Negligence, Symphysiotomy and Past Harm.

Women wrongfully subjected to symphysiotomy in Ireland have human rights to an acknowledgement and apology, to guarantees against repetition, to measures of restitution and rehabilitation and to monetary compensation. I have written about the symphysiotomy redress scheme on this blog and elsewhere on a number of occasions. It was recently reported that over 50 women who applied to the scheme have been denied redress because they were unable to provide the medical records which Judge Harding-Clarke demands. Al Jazeera recently reported women’s experience of the hostile administration of the scheme. A number of members of Survivors of Symphysiotomy decided not to participate in it, preferring instead to try their luck with civil litigation.  There have been three symphysiotomy negligence cases to date. The first, Kearney, initially heard in 2006, was a case of symphysiotomy after C-section, performed in Our Lady of Lourdes Hospital in Drogheda. Mrs. Kearney succeed in the High Court and Supreme Court. Her case is the origin of the test which enabled two further litigants to bring negligence cases to the High Court, against the Coombe hospital. Another plaintiff, Noreen Burns, died last summer before her case against Holles Street  could be heard. The first case to come to hearing, a Kearney-type symphysiotomy after C-section, settled. The second, a case of prophylactic symphysiotomy performed 12 days before the birth ended with a recent judgment by Cross J. As the term is used in this judgment, a prophylactic symphysiotomy refers to an elective, non-emergency symphysiotomy performed before labour begins, purportedly to slightly widen the pelvis and facilitate vaginal birth in the first instance and in future births.

Green shoots from the latest judgment.

What we have learned from these cases so far is that symphysiotomy litigation is not a hopeless strategy, as many TDs who support the redress scheme assert. In particular, we have learned that the Irish courts are likely to be open to hearing claims even where decades have passed since the symphysiotomy was performed.   In his recent judgment, Cross J. held that the relevant date of knowledge for the purposes of s. 2 of the Statute of Limitations was the date at which the plaintiff had sufficient knowledge to justify bringing a claim. This was not the date of the symphysiotomy itself, or the date on which she first began to suspect that a symphysiotomy had been wrongfully performed,  or the date on which she first made inquiries to the hospital. It was the date on which she received her medical records.  This point was not directly argued in Kearney and it is very helpful to have the clarification. Of course, two years remains a ridiculous limitation period for personal injuries of this kind, and many women will find their claims statute-barred despite this decision.

We have also learned that Irish courts are willing to accept that litigants’ injuries are attributable to symphysiotomy. In his recent judgment, Cross J. accepted, against the assertions of the defence, that the plaintiff had suffered life-long physical and psychological consequences as a result of the symphysiotomy.  Even though there were no records of the plaintiff raising her symphysiotomy with her doctor, Cross J. accepted evidence that she had discussed the resulting injuries with a friend long before the question of legal proceedings arose, and accepted the evidence of her medical experts which attributed her injuries to the symphysiotomy. In this respect, it is important to note that the High Court is less demanding than Judge Harding- Clarke’s redress scheme, which requires women to produce paper records going back to the time of the operation. Unfortunately, Cross J. repeatedly stresses that he makes no finding as to the general safety of prophylactic symphysiotomy. 

We have also learned that hospitals’ defence teams are willing to proceed very aggressively against elderly women. The government, of course, has not adopted ‘model litigant principles to moderate hospitals’ or the State Claims Agency’s dealings with victims of abuse. However, it is consoling to see that Cross J. dismisses some of the worst of the defence tactics deployed in this case; for instance, the implication that aspects of the plaintiff’s claim were concocted in collusion with Survivors of Symphysiotomy, and the argument that the existence of the redress scheme meant that he should be less willing to find in the plaintiff’s favour.

Difficulties in winning symphysiotomy cases under Kearney, and this latest judgment.

Inevitably, something is lost by framing a symphysiotomy case as a negligence case. The cost of litigation, and the emotional toll that it can take on litigants, and the campaigners who support them, are important considerations. We may be willing to accept that in exchange for some forms of success in litigation – a finding of liability and an award of meaningful compensation. But the latest symphysiotomy case suggests obstacles to recovery which are internal to Irish negligence doctrine.

There is no difficulty in establishing the duty of care in  a symphysiotomy case because it is clear that doctors owe duties of care to their patients. Other kinds of institutional abuse case are more likely to fail at the point of establishing duty of care, fiduciary duty, or vicarious liability (see e.g. O’Keeffe v. Hickey and a raft of cases in Canada and Australia). As already discussed, the most recent symphysiotomy case also suggests that causation requirements will be readily satisfied. Symphysiotomy litigants are more likely to struggle with establishing breach of the doctor’s duty of care. This is because, for women who gave birth in the 1960s at least, the court’s approach to the standard of care is deeply shaped by their desire to avoid prejudice to the defendants caused by the passage of time.  It is not only that the symphysiotomy is judged according to medical standards prevailing at the time that it was performed, but that the plaintiff’s case is dramatically circumscribed to the advantage of the defendant.

Excluding the consent question and misrecognising torture.

First, Cross J. accepted that the plaintiff was not told that a symphysiotomy would be performed on her. However, he could not hear further argument on this point. In Kearney, the High Court, and the  Supreme Court  held that the plaintiff could not base her claim in the failure to obtain her informed consent to the procedure because it could not be known what information had been given to her at the time the operation was carried out. Almost 40 years had passed since her symphysiotomy. All of those involved in her direct care were either dead, living elsewhere, or uncontactable and the records of the procedure were incomplete. It would be unjust to expect the hospital to defend itself against such a claim. There is therefore no argument in Kearney around assault, or around negligent failure to obtain informed consent along the lines of Walsh v. FPS. Last July, the United Nations Human Rights Committee emphasised failure to obtain women’s consent when it  categorised symphysiotomy in terms of terms of violation of Article 7 of the ICCPR: the prohibition against torture, cruel, inhuman and degrading treatment, including forced subjection to medical experimentation. The Committee advocates prosecution of surviving doctors who performed symphysiotomy. If older symphysiotomy cases are not consent cases, of course, then the  core of the injury done to many women is eliminated from  judgment. If we think of symphysiotomy  as the unlawful intentional infliction of pain and suffering on women for discriminatory reasons – as torture – then the  Kearney judgment is deeply flawed. The removal of the consent question allows the development of symphysiotomy to be presented as an essentially benign practice – part of the natural development of obstetric care in Ireland. In the process, it leaves many of the problematic narratives about the safety of symphysiotomy (embedded in the Walsh Report) untouched. One might almost say that in Cross J.’s judgment, the operating doctor is partially redeemed, without having to take any responsibility.  The judgment also, in Blackburn’s words, requires the divisibility of injuries that people experienced as indivisible. That much may undermine the value of litigation in the eyes of victims, who feel that they can only obtain an incomplete hearing; that their injury, to borrow from Nicky Priaulx, cannot be  ‘seen’ in full.

