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Public Health Reproductive Health Sterilization Women's Issues

Prevent Ovarian Cancer

Ovarian cancer is a terrible disease!

SHAPESHIFTER

I have to make you sick to make you well,

            The oncologist says, five months

we’ll scour each cell of your abdomen clean.

INTRAPERITONEAL CHEMO

It always burns, multiples thousands of bone splinters

stinging cells, murdering nerves, dulling

my mind, my spine alive, a drawn bow

aimed at heaven, sprouting agony’s three stingy feathers.

                        Both from Refugee; poems by Pamela Uschuk

When I first learned that our friend Pamela Uschuk had ovarian cancer, I despaired for her life. Ovarian cancer is one of the worst killers. By the grace of God, and the Mayo Clinic, she is still alive and well 10 years later.

Unfortunately, there is no screening test, like the Pap smear, for this terrible disease. Ovarian cancer has usually spread widely by the time that it is detected, so heroic treatment is required. Despite medical advances, most women who get ovarian cancer are killed by it.

Mysteriously, the risk of getting ovarian cancer is reduced by using birth control pills, by tubal ligation or by hysterectomy. Even more puzzlingly, about a decade ago it was discovered that most ovarian cancers actually start in the Fallopian tubes.

Ovarian cancer is not that rare—about 1 in 80 women will develop it. Some women are at higher risk because they carry a genetic mutation such as BRCA, but they only account for about one tenth of the people who develop this disease. Pamela was at normal risk; she is BRCA negative.

Now, rather than just blocking a woman’s tubes to prevent pregnancy, it is recommended to consider removing the tubes entirely (salpingectomy). The final word isn’t in because the recommendation is too new, but bilateral salpingectomy has the possibility of preventing hundreds of cases of ovarian cancer, saving many lives annually!

If a woman has a planned Cesarean with what she intends to be her last child, why not have a salpingectomy at the same time? After all, her tubes are exposed and this procedure only adds 5 minutes to the surgery.

Regrettably, that may not be possible in some hospitals under Catholic control. They must abide by the “Ethical and Religious Directives for Catholic Health Care Services” of the United States Conference of Catholic Bishops. This document states:

“Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution. Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present or serious pathology and a simpler treatment is not available.”

This statement has unintended consequences. Many women have hysterectomies in Catholic hospitals because the simpler, safer and less expensive tubal ligation is prohibited. Worse, this policy leads to unplanned pregnancies and abortions. Remember, the most effective way of preventing abortions is with effective contraception!

Of course, there is the option for the new mother to go to another hospital at a later time for her tubal surgery, but that means a second anesthesia, additional cost, plus more pain and recovery time. What mother wants to leave her newborn child and not be able to breastfeed?

All healthcare institutions should endeavor to prevent illness and death. A study examined the number of women having tubal ligations at the time of cesarean birth and calculated that over 900 cases of ovarian cancer and 550 deaths every year in the USA could be prevented by doing salpingectomies for women who want sterilization at the time of cesarean.

Let’s look at this issue from a different viewpoint. What if it had been shown that vasectomy decreased the risk of testicular cancer (it doesn’t, unfortunately). Do you think that the Catholic patriarchy would deprive their priests and other men of this potentially life-saving surgery?

Preventing sterilization, especially salpingectomy, at the time of cesarean is a case of religious doctrine standing in the way of good medical care.

© Richard Grossman MD, 2022

Categories
Abortion Population Reproductive Health Women's Issues

Prevent the Supreme Court from Establishing a State Religion

Ann Telnaes Editorial Cartoon used with permission of Ann Telnaes and the Cartoonist Group. All rights reserved.

“Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof….”             First Amendment to the United States Constitution

            The United States of America is becoming a theocracy. The Dobbs decision has bypassed the Congress by having the Supreme Court establishing a de facto religion which forces unwilling women to become mothers.

            So far this religion has evidenced itself with the Court’s failure to uphold the Roe v. Wade decision. The Court’s decision in the Dobbs v. Jackson Women’s Health Organization gave power to individual states to regulate the legal status of abortion. Remember, the majority of Americans are prochoice, according to several recent polls. There are fears that more is to come, perhaps even resuscitating the Comstock laws which forbad use of contraception.

            Abortion has not always been frowned upon. Back when the Constitution was written, women’s healthcare was in the hands of women, including herbal abortifacients, and it is likely that men had no idea what was going on. It is silly to think that the Constitution would include anything about women’s healthcare, let alone abortion, yet part of the argument in the Dobbs decision is that there is no mention of abortion in the Constitution. Remember, the people at the Constitutional Convention were all white males! Abortion was acceptable in colonial America and didn’t become illegal until the mid-1800s.

            This new religion was sired by the coupling of rightwing politics and conservative religions, including Roman Catholicism and the evangelicals who have overtaken the South. The primary tenets of the new religion pretend to be in favor of narrowly defined “life”, claiming that human life begins when human sperm and egg meet. It appears that most followers of this new religion don’t care much what happens to the “life” except when it is in the woman’s reproductive tract—with little attention to the person who supports that uterus. After birth, they tend to not support healthcare, social services or education—especially sex ed. Teen pregnancy rates are highest where the evangelicals are strongest.

            In reality, the “prolife” people may be courting death. They are encouraging continued human overpopulation with consequent destruction of Creation. Humans are causing the massive extinction of species, many of which are essential to our own existence. Our clever synthesis and use of chemicals is toxifying the air and water with poisons, some of which last forever. And don’t forget the climate chaos that even Trump cannot ignore.

            The high priest of this new religion is Samuel Alito, the principal author of the Dobbs decision. His bishops are John Roberts, Clarence Thomas, Neil Gorsuch, Brett Kavanaugh and Amy Coney Barrett; all supported the Dobbs decision. These 6 justices were all appointed by Republican presidents; the three dissenting justices were appointed by Democratic presidents. It is unlikely that this happened by chance. The unescapable conclusion is that this judgement was politically based.

            What can be done about this apparent incursion of a state religion into the USA? A group of religious leaders have sued the State of Florida, which has one of the most prohibitive abortion laws in the country. These leaders claim that that their ability to live and practice their religious faith is being violated by the state’s new abortion law. One of them, Reverend Laurie Hafner of the United Church of Christ, stated “I am pro-choice not in spite of my faith, but because of my faith.”

            Similarly, a patient at Planned Parenthood asked me, after her abortion, “Are you a Christian?”

            “Yes”, I responded. “I am a Quaker. I feel obliged to perform abortions because it is one way I can help people and also help this overpopulated world.”

            Rather than preserving the sanctity of human life, as believers in this new religion profess, it worships the contents of a pregnant woman’s uterus and damns the imagined evil of abortion. This religion ignores the fact that one in five human pregnancies ends in a spontaneous abortion, also called “miscarriage”. If human fetuses are so holy, why does God allow miscarriages to happen?

            I am worried that minority religious beliefs are being imposed on the majority by a powerful minority. We must push back in the upcoming elections and send a signal to the Supremes that we won’t tolerate a state religion.

© Richard Grossman MD, 2022