Copyright 1996 David C. Reardon. Excerpted with permission for from Making Abortion Rare, published by Acorn Books, PO Box 7348, Springfield, IL 62791-7348 for internet posting exclusively at www.afterabortion.org. All Rights Reserved.

In Planned Parenthood v. Casey the Supreme Court approved state mandated informed consent requirements for abortion which are intended to protect the rights of the women as patients. Following this lead, pro-life organizations in several states have successfully lobbied for regulations on the informed consent procedures at abortion clinics. This is a positive development, and should be continued. 

But not all informed consent statutes are created equal. Indeed, there is the danger, in some cases, that statutory informed consent requirements may be viewed by the courts as establishing a sufficient standard for informed consent rather than a minimum standard. In such cases, the statute may be construed to protect the abortionist from liability in cases where the patient may have required more information than that specified in the statute. Such would be the case when a woman had physical or psychological characteristics which place her at higher risk of suffering post-abortion complications than a "normal" patient. In such instances, an ill-drafted informed consent law might actually reduce the injured patient's right to recovery. 

It is therefore important for pro-lifers to better understand the abortion patient's rights as already defined by the judiciary. This is especially so in states where special informed consent legislation is difficult to pass. In these states, existing statutes and legal precedents can effectively be used to defend and expand patient's rights through civil litigation. 

Variations in Disclosure Standards

There are two prevailing standards for informed consent prior to receiving medical care. The first, the so called "traditional" or "community" standard, is physician centered and defined by the common and customary practices in the medical community, namely by what another physician in the same specialty would reveal in a similar situation. The second standard is patient centered, and is defined by what a "reasonable patient" would find relevant to his or her decision to accept or forego a recommended medical treatment. 

The traditional, physician centered standard is best understood in the context of the trust relationship between the physician and patient: "Where the physician-patient relationship is established, the law imposes on the physician a fiduciary duty of good faith and fair dealing; among other things, this duty requires the physician to inform the patient of the nature of his condition and to obtain informed consent as to future treatment."⁽¹⁾

The "reasonable patient" standard has evolved in recognition of the fact that whenever any bias about any medical procedure exists, it tends to produce a bias in favor of underdisclosure of risks, thereby making a "community medical standard" for disclosure inadequate.⁽²⁾ Courts have ruled that: "As the patient must bear the expense, pain and suffering of any injury from medical treatment, his right to know all material facts pertaining to the proposed treatment cannot be dependent upon the self-imposed standards of the medical profession."⁽³⁾ "True consent to what happens to oneself is the exercise of a choice, and that entails an opportunity to evaluate knowledgeably the options available and the risks attendant upon each."⁽⁴⁾ [Italics added] Though the physician may feel strongly about the correct course of action, "it is the prerogative of the patient, not the physician, to determine for himself the direction in which his interests lie," and that requires full disclosure of the nature of the procedure and all the risks and alternatives which a reasonable patient would need to make an informed choice.⁽⁵⁾ Even complications occurring only 1% of the time must be disclosed.⁽⁶⁾

In all, fifteen states and the District of Columbia have adopted the "reasonable patient" standard for informed consent, nineteen have adopted an informed consent doctrine based on the fiduciary relationship of the physician and patient, and ten have combined elements of both.⁽⁷⁾

Under both standards for obtaining informed consent, it is not sufficient merely to give a patient a laundry list of potential risks. It is the attending physician's responsibility to insure that the patient adequately understands the relevant risks and options and has had sufficient time to consider these. These requirements, understanding and time, are especially important in dealing with teenagers who have developmental limitations which may prevent the patient from fully comprehending and weighing the information as quickly as would an adult.⁽⁸⁾ In such cases, the patient may need more detailed explanations and more assistance in reviewing the benefits, risks, and options. Failure to ensure that the patient fully understands the risks, or has had adequate time to reach an informed choice, may provide an additional basis of negligence.⁽⁹⁾

Uninformed consent may also occur when a patient is not informed of personal physical or psychological characteristics which would pre-identify the patient as being at higher risk of suffering one or more post-procedural complications. A patient would reasonably expect to be informed of any high risk factors pertinent to his or her case and to receive counseling with regard to alleviating these risks. If the patient was not informed of these high risk factors because the physician failed to identify them during pre-procedure screening, the physician might be guilty of negligence.⁽¹⁰⁾

If there is inadequate disclosure to a patient, the consent is invalid and the physician's actions are a form of battery. In such cases, the offenses of negligence and battery are intertwined.⁽¹¹⁾

Therapeutic Privilege And Its Limits

Under both informed consent standards, nondisclosure is justified when the information itself "poses such a threat of detriment to the patient as to become unfeasible or contraindicated from a medical point of view."⁽¹²⁾ For example, it may be reasonable to withhold highly stressful information to a cardiac patient when the information itself can cause the onset of a heart attack. 

