Ramona Grigg

Ramona Grigg
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I'm a liberal woman from Michigan's Upper Peninsula, old enough to remember where I was when FDR died. My website, Ramona's Voices, was first published on the afternoon of Barack Obama's Inaugural after hearing his call to service. I include many voices much more eloquent than mine, because one voice isn't enough. Liberal-leaning with humor, except when the days are too dark and the enemy is too strong. Then it's war.

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MARCH 22, 2012 9:36AM

About those Ultrasounds: What if Doctors just say no?

Rate: 18 Flag
  I've been wondering--haven't you?--why primary care physicians, and especially OB/GYNs, aren't speaking out about the current creepy Rightward trend toward using ultrasounds as punishment against women who dare to sign up for an abortion.  Turns out some of them are.

They're angry, they're anguished, they're dumbstruck.  (Join the club.)  And they're speaking out anonymously--sadly--because we live in a country where medical doctors can no longer talk freely about abortion, a legal medical procedure, without fear of retribution.

This from a post called "Civil Disobedience" by palMD at his blog, White Coat Underground. (Take a few minutes to read some of his other posts while you're there.  Good stuff.):
"In the case of abortions, where time is essential and providers may not be easy to find, delays in care are unconscionable.  To enforce a waiting period violates the doctor’s ethical duty to provide appropriate, timely care and to avoid causing the patient unnecessary grief.  The law forces us to violate our ethics. To force us to perform ultrasounds, transvaginal or otherwise, is battery.

No procedure can be performed on a patient without their informed consent.  To make another important procedure contingent on an unnecessary one is a clear violation of medical ethics. Abortions can be safely performed without sonography, and should be unless their is compelling medical reason to perform one—with the patient’s consent.  To say that a woman can always refuse the ultrasound as long as they refuse the abortion is an immoral argument, one which removes all autonomy from the patient, and forces a doctor to make unreasonable choices."
 Another caring doctor used John Scalzi's blog, "Whatever", to lay out a plan for civil disobedience.  He says, in part:
"I do not feel that it is reactionary or even inaccurate to describe an unwanted, non-indicated transvaginal ultrasound as “rape”. If I insert ANY object into ANY orifice without informed consent, it is rape. And coercion of any kind negates consent, informed or otherwise.
In all of the discussion and all of the outrage and all of the Doonesbury comics, I find it interesting that we physicians are relatively silent.

After all, it’s our hands that will supposedly be used to insert medical equipment (tools of HEALING, for the sake of all that is good and holy) into the vaginas of coerced women.

Fellow physicians, once again we are being used as tools to screw people over. This time, it’s the politicians who want to use us to implement their morally reprehensible legislation. They want to use our ultrasound machines to invade women’s bodies, and they want our hands to be at the controls. Coerced and invaded women, you have a problem with that? Blame us evil doctors. We are such deliciously silent scapegoats.

It is our responsibility, as always, to protect our patients from things that would harm them. Therefore, as physicians, it is our duty to refuse to perform a medical procedure that is not medically indicated. Any medical procedure. Whatever the pseudo-justification.

It’s time for a little old-fashioned civil disobedience."
 He then offers a five-step plan designed to keep physicians from ever having to perform an unwanted ultrasound on a female patient, starting it off with a bang:
  "1) Just don’t comply. No matter how much our autonomy as physicians has been eroded, we still have control of what our hands do and do not do with a transvaginal ultrasound wand. If this legislation is completely ignored by the people who are supposed to implement it, it will soon be worth less than the paper it is written on." 
And ends it with a bigger bang:
"It comes down to this: When the community has failed a patient by voting an ideologue into office…When the ideologue has failed the patient by writing legislation in his own interest instead of in the patient’s…When the legislative system has failed the patient by allowing the legislation to be considered… When the government has failed the patient by allowing something like this to be signed into law… We as physicians cannot and must not fail our patients by ducking our heads and meekly doing as we’re told.  Because we are their last line of defense."
Alrighty then.  The man has a way with words, doesn't he?  He's actually echoing more forcefully the guidelines already set long ago by the American College of obstetricians and Gynecologists--the very guidelines the state of Virginia so clearly and consciously aims to violate. ( The story here by Rick Unger in Forbes.).

