Legislature(1999 - 2000)
03/28/2000 03:11 PM House HES
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HB 329 - INFO AND INFORMED CONSENT FOR ABORTION Number 1567 CHAIRMAN DYSON announced the next order of business as Sponsor Substitute for House Bill No. 329, "An Act relating to services and information available to pregnant women and other persons; and requiring informed consent and a 24-hour waiting period before an abortion may be performed unless there is a medical emergency." [Note: SSHB 329 has the designation 1-LS1329\H, which was referenced during the hearing.] Number 1608 REPRESENTATIVE COGHILL made a motion to adopt Amendment 1 [1- LS1329\H.2, Lauterbach, 3/28/00], which read: Page 4, line 29: Delete "that medical assistance benefits may be available" Insert "the possible availability of medical assistance benefits" Page 4, line 31: Delete "that the father is liable" Insert "the father's liability" Page 5, line 2, following "abortion": Insert "; however, the information required under this subparagraph may be omitted by the physician when the physician considers its omission appropriate under the circumstances of the pregnancy" CHAIRMAN DYSON asked whether there was any objection. There being no objection, Amendment 1 was adopted. The committee took an at-ease from 3:40 p.m. to 3:42 p.m. Number 1715 REPRESENTATIVE COGHILL made a motion to adopt Amendment 2, to accomplish the following: Page 3, line 8, eliminate "conception" and replace with "fertilization"; Page 3, strike line 10. Page 3, line 14, replace "conception" with "fertilization"; Page 3, line 16, replace "conception" with "fertilization"; Page 5, line 21, replace "conception" with "fertilization"; page 6, line 1, replace "conception" with "fertilization"; page 6, line 3, replace "conception" with "fertilization"; Number 1747 CHAIRMAN DYSON ask whether there was any objection. There being none, Amendment 2 was adopted. Number 1779 REPRESENTATIVE GREEN made a motion to adopt Amendment 3 [1- LS1329\H.1, Lauterbach, 3/21/00], which read: Page 4, line 4, following "damages.": Insert "In a civil action under this subsection, there is a rebuttable presumption that an abortion was performed without the pregnant woman's informed consent if the physician who performed the abortion does not submit into evidence the copy of the woman's written certification required to be retained in the physician's files under AS 18.16.060(b)(4)(B)." Page 5, line 19, following "paragraph": Insert "and retains the copy in the physician's files" Number 1857 REPRESENTATIVE COGHILL said he had no objection to Amendment 3. REPRESENTATIVE WHITAKER asked Representative Green if the assumption is that there is a rebuttable presumption, and, therefore, it is not an automatic presumption; it may be rebutted, and it is subject to question by the physician. REPRESENTATIVE GREEN said it simply changes the burden to the doctor rather than the person who had the abortion, and the doctor is required to keep this notice in the files anyway. The committee took an at-ease from 3:47 p.m. to 3:48 p.m. CHAIRMAN DYSON asked whether there was any objection. There being no objection, Amendment 3 was adopted. Number 2024 DR. COLLEEN MURPHY testified via teleconference from Anchorage. She represents the practice of obstetrics and gynecology (Ob/Gyn) in Alaska; she practices obstetrics and gynecology in Anchorage at the Alaska Women's Health Services; she is board certified in obstetrics and gynecology and is an active member in the Alaska State Medical Association legislative subcommittee. She gave the following testimony: As a provider of women's health care, I speak in firm opposition to HB 329. As a personal consumer of women's health care, I speak in firm opposition to HB 329. As a mother to a young daughter, who will one day need all options to unbiased reproductive health care, I speak in opposition to HB 329. As a data-driven scientist with knowledge and professional familiarity with the predictable failures of modern contraception, I speak in opposition to HB 329. House Bill 329 is a meddlesome and unnecessary legislative action. This procedure-specific informed consent is opposed by both the American Medical Association and the American College of Obstetrics and Gynecology. It represents a shameless intrusion into the personal decision-making between a patient and her provider. House Bill 329 is a thinly veiled strategy to create additional barriers to a woman's right to legal abortion. In October 1999, the State of Alaska published updated statistics on the rate of unintended pregnancy in Alaska in its professional publication named "Family Health Data Line." Between the years 1996-1997, it is estimated that 42 percent of the over 18,000 Alaskan births were reported as unintended by their mothers. In 1995, the Institute of Medicine delineated that its landmark report, called "The Best Intentions," that unintended pregnancy is associated with many, many