The ‘any justification’ approach

Second, Kearney prescribes a modified Dunne test, again intended to allow the plaintiff to bring a negligence claim without unduly prejudicing the defendant. The plaintiff’s argument must be that “there was no justification whatsoever in any circumstances for the performance of a symphysiotomy on her at the time that it was performed”. If the defendant can establish in credible evidence any realistic reason justifying the symphysiotomy she cannot succeed. As Hardiman J. confirmed in Kearney in the Supreme Court, hypothetical justification will suffice. Cross J. acknowledges that this is obviously a very high threshold for the plaintiff to meet. He finds that there were realistic reasons justifying the performance of the plaintiff’s symphysiotomy – examination of the plaintiff convinced the treating doctors that vaginal delivery would not be possible. Rejecting the plaintiff’s expert evidence, he holds that doctors were justified in their suspicion of multiple Caesarean sections (which were more difficult to avoid given that the same doctors would not provide sterilisation and the law restricted access to contraceptives), and that symphysiotomy was then considered an appropriate and safe  treatment in cases of the plaintiff’s kind by consultants at the Coombe and the National Maternity Hospital.  The plaintiff’s recorded diagnosis matched this prevailing rationale. We can contrast this with Kearney in which Ryan J. held that Mrs. Kearney’s pelvic measurements and presentation did not suggest, on the terms on which symphysiotomy was performed in 1969, that she was a proper candidate for symphysiotomy. Thus there had been no realistic reason for performing the symphysiotomy in her case.

It is important to clarify how Cross J. defines the procedure he is assessing. He works from the assumption that, in 1963, symphysiotomy could be preferred to Caesarean section in cases where the measurements of a woman’s pelvis relative to the size of the as yet undelivered baby’s skull suggested that vaginal birth would be too difficult.  First, he discounts the fact that the plaintiff’s symphysiotomy was performed 12 days before she gave birth. In Kearney, it was crucial to Ryan J.’s reasoning that the symphysiotomy was performed “on the way out” after the baby was already born – there could be no good reason, to his mind, for performing a symphysiotomy in these circumstances. We might have expected the 12 day delay to act as a similar indicator of irrationality in this case. However, the judge accepts that the defendants believed, at the time, that the plaintiff was overdue. So he characterises the symphysiotomy as a prophylactic symphysiotomy and treats it in the same way as any  prophylactic symphysiotomy performed shortly before labour began.  Second, finding justifying reasons does require the judge to select the community of knowledge which generates those reasons. Is it the British and Irish obstetric community of the time, or something narrower? Cross J. frames the justifying reasons very tightly in terms of time and place. He has some regard to the plaintiff’s expert evidence to the effect that a symphysiotomy should not be attempted before labour has been tried, since the most effective way to measure the pelvis is to attempt to put the baby through it. However, he characterises this type of prophylactic symphysiotomy, performed – perhaps erroneously – without trial of labour, as a stage in the evolution of symphysiotomy as a medical practice at the Coombe.  It was carried out during a period of trial-and-error expansion of the original terms on which symphysiotomy had been revived at the National Maternity Hospital, and as a practice was rapidly phased out when the Coombe introduced the (from a feminist perspective highly problematic) practice of active management of labour. Thus, it could be justified on its own terms in 1963 even though earlier and later Masters of the Coombe would never have done it. This indicates  that Kearney may require – in line with Cross J.’s refusal to draw any conclusion on the general consequences of symphysiotomy – that every symphysiotomy will be analysed very strictly on its own terms before any finding of liability will be considered. This is very problematic if we consider that the experimental nature of the practice of symphysiotomy – the tendency to play fast and loose with risk and necessity – is central to its character as a human rights abuse. If broad periods of experimentation are sliced down into ever finer periods of stabilisation and normalisation, that truth is lost.

The issue of ‘inherent defects’.

 Kearney affirms that there is another route open to the plaintiff, which also comes from the judgment in Dunne. She may argue that the type of symphysiotomy performed on her, as a procedure, albeit it was supported by a respected body of medical opinion, suffered from “inherent defects” that “ought to have been obvious to any person giving the matter due consideration” at the time. This element of the Dunne test ensures that the courts are empowered to declare even generally accepted medical practices as unsafe. Expert witness support for a minority practice is a very weighty matter to be taken into consideration, but it is not definitive. As  Sachs LJ held in Hucks v. Cole, ‘The court must be vigilant to see whether the reasons given for putting a patient at risk are valid in the light of any well-known advance in medical knowledge, or whether they stem from a residual adherence to out-of-date ideas”  In Donovan v. Cork Co. Co., Walsh J. held:

” If there is a common practice which has inherent defects, which ought to be obvious to any person giving the matter due consideration, the fact that it is shown to have been widely and generally adopted over a period of time does not make the practice any the less negligent. Neglect of duty does not cease by repetition to be neglect of duty.”

McCarthy J. elaborated on that test in some depth in Roche v. Peilow. In that case, Finlay P. in the High Court had held that “the universality of a particular practice adopted by an entire profession must itself be evidence that it is not a practice which has inherent defects which ought to be obvious to any person giving the matter due consideration”. Finlay P. suggested that “inherent defects” connoted “an act of gross ignorance such as could not have been committed by any other ordinarily informed member of the profession.” McCarthy J. demurred, holding that this test would impose too high a burden of proof on the plaintiff.  Professionals, in effect, are required to notice “clear and present dangers”.

This line of authority is not discussed in Cross J.’s recent decision. However, it looks to me as though his judgment is rather too close to the Finlay approach rejected by McCarthy. He defers, not as Finlay did, to universal or generally accepted practice, but to a minority school of respected obstetricians, and finds that their support of the practice was incompatible with the presence of inherent defects. He finds that given the wide acceptance of prophylactic symphysiotomy among what he calls “the Dublin school” of obstetricians at the time, and the existence of debates around the practice in hospital records and the proceedings of professional societies in which the practice was stoutly defended, it cannot be said that the practice was inherently defective. In Kearney, Ryan J. accepted that there was ‘outright condemnation’ of symphsyiotomy after C-section, but in this case Cross J. finds that prophylactic symphysiotomy was controversial, but defensible and was not the subject of peer criticism. Central to this conclusion, of course, is his acceptance of the defendants’ claim that these doctors at the time generally did not know of, and could not have foreseen, the serious health complaints that immediately and subsequently afflicted women subjected to symphysiotomy.

