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This blog is the work of an educated civilian, not of an expert in the fields discussed.

Monday, November 30, 2009

Informed Consent for "Crisis Pregnancy Centers"

And Also: Don't care about the Tiger Woods drama. Good finish to last night's game, even if the Ravens deserved to lose given all the chances they blew. The other team's third stringer did well, except at the very end (in OT), when another rookie picked him off. I like the NBC announcers more than the ESPN team as well, including Madden's replacement.


"Crisis pregnancy centers" are the target of a yet to be signed local law that requires them to use signs to inform potential clients that no birth control or abortions services are inside. The background to the law is informative as is the citation in the Slate piece of someone trying to compare it to laws like forced ultrasounds for abortion clinics. This Common Secret discusses some of the false information such centers provide, even putting aside the fact that even if you oppose abortion, not getting birth control referrals is likely to surprise:
The individuals who contact federally funded pregnancy resource centers are often vulnerable teenagers, who are susceptible to being misled and need medically accurate information to help them make a fully informed decision. The vast majority of pregnancy resource centers contacted for this report, however, provided false or misleading information about the health risks of an abortion. This may advance the mission of the pregnancy resource centers, which are typically pro-life organizations dedicated to preventing abortion, but it is an inappropriate public health practice

So noted a report by Rep. Waxman, one important since such centers receive government funds. Slate fray response to the article included some recognition even from conservative sorts (shown by joining them with ACORN, an unfair comparison as others noted) recognized the difference between support of a cause and misleading ways of promoting it. This is appreciated. OTOH, see this thread for those whose views blind them to reality. This includes the idea that a sign requiring a clinic to say "baby killing inside" is akin to one that says "no abortions inside." It is one of those times you realize that some people just have different thought processes than you.

This includes a colleague of the Slate writer cited in the first link, who wrote this tripe:
The Baltimore City Council has passed legislation that would, if enacted, require crisis pregnancy centers to display signs saying that they don’t offer birth control or abortions. This measure is annoying on a number of levels, as the libertarian in me generally supports a business’ or charity’s prerogative to operate according to its own mission and guidelines and beliefs. I mean, it’s a bit like telling a Catholic church it must post a sign saying there are no Torahs or Qurans in the pews: Duh. It's also insulting to the women who go to these centers: Aren't they smart enough to figure out pretty quickly what a place has to offer? If they wanted an abortion, wouldn't they have sought out Planned Parenthood or an abortion clinic?

No, women (and teens) do not always know centers advertised as providing "abortion counseling" would not provide counseling in which abortion was one option, but might not even provide birth control information. They are not in the know like you, realizing -- as compared to those about to enter a church and not expecting Torahs -- just what these places are all about. Likewise, a sign to dispel confusion is not doing much to interfere with their operation. And, maybe the girls or women believes the centers (partly from anti-Planned Parenthood rhetoric) would be a nicer place, or they passed them and were curious? More fiction:
Neither side is going to reduce the number of abortions or unintended pregnancies by telling the other side how to deal with the women who come to them.

Not true. A myriad of regulations, including those upheld in Casey, have the intent and/or effect to do just that. You can be pro-life (or whatever) as the writer of that sentence and be honest about such things. I assume so at least. For instance, waiting periods, teenage consent/notification laws, "informed consent" scripts that speak of "unborn children" or false/misleading information as to the harms of abortion and so forth affect the number of abortions. Regulations that burden even the provision of contraceptive information, particularly for minors, including Plan B, will also affect the number of unwanted pregnancies. This is often the point.

Family planning is among other things a health service, so informed consent is an important aspect of regulation, even if (as Susan Wicklund noted in This Common Secret) it should be flexible enough for the provider to fit it to the needs of the client. This includes regulation that the provider might rather not include, but is acceptable commercial or professional speech regulation. As Justice Blackmun noted (citations and quotes omitted):
I agree that the State may take steps to ensure that a woman's choice is thoughtful and informed, and that States are free to enact laws to provide a reasonable framework for a woman to make a decision that has such profound and lasting meaning. But ... the means chosen by the State to further the interest in potential life must be calculated to inform the woman's free choice, not hinder it.

Particularly in context of non-clean hands, the proposed law allows anti-choice services while preventing what amounts to false advertising. Informed consent laws generally are focused on family planning centers that already are comprehensive in their information, Dr. Wicklund, for instance, already had a practice of performing ultrasounds and providing them as an optional service. But, fairness dictates that both sides are treated the same here.

Those behind Hyde and Stupak do not believe in fairness, but hopefully Baltimore's efforts will win in the end.