On June 29, 2022

The mother is the best health care agent for her pregnancy

By Paul Manganiello

Editor’s note: Paul Manganiello, M.D., is emeritus professor of obstetrics and gynecology at Geisel School of Medicine at Dartmouth, co-medical director of the Good Neighbor Health Clinic in White River Junction, and president of the GunSenseVT Education Fund. He lives in Norwich.

I graduated from medical school in 1973, the same year Roe v. Wade guaranteed women the right to an abortion. With the recent U.S. Supreme Court decision, that right has been reversed.

The core conflict surrounding abortion is the issue of personhood. At what time during a developing pregnancy should this intrauterine human organism be considered a “human being,” a person?

Is it science’s role to define personhood? No one is denying that a fertilized egg, a zygote, is “human tissue.” It has the same DNA as an individual human skin cell, but should it be considered a “human being”? Should it be considered a person? Does it deserve the same designation of human being as the child who was just given birth?

We need to be clear: From a medical standpoint, an embryo is not an unborn child/baby, it is an embryo; a fetus is not an unborn child/baby, it is a fetus. By definition, an embryo is a human organism during that period extending from conception to the eighth week after fertilization, while a fetus is a human organism developing from the end of that eighth week. A fetus is capable of existing outside the uterine environment from approximately the 22nd to the 24th week of gestation.

In 1979, I was completing my fellowship in reproductive endocrinology. Assisted reproductive technology and in vitro fertilization were just becoming a clinical reality. Since then, infertility centers have thousands of frozen embryos waiting for a decision from their potential parents about their disposition. If states criminalize abortion, will parents and physicians be prosecuted when the intended birth mother feels that their families are complete and allow the embryos to be thawed and ‘die?’

Well, is it the government’s role to define personhood? Justice Harry Blackmun, who delivered the majority opinion of the U.S. Supreme Court in Roe v. Wade in 1973, stated, “We, the Court, need not resolve the difficult question of when human life begins. When those trained in the respective disciplines of medicine, philosophy, and theology are unable to arrive at any consensus, the judiciary, at this point in the development of man’s knowledge, is not in a position to speculate as to the answer.”

We live in a religiously pluralistic society. The Roman Catholic Church, in Pope Pius XI’s 1930 marriage encyclical Casti Connubii, stated that “life” began at conception, and that abortion was a sin against life. In the early church, St. Thomas Aquinas, a Roman Catholic theologian (1300s), believed “quickening,” the perception of fetal movement occurring at approximately the fifth month, to be the time when the developing fetus became a person. Not all religions believe this to be the case. There are Jews who believe that a fetus is not a person until it takes its first breath at birth.

Our Founding Fathers had the foresight to build into the Constitution a formal separation of church and state, the First Amendment to the Constitution. The government needs to respect the religious, spiritual beliefs of all its citizens and residents. No one individual or religious institution has a monopoly on morality.

Pregnancy, on the surface, appears to present two “competing” interests, the interests of the mother versus the interest of the developing embryo/fetus. We should not look at this situation as an either/or, but rather, what is really the best interest of the pair? There may come a time when all of us may have to surrender our medical decision-making to someone else; we may need to identify a health care agent to decide what health care decisions are in our best interests. We usually think of a health care agent for the elderly, but they may also be required shortly after birth or even into adolescence.

During a pregnancy, the mother is the best person to consider all of the ramifications needed in making medical decisions affecting a given pregnancy, even if it means “removing life support” for a fetus who does not have the capacity to make their own health care decisions.

The mother is the best person to be able to look at the entire context of a particular pregnancy — that is, would a pregnancy interrupt her education; does the mother feel physically, financially, emotionally capable of raising a child; was she a victim of rape, incest?

Will continuing with a pregnancy present a danger to the health of the mother; does the fetus have an anomaly incompatible with life after the delivery? Among so many other questions and circumstances that are life-altering.

State laws that limit the mother’s decision-making are not life-affirming, but are actually paternalistic, infantilizing women — and are punitive for the woman who needs to decide whether or not to terminate her pregnancy.

It is the pregnant woman, and she alone, who is best positioned to be the health care agent for her pregnancy.

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