Bioethics Forum Essay

Arizona’s Ultrasound Mandate, Abortion, and the War on Women

Eager to join the ongoing “war on women” and seize the opportunity to roll back women’s reproductive rights, Arizona Republican Governor Jan Brewer signed into law the Women’s Health and Safety Act, which, despite its name, is neither in the interests of women nor for their health and safety. The new law bans abortions after 18 weeks of pregnancy and imposes a number of undignified and humiliating requirements likely to deter most Arizona women who do not want a child from seeking an abortion, and to distress and shame the remaining few who are going through with it.

Adding to an already onerous regimen of restrictions on women’s reproductive rights, other states have enacted similar abortion laws that are hostile to women, for example, forcing women seeking abortion to endure an obstetric ultrasound and listen to fetal heartbeat while watching the fetus on a screen. Critics have derided these laws as “state-sanctioned abuse” and as asking doctors to “commit a sex crime.” Supporters of these laws insist that the goal is not to punish and shame women but rather to empower them with information they need to make a more informed pregnancy decision.

Traditionally, people opposed to abortion have opposed routine fetal screening like ultrasound. As the thinking goes, ultrasound may reveal ambiguous findings and, rather than having follow-up testing to see if the findings are pathological, women may decide to abort the pregnancy– even if they want a child. This group now contends that ultrasound may decrease the number of abortions because it may reveal information about fetuses that can make women seeking abortion change their minds. Can both propositions be true? I argue that they can’t.

The argument proffered by those opposed to abortion is premised on two implausible assumptions about women who want to continue with their pregnancy and women who do not. The assumption about the first group is that ultrasound is likely to reveal a defect in the fetus and that this information could make a woman consider abortion, thereby increasing the number of abortions. The assumption about the second group is that ultrasound is likely to reveal that the fetus is healthy and that this information could increase a woman’s attachment to her pregnancy and make her decide against abortion. In this view, ultrasound could reduce the number of abortions.

These assumptions rest on the belief that women, like children, can be easily manipulated and swayed to change their minds, only on the basis of ultrasound. This belief is offensive and unjustified. It is offensive because it presumes that abortion decisions are made lightly and thus can reasonably be overruled or ignored. It is unjustified because it is hardly the case that decisions for or against abortion restonlyon ultrasound images.

For example, a recent study in British Columbia illustrates that looking at ultrasound images of their fetuses did not make women seeking abortion change their minds. And when ultrasound screening did affect women’s pregnancy decisions, the result was unexpected:  seeing ultrasound images of fetuses before an abortion was reassuring rather than disturbing or guilt-producing. As one woman, quoted in a New York Times article, put it: “It [the embryo] just looked like a little egg, and I couldn’t see arms or legs or a face. It was actually the picture of the ultrasound that made me feel it was OK [to abort].” Seeing is believing.

Regardless of how pregnant women react to the images of their embryos and fetuses, they should not be forced to have ultrasound procedures. The bottom line is that women do not lose their rights when they become pregnant. To impose procedures that women do not want disregards 40 years of medical practice and legislation that recognize the right of patients – men and women – to refuse any intervention regardless of the consequences. It is ethically (and legally) untenable, at any time, to force women to submit to procedures they do not want or to carry a pregnancy to term against their best judgments. Information about a pregnancy should be made availableonlyif women want it.

Evelyne Shuster, Ph.D., is a philosopher and ethicist at the Veterans Affairs Medical Center in Philadelphia.

Posted by Susan Gilbert at 05/16/2012 10:33:54 AM |

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