Whether, if properly applied, the McCarthy approach in Roche could be of much assistance to plaintiffs is an open question. It is not clear what “inherent defect” means in Irish law. Does the test invite a judge to evaluate the medical practice from his own lay perspective – to engage in his own evaluation of the risks and benefits of the procedure as they appeared in the light of international medical knowledge at the time, and perhaps to consider them in the light of the human rights norms then prevailing in Irish law?  Or is he merely entitled  to consider, against the evidence of the defence’s experts, whether the doctor’s decision was incapable of standing up to rational analysis? (as in the English test in Bolitho) If the latter, is there any real difference between the Kearney “no justification” test and the “inherent defect” test? It may be, following McCarthy in Roche, that inquiry into the presence of an  “inherent defect” should go primarily to the dangerous outcome of the procedure chosen, irrespective of the reasons for performing it. This seems to be the approach taken by Ryan J. in the High Court in Kearney where he emphasised the maternal morbidity associated with symphysiotomy after Caesarean section. (Indeed, Ryan J. was more willing than Cross J. to make general findings, based on expert evidence, about the consequences associated with symphysiotomy). Then, questions arise as to whether the dangers of prophylactic symphysiotomy  should have been obvious to doctors in 1963.  In Roche, McCarthy J. acknowledged, following Kelly v. Crowley, the risks of judging professional conduct with the benefit of hindsight. Nevertheless, he said , “it cannot be a legal principle that a profession is, so to speak, entitled to ‘one free bite’ – to wait until damage is done before taking an obvious means of avoiding that damage.” Arguably, with symphysiotomy, “the Dublin school” had more than “one free bite”, but never sought to properly test their results. Cross J. notes, for instance, that Master Kevin Feeney was interested in pursuing follow-up studies of symphysiotomy patients. But in practice this was never done.

The upshot

The upshot of Kearney as applied here is that (i) we judge the hospitals where symphysiotomy was performed according to a particular construction of  the standards of their former employees’ time and place (the Coombe and the NMH, in Dublin in 1963); (ii) we make them answerable only to a narrow range of claims shaped by the limited archive their practice generated; few records (because they were not kept,or not made) and no records of follow-up with women subjected to symphysiotomy (because it was not done, and they were discouraged from seeking it) and (iii) we evaluate their practice according to particular accounts of the development of particular kinds of medical knowledge, leaving no room to introduce considerations from women’s lived experience or from then-prevailing constitutional and human rights standards

Medical knowledge, hindsight and power.

Cross J. frames himself as dealing with a medical negligence case. The UNHRC would say he was dealing with an instance of historical systemic, institutionalised gender-based violence. There is some recognition of this in Cross J.’s judgment when he acknowledges the importance of allowing the plaintiff to tell her story, and when he apologises because, from his perspective, it is impossible to find in her favour.  He emphasises her good character throughout the judgment to show that she is deserving of respect. He quotes from Chief Justice Crewe (as he did in an essay on judicial reasoning in the Dublin Review of Books last year) when he says that he would have “taken hold of a thread or twine-twig” to support her, but the precedent in Kearney binds him. The quote is an interesting choice. The 17th century judge is lamenting the fact that he cannot find in favour of an established noble family in the Oxford Peerage case, battered by recent war, though he is from an old established family himself: “I have laboured to make a covenant with myself that affection may not press upon judgment”. Arguably, the choice of quote evidences some affection for women of the plaintiff’s class, and some collective shame, to borrow Anne Genovese’s emphasis, and a desire to atone for wrong. But tellingly, it is not a desire rooted in a sense of legal responsibility. It is obvious, on this judge’s view that it would be impossible to find for this plaintiff and still exercise judgment in line with our unassailable common heritage.

Chris Cuneen, writing about Australian efforts to use civil litigation to obtain justice for Indigenous victims of historical institutional abuse argues that processes of common law judgment effectively create a ‘defence of history’ which closes out the ‘worldview’ which motivated systemic injury and  operates to ‘reconstruct and obscure’ litigants’ experience of abuse. It seems that Cross J. has fallen into this trap. The judgment very much depends on forgetting the systemic characteristics of the deliberate revival and development of symphysiotomy by Catholic doctors practising in the 1960s in a state where, as is especially clear from the link between contraception and symphysiotomy acknowledged in this judgment, government was inseperable from projects designed to control women’s reproductive agency. First, the judgment gives great weight to medical records and  debates – he engages in much closer reading of these texts than either court in Kearney, with clearly significant consequences. He is impressed by the fact that the practice of symphysiotomy was “carefully recorded and subject to transparent review”, tending to suggest that they merited great weight. However, as Kune writes in the Australian context, official records are not always as regular as we might expect. They do not always disclose the true reasons for particular decisions. They are prepared for particular institutions’ purposes and legitimate particular institutional narratives. Until these narratives are put in a broader social context, the records are liable to be misread. Cross J.’s approach to that context is remarkable. Cross J. presents the development of medical knowledge in heavily masculinist terms. British and Irish doctors lay down intellectual challenges to one another in a series of robust exchanges, and over time both groups alter their views, to the betterment of medical science. What about the moments in this exchange which appear not to fit that pattern? He describes a recorded 1951 instance of outright British criticism of the Irish approach to symphysiotomy:

the truth of the conflict between the British and Irish experts, though couched in Biblical and religious terms, [was] more of a question of a clash between native obstetricians defending Irish practices, and visitors from the old colonial power.

Thus, symphysiotomy becomes part of an emergent national medical heritage, understandably defended against the English. But there is little examination of the historical reasons why the Irish medical profession defined itself against Britain in this way, or chose to make those distinctions visible on the bodies of women. In another exculpatory passage, he dismisses the claim that Catholic doctors performed symphysiotomies rather than C-sections as a way of avoiding the questions of contraception and sterilisation, by noting that the Rotunda hospital, which was not under the direct control of the Archbishop of Dublin, also performed symphysiotomies, but only after Caesarean section. He does not mention that the Supreme Court, and indeed the government, accept that this procedure generally could not be justified even at the time. Second, Cross J. gives the defendants the benefit of the doubt when he says that doctors performing prophylactic symphysiotomies believed that the operations had no serious consequences for women, even though in coming to that belief they had to ignore or discount women’s immediate responses to the surgery and afterwards  – their pain, difficulty in walking, difficulty in caring for their newborns, confusion, disbelief and shame. They had to ignore the reactions of these women’s mothers, sisters, friends and husbands. They had to neglect to conduct proper follow-up checks. They benefited from a medical and social system which, as Cross J. acknowledges, required women to accept their lot, and which sometimes accused women of imagining or falsifying their symptoms. They were, the judgment notes, “content with the good results and lack of complaints”. They had to engage in the sort of overt dismissal of women’s embodied experience that is only possible in a violently patriarchal society, such as the Ireland of the 1960s. “Time” as Chief Justice Crewe said “hath his revolutions” and so Cross J. accepts that a prophylactic symphysiotomy would not be done today, but he can nevertheless square it with the benificent practice of the ’eminent’ doctors of another time. We could argue that Cross J. finds it possible to treat this body of knowledge otherwise than as defective because he is a product of another iteration of same patriarchal society – a society in which it is at last possible to accept that these women’s suffering was genuine, but not to hold accountable the doctors who caused it.This would be a better judgment if it accepted that medical knowledge is genuinely contestable, and did not supplement the advantage already conferred on the defendants by the Kearney test with unnecessary deference to the official historical record. Borrowing from Nietzsche, Cross J. suggests that doctors were experimenting with symphysiotomy, and gradually coming to better knowledge of it: “philosophising with a hammer  and testing concepts and conclusions by striking them to see if they were hollow”. “Philosophising with a hammer” refers to Nietzsche’s efforts to irreverently dismantle old values; a process of self-overcoming which he acknowledges is necessarily destructive. Cross J. does not pick up any hammer of his own.

