SB 24 PARENTAL CONSENT BEFORE MINOR'S ABORTION  DR. BRUCE CHANDLER , a pediatrician at the Anchorage Health Center, testified that although the concept of parental notification is fine in the abstract, he sees a lot of teen patients who do not come from perfect families. Mandatory parental notification could put those teens at risk of serious mental or physical injury. He thinks most teens will be too frightened to use a judicial bypass procedure and may turn away from any health care at a time they need it the most. SENATOR ELLIS asked Dr. Chandler to speak to the potential increase in liability SB 24 presents for health professionals who perform abortion procedures. DR. CHANDLER replied he sees teenagers as part of his pediatric practice and does not perform abortions, therefore is unable to speak to the liability issue. CHAIRMAN TAYLOR asked Dr. Chandler what medical procedures he performs on minors that do not require parental consent. DR. CHANDLER replied the standard procedure for routine health care is to obtain parental consent before a minor is evaluated. CHAIRMAN TAYLOR affirmed obtaining parental or judicial consent is standard practice when dealing with juveniles; therefore lack of consent would subject health care professionals to tremendous liability. He asked Dr. Chandler to distinguish why a procedure, such as an abortion, should not require parental consent while treatment for the flu does. DR. CHANDLER responded the issues of teenage pregnancy are much more stressful to all those involved than many other medical issues. CHAIRMAN TAYLOR noted a doctor would have to do everything possible to get parental consent to provide treatment to a teenager with a ruptured appendix who was nearing a life threatening situation. DR. CHANDLER agreed but repeated in some cases, when a teenager confides she is pregnant to a parent, the response can put her at risk. CHAIRMAN TAYLOR noted as an attorney he represented a hospital in two hearings involving children of parents whose religious faith totally opposes the use of blood transfusions. The children would not have survived if the Court did not intervene and act. In each case the Court took custody of the child and authorized the necessary medical procedures. He questioned why the state should require parental consent from parents of a certain religion or use the judicial bypass system when a child has a life threatening condition, but not for an abortion. DR. CHANDLER replied he is concerned teenagers will not have advocates and/or the resources to use the judicial bypass in a transparent and expeditious manner to get the care they need. CHAIRMAN TAYLOR stated he understood Dr. Chandler's concerns but felt the public advocacy group and Alaska Legal Services would be very active and aggressive in such cases. Number 177 SENATOR ELLIS discussed the contents of a work order from the Division of Legal Services regarding what activities do and do not require parental notification or consent in Alaska. The memo points out students are required to get parental consent for field trips for liability purposes and as a matter of courtesy for teachers. AS 25.20.025 does not require parental consent for medical and dental services to a minor parent and for the minor parent's child and for the diagnosis, prevention, and treatment of pregnancy or venereal disease. Parental consent was purposely omitted for those situations in statute because there is a fundamental difference in the nature of the situation. Number 210 EVE GARDNER , staff attorney with the Center for Reproductive Law and Policy (CRLP), testified in opposition to SB 24. CRLP attorneys have been involved in nearly every major U.S. Supreme Court case involving abortion and it is currently challenging abortion restrictions involving parental involvement laws, mandatory delays, and numerous other government restrictions on access to abortion. CRLP currently represents the plaintiffs in Mat-Su Coalition for Choice v. Valley Hospital, pending before the Alaska Supreme Court. That case involves the obligation of a community hospital to provide abortions. SB 24 would make it a criminal offense for a physician to perform an abortion on a woman under 18 years of age, unless one of her parents consents to the procedure or the abortion is authorized by a Superior Court judge. Any person who fails to comply with these requirements faces imprisonment for up to five years and a fine of up to $1,000. SB 24 would place numerous and onerous burdens on young women who seek abortions and the doctors who perform them. SB 24 will undermine the rights of young women, particularly those who are low-income, to make reproductive decisions, and will discourage abortions. Because SB 24 imposes criminal penalties for failure to comply, some doctors may stop performing abortions for minors. Defeat of SB 24 is necessary to ensure that young women will continue to obtain safe and legal medical care in Alaska. SB 24 is not only bad public health policy, it is unconstitutional. The medical emergency exception to the bill is impermissibly narrow under long standing federal constitutional precedents and the judicial bypass procedure for immature minors fails to meet well-settled federal constitutional standards. SB 24, in its entirety is unconstitutional under the Alaska Constitution, which unlike the federal constitution, explicitly protects an individual's right to privacy. The Alaska Supreme Court has consistently held that this explicit privacy guarantee provides more protection of individual rights than the federal constitution. While the Alaska Supreme Court has not yet ruled on the case involving the State right to privacy in the context of abortion, it has held that the Alaska Constitution protects an individual's autonomy to make choices affecting his or her body and personal life and has also recognized that the right to privacy provides protection for personal decisions about childbearing. Even though federal courts have upheld the constitutionality of parental consent laws, so long as they have adequate