What follows is a rambling reflection apropos of not much
more than the heartbreakingly sad state of affairs in America on February 4,
2014.
I got a forward from a resident at one of the more
prestigious medical schools in the country.
The subject was one of those interim exams, designed to test the
resident’s knowledge of care in his specialty.
Without boring you with the arcane medical details, the problem posed
was of a young woman with a chronic illness whose severity makes it risky for
her to get pregnant (think Steel
Magnolias). This patient presents to
her physician pregnant and the residents were asked what the proper course of
care might be.
I think the results are telling.
Nearly half of the residents indicated that they would
monitor the pregnancy carefully and recommend caesarean section at a time when
the child would be viable and risks minimal.
But the “correct” answer was to recommend elective termination of
pregnancy. I do take heart that only
about a third of respondents picked that answer, but that’s a third too many. (One commenter mused that the question was
posed simply for the purpose of measuring the acceptance of casual abortion
among medical residents. I am just enough of a conspiracy theorist to believe
that just might be true.)
As bad as the recommended answer is, the reasoning behind it
is worse: Pregnancy in these patients is associated with a 30-50% mortality.
Let me recast this: pregnancy in these patients is
associated with a 50-70% survival rate of the mother. Abortion is associated with a 100% mortality
of the child.
Politicians and propagandists have long known: control
language and you control the argument. The
moral reasoning aside, there’s a medical issue, one of intellectual honesty,
that no one has bothered to look at in the midst of all this.
I spent a long time working in the fields on oncology. In those fields a 70% chance of survival is
pretty good, worth shooting for, at least worth shooting for, especially when
balanced against the 100% risk of loss
of life for the child.
Too often these cases-both in the halls of medicine and the
daily newspaper-- are cast in terms far more dire and far more certain than the
medical data support, I suspect for purposes of polarizing the argument and directing
the answers. The worse the situation is
for the patient the doctor can see, the easier it is to ignore the patient he
can’t yet see. It’s a subtle and
effective way of dehumanizing the baby.
It underscores the need in these situations to pause long
enough to really assess the medical situation rather than rely on what
“everyone knows.” It’s equally important
in these situations not to wield
bioethics like a mathematical formula; the details of the situation matter as
much to morals as they do to medicine.
When mechanical ethics meets melodramatic medicine and the results are
predictably horrific. The harder the
question, the greater the need for good, detailed information and thoughtful
discussion. Fear too often drives us and
when it does, it tends to drive us away from God and from each other and into
the hard, cold silence of our own prejudices.
A woman who hears “you have a 30-50% chance of surviving”
will react differently from a woman who hears “you have a 70% chance of surviving,
and here’s why. Here’s what we can do to
keep you healthy long enough to have your baby.” A physician who encounters an
ethicist willing to enter into the grey areas of life is more likely to be open
to alternate—and more acceptable—plans of care.
And anyone who knows that there are safety nets—economic, emotional and
social—in place to help people struggling with medical tragedies is more likely
to risk alittle of self in return.
But the default in medicine has become elective abortion,
for many reasons. In part because that’s
the mentality of society. In part
because aborting the child is less risky for the doctor than managing a
complicated pregnancy that has a real chance of ending badly and spawning a
malpractice suit. In part because that
care is expensive and abortions are cheap.
Sadly, the more I tease out the problem, the more
complicated the moral answers become. One
malpractice suit can wipe out a lifetime of work; it takes incredible strength
to risk that over and over by caring for high-risk, pregnant patients in
flagrant disregard of the “standard of care,” however immoral that standard
is. In an age when insurance coverage is
shrinking and care for expensive conditions is likely to decrease, the odds of
third party coverage for managing such a pregnancy are diminishing and the
choice to maintain such a pregnancy might bankrupt a family. If we ever get to the era of
government-controlled care, even the option to choose to risk the mother’s life
to bear the child may be gone as treatment options narrow because of mandated
care paths.
It is a tragic reality of modern life that—in the course of
a generation—abortion has become the quick, cheap way of avoiding a whole slew
of medical and societal problems, ranging from our hypothetical lady who should
not get pregnant to parents who feel unprepared to raise a child with Down
syndrome to—God help us!- trying to reduce poverty my reducing the number of
people born in neighborhoods. (The rich
ones are doing a pretty good job of enforcing negative demographics all on
their own.) Life has become at once both
cheap and too expensive for modern America to tolerate.
Fixing that isn’t just a matter of reversing Roe v. Wade. It’s a matter of fixing hearts and
re-educating minds and being willing to give up something of our selves to each
other to make the journey together.
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