A Mother’s Story

When my daughter Cecilia's anencephaly

was diagnosed by ultrasound in September
2002, the first and only real option my husband
and I were given was abortion. I was
encouraged to check in to the hospital
immediately to have a "dilation and extraction".
The maternal-fetal medicine specialist at the
world-renowned medical center told me that I
couldn't carry my baby to term that I would be
risking my life.
 Our first call was to our priest, who told
us that, because our baby could not live
outside the womb, it was acceptable to
induce labor early. The next day my
obstetrician, who is not a Catholic but a
Christian, told me that he would not
perform an abortion and that inducing
early in this case was not abortion.
 It seemed my three choices were "Kill
the baby, kill the baby, or kill the baby," yet
everyone kept saying I was wrong. I could
have any of what the doctors
recommended, induce labor or wait for her
to be stillborn. The doctors made it sound
as if it were perilous for me to give birth to
an anencephalic baby.
 After meeting with our priest, I checked
into the hospital for induction of labor.
Labor was hard; my body wasn't anywhere
near ready to birth my baby. I felt Cecilia
kicking until early in the morning. After 18
hours of very painful Cytotec-induced
labor, she was stillborn. I scooped her up
before the doctor could get her. We didn't
know until that moment that she was a girl.
Early Induction of Labor:
Ethical Considerations

BERNAL, Vanessa Anne C.

BIAG, Joanna Khris L.
 Report Outline
I. Introduction
A. Definition of Terms
B. Early Induction of Labor

II. Ethical Considerations in EIL

A. Pro-EIL
B. Anti-EIL

III. Conclusion
 Definition of Terms
• Viability
– gestational age at which a fetus can
survive outside the womb
– 23 to 24 weeks

• Anencephaly
– lack of major portions of brain and skull
 Early Induction of Labor
• Different methods
– Cervical stretching, amniotomy
– Pharmacological: oxytocin, prostaglandins
– Relaxin, antiprogestins, NO

• Associated with diagnosis of children

with lethal conditions (i.e.
anencephaly)
 Early Induction of Labor
• Reasons

– Lethal condition of the child

– Pathological risk for the mother

 PRO-EIL
• “Anencephaly and Management of
Pregnancy” (1993)
– Sister Jean deBlois, CSJ

• “Early Delivery of Fetus with

Anencephaly” (July 2003)
– Father Norman Ford
 Anencephaly

• Case where “pregnancy can be

terminated anytime”

• Lack of mental development is

justification enough
 Principle of Proportionality and
Double Effect

• Human life – not just biological life

– Anencephalic infants lack psychological,
social and creative capacities

• Resulting fetal death is indirect

• EIL as termination of life support

 EIoL After Viability

• waiting until 33 weeks to induce delivery of

anencephalic infants meets ethical
standards

• cause of death = anencephaly (not

prematurity)
 EIoL After Viability
• Motive
– alleviate the mother's distress
– minimize potential health risks for the mother

• "by this stage the mother's duty of

reasonable care for her fetus would
have been satisfied"
 Anti-EIL
• “Moral Principles Concerning Infants with
Anencephaly” (1998)
– By: Fr. Benedict Ashley, OP
• “Anencephalic Infants and their Care” (1998)
– Committee on Doctrine of the US National
Conference of Catholic Bishops
• “Primer for Health Care Ethics” (2000)
– By: Fr. Kevin O’Rourke
• “NCBC Statement on Early Induction of Labor”
(2004)
 Human Dignity
• To be fully human…

– does not mean that all human functions (and physical

capacities for such) must be actual

– means that an individual by being a member of the

human species possesses a nature that includes the
potential for actual operations, even though this
potential may never be actualized due to some
anomaly
 Human Dignity

• Hence, an anencephalic infant is the

subject of human rights and has a human
dignity equal to all other human beings
 Principle of Proportionality
• Operations, treatments, and medications
that have as their direct purpose the cure
of a proportionately serious
pathological condition of a
pregnant woman are permitted when
they cannot be safely postponed
until the unborn child is viable, even if they
will result in the death of the unborn child
 Principle of Proportionality

• For a proportionate reason, labor may

be induced after the fetus is viable
 Principle of Double Effect

• treatment is directly therapeutic in

response to a serious pathology of the
mother or child

• the good effect of curing the disease is

intended and the bad effect foreseen but
unintended
 Principle of Double Effect

• the death of the child is not the means

by which the good effect is achieved

• the good of curing the disease is

proportionate to the risk of the bad
effect
 Conclusion
• Initial error appears to be the theory that a
presumed lack of mental function is a
lethal pathology that can override the obligation
to provide for the basic needs of a person
• conditions of the human body, regardless of
severity, in no way compromise human dignity
or human rights
• Application of Principles of Proportionality
and Double Effect
 There she was, dead in my hands:
Dead by my hand. She was so delicate
and helpless, and I knew without a doubt
that, no matter what anyone said, I had
done something terribly wrong. God had
entrusted this life to me, and when
I found out it was not a perfect one,
I snuffed it out.
 Nearly a year and a half has passed since
Cecilia's death. Although I've been to
reconciliation and received absolution, the fact
remains that I killed my daughter. Though I
sought and acted on the advice of my doctors
and my pastor, I ultimately made the decision to
end her life. There is no doubt that her condition
was fatal, but it was not for me to decide
how long her life would be. Every day I
mourn her death. I should have fought for her
and protected her, no matter how short a life
God had in mind.
 The people who tell you early induction
is acceptable will try to make it sound as
if babies with fatal conditions are
less than human. They may have good
intentions, but they are wrong. Our
babies, no matter how flawed, are
human beings deserving love,
dignity and respect.
End.