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Critique of Judge Sam Sparks’ Opinion on Texas Ultrasound Law (part 2)

See Part 1, here
Media reports say that due to the injunction by Federal Judge Sam Sparks, the Texas Ultrasound law will not go into effect at all until a higher court rules on it. However, the Judge does note that there is a severability clause and that his injunction is narrow. I’m waiting to see opinions from lawyers as to whether abortionists will be held to parts of the law that are not specifically under injunction.

In the meantime, I wonder how many women will meet the abortionist before they are gowned and sedated for the procedure and how many will insist on seeing their sonograms?

In the second half of the Opinion by Judge Sam Sparks, the Judge outlines the specific complaints brought against the new law, HB 15, (text of the law, here ) . Most of those complaints are dismissed, even as the Judge continues to call the new law “unwise” and ultimately imposes an injunction against enforcement.

Sparks disagrees with the Plaintiffs, the Center for Reproductive Rights out of New York, that the definitions of “medical emergency,”  “sonogram,”  “in a quality consistent with current medical practice,” and “in a manner understandable to a layperson” are unconstitutionally vague.  He also disagrees with the Plaintiffs on whether or not “visit” and “abortion-related services” are unclear to most people.

The major complaints upheld by the judge appear to be that the law doesn’t allow for multiple-physician practices or for a switch if the original doctor who informed the woman about her ultrasound cannot, “through some unforeseen circumstances,” perform the abortion, requires a woman to sign an informed consent acknowledgement, and   forces the physician to “advance an ideological agenda.”  Sparks also does not like the word “soley,” for reasons that I don’t understand.

It is true that one purpose of the law was to ensure that women were given informed consent by the physician who was to perform the abortion, “in a private and confidential setting.” Most abortionists had been satisfying the 24 hour waiting period and informed consent the same way that Dr. Alan Braid’s Reproductive Services of San Antonio,  had:  over the phone  or by referring the woman to the information on the Internet.

However, it doesn’t appear that Sparks overturned these requirements, since the injunction overturns the objection to the requirement that women receive private and confidential informed consent and the exception for those who live more than 100 miles from the abortion clinic. The opinion only finds fault with the lack of accommodations for “unplanned substitutions.”

The judge makes a surprising statement about the requirement that a copy of the informed consent be inserted in the medical record of the woman:

Compounding this problem is newly-added section 171.0121, which requires both that a copy of the above certification be placed in the pregnant woman’s medical records (presumably permanently), and that the facility that performs the abortion retain a copy for at least seven years.See H.B. 15, Sec. 3 (adding TEX. HEALTH & SAFETY CODE ANN. § 171.0121). Given the nature of the certification and the Act’s retention requirements, it is difficult to avoid the troubling conclusion that the Texas Legislature either wants to permanently brand women who choose to get abortions, or views these certifications as potential evidence to be used against physicians and women.

Sparks says that the medical record is “semi-private,” and is concerned that it might someday be subpoenaed for use in a court case. The only time that these would be seen in Court is if the woman herself sues the doctor.

Sparks also engages in a bit of ideological speech of his own about the requirement for the abortionist to describe  “the presence of cardiac activity,” and “the presence of external members and internal organs.”

“ The Court does not think the disclosures required by the Act are particularly relevant to any compelling government  interest, but whatever relevance they may have is greatly diminished by the disclosures already required under Texas law, which are more directly pertinent to those interests.”

and, from page 50:

The net result of these provisions is: (1) a physician is required to say things and take expressive actions with which the physician may not ideologically agree, and which the physician may feel are medically unnecessary; (2) the pregnant woman must not only passively receive this potentially unwanted speech and expression, but must also actively participate—in the best case by simply signing an election form, and in the worst case by disclosing in writing extremely personal, medically irrelevant facts; and (3) the entire experience must be memorialized in records that are,at best, semi-private. In 7 the absence of a sufficiently weighty government interest, and a sufficiently narrow statute advancing that interest, neither of which have been argued by Defendants, the Constitution does not permit such compulsion.

Edit to add this question: How can a doctor “not ideologically agree” with the facts visible on the sonogram when describing heart or limbs?

In my opinion, the worst part of the ruling is Spark’s legal-speak on “compelling’ and his insistence on bringing back the ever-moving line of “viability:”

Second, while Casey refers to the government’s interest in potential life as “important,” “substantial,” and “legitimate,” it stops short of characterizing it as “compelling.” Indeed, one of the holdings of Roe v. Wade, and one this Court does not interpret Casey as having overruled, was that “[w]ith respect to the State’s important and legitimate interest in potential life, the ‘compelling’ point is at viability.”

