A short while ago, a friend posted a list of “emotional doctor
stories in one tweet” on social media. (You can see them all at https://www.boredpanda.com/emotional-doctor-work-stories-shareastoryinonetweet-twitter/).
They are heartwarming, tear-jerking, and superb summaries of the unique joys
and difficulties those in the medical profession face. Here are a couple of
examples:
“Delivered a 450g baby.
Told she was too small- had no chance. She kept stopping breathing so stayed up
with her for 2 nights rubbing her chest for every breath. Consultant said I was
wasting my time.
She just performed her
first ballet as a healthy 6y.o.”
And another:
“You were hit by a car
right in front of me while walking your dog
I ran to you, did CPR,
didn’t think you’d live
I was burned out,
empty, ready to quit med
6 mo later, you called
me on Christmas Eve & told me I saved you
And you ended up
saving me.”
And one more because it’s too good to leave out:
“You came into ICU
with a dissecting AAA at age 19. We coded you for hours. MD told family you had
passed, not knowing we just got a rhythm. They came to say goodbye and I had
you give them the thumbs up. You graduated college 4 years later. “
It’s tremendous testimony to the hard work and dedication,
and emotional pressure and difficulty, that medics face in their working lives.
And yet, in the midst of all the inspiration and human
stories, there are a couple that jarred me. Here they are:
“While in Kenya, a
woman came in septic & haemorrhaging from an unsafe abortion.
Performed a
hysterectomy, gave blood, antibiotics, and she died anyway. She was a 24yo
college student. Abortion bans don’t limit abortion. They just make them unsafe.”
And this:
“Raised with first
world privilege- catholic & anti-choice by default. Then in Africa I met a
14 year old child pregnant as a result of gang rape. She was in obstructed
labour & died on arrival. No one came to collect her body. I think of her
daily.”
Why are these jarring? Because I see little difference
between a baby about to be born and a baby who has just been born; human life
does not begin at birth but a long time beforehand (for more discussion, see this
blog post). Why do medics who are dedicated to saving lives work so hard to
save newly born babies and yet support the killing of babies before they are born?
Medics and Abortion
I can think of four reasons why being a medic might lead to
greater support for abortion:
1/ Medics treat the patient in front of them. Their focus is
on fixing an immediate problem. Long term care issues are typically handled by
social services, elderly care homes or similar groups.
This would explain why medics might discriminate (consciously
or otherwise) between babies who have been born and those who haven’t. When a
baby has been born it is a patient in its own right and medics automatically
give such babies the full benefits of medical treatment or go above and beyond
the call of duty (as in the first tweet above). When the baby has not been born,
it is the mother who is present in front of the medic. The temptation to focus
on the mother’s health first and the unborn baby’s second must be considerable.
2/ Medics are trained to intervene. They must find it
incredibly hard to see a difficult situation and not to carry out a medical
procedure that might save a life… even if, as with abortion, it does so by
taking a life.
3/ Medics want those who are unwell to have the best care
possible, which increases their opposition to unsafe abortions.
4/ Medicine is an emergency service, so they get to see
first hand the results of the dark side of pregnancy: miscarriages, under-developed
children trying to give birth, stillbirths, unsafe abortions. It’s hardly surprising
some seek ways to reduce that pain for mothers and for themselves.
Are there any responses to such beliefs? I believe there are:
·
Pregnancy is indeed a dangerous medical condition.
Even today, it kills roughly 3% of mothers in the poorest countries of the
world, and an average of 0.21% worldwide. Thankfully that figure is 44% lower
than it was in 1990. It also causes ill health for a number of months to many
more mothers.
Those figures are comparable with deaths from illegal drug use. Estimated
figures suggest 200 million illegal drug users in the world and about 250,000
deaths annually. Compare that with 130 million babies born worldwide each year
(and therefore around 125 million pregnant women, allowing for multiple births)
and about 300,000 deaths of mothers. Illegal drug use has other negative effects
on health, too.
