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The Limitations of Medical Prognostications

Dateline: 11/14/99

My friend Laura went to her ob/gyn during her fifth pregnancy, alarmed that she was bleeding heavily. The doctor examined her, told her that she was in the middle of a miscarriage, and asked the nurse to get a cannula. Laura had been a long-time pro-life activist, and in her mind "cannula" was strongly associated with "abortion." She sat up and asked the doctor exactly what he was doing.

He explained that since she was in the middle of a miscarriage, he'd just empty the uterus the rest of the way to reduce the risk of infection. Laura declined. She told him that if her baby was going to die, he'd die in his own time, and she'd deal with any infection when it happened.

Laura gave birth to a healthy baby boy. Far from being dead, there was nothing at all wrong with him. When Laura told her friends her story, others came forward with similar experiences with that doctor. It seemed his standard treatment for pregnancy bleeding was a D&C. Those who accepted his pronouncement that their babies were dead had the procedures. Those who questioned him and announced that they'd just let nature take its course had live babies. How many of the women who had the D&Cs were actually having miscarriages, and how many unwittingly aborted healthy babies? We can never know.

Who could fault a woman for going ahead with a medically recommended D&C after she'd been told her baby was dead? Nobody. But does the fact that her decision is perfectly understandable make it necessarily wise? That's another matter entirely.

I can't guess at Laura's doctor's motives. Maybe he'd once lost a patient to sepsis after a miscarriage, and he figured better safe than sorry. Maybe he just wanted to avoid the possibility of lawsuits. Maybe he'd never noticed how many of these inevitable miscarriages turned out to be perfectly healthy babies. His motives don't change the fundamental fact that he was wrong, and that had Laura acted on his advice, she'd have killed a perfectly healty baby and never known about it.

We tend to have a lot of faith in modern medicine. Doctors are so often able to make a diagnosis, to predict what sort of outcome a patient can expect, that we forget one thing. When a doctor gives a prognosis, he's doing the same thing the meteorologist is doing on TV every evening: he's trying to predict the future. And that is something no human being has ever been able to do with 100% accuracy. Yes, usually when the weather report predicts rain, it's wise to carry an umbrella. When the weather report predicts sunshine, we plan a day at the beach. But many's the day we carry unbrellas that never get opened, and many's the outing that gets rained out despite a forecast of sunny skies. Human beings, be they meteorologists or doctors, are subject to human error.

It's perfectly understandable that women would place their faith in doctor's judgment. But doctors are human, and therefore doctors are sometimes wrong. But because the pro life movement questions the wisdom of staking your child's life on doctors' skill in predicting the future, we're seen as heartless monsters who don't understand the trauma and anguish mothers go through in facing a grim prenatal diagnosis.

Actually, we understand all too well. And we find it cruel to offer a "Sophie's Choice" scenario to a mother -- a "Which nightmare do you prefer?" decision. We advocate supporting parents through the agonizing period of uncertainty, because the stakes are so high. If your doctor is right 999 times out of 1,000, and you're the one patient in a thousand where he guesses wrong, the cost to you is your child's life. That's too high a price to pay.

Related Links
"The Doctors Are Often Wrong"
Marla's Tragic Death
"My Experience With Prenatal Testing"
Some Revealing Insight