to catch it in "Death Be Not Proud," his book about the struggle to control the tumor pressing in on his son's brain-a tumor which killed John Gunther Jr. at 17, the same age as Marilyn. Marilyn's life followed the pattern of so many losing cancer battles: tests; 101⁄2 hour surgery "to get it all"; soaring hope; despair as new cells grow; more surgery-including, in Marilyn's case, a cut right next to the heart to get a tumor along with her cancerous left lung. Chemotherapy. Desperation radiation to relieve the pain-hope of a cure gone -barring the miracle everybody prayed for. Through all this-from despair to hope to hospital to home, Marilyn cried only this one time: Doctor-"I don't think," he said after removing Marilyn's lung in March, 1973, "that you should ever ride again." Marilyn-"It's my life, isn't it?" she asked as those first and only tears came. "I'm going to ride a gentle horse. I'll decide what I'll do." And decide she did-in favor of riding despite the warning that a fall from a horse might lead to a fatal puncture of her one remaining lung. Marilyn got back in the saddle last summer. But cancer won that round, too. The pain after riding eventually proved too much. She gave up temporarily— vowing she would ride again when she got well. She talked of her next horse almost to her last breath. The long night for Marilyn finally ended on May 26, 1974, in the Bethesda Naval Hospital. The Langley Class of 1974 was just getting ready to graduate. She was in its upper 15 per cent academically. The Food and Drug Administration-the federal government's watchdog against drugs that hurt more than they help people-at one point banned DES for cattle, a ban that was lifted in January 1974 after the decision was challenged in court. It also ordered manufacturers in 1971 to warn against the dangers of using DES during pregnancy. But the Malloys still hear of mothers who have taken DES, given birth, but do not know their daughters should be checked for cancer as soon as they reach puberty-by age 16 at the latest. Other mothers do not remember whether they took DES or not, so specialists urge checks of their daughters too. The Navy doctor who treated Marilyn believes DES and her cancer are linked. Dr. Arthur L. Herbst, assistant clinical professor of obstetrics and gynecology at Harvard Medical School, has linked DES to cancer on the basis of studies at Massachusetts General Hospital. "We don't know how many women we're talking about," Herbst has warned. "We think it's many thousands. Its use was fairly widespread." And in advice which the Malloys implore parents to follow so they can catch cancer early enough to beat it, Herbst has said, "We think all girls whose mothers took this drug should have a complete pelvic exam once they reach puberty." [Reprinted from California Medicine. "Official Journal of the California Medical Association," Vol. 113, No. 3, Sept. 1970] A NEW ETHIC FOR MEDICINE AND SOCIETY The traditional Western ethic has always placed great emphasis on the intrinsic worth and equal value of every human life regardless of its stage or condition. This ethic has had the blessing of the Judeo-Christian heritage and has been the basis for most of our laws and much of our social policy. The reverence for eac hand every human life has also been a keystone of Western medicine and is the ethic which has caused physicians to try to preserve, protect, repair, prolong and enhance every human life which comes under their surveillance. Thi straditional ethic is still clearly dominant, but there is much to suggest that it is being eroded at its core and may eventually even be abandoned. This of course will produce profound changes in Western medicine and in Western society. There are certain new facts and social realities which are becoming recognized, are widely discussed in Western society and seem certain to undermine and transform this traditional ethic. They have come into being and into focus as the social by-products of unprecedented technologic progress and achievement. Of particular importance are, first, the demographic data of human population expansion which tends to proceed uncontrolled and at a geometric rate of progression; second, an ever growing ecological disparity between the numbers of people and the resources available to support these numbers in the man ner to which they are or would like to become accustomed; and third, and perhaps most important, a quite new social emphasis on something which is beginning to be called the quality of life. a something which becomes possible for the first time in human history because of scientific and technologic development. These are now being seen by a growing segment of the public as realities which are within the power of humans to control and there is quite evidently an increasing determination to do this. What is not yet so clearly perceived is