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.
Incredible points. Sound arguments. Keep up the great work.
I would love to ask you some questions…
-You stated the Digoxin injection is to euthanize. Can you elaborate…Is it to kill the baby before removing him/her to assure there would be no decisions to be made on what to do with a survivor or is this to prevent the baby from suffering extreme pain during the abortion? Because you mention humane reasons also- but you mention the mother and father, not humanity for the baby.
-When do you personally believe a baby in utero begins to feel pain?
-On an abortion website in Florida reasons for late term abortion include: Gastroschisis, polydactyly, dwarfism, Down Syndrome… Would you agree with this?
http://www.womenscenter.com/late_abortion.html
-Do you agree abortion clinics should have regular Department of Health inspections and not just after a patient files a complaint?
-The hearing Alisa Snow was at was for Florida’s HB 1129. Why was she there speaking if she had no knowledge on the subject? Why did PP send a lobbyist? And PP later condemned such practices, so why did she say it was between the patient and doctor?
(I realize you cannot speak for her or PP, but what are your thoughts?)
Thank you for answering these questions,
Rebecca (NICU RN from Texas)
Hi Rebecca,
Thank you for your questions, I will answer them to the best of my ability. Regarding the use of digoxin (or potassium chloride), it is our practice to do this now because of the Partial Birth Abortion Act and has everything to do with political motivations and nothing to do with medical evidence. In fact, the injection puts women at increased risk of infection and side effects from the digoxin when we may not normally employ the procedure. There are cases when doing this is the preference of the pregnant woman and we may oblige her for that reason as well as the PBAA. I want to make sure it is understood that a fetus does not have the neurological pathways to detect pain before 28 weeks gestation according to experts in the fields of neurology, anesthesiology, perinatology and neonatology. It is impossible for a fetus to feel pain before 28 weeks. As an aside, “feeling pain” has a philosophical interpretation to it as well and the reality is that anything we experience prior to ~2 years of age we do not have the capacity to remember because our brains are not developed to do so until after that age. At any rate, prior to 24 weeks the injection is done mainly because of the PBAA and after 24 weeks it is done to accomplish fetal demise and abortion as opposed to preterm birth with the knowledge that fetal neural pain pathways are not developed before 28 weeks.
The term “late term abortion” is a political term and something we do not use in medicine, but I believe you mean abortion after viability defined as 24 weeks gestation. Abortions may be done after 24 weeks only in cases of lethal fetal anomalies/disease or in cases of rape/incest. The examples you cite do not qualify for abortion after 24 weeks. I would disagree with the website.
Any clinic that provides health care should have regular Dept of Health inspections and be in compliance with health codes. This is of course true for clinics that provide abortion care as well. That said, an abortion is a safer procedure than many other outpatient procedures that are not required to be performed in a Surgical Center-type facility. Laws that target abortion clinics to meet these Surgical Center requirements are medically inappropriate and are merely trying to close the clinic.
Alisa Snow was representing PP appropriately until the panel began asking her questions beyond her area of expertise. I think she was appropriate for testimony, however she was being pressed for information she was not qualified to give. Just as easily I could have been giving testimony to medical care and then been pressed on administrative details (for example) that I may not know or have in-depth knowledge about. All I can speak to is what I would do in that situation and I would act in whatever way my patient (the mother) wanted. If she desired comfort care only, that’s what we would give. If she desired all measures to be taken, we would transfer the infant to pediatric care as quickly as possible. This situation is incredibly rare any more and so it is akin to answering a hypothetical question.
I hope this has given you some more insight, thank you for reading.
-Leah
“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.”
How can you call this humane medicine? Isn’t it the believe of the pro-choice side that the aborted is not human? To practice human medicine on it gives the impression the fetus is human, and thus even attempting abortion would be inhumane. That is like stabbing someone repeatedly and seeing they are slowly dying out, so you say the humane action is to stab them until they die. Nobody is gonna say you did the right thing considering you caused the situation first.
Either its a child and its as inhumane to kill it inside the womb as within it, or its no more than mass of cells to be surgically removed. Once we start treating it as a separate lifeform that needs medical care independent of the host, the same ethical code applies. We don’t deny life saving medical treatment to a child born under regular circumstances because a parent says not to, we shouldn’t in this situation either. Rationalize until you die, Abortion kills humans.
