Missouri tries to apply abortion consent law in other states

The statute is unclear on what doctors or other counselors may say when advising teens about abortion, a lawsuit charges.

By Amy Lynn Sorrel — Posted Jan. 30, 2006

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Missouri is taking aim at Illinois with an unprecedented abortion law that allows lawsuits against anyone who assists a minor in obtaining an abortion without parental consent -- including out-of-state doctors.

Abortion rights groups and anti-abortion groups agree on at least one thing -- Illinois is the target because it doesn't have a parental consent law.

Planned Parenthood filed a lawsuit Sept. 15, 2005, the day the law was signed by Missouri Gov. Matt Blunt, challenging its constitutionality. Jackson County Circuit Judge Charles Atwell declined to rule the law unconstitutional but put the liability provision on hold in November 2005, pending a Missouri Supreme Court decision. No date has been set for oral arguments.

Depending on how the high court rules, Illinois doctors ultimately could be held liable for actions taken while the provision is on hold. The Hope Clinic, which advertises on its Web site to be 10 minutes from St. Louis, is trying to protect itself from legal trouble from Missouri.

Meanwhile, every state surrounding Illinois also has parental consent or notification laws, and it is unclear if they will follow Missouri's lead.

Anti-abortion groups support Missouri's approach. But abortion rights organizations and officials at the Hope Clinic, in Granite City, Ill., oppose it.

"It's pretty outrageous," said Sally Burgess, the clinic's executive director. "How can another state reach in and not honor your laws?"

Burgess said the law places an unnecessary burden on the clinic, where a majority of teens seeking abortions already have their parents involved. But she added that some teenagers cannot go to their parents for fear of being beaten or kicked out of the house, so they seek counsel from a relative or a doctor.

"They are still trying to be responsible and do the right thing" by involving another adult, she said, but by restricting communication, the law endangers their health.

Of the 5,400 patients the clinic saw last year, about 8% were teens, and of those, 3% were from Missouri, according to Burgess. But the minute Missouri's law went into effect, the clinic complied. Hope now requires identification from teens to determine if they are from Missouri, along with proof of parental consent if they are. One clinic doctor, who wished to remain anonymous, said he felt no threat of liability because the clinic always has taken steps to protect its doctors when dealing with out-of-state teens.

Abortion rights groups say the law's constraints force doctors to choose between protecting teens' health and safety and protecting themselves from liability. "The law threatens health care providers ... who provide accurate medical information ... to a young person in need," said Peter Brownlie, head of Planned Parenthood of Kansas and Mid-Missouri.

Anecdotally, doctors say they are mostly confused and uncertain about what they can do, he said.

The Missouri law allows lawsuits against anyone who may "cause, aid or assist" minors in obtaining an abortion without parental consent, which applies to doctors, relatives, clergy and teachers, including those living out of state. The lawsuit may include emotional and punitive damages, and court and attorneys fees.

The Planned Parenthood lawsuit alleges that Missouri's law violates First Amendment rights of those who might counsel the teenager, and that it is vague on what is allowed or prohibited in conversations with minors. Because the law applies to people outside Missouri, the lawsuit alleges it violates the U.S. Constitution's commerce clause and due process rights.

Supporters weigh in

Anti-abortion groups welcome Missouri's law because attempts at a federal law to ban transportation of teens across state borders for abortions have not been successful.

"Missouri has found a creative way to deal with it, and I certainly commend them on it," said William Beckman, executive director for the Illinois Right to Life Committee.

Eugene Diamond, MD, an editor for the Catholic Medical Assn. publication Linacre Quarterly, said, "I've been practicing pediatrics [in Illinois] for 50 years, and I know that parents in general want to be involved in the medical care of their children."

AMA policy, adopted in 1992, on mandatory parental consent to abortion states that physicians should comply with their state laws and try to ensure that patients who are minors have made an informed decision regarding abortion. It also says that doctors should encourage teenagers to discuss pregnancy with their parents or alternative sources if parents are not going to be involved in the abortion decision.

"Minors should be urged to seek the advice and counsel of those adults in whom they have confidence, including professional counselors, relatives, friends, teachers or the clergy," AMA policy states.

The Missouri State Medical Assn. has no position on parental consent. "So few doctors actually perform abortions that liability is almost a nonissue," said C.C. Swarens, the group's executive vice president.

The Illinois State Medical Society had no comment on parental consent or Missouri's law. The state medical societies in Indiana and Wisconsin also have no position and said there was no whisper of similar legislation.

"We know it was aimed at our clinic," Hope's Burgess said. "But one thing people are not clear on is that it affects laws in every other state."

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Case at a glance

Planned Parenthood of the St. Louis Region Inc. v. Jeremiah W. Nixon, attorney general of Missouri

Venue: Missouri Supreme Court
At issue: Whether a Missouri law that imposes civil liability on "trusted adults" who assist Missouri minors in obtaining an abortion without parental consent violates free speech and the U.S. Constitution's interstate commerce clause because it applies to actions taken out of state. "Trusted adults" includes physicians, relatives, clergy and teachers.
Impact: Groups on both sides of the issue say the law is aimed at Illinois, which does not have a parental consent requirement. Abortion rights groups say the statute is vague and the threat of liability keeps doctors and counselors in and out of the state from providing medical information and services to at-risk teenagers. Anti-abortion groups praise the law for protecting minors and the state's right to require parental consent.

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The state picture

Planned Parenthood provides a snapshot of state laws requiring parent's consent or notification when their teenage child is seeking an abortion.

Laws on hold due to legal challenges

Consent: Alaska, California, Idaho, New Mexico

Notice: Illinois, Montana, Nevada, New Hampshire, New Jersey

Laws in effect or scheduled to take effect

Consent: Alabama, Arizona, Arkansas, Indiana, Kentucky, Louisiana, Maine, Massachusetts, Michigan, Mississippi, Missouri, North Carolina, North Dakota, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Virginia, Wisconsin, Wyoming

Notice: Colorado, Delaware, Florida, Georgia, Iowa, Kansas, Maryland, Minnesota, Nebraska, Ohio, Oklahoma, South Dakota, Utah, West Virginia

States with no laws

Connecticut, Hawaii, New York, Oregon, Vermont, Washington, Washington, D.C.

Source: Planned Parenthood Federation of America

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