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165 thoughts on “Lying for the State

  1. art malernee dvm says:

    Lying to obtain hours of CE credits to keep your active license

    In accordance with rule 61g18-16.002 (2) (a),F.A.C. continuing education requirements for active status license renewals, one (1) hour equals a minimum of fifty (50) minutes and a maximum of (60) minutes. Total hours of lecture time cannot be added up and divided into fifty (50) minute intervals to obtain 1 hour credit for each 50 minute interval. Continuing education hours are based on this rule. If the meeting is from 8:00 a.m. to 12:00 p.m. the continuing education credit would be four hours.

    State boards are awarding 5 hours of CE credits for attending state board meeting that start at eight in the morning and end at or before noon. The afternoon hour of CE credit is awarded after the board in the morning has found those they compete with in business are guilty of not having enough CE hours.

    art malernee dvm
    fla lic 1820

  2. DW says:

    Gretemike, you are missing my point utterly. I agree with absolutely everything you say about the ultrasounds. Perhaps you have not read the comment thread through. The law is an abomination. Ultrasounds for the purpose of dissuading someone from having an abortion should not happen. What I am disagreeing with is that it is rape. Get it? You don’t argue my point above – you just go back to arguing against the law. I don’t need to be convinced about the law. The point we were disputing was whether it was rape. This proposition simply mixes up categories, and pisses off rape victims. Do you get what I am saying? There are lots of things that are bad and wrong in the world that should not happen. Not all of them are rape. If my car or house is broken into, I will be very upset, feel violated etc. You wouldn’t need to convince me that we need laws against robbery and vandalism or breaking and entering. You’d need way more convincing arguments than you’ve come up with so far to convince me that I’ve been raped if my car or house is broken into. They are different things.

  3. DW says:

    “Mandating it for all abortions has no medical purpose whatsoever, and your claim to the contrary is disingenuous.”

    I did not make that claim.

  4. nybgrus says:

    Rape is not a procedure in a doctor’s office. Even if the events occurring appear superficially the same, what is going on is not the same thing. The doctor isn’t raping anyone, the doctor is performing a well-known medical procedure. The patient understands what it is for, its medical purpose. She is not being physically restrained, the doctor does not have a weapon, the doctor did not grab her unexpectedly, the doctor is not telling her he will kill her if she doesn’t lie still. The doctor isn’t doing it to humiliate her or control her or terrify her … but to get images of the fetus. Do I really need to go on? The whole argument is disingenuous.

    Rape involves the coerced or otherwise non-consensual insertion of anything into a genital opening. I think we can all reasonably agree on that.

    The easiest form of rape to see is the one DW keeps describing – a bunch of thugs jump out of an alley and commit the crime.

    Intentionally intoxicating someone with, say, rohypnol and then having sex is also rape.

    If a woman walked into a lawyer’s office and once seated he calmly pulled out a gun and pointed it at her, and stated she would be required to have sex with him or he would shoot her is also rape. Regardless of whether he actually would have shot her, hit her or hurt her in any way, yelled, or was otherwise like the “classic” rape that DW refers to.

    If a police officer pulls over a woman for speeding and says he will give her the ticket unless she has sex with him, that is rape. He is using his authority and dangling carrot to coerce her into allowing her vagina to be penetrated which she otherwise would not have allowed.

    So when a woman comes to a physician’s office, and is told by the state, through the doctor, that she cannot have the abortion she wants without subjecting herself to a procedure which involves the insertion of something into a genital openening we have…. rape. The authoritarian dangling of a carrot to coerce a woman into allowing her vagina to be penetrated which she otherwise would not have allowed. The procedure is not medically necessary (in this case) and without this legislation, the woman would have had access to the abortion she wanted. The fact that it is not (on the part of the state nore the doctor) intended as an act to derive sexual gratification means nothing. There are plenty of rapists for whom the act itself is not about sexual gratification but the exertion of power. For the woman, the distinction is utterly moot. It is also immaterial that it is a normal procedure that goes on normally in a doctor’s office in other circumstances. Sex is also normal and normally happens in other circumstances. In fact, the courts have demonstrated that a woman married for 20 years can still be raped by her husband.

    So clearly, by every reasonable and intellectually honest definition of the term, this law will predicate the rape of at least some women (I say some, since in some cases the ultrasound will be medically necessary and/or the woman will consent freely to it anyways).

    Trying to make the claim that this language cheapens the word rape and insults “actual” rape victims is a very poor argument. You could also claim that statutory rape does the same. Or date rape, where no violence was perpetrated. The counter claim that is being asserted insults those rape victims by insinuating that rape must be the product of violent thuggery to “count.”

  5. nybgrus says:

    Honestly, that’s a non-starter in terms of arguments for most people in the pro-life movement. In such a case, you have a medical issue where two people will die or one person will die, and only one is able to communicate for consent.

    Oh really? So if you have two adult people, who are in a situation where one or both will die, the ethical issue is settled by ignoring the one who can’t talk?

    So lets say my father and I are in a car wreck. We both sustain massive injuries and are rushed to a trauma unit. Both of us have extreme liver injuries with significant hemorrhage. It turns out that we are compatible as donors. If one of us donates the viable liver tissue to the other, the doner will die and withe donee will live. So whomever is unlucky enough to be unconsious at the time of the decision making gets to be the donor? And that settles the ethical concept right there?

    What about my father’s family? Do my grandparents have a say in the matter? What about my mother? If they do, then why doesn’t the father of the fetus have a say?

    Sorry Duggan, but the concept is not a non-starter. It illustrates the point clearly that we would not consider a fetus as having the capacity to make decisions for itself and that the mother’s autonomy always wins out. So when it comes to an abortion, why is anything materially different? It isn’t, until you bring in theistic notions of morality on the concept.

  6. nybgrus says:

    But back to the crux of this article:

    All the verbal gymnastics in the world don’t change two very simple facts.

    1) The entire and unequivocal purpose of this law is to create barriers in order to make it unreasonably more difficult to obtain an otherwise legal abortion.

    2) There will, as a result of this law, be at least a percentage of cases in which an unncessary medical procedure is performed that involves the insertion of a device into an otherwise non-consenting and coerced woman’s vagina. AKA rape.

    Quibbling over whether it is always medically necessary, or what about this scenario, or why do we do it for tumors, or any other such bulls4!t cogitations is utterly inane and/or disingenuous. There is no reasonable way by which this law can be considered as anything other than an ideological attempt to make obtainment of legal abortions more difficult to obtain, thus acting as state level coercion to not have an abortion. The same with the 24 hour “cool-off” period. What other medical procedure requires a “cool-off” period so that the person can have forced time to reflect on their decision?

    This law has absolutely nothing to do with medicine, quality of care, serving or protecting women, or any noble cause whatsoever. It has everything to do with trying to stop abortion in any way possible since overturning Roe v Wade is much more difficult.

  7. DW says:

    “Trying to make the claim that this language cheapens the word rape and insults ‘actual’ rape victims is a very poor argument. You could also claim that statutory rape does the same. Or date rape, where no violence was perpetrated.”

    Saying that I also “could” claim something incorrect does not work because I did not in fact claim that. I do not think that the concept of rape is being unreasonably extended in the case of statutory rape or date rape. The concept of statutory rape exists because it is generally accepted that some people (children) are too young to reasonably consent to sex. That’s got nothing whatsoever to do with the present debate. Date rape is just that, rape that occurs on a date, and there’s no reason it should be more or less of a rape than any other kind of rape. (It only has its own name because some ignorant people still believe that if a woman has let a man buy her dinner or drinks, she owes him sex, so she shouldn’t complain if he forces himself on her – she “owed” him sex. Giving it this special name makes that point; it does not assert some new category of acts that fall under “rape.” A date rape could take many forms.)

    In short, both statutory rape and date rape fall quite easily within the general notion of a rape. A medical procedure generally is not going to fit the criteria.

    “The counter claim that is being asserted insults those rape victims by insinuating that rape must be the product of violent thuggery to “’count’.”

    I agree that it would if I had said that but I certainly did not. I’m well aware not all rapes involve “violent thuggery”; what I said was that many do, and it’s bizarre that people keep contradicting that. Plainly, many rapes involve physical violence. Check your local police blotter perhaps? Furthermore, even rapes that do not involve physical violence involve the THREAT of physical violence. (That is what happened to me, so I guess I would know whether all rapes involve physical violence or not.)

  8. nybgrus says:

    I agree that it would if I had said that but I certainly did not. I’m well aware not all rapes involve “violent thuggery”; what I said was that many do, and it’s bizarre that people keep contradicting that. Plainly, many rapes involve physical violence. Check your local police blotter perhaps? Furthermore, even rapes that do not involve physical violence involve the THREAT of physical violence.

    I acknowledge fully that this is the case.

