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

Study Finds that Being Uninsured Does Affect Health Outcomes for Children in Hospitals

Posted on: October 31, 2009  |   Author: Asha
Filed Under: Access to Care, HMOs & Health Plans, Healthcare Reform, Insurers/Payors, Other   |   Leave a Comment

The Children’s Center at Johns Hopkins conducted a study including 23 million children from 37 different states between 1988 and 2005. The study showed that uninsured children hospitalizations compared with children having either private or government insurance had a 60 percent higher chance of dying. The study also indicated that at least 1,000 hospitalized children died annually due to a lack of insurance. This means that uninsured children deaths comprise nearly half of all children deaths nationally.

Though the study was not directed at cause, the study also showed that uninsured children are more likely to end up in emergency rooms, where the condition may have worsened by the time care is administered. The time spent in a hospital between insured and uninsured children varied. On average, uninsured children were in the hospital for less than a day when they died. Overall hospitals charges for uninsured children was significantly less than for insured children (less than half).

The author of the study, Dr. Abdullah, did not believe in a causal connection between the amount of care providers gave and insurance status. He noted that children often arrived at the hospital too late for any revival to occur.  These discrepancies are unique because children do not die often. However, nearly seven million children remain uninsured in the United States.  This study helps to show the vast disparate health outcomes that not having insurance can create. According to the Congressional Budget Office, 14 million children will be covered by CHIP by 2013.

Commentary: As the article mentions, such studies help shine light on a moral obligation we face in granting children insurance. Their insurance status is not a choice but a predetermined situation. Uninsured children are more likely to have unmet medical needs, which leads to poorer quality of life. Having such a high number of uninsured children also contributes to overall costs to the health care system, as these children are more likely to end up in emergency rooms where services are expensive and may not be of the highest quality. Thus, it is to the benefit of society overall to keep the number of uninsured children as low as possible

The New York Times, October 30, 2009.

Providing patients with promising experimental therapy or ruining clinical trials?

Posted on: October 31, 2009  |   Author: Jessica
Filed Under: Bioethics, Drug & Device   |   Leave a Comment

Ninety percent of clinicians in a recent online survey believed that ignoring certain entry criteria for clinical trials was acceptable if the clinician believes that the patient will benefit from the trial. A number of clinicians described under what circumstances they would bend the rules. Downplaying a substance abuse history, altering medical records, and artificially improving an otherwise poor kidney function test are all examples of protocol violations that some clinicians found acceptable under the right circumstances.

All of the protocol violations were presumably made because the doctors felt that they were acting in the best interests of their individual patients. However, the purpose of clinical trials is not to improve the outcomes of individual patients, they are to determine the safety and effectiveness of an experimental drug or treatment. (To learn more about clinical trials see clinicaltrials.gov)

What does this mean for clinical trials? Do researchers need to focus on improving clinical trial designs so that clinicians do not feel conflicted between their commitment to their patient and the research? If so many clinicians seem willing to break protocol, can the results of the trials even be trusted?

The New York Times, October 29, 2009.

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