0:00:00.896,0:00:02.989 Our next speaker is Dr Philippa Ramsey. 0:00:02.989,0:00:05.965 Dr Ramsey is an obstetrician and gynaecologist 0:00:05.965,0:00:08.411 who has been in practice for 20 years. 0:00:08.411,0:00:12.203 Her speciality is obstetric and gynaecological ultrasound 0:00:12.203,0:00:15.576 and prenatal diagnosis of fetal abnormalities. 0:00:15.576,0:00:17.014 She's a visiting medical officer 0:00:17.014,0:00:20.599 at Royal Prince Alfred Hospital and Sydney Adventist Hospital 0:00:20.599,0:00:23.040 and she lectures in obstetrics and gynaecology 0:00:23.040,0:00:24.887 at the University of Sydney. 0:00:24.887,0:00:29.299 Philippa is an examiner in obstetric and gynaecological ultrasound 0:00:29.299,0:00:32.595 for the Royal Australia and New Zealand College of O and G 0:00:32.595,0:00:34.737 and she also runs a busy private practice 0:00:34.737,0:00:39.642 called Ultrasound Care at Newtown, Randwick, St Leonards and Wahroonga. 0:00:39.642,0:00:40.426 Welcome Philippa. 0:00:40.426,0:00:44.490 [applause and footsteps] 0:00:57.028,0:00:59.222 If you choose that… 0:00:59.222,0:01:00.364 Where do we have Philippa's—? 0:01:00.364,0:01:02.982 [inaudible] 0:01:03.191,0:01:04.972 Removable. 0:01:33.532,0:01:33.532 This one? 0:01:33.532,0:01:33.533 Yep. Just check that. 0:01:33.533,0:01:33.533 [inaudible] 0:01:33.533,0:01:33.534 OK, great. 0:01:33.534,0:01:33.534 [footsteps] 0:01:33.534,0:01:33.535 [cough in audience] 0:01:33.535,0:01:33.535 Thank you everybody for coming tonight. 0:01:33.535,0:01:33.536 I'm really heartened by the level of interest 0:01:33.536,0:01:33.536 in this really important topic. 0:01:33.536,0:01:33.537 And I want to thank you for inviting me to speak 0:01:33.537,0:01:33.537 except I have to admit that I haven't been invited to speak 0:01:33.537,0:01:33.538 I volunteered to speak because I feel so strongly about this. 0:01:34.111,0:01:38.335 So, uh, how do I go down? 0:01:42.364,0:01:45.118 So first of all I want to pay due respect 0:01:45.118,0:01:47.665 to those who have been the victims of crime 0:01:47.665,0:01:51.146 and to those who've lost their babies or miscarried their pregnancies 0:01:51.146,0:01:54.138 and who are still mourning them. 0:01:54.138,0:01:56.129 This talk is not about that. 0:01:56.129,0:01:58.881 I want to talk about the issues I have 0:01:58.881,0:02:02.355 with the proposed fetal personhood laws 0:02:02.355,0:02:05.549 and how it would change maternity provision 0:02:05.549,0:02:07.157 in this state and how it would impact 0:02:07.157,0:02:09.779 upon obstetricians and midwives 0:02:09.779,0:02:13.559 and the patients we look after. 0:02:13.559,0:02:15.604 So, I'll start with the small things. 0:02:15.604,0:02:18.727 First of all, I really disagree with the terminology. 0:02:18.727,0:02:22.303 Obstetricians and midwives are completely unanimous 0:02:22.303,0:02:26.218 about the words embryo, fetus and baby. 0:02:26.218,0:02:29.521 We call— we use embryo up until 10 weeks gestation, 0:02:29.521,0:02:32.529 which is 8 weeks of fetal development. 0:02:32.529,0:02:35.290 We use fetus after that, from 10 weeks until birth. 