NOW

The State of Informed Consent

Brian Ferree

PPOG 500-BO4 LUO Spring 2021

February 25, 2021

OUTLINE

Introduction

1. There is an ongoing conflict regarding a state’s involvement in restricting abortions.

a. This conflict has several key factors:

i. There is tension created concerning a woman’s right to make decisions regarding her own body and a state’s perceived intrusion into those rights through over-reaching legislation.

ii. There is an ongoing debate over the personhood of a fetus.

iii. There is significant controversy over the mandated use of 4D ultrasound, as a means of informed consent, prior to an elective abortion.

b. Hypothesis: A state has a moral and ethical obligation to provide protections for the rights of all people, especially the unborn who cannot protect themselves.

Body

2. The role of the State is critical.

a. To establish regulations across a wide range of institutions.

i. Regulations are established for the fair and equitable protection of consumers.

ii. Regulations are also established for the protection of institutions and to standardize the legal functioning of these institution within state guidelines.

iii. Many people are concerned with the risk of government over-reach vs. the protection of civil rights.

b. To define and enforce regulations particularly related to this subject such as:

i. In the area of general medical practice – i.e.: informed consent, abortions.

ii. In defining controversial issues – i.e.: when life begins.

iii. In the area of a woman’s rights, health, and choice.

iv. In the protection of life – i.e.: all life including the unborn.

c. The value of this research is in understanding a state’s role in the debate over the use of 4D ultrasound as a method of informed consent prior to an elective abortion.

d. A state’s legalization of abortion is in opposition with their concern over mandatory informed consent before an abortion is performed.

3. The State Department of Health, Medical Boards, and Doctors

a. Role vs. responsibility.

b. The specific wording of the original Hippocratic oath addresses a doctor’s involvement in the practice of abortion.

c. A doctor has a moral and ethical responsibility to provide adequate treatment for all patients and the preservation of life.

4. The role of informed consent.

a. A practical definition.

b. The purpose of informed consent.

i. Describe the value of informed consent to the patient.

ii. Describe the value of informed consent to the doctor.

iii. 4D ultrasounds, provided as informed consent, act as a last level of protection for the unborn before an elective abortion is performed.

5. The value of providing a 4D ultrasound has mixed results.

a. Evidence demonstrates that there are mixed results in providing a 4D ultrasound to a woman seeking an abortion.

b. Does the mandated use of a 4D ultrasound constitute informed consent or is it simply used to psychologically manipulate a woman’s choice to have an abortion?

c. Statistics prove that providing a 4D ultrasound is most beneficial for women who are undecided about having an abortion.

6. The Elephant in the Room: an analysis of the competing perspectives of the personhood of a fetus.

a. There are multiple perspectives and definitions concerning ‘when life begins.’

b. Statistics demonstrate that those considering whether to have an elective abortion, after viewing an ultrasound, have an increased likelihood of electing to choose pregnancy over having an abortion.

Conclusion

“Abortion is a contentious area of medicine.”[footnoteRef:1] [1: Jen Russo,“Mandated Ultrasound Prior to Abortion.” AMA Journal of Ethics: Illuminating the Art of Medicine. (Apr. 2014) Virtual mentor. 2014;16(4): 240-244. doi:10.1001/virtualmentor.2014.16.4.ecas1-1401. Accessed February 18, 2021:XX]

The January 22, 1973 Supreme Court’s decision on Roe v. Wade, ruled that undue state restrictions on a woman’s right to an abortion were unconstitutional. This ruling fundamentally altered the direction of America’s ethical, spiritual, and moral compass. It was a foot on the neck decision that crushed the strongly held foundational conviction in the sanctity of human life. On that day, America suffered a catastrophic and permanent moral wound. The ruling essentially legalized abortions in the United States and ignited a firestorm of controversy that has extended its reach far beyond the halls of medicine. It has been and will continue to be a fiercely contentious issue. Ironically, the Roe decision could not have come at a more pivotal time in history. America was reeling from the tumultuous events of the 60’s: it was a decade that changed the course of history for millions of Americans. With the assassinations of President John F. Kennedy and civil rights leaders Martin Luther King Jr and Malcom X, as well as Senator Robert Kennedy, America’s confidence was profoundly affected, and its stability undermined. America’s escalating presence in the interminable Vietnam War and the underlying strife caused by the incomprehensible and personal cost of war also added significantly to the social unrest. Additionally, the upheaval created by the Civil Rights Movement, capped a decade of turmoil and civil unrest. For many, the Roe decision was the coup de grâce that forever divided the country. Today, abortion policies and practices are the fuel of divisive political debate and fiery public opinion. It is an issue that has divided the country, unraveling, and alienating a society that was once united.

