Monday 22 December 2014

David Quinn: Even without legislation, we’re going to have more abortions in Irish hospitals

Published 26/04/2013 | 17:00

Dr Peter Boylan: highly intelligent

DR PETER Boylan is a most proficient advocate on behalf of those who want to see X-Case style abortion legislation passed in Ireland.

He is obviously highly intelligent and he has about him an air of infallibility that is hard to challenge and would make a Pope blush.

In debates he is also very quick to pull rank and to subtly, and often not so subtly, belittle his opponents. He even tried that on with another very senior doctor on 'Prime Time' last week, namely Professor John Bonnar.

In addition, he benefits from the inestimable advantage of never having to fear being asked a tough question by a presenter.

For example, listening to him on various programmes it isn't entirely clear to me whether or not he wants Irish law to go further than the X Case.

That case allows doctors to end a pregnancy when there is a "real" and "substantial" risk to the life of the mother. In addition it allows a pregnancy to be ended when a woman is suicidal although there is always an alternative to abortion in such cases.

But Dr Boylan's complaint in respect of the Savita Halappanavar case seems to be that the X Case doesn't allow doctors to intervene early enough, that is, before there is a real and substantial risk to the life of the mother. That would obviously mean we would have to introduce a law that would allow for a more permissive regime than the X Case permits.

So under exactly what circumstances does Dr Boylan want doctors to be able to perform abortions in Irish hospitals?

Does he think they should be allowed to end a pregnancy when there is simply a possibility that a real and substantial risk will develop? Would a presenter somewhere, sometime, please ask him?

We hear complaints that words like "real" and "substantial" are imprecise. But pick any words and you will find some level of imprecision. That is inherent to medicine.

So does Dr Boylan want the law to permit doctors to conduct abortions where there is only a small risk to a mother's life? How small should that risk be?

Dr Boylan in his omniscience probably has a precise answer. So let's hear it. Or have I missed it?

What worries me post-Savita is that we are going to end up with a medical and legal regime in this country that might not save a single additional pregnant woman but might result in the unnecessary deaths of a lot more unborn children.

The tragic and horrible death of Savita Halappanavar was exceptionally rare.

Dr Boylan believes that if the doctors had not been hamstrung by our law (as he sees it), then her medical team could have terminated her pregnancy at an earlier stage and her life would have been saved.

But a group of obstetricians wrote to the Oireachtas health committee a few weeks ago saying they did not think a change to our abortion law is necessary.

Unfortunately, the committee chose not to hear from a single member of this group, nor for that matter did the Savita Halappanavar inquest.

The inquest itself returned a verdict of "medical misadventure" and it recommended clearer medical guidelines around when a termination can and cannot be performed.

However, its remaining eight recommendations concerned themselves mostly with the host of missed warning signs of a developing and deadly infection.

Post Dr Boylan's appearance before the inquest and his various subsequent media appearances, virtually all of the media's attention has shifted back to the law and away from the need to introduce better infection-management systems to Irish hospitals. This won't help pregnant women.

We need to remind ourselves that while deaths from sepsis are exceptionally rare, they do happen. Six years ago Tania McCabe died as a result of sepsis. She was admitted to hospital seriously ill and six months pregnant. Her twin babies were delivered by medical staff as part of her treatment and one died. Tania herself died shortly afterwards from septic poisoning.

However, no-one has ever suggested that our law on abortion contributed to her tragic death.

In Britain, which to all intents and purposes has abortion on demand, there are also deaths from sepsis in pregnancy and in almost every case the signs of developing sepsis are missed.

It is therefore glaringly obvious that medical staff need to become a lot better at spotting when sepsis is developing and learning to stop it in its tracks.

What really worries me about the Savita Halappanavar debate is that even without the X-Case legislation planned by the government, let alone a more permissive regime still, we are going to have more abortions in Irish hospitals no matter what.

Post-Savita will our doctors now recommend abortions much more frequently when faced with potentially life-threatening pregnancies out of fear of legal action or a very public inquest?

Despite the Savita case, our hospitals have an excellent track record at saving both mothers and their babies when severe complications arise in pregnancy.

Our maternal death rate is half Britain's despite the fact that Britain has what amounts to abortion-on-demand.

It is open to debate whether a more permissive abortion regime will save the life of a single woman.

What is not in doubt is that it will lead to the death of a lot more unborn children. That would be a massive step backwards from where we are now.

We should not take it.

Irish Independent

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