Abortion Providers Failure to Communicate Abortion Risks

Abortion Providers' Failure to Communicate Abortion Risks
by Joy Juedes

Informed Consent

If a woman seeking an abortion really knew all the risks involved, would she still get one? Abortion literature often describes abortion as a quick, simple procedure like having a tooth pulled or getting a shot. In reality, it is a surgical procedure carrying hazards like sterility, injuries to internal organs, future pregnancy complications, an increased susceptibility to breast cancer, and death. And those are just the physical risks-studies have also proven the existence of "post-abortion syndrome" (PAS)—a depression that grips a post-abortive woman for the rest of her life unless she seeks psychological help and healing.

Under "informed consent" requirements, hospitals must give each surgery patient information about the risks of their procedure before he or she goes under the knife. The doctor tells the patient about potential complications, the likelihood of success, and how the procedure will be done. Informed consent is a basic principle in medical ethics and "a critical element of any theory that gives weight to autonomy," according to medical ethics scholar Robert Veatch. Autonomy in this context means respecting a person's right to make his or her own decisions about health care. Informed consent in health care is especially emphasized here in the United States because a patient's autonomy in decision-making is considered very important. According to California HMO Kaiser Permanente, "You have the right to, and should expect to, receive as much information as you need to help you make these decisions. This includes... the diagnosis of a health condition, its recommended treatment, and alternative treatments; preventive care guidelines; and the risks and benefits of recommended treatments." The patient also "should be satisfied with the answers to (his) questions before consenting to any treatment." 

In their study on the health consequences of induced abortion, obstetrics and gynecology professors Jim M. Thorp, Jr., Katherine Hartmann, and Elizabeth Shandigan say that there is a "clear need for women to have accurate information as they execute their autonomy."  They stress that in light of recent data collected on abortion risks, "informed consent before induced abortion should include information about the subsequent risk of pre-term delivery and depression," and that "women in general, including those considering abortion, need to be informed that surgical abortion procedures may increase the likelihood of subsequent pre-term births, and that the risk associated with other methods is not known."  They conclude that "(e)lective abortion must be studied in the same fashion with similar vigor, given the frequency with which women choose to terminate a pregnancy and the important and prevalent health conditions that some of the data heretofore have linked to elective abortion, e.g. pre-term birth and breast cancer. Women deserve to be fully and accurately informed about potential health effects of elective abortion, preferably in a health education context separate and distinct from actually being faced with difficult decisions about whether to continue or end a pregnancy."  These OB-GYN professors also say that disclosing abortion risks should not be limited to clinic clients: "In other venues, information about the existence and magnitude of risk may be appropriate for health education summaries of the reproductive correlates of elective abortion."

The abortion industry on informing about risks

So, in theory, every woman who walks into an abortion clinic should be thoroughly informed about the procedure and its risks. According to a National Abortion Federation abortion information pamphlet, "someone should offer to... (e)xplain the abortion procedure and what to expect," and "(m)ake sure you understand any risks or possible complications in the procedure you will be having." The pamphlet goes on to explain how medical and surgical abortions are done. It says that "complications are unlikely," and "(t)he provider should also (e)xplain what to expect and how to take care of yourself after the abortion."

According to Planned Parenthood Mar Monte, which covers the Sacramento area, "(l)ess than 2% of women who have an abortion at Planned Parenthood Mar Monte experience complications or problems as a result of the procedure." When a woman goes to a clinic for a surgical abortion, "(t)he procedure will be explained to you and you will have time to privately ask questions...(t)he staff will provide you with additional details concerning the procedure the day of your initial appointment." If a woman is having a non-surgical, (a.k.a. medical) abortion, the abortion provider will "explain the medications to you involved in the abortion procedure, how to use them, what you can expect to happen, and possible side effects."

Planned Parenthood of Orange and San Bernardino counties and Family Planning Associates Medical Group in San Bernardino give prospective patients handouts that include risks of surgical abortion. Interestingly, both forms begin with an emphatic statement that a D&C abortion is a "very" or "extremely" safe procedure. It is "many times safer than childbirth," (FPA) and "(f)ewer than 1 woman in 100 will have a serious complication following an early abortion," (PP). Planned Parenthood's "Fact Sheet For Early Surgical Abortion" describes surgical abortion and lists "infection of the uterus," "'incomplete' abortion," a perforated uterus and subsequent "damage" to internal organs, "allergic reaction," hemorrhage, "(b)lood clots in the uterus," cervical tear, "(f)ailure to end the pregnancy," an "emotional reaction after the abortion," an "impact on future pregnancies," and lastly, death. FPA's handout also lists "extremely severe cramping... with little or no bleeding," delay in period, "infection in other parts of your body," ectopic pregnancy, "post-abortion depression," and reactions to anesthesia. FPA does not mention death, and repeats that almost all complications it does list are "rare." Neither the FPA nor Planned Parenthood mentions breast cancer.

