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

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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, 41⁄2 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 safer 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.

These comments represented sound reasoning on behalf of the interested parties, and they need answering. We may have success in decreasing the number of abortions and controlling them to some degree if we remove the third party, the doctor, and make it a matter between a woman and her God, or a woman and man and their God. Let us consider the natural order of things pertaining to a pregnancy and see whether or not a physician, or anyone, need be involved at all, or whether intervention of a pregnancy is ever necessary, whether there is ever a time during pregnancy that we cannot prove the condition exists, and proof is obtained by waiting and looking through the retrospectoscope.

or

It is impossible for a woman to detect, subjectively, a pregnancy for 14 days, or until the first missed menstrual period occurs.

Physiologically, it is impossible to detect a pregnancy until the sixth or seventh day after conception. This immunoassay pregnancy test has just been perfected.

Anatomically, it is impossible to detect an early pregnancy, prior to implantation, unless the menstrual specimen were collected and examined microscopically. This might show inconclusive evidence of some change in hormone production-maybe.

It is a known and accepted fact that in most given medical situations, medication is tried before surgical intervention.

In any naturally occurring, spontaneous abortion, occurring within 6 weeks of the conception, surgical intervention to complete the abortion is unnecessary.

In any naturally occurring, spontaneous abortion, occurring after 6 weeks of conception, surgical intervention is necessary to complete the abortion, for placental products are often remaining in the

uterus.

We can conclude, then, that we have a 2-week period after conception in which detection of the pregnancy is virtually impossible. It cannot be proven if a drug or treatment administered during this period actually discourages implantation of a fertilized ovum or does nothing at all. We can also conclude that drugs, when available, are more preferable to surgical intervention, for it is also true that every complication of abortion is due to mechanical instrumentation of the pregnant uterus.

At the present time, abortion is a medical procedure for social therapy. Man is a social animal. We must have a balance of rights and responsibilites. With a concerted effort at educating women, making her aware of preventive medicine, the natural order of things as concerned with the ovarian cycle, the greater safety of preventive medicine over abortion and greater support of medical societies in education and family planning information, we can remove the third party, the doctor, from his role as abortionist to his traditional role as healer of the sick and preventer of disease.

Senator BAYH. Thank you, Doctor.

Let me deal with the last part of your statement first, if I might, please.

You say you can dispense with the role of the doctor?

Dr. CZARNECKI. I say we might consider doing so.

Senator BAYH. Given the testimony of our previous witness

Dr. CZARNECKI. We cannot dispense with the role of the doctor for genetic reasons. That is correct. But I did not mention that here.

Senator BAYH. Did you say that you are a doctor and mother of six children?

Dr. CZARNECKI. Yes.

Senator BAYH. And a concerned citizen, do you in your mind make a distinction between the efforts that might be taken chemically or surgically by a mother or father after the disclosure of genetic disorders as the result of the tests described by, our preceding witness? Can you make a distinction between that and the mother who just may not want a child?

Where do you come down as far as society is concerned on that, the morality issue?

Dr. CZARNECKI. I really think that once a pregnancy is diagnosed that the decision is made, and the pregnancy is what matters. Whether or not there is a genetic problem, or whether or not there is another problem, we have a responsibility toward the child.

Senator BAYH. What responsibility do you have toward the child that has been diagnosed as having Tay-Sachs, with the conclusion that was described by Dr. Horrobin?

Dr. CZARNECKI. I view it as a child at this stage, even though the individual or the baby or the fetus would have a diagnosis of TaySachs or a chromosome abnormality, et cetera. We would be responsible for the treatment of the child.

How can you differentiate? I cannot differentiate an abnormal from a normal; at that point, it is a human being we have to protect. Senator BAYH. I think you stressed a very good point in your testimony when you stressed the prevention and dissemination of information which is not now available. I think almost everybody would agree that that is a better alternative. Even those that are strongly opposed to a constitution amendment in this area would agree that preventive medicine and information is certainly the best policy.

You talked about the situation of rape and incest. The clinical procedures that you described would seem to be the clinical procedures that you described would seem to be the wise course to follow in the event of a rape situation. In the event of incest, I would suppose that a great number of circumstances where that particular act had been practiced would not, in fact, be disclosed as immediately as would be the case with rape, so the pregnancy that would follow in an incestuous relationship would not be known until the pregnancy was known, not at the act of incestuous intercourse. What do you do then?

Dr. CZARNECKI. You do not do an abortion.

Senator BAYH. There is nothing you can do to prevent conception or prevent implantation?

Dr. CZARNECKI. That is correct. You already have another living, growing human being within its mother. You must protect it, as you do all others.

Senator BAYH. In your judgment, you do not make distinctions between any types of pregnancy?

Dr. CZARNECKI. The diagnosis of pregnancy, I feel, would make a difference. As I stated, there is a time-for instance, there is a time