Should Docs Snitch on Their Clients? 

A measure to notify parents when teens seek abortions might reduce state abortion rates, but probably not in the way its backers intended.

Nearly two years ago, Livermore eighteen-year-old Holly Patterson died following an abortion induced by RU-486. Now she is literally the poster girl for a ballot initiative that would require parental notification for minors seeking abortions; we'll vote on it in November.

Patterson's smiling visage and distressing story adorn fliers downloadable from the Web site of Parents' Right to Know, the Sacramento group behind the proposed amendment -- its treasury branch, Life on the Ballot, is based in Oakland. Although a coroner ruled that Patterson died of septic shock caused by incompletely expelled fetal tissue, not the drug itself, her death fueled an ongoing movement by pro-lifers to restrict both RU-486 and teenagers' access to abortion (see "The Making of a Martyr," 12/17/03). If the measure passes, it will amend the state Constitution, requiring doctors to alert a pregnant minor's parent or legal guardian 48 hours before performing the procedure.

The initiative's backers admit their law wouldn't have saved Holly; she was legally an adult. But they say her death underscores a broader point: Teenagers need their parents' support when undergoing a major medical procedure, especially if something goes wrong: "Ear piercing, tattoos, all sorts of things in many states require parental consent, not just notification," says Albin Rhomberg, spokesman for Parents' Right to Know. "A field trip from school; giving medication to a student at school requires parental consent. Here you have a serious medical procedure with long- and short-term consequences for the child, and even the child's future children and reproductive health, and yet we have this peculiar situation in which the parent or guardian can be excluded."

Dealing with pregnancy is a life-changing event, he notes, and who is more likely to provide ongoing love and support: a parent, or a clinic paid to render a service? Camille Giglio, president of the Walnut Creek-based California Right to Life, says a teen pregnancy may be difficult for everyone involved, but revealing it will ultimately improve family relationships. "After the dust settles," she says, "I think parents would realize their daughter needs their help and do whatever would be the most helpful and positive for their daughter, and perhaps their grandchild."

Things aren't always that simple, however. The pro-choice camp says it's a mistake to assume that all teens live in happy nuclear families -- revealing a pregnancy could prove dangerous to some. Studies have shown that roughly 60 percent of minors who have abortions voluntarily tell a parent, and those who don't often have a good reason. "The law sort of retains this traditional notion that there is a mom and a dad and that everything is really functional, and that mom and dad have the best interests of the kid at heart and that they're supportive in a firm way -- this sort of Cleavers idea of what the modern family is like, and that's just not what I see," says Dr. Nancy Palmer, a resident physician at a Martinez hospital clinic, and member of Physicians for Reproductive Choice and Health.

Some of her clients are abused at home, Palmer says, and fear that revealing the pregnancy would make the violence worse. Or they have parents who abuse drugs or alcohol, or who simply aren't around. Palmer says her clinic often sees children of immigrant families with one or both parents still living abroad, or teens being raised by other relatives while the parents -- still the legal guardians -- are peripherally involved. Acrimonious divorces, ailing parents; there are many reasons a girl might want to keep her condition on the down-low. To the measure's opponents, the worst-case scenario is when the girl's father is the one who impregnated her. In any case, how can a physician know that informing a parent won't worsen her patient's fate?

"I have no idea what kind of risk I'd be exposing a woman to -- if she's going to go home and be beaten within an inch of her life when I tell her father," Palmer says. "Is she going to be put out of her home? I do not want to be the doctor who has to make that call." For similar reasons, the American Medical Association and the American Academy of Pediatrics believe that doctors should encourage girls to involve their parents whenever appropriate, but say it shouldn't be mandated.

The initiative's supporters dismiss these concerns as speculative. "You can't make a law that is only written for the most severe hard case you can think of," Rhomberg says. "A lot of people have suffered terrible deaths because of seat belts. ... Hundreds of children have been killed by airbags. But nobody has campaigned against seat belts and airbags." He also points to the measure's "judicial bypass" clause, which would let teens confidentially petition a juvenile court for a waiver; the court would be required to hear the case within two working days and rule on it one day later.

But if teens feel they can't tell their parents, the measure's foes argue, why would they tell a judge? Girls will simply skirt the law, they say -- they'll go to another state, try to self-induce an abortion, or get one from an illicit provider. The most likely result, opponents say, is that California teens will simply have their abortions later in pregnancy, and that poses its own set of dangers. The risk of death for women getting an abortion -- although far lower that of carrying the pregnancy to term -- increases about 30 percent per week of delay, according to Stanley Henshaw, a senior fellow at the Alan Guttmacher Institute. Prior to eight weeks of gestation, it's one in a million. But sixteen to twenty weeks in, the risk is one in 29,000. "We all know how slow the court system can be on an everyday basis, and even if they rush, it's still slow a great deal of the time," Palmer says. "In a pregnancy, you don't have weeks."

And now for the million-dollar question: Does parental notification reduce teen pregnancy or abortion rates? More than half of the states, after all, have active notification or consent laws. (California is one of ten other states whose parental notification laws were struck down by the courts -- ours was passed in 1987 and upheld in 1996 by the state Supreme Court, which then reversed its decision the following year, ruling that the law violated a teen's right to privacy.) But the evidence to date is scant, and ambiguous enough that both sides claim it supports their case.

Teen abortion rates have indeed dropped in some states that enacted such laws. Some studies, however, conclude that these decreases are offset entirely by teens traveling out of state for the procedure. This suggests that notification laws simply delay abortions. Indeed, the California Legislative Analyst's office predicts the measure could cut state abortion rates by up to 25 percent, in part by forcing girls to seek them elsewhere. One national study published in 2003 suggested that parental involvement laws also lower abortion rates by increasing contraceptive use by teens, but not by curtailing their sexual activity. But parental notification opponents point out that California's teen pregnancy rates have already fallen 40 percent over the past decade without laws that mandate parental involvement or abstinence-only sex ed.

To skirt the state Supreme Court ruling, backers of parental notification have long sought to change the California Constitution, whether via the Legislature (not likely) or by ballot initiative. Attempts to put parental notification on the ballot in 1998, 1999, and 2003 didn't get far, but weak voter turnout in 2002 lowered to just 600,000 the number of signatures needed to get a measure on the 2005 ballot. So this year, with the backing of three men with long histories of bankrolling pro-life causes -- winemaker Don Sebastiani, Domino's Pizza founder Tom Monaghan, and newspaper owner James Holman -- Parents' Right to Know got what it wanted.

Most alarming to Amy Everitt, who runs advocacy group NARAL Pro-Choice California, is the language -- "a child conceived but not yet born" -- the measure uses to describe a fetus. "Once you put 'life begins at conception' in the Constitution, it can unravel every other privacy law and pro-choice law that we have in the state," she says. "California could go overnight from being the most pro-choice state in the country to the least."

Proponents insist -- perhaps disingenuously -- that this isn't a referendum on abortion, just an attempt to protect young women's health. "We recognize that this is not going to be an end-all and be-all for solving every single problem of every single family," Giglio says. "It's kind of a foot-in-the-door situation where we are hoping to open the door between parents and child." Trust and sympathy, counter the measure's critics, cannot be produced by fiat. "I don't care how many laws you pass," Everitt says. "You can't force family communication."


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