IN DEPTH: Law and the Realities of Medicine CG Comments on "C-Sections and the Real Crime"
Rebecca Johnson
New York Times, April 12, 2004
Despite the extraordinary medical advances of the twentieth century, a hard reality still confronts countless Americans every year. Some patients just can't be saved; sometimes the right choice by a doctor or a patient will fail to prevent a tragic outcome; and sometimes there are no answers--no one to blame.
A hard reality for a culture too accustomed to finding a guilty party behind every misfortune.
"The difficult truth is that sometimes there is nothing doctors can do to save a fetus," writes Rebecca Johnson in "C-Sections and the Real Crime," a recent New York Times op-ed. Ms. Johnson is an advisory board member at the Sloane Hospital for Women, part of the Columbia University Medical Center. She describes her own difficult experience of consenting to a C-section, having been told it was her baby's "best chance," only to have the child die four days later:
I was not well versed in the facts, or the unpredictable nature of obstetrics--a field in which one of the two patients is separated from the doctor by a wall of flesh and blood. Ultrasound readings can tell us an amazing amount about human gestation. But they are not perfect.
In fact, Ms. Johnson notes, the National Institutes of Health found in 1993 that:
[I]n 15,000 low-risk pregnancies, ultrasound detected only 17 percent of fetal structural anomalies before 24 weeks. Human error accounts for much of the problem. Sonograms rely on precise measurements of the fetus. In an emergency-room setting, it's unlikely the person performing the ultrasound will have the expertise necessary to make highly accurate readings.
In the struggle to deal with uncertainty, C-sections have become "routine, the cure for a baby in trouble almost always means early delivery." Ms. Johnson continues:
Even if my child had survived his traumatic, early birth, there's a good chance he would have required special care for the rest of his life, something my doctor did not mention when she called delivery 'his best chance.'
Evidence suggests that one of the reasons c-sections have become routine is a pervasive fear of litigation. One midwife told the New York Times in March that while hospitals are seldom sued for not performing a C-section, "plenty of them get sued for not doing one, where someone claims it might have made a difference." (Use of Midwives, a Childbirth Phenomenon, Fades in City, 3/15/04)
But deciding whether or not a C-section would have "made a difference" is a near-impossible task: "Each day a premature baby remains in utero translates into four fewer days in the intensive care unit," Ms. Johnson notes. "In the neonatal unit, . . . roughly half the babies will not survive their first year."
Unable to accept this hard reality, many grieved parents will sue their doctors. Their anger and frustration is understandable. But for the law to allow this tragedy, and to allow obstetricians to be driven out of practice amidst a slew of lawsuits and soaring insurance costs, is to demand simplicity and predictability where it cannot exist. This stance is undermining healthcare and creating a culture of blame and of fear.
Related: "C-sections and the Real Crime"
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