Where to draw the line?

I’ll start off by saying, “I don’t know.” There are now and have been in the past different cases which are thorny issues — both related strictly to birth, and those that are not — which have to deal with parents’ rights to choose for their children (or themselves) vs. “the state’s” or “society’s” right to interfere in such matters. There are some clear-cut issues — when a parent is abusing a child… and yet even in that, some people may consider spanking an abuse while others consider it to be merely one form of correction and discipline which parents have a right to use. Some people are trying to get circumcision made to be illegal; and while I think circumcision is unnecessary and ought not be done, I don’t think that I have the right to forbid others to do it, and think it might be trampling on religious rights a bit much (although I think that Christians should not circumcise their children for religious reasons). Yet I don’t think that parents should be allowed to have their females circumcised no matter what their religion. Call me inconsistent.

But where will this end? That’s what concerns me. Do parents have the right to choose what is in the best interests of their entire family? Yes — within reason. They cannot decide that because their 13 year-old is “eating them out of house and home” that it is in the best interests of the family as a whole that that child no longer live with them, or that the child stop eating, or that the child should die. But certainly many other things are within the purview of the parents. Most if not all states have laws concerning buckling children into seat belts and approved car seats. A three month-old child cannot buckle himself into a car seat, after all. When I was working at the pharmacy, I’d see all sorts of things, including people driving up to the drive-through window with unbuckled children. The most memorable is a baby in a bouncy seat, in the front passenger’s lap — oh, yeah, that’s protection! If parents don’t buckle their kids, and they have a wreck, the children could be killed, and they were unable to protect themselves. Does the state or local government have a right to step into the family and dictate to the parents how to treat their children? Some might argue “no,” but most would say that most certainly the authorities have a right to protect the innocent child.

What about the right of parents to decline medical treatment for their children? What if the medical treatment is “iffy” — what if there is a strong chance that the treatment will not work, but will only make the child sicker? Some years ago, there was a case in which a woman had two children diagnosed with HIV or AIDS (her other two children were healthy). When the first child was diagnosed, she complied with all of the medication and treatments that the doctors ordered or suggested, and watched her child die a horrible and painful death, sickened and made weak and in pain by the medications which were supposed to be saving his life. When her second child was diagnosed, she refused all the treatments and medications, saying that she’d rather the child quickly die and in less pain than with the “life-saving” (but health-taking) drugs her first child took. The state took her to court, wanting to force her to give the child the medicine, or to terminate her parental rights and turn the child over to foster parents who would medicate the child. The judge ruled in her favor, though, saying that she had every reason to believe that the drugs would not actually help, and she was within her rights to refuse. Despite the dire predictions of the doctors, the second child was still living and seeming to be in perfect health, two years after the diagnosis, without taking any anti-AIDS/HIV medications. But what if the treatment options were more clear — if the child gets the treatment, there’s a 99% chance that he will live and be perfectly healthy; and if he doesn’t get the treatment, there’s a 99% chance that he will get terribly sick and/or die — and the parents still refuse?

What if it’s somewhat murky? Is any increased risk worth terminating parental rights, or overstepping the parental bounds of authority? We’d best be careful. There have been cases in which women have been forced to undergo C-sections for less-than-clear-cut “medical” reasons. It’s possible that these were ultimately overturned… after the woman was cut open — but perhaps some have been upheld. One such case I’ve heard about is a woman who wanted a VBAC. That’s all — no medical problems that I know of other than a previously cut-open-and-sewn-shut uterus. The risk of uterine rupture is about 1/200, with the risk of death or serious injury to the baby a much smaller percentage than that. Yet she was denied a chance of a vaginal birth because the judge found that her baby had sufficient rights of his own to force her to have surgery.

Don’t get me wrong — I’m strongly pro-life… but I’m also strongly pro-family and pro-liberty. I think the baby had the right to be born alive, and should not have been allowed to be killed at that or any other point in his life, before or after birth. But is the slightly increased risk of death from uterine rupture (which is not completely eliminated with a C-section) a strong enough argument to force an otherwise autonomous woman into having surgery? Is it strong enough to override her parental authority to choose what is best for her, her baby, and her family? We’re not talking about killing babies deliberately, here — we’re talking about a slight risk, but in the absence of uterine rupture, the outcomes will be better for both mother and baby with a vaginal birth.

What about drug use during pregnancy? — and “drugs” includes tobacco, alcohol, and illegal or illicit drug use. Smoking cigarettes most definitely increases the risks to the baby — of preterm birth and low birthweight (which by themselves carry with them a whole bunch of risks and longterm consequences) and also of stillbirth and neonatal and infant mortality. Illicit drug use ditto; and alcohol probably the same, but “fetal alcohol syndrome” is more particularly associated with it. As long as women have the right to ingest all of that stuff during pregnancy, exposing their “captive prisoner” (the baby) to the toxic chemicals, then surely loving and thoughtful parents can choose between two medical options that have both risks and benefits, picking the course of action they think is best altogether.