You make good points, however the treatment of undesired fertility is not so black-and-white. I agree, it can be confusing who believes what regarding the fetus and humanity and rights, etc. I would just clarify this: those who advocate for reproductive rights do not view the developing fetus as “not human.” It is recognized as human because that is its genetic make-up, of course. I believe you may be referring more to the fetus (and I’m using medical/scientific terms to be clear, not to be unfeeling) as “having a life” vs “being alive” vs “living” vs “having rights.” Having a life, being alive, and living may all seem like they are the same thing but really their connotations differ significantly. I do not pretend to have perfect definitions for each but suffice it to say that the fetus is alive, it is human, yet the woman carrying it is alive and human, too. What it really boils down to involves her rights first. The moment the pregnancy she carries is valued over her own being is the moment she is dehumanized. She becomes an object with no decision-making capability, no right to opinion, and no right to feelings or thoughts. Invariably women (and men) act in what is best for them and their loved ones. I’ve not met a woman seeking an abortion who has not put everyone else in her life first, including the embryo or fetus, or who has not thought at length and in incredible depth about the significance of her choice. Thank you for your input.
-Leah
Despite the similarity in spelling, humane and human do not mean the same thing. Even animals should be treated humanely, but that does not mean they are treated like humans.
Sometimes what a patient wants you to do is a crime. A woman undergoing an abortion is not automatically turned into an angel. Are you sure you want to stand behind your statement “I would do whatever the patient wanted me to” without any qualification? What other circumstances would you put your own moral and ethical judgments on hold in absolute deference to the will of the patient without any exception? If there are no other circumstances, what makes this one unique?
I’ve not had a patient ask me to do anything illegal as of yet. You make a good point, though: I do not do “anything” the patient asks in any given context. I meant that merely in the context of initial new pregnancy counseling. I offer her those 3 options and she may choose whichever she desires. She may want more time and information to think about it, both of which I give her. There are times when a patient comes to me asking for surgery, for example, but I may know of other, less risky options. Whenever a patient comes for treatment, and there exists more than one treatment option, it is ethical and prudent to inform the patient about all therapy options, the risks of those options, and the benefits of those options so that the patient may make an informed decision on how to proceed. This is true with pregnancy as well. There are doctors who will not counsel on abortion– this is unethical. There are doctors who will not prescribe birth control– this, too, is unethical, though as long as the patient is referred to someone who will provide this counseling and prescription then I cannot see fault except the inconvenience to the patient. I practice evidence-based medicine to provide my patients with the highest quality of health care I can possibly provide. If I do not inform each patient fully of her options and the risks and benefits that go along with them, then I am doing her a disservice and an injustice.
-Leah
What exactly does the Partial-Birth Abortion Ban Act of 2003 have to do with this? It only made one type of late-term abortion illegal (one which consists of deliberately delivering the baby part-way before killing it). There have been cases since 2003 where babies have been born alive and left to die after abortion. At least one of these was in Florida:
http://www.lifenews.com/2011/07/27/babies-born-alive-in-toilets-at-abortion-center-left-to-die/
Digoxin does not always euthanize the fetus successfully:
http://www.ncbi.nlm.nih.gov/pubmed/20004276
And as you yourself stated on Twitter, post-viability abortions are sometimes done on perfectly healthy fetuses (ie those conceived in rape):
https://twitter.com/LeahNTorres/status/322803636080091136
There have also been cases where Planned Parenthood has violated medical practice, which would be why the clinic in Delaware is under investigation.
http://www.dailymail.co.uk/news/article-2307143/A-meat-market-style-assembly-line-abortions-Nurses-quit-Planned-Parenthood-dangerous-dirty-work-conditions.html
So the discussion in the clip is most certainly not “moot”. And if the lobbyist really was unqualified to speak about how this particular bill would affect the organization she’s supposed to be representing, they probably should have chosen somebody else to speak for them. The bill, by the way, established “that regardless of how a born alive infant entered the world – natural birth, c-section, or abortion – s/he shall be treated with the same degree of professional skill, care, and diligence. The bill provided that a born alive baby would immediately be transported to a hospital”, just so we’re on the same page. It would not require extraordinary care for a baby born after an abortion that any other infant wouldn’t receive. I appreciate your honesty in answering the question of whether or not you would leave a newborn to die, though I would wager that even most supporters of legalized abortion would hold that at that point the baby has a right to live regardless of the wishes of the parents.
By the way, I don’t think you’re a monster. I think you do sincerely care about helping women, and I admire your devotion. I just wish you would extend your compassion to all of your human patients, and realize that everyone is deserving of safe, evidence-based, comprehensive medical care regardless of age, location, or wantedness. That should include the unborn.
