Saturday, December 22, 2007

What real informed consent would look like

I posted this long ago on the old Pro Life Views forum at Now I submit it for the commentary/perusal of visitors here. What would constitute adequate informed consent for abortion?

First, the woman should be told that panic is normal, and that it usually passes. She should be informed of the normal psychology of pregnancy so that she can get a handle on whether she's just in the throes of normal early pregnancy stress, or if there is something bigger going on. She should also be told about the impact of stress on decision-making, so she can assess to what degree stress may be coloring her choice, overriding her real wishes and needs.

Second, she should be informed of the range of responses women have from abortion, from the satisfied customer to the women who suffer unspeakable anguish the rest of their lives. She should be given a collection of post-abortion women's writings, and an opportunity to speak to women who have had abortions, along the spectrum of experience. And she should be given information on risk factors so she can assess which is more likely to be her reaction to abortion.

Third, she should be informed of the particular physical risks of pregnancy and abortion as they relate to her specific case, including her age, any medical conditions she has, etc. This should include telling her exactly how much controversy there is in the medical community about exactly how high the risks are, to her body and to subsequent pregnancies. And she should get this information from people without an axe to grind -- say, a prochoice ob/gyn who does not perform abortions but has treated abortion complications, or a perinatologist who has experience with high risk pregnancies, depending on her specific situation.

Fourth, she should be informed about the entity that the abortion will destroy, including being shown a realtime ultrasound of her embryo or fetus, and pictures or models. After all, she's bound to find out sooner or later, so better to find out while she is still able to back out or go ahead. And she does need to be prepared for what she might see if she expels a whole fetus or fetal parts. She should explore her own ideas of when prenatal life is entitled to protection, and when it is wrong to kill an unborn entity. She should be warned that any moral qualms she has now will likely only intensify after the abortion, rather than fade.

Fifth, she should be informed of resources available to her, not only in her community, but national groups such as The Nurturing Network should she choose to go elsewhere to complete the pregnancy. This should include information relevant to her specific needs, particularly if she is considering abortion for maternal or fetal indications.

Sixth, she should be offered a consult with a clergyperson of her faith -- one whose beliefs are similar to her own. No taking the one prolife Unitarian minister in the county, or the only prochoice Roman Catholic priest. If she's a prochoice Unitarian, get her a consult with a prochoice Unitarian. If she's a prolife Unitarian, it'll be a little tough, but she should be able to sort out the spiritual ramifications of what she's considering while she's still making up her mind, and not when it's too late.

Finally, she should also be offered the opportunity to meet with people who've suffered any complications she has uneasiness about, like a colostomy or a hysterectomy.

The decision to end a pregnancy with a dead fetus instead of a live baby is a one shot deal that she'll carry with her for the rest of her life. We trivialize it, and then trivialize her pain if she's rushed into a bad choice. That's not right.

Please provide any feedback, and suggested links.


Alexandra said...

I like this, for the most part. I think that it would probably be very difficult for a woman who so desired to meet with people who have suffered any of the complications she is uneasy about, just because how do you guarantee that there will be a person available to meet with her for every complication? The complications are not very common, and even if they were, what do you do -- force women who have suffered from them to meet with women considering abortions? I think that that falls more into the realm of charity on the part of those suffering from abortion complications, rather than expectation -- certainly, some people can dedicate their lives to sharing their story and can help a lot of people by doing so, but that should be their choice. We don't do this with any other surgery -- and I accept that abortion is different than most surgeries since it has so many moral conflicts surrounding it; but I think that surgical complications are one of the areas where it's the same as other surgeries. The risk is there, and once you're informed you either accept it or you don't.

Christina Dunigan said...

You have a really good point, Alexandra.

I based a lot of this on the kind of informed consent I got when I was considering oral surgery. I never got to the "talk to somebody who has had a complication" point, but Dr. M had a patient who said she'd be willing to talk to people considering the surgery about how she dealt with it, and he kept her phone number and would set up a time for a call.

Though while a complication might be rare, there are so many abortions performed that there are going to be quite a number of women in larger communities who have had a colostomy or hysterectomy because of abortion complications. It's just like a concurrent ectopic and uterine pregnancy is rare, but if you work in an abortion facility you just see so many pregnant women that you're bound to encounter them.

There's wiggle room. Maybe this is an ideal to shoot for, and if a patient complains or says "Thank you SO much!" the doc can ask if he can arrange a call if a patient wants to talk to her, not giving her name or phone number but just calling from the office.

But again, you brought up good points.

Anonymous said...

Hi, I know this is an old post but I was poking around your blog archives and this really stood out to me.

I have never been pregnant and so have never aborted: if I became pregnant, I would abort.

Regarding your first hurdle, do you really think most women haven't thought about what they would do if they had an unexpected pregnancy? If any "counsellor" tried telling me it was all hormones and not a long ago reasoned out position on my part, I'd probably make him eat a couple pamphlets. Doctors are condescending enough already. (Try getting a tubal when childless and under thirty--doctors beleive they are psychic and can predict that their patients will almost always regret sterilization.)

Your second hurdle suggests that women are so dumb we aren't aware that any and every choice in this life can end well, end horribly, or fall somewhere in between. What I mean is, the decision to cut up a potato might end with a nice pot of boiled potatoes, with a bloody stump where your fingertip used to be, or with mediocre mashed potatoes with an added shred of fingernail. If that is too "trivial", consider that anyone who gets in a car may well die or more likely get to their destination more-or-less unscathed. You makes your bets and you takes your chances with every choice you make. (I think the last sentence comes from a song but I'm not sure.)

I do believe that a lot of people would be spared pain if women were encouraged to know themselves, to think for themselves, to understand their own moral underpinnings. Most women--most people--are discouraged from thinking for themselves and searching themelves for their own "right" answers. It's too easy to let an authority do the thinking for us. Going from doctor to preacher to counsellor can result in perfect confusion and cause people to freeze until the time to make the choice is past.

Christina Dunigan said...

It's not treating people like they're dumb to give them all the information they actually need, regardless of whether or not they'd think to ask for it.

Unknown Agent X said...

What makes you think women need to be told many of these things? Women are not little children who don't understand things like stress, effects of adrenal hormones on the brain, etc. They're adults.

In addition, if a woman thought she MIGHT want a child I'd understand talking her through the various options and resources available, but if she already knows she doesn't want a child why should she have to jump over these hurdles just to preserve her bodily autonomy?

If I were to get pregnant right now, I already know I would abort. I wouldn't need to be told about stress and its effect because even if I didn't understand these things already, they wouldn't be relevant. I don't wish to have a child, case closed. I've already always been sure, when NOT under stress, that I am not willing to go through pregnancy.

Women should not be treated as mentally incompetent.

Christina Dunigan said...

Jessca, for ten years I KNEW that if had the chance to have oral surgery to correct my jaw disprortion, I'd go for it in a hartbeat. I was seriously pissed off that the oral surgeon insisted on a lengty informed consent process. That is, I was pissed off until I realized that I really didn't think the benefits would be worth the risks. He had taken the time to make sure I really KNEW what I'd be getting into.

With abortion, women are so bombared with lies - the fetus is the siae of a grain of rice and is nothing but undifferentaed cells, she will feel only relief afterward, she can always have a baby later when she feels ready, etc. Now, maybe YOU think it's okay to treat women as if they shouldn't worry their pretty little heads, but I beg to differ. I think ALL doctors, abortionists included, should inform patents of ALL the risks.

Giving people full disclosure is NOT treating them as "mentally incompetent." It's treating them like adults who deserve full disclosure.

Do you think it's insulting to offer somebody a CarFax report before they by a used car?