Conflict During Birth – 2022 Michigan HSEB Case 4

While the Michigan High School Ethics Bowl is a fully sanctioned (and arguably the nation’s coolest) NHSEB regional, they don’t use the standard case pool. Instead, local folks author a set intended to be more relevant to the community. From what I can tell, most of the cases and issues are applicable nationally, if not globally. But it’s a uniquely engaging pool, with brief author bios confirming that they’re written by Michiganders, for Michiganders.

Case 4 features a hospital administrator forced to decide whether to honor a request that might complicate a delivery. The mother asks that monitoring of the Unborn Developing Human’s heartrate be disabled during a Cesarean section delivery. The crux of the conflict comes in the final paragraph: Labor and delivery “guidelines suggest that continuous fetal heart rate monitoring is safer for the fetus, because it can allow for early identification of a rupture of the Cesarean scar [a scar due to previous C-sections]—which is deleterious to fetal (and possibly also maternal) well-being. The clinician caring for this person is insistent that the guidelines for continuous monitoring be followed and implemented, but the laboring person is insistent that they will not consent to its use.”

Why a mother would want heartrate monitoring disabled during delivery, I’m unsure. But her motives are relevant to the decision. Is her request driven by some firm, foundational religious reason? (A C-section is already a very unnatural delivery, so it can’t be an objection to the technological help.) Would the monitor make delivery distressing? (Maybe a previous C-section delivery ended badly, and hearing the monitor—or simply knowing the heartrate is being monitored—would cause severe anxiety.) Whatever the case, the strength of the reasons behind her request matter.

The level of risk is also relevant. My wife delivered twice via C-section, and from what I recall, the actual surgery (not counting prep) didn’t last more than twenty minutes, if that. (This doesn’t mean delivering that way is easy or non-dangerous. She suffered a “high spinal” with the second that could have killed her.) If the pregnancy has been normal and checks suggest delivery will be uneventful, maybe disabling the heartrate monitor wouldn’t be a big deal. Maybe complications are exceedingly rare. Then again, to the extent the lack of monitoring would put her or the Unborn Developing Human at unnecessary risk of death or disability, that potential impact would weigh in favor of going ahead and taking the precaution.

It’s also the case that the medical professionals have to balance the mother’s wishes against the Unborn Developing Human’s value, as well as risks to the resulting child’s quality of life. This late in development, the UDH is not only a potential person, but in a few minutes, it will also be a birthed baby. Fully formed and possessing many features of personhood (consciousness, the ability to feel pleasure and pain, the ability to form relationships), and well on its way of becoming a full member of the moral community, more than one party’s interests are at stake. Were the woman not pregnant, we could appropriately focus on her wishes. Were the pregnancy early term, the UDH’s value wouldn’t count as much. But this late in the game, that side of the equation is much weightier.

Ultimately, I’d recommend a conditional analysis. Rather than declaring, “The mother’s wishes should be respected, end of story” or “The UDH’s value should override everything else, end of story,” a thoughtful team could say, “The administrator should decide what to do based on a) the strength of the mother’s motivating reasons and b) the risk of death or disability in light of the value of a late-term UDH.” A team could stipulate additional details and offer a tentative conclusion. But these considerations definitely need to be in the mix.

Cool case! I’m sure the Michigan teams will offer awesome analyses at the bowl next month. I had the honor of judging in 2021, and was very impressed. But for a scheduling conflict, I’d be back this year for sure.

Kudos to case author Lisa Scheiman, Certified Nurse Midwife at the University of Michigan Hospital for 29 years, and trainer of midwifes, medical students and residents, for donating her time and expertise (she also authored case #3). And thanks to the NHSEB for continuing to support the Michigan Bowl’s prerogative to do their thing. Keep doing your thing, A2Ethics!