"fetal reduction" NEW SPEAK i guess... just damn
Posted on 03/28/2005 6:05:34 PM PST by madprof98
IT was an explosive case from the moment the patient walked in the door of Melbourne's Royal Women's Hospital.
She was just four weeks short of delivering a baby diagnosed with skeletal dysplasia, a form of dwarfism that severely stunts growth but not necessarily the capacity to live a richly fulfilling life. With a history of psychiatric illness made more profound by the torment and wretchedness of carrying a disabled child, the woman refused to countenance adoption.
She was so acutely suicidal that doctors "had rarely, if ever, seen a woman so seriously affected by the prospect of fetal malformation".
Last Tuesday evening in a Melbourne consulting suite a small group of clinicians met to discuss the next step in the tortuous saga that began in February 2000 when they agreed to abort the 32-week-old fetus to save the woman's life.
Against a backdrop wintry with growing public disquiet over late-term abortions, the doctors decided to speak to The Weekend Australian for the first time to allege a hospital whitewash and abuse of patient privacy in a Kafkaesque nightmare that visits them daily. Although the RWH held an interim inquiry that found the doctors had acted in good faith in an extremely difficult situation, the hospital has reneged on a promise to hold a full investigation into its handling of the case.
"Anyone who has touched this case has been damaged by it," said the ultrasonologist, who requested anonymity for family reasons.
"We feel wronged in a devastating way that impacts every day of our lives with the hospital telling us to push it under the carpet and go away."
For five years the key clinicians who treated the woman - the ultrasonologist, an obstetrician, a genetics counsellor and a psychiatrist - have been sworn to silence by their lawyers, while the case ping-pongs from the courts to the Medical Practitioners Board, inflamed by anti-abortionist National Party senator Julian McGauran. Next month the Victorian Supreme Court will determine whether another hearing can be held.
The doctors have squirmed while mud was slung, accusations levelled and inaccuracies allowed to stand as facts. Politicians vote for or against abortion according to their conscience. Doctors on the front line face life and death dilemmas with a clock ticking and the jury out.
"I had a mother who was going to kill herself because her baby had dwarfism," the obstetrician, who ran the hospital's fetal management unit for high-risk cases, told The Weekend Australian.
"Someone had to make a call. I would probably do the same thing again in the interests of the mother," the obstetrician said.
"She would have jumped off the West Gate bridge. I could live with the termination more than I could live with the death of the mother."
Thirty-two weeks was the latest "fetal reduction" ever performed at the RWH, a tertiary institution for obstetrics and gynaecology renowned for managing high-risk pregnancies.
Concern was further aroused by the diagnosis of the non-lethal fetal abnormality. In these fraught circumstances the obstetrician took the unusual step of briefing one of the hospital's medical administrators, who gave him a green light to proceed so long as everything was properly documented.
The administrator later denied this discussion, and the file note recording it is said to be missing.
Also absent from the file is the letter documenting the potassium chloride injection that ensures a fetus is stillborn.
The ultrasonologist who gave the injection said: "Some people who I am close to would oppose what I did. It's too easy to be horrified and not think 'how would I have managed this difficult case?' But this issue should not be confused with the separate question of the hospital's despicable conduct.
"You could argue this is the most legal abortion that has ever been done in this state. It was the best prepared and documented for somebody who was as suicidal as anybody could be.
"It comes down to Kafka. One complaint can turn the world around and there's no stopping things from there."
The complaint that kicked off five years of turmoil was made by Christine Bayly, the hospital's associate director of women's services, who first heard of the case when the doctors agreed it should be discussed internally at a meeting held to encourage transparency in ethical conflicts.
Bayly's protest worked its way through senior administrators - none of whom checked the facts with those intimately involved - and wound up on the desk of then chief executive officer John de Campo, who in late June 2000 decided to sack the ultrasonologist. Next de Campo suspended the obstetrician and the psychiatrist. Two other staff were sacked before de Campo realised he did not employ them.
One of the doctors was on holiday at Port Douglas when he took the call. The obstetrician, who had served the RWH for 20 years, recalls the public lashing. "I was shocked at the way it was done ... I remember listening to the radio that weekend and hearing a hospital spokesman suggest we'd done something terribly wrong ... that we were all guilty of a crime."
Three days later, on Sunday July 2, the hospital announced the case would be referred to the coroner. There was uproar among staff, who passed a vote of no-confidence in the hospital's executive committee, prompting de Campo to reinstate the doctors a few days later.
The controversy raged on talkback, in parliament, and in the public domain, with McGauran seizing the trigger for a crusade against late-term abortions.
"I take the battles where I can win them," he said this week. "When you focus on late-term abortion you get more people on side. It's not a political trick I'm trying to play but the reality of late-term abortions is that they are a violent and gruesome affair. The time for choice is over at 32 weeks."
McGauran obtained figures showing the RWH performed 44 abortions of fetuses older than 20 weeks in 1999. In the Senate, he urged prosecution using an untested section of the Crimes Act outlawing any intentional act causing the death of a child capable of being born alive.
