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Debate: Mandatory ultrasounds before abortions

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Background and context

The abortion debate has raged in the United States and around the world for many decades. One of its more recent permutations surrounds laws that have been passed, or are being considered, in many US states that require women seeking an abortion to obtain an ultrasound, be shown the screen, and be described elements of the fetus before the operation. Oklahoma, Texas, and Arizona, for example, have all passed such laws between 2008 and 2011. Advocates of these laws intend to give women imagery and information about the unborn fetus that could change their minds.
They argue that abortions are an unfortunate outcome and that lowering the number of abortions through these kinds of methods is, therefore, a good thing. Further, while women may have the right to their bodies and the choice of abortion, opponents argue that opting for an abortion is still immoral, and thus justifies the state intervening to try to persuade women against it. Opponents claim that this violates a women's right to make decisions regarding their own bodies unmolested by the state. They see women as fully capable of understanding the implications of abortions and that these laws insult their intelligence by imagining the government has something to teach them. On this point, they also argue that showing women these ultrasounds rarely has any impact on their decision, as advocates might hope. Opponents also question the implications for the patient-doctor relationship, in which a doctor is forced to perform an operation that is not medically necessary. These and other pros and cons are considered below.
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Info: Does mandating ultrasounds provide valuable info?

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Pro

  • Ultrasounds help women make informed decisions on abortion Lisa Billy, R member of Oklahoma House of Reps. "New Law Empowers Women." USA Today. May 9th, 2010: "For women facing an unplanned pregnancy, there is often a sense of panic, distress and fear that can lead to hasty decisions. That is why I authored House Bill 2780, which requires that women be given information obtained from an ultrasound before an abortion is performed. Many clinics already perform ultrasounds before abortions — something they have acknowledged in legal filings — but women have told me over the past 20 years that they have not had access to that information. Women should have the choice to see that image. I have personally visited with women who obtained an abortion in a panic and were devastated years later to see a friend's ultrasound and realize: That child is the same age as my baby when ... It is a devastating moment of intense sorrow and regret. I filed this bill to empower women, no matter what their circumstance, to have as much information as possible before making a life-altering decision. Individuals who argue women are too fragile to face the reality of abortion and make an informed decision do not respect women. The image of a baby on an ultrasound provides amazing clarity of thought. What was seen as a closed door suddenly becomes a world of endless possibilities. Critics say the state should stay out of this issue, but I believe turning a blind eye to women in need is inexcusable, and preventing them from receiving accurate medical information is true cruelty. It appears the pro-choice movement believes it is a tragedy only if a woman exercises her informed right to not have an abortion, but they have no problem maintaining barriers to informed consent that will leave women emotionally shattered for the rest of their lives once they learn the truth."
  • Ultrasounds fit well with pro-choice concepts. Zack Krajacic. "Serious about reducing abortion? Make women see an ultrasound of the procedure." Christian Science Monitor. January 7th, 2010: "If pro-choice advocates are sincere with their words, wouldn’t they be happy to see fewer women choosing to have abortions as a result of technology’s ability to help ensure a fully-informed conscience? Since pro-choice advocates want to reduce the number of abortions as long as a woman’s right to choose remains intact, they should support a law that required women to watch a video of an abortion. In fact, proponents of choice would have the best of both worlds: more information for women on which to make a personal choice and fewer abortions."
  • Women review cancer ultrasounds; should for abortions too. Frank Zoz. "Requiring ultrasound before abortion makes sense." USA Today. May 12th, 2010: "Ultrasounds Every woman reviews with her doctor an ultrasound or X-ray of an anomaly that has been found during a breast or uterus examination. A doctor should also review with the woman an ultrasound of a living child within her body. The idea of 'if I don't see it, I don't have to deal with it' doesn't work for a cancerous cyst. It shouldn't be allowed for women seeking abortions. An ultrasound shows her the reality of a child who is living inside her womb."


