Counselling

One aspect I dread about the topic of obstetrics is counselling parents about foetal abnormalities. I often thought that it would be super-duper-cool to be a geneticist, because it's like I'm some kind of God playing with the fibres of life--- it's not like that in reality. I'm wasting my time on Facebook when I should be preparing for my exams, and I come across this headline where a mother writes to her doctor, about how the doctor was so wrong to advise an abortion, since the mother is now very, very happy with her daughter, despite the fact that her daughter has Down Syndrome.

"The truth is, your child is perfect"- is apparently what mothers would have liked to hear, despite a diagnosis of Down Syndrome. I mean, I take communication classes, but I seriously wouldn't phrase it that way. I don't think it's a doctor's job to tell you what you want to hear, but it's to deliver the truth in the most acceptable way. Maybe he failed to communicate certain aspects which mean more to the parents- like how they'll still be parents, and whatever joys of parenting they can still feel that... but I'm guessing that particular doctor was thinking more about how "this child is more likely to die" and "I should screen for heart defects".

I'm torn, really. The dominant side of my personality wants to yell "wtf there's nothing 'perfect' or 'normal' about it, we're all trying to pander around one sad and ugly truth"--- then the more human side of me says, "have you ever considered being less cynical and bitter, and just imagine, for a second, that some people might be happy with the prospect of having a child of their own, and that they are capable of loving that child regardless of whatever medical conditions they have". We often bring "quality of life" into our arguments- that even if a child was born they would have a decreased quality of life, and that makes their life not-worth-living. Well, we don't live that life, so it seems unfair that we get to decide who lives and who dies.

Not that I'm anti-abortion. I believe that the woman's autonomy over-rules everything, and ultimately the child is just a parasite in her body, right? Some people say that she should still carry the pregnancy to term, and give the child up for adoption--- something about the sanctity of life. I uh, think saying that is easy- to be detached and removed from the situation makes it sound so very practical- until you consider that a woman would be pregnant against her wishes, and she would labor against her wishes, and deliver against her wishes. That sounds traumatic as hell, don't you agree?

Ultimately in my opinion, it's all for the mother to decide. It's her child, after all. As for "recommending abortion"- I get it, I really do. I get why the doctor would recommend it, and I get why the mother would be outraged at the suggestion. The doctor probably should have gauged what the parents wanted before saying much- but it's true that raising a child with Down Syndrome would not be easy. Really, if I were the doctor, I would probably tell them that screening for Down Syndrome is optional- you can have the blood test and the scan, or you can just carry on. Nobody forces anything onto the patient. If the results return as "high risk", you can decide to have further testing to confirm whether this child indeed has Down Syndrome or some other thing. Each stage of the process requires consent from the mother, and ultimately she may decide to keep carrying the pregnancy despite the diagnosis. We want to counsel in our patient's best interests, but on this topic, it's difficult to gauge what our patients' interests are, unless we asked.

It's probably better to just ask, eh?