But even when a treatment is lifesaving, the option of withholding potentially upsetting information, commonly referred to as "therapeutic privilege," is very narrow.⁽¹³⁾ This option is narrowed even further in the case of an elective procedure, where by definition the patient may decline the proposed treatment without dire consequences.⁽¹⁴⁾ When the information does not pose a significant health risk, there is no "therapeutic privilege." Furthermore, no court has ever held a doctor liable for giving too much information.⁽¹⁵⁾ Therefore, it seems reasonable that physicians should err on the side of full disclosure. 

When a procedure is elective, then, the only reasons a physician could give for withholding relevant information would be purely self-serving: 1) to save time, or 2) to avoid losing the sale of one's services. 

The application of these principles to the case of abortion is readily apparent. As opposed to therapeutic abortions necessary to save a woman's life, an elective abortion is, by definition, never life-threatening. In the latter case the withholding of information is never justified. A decision to forego a previously desired abortion after learning of possible risks, even remote ones, is always reasonable.⁽¹⁶⁾ Indeed, the Supreme Court itself has found that abortion involves such emotional and psychological risks that a decision to forego a previously desired abortion may often be the wisest course of action.⁽¹⁷⁾

Primacy of the Reasonable Patient Standard

Abortion is a unique medical procedure.⁽¹⁸⁾ Certainly no medical procedure has involved more Supreme Court rulings which have defined its legal nature and the attendant duties and obligations of the physician. On one hand, the aborting physician is responsible for ensuring that his recommendation to abort will benefit the patient, given her unique circumstances and her physical and emotional makeup. On the other hand, the physician is also responsible for helping the patient to fully understand the basis for his recommendation, attendant risks, and alternatives so that she can independently re-evaluate the situation in the light of his disclosures.

With regard to this latter responsibility, the Court has clearly presumed that the informed consent standard which should be applied is the reasonable patient standard. "The decision to abort, indeed, is an important, and often a stressful one, and it is desirable and imperative that it be made with full knowledge of its nature and consequences."⁽¹⁹⁾ [Italics added]

This highest standard, which the Court calls "imperative," has been defined as applying to abortion in order to fully protect both 1) the freedom of women, and 2) health of women. These are precisely the two basic rights in which the Court has found a basis for creating the abortion liberty. Any informed consent standard less than the reasonable patient standard would jeopardize the rights of women as envisioned by the Court.

Thus, regardless of the prevailing standard for informed consent in a particular state, the Supreme Court has determined that a patient centered standard must be applied in abortion cases, if not in general, because this standard for full disclosure is integral to the "abortion liberty."

Provision of this information is necessary to "insure that the pregnant woman retains control over the discretion of her consulting physician."⁽²⁰⁾ The content of disclosure is to be measured not by what the physician deems to be important but by the right of the woman to make a fully knowledgeable choice, for "What is at stake is the woman's right to make the ultimate decision, not a right to be insulated from all others in doing so."⁽²¹⁾

To make this "ultimate decision" women must have access to all of the relevant information. It is not the right of the physician to "screen" information for her, but rather, in consultation with her, to help her fully understand his recommendation for abortion so that she can make an informed choice to accept or refuse his recommendation. To apply a standard based on anything else than the primacy of a woman's right to make a fully informed and free abortion decision undermines the constitutional framework in which the Court has labored to define the abortion right.

Law professor Joseph Stuart, J.D., argues that:

While several states do not accept the "reasonable patient" standard [in general], it seems clear that whatever standard was applied by a state court [in the case of a suit involving abortion] could not fall below the requirements of the abortion right. Furthermore, it would be reasonable to conclude that no standard could ignore the "imperative" of the Court that the abortion decision be made with "full knowledge of its nature and consequences," and that the pregnant woman retain control over the physician's discretion.

