Wow. That’s quite the comment thread we’ve got on Andrea’s previous post. I am delighted with the discussion. Because I’m learning from it, yes, but also because our readers are debating a pretty contentious issue with great clarity, compassion and civility. (We’ve got cool readers.)
One of the things the commenters brought up that I think it worth considering again is that the victim of early inductions are not the mothers so much as the babies. I’ll admit that my first thought when I read that Post article was to think about the pregnant mother in danger of dying. And really, when a situation occurs where the husband or other family member has to agree to early induction to save the life of the mother (these cases do happen; I know of at least two), and has about 41 seconds to make a decision, it’s hard to see it any other way. When the best information available, in an emergency situation, is that the unconscious mother (and baby) will die within the hour if we let nature take its course but the mother will be saved (and maybe the baby as well; in the 2 cases I am familiar with they survived) if we induce, what is a husband supposed to do? I have a hard time believing that what he’s agreeing to is infanticide.
Cases where the choice is between the mother and her baby dying and the mother surviving (maybe the baby, too) are clear to me. These are about both mother and baby. Cases where induction is performed for reasons that are, let’s say, less serious are a lot less clear to me. The mother’s convenience or peace of mind are certainly important, but not nearly as much as the life of another human being, regardless of how difficult it might be due to severe anomaly. I contend that these cases should be about the baby, not so much about the mother.
I don’t know enough about the particulars of St. Joseph’s hospital. I do not know Father Prieur, and I am certainly not qualified to judge whether his actions are properly Catholic or not. I would be curious to know if there is consensus among pro-lifers, and among our readers, with my distinction in the paragraph above. Do most of us agree there can be cases where it’s about both mother and baby?
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Tanya wonders if we’re splitting hairs here: I’m in agreement with early induction for two reasons only. The first is a situation I was made aware of when I was pregnant. There are instances when the baby is no longer thriving due to conditions in the womb — not adequately growing or gaining weight due to a lack of nutrients getting to her. Clearly, early induction here is for the benefit of the baby.
The second instance is based on the health of the mother. The mother is the life support of the baby. If she is going to die if she continues her pregnancy, it seems logical that early induction would be in the best interests of both baby and mother.
Even as pro-lifers, are we always analyzing these issues from the standpoint that the child in the womb deserves equal rights to any other human being? A useful parallel, I’ve found, is the treatment of conjoined twins. Without question, the medical world attributes both twins with equal rights. However there are instances where one twin will die and the other will live. One such case is Jodie and Mary. I’m not suggesting that the actions taken here were ethically irreproachable. I don’t envy anyone who has such a choice to make. But the rights of the twins were equal out of the gate, which is more than we can say for most cases of early induction.
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Where I think the morality of the vast majority of abortion cases is pretty clear, I don’t think that these cases concerning health of both the mother and the baby are so easy to figure out. I always believe that there is some absolute relating to these scenarios, but it’s not always to see what it is or how it is applied.
I can’t comment on all the cases. I want to ask a question about one though:
If diagnostics has discoverd that a child (say about 20 weeks) has not developped a certain vital organ, and that there are signs that other (related) organs are dying as a consequence, but the child is still presently alive, what rule would you apply here? If the missing and damaged organs would guarantee death shortly after birth, is there any difference between early inducement and natural birth?
In this case, there might not appear to be a clear danger to the mother, except perhaps the risk of complication if the child dies before delivery. But for the sake of argument, let’s assume that is not a factor.
At what point could one say they know the child will not survive? Does this even matter?
Good question. I would say (keep in mind I’m no medical expert) that as long as the fetus is alive and posing no grave threat to the mother, he/she should have a chance at life. So I would continue the pregnancy normally. If that means delivering a baby who will die minutes or hours or days after birth, well, so be it. If it were my baby I would rather live the rest of my life knowing I had done everything in my power to give him/her the best chance at any life, however brief. Sometimes, doctors make mistakes. Sometimes, people live when medical science says they couldn’t. If the pregnancy is no threat to the mother, why assume the worst instead of hoping for the best – even if “best” is “only” a short life?
I would hazard to say that there are definitely cases where it is about both mother and baby.
But I would also hazard a guess that the reason so many of us are having a hard time with Fr. Prieur and the induction policy at St. Joe’s is because it does not sound so clear cut. Their decisions do not sound as if they are about the mother and the baby. I find very little evidence in what I have read that makes it sound like, in all or even most cases of their early induction, that the mother’s life was *IMMINENTLY* in danger. Now. Immediate. Induce or the mother will die.