Evidence against the abortion industry on risk information

Evidence suggests that in reality, women are not "fully and accurately informed" of the risks of abortion. According to La Verne Tolbert, a former Planned Parenthood-New York City board member, Planned Parenthood clinics "do not present all of the options, side effects, or consequences of having an abortion; … she (the client) is assured that the 'wart, cyst, or tissue,' is easy to remove... Neither is she warned of the emotional or physical side effects of the procedure."  Carol Everett, a former abortion clinic owner, says that while in the abortion business, "I would not hesitate to help cover up severely mishandled medical procedures- even to the point of falsifying medical records... I would continue to sell abortions, despite the potential consequences for the women involved."  She also writes that "(t)he abortions we performed had a high rate of complication. Out clinics completed over 500 abortions monthly, killing or maiming women at a rate of one per month," and that "abortion clinics never accept any responsibility for complications. They just say it was not their fault. The concern is not the patient at this time. The concern is with taking care of the doctor and keeping his reputation and the clinic's clean."

Perhaps the most tragic example of the abortion industry's lack of informed consent in recent years has been the abortion-breast cancer connection. Despite numerous studies citing a positive correlation between abortion and an increased risk of breast cancer, abortion clinics do not include it in their lists of complications. Karen Malec, president of the Coalition on Abortion/Breast Cancer, writes about the denial and cover-up attempts of several national organizations, including the National Cancer Institute, in her article "The Abortion-Breast Cancer Link: How Politics Trumped Science and Informed Consent," published in the latest Journal of American Physicians and Surgeons. She notes how "(t)he web pages of the NCI and leading American and Canadian cancer organizations contain false statements, misrepresentations, and omissions in their discussions of the research," and that "(a) web page of the National Breast Cancer Coalition... cites a 1998 study by McCredie et al. and a 1995 study by Calle et al. in support of its statement that 'there is no association between abortion and risk of breast cancer.' However, the former didn't report any data on induced abortion and the latter only examined the effect of spontaneous abortions. An overwhelming majority of the studies reporting risk elevations are omitted from the web page altogether."

Malec also quotes Dr. Angela Lafranchi, a medical school professor, on the medical community's silence regarding the abortion-breast cancer link.  Lafranchi says that "(s)ome (doctors) have been straightforward and said they know it is a risk factor but felt it was 'too political' to speak about. Others have been evasive.... Some have been openly hostile.... Some initially hostile doctors... debated it with me and have changed their minds." Later, Lafranchi concludes that "(t)here is overwhelming and convincing evidence that abortion and breast cancer are linked, along with a well-described biologic mechanism. Twenty-eight out of 37 studies have shown this and women still don't know. Not only embarrassment and denial, but also fear of malpractice litigation causes doctors to continue to ignore these data. How can an abortionist not be held liable for increasing a woman's risk of breast cancer and not telling her?"

There are numerous case studies and testimonies from women who were not informed about other post-abortion complications, or simply deceived so they would get one. A woman who calls herself Linda G. had a saline abortion in 1974, when she was 17. She reports in a 1998 edition of The Post Abortion Review that her abortionist "never told me how big my baby was or any of the complications that could happen, and he certainly didn't tell me about the aftereffects. I trusted him because he had the title of 'doctor'... He had kept important information from me, and I was really upset about that."  Cindy Hendrickson, who had an abortion in 1975, writes in her online testimonial "Consequences" that the doctor at her clinic "barely spoke to me. The nurses never spoke to us any more than necessary, either. No one told us what would happen."

Abortion researcher Mark Crutcher writes in his book Lime 5 that "(i)n other surgical procedures, the patient may be old and/or deathly ill or injured, while abortion patients are always relatively young and normally in good health... Additionally, other forms of surgery can often be very complicated, while even the abortion industry touts abortion as a very quick and very simple procedure.”  He says that the vast majority of abortion complications go unreported and unchallenged in court. Nevertheless, he says that there are still a good number of cases on public record. In many of the cases Crutcher cites, women did not survive their legal abortions. His research indicates that women are often convinced to have an abortion despite health problems that put them in higher risk of complications if they have one.

Crutcher’s Lime 5 includes stories of women like “Christie," who went to have an abortion in February of 1990 with a "history of high blood pressure, headaches, dizziness, toxemia, and a C-section during a prior pregnancy;" however, "there was no record that these conditions were ever discussed with Christie." Further, "(c)linic records do not indicate that any counseling was done and there was no informed consent document signed by the patient. Additionally, no ultrasound, physical examination, or blood tests were performed, nor were vital signs taken prior to the abortion.”  In November 1993, 20-year-old "Jane," who was in her third trimester, "was given a fact sheet for first- trimester abortions, and was not adequately counseled on the risky late abortion she was about to undergo nor counseled on alternatives... Jane's 'anatomical anomalies and other risk factors' made her a poor candidate... for a late-term abortion.”

