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EEFECTS OF ANESTHESIA DURING A PARTIAL \^ BIRTH ABORTION Y 4. J 89/1:104/73 J^rj Effects of ftnesthesia During a P^rt. .^^? BEFORE THE SUBCOMMITTEE ON THE CONSTITUTION OF THE COMMITTEE ON THE JUDICIAKY HOUSE OP REPKESENTATIVES ONE HUNDRED FOURTH CONGRESS SECOND SESSION MARCH 21, 1996 Serial No. 73 n '- ^ Printed for the use ofthe Committee on the Judiciary U.S. GOVERNMENT PRINTING OFFICE 26-350 CC WASHINGTON vjae : ForsalebytheU.S.GovernmentPrintingOffice SuperintendentofDocuments,CongressionalSalesOffice,Washington,DC 20402 ISBN 0-16-053423-2 EFTECTS OF ANESTHESIA DURING A PARTIAL BIRTH ABORTION Y 4. J 89/1:104/73 Effects of Anesthesia During a '''''*^- -^^IING BEFORE THE SUBCOMMITTEE ON THE CONSTITUTION OF THE COMMITTEE ON THE JUDICIARY HOUSE OF REPRESENTATIVES ONE HUNDRED FOURTH CONGRESS SECOND SESSION MARCH 21, 1996 Serial No. 73 *"** <j^j Printed for the use ofthe Committee on the Judiciary U.S. GOVERNMENT PRINTING OFFICE 26-350 CC WASHINGTON : 1996 ForsalebytheU.S.GovernmentPrintingOffice SuperintendentofDocuments,CongressionalSalesOffice,Washington,DC 20402 ISBN 0-16-053423-2 COMMITTEE ON THE JUDICIARY HENRYJ. HYDE, Illinois, Chairman CARLOS J. MOORHEAD, California JOHN CONYERS, Jr., Michigan F. JAMES SENSENBRENNER, Jr., PATRICIA SCHROEDER, Colorado Wisconsin BARNEY FRANK, Massachuaetta BILL McCOLLUM, Florida CHARLES E. SCHUMER, New York GEORGE W. GEKAS, Pennsylvania HOWARD L. BERMAN, California HOWARD COBLE, North Carolina RICK BOUCHER, Virginia LAMAR SMITH, Texas JOHN BRYANT, Texas STEVEN SCHIFF, New Mexico JACK REED, Rhode Island ELTON GALLEGLY, California JERROLD NADLER, New York CHARLES T. CANADY, Florida ROBERT C. SCOTT, Virginia BOB INGLIS, South Carolina MELVIN L. WATT, North Carolina BOB GOODLATTE, Virginia XAVIER BECERRA, Cahfomia STEPHEN E. BUYER, Indiana ZOE LOFGREN, California MARTIN R. HOKE, Ohio SHEILAJACKSON LEE, Texas SONNY BONO, California FRED HEINEMAN, North CaroHna ED BRYANT, Tennessee STEVE CHABOT, Ohio MICHAEL PATRICK FLANAGAN, Illinois BOB BARR, Georgia Alan F. Coffey, Jr., General CounselIStaffDirector Julian Epstein, MinorityStaffDirector Subcommittee on the Constitution CHARLES T. CANADY, Florida, Chairman HENRYJ. HYDE, Illinois BARNEY FRANK, Massachusetts BOB INGLIS, South Carolina MELVIN L. WATT, North Carolina MICHAEL PATRICK FLANAGAN, Illinois JOHN CONYERS, Jr., Michigan F. JAMES SENSENBRENNER, Jr., PATRICIA SCHROEDER, Colorado Wisconsin MARTIN R. HOKE, Ohio LAMAR SMITH, Texas BOB GOODLATTE, Virginia KathrYN a. Hazeem, ChiefCounsel WiLUAM L. McGrath, Counsel Keri D. Harrison, Assistant Counsel John H. Ladd,Assistant Counsel Robert Raben, Minority Counsel (II) CONTENTS HEARING DATE Page Maixh 21, 1996 1 OPENING STATEMENT Canady, Hon. Charles T., a Representative in Congress from the State of Florida, and chairman. Subcommittee on the Constitution 1 WITNESSES Alvare, Helen M., Esq., on behalf of the National Conference of Catholic Bishops 331 Bimbacn, David J., M.D., director of obstetric anesthesiology, St. Luke's- RooseveltHospital Center 140 Chestnut, David H., M.D., chairman. Department ofAnesthesiology, Univer- sityofAlabama at Birmingham 143 Cobum, Hon. Tom A., a Representative in Congress from the State ofOkla- homa 135 Costello, Coreen, Agoura, CA 320 Ellison, Norig, M.D., president, American SocietyofAnesthesiologists 138 Line, Mary-Dorothy, LosAngeles, CA 326 Shafer, Brenda Prat, registered nurse, Franklin, OH 310 Wright, Jean A., M.D., medical director, Egleston Children's Hospital, Emory University 146 LETTERS, STATEMENTS, ETC., SUBMITTED FOR THE HEARING Alvare, Helen M., Esq., on behalf of the National Conference of Catholic Bishops: Preparedstatement 333 Bimbacn, David J., M.D., director of obstetric anesthesiology, St. Luke's- RooseveltHospital Center Prepared statement 141 Canady, Hon. Charles T., a Representative in Congress from the State of Florida, andchairman. Subcommittee on the Constitution: Sundry information andcorrespondencerelative to thehearing 4, 304 Chestnut, David H., M.D., chairman, Department ofAnesthesiology, Univer- sityofAlabama at Birmingham: Prepared statement 144 Cobum, Hon. Tom A., a Representative in Congress from the State ofOkla- homa: Prepared statement 136 Costello, Coreen, Agoura, CA: Preparedstatement 324 Ellison, Norig, M.D., president, American Society of Anesthesiologists: Pre- paredstatement 139 Hyde, Hon. Henry J., a Representative in Congress from the State ofIllinois: Letter dated March 20, 1996, to Chairman Canady, from Dr. Mitchell Creinin, MaGee-Women's Hospital 289 Letter dated October 30, 1995, to Chairman Canady, from