Sir, – The letter from Dr John Monaghan et al (May 1st) makes a number of points.
The signatories to the letter suggest that the opinion I provided to the Galway inquest into the death of Savita Halappanavar was a personal view, not an expert one. I do not accept this judgment of me.
I was invited by the coroner to provide one of four expert opinions to the inquest. I reached my conclusions after completing a forensic analysis of Ms Halappanavar’s hospital chart, review of all witness statements and review of the daily transcripts of evidence. The coroner and the lawyers present at the inquest accepted my opinion as expert. Any suggestion that the opinion I gave was not an expert one is to impugn my professional reputation.
As the signatories know well, I have nearly 40 years experience in the field of obstetrics. I am a former Master of the National Maternity Hospital at Holles Street and am currently the clinical director. I also recently served on the Expert Group established by the Minister of Health to advise the Government on the implementation of the European Court of Human Rights judgment in respect of the X case.
The writers suggest that I predicted with certainty Ms Halappanavar’s clinical course. This is entirely incorrect. I clearly stated that “on the balance of probabilities” Ms Halappanavar would still be alive today had her pregnancy been terminated on either the Monday or the Tuesday. It is indeed impossible for any doctor to predict any clinical outcome with absolute certainty.
The signatories then go on to assert their certainty that termination of pregnancy can be performed “where ruptured membranes are accompanied by any clinical or bio-chemical marker of infection”. This is a truly astonishing statement. It implies that an elevated white blood cell count, which is a non-specific marker of inflammation, on its own would justify a termination of pregnancy. Such an opinion would not surprisingly be welcomed by those advocating a complete liberalisation of the abortion law in Ireland because, if adopted, would truly “open the floodgates”. I suspect that many of our colleagues in active clinical practice would not subscribe to this view.
The Galway coroner’s conclusion made a recommendation that greater clarity be brought to the circumstances in which termination may be legally performed in Ireland. The signatories fail to acknowledge that I was critical of many aspects of Ms Halappanavar’s care, and these criticisms clearly informed the coroner in coming to his conclusions. Had a termination been performed on the Monday or the Tuesday it is likely, on the balance of probabilities, that Ms Halappanavar would not have died and therefore an inquest would not have been necessary. Termination on those days, however, was not a practical, legal proposition because of the law as it stands.
The signatories are correct in stating that there has been an increase in maternal deaths from sepsis. What they fail to say is that the increase is due to a resurgence of Group A streptococcal infection predominantly in the late stages of pregnancy and the post-partum period, and is therefore not relevant to the law on termination.
It is indeed important “that all obstetric units in Ireland reflect on the events in Galway”. It is equally important that Irish doctors have clarity regarding the law in this area.
Finally, all the signatories would do well to heed their own advice regarding the avoidance of polemical argument and desist from personal attacks. – Yours, etc,
Dr PETER BOYLAN,
MAO, FRCOG, FRCPI,
National Maternity Hospital,
Holles Street,
Dublin 2.