that in order to bring this about hard choices will have to be made with respect to what is to be preserved and strengthened and what is not, and that this will of necessity violate and ultimately destroy the traditional Western ethic with all that this portends. It will become necessary and acceptable to place relative rather than absolute values on such things as human lives, the use of scarce resources and the various elements which are to make up the quality of life or of living which is to be sought. This is quite distinctly at variance with the Judeo-Christian ethic and carries serious philosophical, social, economic and political implications for Western society and perhaps for world society. The process of eroding the old ethic and substituting the new has already begun. It may be seen most clearly in changing attitudes toward human abortion. In defiance of the long held Western ethic of intrinsic and equal value for every human life regardless of its stage, condition or status, abortion is becoming accepted by society as moral, right and even necessary. It is worth noting that this shift in public attitude has affected the churches, the laws and public policy rather than the reverse. Since the old ethic has not yet been fully displaced it has been necessary to separate the idea of abortion from the idea of killing, which continues to be socially abhirrent. The result has been a curious avoidance of the scientific fact, which everyone really knows, that human life begins at conception and is continuous whether intra- or extra-uterine until death. The very considerable semantic gymnastics which are required to rationalize abortion as anything but taking a human life would be ludicrous if they were not often put forth under socially impeccable auspices. It is suggested that this schizophrenic sort of subterfuge is necessary because while a new ethic is being accepted the old one has not yet been rejected. It seems safe to predict that the new demographic, ecological and social realities and aspirations are so powerful that the new ethic of relative rather than of absolute and equal values will ultimately prevail as man exercises ever more certain and effective control over his numbers, and uses his always comparatively scarce resources to provide the nutrition, housing, economic support, education and health care in such ways as to achieve his desired quality of life and living. The criteria upon which these relative values are to be based will depend considerably upon whatever concept of the quality of life or living is developed. This may be expected to reflect the extent that quality of life is considered to be a function of personal fulfillment; of individual responsibility for the common welfare, the preservation of the environment, the betterment of the species; and of whether or not, or to what extent, these responsibilities are to be exercised on a compulsory or voluntary basis. The part which medicine will play as all this develops is not yet entirely clear. That it will be deeply involved is certain. Medicine's role with respect to changing attitudes toward abortion may well be a prototype of what is to occur. Another precedent may be found in the part physicians have played in evaluating who is and who is not to be given costly long-term renal dialysis. Certainly this has required placing relative values on human lives and the impact of the physician to this decision process has been considerable. One may anticipate further development of these roles as the problems of birth control and birth selection are extended inevitably to death selection and death control whether by the individual or by society, and further public and professional determinations of when and when not to use scarce resources. Since the problems which the new demographic, ecologic and social realities pose are fundamentally biological and ecological in nature and pertain to the survival and well-being of human beings, the participation of physicians and of the medical profession will be essential in planning and decision-making at many levels. No other discipline has the knowledge of human nature, human behavior, health and disease, and of what is involved in physical and mental well-being which will be needed. It is not too early for our profession to examine this new ethic, recognize it for what it is and will mean for human society, 57-676 - 76-51 and prepare to apply it in a rational development for the fulfillment and betterment of mankind in what is almost certain to be a biologically oriented world society. WOMEN'S CLINICAL GROUP, INC., Hon. BIRCH BAYH, Chairman, Senate Sub Committee Constitutional Amendments, Judiciary Committee, Old Senate Office Building, Washington, D.C. DEAR SIR: I am writing you in regards to the question of the constitutional amendment to nullify the January 22, 1973 supreme court decision on