Challenges of Fetal Medicine
This is in reaction to Barry Siegel’s series (Nov. 16-19) on fetal medicine. Particularly to the fourth article, “You Have to Individualize These Cases.” It seems to me Siegel ignored two pertinent individuals in these cases: the woman carrying the fetus and her partner.
Consistently in this series, physicians appeared to make the decisions concerning the fetus. The parents were considered, not consulted, as to what they could tolerate. As both a sociologist and a marital and family counseling trainee, I question whether these physicians are qualified to make such decisions. Is it their place to decide what kind of a parent can deal with a handicapped child, or whether to inform them of test results? Is it Dr. Angela Scioscia’s place to make a value-laden statement such as, “How many people do you alarm and worry in order to benefit and prevent tragedies?” It seems difficult for me to believe these individuals, many of whom openly state their devout religious feelings, are able to refrain from imposing part of their value system on their patients.
Are patients not autonomous individuals with the right to be informed and make their own decisions? Physicians should be there to interpret scientific facts, help parents explore options, but not to make their decisions. It appeared that Dr. Michael R. Harrison was in the minority by his consistent placement of authority to make decisions in the hands of the parents.
Imposition of the physician’s belief system on the patient was also apparent in the discussion of parental right to terminate a pregnancy. Whether the decision is based on an apparent fetal malformation, potential disease later in life for the fetus, or even the sex of the fetus, it is truly the parent’s right to choose. While you and I might disagree with the specific reason for termination, unless we are prepared to take complete responsibility for the life of that fetus, we have no right to impose our own values on others.
This brings me to my second point. In this particular article, women are treated as merely a receptacle for holding and expeling the fetus. This is the same woman who must endure the physical and psychological stress of pregnancy. This was particularly poignant in Drs. Lawrence D. Platt and Harrison’s desire to use anencephalic fetuses for organ transplants. There was no mention of the psychological effect on a woman who completes a pregnancy that she knows will end in the death and dissection of her child. Whose right is it to ask that of another human being?
A more subtle, but equally absurd, indication of the “woman as receptacle” attitude was Dr. Platt’s treatment of his own wife. The article presented the decision to have an amniocentesis as purely his. “She wanted an amniocentesis. He said no . . . He does not know why he refused her an amniocentesis.” Even in his own marital relationship, the pregnant woman evidently had no right to take part in a decision concerning her body, her life, and the future of her child. What does this indicate about Dr. Platt’s respect for the other women he treats? Not only does this attitude degrade women by discounting their power to make decisions, but it completely disregards their partners who, hopefully, will aid and support pregnant women in this time of stress. Regardless of a physician’s decisions concerning his or her own family, unless the doctor is willing to take complete responsibility for the fetus’ future life, the parents should make the decisions that concern their pregnancy.
While the technology being developed in the area of fetal medicine is both exciting, and affords parents additional chances for healthy children, physicians need to look closely at the values and decisions they are imposing on their patients. Additionally, they need to remember that they have another patient to consider besides the unborn child. The pregnant couple, clearly, should be placed in charge of the decision-making process. While various groups continue to debate the point at which a fetus is a separate human being, there are no such doubts concerning the parents.
SUSAN C. REMPEL
La Canada
