There is the potential for a very significant issue to arise in the NICU environment in the coming years. As I was preparing the last blog piece following the decision by SCOTUS to allow same-sex marriage in all 50 states I began to think about the so-called ripple effect. In other words, now that the law has been changed, what impacts could this have that might have been unforeseen. The first thought that crept into my mind was that as male same-sex parents they would read the same literature that promotes breast milk feeding in the NICU and no doubt want the best for their infant in the NICU or for that matter any baby. In many NICUs however there are weight or gestational age restrictions indicating who will receive donor breast milk if the mother is not able or not willing to produce her own. In our unit for example we given DBM to all babies currently under 1250g and those recovering from NEC or other bowel surgery. Might men in a same-sex marriage who have adopted a child or used a surrogate who is not willing to breastfeed demand the same?
In looking into this I came across a very strange story from 2013 in which a nurse in the UK offered to “rent her breasts” to gay parents. The story at the time caused a fairly big stir as it raised a number of questions as to safety and the morality of it all. In some ways it was ahead of its time as there have been a number of articles recently addressing the very issue of safety of milk (will be addressed further in the article obtained outside of HMBANA approved breast milk banks.
As same-sex couples increase and many then choose to have children of their own to raise what demands will be made of access to breast milk? There is no question “breast is best” and I have either written or posted to Facebook many articles suggesting decreased incidence of allergy, necrotizing enterocolitis, improvements in the microbiome and many other benefits as well. What do we do in the situation of the same-sex family who declares that they want to provide breast milk to their infant in hospital as it is the best source of nutrition for their infant. If we say for example that their 2 kg, 34 week infant is too big to qualify for DBM is this fair given that they have no option for producing their own milk in the setting of male same-sex partners? Could we as health care providers be labelled as discriminating?
One option is to allow such parents to bring in their own milk but then where do they source it from? Milk purchased online or from the community may be contaminated with bacteria, viruses or contain some cow’s milk as some recent publications have demonstrated. Can we knowingly allow families to bring such milk into the hospital to feed their infant? Perhaps, but only if we have medical legal safeguards in place that protect the hospital from knowingly allowing patients to bring in milk which could be contaminated. Waivers of liability would need to be in place in each hospital permitting such sourcing of milk. If however we strongly discourage such practice will we direct them to the milk bank supplying our local hospital. Herein lies the challenge though. If availability of volume was not an issue, we could provide to all infants in the unit but the reality is there is simply not enough to go around. Furthermore, the larger the infant, the more donor milk they utilize and the more depleted the supply becomes for those of our smallest infants who are most in need of avoiding formula. Finally, who should pay for this milk if the family cannot produce any as in this situation. This is not a case of a mother who could produce but chooses not to but rather a family who is desperate to use what they have read is best but physically is incapable of producing. The same of course could be said for those women who try and cannot or due to prior surgery are unable to produce milk. I believe this is an issue that will come up across the US and Canada and I will be interested to see how it plays out and what role Bioethics may play in helping to resolve some of these questions.
This will be a slippery slope. If male same-sex parents are provided with free access to donor milk I don’t see how donor milk will not be made available to all families who cannot provide their own. Why would the male parents who biologically be unable to provide milk be given this “liquid gold” while other mothers who are pumping round the clock, taking domperidone and seeing a lactation consultant and getting only drops be denied as their newborn is 1600g and above the weight cutoff. I hope you can see the issue of equity popping up in this discussion.
Finally why not allow those parents who are male same-sex partners to simply pay for the milk they need if they don’t qualify for “free” milk under a unit’s program? Sadly the issue then becomes one of equity again. Do we want to care for infants in an environment where the wealthy who can afford to pay for the donor milk from an HMBANA milk bank get it and the poor are only offered formula? I have to admit I realize there are health care systems where this is the case but in Canada where we have a socialized medical system this kind of two tiered system would cause many to become nauseated.
I fear that this issue will come up as the number of people marrying and choosing to have children in same-sex relationships increases. If it leads to a 100% human milk diet for infants in the NICU I would say that is a good thing but I think the road like Winnipeg will be paved with many potholes that we will have to do our best to navigate around.
This is a lengthier piece than normal but the message at the end is critical to disseminate so I would encourage you to share this if you wish with others to prevent misinformation from being propagated in the media by the sensationalism of a claim by a group of Pediatricians.
My Facebook page became awash in rainbow overlaid posts on Friday. Very quickly I realized as did most of the developed world, that the US Supreme Court ruled in favour of same-sex marriage and just so no one thinks that this will turn into a homophobic piece, I celebrated the change along with many friends and fellow Social Media colleagues.
