Savita’s tragic death could have been avoided – UPDATED

Because I am very nearly burned out, to the point where yesterday I wondered if I should take a blogging moratorium, I shut down the computer rather early and missed this story as it was building.

Well, how dare I? This morning a couple of emails greeted me, all variations on this theme: “hey you &^$%$ pro-life hypocrite and your ^#$%^ church and your ^%$#$%^ Christ, why aren’t you writing about this story and see how you’ve ^$#%#%-ed-up lives and &$%#%@)*^ Ireland! %^$#@ Catholics! Justice for Savita! End &^$%# Rome!”

Around the same time, I noticed in my feed that Father Dwight Longenecker was writing about Savita Halappanavar, so clearly it was time to come up to speed with a story, and it is — make no mistake — a disturbing and tragic one.

Quite rightly an investigation is being launched into what happened and why this young woman is dead, but the facts as they stand presently are these:

1) A beautiful, vibrant 31 year-old dentist, Savita Halappanavar, at 17 weeks pregnant, began experiencing pain and symptoms that convinced her her baby was in trouble. After first being turned away, she was admitted to a Galway hospital where it was determined that she was miscarrying the child.

2) In terrible pain, Savita and her husband requested that delivery be induced.

3) Next:

“They said unfortunately she can’t because it’s a Catholic country,” Mr Halappanavar said. “Savita said to her she is not Catholic, she is Hindu, and why impose the law on her.

“But she said ‘I’m sorry, unfortunately it’s a Catholic country’ and it’s the law that they can’t abort when the foetus is live.”

4) And finally:

But she began vomiting and shivering uncontrollably on Tuesday night, more than 48 hours after she first arriving at hospital, and her baby died the following day.

After an operation to remove the dead foetus, she was taken to intensive care and died four days later on Sunday 28 October of organ failure.

A post-mortem examination found she had septicaemia, a form of blood poisoning, and an E.coli infection.

Okay, this is an awful story; it’s a tragedy and a painful read. No one likes to hear of a young couple, with a splendid future before them, going through this. But having read half-a-dozen reports, I suspect this would have ended an awful story even if Savita had been induced, because of what appears to be a case of medical negligence.

The post-mortem on Savita determined that the cause of death was “septicaemia, a form of blood poisoning, and an E.coli infection.”

I don’t know what is common to Ireland, but my personal experience with miscarriage here in the US is that when a patient is admitted, and while a course of action is being determined, a saline drip is begun and — as a standard procedure — a CBC is ordered to, among other things, take a look at white blood cell counts and see if something else is going on that might be precipitating the miscarriage. A case of E.coli could certainly threaten a pregnancy. So, before we even get to the abortion issue, there are some questions that must be answered:

1) Did Savita present with a fever, even a low-grade fever? Or did one develop while she was in hospital?

2) If so, was a blood count done? Was a course of antibiotics begun? If there was sign of infection and no obvious source, was a blood culture ordered to help identify the bacteria? Was the fever simply shrugged off as part of her miscarriage?

3) If she did not present with fever when did it begin? Septicemia takes time to build, but she was in hospital for some days. Did the fever develop after her internal examinations and were they done with scrubbed hands/fresh gloves and instruments? Did it develop before or after the procedure to remove the dead fetus?

4) Answers to these questions are absolutely necessary; the source of the infection, the length of time she endured it and whether or not she was treated for it at all must be known. Let’s have the Morbidity and Mortality report. These questions are ultimately more relevant to Savita’s death than the abortion issue because if her infection was not being treated, she may well have died even if she had been induced.

On to the abortion part of the story, which is being seized upon and exploited by the usual suspects in a predictable attempt to indict the church’s teaching on the subject. We read that Savita and her husband were told they could not induce Savita’s labor because “this is a Catholic country.”

To which only two words can be said: Hogwash and Hogwash.

… if, for example, the saving of the life of the future mother, independently of her pregnant condition, should urgently require a surgical act or other therapeutic treatment which would have as an accessory consequence, in no way desired nor intended, but inevitable, the death of the fetus, such an act could no longer be called a direct attempt on an innocent life. Under these conditions the operation can be lawful, like other similar medical interventions – granted always that a good of high worth is concerned, such as life, and that it is not possible to postpone the operation until after the birth of the child, nor to have recourse to other efficacious remedies.”

