Legislators vs. Doctors

This post isn’t really about abortion. It’s about the decision-making process the United States uses in reproductive medicine.

Here is a picture of President Bush signing the Partial-Birth Abortion Ban Act of 2003. He is surrounded by a coterie of mostly older, white, male legislators.

Where are the women? Where is the diversity?

The Partial-Birth Abortion Ban is a weasel law. It does make an abominable procedure illegal — but it sets the definition of the procedure overbroadly, so it may apply to other procedures as well. Where will treatment standards and court decisions go from here?

Despite the fact that you can find “partial-birth abortion” in the MEDLINEplus/Merriam-Webster medical dictionary (along with other terms like “pro-life” and “pro-choice”), both the American Medical Association and the American Council of Obstetricians and Gynecologists say that “partial birth abortion” is a non-medical term.

So, why use the law to make a lay term into a legislated term of medical art?

Let’s see what that dictionary definition is.

An abortion in the second or third trimester of pregnancy in which the death of the fetus is induced after it has passed partway through the birth canal.

Now, let’s look at the definition made legal by the Act:

An abortion in which the person performing the abortion deliberately and intentionally vaginally delivers a living fetus until, in the case of a head-first presentation, the entire fetal head is outside the body of the mother, or, in the case of breech presentation, any part of the fetal trunk past the navel is outside the body of the mother, for the purpose of performing an overt act that the person knows will kill the partially delivered living fetus; and performs the overt act, other than completion of delivery, that kills the partially delivered living fetus.

It is interesting to note that the law leaves out “in the second or third trimester of pregnancy.”

When the legislators talk about “partial birth abortion,” they apparently mean what doctors call “intact dilatation and extraction” (or “intact D&X”).

The American Medical Association has a policy statement on intact D&X, in which they recommend that intact D&X or third-trimester abortions not be performed — but they also say that the “physician must, however, retain the discretion to make that judgment, acting within standards of good medical practice and in the best interest of the patient.” It is interesting to note that the Act refers to the procedure recommendations of this policy statement, but not to the statement about physician discretion.

The American Council of Obstetricians and Gynecologists puts it more strongly. They do not support intact D&X either, but they opposes laws like the Act because it puts legislators in between physicians and the best care for the patient:

ACOG’s Statement of Policy explains why ACOG believes such legislation to be “inappropriate, ill advised, and dangerous.” The policy statement notes that although a select panel convened by ACOG could identify no circumstances under which intact D&X would be the only option to protect the life or health of a woman, intact D&X “may be the best or most appropriate procedure in a particular circumstance to save the life or preserve the health of a woman, and only the doctor, in consultation with the patient, based upon the woman’s particular circumstances, can make this decision (emphasis added).”

It’s also interesting to compare the legislators’ view and ACOG’s view of the decision-making process:

There exists substantial record evidence upon which Congress has reached its conclusion that a ban on partial-birth abortion is not required to contain a ‘health’ exception, because the facts indicate that a partial-birth abortion is never necessary to preserve the health of a woman, poses serious risks to a woman’s health, and lies outside the standard of medical care. Congress was informed by extensive hearings held during the 104th, 105th, 107th, and 108th Congresses and passed a ban on partial-birth abortion in the 104th, 105th, and 106th Congresses. These findings reflect the very informed judgment of the Congress that a partial-birth abortion is never necessary to preserve the health of a woman, poses serious risks to a woman’s health, and lies outside the standard of medical care, and should, therefore, be banned.

Versus:

In this case, the bill before the Senate fails to respect the Stenberg test because bill supporters flagrantly refuse to include an exception for the health of a woman. Instead, legislators try to circumvent the Court’s requirements by issuing their own opinion to the nation’s physicians and patients that such a procedure is never needed to protect a woman’s health — notwithstanding opposing opinions from the medical community.

References:

Partial-Birth Abortion Ban Act of 2003
H-5.982 Late-Term Pregnancy Termination Techniques.
ACOG Statement on So-Called “Partial Birth Abortion” Law