Catholic Medical Quarterly Volume 63(4) November 2013

Abortion and Ireland:
Management of second trimester septic spontaneous miscarriage.

Statement by MATERCARE INTERNATIONAL

The recent death of Savita Halappanavar in Ireland is a tragic loss and has generated much discussion and debate but should not be exploited by abortion advocates in order to advance their own political ideology and agenda. Criticism of the Catholic Church paired with a concerted effort by lobbyist groups attempt to capitalize on this loss in order to change the Constitution of Ireland so that it would permit abortion on demand. It is unwise and unproductive to discuss using this incident as a grounds for any legislative change or to frame the incident as a bench marker for the standard of practice and care that takes place in Ireland. It is the intention of this paper to discuss the standard of practice and the ethical approach that is expected and ought be taken concerning these kinds of prenatal cases.

Severe second trimester septic abortion in practice is a life-threatening complication which usually results in the death of the unborn child and of the mother if not treated vigorously. Such clinical situations, although not common, present the obstetrician with serious ethical dilemmas.

In considering the treatment options the following rights must be taken into consideration.

 1. Right to Life

“Bodily life is a fundamental good; here below it is the condition for all other goods’. The commandment “Thou shall not kill” has absolute value when it refers to the innocent person (the mother) and all the more so in the case of weak and defenseless human beings (the unborn child). As far as the right to life is concerned, every human being is absolutely equal to all others and this right is applied universally. The moral norm prohibits the direct taking of the life of an innocent human being.

2. Right to Respect

Every mother has a right to respect for her dignity, religious, moral, social, and cultural values, and the right to be free from every form of unjust discrimination or coercion, during pregnancy and childbirth.

3. Right to Treatment

Every mother and every child has the right to the treatment and care needed to try to ensure the survival of each of them during pregnancy and childbirth; nothing must ever be done deliberately and directly which causes or which is intended to cause the death of either of them, nor must anything morally upright be deliberately omitted in order to provoke the death of either; essential obstetrical care must always be provided.

4. Right to skilled care

Every mother and unborn child has the right to competency in all the skills associated with the care for herself and her unborn baby. In addition legal and social considerations are a fundamental part of the obstetrician’s remit.

5. Right to compassionate care

There must be profound compassion for the mother, her husband or partner and their families no matter what their religious beliefs.

Definition

An inevitable miscarriage is one that is imminent and cannot be prevented. It is characterized by bleeding, uterine cramps, ruptured membranes and cervical dilation, and presentation of the foetus at the cervical os and also infection.

Standard Management

Current practice is to treat with antibiotics and to induce premature labour. MaterCare agrees with the opinion of Dr John Bonnar, Professor of Obstetrics and Gynaecology who explained, in 2000, to an all party Irish parliamentary Committee considering abortion:

 ‘In current obstetrical practice rare complications can arise where therapeutic intervention is required at a stage in pregnancy when there will be little or no prospect for the survival of the baby, due to extreme immaturity. In these exceptional situations failure to intervene may result in the death of both the mother and baby. We consider that there is a fundamental difference between abortion carried out with the intention of taking the life of the baby, for example for social reasons, and the unavoidable death of the baby resulting from essential treatment to protect the life of the mother”.

Such an approach is justified ethically by the Principle of Double Effect, (a time honoured principle based on Aristotelian principles), which states that is morally permissible to carry out a procedure that has two effects, one good and the other bad which are practically inseparable. In this case of septic abortion induction of labour is:

• Morally permissible in order to adequately treat the infection, thereby preventing the deaths of both the mother and her baby.
• The intention of the obstetrician to deliver the baby is a good effect allowing for treatment of the infection and the survival of the mother. The incidental and unintended bad effect, is the death of the baby from severe immaturity.
• The good effect of the induction outweighs the bad effect, which is not intended and is without bad will but is occurring in such grave circumstances which results in a bad effect, the death of the baby.
• The conscientious obstetrician must try to minimize the harmful effects.

With the exception of the rare and tragic case of Savita Halappanavar, Ireland’s practice of maternal medicine has been impeccable in recent decades. Ireland, along with other countries where abortion is not permitted by law, boasts one of the lowest maternal mortality ratios in the world. It ranks sixth lowest in the world for its maternal death ratio (5.7 per 100,000 live births), thus making it one of one of the safest places in the world for women to deliver their children. To dramatically alter these successful medical practices in order to cater to boisterous and uneducated lobbying would be a mistake.

According to the World Health Organization’s list of maternal mortality causes, 91% of all maternal deaths can be prevented by providing basic essential obstetrics alone. Abortion, both spontaneous and induced, accounts for the remaining 9% of maternal deaths, as well as the countless millions of lost lives of unborn children. With advances in technology and modern ultrasound, it is clear to the medical community and even the untrained observer that the obstetrician is caring for at least two patients, a mother and a child.

For many obstetricians, a maternal death resulting from a direct obstetrical cause, such as in the case of a septic miscarriage, is an extremely rare event which legalizing abortion will not prevent. What will prevent these deaths is intensive obstetrical care, provided with the intention of saving both lives.

In closing, let us not forget that 330,000 mothers die annually in developing countries, mostly of sub-Saharan Africa, where the 5th Millennium Development Goal (to reduce maternal death by 75% by 2015) is the most neglected due to lack of minimal maternity care and government focus on the issue. As a global community, if we really and genuinely wish to save the lives of women who die during childbirth, we must respect their rights as mothers and provide them with compassionate and skilled care.

Matercare is the Obstetric arm of the FIAMC

Click here to see subsequent debate related to this issue

Contact people

Dr. Robert Walley	Dr. Bogdan Chazan
Executive Director MCI	Chairman, MCI Council
Professor Emeritus of Obstetrics and Gynaecology	CEO, Holy Family Hospital, Warsaw, Poland
Telephone: +1(709) 579-6472

Email: info@matercare.org

Website: www.matercare.org