Is it just me, or is this one of the most bizarre legislative sessions in Alabama’s recent history? It seems as if once they managed to pass HB 56, they decided to go for broke and introduce every outrageous bill they could imagine! I was busy this past week gathering information about the planned closure of Alabama’s major psychiatric hospitals in September (stay tuned). Then Friday afternoon, I started getting phone calls from local TV stations, asking for an interview about SB12. Please stop a minute and read the actual bill if you haven’t already. Don’t go just on what you see in the press summaries.
I was a little taken off guard by the requests. I’m a pediatrician, not an Ob-Gyn. I have no training in abortions and never witnessed one—I did deliver some babies in medical school, but that’s it. All I can think is that I’ve gotten a reputation for sticking my neck out.
I said yes. I didn’t get to see the one on channel 19, so I don’t know which parts they picked to air. I said a lot on the one by 54 that didn’t get through because of time limits. So here is my effort at reviewing the bill. This is a very long post, the longest I’ve ever done. I want to get every nuance of it in one place. Please chime in if I’ve missed a part. And feel free to copy and quote any part you like, with or without attribution.
SB12 would require physicians or their ultrasound technicians to perform an ultrasound on women seeking abortion, while narrating the details of the image, before the women give consent to the abortions.
Let’s take it apart. First, there is a requirement that a physician or ultrasound technician must perform a trans-vaginal ultrasound instead of an abdominal one (the bill says abdominal but it would really be pelvic) if the image would be clearer. This is most likely in the very earliest pregnancies.
From the woman’s perspective, she is being required to undergo a medically unnecessary procedure before having the right to consent to a fully legal medical treatment. I believe it meets the legal definition of rape. See this well-done discussion of how rape is defined in court. Rape is clearly understood in courts as not requiring physical force—coercion and manipulation alone is sufficient. An example is given, in date rape, of the assailant saying things like “if you really loved me, you’d have sex with me.” The woman is not considered to have given actual consent in that case. So a doctor saying to a patient “you have to let me stick this probe into your vagina before I can give you medical treatment” would certainly be coercion and would count as rape.
From the physicians’ perspective, which I’m not seeing considered much online, the bill forces them to become rapists before being able to perform work they are legally licensed to do. Otherwise, they will be guilty of a Class C felony, with jail time. The doctors I know who perform abortions have entered into this dangerous job, at risk of being shot and killed, because they feel a strong duty to women—they don’t want to see them dying from botched coat hanger jobs. So if they stop doing the procedures to avoid being rapists, they will feel that they are abandoning their patients to death.
This certainly doesn’t square with another current conservative bill in Alabama, SB105, the Health Care Provider Conscience Act!
One alternative the physicians and women would have? Wait longer in the pregnancy, until the fetus is more clearly visible by pelvic ultrasound. This could present more medical risk to the woman. I have to wonder if the bill writers were aware of this possibility and did it intentionally.
When I used the word “rape” on my Facebook posts, someone commented that it wasn’t rape because the woman didn’t have to go to the abortion clinic. We have to expect that argument, despite the wrongness of it. I countered by saying that people don’t have to have any number of elective procedures, such as tooth extractions, vasectomies or cosmetic surgeries. So would it be ok to require vaginal or rectal penetration before these procedures, just because they are elective? The commenter said that these ultrasounds were “related” to the abortion whereas the others weren’t. But that isn’t true—he was confused because it involves the same body part. The ultrasound is in no way related to the following abortion, medically speaking.
In the same vein, I don’t technically have to go out to a movie at the theater—does this mean I can be subjected to a crime, because my behavior is optional?
If we are going to make it legal to deter procedures we don’t like by requiring other procedures first, wow does that open up a can of worms! Some people don’t like Viagra—so they could require doctors to give men painfully prolonged erections before giving a prescription, in order for them to “know and see” the possible side effect.
