Tuesday, June 23, 2009

"But they've already made up their minds"

Supposedly there's no need for informed consent prior to an abortion because women who come in for abortions have already made up their minds.

Now, just imagine for a moment a plastic surgeon. Mary comes in asking for breast enhancement. The doctor just hands her a bunch of paperwork to sign, "Here are the risks, swelling, infection, yada yada yada", then does the breast enhancement. Has he done his job?

Isn't it his responsibility to find out why the patient thinks that this surgery is what is right for her? Maybe she thinks her husband will stop cheating on her with his large-breasted secretary if Mary gets her breasts made as big. Maybe Mary is having bad luck on the dating scene and she's convinced that larger breasts will help her find true love. Maybe Mary's boyfriend taunts her for being "flat chested" and she thinks that this surgery will win his respect. Mary can have any of a number of unrealistic expectations about what this surgery will mean for her. Isn't it the doctor's responsibility to make sure that Mary's expectations about this surgery are realistic? That she really understands what she's getting into? Doesn't she need to know the downsides? And I mean fully know them -- not just be handed a list of possible complications.

A plastic surgeon who just operates on all comers would be considered a quack. It's his job to make sure the patient's expectations about what this surgery will do for her are realistic.

Not so with abortion. She asked for it and that's all he needs to know.

Nobody assesses her for risk factors for poor psychological adjustment and informs her if she is at high risk for being traumatized by the abortion experience. The risk factors are well known; but nobody screens for them and nobody informs the woman of what risk factors she has and what the possible negative outcomes may be.

Nobody informs her of the risk that she might not be able to carry a future pregnancy to term -- despite decades of evidence linking abortion to future pregnancy complications. Instead, she's assured repeatedly that she can have a baby later, when the time is right.

And nobody tells her that ambivalence, even rejection of the pregnancy, are normal early on and that they pass when the mother has a chance to bond with the unborn baby. This used to happen at around "quickening", when the mother felt the baby move. Now it often happens earlier, with an ultrasound or a chance to hear the baby's heartbeat. She's not told that her feelings of being unable to cope are normal and typically self-limiting.

Imagine if any other surgery was being performed, on a self-referral basis, on patients suffering from a temporary condition that they're not told is temporary. And I don't mean that women don't know pregnancy is temporary. I mean they don't know that the feeling of being unable to cope -- which is why they're seeking abortion -- is temporary.

If a patient stung by a stone fish begged a doctor to amputate his arm, and the doctor complied without telling that patient that the pain of a stone fish sting will fade in time and he'll be glad to still have his arm, that doctor would probably not only have his license yanked, he'd probably be charged with assault against the patient.

But doctors, 4,000 times a day in the United States alone, let women think that their normal and self-limiting distress is permanent and that the only way to escape it is abortion. They perform irreversible surgery which can do the patient real, lasting harm.

And this is considered somehow noble and responsible.

17 comments:

Lilliput said...

Christina,

The Dr is a plastic surgeon not a psychologist or a therapist - or are you suggesting that any woman who wants breast enhancement must be forced to have a therapy session before seeing the plastic surgeon?

Under what conditions would you consider it appropriate for a woman to have a breast enlargement? There is no shadow of doubt that on average, men like bigger boobs - evidenced by the porn stars and pin up girls that do the most work - at least its the case here in the UK?

So if a women walks into a plastic surgeon to have a breast enhancement to make more money or attract or keep a guy and it doesn't work out, she has to deal with it - that's her lesson. But because a tiny minority don't think things through - it doesn't make it right to send the rest for a compulsary therapy session to make sure they know what they are doing?

If she says she wants breasts so large she cannot walk or she's there for her 17th operation - then yes the Dr is a quack for giving her what she wants as she is obviously not well. But if a wome has a breast implant to keep a guy and it backfires and he leaves - maybe she'll get the epiphany that he's an idiot and she's much better without him.

That's life!

OperationCounterstrike said...

Why do you think women don't give informed consent before their abortions??? They do, just like before any surgical/medical procedure.