"Phyllis," 35, suffered injuries to her right kidney, right ureter, and colon during a second- trimester abortion performed by abortionist "John Roe 704" in February 1989. Crutcher reports: "Roe later admitted that he did not inform Phyllis of the risks of the surgery because he assumed she already understood them.”  "Ruth" almost died of hemorrhagic shock and had to have her Fallopian tube removed because the "pathology report from (her) abortion had indicated the possibility of ectopic pregnancy, but the facility had failed to inform Ruth.”  "Gloria," an obese woman who had "asthma, chronic lung disease, and a family history of high blood pressure," died of a punctured uterus following an abortion. Consequently, "(t)he medical examiner said that because of Gloria's health problems, Roe (the abortionist) should not have performed the abortion in an outpatient setting, and a court-appointed panel found him negligent in her death.”

Conclusion

It could be argued that a woman seeking an abortion should educate herself on what she is getting into and ask clinic workers questions. But it is clearly part of the provider's job to contribute the "informed" part of informed consent, according to Veatch. Veatch says that the "physician must provide certain information just to protect the patient.”  A patient should not have to ask basic questions, and no one undergoing a procedure with any chance of risk should be left in the dark about possible complications. A woman seeking an abortion is required to fill out an information provision certification form, or she receives a sheet listing all possible risks. But as noted previously, clinics don't mention certain risks, or word their forms to convince the woman the chance of complication is "rare."

Abortion clinics comprise "the largest uncontrolled industry in our nation," according to Everett. If this is true, then no one is there to enforce what a woman is actually told before getting an abortion. Veatch notes that "(w)e don't really care, from the point of view of the ethics, whether a piece of paper has a signature... It will not prove that the patient read the paper; much less that the signer understood it. The court will, in some cases, throw the consent form out if it is believed that the patient never understood what was on the paper."  Not every woman who enters an abortion clinic, or anyone who enters a doctor' s office, for that matter, is in the right state of mind to read a long, dry, and vaguely worded form. A woman seeking an abortion probably has a million anxious thoughts swirling in her head, and she will most likely do anything to get the procedure over with as soon as possible.

For abortion critics, the lack of risk communication in the abortion industry is one more indication that it should be banned. Nevertheless, any rational person, regardless of his or her position on abortion, should be disturbed by abortion providers' failure to inform their clients of the procedure's many risks, particularly breast cancer. The abortion industry should be held to the same informed consent and risk communication standards as the rest of the medical field. Sadly, even if it were, the most common and lethal risk would still go unmentioned: death to the unborn child.

Works Cited

Crutcher, Mark. “Lime 5.” Denton, Texas: Life Dynamics, Inc., 1996.

Everett, Carol. "Blood Money: Getting Rich Off a Woman's Right to Choose." Round Rock, Texas: The Heidi Group, 1992.

Everett, Carol. "What I Saw In The Abortion Industry." Jefferson City, Mo.: Easton Publishing Company, Inc., 1988.

"Fact Sheet For Early Surgical Abortion." Planned Parenthood of Orange and San Bernardino Counties. Form # FS-28, revised on 1/00.

G., Linda. "Misinformed Consent," The Post Abortion Review 6(2), Spring 1998.

"Having an abortion? Your Guide to Good Care." National Abortion Federation: 2001

Hendrickson, Cindy. "Consequences." <http://www.poorchoice.org/>.

Malec, Karen. "The Abortion-Breast Cancer Link: How Politics Trumped Science and Informed Consent." Journal of American Physicians and Surgeons 8(2), Summer 2003, pp. 41-45.

"News for members: Your rights and responsibilities as a Kaiser Permanente member." <http://www.kaiserpermanente.org/locations/california/mod119/rights.html>.

"Preoperative Information and Postoperative Instructions- Elective Abortion (D&C)." Family Planning Associates Medical Group, Inc. FPA/GI 0001 REV 4/02/2002.

"Surgical and Non-Surgical Abortion." PDF file, from <http://www.ppmarmonte.org/services/abortion.asp>.

Thorp, Jim M., Jr., Hartmann, Katherine E., and Shandigan, Elizabeth. "Long-Term Physical and Psychological Health Consequences of Induced Abortion: Review of the Evidence." Obstetrical and Gynecological Survey: 2002, Vol. 58, No. 1, pp. 67-79.

Tolbert, La Verne. "The Soul of Planned Parenthood." Destiny Magazine: August 1994, pp. 20-27.

Veatch, Robert M. "The Basics of Bioethics." Upper Saddle River, NJ: Prentice Hall, 2003.

Joy Juedes is a senior at Marquette University majoring in journalism and with a minor in health care. Joy’s pro-life involvement includes helping with Students for Life at Marquette and volunteering at the Pregnancy Help Center of Milwaukee.  As our summer intern, she contributes articles for California Right to Life Education Fund’s newsletter from her home in Southern California.