Thursday, February 26, 2009

On the Responsibility of Doctors

There is a story getting a lot of attention in the media these days about a woman in California who gave birth to octuplets earlier this year. That in itself would be newsworthy enough, but the fact that the mother already had six children, two of whom are disabled and require special care, is unemployed, unmarried and living with her mother in a house that is about to be repossessed has made the story the subject of numerous dinner conversations, ours included.

In thinking about it more I have come to wonder not so much what the mother "was thinking," for I believe that the mother's right to choose means that the mother may choose to have her children. No, what I'm wondering is: what in fact were the doctors thinking? Now, this is not to say that I think the doctors should have counseled the mother to remove some of the embryos nor that they should have done so against her will as many have suggested.

What I do find hard to understand is what the doctors thought would happen after they delivered all eight babies. Naturally, they spent a great deal of time thinking about and planning for the deliveries, since that required so many coordinated efforts from so many professionals to actually accomplish safely. For them, it was a very 'cool' assignment; a challenge to their skills.

But I have to wonder, did any one of those skilled professional stop to consider--and therefore, plan for--the circumstances into which these eight babies would be delivered? I mean, did anyone give any thought to what would happen to them after they were released from the hospital?

Well, now the doctors are thinking about it. They say that they cannot in good conscience release the infants to the mother's care because they--rightly, alas--fear for the babies health and safety. Well, ok, why didn't we--erm, they, the docotrs--think of this before? Whose responsibility is it to think of such matters?

The mother, of course, had--and still does, by the way--a very key responsibility here. Not just to take care of her children, but to inform her caregivers of the environment into which she was obliged to take them. Perhaps she did this. However, even if she didn't, I still think it is incumbent on the doctors to do more than arrange for the safe delivery of the children.

Now it can be argued, that this--what happens when the patient goes home--is not the responsibility of doctors. Doctors cannot be held accountable for what their patients do after they leave their immediate presence and care.

Or can they? If, say, a patient who has received a heart transplant is not monitored closely after he leaves the hospital, he's very likely to have complications and die. So, the physician naturally takes responsibility to inform the patient of the special needs that the operation will impose on him and even help him to meet those needs. Things like medical equipment, nursing care and medicines are all administered at home or in a rehabilitation setting under the doctor's supervision.

Why has this multiple pregnancy failed to rise to the same level of attention as, say, the heart transplant patient? I suppose that it can be argued that both measures are extraordinary, but by the same token, it can be argued that those measures are justified as necessary; required by extraordinary circumstances.

This is my key point. Of all the people involved with this case, the doctors knew just how extraordinary this situation was. They were not only the best informed participants in the process, but they were also in the best position to make decisions that would have been the the patients best interest. They could have, and should have done this long before it became front page news and they had to announce measures that will effectively punish the mother instead of help her.

After all, with some planning and coordination, money could have been raised to pay the mother's mortgage, sponsors could have been lined up to renovate the house and provide the equipment and supplies necessary to raise eight--or right, fourteen--children at once, and caregivers could have been arranged; all this long ago, certainly well before the proverbial diaper hit the fan. Now the doctors are trapped--hoisted by their own petard, as it were--protecting the children at the expense of the mother, whom they previously 'helped'.

Makes me wonder what the doctors have in mind this time. Oh wait, I know. Nothing.

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