Policy arguments for a modified approach.

Kearney tends to de-contextualise women’s injuries in order to avoid prejudice to the defendant at the stage of gathering and presenting evidence. But it comes at too high a cost. In this case, a woman who arguably has a good case under Articles 3 and 8 ECHR , and plausibly under the equivalent provisions of the Constitution, was left without an appropriate remedy. A woman entitled, perhaps, to aggravated damages to take account of the experimental and non-consensual nature of the practice, was left without a remedy. Now, these are ultimately not run-of-the-mill tort cases. They involve intensely traumatic experiences. They are characterised by an imbalance of power between plaintiff and defendant at a perhaps uniquely vulnerable moment in the plaintiff’s life. The nature of childbirth is such that this imbalance necessarily persists into obstetric care in the present day. These cases have their origins, as the UNHRC recognised last July, in deeply gendered and abusive institutional processes.  They engage significant human rights violations perpetrated by men working under the supervision of the state; they are arguably O’Keeffe-type cases – or, in American terms, analogous to medical experiment cases in which the state was implicated, such as the  Cincinnati radiation case  or Heinrich v. Sweet. Precisely because they are so distinguishable from ordinary medical negligence cases, there should be no significant objection from public policy in adjusting the Kearney approach. Because prophylactic symphysiotomy is unlikely to be revived and has no significant comparators today, there should be no chilling effect on contemporary medical practice. (Cross J. accepts the evidence of Dr. Peter Boylan, for the defence,  that some experimentation is necessary for medical science to advance but as a matter of public policy, doctors must be subject to reasonable constraint.) There is no major cost either to insurers or to the state in permitting the small number of potentially successful cases a fairer hearing.  In other jurisdictions – particularly in Canada – courts have been willing to modify negligence doctrine where public policy compels it, in order to do justice in cases of historical institutional abuse. I would think that the “inherent defect” test provides some scope for this modification. If this cannot be done, then the case for a new public inquiry and a modified redress scheme is stronger than ever.

Negligence, Symphysiotomy and Past Harm.

Ireland before the UNHRC.

I am in Geneva as part of the Irish NGO delegation to Ireland’s 4th Periodic Review under the ICCPR.* Readers will be aware that the UN Human Rights Committee heard testimony early yesterday from some 12 Irish NGOs and civil society organisations, and from the Irish Human Rights and Equality Commission. It might be interesting to give a sense of how the day falls into place. The Committee meets in the Palais Wilson, which is down by the shore of Lake Geneva. People congregate in the cafeteria where the idea is that, as Tobias Kelly writes in This Side of Silence, it can be possible to buttonhole Committee members (if they appear, and if they are willing). There is a great collaborative buzz  in the room, as people mill around, revising their submissions, anxious in anticipation of the next event. The age profile is relatively young and there are a lot of women in the room.  There are very different levels of experience – from first time small campaigns to organisations like the IFPA which have been around for generations. By and large, the groups have a common agenda: the notable exception arrives in the form of two young men from Family & Life and the Pro-Choice Alliance, whose position on abortion is, of course, in conflict with that of the Irish Human Rights and Equality Commission, the other assembled interested NGOs, and on my reading, the Committee itself.  The Irish delegation also features several activists whose lives are directly affected by issues under consideration by the committee – particularly from TFMR Ireland, Survivors of Symphysiotomy and the Irish Traveller Movement. They do some of the most effective advocacy work of the day.

At midday, each of the NGOs has a two minute slot in which to make a briefing statement. The Committee has received written submissions from the NGOS in advance (see here under Ireland), but this oral statement is a chance to define your group’s priorities for the Committee. I learn a lot about what is possible in two minutes. The room in the Palais Wilson is a study in poor design. It is long, narrow, level and warm, with the Committee sitting in a rectangle at the top of the room, and the delegates – and press, if there are any, and perhaps observing students – arrayed in rows behind them. The State’s delegation, when they arrive later in the day, sit on a raised dais at the top of the room. The effect of the layout is that, from the back of the room, you can’t see any member of the Committee, even though they’re not that far away, and you would struggle to tell which of the suited gents from the Departments is speaking at any given time. I sat at the very back, with some of the group from Survivors of Symphysiotomy. The acoustics are poor. Without the translators’ headphones in, you often can’t hear a thing, except the steady typing of delegates taking notes, for themselves or for twitter.

Break for lunch, and then a short and informal briefing meeting,  in a smaller room at which members of the Committee can ask questions of the assembled NGO delegates, and of the members of the  Irish Human Rights and Equality Commission. As people find a space in the small room, an odd tableau assembles by the back wall – the young men from the pro-life NGOs leaning up against a marble mantelpiece, ready to interject, with the women and men of various pro-choice movements arranged in front of and around them.  At this meeting, you can get a strong sense of what is going to happen when the State presents for questioning. Several groups – particularly Doctors for Choice, the Irish Traveller Movement, and the Commission – were able to make very effective responses to the Committee’s queries.

Immediately afterwards, the Minister for Justice arrives, together with the Irish ambassador and a phalanx of civil servants from the Departments of Justice and Equality, Health, Foreign Affairs and the Office of the Attorney General. The Minister outlines Ireland’s efforts, such as they are, to comply with the International Convention on Civil and Political Rights and details some recent developments in Irish human rights law and practice. There is some surprise that she never mentions the issue of Traveller ethnic minority status as an achievement. After the Minister’s opening statement  the Committee asks a focused and demanding series of questions, based on the list of issues here. They are particularly strong, as I had hoped they would be, on the issues of historical reparations, and abortion rights. It is clear both that the NGOs and the Commission have done a hugely effective job, and that the members of the Committee are highly engaged and very well briefed. The State delegation has a 15 minute break in which to consider the questions, before presenting replies.

