An Unplanned Abortion: An Ethical Quandary

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I am a big fan of Paul Levy’s Not Running A Hospital blog and have been moved by one of his recent posts. Here is a brief extract of his post:

An OB/GYN doctor performed a hysterectomy on a patient in her 40’s for irregular bleeding and other problems. She had a long history of infertility and had finally given up. Given this history and the bleeding, the doctor did not do a pregnancy test prior to the surgery.

The pathologist found a tiny fetus in the uterus. The OB/GYN was devastated to learn of this.

It was eventually decided that it would do more harm to her and her family to disclose the fact than not to, since it was an irretrievable situation.

Here is my take on the situation:

  1. Given the history of the patient, omitting the pregnancy test was not too heinous a crime. Her age, her failed attempts, and her giving up on trying to get pregnant may serve as a defense for the doctor but none of them are going to absolve him of the responsibility of doing the test. So, no matter how small, there is liability on this ground for the physician, especially since doing a test to determine pregnancy status is not at all time consuming or resource oriented.
  2. Since I am not aware of the time in which this clinical encounter occurred, it is difficult to note whether an ultrasound was done or not prior to the surgery. Nowadays, it would be a pretty routine investigation (like doing the pregnancy test) to do prior to set the patient up for operating, and a small fetus would be instantly appreciated on the scan. If the scan was not ordered, it is the responsibility of the attending ObGyn physician to justify why it was not done. If he can prove that there was imminent danger to the life of the mother following the bleeding, an emergency hysterectomy would save her, and for that purpose, a tiny fetus could be sacrificed. On the other hand, if the scan was ordered, then the onus lies with the radiologist to identify the fetus and the error in locating the fetus would absolve the ObGyn from the responsibility and land it squarely on the shoulders of the Radiologist.
  3. The most important thing that is objectionable in the whole incident was the willful witholding of information from the patient. In doing so, the doctors acted paternalistically not in the interest of the patient and her family, but in the interest of saving their own careers. Imagine the throwback from the media if such a case came out. Imagine the impact on the careers of the related doctors – they would be over. The media would publicly prosecute them and persecute them until they lost the right to practice medicine.
  4. It was a different era, and one wonders whether the reaction of the doctors would be the same in this day and age. Probably it would be. Probably even fewer people would know about it and given the wildfire phenomenon of viral spreading of information, such a news would have travelled across the globe before one could say abortion!

The whole incident reeks of cover up and that too, motivated for personal gains. This is what I think about it. Any other thoughts would be welcome here and on Paul Levy’s blog post.

Skeptic Oslerphile, Scientist at the Indian Council of Medical Research, National Institute of Cholera and Enteric Diseases. Interests include: Emerging Infections, Public Health, Antimicrobial Resistance, One Health and Zoonoses, Diarrheal Diseases, Medical Education, Medical History, Open Access, Healthcare Social Media and Health2.0. Opinions are my own!


  1. i have to say that its definately the fault of the gynae houseman……how can he plan to do a hysterectomy without prior usg? …….evn if we consider an emergency, how is it that no usg was done during or before the start of the procedure…..considering there were no dearth of resources (leave aside the chances of the situation happening in a country like india) we can say its pure incompetency from the part of the doc.

  2. Hmm..
    The question a good doctor should be asking whether to get UPT done in ALL patients regardless of age with history of irregular bleeding PV? Ditto for ultrasound and beta HCG ? Hysteroscopy and EB?
    That’s how defensive medicine starts, when you start chasing zebras because of one adverse experience or mistake.
    The use of retrospectoscope to sit in judgement over others should be avoided, particularly in the field of medicine where honest mistakes are common but unforgivable in the eyes of a layperson or law..
    PS: 20 years back, ultrasounds were not that commonly done. In USA, ultrasounds are even now less commonly done compared to CT or MRI, though its role and Gynae and Obs is unparalleled..

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