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Introducing Targeted Regulation of Urologists and Male Patients (TRUMP) Laws

June 16, 2015

In April, the Tennessee legislature offered a unique moment of clarity regarding women's access to abortion services. As the Senate debated GOP proposals to institute 48 hour waiting periods and regulate abortion providers like hospitals or ambulatory surgical centers (ASCs), Democrat Sara Kyle asked:

"Here you're putting all this burden on a woman. Why don't we put these same standards on a man who wants to have a vasectomy?"

That seems like a reasonable enough question. After all, each year an estimated 350,000 American men undergo the legal sterilization procedure the Catholic Church considers a mortal sin. Yet 90 percent of the nation's 10,000 urologists perform vasectomies, accounting for 75 percent of all "snippings" each year. Nevertheless, Volunteer State GOP Senator Todd Gardenhire explained to Kyle why the law is, well, vastly deferential to men:

"Having personal experience in that field and also having one reversed I want to promise you that when ... you start talking to a doctor about them whacking on you down there, you want to wait a while and think about it. Men go through a lot more stringent process to have a vasectomy than a woman does, I would assume, on an abortion."

Clearly, Gardenhire assumes wrong. But it's not just because urologists outnumber physicians providing abortion services by 6-to-1. The success of TRAP laws (Targeted Regulations of Abortion Providers) has made abortion facilities an endangered species. Already, Mississippi, North Dakota, South Dakota and Wyoming have only a single abortion clinic each. And with the Fifth Circuit Court of Appeals upholding the draconian curbs in Texas, the Supreme Court may yet decide that no burden on women's access to abortion is an "undue burden."
But a nascent movement could change that. For many years, Justice Ruth Bader Ginsburg and some pro-choice supporters have claimed that the wave of state and federal abortion barriers violate the Equal Protection clause of the 14th Amendment. But in the face of judicial failures to date, a new legislative strategy has emerged. If state legislatures are going to undermine women's reproductive rights, men should get the same treatment.
Here are just some of the Target Regulations of Urologists and Male Patients (TRUMP) laws under consideration:
Mandate the Same Standards as Hospitals and Ambulatory Surgical Centers. Whether done with an incision or the "no-scalpel" method, the vasectomy like abortion is an extremely safe procedure with a very low risk of side effects. (In one rare case, a UK man died as a result of severe septicemia in 2008.) Nevertheless, TRUMP like TRAP laws require physician offices performing vasectomies to meet the same standards as hospitals and ambulatory surgical centers. Minimum corridor widths, ceiling heights, plumbing capacity, lighting updates and janitor's closets and other, often costly construction requirements must be met or the facility will be shuttered. (This week, a federal appeals court upheld the Texas TRAP law that will reduce the number of abortion clinics from 41 now to less than a dozen across the 267,000 square miles of the Lone Star State.)
Hospital Admitting Privileges Required. As with House Bill 2 in Texas, TRUMP laws require that all physicians performing vasectomies must have admitting privileges at a hospital within 30 miles of their offices. But 58 percent of U.S. counties have no urologists at all. And combined with the new facility requirements, the internists, family doctors and general practitioners who also perform the sterilizations will be out of the game. The days of the "cut and run" will be dead and gone.
New Zoning Laws. Anti-abortion forces have turned to municipal zoning laws as yet another tactic to put clinics out of business. The city council in Manassas, Virginia just updated its 70 year-old zoning laws to require women's health centers to "have special use permits, granted only after a public comment period and city council approval." Meanwhile, the Alabama legislature just advanced House Bill 527, which would close three clinics by requiring them to be at least 2,000 feet from a school. TRUMP laws, too, could define when and where the balls are out of bounds.
72-Hour Waiting Period. Todd Gardenhire may want to "wait a while and think about it" before allowing doctors to "start whacking on you down there," but with TRUMP laws his ilk would have no choice. Following in the footsteps of anti-abortion state houses in North Carolina, Oklahoma, South Dakota and Utah, men seeking vasectomies will have wait at least 72 hours after a consultation with their doctor. Multiple office visits, even for the much anticipated birth control pills and implants for men, certainly don't impose an undue burden on those gents committed to forever blockading their life-creating sperm.
Allow Bans on First Trimester Vasectomies. Currently, men must be 18 years old to legally consent to a vasectomy procedure. But with the lifespan for American men headed towards 90 years, there's no reason states shouldn't have greater power to legislate during each 30-year trimester. TRUMP laws typically prohibit interference with vasectomy choice by men aged 60 and older. While states cannot ban the procedure for men between 30 and 60, legislatures can decide that guys under 30 will have just have to wait. (That should give them plenty of time to have that conversation about birth control options with their partners.)
Require Spouse/Partner's Consent. Last December, Missouri Republican Rep. Rick Brattin proposed a bill mandating that a woman get a man's permission before obtaining an abortion. His law stating that "no abortion shall be performed or induced unless and until the father of the unborn child provides written, notarized consent to the abortion" did offer exceptions for cases of rape and incest. Exceptions, that is, in a Todd Akin kind of way:

"Just like any rape, you have to report it, and you have to prove it. So you couldn't just go and say, 'Oh yeah, I was raped' and get an abortion. It has to be a legitimate rape."

That's why TRUMP laws should empower women to shut that whole thing down, too. Currently, state laws do not require men to obtain the written consent of their wives, girlfriends, mistresses or f**k buddies prior to undergoing a vasectomy. (Some individual physicians do.) That should come to an end. So-called "Dry Sack on the Rocks" and "Every Sperm is Sacred" rules guarantee future mothers will have a voice in determining their own potential maternity.
Require Parental Consent. Some men, of course, are single. Nevertheless, the state's dual interests in protecting the life and health of the father and his would-be children are often shared with potential grandparents. That's why some TRUMP bills require guys under age 60 to notify and obtain the consent of their mother or father before they can go under the knife. The spirit of these "Dude, Where's My Grandchild?" laws is that what's good for the goose is what's good for the gander. As Robin Marty explained Rep. Brattin's bill in Missouri:

Even if it never makes it into law, or gets blocked by the courts if it does, H.B. 131 will inevitably serve its real purpose-- which is to reinforce the idea that women cannot be entrusted with ownership over their own bodies. Requiring consent from a male partner legally infantilizes the woman, marking her as not mentally and emotionally mature enough to decide to terminate a pregnancy on her own.

Assign Legal Counsel for Sperm. Abortion foes have tried to erect (no pun intended) new barriers to minors obtaining the procedure even in cases of rape and incest. As ThinkProgress reported, Arkansas GOP State Rep. Justin Harris "who has recently sparked controversy for giving away his adopted daughter to a man who later sexually abused her is sponsoring legislation to make it harder for young victims to end a pregnancy resulting from abuse." And as The Daily Show recently spotlighted:

A new law in Alabama [is] forcing pregnant teenagers seeking an abortion to first receive parental consent. If she is unable to get permission, the teenager is then put on trial, giving judges the right to appoint attorneys to defend the unborn fetus.

Sperm hoping to swim upstream deserve nothing less. That's why some TRUMP advocates have endorsed a judicial bypass to paternity for sperm whose hosts would block the usual route.
Prohibit Public Medical Schools from Teaching the Procedure. In April, the GOP-controlled legislature in North Carolina used a novel approach to curb abortions in the Tar Heel State. As Slate reported, North Carolina's HB 465 would "prohibit instructors at North Carolina public medical schools from performing or supervising abortions as part of their jobs." The bill wouldn't just limit the future supply of OB/GYNs able to provide treatment of all manners of pregnancy complications, but could lead to the highly acclaimed UNC Medical School losing its accreditation.
A similarly targeted regulation of urologists in training could be devastating. After thoracic surgery, urology practitioners on average are the oldest of any specialty. According to the American Urological Association (AUA), the already insufficient number of urologists will decline by 29 percent by 2025. Cutting off the flow of new urologists to treat urinary and reproductive issues out of spite over vasectomies would be public policy at its very worst.
Ban Urologists from Practicing Telemedicine. Telemedicine is emerging as a major advance in lowering health care costs while expanding access to treatment for people living in rural and other underserved areas. But as The Atlantic documented in 2014, anti-abortion extremists are working to ensure that videoconferences and web cams can't help women seeking reproductive health care:

But there is one procedure that, though it could be easily, safely, and cheaply administered via telemedicine, is widely unavailable: the termination of a pregnancy. Fifteen states have adopted bans on telemedicine abortion since 2010. The practice was only ever available in three states--Iowa, Minnesota, and Texas--though Texas now has banned it. In Iowa telemedicine abortion continues to be available, though is being challenged in courts, and in Minnesota the legislature passed a ban, which the governor vetoed.

