Tuesday, January 26, 2010

A strange and troubling story

Should a Florida woman have been ordered by a court to remain in a hospital because her unborn child was in danger? This story is extremely strange:

TALLAHASSEE, Fla. (AP) - Samantha Burton wanted to leave the hospital. Her doctor strongly disagreed, enough to go to court to keep her there.

She smoked cigarettes during the first six months of her pregnancy and was admitted on a false alarm of premature labor. Her doctor argued she was risking a miscarriage if she didn't quit smoking immediately and stay on bed rest in the hospital, and a judge agreed.

Three days after the judge ordered her not to leave the hospital, Burton delivered a stillborn fetus by cesarian-section.

And six months after the pregnancy ended, the dispute over the legal move to keep her in the hospital continues, raising questions about where a mother's right to decide her own medical treatment ends and where the priority of protecting a fetus begins.

"The entire experience was horrible and I am still very upset about it," Burton said through her lawyer. "I hope nobody else has to go through what I went through."

Burton, who declined to be interviewed, is appealing the judge's order. She isn't asking for money but hopes to keep her case from setting a precedent for legal control over women with problem pregnancies. She also worries it could prevent women from seeking prenatal care.

State Attorney Willie Meggs stands by his decision to seek the court order after being contacted by the hospital. "This is good people trying to do things in a right fashion to save lives," he said, "whether some people want them saved or not."

There are a lot of questions raised by this story, not the least of which is the odd conflict between a state trying to save an unborn child and that same state aiding women in the killing of their unborn children. Sooner or later we're going to have to start dealing with the fact that at the very least, it should not be legal to abort a viable unborn human, precisely because of the double standard created when a state intervenes in a case like this one.

But though I read the whole article, and would encourage you to do the same, I still have a lot of questions. Burton is arguing that she should have been allowed to leave the hospital and go home--yet within three days her child had died in utero and was delivered stillborn. Was her medical condition, then, admittedly too fragile for her to leave?

Burton also thinks she wasn't given the proper standard of care and should have been allowed to seek a second opinion or go to a different hospital--but the article never says why this didn't happen. A different article suggests a possibility:

After examining Burton, Dr. Jana Bures-Forsthoefel found the 29-year-old mother of two had a ruptured membrane, had started contractions and was at risk of infection or premature birth, jeopardizing her health and the life of her unborn child.

Burton was ordered to immediately quit smoking and stay in the hospital on bed rest for the remainder of her pregnancy, but Burton didn't like that idea. She wasn't happy with care she was getting and wanted to go to another hospital and get a second opinion. She wanted to be able to go home.

So here we learn that Burton's health was also at risk--an important consideration, given that many news sources are spinning this story as "Court treats woman like incubator" in their coverage of it. Not only was Burton at risk of a miscarriage, but she herself, according to the doctor, was risking infection and possibly dangerous health consequences. Had she insisted on leaving the hospital and suffered these consequences in addition to the loss of her baby, would she have sued the hospital for letting her leave? It would certainly have been possible for her to do so.

And a little more searching uncovers some more details:

Burton was in her 25th week of pregnancy in March 2009 when she started showing signs of miscarrying. Her doctor advised her to go on bed rest, possibly for as long as 15 weeks, but she told him that she had two toddlers to care for and a job to keep. She planned on getting a second opinion, but the doctor alerted the state, which then asked the Circuit Court of Leon County to step in. [Emphasis added--E.M.]

Was the doctor's action in getting the court to back up the bed-rest orders justified from a medical perspective? Samantha Burton was essentially informing the doctor that she had no intention of resting. She was going to continue working at her blue-collar job (though none of the articles I've seen so far mention what that job was) and taking care of two small children, despite serious dangers to her own health and to the life and health of her unborn child. What, given that knowledge, was the doctor supposed to do?

Most of what I've read seems to think that the doctor was supposed to respect Burton's wishes and let her leave regardless of the consequences. If the doctor had done this, though, and Burton had perished along with her unborn baby, would we be reading headlines instead that say "Doctor allowed gravely ill maternity patient to leave hospital," with accompanying cries for the revocation of the doctor's license and sanctions against the hospital?

I acknowledge the danger of letting doctors have this much control over a patient's autonomy. There are many circumstances in which a patient is pressured or all but coerced into following doctors' orders, only to learn later that the doctor was wrong. I do think it should have been possible for Samantha Burton to call in an extra doctor to examine her, even if she had to remain in the same hospital for the examination--provided the doctor in question was also an ob-gyn with some experience in cases like Burton's.

