Her Body, Our Laws
Page 16
So many have helped, in so many ways, over the years I’ve worked on this project that I’m sure I’ve forgotten some names. These omissions belong alongside the other mistakes I’m sure to have made in these pages. Unintentional, and mine alone.
NOTES
Introduction
1. David Foster Wallace, This Is Water: Some Thoughts, Delivered on a Significant Occasion, About Living a Compassionate Life (Boston: Little, Brown and Company, 2009).
2. Michelle Oberman, “Sex, Drugs, Pregnancy, and the Law: Rethinking the Problems of Pregnant Women Who Use Drugs,” Hastings Law Journal 43 (1991–92): 505, http://digitalcommons.law.scu.edu/facpubs/518/.
3. M. Schäfer, B. Schnack, and M. Soyka, “Sexual and Physical Abuse During Early Childhood or Adolescence and Later Drug Addiction,” Psychotherapie Psychosomatik Medizinische Psychologie (2000), http://www.ncbi.nlm.nih.gov/pubmed/10721277.
4. Michelle Oberman, “Eva and Her Baby (a Story of Adolescent Sex, Pregnancy, Longing, Love, Loneliness, and Death),” Duke Journal of Gender Law & Policy 16 (2009): 213–22, http://digitalcommons.law.scu.edu/facpubs/44/.
5. Indeed, it has become common for states to enact ten or more such laws in a single legislative session. Steven Ertlet, “States Pass More Pro-Life Laws Saving Babies from Abortions in Last 5 Years Than the Previous 15,” LifeNews.com, January 4, 2016, www.lifenews.com/2016/01/04/states-pass-more-pro-life-laws-saving-babies-from-abortions-in-last-5-fives-than-the-previous-15/. These new laws govern practices ranging from prohibitions on buying human eggs to mandating physician disclosure of misleading and often inaccurate information. Texas and Arizona have passed laws requiring doctors to tell patients that the abortion drugs they are about to take can be reversed, should they change their minds and decide to keep their pregnancy. This in spite of the lack of any medical evidence proving it is true. Rick Rojas, “Arizona Orders Doctors to Say Abortions with Drugs May Be Reversible,” New York Times, March 31, 2015, http://www.nytimes.com/2015/04/01/us/politics/arizona-doctors-must-say-that-abortions-with-drugs-may-be-reversed.html. Other states require doctors to tell patients that abortion is correlated with elevated risks of breast cancer and suicide—findings lacking scientific support and rejected by the relevant medical authorities. Guttmacher Institute, “Counseling and Waiting Periods for Abortion,” State Policies in Brief (as of June 2013), http://www.guttmacher.org/statecenter/spibs/spib_MWPA.pdf.
6. For a detailed recounting of her story, see Michelle Oberman, “Judging Vanessa: Norm Setting and Deviance in the Law of Motherhood,” William and Mary Journal of Women and the Law 15 (2009): 337–59, http://digitalcommons.law.scu.edu/facpubs/498/.
7. Estimates range from sixty thousand to three hundred thousand abortions annually. E. Prada and H. Ball, “Induced Abortion in Chile,” In Brief, Guttmacher Institute, 2016, https://www.guttmacher.org/sites/default/files/pdfs/pubs/journals/IB_Abortion-Chile.pdf.
8. In the United States, legal induced abortion results in only 0.6 deaths per 100,000 procedures. Worldwide, unsafe abortion accounts for a death rate that is 350 times higher (220 per 100,000), and, in Sub-Saharan Africa, the rate is 800 times higher, at 460 per 100,000. “Facts on Induced Abortion Worldwide,” In Brief, Guttmacher Institute, 2012, http://www.who.int/reproductivehealth/publications/unsafe_abortion/induced_abortion_2012.pdf. See also Department of Reproductive Health and Research, World Health Organization, Unsafe Abortion: Global and Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality in 2008, sixth ed. (Geneva: World Health Organization, 2011), http://www.who.int/reproductivehealth/publications/unsafe_abortion/9789241501118/en/.