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Con

  • Women don't need ultrasound to know implications of abortion. "Ultrasound before abortion: A wasteful bullying tactic." RH Reality Check. February 11th, 2011: "I think we can be pretty sure that a woman about to have an abortion is aware of what’s inside her womb. And in case she’s not, the doctors who counsel her before the abortion are perfectly capable of telling her. By adding another step, Fulton and the other lawmakers championing these bills are implying that they have some insight to offer in the medical process. By requiring that a woman go through an additional medical procedure solely for the purpose of telling her what she already knows – that she’s pregnant – these bills are wasteful and offensive to medical providers."[1]
A woman named Laura who sought an abortion in Arizona in 2010 under its new laws, said to the New York Times: “You don’t just walk into one of these places like you’re getting your nails done. I think we’re armed with enough information to make adult decisions without being emotionally tortured.”[2]
  • Mandating doctors inform women of ultrasounds is enough. "Our view on women's choice: Ultrasound mandates in abortions cross a line." USA Today Editorial. May 9th, 2010: "Oklahoma law already requires that women considering abortion be told about ultrasounds (a sensible requirement), and no one has explained why more is needed." This requirement ensures that women are offered the choice to opt for the procedure and view the fetus before the abortion. It appropriately puts the choice to access information in the hands of the woman seeking an abortion, instead of somehow attempting to mandate the absorption of that information.
  • Ultrasounds are about roadblocks to abortion, not info. Bryan Howard, president of Planned Parenthood of Arizona, said the ultrasound requirement in a February 2011 law “is about putting hurdles in front of people seeking abortions. It’s not about informed consent. It’s not about safety."[3]


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Intrusion: Do mandatory ultrasounds amount to state intrusion?

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Pro

  • Abortion incurs responsibility to view ultrasound. Intrusions on personal choices are not always justified. But, when a woman's choice to have an abortion affects another life (the unborn), the state has the authority to step in with reasonable measures. Given the gravity of killing an unborn child, it is a small intrusion for the "killer" to be forced to have an ultrasound and to be given the option of viewing it.
  • Abortion patients generally want to see ultrasound. Kevin Sack. "In Ultrasound, Abortion Fight Has New Front." New York Times. May 27th, 2010: "In one of the few studies of the issue — there have been none in the United States — two abortion in British Columbia found that 73 percent of patients wanted to see an image if offered the chance. Eighty-four percent of the 254 women who viewed sonograms said it did not make the experience more difficult, and none reversed her decision."
  • Ultrasounds can be reassuring to some women. Kevin Sack. "In Ultrasound, Abortion Fight Has New Front." New York Times. May 27th, 2010: "Because human features may barely be detectable during much of the first trimester, when 9 of 10 abortions are performed, some women find viewing the images reassuring. 'It just looked like a little egg, and I couldn’t see arms or legs or a face,' said Tiesha, 27, who chose to view her 8-week-old embryo before aborting it at the Birmingham clinic. 'It was really the picture of the ultrasound that made me feel it was O.K.'" This may run against the wishes of some pro-life advocates who intend for ultrasounds to discourage abortions, but it also can be offered as a sign that mandating ultrasounds need not be seen as a form of punishment; it's effect is not clearly negative of the psyche of the patient. Indeed, in this sense, it can be viewed as a neutral piece of information for the patient, whom can interpret it as they see fit in making their choice to have an abortion or not.
  • Emergency abortions exempted from ultrasound requirement. Most laws requiring that women view ultrasounds have exemptions for things like medical emergencies, perhaps where the fetus is deformed. Other appropriate exemptions can also be built into specific laws, such as for instances of rape. This can help better target the intended effect of required ultrasounds.


