Friday, April 6, 2007

Fetal Surgery Clarifications [Serge]

Eeks. Sometimes in an effort to quickly post in between patients, I am not as clear nor as precise as I would like to be. In my efforts to explain and post the fetal surgery video, my brevity may have been confusing. I also forgot to link to Prolifeblogs - which I have since corrected.

1. I did not see the episode of House and am quite happy that a TV show displayed the humanity of the unborn even if it may have stretched the truth a bit to do so. This happens often in TV - so much watching certain shows with someone with medical knowledge can ruin the experience. I did record and watch 24 on Monday, and I was about to scream at the TV if President "Waynewreck" Palmer asked for another dose of "adrenaline" to make him feel better. I use epinephrine every day, and I know the effects quite well.

2. I was responding to this post on prolifeblogs in which there was discussion regarding the initial picture of Samuel. Unfortunately, the description of the picture as given by some pro-lifers was labeled "inaccurate" by the urban legends website. I do believe we need to be careful to not exaggerate the characteristics of the unborn in order to "show" their humanity. To do so almost implicitly accepts the functionalism of our opponents. "Look, a 23 week old fetus can grab a surgeon's glove!". If we exaggerate, we either can be accused of using false information, or set ourselves up for defeat if our opponents can show that we are wrong. Never the less, it is unnecessary. I have shown lots of people a longer version of that video from TLC, and everyone that has viewed it has been amazed at our ability to perform surgery on a second trimester fetal human being. No "hand grab" is necessary. At the same time, it is reasonable to assume that the grasping reflex is present in a child of this age, so the kid could be "grasping" the glove.

3. As someone trained in anesthesia, I did not express the nuances of maternal-prenatal anesthesia very well. Most anesthetic agents pass at least somewhat through the placental barrier, so a fetus that is undergoing fetal surgery will have some form of anesthetic on board. Even if a human at that level of development could willfully grab onto the surgeon's glove, they probably would not due to the effects of the inhalational anesthetic. However, due to the imperfect transmission of the anesthetic to the child and the differences in the child's physiology, the child almost certainly would not have enough anesthetic on board to be considered under general anesthesia. In fact, when perform fetal surgery for spinal bifida, the neurosurgeon will inject some local anesthetic in to the site before making the incision. This is to ensure that the child does not feel pain and to avoid the little guy moving during the procedure: an important consideration when working by the spinal column.

In other words, the child would be sedated from the anesthetic but possibly still able to feel pain. This is why the early claims by those who perform partial birth abortions that the child would feel no pain from the anesthetic were shown to be incorrect.

1 comment:

  1. Serge, I completely agree that pro-lifers must always be accurate in their depictions of the unborn. But "House" wasn't done by pro-lifers - who knows if there's even a pro-lifers on the writing staff? Maybe it's someone who cares to represent two sides of the debate. If this was represented by pro-lifers in the real world, I'd agree it would be wrong and manipulative. Hurting our credibility doesn't do the cause any good in the long run. But "House" is a drama and therefore, I think, allowed to take some dramatic license for emotional punch. And sometimes I think it's a good thing, in a dramatic fashion like this, to allow viewers to make that emotional connection to the unborn that may soften their hearts to hear the sound arguments and facts on the pro-life side. Maybe I am just desperately relieved to see a positive depiction of the unborn, as Jay suggests is going on, but what I can say is that I found it incredibly moving and I suspect a lot of people who wouldn't identify themselves as pro-life were affected the same way. I don't think that's a bad thing.

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