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GOP Abortion Foes Are Criminalizing the Doctor-Patient Relationship

February 17, 2014

"The doctor-patient relationship."
For over 20 years, conservative propagandists and their Republican allies have used that four-word bludgeon to beat back universal health care reform. In 1994, GOP strategist Bill Kristol warned that "the Clinton Plan is damaging to the quality of American medicine and to the relationship between the patient and the doctor." Kristol's successful crusade to derail Bill Clinton's reform effort was greatly aided by future "death panels" fabulist Betsy McCaughey, who wrongly warned that Americans would even lose the right to see the doctor of their choice. Twelve years later, President George W. Bush proclaimed, "Ours is a party that understands the best health care system is when the doctor-patient relationship is central to decision-making." With victory of Barack Obama in 2008, GOP spinmeister Frank Luntz told Republicans obstructing the Affordable Care Act in Congress to once again "call for the 'protection of the personalized doctor-patient relationship.'" And during the 2012 campaign, the GOP platform declared the party would "ensure the doctor-patient relationship."
But when it comes to abortion and women's reproductive health, the GOP mantra about protecting "doctor-patient" isn't just demagoguery of the basest kind. It is a cruel and vicious hoax. Even as the nation's abortion rate has dropped to a 40 year low, dozens of draconian restrictions enacted in Republican-controlled states are mandating that physicians lie to their patients, perform unnecessary procedures in needlessly regulated facilities and even withhold potentially life-saving care. Now, Republicans aren't just standing over the shoulders of American doctors who put their patients' health first; they want to put them in prison, too.

Until very recently, the GOP push to put women's health care providers behind bars was largely kept behind the scenes. Few paid attention in 2007 when GOP presidential contender Mike Huckabee explained he hoped to "find some way to sanction" doctors who took money to provide abortions to women if he succeeded in outlawing the procedure or when his former pro-choice rival Mitt Romney endorsed "penalties" including "losing a license or having some other kind of restriction." Fewer still must have been paying attention in 2004 when then Oklahoma GOP Senate candidate Tom Coburn declared:

"I favor the death penalty for abortionists and other people who take life."

But people better start paying attention now. Because as GOP bills in Ohio, South Dakota, Iowa and other states show, physicians just trying to help American women may run the risk of losing their medical licenses--and even their freedom.
As ThinkProgress reported, South Dakota isn't just considering legislation banning abortion after 7 weeks. A new proposal, House Bill 1241 could have the effect of criminalizing any abortion performed after that:

HB 1241 seeks to "prohibit the dismemberment or decapitation of certain living unborn children." The doctors who violate the proposed law would be charged with a Class 2 felony, and could face up to 25 years in prison and a $50,000 fine...
The measure's vague language would actually target the abortion doctors who are providing earlier procedures, because they may be too worried about the potential legal ramifications of ending a pregnancy.
"As soon as there are visible parts, the embryo or fetus is rarely removed intact," one physician who preferred to remain anonymous explained to RH Reality Check. "This bill could ban any abortion past seven weeks."

In the Buckeye State, too, Republicans are turning to the possible threat of prosecution to scare doctors away from providing reproductive health services for the women of Ohio. "Some doctors say new laws limiting abortions in Ohio are interfering with the care they give women facing heartbreaking circumstances," the Columbus Dispatch reported this week, adding "Even those who oppose abortion say that before giving their best medical advice, they may need to call a lawyer."
Here's why.
Despite recent federal court decisions refusing to uphold similar bans in Oklahoma, Ohio prohibits abortion after 20 weeks unless a doctor determines a fetus is not viable. The state deems the fetus to be viable at 24 weeks into pregnancy, at which point an abortion is prohibited. But the law, the Dispatch explained, "fails to distinguish between a woman who wants an abortion and one who should terminate for medical reasons." The result, as Dr. Phil Cass, chief executive officer of the Columbus Medical Association put it, "Doctors can't give their best advice in some situations because of possible repercussions of the law."
The repercussions for women's health--and lives--are very real. Dr. Jason Melillo, an Ob/Gyn who is also an abortion opponent, pointed to his own experience to highlight the risk. In one case he cited, he and other doctors counseled a woman whose fetus had a fatal chromosome disorder to terminate her pregnancy because she was older and at risk of complications. But thanks to Ohio law, they could not provide the treatment that all involved concurred was best for her health:

"She was saying if this baby is not going to make it, I don't want to carry to term. By this point she was 27 weeks. The doctors were saying they can't do it. There wasn't even a medical debate about it. Everyone agreed she shouldn't deliver but were afraid they would run afoul of this law."
"What if she gets a blood clot? What if she needs a cesarean section? Now you're putting this woman through risky medical procedures for no good reason."

