Cura personalis

Hey guys.  I haven't written in eons, but I had a conversation quite recently that has sent me racing back to my little blog, anxious to share my indignation with anyone who will listen.

This was what transpired:  I had a patient last week, a nice, older male, armed with a full set of nice, older male "family values."  Towards the end of our encounter, he told me happily of a story he had heard on the news.  To be brief, the story centered around a young pregnant woman with cancer, who forewent chemotherapy in order to deliver a healthy baby.  Due to the delay in treatment, she died soon after giving birth, a decision my patient lauded and defended.  Lest I doubt his thoughts on the matter, he added:  "Isn't that just great?  So many women would be selfish and put themselves first, and so many would even throw their babies away and have an abortion!"

http://www.turnbacktogod.com/virgin-mary-pictures-06/

Now, who knows what particular instance this man was referencing.  There are countless instances of pregnant women choosing to put the well-being of their fetuses above their own.  Choosing being the operative word.  All well and good.  Yet once this decision becomes expected of women, once we as a society make the Rick Santorum-approved assumption that a woman - endowed with hopes, dreams, life experiences, the abilities to enjoy life an to contemplate death - is worth less than the fetus she is carrying, we have come to a dangerous conclusion.

There is already a disturbing history of Catholic hospitals (which, by the way, comprise 13% of healthcare providers in the U.S.) denying life-saving care to pregnant women.  It is the Church's official policy not to provide therapeutic abortions even in cases of ectopic pregnancy.  Under the auspices of the so-called "Protect Life Act," these hospitals could continue to withhold treatment while still receiving federal dollars!  Catholic hospitals which do perform such procedures may face loss of funding, excommunication, and general Catholic self-righteousness.

Fittingly, just as I had this issue on the brain, I interviewed this morning at Georgetown's (Catholic) School of Medicine.  After a long speech about Georgetown's philosophy of "cura personalis," the "respect for the individual humanity of every patient," we sat in on a class on, of all things, complications of pregnancy.  The descriptions of ectopic and molar pregnancy were not followed by mention of treatment, in good Catholic form.  Question:  Could I really attend this school?

Answer:  Even if I don't, society's views on motherhood and the rights of women extend, alas, far beyond the nunnery walls.

A Call to Arms (and to Scalpels)

Three cheers for America's judicial system.  It may be the least-appreciated branch, the "Holy Spirit" of the federal government, so to speak, but for almost 40 years now it has firmly upheld Roe v. Wade against countless legal attacks to repeal and undermine it.  In the past few decades, however, slander, intimidation, and yes, even pro-life terrorism have been much more successful than legislative initiatives at chipping away at the right to choose. The pro-life side has managed, through numerous back-door approaches, to make obtaining an abortion difficult and humiliating, if still technically legal.  Today, the biggest threat to abortion rights in the US is not the legality of the procedure, but rather the logistical access to abortion services, due in large part to the near crisis-level shortage of practicing abortion providers in the US.

Abortion remains one of the most commonly-performed procedures in America, and is certainly one of the most often discussed.  Therefore, it probably surprises most people to learn that physicians who perform abortions (or "abortionists," as they are so often called) are few and far between.  As in "entire states of separation" far between.  If you need an abortion and live in Wyoming, Missouri, Mississippi, or, God forbid, Hawaii, you are shit out of luck:  these four states lack a single abortion provider.  Even in states with relatively progressive abortion laws access to abortion is hindered merely by the scarcity of providers.  In fact, the 1.21 million abortions performed in 2008 were provided by just 1,793 facilities, with half of these services provided by just 2% of OB-GYNs.  In contrast, the nation is blanketed by well over 4,000 crisis pregnancy centers.

