HomeHealthy LifeHealing Words: Abortion deserves objective and accurate le… : Emergency Medicine News
Healing Words: Abortion deserves objective and accurate le… : Emergency Medicine News
August 1, 2022
Nobody wants to discuss abortion. The conversation is more complex, divisive and tedious than COVID or corporate takeovers of healthcare. But emergency medicine is the profession that trains EPs to brave conversations no one wants but needs to have: intimate partner violence, child abuse, end-of-life issues, depression, sexually transmitted infections, homelessness, substance abuse, sex trafficking, social determinants of health , mental health, suicide… the list goes on and on.
Why should abortion be any different? It can even be part of the same discussion in many cases in the ED. As with COVID, the politicization of scientific information makes speaking objective fact an arduous skill to detach from the polemics embedded in our culture and language. This applies to doctors and medical staff as well as to patients. Winning your position becomes a personal, moral rage instead of being with someone in distress and accepting a solution you may not agree with.
Many years ago I remember a reclusive elderly woman with a STEMI who was unwilling to go to the cath lab until someone came to feed her cats. “I would rather die than starve my cats,” she said. She meant it literally. I was in complete disbelief.
But it wasn’t until I accepted her assessment of her situation that we could begin to resolve a matter of life and death for her – and her cats. We ended up sending one of our security guards to her home to feed her. And it was the first thing she talked about when she woke up from the sedation. She taught me, as a younger doctor, a valuable lesson in training myself not to shake my head inconsistently (metaphorically or literally) while someone is telling me something I don’t want to hear.
Abortion is far more nuanced than a cardiac catheterization lab and cats, but taking an approach to suffering with another person you may disagree with rather than trying to win your position is a valuable emotional framework to medicine upon . I will not provide heroic or feel-good stories about a woman from the ER who wants her pregnancy terminated, or about one who is pregnant again and is not in a physical, social, or mental situation that the Conducive to the birth and rearing of a child. These kinds of anecdotal stories should not be told because a single story, like that of the woman and her cats, runs the risk of being medically generalized under a topic as immeasurably complex and variable as any other topic in all of medicine.
Binary thinking and wisdom
How we define terms in the most measurable and objective way possible is the first critical step in discussing what exactly we are talking about, whether it is sepsis, heart attack or abortion, and should be done well before we can begin to discuss treatment speak. The definitions and approaches to the circumstances vary widely.
The circumstances of an abortion are often varied: are we talking about a blastocyst or a 10-week fetus completing organogenesis? A viable fetus or a fetus that may be viable outside the uterus? A healthy fetus or an anencephalic fetus? A mother whose life is reasonably in physical jeopardy (and how are those odds determined?), a woman who is pregnant as a result of criminal violence, a woman who is pregnant by force, or a mother (and father) with no economic means , mental or social problems Resources to raise a child without the likelihood of neglect? A sperm-fertilized egg stored for embryo transfer, an embryo or fetus that died due to family or community shame, or an embryo or fetus that died at an unfavorable stage in life due to professional demands or aspirations? Or a combination of several of them?
This isn’t just about a woman choosing to have an abortion. Some women refuse to have an abortion but do not want to become pregnant and are deeply unhappy and afraid of having a baby. Some women have an abortion even though they want to have a child because, given the immediate situation they are in, having a baby feels like it will destroy them. The physical and emotional permutations are frankly unimaginable and not necessarily static. Someone on any political side wishing to vote a thumbs up or down on this issue is showing a serious lack of knowledge and perhaps a lack of empathy for people on the other side of the argument. Binary thinking destroys every opportunity for wisdom.
I do not offer expertise in approaching the obstetric, medical, legal, ethical and social dilemmas of abortion, but I would like to explore some aspects of scientific medical definitions and community language related to unintended pregnancy that often push us away from and towards objectivity they lead politically polemically. To use COVID as an analogy again, the medical community should be compelled to repeat these scientific definitions and facts that we know with as much clarity and dispassionate as possible in the hope that we can start a discussion of integrity and purpose .
Can we at least agree on the same scientific language without people just shouting their opinions out with half-truths? We need clarity. We need a neutral scientific lexicon on the use of the word “abortion” in medicine. Here is my short list of suggestions based around our current medical lexicon of abortion.
An ambiguous umbrella
Reporting on G3P1Ab2 lacks the necessary clarity. Abortion is a loaded word, and our medical lexicon needs careful subdivisions of abortion’s ambiguous umbrella. Terms like “spontaneous abortion” or “threatening abortion” should be abandoned for the word “miscarriage” in our language, dictation and notation.
“Wahlabort” should be abandoned for the term “induced termination of pregnancy”. The word “elective” is often used in abortion centers around the linchpin of choice. Miscarriage is not a choice, and termination of pregnancy due to maternal harm is an extremely limited choice. Logically, abortion after rape or with a fetus with compromised viability is not the same unfettered choice as other abortions.
An abortion that is necessary to save the mother’s physical life is not truly elective and could be termed an “emergent near-death termination of pregnancy.” And perhaps abortions as a result of rape or fetal abnormalities that are devastating and barely sustaining life deserve another term like “abortion.” Women deserve this clarity. Ignoring these distinctions under an ill-defined word with “abortion” in it confuses conversation and can falsely accuse women of choosing a situation where they feel they have no other choice.
“Pregnancy” should not be used as a euphemism. Pregnancy is a condition of a pregnant woman. It is not a condition of the father – he is not pregnant. The fetus is not the pregnancy. We’re not looking at your pregnancy; We’ll scan your fetus. A woman does not miscarry; she gets a fetus.
The words “mother” and “baby” in an initial consultation should be given as “the pregnant woman” and “the embryo” (less than eight weeks) or “the fetus” (eight weeks gestation or more). “Fetus” will be the most likely terminology for pregnant women in the emergency room receiving an ultrasound or fetal heart sounds.
The fetus is not the woman’s body. The fetus has its own unique DNA that is not part of the woman’s body. The fetus is not a heap of cells. Anyone who has studied embryology knows that this is a unique human tissue in the process of formation. The word “person” is more problematic because the legal arguments are not about whether the fetus is human, but whether it has the rights of a “person,” the same rights that women and black people did not have earlier in our history.
“Living” is also more problematic for legal reasons, because “ending a life” could be translated as “killing”. A fetus as human or human emergence would be more accurate and less polemical than “part of the woman’s body,” “a lump of tissue,” or “the life of the baby.”
Abortion is not a reproductive term. The embryo fetus is already produced. This is not a decision about reproduction. This is a decision about carrying and giving birth. Termination of pregnancy would fall better under the birthright than under the reproductive right.
Women’s rights have historically focused on full personality and citizenship through elections, and later on cultural power in leadership in family and society. These good developments in empowering women are often placed under the positive umbrella of individual women’s rights.
Complex science deserves an objective and precise dictionary. Medical terms and definitions, like scientific data, must be created as impartially as possible. Manipulations with polemical phrases are to be avoided. The polarization of the abortion issue in the United States has destroyed even the medical community’s ability to create words that do not vote for a political side.
There is nothing wrong with having an informed medical opinion about a course of action in unique and special circumstances, but these discussions cannot be had, let alone translated for our communities, unless we adopt and speak in clear terms. Abortion deserves more. Those pregnant in the ER deserve better.