Slugger O'Toole

Conversation, politics and stray insights

Ireland in desperate need of its own set of secular morals and ethics?

Wed 14 November 2012, 11:28am

There’s a rather disturbing story on the front page of today’s Irish Times, which recounts the tragic case of Savita Halappanavar.

Despite the fact that she was found to be miscarrying Savita was denied an abortion because ‘the foetal heartbeat was still present and they were told, “this is a Catholic country”.’ Here’s a fuller account of what happened:

Speaking from Belgaum in the Karnataka region of southwest India, Mr Halappanavar said an internal examination was performed when she first presented.

“The doctor told us the cervix was fully dilated, amniotic fluid was leaking and unfortunately the baby wouldn’t survive.” The doctor, he says, said it should be over in a few hours. There followed three days, he says, of the foetal heartbeat being checked several times a day.

“Savita was really in agony. She was very upset, but she accepted she was losing the baby. When the consultant came on the ward rounds on Monday morning Savita asked if they could not save the baby could they induce to end the pregnancy. The consultant said, ‘As long as there is a foetal heartbeat we can’t do anything’.

“Again on Tuesday morning, the ward rounds and the same discussion. The consultant said it was the law, that this is a Catholic country. Savita [a Hindu] said: ‘I am neither Irish nor Catholic’ but they said there was nothing they could do.

As Brian has pointed out several times on Slugger, there’s a serious ethical and legal gap here with parliamentary stalling taking place, both north and south of the border.

This is tragic, and extreme. But those political activists who gleefully push the responsibility back onto practitioners now have a cast iron example of why political action in this territory is needed and long overdue.

In the case of Northern Ireland, there simply are no guidelines. In the south, it is actually permitted by the Constitution [in the 8th amendment enacted 1983, in which the right to life of the mother is given equal status to that of the unborn child]. But, again as in so many other cases, the Government is biding its time hoping it can get away without having to craft its own ethical guidelines.

Sorcha Pollak writing in Time Magazine notes:

The Republic of Ireland is one of a minority of four European states (the others are Malta, San Marino and Monaco) that still enforce highly restrictive criminal abortion laws. But, with approximately 4,000 women from the republic and 1,000 from the north traveling to Britain each year for abortions, the Irish electorate is increasingly calling for clarification of abortion legislation.

If there is confusion over the legal status of abortion in Ireland, that’s hardly surprising. Northern Ireland never enacted the 1967 Abortion Act, which legalized abortion in the rest of the U.K. Northern Irish law states that women can have an abortion only if there is a long-term or permanent adverse risk to her physical or mental health.

Even tougher strictures limit the availability of abortions in the Republic of Ireland, where a 1983 amendment to its constitution did seem to permit terminations but only if the mother’s life was in danger.

This right has rarely been tested. There is no official legislation defining what the “risk of life to the mother” actually entails, and earlier laws prohibiting all abortions have never been repealed. Medical practitioners fear criminal and professional sanctions. [Emphasis added]

Irish Constitutional law is already couched way beyond the bounds of Cannon law of the Catholic Church. Therefore resort to church law therefore provides no guidance to how the law might treat the individual medical practitioners faced with real and problematic questions of ethics.

Irish politicians have had 29 years to deal with this problem. And they have serially failed to do so. And there seems little intention to take action the matter anytime soon. Sara McInerney tweeted from the Dail this morning:

[As I noted on Twitter, Gerry could do just as well asking his colleague Martin McGuinness why they're similarly abandoning their responsibilities in the north] In fact, this is what the Taoiseach’s answer was:

Hardly sufficient unto the day that’s in it. Rarely have I seen a single story that so completely condemns a generation of politicians for their lack of moral courage, and utter carelessness for the dictates of their own Constitution.

Secular ethics and Christian dogma have some strong consonances. But a modern, increasingly multi cultural nation like Ireland needs to develop a mature set of secular ethics that enable citizens to step up to their own moral and ethical responsibilities.

Right now, the Taoiseach is being made to eat his own words of just a few weeks ago: ‘I think that this issue is not of priority for government now’. Well, what about now Taoiseach?

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Comments (86)

  1. FuturePhysicist (profile) says:

    It was clearly a “triage” situation and doctors perhaps made the wrong call, if abortion were chosen doctors as human beings would be able to make the wrong call again.

    In the Republic, doctors are allowed to abort when there’s a risk to the physical health of the mother, having abortion even on demand would not change doctor’s ability to determine a treatment as even termination won’t remove all risks.

    In my opinion, if doctors are found to be negligent under the law they will be prosecuted Catholic country or not. The case should be looked without bias. In many occasions doctors have dismissed illnesses and injuries under similar terms that were more severe than expected.

    We need to have laws which acknowledge the fallibility of human beings as well.

    We seen the reverse of this situation where a Mary Stokes clinic carried out an abortion that resulted in the death of a woman. A similar triage situation, a more secularized version of “ethics” but the option taken didn’t save life either.

    So in my opinion it is a triage situation, as would choosing who lives and who dies from two equally critical patients in the recovery in a car crash. In that regards I would hope greater emphasis in put on the opinion of doctors on these matters than on judges and politicians.

    We don’t need secularists and religious people trying to override medical opinion just to get at the other side on these matters. Doctors should be the most pro-life, mother and baby of us all, and where there is a triage conflict be able to save the most likely to survive. It has nothing to do with dogmas one way or the other, but said doctors humble knowledge of medicine.

    We have had cases of babies being born to brain-dead mothers, and mothers only surviving due to a termination.

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  2. Mick Fealty (profile) says:

    FP,

    Here’s the critical clause in your contribution: “under the law”. There is no case law to resort to, nor professional guidance which offers clear pathways through.

    Given the esoteric offering of the 8th amendment, this practitioner appears to have resorted to the only viable ethics available to him, that of the Catholic church.

