Monday, November 19, 2012

Why did Savita die?

You probably have read of the furor over the tragic deaths of Savita Halappanavar and her child. Ms. Halappanavar was a 31 year old woman who died recently in Ireland from a blood infection associated with premature labor (she was 17 weeks pregnant). The story is complex, and official investigations are underway, but there are reports that she and her husband requested that delivery of her pre-viability child be induced. Her husband reported:

“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.”

There have been several thoughtful analyses of this tragedy. A commentor on Elizabeth Scalia's blog provides a professional view:

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.
I don't have any inside knowledge of the facts of the case, and I am not an obstetrician nor a critical care specialist, but as a physician I can make some general points.

It is most likely that Ms. Halappanavar's blood infection was caused by infection of the amniotic fluid (chorioamnionitis), which may have been the cause or the result of the premature labor. The child was alive when she was initially evaluated, so the child was not the source of the infection. There are reports that antibiotic therapy was delayed by several days, which almost certainly is relevant to her subsequent death from overwhelming infection.

Was the delivery of the child delayed because of Catholic moral teaching? Abortion proponents misrepresent the Catholic Church's position on delivery of the fetus to save the life of the mother.

Pope Pius XII in 1951:

… 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 or intended, but inevitable, the death of the foetus, 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 …
Delivery of Ms. Halappanavar's pre-viability child is licit under Catholic moral teaching, because the direct intent is to save her life, and the death of the child is not intended and is not a prerequisite to saving her life.

But is is quite possible that the delay in delivery of her child was not the central issue in her death anyway. The alleged delay in administration of antibiotics-- by several days-- if true, probably plays a much larger role in her death.

It's worth noting that Catholic Ireland is one of the safest places in the world to be a pregnant mother.  Maternal mortality rates are lower in abortion-free Ireland (6 per 100,000) than they are in the abortion-infested United States (8 per 100,000). It's hard to argue that Catholicism makes Ireland a dangerous place to be pregnant.

And if one insists on attributing Ms. Halappanavar's and her child's death to a systematic problem in Irish medical care, wouldn't the fact that Ireland has socialized medicine, rather than the fact that Ireland is Catholic, be more relevant to poor medical care?

None of these facts will matter. Abortion-mongers see an opportunity to exploit the deaths of this woman and her child, and they'll never pass up an opportunity to profit from the death of innocents.

May God bless Ms. Halappanavar, her child, and her family, and may the truth not also be a victim of this tragedy. 


  1. lol egnor y u so stoopid???

  2. Michael,

    If the socialized Irish healthcare was the cause of this unfortunate death, and Ireland has a maternal mortality rate of 6 per 100,000 compared to America's rate of 8 per 100,000, doesn't this mean that America's lack of socialized healthcare mean that it's killing an extra 2 per 100,000 women?

    Agreed. It's not mandatory to surgically evacuate the uterus in case of an inevitable abortion. Usually, the products of conception will pass spontaneously, and possibly it might have advantages in avoiding possible intrauterine adhesions, complicating future pregnancies.

    I suspect she had a threatened abortion which then became inevitable. And then she developed chorioamniotitis, the source of her septicemia and the cause of the foetal death. I don't know whether her medical care was substandard - there's not enough details. A lot of medical care involves following protocols; if 'A' happens, then 'B' is done - based on giving the best clinical outcomes with the lowest complications possible. It might be that in Ireland the standard care of a patient with a threatened or inevitable abortion is admit, observe, await spontaneous evacuation, screen for infection and treat as appropriate, and surgically evacuate as necessary - if this is the case, the clinical care would not have been substandard.

    1. Little John,

      Of course foetuses can die. Just as skin cells can die. Any cell or collection of cells is alive, unless dead (or frozen in liquid nitrogen).

      You're confusing 'being alive' with 'being a person', which is a legal, not a biological definition (despite what Michael insists...)

    2. bach:

      So fetuses have the same biological classification as skin cells. Just tissue.

      But at some point the fetus becomes a human being-- a homo sapiens, not just a part of a homo sapiens.

      You've invented a new biology-- the spontaneous generation of a new human being from a clump of human tissue in the female pelvis, occuring at a time to be decided by a court.

      Brave New Biology.

    3. I guess Michael has never heard the word "continuum". Such things do not exist in his black-and-white world.

    4. @anon:

      So a human fetus isn't either a human being or a bit of tissue. He/she is a "continuum", a new sort of biological entity.

