Thursday, May 07, 2009

More details on coding late-term abortions in Canada

I've often mentioned the issue of the medical coding of late-term abortions as stillbirths in the Canadian medical system.

Much of my evidence has been indirect, but I have found direct evidence of this standard.

I have found a document from a committee of the Canadian Congenital Anomalies Surveillance Network. This is the government agency charged with keeping track of fetal anomalies and the congenital anomalies of newborns.

I don't have a date, but it cites a report from April 2006, so it's only a few years old.

The purpose of this document is to establish uniform definitions for obstetric events in relation to fetal anomalies. They conclude that the same coding would apply as in the case of livebirth congenital anomalies.

On pregnancy terminations, they write:

If an intrauterine fetal death occurs greater than 20 weeks and is induced it is coded as a stillbirth.

Well there you go.

There are also some other interesting tidbits:

Most terminations for congenital anomalies will likely be done prior to 20 weeks and hence are not captured under the Vital Statistics Act. However, a small number of terminations may be done between 20 and 23 completed weeks for serious or lethal anomalies. Such events are then registered as a stillbirth and very rarely as a live birth even though labour started as a termination procedure.

Interesting. What I infer is that if the fetus comes out alive after the onset of a termination procedure, the procedure is coded as a "stillbirth" regardless of his status at expulsion.

I suspect that there could be a Charter Challenged involved in something like that.

If "stillborn" status is conferred on the baby, it's a convenient way for the medical system not to have to care for the patient. If he isn't a "liveborn" then he's not a person in Canada, therefore he has no right to healthcare and the baby can be left to die, as in this case of an abortion of a 35-week old fetus in 1999.

I would have to obtain more details. If the child breathes, but he's only counted as a "stillbirth", he is deprived of the right to an identity and to be legally recognized.

I don't know the details of whether or not this happens in Canada. I suspect it does, but abortion is so hush hush in Canada, that we do not know the truth.

I remember Marc Emory stated that when his girlfriend had a late-term abortion in 1977, the unborn child had to be named even though his death was counted as a stillbirth.

It is also to be noted that these late-term "terminations" do not always involve a live fetus. If the fetus died before the onset of labour through natural means, the procedure is still considered a "termination of pregnancy".

The author of the report makes a note of this confusion. So he recommends:

It is useful to have a field on the computer which helps to classify post 20 week events, e.g., stillbirth – termination, live birth – termination.

In other words, there should be some kind of qualifier to indicate whether there was a procedure previous to the outcome, or whether the outcome was a natural occurrence.

This would be very useful. I hope that all gets coded and tabled for public view. Somehow, I doubt it.