In a debate on the floor of the Georgia State house over a bill to force women to bring all pregnancies after 20 weeks to term, even in cases of dead or non-viable fetus, this Georgia representative reaches a new low. State Rep Terry England seems to be suggesting pigs and cows do it, why can't humans?
Aside from this genius on-the-farm reasoning of Mr England, the failures of reasoning and misrepresentations of scientific knowledge engaged in to pursue this legislation are many.
The legislation is justified ostensibly because of the ability of the fetus to feel pain after 20 weeks, but there is no data or a legitimate scientific basis for this claim. Our knowledge of neurological development would suggest that conscious perception of pain may not be possible for a fetus at any point and the neural framework for transmission of pain is not even mature before 29-34 weeks.
Second is the issue that concern for the pain for a nonviable or dead fetus should not outweigh medical risk to the mother. The American College of Obstetricians and Gynecologists recommend dilation and extraction or induction of labor once the diagnosis of stillbirth has been made. The risks of carrying a non-viable fetus are the higher complication rate of delivery versus dilation and extraction, as well as a very high risk to the mother of complications like disseminated intravascular coagulation (DIC) if the amniotic sac is ruptured and she is exposed to the dying tissue. For stillbirth or nonviable pregnancies, dilation and extraction is far safer and more effective with 24% of patients undergoing labor experiencing complications compared to 3% for D&E.
It has been under-reported that since the 2010 election, the rate of anti-contraception, anti-abortion, and frankly anti-woman legislation has shot through the roof. In 2011 state legislatures have enacted a record number of laws restricting reproductive rights:
In the 50 states combined, legislators introduced more than 1,100 reproductive health and rights-related provisions, a sharp increase from the 950 introduced in 2010. By year's end, 135 of these provisions had been enacted in 36 states, an increase from the 89 enacted in 2010 and the 77 enacted in 2009.
These include everything from preventing physicians from using telemedicine to prescribe medication to requiring ultrasounds prior to abortion despite the fact no association of OB/Gyns supports universal ultrasound prior to abortion. In an effort to legislate their control of women's reproductive systems, they are interfering more and more with the physician-patient relationship. It has become so extreme that in 11 states they have legislation requiring physicians to perform unnecessary invasive procedures, basically forcing physicians to engage in unethical medical practices. There is no legitimate medical reason for these measures. These exist to shame women, and increase the expense and difficulty of constitutionally-protected medical procedures and medical decisions like birth control and abortion.
These efforts to ban abortion after 20 weeks, which have succeeded in several states including Nebraska, Idaho, Indiana, Kansas, Oklahoma,Alabama and Utah, are a highly intrusive attack on women's reproductive freedom. It is once again, an attempt to insert politics in the doctor-patient relationship. Finally it is medically unethical, dangerous, and morally bankrupt to expose women to greater risk by preventing them from having the option of safe termination of pregnancy all for the sake of a dead fetus.
Oh good lord....
I know a woman personally who had a baby die in utero. She lives in a state where abortion is technically legal, but the local culture has never been friendly to it even in cases of rape or incest or maternal risk. Over thiry years ago, her second pregnancy went badly. The baby stopped moving, and it was soon established that the baby was deceased. Labor had not started, but the doctors advised her to wait for it to happen. It didn't. Months later, now long past due, she developed an infection. It still took a while to find a doctor willing to perform D&X on her. It not only saved her life, but it enabled her to have her second child a little later.
To think that today, in the 21st century, women with deceased fetuses might still face challenges getting them removed because of idiots who think that preserving *death* is somehow pro-life, is quite depressing.
Maybe we need a Constitionual admendment that would bar any legislature from making laws that interfer with medical best practices. Or, maybe, just not brain-dead lawmakers.
I have a young friend who is the survivor of a pair of twins. Her sister died at 28 weeks, and she was born the next day. Would being kept in the womb with a dead sibling have risked killing her?