After the initial excitement began to wane I came across a press release that I found a little shocking given that I belong to the group of people (as a Pediatrician not a member of the organization) that released the statement shown below. The statement is from the American College of Pediatricians
Dr. Michelle Cretella, President of the American College of Pediatricians in response to the SCOTUS decision today stated, “[T]his is a tragic day for America’s children. The SCOTUS has just undermined the single greatest pro-child institution in the history of mankind: the natural family. Just as it did in the joint Roe v Wade and Doe v Bolton decisions, the SCOTUS has elevated and enshrined the wants of adults over the needs of children.“
Although it is disappointing only 4 of the 9 justices heeded the scientific findings in the College Brief
, the College will continue to proclaim the important unique contributions of both mothers and fathers to the optimal nurturing of all children.
As I went to their website and read about this organization it became clear that this group is mixing Church and State so to speak. Their mission statement states:
Mission of the College
The Mission of the American College of Pediatricians is to enable all children to reach their optimal physical and emotional health and well-being. To this end, we recognize the basic father-mother family unit, within the context of marriage, to be the optimal setting for childhood development, but pledge our support to all children, regardless of their circumstances.
Who are these people and why are they speaking out in such contrast to the American Academy of Pediatrics who in 2013 published their technical report in support of same-sex couple raising children. The AAP which has about 64000 members dwarfs the membership of possibly 200 Pediatricians that comprise the American College of Pediatricians. The smaller group was formed when a group of Pediatricians became upset in 2002 of the AAPs position that endorsed same-sex couples adopting children. The trouble of course with an organization such as this is that their name implies some degree of credibility but in looking at their track record on this issue they have little to none. They are a group that seems to ignore the literature discussed below in favour of quasi-scientific religious literature suggesting harm from such family units. The support of the AAP, the dominant organization in the field was made clear June 26th with this statement. I particularly like the quote from the president of the AAP.
“Every child needs stable, nurturing relationships to thrive, and marriage is one way to support and recognize those relationships,” said Sandra G. Hassink, MD, FAAP, AAP president. “Today’s historic decision by the U.S. Supreme Court supports children in families with same-gender parents. If a child has two loving and capable parents who choose to create a permanent bond, it’s in the best interest of their children that legal institutions allow them to do so.”
Putting aside my natural suspicion of the American College of Pediatricians, it did lead me to ask an important question. Are kids truly better off being raised in a heterosexual marriage? Perhaps there is evidence to show that indeed this is something that we as Pediatricians should be promoting. Looking at the evidence though would suggest otherwise or at least that there is no difference. In 2014 the largest study to date was published by Australian researcher Crouch et al involving 315 parents representing 500 children from same-sex marriages (complete study here). The study involved a questionnaire that would then be compared against population data to see if differences exist between parental units. A little over two-thirds of the parental units were Lesbian. The results demonstrated that in virtually all measures of child health the parental units were equivalent. Curiously, sense of stronger family cohesion was present with the same-sex groups. Possible reasons for this may be related to the way in which children are brought into this world in the two parental unit types. Given that people of the same-sex must plan (there are exceptions no doubt) to procreate there is little chance of the unexpected pregnancy occurring. These are almost all “wanted or chosen” children as opposed to the situation encountered in many pregnancies that are not planned. That is not to say that these children can’t or won’t be loved but the likelihood seems much lower in a LGBT parenting situation due to the planning that is generally required. While the research did not go on to elaborate on why the cohesion might be enhanced this is just my speculation.
Adding to this piece of evidence that these children are likely to have equivalent health to the traditional family rearing model is a well-timed report that surfaced the same week as the Supreme Court Ruling. The report from the Huffington Post challenges that after reviewing 19000 studies on same-sex parenting there can be no conclusion that the children of such families are worse off in any measure of health. Where the above group derives their mission statement from then is certainly not based on science but rather perception.
Back to the American College of Pediatricians (ACOP). I mentioned earlier that I was suspicious of the ACOP and what they portray as advocating for a child’s best health. As a writer of a blog I firmly believe that the buck stops at me with respect to content. If I have a guest writer I am responsible for their content as well as my own. I took the liberty of reviewing a recent piece from their blog and what I saw both shocked me and left me with the certainty that this group is not so much advocating for the health of children as condemning those lifestyles that they do not believe fit the mother-father mold. On June 5th the group released the following piece entitled “P” is for Pedophile. Please click on the link if you have the stomach for it but to give you a taste of what they are talking about here is the quote from the first line of the entry.
“Driving in this morning I began to wonder. Why isn’t the movement of LGBT not the PGBT movement: “P” for pedophile?”