exceptions for medical emergencies and a proper judicial bypass procedure, which SB 24 does not, it is very likely the Alaska Supreme Court will hold that SB 24 violates the Alaska Constitution's Right to Privacy because it interferes with the right of young women to make the fundamentally private decision to terminate their pregnancies. Alaska is one of only four states in the country that has a free standing provision in its Constitution establishing a right to privacy. The Florida Supreme Court relied on that state's constitutional privacy provision to strike down a parental consent abortion law because the state's interest in protecting immature minors and preserving the family unit were not sufficiently compelling to override what the Court called, "the substantial invasion of the young woman's privacy right created by the parental consent requirement." On behalf of young women and health care providers in Alaska, CRLP is prepared to challenge this measure should it be enacted. Regardless of the outcome, litigation over the validity of SB 24 will be expensive. In addition to the state's cost of defending a suit, the state may be required to pay the plaintiff's costs and attorneys' fees. For example, in the Mat-Su litigation, plaintiffs' attorneys have been awarded attorneys' fees of approximately $110,000 for just the trial court portion of the case. If the plaintiffs win at the Supreme Court level, it will likely be entitled to additional fees. Given the high costs of state government, and the unparalleled needs to support existing social problems, the state should carefully consider whether passage of SB 24 is the best use of its resources. CRLP urged the committee to vote against SB 24. SENATOR ELLIS asked Ms. Gardner to comment on whether requiring parental consent or judicial bypass will protect the health of young women in Alaska, and whether there is any validity to the correlation between abortion in teenage women and a link to breast cancer. MS. GARDNER stated abortion is one of the safest medical procedures performed; twice as many complications occur during tonsillectomies than from first trimester abortions. The risks to the life and health of young women are far greater when a pregnancy is carried to term, such as diabetes, severe hypertension, and complications in delivery. Regarding the correlation to breast cancer, there have been no medically accepted studies to date which show any causal link between abortion and breast cancer and recent studies in both the New England Journal of Medicine and the Journal of the American Medical Association found no causal link. A significant percentage of young girls who carry a pregnancy to term wind up receiving welfare benefits and not finishing high school. Women who carry pregnancies to term when they would prefer not to tend to get less prenatal care and tend to have low-birth weight infants or other delivery complications. There are significant public health ramifications of forcing young girls to carry pregnancies to term, as well as obvious implications for the future of the girls and the infants. Number 479 SENATOR LOREN LEMAN , sponsor of SB 24, gave the following overview. SB 24 is almost identical to SB 105 which was debated during the last legislative session. A parental consent requirement for a minor's abortion already exists in statute but is not enforced. SB 24 provides a judicial bypass procedure that the U.S. Supreme Court determined needs to be in place for the parental consent provision to be constitutional. Ms. Gardner's suggestion that SB 24 is unduly restrictive and would not pass U.S. Supreme Court scrutiny is incorrect. Non-enforcement of the existing statute is rooted in a 1976 opinion by then Attorney General Av Gross. Proponents and opponents of abortion recognize the parental consent requirement as an area of common ground; many agree that parents should be involved in important medical decisions for their children. The Clintons have suggested they want, as a national policy, abortions to be rare and Vice President Gore recently suggested he wants to seek common ground on this issue. SB 42 provides common ground. A recent survey of Alaskans, commissioned by Senator Leman and several others, found 78 percent of respondents support the concept of an enforceable parental consent law, 16 percent are opposed, and 6 percent are undecided. SENATOR LEMAN noted he was asked to sign a parental consent form when his 12 year old daughter got her ears pierced. He believes abortion is a far more serious medical procedure, and has the potential for substantial physical and emotional harm to the minor. For that reason, an enforceable parental consent provision encourages the health of minors and fosters strong family relationships. In response to Dr. Chandler's concern about dysfunctional families, Senator Leman hoped SB 24 will discourage minors from undergoing an abortion before intelligently discussing the options. SENATOR LEMAN responded to Ms. Gardner's legal analysis of SB 24. Currently, 38 states have parental involvement statutes; 27 enforce them. In those 27 states, teen pregnancy, teen birth, and teen abortion rates have decreased. SB 24 is a common sense approach: it does not take away the right to an abortion. Regarding Alaska's Right to Privacy, the courts have consistently allowed that minors be treated differently from adults, therefore he does not believe the court will rule that the Right to Privacy should override parental interest in medical decisions. SB 24 identifies the state's compelling interests as protecting minors against their own immaturity, fostering the family structure and preserving it as a viable social unit, protecting the rights of parents to rear children who are members of their household, and protecting the health of minor women. He read the following quote from Justice Anthony Kennedy in the 1990 decision about parental consent in Ohio v. Akron Center for Reproductive Health, "It is both rational and fair for the state to conclude that, in most instances, the family will