    As Liam Clarke has noted of the abortion law in Norther Ireland. It is a paper tiger, which saves the blushes of parliamentarians who cannot countenance bringing forward much less publicly debating an issue that daily puts medical practitioners into a deep hole.

    We don’t know all the clinical details of the Halappanavar case. But we DO know that political reps in all parties are kicking this ethical can down the road, and choosing NOT to deal with it.

    All the obfuscation in the world cannot hide that…

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  3. FuturePhysicist (profile) says:

    The fundamental point is “We don’t know all the clinical details of the Halappanavar case”, so claiming that “this practitioner appears to have resorted to the only viable ethics available to him, that of the Catholic church” is assuming we know both the legal and clinical details which have yet to be determined.

    It could still be argued that a devote Catholic who adheres to “Evangelium Vitae” and the “Catechism of the Catholic Church” does make the difficult decision to abort because it is better to save one life from two than none.

    There are other grey areas of medical ethics you could judge a doctor’s belief system upon, we need the Medical Council rather than the courts making these decisions.

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  4. FuturePhysicist (profile) says:

    Remember a doctor from Mary Stokes who made the determination to save one life from two still ended up losing both.

    Does that help her morality or society’s morality to do that?

    No, I don’t think there’s any good morale to come from such tragedy.

    Was it ethical to do that? Maybe, if it were a genuine attempt to save a life, but then “We don’t know all the clinical details …” and “this practitioner appears to have resorted to the only viable ethics available to him, that of the Mary Stokes Foundation”.

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  5. John Ó Néill (profile) says:

    Mick – there was an attempt to legislate for this in April – which was voted down. Full details are here. It includes a full list of who voted yes (tá) and no (níl).

    The Taoiseach not only refused to answer on when government would legislate for the X case, he responded with comments about ‘Baron’ Adams, West Belfast and MP salaries – it was a grotesquely inappropriate response.

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  6. Mick Fealty (profile) says:

    Thanks John!

    FP,

    What, and then wait another thirty years, or until the next tragic case occurs?

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  7. FuturePhysicist (profile) says:

    There’s always going to be obfuscation in medicine from doctors, if the goal is to kick out obfuscation in medicine you’d either have no doctors or we’d all be doctors, for want of a better word.

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  8. Alias (profile) says:

    Despite the fact that she was found to be miscarrying Savita was denied an abortion because ‘the foetal heartbeat was still present and they were told, “this is a Catholic country”.’

    Abortion is also heavily circumscribed in India, which is not a Catholic country, so the soundbite isn’t relevant. It is also circumscribed in protestant and Islamic countries.

    Still, it will form the basis for the sectarian caterwauling that will undoubtedly pass for comment on this case in the mainstream media.

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  9. Mick Fealty (profile) says:

    You are stubbornly missing the point. The Constitution says there is a choice to be made, and then we just let them get on with it because we’re Catholic???

    That’s far from moral, whether you are Catholic or NOT!

    And it’s not the way it gets done most other places in the western world either. Unless, of course, you know different?

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  10. Nevin (profile) says:

    “We don’t know all the clinical details of the Halappanavar case.”

    The Guardian is reporting additional information:

    Savita Halappanavar, who was 17 weeks pregnant, died of septicaemia a week after presenting with back pain on 21 October at University hospital in Galway, where she was found to be miscarrying.

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  11. Coll Ciotach (profile) says:

    If the lady had received a d&c would it have stopped the septicaemia?

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  12. Mick Fealty (profile) says:

    Nevin,

    See CC’s well timed question…

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  13. Alias (profile) says:

    Mick, that is an issue relating to an ineffective political class, having zero to do with Ireland being a predominantly Catholic country.

    If the claim is that the political class is useless, well, it took you long enough to figure that one out!

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  14. FuturePhysicist (profile) says:

    FP,

    What, and then wait another thirty years, or until the next tragic case occurs?

    No, what I’m saying is that every triage is tragic, there is no law on earth that is capable of preventing such tragedy, it would be naive to suggest otherwise. In some cases it is possible for a doctor to save all patients and in some cases none. You can debate every triage but you can’t change the outcomes.

    Doctors need to be objective over what lives they can and cannot save on a day by day basis, there shouldn’t be a law judging them by “years” but objectivity in the here and the now, case by case, rather than zealousness to rectify the past. Thirty years comment adds nothing diagnostically but a prerequisite.

    There is no need to blunt Occum’s Razor or rewrite the Hippocratic Oath with scope for uninformed legal and social interjections. I clearly said this should be a matter for the Medical council.

    There is no “ethical formula” that determines treatment because every treatment is individual, you have a different condition and a different case, and face different complications because of the latter two. To have predetermined laws based on one case to be transposed and juxtaposed on every other one is setting a precedent for even more tragedies .

    Far from promoting an “open minded” culture, it’s encouraging doctors to be dogmatic, it’s encouraging them to be pressured by non-medical opinion. There is no ‘open mindedness’ about trying to save a life, it’s not a scenario that encourages creativity as often there’s very little scope for correction.

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  15. Nevin (profile) says:

    Mick, I added the information because it is missing from the Irish Times report that has been linked. The other information information indicates there would have been a very high risk of septicaemia yet I can see nothing which would indicate that such a risk had been factored in.

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  16. Professor Yattle (profile) says:

    Interesting that someone who calls himself ‘Future Physicist’ turns out to be a rather old-fashioned Christian. Seems to fit in with much of what we’ve seen of our students recently.

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  17. Mick Fealty (profile) says:

    Nevin,

    I’m only saying that we don’t have the full picture, and we ought to be careful in that regard not to suggest we have a complete picture.

    My beef is not with the clinicians, but with a generation of lawmakers who seem happy to devolve the determination of what is what is not lawful to the poor chump charged with saving lives.