This shows two aspects of the issue, on opposite sides:
- they are risking killing or injuring mother and siblings,
- but a baby born at 28 weeks became a healthy young lady - post 24 week abortions can kill babies that would have survived. Post 32 week ones might have survived with minimal intervention.
Most of the anti-abortion legislators distort the second point, implying such abortions are routine. In Australia, post 20 week abortions are rare, and usually because of a dead or non-viable baby ; sometimes because the child will be disabled (which is another ethical issue).
Davidp, yes a dead twin does increase the risk of intrauterine injury to the sibling including intrauterine growth deficiency, premature labor, hypoxia and infection.
"Or, maybe, just not brain-dead lawmakers."
Or make them actually brain dead.
As a farmer, with livestock, I have to object to the phrase "genius on-the-farm". England is either a congenital idiot, or has never dealt with livestock, or should be taken out and shot for animal cruelty. Nobody who has even the slightest clue risks a toxic uterus, in any species. While I find England's proposed legislation revolting, for ethical and medical reasons, and find England himself revolting for his total failure to understand that women are fellow humans, leading off your article with such a phrase isn't going to win you any friends either. I certainly won't let an unfortunate phrase in one news article prevent me from calling up England's office and letting him know that I wouldn't have a turd like him in my compost pile, and it is admittedly a picky point and just one phrase, but there's a number of individual words that, on their own, are inflammatory, and should be avoided. Cf. Rush Limbaugh.
I guess I missed something here. Women have to carry a dead fetus to term because dead fetuses feel pain?
Andrew, that was not the intent of that sentence. I could see how it could be read that way, and I'm sorry. I was sarcastically referring to his "genius" in saying that on the farm this happens, therefore it's natural, or women should expect the same. It wasn't to denigrate farmers. Two generations ago my grandfather grew up on a farm in Virginia, it wasn't my intent to insult my family or you.
You are also correct to point out this wasn't even a good approximation of standards of animal husbandry. Frankly, anyone who's ever read All Creatures Great and Small knows that vets will sacrifice a calf for the sake of the cow, even removing it in pieces if a trapped animal has caused an irreversible arrest in labor. Even in our care for animals the mother's welfare has priority. It's pathetic he's used his defective knowledge of farming and his association with cock-fighting to justify a medically dangerous piece of legislation that lower the care of human women to a lower standard than that we apply to livestock.
You seem to think that abortion is a perfectly normal "scientific and medical proceedure." It may seem stupid to "force women....." and it does sound pretty dumb if you ask me. The problem is that this is muddying the water about the issue of when we are allowed to "terminate" a pregnency.
The problem is that "science" seems to have a moral bias, and morals are never an issue of science, except maybe social engineering. If we as a people have legislators that are willing to protect the rights of small people I think that is wonderful.... oh, no!!!! I must be a right-wing freak that is completely brain dead! surely?!
ok so you have no scientific evidence that babies of 20months or any age for that matter can or cannot feel pain. I say who cares whether they can feel you killing them or not. The issue is "are they a person" and are they guaranteed any rights? If you sincerely believe that this is an unfeeling blob of human "material" that can be harvested for "science"... I can allow that because at least you've reasoned throught. Can you honestly say that you have searched the depths of this ethical issue?
I used to be all for women's rights. This is an evil world right? Why bring an unwanted child into the world right? .. I understand, but common we can't just do whatever we want to who ever we want. There have been plenty of "undesirable" humans.
How about we check out what Margaret Sanger the founder of Planned Parenthood said:
or How about we check out a survivor of an abortion.. what does she have to say?
ok.. so who knows if babies of 20 months feel pain, I could care less. It it a person or is it not? ok.. u got me, but check out a baby who in 2007 was born only after 23 months of gestation.
This is my plea to your supposedly rational thinking. Here is my rational thinking. You must proved logically and compassionately that you care about women's rights and their unborn child/fetus, if you can without balling up in anger... you will have earned my respect.
This post is not about abortion in general. The ethics of women's rights versus unborn fetus' rights is a different issue. This blog post is about the termination of a pregnancy that will end up with a dead baby anyway (or removal of a fetus that is already dead anyway).
