A Culture Warrior Takes on Amniocentesis

I have never enjoyed participating in the Culture Wars.  To begin with, I have the problem of unilateral disarmament, because I’m not a gun person.  I do not buy guns. Not real guns, not bb guns, not paintball guns, not pop guns, not even water guns, although I admit that super-soakers are tempting.  For the many small children in my life, my personal stand against guns makes absolutely no difference. The ones whose parents want them to have guns, have guns. The ones whose parents don’t, don’t. It is precisely because I don’t control the role of guns in their lives that I am permitted to make this decision based solely on my own preferences — my conscience, you might say.  So, Auntie Laura gives them another gift.

Healthcare, on the other hand, is not a gift. Healthcare, for most Americans, is a part of the compensation package. My daughter does not need to get her healthcare through her job, so instead they pay her more money. That’s how it works. And if you can’t get something through your healthcare (for free, or with a co-pay, or counting against your deductible — whatever), then it costs you extra, which means you might not get it at all.

This is the issue at the heart of all the recent fuss over the government healthcare plan, which mandates that insurance policies provided by your employer pay for contraceptives, even if your employer is a Catholic hospital or some other entity with a conscientious objection to birth control.  The compromise suggested by President Obama allows religious employers to specify that their dollars will not be used for contraceptives, which will instead be paid for solely out of the employee’s contribution to the plan.  The Catholic bishops have criticized this as merely a fiscal slight of hand, which of course it is – a slight of hand made necessary by their insistence that people that work for them cannot use their own compensation as they see fit.  For the record, gentlemen in skirts: these people are employees, not acolytes.  Once you give them the money, it’s theirs to keep.  Or to spend — on condoms or porn or Rice Krispies treats – because all that stuff is LEGAL (You know what is NOT legal?  Sex with children.  But for some reason that doesn’t seem to get the Catholic Church quite so riled up.  Makes perfect sense — there’s no contraceptives involved before puberty).

Okay, so that was a little nasty.  See what happens when you bring politics to the workplace?  That’s why so many counselors try to leave their politics at home.  But this week, candidate for the Republican presidential nomination Rick Santorum brought politics smack dab into the clinic, through a series of media appearances where he denounced prenatal genetic testing, saying that “prenatal screening, specifically amniocentesis, … is done for the purpose of identifying maladies.  And in most cases, physicians recommend abortion.”  Because, Santorum states, these tests are done to “cull the ranks of the disabled”, employers who disagree with the intent of testing should be able to insist that prenatal testing not be covered by their employee’s insurance policy.

Don’t get him wrong!  Santorum insists he doesn’t want to stop anyone from getting amniocentesis or CVS.  That would be just the sort of intrusion by government that he dislikes so much.  All he asks is that women who work for people of conscience pay for the tests themselves – not get them “for free,” as he says, by which he means that it comes out of the insurance fees that in part you pay for and in part you earn.  Instead, you have to pay out thousands of dollars for a test.  That’s not, like, stopping anybody.

Are you appalled yet? I hope so, because this is cutting pretty close to home.  Keep in mind, this guy is a couple of awkward Romney moments and a few tanks of $6 gas away from being President of the United States of America.  And surely this much ignorance on the national stage bears correcting — but where to start?  It’s tempting to focus on the low-hanging fruit.  Like, NO, Rick: most amnios do not, in fact, “lead to abortion”.  Most amnios are normal and lead to reassured parents-to-be.  And sometimes, when there is a problem, prenatal diagnosis allows us to avoid, ameliorate or even fix it.

Tempting to go there, sure.  But we don’t want to win the battle and lose the war.  By pointing to alternate uses of amnio like they were exculpatory, we imply legitimacy for the argument that prenatal testing for abnormalities is morally suspect if it is done to allow the couple to choose termination.  We suggest that really, you need some other excuse to justify testing.  And we all know that a lot of women have prenatal testing principally to check for chromosome anomalies — and that is legitimate medical care, and it’s not up to Rick Santorum or a bishop or a rabbi or an imam to decide what medical care is going to be available to them.

