In Savita’s death, religion and health collide, yet again

What happens when religious beliefs collide with medical science? Who takes the responsibility if a life is lost in the clash? These and other uncomfortable questions are being raised across the world in the wake of the death of Savita Halappanavar, an Indian-born dentist, in Galway, Ireland.

Halappanavar, 31, arrived at the University College hospital in Galway on October 21 complaining of severe back pain. She was 17 weeks into her pregnancy and found to be miscarrying. A week later, she was dead. The reason - septicaemia or blood poisoning. What happened? For three days, Savita had reportedly asked several times that her pregnancy be terminated. Savita’s husband says the doctors at the hospital refused.

In Ireland, it is illegal to offer termination of pregnancy as a standard procedure. A doctor cannot, under any circumstances, carry out a termination of pregnancy until it is a full-blown emergency. However, waiting until an emergency can be fatal, as in this case.

Ireland, whose population is 84% Catholic, has some of the world’s most restrictive laws on abortion. The doctors are now under fire for placing faith, as embodied in the law, above Halappanavar’s well-being when they chose not to abort the foetus.

Her husband and activists say she may have survived had the foetus been removed sooner. Investigations are on to ascertain the exact circumstances leading to the death.

The tragedy may become a game-changer. Outrage at the unnecessary death of this young woman has led to mass protests within and outside Ireland.

As I write, Sara Burke, an Irish health journalist, is tweeting about the “amazing turn-out at Merrion Square” in the heart of Dublin in memory of Savita. In the last few days, candle-light vigils across Ireland and England have taken place as thousands gathered to pay tribute and demand a change in legislation.

One of the prickliest issues in the current debate is the role of doctors. Dr Peter Boylan, an eminent Irish obstetrician/gynaecologist, told me that “in circumstances where there is a real and substantial risk to the mother’s life, termination of pregnancy is legal, and performed without any dissent or problem.”

Boylan declined to comment on Savita’s death “because the full clinical details are not available” and because he had “no greater knowledge of what happened other than what is in the public domain.”

The real problem, he says,  is that “doctors have to make a judgement call on the probability of death in different clinical circumstances. This gives rise to ambiguity where the risk is not immediately apparent or present.”

What happens to a doctor who puts health above the law? Boylan says, “No one has gone to jail, no one has been prosecuted and neither is likely.” However, “there is considerable uncertainty as to what we, as doctors, can actually do. It is, for example, illegal to refer a woman for a termination despite the fact that we can discuss termination as an option (eg if a lethal foetal anomaly is diagnosed). Our problems are solved by women going to the United Kingdom for terminations, and so the issues are not problematic in day to day practice. One could argue therefore that some of our laws are hypocritical.”

While the focus is on Ireland, it is not the only country confronting tensions between medical science and religious beliefs.  48 states in the USA allow for exemptions from school immunization laws for religious reasons. CHILD Inc., a US-based NGO which tracks religion-based medical neglect says California allows public school teachers to refuse testing for tuberculosis on religious grounds and Ohio has a religious exemption from testing and treatment for tuberculosis – it lets parents use “a recognised method of religious healing” instead. And so on.

What about India? Our laws are not inimical to public health but there are myriad socio-cultural-religious practices that affect health adversely.

One telling example – food taboos. In a 2012 paper titled Beliefs Regarding Diet During Childhood Illness in the Indian Journal of Community Medicine, Asha Benakappa and Poojita Shivamurthy point out that 50-70% of childhood diarrhoea and respiratory infections is compounded by “food restriction during illness due to false beliefs, leading to a vicious cycle of malnutrition and infection.”

Worryingly, the researchers found that it did not help if the caregivers were better educated – harmful practices were dictated by family elders and religious beliefs. These include decreasing breast feeds, initiating bottle feeds, feeding diluted milk and reducing complementary feeds during illness. Unscientific beliefs about “hot” and “cold” foods lead to restriction of food available at home.

We need to battle such taboos, which impact maternal health, even as we pursue the probe into Savita’s death at the diplomatic level.

The author is a Delhi-based writer