A Bioethical Perspective on Oklahoma’s New Abortion Law

The percentage of college educated Americans who support legal abortion seems to have reached a new low among women under thirty and among the population as a whole,  so it should be no surprise that states are passing laws to restrict safe abortions. Before performing any abortion Oklahoma’s new 2010 law requires that the doctor do an ultrasound and describe to the woman the dimensions and gestational age of the embryo, cardiac activity if any, and appearance of external and internal structures.  A vaginal transducer must be used when doing so will display the embryo more clearly than an abdominal transducer.  Oklahoma’s law thus requires doctors to perform an ultrasound that is not medically indicated and likely to be invasive. In this era of skyrocketing medical costs and overutilization of services the new law mandates more of the same while leaving the burden of payment to the women themselves.

U.S. law requires that informed consent be obtained for treatments and diagnostic tests. This means that accurate and relevant information must be disclosed to patients. If current standards of disclosure and informed consent apply then the description of the fetus must include evidence about embryology including clinical and scientific uncertainty about when consciousness, thoughts, sensations, and life begin. This is more than some of the other commentators who are in favor of the law are advocating. Providing abortion without truthful disclosure and informed consent violates existing laws, threatens the doctor-patient relationship, and jeopardizes medical professionalism.  Mandating ultrasound, especially with out disclosing all the information -- especially where the law protects the doctor against deliberate failure to disclose --  means ignoring the need to obtain informed consent. One wonders how such a poorly crafted law ever reached the legislature. Indeed, as a result of legal challenges to the new law an Oklahoma judge has just granted a slight reprieve by delaying implementation for 45 days. 

[Guest blogging this week is Cheryl Cox Macpherson, Ph.D., Professor and the Chair of Bioethics Center at St George's University School of Medicine (SGU) in Grenada where she enjoys teaching medical and graduate students from many nations and background.]

Love’s Labour Lost: An act of desperation leads to a bad law

There is a saying in the law that “hard cases make bad law”.  This tragic story is one of those hard cases:  Last year in June, a 17 year old girl, seven months pregnant, was told by her boyfriend, the baby’s father, that he would leave her if she didn’t get rid of the unborn child.  So, the girl gives 21 year old Aaron Harrison $150 to beat her up and induce a miscarriage; it didn’t work – the baby survived, was born in August and, fortunately, adopted. The girl pled no contest to a second-degree felony count of criminal solicitation to commit murder, but the charges were later dropped as a judge ruled that under state law, she could not be held criminally liable.  Harrison is serving a sentence for up to 5 years for the “attempted killing of an unborn child.”

Utah’s legislative response:  Pass a bill that charges pregnant women and girls with murder for having miscarriages caused by "intentional or knowing" acts; so that if this happens again, the 17 year mother could face a prison sentence of 15 years to life. (The Text of the Bill can be accessed here.)

But no one is addressing the underlying problem  -- Sure, there is plenty of blame to go around – the pregnant minor, the baby’s father, the guy who agreed to beat her up – But there also lots of questions that need to be asked, such as “How could this have been prevented?”   Did the 17 year old or her boyfriend have sex education?  Did either of them have access to birth control?  Was the 17 year old aware that she had the right to a legal abortion?  Did her parents or the boy’s parents discuss alternatives with her?  Did ANYONE in the community discuss her options or offer her support? – Or did they figure that every seventeen year old was as mature as Ellen Page’s character in Juno and everything would be hunky dory? (They obviously haven’t watched Revolutionary Road)   As Lynn M. Paltrow, the executive director of National Advocates for Pregnant Women, commented, how this happened is being obscured because of the sole focus on the baby; she asks “Why would a young woman get to a point of such desperation that she would invite violence against herself?”

According to the Guttmacher Institute, which advocates for sexual and reproductive health in the United States, 93 percent of all Utah counties have no abortion provider. And I would venture to guess that sex education and access to birth control is fairly limited where this happened. (Somebody, please correct me if I’m wrong)

Planned Parenthood Melissa Bird is concerned that the language of “intentional or knowing” is still problematic, leaving suspicion open to any miscarriage: “What happens to women who are in abusive relationships?" she asks. "What happens if a woman threatens to leave the abuser, falls down the stairs and loses the baby? What if the abuser beats the woman and causes a miscarriage? Could he turn her in? Who would the prosecutor believe? What happens if a drug addict who’s trying to get clean loses her baby? Will she be brought up on murder charges?” (full text accessible here)

If there is anything that approaches a consensus in the US on this topic, it is that is prevention of unwanted pregnancy is much better than abortion.  This law doesn’t consider that OR address the underlying problem – it doesn’t help women have control over their reproductive systems or help the unborn; it penalizes the mother for being desperate.

