‘A Consensus Basis’

at

Coombe Hospital

Last week in the Dáil.

Solidarity-People Before Profit TDs Ruth Coppinger and Bríd Smith spoke about a pregnant woman, from Clondalkin, Dublin, whom they claimed had been refused a termination at the Coombe Women & Infants University Hospital in Dublin, despite two consultants certifying that she needed a termination for a fatal foetal abnormality.

Ms Coppinger said the board of the hospital overruled the two consultants’ direction and asked her to wait four weeks to see if she has a spontaneous miscarriage.

After the Dáil debate, the Coombe Hospital denied its board over ruled the decision of the two consultants.

The woman later spoke to Kitty Holland, of The Irish Times, and said she planned to travel to the UK for a termination.

Ms Holland later reported that the couple were told by the Coombe, in a letter, that their unborn baby had a “complex foetal anomaly” and that the hospital did not believe “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, as per the Health (Regulation of Termination of Pregnancy) Act 2018”.

Ms Holland reported on Saturday:

“The couple reject that they were told their foetus had a “complex anomaly”, saying they were told clearly a week before the letter was issued that the anomaly was fatal.”

Further to this…

This morning.

Paul Cullen, in The Irish Times, reports:

Decisions on whether or not to provide terminations in cases of foetal anomaly should be reached by multidisciplinary teams of doctors on a consensus basis, newly prepared guidelines indicate.

The multidisciplinary team (MDT) should be a formally-constituted committee of the hospital whose decisions are documented in clinical notes, according to the guidelines from the Institute of Obstetricians and Gynaecologists.

One such MDT was constituted at the Coombe hospital in Dublin earlier this month to consider the case of a patient whose foetus had been diagnosed with a foetal anomaly. The case was raised by two Opposition TDs in the Dáil last week after the woman’s request for a termination was refused.

In the Coombe case, treating doctors found that despite the presence of a “complex foetal anomaly” they did not believe the condition affecting the foetus was likely to lead to its death either before, or within 28 days of, birth – as required by legislation on terminations in cases of fatal foetal anomaly.

The MDT recommended a re-evaluation of the clinical condition of the foetus after four weeks.

Foetal anomaly cases require ‘teams of doctors’ (Paul Cullen, The Irish Times)

Previously:  “Her Words To Me Were: ‘This Is Not What I Voted For’”

17 thoughts on “‘A Consensus Basis’

  1. Eoin

    “In the Coombe case, treating doctors found that despite the presence of a “complex foetal anomaly” they did not believe the condition affecting the foetus was likely to lead to its death”

    Isn’t this the crux of this case, didn’t the pregnant woman get two certifications from two doctors as specified by s11 of the legislation? And wasn’t it subsequent to this that the Coombe board decided the certifications weren’t valid? And there’s nothing in the legislation for a board to second-guess the opinion of two doctors?

    S11 says “A termination of pregnancy may be carried out in accordance with this section where 2 medical 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.”

    1. The Old Boy

      This is a very strange one. Your analysis is correct. My understanding is that the board of the hospital read the first line of S.11 as “A termination of pregnancy may…” and decided that this rendered it discretionary despite the two doctors’ certifications.

      This is false.

      Consider what would have happened if the two doctors had examined the woman in question and had in the circumstances decided not to issue the certificates. Sections 15 and 16 of the Act would come into effect, and the woman would have been entitled to appeal the decision to a review committee. Say the committee upholds her appeal and grants the relevant certification. Section 16(3) states that “Where the review committee makes a certification referred to in subsection (2) [eg fatal foetal abnormality], it shall* make such arrangements as may be necessary for the carrying out of the termination of pregnancy to which that certification relates”.

      The hospital board have created a perverse scenario whereby because the refusal was theirs, rather than the consulting clinicians, the woman had no right of appeal, in circumstances where a successful appeal from the clinicians’ decision results in a statutory provision making the arrangement of termination mandatory.

      *Emphasis added.

    2. newsjustin

      “..didn’t the pregnant woman get two certifications from two doctors as specified by s11 of the legislation?”

      I’m not sure that was the case at all. To me it reads like she was told by one or more doctors after the scan that this was really serious and may well be a fatal abnormality. But the MDT took a look at the facts and did not perceive it to be a fatal foetal abnormality – particularly, not as laid down in the Bill.

