In 23 states, information that doctors are required to provide to women either verbally or in writing before an abortion falls short of fundamental ethical principles because it is inaccurate or irrelevant, a new nationwide Guttmacher Institute analysis of state counseling requirements finds. The counseling required by these 23 states in many cases appears to be designed more to influence rather than inform a woman’s decision whether to have an abortion, for instance by exaggerating the physical or mental health risks of abortion, or by including information on certain abortion procedures that is irrelevant to most women, according to the report published in the Fall 2007 issue of the Guttmacher Policy Review.

"The widespread misinformation we found is especially troubling in light of the Supreme Court’s recent decision in Gonzalez v. Carhart that gives deference to legislatures, rather than the weight of the evidence, in cases where there is medical disagreement on the potential consequences of abortion," says Rachel Benson Gold, co-author of "State Abortion Counseling Policies and the Fundamental Principles of Informed Consent." "There is ample reason to worry that some state legislatures will view the Supreme Court’s ruling as a green light to set up a new array of misleading counseling requirements that in reality are attempts by politicians to muscle their way into private medical decisions that should be between a woman, her family and her doctor."

For instance, the Guttmacher analysis finds that written materials in 18 states include descriptions of abortion procedures performed after the first trimester of pregnancy, even though this information is irrelevant to the nine in 10 women who have an abortion during the first 12 weeks of pregnancy. In addition to this misguided one-size-fits-all approach, four of the states—Idaho, Oklahoma, South Dakota and Texas—use graphic and inflammatory descriptions of late-term procedures that attempt to steer women away from having an abortion.

Other examples of misleading written counseling materials can be found in six states that inaccurately assert that a link may exist between abortion and breast cancer—a claim that has been decisively rejected by the National Cancer Institute. Another instance where abortion counseling materials make claims unsupported by the evidence can be found in the four states—South Dakota, Texas, Utah and West Virginia— that assert that a woman undergoing an abortion may either experience suicidal thoughts or suffer from "postabortion traumatic stress syndrome," a disorder that is not recognized by major mental health organizations.

"The fact that a significant number of states misuse the informed consent process in this way clearly runs counter to fundamental ethical principles that have long guided the practice of medicine in the United States," says Gold. "With the Supreme Court unlikely to be a backstop against even blatantly biased counseling requirements, the stakes in January when state legislatures convene will be high for reproductive health advocates, for those who care about the principle of informed consent—and especially the women facing an unplanned pregnancy whose well-being will be most directly affected."

About informed consent

In 1982, the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research released what is widely regarded as one of the most authoritative reviews of the principle of informed consent, concluding that it rests on three closely interrelated elements: patients must possess the capacity to make decisions about their care; their participation in these decisions must be voluntary; and they must be provided adequate, appropriate information to make the decision before them. This fundamental principle is embodied in the basic standards of leading professional medical organizations, including the American Medical Association, the American College of Surgeons and the American College of Obstetricians and Gynecologists.

Click here to read "State Abortion Counseling Policies and the Fundamental Principles of Informed Consent," by Rachel Benson Gold and Elizabeth Nash.

Click here for more information on:

Also in this issue:

The medical accuracy of state-developed abortion counseling materials