Curious about oppinions on this third trimester abortion situation from a med student

[Larry]

Deleted post.

[Hubbs]

That was a GREAT post.

It... was?

Seeing as the OP wasn't trying to make a "convoluted scenario" apply to all situations, I'm struggling to see why that was a great post.

[Larry]

It... was?

Seeing as the OP wasn't trying to make a "convoluted scenario" apply to all situations, I'm struggling to see why that was a great post.

Because attacking the scenario is preferrable to responding to it?

(Says a guy who hasn't voted in the poll, because he's a coward, and it's a tough issue.)

[HailGreen28]

Because attacking the scenario is preferrable to responding to it?

(Says a guy who hasn't voted in the poll, because he's a coward, and it's a tough issue.)

OK. Let's have a scenario where if you vote for an abortion, you just killed Albert Einstein. Tough issue, huh?

Do you two get it now?

As Larry hinted he understands earlier, one size does not fit all, for either a total ban on abortion, or allowing abortion as an unconditional "right" either. But based on his posts here, I'm not assuming that.

But please don't let me interrupt your.... debate on this.

[Larry]

OK. Let's have a scenario where if you vote for an abortion, you just killed Albert Einstein. Tough issue, huh?

Do you two get it now?

As Larry hinted he understands earlier, one size does not fit all, for either a total ban on abortion, or allowing abortion as an unconditional "right" either. But based on his posts here, I'm not assuming that.

But please don't let me interrupt your.... debate on this.

However, observing, here:

1) There are no real-world scenarios in which the Mother knows that her fetus is Albert Einstein. There

are

real-world scenarios in which she knows that her fetus will die at birth. Or will be permanently defective. (Which yes, I know, can cover a lot of gray area.)

2) There's only one side in this debate who's position is to mandate a single decision for all, regardless of circumstances.

There is no side demanding that all 8 month old fetuses be killed, regardless of circumstances. There is one side demanding that all of them be carried, regardless of circumstances. (Or at least, one side that keeps passing legislation that says that.)

(However, yes, I also recognize that a scenario like this, while I assume that it's happened at least once, I doubt that it's the typical case.

[Larry]

FWIW,

Yes, I believe that in the scenario described, abortion should be an option.

Which then raises the question of who's decision it is.

I hope that the decision would be made after careful deliberations, involving the Doctor, the Father, the Mother, and likely a lot of relatives and other counselors. That said, I think the decision is the Mother's to make. (I don't think she should make it alone. But I think that if, say, her and the Father disagree, then her vote counts more.)

Which then leads to the question of "How to you write legislation that would allow abortion in this case, but not simply in the case of somebody's whim or convenience?"

And I've got to admit. I can't do it.

[Destino]

How convoluted do you have to make a scenario, to justify general cases of abortion? :doh:

You know, real life is rarely the black and white scenario political hacks want it to be. Real life is almost always far more complicated.

[twa]

Would it be unreasonable to have a medical review board review the facts?

We have them here before medical personnel can remove life support,and since these type cases are the exception,it should be no great burden or expense.

[HailGreen28]

However, observing, here:

1) There are no real-world scenarios in which the Mother knows that her fetus is Albert Einstein. There

are

real-world scenarios in which she knows that her fetus will die at birth. Or will be permanently defective. (Which yes, I know, can cover a lot of gray area.)

2) There's only one side in this debate who's position is to mandate a single decision for all, regardless of circumstances.

There is no side demanding that all 8 month old fetuses be killed, regardless of circumstances. There is one side demanding that all of them be carried, regardless of circumstances. (Or at least, one side that keeps passing legislation that says that.)

(However, yes, I also recognize that a scenario like this, while I assume that it's happened at least once, I doubt that it's the typical case.

1. So by that criteria, in cases where the baby WON'T die at birth, there should be no abortion allowed under any circumstances? Right?

2. Are you referring to the "contraception is murder" crowd, or the "partial birth abortion is a right" crowd? Gee, that makes at least two sides, doesn't it?

If nobody is arguing in favor of allowing abortion of 8 month old fetuses under all circumstances anymore, I would welcome that as one side moving a little closer to moderation, but I'm not sure if that's the case yet.

Or do you mean this "debate"... What is there to "debate" based on this scenario, anymore than there is to "debate" over the Einstein scenario?

[Larry]

Would it be unreasonable to have a medical review board review the facts?

We have them here before medical personnel can remove life support,and since these type cases are the exception,it should be no great burden or expense.

I like the theory.

Odds on appointments to this board not becoming instantly political?

[twa]

I like the theory.

Odds on appointments to this board not becoming instantly political?

I would hope they would be professional physicians,even as wise as I am:) you really need someone well versed in understanding medical risk factors.

That should at least reduce the political aspect.

[Larry]

Actually, thinking about your suggestion some more.

I could see the possibility that a lot of hospitals really wouldn't want that authority. (For liability reasons.)

Perhaps a Judge? (Who receives reports from, say, two Doctors?)

After all, that's what Judges do, is to take generalized law (and precedents) and apply them to cases involving individuals.

