A pregnant Jehovah's Witness woman and her baby have died after the woman refused a blood transfusion in a Sydney hospital.
Doctors described the harrowing effect on staff at the Royal Hospital for Women and Prince of Wales Hospital in Randwick of what some felt were two otherwise avoidable deaths, after the women refused the transfusion when she developed complications nearly seven months into her pregnancy and was discovered to be suffering from leukaemia.
More than 80 per cent of pregnant women suffering from the cancer, called acute promyelocytic leukaemia, will go into remission with proper treatment, and the outlook for their babies is good.
But the 28-year old's religion forbade her from accepting the blood transfusion she needed to save her life and that of her unborn baby.
Ethicists and doctors say they are facing increasingly difficult decisions as the number of potentially life-saving treatments that can be done in utero grows. At the same time, debate has raged over NSW MP Fred Nile's push to introduce laws making it a crime to seriously harm or kill a fetus in utero.
Haematologist Giselle Kidson-Gerber said her experience treating cancer patients and her Christian faith had helped her understand the woman's choice, but it was difficult knowing that choice would affect the unborn child.
The woman's obstetricians, who in Australia would otherwise "rarely see people die, or make a decision that will hasten death" were unable to perform a caesarean.
"She would have had to have a classical caesarean, and she most likely would have bled to death. The obstetricians weren't comfortable with that when there was a chance we could have got her through," she said.
"They were unable to do a caesarean for the sake of the baby without putting her at risk".
But the baby died, and shortly afterwards the woman suffered a stroke and multi-organ failure, Dr Kidson-Gerber and her colleague Dr Amber Biscoe wrote in an account of the case published in the Internal Medicine Journal.
"Refusal of a lifesaving intervention by an informed patient is generally well respected, but the right of a mother to refuse such interventions on behalf of her fetus is more controversial," they wrote. "A doctor indeed has moral obligations to both the pregnant woman, and perhaps with differing priority to the unborn fetus. Circumstances where fetal and maternal autonomy conflict, or where fetal beneficence conflicts with maternal autonomy, create challenges."
Dr Kidson-Gerber said as more fetal-specific conditions become available, there would be more cases where the interests of the fetus and the interests of the mother conflicted.
"With technology improving, there are so many potential interventions that can occur for the fetus, whether it's intrauterine blood transfusions, genetic testing or physical surgery," she said.
In December, Fairfax Media revealed the case of a Sydney couple who wished to terminate a pregnancy after discovering the fetus had a physical abnormality. After delays caused in part by one hospital refusing to do the termination, the pregnancy was eventually terminated at 28 weeks, leading to questions about how consistently decisions about pregnancy termination are being made while it remains a potentially criminal act.
Sascha Callaghan, an expert in ethics and law at the University of Sydney, said the law as it stands allowed the mother to make decisions that would affect the fetus, even if it probably would have been able to survive outside her body.
"This isn't to say it isn't a tragic event … but we live in a society where, within reason, we let citizens be the authors of their own lives," she said. "If you are going to grant women full rights as citizens, are you going to dilute those rights for women who are carrying fetuses?"
Dr Callaghan said Jehovah's Witnesses were often unfairly criticised for their religious stance against blood transfusion despite it being a thoughtfully and strongly held belief.
"This woman had a long-held commitment to the Jehovah's Witness faith and that's how she chose to die. We are all entitled to die with dignity," she said. "When your fetus is in utero, it is inextricably tied to your life."
In the United States last week, a woman was convicted of feticide and neglect of a dependent when she miscarried after allegedly taking abortion medications, although no traces of the drug were found in her system. She was charged under laws that were passed after a pregnant woman was shot during a bank robbery and her five-month-old twin fetuses died.
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