Biased Counseling Against Abortion

Document Date: April 11, 2001

The Supreme Court’s 1992 decision in Planned Parenthood of Southeastern Pennsylvania v. Casey upheld, among other restrictions, a Pennsylvania law requiring that physicians provide women with state-prepared anti-choice materials at least 24 hours prior to the abortion procedure. The law forces a doctor to provide every woman seeking an abortion with information that is intended to discourage the procedure — even if the information is irrelevant, unnecessary, and ultimately harmful to her health.

Such “biased counseling” laws are currently enforced in more than 20 states. In a number of other states, these laws have been enacted but are enjoined or otherwise unenforced. Often introduced under the deceptive label of “Informed Consent” or “Women’s Right to Know,” biased counseling laws in fact serve to hamper women’s access to abortion.

Biased Counseling Gives Women Inaccurate and Incomplete Medical Information.

Mandatory anti-choice lectures do not give women accurate or meaningful medical information. Women are not told, for example, that a legal, first-trimester abortion has a lower complication rate than any other surgery – in fact, the mortality risk of full-term pregnancy and childbirth is more than 20 times greater than that of a first-trimester abortion. Rather, women are typically read a list of possible but very rare complications from the abortion procedure. Some state laws require that women be told that abortions pose risks of post-traumatic stress disorder, severe depression, and other psychological injury. In fact, according to a 1987-88 investigation by the former Surgeon General of the United States, Dr. C. Everett Koop (who is no champion of choice), as well as a study by the World Health Organization, there is no medical evidence that abortion causes psychological injury. On the contrary, relief is the most common reaction to a voluntary abortion, whereas women who are forced to continue unwanted pregnancies suffer adverse and sometimes severe psychological consequences.

Some biased counseling proposals would require physicians to tell their patients that abortion increases a woman’s chance of developing breast cancer. This is a scientifically unsupported statement mandated not out of concern for women’s health, but in order to scare women away from choosing abortion. A study of more than 1.5 million women in Denmark, the largest study to date, found that “induced abortions have no overall effect on the risk of breast cancer.”

Requiring That Physicians Deliver the Biased Lectures Makes Access to Quality Reproductive Health Care More Difficult and Expensive.

Biased counseling measures often prohibit a trained counselor, nurse, or other health care practitioner from providing the biased counseling and materials to the patient, requiring instead that a doctor deliver the state’s anti-choice message. This stipulation has a direct effect on women’s health. Many clinics experience serious difficulty in finding doctors willing and able to perform abortions. Indeed, 86 percent of the counties in the U.S. have no abortion providers. In a number of locations, doctors must fly in to provide abortions once a week or less. By prohibiting doctors from delegating counseling and related tasks to other trained professionals, these laws make it far more difficult for clinics to provide women with the quality health care they deserve. Furthermore, since a doctor’s time costs much more than that of a nurse, clinician, social worker, or counselor, the doctor-only stipulation drives up the costs of abortion and other health services provided by clinics.

Informed Consent Is Already Required For Medical Procedures.

A woman must give her informed consent before undergoing any surgical procedure, including abortion. The standards of the medical profession, as well as state laws, ensure that health care practitioners provide women with accurate and unbiased information regarding the risks and benefits of their various treatment options and obtain their informed consent. Biased counseling laws single out abortion from all other medical procedures. Implicit in the requirement of a biased lecture is the assumption that women do not adequately think through their abortion decision and that the state must do their thinking for them. This assumption reflects a lack of respect for women’s moral decision-making. In fact, virtually all women have carefully considered their decision to have an abortion by the time they arrive at the clinic. Clinics routinely refer for additional counseling the small number of women who remain ambivalent.

Biased Counseling Requirements Violate Standard Medical Practice and the Doctor/Patient Relationship.

In some instances, a state-imposed litany may conflict with the doctor’s ethical obligation to give the best medical advice to the patient, in view of her individual circumstances. For example, it is both pointless and cruel to “inform” a victim of rape or incest that the “father” of the “unborn child” is liable for financial assistance if she carries the pregnancy to term, or to remind a woman carrying a fetus with impairments so severe that it could never survive outside the womb that her “unborn child” will be 20 weeks old at the time of the abortion. Moreover, doctors are forced to provide nonmedical information – about the availability of child support, for example – about which they may not be qualified to speak and which is totally irrelevant to the physician’s ethical obligation to provide the best medical care and advice to the patient.

Indeed, the American Medical Association opposes these types of measures, finding that “informed consent requirements [for specific medical procedures] often are not medically indicated and never are appropriate areas for codification in law.”(American Medical Association, “AMA Opposition to ‘Procedure Specific’ Informed Consent,” House of Delegates Resolution 226 (A-99).)

Biased Counseling Laws Endanger Reproductive Freedom.

Biased counseling laws are not created to protect women’s health. They are enacted instead to make a woman’s very personal decision even more difficult. Biased counseling laws intimidate women and discourage them from seeking medical care and exercising their reproductive rights. Fear of criminal sanctions and the intrusive nature of the state-prescribed litany also deter doctors from performing abortions, further exacerbating the present shortage of providers. Opponents of choice hope that if they create enough barriers like these, women will not be able to overcome them.