    You are missing the point that rape can also occur without the threat of physical violence. Rape can also occur on the threat of with holding something the person wants or needs, or by exacting some other sort of penalty. That is what you seem to be missing.

    Violence, nor the threat of it, need in any way, shape, or form to come into the equation. If a starving woman comes to get food, and has all the means and legal rights to it, but is told that the only way she can get the sandwich is by allowing the insertion of something into her vagina – that is rape. If she says no, there is no violence. She can walk away without any fear of reprisal or any notion that violence may be perpetrated towards her. But it is still rape.

    So when a woman comes to a physician and asks for an abortion, and has all the means and legal rights to it, but is told that the only way she can get the abortion is by allowing the (medically unnecessary) insertion of something into her vagina… well, that is rape. Even though she is otherwise free to turn around and leave without any fear of reprisal or violence.

    And even if it is a transabdominal ultrasound, the principle still applies. It simply wouldn’t be called rape anymore – it would be called assault. If I, as a physician, were to perform an ultrasound on someone who hadn’t reasonably consented to it (which includes not properly informing the patient for consent), even it if it is on his arm, that would still be considered assault.

    So, if a woman comes to a physician and asks for an abortion, and has all the means and legal rights to it, but is told that the only way she can get said abortion is by allowing the (medicall unnecessary) trans-abdominal ultrasound… well, that is assault. Even though she is otherwise free to turn around and leave without any fear of reprisal or violence.

    Is that more clear?

    Obviously in the cases where the US is medically necessary, then it does not constitute rape nor assault since informed consent is obtained and there is a medically necessary invocation of risk:benefit and the law becomes moot. But in the other cases it is not so.

    So the law is either entirely moot and pointless or leads to rape/assault. Sounds like a bad law to me.

  9. nybgrus says:

    I should probably add and clarify a bit:

    If I, as a physician, were to perform an ultrasound on someone who hadn’t reasonably consented to it (which includes not properly informing the patient for consent), even it if it is on his arm, that would still be considered assault.

    Inherent to that, is if I tell the patient “The is medically unnecessary and has no benefit in your case” (which would be the case in question here) then that would meet informed consent. If the patient then agrees to the procedure anyways, that would be informed consent and not constitute rape nor assault. However, that would violate medical ethics, since unnecessary procedures should not be done. By definition the benefit is zero. Therefore any risk involves, no matter how slight, makes it ethically untenable. In the case where risk is genuinely zero (say the trans-ab US) then considerations of mental harm can reasonably come into play. In cases where even that is negligible, then the simple calculus of cost and resource spending must come into play. No matter what level you slice it at, it is medicall unethical to inform a patient a procedure is completely unnecessary and then do it.

    This is inherently different from an elective procedure like cosmetic surgery. The patient in question here did not come to you for an elective US just so she can see her baby (and pay for it out of pocket as is her wish). She came for an abortion and ran into the barrier of this medically unnecessary procedure she did not anticipate nor want. Who is responsible for the costs of the procedure?

  10. gretemike says:

    I don’t think the creator of Doonesbury was trying to say that the Texas legislature was guilty of rape. He was making an analogy, and I was making the point that it is a good one. (My exact words were, “these laws come awfully close to that”). However, I can see that it is clearly a distraction and will refrain from using the word in the future in connection with this issue.

    Glad to hear we are in agreement that the law is an abomination.

  11. DW says:

    We have no disagreement that it is a very bad law and that the ultrasound would be coerced. You make some reasonable points about the (as I see it) *similarities* to rape. I just think it stretches the definition too far. Not every act that is coerced is a rape. Not everything that is done to a person against their wishes, even sexually, is rape. I’ve made this point repeatedly and I’m sure everyone can think of dozens of acts that involve coercion of another person of some sort, and may be against the law, yet are not rapes.

    The most persuasive analogy you use is the the exchange of sex for food, or for money to survive. However, we have another term for that: prostitution. Sex for promotions or advancement at work usually falls under sexual harassment. It’s also wrong and illegal, it also involves coercion and threats of a type (at least the threat of removal of an opportunity) but sexual harassment still isn’t the same thing as rape. There’s lots of reasons people have sex that are really bad ideas, that they later wish they hadn’t done it, they felt the other person had control or power over them that they wish they had resisted, that maybe they didn’t even understand at the time, or they gave in because at the time they didn’t perceive other options. Not all of those situations are rape. Some may be, and I admit the definition is not always totally clear, but not ALL such situations are rape, and my point is we should be careful about expanding the definition beyond reason for a political cause (no matter how good the cause).

    We’ve probably belabored this far enough … the real issue is HOW to address such a bad law. From the angle of this blog, obviously physicians have to stand up against the requirement to “lie for the state” and protest violations of their professional autonomy and of patients’ rights. And they have to resist being used politically, becoming tools in abortion politics. This suggestion to try to classify the procedure itself as a rape is just totally misguided. Casting around for other, unapplicable criminal categories for the problem isn’t helpful. It’s offensive to rape victims – at least some of them – but that’s not the bigger problem.

  12. nybgrus says:

    The most persuasive analogy you use is the the exchange of sex for food, or for money to survive. However, we have another term for that: prostitution.

    You aren’t paying attention to what I am saying. My analogy was in no way related to prostitution. The woman in question wasn’t exchanging sex for food. She had the money and legal rights to the food, and was told that additionally she would have to have sex for it. That is rape, not prostitution. Note that I clearly stated “If a starving woman comes to get food, and has all the means and legal rights to it, but is told that the only way she can get the sandwich…”

    This is an important distinction, since the point here is that if not for said law coercing the woman into an US, she would otherwise have all means (either through private funds or insurance) and rights (by law) to the abortion.

    Sex for promotions or advancement at work usually falls under sexual harassment.

    Inappropriate comments, touching, or flirtation is sexual harrasment. Actual sex for a promotion is often relagted to sexual harrassment but is also reasonably rape. By law it is a form of sexual assault, which is broken into 4 categories, all of which fall under the umbrella term “rape.” Whether the plaintiff chooses to pursue legal recourse via sexual harrasment, abuse, or rape laws speaks more to the politicolegal environment and does not negate the notion that such situations can indeed be a form of rape.

    Having said that, I’ll state that I agree with you for the most part and that we have indeed belabored the point sufficiently. Suffice it to say, whatever word you feel most comfortable assigning it, I think the case can easily be made that it would be a form of sexual assault in cases of TV US and regular ol’ assault in cases of trans-ab US, with the former being tantamount to rape.

    Moving forward, the answer to such a bad law is to be loud in its dissent and for physicians en masse to test the law in the courts (the latter being an unsavory option, but sadly one we are heading towards).

  13. daedalus2u says:

    DW, what if the state required the insertion of a probe into a woman’s vagina as a condition of registering to vote?

    How about as a condition of filing for a tax refund?

    How about as a condition of obtaining a marriage license or a drivers; license?

    How about as a condition of getting her children into school or daycare?

    How about as a condition of boarding an airplane?

    How about as a condition of getting out of jury duty?

    How about for pleading innocent to a traffic ticket?

    How about as a condition of driving a car or walking on the street?

    How about instead of stop and frisk they have stop and transvaginal ultrasonic probe?

    How about as a condition of filing a restraining order or trying to get an order of protection?

    How about for getting food stamps, welfare, unemployment insurance?

    How about as a condition of being admitted to an emergency room?

    If the state can require an invasive non-medically indicated procedure designed to shame and humiliate someone as a precondition for any procedure, they can require it for all procedures.

    The entire purpose of this law is to shame and humiliate women who are trying to get an abortion. Trying to shame and humiliate someone is not a power that the US Constitution grants to government. Not to the Federal government, not to State Government, not to any local government.

  14. DW says:

    I can’t say I’m totally clear on sexual harassment laws … but it seems to me that if you are told you have to have sex to get a raise or a promotion, that’s sexual harassment. If you’re told you have to have sex because otherwise you will be hurt or killed (or some related threat), or because the other person is basically blocking the door, or has you physically under his control, that’s rape.

    As for the prostitution thing, and the other bizarre scenarios raised by daedalus, I just don’t think we can take this debate much further. Those are just silly invented scenarios – nobody WOULD say a woman had to undergo such a thing to be allowed to vote … of course if that happened I would consider it rape, but the ultrasound before an abortion at least has some connection to the event, some medical pretext, so I really don’t see those bizarre scenarios as relevant. We clearly all agree the ultrasound law is terrible, for quite a few reasons.

  15. DW says:

    “If the state can require an invasive non-medically indicated procedure designed to shame and humiliate someone as a precondition for any procedure, they can require it for all procedures.”

    Put another way, yes, theoretically “they” could do all those things and all those things would be terrible. It’s just that not all of them would be rape.