9. E. Koch, “Impact of Reproductive Laws on Maternal Mortality: The Chilean Natural Experiment,” Linacre Quarterly (2013), https://www.ncbi.nlm.nih.gov/pubmed/24844146.
10. Lidia Casas Becerra, “Women Prosecuted and Imprisoned for Abortion in Chile,” Reproductive Health Matters (1997), http://www.rhm-elsevier.com/article/S0968–8080(97)90003-3/pdf. See also Lidia Casas and Lieta Vivaldi, “Abortion in Chile: The Practice Under a Restrictive Regime,” Reproductive Health Matters (2014), http://www.academia.edu/10146213/Abortion_in_Chile_the_practice_under_a_restrictive_regime.
Chapter 1: Beatriz and Her Case
1. Guillermo Ortiz, perinatologist at La Maternidad Hospital, in discussion with the author, June 2014 (notes on file with author).
2. Penal Code of El Salvador 1998, Title 1, Crimes Related to Life, Chapter II, Crimes Related to Unborn Humans, Art. 133–139, http://www.oas.org/dil/esp/Codigo_Penal_El_Salvador.pdf; Soledad Varela, “Persecuted: Political Process and Abortion Legislation in El Salvador: A Human Rights Analysis,” Center for Reproductive Law & Policy 27 (2001): 96n130, http://reproductiverights.org/sites/default/files/documents/persecuted1.pdf, http://www.reproductiverights.org/sites/default/files/documents/persecuted2.pdf; “El Salvador,” in UN Population Division Department of Economic and Social Affairs, Abortion Policies: A Global Review (June 2002), http://www.un.org/esa/population/publications/abortion/profiles.htm.
3. Guillermo Ortiz, author interview.
4. “Ectopic Pregnancy,” Cedars-Sinai, https://www.cedars-sinai.edu/Patients/Health-Conditions/Ectopic-Pregnancy.aspx, accessed November 8, 2016.
5. Alejandro Guidos, MD, president of El Salvador’s Association of Obstetricians and Gynecologists, in discussion with the author, June 2014.
6. Oswaldo Ernesto Feusier, “Pasado Y Presente Del Delito De Aborto En El Salvador,” Universidad Centroamericana “Jose Simeon Cañas” (2016), 135n, http://www.uca.edu.sv/deptos/ccjj/media/archivo/95bbb4_pasadoypresentedeldelitodeabortoenelsalvador.pdf.
7. Loida Martínez and Suchit Chavez, “Salud aboga por aborto terapéutico a mujer enferma,” La Prensa Grafica, April 17, 2013, http://www.laprensagrafica.com/Salud-aboga-por-aborto-terapeutico-a-mujer-enferma.
8. “Red Familia rechaza aborto de Beatriz,” editorial, La Pagina, April 18, 2013, http://www.lapagina.com.sv/nacionales/80505/2013/04/19/Red-Familia-rechaza-aborto-de-Beatriz.
9. Carmen Rodriguez, “Mamá de Beatriz: ‘No quiero que mi hija muera,’” La Pagina, May 14, 2013, http://www.lapagina.com.sv/nacionales/81629/2013/05/15/Mama-de-Beatriz-No-quiero-que-mi-hija-muera.
10. Although there is no information about El Salvador’s IML online, see this description of Colombia’s IML: Medicina Legal y Ciencias Forenses, http://www.medicinalegal.gov.co/en/quienes-somos;jsessionid=2BB1C1A65FC88B98BAA84D741EA0CC34, accessed May 31, 2017.
11. Jose Miguel Fortin Magana, MD, director of the Instituto de Medicina Legal, in discussion with the author, June 2014.
12. “El Salvador,” Center for Justice & Accountability, http://cja.org/where-we-work/el-salvador/.
13. Pew Research Center, Religion in Latin America: Widespread Change in a Historically Catholic Region (Washington, DC: November 13, 2014), http://www.pewforum.org/2014/11/13/religion-in-latin-america/.
14. Paul Glader, “Christianity Is Growing Rapidly in El Salvador,” Washington Post, April 8, 2015, https://www.washingtonpost.com/news/acts-of-faith/wp/2015/04/08/christianity-is-growing-rapidly-in-el-salvador-along-with-gang-violence-and-murder-rates/.
