'Why is simple treatment not available even when a mother's life is at risk?'
One woman tells her story of cancer and pregnancy because she does not want others to go through what she has
MICHELLE HARTE felt it must have been a sign from above.
She was told she was probably infertile as a result of cancer treatment. In the meantime, a tumour in her liver had disappeared, while another in her lung had shrunk significantly as a result of new immunotherapy treatment. Things were looking up. She wasn’t going to be cured of cancer, but it looked as if she was making good strides in managing it.
Then, at the age of 39, she found out she was pregnant.
“It seemed like a fairytale. I was pushing 40 and had thought I’d never have another child,” she says. “I couldn’t believe it. I wanted to keep my baby. I thought, ‘There must be a reason for this’. I was even thinking that maybe the pregnancy hormones might cure the cancer. That’s the way your mind works. I was on top of the world and was determined to keep the baby.”
Her euphoria didn’t last long. The consultants told her that having a baby in her condition was highly dangerous. It would mean months without cancer treatment, at a time when she was due to start a new round of immunotherapy.
“I went to see my oncologist who referred me to a gynaecologist. From that referral, it took just two days to come to a decision that it just wasn’t viable. It would be too big a risk. It would put too much stress on the baby. And they wouldn’t be able to monitor me. I was devastated, but I knew there wasn’t any alternative.”
TERMINATING HER pregnancy, then, was the safest option. First of all, an ethics forum at Cork University Hospital – where she was receiving her cancer treatment – needed to authorise an abortion before it could take place.
“The doctors I was dealing with felt there wouldn’t be a problem. They weren’t directly involved in the ethics committee, but there was never any suggestion that there would be a problem,” she says.
“I had cancer, after all, and it wasn’t going to go away. It had stabilised for the time being, but there was no hope of a cure. The way the consultants described it was that the cancer would ‘seriously affect my lifespan’. I didn’t want to know how long I had left, because I didn’t want to be clinging on to a date.”
The ethics forum is made up of medical and non-medical people who consider any cases brought before them.
In a statement, the Health Service Executive said yesterday that the ethics forum typically meets within “48 hours for emergency meetings and carefully considers any case brought before it in light of the Irish Constitution and amendments to the Constitution”.
Abortion is legal in Ireland in cases where the life of a mother is at risk. However, the lack of legislation setting out detailed guidelines on the circumstances in which a lawful abortion can take place has long been a source of controversy.
Last week the European Court of Human Rights found the State had violated the rights of a pregnant woman in Ireland with cancer who said she was forced to go abroad for an abortion.
In the end, Ms Harte recalls that it took a number of weeks for the ethics committee to come back with a decision. There was a delay of several days in the committee meeting, she says, and based on her diary entry estimates it took about two weeks for a decision.
Her condition was beginning to worsen when she received a phone call: the forum decided she was not eligible for a lawful abortion in Ireland.
“I couldn’t believe the decision when it came. Neither could many of the doctors who had told me informally that it shouldn’t be a problem. I was basically told that I couldn’t have an abortion. Apparently, my life wasn’t at immediate risk. It just seemed absolutely ridiculous to me,” says Ms Harte.
Travelling to England for an abortion was now the only option. Every day counted in having the abortion and resuming her cancer treatment. But she wasn’t ready to travel.
Her UK passport was out of date. On top of that, finding a clinic to perform the abortion on such a vulnerable person meant finding a hospital. A private clinic would have been less likely to terminate the pregnancy of a vulnerable woman with complex health problems. By this stage she says she was about 10 or 11 weeks pregnant.
“If I had realised that I needed to go to the UK for an abortion, I would have sorted everything out. But no one mentioned it as a real possibility. It came as a real shock that I couldn’t have the procedure done here. I didn’t have the money. I didn’t even think I’d be fit for travel.”
MS HARTE’S consultant helped organise an abortion for her at St Thomas’s Hospital in London. By this stage she was growing progressively weaker, and had to be helped on to the aircraft by her partner, Neil Doolan (28).
“She was very unwell,” says Doolan. “She was very stressed out, physically very weak, nauseous, vomiting. We couldn’t afford a taxi to the hospital, so we had to get a train, and then the Tube, and then walk to the hospital. All of that was difficult.”
Ms Harte, who has worked as a nurse for 20 years, had been on disability benefit since she was diagnosed with cancer; her partner, who has spent five years studying at college, is unemployed. They say they got a loan from her family to help finance the trip.
At the hospital the plan was to have a medically induced abortion, which is the least invasive procedure. However, this failed on three occasions because her pregnancy was too advanced.
After five days in hospital, doctors decided to perform a surgical abortion.
This normally involves a general anaesthetic, but this was deemed too risky because of Ms Harte’s condition. Instead she was administered a form of gas which left her semi-conscious.
Following the abortion that evening, the doctors advised her to stay an extra night under observation, but Ms Harte said she had to go. She and Mr Doolan had a Ryanair flight booked at 6.30 the next morning and couldn’t afford to miss it.
Two hours after the abortion they got on a train and found a B&B close to Stansted airport; she remembers catching a few hours of broken sleep before they had to get up again in time for the flight home.
“The whole experience was horrendous. At home, I was very much left on my own. There was no follow-up or support, either medically or emotionally. The Hope Centre in Wexford were brilliant. But apart from that, it was back to the hospital and continuing with the cancer treatment as if nothing had happened.”
At home, her condition began to deteriorate quickly. She says she began to get awful migraines and visual distortions.
When she got a scan in early September of this year, the news from the consultants was bad: the cancer had become more aggressive. It had spread to her brain.
“I was very shook,” she says. “I’d thought that maybe I’d be able to keep plodding along as I had been. But now it was official: it was serious and it was terminal. I knew this meant there was a very serious decline in my progress.”
Plans to resume with a new round of immunotherapy were abandoned in favour of radiotherapy and chemotherapy.
YESTERDAY WAS just another day for Michelle Harte.
She was feeling a bit dizzy and nauseous, mostly the side-effects from the medication she is on. She also lost her hair two months ago following radiotherapy.
The most upsetting aspect of her condition, she says, is the way it impacts on the life of her seven-year-old son.
“He finds it hard that his mummy isn’t able to do the things she used to do before with him, or spend as much time with him as she used to,” she says.
“I did get to travel to Eurodisney with him immediately after the radiotherapy, which was difficult, but it was great to spend time with him . . . My hair started to fall out on the last day . . . It was shocking at first, and people react very strangely, but I’m used to it now.”
Ms Harte is due to have another scan in January to see how the cancer is progressing, and, possibly, another dose of radiotherapy. She doesn’t know, and doesn’t want to know, how much longer she has left.
Her motivation in telling her story publicly is simple: she doesn’t want other women to go through what she has.
“I would hate to see others going through this. It’s so tough when you’re not well to feel like you’re being judged for something which should be a simple procedure,” she says.
“The delay is having an abortion could well have made my condition much worse. It certainly didn’t help. Individual consultants who have treated me have been great. But why is it that such a simple medical treatment is not available, even when a mother’s life is at risk?
“Anyone else who was even half as sick as I am shouldn’t have to uproot themselves and fly over to England. It’s not fair and it’s not humane. ”