Thursday, December 01, 2005

Authorization to perform emergency medicine

Here's your scenario: A loved one has just experienced a major medical problem at around 2:00 am and you rush them to the hospital's emergency room. ER doctors and nurses begin their work and they confirm what you'd hoped not to hear - that the situation is dire and the patient's life is in jeopardy. A medical procedure is called for and the doctor's opinion is that it needs to be done now. Prospects for recovery are very good if the procedure is done; not so good is the procedure is delayed or not done at all. I would submit that there are very few of us who would take longer than 10 seconds to process that information and come up with an authorization for the doctor to proceed with all haste.

Imagine now that, having heard your authorization, the doctor sadly shakes his head and tells you they're waiting for the hospital lawyer to get a judge on the phone. You see, in order for the procedure to be done, a judge must rule that it's OK to proceed. He's going to want the case history, all the details about how you came to be there, and will want to know all about your relationship to the patient, their family, etc., etc., etc. Meanwhile, the clock's still ticking and that life-threatening situation isn't getting any better. No, the judge isn't a doctor, you're told. No, he's not in the medical field at all. But it's his say whether the procedure gets done or not. Oh, and now it's 2:30 am, the hospital lawyer is still on the phone now calling a second judge because he couldn't get the first one to answer his page.

Would you stand still for that kind of treatment? If you're a minor whose pregnancy must be terminated in order to save your life and your parents aren't there to approve it, you will stand for that treatment in the state of New Hampshire if the Supreme Court rules that a law requiring parental notification is to be upheld. The law does not contain a provision to allow an abortion without the notification in cases where the mother's life is in danger. The lack of such a provision has overturned laws in Iowa, Kansas, and Virginia in the past but New Hampshire believes that the judicial review provision would handle that issue.

It's no secret I'm basically pro-choice. It might surprise some folks, however, to know that I support the concept that parents of minors seeking abortions should absolutely be advised of this fact prior to the procedure being performed. Minors cannot now get a tattoo without a parent's permission nor can they get plastic surgery. To suggest that the parents should be cut out of the loop in the event of an abortion is ridiculous on its face. I've heard all the arguments about how kids are scared to tell their parents they're pregnant - no shit - and that it exposes them to abusive behavior by their parents. I've got no problem with public flogging of truly abusive parents, but why make the rest of us (who comprise the huge majority) suffer for the actions of those parents? And you know what? The kids should be scared to tell their parents. They got pregnant while they're still minors, after all, which is behavior they pretty clearly understand isn't approved by most parents. I would submit that the reason they're scared in the first place is that they understand they were doing something they shouldn't have done. That's hardly an excuse to allow them to keep the parents in the dark and thereby avoid one of the major consequences of their decision.

But, seriously folks, medical emergencies do occur. And in the situation where a woman's life - or a girl's life - is threatened and the life-saving procedure will require the abortion of a pregnancy, do we really want to inject a non-medical decision process into that? I don't know about you, but the only persons I want deciding on a course of action that will save my life or the life of my loved one are the doctors and me. This is small allowance in that such procedures are almost certain to be relatively rare and making the allowance secures the rights of parents to be, more often than not, included in their children's medical care decisions. Remember this is only for a situation where the mother's life is in danger. It's not a situation where a minor simply doesn't want to tell the parents. That's what the judicial review is for.

I hope that the Justices see this clearly for what it is: a decision to keep non-medical people out of the process to the greatest extent possible. That's what the focus should be.