for Catholic doctors by MAUREEN VINCENT The latest development in the research into the handicapping condition known as spina bifida is likely to cause acute ethical problems for Catholic medical personnel. The tragedy of a baby born with a mental or physical handicap is nothing new. Advances in the science of medicine have, fortunately, been able to ensure that fewer children come into the world with such congenital defects, since ante-natal care in the wealthier societies has improved.
Even where medical services are at their best, however, there will still be a certain percentage of the newly born afflicted with some kind of handicap. Spina bifida is one of the most common of the major handicapping conditions.
In spina bifida the spine and the spinal cord fail to form properly before the baby is born. A gap is left in the spinal column so that the cord is completely exposed. The condition usually causes paralysis, often there is permanent incontinence, and there is a grave risk of hydrocephalus.
Before 1958 most babies born with spina bifida died. But since then surgical techniques have
made such strides that it has become theoretically possible for about two-thirds of all such babies to survive, even into adult life.
Initially, doctors were enthusiastic about surgery in almost all cases of spina bifida. But as more of the handicapped
children began survive into adolescence doctors, other medical and social workers, and the parents of such children became troubled about the quality of life to which the survivors were being condemned.
The decision to operate on a spina bifida baby must be taken within hours of birth if surgery is to achieve the maximum possible benefit. In the end, the decision to treat or not to treat must be taken by the surgeon. Parents are consulted, of course, but the shock of the handicap will leave them in a mental and emotional state where decision-taking will necessarily be greatly influenced by what the medical experts have to say.
In recent years, then, surgeons have become more selective about the cases on which they will operate. To refrain from surgery is, it must be stressed, in no sense to practise
Spina bifida babies on whom no operation is performed are given every normal nursing care in the hospital ward. They are fed, cuddled and loved, just as are the other babies there. But if a crisis arises no extraordinary measures will be taken to prolong such a baby's life.
A specialist in the condition at a London teaching hospital talked to me about the latest developments. "It is interesting that spina bifida has become very uncommon in the last year or so," he told me. Up until 1973 about 1500 live spina .bifida babies were born annually in England and Wales. There has been a spectacular drop of about 25% in the birth rate for the whole country over the past few years, but the drop in spina bifida babies has been proportionately twice as high, at least.
"One simply does not know why this should be. One theory is that since abortion became legalised girls don't take drugs to try to rid themselves of unwanted pregnancies."
It is a new discovery which is likely to pose an acute ethical problem, particularly for Catholic doctors, who cannot in conscience condone abortion, for no matter what reason. The discovery is that a test for a chemical substance known as alpha-foeto-protein in the amniotic fluid, which surrounds the unborn baby, will show whether that baby is likely to he born with severe spina bifida.
The test has only been in use for about a year, but it appears to be remarkably reliable. At present mothers who have had a previous spina bifida child can be screened. "We have had a number of such tests which proved negative and where the babies born were in fact normal," the consultant says. He estimates the possibility of error in the results of the test as being as low as five percent.
The possibility is that, should such a test become part of routine ante-natal treatment, there will be pressure on Catholic medical personnel, and Catholic parents, to make use of it. Since the only treatment recommended for an expectant mother on whom such a test was positive would be abortion, the test would be unacceptable to Catholics, and indeed to anyone else who refuses to condone abortion.
It is hoped by medical researchers that the widespread use of such a test would quickly eliminate spina bifida births in civilised countries. A sad corollory to this might be that educational and social service authorities might come to regard the provision of special aids for the children and adults suffering from spina bifida as even less urgent a matter than is at present the case.
A Catholic general practitioner had this to say: "At present, as I understand it, the test cannot be made until the pregnancy has reached fourteen weeks. At this stage it would certainly involve some risk to the pregnancy, and this is why it is not performed routinely.
"So far as the question of termination, if the test proves positive, is concerned, one must bear in mind that there are numbers of people born with spina bifida who are now leading happy lives, in spite of their handicaps. "I can think of a patient of my own. now in her thirties, who is an example of this. She would not have existed at all, presumbly. Had such a test been current before she was born,"