0:02:35.290,0:02:37.351 And after that until one year of age 0:02:37.351,0:02:40.827 we call the baby a baby. 0:02:40.827,0:02:44.140 And, uh, too, I've got to say, 0:02:44.140,0:02:46.445 obstetricians and midwives agree with that, 0:02:46.445,0:02:48.182 embryologists agree with that, 0:02:48.182,0:02:50.663 and even Wikipedia agrees with that. 0:02:50.663,0:02:51.865 [laughter] 0:02:51.865,0:02:57.486 So, uh, to rename the fetus an unborn baby 0:02:57.486,0:02:59.726 is really messing with our heads. 0:02:59.726,0:03:06.582 So the proposed law calls this, sorry, an "unborn child" from 20 weeks gestation on. 0:03:06.582,0:03:09.942 And I guess it's going to be a fetus before that. 0:03:09.942,0:03:14.377 But uh, this new label "unborn child" really messes with my head. 0:03:14.377,0:03:16.555 I think that the milestones of birth and death 0:03:16.555,0:03:19.839 are really clear and really unambiguous. 0:03:19.839,0:03:25.085 But if we rename the ch— the fetus to be 0:03:25.085,0:03:27.634 an "unborn child" it's as silly as 0:03:27.634,0:03:30.530 calling a newborn baby a "born fetus". 0:03:30.530,0:03:31.533 Or deciding that from now on 0:03:31.533,0:03:34.366 I want to be known as a "live corpse". 0:03:34.366,0:03:35.589 [laughter] 0:03:35.589,0:03:36.997 I just think it's, uh, 0:03:36.997,0:03:40.307 ridiculous and it just confuses, uh, 0:03:40.307,0:03:42.635 it confuses the issue. 0:03:42.635,0:03:45.634 But I understand the reason behind the new label. 0:03:45.634,0:03:50.328 Uh, because obviously, the phrase "unborn child" 0:03:50.328,0:03:52.247 is an elevation in status. 0:03:52.247,0:03:55.485 It's a promotion from fetus. 0:03:55.485,0:03:58.690 And this new label implies that this fetus 0:03:58.690,0:04:00.654 warrants the status of parenthood, 0:04:00.654,0:04:04.959 sorry, personhood, as if it's independent of the pregnant woman, 0:04:04.959,0:04:07.150 as if it's separate from the pregnant woman. 0:04:07.150,0:04:09.296 And I can promise you, 0:04:09.296,0:04:10.745 I've been an obstetrician for a long time, 0:04:10.745,0:04:12.842 and I can promise you that a fetus is 0:04:12.842,0:04:16.603 not independent and separate from the pregnant woman. 0:04:16.603,0:04:19.263 And I want to talk about three issues: 0:04:19.263,0:04:21.046 of pregnant women's lifestyles, 0:04:21.046,0:04:23.581 pregnant women's right to consent 0:04:23.581,0:04:26.327 to medical or surgical treatment for fetal conditions, 0:04:26.327,0:04:31.558 and the issues again of termination of pregnancy. 0:04:31.558,0:04:33.108 Just look at the picture. 0:04:33.108,0:04:34.637 The fetus is not independent 0:04:34.637,0:04:36.962 and separate from the pregnant woman. 0:04:36.962,0:04:39.502 And research shows that 1 in 7 Australian women 0:04:39.502,0:04:42.254 keeps smoking during pregnancy, 0:04:42.254,0:04:46.837 even though their health carers explain to them 0:04:46.837,0:04:48.747 that it is not good for the fetus, 0:04:48.747,0:04:51.388 that it causes fetal interuterine growth restriction, 0:04:51.388,0:04:55.383 that it increases the risk of stillbirth and neonatal problems, 0:04:55.383,0:04:58.205 even with all the knowledge in the world, 0:04:58.205,0:05:01.714 1 in 7 Australian women keeps smoking during pregnancy 0:05:01.714,0:05:05.035 because they are addicted. 0:05:05.035,0:05:08.275 And what about pregnant women who are addicted to illict drugs? 0:05:08.275,0:05:09.959 Or addicted to alcohol? 