Even if you are not well-versed on Catholic teaching, as apparently whoever spoke to the Halappanavars was not, just thinking this one through — if people do that, anymore — should have answered the question. Inducing the delivery of a baby at 17 weeks would likely insure its death (I believe the earliest gestation stage to survive is about 21 weeks) but unlike a dilation and curettage, which destroys the baby in utero (and which would not have been performed at 17 weeks, regardless) an induced delivery still allowed for the longshot of a live delivery — it still would allow for God’s determining hand in this life.

Some may (undoubtedly will) argue (and please do correct me if I am wrong, churchfolk), but my understanding of Catholic teaching is that this inducement could have been performed, and whoever told Savita and her husband that what they were asking for was impossible because of the “Catholic country” frankly did not know what he or she was talking about.

As I say, however, there is no guarantee that an inducement would have saved Savita, if there was an infection that was going unaddressed, in fact the physical stresses involved in delivering the baby after inducement might have sped the infection along.

At the crux of this death and why it happened, are questions about this Galway hospital’s policies and procedures, and whether medical negligence was a contributing factor. I suspect it very much was.

Abortion is an emotional issue; people on both sides go from silence-to-stridency in a heartbeat, but this story should not be running on the cheap fumes of hatred, emotionalism, sentimentalism and political opportunism. A young woman is dead; her young husband is grieved. Let’s actually find out what actually caused her death. I am willing to bet it was something other than her dying fetus and the poorly understood teachings of that “miserable ^%$$^& Catholic church”. The medical circumstances should not be discarded for the emotional catharsis of a good scream.

Yesterday we wondered whether Dorothy Day might not be a good Patron for post-abortive women, or perhaps an excellent Patron for Sanity in all of these life and “justice” questions. I think I will ask the Servant of God to pray for wisdom, light and clarity on this issue.

UPDATE: In the body of the above text I wanted to add, but was unsure of my facts, “Was the source of infection a fully-dilated cervix and leaking amniotic fluid going unaddressed?” Digital hairshirt quotes some unnamed source from Reddit, who makes a few educated guesses, but clearly, more information about this infection and treatment is needed.

UPDATE II: From The Thirsty Gargoyle: “It’s been pointed out to me that according to the reports, Savita was admitted to hospital with a miscarriage underway, her cervix being open from Sunday, but that antibiotics were only brought into play on Tuesday night, a full two days later; it’s as though she spent two days there with an open wound. Again, I’m no doctor and would appreciate if someone could clarify this, but given that this was a case of death from infection, it seems to me to have been utterly egregious medical negligence from the start, and nothing whatsoever to do with the law, medical guidelines, or religious principles.”

UPDATE III: People keep sending me this link spelling out Ireland’s abortion laws. It’s worth reading, and I had already linked to it in the text of the post — it’s the second “hogwash.”

About Elizabeth Scalia
  • Dad of Six

    You are right…there seems to be a real lack of facts in the story. One could also make it into a case of how poor socialized medicine is.

    [My understanding is that Ireland has a very good record on this sort of thing, in general, better than the US -admin]

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  • Adam

    The cynic in me says that this is one of those stories where the narrative will trump the facts–it’ll become a well-known malfesance of pro-life Catholics regardless of what really happened. This will also further push the unspoken non-sequitur argument: abortion in cases of rape/incest/life of the mother should be legal; therefore, all abortion should be legal.

    I lived in Galway over a decade ago and had the pleasure of meeting their local pro-life group. The impression I got from them was that Ireland was always 10 years behind America in terms of social decline: while divorce was pretty common in the U.S. by the 1990s, Ireland was only beginning to reach our levels. I don’t know if that means that Ireland is a shining example for us on conservative values, or if America is a sad vision of where Ireland is going. Pray for those folks: their branch of the Catholic Church is under plenty of attack as well, and this story will undoubtedly add to their woes.

  • Brian A. Cook

    I meant to ask you to address that story in your previous post, but I wasn’t sure if it was appropriate, especially as barely off-topic as it was. I know you have tried to really get at the truth by sifting through all the talking-points–that’s something that I respect about you. Sadly, I don’t see this ending well for Mother Church, as this has been such a complicated and difficult case that inflamed such heated passions and anguish, and any mistake from Catholics could spoil the face of Christ badly.