Jeannie Wal- lace French 341 Line, Mary-Dorothy, LosAngeles, CA: Prepared statement 329 Schroeder, Hon. Patricia, a Representative in Congress from the State of Colorado: Letter datedFebruary 28, 1996, to Chairman Hyde, from President Clin- ton 125 Ohio court 100-page decision 23 Shafer, BrendaPrat, registered nurse, Franklin, OH: Letterfrom Congresswoman LynnRiversto one ofherconstitutents 337 Prepared statement 312 (III) IV Page Wright, Jean A., M.D., medical director, Egleston Children's Hospital, Emory University: Preparedstatement 148 APPENDIX Material submitted forthehearing 353 EFFECTS OF ANESTHESIA DURING A PARTIAL-BIRTH ABORTION THURSDAY, MARCH 21, 1996 House of Representatives, Subcommittee on the Constitution, Committee on the Judiciary, Washington, DC. The subcommittee met, pursuant to notice, at 9:40 a.m., in room 2141 Rayburn House Office Building, Hon. Charles T. Canady (chairman ofthe subcommittee) presidmg. Present: Representatives Charles T. Canady, Henry J. Hyde, Bob Inglis, Michael Patrick Flanagan, F. James Sensenbrenner, Jr., Bob Goodlatte, Barney Frank, John Conyers, Jr., and Patricia Schroeder. Also present: Kathryn A. Hazeem, chief counsel; Keri D. Har- rison, assistant counsel; Jacquelene McKee, paralegal; Mark Car- roll, staffassistant; and Robert Raben, minority counsel. OPENING STATEMENT OF CHAIRMAN CANADY Mr. Canady. The subcommittee will be in order. It is unfortunate that we are forced to take time out of our busv schedule today to examine one ofthe myths created by abortion aa- vocates about partial-birth abortion, but I believe that it is important to the health ofpregnant women to set the record straight. Shortly after H.R. 1833, the Partial-Birth Abortion Ban Act, was introduced, abortion advocates began to claim that anesthesia fiven to the mother at the beginning of a partial-birth abortion ills the unborn child. Based on this myth, they argue it is mis- leading to call the procedure a partial-birth abortion and any con- cern that the child experiences pain during the procedure is mis- placed. The claim was originally disseminated by the National Abortion Federation, a group representing abortion providers. A federation factsheet says, "Antiabortion groups claim that the fetus is still alive until the very end ofthe procedure. This is absolutely untrue. Neurological fetal demise is induced either before the procedure begins or early on in the procedure by taking steps to pre- pare the women for surgery. This includes narcotic analgesia, ex- tensive cervical dilation, and rupture of the membranes. Dr. McMahon calls the statements to the contrary preposterous. Dr. Martin Haskell of Ohio agrees with Dr. McMahon's assess- ... ment. In the event that there is any possibility ofpain per- ception in later-term fetuses prior to fetal demise, the narcotic analgesia given to the pregnant women prevents any such sensation." (1) Another leading proponent of the anesthesia myth is Kate Michelman, president of the National Abortion Rights Action League, who was invited to testify today, but indicated that she had a previous commitment. In an interview on Newsmakers in St. Louis on November 2 of last year, Ms. Michelman said, "[T]he other side grossly distorted the procedure. There is no such thing as partial-birth abortion. That's a term made up by people like these antichoice folks that you had on the radio. The fetus, I mean, it is a termination ofthe fetal life. There is no question about that, and the fetus is, before the procedure begins, the anesthesia that they ^ve the women already causes the demise of the fetus. That is, it IS not true that they are born partially. This is a gross distor- tion, and it's really a disservice to the public to say this." Dr. Maiy Campbell of Planned Parenthood circulated a factsheet titled, "H.K. 1833, Medical Questions and Answers," which includes this statement, "Question: when does the fetus die? Answer: the fetus dies of an overdose of anesthesia given to the mother intra- venously. A dose is calculated for the mother's weight which is 50 to 100 times the weight of the fetus. The mother gets the anesthesia for each insertion ofthe dilators twice a day. lliis induces brain death in a fetus in a matter of minutes. Fetal demise therefore oc- curs at the beginning ofthe procedure while the fetus is still in the womb." The press accepted abortion advocates' claims as fact and pro- mulgated the anesthesia myth. U.S. Today claimed, "The fetus dies from an overdose of anesthesia given to its mother." And the St. Louis Post-Dispatch reported, "The fetus usually dies from the anesthesia administered