Roe v Wade has been overturned. How do you feel about that?

[Túrin Turambar]

Some interesting issues have been raised in Victoria.

The Victorian Parliament has amended the act legalizing abortion on demand in the state, requiring pro-life doctors to perform abortions in cases where the life of the mother is threatened and, in other cases, referring their patients to a doctor who will perform an abortion if they will not.

This is obviously an issue for the Catholic healthcare system, which is the largest private healthcare provider in the state. It has a policy of refusing abortions in all cases, which has yet to be tested under the new law.

Julian McGauran, a Liberal Senator for Victoria, has called for the section to be repealed and, if the Victorian Parliament will not do so then the Federal Parliament should override it. The Federal Government in Australia has no ability to regulate abortion, but he suggests that forcing a doctor to perform an abortion or send a patient to someone who will is a breach of their human rights. Therefore, the Federal Parliament could pass a law mandating freedom of conscience for doctors in abortion cases based on Australia’s human rights obligations. This was how the Federal Parliament overrode Tasmania’s anti-homosexuality law in 1996, which McGauran sees a model. I doubt he will have any success – few Federal MPs are genuinely pro-life, and I doubt many would be too concerned with Victoria’s new law even if they disagree with it.

I’m still thinking about it, myself. I’m not comfortable with the idea of anyone having to perform an abortion, but I’m also not comfortable with women dying because a doctor’s belief on the issue. I’m also concerned with how broadly ‘threat to life’ can be interpreted. Prior to Victoria’s legalization of abortion state law only allowed abortions in the case where the life or health of the mother was threatened (as is the case in my own state of Queensland now). Then, a woman’s abortion was held to be legal because she was suicidal because her unborn child was found to have dwarfism. I’m concerned that it could potentially be a back-door approach to compelling every doctor to perform an abortion in every case.

[vison]

No doctor should be required to perform an abortion, or, for that matter, any other procedure. For instance, a Jehovah's Witness doctor should not be required to perform a blood transfusion.

On the other hand, since both abortion and blood transfusions are legal, a doctor ought to be required to provide a patient with a list of names of doctors who will perform these and other procedures.

My own family doctor years ago would not perform abortions, but freely provided his patients with the names of those doctors who would. This information was posted in his office.

[Cenedril_Gildinaur]

I do find it downright incomprehensible why someone would try to force a doctor to perform a procedure he disagrees with. Isn't the patient putting her life in her doctor's hands by going to that doctor in the first place? Wouldn't a sane person rather have a willing doctor than a coerced doctor, especially for any sort of invasive procedure?

[River]

A doctor has a moral obligation to treat their patient. If they can't square that with their own personal beliefs then medicine is not a profession for them. End of story.

[Cenedril_Gildinaur]

That's not an absolute. That's not 'end of story.'

Hypothetical scenario: A burglar breaks into the home of a doctor. He beats the doctor and proceeds to rob the house. He opens one of the doors and discovers the Doctor has three Pit-Bull Rottweiler mixes who proceed to maul the burglar mercilessly. The burglar then says "since you are a doctor you have a moral obligation to tend to my wounds. If you do not it means that medicine is not the right profession for you."

A doctor who believes abortion is wrong because he took an oath to save lives instead of end lives should never be required to perform one, and saying he should not be a doctor because of that is wrong.

[Primula Baggins]

The burglar in your example would be right. The doctor would in fact be ethically obligated to tend to his wounds. You can't murder people by causing them to be mortally hurt and then standing around, whether or not you're a doctor.

[halplm]

that would nto be murder, it would be self defense.

[Primula Baggins]

It's not self-defense once your life is no longer in immediate danger. The mauled burglar lying on the floor presumably isn't any threat to the doctor's life or property, so the doctor can't kill him and call it self-defense; in fact he has to try to save him.

[River]

What Prim said. And the doctors I know would do it too - a patient can refuse care. A doctor can't deny it.

[Cenedril_Gildinaur]

If I were that doctor, facing a demand that a burglar who just assaulted me and robbed my house should receive treatment from me, I'd be sure to let him know exactly what I think of his demand.

I'd fulfill his request for treatment by asking for an ambulance when I dial 911. Anything further makes a mockery of the moral code that demands doctors provide treatment.

Meanwhile, given that want of an abortion is very unlikely to cause death within the next hour, a doctor who really does believe that abortion is the ending of a life and therefore contrary to his Hypocratic Oath is under even less obligation to provide one. He became a doctor to heal, not harm. The only way I'd say otherwise is if that doctor, for reasons unknown, took a job as an abortion provider at an abortion clinic.

[vison]

Hippocratic. Mind you, I like the typo, C_G.

