1992 – 2012 Legislating for X and Savita?

Savita Halappanavar was a 31 year old Indian dentist based in Galway, Ireland. She was married to Praveen Halappanavar who was a 34 year old engineer. Savita was pregnant. On the Sunday 21^st October 2012, she presented to University Hospital Galway with back pains while in her 17^th week of pregnancy.

Sadly, hospital staff told her she was miscarrying her pregnancy but there was still a foetal heartbeat present.

The doctors in the hospital told Savita and Praveen that her cervix was fully dilated and that amniotic fluid was leaking. They also told Savita that the foetus would not survive – but it would be over in a few hours.

For the following three days, Savita was upset and in “agony” but according to Praveen she had accepted that she was having a miscarriage and the doctors continued to check the foetal heartbeat. She asked the doctors on several occasions to terminate her pregnancy. They had said there was no prospect of the foetus surviving.

On Monday 22^nd October, the consultant did ward rounds. Savita asked the consultant if there was no prospect of saving her pregnancy, could doctors induce to end the pregnancy instead. The consultant responded “As long as there is a foetal heatbeat, we can’t do anything.”

The same conversation took place with the consultant on the morning rounds of Tuesday 23^rd October, and the consultant said that nothing could be done, as it was “against the law” and “this is a Catholic country.” Savita responded that she was a Hindu but the consultant said that there was nothing to be done. During that evening, Savita began to shake and shiver. The pregnant 31 year old began to vomit. She went to the toilet where she collapsed. Doctors took blood tests and gave her anti-biotics.

On Wednesday 24^th October, Savita was still sick, and she and Praveen again pleaded with doctors to end her pregnancy and the response was unchanged from the previous days.

It is the law. It is a Catholic country. There will be no termination.

An open cervix has the same risk of infection as an open head wound.

Her cervix had been dilated since Sunday.

At around lunchtime, the foetal heart stopped and doctors brought Savita to theatre where they removed the womb contents. After the procedure she spoke to her husband Praveen, but she was very sick. This was the last time Praveen spoke to his young wife.

At 11pm that night Praveen received a call from the hospital to say she was being moved to an intensive care unit. Her heart was low. Her pulse was low too. Her temperature was high. The doctors said she was critical but stable.

By 7pm on Saturday her heart, kidneys, and liver were no longer functioning. She had contracted septicaemia and E.coli ESBL.

Savita Halappanavar, 31 year old Indian dentist, and wife of Praveen, died during the early hours of Sunday morning in this “Catholic country”. Praveen brought his wife home to be cremated in India. She was laid to rest on November 3^rd.

Savita should have been celebrating Diwali this week with her husband.

Instead, the Health Service Executive have started an investigation in to her death and University College Hospital have extended their sympathy to her family and friends. External experts are being consulted and a ‘risk review’ is being carried out.

Under Irish law, the Supreme Court decision handed down in the 1992 X Case, Savita would have had a right to a legal termination of her pregnancy where there was a “real and substantial risk to her life.” There must not merely be a threat to a woman’s health. She must be at risk of death for an abortion to be performed legally in Ireland. But it is a Constitutional right in that case, according to the Supreme Court.

There is no legislation to give effect to this though.

Seven different governments have decided that women at risk of dying as a result of their pregnancies are not important enough to provide a law for. There are no legal rules to say to a doctor that yes, an open cervix for a number of days is a risk to a pregnant woman’s health, or that it may be such a risk to her health that it veers in to the category of being a risk to her life, and she is therefore constitutionally entitled to an abortion. Yes, the medical profession will know when a woman is at risk and when she isn’t, but there is no clarity as to whether there is legal cover for them to be able to act in a case such as Savita’s. They could be liable for severe penalties under the Offences Against the Person Act 1861 if they are found to not have the legal cover required.

Perhaps the doctors in this case genuinely felt that there was not such a high risk of infection and that this did not reach the very high standard of being a “real and substantial risk to her life”. However, the response the consultant gave Savita and Praveen while she was pleading in agony for a termination was that it was “against the law” in “this Catholic country” – rather than “you don’t actually need a termination.” Strange that.

The European Court of Human Rights said during the ABC v Ireland case that women should know under what circumstances they are entitled to a lawful termination in Ireland. It is a ruling based on the constitutional law of Ireland.

For many years, some prochoice activists have been of the clearly held view that, when it comes to the political establishment, someone would actually have to die before the Government would legislate for the Supreme Court decision in the X Case handed down twenty years ago. If the HSE inquiry finds that Savita died as a result of not receiving a termination, leaving her open to the massive risk of infection which eventually killed her, this Government, and the six Governments that have gone before them must realise her blood is on their hands. That is not to be melodramatic about things. A woman has died. If the HSE inquiry finds that Savita did not die from being prevented from having a termination and it was something else, her story will still send shivers down the spines of every woman in Ireland who has had a miscarriage who may well think “what if that had been me? What if the foetal heartbeat hadn’t stopped when it did?”  – because under those circumstances there is still a real and substantial risk of death. The fact remains, there are some conditions that will arise in pregnancy that will make the pregnancy itself life-threatening.

At this stage, it is either wilful ignorance or complete and utter misogyny that prevents the Government in Ireland from legislating for the X case to allow women in life-threatening situations have abortions legally and safely. The ABC case judgment was delivered in 2010. The Government responded by convening an Expert Group to examine “options” rather than actually produce legislation. The time is now over for the Expert Group.

While the Expert Group are examining, there is no way of knowing whether there is a woman in a hospital somewhere in Ireland with a dilated cervix miscarrying and pleading for a termination to take place. We have no way of knowing whether there is a woman contracting the e.coli that will kill her at this very moment because doctors have refused to terminate her pregnancy.

It is time to legislate for X. Savita Halappanavar should not be dead.

This must never happen again.