If the Supreme Court of the United States ruled that undue state regulations on a woman’s right to choose and abortion are unconstitutional, why then is abortion such a contentious issue in medicine, politics, and religion? The answer is best discerned by considering the state’s renewed interest in abortion politics. Beginning in 1985, the State of Pennsylvania, under the leadership of Governor Robert P. Casey, revisited the abortion issue challenging the permissiveness of liberal abortion policies. The case, Planned Parenthood of Southeastern Pennsylvania et. al. vs. Robert P. Casey et. al. “began with the enactment of the 1988 and 1989 Amendments to the Pennsylvania Abortion Control Act of 1982.”[footnoteRef:2] The provisions of Casey’s amendments were pivotal to the success of the case and continue to be crucial to the current discussion. The specific provisions of the Amendments are clearly described in the article by Nancy Kassop, “From Arguments to Supreme Court Opinions in Planned Parenthood v. Casey. She writes, [2: Nancy Kassop, "From Arguments to Supreme Court Opinions in Planned Parenthood v. Casey." PS: Political Science and Politics 26, no. 1 (1993): 53]

At issue here were six provisions: a medical emergency exception to the Act’s abortion restrictions; physician and counselor information disclosure requirement (informed consent); and a 24-hour waiting period; a one-parent informed consent requirement, with a judicial bypass provision, for minors under 18 years of age; a spousal notice requirement for the filing of confidential medical reports by abortion providers; and a requirement of the filing of reports by abortion facilities supplying their names and addresses and those of their affiliated organizations end the names of doctors who perform abortions at these facilities, and further requiring such reports to be publicly available for those facilities receiving public funds.[footnoteRef:3] [3: Nancy Kassop, 53. ]

This landmark case initiated a new approach to regulating out-of-control abortion practices and served to dismantle the liberality of the Roe decision. “The court held that Roe (1973), Akron (1983), and Thornburg (1986) were no longer the law of the land and that strict scrutiny standards for evaluating abortion regulations had been replaced by the [Casey] “undue burden” standard…”[footnoteRef:4] With the trimester framework of Roe dismantled, “which in principle allowed varying levels of state regulation of abortion after the first trimester of pregnancy,”[footnoteRef:5] the new standard of ‘undue burden’ opened the door for a “dramatic expansion of state-based restrictions on abortion” such as the controversial use of ultrasound image viewing as a matter of informed consent.[footnoteRef:6] The Court’s decision also reopened political debate concerning the definition of human life and the personhood of the fetus. Glen Halva-Neubauer and Sara Zeigler confirm that, “Following Roe, anti-abortion groups launched several strategies to overturn or limit its effects, among the most popular being efforts to amend the Constitution to state that life begins at conception.”[footnoteRef:7] The Casey decision validates the need for the state to act within their moral, ethical, and legal obligation to provide protections (in the form of regulations) for the rights of all people, especially the unborn who cannot protect themselves. [4: Nancy Kassop, 53. ] [5: Cynthia R. Daniels, and Janna Ferguson, Grace Howard, Amanda Roberti. 2016. “Informed or Misinformed Consent? Abortion Policy in the United States.” Journal of Health, Politics, Policy and Law, Vol. 41, No. 2, April 2016. DOI 10.1215/03616878-3476105: xx ] [6: Cynthia R. Daniels, and Janna Ferguson, Grace Howard, Amanda Roberti. 2016. “Informed or Misinformed Consent? Abortion Policy in the United States.” Journal of Health, Politics, Policy and Law, Vol. 41, No. 2, April 2016. DOI 10.1215/03616878-3476105. ] [7: Glen A. Halva-Neubauer, and Sara L. Zeigler. "Promoting Fetal Personhood: The Rhetorical and Legislative Strategies of the Pro-Life Movement after Planned Parenthood v. Casey." Feminist Formations 22, no. 2 (2010): 101-23. Accessed February 11, 2021. http://www.jstor.org/stable/40835373. ]