Where is the outrage, I ask you?  Where is the statement from the NSGC?  This is a full frontal, ill-informed attack on the fundamental concept of prenatal testing.  It could affect our patients’ ability to get care, and it is certainly having an impact right now on the way Santorum’s listeners view our practice.  Shouldn’t we be, you know, objecting?

I believe in the right of conscience.  But your right to conscience doesn’t trump someone else’s right to healthcare.  Scientologists can’t not cover psychiatry for their employees and Jehovah’s Witnesses can’t not cover blood transfusions for their employees and, as much as it pains me to say it, should the day come that I have employees, I won’t be able to not cover self-inflicted gunshot wounds. It’s true the world’s not fair – but this way, it’s just a little bit fairer.

7 Comments

Filed under Laura Hercher

7 responses to “A Culture Warrior Takes on Amniocentesis

  1. Meghan G.

    Much more eloquently put than the choice words I have for Santorum.

  2. Erica Ramos

    Excellent excellent post Laura! I have also been a little surprised at the lack of posts on Facebook from my GC friends. Although, I’m equally to blame. Every time that I started to post something, I just couldn’t even find the words. Thanks for doing so – it’s getting shared right now.

    My last two cents – it amazes me when someone like Santorum is so very focused on bringing life into this world and so completely against giving equal rights to those who live in it.

  3. Jaime

    This is a fantastic post. Thank you. You took the words right out of my mouth, from the gun gift-giving issue, to the hypocrisy/inconsistency of the Catholic Church, to your assessment of the implications of Santorum’s statement.

    I wonder if the lack of GC response to Santorum’s statement is due to the fact that his ideas are SO extreme and misinformed. It’s like someone saying that the world is flat and you don’t even want to discuss the issue with them because it’s like trying to rationalize with a crazy person–clearly, a logical, fact-based argument will never will change that person’s mind. That being said, enough people are voting for Santorum now (as opposed to a month ago) that you have to at least entertain the idea that a decent proportion of Republican voters are really on board with these ideas. Coupled with the surprising amount of legislative support for the recent Virginia bill requiring ultrasound prior to elective termination, it seems to me that these are not the thoughts of a single person, or even a very small minority without any real influence; rather, these ideas are gathering support from a deal of (mostly conservative Republicans in) the general population are are indeed a threat to the responsible, ethical practice of medicine. When viewed from that perspective, informal social media “protests” from GCs as well as statements from NSGC, ACOG, and other key professional societies seem more necessary.

  4. Katie S.

    While I firmly believe that prenatal testing and contraception need to be available from the standpoint of equity, they also present significant social and ethical complexities that go well beyond healthcare. Access to contraception is clearly a mandate but I am still not clear as to whether amniocentesis or other prenatal genetic tests are actually mandated through the Affordable Care Act. If not this whole debate boils down to a political stunt. I can’t find anything in the law referencing these specific tests. Please reply if this is the case and I have missed it.

    This debate has left me with two conclusions: 1) the world of politics is ugly and dishonest 2) the ethical issues of prenatal testing are extremely complex . Perhaps those are the reasons why NSGC doesn’t really want to jump in to this. We are not doing any favors to the reputation of our profession or to society as a whole if we continue to try to dichotomize this issue into a simple right and wrong. I am certainly not a fan of Santorum but for that reason it is too easy to line up in opposition without fairly examining the issues. In this instance I have to admit that there is some truth in what he has said. Sure, most of the time amniocentesis does not lead to abortion because results are reassuring…but then what percentage of amniocentesis leads to abortion when those results aren’t reassuring? Laura, I so appreciated a comment you made from an earlier post stating “improving our prenatal screening is not about giving parents the chance to know in advance that they are having a kid with DS. And if it was, insurance wouldn’t pay for it.”* Prenatal testing is far more complicated than just a healthcare issue and deserves further dialogue. Thank you for initiating the conversation.

    *https://thednaexchange.com/2011/08/11/genetic-counseling-and-the-disability-community-a-cautionary-tale/

  5. Robin Gold

    THANK YOU!!

  6. Leslie

    Just heard that Rick Santorum has a daughter with Trisomy 18. As much as I detest this man’s politics, it does seem to put things into some perspective regarding his views.

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