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Spring Dew [userpic]

HHS and the definition of abortion

July 18th, 2008 (06:04 pm)
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The following started as a reply to comments to my previous post. Of course that post is hurried because I was hurried. It still is crazy time, but I've taken a few moments here and there to write. It was getting long, so it became an entry.

By the way, I've seen a lot of hysteria on the net over this. I want to thank everyone I know, not just in my comments but everywhere, for not getting hysterical.


Least important points first - I find it grand that it's a proposal and subject to comment, on account of people certainly have comments!

My take is that it's also grand to prevent discrimination. I don't think defining pregnancy and/or abortion helps with that. It's like having government agencies define what's trafe and what's kosher - really none of their business, and that's why we have private oversight over certification and symbols regarding this. People generally know what they are opposed to and why, and anti-discrimination practices should help protect people's right to use their consciences.

I also have a problem, though, in forcing employment that should be self-selected out. For instance, if I am an adherent to a religion wherein a particular day of the week is holy and I must not work it, I have no business applying for a job that is hiring someone to work that day. It wouldn't be right for an employer to be forced to hire me anyway and then give me that day off.

One true example is that I am really, strongly opposed to ADHD medications being prescribed by general practitioners or even pediatricians who have not had the specific training involving their use, as these are way too easy to screw up. These are widely overprescribed and abused by people at large. Same thing with decades of overprescription and mis-prescription of antibiotics now resulting in resisting strains. I really shouldn't be a pharmacist. Really, really shouldn't. I'd have to work in a pharmacy that had signs up saying, "We only accept prescriptions for ADHD medications from these doctors [list]" and "We only accept prescriptions for antibiotics from these doctors [list]". Even then I might look googly-eyed at some of the prescriptions coming in.

One commenter I read pointed out that they had faced a similar choice in selecting not to work in neonatal medicine, as they are morally opposed to circumcision and would not participate in any way with its enactment. The onus of adherence to a moral, religious, or ethical code is on the individual.

What really got people's panties in a bunch is the matter of definitions:

Abortion: An abortion is the termination of a pregnancy. There are two commonly held views on the question of when a pregnancy begins. Some consider a pregnancy to begin at conception (that is, the fertilization of the egg by the sperm), while others consider it to begin with implantation (when the embryo implants in the lining of the uterus). A 2001 Zogby International American Values poll revealed that 49% of Americans believe that human life begins at conception. Presumably many who hold this belief think that any action that destroys human life after conception is the termination of a pregnancy, and so would be included in their definition of the term "abortion." Those who believe pregnancy begins at implantation believe the term "abortion" only includes the destruction of a human being after it has implanted in the lining of the uterus.

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Both definitions of pregnancy inform medical practice. Some medical authorities, like the American Medical Association and the British Medical Association, have defined the term "established pregnancy" as occurring after implantation. Other medical authorities present different definitions. Stedman's Medical Dictionary, for example, defines pregnancy as "[t]he state of a female after conception and until the termination of the gestation." Dorland's Medical Dictionary defines pregnancy, in relevant part, as "the condition of having a developing embryo or fetus in the body, after union of an oocyte and spermatozoon.

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The Department proposes to define abortion as “any of the various procedures—including the prescription and administration of any drug or the performance of any procedure or any other action—that results in the termination of the life of a human being in utero between conception and natural birth, whether before or after implantation.”

(By the way, "termination of the life of a human being" above is out of line, as application of the scientific method hasn't, and probably cannot, identify just when it is in this whole process that a human being occurs. If it could, we'd have a lot less controversy.)

I am STILL trying to find the American College of Obstetricians and Gynecologists' definitions of several of these terms. My scholarly research database tool isn't turning up much that is helpful so far. Could be user error. It's running slow and my search terms may not be so great. Plus I am only coming up with abstracts, some of which are not so helpful. I see several third-person mentions that ACOG has long held that pregnancy begins at implantation, and therefore an abortion cannot be performed until the implantation has occurred.

Part of the problem is that hormonal contraception methods (and also copper IUDs) don't act upon an event; they act upon an environment. They make the reproductive area less amenable to pregnancy. The nature of the effect varies. The sperm and egg may never meet. Or if they do meet, there may not be a successful conception. Or if there is, the blastocyst now might not implant. So, maybe "contraception" is a misnomer, but methods generally regarded as "contraceptives" may be considered by others as "abortifacients", if they consider preventing implantation as abortion. Usually "abortifacients" refers to any agent that disengages an implantation that has already occurred.

I have no problem with people holding this belief. I have a lot of problem with a piece of policy trying to base official medical definitions on people's beliefs in one piece with protecting against discrimination. Unlike vinegar and oil, these do not produce salad dressing. That's where -I- find the stoopit.

I'm not so sure I'm as riled up about the idea of agencies losing their funding over it as some other people are, given that there are measures to "help medical entities come into compliance" before funding would be cut off. I do have some concern about the wide interpretation of "assisting" in that someone who was asked about help, say, after a rape, might not only refuse to have anything to do with it but might also not report the patient's concerns to anyone else, effectively denying the treatment entirely rather than just refusing to participate. While I could hope there would be other opportunities for this hypothetical patient to ask someone, I don't like the chanciness of that. I'd really rather not have the conscientious objector at the front lines at all. There are other ways they can help their fellow beings.

I'd like to see ways to accommodate all concerns of conscience in such that they don't impact the missions of the facilities involved, like, you know, maybe job-swapping. If I work in a Catholic hospital but I don't have a problem assisting with abortion, then it would be great if I could swap with my colleague at a state university hospital who does. I'm sure we can get creative.