Abortion and Informed Consent

Informed consent is a big deal in health care. And it should be.

If a person is planning to undergo medical treatment, his or her doctor will go to great lengths to make sure the patient understands what is involved -- whether for preventative care, elective procedures, or treatment for serious illness.

There are often multiple discussions. Test results are reviewed. Printed materials may be provided. Doctors may sketch visual images. They may use computers to show medically relevant videos. Internet resources may be recommended. Sometimes patients can watch procedures being performed on their body in real time, such as during a flexible sigmoidoscopy. After an organ transplant, a patient may be shown the diseased organ, especially in cases when patients had doubts about just how sick they were. Many patients also reap the benefits of diagnosis-specific support groups where they receive emotional support along with helpful resources as they continue to learn about their medical issue.

But in the case of abortion, these standards of care disintegrate. Instead, as the title of a recent piece I wrote on abortion suggests, abortion is in a class of its own. The standard for informed consent in the abortion industry is dangerously low.

Once a woman says she wants an abortion, medical standards and norms change. If the process of getting informed consent involves making the unknown, known, the process in the abortion industry is all about unknowing.

When I regrettably and wrongly had an abortion many years ago, no one at Planned Parenthood explained anything to me -- and I mean nothing -- about my baby's development. No one even showed me a picture of a 3-month old baby in the womb. No one said or did anything to help make my baby real to me. Nor did anyone explain precisely and honestly what would happen to my baby during the abortion procedure. This lack of information helped keep reality at bay. It allowed me to think in abstract and disconnected ways as I entered a world where there was no comprehensive process to gain my informed consent.

I am not blaming anyone but myself for my evil deed. It was my responsibility and mine alone. However, there are clearly standards, protocols, and values in the medical community about informed consent which are not upheld at the same level in the abortion industry.

Ironically, the very feminists who support abortion are the same group who tout "empowerment." But by withholding valuable information from women who want abortions, the abortion industry is behaving in a paternalistic way. Unless the woman peppers the staff at an abortion clinic with questions, comprehensive information usually will not be forthcoming. As a result, she is ill-prepared to truly make an informed decision.

If common standards of medical care were in place, including a thorough educational process to gain informed consent, perhaps many women considering abortion would make a different choice.

I would like to think I would have.

I cannot help but believe that had someone sat down with me and showed me pictures and/or videos of a 3-month old fetus, I would have been profoundly moved and stirred to connect to the reality of having a baby growing inside me. My baby!

I cannot help but believe that if I had an ultrasound with a technician joyfully showing me my baby and his or her heartbeat, I would have been captivated, enthralled. In love. And if not any of those things, then at least awakened to the realization that there was a child growing in me. My child!

I cannot help but believe that if there had been someone -- even just one person -- who balanced the conversation about abortion with a conversation about life, I might have felt confident, or at least encouraged, that I had something to grab onto.

Those who support abortion might argue that once I made my decision (which I did in a virtual vacuum) it would have been inappropriate for my doctor to do anything to influence me or potentially change my mind.

But here, again, that is a departure from the norm in health care. Patients share all kinds of health decisions with their doctors. And doctors often do everything in their power to change the patient's thinking. Why? Because the doctor determines that the patient does not appear to fully understand the health matter at hand; the patient does not seem adequately informed.

One might say it's up to the woman to understand what her options are. She should understand that she could raise her child. Or give the child up for adoption. And that's fair to think. Up to a point. Most of us are not health care professionals. If a woman tells her doctor she wants to have a double mastectomy, the doctor won't assume she's made a sound decision. He or she will want to review her health history, get a detailed family history, find out if the woman has tested positive for the gene that will put her at increased risk, and so forth.

Similarly, when a woman expresses her desire to have an abortion, the health care provider should not assume she's making a sound decision. It is their duty to make sure she understands her baby's development, including a way for her to see an image of her baby. And if that's not possible, at least an image of a baby at the same developmental stage. Pregnant women deserve exposure to as much information as possible. I would argue that there is no more serious matter than the creation of a new life, save the destruction of it. This is no time to withhold vital information and resources.

As a point of comparison, several years ago my routine screening mammogram showed something abnormal. The immediate follow up diagnostic mammogram confirmed an abnormal mass. The radiologist brought me into her office to discuss the images with me. She showed me the area of concern. Explained the difference in color and shadow and what that meant. She also discussed why the image suggested a mass that was hard, and why that added to her concern. She recommended we move forward with an ultrasound and a fine needle aspiration. Throughout the entire discussion she checked in to make sure I understood everything. She invited questions. During the fine needle aspiration, she showed me the image on the monitor as she was guided with the needle to the area in question. When she withdrew the contents of the mass, she showed it to me and explained, to our great relief, that it appeared that I had nothing more than a benign cyst.

Looking back, I now realize that I knew more about the cyst in my breast than the 3-month old baby who once grew inside me. And that is dreadfully wrong. Not because I knew too much about the cyst. But because I knew too little about my baby.

In addition to be given comprehensive information, women who are considering abortion should also have the opportunity to meet with other women who've faced similar circumstances. What an amazing support group that would be. She could hear their stories. Hear how they faced motherhood. Shouldn't a pregnant woman leaning toward abortion be provided support from those who've faced a similar challenge? This model of support is nothing new and is put into practice all the time for individuals with cancer and other serious health issues. Why isn't it a standard of care in this situation?

Curiously, many women who've had an abortion talk about the stigma they felt and feel. For some, it becomes a very dark secret that wreaks havoc on their life. And I don't disbelieve them. But for me, the stigma was related to keeping my baby, because no one -- not a single soul -- talked about the possibility of carrying my baby to term. In my mind, silence equaled stigma.

For example, few women know how the process of adoption works. It would be helpful for someone to explain it. Explain the care Mom would receive throughout her pregnancy. Explain what would happen when she delivered the baby. Explain how she and her health care provider would link up with adoption agencies. Explain the say-so she may or may not have in selecting an adoption agency. Explain how the baby would be cared for while waiting for a loving home. Explain how she may or may not be able to know anything about her baby's fate once the baby was handed over to the adoption agency. And so on. Then, and only then, could the mother truly envision a scenario of carrying her baby, giving birth, and relinquishing her baby into the hands of those who would find a couple eager to start or grow their family. It would become a very real and tangible option for the Mom, rather than some hazy notion in the back of her mind that no one addressed.

Women who are considering an abortion should also be told and shown in graphic detail precisely how their baby's life will be brought to an untimely and horrific end. Those who support abortion might say this is provocative and manipulative. But I would disagree. I say it is honest and thorough. If a woman found such information illuminating, shocking, ghastly, that would be crucial information for her that would help guide her ultimate decision. She would be confronting the truth in all its awful form.

How come this information is not provided routinely when a woman seeks an abortion? What are those in the abortion industry afraid of? And why should a woman about to embark on the calculated murder of her unborn child be able to avoid the dark reality of what she is planning?

And finally, I believe a waiting period before an abortion is appropriate. Many states require a waiting period if a man wants to get a vasectomy. Many health insurance plans require a waiting period, as well. And for good reason. It is an acknowledgement of the serious consequences of having a vasectomy and a way to help increase the chances that the patient is making an informed decision when, and if, they ultimately decide to move forward with the procedure.

Figuring out how to reduce the number of abortions performed in this country is difficult and complex. I offer this perspective on informed consent as one way, perhaps, to have an impact on this problem. It is certainly not the only approach. And it surely does not get to the heart of the matter, which is that so many have morally lost their way. But forcing the abortion industry to the same comprehensive standard of informed consent that exists for all other health matters may cause some women to awaken to the truth about abortion.

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