OF Medicine,A dying mother and PREJUDICE ~ The Analyst

The Case

“Two investigations are under way into the death of a woman who was 17 weeks pregnant, at University Hospital Galway last month. Savita Halappanavar (31), a dentist, presented with back pain at the hospital on October 21st, was found to be miscarrying, and died of septicemia a week later… Ms Halappanavar asked for a medical termination. This was refused, he (Praveen Halappanavar, her husband) says, because the fetal heartbeat was still present and they were told, ‘this is a Catholic country’.” Despite knowing that,“the cervix was fully dilated, amniotic fluid was leaking and unfortunately the baby wouldn't survive.”, The Irish Times reports. In short, as it appears in The Telegraph, “A woman died after she was refused an abortion at an Irish hospital whilst undergoing a miscarriage”.

The Law

The medical consultant said “it was the law, that this is a Catholic country.” But the reality is, in Ireland, a woman has a legal right to an abortion where there is a ‘real and substantial’ risk to her life… writes Sally Peck (The Telegraph 3:44PM GMT 14 Nov 2012)

Reflection is there in ToI report on 17Nov 2012 , “Ireland law provides for abortion, say legal eagles ”

The Therapeutic Guideline

T.N.A.Jeffocate, M.D., F.R.C.S.Ed., F.R.C.O.G wrote in the indubitable article published in the BMJ, abortion is permitted but “It has to be shown that the continuance of the pregnancy will be more harmful than therapeutic abortion.”

Clinically evident intra-amniotic infection is among the CONTRAINDICATIONS TO EXPECTANT MANAGEMENT (surveillant maintenance of pregnancy) OF PPROM (Preterm Premature Rupture of Membranes, clinical term for what happened to the unfortunate Savita) as writes Dr Carol L. Archie in 'Lippincott's Obstetrics Case-Based Review'.

The other way out is to deliver the uterine contents as soon as possible, whether living or dead. I don’t know a pediatrician who hopes that a 17 weeks fetus would survive even, the record minimum age of viability of a fetus being 180 days.

United Health care guideline, Oxford cited ‘Infection of amniotic cavity, antepartum’ as an indication of therapeutic abortion beyond a shadow of a doubt.

The list grows longer…

Whatever it is, the Irish obstetricians believe that ABORTION IS NEVER MEDICALLY NECESSARY. The Sept. 8, 2012 press release by the symposium organizers presented the conclusions contained in the Dublin Declaration on Maternal Healthcare, which states:

“-- As experienced practitioners and researchers in obstetrics and gynecology, we affirm that direct abortion is not medically necessary to save the life of a woman.

-- We confirm that the prohibition of abortion does not affect, in any way, the availability of optimal care to pregnant women.”

These owlish experts seem quite correct, no?

The ‘should have been’

The Indian National Commission of Women Chairperson Mamta Sharma told reporters that Ireland should have rules to deal with cases like that of Savita. Everybody is now reverberating the same, starting from Enda Kenny, the Taoiseach, the Irish youth, as did Ireland’s Supreme Court in 1992.

But it is not only a matter of moral obligation, recommendation of some society or the laws even… let us have a look on how the incident violates a doctor’s oath.

The oath

Extracting from The Declaration of Geneva:

The health and life of my patient will be my first consideration.
I will not permit considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patient.

“I will NOT give to a woman an abortive remedy.” Tells the Hippocratic Oath, which was amended to “I will maintain the utmost respect for human life, from the time of its conception, even under threat, I will not use my medical knowledge contrary to the laws of humanity” and “Most especially must I tread with care in matters of life and death. If it is given to me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty.” The omen is clear from this loosening of stringency.

The Modern version of Hippocratic Oath (Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.), as currently amended, reads:

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of over-treatment and therapeutic nihilism.
I will prevent disease whenever I can, for prevention is preferable to cure. (Surely enough, the abject could be deflected.)

I think it clearly elucidates what was the expected conduct of the doctor under the circumstance.

Of prejudice

Faith at its very worst, manifested by a dogmatic reluctance to take action - that is what slaughtered the poor Savita in a hostile land far away from her home. Anti-abortion chauvinism is surely not the only one in the list of prejudices that are very much intertwined with orthodox Christianity despite being fatal to humanity. For instance some Christians still believe that women are second to men, that men should lead and women should follow (as 1 Timothy 2:8–15), reports BBC , trusting the words of St Paul :

It is disgraceful for a woman to speak in the church.

(1 Corinthians 14:34-35)

If a woman does not cover her head, she should have her hair cut off; and if it is a disgrace for a woman to have her hair cut or shaved off, she should cover her head. A man ought not to cover his head, since he is the image and glory of God; but the woman is the glory of man.

(1 Corinthians 11:3-7)

Participants subliminally primed with Christian words displayed more covert racial prejudice against African-Americans (Study 1) and more general negative affect toward African-Americans (Study 2) than did persons primed with neutral words, a study by Megan K. Johnson, Wade C. Rowatt,and Jordan LaBouff reveals, echoing Gordon Allport who more than 55 years ago pointed out that ,

"on the average, churchgoers are more intolerant than non-churchgoers." A dozen years later Andrew Greeley noted: "The research findings on the connection between religion and prejudice are over whelming." Morerecently, Daniel Batson and Larry Ventis have concluded: "At least forWhite, middle-class Christians, religion is not associated with increased loveand acceptance but with increased intolerance, prejudice, and bigotry."

This author does not mean to aver that we, the pre-historic oriental jungle-dwellers, are clean-chits and they (the enlightened) don’t just have right to point a finger at us. My opinion is we are transcending our bias in the same meaning as they are (like in 2000, Pope John Paul II issued a formal apology for all the mistakes committed by some Catholics in the last 2,000 years of the Catholic Church's history, including the trial of Galileo among others), and they have better business to mean than pick holes in the eastern customs and tradition. The benefit always lies in self-criticism!