0:05:09.959,0:05:12.019 What about the pregnant woman who still 0:05:12.019,0:05:15.254 eats sushi and salami and pre-mixed salad 0:05:15.254,0:05:17.951 even though we advise them not to. 0:05:17.951,0:05:19.290 I can see you out there. 0:05:19.290,0:05:20.511 [laughter] 0:05:20.511,0:05:24.381 We know that this food might or could possibly harm the fetus 0:05:24.381,0:05:26.418 and still, it's not that easy. 0:05:26.418,0:05:29.892 We don't universally stop all behaviours 0:05:29.892,0:05:31.616 which could adversely affect the fetus 0:05:31.616,0:05:32.667 when we're pregnant. 0:05:32.667,0:05:35.387 Even though it may be a very wanted pregnancy 0:05:35.387,0:05:40.477 and a beloved fetus and beloved baby. 0:05:40.477,0:05:42.680 So if there is an adverse outcome, 0:05:42.680,0:05:45.508 the proposed law labels it, you know, 0:05:45.508,0:05:50.246 harming the fetus, grievous bodily harm to the unborn baby. 0:05:50.246,0:05:54.079 And it would be a criminal act under the proposed legislation, 0:05:54.079,0:05:56.120 except for a tiny exception, 0:05:56.120,0:06:01.221 and that is that it's OK for the pregnant woman to do it. 0:06:01.221,0:06:03.957 And when it comes to fetal procedures, 0:06:03.957,0:06:07.112 the fetus is clearly not independent and separate 0:06:07.112,0:06:09.012 from the pregnant woman. 0:06:09.012,0:06:10.916 Under those blue drapes 0:06:10.916,0:06:14.858 there are living breathing anaethetised women 0:06:14.858,0:06:20.558 who are allowing their body to be operating upon and traversed 0:06:20.558,0:06:23.942 to benefit their fetus. 0:06:23.942,0:06:28.624 Not to benefit them. 0:06:28.624,0:06:34.175 So if a paediatrician or a husband 0:06:34.175,0:06:37.342 wants a Caesearan section for this fetus 0:06:37.342,0:06:43.142 it has to be through the body of that pregnant woman. 0:06:43.142,0:06:47.490 So it would be great if fetal rights were 0:06:47.490,0:06:50.193 completely independent of women's rights. 0:06:50.193,0:06:52.846 And I love this graph, which I found on the Internet, 0:06:52.846,0:06:55.879 that shows the ideal situation. 0:06:55.879,0:06:57.473 Wouldn't it be great if the pregnant woman 0:06:57.473,0:07:00.540 had 100% of all of her pre-pregnant rights 0:07:00.540,0:07:02.395 continuing right through the pregnancy 0:07:02.395,0:07:05.248 despite the fact that some would like 0:07:05.248,0:07:09.250 to give the fetus the rights of personhood 0:07:09.250,0:07:15.710 in the third trimester or any time after 20 weeks gestation. 0:07:15.710,0:07:20.600 That the rights of the fetus should increase with gestational age. 0:07:20.600,0:07:22.159 But unfortunately this graph is 0:07:22.159,0:07:26.849 uh, a dream. 0:07:26.849,0:07:30.463 If a fetus has personhood, it has rights 0:07:30.463,0:07:32.594 equal to those of the pregnant woman 0:07:32.594,0:07:36.898 so for example if a paediatrician was advocating for the fetus 0:07:36.898,0:07:39.331 he may recommend that the obstetrician 0:07:39.331,0:07:41.815 perform a procedure on the fetus. 0:07:41.815,0:07:43.530 But as I've mentioned, it has to be via 0:07:43.530,0:07:45.334 the pregnant woman's body. 0:07:45.334,0:07:49.219 If the pregnant woman listens to all of the medical advice 0:07:49.219,0:07:51.212 and considers all of the evidence 0:07:51.212,0:07:53.027 and considers the impact on the fetus 0:07:53.027,0:07:55.760 and considers the impact on herself 0:07:55.760,0:07:58.760 and decides she doesn't want this procedure, 0:07:58.760,0:08:02.760 whose rights are going to be preeminent? 