PSYC 207 Lecture Notes (1) PDF

MIDTERM 2 Lecture 10: Associative memory Understand and distinguish between - Intuitive valuation and deliberate evaluation - Associative memory and semantic memory...

MIDTERM 2 Lecture 10: Associative memory Understand and distinguish between - Intuitive valuation and deliberate evaluation - Associative memory and semantic memory - Our implicit and explicit models of the world - “System1” and “System2” and how they shape our judgements - The availability heuristic, processing fluency, and attribute substitution - When and why the concepts of ‘dangerous’ and ‘safe’ can become culturally based and disconnected from statistics Associative Memory: implicit model of the world, condensation of a lifetime of experiences, not conscious Semantic Memory: an explicit model of the world, general knowledge, and consciousness, can be verbalized Culture is a major source of associative learning - Culture influences what we are exposed to every day - Repeated exposure strengthens some associations - Lack of exposure weakens other associations Associative memory determines our intuitive judgments (system 1) where they get rejected or accepted by deliberate judgments (system 2)  Reading 1: Associative Processes in Intuitive Judgment Dual-System Models of Judgment: - System 1: Operates automatically, generating quick, intuitive judgments using associative memory. - System 2: Deliberate and controlled, tasked with correcting potential errors from System 1 but often fails to do so. Semantic Memory: Associative Memory: connects ideas, emotions, and responses automatically, often explaining biases - Major biases in judgment are explained by three features: 1. Associative Coherence: when a stimulus triggers memory, it activates a self-reinforcing network or related ideas and responses (eg. “vomit” → disgust) - Confirmation Bias arises because associations favour compatible ideas (eg. “Is Sam friendly” → activates friendly evidence) 2. Attribute Substitution: when faced with a difficult question, the mind often substitutes it with an easier one (eg. estimating someone's future success may lead to evaluating their last speech) - Heuristic Judgments arise where a simpler question is answered without realizing it (eg. substituting “How happy are you?” with “How many dates did I have recently”) 3. Processing Fluency: if something is easy to process, it may be judged as more familiar, truthful, good - Effortful tasks increase deliberate thinking, improvising performance on complex tasks - Overconfidence and incorrect judgments arise from the belief that ease of recall ≠ truth (eg. recalling fewer instances of assertiveness makes people rate themselves as more assertive)  Lecture 11: Heuristics vs. Statistics Understand and distinguish between - The availability heuristic, processing fluency, and attribute substitution - When and why the concepts of ‘dangerous’ and ‘safe’ can become culturally based and disconnected from statistics - Micromorts and mortality - The miscommunications (and misdirections) that frequently occur when talking about danger Availability Heuristic - Good mental shortcut to follow before invention of agriculture - Could be misleading, not representative of the real world Talking About Danger - Fractions are non-intuitive and words we use instead of them can be misleading - Words of Estimative Probability: certainly, almost certain, probable, chances about even, probably not, almost certainly not, impossible Our judgments about what is “dangerous” or “safe” are - Generally not based on statistical probabilities - Culturally influenced - Based on associative memory and heuristics  Lecture 12: Motivated Reasoning Understand: - Materials from the last lecture — quickly review so you can ask Qs - What our dominant cultural values are and how do they play out in our general model of childbirth - Motivated reasoning (and how reasoning is always motivated) - Accuracy motivation vs directional motivation in reasoning - Why labour induction is common and what the most common methods for inducing labour are - The umbilical cord and what it does right after birth Two Famous Representations of Birth Alternative Representations of Birth - Neutral colours - Bright colours - No presence of babies - Presence of babies - Presence of men - No presence of men - Neutral facial expressions - Facial expressions - No presence of umbilical cord - Presence of umbilical cord Culturally Motivated Reasoning - Dominant culture tends to avoid & doesn’t value: - The physiological reality (eg. blood, bodily fluids, organs, etc) - Vulnerability and dependency of human newborns on their mothers - Animalism and emotional birth - We are motivated to attribute positive outcomes with dominant cultural values and negative outcomes with non-dominant cultural values (bias) - Intervention during birth is a culturally dominant value 1. Accuracy Motive: motivation arrives at an accurate thorough explanation a. Generally, it leads us to expend more cognitive effort, process information