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.