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that time, at the beginning of these tests, was not the technique that is now used. Refinements in technique are occurring all the time.
There have been a few mistakes. The number of mistakes has been very small compared to the numbers of accurate diagnoses that have been made. And it has been felt—and I was talking to the people in our genetics department, and they fell that now in good centers and as I said in my testimony, this is not a technique that should be done in every hospital laboratory. These are very precise tests that have to be controlled very accurately. It is not like having your hemoglobin done. They are complicated, and they are difficult to do, and small alterations in technique can give very misleading results.
And some of the errors that have, occurred have been caused by things such as, the acidity of the solution that was used as a culture medium was just microscopically off, and that changed some of the characteristics.
Where the tests are done properly with the best techniques that we currently have, and where the results have been checked and rechecked, the accuracy now does seem to be approaching 100 percent. I do not think you will ever get 100 percent accuracy in anything.
Senator Bayh. On the genetic, chromosomal disorder, is that kind of abnormality correctable?
There are a number of people who expressed concern to me about abortions that are performed in order to prevent the birth of a child who is likely to be deformed. That child may develop and have a very productive life for himself, his family, and society generally,
Is it possible in absoluteness to determine the extent of a deformity before birth?
Dr. HORROBIN. As far as the chromosome disorders are concerned, the vast majority of these are associated with, at best, moderate retardation and very frequently with really profound retardation, which, although some people—and I have a research program to enhance the development of children with Down's syndrome, so I am not against doing the best we possibly can for children who have birth defects. But generally with the chromosome disorders, the conditon is so severely handicapped that these children are never able to assume any kind of productive life.
Some children can be somewhat productive, but there is no cure for a chromosome disorder. There is no way that extra chromosome or another condition, a lack of chromosome or an abnormal chromosome, can be corrected.
Around several corners, in terms of the biochemical defects, it may be that some of those conditions that are due to an enzyme deficiency, that that enzyme may be able to be replaced. It is not exactly Orwellian, but that kind of thing we may use the viruses to help give a message to the developing embryo who is going to be short this particular enzyme, that a virus may be able to be used to give that message to produce the enzyme.
These are things that, like I say, are around several corners, but are theoretically possible to correct some of the enzyme deficiencies. There is no way to take that extra chromosome out, though. That is present in every cell.
Senator Bayh. Once you determine the presence of Tay-Sachs, can you also predict the severity of the disease and predict with certainty the death of the fetus?
Dr. HORROBIN. We know pretty much. Things are never as simple as one has to make them sound in a brief testimony.
There are several forms of similar metabolic disorders to TaySachs where the course may not be so severe. But we can say that if Tay-Sachs disease is present that we can expect that this child will develop according to the way I have expressed it here, that deterioration will certainly set in. The child will become blind and deaf and deteriorate severely and will die by 5 or so years. I cannot predict whether children will die at 2 or die at 4. But one can say that this is the course of events in Tay-Sachs disease.
Senator BAYH. In the rubella measles situation, can you predict with certainty what the damage there will be!
Dr. HORROBIN. No; that is a different kettle of fish. That is where the fetus has been affected with a virus condition.
There are other diseases that the mother may contract during pregnancy that can damage the fetus. And the passage that I referred to about prenatal diagnosis of rubella, it is something that is very new and had not occurred before. Previously, all we could say was, this mother has just had rubella, and at this time in pregnancy there is such and such a likelihood of the fetus being affected. We could not say that that fetus would be affected or would not be affected, and we could not say that this is the defect that this particular fetus would have. All we could say is whether or not the fetus was likely to have been affected by the virus.
Senator BAYH. Now?
Dr. HORROBIN. In light of the recent reports, one, we will be able to say yes, this fetus was affected, or no, this fetus was not affected, even though the mother had the disease, although we are still not able to say it means that this fetus if carried to term will become a child who will be deaf, or this fetus if carried to term who will be a child who will be severely retarded with heart disease and cataracts and every other known condition that rubella is known to produce in a fetus. We cannot say yet what will be the birth defect of the fetus. We can say that, yes, the fetus did have rubella. Then the mother makes her choice as to whether this is a risk that she is prepared to assume.
