Insufficient Strength to Support Present Pregnancy - Case Study Example

149488 REPORT FROM DR. CROOMBER PATIENT: Ms. White Age: 19 HISTORY: Third Trimester, First Pregnancy terminated when she was 15. Second pregnancy resulted in 10 month old child. PROBLEM: Insufficient strength to support present pregnancy. Hospitalised and is put on intravenous support. PRESENT: Wants to terminate 26 week pregnancy. It is almost impossible to allow Ms. White to have premature baby, precipitating life long damage to the infant. There is very little chance of baby's survival in a delivery during 26th week gestation period. It is a non-viable foetus with minimum chances of survival. Even if it survives1, it can have intra-uterine heart arrhythmia, postpartal respiratory insufficiency and bradycardia and cometimes, hypoglycaemia. The harm to the unborn child could be immense. The child might lose its life as a result of mother's decision. Or child could be crippled for life and doctor would be responsible for its continuous agony throughout life2. It will be either like an abortion, or like permitting a child to be born without proper health, even though alternatives exist. Many ethical and moral issues are connected with abortion like the rights of foetus,3 and mother's self-determination that should not be questioned. I am also well aware of the fact that the foetus is already very weak and might not survive the entire gestation period without hospitalisation and continuous monitoring, or even might be born after that with certain milder chronic problem. I could try to find another physician and transfer the case to him as it is. This would be risky too, because physician might not be willing to take the burden. It could work well in another way, because the mother will get a cooling-off period to reconsider her hasty decision so that she could be sure that she could live with such a decision for the rest of her life4. If I don't make her understand all implications and alternatives, I could be charged of post-conception harm, for not only informing the mother the risks of discontinuing the pregnancy (which I have already done), but also the harm that could come to the foetus by indefinitely prolonging the pregnancy without proper treatment for foetus. Professional duty and ethical confusion will plague this issue as this is an ethical as well as medical dilemma for me to be torn between the two. I can also refuse to abide by her wishes and try to obtain a court order to force her to undergo treatment. No doubt, this is perhaps a semi-legal way to do it, because foetal rights are not yet fully recognised as against the rights of mother, and this course of action would never work properly5. A resentful mother cannot be forced to have the baby, or to look after it with genuine affection after it is born. It will also jeopardise baby-mother bonding and an awfully strained relationship will develop between the two. It is also doubtful if I would be able to get the court order forcing Ms. White to undergo treatment and retain her pregnancy. There exists an unending argument whether the foetus right is more important or the mother's health. There had been no solution till now, even though as it is today, mother's right is recognised more than that of the foetus. I can go for Five step process of ethical decision making after taking into consideration all existing issues that have caused ethical distress and dilemma to medical fraternity by being forced to choose between woman's right to self-determination and right to life of the child. I have to consider Ms. White's psychological and physical wellbeing too before making a decision. Usually the child's right is rather suppressed. But to some extent, ethical consideration of women's right too is rationalized. Here foetal disability does not exist, though pointers towards it are present; but there is reasonable assumption that with the continuation of treatment, the child should be benefited and normal. Ethics is an essential dimension of clinical practice and we cannot totally ignore it. Ethical issues get complicated if, along with the mother, foetus too is treated as a patient, as it is already under treatment6. Also there is no indication that child could be born with a genetic disorder. Ethical and moral aspects of human reproduction have always been knotty7. Ms. White definitely has a right on her unborn baby and can take decisions keeping in mind her wellbeing, as she finds foetus 'painful and uncomfortable'. She had gone through the trauma of an abortion when she was only fifteen (this might even lead to the thought that she had been irresponsible even as a teenager); but now she is the single mother of ten month old child, and she is only nineteen and is expecting another baby. Naturally she has the right to say no, to another financial and emotional burden. Ms. White should have used contraceptives as they are very easily available and the present unwanted pregnancy could have been avoided. Also she has a duty towards her ten month old child. This does not wipe out her duty towards unborn child and she has very little right to inflict permanent suffering on her future child. But she has a right to consider her own health. Abortion is negated by Pope and the Catholic Church and there are Human Right Organisations which would argue on behalf of the child. There are also feminine organisations and ordinary women's organisations who would uphold the right of the mother8. This is an issue raging all over the world with widely divided opinions. Different countries have different issues that force mothers to terminate pregnancies. In traditional countries it is done for the fear of society and stigma of being an unwedded mother9 and in advanced countries, it is done to avoid additional responsibilities and problems. The moral status of foetus is a contentious issue10 that has human rights and legal aspects. ACTION TO BE TAKEN: Weighing all pros and cons, I am of the opinion that convincing Ms. White about the abnormal and difficult results of terminating a pregnancy at such an early period is of paramount importance. If she is totally against bringing up this child, she will be advised to give away the child in adoption and this might ease her tensions to some extent. She might even reconsider her decision. She shall go through psychological counselling that would help her to regain control. She might be running away from responsibility and reality again, by having a premature child with disastrous consequences, and this should be prevented. Father of her earlier child is not mentioned in her records. He could be traced and made to look after her child while she could go through pregnancy and birth of another child. With Care help, this need not be impossible and after the birth, she might be able to care for both children. Another practical solution is look for the father of unborn child and make him equally responsible. Perhaps Ms. White wants to terminate pregnancy because she does not feel capable of looking after 2 children being so young and vulnerable. She could be provided with a good, but easy job and that would make her financially sound. Carers and volunteers could help her in looking after her children. Secure housing, financial benefit, good job, help with baby care will all help her to explore other possibilities. Being in the hospital she must have been worrying about her other child's welfare. This problem could be solved by making suitable arrangement for looking after the child. While pursuing these alternatives, I would advice Ms. White to continue her treatment in hospital till she could deliver a normally monitored and healthy child. BIBLIOGRAPHY: 1. Cook, Rebecca, Bernard Dickens and Mahmoud F. Fathalla (2003), Reproductive Health and Human Rights, Clarendon Press, Oxford. 2. Hayry, Heta (1998), Individual Liberty and Medical Control, Ashgate, Aldershot. 3. Mulburn, Marj (2001), Informed Choice of Medical Service: Is the Law Just Ashgate, Aldershot. 4. Trohler, Ulrich and Stella Reiter-Theil (1998), Ethics Codes in Medicine, Ashgate, Aldershot. ONLINE SOURCES: 1. http://www.libertarian.co.uk/lapubs/philn/philn047.pdf 2. http://politics.scienceboard.net/archives/2005/04/02/33/ 3. http://www.owen.org/blog/528 4. http://conservativehome.blogs.com/torydiary/2006/10/nadine_dorries_.html 5. http://www.obgynsurvey.com/pt/re/obgynsurv/abstract.00006254-200307000-00023.htm;jsessionid=FnGdj1Q7Wt0hh2QHqyF07NkhJvFDk7Msn2LS3SrfWgw1Tm6TPNZx!990059801!-949856144!8091!-1 6. http://journals.cambridge.org/action/displayAbstractfromPage=online&aid=113787 7. Read More