And you wrote: "Nobody informs her of the risk that she might not be able to carry a future pregnancy to term -- despite decades of evidence linking abortion to future pregnancy complications."

That's because there is much MORE evidence that abortion is NOT linked to future pregnancy complicataions.

There are always SOME studies which get the wrong answer, because of statistical noise. You could find some studies that say smoking PREVENTS lung cancer. Should we be telling patients about those studies? If not, why not? Because we know they got the wrong answer.

GrannyGrump said...

Lil, at least you're consistent and believe that doctors are absolved from all responsibility for the well being of self-referred patients.

OC, you just keep repeating that to yourself.

Kathy said...

OC --

That's because there is much MORE evidence that abortion is NOT linked to future pregnancy complicataions.

Care to cite your sources for that?

OperationCounterstrike said...

Kathy, google it. You'll find 'em. The mainstream orgs like AMA and ACOG and all the Surgeon Generals' offices and all my OB/GYN profs in med school are enough source for me.

Remember as you google, crank sites run by right-to-lifers don't count, only MAINSTREAM medical organizations. And Journal of American Physicians and Surgeons does not count.

Now someone's gonna say, AMA and ACOG and WHO and whatever the professional association of epidemiologists is, those are all pro-abortion sites, biased. Suuuure. How about the US Surgeon Generals under Reagan and both Bushes? If abortion causes subsequent problem pregnancies, why is it that NO US Surgeon General has ever said anything about it? Wouldn't it be the USSG's job to warn everybody?

Here's an exercise for you. Go to your GYN and ask about it. "Should a pregnant woman considering abortion worry about danger to future pregnancies?" If the answer is anything but "no, almost never", your GYN is committing malpractice.

Sorry but facts are facts, boss.

OperationCounterstrike said...
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OperationCounterstrike said...
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Lilliput said...

"Lil, at least you're consistent and believe that doctors are absolved from all responsibility for the well being of self-referred patients."

I'm not saying they are absolved from all responsability - I specifically wrote that if the woman wants boobs she can't walk with or its her 17th surgery - then he should not do the surgery. I want to know where the line between Dr and Patient responsability lies and on what basis would somebody be seen as not of sound mind to be able to make their own decisions?

Kathy said...

Kathy, google it. You'll find 'em. The mainstream orgs like AMA and ACOG and all the Surgeon Generals' offices and all my OB/GYN profs in med school are enough source for me.

Oh, you mean you don't have actual proof, like studies. Well, whenever you can come up with them, feel free to let me know. I'm not going to do your research for you, although Google Scholar might be a good place to start. Here is a pdf which discusses the link between prior abortion and future preterm birth, discussing several studies in particular. Until you have any actual rebuttal for that that can be verified, this discussion is pointless, because you could be a bored prisoner with access to a medical dictionary for all I know, pretending to have been a med student who failed.

And, actually, the national C-section rate in the US is 31.7% for the latest figures, and likely going up higher. So we generally say "about 1/3 of all births end in a C-section." There is controversy regarding VBAC (not "cervical" birth, but vaginal birth), but this is primarily driven not by evidence but by defensive medicine and malpractice insurance companies. The evidence shows a uterine rupture rate of about 0.5% (depending on the study) for a planned VBAC in the absence of induction or augmentation agents; and a percentage of those "ruptures" are actually the less severe "dehiscence" or "windows" in the uterus, which may even be asymptomatic and therefore not a problem to either mother or baby. Even the true ruptures are not necessarily lethal to the baby -- a lot of factors go into that discussion, including how fast an emergency C-section can be done. So I would not say that "a good deal of the time" you do need a repeat C.

runningatlarge said...

I have a friend who had a late second trimester abortion when she was 14. When she was in her 20s she lost her twins at the same gestational age (22 weeks) because of the damage done to her cervix. 3 dead babies, one childless mother. That's enough source for me.