more deeply, and use more complex thinking strategies 2. Directional Motive: motivation arrives at a particular, directional explanation a. Generally, it leads us to try to justify a particular conclusion in a rational, convincing manner, undertake a biased memory search for particular beliefs and rules, access only a subset of our relevant knowledge b. Tends to result in bias Multiparous: not first pregnancy Nulliparous: first pregnancy Due Date: 28- days (40 weeks) from the first day of the last menstrual period Term Pregnancy: between 37 and 42 weeks (“window”) Pre-term: before the full 37 weeks of pregnancy Past term: after 42 full weeks of pregnancy Medical guidelines - Membrane sweeping at 38-41 weeks - Sweep inside the vagina to trigger the release of endogenous prostaglandins (hormone-like lipid compounds–initiates labour) from the adjacent membranes and cervix - Pros: - It may decrease the length of pregnancy - May reduce the rate of formal medical induction (⅛ chance) - Cons: - Painful - Cause bleeding or irregular contractions - 1/10 women’s amniotic sac ruptures (water breaking) which then leads to formal induction within 24 hours according to current medical guidelines - Sometimes done without consent - Offer induction at 41-42 weeks At least 20-30% of women have their labour induced currently The most common methods for induction of labour - Artificial oxytocin (via IV) - Recommended and common - Prostaglandins - More effective than oxytocin - More likely than oxytocin to cause uterine hyperstimulation - Mechanical methods (balloon catheters, amniotomy, etc) - Less likely than prostaglandins to cause uterine hyperstimulation - Increased maternal and neonatal infectious compared to prostaglandins and artificial oxytocin  Reading 2: Misguided medicine Most of doctor's advice is often not based on evidence obtained through rigorous testing - They have a tendency to adopt ideas because they “should” work before they know if they actually do - “Once a treatment has been dubbed ‘standard of care’ it tends to persist” - “Medical school is wrong, some of it may even be considered malpractice Hormone Replacement Therapy Advice: HRT for menopausal women Rationale: protective effects on heart and bones Adoption: given to millions in the 1990s Reversal: in 2002, found to increase the risk of breast cancer, heart disease and stroke, largely discontinued. Largely discontinued, though some believe future studies may show benefits for certain women Peanut Allergy Advice: no nuts for young children Rationale: for an immature immune system, exposure increases allergy risk Adoption: widespread in Western countries Reversal: A major trial found early exposure actually decreases allergy risk, new guidelines issued in 2015 Keyhole Surgery for Osteoarthritis of the Knee Advice: surgical removal and smoothing of cartilage fragments Rationale: reduces inflammation, improves motion and decreases pain Adoption: by 2002, 650,000 surgeries per year in the US Reversal: several trials found no benefit over physical therapy alone, surgery is still common though Cancer Screening Advice: routine early screening Rationale: early detection is a chance to intercept disease Adoption: mammograms and the PSA test for prostate cancer became routine in the 1980s Reversal: early stages of cancer do not always develop further, many are being treated unnecessarily. PSA test is no longer recommended in the US, age for routine mammograms raised from 40 to 50 Heart Stents Advice: stents for people with coronary heart disease and angina Rationale: clear benefits in cases of heart attack, so those with stable heart disease should benefit too Adoption: commonplace by 2004 Reversal: shown not to reduce risk for future heart attack or death and may cause harm. Practice remains common Vertebroplasty Advice: inject medical cement into six fractured vertebrae Rationale: though to improve spine stability and reduce pain Adoption: by 2009, 750,000 operations per year in the US Reversal: although we now know the procedure is no more effective than a placebo, it is still widely carried out Intensive Blood Sugar Lowering for Type 2 Diabetics Advice: diet and drugs to get long-term blood sugar metric (glycated hemoglobin) below 7% Rationale: A 1997 study found a lower risk for heart attack at 7%. The aim became lower the better Adoption: by the early 2000s, advice was often to aim for under 7% Reversal: a 2008 study found that trying to keep levels too low increased the risk of death. Aiming under 7% is now seldom advised Pre-implantation Genetic Testing Advice: screen embryos for older women doing IVF Rationale: genetic screening should reduce pregnancy failure due to chromosome abnormalities in embryos Adoption: common for older women undergoing IVF Reversal: A 2007 trial found screening decreased pregnancy rates and live births for older women Lowering Body Temperature for Aneurysm Surgery Advice: cool down your body during surgery Rationale: animal studies suggested improved outcomes Adoption: common by 