Mar 30 2012
Quacks lie. In some ways, that’s what separates us from them. Real doctors are stuck with the messy truth: with bad news, with uncertain outcomes. It’s this reliance on the truth which gives us much of our credibility.
Laws forcing doctors to lie to patients take me back to reading Kundera in the 80s; the hovering fear that everyday actions might bring the authorities to your door. These feelings affect every portion of your life, whether you are a patient or a doctor. Lying in service of the state is pervasively oppressive. Laws requiring doctors to lie have become a popular tactic in the abortion wars.
Let’s look at Texas’s law, it’s requirements, and internal contradictions.
Sec. 171.012. VOLUNTARY AND INFORMED CONSENT.
(a) Consent to an abortion is voluntary and informed only if:
(1) the physician who is to perform the abortion informs the pregnant woman on whom the abortion is to be performed of:
(A) the physician’s name;
(B) the particular medical risks associated with the particular abortion procedure to be employed, including, when medically accurate:
(i) the risks of infection and hemorrhage;
(ii) the potential danger to a subsequent pregnancy and of infertility; and
(iii) the possibility of increased risk of breast cancer following an induced abortion and the natural protective effect of a completed pregnancy in avoiding breast cancer;
(C) the probable gestational age of the unborn child at the time the abortion is to be performed; and
(D) the medical risks associated with carrying the child to term;
We have encountered a problem. Informed consent is a medical term d’art that protects both the patient and the doctor. To the extent possible, a doctor must communicate risks and benefits of a proposed procedure in a way the patient can understand and acknowledge. These risks and benefits are not set in statutes but found in the medical literature. Statistics such as complication rates of various procedures are usually easy to find and to cite.
The statute does not use the medical definition of informed consent but it’s own concoction. It throws in “…when medically accurate…” but then insists that the doctor state information that is counterfactual (that is, a lie). In this section, the most glaring lie is that abortion is associated with breast cancer. It most certainly is not. And where are the “benefits” in “risks and benefits”? It is implied that there are none.
What about the next section?
(2) the physician who is to perform the abortion or the physician’s agent informs the pregnant woman that:
(A) medical assistance benefits may be available for prenatal care, childbirth, and neonatal care;
(B) the father is liable for assistance in the support of the child without regard to whether the father has offered to pay for the abortion; and
(C) public and private agencies provide pregnancy prevention counseling and medical referrals for obtaining pregnancy prevention medications or devices, including emergency contraception for victims of rape or incest;
The above section is slightly murkier. It looks superficially to be innocent enough, perhaps even compassionate. This makes the lie even more dangerous. The section infantalizes the woman seeking an abortion, assuming that she needs this information to make her choice. Likely, she’s already made her choice. It’s not up to a doctor to give information that is clearly designed to topple the patients autonomy. It’s also only somewhat factual. ”Medical assistance may be available…” (emphasis mine). I’m sure that’s very comforting, a real promise of assistance (sarcasm mine). I’m sure that the state can hunt down the father and find a way to make him pay child support (additional sarcasm), assuming the patient feels this is wise, safe, and desired (although the patient’s desires aren’t taken into account here). And then there are “referrals” to agencies that provide pregnancy counseling (often thinly-veiled anti-abortion offices) and to “emergency contraception” for rape and incest. If they are seeking an abortion, it’s a bit late for Plan B. And why only for rape and incest? According to the law, the crime must be reported in order to avoid some of this law’s consequences. This is problematic in ways that would take another full post.
This section assumes that it is economics or assault driving the patient to choose an abortion, that it is not a well thought-out choice by an adult who wishes control over her own body. It makes the woman invisible, except for her womb.
The following section goes on to delineate exactly how the doctor is to perform the state-mandated rape of the patient with an ultrasound probe*. This violation of trust between the physician and patient is too obvious to mention, but mention it I will. It’s bad enough to demand we lie, but to demand we commit rape is, it would seem, obviously bad.
The statute also requires the doctor to give the patient a booklet full of misinformation about abortion with trumped up descriptions of risks, and no discussion of benefits.
The statue does a lot of bad things I haven’t listed, as do similar statues being passed in other states. The point here is not that statues that essentially outlaw abortion, infantalize and shame women, and require forcible penetration are bad. Any sensible person knows this.
The other consequence is the complete destruction of the doctor-patient relationship. If the state can compel a doctor to lie to a patient in one circumstance, it can in any circumstance, and patients will no longer be able to believe anything a doctor says. They would be fools to trust us.
