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The tragic death of Savitha Praveen Halappanavar in Galway, Ireland, has brought to the fore the fault lines between Catholic doctrine and the medical profession. Halappanavar, a 31-year old dentist hailing from Belgaum, India, died due to complications in her pregnancy because her doctors refused to operate on her for an abortion. Experiencing her first pregnancy, Halappanavar was on top of the world, but problems arose on October 21, when she was admitted to Galway University Hospital for back pain and suspected of having a miscarriage. Over the next week, Halappanavar’s condition deteriorated, her last three days in excruciating pain. Despite repeatedly being asked to induce a termination of the pregnancy, the hospital staff refused. According to the consultant, Ireland was a Catholic country, and as long as there was a foetal heartbeat, the hospital could do nothing; that Halappanavar was neither Irish nor Catholic had no bearing on the matter. On October 28, 2012, Savitha Halappanavar passed away. An autopsy revealed that the cause of death was septicaemia, documented ante-mortem, and E. Coli ESBL. An unviable foetus had been given priority over a mother’s life. Halappanavar was cremated as per Hindu traditions on November 03.

On a side note, two months ago, about 140 medical professionals in Ireland participated in a consortium which declared abortion to be medically unnecessary. Claiming that abortion is never required to save a woman’s life, they announced, “We confirm that the prohibition of abortion does not affect, in any way, the availability of optimal care to pregnant women.” Ambiguously, Eamon O’Dwyer, a conference organiser and professor emeritus of obstetrics and gynaecology at NUI Galway, also said that “no treatment should ever be withheld from a woman if she needed it to save her life, even if that treatment resulted in the loss of life of her unborn child.” Irish law (going back to 1861) prohibits abortions, but a 1992 Supreme Court ruling allowed it only if the mother’s health was in danger, even from herself (threats of suicide). Successive governments, however, have refused to pass legislation in line with that judgement.

The debate over abortion and its lesser cousin, contraception, can be found easily online but it is important enough to be repeated here once more. Briefly the arguments for legal abortion are:

  1. The state has no right to control an individual’s body
  2. A woman’s life may be at risk during a pregnancy; abortion may be the only way to save the woman’s life
  3. Abortions may be desired in the case of rape or incest victims
  4. Abortions may be the kinder option out if the foetus is diagnosed with debilitating diseases such as Cystic Fibrosis, Down Syndrome, or Escalante’s Syndrome
  5. It is argued that women may use abortion as a worst-case contraceptive. This is not only a deeply offensive belief but also ignorant. If one cares to check contraception (which Catholics want to ban, too) packaging, it will usually say 99% effective – even if all care is taken, there is still a tiny chance of pregnancy.
  6. Motherhood should not be a punishment. The quality of care given to an unwanted child should also be considered, whether the deficiency is for economic reasons or others.
  7. It is possible for the financially secure to travel to a country where abortion is legal for the procedure. An anti-abortion law thus only affects the lower rungs of the economic ladder, who will have to do without access to such medical facilities or will probably avail of other alternatives which are dangerous (such as self-induced or back-alley procedures). Legal abortions thus protect a woman’s health.
  8. Given the rate of teenage pregnancies and young women who are not ready for motherhood becoming pregnant, a law pushing compulsory pregnancy will be detrimental for society.
  9. The argument that life begins at conception is specious. Personhood certainly does not begin at least until birth, and a foetus is therefore not a person. Even if one were to concede to the notion of the foetus as a potential person, this event can be dragged further back to the point where every ejaculation is mass murder.

For all the points for and against legal abortion, it is the last one that causes most friction. It is usually based on religious belief and has little to do with science or empirical evidence. However, abortion is not the only issue which has attracted religious attention. The clergy has also opposed contraception, some on the grounds of President Obama’s proposal to make them pay while others on theological points. In 2010, in the United Kingdom, Muslim female medical staff refused to comply with a health directive that stated that arms should be bare below the elbow to avoid sleeves picking up contaminants and allowing staff to wash quickly and cleanly. They also refused to use natural alcohol to as disinfectant since it was prohibited by Islam. Sikhs were also allowed to wear their bangles. In April 2012, Tennessee voted to have creationism taught side by side with evolution.

In this age of hypersensitivity, it is never clear what the religious lobby will find offensive to their faiths, and when. Today, it is abortion and scrubbing, but tomorrow, it may be an injunction against treating homosexuals, or obese people since gluttony is a sin. It is galling to think that priests can lecture doctors on medicine when doctors rarely try to explain theology to the clergy. Yet rather than deal with every new tantrum in an ad hoc manner, a pragmatic way must be found that protects the sentiments of the religious while ensuring the liberty of those who choose not to have their pastors (or other religious figures) as their doctors.

It must be noted that any of the following suggestions apply in secular countries only and not theocratic states, even ones inspired by their scriptures. Presently, the confrontation seems to be only with Christian theology, but the system proposed below can accommodate any faith or sect that wishes to avail of it.

Presently, a medical license is dispensed by the state. It is based on examinations, practical and theoretical, and various other criteria that judge a person’s scientific (or at least medical) competence. Since the license to practice medicine is issued by the state, it is only fair that the rules of the state be followed. Medical boards usually follow what scientific research indicates is best, and follow practices based on empirical data. This means that no doctor with a state-issued medical license would be allowed to refuse treatment to a patient regardless of religious or other beliefs, and will follow all codes set by the hospital or facility at which s/he is employed. Thus, there is to be no leniency shown in scrubbing requirements, jewelry allowances, and no treatment within the expertise of the facility is to be denied.

For those who feel that contemporary medical practices violate their faith, another accreditation system should be set up in consultation with representatives of various belief systems. Hospitals are free to hire people with these alternative licenses as they please – for example, a hospital may hire an alternatively licensed “doctor” in the Ear, Nose & Throat department but perhaps might have reservations about hiring such “doctors” in Obstetrics and Gynaecology. Alternately licensed professionals may also prefer to work at such institutions too, for they need not face the daily indignity of the violation of their modesty and/or faith. Religious institutions that run hospitals may wish to hire alternatively licensed practitioners alone as they fit the moral environment better.

Most importantly, patients are clear when they go to a doctor what sort of care they can expect; they can be treated according to their comfort. Religious institutions that hire predominantly alternately licensed professionals should be exempt from state mandates that go against their faith. Thus, freedom for people of faith from the secular state is assured, as is patient awareness increased. Two accreditation are certainly not a burden to handle – countries do it routinely in education. For example, the US has SATs and ACTs; India has the ICSE, the CBSE, and over 30 (!) state boards.

Control over one’s own reproductive facilities is, for me, non-negotiable. However, imposing one’s views on others is also unacceptable. A separation of licensing requirements and authority would certainly be in the best interest of patients, as would it soothe the consciences of medical staff who presently feel the pressure to conform to secular (scientific) standards. As this debate rages on, 22 million women worldwide undergo unsafe abortions, 47,000 of whom die from complications and perhaps as many as 470,000 of whom suffer long-term health consequences. The pragmatic amongst us must argue not for the truth of our cause but for the right to be left alone to follow our conscience. But perhaps we should think on the words of Sarvepalli Radhakrishnan, India’s second president, who said, “It is not God that is worshipped but the authority that claims to speak in His name. Sin becomes disobedience to authority, not violation of integrity.”

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