[Cross-posted on IEET’s blog]

Some articles on our radar screen this past week...

Autonomy and Authenticity of Enhanced Personality Traits
Abstract: There is concern that the use of neuroenhancements to alter character traits undermines consumer's authenticity. But the meaning, scope and value of authenticity remain vague. However, the majority of contemporary autonomy accounts ground individual autonomy on a notion of authenticity. So if neuroenhancements diminish an agent's authenticity, they may undermine his autonomy. This paper clarifies the relation between autonomy, authenticity and possible threats by neuroenhancements.

Tech-assisted reproduction growing worldwide:
Worldwide report shows increase in assisted reproduction: 250,000 babies (approximately) born in 1 year.
Assisted reproductive technology (ART) is responsible for an estimated 219,000 to 246,000 babies born each year worldwide according to an international study. The study also finds that the number of ART procedures is growing steadily: in just two years (from 2000 to 2002) ART activity increased by more than 25%. As this technology becomes more accessible to more people, will this encourage the ART industry to go further in their efforts and should more regulation be considered?

Boy or Girl? As early as 10 weeks gestation, a new at-home test has an 80% accurate predication rate. But will this result in more female fetuses being terminated?

Udo Schuklenk on the Murder of George Tilly

Colleague and friend Udo Schuklenk agreed to do a guest post/cross-link from his blog about the recent murder of physician George Tilly:

Another murder aimed at furthering the 'pro-life' agenda

It had to happen, the pro-life affirming loonies in the USA have taken yet another person's life. George Tiller, MD, a medical doctor specialising in reproductive health services, including medically indicated late-term abortions, was gunned down outside a church service in his home town. I'm probably as shocked about this killing as most reality based people. However, there's a deeper issue about this, at least to my mind.

The religious ideologies that triggered the murder of Tiller (and, in the past, others like him) want their adherents to subscribe to the view that from the moment of biological conception (marriage and all, you know the drill) the developing embryonic cell mass is of infinite value and should be treated as if it was a person. Well, persons - all other things being equal - are usually seen to have a right to life. At a minimum this is understood as a negative right, ie I must not interfere with such a person's right to life (by way of killing that person).

Let me be clear: I do think the view that something that has no central nervous system, that has no capacity to suffer, and that has no higher brain function has a right to life, makes no sense at all. What harm could possibly have been done to such a thing if it is destroyed? None at all, at least as far as I can see. It is for that reason that I reject the idea that we should treat the developing embryonic cell mass from the moment of conception as if it was a person. After all, it isn't a person, so why bother? It's a bit like saying that I should treat the leader of the opposition as if she was the leader of government. She might have the potential to be the next leader of government, but right now she is not. I surely cannot smuggle the right to be treated as if you were the leader of government into the potential to become the leader of government. A lot of potential things never eventuate (eg my potential to be an astronaut will not ever be realised).

However, and here is where I am troubled about this matter. IF someone really holds the barmy view that the embryonic cell mass after conception is infinitely valuable and should be treated as if it was a person from that moment onwards, it is only logical that you consider abortions murder. In turn it is perfectly reasonable for such a person to treat abortion providing health care professionals as if they were murderers. Surely it is not unreasonable (from such a person's perspective) to try to prevent further murders from happening. Ergo it should not come as a big surprise that Doctor Tiller was murdered by a 'good citizen' trying to prevent further murders at the hands of the good doctor.

So, the pro-life crowd's handwaving along the lines that the murderer is not one of theirs, makes not much sense. The ideology they propagate leads, to my mind inevitably so, to the killing of people like Tiller. Freedom of speech seemingly covers Catholic propaganda ministers freedom to spout lies about a supposedly ongoing 'genocide', whereby the deliberately and mistakenly refer to blobs of cells as 'children'. IF you really believe that propaganda, surely it's not unreasonable to conclude that in order to stop the genocide the perpetrators of the genocide must be stopped. Killing one person (eg Dr Tiller) is clearly seen by some of those on the pro-life side as the lesser of two evils. They are only able to reach this conclusion, however, because the church hierarchy continues to propagate outrageous nonsense about 'genocide' and 'holocaust' and whatnot when it comes to abortion. This is where the blame for Tiller's murder as well as that of others like him squarely belongs. You shouldn't be too surprised if some people at least do actually fall for your agitprop.

