented by the expert witnesses in Court at the time they were making the decision to place the corpse of N.P. on somatic support, nor did they have foreknowledge that N.P.s condition would become so unmanageable so quickly ( somewhat different from your restatement as having every reason to know that NP's situation was unmanageable). There's no mention of their feelings on doing apnoea tests in the transcript, but Dr Marsh asserts the angiogram carried out on the 3rd confirmed she was brain dead, and there's no indication in the transcript that inevitability (at least as regards the future of the unborn child) was a predominant feature of Doctors thinking on the 3rd; even on the 17th a tracheostomy operation was carried out in an attempt to attain foetal viability. I'd regard that as evidence that even by the 17th the Doctors thought they could attain foetal viability, would you not?

"I can come to it because there is nothing to show that they did have the evidence presented by the expert witnesses in Court at the time they were making the decision to place the corpse of N.P. on somatic support"

See above, also, there is nothing to show they didn't, and being responsible clinicians, they most likely would have made it their business to educate themselves if they felt there was a significant gap in their knowledge. In any case, the information they would have found would have been of limited significance to the case in front of them.

"nor did they have foreknowledge that N.P.s condition would become so unmanageable so quickly ( somewhat different from your restatement as having every reason to know that NP's situation was unmanageable)"

They had every reason to know that NP's situation was unmanageable! A brain dead patient with an open wound to the brain and an absence of blood flow. By Dec 3rd, even if infection was not apparent, although I would expect it would be, the area would have been obviously necrotic. The progress to deep seated infection that is essentially untreatable is inevitable. Generalised sepsis will follow, which inevitably lead to somatic death, or PROM and preterm labour.

"and there's no indication in the transcript that inevitability (at least as regards the future of the unborn child) was a predominant feature of Doctors thinking on the 3rd"

Well, apart from the fact that there was no recommendation to the family that support should be continued in an effort to attain a live delivery, in fact the reported conversation was to the effect that the doctors wanted to comply with the family's wishes but were constrained only by legal and not ethical or medical ones.

"even on the 17th a tracheostomy operation was carried out in an attempt to attain foetal viability. I'd regard that as evidence that even by the 17th the Doctors thought they could attain foetal viability, would you not?"

No, I wouldn't. A tracheostomy is fairly standard for any patient who is being ventilated for anything other than a very short period. The idea that doctors though they could attain viability on the 17th - 5 days before the clinical reports presented in court were written - is ridiculous.

Absolam wrote: »

Whether or not Doctors may choose to use the literature to draw conclusions with any kind of what they think is statistical power, or even simply use what they can learn from the literature to try and make decisions that may increase the possibility of viability of unborn children in similar circumstances, I can't say; I'm not one of them.

I don't think anyone thought you might be:rolleyes:

Absolam wrote: »

so Doctors may, at their discretion, decide to withdraw somatic support whether the patient is born, or unborn (Re A (A Minor) [1993] 1 Med L Rev 98).

I'm not sure what brought you to this conclusion. And the recent enactment of the Assisted Decision-Making (Capacity) Act 2015 would seem to refute that view.

"(b) Where a directive-maker lacks capacity and is pregnant and her advance healthcare directive sets out a specific refusal of treatment that is to apply even if she were pregnant, and it is considered by the healthcare professional concerned
that the refusal of treatment would have a deleterious effect on the unborn, an application shall be made to the High Court to determine whether or not the refusal of treatment should apply."

wokingvoter

Cabaal wrote: »

I'd imagine many people in the rest of the UK are surprised and disgusted with the sentence handed down to this women in Norther Ireland, http://www.bbc.com/news/uk-northern-ireland-35962134

Woman who bought drugs online to terminate pregnancy given suspended sentence

She was left with little choice due to her financial circumstances and the backwards laws that exist in Northern Ireland,

Personally I'd like to see the "pro-life" lobby for prosecutions to happen in Ireland like this,
In addition I'd like to see them lobby to ban pregnant women traveling for abortion. But they won't, because they are scared of the one thing I want to see happening in Ireland, that such cases and bans will finally lead to a referendum and no before time.

Until then they'll claim Ireland is abortion free while being totally happy and content with exporting abortions and doing nothing to stop these abortions, the same as basically all so called "pro-lifers". It seems they can't even stand up for what they believe in.
:rolleyes:

It's terrifying type think that my daughter could go online and buy drugs to induce an abortion.
Absolutely anything could have happened to that girl once she took those tablets.
Throwing the aborted baby in the bin afterwards, knowing that it would attract the attention of flat mates, when she could have so easily disposed of it more discreetly, would indicate that she is a very vulnerable person who hopefully now will get some counselling for what I would imagine are many many issues she is dealing with in her life.

ProfessorPlum wrote: »

"So they were similar enough to be grouped together in the transcript." It was a review of case literature <...> and of course you therefore can't be expected to see that one simply can place no significance on any statistic you have arrived at.