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  • Victor

    (((Well, how dare I? This morning a couple of emails greeted me, all variations on this theme: “hey you &^$%$ pro-life hypocrite and your ^#$%^ church and your ^%$#$%^ Christ, why aren’t you writing about this story and see how you’ve ^$#%#%-ed-up lives and &$%#%@)*^ Ireland! %^$#@ Catholics! Justice for Savita! End &^$%# Rome!”)))

    A Super Spiritual, Reality Woman as yourself should watch her language and “HOW DARE YA MISS THIS IMPORTANT STORY?” :)

    http://www.splendoroftruth.com/curtjester/2012/11/the-pun-is-mightier-than-the-sword/#comments

    What’s with this world NOW LORD?

    http://www.metacafe.com/watch/1045024/johnny_cash_gods_gonna_cut_you_down/

    Piece!

    NO! NO! sinner vic! :(

    PEACE

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  • Mary

    Whether the Principle of Double Effect would have applied in this situation I do not know since I’m not a specialist in bioethics and we clearly do not have all of the informtion. But for anyone who is interested in learning more about PDE, I’m attaching a link. http://www.cuf.org/faithfacts/details_view.asp?ffID=56

  • Peter Brown

    I think there’s even less of an argument here than you’re pointing out. As you note, the facts of the case known so far really don’t provide support for legalizing abortion, but let’s suppose for a moment that a prompt abortion *would* have saved Mrs. Halappanavar. That’s still far from an open-and-shut argument that “we *must* have abortion!” First, hard cases (like this one) make bad law; second, there’s no great effort required to come up with tragic (even criminal) cases that argue against, rather than for, abortion. (Kermit Gosnell, anyone?)

  • Ray Mc Intyre

    The Irish Minister for Health, James Reilly is no particular friend of the prolife community so his words here do carry a lot of weight….yesterday in the Irish parliament he said…“I am privy to certain facts but I am not privileged to share them,’’ Dr Reilly said…
    The question of a Catholic ethos preventing …or inhibiting people from carrying out proper medical treatment, as defined by the Medical Council, had been raised, he said.
    “I have no evidence of that, but, again, I am not going to preclude what a coroner’s court will find, and I want to await that independent investigation that a coroner always undertakes.’’
    He knew, as a doctor in a general sense, that often in a case where miscarriage was inevitable, it was the view of the medical experts that allowing that to occur naturally represented the safest option. There would come a point and a time where that was not the safest option and intervention must take place.

    http://www.irishtimes.com/newspaper/ireland/2012/1115/1224326606753.html

  • Alex
  • M

    This is clearly a tragedy, but I am very interested in your question about whether inducing at 17 weeks is an abortion. This is how many early abortions are performed–take this medicine that will induce labor and come back in a few days. That’s a pretty standard abortion procedure. Does the age of viabilityhelp determine whether it is an abortion? Is abortion in the intention in the cases that occur around the age of vibility?

    [I did not suggest that the age of gestation was relative to whether inducement is an abortion -- I just threw that out as one thing to consider, if one is reasoning it out absent a right understanding of Catholic teaching. I was suggesting that even if someone thought they understood the teaching (but did not) simple reasoning could have still reached the conclusion that inducing labor would be appropriate medically and by church teaching. Intention has everything in the world to do with this. -admin]>

  • Peggy m

    God bless this woman, her child and her family. It is a tragedy. However, like Adam I am cynical about the facts of the story and the people pushing the narrative.

    Dear Anchoress please hang in there. I cannot imagine being routinely assaulted via e-mail by hate-mongers. Since last week I have pulled back from many sites, people and activities which depress and disgust me, yet I know my nemeses and thorns are far fewer than what you put up with. You are a light in the darkness.

  • Anna

    I mentioned this over at Calah’s blog too, but will say it again: does anyone think the headline spin *might* have something to do with the resistance Irish/Northern Irish pro-life folks are putting up to the recent opening of the first abortion clinic on that island? A counter-narrative is needed to silence the people protesting the abortions taking place there and now they have one, even though there’s exactly zero indication that “abortion would have saved this woman!” This should be, apparently, about boring old medical malpractice in diagnosing and treating infection, but has conveniently (both for Irish/UK pro-abortionists and for US politicians looking to deny conscience protections to pro-life medical workers) gotten turned into “evil Catholics with their ‘conscience thing’ vs. wonderful, life-saving abortion.”

