In Canadian health care, hospital funding is front-loaded and each patient chips away at the pile. Many have suggested a model whereby hospitals are paid per patient “served.” This way, each patient becomes a source of revenue as opposed to a drain on resources. Makes sense? Well this idea has been met with much weeping and gnashing of teeth. Too complicated they say. Well, apparently it works for the education system. Can you imagine local hospitals engaging in PR battles over patients? Could we send a couple of education bureaucrats to hospitals please?
An article from the lovely Ms. Rebecca Walberg in the National Post online; I meant to post this yesterday. She has written about the (heartbreaking) case of Brian Sinclair who passed away in a Winnipeg hospital emergency room after waiting 34 hours for care.
An editorial in the Ottawa Citizen today on prenatal testing:
Consider how prenatal testing has affected the Down syndrome community. It used to be that only the fetuses of women over 35 were tested for the extra chromosome that causes the condition. Now, in some jurisdictions, women of all ages are tested, and 90 per cent of fetuses with the defect are aborted. Whether you believe this is good or bad, there’s no denying that it’s significant.
I just returned from listening to Barbara Farlow talk at an Action Life meeting about her daughter Annie, diagnosed in the womb with a genetic problem, Trisomy 13. Annie lived for 80 days, and then died under suspicious circumstances in hospital. Barbara (in her quiet, steadfast, unemotional manner) explained she is concerned about the doctors–who see in a disabled patient dollar signs and bed spaces where a person with a better chance of living, or a higher quality of life–could be. In some cases, these doctors would prefer you terminate and where they don’t–a callous attitude has evolved in the health care system at large. Why help someone who is weaker at the expense of someone who is stronger? When our health care system won’t allow for both.
Prenatal testing–it’s neither good nor bad–in and of itself. How we use it most certainly is. I hear stories of doctors pushing for testing where patients don’t want it, and I wonder how often this happens. Or, how often a patient feels pressure to terminate because the baby *may* not be perfect. (These tests are often wrong.)
Rebecca adds: The key, in my opinion, is informed choice, rather an informed consent. The implication of the phrase “informed consent” is “we will explain everything about the test to you, and then you will agree to it.” Implicit in true consent is that you can choose to withhold your consent. We need to explain to all healthcare consumers that they can refuse any test or treatment. Of course, when it’s your child’s wellbeing on the line, it’s especially easy to be browbeaten by medical personnel.
Quite apart from the very real issue of false positives (and, for some tests, false negatives) it should be made much more clear that testing for genetic conditions does nothing to improve outcomes, will not change whether your baby does or does not have a given disorder, and can cause more stress that it’s worth. While I believe non-invasive testing for issues with a higher than average probability it worthwhile, one could certainly make the case that, if you would not abort under any circumstances, these tests are best declined.
Tanya comments: A friend of mine recently said to me, “I am better off getting pregnant soon, rather than waiting another year, because when I’m 35, the doctors will make me have an amniocentesis.”
Culturally, we actually expect to be pushed into things we don’t want to do (when it comes to all that lies under the umbrella of healthcare, that is).
For the record, I did remind her that no one can make her get an amnio, that they are in and of themselves risky, and that their accuaracy is questionable.
I heard Judy Graves speak this morning. She works with the homeless in Vancouver. Goes out at night and meets homeless people “in their home”—under bridges and in alleys. She then works to find rooms for them, get them to doctors, provides them with the necessities to live. Her talk was entirely inspirational.
She told her story: As a young woman, single and without support, she made a call from a phone booth to find out the results of a pregnancy test. The person at the other end said—you’re pregnant. But if you don’t want to be, I can get you an abortion.
Different time, different place: A friend recounted recently how she was told in person that she was pregnant. Her response, in shock: “Wow, this is difficult.” Nurse’s response was to tell her she can help her get an abortion. My friend retorted, “It’s not that difficult!”
Finally, I just got an email to the site. Girl, this time in first year university, gets pregnant. Health care worker tells her first thing—here’s where you go for the abortion.
Is this what passes for compassion, for help? What kind of choice is this? Have these health care workers lost any semblance of compassion or empathy? Do they not care? Do they think providing an abortion constitutes care? Such a response is incredible. How can they so completely fail to register the real issues at hand—to send women packing with nothing more than the words “I can get you an abortion” ringing in their ears?
These three women I spoke of kept their babies. And lived to tell the tale, imagine that. Not everyone gets the same happy ending. Health care workers, clinic workers, those who give this kind of lame excuse for advice—our pro-abortion culture is at least in part, courtesy of them.
I’ve said for a while that women don’t really get choices. It just dawned on me how very painfully true this actually is.
It’s a special kind of country for young women to live in where killing our unborn children is the first choice presented. The very first one. Do you have to call yourself pro-life to think this is wrong?
Interesting editorial in the Canadian Medical Association Journal, read it here. One passage brought back memories of my ethics placement at the Montreal’s Children’s Hospital:
The case of Samuel Golubchuk, an elderly and very ill man at the threshold of multiple organ failure in a Winnipeg intensive care unit, illustrates this problem. The doctors wanted to withdraw care, and they met with the family on several occasions to seek consent; however, a religious impasse was reached, and Mr. Golubchuk’s son and daughter would not give consent.
