Iowa recently passed a bill that will outlaw abortion after the sixth week of pregnancy, and there is concern that other states that have already moved to restrict reproductive rights, including Missouri, will attempt to emulate Iowa. This specific time was selected because it coincides with the ability to first detect a fetal heartbeat on ultrasound.
The news made me remember a woman I had seen in consultation over a decade ago. She was in the 18th week of a pregnancy, which she already knew would tax the financial and personal resources of her family. An ultrasound scan had identified a brain malformation that was incompatible with a normal childhood.
It was difficult for her gynecologist to anticipate the precise implications of the scan, so she was referred to me, a pediatric neurologist. We talked for a while, and I explained that there was no way to provide an absolute prediction, but that the malformation was highly likely to interfere with most childhood activities. She explained that she already had two children and that her husband would not be able to deal with a child with special needs. She terminated the pregnancy a few days later. Several months after, I received a short note thanking me for assisting her in making a gut-wrenching decision.
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That note, and the conversation that had preceded it, made me realize how misguided Iowa lawmakers are. Their law flies in the face of half a century of medical ethics precedent. Since 1968, physicians — and all 50 states — have accepted that neurological function, not heartbeat, defines life. The specific neurological circuits that have been used to define life do not exist in a six-week embryo. While there is some evidence of electrical activity in the brains of six-week embryos, the parts of the brain considered essential for human awareness have not yet made the necessary connections. The deeply complex issue of life’s onset should remain the province of philosophy and theology, not state legislatures.
While the Iowa bill includes a provision allowing for abortion if “the fetus has an abnormality that is incompatible with life,” it fails to acknowledge debilitating anomalies that do not rise to the level of lethality. In 2002, my colleagues and I published an article that analyzed an ultrasound database on over 50,000 pregnancies. We looked at how the severity and anatomy of an anomaly influenced decisions about pregnancy termination. We found, first, that the more likely an anomaly to impact quality of life — walking, talking, and living independently — the more likely a termination decision. Second, anomalies that affected the nervous system were associated with higher rates of termination.
The results of that analysis are relevant to the Iowa law; parents do not decide impulsively to terminate pregnancies. Only if anomalies were anticipated to adversely affect quality of life — after optimal therapy — did termination rates approximate or exceed 50 percent.
The Iowa law will be especially cruel to the women compelled to give birth to children with serious disabilities, and to their other children as well. While it is well established that many congenital anomalies that are detected by ultrasound after six weeks are partially treatable, the therapies are often prolonged, painful and not ultimately curative. They do not normalize paralysis or severe intellectual delays. Furthermore, these resources are often a fantasy. Even for families with financial reserves, the appropriate therapies can be hours and miles away. The time needed to access these facilities makes their utilization unrealistic for families with additional children. It is not so hard to accept that many prospective parents do not wish to explore this territory and subject an unborn child to life-long, painful disabilities.
Governments should never try to influence the actions of prospective parents who oppose abortion. Moreover, parents have a right to expect medical and social services that will maximize their child’s potential, should they decide to carry a special needs infant to term. However, there is no justification for Iowa’s attempt to enforce a set of beliefs that deny legitimate ethical and religious differences related to abortion. This denial will inflict enormous pain and suffering upon those it purports to protect. Other state legislatures are undoubtedly waiting to see whether Iowa’s version of the definition of “pro-life” stands.
Dr. Steven Rothman is a clinical professor of neurology at State University of New York at Syracuse. He serves as a professor of neurology at Washington University School of Medicine from 1980 to 2007 and directed pediatric neurology at St. Louis Children’s Hospital from 1992 to 2004.