To take this line of reasoning a step further: if the factors to be considered should operate for the benefit of the woman and if she should have "full knowledge of the nature and consequences" of an abortion, then it seems that the needs of the patient-pregnant woman would determine the substance of the information disclosed. Therefore, a standard that held a physician only to some common medical practice (whatever that might be) or to some reasonable practice under the circumstances could very well fall short of the consultative model developed through the abortion cases.⁽²²⁾

If the abortion right is to be construed for the benefit of women, it is difficult to see how a woman's rights are harmed by use of the reasonable patient standard; on the other hand, it is abundantly clear that a woman's rights may be infringed upon by the self-serving "community standard" of the abortion industry. Without the freedom to be fully informed, a woman's right to choose is rendered meaningless. The withholding of information, therefore, is a violation of her civil rights as defined by the Supreme Court.

In their defense, abortion providers may argue that provision of detailed information regarding risks and alternatives is too burdensome. But because the right to choose is held by the woman, not the physician, "the fact that a duty 'makes his work more laborious' is not relevant. The determination that the information given is particularly dissuasive or persuasive is, likewise, not significant, since the duty is to inform and the assumption is that the woman can make the decision for herself."⁽²³⁾
 
 

The Scope of Disclosure

As a general rule, the more complex the treatment options and the more dramatic the risks, the more demanding are the disclosure requirements. This is especially true for elective procedures. For example, it may be reasonable to accept a physician's choice for a particular antibiotic without a lengthy explanation of every risk and alternatives to that prescription. But in the case of prostate cancer, which can be treated by drugs, surgery, or non-intervention, the patient would properly expect to receive much more precise and detailed disclosure of the risks and alternatives.

Because abortion is a very unique medical procedure, involving a very complex decision involving more medical, psychological, familial, social, and moral issues than any other form of surgery, the requirements for disclosure in this case are higher than for any other medical procedure. Indeed, the Court has raised the standard for disclosure to "full knowledge of [abortion's] nature and consequences."⁽²⁴⁾ This highest standard, which the Court calls "imperative," has been applied to abortion in order to fully protect both the freedom and health of women, which are exactly the two basic rights in which the Court has found a basis for the abortion liberty.

The scope of health risks which should be discussed prior to an abortion should also be consistent with the broad definition of health reasons upon which the abortion right was established, including physical, psychological, familial, and social complications.⁽²⁵⁾ Indeed, to be fully informed, the Court notes, disclosure should even include the effects of abortion on the fetus. This is evident in the 1992 Casey decision in which the Court stated:

It cannot be questioned that psychological well-being is a facet of health. Nor can it be doubted that most women considering an abortion would deem the impact on the fetus relevant, if not dispositive, to the decision.... [This information] furthers the legitimate purpose of reducing the risk that a woman may elect an abortion, only to discover later, with devastating psychological consequences, that her decision was not fully informed.⁽²⁶⁾

Furthermore, since abortion is an elective procedure, an abortion practitioner's opinion that one or another risk is not yet firmly established, or has not yet been adequately measured, does not relieve him of the responsibility to disclose to the patient that members of the medical community are concerned about this disputed risk. This is especially true because the abortion practitioner may be biased against believing in the reality of a certain class of risks, no matter how strong the evidence may be, due to his personal and financial interests in advocating for the abortion option. It is the reasonable patient's right to weigh the evidence for or against a contested abortion complication without paternalistic "screening." Indeed, because it is an elective procedure, women are entitled to the full disclosure of even theoretical risks, such as would be given in the case of experimental drugs.

Finally, it should be noted that all disclosures relating to potential risks should include reported complication rates for women undergoing multiple abortions. It is well known that the rate of both physical and psychological sequelae increases with each subsequent abortion. Since over 40 percent of abortions are for women who have previously had an abortion, this information is immediately relevant for a large number of patients. It is also relevant to women having their first abortion since they too may someday be in a position where they will be compelled to consider a subsequent abortion. They must understand that their decision today will affect the risks they may face if they subsequently choose to abort again. Furthermore, it is well known that many women seeking abortions will, out of shame, conceal a previous abortion from their counselors. A standard routine of disclosing risks for multiple abortions is the only way to insure that such "concealers" receive accurate information about the risks they face.

Review of Moral Considerations

Because the Court recognizes the relevance of fetal development to a woman's future psychological health,⁽²⁷⁾

we can also infer that abortionists might also be obligated to discuss the relevant moral issues of abortion with a woman. This may be especially true in cases where women have not fully explored their own moral views, and even more true when a woman's decision to abort is clearly contrary to her belief system.