    I’m not saying that any of the choices are easy…

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  18. Robbie (profile) says:

    One wonders how many more of these cases need to occur before people start politically thinking and moving on this issue both down South and up here. It’s nigh on revolting, as is looking on to see those who would justify the situation make their qualifications about how this has little or nothing to do with the issue of a woman’s right to choose what she does with her body. If you don’t approve of abortion: don’t have one. But don’t force your morals on others. People need to learn this in both parts of this island some day.

    One also wonders what the rabble protesting outside Marie Stopes make of it. Not much I’d imagine: you can’t reach the genuine brain-dead. It brings to mind the guy bellowing on the Nolan Show a few weeks ago: ‘You want to make us like everybody else! Well we don’t want to be like everybody else!’ Says it all.

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  19. FuturePhysicist (profile) says:

    @ Nevin

    “We don’t know all the clinical details of the Halappanavar case.”

    The Guardian is reporting additional information:

    Savita Halappanavar, who was 17 weeks pregnant, died of septicaemia a week after presenting with back pain on 21 October at University hospital in Galway, where she was found to be miscarrying.

    That is awful, naturally we will see pro-choice camps calling it a complication of the pregnancy/miscarriage and pro-life camps calling it an unrelated condition which may have caused the miscarriage, there will also be conspiracy theorists saying that this is a media cover up.

    Naturally the legal definition of objective medicine would do little to change anything here. If it was the case that the doctor couldn’t detect the septicaemia in the first place then in all likelihood it wouldn’t matter where the doctor stood on the abortion issue, the patient needed antibiotics and an abortion would not be a substitute.

    I could understand a legal argument that a pregnant woman was denied antibiotics due to her pregnancy, but we don’t know if that was the case. That would still be a very complicated matter if the woman had an abortion too, as there is a greater risk of septicaemia after any surgery.

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  20. Scáth Shéamais (profile) says:

    Savita knew she was miscarrying and was in extreme pain so asked for a termination. The doctors refused because the fetus technically still had a heartbeat, and Savita died.

    There is no either/or in this situation where the doctors had to save one of the other, so I don’t know why FuturePhysicist keeps falling back on that.

    If the doctors didn’t want to Carry out the termination because they were worried about some kind of legal liability, well that points to a serious need to sort out the law. However, where do they get off telling the poor woman that “This is a catholic country” like it’s some kind of rationale for denying her treatment?

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  21. FuturePhysicist (profile) says:

    Professor Yattle (profile) 14 November 2012 at 1:22 pm
    Interesting that someone who calls himself ‘Future Physicist’ turns out to be a rather old-fashioned Christian. Seems to fit in with much of what we’ve seen of our students recently.

    You’re playing the man not the ball here, and whatever speculation you have about me contributes nothing to the debate, it just means you perhaps you don’t want to voice a counter-argument.

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  22. BarneyT (profile) says:

    The first thing that jumped out was the broken waters. If waters break, you have a 24hour period to ensure the child is born, otherwise you run the risk of serious infection, primarily for the child.

    Now, I’m no medic but surely the failure to bring the pregnancy to an end allowed a cocktail of bacterium to mature over the days that followed the initial detection of amniotic fluid. That is surely a major contributing factor in this poor woman’s death (assuming the infection made its way to the placenta and into her blood stream).
    The failure was twofold and the medics and the government are not off the hook on this one:

    1. The decision should have been made to end the pregnancy when it was clear the pregnancy was not going to mature towards viability. I can’t help feeling that the medics are culpable to some degree here as the onset of infection and the impact to the mother could surely have been foreseen. This alone should have triggered the termination using current guidelines.

    2. The medics were and remain ill-equipped solely because of the lack of “political action in this territory”. It is indeed needed and very much overdue.

    Now, I can live with a lot of crap…and flags and nationality and all the horse muck and take a hike. Its this kind of stuff that really makes me angry.

    Could this case be the catalyst for change?

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  23. BarneyT (profile) says:

    100% Scáth Shéamais

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  24. Nevin (profile) says:

    “we ought to be careful in that regard not to suggest we have a complete picture.”

    I agree – hence my use of ‘additional’.

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  25. oakleaf (profile) says:

    Is it not best practice for the miscarriage to happen naturally?

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  26. BarneyT (profile) says:

    It was the inaction and the lack of intervention that was at fault here. The infection timebomb was ticking so there only the process of decay and death was allowing to happen naturally.

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  27. BarneyT (profile) says:

    excuse typos…got emotional

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  28. FuturePhysicist (profile) says:

    Savita knew she was miscarrying and was in extreme pain so asked for a termination. The doctors refused because the fetus technically still had a heartbeat, and Savita died.

    There is no either/or in this situation where the doctors had to save one of the other, so I don’t know why FuturePhysicist keeps falling back on that.

    If the doctors didn’t want to Carry out the termination because they were worried about some kind of legal liability, well that points to a serious need to sort out the law. However, where do they get off telling the poor woman that “This is a catholic country” like it’s some kind of rationale for denying her treatment?

    I’ll concede I may have hastily jumped to assume a triage when there was none. I won’t retract any comments on that matter, other than it’s the only issue under which abortion is legal in Ireland.

    Nor will I’ll concede on my comments about the coldness of the medical practice towards people’s emotions as they have to look at everything in a medical context.

    From the point of view of objective medicine you would have to determine a probability between the back pain and possibility of miscarriage before making any choice.

    You would also have to acknowledge under Irish law the possibility that a miscarriage may be possible in less sterile grounds than a hospital which was not determined from something as obscure as back-pain.

    Again you would probably have the pro-life camp and pro-choice camps playing politics, when at the end of the day this was a doctor’s judgement call about a patient carrying a child with back pain asking for what he believed was abortion on demand, and we don’t know if abortion would’ve saved Savita’s life.

    So to me where the legal liability lies is in the doctor being able to determine any link between back pain and a possible miscarriage, which would be defined under Irish law as a “risk of life to the mother”. Doctors have to include the possibility of complications outside of supervision as part of their treatment plan.

    In terms of legal objectively, we can only prosecute doctors for decisions they make not on the sole basis of their outcomes. I will also repeat that the law cannot standardize treatments as conditions are not naturally standard.

