Irish abortion debate inflamed by pregnant woman's death

The death of a pregnant woman who was refused an abortion has reignited the debate over Ireland's near-total ban of the procedure, already under reexamination by the Irish government.

Tuesday night, even as a government-appointed "Expert Group" formally presented its advice on how to clarify Ireland's abortion laws, it was revealed that Savita Halappanavar, a 31-year-old dentist who was 17 weeks pregnant, had died in Galway University Hospital on Oct. 28 after being refused an abortion.

Ms. Halappanavar had asked several times for her pregnancy to be terminated because she was was miscarrying, according to her family. But her husband, Praveen, told reporters a termination was refused because there was a fetal heartbeat. Praveen also claimed his wife was told she could not have an abortion because Ireland was "a Catholic country."

A coroner's inquest and separate inquiry by health authorities are under way. The government has not ruled out a further, full public inquiry.

A controversial law

The news of Halappanavar's death broke late Tuesday as the government received the long-awaited findings of its Expert Group on the legal status of abortion.

Abortion is outlawed in the Republic of Ireland under the 1861 Offenses Against the Person Act. In 1983, the country strengthened its anti-abortion stance, amending its constitution to recognize a right to life in the unborn, "with due regard to the equal right to life of the mother."

However, a 1992 Supreme Court judgement known as the X Case ruled abortion was permitted if there was "a real and substantial risk" to the life of the mother.

And in 2010, the European Court of Human Rights stated that the Irish law was likely to result in legal terminations not going ahead as a result of doctors' fear of prosecution. The ECHR called for the law to be clarified, as "the criminal provisions of the 1861 Act would constitute a significant chilling factor for both women and doctors."

Pro-choice campaigners say this lack of clarity endangers women's lives, linking Halappanavar's death to it.

"Two decades ago, the Supreme Court ruled women have a right to an abortion if there is a risk to her life. The issue in this case is that doctors don't know what to do," says Sarah McCathy of campaign group Galway Pro Choice.

Against this backdrop, the emotive Halappanavar case immediately took on enormous political significance. Opposition politicians slammed the government, some demanding action to legislate for abortion.

"We warned [the government] that this would happen but they didn't listen," says independent socialist lawmaker Clare Daly. [Editor's note: The original version misidentified Ms. Daly's party affiliation.]

Ms. Daly, whose bill to legalize abortion in limited circumstances was defeated on April 19, says she plans to challenge the government.

"If they don't deliver, we'll be reintroducing our bill without further delay," she told the Monitor.

Irish Prime Minister Enda Kenny says the government will assess the expert recommendations in the next two days.

Mr. Kenny's conservative Fine Gael party is overwhelmingly anti-abortion, whereas the junior coalition partner, the center-left Labour party, is largely, though not entirely, pro-choice.

An avoidable tragedy?

Ireland's abortion laws are among the strictest in Europe, with only Malta's absolute ban more forthright. However, medical experts agree that Irish law allowed for a termination in Halappanavar's case.

Patricia Casey, professor of psychiatry at University College Dublin and consultant psychiatrist at Dublin's Mater Misericordiae hospital, says terminations go back several decades.

"It [the legal situation] is not confused at all," she says. "Even when I was an intern 25 years ago, women who had life-threatening pregnancies would have terminations, usually by induced labor."

"These are textbook scenarios. There is no moral issue about terminating a pregnancy in these circumstances," she says.

Prof. Casey, who opposes abortion, also says if a termination was refused on religious grounds, those responsible will have to answer.

"What we need to do is find out what went wrong in this case – and if someone did say 'you can't be saved because of a heartbeat,' or 'because Ireland is a Catholic country,' then there is the potential for a malpractice suit."

But Gerry Rafferty, consultant obstetrician at Mount Carmel Hospital in Dublin, told Newstalk radio in Ireland that while obstetricians in Ireland do perform terminations in cases where the patient is obviously unable to carry to term, the lack of case law means doctors are afraid to make decisions in more ambiguous circumstances, fearing being convicted of unlawful killing.

"Patients should know what they're entitled to. Doctors should know what they're entitled to do," he said. "The Supreme Court has made a decision on the [1992] X Case. Just let us know what we can and cannot do. We don't know where the gray areas are."

Health Minister James Reilly told parliament he found it unlikely "moral or religious beliefs" were involved in treatment not being offered to Halappanavar, and if it transpires that this was the case, it "would be a very serious matter." Dr. Reilly, a medical doctor, said if a miscarriage is likely, it is often the view of medical staff that allowing it to occur naturally is the safest option.

Nonetheless, pro-choice campaigners marched on the Irish parliament. More than 2,000 people assembled at 6 p.m., many with candles and placards, blocking streets. Simultaneous protests and vigils were called in other Irish cities and outside the Irish embassy in London. A further protest is scheduled for Dublin on Saturday.

Caroline Simons, legal adviser to Pro Life Campaign, cautioned against speculation.

"The difficulty is we know so little about the case. We just don't know the full story. Miscarriages occur routinely and we've never had a case like this before. Serious questions need to be asked," she says.