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Tag Archives: treatment

In day to day conversations and on Facebook I’ve been avoiding speculation and talking instead about a range of possibilities as to what could have gone so wrong in Galway University hospital which has an excellent record. It is however time now to speculate for a very good reason.

Speculation on the events leading to the death of Savita Halappanavar has for some time now been fuelling arguments for and against the enactment of legislation – as recommended by the Supreme Court a full two decades ago – to regulate and clarify the Irish constitutional position: that an abortion is permissible to protect the life of the mother. It needs to be emphasised that the only circumstance in which this young woman’s death has relevance to the debate on the need to move on such legislation is if there is any scenario in which the medical staff weighed the baby’s life against the mother’s and favoured the baby.

The reason I am about to speculate is that the most likely happenings in Galway are being ignored in favour of accounts which can be used to engage in the current debate. However, the most likely account has enormous significance for the abortion debate beyond the rare cases of risk to a mother’s life but a long way short of anything that could be described as liberal abortion law, never mind abortion on demand.

Incidentally, while I’m attracted in principle to the view that there should be no speculation and therefore no debate until an enquiry has established the facts of what happened, in practice holding such a line was never possible and is completely irrelevant now after weeks of comment.

The following is most likely what happened. I can only assume that it is ignored by media because it is irrelevant to the current spectacular row over the need for legislation to protect the life of a mother.

The death of Mrs. Halappanavar was the first maternal death at Galway University Hospital in 17 years. [i] We are not, therefore, talking about a hospital with a poor record. Moreover, despite all the allegations about “Catholic country” comments and missing notes – both of which need thorough investigation – it doesn’t seem remotely likely that the hospital staff were unaware of the legal or Catholic church position but for some unexplained reason decided to favour the baby’s life over the mother’s life. On the contrary it is, I think, safe to assume that the staff involved were caring, experienced and familiar with law and Catholic doctrine.

It is virtually certain that if at any moment from her first entering the hospital, it became clear that Mrs. Halappanavar’s life was in danger, these staff would have performed an abortion. So what happened? Here is the most likely explanation.

Mrs. Halappanavar was miscarrying, i.e. the baby at that age was doomed to die. However, Mrs. Halappanavar was not yet in mortal danger and there were no indications that she might die. Because, Catholic teaching and Irish law give an equal right to life to mother and to baby until the mother’s life is threatened, an unfortunate baby with just a short time to live would be monitored and allowed to die naturally. A mother’s distress, discomfort or illness would be irrelevant. Threat to life is the sole criterion for legal abortion in Ireland.

The truth that Irish media have been neglecting is that Mrs. Halappanavar’s treatment and death have very likely got nothing whatsoever to do with clarifying a mother’s superior right to life when her life is threatened but a great deal to do with the treatment/management of miscarriage. The position in Ireland is that abortion is not a permissible part of that treatment/management.

I’ve no information on how often abortion might be considered in the treatment of miscarriage but it does seem to be an issue for Catholic hospitals outside Ireland.

“The experiences of physicians in our study indicate that uterine evacuation may not be approved during miscarriage by the hospital ethics committee if foetal heart tones are present and the pregnant woman is not yet ill, in effect delaying care until foetal heart tones cease, the pregnant woman becomes ill, or the patient is transported to a non–Catholic-owned facility for the procedure.”[ii]

If in Ireland we are using the death of a young woman to inform or fuel an important public controversy, it is vital that the full controversy be aired or that the relevant controversy be aired or at the very least that the relevant controversy not be ignored.


[ii] Freedman, L.R. et al “When There’s a Heartbeat: Miscarriage Management in Catholic-Owned Hospitals” in American Journal of Public Health. 2008 October; 98(10): 1774–1778. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2636458/

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Paul O’Donoghue, writing in the Irish Times on Sept. 9th http://www.irishtimes.com/newspaper/sciencetoday/2010/0909/1224278501793.html , draws attention to the minor scandal that is wasting health insurance on silliness. I too have been exercised about this. Quite some time ago I complained to the VHI. My point essentially is that medical insurers, in paying for reflexology and the like, are saying one of two things: that these practices are medical treatments within the meaning of the Act, or that medical insurers can pay out for anything they wish. Moreover, VHI approval confers status – a degree of official medical approval which these practitioners crave.

VHI assured me that their decision to pay conferred no recognition that reflexology etc. were medical treatments. The decision to pay was determined solely by competition. In other words, if there is a competitive advantage in listing a practice for payment, it could happen; medical and scientific considerations are irrelevant.

Given that VHI is one operator in a market, I was sympathetic to their position and turned my attention to the regulator, The Health Insurance Authority. My point was essentially unchanged. If the Regulator, as guardian of the Acts, allows payment to be made for Reflexology and the like, the Regulator defines them as medical treatments. Response was swift and brief: the VHI and others were acting legally but this did not mean that the Regulator accepted that reflexology etc. were medical treatments. I tried many times to point out that unless the Regulator had a compelling argument, this is precisely what the decision meant. The thinking behind the Regulator’s decision was withheld and I had to change tack.

I asked for the matter to be put to the Authority, the board, for their consideration. I had been testing this form of citizen initiative for some time and to the credit of the HIA, I received full and friendly cooperation. I was aware that no one on the Authority had a medical or science background and assumed that there would be delay as they sought professional advice.

It would appear that the advice sought was legal and the advice – accepted by the HIA – is that health insurers can pay for reflexology etc. as long as they first provide adequate medical cover under the “Minimum Benefits Regulations”. This brings me back to where I started. If this stands, “medical treatment” in the Act is either meaningless or can be ignored once basic provision has been established. This produces a bizarre outcome whereby a health insurer can pay for reiki, Hopi ear-candling or indeed replacement windows!

It is clear that the intention of the legislation was to confine payment to medical treatments. It is equally clear that the intention of later minimum-benefit regulation was certainly not to permit payments for other than medical treatments. It is clear too that VHI do not consider reflexology a medical treatment. It is the HIA’s position, supported by legal advice, that control can be exercised over only “prescribed minimum benefits”. Beyond these, health insurers are not limited to making payments for medical treatments only and the HIA accepts no role in determining what is or is not included in a health insurance contract.

The basic problem remains. Payment by a medical insurer IS recognition that something is a medical treatment. It is more than a matter of practitioners having access to insurance funds; it is about official sanction. Uncomfortable or not, health insurers and the HIA are effectively a part of the medical establishment.