"pre-pregnant"

[cellio]

The Washington Post reported yesterday that new federal guidelines ask all females capable of conceiving a baby to treat themselves -- and to be treated by the health care system -- as pre-pregnant, regardless of whether they plan to get pregnant anytime soon. amergina posted a link to the 30-page report from the CDC, which I haven't gotten to load yet but I'm caching the link for future reference.

Recognizing that this is (currently) a limited recommendation, I am still fearful of where this could go. It's a small step from "recommend" to "require"; even if the government doesn't formally require, will doctors follow the recommendation to stay on the right side of malpractice claims and future federal action? Will many (or most) pharmacists refuse to fill prescriptions for drugs to treat actual ailments for fear of harming a hypothetical fetus (even if the woman says "if impregnated I will not carry to term")? Will restaurants and bars start refusing to serve alcohol to women? Will employers keep women out of jobs with environmental hazards? No, not immediately, but we shouldn't ignore it any more than we should ignore other dangerous trends oozing from Washington (and Washington's handlers).

Women are not incubators. It is hubris for anyone not directly involved to expect women to restrict ourselves for the sake of children we're not necessarily even planning to have. If, heaven forbid, I come down with some serious illness, I want the best treatment available -- regardless of what it could do were I to become pregnant. [1] I will listen to my doctor's advice about things like alcohol, diet, and exercise for my own sake (that's part of what I pay him for), but acting on it is my decision alone, morally speaking, and it's insulting to say "think of the baby!" rather than "think of your own health!". ('Cause, I suppose, we aren't smart enough to want to take care of ourselves, but we're programmed to love babies. Bzzt.)

By all means -- make patients aware of the effects of their choices and treatment options on hypothetical future children if they care about this. That's being a good doctor. So long as we stay in the space of recommendations from doctors to patients, we're fine. But I fear the slope before us -- that it will not stay between doctors and patients, and that it will not stay as mere recommendations. And I don't know what the best way to prevent a slide down that slope is.

[1] Ok, I am not personally capable of becoming pregnant, but that is irrelevant to my point.

Comments

[jducoeur]

Will many (or most) pharmacists refuse to fill prescriptions for drugs to treat actual ailments for fear of harming a hypothetical fetus (even if the woman says "if impregnated I will not carry to term")? Will restaurants and bars start refusing to serve alcohol to women?

Hmm; interesting point. Combine this with the American tendency towards litigation, and the corporate phobia about it, and the mix becomes explosive.

Consider: what happens when a woman receives a drug that *does* harm her baby, which she received because she didn't know that she was pregnant? The fact of these recommendations adds a fair possibility that she could sue the pharmacy and win -- the argument being that the pharmacist *should* have treated her as if she was pregnant (since those federal recommendations now exist), and didn't.

As soon as that happens, it's all over. It doesn't require intrusive laws: the chilling effect of such a verdict would shut many doors to women, from companies simply protecting their own asses...

[cellio]

It doesn't require intrusive laws: the chilling effect of such a verdict would shut many doors to women, from companies simply protecting their own asses...

Yes, exactly. Some of the far righteous will also attempt legislation, and that's a problem, but even absent that, on something that pulls at some people's core values this strongly, there will be problems. Many women would, I'm sure, happily sign waivers of liability in order to get their epilepsy prescriptions filled, but the corporate lawyers will rightly ask their employers: "do you really want the responsibility of tracking all that, and the risk of making a mistake, whe you could just play it safe?". There'll be businesses that take the moral high ground, and those who see sound business reasons to offer services their competitors won't, but in what proportions, it's too difficult to predict.

I'm not as worried about Boston and Pittsburgh as I am about South Dakota and the bible belt. "Just move to a saner place" isn't always an option for people, especially if you didn't anticipate getting cancer or epilepsy or migraines (and who does?) when you chose where to live. And one should never, ever grow so complacent as to say "it can't happen here", no matter what the "it" is. Eternal vigilance...

[jducoeur]

And one should never, ever grow so complacent as to say "it can't happen here", no matter what the "it" is.

You have read the book of that name, right? Made a profound impact on me in my teenage years; it's part of why I simply *can't* just let stuff like this go...