1 00:00:00,896 --> 00:00:02,989 Our next speaker is Dr Philippa Ramsey. 2 00:00:02,989 --> 00:00:05,965 Dr Ramsey is an obstetrician and gynaecologist 3 00:00:05,965 --> 00:00:08,411 who has been in practice for 20 years. 4 00:00:08,411 --> 00:00:12,203 Her speciality is obstetric and gynaecological ultrasound 5 00:00:12,203 --> 00:00:15,576 and prenatal diagnosis of fetal abnormalities. 6 00:00:15,576 --> 00:00:17,014 She's a visiting medical officer 7 00:00:17,014 --> 00:00:20,599 at Royal Prince Alfred Hospital and Sydney Adventist Hospital 8 00:00:20,599 --> 00:00:23,040 and she lectures in obstetrics and gynaecology 9 00:00:23,040 --> 00:00:24,887 at the University of Sydney. 10 00:00:24,887 --> 00:00:29,299 Philippa is an examiner in obstetric and gynaecological ultrasound 11 00:00:29,299 --> 00:00:32,595 for the Royal Australia and New Zealand College of O and G 12 00:00:32,595 --> 00:00:34,737 and she also runs a busy private practice 13 00:00:34,737 --> 00:00:39,642 called Ultrasound Care at Newtown, Randwick, St Leonards and Wahroonga. 14 00:00:39,642 --> 00:00:40,426 Welcome Philippa. 15 00:00:40,426 --> 00:00:44,490 [applause and footsteps] 16 00:00:57,028 --> 00:00:59,222 If you choose that… 17 00:00:59,222 --> 00:01:00,364 Where do we have Philippa's—? 18 00:01:00,364 --> 00:01:02,982 [inaudible] 19 00:01:03,191 --> 00:01:04,972 Removable. 20 00:01:33,532 --> 00:01:33,532 This one? 21 00:01:33,532 --> 00:01:33,533 Yep. Just check that. 22 00:01:33,533 --> 00:01:33,533 [inaudible] 23 00:01:33,533 --> 00:01:33,534 OK, great. 24 00:01:33,534 --> 00:01:33,534 [footsteps] 25 00:01:33,534 --> 00:01:33,535 [cough in audience] 26 00:01:33,535 --> 00:01:33,535 Thank you everybody for coming tonight. 27 00:01:33,535 --> 00:01:33,536 I'm really heartened by the level of interest 28 00:01:33,536 --> 00:01:33,536 in this really important topic. 29 00:01:33,536 --> 00:01:33,537 And I want to thank you for inviting me to speak 30 00:01:33,537 --> 00:01:33,537 except I have to admit that I haven't been invited to speak 31 00:01:33,537 --> 00:01:33,538 I volunteered to speak because I feel so strongly about this. 32 00:01:34,111 --> 00:01:38,335 So, uh, how do I go down? 33 00:01:42,364 --> 00:01:45,118 So first of all I want to pay due respect 34 00:01:45,118 --> 00:01:47,665 to those who have been the victims of crime 35 00:01:47,665 --> 00:01:51,146 and to those who've lost their babies or miscarried their pregnancies 36 00:01:51,146 --> 00:01:54,138 and who are still mourning them. 37 00:01:54,138 --> 00:01:56,129 This talk is not about that. 38 00:01:56,129 --> 00:01:58,881 I want to talk about the issues I have 39 00:01:58,881 --> 00:02:02,355 with the proposed fetal personhood laws 40 00:02:02,355 --> 00:02:05,549 and how it would change maternity provision 41 00:02:05,549 --> 00:02:07,157 in this state and how it would impact 42 00:02:07,157 --> 00:02:09,779 upon obstetricians and midwives 43 00:02:09,779 --> 00:02:13,559 and the patients we look after. 44 00:02:13,559 --> 00:02:15,604 So, I'll start with the small things. 45 00:02:15,604 --> 00:02:18,727 First of all, I really disagree with the terminology. 46 00:02:18,727 --> 00:02:22,303 Obstetricians and midwives are completely unanimous 47 00:02:22,303 --> 00:02:26,218 about the words embryo, fetus and baby. 48 00:02:26,218 --> 00:02:29,521 We call— we use embryo up until 10 weeks gestation, 49 00:02:29,521 --> 00:02:32,529 which is 8 weeks of fetal development. 50 00:02:32,529 --> 00:02:35,290 We use fetus after that, from 10 weeks until birth. 