Court Opinion

ID: 9495401
Source: CourtListenerOpinion
Date Created: 2023-08-05 16:02:02.677074+00
Date Added: 2024-06-11T17:52:32.850337
License: Public Domain

COFFEY, Circuit Judge,
concurring.
I.
This case once again requires me to review the constitutionality of informed consent legislation in the context of the abortion industry. Seventeen year’s ago, I stated that a 24-hour waiting period enacted by the Illinois General Assembly was a reasonable and lawful means of ensuring that a woman has “at least a brief time to discuss and consider” the numerous moral, social, economical, practical, psychological, and medical factors “involved in reaching a mature, well-informed decision of whether or not to abort the pregnancy.” Zbaraz v. Hartigan, 763 F.2d 1532, 1552 (7th Cir.1985) (Coffey, J., dissenting). Similarly, I concluded three years later in another case from Illinois that the state is empowered to promote childbirth and discourage abortion on demand by requiring abortionists to advise women about the reasonable alternatives to abortion, just as the state may require physicians to notify their patients about the risks and alternatives to many other invasive medical procedures. See Ragsdale v. Turnock, 841 F.2d 1358, 1396-97 (7th Cir.1988) (Coffey, J., dissenting). Accordingly, for more than a decade, there has been authority for the view that a state legislature may require abortion clinics to provide expectant mothers “with a description of the procedure to be performed, an explanation of risks and possible complications, and a discussion of alternatives so that the woman can make a responsible enlightened choice” prior to terminating the life of her pre-born child. Id. at 1397.
In today’s opinion, the majority of this panel embraces the dissenting opinions in Zbaraz and Ragsdale, rejects the abortion clinics’ facial challenge, and allows the state of Indiana to enforce its informed consent statute. Although the dissent criticizes the majority for reversing the district court and “findpng] flaws with the evidence on which the court based its factual findings” — findings which Judge Wood believes “should stand” regardless of “[w]hether this court is looking at the record de novo, under an abuse of discretion standard, or merely for clear error,” post at 711, 715 — I take issue with my colleague’s criticism, for the “undue burden standard” applicable in this case may be uniformly applied only if appellate courts independently inquire whether the trial judge’s findings of constitutional fact are firmly supported in the record and based upon a proper application of the law. See, e.g., Memphis Planned Parenthood Inc. v. Sundquist, 175 F.3d 456 (6th Cir.1999); see also Planned Parenthood v. Casey, 505 U.S. 833, 991 n. 6, 112 S.Ct. 2791, 120 L.Ed.2d 674 (1992) (Scalia, J., dissenting).
*694Judge Easterbrook succinctly and forcefully explains that the trial judge’s conclusion in this case involves a “leap of faith” that events which may or may not be occurring in Mississippi and Utah will be replicated in Indiana. Ante at 690. I add that the trial judge’s factual findings in this case are based on a faulty study by biased researchers who operated in a vacuum of speculation. As even the dissent recognizes, the “key” piece of evidence relied upon by the district court was a study published in the August 27, 1997 Journal of the American Medical Association (“JAMA”), post at 713, and was coauthored by a statistician employed by the Planned Parenthood-affiliated Alan Gutt-macher Institute. It is most obvious that the study fails to shed any light on the question before us today: Will Indiana’s abortion statute cause a decline in abortion rates in Indiana? The answer is “no, ” for the study is riddled with flatos and biases, one of the most serious being its failure to account for the effects that will result from the substantive differences between the scope of the “medical emergency” exception in the state of Mississippi’s statute as contrasted with the state of Indiana’s statute. Thus, it is logically impossible to draw upon the study of Mississippi’s legislation when predicting the future effects of Indiana’s legislation.
A.
