Virginia’s medical gauntlet

Oh, Virginia.  It may be pretty, but I’m so glad I don’t live there.

Over at the main page, Patrick has already noted its new law that requires women seeking an abortion to undergo an ultrasound before being allowed to proceed.  One presumes this is intended to make the decision as psychologically difficult as possible by confronting the women with the visual evidence of the fetus that would be destroyed.  While I do not endorse this particular tactic, I can at least understand why those who believe abortion to be murder might support it.  Making the fetus (or, if one prefers, baby) less of an abstraction and more of a life that is about to be destroyed could, one might argue, make the woman less likely to have it killed.  The intent of the law seems unduly coercive to me, but I’m not ardently anti-abortion.

What makes me recoil from the law is the particular detail that Patrick also found repellent.  In order for the ultrasound to visualize the fetus at the gestational age at which the overwhelming majority of abortions would be performed (<12 weeks), a pelvic ultrasound would be necessary.  Pelvic ultrasounds require the use of a vaginal probe.  “Vaginal probe” means exactly what you’d think it means.  The instrument is a long wand with a somewhat bulbous end.  Deracinated from the ultrasound machine, one could easily mistake it for what is often euphemistically called a “marital aid.”  Women seeking abortions in the commonwealth of Virginia are now required to submit to being penetrated thusly.

This is a disgusting law.

I have long found the pro-choice rallying cry of “my body, my choice” to be a blatant example of begging the question.  Opponents of abortion do not agree that the fetus, though contained within the woman’s body, is actually part of it.  They argue that the woman and the fetus are separate entities, each with their own separate (though necessarily entwined) rights.  One can still be pro-choice (as I am) while questioning the validity of the “I should have the right to do what I want with my own body” argument.

You know what is inarguably part of a woman’s body?  Her vagina.  And it is appalling that any state feels it can force a woman to allow her vagina to be penetrated if she wants a procedure of which it disapproves.

To my mind, this appears to be nothing more than the government of Virginia’s attempt to make abortion an ordeal for the woman, in the truest historical sense of the term.  As a pediatrician and specialist in adolescent medicine, I am generally loath to order pelvic ultrasounds on virginal teenage girls, as the procedure is likely to be very unpleasant for them and potentially traumatic, and is thus very narrowly indicated.  I am horrified that the good people of the Virginia legislature find women seeking abortion so unworthy of their own dignity that they feel it meet and proper to force them to undergo a needless and invasive medical procedure involving penetration of their vaginas in an effort to dissuade them from terminating their pregnancies.  While I do not style myself a legal scholar, this seems a flagrant violation of the “undue burden” standard as laid out by Sandra Day O’Connor.  I hope it meets a speedy judicial demise.

I can understand why those stridently opposed to abortion might want to make it as difficult and burdensome to obtain as possible.  But stripping women of their right to refuse the insertion of an instrument into their genitals for the purpose of changing their minds is coercive in the extreme.  This law is a blight on the state and the country as long as it is allowed to stand.

Russell Saunders

Russell Saunders is the ridiculously flimsy pseudonym of a pediatrician in New England. He has a husband, three sons, daughter, cat and dog, though not in that order. He enjoys reading, running and cooking. He can be contacted at blindeddoc using his Gmail account. Twitter types can follow him @russellsaunder1.


  1. … I kinda wanna do a guest post… Entitled “How to save Babies, and Have More Abortions!” It’s kinda running off a TVD line “anything that isn’t murder is okay, so long as it saves babies.” That, and I’m kinda sick and bloody tired of people yelling, when they could be doing something Productive!
    (you interested? if so, drop me your e-mail)

  2. If the anti-choicers were really interested in informed consent, they’d be satisfied with showing women someone else’s ultrasound at the same gestational age. That should tell a woman everything she needs to know, even if you grant the dubious premise that an ultrasound tells a woman anything morally relevant about whether she should continue a pregnancy. Forcing all women to ritualistically view their own ultrasounds as a precondition of abortion is about shaming, not educating.

    If women are rational moral agents, it should be more than enough to tell them the facts about embryological development and show them pictures. There should be nothing special about seeing your own ultrasound compared to an ultrasound of an embryo of the same gestational age.

    • Lindsay,

      Agreed. The question is whether humans–not just women–are rational moral agents in this case, or whether we respond to ultrasounds irrationally. Speaking as a guy, I know I was never moved by an ultrasound until I saw one of my own first child.

      Don’t get me wrong, I’m not arguing against you. If we humans are rational (and my normal operating mode is to assume we are), then your argument is perfectly correct. But what if, at least in certain domains, we are not?

      • Then there is no fucking pr0blem and they ought to leave the fucking ultrasound out of it.
        A pregnant woman already has to fight her own fucking body to get an abortion… she shouldn’t have to “have her heartstrings” pulled, in some vague attempt to get the “more sensitive” gender to umm… “act more like a woman.”
        The last sentence may mischaracterize other people’s views. Don’t bitch, it is the thought of a considerable number of people on that side.

