The practice of medicine is as much an art as it is a science. There are subtleties that demand one’s attention as well as an appreciation of the risks, benefits and alternatives to treatments that confront every patient and physician. The practice of medicine is never black and white.
The Arizona Legislature is pushing several bills under the guise of “protecting” the health of Arizona’s women. Though the social impact may superficially appear laudable, these are not just simple anti- abortion bills. They are weighted down with many entanglements that violate standard obstetric practice, interfere with the doctor-patient relationship and are adverse to women’s health.
As obstetrician/gynecologists, we are at the forefront of caring for the women of Arizona. We are deeply troubled by lawmakers’ attempt to legislate the practice of medicine against the standard of care set by the American Congress of Obstetrics & Gynecology (ACOG), our national organization.
HB2036, which would ban abortion after 20 weeks, awaits a vote in the House. This bill is particularly troublesome and would affect all physicians practicing obstetrics, regardless of whether they provide abortions.
Imposing this ban is simply not reasonable. HB2036 imposes the 20-week ban, except in the case of a “medical emergency” which, based on the language of the bill “means a condition that, on the basis of the physician’s good faith clinical judgment, so complicates the medical condition of a pregnant woman as to necessitate the immediate abortion of her pregnancy to avert her death or for which a delay will create serious risk of substantial and irreversible impairment of a major bodily function.”
Must the bill be so prescriptive that nothing short of death or permanent bodily injury qualifies as an exception? And what time frame is “immediate,” within an hour, four hours, 24 hours, two weeks?
Imposing a ban on terminating a pregnancy after 20 weeks is simply not in line with routine prenatal care. The standard of care within the medical community (nationally) is to obtain an ultrasound at 18 to 20 weeks to check the size of the fetus as well as to check for any anatomical abnormalities. The 20 week ban will limit the time a pregnant patient would have to work up any abnormalities found on the mid-trimester ultrasound. An ultrasound performed before 18 to 20 weeks is not nearly as effective in picking up these abnormalities. In order to “beat the deadline,” a woman may even choose to terminate a pregnancy without obtaining all of the information that may ultimately be available to her because of arbitrary time constraints.
HB2036 places the state Legislature in the position of “practicing medicine.” Should this bill pass, Arizona women will not be the beneficiaries of quality, evidence-based medical care. One such example is that HB2036 would mandate that women who choose to undergo a medical termination receive the less effective and markedly more expensive regimen of Mifeprex. An outdated regimen that has been shown to have increased adverse side effects compared to the alternative Mifeprex regimen used today. As physicians, we are troubled that this bill empowers the Legislature to prohibit sound, evidence-based treatment regimens that comprise the standard of care.
As if HB2036 weren’t enough, there is another bill moving through the
Legislature that seeks to set a dangerous precedent, SB1359.
Sponsored by Sen. Nancy Barto, the bill protects a physician from liability for damages in any civil action for wrongful life/birth if information about a fetal anomaly was omitted. What does this really mean? The bottom line is that a physician would be protected if he or she chose not to fully inform a pregnant woman of any prenatal health issues if such information could lead to an abortion. This totally disregards the doctrine of informed consent in which risks, benefits and alternatives are discussed between a physician and his or her patient. Why our Legislature would even consider a bill that protects physicians who chose not to give their patient all the information regarding her pregnancy is a question worth asking.
Terminating a pregnancy is a serious decision. With these bills, there is little indication that our legislators have weighed the measures’
far-reaching effects. In pursuing a social agenda, they have neglected to account for the health of Arizona’s women. These bills, as they stand, will have long-lasting effects for our state. Arizona physicians and their patients deserve much better.
— Maria Manriquez, MD, Ilana Addis, MD and Julie Kwatra, MD are officers with the Arizona Section of the American Congress of Obstetrics & Gynecology.