After Brexit, what now for the North?

I was troubled last night to read people expressing delight at the huge queues at polling booths across the UK. Such a massive turnout, seemingly, was a triumph for democracy. I wasn't so sure. There's far more to democracy than just casting votes, and those who act as though democracy is something that happens but on rare occasions and purely in the privacy of the polling booth do a disservice to democracy. 

If democracy is to mean anything -- if our votes are to mean anything -- we have to participate in an informed way. I was pretty sure that wasn't happening: how valuable are votes cast on the basis of a mythical £350m a week, or to ward off Turkish accession, or in the belief that EU laws are made by unelected bureaucrats, or that there's no way to remove the European Commission from office, or because of the belief that British fishing collapsed when it joined the EEC, or any of a host of other lies? 

The 'Leave' campaigners lied and lied egregiously throughout the Brexit referendum campaign, and did so tapping into decades of popular poison from the British press, and if lots of people who've long felt disenfranchised and ignored should have been willing to go along with this kind of stuff, well, maybe that should have been expected.

I've less sympathy for others, for those who take the pains to be informed of things they care about, but who on other issues prefer instead to listen simply to those whose political views conveniently tally with their own judgments and to shout down calls for them to inform themselves as mere elitism.

So for those who make much of their pro-life credentials, and who dismissed my concerns and those of others about the lives and livelihoods of those in Northern Ireland being actively endangered by a vote to quit the EU, here are just a handful of things they might look before they next put themselves forward to speak as Catholics or pro-lifers, or even just look in the mirror.

Not for nothing has The Irish Times said, "Of all the things that could happen to an Irish government short of the outbreak of war, this is pretty much up there with the worst of them."

Then there was The Guardian a couple of days back, observing that, "Great Britain may be able to weather a Brexit, but Northern Ireland simply cannot."

Lucinda Creighton may not be everyone's cup of tea, but she had a point when she said the other day that, "Brexit poses the greatest threat to the Northern Irish Peace Process since the Good Friday Agreement was signed in 1998."  

For a more cautious take, unsurprisingly from a pro-Brexit paper, The Telegraph warned, "The scenario of the UK leaving the European Union, when a majority of the population of Northern Ireland have opted to remain (and especially if there has been a decisive vote in favour among the nationalist community), may exacerbate tensions, fuel demands for a border poll on Irish unification and challenge the durability of the peace process."  

Then we have from the Centre on Constitutional Change the observation that "a British exit from the EU risks undermining the very self-determination and national sovereignty that its adherents believe it will bring about", continuing, "This is because it risks shattering the fragile balance and stability of the UK by threatening the peace settlement in Northern Ireland ".  

Onetime MEP Brendan Donnelly wrote from the London School of Economics, meanwhile, that "it is clear that much potential exists for the destabilisation of Northern Ireland through a vote to leave the EU on 23 June", continuing, "The Good Friday agreement is under more strain from a currently low level of sectarian violence than is sometimes appreciated".  

At the Euractiv site, Paul Brannan hammers this home when he says, "with politics in Northern Ireland already on the brink of breakdown and the Good Friday Agreement in jeopardy, a UK EU exit threatens a total collapse of the peace process".

And for those who think Britain can keep the show on the road, as though it's taken seriously as an honest broker and was never known as 'perfidious Albion', The New Statesman points out: "Funnily enough, the same people who don't trust Britain to administer the peace process would also be unhappy with the EU leaving that process."

I could say more, but that'll do for now. Words seem unlikely to do any good now the die is cast.

Final Week Brexit Thoughts II - The Threat to Northern Ireland

About a week or so back Catholic Voices hosted a debate in London in which two speakers gave impressive speeches on why the UK should remain in the European Union and two argued in similarly impressive fashion to the effect that the UK should leave the Union. 

Better-humoured, more honest, more thoughtful and broader-minded than almost all engagements I've read or witnessed on the topic, the debate on the motion "This house believes that Catholic values are best served by remaining in the European Union" was nonetheless striking for a complete absence of references to the single most Catholic part of the UK, that being Northern Ireland.

According to 2011 figures, 40.8% of the Northern Irish population is Catholic. This stands in stark contrast to England and Wales, for instance, where, if Steven Bullivant is right, just 13.7% of the population say they were raised Catholic, with a mere 8.3% of the population holding to the Faith now.

I appreciate the Brexit debate is really an 'Exit' debate in that the discussion is primarily driven by English concerns and will be decided by English votes, with the lesser partners in the UK at best hoping to tip the scales if an English vote is finely balanced, but I think that English voters should at least give some thought to how their votes are likely to affect things beyond England.

Northern Ireland's bishops have, of course, warned of the dangers of a Brexit to the North, and their concerns seem shared by Northern Ireland's Catholics. A Millward Brown poll in early June found that 70% of Northern Catholics were in favour of the UK remaining in the EU, with a mere 12% advocating that the UK quit the Union. A more recent Ipsos Mori poll has shown just 56% of Catholics in favour of remaining in the Union, though again a mere 12% seem to back a Brexit. 

Dividing countries the hard way

Such low support for withdrawal from the Union is understandable in a region where the UK's only land border is to be found, and where there has never really been a traditional border: for centuries, after all, Ireland was united under one form or other of British rule, and even after the Irish War of Independence it was possible for people to cross back and forth without a passport. Under the UK's 1949 Ireland Act Irish people are not considered aliens in British law, and the soft and porous nature of the border has been vital for the North's economy. It's not really surprising that people in the border counties especially might not be looking forward to this ending.

Of course, it's far from obvious that a hard border will be imposed between Ireland and the UK within the island of Ireland. Given the realities of Irish roads, about 200 of which cross the border, and how farms and fields straddle the boundary, it's hard to see how any border within Ireland, even one policed by border guards and soldiers, could bar from the UK anyone really intent on crossing over. And given that immigration fears are utterly central to Britain's EU debate, this is a question that needs pondering.

Cameron engaged with this in the Commons last week, when he answered a question from the SDLP's Alasdair McDonnell by saying that following Brexit there would have to be a hard border. "Therefore," he said, "you can only have new border controls between the Republic and Northern Ireland or, which I would regret hugely, you would have to have some sort of checks on people as they left Belfast or other parts of Northern Ireland to come to the rest of the United Kingdom."

I suspect that in practical terms a functional EU/non-EU border would have to be not in Ireland but between Britain and Northern Ireland, thus splitting the UK and making the Northern Irish second-class citizens, as the alternative would be bringing in checkpoints on dozens of Irish roads with soldiers patrolling the lands and minor roads between them, all of which would be likely to require the kind of security apparatus likely to fire up the republicans again, inviting a return to the kind of protracted low-intensity civil war that previous blighted the North.

Impoverishing the Six Counties

Even aside from the technical issue of the border, there's a high chance that a Brexit vote would impoverish Northern Ireland. Farm subsidies are regional expenditures, and it's striking that Northern Ireland's farmers receive four times the amount of EU subsidies than do England's ones. 80% of Northern dairy produce is exported, and when pondering this people need to remember that no part of the UK exports a higher proportion of its exports to other parts of the EU than does Northern Ireland. Any kind of border would hurt that, as would any imposition of tariffs and any hindering of the currently free trading arrangements. Tariffs on dairy imports to the EU, it's worth pointing out, average 36%.