Moral Outrage of the Week: Excommunication in Brazil

In a very sad and disturbing case from Brazil, Yahoo news reports:

“A senior Vatican cleric has defended the excommunication of the mother and doctors of a nine-year-old girl who had an abortion in Brazil after being raped…."It is a sad case but the real problem is that the twins conceived were two innocent persons, who had the right to live and could not be eliminated," he said. The girl was apparently raped by her stepfather since she was six; he also allegedly sexually abused the girl's physically handicapped 14-year-old sister -- but the stepfather is not being excommunicated -- he is still a Catholic in good standing (at least if he ‘confesses’). The doctors who carried out the abortion did so for fear that the slim girl would not survive carrying the fetuses to term; President Lula da Silva said "in this case, the medical profession was more right than the church."

As one of my colleagues commented, 'Surely, the Vatican is pursuing a foolish consistency." Couldn't the Church have acknowledged that this was a case of self-defense, like an ectopic pregnancy? (Ideally, the Church could have considered its pre-Vatican Council I [1860s] position that abortion is permitted prior to the ‘quickening,’ but I don’t see that happening any time soon). And what happens if the mother and doctor ‘confess’, like the stepfather? Will the excommunication be lifted? Or will politics outweigh morality?

Here We Go Again...

[Hat tip to supporter Paul Root Wolpe and our colleagues at Bioedge for bringing our attention to this story]

As we blogged about before on several occasions, the debate over the personhood and the legal/moral status of embryos (as well as other entities) continues: Even though the 'personhood for embryos' amendment in Colorado was resoundingly defeated, North Dakota is next in line to attempt to create a law that would give full moral and legal status to embryos.

The Grand Fork Herald reports that [The] "measure approved by the North Dakota House gives a fertilized human egg the legal rights of a human being, a step that would essentially ban abortion in the state.

The bill is a direct challenge to Roe v. Wade, the U.S. Supreme Court decision that extended abortion rights nationwide, supporters of the legislation said.

Representatives voted 51-41 to approve the measure. It now moves to the North Dakota Senate for its review.

The two-paragraph bill declares that 'any organism with the genome of homo sapiens' is a person protected by rights granted by the North Dakota Constitution and state laws.

It says the Legislature may choose one of its members to help defend the new law if its constitutionality is challenged in court." Full article accessible here.

I don't know if there are any fertility clinics in North Dakota, but I don't believe there are any exceptions for IVF. Given that this is an attempt to ban abortion, I wonder what consideration, if any, has been given to victims of rape or incest or those families who are choosing PGD to avoid transmission of painful genetic disorders. Or those women whose health might be threatened by a pregnancy (e.g. women with certain forms of MS or Eisenmenger's Syndrome).
There are less coercive ways to discourage and reduce numbers of abortions; and different ways to approach the issue, like Aspen Bakers' Pro-Voice solution.

Obama Repeals Global Gag Rule

One of the clearest things I remember about my time working at Planned Parenthood was the rejoicing that happened when Clinton repealed Bush, Sr's global gag rule order. Although I was no longer working for Planned Parenthood by the time W. re-enacted his father's gag order, I despaired at the number of women worldwide who were going to have their access to safe and legal information about abortion restricted or completely taken away.

Checking the news before bed tonight, I actually scared my cats reacting to the news that Obama has overturned the Mexico City Policy.

I realize that there are people in the reading audience who will be disappointed by this news, and will work to continue having it placed back into effect. And personally, my concern was never so much about the abortions being provided (or not), as it was my issue with the fact that NGO's were forced to choose between discussing the full range of care options for a pregnant woman or losing their funding from the US government. I haven't been where these NGOs work, and I can't even pretend to know what they see, daily, in the lives of the women they treat. But I know that medical abortions are necessary around the world, and I know that there are situations and reasons for choosing abortion in these countries that I might never fully comprehend. A woman should have the right to a full and open, honest discussion of all of her options with her health care provider, regardless of where she lives in the world. That honesty should not be a privilege only granted to those lucky enough to live in a first world country.
-Kelly Hills

Yo, Vitter: knock it off!

