The Savita Inquest

Last week in Ireland, the official inquest into the death of Savita Halappanavar began with several days of testimony.

So far, nothing has altered the basic sequence of events as we know them. Savita arrived at Galway University Hospital in October 2012, 17 weeks pregnant, with ruptured membranes and a dilated cervix, clear signs that a miscarriage was beginning. As ob/gyn Dr. Jen Gunter has said, “Her presentation should not have posed a diagnostic dilemma, not even for an intern.” An open cervix leaves a woman at grave risk of chorioamnionitis, a serious infection. The standard treatment is immediate delivery, regardless of the fetus’ viability, and antibiotics.

Knowing her pregnancy was doomed, Savita asked for an abortion to get it over with. But the hospital staff refused, saying that Ireland was a “Catholic country” and that the law forbade them to act as long as there was a detectable fetal heartbeat. (The hospital obstetrician, Dr. Katherine Astbury, said that her only option was to “sit and wait“). Savita and her husband Praveen waited for several agonizing days. Finally the dead fetus was delivered, but it was too late. She had developed septicemia, an infection of the bloodstream, which led to multiple organ failure and death from sepsis.

A few appalling new details did emerge, like these remarkss from Dr. Astbury on cross-examination (reported on Twitter by Galway Independent editor Marie Madden):

So, at least according to Savita’s doctor, the Irish law forbids abortion unless there’s literally a 51% or greater chance that the woman will die without one, and since Savita had only – “only” – a 16% chance of death from sepsis, there was nothing they could do. It should go without saying that, by the time a woman is so sick that she has a more than 1-in-2 chance of dying, an abortion is probably going to be too late to do any good!

Irish pro-life groups, like this one, have tried to distort the issue by arguing that the hospital’s only error was their failure to diagnose and treat sepsis in time. But this is an obvious falsehood: the most probable reason Savita got that infection was because the hospital refused her request for an abortion, leaving open a window of days during which she was vulnerable to infection as the miscarriage dragged on. Again to quote Dr. Gunter: “Standard of care is not to wait until a woman is sick enough to need a termination, the idea is to treat her, you know, before she gets sick enough.”

I suspect what’s going to happen is that the inquest will throw Savita’s doctors under the bus, taking the anti-choice line and blaming them for not being able to pull her back from the brink once the miscarriage had progressed to septicemia. In fact, the blame rightfully belongs to Irish law, which doesn’t clearly permit abortion in a case like this and therefore encourages the kind of uncertainty and delay that killed Savita.

This isn’t just a lesson for Ireland, but every country, “Catholic” or not, where the law bends to religious dogma: if abortion is allowed only in case of a clear and serious risk to life or health, it has the perverse effect of tying doctors’ hands until the woman is at death’s door. If the law isn’t reformed, the odds are that more women will die, and every one of those deaths will be as senseless and unnecessary as Savita’s was.

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