Early Induction of Labor

A Mother’s Story

When my daughter Cecilia's anencephaly was diagnosed by ultrasound in September 2002, the first and only real option my husband and I were given was abortion. I was encouraged to check in to the hospital immediately to have a "dilation and extraction". The maternal-fetal medicine specialist at the world-renowned medical center told me that I couldn't carry my baby to term that I would be risking my life.

Our first call was to our priest, who told us that, because our baby could not live outside the womb, it was acceptable to induce labor early. The next day my obstetrician, who is not a Catholic but a Christian, told me that he would not perform an abortion and that inducing early in this case was not abortion.

It seemed my three choices were "Kill the baby, kill the baby, or kill the baby," yet everyone kept saying I was wrong. I could have any of what the doctors recommended, induce labor or wait for her to be stillborn. The doctors made it sound as if it were perilous for me to give birth to an anencephalic baby.

After meeting with our priest, I checked into the hospital for induction of labor. Labor was hard; my body wasn't anywhere near ready to birth my baby. I felt Cecilia kicking until early in the morning. After 18 hours of very painful Cytotec-induced labor, she was stillborn. I scooped her up before the doctor could get her. We didn't know until that moment that she was a girl.

Early Induction of Labor:Ethical Considerations

BERNAL, Vanessa Anne C.

BIAG, Joanna Khris L.

Report Outline

I. IntroductionA. Definition of TermsB. Early Induction of Labor

II. Ethical Considerations in EILA. Pro-EILB. Anti-EIL

III. Conclusion

Definition of Terms

• Viability– gestational age at which a fetus can

survive outside the womb

– 23 to 24 weeks

• Anencephaly– lack of major portions of brain and skull

Early Induction of Labor

• Different methods– Cervical stretching, amniotomy– Pharmacological: oxytocin, prostaglandins– Relaxin, antiprogestins, NO

• Associated with diagnosis of children with lethal conditions (i.e. anencephaly)

Early Induction of Labor

• Reasons

– Lethal condition of the child

– Pathological risk for the mother

PRO-EIL

• “Anencephaly and Management of Pregnancy” (1993)– Sister Jean deBlois, CSJ

• “Early Delivery of Fetus with Anencephaly” (July 2003)– Father Norman Ford

Anencephaly

• Case where “pregnancy can be terminated anytime”

• Lack of mental development is justification enough

Principle of Proportionality and Double Effect

• Human life – not just biological life– Anencephalic infants lack psychological,

social and creative capacities

• Resulting fetal death is indirect

• EIL as termination of life support

EIoL After Viability

• waiting until 33 weeks to induce delivery of anencephalic infants meets ethical standards

• cause of death = anencephaly (not prematurity)

EIoL After Viability

• Motive– alleviate the mother's distress– minimize potential health risks for the mother

• "by this stage the mother's duty of reasonable care for her fetus would have been satisfied"

Anti-EIL

• “Moral Principles Concerning Infants with Anencephaly” (1998)– By: Fr. Benedict Ashley, OP

• “Anencephalic Infants and their Care” (1998)– Committee on Doctrine of the US National

Conference of Catholic Bishops

• “Primer for Health Care Ethics” (2000)– By: Fr. Kevin O’Rourke

• “NCBC Statement on Early Induction of Labor” (2004)

Human Dignity

• To be fully human…

– does not mean that all human functions (and physical capacities for such) must be actual

– means that an individual by being a member of the human species possesses a nature that includes the potential for actual operations, even though this

potential may never be actualized due to some anomaly

Human Dignity

• Hence, an anencephalic infant is the subject of human rights and has a human dignity equal to all other human beings

Principle of Proportionality

• Operations, treatments, and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child

Principle of Proportionality

• For a proportionate reason, labor may be induced after the fetus is viable

Principle of Double Effect

• treatment is directly therapeutic in response to a serious pathology of the mother or child

• the good effect of curing the disease is intended and the bad effect foreseen but unintended

Principle of Double Effect

• the death of the child is not the means by which the good effect is achieved

• the good of curing the disease is proportionate to the risk of the bad effect

Conclusion

Initial error appears to be the theory that a presumed lack of mental function is a lethal pathology that can override the obligation to provide for the basic needs of a person

• conditions of the human body, regardless of severity, in no way compromise human dignity or human rights

• Application of Principles of Proportionality and Double Effect

There she was, dead in my hands: Dead by my hand. She was so delicate and helpless, and I knew without a doubt that, no matter what anyone said, I had done something terribly wrong. God had entrusted this life to me, and when I found out it was not a perfect one, I snuffed it out.

Nearly a year and a half has passed since Cecilia's death. Although I've been to reconciliation and received absolution, the fact remains that I killed my daughter. Though I sought and acted on the advice of my doctors and my pastor, I ultimately made the decision to end her life. There is no doubt that her condition was fatal, but it was not for me to decide how long her life would be. Every day I mourn her death. I should have fought for her and protected her, no matter how short a life God had in mind.

The people who tell you early induction is acceptable will try to make it sound as if babies with fatal conditions are less than human. They may have good intentions, but they are wrong. Our babies, no matter how flawed, are human beings deserving love, dignity and respect.

End.