Yes – I am certain there really have been cases at St. Joe’s where the decision had to be made NOW, in order to save the mother’s life. The first time the issue was raised was perhaps one such situation. And in these instances I think most would be sympathetic.
However, the language used by Fr. Prieur in the article makes it sound like induction decisions are being made well in advance, far removed from any actual immediate necessity to save the mother. The danger to the mother remains hypothetical and potential and may *never* appear. (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.”) As Patricia’s search indicated, fetal anomalies contributing to maternal death seem to be somewhat rare. Yet St. Joe’s is intervening early, apparently without waiting to find out if any crisis would even occur.
I also am leery of the line in the article….”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.” What? Let me get this straight – if a fetal anomaly diagnosis is made, the hospital can make these preparations if the patient has an early induction. So the hospital is incapable of preparing for the psychological and spiritual support for the family if an anencephalic child is brought to TERM first, and then dies? One would think the extra weeks of preparation might come in handy. Perhaps more importantly, we know all of the evidence that indicates the trauma and distress that many post-abortive women eventually go through…women who felt that abortion was absolutely the right thing for them to do at the time. Is it not conceivable that a mother who *wants* a baby but then is given the option to induce early and thus end her child’s life early (for that is indeed what happens), well, is it not reasonable to assume that the trauma to these women is just as great? Don’t we think these women will suffer just as much in thinking that they caused the death of their child? These mothers will undoubtedly need counseling to deal with the anomaly their child had, and the fact that it was not likely to survive. But now they need further counseling to deal with the fact that they caused the early death of their child. I would suggest that many of these women are being done a psychological disservice by the option to induce early (causing fetal death), without clear evidence that Mom’s life was in immediate danger.
At any rate – if the article had suggested that St. Joe’s was making immediate, absolute, black and white do-or-die decisions, there might be less brouhaha. But if St. Joe’s and Fr. Prieur are truly making ethical decisions that all pro-lifers could be in agreement with, then the article was either written terribly or Fr. Prieur did not present his case well at all.
Ectopic pregnancies are often cited as a black-and-white case for abortion. An embryo will implant in the mother’s fallopian tube, instead of her uterus, and start to grow there. The fallopian tube cannot sustain a pregnancy, and, what’s more, if the pregnancy is allowed to continue, the growing fetus will rupture the fallopian tube, causing complications (sometimes life-threatening ones) for the mother. The routine course of treatment for ectopic pregnancies is to terminate, and I have NEVER heard a pro-lifer suggest abortion is an immoral course of action in this case. What’s more, doctors won’t sit around and wait for the crisis to occur, but once the pregnancy is diagnosed as ectopic, they will abort as soon as possible.
The reasoning, I guess, is that the baby is doomed anyway, so why wait around for the mother to get sick as well.
I suppose a sort of parallel can be drawn between aborting ectopic pregnancies, and inducing early labour when the fetus has lethal anomalies. However, whereas crisis is foreseen and inevitable in the case of an ectopic pregnancy, it’s not so clear that a crisis is forthcoming in the cases described in the Post article. My personal preference tends to take a “wait and see” attitude, and err on the side of life.
Whenever there is a risky pregnancy, I do think that abortion ought to be an option that is at the back of the table. I do think it ought to be a measure of last resort. The riskier the pregnancy becomes, the closer abortion moves to the front of the table. The Post article states that 8-10 patients a year go to the ethics committee to discuss early induction. I’m curious to know how many actually induce early labour, or if any decide to continue with the pregnancy to its natural conclusion.
I’ve said this before, and I’ll say it again: I don’t like how we as pro-lifers say such things as “[p]rocedures whose immediate effect is the termination of pregnancy before viability are considered direct abortions,” (from the Post article), and then go on to conclude that early induction is NOT abortion because it doesn’t fit those criteria. It’s vaguely reminiscent of how the pro-choice movement claims that embryos/ fetuses are not human, or are not persons, and then go on to define humanity or personhood so that embryos and fetuses do not fit the bill. I think it would be much more honest if we acknowledged that there are times (few and far between, but they do exist) when a physician can legitimately hit the abort button on a pregnancy.
But let’s look at what St. Joe’s is doing well. For a hospital that specializes in risky maternal-fetal medicine, in a major Canadian urban hub, if 8-10 cases go to committee for abortion every year that suggests that they are being VERY stringent about which cases they refer for early termination. And the ethics committee the family meets with to discuss their options? It includes medical specialists, ethicists, theologians and staff administrators in a meeting that can last all day. Talk about informed consent! If this were any hospital but a Catholic hospital, we would be throwing up our hands and shouting “Hallelujah!”
