In the 1970s, for every 100,000 live births, there were 27 birth-related maternal deaths. This mortality rate, though high, rarely led to medical disputes. In the 1990s, the maternal mortality rate dropped to 10 per 100,000 live births, indicating a marked improvement of gynecological healthcare standards. Today, however, it seems unavoidable that deaths linked to childbearing will make the headlines, as family members protest by publicly tossing ghost money to vilify the doctor allegedly guilty of malpractice or collude with gangs to make threats, all in order to gain compensation and justice.
Gaining "justice" normally means that the relatives of the deceased ask for compensation from the doctor for mental or physical suffering resulting from the doctor's negligence. If it is not possible to anticipate the complication, as in the case of cerebral palsy, shoulder dystocia, or amniotic fluid embolism (AFE), then the doctor has done nothing wrong. Maternal mortality due to AFE is more than 90 percent, even when proper emergency treatment is provided. Is it reasonable that a physician should be held fully responsible in such cases?
I have witnessed many medical school graduates shy away from gynecology, at their parents' urging, when they have to choose a speciality. The reason is simple: malpractice lawsuits in this speciality are more frequent than in most others. When the general public begins to voice doubts regarding the fairness and reasonableness of malpractice lawsuits, then it is time to develop measures and mechanisms to address such disputes.
I propose that a "Taiwanese Women's Childbearing Risk Protection Fund" be established in the hopes of achieving the following objectives:
First, providing reasonable compensation for pregnant women or their families in the event that the women die or suffer grave injuries during labor.
Second, safeguarding the reputation and dignity of obstreticians/gynecologists who may not be at fault in the relatively rare cases involving AFE (one in 50,000 births), shoulder dystocia (eight in 10,000 births) and cerebral palsy (four in 1,000 births). Such complications are impossible for physicians to anticipate.
Since there is no way of predicting the occurrence of such complications, and it is difficult for physicians to sidestep them when they do arise, doctors should not have to shoulder responsibility for them.
When discussing the establishment of this fund, it is important to keep in mind that compensation awarded to families in cases of grievous injury to the infants (those involving cerebral palsy or other kinds of severe brain damage due to oxygen deprivation in fetuses) should not be significantly less than in cases of death. This is because the pain and suffering of family members over such injuries is often more severe than in the case of death.
Such a fund also needs to be carefully administered. It must not be treated as regular medical insurance; otherwise, the money will dry up quickly. This means that pregnant women must be made to understand the limits and requirements of such a fund so disputes can be avoided.
Because the fund would be in the interests of both patient and doctor, both sides should contribute to its establishment. As to the questions of who should contribute how much, and if all pregnant women should be required to pay into the fund (considering that some may suffer a miscarriage), many factors will need to be weighed in arriving at a fair and reasonable arrangement.
The sooner such a fund is established, the sooner the health and well-being of mothers and their children can be better provided for, and the sooner OB-GYN doctors can safeguard their reputations and dignity.
Juang Chi-mu is the doctor in charge of the obstetrics and gynecology department at Taipei Veterans General Hospital.
Translated by Lin Ya-ti and Paul Cooper
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