strive to give a lonely or even terrified minor advice that is both compassionate and mature. The statute in issue here is a rational way to further those ends. It would deny all dignity to the family to say that the state cannot take this reasonable step in regulating its health professions to ensure that, in most cases, a young woman will receive guidance and understanding from a parent." The judicial bypass process in SB 24 provides for confidentiality, no cost, free legal services, and has been accepted by the U.S. Supreme Court as constitutional. SENATOR ELLIS asked Senator Leman whether, in his reference to President Clinton, he deliberately omitted the President's expressed concern that abortion be safe and legal. SENATOR LEMAN responded he did not because SB 24 does not deal with the safety of the medical procedure of abortion. While he personally does not believe it is as safe as proponents say, his argument is on behalf of judicial bypass. Number 491 SENATOR ELLIS referred to the memo from the Division of Legal Services, that contains a list of activities requiring parental consent, and asked Senator Leman's opinion of whether the specific omission of diagnosis, prevention, and treatment of pregnancy or venereal disease from the parental requirement was warranted in statute because of a fundamental difference in nature from other procedures. SENATOR LEMAN replied he could not respond without the statute in front of him. He noted, however, he would want to be informed and provide consent if any of his children needed treatment for those conditions and he believes most parents would. He added he recently learned of a woman who was denied the ability to be with her daughter who was seeking that type of counsel. The woman felt her rights as a parent were denied. SENATOR ELLIS asked Senator Leman's response to public health officials' warnings that a mandatory reporting requirement for venereal disease would discourage people from seeking treatment. SENATOR LEMAN replied he would not be surprised that Dr. Nakamura and other public health officials would suggest that. SENATOR ELLIS asked Senator Leman if he would reject that belief as untrue. SENATOR LEMAN indicated he was not going to suggest that. Number 529 JOHN COGHILL, JR. , Chairman of the District 32 Republicans, testified in support of SB 24. The Alaska Constitution is meant to protect Alaskans, not to give one person more rights than another. Families have responsibilities to their children, and the state enforces those responsibilities. When a child is emancipated from his/her family, that child must have a guardian. SB 24 upholds parental rights and encourages responsibility. He expects Legislators to take a courageous move in a culturally changing situation to preserve the family. Regarding public health policy, a precedent for parental consent has been established for medical procedures. Individual rights in Alaska are denoted throughout the statutes: it is important to also protect the rights of the family. DAVID ROGERS , representing the Alaska Women's Lobby, read the following statement into the record. The Alaska Women's Lobby opposes SB 24. We wholeheartedly encourage open and honest communication between parents and their children, and support efforts to prevent teenage pregnancy; however, we don't believe that SB 24 will accomplish either of these goals. Responsible parents should be involved when their young daughters face crisis pregnancies. It's the hope of every parent that a child confronting the crisis will seek the advice and council of those who care for her most and know her best. In fact, most young women do turn to their parents when they are considering an abortion. Unfortunately, some women cannot or will not because they come from homes where physical violence or emotional abuse are prevalent, or because their pregnancy is the result of incest of rape. The government can't force healthy family communication where it doesn't already exist. Ironically, laws mandating parental notice or consent can actually harm the young woman that you are trying to protect by increasing illegal and self-induced abortion, family violence, suicide, later abortions, and unwanted childbirth. These concerns are shared by the American Medical Association and the American Academy of Pediatrics. But, doesn't SB 24 solve these well recognized, documented problems by allowing teens to ask a judge for permission to terminate their pregnancies, an alternative to parental consent? We don't think so. For most adults, going to court for any purpose is difficult, for teens it can be overwhelming and at times impossible, especially under these circumstances, assuming they have reasonable access to a court in the first place. Some young women will not go or delay going because they fear that the proceedings are not confidential, or that they will be recognized by people at the court house. Many will experience general fear and distress or will not want to reveal intimate details of their personal lives to strangers. Others won't be able to attend hearings because they are in school, still others, victims of rape or incest, will fear the consequences of possibly having to identify the perpetrators, who, under state law, must then be reported to the proper authorities. And if they do eventually find the courage to go to court, even with the tight deadlines proposed in this bill, the time it takes to schedule, not to mention appeals, may result in delays that significantly increase the health risks of the procedure. We understand and sympathize with the goals of SB 24's sponsors and supporters. In a perfect world all children should talk to their parents before any decisions are made about a teenage pregnancy, and in fact most do. But this is not a perfect world. For a variety of reasons, many young women will not or cannot talk to their parents or a judge about this unique, very personal, and very difficult decision. Unfortunately, instead of transforming dysfunctional families into stable ones, SB 24 may force many teens - faced with