Senator Bays. What type of testing?
Dr. HORROBIN. Yes; it is. Withdraw the amniotic fluid, and having the virus from the fluid or the virus cells.
Senator Bayh. I want to thank you, Doctor. You have been very helpful to us.
This certainly must be a fascinating area to explore.
If you could provide us later on for the record the probability that we discussed earlier, I would appreciate it.
Senator Bayh. Our next witness this morning is Dr. Dorothy Czarnecki, obstetrician-gynecologist, from Philadelphia, Pa.
STATEMENT OF DR. DOROTHY CZARNECKI, OBSTETRICIAN
GYNECOLOGIST, PHILADELPHIA, PA. Dr. CZARNECKI. My name is Dorothy Czarnecki. I am a physician trained in obstetrics and gynecology, practicing in Philadelphia, Pa. I have special training in the field of oncology and the treatment of pelvic cancer was my main interest until 4 years ago, when the abortion question started to surface. In 1972, as a member of Governor Milton Shapp's Pennsylvania Abortion Law Commission. I was introduced to every aspect of the abortion dilemma. These may be the qualifications that got me invited here today, but in addition to these, and as important as the above, I am female, married, and a concerned mother of six children, five of whom are daughters. All these positions qualify me to speak on this subject. It is my concern for women, my concern for my children, my concern for medicine, my concern for society that prompted my acceptance of your invitation to speak today. This testimony is "prolife” and it is guaranteed to be different from that you have heard before.
It is my opinion that women are equal to but not the same as men. In the natural order of things, this will never change. Women deserve equal rights, equal pay, equal job opportunities, and equally under the law. Women ought to have the right over their own bodies, insofar as they can determine whether or not they shall become pregnant. They deserve to be educated. Equal opportunity means that, rich or poor, black or white, they shall be required under the law to receive sex education, and contraceptive information by people trained in the field. It does not mean that we shall supply abortion to those who cannot afford it. Preventive medicine always has been, is now, and always will be better, safer, and cheaper than destructive medicine.
Prior to 1970 the word abortion was almost never mentioned, never discussed, except in medical schools. As the issue surfaced, the abortus became "human life" vs. "a blob of protoplasm,” with proponents of abortion refusing to recognize it as human life. In 1972, an eminent professor of obstetrics and gynecology from a Philadelphia medical school testified before the Pennsylvania Abortion Law Commission and could not be pinned down as to when he thought life began, giving the reply that ova and sperm are life, and every cell in the body is life, or is living tissue, and that nobody really knew. This is a false piece of information that is frequently passed along. Even Justice Blackman stated that nobody really knows.
It is important to mention what the eminent professor of obstetrics and gynecology did not say. What he did not say was that the new human life we talk about is a different organism, with a new genetic code, totally different from the two people responsible for its existence. What he did not say was that this new living human being was the only thing other than an abnormal pregnancy that can give us a positive pregnancy test because of its production of a specific hormone in the body of its mother, human chorionic gonadotropin. No other living cell, living ova, living sperm, living anything can give this test, which specifies pregnancy, the existence of new life.
We have matured a bit. We now all agree that it is human life we are dealing with, only its value is suspect. Now we deal with a class of individuals, the unborn.
You have heard testimony from experts in the fields of law and medicine. I am not in research. I am not in any subspecialty such as perinatology or genetics where I can relate the latest developments in genetic engineering or intrauterine surgery. But what I can do is relate to people and in the past 2 years I have done just this. As guest lecturer in Pennsylvania and New Jersey schools and guest speaker at numerous community gatherings and parent-teacher organizations, I have been before at least 200 audiences in the past 2 years. I am appalled by what the people do not know-about themselves, about each other, about the availability of community services, about sex education, about medical treatment of rape, about the increase in rape in our communities, about the possibility of V.D. contact in cases of rape. The most frequent question they ask is: Should an abortion be done for cases of rape or incest?
The immediate and essential treatment for the victim of rape is medical: to observe, examine for injury, sew up lacerations, treat contusions, treat for possibility of venereal disease contact, and treatment to discourage pregnancy. Every medical school in the land gives its students this information. The medical treatment given is high doses of estrogen to change the condition of the endometrium or the lining of the uterus to discourage implantation. Statistically, 1 in 300 rape cases without treatment may result in pregnancy, 1 in 300 rape cases with treatment may result in pregnancy.