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Con

  • Govt shouldn't try to tell women what they should do. Andrea Bolt. "Con: Required sonograms before abortion." Skiff.com. February 23, 2011: "My argument is not about condoning the killing of anyone or anything — it is about the choice a woman has to do what she wants with her own body. The government should never, ever have the explicit power to tell people what they can and cannot do concerning their own bodies."
  • Forcing ultrasounds on women amounts to punishment. Ultimately, if it's not going to change a women's mind, since the ultrasound is given only after they've made the choice and gone in to have an abortion, then the process amounts to punishment.
"Ultrasound before abortion: A wasteful bullying tactic." RH Reality Check. February 11th, 2011: "having a cadre of politicians take this image by force does add something to the experience: the sense of having been intimidated, assumed stupid, and even violated."


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Changing minds: Do ultrasounds change women's minds?

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Pro

  • Ultrasounds inform mothers, may reduce abortions Senator Tony Fulton, Republican of Nebraska: "If we can provide information to a mother who is in a desperate situation - information about what she's about to choose; information about the reality inside her womb - then this is going to reduce the number of abortions."[4]
  • Nothing wrong with persuading women against abortion. Zack Krajacic. "Serious about reducing abortion? Make women see an ultrasound of the procedure." Christian Science Monitor. January 7th, 2010: "Some might object to a law that could produce such a strong influence, but abortion providers and organizations like Planned Parenthood, who profit from performing abortions, exert their own influence right now in the opposite direction. In other words, the abortion decision in its current state is not a pure one – it is tainted with various motives. Is it not better to influence women to refrain from having an abortion than to persuade them to have one? Indeed, a lower abortion rate resulting from the free and voluntary choices of well-informed women should be welcome news to everybody. After all, even the most ardent pro-choice advocates, including President Obama, insist that nobody is for abortion and that everyone wants to reduce the number of abortions. Naomi Wolf, a feminist author and supporter of abortion rights, described abortion in a 1995 essay as a 'necessary evil.' As a guest on Fox News’s 'Hannity' last fall, Steve Murphy, a Democratic strategist, said he and other pro-choice advocates are morally opposed to abortion, but they feel it is important to ensure it remains a woman’s choice. In fact, every pro-choice advocate I have ever come across has stressed that they are pro-choice, not pro-abortion."


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Con

  • Ultrasounds don't convince women against abortion. Ferretlas. "Laws that mandate ultrasounds prior to abortions don't work." Daily Kos. May 28th, 2010: "According to a NYT article a new study outside the US has come to the conclusion that laws forcing women to have ultrasounds before having an abortion do not change the women's mind! What intrigues me is that these invasive laws are not changing women's minds, they are, in some instances, reassuring the woman that what she's doing is the RIGHT thing for her. I suspect this is the exact opposite effect the anti-choicers had in mind. So, once further studies, preferably one done here in America, confirm or deny these findings, will the states that have these laws on their books take another look at them? I suspect, like abstinence only, which HAS been proven ineffective, these laws mandating medically unnecessary ultrasounds will continue to add to a woman's burden if she is considering having an abortion."
  • Ultrasounds forced on women who already chose abortion. "Ultrasound before abortion: A wasteful bullying tactic." RH Reality Check. February 11th, 2011: "This bill hits women in the doctor’s office, after they’ve already decided to have an abortion. They have taken stock of their lives, their social, emotional, and economic 'circumstances,' and they’ve decided that abortion is the best option for them. Having an ultrasound and hearing a description of the fetus does not change these circumstances. It does nothing to make the pregnancy easier to bear[...]"
  • Legislators arrogant thinking they can change women's mind. "Ultrasound before abortion: A wasteful bullying tactic." RH Reality Check. February 11th, 2011: "The legislators behind these bills are arrogant in assuming they have something to say to a woman about her “womb.” There’s no doubt that, as a woman, it’s hard to predict how you’ll feel after an abortion. But an image of the fetus sheds no light on the decision and adds nothing to the emotional process."


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Averting eyes: Is it adequate for patients to be able to avert eyes?

