72-hour abortion delay bad NC law, bad medicine

Introduced on April Fool’s Day, N.C. House Bill 465 is laughably bad for North Carolina. HB 465 would triple the current needless 24-hour waiting period for women seeking an abortion to 72 hours and add intrusive reporting of patient information to Raleigh. As the heads of five American medical specialty societies noted in the New England Journal of Medicine, “Increasingly in recent years, legislators in the United States have been overstepping the proper limits of their role in the health care of Americans to dictate the nature and content of patients’ interactions with their physicians.” HB465 is a prototype of this dangerous meddling in medicine.

HB 465 is a bad law: North Carolina would be one of only four states with such an extreme delay in receiving medical care. These delays translate into increased risk and expense. No medical justification exists for these waiting periods, and paradoxically they can cause harm: While abortion is an extremely safe procedure, it is safest when done as early as possible in the pregnancy. Thus, HB465 could have the unintended consequence of causing abortion complications.

Some women will be harmed by HB465 more than others.

One of our patients was a young mother of two whose abusive boyfriend hit her multiple times in the abdomen while pregnant. She made the courageous decision to leave that relationship, get a restraining order and have an abortion. Having to wait three days after contacting the clinic could have put her life in jeopardy if her partner had discovered her plans. Another patient had a desired pregnancy but learned that her fetus had no kidneys. It would not survive if born. The diagnosis was not made until she was at the upper gestational-age limit for abortion. Having to wait another three days would have meant that she would need to travel out of state, at great expense, to have her procedure.

Women do not walk in off the street for an abortion. Their care is scheduled in advance. Women have already had time to reflect on their decisions by the time they reach the provider, and most are resolute. Should a patient need more time to make a decision, we encourage waiting. Medical care should be individualized, not lock-step.

The sponsors of HB465 would have us believe that

if a one-day waiting period is good, then a three-day waiting period will be better. By analogy, if a woman develops breast cancer, should she be required to wait three days before beginning treatment? A mastectomy is a serious operation. We suspect that breast cancer patients – and their physicians – would find such a mandatory waiting period patronizing, dangerous and unacceptable.

Another part of HB465 imposes burdensome reporting requirements, going well beyond what is standard data collection for the Department of Health and Human Services. The measure would demand personal information from women and physicians, going so far as to require doctors to share private images from a woman’s medical file with the government. HB465 also fails to adequately protect the confidentiality of the physician, which could leave doctors vulnerable to harassment or threats. Transmitting private medical information to the state in this era of frequent security breaches invites problems while not improving women’s health.

HB465 is bad medicine. The World Health Organization advises, “Once the decision is made by the woman, abortion should be provided as soon as is possible to do so.” Thus, HB465 directly contradicts the medical advice of the World Health Organization.

Groucho Marx once commented that, “Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies.” His critique certainly applies to HB465. Medical care should be directed by licensed physicians and other health professionals, not by part-time politicians unaware of the realities of medical practice. North Carolinians deserve better.

David A. Grimes, M.D., lives in Carolina Beach. Amy G. Bryant, M.D., lives in Durham.