The Irish Catholic Bishops have seen fit to clarify the church’s view on gynecology given Savita Halappanavar’s death from sepsis at 17 weeks in her pregnancy and the concern that evacuating her uterus was delayed because the fetus still had a heart beat. The full statement is here, but this is the excerpt I find most troubling:

– Whereas abortion is the direct and intentional destruction of an unborn baby and is gravely immoral in all circumstances, this is different from medical treatments which do not directly and intentionally seek to end the life of the unborn baby. Current law and medical guidelines in Ireland allow nurses and doctors in Irish hospitals to apply this vital distinction in practice while upholding the equal right to life of both a mother and her unborn baby.

I spent quite sometime trying to understand how one could possibly translate this statement into medical care. I’ve been a doctor for 22 years and an OB/GYN for 17 years and I admit that I am at a bit of a loss. My three interpretations are as follows.

Terminating a pregnancy is “gravely immoral in all circumstances.” All circumstances includes 17 weeks and ruptured membranes. Unless I misunderstand the meaning of “all,” then Irish Catholic Bishops also view ending a pregnancy at 17 weeks with ruptured membranes and sepsis, either by induction of labor or the surgical dilation and evaluation (D & E), to be “gravely immoral.” They must also view ending a pregnancy for a woman who previously had postpartum cardiomyopathy and a 50% risk of death in her pregnancy as “gravely immoral.” So if you have a medical condition that is rapidly deteriorating because of your pregnancy, too bad for you if you live in Ireland. Because the mother and unborn baby have equal rights to life, Irish law spares women the anguish of choosing their own life. Neither can be first, so both must die.

The latest edition of the medical textbook of Irish Catholic gynecology defines “abortion” as elective abortion and “medical treatments that do not directly and intentionally seek to end the life of the unborn baby” as medically indicated abortion. I admit this interpretation is a bit of a stretch. Whether it’s an induction or a D & E at 17 weeks for a woman with ruptured membranes and a runaway infection the intention is to end the life of the “unborn baby” because the infected uterine contents are what is killing the mother. And who defines medically indicated? A physician? A committee of physicians? A bishop? Does Cardinal Grady have a hotline for doctors? And what criteria is used? Risk of death 100%? 50%? 25%? 1%? It’s not always possible to say specifically and the Irish Catholic Bishops do not offer further clarification. The risk of sepsis, a life threatening infection, when a woman presents with ruptured membranes before 24 weeks is 1%. Not everyone with sepsis dies, but many do. I wonder how many Irish Catholic Bishops would get on an airplane if they knew that there was a minimum of a 1% risk the plane would crash? What if the risks were 10%? Or 25%? Hey, not all airplane crashes are fatal.

The statement is an attempt to distinguish induction of labour from a D & E (you’ll have to bear with me on this one as neither “induction of labor” nor “D &E” are specifically mentioned). “Abortion” could be Irish Catholic Bishop code for D & E (a surgical procedure) and “medical treatments” code for induction of labor. After all, with an induction of labor (medication placed in the vagina or given intravenously to bring on contractions and empty the uterus) the fetus technically dies as a result of the mother getting medication and not by something that “directly” touches the fetus. Sort of in the way that if you tell a lie and your fingers are crossed you’re not really lying. Under this if-you-just-knew-the-secret-code-because-we-don’t-know-or understand-appropriate-medical-terminology interpretation, Dr. Halappanavar could clearly have had an induction of labor at 17 weeks and thus the blame for her death sits squarely on the shoulders of her medical team. However, under this interpretation should a uterus fail to contact with medication (as infected uteri are wont to do) a woman with previable ruptured membranes couldn’t have a D & E on an alive infected fetus with 0% chance of survival, but she could have a far more invasive hysterectomy, because that is “intentionally” destroying the uterus not the fetus.

The statement from the Irish Catholic Bishops is medically nonsensical, contradictory, and immoral and as it represents a group of men who have never practiced medicine opining on an aspect of medical care that they clearly can’t understand.

The only thing this statement clarifies is how Irish physicians could easily be confused by an Irish abortion law steeped in religion, and thus reinforces the claim that Catholicism contributed to Dr. Halappanavar’s death.