SB 30-ABORTION: INFORMED CONSENT; INFORMATION  CHAIR FRED DYSON called the Senate Health, Education and Social Services Standing Committee meeting to order at 5:10 p.m. Present were SENATORS GUESS and DAVIS. He announced SB 30 to be up for consideration. He explained that the new version adds a new section to legislative findings, recommended by the Department of Law that explains the state's compelling interest in regulating this issue. Section 2 of the bill directs the Department of Health and Social Services (DHSS) to develop a free pamphlet to assist pregnant women in their choices. Doctors are not required to use the pamphlet, but they are offered the option and can supply whatever other information they want to. This version (Q) also elevates informed consent, which was in regulation, to statute and adds to the current abortion reporting requirement whether or not the client received the pamphlet. SENATOR BETTYE DAVIS moved to adopt the CS to SB 30, version Q for purposes of discussion. There were no objections. MS. MARI GALREAVE, Fairbanks medical professional, said that a fetus is not an unborn child unless you subscribe to a certain religion. In her religion, the soul enters the body 40 days after conception. Her point is to keep religion separate from abortion rights. She stated, "If the new pamphlet uses the words 'unborn child,' it is harassment. Don't legislate what someone should say in the new pamphlet." SENATOR WILKEN arrived at 5:15 p.m. MS. RUTH ABBOTT testified on behalf of a local Delta Junction charity and said, "Women should insist on being given the respect of being provided with all the information necessary to make an informed decision as is mandatory in all of their medical procedures." DR. BOB JOHNSON, Kodiak, said he is a retired physician and while he was practicing, he did abortions. He has plenty of experience talking to women about their decisions and responding to their questions about the procedure and believes this is a highly private matter. Women have the right to know everything they want to know and everything they should know and that applies to any procedure that is performed on them. He noted: For the Legislature to make the assumption that they know what women should ask is presumptuous. I think they do have the right to know anything they want to know and they should be able to ask and they should be able to learn what they need to learn.... DR. JOHNSON explained that he scheduled four appointments for each abortion. The first one was to help decide whether the patient had made an appropriate decision; the second was to answer questions about the procedure as well as its short and long-term effects. In his experience, he found none of the short and long term effects publicized by the Right-to-Life group to be factual. MS. CYNDI SAUNDERS said she wanted both men and women to know the truth about the pain, guilt and relationship problems that a 20 to 30 minute procedure can have on the rest of a person's life. She is sad that she had the procedure three times and no one told her how she would feel 30 or 40 years later or how it would affect her children that are alive today. MS. CASSANDRA JOHNSON said the main purpose of the wording in the proposed pamphlet is to intimidate women and make them feel guilty for exercising their rights. Aside from being an attempt to withdraw women's rights, there are several other problems with the bill. First, the Legislature has no business telling doctors the specifics of what they can tell their patients. Doctors are already bound by standards of practice which include complete and unbiased information about medical procedures, and insures that any patient truly consents to the procedure they are about to undergo. There is no need for special information/consent for an abortion. The proposed "counseling" material is clearly biased and includes a lot of other information about pregnancies and possible serious complications. MS. AMY MENARD said she is an attorney primarily for health care delivery, medical licensing and liability issues. She recommended that the committee table this bill, because it is contrary to existing Alaska law and its need has not been demonstrated. She maintained: As a matter of Alaska law, abortion like any other medical treatment or procedure, always requires informed consent under AS 09.55.556. That has been law for 27 years. This law guarantees not only that women have a right to information about medical care, but that all Alaskans do. Moreover, the content of informed consent is covered ethically by the American Medical Association's code of ethics. Code provision 8.08 already directs physicians and their informed consent obligation to their patient. The so-called findings as articulated at the outset of the bill are patently wrong. This bill does not promote judicial economy nor will it provide clarification for physicians. It's actually contrary to the rubric of [indisc.]. And what this bill does, particularly with its informed consent provisions, it decrees a double standard for physicians who provide abortion services contrary to those who do not. The creation of this pamphlet and the language that's supposed to be added to the bill, and I'm referring to subsection (h) that would be under Title 18.16.010, is contrary to existing law as it regards physicians and their practices. Decreeing [indisc.] language with regard to informed consent that is contrary to what is already called for under Title 9. This law is poorly written and unsupported. As far as the findings articulated, it will not clarify anything for physicians and it will guarantee litigation for the state. MS. JENNIFER ESTERL, Alaska Civil Liberties Union, opposed SB 30; one reason being the extra mandatory counseling that includes irrelevant medical information. Mandatory extraneous lectures do not give women accurate or meaningful medical information; they put words in doctors' mouths and involve a litany of conceivable pros and cons even when those alternatives are not in the patient's best interest and, worse yet, may even harm her. Women who are seeking prenatal care in order to carry a pregnancy to term should not be forced to waste time and money listening to a diatribe about their options and alternatives. She informed them that the risk of carrying a pregnancy through to childbirth is 20 times greater than that of a first trimester abortion. Second, this bill refers to possible psychological effects that have been associated with having an abortion. Substituting politicians' judgments to that of doctors' is misleading. A 1987-88 investigation by the attorney general of the United States (who was not a champion of choice) and a World Health Organization study state there is no medical evidence that shows abortion causes psychological injury. Third, requiring physicians to deliver extraneous lectures makes access to quality reproductive health care much more difficult and expensive. Informed consent is already required for medical procedures. "This bill is designed to make a woman's very personal decision even more difficult...." DR. KATHY TODD said she is a practicing physician in Valdez and opposes SB 107 for all the reasons previously stated. Women come to her already having very carefully considered their options - having talked to their significant others, their friends, their pastors and another physician sometimes. They