problems in pregnancy and later on. This includes late onset of prenatal care, lower birth weight babies, a higher infant mortality rate, higher rates of maternal depression, higher rates of physical abuse of the child and mother, higher rates of single parent homes, lower socioeconomic status for the family, and less intact families. The state of Alaska, in the "Family Health Data Line," October 1999, made recommendations to our legislators in an effort to decrease the high rate of unintended pregnancy and the necessity to going toward abortion. This includes the recommendation that your very committee strongly consider the current HB 29 for prescriptive equity. Currently there are over 60,000 women in Alaska that do not have access to the five most reliable forms of FDA [Food and Drug Administration] approved contraception. Women currently pay 68 percent more in out-of-pocket health care costs because they have to pay for these forms of contraception. I urge you to put your efforts into the prevention of unintended pregnancy, and currently you have legislation that would allow 60,000 more women to have access to more reliable access to contraception through their private insurance rather than making this thinly veiled attempt to decrease the options to legal termination in the state of Alaska. REPRESENTATIVE GREEN asked Dr. Murphy how this would be an invasion of the privacy between the doctor and the patient. DR. MURPHY said currently when a patient undergoes any sort of surgical or medical procedure, he/she undergoes informed consent prior to it. The standard of care prior to a termination is generally to date the pregnancy, which includes a physical exam, history taking, and in most cases an ultrasound exam. The issues raised in HB 329 are pretty much the standard of care statewide in which a patient is fully informed about the risk of the procedure and the gestational age of the pregnancy in which she is planning to terminate. This is currently being done by licensed providers, and this bill isn't needed. Number 2216 CHAIRMAN DYSON noted that the committee has heard that there are regulations that already require that doctors inform their patients. If it is already the current practice and is in regulations, he asked Dr. Murphy if she would have the legislature repeal the regulations. DR. MURPHY replied no. CHAIRMAN DYSON asked Dr. Murphy if there have been times, in her experience, when women have asked to get the remains of the fetus for a burial ceremony. DR. MURPHY replied no. TAPE 00-36, SIDE B Number 2231 CHAIRMAN DYSON asked Dr. Murphy if the option of getting the remains for a burial service is made available or should it be made available if the woman chooses. DR. MURPHY said currently burial is not required in Alaska for fetuses below 500 grams [in weight] or less than 20-24 weeks [in age]. Currently, most women do not view the fetus as something they want to bury. Legally it is required after a certain gestational age or certain birth weight. CHAIRMAN DYSON asked what is done with the remains that are not buried. DR. MURPHY answered that they are generally disposed as most medical waste is which is incineration. CHAIRMAN DYSON asked Dr. Murphy if women should have the option to donate fetal body parts like other organ donations. DR. MURPHY reported that there is some exciting work being done that will probably replace the need to consider fetal tissue and that is with stem cells which can be cultured and collected from the umbilical cord plug at live birth near term. That will probably be a nonissue very shortly with advancing technology. Number 2166 DR. JAN WHITEFIELD testified via teleconference from Anchorage. He is a practicing obstetrician/gynecologist; he is a member of the Alaska State Medical Association and American College of Obstetrics and Gynecology, and he represents women in Alaska. He noted he had sent in written testimony that committee members have so he will limit his remarks to three points. In terms of the mandatory 24-hour waiting period, he has maintained an active database on abortion in Alaska for quite a few years. He believes a data analysis will show it will mostly affect people monetarily who live out-of-town and that is going to be discriminatory to the Alaskan Natives. The Alaskan Natives generally have to come in from villages or outlying areas to have an abortion. If they choose to come into town for a pregnancy termination and have to wait an additional 24 hours, that is going to mean additional expense that won't be borne by people who live near the locale where abortion is available. That discrimination issue will make this bill challengeable. DR. WHITEFIELD said his second point has to do with the definition of conception. CHAIRMAN DYSON told Dr. Whitefield the word "conception" had been changed to "fertilization" throughout the bill. DR. WHITEFIELD pointed out that the definition chosen for fertilization is not necessarily a medically