So here's something I feel fairly outraged about, just 'cause it seems like unfair piling on: because of an anti-abortion amendment Senator David Vitter (R-Louisiana) attached to the reauthorization of the American Indian Healthcare Improvement Act, the Act is being held up yet again.

Some people think the writing has been on the wall for some time about this (you can read more about the history of this mess at Indian Country Today), but the reality is that the state of health care for Native American people on and off the reservations in this country is a national shame ... and to tie the fate of health services to the perennial third rail of politics is a travesty.

Hat tip to the Kaiser Health Disparities Report (which does a swell job getting you your weekly dose of reality and high blood pressure--as well as daily reports on health policy and other issues).

Continuing Coverage: Abortion as Art

The debate around Aliza Shvarts' abortion as art project/social commentary continues as Yale officials now say that without a disclaimer clearly stating the entire project is a work of fiction/hoax and contains no human blood, and is merely performance art.

"In this case, we will not permit her to install the project unless she submits a clear and unambiguous written statement that her installation is a work of fiction: that she did not try to inseminate herself and induce miscarriages, and that no human blood will be physically displayed in her installation," Peter Salovey, dean of Yale College, said in the statement.

Additionally, Yale officials have said that Shvartz' advisers made serious errors in judgment in approving the project once they were aware of the controversial nature of the piece; the faculty involved have apparently been spoken to with "appropriate action" taken.

Now, this raises even further questions for me. First - if Shvarts presented the project to her faculty advisers as a performance piece/hoax project designed to get the rise that is has been out of us chatty media commentators, why would the faculty raise questions, or seek additional approval? On the face of it, if you want to believe that this is a performance piece and not actually what Shvartz says it is - the result of repeated attempts to inseminate and then herbaly abort resulting pregnancies - then what's the problem? Gelatin, food colouring, plastic, a controversial artist statement, and the precise results any performance artist is hoping to achieve. And if she lied to the advisers, why does this then become something that they should be punished for?

Secondly, the automatic ban on art that contains human body fluids/cast-offs strikes me as stepping very close to censoring art because it is controversial. Many modern, performance, and even "traditional" artists work in human fluids - is this really the appropriate response for officials to have to controversial art?

At this point, unless someone goes in with Luminol or DNA swabs and then runs PCRs, etc, we're never going to know if she actually did what she said - in a way, it's a wonderful example of just how flexible truth and knowledge actually is.
-Kelly Hills

Abortion as Art Debate Continues

Aliza Shvarts abortion as art Yale senior art project is continuing to create controversy. Originally billed as a student deliberately impregnating and aborting over the span of many months, and saving the fluids for an art project, was labeled fictitious performance art by Yale - a statement Shvarts immediately called inaccurate:

Shvarts reiterated Thursday that she repeatedly use a needleless syringe to insert semen into herself. At the end of her menstrual cycle, she took abortifacient herbs to induce bleeding, she said. She said she does not know whether or not she was ever pregnant. No one can say with 100-percent certainty that anything in the piece did or did not happen, Shvarts said, because the nature of the piece is that it did not consist of certainties.

Well, at least we are now starting to see bits and pieces of an artist's statement - something I'm still trying to track down.

But Yale isn't happy with this latest development, with the dean of the art school, as well as Yale proper, speaking out against this, and discussing how future senior projects will be reviewed, supervised, and approved.

Shvarts is right - we'll never know what "the truth" of this situation is. But that's not necessarily the point; truth isn't always needed to have discussion, to consider possibilities and what if's. And my problem with this entire situation is both narrow and broad in scope. Narrowly speaking, as a student myself, I'm irritated with the very idea of someone so blatantly causing trouble that will then turn around and impact other students - future art students are going to have a lot more grief and oversight and hoops to jump through because of Shvarts, and that seems almost intuitively unfair, and selfish. There's an element of "about-me at the expense of others" to the piece that I simply find distasteful.

But the broader concern is over art in general, and who supervises it - especially bioart.

It's no secret that I'm a fan of DIY biotech and the art that comes out of the movemet. The Critical Art Ensemble is one of my favourite performance art groups, and I love how thought provoking their biotech projects are. And as it becomes easier and easier to grow your own biotech, we're going to see more artists using biological materials in their work. The difficulty of Kac's Alba the GFP Bunny is going to give way to homebrewed experiments and art - sort of literally. As is, the walls of my office are decorated with art from students using osteoblasts to make things as diverse as religious symbols and art highlighting the life cycle of Pacific Northwest trees; freshmen and sophomores with no biology background spending 5 weeks in a basically equipped lab, making fascinating and interesting art. (I still wish I had a picture of the spiral nebula one student made out of her DNA. Figuring out how to photograph that one was a challenge!)