two equally unacceptable options - to have their stepfather's or rapist's children, to risk their lives by having illegal or self-induced abortions or to suffer with the results of exacerbating an already troubled or dangerous home life. That's a pretty dear price to pay for a message that may not be heard. For these reasons, Mr. Chairman, the thousands of Alaskans represented by the Alaska Women's Lobby oppose SB 24. TAPE 97-6, SIDE B Number 580 SENATOR MILLER commented a lot of people and groups testify that they would like to see the number of abortions reduced, but every time someone comes forth with a proposal, it gets shot down. He asked Mr. Rogers to ask the Alaska Women's Lobby to offer a constructive proposal to reduce the number of abortions. MR. ROGERS appreciated Senator Miller's comments and felt one response is to focus on the prevention of pregnancy. He encouraged committee members to review a 1979 report entitled Three a Day and suggested focussing on comprehensive prevention strategies. He offered to get back to the committee after talking to the Alaska Women's Lobby. CHAIRMAN TAYLOR stated current standards regarding the health of teens are inconsistent. The same people who are advocating extensive measures to curb teen smoking are distributing free condoms and encouraging early sexual activity. Some are fighting to protect the juvenile's right to choose to be sexually active, while saying those same juveniles don't have enough brains to decide whether to smoke a cigarette. He noted the minimum age for consensual for sexual activity is 13. MR. ROGERS said one common response is that nothing ever works, but he was not sure whether a comprehensive view of the problem and solutions has ever been undertaken. CHAIRMAN TAYLOR noted Senator Leman suggested the 27 states with parental consent laws have lower rates of venereal diseases, lower rates of teenage pregnancy, and lower abortion rates. He asked Mr. Rogers how he would explain the lower rates. MR. ROGERS stated although those statistics are probably legitimate, one could find other legitimate studies that contradict them. He added there are children who have been killed by their own fathers and children who have died from illegal abortions because they did not want to tell their parents. The Alaska Women's Lobby is concerned that passage of SB 24 will result in more of those cases. Number 526 CHAIRMAN TAYLOR indicated he intended to hold SB 24 in committee for another week, and asked Mr. Rogers to provide some alternatives to the committee and to review Senator Leman's statistics for accuracy. Number 516 SENATOR PEARCE commented abstinence-based sex education works, however whenever a school system tries to teach any sex education program there is opposition by a number of parents who do not want anyone but themselves teaching their children about sex education, whether abstinence-based or not. In her opinion, most of the people leading the charge against sex education in schools are the same people who are pro-life. VIRGINIA PHILLIPS testified via teleconference from Sitka in support of SB 24. After the end of World War II she lived in Vienna, Austria with her husband and three children and became pregnant. Her husband was having an affair and forced her to have an abortion. Although she was an adult, she was terrified during the experience. She believes young women who choose to have an abortion need the comfort and protection of their parents. She spoke of the negative physical effects she experienced after the abortion, and believes teenagers will experience the same symptoms. She has spent a lot of time dealing with the emotional and mental repercussions. She questioned how many legal abortions performed in hospitals have been bungled, resulting in injury or death while doctors and hospitals are able to hide behind the privacy right of the patient. She asked committee members to not trust the false words of compassion for young mothers spoken by the experts who are actually expressing compassion for their bank accounts. If they were truly compassionate, they would perform these services for free. Number 454 KRISTEN BOMENGEN , Assistant Attorney General, Department of Law (DOL), focussed her remarks on the legal issues raised by SB 24. A provision in the Alaska statutes requires parental consent for abortions for minors, but is not enforceable, in part because it serves as an absolute barrier to access if a minor does not have parental consent. A judicial bypass procedure has been adopted by many states to meet constitutional requirements, and in some states has been upheld. DOL believes the consent requirement would be determined unconstitutional under the Alaska Constitution if tested in Alaska courts, based on a study of state jurisprudence and other states that have scrutinized similar consent statutes under a broader privacy right analysis. DOL's analysis distinguishes between the federal privacy protection analysis and an analysis under Alaska's Constitution. Other states with a broader privacy protection have encountered difficulties in enforcing their parental consent statutes. Florida and California presently have unenforceable consent statutes: in Florida the statute was ruled unconstitutional, in California the case is pending appeal. MS. BOMENGEN explained DOL believes the Alaska Court would find a minor has a fundamental right to privacy. Although the Court may acknowledge the state's interests, articulated in Section 1, are of a legitimate and compelling nature, the state would be required to demonstrate that the consent requirements do not place an undue burden on a young woman and that the state's interests are actually furthered by the parental consent requirement. This test has been difficult for other states to meet, especially with regard to interests such as fostering family relationships, partially because no facts support the assertion that the requirement actually encourages the communication to take place. Regarding the state's interest in protecting the health of minors, minors are more