The EU has played an absolutely crucial role in the Northern Irish peace process, of course, with John Hume detailing in his 1998 Nobel Prize acceptance speech how he had been hugely inspired in his work for peace by his European experience.

"I always tell this story," he said, "and I do so because it is so simple yet so profound and so applicable to conflict resolution anywhere in the world. On my first visit to Strasbourg in 1979 as a member of the European Parliament. I went for a walk across the bridge from Strasbourg to Kehl. Strasbourg is in France. Kehl is in Germany. They are very close. I stopped in the middle of the bridge and I meditated. There is Germany. There is France. If I had stood on this bridge 30 years ago after the end of the Second World War when 25 million people lay dead across our continent for the second time in this century and if I had said: 'Don't worry. In 30 years' time we will all be together in a new Europe, our conflicts and wars will be ended and we will be working together in our common interests', I would have been sent to a psychiatrist."  

"But it has happened," he continued, "and it is now clear that European Union is the best example in the history of the world of conflict resolution and it is the duty of everyone, particularly those who live in areas of conflict to study how it was done and to apply its principles to their own conflict resolution." 

"All conflict is about difference, whether the difference is race, religion or nationality," he said, continuing, "The European visionaries decided that difference is not a threat, difference is natural. Difference is of the essence of humanity. Difference is an accident of birth and it should therefore never be the source of hatred or conflict. The answer to difference is to respect it. Therein lies a most fundamental principle of peace - respect for diversity."

"The peoples of Europe then created institutions which respected their diversity - a Council of Ministers, the European Commission and the European Parliament - but allowed them to work together in their common and substantial economic interest. They spilt their sweat and not their blood and by doing so broke down the barriers of distrust of centuries and the new Europe has evolved and is still evolving, based on agreement and respect for difference," he said, before declaring, "That is precisely what we are now committed to doing in Northern Ireland."

Fine words? Sure, but accurate ones too, and not merely has the European project, with its dedication through most of its history to peace-building through calling people of different communities to work together, inspired peace in the North, but it has underpinned it too. 

As the Ulster Unionist MEP Jim Nicholson wrote the other day, "I will always remember when, in October 1994, just as the loyalist ceasefire was announced, Ian Paisley, John Hume and I met with then European Commission president Jacques Delors. He shared our optimism that Northern Ireland would move to a new beginning away from violence and pledged EU financial support. And he was true to his word -- weeks later, £240m of European funding for peace-building in Northern Ireland was approved. By 2020, Northern Ireland and the border region of the Republic will have received more than €2bn in PEACE funding alone.

PEACE funding only makes up one part of the money the North draws down from Europe, Nicholson continued, and the truth is that the EU has largely rebuilt Northern Ireland since the ceasefires began. Northern Irish prosperity, and Northern Irish peace, in no small part depend on the EU.

(Of course, the EU has done a huge amount in general to support those parts of the UK furthest from London; whether London lets them languish and runs the UK for the benefit of the English South-east you can mull over for yourselves.)

Explicitly undermining the Good Friday Agreement

Those who might doubt that a vote for Brexit is a vote to destabilise Northern Ireland should look too at the Good Friday Agreement, which explicitly rests on the fact of the UK and Ireland being "partners in the European Union".

The North-South Ministerial Council envisages the Northern and Republican governments working together -- at a local level, for those who doubt that subsidiarity matters to the modern EU -- on a range of such necessarily EU-related matters as agriculture, the environment, tourism, transport, and the management and oversight of EU programmes through Ireland's National Development Plan and Northern Ireland's Structural Funds Plan.

It's hard to see how this strand of the agreement can work if Northern Ireland is no longer in the EU, and since the Northern Assembly is explicitly described in the agreement as "mutually interdependent" with the Council, it looks as though withdrawal from the EU could endanger the entire Northern settlement.

And that's not even getting into how under the agreement everyone in Northern Ireland is entitled simultaneously to be citizens of the UK and Ireland, such that following a Brexit they could -- on the face of it -- both be citizens of the EU and non-citizens of the EU. I'm not sure how how much thought's been given in the Brexit camp to Schroedinger's Ulstermen.

Overall, a Brexit vote is a vote to risk instability, poverty, and civil war in Northern Ireland. It's not really surprising that the Northern bishops and the vast majority of Northern Catholics are opposed to it. It baffles me how many in England seem not to care in the least about this. 

Charlie: It's Not All About Us

It's been very strange watching some Irish responses online to the week's horrific events in Paris.

 

Following the murders at the offices of Charlie Hebdo, and subsequent hostage-taking and killings elsewhere, far too many people have seen this as a suitable time to demand that Ireland's 'blasphemy laws' should be repealed, and to scorn as hypocritical the Irish Times' criticism of the murderers' attempts to silence debate, given how our self-proclaimed 'paper of reference' once removed a cartoon from its archives.

 

Now, you might just think this kind of behaviour is just cynical opportunism, or is typical of that clueless parochial narcissism that so often blights our national discourse, and you might well be right, but it's worth looking at both issues separately for a moment.

 

 

Comparing Like with Loike, Totally

Just to take one example, Ed Moloney, one of the finest analysts of the Northern Irish Troubles and Peace Process, for instance, tweeted last night, 'When Will The Irish Times Remember The Cartoon It Censored At The Behest Of Religious Fanatics?'

 

Writing about this on his blog, where after some reflection he changed his headline from one identical to the tweet to one saying, 'Irish Times Leads Nation’s Protest Over "Charlie" But Forgets About Cartoon It Censored At Behest Of The Bishops,' he quotes the Irish Times's comment that 'The right to offend must be defended with courage and vigour', before saying that it would have been more 'uplifting' if the Irish Times editorial had expressed regret for how it had removed from its archives a Martin Turner cartoon because, he said, it had offended senior members of the Irish Catholic hierarchy.

 

'It seems,' he concludes, 'that sauce for the Catholic goose is not sauce for the Islamic gander.'

 

Now. Moloney's a smart man, and on the face of it you might think he's making a fair point. It's worth taking a look at the cartoon, though, which we can easily do because, well, it's not 1904, and things tend to end up online about two minutes after newspapers remove them. 

 

(For instance, do you remember in October 2004 when the Guardian removed from its archives a Charlie Brooker 'Screen Burn' column that ended by lamenting the probability of George W. Bush being reelected president, and said 'John Wilkes Booth, Lee Harvey Oswald,  John Hinckley Jr -- where are you now that we need you?' No?

 

Well, perhaps you remember how in August 2013, the Irish Times ran a front page piece about a twin pregnancy being terminated at the National Maternity Hospital as the first termination conducted under the terms of the Protection of Life during Pregnancy Act? Remember? You should: it was such an impressively detailed report that Peter Boylan, who was reportedly involved in the termination, spluttered about how the patient's confidentiality had been breached, and yet it was utterly revoked and wiped from the paper's archives a week later, with a small and inappropriately discreet page seven apology pointing out that the law was not yet in force, and claiming that 'The hospital has pointed out that the case described in the article did not happen.'

 

If you don't remember either of these peculiar episodes, well, don't worry, because this is 2015, and so I've kindly given you links to the missing stories. And then, if you really have an issue with censorship, go and write to the said papers to complain about their willingness to bow to, I dunno, angry politicians and embarrassing obstetricians. Or something.)

