Bioethics Discussion Blog: Is Pregnancy a Disease?

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Wednesday, October 01, 2014

Is Pregnancy a Disease?








Here is a topic hot off the September-October 2014 Hastings Center Report, a bioethics journal, that should raise a few eyebrows of agreement or rebuttal.

The point of the article is if pregnancy is NOT a disease then healthcare providers who refuse to perform abortions need not claim "conscience" as the basis for their refusal but claim that pregnancy and abortion are not part of what medicine has always been defined. The premise: "the scope of the very concept of medicine and disease circumscribes the scope of proper medical practice.  Procedures and activities that fall outside the scope of medicine and disease are not properly within the brief of healthcare personnel."

Currently, physicians and other healthcare providers can refuse to provide abortions if it is against their religious or moral views.  However, it also a social understanding that every employee 's responsibility toward his or her occupation in terms including of "taking on a job" depends specifically on the what society expects from those trained for that work.  You don't expect a plumber to perform an appendectomy or a physician to design or construct a highrise building as part of the criteria of the profession of medicine.  So the argument could be that the duty to perform the work of healthcare is set by the standards set by the work itself and to refuse an activity which has not been formally set is acceptable. Pregnancy itself is not a abnormal condition or disorder of a healthy life and therefore a disease and for a healthcare provider whose professional responsibility is to attend to the issues of disease or the prevention of disease, to be compelled to terminate a normal life function without a disease basis could be considered professionally unacceptable. What do you think? What view do you hold? ...Maurice.


Graphic: Pregnancy. From Google Images.

6 Comments:

At Thursday, October 02, 2014 9:13:00 AM, Blogger A. Banterings said...

I need to publish this comment in 2 parts.
This is part 2:
Published in reversed order for readability.

Look at the high rate of caesarians in the US and the rate of vaginal births after a caesarian is almost 0%. There is a backlash against caesarians which is why many women choose home birth and midwives.

Pregnant women put a lot of trust in their doctors and hospitals. But a Consumer Reports investigation of more than 1,500 hospitals in 22 states suggests that such trust may be misplaced. It found that in many hospitals, far too many babies enter this world through cesarean section.

While some C-sections are absolutely necessary for the health of the mother or baby, the high C-section rates in our low-scoring hospitals are “unsupportable by professional guidelines and studies of birth outcomes,” said Elliot Main, M.D., director of the California Maternal Quality Care Collaborative and former chairman of the department of obstetrics and gynecology at the California Pacific Medical Center in San Francisco, who reviewed our data.

Our Ratings reveal that C-section rates vary dramatically—even between neighboring hospitals. For example, almost 55 percent of pregnant women anticipating low-risk deliveries—that is, women who haven’t had a C-section before, don’t deliver prematurely, and are pregnant with a single baby who is properly positioned—nonetheless undergo a C-section at Los Angeles Community Hospital. But at California Hospital Medical Center, also in Los Angeles, the rate of C-sections for low-risk deliveries is 15 percent; at Western Medical Center Anaheim, 28 miles away, it’s about 11 percent.
Source: Consumer Reports



Why such a high rate of C-sections?

Some economists have suggested financial incentives may be at play; a 2013 paper by the Source: National Bureau of Economic Research determined doctors make a few hundred dollars more and hospitals make a few thousand dollars more for C-sections versus vaginal deliveries. That same paper found doctors were less likely to perform C-sections on mothers who were doctors, which they hypothesized was because medical knowledge made them less resistant to pressure.
Source:


Back to the abortion issue. In China practices of forced abortions, infanticide and involuntary sterilizations [are] all banned in theory by the government, but they still happen. Source:

I ask, are Chinese physicians allowed to become licensed and practice in the United States? Perhaps we should ban Chinese physicians from practicing in the US based on these same moral objections.

But wait, there is a shortage of physicians in the US and we need them to fill the gap. Source: NY Times article: America Is Stealing the World’s Doctors

Economic reasons (again)!

Perhaps the solution to the abortion debate is to make abortions more profitable like C-sections, plastic surgery, IVF, etc., and see what happens....

--Banterings

 
At Thursday, October 02, 2014 9:13:00 AM, Blogger A. Banterings said...

I need to publish this comment in 2 parts.
This is part 1:
Published in reversed order for readability.

Note: My position on the abortion debate is that I personally do not approve unless there are certain situations (risk to mother's life, incest, rape, etc.). That being said, I do not push my beliefs on anyone else. I do not believe in legislating morality either, hence I do not believe it should be illegal.

