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PBA203Y: Medical Dilemmas
for updated version:- Guiding principles: 2 patients, can't kill to save, instead treat underlying pathology
- Dr. Anthony Levatino's testimony
- Dublin Decl'n
- Double-effect reasoning
- Examples (different pathologies)
- Analogies
- (Maternal Mortality Rates - in longer presentation)
Guiding Principles: How Many Patients?
The guiding principle, recognizing the human rights of the pre-born, is not that either the life/rights of the child or mother takes precedence over the other, but that we're dealing with two patients in any complication surrounding pregnancy and we need to do our best to attend to the well-being of both.
Is Abortion Ever Medically Necessary?
What do abortionists say?
: https://www.nrlc.org/archive/abortion/pba/HowOftenAbortionNecessarySaveMother.pdf
Oriyana's testimony: “Would you agree that the majority of life-threatening scenarios that are specifically related to pregnancy tend to arise in the 2nd or 3rd trimester? … How long does an emergency C-section take? … How long does a late-term abortion take?”
Dublin Declaration
“As experienced practitioners and researchers in obstetrics and gynaecology, we affirm that direct abortion – the purposeful destruction of the unborn child – is not medically necessary to save the life of a woman. We uphold that there is a fundamental difference between abortion, and necessary medical treatments that are carried out to save the life of the mother, even if such treatment results in the loss of life of her unborn child. We confirm that the prohibition of abortion does not affect, in any way, the availability of optimal care to pregnant women.”
Is Abortion Ever Ethically Permissible?
- Killing an innocent human being is never OK – even if it's to save another human being
- example: if one 5yo needs a heart transplant, we can't kill another healthy 5yo to take that child's organ
- Katie's wording: “I agree that there may be times when we need to end pregnancy and remove a child. The question is, do we remove that child in one piece–or in pieces?”
- paraphrasing Devorah: “Abortion can certainly make the medical scenario simpler – because it's always easier to treat just 1 patient, rather than 2. But we acknowledge that we can't kill a human being just because her presence causes difficulty; and we acknowledge that there's no situation where a woman would have to die because she can't get an abortion. That's what we mean when we say that abortion is never medically necessary: we mean that if, tomorrow, abortion was somehow eradicated from the earth, there's not a single woman who would have to die as a result.”
"But what's the difference?" Comparing different interventions
Imagine that you are rowing on a lake, and you see two people drowning. You want to save both, but you only have the time or the strength to rescue one person–and while you are doing that, the other person drowns. Were you responsible for the second person's death? Certainly not–you just weren't able to save them.
Now imagine that you are in the same scenario, where two people are again drowning. You pull the first person out of the water–but then you push the second person's head under water. This time, we you responsible for the second person's death? Yes, you were.
In both cases, the second person dies. But morally, we recognize that there is a difference between not being able to save someone, and intentionally killing them.
Double-Effect Reasoning
http://www.unmaskingchoice.ca/training/classroom/circumstances/danger
Principles:
- Can't do evil (the action taken must be good or morally neutral)
- Can't intend evil (the evil effect must not be intended)
- Can't depend on evil (the evil effect must not be the means through which the good comes about – the ends doesn't justify the means, we cannot do evil so that good may come about.)
- Blaise: Could we add another step? E.g. with salpingectomy: if, in the future, we can care for an embryo or fetus that young, then the baby could be transferred (to an artificial womb or whatever). But with salpingostomy or methotrexate, she will always be dead b/c we killed her
- There needs to be a really good (proportionate) reason to tolerate evil as an unintended but foreseen side-effect
Examples
Catholic Health Care Services Ethical Directives
The Ethical and Religious Directives established in the United States for Catholic Health Care Services provides thoughtful guidelines that respect both lives (not because they're Catholic, but because they're pro-life)1):
47. Operations, treatments, and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child.
49. For a proportionate reason, labor may be induced after the fetus is viable.”
Ectopic Pregnancy
* ectopic pregnancy
(Uterine) Cancer
- chemotherapy
Preeclampsia
Misc Notes
- Dan Bader Nov 2008 tutorial
- Oriyana's speaker notes for presentation https://drive.google.com/file/d/0B7F56ieEvQdpZEF0ejFEMWdhNTZ3MkdDUjFIWl90SU96bUFv/view?usp=sharing
- Reasons given for late-term abortions
- CMA guideliness
- Dr. Fraser Fellows (debate clip in response to video)
- Fetal pain
- Viability
- Pulmonary Hypertension and Excommunication of Margaret McBride
- Sumner/Rosendal Ryerson debate cross-examination
- Can we ever “kill [an innocent person] to save?” What if there are no good moral options? (e.g. modified Chilean miner's scenario)
- Pregnant with a disability