According to bio-ethicist Daniel Callahan, a noted supporter of legalized abortion, reflection on the moral issue of abortion is in fact central to the idea of freedom of choice. "How can it make sense to favor the right of choice, but to be morally indifferent about the use of that right?" asks Callahan. While insisting that each woman must be free to make her own decision, he also insists that we must recognize the "moral seriousness of the abortion choice." Indeed, Callahan admits, "Nothing has so baffled me over the years as the faintly patronizing, paternalistic way in which, in the name of choice, it has been thought necessary to protect women from serious moral struggle. Serious ethical reflection...requires thinking carefully about the moral status of the fetus, and about the best way to live a life and to shape a set of moral values and ideals."⁽²⁸⁾

Such serious ethical reflection can in fact be considered an important prophylactic against post-abortion psychological sequelae. It is well known that women who have pre-existing moral conflicts with an abortion decision are significantly more likely to experience post-abortion maladjustments. It is entirely reasonable, and I would maintain, necessary in order to reduce post-abortion sequelae, to insist that women considering an abortion recommendation must confront and work through any moral ambivalence they have prior to the abortion. Unless the woman is able to honestly reconcile an abortion choice with her own moral beliefs, she is certain to experience post-abortion sequelae.

Even the director of the National Abortion Federation, Sylvia Stengle, has admitted in an interview with The Wall Street Journal that one in five women having abortions are doing so in violation of their own moral consciences. (This estimate is almost certainly low). Stengle says these women are a "very worrisome subset of our patients," and admits: "Sometimes, ethically, a provider has to say, 'If you think you are doing something wrong, I don't want to help you do that.'"⁽²⁹⁾ Stengle does not say how often, if ever, NAF abortionists actually take this ethical stand. Still, it is nice to have an NAF official admit that it is ethically necessary to refuse to do some abortions.

More Reasons for Full Disclosure

Women seeking abortions are often in a state of emotional turmoil, often under conditions of duress from other people, and with no prior knowledge of abortion's risks. Because of the intense urgency of their circumstances, it is all too easy to make a hasty choice just to "get it over with." This tendency for haste which too often leads to post-abortion sequelae⁽³⁰⁾ can only be corrected by ensuring that women take the time to learn every bit of information relevant to their decision.

Full disclosure is especially important for women who are very ambivalent about the abortion choice. Because the decision to abort is often tentative, or even undertaken solely to please others, "upsetting" information may be exactly what a woman is looking for as an excuse to keep her child when everyone else is pressing her into an unwanted abortion. In some cases, it may be far easier for a reluctant woman to resist a boyfriend who is pushing for an abortion by claiming that, "The doctor says abortion is dangerous." She may rightly feel that this argument, even if exaggerated, will be more effective than, "I want this baby, even if you don't."

The right of women to be fully informed is further accentuated by the fact that abortionists have historically shifted "basic responsibility" for the abortion decision to the patient. Rather than making a informed medical recommendations based on case by case risk-benefit analyses, abortionists have tended to provide abortions simply on request. Since abortionists cannot be trusted to do a complete risk-benefit analysis, especially if the patient is withholding relevant information, the importance of each patient doing her own risk-benefit analysis is much further amplified. In order to do this evaluation, the patient needs all of the relevant information which is available.

The Danger Of Bias In The Informed Consent Process

Research conducted at abortion clinics has also found that the majority of women seeking abortion have little or no prior knowledge about the abortion procedure, its risks, or fetal development.⁽³¹⁾ For most women, the counseling they receive at the clinic, is the only information they will receive about abortion and alternatives.

Research also shows that persons involved in a crises are especially vulnerable to being influenced, for good or ill, by third parties. This reliance on others, especially an authority figure who appears capable providing the stressed person an escape from her crisis, is called heightened psychological accessibility.⁽³²⁾

Because a woman faced with a crisis pregnancy is more vulnerable to the influence of authority figures, she is also more exposed to their prejudices. Thus, the only way to minimize the biases of abortion counselors is to hold them to the highest standards for full disclosure. If counselors instead introduce their own biases, the results can be tragic.