I used to be pretend to be all for women's rights.
Fixed that one for ya, bud.
Nathaniel - "It it a person or is it not?"
No, not in the cases being talked about here. Deceased foetus, anencephaly, renal agenesis are all non-viable pregnancies. No person will ever exist, it's simply either there is no life, or there is incompatability with life. It's lunacy to place artificial restrictions which limit medical staff and their patients from making reasonable decisions about care in situations like this. One of these being the option of terminating the already doomed pregnancy and trying again for a healthy one. It's clear what the compassionate thing is to do here, and it's not to legislate but allow people choices. Also, I'm trying to figure out what happens here if a women develops a condition like HELLP after 20 and up to 24 weeks where their foetus isn't likely going to survive, is the doctor compelled to watch both mother and foetus die? Because that is what will happen, the treatment is basically ending the pregnancy. I suspect what will happen is that doctors will have to resort to some sort of artifice to try and do what is medically appropriate.
I'm not from the US, but what I'd consider beyond this is that up until the foetus can be born *and* support it's own breathing and heartbeat it's non-viable, not going to be a person once born. Most terminations happen before 12 weeks, and so do most miscarriages. Both at this stage involve foetuses that are way, way away from being able to be considered viable, living persons. Not enough neurological development that you can talk about pain, that's not going to happen until much later in the third trimester. We have the concept of the 'age of viability' at 24 weeks (or sometimes earlier, if a medical decision can be justified) whereby once born the foetus can be expected to survive. If born after this stage, they accrue rights as persons, such as birth/death certification. This is only a general limitation, as if the pregnancy is non-viable i.e. there is intra-uterine death, fatal anomalies detected late or the health of the mother is at risk and the foetus cannot be saved even after this point, it's still an option to terminate. It's the already living person that has the rights over their body and can make choices with their health care provider, not just about pregnancy, but for all of their health care. That already living person cannot have their rights ended because their body is in any particular state, nor can or should their rights be diminished for a not as yet even viable pregnancy, or one clearly not viable at all.
That's the sensible thing to do, as any other option has an array of damaging effects - yet in the US at present there are moves like this. I'm very surprised there doesn't seem to be a considerable medical backlash to this interference in the doctor-patient therapeutic relationship.
You are also correct to point out this wasn't even a good approximation of standards of animal husbandry. Frankly, anyone who's ever read All Creatures Great and Small knows that vets will sacrifice a calf for the sake of the cow, even removing it in pieces if a trapped animal has caused an irreversible arrest in labor.
I had a biology teacher who used to be a dairy farmer. (He grew up on a family farm, but left to teach, and because his older brother was going to take over the farm.) He had a very interesting anecdote that he used to explain the pubic symphysis and how important it is, structurally speaking, but which also ended up being a potent lesson in ethics.
Back when he was still on the farm, one of the cows was pregnant. Well, actually most of them were, but this one had a problem. She had broken her pelvis, separating the pubic symphysis. It was terrible. Ordinarily, the correct course of action at this point is to euthanize the animal. Even in humans, this is a horrible injury to recover from, and you cannot ask an animal to endure that pain -- especially not a large quadriped, as extended convalesnce can quickly become fatal. But with the arrogance of youth, he felt he could save the calf. He rigged a harness to support the cow in something like a standing posture, with her fractured pelvis, with the idea of keeping her alive long enough to deliver the calf by c-section. It almost worked, but the calf was stillborn anyway, and it had required very intensive care of the mother during this time. Depsite his feeding her, she lost a great deal of weight due, probably because of the severe pain and her immobility, and he had to face the fact that he had made this cow suffer horribly for nothing. He never tried anything like that again, and because he told us that story, he made sure none of us would either. Sometimes the life of the baby really isn't worth what you have to do to the mother.
ok so you have no scientific evidence that babies of 20months or any age for that matter can or cannot feel pain. I say who cares whether they can feel you killing them or not.
