Ramona's picture

    About those Ultrasounds: What if Doctors just say no?

     I've been wondering--haven't you?--why primary care physicians, and especially OB/GYNs, aren't speaking out about the current creepy Rightward trend toward using ultrasounds as punishment against women who dare to sign up for an abortion.  Turns out some of them are.

    They're angry, they're anguished, they're dumbstruck.  (Join the club.)  And they're speaking out anonymously--sadly--because we live in a country where medical doctors can no longer talk freely about abortion, a legal medical procedure, without fear of retribution.

    This from a post called "Civil Disobedience" by palMD at his blog, White Coat Underground. (Take a few minutes to read some of his other posts while you're there.  Good stuff.):

    "In the case of abortions, where time is essential and providers may not be easy to find, delays in care are unconscionable.  To enforce a waiting period violates the doctor’s ethical duty to provide appropriate, timely care and to avoid causing the patient unnecessary grief.  The law forces us to violate our ethics. To force us to perform ultrasounds, trans-vaginal or otherwise, is battery.

    No procedure can be performed on a patient without their informed consent.  To make another important procedure contingent on an unnecessary one is a clear violation of medical ethics. Abortions can be safely performed without sonography, and should be unless their is compelling medical reason to perform one—with the patient’s consent.  To say that a woman can always refuse the ultrasound as long as they refuse the abortion is an immoral argument, one which removes all autonomy from the patient, and forces a doctor to make unreasonable choices."

     Another caring doctor used John Scalzi's blog, "Whatever", to lay out a plan for civil disobedience.  He says, in part:

    "I do not feel that it is reactionary or even inaccurate to describe an unwanted, non-indicated transvaginal ultrasound as “rape”. If I insert ANY object into ANY orifice without informed consent, it is rape. And coercion of any kind negates consent, informed or otherwise. In all of the discussion and all of the outrage and all of the Doonesbury comics, I find it interesting that we physicians are relatively silent.

    After all, it’s our hands that will supposedly be used to insert medical equipment (tools of HEALING, for the sake of all that is good and holy) into the vaginas of coerced women.

    Fellow physicians, once again we are being used as tools to screw people over. This time, it’s the politicians who want to use us to implement their morally reprehensible legislation. They want to use our ultrasound machines to invade women’s bodies, and they want our hands to be at the controls. Coerced and invaded women, you have a problem with that? Blame us evil doctors. We are such deliciously silent scapegoats.

    It is our responsibility, as always, to protect our patients from things that would harm them. Therefore, as physicians, it is our duty to refuse to perform a medical procedure that is not medically indicated. Any medical procedure. Whatever the pseudo-justification.

    It’s time for a little old-fashioned civil disobedience."

     He then offers a five-step plan designed to keep physicians from ever having to perform an unwanted ultrasound on a female patient, starting it off with a bang:

      "1) Just don’t comply. No matter how much our autonomy as physicians has been eroded, we still have control of what our hands do and do not do with a transvaginal ultrasound wand. If this legislation is completely ignored by the people who are supposed to implement it, it will soon be worth less than the paper it is written on." 

    And ends it with a bigger bang:

    "It comes down to this: When the community has failed a patient by voting an ideologue into office…When the ideologue has failed the patient by writing legislation in his own interest instead of in the patient’s…When the legislative system has failed the patient by allowing the legislation to be considered… When the government has failed the patient by allowing something like this to be signed into law… We as physicians cannot and must not fail our patients by ducking our heads and meekly doing as we’re told.  Because we are their last line of defense."

    Alrighty then.  The man has a way with words, doesn't he?  He's actually echoing more forcefully the guidelines already set long ago by the American College of obstetricians and Gynecologists--the very guidelines the state of Virginia so clearly and consciously aims to violate. ( The story here by Rick Unger in Forbes.).

    In 2009 ACOG reaffirmed their recommendations on non-medical ultrasounds:

    "The American College of Obstetricians and Gynecologists (ACOG) has endorsed the following statement from the American Institute of Ultrasound in Medicine (AIUM) discouraging the use of obstetric ultrasonography for non-medical purposes (eg, solely to create keepsake photographs or videos) (1):

    The AIUM advocates the responsible use of diagnostic ultrasound. The AIUM strongly discourages the non-medical use of ultrasound for psychosocial or entertainment purposes. The use of either two-dimensional (2D) or three-dimensional (3D) ultrasound to only view the fetus, obtain a picture of the fetus or determine the fetal gender without a medical indication is inappropriate and contrary to responsible medical practice. Although there are no confirmed biological effects on patients caused by exposures from present diagnostic ultrasound instruments, the possibility exists that such biological effects may be identified in the future. Thus ultrasound should be used in a prudent manner to provide medical benefit to the patient."

