On birthing - part 2

I once met an obstetrician who told me “a healthy baby lives, a sick baby dies”. That was his approach to that time around the birth of a child and also to prenatal care. At the time, I was quite shocked! I thought, then what is the point of medical advances in technology, of medical research, and basically of “medicine” in general? We have studied disease, pathophysiology, human anatomy, microbiology, biotechnology, and devised all sorts of theories and methods to try to keep people alive and healthy. What’s the point of medicine if not that? Well, the obstetrician’s theory was that we may have studied too much, devised too many new things, and medicalised too many things that would (and should, apparently) be just thought of as part of human life: things like childbirth and pregnancy.

I admit that it does concern me when you consider the massive amounts of money spent in neonatal intensive care wards and the number of chronic health problems suffered by those born prematurely. Over the past few decades, the gestational age at with a child could be born safely and with the best chance of survival has drastically lowered. At one point in history, a child born 6 weeks before its due date had little chance of survival. Then someone decided that this should not just be accepted as fact and the chance of survival could be increased by some or another medical intervention. Gradually, newer and newer methods have been devised to support the survival of increasingly more premature (younger) babies. However, the issues has become one not just about supporting a premature baby to survive its first few months of life, but these babies go on to become infants, adolescents, and even adults. The earlier than anticipated a child is born, the greater his chance of dying. The medical efforts needed to keep these babies alive costs a lot of money. Then after ensuring the baby will survive into infanthood, the fact is the younger that child was born, the greater the risk that he will suffer chronic, sometimes lifelong, health problems. The management of chronic health problems of children and adults again costs a fortune. The life of a person who is prematurely-born is, therefore, very draining of resources, economically speaking.

Would it be better if we made health care decisions based solely on economics? Or would it be better if we based them based solely on “nature”, and ‘let nature take its course’ when a woman goes into labour prematurely? Why do we find it so repulsive to accept that “a healthy baby lives, a sick baby dies”? The truth is that the majority of us human beings couldn’t sleep at night if we made decisions like this. If you ask the women who have given birth to premature babies, even extremely premature ones, if the life-saving efforts to keep their children alive into adulthood were worth it (even if that life went on to be marked by chronic illness), do you know what almost all of them would say? They’d say “Yes, of course it was worth it!” And that is because you are talking about a person to whom they have a profoundly close connection, and also because it is a small “innocent” child, apparently deserving of all our best intentions, efforts, love, money, protection, etc. etc. It is also another human being, a person. You could summarise it by saying that we are humane towards other human beings; we are human. That is why we act so many times against logic, against “nature”, against economic viability, and against the greater majority’s good.

For the majority of persons, our instinct is to promote the survival of ourselves and other people; but when it comes to fetuses, there has always been a discussion into whether or when they can be considered a “person”. Now, I’m not about to go into a philosophical, theological, or bioethical discussion about abortion because frankly I think that is a discussion an individual can only have with themselves and come to their own conclusions; I only care to discuss an interesting scenario that was recently raised. Some Australian philosophers made an argument that newborn children are no different to fetuses because they do not understand or yet know what life is, let alone appreciate it. They don’t know what it is to be human, they don’t identify themselves as persons, therefore, they are not persons with the usual “standard” human rights, including a right to be alive. In theory at least, then, you could extend the arguments raised about fetal abortion to “post-natal abortions”, i.e. a newborn child being considered no different to a fetus. If is right or wrong to carry out a procedure to procure the destruction of a fetus with no known congenital defect, so it should be right or wrong to destroy a full-term newly born healthy child... Before I digress, let me just ask if a child has rights? If so, when do those rights come into effect?

Now, I wanted to discuss birthing and not actually “abortion”. Ms. Janet Fraser, whom I spoke about earlier, claims to have incorporated into the coroner’s investigation into her daughter’s death, a stance to defend “women’s rights”. Specifically, she wants acknowledgement of a right of a woman to decide the birthing method of her unborn child, independent from any right owed to the child (or potential child). That’s ok, right? Legally, a cognitively competent person has a right to make decisions over her own body and any intervention to it, medically or otherwise. That legal right overrides the fact of whether an intervention is actually good for you or not. For example, I can refuse to have any surgery being performed upon me, even if that surgery can save my life and without it I will undoubtedly and precipitously die. But not just life-saving surgery, I have a legal right to refuse any medical intervention at all… What about epidural anesthesia at the time of birthing, is it ok to refuse that? What about antenatal care? I mean, pregnancy is not illness, so why should a person be forced to see a medical person, right?.. And what about fetal monitoring? No woman in labour particularly wants to be touched by anyone else. What about wanting to deliver a child traditionally at home and not in a modern hospital, particularly if you are scared of hospitals? And what about assisted delivery, I mean that is rarely to help the woman, is it? What about refusing a caesarian section, that’s a type of surgery so why should a person not have a right to refuse that?...

Why are these questions interesting? Because we accept that a person has a right to make decisions about their own body and their healthcare, but we are also aware that the decisions of this person affect another human being (even if we don’t consider them an independent person yet). Though we are unsure whether this “person” or “potential person” is owed any rights, we have this niggling little feeling that they deserve at least a chance or some consideration in the whole argument. What is the answer? Should a hierarchy be legally set up to nominate whose rights are or whose life is more important at the time of birthing? I don't claim to know what the right answer is, but unfortunately in the world we live in, people tend to be motivated more by laws and potential for punishment (or material reward) than the things that moved us in the past. I guess we can’t expect all people to reason that they will sacrifice something, anything, to ensure the safety and health of their child as a priority to their own personal preferences.

(I will not be donating any of my money to Ms. Fraser’s ‘fight for the rights of all women’, mostly because I appreciate and encourage more people [and not just women] to consider at least in some situations, that other fellow human’s lives are at least as worthy as their lifestyle preferences.)