biomedical ethics: February 2005 Archives

more detail on tubal ectopic pregnancy treatment
scroll down, it's the second item on this page

Bishop's statement on anencephaly
National Catholic Bioethics center: On Early Induction

that we don't know all the facts.
Over at Elena's blog, Anne posts this comment:

There is no age of "viability" for my baby. She is not viable. I would give my own life to change that. With all due respect, Alicia is a nurse midwife. Not a doctor, not my doctor, not my priest, councilor, or any other person involved in my care. Nor does she have all of the information in my case. I pray that when I go in, a miracle will take place, and that my baby will be perfect and whole. But you don't know, either, what physical condition I am in, or what risks this presents to me. I am not taking my baby apart, only delivering her peacefully, should that be the ultimate outcome. It has not been yet. And the catholic church does not teach that I should carry my baby if I am at risk.

Thank you for respecting my wishes on my blog. But I'm starting to believe what people say about opnions and everyone having one. I am fiercely pro-life, and would protect my babies rights to the end of the earth, even if she could live only a short time. That is not what we know to be true right now.

I hope your blissful ignorance of your baby turns out great. I wish you all the best. But I wish to GOD people would stop judging my situation as if they know what's going on when they don't.

I only know what Anne chooses to post. I only know what I have learned through my 20 years in OB. I know from experience that there are many ways in which the process of fetal development can go wrong, sometimes horribly wrong. I've personally seen moms with prenatal fetal diagnoses of Exencephaly with encephalocele (Part of the skull missing and the brain protruding into the amniotic fluid), heart outside the chest (can't remember the
long Latin name for that one), total renal agenesis, Trisomy 13, Trisomy 18 and a whole host of other less serious conditions like spina bifida, Down syndrome, clubfoot. I've also seen moms with pretty severe health conditions go through some pretty high risk pregnancies.

But without all the facts, I am not competent to have an opinion on this particular case. That is why my post below was aimed at discussing the general moral and ethical principles that the Church calls on us to follow - and maybe a little bit of a call to all of us, myself included, to be willing to embrace suffering.

I also have a bit of a quibble semantically. Viable is a term that is being tossed around a lot, and it seems that we have some very different definitions of the term. Obstetrically, we usually mean the gestational age at which a baby, if born, might have a fighting chance of survival. When Roe V Wade was handed down, the bottom age of viability was pretty generally held to be 28 weeks, and the stratification of allowable state intervention into a woman's personal decision re: abortion was based at least partly on that. The question being posed (and I think it is a valid one) is "Can a baby who has anomalies incompatable with prolonged extrauterine life properly be said to be viable?" I think that another question that may arise would be,"In the case of a baby with these conditions, does that placenta (and thereby the mother's body) constitute ordinary or extra-ordinary life support?"

Twenty-five years ago I was in the camp that held it didn't make a real difference when in pregnancy one delivered a baby with life-incompatable anomalies. I no longer believe that.

Maternal-fetal conflict is an area of biomedical ethics that I have studied extensively. It covers not only situations like EIFWAIL but also matters like does the court have the right to order a mom to undergo a cesarean for the health of her baby. In reality, there is very seldom a true conflict between the needs of the unborn and the mother, but those rare cases make for anguish and agony all the way around.

First off, let me say that this is not the post I had wanted to write this Sunday. I wanted to post on Terri Schiavo, I had some thoughts about the literature of ideas and how science fiction can be a near occasion of sin. But an issue has come up and I seem to have rubbed some nerves raw.

I want to take the time, in this my personal space to which you are invited, to explain a bit of why I have spoken as I have. I am not a theologian, I am not a moral philosopher or even a particularly holy person. I do not claim to have any special moral authority beyond that of any educated layperson who has researched and thought through this issue. All I can say that might make me a bit different is that I encounter the situation of an ominous prenatal diagnosis approximately once a year among my patients, and so I have been forced to think this through.

I am also not interested in judging the actions of another person. I am not competent to judge if some one other than myself is a sinner. Mortal sin requires 3 components:
1857 For a sin to be mortal, three conditions must together be met: "Mortal sin is sin whose object is grave matter and which is also committed with full knowledge and deliberate consent." (CCC). God calls us to love the sinner even as we hate the sin.

I was struck at Mass this morning by the second reading from 2 Timothy 1. Here is the King James translation of that reading and the verse just before it.
7:For God hath not given us the spirit of fear; but of power, and of love, and of a sound mind.
8:Be not thou therefore ashamed of the testimony of our Lord, nor of me his prisoner: but be thou partaker of the afflictions of the gospel according to the power of God;
9:Who hath saved us, and called us with an holy calling, not according to our works, but according to his own purpose and grace, which was given us in Christ Jesus before the world began,
10:But is now made manifest by the appearing of our Saviour Jesus Christ, who hath abolished death, and hath brought life and immortality to light through the gospel
and the NAB
7 :For God did not give us a spirit of cowardice but rather of power and love and self-control.
8 :So do not be ashamed of your testimony to our Lord, nor of me, a prisoner for his sake; but bear your share of hardship for the gospel with the strength that comes from God.
9 : He saved us and called us to a holy life, not according to our works but according to his own design and the grace bestowed on us in Christ Jesus before time began,
10 :but now made manifest through the appearance of our savior Christ Jesus, who destroyed death and brought life and immortality to light through the gospel

(from my inbox)

Hello. Thank you to all who prayed—your prayers definitely made a difference, and this decision WILL have an immediate impact. A decision was not reached until 5:50 p.m. on Friday, Feb. 18, but the final decision is a strong pro-life document that actually is better than we had hoped for. Below is first of all, the “official” press release from the pro-life pro-family coalition of NGO’s, followed by two posts from C-Fam, Catholic Family and Human Rights Institute, one of several key organizations involved. You may forward this. Having this ban in place will probably have a favorable effect on a cloning bill just introduced this week in U.S. Congress, and also is expected to affect a court case now in progress in UK which has granted two licenses to clone, the first of which is being challenged in British High Court. The document passed by the UN urges all member nations to adopt laws banning all forms of human cloning.

Read it and weep.