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On Virginia

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The New York and Virginia legislatures have been in the news lately with proposed bills that address the legality of third trimester abortions, also known as late-term abortion. Abortion, because of its inherent intention to end the life of a human person is indefensible. Even less so is the termination of a pregnancy when a child is fully developed.

In the heat and emotion of debate, Virginia governor Ralph Northam gave an interview to an influential news radio station. The quote sounded pernicious and even callous, but I think there’s a mistake made in analysis. Northam was accused of infanticide, which is a sub-classification of homicide relating to a very young child.

Gov. Northam is a board-certified pediatric neurologist. In the interview, set up a scenario to illustrate his point. A mother, who presumably has abortive intent, is in labor with a non-viable pregnancy. This child has zero possibility of surviving outside of the womb due to structural defects that occurred in development. Here’s the quote:

When we talk about third trimester abortions, these are done with consent of the mother, with the consent of the physicians, more than one physician by the way, and its done in cases where there may be severe deformities, there may be a fetus that is non-viable. So in this particular example, if a mother is in labor, I can you tell exactly what would happen. The infant would be delivered. The infant would be kept comfortable. The infant would be resuscitated if that’s what the mother and the family desired, and then a discussion would ensue between the physicians and mother.

From the jump, there are two different parts that require an ethical assessment and judgement. The first is the intent. This situation is set up as a pregnant mother approaching her physician with the intention of obtaining a late-term abortion. Without equivocation, the mother is culpable for this unethical request, and the physician is culpable to the extent that they participate in the abortion. The second part is the actual action. In this case, the physician delivers the child, provides comfort care, and follows a valid Do No Resuscitate (DNR) order.

Setting aside the dubious intent, Northam’s scenario appears, on its face, to be ethically valid. The child is born, given comfort care, and in consultation with multiple physicians, the parents elect to issue a DNR order. The child dies, but in this case, dies of natural causes instead of a direct intervention, vis a vis elective abortion.

All patients who are admitted to the hospital, for any reason, are asked to give a “code status,” or to provide a copy of their medical directive/medical power of attorney. Code status is the medical term for whether or not a patient wishes to be resuscitated if they suffer a catastrophic medical event while in the hospital. There’s nothing ethically wrong with a DNR order. In effect, it is the request to let the patient’s body stand, or fail, on its own without life-sustaining intervention.

Back to Northam’s example. The non-viable baby has structural problems that will prevent it from being able to live outside of the womb. Northam clearly states that the infant would be kept “comfortable,” which satisfies the moral and ethical requirement of comfort care for all persons. The child may be able to survive for minutes, hours, or days. Regardless of the duration of the child’s life, appropriate therapies would be used to alleviate undue physical suffering.

This situation is heartbreaking, and occurs on a daily basis. Human reproduction is a remarkably complex biological process, with any number of opportunities for errors that result in birth defects. If the child is born, and cannot survive on its own without substantial and invasive interventions, it is ethical to allow for the child to succumb to its weaknesses through a natural death.

In the larger picture, Northam does approach the question of abortion, as both a policy maker and a physician, with an ethically challenged viewpoint. From his public statements, even his support of the now failed House Bill 2491, he has demonstrated that, as a physician, he supports abortion. It is right to challenge him on this support, but it is a mischaracterization to say, based on this quote alone, that he supports infanticide.