    For instance, what about the subjects of forced medical experimentation, e.g., the Tuskegee syphilis experiments? Should we call all those victims rape victims? What about all the subjects of lobotomies, bleedings, purgings, etc.? Are they all rape victims too? Were the thalidomide babies all rape victims?

    It’s an interesting discussion but I’m hijacking this comment thread so I’ll stop now.

  16. Peter Lipson says:

    The meme did not start with Garry trudeau. It was an obvious conclusion of many on seeing these laws.

  17. daedalus2u says:

    DW, rape has a specific definition, the insertion of something into a bodily orifice without the permission of the person who owns the orifice. If it is your orifice, you get to give permission or not for something to be inserted in it, and if you don’t give permission, you get to decide if it was rape.

    If you listened to the comments the legislators were making about the law, they dismissed the idea that a woman would object to a probe being inserted into her vagina because she was already pregnant and had consented to having the sex that got her pregnant (they of course neglected rape and incest because that was inconvenient), so there was no reason for her to not consent to a probe being inserted into her vagina to shame and humiliate her. If she wanted an abortion and this was necessary to get an abortion, then she had consented.

    Medically unnecessary is medically unnecessary. Just because some politician feels there is a nexus between a woman’s vagina and abortion and decides that having a probe inserted so as to humiliate and shame her doesn’t make it medically necessary. If the government can compel probe insertion for one medically unnecessary condition, they can compel it for any medically unnecessary condition.

    There is also the issue of compelling doctors to lie to their patients. There is nothing in the Constitution that gives any government the authority to compel someone to lie.

    If the government can compel one lie, they can compel any lie. This strikes at the heart of the First Amendment. If you are compelled to lie, then you don’t have freedom of speech.

    I would say that this also violates the eighth amendment. They have in effect criminalized seeking an abortion and imposed the cruel and unusual punishment of having a probe inserted into the woman’s vagina to shame and humiliate her.

  18. Stuartg says:

    From a different location, outside of the USA:

    Locally, prior to a termination of pregnancy, a woman is required to have a transabdominal ultrasound.

    The medical purpose of the ultrasound is to establish whether she is in the first or second trimester of her pregnancy. This allows her to have the termination in the safest place, by the safest method and by the most appropriate practitioner.

    There is no requirement for the physician to be present at the sonogram, no requirement for the sonographer to discuss the sonogram, no requirement for the woman to see or hear any results from the sonogram unless she herself wishes to.

    Unless there are ulterior motives intended by the legislators, as appears obvious, I can see no reason why an ultrasound in Texas prior to a termination need be any different.

  19. DW says:

    Daedalus, your post is full of all the reasons calling this rape would be such a bad idea legally. Don’t get me wrong, I fully understand and am sympathetic to the *comparison* to rape, the possible similar feelings of women subjected to this. If it were me I would be utterly enraged, no doubt about it.

    But your “definition” of rape and is completely off and so would it be to try to suggest legally that the procedure would be done to “shame and humiliate.” That may be some of the proponents’ motives, it isn’t an unreasonable thought. But clearly the proponents would argue that this motive can’t be known and more plausible is that the motive is to show the woman the fetus, so that she then wants to keep it. I really don’t think the idea of the law is that if a woman sees she has to go through this procedure, she realizes she will feel ashamed and humiliated, so instead of having the ultrasound, she will decide not to have the abortion? That’s just not a realistic scenario. If she decides to have the baby, she’d usually undergo a whole bunch more ultrasounds! If the procedure is shameful and humiliating, it would make a lot more sense to have the abortion and get it over with.

    No, the idea is that it is *when she sees the sonogram* that she will decide not to have the abortion. And I actually agree with the proponents that it doesn’t make a lot of sense to define “insertion of something into the vagina” as inherently “shaming and humiliating”; that’s just silly puritanism, and plays to old stereotypes whereby a pure woman is “shamed” by her own sexuality. Women shouldn’t want to go along with legal definitions whereby something inserted in the vagina is shaming and humiliating! Good grief, let’s not go backwards.

    What’s wrong with the law is that it is clearly intended mainly as an obstacle to abortion. The medical justifications for the ultrasound are bogus. But so is a countermeasure to call the ultrasound itself rape. We need a REAL countermeasure to the law, based on women’s right to abortion without a hassle of any sort.

  20. DW says:

    Well daedalus, you may be right about the definition – I was aware that it had recently been sort of expanded this way, but I think the aim was to (to put it crudely) include all the possible orifices … so that oral penetration is just as much rape as vaginal penetration, for example. I don’t think the aim was to expand the definition to include medical procedures in which something might be inserted, somewhere.

    Ideas like this – using rape laws to fight antiabortion legislation – often have a lot of unintended consequences. The law that is bad, the law that should be fought, should be fought using appropriate tools. Dragging in unrelated legal concepts can lead to a lot of completely unforeseen crazy stuff. Like we end up agreeing that it is “shaming and humiliating” to have an ultrasound. Think about the possible consequences of THAT. That kind of legislation could go a hundred really bad places that prochoice people would NOT want.

    If an ultrasound was really being done against the patient’s wishes, perhaps it would be assault. I would feel a lot more comfortable with invoking existing assault laws, than with expanding “rape” to include medical procedures.

    Sheesh … physicians, too, should be really wary of allowing the law to define a very common medical procedure to be considered “rape” under anything but but circumstances that are clearly criminal and unusual. Do you want to see physicians prosecuted for RAPE for adhering to an antiabortion law? I do not.

    Physicians have a lot to lose, too, if procedures performed for a questionable indication can become criminalized. There is a lot of professional judgment in there, right? Physicians should fight this tooth and nail.

    1. Harriet Hall says:

      @DW,
      “I think the aim was to (to put it crudely) include all the possible orifices ”
      A definition of rape that included all possible orifices would imply that a mother who uses a Q-tip to clean her child’s ear canal is raping the child.

  21. mdstudent says:

    @ Brandt,

    The pro-life side of the debate has nothing to with a lack of critical-thinking skills. I brought up certain ideas because I was prepared for a challenge and sure enough was met by alot of compelling arguments and points (namely by Dr. Hall, evilrobot, nybgrus, and Dr. Lipson) that forced me to re-evaluate my appreciation of how complex the issue actually is.

    If everybody on this site always agreed on everything it wouldn’t be a very interesting place to have a discussion.

  22. DW says:

    Yeah, that came up earlier with the thermometer example. It occurs to me that if “inserting something” somewhere for medical purposes, such as an ultrasound, against a person’s wishes is going to be classified as rape, then if antiabortionists get their way and get fetuses declared full persons, then we could have people suing doctors for raping their fetuses in utero.

  23. daedalus2u says:

    DW you miss the part about without permission. Good and competent doctors only do things that are medically necessary and they get informed consent before they do them. Good and competent doctors have no problem with defining unnecessary transvaginal ultrasounds given without informed consent as rape. Good and competent doctors don’t do such things. That is one of the characteristics of a good and competent doctor.

    That is what distinguishes a medically necessary transvaginal ultrasound administered with informed consent from an unnecessary vaginal probing imposed under duress to shame and humiliate a woman seeking an abortion.

    In emergency situations, where the patient is unconscious, then consent for medically necessary interventions is presumed (in some cases).

    The problem for doctors isn’t the definition of rape, it is the legislature mandating non-medically necessary interventions to shame and humiliate patients. Doctors are put in an untenable situation. They follow the law and commit rape, or they don’t follow the law and are put under legal jeopardy.

    This is exactly like the situation that soldiers are put under when they are given illegal orders to commit war crimes. Follow the order and commit the war crime, or not commit the war crime and be punished for not following orders.

    This law is so egregious that I don’t think there is any way a jury or any competent tribunal would sanction a doctor who refused to follow it. I know that I wouldn’t if I were on a jury.

    If a woman sued for being raped under this law, I would find the legislators to be mostly liable for the damages (which I would find to be gigantic).

  24. DW says:

    I agree with you that the courts have got to toss this out and/or refuse to sanction doctors who won’t follow it. I sincerely hope you’re wrong that doctors are going to end up getting charged with rape if they do follow this law.

    “DW you miss the part about without permission. Good and competent doctors only do things that are medically necessary and they get informed consent before they do them.”

    Arrgg. Again, I am not at all unsympathetic to what you are trying to do and I know what informed consent is. I definitely get that “without permission” such a procedure might be rape. I am, of course, assuming that the doctor would have the patient’s signed consent before performing the ultrasound. You and I may feel that it’s a terrible law that requires she jump through these hoops before getting an abortion. Nevertheless, doctors routinely require certain tests or screening before treatments of a wide variety. The patient HAS to have the required testing before the doctor will treat her. Are those patients being raped, too? This way lies madness.