As DIY biotech becomes easier, as more artists begin to question what it means to use our bodies as art, interactive with the world, or any number of other justified reasons, we're going to hit these boundaries. These points that might generate a yuck or a wince or a deep-seated intuitive response; and what do we do then? Where do we draw the line? Art has often pushed boundaries, and in general we allow for the freedom of the artist to engage in whatever work they want, so long as it breaks no laws. That's part of art, to push and make us think, re-evaluate.

Are we going to need to change this idea in the face of DIY biotech and bioart? Are some sort of reviews of bioart proposals necessary? Does it need to be vetted by an ethicist, some sort of specialist? Or at least supported? Is it even a valid area for an ethicist to get into, or does it become antithesis to the entire idea of art, having someone approve or deny the process itself?

Shvarts is certainly getting debate and dialogue over her art project - I'm just not certain it's the dialogue she was hoping to create.
-Kelly Hills

Abortion As Art A Hoax

Never fear Kelly, from Yale University:

New Haven, Conn. — April 17, 2008

Ms. Shvarts is engaged in performance art. Her art project includes visual representations, a press release and other narrative materials. She stated to three senior Yale University officials today, including two deans, that she did not impregnate herself and that she did not induce any miscarriages. The entire project is an art piece, a creative fiction designed to draw attention to the ambiguity surrounding form and function of a woman’s body.

She is an artist and has the right to express herself through performance art.

Had these acts been real, they would have violated basic ethical standards and raised serious mental and physical health concerns.

Even with the explanation, I'm still not sure I get it. Anyone?

Abortion as Art

I'm coming off a two week conference rush and rounding the bend right into final exams and papers, a condition that generally dramatically decreases the amount of news I ingest or general attention I pay to the world. That said, I got home from school this afternoon to find at least half a dozen messages, via email, LiveJournal and Facebook, all wanting to know if I had seen this:

Art major Aliza Shvarts '08 wants to make a statement. Beginning next Tuesday, Shvarts will be displaying her senior art project, a documentation of a nine-month process during which she artificially inseminated herself "as often as possible" while periodically taking abortifacient drugs to induce miscarriages. Her exhibition will feature video recordings of these forced miscarriages as well as preserved collections of the blood from the process.

The goal in creating the art exhibition, Shvarts said, was to spark conversation and debate on the relationship between art and the human body. But her project has already provoked more than just debate, inciting, for instance, outcry at a forum for fellow senior art majors held last week. And when told about Shvarts' project, students on both ends of the abortion debate have expressed shock . saying the project does everything from violate moral code to trivialize abortion.

So yes, internet, I have seen this, and the reason I didn't place it up here sooner is... I really, honestly don't know what to say.

The display of Schvarts' project will feature a large cube suspended from the ceiling of a room in the gallery of Green Hall. Schvarts will wrap hundreds of feet of plastic sheeting around this cube; lined between layers of the sheeting will be the blood from Schvarts' self-induced miscarriages mixed with Vaseline in order to prevent the blood from drying and to extend the blood throughout the plastic sheeting.

Schvarts will then project recorded videos onto the four sides of the cube. These videos, captured on a VHS camcorder, will show her experiencing miscarriages in her bathrooom tub, she said. Similar videos will be projected onto the walls of the room.

In my office, I have artwork made by students - and some of that artwork contains human osteoblasts. Although I don't own any of it, some students used their own blood or sperm in their projects; I have an art project done for a research course that is bound with my hair. And then, of course, there is Critical Art Ensemble's BioTech projects, including Cult of the New Eve, GenTerra and Marching Plague.

The idea of using the body and its cast-offs in art is nothing new. There are even well known artists, male and female, who use menstrual blood in their work, and of course, Turner Prize winners have used just about every secretion and bodily cast-off possile in their art. So I can approach it from that view and theory and it's interesting, potentially provocative. I'd like to see her artist statement and what the point she was driving at with is.

And then I pause and go "waitaminute, she intentionally got pregnant and aborted multiple times for art?!" and it's hard not to have an intuitive moral outrage - perhaps regardless of your position on abortion. Abortion is not something to be done lightly, it's not a lark. It's often a difficult and wrenching position for women to be in, especially those in areas where the local community is not so supportive of a woman's right to choice. And even if a woman feels nothing but lightness and joy at no longer being pregnant, it's still hard to ignore the fact that the choice made was a serious decision. I think Yale student Sara Rahman ('09) had it right when she said that the art project "turns what is a serious decision for women into an absurdism, [and it] discounts the gravity of the situation that is abortion."

