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Tuesday, May 24, 2005

Difficult choices - medical ethics (I)

Last week, I met a young lady who had come into hospital with abdominal pain. She had recently been diagnosed with cancer and had just completed a course of chemotherapy - her blond hair was just beginning to grow back, a fine layer of peach fuzz on her scalp. I had a short chat with her, performed a physical examination and then sent some blood and urine samples off for testing. And, as with all young ladies who come into the emergency room, I made sure she had a urinary pregnancy test.

Which came back positive.

I repeated the test a few more times just to make sure, then called the labs to ask if I could get her blood sample tested for bHCG (a hormone produced in large quantities in pregnant women). All the tests pointed to the inevitable - she was pregnant. Probably about a month. She had no idea at all.

Perhaps you might think this is a wonderful thing - life in the midst of death, so to speak. But it's not. It is terrible news for someone in her situation.

Let's start with a little bit of background information about chemotherapy.

The theory behind chemotherapy is based on the fact that cancer cells are human cells in rebellion.

Normal human cells are programmed with rules on how to grow, where to grow, when to stop growing, when to die. Cancer cells have do not follow instructions - they grow where they are not wanted and they do not stop growing and they do not seem to die. Like weeds, they grow quickly and begin to choke normal human cells to death. This is why cancer appears in the form of ugly tumours that grow, spread and eventually disfigure human tissue.

Chemotherapy drugs target the parts of a cell that deal with cell growth and division - thereby having a greater effect on the fast growing/dividing cancer cells, than slow growing normal cells. This also means that chemotherapy also poisons normal cells (albeit at a lesser extent) leading to the hair loss, nausea and tiredness so often associated with cancer patients.

In short, chemotherapy kills cancer faster than it kills the patient. (And we claim that modern medicine has nothing to do with homeopathy. Hah!)

I see that it is starting to dawn on you why pregnancy would not be a good thing for a cancer patient. Oh yes, pregnancy = foetus = fast dividing cells = more prone to chemotherapy induced damage.

The look in her pale blue eyes still haunts me.

What are her options?

1) keep the child, continue with the chemotherapy - she may live, child most probably will die or be severely deformed. (This option is actually impossible - no responsible doctor will allow a pregnant woman to undergo chemotherapy)

2) keep the child, stop the chemotherapy - she will die (likely before pregnancy can come to term), child may die

3) abort the child, continue with the chemotherapy - she may live, child dies

So. In all scenarios (we're not including divine intervention), the child has a very poor chance of survival. And if it somehow survives the pregnancy, it may be severely damaged by chemotherapy.

It all boils down to 'my life vs. my child's life'. Does she forego her next course of chemotherapy and hope that (miraculously) the child hasn't been damaged too severely by the previous course? Or does she go with the odds and abort the child, saving at least one life - her own? The latter seems (sadly) the more rational choice.

I dare not even suggest the idea of divine intervention to a person in her situation...sometimes it feel too much like raising false hope whilst instilling a sense of guilt. She has to make her own choices and be responsible for them...and I must do the same. My choice is to be compassionate and non-judgemental.

Somebody once told me that women who have abortions are feckless, heartless and flippant. I have met many other women who use abortion as a form of contraception, throwing away a baby like a used condom; Flippancy masking Denial. I think of this young girl and I realise that sometimes there are situations where difficult choices have to be made in order to save lives. It is what doctors like to call a 'therapeutic abortion'. Do the ends justify the means? I don't know.

As a Christian, I do not agree with the concept of abortion and I would never be able to perform the procedure, but once a woman has gone through the harrowing experience of an abortion, my responsibility as a Christian is not to condemn her for her actions, but to comfort her in her grief.



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