by Craig Klugman, Ph.D.
A young black family is in the OB ward for a C-section to deliver their second baby. The OB displays overt racism when he asks Pravesh, “What country are you from”? Pravesh responds, “New Jersey.” Post-surgery the mother has pain and some blood in her urine output. The OB ignores her. The ward is stretched and understaffed. The patient worsens. Only when Pravesh returns and herurine is mostly blood is she taken to the OR where the trauma team comes in after finding that she has bled most of her blood volume into her abdomen. Pravesh asks if this would have happened to a white patient. The principle characters talk about the high rate of maternal death in the US, and the much higher rate among women of color. The patient dies.
Since 1997, the rate of maternal mortality in the US has been increasing to its present high of 18 deaths per 100,000 live births. This rate is the highest in the developed world (45thlowest out of 183 nations) but the statistic hides a stark reality: For white women, the rate is 12.4 per 100,000 births, but for black women, the rate is 40 deaths per 100,000 births. The episode ends with a title card: “While tonight’s episode was fictional, it was inspired by the true stories of women who die as a result of childbirth, such as Kira Dixon Johnson”. The episode was based on Johnson’s true story and concludes with footage from the real life husband giving a speech about his experience and the problem of high maternal death in women of color in the U.S.
Accompanied by a man, Lynn comes to the ED after she nearly collapses. Her blood pressure is very high and her fetus’s (39 weeks gestation) blood pressure is rapidly dropping. An emergency C-section gives birth to a healthy baby boy, Robin. However, we soon learn that Lynn is a surrogate for the man in New Jersey. Their surrogacy contract is not legal in New York and according to NY law, the baby is hers. Lynn is unconscious with her blood pressure still high. Her parents, however, can sign a waiver on her behalf to allow the father to take the baby, but they refuse, saying the baby is their last link with their daughter (even though there’s no genetic connection to the child). In family court (in the hospital), the Solomonic judge says that the interstate complications means neither party can have the child, who has to go into foster care while other courts hear the case. The father tells Lynn’s parents that he will withdraw his case because the child needs to grow up with loving parents, not in the foster care system. The parents later choose to honor their daughter’s choice and actions, giving the baby to his father.
Surrogacy laws differ by state and New York is not one of the 11 states with one. However, a new law may change that. As of 2018, New Jersey has legal surrogacy that requires no genetic relationship between the surrogate and child; the raising parents can pay for all medical treatments and living expenses during the pregnancy. The ethics of surrogacy are complex, dealing with autonomy, procreative liberty, gender, commodification of life and women, exploitation, inequality, and parenthood. Also, in this fictional case, the hospital has a psychiatrist deal with the ethical and legal issues instead of a hospital attorney and an ethics consult. Seems like a bad mechanism on a show that desperately needs another character, because for a hospital to work, you need more than just physicians.