Personhood, moral agency - these are things that are difficult to define, and defend. It's a core discussion in bioethics, and probably always will be; I have a hard time seeing us suddenly wake up one morning and all agree. But this seems to go beyond, and I fear that why it's going beyond might get lost in the shuffle, or accusations that I've already seen (if you support abortion this should be fine it's the same thing etc).

I'm still thinking about it, but I think the line it crosses it not that it's an abortion, but that it's an abortion for entertainment. While it is certainly her body and her own right to do with it as she will, it's coming dangerously close to the almost apocryphal stories of women who use abortion as birth control, only instead of finding herself unintentionally pregnant and aborting, she is intentionally impregnating herself, aborting while filming, rinse and repeat. There seems to be an intentional callousness to this that separates it out from the often legitimate moral questioning that revolves around the abortion debate, and knocks it into an entirely separate sphere best defined by three letters: W T F.

I admit, I find myself really hoping that the actual art project is analyzing social reaction to a "fake" project (of abortion as art).

So tell me, internet, as I mull this over and see if I can come up with a more coherent argument: what do you think?
-Kelly Hills

Sex selection among Asian Americans

An article in the April 1 Proceedings of the National Academies of Sciences (abstract) suggests--based on analysis of data from the 2000 Census--that prenatal testing and abortion (as well as, potentially, preimplantation screening) are being used to deliver more male babies to Asian families in the United States. Listen to the story on NPR here, or read the AP story here.

Prior posts on the subject of sex selection (or "family balancing," if you think it's ok to do, or you happen to sell a related service) abound here on the blog: you can search at the top of the page to find them, and to learn about reasons the practice is declining in Korea; its legal status in India; and other aspects.

News: Kansas Court Blocks Records Request

The Kansas Supreme Court has temporarily ruled on an appeal filed by Dr. George Tiller's attorneys, blocking the grand jury from obtaining semi-redacted medical records of patients that had late-term abortions.

Tiller's attorneys had asked that the court squash the subpoenas and disband the jury, primarily citing serious concerns about patients' privacy, and the power and reach of the Kansas grand jury system. The Center for Reproductive Rights of New York has filed a second petition with the court, also asking that the case be dismissed on behalf of the patients affected by the records subpoena, again citing patient privacy laws and expectations of medical privacy.

The spokeswoman for Kansas For Life, one of the groups behind the grand jury formation, has said that the ruling is extremely disappointing and that

there is no way to determine if the reasons for these late abortions were done within the narrow legal criteria without looking at the records themselves. His lawyers say they are worried about women's privacy. They are worried about protecting Dr. Tiller.

Those presiding over the grand jury have until February 11 to file their objections with the Kansas Supreme Court, who then plan on issuing a ruling by the end of February.
-Kelly

Kansas Abortion Provider Ordered to Turn Over Medical Records

What do you consider identifying personal data in your medical records? It's not a trick question, but a genuine one based on the ruling, earlier this week, that a Kansas abortion provider must turn over 2,000 patient records - the records of all women who have had late term (21 weeks or later) abortions in the past five years.

In Kansas, citizens have a right, based on an obscure 19th century law, to convene grand juries when they feel the government isn't enforcing a law. As far as I can trace back, the two citizen subpoena's are based on two separate laws that Kansas for Life feels are not being enforced, and that these records are necessary to prove it. The first law requires reporting sexual abuse in minors (and they argue that 11 and 12 year old's are receiving late term abortions without the 'abuse' being reported), while the second prohibits late term abortions unless they are medically necessary.

In other words, it's a wide dragnet to investigate abortion in Kansas.

Now, to be clear, I'm not basing this conclusion on who is behind the subpoena, or even the stated goals of the prosecuting attorneys. I'm basing it on the argument that they are looking for signs of abuse, or medical necessity - in health records that are supposedly going to be redacted of name, age, and identifying medical history.

If you take away name, age, and identifying medical history - exactly what do you have left, that allows the investigation of either of these laws that Kansas for Life says are not being enforced?

