Friday, January 18, 2013

Collateral Damage in the War for Fetus-rights: unexpected victims of pro-life zeal

Abortion is one of those enduring points of contention in our political landscape. We may rail for a season about war, water boarding, gun control, voter fraud, or debt ceilings, but there seems to be an enduring passion in this nation to revisit Roe v. Wade. Sure, the decision is already there; but that doesn't stop people from demanding that it be overthrown or legislated into oblivion. There's no denying that the pro-life base is fervently committed to their cause, arguably even more so than many in the pro-choice community. After all, abortion is legal; to many people's minds, that's the end of that. Not so to the pro-life community. The last few years have seen literally hundreds of anti-abortion bills pushed throughout the country. They have seen the return of social conservatism on the national scale. Republican presidential contenders were tripping over themselves this past election season to convince voters that they were the most opposed to abortion. And anti-abortion protests are as alive and well (and I use the term lightly) as they ever were.

Oftentimes, in the zeal to win over voter bases and earn Heaven Points, the implications of these moves are ignored or even embraced. The people who suffer are ignored as more or less collateral damage in the fight to win rights for fetuses. But make no mistake. People do suffer, and even die, because of pro-lifers' efforts, here and in other nations, to establish the inviolable rights of the fetus, regardless of who they hurt in the process.

Miscarriage
It's a given that whatever prompts a woman to seek an abortion – be it a difficult or easy choice for her – would be of little consequence to those who consider it murder. Her comfort, peace of mind, future, and even ability to adequately provide for other children aren't as important as preventing what the pro-life doctrine considers murder. While that's a discussion for another post, I take it for granted hereafter that those motivations and reasons are beyond consideration by the pro-life community (since they are).
But one of the truly strangest side effects of some pro-life activity is the impact it has on women who miscarry. These measures are generally aimed at women who are attempting to terminate a pregnancy that involves a live fetus -- because, according to the pro-life POV, this is murder, and little (in some cases, nothing, not even the woman's very life) justifies that choice. But in practice, they often impact women (and men) who very much wanted to carry a child to term: grieving would-be parents, who have lost a wanted member of their family. People who should, according to the pro-life narrative of parenting and family, be the object of sympathy and kindness. Not when they're collateral damage in the fight to eradicate abortion, however.

For example, consider the experience, at the hands of pro-life protesters who frequent the clinic, of one couple in Alabama:

whose baby had died en utero [and] was coming to the clinic to have it removed. In an awful coincidence, that was the day, Watters said, when the pro-life demonstrators collected a children’s choir on the sidewalk to sing “Happy Birthday Dead Baby” to anyone driving in.
“Will had to physically restrain the father,” Watters said, nodding to one of the men marching in a pro-choice jacket. “And by the time she walked through them, she was an emotional wreck.”

This is a clinic where at least one protester has been arrested for assault. In such a case, there seems to have been no thought spared whatever for the circumstance that drove people to seek abortion: the protesters assume that the person requesting an abortion is simply a callous baby murder. And if she happens to be a grieving mother, there with her grieving husband? Well, collateral damage. There can be no thought spared, or compassion given, for the “enemy”, whether that is the woman who can't afford another child or the woman whose pregnancy ended in a heart wrenching death. This is a deep running problem in much of the pro-life movement. People who need or want abortions do not matter; the fetus, dead or alive, is what matters. The woman's circumstance ceases to matter. It used to be that a woman's bodily autonomy was dismissed out of hand, but now there are no extenuating circumstances that justify abortion, even within the very narrow pro-life parameters. If you get an abortion, you are the enemy. Period.

But individual experiences at the hands of sanctimonious, callous protesters pale in comparison to the legislation that has been introduced. There were the fetal remain bills in Michigan, which classified fetal tissue after 10 weeks as a “dead body” – meaning that women who miscarried now had to consider whether to cremate, bury or inter a 10 week old fetus. There was the bill in Georgia (that eventually passed, after adding an exception for “medically futile” pregnancies) that, in its original form would have forced women to carry dead fetuses to term. The argument for this, from Georgia Representative Terry England, was that:

Life gives us many experiences…I’ve had the experience of delivering calves, dead and alive. Delivering pigs, dead or alive. It breaks our hearts to see those animals not make it.