well informed about their own medical needs. The maturity of the minor and the level of knowledge will have to be balanced against the possibility that a minor faced with limited access will postpone a decision thus increasing risks, or seek an illegal remedy or self- inducement. A lower court in California found overwhelming evidence that the state's interests were not advanced by the consent statute. MS. BOMENGEN believes equal protection rights might be of concern because of the unavailability of easy access to the court system that may be encountered in rural Alaska communities. This problem is unique to Alaska so it may distinguish the appropriateness of the judicial bypass procedure in Alaska from other states. MS. BOMENGEN noted DOL's third concern is more of a legal policy matter. Tort issues are being closely scrutinized by this Legislature and the creation, in Section 3, of a new course of action might be appropriately addressed in that general context. In summary, Ms. Bomengen summarized she expects passage of SB 24 to instigate a constitutional challenge and that the consent requirement could very well fail. Number 393 SENATOR PEARCE asked if there are rural areas of the State where one can get an abortion but cannot get access to the court system. MS. BOMENGEN did not know but clarified the State is not in the business of providing medical services in rural communities but is in the business of providing judicial access. The facts of a case will present whether a judicial bypass procedure was genuinely available to an individual minor. SENATOR PEARCE asked, if the abortion procedure is unavailable in an area, what difference it would make if the judicial procedure was available. MS. BOMENGEN believed the availability of access to the judicial procedure in a community would be scrutinized. SENATOR PEARCE discussed the reference to incest in SB 24 and then referred to the judicial bypass provision on page 5, line 17, and questioned what would be considered clear and convincing evidence to determine whether a 17 year old is sufficiently mature and well enough informed. MS. BOMENGEN replied the judge would ask questions to find out the premise for the minor's decision. Court judges are familiar with making that kind of inquiry because they make determinations for emancipation. SENATOR PEARCE asked if a test for emancipation is set in law . M BOMENGEN replied there is an emancipation procedure available in law that a model could be built on. SENATOR PEARCE noted the language on lines 26 - 29, "...if the complainant has alleged that one or both of the woman's parents, guardian or custodian was engaged in a pattern of physical, sexual or emotional abuse against the woman, or that the consent is not in the best interest of the complainant,..." refers only to parents and not brothers, grandfathers, and uncles. She stated if a woman became pregnant by a family member, the court can only allow a judicial bypass if it finds, by clear and convincing evidence, that there is evidence of a pattern of physical, sexual or emotional abuse, by one of the parents. However, on page 6, line 14, the court may not notify the parents of the complainant's pregnancy or request to have an abortion, She questioned how one gets clear and convincing evidence of a pattern of abuse without asking, and how confidentiality could be kept by a judge trying to meet this test. Number 326 MS. BOMENGEN commented SB 24 does place a significantly higher burden on a complainant than the standard required to take action to protect a child. The clear and convincing evidence requirement will be a difficult test for the court to apply, especially with regard to generating enough evidence. She noted she does not know whether the emancipation test requires a preponderance of the evidence or clear or convincing evidence. CHAIRMAN TAYLOR pointed out a preponderance of the evidence was required in the O.J. Simpson civil case. MS. BOMENGEN added the "beyond a reasonable doubt" standard is the highest standard, the "clear and convincing evidence" standard requires that the evidence be weighted more on one side. CHAIRMAN TAYLOR questioned whether that standard must be met in child abuse cases. MS. BOMENGEN answered the clear and convincing evidence standard is not the standard test but that test does arise in some cases under the Indian Child Welfare Act. Number 298 SENATOR PARNELL commented if a minor child was in court making allegations about activities in her own home, there would be no other rebutting evidence. He asked if the evidence would be considered clear and convincing if the judge believed that child. MS. BOMENGEN was unsure, but believed the hearing would be described as ex parte. SENATOR PARNELL said he shares Senator Pearce's concern about abuse by members of a household other than the parents. CHAIRMAN TAYLOR noted SB 24 is solely and narrowly focussed upon a need for parental consent. The bill does not address stepfather consent, or consent from any other family member. If another family member is involved, the parent does get involved. If the parent is involved in incestuous activity, the judicial bypass provision can be used. MS. BOMENGEN agreed with Chairman Taylor's analysis, but noted that parents do not always provide the necessary support in such instances because a favorite relative might be involved. SENATOR PARNELL asked whether any other jurisdictions, with an expressed right of privacy, have held legislation similar to SB 24 valid. MS. BOMENGEN was not familiar with any. SENATOR PARNELL asked if she looked at all states with a right of privacy. MS. BOMENGEN replied she reviewed the Florida and California cases and did a survey of cases in other states. SENATOR PARNELL asked if Ms. Bomengen was familiar with any rural communities in which abortion services are available but judicial access is not. MS. BOMENGEN was not aware of any, but repeated the State is not in the practice of offering general health services. Her concern is with the State's responsibility to citizens to make judicial access