The Virginia Abortion Law
The recent highly publicized Virigina bill regarding abortion has been causing quite a bit of stir. OK, that's an understatement. However, in most of the stories and essays I've read there seems to be quite a bit of missing information. Shortly after the story broke, a woman of my acquaintence expressed her confusion at the reaction saying simply, "In my experience, an ultrasound is part of the procedure." In response, a number of people, like my friend L have said things like, "An ultrasound that is actually part of the procedure is not the same as an ultrasound administered to harass the patient. There is no real comparison." These fairly typical responses point to the heart of the matter in more ways that one.
First of all, the bill approved by the Viriginia Senate on February 28th was not a new law. It was an amendment to existing law. That existing law (Section 18.2-76 of the Code of Virginia) concerns informed consent. It already required that a woman seeking an abortion be advised of the gestational age of the fetus. 98% of Planned Parenthood clinics use tranvaginal ultrasounds (the part of the bill being touted as controversial) to determine gestational age. What changes this amendment are two things:
a) That the woman be offered the opportunity to see the image (and the language very clearly states that she may decline).
b) That the information be added to her medical file where it would be available to future care providers. This second part is important. I'll get back to it in a minute.
Now, for the pertainent changes to make any sense, language must be added indicating that an ultrasound is to take place, and the only way to do that, is to require it. As noted, Planned Parenthood already performs TVUS as part of abortion preparation (usually the day before) in 98% of patients (I don't know why not in the other 2%, unless perhaps they are women seeing the "day after" pill). It may well be that there are other, less meticulous, abortion providers than Planned Parenthood who need to be compelled to raise their standards to that Planned Parenthood, I really can't say. Given that that is the case, all the hysterical rhetoric about this bill amounting to state-sanctioned rape is precisely that: hysteria (and yes, I am well aware of the irony involved in chosing that particular word). The TVUS are note given to harass the patient: they are medically necessary and ALREADY COMMON PRATICE.
The real issue is the requirement that the woman be given the opportunity to view the image. The bill's sponsors and supporters have been honest that they believe this will lessen the number of women who actually choose to go through with an abortion. I'm not the first to say the opposition is being a little less than forthright in shifting attention from the full-disclosure aspect to the diagnostic procedure which is standard, but which can be graphically re-construed as something else entirely. If abortion is truly a choice, then it behooves providers to furnish women with ALL the information regarding both the procedure and the pregnancy. To do otherwise is to treat a woman as an irrational child, which is completely contrary to the spirit and the goals of feminism.
As for the second innovation of the Virginia law revision (placing the records in the woman's medical file), I am also hearing this framed as "harrasment" and an attempt to "shame" the woman. I submit that it is not. It would only be shameful if the woman was doing something shameful, but if abortion is a legitimate choice, then there should be nothing shameful or harrasing about the record of the procedure being placed in the file.
Whether one believes that abortion is a harmless procedure or that it is murder, one fact remains in common: it is a medical procedure. ALL medical procedures carry an element of risk. We undergo them because we judge the benefits to outweigh the risks. But a favourable risk-benefit analysis does not make the risk magically vanish. This is why full disclosure is ethicially indispensible. Futhermore, ALL medical procedures alter us to some degree. This is why information about past illnesses, surgeries and injuries are placed in our medical files: so that future physicians who treat us have accurate information and do not overlook something, or pursue a course of treatment that could harm us because something done previously. Abortion is no different in this respect. The various methods carry various degrees of risk to the woman. Death, although rare, can occur even in "safe and legal" abortions. [1] Common complications are hemorrhage, [2] laceration of the cervix, [3] menstrual disturbance, [4] inflammation of the reproductive organs, [5] bladder or bowel perforation, [6] and serious infection. [7] These are managable, but require follow-up care. Other risks (which may surface only at a later date) include sterility (which may or may not be a concern, it depends on the woman), [8] complications to future pregnancies (including increased risks of either ectopic pregnancy or miscarriage), [9] and also increased risk of certain woman's cancers, particularly breast cancer. [10] Why this is pertainent to the Viriginia law is simple, although rarely mentioned: These risks increase with the duration of the pregnancy (i.e. gestational age of the fetus) before the abortion. [11] Therefore, including this information in a woman's medical file is medically valid.
I have read impassioned criticism of this bill to admend the Viriginia law which dismiss those who wrote it as "ideologues." Given that the TVUS are already part of the procedure, given that full disclosure is in fact relevant to choice, and given that making the information available to a woman's other doctor(s) is medically warranted for follow-up care and potential future complications, it seems to me that those who are chosing to oppose this laws on the grounds that it is "invasive" and "harrasing" are no less dogmatic and blindly partisan in their ideology. The pro-choice rhetoric is "legal, safe, and rare." This law is in keeping with all three of those goals, so the only real reason for opposing it would seem to be the ideology of those who proposed it, which painfully highlights the partisan nature of civil discourse in the United States today.