In other words, if livestock could do it, women can do it too: nevermind that carrying a dead thing around inside you is by no means healthy. Pigs can do it. So can you, ladies! This is only just collateral damage, in that its supporters acknowledged beforehand that a woman whose fetus expired through no desire of her own would still be forced to carry that fetus' dead body around until such time as her body expelled it. But that was, shall we call it, an added benefit: the desire was to curb abortion of live fetuses. Legislators like England were perfectly happy to force women to carry dead human tissue inside their wombs, but it wasn't the goal of the bill. Just collateral damage.

The view of women and others connected to pregnancy as secondary concerns to the fetus creates perhaps the most damaging collateral damage when it permeates medicine. Such is the case in many Catholic hospitals, where so-called “heart beat” rules are in place – rules that dictate that, so long as there is a fetal heartbeat, physicians cannot interfere with a pregnancy (even if it is doomed, and waiting imperils the life of the mother). The following example from a report in the American Journal of Public Health in 2008 illustrates the problem rather well:

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.”

In some cases, as above, other physicians can and do accept the patient (despite the risk such a delay presents to the woman's life). In others, this is not an option. One physician quoted in the study tells another story:

I'll never forget this; it was awful—I had one of my partners accept this patient at 19 weeks. The pregnancy was in the vagina. It was over… . And so he takes this patient and transferred her to [our] tertiary medical center, which I was just livid about, and, you know, “we're going to save the pregnancy.” So of course, I'm on call when she gets septic, and she's septic to the point that I'm pushing pressors on labor and delivery trying to keep her blood pressure up, and I have her on a cooling blanket because she's 106 degrees. And I needed to get everything out. And so 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… . She was in DIC [disseminated intravascular coagulopathy]… . Her bleeding was so bad that the sclera, the white of her eyes, were red, filled with blood… . And I said, “I just can't do this. I can't put myself behind this. This is not worth it to me.” That's why I left.

Anyone familiar with the details surrounding the needless tragedy of Savita Halappanavar's death can get a pretty good idea of how close the patient in the story above was to needlessly dying. In this case, the “collateral damage” would have been fatal; instead, the patient suffered excessively, and very nearly died (to say nothing of the costs that such a 10 day hospital stay would have incurred). Why? Because of a rigid set of rules designed to protect the fetus (even when there is no hope for its survival) regardless of who is killed or nearly killed in the process. The mother's death would simply be collateral damage in this war to protect fetal rights.

Enter the courts
But it's not only women who miscarry or those seeking abortions who suffer under efforts designed to look out for the rights of the fetus with no thought to others. Consider, for instance, the case of Laura Pemberton, who:

was in active labor at her home in Florida. Doctors, aware of this, believed that she was posing a risk to the life of her unborn child by attempting to have a vaginal birth after having had a previous cesarean surgery (VBAC). The doctors sought a court order to force her to undergo this surgical procedure. A sheriff went to Pemberton’s home, took her into custody, strapped her legs together, and forced her to go to a hospital, where an emergency hearing was under way to determine the state’s interest in protecting the fetus still inside her. While lawyers argued on behalf of the fetus, Pemberton and her husband, who were not afforded the opportunity to be represented by counsel, “were allowed to express their views” as she was being prepared for surgery. The judge presiding over the case compelled Pemberton to undergo the operation, which she had refused and believed to be unnecessary. When she later sued for violation of her civil rights, a trial-level federal district court ruled that the state’s interest in preserving the life of the fetus outweighed Pemberton’s rights under the First, Fourth, and Fourteenth Amendments. Pemberton subsequently gave birth vaginally to three more children, calling into question the medical predictions of harm from a VBAC on which the court had relied.

The mother's rights simply didn't matter, if they were deemed by others to be at odds with the interest of the fetus. Nevermind that, despite the wishes of both mother and father, physicians were forcing surgery on Ms. Pemberton. Her rights were simply collateral damage when they interfered with the perceived best interests of the fetus – down to the point of taking her into custody and strapping her legs together until the surgery could be performed.