Abortion Regulations on the State Level

Pro-choice and pro-abortion advocates routinely protest the states’ interference and abortion regulations. However, “the 10th Amendment of the United States Constitution authorizes the states to establish laws and regulations protecting the health, safety, and general welfare of their citizens;” therefore, according to the Federation of State Medical Boards, “it is the responsibility of the individual states to regulate the practice of medicine.”[footnoteRef:8] Regulations are rules that are established by, in this case, state government that outline how an individual, organization, industry, or any activity within such entity can operate. These regulations are established for a multitude of reasons and are a vital aspect of ‘protecting the health, safety, and general welfare of [its] citizens. The state oversees a host of agencies through stringent regulations such as: aging, agriculture, banking, commerce and trade, conservation of natural resources, corporations and business associations, education, environment, and labor and industry, human services, transportation, professional and vocational standards, and public utilities, etc. This list offers just a few of the multitude of agencies and organizations that each individual state oversees through carefully enacted regulations. These regulations are intended to cultivate accountability for fairness and equality of function; to develop standardization within organizational procedures, processes, and parameters; and to provide protection for the rights of both the consumer and the institution alike. [8: Understanding Medical Regulations in the United States: A Special Educational Program for New Members of State Medical Boards, 2018. Federation of State Medical Boards, https://www.fsmb.org/education/understanding-medical-regulation-in-the-united-states/]

Considering the states’ extensive regulatory reach into every facet of life it must be acknowledged that the states also have a vested interest in regulating medicine and medical practice. While this may not be a popular opinion, it falls within the scope of state jurisdiction. According to the Supreme Court’s decision in Planned Parenthood v. Casey, “the very notion that the State has a substantial interest in potential life leads to the conclusion that not all regulations must be deemed unwarranted.”[footnoteRef:9] It can be concluded then that the state has a moral and ethical obligation to provide protections, in the form of regulations, for the rights of the unborn. [9: Cynthia R. Daniels, and Janna Ferguson, Grace Howard, Amanda Roberti. 2016. “Informed or Misinformed Consent? Abortion Policy in the United States.” Journal of Health, Politics, Policy and Law, Vol. 41, No. 2, April 2016. DOI 10.1215/03616878-3476105: ]

The State Department of Health, Medical Boards, and Doctors

Within a state’s responsibility “to regulate the practice of medicine” is another group of professionals who work in cooperation with the state in regulating the medical field. Every state relies upon the expertise of medical professionals, typically consolidated into a State Department of Health or a Medical Board. Often, the input of professionally recognized doctors who are experts in their field are also consulted. The Federation of State Medical Boards illustrates the uniqueness of this invaluable resource.

Rather than being seen as an inherent right of an individual, the ability to practice medicine in the United States is considered a privilege granted by the government of a state acting through their elected representatives. With this constitutional definition in place, each of the 50 states, the District of Columbia and the U.S. territories have enacted laws and regulations that govern the practice of medicine and outline the responsibility of state medical boards to regulate that practice within their borders. The ultimate goal is to foster the professional practice of medicine and protect the public from unprofessional, improper and incompetent actions.[footnoteRef:10] [10: Understanding Medical Regulations in the United States: A Special Educational Program for New Members of State Medical Boards, 2018. Federation of State Medical Boards, https://www.fsmb.org/education/understanding-medical-regulation-in-the-united-states/ ]

This explanation provides substantial credibility to the state’s enactment of regulations in the medical field. Secondly, it also provides indispensable clarity to what is often perceived as state over-reach in regulating medical practice. A third point is that it also addresses the state-granted privilege bestowed upon physicians to practice medicine. Clearly, the state evaluates regulatory legislation in full cooperation with medical professionals who are ultimately responsible for ensuring that these regulations are followed. State medical boards are responsible for regulating medicine in the United States, the licensing of physicians, investigating complaints, discipline, and the adopting of “policies and guidelines related to the practice of medicine and [are] designed to improve the overall quality of health care in the state.”[footnoteRef:11] This explanation also prompts an assessment of a medical doctor’s role and responsibility in the context of abortion regulations. A careful evaluation of the original Hippocratic Oath, “one of the oldest binding documents in history… and [one that] is held sacred by doctors to this day,”[footnoteRef:12] addresses a doctor’s involvement relating to the practice of abortion. It is, as some would conclude, an invaluable moral guide. A new physician would swear in part, “I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly, I will not give a woman a pessary to cause an abortion.”[footnoteRef:13] Today, most modern versions of the Hippocratic Oath are substantially revised and make no direct reference to abortion. Nevertheless, a doctor has a moral and ethical responsibility to provide the best available treatment to all patients and to fight for the preservation of life. [11: Understanding Medical Regulations in the United States: A Special Educational Program for New Members of State Medical Boards, 2018. Federation of State Medical Boards, https://www.fsmb.org/education/understanding-medical-regulation-in-the-united-states/ ] [12: Peter Tyson, “The Hippocratic Oath Today” NOVA, March 2001, https://www.pbs.org/wgbh/nova/article/hippocratic-oath-today/ ] [13: “Greek Medicine – The Hippocratic Oath,” The United States National Library of Medicine. https://www.nlm.nih.gov/hmd/greek/greek_oath.html, accessed February 20, 2021.]

