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British Journal of Medical Ethics

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BMJ on RCOG Fetal Awareness White Paper #SB5 #TxProlife

The Royal College of Obstetricians and Gynecologists published their white paper on “fetal awareness” in 2011. (Royal College of Obstetricians and Gynaecologists. Fetal Awareness – Review of Research and Recommendations for Practice. London: RCOG Press 2010 http://www.rcog.org.uk/files/rcog-corp/RCOGFetalAwarenessWPR0610.pdf  Accessed June 24, 2013).

 
Here is a peer-reviewed, “editor’s choice” editorial outlining the flaws in that paper. “Fetal awareness and fetal pain: the Emperor’s new clothes” by Dr Martin Ward Platt, Newcastle Neonatal Service, of the Royal Victoria Infirmary http://fn.bmj.com/content/96/4/F236.long#ref-1 (Accessed June24, 2013).

 
The author, Dr. Platt, points out that the evidence for no fetal awareness until birth has no evidence in humans, only in animals. He further points out that it goes against our experience with sleep/wake cycles and what we know about the ability of the fetus to learn his mother’s voice and other learning, including long-term effects on brain anatomy and response to pain:

 

“So, what is the evidence that the human fetus lacks ‘awareness’? In a word, there is none. The only evidence, including the bit about the chemical environment, is in sheep and one or two other experimental animals. I have looked at the references in the report, and the references in the references, and when I finally got back to the primary literature I found no evidence for the contention that human fetuses lack awareness, or exist in some different conscious state, beyond the unwarranted extrapolation from sheep.

“In contradiction to the notion of the ‘unaware’ fetus, the everyday experience of pregnancy – the felt behaviours and responses of the unborn baby, especially to sound – as well as much primary research literature on the human fetus, contains strong evidence for an opposite view. There is an extensive literature, in humans, on fetal sleep and wakefulness, fetal motility, fetal memory, fetal hearing, fetal breathing and its control and fetal behaviour – and these are just examples that scratch the surface. None of this work is easily reconciled with the notion of a permanently unconscious human fetus. The third point in box 1 is simply not true.”

and

“. . . the precautionary principle of prevention and treatment of pain in case it is being experienced, which is an ethical rather than a scientific argument, nor does it affect the evidence in relation to the long term neurobiological effects of pain experiences in preterm babies.”

and

 

 

. . . “One notices statements in the report such as: “Interpretation of existing data indicates that cortical processing of pain perception, and therefore the ability of the fetus to feel pain, cannot occur before 24 weeks of gestation”. We could rewrite this as ‘in theory they can’t feel pain, therefore they don’t’. It is the substitution of wishful thinking for empirical enquiry. It reminds me of my days as a medical student when I was taught that once the periosteum was anaesthetised, bone marrow aspiration was painless because there were no nerve endings in the bone. As soon as I came to perform bone marrow aspiration I realised that, whether there were supposed to be nerve endings or not, the procedure caused deep bone pain. So: should we deny patients’ real experiences on entirely theoretical grounds, or accept them and look harder for the underlying cause? We now know that bone is richly innervated, but older techniques of bone histology were unable to demonstrate the fibres.”

BTW, Here’s the part of that (debunked by Dr Platt) 2011 RCOG paper that I found most interesting:
“One possible solution is to recognise that the newborn infant might be said to feel pain, whereas only the older infant can experience that they are in pain and explicitly share their condition with others as an acknowledged fact of being.”

British Journal of Medical Ethics: “after-birth abortion”

“1. The moral status of an infant is equivalent to that of a fetus, that is, neither can be considered a ‘person’ in a morally relevant sense.
“2. It is not possible to damage a newborn by preventing her
from developing the potentiality to become a person in the
morally relevant sense.”

The British Journal of Medical Ethics  continues to publish thought exercises that go against common sense and traditional medical ethics, “emphasising” (British spelling) the utilitarian world-view  of today’s “medical ethics,” without the slightest acknowledgment that there might be harm in the act of arguing that not all human beings are “morally relevant persons.”

This month, Alberto Giubilini and Francesca Minerva, redefine “abortion,” “euthanasia,” and “infanticide” in “After-Birth Abortion: Why should the baby live?”

In spite of the oxymoron in the expression, we propose to call this practice ‘after-birth abortion’, rather than ‘infanticide’, to emphasise that the moral status of the individual killed is comparable with that of a fetus (on which ‘abortions’ in the traditional sense are performed) rather than to that of a child. Therefore, we claim that killing a newborn could be ethically permissible in all the circumstances where abortion would be. Such circumstances include cases where the newborn has the potential to have an (at least) acceptable life, but the well-being of the family is at risk. Accordingly, a second terminological specification is that we call such a practice ‘after-birth abortion’ rather than ‘euthanasia’ because the best interest of the one who dies is not necessarily the primary criterion for the choice, contrary to what happens in the case of euthanasia.

The arguments don’t work other than as an example of the logical results of the utilitarian world view that has come to dominate medical ethics and to illustrate what Leon Kass called “The Wisdom of Repugnance,” or the “yuck factor.”

One of the editors, Julian Salvulescu, who believes that values and conscience lead to “a Pandora’s box of idiosyncratic, bigoted, discriminatory medicine,” defends the piece on the grounds that that the ideas are not new.  Indeed, the authors discuss the history of killing babies before and after birth because of medical diagnoses such as Down’s syndrome and after birth due to suffering of the child or the lack of worth placed on the child by his or her mother. The Netherland’s “Groningen Protocol” for active euthanasia of children is mentioned as precedent for government support for their position.

We should let these “expressions” be a warning to us all in these days of increasing government involvement in healthcare. As the authors argue,

“Nonetheless, to bring up such children might be an unbearable burden on the family and on society as a whole, when the state economically provides for their care.”

Freedom of expression and the discussion of even such unpopular ideas do have a place in our world. However, I wonder at an “ethics” journal whose editors claim that their

“Journal does not specifically support substantive moral views, ideologies, theories, dogmas or moral outlooks, over others. It supports sound rational argument. Moreover, it supports freedom of ethical expression.”

Obviously, they do support “sound rational argument” and “freedom of ethical expression”  over “moral views, ideologies, theories, dogmas or moral outlooks.”

At what point would the editors determine that “ethicists” should be censured, corrected or even retrained? Would the Journal publish a “sound rational argument” that advocates the end of “freedom of ethical expression?”

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