A Wrongful Birth?

[Cosmo]

There was a very interesting article in this week's (March 12) edition of The New York Times Magazine with the above title. The article leads off with this 'teaser':

Mothers are suing over poor prenatal care, claming that if they'd known they were going to give birth to severely disabled children, they would have terminated their pregnancies.

But, legally and morally, what does it mean to say that a child should not have existed?

The article focuses on the case study of one Donna Branca, who bled during her first trimester (a possible indication of birth defects), and, at her midterm sonogram, had a fetus that was far smaller than it should have been. Her son, A.J., was born six weeks early, was 15 inches long, weighed 2.5 pounds, and didn't cry when he came out. "One of the first things the attending doctor said to me", she says, "was, 'It's not hereditary, so you should just have another child right away.'"

At six years old, A.J. has the mental capacity of a six-month old. Despite this, the family has come to love him deeply and has sucessfully sued Donna's obstetrician for millions of dollars in damages - the claim being that her doctor's poor care deprived her of the right to abort him.

Basically, the article, despite being written by a painfully obvious pro-lifer who I feel introduced some unnecessary bias, had a number of interesting points.

One interesting aspect is that, with recent (and continuing) advances in prenatal care, we are able to detect increasing numbers of birth defects in unborn children - everything from blindness to Down's syndrome and beyond. But, despite these advances in detection, we are still completely and wholly unable to do anything to "fix" the situation other than terminating the pregnancy.

The case study about the Brancas serves, really, to provide a foundation for asking a broader question:

No regulations guide parents about fair reasons for ending a particular pregnancy.

Should it be OK to terminate a deaf child? What about a blind one? How mentally retarded is too mentally retarded?

It seems to me like these "prenatal ethics" would be the very poster child for the slippery slope fallacy. As I was reading the article, the movie Gattaca came to mind (and was, surprisingly, mentioned in the article itself later on). Is a future where 'defective' fetuses are aborted a future that we would want? I don't know. If not, how could we prevent that from happening?

How much regulation is too much? Or, as the article put it, how mentally retarded is too mentally retarded?

 

[meg]

Hi Cosmo,

I didn't see the article, but I was listening to NPR discuss the article with the author the other day. Really interesting, I agree. I don't have any answers to your questions. Just more of my own.

One question I came away from the whole radio discussion thinking was: just because there might *be* a test for a certain disease, disability, etc, does that mean that we *should* be testing for that every time? Would/should a doctor be considered negligent for not testing for it, if everything else seems to be fine?

Meg

 

[Kevin_Lowe]

If a doctor fails to run available tests or gives bad advice, leading to a parent having a damaged child, I think it's perfectly fair that the doctor have to pay the costs involved.

 

[Cosmo]

If a doctor fails to run available tests or gives bad advice, leading to a parent having a damaged child, I think it's perfectly fair that the doctor have to pay the costs involved.

What's bad advice? Depending on the doctor and the expectant mother, bad advice could be suggesting an abortion - or not suggesting an abortion.

Similarly, what's a damaged child? A child with Down's syndrome? Or one who will require reading glasses when he or she is 35?

Here's the slippery slope again. Where should the line be drawn?

 

[meg]

If a doctor is expected to run ALL possible tests on the child, regardless of how expensive they are or how rare the condition might be, what would that do to the cost of prenatal care? There are many mothers in this country now that forego most prenatal care because of the cost. Do we really want more?

What if the test procedure, for example amniocentesis, itself has a certain amount of risk involved? Should the mother then also be able to sue the doctor for damage/death of her fetus from a test for a very rare condition?

 

[meg]

Cosmo,

I guess I just really don't see the slippery slope that you write about. I don't see (most) people choosing to abort a fetus because it looks likely it might need reading glasses. I do see families feeling the need to know, though, if the child they are expecting is going to have serious, possibly life threatening and expensive problems for the entirety of its life.

I certainly don't want government regulations telling a family that they cannot abort for certain reasons. Is that what you're getting at? When you ask "where should the line be drawn?", the only response I can think of is, It's not our line to draw. That line can only be drawn by the parents of the child. It's not your or my business what burdens other parents might choose or not choose for themselves.

Meg

 

[strathmeyer]

What's bad advice? Depending on the doctor and the expectant mother, bad advice could be suggesting an abortion - or not suggesting an abortion.

Strawman; nobody's suggesting that Doctors should suggest abortions. Only that mothers should be given the information that they should expect*.

* For certain values of expect.