    It’s just not the same thing. If a doctor corners a patient, pins her to the examining table, and shoves something up her, that’s rape. If a doctor says, “The law requires that you have an ultrasound before I can refer you for abortion. If you consent, please sign here,” then the patient signs and the doctor performs the ultrasound, the doctor has not raped anyone. I’m sorry but it’s just nuts.

  25. EricG says:

    @ dw

    the quibble appears to be in your second to last sentence. if the patients signs a release for a procedure that they do not want, that is medically unncessarry and they are unable to obtain the procedure they wish without the aforementioned procedure – there’s the issue. though i must agree, “rape” by itself is a very strong term to describe this situation.

    @ all discussing this

    sounds like a new term is needed.

    I very much enjoyed reading this discussion, as it really forced me to think of my own definitions. I found myself persuaded in part by all sides, but found that the words used to describe the situations were critically lacking.

    Here are some situations:
    alley thugs + sexual force = rape (with probable inclusion of battery, assault and possibly homicide)
    drugs/alcohol + sexual force = rape (quite possibly non-violent)
    lack of consent = date rate (probably non-violent, more emotionally coercive)
    sexual acts with a minor = statutory rape (might even be consensual to the extent that you believe a minor can make those choices)

    now we get to our point at hand: we need a new term. We have slid on down the scale of force and violence and now are at a place where no violence exists, but certainly a kind of force and that of a sexual orientation but without actual sexual gratification (at least we hope). I agree that forcible Q-tip ear cleaning is unlikely to be considered rape in any case – among the other “orifice oriented” cases one could likely posit to make a counter case (nostrils, for instance).

    but, let’s take it to the male equivalent. Clearly men can be raped, and in a very traditional sense. If I were to be required to (and ultimately consented to) undertake a medically unnecessary prostate exam (force, non-sexual, medically unnecessary, im sure you could invent a scenario to where it was shame oriented for its own sake), to achieve any medical ends at all (antibiotics, chemo, liver transplant etc.) I would consider that “insert new term here.”

    rape is too strong for that, IMO, but it definitely has many of the same characteristics of rape and could be of a more severe magnitude that statutory and date rape, for that matter.

    Any ideas? clearly a 120+ comment string largely devoted to defining rape in this case necessitates a new term that adequately address the issues without the baggage of the other word. medical force? sexually charged force? medical rape?(that sounds perhaps too intense…) SCUMP (sexually-charged, unauthorized medical procedure)?
    Just saying “rape is rape – forced entry into an orifice” clearly isn’t cutting it, given our wonderful brand new example of how humans have managed to inflict force and discomfort in yet another way upon one another.

  26. bgoudie says:

    I thought my wife’s comment on these bills was quite good, “Shouldn’t we be discussing charging the authors of these laws with practicing medicine without a license?”

  27. EricG says:

    in proofreading-post-production…

    “unnecessary prostate exam (force, non-sexual, medically unnecessary, im sure you could invent a scenario to where it was shame oriented for its own sake), ”

    that was said to demonstrate equivalency to the ultrasound, not to imply that prostate exams are of that nature by default.

  28. DW says:

    Eric, I too really sympathize with both sides, I see the *point* of declaring it rape but I just think it’s a very inadvisable strategy, with many unforeseen consequences.

    “if the patients signs a release for a procedure that they do not want, that is medically unncessarry and they are unable to obtain the procedure they wish without the aforementioned procedure – there’s the issue. ”

    But patients do sometimes agree to procedures that they don’t want; those are two different things. Patients can also change their minds, and that’s exactly the reason you get signatures. And as to whether it’s medically necessary, I fully understand that in most of these cases it is not, and to require it is wrong. But as I also pointed out, what is medically necessary in many situations is a judgment call, and can be very controversial. Surely doctors do not want to risk being charged with RAPE! for recommending something that someone else thinks is medically unnecessary. The possible tangles here are really, really thorny.

    It’s an issue all right, we just can’t agree on what that issue is, I don’t think that issue is rape, I think that issue is, as usual, abortion politics.

  29. EricG says:

    @ dw

    of course, people comply with procedures they dont want all the time. who wants a triple bypass? the consequences of non-compliance are death and/or extreme suffering in the mean time, in that case, and the benefits drastically outweigh the risks. are there any forseeable consequences to proceeding with an abortion without a transvaginal ultrasound? (based on what I take as your position, I assume you agree there are none – thats not the point i’m trying to make).

    would you feel i be justified in using the term “rape” to describe being forced to submit to a prostate exam in order to obtain a vasectomy? I’m not a doctor – so its only my speculation that those are unrelated events. And, supposing there was some group with lawmaking power and a moral objection to getting a vascetomy, couldn’t this conceivably “shame” me enough to mentally traumatize and change my mind? (though, I admit there is no real comparable male event to seeing a fetus in your womb). you’ve stated that legislation of this kind is absurd, so i’m not trying to continue to imply that by you holding your position on the definition of rape, that you somehow embrace the legislation by default. don’t worry, I read you :)

    All I’m saying is that I would be pretty freakin reluctant to get a probing of any kind if only for the purpose of some righteous lawmaker to sneer at the discomfort they’ve imposed – reluctant enough to call that something resembling rape. I’d call that a sciump (added invasive) procedure.

  30. daedalus2u says:

    If a doctor lied and said “there is a new way of measuring blood pressure that I have to use that involves sticking a probe into your vagina”, and then did so, that would be rape even if the patient consented because the doctor lied about the medical necessity.

    Substitute any other lie for the excuse to stick a probe in a patient’s vagina and it is still the same.

    Substitute a lie mandated by the legislature and it is still the same.

    There isn’t a way around it. The legislature mandating medically unnecessary probing of a woman’s vagina is the legislature mandating rape.

  31. gretemike says:

    EricG,

    There’s another situation you didn’t consider, and that is of a prison guard having entirely consensual sex with an inmate. In that situation the guard is without question guilty of a felony sexual assault. Why? Because due to the fact that the potential for abuse is so high, such a relationship is utterly forbidden in all fifty States (well, in Vermont anyway. I assume in all fifty States).

    I’m not arguing that such laws apply here. It’s just interesting to compare: we are at a place where we shield female prison inmates from the mere potential of abuse (rightly so, in my view), while simultaneously subjecting female rape victims who choose abortion to state-mandated lies and shame.

  32. nybgrus says:

    @DW:

    I think you are missing the finer points of informed consent:

    It’s just not the same thing. If a doctor corners a patient, pins her to the examining table, and shoves something up her, that’s rape. If a doctor says, “The law requires that you have an ultrasound before I can refer you for abortion. If you consent, please sign here,” then the patient signs and the doctor performs the ultrasound, the doctor has not raped anyone. I’m sorry but it’s just nuts.

    If the doctor says “We need you to have this US before the abortion” and the patient, for whatever reason, says no or asks why the US is necessary, then the doctor is required to explain why it is medically necessary. If the patient still refuses but wants the abortion, it puts the physician in a medical dilemma…. (s)he has to weigh the risks of not getting the US with the outcomes and risks of the procedure and see how firmly the medical requirement must stand. If the only reason it must stand is because the law says so, and the woman hangs her head in defeat and accepts the US in order to get her abortion, then by definition the state has committed rape through the hands of the physician.

    This is the analogous situation to the woman wanting food and having money to pay and rights to buy it, except being told she needs to have sex (or even just allow a probe inside her) in order to pay for the food. That is rape too.

    But as I also pointed out, what is medically necessary in many situations is a judgment call, and can be very controversial.

    Indeed. And there will be some cases where the TVUS is necessary or at least genuinely medically controversial as to its necessity. But by virtue off the law, since all cases will be captured here, there will be a subset of women for whom it is absolutely uncontroversial that they do not require it at all from a medical standpoint. There will also be a subset for whom it is a shaming and extremely onerous to get a TVUS (or even trans-ab US). Lastly, there will be a subset of the population where those two circles intersect, and there will be women for whom it is not necessary and find it shaming and onerous and are only doing it to achieve their goal of abortion…. that is the subset for whom the rape term applies quite correctly and adequately. And even if that is only one woman (it will undoubtedly be more) that is still one too many. And when the law does absolutely nothing else of utility (i.e. it does not somehow gaurantee that woman who need a TVUS and would not have gotten it will) and we can predict that certainly at least a few women will fall into those categories, it is not unreasonable to be morally outraged at something that will ultimately lead to state demanded rape.

    I don’t think a new term is needed. The point is that rape is a very strong word. It is also a word that accurately and adequately describes the situation. The point of using the strong word is to clearly state how disgusting this law is and why. Inventing a new word makes the point meaningless – “Oh, it’s a case of SCUMP, that’s not good, right?”