1980s Reversal: A large 2005 study found no improvement and increased risk of infection Ear Tube Surgery Advice: implant tubes in the ears of children with persistent infection Rationale: fluid drainage would improve hearing and cognitive development, best to do surgery sooner rather than later Adoption: most performed surgery in children Reversal: A review in 2014 found no adverse effect on long-term child development if surgery is postponed. But surgery which carries the risk of bleeding and eardrum damage, is still common in the early stages of infections  Reading 3: A Women In Residence, Ch 4 excerpt Anesthesiologists do not care for the patient whereas an obstetrician would The table is tilted slightly so the blood and fluid run onto the assistant and not onto the surgeon Epidural dose too low = pain during surgery Epidural dose too high = difficulty breathing, requires medical assistance 1. Crescent-shaped incision along women's pubic hairline 2. Deeper cut beneath the subcutaneous tissue to a thick layer of fibrous tissue 3. The peritoneum is lifted and an incision is made in it 4. The bladder is peeled away from the uterus 5. The incision is made in the uterus 6. Baby’s head is usually down and under incision 7. Push baby out of the uterus 8. Baby’s throat is immediately suctioned with a small ear 9. The rest of body is pushed out 10. The umbilical cord is clamped Post-birth repairing is usually more difficult for mother (more pain, vomiting and complaining, no anticipation) Pitocin is added into the woman’s IV to help uterus contract and to decrease bleeding Small sutures re used to tie and retie bleeding blood vessels Apgar score: a standardized set of criteria to rate the condition of the baby at 1 minute and then at 5 minutes  Lecture 13: Medical Knowledge (Part 1) Understand: - The most common methods for inducing labour - How the risk of intervening in labour tends to be under-estimated, while the risk of not intervening can be over-estimated - The umbilical cord and what it does right after birth - The intervention of cord clamping/cutting with its history and current status - What active management of the third stage of labour is - The differences between scientific and medical knowledge - In general terms: semantic and procedural knowledge - Why medical reversals are common Hyperstimulation of the uterus: too frequent/strong contractions Risk of Stillbirth: - Week 36-40: 1 (per 1000 babies born are stillbirths) ∴ Induction is performed after 41 weeks (This results in many unnecessary inductions, the risk is overestimated) Precautionary Principle: assumed unsafe until proven otherwise Anti-cautionary Principle: assumed safe until proven otherwise - Not unique to obstetrics and medicine - Within medicine–linked to medical reversals: removal/reversal of a medical practice that was approved Eg. Umbilical Cord Clamping/Cutting - Animals don’t clamp/cut the umbilical cord - Baby states connected to the placenta - Baby continues to receive blood and oxygen - Enables the gradual transition to breathing - Biggest umbilical cord transformation happens in the first few minutes right after the birth Wharton’s Jelly: a gelatinous substance within the umbilical cord (also in the eyeball) - Protects and insulates the umbilical blood vessels - Changes its structure with cooler temperature (compared to the body) - Provides a physiological clamping action, slowing the flow of blood - Contains stem cells  Lecture 14: Medical Knowlege (Part 2) Understand: - The intervention of cord clamping/cutting with its history and current status - What active management of the third stage of labour is - The differences between scientific and medical knowledge - In general terms: semantic and procedural knowledge - Why medical reversals are common - There are different levels of evidence used in medicine - The evidence-practice gap and the Cochrane Library database If time: - What medico-legal pressures are and some of their negative effects Cord Clamping–When? - Historically, midwives would wait until the cord stops pulsating (blood pulsing through) before they do anything to it (supported by Aristotle and Hippocrates) - Immediate cord clamping first records date from the late 1600s - To avoid blood loss from a baby before the physiological closure of the umbilical vessels - To “spare the bed linen” from being soiled by placental blood leaking from the cut end of the cord - Early 20th century: to prevent the baby from receiving any more chloroform (which was in general anaesthesia and passed through the umbilical cord to the baby with the potential to cause profound respiratory depression) - 1960s: became the “standard of care” in obstetrics to prevent postpartum hemorrhage Third Stage of Labor Active Management - An interventionist package of care, the “cornerstone” (critical quality) of obstetric and midwifery practice - Goal: limit postpartum hemorrhage 1. Administration of prophylactic uterotonic drug (Pitocin) a. To induce contractility of the uterus and make placenta seperate