When legislators play doctor: a local response

This article is a LifeChoice original.

A response to Minkoff, H. & Ecker, J. 2012. When legislators play doctor: the ethics of mandatory preabortion ultrasound examinations. Obstetrics & Gynecology. 120:3, 647-649.

In a landmark ruling for pro-life activists February 2012 marked the month Virginia voted in favour of becoming the 8th state in the U.S to pass the revised ultrasound bill: a bill which requires women seeking abortion to undergo mandatory transabdominal ultrasounds prior to the procedure, as part of a fulfilment of informed consent.

Responding to an increase in favour for this bill in the U.S., a commentary was released in the September 2012 edition of the journal of Obstetrics and Gynaecology by Howard Minkoff (MD) and Jeffrey Ecker (MD), arguing that

‘{…} Legislating imaging procedures inappropriately limits women’s autonomy and undermines the physician-patient relation.’

The article argues, and I agree, that the foundation of informed consent consists of a respect for autonomy, which supports the dual pillars of voluntariness and information.  However, our harmony in opinion stops at this definition.

 

Physician-Patient Relationship

Minkoff and Ecker declare that the ultrasound Bill fails in regards to both the ‘information and voluntariness’ of informed consent, and define information as ‘relevant, non-judgemental and acceptable to the patient.’ Their main argument is that women who seek an abortion have already wrestled with the burdensome issues inherent in their decision, and by consequence, an ultrasound is unnecessary on the grounds of irrelevance. However, Minkoff and Ecker fail to acknowledge that the bill contains a provision in section B, which states that it ‘shall be made to pursue standard medical practices in the community.

As a means of providing relevant information, the role of a physician is to transmit and contextualise the facts. Nothing is more factually correct than viewing an image of what is already occurring inside a pregnant woman’s womb. In a doctor’s duty of following a standard of care, performing an abdominal ultrasound was already part of pre-abortive procedure before the introduction of the bill. However, ultrasound scans were limited to the viewing of only health professionals.

As a parallel example, routine breast-cancer screening procedures require doctors to perform a mammogram, where scanning results are shared and discussed by the doctor with the woman.  The trust forged between a patient and their physician, fostering the physician-patient relationship is based on a mutual agreement that the physician is acting in reason of empirical evidence.  In many other medical scenarios, such as the mammogram example, information and evidence is often shared with the patient. In comparison, nothing is different with the ultrasound bill, which stresses in Section C that physicians are not mandated to show the ultrasound to the patient, but only offer her a chance to view it.

 

Autonomy

I do not seek to argue that state enforced ultrasounds do not impede on personal autonomy, however, I feel that hindering autonomy is by and large the lesser of two evils: acknowledging the existence life. Preserving autonomy is at risk of ignoring a foetus’ right to life. For example, most western States enforce mandatory immunisations of children. This reduces personal autonomy, yet ensures children are able to live disease free.  In this sense, the rights of the child to live a healthy life trump autonomy on immunisations.

Returning to abortion, as ultrasounds are already a routine part of the process, in order to ensure the safety of the patient in the procedure, (according to Planned Parenthood,) the patient’s autonomy has already been inhibited. This fact does not justify a reduction in autonomy, but simply shows that even if the bill didn’t exist, autonomy would still not be preserved.

The preservation of life has always been enshrined in society, where the historical Hippocratic Oath calls for all physicians’ duties in the preservation of life. Although it has been tampered with through modernity, it marks a historical intention to keep life. As argued before, ultrasounds are a current part of the abortion procedure. The state is not acting as a control over personal autonomy per se, but rather calling on the values of the Hippocratic Oath, as an encouragement to view life in order for a woman to make the best informed decision.

Lastly, it should also be considered that it is, perhaps, not in the financial interest of an abortion provider to yield information to their patients. Creating an opportunity for a woman to see the image of her unborn child could possibly cause her to retract on her decision to abort. Considering that Planned Parenthood, the largest abortion provider in the U.S., amasses approximately $1.3 billion in abortion services as of 2010 figures, it’s no wonder trumpets are blaring and tempers are flaring.

Let’s face the facts: for too long have the mysteries of abortion been whispered behind closed doors. Women have consistently been left in the dark on factual information on the proceedings of an abortion. The most truthful information a provider can give women is the picture of her unborn child, illuminating what abortion providers are trying to shadow: life.

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