Wednesday, September 18, 2013

A Tragic Unintended Consequence of the Failure to Treat Unborn Children as Unique Persons

Recently, SPL member Mollie G. sent in a horrific July 11, 2013 alert from the Institute for Safe Medication Practices, entitled "In Utero Medication Administration to Fetus Presents Unique Safety Challenges." The advisory relates a tragic incident that occurred when an unborn baby needed to be treated for erythroblastosis fetalis, a complication that can arise when the baby has Rh-positive blood and the mother has Rh-negative blood. The treatment required an infusion into the umbilical vein, for which the baby had to remain still (obviously):
In the recent case, an obstetrical resident asked another resident to order a neuromuscular blocking agent for the procedure. The resident ordered the drug in the mother’s medical record, but did not include the dose or route. It wasn’t clear that the drug was intended for intramuscular administration to the fetus in utero. Therefore, the order was processed for the mother, not the baby, and pharmacy dispensed a vial of the paralyzing agent. A medical intern, who was unfamiliar with the procedure and neuromuscular blocking agents in general, administered the drug intravenously to the mother since it had been ordered on the mother’s medical record. Apparently, the intern did not realize that the neuromuscular blocking agent would paralyze the respiratory muscles, and that administration of this class of drugs required concomitant mechanical ventilation. It is believed that the entire vial was administered, not just the small amount intended for the unborn baby. The mother suffered a respiratory arrest, which regrettably was not recognized immediately given prior sedation the mother had received. The mother died and the infant sustained central nervous system (CNS) impairment as a result of this event. 
This tragedy could have been prevented in several ways. The order should have been clearer. The procedure should have been in the hands of an experienced doctor, not an intern. And above all, there's the fundamental structural problem: why was a drug intended for the baby ordered in the mother's medical record?

The author of the advisory states: "A separate account and medical record for the fetus seems appropriate, but there may be obstacles given the baby’s unborn status." What obstacles? You don't need a photograph of a patient to create a record. You don't need the patient's driver's license. The patient doesn't have to be able to communicate. Extremely premature babies in the NICU get separate medical records. The only "obstacle" I can think of is the cognitive dissonance that an unborn baby's medical record might cause in the sensitive psyches of obstetricians who also perform abortions. You want to risk someone's life over that? Get over it, or better yet, stop doing abortions.

Indeed, the advisory continues, "Some hospitals enter the orders for the fetus temporarily on a paper form or electronically as “Baby Doe” (or generic name with parent identifier) if the infant’s birth is imminent" (emphasis mine). So long as birth is imminent—so long as the baby is no longer "abortable"—a separate medical record is fine.

Constitutional law scholars sometimes speak of an "abortion distortion," in which the ideological desire to maintain abortion access causes judges to twist legal doctrines and create lousy precedents. Sadly, the abortion distortion exists in the medical context, too. Our society is schizophrenic about life in the womb, to the detriment of unborn children and their families.


Jameson Graber said...

We need more of this kind of reporting. Good work.

Max said...

I agree!

To the degree that this happened because of "abortion distortion" and that it is not just crappy medicine generally, I think that this is a great example how pro-choicers mistake their project of enabling or protecting women's autonomy as being reducible to protecting abortion rights.

It seems to me that that is a place where there ought to be wide spread agreement between both the pro-choice and the pro-life camp that doctors (and mothers) ought to be aware of how medical treatment of the mother will affect the health of the fetus. I would hope that all pro-choicers would recognize that legal fictions that require doctors to ignore how their actions would affect the fetus in situations such as this presents an obstacle for woman who want to be mothers, and is, therefore counterproductive to what pro-choicers really care about. Or, at the least, what I think pro-choicers really care about.

Perhaps I am overly optimistic but I hope that more reporting like this might help alleviate some of the deep distrust the pro-choice and pro-life camps have for each other. It seems to me, as someone who is in the pro-choice camp, that this is a great place where both camps ought to work together. While I'm not optimistic that this sort of cooperation is likely to resolve the abortion issue (either way), it does seem that we should all agree that it would be better to continue to fight out the abortion issue against a backdrop where tragedies like this don't happen.

Vita said...

Glad you support common sense action that will protect lives. You are correct, almost every pro-choice individual wishes for the safety of the mother and any child she wants. Everyone should be outraged that the medical personal could not label the drugs properly.

The reason the drugs were not labeled properly however is due to the "abortion distortion" mentioned above. The drugs were not labeled for the child, because to do so would be to admit that a separate person is present. This is something this hospital could not admit even though basic embryology textbooks explain clearly when a new human life begins.

I have a question Max. How can you agree with creating a chart for a separate human being without acknowledging that there is another human being present. If you acknowledge there is another human being present why is she not entitled to a right to live?

I really do applaud you standing up for common sense, however by doing so you are showing the ridiculousness of the pro-choice position.

