Monday, March 27, 2006

You Will Respect My Authori-tah!

The legislation signed by Michigan Gov. Jennifer Granholm on Friday requires that patients with a nonviable fetus receive prenatal care and parenting information before they're allowed to have an abortion [even coming from a politician, that's contemptible]. The bill also requires physicians to offer patients unnecessary tests, tests for which the patient is financially responsible. It also misleads patients about the risks of undergoing an abortion.

From House Bill 4446:

(e) Provide the patient with a physical copy of the prenatal care and parenting information pamphlet distributed by the department of community health under section 9161.

Why? What is the medical rationale for providing a patient, who either needs or has decided to have an abortion, with this type of information?

Providing prenatal care and parenting information to a patient undergoing an abortion [I can't imagine how you go about presenting this information to a patient with, say, an anencephalic fetus] is as nonsensical as providing abortion information to a term patient before allowing her to deliver via C/S.

(8) If at any time prior to the performance of an abortion, a patient undergoes an ultrasound examination, or a physician determines that ultrasound imaging will be used during the course of a patient's abortion, the physician or qualified person assisting the physician shall provide the patient with the opportunity to view or decline to view an active ultrasound image of the fetus, and offer to provide the patient with a physical picture of the ultrasound image of the fetus prior to the performance of the abortion.

What if the patient either forgets or doesn't want to disclose that she's had an U/S?

Since no exception is provided, it looks like the physician is liable, no matter what the circumstances. [Forget history taking skills; it looks like it's time for Michigan physicians to familiarize themselves with effective interrogation techniques.]

Why should the patient be offered an unnecessary test, and why should she be expected to pay for it?

If the patient undergoes an U/S at an outside facility at any time prior to the performance of an abortion, or if the physician plans to use imaging during the procedure, when the patient is under anesthesia, the physician will have to order an additional scan in order to comply with the requirements of the Bill. Since this would be an elective scan--there's no medical indication for it--there are only three options when it comes to payment: 1) the physician can make up a medical reason for it so that the test is reimbursed by the insurance company [can you say "malpractice and fraud"?], 2) the physician can use his/her own money to pay for the test or 3) the patient has to cover the cost.

The Bill is quite clear that the patient is expected to pay for this politically-indicated test:

(9) This subsection does not prohibit notifying the patient that payment for medical services will be required or that collection of payment in full for all medical services provided or planned may be demanded after the 24-hour period described in this subsection has expired.


There's also a provision requiring the department of community health to

(h) Include on the informed consent website developed under subdivision (g) a list of health care providers, facilities, and clinics that offer to perform ultrasounds free of charge.


So, if you're a patient who either needs or has decided to have an abortion, before you're permitted to undergo the procedure, you must be offered the option to have an unnecessary test, and you are expected to pay for it. Alternatively, you have the option to search for and locate a facility offering free tests in your area, take time off and make arrangements to go to that location and have the U/S performed, make sure the place performing the test and the place where you'll be having the abortion get in touch and somehow coordinate, and insure the proof requirements of HB 4446 have been satisfied [can you say "patient inconvenience", "bureaucracy", "mix-ups"?]. The good news is that, as of yet, the Michigan legislators do not mandated that patient be offered ukulele lessons before being allowed to undergo an abortion.

Last, but not least:

Why show the patient an image of the fetus, as opposed to one of the uterus or the cervix, or even the anesthesia equipment?

If your main concern is medical--the health of the patient and informing her of the risks of the procedure--it doesn't make sense to show her a picture of the fetus. That's not the source of your expected complications. Instead, the patient should be looking at pictures of the uterus or cervix to better understand the risk of perforation, atonia, or laceration. In fact, even showing the patient pictures of anesthesia equipment/drugs [to help the patient better assess her anesthesia-related risk] is more relevant than showing her an image of the fetus.

I wasn't able to find any news article detailing Gov. Granholm's reasons for signing this law. The closest I came to a motive was this speculation from Ed Rivet, chief lobbyist for the anti-abortion group Right to Life of Michigan:

"I think she looked at both the substance of the policy, and at the politics, and determined that a veto was not the prudent thing to do"....