nor scientifically accepted definition. But as such, the committee should be aware that there is one institution in the state where people can through in vitro fertilization, which is having the ovum fertilized and saved to attempt to get pregnant. If a woman has six or eight fertilized eggs which are stored, and she manages to get pregnant, and two or three fertilized eggs are left over that she hasn't used, by using this definition of fertilization, now the person who has stored fertilized eggs and decides to get rid of the fertilized eggs not used, will be an abortion. He wondered how this law will affect the people who go through in vitro fertilization. DR. WHITEFIELD said his third point is that the bill is highly biased. One of the questions that was asked is How will this informed consent be an onus on the patient? As he reads the bill, it says that the Department of Health & Social Services (DHSS) needs to maintain information that can be supplied to a patient on a two-week basis. When an abortion is chosen, it says that DHSS will maintain this information, that the physician has to give it to a patient, and she has to sign she has obtained this information. That information is going to be placed in the patient's hands. Last week he did two abortions for women who wanted to be pregnant but had fetuses that were incompatible with life. If he had to go through a detailed explanation for those women at 16-18 weeks as to what a fetus looked like, that would be emotional torture for that person. CHAIRMAN DYSON pointed out to Dr. Whitefield that an amendment had been adopted that allows the physician to use his/her judgment if it is not in the woman's best interests to have that information. Number 1834 KATE LINDHOLM testified via teleconference from Sitka. She does not believe that any woman takes the question of having children lightly. She gave the following testimony: When I became pregnant unexpectedly at the age of 21, I struggled with many overwhelming emotions. Opinions came to me from all sides, and questions I thought I had answered materialized again. Wanting to make the right decision, I carefully examined all of these things. Forcing me to wait an extra 24 hours in order to think things over would have been superfluous. I had been weighing options about unplanned pregnancy from the time I had become sexually active. I had been thinking things over for years. Most women grow up expecting to be faced at some point with the decision about pregnancy. I assume the majority of them, with or without federal requirement, will spend quite a bit more time than 24 hours thinking about what they will do when it happens. But the real question posed by this bill isn't about the cruelty imposed by forcing unwanted and inappropriate misinformation down women's throats, it is about whether or not a medical procedure, a procedure that is statistically safer than birth, should be regulated by politicians or by doctors, and whether information about that procedure, a legal surgery that has never been medically proven to have any correlation to adverse psychological effects, should be presented in a biased or unbiased manner. It is about whether the politically-loaded words agreed upon by a minority should be allowed to replace universally accepted medical terminology. And lastly, it is about whether policies concerning women's health and freedom should be determined based on the opinions of a group of people dependent on public approval for the safety and longevity of their jobs or by doctors. In reality this bill isn't about providing information to women; it is about intimidating and coercing them into thinking the information they have is wrong. That what they feel is the best choice for them, a choice that has been upheld by the Supreme Court of this country, is irresponsible and ignorant. In addition, this is not taking into account the effects such tactics may have on victims of rape or incest nor do they consider women who should not continue pregnancy because of various physical or psychological conditions. It does not consider the women at all. For these reasons I strongly oppose HB 329. Number 1729 COLETTE CASAVANT testified via teleconference from Sitka. She spoke as a former women's advocate at the domestic violence shelter and sexual assault shelter. She personally and politically finds this bill appalling in cases of incest, rape and domestic violence. Survivors of these abhorrent acts do not need yet another way to restrict access and choice to a safe and legal medical procedure. She objects to HB 329. Number 1698 JANE ALBERTS, Kachemak Bay Family Planning Clinic, testified via teleconference from Homer. She represented 12 Homer citizens: Carri Thurman, Jane Alberts, Melon Purcell, Judy Flora, Jim Meesis, Kathy Steberl, Tarri Thurman, Michelle Waneka, Lora Wilke, Kate Finn, Donna Rae Faulkner, and Heidi Glotfelty and the 40 additional members of the Kachemak Bay Family