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  29. BarneyT (profile) says:

    Are we not missing the point here. Infection, delay, more infection…and back pain..perhaps due to blood poisoning and organ failure?

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  30. FuturePhysicist (profile) says:

    oakleaf (profile) 14 November 2012 at 1:47 pm
    Is it not best practice for the miscarriage to happen naturally?

    No, in neither jurisdiction would the medical authorities advise that a spontaneous abortion over an abortion to save a mother’s life in sterile conditions. In fact there was a report talking about 73 cases in Northern Ireland and hundreds in the Republic of Ireland where a medical termination was carried out under current legal definitions.

    Only people looking for straw men believe otherwise.

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  31. FuturePhysicist (profile) says:

    Are we not missing the point here. Infection, delay, more infection…and back pain..perhaps due to blood poisoning and organ failure?

    Suggesting a medical misdiagnosis, if so what guards the patient against a legal misdiagnosis if not the doctor?

    Are you not just passing responsibility from one fallible human being to another?

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  32. BarneyT (profile) says:

    Perhaps I am reading between the lines and getting it wrong. Was there not full dilation and broken waters? Infection is a real risk, so perhaps I drew the wrong conlusion with regard to a progressive infection and her subsequent death.

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  33. Alias (profile) says:

    The autopsy gave septicaemia as the cause of her death, not her failure to secure an abortion-on-demand.

    Until or if the enquiry gives a link between the former and the latter, it’s a case of ‘Nothing but anti-Catholic, pro-abortion ranting to see here.’

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  34. FuturePhysicist (profile) says:

    Perhaps I am reading between the lines and getting it wrong. Was there not full dilation and broken waters? Infection is a real risk, so perhaps I drew the wrong conclusion with regard to a progressive infection and her subsequent death

    There are two investigations on that doctor’s assessment of that risk, keeping in mind that infection is also a risk from surgical procedures. You would have to ask why antibiotics wasn’t given in either case, you would also have to ask why infection risks in a hospital are not under control. You would also have to ask if the triage procedures which would’ve saved one life instead of none were easily ignored.

    Forgive me Mick if I’m gleefully pushing responsibility back onto practitioners here, it’s logical they have a high degree responsibility on these matters anyone who has spoken to a doctor who has “killed somebody” they couldn’t save could not believe that the matter could be rectified through sardonic judgements.

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  35. BarneyT (profile) says:

    Am I the only one looking at the possibility that the protracted labour (which is effectively the state you are in when you are fully dilated and the waters break) may have been a contributing factor to the infection…which over the days that followed contributed to septicaemia?

    The ability to recognise that the baby was not going to make it combined with a license to bring the pregnancy to a justifiable swift end using the “A” word may have saved her? No? How far off the beaten track am I?

    I’ll refer back..”This is tragic, and extreme. But those political activists who gleefully push the responsibility back onto practitioners now have a cast iron example of why political action in this territory is needed and long overdue”

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  36. Nevin (profile) says:

    The Irish Times story continues to be updated:

    Speaking from Belgaum in the Karnataka region of southwest India, Mr Halappanavar said an internal examination was performed when she first presented [Sunday].

    “The doctor told us the cervix was fully dilated, amniotic fluid was leaking and unfortunately the baby wouldn’t survive.” The doctor, he says, said it should be over in a few hours. There followed three days, he says, of the foetal heartbeat being checked several times a day.

    “Savita was really in agony. She was very upset, but she accepted she was losing the baby. When the consultant came on the ward rounds on Monday morning Savita asked if they could not save the baby could they induce to end the pregnancy. The consultant said, ‘As long as there is a foetal heartbeat we can’t do anything’.

    Again on Tuesday morning, the ward rounds and the same discussion. The consultant said it was the law, that this is a Catholic country. Savita [a Hindu] said: ‘I am neither Irish nor Catholic’ but they said there was nothing they could do.

    “That [Tuesday] evening she developed shakes and shivering and she was vomiting. She went to use the toilet and she collapsed. There were big alarms and a doctor took bloods and started her on antibiotics.

    “The next morning [Wednesday] I said she was so sick and asked again that they just end it, but they said they couldn’t.

    On the basis of this account, is it fair to say that the medical staff knew on Sunday that the baby couldn’t have survived and that a prolonged delay greatly increased the risk to the mother’s life? Was a consultant not available until Monday morning?

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  37. Alias (profile) says:

    “On the basis of this account, is it fair to say that the medical staff knew on Sunday that the baby couldn’t have survived and that a prolonged delay greatly increased the risk to the mother’s life?”

    It would be fair if it was given as a contributing factor in the autopsy report. As it stands, it’s pure speculation that is, presumably, designed to give longer legs to a non-story.

    Also, it makes no difference whether neither Mr Halappanavar is “neither Irish nor Catholic” since he is still subject to the laws of the state in which he resides.

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  38. Nevin (profile) says:

    “that is, presumably, designed to give longer legs to a non-story.”

    Alias, that is speculation.

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  39. FuturePhysicist (profile) says:

    If she was on antibiotics and still died of septicemia, it does bring a dilemma to any doctor as to what other interventions could be found. It is clearly a risk to carry out any surgical procedure on someone with septicemia and we are asking doctors not only to “respect a choice” but also to play against the odds here.

    No law would be able to determine Sevita’s prognosis here. Even with “equal status” this should’ve been considered a triage and medical decisions should be in favor of that most likely to survive which was determined to be the mother, we shouldn’t be quick to assume that the doctor’s motives were dogmatic before the investigations are complete.

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  40. FuturePhysicist (profile) says:

    Sorry let me correct myself, medical decisions in favor of the mother when there is no determined chance that intervention may save the child.

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  41. Mick Fealty (profile) says:

    Alias,

    We are mixing several things here. The equal right to life of the mother is in the constitution. At this point, we leave the teaching of the church behind.