Reading over my post, I see that the case I cited happened before the PBA ban was signed into law. There’s another case here however:
http://www.cnn.com/2009/US/02/06/florida.abortion/index.html
Thank you for your thoughtful post. I regret you did not identify yourself, I would hope you felt this is a safe place. Unfortunately not every doctor practices sound, evidence-based medicine. That said, they should be punished, not the women they are supposed to be caring for. Malpractice affects all fields of medicine, yet access to medicine is only legislated (and therefore limited) in women’s reproductive health care. Also, when digoxin fails, a repeat dose is given. Every effort is made to ensure cessation of fetal cardiac activity prior to commencing the abortion or induction procedure. Supportive care is necessary if born alive, however overt life-saving measures are not. Those are decisions and discussions that take place in the health care setting, not the courtroom, between the parent(s) and the medical team caring for them. My compassion lies first with the women who come to me seeking comprehensive, unbiased, non-judgmental, evidence-based health care. Thank you again.
-Leah
I generally don’t use my real name or email on any of the sites I post on. I apologize if I was supposed to. Please don’t take it personally!
My only claim is that it’s not “impossible” for babies to be born alive after abortion. It’s true that in late abortions, measures are generally taken to avoid live birth (especially in the third trimester). This is one of the reasons why the lethal injection technique was developed. However, it still remains true that:
– Violating the PBA ban requires intentionally delivering a live fetus partway before killing it. One injection might not always euthanize the fetus, but will mean avoiding the PBA ban because it demonstrates lack of intent. See: http://www.societyfp.org/_documents/resources/InductionofFetalDemise.pdf
– There is no universally practised late-term abortion procedure, and some abortion clinics do break the law or violate medical guidelines.
– Ultrasounds to determine gestational age become less and less precise as pregnancy continues. In the late second trimester, the margin of error is two weeks.
The bill in question does not involve punishing women, nor does it specify how doctors have to treat their patients. All it does is require that all infants born alive are to be considered patients regardless of how they’re born. It does not mandate that a 23-week old abortion survivor has to be given any more “overt life-saving measures” than a 23-week preemie born naturally or via caesarean section would normally receive. Determining and applying the standard of care would be up to the medical team. A federal bill identical to this one passed the U.S. Senate unanimously. It was good enough to appease even leading opponents of the PBA ban like Barbara Boxer and the National Abortion Rights Action League.
Certainly, all areas of medicine have malpractice. There was Kermit Gosnell’s House of Horrors, and there was a dentist without any medical training that operated out of his basement. It’s not entirely true that abortion is the only area of medicine that’s legislated. Even if it was however, that’s not particularly outrageous. At least half the country considers it unjust killing of human beings in most cases. A good deal more would say the same about late-term abortion. This cannot be said about any other medical procedure. You stated in an earlier blog that you “do not pretend to understand why there is such force behind trying to control women’s reproductive organs and, in turn, their bodies and their lives”. But framing it solely as a reproductive health issue comes across as question begging to anyone that considers it unjust killing. No doubt, you would disagree with this assessment. However, it’s still essential to at least understand and acknowledge where one’s adversaries are coming from rather than assuming they’re all just out to control and marginalize women.
A few things to clarify and consider:
-To my knowledge, if fetal lethal injection failed at the first attempt, a second injection is done prior to the D&E procedure to ensure cessation of cardiac activity.
-Any abortion clinic that does not abide by federal law would lose its ability to treat patients, the physician would lose his/her medical license and career. It is bold to state “some abortion clinics do break the law…” without evidence that this is the case. I doubt your statement is true outside of horrific cases like Gosnell’s and would caution against making such cavalier statements.
-Your statement regarding ultrasounds is true, however I am unclear as to its relevance. Be that as it may, we can only go by information that we have, which is usually a guessed date of last menstrual period and our best ultrasound technology.
Question for your consideration and not necessarily for you to respond to:
-How would you feel about a woman with a desired pregnancy who gives birth to a premature infant at 24 weeks gestation (viable) but does not want any extra efforts in medical care performed? She knows that without medical care the baby will most likely die and she accepts this and declines Pediatric intervention. What should be done in that situation?
I only bring this point up because it shows that the world is not black and white and that these situations are difficult at baseline, let alone along with trying to navigate legislation that is not medically based. I very much understand and acknowledge where my adversaries are coming from, but here is the counter-point I try to convey: it doesn’t matter where they are coming from. It doesn’t matter where I am coming from. The only thing that matters is a woman’s autonomy regarding her reproductive health, her family planning desires, and her life and body. A fetus cannot survive without its mother, nor can a baby, so the woman is ultimately responsible for her own fate and the fate of her pregnancy. She does not make decisions regarding her pregnancy lightly. She thinks about current children if she has any, her partner or lack thereof, her health, and many, many other things. If she decides she cannot carry a pregnancy to term and give birth, who is anyone to force her to?
Think about what not having autonomy regarding health care decisions would mean. Trust women.
That was an eloquent and powerful statement. Thank you for being this kind of doctor.
I appreciate your taking the time to read it. I am humbled every day to have the honor of doing what I do.
-Leah