Let me pose this to you, if you oppose abortion based on the rational that it interferes with "a normal life process," would you also not oppose contraception based on the same principal (interfering with a normal life process)?

As to the "issues of disease or the prevention of disease;" What about plastic surgery for the sake of vanity? It is argued that there is a psychological component to the "mental wellbeing of the patient." Can this not also apply to an unwanted pregnancy? Is there an economic component to plastic surgery, mainly its profitability?

What about screening for disease and gender in IVF? Is this not a form of "plastic surgery" on a "normal life process?" Is there a profitability component to this too? (Remember profitability for later.)

Are there not cases where abortions are performed as an acceptable part of healthcare (ectopic pregnancy, risk to the mother slim chance of survival of the fetus, where the fetus is not viable, placenta bleed, etc.) ?

Are they taught in medical school? If not, how does one learn to do them?

If they are taught in medical school, then they are considered an accepted medical procedure. The physician's fiduciary duty to the patient (the benefit of the patient over the physician's own benefit) may compel physicians to perform them against their own moral judgement.

Can a physician refuse to treat a serial killer based on religious and moral objections, and under what circumstances?

Can a physician refuse to treat a transgender/bisexual/homosexual patient based on religious and moral objections, and under what circumstances?

Can a Muslim physician refuse to treat a Jewish patient under religious and moral objections?

These questions may provide insight to the ethical answer.

It seems that healthcare treats pregnancy as a disease. I know this strays from the topic of abortion, but supports healthcare treating pregnancy as a disease.

--Banterings

 
At Monday, October 06, 2014 10:33:00 AM, Blogger A. Banterings said...

If pregnancy was a disease, then why are we trying to cure it?

See First womb-transplant baby born

 
At Sunday, October 12, 2014 10:10:00 AM, Anonymous Anonymous said...

If you can't do the full duties of a job due to your beliefs, you shouldn't have that job.

There are plenty of jobs in medicine where birth control, abortions, etc, will not be an issue in your career. If it is that important to you that you never provide someone with birth control, then get a job where providing birth control won't be asked of you.

-JR

 
At Thursday, November 13, 2014 3:54:00 PM, Anonymous Anonymous said...

yea! you have to take the full duties of the pregnant.

 
At Tuesday, December 09, 2014 3:54:00 PM, Blogger A. Banterings said...

British government says giving birth at home or birthing centers with midwives is safer for 45% of women. Healthy women had more epidurals, more, cesarean sections, and more complications in maternity wards.

Reversing a generation of guidance on childbirth, Britain’s national health service advised it was safer to have their babies at home, or in a birth center, than in a hospital.

Women with uncomplicated pregnancies — about 45 percent of the total — were better off in the hands of midwives than hospital doctors during birth, according to new guidelines by the NICE.

Hospital births were more likely to end in cesarean sections or involve episiotomies, a government financed 2011 study carried out by researchers at Oxford University showed. Women were more likely to be given epidurals, which numb the pain of labor but also increase the risk of a protracted birth that required forceps and damaged the perineum.

The risk of death or serious complications for babies was the same in all three settings, with one exception: In the case of first-time mothers, home birth slightly increased that risk. Nine in 1,000 cases would experience serious complications, compared with five in 1,000 for babies born in a hospital.

Not everyone was at ease with the new guidelines. “Things can go wrong very easily and we do feel this advice could be dangerous,” Lucy Jolin of the Birth Trauma Association told the BBC.

So far doctors have not expressed any outrage over the decision. “If we had done this 20 years ago there would have been a revolution,” Dr. Baker said. “The penny has dropped. We’ve won the argument.”Source: NY Times

National Institute for Health and Care Excellence press release.

"The principal reason is because they are kept away from doctors with their knives." "We have over-medicalized delivery and are doing more harm than good as a result." --Professor Mark Baker, NICE’s clinical practice director and author of the new guidelines. Source: NBC News

So what is birth in the US like? Another case of physicians think that they know your body better than you...


Insane Hospital Threatens Mom Who Wants VBAC With CPS And Forced C-Section

Pregnant Mom Says Hospital Threatened To Call Child Services Unless She Has C-Section

Florida woman ordered to have a C-section against her will

Case of New Jersey woman who lost custody of baby because she refused a cesarean raises many issues

CPS removed Illinois baby after homebirth - can it happen to any of us?

What ever happened to first do no harm?

--Banterings

 

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