0:08:05.274,0:08:11.559 This fetus may want an operation on itself 0:08:11.559,0:08:14.797 or someone advocating for this so-called person 0:08:14.797,0:08:18.159 might want an operation on the fetus 0:08:18.159,0:08:25.683 um, but it has to be done through the mother. 0:08:25.683,0:08:30.402 So in reality if the fetus's rights increase 0:08:30.402,0:08:34.439 after 20 weeks gestation because it's been elevated to personhood 0:08:34.439,0:08:37.407 then by definition the mother's rights 0:08:37.407,0:08:39.465 to say no to these things 0:08:39.465,0:08:42.210 which may be beneficial for the fetus 0:08:42.210,0:08:46.647 by definition the mother's rights have to decrease. 0:08:46.647,0:08:48.743 But I feel that women must have the right 0:08:48.743,0:08:52.283 to choose what will or won't be done to their body. 0:08:52.283,0:08:55.686 Women must be the gatekeepers of their own body. 0:08:55.686,0:09:00.836 I mean we have been struggling for that for centuries. 0:09:00.836,0:09:02.649 And many women in many countries 0:09:02.649,0:09:05.961 are still not the gatekeepers of their own body. 0:09:05.961,0:09:10.655 They are still subject to rape in marriage, as an example. 0:09:10.655,0:09:12.605 And it's not illegal. 0:09:12.605,0:09:14.961 So I don't think we can get away from the fact 0:09:14.961,0:09:17.548 that conferring personhood on a fetus 0:09:17.548,0:09:22.726 impacts on the rights of the pregnant woman over her own body. 0:09:22.726,0:09:25.164 So what about when a pregnant woman 0:09:25.164,0:09:30.832 has a fetus who's found to have a lethal abnormality? 0:09:30.832,0:09:33.652 An abnormality that is going to lead to the death of that fetus, 0:09:33.652,0:09:37.517 either as a fetal demise in utero, a stillbirth, 0:09:37.517,0:09:42.770 or a fetal death during labour or soon after labour. 0:09:42.770,0:09:48.850 Or a pregnant woman whose fetus has a major fetal abnormality. 0:09:48.850,0:09:51.644 I counsel lots of women and their partners 0:09:51.644,0:09:55.653 in this situation every week. 0:09:55.653,0:09:58.894 And unfortunately there are really only two options. 0:09:58.894,0:10:01.138 The option to continue the pregnancy 0:10:01.138,0:10:04.423 or the option to terminate the pregnancy. 0:10:04.423,0:10:07.699 Fetal medicine has come a long way 0:10:07.699,0:10:14.443 but— and it's certainly come a long way with diagnostic tricks. 0:10:14.443,0:10:16.952 So we are now very good at diagnosing 0:10:16.952,0:10:19.700 all sorts of fetal abnormalities and 0:10:19.700,0:10:24.195 we know most of the prognoses for most of them. 0:10:24.195,0:10:26.116 But unfortunately fetal medicine hasn't 0:10:26.116,0:10:28.331 progressed to the stage where 0:10:28.331,0:10:31.800 some sort of fancy in utero treatment 0:10:31.800,0:10:33.645 is going to save lots of lives 0:10:33.645,0:10:35.597 or relieve lots of suffering. 0:10:35.597,0:10:40.034 There are actually very few fetal interventions 0:10:40.034,0:10:42.793 for major fetal abnormalities 0:10:42.793,0:10:45.103 and most of the lethal fetal abnormalities 0:10:45.103,0:10:49.103 are still lethal.