      What we have now is people who told us to trust doctors and trust women during the referendum saying, “Ah go on, sure it’s nearly fatal, as good as, sure we may as well. Who needs all these doctors anyway, all these checks and balances?”

      1. Eoin

        She either got two certifications or she didn’t. The two TDs in the Dail last week were adamant she had the necessary certifications under s11. What isn’t clear is what happened next. The Coombe says it didn’t overrule the two doctors, but if the two doctors did give a certification and the board refused the woman the abortion, then that is what happened.

        Did Emma in fact have the two certifications as asserted in the Dail last week when Ruth Coppinger stated

        “I wish to raise what I believe is the first test case for the new abortion legislation. I have been contacted by a woman who has a fatal foetal abnormality that has been certified by two consultants. It appears that the board of the Coombe Hospital is refusing her constitutional right, that we all voted for, to have an abortion at a time she chooses.”

        1. Cian

          It depends what exactly “certified by two consultants” means. Do they just say the words? or do they need to write it down in her notes? or is there an official form?

          As an aside Ruth Coppinger is talking rubbish when she says the hospital is “refusing her constitutional right”. There is no Constitutional right to abortion.

          1. millie st murderlark

            But she is absolutely entitled to one should she wish or require it, having fulfilled the requirements for one after 12 weeks.

            Which is the point I suspect people are making, albeit in technically incorrect terms.

            She is entitled to one, but it’s not a constitutional right, correct.

          2. newsjustin

            “But she is absolutely entitled to one should she wish or require it, having fulfilled the requirements for one after 12 weeks.”

            It’s not at all clear that she fulfilled those requirements. The opposite is the case, in fact, according to the hospital.

  2. The Old Boy

    This is a very strange one. Your analysis is correct. My understanding is that the board of the hospital read the first line of S.11 as “A termination of pregnancy may…” and decided that this rendered it discretionary despite the two doctors’ certifications.

    This is false.

    Consider what would have happened if the two doctors had examined the woman in question and had in the circumstances decided not to issue the certificates. Sections 15 and 16 of the Act would come into effect, and the woman would have been entitled to appeal the decision to a review committee. Say the committee upholds her appeal and grants the relevant certification. Section 16(3) states that “Where the review committee makes a certification referred to in subsection (2) [eg fatal foetal abnormality], it shall* make such arrangements as may be necessary for the carrying out of the termination of pregnancy to which that certification relates”.

    The hospital board have created a perverse scenario whereby because the refusal was theirs, rather than the consulting clinicians, the woman had no right of appeal, in circumstances where a successful appeal from the clinicians’ decision results in a statutory provision making the arrangement of termination mandatory.

    *Emphasis added.

  3. Andyourpointiswhatexactly?

    As an aside, I was listening to Jacqueline Gold on Desert Island Discs. She got IVF and gave birth to twins at 48. She was told when pregnant that her son probably wouldn’t make it through the pregnancy and if he did, he’d die soon after. He did make it, and was born (she said) crying with pain. He died 8 months later.
    This FFA issue is very complex.

    1. Starina

      Twins is difficult because if you remove the one with an FFA it could put the other child in danger. Happened to someone I knew. Such joy and such sorrow in one day.

      1. Ads

        Happened to someone I know that she wasn’t told that she was pregnant with twins when the first foetus died in her womb. She carried to term and gave birth to a dead baby (nurses and doctor staggering back covering their faces saying “Oh! It stinks!”) and to a living baby who was severely spastic and mentally disabled and has spent life in a wheelchair.

        In Ireland the authorities will do anything to stop women having authority over their own lives and the right to decide what happens to their bodies. We have to change that.

    1. postmanpat

      And nothing ever will, as long a Opus Dei and similar creepy societies are lurking in every shadow of every state organization. But , they get there power from the people and we are a silly catholic lot, it doesn’t matter what way you vote. Catholicism is not, and never was a democracy. Progressive laws are merely an amusement to the real powers that be in this moss covered kip! And that’s my rant, signing off now. see you all in mass down the country on Sunday!!

  4. Jake38

    Coppinger and Smith went off half cocked without checking their facts. Anything for a bit of publicity.

    1. newsjustin

      Yep. And to push the boundaries of the Bill. People who scoff at the “slippery slope” line of argument need to watch closely what is going on here.

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