I initially reject the notion that we must defer to the JAMA study because, according to the dissenting judge, the study “meets any conceivable standard for peer-review ” and was published in “one of the most highly respected journals in the medical field.” Post at 713. A party proffering expert testimony must always establish that it is reliable and relevant to an understanding of the issue before the court, Clark v. Takata Corp., 192 F.3d 750, 759 n. 5 (7th Cir.1999), and JAMA’s peer review policy is no guarantee of reliability. As one commentator has noted, JAMA may send a manuscript out to as many as ten reviewers “but it may actually be reviewed by only three, two, or even one. Furthermore, an article may appear in print even if a majority of JAMA’s reviewers recommends against publication, provided that the editor decides in its favor.” D. Murray et al., It Ain’t Necessarily So 151 (2001) (emphasis supplied). Moreover, the test for admissibility is not whether an article has been reviewed, or even well accepted, by one’s peers. According to the Supreme Court: “Publication (which is but one element of peer review) is not a sine qua non of admissibility; it does not necessarily correlate with reliability, and in some instances well-grounded but innovative theories will not have been published. Some propositions, moreover, are too particular, too new, or of too limited interest to be published.... The fact of publication (or lack thereof) in a peer reviewed journal thus will be a relevant, but not dispositive, consideration in assessing the scientific validity of a particular technique or methodology in which an opinion is premised.” Daubert v. Merrell Dow Pharm. Inc., 509 U.S. 579, 593-94, 113 S.Ct. 2786, 125 L.Ed.2d 469 (1993) (emphasis added). See also L. Noah, Sanctifying Scientific Peer Review, 59 U. Pitt. L.Rev. 677, 698 (1998) (“At best ... editorial peer review manages to filter out obviously sloppy work.”).
Caution regarding the value of “peer review ” as a judicial gatekeeper is particularly important in the case of an abortion-related study published in JAMA. George D. Lundberg, the editor at the time of publication of the 1997 study relied upon by the plaintiffs in this case, has publicly stated that abortion is “a religious issue” which should be decided solely by the ivoman “after consultation loith the father *695(if possible), members of her family, perhaps a religious adviser, and the woman’s physician.” G.D. Lundberg, JAMA, AboHion and Editorial Responsibility, 280 JAMA 740, 740 (Aug. 26, 1998). Lundberg went on to assert that the abortion decision is “not the business of police, lawyers, courts, the U.S. Department of Health and Human Services, the Congress of the United States, various state legislatures, or anybody else except the individuals named above.” Id. The executive vice president of the American Medical Association, an organization which at one time was considered to be the voice of the vast majority of physicians and surgeons practicing in this nation, stated that Lundberg was terminated for “inappropriately and inexcusably interjecting JAMA into a major political debate that has nothing to do with science or medicine ” by choosing to publish a study on how college students defined “having sex ” in the midst of President Clinton’s impeachment proceedings. See D. Ballingrud, AMA Chief Defends Editor’s Firing, St. Petersburg (Fla.) Times, Feb. 23, 1999, at 3B. Relying on these facts, it is apparent that this JAMA study must be viewed with a jaundiced eye, for it was written by a statistician and published by an editor who are outspoken supporters of “abortion on demand, ”1 and thus cannot reasonably be classified as impartial and without prejudice or bias.
B.
Moreover, the faulty JAMA article cannot be utilized to serve as a reliable, trustworthy, and independent basis for predicting the effects of the Indiana legislation for the additional reason that neither the article nor anything else in this record accounted for the fact that a greater number of Indiana women with medical problems (as compared to similarly situated women in Mississippi) will avoid the burdens of Indiana’s notice-and-waiting provisions by qualifying for the state’s “medical emergency” exception. The trial judge concluded that the number of Indiana women who will find themselves unable to obtain abortions as a result of the notice- and-waiting provisions will be equivalent to the number of women in Mississippi who supposedly are foreclosed from having an abortion — approximately 10 percent of the relevant population. See 132 F.Supp.2d at 1175. However, as is evident from even a cursory reading of the statute, the exceptions to the notice-and-waiting requirements are far more broad in scope and more inclusive in Indiana than they are in Mississippi. As a result, even after attempting to accept the trial judge’s notion that properly performed regression analy-ses have accounted for all other differences between the female population in Indiana and Mississippi, id. at 1163-71, the breadth of the Indiana exception will obviously result in a greater number of Indiana women being excused from the *696statute’s requirements, and thus a lesser number of Indiana women will be burdened by Indiana’s requirements than the requirements in Mississippi
The Supreme Court of Indiana in its decision broadly defines the term “medical emergency” as any physical or mental condition that is more severe and prolonged than those “lesser and regular conditions normally associated with pregnancy,” A Woman’s Choice v. Newman, 671 N.E.2d 104, 109 (Ind.1996), while the Mississippi legislature has narrowly defined “medical emergency ” as “that condition which, on the basis of the physician’s best clinical judgment, so complicates a pregnancy as to necessitate an immediate abortion to avert the death of the mother or for which a twenty-four-hour delay will create grave peril of immediate and irreversible loss of major bodily function.” Miss.Code Ann. § 41-41 — 31(b). In Indiana, an abortion clinic may disregard the notice-and-waiting requirements if “the attending physician, in the exercise of her clinical judgment in light of all factors relevant to a woman’s life or health, concludes in good faith that medical complications in her patient’s pregnancy indicate the necessity of treatment by therapeutic abortion” without delay. Newman, supra at 111. On the other hand, in Mississippi at the time of the 1997 JAMA study, an abortion clinic was allowed to waive the notice-and-waiting requirement only in “medical emergencies to avoid the death of the woman or prevent peril of immediate or irreversible loss of major bodily functions.” Pro-Choice Miss. v. Fordice, 716 So.2d 645, 656 (Miss.1998). See also Utah Women’s Clinic Inc. v. Leavitt, 844 F.Supp. 1482, 1491-93 (D.Utah 1994) (similarly interpreting Utah Code Ann. § 76-7-301(2)). Cf. Stenberg v. Carhart, 530 U.S. 914, 938, 120 S.Ct. 2597, 147 L.Ed.2d 743 (2000).