Well, I care, and I think you should too. It matters a great deal, because we're talking about LIFE, not some precious jewel that you can put on a shelf to admire. When a baby is alive but has no brain, what is the value in making the mother go through labor? Labor is usually quite painful (there are rare exceptions), and it is risky even with modern medical care. Dilation & extraction has less risk to the mother; if the baby cannot live outside the womb, there is no point asking more of the mother. If she feels, emotionally, that she cannot grieve properly for this child without bringing it to term, fine. That's a good reason to keep the pregnancy. But because someone feels that an anencephalic's life is more important than the mother's pain? No.
And then there's the question of methods. If a woman develops eclampsia at 20 weeks pregnant, and blood tests show that the baby's lungs are not adequately matured to survive outside the womb despite administration of cortisone, and the mother is no longer responding to blood pressure medication (which tends to not work very well in eclampsia anyway), what do you do? You can attempt to deliver the baby, which puts mother through great risk (eclampsia makes labor much more dangerous), and which has at this point a pretty good chance of ensuring the baby dies a prolonged and painful death as it struggles and fails to breathe. Or you can have D&C (dilation and curretage) performed, which is the only method of late-term abortion available in places which have banned D&X (the so-called partial birth abortion); in this, the alive and probably conscious baby is cut into pieces small enough to pass out of the partially dilated cervix, and removed in chunks. It's hard to imagine this not being painful, unless enough of the general anesthesic manages to cross the placenta and knocks the baby out. Or you can do D&X, where the baby's skull is punctured first and the contents suctioned out. In addition to being safer for the mother (since it doesn't involve the repeated introduction of sharp objects into the confines of the uterus), this kills the baby much more swiftly. If it must be done, surely you would want it to be as humane as possible under the circumstances.
Or perhaps not; you have said you don't care if the baby feels pain.
I listed three options for the woman facing late-term pregnancy. One of them was to attempt birth. In addition to being riskier for the mother, I am not convinced we as a society are doing a good job of appreciating what we are asking of the *baby*. Life in a NICU is not pleasant. The nurses do a spectacular job under what have to be stressful circumstances, since most of these ultra preemies will die and it is always hard to lose a patient. But some things cannot be avoided. Many of these babies are too small for even the smallest cannulas and blood pressure cuffs and endotracheal tubes, which means staff end up making do with larger equipment that cannot help but be even more uncomfortable. All will require multiple blood tests, often several per day; that's a lot of times to get your skin punctured, and these babies don't have the body fat or musculature of a full-term baby; there isn't much between the skin and the bone, which means they're going to get their bones poked by the lancet, sooner or later, and that *hurts*. They'll have electrodes glued to them, and then peeled off later for baths, which has got to hurt that delicate, delicate skin. No matter how gentle the staff are, this is going to be painful. The only blessing is that if the baby survives to adulthood, he or she will not remember it. It is worth it if the baby survives and is reasonably healthy; but is it worth asking this of a baby who will not survive? Are months of agony better than a swift death? There are no clear answers; nobody can predict with 100% assurance which babies will live and which will die. But I think we need to be better about remembering this when we make the decisions. I know someone who was advised to terminate one of her babies; she was carrying triplets, and one was much smaller, with evidence of kidney troubles. She decided to stick it out; she ended up carrying them 38 weeks, which is pretty damn impressive for triplets, and although that small one did require several surgeries to sort out his plumbing, he's healthy now. She took the gamble, and won! I also know someone who declined "pregnancy reduction" for a pregnancy involving higher-order multiples. In the end, all but one died, and most of them lingered for a few months. The survivor was not well at all. I've lost touch with that family, so I don't know how things are going now. But clearly they did not win the gamble. This is why I feel very strongly that it should be up to the *parents* to decide, with as much medical advice as is practical so they can gauge what is more important to them, and what risks they are willing to shoulder.
