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Dr. BERNSTEIN. Well, let me say it this way. In my experience I do see a lot of them because I am at the medical school. Surprisingly enough, there are very few severe illnesses in my experience in Twin Cities now that I know of after delivery. There are not very many, Most people seem to take their pregnancies pretty well. There are not many post-patrum illnesses that are very severe.

Senator BAYH. Is the impact of the disturbance or the development of the disturbance more or less or about the same now that the Supreme Court has ruled and abortions are granted ?

Dr. BERNSTEIN. I do not think I really answered that, because most patients that are having abortions—I can only speak of in Minneapolis-are not sent to psychiatrists. Yes, they seem to be getting along. I see a couple of them, but not a lot. They seem to be getting by. I have to say that, but I do not know what is going to happen in the future. I think that is the important factor. The guilts are going to be there. Now, they may not be severe. I think we will see more of this.

Now, unfortunately we do not have good data because at least up in Minnesota we don't have a law through yet to determine what happens to patients after abortion. We have tried to get a law through, but they have not been successful. Nobody is going to know what happens after abortion unless we have good follow-up. It is called very privileged information, you see, and I can understand that, too.

Senator Bayh. Have you consulted women that have had illegal abortions?

Dr. BERNSTEIN. Yes, I have seen some that had illegal abortions. Senator BayH. About psychiatric problems?

Dr. BERNSTEIN. They have come to me for psychiatric problems, yes. Senator BayH. Is this a guilt kind of problem?

Dr. BERNSTEIN. The ones I see, yes. Of course, I am only one psychiatrist, and they may be going to other psychiatrists or they may not be going at all.

Senator Bayh. It would seem to me that at least we ought to try to find the answer if we can as to whether this guilt feeling is sig. nificantly affected by the legal nature of the operation. If it is illegal in the back room kind of situation, does that present a different kind of mental burden than if it is sanctioned by the Supreme Court!

I am asking not from the moral viewpoint, but from the psychiatric viewpoint.

Dr. BERNSTEIN. The problem is, sir, that we are not getting this data. We just cannot seem to get that. I do not know how it is in your State or the rest of the country, but the women are getting aborted, are just gone. I was hearing one of the obstetricians the other day in Minneapolis. He does lots of these abortions. A lot of them never even get paid for. As a matter of fact, people say they make a lot of money, and I think they do. But a lot of people come and have their abortion and then they are gone. There is no follow-up.

Senator BAYH. I understand you cannot give me your opinion of the psychiatric impact on a patient that you never saw.

But what about those that you have seen since the court ruling?

Have you sensed any difference in those cases you have seen since the ruling?

Dr. BERNSTEIN. I see your point. The guilty ones are still getting guilty, yes.

I might clarify a point. A certain number of people that have any kind of procedure, are not going to get guilty. They do not have that kind of personality.

Senator BAYH. It would seem that if that were going to have a mental impact, just for me the impact of taking the unborn child would be a great impact, regardless of what the statute book might say at the moment. But I just wondered whether you had been able to differentiate.

Dr. BERNSTEIN. I would think in general the guilt that the individual feels is not going to be related too much to what the Supreme Court decision said. It is going to be related to what happened to that person early in her life. That is when the guilts are engendered in ourselves.

Senator Bayh. I heartily concur in what you just said about what is going to motivate a person to do something or not do something and the impact the action will have on them, being related to early childhood experiences and the basic principles that were inculcated at a very early age. Would you give us your opinion about what is going to happen to these women that have been getting illegal abortions?

Dr. BERNSTEIN. Illegal abortions? Senator Bayh. Illegal abortions. Now we have made it legal. If we made it illegal again, does one assume that the same number of women are going to have and continue to have illegal abortions. having gone through all this publicly?

Dr. BERNSTEIN. I am not sure I exactly have the question. But I still think there are some illegal abortions going on.

Senator BAYH. Well, let me rephrase the question a little more succinctly, because it was sort of a round robin question.

There are x number of women getting illegal abortions.
Dr. BERNSTEIN. Legal?

Senator Bays. Illegal abortions, prior to the Supreme Court decision.

Dr. BERNSTEIN. Right.