Ok, on to the next outrageous element. In section 2, where the terms are defined, the bill specifically includes not only elective pregnancy termination but removal of an ectopic pregnancy or removal of a “dead unborn child who died as a result of natural causes, accidental trauma, or a criminal assault on the pregnant woman or her unborn child.” It is true that in medical terminology, what laypersons call a miscarriage is technically a “spontaneous abortion.” But, really?? Why on earth did Scofield include this part?
For those of you who don’t know, an “ectopic” pregnancy is one where the fetus has implanted somewhere it will not be able to live to term. This includes the fallopian tubes, the ovary itself, the area of the uterus leading into the fallopian tubes (too small to hold a baby), the abdominal cavity, or the cervix. These are very scary—not only is it impossible for the fetus to survive, but the woman will bleed to death in a hurry if the fetus is not removed before whatever part it is in ruptures. If she is already bleeding, the exception for medical emergencies would apply—but the medical emergency category is very narrowly written.
This horrific element of the bill would require that a woman who may have become pregnant intentionally and with great longing for a child would have to be told in detail about the dead body of her baby, or the live body of her ectopic fetus, before it could be removed. It seems to me that most of these women would have to have ultrasounds for medical reasons, prior to surgery. But the doctor must point out the parts—“here is the heart, no longer beating, of your dead baby. Here are the fingers, let’s count them. Here is his mouth and nose.”
What sort of permanent psychological damage might that cause to a woman under the circumstances? How about the doctor, who is now being required not just to rape but to inflict torture?
What sort of legislator would even THINK to insert such a requirement? I’m going to hope Scofield didn’t write it himself but was provided the text by one of the conservative lobbyist groups. And I’m hoping he also didn’t really read or think about what it said. Whoever actually thought about it and wrote it is a sadist. This part of the bill does nothing to address elective abortions—it can only be to torture women whose babies have already died. Those who vote yes may not have read the actual bill, but if they did and if they understood it, they are also sadists. Is there some ground for impeachment?
I am so appalled by this incomprehensible bit of cruelty that I had to take a break before returning to the computer. Now let’s look at the exceptions for emergency exemption from the ultrasound requirement. If an immediate abortion is required to prevent death or “irreversible physical impairment of a major bodily function”, without time for rape or torture first, there doesn’t have to be an ultrasound. In this bill, “major bodily function” specifically excludes psychological or emotional conditions.
There you have it—Senator Scofield and his buddies do not consider the brain to be an important body part. They may not be aware of the significant advances in science demonstrating actual structural changes in the brain as a result of major depression or some anxiety disorders. They are falling right in line with corporate health insurance, which almost always tries to treat the brain as a minor, dispensable organ. And, based on what I’m seeing in this legislative session, it is true that you don’t need a fully functioning brain to be elected to office.
It is not an emergency, according to Scofield,” if based on a claim or diagnosis that the woman will engage in conduct which she intends to result in her death.” Even though a person diagnosed as suicidal is considered by every insurer and hospital as requiring emergency treatment, Scofield says that doesn’t count. This means that if a doctor is fully aware that a woman is suicidal and that if the mandated ultrasound is performed, she is likely to kill herself, that doctor must go ahead and coerce her anyway. It is a crime to encourage another person to kill themselves—in some states it is called manslaughter. Under this bill, doctors must rape, torture, and commit manslaughter in order to practice their professions, or be put in jail. I’m beginning to think Scofield hates not just women but doctors as well.
I understand Scofield may be retracting the part about vaginal probes. Let’s say he also removes the parts I’ve just discussed, leaving only the requirement to do a abdominal (pelvic) ultrasound and narrate it before elective abortion of a living fetus in the safe area of the uterus, with exceptions to include psychological trauma and suicide risk.
I suspect the final version of the bill will be much watered down. Is it still a problem? Yes.
In general, it is better to avoid legislating medical practice, with a few exceptions for matters of public health. Medicine, if properly practiced, is based on evidence. Much of what I was taught in medical school, 19 years ago, has changed because of new evidence. These days, by the time a medical textbook is printed, it is out of date. The law can be slower and harder to change than a textbook. We can legislate morality, it turns out—we do it all the time. But we can’t legislate science.