15. Xochitl Sandoval, MD, gynecologist, in discussion with the author, June 2014.
16. Alejandro Guidos, author interview. Guidos explained his association’s opinion as a matter of scientific fact: “It’s well known that a pregnant patient with Lupus is considered high risk, especially if she had preeclampsia in a prior pregnancy. So, taking all this into account, and finally because of the fetal abnormality, we published an opinion supporting the termination of pregnancy.”
17. Christian Melendez, “La Sala de lo Constitucional recibió ayer el informe médico que había solicitado sobre la joven con lupus,” La Prensa Grafica, May 8, 2013, http://www.laprensagrafica.com/iml—beatriz-puede-continuar-con-su-embarazo.
18. Fortin Magana, author interview.
19. Carmen Rodriguez, “Salud pone en duda resultados de Medicina Legal en caso de Beatriz,” La Pag
ina, May 11, 2016, http://www.lapagina.com.sv/nacionales/81502/2013/05/11/Salud-pone-en-duda-resultados-de-Medicina-Legal-en-caso-de-Beatriz.
20. “El Presidente de El Salvador dice que la mujer que pidió aborto tiene el derecho a decidir,” Qué!, May 13, 2013, http://www.que.es/ultimas-noticias/espana/201305132346-presidente-salvador-dice-mujer-pidio-efe.html.
21. Maria R. Sahuquillo, “Beatriz: Pido al presidente Funes que salve mi vida,” El Pais, http://sociedad.elpais.com/sociedad/2013/05/30/actualidad/1369922985_768623.html; Karla Zabludovsky, “A Salvadoran at Risk Tests Abortion Law,” New York Times, May 28, 2013, http://www.nytimes.com/2013/05/29/world/americas/pregnant-sick-and-pressing-salvadoran-abortion-law.html.
22. Adam Cassandra, “HLI President Calls on El Salvador Supreme Court to Protect Life,” Human Life International News, May 16, 2013, http://www.hli.org/2013/05/hli-president-calls-on-el-salvador-supreme-court-to-protect-life/.
23. “En defensa de nuestra soberania” (author’s translation), elsalvador.com, May 8, 2013, http://www.elsalvador.com/opinion/editoriales/106401/en-defensa-de-nuestra-soberania/.
24. Amnesty International, On the Brink of Death: Violence Against Women and the Abortion Ban in El Salvador (2014), https://www.amnestyusa.org/sites/default/files/el_salvador_report_-_on_the_brink_of_death.pdf.
25. Nelson Rauda Zablah, “Magistrates Finalized ‘Historic’ Hearing to Resolve Abortion Petition,” La Prensa Grafica, May 17, 2013, http://www.laprensagrafica.com/csj-da-un-plazo-maximo-de-15-dias-para-caso-beatriz.
26. Karla Aabludovsky and Gene Palumbo, “Salvadoran Court Denies Abortion to Ailing Woman,” New York Times, May 29, 2013, http://mobile.nytimes.com/2013/05/30/world/americas/salvadoran-court-denies-abortion-to-ailing-woman.html?from=world.
27. Corte Suprema de Justicia, Case BC, Amparo 310–2013 at 10 (El Salvador).
28. Guillermo Ortiz, author interview.
29. Thomas Aquinas is credited with introducing the principle of double-effect in his discussion of the permissibility of self-defense in the Summa Theologica (II-II, Qu. 64, Art. 7). Killing one’s assailant is justified, he argues, provided one does not intend to kill him. “Doctrine of Double Effect,” Stanford Encyclopedia of Philosophy, revised September 23, 2014, http://plato.stanford.edu/entries/double-effect/, accessed May 31, 2017. See also “The Principle of Double Effect,” Catholics United for Faith, November 1997, http://www.cuf.org/2004/04/principle-of-double-effect, accessed May 31, 2017.
