A pregnant 16-year-old in the Dominican Republic took center stage in the abortion debate when she died last Friday of leukemia complications amid reports that doctors had delayed chemotherapy out of fear that it could terminate her pregnancy. The Dominican Republic has a strict anti-abortion law.
But the young woman's doctor at Semma Hospital in Santo Domingo told ABCNews.com that the hospital had postponed chemotherapy not because of the country's abortion ban but because it was waiting for her bone marrow test results to come back from a hospital in New Jersey to determine what kind of leukemia she had.
The young woman, whose name has not been released, was admitted to the hospital on July 2, Dr. Tony Cabrera told ABCNews.com. She told doctors she'd missed her period, and they immediately gave her a blood test and pelvic sonogram to determine she was pregnant.
Since chemotherapy interrupts tumor progression by halting the rapid division of cancer cells, "it's likely to also have an adverse effect on a rapidly dividing organism, such as an embryo," said Christina Chambers, at the Organization of Teratology Information Specialists' Collaborative Research Center in San Diego.
Dr. Lauren Streicher, an obstetrician at Northwestern University Hospital in Chicago, said doctors practicing in the United States generally recommend that cancer patients requiring chemotherapy terminate their pregnancies in their first trimester, "given the limitation of information about what generally happens at 10 weeks."
The young woman's mother, Rosa Hernandez, had urged doctors to give her daughter an abortion so she could undergo chemotherapy immediately, according to CNN, but Article 37 of the Dominican Republic's constitution prohibits abortion, claiming "the right to life is inviolable from conception until death." The doctors did not perform an abortion.
"My daughter's life is first. I know that [abortion] is a sin and that it goes against the law ... but my daughter's health is first," Hernandez told CNN in July.
Cardinal Nicolas de Jesus Lopez Rodriguez, an archbishop in Santo Domingo, spoke out about the case after a Mass in late July, saying that a "direct abortion" was wrong, but "everything possible" should be done to save the life of this young woman, according to the news organization Dominican Today.
"Her situation can be saved, but we don't agree with performing an abortion directly," Rodriguez said.
Once the doctors received the test results from the Carol G. Simon Cancer Center in Morristown, N.J., they learned their patient had acute lymphoblastic leukemia, which Cabrera said had a "very poor prognosis," especially for children more than 10 years old. (For its part, the Carol G. Simon Cancer Center has not confirmed that it ever processed these tests.)
The doctors started chemotherapy when the young woman was nine weeks' pregnant, just as her first trimester was ending, in late July, Cabrera said.
Speaking generally, Dr. Brian Druker, an oncologist at the Oregon Health and Science University, said that a short delay in administering chemotherapy should not in itself drastically affect a patient's outcome.
"A delay of a couple of weeks should have no bearing on the outcome unless there was a complication that made someone's medical condition less able to handle therapy," said Druker.
But last Thursday night, the young patient had begun to cough up blood and was moved to the intensive care unit, where she was placed on a respirator, Cabrera said. She also had vaginal bleeding and severe respiratory distress.
She underwent a blood transfusion, but by 2 a.m. Friday, she'd miscarried, Cabrera said. A few hours later, she went into cardiac arrest. Doctors were able to revive her, but she died at 8 a.m. Friday.
Death was attributed to hypovolemic shock (not enough blood or fluid), alveolar hemorrhage, acute respiratory distress syndrome and acute lymphoblastic leukemia, Cabrera said.
After her daughter's death, Hernandez told CNN, "They have killed me. I'm dead, dead. I'm nothing. … She was the reason for my existence. I no longer live. Rosa has died. Let the world know that Rosa is dead."