Protecting the Patient or the Doctor?

iVillage Member
Registered: 12-12-2003
Protecting the Patient or the Doctor?
16
Fri, 08-17-2007 - 3:46pm


Kaiser Daily Women's Health Policy

Friday, August 10, 2007

Abortion News
Some Abortion Providers Inject Fetuses With Lethal Drugs Prior to Procedure To Avoid Prosecution, Boston Globe Reports
Many abortion providers in response to the Supreme Court decision to uphold a ban on so-called "partial-birth" abortion have begun injecting fetuses with lethal drugs prior to the procedure to avoid accusations that they violated the ban and potential prosecution, the Boston Globe reports. According to the Globe, medical staff members inject fetuses older than 18 to 20 weeks' gestation with the heart drug digoxin or potassium chloride to ensure the fetus is dead before the abortion is performed.

If a fetus is not dead when it begins to emerge from the woman's body, medical staff could be accused of violating the law under the Partial Birth Abortion Ban Act. Although providers are not performing the banned procedure, many "feel compelled to do all they can to protect themselves and their staff from the possibility of being accused," the Globe reports.

According to the Globe, the injections can cause a slight risk to the woman and do not provide a medical benefit. Philip Darney, chief of obstetrics at San Francisco General Hospital, and colleagues have studied the two drugs used in the injections. They found that digoxin is safe but provides no advantages in performing the actual procedure. They also found no safety record for potassium chloride, but a few cases suggest that it could be dangerous if it is accidentally injected into the woman instead of the fetus. The researchers determined that women undergoing abortions should decide whether to use the injections. Darney, who has decided not to use the injections, said the researchers do not "believe that our patients should take a risk for which the only clear benefit is a legal one to the physician."

The National Abortion Federation in response to increasing interest among abortion providers in using digoxin has developed guidelines for NAF members on using the injections and is conducting training. Mark Nichols, an ob-gyn professor at Oregon Health & Science University, said he believes the majority of late-term abortion providers are making the injections routine, adding that he requires injections for all fetuses beginning at 20 weeks' gestation at his clinic. He said that although he respects Darney's position on the injections, he is a "little bit more concerned about the risk for the faculty and staff." According to Michael Greene, director of obstetrics at Massachusetts General Hospital, patients have not objected to the injections.

Massachusetts General, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center have made the injections standard policy for all abortions beginning at 20 weeks' gestation, according to Greene. In addition, Boston Medical Center has begun using the injections for later-term surgical abortions, according to Phillip Stubblefield, an ob-gyn professor at Boston University School of Medicine. Greene said, "No physician even wants to be accused of stumbling into accidentally doing one of these procedures" (Goldberg, Boston Globe, 8/10).

http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=46797

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iVillage Member
Registered: 12-12-2003
Sun, 08-19-2007 - 3:50pm

< He said that although he respects Darney's position on the injections, he is a "little bit more concerned about the risk for the faculty and staff." >

I thought that doctors were supposed to do what is in the best interest of the patient and not what's best for himself.

iVillage Member
Registered: 06-03-2007
Mon, 08-20-2007 - 8:57pm

I suppose there comes a point at which one must, as a healthcare provider, try to balance a tiny risk that an injection gets into the wrong bloodstream against the current witchhunt environment and the more sizeable risk of not being able to provide care for other patients in the future.

Doesn't that stink? No wonder there are physicians coming down on both sides.

As far as I've been taught, they're just decreasing the gestational age at which they give these, they were always standard after circa 24 weeks (at a later gestational age, it's an easier thing to do to ensure that the needle is in any exact space).

iVillage Member
Registered: 07-29-2004
Wed, 08-22-2007 - 10:48am

"I thought that doctors were supposed to do what is in the best interest of the patient and not what's best for himself."

Unfortunately in today's sue-happy society this doesn't happen very often. Why do you think our c-section rates are at almost 1/3 in this country. It's certainly not in the best interest of the patient!

iVillage Member
Registered: 12-12-2003
Wed, 08-22-2007 - 2:00pm

I don't think that is a valid comparison.

There is a benefit to many women that have a c-section. There is no benefit to the women that get this shot prior to the abortion, only risks. The doctors are the only one to benefit while the women assume all of the risks. If a woman were to have complications from this shot, she would be able to sue for damages.

iVillage Member
Registered: 07-29-2004
Wed, 08-22-2007 - 5:54pm
Many women who get c-sections do not get a benefit as opposed to having a vaginal delivery. I think it's very valid and it was just one example of invasive procedures that Dr.s do that serve only to protect them.
iVillage Member
Registered: 06-03-2007
Wed, 08-22-2007 - 8:21pm

This is what we call "defensive medicine". Defensive medicine is that which is bent out of its original shape by our need to cover our asses and not get sued. It leads to extraneous procedures in all fields, including a proportion of cesarean sections, a whole lotta x-rays in medicine and surgery, extra antibiotics in primary care, etc.

This particular example is on the mild end of the spectrum.

Now, scheduling a cesarean or an induction for convenient business hours, or allowing a woman to believe that that option is just as safe as waiting for natural onset of labor - that's a different illness. I'd call that arrogance, or maybe half the time it's a paranoid mistrust of any biological process not under strict pharmacological or surgical control. I can somewhat empathize with the feelings that lead to the latter, even though they certainly oughta be trained out of it.

iVillage Member
Registered: 11-18-2005
Tue, 08-28-2007 - 8:41am
Well, if he gets sued and loses his license than no one benefits.
iVillage Member
Registered: 11-18-2005
Tue, 08-28-2007 - 8:43am
No, there is NOT a benefit to *many* c-sections. There is a need for c-sections but not at the rate they are being performed in the US.
iVillage Member
Registered: 12-12-2003
Tue, 08-28-2007 - 4:42pm

The article said nothing about this being done to protect them from being sued for Med/Mal. It's being done to protect themselves with regard to the Supreme Court decision about abortion.

iVillage Member
Registered: 11-18-2005
Wed, 08-29-2007 - 10:19am
Right and going against that decision could lead to lawsuits....

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