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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, or 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.

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 Bays. 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 Bays. 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 Bays. 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 Bayu. 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 Bayn. 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 in pregnancy when you do not know whether or not you are dealing with a pregnancy or not. In that respect, you would be preventing a pregnancy. Although some people maybe would consider that giving something, such as an IUD, as an abortifacient. They consider that in this realm.

We are dealing with something that we really have no proof on. I consider that still as preventive medicine, preventing a pregnancy. Beyond that, we would be destroying something that is already created.

Senator BayH. Regardless of the biological effect of the IUD or the morning after pill, there would be a significant difference of opinion as to the effect these devices or substances would have on the body. As long as it is in the area of the unknown, you are not concerned about whether it is abortifacient or otherwise.

Dr. CZARNECKI. That does not concern me.

Senator Bays. You know, there are a number of witnesses who have testified-specifically Senator Helms, who is a sponsor of one of the amendments before us—that life begins upon fertilization, when the sperm and the egg get together, and that anything that is done after that time would, indeed, be the same as a clinical abortion as far as the moral aspect of taking life.

Dr. CZARNECKI. I agree that life begins at conception. I know that there are others that believe that we are not concerned until there is implantation. What I am concerned with is the practicality of the whole thing. The situation that exists today is appalling, and anything might be better.

In a given individual, at a given time, we cannot detect a pregnancy. And even though life begins at conception, it is an unknown; it is a gray zone. There is no way that we can prove a pregnancy. To me, giving a woman medication at that time is not destroying anything, because it is in the realm of the unknown. No proof positive can be done of a pregnancy. That is acceptable to me.

Senator Bayu. We all have to make this decision for ourselves. On the question that we are facing on this side of the table, there is a very great division of opinion. Theologians, physicians, mothers are divided. We have had all of these different groups, and we will have others, and I am sure we will find them divided.

There has been a strong moral question raised about abortion, the right to protect a life vis-a-vis the right of a mother. And you sort of come down with a mixture.

Dr. CZARNECKI. They are not mixed after a diagnosis of pregnancy.

Senator Bays. Let me finish here. I want one more chance to define your reasoning here where you come down in a very strong moral standpoint of the child and the wrong of taking that life. But from a practical standpoint, during a certain number of days you are willing to waive your feeling of morality.

Dr. CZARNECKI. There is much discussion on this intrauterine device, whether it is or is not abortifacient. This is why I brought this up in particular today.

Senator Bays. The reason I pursue that is that you seem to be following the medical testimony which reasons if you can prove positively that a woman is going to have a baby that has Tay-Sachs, then would it not be at least within the realm of possibility to consider the practical aspects of giving that woman the right that you give any woman during the first 14 days?

Dr. CZARNECKI. Society, I am sure, has to decide this after a diagnosis.

Senator Bays. What do you feel?

Dr. CZARNECKI. If you have a decided diagnosis of life, you do not take it; you just do not. That is where I stand. If science can determine today an hour after I conceive that I am pregnant, if there is any practical way of doing that, then that is what we have to deal with, and we should not destroy that. There is a definite point in time

Senator Bays. One last question: How do you weigh the value of life in those instances and I know they are not frequent-where a choice must be made between the life of the mother and the child!

Dr. CZARNECKI. They are very rare. And if you have a mother in distress, you must protect the mother's life. I would do an abortion to save the life of a mother, if it should ever occur. And it is very rare today in medicine.

Senator BAYH. Senator Cook, I appreciate your being here with us this morning.

Senator Cook. Thank you very much, Mr. Chairman.

Having just come in, I hope you would not mind if I thank the Doctor very much for what I have heard. And if I do have any questions to submit to her, I would be delighted if she would respond to them. I would so in writing.

Senator Bayh. Thank you, Doctor.

I should say for the record that Senator Cook has been one member of our committee who has shown great interest and concern by his presence, has made a significant contribution in our efforts to find the right way to deal with the problem.

Our next witness is Kay Jacobs Katz, National Capital Tay-Sachs Foundation.

Ms. Katz, we appreciate your being with us.

STATEMENT

OF

CAPITAL

KAY JACOBS KATZ, NATIONAL
TAY-SACHS FOUNDATION

Ms. Katz. Mr. Chairman and members of the subcommittee, I would like to introduce myself and thank you for the opportunity to testify in opposition to proposals intended to outlaw legal abortion in the United States by amending the Constitution.

My name is Kay Jacobs Katz of Silver Spring, Md., and I am the mother of a child who had Tay-Sachs disease. I appear here today to express my personal beliefs and to represent the National Capital Tav-Sachs Foundation, an organization committed to public education, cure research, health care, and prevention of Tay-Sachs disease and its allied disorders.

These genetic diseases, known as sphingolipidoses or lipid storage diseases, are characterized by inborn errors of lipid metabolism. In each disease, an enzyme necessary for normal human function is either deficient or inactive. In Tay-Sachs disease the crucial enzyme is hexosaminidase-A which results in neurological deterioration and early death. It is estimated that one in every 30 American Jews of Eastern European ancestry is a carrier of this trait.

A carrier is totally unaffected by the disease, but a blood test can determine that the amount of activity of "hex-A” is somewhat less than that of most individuals. Statistically, one in every 900 Jewish marriages is between two carriers who are therefore capable of producing a child with Tay-Sachs disease. One child in every 3,600 births to Jewish couples will be afflicted with Tay-Sachs disease, and every child born with this disease will die by the age of 4.

I am not here to speak about every facet of the abortion question, but to help develop an understanding of the need to preserve the right to abortion when a fetus is known to have Tay-Sachs disease or a comparable disorder. There are a great many people who wish to deny potential parents of infants with fatal genetic disorders the option to terminate affected pregnancies.

However, once a doomed baby is born, these same people who insist on his birth disappear, leaving total responsibility to his parents. Besides the heartbreak, mental anguish, and, quite frankly, physical burden that the parents must endure, there is the problem of finding people willing or qualified to help in caring for such a child.

In most cases the families seek out institutionalization at some point because of increasing medical problems or simply overwhelming demands on the parents' time. Most retardation centers are inappropriate, and hospital care costs are prohibitive. Most insurance companies refuse to cover prolonged hospital care on the basis that it is custodial care even though the medical profession disagrees. Even those insurance companies that do cover a prolonged hospital stay will not cover the cost of a nurse at home, which for many families would be a more acceptable form of help.

For those afflicted families fortunate enough to live in Montgomery or Prince Georges County in Maryland, there is a very progressive, State-operated retardation center whose hospital is very satisfactory and whose nursing staff is loving and caring. But to place one's child in even such a fine center is a terribly sad event, as it is an admission that one more aspect of normalcy is being stolen from the child's life. I strongly urge every Senator to visit the patients in the Great Oaks Center Hospital building in Silver Spring, Md., and see for yourself exactly whom you will be voting about.

It all started for us 412 years ago when we had our first baby. She was beautiful and, we were assured, healthy and normal. She grew and developed very normally for several months, or so we were told. There were a few little problems such as a pronounced startle response which she never outgrew, but the doctor reassured us that she was normal.

By 10 months of age, she had begun to grow weak and to lose some of the skills she had learned, and once again I pleaded with the pediatrician to tell me what was wrong. Again, as before, I was put off. Finally, a couple of weeks prior to her 1st birthday, he admitted that her development was not progressing normally, and we were referred to a specialist at Children's Hospital here in Washington. We brought Joann home the day before her 1st birthday with the knowledge that she had Tay-Sachs disease, that the birthday cake placed in front of her the next day would be the only one she would ever see, and that she would no doubt be dead before her 4th birthday.

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