Rights of the Unborn

          Years of Obstetrics practice has failed to resolve a dilemma that haunts me. Should I or shouldn’t I oblige this couple before me who have come requesting for an abortion?  Should I respect their wishes and do a favour to the demography of the country and interests of the family by reducing the count by one? Or should I fear the Unknown, bat for the unborn, and refuse the abortion?       

Abortion is defined as the termination of pregnancy before the viability of the foetus. The catchword here is VIABILITY- which means the capacity of the newborn to survive on its own with little outside support. In India, this period is about 28 weeks (total human pregnancy is 40 weeks) but western countries have been constantly reducing this period of viability and now it is as less as 24 weeks! Thus, it means any termination of pregnancy before 28 weeks is abortion. However, abortion laws in India do not permit termination beyond 20 weeks of gestation.

            Here then is the main contention. Can a foetus, alive within the mother’s womb, be considered an individual? If yes, from what age does it merit its own rights? After 28 weeks? After 20 weeks? Or at conception? Legally, the foetus is not granted an individual status.

 So, ‘Alive but not an individual’-can this status automatically confer sole rights to the biological parent/s to decide on an abortion? Probably yes. Because science has not invented ways to map fetal emotions let alone take consent from the unborn! Imagine someone holding a gun to your forehead. What would you say if he/she ever asked if you’d like to be killed? Don’t bother to think, for you’ve been emotionally numbed already. Because the person wanting to kill you is your favourite face-your mom or dad! And who in the whole wide world would ever fight against them for you?

            Which then trails down to yet another basic query- From when do I become ‘I am’ in the womb? At what point is the growing zygote no more a mass of cells but a tiny human entity? Is it at the first beat of a primitive heart (around 6 weeks of gestation) or at the first flailing of a limb bud (8-9 weeks) or the first sudden intrauterine breath?

            After the fusion of the sperm with the egg, the resulting cell (called zygote) begins its shaping out sojourn. One cell doubles (by 30 hours), then the daughter cells double...a mass of cells is formed. At one point, it is a miniscule round cell mass containing eight potent cells. If, at this stage, each of the eight cells is separated and allowed to develop separately, every one of them is potentially capable of developing into an individual! So at the eight celled stage, we are theoretically, eight persons in one-not yet ONE person! Only after further cell division, the 16- and 32 cell stages are reached (Blastocyst and morulla) and by then the cells are no longer omni-potent. So then, does my life start from after this eight-celled stage?

            It may seem very frivulous to discuss and dissect life at cellular level. But this technical dilemma is more pronounced in infertility clinics. For medical reasons, the couple have their eggs and sperms fused outside the body and the resulting zygote/s are then implanted into the uterus (In Vitro Fertilization or IVF) But in the process, more than one zygote may be obtained. And these are capable of forming into different individuals when implanted in the uterus. IVF clinics have various uses for this ‘extra’ embryos (note how life is trivialised even when in limbo). They are kept frozen for further use-either for the same couple later on or donated (Embryo donation) to other infertile couple or may end up as research material under a powerful microscope for lack of suitable takers!

 However, there have been unfortunate incidents of the biological parents dying in accidents or divorcing or even simply not wanting to have more than one child. What happens to the potential individual in the freezer? Who decides whether they should be preserved and if so, how long or should they be allowed to ‘die’? And who will take up the cudgels for a frozen mass of cells in some obscure corner of a freezer in yet another Infertility Clinic?

            Which then throws the question back at us-Is the unborn an individual meriting at least some if not all the rights of a citizen? Is abortion just another medical intervention or acceptable homicide?

During mid-2008, the Bombay High Court refused permission to Harsh and Nikitha Mehta for aborting their 26 weeks old foetus. The baby had a congenital heart disease and the medical faternity was divided on the prognosis for this baby after birth. So the petitioners had sought permission citing imperfection and because the foetus was over 20 weeks.

 Is it right to abort an imperfect unborn? If yes, then what is imperfection? By definition, an extra digit is imperfection and so is a huge hole in the heart or a total absence of skull, exposing an improperly formed brain. So, which foetus gets the full stop? It is almost unanimous amongst us that those anomalies that cannot sustain life merit abortion at the earliest in order to avert the physical and mental trauma the mother has to suffer if the foetus is allowed to grow full term. But what is the consensus on the borderlines? The anomaly, which is not lethal? What must be done to those babies with contorted ankles (Talipes equinovarus) or excessive water in the brain (hydrocephalus) or some gut anomalies that need to be operated after birth, or as in Nikitha’s case, a cardiac anomaly whose prognosis is unknown or guarded?

            Is it correct to allow the biological parents to make the decision? Has the unborn been asked? Its rights considered? Or should there be a human rights organisation fighting for every foetus coming up for abortion? If allowed to be born, what is the degree of mental, financial and medical burden the baby and her parents must go through? Who is expected to bear the costs-the unwanting parents or the organisation that fought for the baby? Is it worth the trouble?  The debate only gets more confusing with a clash of ethical, moral, financial, legal and personal issues.

Should individual status be granted to the unborn then? Make laws to protect them? A few years back a pregnant woman (beyond 28 weeks) was killed in an accident,in Gujrat, I think. The survivors claimed monetary compensation from the Insurance agency on behalf of the baby too, citing it was viable! Only the baby was dead like its mother and the life insurance money claimed would go to the kin whom it never saw or knew!

My mother ran away!