51 00:02:35,290 --> 00:02:37,351 And after that until one year of age 52 00:02:37,351 --> 00:02:40,827 we call the baby a baby. 53 00:02:40,827 --> 00:02:44,140 And, uh, too, I've got to say, 54 00:02:44,140 --> 00:02:46,445 obstetricians and midwives agree with that, 55 00:02:46,445 --> 00:02:48,182 embryologists agree with that, 56 00:02:48,182 --> 00:02:50,663 and even Wikipedia agrees with that. 57 00:02:50,663 --> 00:02:51,865 [laughter] 58 00:02:51,865 --> 00:02:57,486 So, uh, to rename the fetus an unborn baby 59 00:02:57,486 --> 00:02:59,726 is really messing with our heads. 60 00:02:59,726 --> 00:03:06,582 So the proposed law calls this, sorry, an "unborn child" from 20 weeks gestation on. 61 00:03:06,582 --> 00:03:09,942 And I guess it's going to be a fetus before that. 62 00:03:09,942 --> 00:03:14,377 But uh, this new label "unborn child" really messes with my head. 63 00:03:14,377 --> 00:03:16,555 I think that the milestones of birth and death 64 00:03:16,555 --> 00:03:19,839 are really clear and really unambiguous. 65 00:03:19,839 --> 00:03:25,085 But if we rename the ch— the fetus to be 66 00:03:25,085 --> 00:03:27,634 an "unborn child" it's as silly as 67 00:03:27,634 --> 00:03:30,530 calling a newborn baby a "born fetus". 68 00:03:30,530 --> 00:03:31,533 Or deciding that from now on 69 00:03:31,533 --> 00:03:34,366 I want to be known as a "live corpse". 70 00:03:34,366 --> 00:03:35,589 [laughter] 71 00:03:35,589 --> 00:03:36,997 I just think it's, uh, 72 00:03:36,997 --> 00:03:40,307 ridiculous and it just confuses, uh, 73 00:03:40,307 --> 00:03:42,635 it confuses the issue. 74 00:03:42,635 --> 00:03:45,634 But I understand the reason behind the new label. 75 00:03:45,634 --> 00:03:50,328 Uh, because obviously, the phrase "unborn child" 76 00:03:50,328 --> 00:03:52,247 is an elevation in status. 77 00:03:52,247 --> 00:03:55,485 It's a promotion from fetus. 78 00:03:55,485 --> 00:03:58,690 And this new label implies that this fetus 79 00:03:58,690 --> 00:04:00,654 warrants the status of parenthood, 80 00:04:00,654 --> 00:04:04,959 sorry, personhood, as if it's independent of the pregnant woman, 81 00:04:04,959 --> 00:04:07,150 as if it's separate from the pregnant woman. 82 00:04:07,150 --> 00:04:09,296 And I can promise you, 83 00:04:09,296 --> 00:04:10,745 I've been an obstetrician for a long time, 84 00:04:10,745 --> 00:04:12,842 and I can promise you that a fetus is 85 00:04:12,842 --> 00:04:16,603 not independent and separate from the pregnant woman. 86 00:04:16,603 --> 00:04:19,263 And I want to talk about three issues: 87 00:04:19,263 --> 00:04:21,046 of pregnant women's lifestyles, 88 00:04:21,046 --> 00:04:23,581 pregnant women's right to consent 89 00:04:23,581 --> 00:04:26,327 to medical or surgical treatment for fetal conditions, 90 00:04:26,327 --> 00:04:31,558 and the issues again of termination of pregnancy. 91 00:04:31,558 --> 00:04:33,108 Just look at the picture. 92 00:04:33,108 --> 00:04:34,637 The fetus is not independent 93 00:04:34,637 --> 00:04:36,962 and separate from the pregnant woman. 94 00:04:36,962 --> 00:04:39,502 And research shows that 1 in 7 Australian women 95 00:04:39,502 --> 00:04:42,254 keeps smoking during pregnancy, 96 00:04:42,254 --> 00:04:46,837 even though their health carers explain to them 97 00:04:46,837 --> 00:04:48,747 that it is not good for the fetus, 98 00:04:48,747 --> 00:04:51,388 that it causes fetal interuterine growth restriction, 99 00:04:51,388 --> 00:04:55,383 that it increases the risk of stillbirth and neonatal problems, 100 00:04:55,383 --> 00:04:58,205 even with all the knowledge in the world, 101 00:04:58,205 --> 00:05:01,714 1 in 7 Australian women keeps smoking during pregnancy 102 00:05:01,714 --> 00:05:05,035 because they are addicted. 103 00:05:05,035 --> 00:05:08,275 And what about pregnant women who are addicted to illict drugs? 104 00:05:08,275 --> 00:05:09,959 Or addicted to alcohol? 