Ever since Wednesday night's presidential debate, many Americans have been talking about what "women's health" really means. Nowhere is this issue more relevant than in South Dakota, where voters are poised to decide on a comprehensive ban on abortion. Initiated Measure 11 would ban most abortions, with narrow exceptions for rape, incest, and "serious risk of a substantial and irreversible impairment of the functioning of a major bodily organ or system of the pregnant woman." That's how South Dakota would define "women's health" if the initiative passes.
In August, I spoke out on behalf of the many doctors in South
Dakota who, like myself, have devoted their lives to protecting women's
health. They are concerned that the language used in this initiative
would put women at risk. Doctors in South Dakota--and around this country--have
all seen patients whose health was affected by pregnancy. As a family
physician who ran an abortion clinic for many years, I've often seen
women whose diabetes and heart disease were worsened by pregnancy. Many
of them were mothers who chose to end their pregnancies so they could
care for the families they already had. Every woman I treated made the
decision to have an abortion thoughtfully and carefully, and thanked
me for being there in a time of great need.
Proponents of Initiated Measure 11 argue that the health exception protects women's well-being. However, "substantial and irreversible harm" is hardly a black-and-white issue. Imagine a woman, recently diagnosed with cancer, who cannot begin chemotherapy while she is pregnant. Would she be forced to continue her pregnancy to term regardless of the risks? Who decides? If medical experts cannot agree on the precise risk to a woman's health, they may opt not to act at all rather than risk criminal penalties. As Dr. Marvin Beuhner, an obstetrician/gynecologist in Rapid City, told me: "We physicians [would be] left in the untenable position of trying to make a medical decision with our attorneys rather than our patients. The threat of a felony is truly frightening."
Just how murky the language in Initiated Measure 11 is became clear earlier this week, when a memo from Sanford Health (a hospital in South Dakota) was leaked to the media. In the memo, the hospital's lawyers state that the law is unclear, and could have "substantial legal implications." The end result is that, if passed, this law would tie doctors' hands and force them to watch as their patients' conditions worsen. As a physician, I can only imagine the needless suffering women in South Dakota would be forced to endure.
Beyond the risks to individual
women, eliminating "women's health" in abortion regulations would
undermine the doctor-patient relationship. Women rely on their physicians
to give them complete and accurate information about their health, and
to help them decide on the right medical treatment. Imagine your doctor
saying, "Your heart disease is getting worse. I know a treatment that
will cure you, but I can't provide it because our state believes you
don't really need it." Women and men would be up in arms!
This isn't just an issue in South Dakota. We all need to be concerned about how women's health is defined in--or left out of--regulations that govern healthcare. Once a cornerstone of Roe v. Wade, protections for women's health were deliberately left out of the federal abortion ban-legislation upheld by the Supreme Court in 2007. We can no longer count on the courts to protect women's health.
When Roe was decided, women across America were dying from unsafe, illegal abortions. Women's health was essential to the ruling precisely because the risks of illegal abortion were so apparent. Thirty-five years later, we are fighting to protect the right of women to receive the medical care they need, and the right of doctors to provide it. I only hope we never go back to the days when the risk to women's health is visible in hospital wards everywhere.
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