abortions. I feel and many of my colleagues feel that such an amendment would cause far reaching harm and injury to women in general. We feel that it is a womans right to choose as the supreme court has stated. We feel that such an amendment would expose the female population again to immense mortality and morbidity. As recent statistics have shown the risk of death from early abortion is far less than carrying a pregnancy to term and childbirth. New York City alone has reduced maternal deaths per 10,000 by 50% since the New York law has gone into effect. There has been a striking decline in the number of women hospitalized for incomplete abortions, both spontaneous and induced. I would be happy to come and testify for the Sub Committee on Constitutional Amendments per your request. Would you please enter these comments to the hearing records. Thank you. Sincerely, ALLEN S. PALMER, D.O. GARY, IND., April 5, 1974. Re Amendment on Abortions. Hon. BIRCH BAYH, U.S. Senator, Senate Office Building, Washington, D.C. DEAR SENATOR BAYH: I am strongly opposed to the proposed amendment. As a medical doctor I believe this should be a decision between a woman and her doctor and not a decision regulated by law. My experience has been that women with unwanted pregnancies will seek abortions whether they are legal or illegal. An illegal abortion often results in serious infections or heavy bleeding and sometimes death. A legal abortion by a good physician offers a good medical procedure. I want my patients to have good medical care if they opt for termination of a pregnancy. I would like to be present at the hearing, but since this is not possible, I am requesting that this letter be made part of the hearing record. Very truly yours, ROBERT FLOWE, M.D. ROCKVILLE CENTRE, N.Y., April 20, 1974. Mr. HECKMAN, Counsel, Sen. Bayh's Committee, Washington, D.C. DEAR MR. HECKMAN: It is my understanding that Senator Bayh is presently taking evidence in support of a "Human Life Amendment". I wish to have a statement placed into the record that as a physician I am strongly in favor of such an amendment. I am convinced that the United States Supreme Court has clearly exceeded its own competence in its recent ruling on abortion and that the U.S. Constitution should be amended to protect the lives of unborn children in this land. Thank you for your courteous attention. Yours truly, JOHN H. TRAVERS, M.D. Senator BIRCH BAYH, GROUP HEALTH COOPERATIVE OF PUGET SOUND, DEAR SENATOR BAYH, As a practicing obstetrician and gynecologist, and as a woman, I have both a personal and a professional interest in the current controversy about abortion laws. You are, no doubt, acquainted with recent statistics showing a decrease in maternal and infant mortality associated with liberalization of abortion laws. Early abortion is statistically safer to a woman than delivering an infant at term. In the years since abortion has been available in the state of Washington, I have noticed some impressive changes. Almost all my obstetrical patients have planned their pregnancies and are delighted at the prospect of parenthood. There is no question that they are making better parents than mothers who looked upon pregnancy as something to be suffered, children as punishment for an indiscretion. During my residency (1966-1970) I removed at least four young women's uterus' because of infection or trauma related to illegal or self-induced abortion. Since abortion has been legal in our state, I have seen no serious complication of abortion, nor have I seen any self-induced abortions. Despite the fact that I do lots of challenging major surgery for gynecologic complaints, my most grateful patients are those who have just been relieved of the burden of an unwanted pregnancy. I find that these women are usually effective users of contraception in future. Your committee must realize that until the perfect contraceptive has been found, abortion will always be with us. At issue is whether it will be safe, legal abortion, or the back-alley butchering we used to see so much of. I hope our legislators will decide to maintain a woman's or a couple's right to plan their family, including abortion as an option, should contraception fail or fail to be used. Very truly yours, RUTH H. KRAUSS, M.D. TAYLOR-BROWN MEDICAL CENTER, Re Subcommittee Hearings on Constitutional Amendments Concerning Abortions. Senator BIRCH BAYH, Senate Office Building, DEAR SENATOR BAYH: I write to register my vigorous opposition to any type of constitutional amendment on the subject of Abortion. I base my position upon concern for the health, welfare, and peace of mind of women, and men, and children based upon my intellectual appreciation, philosophical conviction, ethical decision, and vocational commitment as expressed in 30 years of general medical practice including obstetrics and gynecology. I speak as a technically qualified expert in the area (see enclosure) and as an informed and concerned citizen. Among the chief compelling reasons against constitutional modification are the following: 1. Restriction of abortion is not the will of the people. Not only is a minority of the people now avowedly opposed to abortion, a considerable number of even these will seek abortion, legal or illegal, when certain circumstances arise. 