Number 910 SB 91-ABORTION: INFORMED CONSENT;INFORMATION  CHAIRMAN TAYLOR noted that at the last committee hearing on SB 91, time was short and not everyone was able to testify. Because of that, Ms. Carmen Nantez, Ms. Pat Salzbo, Ms. Marlee Starnez, Ms. Neva Starnes, Ms. Jennifer Rudinger, Ms. Jana Franks, and Dr. Bob Johnson submitted their written testimony to the committee. Senator Ward's office had also submitted a memorandum giving a further breakdown on SB 91. He then took testimony. MS. KAREN VOSBURGH, Executive Director, Alaska Right to Life, testifying via teleconference, said she had gathered statistical information about the psychological and physical damage that can be incurred from an abortion. She said women need to know what can happen to them because of an abortion and they also need information about the developing child within them. She said the abortionist decides what information, if any, to give, and that it was not in the best interest of the abortionist to dissuade a client, as they would lose money. She said the abortion industry generates about $500,000,000 a year and most of that money goes into the pockets of the abortionists. MS. VOSBURGH said that SB 91 was not as much an abortion issue as it was a health issue because there are over 100 complications associated with abortions. Ms. Vosburgh said she supports SB 91. MS. KAREN PEARSON, Division of Public Health, Department of Health and Social Services (DHSS), spoke to Section 1(a)(1) - (9) saying many of the requirements in those sections would make the required pamphlet a very large document. She suggested that the information should be put in several different pamphlets, each with different information. She was not comfortable with asking women to review all the information if it was not relevant to their situation. She noted that this is where different pamphlets with different information would be useful. She gave an example of a woman who had chosen to go ahead with her pregnancy and then placed the child with an adoption agency. She said that giving that woman a pamphlet, showing all the complications of an abortion, would not be fair. Number 421 SENATOR COWDERY said insurance companies have policies that include a lot of information and he felt a pamphlet could be designed to cover all the information required in SB 91. MS. PEARSON said that would be difficult because Section 1(B)(7) says: describes the fetal development of a typical unborn child at two-week gestational increments from fertilization to full-term, including photographs depicting the anatomical characteristics of a typical unborn child at two-week gestational increments." MS. PEARSON said this information and the photographs would have to be very small to be included in one pamphlet. Number 331 SENATOR THERRIAULT asked about the example Ms. Pearson gave and if DHSS had a pamphlet concerning adoption. MS. PEARSON said DHSS has different types of information but she said there needs to be clarification on who the pamphlet's audience is to be. SB 91 says the department shall prepare a pamphlet for, "Information relating to pregnancy and pregnancy alternatives," but it is not clear if the pamphlet is to lay out different alternatives or whether it is to say these are the alternatives to an abortion. CHAIRMAN TAYLOR asked how DHSS came up with the materials it distributes for planned parenthood. MS. PEARSON said the department does not put all the information in one document; several documents are used for different situations. MS. JENNIFER RUDINGER, Executive Director, Alaska Civil Liberties Union, read a statement from Dr. Jan Whitefield. Honorable Senators, I recently read SB 91 proposed by Senator Ward. I must object to this bill on multiple grounds. This bill is a thinly veiled attempt squarely aimed at making it more difficult for women of Alaska to receive abortions. It contains biased language throughout, and indirectly suggests placing new limitations on the availability of the abortion procedure. The bill claims to be about informed consent. As physicians we are quite familiar with informed consent. If there is a complication of a procedure and informed consent was not obtained, we are painfully aware of the consequences. Getting proper informed consent before an abortion is very high on my list of priorities. Contrary to what some people may think, there is no [indisc. - end of tape[. TAPE 01-18, Side A  ... If a patient carries a pregnancy to term, our practice will have a much larger revenue stream than if the patient has an abortion. There is no incentive on our part to encourage abortion over an ongoing pregnancy. The bill starts in a biased manner by saying that it is meant to 'ensure informed consent before an abortion may be performed except in cases of medical emergency.' A pregnancy has several possible outcomes including carrying and delivery, abortion, adoption, miscarriage, and ectopic miscarriage, and others. There is no mention of getting informed consent from women regarding carrying a pregnancy to term or giving the pregnancy up for adoption. In my practice as a physician, I perform abortions as well as multiple other procedures including both office and hospital procedures. The legislature has not chosen to pass a bill on how I obtain consent from a person for a C-section or a hysterectomy, both of which carry far more risk to the patient than an abortion. Clearly the abortion is being singled out, but not for medical reasons. This bill relates to politics and belief, not medicine or the safety of Alaska women. Throughout the bill the term unborn child is used. A review of the 23rd edition of Stedman's Medical Dictionary reveals that the term unborn or the phrase unborn child are simply not recognized. There are medical terms such as blastocyst (ph), morulla (ph) embryo, fetus, and several other terms referring to the conceptive. The term unborn child is included to incite only emotion. On page 2, line 25 the term non-judgmental is used when the decidedly judgmental phrase - unborn child - is used in the very same sentence, a contradiction of terms. In page 1, line 1 through 3, line 23 a standard pamphlet of information is described again using biased terms defined by the legislators not terms recognized in medical science. Page 2, paragraph 7, lines 19 to 27 describe in detail the pictures that need to be included in this pamphlet. Why are these to be included, are these meant to 'educate the patient regarding the fetal development when she is deciding whether to carry a pregnancy or whether to have an abortion. If so, where are the parallel photographs describing the complications of abortion as well as the complications of carrying the pregnancy to term. Of what value are these pictures specified in the bill. When I council patients regarding an ongoing pregnancy or an abortion, if a patient asks me for drawings or photographs of a fetus at various stages of development, I have an encyclopedia containing the information and I go over it with the patient. But I tailor the information to the needs of the patient. Each person is an individual and a standard information packet alluded to by this bill leaves very little room for patient individuality. C. Everett Koop former surgeon general who is no friend to choice and the American College of Obstetrics and Gynecology after extensively reviewing the literature concluded that there is not solid scientific data suggesting that there are long-term negative psychological effects from an abortion. Yet paragraph 8, page 2, line 31 refers to "possible psychological effects' that have been associated with having an abortion. Why should a patient be subjected to this concept when there is no proof that it exists and will only serve to frighten the patient with false information. Informed consent should only involve actual scientific information, not speculation or conjecture. Actual scientific information is referred to line 26 page 2, if this reference remains in the bill where is the comparable line referring to the possible psychological risks of adopting the baby out. Finally, Dr. Whitefield concludes this bill is not about science, it's not about medicine, and this bill is not about information or informed consent. This bill is simple bias, placing more obstruction in the paths of women seeking an abortion. The suggested body of information already available and gathering it as suggested is duplication of effort. The requirements of SB 91 serve only as an obstacle intended to discourage patients from choosing a procedure that is recognized as one of the safest performed in medicine. The persons served are not the patients but those who wish to further obstruct abortion in Alaska. MS. RUDINGER said she also had statements from Dr. Kathleen Todd and Dr. Sharon Smith whose comments were basically the same as Dr. Whitefield's and she would fax them to the committee. Number 444 MS. ROBIN SMITH, testifying via teleconference, said she is deeply opposed to Senator Ward's bill. She said that if abortions are to be prevented, unintended pregnancies that lead to abortions need to be addressed. SB 91 is an attempt to intimidate women from making the choice to having an abortion. Ms. Smith said the required pamphlet was redundant. The decision to have an abortion was a difficult one and the government should not make women feel guilty or bad by imposing more barriers. Women are capable of making moral decisions without government interference. She said that if the legislature goes forward with SB 91, women also need to be informed about unintended pregnancies. She said another concern with SB 91 was the likelihood of receiving child support from an absent father and how much support the state would provide throughout a child's life. Ms. Smith said that if SB 91 passed she would lobby to have this other information included in the pamphlet. MS. SMITH said she would support legislation to prevent unintended pregnancies and she urged the committee to pass the prescription equity bill, which would make insurance companies cover birth control. She also urged the passage of the safe surrender bill that would allow women an anonymous and safe way to relinquish a newborn child. MS. DEATRICH SITCHLER, testifying via teleconference from Anchorage, said she is opposed to SB 91. She said at the age of 14 she was diagnosed with hemophilia, a disease affecting the blood, and as a result of this condition it is medically dangerous for her to carry a pregnancy to term. If she were to become pregnant it would be in her best medical interest to terminate the pregnancy rather than carry the pregnancy to term. She felt this decision should only be between her partner, her doctor, and herself - the government should have no place in this personal painful choice. She and her partner would find it very painful to listen to a litany of alternatives to abortion, alternatives that would not be in her best interest and that could actually threaten her life. Her greatest objection to SB 91 was in the definition of medical emergency. Ms. Sitchler would not fall under the medical necessity exception because having an abortion at that very moment would probably not be a lifesaving measure or an emergency situation. Therefore, she would be subject to the extra counseling, which would be irrelevant to her situation. She said this decision would be very painful for her and she would only be terminating her pregnancy to save her own life. She urged the committee to oppose SB 91. MS. KAREN VOSBURGH said psychological damages are very real. There is