The big difference is that pregnancy is seen as valuable to society while
drug use is not. So as a society, we accept the health risks of pregnancy –
while doing out utmost to minimise them -- in order to achieve the greater goal
of having children.
Medics suffer because they are an emergency service for problem
pregnancies. I don’t see that as a good reason to end a pregnancy through
abortion, because society accepts the risks involved in pregnancy for good
reason. And for the record, abortion is not a risk-free procedure: depending who
you believe, between 25,000 and 75.000 women per year worldwide die as a result
of having an abortion. Again, the majority of these are in developing countries
but not all of them are.
·
Pregnancy is almost unique amongst medical
conditions in that two lives are affected by any treatment the mother receives
rather than one. It’s disingenuous to claim that saving the life of a pregnant
woman saves two lives, but that abortion does not end one life.
That’s why the “treat what is in front of you” and “trained to intervene”
mentalities are a problem in this case. In the vast majority of medicine it
works well, but not in the case of pregnancy.
Hard Cases
There is a saying that “hard cases make bad law”. The examples quoted in
the tweets above are definitely hard cases. However, they are also real
examples of agonies faced by real women. What can be said about the difficult
issues expressed in these tweets?
Pregnancy through rape
Rape is viewed as a serious crime and rightly so. It violates a woman at
many levels. So if she becomes pregnant even those who oppose abortion will
sometimes allow an exception for such pregnancies.
The trouble is, the rape was not the baby’s fault. If we allow abortion
in cases of rape then we are killing a person who wasn’t even there at the time
of the crime! But if we disallow it, we force a woman to change her life dramatically
for a year at least and perhaps longer… though I must add, some women have
raised and loved their child of rape and while they hate the cause, they are actually
grateful for the effect.
I’m going to try to be dispassionate. If we weigh a human life against a
year of serious disruption to a woman’s life then I would vote to save the
human life. However, I’d also expect society to supply considerable resources
to the woman – care, compensation, whatever – in return for bearing a child she
may not want and enduring the consequences of that.
Unsafe abortions
One of the tweets above said, “Abortion bans don’t limit abortion. They
just make them unsafe.” To add to this, a friend who recently discussed a
country that has an abortion ban said, “The legislation doesn’t work” – because
women there can easily travel to neighbouring countries to get abortions.
Both these statements disagree
with statistics. This
blog says, “What we see in all of
the countries where
actual data exists is a dramatic
increase in abortion frequency in the years immediately following its
legalization. We also see that even minor restrictions to the circumstances
under which abortion is permissible can significantly reduce the rate of
abortion. Waiting periods, mandated counselling sessions, parental notification
laws—all of these requirements reduce a woman's likelihood of going through
with an abortion.”
Let’s make the comparison with illegal
drugs again. There are regular calls to legalise the taking of some drugs and
one reason often given is that “bans don’t work”. What the speakers mean is that in
their experience, illegal drugs are easily available. But just because people
defy the law it doesn’t make it a bad law. And I’m sure plenty of people stay
off drugs (or hard drugs) because of fear of legal consequences—that’s how all
legislation works.
Let’s be honest. If a country
that permits abortion introduces a ban, will that increase the number of illegal
abortions? Yes. Will those abortions be unsafe? Some will. Will it reduce the total
number of abortions? Yes, probably dramatically.
So, should we allow the killing
of unborn babies to save mothers from the risk of unsafe abortions? Again,
being entirely dispassionate, the answer would be No because of sheer numbers:
the number of abortions worldwide is (depending who you believe) between 4
million and 40 million per year, against maybe 50,000 who currently die in unsafe
abortions. That’s somewhere between 80
and 800 babies for every 1 mother.
Of course, it’s a tremendously
difficult subject to be dispassionate about. I am writing this the day after
the referendum on abortion in the Republic of Ireland. I shall finish with a
quote I heard during that campaign which is emotive, but so is this whole
subject:
“Would you still be pro-choice if
you were the one chosen?”
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