  33. DW says:

    Eric, daedalus et al. – I do take your points. I see the arguments for calling it a rape. I guess I am talking more about a strategy (for fighting the law). Some of these arguments are very convoluted – a doctor lies and says I have to stick a probe in you to take your blood pressure; a law is passed requiring an ultrasound before you’re allowed to vote … well, you can invent bizarre scenarios all day to find a way to make these bizarre occurrences be “rape” and maybe you’re not always wrong – but casting the preabortion ultrasound as “rape” is still going to be a bad idea.

    So daedalus says “there isn’t any way around it” but fortunately there is, because the unintended consequences and implications of calling this rape are just not worth it.

    The scenarios described are too far from reality. No one is going to declare a forced prostate exam is required before a vasectomy, because there is no political motive for such a weird thing. The political motive (the antiabortion motive) is the problem here and so the solutions should address the problem. People are not focusing on the problem.

    Nybgrus: “definition the state has committed rape through the hands of the physician. “ Ah – well that is slightly
    different than the scenarios previously proposed. Not sure what I think about that, but it is definitely different to accuse the state of rape rather than to accuse the individual physician. We just can’t have physicians complying with laws being accused of rape. Why aren’t more of the physicians here (I’m not one) recognizing what a disaster that would be? Jeez, you take an oath, you’re law abiding, a crazy politically motivated law gets passed, and you’re accused of rape for performing an everyday medical procedure, with the patient’s signed consent? How can I be the only one who thinks, this is not something doctors should be supporting, any more than they should be supporting the law requiring the ultrasound. Get a grip!

    So the point is to FIGHT THAT LAW. Not to find ways to prosecute individual physicians for following the law.

    Again, I take all the points that the strong language describes the strong feelings, and I share them. I’m talking about strategy – this is a bad one.

  34. daedalus2u says:

    DW, it is my opinion that the only way to fight the law is to put the law makers who passed such a thing in legal and financial jeopardy. That is why I think the best approach is to consider it to be rape and to prosecute the legislators for Crimes Against Humanity under the Rome Statute.

  35. DugganSC says:

    Goodness, but this is a rather strong discussion. I think that it’s good that everyone’s so willing to discuss the matter, although I find it disturbing, as always, how often it comes down to “You’re accusing me of saying this one thing, but I said this other thing instead. Please argue with me over what I actually said” followed by a reply saying “But by saying this thing…” ignoring that they didn’t say it. This is a contentious issue. Twisting peoples’ words so that you can cast them as the ignorant enemy doesn’t help matters.

    @nygrbus:
    Did I say that it was always settled in favor of the conscious person? No. I’m saying that it’s not a new medical issue. Also, while I know it was a minor comment on your part, but there are operations that require a cool-off period. Sex reassignment surgery is one of the most prominent ones. Now you may or may not agree with that cool-off period — I’ve known several people who argue that it’s the result of unreasonable bias against such surgery — but it exists. I wouldn’t be horribly surprised if other radical surgical procedures, like complete hysterectomies, similarly required a period of contemplation as to whether the patient felt it was the right step to take, but that’s not something I know about.

  36. DugganSC says:

    On a side note, if we prosecuted lawmakers for making laws they aren’t qualified to make… well, we wouldn’t have a government for long. That and, from a philosophical point of view, that raises the issue of who watches the watchmen. Ideally, we would have the people most knowledgeable about the subject making the law in an impartial manner. In an ideal world, teachers would make as much as engineers, but we don’t live in an ideal world. As it is, we can only hope that most lawmakers do consult with experts and they make laws based on what’s most right, not necessarily the cause that they most believe in. I think both sides are guilty of the latter, making laws to fit their view of the world rather than sit down and look at the evidence, especially on polarizing topics like abortion where it seems like you’re only allowed to take one extreme or the other.

  37. DW says:

    Daedalus, but it would be individual doctors who would be prosecuted under such a scheme – it’s folly to imagine the legislators would somehow end up getting prosecuted.

  38. nybgrus says:

    First off, I for one think this is an interesting discussion and there has been no anger, malice, or frustration in my responses. I am interested in fleshing it out a bit and am willing to amend my view. I just haven’t seen an argument that has made me reconsider yet.

    Ah – well that is slightly different than the scenarios previously proposed.

    Apparently we managed to misinterpert each other and/or the post. This is not different than what I had been reading as the entire discussion all along.

    Not sure what I think about that, but it is definitely different to accuse the state of rape rather than to accuse the individual physician.

    I don’t think anyone here, Dr. Lipson included, intended to say that individual physicians were rapists. The point was that the law would create a situation in which a physician will almost certainly be placed in a position where they must either break the (new) law or commit a state-demanded rape. Now, the distinction as to who actually committed the rape is somewhat moot here, but interesting none the less. It harkens to the concept of an unjust military order – the soldier may be breaking a rule of engagement or fail to follow an order. In general, the military courts rule in the favor of the soldier, but only if it can be demonstrated clearly that the commanding officer’s order was indeed illegal. Otherwise, the soldier is indeed found guilty for breech of duty.

    This is not a military case, and I am not a legal expert, but a similar scenario could forseeably arise, in which case establishing that the law was clearly unjust is necessary. An easy and accurate way to do so would be to demonstrate, as we have been doing here, that following the law leads to a form of rape (not something like rape, but a form of it) and thus the physician is justified in breaking the law.

    The flipside would be if a physician who did not have the qualities DW assumes (incorrectly) each and every one of us do have does follow the law. Then a woman could (and should) accuse the physician of rape. Defense and exploration of the matter would hinge on the law itself and, I hope, ultimately find that it is an unjust law as well. In the meantime, the physician in question would likely have minor sanctions in light of the dilemma in which (s)he was placed. However, I actually agree that a physician in such a circumstance should be punished somehow, since it seems clear that everyone here is advocating that the law not be followed in the first place on professional ethical grounds.

    Jeez, you take an oath, you’re law abiding, a crazy politically motivated law gets passed, and you’re accused of rape for performing an everyday medical procedure, with the patient’s signed consent?

    So the point here is not to start racking up docs in prison for rape, but to use the fact that rape accurately describes the outcome of this law as a powerful tack for demonstrating its unjustness (is that a word? lol) from a few potential angles.

    How can I be the only one who thinks, this is not something doctors should be supporting, any more than they should be supporting the law requiring the ultrasound. Get a grip!

    So the reason for physicians (myself included) to support the outcome of this law being called rape as opposed to something else is many fold.

    First, it helps raise rapid awareness.

    Second, hinging it on the notion that it is purely ideologically motivated by theistic notions of morality in regards to fetal life is a non-starter. The majority in this country, and by far the majority in legislation, support this ideological morality! The would agree and thank you for supporting their law! Calling it rape is something no one can support.

    Third, it forces physicians to realize that when pressed with the decision, obeying the law is something much more significant. Calling it “SCUMP” or whatever makes it easy(er) to rationalize and be rather milquetoast about it. If a physician is thinking “Meh, just another regular’ ol’ procedure with little likelihood of direct harm, mortality, or morbidity” (s)he will have less motivation to actually stand up to the law when faced with the likely unpleasant consequences of civil disobedience.

    So the point is to FIGHT THAT LAW. Not to find ways to prosecute individual physicians for following the law.

    So from my vantage point, and I would dare to say Dr. Lipson’s, that has been the point of this rhetoric.

  39. nybgrus says:

    @dugganSC:

    Did I say that it was always settled in favor of the conscious person? No. I’m saying that it’s not a new medical issue. Also, while I know it was a minor comment on your part, but there are operations that require a cool-off period.

    My apologies then. I made the implicit argument and when you did not rebut it I assumed that as acquiescence to the point. No need to rehash however.

    As for the cool-off period… actually there really aren’t any surgeries or procedures that require a specific “cool off” period. Not even gender re-assignment.

    For gender reassignment, the standard of care is a slower transition with psychological counseling along the way to ensure the best possible outcome. That includes active gender-reassignment therapy during the period prior to final surgery. In the US, that period is partly justified and partly extended by erroneous moralistic considerations.

    However, it is no different than due diligence for any other significant procedure (such as, say vasectomy) in which the physician has a duty of care the ensure that the decision is of the patient’s own volition and truly desired. This changes with each patient – a 45 year old man, happily married with 5 children asking for a vasectomy is indeed different from a 19 year old with no children asking the same.

    However, there exists no such paradigm in ethical medical practice that a randomly assigned “cooling off” period is necessitated for anything other than medical need – which could, should, and does include due diligence for mental health of the patient. As such, proper (and accurate and truly informed) counseling prior to abortion is ethically demanded. However, an arbitrary 72 hours (and in many cases parental consent) after being bombarded with unnecessary sonograms is does not fall under the same principle. Neither is the “counseling” offered by many anti-abortion clinics (and health professionals) wherein lies are told, positives are downplayed, and negatives are trumped up in order to sway the patient’s decision.