Senator Bays. The Supreme Court ruling basically made abortions legal. Now, if we proceed along the legislative channels of a constitutional amendment to prohibit abortions, what could we reasonably expect to happen to the number of abortions !

In denying these expectant mothers the abortion option, would we be going back to the number before the Court ruling, the number since the ruling, or somewhere in between?

That may be a question you cannot speculate on. But I am trying to get some background.

Dr. BERNSTEIN. You are wondering if we should go back to what it was before?

Senator Bayh. I just wonder what the impact on society is going to be. I think those of us sitting back here, the toughest job we have is not to determine in our own mind what we believe, but to try to determine what the impact on 210 million other Americans is going to be if we put our conduct into the Constitution of the United States, and this is one of the questions that has been brought to the committee rather frequently.

get it.

Now, what is going to happen to the women that were having the illegal abortions before the Supreme Court ruling?

Do you feel that what we do or do not do is going to have an impact on the desire of a woman who wants to have an abortion?

Dr. BERNSTEIN. I would think, Senator, that if somebody wants an abortion they are going to get it unless they get some kind of psychiatric kind of care or good counseling. I think we could carry them through. But if somebody really wants it, they are going to

Now, as you well know, we did not have a lot of deaths in Minnesota from the illegal abortions. There is no question of that. And one of the funny stories was, with all the exaggerated figures coming from other States, was send them to Minnesota for illegal abortions and everything will be all right. We did not have many deaths. They did them well. I do not know why. I cannot explain that. But there were not very many.

But I do not believe in the illegal abortions. I think if we have to have abortions for medical reasons—and I think there are someI think they should be done in hospitals by competent people.

Senator Bayh. Let me ask you one more question. To define once again the parameters you would place on abortions, you said you felt there should be some legal abortions?

Dr. BERNSTEIN. Yes. I have been on abortion committees. If somebody had a malignant hypertension and was going to die, I think it would be passed to have the life of the mother. There are certain things that you have to do to save the life of the mother.

Senator Bays. One of the witnesses we had last time had given birth to and subsequently lost a Tay-Sachs child.

Would there be grounds for abortion, if a thorough examination had disclosed with certainty that the Tay-Sachs trait was present in the embryo?

Dr. BERNSTEIN. I suppose I would have to beg the question, because I do not think this is something I know a great deal about, for one thing. I do not think I could tell you that.

Senator Bays. Maybe you are safe not to answer it, then, because that is a tough one.

Thank you very much, Doctor. I appreciate your contribution.

Our next witness, Dr. Zigmond M. Lebensohn, chief, Department of Psychiatry, the Sibley Memorial Hospital and clinical professor of psychiatry at Georgetown University Medical School.

Doctor, we appreciate your taking the time to be with us.

STATEMENT OF ZIGMOND M. LEBENSOHN, M.D., CHIEF, DEPART

MENT OF PSYCHIATRY, SIBLEY MEMORIAL HOSPITAL AND CLINICAL PROFESSOR OF PSYCHIATRY, GEORGETOWN UNIVERSITY MEDICAL SCHOOL

Dr. LEBENSOHN. Mr. Chairman, and members of the subcommittee, I should first like to thank the members of the subcommittee for this opportunity to testify today in opposition to the proposed amendments to the Constitution which would prohibit abortion.

Throughout my professional career, I have been acutely aware of the destructive nature and impact of restrictive abortion laws. I became most intensely involved in the abortion issue through joint discussions with my colleagues when serving as chairman of the committee on psychiatry and law of the group for the advancement of psychiatry.

In 1969 the committee issued the report, The Right to Abortion: a Psychiatric View. This report was issued following a two-decade period when there was an increasing tendency to invoke the psychiatrist as the arbiter in the issue of abortion and the psychiatric profession began to examine or reexamine its responsibilities in this regard.

I would like to begin by discussing some of the basic concerns raised in that report.

First and foremost, the committee felt that the regulation of access to abortion should be the product of religious, moral, ethical, socioeconomic, political, and legal considerations. Psychiatric factors, if they existed, must be examined in relation to these broader perspectives.

