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Material by Professor Omar Hasan Kasule Sr. for Year 1 Semester 1 Med PPSD session on 3rd September 2008
Background
Zulaikha, a 45-year old housewife and mother of 7 healthy children, went into labor with no worries or anxieties since she has been through this many times. When the baby was delivered she wanted to see him immediately but the midwife seemed reluctant and her face showed that she was worried but she said nothing. The mother was told that the doctor has been called to look at the baby and that after that she will be able to see and hold the baby. Zulaikha suspected that something was wrong because on previous occasions she was able to see and hold the baby immediately. She was told after half an hour that the baby had difficulty in breathing and was being treated in the intensive care unit.
Q1. What ethical issue (s) can you identify at this stage?
Pediatric examination:
Examination by a specialist physician showed a child with unusual facial features but not much was made of these because normal new borns have faces distorted by the birthing process. Heart murmurs were heard. The examining pediatrician requested chromosomal analysis. The results indicated a karyotype of 47,XY,+21.
Q2. What do you think is the problem?
Encounter with the pediatrician
It was not until 3 days after birth hours later that the pediatrician came to talk to Zulaikha. The doctor went straight to the matter ‘I am sorry Mrs Zulaikha, you have produced an abnormal baby with a congenital condition of genetic origin. You should not be surprised at this outcome because mothers of your age have a high risk of having abnormal babies. Someone should have advised you not to get pregnant this late in your life. We have delivered a couple of such babies in the past but very few survived early childhood. I only pray that your also survives for sometime’. Mrs Zulaikha asked the pediatrician why she was not informed of the genetic anomaly during pregnancy. The pediatrician answered that it was the fault of the obstetrician who looked after her in the pre-natal period.
Q3. What is your opinion about the communication between the pediatrician and Mrs Zulaikha?
Q4. Give a reason for and reason against screening for genetic anomalies during pregnancy
Encounter with the baby
Zulaikha was shocked but she retained her calm and asked the doctor that all she needed was to see the baby. The doctor ordered the nurse to bring the baby. Zulaikha was shocked to see the baby and refused to touch him. “This is an abnormal baby. This is not my baby. You have mixed up my baby with someone else’s baby. I actually suspected this because the midwife would not let me see the baby immediately after delivery as is the usual practice’. She started crying and moving off the bed and has to be restrained and calmed down. The baby was taken back to the newborn nursery.
Probability of congenital anomalies
The next morning, a social worker came to talk to Mrs Zulaikha who continued insisting that the abnormal baby was not hers. The social worker tried to explain that the risk of Darwin’s syndrome increased with maternal age. Mrs Zulaikha would have none of this. She said ‘I know many women in my village some of the same age as me and others older than me who have produced perfect children. This is the first time that I hear that age can cause abnormal babies; no doctor ever told me this before. I and my husband fulfill all our religious and social obligations so I see no reason why God should punish me this way. I followed all the pre-natal advice and I attended clinics regularly. I have been examined regularly by the doctors and they never told me that something was wrong with my baby’. The social worker gave up any further explanations and left to call a religious preacher to try to convince Mrs Zulaikha.
Q5. Explain how you would explain to Mrs Zulaikha the birth of an abnormal baby using probability concepts
Q6. Explain how you would explain to Mrs Zulaikha the birth of an abnormal baby using the concept of pre-determination.
Q7. How do you think congenital anomalies can be prevented?