Having to deal with epilepsy is a difficult situation alone, but being pregnant further complicates the situation. Physicians treating these epileptic women are no longer obligated to care for the mother but also the fetus within her. However, in the interest of caring for the mother by using epilepsy drugs, the fetus could also be harmed. Previous studies have found valpropate, but sold as “Depakote” to increase malformations and developmental difficulties of the fetus. But most recently, a new study soon to be published compared valpropate to other antiseizure medications. The study found that children and toddlers born from mothers who have taken valpropate during her pregnancy displayed lower I.Q. scores. These results suggest valpropate to have serious cognitive consequences on the welfare of the fetus. As pointed out by Dr. Kimford, a neurology professor at Emory University, “If I put the patient on valpropate as a first choice and the baby has cognitive impairment or a malfunction, I can’t repair that.” Despite these findings, specialists still do not advise pregnant women to discontinue their use of valpropate without consulting their physicians.
Amidst these findings, a few other issues concerning this study surfaced. Can I.Q. points really reflect accurately the cognitive abilities of these children born from valpropate-using mothers? How should the physician prioritize the interest of his two patients: the mother and the fetus? But more importantly, was it ethical for the researchers to study pregnant women using valpropate versus other antiseizure medications when it is previously known that they may cause developmental harm to the fetus?
Source:
http://www.nytimes.com/2009/04/16/health/research/16child.html
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2 comments:
The questions you raise are certainly interesting and perhaps the most intuitive way to confront them is to reference cases we are familiar with. The choice between mother and child during a delivery with considerable complications is not unheard of. Medical dramas depict fathers agonizing over the decision while doctors stand awaiting a command and common sense tells us that labor is hard on both mother and child. Yet the frequency of difficult labors does not jade us in the absolute torture of choosing between one human and another. The ethical implications of such a choice are too complicated, beyond even what utilitarians may feasibly tabulate. There simply is no generally 'right' decision.
When judging the case of valpropate and epileptic mothers, however, we cannot rely on our intuition for moral guidance, because this situation does not involve the same ethical choice as in the case of a difficult labor. In fact, the choice in the case of valpropate is more scientific than ethical. Epileptic mothers who stay off antiepileptic drugs (AEDs) in order to protect the IQ of their children are in fact exposing themselves and their children to greater risk due to the increase in epileptic seizures. These seizures can cause spontaneous abortion, fetal death, fetal brain death, and a multitude of nerve damage in the child. The decision of the physician is merely to temper the treatment level by employing just enough AEDs to stay the seizures without overdosing. This path is the single ethically responsible choice for both the mother and the child, the one that maximizes both their chances at survival.
Although Natalie makes a good point- in this case, the fetus would be harmed more by discontinuation of AEDs than by continued use of them- the theoretical ethical issue here is still an interesting one. If a child's IQ were really at stake, would it be ethical for a mother to continue taking these drugs? It's an interesting question that may go beyond the more typical mother-vs.-fetus conundrum, which involves actual lives: in a case in which either the mother or the child can survive, but not both, what is the ethical decision to make? Assuming the mother can survive without AEDs, but will have significant medical issues that will not affect the child, this becomes an entirely different question.
I think that the key issue here is quality of life. Lower IQ probably does not lead to lower quality of life, while seizures certainly will lead to a lower quality of life for the mother. Any decision made about taking these drugs should be made based on actual quality of life analysis, rather than simply the assumption that lower IQ is a bad thing. The future child's rights should certainly be respected to some extent; but respecting them to the extent that the mother is expected to go through seizures in order to ensure higher IQ for her child is overdoing it.
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