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This column’s intention is to give readers a look at the results of Indiana’s abortion legislation from a physician’s perspective; it is not meant to take a position on the pro-life and pro-choice debate.
This legislation is termed as one of the most restrictive in the country as it bans abortion from zero weeks’ gestation. But it allows certain exceptions for protection of the health and life of the mother, fetal anomalies, and incest and rape.
Indiana’s abortion bill is the most consequential legislation enacted in memory. But unfortunately, it was passed in haste. Public testimony was cut short. And legislators should have allowed more time to engage with physicians and other health professionals to study the legislation’s ramifications thoroughly and thoughtfully.
The introduced bill was pretty much a done deal, only tweaked around the edges before passage. Legislators were largely deaf to the long procession of physicians who testified to the high potential for unintended consequences and who offered solutions to mitigate potential problematic outcomes.
According to the law, abortions involving rape and incest must be performed at 10 weeks’ gestation or earlier. Especially for children, more time is needed to identify the pregnancy due to delay in diagnosis from unawareness, hiding the pregnancy because of intimidation or shame, irregular menstrual cycles, and denial and rationalization.
Although there might be confusion due to inconsistent bill language, the law allows for abortion throughout the entire pregnancy to protect the health and life of the mother. However, the legislation’s use of a standard of “reasonable medical judgment” for that determination is problematic, as it is open to interpretation.
What is reasonable medical judgment? What conditions are legitimate risks to the mother? At what point is the disease severe enough for an allowed termination? Further, a certificate with clinical documentation needs to be filed first with the hospital to justify the termination. I cannot find any provision for emergency situations that demand immediate action.
There is an exception when “the fetus is diagnosed with a lethal fetal anomaly,” defined as a condition that with reasonable certainty results in death not more than three months after birth. “Reasonable certainty” is subject to opinion and clinical variability, as is the life expectancy of a specific condition.
My above concerns largely result from inclusion of physician felony criminal prosecution. The abortion ban beginning at zero weeks’ gestation creates many more potentially unlawful situations. Non-physicians, some with political or philosophical agendas, will second-guess and challenge physicians who are acting in a responsible, evidenced-based, good-faith manner. Physician accountability rests with the Indiana Medical Licensing Board, not in criminal court.
Physicians might hesitate to act or withhold care in emergency situations, weighing their duty as a physician against criminal prosecution. Criminality should be a matter of intent and only for blatant and egregious violations. Such a punitive, adversarial and restrictive law will have a chilling effect on practicing obstetrics. Maternity-care access and Indiana’s already-high maternal/infant mortality rates will suffer.
Admirably, the General Assembly enacted companion legislation that provides much-needed funding, especially for low-income families, in support of healthy pregnancies, infants, children, families and adoption. Allocations total $75 million, with $45 million for establishment of the Family First Fund. More will be needed.
Commitment to pro-life should not end with the birth of the baby.•
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Feldman is a family physician, author, lecturer and former Indiana State Department of Health commissioner for Gov. Frank O’Bannon. Send comments to ibjedit@ibj.com.
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