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Woman who was refused an abortion died as result of “medical misadventure,” inquest finds

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2617 (Published 23 April 2013) Cite this as: BMJ 2013;346:f2617
  1. Clare Dyer
  1. 1BMJ

An Indian dentist who died from sepsis in an Irish hospital after being refused a termination under Ireland’s strict abortion law was a victim of “medical misadventure,” the inquest into her death has found.

An inquest jury in Galway delivered the unanimous verdict in the case of Savita Halappanavar, 31, who was 17 weeks pregnant when she died of sepsis at Galway University Hospital on 28 October last year, three and a half days after a miscarriage.

After the verdict the Irish government promised to introduce legislation to clarify procedures for determining when a termination may be permitted if a woman’s life is at risk, the only circumstance in which abortion is lawful in Ireland.

The country has been under pressure to act since the European Court of Human Rights found in 2010 that the lack of an “accessible and effective procedure” to establish the possibility of a lawful abortion if a woman’s life was at risk was a breach of the European Convention on Human Rights.1

In its annual report this month the Committee of Ministers of the Council of Europe “invited the Irish authorities to take all necessary measures” to implement the 2010 judgment. It added, “The general prohibition on abortion in criminal law constitutes a significant chilling factor for women and doctors due to the risk of criminal conviction and imprisonment.”

The inquest jury endorsed nine recommendations from the coroner, Ciaran MacLoughlin,2 including that the Irish Medical Council should make clear the circumstances in which doctors could intervene to save the life of a mother. The coroner said that this would provide clarity to doctors and patients.

The case has focused international attention on the Irish Republic’s restrictive abortion laws. An obstetric expert witness, Peter Boylan, told the inquest that Halappanavar’s life was not at risk when she asked for a termination on the morning of 23 October. But by the morning of 24 October she had sepsis and there was a real and substantial risk to her life.

“The real problem was the inability to terminate prior to Mrs Halappanavar developing a real or substantial risk to her life,” he said. “By that time it was effectively too late to save her life.”

Other recommendations by the coroner targeted areas of failure in Halappanavar’s care, including a protocol for sepsis management in each hospital and effective communication between staff on call and those on duty.

Notes

Cite this as: BMJ 2013;346:f2617

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