Tuesday, 2 April 2013

Tasmania's Reproductive Health Bill

Submission In Response To The Proposed

Prepared by Dr. Andrew Corbett

We have serious concerns about this proposed legislation, its process for public consideration, its wider implications and the motive for its promotion.

The discussion paper introduces its interpretation definitions for the language within the proposed Bill. Of immediate concern is the definition of the word “terminate”. The Draft Bill states - 
terminate   means to discontinue a woman’s pregnancy by – 
(a) using an instrument or a combination of instruments; or 
(b) using a drug or a combination of drugs; or 
(c) any other means; 

This is an unsatisfactory definition of the term “terminate” even in the context of this Draft Bill. What does the word “terminate” mean? This is a question that: “to discontinue a woman’s pregnancy” does not answer - because to discontinue a woman’s pregnancy answers a different question: What happens to a woman’s pregnancy when her in utero baby dies? Thus, the stated definition is answering what happens after a “termination” has occurred - not what a termination actually is. 

Access To Terminations
It was with a reasonable amount of surprise to read the proposals in this Draft Bill. This surprise resulted from hearing Ms. O’Byrne’s own media statements at the launch of this Draft Bill where she repeatedly stated that this proposed legislation was simply “tidying up” the current ‘out-dated’ pieces of legislation. But upon reading this Draft, we are immediately confronted with a proposal to terminate unborn babies that is radically different to anything currently being legally practised. 
4. Terminations by medical practitioner at not more than 24 weeks 
The pregnancy of a woman who is not more than 24 weeks pregnant may be terminated by a medical practitioner. 

This is not “tidying up”. This article from the Draft Bill is concerning for what it doesn’t say (and what the Draft Bill goes on to make clear). Under this proposed legislation a medical practitioner may not refuse to carry out a termination. Rather than tidying up a medical practitioner’s legal standing, this Draft Bill, if legislated, could create a mine-field of legal uncertainty for medical practitioners. Secondly, a medical practitioner may not refer a patient to counsellor who does counsels against getting a termination. This proposal is not a revision change, this is a regime change. 

Terminating an unborn baby “after 24 weeks” presumably means up to full term. Again, this is not a slight adjustment to any existing legislation. This is a radical proposal. 
5. Terminations by medical practitioner after 24 weeks 
(1) In this section – 
informed consent means consent given by a woman where a medical practitioner has provided her with counselling about the medical risk of termination of pregnancy and of carrying a pregnancy to term. 

The proposal to provide women enquiring about terminating the life of their unborn child with a list of the medical risks associated with such a procedure is long overdue - because the risks are numerous. These include-
  • Increased mortality rates for the mother
According to the best record based study of deaths following pregnancy and abortion, a 1997 government funded study in Finland, women who abort are approximately four times more likely to die in the following year than women who carry their pregnancies to term.
- Gissler, M., et. al., “Pregnancy-associated deaths in Finland 1987-1994 — definition problems and benefits of record linkage,” Acta Obsetricia et Gynecolgica Scandinavica 76:651-657 (1997).
  • Increased risk for the mother: ovarian, cervical, and liver cancer
Women with a history of one abortion face a 2.3 times higher risk of having cervical cancer, compared to women with no history of abortion.  Women with two or more abortions face a 4.92 relative risk. Similar elevated risks of subsequent ovarian and liver cancer have also been linked to single and multiple abortions. These increased cancer rates for post-aborted women may be linked to the unnatural disruption of the hormonal changes which accompany pregnancy and untreated cervical damage or to increased stress and the negative impact of stress on the immune system.
- M-G, Le, et al., “Oral Contraceptive Use and Breast or Cervical Cancer: Preliminary Results of a French Case- Control Study, Hormones and Sexual Factors in Human Cancer Etiology, ed. JP Wolff, et al., Excerpta Medica: New York (1984) pp.139-147; F. Parazzini, et al., “Reproductive Factors and the Risk of Invasive and Intraepithelial Cervical Neoplasia,” British Journal of Cancer, 59:805-809 (1989); H.L. Stewart, et al., “Epidemiology of Cancers of the Uterine Cervix and Corpus, Breast and Ovary in Israel and New York City,” Journal of the National Cancer Institute 37(1):1-96; I. Fujimoto, et al., “Epidemiologic Study of Carcinoma in Situ of the Cervix,” Journal of Reproductive Medicine 30(7):535 (July 1985); N. Weiss, “Events of Reproductive Life and the Incidence of Epithelial Ovarian Cancer,” Am. J. of Epidemiology, 117(2):128-139 (1983); V. Beral, et al., “Does Pregnancy Protect Against Ovarian Cancer,” The Lancet, May 20, 1978, pp. 1083-1087; C. LaVecchia, et al., “Reproductive Factors and the Risk of Hepatocellular Carcinoma in Women,” International Journal of Cancer, 52:351, 1992.

