Columnist: Sarah Palin is hypocritical on reproductive choice
September 5th, 2008Writing in Salon.com, Rahul K. Parikh, MD, says what troubles him about vice presidential candidate Sarah Palin is that she had a choice about whether to have Trig, yet she would deny that choice to other women.
By knowingly giving birth to a Down syndrome child, Palin represents a minority of women. A 2002 study found that about 90 percent of pregnancies in the United States where the fetus was diagnosed with Down syndrome were terminated.
Rabid anti-choice activists have called that trend eugenics via medicine. But try telling that to a mother who is told early on in her pregnancy that she will be raising a child who will have a host of medical and developmental problems, requiring intense medical and social attention for the rest of his or her life. It can be tragic and nearly impossible news to bear.
… while I respect Palin’s decision to raise Trig, that’s all the respect she will get from me. I don’t see eye-to-eye with her on anything else: energy, guns, sex education and of course a woman’s right to choose. Her supporters say that Trig signals that she practices what she preaches. But her to decision to have him is also a sign of her hypocrisy.
UPDATE: Salon subsequently issued a correction on this column.
The last sentence of the originally read: “But her decision to have him is also a sign of her hypocrisy.” The corrected version, now posted on the web, reads: “Her decision to make her own choice but not grant it to others is a sign of her hypocrisy.”
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September 5th, 2008 at 11:55 am
Sara, while you are correct that the Republican Senator Coburn (the “NO” senator who happens to be an OB/Gyn) was responsible for the defeat of a package of bills including that wonderful Act, he could not have done so without the cooperation of his Republican cohorts who voted “NO” in solidarity. While I realize this Act was not the target of those political games (it is a bipartisan act unanimously approved by the health committee and approved of by both parties) it was most certainly collateral damage. And the cost of the Republicans taking a negative stand on the passage of beneficial and undisputed bills? The fallout that results from the delivery of a prenatal diagnosis without accurate or adequate information.
Incidentally, the Act as written (as I understand it) had some of its teeth removed - the MANDATE for accurate information is no longer included.
September 5th, 2008 at 10:21 am
A Republican, Senator Tom Coburn of Oklahoma, killed the proposed Kennedy-Brownback bill which would have mandated that doctors give positive information and support group referrals to couples receiving pre-natal diagnoses of Down syndrome and other issues. This from the “pro-life” Party?
September 5th, 2008 at 6:23 am
I posted a letter on Salon. They had a word limit though!
The ignorance of many doctors
“We could ask, given that Palin had no doubts about seeing her pregnancy through, why she bothered to take a genetic test.”
And THIS is the question of a medical professional? I am horrified, but it certainly represents the attitudes of many medical professionals when it comes to prenatal testing.
Many women truly grappling with a decision to do invasive testing need to be aware of ALL of the pros and cons, not just the ones many doctors bring up. And if they would not terminate a pregnancy, they need to be emotionally prepared for the onslaught of termination offers, comments, and sometimes intense pressure both internally and externally from family, friends, and medical professionals. Here is a list women who would not terminate can actually use:
PRO:
* settles the question
*better prenatal care (monthly growth scans; fetal echocardiogram; late-term non-stress tests; heightened sense of caution by docs); monitoring may pick up problems to be treated by bed rest, early delivery, or a change in the birth plan
*time to adjust, grieve now, happy when the baby is born (do not underestimate this)
*time to learn (and there is a LOT to learn)
*possibily rethink birthing plan & place of delivery ((hospital with a NICU? Higher level hospital? near a children’s hospital? induced delivery during the day before 40 weeks?)
*prepare the family & friends (as much for them as for you so you can have their full support)
*better birth experience than if diagnosed at birth (Dr. Skotko’s research)
*make after-birth plans such as child-care, breastfeeding with DS in mind
*check on quality of health insurance
CON:
*risk of miscarriage (MUCH lower than thought in the past)
* squeamishness over procedure itself
* offers from doctors to terminate, possibly pressure (even if you assert your view ahead of time); possibly comments from friends & family, possibly pressure
* faced with possible termination decision (for many moms who are sure they won’t terminate, this is not an issue; for others such thoughts take them by surprise, which can itself create feelings of guilt and shame on top of the grief)
*grief possibly complicated by not seeing the baby
*possible emotional distance from pregnancy and thoughts of miscarriage
*overwhelmed with info about potential medical issues, possibly out of proportion to reality
“Kids with special needs require and deserve intense therapies and attention to their needs.” This is a common over-simplistic generalization many women receive from medical professionals when receiving a prenatal diagnosis.
These children are INDIVIDUALS and as such their situations vary. As far as “intensive” therapies are concerned, for many this consists simply of PLAY THERAPY - something your child enjoys. The “attention” may be the same level a typical child would receive, or more intensive attention. The simplistic over-generalization above in no way reflects the rainbow of experiences of parents with children with Down syndrome, nor does it take into account the high levels of parental satisfaction and family stability shown in studies following families of a child with Down syndrome.
Ms. Palin does not need your “admiration” for continuing her pregnancy, nor do I and the many women I know who have had a prenatal diagnosis. Such admiration implies a burden greater than that taken on, and diminishes the many benefits in parenting one’s child. What we as patients NEED from our doctors is support in a decision to continue a pregnancy. The research, my personal experience with a leading obstetrical organization, and the personal stories of many of the women with whom I have spoken all lead me to the conclusion that doctors push terminations, either deliberately or unintentionally, and are completely unaware of the cumulative, devastating emotional impact of repeated termination offers.
Women need accurate information about the risks and benefits to testing that go beyond a simplistic “terminate or not” mentality. Women facing a prenatal diagnosis of Down syndrome need accurate information, and doctors should have solid, accurate information, referrals to genetic and developmental experts, and parent groups. No parent should have to seek out referrals and parent groups on her own. I have both experienced and heard many stories of mothers hearing termination information immediately after a diagnosis but having to struggle to get referrals, information, and contact information. Doctors often negatively over-simplify the experience of the life of an individual with Down syndrome, are unaware of the progress this population has seen on so many levels in past decades, and are unaware of the current research on improving cognition for individuals with Down syndrome (see the DSRTF).
Regardless of a doctor’s predispositions and prejudices, regardless of a woman’s decision, women deserve accurate, balanced information, and non-judgmental counselling. If a woman (like me) tells her doctor in advance she will not terminate a pregnancy, why do doctors feel they need to repeatedly bring it up? Why would a doctor NOT have available a list of resources, experts, parent support groups? I think a lot of that has to do with the opening sentence, along with the high termination rates influencing the expectations of doctors. I also believe many more things are involved, including an idea in the minds of OBs that termination is within their area of practice and advice, while information about a child is another’s area. While that may be true, advances in prenatal testing have resulted in OBs being the gatekeepers of this information, and as such they have a responsibility to see that their patients are adequately informed and supported.
If a woman chooses termination, doctors need to be aware of the emtional impact of such a decision and have adequate information and support at the ready. Research reveals that many mothers who have had a termination for medical reasons experience symptoms of post-traumatic stress, even years afterwards. As I remember that research, such symptoms were reduced if the mothers felt their decision was based on adequate information and not rushed. Mothers receiving a prenatal diagnosis, regardless of their decisions, are benifitted by information, neutrality, and respect — not assumptions, ignorance, or admiration.