30. Jorge Ramirez, MD, chief assistant to the minister of health, in discussion with the author, June 2014.
31. Wayne R. LaFave, Substantive Criminal Law § 10.4, at 142, second ed. (St. Paul, MN: Thomson/West, 2003).
32. The fundamental right to life and enjoyment of health appear in the Salvadoran Constitution.
33. Corte Suprema de Justicia, Case BC, Amparo 310–2013, at 22 (El Salvador). “In the event of termination of the pregnancy after twenty weeks gestation, the aim is not to destroy the fetus, and that the medical team will take all necessary measures to ensure, as far as possible, extrauterine life.”
34. LaFave, Substantive Criminal Law.
35. Corte Suprema de Justicia, Case BC, Amparo 310–2013, at 14 (El Salvador).
36. Karla Zabludovsky, “A Salvadoran at Risk Tests Abortion Law,” New York Times, May 28, 2013, http://www.nytimes.com/2013/05/29/world/americas/pregnant-sick-and-pressing-salvadoran-abortion-law.html.
37. A zygote is the fertilized egg cell that results from the union of a female gamete (egg, or ovum) with a male gamete (sperm). In embryonic development, the zygote stage is brief and is followed by cleavage, when the single cell becomes subdivided into smaller cells. The zygote represents the first stage in the development of a genetically unique organism. Encyclopaedia Britannica Online, s.v. “zygote,” https://www.britannica.com/science/zygote, accessed November 8, 2016.
38. Cass R. Sunstein, “On the Expressive Function of Law,” University of Pennsylvania Law Review 144 (1996): 2021, 2031.
39. Ibid., 2045.
40. Ibid., 2047.
Chapter 2: Assessing the Impact of El Salvador’s Abortion Ban
1. Penal Code of El Salvador 1998, Title 1, Crimes Related to Life, Chapter II, Crimes Related to Unborn Humans, Art. 133–139, http://www.oas.org/dil/esp/Codigo_Penal_El_Salvador.pdf.
2. Abortion being illegal, it is hard to get accurate information about the rates of abortion. The WHO bases its estimations on numbers of women hospitalized for abortion complications (where available) and information on the safety of abortion, as well as on findings from surveys of women and studies using an indirect abortion estimation methodology from countries where those were available. E-mail from Dr. Gilda Sedgh, Guttmacher Institute, to author, July 7, 2012 (on file with author). See article by Gilda Sedgh, https://www.guttmacher.org/sites/default/files/pdfs/pubs/journals/Sedgh-Lancet-2012-01.pdf.
3. A recent survey by the El Salvador Ministry of Health reported 19,290 between 2005 and 2008; other surveys put that number as the annual average. See Nina Strochlic, “On the Front Lines of El Salvador’s Underground Abortion Economy,” Foreign Policy, January 3, 2017, http://foreignpolicy.com/2017/01/03/on-the-front-lines-of-el-salvadors-underground-abortion-economy/?utm_source=Sailthru&utm_medium=email&utm_campaign=New+Campaign&utm_term=%2AEditors+Picks.
4. Vinod Mishra, Victor Gaigbe-Togbe, and Julia Ferre, Abortion Policies and Reproductive Health Around the World (New York: UN Department of Economic and Social Affairs, Population Division, 2014), http://www.un.org/en/development/desa/population/publications/pdf/policy/AbortionPoliciesReproductiveHealth.pdf, accessed January 24, 2017.
5. For an excellent history of abortion in pre-Roe America, see Leslie J. Reagan, When Abortion Was a Crime: Women, Medicine, and Law in the United States, 1867–1973 (Berkeley: University of California Press, 1996), http://ark.cdlib.org/ark:/13030/ft967nb5z5/. For an equally rich history of abortion doctors in pre-Roe America, see Carole E. Joffe, Doctors of Conscience: The Struggle to Provide Abortion Before and After Roe v. Wade (Boston: Beacon Press, 1995).
6. Tekoa King and Mary Brucker, “Pharmacology for Women’s Health,” Journal of Midwifery & Women’s Health 55 (2010): 394, doi:10.1016/j.jmwh.2010.05.005.