      Is a "continuum" an individual, a species, an organ, or what?

      Where did you learn your biology?

    5. You really don't understand or are you just pretending?

      - A fertilized ovum is not a person.
      - A newborn is a person.

      There is no single moment when the cells turn into a person, but it happens gradually (that's what I meant by "continuum").

    6. I get it. So fetuses are kind of like hangnails. And there was no such thing as a person before there was a law. Law defines people. If the law decides tomorrow that blacks or Jews are unpersons, then that's what they are.

      "There is no single moment when the cells turn into a person, but it happens gradually (that's what I meant by "continuum")."

      So there is a moment when the child is 1% a person, and 10%, and 90% and so on. How much of a percentage of a person are you willing to kill? How can you be sure how much of a percentage the child is at any given point? When can we be sure it's at 0% and when it's at 100%?

      I'm not sure I believe this continuum argument. What scientific basis do you have you have for it?

      Little John

    7. Pro-choicers are always sketchy on the details of when life begins. That allows for lots of fudging around the edges. They don't want to talk about a threshold being crossed because that would limit a "woman's choice" and because then they would have to defend why they draw the line where they do.

      Hence, anonymous tells us that a fertilized ovum is not a person, but a newborn is. Everwhere in the middle is a mystery.

      If we don't know, then we must err on the side of caution. We don't execute criminals when we "don't know" their guilt. Or when we do, it's a great injustice. Not knowing when human life begins is not an argument for the pro-choice side of the debate.

      Little John

    8. @Fetus-eating Atheist: At what point along the continuum was Gianna Jessen when her mother tried to abort her? How did she leap from being a partial person to a full person the moment she survived attempted murder?

      What about the seven born alive children Kermit Gosnell killed at this abortion clinic? No, I'm not talking about the woman he tied down and performed a forced abortion on, I'm talking about the seven kids whose spinal cords he severed. Those kids. Were they halfway down the continuum to personhood? Eighty percent? Ninety? At what point are they person enough to deserve some protection?


    9. I'm not certain that I agree with the 'continuum' view of personhood. I regard it as a legal definition, similar to the way we define 'adulthood'. In Australia, people generally gain most of the privileges of an adult at age 18. The right to drink alcohol. To vote in elections. To smoke cigarettes. A person isn't psychologically unfit to drink alcohol at 17 years and 364 days old, and magically capable just one day later.

      A ten year old isn't capable of managing alcohol consumption safely. A 30 year old might be. So we set the age at 18.

      A foetus one day before birth is a person. An unimplanted fertilized ovum isn't (despite Michael's protests). There's no clear point at which 'personhood' is achieved. But the law in many states sets it at 20 weeks. Before 20 weeks, the woman has the right to an abortion by choice. After 20 weeks, there has to be an adequate medical reason.

      My view is that abortion shouldn't be encouraged. It is a surgical procedure, with complications, after all. Birth control should be readily and affordably available making abortion rare, except as a backup for failed contraception, rape or incest.

      It's not actually true that Ireland is abortion-free. At least 4,000 Irish women have an abortion each year. They just travel the short distance across the Irish Sea to have the abortion in Britain. And the 4,000 doesn't include the unknown numbers who go to the European continent.

      Banning abortion might make you feel better, but it's not going to stop it. Even before Roe versus Wade, abortions were occurring in America, but they were illegal and hence hidden from view.

    10. I regard it as a legal definition, similar to the way we define 'adulthood'.
      But it's similar: there's not a magical moment when a child turns into an adult, so someone has to set an arbitrary limit.

    11. So a embryo/fetus gradually becomes a person, like maybe 2% more person-ness each week of gestation.

      So if you abort at 10 weeks, you've killed 20% of a person. If you abort twins at 13 weeks, you've killed 52% of a person.

      Seems like an intelligent system.

    12. Michael,

      No. Personhood is a legal definition, not a biological one. The voters in the conservative state of Mississippi were asked in a referendum to decide on the legal definition of 'personhood' to start at the moment of conception (as you believe), but sensibly it was rejected.

      Personhood, being a legal not biological concept, is arbitrary. On the other hand, for example viability, being a biological concept, is on a continuum. A 26 week fetus has a slight chance of surviving, with the odds progressively improving with increasing gestation age.

  3. I suspect the fetus cursed the holy spirit and is now burning in hell along with its heathen mother. Just like the good lard must have wanted.

  4. And, of course, these Christ-haters play to type.