 

So, anyway, here's the Turner cartoon, the removal of which so irks Mr Moloney, because, of course, an Irish publication freely deciding to withdraw a cartoon while retaining the services of its cartoonist is comparable to a load of cartoonists and other magazine staff being butchered.

It is, we should start by conceding, not a very good cartoon. It's a leaden thing, where three priests, all rather surprisingly wearing what I presume are meant to be cassocks*, and one stepping out of a confessional box rather perplexingly wearing an alb as well as his stole, sing 'I would do anything for children (but I won't do that)'.

 

Presumably this is to the tune of Meatloaf's seminal return hit, 'I would do anything for love (but I won't do that)'**, though if you can get the priests' line to scan to the original tune you're a better man than I am.

 

In case you're too thick to realise that this was intended as a comment on Catholic opposition to one element in the child protection laws being introduced at the time, one of the priests -- presumably singing with his mouth closed -- is scowling down at a newspaper running the headline 'Children First Bill: Mandatory Reporting'. As an English friend pointed out the other day in a more general context, if you feel the need to include newspaper headlines to spell out what your cartoon is about, you've probably not done a very good cartoon.

And, of course, if you don't see the significance of Catholics taking issue with a particular proposal that might limit freedom of religion in return for nothing that would actually protect children, and if you're not willing to concede that the Church in Ireland has -- so, so, belatedly -- been pretty much the leader in Irish child protection over the last decade or so, and if you don't have a problem with government ministers crowing about this proposal while actual experts in child protection point out that the planned legislation wouldn't help anyone and was being conducted in tandem with policies that would endanger children, well, then you're probably not very bright, not very well informed, or just not really interested in protecting children at all.

 

The day after the cartoon appeared, there were two letters in the paper, both from priests, one describing the cartoon as 'bigoted, nasty and downright disgraceful', pointing out that given the Church has more stringent child protection guidelines than any other body in Ireland, it was a cheap shot and a betrayal of anti-Catholic bigotry to 'use the sins of the past as a stick to continue to beat the church of the present', while the other describe it as 'offensive in the extreme to every priest in the country', and required an editorial apology unless the paper was of the view that it was 'open season on priests'.

The following day there were four letters about the cartoon, one of which said the cartoon was below the belt, but that as a satirical cartoonist it was Turner's job to be offensive. The other three were less understanding. One described the cartoon as 'a new low in Irish journalism', reminiscent of the sectarian cartoons of the nineteenth-century American Thomas Nast. Another, from a long-time fan of Turner, said the cartoon was 'bigoted', 'nasty', and 'spectacularly unfunny', revealing a potent double standard where the paper's general 'zeal for anti-religious comment' was not being 'applied to critical analysis of current government scandals'. A third, from a reader of the 55 years, described the cartoon's publication as 'an error of judgement' that warranted an apology to Ireland's priests and the paper's readers.

 

That same day, speaking in Dublin's pro-Cathedral, Diarmuid Martin, the Archbishop of Dublin, said 'I am a strong believer in freedom of speech and of the vital role of satire in social criticism, but I object to anything that would unjustly tarnish all good priests with the unpardonable actions of some.'
 

What was the problem? Well, if you look down in the cartoon's bottom corner, in very small writing, you'll see an authorial aside saying, 'But there is little else you can do for them... except stay away from them, of course.'

 

Bear that in mind, when you read the Irish Times editorial that made clear why the cartoon was removed. The editorial states that the paper is bound by the Irish Times Trust's principles which require that the paper is meant to ensure that comment and opinion should be 'informed and responsible', with 'special consideration ... given to the reasonable representation of minority interests and divergent views, and that and it should uphold  'the promotion of peace and tolerance and opposition to all forms of violence and hatred, so that each man may live in harmony with his neighbour, considerate for his cultural, material and spiritual needs.'

 

No, really. No laughing at the back there.

 

'That means, however, that there is no carte blanche,' the editorial explained, 'and that there are ground rules which we try to adhere to, mostly with no argument from those contributors. Civilised debate, we accept, requires the eschewing of ad hominem argument, playing the ball, not the man, and avoiding crude stereotyping.'

Turner's cartoon was described as having flown under the editorial radar, the editorial explained, picking up on the authorial aside about how priests should keep away from children. 'In making a legitimate argument about the debate over priestly responsibility for reporting child abuse and the concerns for the seal of the confessional, Turner also took an unfortunate and unjustified sideswipe at all priests, suggesting that none of them can be trusted with children. This has, unsurprisingly, caused considerable offence and we regret and apologise for the hurt caused by the cartoon whose use in that form, we acknowledge, reflected a regrettable editorial lapse.'

 

The Turner thing was very simple. The Irish Times has its own guidelines, Turner breached them by irresponsibly and ignorantly casting all priests as dangers to children -- and if you think this is a fair comment on the phenomenon of abuse in Ireland, you really should read more --  and so the paper pulled it. To make out that this has broader implications would be as outrageous as me saying that because my school magazine was once pulled from distribution because of a story I had done in it, so nobody at that school should ever be allowed to take issue with cartoonists being murdered.

 

It really is that simple.

Blas for me! Blas for you! Blas for everybody in the room!

Then there's the blasphemy law thing. It's probably worth starting with the fact that I don't much care either way about the blasphemy law, such as it is: it doesn't bother me, and it wouldn't bother me if it were removed. I don't know any Catholics who are fans of it, to be honest. Some are opposed to it, and many wouldn't even bother shrugging if it were removed.

Now, the standard line about the blasphemy law over the last few years that it should be removed because it encourages Muslim countries to introduce similar blasphemy laws has been tweaked in the last week to the effect that 'Because of Ireland's blasphemy law, Charlie Hebdo wouldn't even be allowed in Ireland!' As such, so fools argue, we should remove the blasphemy law as a mark of respect and as a way of championing real free speech.

It's worth bearing in mind where the blasphemy law came from. A constitutional quirk basically requires the state to have some kind of blasphemy law, but Ireland's politicians sat on this legal oddity for ages, without people jumping up and down and claiming that they had to give legislative force to a constitutional imperative. Eventually, though, when tidying up issues of libel and slander and such in 2009's Defamation Act, the issue of other limitations on speech came up. The result was the so-called 'blasphemy law', better known to those who read as section 36 of the Defamation Act.

Section 36 says that those who publish or utter blasphemous matter can be subject to a fine of up to €25,000. Matter should be deemed blasphemous, if says, if a) it is "grossly abusive or insulting in relation to matters held sacred by any religion, thereby causing outrage among a substantial number of the adherents of that religion" AND b) if the causing of such outrage is intended.

That bit about intent is crucial, and not just because it is half the definition of blasphemy, such that in Irish law you cannot blaspheme unless you have deliberately caused large-scale outrage. The law goes on to say that it is a defence to allegations of blasphemy for a reasonable person to find 'genuine literary, artistic, political, scientific, or academic value in the matter to which the offence relates'.

In other words, the law has a three-part test: has the matter under investigation caused outrage among a significant number of people of a particular religious line, was it intended to cause such outrage, and is it bereft of literary, artistic, scientific, academic, or political merit?

To all intents and purposes it's a deliberately toothless law, designed to tidy up a constitutional glitch in such a way that nobody is ever troubled by it, and surely pretty much unnecessary given how the actual crime here seems to be substantively covered by 1989's Incitement to Hatred law.  You might take issue with its symbolism, or feel it's anachronistic, but one thing you can't really do is say that it does any actual harm. Our laws are often merely aspirational; this isn't even that.

