Silence and Denial Don’t Work: Ireland, Malta, the European Union and the Lessons of Savita’s Death


See all our coverage of the tragic case of Savita Halappanavar here.

Much has been said about the tragic death of Savita Halappanavar in Galway, Ireland last month. Even before seeing the outcome of the official investigation we can conclude that her death was the result of a combination of factors: inhumane laws, lack of guidelines on how to apply the laws that do exist, fear of prosecution on behalf of doctors, medical incompetence, influences of the most conservative wing of the Catholic Church over hospitals, and—as pointed out recently by Jodi Jacobson—a general climate of misogyny, poisoning both the medical establishment and society at large.

Twenty years ago, the Irish Supreme Court established that abortion is legal when a pregnant woman’s life is in danger. More specifically, it ruled that termination of pregnancy is lawful “if it is established as a matter of probability that there is a real and substantial risk to the life, as distinct from the health, of the mother, which can only be avoided by a termination of the pregnancy.” Please note how restrictive these words are: “real and substantial risk” and “life, as distinct from the health.” With due respect for a court that took a courageous step forward in a country where the issue of abortion is and was taboo under any circumstance, it is remarkable how the ruling goes out of its way to make this exception to the abortion ban as narrow as possible. Anyhow, these are the parameters. It is the law of the land.

But nobody knows how this rule should be understood because there is no further guidance. No written law, no guidelines, no official interpretation. So doctors in Ireland, whether pro- or anti-choice, whether in Catholic hospitals or elsewhere, must navigate around this. It may be that in Savita Halappanavar’s case, the situation was crystal clear: her life was in danger, the situation was acute, an abortion would probably have saved her, and doctors refused her care because they favored the life of her unviable fetus over hers. It is even likely that this was the case. But in most situations, threats to the life and health of the pregnant woman cannot be so clearly distinguished. Usually, a threat to life is preceded by a threat to health. So is a doctor to wait until a critical health situation turns into a life-threatening situation? It appears that way. How does this correspond with medical ethics? It doesn’t. I do not envy ob/gyns in Ireland. I cannot imagine the agony that they, or many of them, must experience when a woman shows up with pregnancy-related complications. This is not to take away any of the responsibility from those doctors or the hospital that treated, or mistreated, Savita Halappanavar. It is only to shed light on the context in which they are operating.

The Irish government thus refuses to make life a tad easier for doctors and thereby out of sheer cowardliness refuses to prioritize women’s right to life. Related is its general “no-see, no-hear” approach to the issue of abortion. As described brilliantly in a recent piece in the Irish Times, the government wishes that abortion didn’t exist so pretends that it doesn’t exist. There is no data on abortion in Ireland. Abortion under certain circumstances is supposed to be legal, but the government gathers no statistics on its occurrence. When asked a few years ago by the European Court of Human Rights how often the constitutional right to terminate a life-threatening pregnancy is practiced in Ireland, the government answered that it does not know. Because it is struggling to find out, but hospitals and doctors conceal this critical information? Of course not. It is because the government wants to uphold the myth that yes, theoretically such terminations are legal—this is convenient to report to human rights bodies and the UN, for example—but really, pregnancies don’t tend to threaten anybody’s life and so this  theory does not have to be turned into practice. Shouldn’t pregnancy be a happy occasion, after all? Let’s pretend it always is.

In Malta, another island-nation on the outskirts of Europe, abortion is banned altogether. Not only in practice but also on paper; under no circumstances is the termination of pregnancy allowed. Malta is heavily influenced by Catholic Church policies and there tend to be strong links between the Vatican and the Maltese political class. No official statistics on abortions exist in Malta either, but it is well-known that a number of Maltese women travel to the UK and to Italy for terminations every year. In contrast to Ireland, very little opposition to the harsh law is aired. Not because nobody thinks the law is unjust, but because, as one Maltese anthropologist recently pointed out, in Malta the issue tends to be discussed in terms of life or death for babies, and “who wants to kill little babies?”

What do Malta and Ireland have in common, that is in addition to being under strong Catholic Church influence and that the women living there are taking the toll (as always)? They are also both members of the European Union (EU). And being part of the EU means that they both nominate members to the European Commission, the Union’s powerful executive body. The European Commission members, or commissioners, are supposed to serve not as representatives of their home countries but as officials of the Union, as experts who will pursue the interests of the EU as a whole. Now, Malta is one of the smallest member states. And health is an issue on the outskirts of the EU’s mandate. In health matters the EU cannot issue binding legislation but only conduct research, publish recommendations and guidelines, disseminate best practices, and so on. Thus, the responsibility for health matters has been given to the small and somewhat insignificant member state Malta.

