By Deborah E. Klein, M.D.,
based on questions posed by Andrea Greenstein
As a physician and longtime reproductive health advocate, I have been disturbed and incensed by the increasing number of states that require special mandated counseling prior to an abortion. Allowing legislators to insert their own scripts into informed consent counseling subverts a standard medical practice that is an essential component of every medical procedure. So I sat down with Andrea Greenstein, my Legal Voice work group colleague, to answer some questions about informed consent.
One of the major concerns surrounding anti-choice legislation has to do with informed consent. As an advocate for reproductive health and justice, what are some things I should keep in mind when reading about recent attacks on abortion access and services?
Informed consent is based on truth. The provider-patient relationship is based on trust. Truth and trust go out the window when state-mandated misinformation is injected into abortion counseling.
Informed consent is a cornerstone of medical ethics, and is required by law, for all medical procedures in all 50 states. Informed consent requires that patients and their providers discuss the benefits and risks of a medical procedure in order to arrive at a sound medical decision.
The principles of informed consent include:
1. The provider must disclose all relevant medical information needed to make the decision, including risks, benefits, expected outcomes and alternatives
2. The patient must have the ability to understand and process the information
3. The patient must make the decision free from coercion or unfair incentives
Women’s health services, including abortion, seem to be treated differently than most other medical procedures. Why is that? How might additional restrictions affect the relationship between a healthcare provider and her patient?
Under the guise of informed consent, many states have enacted additional requirements unique to abortion. In some cases the required information is outdated, biased, or false—some states require women seeking abortions be told that personhood begins at conception, be provided with information on the ability of a fetus to feel pain, or be presented with inaccurate medical information, such as:
• Alaska, Kansas, Mississippi, Oklahoma and Texas require that a woman seeking an abortion be told there is a possible link between abortion and breast cancer.
• Arizona, Kansas, South Dakota, Texas and West Virginia require that a woman seeking an abortion be told there is a link between abortion and infertility.
• Kansas, Michigan, Nebraska, North Carolina, South Dakota, Texas, Utah and West Virginia require that that a woman seeking an abortion be told there is a link between abortion and long-term psychological harm.
All these assertions are inaccurate.
Legislators without medical expertise can require that providers deliver medically inaccurate materials, undermining the provider-patient relationship, and putting patients at risk for making medical decisions based on false information. These special laws, required only for abortion procedures, not only provide deceptive information, but are an attempt to disrupt and invalidate the provider-patient relationship, and to undermine the integrity of the medical and scientific evidence that informs medical decision making.
Is there any reason abortion procedures should be subject to different informed consent requirements?
There is no reason that abortion procedures should be singled out for unique informed consent requirements. Anti-choice forces rely on the fact that the public may be unaware of the rigorous informed consent protocols already in place. Since these laws apply only to women, there is the suggestion that women need special protections with regard to medical decisions, and do not have the capacity to engage in medical decision making. State-mandated counseling is further intended to suggest that clinicians might not provide accurate information to patients without specific legislation requiring them to do so. In fact, informed consent is a process that is tailored to each procedure, and the clinician who will perform the procedure is the one who has the greatest expertise to appropriately counsel the patient.
As a women’s healthcare provider, what is your approach to building trust with patients and helping them make decisions about their health?
Shared decision making is a relatively new concept, and is at the heart of the patient-provider relationship. It’s a collaborative process that allows patients and their providers to make health care decisions together, taking into account the best scientific evidence available, as well as the patient’s values and preferences. The patient is placed at the center of the decision making process; patient preferences are honored, and the process is an open dialogue that enhances patient autonomy and confidence.
How can women’s health advocates frame informed consent and abortion counseling as a problem? What is your opinion on these requirements as a healthcare provider who is familiar with advocating for your patients’ health and well being, and helping them make healthcare decisions?
The requirement for unique informed consent counseling for abortion is different from the counseling required for all other medical procedures. It distorts the informed consent process, imbuing it with often medically incorrect, politically driven, coercive, discriminatory, and dangerous statements. This violates medical ethics, and may result in women making decisions that compromise their health.
As a healthcare provider, I believe healthcare decisions should be informed by medical evidence, using standard informed consent and shared decision making processes that protect patients and help them arrive at decisions that are right for them. Politicians should have no authority to obstruct safe medical practice and no right to interfere in the relationship between the provider and the patient.
Deb Klein has practiced family medicine in Seattle for 21 years, and serves on the Legal Voice Reproductive Justice Work Group.
Andrea Greenstein is a women’s health advocate, Seattle young professional, and graduate of the University of Washington where she studied Law, Societies, and Justice. Andrea volunteers with Legal Voice on the Reproductive Justice Work Group.