But given the details revealed in this story, I have to think that any respectable ob-gyn would have confirmed the original doctor's diagnosis: the mother was risking infection, the baby was at risk of premature birth, and Burton should stay put. Since her child did, in fact, most sadly die in utero, it seems that this was not an erroneous diagnosis or misplaced concern.

And that brings us back to the central question: an adult is free to leave a hospital even if he or she is dying; he/she is allowed to refuse even lifesaving treatment. But a parent can't remove a gravely ill child from that sort of care without the intervention of the state--so into what category does a pregnant woman fall? Can she, in a post-Roe world, refuse to let a doctor try to save her unborn child? Is the unborn child hers to kill through neglect just as he/she is hers to kill through direct abortion?

That, essentially, is what Samantha Burton's lawyers are arguing.


Anonymous said...

"Is the unborn child hers to kill through neglect just as he/she is hers to kill through direct abortion?"

Yes, I don't see why not, it's not like she made a terrorist feel uncomfortable or anything bad like that...She's only killing an unborn child.

Go Democrats!

Anonymous said...

Membrane broke = water broke?
I didn't think you had a choice, it was going to happen unless it was not full rupture or something.
That is so sad.
I do not agree with what happened to Burton, that the State stepped in (Medicaid?) because I just don't see that happening to everyone.

If the doctor was concerned about her suing, she could have signed something saying that she understood her risks if she left.

It is wrong on all accounts in my opinion and I am sure she felt that she didn't have a choice to not to go back to work.

Anonymous said...

Oh, I like your picture.
It really personalizes your blog even more.

Red Cardigan said...

A reminder to commenters: I don't tolerate abusive comments or foul language. Just deleted one of those.

Kim said...

Wow! I've been picturing you with dark, dark hair all this time. Thanks for posting the photo and clearing that up! :)

Anonymous said...

"she had two toddlers to care for and a job to keep."

I'm curious why you bolded the sentence above? Does her circumstances means it was ok for her to kill her baby. Is she married? Did the NYtimes article have that information?

Are you really pro-life?

Anonymous said...

This situation has simply got to happen oftener than this one report. Every time a high-risk pregnancy is admitted, and usually subsequently transferred to a tertiary care facility with state-of-the-art neonatal and maternal intensive care, there is always a decision-making progress...does mother go along with the MD's recommendation or not?

I remember when in elementary school 45 yrs ago our principal and his wife devout Christian Scientists, made the decision not to take their young child for pneumonia treatment, and the youngster died. I don't remember that they were prosecuted for allowing the natural course of events for an untreated upper respiratory infection, nor do I recall if the principal was asked by the school board to seriously consider not being responsible to make decisions for the pupils of my school district, but... in the case of the woman, one has to wonder at the cause of fetal demise, as well as rational decision-making skills and care of the other children.

Dawn Farias said...

I, too, have always imagined you with dark hair!!

Red Cardigan said...

Dark hair? Haven't I mentioned the "redhead" thing before? :)

Oh, and Anonymous who asks if I'm really pro-life--I bolded that sentence to show why her doctor was worried. She wanted to go home not to rest, but to take care of her other two children and to go back to work, this despite a ruptured membrane and a doctor's order to get bed rest.

The article mentioned a common-law husband, by the way.

So, here's a woman whose own health is in danger and whose baby is in grave danger, who says to the doctor, "Oh, no. I'm not staying in the hospital or going on any "bed rest" for what might be fifteen weeks. I've got two kids to take care of and a job I need to keep. Check me out now, please."

At that point I think the doctor's in a horrible position. Let the woman leave, knowing she plans to keep working and that she could be back not only miscarrying the baby but perhaps with a severe infection requiring a hysterectomy in a few days? Or get the court to order her to stay?

Heather Ricco said...

I think that this is a bad precedent for the state to set. I don't want a woman to put herself or her child at risk of death through neglect or anything else. But I also don't want to set a precedent where a doctor can prevent you from getting the type of medical treatment you want. Isn't it possible that in a culture of death, a future case could come up that because the mother is in danger of dying, the state forces her to abort the baby on the doctor's recommendation?

freddy said...

I, too, think I'm in favor of some sort of informed-consent scenario.

Yes, bring in another doctor, then have the woman sign oodles of forms in which she states that she is aware of the risks to herself and baby, etc.

This really seems to be one of those case in which medical science can only do so much and those cases, to my mind, should have more latitude than, say, refusing treatments with lower risks and high success rates.

For example, if I refused rabies shots for my child, I should be locked up and the key eaten by a rabid dog.

If, however, my child (born or unborn) is facing a treatment that is either extremely risky, or has only a small chance of success, or both, we parents should have more latitude in persuing treatment options.

