I am writing in a professional capacity to express support for the proposed amendment to the Maltese Constitution granting the right to life to unborn children. I understand that some may have legitimate questions on the effect such an amendment might have on rendering some forms of medical care.

In my capacity as a faculty member at the Albany Medical College in New York State, I faced such concerns regularly. Occasionally we would see complications of pregnancy that demand that the pregnancy be ended prematurely to ensure the mother’s health. I worked in a tertiary referral centre where the most ill and highest risk mothers were transported for care. These included cases of severe pre-eclampsia (toxemia), diabetes, cardiac disease and even occasional cancers. In the most severe cases, it was clear that delivery would have to be accomplished early to preserve the life of the mother.

The vast majority of such cases do not appear until after foetal viability at about 23 to 24 weeks’ gestation. In cases where we could safely delay delivery for 24 hours, we would treat the mother with steroids to hasten maturation of the baby’s lungs and then either induce labour or perform a caesarean section.

If the situation demanded more immediate attention, we would usually stabilize the mother and accomplish delivery in the most expeditious manner – usually by C-section.

In my career of 30 years, I have saved hundreds of women’s lives in this manner and have not once had to deliberately kill a baby to accomplish my purpose. Surely some of these children had problems resulting from premature birth but that was an inevitable result of providing the mother with the emergency care she needed.

An amendment granting the right to life to an unborn child will have no effect on care managed in this way. When an emergency condition exists, which requires that delivery be accomplished earlier than planned, it is moral and ethical to proceed while providing that child with the neonatal care she requires to maximise her chances of survival and a good quality of life.

In very rare cases, a grave condition such as cervical or breast cancer would be detected at an early stage of pregnancy before foetal viability. In such cases, the mother would have the choice to either proceed with treatment immediately, even though that treatment would be fatal to her unborn child, or delay treatment until she had reached 23-24 weeks and then proceed with treatment after delivery of her child. Again, an amendment granting the right to life to an unborn child would have no effect on care managed in this way.

No ethical position has ever been held that would prohibit a mother from choosing to initiate therapy immediately if she wishes after receiving appropriate information and making an informed consent.

I have never personally seen such a case although they occur in rare instances.

Lastly, a word about non-viable pregnancies. A surprisingly large percentage of pregnancies are not viable. This includes ectopic pregnancy (where a pregnancy has implanted in a Fallopian tube) and spontaneous miscarriage (including missed abortion in which the foetus has died in utero but has not miscarried as expected) as the most common examples.

In such cases, a constitutional amendment granting a right to life to the unborn would be irrelevant in medical decision-making as there is nothing anyone can do to save the life of a human foetus in the case of ectopic pregnancy, even if there is a detectable foetal heart at the time of diagnosis.

Anthony Levatino

Las Cruces

NEW MEXICO