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Tuesday, October 14, 2008

Sanford Medical Internal Memo: More Reason to Vote No on IM11

Terry Woster at that Sioux Falls paper is busy analyzing an internal memo from Sanford Medical on the implications of Initiated Measure 11 for that hospital's operations. I'm busy reading it, too. So should you be. Click here to do so (2.2MB PDF alert).

While you wait for the download, here are the nuts and bolts, according to the legal minds at Sanford:

  • Sanford Medical doesn't do elective abortions, so in large part, IM11 shouldn't interfere much with Sanford's normal operations.
  • Sanford as an organization takes no position on IM11.
  • Should Sanford staff perform an abortion for medical reasons, the doctors, nurses, and pharmacists involved could be subject to felony prosecution under IM11.
  • Any other Sanford staff could potentially be guilty of aiding and abetting a felony by "knowingly making resources available for" an unlawful termination (pp. 2-3). Receptionists, call your lawyers.
  • Carrying an anencephalytic fetus -- i.e., no brain development, maybe no brain, period? IM11 may force you to carry that non-viable fetus to term. It's arguably "living": it has a heartbeat and continues to develop, even though the condition is terminal. IM11 language about "living" likely disallows aborting that fetus. (pp. 5-6)
  • Docs have to gamble on preeclampsia: if not treated, preeclampsia poses risk to mother of "life-threatening event" like liver rupture or renal failure. But it's unclear when that risk becomes serious enough to trigger IM11's "exceptions." So physicians face a dilemma: "(i) terminate the pregnancy too early and face possible criminal prosecution, or (ii) wait for the condition to worsen and risk losing the mother's life" (pp. 6-7). Ladies, imagine sitting in the doctor's office and being told "Let's wait and see" on that one.
  • Multiple pregnancies: "As drafted, Initiated Measure 11 does not provide an exception that would allow for selective reductions, unless the pregnant mother is facing 'substantial and irreversible' health risks—which is not usually the case" (emphasis in original, p.7)
  • Amniocentesis and chorionic villus sampling may be out. These tests are used to diagnose over 100 disorders in fetuses. These procedures pose a 1-in-200 chance of causing miscarriage. Now sure, IM11 exempts accidental or unintentional termination caused by "medical treatment." This kind of sampling, however, is not treatment for a medical condition, just an "informative tool." Again, doctors have to choose: risk going to jail and losing their license, or deny women an important diagnostic procedure about the fetuses they are carrying.
  • To perform an abortion to protect a woman's life or health, doctors must prove that they have followed "accepted standards of medical care." Problem is, "accepted standards of medical care" don't exist. Neither does "serious risk," another key term in the "exception" language (p. 8). Or, more accurately, the words exist, but not ironclad objective definitions that will give doctors solid legal protection for acting under the "exceptions" IM11 supposedly affords.
  • IM11's requirement that doctors report rapes, even against the patient's wishes, harms the doctor-patient relationship. It doesn't harm Sanford's operations, though, since Sanford doesn't perform abortions to end rape-induced pregnancies (p. 9).
This legal analysis makes clear that Initiated Measure 11 will put doctors and pregnant women in an awful situation. Doctors will have to choose between subjecting themselves to possible felony prosecution or subjecting their pregnant patients to greater medical risk.

Don't doctors have a hard enough job without us telling them how to do it? I doubt any doctor is eager to perform an abortion, for any reason. The doctors at Sanford do them only under grave circumstances, when their years of study and experience tell them the procedure is the best option.

I don't have the knowledge to determine when an abortion is the right thing for a doctor to do. Neither do you. Neither do any combination of 51% of South Dakotans. So let's not try.


  1. Good points, and all worth discussing. Why is it that when IM11 came out this spring, it was so much more restrictive than the previous attempt, yet they are trying to sell it as lenient? This is a terrible Initiated Measure and I hope every voter takes the time to read the entire law as it is written and as it will be enforced. Scary, that's for sure.

  2. anonymous, I have to agree with you.


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