available and what expectations may be placed on that availability where there is a five day turn around time. SENATOR PARNELL asked whether Ms. Bomengen had any proof an equal protection problem exists or whether she raised the question as a warning. MS. BOMENGEN replied a test similar to the one applied to the privacy right analysis would be applied to the equal protection clause. Number 223 CHAIRMAN TAYLOR commented on the many ways the privacy right is applied to totally different situations. He discussed the Herb Raven case and how the privacy right was successfully applied to justify the possession of marijuana but was unsuccessful in a case involving cocaine possession. He asked how DOL chooses to enforce some statutes based on a concept of privacy, but not others. MS. BOMENGEN replied enforcement of the laws is not always in DOL's hands. When a statute includes the imposition of criminal penalties, enforcement falls to DOL; however, increased tort liability places enforcement in the public's hands. CHAIRMAN TAYLOR referred to AS 11.61.123(a), which prohibits a juvenile from viewing an indecent photograph without parental consent, and contains criminal penalties and asked how DOL would apply the juvenile's right to privacy to that situation. MS. BOMENGEN answered she is not completely familiar with the level of protection offered in the viewing of pornography and the circumstances under which it is regulated, however the right to an abortion under the federal constitution is entitled under the privacy protection. CHAIRMAN TAYLOR repeated very different standards are being applied for rather innocuous activities and it seems DOL is espousing different positions on them. He asked her to research the questions asked by Senators Pearce and Parnell and to review the document provided by Senator Ellis so that she can inform the committee on how DOL determines which activities will be defended under the Right of Privacy. Number 113 TERRY PRUETT , a pastor, testified via teleconference from Tok in support of SB 24. He believes the issues involved are the well- being of young children, the respective rights of the young women and their parents, and their responsibilities. The concept and practice of responsibility must be accepted and promoted in the home and society, or people will simply become less responsible. The primary reason we have a nation and state ruled largely by responsible people is because the majority of us were taught responsibility. Many dysfunctional families exist, yet he is convinced the majority of parents do their best to be responsible to their children. He suspects the majority of teen pregnancies are not the result of incest. He believes our nation has elevated rights over responsibilities and made it increasingly easy for people who have acted irresponsibly to avoid the consequences of that behavior. Number 043 DR. NAKAMURA , Director of the Division of Public Health, Department of Health and Social Services (DHSS), discussed SB 24 as follows. The common ground on this issue is the belief that parents should be responsible in seeking care for their children, that most parents are well meaning, and that children generally benefit from parental involvement. Unfortunately, a significant number of families are dysfunctional. Prevention is key, and early intervention to create healthy family activities and communication is occurring. Of the total number of minors who are pregnant, at least 20 percent do seek counsel from a responsible adult other than a parent. One-third of the minors who do not seek the involvement of their parents are in home situations with domestic violence, coercion, and/or lack of trust. SB 24 would mandate that these children be required to deal with these pathological home situations, possibly endangering themselves further. Physicians and health care providers, in all situations, explain the options to pregnant minors. If it becomes apparent the minor is unable, or unwilling, to face their parents, the provider must decide whether to stop helping the minor, in which case the minor may seek an illegal abortion. The judicial bypass procedure makes sense except that it is very intimidating for a minor to deal with the court system, and it is difficult to access. Legal abortions are not performed in rural communities, nor is there judicial access. Sometimes a child does not want to hurt her parents by informing them of the pregnancy. Professional counselors do encourage minors to seek parental guidance. If a minor is required to access the judicial system to get consent, there will be a significant delay and a barrier. TAPE 97-7, SIDE A Number 080 DR. NAKAMURA discussed the issue of the health risk of abortion. Although abortion is a serious procedure, the risks of childbirth at any age is 20 times higher, and 200 times higher for minors, than for an early abortion. No correlation has been found between breast cancer and abortion, and a recent study of 1.5 million women in Denmark concluded there is no correlation between abortion and any type of cancer. Regarding the issue of psychological damage resulting from an abortion, a literary review of 225 studies concluded psychological damage increases significantly when a minor has no choice but to give birth to an unwanted child, compared to minors who had abortions. A historical trend shows psychological damage was significantly higher for those who had abortions when the procedure was illegal and unaccepted by society. DR. NAKAMURA indicated more than 40 health related organizations, including the Academy of OBGYN Pediatrics, have testified against mandatory parental consent. Regarding privacy and confidentiality, maintaining confidentiality in rural communities could be difficult because extended families are not uncommon among Alaska Native families, and finding the true parent could require asking many community members. In response to Senator Leman's statement about the successful outcome of enacting similar laws in other states, the States of Rhode Island, Mississippi and Massachusetts have