    What we have is another case of ‘creative ambiguity’, ie, ‘it’s not a sin/crime if you don’t tell me about’, that you so dislike about the GFA’s effects on Irish sovereignty.

    Unless you are arguing that that provision be struck from the Constitution, you yourself are off ground so far as the Church is concerned.

    There’s a passive aggression around this in the sense that the important point of principle has been ceded in the constitution, but no one want to facilitate strong judgements in their field by issuing legislative guidelines for the interpretation.

    At the end of the day, clinicians will not fear to take tough decisions if they know there’s a line somewhere in the sand that allows them to take positive action.

    I’m not favouring one outcome over another, but I don’t think we can just continue ignore the problem.

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  42. Alias (profile) says:

    “Alias, that is speculation.”

    Yep, but I’d guess it’s much closer to truth than the speculation proffered by folks who are inventing the contents of an autopsy report according to the needs of a particular agenda.

    Where is it shown that the miscarriage caused her septis, and not vice versa? She was admitted with severe back pain so that could indicate a kidney infection, appendicitis, or other pre-condition.

    Like you, I’m not a doctor and do not have access to the medical details in this case so I’m a bit suspicious of the self-taught omnipotent medical professors who suddenly emerged to proffer a pro-abortion agenda on threads, media, et al…

    My view is that abortion should have been performed once her waters broke at 17 weeks for very obvious reasons but until we know the facts we know precisely nothing.

    The abortion fanatics will of course seize on this story because it is seem as linking religion (with only Mr Halappanavar’s word for that) to a pro-life position, thereby further spewing pro-abortion propaganda that such objections are not based on ethics or other secular values but are just ‘mere superstitions’ to be dismissed accordingly.

    Plus, of course, from the British media’s viewpoint, we have the uppity Irish (never fit to govern themselves) daring to govern others with said others suffering at the hands of the hapless Micks.

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  43. Alias (profile) says:

    Mick, I think the above reply to Nevin covers some of those bases.

    If it is the case that an abortion would have saved this mother’s life then, of course, there needs to be legal guidance on that. But is it the case? We’ll have to wait and see.

    Incidentally, euthanasia is quite a common occurrence in the Irish medical profession despite clear laws against it. Doctors make a decision not to save the patient’s life, and do it quietly. Should they do that? They’re not as observant of law (or the absence of it) as you seem to think.

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  44. Nevin (profile) says:

    The RTE timeline appears to differ from the account published in the Irish Times.

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  45. gendjinn (profile) says:

    The consultant said, ‘As long as there is a foetal heartbeat we can’t do anything’.

    This is false. The X case established the right of Irish women to an abortion if a pregnant woman’s life was at risk because of pregnancy

    [You want to field that legal case, go right ahead. Just leave us out of it! - Mods]

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  46. Desmond Trellace (profile) says:

    Here in Germany there are what they call Ethikkommissionen (statutory ethical review board) to deal with similar issues. They are advisory and the leglislature has the final word, of course.

    I know it is not a perfect system but would be better than the current faint-hearted vacuum.

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  47. If what has been reported is true, then the consultant clearly failed his duty to provide this unfortunate woman the care she needed. I think that, in Canada, he would certainly be struck off the medical registry and would likely face criminal charges. This was not a pro-life versus pro-choice issue. The woman was clearly very ill and the foetus had no possibility of surviving.

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  48. Mick Fealty (profile) says:

    None of my argument is predicated on the outcome of any such inquiry. It’s aimed dead square on the inertia at the heart of the political system, which holds it right that everyone just coast.

    The hub point is also not that this lady asked for an abortion and was refused it (as you implied earlier). But that there has been no public discussion of these dilemmas.

    Where the law actually stands at the moment is that you can do what you bloody well like with mother and baby so long as we don’t get to hear about it.

    Until the Marie Stopes issue arose, most people in Ireland, north and south, presumed that abortion was an alien. The kind of thing the British were good for taking off our hands so we don’t have to think for ourselves.

    And before you put me in the liberal fascist british entrist category, I understand only too well the conservative impulse to keep doors shut that may lead on to other much more problematic doors.

    That conservative impulse needs to be kept *very much* on the table IMHO.

    That it took a well educated foreign couple to blow a whistle on the elite’s fear of public discussion (or having to recognise that the breach with the church took place some 29 years ago) makes it all the more difficult to assimilate.

    Those were Irish citizens in Dublin and London today. I don’t believe in giving into mobs, and there is a reason why we grant permissions to politicians to do our business by proxy.

    But continuing not to talke about this should not be an option!

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  49. Mick Fealty (profile) says:

    joe, I am going to presume that that statement is legal.

    Now tell me this (anyone?): How do you parse a tiny clause in constitutional law to extrapolate a clear judgement in such a case: 1, without secondary legislation; or 2, causing utter mayhem?

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  50. FuturePhysicist (profile) says:

    Desmond Trellace (profile) 14 November 2012 at 7:48 pm

    Here in Germany there are what they call Ethikkommissionen (statutory ethical review board) to deal with similar issues. They are advisory and the leglislature has the final word, of course.

    I know it is not a perfect system but would be better than the current faint-hearted vacuum.

    In the Republic of Ireland’s there’s the Medical Council, but neither establishment can take the difficult medical decisions out of doctors hands or impose a standardized admission guides, differentiation guides, diagnostic guide, treatment guides, aftercare guides for every ill and ailment, particularly when those ills and ailments are not always known.

    We don’t have the capacity or the resources to save every doctor in every case from what seem in hindsight to be preventable mistakes, when there is so much capacity in medicine to make a fatal error.

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  51. Republic of Connaught (profile) says:

    We need to wait and see the clarified medical details of what happened before any firm judgement can be made. It’s a horrible story and sounds more like a case of medical negligence than anything else. They assumed her life wasn’t in danger and were wrong.