More on the likely political machinations, from an insider:

State Sen. Gilda Jacobs, D-Huntington Woods, said Friday that she thinks the legislation was designed to place Granholm in a politically awkward position in an election year. But Jacobs said the final product does not unduly restrict abortion rights and "is not a very big deal."

Sen. Jacobs, ladies and gentlemen: The One that gets to decide what degree of restriction of our rights is, or isn't a very big deal! [How, oh how, would we ever be able to lead our lives and tie our shoes without this most invaluable oversight from our beloved politicians?]

I don't know why Gov. Granholm signed HB 4446. What I do know is that the health and well-being of female patients were not a consideration. Nor, for that matter, was the competence of medical professionals. All in all, yet another misguided piece of legislation with the potential to negatively impact the medical care of female patients of reproductive age.

In an effort to cut down on the enactment of misguided/malevolent legislation, I have a suggestion:

If you truly believe in your own version of the FSM and you wish to impose your beliefs on perfect strangers, and/or if you're a politician up for reelection, stop the subterfuge and the pretense. Stand up for what you believe in, and/or your political calculation de jour. Get over your shame, and say it loud, and say it proud: "You will obey my Deity, and/or be a peon in my political games!" Just leave medicine and science alone.

10 Comments:

At 6:30 AM, Anonymous Anonymous said...

It is a piece of legislation perfectly designed to make an abortion as heart-breaking as possible. Nice
Izabela from Melbourne

 
At 4:39 AM, Anonymous Anonymous said...

Sigh. Jacobs is my state senator too. She's even one of the better ones in this nutjob state. Don't forget that there is a huge Catholic presense here and they have gotten nuttier over the years. The guv gets guff from that quarter for not being pro-life enough. The really scary thing is that I think she's the best gubernatorial election.

 
At 7:29 AM, Anonymous Samson Isberg said...

In Norway (Europe) abortions are perfectly legal up to twelve weeks of pregnancy, the woman even has a legal right to have it performed on demand. But then the Board of Health (political) is forcing us to ask every one of them "if they want any counsellng" before the termination. I am always embarrased by having to ask this question, so I always say clearly to them that this is a question I am forced to ask, and it really means "do you (patient) want me (doctor) to try to talk you out of this?"
- I have never yet experienced a woman answering "yes" to the question.

 
At 2:56 PM, Anonymous Anonymous said...

I bet the only places on the list of providers who provide free ultrasounds are crisis pregnancy centers. I bet that's the point.

 
At 4:23 PM, Anonymous Anonymous said...

It's very simple, you just have to put on your right-wing tin-foil hat:

1) An expectant mother with a non-viable fetus upon seeing the black-and-white, grainy, but definite presence of life inside her womb will instantly realize that "viciously butchering" a nonviable life will result in, well, the same thing, BUT JUST IN CASE A MIRACLE HAPPENS...

2) Showing said mother pamphlets on prenatal care for a nonviable fetus makes sure she understands for next time, provided she's married and conceives the child in an act of marital love

3) Any guilt, shame or loss from the above will also act as aversion therapy from using abortions as a means of birth control for the promiscuous, should she ever decide to stray from a virtuous path.

You see? It's not hard once you warp your mind the correct way.

 
At 8:18 PM, Blogger JivinJ said...

Hi Ema,
I think you've misconstrued this legislation a bit. The legislation doesn't force an abortion provider to perform an ultrasound, it merely says that if they do, then they have to give the woman the option of seeing that ultrasound. Plus, the vast majority of abortion providers perform ultrasound because it's standard medical practice.

Shouldn't women have the choice of whether or not to see their ultrasound? How is asking women if they want to see their ultrasound a restriction of their rights?

Gilda Jacobs is as pro-choice as they come. To imply that she's not pro-choice enough would have any prolifer familiar with Ms. Jacobs laughing out loud.

 
At 8:58 PM, Blogger JivinJ said...

Ema,
Unfortunately, the link you're using doesn't differentiate between Michigan previous informed consent law (which was law before Granholm took office) and HB 4446. The parenting and prenatal health information wasn't in HB 4446.