Luckily I wasn't looking to persuade anyone they should attach any significance to the study; it was Dr Marsh testifying to the High Court who was doing that. Which demonstrates (as I said) that there was some consideration being given to just how likely survival might be, not that it was a foregone conclusion.

ProfessorPlum wrote: »

Regardless of weather they did or didn't (and it would be usual for clinicians faced with unusual cases that they might not be familiar with to do a bit of research), the evidence would have been of limited use, as the case in front of them was significantly complicated by an open wound to the brain and a lack of blood flow to the brain.

I must admit, I didn't notice anything in the transcript about an open wound to the brain, just one to the head (or skull, depending on which of the mentions you choose)? Still, regardless as you say, given there's no evidence they had the extragavance of later evidence, and that N.P.s wound had not progressed quite so much, I still can't see any real reason to think any of the Doctors involved knew from the outset that there was no hope of saving the child. Or even that they thought so.

ProfessorPlum wrote: »

See above, also, there is nothing to show they didn't, and being responsible clinicians, they most likely would have made it their business to educate themselves if they felt there was a significant gap in their knowledge. In any case, the information they would have found would have been of limited significance to the case in front of them.

I suppose see above as well so.

ProfessorPlum wrote: »

They had every reason to know that NP's situation was unmanageable! A brain dead patient with an open wound to the brain and an absence of blood flow. By Dec 3rd, even if infection was not apparent, although I would expect it would be, the area would have been obviously necrotic. The progress to deep seated infection that is essentially untreatable is inevitable. Generalised sepsis will follow, which inevitably lead to somatic death, or PROM and preterm labour.

I see that open brain wound re-appearing there! But to cut to the chase; you don't know what they knew. We can both speculate about what we think they might have, or even ought to have, known, but you don't know, no more than I do. The Doctors certainly knew by the time the court case concluded, but on the 3rd of December, I think it seems unlikely they knew it would become so.

ProfessorPlum wrote: »

Well, apart from the fact that there was no recommendation to the family that support should be continued in an effort to attain a live delivery, in fact the reported conversation was to the effect that the doctors wanted to comply with the family's wishes but were constrained only by legal and not ethical or medical ones.

Hmm. Well, there is the fact that in the transcript it says "The plaintiff was advised by the medical staff at the hospital that it was intended to maintain this regime of treatment for the duration of the pregnancy of N.P." which would indicate (at least) that they intended to maintain the pregnancy. And obviously after that, as I pointed out before, it says that "On the 17th December, 2014 a tracheostomy operation was carried out on N.P. to facilitate the continuation of maternal organ supportive measures in an attempt to attain foetal viability." which to me indicates they thought they could attain foetal viability. Now I know; you say it means no such thing, as a trachoestomy is standard for any patient who is being ventilated for anything other than a very short period. So at least you agree there was an intention to provide ventilation for more than a very short period. That you directly refute the statement (an attempt to attain foetal viability) in the transcript is not something that I think I need argue I'm afraid; I'm sure you'll understand that I'd prefer the testimony entered into the Court record over your own version of what happened at the time?

ProfessorPlum wrote: »

I don't think anyone thought you might be:rolleyes:

Glad to see you're still keeping those eyes firmly on the bigger picture

ProfessorPlum wrote: »

I'm not sure what brought you to this conclusion. And the recent enactment of the Assisted Decision-Making (Capacity) Act 2015 would seem to refute that view.

Well, the recent legislation obviously happened quite some time after the Courts provided the judgments that led me to that conclusion, but still I came to the conclusion from reading this:
"The Court is therefore satisfied, in the circumstances of this case, that, in the best interest of the unborn child, it should authorise at the discretion of the medical team the withdrawal of ongoing somatic support being provided for N.P. in this tragic and unfortunate case."
and this
"It would be wholly contrary to the interests of A., as they may now be, for his body to be subjected to the continuing indignity to which it was currently subject"
Still, when I read this: ""(b) Where a directive-maker lacks capacity and is pregnant and her advance healthcare directive sets out a specific refusal of treatment that is to apply even if she were pregnant, and it is considered by the healthcare professional concerned that the refusal of treatment would have a deleterious effect on the unborn, an application shall be made to the High Court to determine whether or not the refusal of treatment should apply." I think of the ruling in the case we've been discussing, which said that ' in the best interest of the unborn child, the Court should authorise at the discretion of the medical team the withdrawal of ongoing somatic support. The Assisted Decision-Making (Capacity) Act might have said 'a deleterious effect on the health of the unborn', but it doesn't, it says 'a deleterious effect on the unborn'. I'd suggest that an act that is in the best interest of the unborn child is not at act that has a deleterious effect on the unborn child. I imagine a Court will have an opportunity to rule on the notion at some stage.