Michael Nugent and his friends in Atheist Ireland disagree, of course, and regard it as a great betrayal that the government doesn't see its removal from the statute books asap as a massive priority. But then, of course, Atheist Ireland has never really understood the law. When the law was first instituted, they ran a list of 25 supposedly blasphemous quotations, daring the State to prosecute them. Of course, leaving aside now many of the quotations could be said to have had literary, artistic, political, scientific, or academic value, and that their publication in 2009 did not provoke large-scale outrage -- nobody cared -- the simple fact of the list having been published to make a political point about free speech meant it was clearly safe from prosecution.

Could Charlie be published in Ireland? Well, put it this way: was it intended to provoke anger among Muslims or Catholics or whoever or was it intended to make people think? To take a non-religious example***, is the accompanying cartoon a homophobic or racist piece designed to anger gay people or black people, or is its aim to get people to think about the socio-economic realities surrogacy can entail, with poor women, often from developing countries, being paid to serve as vessels for others' children?

'Surrogacy is two parents... and one slave.'

No, I think, Charlie certainly could be published in Ireland. Whether shops would want to stock it, or people would want to buy it... that's a different matter.

 

There's no getting away from the fact that the intentional provocation of large scale outrage is a central element in Ireland's blasphemy law; it's a law less about offending God, as in other blasphemy laws, as about deliberately angering people. This matters if we want to think about the trope that Muslim countries, especially Pakistan, like using Ireland's blasphemy law to justify their own similar laws.

Do they really do this?

 

Now, I might be wrong, I've only ever really heard of one instance of this happening, and even then it's a pretty dubious instance. At an October 2009 meeting of the UN's Human Rights Council, discussing discrimination, Pakistan entered a six-part proposal to oppose discrimination based on religion and belief. The first of these six propositions was clearly modelled on part of the Irish definition of legal blasphemy: 'State parties shall prohibit by law the uttering of matters that are grossly abusive or insulting in relation to matters held sacred by any religion, thereby causing outrage among a substantial number of adherents to that religion.'

So, yes, clearly based in part on the Irish one. And yet also spectacularly different from the toothless Irish law, because it utterly omits the role of intent in Ireland's law, that crucial point which means that you cannot blaspheme accidentally or inadvertently, that blasphemy must not merely be offensive, but must deliberately cause large-scale outrage, and that even should large-scale outrage deliberately be caused, there are a range of legitimate defences, including 'I intended to provoke large-scale outrage, but I was engaged in scholarly research and was telling the truth', and 'I intended to provoke large-scale outrage, but I did so in an aesthetically pleasing way', and 'I intended to provoke large-scale outrage, but I was making a point about free speech'.

The Pakistani proposal entailed using a truncated version of the Irish definition, and tried to promote that. It did not explicitly acknowledge the Irish law, and its proposal was crucially different from the Irish reality, except as misrepresented by, for instance, Atheist Ireland, which falsely states on its Blasphemy.ie website that 'The law defines blasphemy as publishing or saying something "grossly abusive or insulting in relation to matter held sacred by any religion, thereby causing outrage among a substantial number of the adherents of that religion."'

No it doesn't, you buffoons. Please learn to read.

It is disappointing that oafs and otherwise smart people like Ed Moloney have tried to draw links between a responsible editorial decision and brutal acts of murder, just as it is disappointing that others claim Pakistan uses Ireland's blasphemy law to push for blasphemy laws elsewhere and present part of Ireland's legal definition of blasphemy as though it's the whole definition.

 

But that's the thing about free speech: it allows people to say stupid things.

 

Now if you'll excuse me, I have some work to do.

 

 

 

* It looks rather as though they're wearing mysterious black night-shirts over lighter-coloured shirts with clerical collars. It's almost as though Turner has never seen a cassock and doesn't actually know what one looks like. Whether such basic ignorance might somehow undermine his point I leave to you to decide.

** Yeah, I know that's not the actual video. Watch it anyway, though. It may prove an education.

*** Because I don't see much virtue in republishing things I know many people would be upset by for the sake of making a broader, if somewhat self-aggrandising, point about the importance of free speech. That strikes me as doing something bad in the hope of achieving something good, and, well, there are forbidden weapons.

X and Y, or Being Careful What You Ask For

"The constitutional equal right to life of pregnant women and unborn children means that viability closes off the possibility of abortion," wrote Fiona de Londras in Tuesday's Irish Independent. It's a powerful soundbite, but in some ways a redundant one, as it's not really Bunreacht na hEireann that causes viability to close off the possibility of abortion. It's basic medical reality that does that.

The Oxford English Dictionary's primary definition of abortion says that an abortion, of its very nature, occurs before a child "is capable of independent survival". The previous edition of the OED spelled out that from a medical point of view, "abortion is limited to a delivery so premature that the offspring cannot live, i.e. in the case of the human foetus before the sixth month." Stedman's medical dictionary spells this out, saying that abortion takes place "before viability" which it defines as "(20 weeks' gestation [18 weeks after fertilization] or fetal weight less than 500 g)".

If we trawl the report of 2000's All Party Oireachtas Committee on Abortion we find that the then-Master of the Coombe said that abortion constituted the premature ending of a pregnancy at any point before the foetus or baby is viable, with both the then-President of the Medical Council and the then-Master of the National Maternity Hospital saying that abortion meant the ending of a pregnancy in the first trimester, so within fourteen weeks.

There's obviously some disagreement here, but still, it seems clear from all of these points that medically speaking it is oxymoronic to talk of aborting a child who could -- with help -- survive without depending wholly upon its mother. In other words, it's just not that it's immoral or illegal or against the Constitution to abort a viable child. Medically speaking, it seems to be impossible. 

That's not to say that it's impossible, medically speaking, to kill that child. Just that such an act may not, medically speaking, be abortion. Or so, at least, the medical authorities would seem to believe.

With that it mind, it's worth considering what happened in the horribly sad case of the lady we'll presumably all know henceforth as 'Miss Y', a story which is filling Ireland's papers and which has two victims: a small child, prematurely taken from the womb and currently fighting for its life, and a young woman who has been the victim of a rapist, a culture that left her terrified of pregnancy, a state unprepared to help asylum seekers let alone pregnant ones, and a pro-choice charity that her own account suggests allegedly gave advice both incorrect and incomplete. 

The backstory we can only imagine, of course, but if all the papers other than the Irish Times are right, Miss Y arrived in Ireland as an asylum seeker and someone who'd been raped before leaving her home country; here she would have lived in one of those pitiful Direct Provision centres, and a fortnight or so after arrival she underwent a medical examination.

This examination established that she was eight weeks pregnant; shocked by this news she immediately expressed a desire to end the pregnancy,and the nurse with whom she was dealing suggested she talk to the IFPA. It makes no sense to paint this as her having been denied an abortion at this point, as she'd not spoken to the proper people, and there's no suggestion in her recent Irish Times interview that she was immediately suicidal. In shock, yes, and distressed and surely sick with worry, yes, but not suicidal. 

It looks like she was given no meaningful care at all at this stage, which doesn't reflect well at all on how we treat those who would seek asylum among us. 