You can see the language that HB 4446 adds at the web address below. I'm guessing Granholm wouldn't have signed the original bill.

http://www.legislature.mi.gov/documents/2005-2006/billengrossed/House/htm/2005-HEBS-4446.htm

 
At 1:11 AM, Anonymous Anonymous said...

I cannot understand why the white people hide under the "choice" flag when really all they are interested in is limiting the population growth of blacks and latinos. Everybody knows that whites have the lowest abortion rates of all races. So the more liberal the abortion laws are the more minority abortions will occur, keeping the minority population down.

 
At 7:31 PM, Blogger ema said...

Anon 6:30,

Possibly, but that's not a legitimate reason to pass public health legislation.

Dr. Isberg,

That's terrible; I had no idea. [Always looked at you guys in Europe as a model of Ob/Gyn care.]

Anon 2:56,

That thought has crossed my mind. Which brings me to something I haven't even mentioned in the post--what will be the standard for these U/S?

Anon 4:23,

Hat or no hat, there's no justification for mandating substandard care for a group of patients just because they happen to be pregnant females. Patient dignity and patient misfortune aren't contingent on political affiliation.

jivinj,

The legislation doesn't force an abortion provider to perform an ultrasound, it merely says that if they do, then they have to give the woman the option of seeing that ultrasound.

Read the text again. It says: If at any time prior to the performance of an abortion, a patient undergoes an ultrasound examination.... This says nothing about the MD performing the abortion being the same one who has performed the prior U/S. The legislation 1) forces MDs to offer an unnecessary additional test (and expects pts to pay for it), and, depending on circumstances (pt had a scan at an outside facility, the MD plans an intraop test, when the pt is under), 2) forces the MD to perform an additional test.

Shouldn't women have the choice of whether or not to see their ultrasound? How is asking women if they want to see their ultrasound a restriction of their rights?

Heh, the politicians have tricked you. See how propaganda works? Just because this Bill was passed you are assuming pts don't have the choice of whether or not to view their scan. That's incorrect. When you perform an U/S, you're the one who asks the pt if she'd like to take a look.

Pts should always be asked, and are asked, if they want to see their U/S. Passing legislation based on the assumption that, because we're dealing with pregnant patients and the MDs who care for them, neither pts, nor MDs know what they're doing is a restriction.

Gilda Jacobs is as pro-choice as they come. To imply that she's not pro-choice enough would have any prolifer familiar with Ms. Jacobs laughing out loud.

Other than what I read in the linked article, I know nothing about Ms. Jacobs. Thus, I don't have enough info to imply anything about her position. That's not what I was going for. I was mocking her for her incompetence and grand pronouncement (as a politician, it's her job to be familiar with the legislation and its impact).

You can see the language that HB 4446 adds at the web address below.

I see what you mean; the add-on part has mostly to do with the U/S. This makes the Gov.'s decision even more puzzling. Instead of removing the problematic parts from the old Bill, she agreed to leave them in, and add some more.

 
At 1:45 PM, Blogger JivinJ said...

Hi Ema,
You reread the text of the legislation again. It nowhere says that if a woman considering an abortion has previously obtained an ultrasound during this pregnancy at another location that the abortionist has to offer another ultrasound. Your reading of this legislation is completely off. The prior to part is referring to the initial time when a patient visits the abortion clinic, possibly has an ultrasound and gets her informed consent papers. It has nothing to do with ultrasounds outside the abortion clinic she is currently visiting.

Nowhere does the legislation say that an abortion provider has to offer an ultrasound. Granholm wouldn't have accepted that and neither would have Ms. Jacobs.

Pts should always be asked, and are asked, if they want to see their U/S.

This legislation merely codifies that reality. You're reading way, way, way too much into this legislation. Do you believe that every abortion provider asks a woman if they want to see their ultrasound?

Well, Gilda was certainly more familiar with HB 4446 than you were when you took a swipe at her. She understood that the legislation merely adds unto the informed consent law while you thought it was the entire law.

Granholm didn't have the choice to remove parts of the bill. That wasn't an option. She could either accept the add-on or not.

 

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