Posts Tagged abortion

Observations and Assessments

NOTIONS TO SMALL FOR A BLOG POST, ALL IN ONE PLACE, A.K.A. THE PERIODIC LINK DUMP.

Further to my post “Sleepy Sleepy Nurse”: Sleep or Die. Really.

My jobRegistered Nurse.

We don’t know as much about infection control as we think we do. “Less than a quarter of the Clostridium difficile cases in a hospital could be traced to patients in the same ward, challenging a common assumption about how the infection spreads.” Medscape summary. Original article here.

And we’re not as smart at Triage as we think we are. Analyzing the records of 519 patients aged 65 years or older who were triaged using the Emergency Severity Index, from University Hospital Basel in Switzerland, found that 117 patients were undertriaged and 15 were overtriaged.” Anecdotally, I think this is true. My only quibble is why the small sample size? I mean, 519 patients is two days of volume in a busy ED, which means only a few poorly trained triage nurses could skew the results.

Nurses’ Presenteeism and Its Effects on Self-Reported Quality of Care and Costs. I read the article and went “Meh.” Rather evades the real issues around presenteeism, i.e. workplaces penalizing nurses for taking sick time.

Oh, dear.

On the menu: Pink Slime! I swear I will never, ever buy ground beef ever again.

And they didn’t live happily ever afterReal life Disney princesses, fallen. A photo exhibit by Dina Goldstein. My favourite: Cinderella knocking back shots in a bar on Hastings Street in Vancouver’s Downtown Eastside.

Younger than the Happy Meal. An important reminder from Fred Clark the supposedly “eternal” truths about abortion maintained by evangelical Christians are of much more recent vintage than you think.

Great music in the cause of crap content. Dissecting the cultural significance of country music. Quote:

The conservative movement has been cannibalizing conservative art for years now, to the point where I’d say country music is far from a victory of conservative cultural or artistic success and is instead a mirror image of what conservative politics have become: easy and unthinking. No depth, all surface. Superficial and insular. Maybe I’m wrong, but building an entire genre on the back of the idea that regurgitating the same sound on top of the same basic premise over and over again hardly strikes me as a triumph of cultural conservatism.

What language do deaf people think in?

Ayn Rand is the Karl Marx of the Right. Mostly because she tells people with incredible amounts of privilege they are the real victims in life’s lottery. Quote: “She offers them something that is crucial to every successful political movement: a sense of victimhood. She tells them that they are parasitised by the ungrateful poor and oppressed by intrusive, controlling governments.”

The Reformed Whores respond to Rush Limbaugh: “I’m a slut.” Hugely funny and right on the money.

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A Nasty, Medically Unnecessary, Coercive Procedure

This is just grostesque:

A Republican supermajority has muscled two of the most restrictive anti-abortion bills in years through the Virginia House, despite bitter yet futile objections from Democrats, with one GOP delegate deriding most of the procedures as “matters of lifestyle convenience.”

You want to put what where?

[SNIP]

And the ultrasound legislation would constitute an unprecedented government mandate to insert vaginal ultrasonic probes into women as part of a state-ordered effort to dissuade them from terminating pregnancies, legislative opponents noted.

“We’re talking about inside a woman’s body,” Del. Charnielle Herring said in an emotional floor speech. “This is the first time, if we pass this bill, that we will be dictating a medical procedure to a physician.”

The conservative Family Foundation hailed the ultrasound measure as an “update” to the state’s existing informed consent laws “with the most advanced medical technology available.”

The Oklahoma legislature passed a similar law a couple of years ago. Full disclosure, in case you didn’t know it: I dislike abortion, but I’m strongly pro-choice. Even if you are strongly against abortion on moral or religious grounds, I would like to know how a medically unnecessary, coercive, invasive procedure can be ethically justified in order for a patient to receive health care? (I think we can safely dismiss the Family Foundation’s reasoning as spin.) And if the patient is a 13-year-old rape victim, how is this not despicable and evil?

Another question I would like to ask: if you’re a health care professional, would you excuse yourself from participating or facilitating in enforcing this law?

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Why This Nurse is Pro-Choice

A few weeks ago, I was at triage when a pale young woman came in. She was suffering complications of a therapeutic abortion; we occasionally see post-procedure patients from the Morgentaler Clinic or some other provider of therapeutic abortions with ongoing bleeding or pain. A nurse colleague triaged the patient, and her distaste, even disgust, was evident with this patient. I was, I think, a bit appalled at her reaction. Afterwards I remarked she wore her feelings on her sleeve.

“I can’t help it,” she replied. “I think abortion is wrong, and girls like her use Morgentaler’s like birth control.”

About the same time some anti-abortion activists were arrested at Carlton University, causing a slight, if predictable uproar over free speech rights and anti-abortion activism. I might mention parenthetically I myself believe anti-abortion protesters have the right to demonstrate where ever they please, within reason: demonstrating on the doorsteps of the providers of therapeutic abortion would be an obvious exception, because it’s a rather obvious attempt at intimidation, not to exercise of the right of freedom of speech or assembly. I’m not particularly swayed by the university’s argument that graphic photography displayed offends the delicate middle-class sensitivities of Carleton students and should be safely tucked away. The world is sometimes a very ugly place, and seeing what offends or disgusts us helps our understanding of it. No sunshine or lollipops here, sorry.

