What's Wrong with Healthcare?

Thinking inside and outside of the healthcare box. After 41 years of family practice, what's happened to Canada's healthcare system?

Saturday, February 11, 2006


I’m not sure whether I am anti-abortion or simply pro-life, and I realize that immediately some people will say: “they’re the same thing”. As a youngster growing up on a mixed farm in Saskatchewan, I quickly recognized my nature was pro-life. I spent much of my younger years patching up injured birds and animals and marveling at the miracle of birth. On one occasion, when I was 12 years of age, my brother shot a very pregnant skunk. I quickly did a cesarean section and a mother cat that had kittens at the time, happily adopted five newborn baby skunks. I was so protective of life that at one point we had over thirty cats on the farm. My father quickly introduced me to the realities and the economics of farm life.
When I graduated in 1962 abortion was only allowed if the mother’s life was at risk. Most of the teaching pertained to dealing with incomplete abortions (spontaneous, also called miscarriages), and complications there-of. By the time I was doing my residency (internship) I had little exposure to what was going on in the real world, and I’m sure at that time, if I had been asked, I would have spoken out strongly against abortions.
One night when I was working the Emergency department at the Holy Cross Hospital, an ambulance brought in a 23 year old woman (about my age at that time) who was dead on arrival. She lived in Calgary but one week previously had a criminal abortion in Winnipeg. She died by herself in her apartment in Calgary from sepsis, likely too afraid to seek help. I was devastated. Someone with her whole life ahead of her felt she was so alone and without alternatives that she risked and lost her life. I realized from that point on that there had to be a better way.
Though my thinking on the matter had changed, I never did an abortion. I spent an inordinate amount of time in my practice discussing birth control with my young patients, and was seen by my patients (I believe) to be very open with them in these matters. For those that found themselves in a difficult pregnancy position (once abortion was legalized) I spent much time pointing out the pros and cons of all the alternatives. I reassured them of confidentiality and made a second appointment one week later to accept and discuss their position. If they wanted to terminate the pregnancy I referred them to a gynecologist (who did abortions) and any other consultants that I thought would be beneficial.
In honesty, my discussions may have been slightly prejudicial to keeping the pregnancy. It was at times very difficult for me to always accept the reasons given by the patient for wanting an abortion. On one occasion a 38 year old healthy woman with three healthy children at home, once more found herself pregnant. She was obviously quite conflicted since the youngest child was 10 years old and they were looking forward to their life “after the children are grown”. I recall telling her she had the baby-sitters already in-house so she mostly had the next year to deal with!. She went on to have a beautiful healthy baby girl. As this child grew up and eventually married, there was always a strange connection between the two of us.
My issue with the present abortion laws in Canada are that there basically aren’t any. Since 1988 (I believe) this entire matter has been left to medical and authoritarian people on a case by case basis. As such there is no clear National perspective as to where Canada stands on this complex issue. Most countries in the free world have taken the position that a woman does have the right of medical assistance to “evacuate” her uterus. The real question in my mind is does she have the right to terminate the life of the viable (could live outside of the uterus independent of mom) fetus (usually considered at least 24 weeks gestation). This situation is not dealt with in Canada and as a result we have no laws that pertain to some bizarre scenarios. You may recall a woman who isolated the head of her 36 week old baby, still in her abdomen, and shot it through the head. I don’t believe there was a conviction of any kind in that case. A couple could possibly ask for the termination of a pregnancy because an ultrasound showed a lip and cleft palate deformity (easily correctable) in an otherwise healthy seven pound baby intra-uterine baby. Alive or dead, the mother would have to go through some type of labor and delivery. Why not give birth to a live infant and give it up for adoption?
I’m sure that the above scenarios come up very rarely but if we wish to lay claim to being a compassionate and caring society, should we not give consideration to the most vulnerable in our society and work out some compromise with women who rightfully should have final jurisdiction over themselves. The question in my mind is: “Should the right to evacuate ones uterus include the right to terminate the life of a fetus that could survive and be cared for outside of the uterus. Time, I feel must come into the equation, and I believe the woman has a responsibility to her fetus to make a decision in a given period of time. I also believe not making a decision is a decision.
As to abortions before viability, I’m afraid I’ve come to the conclusion that we as a society have simply:
1) Stopped putting significant value on procreation
2) Stopped emphasizing “responsibility” as a positive trait when raising our children
3) Extended our general “throw away attitude”, specifically to fetuses.
The “rights” issue without guidelines and responsibility simply can become an issue of: “I want what I want, when I want it, and you’ve got to give it to me". Like many people, I have come to accept it as something I am prepared to live with although a recent New Zealand study reports that: “Young women having abortions are at heightened risk of later developing mental health problems such as depression, anxiety, and drug and alcohol abuse. Perhaps if there were more discussion on the subject, approaches could be adopted that would benefit the mother and society as a whole.
While we are discussing controversial things; Can anyone tell me why thousands of abortion “by-products” are thrown away in this country every year, when embryonic stem cells supposedly are ideal for doing research that could lead to incredible cures?


