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60 Medicalizing Abortion Decisionshttps://www.firstthings.com/article/1996/03/003-medicalizing-abortion-decisions
Fri, 01 Mar 1996 00:00:00 -0500Moral decisions related to medical matters require the unbiased representations of competent medical authority. Information may come from the scientific literature or from individual physicians directly involved in a given case or acting as consultants. But in every case, suitable moral analysis requires a firm base of unbiased scientific data.
Despite a common perception to the contrary, the scientific domain of medicine is as subject to bias as any other domain. Indeed, much of the emphasis in clinical research in recent years has been directed toward standardizing study design to remove bias in clinical investigation. But there are certain sources of systematic bias in the medical community that influence the ability to pose moral questions fairly and have far”reaching consequences for all who come in contact with the medical establishment. One particular source of bias arises from merging the legal and political dimensions of the abortion debate into medical judgment and decision-making.
My practice and clinical research are in a subspeciality of obstetrics and gynecology, maternal fetal medicine, which concerns pregnancies complicated by maternal or fetal disease. There are few situations more daunting to those who advocate a consistent ethic of life than the circumstance in which the life of the mother is threatened by the continuation of the pregnancy. Although I do not acknowledge this conflict as justifying abortion, even the most dedicated of advocates for the life of the unborn are awed by this dilemma. Indeed, the power of this image has been one of the principal forces advancing the abortion movement in the United States and elsewhere. What do we know about it objectively?
Certain conditions that can be diagnosed in advance are associated with risk of maternal mortality greater than 20 percent: pulmonary hypertension (primary or Eisenmenger’s syndrome), Marfan’s syndrome with aortic root involvement, complicated coarctation of the aorta, and, possibly, peripartum cardiomyapthy with residual dysfunction. Taken altogether, abortions performed for these conditions make up a barely calculable fraction of the total abortions performed in the United States, but they are extremely important because they have been used to validate the idea of abortion as a whole. They stand as a sign that abortion is in some cases unavoidable”that it can be the fulfillment of the good and natural desire of the mother to live.
It should be emphasized how rare these conditions are. Our obstetric service in the Los Angeles area has been the largest in the United States for most of the last fifteen years, averaging fifteen thousand to sixteen thousand births per year. Our institution serves a catchment for all high-risk deliveries in an area with thirty thousand deliveries per year. Excluding cases that have been diagnosed late in pregnancy, we do not see more than one or two cases per year that pose this degree of risk of maternal mortality; these are exceedingly rare conditions. This rarity does not diminish the tragic dimension of such cases, but the cases are seen in perspective when their numbers are compared to the total number of abortions performed.
If we examine other conditions associated with lesser though still significant risk of maternal mortality (conditions for which abortion is often recommended), we find that in many cases the prognoses are changing, both because of a better understanding of the natural history of the disease and because of advances in therapy. Here is the paradox, however. As the actual risks to the mother diminish because of medical advances, concern about maternal and fetal risks from complications of pregnancy is still offered as a justification for many abortions. From the case histories that follow, the distorted milieu of medical practice into which most pregnant women now enter can be shown.