Last week, the Virginia State legislature's bill which would require all females considering abortion to undergo a mandatory ultrasound test was received with incredible ire and consternation. While the political merits of the bill, its constitutionality, and its implicit stance on abortion can be debated back and forth, one thing is clear: From a medical point of view, it is a completely reckless attempt to regulate doctors’ ability to practice sound, responsible medicine.
Virginia’s ultrasound bill prevents doctors from participating in the decision to administer certain medical tests to their patients. That, in and of itself, should raise alarm. Legislators in Virginia have claimed that a major impetus behind the passage of this bill was to prevent complications during abortions, such as ectopic pregnancies. Though this may come as a surprise to government officials in Virginia, doctors are actually well aware of the risks of abortion; that is why they order ultrasound tests to be performed when they deem them to be medically necessary. The key word here, however, is necessary. In many instances, doctors, in their professional judgment, choose not to perform such ultrasound tests because they are often regarded as superfluous and not medically indicated. Virginia’s determination to take such decisions out of the hands of doctors and health professionals is foolish and, quite frankly, scary.
Moreover, arbitrarily enforcing every female to undergo such a procedure, one that can often be invasive (all ultrasounds conducted within the first twelve weeks of pregnancy must be performed trans-vaginally), puts both the patient and fetus through discomfort and inevitable risk without any proven benefit. Ultrasound imaging has been in standard medical practice for well over fifty years, and its record of safety has never been challenged. However, like every medical procedure, it cannot be considered to be completely innocuous. For one, there is the ubiquitous risk of infection (although specific epidemiological data is lacking). In addition, laboratory studies have demonstrated that ultrasound energy can produce tangible physical effects in fetal tissue, such as mechanical vibrations, rise in temperature, and the formation of cavities within the tissue. As a result, the Food and Drug Administration has concluded that all fetal exposure to ultrasound for nonmedical purposes should be avoided. Virginia’s ultrasound bill brazenly flouts this recommendation by doctors and public health experts in favor of a conspicuous sociopolitical ploy that would risk endangering both the mother and the fetus. And this does not even begin to address the legal ramifications that would ensue. As many have already pointed out, subjecting a woman to invasive vaginal penetration against her will could constitute rape. And for those that consider the life of a fetus to be sacred, subjecting a defenseless fetus to such unnecessary and invasive medical testing could be considered cruel and unlawful.
Finally, given the current climate of the national healthcare debate, it is troubling that the Virginia legislature is comfortable asking patients and insurance companies to pay hundreds of dollars for a procedure that is not considered necessary by the patient’s obstetrician/gynecologist (the average trans-vaginal ultrasound costs $525). As Atul Gawande argues in “The Cost Conundrum” (an article that President Obama deemed mandatory reading for all White House employees), such superfluous medical testing is at the heart of the healthcare economic crisis. Virginia’s decision to enforce ultrasound tests before every abortion only adds to the problem at hand.
No matter one’s opinion on abortion, it seems clear that the Virginia legislature has made a costly blunder, from both a medical and public health standpoint. If Virginia wants to start a national political debate on the merits of abortion, that is for them to decide. As for adjudicating on the necessity of medical procedures — leave those decisions to the experts.
Photo Credit: andrewmalone