In a retrospective survey of 252 women who experienced post-abortion sequelae, we found that 66 percent of the woman said their counselors advice was very "biased" toward choosing abortion. This is especially important since 40 to 60 percent describe themselves as not certain of their decision prior to counseling, of whom 44 percent were actively hoping to find an option, other than abortion, during their counseling sessions. Only five percent report that they were encouraged to ask questions, while 52 to 71 percent felt their questions were inadequately answered, side-stepped, or trivialized. In all, over 90 percent said they were not given enough information to make an informed decision. These omissions are especially relevant since 83% said that it was very likely that they would have chosen differently if they had not been so strongly encouraged to abort by others, including their abortion counselor.⁽³³⁾

Examples of biased counseling are abundant. For example, when asked about clients who express a desire to keep their child, abortion counselor Betty Orr says: "I ask them who is going to take care of the baby while they're in school. Where are they going to get money for clothes?"⁽³⁴⁾ Other counselors bluntly tell the woman to forget the motherhood fantasy and "get realistic. Medical bills for having a baby will run over three thousand dollars. Do you have that kind of money? Raising a child is even more expensive. It costs over two hundred thousand dollars to raise a child right. Where are you going to get that kind of money?" This kind of "counseling" is little more than an way of reinforcing a young woman's feelings of powerlessness.

Faced with such antagonism, from parents, boyfriends, and their "health-care" advisors, is it any wonder that young women cave in to the unrelenting pressures to abort even when 60% to 80% would actually prefer to keep their babies?⁽³⁵⁾ Pressured into "choosing" abortion by Planned Parenthood counselors at the age of 13, Kathy Walker charges: "I felt like my family had no control over anything. My parents felt as deceived as I was; we never really made an informed decision. Planned Parenthood railroaded us...But nobody ever really asked me what I wanted to do."⁽³⁶⁾

In another case, an Indiana Planned Parenthood affiliate ignored the warnings of Kathleen Kitchen's own physician who believed an abortion could be fatal because she suffered from certain birth defects. Evading two court orders blocking the abortion, counselors procured a dangerous out-of-state abortion for the girl which resulted in hospitalization for abortion related complications.⁽³⁷⁾ These events demonstrate that a pro-abortion bias may overcome even the most basic evaluation of abortion's dangers for high risk patients.

When physicians or counselors withhold information because they fear the information will lead to an "unreasonable" choice for childbirth, they are reflecting their own bias into the decision making process, a bias that has no medical basis. Such bias is of special concern since the majority of abortion patients are ambivalent about their choice, with up to 84% saying they would have kept their pregnancies under better circumstances.⁽³⁸⁾

Furthermore, biased pre-abortion counseling can, in itself, be injurious. Substantial evidence suggests that inadequate, inaccurate, or biased counseling increases the occurrence and severity of negative post-abortion psychological reactions.⁽³⁹⁾

Understanding the Cause of Counseling Bias

There are many reasons for bias in abortion counseling. Some abortion counselors have a financial bias. They see themselves in the "business" of selling abortions.⁽⁴⁰⁾ Some act paternalistically, honestly believing that abortion is the best solution to every problem pregnancy.⁽⁴¹⁾ Still others have a psychological need to see other women choose for abortion as they once did, thus seeking affirmation of a choice which still troubles them on some deeper level.⁽⁴²⁾

Even more troublesome are those who see abortion as a tool for social engineering. Whether they seek to use it to reduce welfare roles, to eliminate the "unfit," or to save the world from overpopulation, these social engineers see some "greater good" which is served by abortion, and this greater good may be deemed of more importance than a "little guilt" or a "few torn uteruses" among the women whom they abort.

Some abortion providers of the social engineering mindset also have misogynist and racist attitudes. Such persons want to promote abortion to prevent "unfit" persons from raising "unfit" children. For example, Dr. Edward Allred, owner of the largest chain of abortion clinics in California is a staunch advocate of abortion as a method of controlling the population of minority groups:

"Population control is too important to be stopped by some right-wing pro-life types. Take the new influx of Hispanic immigrants. Their lack of respect of democracy and social order is frightening. I hope I can do something to stem that tide; I'd set up a clinic in Mexico for free if I could.... When a sullen black woman can decide to have a baby and get welfare and food stamps and become a burden to all of us it's time to stop."⁽⁴³⁾

Most of those who are ideologically committed to population control, however, are more circumspect in their rhetoric. But there is no denying the fact that the primary purpose of many "family planning" groups, such the Planned Parenthood Federation of America, is to promote a policy of population control. Any health care services it provides are subservient to that goal.⁽⁴⁴⁾

According to the PPFA's organizational documents, population control, "is a most essential step, if not the most essential step ... to solve the most critical problems of hunger, deprivation and the hopelessness of poverty, as well as deterioration of our water, land and air."⁽⁴⁵⁾ Other PPFA documents declare that population control is also crucial for bringing about world peace.