http://www.catholicvoteaction.org/americanpapist/index.php?tag=pro-life

It's not difficult to imagine why so few physicians provide abortions.  Clinic bombings, "abortion hit lists," Bill O'Reilly's abortion witch-hunt, and the 2009 assassination of Dr. George Tiller have all achieved their intended effect:  terrifying physicians out of providing a legal and judicially-protected procedure.  There are additional factors at play as well.  Catholic hospitals, which employ around 16% of American doctors, prohibit their employees from performing abortions even to correct an ectopic pregnancy or other life-threatening complication.  Many OB-GYNs aren't even trained in the procedure, as fewer than half of residency programs require this training.  And even physicians who identify as pro-choice may be reluctant to perform abortions due to societal pressures and the awkwardness of rarely being able to discuss their work in polite conversation.

http://worstgenerationseed.blogspot.com/2009/03/truth-truck-meets-tiller-killer.html

As a very pro-choice pre-med, these matters have been on my mind for some time now.  The nation needs abortion providers.  Women need abortions, and they will not stop needing (and procuring) them just because their doctors are incompetent or untrained.  I will someday need a specialty, and I believe in providing a service that millions of women want and need.  Of course, now is not the time to commit to a career:  even by the most optimistic estimates, it will be more than five years before I have my MD.  And regardless of how passionate I am about the cause, I'm not sure whether I'm prepared for a career that will spell a lifetime of harassment, fear, disdain, and maybe even a bullet to the head.  But it's something to consider.

http://www.theologyonline.com/forums/showthread.php?t=66908&page=2

The Utility of Choice

As a matter of reason, good taste, and, well, the entire principle of separation of church and state, Bible verses have no place in political discourse.  However, it's unsurprisingly difficult, if not impossible, to disentangle the abortion debate from religion.  The Bible apparently has a lot to say on the matter, since most pro-life websites are headed with quotes from the Book of Proverbs, images of a pained and sorrowful-looking Virgin Mary, and (the ultimate trump card) the question "What if Jesus had been aborted?"

What you don't hear much of are utilitarian arguments against abortion.  In a nation faced with a growing deficit and heinous unemployment, the far right still doesn't seem interested in forming logical social and economic justifications for its endless effort to overturn Roe v. Wade.  Now, I am fully on board with decreasing the national deficit and bettering overall quality of life, so I think we would do well to transfer the abortion debate from the religious to the practical sphere.  From a small-government, fiscally-responsible standpoint, are there any positive external effects of legally requiring a woman to carry an unwanted pregnancy to term?

http://intenseproductions.blogspot.com/2010/08/practicing-your-scales-effectively.html

Weighing pro-life against pro-quality of life.

The term "utilitarianism" scares us, or at least makes us uncomfortable.  We like to fancy ourselves ethical, to think that we don't "cut our losses" when it comes to issues of morality.  Yet we make a utilitarian bargain every time we eat meat or wage war.  So how do we apply these calculations to issues of reproductive choice?

First, there is the issue of population.  In a matter of months, the world's population will hit 7 billion; by 2030, it will be over 8 billion.  Needless to say, this "population bomb" will have far-reaching implications on the environment, politics, economics, and general quality of life.  Basically, everything.

http://www.blogiseverything.com/general/worlds-population-graphs/

This graph should scare the shit out of you, and if it doesn't, you probably lack basic abilities of projection.  Now add to this stunning rate of growth the fact that even in the United States, where contraception is readily available, half of pregnancies are unintended or unwanted.  This leaves us with a rapidly exploding world population of 7 billion people, at least one half of whom were born to parents who didn't want them, or didn't have the maturity or resources necessary to raise them.  Would illegalizing abortion impact these statistics positively?

Then there are the social effects of abortion.  As we learned from Freakonomics, the legalization of abortion in America corresponded with a decrease in the crime rate.  Similarly, there are indications that abortion lowers the incidence of child abuse.  Correlation doesn't imply causation, of course, and both these claims are surrounded with controversy based on statistical approachs to the questions.  Nevertheless, we can imagine how unwilling parents would be more likely to lash out at an unwanted child, and unwanted children more likely to last out at society.  And then there is the fact that abortion actually saves money:  by conservative estimates, each dollar spent on family planning saves us almost four down the road, in Medicaid and welfare costs.  Would defunding Planned Parenthood or overturning Roe v. Wade better financial stability and quality of life?