from uterine wall quicker 2. Early cord clamping and cutting 3. Controlled traction of umbilical cord a. Pulling the cord while applying counter pressure to help deliver the placenta Statistical Evidence (medical reversal) - Immediate cord clamping does not decrease postpartum hemorrhage rates - Cord traction may not be important - Giving uterotonic might be the only intervention in the active management of stage 3 that is associated with reduced hemorrhage - The quality of evidence is generally low - More data and research have ended Placental Transfusion  - Delayed cord clamping: - Increased blood volume in the newborn - Increases red cell volume in the newborn - Higher birth weight - Fewer infants are iron-deficient - Not passive or influenced by gravity–even when the baby is held above the placenta, transfusion still occurs - Immediate cord clamping: - Can lead to iron deficiency anemia in babies - In premature infants, can lead to intraventricular hemorrhage Recommendations - WHO: delay of umbilical cord clamping for 1-3 mins - UK guidelines: delay of umbilical cord clamping earlier than necessary - Canadian Guidelines: delay of umbilical cord clamping for 60 seconds, if more, then it increases the risk of hyperbilirubinemia (jaundice) requiring phototherapy - Evidence suggests that delaying cord clamping for more than 60 seconds doesn’t reduce the chance of jaundice but decreases the percentage of infants who need phototherapy for it Medical Knowledge Scientific Knowledge - Mostly procedural - Mostly semantic - Some semantic - Some procedural - Semantic knowledge serves procedural - Procedural knowledge serves semantic knowledge (explains why certain knowledge (prescribes what we should do practices are adopted and others are not) to update and improve semantic knowledge) Evidence Practice Gap - It takes a long time for science to influence medical practice and it only does so partially - Clinical articles are much more likely to examine new possible medical practices than an already existing standard of care - The percentage of reversal among articles testing standard of care was 40% Archie Cochrane - Criticized the lack of reliable evidence behind many of the commonly accepted healthcare interventions - Advocated for the use of randomized control trials to make medicine more effective and efficient - Led to the development of the Cochrane Library database of systemic reviews - Helped lay the foundation for evidence-based medicine Levels of Evidence Many Cochrane Systemic Review articles conclude that there is insufficient evidence to endorse the interventions they examine Systemic reviews–Meta-analysis reviews: most accurate Randomized Controlled Trials (RTC) –Individual studies: somewhat accurate Expert Opinion: not accurate Semantic (declarative) knowledge Procedural Knowledge - Forms and changes based - Forms and changes based on on the ‘evidence’ we are - What we frequently exposed to (the evidence do (habits) could be biased or faulty) - The system of incentives and disincentives (motivations and discouragments) that are part of our environment Systems of incentives and disincentives that influence the practice of obstetrics - Personal - Professional - Duty of care: an obligation to benefit one’s patients medically - Financial: certain procedures make more or less money - Medicolegal: litigation pressures and insurance policies  Reading 4: Informed consent and refusal in obstetrics: A practical ethical guide Autonomy and Maternal Rights: - A woman has the fundamental right to make decisions about her body, including the right to refuse medical procedures that may increase risk to herself or her fetus. - This principle of autonomy is enshrined in medical and legal standards, prioritizing the patient's right to consent or refuse. Subjectivity in Risk and Benefit: - Perceptions of risk and benefit vary among individuals. Eg. some women may accept a higher level of risk to avoid certain interventions, such as cesarean sections. - Individuals willingly accept risk for personal values and goals. Challenges of Dichotomous Thinking: - Healthcare professionals tend to view decisions in black-and-white terms (right vs. wrong, safe vs. unsafe). - Kotaska advocates for nuanced thinking, especially in cases where the benefits and risks are balanced, allowing women to choose based on their values. Ethics of Coercion: - Coercion undermines true consent and can take forms such as exaggerating risks, restricting options, or threatening legal action. - Policies that limit a patient’s choices (e.g., banning VBAC or vaginal breech births in certain hospitals) also constitute coercion and violate ethical standards. Offer vs. Recommend in Clinical Guidance: - The paper suggests that while "offering" options can empower patients, clear "recommendations" are sometimes necessary to guide patients based on professional expertise. - Clinicians should balance offering unbiased information with transparent recommendations when they strongly believe in a particular course of