Friday 15 December 2017

Julia Molony: Can 'brutal' removal of baby be justified?

We must wait to judge this seemingly barbaric case until the full facts are known

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Julia Molony

On first reading, it sounds like an act of unthinkable barbarism by the British state against a vulnerable woman in its care.

In 2012, an Italian woman travelled to the UK to take part in a Ryanair training course. She was pregnant, and suffered from a previously diagnosed psychiatric condition – she had bipolar disorder. She had stopped taking her medication because of a concern about how the drugs might affect the foetus. As a result, she suffered a relapse of her symptoms while staying in a hotel in Essex, described in the newspapers as a "panic attack". She was sectioned.

Five weeks later, having applied for and received a court order, her medical team sedated her and delivered her child by Caesarean section against her will. The child was taken into care and promptly adopted.

One human rights group has declared the case "the stuff of nightmares", which, on the face of it, sounds fair. As a narrative, this taps into a deep, profound fear that exists in all of us, and not least those of us who have had brushes with psychological distress. The horror of having your autonomy taken away and your judgement discredited. To be powerless to protest as a malign authority holds you prisoner, invades your body, or takes away your child, is a fear regularly invoked to great effect in fiction.

What's more, this sort of thing is not just the stuff of fiction. It's happened in recent memory. In the Forties, up to 1,000 psychiatric parents a year were treated with lobotomies in the UK. Even more recently, in Ireland, women were forced to submit their newborn babies for adoption at the behest of religious organisations with the tacit support of the State. "For your own good" has long been the justification behind many of the worst atrocities conducted by authorities.

With that in mind, it's hard for most of us to imagine a circumstance under which it could ever be justifiable for a pregnant woman to be sedated so that her child might forcibly be removed from her womb. But despite what we might imagine, the fact is that those circumstances, in extremis, do exist.

If someone is in the grip of a psychotic episode they could legitimately be deemed unable to consent to surgery. The woman in this case had two previous deliveries by Caesarean section, a known complicating factor that could, potentially, make a vaginal delivery more difficult or, in some cases, impossible. We don't know the exact circumstances here, but we do know that the decision to perform the operation itself was a purely medical one, taken by the NHS, not the social services in charge of her case. If, as has been claimed, she was suffering "very intrusive paranoid delusions", it's plausible that she was in an urgent medical situation, and unable to comprehend or respond appropriately. If this woman had been allowed, while temporarily beside herself, to refuse a necessary medical intervention that resulted in physical injury or death, where would the liability fall? Once back on her meds, how might she (or her family) feel?

We don't know yet for sure if that was the case. The NHS authority that sanctioned the operation insists that this intervention, though brutal, was necessary. The woman's lawyer disagrees. "The woman . . . was perfectly cognisant. She was responding to questions," he has said.

More contentious still was the decision, by social services this time, not the doctors, to take away the woman's newborn daughter and have her adopted. In defence of this decision, Essex County Council insists, "the mother was too unwell to care for her child . . . Historically, the mother has two other children, who she is unable to care for due to orders made by the Italian authorities."

Is this a real-life One Flew Over the Cuckoo's Nest and Philomena rolled into one? In cases like this, in which nuanced and complex ethical considerations must be taken into account, it's essential that we park our horror-story narratives and fears until we are in full possession of the facts.

At the moment, disturbing high-handedness on the part of the social services seems likely, but remains unconfirmed. And a number of disquieting questions remain. Why was the patient's daughter adopted so quickly? Why was she bundled back to Italy straight away? Bipolar disorder is a fluctuating illness and the woman has apparently since been successfully treated. Why were greater efforts not made to aid her recovery?

It is completely appropriate, indeed necessary, that these kinds of interventions by the State should be subject to intense public scrutiny. We can, and should, demand greater transparency around cases such as these, which pass through the family courts. But we can't legitimately call for the heads of those in charge until we have a clearer view.

Sunday Independent

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