Planning Clinic. She read the following testimony: We are here to testify against HB 329. It has been 30 years since American women were granted the right to choose abortion for unwanted pregnancy. Roe v. Wade was crafted in such a way to make abortion legally possible, accessible and practical. Since 1971, there have been many attempts to erode this right. House Bill 329 is another example. This bill incorporates additional shame, pain, and guilt into a woman's decision to have an abortion. The proposal for a 24-hour waiting period after "informed consent" seems as if it is designed to place a woman into a purgatory while she waits for the procedure that BY LAW she is allowed to choose. We don't know of anyone who has ever hopped on down to her physician for an abortion without an intensive decision-making process, or without considering that it is her alternative of the last resort. This decision-making process is disrespected and disregarded by the proposed bill. It is additionally disrespectful to use tactics such as forcing women to view and study the various anatomical and physiological characteristics of fetuses from conception on and then sign that she has done this before an abortion can be performed. Alaska women have the right to choose abortion, just like all other American women. The state should not be trying a hinder a woman who has made this difficult choice, nor by using scare tactics and roadblocks to erode a woman's right to choose. Number 1570 ADENA WHEELES testified via teleconference from Anchorage. She stated that the Supreme Court ordered the state of Alaska that it does not have the right to discriminate against poor women and their lawful choice to an abortion. She has a hard time with this bill. It is a difficult choice for any woman at any stage of her life. To abort or have a child is a private decision--a decision between a doctor and a patient. She doesn't understand why the legislature has such a need to step in and intervene when the law is already clear. Some women who do have children struggle with such dysfunction as alcoholism and addiction; and child care assistance is being cut. She believes the language in the bill is scary; it isn't to inform. Number 1499 MCKENZIE WHEELES testified via teleconference from Anchorage. She informed the committee that she is nineteen years old and in the past year, she found herself in the position of choosing between being a child trying to raise a child or trying to continue her education until she is mature enough and has the ways and means and the parenting skills to raise healthy, happy children with a realistic chance of succeeding. The women's clinic gave her detailed information about her choices. In no way did the people at the clinic try to persuade her or misguide her; they were direct and honest in every way. For the legislature to work toward making this already traumatic and disturbing choice even more difficult is indefensible and mean- spirited toward the helpless and vulnerable young citizens. She expressed her objection to HB 329. Number 1442 AMANDA CLEMENS testified via teleconference from Anchorage. She told the committee she has seen her friends struggle with this issue and does not believe there needs to be a 24-hour waiting period before having an abortion. Anybody who has found out she was pregnant and does not want the child, from the minute she found out, she has been constantly thinking about how this will affect her life and what she should do. Number 1407 CATHY GIRARD testified via teleconference from Anchorage. She restated her disappointment on the legislature's interest in "living government" and yet at the same time finding great interest in her personal life. She finds this bill to be a redundancy of legal options already available in the state and also legal opportunities granted on the federal level. She believes if men were able to have abortions, this bill would not even be on the table for discussion. She does not believe there should be a 24-hour waiting period for this or any other medical procedure. If a 24-hour waiting period is necessary, she believes it is the responsibility of the medical community to make that decision, not the legislature. MS. GIRARD mentioned that last week there was testimony in support of the bill from many women whose experiences happened twenty years ago. She urged the committee not to make judgments on that kind of information about what should be done today. The medical profession has changed greatly; there is much more information disseminated, and people are much more educated about the medical procedures available. She summarized that abortion is legal and "if I can be blunt, but respectful, please get over it. Bringing your personal religious and moral agendas to the law is an abuse of your position as a legislator." Number 1293 TIM HUFFMAN testified via teleconference from Anchorage. He told the committee of a friend of his who had a miscarriage