 

[strathmeyer]

If a doctor is expected to run ALL possible tests on the child, regardless of how expensive they are or how rare the condition might be, what would that do to the cost of prenatal care?

Strawman again; the mother here is only expecting a minimally competent* level of care.

* normal, average

 

[Cosmo]

I guess I just really don't see the slippery slope that you write about. I don't see (most) people choosing to abort a fetus because it looks likely it might need reading glasses. I do see families feeling the need to know, though, if the child they are expecting is going to have serious, possibly life threatening and expensive problems for the entirety of its life.

Well, the reading glasses suggestion was an example. I'll try to elaborate.

Most parents, I think, would choose to abort a deaf, blind child who also had Down's syndrome. A smaller amount would choose to abort a deaf or blind child, while not many parents at all would abort a child with ADD and almost none would abort for poor eyesight. The problem, according to the article, is that there are no regulations for this kind of thing.

No reasonable person, we could argue, would choose sickness over health, and we seem to have the ability to choose. It's probably somewhat likely that there will always be disabilities, but could there be fewer? And if rational people do not choose sickness over health, shouldn't there be fewer?

I guess that's more along the lines of what I'm wondering about.

I certainly don't want government regulations telling a family that they cannot abort for certain reasons. Is that what you're getting at? When you ask "where should the line be drawn?", the only response I can think of is, It's not our line to draw. That line can only be drawn by the parents of the child. It's not your or my business what burdens other parents might choose or not choose for themselves.

I suppose 'regulation' might be the wrong word, in that it seems to be more of a personal choice each parent has to make. I don't want to see the government regulate this situation either.

 

[meg]

I don't think my question was a strawman at all, strathmeyer. I think it comes down to the root of what the conversation is about. Namely, what is "minimally competent* level of care". Does that statement imply that if there's anything at all wrong with the fetus that *could* have been seen by testing, that the doctor is negligent for not testing?

 

[Cosmo]

* For certain values of expect.

What values would those be?

Suppose a new test is developed that accurately detects the chance of a fetus developing Diabetes later in life. Should it be the doctor's duty to inform the parents of this new test?

How should we determine what information expectant mothers ought to have in prenatal care?

 

[strathmeyer]

I don't think my question was a strawman at all, strathmeyer. I think it comes down to the root of what the conversation is about. Namely, what is "minimally competent* level of care". Does that statement imply that if there's anything at all wrong with the fetus that *could* have been seen by testing, that the doctor is negligent for not testing?

Hmm... I don't mean to start an unproductive back and forth troll session, but I don't feel that's what the original article is saying. Nobody is claiming that everything should be tested for, but that the expectant mother paid for something and expected something in return, and didn't get that return.

 

[meg]

Cosmo wrote:

How should we determine what information expectant mothers ought to have in prenatal care?

That's a good question. I would add to it, - and when should she get it?

The NPR discussion included an interview with a woman that had been pregnant and everything was going along fine, but when she went in for her 5 month sonogram, they found some very serious problems with the fetus. It took some weeks to finally get a diagnosis that she had been exposed to a virus that had been carried to the fetus. While, of course, no doctor could say anything with complete certainty, what they told her was that the child, if it lived, would likely be severely mentally retarded, blind, deaf, and have other serious health problems, too. This family agonized, but eventually decided to abort.

One of the things I kept thinking about after that was: What if the sonogram had happened just a couple weeks later? Third trimester abortions are banned in most (all?) states. If they had been forbidden to get an abortion, would there be a legal case there that the state should pick up the tab for this child?

Meg

 

[Beth]

One interesting aspect is that, with recent (and continuing) advances in prenatal care, we are able to detect increasing numbers of birth defects in unborn children - everything from blindness to Down's syndrome and beyond. But, despite these advances in detection, we are still completely and wholly unable to do anything to "fix" the situation other than terminating the pregnancy.

That's not quite true. Some problems that are detected can be, well if not fixed, at least mitigated. In utero surgery has been done on occasion. My recollection from my last pregnancy was that amnio could identify spinial bifida which would allow the doctors to alter their birthing procedure in order to keep the child from suffering further damage during birth. Still, for many problems all we can do is detect and inform parents. Then it's their decision what they want to do about the situation.

The question I find intersting is what if your family had a debilitating fatal genetic disease that didn't strike until midlife. Would you abort a child destined to have such a disease?

 

[TimmyBerry]

No. But if a child can't develop properly for the first, say , 10 years of h/er life, I'd think it would be reasonable to abort them. (Enough people in the world as it is.)