The former Health Commissioner, John Dalli, was recently forced to step down following accusations of corruption and now his replacement has been announced, Malta’s current foreign minister, Tonio Borg. True to his government’s official stance, Borg is a long-standing opponent to reproductive and sexual health and rights. He voted against the legalization of divorce in Malta in 2011. He is staunchly opposed to rights of same-sex couples. And, proudly involved with an outspoken anti-abortion group, he has advocated for introducing the ban on abortion into the country’s constitution so that it cannot be repealed by parliament or annulled in a court. This man has been nominated to be the primary spokesperson of the EU on issues related to health. The vote on his nomination will take place on Wednesday, November 21.

Before adopting the EU Treaty in 1992, Ireland received a guarantee that the Union would not touch its abortion legislation. During its accession negotiations in the early 2000s, Malta obtained the same assurances. And more generally, due to its narrow mandate on health, the EU cannot legislate on issues related to abortion or other reproductive health matters. In the hearing before the European Parliament last week, Tonio Borg eloquently assured concerned parliamentarians that he will abide by EU policies and that his personal views on abortion will not cause any problems as these issues fall outside of the EU’s mandate.

However, contacts in Brussels have testified that when former Maltese Commissioner Dalli assumed his position, most Commission initiatives—whether research, exchange of best practices, or recommendations—even remotely linked to sexuality or reproduction were stopped. And yet Dalli’s official profile was nowhere near as anti-women and anti-choice as Borg’s. The point is not whether the EU can legislate on abortion or not. The more important point is that the Union, and all its representatives, should stand for and defend the fundamental human rights that are enshrined in the EU Charter on Fundamental Rights and in other international treaties. Borg’s position appears to be that as long as he ignores the relationship between these values, which he as an official of the Union is supposed to embody, and women’s access to fundamental reproductive health care, including abortion, then he can do his job just fine. He seems to think, similar to the Irish government, that as long as he is silent about women’s need to terminate their pregnancies, and the rights violations that occur when abortions are denied to them, then maybe these ugly issues will simply disappear.

The Irish government has tried silence and denial for twenty years. Clearly, it doesn’t work.

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  • michaelofkells

    The foetus has rights.  That’s the law in Ireland and it is a democratically-enshrined principle of the Irish constitution.  

     

    The mother has rights too.    There is NOTHING in the Irish constitution that puts the right to life of the foetus ahead of a mother’s right to life.

     

    No doctor in Ireland  has EVER been prosecuted for carrying out a termination which, in the doctors clinical judgement, was required to protect the mother’s life.    (The linguistic gymnastics are such a surgical procedure which has the result  – but not the primary objective – of loss of the foetus, and has as its objective saving the mother’s life doesn’t count as an abortion.  )

     

    Please everybody;  stop using this tragedy as a proxy for a wider debate.

     

  • crowepps

    The ‘wider debate’ is about whether one of the ‘rights’ the foetus has is to kill women.  The ‘wider debate’ is about whether women do have the right to self-defense or whether “It is not better that the mother live the rest of her existence having had her child killed.”

    We have previously discussed the case of the young woman who died of lung cancer in the Dominican Republic because the Catholic Church wouldn’t allow her to receive standard medical treatment, and how passage of H.R. 212 would mean American women would inevitably join the women in Mexico and South America who die of untreated ectopic pregnancies because the Catholic Church won’t allow them to receive standard medical treatment, and the risks to children forced to carry incestuous pregnancies to term because the Catholic Church won’t allow abortions.

    In addition we discuss the thousands and thousands of women who die from illegal abortions, the thousand women who die every day from pregnancy and childbirth complications and those who have their physical and/or mental health ruined by complications of pregnancy, and those who are infected with HIV/AIDS because the Catholic Church insists every single act of sex (for women) must be structured as a religious ceremony about fertility.

    We even discuss those cases where some brave soul like Sister McBride resists the urgings of the Catholic Church that women should *want* to be martyrs and is punished for allowing a woman’s life to be saved.

    As women I guess we just have more of an interest in discussing those subjects than you.  After all, it’s not like it matters to *you* whether doctors stand by, selfishly worrying about whether the Church will get mad at them, while pregnancy complications kill women.  It’s not like it matters to you if the rights of the foetus just sort of *incidentally* end up being held to be more important than the woman’s right to life, over and over and over.  I’m sure you faithfully set aside a little time out of your busy life to to be really really *sad* about all those deaths and how terrible it is that morality and upholding the sanctity of the Church’s linguistic gymnastics *required* them to happen.

