Archives for February 2009

Today the Post ran this story about a London-area Catholic hospital, St. Joseph’s, and whether or not they have been doing early induction abortions over the past twenty years. The story is a long, in depth look at a rare but very difficult and sad thing: babies who are diagnosed with things like anencephaly in the womb, who won’t live past birth–and whose delivery may pose a threat to the life of the mother. The question is what to do at a pro-life hospital.

What I read in the Post today makes it sound as though they have adopted a very thoughtful approach with grave concern for the lives of mom and baby–they induce labour but not until after viability–that way if there’s been a mistake the baby receives care and lives and the mom is safe too.

I’m not a medical doctor–so actually, I’d appreciate it if some of those weighed in. I suppose two questions would be is the life of the mother threatened by delivering such a baby at term, and is it true that these babies never live? (We have our own thoughtful ethicist on the PWPL team here, however, she may be in labour as I type this.)

But sounds to me like the initial reports, like this one, were off base. We shouldn’t bandy about the word “eugenics”–it will lose its potency for the instances where eugenics truly is a factor. I’m open to hearing the other side, as usual, but sounds to me like this Catholic hospital is doing an admirable job of balancing what has to be the most heartwrenching scenario for any parent.

The piece ends with this:

Years ago, we didn’t know about the complications,” Fr. Prieur said. “We didn’t have these very sophisticated diagnostic tools. So sometimes the risks suddenly appeared and it was a high-risk pregnancy and you may have minutes to save the mother and the baby. Now we know. And with that knowledge do we have to wait till that crisis occurs, or do you intervene earlier? That’s part of the rationale of what we’re doing with early induction.”

It also means there is time to plan for the psychological and spiritual support of the family, a key component of how the hospital deals with the trauma.

When the baby is delivered, the parents have a chance to hold it quietly for a few minutes as the life drains out. A priest is often in the room to perform a baptism and someone trained to take a family photo if that is requested.

“For the vast majority of people there is a sense of peace,” Dr. Coughlin said. “The baby they were expecting to look very abnormal may not be as abnormal as they thought.”

“Many times I’ve walked home and say to myself, ‘We’ve held a human being in the palm of our hands,’ ” added Fr. Prieur. “This is not easy. This is the most difficult area for us Catholics.”

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Brigitte adds: I noted with much interest the following bit:

There are no s pecific Church guidelines in Canada when it comes to early induction. So LifeSite looked to guidelines laid out by the United States Conference of Catholic Bishops and the U.S. National Catholic Bioethics Center to draw a judgment about what was going on at St. Joseph’s.

It cited Directive 45 of the “Ethical and Religious Directives for Catholic Health Care Services,” which states: “Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted. Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion, which, in its moral context, includes the interval between conception and implantation of the embryo.”

The St. Joseph’s guidelines for early induction says the same thing: “Procedures whose immediate effect is the termination of pregnancy before viability are considered direct abortions.”

I am no ethicist, and also not a doctor. But it seems to me that if the intention is not to terminate the pregnancy, and that if every reasonable measure is taken to try and save the lives of both mother and child, then it’s not an abortion. Like Andrea, I’m willing to hear the other side. But I would certainly refrain from calling people like Fr. Prieur ugly names.

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Patricia says: Brigitte and Andrea, I don’t agree with you on this one.

I am not a doctor or an ethicist, but the procedure described in the article troubles me (to put it mildly) for several reasons.

Firstly, there is a big difference between the early intervention policy of the US Conference of Catholic Bishops and the policy in place at St. Joseph’s. Under the US Bishops’ policy, “the psychological condition of the mother is never enough to do an early induction; it is allowed under the St. Joseph’s guidelines”. Fr Prieur comments in the article that “[i]f a mother is suicidal because she is carrying a baby that will not survive, that would be a reason to do an early induction”. The article then says that he could recall only one or two cases in which psychological well-being was enough to do an early induction, but it does seem to me that the rationalization of psychological well-being is broad enough to drive a truck through. This leaves me wondering how strict the requirement of risk to maternal health must be when it is used as a justification for early induction.