[MithLuin]

Lord M, there is a significant legal distinction between "life of the mother" and "life or health of the mother." The former is interpreted fairly narrowly, ie, reasonably life-threatening situations. The latter...is a euphemism for "abortion on demand." A threat to the mental health of the mother includes being pregnant while not wanting to have a child. Thus, requesting an abortion (for any non-medical reason) falls under "health of the mother."

At least, that has been a fairly consistent interpretation to this point and the case you mention seems to fall under that.

The most obvious reason to invoke 'life of the mother' as a reason to have an abortion is an ectopic (or tubal) pregnancy, where the embryo has implanted somewhere other than within the uterus. Failure to remove this misplaced baby is life threatening, and there is no way the baby could successfully be carried to term anyway. There are other scenarios where an abortion is medically prudent, and failure to perform one could cost the woman her life. For instance, if she has uterine cancer, she may need a hysterectomy. Waiting until the baby is born...can be unwise, to say the least. Up to nine months of untreated cancer...yeah. [Pregnant women can't take *aspirin*, so chemo and radiation are generally out!] A non-viable fetus cannot survive a hysterectomy, obviously.

A law without a 'life of the mother' clause can unnecessarily tie a physician's hands and prevent the doctor from saving a woman's life, so it is irresponsible of lawmakers to write them (especially if it is a law restricting abortion). A conscience clause is meant to be a loophole for a particular doctor, but requiring the doctor to refer the patient to someone else (at least) in a 'life of the mother' situation respects both the doctor's personal conscience as well as the physician's responsibility to save the life of patients who have not refused treatment.

A 'life and health of the mother' loophole, on the other hand, would negate the conscience clause entirely, because as you point out, every case would apply.


Just in case anyone was curious, the Catholic Church does not claim that a woman has to sacrifice her own life in an attempt to save the life of her unborn baby. If in the course of saving the mother's life, the baby's is lost, that is an unfortunate tragedy for the family, but not a sin for the doctor (or anyone else). Gianna Molla is honored as a saint for her heroic virtue in doing all that she could to save the life of her 4th child, even though it cost her her own. Thus, that choice is clearly 'above and beyond' what is required in life...even by the Catholics.

I would be very surprised if the Catholic healthcare system in Australia did not take care of tubal pregnancies. What they are refusing to do are abortions as elective procedures.

[BrianIsSmilingAtYou]

http://www.cuf.org/Faithfacts/details_view.asp?ffID=57

There is much more to the discussion at the above site, which is concerned with the Catholic moral response to ectopic pregnancies, but the following sums up the basic guiding principles as expounded by the U.S. Conference of Catholic Bishops:

In the case of an ectopic pregnancy, the lives of both the mother and child are placed at risk. The moral teachings of the Church call for medical treatment that respects the lives of both. Most recently, the U.S. Conference of Catholic Bishops reiterated these principles:

· In the case of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion.[2]

· Operations, treatments and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child[emphasis added].[3]

...


[2] National Conference of Catholic Bishops. Ethical and Religious Directives for Health Care Services (Washington, DC: NCCB, 1994), 28

[3] Ibid., 47.

The following site has an extremely interesting examination of the evolution of Catholic thought on abortion. Of particular interest is the concept of quickening or ensoulment.

http://www.religioustolerance.org/abo_hist_c.htm

A brief history:

Many religions, including many denominations within Christianity, have adopted the general principle that abortion is a form of murder if it is performed at or after the time that a soul enters the body of an embryo or fetus. Down through the ages, beliefs varied about when this "animation" happened.

Various church authorities and popes placed the time at:
* At a specific time into pregnancy (40 days, 80 days, 116 days), or
* Quickening (when the woman first feels the fetus move), or
* At conception.

The latter is the current church teaching.

The Catholic Church has consistently taught that abortion -- at any stage of development -- is evil. However, its stance has changed down through the years on whether a given abortion is murder. John Cardinal O'Connor, Archbishop of New York, wrote:

"Pope Paul Vl declared that the teaching of the Church about the morality of abortion 'has not changed and is unchangeable.' Although some people point out that Saint Thomas Aquinas thought the soul did not come to the fetus ('ensoulment') until sometime after conception, the fact is that he considered abortion gravely sinful even before this time. He taught that it was a 'grave sin against the natural law' to kill the fetus at any stage, and a graver sin of homicide to do so after ensoulment." 2