  • Increased risk of uterine perforation
The risk of uterine perforation is increased for women who have previously given birth and for those who receive general anesthesia at the time of the abortion. Uterine damage may result in complications in later pregnancies and may eventually evolve into problems which require a hysterectomy, which itself may result in a number of additional complications and injuries including osteoporosis.
- S. Kaali, et al., “The Frequency and Management of Uterine Perforations During First-Trimester Abortions,” Am. J. Obstetrics and Gynecology 161:406-408, August 1989; M. White, “A Case-Control Study of Uterine Perforations documented at Laparoscopy,” Am. J. Obstetrics and Gynecology 129:623 (1977)

  • Increased risk of cervical laceration
Significant cervical lacerations requiring sutures occur in at least one percent of first trimester abortions. Lesser lacerations, or micro fractures, which would normally not be treated may also result in long term reproductive damage. Latent post-abortion cervical damage may result in subsequent cervical incompetence, premature delivery, and complications of labor. The risk of cervical damage is greater for teenagers, for second trimester abortions, and when practitioners fail to use laminaria for dilation of the cervix.
- K. Schulz, et al., “Measures to Prevent Cervical Injuries During Suction Curettage Abortion,” The Lancet, May 28, 1983, pp 1182-1184; W. Cates, “The Risks Associated with Teenage Abortion,” New England Journal of Medicine, 309(11):612-624; R. Castadot, “Pregnancy Termination: Techniques, Risks, and Complications and Their Management,” Fertility and Sterility, 45(1):5-16 (1986).

  • Increased risk of placenta previa
Abortion increases the risk of placenta previa in later pregnancies (a life threatening condition for both the mother and her wanted pregnancy) by seven to fifteen fold. Abnormal development of the placenta due to uterine damage increases the risk of fetal malformation, perinatal death, and excessive bleeding during labor.
- Barrett, et al., “Induced Abortion: A Risk Factor for Placenta Previa”, American Journal of Ob&Gyn. 141:7 (1981).

  • Increased risk of subsequent miscarriage
Women who had one, two, or more previous induced abortions are, respectively, 1.89, 2.66, or 2.03 times more likely to have a subsequent pre-term delivery, compared to women who carry to term. Prior induced abortion not only increased the risk of premature delivery, it also increased the risk of delayed delivery. Women who had one, two, or more induced abortions are, respectively, 1.89, 2.61, and 2.23 times more likely to have a post-term delivery (over 42 weeks).
- Zhou, Weijin, et. al., “Induced Abortion and Subsequent Pregnancy Duration,” Obstetrics & Gynecology 94(6):948-953 (Dec. 1999).  Klemetti R, Gissler M, Niinimäki M, Hemminki E. Birth outcomes after induced abortion: a nationwide register-based study of first births in Finland. Hum Reprod 2012 Aug 29. [Epub ahead of print]. Rooney B, Calhoun BC. Induced Abortion and Risk of Later Premature Births. Journal American Physicians & Surgeons 2003;8(2):46-49 Bhattacharya S, Lowit A, Bhattacharya S, Raja EA. -et al. Reproductive outcomes following induced abortion: a national register-based study in Scotland. BMJ OPEN Summer 2012. Swingle HM, Colaizy TT, Zimmerman MB, et al Abortion and the risk of subsequent preterm birth: a systematic review and meta-analysis. J Reproductive Med 2009;54:95-108.

  • Increased risk of pelvic inflammatory disease (PID)
PID is a potentially life threatening disease which can lead to an increased risk of ectopic pregnancy and reduced fertility. Of patients who have a chlamydia infection at the time of the abortion, 23% will develop PID within 4 weeks. Studies have found that 20 to 27% of patients seeking abortion have a chlamydia infection. Approximately 5% of patients who are not infected by chlamydia develop PID within 4 weeks after a first trimester abortion. It is therefore reasonable to expect that abortion providers should screen for and treat such infections prior to an abortion.
Endometritis is a post-abortion risk for all women, but especially for teenagers, who are 2.5 times more likely than women 20-29 to acquire endometritis following abortion.
- Burkman, et al., “Morbidity Risk Among Young Adolescents Undergoing Elective Abortion” Contraception, 30:99-105 (1984); “Post-Abortal Endometritis and Isolation of Chlamydia Trachomatis,” Obstetrics and Gynecology 68(5):668- 690, (1986)

  • Increased risk of immediate complications
Approximately 10% of women undergoing elective abortion will suffer immediate complications, of which approximately one-fifth (2%) are considered life threatening. The nine most common major complications which can occur at the time of an abortion are: infection, excessive bleeding, embolism, ripping or perforation of the uterus, anesthesia complications, convulsions, hemorrhage, cervical injury, and endotoxic shock. The most common “minor” complications include: infection, bleeding, fever, second degree burns, chronic abdominal pain, vomiting, gastro-intestinal disturbances, and Rh sensitization.
- Frank, et.al., “Induced Abortion Operations and Their Early Sequelae”, Journal of the Royal College of General Practitioners (April 1985),35(73):175-180; Grimes DA, Cates W Jr.  Abortion:  Methods and complications.  In:  Hafez ESE, ed.  Human reproduction:  Conception and contraception  (2nd ed).  Hagerstown, Maryland:  Harper and Row, 1980:796‑813.; M.A. Freedman, “Comparison of complication rates in first trimester abortions performed by physician assistants and physicians,” Am. J. Public Health, 76(5):550- 554 (1986).
  • Increased risk of psychological and psychiatric disorders
A study of the medical records of 56,741 California medicaid patients revealed that women who had abortions were 160 percent more likely than delivering women to be hospitalized for psychiatric treatment in the first 90 days following abortion or delivery. Rates of psychiatric treatment remained significantly higher for at least four years.
- Badgley, et.al.,Report of the Committee on the Operation of the Abortion Law (Ottawa:Supply and Services, 1977) pp.313-321.