The mood is good. The quality of the questioning strikes home with everyone. How much of the domestic law-making process is based on rigorous, informed questioning of this kind?  How hard do NGOs like the IFPA or Survivors of Symphysiotomy have to work to get questions like the ones below on the domestic agenda?  It’s a pity, on reflection that Irish media outlets haven’t sent more journalists to these hearings, simply because the discourse on many issues is so different in this context. Too much media reporting of human rights issues begins and ends with the ‘human tragedy’ angle. There is much less interest in/engagement with/informed critique of the sorts of structures which might be proposed to address and prevent such violence.

Of the state replies, when they come, the less said, perhaps, the better.  The mood in our camp deflates a little. People are tired. I am told that in the ICCL Green Room back in Dublin there were audible sighs at some of the Government responses.  One of the Committee members has brought some of his Masters students to observe. Among them is a former student of mine. Later, after the State submissions, he expresses amusement at how little the government’s representatives are willing to give away. It is hard to tell how much of what is said is immovable government policy, and how much is stalling.

I will be paying special attention to three issues in the follow up questions tomorrow:

  • Professor Yuval Shany, having noted Ireland’s ‘disappointing’ refusal to bring our abortion law into compliance with the ICCPR, reminded the Minister that her predecessor had described the operation of the law in cases of fatal foetal abnormality as ‘unacceptable cruelty’.  He then asked a series of very detailed questions about the operation of the Protection of Life in Pregnancy Act 2013. These, by and large, mirror the joint submission of the Abortion Rights Campaign, the IFPA, Doctors for Choice, Lawyers for Choice and Termination for Medical Reasons, Ireland. The Government’s response ignored all of these questions. It simply asserted the legitimacy of the constitutional position as striking a ‘balance’ between the right to life of the mother and that of the unborn. The assertion is that Irish abortion law is the product of some sort of delicate evolutionary process which cannot be rushed. It is, to paraphrase the Minister, a nuanced and proportionate response to a profound moral question. Mary Jackson, the Principal of the Department of Health asserted that Irish abortion law is compatible with the ICCPR (even though it does not permit abortion in the cases of rape, incest or fatal foetal abnormality) because the convention must be read as a whole, and Ireland is complying with Article 25 ICCPR  (the right to vote and participate in elections….) by giving effect to the ‘will of the people’. Make of that what you will.
  • Christine Chanet raised the issue of the investigation of the Magdalene Laundries. She notes the narrow remit of the McAleese report and questions the degree to which it was independent of the State. The twist in the question is very telling: “Why is the state so reluctant to find out what happened in the laundries?” The Minister almost omitted to answer this question, but insisted again that the Magdalenes  report and scheme were on solid ground. UNCAT have already pressed this issue with the last government, and it isn’t going to go away.
  • Professor Shany also raised the issue of the symphysiotomy redress scheme. This was an especially useful question because he did not simply ask an open ended question about what the State proposed to do for survivors. He acknowledged the redress scheme, and asked what the State now proposed to do, given that the majority of survivors had refused to co-operate with it and had criticised its failure to produce accountability.  The tenor of Professor Shany’s question is important because it may suggest that survivors should be allowed to participate properly in designating the remedies they receive for human rights abuses. This is a refreshing perspective, because it directly contrasts with the government’s paternalism in respect of members of S.O.S. The government offered no response yesterday, but has promised to address ‘additional issues’ at tomorrow’s session. If we read this question together with Madame Chanet’s question on the Magdalenes, and Prof. Shany’s later question on proposals to investigate the Mother and Baby homes, it may be that the Committee is about to take a firm  stance on the state’s obligations to repair historical injuries, and on the right to an effective remedy.

*I am tagging along with Survivors of Symphysiotomy, and I am a member of the newly-formed Lawyers for Choice (@lawyers4choice). The delegation is led by the ICCL. The University of Kent have funded my trip. However, this is a personal reflection, and all errors, opinions and omissions are my own.

You can watch  tomorrow’s session live at http://www.treatybodywebcast.org/ from 9am. A number of people are live-tweeting from Geneva and elsewhere using the hashtag #ICCPR. Look out in particular for @Doctors4Choice, @SoS_Ireland, @ICCLtweet and @smullallylaw ( Prof. Siobhan Mullally of UCC Law and the IHRC). I’ll be tweeting at @maireadenright.

Ireland before the UNHRC.

What's Wrong With The Murphy Redress Scheme?

The report of the Independent Review of Issues Relating to Symphysiotomy is out. So too, at long last, is Prof. Oonagh Walsh’s final Report on Symphysiotomy in Ireland 1944 -1984.  If you need a reminder of what symphysiotomy is, and of the human rights abuses which characterised its practice in Ireland, you can see Survivors of Symphysiotomy’s submission to the UN Committee Against Torture here. In just under two weeks’ time, Survivors of Symphysiotomy will put their case when Ireland is examined under the ICCPR. Doubtless, the redress scheme, which is the primary outcome of Judge Murphy’s review will be a topic of conversation there.

Here are 9 talking points on the Murphy redress proposals, which she presents as a tentative sketch for a potential scheme. Comments are most welcome.

