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That's a bit harsh. Nobody here has access to the medical records, we are largely discussing events as reported by a media barely more medically knowledgeable than us.

Frank is trying to be fair while avoiding pre-judgement, preferring instead to try to determine if there are scenarios where the actions of the medical team might be seen as reasonable and justifiable. That seems a worthwhile activity to me, even if I personally think that the medical team bear considerable responsibility for the tragic result.

keep to the Fen Causeway

by Helen (lareinagal at yahoo dot co dot uk) on Wed Nov 21st, 2012 at 01:37:10 PM EST
[ Parent ]
That's a bit harsh. Nobody here has access to the medical records

What metatone is saying (though he can correct me if I'm putting words in his mouth) is that we're debating whether there's a causal link between miscarriage and septicaemia, which he claims is well documented in developing countries and we in the west must have forgotten about because we weren't born when out grandmothers were giving birth without access to antibiotics and, in some cases, electricity or medical facilities. And thus the "debate" on the "link" is concern trolling.

I distribute. You re-distribute. He gives your hard-earned money to lazy scroungers. -- JakeS

by Migeru (migeru at eurotrib dot com) on Wed Nov 21st, 2012 at 01:49:07 PM EST
[ Parent ]
Actually I didn't think the link between miscarriage and septicaemia was contentious; indeed from the newspaper articles I've read the "medical" opinion seems to be that the moment the cervix opens from the "waters" breaking is when the susceptibility to disease goes from low to high.

So, I thought Frank was trying to determine if there was a medical justification beyond religiously-inspired negligence for allowing a woman to face this risk for over three days

keep to the Fen Causeway

by Helen (lareinagal at yahoo dot co dot uk) on Wed Nov 21st, 2012 at 02:03:38 PM EST
[ Parent ]
Actually I didn't think the link between miscarriage and septicaemia was contentious

That what is the whole debate about?

I distribute. You re-distribute. He gives your hard-earned money to lazy scroungers. -- JakeS

by Migeru (migeru at eurotrib dot com) on Thu Nov 22nd, 2012 at 04:05:43 AM EST
[ Parent ]
How great is the risk of septicaemia, over a period of several days, in a woman whose waters have broken but has not yet miscarried?

I find it unlikely that accurate statistics exist for this risk, because it is such grave medical malpractice to allow such a situation to drag on for several days. Because, in particular, of the risk of septicaemia.

It is rightly acknowledged that people of faith have no monopoly of virtue - Queen Elizabeth II

by eurogreen on Thu Nov 22nd, 2012 at 04:47:41 AM EST
[ Parent ]
As I understand it, whatever about the third world, the incidence of septicemia in or subsequent to miscarriage is very low in Ireland, which is partly why our maternal and child mortality rates are so low. It may also be why the medical team felt the "real and substantial risk to the life of the mother" standard wasn't met - until she actually did develop septicemia by which time (AFAIK, but I don't have a precise timeline) the foetus was already dead, but also by which time an abortion/womb evacuation/hysterectomy or other surgical procedure might only have increased the risks to her life.

The real issue here is that the current Constitutional standard in Ireland ("real and substantial risk to the life of the mother") is too high, and ANY risk to the life or health of the mother should have been taken into account - in which case an immediate abortion on admission would have been a no brainer, as the foetus had no chance of survival in any case.

It would require a Constitutional Amendment, by popular referendum, to change that standard. I don't sense any appetite, amongst the political parties, to go through the very bitter and divisive "right to life" Constitutional referenda campaigns of the 1980's all over again. The RC Church and "Pro-life" campaigns would attempt to spin any attempt to lower the Constitutional Standard (to real and substantial risk to the  Life OR Health of the mother) as tantamount to abortion on demand and point to statistics in the UK where, apparently, the justification of risk to the mental health of the mother is utterly routine and used in the vast majority of abortions.

I'm not sure, in that context, whether such a referendum would pass and it would be very unlikely to do so unless at least some of the major political parties campaigned actively and energetically in favour. They show little inclination to do so, and so  in that context I doubt such a referendum would pass.

Losing such a referendum could throw the the ongoing liberalization of Irish society into reverse and it might be at least another generation before women's rights to their own health and bodies were placed on a firmer Constitutional footing.

The bottom line is that Savita may have died because her medical team were justifiably reluctant to intervene aggressively and early enough in the context of current Irish law. It may sound callous (and it is), but the "Right to Life" movement will probably argue that one life lost in rare and exceptional circumstances is a small price to pay in the context of the thousands of "lives of unborn babies" that would be lost if Ireland were to introduce what they call abortion on demand on the British model.