  3. If ultrasounds “work” on a non-rational level, the state should never force anyone to look at them.

    It’s one thing to say that you have to provide information so that a person can make their own decision. It’s another to say that you have to expose someone to stimuli that are calculated to subvert their rational decision-making. That’s the essence of propaganda.

    As rational people, we plan in advance to keep ourselves away from stimuli that will derail our plans by circumventing our intentions. I know I shouldn’t adopt a cat right now, so I know better than to spend my free time holding kittens!

    If I know this isn’t the right time for me to have a baby, I know better than to look at ultrasounds that might distract me from my well-laid plans. It’s wrong for the state to force me to look at propaganda ultrasounds.

    • Being human is more than just cold cold reason. See CS Lewis, “Men Without Chests,” the modern person where cold reason is all there is, no heart.

      The Abolition of Man.

      • Yes. Yes it is. However, a “for the children” argument is foul play, and so is this.
        “Aww, look at how cute it is…” should not be an argument for irrational decisionmaking.
        I’d bitch less about this if our foster care system worked better (and our “woman is pregnant” system as well).

        How much are you willing to pay, per baby, TVD?

    • If ultrasounds “work” on a non-rational level, the state should never force anyone to look at them.


      • I disagree. While I’m not so sure about this particular use of irrationalism, I do not think that appeals to emotion or other irrational facets of human existence are necessarily out of place in the hands of the state. An appeal to patriotism to encourage people to join the military, for instance, is a perfectly valid think for the government to make.

        • Expected appeal to make doesn’t = valid appeal to make. Of course the government would use patriotism for military recruiting, they want people to see joining the military as a way of doing your part for your fellow citizen rather than as submission to fight and potentially die/be scarred physically and/or mentally on the orders of political operatives wh0 have motives of their own that may not overlap.

          • I fear that I’ve articulated myself poorly. The emotional appeal of “don’t abort your baby, this is what your baby looks like” is distasteful to me, but the reason for my distaste is not that the pitch appeals to emotion rather than reason.

    • “It’s another to say that you have to expose someone to stimuli that are calculated to subvert their rational decision-making.”

      That’s hilirious! The only rational decision is to….ABORT!!

      • I don’t understand the distinction between rational and non-rational here. In medicine, there’s always a normative element.

        • At the outset, let me say that I think abortion should be legal. I also don’t think the sate should be in the business of compelling women to undergo ultrasounds. But your rationale is not why.

          I don’t think there is any major medical and/or child-bearing decision wherein one should not consult one’s emotions. Emotions are part of practical rationality. Visual information conveys something that nothing else can – how baby-like the baby is. And I do think that’s relevant to informed decision-making.

          • You can show what an embryo or fetus looks like at different stages of development without forcing a woman to have a transvaginal ultrasound just so she can look at it.

            Virginia women who have decided to abort have already grappled with their feelings. It would be condescending to assume otherwise. If I’ve already decided, intellectually and emotionally, that it’s irrelevant what my pregnancy looks like on an ultrasound, it’s completely inappropriate for the state to try to browbeat my into changing my mind, especially if this head trip involves forcing me to undergo an invasive and unnecessary procedure.

            Once a woman has decided that she wants an abortion, the state has no business forcing her to submit to a propaganda ultrasound in an attempt to subvert her decision.

            In this case “informed consent” is just a figleaf for coercion.

  4. Burt: my remark was more meant to question your view of emotional appeals in general. Calculating cynicism can still be behind the curtain — honestly, I’m inclined to assume it usually is.

  5. If the state wants to appeal to our emotion through commercials (which we can switch off) or rallies (which we’re free to blow off), that might be acceptable.

    It’s definitely not OK for the state to make everyone who shows up at the ER watch a military recruiting video before they can get the care they came for.

  6. I’ve got to say, in my several pregnancies that have been classified as high risk, I’ve had an unseemly amount of early ultrasounds. It’s really not a big deal (unless one is a rape victim).

    That said, I think the state should not be ordering unnecessary medical procedures. I just don’t think it matters whether it’s vaginal penetration or venipuncture.

    • It is painful, yes? I don’t think the government should be forcing unnecessary pain onto people for no goddamn reason other than a “fat chance.”

    • I’ve obviously never had a pelvic ultrasound, so my experience with it is going to be limited. That said, I respectfully disagree that it is uniformly not a big deal for everyone who has one. By way of a parallel, I’ve done several hundred pelvic exams on teenage girls and young women in my career. Same examination, same examiner. For some of these patients, it was easily tolerated and over quickly. For others it was a very difficult and uncomfortable examination, requiring lots of time, explanation and patience. I think many women might find the experience of a pelvic ultrasound unpleasant, particularly if they know it is being done in an effort to dissuade them and for reasons other than their choosing.

  7. Kimmi – I didn’t find it at all painful, and less uncomfortable than a typical pelvic exam (no speculum!). But Dr. Saunders obviously has wider experience. And, as I said, I don’t think it matters how uncomfortable it is.

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