He accused the RWH of "an appalling cultural acceptance ... effectively saying, 'To relieve your anguish we agree to destroy your child"'. He read the ultrasonologist's office address into Hansard.
A police brief was prepared for the coroner, who used a discretionary power to rule the case beyond his jurisdiction: to investigate a death there must first be a life. The homicide squad found no breach of the Crimes Act based on the 1969 Menhennitt ruling that abortion is legal to preserve the mother's life or her physical and mental health.
Before sealing the file, coroner Graeme Johnstone approved a request from McGauran for a copy of the police brief, which was handed over, private medical documents and all. A similar application by one of the doctors was rejected. McGuaran was "surprised and delighted" at his trove and used it to lodge a formal complaint with the Medical Practitioners Board.
The obstetrician, one of eight senior doctors to resign during this period, was dumbstruck by the transaction. "What worries me to this day is the fact that Graeme Johnstone, a man in an amazingly privileged position, handed the most sensitive papers over to McGauran. That seems to me an amazing breach of privacy."
McGauran's use of the file riles the doctors, but their anger is directed at the RWH and its refusal to fully investigate management's role in the case, while they brace themselves daily for slanderous mention in the press or parliament whenever the abortion debate heats up. The Supreme Court next month may order the hospital to release its files to the medical board, which already has a wad of documents courtesy of McGauran, for the purpose of perhaps launching a fresh inquiry.
Like Franz Kafka's novel The Trial this case is caught in a current that swirls and eddies in search of an investigation. Not at the behest of the doctors or their patient, who wants no part of the circus. She has refused to give consent for release of her file and does not wish to be contacted by the board ever again.
"We've been left totally without a voice. There is always the prospect of a trial ahead," one of the doctors said. "Next the court case, then possibly the medical board, then who knows? It may never go away. In the future they could change the coroner's act to re-open this case or the Director of Public Prosecution could say 'I don't agree with the assessment at the time, perhaps we should lay charges'. There is no statute of limitations.
"I am constantly going over it, day and night. It is the first thing I think of on waking. I think of it often during the day. I think of it at night."
He and his colleagues are determined to hold the hospital to its promise of an inquiry but the new chief executive, Dale Fisher, could commit only to a general review of "current human resource practices".
"It is clear to me that the hospital could have handled the situation much more sensitively than it did and I am sorry that you all feel aggrieved," she said in a letter this month.
The doctors do not want to sue. "Even if we win what would we gain?" they ask.
One participant has been stirred to fight for abortion law reform because of the alarming inconsistency between the states. He is pressing the Australian College of Obstetrics and Gynaecology to follow the lead of its London counterpart and produce clear policy statements on termination procedures to guide doctors who must deal with these dilemmas.
The hospital's interim inquiry, led by professor Michael Permezel of the Mercy Hospital, a Catholic institution that does not perform abortions, reported that Section 10 of the Victorian Crimes Act -- which McGauran believes has been breached -- remains untested.
"It is difficult, therefore, to suggest that any of the clinicians knowingly contravened the law. In fact, there is published opinion that might have given the clinicians a basis to believe it likely they were acting within the law," he found.
However, McGauran alleges the child was normal, quoting the delivery nurse's scribbled note that "baby doesn't look small". The obstetrician is adamant that photos of the baby at birth show classic symptoms of dwarfism.
Permezel's six-page report concedes there is less clinical support for a late termination "where there is some doubt about the diagnosis or where the fetal abnormality is less severe". The medical board's own 1998 policy paper on late-term abortions acknowledges that fetal abnormality of a lesser degree "may cause psychological harm to the mother" and opens the door for termination provided the patient receives adequate counselling from a geneticist and paediatrician.
The mother at the centre of the RWH case received this support and copies of the medical records obtained by McGauran chronicle a history of psychiatric illness made more profound by the prospect that she was carrying a disabled child.
"We had to make a decision. We did what we thought was the most humane thing," the obstetrician said.
Thank you for posting an article on this awful case. It has concerned me a great deal - very dreadful. The baby was born alive and killed by lethal injection - for no reason, except that it was thought to be disabled.
I notice that no one discusses the ordinary remedy in such cases. If this woman was threatening suicide because of her pregnancy, the option is not to terminate, it is to confine her in a psychiatric facility, because she is evidently mentally ill. There was a time - until recently - when threats of suicide automatically got a patient committed.
"fetal reduction" NEW SPEAK i guess... just damn
I was saying the exact same thing to my husband as I read this. I asked why they didn't just lock her up in a [non-pc term for psychiatric facility] until after she had the baby. There are some sedatives that can be used on pregnant women I am sure.
You weren't referring to - the nuthouse, the loonybin, the laughing academy, or the funny farm were you? I might have to report you to the speech police.
I can't remember if I used loony-bin or nut-house, now. ; )
You had better be careful. Very careful.
Making jokes about the afflicted and disabled - as distinct from starving them or giving them a lethal injection - is a SERIOUS matter.
I don't make fun of the disabled, though- unless they are in my family!
Speaking of the culture of death - look at this case, from Australia.
Aust is now a country where a baby can be killed by lethal injection, because it is disabled. This is described as a 'humane' solution. This case really bothers me.
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