The NIH VBAC Conference: Could have used more Shrimp

(With a side of egg, as in: on my face.)*


It'll all make sense in a second.

As most of you reading this blog know, the NIH Conference on VBAC just wrapped. I tuned in to various bloggers' reports, got their updates and summaries on Facebook and Twitter, and was generally pleased, as were all the attendees I know of, with the overall optimistic and supportive tone of the conference. If hospitals and care providers actually put what's being said into action, a real turning of the tide is imminent.

However.

There was a moment at the end that is sticking in a lot of craws at the moment: a panel was pressed on the matter of informed refusal, and whether or not a pregnant woman has the same rights to informed refusal as any other citizen. The response was less than satisfactory, to say the least. Briefly, from The Unnecesarean's transcript:

SJ: [I]n spite of Dr Lyerly’s ethical presentation yesterday, the panel is unwilling to affirm the ethical necessity of recognizing that a woman has an absolute right to informed refusal of a surgical procedure that may cause harm to her?

Laurence B. McCullough: This is Larry McCullough, the ethicist on the panel.

SJ: Yes

LM: The claim that the right to refuse is absolute is a controversial claim, it’s not at all settled in the law or medical ethics.

Here's what I don't understand. I am not a lawyer or even a law student, but I do know of a precedent that seems, to my admittedly unprofessional eye, to establish this matter quite thoroughly. The case is McFall v. Shrimp, 1979 in Pennsylvania. McFall was suing one of his cousins, Shrimp, for a bone marrow donation that would have saved his life, as they were blood type matches. Shrimp refused. The court ruled in Shrimp's favor on the basis that society could not forcibly, against Shrimp's consent, invade his body even if it would save another person's life.

Again, total layperson. But it seems to me that the court has thus established bodily integrity as a key, undeniable factor of personhood, including situations where another person's life is affected.

This case has been invoked in abortion debates, and I don't mean for this post to start getting into "fetal rights". But the debate currently going in the comments on Unnecessarean, as well as other places on the internet, keeps bringing me back to this precedent. Some people do feel that a woman has a right to refuse surgery as long as it only affects her, but in cases where a cesarean would clearly save a baby's life, her right to refusal gets trumped. I personally think it's unlikely to incredibly rare that a mother would refuse a cesarean for a clear-cut contraindication to vaginal delivery (though I did read of one case of c-section refusal with a placenta previa; both did survive, though very much against the odds). And I always find it galling, on a personal level, that anyone ever presumes to think they care more about the safety of a baby than the baby's mother.

But these arguments seem beside the point to me, with a legal precedent like McFall v. Shrimp. If we do not grant full informed refusal to pregnant women, that means that we lose personhood, bodily integrity and the ability to consent as basic human rights once we become pregnant. If we decide that pregnancy takes away your personhood because another human life is involved, then it follows that we have to overturn decisions like McFall vs. Shrimp and people can start harvesting organs from each other, just for starters.

Legal-stuff-minded birth advocates, what are your thoughts? I say we start ordering the Shrimp.

*And with that, I am compelled to point out my mistake - which would normally be a run-of-the mill typo had I not gone overboard with the jokey title, final line, and pic for comic effect. As Courtroom Mama points out, the defendant's name is Shimp - NOT SHRIMP.

In my feeble defense, I swear on a stack of scripture that the message board post from which I originally learned of this case spelled it Shrimp, and I had copied and pasted a few key facts into a word document (the post was otherwise very well-written by a sharp, articulate member), including the names as written. I had even looked it up online and found it cited in quite a few places, also as Shrimp. I stand behind my overall point, of course, but I should have triple-checked, especially before getting cutesy. Blog and learn!