found that 39 to 49 percent of minors went out-of-state to have abortions performed. The number of deliveries increased in some of those states, but so have the number of adults having babies, and more second trimester abortions were performed. DR. NAKAMURA concluded by saying he is concerned SB 24 will criminalize an act of physicians or providers if, in consultation with their patients, they feel that lack of parental consent for an abortion is safer for the minor and perform the procedure. Number 199 CHAIRMAN TAYLOR asked if DHSS has statistics on the percentage of abortions performed on minors. DR. NAKAMURA replied that kind of condition is not reportable so those numbers are not available. CHAIRMAN TAYLOR asked if the state funds abortions. DR. NAKAMURA responded it is an allowable Medicaid reimbursement. CHAIRMAN TAYLOR asked if it is reported as such a procedure for funding purposes. DR. NAKAMURA answered DHSS could determine the number of abortions paid for with Medicaid funds, but that number would not reflect the total number performed. He added age information could also be determined. CHAIRMAN TAYLOR asked him to provide those numbers, as well as the number of minors who have had more than one abortion. He noted he was recently informed of situations where women have repeated abortions and use it as a form of birth control. SENATOR PARNELL questioned how Dr. Nakamura came up with the percentages of minors who do and do not inform their parents when the annual number of abortions performed in Alaska on minors is not available. DR. NAKAMURA said he was using national figures. Number 260 SENATOR PARNELL asked what a pregnant teen in a rural community would do if she wanted to have an abortion and didn't want to tell her parents. DR. NAKAMURA said hopefully an adult would guide her to a clinical or medical situation where she could get adequate consultation. If no responsible adult is involved, it is likely the child will not inform anyone until later in the pregnancy. She may terminate the pregnancy herself, or may find a way to get to a larger community with the hope of finding abortion services. SENATOR PARNELL asked whether a minor is likely to call a referral service or doctor in Anchorage. DR. NAKAMURA said it would depend on what kind of support system she has. If the minor can get to a place like Nome or Bethel, she can access the medical community, get counselled on the options and be encouraged to involve her parents. If, at that point, it is obvious the minor wants to get an abortion without parental consent, she would go to a larger community alone or with the help of an adult. SENATOR PARNELL asked if anyone without an economic interest provides advice. DR. NAKAMURA guessed very few of the people involved have an economic interest. He did note a wide variety of choice and competition is not available in small communities, however he did not believe economics are the incentive for the profession. SENATOR PARNELL asked what percentage of abortions are performed by providers with that specialty. DR. NAKAMURA guessed there are less than five physicians performing abortions in the state. SENATOR PARNELL feared counseling might not be as compassionate as Dr. Nakamura portrayed if so few physicians perform abortions, because those physicians do have an economic interest. DR. NAKAMURA was confident minors have access to the medical system way before an abortion is performed. Number 333 SENATOR ELLIS asked Dr. Nakamura to speak to the longstanding reasons for the lack of parental consent for treatment of venereal diseases and pregnancy. DR. NAKAMURA said society has identified certain conditions as less socially acceptable, and most people would want to keep that information confidential. Allowing minors to seek services for those conditions prevents them from waiting until treatment becomes more complicated. CHAIRMAN TAYLOR asked what an abortion costs in Alaska. DR. NAKAMURA was unaware and offered to find out. SHERRY LEE ZACHARY testified, via teleconference from Petersburg, in support of parental rights in guiding the health care of their children and medical procedures performed on them. Alaska's laws must be designed to strengthen the family unit and enable families to work through problems and crises together. Allowing people outside of the family to step between the parents and child when a child is faced with a situation as serious as pregnancy, teaches the child to keep secrets from the family, and can result in the death of a viable baby. Children need to be taught to take responsibility for their actions. Minors do not have the maturity to make such decisions on their own. She has spoken to many women who would not have had an abortion if they had received full counseling at the time. She asked if SB 24 would allow a minor to go to Court to get consent to have a child when a parent or guardian wants the minor to have an abortion. Number 408 CHAIRMAN TAYLOR did not believe SB 24 allows the minor to request a court order preventing her parents from insisting she have an abortion, however he believed that opportunity is already available. DR. NAKAMURA commented of those minors who were required to get parental consent, 18 percent received abortions and he suspected a significant number of those were coerced by their parents. CHAIRMAN TAYLOR felt it is necessary to make sure the judicial door swings both ways. ANGELA SALERNO , Executive Director of the Alaska Chapter of the National Association of Social Workers (NASW), gave the following testimony in opposition to SB 24. SB 24 is an additional skirmish everyone must go through until some common ground is found. Parental consent is part of a larger strategy to illegalize abortion in this country, and by restricting access to abortion, we are targeting those most vulnerable: minors. There is a great deal of ambiguity in this country about what minors' rights are. One of the findings of SB 24 is to protect the health of minor children, yet SB 24 increases health risks. According to the Institute of Social and