105 00:05:09,959 --> 00:05:12,019 What about the pregnant woman who still 106 00:05:12,019 --> 00:05:15,254 eats sushi and salami and pre-mixed salad 107 00:05:15,254 --> 00:05:17,951 even though we advise them not to. 108 00:05:17,951 --> 00:05:19,290 I can see you out there. 109 00:05:19,290 --> 00:05:20,511 [laughter] 110 00:05:20,511 --> 00:05:24,381 We know that this food might or could possibly harm the fetus 111 00:05:24,381 --> 00:05:26,418 and still, it's not that easy. 112 00:05:26,418 --> 00:05:29,892 We don't universally stop all behaviours 113 00:05:29,892 --> 00:05:31,616 which could adversely affect the fetus 114 00:05:31,616 --> 00:05:32,667 when we're pregnant. 115 00:05:32,667 --> 00:05:35,387 Even though it may be a very wanted pregnancy 116 00:05:35,387 --> 00:05:40,477 and a beloved fetus and beloved baby. 117 00:05:40,477 --> 00:05:42,680 So if there is an adverse outcome, 118 00:05:42,680 --> 00:05:45,508 the proposed law labels it, you know, 119 00:05:45,508 --> 00:05:50,246 harming the fetus, grievous bodily harm to the unborn baby. 120 00:05:50,246 --> 00:05:54,079 And it would be a criminal act under the proposed legislation, 121 00:05:54,079 --> 00:05:56,120 except for a tiny exception, 122 00:05:56,120 --> 00:06:01,221 and that is that it's OK for the pregnant woman to do it. 123 00:06:01,221 --> 00:06:03,957 And when it comes to fetal procedures, 124 00:06:03,957 --> 00:06:07,112 the fetus is clearly not independent and separate 125 00:06:07,112 --> 00:06:09,012 from the pregnant woman. 126 00:06:09,012 --> 00:06:10,916 Under those blue drapes 127 00:06:10,916 --> 00:06:14,858 there are living breathing anaethetised women 128 00:06:14,858 --> 00:06:20,558 who are allowing their body to be operating upon and traversed 129 00:06:20,558 --> 00:06:23,942 to benefit their fetus. 130 00:06:23,942 --> 00:06:28,624 Not to benefit them. 131 00:06:28,624 --> 00:06:34,175 So if a paediatrician or a husband 132 00:06:34,175 --> 00:06:37,342 wants a Caesearan section for this fetus 133 00:06:37,342 --> 00:06:43,142 it has to be through the body of that pregnant woman. 134 00:06:43,142 --> 00:06:47,490 So it would be great if fetal rights were 135 00:06:47,490 --> 00:06:50,193 completely independent of women's rights. 136 00:06:50,193 --> 00:06:52,846 And I love this graph, which I found on the Internet, 137 00:06:52,846 --> 00:06:55,879 that shows the ideal situation. 138 00:06:55,879 --> 00:06:57,473 Wouldn't it be great if the pregnant woman 139 00:06:57,473 --> 00:07:00,540 had 100% of all of her pre-pregnant rights 140 00:07:00,540 --> 00:07:02,395 continuing right through the pregnancy 141 00:07:02,395 --> 00:07:05,248 despite the fact that some would like 142 00:07:05,248 --> 00:07:09,250 to give the fetus the rights of personhood 143 00:07:09,250 --> 00:07:15,710 in the third trimester or any time after 20 weeks gestation. 144 00:07:15,710 --> 00:07:20,600 That the rights of the fetus should increase with gestational age. 145 00:07:20,600 --> 00:07:22,159 But unfortunately this graph is 146 00:07:22,159 --> 00:07:26,849 uh, a dream. 147 00:07:26,849 --> 00:07:30,463 If a fetus has personhood, it has rights 148 00:07:30,463 --> 00:07:32,594 equal to those of the pregnant woman 149 00:07:32,594 --> 00:07:36,898 so for example if a paediatrician was advocating for the fetus 150 00:07:36,898 --> 00:07:39,331 he may recommend that the obstetrician 151 00:07:39,331 --> 00:07:41,815 perform a procedure on the fetus. 152 00:07:41,815 --> 00:07:43,530 But as I've mentioned, it has to be via 153 00:07:43,530 --> 00:07:45,334 the pregnant woman's body. 154 00:07:45,334 --> 00:07:49,219 If the pregnant woman listens to all of the medical advice 155 00:07:49,219 --> 00:07:51,212 and considers all of the evidence 156 00:07:51,212 --> 00:07:53,027 and considers the impact on the fetus 157 00:07:53,027 --> 00:07:55,760 and considers the impact on herself 158 00:07:55,760 --> 00:07:58,760 and decides she doesn't want this procedure, 159 00:07:58,760 --> 00:08:02,760 whose rights are going to be preeminent? 