to the mother before the procedure begins." The New York Daily News editorialized, on December 15, as follows, "The fetus is partially removed from the womb, it's head col- lapsed, and brain suctioned out so it will fit through the birth canal. The anesthesia given to the woman kills the fetus before the full procedure takes place. But you won't hear that from the antiabortion extreme. It would have everybody believe that the fetus is dragged alive from the womb of a woman just weeks away from birth. Not true." Syndicated columnist, Ellen Goodman, wrote in mid-November that "if one relied on statements by supporters of the bill, you wouldn't even know that anesthesia ends the life of such a fetus before it comes down the birth canal." Members of Congress have also relied on abortion advocates for information and neglected to check their facts, repeatedly arguing that the child in a partial-birth abortion is killed by anesthesia before the procedure begins. But Dr. Norig Ellison, the president of the American Society of Anesthesiologists, says that this claim has "absolutely no basis in scientific fact." Dr. David Bimbach, the president-elect ofthe Soci- ety for Obstetric Anesthesia and Perinatology, says it is "cra5:y." We are looking forward to hearing testimony of both Dr. Ellison and Dr. Bimbach today. Despite these and other authoritative statements to the contrary, the medical misinformation is still being disseminated. The Amer- ican Medical News reported the controversy in a—January 1 article which—stated, "Medical experts contend the claim" regarding anesthesia ^"is scientifically unsound and irresponsible, unnecessarily — worrying pregnant women who need anesthesia." But while some are now qualifying their assertion that anesthesia induces fetal death, they are not backing away from it. Abortion advocates have repeatedly denied or misrepresented the facts on partial-birth abortion. While I do not believe that any mis- representation is acceptable, the creation of this anesthesia myth is particularly unconscionable. It could cause women who are pregnant to refuse anesthesia for needed medical treatment because they fear it will harm or kill their unborn child. Dr. Ellison has stated, "I am deeply concerned that widespread publicitv may cause pregnant women to delay necessary and per- haps life-saving medical procedures totally unrelated to the birth- ing process due to misinformation regarding the effect of anesthet- ics on the fetus." I believe it is important for us to fully examine this issue today to put an end to this myth, and to ensure that pregnant women know their unborn children are not endangered by anesthesia. [Additional information follows:] ' LATE&ABORTIONS: QUESTIONSANDANSWERS Now pending in Congress are two bills. H.R. 1833 and S. 939, which would ban a parumlar cype oflater abortion procedure. Those promotingthese bilb have used sensationalizeddrawringsandgraphiclanguagetoattempttoinflameopposiuonluthis surgery. They have left out or distorted the realities that lead to a (^fficult aboruon decision latein pregnancy;thefacuabouthow thisprocedure is performed; and how rarelythissurgerycakesplace. TheNationalAbortionFederation(NAF)isthenational professional ajsociaoon ofabortion providers. We set standards for quality care and provideaccreditedcontinuingmedical educadoo. Inthissetofquestionsandanswers. NAF will provide the facu about these later abortionsand the personal and political contextsurroundingthisissue. ifnv•fiamdoImttrakmrtumskaffmmf StatisticalinformationcompiledbytheAbnGutunacherInstitute,a privateinstiiuiinti for reproductive health research and policy analysis, and the Nauonal Aboruon Federation(NAF).documenuthefolkmdng: Tweheekso'vegerswthaetilomni,nignmtahjeorfiitneyo-r9v5e.r5ypeearrcleyntse-coonfdaltlraimbeosrtteiro.nsAtbaokuetpl9a0c%eaotfotrhebseefo4rrii' Im' thefirsttrimester. OnlyaUtsleover 1/2ofonepercentofallabortionstakeplace.it -t after20weeks'gestation. Fewerthan600abortionsperyearoccurinthethirdiriincMct ofpregnancy,andaflofthesearcperfenncdduetoseverefiecalabnormalityor ri^k (•• thelifeofthepregnanttvoman.' Wsoheaatrldyomesptrheisgntealnlcuys?-tIhtatte%UMs>umsetnhdatovniorttuwaalloytatlolhwaovmeelnatesreeakbionrguoanbso.rtWioonmse*tnv(l<<! endapregnancyatanysuge.particulariyalaterone.lightlyorcavalierly. Somcim.. • though,unavoidablecirctunstancesforcethemtoconfrontthisdecision,andthe\ m.ik. itresponsibly,carefully, witha greatdeal ofthought: ' Henshaw, S.K. and Van Vort.J., e^ AbartioH FaOhoak. The Alan Gutut.... Institute. 1992. Also. The NationalAboruon Federation, quarterly statistical i. i ma CawMh i