Battling insensitivity over symphysiotomy

How much compensation should you get if someone hurts you, damages you irreparably? That’s the question survivors of a dreadful medical practise in Ireland are having to consider, and to consider in short order.

As we reported recently, hundreds of middle aged and elderly women whose lives were blighted by a procedure called symphysiotomy are faced with this extremely difficult choice.

Symphysiotomy, or the separation of the pelvis, was conducted routinely only in Ireland throughout most of the 20th century. It involved sawing through the base of a woman’s pelvis during childbirth, on the grounds that it would enable birth more easily. It was, it’s widely held, a preferred option in Ireland to caesarian section as C-sections would limit the number of babies a woman could have, normally to three. The logic ran that a woman whose pelvis had been broken open would be able to have many more children, in line with Catholic orthodoxy about norms of family size.

Unfortunately, it didn’t work very well in the interests of the woman, and very many were left in excruciating pain, unable to walk or have sexual intercourse.

Well, the practise is supposed to have been stopped, but of course the women are still around, and they’ve been fighting for some years (in the almost total absence of any media coverage in Ireland or anywhere else) for redress. What their campaign group is really after is an acknowledgement from the state that its hospitals conducted medical practice under theocratic doctrine, rather than having the wellbeing of the mother as their primary focus.

But the Irish state doesn’t see things like that at all. It has issued a compensation scheme to the survivors with a minimal payment of $62,000, or $125,00 if the woman can prove she has suffered serious disability as a result of the procedure.

Highly unusually, the offer has a limit of four working weeks on it, so having spent much of their lives in constant pain, the women (as of this writing) have two and a half working weeks to decide whether to accept. If they do, they lose all legal rights to challenge the state in court if they don’t accept, their only recourse would be the courts, but it’s not clear how long that process would take or even if someone of them would live to see their day in court.

Ireland’s new human rights commission, the IHREC, doesn’t like the scheme, or its time limits, much either. It announced this:

‘In announcing a limited ex gratia payment scheme, the Government is limiting survivors’ access to an effective remedy for the damage sustained, which would be otherwise available under a scheme established on a statutory footing. The time limit imposed where applications must be made before 5 December 2014 (or 14 January 2015 in exceptional circumstances) makes it extremely difficult for the women involved to seek independent advice in making their decision. In addition, the waiver of legal rights under the scheme are also of concern.’

So it’s an invidious decision. After all, as one survivor put it to us bluntly, ‘I must have spent 50 thousand euros on incontinence pads’.

At a mass meeting of the survivors, which we were invited to, it was pointed out to the women that in Ireland $62,000 is the sort of compenstion someone would expect to get if they broke a leg or a rib in an accident at work. That’s hardly the same as the brutal long term damage that symphysiotomy did – and bear in mind too the moral issue that the procedure was by no means an accident, but a deliberate procedure done by obstetricians tasked with helping women during childbirth.

The other thing about the scheme is that it exempts the state from any sense of responsibility or blame, distancing it from its hospitals and the past. That’s why the many of the survivors take the view that as well as being a final insult to their suffering, it’s also an attempt by the current government to bury the past rather than confront it and, in a transparent way, prove that Ireland has moved on from the days when the church was arguably more powerful than the state.

Having said that, it’s not easy to know what the government thinks because it continues to refuse interviews. Instead, it directed us to a private company which receives government funding, and which is much more positive about the compensation offer. The organisation, called Patient Focus, insists absolutely that it is entirely independent from government. It says it feels deep sympathy for the sufferers, but that because many of them are elderly, a court process is the last thing many of them would want to go through – and so a one-off compenstion scheme is more appropriate for their situation. They also claimed that some of the women might not even have been victims of symphysiotomy at all, and wouldn’t have the medical records to support a case.

Patient Focus says it believes a majority of the survivors will end up accepting the compensation offer though at the mass meeting in Dublin we attended, and at another in Cork, an overwhelming majority of the survivors said they were going to reject it. We’ll know by early December whether the Irish government’s offer will have been accepted as the best people can expect but it hardly looks full of generosity, given the pain so many women went through at the hands of doctors who were supposed to have their best interests at heart.