Reproductive Medicine's Ethical Failure

“Primum non nocere,” above all do no harm, was the American medical ethics standard in 1965, on the eve of widespread contraceptive use.  However, preventing implantation of a newly fertilized ovum in the uterus, one of the lesser modes of action of the birth control pill, sounded ethically troublesome to the obstetricians of the time.  With ethics not quite as motivating as that nice Corvette, the American medical establishment simply changed the definition of conception from fertilization to implantation of the new life into the uterus, ignoring the first six days of human life in the fallopian tube, and making the pill easier to market to consumers.  This medical ethics malpractice dishonored the physician and ushered in a more lucrative vision for the reproductive system. Today, after 60 years of ethical disinterest, reproductive healthcare has become the wild west of American medicine, in which money talks, morals walk, and sex is big business.

As a family physician, I am expected to prescribe risk-filled medications and surgical procedures designed to prevent the healthy function of my patient’s reproductive organ system and/or to destroy its end products.  I am supposed to help my patients arrange gender-affirming surgeries that permanently mutilate their reproductive anatomy and deny them the chance for natural children.  I am instructed, as it relates to reproductive medicine, to ignore my experience and knowledge and follow blindly the orders given by an often underaged, immature, anxiety riddled patient with minimal medical knowledge. For the body’s ten other organ systems it is not so.  Ivermectin, for example, a medication with minimal side effects (unless taken at doses for horses), may not be prescribed because the level to which it improves function of the immunologic organ system is not sufficient to please the authorities.

Years of conditioning and lies have led us to not only accept this distorted vision of reproductive healthcare, but to become blind to the value of human life and the ethical role of a physician in a healthy society.  With the medical community unwilling to address this tremendous ethical challenge, the government has been forced to intervene in the practice of medicine as the Supreme Court attempts to secure the basic human right to life for all of the country’s population.  Such intervention, although needed currently, is admittedly inadequate, as no legislation can fully resolve the ethical dilemmas that occur frequently in the care of patients.  Ironically, but strategically, in the post-Roe v. Wade world, many abortion providers have suddenly begun to make public proclamations about the importance of ethics in the care of half of their patients, as they describe difficult medical situations in which the life of the pregnant mother is at risk. 

Clearly, a very small percentage of abortions are performed in ethically challenging situations; it is these cases, which are used to rationalize the remainder and to argue against any legal limitations.  For these situations, however, it is hard to imagine a case in which a mother can only be saved by killing her child rather than simply delivering the baby and providing supportive care.  Even an ectopic pregnancy, which by its location outside the uterus is not considered a pregnancy per the 1965 definition, can be surgically removed without deliberate killing of the new life.  Ideally, a physician would be able to present these ethical dilemmas to self-governing medical ethics boards composed of colleagues, spiritual representatives, and other experts to help guide him in the proper care.  How disappointing it is to realize, however, that without a universal respect for human life among physicians, it is for the legal system to decide what is appropriate in challenging medical ethics cases.   

Recently, South Carolina Rep. Neal Collins received national attention for his emotional testimony describing the many sleepless nights he experienced worrying about a 19-year-old pregnant mother whose “water broke” at 15 weeks (Preterm premature rupture of membranes), a case described to him by a local emergency room physician.  The doctor wanted to euthanize the fetus because of its bleak prognosis and the risk of serious infection in the mother, but was advised by legal not to do so because of the state’s heartbeat bill.  Rather than accept the physician’s proper offer for hospital admission to help mitigate health risks from the failing pregnancy, the mother chose to be discharged with instructions for close follow up.  Within two weeks the baby died and was subsequently delivered at the hospital; the mother had no physical complications.  Despite using the case to express his regret for previous support of the state’s heartbeat bill, Rep. Collins never explains how a surgical abortion would have benefitted either the mother or child.  Rather, the episode illustrates another instance in which killing a baby is not necessary to protect the life of a pregnant mother.  More importantly, however, it is the heartbeat bill, which will allow this young mother, for the rest of her long life, to find comfort knowing she did everything possible to save the life of her child.  As the medical director of a crisis pregnancy center, I am sadly familiar with the anxiety and sleepless nights experienced by many post-abortion mothers, as they ruminate over what could have been, if permission had not been given for their child to be aborted. 

Despite the emotional description of difficult cases, most abortions are performed in a medical ethics wasteland, in which abortionists, who know better than anyone the humanity which exists in the uterus, assess certain lives to have less value than others.  The power and money that comes with being the final arbiter of who gets to live and who is to die has proven disastrous for many children and mothers, and has been devastating to our society.  Of course, admitting to this view of humanity puts those who hold such positions in union with many of history’s most ruthless people.  For this reason, abortionists always avoid questions regarding the humanity of the child they dismantle, resorting rather to half-truths and euphemisms, recited as part of emotional and unscientific arguments to defend their work. 

Part of its plan for a post-Roe world, in stark contrast to an emotionally targeted public-relations campaign highlighting health risks of pregnant mothers, is the abortion industry’s efforts to minimize these same health risks as they seek relaxed regulations for the two-drug (RU-486 and misoprostol) chemical abortion regimen.  Nothing exposes the lie that abortion is about women’s health more than the industry’s goal to make these dangerous pills available online without an in-person visit.  Without exact dating, the mother’s risk for infection due to retained fetal products increases. Without ultrasound to confirm an intrauterine location, ectopic pregnancy complications increase.  Without psychological support, an unprepared woman seeing her dead baby in the toilet can be devastating.  Most tragically, however, making these pills available simply with an online request, takes away what may be the one opportunity an abused woman has to seek deliverance from an abuser, who would otherwise force her to ingest these pills and destroy evidence of his abuse.    

I do not understand my colleagues who promote and perform abortions. I do not understand how large organizations like the American Academy of Family Practice, which waxes proudly about care for the whole family, can ask their members to abdicate responsibility in caring for those unborn family members, who apparently have less value.  And I do not know how to convince my colleagues that all life is created equal with certain unalienable rights, including the right to life. Until I do, and physicians ethically govern themselves as we are morally required to do, I pray for my colleagues’ conversion, and sadly must support government involvement in medicine to ensure protection of all innocent human life.

Image: Public Domain Pirctures

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