Imagine, then, that doctors were prohibited from using telemedicine to prescribe and patients prevented from using the Internet purchase Viagra or other erectile dysfunction drugs. After all, in 2011 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 safe, 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:

"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."

The Pfizer web site says, "Why not order Viagra from the comfort of your own home?" That would be awfully hard to do if buying it online was illegal, and no doctor could legally talk to you about it anywhere but in a hospital or ASC.
Mandate Physicians Lie to Male Patients. Republicans decry "junk" malpractice lawsuits while always promising to "protect the doctor patient relationship." But when it comes to abortion, the GOP insists doctors commit medical malpractice. The current torrent of Republican legislation dictates that OB/GYNs who "practice their love with women all across this country" must lie to women about mythical abortion-breast cancer links, dangerous "abortion reversal," fetal heartbeats, imagined "fetal pain", so-called "post-abortion syndrome," potentially life-threatening fetal genetic diseases and so much more.
Why should men seeking vasectomies be treated any differently? Male patients seeking to be snipped shouldn't just be warned that a vasectomy is very difficult--and very costly--to reverse. Doctors must also warn men that vasectomies could cause impotence, prostate cancer, audible public flatulence or even Koro, a syndrome in which a man suffers from an overpowering belief that his genitalia are retracting and will completely disappear within his body cavity.
Now, there is no data to suggest that a vasectomy can produce these or any other similarly preposterous side-effects. But as Supreme Court Justice Anthony Kennedy showed in his 2007 Gonzales v Carhart majority opinion, the complete lack of evidence is no barrier to banning so-called "partial birth abortions." As Ruth Marcus summed up Kennedy's shocking paternalism:

"Respect for human life finds an ultimate expression in the bond of love the mother has for her child," Kennedy intoned. This is one of those sentences about women's essential natures that are invariably followed by an explanation of why the right at stake needs to be limited. For the woman's own good, of course.
Kennedy continues: "While we find no reliable data to measure the phenomenon, it seems unexceptionable to conclude some women come to regret their choice to abort the infant life they once created and sustained." No reliable data? No problem!

It's no wonder Iowa Republicans pushed a bill allowing women to sue for "abortion regret" up to 10 years after having the procedure to which they consented. Vasectomy regret, anyone?
Vasectomies Require Mandatory Prostate Exams and Colonoscopies. Before he became a convicted felon, former Virginia Governor Bob McDonnell was best known as "Governor Ultrasound." But McDonnell wasn't the only fan of requiring women seeking abortions to undergo completely unnecessary trans-vaginal ultrasounds or view sonograms. Former Pennsylvania Governor Tom Corbett told women who don't want to see the image "you just have to close your eyes." Despite studies showing that forced viewing of an ultrasound image of a fetus has essentially no impact on women's decisions to proceed with an abortion, Wisconsin Governor and 2016 GOP front-runner Scott Walker said of his state's law:

We signed a law that requires an ultrasound. Which, the thing about that, the media tried to make that sound like that was a crazy idea. Most people I talk to, whether they're pro-life or not, I find people all the time who'll get out their iPhone and show me a picture of their grandkids' ultrasound and how excited they are, so that's a lovely thing. I think about my sons are 19 and 20, you know we still have their first ultrasound picture. It's just a cool thing out there.

Now, there are doubtless a few men who might think seeing their shaved nutsacks clamped, pierced, cut and sewn up is a "cool thing," too. Therefore, all vasectomy seekers--no matter how squeamish-- should be required to watch the procedure in glorious HD. And while we're adding needless and unrelated medical procedures, those men should get prostate checks, rectal exams and colonoscopies, too. (Federal and state TRUMP laws should also dictate that these procedures cannot be covered by insurance under the Affordable Care Act and that they should be taxed.) As Idaho State Rep. Vito Barbieri seriously suggested, women could swallow a camera pill to determine if they are pregnant.
And so it goes. The potential scope of TRUMP laws is virtually limitless. Of course, none of these obviously imaginary and admittedly inane curbs on men's reproductive freedom would--or should--ever come to pass. For guys, apparently, any regulation is too targeted and any burden is an undue burden.


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

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