COMMENTARY

Abortion and Medical Students: Education at a Crossroads

Emily Kahoud

Disclosures

July 30, 2019

Questions of fetal pain often get muted amidst politicized commentary. However, understanding this aspect may enable medical students to become physicians who have "a concise, medically accurate answer" to those seeking abortions, says Tocce. On issues of fetal pain, she suggests that four major points are important to learn: (1) the majority of procedures are done well before the fetal pain receptors have developed; (2) for an abortion performed in the operating room with general anesthesia, the fetus gets general anesthesia as well; (3) the initial transecting of the umbilical cord leads to "almost an induced demise right there, so that negates the fear of fetal pain;" and (4) "for a patient who is just not at peace with that explanation being right for her, we can also offer feticidal injection, and that basically establishes demise before the evacuation procedure."

Some critics believe that providing pain relief to a fetus during an abortion is paradoxical, experimental, and potentially risky to the mother. Sandy Christiansen, MD, FACOG—the national medical consultant to Care Net who has provided testimony before the President's Council on Bioethics, the Maryland senate, and Capitol Hill—says incredulously, "There is enough evidence that the unborn fetus at 20 weeks from fertilization can experience, not just react to, pain—the neural pathways are there, the subcortical plate, the thalamus, the connections are there." Thus, Christiansen says that, for her, the bottom line for all medical students to consider when learning about late-stage abortion is, "Do we protect these vulnerable individuals or not?"

Learning to Care for "Two Patients"

One of the questions that medical students must learn to answer is about autonomy. Is there a point in pregnancy when a physician has not just one patient but two? Rutgers NJMS medical student Irene Martinez says, "If the mother wants this baby, and she has the capacity to safely have and hold this child, then the child will be treated as a patient, as a child." The literature on patient autonomy declares that, for example, in the rare situation in which a mother refuses a cesarian delivery despite indication that it is essential, she is the autonomous patient for whom her physician is caring.

Beyond autonomy lies the sanctity of the relationship between physician and patient, which recent legislation may threaten. Noa'a Shimoni, MD, MPH, an associate professor in family medicine at Rutgers NJMS, reminds us that "Our professional societies—the American Academy of Family Physicians, the American Osteopathic Association, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians, and the American Psychiatric Association—are all supportive of decisions being made by women and their doctors." She adds, "If legislators supporting these bills don't involve women and their doctors in decision-making, they're not going to reflect our understanding of medicine and our patients' needs."

Regardless of our political affiliations or religious beliefs, we medical trainees must learn to practice ethically and with the principles of justice, beneficence, and nonmaleficence. "As some of the most trusted spokespeople in the media, in our country," says Blanchard, "it is important for physicians who provide this care to bring some of the experience of the people they take care of into the discussion."

As future physician-scientists in an evidence-based profession, we must check our emotional reactions and analyze data, untainted by the lenses of our inherent biases. As the future members of a profession with life-or-death consequences, the burden falls on us to best learn how to evaluate the totality of evidence at our disposal, so that we can advise our patients not based on feelings, but on the facts before us.

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