Meanwhile, Iowa and other states are similarly considering banning "telemedicine" for no good reason, too.
Three years ago, a study published in the journal Obstetrics and Gynecology found that allowing physicians to remotely supervise administration of the pregnancy-ending drug RU-486 is just as effective and acceptable to patients as a face-to-face office visit. In the first 10 years since its introduction in the United States, over 1.5 million women used RU-486 to induce abortions. The mortality rate for RU-486 (also known as Mifeprex) is one in 100,000; by contrast, Viagra's is five in 100,000. Even the small number of "adverse events" (14 deaths and 612 hospitalizations) could not be confirmed by the FDA to be related to the drug itself, prompting medical ethicist Arthur Caplan to warn that opposition to such medical conferencing has litle to do with safety and everything to do with abortion itself:

"Unless these groups have some broader heartburn over the notion of rural areas getting access to doctors by video, I don't think this is in any way a serious complaint. Clearly we don't have enough primary care providers. One way to solve this is through telemedicine. We don't want to be attacking that, we probably want to be celebrating it."

But in Iowa as in states like Arizona, Kansas, North Dakota, Nebraska and Tennessee, attacking telemedicine and the doctors who deliver it is exactly what Republicans are doing. As the Quad City Times reported this week, the Iowa House voted for a prohibition on just such procedures. By a 55-42 vote, legislators passed House File 2175, which would "ban the practice of doctors prescribing abortion-inducing drugs from remote locations, typically using a video link." Compared to an earlier draft of the bill, Hawkeye State doctors caught helping rural women will get off easy:

Under HF 2175, doctors could be fined and have their licenses suspended for performing abortion-inducing. Fines and license suspension provisions were amended onto the bill to replace criminal penalties originally included in the bill.

But in other states, neither women nor doctors will be so "lucky." In December 2012, Ada Calhoun documented cases of women in Idaho, South Carolina, Massachusetts and New York "who charged with murder in the wake of a miscarriage or stillbirth; others, like [Jennie Linn] McCormack, have been charged with violating the abortion laws in their state. Meanwhile, the pressure on physicians continues:

Several states have recently passed or are considering legislation to limit access to abortion drugs online and off. In 2011, Wisconsin passed a measure that would potentially subject doctors to criminal charges for performing medication abortions without adhering to certain specific protocols, such as seeing the patient three times; Planned Parenthood clinics in the state stopped providing medication abortions in April, and the organization has filed suit against the law.

As the Guttmacher Institute has detailed, "more state abortion restrictions were enacted in 2011-2013 than in the entire previous decade."

Forty-five percent of the abortion restrictions enacted over the last three years fall into four categories: targeted restrictions on abortion providers (TRAP), limitations on insurance coverage of abortion, bans on abortions at 20 weeks postfertilization (the equivalent of 22 weeks after a woman's last menstrual period) and limitations on medication abortion. States enacted 93 measures in these four categories from 2011 through 2013, compared with 22 during the previous decade.

But when these new GOP crackdowns aren't violating the relationships between women and their doctors by threatening them with jail time, they are demanding doctors commit medical malpractice.
You read that right. The same Republicans who decry "jackpot" justice and that "too many OB/GYNs aren't able to practice their love with women all across this country" are legally requiring that American doctors commit medical malpractice. In many states, physicians must withhold potentially life-saving care or, conversely, provide unneeded tests and procedures. When it comes to topics like "fetal pain," so-called "post-abortion syndrome" and the mythical breast cancer link, doctors are mandated to lie to their patients. And if they remain silent about severe fetal conditions which might lead a woman to terminate her pregnancy, physicians would be immunized from liability.
(For more background on the junk science and even more vile law of the Republicans standing between patients and their doctors, see "GOP Abortion Bills Mandate Medical Malpractice.")
When "pretend doctor" and Kansas Governor Sam Brownback signed his state's harsh new antiabortion bill last April, he didn't just write his name on the document. He also inked "Jesus+Mary" and "culture of life" on a law that, among other things, requires doctors to warn their patients that breast cancer is a potential risk of abortion. Of course, there is no such link: the American Cancer Association and the National Cancer Institute concluded that "abortion is not associated with an increase in breast cancer."
So why do the phony physicians of the Republican Party continue to traffic in such flagrant falsehoods where women's health is concerned? John McCain gave the game away during an October 2008 debate with Barack Obama when he used "air quotes" to mock the very idea of the health of the mother:

"Just again, the example of the eloquence of Sen. Obama. He's [for] health for the mother. You know, that's been stretched by the pro-abortion movement in America to mean almost anything. That's the extreme pro-abortion position, quote, 'health.'"

2012 GOP vice presidential and 2016 White House hopeful Paul Ryan couldn't agree more. As he put it on the House floor in 2000:

"The health exception is a loophole wide enough to drive a Mack truck through it."

Apparently, when it comes to health care Paul Ryan is an expert. After all, he says opposes Obamacare because it "intrudes in the doctor-patient relationship."


Jon Perr
Jon Perr is a technology marketing consultant and product strategist who writes about American politics and public policy.

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