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utsfl:classroom:seminars:pba203y [2020/04/07 11:45] – mmccannutsfl:classroom:seminars:pba203y [2023/10/30 20:25] (current) – mmccann
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 ====== PBA203Y: Medical Dilemmas ====== ====== PBA203Y: Medical Dilemmas ======
 +
 +FIXME abortion as self-defence? https://blog.equalrightsinstitute.com/refuting-abortion-as-self-defense/
 ===== Guiding Principles: How Many Patients? ===== ===== 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. 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.
 +
 +As this [[https://www.cnn.com/2023/05/04/health/brain-surgery-in-utero/index.html|CNN article]] about a successful fetal surgery writes: "But for this surgery, there were **two patients:** Kenyatta and her baby."
 ==== Is Abortion Ever Ethically Permissible? ==== ==== Is Abortion Ever Ethically Permissible? ====
   * Killing an innocent human being is never OK -- even if it's to save another human being   * Killing an innocent human being is never OK -- even if it's to save another human being
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     * http://www.unmaskingchoice.ca/blog/2011/09/23/pamela-cooks-example-ethical-response-difficult-pregnancy     * http://www.unmaskingchoice.ca/blog/2011/09/23/pamela-cooks-example-ethical-response-difficult-pregnancy
     * http://www.jillstanek.com/2011/09/x-factor-australia-contestant-gives-powerful-anti-abortion-testimony/     * http://www.jillstanek.com/2011/09/x-factor-australia-contestant-gives-powerful-anti-abortion-testimony/
 +    * https://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/cancer-during-pregnancy/?region=qc
 == Preeclampsia == == Preeclampsia ==
 [[https://en.wikipedia.org/wiki/Pre-eclampsia|Pre-eclampsia/ Eclampsia]] [[https://en.wikipedia.org/wiki/Pre-eclampsia|Pre-eclampsia/ Eclampsia]]
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   * Labor induced early labor if needed   * Labor induced early labor if needed
   * (Difference between inducing labor to prevent keeping baby and mom in a serious riskyy situation and inducing labor just because--> Terminal diagnosis, inducing labor)   * (Difference between inducing labor to prevent keeping baby and mom in a serious riskyy situation and inducing labor just because--> Terminal diagnosis, inducing labor)
 +==== Savita Halappanavar ====
 +  * Savita H. Didn't get an abortion when she requested one, then died. Problem: correlation isn't causation, post hoc ergo propter hoc fallacy. Example of ice cream cone, if you ask me for an ice cream and I don't give it to you, and then you die of a heart attack, no one suggests that the heart attack was because of the ice cream cone
 +  * 
 +(notes from STUCK + https://thelifeinstitute.net/info/the-tragic-death-of-savita)
 +  * In 2012, the debate in Ireland over legalized abortion exploded with the tragic deaths of Savita halappanavar and her pre-born daughter Prasa
 +  * Media outlets around the world were quick to point out that Savita was denied the abortion that could have addressed her condition - septicemia, or a bloodstream infection – and saved her life. The case is often presented as a clear example of the necessity of abortion to save a mother's life. 
 +  * However, what many news reports failed to discuss was that an autopsy revealed that in addition to septicemia, Savita had **E. coli ESBL**, an antibiotic-resistant bacteria that is associated with urinary tract infections, or UTIs. The fact that e. coli ESBL was present is significant, as this type of bacteria can lead to septicemia. In fact, the //Journal of antimicrobial chemotherapy// records that E coli is one of the most common organisms to cause a UTI, and complicated UTIs are often associated with pregnancy. This information means that it is difficult to reach a definite answer as to how Savita actually died, and it calls into question how ending the life of baby prasa through abortion would have killed the E coli. 
 +  * Scenario #1: It is possible that the E coli bacteria was present in Savita's uterus, as a result of ascending into her vagina and entering the other dilated cervix. In this case, in order to save her life, the infected membranes would have had to be eliminated from her uterus. The ethical course of action in this situation would have been to induce labour, which would have targeted her condition - expelling the infected membranes - rather than directly ending the life of her pre-born daughter through an abortion. 
 +  * Scenario #2: However, it is also possible that the E coli ESBL ascended her urinary tract and caused an infection in her kidneys. This type of infection can lead to uterine contractions that, left untreated, can result in cervical change. If this was the case, neither induction of labour nor abortion would  have eliminated the E coli esbl, and because this bacteria is resistant to antibiotics, this is what could have led to septicemia. 
 +  * What many news reports did not mention regarding this case is that medical inquest revealed more than a dozen preventable human errors which resulted in the necessary medical action not being taken. 
 +    * For example, while a blood test was taken when Savita first arrived at the hospital which showed an elevated white blood cell account, this information was not recorded on her chart. 
 +    * Further, her vitals were not checked every 4 hours, and several clear signs of sepsis were missed. 
 +      * If you want an article that details the full 13 human errors that occur during Savita's medical case: https://thelifeinstitute.net/info/the-tragic-death-of-savita  
 +    * All of these discoveries that I'm mentioning were found in the investigative reports by the Health Information and Quality Authority, and the Health Service Executive, as well as the Coroner's Court inquest into savita's death. 
