A double misadventure
Medical misadventure. The words sound like a euphemism and seem hardly adequate to describe the sad, unnecessary death of Savita Halappanavar. The limitations of the inquest system, constrained to discern just the "who, where, when and how" of an unexpected death, not responsibility, offer the coroner and jury little scope And the jury's choice between "medical misadventure" and a narrative verdict, in truth, says less about their sense of what went wrong than their important and welcome rider recommendations.
But the recommendations were also, because of the nature of the process, unable to critically address the real ghost in the room, the legal understanding of medical staff that they were not able to perform a termination while there was still a foetal heartbeat or while Savita's condition was considered non-life-threatening. That understanding of the implications of the X case was not challenged although it is not shared to different degrees by much of the medical profession.
The profession's own ambiguous ethical guidelines, however, and the absence of statutory elaboration of the X case conclusions have left a legal and ethical vacuum into which Savita's doctors fell and which badly needs to be filled by the legislation that is being currently drafted. Had they been allowed it, a verdict of "medical and legal misadventure" might have been appropriate.
The jury's call on both the Medical Council and An Bord Altranais to provide new, clear guidelines is welcome and necessary, but not sufficient - such guidelines must be informed by new legislation. And such legislation and regulations need to take account of the words of Mr Justice Hugh O'Flaherty in his X case ruling that an abortion should be permitted when there is "substantial" risk to the life of the mother "though this does not have to be imminent as long as it is identifiable…The law does not require the doctor to wait until the mother is in peril of immediate death."
Would such a consideration have been sufficient on the Monday or Tuesday of Savita's last week to free doctors' hands to give her a termination? Perhaps. Perhaps not. We do not know if they seriously considered whether her condition might become life-threatening. But the legislation should also make explicit that women should not need to continue to carry a foetus that is clearly unviable and when such a foetus is threatening her health.
The inquest jury also drew attention to a series of breakdowns in communication, a weakness in protocols for testing and treatment, and dubious medical notetaking practises in the Galway hospital. These lacunae appear to have been particularly serious on the Wednesday morning as the sepsis developed with extraordinary rapidity. The HSE must ensure their recommendations are acted on promptly.