One advantage I see of making the decisions part of the Judicial Branch is that over time, a body of precedents would build up, creating, eventually, some uniform standards.

Drawbacks I see are that it means Judges (and lawyers, shudder) making medical decisions, and that Judges are already political.

[Larry]

1) Wow. What killed the thread? I thought maybe we were on to something.

2) Curious: In states that allow assisted suicide, what sort of checks do they have on it, right now? And, does anybody have any opinions on how well that works?

[twa]

1) Wow. What killed the thread? I thought maybe we were on to something.

2) Curious: In states that allow assisted suicide, what sort of checks do they have on it, right now? And, does anybody have any opinions on how well that works?

Not real familiar with assisted suicide law(we do not allow it here)

We empower medical ethics committees with the legal power to decide to remove life support in medically futile cases(even against the families wishes), though they do have the option of transferring the patient to a private facility.

https://content.nejm.org/cgi/reprint/357/15/1558.pdf

I think a similar option/review for medically necessary abortions is reasonable as well.(and might quiet some objections)

This is going to be a issue that will have to be addressed with the continuing push for universal healthcare and the cost/benefit factor increases.

Where you draw the line is always a controversial topic

Added

The committee and hospitals are granted a waiver from lawsuits under the bills

[Larry]

Not real familiar with assisted suicide law(we do not allow it here)

We empower medical ethics committees with the legal power to decide to remove life support in medically futile cases(even against the families wishes), though they do have the option of transferring the patient to a private facility.

https://content.nejm.org/cgi/reprint/357/15/1558.pdf

I think a similar option/review for medically necessary abortions is reasonable as well.(and might quiet some objections)

This is going to be a issue that will have to be addressed with the continuing push for universal healthcare and the cost/benefit factor increases.

Where you draw the line is always a controversial topic

Added

The committee and hospitals are granted a waiver from lawsuits under the bills

Yeah, I remember reading about that law. Remember The Daily Show contrasting that law, which allows the disconnection of life support over the next of kin's objections (which the GOP passed and George Bush signed) against the law that Congress was passing specifically to prevent the disconnection of life support for Terry Schiavo, under the next of kin's orders.

I recall John Stewart concluding the story about Schiavo, who Congress was intervening to save, and whoever it was who was the first person to be disconnected under the new law, with "Of course, the Texas law does make the patient's inability to pay part of the decision."

(But I do agree. There needs to be some reform of our end-of-life treatment, too. The old laws of "do whatever it takes to keep the corpse alive, no matter what it costs" is obviously unsustainable.)

[twa]

A explanation of sorts

http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=642233

“The reverse right to die.”

Robert L. Fine, MD, director of the Office of Clinical Ethics at Baylor Health Care System and director of palliative care at Baylor University Medical Center, describes it as “the reverse right to die”—when treatment causes extreme suffering or has no benefit to the patient and it’s the physicians and nurses who object to continuing such treatment. The Texas Advance Directives Coalition, comprising the Texas Medical Association, the Texas Nurses Association, the State Bar of Texas, and other professional and lay organizations, recommended changes to state law that ultimately resulted in the Advance Directives Act (see Texas’s Advance Directives Act of 1999, page 26). The law doesn’t actually define medical futility. Rather, it describes a process for dispute resolution and delineates procedures that must be followed scrupulously to ensure that patients’ and families’ rights are protected during disagreements about treatment.

[Larry]

The way it was described was that it's a procedure whereby a hospital can discontinue life support over the next of kin's objections, if the next of kin can't pay for the treatment.

Which sounds really all "evil Republicans want to kill poor people" and all. But I have to admit that I'm not aware of any Constitutional Right to demand that the taxpayers pay unlimited amounts of money to keep a corpse from rotting. IMO, there needs to be a procedure for stopping life support, and when the next of kin doesn't agree. (Because let's fact it, I expect the next of kin to demand that the hospital do everything.)

(Frankly, I think there ought to be a procedure for cutting off life support before the patient is bankrupt. Heck, I support assisted suicide. I can even sympathize with the poster who said that he intends to move to a state that has it, when he's older.)

Medical technology has progressed to the point where we really have a lot of choices that we didn't have, before. But somebody needs to make the choices.

For example, back on the abortion discussion, there's a lot of people mentioning "viability".

Let's face it. Now days, almost everything is "viable". If you've got a Billion dollars. We're going to get to the point, soon, where a dead skin cell is "viable".

And I know it can seem really heartless to be putting dollar signs into a discussion of how hard we should try to save Mom's life. But this is reality, and dollars are part of that decision.

[twa]

And I know it can seem really heartless to be putting dollar signs into a discussion of how hard we should try to save Mom's life. But this is reality, and dollars are part of that decision.

I'll let the Rep crack:) go ,and just say

when treatment causes extreme suffering or has no benefit to the patient and it’s the physicians and nurses who object to continuing such treatment

It is inhuman and unethical imo to force someone in the health field to perform acts that are of no benefit,simply to salve the conscience of the family and delay the inevitable.

