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On Privacy

Dr. Paula Hillard

The Supreme Court first established this right to privacy more than a century ago, and most Americans take it for granted every time they visit a doctor. Yet today I find myself having to defend this right on behalf of my patients.

As a physician, I help people
exercise their right to privacy every day. The decisions my patients
make about their health are theirs alone — aside from having my input
as their doctor, they do not need to involve anyone in their choices.
They know that I will not share any information about their medical
condition with their families, friends, or employers without permission.
I happen to be an ob/gyn, but even if I were an orthopedist or a neurologist,
my patients would expect the same degree of confidentiality. The Supreme
Court first established this right to privacy more than a century ago,
and most Americans take it for granted every time they visit a doctor.
Yet today I find myself having to defend this right on behalf of my

Although the right to privacy
is not explicit in the Constitution, the Supreme Court has found Constitutional
support for it at least since 1891. The justices ruled then in Union Pacific
Railway Co. v. Botsford

that an employer cannot compel a worker to have a physical examination.
The majority of the Court offered a powerful description of the right
to privacy: "No right is held more sacred, or is more carefully guarded,
by the common law, than the right of every individual to the possession
and control of his own person, free from all restraint or interference
of others…"  

Even in 1891, the Supreme Court
understood how vital privacy is to our freedom. Today, the medical profession
does everything it can to protect patients’ identities and diagnoses.
We are now so accustomed to confidential care that as patients, we reveal
important, personal, or even potentially humiliating details to our
doctors without even asking about privacy. My patients know I will help
them without reporting their flu or their diabetes to the boss. They
know I will help them choose the best course of treatment without consulting
the government first. But for women who are pregnant — especially those
younger than 18 — the expected right to privacy may be in jeopardy or
have disappeared altogether. 

More than eighty years after
, Roe
v. Wade
privacy rights to a woman’s decision whether to terminate her pregnancy.
In the ruling, the justices placed reproductive freedom on the same
level as freedom of religion, freedom of speech, and our other fundamental
liberties. Whenever I provide a patient with contraception or an abortion,
I feel that I am helping her exercise a basic human freedom. Of course
my patient has "possession and control of [her] own person." Of
course she decides when and whether to be pregnant. 

Roe is gone. The chaos is just beginning.

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But Roe offers women
no guarantees. Since 1973 when Roe legalized abortion, the government
has encroached on pregnant women’s privacy until it barely exists. 

We would never let the government
tell a cancer patient to wait 24 hours between requesting a medical
procedure and receiving it, especially if the implication were that
the patient is not capable of considering the decision carefully enough.
In 20 states, any woman at any age who is seeking an abortion is told
that she must wait 24 hours so that she can be sure that she has thought
hard about ending her pregnancy. This is an example not just of outrageous
condescension but also of governments’ interference in women’s right
to privacy. 

After a leukemia patient has
chosen a safe, legal course of treatment, we would never force her physician
to give her printed material containing medically inaccurate arguments
against that procedure. But again, privacy does not always apply to
pregnant women. In six states, politics trumps a woman’s right to
sound, confidential medical advice, requiring her to accept a publication
containing disproved claims that abortion causes breast cancer, then
certify she has received it. 

As I write this, South Dakota voters
are considering Initiated Measure 11
which would eliminate a woman’s right to decide whether to terminate
her pregnancy. To have a safe, legal abortion under Measure 11, a pregnant
woman and her doctor would have to prove to the state government that
she was raped, was a victim of incest, or has a medical condition that
would seriously threaten her health if she continued her pregnancy.
No other reason would do.  

Young women’s privacy rights
are especially vulnerable. Minors can obtain confidential abortion services
in only 16 states and the District of Columbia. The other 34 states
require parents to be involved in a minor’s decision to terminate
her pregnancy. As an ob/gyn who specializes in treating teens and young
girls, I have witnessed both.  

I practiced in Ohio for 23
years, where a parental
notification law

requires doctors to inform parents if their daughter is having an abortion.
It may seem reasonable for parents to be involved in their daughters’
medical care — and in fact, most teens do inform a parent or a trusted
adult about an unplanned pregnancy. But because not every family is
loving and functional, mandated parental notification for abortion endangers
the teens who are at risk of abuse or neglect. Pregnant teens who fear
their parents’ reaction will often put off going to the doctor as
long as possible, increasing the risk to their health whether they have
an abortion or carry the baby to term. Because of these hazards, the American Medical
, the American College
of Obstetricians and Gynecologists
the American
Academy of Pediatrics
, the American Academy
of Family Physicians
, the Society for
Adolescent Medicine

and other major medical organizations support confidential reproductive
healthcare for adolescents.  

I now practice in California,
a state that mandates confidential care for minors. My patients and
I work together to decide when and how we involve their parents. Most
of the time, we do, but we can only reach that point because teens trust
that I will not share what they tell me without their permission. When
a girl fears abuse or abandonment, we work on ways to improve her situation
while providing the medical care she needs to stay healthy. This is
how the right to privacy should work for adolescents.  

But this approach is under
attack in California. In November, we will vote on Proposition 4, a state ballot initiative that would
mandate parental notification, undermining teens’ privacy and driving
them away from needed medical care. The proponents of the initiative
say that it provides two alternatives to parental notification for girls
who have reason to fear their parents, but neither option would protect
these teens. One route would require a written statement from the girl
saying that her parents abuse her, which would trigger an investigation
of her home that would be anything but confidential or safe. The other
choice would send the pregnant girl to court to present intimate details
about her physical and emotional state.  

To keep pregnant teens healthy
and defend their privacy, I
have been speaking out against Proposition 4

and urging Californians to vote no. 

In far too many places and
in far too many ways, a woman who becomes pregnant finds her right to
privacy diminished or eradicated. If we as a nation cannot let her make
confidential decisions with her physician, how free can the rest of
us be when we go to the doctor’s office?  

Dr. Paula J. Adams Hillard’s clinical practice, research and teaching
focus on the fields of adolescent reproductive health, contraception
and gynecologic care. Dr. Hillard has been a board member of Physicians for Reproductive Choice and Health since 1999.