Over the last month, the story of Kate Cox, a 31-year-old mother of 2 from Dallas Texas, has become the centre of media attention. At 20 weeks pregnant with her much-wanted 3rd child, Mrs. Cox was given the unfortunate news that her child would be born with a chromosomal abnormality Trisomy 18.
Trisomy 18 is a condition that leads to a variety of symptoms, including severe intellectual difficulties, respiratory illnesses, seizures, and heart defects. This is the result of the foetus possessing 3 copies of chromosome 18 instead of 2, and of the 50% of babies with this condition carried to term, only 5-10% survive to the age of 1.
Mrs. Cox’s doctor emphasised the potential risk to her health, well-being, and future fertility, and per her doctor's recommendation an abortion needed to be performed. There was little Cox could do but file a lawsuit, as the state of Texas deems abortion a felony punishable by up to life in prison if performed past the 6-week mark.
A lower court in Austin, which is known for being quite liberal in its views on abortion, granted the exception. Judge Maya Guerra Gamble said in her ruling, “The idea that Mrs. Cox wants desperately to be a parent, and this law might actually cause her to lose that ability, is shocking and would be a genuine miscarriage of justice,”.
However, in an unprecedented move, US Attorney General Ken Paxton intervened, declaring that anyone who attempts to help Cox would be liable for 1st-degree felony prosecution. Paxton further appealed the case to the Texas Supreme Court, which ruled to overturn Judge Gamble's decision. The court found that Cox’s doctor had not proven that her safety was at an immediate risk due to a life-threatening physical condition, as required under law.
Since the ruling, Kate Cox has left the state to perform the procedure.
Why did judges deny Cox’s abortion request?
According to Dr. Christina Francis, board-certified OB/GYN and CEO of the American Association of Pro-Life Obstetricians and Gynaecologists, Trisomy 18 is not a uniformly fatal condition for the mother and child.
“Many of these children, unfortunately, will pass away in utero or shortly after birth – but for those that survive to 1 month of age, which may be as high as 15% if they are given appropriate medical intervention, up to 70% of them will survive until 1 year of age, and if they survive until 1, the likelihood is very high that they will survive into their teen years”.
But in the specific case of Mrs Cox, which includes life-threatening risks and risks of infertility, Dr Christina Francis said,
“I can't comment specifically on Miss Cox's case because I don't have her full medical record in front of me… Again, when I look at the court documents that talk about, you know, that she has previous C-sections or that she’s had gestational diabetes in past pregnancies, these are common conditions that we as qualified board-certified OBGYNs manage all the time.”
It is clear that in some cases, Trisomy 18 does not pose an immediate risk to the mothers health., Still, leaving this decision up to individuals with no medical experience, especially in such a unique case, is ill-advised at best. This case does not bring any peace of mind to any mothers in Texas. The idea your life may be is in the hands of a judge as opposed to your doctor is extremely disconcerting.
Why Texas should not have denied Cox’s request
To further illustrate the risks posed to Mrs. Cox’s life, Dr. Alireza Shamshirsaz, a maternal-foetal medicine specialist, explained that “Many women who continue trisomy 18 pregnancies will need a cesarean section”.
The risks of gestational diabetes and, high blood pressure, including a history of multiple emergency room visits for severe cramping and fluid leaks of an undetermined origin, are associated with obstetric complications.
Therefore, induction of labour may increase Cox’s risk of uterine rupture, which can lead to uterine removal, excessive bleeding, and death. During a subsequent pregnancy, a repeat caesarean can cause a uterine rupture and issues with the placenta, necessitating a hysterectomy. Additionally, the procedure can damage nearby organs such as the bladder.
The chair of the Texas medical board states that it is not the group's role to provide clarity on the law, but that the pro-life movement should maintain its position that such scenarios should be handled by doctors and their patients. A lack of clarification on this issue could be detrimental to the life of the mother in future cases.
There is much distrust between pro-life and pro-choice campaigners. While some say that doctors are too liberal in their abortion practices, it is difficult to believe that Cox’s doctor would go ahead with the termination of the unborn child given the threat of legal prosecution.
Valuing all lives regardless of disability is still important
Abortions have become a very powerful medical tool for human beings to use, as it allows us to decide if life may or may not begin. We only need to look at the plummeting rates of Down syndrome over the past few decades to understand the prevalent fear of having a child with a disability.
Doctors should not fear prosecution for providing life-saving treatment to their patients, nor should patients be afraid that lawmakers do not value their health. But when a mother finds that her child has a life-threatening condition and might die before or shortly after birth, it is important to introduce a variety of options to ensure best practice. Doctors should encourage discussions around perinatal palliative care, which provides resources to help patients through an unviable pregnancy and gives the mother and child dignity and respect.
Attempting to define when life truly begins, whether based on the viability of the foetus or on how much suffering a mother should endure, is an impossible task. Instead, we should be focusing on compassionate care, personalised to each specific case. In striving for a better world, we must try to treat struggling mothers with kindness, empathy, and understanding.
Edited By Sydney Smith
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