action. Maintaining Therapeutic Alliance: - Respecting a woman’s informed refusal fosters trust, even if it conflicts with the caregiver's views. This trust can be crucial if circumstances change, as patients are more likely to follow advice when they feel respected. - Practicing "detached caring" allows clinicians to honour patient choices without taking personal offence or pressure. Ethical and Legal Implications: - Respecting a woman’s right to refuse is not an endorsement of her decision. In cases of adverse outcomes due to informed refusal, the legal responsibility lies with the patient. - Continuing care despite refusal aligns with professional duties and reduces liability for clinicians, who must document such instances carefully. Guideline Flexibility: - Advocates for guidelines that respect patient choice, allowing room for women’s preferences in settings that offer full disclosure of risks and benefits.  Lecture 15: Medicolegal Pressures (Part 1) Understand: -The different levels of evidence used in medicine - Semantic vs procedural knowledge - Medico-legal pressures and some of their negative impacts - The general concepts of emotional salience and cognitive control - The basics of amygdala function - How the ventromedial prefrontal cortex (VMPFC) integrates physiological states into ‘somatic markers’ that influence our behaviour - The Georgia Case, the Pennsylvania case, and the moral and legal difficulties that stem from treating the fetus as a second patient - Pregnant people’s human rights in the US in two legal cases Medicolegal example: ‘traumatic’ birth results in $5.2M award for disabled teen - Obstrician = guilty - But protected from lawsuit (they don’t have to pay, but they have to go through ≈17 years of being sued) When faced with the risk of lawsuits, physicians do what they can to minimize the risk - Most lawsuits don't go to trial (only ≈25%), the rest are settled out of court or dismissed - Of those that don’t go to court, ≈75% are resolved in the obstetricians/gynecologists favour - ∴ the risk of ‘losing’ the lawsuit is very small (≈5%) Negative impacts of this: - More than half of obstetricians/gynecologists say that their thinking and actions are continuously affected by the threat of lawsuits - The majority describes being sued as an extremely negative experience - More than a third agreed that they “no longer trust patients” and they “treat them differently” and in some cases, they “lost trust in colleagues and organizations” - Legally speaking: the fetus does not become a person until it’s fully born and separated from the mother - However, once the child is born, alive, and viable, the law may recognize that its existence began before birth for certain limited purposes (ie. attracting a duty of care in negligence during delivery) - Therefore, obstetricians currently regard the fetus as a separate entity from the mother, or their ‘second patient’ - Medical practitioners become responsible for negative fetal/newborn outcomes ∴ vulnerable to lawsuits - Canada uses tort litigation for compensation for medical injuries (in court–relies on proving that a practitioner was at fault in order for the patient to obtain compensation) - Maybe unconstitutional (not relating to an established set of principles)  - Creates conflict between medical practitioners and pregnant women who decide to refuse medical treatment - Providers see themselves as the advocate for the baby - Can resort to court orders to force invasive interventions on pregnant women for the perceived benefit of the fetus - Third-trimester abortions are illegal, so at some point, the government does legislate dominion over a woman’s body Example: the Georgia Case - Woman’s Religious belief: the Lord had healed her body and whatever happened to the child was the Lord’s will - The hospital sought a court order authorizing it to perform a cesarean section should she enter the hospital and refuse - At an emergency hearing conducted at the hospital, her examining physician testified that - She had complete placenta previa, based on ultrasound scan - There was a 99% chance that the fetus would die during a vaginal delivery - There was a 5% chance the mother would die too - Parents immediately appealed the decision to the Supreme Court of Georgia - On the evening of the same day as the emergency hearing, the court denied their appeal, they favoured the child’s right to live over the mother's right to refuse surgery based on her religious beliefs - A few days later: the woman delivered a healthy baby without intervention - The second ultrasound scan after emergency hearings found that her placenta had moved so that the cesarean delivery was no longer needed - Doctors had testified at the emergency hearings that it was “highly and virtually impossible” for the condition to reverse itself - Q: What was most likely to happen? - A: The first ultrasound and its interpretation was inaccurate  Lecture 16: Medicolegal pressures (part 2) Understand: - The Georgia Case, the Pennsylvania case, and