---------------------------------

A brief timeline:
* Circa 100 to 150 CE: The Didache (also known as "The Teaching of the Twelve Apostles"), was a document written for the guidance of Christians. It forbade all abortions.
* Prior to 380 CE: Many Christian leaders issued unqualified condemnations of abortion. So did two church synods in the early 4th century:
* Circa 380 CE: The Apostolic Constitutions allowed abortion if it was done early enough in pregnancy. But it condemned abortion if the fetus was of human shape and contained a soul.
* St. Augustine (354-430 CE) accepted the Aristotelian Greek Pagan concept of "delayed ensoulment". He wrote that a human soul cannot live in an unformed body. 3 Thus, early in pregnancy, an abortion is not murder because no soul is destroyed (or, more accurately, only a vegetable or animal soul is terminated).
* Pope Innocent III (1161-1216):
* He determined that a monk who had arranged for his lover to have an abortion was not guilty of murder if the fetus was not "animated" at the time.
* Early in the 13th century, he stated that the soul enters the body of the fetus at the time of "quickening" - when the woman first feels movement of the fetus. Before that time, abortion was a less serious sin, because it terminated only potential human person, not an actual human person.
* Pope Sixtus V (1588) issued a Papal bull "Effraenatam" which threatened those who carried out abortions at any stage of gestation with excommunication and the death penalty.
* Pope Gregory XIV (1591) revoked the previous Papal bull and reinstated the "quickening" test, which he determined happened 116 days into pregnancy (16½ weeks).
* Pope Pius IX (1869) dropped the distinction between the "fetus animatus" and "fetus inanimatus." The soul was believed to have entered the pre-embryo at conception.
* Leo XIII (1878-1903):
* He Issued a decree in 1884 that prohibited craniotomies. This is an unusual form of abortion used under crisis situations late in pregnancy. It is occasionally needed to save the life of the pregnant woman.
* He issued a second degree in 1886 that prohibited all procedures that directly killed the fetus, even if done to save the woman's life.
* Canon law was revised in 1917 and 1983 to refer simply to "the fetus." The church penalty for abortions at any stage of pregnancy was, and remains, excommunication.

The same web site has a discussion of exceptions to the general Catholic ban on abortion:

http://www.religioustolerance.org/abo_hist_c1.htm


BrianIs AtYou

[Túrin Turambar]

Some news from Oklahoma:

Online posting of women's abortion information challenged in Oklahoma

By Wayne Drash, CNNDecember 18, 2009 3:58 a.m. EST

(CNN) -- A judge could determine Friday whether to allow an Oklahoma law to go forward that will post information online about women who get abortions in the state -- an act critics say would be harassment and an invasion of privacy.

"We don't feel that the government should be able to run a grand inquisition into women's private lives," says Jennifer Mondino, an attorney challenging the law on behalf of the New York-based Center for Reproductive Rights.

State Sen. Todd Lamb helped draft the abortion legislation and describes it as "a common sense measure with bipartisan support." He says the left has tried to skew the law's intent through a campaign of misinformation.

"We're not trying to embarrass anybody, hurt anybody or make anybody's identities known. That's not the purpose of the legislation," the Republican lawmaker says.

"We want to collect hard data that can be a useful tool in helping prevent future unwanted pregnancies."

The law requires doctors to fill out a 10-page questionnaire for every abortion performed, including asking the woman about her age, marital status, race and years of education.

One section of the "Individual Abortion Form" says the woman must state her reason for seeking an abortion and answer this checklist. "Having a baby:
• Would dramatically change the life of the mother;
• Would interfere with the education of the mother;
• Would interfere with the job/employment/career of the mother."

A Democratic former state legislator calls the law "abusive and invasive."

"Nosy neighbors with some effort could identify or, even worse, misidentify these women who answer these questions," says former state Rep. Wanda Jo Stapleton, one of two Oklahoma residents on whose behalf the Center for Reproductive Rights brought the lawsuit against the measure.

Lamb, who is running for lieutenant governor, rejects that notion. How can it violate women's privacy, Lamb says, if their identity is kept confidential?

The measure specifies women's identities will be protected. "Nothing in the Individual Abortion Form shall contain the name, address or information specifically identifying any patient," it says.

Nosy neighbors with some effort could identify or, even worse, misidentify these women.

"Nobody's identity will be made known," Lamb says.

Oklahoma County District Court Judge Daniel Owens will hear arguments Friday afternoon on a temporary injunction to keep the law from going into effect and a separate motion to dismiss the law altogether.

Troy Newman, the head of the Kansas-based anti-abortion group Operation Rescue, says the law is "designed so that the pregnant mother can have as much information as technology and medicine will allow."

"Naturally, the abortion industry wants to block this, because they know the more information the mom has, the less likely she is to abort her baby," Newman says.

The Center for Reproductive Rights argues that the measure is unconstitutional and in violation of the state's "single subject rule" because it covers different aspects of abortion. The law also bars women from seeking abortions solely because of the sex of the fetus, with fines up to $100,000 for doctors who "knowingly violate" it.

"We are very committed from keeping the law from going into effect," Mondino says. "The law represents a very serious invasion of women's privacy interests."

Lamb says he believes the law will stand. "None of the bill is being challenged on the merits of the legislation," he says.

Abortion rights supporters are extremely concerned about the intrusiveness of the questions, and fear that identities of women could be compromised, especially in small communities.