Further indications that this is a wide dragnet hidden behind other laws is the fact that they also want the records of any woman who was 22 or more weeks pregnant who came in and even consulted about an abortion, even if she didn't have one. Where's the necessary information here in enforcing laws? I can't see one - and the request is construed broadly enough that it sounds as if even mentioning abortion (even to say "well, I know it's an option because the fetus has XYZ problem, tell me more about it... mm, I don't think that's for me, but thanks") is enough to flag your record.

So the question then becomes - can you truly redact medical records that will remove personal and identifying information, and still leave meaningful data that will tell them what they want to know about abortions in Kansas? Your medical history is a map across your body, building a record that's unique to each individual. Every scar I have leads the way to a story, every surgery, every break and set of bone, every time my lungs decide to stop working. Every medication taken is a marker along the path, all of which will build to create a single individual.

Yes, in theory Tiller, the abortion provider, will be passing these files to another doctor and attorney to independently review and redact. But I remove identifying data from papers all the time, and I know how easy it is to miss just a single word that clearly flags who the person is. Attempting to redact 2,000 medical records in 68 days? The magnitude of error possible is staggering.

As of yesterday, Tiller's attorneys have filed an appeal to the Kansas Supreme Court, and refused to hand over any files until after the Supreme Court makes their ruling.

-Kelly

2008 State of the States

For folks looking for a good primer on the "state of the states", Stateline.org has published their State of the States 2008 pamphlet. In this, they discuss subjects as broad as the various states both funding and banning human embryonic stem cell research, as well as state abortion laws, Romeo and Juliet laws, campus security, same sex marriage laws, and more. It's 75 pages of data, graphs, and trends - well worth reading for anyone interested in health care, policy, and federalism.

Of particular interest to me was Christine Vestal's analysis of states attempting to attract prominent stem cell researchers to grow their hESC research facilities into world class research labs. Once the fear was federal stem cell research laws would create a brain drain of science talent, as American scientists picked up and moved to countries more open to doing hESC. Now, the concern is the state next door, as California, Connecticut, Illinois, Maryland, New Jersey, New York and Wisconsin have awarded nearly $250 million in grants, which is three times more than the federal government spent in the same time frame.

While some states consider how to keep up with the funding next door (Iowa, Massachusetts and Missouri), others have simply bowed out of the stem cell race (Arkansas, Indiana, Louisiana, Michigan, North Dakota and South Dakota).

The State of the States 2008 document appears to be a great resource, full of interesting information. For example, did you know that 100 bills both for and against hESC research were considered in 39 states, but only three laws actually enacted? (New York State approved its hESC research funding, Iowa repealed a ban, and Illinois confirmed an executive order.)

While the ethics of the research are briefly mentioned (and Jonathan Moreno is quoted, albeit in another section of the article), overall they are given rather short shrift. That flaw aside, however, this appears to be a valuable addition to any researchers stack of pdfs.
-Kelly

The Bitterly Unfair Truth of Sexuality

Caitlin Flannigan has an op-ed in the New York Times that uses the movie Juno as a starting point to discuss female sexuality. Specifically, she talks about the fairy tale nature of the film (don't read the op-ed if you've not seen the film and don't want the ending completely spoiled), and highlights what she calls

the bitterly unfair truth of sexuality: female desire can bring with it a form of punishment no man can begin to imagine, and so it is one appetite women and girls must always regard with caution.

She goes on to make some very interesting points: that abortion, adoption, or even keeping a child is not an easy decision for a single woman, let alone a single teenage girl, and that very few woman escape from any of these decisions unscathed and able to return to who they were beforehand. (A sentiment I strongly agree with. While I don't buy into the supposed grief and regret that wracks any and every woman who's had an abortion, I do strongly agree that the experience forces significant change in a woman.)

Flannigan continues,

Even the much-discussed pregnancy of 16-year-old Jamie Lynn Spears reveals the rudely unfair toll that a few minutes of pleasure can exact on a girl. The very fact that the gossip magazines are still debating the identity of the father proves again that the burden of sex is the woman’s to bear. He has a chance to maintain his privacy, but if she becomes pregnant by mistake, soon all the world will know.

Pregnancy robs a teenager of her girlhood. This stark fact is one reason girls used to be so carefully guarded and protected — in a system that at once limited their horizons and safeguarded them from devastating consequences. The feminist historian Joan Jacobs Brumberg has written that “however prudish and ‘uptight’ the Victorians were, our ancestors had a deep commitment to girls.”