When the state can demand that we violate our basic responsibility to our patient—that of delivering the truth—we are no better than quacks, and deserve no better than quacks.
Here is the ultrasound part of the statue for your revulsion:
(A) the physician who is to perform the abortion or an agent of the physician who is also a sonographer certified by a national registry of medical sonographers performs a sonogram on the pregnant woman on whom the abortion is to be performed;
(B) the physician who is to perform the abortion displays the sonogram images in a quality consistent with current medical practice in a manner that the pregnant woman may view them;
(C) the physician who is to perform the abortion provides, in a manner understandable to a layperson, a verbal explanation of the results of the sonogram images, including a medical description of the dimensions of the embryo or fetus, the presence of cardiac activity, and the presence of external members and internal organs; and
(D) the physician who is to perform the abortion or an agent of the physician who is also a sonographer certified by a national registry of medical sonographers makes audible the heart auscultation for the pregnant woman to hear, if present, in a quality consistent with current medical practice and provides, in a manner understandable to a layperson, a simultaneous verbal explanation of the heart auscultation;
(5) before receiving a sonogram under Subdivision (4)(A) and before the abortion is performed and before any sedative or anesthesia is administered, the pregnant woman completes and certifies with her signature an election form that states as follows:
“ABORTION AND SONOGRAM ELECTION
(1) THE INFORMATION AND PRINTED MATERIALS DESCRIBED BY SECTIONS 171.012(a)(1)-(3), TEXAS HEALTH AND SAFETY CODE, HAVE BEEN PROVIDED AND EXPLAINED TO ME.
(2) I UNDERSTAND THE NATURE AND CONSEQUENCES OF AN ABORTION.
(3) TEXAS LAW REQUIRES THAT I RECEIVE A SONOGRAM PRIOR TO RECEIVING AN ABORTION.
(4) I UNDERSTAND THAT I HAVE THE OPTION TO VIEW THE SONOGRAM IMAGES.
(5) I UNDERSTAND THAT I HAVE THE OPTION TO HEAR THE HEARTBEAT.
(6) I UNDERSTAND THAT I AM REQUIRED BY LAW TO HEAR AN EXPLANATION OF THE SONOGRAM IMAGES UNLESS I CERTIFY IN WRITING TO ONE OF THE FOLLOWING:
___ I AM PREGNANT AS A RESULT OF A SEXUAL ASSAULT, INCEST, OR OTHER VIOLATION OF THE TEXAS PENAL CODE THAT HAS BEEN REPORTED TO LAW ENFORCEMENT AUTHORITIES OR THAT HAS NOT BEEN REPORTED BECAUSE I REASONABLY BELIEVE THAT DOING SO WOULD PUT ME AT RISK OF RETALIATION RESULTING IN SERIOUS BODILY INJURY.
___ I AM A MINOR AND OBTAINING AN ABORTION IN ACCORDANCE WITH JUDICIAL BYPASS PROCEDURES UNDER CHAPTER 33, TEXAS FAMILY CODE.
___ MY FETUS HAS AN IRREVERSIBLE MEDICAL CONDITION OR ABNORMALITY, AS IDENTIFIED BY RELIABLE DIAGNOSTIC PROCEDURES AND DOCUMENTED IN MY MEDICAL FILE.
(7) I AM MAKING THIS ELECTION OF MY OWN FREE WILL AND WITHOUT COERCION.
(8) FOR A WOMAN WHO LIVES 100 MILES OR MORE FROM THE NEAREST ABORTION PROVIDER THAT IS A FACILITY LICENSED UNDER CHAPTER 245 OR A FACILITY THAT PERFORMS MORE THAN 50 ABORTIONS IN ANY 12-MONTH PERIOD ONLY:
I CERTIFY THAT, BECAUSE I CURRENTLY LIVE 100 MILES OR MORE FROM THE NEAREST ABORTION PROVIDER THAT IS A FACILITY LICENSED UNDER CHAPTER 245 OR A FACILITY THAT PERFORMS MORE THAN 50 ABORTIONS IN ANY 12-MONTH PERIOD, I WAIVE THE REQUIREMENT TO WAIT 24 HOURS AFTER THE SONOGRAM IS PERFORMED BEFORE RECEIVING THE ABORTION PROCEDURE. MY PLACE OF RESIDENCE IS:__________.
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