which damaged her uterus. According to this law, what was already a tragic situation would have been compounded by having to view pictures of fetus development at every two weeks. He understands there has been an amendment that says this information does not have to be shared if the physician decides, but he doesn't find the language any more palatable. He concurred with all of the statements said so far today. He believes that this most private decision should be left up to the individual involved in the situation. Indeed, if conservatives champion personal responsibility, then get the government out of this particular choice. Number 1218 KATHERINE DAVEY testified via teleconference from Anchorage. She read the testimony of KAREN FISH: I am writing in response to the possibility of HB 329 coming out of committee. It appalls me to think that this is even a possibility, and I strongly oppose this bill. Let me tell you my story. I am a 40-year-old woman who was faced with making a decision when I was 20 years old, single and pregnant. My lifestyle at that time was not a healthy one in which drugs and alcohol were much more important to me than the health and welfare of myself, let alone a baby. I was scared and felt alone and was told "What do you expect me to do, marry you?" With the amount of drugs that I had put through my system, I decided that the best option for me was to terminate the pregnancy. This already was an extremely emotional and traumatic time for me. Would I have been forced to look at pictures and have biased counseling, it would not have changed my mind. It would have only added to my traumatic time and possibly delayed the procedure. I was already at 12 weeks and a few more weeks would have moved it from a first trimester procedure to a second trimester procedure which statistics show is at much higher risk to the woman. The fact that the bill alludes to abortion causing future infertility problems is absurd. I'm happily married for 15 years, been drug-free for 15 years and have two children, ten and thirteen years old. When I chose to become pregnant, I was not forced to look at pictures of the birth or have a forced counseling on my decision to give birth. Why should a woman be forced to look at pictures or have biased counseling when she chooses to terminate the pregnancy? I do not feel that passing this bill will reduce the number of abortions. I do believe it will increase the number of fatalities due to the desperate attempts to terminate the pregnancy without going to a safe and legal medical professional so they will be forced to look at pictures. Isn't it sad to know that 60 percent of all pregnancies in the U.S. are unplanned pregnancies? Instead of spending money and time and energy and resources to get this bill passed through the committee, why not focus on education and preventing unplanned pregnancy from happening in the first place? Why not target the places that women like me were hanging out and give them the options of preventing pregnancy? Lastly I realize this bill does not affect me personally, however, I have a daughter, and I would like to know that she will continue to have options and decisions to make without being forced to make a decision because of what lawmakers believe what is right for her. Number 1069 AMY BOLLENBACH testified via teleconference from Homer. She expressed her strong opposition to HB 329. She agreed with all the people who testified today, particularly with Dr. Whitefield and Dr. Murphy saying more work needs to be done on getting contraceptives out to people in Alaska. She found it ironic that the committee discussed Fetal Alcohol Syndrome earlier because this is one of the horrible things happening in the state and frankly, abortion is one of the ways to deal with this very serious problem. She noted that the current legislature wants to cut funds to the Division of Family and Youth Services and possibly to education and to other services to children. It is unconscionable to add more unwanted children into the world when the ones already here aren't being taken care of. She believes that the Women's Liberation Movement was the most important movement of the twentieth century, and she is sad to see this continual attack on the right of women to abortion. Number 0984 CHAIRMAN DYSON commented that people who are concerned about children who are not being taken care of, can adopt them, be a foster parent or big sister. Also, for those services that need more money, all of Alaska's citizens can donate money or the permanent fund dividend to those departments. Number 0949 ROSE MIDEROS (ph) came forward to speak on the point of psychological effects of abortion. Neither the American Psychological Association or the American Psychiatric Association recognize any widespread psychological or psychiatric problems among women who have had abortion. These are the people who write the diagnostic and statistical manual that is