Decisions must be the people’s will

The Scottish Patient Safety Programme has identified six key interventions for the early recognition and treatment of Sepsis (severe infection).

This initiative is known as the ‘Sepsis 6 Bundle’. The key intervention is the early administration of appropriate Antibiotic therapy. As a clinician working at the frontline, in an Emergency Department with the highest rate of Sepsis attendances per year in Scotland, I appreciate that the recognition of Sepsis can sometimes be extremely difficult and subtle. The consequence of this failure to recognise Sepsis early, and treat appropriately, is often death. Without wishing to preempt the findings of the Coroner’s inquest, this is sadly what seems to have happened in the tragic case of Savita Halappanavar, who is widely reported in the media to have died as a consequence of an E.coli sepsis precipitated by spontaneous miscarriage.

Early provision of appropriate antibiotic therapy is the treatment required for suspected or evolving Sepsis. When miscarriage proceeds to the stage where it is medically described as ‘inevitable’, then emptying the womb is the required medical intervention with appropriate antibiotic cover, even in the presence of a baby’s heartbeat.

This is not an ‘abortion’ in the layperson’s understanding of the term, but an essential therapeutic intervention to treat or prevent sepsis.

Existing Irish Medical Council guidance provides for this clinical situation. Ireland has long been a world leader for patient safety in respect to maternal and neonatal mortality. The general standard of obstetric and gynaecological practice in Ireland is among the very best in the world. This would not be possible if the women of Ireland were being regularly denied an essential treatment which was compromising their clinical safety. Throughout the world, even in the centres of greatest clinical excellence, aggressive disease processes claim lives.

Unfortunately, isolated tragic clinical mishaps and avoidable errors also occur, wreaking devastation on patients and their families. There is no room for complacency, lessons must be learned and acted upon, however a tragic individual case is not grounds for broad sweeping change to abortion legislation in Ireland. Existing IMC guidance already provides for this rare clinical situation, and clinical protocols should be clear.

Abortion is an emotive subject, with well-intentioned people on both sides of the divide; it is therefore essential that legislative decisions are based on the will of the people, whose views should be shaped by objective facts and mature debate, rather than scaremongering and ill- informed sound bites.

Dr D Maguire

LRCP&SI, FRCSEd, MRCPI, FCEM

Emergency Medicine Consultant

Clinical Lead for Emergency Medicine

EM Patient Safety Lead

Glasgow Royal Infirmary

Scotland

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