a sense of depression and a sense of loss that are very common after an abortion. An abortion also creates the feeling of low self-esteem and feelings of having compromised values. Feelings of guilt are the most common reaction to abortion. She said the suicide rate is phenomenally high among women who have had abortions. She said that abortion was suppose to reduce teen pregnancy but the unmarried teen pregnancy rate has risen, and child abuse was to be eliminated due to abortion but studies show that there had been an increase in child abuse in the last two decades. She said abortion had devalued children, born and unborn, and women were told that abortion would empower them but they were not told how guilty and angry they would feel. She urged the committee to pass SB 91. Number 1003 MR. BOB JOHNSON said that he had been listening to some horrendous complications from an abortion during the meeting but, in fact, there were very few complications, and his experience with 700 abortions shows very few incidents with complications or depression. He said complications from a normal pregnancy far exceed complications from abortions. He echoed Dr. Whitefield on Dr. Koop's study that said there were very few complications from an abortion. He said this type of legislation insults a woman's intelligence. SENATOR THERRIAULT asked if Senator Ward had considered whether he wanted one piece of information or a series of pamphlets. MS. SANDRA ALTLAND, staff to Senator Ward, said the pamphlet was not to replace other pamphlets. The intent of SB 91 was to give more information than what was available now. She said there was no hidden agenda to SB 91, Senator Ward was trying to lay out ideas he would like to see submitted so that when a woman was trying to make a decision she would have the information she need. She said Senator Ward would be happy to work with DHSS to develop a pamphlet that would work. SENATOR THERRIAULT suggested that the pamphlet could have a geographically indexed supplement included. CHAIRMAN TAYLOR said he was incredulous at the comments that had been received on Senator Ward's attempt to merely distribute some information. He said: The same types of comments are made in every totalitarian society when somebody wants to 'burn up books' - we don't want that information going out, that information isn't correct, that information isn't politically correct or what we want to have out there. So if you're going to put any information out there that we, the dominant liberal cause don't want to have out there, why we'll do everything we can to ban you book. That to me is just incredible testimony. You would think that people would want to have the greatest level of information available to be made readily available. This state has already put it into law that all of Planned Parenthood's materials are going to be distributed for them. The very same people that happily go out and fill up the little brochure boxes at every place to make certain that Planned Parenthood's documents get disbursed are some of the same people we're listening who say you can't possibly give that information to anybody else or require that they should have an opportunity to see that information before going through a procedure. I consider that somewhat amazing in the 20th Century. MS. ALTLAND said there are doctors who take the time and give good information, but if they are not recognizing any psychological harm, how can they be fully informing the woman they are working with. CHAIRMAN TAYLOR said there seemed to be quite a medical dispute about that. He said the items included in the pamphlet should be as accurate as possible so they cannot be disputed. MS. KAREN PEARSON clarified that the department's interpretation of planned parenthood in the statute was not Planned Parenthood the organization. DHSS does not distribute Planned Parenthood materials. The information DHSS distributes to the public is about planning to be a parent. CHAIRMAN TAYLOR said he understood that but if he were to put the department's documents next to Planned Parenthood's documents he would have a hard time seeing much difference. MS. PEARSON said that the department does its best to get the information out that it believes is appropriate and to inform the public on all perspectives. CHAIRMAN TAYLOR asked if the department was pushing abstention or was it handing out condoms. MS. PEARSON said DHSS has a very active program for teenagers in relation to abstinence and there are no abstinence programs for adults. CHAIRMAN TAYLOR asked if DHSS kept any statistical information on the age of people receiving abortions, especially those receiving state financing. MS. PEARSON said the department does not have abortion reporting. She said there was a piece of legislation going through this year that mandated the reporting of terminated pregnancies. The department does have information on terminated pregnancies paid for with public dollars though. CHAIRMAN TAYLOR asked if DHSS had information on how many times a woman has had a state paid abortion. MS. PEARSON said she did not have the answer to that question. She would have to check with the division dealing with Medicaid. CHAIRMAN TAYLOR said that in his district there were five girls, still in high school, each of which had already had three abortions all paid for by the state. He said that whatever is being done to convince people about abstinence or use of birth control devices was not working very well and the ultimate solution is, "you don't have to take a pill and you don't have to worry about using a condom, if in fact you get pregnant, just go get the state to give you an abortion." SENATOR COWDERY moved SB 91 from committee with individual recommendations. There being no objection, SB 91 moved from committee.