Tell me, Judge Sparks, just what is “viability?” 24 weeks, 20 or 18 weeks?

link to Part 1 and “sticky” added September 5, 2011 12:19 PM BBN

Doing the work skilled providers won’t

Will someone tell me why it is logical for Federal Judge Sam Sparks to assume that “less-skilled providers”  will be willing to meet the “onerous requirements” that more-skilled providers won’t?

” The Court has grave doubts about the wisdom of the Act, but that is no legal basis for invalidating it. The Act’s onerous requirements will surely dissuade or prevent many competent doctors from performing abortions, making it significantly more difficult for pregnant women to obtain abortions. Forcing pregnant women to receive medical treatment from less-skilled providers certainly seems to be at odds with ‘protecting the physical and psychological health and well-being of pregnant women,’ one of the Act’s stated purposes.”

Critique of Judge Sam Sparks’ Texas Ultrasound Opinion

I’m a doctor, not a lawyer, so I may not understand all of the words and references in the opinion, but I’m shocked that any self-respecting Federal Judge would allow such a frankly biased opinion out of his office. Perhaps Sparks doesn’t mind burning his chances of ever being appointed to another Court, and is quite happy with his life time appointment in the Federal Court at Austin.

I’m halfway through the ruling and thought I’d post some thoughts before these comments got too long.

Sparks decided that it’s not really important for the Plaintiffs to be someone actually harmed by the Law in order to have standing in his Court. He approved the class action suit filed by a New York State corporation, The Center for Reproductive Rights, who filed a class action suit on behalf of all the abortionists in Texas, supported by affidavits from three abortionists:

  1. 1. Alan Braid, MD is the only one  of the three who lives and works in Texas. He owns a privately owned abortion clinic in San Antonio, Reproductive Services, S.A. http://www.reproductiveservicessa.com/
  2. 2. David A. Grimes, MD, inventor of the partial birth abortion and instructor in “family planning and OBGyn at the University of North Carolina. In 1995, Grimes testified in favor of forcing residency programs and residents to perform and  train doctors in abortion http://www.nchla.org/issues.asp?ID=28  “Making abortion training a routine part of any residency…will put abortion back in the mainstream of medicine.”
  3. 3.  Anne D. Lyerly, MD, from the University of North Carolina at Chapell Hill, who was once the chair of the ethics committee of the American College of Obstetricians and Gynecologists. She testified *against* conscience rights before the Bush President’s Bioethics Council in 2006.

If R. v. W. isn’t found to be gross misconduct, this ruling should be. Sparks can’t resist a revealing his prejudice and mocking the legislature.

Citing Planned Parenthood of Se. Pa. v. Casey, 505 U.S. 833, 846 (1992), a US Supreme Court ruling on abortion limitations and Equal Protection, Sparks not only has to admit that the Texas law is legitimate under prior law and Court rulings, but that:

“This legitimate interest obviously justifies “singling out” abortion providers and the patients thereof, because they pose a serious potential risk to “the life of the fetus that may become a child.”’

However, he goes on to admit his prior bias:

“The Court has grave doubts about the wisdom of the Act, but that is no legal basis for invalidating it. The Act’s onerous requirements will surely dissuade or prevent many competent doctors from performing abortions, making it significantly more difficult for pregnant women to

obtain abortions. Forcing pregnant women to receive medical treatment from less-skilled providers certainly seems to be at odds with “protecting the physical and psychological health and well-being of pregnant women,” one of the Act’s stated purposes. H.B. 15, Sec. 12(1). However, rational basis review requires this Court to accept even tenuous rationales for the advancement of a legitimate government interest.

In short, if the Texas Legislature wishes to prioritize an ideological agenda (2) over the health and safety of women, the Equal Protection Clause does not prevent it from doing so under these circumstances. Accordingly, the Court must reject Plaintiffs’ Equal Protection arguments. (p. 20/55)

That footnote (2) ?

“2 It is ironic that many of the same people who zealously defend the state’s righteous duty to become intimately involved in a woman’s decision to get an abortion are also positively scandalized at the government’s gross overreaching in the area of health care.”

S

“(It) is difficult to avoid the troubling conclusion the Texas Legislature either wants to permanently brand women who choose to get abortions, or views these certifications as potential evidence to be used against physicians and women,” Sparks wrote.

Wonderful news on Conscience from Arizona

Without a conscience, what is a doctor, nurse, or pharmacist except a technician willing to follow the whims of law?

(Again, this is not sound-bite material!)  I received an e-mail from the American Defense Fund concerning the lawsuit against the State of Arizona by Planned Parenthood over a law to protect those of us in medicine who have consciences.

The ruling overturned a two year old injunction that prevented quite a few limitations placed on abortion in the State, including informed consent, parental consent, and the requirement that doctors, not nurses, perform abortions as well as the conscience issue.