These are only some of the health risks for women directly related to terminating an unborn baby. Currently, there is no obligation for a medical practitioner to convey these risks to a woman enquiring about terminating her baby. What is confusing about the wording of this Draft is that the medical practitioner is required to warn an expectant mother of the risks of carrying to full term her baby!

The Draft Bill places an unfair, unjust, and unqualified burden on medical practitioners when it requires of them-
5. (3) In assessing the risk referred to in subsection (2)(a)(i), the medical practitioners must have regard to the woman’s current and future physical, psychological, economic and social circumstances. 

How on earth can a medical practitioner be expected to evaluate a judgment on a woman’s worthiness to become a mother on the basis of her economic and social circumstances?! 
The Bill proposes to give a medical practitioner who seconds another medical practitioner the legal power to abort a woman’s baby - even against her will.
5. (4) If it is impracticable for the woman to give informed consent, the two medical practitioners referred to in subsection (2)(a)(i) are to make a declaration in writing detailing the reasons why it was impracticable for the woman to give informed consent. 

This requires the reasonable section of the current Criminal Code to be amended to what even sounds unreasonable and unjust. This Draft Bill therefore requires Section 178E of the Criminal Code to be removed -
178E. Termination without woman’s consent 
(1) A person who intentionally or recklessly terminates the pregnancy of a woman without the woman’s consent, whether or not the woman suffers any other harm, is guilty of a crime. 

Medical practitioners who have a reasonable conscientious objection to the deliberate taking of a human life are prohibited from exercising their conscience in instances where a pregnant women is in physical danger (where it is deemed that the pregnancy contributes to her danger). This places these medical practitioners in an impossible situation. With the exception of ectopic pregnancies, pregnancy is rarely life-threatening (natural birthing might be, thus giving cause for the baby to be delivered by caesarian section). The Draft Bill similarly requires of nurses who also have a conscientious objection to terminating the life of the unborn without just cause in an impossible situation.
5. (4) Despite any conscientious objection to terminations, a nurse is under a duty to assist a medical practitioner in performing a termination in an emergency if a termination is necessary to save the life of a pregnant woman or to prevent her serious physical injury. 

Public Consideration
We are deeply concerned over the process for public consideration of this Draft Bill. It is our fear that even with the weight of submissions against the tenor, direction, and intention of this proposed legislation, that the sponsor of the Bill will proceed before there has been due process of analyzing the various submissions.

Wider Implications
The Draft Bill seeks to regulate far more than what its title suggests. We are deeply concerned that it places heavy financial penalties on medical practitioners who for reasons of oaths and consciences object to taking part in this contentious practice.
But the Draft Bill goes further and purposes to make free speech, a foundational democratic right, also the subject the hefty financial penalties for ordinary citizens. This sounds extraordinarily draconian.
What is most bizarre though, is that we now know that an “abortion” is not merely the terminating of a pregnancy - it is the deliberate ending of a human life. To justify this on “economic” or “social standing” grounds is deplorable! The only reason that such a proposal is generally countenanced is because there is an invisibleness to the unborn. This leads to a lack of emotional engagement for those involved. But today we can banish the invisibleness of the unborn with 3D and 4D ultra-sounds whereby we can observe a child in the womb at the early stages of a pregnancy acting very much like a child. What this Draft Bill seeks to legitimatise is the idea that the unborn is either: not a human being, or that they are a human being who does not deserve to live. There is no economic or social argument against someone’s most basic right: the right to live.

Reading through the Draft Bill it is difficult not to get the feel that there is some commercial interest behind it. It reads like a major abortion clinic provider would have heavily contributed to it. It is sophisticated (literally) in much of its language. If it plainly spelled out what it would actually result in, most people would be appalled. Far from being an exercise in “tidying up existing legislation” it will inevitably lead to partial-birth, post-natal and after-birth abortions of babies up to full term! That is, the Draft Bill removes from the Criminal Code prohibitions for the homicide committed by a “medical practitioner” of a birthed  healthy, functioning baby. One of the reasons this will inevitably happen if this Draft Bill is enacted is that it is physically safer for the mother to deliver her baby, and easier for the “medical practitioner” to then terminate the life of the baby.

With so many couples seeking to adopt - and the Tasmanian Government ironically seeking to broaden the criteria for who can adopt - it seems infinitely better economically, medically, socially, morally, ethically, to place the focus on adoption rather than infanticide. We strongly condemn this proposed Bill for the reasons herein. 

Prepared by Dr. Andrew Corbett

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