  1. Ex gratia: Payments under the scheme will be made without any finding of liability. I noted the difficulties with ex gratia schemes back in February.
  2. Walsh and truths The Walsh Report is not an adequate substitute for an individualised finding of liability. It cannot vindicate  women’s right to an effective remedy. Section 1 of the Report repeats the Draft Report already published, and roundly criticised by Survivors of Symphysiotomy. Section 2 makes some amendments, but does not change the overall tenor of the draft. It explains and clarifies the draft’s arguments, and buttresses them with testimony obtained from survivors who were members of Patient Focus,  of Survivors of Symphysiotomy Ltd., or of no organisation at all. It is important to note that the largest survivor group – Survivors of Symphysiotomy – boycotted the second stage of the Walsh Report, as a means of demonstrating their objection to its draft findings. The second part of the report criticises perceived misrepresentations of the Draft (82-83). However, it is interesting to note that, by and large, the testimony of those survivors  interviewed by Walsh chimes with that submitted by Survivors of Symphysiotomy to the United Nations Committee Against Torture, particularly on issues such as the outcome of symphysiotomy (pp 87-95) and the impact on family members (98-103) . Where the Walsh report breaks away, in my view, is in its interpretation of the reasons why symphysiotomy was performed. She places more exculpatory emphasis on a particular reading of the interaction of a rigid form of Catholic moral teaching and medical care, and on the good faith practice of medical practitioners. There is insufficient space here to discuss the Walsh report in detail.  But what is clear is that we now have two very different public  readings of the harm done to these women, only one of which  has been rubber-stamped by the state. When the government talks about ‘closure’, it is important to bear this ongoing contestation in mind.
  3. Payment: Survivors of Symphysiotomy had asked for individualised assessment of women’s financial entitlement. Judge Murphy has not met this request. There are three bands of payment under the scheme (€50,000 for surgical symphysiotomy with no long-term effects, €100,000 for surgical symphysiotomy with long-term complex effects, and €150,000 for symphysiotomy ‘on the way out’ or post-birth). Most will receive €50,000. Judge Murphy notes at p.46, based on precedent,  that the sort of claim which she values at €100,000, would likely reap damages of €250,000 to €275,000 in court. Survivors of Symphysiotomy had valued the women’s negligence claims at between €250,000 and €450,000. It is also worth noting that in order to qualify for the higher awards, a full medical assessment will be required, to prove, on the balance of probabilities, that the woman’s additional injuries are attributable to the symphysiotomy rather than to e.g. subsequent births or difficult delivery. It will be interesting to see what form those standard examinations take, and whether women will be offered the opportunity to select independent medical assessors. Many women, of course, have already undergone medical assessments and are already receiving treatment for injuries which have been diagnosed as the result of their symphysiotomies.
  4. Giving up legal claims: Participants in the scheme will have to discontinue any legal claims, including those against the state. Interestingly at p.49, and following the example of the Lourdes Hospital Redress scheme, Judge Murphy advises that those currently involved in High Court litigation who wish to discontinue it, should receive sums towards the costs already incurred. She recommends that applicants to the scheme should also receive money to cover the cost of legal advice in respect of an application to the scheme.
  5. A better deal in the High Court? This is a particularly interesting redress scheme because it emerges against a backdrop of (in March) 154 ongoing cases in the High Court. Judge Murphy presents her scheme as unburdening vulnerable women who are, on her reading, unwilling to accept the complexity of their predicament. At page 48 she describes the legal claims which survivors of symphysiotomy have brought in the High Court as ‘frail’, worrying, stressful and risky. She is not in a position, given the nature of the report, to assess the individual claims for herself. However, it is by no means clear that every woman will receive a better deal under this sort of scheme than she would obtain in the High Court.
    1. First, she cites the Statute of Limitations as a particular obstacle to success in the courts. Of course, the Statute remains in place for these women because the government made an abrupt U-turn on original plans to lift it. Moreover, some judges will be unwilling to allow questions of delay to upset every historical symphysiotomy claim. This is particularly true of symphysiotomies ‘on the way out’. In just such a case –Kearney v. McQuillan – the Supreme Court held in 2010 that the defendant cannot be prejudiced by delay where the justifiability of the procedure even on the basis of the standards prevailing in obstetrics at the time of the operation is in issue. This is because witnesses are not necessary to determine that sort of claim.
    2. Second, she suggests that it will be difficult for negligence claims to succeed. In 2012, again in the Kearney litigation, the Supreme Court accepted that, even by 1969, symphysiotomy was not a generally approved practice in Ireland. It was supported by a minority of doctors, who only considered it justified in a small number of circumstances. In their submission to UNCAT, Survivors of Symphysiotomy document the essentially experimental nature of symphysiotomy in Ireland at certain periods. There are likely to be cases which fall outside the limits which that minority of doctors set for themselves and which, accordingly, could ground successful negligence cases.
    3. Third Judge Murphy devotes significant time to discussing whether claims could be based on the absence of informed consent to symphysiotomy. This is a very real issue – many women did not discover the true nature of the procedure performed on them until decades after the event. Here again, Judge Murphy emphasises (at p.29) the impact of delay, and the death of the doctors involved, on attempts to establish whether reasonable efforts were made to obtain women’s informed consent. (At pp.28-30 the report discusses whether women would likely have consented to symphysiotomy anyway, even knowing the risks, because they were reluctant to have Caesareans. It strikes me as very odd that this line of reasoning is substantiated by extensive quotation from the writings of the doctors who performed symphysiotomies. There is also an incongruous reference at p.16 to a resurgence in modern interest in certain kinds of surgical symphysiotomy – presumably performed under circumstances vastly different to those documented in Ireland – as alternatives to Caeserean. At p. 20, the report notes that many survivors now feel that Caesareans would have been safer. Judge Murphy here  may be misreading the Walsh report in assuming that a certain set of Catholic views on reproduction was as persuasive to all women, in all relevant decades, as it was to powerful doctors and laity.)
    4. Finally, in the High Court, litigants would obtain a statement of liability, whether they win or lose.
  6. A better deal for the State: On Judge Murphy’s reading, the State is set to assume a central role in the symphysiotomy litigation. Following O’Keeffe v. Ireland,litigants are likely to argue that the state should have done more to supervise the hospitals which it funded (though Judge Murphy notes at p.33 that it might be possible to refine this reading of O’Keeffe to let the state off the hook). The point of an ex gratia scheme is that it is cheaper for the State to create one than to defend claims in court. Judge Murphy sets out the calculations at p.50 of her report. She sets out a scenario in which 10 symphysiotomy claims are successful at an equivalent rate of damages to the cases already litigated, and the remainder settle. In this scenario, she estimates the potential cost to the state at €95m. The redress scheme is a relative bargain at €34m – cheaper, for instance, than the LE Samuel Beckett.
  7. Who pays? Should the State lose some of the cases in which it is involved, it would be entitled to seek contributions from relevant insurers.  However, the review was unable to assess the likely financial value of these contributions, because the necessary information was not made available to it. Most insurers were unwilling, in the absence of direct instruction from the hospitals where symphysiotomies were performed, to discuss specific cases. Large portions of the report containing ‘commercially and litigiously sensitive material’ relating to insurance are redacted. The report also notes at p.30 that a large majority of hospitals are unable to trace their insurance records, and so may be unable to make use of their insurance, assuming, of course that insurance taken out decades ago would be sufficient to meet awards of damages calculated at today’s rates. The report devotes a little time to the financial circumstances of the hospitals where symphysiotomies were performed, and suggests that they would find it difficult to meet the cost of litigation.
  8. Apologies: Judge Murphy notes that the Institute of Obstetricians and Gynaecologists have twice apologised to women who underwent symphysiotomy. In fact, the Institute has offered its ‘unreserved sympathy and support’ to the women, while maintaining the line that symphysiotomy was justifiable in most circumstances. The Medical Missionaries of Mary, who ran the hospital at Drogheda where many of the procedures were carried out, similarly regret women’s ‘hurt’ and ‘trauma’. (p.65) The women who suffered this procedure have received no formal apology or admission of liability. Any state apology, Judge Murphy says, will be a matter for the government and the Attorney General. Perhaps confident that a redress scheme will resolve the matter, the Minister for Health says the question of an apology ‘does not arise’.
  9. Death of a baby: P. 19 briefly raises the issue of babies who died during symphysiotomy, and whose parents were never informed of their place of burial.

