Wednesday, September 27, 2006

Young Pregnant Teenagers: The Vaterland Welcomes You

And wants to make sure you have a hell of a time getting out.

If you are a young pregnant teenager, passage of House Bill S. 403* will insure you have less rights than, for example, my dog. While the government imposes no restrictions on my dog's travels (he's been to New Jersey, several Indian reservation[s], and Canada), it plans to no longer permit you to move freely about the country, or, for that matter, the world.

'(a) Offense-

'(1) GENERALLY- Except as provided in subsection (b), whoever knowingly transports a minor across a State line, with the intent that such minor obtain an abortion, and thereby in fact abridges the right of a parent under a law requiring parental involvement in a minor's abortion decision, in force in the State where the minor resides, shall be fined under this title or imprisoned not more than one year, or both.

'(2) DEFINITION- For the purposes of this subsection, an abridgement of the right of a parent occurs if an abortion is performed or induced on the minor, in a State or a foreign nation other than the State where the minor resides, without the parental consent or notification, or the judicial authorization, that would have been required by that law had the abortion been performed in the State where the minor resides.


Notice how, while section (1) names as the offense transport[ing] a minor across a State line, with the intent that such minor obtain an abortion, and thereby in fact abridges the right of a parent..., section (2) expands the definition of the offense to encompass performing or inducing an abortion on the minor. 'Cause just criminalizing family and personal relationships isn't enough. What better company in jail for all those brothers, grandparents, and close family friends, than some medical personnel?

While I have no idea how this new offense will be enforced--spot pelvics on buses; mandatory blood pregnancy test highway checkpoints; massive TSA personnel deployment to every foreign country Ob/Gyn hospital and clinic--I do have a few comments about the bill.

Before I begin, let me just say that I have two problems with the concept of mandatory parental consent for abortions. First, it's illogical. If a young patient becomes pregnant and decides to carry the pregnancy to term (higher risk), she is considered mature and responsible, and no parental consent is required. By contrast, if the same patient decides to terminate the pregnancy (lower risk), she's no longer deemed mature enough to make her own decisions. This doesn't make sense. Second, once you allow parents to force a pregnancy, you must also allow them to force an abortion. [For the record, I find both forced pregnancies and forced terminations equally reprehensible.]

Back to bill S. 403. First, an amendment summary of S. 403 actually contains the word "abortionist".

SUMMARY OF AMENDMENT IN THE NATURE OF A SUBSTITUTE CONSIDERED AS ADOPTED ~

Sensenbrenner (WI): Amendment in the nature of a substitute. Substantially similar to H.R. 748 (passed House 270-157 in April, 2005) with the following changes: (1) contains Senate clarifying provisions, which prevent a parent who has committed incest from being able to obtain money damages under the bill's provisions. (2) makes an exception to the notification requirement if a parent is physically present when the minor shows up to get the abortion, and makes clear that the parental notification may be provided by an agent of the abortionist. Also makes a technical change to the definition of 'abortion' to exclude treatment for potentially dangerous 'ectopic' pregnancies and creates a new 'medical emergency exception.' Also makes clear that the bill applies when state lines are crossed to enter any foreign nation or Native American land. ~~~


Clearly, the morons politicians in charge of our health decisions thought it cute, not to mention appropriate, to use "abortionist" as some type of ideological dog whistle. [In the real world, a doctor who performs appendectomies is not an appendectomyist. He/she is a general surgeon. And a doctor who performs abortions is an Ob/Gyn or a FP.] Funny how these very same politicians would never dream of using the term "torter" in official government documents. But I digress.

In their ideological zeal, the politicians omitted a small detail (there's a reason why, when dealing with medical matters, terminology must be precise and, preferably, not made-up). There's no mention in the text of the bill of any medical qualification requirements for the person performing the abortion. This means the bill applies to anyone who performs an abortion. *Anyone*, including the patient. [Tsk, tsk, them "abortionists; they're everywhere.] Only S. 403 clearly states that the patient is exempt from prosecution:

'(2) A minor transported in violation of this section ... may not be prosecuted or sued for a violation of this section, a conspiracy to violate this section, or an offense under section 2 or 3 based on a violation of this section.


So if the pregnant teenager performs the termination herself, all's well in the Vaterland? [Yes, I realize performing a DIY safe abortion is not an easy task, but, in a best case scenario, the patient could initiate a medical abortion, present to the hospital for a diagnosis of "inevitable" abortion, and, voilà, the patient would be able to receive proper medical care without anyone having to go to jail for it.]