Over the last decade, there have been several deliberate attacks against the right of medical professionals to obey our consciences and to refuse to provide services that we do not believe are “medical care.” I’ve tried to cover them at LifeEthics.org., even though I had a hard time keeping my promise to avoid politics and religion on that blog.

The articles at LifeEthics.org include this one from the American Journal of Bioethics, this one by a lawyer writing in the New England Journal of Medicine, and this one from this year about the Obama Administration’s refusal to protect the conscience.

Here’s the update, dated August 11, 2011:

A litigation update:

The Arizona Court of Appeals issued an opinion today on conscience rights.

In a case litigated partially by the State, partially by the Speaker of the Arizona House, and partially by ADF, BDF, and CAP on behalf of a variety of pro-life medical groups (Ave Maria Pharmacy, Christian Medical and Dental Associations, Christian Pharmacists Fellowship International, American Association of Pro-Life Obstetricians and Gynecologists, and Catholic Medical Association) . . . . . . the Court upheld Arizona’s state conscience protection statute Ariz. Rev. Stat. § 36-2154, against a challenge by Planned Parenthood of Arizona. The Court also upheld the right of the aforementioned pro-life groups to intervene in the case to defend the conscience law.

Here is the opinion,http://azcourts.gov/Portals/89/opinionfiles/CV/CV090748.pdf and below I provide some highlights.

The conscience statute protects hospitals, physicians, and staff from being involved in abortion, and all of the above plus pharmacists and pharmacy employees from being involved in any abortive or anti-implantive drug or device. The Court of Appeals’ decision reverses an injunction that Planned Parenthood had obtained below in the Arizona trial court, which had enjoined not only conscience protections but a bunch of pro-life provisions of Arizona law (including laws about parental involvement in abortion, prohibiting non-doctors from performing them, and other pro-life measures).

PP threw the kitchen sink of anti-conscience arguments against this conscience statute, and the Court specifically addresses PP’s arguments on pages 32-37, saying some very helpful things against some of the popular “access” arguments we all hear against conscience rights. (The Court does unfortunately characterize the conscience statute as “refusal provisions.”)

Among the arguments the court smacked down are the following:

  • The Court rejected PP’s argument that conscience protections violate a woman’s right to access abortion. The Court gave several reasons. First, in a previous case the Court had upheld an Arizona law prohibiting abortions at state university hospitals, saying “Even as plaintiff does not have an absolute right to an abortion on demand, she also does not have the right to select any public facility she chooses for an abortion.” By extension, therefore, the Court held that since “Even a state actor can refuse to facilitate an abortion,” it is even more true that private actors can refuse.
  • In addition, the Court declared that the conscience law protecting private individuals and institutions can’t possibly violate a woman’s constitutional rights because “any reproductive rights that might exist under [the Arizona Constitution] can only be asserted against governmental acts, not the decisions of private individuals. . . . Therefore a woman’s right to an abortion or to contraception does not compel a private person or entity to facilitate either.”
  • The Court further noted: “In its arguments below, PPAZ also contended the statutes would ‘thwart women’s ability to chart their own medical course.’ As explained above, whatever right a woman may have to ‘chart her own medical course,’ it cannot compel a health-care provider to provide her chosen care.”
  • The Court rejected PP’s argument that the conscience law “allows medical professionals to abandon their patients, even in an emergency.” The Court pointed out that because the Arizona Constitution protects common law medical malpractice actions from being abrogated by statute, the conscience statute therefore does prevent a woman from suing any physician for denying her the standard of care, whatever that might be. A woman’s ability to impose malpractice liability therefore defeats the argument that the conscience statute allows abandonment in an emergency.
  • The Court rejected PP’s argument that the conscience statute “justif[es] practices inconsistent with the peace and safety of the state.”
  • First, “no authority suggests that permitting individuals to choose whether to facilitate abortions places the peace and safety of the state at risk.”
  • Second, the Arizona Constitution says that constitutional protections for conscience do not protect violations of peace and safety, but it does not prohibit the legislature from protecting conscience even more than the constitution happens to do.
  • Third, the “peace and safety” limitation is merely a limit on how far judges are supposed to interpret the constitutional protections; it does not allow private citizens to sue to contend that too much conscience is being protected.
  • Notably, the Court observed that the conscience statute may well protect employees of Planned Parenthood who object to involvement in abortion, but it went on to reject PP’s above arguments anyway.

Presumably PP will appeal this case to the Arizona Supreme Court, but the Court has discretionary review so it could simply deny the petition. In any event, the case will go back down to the trial court for final proceedings (to the same judge who issued the injunction), because this was just a “preliminary” decision.

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