I have watched a baby die during labor because my informed and autonomous patient chose not to give consent for an emergency cesarean section. Neither my medical opinion nor expertise can overrule my patient's autonomy -- at least, not if I am providing ethical medical care. Yet Utah Gov. Gary Herbert just decided to force me to perform a medical procedure that is not even standard medical practice -- giving a fetus anesthesia during an abortion over 20 weeks in gestation. If I don't, I have broken the law.
Here's the kicker: The law does not tell me how to provide this anesthesia. Do I put my patient under general anesthesia? Do I insert a long needle into her abdomen? Both of those options carry far more risk than current evidence-based practices in abortion care. They are also expensive. Who is responsible to pay for these unnecessary procedures that increase risk and cost without medical benefit?
Current high-quality research has shown that a fetus does not possess the part of the brain that can process pain until the third trimester. This is agreed upon across various medical specialties, including obstetrics/gynecology, pediatrics, neuroscience and anesthesiology. The bill that Herbert just signed into law, proposed by State Sen. Curt Bramble (an accountant), is not even based on our present-day understanding of fetal development. He may as well have signed a bill mandating doctors to use leaches while prohibiting the use of antibiotics in treating infections.
For a moment, let's entertain the notion that the fetus can feel pain, beyond a shadow of a doubt. I wonder, then: Why are there no laws mandating fetal anesthesia before a newborn has its skull compressed during a vaginal delivery? Why aren't doctors mandated to provide anesthesia before performing circumcisions? Why is it permissible to withhold anesthesia before performing a spinal tap on a premature baby in the intensive care unit?
The answer is this: This law, like many anti-abortion laws, has nothing to do with medicine. It has nothing to do with whether or not a fetus "feels pain." It has everything to do with interfering with the sacred patient-physician relationship and revoking the human rights of pregnant people -- namely the right to decide if and when to have children. With legislators passing health care laws that are fiercely opposed by medical professionals but supported by campaign donors, my scientific mind cannot come to any other logical conclusion.
To my knowledge, no other area of medicine is legally manipulated to do people harm, yet legislators find this perfectly acceptable when it comes to reproductive medicine. A first-trimester abortion is significantly safer than carrying a pregnancy to term and giving birth, for example. Very few abortions are performed after 20 weeks, and those that are performed around or after 20 weeks are most commonly done for lethal fetal anomalies: conditions where the fetus will not survive birth. What this law will effectively do is impose a nonmedical requirement that pregnant people may not be able to meet (namely financial), and they will be forced to carry the pregnancy to term, give birth, incur the associated risks therein, only to watch the newborn die.
The four cardinal medical ethical principles that should be practiced by all health care providers are these: autonomy, justice, beneficence and nonmaleficence. Anti-abortion laws require health care providers to violate all four ethical principles. Without access to desired abortion care, a pregnant person cannot exercise autonomy. Without the ability to provide abortion care, I cannot respect my patient's autonomy. Similarly, laws that reduce financial assistance for any aspect of health care favor the rich and harm the poor -- a violation of justice. For anyone seeking an abortion, it is clear that the risks of continuing the pregnancy and giving birth are higher than having an abortion. Without the ability to provide an abortion, I cannot exercise beneficence nor can I avoid maleficence.
The American Congress of Obstetricians and Gynecologists, the leading authority in reproductive health care in our nation, says: "The best health care is provided free of governmental interference in the patient-physician relationship." Utah legislators are actively harming their constituents -- my patients and Utah families. I provide safe abortion care because not only is it standard medical care, but it is also my moral and ethical obligation.
You have put lives in danger, Gov. Herbert.
