Pregnant couple having sonogram (Getty Images)
“Lethal fetal anomaly” is the medical term used to describe a severe birth defect that results in an infant’s death shortly after delivery. It is a devastating, heartbreaking finding on a pregnancy ultrasound and every expectant parent’s worst nightmare. It means that their beloved child will not survive.
Some parents choose to continue the pregnancy. They choose to wait and to let the mother assume the risks to her physical and emotional health throughout the remainder of her pregnancy. They choose to let their child take a few breaths after delivery and watch them die while swaddled on the mother’s chest. And we physicians fully support their decision.
We also support those parents who choose to let their beloved infant pass earlier in the pregnancy by choosing medical termination after receiving a tragic diagnosis. These parents believe that prolonging their infant’s life will result in more suffering and pain for their child. They choose to protect the mother’s health by inducing labor, knowing their child will not survive and that there are risks to the mother’s health by continuing the pregnancy. They are aware the mother’s emotional health may be severely impacted if the pregnancy continues, as postpartum depression and anxiety disorders are the most common medical complications of childbirth.
A proposed amendment to Legislative Bill 574, AM 1658, scheduled to be debated in the Nebraska Legislature on Tuesday May 16, would not allow families a choice. The amendment seeks to ban abortions after 12-week gestational age despite the medical fact that physicians cannot accurately detect most significant fetal abnormalities until at least gestational age 18-20 weeks. If passed, this legislation would remove the highly personal decision about whether to terminate a pregnancy with documented lethal fetal anomalies from mothers, fathers and their doctors.
We, as a society, are already in agreement that family members have the right and responsibility to make the difficult decision to cease futile care when a family member has a terminal condition. Most Nebraskans agree that we do not want the government to decide if a family can withdraw life support, and we do not want the government in the exam room with our doctors and our families when we are going through the most difficult period in our lives. This legislation intrudes on one of the most sacred, heart-wrenching and complicated decisions that a couple and their family can face.
An additional major concern about the proposed amendment is that it classifies psychiatric illness in a separate category from other medical illnesses regarding exceptions for pregnancy termination as a life-saving procedure to protect the life of the mother. Psychiatric illnesses are medical illnesses. Excluding women with psychiatric illness as not meeting the medical exception is callous and would deny abortions specifically to women with severe mental illness even when their lives are at stake. Some women may be hanging on by a thread early in pregnancy and then decompensate in the second trimester, leading to suicidal ideation and self-harm.
These women are fully competent to make medical decisions for themselves and can, despite aggressive psychiatric treatment, have significant suicidal ideation if forced to continue an unwanted pregnancy. They need as much care and concern as a pregnant woman with pre-eclampsia or other life-threatening conditions associated with pregnancy. To exclude severe mental illness as an exception and putting their lives at risk is ill informed and prejudicial towards the Nebraskans who live with psychiatric illness.
Many physicians will be in the Capitol Rotunda on Tuesday. We have busy schedules and clinical duties, but we will be there. It is our responsibility to share the complexity of the suffering that we see on a daily basis. We urge legislators and fellow Nebraskans to consider the women and families involved and oppose LB 574 and AM 1658. Our current abortion restrictions are compassionate and humane, and allow Nebraskans appropriate time to make the best health care decisions for their families.
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