However, if the parents (or more particularly, the mother, since she is the one who really calls the shots, since it’s her body carrying the baby) are being grossly negligent, then it’s possible that as the state can step in and remove children who are being subjected to abusive parents, so the state can step in and force a woman to stop prenatally abusing her child. But we must be very, very careful when we do things like this. Horror stories abound in the foster-care system (and all that surrounds it), of children being repeatedly abused but nothing is done about it, while perfectly innocent parents are stringently investigated due to an angry neighbor’s spiteful and false report, and even of children removed from parents (abusive or not) and placed in abusive foster homes. Similar things might exist when tampering with the maternal-fetal relationship. I might liken forcing a woman to undergo a repeat C-section rather than an attempted VBAC as being in the second or third category — the “cure” is worse than the disease; whereas I would have little or no problem with forcing a woman who is pregnant and abusing drugs to enter some sort of treatment, so that her innocent child is not born addicted to crack. But so much of the problem exists not in a particular case, or a case-by-case basis, but rather the precedent that is set when the government starts interfering. What might be perfectly innocent or even laudable interference can become heinous and loathsome, depending on the circumstances. And as this post points out, it is hard to draw the dividing line. When you’re not talking about certainties — such as, “if you do X, then your child WILL die or be harmed,” but just, “if you do X, then your child MIGHT die or be harmed… or might not… and if we do Y instead, your child also might be harmed or killed.” For instance, I think the stillbirth rate is about 1/1000 around 41 weeks and perhaps 2/1000 around 42-43 weeks or above — still pretty darn good odds that any given baby will NOT be born dead if the mother declines an induction or C-section. There is a slightly increased risk of stillbirth, but very, very far from a certainty. And it’s also a possibility that the child will be harmed or killed as a result of an induction or C-section — something like not being able to tolerate an induced labor, or actually being premature so ends up in the NICU for weeks, or with serious asthma or other breathing problems, or something like that.

For me, it seems to come down to the parents’ intentions and desires — if they are good and loving parents, and want what is best for their child, then they have the right to give or withhold treatment as seems best; but if they are selfish or uncaring, then their motives may be suspect. But then the problem becomes, what if the “people in authority” believe that the parents do not have their child’s best interests at heart — such as the woman whose children had AIDS, mentioned above? Whoever took steps and set in motion the process to override her parental decision to withhold the drugs with the horrific side effects was either convinced that the child needed them (and thus that he was acting in the best interests of the child, while the mother was not) or he was some sort of sadist who liked to see children get sick and die horrible and painful deaths. Hindsight proved the mother to be correct; but we don’t always have the luxury of hindsight, nor the luxury of time.

As big as the implications I’ve highlighted are, they are even bigger — this topic is so broad and wide-ranging, covering everything from prenatal care, labor decisions, vaccinations, child care, home school, circumcision, ear-piercing, food choices, etc. If loving and concerned mothers (and fathers) cannot choose what they believe to be in the best interests of their child and/or the whole family, who gets to make that choice? What if society (or science or medicine) decides that eating meat is bad for people, so they take away your child so he can be fed a “proper” vegetarian diet? What if they decide that vegetarianism is bad, so they terminate parental rights so they can feed your child a “proper” omnivorous diet? What if you decide that vaccinations are not in the best interest of your child – that your child’s situation is such that you believe that the risk of vaccinating is higher than the risk of not vaccinating? Should the state overrule you, and decide your child must be vaccinated? What about home birth? or unassisted birth? What if the court system decides that ACOG and the AMA are right and homebirth is unsafe — should they have the right to forbid you to have a home birth, to incarcerate you in a hospital and force you to give birth there?

Does the state have the right to tell you what to do with your child? Why or why not? Tough questions to answer in general, although specific questions may be clearer. I can say, “Absolutely not, because I am a good and loving mother, and I’m doing what I believe to be is best for my child. I am not harming and certainly not killing him, so you have no right nor reason to step into my family and tell me what to do.” And I think that most if not all of you reading this would be able to say the same with a clear conscience. But who decides where the line is drawn between a good parent and a bad one? Ah, now that is a scary thought.

3 Responses

  1. I COMPLETELY and WHOLEHEARTEDLY agree with you on this. I want to protect children from parents who are actually, even intentionally, harming them — but I’m frightened by the questions regarding who draws the line and where it is drawn.

  2. There should be a boycott of this doctor. Perhaps people should write to the hospital and encourage them not to renew her contract. Let us vote with our dollars. Money talks!

    Jana M. Bures-Forsthoefel, M.D.
    Gynecology & Obstetric Associates
    1405 Centerville Rd., #4200
    Tallahassee, FL 32308
    850-877-3549
    Fax: 850-671-2971

    Tallahassee Memorial Hospital
    1300 Miccosukee Road
    Tallahassee, FL 32308
    (850) 431-1155

  3. Thank you for posting about this! I just read about the FL case, and was thinking and talking with my husband about this issue yesterday. (I know I’m a bit behind the times…) Anyway, you wrote out my thoughts much better than I tried to! 🙂

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