Forcing Doctors to Perform Unnecessary Medical Procedures is Unethical and Unlawful [denialism blog]

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February 19, 2012 by ScienceBlogs

Many bloggers and commentators have expressed outrage over the decision by Virginia to require ultrasound examination, possibly transvaginal ultrasound, prior to women obtaining an abortion. From Bill Maher to Dahlia Lithwick people are outraged and have even suggested that it should be considered rape to force women to undergo vaginal examination by ultrasound prior to receiving abortion. Worse, it's clear from statements like this one by delegate Todd Gilbert, that there isn't a medical concern related to this intervention. It's simply designed to humiliate women and interfere with the doctor patient relationship with exclusively anti-abortion motivations:

"the vast majority of these cases [abortion] are matters of lifestyle convenience." And, 

"We think in matters of lifestyle convenience and in other matters that it is right and proper for a woman to be fully informed about what she is doing.

This just reflects how stupid these guys are, because anyone with half a brain could come up superficially plausible defense of the statute from grounds of medical safety. They're just too brainless to do so and clearly are just trying to interfere with women and their doctors as they try to make a difficult decision.

There are some indications for ultrasound prior to abortion. Many physicians performing the procedure or especially offering medical abortion might perform a transvaginal ultrasound prior to proceeding. It can serve a few useful purposes. It can help confirm intrauterine pregnancy as well as uterine location. It may be needed to assess patients in their postoperative exam or medical follow up visits to rule out retained products of conception. In cases of uncertain dates, it can give you gestational age of the fetus, which may be critical in determining the appropriateness of the subsequent procedure used. After all, medical abortion is typically limited to the first 9 weeks and uncertainty about gestational age should result in ultrasound prior to use of medical abortifacients.

However, neither the FDA nor any professional organization of obstetricians and gynecologists indicate ultrasound should be a required component prior to medical or surgical abortion. The procedure is often unnecessary. So, what Virginia has done has legislated a requirement for an unnecessary medical procedure, unsupported by any professional medical association, on a specific subpopulation of women. Given the history of forced sterilization in Virginia, you'd think they'd be more sensitive on this issue. This is the state where Buck v Bell brought the issue of forced medical procedures to light.

This statute cannot, therefore, stand on either medical ethical or constitutional grounds. The state legislature can not force me or any other physician to perform an unnecessary, and therefore unethical, medical procedure. The state legislature can not pick on a subpopulation of citizens and force them to receive an unnecessary medical procedure.

I don't think this law will stand, but it once again will require a legal fight, waste of time and resources, and all of this once again in a effort by governmental busybodies to interfere in women's health decisions in a punitive fashion. The Republicans need to watch out. This is just another indication of a the size of the assault on women's reproductive rights, and if they keep pushing, they're going to see what a mistake it is to piss off 51% of the population.

**Update: I also noticed from Lithwick's article Virginia has enacted a personhood law saying life begins at conception. More idiocy. This is like Indiana legislating the value of pi = 3. It is unscientific and illogical. Life does not begin. It is continuous. There is no dead state between parents and offspring. Sperm are alive, eggs are alive, the fusion of the two is alive. Instead they are legislating what constitutes life that is important, or more likely "ensouled". As a fundamentally philosophic/religious and ultimately arbitrary point, government has no business legislating such a thing. But legislating that life has a "beginning" is biologically ignorant.

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