Sometimes methinks we Catholics are just a little too hard on one another.
“While he was United States Surgeon General, Dr. C. Everett Koop stated publicly that in his 38 years as a pediatric surgeon, he was never aware of a single situation in which a preborn child’s life had to be taken in order to save the life of the mother. He said the use of this argument to justify abortion in general was a “smoke screen”.” Pro Life Answers to Pro Choice Arguments by Randy Alcorn
“Today it is possible for almost any patient to be brought through pregnancy alive, unless she suffers from a fatal illness such as cancer or leukemia, and, if so, abortion would be unlikely to prolong, much less save, life”. Abortion – Yesterday, Today, and Tomorrow by Dr. Alan Guttmacher of Planned Parenthood
“… less than 1% of all abortions are performed to save the mother’s life.” Rites of Life by Dr. Landrum Shettles
The actual incidence of a life-threatening pregnancy are extremely low. What gets thrown into this equation is the mother’s mental health, which as was said by someone else, leaves a loophole big enough to drive a truck through.
I disagree with Melissa that ectopic pregnancies are a black and white abortion issue. With early prenatal care, a diagnosis of ectopic pregnancy can be closely monitored and in the event of tubal rupture, the hemorrhaging can be treated (which is the primary threat to a mother’s life). The mother then has emergency surgery. Yes, there is always the risk that without early prental care, an ectopic pregnancy could cause tubal rupture and threaten the mother’s life, but then we are dealing with what “might” happen instead of what “will” happen. I’m not convinced that what “might” happen is blanket justification for automatic abortions for ectopic pregnancies. There is always the risk that pregnancies will have complications – from pre-eclampsia to birth defects to the very rare life-threatening situations. I just don’t think that preemptive abortion is the answer.
“To date, at least 14 studies have documented that 68 to 77 percent of ectopic pregnancies resolve without intervention.”
“In 1999, a healthy baby boy was delivered in London after having implanted in his mother’s fallopian tube. When the tube ruptured, the embryo attached itself to the mother’s uterus and spent the rest of the pregnancy in the mother’s abdominal cavity. In 2000, a healthy baby girl was delivered in Nottingham (UK) despite the fact that she spent the duration of her ectopic pregnancy attached to the lining of her mother’s bowels. In 2005, a woman in Hertfordshire (UK) gave birth to a healthy baby girl, despite the fact that she spent the entire pregnancy in her mother’s abdomen. In 2008, an ovary-based, ectopic pregnancy delivered a healthy baby girl in northern Australia.”
“Without question, the odds of survival for ectopic babies is extremely slim, but clearly it is erroneous to claim that “there is no way to save an ectopic pregnancy”. If more ectopic pregnancies weren’t ended prematurely, who’s to say there wouldn’t be far more examples of successful births?”
http://www.abort73.com/index.php?/end_abortion/is_abortion_ever_justified/
I guess I stand corrected. I’d never heard of an ectopic pregnancy resolving itself and continuing to term.
However, I still think abortion should still be on the table when continuing the pregnancy poses serious risks to the mother.
Melissa: If I honestly believed that abortions would only be used in the very rare but genuinely life threatening situations, then yes I agree.
But somehow pro-choice arguments tend to stretch (exploit?) these uncommon exceptions, the occasional life saving intervention that results in the tragic loss of a baby, into a fundamental right to never be pregnant under any circumstances whatsoever without any acknowledgement of the innocent baby. We give an inch, they’ll take a football field.
I am a pediatrician and not an OB Gyn but it seem to me that no one is taking into account the mother’s desire for future children. Even if this pregnancy is doomed, be it a life span of 6 hours or 6 months; most women want the chance to have a further normal healthy baby. Some complications with the baby, some anomalies – lead to damage to the mother’s reproductive tract if tried to deliver to term. Inducing earlier when smaller means she won’t have to be damaged and then could have children later. All this must be balanced with the best possible medical decision making, when in reality we can never know everything. These ethical panels must be very intense.
As for the ectopic pregnancy case – you realize that in the extremely rare case that the pregnancy somehow attaches to another part of the body and survives – that tube is now destroyed and all future fertility is ended from that side. Thus her chance of ever having another baby is cut at least in half.
If it was my 6th or 8th baby I’d be willing to risk it, but not if it was my first.