'Partial-Birth' Abortion Ruling a Mistake: Physicians


April 19, 2007 — -- Alarmed. Disappointed. Sad. Fearful. Concerned.

These are just a few of the words obstetricians and gynecologists are using to describe their feelings in reaction to yesterday's United States Supreme Court ruling to ban certain types of late-term abortions.

The 5 to 4 decision was arguably the most significant abortion ruling since Roe vs. Wade in 1973.

This ruling makes it illegal for a doctor to perform a medical procedure called intact dilation and extraction, commonly known as a 'partial-birth' abortion.

Many physicians who provide obstetric and gynecologic services to women are concerned that the ruling will have a negative impact on women's health by taking some medical decisions out of doctors' hands.

"From a public health perspective, today's ruling will not advance the health of women and children in America," said Dr. David Grimes, former chief of the abortion surveillance branch at the Centers for Disease Control and Prevention.

"It allows [an] intrusion into the relationship between doctors and patients. What would Americans think about that?"

Other physicians see the ruling as a violation of the Health Insurance Portability and Accountability Act which, among other things, ensures the privacy and security of a patient's health information.

"If HIPAA prevents me from speaking to family members about medical decisions without permission, how can the federal government insert itself into the decision-making process without invitation from either the physician or the patient?" asked Dr. Lisa Jones, practicing gynecologist and fellow of the American College of Obstetricians and Gynecologists.

"I feel strongly about the right of a woman to choose and the right of a physician to suggest the most appropriate treatment for a patient without the interference from a nonmedical body," Jones added.

Dr. Carla Lupi, assistant clinical professor of the department of obstetrics and gynecology at the University of Miami Miller School of Medicine, said, "As a physician, I am aghast that a jurist, with no professional licensure or experience in the care of women facing very complicated medical and personal decisions, should have the power to dictate my medical practice. These cases are often challenging even for the most seasoned practitioners.

"Doctors' hands should not be tied by categorical legal decisions."

The upheld law not only makes certain types of late-term abortions illegal, but it also does not allow for any exception to be made when a woman's health is at stake.

Dr. Diane Harper, director of the Gynecologic Cancer Prevention Research Group at Dartmouth Medical School's Norris Cotton Cancer Center, said this part of the ban, in particular, puts many women's health at risk.

She said that in cases where there are complications with labor, prohibiting doctors from performing this procedure could make it impossible for them to remove the fetus by artificial means -- sometimes the only way to save the woman's life.

"Preventing care providers from preventing further injury and morbidity, resulting in possible mortality to the woman, jeopardizes her life," Harper said.

Grimes agreed, adding that even though major medical institutions and peer-reviewed journals have shown this procedure to be medically indicated at times, the ban completely ignores this evidence.

Furthermore, Dr. Ronald Gibbs, chairman of the department of obstetrics and gynecology at the University of Colorado Health Sciences Center, said that the ruling opposes the "position taken by the American College of Obstetricians and Gynecologists, which indicates that, under certain circumstances, the dilation and extraction procedure is the best one for a women's health."

Many doctors say the ruling could have big implications for the future of abortion rights and women's health.

"I think the most profound concern is that it's going to spawn another epidemic of legislation at the state and local level," said Grimes.

"Every day spent on this will take away from attention on more important medical issues. Nobody has ever identified that this intact dilation and extraction is a medical problem."

Lupi said she is also concerned that the ban could have a disproportionate effect on poor women.

"Limiting second trimester access will also have greater impact on poor women in the many states with Medicaid programs that do not pay for abortions or only under very narrow circumstances," she said. "Poor women tend to have abortions in the second trimester for many reasons, including the time needed to obtain funds."

However, the impact that this ruling will ultimately have on abortion practices remains to be seen. Lupi said she worries that physicians may limit or even stop offering services completely.

"Many providers of second trimester abortion have already stated that they may stop offering services, not because their surgical abortions usually entail the poorly defined 'partial-birth abortion,' but because an unsympathetic observer may occasionally construe their observation of the procedure as such and initiate prosecution," she said.

On the other hand, the ruling could have little practical effect. Grimes anticipates that doctors will continue to perform the procedure due to a possible loophole in the law.

"It says that to intend to do an intact dilation and extraction is illegal," he said. "If you do an intact dilation and extraction inadvertently, that is OK? How does one determine intent after the fact? Who is going to be monitoring this?"

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