Manoocher Deghati / AFP-Getty Images
Under a new regulation poised to become law any day now, any health-care worker may refuse to perform procedures, offer advice or dispense prescriptions--like the morning after pills pictured here--if doing so would offend their 'religious beliefs or moral convictions'
THE VERDICT

The Abortion Wars Get Technical

Women have few rights at all when doctors can legally misinform them or deny service entirely.

 

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What does it tell us about the state of the abortion wars, that battles once waged over the dignity and autonomy of pregnant women have morphed into disputes over the dignity and autonomy of their health-care providers? Two of the most pitched battles over reproductive rights in America today turn on whether health workers can be forced to provide medical services or information to which they ethically object. But as we learn from these fights, our solicitude for the beliefs of medical workers is selective: abortion opponents will soon enjoy broader legal protections than ever. Those willing to provide abortions, on the other hand, will enjoy far fewer. And women seeking reproductive services will be more caught up than ever in the tangle between the two.

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The first dispute concerns a new rule purporting to protect the "right of conscience" of American health-care workers. Under a new midnight regulation crammed through by the Bush Department of Health and Human Services and poised to become law any day now, any health-care worker may refuse to perform procedures, offer advice or dispense prescriptions, if doing so would offend their "religious beliefs or moral convictions." Congress has protected the right of physicians to opt out of providing abortions for decades. This new rule, which President-elect Obama can overturn (although it may take months), is far broader. It allows one's access to birth control, emergency contraception and even artificial insemination to turn on the moral preferences of a pharmacist, nurse or ambulance driver.

The second dispute involves a South Dakota law that went into effect last summer after an appeals court lifted a preliminary injunction. The law requires physicians providing abortions to read from a state-mandated script advising the patient that she is about to "terminate the life of a whole, separate, unique, living human being" with whom she has an "existing relationship." The doctor must have her patient sign each page of a form indicating that she has been warned of the "statistically significant" risks of the procedure, including "increased risk of suicide ideation and suicide." These "risks" are almost completely unsupported by the scientific literature. A new comprehensive study released by Johns Hopkins found "no significant differences in long-term mental health between women in the United States who choose to terminate a pregnancy and those who do not." The disparity between the empirical data and the mandatory script thus forces physicians into a Hobson's choice between providing patients with accurate medical information, and possible license suspension and misdemeanor charges.

Reading the new HHS regulations together with the mandatory South Dakota "script," one can only conclude that those same health providers who cannot be compelled to perform an abortion may nevertheless be compelled to deliver misinformation about it. The freedom and autonomy of doctors who oppose abortion are protected by law. But those willing to provide abortions can be forced to deliver a state message with which they completely disagree. Both the HHS's right-of-conscience rules and the South Dakota script purport to clarify the complex legal relationship between health provider and patient, but each instead confuses and obfuscates settled law. The HHS rule, as written, is so ambiguous that nobody can say for certain which health-care workers or medical procedures are covered, beyond establishing that both categories are broadly expanded beyond those protected by existing right-of-conscience laws. The rule even fails to define abortion, leaving open the possibility that anyone who thinks birth control is abortion may decline to dispense it, turning every visit to the ER or the pharmacy into a spin of the constitutional roulette wheel.

A recent article in the New England Journal of Medicine similarly blasts the South Dakota script for introducing novel and confusing legal language about "human beings," "constitutional rights" and "relationships" into a medical conversation between doctor and patient, concluding that these words are there "to intimidate pregnant women with vaguely described and legal-sounding consequences."

Almost completely missing from this fascinating legislative discussion of what health workers might be forced to do and say with respect to reproductive rights are the reproductive rights themselves. Whether we like it or not, the right to birth control, emergency contraception and—under most circumstances—abortion is still constitutionally protected. But these are not services a woman can provide for herself, which leaves her with few rights at all when her doctors are empowered by law to misinform her, withhold advice or deny services altogether. Even beyond the problem of subordinating a woman's rights to her doctor, however, there looms a larger question for health-care workers themselves: if they are indeed seeing their rights and freedoms either hugely expanded or severely restricted based solely on which side they've chosen in the culture wars, they might properly wonder whether any of them are truly free at all.

Lithwick is a NEWSWEEK contributing editor and a senior writer for Slate. A version of this column also appears on Slate.com.

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  • Posted By: cmanecke @ 03/26/2009 6:26:25 PM

    I disagree with the South Dakota law. It is not right to force a physician to read the state mandated script that is basically flat out telling them to not have an abortion. It is the patients own business whether or not they feel comfortbale going through with an abortion, and they do not need their doctor to try and persuade them otherwise. The wording of the script is completely biased. It is not necessary to comment that a women has an "existing relationship" with their unborn child, and by wording it in that way they are displaying too much of their own thoughts on a situation that is none of their business. The patient has a right to privacy and they should not be interrogated in this way. Also, it is not fair to require that the physicians say this script if they do not believe in it. If this law is passed many physicians willl become angry and they will probably fight the law. I think that it would be in everyone's best interest if they just left this situation alone.

  • Posted By: jharburg @ 03/03/2009 9:07:06 PM

    Ms. Lithwick,
    I have 2 things to say in response to your article on the "Abortion Wars."
    First, you make reference to one research study which did not find any lasting deleterious effects of abortion. Just a superficial query on the internet led me to many studies which contradict that finding. I would also challenge you to meet with any of the Silent No More women face to face to hear their story. They will describe each in their own unique way the ravages of Post Traumatic Stress Disorder (PTSD). I can think of no other event, besides rape, which creates more trauma for MOST women than having an abortion. It is the ultimate denial of the life giving genius which only women can contribute to human existence.
    Second, be careful when you frame a person's right of conscience as a stumbling block to your agenda. Wasn't it the right of conscience that our forefathers exercised when they wrote the Declaration of Independence throwing off the oppressive rule of a Monarchy depriving their citizens of their right to life, liberty and the pursuit of happiness? Wasn't it the right of conscience which women in the suffrage movement relied upon when they fought for the right to vote? Wasn't it the right of conscience which Martin Luther King Jr. used when he fought for racial equality by using non violent means? Were you not exercising your right of conscience to express your views publicly about this whole issue? If you don't want religious fanatics dictating your right to exercise your conscience then don't set yourself and/or your ideology up as the dictator of what a person's right of conscience entails. Please don't do that. It is the right of conscience which makes any society at least approach the difficult task of being civilized. Without it, rest assured power mongers of every sort will have their way with whatever arbitrary purpose they align themselves.
    Thank you for your consideration of my views.
    John Harburg
    jharburg2007@gmail.com
    3-3-09

  • Posted By: treehuggress @ 01/14/2009 9:42:18 PM

    "...Birth control, emergency contraception and???under most circumstances???abortion...are not services a woman can provide for herself...."
    Part of the problem of our entire health care system is the dis-empowerment of the patient. Our society teaches us that we needs pills for everything. Although I agree with this article, I take issue with the quote above. Women are very capable of preventing pregnancy, being aware of their own cycles and fertility. To assume their incapacity is disempowering and insulting.

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