I have discovered that one of the most emotionally charged and a labile moment for a woman is immediately after childbirth. Probably a sense of accomplishment or an acknowledgement of responsibility of adulthood emboldens even the shy and timid to become eloquent. Women often reveal very personal information during cesareans or normal deliveries when we are suturing them.

For my part, I sense that having helped them to deliver their facsimile, further promotes our patient-doctor relationship. At these times, they pour out their innermost insecurities and feelings.

            As the staff involved in a normal delivery is less than in a Caesar and the patient is not under anesthetic influence, the tete-a-tete is more direct. As I deliver the placenta and prepare to suture them, to keep some conversation going I often ask -“So, will you be going to stay with your mother?” Of course, I know that our girls go to their mother’s and stay there for up to nine months after delivery. My question is most often meant to be a light banter.

However, the responses to this simple question always give me an insight into the kind of life this woman may be living in a man’s world. Answering this innocuous question, they reveal more about themselves than they could ever guess.

And so goes the conversation and my assessment.

            “So, will you be going to stay with your mother?”

            “Yes doctor. I shall stay there for the next nine months.” The mother and child will be cared for well here. She comes from a close- knit family. A family that will accept her and her newborn girl and probably will not tolerate the in-laws if they grumble and accuse her of not having delivered a baby boy.

            “Yes. But not for long.” It could be that her absence from her husband’s home will be missed- probably as the loss of a helping hand. Or, there must be that first-born who had to be cared for too. A responsible woman, struggling to cope up with family pressures.

            “No. But my mother is coming here to help me out.” A responsible, older woman (the mother) valiantly coping up with extended pressures even when her children have begun their own families. This young woman will learn to appreciate the sacrifices of her mother and probably will emulate the same in years to come.

            “No. I may have to manage alone. My husband is busy.” The wistful sigh of the young girl who married against her parents wishes. No parents, no in-laws to turn to. This just out of teens is prone to disregard her health. The initial physical attraction in their marriage is already on the wane and in a few months, she will have the first real exposure to her husband’s character. I hope it will be a pleasant one!

            “No. My in-laws will not hear of it. They have had a row with my parents.” A great tension…most often for lack of dowry and a clash of egos. The poor lady will have to make a lot of compromises and if it is a female child, her other problems have just begun.

            But the irony of it all is that that the most startling answers are given out in a feeling-less voice. The pain of the memory becomes temporarily camouflaged by the recent even of labor and a sympathetic ear at such times will get its earful!

           

            “My mother stays with us, doctor. My father married again when I was born.” What was her mother’s fault? Delivering a girl baby! No wonder this young woman had such low perception of self-worth.

“I don’t have one, madam. She is dead….committed suicide when I was young.” Fifteen years of solitude as an orphan…No mother to braid her hair or pack her lunch- box or confide about her heavy period…Becoming, and playing the role of a mother will be a  challenge to this woman and she needs a lot of family support.

And finally, one evening, as I was doing her skin and popped the question, a patient said:

            “Doctor, my mother ran away.” A flat statement... I looked at her from my seat...dry eyes and a wry smile.

             I halt midway the second suture. Did I hear her right?  

            “What did you say?.... When?”

            “My mother ran away. Four days ago. She doesn’t know I have delivered.” A woman runs away at that age? And where to? This lady was 28 years and her mother could be in her sixth decade. Running away at 55?Eloping? Can’t be.

            “But…why?”

            “My father tortures her.” The bitterness in that voice haunts me even to this day.

            What do you call a man who abuses his wife even after the grandchildren are around? And how much of an abuse it must have been for the poor elderly woman to abandon a place she believed was her home and a man whom she had served for over forty years? Where could she have gone-talking along, suffering her depression, arthritis and all? It could probably be to anyone of her relatives’ houses...or to end up as a statistics on a railway track or float on a god-forsaken pond four days hence.

            “She might come back...when she learns you have delivered...” I tried to put off that vision.

            “No madam. Not this time...She has had far too much...We’ve lost her...” Now the new mother was crying. It was yet another moment of helplessness in my profession. I could neither continue the conversation nor look into those sorrowful eyes. And what consolation should I give this wretched woman?

            They taught me history-taking, examination and surgery in Medical Colleges; preaching Medicine was an inexact science...but no one had warned me that I could often be stumped by such emotional tempests....

            As I ripped off my gloves, I realized again that Medicine is very finite...

The desperate spinster!

Poor Miss Under Stud

is communicatively challenged.

At front office job, she lasted a day.

“Hello? Miss Under Stud here!” she’d said.

Her esteemed caller was cross,

she was shown the doorway.

As a H.R manager,

she lasted a little longer.

Until she signed-“Under Stud.”

The umbraged client got it, ‘Understood?’

Alas, when she signed just- “U.S”,

its intimacy lured lechers

who inferred her amorous!

Lonely, Miss Under Stud

longed for a man who understood,

a quiet home and a little brood.

But she remained long un-wooed. 

For,

could she marry Mr. Side or Mr.Hand,

risk being called Mrs. Under Side or Under Hand?

To wed Mr. Ram or Mr. Bush

surely would indecency out-blush.

“ ‘Mrs. Under Stud’ makes out

a lesser man of me,” other suitors rued.

“Under Stud sounds so horsey and less mare-y too,

I can’t have her about!”

“Miss....U....Stud!? Are you?”

The kinky women would huskily leer.

And thus poor Miss Under,

paid for her parents’ blunder.

She willed her epitaph, at final surrender:

“Mis-Under-Stud-

she learnt to live with fortitude!”