The Role of Informed Consent

In an effort to circumvent the strict scrutiny standard of Roe v. Wade and other prior abortion cases, Casey proposed the use of informed consent statutes to gain regulatory control of abortion procedures. Specifically, the informed consent statute “require[s] that a woman seeking an abortion receive a state-authored informational packet before the abortion procedure can be performed. These laws, often labeled “Woman’s Right to Know” acts, typically require details of fetal development and information about alternative to abortions and risks associated with abortion and pregnancy.”[footnoteRef:14] The Supreme Court carefully evaluated the constitutionality of informed consent laws and “affirmed three principles of informed consent laws namely, [14: Cynthia R. Daniels, and Janna Ferguson, Grace Howard, Amanda Roberti. 2016. “Informed or Misinformed Consent? Abortion Policy in the United States.” Journal of Health, Politics, Policy and Law, Vol. 41, No. 2, April 2016. DOI 10.1215/03616878-3476105.]

1) The state has an interest in fetal life from the moment of conception,

2) The state could prefer childbirth over adoption, and

3) The state could enact regulations to ensure that a woman’s choice was “thoughtful and informed.”[footnoteRef:15] [15: Daniels ]

With the Court’s ruling, a state was free to “promote its interest in the potentiality of human life by regulating or even proscribing abortion…”[footnoteRef:16] The Court insisted however, that the state must ensure that the information provided to the woman must be truthful and not misleading[footnoteRef:17]. As a result, the confirmation of Pennsylvania’s informed consent statute instigated a wave of other states to adopt similar or more restrictive regulations on abortion practices. For instance, “in July 2013, a Wisconsin law took effect mandating that abortion providers display and describe the ultrasound image to patients prior to offering an abortion.”[footnoteRef:18] Several other states quickly followed suit passing their own informed consent regulations that include the mandatory use of ultrasounds prior to abortions. Katrina Kimport’s article, “Women’s Perspective on Ultrasound Viewing in the Abortion Care Context, provides a brief explanation of the emergence of ultrasound use in the context of abortion care. She writes, [16: Daniels ] [17: Daniels, 182. ] [18: Ushma D. Upadhyay, and Kimport, K., Belusa, E., Johns, N. E., Laube, D. W., & Roberts, S. (2017). “Evaluating the impact of a mandatory pre-abortion ultrasound viewing law: A mixed methods study.” PloS one,12(7), e0178871.https://doi.org/10.1371/journal.pone.0178871. ]

The use of ultrasound in obstetrical care at all is a relatively recent development. Only in the last few decades have medical professionals regularly used ultrasound imaging to aid in assessing the health of a developing fetus. In Parallel, ultrasonography has become routine in abortion care, used to establish a pregnancy, confirm gestational age, and check for multiple pregnancies. Currently 24 states have laws regulating ultrasound in abortion providing facilities (Guttmacher Institute, 2012). The content of these laws varies, from requiring that all women receive an ultrasound in advance of an abortion to requiring that women view their ultrasound image.[footnoteRef:19] [19: Katrina Kimport, and Felisa Preskill, Kate Cockrill, Tracy A. Weitz, Women's Perspectives on Ultrasound Viewing in the Abortion Care Context, Women's Health Issues, Vol. 22, Issue 6, 2012, Pages e513-e517, ISSN 1049-3867, https://www-sciencedirect-com.ezproxy.liberty.edu/science/article/pii/S1049386712000722?via%3Dihub ]

A recent review of related statistics on state mandated ultrasound use, provided through the Guttmacher Institute, reveals that currently 26 states now regulate the requirement of ultrasound by abortion providers. They write,