the moral and legal difficulties that stem from treating the fetus as a second patient - How ultrasound technology works - Pregnant people’s human rights in the US in two legal cases - Electronic Fetal Monitoring (EFM), its reliability, and the effects of its use during labour - The use of EFM recordings during brain injury litigation and legal reasoning - How counterfactual reasoning and the hindsight bias occur during reasoning around childbirth - The myth of cerebral palsy (CP) causation Ultrasound (sonography) - Uses sound waves with frequencies higher than those audible to the human - Sends pulses to ultrasound into tissue using a probe - When a sound wave encounters a material with a different density, part of the sound wave is reflected back to the probe and is detected as an echo - The greater the difference in density, the greater the echo - Seeing deep into the body with sonography is very difficult because most of the signal is lost from acoustic absorption - Can produce false positives as well as misses The Pennsylvania Case - After an ultrasound, doctors decided that the baby was too big to deliver vaginally, and told Amber she needed a C-section - She already had given birth to 6 babies vaginally, each almost as big as this one - Amber and her husband checked out against the doctor’s advice and went looking for another hospital - Meanwhile, the hospital’s lawyers obtained legal guardianship of her unborn child - A court allowed the hospital to force Amber into surgery if she returned - At another hospital, Amber had a quick natural birth she described as easy - She didn’t know about the first hospital’s action until her husband was told by a reporter Pregnant people’s human rights in the US Roe V. Wade: US (all-male) Supreme Court Ruling from 1973 - The constitution protects the right of an individual to choose to end their pregnancy prior to viability Dobbs V. Jackson: US Supreme Court Ruling from 2022 - Eliminated the constitutional right to an abortion Electronic Fetal Monitoring (EFM) - The most common obstetric intervention  - Introduced in the late 1960s with the promise that it would reduce (by half) the incidences of: cerebral palsy, intellectual disability, and peri-natal mortality EFM use in fetal surveillance - Interpretations of fetal heart tracings are highly subjective - There is very little agreement among experts as to the interpretation of “non-reassuring” tracings - “False-positive” predictions of fetal distress are almost certain - Using it increases c-section rates, without improving outcomes for babies EFM use in brain injury litigation - Used by expert witnesses who testify as to when the baby sustained irreversible neurological injury - The main “tool of blame” - It is heavily relied upon to support counterfactual claims that a poor outcome could been avoided Counterfactual reasoning - Reasoning about “what might have been” - Relies on counter facts: mental representations of alternatives to the past, often activated automatically in response to negative affect - Often takes the form of if/then statements or questions (eg. “If you had been paying attention, you wouldn’t have gotten hurt”) - The basis of assigning blame for harmful outcomes or giving credit for beneficial outcomes - This could be highly problematic because of hindsight bias Hindsight Bias - The “knew-it-all-along” effect - Knowing that an event (outcome) has occurred increases it’s perceived predictability - Linked to the availability heuristic - Accompanied by over-confidence in the certainty of one’s judgements: people are unaware of the effect that outcome knowledge has on their perceptions of predictability - Situations that (after the fact) lend themselves to straightforward (causal explanations) evoke greater hindsight bias than situations that are more ambiguous The Myth of Cerebral Palsy (CP) Causation - Rarely due to birth asphyxia - Most acute severe hypoxia follows intrapartum hypoxic events - Causes aren’t well understood, but most are thought to precede labour and birth (genetic, inflammatory, preterm) - The medico-legal climate encourages blame of the insured - A major cause of C-section escalation - No association between elective or emergency C-sections and CP outcomes - CP incidences are the same in Western and resource-poor settings  Lecture 17: Reasoning About Childbirth Understand: - The myth of cerebral palsy (CP) causation - Some of the history of pregnant people’s human rights in Canada - What therapeutic abortions committees were and why they were eventually ruled to be unconstitutional in Canada - How all abortions were legalized in Canada - A forced abortion case in BC (Baby R) and how it legally concluded - Why the fetus is not a legal person in Canada and the Winnipeg case - How consent rights work in the medical context - What free birth is and why do pregnant people consider it Pregnant people’s human rights: Canada 1800s - The British parliament outlawed any abortions after “the quickening” in the UK - New Brunswick soon passed an