I can only imagine what this poor mom must have been going through. Worried about her job, worried about her little ones at home, worried about her unborn baby and not feeling that she was getting the care she needed -- it's hard to make any sort of good decision in those circumstances.

Anonymous said...

why did my comment get deleted?

Jacque said...

Erin, I see by the varied comments here, that I am not alone in feeling uneasy about this story. I agree with Heather Ricco. This can be a dangerous situation.

I have known many mothers in this woman's economic situation, and moral one for that matter. They live day by day with no future in mind. They just let life happen to them thinking they have no options.

It's a sad situation. May this mother,and others like her, find some peace and the Truth.

btw... thanks for blogging on this

Geoff G. said...

It's an interesting and extremely provocative question, and it does great credit to this blog to post about it.

There's no indication here whatsoever that the woman in question did not want her child. She appears to have fully expected to go through the pregnancy but merely disagreed with what the doctor had prescribed for her.

So ultimately, the question here is who is in control? We take "pro-life" to mean "not allowing abortion," but of course that's not the sum total of what being "pro-life" means, or should mean (for another instance of this, look at the Church's strange silence on the issue of health care reform which will unquestionably preserve lives, but just the lives of post-partum people).

We actually carve out religious exemptions that allow people to make "bad" medical decisions on behalf of others all the time. For example, Jehovah's Witnesses don't permit blood transfusions. in extreme cases, children who might otherwise have lived and made a full recovery are instead permitted to die rather than violate the parents' religious views.

On the other hand, parents who believe in faith healing have been convicted for child neglect for refusing to take a sick child who subsequently died to hospital. (One example)

The question here is, do we substitute the doctor's judgment for the patient's? And if so, where do we draw the line and under what grounds can that line be crossed?

It's easy to see how an absolutist pro-life position means taking away considerably more freedom than the simple choice of whether or not to kill a child in the womb. Would such a position require people to undergo all efforts to preserve life in the elderly or seriously ill or injured, regardless of the individual's wishes and the potential outcomes? Can your doctor "commit" you to hospital because of potentially unhealthy habits (smoking in this case, but where do we draw the line? Drug or alcohol abuse? Junk food or obesity? Lack of exercise?)

Just what exactly does it mean to be "pro-life?"

Barbara said...

If I were the doctor I'd have asked the mother if she had family members, neighbors, and/or parishioners that could help. If not, could I call members of my parish to get a group of men and women to help you? Call your employer? Was the doctor too busy to ask these question before he picked up the phone? Would these questions get him sued? What about a nurse taking the woman aside and asking her the same questions?
Think you couldn't get some Knights, St. Vincent de Paul-ers, Legion of Mary ladies, etc. to help? I have a feeling that there are many Protestant churches who'd be equally helpful.
It is not Christian to seek government intervention of any kind asthe first step when seeking a solution to a problem. Had Catholic teaching on subsidiarity as part of social justice been applied this baby needn't have died.
Her attitude post death of her baby is sad. Having a daughter a few years older than this woman, who happens to be expecting her first baby, I know how I would want her treated in this situation: as everyone's daughter as a daughter of Christ.

Siarlys Jenkins said...

I think her job and two other children is the first consideration in exploring how this should have been handled. If we expect a woman who is supporting a family to got to complete bed rest, then we need to provide a fund for family support so she can do that. Or is it OK if the landlord evicts her for nonpayment of rent, but not OK to let her go home from the hospital?

Bascially, if society is going to step in, then society has to step in all the way, consider all the factors, provide all that is lacking, not just a bit of police intervention, and then she is on her own. It is the same principle that states should not mandate counties to provide services without funding the mandates.

Other than that, I am doubtful about the notion of a hospital "allowing" or "not allowing" a patient to do anything. The doctor can advise, the hospital can even insist on an informed consent form (we told her this could happen, she didn't take our advice, don't sue us...) But as a patient, I expect to make the final decision, and therefore I have to say this woman should have had the same right.

The presence of a near-birth child complicates that last paragraph. The state does not, of course, promote abortion, it is merely restrained from stopping it. In the third trimester, it is illegal in every state, so no conflict over the state stepping in. But I'm still doubtful about anyone having to get permission from their doctor to make a decision.

eulogos said...