    On the broader issue, I don’t see in this day and age why Ireland has to try to be the beacon of non abortion in western Europe. It isn’t even a Catholic Irish thing; it’s an Irish thing. Because even an arch Protestant like Jim Allister I notice is very anti-abortion on this island. Which leads me to think many northern Protestants are the same.

    I don’t understand it, personally. Shipping Irish women off on boats or planes to next door England for the abortions is cowardly.

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  52. Mick,

    I was careful to say that “If true..” My second sentence would be predicated on that.
    But, you are totally correct that the underlying problem is the lack of clear legislation and guidelines for medical staff. In N.I. too, of course, with respect to guidelines.
    I wouldn’t fault a doctor who felt that he couldn’t perform an abortion because of religious beliefs; the duty of care would/should require him or her to turn over the care of her/his patient to another doctor who did believe it was proper to do what was medically necessary.

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  53. The Taoiseach is being reported as saying that the coalition government will introduce legislation but didn’t say when. Hopefully this tragedy will be the last such one.

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  54. Alias (profile) says:

    “None of my argument is predicated on the outcome of any such inquiry. It’s aimed dead square on the inertia at the heart of the political system, which holds it right that everyone just coast.”

    My cynical side nods approvingly at the latter part. However, I dare say that I could google “Mick Fealty” and “Hard cases make bad law” and find a match for your use of the maxim at some point.

    If anything (and we don’t actually have a confirmed case here where the life of the mother was not given precedence over the life of her unborn child) this would be the exception that proves the rule that no such law is needed.

    How many women have died in Ireland as a result of this missing law? Not a single confirmed case exists, so the only correct answer can be that none have died.

    Now we all know about the dangers of making laws in response to public hysteria and there is no reason here to suspend that good judgement.

    On the other side of the mother/child equation, how many children’s lives have been saved by the missing law? Probably tens of thousands so is it the vile case that the life of unborn child is deemed by the ‘enlightened’ to be utterly worthless and therefore doesn’t even factor into the equation?

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  55. Alias (profile) says:

    Incidentally, if you look at how a similiar law works in the UK, you’ll see that it is used as a pretext for abortion-on-demand so abortion occurs despite no risk at all to the mother – who merely has to make a bogus declaration that she would commit suicide if he state did not permit terminating the life of her unborn child.

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  56. Mick Fealty (profile) says:

    From above: “This is tragic, and extreme.”

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  57. BluesJazz (profile) black spot says:

    Alias, get real:

    http://www.womenonweb.org/

    Your ‘every sperm is sacred’ spiel is hopelessly undermined by contraception and the wonderful internet.

    Do you also wish to save the life of every runt of a kitten litter? While the racehorse Frankel costs £125,000 for an ounce of his sperm. We’re all animals.
    In Apes, we generally have a choice of mate.
    In our particular ape species we now have the choice to control how many offspring.
    Accidents happen, a lot of shit happens. The life of any unborn animal, cockroach or human, is subject to randomness. That’s the way the cookie crumbles.

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  58. Mick Fealty (profile) says:

    Caroline Simons, Legal Consultant to the Pro Life Campaign is saying on Vincent that in her view in the run-of-the-mill management of a miscarriage abortion is normal.

    But there is NO legal protections for a medical practitioner who takes a liberal view of risk to the life of the mother.

    Caroline says that Obstetricians have the option of taking therapeutic interventions including that of aborting the foetus where there is little chance of it surviving on its own.

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  59. Alias (profile) says:

    “But there is NO legal protections for a medical practitioner who takes a liberal view of risk to the life of the mother.”

    And that is as it should be. The test is that there should be a “real and substantial risk” to the life of the mother to justify the termination of the life of the child, not that a doctor may terminate life without being able to justify his action.

    A surgeon may take a ‘liberal view’ that your leg should come off if he has a golf appointment later in the afternoon and he can’t be bothered to repair the damage but, thankfully, there are legal consequences to such actions that serve to deter them.

    It is not for doctors to play g-d…

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  60. Mick Fealty (profile) says:

    We don’t need them to be god, but they day and daily have to exercise judgement in very difficult circumstances.

    What can be the objection to primary legislation on the matter?

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  61. Robbie (profile) says:

    A gem here:

    ‘Incidentally, if you look at how a similiar law works in the UK, you’ll see that it is used as a pretext for abortion-on-demand so abortion occurs despite no risk at all to the mother”

    It’s most uninteresting, and revealing, how such comments have no regard whatsoever for the life, or wishes, of the mother; she who goes through the ritual of birth. Orwell always wrote of the abuse of language – where phrases are recycled and peddled lazily, appealing to a kind of debased sentiment. So once again I marvel how such ‘pro-life’ supporters use such fatuous slogans as ‘abortion on demand’ – stock phrases which are inaccurate and calculated to shut down a debate from occurring.

    But then earlier the same person denounced those ‘immoral’ people (like me) calling for reform and the extension of the 1967 Abortion Act as ‘anti-Catholic’, ‘anti-Irish’, etc. Go figure. And wrong again, perhaps for the umpteenth time as someone else pointed out such attitudes are shared by Evangelical Protestants and Paisley’s crew, and have been for decades.

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  62. Coll Ciotach (profile) says:

    If the lady had received an ECPR would she still be alive?

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  63. Nevin (profile) says:

    I think the Irish Times’ calm dispassionate chronology of events and conversations articulated by Savita’s husband is in the public interest; it helps reduce the temptation by various institutions to be economical with the facts and, hopefully, it will calm down the more excitable elements in the pro-life and pro-choice camps.

    I’ve been keeping an eye on the Connacht Tribune website; it has relegated the tragedy to a series of brief snippets in Breaking News. There’s no opinion piece as yet; yesterday’s one is entitled “Big Breakfast holds the key to a new, healthier you!”. Today’s lead is “At long last – international recognition for the humble snack box!”

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  64. FuturePhysicist (profile) says:

    Mick Fealty (profile) 15 November 2012 at 6:28 am
    We don’t need them to be god, but they day and daily have to exercise judgement in very difficult circumstances.