Early on in the report, Judge Murphy says that ‘there was nothing at all furtive’ about the practice of symphysiotomy. That says as much about the power of the men who performed these operations as it does about their bona fides. I have suggested before that there is something furtive about the way in which Ireland deals with past wrongdoing. These are the terms on which demand for a public inquiry into symphysiotomy is to be defused, and they deserve public scrutiny.

What's Wrong With The Murphy Redress Scheme?

The Trouble with Redress – Symphysiotomy and Other Failures.

In recent days, we have heard a lot from the Government about the scars of past institutional abuses of power in Ireland. We know that women and children were subjected to routine and varied abuses of power in schools, religious penal institutions and hospitals. These violences were bodily, intimate, painful and entirely beyond reduction to any talk of shared scars. Increasingly, the Government takes a firm line on these matters. On its view, they belong to a past which is simultaneously unrecognisable to ‘modern’ Ireland, but which extends out into the 1970s and 1980s; into the middle of living memory. The state professes to share survivors’ wounded memory, but cannot be held responsible for it. Instead, we are to become reconciled to our shared hurt by the offer and acceptance of apology to selected victims and by the offer and acceptance of limited redress. Survivors of Symphysiotomy are asking us to reconsider this position.

Yvonne Murphy is due to report soon on her deliberations on a possible ex gratia redress scheme for women who were subjected to symphysiotomy. Survivors of Symphysiotomy have pre-emptively rejected such a scheme and with good reason. There is every danger that it will be a re-run of its predecessor; that prescribed by John Quirke for the surviving Magdalene women. Quirke showed us how redress schemes enable  the State and powerful interest groups to deny liability for past wrongdoing, refuse proper compensation and – without regard for transparency or publicity – discourage recourse to law.

First, like Quirke’s, a Murphy scheme would follow on a flawed prior investigative process; like the McAleese report, the process leading to the compilation of the unpublished Walsh report has been shielded from public scrutiny. Like the McAleese report, the draft Walsh report was criticised as attempting to explain away gendered violence by reference to prevailing cultural norms. While McAleese ignored swathes of survivor testimony, Walsh excluded it entirely. Survivors of Symphysiotomy are now  following Justice for Magdalenes’ path to the UN Committee Against Torture. That Committee confirmed the inadequacies of McAleese, and no doubt will respond sharply to Walsh.

Second, payments under an ex gratia scheme are intended to express regret, but not responsibility. An ex gratia scheme operates entirely outside the relationship of recognition, contestation and repair available within the ordinary legal system to individuals who have suffered singular and meaningful harms. First, any money paid to the women will not be commensurate with that available through litigation. It will not be enough to put them – financially – in the position they would have been in had they been spared these operations.If anything, Yvonne Murphy’s terms of reference suggest a hierarchical administrative scheme, likely to take as much account of the financial demands of State, insurers and indemnifiers as of survivors’ needs. We already know how these juggling acts pan out. It is obvious now that Government’s priority is to restrict the amount of money paid to survivors, and past experience with religious orders must cast doubt on its ability to hold private hospitals and their insurers to account as part of any redress scheme. Troublingly, the experience of women within the Quirke scheme suggests that payments may be roughly calculated, poorly tailored to individuals’ needs, and badly administered. Last week, James Smith and Maeve O’Rourke wrote that, now that the time has come for Quirke to be implemented, Government does not even appear to be willing to comply with his recommendations. Finally, an ex gratia redress scheme will not produce any finding of medical negligence, or associated liability, in relation to the harms suffered by these women. The private hospitals where many of the women’s injuries were inflicted will not be held directly responsible. And of course, as survivors have said again and again in the past, their claims have as much if not more to do with the establishment of a public narrative of responsibility as with any monetary compensation. Indeed, if the purpose of these performances of restorative justice is to enable societal engagement with the causes and repetitions of institutional abuse in Ireland, an ex gratia redress scheme can only be part of the puzzle.

Third, the government has offered Yvonne Murphy’s deliberations as a substitute for lifting the Statute of Limitations. The measure had wide cross-party support and would have enabled some women to more easily pursue civil claims. In a related vein, John Quirke asked participants in the Magdalenes redress scheme to forego their access to the courts as a condition of receipt of payment. A number of symphysiotomy cases have begun in the High Court. One or more successful claims would definitively establish the law on liability for symphysiotomy, and provide – at least partially- the narrative of responsibility the victims require.[1]  Recourse to law is often represented as a matter of greed or folly. Louise O’Keeffe might disagree; often litigants are compelled to go to court against a background of state intransigence. The Government, keen to show the more caring of its faces, now says that it did not lift the Statute of Limitations, because doing so would not have assisted these women, but would instead have exposed many of them to a long and difficult course of litigation. This is a disingenuous and paternalistic argument. It clothes many of the women who can establish a claim, and who are currently on their way to the High Court to do so, in broad brush assumptions of vulnerability and fragility which minimise the importance of each singular case. In Kearney v McQuillan, Ryan J. noted that Olivia Kearney’s symphyisotomy case could have been obstructed by procedural concerns around delay, of the kind which motivate the Statute of Limitations. He said: ‘it is disturbing to consider how close this victim of grave medical malpractice  came to being sacrificed on the altar of fair procedures.’ In other words, each victim matters, and when an individual’s case is destroyed on the edges of a general principle of public policy, it needs to be for very good reason.

In a sense, government paternalism is a softer, but no less dangerous, version of the tactics adopted with Louise O’Keeffe. In her case, successive governments actively used the threats of emotional distress and impoverishment through costs to deter her claim. Here, the argument is reversed: Government claims that its refusal of assistance is  ‘for the victims’ own good’ – they are being spared the pain of court cases. Both approaches betray the Government’s assumption that wronged citizens have no right to seek justice in the courts, and that access to the legal system is – one way or another – in its sole gift. In any event, Survivors of Symphysiotomy are not insisting on litigation, on its inequalities or expense. Instead of an ex gratia scheme, they are asking for alternative dispute resolution. They want a statement of truth, access to relevant records, support in establishing their legal claims, and speedy settlement of those claims. Government is ignoring this demand, and so the courts- for all their failings – remain the only appropriate forum for pursuit of these cases.