  • Myssi

    Ten years ago, my very healthy Husband nearly died of an e.coli infection. E. coli often turns to septicemia with no help from pregnancy or other immune considerations. I think there was negligence involved in the poor woman’s death, but I don’t know that it could have been prevented with the best of care.

  • Nancy Reyes MD

    check: link. Yes, she should have had antibiotics. Sometimes the membranes close and you carry the baby to term, but more often you treat it with “expectant waiting”, and even a few weeks can result in a viable baby.

    Once you get infected, you remove the child, who has a better chance to live outside the womb than inside.

  • Nancy Reyes MD

    check: link. Yes, she should have had antibiotics. Sometimes the membranes close and you carry the baby to term, but more often you treat it with “expectant waiting”, and even a few weeks can result in a viable baby.

    Once you get infected, you remove the child, who has a better chance to live outside the womb than inside. My question is why did she have so much back pain? Usually there is no pain until the onset of labor…

  • Ann

    You know what no one is talking about? The horrendous healthcare system in Ireland, that is, yes, socialized medicine. My 60 yo uncle over there had a blistering welt on the top of his ear and he had worked outside his whole life, so lots of UV exposure. He went to the GP who gave him antibiotics pills (?) and sent him home and said come back in SIX months if it’s not gone. Well, it was melanoma and it was all over his brain by the time he went back, this time on a stretcher and died soon after. Did my uncle even get offered a biopsy or even a referral to a dermatologist when he went the first time? Nope. Maybe the calculations were already done that he was old and so and so.

    So I suspect this poor woman is a victim of the socialized healthcare system over there. She probably acquired the E Coli infection in the hospital, most likely. And then because they are a bunch of incompetent government nitwits, she wasn’t diagnosed or treated for the infection in time, and there you go.

  • Stacey MD

    Yes, she should have had antibiotics with a wide open cervix leaking amniotic fluid. It sounds like she developed an infection in the amniotic fluid – this may have induced the early labor in and of itself, or it may have been a consequence of early labor opening the cervix. Often, there’s a little leakage, infection sets up, and then early labor starts in earnest. When this happens, the uterus (almost always) has to be emptied, or a hysterectomy must be done; otherwise the infection cannot be managed and eventually will progress. Ireland’s law does permit an abortion to defend the life of the mother, so I am not sure why it was not done, as the uterus would have been grossly infected, and it would have to be emptied sooner or later, and the baby could not have made it to the limit of viability; there would have been no way, short of a genuine miracle, to keep the pregnancy going five or six weeks in the presence of gross infection. Besides, with an undrained infection, the mother would die eventually. E. coli would have been a very typical organism to get into the amniotic fluid, from the mother’s own bacterial population. What is surprising is that she apparently died of a very resistand E coli with an Extended Spectrum Beta Lactamase – not something covered by the usual antibiotic regimens used. It was more resistant than you would expect for someone who had only been in the hospital a few days, and that would have been hard to predict; it didn’t sound like she’d been in the hospital long enough to acquire a secondary infection there. Such a terrible thing; Almost a perfect storm. But the law apparently would have permitted them to take a live child while draining the uterine infection, if that were the only way the mother could survive (and of course, the baby would have had an overwhelming infection also.). As it happens, that WAS the only way this mother could survive. Maybe she was so young and healthy at baseline that she looked pretty good for a couple of days, until it was too late. But the law would have permitted her to have the life-saving procedure, and I expect I will hear from you all that church teaching would have allowed it also. But I am still waiting to hear about church teaching. My husband knows more about that than I do, and he was not exactly sure.

  • Peggy Coffey

    Did she miscarry the baby because of the blood poisoning, or did she become infected because she was miscarrying? She should have been on IV antibiotics, if she had a raging fever, any medical professional will tell you that. If she came in with symptoms of sepsis, that would have been the first thing done. Then they would have evaluated the baby and probably induced right away. But it’s socialized medicine. It’s what we have to look forward to.

    I also have pulled back from many of the sites I had routinely read. I can’t do it amymore. I do read you, Anchoress. You are a light in this dizzy world.

