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THE RESPONSE OF the Minister for Health and the tone of the HSE’s statement on the questionable treatment received by Ms Y attempt to frame this case as wholly about abortion and the application of the legislation governing the right to life of the unborn.
But abortion is only one part of this picture and in many ways not the main issue. The main issue in this case is care – what kind of care is available to pregnant women? Is that care of high quality? Does it meet with the care commitments of the European Charter for Patients’ Rights, the Health Information and Quality Authority’s National Standards for Safer Better Healthcare and World Health Organisation recommendations on maternity care? Who was privy to the design of the care treatment plan and was it discussed with the patient or imposed on her? Was she fully informed and did she understand the dimensions of the treatment options fully? And, after the fact, can we honestly view her (and her baby) as having been adequately cared for?
What do we know for certain?
Ms Y’s case is a microcosm of the myriad of problems within debates around maternity care past and present. Remove abortion from the case and we are still left with the highly troubling instance of a young, vulnerable women left traumatised by her encounter with the health service. Both the Minister and the HSE have demanded that we reserve judgement until all the facts are made clear – that we remain “non-ideological” (to use the Minister’s phrasing) in our assessment of the case. But if we do ignore the personal accounts of Ms Y and those close to her, treat the interactions between healthcare professionals and Ms Y as problems in delivery and communication rather than systemic problems in the maternity care system, and focus solely on the facts then we only know two things for certain:
Taken in context, we also know that this is the only concern of maternity services in Ireland. Constitutionally, medical professionals are obliged to preserve life “as far as practicable” but there is no obligation on doctors to demonstrate that they have factored in the future effects of pregnancy and childbirth on either the mother or the foetus. Their assessments on risk to life take place within the boundaries of gestation. They protect life DURING pregnancy. The patients are pregnant women and the unborn, not women and children.
Considering post-partum mental or physical health
The overwhelming focus on preservation of life is a consistent theme in both inquiries into care quality in maternity services in Ireland and legislation relating to maternity care. The report following the death of Savita Halappanavar explored whether the accepted clinical practices for preserving, insofar as practicable, the life of the unborn and of the mother had been followed.
The review of the practice of symphysiotomy is being couched in the language of ‘necessity’ – was the procedure necessary in order to keep women alive? There is specific guidance on the protection of life during pregnancy but none on ensuring that the health outcomes of pregnancy for women and children are the best they can be. Under the current system there was, and is, no obligation for health professionals (or their institutional and governmental representatives) to examine the effect Ms Y’s contact with maternity services has had on her post-partum mental or physical health.
At this juncture what we need to ask ourselves is not whether we think abortion is right or fair or legitimate. What we need to ask ourselves is whether we are content with a healthcare system which is obliged to keep you alive but not well. Are we satisfied to assess the quality of maternity care solely in terms of whether women and children are alive at the end? Is this going to be Ireland’s health legacy?
Are pregnant women being adequately cared for?
At the very least, to sit back and accept Ms Y’s experience as either necessary or indicative of best practice shows how unwilling we are to learn from historic scandals in maternity care. The Lourdes revelations, the accounts of symphysiotomy survivors, and the recent cases of Dhara Kivlehan and Sally Rowlette who died shortly after receiving emergency caesarean sections at Sligo General Hospital should, by rights, make a comprehensive review of the dynamics and quality of maternity care in Ireland an immediate and absolute necessary. And yet despite the obvious questions regarding what happens in maternity wards, the HSE and Minister for Health are seemingly happy to reduce Ms Y’s experience to a question of keeping pregnant women and the unborn alive for the duration of pregnancy – not a question of whether pregnant women are being adequately cared for.
The image of women entering maternity wards healthy and excited and leaving physically debilitated and mentally traumatised haunts the Irish maternity care system. Ms Y is only the most recent example of inadequacies in maternity care. Unless we begin to question how well women are being cared for within the confines of maternity wards the emergence of future scandals and continuance of care inadequacies remains a distinct possibility.
Dr Deirdre Duffy is a Lecturer in Social Science and a specialist in social and public policy research and evaluation based at Edge Hill University.
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We need to separate science from superstition and draw a line. Those who object to treating people because of their superstitions should consider changing their professions to one that will not endanger people who live in the real world.
There are many conscientious objectors to abortion, on grounds that have absolutely nothing to do with religion. If the sole focus of pro choice campaigners is target Catholicism, you’ll miss the target
@Joseph – you see it’s ignorant comments like yours which get people’s defences up.
The Hippocratic Oath contains a vow not to carry out abortions, and pre-dates Christianity by centuries
And doctors swear a duty of care oath, not the Hippocratic one.
Hippocrates also spoke about the importance of diet and physical therapy like massage – something almost absent from modern medicine.
@ Shanti
Exactly my point, how about a little balance. I have seen only articles concentrating on the outcome for Ms Y, and not a single consideration for baby Y.
In reality there is little care expressed for Ms Y, just another journalistic vehicle on which to look for support for removing 40.3.3. Sad for Ms Y, baby Y, and Ireland.
Sorry should be posted in the thread below.
Well Paddy. For once, I agree with you. We aren’t getting enough info on how this poor child – born horrendously premature, with pretty much every odd stacked against them is doing.
Mind you – it’s a ward of the state now. And we all know that’s not much of a life. I do hope that it is doing OK. But I can also appreciate that it has a right to privacy, something the mother may only waive in regards herself unless she decides to take custody. So I doubt there will be much info for that reason.
Nice to find *some* common ground, no matter how rare..
I still don’t agree with the circumstances that led to the child’s life, but now that it is indeed alive I wish it as much luck as can be mustered for it.
My point was that you don’t need to be Christian to have misgivings about abortion. Your reply had nothing to do with that
Yes Silver Planet, and my point was that the Hippocratic oath is just as irrelevant.
Irrelevant to what? It’s evidence that you don’t need Catholicism to oppose abortion.
Focus on the woman, focus on the woman, I said focus on the woman. (There is no child endangered!)
P.S. Is the woman now in a more or less difficult situation, 1)than if she was allowed to go to term 2)than if she had an earlier abortion?
If the child dies, will the “leak” be forthcoming with that information? This is the state of Irish media, only that which serves abortion shall be leaked, all other information is on a need to know basis. Also available is any other information which can be easily distorted and abused to, for instance, lead to abortion legislation.
The Truth is dead, long live the Truth.
Well Paddy, you would focus entirely on the foetus and ignore the woman.. Would a little balance be too much to ask?
His comment was about the woman! You really don’t read these things you’re replying to, do you?
That comment did indeed give some concern to the girl – I was speaking more to Paddy’s general contributions around here – where he is only too happy to completely ignore the woman in these situations.
You’re not that new here that you would be unaware of that which I refer to.
The comment you were replying to disproved the pint you made before you even made it
I find the actions of th state beyond all reason, sanity and compassion. This case has only confirmed the pro choice stance in my mind as th only civilised option. There is no justification for depriving women of control of their person and body.
Very interesting article, I don’t understand why the comments are again focusing on abortion. The issue is much wider than that. I think the problem stems from the thinking that woman don’t know what’s best for themselves which still underpins the modern maternity services. I was told when expecting my first child twenty three years ago not to be telling the doctors what I wanted, I’d only alienate them. I wonder have thing really moved on. The truth is that while midwives and individual doctors may care deeply about the quality of the mother’s experience, the system could not care less. It amazes me that doctors can decide to induce labour in a healthy mother and baby before due date just to accommodate their holidays and people accept this as good practice. In common with every aspect of our health service, maternity services are falling apart at the seams
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