Max said...

I agree with the pro-lifers to some degree in that, at some point, the fetus is a separate human being with a valid interest in her life. And, therefore, at that point legal restrictions (and a lot of them) on abortion should be imposed. I disagree with most people here that that point is conception, but I also disagree with most pro-choicers that that point is in the third trimester. At any rate, I do not think that pro-choicers adequately grasp what abortion is, particularly second trimester abortion.

But, I also agree with pro-choicers that for woman to have meaningful autonomy they have to be able to choose not to have children. I do not think that pro-lifers adequately grasp the burden that banning abortion would have.

To me, the abortion debate presents a complex conflict of interests that is not easily solved through slogans-- no matter how much we would like that to be the case. Rather, the rights of pregnant woman and the the rights of fetuses have to be weighed against each other.

So IMO, I need not ignore the fetus and fail to create a separate chart in a hospital in order to mindlessly chant my slogan. I understand that there is a conflict of interest and that abortion presents tough issues-- ones in which moral certainty would require creating fictions and ignoring reality.

What I hope articles like this might do is show that our current political/legal/ philosophical divide on this issue is not very productive. At least not unless what you're interested in is a lot of unplanned pregnancies and lost abortions and crappy medicine and the like.

My opinion is that if we were more willing to take seriously what the other side was saying, both sides would come out in a better positions.

For example, we might have better access to contraception and better sex education so we would have less unplanned pregnancies; better emotional and economic support for woman so they would not feel that abortion was their only real choice; and more restrictions on abortion.

That doesn't mean that either side would just fold at that point. But IMO, I'd rather continue this fight in a world with fewer unplanned pregnancy, fewer pregnant woman who feel pressured into having an abortion they do not want because they are poor, and where there are fewer abortions.

And I don't think that can happen if we continue to think that acknowledging that the "other side's position" has value entails having to take take a position that all abortions should be banned or that third trimester abortion on demand should be legal.

Vita said...

Thanks for the response. I understand where you are coming from now at the very least. You are correct that many of us on both sides of the issue tend not to acknowledge any validity at all in the other sides position.

You are correct on the burden caused to pregnant women by their unborn child. Naturally you are also correct that we need to have more economic assistance to pregnant woman.

I understand your pain on the inability of both sides working together for some common ground on prevention of unplanned pregnancy.

"I agree with the pro-lifers to some degree in that, at some point, the fetus is a separate human being with a valid interest in her life."

When do you believe this occurs? Before this point occurs what do you believe the fetus is? It is obviously not part of his or her mother because this child has separate DNA from his/her parents. Living human cells scientifically constitute a living human being from the time of fertilization this being has unique human DNA that is distinct from his/ her parents.

Thanks for your well thought out points and respectful discussion.

Max said...

I admit I don't have a great answer with regards to when the fetus is a separate human being or a person, etc. I think this a difficult question and I have yet yo come across a explanation that I've found compelling definition that of when a fetus is human in the sense that it has interests or rights.

I think separate DNA is necessary but not sufficient.
That is, when I think of what makes me a human being, I think there is something more to me being a human being than the fact that I have unique DNA.

I find that I am qualitatively different from a zygote in a way that I am not qualitatively different from, say, a baby. i'm rational, I can feel pain, etc. Maybe another way to say this is that I'm not sure what it would mean that a cell, regardless of its DNA, would have interests or rights.

LN said...

Max, scientifically a new human organism is created upon conception. I think what you're looking to define is when that human becomes an "actual person," as in a human deserving of rights. Based on what you've said here. When you talk about quality, for example, that's just differences in a human's development level.

But I want to reiterate that by a scientific definition, unique human life does begin at fertilization. A human being is a member of the species Homo sapiens ( "Biologically speaking, fertilization (or conception) is the beginning of human development...The result is a single-cell embryo called a zygote, meaning "yoked or joined together," and it is the first cell of the human body."

An embryo is capable of response to stimuli, reproduction, growth and development, and maintenance of homeostasis as a stable whole, which is what is required to be considered an organism.

No embryologist text will contradict this. At the most it will fail to overtly state it. But otherwise, you will find many which do overtly state it, and none that say human life begins in another phase.

Max said...

Yes that's pretty much sums up what I was somewhat inarticulately trying to express. Thanks!

I don't find the scientific definition of human life (in which we are just an organism) a compelling reason to sufficiently ground rights. It seems to me that we don't get the qualities necessary to have interests, let alone rights, until later in development.

Jon Kay said...

The only quality for to have rights is the quality of being a human being. Once you start allowing other qualities to dictate who should get rights or not, then you repeat the process of those who were involved in slavery, and many, many other human rights abuses throughout history. Enjoy this beautiful day that God has given to you, become a better version of yourself every day, and never settle for mediocrity.