Anyway, Miss Y followed the nurse's suggestion and contacted the IFPA, which on the face of it seems to have mucked her about for ages: it talked about 28-week limits in Britain when the reality is that there's a 24-week limit there -- leaving aside how most abortions in England are almost certainly technically illegal -- and it apparently never told her about how such pro-choice charities as the Abortion Support Network might have helped her with money. It seems too that it didn't send her to doctors or arrange for her to get proper counselling or psychiatric help. Certainly, she said nothing about such things when being interviewed.

During this period she became genuinely suicidal, even attempting suicide -- she tried to hang herself -- shortly after the IFPA informed her that it would cost her €1500 to go to England for an abortion. In an article she wrote a day after interviewing Miss Y, Kitty Holland said it is understood that Miss Y was referred to the HSE in May, which suggests that if she was referred to the HSE it happened in the aftermath of this incident. However, leaving aside how it is unclear whether Miss Y ever acted on the reference and contacted the HSE, it is difficult to accept this detail as true: if this really happened, did Miss Y say it in the Irish Times interview with Kitty Holland? If she said it, why didn't Kitty report it? Is it really plausible that Kitty failed to ask whether Miss Y had any dealings with the HSE between her initial examination and her mid-July approach to a GP?

Eventually, during her twenty-third week of pregnancy, she went to a GP who directed her to hospitals where she was established as being both suicidal and 24 weeks pregnant; although she wanted an abortion, she was told that it was too late for one. She then attempted to starve herself to death -- technically this was her second suicide attempt, and should probably be seen as such rather than as a hunger strike -- and the HSE took out a court order so she could be forcibly hydrated, though this was not acted on, as Miss Y was persuaded to start eating again in the belief that she would need to be strong if there was to be an abortion. 

Instead, though, she was presented with the decision of her termination panel to the effect that her pregnancy could be terminated by by premature delivery through caesarian section. Miss Y accepted this, as she felt she had no choice, and the delivery took place, it appears, on Wednesday 6 August, 26 weeks into Miss Y's pregnancy, and two weeks after her arrival in hospital. 

(Nothing that has been reported suggests that the criteria for evaluating risk were established in line with the sensible principles laid down by the High Court in the 2006 Cosma case, which required that patients should be evaluated in the context of ongoing therapeutic relationship involving counselling and all psychiatric treatment that she needed and that the evaluation should show that all other ways of treating suicidality should have been considered properly before the 'last resort' was deemed necessary. But perhaps these principles have been deemed null and void by the X Legislation; I am no expert, and cannot say. I would like to know, just as I would like to know what is the normal therapeutic response when presented with a suicidal patient, and indeed with a patient seeking to starve herself to death. Without knowing these answers, I'm loath to comment.)

Now, much of the early outrage on this -- and you'll see it being picked up on in the likes of the Guardian and following that the New York Times -- seems to have been based on the assumption that Miss Y had sought an abortion for seventeen weeks and had been deliberately denied one until it was too late and a caesarian was the only option. However, by her own account she only went to the proper authorities in the twenty-third week of her pregnancy; things moved quickly after that.

It seems, therefore, to have been on the first day of her twenty-fourth week of pregnancy that Miss Y went to hospital to be assessed and scanned. Should she have been granted an abortion at that point?

Many, clearly, think so; many others, equally clearly, do not; both views are defensible, depending on one's premises. Medically, though, it seems that there's a case that an abortion at that point would have been not merely illegal or immoral, but, as detailed above, impossible. Miss Y's child was by this point not simply a unique human being, but a unique and viable human being, and it is impossible to abort viable human beings. You're not engaging in an abortion then, medically speaking. You're doing something else.

It is crucial to remember that this very scenario was foreseen during the discussions surrounding last year's X legislation. Indeed, the heads of the bill spelled out the obligation to preserve the life of the unborn child if at all possible, noting that:

"In circumstances where the unborn may be potentially viable outside the womb, doctors must make all efforts to sustain its life after delivery. However, that requirement does not go so far as to oblige a medical practitioner to disregard a real and substantial risk to the life of the woman on the basis that it will result in the death of the unborn."

Last year's legislators didn't pluck this obligation out of the air. They were acting, after all, in strict accordance with the provisions of the 1992 X judgment, which the aforementioned Fiona de Londras summed up last year as demanding the following reading of the Constitution:

"Article 40.3.3 of the Constitution recognises the equal right to life of pregnant women and the unborn. This means that abortion is generally prohibited in Ireland but is constitutionally permissible where three conditions are met: (i) there is a real and substantial risk to the life of the woman, (ii) in all probability that risk can be averted only by termination of the pregnancy, and (iii) the foetus is not viable such that abortion (rather than early delivery) is the appropriate means of termination."

(It should be remembered that in 1983, when article 40.3.3 was added to the Constitution, twice as many people voted for it as against it; it's utter nonsense to talk of a cadre of "Catholic fundamentalists" getting their hands on Bunreacht na hEireann and jamming the eighth amendment into it, as I saw one particularly crude piece claiming during the week. The eighth amendment was twice as popular than it was unpopular, and of those eligible to vote, only one person in six voted against it.)

So the X judgment ruled that abortion was permissible only when there was no other way of saying a woman's life, or, if you like, that it was legitimate to take one human life if not doing so meant the loss of two. It did not rule that abortion was permissible when it was the best, or the most humane, or the least distressing way of saving a woman's life. It ruled that it was permissible if it was only way of doing so.

What does this mean? Well, to start with, every single person who for the last twenty years and more has been arguing that we should be legislating for the X judgment has in effect been campaigning for what happened to Miss Y. I'm not saying that they were campaigning for this knowingly; I don't believe that for a moment. I am, however, saying that all their slogans and marches and articles and banners have implicitly demanded the very mess that happened in the last month or so. Every single one. They can hardly say they weren't warned. 

Breda O'Brien, for instance, wasn't joking when she wrote in the Irish Times on 6 July 2013 that the bill allowed that "a baby can be delivered prematurely, but cannot be killed after viability." Scorning the notion that this supposed "protection" for the unborn was an appealing facet of the Bill, Ms O'Brien described this "much vaunted provision" as a "truly monstrous proposal", posing a grim and challenging rhetorical question: 

"In a couple of decades, there will be young adults appearing before tribunals, passionately demanding to know why they, as perfectly healthy unborn children, were singled out for deliberate premature delivery, and left blind, disabled or suffering from cerebral palsy? All in the complete absence of any demonstrable benefit to their mothers."

One would, at the very least, wonder where the burden of proof would lay in such cases. Would doctors be obliged to demonstrate that there they couldn't think of any other way to keep desperate mothers alive? 

Breda O'Brien was hardly alone in pointing this out. It was in the heads of the bill, after all. Everyone who campaigned for X legislation, who voted for X legislation, who supported politicians because they'd promised X legislation, who cheered when X legislation was passed -- this is their mess. And that includes those who saw this as a step towards the repeal of the Eighth Amendment, and the eventual introduction of openly pro-choice legislation, because they were willing to allow situations like this, horrible messes like this, as a 'step'. They were willing to use human beings as a means to the end they wanted. 

They were willing to treat people like things.

It won't do for supporters of the X legislation to say that they didn't realise this would happen: they were campaigning for X to be given legislative force, and as such it was their duty to understand what it was they were campaigning for. If they campaigned in ignorance then, why should they be assumed to be campaigning in an informed way now? Why would they even believe that of themselves?

