Tuesday, July 20, 2010

Between a rock and a hard place (Part II - cancer)

This is part two of a series about whether there are any case where abortion needs to be performed to save the life of the mother. In the first post on this topic we covered the case of Sr. Margaret McBride who approved of an abortion to save the life of a woman with pulmonary hypertension. As we saw, the abortion wasn't necessary.

Next I'd like to consider the case of women who are diagnosed with cancer during pregnancy. Again, certainly there is an increased risk (especially for the baby) in some forms of cancer treatment, but is abortion ever necessary?

One way to side step the issue is to wait until the child is old enough and deliver it. This is typically about 32 weeks or later. If the cancer is detected later in the pregnancy, or it is not a particularly aggressive form of cancer, this is a viable alternative to abortion. But what if the cancer needs to be treated before the baby can be delivered safely?

The major methods for cancer treatment are surgery, chemotherapy and radiation. Depending on where the cancer is located, radiation may not be recommended. However, radiation is usually used as a follow up, after surgery and chemotherapy, and it can be used after delivery. Surgery does not carry any significantly greater risk during pregnancy.

Which leaves chemotherapy. Women are routines told they have to have an abortion before chemotherapy begins. This is simply nit true.

According to Pregnancy and Cancer patient guidelines at the M D Anderson Cancer Center:
First trimester – The fetal effects of chemotherapy drugs during the first trimester of pregnancy are unclear. In certain circumstances it may be necessary to start chemotherapy as soon as the diagnosis of cancer is made. An example would be acute leukemia. Even if the diagnosis is in the first trimester and the use of chemotherapy becomes necessary most of a baby’s major organ systems are already formed by 8 weeks of pregnancy.
Second and third trimesters - Many chemotherapy drugs can be used during the second and third trimester of pregnancy without harming the fetus, since major organ formation has been completed.
The Journal of Clinical Oncology published the results of a study "Chemotherapy for Breast Cancer During Pregnancy: An 18-Year Experience From Five London Teaching Hospitals":
All but one of the women were treated after the first trimester. One spontaneous abortion occurred in the woman treated during her first trimester; otherwise, there were no serious adverse consequences for the mothers or neonates.
CONCLUSION: These data provide evidence that in terms of peripartum complications and immediate fetal outcome, chemotherapy can be safely administered to women during the second and third trimesters of pregnancy.

Note that in 18 years of treating cancer, only one woman lost her baby. Had they aborted, all of them would have lost their babies. The National Institute of Heath published "Children exposed to chemotherapy in utero":
...fetuses exposed to chemotherapy in utero in the second and third trimesters can be carried to term, be born without evidence of congenital abnormalities, and develop normally.
Of course there are cases where the baby can't be saved. For instance, there are cases where the uterus is cancerous, and needs to be surgically removed. This is truly the case where the the mother and child cannot both be saved. In treating the disease, the child will not survive. But note that these are not abortions. Killing and removing the baby does nothing for the mother. Removing the uterus is what saves her. Removing the uterus will result in the death of the child, but it is not the death of the child that is the object of the operation. This is called "double effect", and the legality of abortion would not affect these procedures from being performed. Such procedures are considered moral and are not prohibited by the Catholic church. I'll get into the double effect in the next post, talking about ectopic pregnancy, but I wanted to mention it here because in the case of some cancers it is applicable.

Now, cancer and heart disease aren't the only two conditions which can happen during pregnancy, they are merely the "popular" ones used to justify abortion to "save" the mother. The fact is, as several doctors have stated, there is no medical condition that requires abortion.

You can find part III here.


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