160 00:08:05,274 --> 00:08:11,559 This fetus may want an operation on itself 161 00:08:11,559 --> 00:08:14,797 or someone advocating for this so-called person 162 00:08:14,797 --> 00:08:18,159 might want an operation on the fetus 163 00:08:18,159 --> 00:08:25,683 um, but it has to be done through the mother. 164 00:08:25,683 --> 00:08:30,402 So in reality if the fetus's rights increase 165 00:08:30,402 --> 00:08:34,439 after 20 weeks gestation because it's been elevated to personhood 166 00:08:34,439 --> 00:08:37,407 then by definition the mother's rights 167 00:08:37,407 --> 00:08:39,465 to say no to these things 168 00:08:39,465 --> 00:08:42,210 which may be beneficial for the fetus 169 00:08:42,210 --> 00:08:46,647 by definition the mother's rights have to decrease. 170 00:08:46,647 --> 00:08:48,743 But I feel that women must have the right 171 00:08:48,743 --> 00:08:52,283 to choose what will or won't be done to their body. 172 00:08:52,283 --> 00:08:55,686 Women must be the gatekeepers of their own body. 173 00:08:55,686 --> 00:09:00,836 I mean we have been struggling for that for centuries. 174 00:09:00,836 --> 00:09:02,649 And many women in many countries 175 00:09:02,649 --> 00:09:05,961 are still not the gatekeepers of their own body. 176 00:09:05,961 --> 00:09:10,655 They are still subject to rape in marriage, as an example. 177 00:09:10,655 --> 00:09:12,605 And it's not illegal. 178 00:09:12,605 --> 00:09:14,961 So I don't think we can get away from the fact 179 00:09:14,961 --> 00:09:17,548 that conferring personhood on a fetus 180 00:09:17,548 --> 00:09:22,726 impacts on the rights of the pregnant woman over her own body. 181 00:09:22,726 --> 00:09:25,164 So what about when a pregnant woman 182 00:09:25,164 --> 00:09:30,832 has a fetus who's found to have a lethal abnormality? 183 00:09:30,832 --> 00:09:33,652 An abnormality that is going to lead to the death of that fetus, 184 00:09:33,652 --> 00:09:37,517 either as a fetal demise in utero, a stillbirth, 185 00:09:37,517 --> 00:09:42,770 or a fetal death during labour or soon after labour. 186 00:09:42,770 --> 00:09:48,850 Or a pregnant woman whose fetus has a major fetal abnormality. 187 00:09:48,850 --> 00:09:51,644 I counsel lots of women and their partners 188 00:09:51,644 --> 00:09:55,653 in this situation every week. 189 00:09:55,653 --> 00:09:58,894 And unfortunately there are really only two options. 190 00:09:58,894 --> 00:10:01,138 The option to continue the pregnancy 191 00:10:01,138 --> 00:10:04,423 or the option to terminate the pregnancy. 192 00:10:04,423 --> 00:10:07,699 Fetal medicine has come a long way 193 00:10:07,699 --> 00:10:14,443 but— and it's certainly come a long way with diagnostic tricks. 194 00:10:14,443 --> 00:10:16,952 So we are now very good at diagnosing 195 00:10:16,952 --> 00:10:19,700 all sorts of fetal abnormalities and 196 00:10:19,700 --> 00:10:24,195 we know most of the prognoses for most of them. 197 00:10:24,195 --> 00:10:26,116 But unfortunately fetal medicine hasn't 198 00:10:26,116 --> 00:10:28,331 progressed to the stage where 199 00:10:28,331 --> 00:10:31,800 some sort of fancy in utero treatment 200 00:10:31,800 --> 00:10:33,645 is going to save lots of lives 201 00:10:33,645 --> 00:10:35,597 or relieve lots of suffering. 202 00:10:35,597 --> 00:10:40,034 There are actually very few fetal interventions 203 00:10:40,034 --> 00:10:42,793 for major fetal abnormalities 204 00:10:42,793 --> 00:10:45,103 and most of the lethal fetal abnormalities 205 00:10:45,103 --> 00:10:49,103 are still lethal.