And again, she makes a good point with a contemporary illustration - Jamie Lynn faces the burden of the pregnancy, the gossip, the everything. A guy can impregnant and run, emotionally distant if he so chooses - a girl doesn't have that option, no matter what choice she makes regarding her pregnancy.

It's hard to argue with the idea that pregnancy robs a teenager of her girlhood. Pregnancy forces a girl to start making decisions that affect her life, short and long term - and also to make decisions that will impact others (or at least potential others). Adolescence is the period of moving from a world revolving around self to a world of interacting with others, and anyone who's spent any amount of time around a teenager can tell you how rapidly they oscillate between the two. Pregnancy forces the hand; wild oscillations have to stop in the face of reality (at least, one hopes).

What then, is the answer, if any? As Flannigan also so rightly notes, it's not as though we have no deep commitment to our teenage girls. Unlike the Victorians, we place our emphasis on commitment elsewhere, not on safeguarding but empowering. We don't look at focusing on their chastity, but instead on empowering girls to believe that they can compete with boys, be better than boys, and don't need to be dependent on anyone but themselves. But to repeat Flannigan's question,

we have to ask ourselves this question: Does the full enfranchisement of girls depend on their being sexually liberated? And if it does, can we somehow change or diminish among the very young the trauma of pregnancy, the occasional result of even safe sex?

I don't know that there is a neat answer to this, at least not when the country itself is divided, in so many ways, about teen pregnancy. And maybe, ultimately, the answer lies not in how we empower or protect the girls themselves, but how we treat those whose values and opinions differ than our own. Maybe the ultimate solution is to move further away from the Victorians, who protected that chastity with shame, and forget the entire concept of shame and sex.

...it's either that or find some way to subject teenage fathers to the same ostracization and stigmatization that pregnant teens are subjected to, and that seems like a much more difficult proposition.
-Kelly

"We" not "She" had an abortion

(This follows nicely from the post on gender.)

blog.bioethics.net reports on a new movement to involve men in outlawing abortion.

According to the article by the L.A. Times:

Abortion is usually portrayed as a woman's issue: her body, her choice, her relief or her regret. This new movement -- both political and deeply personal in nature -- contends that the pronoun is all wrong.

I think that it is great that there is an effort to involve men more in the process of sex and pregnancy. But let's encourage a genuine effort to empower men and give them a voice in this process - let's advocate for men to become more aware of all the processes related to sex, pregnancy, and birth. The archaic "predatory" model of men and sex needs to be fully rejected, and parents need to stop raising their boys to "go get 'em!" while relying on intimidation and threats to foist the burden of chastity only onto their daughters.

It is a good start that men are beginning to realize the emotional impacts of pregnancy termination, but our society ought to come together to share the emotional impacts of all aspects of intimacy and reproduction, aspects that until recently have been shrouded in mystery and shame (and just a bit of possessiveness by women) and withheld from men.

Let's truly forge new respect for life by bringing in both sides of the equation into this effort.

Quote of the Day: Being both pro-life and pro-choice

Anna Clark over at RH Reality Check wins the spot for "Quote of the Day" for the moving essay she has written about how she considers herself both pro-life and pro-choice -- She starts out:

"What if I told you that I used to call myself pro-life?

What if I said that I once believed abortion was murder, or that I suspected women used the procedure to bypass the consequences of sex?

If I told you, would I lose your respect? Would you be suspicious when I say that today I'm committed to the right to reproductive health, access, and choice?"

She then details her ambivalence, her journey and the realization of the complexity of the issue -- the quote that got me, though was this one:

"Pro-choice society, like democractic society, is predicated on space for those who disagree. When we play sides, we forget there are no enemies in the vision we pursue. Our inclusiveness of those who choose not to have abortions, and even those who judge abortion to be morally wrong, is our movement's power. When we approach anti-choicers as friends, not only do we act on the heart of our beliefs, but we create space for anti-choicers to become our allies."

What a poignant reminder -- Life -- it's a beautiful choice.

More on the Ballot Initiative to give Personhood to Embryos

Judith Graham and Judy Peres of the The Chicago Tribune have done a follow-up article on ballot initiative we had blogged about before -- the proposed referendum to grant the legal status of personhood to embryos from the moment of fertilization. The strategy of the groups proposing the ballot and the response from all different viewpoint is revealed, including the thoughts of some ethicists -- a major concern being that "many people won't understand the potentially profound consequences." Check out the full article here.