Both my colleague’s reaction and the protests at Carlton were a reminder to me that figuring out the whys and wherefores of therapeutic abortion is always a challenge to me and, I suspect, many health care professionals in general. I’m decidedly ambiguous. Therapeutic abortions trouble me, especially those later in pregnancy, for reasons that I can only describe as instinctive, and probably emotional. But theological arguments* (as a Christian) or ethical considerations against therapeutic abortion leave me unmoved: there is always tension between the definite autonomy and dignity of a woman versus the putative dignity and autonomy of a fetus, if indeed those characteristics can be ascribed in such a way. To put it another way, I am fairly clear that a mass of cells in the womb at four weeks is not a person; it is alive, yes, and is human because it contains human DNA in the same way that a hair follicle or a bit of skin does. But the embryo is simply not viable outside the uterus at this point and potentiality, in the sense that an acorn has the potential of an oak, is not the same as actuality. Believing a whole person is somehow contained within a fertilized egg cell at conception, as anti-abortionists do, when between a quarter and a third of all pregnancies at this point onwards will end in miscarriage, suggests a very black, cosmic practical joke.

But at twenty weeks? I’ve seen fetuses miscarried at that gestational age. I’m not so sure. Is there a time between four and twenty weeks does that mass of cells becomes a person? Or does a person become fully human when it obtains self-consciousness, which may not occur for some time after birth? I don’t pretend to have all the answers. I don’t know when human life truly begins, except to say probably not within the first trimester; sometimes I have trouble even saying when it definitely ends.

That being said, for myself, though I may dislike abortion in some circumstances, I am determinedly pro-choice. From a purely nursing perspective, therapeutic abortion is a medical procedure, and I have a duty to support any patient seeking health care, whether I agree with that choice or not. All patients have autonomy and must be treated with justice  — that is, as equally as possible — when seeking health care. In the same way, I subscribe to the premise of supporting choice in therapeutic abortions: no enforced pregnancies, no enforced abortions. To follow the anti-abortion position to its logical end — no therapeutic abortion regardless of the harm done to the mother or particular circumstances such as rape or incest, as many now advocate — denies that essential autonomy of patients who might come under my care. Obviously, personally and as a nurse, I can’t support that position.

As a nurse, I am also somewhat of a political animal, and my pro-choice views are admittedly coloured by the ideology and attitudes of the pro-life movement. In short, to believe the pro-life movement is only about ending therapeutic abortion is either to be astonishingly stupid, or disingenuous. The abortion wars are really one of the many proxy wars between a modern progressive and secular state (which as a Christian I support without hesitation, because a secular society provides the only guarantee anyone and everyone can practice their faith, or not) and an unambiguous and retrogressive social and religious conservatism. A cursory glance through pro-life websites will bear this out: the anti-abortion movement is bundled with all sorts of tangential issues dear to many conservatives, like same sex-marriage, stem cell research and (my favourite, from the Campaign Life site) “Creeping Socialism”.  It’s probably fair (and ironic) to say the radically conservative political positions of most anti-abortion organizations have made me, the fence sitter, very strongly pro-choice.

In the end, I think it comes to recognizing that inflicting my uncertainty on others denies their free action. I realize we live in an imperfect world, and sometimes our choices and decisions sometimes come to picking between equally bad options. And yes, I do believe also that there are times when therapeutic abortion is absolutely the moral choice. In the end, it’s a conflict between faith and personal morality, and (someone else’s) autonomy, and in this case, the imposition of personal belief has no place in professional practice. It’s an internal conflict not easily concluded, and I suspect for me personally, I will never fully resolve it. Frankly, I have enough trouble keeping my own socks pulled up without worrying about the foibles of others.

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*I don’t want to get into the theological debates here, but it seems to me the classic “clobber” texts of the anti-abortionists, e.g. “Before I formed you in the womb I knew you,” etc (Jeremiah 1:5) are taken, as usual with these things, out of context.

Another point: various Christian denominations have written vast theological treatises have been defending the practice of warfare, which has in the past century alone has featured the deliberate killing of tens of millions. This has been called a “necessary sacrifice.” I’ve never been clear, in this context, why abortion is a sin and warfare isn’t.

[Cross-posted at Sister Sage’s Musings]

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Rape Me All Over Again

Regular readers will know I am not much in the habit of commenting on politics, especially those of another country, but this is just plain ugly:

Transvaginal ultrasound transducer

Oklahoma lawmakers overrode their governor’s veto Tuesday to enact tough abortion laws that force women to undergo invasive ultrasounds and allow doctors to withhold test results showing fetal defects.

Even women who are victims of rape or incest will be required to listen to a detailed description of the fetus and view the ultrasound image prior to terminating a pregnancy.

They will also likely be required to undergo vaginal rather than abdominal ultrasounds as doctors are required to use the method that “would display the embryo or fetus more clearly.”

Transvaginal ultrasound anatomy

Patients and ultrasound techs have told me transvaginal ultrasounds are horribly invasive procedures. In essence, a long probe like the one above is inserted into the vagina up to the cervix. At my hospital they aren’t done routinely, and are only performed if absolutely necessary. Now imagine a 15 year-old incest victim or a 23 year-old rape victim being compelled to undergo this procedure in order to obtain an abortion.

Hey, let’s re-enact the crime! Let’s victimize the victim! Because evidently, in Oklahoma anyway, this is considered good heath care.

I’m not a fan of abortion, to be clear. But I am a nurse, and it seems to me to compel women to be symbolically raped to obtain health care is particularly evil. And unless you’re willing to have this procedure performed on yourself, or your raped daughter, please spare me any cant about the rights of the fetus.

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