Difficult Choices in Pregnancy

Slate features an interesting account from Eugenie Samuel Reich. Ms. Reich was faced with a baby that needed to be delivered very early (around 24 weeks) or risk stillbirth. There are risks associated with both. Pre-term births often result in serious complications or death. Reich considered this, and ultimately decided to accept the high risk of stillbirth by postponing delivery until the baby was full term.

Thankfully, her baby recovered and was born healthy and on time. In her article, however, she chronicles her difficulty in finding people willing to talk about this choice. Her experience is interesting. From the piece (click here to read the whole thing):

To rest the question there, on a woman’s right to choose, may sound like an iteration of the abortion debate, but there are important differences, as I came to realize. Unlike a termination, neither a choice to deliver nor a choice to miscarry has a definite outcome, so women are dependent on counseling from their doctors to understand evidence or medical nuances that might tip them one way or the other. Given uncertainty, many obstetricians counsel in favor of delivery because—as Dr. Jay Iams of Ohio State University Medical Center says—stillbirth is the one option that isn’t treatable. Still, several experts I spoke to said that evidence-based guidelines for obstetricians who discuss stillbirth as a valid alternative to an early delivery would help women make more informed choices and standardize practice across the country, as might more public awareness of the existence of early-delivery dilemmas. I made my decision to take that very high risk of stillbirth on the information available to me at the time, without knowing how things would turn out. Some situations don’t present any right choices, but at least for me, interrupting a pregnancy with a delivery so early that my baby was not very likely to have a good outcome would have been the wrong one.

This topic bears some similarities to difficult end-of-life decisions. At some point, it is acceptable for a patient to refuse further treatment of a disease. There is a point at which such a decision is ethical – unlike suicide, because in the former situation you are not actively killing yourself. You leave it open to the natural course of things.

Similarly, it seems to me, women in this difficult position are weighing different options. They are not actively choosing to kill their child like in an abortion, but they may refuse risky treatment in favor of letting nature take its course.

I’m not sure what I would do, but I think the situation is far from ethically clear.