Blogger Procrastinatrix said...

I think you make some excellent points, and while my personal feelings on abortion remain pro-life in that I don't think I could ever go through with it (unless my life were in danger), I believe that women should have the ultimate choice on what happens to their own bodies. That being said, you are right, we live in an instant gratification society. Accidents just shouldn't be happening if people are taking responsibility for their own actions.

If we take the issue of fetal viability literally, and a woman wants to terminate a pregnancy at a time where the fetus could be kept alive, at 24 weeks gestation, children go through a lot to be kept alive, don't they? I mean, don't they have to be put on TPN and risk all sorts of complications (necrotizing enterocolitis, liver damage resulting in the need for transplantation etc)that could follow them throughout life? Then who takes responsibility for that? I mean purposely terminating a healthy pregnancy vs. purposely reducing a child's quality of life then becomes an issue.

I think that its great that you counselled with an open mind. My friend's doctor told her her son likely had spinabifida and that she should get an abortion, and when she refused she was told her son would likely die in his first year or be severely disabled. He is now 11 years old and completely normal. So, its important that people see all sides of the story.

However, I disagree with imposing laws (at least for 24 weeks gestation) and think that it would probably be beneficial if a more solid support system existed, since not all doctors do give all the possible outcomes to patients or encourage a second opinion. Late pregnancy abortions are such a touchy subject. And if I could be convinced that the babies born could be born alive with no/little risks to their overall health, then I would be more inclined to agree with you.

It also brings up the issue (and I do not really know anything about this so it could be totally ignorant), are late gestation babies killed in utero or would a live birth occur in exactly the same manner? Like, once the baby leaves the mother, it is no longer part of her body, and then does she really have any say if she wanted to abort it in the first place? Shouldn't this be counselled as well? At 7 pounds a baby is healthy enough to survive outside the womb. Is it standard practice?

Anyway, just my two cents.

13/2/06 2:09 PM  
Blogger Al said...

I was not stating that 24 weeks was the appropriate gestational age, some countries use 30 or 32 weeks for the reasons you site.
Basically, society would have to accept the responsibility for the child if the mother didn't want it. Since there is no cost incurred from our health care system, a list of adoptive parents could be established and they could be "put together with the infant" right after birth.
I guess the question I was attempting to raise was: "should the right of a woman to evacuate her uterus at any stage during the nine months of her pregnancy, extend to,and include, the termination of the in-utero child's life during that full nine months?
And yes, getting a six or seven pound infant out is the same whether the infant is alive or dead. The extraction can be made easier by certain procedures but my wife says that I am not an expert in that field and it may give you bad dreams!
Thanks for the comment. If these things are never discussed, even moderates will be unhappy. Every "rights" issue isn't black and white.

13/2/06 4:26 PM  

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