I'm not blaming those who were open in their opposition to so-called 'Protection of Life During Pregnancy Act'. I may disagree with those who want to repeal the Eighth Amendment, but at least they're consistent in their thinking, wrong though I believe it to be. No more than Ireland's pro-lifers who opposed legislating for X, they didn't do this. They'd rather the problem had been dealt with discreetly in the first place. Out of sight, out of mind.

Papers of Record Don't Refuse Ink

The Irish Times hasn't exactly had a spotless record on the abortion debates in Ireland over the last year or so. 

You'll remember how last September it bowed to pro-choice pressure and jibes from the likes of Graham Linehen to revise initial reports that "less than 1000 people" had participated in a pro-choice rally -- a figure borne out by video footage taken at the march -- in favour of a claim that "several thousand people" had taken part.

You'll remember too how last November it broke the story of Savita Halappanavar's death, relating a range of details which were subsequently cast into question by April's coroner's inquest. It also falsely claimed that in Britain doctors are "legally able to carry out abortions until the 24th week of a pregnancy for all reasons, not just medical"; I know someone who wrote to the paper to alert it to its misrepresentation of British abortion law, just as I did so about the discrepancies in the paper's reporting of the story. Neither letter was published, and corrections did not follow.

I could go on, pointing out the relative emphases given to different stories, depending on whether they leaned towards a pro-life or pro-choice agenda, but time is short and you get the idea. The last couple of weeks, though, may well have topped this. 

On 23 August, the following story appeared on the paper's front page, relating how a twin pregnancy had been terminated at the National Maternity Hospital on Dublin's Holles Street to save the twins' mother's life; supposedly this was the first termination conducted under the terms of the Protection of Life during Pregnancy Act.

A tragic story, it provoked the hospital's Clinical Director and former Master, Dr Peter Boylan -- yes, that Peter Boylan -- to call the report "outrageous", declaring that the details in the Irish Times allowed the woman in the story to be identified: "The breach of patient confidentiality - that's the most serious thing about this whole episode."

Peter Boylan, you'll have noticed, was named in the article as having been party to the decision to terminate the pregnancy:

"The Act does not provide for the identification of either patients or the doctors involved in the process. In this case, it is understood the master of the hospital Dr Rhona Mahony, former master Dr Peter Boylan, other senior obstetricians at the hospital and a paediatrician were involved in the decision-making process."

Given his supposed involvement in the process, you can understand his anger over how the woman being treated could be identified; presumably, you might think, he knew exactly who the paper was talking about. No wonder he was talking about possibly reporting a fellow doctor to the Medical Council.

The day the story broke, however, the Department of Health issued a statement pointing out that the Protection of Life During Pregnancy Bill 2013 had not yet commenced -- I'm not sure how the paper's legal people missed that little detail -- and the following day the article on the paper's website was prefaced with a sentence to the effect that subsequent sentences were untrue. The headline wasn't the only part of the article that was poppycock, after all; from the very first sentence on, the article, seemingly, was claptrap. 

A week later matters took a turn for the truly bizarre, as tucked away in a corner of page seven of Saturday's paper was a little box reading as follows. 

"On August 23rd last, under a story headlined 'First abortion carried out under new legislation', we reported on a purported clinical case at the National Maternity Hospital. The hospital has pointed out that the case described in the article did not happen. The Irish Times accepts this and apologises unreservedly to the hospital for any distress caused. 

The National Maternity Hospital has welcomed the correction and apology, accepts that the article was published by The Irish Times in good faith, believes the matter is now concluded and wishes to make no further comment."

Now. I don't even know where to start with this. The key sentence, of course, is: "The hospital has pointed out that the case described in the article did not happen." 

Yes, the entire story, we're now told, was fiction from start to finish. The Irish Times ran a piece of fiction on its front page, and eight days later issued a tiny discreet correction to the effect that Ireland's so-called paper of record doesn't refuse ink.

As Simon McGarr has so well shown, newspapers have a duty to correct errors with "due prominence", guidelines on how to do this being conveniently supplied by the Press Council of Ireland. I think it's pretty clear that that's not been done here. This, rather, is the journalistic equivalent of tucking something away in a dark cellar at the bottom of a locked filing cabinet stuck in a disused lavatory with a sign on the door saying "Beware of the Leopard".

When I did Accounting in school I was taught that when you'd made an error, you corrected it by putting a line through the erroneous figure with the correct one above the struck out one; under no circumstances, we were told, were we to reach for the Tipp-Ex bottle* and cover up the error so people couldn't see the problem. It's a good principle and one that the Irish Times would do well to live by.

Sadly, it seems that the Irish Times editorial staff weren't sitting in on my bookkeeping lessons, because the original story has now been wiped from the website, with all its fictional detail a thing of the past. Instead, under the same old dodgy headline, we have the bald statement that the HSE had confirmed on 23 August that the Protection of Life during Pregnancy Act, signed into law by the President on July 30th, 2013, had not yet commenced, followed by the 31 August correction.

Thing is, I'm still a bit puzzled. 

There was no termination, as the hospital says and as the Irish Times now accepts. I understand that. 

Had there been a termination, it would not have taken place under the Protection of Life during Pregnancy Act, as that has yet to commence. I understand that too.

What I don't understand is this. Given that he'd been identified as party to this supposed double termination that we're now told didn't take place, why on earth did Peter Boylan react to the original story by saying that the breach of confidentiality was an outrage and that the woman in the report was identifiable? Why didn't he say that such breaches of confidentiality are completely unethical, that to his knowledge the case described in the report never happened, and that he could confirm that he personally had never been party to such a case?

I don't understand that. Why not kill the story on the very first day?

___________________________________________________________________________
* You remember Tipp-Ex, right?

Who controls the past, controls the future...

It’s astonishing to look at the reaction of so many people in Ireland to the recent inquest into the death last October of Savita Halappanavar in Galway, and in particular at how so much attention is being paid to Dr Peter Boylan, erstwhile master of the National Maternity Hospital, that the inquest seems to be being rewritten in the popular mind.

Everyone seems aware of what Dr Boylan said at the inquest, but in directing the jury towards its verdict, the coroner didn’t so much as acknowledge Boylan’s claim that Savita would have survived if the law permitted doctors to terminate pregnancy in order to pre-empt hypothetical risks rather than real ones.

The jury could, of course, have disregarded the coroner's advice and given a narrative verdict which would have given due weight to Dr Boylan's belief that the law was the problem. Instead it opted for a verdict of medical misadventure, accepting the coroner's recommendations, the emphasis of which was almost wholly on procedures and systems failures, with the sole reference to terminations being a recommendation that the Medical Board and An Bord Altranais should have a common, clear, and explicit set of guidelines for how situations such as Savita’s should be handled. It looks, in truth, as though the inquest implicitly rejected Boylan’s analysis.

The official response from Galway University Hospital seems to recognise this, with lots of browbeating about systems failures and not a word said about the law putting Galway's staff in an impossible position.

If the inquest implicitly rejected Boylan’s analysis, Savita’s widower Praveen seems to have gone rather further, going so far as to cast aspersions on Boylan’s integrity.

Praveen's View

Interviewed by the Irish Times, Praveen stated that he believes Dr Katherine Astbury, the obstetrician who was in charge of Savita’s case, used the law as an excuse, a scapegoat for Galway’s poor handling of the case, and suggested that Boylan, by determinedly attributing Savita’s death to a failure of law, was effectively covering for her.

