ACOG Proves the Point

Last week I wrote about our culture’s shift from a scientific worldview to the acceptance of untrusted authority as a source of truth. Over the weekend I happened upon an election-time statement from the American College of Obstetricians and Gynecologists that I believe illustrates my point.

The statement titled, “Initiative 11 is Deceptive and Dangerous for Women and Doctors“, is an appeal to voters to oppose a measure that would have banned nearly all abortions. ACOG’s arguments make the typical appeals to “women’s health” and to “science.” However, both appeals ring hollow, as an examination of ACOG’s major objections will show.

Physicians’ hands are tied by an unworkable, ambiguous health exception. While appearing to permit a physician to exercise his or her clinical judgment, in fact this ban places physicians and their patients in an untenable situation with grave consequences for women’s health. The specter of criminal liability will have a profound chilling effect on physicians’ willingness to perform abortions even in circumstances where this ban cannot apply.

A doctor cannot know whether he or she will be judged according to a standard that evaluates whether he or she acted in good faith based on his or her own medical judgment or according to some other standard that allows prosecutors and judges and juries to second-guess the reasonableness of that judgment.

Doctors should not have to compromise their best medical judgment out of concern for their own freedom. In fact, under this ban, more pregnant women will be transferred out-of-state for care with potentially devastating consequences for maternal health care in our state.

ACOG makes it sound like life-saving abortions are a daily event, and that banning abortions would put women’s lives needlessly in danger on a daily basis. The truth is that even the most generous statistics show that fewer than 1% of all abortions are performed due to life-endangering health conditions (ACOG’s statement claims 2.7% – I do not honestly know which figure is most accurate). Of those 1-2.7% many are conditions that may not actually endanger the woman’s life, and abortion is rarely the only option for treatment. There are some hard cases in which the baby’s presence in the womb makes life-saving treatment difficult or even impossible, but these are very few. Furthermore, the moral principle of double effect would allow for a woman to receive life-saving treatment that may secondarily lead to the death of the unborn child, even the removal of the uterus if necessary. There is a very large moral difference between performing such treatments and directly killing a baby. The general principle is that the mother and the baby are both human beings so every attempt should be made to save both lives.

This ban imposes a practical burden on physicians and an ethical dilemma. Because medical conditions are unpredictable and change frequently, it is impossible to forecast with certainty when a serious health condition will rise to the level of a catastrophic condition. Physicians must have the ability to act quickly to protect their patient’s health. For example, a pregnant woman may have a serious medical problem that worsens during pregnancy, or a pregnant woman may face an uncertain but potentially life-threatening condition (e.g., severe preeclampsia or HELLP syndrome, a variant of severe preeclampsia). This ban puts the physician in the unthinkable position of either treating her in a medically appropriate fashion and being prosecuted as a criminal, or not treating appropriately and not only facing claims of negligence but, worse, seeing her suffer.

This statement, along with the sentence from the previous objection, “Doctors should not have to compromise their best medical judgment out of concern for their own freedom,” seems strange and even hypocritical considering ACOG’s statement on the limits of the moral conscience. It seems the only time a doctor should have absolute freedom is when it comes to killing babies and avoiding pregnancies. Once again the assumption is that abortion is a necessary treatment for complications, and that it may be the only option. Such statements are blatantly false. It is often the first and only solution considered, but it is not the only option available. In fact, if abortion were banned, perhaps OB-GYNs would focus on learning to actually heal such conditions.

Lacks an exception for lethal congenital birth defects. These are severe conditions in the fetus that, if they do not result in miscarriage, almost always lead to certain infant death – usually upon or shortly after birth. These include anencephaly where the fetus is missing most of its brain, for example. Relatively uncommon, these conditions still afflict substantial numbers of pregnant women each year and need to be treated appropriately. Yet, under this ban, terminating a pregnancy due to anencephaly would be a criminal offense. Under this ban, families in our state would lose their right to make their own private decisions about whether to continue such a pregnancy.

The unscientific and illogical assumption here is that a baby’s life in the womb is worthless. Therefore, if a baby is not going to live outside of the womb it is better to kill the baby in the womb before it has a chance to die out of the womb. There is no scientific or logical reason that abortion is the “appropriate” treatment for such conditions.