need other health information by the time they see her. She stated that sometimes 24-hours is a long time and means an extra journey for people who live 100 miles from her office - and this happens a lot. Evidence shows that informed consent issues are best discussed with social workers and specially trained nurses, not the physician. It has also been proven that people won't read any pamphlet that is more than two pages long. MS. VIRGINIA PHILLIPS said that SB 30 is desperately needed in Alaska. She explained, "Most of the time a woman is not told of her options. A 24-hour waiting period is needed to give a woman time to evaluate all her options along with the consequences." She said that most women don't realize that the National Physicians Center for Family and the [indisc.] Cancer Center have acknowledged there is an abortion-breast cancer link. She surmised, "The state has a compelling interest to pass this bill to protect a woman's physical, mental and emotional health...." MS. EILEEN BECKER said she has five children and has been involved with the Homer Pregnancy Care Center for 15 years. She stated that in a recent article, she read that only 24 percent of women who have abortions don't have regrets or after effects. About 10 million women in American regret their decision and, in the last 30 years, 40 million babies have been aborted. One out of every four women in American has had an abortion, very high numbers. Post abortion syndrome is an actual feeling that she helps women deal with at the Homer Pregnancy Care Center. MS. JENNIE GRIMWOOD, Cordova resident, said that this informed consent bill and pamphlet is very important. She indicated: Often many women who are pregnant don't understand fetal development. Many times health professionals don't answer all the questions. A scared pregnant women is often an uninformed one...The abortion industry puts blinders on women. They don't want women to really know what is happening to their bodies. Many women today are coerced into having abortions by their boyfriends, health professionals, their parents and uncles. It often is not an individual choice or a pro choice, as people would have us believe. It is often a choice made out of fear and ignorance.... DR. COLLEEN MURPHY, Anchorage OB/GYN, said she is an abortion provider and provides health care that is sanctioned by the National Abortion Federation. She has a multitude of guidelines to follow in her practice and she endeavors to provide the highest quality care for women throughout their reproductive health careers. She informed the committee that current levels of care already exceed those prescribed in the bill. Birth and abortion considerations are a private concern between her and her patient. They talk about it and decide together what is needed. She urged them to, "Leave medicine to doctors...." MS. DEBBIE JOSLIN, Delta Junction, said one of her four sons, Isaiah, was born May 10, 1999 and died 32 days later. It's largely because of her experience with him that she supports this bill. The bill contains: ...unbiased medical information regarding the development of the unborn child, abortion procedure, risks associated with abortion, alternatives to abortions including adoption agencies and support groups for parents and children with special needs such as Down's Syndrome.... She explained how her husband had received a similar booklet for his eye cataract procedure that gave him sound medical facts that allowed him to make a good informed decision. In Planned Parenthood of Southeast Pennsylvania v. Casey, the Supreme Court upheld a state statute requiring disclosure of the nature of the abortion procedure, the risks of the procedure, the alternatives to the procedure, the gestational age of the unborn child and the medical risks of carrying to term. The court also said if a woman shall request, she must be given a State Department of Health brochure describing fetal development and a list of agencies offering alternatives to abortion. Many states have initiated legislation that protects the state and the physician from liability by giving this information to all women who are considering abortion as an alternative.... 5:43 p.m. MS. EVA SMALL, Juneau R.N., said as a registered nurse, she truly understands the significance of informed consent and rational decision making for patients undergoing surgical procedures. Informed consent laws form the foundation of medical ethics that guarantee the patient the right to make autonomous rational decisions free of coercion. Women's right-to-know laws empower women to make informed decisions. Not only do they insure knowledge of the procedure and options, but include information on paternity establishment and child support. She supported many of the statements made earlier. MR. JOHN MONAGLE, President, Alaskans for Life, said he recently had major surgery and the doctor spent three hours making sure he understood everything about it beforehand. Doctors want to protect themselves from liability and want to furnish as much information as possible to their patients for their own good. Conversely, women would want as much information as they can get about any surgery, certainly in the case of pregnancy and abortions. DR. CAROLYN BROWN said she has been a physician for about 44 years and for 25 years had been in the practice of obstetric and gynecology. She said: This proposed bill will not mandate much of anything. If offers a pamphlet that we're supposed to give to some people and doesn't tell us who we have to give it to; it doesn't tell us who has to give it to anybody; it doesn't tell us the person we're giving it to wants an abortion, doesn't want an abortion or hasn't made their mind up yet. So, let's be clear on that. DR. BROWN said she has three basic issues with the bill; the first being that it is not equitable and has a "sincere amount of discrimination." There are 10,000 babies born in this state every year and some are lost through miscarriage. The bill does not mandate this information be given to all pregnant women; it only suggests that the pamphlet can be given out. The bill does not say who is going to have the oversight of the distribution of the pamphlet and who will make sure the information is correct. DR. BROWN said that some terms were not defined very well, like "circumstantial criteria," "unbiased," "major bodily function" and "major psychological function." She noted that even doctors can't agree on what those things mean and asked how the legislature can come up with something and put it in stone. Third, she said the fiscal note is $42,000 for the first year and $24,000 for the next five, but that wouldn't begin to cover costs when they are talking about a waiting period with women having to travel. Somebody is going to pay for them to stay over night. Many women are on Medicaid and the oversight for policing will cost a great deal of money. MS. APRIL FERGUSON said, "I have had a child; I have had miscarriages and I have had an abortion and it's all my business. It's not your business; it's not the business of the woman down the street...." Further she said that anyone who bases a decision of this magnitude on a pamphlet that someone hands them 24-hours beforehand is absolutely ignorant. CHAIR DYSON announced that Senator Green arrived at least a half hour ago and that the committee would hold the bill for further work.