End of Life Care Before It Begins

Question:

What would you do if a premature baby, so premature that it didn’t have working lungs yet, were suddenly born right in front of you?

A) I would give it comfort care until it passed away on its own.

B) I would put a tube down its throat for breathing and insert multiple needles into it to place lines for fluids and medicines knowing that there was a 99% chance it would die anyway and a 100% chance that it would be severely incapacitated, possibly vegetative, if it lived.

C) I don’t know because I’m neither a doctor nor a person who has ever had to face that situation.

This is the impossible question posed to a Planned Parenthood representative in the video posted below that has made its way around the Internet. There are a few things you should be aware of prior to watching it:

1) The Partial-Birth Abortion Ban Act of 2003 ensures that any physician who desires to continue practicing medicine will not allow a live birth of an aborted fetus.

2) Asking someone who is not a physician what they would do in a clinical scenario is like asking someone who is not a pilot what they would do if the right jet engine went out. It is unfair and akin to trying to squeeze water from a stone.

The video:

http://www.youtube.com/watch?feature=player_embedded&v=qEv1afKaLhA

This woman was not qualified to answer medical questions, regardless of how they are phrased. That being said, it was no wonder she was uncertain 1) what they were asking and 2) how to answer.

I, however, am qualified to answer their questions and I will.

During an abortion in the 2nd trimester, specifically after 22 weeks, it is general practice to perform feticide (injection of a lethal medicine into the amniotic cavity or into the fetal heart) to essentially euthanize the fetus prior to the dilation and evacuation (D&E) procedure. It is therefore not alive once the abortion procedure is started. This is routine practice due to the Partial-Birth Abortion Ban Act passed in 2003 and requires physicians to perform the invasive procedure of intra-amniotic injection (putting the woman at risk of injury and infection) prior to the D&E. That being said, for an abortion to be “botched” (which is an unprofessional and inappropriate term to use) and the “baby to be born alive” will not happen. It cannot happen if the physician wishes to stay out of jail and continue practicing medicine. The baby cannot be born alive during an abortion because of the Partial-Birth Abortion Ban Act. The entire discussion in this clip is moot.

I’ll tell you what I would do if this impossible scenario were to happen, however: I would do whatever the patient wanted me to. The newborn would be unable to make medical decisions for itself and therefore medical-decision making would legally fall to the parents. There comes a difficult legal area, however, and if the infant were able to survive outside of the womb (> 24 weeks), were able to be resuscitated, the pediatricians may presume control over the care of the newborn if its life were in danger due to the parents’ decision. This gets into a whole legal battle I am not qualified to speak to, however, as previously stated, the scenario of an incomplete abortion with the fetus being delivered alive would not happen.

Even in cases of 3rd trimester abortion, the fetus is euthanized. This is not only due to the Partial-Birth Abortion Ban Act, but it is also humane medicine. It would be very traumatic to the mother, father (if present), and caregivers (physicians, nurses, etc) if during the induction of the abortion the baby were born alive then left to die. How horrific! Despite popular opinion, we are not monsters. We are physicians who seek to minimize the trauma of this difficult decision. In the rare cases of 3rd trimester abortions that are most commonly performed because of severe, lethal fetal anomalies that would not allow the newborn to live for very long (and suffer significantly if/while it did live), the fetus is euthanized and therefore not born alive.

As an OB/Gyn who takes care of women who are young and old, pregnant and not pregnant, my responsibility is to my patient. In the case of a pregnant woman, my responsibility is to her. When a woman comes to me for an office visit and her pregnancy test is positive, my first response is: “How do you feel about that? If you are not sure, I want to talk to you about all of your options which include continuing the pregnancy and keeping the baby, continuing the pregnancy and giving the baby up for adoption, or terminating the pregnancy by having an abortion.” If she desires I care for her and her pregnancy, I will do so and provide her with the best prenatal care I can so that she can have a safe, healthy pregnancy and childbirth experience. If my pregnant patient wishes to have an abortion, I will perform that as well so that she may have a safe procedure and termination of her pregnancy. My responsibility is to provide safe, evidence-based, comprehensive medical care, and that is what I do.

Science vs. Ideology

A new political low was reached in Salt Lake City Wednesday evening during a political debate arguing HB 461 which requires a 72-hour waiting period before a woman may obtain an abortion: Representative Bradley Daw made his opening remarks by reading from a “well-known philosopher and poet.” This would not have been remarkable, and perhaps it would have even been touching, had the context not been the infringement of women’s reproductive rights. Representative Daw’s opening remarks were read directly from “Horton Hears a Who” by Dr. Seuss, closing his remarks with “After all, a person is a person, no matter how small.”

Needless to say, I was outraged from the start. Representative Daw’s point was, of course, that pregnancy at any gestational age is a “person.” He failed to mention that the woman carrying the pregnancy is also a person. He was, however, quick to point out the thousands of women he represents and on their behalf advocated for HB 461. Representative Daw also seemed very knowledgeable regarding availability of health care and contraception to those in the lower socioeconomic classes, stating “contraception is available in any drug store, gas station, clinic for only a few dollars.” As someone on the front line in the daily health care battle I opine that statements like these are grossly ignorant.

Like most politicians, and like almost all who restrict women’s access to comprehensive reproductive health care, Representative Daw is not a clinician. He has no clinical training or experience and has no credentials to speak to health care provision, practice, or availability. This does not prevent him or any others from making statements such as “access to contraception is widespread,” or “pregnancy from rape is a justifiable reason to have an abortion,” as if he has a list of “justifiable” and “unjustifiable” reasons. For the record, cases like Savita’s do happen here, fortunately not often.

I have a request of journalists who have the paramount opportunity to ask questions of our legislators writing and passing laws affecting women’s lives: ask the right questions.

  • Can you speak to the risks of carrying a pregnancy to term? Of giving birth? Of rearing a child?
  • Can you speak to the risks of having an abortion? Medical versus surgical? First versus second trimester?
  • Do you feel you are medically qualified to counsel a woman on her options regarding a newly diagnosed pregnancy?

A politician no more belongs in my clinic instructing me how to care for my patients than I do in their staffing office writing legal bills. Evidence-based medicine and science, not ideology, should guide policy-making in health care.

The greater the ignorance the greater the dogmatism.
— Sir William Osler