Tuesday, December 1, 2009

Clarifications on "early inductions"

A few days ago, I wrote a post regarding the unethical practice of "early inductions".  I would like to clarify something.  I will also add this new information to the original post.

There exist some rare conditions where it may be necessary to remove the membranes that surround the unborn baby because these membranes have become diseased and could result in the death of the mother (and, of course, of the baby).  For example: 
  • Chorioamnionitis is an inflammation of the amnion and chorion membranes that surround the baby due to a bacterial infection.  The amniotic fluid typically gets infected too. If left untreated, both the mother and baby could die.  Apparently, antibiotics are not sufficient to fix the problem.  As a result, it is necessary to take out those membranes and the amniotic fluid from the mother.  Of course, since the baby is inside those fluids, the baby comes out at the same time.
  • Pre-eclampsia is a dangerous condition that  leads to high blood pressure, high protein levels in the blood and seizures in the most severe cases (this is not an exhaustive list of symptoms).  This condition is potentially fatal for the mother and baby.  While the cause is not known, some theorize that it may be due to problems with the placenta.  Medication can be used to treat the moderate cases, but the most severe cases appear to be resolved only by removal of the placenta, which takes the baby out.
I've chosen my words carefully because I'm making a direct reference to the principle of double-effect. In these two cases, you will notice that it's not the baby that is killing the mother. It's the "stuff" that surrounds the baby
(amnion, chorion, amniotic fluid, placenta, etc.) that is causing harm. Removing a diseased part of the body is an acceptable thing to do. For example, you may have your tonsils or your appendix removed if they become sick. In the case of the "stuff" surrounding the baby, the unintended side-effect is the removal of the baby from the womb.

Because of this distinction, I think it would be ill-advised to call these particular procedures "early inductions" because that term gives the impression that the baby is the problem and that direct action is taken against the baby to solve the problem. If you look at it from the perspective of taking out the "stuff", then you understand the morally licit nature of the intervention. Is this just a question of semantics? I don't think so. The principle of double-effect REQUIRES the physicians to approach the treatment as a removal of diseased "stuff" and not a removal of a baby. Just like the treatment of an ectopic pregnancy is the removal of a diseased fallopian tube, not the removal of a baby.

So is St. Joseph's off the hook? I don't think so. First, we have real evidence of women being asked or pressured to have an "early induction" in the absence of life-threatening complications for the mother. See my original post for three examples. Second, and more importantly, even if the mother's health is really in danger AND that removing the "stuff" would solve the problem, the only morally acceptable approach would be for the physicians to take every necessary means to save the baby by giving it specialized care in an incubator. That's not the practice at St. Joseph's. They just let the baby die.

By someone could argue: all that specialized care is simply "extraordinary" and "burdensome" treatment, which a patient has the right to refuse in order to allow nature to take its course and for a natural death to ensue.
Catholic teaching does contain provisions for refusing extraordinary treatments.  BUT in the case where a baby is delivered as a result of the removal of diseased "stuff", remember that the life-threatening condition of the baby was inflicted by the physicians through premature delivery. That's not a death by natural causes. You can't put the baby in critical condition and then wash your hands of the situation by invoking "extraordinary means" of treatment. If you inflicted the condition, you're responsible to do everything you can to fix it.