Second, S. 403 defines abortion as:

'(e) Definitions- For the purposes of this section--

'(1) the term 'abortion' means the use or prescription of any instrument, medicine, drug, or any other substance or device intentionally to terminate the pregnancy of a female known to be pregnant, with an intention other than to increase the probability of a live birth, to preserve the life or health of the child after live birth, to terminate an ectopic pregnancy, or to remove a dead unborn child who died as the result of a spontaneous abortion, accidental trauma or a criminal assault on the pregnant female or her unborn child;


As noted in the amendment summary, our beloved leaders [Praise Be Upon Them] did, indeed, decide in their magnanimity to make[ ] a technical change to the definition of 'abortion' to exclude treatment for potentially dangerous 'ectopic' pregnancies and create[ ] a new 'medical emergency exception.' Good news for those young patients blessed with an ectopic.

[Just so we're clear. There is no such thing as a run-of-the-mill ectopic. All ectopics are potentially dangerous and must be actively managed. Here are some good intra-op pics (WARNING-graphic) of a tubal ectopic.]

Our wise politicians even went so far as to permit the removal of a dead unborn child who died as the result of a spontaneous abortion, accidental trauma or a criminal assault on the pregnant female or her unborn child. Super news for those patients fortunate enough to have had a pregnancy loss caused by one of the three state-sanctioned etiologies.

But what about those patients who suffer a FDIU (fetal demise in utero) at a later stage in pregnancy? [Medically, the term 'spontaneous abortion' is reserved for an early pregnancy loss.]

Well, as per our most knowledgeable politicians, all these patients can do is hope, really, really hard, that the tissue maceration inside the uterus proceeds at a brisk pace, and (fingers crossed) coagulation defects severe enough to endanger their lives follow in short order so that they, too, may be permitted to receive adequate medical care.

[Here's an exercise for you: find another instance in medicine where intervention is prohibited by governmental decree until, and unless, the patient's life is in danger. Shouldn't be too hard, since, as we all know, one of the aims of medical care is to maximize the chances that one will have to treat (or operate on) an unstable patient.]

Third, our most esteemed leaders take special care to address the issue of incestuous parents, sort of:

Any parent who suffers harm from a violation of subsection (a) may obtain appropriate relief in a civil action unless the parent has committed an act of incest with the minor subject to subsection (a).


So, under the bill's provision, a parent who has committed incest isn't able to profit financially from the incest. Good. Yet, this very same parent is still able to force a pregnancy on his victim?

Fourth, S. 403, the "Teen Endangerment Act," (according to the ACLU) is to be cited as the 'Child Interstate Abortion Notification Act'. Brilliant propaganda, except for one thing. Children (individuals between birth and puberty) cannot become pregnant. Teenagers can, and do.

Last, but not least, from the ACLU press release:

The bill creates two new federal crimes. It imposes a federal parental notification and waiting period on a teenager seeking an abortion outside of her home state, even if neither her home state nor the state where she seeks an abortion requires such measures. It would also make it a federal crime for a person other than a parent - including a grandmother, aunt, or older sister - to help a teen cross certain state lines for an abortion unless she had already fulfilled the requirements of her home state’s law restricting teens’ abortions.

By doing so, the Teen Endangerment Act raises serious constitutional concerns. The Constitution protects the right of every individual to travel freely from state to state and, when visiting another state, not to be treated as a foreigner. Instead, this bill saddles a young woman with the laws of her home state no matter where she travels in the nation. The bill pits states against each other, requiring one to enforce another’s laws even when a state has chosen not to restrict teenagers’ access to abortion care.


With all due respect to the ACLU, I don't see where the bill imposes a notification and waiting period if these requirements aren't already in force in the patient's home state. See:

...abridges the right of a parent under a law requiring parental involvement in a minor's abortion decision, in force in the State where the minor resides...


and

...without the parental consent or notification, or the judicial authorization, that would have been required by that law had the abortion been performed in the State where the minor resides.


I do, however, strongly agree that S. 403 arbitrarily restricts the free movement of some Americans.

[Notice that it's not the pregnant state of the uterine organ of some young Americans that triggers the prohibition. It's the degree of approval politicians bestow on a pregnant stranger's medical decisions. Those young teenagers who intend to carry the pregnancy to term are allowed to make this (comparatively high-risk) medical decision on their own, and are permitted to travel freely. By contrast, patients who intend to make a different medical decision, one that the politicians find icky, are denied the same opportunity afforded their peers. No ability to make their own medical decisions, and, thus, no freedom of movement, in the U.S. or abroad, for this bunch.]



*If the link doesn't work properly, try this, and click Beginning.

6 Comments:

At 6:23 PM, Blogger dicconzane said...

Marvelous a way to increase th demand for blackmarket and unsafe abortions... well I suppose you eliminate the problem entirely if you wipe out teenage mothers who get an abortion though blood disease or medical complications.

Diccon

 
At 2:44 AM, Anonymous D-V said...

In her seminal blog on abortion (http://bitchphd.blogspot.com/2004/10/abortion.html), b-tchphd vigorously argues for legalized abortion "because no one is better qualified, no one cares more, no one knows better than I do, or than any woman does, what is best for my kid. Period." For the same reason, this bill is sensible-- I should decide whether my daughter has an abortion, and not some child predator who wants to conceal his crime or some abortion provider who wants to make a buck.