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Pro

  • Women are not required to look at the ultrasound. Women are not required to look at the ultrasound image, even if doctors are required to show it. This means that it is ultimately the women's choice as to whether to look at the images. Nobody is holding a woman down and taping their eyes open. As with her choice to have an abortion, ultrasounds fully respecting their rights to free choice.


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Con

  • Ultrasound forced on women, even if they don't look. Some claim that women's rights are respected in these laws because they don't have to look at the ultrasound image. But, they are forced to have an unnecessary and potentially unwanted medical procedure performed on them, even if they don't look at the resulting image. Their personal liberties, therefore, are obviously violated irrespective of their choice to view the ultrasound.
  • Patients can avert eyes, but can't avoid descriptions. Kevin Sack. "In Ultrasound, Abortion Fight Has New Front." New York Times. May 27th, 2010: "During the six days the law was in effect [in Arizona in 2010], all of the patients at the Reproductive Services abortion clinic in Tulsa averted their eyes from the ultrasound screen, said Linda S. Meek, the clinic’s director. But they could not avoid hearing descriptions of fetal length and heart activity, she said. Many left in tears, but none changed course. 'It’s very intrusive, and very cruel,' Ms. Meek said."


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Doctor-patient: Do mandates respect doctor-patient relationship?

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Pro

  • Doctor-patient relationship sometimes needs ethical boundaries. Doctors and patients sometimes need boundaries, just like the free market. A good example might be the assisted suicide laws in some US states like Oregon, in which a panel of ethicists as well as doctors must assess the legitimacy of a patient's request for the procedure and the termination of their own life. This is a government imposed process between the doctor and the patient due to the ethical sensitivity of the issue. The same justification can be put forward for mandating ultrasounds before abortions - it's a minimum step to ensure that the doctor and patient are operating with a basic understanding of the unborn life that they are taking.


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Con

  • Ultrasound mandates hijack doctor-patient relationship. Bebe Anderson, senior counsel for Center for Reproductive Rights, told the HuffPost about the 2011 Texas law: "It hijacks the doctor-patient relationship, assumes what a woman must know to make a decision and forces doctors to say things to their patients that they otherwise shouldn't and wouldn't."[5]
  • Mandatory ultrasounds force doctors to compromise practice. Emily Bazelon. "Required viewing: Oklahoma's gallingly paternalistic ultrasound law." Slate. October 22th, 2008: "[With the 2008 Oklahoma law,] doctors would be stuck practicing medicine in a way that doesn't make sense to them. [...] the Oklahoma abortion law is like a South Dakota statute that requires doctors to give patients who come for an abortion a mandatory written statement telling them that an abortion includes 'increased risk of suicide ideation and suicide,' even though there's no good evidence of such a risk. Both laws leave doctors with an ethical quandary. They can either risk criminal prosecution by breaking the law or follow it and either (in Oklahoma) do an ultrasound against a patient's will or (in South Dakota) read a state-mandated script for which there's no solid medical backing."


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Resources: Is mandating ultrasounds a good use of resources?

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Pro

  • Ultrasounds are a procedure any pregnant woman should have. It's a basic and expected procedure for any pregnant woman. The majority of those seeking abortions have ultrasounds performed. It is a stretch to say, therefore, that this is too great a strain on medical resources.
  • Medical expenses justified for ethically sensitive abortions. When ethics are concerned, there is nothing wrong with expending some extra, non-medically-required resources to ensure that women have all the information they need to make a judgement about abortion.
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Con

  • Money should be spent on contraception etc, not ultrasounds. "Ultrasound before abortion: A wasteful bullying tactic." RH Reality Check. February 11th, 2011: "Eleven states are considering bills that would make ultrasounds mandatory for women seeking abortions. So instead of spending money on the development and distribution of contraception, on education, and on the support of women who choose to go through with unplanned pregnancies, someone is going to be spending money on ultrasounds."


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Pro/con sources

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