If this group had any credibility by having a professional sounding name, my hope is that this post will spread wide and far to help discredit this organization. The evidence suggests that members of the LGBT community raise just as healthy kids as any of us and any attempts to smear people simply for who they happen to bond with for life amounts to hate and there should be no room in Pediatrics or any other field of medicine for that.
I know, this sounds like a ridiculous title to a post but it actually happened in Detroit recently. Krista and Jamie Contreras loving parents of 6 day old Bay were denied care by a Pediatrician solely due to the parents being Lesbians. Please watch this short video before reading on.
I can’t help but think that the recent laws that have been passed in Indiana and Arkansas open the door for similar situations in those states. Moreover, imagine the impact if the laws spread to other conservative states in the US. If you look at some history though, the Religious Freedom Restoration Act (RFRA) was first passed in 1993. The act was brought into being after an American Indian man was fired from his job for failing a company drug test. The drug in this case was peyote which culturally was acceptable for him to use but not in keeping with company policy. The law that was brought into existence was therefore designed to protect people from the Government and industry interfering with religious practices which in this case they were as peyote was used as part of his religious practice.
That sounds like a very positive step in the right direction so why have Indiana and Arkansas come under so much heat over this current legislation? The reason is that the law makes it possible for not only the individual but a company or business to sidestep the law if their religious beliefs are found to be in conflict with a person or request. Don’t believe this could happen? It already did. The US Supreme Court recently ruled that the Hobby Lobby company could refuse to provide birth control to employees as a health benefit. Using birth control violates the company’s Christian religious beliefs.
The physician in this case lacked a solid RFRA in Michigan so she could do nothing more than apologize for her stance. What concerns me greatly though is the hypothetical situation in which a member of the Lesbian Gay Bisexual Transgender (LGBT) community decides to have a child with a member of the same sex in a state with an RFRA. What if for instance Michigan had such a law? Would this Pediatrician have apologized or simply stood behind the government? I am not sure what would have happened and in a state like Michigan which in my view is a little more progressive than some of the states in the “Bible Belt” I suspect this family would have found another Pediatrician to take care of them. If this story had taken place in Arkansas, how difficult would it have been to find another Pediatrician on short notice while the infant was still hospitalized? Might be a little harder.
On the first day of Medical School all students are asked to take the Hippocratic Oath. The Oath is not the same as was first spoken by Hippocrates but rather in one form or another is based on the version that came from the Declaration of Geneva and reads as follows:
At the time of being admitted as a member of the medical profession:
- I solemnly pledge to consecrate my life to the service of humanity;
- I will give to my teachers the respect and gratitude that is their due;
- I will practice my profession with conscience and dignity;
- The health of my patient will be my first consideration;
- I will respect the secrets that are confided in me, even after the patient has died;
- I will maintain by all the means in my power, the honour and the noble traditions of the medical profession;
- My colleagues will be my sisters and brothers;
- I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;
- I will maintain the utmost respect for human life;
- I will not use my medical knowledge to violate human rights and civil liberties, even under threat;
- I make these promises solemnly, freely and upon my honour.
Point number 4 states “The health of my patient will be my first consideration”. Furthermore point #8 specifically spells out that sexual orientation should not matter.
In essence the newborn baby is in need of treatment and you are obligated to provide such treatment without consideration of whether the parents are members of the LGBT community.
Quite frankly I am embarrassed for this physician. Do not misunderstand my intention here though. Whether I support the LGBT community or not is irrelevant to this discussion. What is relevant is that a member of the medical community who swore an oath to put the patient first has violated that oath. It is my hope that these words will reach the eyes or ears of physicians who may have had similar thoughts and remind them of the oath that they once swore to uphold. The United States is at a tipping point (quoting Malcolm Gladwell again) where physicians or medical corporations may opt to refuse treatment for infants who happen to be born to LGBT parents. The infant was born into this world and needs someone to care for them from a medical standpoint. Whether their parents choose to be intimate with members of the same sex should never enter the equation and I hope that this is the last report I hear of this behaviour by a member of the medical community. Sadly as I often say hope is not a good plan and I fear that this indeed will not be the last instance we hear of.
The President of the United States no doubt wishes to leave a legacy as he prepares to leave office. Obamacare, a nuclear deal with Iran and a two state solution for Israel and the Palestinians will be great accomplishments if they last. Sadly if he doesn’t weigh in and do something soon the ability of companies, organizations and governments to discriminate against member of the LGBT community will leave a black mark on the Presidency that will be remembered long after the Republicans undo much of what he feels will be his “accomplishments”.
Please Mr. President. Do something.