Mr. Jenkins, I agree with your first three paragraphs. Without assistance, a woman might have to choose to risk losing her unborn baby in order to keep her job and keep from being on the street with her two toddlers, which probably would mean losing them to the foster care system. While I believe the state should prevent anyone from deliberately killing an unborn child, I don't believe the state should be mandating medical treatment. There are lots of mandates which would be medically good for the unborn; use mandatory hospitalization to force pregnant women not to smoke, not to take drugs, not to drink alcohol, to eat a good diet. I am sure those who take care of certain populations of pregnant women greatly wish that they could do this. But I consider this too great an imposition of the state on personal freedom. And it would certainly lead to forcible hospitalization for a C section which doctors say is necessary but a woman doesn't want. (The last time a hospital attempted this the woman delivered a healthy baby vaginally while the hospital was presenting the petition to the judge for a court order.) And to the prohibition of home birth. And to mandatory vaccinations when parents don't believe in them, even, for instance, of the HPV vaccination for young girls which many here disagree with. The right to life means a right not to be killed. It doesn't mean a right to wisest and most careful mother or to an optimum uterine environment, as desirable as these things are.

However I believe you are wrong that abortion is illegal in the third trimester in all states. I believe that it is legal in most states but must be carried out in a hospital or facility with hospital like equipment, and there has to be a reason like life or health of the mother, which is broadly interpreted. Not many doctors want to do this but it is legal and it is being done, sometimes even to babies who would be viable if delivered by C section.

Susan Peterson

eulogos said...

Usually conservatives, which most of us are, are rather concerned about violations of individual liberties.

I remember when my doctor told me that one of his female medical students had given birth to a very premature baby at about 6 months gestation. If that baby died, did its mother kill it? It is likely, although not certain, that the lack of sleep, stress, and poor diet of a medical student was the reason for the premature delivery. Do you want to make a law that all female medical students or residents have to quit the minute they become pregnant?

The woman in the story did stay in the hospital and still lost her baby. If she killed it, it was by what she had done for the previous six months. IF. We really don't know the story. Perhaps she had an infection of a sort that causes premature delivery. It is totally illegitimate to say that she killed her baby. But suppose it was poor diet and stress and lack of sleep which did it. That doesn't constitute "killing", it constitutes the unfortunate results of a difficult life.

Susan Peterson

Anonymous said...

I don't quite understand the reasoning of how 'insufferable anonymous' believes the woman in the report 'killed' the baby.

The baby died. Miscarriage can be an unfortunate complication of pregnancy for any number of reasons. 15-20% of all pregnancies naturally result in miscarriage. Given the nourishment of placental blood flow, most miscarriages result from damaged ova due to maternal age, and then the other factors such as exposure to teratogens, chromosomal abnormalities, and inadequately oxygenated blood flow from diabetes, anemia, etc., as well as physical factors impacting the normal fetal development.

The report does not mentiont the cause of death. We don't know the cause of death.

We do know that the physician advised the patient to stay put, and she did not want to follow the order for her own reasons, which can be expounded on because they are not unselfish nor unreasonable, just that many might feel that given the circumstances, there SHOULD have been other alternatives so that the woman needn't have taken the particular risky stance.

My second son was born with the umbilical cord wrapped around his neck, a 'blue baby' by the time of his delivery. There were no other risk factors. Had we not been in a hospital, more time spent inadequately oxygenated would've resulted in severe neurological deficits or death from complications of birth. Instead, given our circumstances, he was baptized quickly and whisked away to neonatal intensive care, music prodigy, attending college IQ 140.

I am a Catholic. I believe what I believe based on reason, whether another person says it's conservative or liberal or moderate is up to them.


Siarlys Jenkins said...

Eulogos, it is true that abortion in the third trimester is legal if the life or health of the mother are in danger. That is the only restriction the Supreme Court has put on state abortion laws in the third trimester, and otherwise, all states ban the procedure. I believe it is appropriate that if a woman's life, or her physical long-term health, are truly endangered, she may opt for abortion, even though it is a baby that is being destroyed. I also believe that if the woman freely chooses to risk or sacrifice her life for her baby, she has a right to do that. Nobody has a right to a court order to prevent her.

There has been a good deal from the pro-life side charging that the "life or health of the mother" standard is being abused. I find at least some of that argument credible, and the abuse should be foreclosed. A woman's life can't be left "in danger" if it truly is pending lengthy litigation, but there should be a solid medical diagnosis in the record stating why and how her life or health were endangered. Not a quick conversation like "Are you feeling suicidal?" "Uh, oh yeah, suicidal, uh-hunh." A woman who doesn't want the pregnancy really ought to make up her mind in the first trimester.

Red Cardigan said...

Okay, gang, I'm sorry, but thanks to the anonymous troll who apparently thinks the only Catholic response is to jail women who smoke when they're pregnant and who has been using intemperate speech all over this thread--leading me to delete his/her many missives--I'm closing down comments on this one.

May have to consider ending anonymous commentary. Will post about that later.