I am curious about the statistic that “one-third of the deaths of pregnant women is caused by lethal fetal anomalies”. I have never heard that before. I did a quick Google search of “causes of maternal death”, “maternal death and fetal anencephaly”, and “maternal death and fetal anomalies”. I found an abstract of one article in the British Journal of Obstetrics and Gynecology that states that “continuation of pregnancy after a diagnosis of anencephaly is medically safe and should be considered as an option”. But that hardly represents a comprehensive review of the subject and I would be grateful for any expert insights on this issue.

I have to say that I find the whole “humane” procedure described in the article chilling. The proponents claim that 23 weeks is the magic number of viability: “What is key for them (the practitioners and ethicists at St. Joe’s) is that labour is not induced until at least 23 weeks, so if the baby is born alive, everything possible could be done to save it. And if the diagnosis is wrong, the child would have a chance”.

Okay, so, have any babies actually survived this process, even for a day or two? If a baby does survive the induction and delivery, who decides whether “everything possible” is done to save it (because I suspect that there isn’t a lot of time in which to make this decision) or whether the parents will simply “have a chance to hold it quietly for a few minutes as the life drains out of it”. Doesn’t that sound so natural – “the life draining out of it”, except that we have just stacked every card in the deck to make sure that that life is certain to drain out of it (it? shouldn’t that be he or she?).

Finally, I am a little suspicious of so-called lethal fetal diagnoses. What conditions do they apply to? The article refers only to anencephaly and, tragically, a child with anencephaly who survives to birth does only live for a very short time. The same article I referred to above sets out some pretty heart-wrenching statistics: in its study of 211 pregnancies where a diagnosis of anencephaly had been made, “one hundred and fifty-three (72%) of anencephalic offspring were liveborn, of those, 103 (67%) died within 24 hours but 6/211 survived 6 or more days (maximum 28 days)”. What should we do for a life of 28 days? For 6 days? For 6 hours? How do we know in advance what length of time we are dealing with? A child with trisomy 13 or 18 (other conditions commonly described as “lethal”) may live for days, months or years (see, for example, http://www.livingwithtrisomy13.org/trisomy-13.htm). One mother of a child with trisomy 13 has told me that to determine a life expectancy of a baby based simply on a determination of trisomy 13 is like determining life expectancy of an adult basis on a diagnosis of “cancer” without taking into consideration whether it’s skin, lung or liver cancer, whether it’s stage 1 or stage 3. There is a wide range of degree of affliction with many of these conditions, just as there is with Down Syndrome. My friend’s experience is that this is rarely taken into consideration by doctors, many of whom assume that these conditions are a death sentence and wouldn’t we all be better to just move on.

I agree that the word “eugenic” should be used carefully. But we live in a country where 80-90% of children prenatally diagnosed with Down Syndrome are aborted. And our health system’s biggest initiative on Down Syndrome is to make sure that we get that new test (“Now know even earlier in your pregnancy!”) out on the market as quickly as possible. It’s a big old eugenic world out there and I think that an organization such as LifeSite is right to scrutinize a practice such as this. The fact is that we would not even be having this discussion if they had not made the procedure public.

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Andrea adds: Thanks, Trish, for being suspicious. (I mean that.) I have no desire to naively accept the Post report at face value. (And I was concerned about the loophole for mental distress, which is indeed a loophole large enough to drive a truck through, it’s true.) It could be this hospital has allowed for excuses to kill a baby early. It could be. It could also be that the mother’s life will genuinely end if they don’t induce. And that’s what I’m keen on learning about. I also took issue, I should add, with the headline “when good medicine and religious teaching collide). Because ethical treatments are good treatments, period. (This is not about religion versus good treatment.)

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Andrea is starting to realize she got it wrong: and will post again on this topic, once I confirm a few facts and details. In any event, thank you to all those who took the time to write thoughtful comments and point out new information/a new way of seeing this story. I’m sorry to say I was taken in by the Post report. My new look at this would be they are certainly aborting, and most likely unnecessarily so (ie not to save the life of the mother–but that’s what I’m waiting to hear back about from a few ob-gyns). I suppose I wanted to believe the best about that hospital; as a non-Catholic; I tend to believe that Catholics are the ones who hold the line on this topic. I suppose it was somewhat naive of me to believe that no Catholic could ever make a mistake. (All the more discouraging then, when they make up fancy covers to get around what they are actually doing to convince the ill-informed among us…which apparently includes me.)