    What can be the objection to primary legislation on the matter?

    Perhaps primary legislation is merely a bureaucratic reform rather than a real enabling device. Right now it is seems that this is more a face saving exercise than increasing the capacity for doctors to make as you call them “liberal” life and death decisions.

    Unless you have Private Healthcare you cannot choose your doctor, or dictate the way you want to be treated. Even the most “life-conservative” doctors knows that it’s his or her job to take calculated risks at times and produce routine care at others. It’s also their job in the current law to choose one life over another ideally not on their own preference, or even patient consent but on the logic of the improvement in survival chances their medical intervention is capable of producing.

    You cannot predetermine outcomes and at most complications, you can’t predetermine procedures, you are always at the mercy of a doctor or medical team’s ability.

    At the end of the day these tragedies happen at the hands of pro-life and pro-choice doctors, you cannot fully legislate against fate.

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  65. BarneyT (profile) says:

    Ye know, the more I read on this, the more I am inclined to wait for the full picture to emerge, in the hope that it actually does.

    The success of the enquiry will depend on the terms of reference that are established and these need to be made available for wider consumption and deliberation, to ensure the effectiveness of any enquiry.

    The enquiry needs to paint an accurate picture from initial contact through to delivery of the child and the mother’s subsequent death.

    • Based on the material in the public domain, it seems that the main cause is medical negligence and inaction.
    • It seems that infection was found and not adequately acted upon or given the seriousness that it deserved.
    • It appears that it was determined early in the cycle that the baby could not survive.

    If the enquiry establishes these facts, it needs to turn its attention to the decision making within the hospital and ask if the current legal guidelines (weak as they are) were sufficient to help the medics make a decision to abort in the interests of the mother health. It appears that there was enough in this case, to bring the pregnancy forward and induce birth.

    Now, before we turn to the issue of weak legislation, it needs to determine if the decisions made in the hospital were informed by faith or personal ethics.

    We may indeed find that those charged with making the difficult decision to (effectively) abort were shackled due to weak or insufficient legislation.

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  66. Nevin (profile) says:

    BarneyT, a scaled down version of the Hillsborough Independent Panel might be a sensible approach. A range of expertise both local and more distant was deployed.

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  67. BarneyT (profile) says:

    Its important that the truth comes out…now I’m sure that will start the hares running on other matters :-)

    A Fianna Fail friend of mine gave this opinion (quote below), which I think I agree with in some respects, but reject too on the basis that is maybe implies there is adequate legislation for abortion in general.

    “There should have been no issue under the law as it stands if treatment was considered medically necessary.”

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  68. Alias (profile) says:

    “What can be the objection to primary legislation on the matter?”

    The absence of need? Remember, nothing in law prevented this doctor from saving the life of the mother by terminating the life of the child. The doctor merely declined the mother’s request to terminate that life, as is right and proper. Had he believed the termination was required to save her life then, presumably, he would have done so – he could certainly have done so.

    It’s really a case of waiting for the results of the enquiry here and then considering what if any changes are required rather than reacting to media-engineered public hysteria that is designed to promote an abortion-on-demand agenda without proper consideration by the public and their legislative.

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  69. FuturePhysicist (profile) says:

    Now, before we turn to the issue of weak legislation, it needs to determine if the decisions made in the hospital were informed by faith or personal ethics.

    On the other hand I suppose if a doctor defies medical council opinion on a personal faith basis (not necessarily a religious one) and saves a life as a result (or regardless to be utterly cynical), said doctor should be struck off retrospectively in consistency with this legislation?

    If a doctor says a prayer helped him make a difficult decision in a triage situation we should clamp down on that sort of thing, but not a doctor who uses say a coin toss between equally likely to survive patients?

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  70. BarneyT (profile) says:

    Alias – this should not be seen as an opportunity for the Pro-life and Pro-choice campaigns.

    FP – I take your intellectual point, but its a distraction from the real issue and case in hand.

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  71. Nevin (profile) says:

    “media-engineered public hysteria that is designed to promote an abortion-on-demand agenda without proper consideration by the public and their legislative.”

    alias, I seem to have missed that one. One of the media commentators is the Iona Institute’s David Quinn – linked in another thread – and I can’t see him pushing the line you suggest. As for Twitter, there’s a wide spectrum of views available there.

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  72. FuturePhysicist (profile) says:

    I’m slightly unnerved by some in the media to bundle together national ethics with medical ethics. Isn’t that simply just introducing nationalism into medical ethics?

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  73. FuturePhysicist,

    If what was reported said by the medical staff at the hospital is true – “This is a Catholic country…”, Then it wasn’t the media who introduced national ethics into medical ethics.

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  74. FuturePhysicist (profile) says:

    It’s possible to have two separate introductions. But I take your point that medical ethics should avoid nationalist labeling.

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  75. Alias (profile) says:

    “Isn’t that simply just introducing nationalism into medical ethics?”

    No, because all within a jurisdiction are accountable for their actions within that jurisdiction to those who are sovereign within that jurisdiction. There is nothing within Article 6 of the Irish Constitution that exempts the medical profession from such public accountability or that grants them the power to determine the requirements of the common good.

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  76. Alias (profile) says:

    “alias, I seem to have missed that one.”

    A bit like the proverbial Japanese solider who missed the end of the war then…

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  77. Alias (profile) says:

    “or that grants them the power to determine the requirements of the common good.”

    That derogates> that power to them.

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  78. Nevin (profile) says:

    “A bit like the proverbial Japanese solider”

    Alias, an example I gave was Iona Institute’s David Quinn – definitely unlike a Japanese soldier.

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  79. Coll Ciotach (profile) says:

    Again I ask if the lady got an ECPR would she be alive? Anyone?