7. Mifeprex, RxList, http://www.rxlist.com/mifeprex-ru486-drug.htm, accessed June 2, 2017.
8. Beverly Winikoff and Wendy Sheldon, “Use of Medicines Changing the Face of Abortion,” International Perspectives on Sexual and Reproductive Health 38, no. 3 (September 6, 2012), https://www.guttmacher.org/about/journals/ipsrh/2012/09/use-medicines-changing-face-abortion. The most widely available illegal abortion drug in Latin America is misoprostol (brand name is Cytotec), which is less effective than mifepristone (brand name is Mifeprex). Nguyen Thi Nhu Ngoc et al., “Comparing Two Early Medical Abortion Regimens: Mifepristone Plus Misoprostol vs. Misoprostol Alone,” Contraception 83, no. 5 (2011): 410–17.
9. “Abortion Induction with Misoprostol Alone in Pregnancies Through 9 Weeks’ LMP,” Gynuity, October 2013, http://gynuity.org/resources/read/misoprostol-for-early-abortion-en/, accessed August 30, 2017.
10. Anibal Faundes, “Use of Misoprostol in Obstetrics and Gynaecology,” Latin American Federation of Obstetrics and Gynaecology Societies (FLASOG) (Santa Cruz, Bolivia: Industrias Gráficas Sirena, April 2005), www.ibrarian.net/navon/paper/Translated_from_Spanish.pdf.
11. Donna Bowater, “Abortion in Brazil: a Matter of Life and Death,” Guardian, February 1, 2015, https://www.theguardian.com/world/2015/feb/01/abortion-in-brazil-a-matter-of-life-and-death, accessed January 23, 2017.
12. See Bela Ganatra et al., “From Concept to Measurement: Operationalizing WHO’s Definition of Unsafe Abortion,” Bulletin of the World Health Organization 92, no. 155 (2014), doi: http://dx.doi.org/10.2471/BLT.14.136333 (discussing the definition of “unsafe abortion,” in view of factors ranging from legal context to relative risks depending on access to trained health care providers and medical abortions).
13. According to the World Healt
h Organization (WHO), Latin America and the Caribbean have the highest regional rate of unsafe abortions per capita in the world (31 per 1,000 women, aged fifteen to forty-four) and see an estimated 4.2 million unsafe abortions every year. See Department of Reproductive Health and Research, World Health Organization, Unsafe Abortion.
14. Alejandro Guidos, author interview. For a thorough discussion of these conflicting laws, see Heathe Luz McNaughton et al., “Patient Privacy and Conflicting Legal and Ethical Obligations in El Salvador: Reporting of Unlawful Abortions,” American Journal of Public Health 96 (2006): 1932.
15. McNaughton et al., “Patient Privacy and Conflicting Legal and Ethical Obligations in El Salvador.”
16. For a detailed history of the Hippocratic oath and its ongoing relevance, see Steven H. Miles, The Hippocratic Oath and the Ethics of Medicine (Oxford, UK: Oxford University Press, 2004).
17. Raphael Hulkower, “The History of the Hippocratic Oath: Outdated, Inauthentic, and Yet Still Relevant,” Einstein Journal of Biology & Medicine 25/26 (March 2010): 43, https://www.einstein.yu.edu/uploadedFiles/EJBM/page41_page44.pdf.
18. El Salvador’s Health Code 287 states that breaching [patient] confidentiality may result in oral reprimand, written reprimand, a fine, a five-year suspension or the loss of one’s medical license. For US law requiring doctors to maintain confidentiality, see Health Insurance Portability and Accountability Act, Pub. L. No. 104–191 (1996), requiring health-care providers and health plans to have policies and procedures concerning use and disclosure of protected health information.
19. Breach of Professional Confidentiality Sect. 187.
20. See Republic of El Salvador, Criminal and Procedural Codes: Prison Law and Its Regulations, Editorial Jurídica Salvadoreña, 2001, Penal Code, Art 312.
21. See Republic of El Salvador, Health Code (with incorporated reforms), Criminal and Procedural Codes: Prison Law and Its Regulations, Editorial Jurídica Salvadoreña, 2001, Penal Code, Art 232. Doctors, pharmacists, nurses, and other health professionals must report unlawful criminal acts that they become aware of in the context of their professional relationship, unless the information they acquire is protected under the terms of professional secrecy (translation; italics added).