"Well everyone has their opinion. He's a doctor. I think he was soft on Astbury. I was told the obstetricians' is a small world and they all know each very well. I don’t know. It looked like he came across very soft on her."

Although Katherine Astbury trained at the National Maternity Hospital, among other hospitals, it should be pointed out that Peter Boylan says he does not know her. It’s intriguing that those who were so keen to make Savita a martyr for the pro-choice cause have been rather quiet about her husband questioning the integrity of the one obstetrician who keeps pushing the idea that Savita's case shows a need for a profound change in the Irish law, far beyond legislating for the X judgment.

I watched Boylan reel off his spiel on Prime Time on Friday night, and listened to him on Marian Finucane yesterday; I was too busy to experience him a third time this evening on Vincent Browne, but irked by his contemptuous conduct yesterday, and with my work done for the night, I think it’s worth highlighting a few issues with things he’s said over the last couple of days.

British Abortion Law: A Basic Primer
Boylan burbled away yesterday about terminating a pregnancy on hypothetical grounds being illegal in Ireland but legal anywhere other than theocracies. This simply isn’t true. Let’s take Britain for example, as that’s the nearest jurisdiction where abortion is routinely available, and the one in which more than 4,000 Irish women have abortions in any given year – a horrendous figure, but one that's been in steady decline for years, probably reflecting the long overdue demise of the cruel and unjust stigma against single mothers that used to mark the popular mind at home.

Now, I'm not saying a British doctor wouldn't terminate on the grounds of hypothetical harm, but I am saying they'd probably be breaking the law if they did so and would only get away with it because the British system is poorly audited and basically assumes doctors act in good faith.

If Peter Boylan had been in Britain and terminated the pregnancy of a woman he believed to be physically and mentally well, there's a good chance he'd have been in breach of the 1861 Offences Against the Person Act.

Here’s the thing most Irish people don’t get, which enables all manner of people to muddy the waters: abortion is not legal in Britain.

I know, roughly 200,000 human beings are killed in Britain every year whilst still in their mothers’ wombs, but the fact is that the 1861 Act forbids abortion. The 1967 Abortion Act did not legalise abortion; rather, it provided doctors with a series of defences that could be used to justify the performance of abortions on medical grounds.

There are seven such defences, and it’s worth looking at them with a view to seeing how Savita’s request for a termination as she wanted the ordeal over with might have been understood.

Grounds F and G relate to clinical emergencies, where a pregnant woman’s life is in danger or there is a grave threat of permanent injury to her physical or mental health; as Boylan makes clear, there was no emergency until Wednesday, so these grounds wouldn’t apply.

Grounds A and B relate to situations which are not clinical emergencies but where termination is deemed necessary to prevent loss of life or grave permanent injury; again, these was no evidence of any such threat before Wednesday, so these grounds wouldn’t apply.

Ground E permits terminations where the child is expected to be born with a severe handicap, but the histopathologist Dr Michael Tan Chien Shang reported that the child had been perfectly healthy and normal; there was even, as Boylan has admitted, a chance she might survive and come to term.

Ground D concerns risk to any existing children of the pregnant mother; as Savita had no children, this ground clearly wouldn’t have applied.

This leaves ground C, upon which the justifications for 98pc of British abortions rest. This allows terminations when the pregnancy has not exceeded its twenty-fourth week and where its continuance would be more dangerous for the pregnant woman than the termination of pregnancy.

Note that as far as Boylan was concerned, Savita was well until Wednesday*; assuming he believes this was the case, it is difficult to see on what basis he would argue that it would be have been better practice to expose her to risk through abortion than allowing her to give birth or miscarry naturally, given that the risks the latter option posed were purely hypothetical.

If a Ground C defence were to be legitimate it would almost certainly have to rest on the claim that terminating the child she wanted would have been less harmful to Savita’s mental health than seeing what would happen. Almost all Ground C terminations – 99.96pc of them – take place on mental health grounds, despite the RCOG pointing out that the evidence shows that abortion does not help people's mental health.

As Dr David Walsh explained on Vincent Browne last November, “the interventions carry risk as well as the non-interventions.”

What did Professor Bonnar say?
Interruptions were pretty much the hallmark of Dr Boylan’s Marian Finucane performance, and cutting in to ‘correct’ Breda O’Brien, he struck me as having rather egregiously misrepresented Professor John Bonnar, former chairman of the Institute of Obstetricians and Gynaecologists, with whom he’d discussed these matters on RTE’s Prime Time on Friday night.

“That’s incorrect,” butted in Boylan on Breda, explaining, “I was on Prime Time with him there last night I think it was…Friday night. And that’s not correct what he said. He said he would wait until she was ill and then he would have no hesitation in intervening… He was very clear about that because I picked him up on that.”

This simply isn’t true. John Bonnar did not say doctors should wait till a patient is ill before acting; he said they should find out if a patient is ill and then act.

Bonnar has said that had proper tests been carried out the hospital would have had evidence of substantive risk by Tuesday, and that this evidence would have justified termination. In other words, unlike Peter Boylan, and with microbiologist Dr Susan Knowles and apparently the Coroner, John Bonnar takes the view that the issue was systems failures and mismanagement, not law:

"My concern would be that the tests for infection were not heeded. There should have been swabs taken when she was admitted, we should have identified what the organisms were, we should have started the antibiotic treatment, and then terminated, and that could have been done by Tuesday."

Boylan’s response to this was simply to pull a sceptical face, while saying “John. Come on.” Like so.

Good eyebrow action. Always works well in the absence of an argument.

Note that Boylan hasn’t rebutted or refuted this argument; he’s merely looked condescendingly at another obstetrician, and then subsequently misrepresented what he said.



And remind me – what exactly did Dr Knowles say?

Earlier in the Prime Time discussion, Peter Boylan said something very odd.

“To me the deficiencies were mainly in appreciating that the ruptured membranes may well have been due to chorioamnionitis –" began Bonnar.
“There was no sign of that whatsoever,” butted in Boylan, “until the early hours…”

The thing is, that’s not quite true, and Peter Boylan should know this, given his supposedly forensic scrutiny of the case files and how he received transcripts of all testimonies at the inquest. He wasn't, after all, the only expert witness at the inquest.

Dr Susan Knowles was the consultant microbiologist who gave expert testimony to the inquest, and given that the whole Savita affair was basically a story of infection, I'd have thought her testimony should be given at least as much scrutiny as Peter Boylan's. She was, as Muiris Houston put it in The Irish Medical Times, a "beacon of light" at the inquest. She made several important points in this regard during her evidence.

• Firstly, she said that the Sunday blood test suggested that Savita’s body might have been fighting a subclinical infection even before her membranes ruptured, and that this test should have been followed up properly.
• Secondly, she pointed out there were “subtle indicators” of sepsis and chorioamnionitis on Tuesday.
• Thirdly, she made clear the antibiotic treatment Savita received prior to lunchtime on the day she lost her child was less comprehensive that what she would have received in any of the Dublin maternity hospitals and didn't meet Galway's own standards.

I realise that Dr Boylan has argued that the initial Sunday blood test probably didn’t mean anything, but I don’t think it makes sense simply to act as though the testimony of another expert witness – who happens to be a colleague of his at the National Maternity Hospital, as well as one of the country's leading experts on infection in pregnant women – simply didn’t happen.

