Call this one a win.
My patient’s unborn baby had been diagnosed with a complex heart defect making the baby’s prognosis uncertain, with a significant chance of dying before birth or soon after delivery. Throughout the pregnancy my patient and her partner met with many doctors, including pediatric cardiologists, maternal-fetal medicine specialists, neonatologists and surgeons.
All had the same objective – helping this family arrive at decisions and respecting those decisions that best aligned with their goals.
This couple felt that support and collaboration during the delivery of their baby. That’s the win.
As a high-risk pregnancy physician for 12 years, I’ve observed that in most of medicine – and particularly in my specialty – there are multiple unknowns, and the outcome is something over which we have minimal control. The sometimes fragile relationships we establish with patients are critical to helping them navigate that ambiguity.
Trust is a crucial component. Patients need to believe their physicians are honest and will provide them with the best available medical information. That’s why the recent spate of laws and bills interfering with the interactions between patients and doctors is so disheartening and destructive.
Utah Gov. Gary Herbert recently approved legislation making it mandatory for physicians to tell patients undergoing drug-induced pregnancy terminations that the procedure can be reversed. This is despite established organizations such as the American Congress of Obstetrics and Gynecology stating that such claims are not supported by medical science.
In Texas, state Senate Bill 25 would prevent patients from suing their physicians if they deliver a child with a disability if the doctor knew of the disability and did not disclose it. The bill language presumes that the only reason a physician would tell a patient about an anomaly in the fetus is for the purpose of termination. Yet it is only one of multiple reasons that prenatal diagnosis of an anomaly is of use, including planning delivery location or arranging prenatal consultations. And while it is difficult to find an accurate estimate of the number of wrongful-birth cases in this country, it is generally accepted as infrequent.
The likelihood that doctors would lie to their patients or knowingly give them incorrect information is remote. Such behavior is antithetical to the sense of duty doctors feel to their patients. But this bill would create that uncertainty in the mind of a patient.
A law passed recently in Arkansas requires doctors to inform patients that pregnancy termination for sex selection is illegal. There is limited evidence that patients commonly seek pregnancy termination for gender selection in the United States.
Such statutes place the ethical construct of paternalism over autonomy, counter to the general direction of health care in this country. It is difficult to imagine a scenario in which it would be acceptable for a physician to withhold a diagnosis of an illness, such as HIV or cancer, from a patient out of fear for how he or she may respond to the diagnosis.
Multiple studies have demonstrated that the vast majority of women who seek abortion are certain of their decision, even in the face of such unnecessary hurdles as waiting periods and ultrasound imaging, making discussion regarding reversal irrelevant and offensive.
Such misinformation as in Utah may mislead patients who are uncertain about their wishes into thinking that there is no harm in starting the termination process while they are deciding because the effects can be reversed. Furthermore, enforcement of such laws would be technically challenging and costly.
Legislators introduce these bills under the guise of protecting life, when they are merely restricting women’s rights. They wrongfully invade territory that is the purview of a patient and her physician. They are a waste of taxpayer money and a ploy to gain publicity by manufacturing problems. It is time for policymakers to stop this interference.
Whatever popularity or visibility these laws may gain is certainly a loss for many women. And it perpetuates a loss of trust in the doctor-patient relationship I have spent my career protecting.
The writer is a maternal-fetal medicine physician and an assistant professor at Northwestern University.