As far as is it a person or is it not . . . that probably depends on who you're asking. All the women I've known who had miscarriages (and who told me about it; I'm sure more have had miscarriages than I know) regarded the babies as people. They mourned the loss. I know someone who had an abortion so she could get treatment for her cancer; she also regarded that child as a person, and mourned the baby's loss. But she was able to comfort herself with the knowledge that because that one died, she could have more children who would not otherwise exist. There was a good chance that child would've died anyway; the doctors didn't give her very good odds for completing the pregnancy successfully. I tend to think that "yes" it's a person. To me, that doesn't really answer the question of whether or not an abortion is appropriate, though. It can help with understanding the stakes involved, but that's about the extent of it.
I suspect Nathaniel didn't even read the article as it was, of course, not about elective abortion. It was about intervening for the benefit of the mother in the case of a non-viable fetus. And for the record, the mother's life and safety are always primary in my mind.
As far as when we should define someone as being a "person" that is something I've thought about and my answer is "I don't know". Part of it is because there is debate about what personhood is. My definition of a person includes attributes such as self-awareness, agency, and consciousness. Therefore to me, an embryo is not a person and a fetus without a mature neurological system can not be a person. Certainly, a dead fetus or fetus without a brain is not a person.
A person is not just a beating heart. And I say that as someone who has harvested organs from humans who were still "living" in that their heart was still beating, but their brain was dead. The person was gone, and the families then made the exceptional decision to save other living people with the donor's organs. It's hard to accept notions of personhood being any living human, regardless of mental capacity, when we are practiced in taking kidneys or a liver out of a brain dead person who still is breathing with a beating heart. Personhood is more than just life, it requires consciousness, and agency. It needs a brain. Newborns might have those things. The exact moment they acquire those features? Who knows, but not likely before 32-34 weeks when the neural connections are still maturing, a process that continues for quite a while after birth.
Finally, this is all irrelevant to the discussion which is about the primacy of the health and safety of the mother. Which, no matter what the personhood status of the fetus, must always come first.
I dunno; I think someone without a pulse can be a person. Just look at Dick Cheney. (Zing!) Seriously, though, I think a lot of people regard others as people even after death. All human societies have death rituals, some extremely elaborate, and most revolve around the disposition of the deceased's mortal remains. And although some societies have required the living to harm or even kill themselves when a loved one dies (c.f suttee), our culture tends to call this barbaric.
Which is why I don't like arguments about whether or not the fetus is a person -- it's not really relevant. I think it's just semantics; the actual facts of the situation are the same no matter what you decide to call the baby, and romanticizing any part of it isn't going to help.
"All human societies have death rituals, some extremely elaborate, and most revolve around the disposition of the deceased's mortal remains"
Mostly because we're alive at that point, and don't want people desecrating OUR dead bodies.
No, it's more than that, Wow. We don't attend funerals because we're afraid of someone pissing on our own graves later, or at least most of us don't. Death rituals have to do with grieving, not merely a morbid focus on one's own mortality, although that's inevitably going to come to people's minds. If it's someone you don't know very well, sure; you attend because it's what's done, and if you do it for them, then maybe people will do it for you. Or because you know the bereaved and wish to comfort them. But if it's someone you loved, then you go because you are in pain and you miss them already and are trying to come to grips with that. It's a time of transition, and the rituals help to ease that. In my opinion, that is the main value of rituals -- to help tag events in our minds so that we can transition.
My baby girl died at 36 weeks. They induced labor on me, and this would now be against the law? What the hell?
The last time I was pregnant I noticed the fetus moved, but a few weeks later, it quit moving. I was sure the baby was not alive any more. The doctor did not do anything about it and told me just to wait, and my body would dispose of it by itself. He told me the baby would not be bigger than a golf ball and I should just drop it in the toilet. In the sixth month I started to go into labor, and aborted the fetus, which was a complete little body, and attached to her hand was the naval cord. She fit in a shoe box. We buried her in the back yard under the apple tree. To this day I wonder if the little skeleton will ever be found and people would think we murdered the child.
At no point in his ramblings did he even say WHY this is a good idea.