On Privacy

As a physician, I help people exercise their right to privacy every day. The decisions my patients make about their health are theirs alone -- aside from having my input as their doctor, they do not need to involve anyone in their choices. They know that I will not share any information about their medical condition with their families, friends, or employers without permission. I happen to be an ob/gyn, but even if I were an orthopedist or a neurologist, my patients would expect the same degree of confidentiality. The Supreme Court first established this right to privacy more than a century ago, and most Americans take it for granted every time they visit a doctor. Yet today I find myself having to defend this right on behalf of my patients. 

Although the right to privacy is not explicit in the Constitution, the Supreme Court has found Constitutional support for it at least since 1891. The justices ruled then in Union Pacific Railway Co. v. Botsford that an employer cannot compel a worker to have a physical examination. The majority of the Court offered a powerful description of the right to privacy: "No right is held more sacred, or is more carefully guarded, by the common law, than the right of every individual to the possession and control of his own person, free from all restraint or interference of others..."  

Even in 1891, the Supreme Court understood how vital privacy is to our freedom. Today, the medical profession does everything it can to protect patients' identities and diagnoses. We are now so accustomed to confidential care that as patients, we reveal important, personal, or even potentially humiliating details to our doctors without even asking about privacy. My patients know I will help them without reporting their flu or their diabetes to the boss. They know I will help them choose the best course of treatment without consulting the government first. But for women who are pregnant -- especially those younger than 18 -- the expected right to privacy may be in jeopardy or have disappeared altogether. 

More than eighty years after Botsford, Roe v. Wade extended privacy rights to a woman's decision whether to terminate her pregnancy. In the ruling, the justices placed reproductive freedom on the same level as freedom of religion, freedom of speech, and our other fundamental liberties. Whenever I provide a patient with contraception or an abortion, I feel that I am helping her exercise a basic human freedom. Of course my patient has "possession and control of [her] own person." Of course she decides when and whether to be pregnant. 

But Roe offers women no guarantees. Since 1973 when Roe legalized abortion, the government has encroached on pregnant women's privacy until it barely exists. 

We would never let the government tell a cancer patient to wait 24 hours between requesting a medical procedure and receiving it, especially if the implication were that the patient is not capable of considering the decision carefully enough. In 20 states, any woman at any age who is seeking an abortion is told that she must wait 24 hours so that she can be sure that she has thought hard about ending her pregnancy. This is an example not just of outrageous condescension but also of governments' interference in women's right to privacy. 

After a leukemia patient has chosen a safe, legal course of treatment, we would never force her physician to give her printed material containing medically inaccurate arguments against that procedure. But again, privacy does not always apply to pregnant women. In six states, politics trumps a woman's right to sound, confidential medical advice, requiring her to accept a publication containing disproved claims that abortion causes breast cancer, then certify she has received it. 

As I write this, South Dakota voters are considering Initiated Measure 11, which would eliminate a woman's right to decide whether to terminate her pregnancy. To have a safe, legal abortion under Measure 11, a pregnant woman and her doctor would have to prove to the state government that she was raped, was a victim of incest, or has a medical condition that would seriously threaten her health if she continued her pregnancy. No other reason would do.  

Young women's privacy rights are especially vulnerable. Minors can obtain confidential abortion services in only 16 states and the District of Columbia. The other 34 states require parents to be involved in a minor's decision to terminate her pregnancy. As an ob/gyn who specializes in treating teens and young girls, I have witnessed both.  

I practiced in Ohio for 23 years, where a parental notification law requires doctors to inform parents if their daughter is having an abortion. It may seem reasonable for parents to be involved in their daughters' medical care -- and in fact, most teens do inform a parent or a trusted adult about an unplanned pregnancy. But because not every family is loving and functional, mandated parental notification for abortion endangers the teens who are at risk of abuse or neglect. Pregnant teens who fear their parents' reaction will often put off going to the doctor as long as possible, increasing the risk to their health whether they have an abortion or carry the baby to term. Because of these hazards, the American Medical Association, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, the American Academy of Family Physicians, the Society for Adolescent Medicine and other major medical organizations support confidential reproductive healthcare for adolescents.  

I now practice in California, a state that mandates confidential care for minors. My patients and I work together to decide when and how we involve their parents. Most of the time, we do, but we can only reach that point because teens trust that I will not share what they tell me without their permission. When a girl fears abuse or abandonment, we work on ways to improve her situation while providing the medical care she needs to stay healthy. This is how the right to privacy should work for adolescents.  

But this approach is under attack in California. In November, we will vote on Proposition 4, a state ballot initiative that would mandate parental notification, undermining teens' privacy and driving them away from needed medical care. The proponents of the initiative say that it provides two alternatives to parental notification for girls who have reason to fear their parents, but neither option would protect these teens. One route would require a written statement from the girl saying that her parents abuse her, which would trigger an investigation of her home that would be anything but confidential or safe. The other choice would send the pregnant girl to court to present intimate details about her physical and emotional state.  

To keep pregnant teens healthy and defend their privacy, I have been speaking out against Proposition 4 and urging Californians to vote no. 

In far too many places and in far too many ways, a woman who becomes pregnant finds her right to privacy diminished or eradicated. If we as a nation cannot let her make confidential decisions with her physician, how free can the rest of us be when we go to the doctor's office?  

Dr. Paula J. Adams Hillard's clinical practice, research and teaching focus on the fields of adolescent reproductive health, contraception and gynecologic care. Dr. Hillard has been a board member of Physicians for Reproductive Choice and Health since 1999.