copy this post

[ljgeoff]

On the consequences of the recent SCOTUS partial birth abortion decision, this is an excerpt from an article in the Journal of the American Medical Association (subs. reqd.) :

…Over the next two days, the power of modern pharmaceuticals is unleashed in an attempt to quiet her uterus and save the twins. In reality, this attempt is focused on the twin who is fully contained in the uterus, since the one who is almost inside the vagina has no realistic chance of achieving viability. The efforts are valiant — these twins were conceived after 10 years of marriage — and the desire is strong to salvage as much of this pregnancy as possible….

Inducing labor before membranes have ruptured, or before there is a maternal indication such as infection, is technically an elective abortion. This hospital, like most hospitals in the metropolitan area in which they live, has a strict no-elective-abortion policy, which forbids her obstetricians from rupturing her membrances and initiating labor. Women who want elective abortions go to Planned Parenthood; the ones who want to deliver full-term babies go to hospitals; and so the woman and her husband are told they cannot exercise that option at this hospital. The two of them, recent transplants from California used to a less faith-based practice of medicine, are shocked by this. Nobody wants this pregnancy more than they, they argue. The sole reason they are doing this is because the risks outweigh the benefits. Does the hospital require emergence of a frank infection before intervention is permissible? Is this in keeping with the highest standards of practice in modern obstetrics? Her obstetricians are sympathetic but helpless. Finally, they come up with a plan. The sole hospital that does not have such an abortion policy is a university teaching hospital several miles away. Telephone calls are made, a direct admission is arranged, and the woman's husband drives her to the teaching hospital, where labor is induced. The twins are delivered the next day. They are stillborn.

You might wonder, reading this vignette, how I happen to know so many details about this case, or even whether this is a fictional teaching case that so bedevils medical students. The unfortunate truth is that this is real life: I am the husband in this story.

But the greater tragedy here, to my mind, is the straitjacket that a religious worldview imposes on the complexity inherent within clinical medicine. Our world sometimes presents us with situations that cannot be simplistically categorized as pro-choice or pro-life, and other patients across the nation will be faced with decisions like the ones we made on that fateful day.

This is why hospital policies that originate in religion rather than science can be unhealthy and unsafe. Personal religious beliefs can and should guide the lives of clinicians of faith. The extent to which they guide a clinician's professional life is the clinician's personal matter, and I hope that clinicians will choose specialties and practice settings that ensure that patients receive needed care regardless of the clinician's religious beliefs. However, the extent to which these beliefs guide hospital policy is a matter of concern to all of us, whether we are patients or clinicians. The extent to which the US medical establishment succeeds in circumscribing the circle of influence of religion-based medicine will determine the quality of health care that phsycians can offer their patients. Clearly, irrespective of what religion each of us belongs to, this is the very least that our patients deserve.