  • Meri

    It sounds like she died because she was sick and not because of her pregnancy. She wasn’t asking for an abortion either. She was already in the process of losing the child and was just asking for it to be hastened. I don’t think that it would have made a difference if she was induced and delivered the baby sooner. It appears to me that she had been unwell for quite some time from the e coli and not the baby. So the arguments coming from the other side are hogwash indeed! They will exploit this poor woman and her dead child to the hilt to try to get abortion legalized in Ireland. I hope it doesn’t work!

  • MRD

    I am a critical care physician and have a great deal of experience treating septic shock as well as a fair amount of experience treating critically ill pregnant woman. Much of this story sounds incomplete and wrong. We of course do not have the clinical details so some of what is being said is no doubt speculation. That said however it it is difficult for me to imagine a situation where the was a medical indication to abort the pregnancy, if of course the unborn child is already dead, then there is no ethical issue. Lets start with the first scenario. It sounds like most likely that patient has Chorioamnionitis, which is a common infection in pregnant women, often associated with miscarriage but rarely not commonly bacteremia. The treatment is antibiotics, and in the case of sepsis organ support. Termination of the pregnancy is not a routine part of the treatment and in fact since most cases occur in the last trimester, even in the abortion mad culture we live in, this is not typically done. In fact the baby may be delivered to prevent neonatal harm.
    Another possibility would be a septic abortion, or an infection in the uterine cavity because part of the dead unborn child is retained. This is possible and is treated with antibiotics, support and removal of any retained parts of the unborn child that remain in the uterus. Surgically the procedure is identical to an abortion, but obviously morally it is not an abortion at all since the child is dead. Other causes of sepsis are possible in a pregnant woman, as they are in any adult, including a perforated bowel, pneumonia, pyelonephritis (an infection of the kidney) and these may be associated with spontaneous abortion, but none of them are treated with induced abortion. In fact since this woman had her uterus evacuated 4 days before death, then to the extent that the uterine contents had anything to do with sepsis it was treated. She died 4 days later.

    As it stands we do not know the details but I do not believe this woman died because she was not given an abortion. It is quite possible that her sepsis and medical management were suboptimal, or it might just be that she died in spite of optimal treatment. I think what is obviously going on is that the political left ( and it is the political left Ms. Scalia much as you like to wink and nod at them) is on a Jihad to make pro-life sentiment seem extreme by distorting the facts to a public that is clueless when it comes to most things but especially science in general and medicine in particular. We saw a similar drill in the Arizona abortion case involving the woman with pulmonary hypertension. Left out of all of the coverage was the fact that the modern management of PAH allows for therapies that make delivery of the baby possible, ( although with increased risk) but that the pregnancy was terminated when the baby was in the first trimester and significant risk does not acrue until much later in pregnancy and which would allow for time to treat the PAH. None of this was discussed, not even in the Catholic press or Catholic blogosphere ( one would think some Catholic blogger would have found a doctor and asked does this make sense to you? Well this is the same thing. This story sounds to me like it is being manipulated as pro-abortion propaganda. Finally Abortion is legal to save the life of the Mother in Ireland. ( leaving aside for the moment the moral distinction between direct abortion which is never morally acceptable and indirect abortion which can be in cases in which the mother’s life is threatened) In Ireland they already allow for abortion if they think it necessary to save the life of the Mother, so.. I think what is going on here is that the left wing pro-abortion media is distorting the facts of this case to make pro-lifers seem extreme. They are trying to do what the gay lobby has done, made opposition seem immoral in itself. We should resist this.

  • Mr. Patton

    ” dead unborn child ” – MRD

    I sure hope, that you are NOT a physician. But if you are, what is the difference between a “dead unborn child” and an “undead fetus”?

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  • Peggy m

    I do not get Mr. Patton’s question. The difference between the “dead unborn child” and the “undead fetus” is that one is dead and the other is alive. Is the problem that a physician is using “unborn child” and “fetus” interchangeably in this forum of mostly-unmedical people? My experience is that doctors do talk like this with the likes of us…the word “miscarriage” for example, is used instead of “spontaneous abortion”.

  • http://www.cleansingfiredor.com Nerina

    I must admit that when I read this story, my first thought was the delivery of my second child. I was in the throes of chorioamnionitis and the doctors believed that infection is what triggered labor. Fortunately, labor was triggered in my 39th week and my daughter survived. It was, however, a scary labor and intense delivery. During labor they flooded me with antibiotics and when my daughter emerged from the birth canal, a resuscitation team was standing by – good thing too because she was blue, blue, blue. APGAR was horrible.