    The point I am trying to make is that “cooling off” periods are never a medically justified practice – not in the sense used in conjunction with abortion legislation. In the latter sense it is purely ideological with the implicit intent to give a woman every reason to feel ashamed for her decision and have a minimum time to stew over it and reneg. This is fundamentally different from proper, caring, informed medical counseling prior to the abortion itself.

    I’ll add that I would not support walk-in hair cut style abortion clinics. I’m not sure if they exist or to what extent, but a place where a woman can go in and with minimal or no counseling have an abortion within an hour or two of arrival. Just like any other surgical procedure, there should be an initial consultation, with appropriate information and medically accurate pamphlets (which do include the legitimate concern of regret in a portion of women), and then scheduling of the appointment at the earliest convenience of the patient and practitioner. In the interim, the woman can freely decide to cancel her appointment.

  40. DugganSC says:

    @nygrbus:
    Ah. It would seem that we may have been two of those people arguing past each other. I’ll admit that I’m often a bit quick to fly off of the handle on this subject. As crazy as it may sound, I’ve had people argue with me that abortion should be a “haircut” procedure where you walk in, get the procedure, and walk back out. As I’ve said before, it’s one of those polarizing topics… one side feels that delays give the chance for people to reconsider while another side feels that any form of delay or roadblock automatically means that someone is having their liberties infringed. The latter are the sort of people who also argue that abortion clinics shouldn’t have to follow the guidelines of sanitation that other surgical clinics do because they feel that it would be like bicycle helmet laws, used only to target one particular group (I know… bicycle helmets? But it’s been shown in several studies that minority children are almost ten times more likely to be fined for not wearing their helmet in states that have these laws). Frankly, I can somewhat see their point of view, but I feel that extremes like that throw the baby out with the bathwater, much like how many pro-lifers have gotten swept up in protesting contraception methods (although that, I also partially blame on lobbying to prevent the Pill from being listed as a more medically accurate abortifacient due to its prevention of implantation rather than conception).

    Honestly, the other thing which I don’t quite get is where people go from the law stating that an ultrasound is required to it necessarily being the invasive vaginal one. A couple of people have pointed out in the comments that the law does not require the more invasive one. Much like calling the procedure “rape”, this is another area where I feel people are distorting the truth of the law in an attempt to paint the law as more monstrous than it is.

  41. cloudskimmer says:

    One point that has not been considered in the discussion of rape: Rape is, I think, a criminal statute. This means that it requires a district attorney to prosecute the crime and an agency, like a police force, to file a report. Can anyone imagine that happening in anti-choice states like North Dakota or Texas? Practically speaking, Doctors probably don’t have to worry about being charged with rape for doing the state’s bidding by performing unnecessary and humiliating medical procedures, or treating adult women like children. The only source of concern is if you are committed to providing good medical care, based on scientific information. In that case, you are in a lot of trouble, because you will have to choose between following your training, or being a political tool of state legislators and the religious right. And you don’t have to wait for that to happen, because it’s already here in many states. Most Doctors have opted out of providing medical care that would cause them to have political problems: witness the lack of abortion providers in this country. Why doesn’t every gynecologist provide first-term abortion as a routine office procedure? Because they are afraid of the anti-choice fringe. That’s completely understandable; anti-choicers will commit murder to further their own moral and religious agenda. Understandable…. but very sad. Because if many Doctors agreed to perform abortions, it would make it harder for individuals to be targeted by fanatics. By allowing abortion to become a marginalized procedure, performed by only a few specialty clinics, such targeting is easy.

  42. Calli Arcale says:

    DugganSC:

    although that, I also partially blame on lobbying to prevent the Pill from being listed as a more medically accurate abortifacient due to its prevention of implantation rather than conception

    Wait a sec — are you seriously arguing that the Pill (meaning, presumably, the usual sense, products such as Ortho Tri-cyclen, Yaz, etc.) doesn’t prevent conception??? It prevents ovulation, and I have yet to see any evidence it can act as an abortifacient or even to prevent implantation. I know there’s been talk that maybe it does, but I’m unconvinced, especially given that the effectiveness of emergency contraception drops off sharply within a few days of intercourse, faster than the likely interval between intercourse and implantation.

    (Note, of course, that if we’re being medically accurate, something that prevents implantation is not an abortifacient; medically speaking, pregnancy begins at implantation, so before that there is nothing to abort. There is a gray area between conception and implantation where there is the beginnings of human life but no pregnancy. Otherwise, a woman who adopted a surplus frozen embryo from a fertility clinic could find that she’s actually been pregnant since several years before deciding to become pregnant, which is obviously absurd.)

  43. nybgrus says:

    @dugganSC:

    one side feels that delays give the chance for people to reconsider while another side feels that any form of delay or roadblock automatically means that someone is having their liberties infringed.

    Delays for the sake of delay are one thing. Delays as a matter of proper medical conduct are different. I think we are closer to each other in thought than we may have thought, but still rather divergent. For example, if the resources are available, and the practitioner is sufficiently skilled and confident, I believe that a 20-30 minute evaluation could be sufficient to then have an abortion immediately following. I’m not an expert on the psychology involved therein, but I do agree that putting unnecessary roadblocks to any procedure is wrong. If the 19 year old was able to convince me that he really wanted that vasectomy for good reasons, I would be hard pressed to come up with anything but a personal hesitation at providing it.

    That is the genuine gray area of medicine here. Arbitrarily defining a “cooling off” period makes no sense. Perhaps for most people it really does take an hour long consultation and a day to make an informed decision about abortion. For some it wouldn’t. So legislating a delay – whether it be 1 hour or 1 week – makes no sense.

    Compare it to breast cancer surgery. Lets say a patient comes in with a T1N0M0, low grade DCIS. By definition this is very easily resectable by lumpectomy. Let’s further say that the woman has ample breast tissue and zero family history and is 70 years old just to make lumpectomy as much a slam dunk in medicine as you can get.

    Now lets say she wants a complete bilateral mastectomy because she is deathly afraid of the cancer spreading or coming back. As a physician, it would be my duty to inform her of the medical fact that lumpectomy a much better option and furthermore that data clearly shows many women have regret from elective mastectomy because of body image issues once the fear of cancer has faded (all of this is actually medically correct, BTW).

    Should I tell her she has to take a time out and wait 1 week? 1 month? before I accept her decision for mastectomy over lumpectomy? What if I happened to have OR time the next day?

    I believe the correct course of action would be to extend the consultation and probe to the best of my ability and satisfy both myself and the patient that this truly is the best course of action for her. I would admonish her to think more on it and potentially use delays that are out of my hands to offer her that as time to think. But if I had the time the very next day, unless I had extremely good reason to deny her, I would be ethically bound to perform the surgery. Note that the burden of proof is on me as the physician to prove she should not have the operation – the burden is never on the patient to prove why they should.

    The paralell is clear for abortions. If a woman wants the abortion I would consult, advise, and then schedule at earliest convenience with the same admonition of deliberation until the procedure. If she wanted it immediately there would be an inherent ethical and professional onus on my part to try and suss it out. But, ultimately, if I couldn’t demonstrate good reasons why to deny her the procedure and it could be done the same or next day… it should.

    Honestly, the other thing which I don’t quite get is where people go from the law stating that an ultrasound is required to it necessarily being the invasive vaginal one.

    You are correct that the law does not explicate it must be TVUS. However it does say:

    (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

    This means that in most cases it will be TVUS, since most abortions are early in the 1st trimester and the only way to visualize the conceptus is via TVUS at that time.

    So you are right, that it isn’t a firm requirement of the law, however in its wording most women seeking abortion will still have TVUS required. Apparently this was a big enough issue that the wording was changed (at least in VA) such that women may have the option to opt out of TVUS, but must still get the trans-abdominal version and hear a description of the conceptus and its development, as well as wait 24 hours. That is a step in the right direction, though it would still fall under assault laws, albeit not sexual assault.

    Lastly, I will echo what Calle Arcale said – you can’t be serious about the OCP can you?

    Though I will moderate that by saying that indeed it has been demonstrated that in a very small amount of cases (I believe <5%) it does act by preventing implantion, but mostly it is a prevention of ovulation.

    However, neither aspect could possibly make it an abortifacient.

  44. DugganSC says:

    @nygrbus:
    You’re right. Stating it as an abortifacient is as much as overstatement as claiming that the ultrasound is rape or assault. However, the legal definition of a “contraceptive” did get changed to include implantation to avoid having to indicate that it worked later than conception in some percentage of cases (as to what percent, I’ve seen varying numbers of that from as low as 1% to as high as 10%. I’ll be honest that I don’t remember the sources for those figures). I don’t know whether it got changed to avoid getting barred off of lists or if it was just to prevent the companies from having to include a disclaimer on the package indicating that it “fails to prevent conception but will prevent implantation in n% of cases” that might scare off consumers. If I were inclined to argue the point of the latter, I’d comment on how it’s similar to how the supplement manufacturers were fighting to avoid having to disclose the medical risks of overdosing on their supplements.