     Of course, the states advocating this unprecedented invasion into women's lives aren't in the least impressed by protestations from anybody not connected with their own Koch-fueled, pseudo-religious circles--not even the medical pros, who are, you know, medical professionals.

    According to the Guttmacher Institute, as of March 1, 2012:

    •  11 states require verbal counseling or written materials to include information on accessing ultrasound services.
    • 20 states regulate the provision of ultrasound by abortion providers.
    •  7 states mandate that an abortion provider perform an ultrasound on each woman seeking an abortion, and require the provider to offer the woman the opportunity to view the image.
    •  9 states require that a woman be provided with the opportunity to view an ultrasound image if her provider performs the procedure as part of the preparation for an abortion.
    •  5 states require that a woman be provided with the opportunity to view an ultrasound image.

    There are signs that some state legislatures may be rethinking their actions (Idaho, for instance), but it's a cinch they're only rethinking them in order to get around any detours to their goals.  When they come up with something this nutty in the first place,  the chances that either common sense or common decency will prevail are slim to none.

    So how do we get through to them?  We can't shame them; they're shameless.  We can't shun them; they're in charge.  But we can raise our voices in decibels loud enough to be heard above the din of old-testament retribution disguised as modern-day government.

    This was never how it was supposed to be.

    (Cross-posted at Ramona's Voices)


    My first reaction to this is quite disturbing.  James O'Keefe, in pregnant drag with a hidden camera, trying to trick doctors into performing abortions on him without first using the wand...

    Lol, Destor.  You have a wicked sense of humor!

    Again, I reiterate, where are all the outraged women?  And the MSM seems to have done a hit and run on this issue.  Where are all the petitions and outcries from healthcare professionals (not only doctors).

    OMG, Limbaughs debacle got more attention/action and national outrage!

    Aunt Sam, there is a lot of outrage, it just doesn't make the headline news.  I don't know why, it's certainly provocative enough.  It could be there aren't enough women in government or in high MSM places.  Just gotta keep trying.  This isn't going to go away any time soon. 

    I have a feeling this will be the tide that turns.

    I have a feeling that what we need is for the daughter of a powerful and prominent couple to be traumatized and willing to speak out.  Which is unlikely for a zillion reasons.

    That will never happen.  Guaranteed.

    Amanda Marcotte is worth considering on this issue.  This side of the argument had not occurred to me.

    I think Amanda Marcotte is missing the point:  it's vitally important that doctors who don't perform abortions--general practitioners and OB/GYNs--voice their objections to the use of pre-abortion ultrasounds for non-medical reasons.

    She uses one example from the doctor's essay, the one about doctoring the paper-work (one that I admit I was queasy about, also), and ignores anything else he said about the misuse of ultrasounds.

    I agree that in order for civil disobedience to be most effective, it has to be public, but I don't get her over-reaction to this essay, even to the point of telling people not to pass it on.  In other words, discouraging any form of civil disobedience that doesn't quite fit her idea of the movement.

    She objects to the fact that he isn't an abortion doctor and that he wants to remain anonymous, as if that somehow disqualifies him from helping to fight against these egregious laws.  She's saying that every doctor who objects should be out there performing abortions, instead.  My take is that the more the medical profession voices their objections, the easier it will be for abortion doctors to do their jobs.

    I'm sorry.  I don't get it.

    Some of it, I don't get either.  Or, at least, some of it is just that she thinks there's one way to protest this and this doctor has another idea.

    Where I think she's on point is where she says that resisting doctors could lose their rights to practice, which is what the anti-choicers really want -- reduced reproductive health options.

    I agree with that, too.  And I hadn't thought about that aspect of it.  It was a good point.

    Well I have come to some conclusions following a reading of some of this new legislation.

    First, every health care worker should have a gun when he/she makes some medical decision or gives medical advice. As long as he/she has a gun, he/she can stand his/her ground pursuant to the dictates of the new gun legislation.

    Second, every health care worker should say a Christian prayer before making a medical decision and this prayer should be recorded and the recording downloaded onto a computer; carefully noting the time and date that the prayer was made.

    Third, every patient should be given a gun, a copy of the Christian prayer, a copy of the constitution and that patient should sign an acknowledgement noting receipt of same.

    Fourth, the clinic should have lots of crosses hung on its walls as well as copies of the Constitution. Pictures of Christ should be prominently displayed also.

    Fifth, all clinics should be incorporated and all the employees should sign contracts promising never to divulge corporate secrets.

    That's all I have now.

    My research shall continue.


    6th. All males who receive a Viagra prescription, before having it filled,  will first be required by law to appear for questioning and physical examination before the Viagra Review Board comprised of upstanding citizens like those pictured below.

    see: link

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