Mr. President, I call up amendment No. 261 and ask for its immediate consideration. It is short, and I would appreciate it being read by the clerk. Mr. President, this amendment is simple and straightforward. It bans any abortion after…
Mr. President, I call up amendment No. 261 and ask for its immediate consideration. It is short, and I would appreciate it being read by the clerk.
Mr. President, this amendment is simple and straightforward. It bans any abortion after viability, except when a doctor has determined that it is necessary to save the life or protect the health of the woman.
I have been a part of the Judiciary Committee now for 10 years and I have seen this bill come up in three Congresses and listened to or read testimony on this bill for three Congresses.
The first time it came up, it became very apparent to me that the definition of partial-birth abortion was too vague. I wondered why it was so vague. It looked like it covered different medical procedures. And now, about 8 years later, I believe I know why it is so vague. I believe it is so vague because it could actually cover all abortions and therefore be a major strike against a woman's right to choose. Eighty percent of the people of this country believe that abortion must be safe and legal to preserve a woman's health. People strongly believe that this is a decision between a woman, her clergy, her doctor, and her family.
I deeply believe politicians should not be in the business of making decisions about women's reproductive rights. In my view, the Santorum legislation, S. 3, is a Trojan horse. It is not what it purports to be. It supposedly bans one procedure, D&X, but actually confuses this procedure with another, D&E, the most commonly used abortion procedure. In fact, its wording is so vague that it could be construed to criminalize all abortions.
Yesterday's Congressional Record shows that Senator Santorum--and I have great respect for my distinguished colleague--stated:
I have not been asking about medical necessity. . . . I
have not asked for someone's opinion on what ought to be or
what could be. What I have asked for is an example. I wanted
a fact circumstance to be provided as to where this would be
the best, this would be appropriate, this would be medically
indicated.
I would like to answer Senator Santorum's question at this time, through a letter. After we heard this question, we called the University of California San Francisco Medical Center, the Department of Obstetrics, Gynecology, and Reproductive Sciences, and talked to the chief of that department at San Francisco General Hospital, who is also a full professor. His name is Philip D. Darney. Dr. Darney just sent me this letter, and I would like to read that letter into the Record:
Dear Senator Feinstein: I write to provide examples of the
need for a ``medical exemption'' to the proposed restriction
of use of the so-called ``partial birth abortion'' technique
which is now before the Senate. The medical term for the
technique is ``intact D&E''.
I am Chief of Obstetrics and Gynecology at San Francisco
General Hospital, SFGH, where my department provides about
2,000 abortions yearly to poor women from throughout Northern
California. Patients who are in the second trimester and who
have special medical problems are referred to SFGH for
treatment because our staff has special competence in second
trimester abortion and because we can provide specialized
care for women who are more likely to have a complicated
pregnancy termination. Although I have not reviewed medical
records in order to count the number of times we have
employed intact D&E, I will provide examples of cases in
which the technique was critical to safe conduct of our
surgery:
A 25 year old with two previous vaginal deliveries and
bleeding placenta previa and a clotting disorder at 20 weeks
was referred for termination of pregnancy. After checking her
coagulation parameters and making blood available for
transfusion, we dilated the cervix overnight with Laminaria
and planned uterine evacuation when adequate dilation was
achieved or bleeding became too heavy to replace. Within 12
hours cervical dilation was 3 cm and heavy bleeding had
begun. We removed the placenta quickly and used the ``intact
D&E'' approach to complete the abortion and accomplish quick
control of blood loss. The patient required a transfusion of
two units of whole blood and was discharged the next day in
good health.
A 38 year old with three previous caesarean deliveries and
evidence of placenta accreta was referred for pregnancy
termination at 22 weeks because her risk of massive
hemorrhage and hysterectomy at the time of delivery was
correctly estimated at about 75 percent. After SFGH
sonographic studies confirmed placenta previa and likely
accreta we undertook cervical dilation with laminaria and
made blood available in case transfusion was required. To
reduce the 75 percent probability of emergency hysterectomy
in the situation of disseminated intravascular coagulation
(DIC is quite likely with accreta) we decided to empty the
uterus as quickly as possible with the intact D&E procedure
and treat hemorrhage, if it occurred, with uterine artery
embolization before our patient lost too much blood and
hysterectomy was our only option. This approach succeeded and
she was discharged in good health two days later.
These two patients provide examples from my memory of
situations in which the ``intact D&E'' technique was critical
to providing optimal care. I am certain that a review of our
hospital records would identify cases of sever pre-eclampsia,
for example, in which ``intact D&E'' was the safest technique
of pregnancy termination, I hope the law will not deny our
patients the best treatment we can provide them under life-
threatening circumstances. Sincerely, Philip D. Darney.
This letter is from the chief of obstetrics, gynecology and reproductive sciences at one of the best hospitals in the country. It answers Senator Santorum's question. It provides two examples of where D&X, or what some also call intact D&E, may well have been necessary to protect the health of the woman.
