The July 2 letter from state Rep. Glenn Cordelli (R-Tuftonboro) stated he did not understand why the Carroll County Democratic representatives voted against the New Hampshire budget.
Writing as both a retired surgeon and a state representative, I will say there are many reasons to oppose this budget, one of which is the inclusion of a ban on abortions after 24 weeks without exception for rape or incest or the discovery of a fetal anomaly inconsistent with fetal survival.
This ban legislates the practice of medicine, including criminalizing a standard of medical practice. The budget also mandates an ultrasound before any abortion, even early in pregnancy. Such an ultrasound is not always medically necessary, is expensive and places an undue burden on a woman seeking an abortion, disproportionately impacting lower-income patients.
State Rep. Anita Burroughs (D-Bartlett) recently wrote a column discussing the Free Staters’ control over the House Republicans. They profess to support the right of individuals to make their own decisions, but this right is apparently not extended to those who have a uterus.
The House Health, Human Services and Elderly Affairs Committee carefully avoids legislating the practice of medicine. This abortion restriction, mandated by Republican legislators without appropriate training to make medical decisions, interferes with the practice of medicine, compromising patient-centered, evidence-based care.
HB 625, the original bill to prohibit abortions after 24 weeks' gestational age, was sent to the Judiciary Committee, which deemed it inexpedient to legislate. Given the impact on the practice of medicine, it should have gone through the HHSEA committee also. On the House floor, the committee recommendation was overturned by House Republicans and the bill passed. It was later tabled in the Senate,but was added to the budget in an attempt to be certain that it would become law.
Abortions after 24 weeks' gestational age are a very rare medical procedure, usually done in major medical centers, nearly exclusively because of the discovery of a severe fetal abnormality incompatible with survival of the infant or, rarely, when the pregnancy presents a severe risk to the mother’s health.
Severe fetal anomalies incompatible with survival outside the uterus are also rare. Examples include lethal skeletal dysplasia and anencephaly, both untreatable and lethal shortly after birth. Accepted medical choices available to the parents are either termination of the pregnancy or to carry to term and provide comfort care until the baby dies.
It is devastating for both mother and father to be confronted with a severe fetal anomaly. The difficult decision of what to do should be made by the parents and the provider, not legislators.
Severe fetal anomalies may be discovered before 24 weeks through ultrasound, but the severity of the anomaly may not become apparent until later in pregnancy. Given our large population of uninsured and underinsured patients, there will be some women who never obtain prenatal care before 24 weeks. There are women who are not aware they are pregnant or, in a case of rape or incest, too traumatized to seek early prenatal care.
This abortion restriction would prohibit the choice of termination, forcing the mother to carry the baby to term and go through labor and delivery. This is particularly odious given that this year the House also passed HB 233 (still in committee in the Senate) which would require the non-viable infant be snatched from the grieving parent’s arms and taken to the ICU in the futile attempt to keep a non-viable baby alive rather than allow the parents to hold the child and grieve.
A very troubling part of the prohibition on pregnancy termination after 24 weeks is that it criminalizes the medically acceptable choice of termination with up to a $100,000 fine and seven years in prison.
The prohibition does have an exception to allow termination in the case of a medical emergency in which termination is necessary to save the life of or prevent permanent impairment of the pregnant woman. But the criminalization of the “wrong” decision places an extra burden on the physician.
The decisions we face as physicians are often not easy, with serious consequences and lots of gray areas. Providers may make justifiably different decisions when facing the same clinical problem. Place yourself in the shoes of a physician who must rapidly make a decision when faced with a seriously ill pregnant women. No longer can doctors make the best decision for the mother. They need to wonder whether some court will later decide that it was “not serious enough” to justify the termination, sending them to prison for seven years.
Good luck recruiting OB/GYN practitioners to New Hampshire with this law in place.
Jerry Knirk is a Democratic state representative from Freedom.