    And by the way section 24.1 of the Irish Medical Ethics Guidelines are quite clear.

    http://www.medicalcouncil.ie/Information-for-Doctors/Professional-Conduct-Ethics/The-Guide-to-Professional-Conduct-and-Ethics-for-Registered-Medical-Practitioners.pdf

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  80. abucs (profile) says:

    What exactly do we mean by secular morals and ethics?

    If we mean morals and ethics “without God” we have a word for “without God” – atheist.

    https://www.christiancourier.com/articles/1533-atheism-the-no-god-religion

    “Secular” as it is being used is not some neutral half-way house.

    When people say they want a secular constitution / school system / politics / media etc they are asking for these institutions to be ‘without God’ which is an atheist institution.

    Let’s have people stop saying ‘secular’ and pretending to be neutral when they actually mean ‘atheist’ and want to be dominating.

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  81. Nevin (profile) says:

    “Let’s have people stop saying ‘secular’ and pretending to be neutral”

    abucs, words can be exceedingly slippery. Secular rules can mean those determined by a state institution rather than by a church one. eg state law rather than canon law. If the majority religious views of the parliament coincide with those of a church then it’s quite likely the two sets of rules would coincide. A problem would arise for the state if it is bound by the rules of a higher authority ie if it is not wholly sovereign.

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  82. abucs (profile) says:

    Hello Nevin,

    problems arise for the people when a state is wholly sovereign.

    I refer to the most successfull Chinese investment banker and liberal enlightenment figure He Di, commenting on the current handing over of power in the Chinese communist government when he said :

    ”The history of Germany and Japan in the 1930s shows that if statism fulfils its potential, it will lead the entire nation into catastrophe.”

    Read more: http://www.smh.com.au/world/building-chinas-enlightenment-20121111-29660.html#ixzz2CY15bode

    or Mussolini : All within the state, nothing outside the state, nothing against the state.

    Secular statism is very dangerous and loses support very quickly and resorts to oppression very quickly in response.

    A free society is one where there are checks and balances and strong non-state voices who also hold respect and authority.

    The wholly sovereign secular state paradise is a proven disastrous idea of the past. It promotes intolerance, narrow mindedness and a fragmentation of community.

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  83. Nevin (profile) says:

    abucs, Mick hasn’t defined his use of secular so we’re in a bit of a quandary. Secular statism might just be state statism.

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  84. Robbie (profile) says:

    Another spurious point about ‘secularism’. France is a largely Catholic country with substantial Protestant and Mulsim minorities. Yet France is a secular country. It has had its racial tensions in the suburbs surrounding Paris, exacerbated by the thankfully-departed Sarkozy, but functions a damn sight better than here. The sooner Ireland North and South is secular the better. ‘Without God’ is a wrongheaded phrase as God may or may not exist; we can have no way of knowing. Certainly Alias and others have no mental powers or line to God better than the rest of us, so the point is utterly void.

    Secondly, it is a telling point for this website and this society that if you look at what story generates the most interest it is not actually this one, let alone issues about health, education or welfare. The most commented-on story – double in fact those commenting on this – is the highly significant issue of the Alliance Party ding dong with the Unionist Parties over those all-important flags again! Tells you where people’s true interests and passions (unfortunately) lie here.

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  85. BarneyT (profile) says:

    Below contains various comments from Catholic bishops (article lifted from rte.ie)

    The bishops’ group said the Catholic Church has never taught that the life of a child in the womb should be preferred to that of a mother but that both had an equal right to life.

    It also said there was a moral distinction between “the direct and intentional destruction of an unborn baby” and medical treatments which do not intentionally seek to end the life of the unborn.

    The bishops said current law and medical guidelines in Ireland allow nurses and doctors in Irish hospitals to apply this distinction in practice “while upholding the equal right to life of both a mother and her unborn baby”.

    This line, “the direct and intentional destruction of an unborn baby” illustrates why we need clarity and supporting legislation.

    The baby’s heart was beating, but it had no future. Direct and intentional intervention was necessary and it would have led to the destruction of the baby. The medical treatment necessary would have led to the death of the child. The right to life of the child was at this point moot, as life could no longer be offered to the child, but it could have been preserved for the mother.

    Clearly the medics should have followed up quickly with a delivery\termination as soon as it was confirmed the child would not survive, particularly in light of the pain the mother was in.

    However, I can now see why the medical staff may have stalled as their actions would (in their thinking) have introduced the baby into an environment where it would die, irrespective of the fact that it would later die in the compromised womb. This could be regarded as an intentional attempt to end the baby’s life….at that point in time.

    Without clear laws and solid protection for the medical staff, this will happen again. Our abortion laws are in my view informed by Church morals and ethics, and whilst the Church view remains unclear, any Church derived legislation on this matter will continue to fail. We cannot rely on the Church to remove their carefully designed traps and pitfalls, so the Government has to legislate independently now….and not worry about rewarding Sinn Fein a quick win!!!

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  86. Alias (profile) says:

    “Direct and intentional intervention was necessary and it would have led to the destruction of the baby.”

    That’s the doctrine of double effect. The intent refers to the purpose of the act, i.e. to save the life of the mother where the life of the child could not be saved. Therefore, the intent is not the “destruction of the baby” but the survival of the mother. That does not contravene Church teaching. If, on the other hand, the intent was simply to kill the child then that would fall foul of Church teaching.

    Keep in mind also that you don’t have a clue what religion the doctor has, if any. Even if he has a religion it doesn’t follow that he misunderstood its doctrines and acted accordingly, so you are making a lot of assumptions there that are not based anything substantial.

    If there was, in the doctor’s opinion, a real and substantial risk to the life – as opposed to the health – of the mother then he could have performed an abortion under the existing precedent law. He can’t perform it if the purpose is simply to ameliorate short-term pain.

    If the enquiry finds that the delay contributed to her death then there is clarity needed in law about whether it is legal to perform an abortion in circumstances where it would not survive even if the abortion was not performed. No point waiting for the Courts to decide that when that is what he pay the political class to do…

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