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Abortion bills out of line with accepted standards of prenatal care

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.


  1. It’s most unfortunate that our elected officials believe they must redefine the standard of care for obstetricians and gynecologists in AZ while simultaneously eviscerating patients’ rights to make informed decisions regarding their prenatal care. Informed decisions are fundamental to our healthcare delivery system. Healthcare is not a unilateral, physician-directed decision process. It is a collaborative, patient-centered process wherein the physician enables the patient to make intelligent decisions about their care. Allowing politicians to intervene in this highly-sensitive and private matter is unhealthy for all.

  2. Each year of the “approximately 2 million women who experience pregnancy loss” in the U.S. the following causes are noted in the statistics (per The American Pregnancy Association at

    “600,000 women experience pregnancy loss through miscarriage

    “64,000 women experience pregnancy loss through ectopic pregnancy

    “6,000 women experience pregnancy loss through molar pregnancies

    “26,000 women experience pregnancy loss through stillbirth”
    Did (or does) a god, or “the God”, purposely install a unique “soul” in those fetuses? Does that fetus “soul” have an ‘afterlife’ per any (or all) current theology(s)? Do even those fetuses without a developing brain have a “soul” that goes to “heaven”? (Having had little time to commit any ‘sins’, let alone the physical organ necessary to form the required ‘internationality’ to commit a ‘sin’, where else could such a “soul” end-up in any ‘afterlife’ scenario?)

    Given that the current movement to restrict abortion regardless of any fetal abnormalities, even those that would preclude surviving outside of the womb, the “soul” question is a critical one for believers. Given also that modern public health and standards of living have dramatically reduced the rate of “pregnancy loss” (and given that many miscarriages go unnoticed and/or unreported) we can assume the possibility exists that a high percentage of the “souls” in “heaven” never had a fair chance of committing a sin that might allow them to at least visit the “other place” (or places in between, depending on religious doctrine). Heaven is most likely overrun with such “souls” (even assuming there really is only 5,000 years of history, any history)!

    This analysis is not meant to be flip. It is meant to underline the highly doctrinaire religious nature of the most recent government intervention, H.B. 2036 (AZ), into one of the most anguishing areas of motherhood (and fatherhood).

    The biggest question is still “separation of church and state”. Given the big “who is imposing on who” flap over requiring almost all employers who provide healthcare insurance, even church affiliated non-profit organizations who have significant religious diversity among their employees, to follow all the ‘preventive care regulations’ in paying for medical care (including paying for contraceptive care for those whose religion does not prohibit it), it would seem that H.B. 2036 (AZ) imposes not just a religious standard for healthcare(!) on all Arizona citizens, but a particular religious standard of healthcare!

    H.B. 2036 is the first major religious edict (“fatwa”, whatever) of the now semi-theocratic State of Arizona! H.B. 2036 gives new meaning to the Arizona State Motto (one of only 7 state mottos that reference God).

    Ditat Deus! y’all

  3. Arizona Legislators have failed Arizona’s women, their health care and families, having taken them back to the dark era PRIOR to the ’60’s, which makes Arizona a very undesirable state to live in and has lowered the quality of life.

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