almost exact replica of the British act - Then the British parliament passed another law that made all abortions illegal - Upper and lower Canada followed with their own abortion criminalization laws - Criminal Code of Canada: all abortions illegal nationwide Pregnant people’s human rights: Canada 1900s - Pierre Trudeau legalized contraception, homosexuality, and some abortions - Abortions were legal if they took place in hospitals provided that the pregnancy posed a danger to the pregnant person as determined by a three-doctor therapeutic abortion committee - Decisions were highly biased and sterilization was sometimes conditional for Indigenous people and other marginalized groups - The Abortion Caravan (1970): women march from Vancouver to Ottowa - Henry Morgetaller is a physician who established illegal clinics to administer safe abortions (as well as contraceptives, and vasectomies) - R. V. Morgetaller legalized abortion fully Baby R Supreme Court of BC case - The mother of the baby was admitted at her request to hospital - 3 hours later, an obstetrician was consulted whose opinion was that a C-section was necessary - The mother declined to consent to a C-section - The obstetrician brought the Family and Child Services Department for assistance - Child services advised the obstetrician that there was provision available for treatment to be performed on a mother against her will under the Mental Health Act following the committal of the person under the act - The hospital’s psychiatric unit was consulted but it found there was no foundation to initiate proceedings under the Mental Health Act to commit to the mother - 3 hours later, child services called the obstetrician to tell him that they were apprehending the unborn child they gave consent to emergency medical treatment of the child  - Child Services arrive at the hospital with the emergency service unit - At the last moment, the mother consented to the c-section - Baby R was born via c-section in good health and suffering no apparent ill effects “from the lifestyle adopted by the mother - The baby was physically taken into custody by child services and placed in a foster home - The provincial court of BC ordered that permanent custody and guardianship of the child be granted to child services - Supreme Court of BC overturned the Provincial Court’s decision and found that: - The powers of Child Services apprehend “are restricted to living children that have been delivered, therefore the apprehension had no basis in law - For the apprehension of an unborn child to be effective, there would have to be a measure of control over the body of the mother. Such power to interfere with the rights of women, if granted and if lawful, must be done through specific legislation and anything else will not do Does the fetus have human rights? - Canadian Supreme Court Ruling (1989): right to abort despite father’s wishes, fetus aren’t legal people - Canadian Supreme Court Ruling (1991) person can’t be charged woth murder or homicide in the demise of a pregnancy Winnipeg case - 5 months pregnant with 4th child, addicted to glue sniffing, was in foster care herself from 13 years old - A Provincial Supreme Court judge ordered that she be placed in the custody of Child and Family Services and Detained in a health center for treatment until the birth of the child - The Provincial Court of Appeal overturned the Provincial Supreme Court’s order. The Supreme Court of Canada affirmed the Court of Appeal’s judgement: the law in Canada does not recognize the unborn child as a legal person possessing rights Consent Rights in BC Canada - Every adult who is capable of giving or refusing consent to health care has - The right to give consent or refuse consent on any grounds, including moral or religious grounds, even if the refusal will result in death - The right to select a particular form of available health care on any grounds including moral or religious grounds - The right to revoke consent General Rule: consent needed - A healthcare provider must not provide any health care to an adult without the adult’s consent - Exception: urgent or emergency health care: to preserve an adult’s life, prevent serious physical or mental harm or alleviate severe pain Spectrum of Childbirth experience  - Scheduled c-section in a hospital - Hospital birth with an obstetrician - Hospital birth with a family doctor - Birth center with registered midwife - Home birth with a registered midwife - Home birth with a traditional birth attendant and/or doula - Freebirth or unassisted/unattended childbirth’ Freebirths - About ⅓ of home births in the US have “other” listed as birth attendant or their birth certificates - Considered to be growing as a trend - Often presented by the media as deviant behaviour - Online newspaper reports tend to attract negative public comments in which freebirthing women are described as irresponsible, selfish, stupid and rash - Motivations for considering free birth are complex (avoiding hospital, birth preferences, practicalitie)