When it comes to medical practice, we must ensure that the patients do not suffer
20 March 2006
Following the publication of the Lourdes Hospital Inquiry a Dáil colleague asked me if I had ever known of what is described in the Report as a "compassionate hysterectomy" being carried out. This is where a hysterectomy was carried out for the purpose of the sterilization of the woman rather than the similar and less intrusive operation of tubal ligation. She was shocked that such a medical practice could have happened and despite the Report repeatedly alluding to the practice I knew she wanted me to say it was rare. With regret I told her it had happened frequently and told her the following story.
When I began working with women patients, in the Rotunda Hospital and Sir Patrick Dun's, who had problems with varicose veins or the post phlebitic limb it soon became obvious that older women who had had large families were those must seriously affected. The literature pointed to the increased risk of a deep-vein thrombosis and possible pulmonary embolism in older patients of high parity, particularly if they had had a previous deep-vein thrombosis. Thanks to the assistance of the late Dr. St. John Cowell I reviewed the Irish maternal mortality figures from 1966 to 1973 in 1975.
Between 1966 and 1973, 23 deaths from pulmonary embolism were reported. In one case neither age nor parity was stated.
Of the 22 patients in whom age was stated, 19 were over 30, 11 were over 35 and 8 were over 40 - for those who like percentages, 86 percent of the patients were over 30, 50 percent over 35 and 36 percent over 40. (The age of women giving birth was dropping at this time and by 1972 only 5 percent of births took place to women over 40.)
Of the 21 patients in whom parity was stated, 18 were on their third or subsequent pregnancy, 12 on their fifth or greater and in 5 the number of pregnancies ran into double figures. In 1972 a 48-year-old woman died on her eighteenth pregnancy. So, 25 percent of those who died 30 to 40 years ago had had ten or more children. In deaths from other reasons than pulmonary embolism, the parity rate was much lower.
There would have been no effort to discuss contraception with these women because it was, of course, illegal then. The pill-high dose-was available as a "cycle regulator" but would have been unsuitable from a medical point of view for these older women. Sterilisation was not illegal but was not available.
Having published this paper and got little reaction I presented it at a meeting which I believe was of the Institute of Obstetricians and Gynaecologists but certainly at which many obstetricians were present. When I had finished the presentation I suggested patients who were at high risk of pulmonary embolism should be counselled regarding further pregnancies and that they should be offered sterilisation by tubal ligation if that was what they desired. One member of the audience said "Surely, doctor, you know some friendly gynaecologist who would do hysterectomies on these patients for you?" I do remember another saying then "Oh, that's a bit much."
So I was able to tell my Dáil colleague compassionate hysterectomies took place alright.
We are all entitled to our religious beliefs but I feel we have to be careful on imposing them on the lives of others. No one should be expected to be involved in treatments or procedures which come under this category but patients are entitled to have their religious beliefs respected, too. If the law of the land allows a procedure and it is best medical practice it should be offered to patients and those who object to such practices should refer them with care to other practitioners and not abandon them with little or no information.
Dr. Michael Neary and his colleague Dr. Finian Lynch did apparently try to get guidance from both the Department of Health and the Medical Defence Union as to what they should do about the ban on tubal ligation in the Lourdes Hospital. Having no satisfactory reply is no excuse for the dreadful practice which went on regarding peripartum hysterectomies in Dr. Neary's case on young women with few children-in Dr. Lynch's cases the women were older and had more children.
But the fact that "compassionate hysterectomies" were carried out in Ireland instead of tubal ligations must have lead to the feeling hysterectomy wasn't such a big deal, indeed was a blessing for many women.
Now, I realise I won't be thanked for saying all this but we must learn the lessons of this inquiry. One is that best medical practice must prevail in all our hospitals. We have to become far more concerned about the outcome for the patient. There have been many apologies to the women who were so grievously injured but their husbands who would have liked more children require an apology too-and their parents who were denied grandchildren and the little children these women had already who were denied siblings.
Recent problems in the Mater Hospital reported in the media concerning a multi-centred trial of chemotherapy for women with advanced breast cancer depressed me. Apparently the leaflet for the patients advised that the women should avoid pregnancy by using contraception if they were not abstaining from sexual intercourse and this was considered in conflict with the ethos of the hospital. Surely, the ethos of the hospital should be that the best possible outcome is desired for all its patients? While I have only the press reports to rely on surely the possibility of them remaining on this earth for a few more months was of the greatest importance and if they felt like sex why should they have to worry about an unplanned pregnancy? The fact that the public purse, the Irish taxpayer pays for the patients in the hospital is but a small thing compared to the necessity of ensuring our patients get the best possible treatment. The relationship between strongly held religious beliefs and human reproduction is difficult but we must ensure that women do not suffer.
Senator Mary Henry, MD