"It requires doctors to ask and submit answers to at least 37 intensely personal questions. There are details in those questions about rape, incest, abuse, relationship problems and emotional health," Stapleton says. "I think women can be identified."

According to state estimates, the Oklahoma State Department of Health will spend roughly $250,000 a year to carry out the law.

"To spend a quarter of a million dollars on this is absolutely ridiculous," Stapleton says, adding, "Oh goodness, all the publicity over this has severely blighted the image of Oklahoma."

The Centers for Disease Control and Prevention in 1969 drafted criteria for vital statistics around abortion to look at infant and maternal mortality in an effort to make the procedure safer.

The CDC's guidelines have long been considered the standard and "all the states pretty much follow that," says Elizabeth Nash, who tracks state abortion legislation for the Guttmacher Institute.

"You compare the law in Oklahoma to the CDC standard, and you see the law in Oklahoma goes far beyond what has been considered appropriate for vital statistics purposes," Nash says.

The law's co-sponsor, Lamb, says legislators drafted the measure using portions of a Guttmacher study. "Some of this was gleaned from the Guttmacher Institute," he says. "It's not Draconian."

"If we collect this evidence, we can better treat, we can better counsel, we can better provide alternatives," Lamb says.

Why draft the legislation?

"I'm pro-life," he says. "Oklahoma is a conservative state. We are a pro-life state, and I believe it's important public policy to stand on the side of sanctity of life."

Stapleton, who served in the state House of Representatives from 1986 to 1996, says the law is another example of the GOP "onslaught" in recent years in Oklahoma, with lawmakers taking aim at abortion.

"They're trying to do away with abortions completely," she says. "They can't because of Roe v. Wade. But they're finding ways around Roe v Wade."

If the law does go forward, the state Department of Health is to have the Web site up and running by March 1, 2011. Doctors are to begin submitting completed questionnaires 30 days later.

link

[River]

Um, this might be a violation of HIPAA...

[Dave_LF]

You'd think, wouldn't you? People who work with medical information can be sued or fired over the tiniest little things; how is it that this is even being considered?

[River]

Because some gang of politicians in Oklahoma want to look good?

[Voronwë the Faithful]

It probably doesn't violate HIPAA since the patients names are not collected (nor what county they live in, or other identifying feature). I think that the basis of the challenge is that it is intended to have a chilling effect on women having abortions and on doctors performing abortions. Reporting statutes like this are actually very common (46 states have them); it is just a matter of degree. According to a report I heard on NPR, "Joseph Thai, a professor at the University of Oklahoma, says the U.S. Supreme Court already struck down a Pennsylvania reporting law that was not as stringent as Oklahoma's." He must have been referring to the seminal abortion case Planned Parenthood of Southeastern Pennsylvania v. Casey. If so, that is a vast over-simplification of the court's holding. In fact, the court held that most of the reporting requirements were constitutional. It stated "The collection of information with respect to actual patients is a vital element of medical research, and so it cannot be said that the requirements serve no purpose other than to make abortions more difficult. Nor do we find that the requirements impose a substantial obstacle to a woman's choice." The one exception was the requirement that the patient report whether she had given notice of the abortion to her husband, and the reason why that was struck was because in the same case the court ruled that such a spousal notice requirement was itself unconstitutional. There is no spousal notice requirement in the Oklahoma law. So Casey really doesn't give much guidance to what the Court will do with this Oklahoma.

As usual, it will come down to what Justice Kennedy thinks. [/quote]

[Dave_LF]

When I used to work for a medical software company, they were very careful to tell us that the mere act of deleting names is not enough to keep you safe from HIPAA. As long as the information that is left is enough for a friend or relative (or P.I.) to make a good guess about who it is, you can get in trouble. The combination of "age, marital status, race and years of education" seems like it would be pushing the limit already (if you saw "18-year old single Caucasian woman with a Ph.D. who got an abortion in Kansas in 2003", I'll bet it would narrow down the possibilities real fast), and who knows what's on the rest of those 10 pages?

But I guess I am talking to an attorney here. Do you have experience with HIPAA that says otherwise?

[MithLuin]

Well, if it doesn't identify the county, so you're really talking about an entire state; age-race-marital status doesn't really narrow it down that much. I'm pretty sure it wasn't a violation of confidentiality standards for my sister to come home from work and tell me she treated at teenage male patient who was incarcerated (for instance). That really doesn't narrow anything down, even if she added that he's Hispanic and I (obviously) knew which ER she worked in.

But if there's enough other information? Yeah, it could certainly be seen as an invasion of privacy.


Collecting abortion statistics isn't original (or a bad idea), but certainly it's possible that this particular attempt to do so is overdone. I don't think there's any harm in collecting more info than the bare minimum requested by the CDC, but if it takes an hour to fill out the paperwork, that's a bit overdone, certainly.