The doctors wanted to withdraw care. One day during morning rounds, we were discussing withdrawal of treatment for a dying infant. A resident used these very words “withdraw care” and was immediately corrected by the attending neonatologist who said: “We never withdraw care…” and a chorus of students completed her sentence: “we withdraw treatment!”
Without referring to the particulars of the Golubchuk case, I wonder to what extent “religious impasses” are not reached when families are given the impression that “care” is withdrawn along with treatment. After all, no religion contends that physical life should never end. But most religions – at least those I know – advocate death with dignity. By this, I do not mean the so-called dignity brandished by euthanasia and assisted suicide supporters. I mean respecting the intrinsic dignity of every human being, regardless of their physical and mental condition. Faced with the imminent death of a loved one, families shouldn’t be made to feel like they are a burden to the system or that health care professionals are giving up on them. If health care professionals can’t or won’t respect the dignity of their dying patients, they are only inviting resistance from those who do. The Golubchuk case is not an invitation to draft more stringent end-of-life clinical guidelines – as was so sensitively done by the Manitoba College of physicians and surgeons, read my previous post on the topic here – but rather an invitation to review how we can effectively extend care where treatment is no longer appropriate.
An upcoming event on the ethics of prenatal screening. It sounds interesting. I read the abstract–the speaker will, I think, argue against prenatal screening on the basis that it doesn’t serve women well:
I argue that in the vast majority of cases the option of prenatal screening does not promote or protect women’s autonomy. Both a narrow conception of choice as informed consent and a broad conception of choice as relational reveal difficulties in achieving adequate standards of free informed choice.
I will, however, further argue that she might benefit from the firm hand of a non-academic editor.
This study, published in January in the Journal of Epidemiology and Community Health shows a substantive link between abortion and subsequent preterm births and low birth weights.
The Medical Post reported about this study on February 5. (It’s a registration required site so I’ll just quote from the article here.)
With increasing number of abortions, there was an increasing risk for both premature birth and low birth weight, Dr. Adera told the Medical Post. That is one major indication of a causal connection. […]
We believe this study confirms that both induced and spontaneous abortions are risk factors both for low birth weight and for premature births. And therefore we believe that women need to be informed about these potential risks by their doctors.
This has been known for a while. Researchers have cited the example of Poland, where abortion is illegal.
Poland dramatically reduced its rates of premature birth, maternal mortality and infant mortality within a few years after its abortion rate declined by 98% between 1989 and 1993 (as a result of the passage of an abortion ban). “If induced abortion significantly elevates pre-term birth risk, one would expect Poland’s pre-term birth rate to slump 5–10 years after the induced-abortion rate plunge,” [researchers] wrote. They say data from UNICEF found that, between 1995 and 1997 (after abortion declined by 98% from 1989 – 1993), Poland’s pre-term birth rate dropped by 41.8% and maternal mortality decreased 41.4%, and infant mortality was down by 25.0%.
This is important because in Canada, 17 per cent of abortions are done on girls age 10-19, 54 per cent on women age 20-29. In short, it’s likely these women are aborting their first child, with the hope of having another one later. Preterm birth is a risk factor for all kinds of complications, as is low birth weight. When babies experience complications, it is personally distressing to young mothers. It’s also a stress on our health care system. (This, in my estimation, falls a very distant second as a reason to make the information public. But dollars and cents matter, especially as our health care system declines.)
No, the information should be public so women can know and learn. And women are not hearing this information. I don’t bring it up as a scare tactic. Take a look at the study and decide for yourself.
Ninety-four per cent said that an alcoholic who refused to stop drinking should not be allowed a liver transplant, while one in five said taxpayers should not pay for “social abortions” and fertility treatment…
Managers defend the policies because of the higher risk of complications on the operating table for unfit patients. But critics believe that patients are being denied care simply to save money.
It’s not because the government cares about us that we have such a zealous anti-smoking campaign. It’s ’cause when we smoke, it costs them money in treatment. Now this article from the UK discusses other problematic aspects of health care. Ending taxpayer funding of “social abortions,” would be a real coup, where in Canada at least, the vast majority of abortions are done for social reasons. But denying the elderly? The obese?
No health care crisis here. Nope, there’s nothing to see here. Pro-choicers talk incessantly about access as if they’d like a clinic beside every 7-11. Here’s betting the vast majority of Canadians are more concerned about the fact that they can’t find a family doctor.
A story in the Daily Telegraph explains how an overwhelming majority of British GPs do not wish to perform abortions.
Family doctors are threatening a revolt against Government plans to allow them to perform abortions in their surgeries, The Daily Telegraph can disclose.
Four out of five GPs do not want to carry out terminations even though the idea is being tested in NHS pilot schemes, a survey has revealed.
The findings will throw doubt on Government trials to provide medical abortions – using drugs in the early stage of pregnancy – outside hospitals.
In a survey for The Daily Telegraph that was carried out by Doctors.Net, an online organisation representing GPs in England and Wales, only 14 per cent of the 2,175 GPs who responded were willing to undertake the procedure.
More than three quarters said they were not willing to carry out abortions and 54 per cent of these strongly objected to the idea.
The comments at the bottom of the news story are quite interesting. Most seem strongly against the idea of forcing doctors to abort babies.