You notice I use "may result in pregnancy.” In these days with so many women on oral contraceptives and having IUD's, I feel the incidence of pregnancy after rape, with treatment, is almost nonexistant. Abortion plays no role in rape or incest, but proper attention and treatment of the rape victim does.
What then is the problem? Why do people not know that treatment for rape is available? Who is responsible for distributing this information? The government? The State? The medical societies? Should this information be provided in community service programs? I have encouraged active community groups to appeal to ther medical societies for information. Women deserve to know.
The second part of my testimony concerns the practice of medicine. I am a firm believer in preventive rather than destructive medicine and I prefer medicine in its traditional role of healing the sick rather than its newer role of sociological therapeutics. Abortion is only a temporary solution to the symptoms of a new disease, unwanted preg. nancy, and it is not a cure for the disease itself.
The practice of obstetrics in this country has changed significantly since January 22, 1973, at which time the now famous U.S. Supreme Court decision was handed down. The U.S. citizens had always regarded the unborn as human beings with potential, and now we seem to be dealing with potential human beings, with born persons having superior rights to the unborn. An obstetrician now may take care of the mother pregnant with child, or may, with her permission, take care of the child.
By definition, abortion is the termination of a pregnancy at any time before the fetus has attained a stage of viability. Viability. The interpretations of this word viability have varied between fetuses with weights of 400 grams, about 20 weeks gestation or weight of 8 ounces, and those of 1,000 grams, about 28 weeks gestation or weighing 2 pounds, 2 ounces. A premature baby is one defined as weighing less than 2,500 grams, 5 pounds, 8 ounces, at birth. Although the smallest surviving infant weighed 540 grams, 1 pound, 1 ounce, at birth, survival even at 700 grams or 800 grams, 1 pound, 6 ounces, is unusual. Attainment of a weight of 1,000 grams, 2 pounds, 2 ounces, is therefore widely used as the criterior of viability. Infants below this weight have little chance of survival, whereas those over 1,000 grams, 2 pounds, 2 ounces, have a substantial chance, which increases greatly with each 100 gram increment.
With this information in mind, gentlemen, how can we justify this medical procedure, abortion, when the body removed from the uterus sometimes weighs 2, 212, 3, 312, 4, 412 pounds after delivery?
This is not abortion, but is being performed daily. This is deliberate destruction of a viable infant. This can be called what? Poor medical judgment ? Inaccurate diagnosis? Distortion of facts? Woman's right? Murder? Or abortion for genetic reasons ?
Medicine on the whole has done very little to discourage abortion in favor of preventive measures, although it is a known fact that all physicians believe in preventive medicine, including proabortionists. We know that preventing a pregnancy is so much better and sa fer than having an abortion.
Where do we find these facts? These facts are found in almost every article pertaining to abortion or contraception in medical literature.
But who needs the information? Every female in the land-and she does not read the medical journals. Every mother ought to have this information at her fingertips. And if she does not read the Redbook or Ladies Home Journal the one or two times a year an excerpt may be printed there, she has also missed the boat.
What about the poor in the ghettos ? Instead of access to free and easy abortion, why not free sex education and access to contraception if desired ?
The third part of this statement I have reserved for my own ideas as to the possible solution to this abortion dilemma. The question I ask is this: Is there any way that the supporters of life can be in agreement with those favoring woman's rights?
I believe we agree on the necessity of sex education. We also agree on preventing, if possible, the unwanted pregnancy. This is only possible if we make a concerted effort to make women and men aware of their sexuality and their profound responsibility for their sexual activity. We can agree upon medical treatment for rape and incest, or hormone therapy for the unexpected intercourse, which includes rape and incest. All of these are preventive measures, whereas abortion is destructive medicine.
I once heard a minister expound on how abortion should be legalized because this is a matter between that woman and her God, and no person should interfere." Another gentleman objected to the statement made that abortion is a private personal relationship between a woman and her doctor, referring to the fact that the doctor, in most cases, had nothing to do with the jointure of the egg and sperm.