In 2009 ACOG reaffirmed their recommendations on non-medical ultrasounds:
"The American College of Obstetricians and Gynecologists (ACOG) has endorsed the following statement from the American Institute of Ultrasound in Medicine (AIUM) discouraging the use of obstetric ultrasonography for non-medical purposes (eg, solely to create keepsake photographs or videos) (1):

The AIUM advocates the responsible use of diagnostic ultrasound. The AIUM strongly discourages the non-medical use of ultrasound for psychosocial or entertainment purposes. The use of either two-dimensional (2D) or three-dimensional (3D) ultrasound to only view the fetus, obtain a picture of the fetus or determine the fetal gender without a medical indication is inappropriate and contrary to responsible medical practice. Although there are no confirmed biological effects on patients caused by exposures from present diagnostic ultrasound instruments, the possibility exists that such biological effects may be identified in the future. Thus ultrasound should be used in a prudent manner to provide medical benefit to the patient."
 Of course, the states advocating this unprecedented invasion into women's lives aren't in the least impressed by protestations from anybody not connected with their own Koch-fueled, pseudo-religious circles--not even the medical pros, who are, you know, medical professionals.

According to the Guttmacher Institute, as of March 1, 2012:
  •  11 states require verbal counseling or written materials to include information on accessing ultrasound services.
  • 20 states regulate the provision of ultrasound by abortion providers.
  •  7 states mandate that an abortion provider perform an ultrasound on each woman seeking an abortion, and require the provider to offer the woman the opportunity to view the image.
  •  9 states require that a woman be provided with the opportunity to view an ultrasound image if her provider performs the procedure as part of the preparation for an abortion.
  •  5 states require that a woman be provided with the opportunity to view an ultrasound image.

There are signs that some state legislatures may be rethinking their actions (Idaho, for instance), but it's a cinch they're only rethinking them in order to get around any detours to their goals.  When they come up with something this nutty in the first place,  the chances that either common sense or common decency will prevail are slim to none.

So how do we get through to them?  We can't shame them; they're shameless.  We can't shun them; they're in charge.  But we can raise our voices in decibels loud enough to be heard above the din of old-testament retribution disguised as modern-day government.

This was never how it was supposed to be.

(Crossposted at Ramona's Voices)

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You know, I actually hadn't thought about the role that doctors would play in all this. I'm so glad to know that there are doctors who are objecting to this, and planning to take a stand. Excellent post.
The decibel level has increased so that some legislation has been tabled, other has been withdrawn for review and amendment, and some has gone down in defeat... keep up the noise.
Happy to hear that physicians are speaking up about this outrage so many of us cannot believe is happening in the second decade of the 21st century.
Considering how many of the proposed changes have been withdrawn or modified, it appears that they are realizing their folly. It is not over, but at least it seems the tide is turning. Informative post. Thanks for fighting the good fight.
It's a wonderful thought, but the idea that a doctor would risk his license and jail time to protest this truly idiotic law adopted by fools strikes me as an audacious hope.
Tom: I am a bit more optimistic about physicians. They are one group of professionals with substantial loot, clout, and organization to effectively resist demands that clearly contravene all thier ethical and professional standards. We shall see. I cetainly hope they will!
Never mind the doctors - where are the lawyers? Surely at some level this mandating of an unnecessary invasive procedure must violate the Constitution? Not that I have much faith in the Supreme Court in its current configuration, but shouldn't someone be suing the hell out of all these states that are passing these reprehensible statutes?
GeeBee, lawsuits are important. But they take time. Some groups in TN successfully challenged a restrictive abortion law, but it took eight (8!) years for the case to wind its way through the court system.
Yes, I think it's going to have to be the doctors who will have to just say "no". It's not as if they don't have justification. Medical necessity is what it's all about. Ultrasounds as deterrents or punishments don't apply.
I tend to be the eternal optimist but I really do think they've gone too far this time. The states that are still trying to get their phony laws passed just haven't caught up yet.

There's no pretending it's anything but what it is--an attempt at intimidation. This is not what we elect lawmakers to do.
Keeper. I met a medical student via farm folks.
She's hasn't decided if She be a OBGYN or what.
She was delightful. I sake for her. Excellent read.
The present Lawmakers?
What are they good for?
Absolutely nothing IMO.
Their are some? I hope.
But,
if you ever saw K-street?
It's pathetic. Very Wastrel.
I use to see K- street weekly.
I had read about K- Lobby.
To see with your eyes. Sad.
They are cracked kooky. Sad.
They would not tape Duck-
Tape . . .
Fix thee
Liberty Bell.
They Flaunt.
Wear Silks.
Waddle butt.
Wear tailored:
shirts, britches,
and underpants?
I watch and ask?
I get sad. Grieve.
The lawmaker do:
court & curtsy too.
I heard they drink:
`
a bottle of French
cognac (aged) for:
`
$7,000 and lobby.
I use to gag to hear:
They sip wine that's
$350.00 a jug. Oy!
`
They dress silly too.
I'd rather dress like:
a hick or Tinkerbell.
`
a piglet who oinks
a gulps at troughs
I mean Ya get sick
They dogs that go
barf & lap up `gin

apology - I saw that
It always makes me
a feel like vomiting

I know it's dinner grub time
my sincere Homer apology
apology . . . typo.
She's not `sake bibber.
I meant `I'll save.
`
If normal folk go o K- street?
fie example - farmer market
Venders . . .
`
They go to a French restaurant
and ask what entrees come with
French Fries with K-mart cheese?
You know . . .
A can of cheese.
Take a can of:
Whipped Cream.
Toss at Politicos.
Spread cream on"
Nose, toes, cheeks.
tease . . .
This guy can be my Ob-Gyn ANY day! I hope he inspires his colleagues, as well. And I hope more doctors will raise their voices and refuse to comply.

In the meantime, we need to speak out, shout out do whatever we can to stand up to elected bullies who appear to have lost all sense of proportion or decency.

If you wouldn't call a medically unnecessary vaginal probe used for the single reason to cause shame and humiliation to the patient "Intrusive Government" what the hell WOULD qualify???

rated
First a question. Do the two doctors you quoted even do abortions? It's great for him to make grand statements as long as they apply to his practice.

Next there is no way that a doctor is going to make a regular practice of doing, or not doing, something that will risk his license. Unlike what one of the comments doctors are broke. The years and money it took to get to the point where you can practice is staggering.

They won't break the law, they will just quit doing abortions.
@Art James, interesting comments. Like poetry only better. Thank you.

@Catlion, I don't know if either doctor does abortions. What they were objecting to was the use of ultrasounds for reasons outside of medical necessity. They made it pretty clear that they would protect a woman's right to privacy and good medical care.

I think the part about destroying papers is a bit of hyperbole. You're right that no physician is going to jeopardize his career by doing something illegal or unethical, no matter how good the cause.

I didn't see anything there that would indicate the end of abortions. Just the opposite, in fact. The MDs wouldn't be stepping forward and objecting to pre-abortion ultrasounds unless they believed in that procedure. They would instead be siding with those who see this as the perfect excuse to end Roe v. Wade.
"They're speaking out -- anonymously."
That's not speaking out. As noted elsewhere in the comments, doctors have a lot of clout. And, it would appear, they feel they have a lot to lose. All the big talk quoted here is easily dismissed. Doctor X is being forced to violate their ethics? Do something, doc! In every social conflict of the last 50 years, the only folks who had an impact were those who were willing to take a risk by taking action.
RV

"I didn't see anything there that would indicate the end of abortions."

It's so simple. They won't do a medical procedure that is unnecessary. They won't break the law and risk their license. There is only one other option. That's to not do the abortion. That's the only 3 options that they have. But no, it didn't say end abortion but that is the logical conclusion when the other options are jail or unemployment.