As a movement, Survivors of Symphysiotomy represents a watershed in the Irish approach to past institutional abuse. There is speculation that the O’Keeffe judgment may, in due course lead to new causes of action on foot of institutional abuse by non-state actors. When this issue is being debated, we should expect Government to work and rework its current tactic: opposing redress to litigation, while casting itself – in the language of concern and regret – as making up for the ills of the past. It will be important to listen to Survivors of Symphysiotomy then. Women who survived symphysiotomy are not relics of an ever-extending ‘past’. They are entitled to reject the ‘closure’ offered by the State, and to make live and wilful claims to justice in the present, on the present’s terms.

[1] The judgment in Kearney v McQuillan concerned a woman who had undergone a symphysiotomy after a caesarean section, and who did not present with the ‘foeto-pelvic disproporation’ which, in some medical views, might have justified the operation. Therefore, there is some need for additional litigation.

The Trouble with Redress – Symphysiotomy and Other Failures.

Symphisiotomy and the Statute of Limitations

We are delighted to welcome the following guest post from Marie O’Connor, Chairperson of  Survivors of Symphysiotomy (SoS) and author of Bodily Harm: symphysiotomy and pubiotomy in Ireland 1944-92

The Statute of Limitations (Amendment) Bill 2013 for survivors of symphysiotomy is now before the Select Committee on Justice of the Irish Parliament. Its passage at Second Stage reflects the fact that these were effectively clandestine – as well as abusive – operations, performed without consent, that breached human, constitutional and other legal rights. Laws protecting human subjects in clinical research were also flouted: hospital clinical reports and medical writings show that these procedures were often experimental. Moreover, carried out before, during and after labour, the surgery amounted to cruel and inhuman treatment.    Continue reading “Symphisiotomy and the Statute of Limitations”

Symphisiotomy and the Statute of Limitations

Kearney v McQuillan: Religion, Harm and History.

In March, in Kearney v. McQuillan Mr. Justice Ryan (pictured left) awarded damages in the amount of €450,000 to Olivia Kearney; a 60 year old woman who was subjected to a symphysiotomy by Dr. Gerard Connolly after she gave birth to her son Martin at Our Lady of Lourdes Hospital in Drogheda in 1969 (for more about the hospital and Dr. Connolly see the Report of the Lourdes Hospital Inquiry).  She was 18 years old. The consequences were devastating and included lifelong pain and discomfort, inability to bond with her baby, lifelong incontinence and lack of sexual function, inability to have other children (because of her fears about the consequences), ‘victim’s guilt’ and severe depression. Her depression degenerated into a major psychiatric disorder when she discovered that her injuries had been caused by a deliberate act. The procedure was carried out without her knowledge or consent and she did not understand what had happened until, in 2002, she heard other women discussing their experience of symphysiotomy on a radio show. In the High Court Mrs. Kearney argued “there was no justification whatever, in any circumstances, for the performance  of a syphysiotomy on [Mrs. Kearney] at the time it was performed and following  delivery by caesarean section.”  The High Court agreed. To underline the significance of this decision, the defendants would have succeeded if they had established in credible evidence any realistic reason for the procedure in the circumstances actually prevailing in relation to Mrs. Kearney in 1969. On the contrary, the position taken in the medical literature in 1969 was that symphysiotomy could only be justified where the mother’s pelvis was too small to allow the baby’s head to pass during vaginal delivery and a caesarean section was otherwise impossible.  Even if a symphysiotomy could be justified on the basis that it would make future vaginal delivery easier, Mrs. Kearney’s pelvis was of a normal size. There was no feto-pelvic disproportion and there was no evidence to suggest that she would have encountered future problems with vaginal delivery – her caesarean had been necessitated by the baby’s position on delivery. The procedure could not be justified where, as in Mrs. Kearney’s case, a caesarean had already been performed. Mrs. Kearney’s case is being appealed to the Supreme Court.

Continue reading “Kearney v McQuillan: Religion, Harm and History.”

Kearney v McQuillan: Religion, Harm and History.

Symphysiotomy in the Courts: Kearney v. McQuillan

On Friday the Supreme Court cleared the way for Louth woman Olivia Kearney to bring an action in respect of the symphysiotomy which was performed on her in Our Lady of Lourdes Hospital Drogheda in 1969, when she was 18.  The judgment is here. We blogged about the question of symphysiotomy in February. The Minister for Health has since commissioned a report into the practice from the Institute of Obstetricians and Gynaecologists. Although symphysiotomy is often argued to be justified where it would be dangerous for a woman to attempt to deliver her baby without it, Ms. Kearney was – for reasons which are not clear – subjected to the operation after the birth. Her argument is that ‘there was no justification whatever, in any circumstances, for the performance of symphysiotomy on the plaintiff at the time it was performed and following delivery by caesarean section’. The hospital, as Hardiman J. noted, will be able to ‘defend the case by establishing in credible evidence some realistic reason for the procedure in the circumstances actually prevailing in relation to the plaintiff in 1969’.


Symphysiotomy in the Courts: Kearney v. McQuillan

No to Symphysiotomy Inquiry

“If Minister Harney was in my body even for one day we would have the review the next day”.

Kathleen Naughton, Survivors of Symphysiotomy

Following last night’s Prime Time  report on symphysiotomy, the group  Survivors of Symphysiotomy has called on the Taoiseach  to initiate an immediate inquiry into the use in Irish hospitals of the childbirth surgery which permanently widens the pelvis. IrishHealth.com carries a good report on the issue and on the survivors’ campaign here.

The Minister for Health, Mary Harney (above left), has refused to set up any inquiry . Calls for an inquiry in 2002 met with a similar response. Survivors of Symphysiotomy have now called for the Minister to be dismissed from cabinet.

Ireland was the only country in the developed world where symphysiotomy was practiced in the 20th century. It was used into the 1980’s and has left many women with lifelong serious medical difficulties including chronic pain, difficulty walking and incontinence. The Institute of Obstetricians and Gynaecologists, however, has said that the practice was considered valid at the time when it was employed.

A health package has been made available to women who are suffering the after-effects of the operation, but it seems entirely reasonable that, in addition to this provision, their claims should be examined and debated in the public sphere. This is especially the case because survivors have raised issues around their consent to the practice, and about its use on young mothers and mothers who were in the ‘care’ of state and religious organisations at the time of their operations.

You can watch some very interesting presentations on the issue given at a meeting hosted by the Feminist Open Forum in October here. Speakers included solicitor Colm McGeehin, who represents over 100 women affected by the practice. BBC’s Women’s Hour also discussed the issue in 2002.

We hope to have more indepth commentary on the story as it develops.

No to Symphysiotomy Inquiry