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cancer when pregnant
Question from anonymous on 11/4/2012:

Can a pregnant woman who has cancer morally get chemotherapy?

Answer by Judie Brown on 11/4/2012:

I am pasting two articles below . . . one from our American Life League website . . . . . . titled "Chemotherapy during pregnancy" and another article from Catholic News Service titled "Moms' Moral Dilemma: When preserving life may mean death."

Chemotherapy during pregnancy: Abortion is frequently recommended for pregnant women who are diagnosed with cancer. Children carried to term after chemotherapy, the argument goes, are destined to be born with disabilities - if they even make it to birth. New studies are indicating otherwise.

Research Into Cancer During Pregnancy: Treating Pregnant Women With Chemotherapy Has No Detrimental Effect On The Foetus 24 Oct 2009 Professor Frederic Amant of the Katholieke Universiteit Leuven (K.U.Leuven) directs research into the treatment of cancer in pregnant women and the consequences of such treatment on foetal development. In her PhD dissertation on chemotherapy during pregnancy, Kristel Van Calsteren presents new scientific discoveries. Kristel Van Calsteren has concluded that there is no increased risk of congenital defects in children who are exposed to chemotherapy during pregnancy. Nor do these children suffer from any discernible negative effects in the long term. The primary explanation for this reassuring discovery is that the placenta functions as a filter for most of the products researched and that it protects the foetus against the damaging effects of chemotherapy. A second important criterion is that chemotherapy is not administered during the first trimester, which is the most vulnerable period of a pregnancy. A team of paediatricians and psychologists intensively monitored 64 children. This is the very first time such research has been conducted. A special research project was established in 2004 to acquire better insights into the complex issue of cancer during pregnancy. -- The first part of this project examined the treatments that are currently administered to pregnant women with cancer. Furthermore, it researched the influence of these therapies on foetal development and the health of the child at birth. In cases of specific types of cancer and specific cancer treatments, growth retardation in the womb was observed, but the children made up for this delay after birth. However, the researchers' most important discovery is that the number and types of congenital defects are no different in cases where chemotherapy was administered to mothers. These reassuring findings will be published in the leading scientific periodical 'Journal of Clinical Oncology'. -- The second part was of a pharmacological nature; it analysed the "pharmacokinetics" of chemotherapy drugs in pregnant women (i.e. the absorption, progression and distribution of the medication in the body) and the "transplacental transfer" of the medication (transfer through the placenta) to the foetus. Kristel Van Calsteren's dissertation demonstrates that physiological changes during pregnancy result in lower maximum concentrations of chemotherapy and in reduced exposure to chemotherapy. It appears that the medication is distributed over a greater volume and is also excreted more quickly by the body. Further research is necessary to determine whether this results in the medication having less impact on the tumour, and thus to evaluate whether chemotherapy is sufficiently efficacious. Initially, the researchers had no notion of the quantity of chemotherapy that reaches unborn children. For this reason, they closely examined the transfer of chemotherapy through the placenta in animals. The results indicated that this transfer differs significantly depending on the type of medication. Some medications barely penetrate the placenta, while in cases of other drugs the same concentration is found in both the mother and foetus. The research indicates that the placenta acts as a filter for most tested chemotherapy drugs and thus reduces the foetus's exposure to chemotherapy. These discoveries are directive and reassuring. -- The third part focused on the effects of prenatal exposure to chemotherapy on the general and neurological development of the child. The researchers established international co-operation with the universities of Nijmegen and Prague. The children were examined by pediatric neurologists and neuropsychologists in the same ways at the three centres. The results are based on the clinical examination of 64 children who were exposed to chemotherapy during pregnancy. The majority of them are under 6 years old, while the oldest child is 15. This research indicated that most of the children were in a normal condition at birth. As they grew older, the children's development was in accordance with the expectations for their age. Specific tests of their memory and attentional functions did indicate increased impulsivity in these children, however. This has previously been described in children born prematurely and children exposed to their mothers' increased psychological stress during pregnancy. These factors also play a role in women to whom chemotherapy is administered during pregnancy. Source: K.U.Leuven

