Opinion ID: 2103784
Heading Depth: 5
Heading Rank: 1

Heading: Informed Consent and Physician-Only Counseling Requirements

Text: Planned Parenthood challenged the statutory requirement that before a woman consents to an abortion, her attending physician must orally inform her of certain information about the procedure and her options. Tenn.Code Ann. § 39-15-202(b) and (c). The legislature has spoken on the issue of informed consent in another context. Tenn.Code Ann. § 29-26-118. This section applies to all other actions involving the issue of informed consent except for abortion. Section 29-26-118, captioned Proving inadequacy of consent, provides that a plaintiff to a malpractice action proves lack of informed consent by presenting evidence that the physician did not supply appropriate information to the patient in obtaining his informed consent ... in accordance with the recognized standard of acceptable professional practice in the profession and in the speciality, if any ... Id. The legislature has provided for a cause of action based on the lack of informed consent and has recognized that informed consent is intended to benefit the patient, i.e., the pregnant woman. Accord, e.g., Bryant v. HCA Health Services of Tennessee, Inc., 15 S.W.3d 804, 809-10 (Tenn.2000). Although it is important that a woman contemplating abortion be informed in accordance with the recognized standard of acceptable professional practice, the physician-only counseling requirement is not narrowly tailored to accomplish this requirement. The State argues that medical ethics require the attending physician to impart the required information to the woman. The State suggests that nothing in the statute prevents the attending physician from informing the woman of the required information over the telephone, thereby reducing any burden which could result from the combined effect of the physician-only counseling requirement and the two-day waiting period requirement. In our view, however, this interpretation disregards the plain language contained in Tenn.Code Ann. § 39-15-202(d)(1) that a woman may return to the physician's office following the two-day waiting period. In requiring that a woman wait two days before she may return to her physician, id., the legislature clearly intended that the woman make two trips to the physician in order to fulfill the informed consent requirements. In any event, the State maintains that these provisions are constitutionally sound, pointing to evidence in the record that Planned Parenthood has been providing similar information to its patients. Medical experts for Planned Parenthood testified that most women have already made up their minds before going to the abortion provider, and for those who seem uncertain upon arrival, that doctors either discuss the matter further or will not perform the abortion. Moreover, evidence indicates that it is standard throughout the medical community for health care professionals other than the attending physician to provide needed counseling and that the attending physician's role should be to ensure that the patient has received appropriate information. See also Akron, 462 U.S. at 448, 103 S.Ct. at 2502 (The State's interest is in ensuring that the woman's consent is informed and unpressured; the critical factor is whether she obtains the necessary information and counseling from a qualified person, not the identity of the person from whom she obtains it.). Because it is not necessary that the physician personally impart the required information to the woman in order for informed consent to occur, the physician-only counseling requirement is not narrowly tailored to further a compelling state interest and will not be upheld. We likewise conclude that the physician-only counseling requirement cannot be upheld, even under the less exacting undue burden analysis. Because the information may be provided to the woman contemplating abortion by another health care professional and the same result be achieved, we can only conclude that the purpose or effect of the physician-only requirement is to place a substantial obstacle in the path of a woman seeking an abortion. Casey, 505 U.S. at 878, 112 S.Ct. at 2821. Our analysis of the physician-only counseling requirement, as well as the lower court's conclusion and the State's concession that § 39-15-202(b)(4) ([t]hat abortion in a considerable number of cases constitutes a major surgical procedure) is unconstitutional, pretermits our discussion of each of the informed consent provisions individually. We decline to simply elide those portions of subsections (b) and (c) relating to the specific information the woman is to be told. See State ex rel. Barker v. Harmon, 882 S.W.2d 352, 353 (Tenn.1994). In Harmon, we explained that [t]he doctrine of elision allows a court, under appropriate circumstances when consistent with the expressed legislative intent, to elide an unconstitutional portion of a statute and find the remaining provisions to be constitutional and effective. Id. at 355. Even though the General Assembly included a severability clause when the statutes were recodified in 1989, 1989 Tenn.Pub. Acts, ch. 591, § 120, the State's arguments have not only stressed the importance of having the physician personally inform the woman but have further insisted that medical ethics require the physician to inform the woman. Accordingly, we conclude that the legislature would not have enacted the informed consent provisions in absence of the physician-only counseling requirement, and that consequently, the doctrine of elision cannot apply to save the remaining informed consent provisions. [11]