The early induction of labour.On December 11, 2008, LifesiteNews.corn reported that Father Michael Prieur, chief bioethicist at St. Joseph's Catholic Hospital in London, Ontario, stated that for the past 20 years, St. Joseph's has been performing "early induction" of labour in cases of diagnosed "lethal fetal anomalies." The Ethical Guide Lines For Lethal Fetal Anomalies at St. Joseph's Health Care, London, Ontario, state that the presence of a lethal fetal anomaly indicates that an infant "is dying in the womb, or will die shortly after birth." The Guidelines also indicate that early induction is not done until after "viability" of the fetus, and is permitted only for a "proportionate reason, which can include grave physical, psychological or psychiatric considerations."
Relevant medical facts Lethal fetal anomalies include: Anencephaly;, Cardiac myopathy; Fetal alcohol syndrome; Turner syndrome; Fragile X syndrome; Triple X syndrome.
It should be noted that the fact that a fetus has a lethal fetal anomaly is not associated with a threat to the life of the mother. 'Fetal viability' is the age beyond which the fetus has a good chance of surviving delivery. The normal fetus rarely survives at less than 22 weeks gestation, at which time it has a 10% chance of survival. In fact, he or she has difficulty surviving at less than 28 weeks. Estimation of fetal age is not precise and, depending on when tested for, can be plus or minus 2 to 3 weeks above or below the true fetal age.
Furthermore, the diagnosis of fatal fetal anomaly is not always correct. Since there is no risk to the mother's life, the diagnosis of fetal disease may be inaccurate, and early induction cannot help the fetus with 'lethal fetal anomaly.' Early induction is equivalent, not to abortion, but to euthanasia, if the baby does not die until after birth. If the infant dies as a result of the early induction before birth, early induction is an abortion.
The Principle of Double Effect The Ethical Guidelines of St. Joseph's Hospital state that "Medical treatment is permitted to prevent or cure a grave illness in a pregnant woman that cannot be deferred until the unborn child is viable, even though pregnancy may be endangered. Thus, operations, treatments, and medications that have as their direct purpose, the cure of a proportionately serious pathological condition of a pregnant woman, are permitted if they cannot be safely postponed until the unborn child is viable, even though they will result in the foreseen but unintended death of the unborn child."
The above guidelines here refer to Catholic Church teaching on the Principle of Double Effect. The Church teaches that one may legitimately choose to carry out an act that is morally good, but which has one or more unintended side effects that are morally evil. Guidelines that must be met for that act to be morally acceptable are as follows.
* The intended act must be morally good in itself and may not be morally evil.
* The good effect of the act must be that which is directly intended by the one who carries out the act. The bad effect that results may be foreseen but must not be intended.
* The good effect must not be brought about by using morally evil means.
* The good effect must be of equal or greater proportion to any evil effect that would result.
* Acts that have morally evil effects are permissible only when truly necessary, i.e. when there are no other means by which the good may be obtained.
Further relevant medical facts The St. Joseph's Guidelines fail to distinguish between lethal fetal anomalies and diseases of the mother that pose a risk to the health or life of the mother and/or child. Such diseases include: Preeclampsia, pregnancy inducted hypertension, and also conditions related to preeclampsia, such as
* HELLP. This stands for Hemolysis, Elevated Liver Enzymes, and Low Platelet Count.
* Eisenmenger's Syndrome.
* Ballantyne Syndrome.
In all of these diseases, complications may occur that threaten the life of the mother and child. These complications include, lack of blood flow to the placenta, separation of the placenta from the uterus, with hemorrhage, and eclampsia, convulsions that can cause brain damage and death for both mother and child. Treatment includes bed rest, anti-hypertension medication, and delivery at, or close to, term. In very severe cases, it may be necessary to induce labour or perform a Caesarian section before the child is viable. However, in most cases, this is not necessary. Such an early induction of labour or Caesarian section would be justified by the principle of double effect if the life of the mother and/or child is threatened by the disease.
Another condition that may require early induction of labour is placenta praevia, where the placenta is low lying and fully or partially obstructs the cervix of the uterus.
None of these diseases is associated with fatal fetal anomaly.
In light of the above medical facts and of the Catholic Church teaching in regard to the right to life of every human being and in regard to the principle of double effect, it appears that a final judgment cannot be made about the practice of early induction at St. Joseph's Hospital until the full medical facts are revealed. On the information released so far by St. Joseph's Hospital, its practice of early induction does not appear to be justified.
By John B. Shea, MD FRCP(C)