Missouri Politicians Should Stay Out of the Exam Room

By Colleen McNicholas, DO, MSCI

Dr. Colleen McNicholas, Physicians for Reproductive HealthThe Missouri Legislature is just hours away from deciding if politics will once again trump medicine. Earlier this year the Legislature passed a measure that would increase the mandated waiting period to obtain an abortion from 24 hours to 72 hours. Governor Nixon vetoed the legislation, citing concern with its many intended and unintended consequences.

As an abortion provider in the state, I share many of those concerns. Missouri is already one of the most restrictive states for women seeking abortion care, and that has real-life, harmful consequences for women. For instance, on average, a woman has to travel 100 miles to obtain the care she needs. She must present twice for care, to comply with our existing 24-hour waiting period. This creates logistical and economic difficulties.

Extending the waiting period will only exacerbate those difficulties by forcing women to endure the expense of travel, missed work, lost wages, and child care twice — all for a decision they were certain about before their first trip.

I fear this legislation will disproportionately affect families faced with the devastation of a fetal anomaly. The current standard of care includes an ultrasound at around 20 weeks of gestation to evaluate all the organs of the fetus. Unfortunately this is when many fetal anomalies are first detected. Because of the complexities associated with accurate confirmation of anomalies, an additional few days or even weeks may pass before a family has confirmation of a devastating finding. During that time, they are agonizing over their options. The current restrictions in gestational age mean families must find a way to travel to St. Louis to obtain care. Forcing them to wait an additional 48 hours is not only cruel and medically unnecessary, but it may also remove the option of termination completely by putting them over the legal gestational age.

Beyond the implication for families living far from providers (everyone outside of St. Louis) and families with pregnancies affected by fetal anomaly, this type of legislation sends the unfortunate message that our lawmakers believe women are not capable of making informed decisions. The assumption that women have not given sufficient thought and consideration to this important decision, merely because they came to a different conclusion than supporters of this legislation ASSUME they should reach is paternalistic at best. In fact, the legislation borders on coercive.

Attempts such as this, to use political tactics to influence medical decisions, clearly violate the medical principle of patient autonomy. Perhaps this is not a concern of the Legislature; after all they are not physicians and not held to the standards that we are.

Despite many examples to suggest differently, I am optimistic that Missouri women will eventually get the respect, autonomy, and health care they deserve without interference from those outside their family and their physician’s office.

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