Controversial Abortion Procedure Reporting Laws Under Fire

Posted on: October 31, 2009  |   Author: Tiffany
Filed Under: Access to Care, Legislation, Other, Public Health Policy   |   Leave a Comment

An Oklahoma judge has temporarily barred a controversial new law related to the reporting of abortions. Originally set to be enacted on November 1st, the legislation will now be the subject of a December 4th hearing. HB 1595, or the Statistical Reporting of Abortion Act, requires all physicians who provide a woman with abortion services to submit an “Individual Abortion Form” to the state Health Department. The Health Department, in turn, will post the aggregate information on its website. The form includes 37 items, which include: the county in which the abortion was performed; the mother’s educational background, race, age, and marital status; the reason for having the abortion; and the method of payment.

Opponents have sharply criticized the law, claiming that it is designed to intimidate women who are seeking abortions and constitutes an invasion of privacy. Advocates claim that there are no privacy issues because the Health Department will be required to ensure that “personally identifiable information” does not appear on the website and that the questionnaires themselves will be kept private. The House drafters and supporters of the bill claim that the information garnered from the mandatory forms will provide a much clearer picture of abortion trends and aid the state in reducing its abortion rate.

Although the law has fueled the abortion debate, it is being challenged on the grounds that it violates a provision of the state constitution which mandates that bills pertain to one subject only. (In addition to the Statistical Reporting of Abortion Act, HB 1595 also contains a provision prohibiting gender-selective abortion as well as some modifications to definitions in the current state abortion statutes.)  Legislators have stated that they will likely rectify the problem by submitting the reporting provision as a separate measure next session.

Commentary: Despite the fact that the law is being challenged on constitutional grounds that have nothing to do with abortion, the heart of the controversy is obviously the state’s creation of another hurdle that women must clear in order to lawfully obtain an abortion.  Although the state website will publish the information in aggregate form, there is still room for concern over the potential for identification based upon particularly unique answers.  Moreover, it is questionable just how much some of the form’s questions contribute to the legislature’s stated goal of reducing the number of abortions.  While having certain socioeconomic data may help to target “at-risk” groups with family planning campaigns, one could argue that the questionnaire as a whole is over-reaching.  There are 38 options (including “other”) for a question pertaining to why the woman wishes to have an abortion.  The form instructs that all applicable choices should be selected.   A woman may be understandably hesitant to paint such a detailed picture of her life circumstances and it is dubious that some of the responses (i.e. - “Mother has completed her childbearing.”) would provide any meaningful data to the state.

The law further provides that a physician must submit a form for any woman to whom he/she provides the state-mandated pre-abortion information even if no abortion is performed.  (In Oklahoma, a number of materials must be provided to any woman before she undergoes an abortion.  They include information about the development of the fetus at various stages, the available methods of abortion, the risks involved, and the state aid available for pre-natal care, labor & delivery, and the general needs of the child.)  In theory, a woman could consider an abortion, discuss it seriously with her physician, decide against it, and still be subjected to the reporting requirements.  It seems that this could deter women from even speaking with a healthcare provider, for fear of having their information passed along to the state.  The provision also does not appear to aid in the state’s purported effort to compile abortion trend statistics.  Integrating the data of women who ultimately do not elect to have an abortion does not paint an accurate picture and ends up only showing how many women had unwanted pregnancies.

Although the majority of states do have abortion reporting requirements, Oklahoma’s law is far greater in scope and seems to be an undue invasion of privacy and, arguably, a legislative effort to hinder women seeking an abortion.  Regardless of its controversial nature, pre-viability abortion is legal and it is concerning when a state attempts to circumvent that with questionable law-making.  It will be interesting to see what becomes of the Statistical Reporting of Abortion Act in the future.  Given lawmakers’ stated intentions to reintroduce the Act on its own if HB 1595 is struck down, the issue could be on the table for quite awhile

Baseball’s Use of DNA Raises Questions

Posted on: August 1, 2009  |   Author: Tiffany
Filed Under: Bioethics, Health Information, Life Sciences, Other, Technology   |   Leave a Comment

In recent years, there have been a number of high-profile instances in which MLB players and prospects have lied about their ages. Just last year, Houston Astros shortstop Miguel Tejada admitted that he was 19 when he entered the league in 1993, not 17 as he told his then-club, the Oakland A’s. Tejada’s situation is not unique; many Latin American prospects have been caught representing themselves to be younger than they really are. Knowing the MLB’s preference for younger prospects, they alter the birth certificate of a younger sibling or borrow a birth certificate from a willing family with younger children.

To combat this issue, the MLB has begun to perform genetic tests on prospects and their families in order to verify ages. While the tests themselves will not provide the individual’s age, they will show whether the prospect is the natural child of his purported parents (to defeat the “borrowed birth certificate” ploy). Bone scans have also been performed on siblings to confirm that they are older than the prospect (to defeat the “altered birth certificate” ploy).

While the MLB claims that the testing is infrequent and always consensual, many critics worry that any amount of genetic testing will create a slippery slope towards trying to predict players’ medical futures. Determining a susceptibility to injury and disease is tempting in an industry where salaries are enormous and success depends upon physical performance. However, as Professor Mark Rothstein ironically points out, “the most famous baseball player with a genetic disorder was Lou Gehrig. Would they have signed him if they knew he was predisposed to A.L.S.?”

Further complicating the issue is last year’s passage of the Genetic Information Non-Discrimination Act, a federal bill designed to prevent discrimination in employment and health insurance coverage on the basis of genetic information (Public Law No: 110-233 text). The legislation prohibits employers from requesting DNA and from using genetic information (either the employee’s or his family’s) to hire, fire or compensate. The law will go into effect in November and it remains to be seen how it will impact the MLB’s testing practices.

Commentary: It will be very interesting to see whether the MLB’s genetic testing survives GINA’s implementation. On its face, it appears that the testing would be in violation of the law; the MLB as an employer is performing genetic testing its potential “employees” and their families. However, GINA explicitly excludes from its definition of genetic information, “information about the sex or age of any individual”. If the MLB could demonstrate that the ONLY information garnered from its genetic tests is the age of the individual, it may not be in violation of GINA. It seems that this would be a bit of a stretch; the MLB has admitted that the tests do not provide the individual’s age, but rather offer evidence of his familial relationships.

The testing of family members presents another problem; not only does GINA define “genetic testing” to include testing of up to fourth-degree relatives, but, from a practical standpoint, it begins to look a lot more like an effort to predict an individual’s medical future. Individual genetic testing is a powerful tool for determining pre-disposition to certain conditions; family testing is all the more potent because it provides a more complete picture.

There are countless other considerations–whether GINA will be applicable to US businesses testing employees outside of the U.S., whether the MLB would actually use the test results for anything other than age verification, whether it is necessary to go to the lengths of genetic testing to determine whether a player is 2-3 years older than he claims to be, etc. Regardless of one’s individual opinions of genetic testing, as GINA goes into effect, it will be interesting to see what kind of an impact, if any, it has on the MLB’s age-verification practices.

The New York Times, July 21, 2009.