In some cases, the collateral damage in the pro-life fight for the fetus is the fetus itself. Consider Martina Greywind's case:

Martina Greywind, a twenty-eight-year-old homeless Native American woman from Fargo, North Dakota, was arrested when she was approximately twelve weeks pregnant. She was charged with reckless endangerment, based on the claim that by inhaling paint fumes she was creating a substantial risk of serious bodily injury or death to her unborn child. After spending approximately two weeks in the Cass County Jail, Greywind was able to obtain release for a medical appointment. At that appointment Greywind obtained an abortion, despite widely publicized efforts by abortion opponents to persuade her to carry the pregnancy to term. Following the abortion, Greywind filed a motion to dismiss the charges. The state agreed to a dismissal: “Defendant has made it known to the State that she has terminated her pregnancy. Consequently, the controversial legal issues presented are no longer ripe for litigation.” According to news reports, the prosecutor in the case stated that since Greywind had had an abortion, it was “no longer worth the time or expense to prosecute her” (Orlando Sentinel 1992)

Such laws are designed with the goal of punishing those who would harm a fetus, presumably with the longterm aim of protecting fetuses. But in practice, Ms. Greywind was legally better off terminating her pregnancy than continuing it. In other words, the pro-life zeal to punish anyone who would even inadvertently harm the fetus in practice convinced Ms. Greywind to obtain an abortion. Thus the exact opposite of the very thing that, presumably, was the goal – protecting the fetus – was achieved. The fetus was the collateral damage.

Personhood
And then there's personhood. Paul Ryan, Todd Akin, and others have supported personhood on a national scale, and states around the nation have entertained similar measures. Personhood would define a human egg and its subsequent forms, from the moment of conception on, to be fully human, and extended full rights under the law as such. The potential for “collateral damage” is tremendous here. For starters, it would encompass everything we've already talked about: no medical procedure that would destroy an zygote, embryo or fetus would be permissible, as such would be killing a “person”. Imagine a world where you could not terminate a doomed ectopic pregnancy, but must instead let a woman die because ending that ectopic pregnancy would be “murder”. That is precisely what personhood would entail. It is exactly what personhood has entailed for women in countries where such measures are already in place – like the Dominican teenager who was denied leukemia treatment until it was too late, or Savita Halappanavar in Ireland who died of a blood infection after doctors refused to remove her dying fetus while there was still a heartbeat. These women (and girls), and their lives, were simply collateral damage to those who prioritize the personhood of the fetus above the personhood of women.

But the implications reach beyond the medical decisions of the mother. Today, if a minor person dies, it is a legal matter. Investigation ensues, and a cause of death must be established that absolves parents from responsibility. Otherwise, they tend to find themselves charged. If a fetus is a person, and a woman miscarries, she will then find herself in the same spot as a parent whose child dies – except that that “person” exists inside of her, and any harm to it is more likely to be pinned at her door. A woman who miscarries, then, will have to prove that she did not in some way precipitate the death of that “person”.


And these are a handful of the examples I've found in news articles or journal papers that I've stumbled across recently. The point that is particularly interesting to me is that the pro-life movement seems not to take into account, or, from a more cynical view, not to care, about the collateral damage their efforts create – no matter how loudly people decry the dangers, the personhood measures and anti-abortion measures continue. The Republican party in 2012 made no effort to include exceptions to its anti-abortion platform even for the life and health of the mother – to say nothing of rape and incest victims. The obsession with the rights of the fetus trump the rights of the mother and the father. Women can die, even if it the fetus dies as well; rape victims should be happy with their “gift from God”; and who can pass up singing “happy birthday dead baby” to a family whose baby just died? The rights of the fetus are sacrosanct. The means of conception doesn't matter; the mother's health and life doesn't matter. The right-to-life of the fetus is supreme.

On the other hand, if we're talking about the right-to-life of that fetus a few years down the road? Well, don't look to America's pro-life culture warriors for any help there. As anti-abortion advocate and pro-life darling Rick Santorum put it, the sick child's rights depend on the market return:

I sympathize with these compassionate cases. … I want your son to stay alive on much-needed drugs. Fact is, we need companies to have incentives to make drugs. If they don’t have incentives, they won’t make those drugs. We either believe in markets or we don’t.

As a fetus, you can kill your mom or destroy her health and the Santorums and LiveAction's of the world will be behind you all the way; but once you're out of the birth canal, you better pray that nothing's wrong. Because, in their world, you'll wind up collateral damage to the free market if you can't afford the medicine you need to stay alive. Which really is an interesting dilemma. Fetal life is All in All, sacrosanct and untouchable, and must be protected even if it destroys its mothers (and its own) in the process. But a mother's life can be sacrificed as collateral damage. A child's life can be sacrificed as collateral damage.

None of which seems very pro-life to me. But, hey, maybe that's another victim in this discussion – the desire to preserve actual life has been sacrificed on the altar of advancing particular religious and political views regarding fetuses. Beyond that goal, the rest is negotiable. Collateral damage, if you will.

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