Besides, even if Boylan were right to say that there was no evidence of chorioamnionitis before Tuesday, this would hardly negate Bonnar’s point that evidence of such things simply wasn’t looked for. As Dr Knowles pointed out, the Sunday blood test should have been followed up!

And, for those who are determined to support experts who say what we want to believe...

I’m loath to point to her, given her comments on the Savita affair have been sometimes prone to disregarding facts and to have shown a surprising misunderstanding of details that were in the public domain, but it might be worth looking at what the American pro-choice doctor Jen Gunter has said on this issue.

On 9 April she wrote that Savita’s combination of ruptured membranes, dilated cervix, and an elevated white blood cell count – all of which were in play by the early hours of Monday – all point towards a diagnosis of chorioamnionitis. On 13 April she added that the facts that Savita had an elevated heart rate –  on Tuesday evening –  and shaking chills –  by the early hours of Wednesday –  suggested that the infection had spread from her uterus into her blood stream as a result of chorioamnionitis being inadequately treated.

Now, I’ve been sceptical of Dr Gunter’s approach to this stuff, but I’ve seen pro-choicer after pro-choicer citing her with approval ever since the Savita story broke. If she’s even remotely credible, we have to at least recognise that her thesis poses a serious challenge to Dr Boylan’s claims.

To be honest, I think Dr Knowles’s testimony is challenge enough.

For the record, it's not Breda O'Brien who's been rewriting history...

Dr Boylan was very quick on yesterday's Marian Finucane to correct Breda O’Brien when she said that Savita had been admitted to hospital with her cervix fully dilated. He may well have been factually correct to point out that Breda was wrong, but it was both churlish and inaccurate of him to describe Breda’s point as “revisionism and the rewriting of the history of what actually happened”.

The problem is that even if Boylan is right to say that Savita’s cervix was not fully dilated when she was admitted – and he should know, as unlike most people, he’s had full access to Savita’s medical records – this isn’t what Praveen said back in November.

The Irish Times twice in November cited Praveen as saying that when Savita was admitted “The doctor told us the cervix was fully dilated, amniotic fluid was leaking and unfortunately the baby wouldn’t survive.”

Dr Olutoyele Olatunbosun, the gynaecology SHO who treated Savita on the Sunday told the inquest that she had found that Savita's cervix was dilated, and when addressing the inquest on 9 April, Praveen stated that when Savita was admitted she was told that there was “some cervical dilation”.

There may well be some revisionism – some rewriting of history – going on with this part of the story, but it’s not been Breda O’Brien who’s indulged in it. If Breda and her obstetrician friends can be faulted here, it’s for having trusted the original story as told by The Irish Times, and not having caught its most recent incarnation as told by Praveen.

Revisionism isn’t necessarily a bad thing, by the way. Sometimes we discover new facts or think of new questions, and these should force us to revise our old views and old narratives. That's just being honest and being thoughtful. Hanging onto "the crippling version of this story that was initially presented to the country by The Irish Times, which sought to shape this woman's tragic death into a rallying cry for a change to Ireland's abortion laws", would be neither honest nor thoughtful.

But that’s by the by.

Failings, failings everywhere...

Another oddity on Marian Finucane took place when Dr Boylan claimed that the only thing that the inquest identified as being deficient in the first two days was "the lack of a repeat of a white cell count".

That may have been the only thing he identified as deficient in the first two days, though even then he played down the significance of that, but it simply wasn’t the only thing the inquest identified as deficient in that period.

The coroner recommended – and the jury strongly endorsed this view – that blood tests should always be followed up properly, with procedures in place to make sure such errors as happened don't occur, and that there should be proper communications between hospital staff. Now...

• Susan Knowles noted that Savita was not given a vaginal examination or checked for leaking of amniotic fluid on the Sunday.
• The failure to follow up the blood test Dr Olatunbosun ordered on the Sunday meant the hospital's treatment of Savita was conducted in the assumption that Savita was not already fighting infection, whereas she may already have been afflicted with a subclinical infection.
• Dr Andrew Gaolebale said that he was not informed of the results of the Sunday blood test and he was not told that her membrane had ruptured after he saw her, even though he was still on duty for another 12 hours into the Monday.
• I don't know if Tuesday evening counts as being within the first two days, but just over 48 hours after Savita was admitted there seems to have been an issue with information about Savita's elevated pulse being brought to Dr Ikechukwu Uzockwu by the midwife manager Ann Maria Burke; we don't what happened, as their evidence is contradictory, but it seems that something went wrong with tachycardia, a classic sign of sepsis, not being taken properly into account.

To this I'd add that when Peter Boylan asked Breda, "Which is what? What have your colleagues – your obstetrician colleagues – identified as proper care?", I cannot help but recall how John Bonnar's answer, quoted above, sums up what he believed ought to have happened, had the white blood cell issue been spotted, perhaps in connection with Dr Gaolebale been told in a timely fashion of how Savita's membranes had ruptured since he'd inspected her, with her collapsing and vomiting.

It’s striking how Dr Boylan cuts Breda O’Brien short and misrepresents her as saying that an elevated white blood cell count would have justified a termination; she had never said any such thing.

What she was clearly trying to get at, though, was that if this had been spotted –  as Susan Knowles said it should have been, and indeed as was obviously the case from the HSE leaks some weeks ago –  it could have justified a whole series of other steps, as outlined by John Bonnar, which in turn might have justified a termination in accord with Irish law and normal Irish medical ethics.


I'd also point out that if the New York Times has reported things accurately, Dr Astbury herself, like Dr Knowles and evidently Dr Bonner, gave rather more weight to the failure to follow up the Sunday blood test than Dr Boylan did.

"The inquest has also heard testimony that several hospital protocols were not followed, amounting to system failures that contributed to Dr. Halappanavar’s death. Dr. Astbury said she might have intervened sooner had she been made aware of the results of earlier blood tests."

She presumably didn't mean she'd have leapt in to terminate or accelerate the miscarriage, but rather would have taken steps to find out what was going on  – steps that could have found out just how sick Savita was, regardless of how she appeared, and that would have necessitated decisive action. It's nonsense for  Peter Boylan to say there was no other evidence of problems; there was no evidence because the evidence wasn't sought.

As John Bonnar has said, there were ways of seeking that evidence.

___________________________________________________________________________

* No, really. That's the central plank of his argument. 44 minutes into Marian Finucane, for instance, he tried to explain away Galway’s failure to terminate Savita’s pregnancy before Wednesday morning by saying it’s an issue of law and clearly stating “She was well till then – that’s the issue, you see.”

This seems, at best, a presumption, as if she really had been well till Wednesday, then we must assume that she developed her infection on Wednesday. The reality, clearly, is that she merely appeared well, while harbouring a serious infection that had yet to kick in in a serious way.

That the white blood cell was high on Sunday may well have indicated that she had arrived in hospital fighting a subclinical infection, according to Susan Knowles, who is adamant that the test should have been followed up. Even without following up the test, and conducting further tests along the lines suggested by John Bonnar, who suspected that the rupturing of Savita’s membranes just after midnight on Monday may have been due to chorioamnionitis, it’s clear the hospital had recorded  'subtle indicators' of sepsis and chorioamnionitis before Wednesday, however, including a high pulse rate on Tuesday, according to Susan Knowles.