Decades ago, we thought x-rays were perfectly safe. We even used them to size our shoes. Now we know better. Acetaminophen, used in over the counter pain medicines, was once thought relatively safe—now we have evidence it can cause liver problems even at the correct dose, may contribute to high blood pressure, and may even be a factor in asthma. Ultrasounds, so far as we can tell, are very safe—but what if we’re wrong? Suppose we find out they cause some unexpected side effect, maybe decades later? It’s generally better not to do any medical test or treatment, whether that’s aspirin or a CT scan, unless there is a definite medical benefit. At the least, it is a waste of money and resources we need for other purposes.
Channel 19, WHNT, says that Senator Greg Reed, who is on the health committee, is VP of a company that sells ultrasound equipment. Could there be a profit motive involved as well?
The better way to regulate medical care is through oversight by licensing boards. Lawsuits provide a painful but probably necessary additional means of reining in bad doctors. There are also more general laws requiring informed consent before surgical procedures, including abortions. Which brings me to my next point.
This bill, titled “The Right to Know and See”, presumes that women do not know what they are doing when they come to the doctor for abortion. This is absurd and insulting to our intelligence. Of course they know—of course they have agonized and sweated and cried about it. I know several women who have had abortions for various medical or personal reasons, and there is not one who made the decision lightly. It’s an awful, wrenching position to be in, and no one but that particular woman can possibly know what it is like.
I’m not sure if Roe v. Wade could have been settled with different reasoning. Using viability and personhood as a criterion may have been a huge error. An analogy called the “dying violinist” has been proposed instead, although it certainly has flaws. The best I can do is say it is a terribly complicated matter duplicated nowhere else in ethics or law. To me, the question is: can we really force one human being to give her very body over to another, for any period of time? I do not think we have that right.
To cap the whole thing off, Scofield and his supporters are spouting off some questionable statistics. They are saying that if shown the ultrasound, 95% of women will change their minds and not abort. I wondered about that number so I went hunting on Medline. Lo and behold, there are no such data, at least not published in a peer-reviewed journal. Instead, I found only one study, done recently in Canada. 350 women seeking abortion were asked if they wanted to see the images (remember, the law already says we can request our medical records). Interestingly, the majority said yes, and they also said women should be offered the option. How many, after seeing the images, changed their minds?
Exactly zero. So where is this 95% coming from? My guess is from pseudo- abortion clinics that lure women in on false pretenses and assault them with pro-fascist techniques. I say pro-fascist, not pro-life, because I don’t think life has much to do with most of them—it is about power, not the baby. The unfortunate women who get caught in this trap would probably say anything to get these folks to shut up. How many leave and find a real abortion clinic? I doubt if they keep track. The truth is more likely the result found in the Canadian study—women who have already thought through the decision know what they have decided to do. If this bill passes, it will be unlikely to reduce our abortion rate.
Personal disclosure: I have two children, both planned and wanted. I have never had an abortion or been in a position where I was faced with that choice. I am not pro-abortion—I think it is a dreadfully sad event. I am pro-contraception and safe sex. I am 48 and peri-menopausal, hot flashes and all—my husband and I take precautions, and we have no plans for more children. What would I do if our precautions failed? I don’t know. I have inflammatory arthritis in my sacro-iliac joints and spine that would make pregnancy very painful. Pregnancy for me was miserable, even knowing how much I wanted the end result—I threw up almost the entire time. I work about 70 hrs a week on average, help care for a disabled family member, and have multiple other obligations to my community I couldn’t maintain in that state. If I became pregnant next week, there is a strong possibility I would decide to abort. It would be a traumatic decision and experience, and I would have no need for my doctor to further damage me.
This is a disastrous bill, on all counts. It is an affront to women and their physicians. Please contact your legislators today and tell them that if they vote yes, you will do everything in your power to put them out of office.