Before the Supreme Court decisions of January 22, 1973, the majority of State abortion laws required virtually all women, married or single, old or young, to carry the fetus to term, regardless of their emotional, environmental, or economic situations. This pregnancy, whether voluntary or compulsory, would then have lifetime consequences for the woman and the child. The woman who became pregnant out of ignorance or inability to utilize effective contraception lost permanently the right to control her own fate unless she could prove to doctors that her mental or physical health were in danger.

In the years preceding the Supreme Court decisions, several States legalized abortion or greatly liberalized the conditions under which it could be obtained legally. It is ironic that now, close to 18 months after the Supreme Court has spoken on the subject, this country is considering proposals which are even more restrictive than those imposed in the past, and which would totally disregard the mental or physical health, and in one instance even the life, of the mother.

The first step toward liberalization of abortion laws followed the proposals outlined by the American Law Institute-ALI—which stated in part that:

A licensed physician is justified in terminating a pregnancy if: (a) he believes there is substantial risk that continuance of the pregnancy would gravely impair the physical or mental health of the mother. For a number of reasons, the ALI proposal was unsatisfactory.

First: The ALI proposal was of no help in providing a social resolution of the moral issues involved. Second: The extent of the role assigned to psychiatrists was unacceptable because the language used defied objective or consistent interpretation. The crucial question which remained unanswered was: Are there psychiatric criteria that can be consistently and validly applied in the face of an ambiguous medico-legal standard?

The issue of whether or not there are psychiatric indications for abortion engendered debate in the psychiatric community which still continues today, and Dr. Bernstein in his testimony alluded to

this. The debate reflects the different concepts of what is mental health and what constitutes a threat to mental health.

Some would have us believe that unless an unwanted pregnancy were to bring about suicide or total breakdown, abortion could not be justified on psychiatric grounds. All of us know that such cases are extremely rare, although women have been known to take extraordinarily dangerous and damaging measures to terminate an unwanted pregnancy.

The major, and real, question is: When should abortion be recommended on psychiatric grounds? The Group for the Advancement of Psychiatry defined those criteria as follows; on the basis of the answer to this question: Will the abortion and its effect be more traumatic than pregnancy, childbirth, and forced motherhood ?

Senator Bayu. Doctor, may I just interject here a poor layman's observation ?

Dr. LEBENSOHN. Please.

Senator BAHY. As a lawyer, I find it difficult to nail down the criteria definition given by the American Law Institute. Could you tell me, how you as a doctor, nail down the definition you just read?

Is there a way that you can weigh that on the scales?

Dr. LEBENSOHN. Toward the end of my testimony, Mr. Chairman, I will try to point out that I am in favor of psychiatry getting out of the abortion business entirely, with very rare exceptions.

Senator Bayh. Then just go ahead with your statement.

Dr. LEBENSOHN. The question which puzzled you as a lawyer puzzled us also as psychiatrists. Therefore, we felt that abortion should be, a matter between the woman and her physician, and that psychiatrists ought to stay out of the situation except for research, conducting studies on the psychiatric sequelae of abortion or pregnancy, and treating those clear-cut cases where there is psychiatric illness. Other than that, I do not feel that the average woman, faced with an unwanted, unplanned pregnancy desiring an abortion, needs a psychiatrist. So in a sense we felt that was a decision that psychiatrists should not make.

Senator Bays. I just did not want to forget that one.

Dr. LEBENSOHN. I completely agree. This issue puzzled our committee so much, that we concluded this should be the decision of the woman in consultation with her doctor.

Until fairly recently, we thought women often experienced severe mental and physical trauma as a result of abortion. It was not clear to us whether these apparently negative reactions were due to the fact that the operations for the most part were conducted illegally, under clandestine and demeaning conditions, or whether they were a more direct effect of the procedure itself.

We have found, however, that the older literature is full of alarming reports suggesting that women who had experienced abortions suffered deep psychic trauma and profound guilt which would haunt them to the end of their days and which would eventually form the basis for future depressive or psychotic episodes. Most of these studies simply do not stand up to serious critical review. Simon and Senturia in one of the best papers on the subject reviewed 28 publications which included the major studies conducted between 1935

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