Of these, 4 states mandate that abortion providers perform an ultrasound on each woman seeking an abortion and require the provider to show and describe the image. 10 states mandate that an abortion provider perform an ultrasound on each woman seeking an abortion, and 8 of these 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 abortion. And finally, 6 states require that a woman be provided with the opportunity to view an ultrasound image.[footnoteRef:20] [20: “Requirements of Ultrasounds” (2021) Guttmacher Institute. https://www.guttmacher.org/state-policy/explore/requirements-ultrasound ]

States have recognized the value of providing a woman the opportunity to view an ultrasound prior to having an abortion. As justice Kennedy wrote, “the state has an interest in ensuring so grave a choice is well-informed”[footnoteRef:21] Clearly, a woman’s decision to have an abortion is often difficult. Given the opportunity to view an ultrasound image of her child, a woman may be persuaded to continue with the pregnancy and save the life of her child. [21: Kaitlin Moredock,"'Ensuring so grave a choice is well informed': the use of abortion informed consent laws to promote state interests in unborn life." Notre Dame Law Review 85.5 (2010): 1973+. Business Insights: Global. Web. 10 Feb. 2021. http://bi.gale.com.ezproxy.liberty.edu/global/article/GALE%7CA250134314?u=vic_liberty ]

The Value of 4D Ultrasound

The regulations on abortion that were introduced in Planned Parenthood v. Casey and subsequently upheld by the U.S. Supreme Court were necessary and bold encroachments by the state into an under-regulated medical practice. With the few liberal restrictions on abortion granted under Roe v Wade, the practice of abortion needed to be curtailed and someone needed to restrain this out-of-control practice. In light of the new informed consent mandate and the increasing support for the use of ultrasound in pre-abortion care, speculations developed on both sides as to the impact these mandates would have on women considering an abortion. Pro-life advocates claimed that a woman who views the ultrasound will be less likely to follow through with the abortion and chose to continue the pregnancy. Pro-choice and pro-abortion advocates, on the other hand, stood in opposition to the regulatory interference and reeled at the new provisions, claiming that the legislature had no business regulating medical practices. Additionally, they expressed concerns that such regulations would have a negative emotional impact on women who already face the difficult decision of whether to have an abortion. From the pro-abortion perspective, viewing an ultrasound may place an ‘undue burden’ and cause unneeded stress to the woman pursuing an elective abortion.

Several studies have been conducted since the Casey decision to assess the impact that informed consent has, particularly the use of mandatory versus optional ultrasound viewing, and the effect it has on a woman’s decision to have an abortion. Ironically, these studies came to similar conclusions; that viewing ultrasounds had unexpectedly mixed results. One such study, documented by Dr. Katrina Kimport, Women’s Perspectives on Ultrasound Viewing in the Abortion Care Context, confirmed that,

As activists opposed to abortion rights predict, some women told stories of being persuaded to continue a pregnancy after viewing their ultrasound. In addition, as abortion rights advocates expect, some women reported feeling upset by the viewing, but continued with their plan to terminate the pregnancy. Finally – significantly diverging from both sets of expectations – other women reported feeling positive feelings about seeing their ultrasound image.[footnoteRef:22] [22: Katrina Kimport, and Felisa Preskill, Kate Cockrill, Tracy A. Weitz, Women's Perspectives on Ultrasound Viewing in the Abortion Care Context, Women's Health Issues, Vol. 22, Issue 6, 2012, Pages e513-e517, ISSN 1049-3867, https://www-sciencedirect-com.ezproxy.liberty.edu/science/article/pii/S1049386712000722?via%3Dihub ]

In another similar and comparable study, it was concluded that “the effect of mandated viewing impacts all women regardless of their decision certainty…. ………………….. Nevertheless, the current study showed that low decision certainty has strong associations with continuing pregnancy, and this is consistent with the previous study done in the context of voluntary ultrasound viewing.”[footnoteRef:23] These studies confirm that the regulatory use of an ultrasound in the pre-abortion care context has little effect on a woman’s decision to terminate her pregnancy. However, in each study, a few women chose to continue with their pregnancy after viewing the ultrasound image. While this may not be a landslide victory, it does confirm the value of viewing an ultrasound image in certain cases where a woman considering an elective abortion is somewhat undecided about her decision. Those who viewed the ultrasound image and decided to continue their pregnancy preserved a life from being aborted. [23: Ushama D. Upadhyay, and Kimport, K., Belusa, E., Johns, N. E., Laube, D. W., & Roberts, S. (2017). “Evaluating the impact of a mandatory pre-abortion ultrasound viewing law: A mixed methods study.” PloS one,12(7), e0178871.https://doi.org/10.1371/journal.pone.0178871. ]