In their view, population control is a virtual panacea. It is so important that PPFA officials have frequently supported the right of governments to force abortion on women who become pregnant without government consent.⁽⁴⁶⁾ Even though they once lost U.S. funding because of this stance, PPFA's international affiliates continue to provide assistance to the Chinese government's program in which unlawfully pregnant women are "handcuffed, tied with ropes, or placed in pig's baskets" while awaiting their forced abortions.⁽⁴⁷⁾

Other examples of abortion proponents who support coercive population control, including forced abortion, are numerous. For example, Lawrence Lader, founder of the National Abortion Rights Coalition, and author of the pro-abortion tract Abortion (1966) which was cited as an authority eight times in Roe v. Wade, is also a radical proponent of coercive population control. Lader argues that forced population control is "imperative," both at home and abroad, claiming that "We must accept the principle that having a child is no longer a matter of private will, but of public welfare."⁽⁴⁸⁾ In a review of the Chinese program of forced population control which includes forced abortion, forced sterilization, forced contraceptive implants, infanticide of handicapped newborns, and infanticide of undesirable female offspring, Lader has only the highest praise.⁽⁴⁹⁾

Similarly, former N.O.W. president Molly Yard has defended the Chinese anti-choice policy, saying: "I consider the Chinese government's policy among the most intelligent in the world."⁽⁵⁰⁾

Persons or organizations who advocate coercion, privately or publicly, would certainly not hesitate to conceal or understate the risks of abortion. Indeed, such population control zealots have frequently defended the use of dangerous or insufficiently tested birth control technologies on the grounds that injured women are a "secondary" concern compared to "overpopulation."⁽⁵¹⁾

Since PPFA's organizational mandate is to reduce birth rates, here and abroad, especially among the poor, its "family planning" services are simply a means to that "all-important" end. It is no wonder then that patients report that Planned Parenthood's abortion counseling services are even more biased toward abortion then counseling at non-PPFA clinics.⁽⁵²⁾

If a few women, or even 80%, suffer minor to severe post-abortion trauma, population controllers may deem this a small price to pay for world peace, prosperity, and environmental purity. Abortion is an essential tool for population control, and many are willing promote it even if it means hiding its risks from their patients.⁽⁵³⁾

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1. Louisell & Williams, Medical Malpractice, Section 8.02 (1985); Stuart, "Abortion and Informed Consent: A Cause of Action," Ohio University Law Review, 14(1):1-20. 

2. Schneyer, Informed Consent and the Danger of Bias in the Formation of Medical Disclosure Practices, 1976 Wis. L. Rev. 124; Stuart, "Abortion and Informed Consent: A Cause of Action," Ohio University Law Review 14(1):1-20. 

3. Cooper v. Roberts, 220 Pa. Super Ct. 260,267,286 A.2d 647, 650 (1971). See also Wilkinson v. Vesey, 110 R.I. 606,624,295 A.2d 676,687 (1972). 

4. Canterbury v. Spence, 464 F.2d 772 (D.C. Cir. 1972) at 780. 

5. Ibid., 787-88. Also, "A risk is thus material when a reasonable person in what the physician knows or should know to be the patient's position would be likely to attach significance to the risks or clusters of risks in deciding whether or not to forego the proposed therapy." Canterbury, at 792. In short, any risk that could affect the decision must be disclosed. 

6. Canterbury, op. cit.; Wilson v. Scoll, 412 SW2d 299 (1967) 

7. Stuart, "Abortion and Informed Consent: A Cause of Action," Ohio University Law Review 14(1):9-10. 

8. Lewis, "How adolescents approach decisions. Changes over grades seven to twelve and policy implications," Child Development 52:538-544 (1981); Weithorn & Campbell, "The competency of children and adolescents to make informed treatment decisions," Child Development 53:1589-1598 (1982). 

9. Standards of care requiring full disclosure of risks, screening for medical and psycho-social risk factors, exploration of alternatives, and adequate time for consideration are set out in the following: M. Borton, "Induced Abortion" Obstetrical Decision Making, Second Edition, E. Friedman, et al., eds. (Philadelphia: B.C. Decker Inc., 1987); Ambulatory Maternal Health Care and Family Planning Services Policies, Principles, Practices, ed. F. Barnes, Committee on Maternal Health Care and Family Planning, Maternal and Child Health Association, American Public Health Association, Interdisciplinary Books and Periodicals for the Professional and Layman (1978). 

10. For a discussion of pre-abortion screening standards and the risk factors for which patients should be screened see Reardon, "Identifying High Risk Abortion Patients," The Post-Abortion Review 1(3):3-6, 1993. 