Heart disease, cancer, and grave fetal abnormalities are among the many conditions that can make pregnancy especially dangerous to a woman's physical health. Under S. 3, these patients would be forced to continue a dangerous pregnancy. That is why I am offering my health exception amendment today.
Indeed, there are many tragic situations that face women today, situations that most could never imagine. There is one thing that has always characterized these debates. That is that everyone looks at them from their own vantage point without taking into consideration the situations of others. If you have not encountered a difficult situation, such as a possibly dangerous pregnancy, it is hard to know what you would do. But women and their families face these situations daily.
That is as good a reason as any why the Senate should not intrude into this area, and why the reproductive choices of women should be left to the women, their clergy, their morality, their families, their doctors, and not to the Senate.
Having said that, the amendment I am offering strikes a balance between protecting a woman's health and ensuring the D&X procedure is not abused. This amendment would ban all post-viability abortions unless a doctor determines that these abortions are necessary to protect the life and health of the woman. To ensure compliance with this ban, a doctor who performs a postviability abortion on a woman whose health or life is not at risk could be fined up to $100,000.
What is wrong with S. 3? I will take a moment to explain why I believe Senator Santorum's bill is a bad bill. To begin with, it is unconstitutional because it lacks a health exception. I heard Senator Santorum say a health exception is not necessary. It is necessary. A review of the Supreme Court's abortion decisions and the record makes clear that any ban on D&X--or what supporters of the Santorum bill incorrectly call partial-birth abortion--must include a health exception. My amendment includes such an exception.
In 1973, Roe v. Wade grounded the abortion right in large part on the States' compelling obligation to protect maternal health. In fact, the Court states that the States' interest in preserving the health of a pregnant woman grows more important as a woman's pregnancy progresses. Thus, under Roe, the need for a health exception becomes even stronger with second- or third-term abortion procedures.
In 1992, as my colleagues have stated this many times on the floor, the Supreme Court explicitly reaffirmed Roe in Planned Parenthood v. Casey. Then in the year 2000, in Stenberg v. Carhart, the Supreme Court ruled that any ban must have a health exception. I have outlined two specific examples of why such a health exception is necessary. Yet Senator Santorum's bill does not have such an exception.
At the same time, S. 3 attempts to ban a specific medical procedure which it calls partial-birth abortion. But the bill offers no medical definition of partial-birth abortion. Now the American College of Obstetricians and Gynecologists, whose more than 44,000 members represent approximately 95 percent of all board-certified OB/GYNs practicing in the United States, has developed a medical definition of what is a D&X procedure. The American College of OB/GYNs's definition of the procedure is very different from Senator Santorum's.
I have to ask, why? Why wouldn't the proponents of this bill put in a medically acceptable definition so that those physicians who were practicing medicine and may encounter this kind of case would know precisely what is prohibited? I believe I know the answer. The answer is that the bill is calculated to cover more than just one procedure. I think it is calculated to ban all abortions. I believe if the bill becomes law, it would be struck down as unconstitutional.
I ask unanimous consent to have printed in the Record the letter from the American College of OB/GYNs.
According to the American College of OB/GYNs, any definition of D&X must include all four of the elements I mentioned performed in the proper sequence.
The proponents have refused to use this definition, although the definition has been available for years. Rather, the language in S. 3 is so vague that far from outlawing just one particular abortion procedure, the way this bill is written, it virtually outlaws any abortion procedure. This, I believe, is the true intent of this bill--a major strike, and perhaps a fatal strike, against a woman's right to choose.
Everyone agrees that S. 3 lacks a health exception. It purposefully lacks a health exception. In the Stenberg case, the Supreme Court ruled ``significant medical authority supports the proposition that in some circumstances this procedure would be the safest.'' In her opinion, Justice O'Connor stated:
Because even a post-viability proscription of abortion
would be invalid absent a health exception, Nebraska's ban on
pre-viability partial-birth abortions under the circumstances
presented here must include a health exception, as well. The
statute at issue here only accepts those procedures necessary
to save the life of the mother whose life is in endangered by
a physical disorder, physical illness, or physical injury.
This lack of a health exception necessarily renders the
statute unconstitutional.
Let me repeat her words.
This lack of a health exception necessarily renders the
statute unconstitutional.
Now, that is not my colleague, Senator Boxer, speaking. That is not the distinguished Senator from New Jersey speaking. That is not the distinguished Senator from Pennsylvania speaking. That is not the majority leader, a distinguished physician, speaking. That is the Supreme Court of the United States. That is the law of the land.
This language could not be more clear. However, supporters of the Santorum bill argue that they can ignore this language by throwing into their bill some questionable facts that a health exception is unnecessary. They argue that the so-called findings make irrelevant the Supreme Court's constitutional determination in Carhart that a health exception is necessary.
Now, it is not only Carhart. There are a series of other cases.
One is Richard Medical Center for Women v. Gilmore, in 1999, which was affirmed by the Fourth Circuit Court in 2000. I quote:
The record contains significant evidence that the D&X
procedure is often far safer than other D&E procedures.