The Elephant in the Room

The question remains, why do so many states seem to have a renewed interest in abortion politics? Is there a restored and irrepressible consciousness to the depravity of abortion practices that has been rekindled in people’s hearts? This subject is what is referred to as the elephant in the room! It is the underlying contentious issue that everyone knows needs to be addressed, but no one wants to discuss - the pivotal question of the personhood of the fetus. During the Casey trial, Solicitor General Starr was asked repeatedly “whether a fetus is a person within the meaning of the Fourteenth Amendment. Starr reiterated no fewer than seven times that “We do not have a position on that question and … this Court… need not address it in this case.” (OA 42)”[footnoteRef:24] [24: Kassop, 55. ]

Why does the state continue to avoid the fundamental solution to these issues: establishing the personhood of the fetus? In Casey, the court held that this interest in fetal life, even before viability was entirely consistent with Roe v. Wade, “that portion of the decision in Roe has been given too little acknowledgement and implementation by the Court.”[footnoteRef:25] [25: Daniels, 183. ]

It is true that pro-life advocates have changed their approach on the abortion issue to suggest that viewing ultrasound images of the fetus has the potential to develop the maternal bond between the mother and the child. This restrained approach hints to the reality of fetal personhood but falls short of a clear determination. Conversely, “Pro-choice forces create a false antagonism between a woman and her fetus, that abortion is a violent choice, and that, ultimately, abortion harms the woman who is misled into undergoing it.” While at the same time the state, and advocates on both sides try to circumvent the issue, thousands of babies continue to be aborted every day. As Justice Kennedy wrote, “[t]he government may use its voice and its regulatory authority to show its profound respect for the life within the woman.”[footnoteRef:26] [26: Kaitlin Moredock, "'Ensuring so grave a choice is well informed': the use of abortion informed consent laws to promote state interests in unborn life." Notre Dame Law Review 85.5 (2010): 1973+. Business Insights: Global. Web. 10 Feb. 2021. http://bi.gale.com.ezproxy.liberty.edu/global/article/GALE%7CA250134314?u=vic_liberty]

Conclusion:

What is at evident from this research is that a state has a moral and ethical obligation to regulate the medical practice of abortion. Although there are many dissenters who claim that regulations are an infringement on their rights, the truth is that “abortion is one of the few health procedures that is legally regulated in most countries.”[footnoteRef:27] What this research has made clear is that there are four essential components to the abortion debate: 1) that there is intrinsic value in the sanctity of human life. According to Genesis 1:26-27 men and women are created in the image of God. We are distinct from every other created thing in that we have the capacity to have a spiritual relationship with the One who created us, 2) that according to Scripture life begins at conception. King David expressed this several times in the Psalms, most notably Psalm 139:13-16, [27: Antonella F. Lavelanet, and Stephanie Schlitt, Brook R. Johnson Jr., Bela Ganatra. 2018. “Global Abortion Policies Database: a descriptive analysis of the legal categories of lawful abortion.” BMC International Health and Human Rights 18, 44 (2018). https://doi.org/10.1186/s12914-018-0183-1 ]

For thou hast possessed my reins: thou hast covered me in my mother's womb. I will praise thee; for I am fearfully and wonderfully made: marvellous are thy works; and that my soul knoweth right well. My substance was not hid from thee, when I was made in secret, and curiously wrought in the lowest parts of the earth. Thine eyes did see my substance, yet being unperfect; and in thy book all my members were written, which in continuance were fashioned, when as yet there was none of them.

3) that the practice of abortion is immoral in all but the rarest of medical cases. Jeremiah proclaimed (Jer. 1:5) that God knew him even before he was conceived. This illustrates the truth that every abortion kills a child that was distinctly known by God, and 4) that it is the responsibility of those who have a voice, whether an individual, group, or a state legislature, to endorse the biblical, moral, ethical, and legal principles against the practice of abortion. As is evident in this research, one practical and sustainable way to regulate abortions is to require doctors, as a matter of informed consent, to provide 4D ultrasounds to all patients during pre-care visits. As Cynthia Daniels wrote, “Abortion informed consent statutes are viable avenues for states to further their interests in patient autonomy, women’s health, and protection of unborn life. Neutrality toward abortion is not constitutionally required for informed consent legislation; states can use such statues to persuade women to choose childbirth over abortion in addition to informing them about the nature of the abortion procedure.”[footnoteRef:28] [28: Daniels, 183]

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