OperationCounterstrike said...
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runningatlarge said...

call it whatever makes you feel the most clever, doesn't change that they're dead, and their mother will likely never carry a child to term. It doesn't surprise me one bit that you have no feelings of empathy for women such as her.

Kathy said...

OC,

You are the one that put forward the point citing no sources except a vague one. I merely asked you for evidence, which I now must assume you do not have and cannot get. If I put forward a point that abortion increases the risk of secondary infertility or future preterm birth, I'd better be able to cite studies that say that; if you put forward the opposite position, you'd better be able to cite sources for that. Your refusal leads me to believe that you can't. I have studies that support what I say -- I don't need to find studies that support what you say, because the onus is on you. Just because an organization has a position statement doesn't mean it's built on actual evidence. As an example the SOGC (the Society of OB/GYN in Canada) just recently reversed their position on vaginal breech birth -- formerly the recommendation was 100% Cesarean; they've now said that doctors should study and become competent in vaginal breech birth so that that can be offered to women with a baby in breech presentation. They said that the studies on breech birth just didn't support the 100% C-section rate. But they held that position despite the studies for years. Then they looked more closely at the evidence. Then they switched their position.

So, again, if you have no evidence in support of your opinion, that's fine -- just declare it as your opinion. If you can find some evidence in support of your opinion, I'll look at it. But I'm not going to do your research for you.

OperationCounterstrike said...
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Kathy said...

You can "declare" it as such until you're blue in the face -- who knows? it might be a good color on you! But it would be nice to know what EVIDENCE the opinion is based on. I may be of the opinion that you are a one-eyed, one-eared flying purple people-eater, but I daresay that anyone I tell that to would wish to know what that opinion is based on. I may be of the opinion that pork is good for you and carrots are bad for you, but unless I have evidence of such, people would be right to ignore me or to ask for some evidence to back up my claim. Quite frankly, don't get me started on ACOG's "opinion" because too many times it has not been based on EVIDENCE but political opinion, which is not worth much. I don't have *quite* the low opinion of the AMA as I do ACOG, but it's awfully darn close, especially after they declared home-birth to be unsafe despite the evidence. So, no, it's not okay with me to state and restate your opinion without evidence, because until you come up with something akin to EVIDENCE as opposed to OPINION, I will treat it as merely the deranged ravings of an internet loon, which is what MY opinion of you is tending towards. You see what opinions get you?

army_wife said...

You know, I was watching a show about gastric bypass patients last night on TV. The people who wanted this surgery (who, by the way, were morbidly obese and had life-threatening conditions because of it, so they really did NEED the surgery) were first made to go through a rigorous mental AND physical evaluation process before they could be cleared for surgery. As a matter of fact, one woman was found to have too many mental issues to be immediately ready for the surgery, and the psychiatrist (who was on staff at the obesity clinic) along with the two surgeons who would be doing the gastric bypass surgery decided to come alongside the woman and support her until she was emotionally ready to go through with the surgery.

I thought all this was a great example of a doctor really getting into the "whys and wherefores" of how their patient got into the trouble they are in (in this case, morbid obesity), and what their expectations are for the surgery, and what they really want to accomplish, etc. Also, they gave real informed consent to the ones preparing for surgery - detailed discussion of the risks, good support during the recovery period, nutritional guidance, etc. I would assume that the emotionally troubled ones would get psychological help as well (the psychiatrist mentioned that it might take 3 years of counseling for the one woman to work through her problems).

Something to think about.

GrannyGrump said...

From what I've seen, none of Tiller's patients aborting for psychiatric reasons had referrals from psychiatrists, and there were no provisions made for psychiatric aftercare. In the old pre-legalization days the woman at least had to go to a psychiatrist and get him to rubber stamp her "need".

Psychiatrists (at least in this county) who examine welfare clients to determine if their mental illness prevents them from participating in work or work preparation activities, insist on AT LEAST THREE VISITS before they'll even say that the patient needs time away from the demands of a work program. But Neuhaus wasn't even doing a basic psychiatric intake on women, and was prescribing abortions for them.