A more winnable proposition, in the short term, for the pro-choice movement might be to argue that where the death of a foetus is inevitable, an abortion should be permissible if it would reduce ANY risk to the life or health of the mother. The "pro-life movement" will undoubtedly argue that this is a form of euthanasia and that it is open to abuse by doctors exclusively concerned about the health of the mother and who might be over eager to declare a threatened miscarriage unavoidable or a fetus unviable, and thus a foetal death inevitable.

However doctors generally, and maternity services more particularly, still have a very high standing and reputation in Ireland. Any attempt by the "Pro-life movement" to impugn the integrity of the profession would not go down well, and such a proposal would probably pass in parliament. What is not clear to me is whether it would require a Constitutional amendment to be passed. Any attempt by the Dail to legislate to that effect would probably be challenged as unconstitutional by the "pro-life" movement, and depending on how the Supreme Court ruled, a referendum might be necessary.

It might only be a small step forward for women's rights in Ireland, but at least it sounds to me like a winnable campaign and it would probably have saved Savita's life.

Index of Frank's Diaries

by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Thu Nov 22nd, 2012 at 06:41:26 AM EST
[ Parent ]
Migeru:
we in the west must have forgotten about because we weren't born when out grandmothers were giving birth without access to antibiotics

giving birth != miscarriage

In fact why our "grandmothers" (Early Modern ancestresses) died of infection in or after childbirth (and they did, massively) was because the physicians of the time infected them with dirty hands -- until antiseptic precautions became understood and standard. Poor women who could afford neither physicians nor midwives were better off because they did not undergo the intervention of professionals who came hotfoot, bearing pathogens, from other births.

Frank's diary suggested an iatrogenic e.coli infection, which prompted my comments above. However, if this were not the case, a miscarriage is sufficiently dangerous of itself, and this was a long, fraught miscarriage that did not conclude (except in the death of the patient).

Refusing to consider an abortion and leaving this woman to suffer with either insufficient monitoring or a deliberate decision (or both) not to place her life before that of a condemned foetus's heartbeat (when did they diagnose septicemia and realize they would save neither the mother nor the foetus?) was an evident dereliction of medical duty.

by afew (afew(a in a circle)eurotrib_dot_com) on Wed Nov 21st, 2012 at 02:39:00 PM EST
[ Parent ]
afew:
Poor women who could afford neither physicians nor midwives were better off because they did not undergo the intervention of professionals who came hotfoot, bearing pathogens, from other births.

Midwives were better at physicians, that was in part how Semmelweis discovered the importance of washing hands. And physicians came not only from other births but also from things like autopsies.

Best was probably having a midwive coming to the home. That was the practise up here until the physicians monopolised childbirths through legislation.

A vote for PES is a vote for EPP! A vote for EPP is a vote for PES! Support the coalition, vote EPP-PES!

by A swedish kind of death on Thu Nov 22nd, 2012 at 04:01:42 AM EST
[ Parent ]
Yes, midwives were better because they intervened less than physicians, and may have had the advantage of traditional practices like hand-washing (though a ready supply of clean water in homes was problematic, in cities at least). Yet a poor woman who gave birth aided only by a family member or neighbour was probably "best off", because more isolated from causes of infection.
by afew (afew(a in a circle)eurotrib_dot_com) on Thu Nov 22nd, 2012 at 04:41:37 AM EST
[ Parent ]
Ignaz Semmelweis - Wikipedia, the free encyclopedia

Despite various publications of results where hand-washing reduced mortality to below 1%, Semmelweis's observations conflicted with the established scientific and medical opinions of the time and his ideas were rejected by the medical community. Some doctors were offended at the suggestion that they should wash their hands and Semmelweis could offer no acceptable scientific explanation for his findings. Semmelweis's practice earned widespread acceptance only years after his death, when Louis Pasteur confirmed the germ theory and Joseph Lister practiced and operated, using hygienic methods, with great success. In 1865, Semmelweis was committed to an asylum, where he died of septicemia at age 47.

we reserve usually for those who come to show us what should be obvious...

"We can all be prosperous but we can't all be rich." Ian Welsh

by melo (melometa4(at)gmail.com) on Thu Nov 22nd, 2012 at 06:06:26 AM EST
[ Parent ]
It is ironic he died of Septicemia when he spent his life trying to reduce its incidence. I wonder if the doctors treating him at the asylum didn't approve of his hand washing theories and succeeded in infecting him...

Index of Frank's Diaries
by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Thu Nov 22nd, 2012 at 06:55:46 AM EST
[ Parent ]

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