Uncaring, unrealistic treatment of sexual assault victims. This ban cruelly puts too many obstacles on women who are victims of rape or incest. It mandates a lengthy, cumbersome process that is unworkable, especially for sexual assault victims who choose to undergo a medical rather than a surgical abortion. In fact, it mandates that the medical community take on a law enforcement role by forcing doctors to report rape or incest to authorities – even against an adult patient’s wishes.

I treated the false assumption that emergency contraception and abortion constitute “compassionate care” for sexual assault victims in an article on my website. This assumption has no scientific backing and actually flies in the face of anecdotal evidence that shows bringing new life out of sexual assault can be a good coming out of an evil and can provide healing.

Obstructs women’s access to contraceptives. Although the ban appears to exempt the prescribing, dispensing and use of contraception from prosecution, in fact, its definition of terms including “pregnant” are contrary to accepted medical and scientific knowledge. The ban could be interpreted and enforced as making some types of hormonal contraception illegal in South Dakota, including emergency oral contraceptive pills and copper IUDs. These methods work to prevent, not terminate, a pregnancy.

In addition, because the ban permits only contraceptives “prescribed or sold in accordance with manufacturer instructions,” it would make a common and medically acceptable method of dispensing emergency contraception – where the physician combines different types of ordinary birth control pills in an emergency situation – a prosecutable offense.

Here we go. ACOG loves the term “accepted,” as in, “accepted medical practice,” and, “accepted scientific knowledge.” Their use of the term “accepted” is the use of authority as a source of truth, not science. The definition of pregnancy beginning at implantation actually runs contrary to all scientific knowledge about how human life begins. The change in the definition of pregnancy was a purely political change. In fact, the categorization of contraception as “women’s health” is also “accepted medical practice” that actually opposes scientific truth about what it really good for women.

Setting the record straight on psychological and physical risks. The ban’s claim that an abortion “subjects the pregnant woman to significant psychological and physical health risks” is not supported by over two decades of published research on mental health and abortion. In fact, a report released in August of this year 3 by the American Psychological Association confirms there is no evidence that an abortion causes significant mental health problems. Extensive reviews have also concluded that there are no documented negative psychological or medical sequlae to abortion among young women, who are not at greater risk of complications in future pregnancies, future medical problems, or future psychological problems.

We also note that, contrary to the claims of the ban’s proponents, abortion is safe, with an extremely low complication rate. (Complications requiring hospitalization result in 0.27% or fewer cases.) A woman’s risk of death due to complications from pregnancy or childbirth is ten times greater than the risk of fatality from an abortion. The claim that abortion increases the risk of breast cancer has been thoroughly disproved.

ACOG’s statement that the claim of psychological trauma caused by abortion is, “is not supported by over two decades of published research on mental health and abortion” is another example of an appeal to (untrusted) authority rather than true science. Such published material has been mostly opinion and surveys of women taken directly after abortions. Such studies use surveys of post-abortive women and fail to take into account the possibility of psychological defense mechanisms. ACOG completely ignores the ever-growing phenomenon of post-abortive women seeking psychological counseling and spiritual support for depression and guilt.

The appeal to the “American Psychological Association” is purely an appeal to (untrusted) authority. The APA is an extremely political body, who removed homosexuality from the list of gender identity disorders despite ongoing success in counseling with homosexuals seeking treatment for gender identity. A statement by the APA does not indicate a scientifically valid statement.

The last paragraph of this objection actually seems to be an appeal to real science. However, the claims made by ACOG are misleading. I do not personally know the validity of their statistics about complications due to abortion. However, I do know that their claim that the link between abortion and breast cancer have been disproved is wrong. Abortion leads to increased risk of breast cancer in women who have their first pregnancy aborted but not in women whose first pregnancy was completed to term or ended in natural miscarriage. The reason for this risk in breast cancer has to do with the way that hormones mature the breast during a pregnancy. Abortion interrupts this maturation in a way that natural miscarriage does not.

Like many professional organizations, ACOG has become a political body rather than a body of experts. They use politically charged statements and appeals to (untrusted) established authorities to support their arguments while they ignore true science and reason.

End Note

When we call groups like ACOG for making false scientific claims and for appealing to illegitimate authorities, we want to make sure that we do not fall into the same errors. I would appreciate your help, if you are able to point me to any scientific studies that can help to verify the information above or to correct any factual errors I may have made.

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