    And yeah, we do have some similar points of view, I think. We’re on opposite sides, but willing to actually listen to the other side and not grounded on an extreme. Frankly, that does distinguish us from a lot of others out there.

    @cloudskimmer:
    I just want to point out that it’s always been a lunatic fringe within pro-lifers that have resorted to violence. If you’re going to hold a philosophy liable for the action of a minority of their members, you’d might as well say that all environmentalists are violent nutters because a few of them are willing to send mailbombs and smash equipment, or that all vegetarians are willing to assault meat-eaters because some members of PETA do so. As it is, most pro-lifers are so devoted to the sanctity of life that they don’t resort to violence, even in the defense of a human life. *wry grin* In some ways, I feel like it makes us the guy who sees someone getting their head kicked in and does nothing more than call 911 and lobby for better laws against assault because they abhor violence. I don’t know where that puts our moral ground.

  45. Brandt says:

    @ mdstudent

    “The pro-life side of the debate has nothing to with a lack of critical-thinking skills.” Please note that this was not stated in my previous comment. There are meritorious arguement on the “pro-life” side of the debate. I take issue with the misuse of terms to make an emotional appeal which often (but not always) indicates a lack of substance to an underlying argument, as is evident here. Jann Bellamy provided citations to cases which have questioned this statue on legal grounds, and while I have not taken the time to read them, I am fairly confident that no arguement has been made that this law requires rape.

  46. daedalus2u says:

    Brandt, if you do a google search on rape definition, you will find that non-medically warranted transvaginal ultrasound can meet the definition of rape.

    However, many people here are missing the point in their quest for definitions and legalities. The bottom line is that good doctors don’t want to do this because it harms people, not because it might be illegal.

    If rape were legal, I would still not rape anyone because I don’t want to harm anyone by raping them.

    This is really what the statute is about, defining something that harms women as “legal” and mandating it so as to harm them.

  47. daedalus2u says:

    Just to expand on my last comment. The bottom line is that the legislators who passed this law don’t consider women who are seeking abortions to be human beings and deserving of human rights. They have “othered” those women and dehumanized them so that they are not human beings any more, they are simply objects, evil non-human objects.

    Women seeking abortions and the medical professionals who perform them are inhuman monsters without the capacity for human feelings. They are “fair game”, and any maltreatment of them is acceptable, even praiseworthy.

    In contrast, a fertilized egg is a complete human being with full human rights. Women seeking abortions and those who perform them have forfeited their human rights by their inhuman behaviors.

    Some people who consider themselves pro-life won’t admit this, but this is how they feel. This is why they have no desire to promote contraception. It isn’t about preventing abortions, it is about harming women who would have sex and women who would have abortions.

  48. DugganSC says:

    @daedalus2u:
    Oof… again with the generalization and demonization of pro-lifers. So wonderful to know that you understand entirely how a group of people feels and can authoritatively comment on their mental state. Except, of course, you’re wrong. The pro-lifers feel that the baby is a human being. So is the woman. Both need to be protected because we don’t judge one more human than the other. Your arguments are akin to stating that anyone who opposes the lynching of blacks doesn’t consider white people to be human.

  49. DugganSC says:

    @daedalus2u:
    Sorry… that was harsher than I meant to state it. It just brought me back to growing up hearing people expound upon how they knew why black people were always criminals or why Hispanics were always lazy. It’s false knowledge on a false premise based on personal prejudices. I advise that you talk to some pro-life people, and not just the foaming-mouth ones, and find out where they’re really coming from. You may learn something from it.

  50. DugganSC says:

    And… upon rereading things with a calmer head, you indicated “some pro-lifers”. I still feel like you’re generalizing based on what you feel they believe rather than on any evidence, but I’ll also accept that you probably don’t feel that way about most people in the pro-life movement. If you do, then we’re back to my original statements. :-/

  51. nybgrus says:

    well… I for one think that this has been an interesting conversation.

    I will also admit that through the course of it I am feeling a bit less robust in being able to call this a “law that demands rape” or some such robust and clear statement to that effect.

    However, I still do believe that the law is overall harmful and that a subset of that harm will ultimately be cases that can reasonably be referred to as rape. And that, to me, is all one needs to know. If only 1% of all women affected by this law can be said to be raped in any sense or definition of the word, then that is the defining character of this law.

    If a law led to 1% (or even 0.1 or 0.001%) of people being harmed in a way that would be reasonably called “murder” then that would be its defining characteristic for me as well.

    I personally think this thread has run its course for me… so , till next time.

    Best!

    Oh, lastly, I should say to DugganSC – I am never grounded in anything “extreme” and am always willing to listen to other viewpoints. The exceptions being viewpoints that have already handily been demonstrated as completely false and counterproductive (creationism, religion, CAM, for example). I think abortion the patient-practitioner milieu is not one of these. I do think, however, that in a progressive society we must acknowledge the right to choose, and that the single most robust argument against choice is the inherent sanctity of human life. However, it is my opinion that the banning of all abortion relies on a theistic interpretation of said sanctity, since a blastocyst or 1st trimester fetus is hardly human life. I am actually against very late term (i.e. 3rd trimester) abortions. The middle ground is where it gets fuzzy for me, and the convenient cut off I use is the youngest age at which a fetus will be viable ex-utero. Currently this is ~24 weeks. As technology improves, that will force harder and harder decisions, though the concept that cryogenically frozen blastocysts may never develop and that doesn’t cause much bother to me seems to predict a lower limit to my own personal dilemma. But that is a discussion for another time, perhaps.

  52. daedalus2u says:

    DugganSC, I have outlined my reasoning as to the mechanisms behind xenophobia.

    http://daedalus2u.blogspot.com/2010/03/physiology-behind-xenophobia.html.

    They are fundamentally due to feelings that the other person is “other”, not sufficiently like them to be treated as a human being.

    This is why people who call themselves pro-life can be pro-death penalty, bomb clinics, torture prisoners, shoot doctors and bully gay people until they commit suicide. They can even accept that some abortions can be moral, but only their abortion is moral.

    http://mypage.direct.ca/w/writer/anti-tales.html

    Their position did not come from facts and logic, it came from feelings. If those feelings change, then there will be different rationalizations of those feelings.

    This is why such people can have nonsensical ideas about how hormonal birth control works and have no need to rationalize how a human being can exist in the absence of a brain. They are experiencing truthy, the prioritization of their own feelings above all else, even external reality.

  53. DugganSC says:

    @daedalus2u:
    All I can say is that hypocrites exist in every belief system and that generalization based on anecdotes flies in the face of what this site stands for. And… honestly, I don’t think that will do anything to change your mind about what you’ve decided to believe about the other side. I’m sorry that that’s the case. I like debating with people, but there comes a time when discussion becomes fruitless because the other person has their mind made up already.

  54. daedalus2u says:

    DugganSC, in this discussion I am not talking about “all” pro-lifers, or generalizations made to all pro-lifers, I am talking about the self-proclaimed pro-lifers who are legislators and who are legislating laws that require non-medically necessary transvaginal ultrasounds prior to abortions.

    Their sole interest is in making abortion more difficult and more expensive and more time consuming for women who are seeking to have one, and to shame and humiliate women who are seeking to have one.

    If their interest was in reducing the number of abortions, they would in addition be pushing for greater access to effective sex education and effective contraception so that women don’t have unwanted pregnancies so that women with unwanted pregnancies do not seek to abort those unwanted pregnancies.

    The legislators passing this type of legislation are not telling us the truth about what their motivations are. They proclaim they are “pro-life”, but they do not act as if they actually valued human life. If they did, they would have life-of-the-mother exclusions, but they don’t. They don’t want women who could have their lives saved by a timely abortion to have their lives saved, they want them to die without having an abortion.

    The Catholic Church has even explicitly stated that it is better that both mother and fetus die than that the mother’s life be saved by having an abortion. This is not a “pro-life” position, it is an anti-abortion position. It is an anti-woman position.

    The Catholic Church is also anti-contraception by essentially every effective method, even condoms. The Catholic Church is against the use of condoms even for prevention of transmission of STDs. This is not a pro-life position, it is an anti-sex position.

    Anti-abortion legislators have convinced themselves that they are pro-life, even as they do actions that will kill people. They may fool themselves and their followers, but they do not fool me.

    I agree with you, that discussion is fruitless with people who are unable to consider alternatives to their already made up minds. Such people occur on multiple sides of issues. Such people are characterized by an inability to address facts and logic, not necessarily by the use of anecdotes.

    Anecdotes are perfectly acceptable data for some uses. If someone declares that women dying without a timely abortion is so rare that it doesn’t matter, then what they are saying that they are not pro-life because the death of that woman and her fetus doesn’t matter to them.

