One way to determine how Initiative 26 might impact women’s health is to look at Mississippi hospitals which operate under strict pro-life principles, including Catholic hospitals such as St. Dominic’s here in Jackson.
When I was pregnant with my son and deciding on a hospital, my own OB counseled me that I should choose River Oaks over St. D’s if I wanted a tubal ligation performed as part of my C-section. St. D’s takes Catholic doctrine so seriously that they will not allow elective sterilization procedures to be performed. That’s their right, and I respect it even if I don’t agree with it, so I chose to deliver at River Oaks in order to keep my options open.
When I began researching Initiative 26, a repeated assertion from the pro-26 side was that ectopic pregnancy and similar situations would continue to be treated. The language of their FAQ has been changed multiple times times, but at various times they’ve stated that “every effort [should] be made to save both lives”, and the current version of their printable flyer states that “the doctor would be required to save both lives if possible”.
So what does it mean to “save both lives”, and who decides what constitutes “every effort”?
As we’ve already seen in our post on ectopic pregnancy, there is no single universal pro-life answer. Some pro-lifers feel that methotrexate is permissible, while others feel that the standard of “every effort” requires them to perform surgery as a last resort when rupture is imminent.
I’ve confirmed that St. D’s pharmacy has methotrexate available in the correct dosages for pregnancy termination, but according to the physician I spoke with, this is somewhat hypothetical. Methotrexate is used when a symptomless ectopic is diagnosed in an outpatient setting, and any patient who presented to the ER with bleeding or pain would probably require surgery anyway. My physician did confirm that St. D’s does offer surgical management of ectopic pregnancies, although I’m not clear if they offer tube-sparing surgery (see our earlier post on ectopics for a discussion of the ethical issues in play).
That said, things get much less clear when we start talking about more advanced pregnancies. In at least one case of which I am aware, St. D’s has refused to induce labor in a critically ill mother of of a pre-viability fetus, claiming that it was not their place to decide which life to save.
Now, I realize that our pro-26 readers may be inclined to dismiss that as hearsay, especially since I do not know or am unable to provide further specifics due to patient privacy concerns. That’s why I would like to direct you to this article from the University of California, discussing physicians’ real-world interactions with pro-life Catholic hospitals.
The article discusses how Catholic hospitals handle situations where there is a clear medical indication for termination of a fetus who still has a heartbeat, when the life of the mother is in serious risk, and how hospital policy limits doctors’ ability to treat their patients. A few choice quotes:
Physicians such as Dr H found that in some cases, transporting the patient to another hospital for dilation and curettage (D&C) was quicker and safer than waiting for the fetal heartbeat to stop while trying to stave off infection and excessive blood loss.
Because the fetus was still alive, they wouldn’t intervene. And she was hemorrhaging, and they called me and wanted to transport her, and I said, ‘‘It sounds like she’s unstable, and it sounds like you need to take care of her there.’’ And I was on a recorded line, I reported them as an EMTALA [Emergency Medical Treatment and Active Labor Act]violation. And the physician [said], ‘‘This isn’t something that we can take care of.’’ And I [said], ‘‘Well, if I don’t accept her, what are you going to do with her?’’ [He answered], ‘‘We’ll put her on a floor [i.e., admit her to a bed in the hospital instead of keeping her in the emergency room]; we’ll transfuse her as much as we can, and we’ll just wait till the fetus dies.’’
Physicians working in Catholic- owned hospitals in all 4 US regions of our study disclosed experiences of being barred from completing emergency uterine evacuation while fetal heart tones were present, even when medically indicated. As a result, they had to delay care or transfer patients to non–Catholic-owned facilities. Some physicians violated the authority and protocol of the ethics committee to deliver what they considered safe medical care that reflected the standard of care learned in residency
I put the ultrasound machine on and there was still a heartbeat, and [the ethics committee] wouldn’t let me because there was still a heartbeat. This woman is dying before our eyes. I went in to examine her, and I was able to find the umbilical cord through the membranes and just snapped the umbilical cord and so that I could put the ultrasound—‘‘Oh look. No heartbeat. Let’s go.’’ She was so sick she was in the [intensive care unit] for about 10 days and very nearly died…Her bleeding was so bad that the sclera, the white of her eyes, were red, filled with blood.
Putting forth every effort to save fetuses can have grave impacts on mothers’ lives.
I want to note something very important about the stories from this article: in all cases, the physicians had the option to transfer their patients to another hospital with less stringent standards.
Under personhood, all Mississippi hospitals would have to adhere to the same standard, so there would be no way to transfer critically ill and unstable patients elsewhere for treatment. Likewise, it takes much longer to get legal approval than to contact a hospital’s ethics representative on an emergency basis.
Stop and think about that for a minute. Pro-life hospitals currently interpret their pro-life principles to mean that mothers who are actively bleeding to death, or dying of infection, can’t have their pregnancies terminated to end the immediate critical threat to their very lives. That’s what fetal personhood means to the ethics committees of those hospitals, which are composed of smart people who think very hard about the medical and ethical issues at stake.
Do you think that your state senators and representatives, or your county judges, would be somehow qualified to make better decisions than those ethics committees? Are you willing to trust that they will use a looser interpretation of personhood than the pro-life ethicists at hospitals like St. D?
If you were unfortunate enough to be in that situation, would you want the government to decide for you when you were really and truly sick enough to be permitted to terminate the pregnancy? Or would you want to use your best judgment and your doctor’s expertise, without worrying about getting judicial approval or facing legal enquiry?
I know what I would do. I would pray, and talk it over with my husband if there were time, and then I would put my trust completely in the hands of the doctor whom I had hoped would help me give birth to a healthy baby. And that’s yet another reason why I believe Initiative 26 is bad for ALL women, pro-choice and pro-life.
This post is for Cecily, who lost her sons in 2004 to preeclampsia.