Tuesday, March 06, 2007

The evolution of birth risk...

Having babies used to be an enormous risk for women. Medical efforts have drastically reduced the chance of bad outcomes - largely in the last century. But the risks are not zero - and modern parents find no comfort in tiny numbers.

But the key question centers on both the number needed to treat to avoid one adverse neonatal outcome and the level of risk that is currently considered acceptable. As practicing obstetricians, we find that the risk that women are now willing to assume in exchange for a measure of potential benefit, especially for the neonate, has changed: for many, the level of risk of an adverse outcome that was tolerated in the past to avoid cesarean delivery is no longer acceptable, and the threshold number needed to treat has thus been reset.

In the face of the resulting continued increase in cesarean deliveries, our obligation as providers is to educate patients about the trade-offs entailed in choosing a particular course or intervention and to ensure that their choices are congruent with their own philosophy, plans, and tolerance of risk. In areas in which there is still uncertainty, we must organize clinical trials that will produce the data we require for counseling patients. For the moment, however, few of the relevant factors seem likely to change, and the cesarean rate can be predicted to continue its climb. [More]

The growing assumption that every physiological problem is "fixable" seems well-grounded in daily medical advances. For example, I expect to see an effective end to most cancer before I die. But this brave new world of body repair offers some moral pitfalls.

Suppose, as I do, homosexuality is biologically determined via genetics. Now further suppose it can be easily and safely tested for in utero. This offers an interesting quandary for many committed pro-life supporters. Some evangelicals are trying to get out ahead of this issue, suggesting they too read and believe genetic research.
If a biological basis is found, and if a prenatal test is then developed, and if a successful treatment to reverse the sexual orientation to heterosexual is ever developed, we would support its use as we should unapologetically support the use of any appropriate means to avoid sexual temptation and the inevitable effects of sin. [More]
Consider this position carefully. The insistence on perfect children is not just moderately creepy, it demonstrates how many ideals we will sacrifice to insure their arrival. The same voices who find IVF abhorrent would rush to embrace it to allay their homophobia.

Medical science is handing us moral issues that make nuclear power look like Sunday School. It seems to be speeding up. To date in the West, we have found no effective answer to the struggle to match wisdom with knowledge. Perhaps that is simply how it must be. Discovery is random, and only by discourse and yes, error will we come to grips with new choices.

Of course, we could just opt for fundamentalism to avoid the work, such as our bitter detractors in the Muslim world do.

Most curious is how many of these issues seem to arrive first in our livestock.

(BTW, it's been 10 years since Dolly.)

No comments: