Abortion Extremes and Florida Amendment #4
Exceptions aren’t enough when every problem is unique
I got a door hanger recently urging me to vote no on Florida’s 2024 amendment #4, saying, “It’s just too extreme.” I want to address the arguments on it, because I think some of them are misleading. (Is rebutting a flyer better or worse than rebutting a meme?)
First, however, I want to emphasize that I fully believe the sincerity of whoever made and hung the flyer. Growing up, I was involved in the Pro-Life political movement. The pro-life people I know are truly concerned about saving babies’ lives. You can accuse the Republican Party of taking an anti-abortion stance merely to consolidate a voting bloc, but no one walking neighborhoods to hang these tags in the Florida heat is a cynical political operative.
That’s why I want to make sure people get accurate information in a calm, empathetic discussion rather than through hyperbolic arguing.
Table of Contents
- My position
- Exceptions aren’t exceptional
- What is extreme?
- Countering the arguments
- Women are already dying
- Is there a way to restrict abortion safely?
- Conclusion
My position
I think it’s only fair to be upfront about my position, because everyone has biases no matter how fair we try to be.
I consider myself pro-life, but my policy preference aligns pretty closely with the proposed Amendment 4. If you’re interested in the details, I wrote a long and detailed explanation of why I support legal abortion. I can think of very few circumstances where I would counsel a friend that an abortion was her best option, but politically, I’ve shifted toward advocating for prevention rather than prohibition.
The short case for voting pro-choice (regardless of personal beliefs) is the difficulty — arguably, the impossibility — of writing a law that can account for all possible medical situations.
Exceptions aren’t exceptional
The flyer that was hung on my door says, in reference to current Florida law, “There are exceptions in cases of rape, incest and human trafficking up to 15 weeks of pregnancy. It also allows physicians to terminate a pregnancy if necessary to save the life of the mother or prevent ‘a serious risk of substantial and irreversible physical impairment.’ Isn’t that enough?”
Unfortunately, the answer to that question is no. Look at just that one sentence. How close does a woman have to be to dead before she can get treatment? How do you quantify severity of risk? What is “substantial” impairment? That is not what I want my doctor thinking about when I’m getting treatment!
We think it will be obvious when an exception should be made, but it’s not. Around 8% of women experience potentially serious complications. (I must be “lucky,” because both my children required assisted births.) Estimates of maternal mortality prior to modern medicine are 1–3% of pregnancies — and most women got pregnant multiple times!
Even today in the US, carrying a pregnancy to term has a risk of death anywhere from 10 to 41 per 100,000 births (to say nothing of other complications). Meanwhile, deaths from safe (legal) abortion are negligible — less than 1 in 100,000 births. I’m not saying that everyone should get an abortion, I’m just pointing out that pregnancy is naturally risky. Modern medicine has many ways to detect and prevent problems, but doctors can only help if they’re allowed to practice.
Here are just a few examples of women whose situations were made much worse by restrictive abortion laws:
- Amanda Eid also conceived after months of fertility treatment, but her water broke 18 weeks into her pregnancy. There is no medical treatment that could have saved her daughter, and her risk of developing fatal sepsis increased with every hour delivery was delayed. She finally got sick enough after three days that doctors felt they could justify performing an abortion if they got sued* (which Texas allows anyone to do). Ms. Eid nearly died from the infection, requiring invasive rescue, and her uterus was scarred such that she might not be able to get pregnant again.
- Jaci Statton had a molar pregnancy, which means the “pregnancy” is really a tumor. It should be an easy exception to make — especially in her case, when the tumor was also cancerous. But she was told, “We cannot touch you unless you are crashing in front of us or your blood pressure goes so high that you are fixing to have a heart attack.” She’s “now facing another surgery to remove more cancerous tissue, and she may need chemotherapy,” neither of which would have been necessary if she had gotten a D&C immediately.
- Beth Long finally conceived after years of infertility treatments, only to learn that her baby had a condition (warning: illustration in link) that is 100% fatal. Because she was not in imminent danger of dying, her insurance (as required by Ohio law) wouldn’t cover getting an abortion. After three weeks, during which the risk to Ms. Long increased, they found an affordable option out of state.
What is extreme?
Now, here is the text that would be added to Florida’s state constitution if the amendment were to pass (it has to be approved by 60% or more of votes):
Limiting government interference with abortion. — Except as provided in Article X, Section 22, no law shall prohibit, penalize, delay, or restrict abortion before viability or when necessary to protect the patient’s health, as determined by the patient’s healthcare provider.
(Article X, section 22, allows for a requirement to notify a minor’s parents of their abortion.)
In comparison, 14 states have now banned abortion entirely, while 9 states have no restrictions. Those are the literal extremes: the opposite ends of the spectrum of possible laws. Florida’s new amendment would fall slightly closer to the “No restrictions” than “completely banned” side, but is by no means the most permissive.
Countering the arguments
Here are the arguments against Amendment 4, according to the flyer I received.
“NO Medical Doctor required! (Healthcare Provider is deceptive language)”
The term is in fact defined elsewhere in Florida code: “‘Health care provider’ means a physician or any recognized practitioner who provides skilled services pursuant to a prescription or under the supervision or direction of a physician and who has been certified by the department as a health care provider. The term ‘health care provider’ includes a health care facility.”
Thus “healthcare provider” refers to practitioners or clinics who are certified by the Department of Health, which I do not find “deceptive.” As someone who has received great care from physician assistants and nurse practitioners, I appreciate the language of “provider,” since M.D.s are in short supply and may not be available.
“NO Parental Consent required! (Notification is NOT consent)”
The amendment specifies no requirements but explicitly specifies that it’s not meant to override laws regarding minors. Although parental consent for a minor seeking abortion is currently required unless waived by a court, that only became legal in Florida on April 1st, 2024. Whether that law remains if the amendment passes is unclear and would probably be decided in court. (Politifact: “While Section 22 only relates to notification, not consent, it still clearly indicates a desire in the Constitution to limit abortion rights for minors.”)
“NO gestation limits to abortion! (Would allow 3rd Trimester Abortions)”
The first half of this objection is incorrect. The amendment specifically says “before viability,” which is clearly a limit based on gestation. The second half is technically correct, since fetal viability is around 28 weeks, which is right at the beginning of the third trimester. Elective abortions after week 28 would still be prohibited even if the amendment passes.
This objection could also refer to the exception “to protect the patient’s health” — as in, yes, that exception applies in the third trimester as well as the first two. But that’s the definition of an exception. Third trimester abortions remain extremely rare (in 2022, there were none in Florida) and are most often the result of a serious health problem of either mother or baby, which may not have been discoverable sooner.
“NO choice for fathers! (Men are silenced)”
The first part is technically correct, but it’s true with or without this amendment, so don’t let that change your vote. The legal question of abortion is whether the pregnant person’s bodily autonomy outweighs the baby’s right to life. In this debate, the father has parental rights but no bodily rights in play, thus he is not relevant to the legal argument.
A man trying to give his baby’s mother the right to choose might think he shouldn’t talk to her, but a woman who’s unsure if she can raise a child can absolutely benefit from the father’s support for her decision. It’s reasonable for her to include him in those discussions, and nothing in the amendment prevents her from doing so.
“NO prohibitions on abortion! (Abortion on Demand/NO Questions Asked)”
I’m a little confused by this objection, because, as stated above, this amendment absolutely leaves room for legal limitations after fetal viability. It does allow for elective abortion before then, which could be considered “on demand” (although anyone who’s been to a doctor lately knows that nothing happens that fast).
Whether patients seeking abortion are asked enough questions doesn’t change with the amendment. Some standalone abortion clinics have a conflict of interest with patients’ informed consent (because they depend on performing abortions to pay their bills), so it’s not out of the question that a woman wouldn’t get all the facts. Making abortion more broadly legal actually helps, though, because people could use the providers they already know.
“NO State regulation! NO laws on abortion!”
As far as I can tell, these objections are simply incorrect. The state would still regulate health care providers, including clinics. Laws requiring parental notification (and perhaps consent) for minors or prohibiting abortion after fetal viability would still be allowed.
“NO penalties to abortion providers! NO restrictions on abortions!”
If these objections refer to “prior to fetal viability,” then they are correct: Amendment 4 would indeed remove penalties and restrictions on those abortions. Any restrictions after viability would remain in effect, along with their penalties.
“Amendment #4 = NO Protections for Women.”
This argument against abortion rights is the most confusing for me. Amendment 4 is all about protections for women, because in states with restrictive abortion laws, women are already dying because of them.
- Yeni Glick didn’t have health insurance, and the town where she lived doesn’t have any maternity care. People there are accustomed to having to wait until their condition is an emergency to go to the ER. She was married and got pregnant with a baby she very much wanted, but she had severe complications. Once her situation was urgent, getting an abortion could have saved her life, but none of the doctors could perform or recommend one. Both she and her daughter died.
- “[A] program director described one harrowing case where a pregnant patient was transferred to their emergency room with an infection and with no fetal heartbeat. Because an abortion could not be provided earlier due to restrictive state laws, the patient became increasingly sick and ultimately died in the Intensive Care Unit (ICU) from sepsis.” (interview)
The greatest irony is that abortion bans are driving away OB/GYNs — the very doctors women need when they get pregnant and give birth. For example, in Iowa: “It’s not just this amorphous fear that doctors are leaving. We cannot recruit doctors to come here.” In Indiana: “We’re seeing fewer residents that are training in Indiana. And then we’re also seeing subsequently fewer people are sticking around.”
Is there a way to restrict abortion safely?
I don’t know about the politicians, but sincere pro-life people I know truly don’t want women or babies to suffer needlessly. Is there a way to restrict abortion without causing the above problems?
My answer is, “maybe.” But before we get to that, I want to remind readers of all the ways to reduce the number of abortions besides restricting it (which is actually not effective, although I understand the moral desire behind it).
Both sides claim they want to reduce the number of abortions. Providing free birth control reduces the abortion rate, and policies such as paid sick leave, affordable health insurance, and affordable childcare address most of the top reasons women say they consider abortion.
When it comes to laws, exceptions cause confusion and uncertainty among health care providers — but without exceptions, banning abortion is unethical and dangerous (to both mother and child). The following suggestions might not be appropriate for a constitutional amendment (which tend to be less specific), but could be changed in existing laws.
- Make it clear that abortion procedures and medications are always allowed when a fetus is dead, dying, or certain to die. This should be a no-brainer. There’s no reason to make a woman who is already having a miscarriage wait until she’s “sick enough” to get treatment when the baby is going to die no matter what.
- Make it clear that the courts will defer to physicians’ judgment when it comes to whether their pregnant patient was in danger. Most exceptions to bans on abortion are vague, but the more specific they try to be, the more confusing laws become. The burden of proof should be on the prosecutor, not the doctor, when enforcing exceptions.
- Get rid of the ability for anyone unrelated to sue. Allow people to give anonymous tips if you must, but the law should require plaintiffs to have standing and prosecutions to have cause. As a provider in Texas said, “One of the things that S.B. 8 does is undermine a sense of common mission and trust, even within a care-giving team — you know, who’s going to go behind your back and sue you because they watched you do your care?” Let’s not put our medical professionals in that situation.
While those still wouldn’t cover every case, adding such clarity to restrictions would go a long way toward minimizing the possible harms of such laws.
Conclusion
In the end, however, I am not willing to take a permanent side in the debate between bodily autonomy and right to life. What is one without the other? They are equally important. If no one should force you to have an abortion (and both sides agree on that), then no one should force you not to. The best use of my time and energy are on policies that reduce the number of unwanted pregnancies and abortions.
Laws that restrict legality of abortion mean legislators are making complicated, highly personal medical decisions for people they know nothing about and have never met. When abortion is broadly legal, the people who have the most information and greatest stakes in each situation — the pregnant woman, her family, and her medical team — are the ones making the difficult choices.
Doctors need to know they can focus on saving their patients without worrying about being prosecuted. New doctors need to be trained in these vital aspects of care, which are used far beyond elective abortion. Women need OB/GYNs nearby so that they can get safe prenatal care when they do get pregnant. All of these needs are jeopardized by harsh restrictions on abortion.