I'm a big fan of advance directives.(which remove the family and honor the patients wishes), unfortunately many put off making them.

On the abortion note,perhaps we should require consent from the other patient(fetus) except in cases deemed medically necessary by committee and simply get their consent to terminate when they are legally able to consent?

We allow minors CHOICE in abortion so it's not like they would have to be adults or anything;)

Medical advances are a double edged sword

[stevenaa]

Just a gut feeling, but I suspect that "a very tiny fraction of cases" is what we have, right now.

I seem to remember in The Tiller Thread, reading that supposedly there are only three Doctors (now two) in the entire US who are willing to perform these procedures, right now.

Which implies to me that these procedures are already a tiny fraction, right now.

I think it is likely that a very tiny fraction of all abortions perfromed at any stage of developement are due to true health concerns for the mother or fetus. I'm not convinced that all late term abortions fall into this category, either. It would seem that situations dire enough to warrant an abortion would be identifiable earlier than the 3rd trimester. Though I'm no doctor and could be off base here.

It would be nice if we could see some factual data on the breakdown of when they occur and why.

[twa]

I think it is likely that a very tiny fraction of all abortions perfromed at any stage of developement are due to true health concerns for the mother or fetus. I'm not convinced that all late term abortions fall into this category, either. It would seem that situations dire enough to warrant an abortion would be identifiable earlier than the 3rd trimester. Though I'm no doctor and could be off base here.

It would be nice if we could see some factual data on the breakdown of when they occur and why.

I can give a example of sorts

In 1997, the Guttmacher Institute estimated the number of abortions in the U.S. past 24 weeks to be 0.08%, or approximately 1,032 per year.

http://www.guttmacher.org/pubs/ib14.html

my daughter just turned gravely ill a few days into the 3rd trimester(HELLPS I believe they call it)

From my understanding in most states(those w/o a presumption of viability) a abortion request could be granted at a patients or guardians request in such a case.

or am I wrong?

what my barely 3rd trimester grandchild looks like

(naked kid warning )

http://a3.sphotos.ak.fbcdn.net/hphotos-ak-ash4/393655_2552829589261_1509549531_2758316_1374322741_n.jpg

should presumption of viability be a mandated policy...or choice?

[Larry]

I can give a example of sorts

In 1997, the Guttmacher Institute estimated the number of abortions in the U.S. past 24 weeks to be 0.08%, or approximately 1,032 per year.

http://www.guttmacher.org/pubs/ib14.html

my daughter just turned gravely ill a few days into the 3rd trimester(HELLPS I believe they call it)

From my understanding in most states(those w/o a presumption of viability) a abortion request could be granted at a patients or guardians request in such a case.

or am I wrong?

what my barely 3rd trimester grandchild looks like

(naked kid warning )

http://a3.sphotos.ak.fbcdn.net/hphotos-ak-ash4/393655_2552829589261_1509549531_2758316_1374322741_n.jpg

should presumption of viability be a mandated policy...or choice?

I don't understand your description of your situation, or your question.

(Or whether I should be expressing sympathy.)

[twa]

The question is should the viability of the child itself matter......and who decides

in the orig post there seemed no viability of the fetus.....what about when it is indeterminate?

Do you try to save both equally ....or choose

(congrats are in order,both are doing well so far )

[Larry]

Well, certainly it matters.

The entire scenario in the OP is based around the fetus' non-viability.

Are you asking if there is any OTHER factor that should be considered, in addition to that?

[twa]

From my understanding of the Thornburg SCOTUS ruling,viability is irrelevant and the mothers life paramount.

http://www.guttmacher.org/pubs/ib13.html

in Thornburgh v. American College of Obstetricians and Gynecologists (1986), the Supreme Court ruled that when performing a postviability abortion, a physician must have the authority to choose the method most likely to preserve his patient's health, even if it might jeopardize fetal survival. The Court struck down a provision of a Pennsylvania abortion law that required a physician to exercise the same degree of care in performing a postviability procedure as he would be required to exercise "to preserve the life and health of any unborn child intended to be born and not aborted."

In addition, the law had required the doctor to use the abortion technique that would give the fetus the best chance of being aborted alive, unless "in the physician's good-faith judgment, that technique 'would present a significantly greater medical risk to the life or health of the pregnant woman.'" But the Court upheld an appeals court's ruling that the law was unconstitutional because it required "a 'trade-off' between the woman's health and fetal survival and failed to require that maternal health be the physician's paramount consideration."

[Special K]

The fact that abortion is even a hot-button political topic irks me. This is an issue that should be left to a family and their health care provider, not the dumbasses in Washington.

So, with that being said, I would support whatever this couple and their health care provider chose to do. I think people who make reflexive, politically based judgements about these cases need to spend a little time working with pregnant women who find out late in their pregnancy, their unborn child has congenital defects that will drastically reduce their lifespan. Doing so has certainly opened my eyes a bit more on this issue. Not everything in life is black and white, no matter how much politicians want us to believe this to be the case.