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PBA203Y: Medical Dilemmas
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 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
- But that doesn't mean we do nothing
- Stephanie Gray analogy: we're driving and trying to get safely to our destination. One route involves driving over and killing an innocent person, so that particular route is blocked off to us – but there are other routes that get us to the same destination, may just be longer/more complicated
Is Abortion Ever Medically Necessary?
What do abortionists say?
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.”
Double-Effect Reasoning & Examples
http://www.unmaskingchoice.ca/training/classroom/circumstances/danger
Performing an act with 2 morally significant effects is justified if 1) the evil effect is not intended as a means or an end, and 2) there is a proportionately serious reason for allowing the evil effect. 1)
Or, to put it differently, 4 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
Summary of Interventions
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)2):
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
-
- Methotrexate stops the growth of rapidly dividing cells, including embryonic cells, and thereby kills the embryo
- Unethical: intentionally targeting + killing baby
- salpingectomy vs. salpingotomy
- Salpingectomy refers to the surgical removal of a Fallopian tube.
- Ethical because intention is to target pathology, not baby (could hypothetically add a step to save baby, in future, e.g. with an artificial womb)
- Salpingectomy is different from and predates both salpingostomy and salpingotomy. The latter two terms are often used interchangeably and refer to creating an opening into the tube (e.g. to remove an ectopic pregnancy), but the tube itself is not removed
- Salpingotomy/ostomy: Unethical: directly and intentionally killing the baby
“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.
(Uterine) Cancer
- chemotherapy
Preeclampsia
- A disorder of pregnancy characterized by the onset of high blood pressure and often a significant amount of protein in the urine.
- The condition begins after 20 weeks of pregnancy.
- In severe disease there may be red blood cell breakdown, a low blood platelet count, impaired liver function, kidney dysfunction, swelling, shortness of breath due to fluid in the lungs, or visual disturbances.
- Pre-eclampsia increases the risk of poor outcomes for both the mother and the baby.
- If left untreated, it may result in seizures at which point it is known as eclampsia.
ex. Sybil in Downton Abbey
- Close monitoring is 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)
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 conversation
- Define abortion - direct and intentional killing of preborn child
- Confirm whether person is pro-life in other cases. Do they acknowledge presence, rights of both humans? (HRA etc.)
- Remember heart apologetics – person may have personal connxn – ask if they had a particular medical scenario in mind
- Oriyana's testimony, based off Dr Levatino:
- “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?”
- “Even if abortion was morally neutral, which procedure would you pick?”
- 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?”
- Stephanie Gray: “What medical condition in the woman's body will be fixed by attacking the baby's body?” 3)
- 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.”
testimony videos
Nina's testimony – Dublin Decl'n, Levatino
https://www.facebook.com/217971845050/videos/913740249023182/ – intention, drowning analogy
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