Moms' moral dilemma: When preserving life may mean death By Carol Glatz Catholic News Service VATICAN CITY (CNS) -- Some Catholic women may have felt they were prescribed a hard pill to swallow when the Vatican openly praised an Italian woman who refused cancer treatment so she could carry her weeks-old embryo to term. The story of Rita Fedrizzi made Italian and Vatican headlines in late January when she died of skin cancer just three months after delivering a healthy baby boy. Doctors had recommended she undergo an abortion so as to pursue treatment for melanoma. She refused the abortion and all medical treatment, saying it would have been like "killing one of my other two children to save my skin." The Vatican newspaper, L'Osservatore Romano, said her sacrifice was "a courageous gesture ... a gesture of love and faith in order to let life win." The paper recalled a similar, heroic gesture of another Italian woman, St. Gianna Beretta Molla, the "pro-life saint," canonized last May by Pope John Paul II for having put her unborn child's life before her own during her struggle with a benign uterine tumor. By putting these acts of self-immolation in such bold relief, the church underlines its unwavering respect of the sacred value of the life of the unborn. But what of the life of the woman carrying the child? Just one month after Fedrizzi's death, the Vatican sponsored a conference devoted to "The Quality of Life and the Ethics of Health." The late-February gathering discussed many issues, including the right of every person to life, health and treatment. How were Catholic women to reconcile what on the surface seemed like two contradictory messages? Forgoing treatment for a pathological condition brought praise, even sainthood, from the Vatican, yet in the background there was the reminder that people have a responsibility to look after their health. In the case of St. Gianna and Fedrizzi, "It was within their right to undergo treatment," even if the treatment would have "indirectly compromised the pregnancy," said Bishop Elio Sgreccia, head of the Pontifical Academy for Life. Following the principle of double effect, the church teaches it is morally acceptable to undergo treatment for a serious medical condition even if the therapy is potentially harmful, even lethal, to an unborn child. The "bad effect" of harm or death occurring to the fetus is tolerated only as long as the aim of the medical intervention is to acquire the "good effect" of helping treat the patient. For example, "It would be morally acceptable for a woman to ask to remove a cancerous womb" even if she were pregnant, explained Redemptorist Father Brian Johnstone, an Australian moral theologian at Rome's Alphonsian Academy. "If (the cancerous organ) is not removed, she will die and the fetus will die. The intention is not to kill the embryo, but to remove the cancer," he said. But a woman is also justified in opting to refuse any treatment for a condition that may put her fetus at risk, Father Johnstone said. "It is not morally required" by the church, he said, but the church recognizes such an act to be "a heroic decision to sacrifice oneself for someone else." A heroic act is, in fact, one that is not obligatory, said Bishop Sgreccia. If it were obligatory to give up one's life so that another could live, it would no longer be an example of heroism or martyrdom, he told Catholic News Service. By praising the sacrifice made by St. Gianna and Fedrizzi, the church "is not necessarily saying that forgoing treatment for a disease that might harm the child is the right thing to do," said Father Tadeusz Pacholczyk, a neuroscientist and director of education at the National Catholic Bioethics Center in Philadelphia. "The church is rather recognizing that a voluntary decision on behalf of one's unborn child is a powerful sign in the midst of a culture of death where the unborn child is routinely sidelined at the slightest provocation," he told CNS. Father Pacholczyk also warned that each case needs to be looked at thoroughly. How far along Fedrizzi's melanoma had progressed at the time of its diagnosis was never mentioned in the news stories. Since melanoma is very difficult to treat after a certain point, he said there would be the question of whether a regime of chemotherapy would have offered any real benefit. On the other hand, St. Gianna did undergo treatment for her uterine fibroid. Though benign, it could have led to fetal abnormalities or complications if left alone.

Surgical procedures in the 1960s, however, called for removal of her entire uterus. St. Gianna was a doctor and instead insisted surgeons only remove what was necessary and allow her baby to live and reach term. Seven days after she gave birth, she died of an infection that "almost certainly occurred consequent to the Caesarian" delivery of the baby, wrote Father Pacholczyk in an online essay describing St. Gianna's medical condition. Franciscan Father Maurizio Faggioni, a moral theologian, agreed each woman's case is different. If a pregnant woman discovers she has a medical condition needing treatment that may potentially harm the fetus, she has a range of options open to her, including giving birth early if possible so as to begin therapy immediately, said Father Faggioni. Many factors should be considered in deciding whether to opt for full medical treatment to save one's own life or to refuse treatment for the sake of the life of the fetus, said the theologians. For example, "it would have to be taken into consideration" if a woman already had other children who were dependent on her, said Father Johnstone. "No other person outside herself ought to tell her to sacrifice herself," said the priest. "The church does give forth these examples (of heroism), but it also recognizes that people do have to live their lives and will use practical reasoning," he said. END -------------------------------------------------------------------------------- Copyright (c) 2005 Catholic News Service/USCCB. All rights reserved. This material may not be published, broadcast, rewritten or otherwise distributed. CNS • 3211 Fourth St NE • Washington DC 20017 • 202.541.3250


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