11. Fogal v. Genesee Hospital, 41 A.D.2d 468,473,344 N.Y.S.2d 552,559 (1973); and Bowers v Talmage, 159 So.2d 888,889 (Fla. Dist.Ct. App. 1963). 

12. Canterbury at 789. 

13. "The privilege [to withhold risk information which in itself would "present a threat to the patient's well being"] does not accept the paternalistic notion that the physician may remain silent simply because divulgence might prompt the patient to forego therapy the physician feels the patient really needs. That attitude presumes instability or perversity for even the normal patient, and runs counter to the foundation principle that the patient should and ordinarily can make the choice for himself." Canterbury at 789. 

14. Annas, The Rights of Hospital Patients: The Basic ACLU Guide to a Hospital Patient's Rights, (New York: Discus Books, 1975), 68. 

15. Ibid. 

16. "The very foundation of the doctrine of informed consent is every man's right to forego treatment or even cure if it entails what for him are intolerable consequences or risks, however warped or perverted his sense of values may be in the eyes of the medical profession, or even of the community, so long as any distortion falls short of what the law regards as competency. Individual freedom here is guaranteed only if people are given the right to make choices which would generally be regarded as foolish." Harper & James, The Law of Torts (1968 Supp.) section 17.1 at 61. 

17. "If the pregnant girl elects to carry her child to term, the medical decisions to be made entail few -- perhaps none -- of the potentially grave emotional and psychological consequences of the decision to abort." H.L. v. Matheson, 412-413. 

18. Casey, at 698. 

19. Danforth, at 67. The patients right to "full knowledge" is repeated in Akron 462 U.S. at 448. The medical profession has seen in these rulings a trend toward defining the physician's right to determine what information should be disclosed about risks and alternatives "only as an adjunct to the realization of patient's rights, and not as significant in themselves." Kapp, "Abortion and Informed Consent Requirements," Am. J. Obstetrics and Gynecology, 144(1):1-4 (1982). 

20. Danforth, 66. 

21. Casey, 715. 

22. Stuart, "Abortion and Informed Consent: A Cause of Action," Ohio Northern University Law Review, XIV(1):1-20 (1987), note 92. 

23. Ibid., 17, citing Whalen v. Roe, 429 U.S. at 604, n.33., and Canterbury 464 F. 2d at 789, and others. 

24. Danforth, 67; see also Casey, 718. 

25. For additional discussion of this principle, see Jipping, "Informed Consent to Abortion: A Refinement," Case Western Reserve Law Review 38:329-386 (1987/88). 

26. Casey, 120 L Ed 2d, 718-719; see also the discussion in Stuart, "Informed Consent," 18-19. 

27. Ibid. 

28. Daniel Callahan, "An Ethical Challenge to Prochoice Advocates," Commonweal Nov. 23, 1990, 685, 686. 

29. Junda Woo, "Abortion Doctors' Patients Broaden Suits," Wall Street Journal (10/28/94) B12. 

30. Landy, "Abortion Counseling", op. cit. 

31. Zimmerman, Passage Through Abortion,139. 

32. For discussions of heightened psychological accessibility of persons in crisis, see Gerald Caplan, Principles of Preventive Psychiatry (New York: Basic Books, 1964) and Howard W. Stone, Crisis Counseling (Fortress Press, 1976). 

33. Reardon, Aborted Women, 15-19. 

34. Linda Bird Francke, The Ambivalence of Abortion (New York: Random House, 1978) 179. 

35. Zimmerman, Passages Through Abortion, 139, also Reardon, Aborted Women, 16-18. 

36. Kupelian,"Abortion, Inc." New Dimensions, (October 1991) 14. 

37. Bond, "Mother Files $1 Million Lawsuit," National Right to Life News, October 23, 1986, p6. 

38. Zimmerman, Passage Through Abortion, 110-112,143; Reardon, Aborted Women, 11-20. 

39. Statistical analysis demonstrates that patient dissatisfaction with abortion counseling is a highly significant predictor (p<.0001) of severe psychological reactions after an abortion. Franz and Reardon, "Differential Impact of Abortion on Adolescents and Adults," Adolescence, 27(105):161-172 (1992); See also, Vaughan, Canonical Variates of Post Abortion Syndrome (Portsmouth, NH: Institute for Pregnancy Loss, 1990); and Steinberg, "Abortion Counseling: To Benefit Maternal Health," American Journal of Law & Medicine 15:4, 483-517 (1989). 

