Two years ago, on October 28, Savita Halappanavar died a slow and painful death in Galway, Ireland. The inquest held in April 2013 considered reports of the Health Service Executive, Ireland (HSE) and Health Information and Quality Authority, Ireland (Hiqa) but dismissed them as “just findings in relation to Ms. Halappanavar’s death”. The final unsatisfactory verdict given by the legal luminaries chose the term “medical misadventure” to describe the ordeal suffered by the 31-year old Indian expat.

The inadequacy of the entire exercise is reflected in a statement made by Praveen Halappanavar, Savita’s husband – he still doesn’t know the real reason for Savita’s death. A year after her death the HSE was yet to make public its report and only in September, 2014, nine members of the medical team that attended to Savita were ‘disciplined’. Early this year a disheartened Praveen opted for a transfer to California, USA and the case of negligence against gynaecologist Katherine Astbury may not be pursued in earnest.

In India, there has been an unfortunate, continued silence from the obstetrician and gynaecologist fraternity with regard to this case. There seems to be a curious reluctance to lay bare the facts and state the obvious. Two years on, when neither home country nor host country have made an effort to answer questions and give a sense of closure to the bereaved family, revisiting the case and speculation based on available information and reports is justified.

On the morning of October 21, 2012 Savita, pregnant at 17 weeks, presented at the Galway University Hospital with a complaint of intense pain in the lower back. Amniotic fluid was leaking out of a fully dilated cervix. The doctors found sufficient evidence of a miscarriage and relayed the information to Savita and Praveen who resigned themselves to losing their baby. However, a request that labour be induced was declined with the doctors quoting Irish Catholic law that prevented them from aborting the live but doomed foetus.

It is strange that the same doctors who diagnosed miscarriage and refused abortion did not realise that a dilated cervix makes the sensitive and susceptible uterus vulnerable to infection. Sepsis associated with pregnancy starts innocuously but progresses rapidly and a combination of Amoxicillin-clavulanate is considered safe and used routinely to treat the condition. Yet the doctors waited two whole days, despite Savita’s violent shivering, to start on antibiotics from the night of October 23. Did these doctors have reservations about giving antibiotics in case the (already dying) foetus was harmed? There is no apparent medical reason for the delay in administering antibiotics since a 17-week foetus would never have survived outside the mother.

When the foetal heartbeat was no longer detectable (in accordance with Irish Catholic law) the doctors removed it on October 24. Perhaps the faulty placenta that triggered miscarriage killed the foetus. By this time, however, severe septicemia had set in, Savita’s condition rapidly deteriorated and she finally gave up on October 28. The last rites were performed on November 3 at Haveri, her native place in Karnataka, India. Her grieving family and friends struggled to come to terms with her sudden death and Praveen returned to Ireland to report for duty. For the University Hospital, Galway, Savita was a closed chapter.

Everything would have been quiet if the Indian expat community in Galway hadn’t cancelled Deepavali celebrations in mourning the death of one of its founding organisers, Savita Halappanavar. On November 14, first the Irish Times (1), then British newspapers, Fox News, Al Jazeera and much later, the Indian media reported that “a pregnant Indian woman died in Catholic Ireland after being denied abortion”. Then Ireland seized the opportunity to demand a repeal of the anti-abortion law, quickly organizing candle light vigils and protests across the country. Savita became an excuse for Catholic-bashing and to say “my sect is better than yours”.

The whole issue thus got hijacked into a pro-abortion campaign that ended in an amendment of the abortion law. It is not as if abortion clauses were not defined - Article 40.3.3 of Bunreacht na hEireann (the Irish Constitution) guarantees “the right to life of the unborn child and the equal right to life of the mother. Abortion in Ireland is permissible only where there is a real and substantial risk to the mother’s own life” (2).

Irish policy makers have been accused of bowing to public pressure hoping to reap the dividends in the impending elections just as former Prime Minister Mary Robinson may have won the 1996 elections on the winning manifesto of making available all information pertaining to safe abortion practices. However, the amendment in the anti-abortion law attempts to define the circumstances under which pregnancy can be terminated and leaves little room for misinterpretation of the same by doctors.

Should the Catholic Church have gone on the defensive about its stand on abortion? Surely no one denies that an act of procreation should be undertaken responsibly while accepting the consequences. But Savita was not a giddy-headed teenager dismayed at the prospect of motherhood when she pleaded for an abortion. Perhaps the Church should look into a report published in the European Journal of General Practice (September 2012), where more than 70% of Irish doctors admitted that they were devout Catholics and practiced their profession accordingly. 51% agreed that women should be allowed to abort a foetus with 66% putting the upper limit of gestational age as 16 weeks (3).

Did Catholic indoctrination cloud the judgment of the University Hospital doctors and blur the fine and dubious line between a 16-week and 17-week foetus? Was this an error of judgment that cost Savita her life? If so, why didn’t the inquiry commission/coroner ask whether administration of antibiotics was delayed for fear that it might have affected and/or killed the foetus?

Following the verdict, the blame game was played out between Irish doctors who faulted the legal system, the legal system that hid behind religion and the powers-that-be (religious and political heads) that were/are defensively anti-abortion. Savita was nowhere in this confused picture and even now there are as many rallies by pro-life activists as there are by pro-abortion activists.

Ireland may have great statistics in maternal mortality, but its doctors are not infallible. It appears that in this case, an Indian expat died an agonizing death because of medical negligence - not a ‘medical misadventure’. Acknowledging this rather than ‘disciplining’ the guilty like errant schoolchildren is the least that can be done for Savita’s family. Being a good Catholic and not killing the foetus is all very well but being a bad doctor and killing the mother violates the basic Hippocratic Oath.

Savita unwittingly made it possible for the Irish anti-abortion law to be amended. Now scores of women in Ireland need not travel to England for abortion in case of miscarriage, where foetal abnormalities have been detected or when saddled with unwanted pregnancy following rape. On October 28, 2014, these grateful women held candle-light vigils in Galway and Dublin in the memory of Savita Halappanavar – the Indian woman who died so that Irish women could live (4).

References:

-        http://www.irishtimes.com/news/woman-denied-a-termination-dies-in-hospital-1.551412

-        Daly B. (2011)."Braxton Hick’s" or the birth of a new era? Tracing the development of Ireland’s abortion laws in respect of European Court of Human Rights Jurisprudence. Eur J Health Law. 18(4):375-95.

-        Murphy et al (2012). Termination of pregnancy: Attitudes and clinical experiences of Irish GPs and GPs-in-training. Eur. J Gen Prac. 18( 3):136-142.

-        http://www.irishtimes.com/news/social-affairs/savita-halappanavar-remembered-at-candlelight-vigils-in-galway-and-dublin-1.1979759

The author is a research scientist by training and consultant by profession