Unless they do abortions it's easy to make grand statements. It's like those in the $30,000 income range yelling tax the rich. It's easy since they are not likely to get there. If you want to make grand statements, make them about something that will hurt your life.
As far as I know, most physicians don't actually do ultrasounds themselves. I have ordered many ultrasounds, including pelvic and occasional transvaginal (if abdominal isn't sufficient for imaging), and it is done by a tech. Of course, these are diagnostic. An OBGYN performing a surgical abortion would need to know how to do one if there was a reason- like identifying a tubal pregnancy- but they aren't typically necessary or present. I can't imagine any physician who is willing to perform an abortion would suddenly throw compassion for their patient out the window because some dickhead in congress decided to tell them, again, how to do their job. How would this even be enforceable?
"In the case of abortions, where time is essential and providers may not be easy to find, delays in care are unconscionable."

This makes no sense. If an eye doc gets 20 new patients in the office today and they all need cataract surgery, they will all be told they need 3 days of eye drops prior to surgery. All 20 will say OK, I want surgery in 3 days. Obviously the doc time and the clinic time will not be available in 3 days for all of them. If no drops are needed all 20 will say I want it tomorrow. Same problem. While checking my first eye my doc recently asked if I wanted my 2nd eye done in 3 days. I said sure. He nurse said, sorry the clinic is not available in 3 days. And on the 4th day the clinic was available but not the doc. See how that works (or doesn't work) regardless of the medical need to wait.

And certainly if someone needs their vision saved with immediate surgery the doc won't require the patient wait for 3 days while taking antibiotic drops. They will save the eye and worry about infection after.

There is no guarantee that under today's laws that a woman can get scheduled any sooner. It is a mathematical/logistical problem. It does not change regardless of the length of required wait time after the decision is made. Everyday x number of people make the decision, x number of docs are providers. If the wait is 3 days it simply means that x number of procedures are desired in 3 days instead of today.

In the case of an emergency like pre eclampsia, where a woman can die if the infant is not immediately delivered/aborted (which ever the case may be) I have to believe there will be no such exams or waiting. The only limitation would be how fast she can get to the hospital if not already there. Even if suspected, it can come on quickly and minutes will matter. No way any doc , law or not, is going to let a woman die in the bed while waiting for an ultrasound.
@Jeremiah, there is an urgent need to hear from the medical profession on this issue, and up to now they've been silent. Whether they speak out anon. or with a name and a face, the point is, they're voicing their views about lawmakers forcing ultrasounds on women.

Legitimate protests from professionals in the field have far more clout than those of the rest of us. I don't see how you can dismiss what physicians are saying, or what ACOG and AIUM are saying. Anything they can do to highlight how wrongheaded those decisions are can only be a good thing.

@Catnlion, again, I think you need to look at the larger picture. This is big because we're hearing from the medical profession for the first time about an issue that directly affects how they do their jobs.

Of the hundreds of thousands of physicians in the U.S only a small percentage do abortions. The fact that doctors with no stake in the game are coming forward to voice their opposition to the ultrasound laws should be an indication that this isn't going away. This is just the beginning. What happens next is anybody's guess, but I see this as a huge step forward.

@Oryoki Bowl, I agree with you. If the medicos join together and make it clear that this is not how the medical profession operates--and will not operate--the lawmakers will have to back down. It's happening already. And yes, it's the techs who do the actual ultrasounds usually, but a doctor has to prescribe them. They're ultimately responsible for having the ultrasound done, no matter who runs the machine.

@Joseph Cole, your argument is specious. Yes, there often are unavoidable delays in patient care, but obviously the quote is directed at needless delays. State-ordered ultrasounds for no medical reason constitute the kind of red-tape delays that are, in fact, unconscionable.
Most doctors are fairly bright and will have no problem requiring a patient to face the consequences of her arguably life-ending choice.

Those who object can refuse and face the legal consequences. The medical profession is better without them.
Given that forced pregnancy/childbirth is a violation of human rights, a form of torture per the UN Convention on Torture, and a crime against humanity per Article 7(g) of the Rome Statute of the UN, I would like to know WHY doctors are OK with this. Please see my recent article on forced pregnancy/childbirth as a human rights violation here and let me know your thoughts, please: http://open.salon.com/blog/jacqueline_s_homan/2012/03/23/women_are_the_last_slaves_to_be_freed
@ Gordon Osmond says: "Most doctors are fairly bright and will have no problem requiring a patient to face the consequences of her arguably life-ending choice."

Good lord, what does that even mean? What consequences? An ultrasound? What consequences do you have in mind for the man who got her pregnant? (You do understand, don't you, that a man was involved?)

Your comments on this subject are too silly to be taken seriously. Your notions about the very private decisions on abortion are straight out of the Cave Man Comix.

"Face the consequences" tells me all I need to know about where you're coming from. I suggest you go back there. You'll be much happier.
I appreciate the discussion. While we wait for our society to come out of the middle ages there is much we physicians can do, and so can non-doctors. Since we're never going to convince Santorum voters, we can lobby our politicians, but we can also ask doctors' professional organizations what their official stances are, pressure them to take a stand.
Doctors can speak out, but so few of us can do abortions ourselves.
@Pal MD, thanks so much for joining in the comments here. And thank you for standing against these hateful laws designed to do nothing more than punish and humiliate women who have had to make an already difficult decision.

The medical profession, as one voice, can do more than millions of us combined. If the states can legislate something as egregious as unnecessary, non-medical ultrasounds and get away with it, there's no telling where they'll go from here.
@ Joseph Cole: The "Let Women Die" Act was passed by Congress last year without a peep from those who swear to "first do no harm." All I heard was crickets from this bastion of white upper-middle class male privilege.

Many doctors are more than willing to let women suffer in physical and mental agony, facing death as they bleed out from pregnancies gone awry, while deliberately doing nothing because they put their pious patriarchal "moral beliefs" ahead of the life, health, and wellbeing of the pregnant woman. Doctors have been guilty of :

1. Denying rape victims brought to the ER Plan B as part of the rape kit, or even info on where to get it. [Read here:http://godlessfeminist.wordpress.com/2010/01/27/when-religion-false-morality-and-medicine-collide-%E2%80%94-ec-and-conscience-clauses/]

2. Letting women suffer and almost DIE rather than perform a life-saving abortion on nonviable pregnancies [Read here: http://www.salon.com/2011/05/26/abortion_saved_my_life/singleton/]

3. Have a consistent track record of abusing women in childbirth by denying adequate pain relief among other things with little to no repercussions. [Read here: http://www.hencigoer.com/downloads/cruelty_maternity_wards.pdf ]

4. Willingly earned their comfortable lives by accepting employment at religious affiliated hospitals to earn a good living (better than 80% of the rest of Americans), even though that meant inflicting gratuitous cruelty on women while passing the buck and blaming it on some higher-ups. [Read here: http://www.nwlc.org/resource/below-radar-fact-sheet-religious-refusals-treat-pregnancy-complications-put-women-danger ]

5. Willingly go along with this sociopathic program of femicide because their status, comforts and luxuries of upper-middle classdom are more important to them than the lives and wellbeing of the women coming to them for help, especially POOR women.

Doctors have far more clout, cultural and social capital and financial capital than most of their patients, whom, if they truly gave a damn about, they would be protecting. The AMA and the ACOG and countless states' medical communities have far more political pull in this society than the majority of women they treat.

How many have used their privileges to speak out for the largest subgroup of the population with the least economic opportunity and political power since this War on Women was launched beginning with the Hyde Amendment back in 1976 when women's human rights were re-framed as a social class privilege that only SOME women "deserve" but not others?

Doctors are not innocent bystanders, and they're not "apolitical" like they claim. They are a product of this same fetid, greed-driven, misogynist sepulcher decaying from within from its own hubris that holds women as disposable incubators as Rush Limbaugh and Bill O'Reilly — whose hate speech over public airwaves for years have dehumanized women as "lesser thans" undeserving of basic human rights while citizenship and personhood is conferred upon corporations and zygotes.

Meanwhile, those of us among the oppressed who dared to speak out against the oppressor are demonized as "man-haters" and "feminazis."

Words have consequences, because deeds follow words.

The medical community is just as culpable as right-wing talking heads of prime time TV and talk radio, the powerful sadistic religious lobbies (like the USCCB) and ideological demagogues driving this forced birth phantasmagoria because silence is consent.

