Wednesday, 1 May 2013

"The Protection of Life during Pregnancy Bill 2013" : Removing the Woman, in Rights and in Name. (updated 2/5)

 "The Protection of Life during Pregnancy Bill 2013": Removing the Woman, in Rights and in Name.

Over the last few months, Ireland has been gripped by debates surrounding abortion.

The failure to legislate despite two referendums from the Irish people, despite a push from the ECHR to legislate, all came to a head following the  unnecessary and tragic death of Savita Halappanavar, who died of sepsis during an inevitable miscarriage, despite requests for an abortion. A whirlwind of debate ensued and finally, last week, we were told the end was near; that draft legislation would be soon.

The speculation has been emotive, intense, and constant. The silence and wait nearly unbearable. There was nearly a collective sigh of relief, when it was announced legislation would be published by the Summer and then, apprehension as the Government indicated it would follow the terms outlined in the X case. Where would the compromises lie?

Legislating for abortion under the terms of the 'X Case' was always going to be restrictive. The X case recognizes the right to an abortion where a pregnant woman's life is at risk, including suicide, as a result of her pregnancy. No right to autonomy. No right to bodily integrity. No right to choice in instances of rape, incest, health, or any other area. But there was still ground to play for, and the rumour mill was on high alert.

  This week, The Labour Party and Fine Gael hashed out the details through what we believe were intense negotiations. We heard rumours of 'bottom lines'. We hoped legislation would be woman-centred.

 During negotiations, something happened. Something almost subtle but yet so pointed.....Something so poignant it encapsulates women's struggle for rights in Ireland. The "Protection of Maternal Life Bill" suddenly became "The Protection of Life during Pregnancy Bill 2013". All traces of women, removed. Removed in rights and in name, from pregnancy.

"The Protection of Life during Pregnancy Bill" proposes:

• One consultant in the case of emergency.
• Two consultants in the case of a physical risk.
• Three consultants in cases of a suicide threat.

In the Case of Suicide, the Bill proposes that the woman must go before a panel of 3 consultants: 2 psychiatrists and 1 obstetrician and their decision must be unanimous. Should the woman wish to appeal a decision, she must go before a further panel of 3 consultants, whom also must reach a unanimous decision.

So, in other words, where a woman is pregnant- suicidal-wants an abortion, she must go before a panel of doctors to 'prove' how suicidal she is. She will have to put her life in their decision, without knowing their personal stance, opinions, biases... and she has to accept if they believe her or not.

Assuming. Dictating. Humiliating. Degrading. Distressing.
Ireland: No Country for Pregnant Women.

What measures will be taken to alleviate personal bias vs appropriate care on review panels? 

In maternity care, a woman's accessibility to appropriate care often depends on the care provider she is assigned on the day and their clinical recommendations/personal opinion often influence practice, which can vary greatly. Ireland has no standardization of care in maternity services and practice and policy varies greatly regionally, between units, and between individual care providers.

What happens to the woman who gets an anti-choice obstetrician or psychiatrist on her review panel? What are the Government doing to alleviate personal bias vs appropriate care?

This morning, AIMS Ireland were sent a letter from 11 Consultants opposing opinion expressed in the Savita Halappanavar inquest. (see footnotes)

Will these Consultants be available for appointment on a review panel?

Assuming. Dictating. Humiliating. Degrading. Distressing.
Ireland: No Country for Pregnant Women.

"The Protection of Life During Pregnancy Bill" also suggests a 14 year jail sentence for women who self-induce abortion and medical professionals who perform 'illegal' abortions. Just for comparisons, the average rape sentence is 5-7 years.

This is the second piece of legislation from this Government to oppress and control pregnant women and criminalize professional practice which respect women's right to bodily integrity. This proposed Bill gives a 14yrs sentence to a woman or medical professional who performs an 'illegal' abortion, regardless of the woman's informed choice, autonomy, bodily integrity, desire, health....This Government enacted the Nurses and Midwives Act, which gives a 10yrs prison and/or €60,000 fine to a midwife who provides clinical care to a woman choosing to birth at home who doesn't fit State approved criteria, regardless of the woman's informed choice, autonomy, bodily integrity, desires, health.....

Assuming. Dictating. Humiliating. Degrading. Distressing.
Ireland: No Country for Pregnant Women.

And here lies the crux of the issue. Pregnant women do not have the same rights as other citizens in Ireland. Where other jurisdictions strive for 'woman-centred' care in reproduction, pregnancy, birth; we remove women from her experience.

The State.
The Government.
The Courts.
The HSE.
The Electorate.
The Consultants and Psychiatrists.
The foetus.

All have been given the right to make choices for pregnant women.
Only the pregnant woman has no power over her own rights and choices.

Draft HSE Guidelines state that pregnant women need a separate guideline for consent in their health care. Pregnant women are not protected to make informed decisions, practice autonomy or bodily integrity where there is or may be 'risk' to the foetus. Regardless of if this risk is perceived or otherwise.....

AIMSI have spoken to women who have been threatened to have their baby made ward of the State for attempting to exercise their informed choice on where/how to birth. The State considers the High Court appropriate action should pregnant women refuse medical advice.

HSE: The Draft National Consent Policy - section 7.8.1 'Refusal of Treatment in Pregnancy'

"The Consent of a pregnant woman is required for all health and social care interventions. However, because of the constitutional provisions on the right to life of the 'unborn', there is legal uncertainty regarding whether a pregnant woman's right to refuse treatment extends to the refusal of treatment which puts the life of the foetus at serious risk. This matter can ultimately only be decided by the Courts. Thus, where a pregnant woman refuses treatment and this refusal may impact on the life of the foetus, it is essential that the consequences of the refusal are fully and clearly explained to the woman, and legal advice should be sought if she persists in the refusal"

Draft HSE guidelines here

Go back again. To the start.
During negotiations, something happened. Something almost subtle but yet so pointed.....Something so poignant it encapsulates women's struggle for rights in Ireland. The "Protection of Maternal Life Bill" suddenly became "The Protection of Life during Pregnancy Bill 2013". 

