“Necessary, in appropriate medical judgment, for the preservation of the life or health of the mother” does not mean the same thing as medically necessary

Even though most Americans believe that “necessary, in appropriate medical judgment, for the preservation of the life or health of the mother” means the same thing as medically necessary, an abortion that is not medically necessary can be legally considered to be “necessary, in appropriate medical judgment, for the preservation of the life or health of the mother” because the United States Supreme Court broadly defined “health of the mother” as “all factors — physical, emotional, psychological, familial, and the woman’s age — relevant to the wellbeing of the [mother]” in the Doe v. Bolton case, which is the companion case of Doe v. Bolton. The broad definition of health in the Doe v. Bolton decision, along with the requirement that abortions after viability be legal whenever they are “necessary, in appropriate medical judgment, for the preservation of the life or health of the mother,” has allowed abortion on demand to be effectively legal for any reason during all nine months of pregnancy in the United States because abortionists can legally claim that an abortion is “necessary, in appropriate medical judgment, for the preservation of the health of the mother”, even when the abortion is medically unnecessary.

There are certain criteria that have to be met in order for a medical procedure to be medically necessary, and some of the abortions that are legally considered to be “necessary, in appropriate medical judgment, for the preservation of the life or health of the mother” under the criteria set forth in the Roe v. Wade and Doe v. Bolton decisions are not considered to be medically necessary under the criteria accepted by most of the medical profession and health insurance companies. Here are the criteria that have to be met for a medical procedure to be medically necessary:

  1. The procedure must be in accordance with the generally accepted standards of medical practice.
  2. The procedure is performed for the purposes of preventing the death of the patient or preventing, diagnosing, or treating an illness, injury, or disease of the patient.
  3. The procedure is clinically appropriate, in terms of type, frequency, extent, site and duration.
  4. The procedure is effective in preventing the death of the patient or in preventing, diagnosing, or treating an illness, injury, or disease of the patient.
  5. The procedure is not primarily performed for the convenience of the patient, the physician, or other health care provider.
  6. The procedure is less expensive than an alternative which is at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of the patient’s illness, injury or disease, or as to preventing the death of the patient.

Abortions that are legally considered to be “necessary, in appropriate medical judgment, for the preservation of the life or health of the mother” under the criteria established under the Roe v. Wade and Doe v. Bolton decisions might not be considered to be medically necessary under the criteria accepted by most of the medical profession and health insurance companies for several reasons. First, such an abortion might not be in accordance with the generally accepted standards of medical practice. Second, most of the abortions that fall under the so-called “health of the mother exception” are performed for purposes other than and apart from preventing the death of the mother or preventing, diagnosing, or treating an illness, injury, or disease of the mother.  Third, most abortions are primarily performed for the convenience of the mother, and as such would not fall under the medical necessity criteria used by health insurance companies and most of the medical profession. Finally, an abortion might be considered to be clinically inappropriate under the criteria used by health insurance companies and most of the medical profession, even though abortion providers often consider these abortions to be clinically appropriate.

Many Americans misunderstand the difference between an abortion that is “necessary, in appropriate medical judgment, for the preservation of the life or health of the mother,” as defined by the Roe v. Wade and Doe v. Bolton decisions, and an abortion that is medically necessary under the definition accepted by most of the medical profession and by health insurance companies. This misunderstanding has allowed abortionists to legally perform medically unnecessary abortions during all nine months of pregnancy in the United States. In addition, this misunderstanding has enabled abortionists and abortion providers to file claims for abortions that are considered to be medically necessary by the abortion provider but would not be considered to be medically necessary by the health insurance provider. Moreover, some of the women who are seeking an abortion that is deemed to be “necessary, in appropriate judgment, for the preservation of the health of the mother” by an abortionist might not understand why such an abortion might not be covered under an health insurance policy that covers medically necessary abortions but does not cover elective abortions. Furthermore, this misunderstanding has allowed abortion providers to receive taxpayer funding that it should not have been entitled to by claiming that the abortions are “necessary for the preservation of the health of the mother.” Finally, if more individuals understood the difference between “necessary, in appropriate medical judgment, for the preservation of the life or health of the mother” and medically necessary, there would be increased support for prohibiting medically unnecessary abortions after viability and there would be decreased support for taxpayer funding of abortion providers.

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