Economic Research at the University of Alaska statistics, 52 percent of women on AFDC today had their first child as a minor. Because we live in a pluralistic society, we have to respect and tolerate different moral systems and ideologies. She referred to a fact sheet she supplied to committee members: 97 percent of women who obtain abortions before 13 weeks of pregnancy report no complications. Following enactment of Minnesota's parental notification laws, second trimester abortions among minors increased 18 percent, and the birth rate for 15 to 17 year olds rose 38 percent. CHAIRMAN TAYLOR asked if, in Minnesota, 38 percent more teenagers carried their children to term after the parental consent law was enacted, 38 percent more abortions had occurred before parental consent was required. MS. SALERNO thought that was probably true. MS. SALERNO continued. There are more than 1 million teenage pregnancies per year in the United States; 80 percent are unattended and 40 percent of those teenagers choose abortion. Regarding post-abortion trauma, neither the American Psychological Association nor the American Psychiatric Association, recognizes its existence. CHAIRMAN TAYLOR noted the same association decided in 1967, through a vote of association members, homosexuality was no longer an objective symptom of a major neuroses. MS. SALERNO commented she has cited five studies that show, through research, the most prominent response of most women who have had a first trimester abortion is relief. The American Journal of Psychiatry cites a study in which 98 percent of women who had abortions had no regrets and would make the same choice again. In 1967, Surgeon General Koop was asked by President Reagan to develop a study to determine the long term effects of abortion. He concluded he was unable to do so because there was no evidence that abortion caused traumatic effects. Ms. Salerno agreed research shows there are women who experience problems after abortion, but those women had emotional problems before the abortion. Approximately 21 percent of women in the United States have had an abortion; if severe emotional reaction were common, there would be an epidemic of women with this trauma. Professionals in the counseling business see the decision to become a parent or have an abortion as monumental. NASW does support strong families and parents who have a profound interest in their children's decisions. When a parent's reaction to a minor's pregnancy might be extremely abusive, the minor's right to privacy is paramount. The courts who have dealt with teenagers who want to keep their pregnancies secret have found the teenagers have very good reasons for doing so. Number 549 POLLY UTTER testified on behalf of the Abortion Rights Project and read the following statement by Robin Smith. Dealing with an unwanted pregnancy is extremely difficult. Unfortunately in the United States today if a woman becomes pregnant there is only one acceptable choice: have the child and become a good mother. An abortion is considered heinous and society does not really accept giving up a child as a wonderful, loving act. We prosecute parents who abandon a child at someone's door. What position do we really put women in who have an unwanted pregnancy. If a woman feels cornered and threatened her actions can become extreme. Examples are numerous: the young couple who recently may have killed their newborn; and one of our legislators unwanted grandchild who died of starvation in 1990. Abortion was not chosen and the results were deadly. In both cases I'm sure the couple's parents wanted to help their older children through their desperation. It did not happen. The communication process was not there. You cannot legislate family interaction. I understand your good intentions. I pray for good family communications. I prefer birth control or abstinence to abortion, but when abortion is not readily accessible, dangerous, back-alley procedures befall, and worse. The way to reduce abortion is to reduce unwanted pregnancies. I implore you to spend your time and effort in this direction. All research shows that the vast majority of Americans support more money on family planning. Community involvement in a parent-child relation program is another possibility, or required high school community service programs. We are wasting time, energy, money and losing goodwill in this ongoing debate over abortion. Please use your religious convictions for the common good and address prevention of unwanted pregnancies, not the consequences. After all, women, young and old, are capable of making their own decisions. Thank you. TAPE 97-7, SIDE B Number 595 RICH DUNCAN , Emergency Medical Technician, testified from Juneau in support of SB 24. SB 24 speaks to children, not women who are adults. He questioned whether minors who cross state borders to seek out an abortion take medical records with them to notify physicians of medical conditions or allergies. EMTs always ask for that information prior to starting treatment on a patient. About 80 percent of the minors he has dealt with are uninformed about their medical history and often forget the names of medications they are taking. He cautioned Ms. Salerno's statement that 98 percent of women who have reported having an abortion would do it again only applies to those women who disclosed the information. He believes those who vote against SB 24 will be using pregnancy as a gauge for maturity, and a gauge for wisdom and responsibility. If those three things were in place, a minor would not be facing an unwanted pregnancy. As a parent he asked committee members to not take away the time and investment he has put into his children by not allowing him to be involved in important decisions about them. There being no further testimony, CHAIRMAN TAYLOR announced SJR 3 would not be taken up by the committee today, at the sponsor's request, and both SJR 3 and SJR 10 would be heard at the next Senate Judiciary Committee meeting and SB 24 will be heard again on February 19. He adjourned the meeting at 4:04 p.m.