Finally, there are the effects of abortion on women themselves.  The pro-life side loves this argument, because it is a perfect opportunity for them to rail against abortion while pretending to care about women's rights and health.  From this ostensible concern has arisen the concept of "Post Abortion Syndrome," a mental-health condition which supposedly causes flashbacks, depression, and suicidal thoughts in 50% of women who have abortions.  

But alas, as much as the pro-life camp wishes that it existed, it turns out that studies which supported "PAS" were fraught with statistical errors, and it's actually just a load of shit.  When compared to women of similar socio-economic backgrounds who decided to carry their pregnancies to term, women who have had abortions actually fare the same, and often better, in terms of mental health.  Not surprisingly, being able to finish an education or further a career, remaining financially stable, and not having to bear and raise an unwanted child actually has positive effects on a woman's well-being.  And this isn't even touching the fact that Roe v. Wade ended the bloody era of coat-hanger abortions.

I haven't said a single thing here that hasn't been regurgitated time and time again.  That doesn't, however, dilute its significance.  Allowing women to take charge of their own reproduction has far-reaching positive implications, and I know not of any non-religious, practical justifications for the other side.

A fetus does not have a fully developed nervous system, lacks self-awareness, and cannot feel pain until at least 24 weeks of gestation.  In these regards, it ranks somewhere between a jellyfish and a salamander.  Thus, any concern felt for a fetus in another person's body can only be for its nebulous "soul," and thus can only be religious.  Naturally, this realization isn't likely to send shockwaves through a country of which 90% self-identifies as religious, and I would have to be fairly naive to pretend that the barrier between church and state is impermeable.  But let's make that barrier a latex barrier, and keep the pro-life separate from the pro-quality of life. 

International Women's Day

For a few years now, I've been hearing about the 8th of March's celebration of "International Women's Day" from my very Bulgarian boyfriend.  This very Socialist holiday is Valentine's Day and Mother's Day rolled into one, but I'd never heard of it from anyone besides Nikolay. Today, however, while walking in the streets of Madrid, I saw Spanish women carrying roses, and signs and banners commemorating the 100th annual Women's Day.  Turns out the Bulgars didn't make it up.

In honor of this festive and feminist occasion (and given that my sojourn in Spain doesn't give me much time to write a blog post!), I wanted to post an extremely relevant film.  It runs almost an hour, but it is well worth the time.

http://www.answers.com/topic/a-walk-to-beautiful-1

Film: A Walk to Beautiful

This award-winning documentary focuses on five Ethiopian women living with obstetric fistula, a devastating yet reversible injury incurred during childbirth.  If you have never heard of obstetric fistula, I am not going to describe it here - just be aware that there are complications of pregnancy far worse than going into labor in a taxi or elevator, as per sitcom convention.  

According to the UNFPA, approximately 2 million girls and women worldwide currently suffer from this condition.  Obstetric fistula almost exclusively affects women from impoverished regions who give birth before the age of 18.  Married off before puberty and impregnated through what would most tactfully be called statutory rape, the girls unlucky enough to develop a fistula endure their condition along with the disgust of their husbands and the rejection of their communities.

The documentary is poignant but not preachy, powerful, yet not overdone.  The disclaimer at the beginning of the film warns the viewer that the subject material is "mature."  Unfortunately, there are some aspects of pregnancy too unpleasant for baby shower games, and not cute enough for a TLC special.  In a nation that loves to raise its voice about choice vs. life, Roe vs. Wade, we so rarely discuss the victims who suffer most at this crossroads of culture, politics, and religion:  young, impoverished girls who have never had a "choice" about anything.