    I appreciate the medical insight offered above. Thank you to those giving the rest of us some helpful information. As others have said, I’m not sure anything would have made a difference in the outcome. Sometimes, patients die. We once had a young, first time mom deliver a baby and then throw an AFE (amniotic fluid embolism). She coded and died despite intense resuscitative efforts. It was awful and heart-wrenching and the sounds of the patient’s sister wailing over the phone deeply affected the nurse who had to make that call. There is something so wrong to have impending birth end in death. In this case, two lives were lost. That family needs our prayers.

  • bill bannon

    Fascinating and high content posting and thread. Awful reality for husband and for family of both spouses.

  • http://www.rosariesforlife.com Dave

    To be brief: seems like some devilishly unscrupulous person or group of people decided this case could be used as pro-abortion propaganda. Praying that the truth will come out.

  • http://jscafenette.com Manny

    I heard about this. I’m sure the pro-abortion crowd will make hay of this, and Ireland trending toward joining the rest of the repulsive western world in legalizing abortion. But the counter argument is this. How many deaths happen because doctor’s negligenmce in all sorts of medical procedures? This poor woman is a one in a billion type of occurence if it’s proven that the pregnancy caused her death. I’m willing to bet that other medical procedures have a higher death rate than giving birth.

    By the way, I do support abortions in the rare event that a mother’s life is truly at risk. I don’t know if that makes me a poor Catholic, but that’s common sense.

    May Savista be in God’s graces now.

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  • NBW

    It’s a very tragic story. It seems to me that this case will be used to push the abortion agenda in Ireland rather than taking a cold hard look at Socialized medicine as being the culprit. But again I don’t think all the facts are available to us. The facts that are available serve to make the Catholic Church and her beliefs the culprit. My prayers go out to Savita and her family.

  • http://a-star-of-hope.blogspot.com JoAnna

    Beth – yes, labor can be induced prior to viability under the principle of double effect, as long as the intent is to save the mother’s life by removing the infection organ (placenta/amniotic fluid sac) and the baby’s death is an unintended even if foreseeable side effect.

    It’s similar to how ectopic pregnancies or uterine cancer can be licitly treated while a woman is pregnant. The portion of the fallopian tube or the diseased uterus can be removed even with the baby inside, because the intent is to remove the diseased organ and save the mother, and the baby’s death is an unintended if foreseen side effect of that treatment.

    The mother’s danger of death must be immediate and grave, however — if she is not in immediate danger of death, then all measures need to be taken to save both her and the child. In Savita’s case, the danger was indeed immediate and grave, so inducing labor would have been an option allowable by Irish law and Catholic teaching.

  • Adam

    I think the discussion on “Savita could have been saved here” or “Savita could have had labor induced consistent with Catholic teaching” is great. I think it’s also off-track. What the world at large is going to see/hear, regardless of the outcome of this case, is that an undeveloped glob of cells is always going to take precedent over a living, breathing person. (Not my position.) It doesn’t matter how we examine and argue this case.

    In stories like this, we need to reclaim the argument and make several positions clear:
    1) The unborn child is always a human person, whether at 1 or 39 weeks of development. (It would probably help to know the stages of fetal development–IANA doctor, but I’d guess a 17-week baby would have all the major organs and limbs.)
    2) Because an unborn child is a person, intentionally killing him/her is always murder.
    3) Mother and child are of equal value, as are all human persons.
    4) In a life-threatening situation, all efforts should be made to save both.

    The tough, difficult to explain and harder to accept concept that we nonetheless need to teach is that there may be rare but difficult circumstances where we cannot save the mother’s life without directly and intentionally killing the child, which is murder. Again, IANA doctor, so I don’t know what circumstances those would be and whether modern technology has made those rare or impossible. Apparently they didn’t exist for St. Gianna Molla, who accepted death rather than aborting her child. (http://en.wikipedia.org/wiki/Gianna_Beretta_Molla)

    How do we explain to the world that in some cases (even if not this one), you need to suck it up and prepare for an honorable death over an act of mortal sin? Particularly when the world doesn’t accept that the unborn child is human? I’d love to hear some answers on that one, but that’s the fight we’re facing.