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Notes:
1. Between 1973-1992, 200 women died from legal abortions in the United States. I'm looking for more up-to-date numbers. This information comes from: Lawson , H. et al, "Abortion Mortality U.S., 1972-1987," American Journal of Obstetrics and Gynecology, Vol. 171, No. 5 (November 1994), pp. 1365-1352. And: Morbidity and Mortality Weekly Report (CDC), "Abortion Surveillance - U.S., 1989, Vol. 141, No. 55-5, September 4, 1992.
2. Kenneth F. Schulz, David A. Grimes, Willard Cates, Jr., "Measures to Prevent Cervical Injury During Suction Curettage Abortion," The Lancet, May 28,1983, p. 1182.
3. Phillip G. Stubblefield, "First and Second Trimester Abortion," in Gynecologic and Obstetric Surgery, ed. David H. Nichols (Baltimore: Mosby, 1993) p. 1023-1024, and Steven G. Kaali, M.D., et al, "The frequency and management of uterine perforations duing first-trimester abortions," American Journal of Obstetrics and Gynecology, August 1989, pp. 406-408.
4. Stubblefied, ibid, p. 1023
5. L.H. Roht, et al, "Increased Reporting of Menstrual Symptoms Among Women Who Used Induced Abortion," American Journal of Obstetrics and Gynecology, Vol. 127 (1977), p. 356.
6. Ibid.
7. David N. Danforth, Ph.D., M.D., ed., et al, Obstetrics and Gynecology, 5th ed. (Philadelphia: J.B. Lipincott, 1986), pp. 217, 257, 382-383. See also Jack Pritchard, et al, Williams Obstetrics, 17th ed. (Norwalk, CT: Appleton-Century-Crofts, 1985), p. 484.
8. Danforth, cited above, p. 887, and David H. Nichols, M.D., Gynecologic and Obstetric Surgery (St. Louis: Mosby-Year Book Inc., 1993), p. 260, and Leon Speroff, Robert H. Glass, Nathan G. Kase, Clinical Gynecological Endochrinology & Infertility (Baltimore: Williams & Wilkins, 1983), pp. 156-157, and Anastasia Tzonou, et al, "Induced abortions, miscarriages, and tobacco smoking as risk factors for secondary infertility," Journal of Epidemiology and Community Health, Vol. 47 (1993), p. 36.
9. A. Levin, et al, "Ectopic Pregnancy and Prior Induced Abortion," American Journal of Public Health, Vol. 72, No. 3 (March 1982), pp. 253-256.
10. Janet Daling, et al, "Risk of Breast Cancer Among Young Women: Relationship to Induced Abortion," Journal of the National Cancer Institute, Vol. 86, No. 21 (November 2, 1994), pp. 1584-1592.
11. Pritchard, cited in note 7, p. 483.
First of all, the bill approved by the Viriginia Senate on February 28th was not a new law. It was an amendment to existing law. That existing law (Section 18.2-76 of the Code of Virginia) concerns informed consent. It already required that a woman seeking an abortion be advised of the gestational age of the fetus. 98% of Planned Parenthood clinics use tranvaginal ultrasounds (the part of the bill being touted as controversial) to determine gestational age. What changes this amendment are two things:
a) That the woman be offered the opportunity to see the image (and the language very clearly states that she may decline).
b) That the information be added to her medical file where it would be available to future care providers. This second part is important. I'll get back to it in a minute.
Now, for the pertainent changes to make any sense, language must be added indicating that an ultrasound is to take place, and the only way to do that, is to require it. As noted, Planned Parenthood already performs TVUS as part of abortion preparation (usually the day before) in 98% of patients (I don't know why not in the other 2%, unless perhaps they are women seeing the "day after" pill). It may well be that there are other, less meticulous, abortion providers than Planned Parenthood who need to be compelled to raise their standards to that Planned Parenthood, I really can't say. Given that that is the case, all the hysterical rhetoric about this bill amounting to state-sanctioned rape is precisely that: hysteria (and yes, I am well aware of the irony involved in chosing that particular word). The TVUS are note given to harass the patient: they are medically necessary and ALREADY COMMON PRATICE.
The real issue is the requirement that the woman be given the opportunity to view the image. The bill's sponsors and supporters have been honest that they believe this will lessen the number of women who actually choose to go through with an abortion. I'm not the first to say the opposition is being a little less than forthright in shifting attention from the full-disclosure aspect to the diagnostic procedure which is standard, but which can be graphically re-construed as something else entirely. If abortion is truly a choice, then it behooves providers to furnish women with ALL the information regarding both the procedure and the pregnancy. To do otherwise is to treat a woman as an irrational child, which is completely contrary to the spirit and the goals of feminism.
As for the second innovation of the Virginia law revision (placing the records in the woman's medical file), I am also hearing this framed as "harrasment" and an attempt to "shame" the woman. I submit that it is not. It would only be shameful if the woman was doing something shameful, but if abortion is a legitimate choice, then there should be nothing shameful or harrasing about the record of the procedure being placed in the file.
