Questions to be answered about Holles Street case

The tragic case of a couple whose healthy baby was aborted in Holles Street on the grounds of an alleged fatal foetal abnormality would seem to have all the necessary ingredients for public attention: a devastating event involving a young family and questions about how our health system deals with people in crisis.

But if it were not for the efforts of Peadar Tóibín of Aontú raising it in the Dáil, it would have received very little coverage.

According to the couple involved, they first had a non-invasive prenatal test for anomalies in the private Merrion Fetal Health clinic. They were told after the results of two tests – the latter conducted in the National Maternity Hospital itself – that the case was black and white, that the baby had a fatal foetal abnormality. They have said that they would have had no difficulty caring for and loving a sick baby and that they initially never even mentioned the word termination but that is what they ultimately ended up having.

Public and private medicine is too entwined in this State and this leads to the odd situation that work carried out by a private clinic is indemnified by the State Claims Agency

After the abortion, they received the results of a test, which they say that they had to work out for themselves because no one had the kindness or courtesy to explain clearly that in fact, their child had been perfectly healthy.

Breda O'Brien: The pain of the Leaving Cert should be spread out over two years

---

Breda O’Brien: Aontú’s superpower seems to be invisibility

---

Breda O’Brien: Irish culture needs to learn how to deal with grief

---

Breda O’Brien: State must start nurturing marriages

---

Review panel

A review panel is being appointed and its work should get underway shortly. Let’s hope that it can shed light on what happened and in particularly on how support and information are given to couples in these very difficult situations.

Merrion Fetal Health, where the initial screening test was carried out, is a private concern run by five consultant obstetrician gynaecologists who work in Holles Street. The clinic states on its website that it exists because “the current public health system in Ireland is unable to cope with the existing demand and many patients and doctors seek ultrasound services in the private sector”.

Historically, the State has indemnified consultants both for their work in the public and private sectors. Public and private medicine is far too entwined in this State and this leads to the odd situation that even work carried out by consultants in a private clinic is indemnified by the State Claims Agency.

The legislation also demands that the Minister for Health be notified within a month of any abortions but it appears that did not happen

In terms of how the events played out, the hospital is precluded from responding, on the basis of patient confidentiality, so we do not know its take on what happened and will have to await the outcome of the review to discover this.

Questions are raised by what Tóibín told the Dáil. He said that the family has claimed that the abortion did not comply with all the steps set down in the legislation. The Health (Regulation of Termination of Pregnancy) Act 2018, section 11 states that a termination may be carried out after two practitioners “having examined the pregnant woman, are of the reasonable opinion formed in good faith that there is present a condition affecting the foetus that is likely to lead to the death of the foetus either before, or within 28 days of, birth”.

The interaction between medics and the family in this case and the precise responsibilities of medics in such cases will – we presume – be a key issue for the review. Tóibín told the Dáil that, according to the family, the second medical practitioner never even met the mother, much less examined her. Can that be judged to meet the new legislative demands? If a the second medic only examining the patient information can that be deemed to be sufficient?

The legislation also demands that the Minister for Health be notified within a month of any abortions but it appears that did not happen, either. How are we to trust abortion figures if, this early on, basic procedures, such as informing the Minister, are not being followed?

Clinical guidance pathway

Another issue for the review to examine is that, if the family’s account is correct, the procedures were also in breach of the January 2019 interim clinical guidance pathway for management of fatal foetal anomalies and/or life-limiting conditions. The latter states: “The option of continuing the pregnancy with planned perinatal palliative care for the baby or terminating the pregnancy (in accordance with the Health (Regulation of Termination of Pregnancy) Act, 2018) should be discussed with the parents.”

This should happen in conjunction with a multi-disciplinary team. According to the family, only termination was presented as an option. Again, the review will have to come to an assessment of how this aspect of the case was handled.

There are hospitals in this country where the majority of families continue with a pregnancy even where there is a diagnosis of a life-limiting condition because they are offered compassionate continuity of care, including a dedicated bereavement midwife. As a result, parents have a chance to realise that despite the appalling heartbreak, they are still parents who have a role to play in their child's brief life .

The sad thing is that devastating stories, no matter how important, do not always garner the attention or support they deserve because they lack one ingredient – being in tune with the current cultural moment. A mere year on from repeal, staunch pro-choice advocates, including in the media, do not want to see any downside to our brave new regime. And that is a tragedy of a kind, too.