Once again, the woman has been removed.
In rights.
In name. From pregnancy.

Assuming. Dictating. Humiliating. Degrading. Distressing.
Ireland: No Country for Pregnant Women.

** BILL UPDATE: Women could face spending pregnancy in psychiatric unit : "Irish Examiner writes, "A woman refused a termination on the grounds of suicidal intent could be forced to spend the remainder of her pregnancy in a psychiatric unit, Health Minister James Reilly has said."

To recap, this is how the State treats women in Ireland in 2013:

If a woman is suicidal and requests a termination....lock her up and force her to continue the pregnancy.

Pregnant women who go against medical recommendations in maternity care....... doorstepped by social workers, threats to have their baby taken into State custody, threats with High Court, forced intervention via High Court, threats to have mental health assessments.

Why don't we have them do unpaid laundering services while we are at it?

Assuming. Dictating. Humiliating. Degrading. Distressing.
Ireland: No Country for Pregnant Women.

References and more info:

Analysis: Average sentence for rape is 5 – 7 years:

AIMS Ireland: What do Human Rights in Childbirth look like?

AIMS Ireland: HSE say women don't have the same rights:

AIMS Ireland: Realise Your Rights:

Letter from 11 Consultants sent to AIMSI April 30, 2013:

Dear Sir:
The recent inquest on Ms Savita Halappanavar has raised important issues about hospital infection in obstetrics. Much of the public attention appears to have been directed at the expert opinion of Dr Peter Boylan who suggested that Irish law prevented necessary treatment to save Ms Halappanavar's life. We would suggest that that this is a personal view, not an expert one.

Furthermore, it is impossible for Dr. Boylan, or for any doctor, to predict with certainty the clinical course and outcome in the case of Savita Halappanavar where sepsis arose from the virulent and multi drug-resistant organism, E.coli ESBL.

What we can say with certainty is that where ruptured membranes are accompanied by any clinical or bio-chemical marker of infection, Irish obstetricians understand that they can intervene with early delivery of the baby if necessary. Unfortunately, the inquest shows that in Galway University Hospital the diagnosis of chorioamnionitis was delayed and relevant information was not noted and acted upon.

The facts as produced at the inquest show this tragic case to be primarily about the management of sepsis, and Dr Boylan's opinion on the effect of Irish law did not appear to be shared by the Coroner, or the jury, of the Inquest.

Obstetric sepsis is unfortunately on the increase and is now the leading cause of maternal death reported in the UK Confidential Enquiry into Maternal Deaths. Additionally there are many well-documented fatalities from sepsis in women following termination of pregnancy. To concentrate on the legal position regarding abortion in the light of such a case as that in Galway does not assist our services to pregnant women.

It is clear that maternal mortality in developed countries is rising, in the USA, Canada, Britain, Denmark, Netherlands and other European countries. The last Confidential Enquiry in Britain (which now includes Ireland) recommended a "return to basics" and stated that many maternal deaths are related to failure to observe simple clinical signs such as fever, headache and changes in pulse rate and blood pressure. Many of the failings highlighted in Galway have been described before in these and other reports.

The additional problem of multi-resistant organisms causing infection, largely as a result of antibiotic use and abuse, is a serious cause of concern and may lead to higher death rates in all areas of medicine.

Ireland’s maternal health record is one of the best in the world in terms of our low rate of maternal death (including Galway hospital). The case in Galway was one of the worst cases of sepsis ever experienced in that hospital, and the diagnosis of ESBL septicaemia was almost unprecedented amongst Irish maternity units.

It is important that all obstetrical units in Ireland reflect on the findings of the events in Galway and learn how to improve care for pregnant women. To reduce it to a polemical argument about abortion may lead to more - not fewer - deaths in the future.

Yours sincerely,

Dr. John Monaghan, DCH FRCPI FRCOG Consultant Obstetrician/Gynecologist,
Portiuncula Hospital, Galway.

Dr. Cyril Thornton, MB BCh MRCOG Consultant Obstetrician/Gynecologist,
Cork Clinic, Cork.

Dr. Eamon Mc Guinness, MB BCh MRCOG Consultant Obstetrician/Gynecologist,
Mount Carmel Hospital, Dublin.

Dr. Trevor Hayes, MB BCh FRCS MRCOG Consultant Obstetrician/Gynecologist, St. Luke’s General Hospital, Kilkenny.

Dr. Chris King, MB DCH MRCOG Consultant Obstetrician/Gynecologist,
Letterkenny General Hospital.

Dr. Eileen Reilly, MB ChB MRCOG Consultant Obstetrician/Gynecologist,
Galway Clinic, Galway.

Prof John Bonnar, MD FRCPI FRCOG Professor Emeritus Obstetrics & Gynaecology,
Trinity College Dublin.

Prof Eamon O’Dwyer, MB MAO LLB FRCPI FRCOG Professor Emeritus Obstetrics & Gynaecology, NUI Galway.

Prof Stephen Cusack, MB BCh FRCSI Consultant in Emergency Medicine,
Cork University Hospital.

Dr. Rory Page, MB BCh FFA RCSI Consultant Anaesthetist, Cavan General Hospital.

Dr. James Clair, MB BCh PhD FRCPath Consultant Microbiologist,
Mercy University Hospital, Cork.


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