 
At 11:55 PM, Blogger ema said...

d-v,

For the same reason, this bill is sensible-- I should decide whether my daughter has an abortion...

How medical decisions are made in your family is your private business. That's not the issue. The problem is the State mandating parental consent for a low risk procedure (abortion), but not for a high risk one (pregnancy/delivery). It doesn't make sense. [And, as I mentioned in the post, there's always the problem of State-approved forced abortions.]

...not some child predator who wants to conceal his crime or some abortion provider who wants to make a buck.

Please explain how a stranger, be it predator or physician, decides for the patient. [Hint: familiarize yourself with the concept of consent.] And just for the record, the reimbursment for a delivery is much higher vs. that for a termination.

 
At 12:19 AM, Anonymous D-V said...

With respect to the paradox that parental consent is required for a low-risk procedure while it is not required for a high-risk procedure, please note two points:

1. Whether abortion involves less risk than delivery depends on your understanding of "risk." If you are using it in a stastical sense, to refer to the variability of possible outcomes, then I concede that you are correct. However, if you are using "risk" to refer to a degree of danger, then abortion is a far riskier procedure than delivery because it always results in the death of at least one human being (unless it is botched).

2. While this paradox initially appears to be a persuasive argument, it ignores the reality that it is far more easy for a teen to sneak off to get an abortion without her parents' knowledge than it is for her to carry a pregnancy to term. This difference in a girl's ability to evade her parents' guidance is a far more relevant distinction than the riskiness of the procedure.

I concede that saying that a predator or abortion provider "decides" whether a girl has an abortion may have been a bit imprecise. What I meant is that there is a risk (by which I mean danger) that a girl facing a pregnancy will be pressured by her "boyfriend" or abortion provider to have an abortion (without ever consulting with her parents). Can we really say that a girl in this situation has given her "consent"? This is consistent with statutory rape laws, where consent is not a defense.

The fact that reimbursement rates for delivery may be higher than those for abortion are another inconsequential distinction, unless a particular abortion clinic also provides delivery. I understand (perhaps incorrectly)that most abortions in this country are performed in clinics that do not also provide delivery services. In this case, an abortion provider will only make a buck from abortion, not delivery. As an example, if you go to a Mercedes/Chrysler dealership, then the dealer will prefer to sell you a Mercedes; if you go to a Chrysler dealership, the dealer will push a Chrysler.

By the way, where is that blog refuting the Dr. Irving Plan B submission that you promised on b-tchphd's blog?

 
At 1:54 AM, Blogger ema said...

Ha d-v, I thought that was you! I haven't forgotten. Apologies for the tardiness; the draft is almost ready, and I'll post it shortly.

As to your comments:

1. The risks associated with a medical procedure are not plastic. They are what they are, irrespective of one's personal beliefs (in your case, removal of POC=death of at least one human being).

2. Two points. First, the reality that it is far more easy for a teen to sneak off to get an abortion without her parents' knowledge than it is for her to carry a pregnancy to term. is not the basis for the parental consent law. It's the presumption that a young person is not mature/responsible enough to make her own medical decisions. My point is that, if she's not mature enough to make an abortion-related decision (medically, a low-risk procedure), she's not mature enough to make a far more medically risky decision (carrying the pregnancy to term).

Second, why should a patient's ability to evade her parent's guidance be more relevant than the riskiness of the procedure?

If your objection to not having parental consent laws is that there is a risk that a girl facing a pregnancy will be pressured by her "boyfriend" to have an abortion, my objection to having these laws is that there's a risk that a girl facing a pregnancy will be forced by her parents to have an abortion.

The fact that reimbursement rates for delivery may be higher than those for abortion are another inconsequential distinction...

Not when you referenced in your initial comment the abortion provider who wants to make a buck. Also, in the context of considering the physician's finances, the fact that abortion clinics do not provide delivery services is irrelevant. The physicians who perform this procedure (mostly Ob/Gyns) are affiliated with a hospital where they can, and do, perform deliveries, and a bunch of other, more financially lucrative, procedures.

 
At 2:54 AM, Anonymous D-V said...

ema-- I've been a bit distracted lately and thought that I'd be too late to post a reply, but perhaps not, given that your Plan B blog still hasn't shown up.

Anyway, I thought I'd limit my response to the following, given that it appears to be the real nub of our disagreement:

{They are what they are, irrespective of one's personal beliefs (in your case, removal of POC=death of at least one human being).}

That a fetus is a living human being is not my "personal belief"-- it is an objective scientific fact. The fetus is an organism (he has separate systems that contribute to his life support) who is separate and distinct from his mother. He is alive-- he is growing; if you inflict a severe trauma, the growth will stop and cannot be resumed. He is certainly human-- just look at the DNA.

If he's not a living human being, then (1) what is he (my apologies, I'm not familiar with the TLA "POC") and (2) when does he become a living human being?

 

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