The Toughest Calls

Pediatrician: It's Not About Being Pro-Life or Pro-Choice. It's About Being Pro-Parent.

The anguish and devotion of parents who must make heartrending choices about the health of their children convinces one doctor that only parents have the ultimate say.



Last week saw the largest demonstrations for women’s rights in human history. And yesterday saw the annual the March for Life in Washington, D.C., which describes itself as opposing “the greatest human rights violation of our time, legal abortion on demand.” The March for Life was attended by hundreds of thousands of people, and was accompanied this year as in years before by much hand-wringing about the lack of media attention it garners. Amid my own gleeful posts about equal rights for all people, I was asked by a pro-life colleague if I also consider “the rights of unborn children.”

I happen to be a pediatrician, so children’s rights concern me deeply. Indeed, what I see in my practice as a pediatric resident is that children enjoy few rights. In the emergency room, we sedate children or hold them down physically while we perform painful procedures that they are fighting with every mitochondrion in their body to refuse. We teach parents how to pry open the mouths of their autistic children for a nightly ritual meant to prevent their teeth from rotting out. On the oncology ward, we drip poison into the blood of children whom we physicians suspect may be beyond saving, but whose parents are desperately longing for just a few more weeks. In operating rooms, we make cyborgs of children who lack the capacity to assent or refuse—inserting breathing tubes, permanent feeding tubes, tubes to shunt fluid from their brains into their bellies. Because parents ask us to, we force children to live when their bodies are no longer capable of sustaining life.

The limited rights of children are nowhere more evident than in the neonatal ICU—the NICU—where fetuses on the cusp of viability are transformed into babies skimming along the lumen of aliveness, vulnerable to sudden death should the machines blink out. The smallest ones cannot eat, or breathe, or maintain their own body temperatures. They are translucent; their skin tears at the slightest touch. Their brains are so undeveloped that they forget to breathe, and so we dose them with caffeine. If they will not breathe, we make them breathe. If still they will not breathe, we place them on ventilators. If their bones will not make blood, we pour blood into them through a catheter stuck in their vein. If their brains fill with so much blood and fluid that it pushes the white matter from one side to the other, we place a tube to drain that fluid. We drip in antibiotics. We cut out chunks of gut. Some try over and over to die; we make them live.

You can tell that a micro-preemie is in pain by the way she grimaces when you touch her. Some of our babies need morphine every three hours, before every time they are touched. I will admit that, as a pediatrician, I sometimes feel complicit in brutality.

We talk about “clinical outcomes,” and often the outcome of these efforts is a recognizably healthy child. Or it is a child with disability, mild or severe, who retains the capacity to enjoy life and participate in community. When these children survive, as most do, they are beloved no matter their conditions. They were loved before they were born, and are loved now. The love of parents for their profoundly disabled children has deepened my own appreciation for neurodiversity and for life itself.

Because of the huge and humbling parental love that I am privileged to bear witness to every day, I have come to recognize that my own sense of right and wrong—my own dismay at being implicated in the suffering of children—can only ever play a secondary role in these dramas. I am meant to bring my experience, and even my advice, into the conversation about next steps for a child’s care. But they are not my children. I am not their parent, and I am not the person who can make decisions about them from the place of greatest love. I have to trust parents—and generally I do—to make decisions for their children.

So when I consider whether fetuses have a positive right to life—or a negative right to freedom from abortion—I consider this question against my understanding of the limited rights of children. Children are not medical decision-makers. Parents are. Abortion has its own brutality, and its own loss. It is often a heart-wrenching decision. But parents are the only people who can make that decision from the place of greatest love. As a physician, I have to trust them.

Rachel Pearson, MD/PhD, is a resident physician who also holds a PhD from the Institute for the Medical Humanities. A fifth-generation Texan, she is currently training as a pediatrician. Her book No Apparent Distress: A Doctor’s Coming-of-Age on the Front Lines of American Medicine is forthcoming in May from W. W. Norton & Company.