Doctors and nurses have been just as guilty in this dirty war against women as the Congressmen who pass "fetal pain" laws while blatantly disregarding the pain, trauma, and disfigurement a woman suffers in pregnancy and childbirth and claiming that women "use rape as an excuse to get abortions" (Sen. Chuck Winder, R-ID), and state lawmakers who publicly refer to women as reproductive livestock and "farm animals" (Terry England of Georgia).

As a member of the most disempowered class (the jobless poor) among the most oppressed group (women), I have seen exactly how little women are respected and valued in this society and how much most men really hate women — including those in the lucrative self-policing profession who took an oath of ethics.

My grandmother once taught me: when someone shows you who they really are, believe them.
What is the Arizona legislature passed a law that said any woman seeking an abortion must first be slapped -- hard -- in the face and called a murdering whore?

If you don't want to get slapped and insulted, don't have an abortion. If you want an abortion, you have to agree to a battery.
"Face the consequences" tells me all I need to know about where you're coming from.

Perhaps I can help you with the concept of consequence. Pregnancy can be a consequence of fucking. Human life can at some point be a consequence of pregnancy. The destruction of human life can at some point be a consequence of abortion. Aside from situations of rape, women have control of each consequence. Most women accept that responsibility; others whine about it.
Gordon, when you grow tits and a vagina, we'll talk about it. Then maybe you'll make some sense.
Until now, it has never occurred to me that the presence of tits and vagainas inactivates the brain.
A majority of Americans support the freedoms and restrictions that can apply under Roe/Wade.
Those who feel their contrived outrage allows them to attempt to negate the majority approval resort to harassment.

The Catholic Church used to have varying degrees of sin attached to abortion, depending on what stage of pregnancy. The religious right didn't get involved in abortion politics until it was realized it was a great way to raise anger and money and political power.

So, 150 years ago the Catholics had a different opinion,and around 40 years ago the religious right leaders declared they wouldn't object, and then did. In their case, the sound of fake outrage is very similar to the sound of a cash register ringing.

As always with fanatical ideological movements, the contrived outrage builds because what gins up anger has to escalate to keep True Believers hooked in, and the attempts to harass follow the same course. They're all varying degrees of phonies and charlatans. I haven't really thought about where to place ol' Gordon on that scale, though.
Ramonas: You need to be aware that when Gordon is not rating and positively commenting on blog posts written by racist doofuses, he’s well known to write sophomoric comments, such as those seen above. More often than not, his comments provide good comic relief. On occasion however, his remarks are so dumb that it’s not even funny.
Thanks, Kanuk, I hate myself when I stoop to take the bait. But "Sophomoric" gives too much credit. More like Kindergarten.
Is everyone forgetting the many doctors who have already been killed defending abortion?

http://en.wikipedia.org/wiki/Anti-abortion_violence

Roe vs. Wade is based on a technicality: it's going to get challenged. We better be prepared to redefine a lot of things.
Helvetica, you're right. Roe v. Wade has always been on shaky ground. Frankly, I'm surprised that it's still in place, given the decades of heavy opposition. I suspect congress really doesn't want to touch it with a ten-foot pole.

But now, suddenly, the Tea Party states have figured out that harassment and attempts at draconian regulating are almost as good a deterrent as outright banning.

It's going to be a bumpy ride.
"What consequences do you have in mind for the man who got her pregnant? (You do understand, don't you, that a man was involved?)"

When you sprout a cock, then you can spout off about male responsibilities.

Does this argument sound familiar?
Gordon, may I ask how old you are? Because you seem very young. Cocky young. Not an attribute conducive to good adult conversation. We adults tend to ignore cocky kids. What seems hilariously clever to them is just ho-hum and a real time-waster to the rest of us who have heard it all before.
No, this was never the way it was supposed to be. I welcome the medical community to rise up and use their voices in protest of this entirely unnecessary requirement.

Who is the government to shame women in this way? Maybe we should require they wear a scarlet "A" to stand for "abortion" following the procedure, that would really teach 'em.
Agreed, Wichywmn. There is no medical necessity for these actions. So then what? The necessity to punish and humiliate. I thought this was the kind of thing the founders worked against when they wrote the constitution. They then added amendments to make sure everyone understood about specific freedoms.

These guys didn't get the message, and neither did the people who voted for them.