40. Zeckman and Warrick, "Abortion Profiteers," Special Reprint, Chicago Sun-Times, 1978. 

41. Reardon, 251-243. 

42. Reardon, Aborted Women, 256. 

43. "Doctor's Abortion Business Is Lucrative", San Diego Union, Oct. 12,, 1980 B1:1. 

44. Ample documentation of this can be found in the following: J. Kasun, The War Against Population: The Economics and Ideology of Population Control, (1988); A. Chase, The Legacy of Malthus: The Social Costs of the New Scientific Racism (1977); J. Simon, The Ultimate Resource (1981); G. Greer, Sex and Destiny (1984). 

45. Schwartz, "Bringing the Sexual Revolution Home: Planned Parenthood's 'Five-Year Plan'", America 138:6, 18 February 1978, 114-116. 

46. Planned Parenthood has frequently supported coercive population control. For example, at the White House Conference on Hunger in 1969, Dr. Alan Guttmacher of Planned Parenthood supported a national plan of (1) mandatory abortion for any unmarried girl found pregnant within the first three months of pregnancy, and (2) mandatory sterilization of any such girl giving birth out of wedlock for a second time. (E. Craven, "Abortion, Poverty and Black Genocide: Gifts to the Poor?", Abortion and Social Justice, eds. Hilgers, 235 (1972).) 

Similarly, Frederick Jaffe, Vice President of the Planned Parenthood/World Population and head of research for Alan Guttmacher, has argued for government population programs which would require "permits for children", "compulsory sterilization of all who have two children", "compulsory abortion", "encourage homosexuality", and "fertility control agents in water supply." (Family Planning Perspectives, Special supplement-U.S. Population Growth and Family Planning: A Review of the Literature, vol. 2, no. 4, October 1970, ff.p.24.) 

Planned Parenthood president Faye Whattleton has likewise promoted an us-against-them, rich-versus-poor mentality as motivation for population control at any price (Simon, 327). 

47. Kasun, 91. 

48. Lader, Abortion II: Making the Revolution, (1973) 218-222. 

49. Lawrence Lader, "The China Solution," Science Digest, 91:4, April 1983, 78. 

50. Transcript of "Oprah Winfrey Show," July 6, 1989. 

51. In 1970, Planned Parenthood President, Dr. Alan Guttmacher testified before a Senate subcommittee that the health dangers of the Pill are secondary to the social "dangers" of pregnancy and overpopulation. ("Expert Decries 'Alarm' on Birth Control Pill," New York Times, Feb. 26, 1970, 50:3) 

As another example, at a 1962 conference sponsored by the Population Council, the IUD was being promoted as the panacea for controlling the world's "overpopulation." Arguing that the risks of IUD use were acceptable, Dr. J. Robert Willson, of the University of Michigan School of Medicine defended its wide-spread promotion saying: "If we look at this from an overall, long-range view, perhaps the individual patient is expendable in the general scheme of things, particularly if the infection she acquires is sterilizing but not lethal." (Mendelsohn, Male Practice: How Doctors Manipulate Women, 120) 

Similarly, Dr. Ravenholt, head of AID's population control programs, defended the widespread promotion of Depo-Provera, despite initial negative results, on grounds that the ill-effects could not be fully ascertained until tested on tens of millions of women. (Ehrenreich, et.al., "The Charge: Genocide," Mother Jones, November 1979, 30) 

52. Reardon, Aborted Women, 18-20. 

53. While the sincerity of population controllers' beliefs is not questioned here, it is noteworthy that the myth of overpopulation has been thoroughly debunked. Indeed, the overwhelming benefits of population growth are only now becoming fully appreciated. (See the exhaustive works of Simon, Kasun, Chase, op.cit.) Notably, even population controllers admit that the evidence against their theories of overpopulation problems is impossible to refute, but they insist that their approach of forced population control is still a safer bet. (Hardin, "The Tragedy of the Commons," Science, December, 1968, 1243-1248) Hardin, incidentally, claims to have been the first to develop the rhetoric of a "woman's right to control her own body," yet in practice he too supports coercive population control programs, especially of "feeble-minded" groups, because "Injustice is preferable to total ruin." Ibid.
 

Copyright 1996 David C. Reardon. Excerpted with permission for from Making Abortion Rare: A Healing Strategy for a Divided Nation, published by Acorn Books, PO Box 7348, Springfield, IL 62791-7348 for internet posting exclusively at www.afterabortion.org. All Rights Reserved.