Tuesday, 19 February 2013

When losing even one mother looks like carelessness

Traditionally, there was nothing safe about giving birth to a child. 

In many parts of the world, it’s horrendously dangerous even today: in Chad, according to the CIA (yes, these guys taken an interest in everything), the rate of maternal death is 1100 per 100,000 pregnancies; even in far wealthier South Africa, it’s still 300.

That figure is particularly worth comparing with the rate in England as late as 1935, when it was between 500 and 600. In living memory, the rate of maternal death in England was getting on for twice as high as in South Africa today.

The 1935 rate, to set the figures in context, would see around 10 fit, healthy young women dying in England each day as a result of pregnancy. The actual figure is around 80 a year, and about half the women are already ill, most often with cardiological problems.

England now loses around 12 mothers per 100,000 pregnancy, a colossal improvement which perhaps represents one of the most striking advances in medicine in the last couple of centuries. The US does significantly less well despite its hugely more expensive healthcare system (21 per 100,000) but Ireland, curiously, does twice as well, at 6 per 100,000. And yet Ireland is undergoing a major exercise in soul-searching over maternal death, and with good reason.

Savita: tragic victim of rigid adherence to
one principle against all others
and not a litte incompetence

Last October, Savita Halappanavar was admitted to hospital suffering from an infection which was likely to end her 17-week pregnancy. A leaked report has found that medical staff failed to follow up a series of signs, including results of diagnostic tests, instead claiming that they thought it was someone else’s job.

The saddest aspect of this case is that when husband and wife asked for a termination of what was almost certainly a lost pregnancy, staff told them this couldn’t be done in Ireland, because ‘this is a Catholic country’. There could be no question of a termination while it was still possible to detect a foetal heartbeat.

The report concludes that the catastrophic end to the case ‘could have been avoided by earlier termination of pregnancy knowing that – without termination – the prognosis for the fetus and potentially the patient was poor.’

Yes. The prognosis was poor for the unborn child anyway, and refusing the abortion made it poor for the mother. 

In the event, after seven days in hospital, she went into septic shock and died.

Instead of losing just the baby, a rigid commitment to the principle of banning abortion led to the mother being lost too – condemned to die by 
pro-life thinking.

Commitment to principle is often commendable. But simplistic commitment to one principle above all others is miserably limited and, as this case shows, potentially dangerous. ‘Thou shalt not kill’ is surely an attractive principle only to those who don’t want to see below the surface of ethics. No principle has been so honoured in the breach. Why, Christianity which proclaims it came to power in Rome thanks to the Emperor Constantine’s success in war. And that’s without mentioning the crusades.

Any morality worthy of the name has to recognise that it will be woven of a wide range of principles that sometimes contradict; the points of contradiction are its real tests, because they can’t be addressed by simply referring to a book or a commandment, however sacred. Instead they depend on the exercise of judgement by people doing the best they can in difficult circumstances.

That certainly failed lamentably in Savita’s case. But what makes it particularly shocking is that in its defence of an unborn child against abortion, this simplistic morality cost both the child’s life and the mother’s. That’s not just a dereliction of duty; it’s shameful.

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