    The one thing I *have* noticed that apologists for the Church are always *eager* to discuss is how each and every one of those cases is a unique and individual tragedy, and how everybody involved just misunderstood things, and how nobody should talk until after they know every single fact of the incident, and how none of the incidents should be used as a proxy for the larger debate, and how it’s not like any case proves there’s some kind of PATTERN EVIDENT.

  • michaelofkells

    The ‘wider debate’ is about whether one of the ‘rights’ the foetus has is to kill women.  The ‘wider debate’ is about whether women do have the right to self-defense or whether “It is not better that the mother live the rest of her existence having had her child killed.”

     

    Yes – that is a wider debate.  But not in Ireland.  In Ireland, the foetus does not have the right to kill a woman.    Nothing trumps the mother’s right to life.  The law is clear about  that.   

     

    If there are countries which do not value and protect a mother’s right to life, it is right that we should question this.  But Ireland is not one of those countries.  Which is why it is frankly mystifying that this tragedy happened.  Tragic outcomes like this are not the norm, but are so rare, so shocking and so contrary to the superb standards achieved in Ireland in maternal and foetal health, that the entire nation is debating this tragedy.   

     

    It is needlessly insulting to suggest that women have more of an interest in discussing these subjects.  This stuff matters to everyone.

  • crowepps

    I think you’re being disingenuous because nobody can believe that “Nothing trumps the mother’s right to life” when they aren’t willing to legislate that principle, or that “The law is clear about that” when so obviously the doctors in this case believed that they were not allowed to abort a doomed fetus until the heartbeat stopped AND that they weren’t allowed to prescribe prophylactic antibiotics because they might have a negative effect on a doomed fetus.  The first could possibly be justified as misreading the law, but IF the law was clear the second could only be stupidity that rises to the level of professional incompetence and malpractice.  In fact, though, the articles have been clear that:

    The case has highlighted Ireland’s failure to legislate in line with a two-decade-old Supreme Court judgment that women should receive abortions in cases where the pregnancy places their lives at risk.
    http://www.windsorstar.com/news/Widower+rejects+planned+Irish+probe+into+death+wife+denied+abortion/7575028/story.html#ixzz2D5GgT08B

    I work in the legal field.  If there is NO LEGISLATION then the law is NOT clear.

    You could be right that this rarely happens, since most women whose health is compromised by their pregnancy complications can make it to England where real medical care is available to them, but since Ireland refuses to actually track medically necessary abortions statistically, tragic outcomes like this could be for all we know fairly common, and the shocking thing is that in this case somebody actually went to the press and created scandal by publicly complaining.

    As to whether my statement was insulting, sorry if you think so, but I think it is just the truth.  Women are discussing “if I get pregnant am I going to die while my obstetrician stands by and watches?” while men are discussing whether or not they are willing to sacrifice the woman or violate the ‘sanctity of life’ of a doomed fetus, but in either case finely parsing their philosophical opinions about whether somebody ELSE should die.  The difference in perspective may seem minor to you, but then that’s my point; you aren’t, and will never be, the one whose life is actually at risk.

  • give-em-hell-mary

    I suspect maternal deaths are shockingly under-reported everywhere, especially because of time lags that enable coroners to blame “other causes”, never mind that childbirth triggered those “other causes”.  The Washington, DC area has many maternal deaths found in The Washington Post obits.

  • ljean8080

    death in my area in years.Women with kids die from things unrelated to childbirth all the time.Look at Liam Neeson’s wife.her death was an accident unrelated to her giving birth.

  • crowepps

    The existence of reality doesn’t depend on your seeing it personally.

  • crowepps

    Michelle Harte, of Co Wexford, sued for violation of her human rights last year. In 2010, after she became unintentionally pregnant while suffering from a malignant melanoma, doctors at Cork University Hospital advised her to terminate her pregnancy because of the risk to her health. Her obstetrician was willing to perform a termination but was “hamstrung” by legal issues. The matter was referred to the hospital’s “ad hoc” ethics committee. which decided against authorising an abortion on the basis that her life was not under “immediate threat”.

    http://secular-europe-campaign.org/2012/11/ireland-another-abortion-scandal-emerges/

    and

    Michelle Harte (39) from Wexford told The Irish Times that doctors at Cork University Hospital advised her for medical reasons to terminate her pregnancy but then refused to carry out the procedure.

    A previous Irish court judgement had allowed such a procedure where the mother’s life was in danger. However the ethics committee refused to allow an abortion because they claimed no “immediate threat”.

    http://www.irishcentral.com/news/Terminally-ill-woman-refused-abortion-in-Cork-hospital–112236794.html