used to diagnose mental illness; they would know. Surveys of women who have had abortions show that an overwhelming majority feel positively about the experience and would make the same choice if they had to option to repeat the experience. Further, the majority of scientifically sound studies on the subject have revealed that any lasting psychological effects of abortion are positive rather than negative. The only time abortion has been found to produce reliable, long-term negative emotional effects is when a wanted pregnancy is terminated for medical reasons. Number 0895 DR. PETER NAKAMURA, Director, Central Office, Division of Public Health, Department of Health & Social Services, came forward to testify. He commented that the change of the definition of "conception" to "fertilization" is pretty scary; the way the word "fertilization" is used in the document, page 5, line 31, "pregnant or pregnancy means the female reproductive condition of having a developing fetus in the body from the time of fertilization" still presents a problem in the use of medical treatment using drugs or other products for other diseases. As he mentioned earlier, from the time of fertilization, most fertilized ovum pass through the body and never come to the state of conception, where it fixes to the body, and the body starts to respond with hormones. DR. NAKAMURA went through the issues that came up with Representative Brice. On page 3, line 31, there is a requirement that the pregnant female be domiciled in the state for at least 30 days before the abortion. Very often an Alaskan child may come back from school outside and consult with her parents about an abortion procedure and then be required to wait another 30 days before a procedure can take place. That can put her into a much more dangerous time than an abortion done initially. That is a problem. On page 4, line 3, the issue of civil liability for physicians: that is just coercing physicians by putting something else on the table that threatens their practice and the way they deal with medical issues. The whole consultation issue is really biased consultation not informed consent. He believes he can defend that because it doesn't present the risk involved in a normal pregnancy against that of an abortion. CHAIRMAN DYSON pointed out page 2, lines 25-26, where it includes informing "the medical risks commonly associated with carrying an unborn child to term;" DR. NAKAMURA apologized for missing that. It is very important that that be included because there are some risks in carrying a child to term. DR. NAKAMURA noted that there was a false and unverified implication of the many medical and psychological risks related to an abortion. He said that a lot of literature and studies would counter those kinds of charges. Number 0652 DR. NAKAMURA referred to the 24-hour waiting period. He knows from previous experiences that every barrier put up to accessing abortion services makes a longer period of time before it actually takes place. There is about a 20 percent increase in risk for every week that the procedure is delayed after the eighth week. DR. NAKAMURA noted in medicine there are several ways to respond to a problem or disease. It can be made less harmful by relieving the pain and maybe reducing the level of damage or curing with medications or intervention or preventing the problem. Preventing the problem is much better. In his mind, prevention is not having this bill pass beyond this committee. Number 0495 REPRESENTATIVE COGHILL made a motion to move SSHB 329, as amended, out of committee with individual recommendations and the attached fiscal note. Number 0458 REPRESENTATIVE KEMPLEN objected. He noted that the issues raised in testimony and correspondence cause him significant concern particularly those pointed out by correspondence from the Department of Law, which noted that the 24-hour waiting period will cause hardship for poor, rural women and that will be subject to challenge in terms of its constitutionality and the lack of consideration for women who are pregnant due to rape or incest or who carry a fetus with a lethal fetal anomaly. The bill is not balanced in terms of the information required to be presented. The wording is troubling in instances where there is a clear bias. He respectfully asked his colleagues to rethink their position on this bill. REPRESENTATIVE WHITAKER noted that anytime abortion is discussed, it becomes a very emotional issue. He agreed that all this bill is asking is to stop and think before a human life is terminated. He urged support for HB 329. A roll call vote was taken. Representatives Coghill, Green, Morgan, Whitaker and Dyson voted in favor of moving the bill. Representative Kemplen voted against it. Representative Brice was absent. Therefore, CSSSHB 329(HES) moved from the House Health, Education and Social Services Standing Committee by a vote of 5-1.
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