2. Creation of constitutional law which the people will not abide is demoralizing and threatens government. 3. Legal abortion promotes health and prohibition of abortion is detrimental to health, as has been amply documented in careful studies over the past half decade. Legalization of abortion has been long needed and the Supreme Court decision of January 22, 1973 was a brilliant act in which the Court brought law in conformity with known reality. Any return to restriction would be a great backward step with serious consequences legally, socially, and economically. Should further amplification of my position in this matter be of value to the committee's deliberation I would be willing to appear before the committee at some later time. I request that this letter be read into the proceedings of the Subcommittee. Sincerely, PAUL C. JENKS, M.D. [From The Medical Tribune and Medical News, Wednesday, May 1, 1974] 530 2ND-TRIMESTER ABORTIONS DONE 'SAFELY' (By Margery Barnett) Memphis, Tenn.-"The midtrimester abortion is the court of last resort in birth control, served by the few of us willing to engage in what I term midtrimester obstetrics," Dr. Paul C. Jenks told the 12th annual Planned Parenthood Physicians meeting here. But late induced abortion can be as safe or even safer than early abortion, he said, as demonstrated by his series of 530 second-trimester patients whose pregnancies were terminated by saline injection with an initial success rate of 97.7, no deaths, few complications, and no live fetuses. All but nine of the 530 saline injections were initially successful, reported Dr. Jenks, department of obstetrics and gynecology, Taylor-Brown Memorial Hospital in Waterloo, N.Y. Eight of the nine were successful on second injec tion, the single failure proving later to be of less than 16 weeks' gestation. After adopting a stronger, 23.4 per cent solution, he found that a second injec tion was not needed for any patient over 16 weeks. The most significant complication was retained placenta "the bane of the midtrimester obstetrician's existence"-which required operative removal with anesthesia in five cases and manual-instrumental removal, without anesthesia. in 21. "This very low incidence of retained or delayed placenta may be related to our routine of removing all available amniotic fluid and usually instilling 200 cc. of saline," Dr. Jenks said. He noted that retained placenta correlated closely with early gestational age, removal of less than 200 cc. of amniotic fluid, instillation of less than 200 cc. of saline, and prolonged abortion time. Average time from injection to abortion in his series was 40.6 hours. True complications-fever, infection, depression, hemorrhage were noted in 3.4 per cent of his cases, but there was no septicemia, major injection accident, or uterine rupture, though several women had had previous cesareans. Complications actually diminished with advancing gestational age, reaching a low of 0.9 per cent at 20 weeks-plus. COMPLICATIONS NOTED IN 8% When he compared his success and complications in this series of late abortions with a smaller series of first-trimester abortions that he had performed at the same hospital, Dr. Jenks found that the complications of suction and curettage ran 8 per cent. These included infection, hemorrhage, uterine laceration, and late excessive bleeding. He concluded that "in our hands, saline abortion is no more likely to be complicated than suction, anl even when retained placenta is taken into consideration, results are still as good after 18 weeks as before nine weeks." Attempting to assess his unusually good results in these late abortions, Dr. Jenks speculated that the rather long interval-40.6 hours, on the averagebetween injection and expulsion might be contributory, and very sparing use of oxytocin might be even more significant. "Generally, we have withheld oxytocin until 48 hours postinjection," he said. "Early vigorous use of oxytocin may lead to water intoxication, an avoidable. serious, life-threatening condition; early expulsion may be associated with more coagulopathy; early use may often raise the expectation of patients more than it shortens time and may lead to considerable emotional distress; there is no evidence that any advantage is present other than that of reduced time; and tubes and armboards should not be used to serve the convenience of personnel and institution more than the safety and comfort of patients." |