Another is Rhode Island Medical Society v. Whithouse, in 1999, affirmed by the First Circuit in 2001:
Defendants claim that a D&X could never be necessary to
save a woman's health, but the evidence at trial failed to
support that contention. Therefore, this court finds that the
D&X could be used to preserve a woman's health and must be
available to physicians and women who want to rely upon it.
If that is not enough, let me mention Hope Clinic v. Ryan, a 1998 decision.
Intact D&E reduces the risk of retained tissue and reduces
the risk of uterine perforation and cervical laceration
because the procedure requires less instrumentation in the
uterus. An intact D&E may also result in less blood loss and
less trauma for some patients and may take less operating
time.
Another example is Women's Medical Professional Corp. v. Voinovich, 1995, affirmed in 1997:
After viewing all of the evidence and hearing all of the
testimony, this court finds that use of the D&X procedure in
the late second trimester appears to pose less of a risk to
maternal health than does the D&E procedure. This court also
finds that the D&X procedure appears to pose less of a risk
to maternal health than the use of induction procedures.
These are all clear district court and appellate court decisions, plus a number of clear Supreme Court decisions, and yet S. 3 flies in the face of all of them. All it offers is 15 pages of weak factual findings.
The Framers of the Constitution did not intend that Congress be able to evade Supreme Court precedent and effectively amend the Constitution by holding a hearing and generating some questionable testimony from hand-picked witnesses. Let me quote former Chief Justice Warren Burger on this point.
A legislature appropriately inquires into and may declare
the reasons impelling legislative action, but the judicial
function commands analysis of whether the specific conduct
charged falls within the reach of the statute and, if so,
whether the legislation is consonant with the Constitution.
The supporters of this bill are effectively trying to overturn binding Supreme Court precedent and to rewrite the Constitution by enacting a bill that openly violates Stenberg v. Carhart and other Supreme Court opinions. This, in my view, clearly oversteps legislative authority.
The Santorum bill also presumes guilt on the part of doctors and forces them to prove that they did not violate the law. This is putting a burden on one group of people, the very people charged with protecting pregnant women from harm. The legislation provides that an accused physician could escape liability only by proving that he or she reasonably believed that the banned procedure--whatever that procedure turns out to be, because it is not defined in the legislation--was necessary to save the woman's life and no other procedure would have sufficed.
It also opens the door to the prosecution of doctors for performing almost any abortion method by forcing them to prove they did not violate a law that can be interpreted in many different ways. Indeed, this bill is a major step toward making all abortions illegal in the United States.
Why does the Federal Government need to be involved in this issue? Why is this legislation even necessary? Roe v. Wade clearly and unequivocally allows States to ban all postviability abortions unless necessary to protect the life and health of the woman. Forty-one States already have bans on the books. So the States have accepted the premise of Roe v. Wade. If they have been concerned about postviability abortions, as most are, they have taken action, as Roe so provides.
The fact is, abortions late in a pregnancy are rare and usually performed under very tragic circumstances. Some States have not seen the need to legislate in this area. Surely anyone who believes in States' rights must question the logic of imposing a new Federal regulation on States in a case such as this, where States have already legislated.
Finally, I say to my colleagues, the Santorum bill is a bad bill. It is clearly unconstitutional. I have cited district court cases. I have cited appellate court cases. I have cited Supreme Court cases. S. 3 fails to provide a straight health exception for the woman, which is necessary to stand the constitutional test. It is not the role of the Federal Government to make medical decisions. It should be up to the doctor and his or her medical judgment.
This bill is bad because it attempts to ban a medical procedure without properly identifying that procedure in medical terms; ergo, it muddies the water and it throws all procedures into risk. It could affect far more than the procedure it seeks to ban. And it presumes guilt on the part of the doctor, something that, in the case of physicians, may be unprecedented in American law.
In our criminal justice system, somebody has to prove you guilty. You are presumed innocent. This bill puts the burden on doctors, and it ignores the vital health interests of women who are often facing tragic complications in their pregnancies.
That is why I am offering this complete substitute to S. 3. This substitute amendment puts medical decisions back in the hands of doctors. If the doctor believes such a procedure is necessary to protect a woman's life or health, then he or she should be able to perform the procedure. I believe it is that simple.
I strongly believe that Congress should be supporting legislation that protects a woman's health. For the sake of all Americans, 80 percent of whom believe they should have the right to choose to protect the woman's health, from all walks of life, present and future, I urge my colleagues to join me in supporting this amendment.
Madam President, I yield 15 minutes of my time to the Senator from New Jersey.
I have no problem with that.
Madam President, how much time is remaining on our side?
Thank you, Madam President. I ask that 15 minutes go to the distinguished Senator from New Jersey.
Madam President, I ask unanimous consent to add Senator Stabenow and Senator Edwards as cosponsors of my amendment.
I yield 2 more minutes to the Senator.
May I ask, first, how much time we have remaining?