 +  * Ultimately, what can be learned from this tragic story is that it is possible that an ethical course of action was necessary to treat Savita's septicemia -- to treat her bloodstream infection. But in neither case was abortion the answer. Abortion doesn't cure septicemia. Abortion doesn't kill E. Coli bacteria. All abortion does is kill a pre-born child. It's very much possible that it would have been necessary to end savita's pregnancy and remove her child. The question is, should they have removed her child in one piece, or in pieces? 
 +  * When the media used this story to further the case for legalized abortion in Ireland, they forgot a fundamental moral principle: we may not kill to save.
 +
 +===== Do maternal mortality rates increase under anti-abortion legislation? =====
 +  * Statistical response: pro-life legislation =/= high maternal mortality rate
 +    * E.g. see lower maternal mortality rates of Ireland, Poland, Chile
 +    * 2 cases
 +      * South Africa [208-1980, 121-1990, 155-2000, 237-2008]
 +        * Legalized abortion in 1997: 11 years later highest it’s been. MMR increased after becoming legal!
 +      * Chile [70-1980, 44-1990, 24-2000, 21-2008]
 +        * 1989, abortion completely prohibited
 +        * provides a singular research case of maternal and abortion mortality before and after abortion prohibition
 +        * Reduction in MMR during last 5 decades correspond with improvements in education, access to clean water, decr. illiteracy rate of pregnant women, incr. maternal health facilities e.g. delivery by skilled attendants
 +        * In other words, access to legal abortion not necessary to achieve low rates of maternal deaths.
 +
 +> A [[https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0036613 | peer-reviewed study]] published last week examines 50 years of data and concludes that the trajectory of maternal mortality in [Chile] has consistently declined, decreasing from 293.7 in 1957 to 18.2 in 2007 (per 100,000 live births). That’s a decrease of 93.8%, which constitutes a major success story measured in women’s lives. Yet Chile outlawed abortion in 1989. Chile didn’t just place small restrictions on abortion — it outlawed abortion without exception, including in instances of rape or for the health of the mother. And since many neighbouring countries also restrict abortion, there’s no real reason to believe Chilean women are travelling outside Chile to get abortions. - Andrea Mrozek https://nationalpost.com/opinion/andrea-mrozek-if-abortion-saves-lives-whats-happening-in-chile 
 +
 +
 +http://www.imfcanada.org/archive/283/creative-math
 +
  
 ===== In conversation ===== ===== In conversation =====
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 ===== Misc Notes ===== ===== Misc Notes =====
 +  * FIXME https://prolifereplies.liveaction.org/medically-necessary/ good summary
   * FIXME Dan Bader Nov 2008 tutorial   * FIXME Dan Bader Nov 2008 tutorial
   * FIXME Oriyana's speaker notes for presentation https://drive.google.com/file/d/0B7F56ieEvQdpZEF0ejFEMWdhNTZ3MkdDUjFIWl90SU96bUFv/view?usp=sharing   * FIXME Oriyana's speaker notes for presentation https://drive.google.com/file/d/0B7F56ieEvQdpZEF0ejFEMWdhNTZ3MkdDUjFIWl90SU96bUFv/view?usp=sharing
 +  * FIXME Maria's [[https://docs.google.com/document/d/1uEZfENKmz0jkgnJF8lsi13rMr8dFyZAcsMAjhngY5EY/edit?usp=sharing|speaker notes]] and [[https://drive.google.com/file/d/1oiLcC4uxSKnSfGfRTwHUDe8jWrUxOBX4/view?usp=sharing|powerpoint]]
   * Reasons given for late-term abortions   * Reasons given for late-term abortions
     * CMA guideliness     * CMA guideliness
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   * FIXME Savita https://www.youtube.com/watch?v=S24yxcn379Y&list=PLrPqu4eanx6355cp8aIiAB7qpl0EmzAeA&index=26   * FIXME Savita https://www.youtube.com/watch?v=S24yxcn379Y&list=PLrPqu4eanx6355cp8aIiAB7qpl0EmzAeA&index=26
  
 +FIXME Communication/PR and legal problems for when pro-lifers say "abortion is never medically necessary"
 +ERI article: https://blog.equalrightsinstitute.com/abortion-and-medical-necessity-improving-the-pro-life-approach/
 +SPL short video summary of article: https://youtube.com/shorts/4bZqIkJ9gH4?feature=share
 +
 +FIXME both an apologetics issue AND a strategy issue re: laws
 +FIXME objection: "we need to get rid of all abortion laws because even if there are medical exemptions, providers will not intervene out of fear or confusion about the laws"
 +
 +This is like saying "we need to get rid of all sexual assault laws because sometimes healthcare providers need to perform emergency pelvic exams on unconscious patients, and if there are laws prohibiting sexual assault, they will hesitate or refrain from doing emergency pelvic exams because of fear or confusion about the laws"
 +
 +Or "if we have laws that generally prohibit sticking a knife in another person's head, then fearful/confused doctors will hesitate to perform emergency brain surgeries, so we need to get rid of all laws against head stabbing"
 +
 +FIXME missed miscarriage case in Ohio and DC: explanation of why it seems incredibly unlikely that anti abortion laws played a role in delay of care, especially since the delayed care began in a place with no abortion restrictions (Washington DC) https://youtu.be/nRZAFw3tNiM?si=MuQ58c7beJZacO2G