    If people who proclaim themselves to be pro-life also say they don’t care about deaths due to illegal abortions, they are also demonstrating that they are not pro-life. If they were pro-life, they would seek harm mitigation to reduce lives lost due to illegal abortions by reducing unwanted pregnancies.

    If such people were actually pro-life, they would want good data to derive their pro-life conclusions from. The legislators in these cases do not want good data based on sound science because the basis of their beliefs is not in science or in being pro-life, it is in being anti-woman.

  55. DugganSC says:

    @daedalus2u:
    Ah. So your concern is with these particular legislators. I’ll understand that you don’t tar all pro-lifers with the same brush. I’ll just note that you’ve got the wrong line on the Catholic Church. The Roman Catholic Church has held grave danger to the life of the other as a sound rationale for an abortion since Humanae Vitae, “the Church does not consider at all illicit the use of those therapeutic means necessary to cure bodily diseases, even if a foreseeable impediment to procreation should result there from—provided such impediment is not directly intended for any motive whatsoever”. In other words, if the intent is to save a life rather than to end one, even if ending one is an unavoidable risk of the procedure, it’s not considered to be murder. Individual members of the Church may hold stronger viewers, including people in the hierarchy, but the official position of the Church is not to sacrifice the mother for the child unless she so chooses.

    As regards the church and sex… most of that is theological matters, so I doubt you’d be interested in an explanation of rationales, but I do find it a bit funny, although probably not intentional on your part, that you accuse them of doing nothing to stem pregnancy and yet you also accuse them of being anti-sex. :) Sex is generally an important part of pregnancy, you see. Anyhow, the Church isn’t anti-sex. They believe that sex is a beautiful and wonderful thing, a form of prayer to God, but they believe that it belongs in a marriage. And the Church has had the position for decades now that people should not have more children than they can provide for, and provide training in how they can control their fertility by more properly understanding it. It requires a degree of education and a degree of self-control, but you can’t fault the Church for wanting to believe that its people can reach that level of competence.

    Ultimately, your statements on the Catholic Church reflect pretty old theology. Admittedly, it’s not an uncommon set of beliefs, even among some of the Catholics who don’t properly educate themselves on their religion. Still, I felt that you’re the sort of person who would prefer not to be unwittingly spreading false information, so I hope you don’t mind my corrections.

    Personally, I mourn for the deaths of women in illegal abortions. I still don’t think that justifies legalizing them. I also mourn the death of people involved in the drug trade, people who die while building illegal explosives in their garage, and bank robbers who get gunned down in the midst of their heist. The loss of human life is tragic, but but just because people died pursuing something illegal doesn’t mean that it’s best to make it legal. Again, I feel that your argument is based on what you project their motives to be rather than any judgment of what they are.

    So yeah… we’re not going to convince each other, but I’m glad that we managed to settle a few of our differences in miscommunication and I’m glad I got a chance to set you right on the Church’s position. Incidentally, happy Easter weekend. I hope you enjoy it.

  56. MerColOzcopy says:

    Man, you guys really know how to flog a dead horse.

    The one being penetrated can be the raper. Rape in terms of abuse or violation can apply to many different scenarios. This is all rather moot.

    For those who argue that the unborn are of no significance and that pro-lifers guarantee full support for the woman and child until it reaches adulthood… How about this, any woman that gets pregnant will be required to terminate unless they can prove to be fit parentally and financially.

    Dr. Hall, after reading your comments, I wish I would have spent more time telling my mother how much I loved her, I didn’t realize I was such a burden. I hope I gave her some happiness.

  57. daedalus2u says:

    I think you need to check your understanding of Catholic doctrine. There was a recent clear case

    https://en.wikipedia.org/wiki/Excommunication_of_Margaret_McBride

    and in the aftermath there have been explicit statements by high Church officials that allowing both to die is better than performing an abortion to save the mother which is never acceptable.

    http://atheism.about.com/b/2012/03/23/american-bishops-order-hospitals-to-let-women-die.htm

    All of the patriarchal religions are about control, control of the members by the power hierarchy. Keeping women pregnant and with small children is a good way to control them because women are hard wired to place high priority on the welfare of their infants.

  58. nybgrus says:

    In other words, if the intent is to save a life rather than to end one, even if ending one is an unavoidable risk of the procedure, it’s not considered to be murder.

    It is one thing to say something vague and wonderful sounding and another to actually live up to it. I used to work in a Catholic hospital. I had a friend whose second trimester fetus died in utero – confirmed by US. The physician wanted to do an D&C to remove it, but the powers that be at the hospital (aka the Church) denied the request, stating that she would have to expel the fetal corpse herself. Completely emotionally torn apart, she was forced to leave the hospital and go find somewhere else the next day to remove her dead baby from her, because technically she wasn’t in immediate danger of death from the situation. Most likely she would have birthed the dead baby in a few days, but besides the emotional anguish the church was forcing her to absolutely unnecessarily endure, there was a chance she wouldn’t birth the corpse and become rather septic from it. At that point, with her life imminently at risk, they might have allowed it. But if you look around, you’ll find many reports where even that wasn’t accomodated.

    Anyhow, the Church isn’t anti-sex.

    The church is anti-sex unless it meets their specific requirements – i.e. a subservient woman receives it from her dominating man within the confines of their blessing (marriage).

    And the Church has had the position for decades now that people should not have more children than they can provide for, and provide training in how they can control their fertility by more properly understanding it.

    Which is absolutely inane. The only way, outside of the contraceptive methods the church explicitly bans, to adequately manage family size is to abstain from sex. So how again is it that the church is not anti-sex? They severly limit it to a power hierarchy and further to acts of procreation only – no joy in it.

    Ultimately, your statements on the Catholic Church reflect pretty old theology

    There is a new theology? The entire concept of theology is that it is old – that things written by the most backwards of the bronze aged goat herders are infallibly correct and never changing. No, I disagree. While not as expansive as something I may write, deadalus was pretty spot on in his indictment of the theistic position on these matters.

    I also mourn the death of people involved in the drug trade, people who die while building illegal explosives in their garage, and bank robbers who get gunned down in the midst of their heist

    False and/or poor parallels. The drug trade should be legal. Why are the explosives illegal and what was the intent of their use? And bank robbers are unequivocally causing harm to others in society. The paralell does not hold up to back alley abortions.

    Again, I feel that your argument is based on what you project their motives to be rather than any judgment of what they are.

    Your latest post is a rehash of the typical, trite, and hackneyed stance that is common amongst theistic apologia. It all always boils down to, “No no… we really are this way, despite all the evidence of how things are actually done.” In other words, it is pure lip service. People like myself and daedalus are more interested in what actually happens in real life to real people, not what some pontiff claims is the official policy of the church. Because the last time I checked, the church was unequivocally against homosexuality and pederasty….

  59. daedalus2u says:

    In the case of an ectopic pregnancy, the Catholic church mandates major surgery and removal of the fallopian tube, rather than the less invasive administering of methotrexate. Removal of the fallopian tube often causes fertility problems, more so than methotrexate.

    If we look at the situation from the perspective of the fetus, what would the fetus prefer if it was capable of thinking and so having a preference? Since we can’t ask the fetus, what would the “reasonable fetus” want? If the fetus is going to die, why would it want its mother to die also? That makes no sense to me at all.

    Why would a fetus want their mother to undergo a more costly and more invasive surgery with a worse outcome that could potentially prevent future siblings?

    Many adults would sacrifice themselves to save their mother’s life. We accept that adults can sacrifice themselves to save others. In war, they are called heroes and are given medals posthumously. Why is the idea that a fetus would choose to die so as to save its mother’s life such an evil idea?

    That anecdote of not allowing the removal of the dead fetus is horrible.

    There is no way anyone can honestly spin that position in to one that is pro-life.

  60. weing says:

    “How about this, any woman that gets pregnant will be required to terminate unless they can prove to be fit parentally and financially.”

    Where the hell are you from? China? Why do you insist on making decisions for someone else?

  61. Just because I cannot bear to be silent about this, I would like to contribute that I have been raped, I have had a (medically necessary) transvaginal ultrasound, and I would ABSOLUTELY call a non-consensual transvaginal ultrasound rape. Absolutely I do. To my mind, it is unambiguously a state-ordered rape. I, as a rape victim, am not at all offended by a non-consensual state-ordered transvaginal ultrasound being called rape, and frankly, it gives me shivers and PTSD to hear people arguing for NOT calling it rape. It does not trivialize or muddy the issue– it sheds the cold light of reality on it. State-mandated penetration of a woman’s vagina with an object for no medically-indicated reason is state-mandated rape.

    I cannot bear to look at this thread anymore, but believe me, I will continue to protest and fight against this any other such legislation that comes up in my lifetime.

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