Whether one believes that abortion is a harmless procedure or that it is murder, one fact remains in common: it is a medical procedure. ALL medical procedures carry an element of risk. We undergo them because we judge the benefits to outweigh the risks. But a favourable risk-benefit analysis does not make the risk magically vanish. This is why full disclosure is ethicially indispensible. Futhermore, ALL medical procedures alter us to some degree. This is why information about past illnesses, surgeries and injuries are placed in our medical files: so that future physicians who treat us have accurate information and do not overlook something, or pursue a course of treatment that could harm us because something done previously. Abortion is no different in this respect. The various methods carry various degrees of risk to the woman. Death, although rare, can occur even in "safe and legal" abortions. [1] Common complications are hemorrhage, [2] laceration of the cervix, [3] menstrual disturbance, [4] inflammation of the reproductive organs, [5] bladder or bowel perforation, [6] and serious infection. [7] These are managable, but require follow-up care. Other risks (which may surface only at a later date) include sterility (which may or may not be a concern, it depends on the woman), [8] complications to future pregnancies (including increased risks of either ectopic pregnancy or miscarriage), [9] and also increased risk of certain woman's cancers, particularly breast cancer. [10] Why this is pertainent to the Viriginia law is simple, although rarely mentioned: These risks increase with the duration of the pregnancy (i.e. gestational age of the fetus) before the abortion. [11] Therefore, including this information in a woman's medical file is medically valid.
I have read impassioned criticism of this bill to admend the Viriginia law which dismiss those who wrote it as "ideologues." Given that the TVUS are already part of the procedure, given that full disclosure is in fact relevant to choice, and given that making the information available to a woman's other doctor(s) is medically warranted for follow-up care and potential future complications, it seems to me that those who are chosing to oppose this laws on the grounds that it is "invasive" and "harrasing" are no less dogmatic and blindly partisan in their ideology. The pro-choice rhetoric is "legal, safe, and rare." This law is in keeping with all three of those goals, so the only real reason for opposing it would seem to be the ideology of those who proposed it, which painfully highlights the partisan nature of civil discourse in the United States today.
* * * * * * * * * *
Notes:
1. Between 1973-1992, 200 women died from legal abortions in the United States. I'm looking for more up-to-date numbers. This information comes from: Lawson , H. et al, "Abortion Mortality U.S., 1972-1987," American Journal of Obstetrics and Gynecology, Vol. 171, No. 5 (November 1994), pp. 1365-1352. And: Morbidity and Mortality Weekly Report (CDC), "Abortion Surveillance - U.S., 1989, Vol. 141, No. 55-5, September 4, 1992.
2. Kenneth F. Schulz, David A. Grimes, Willard Cates, Jr., "Measures to Prevent Cervical Injury During Suction Curettage Abortion," The Lancet, May 28,1983, p. 1182.
3. Phillip G. Stubblefield, "First and Second Trimester Abortion," in Gynecologic and Obstetric Surgery, ed. David H. Nichols (Baltimore: Mosby, 1993) p. 1023-1024, and Steven G. Kaali, M.D., et al, "The frequency and management of uterine perforations duing first-trimester abortions," American Journal of Obstetrics and Gynecology, August 1989, pp. 406-408.
4. Stubblefied, ibid, p. 1023
5. L.H. Roht, et al, "Increased Reporting of Menstrual Symptoms Among Women Who Used Induced Abortion," American Journal of Obstetrics and Gynecology, Vol. 127 (1977), p. 356.
6. Ibid.
7. David N. Danforth, Ph.D., M.D., ed., et al, Obstetrics and Gynecology, 5th ed. (Philadelphia: J.B. Lipincott, 1986), pp. 217, 257, 382-383. See also Jack Pritchard, et al, Williams Obstetrics, 17th ed. (Norwalk, CT: Appleton-Century-Crofts, 1985), p. 484.
8. Danforth, cited above, p. 887, and David H. Nichols, M.D., Gynecologic and Obstetric Surgery (St. Louis: Mosby-Year Book Inc., 1993), p. 260, and Leon Speroff, Robert H. Glass, Nathan G. Kase, Clinical Gynecological Endochrinology & Infertility (Baltimore: Williams & Wilkins, 1983), pp. 156-157, and Anastasia Tzonou, et al, "Induced abortions, miscarriages, and tobacco smoking as risk factors for secondary infertility," Journal of Epidemiology and Community Health, Vol. 47 (1993), p. 36.
9. A. Levin, et al, "Ectopic Pregnancy and Prior Induced Abortion," American Journal of Public Health, Vol. 72, No. 3 (March 1982), pp. 253-256.
10. Janet Daling, et al, "Risk of Breast Cancer Among Young Women: Relationship to Induced Abortion," Journal of the National Cancer Institute, Vol. 86, No. 21 (November 2, 1994), pp. 1584-1592.
11. Pritchard, cited in note 7, p. 483.