As we have pointed out above, because the statutory exception is much more expansive in Indiana than Mississippi, a greater number of Indiana women will be exempt from the limitation of their statute than similarly situated women in Mississippi, and thus I cannot agree that evidence of a 10 percent reduction in Mississippi’s abortion rate predicts that a similar reduction is on the horizon in Indiana.
I cannot understand the dissent’s attempt to enlarge the scope of Indiana’s medical emergency exception by claiming that “the majority acknowledges [that] Indiana’s law has been construed to have an emergency by-pass provision that covers any kind of physical or psychological risk to the woman from any of its provisions, including presumably the ‘presence’ requirement.” Post at 708, n.2. In doing this, the dissent has mischaracterized the majority opinion as well as the Indiana Supreme .Court’s construction of the statute before us. We in the majority, when stating that Indiana’s emergency bypass has been “held to encompass any kind of threat to the woman’s health or safety,” ante at 691, are referring to the Indiana Supreme Court’s statement that the “medical emergency exception excuses a woman from the informed consent requirement when there is a significant threat to her life or health, physical and mental” but that “severe-but-temporary conditions in which an abortion is not the medically necessary treatment are not covered by the exception.” Newman, 671 N.E.2d at 111. “Federal courts must interpret a state statute as that state’s courts would construe it.” Brownsburg Area Patrons Affecting Change v. Baldwin, 137 F.3d 503, 507 (7th Cir.1998). In light of Newman’s interpretation of the emergency bypass provision, I disagree with the dissent’s misinterpretation of the legislature’s intent wherein it asserts that the bypass shall *697apply in situations when the alleged emergency determination is triggered by simple compliance with the 18-hour notice-and-waiting provisions, which will in turn expose the woman to either: (1) a temporarily greater risk of harm from an abusive parent, spouse, or partner; or (2) a temporary period of emotional distress, mental anguish, or trauma. See Newman, supra at 108-11.
Furthermore, even if I were to ignore the decision of the Indiana Supreme Court and the many methodological flaws within the JAMA study, it is evident that the very language of the study disproves the theory that the effects of Indiana’s abortion law will be the same as Mississippi’s, for the study’s authors admit on the final page of their study that the burdensome effects of abortion legislation “may be greater in states that have relatively fewer abortion providers” (Mississippi) than in other states (Indiana). According to the authors:
The availability of abortion providers is also important to consider. The effect of mandatory delay statutes necessitating 2 visits to a provider may be greater in states that have relatively few abortion providers. In Mississippi, there were only 8 abortion providers in the entire state in 1992 or 1.3 providers per 100,000 women aged 15 to 44 years.... [T]he large decline in abortion rates we observed in Mississippi may not occur in states with greater availability of abortion providers both within the state and among neighboring states.
(Ex. 224 at 658.) The undisputed evidence in this record establishes that: (1) Indiana has eleven more abortion clinics than Mississippi; (2) Indiana women have much easier access to clinics in nearby states than Mississippi women; and (3) Indiana women, on average, live closer to abortion clinics than Mississippi women.2 More than 99 percent of Indiana women — but only 85 percent of Mississippi women — live within 100 miles of an abortion clinic.3 (Tr. 67-72). Thus, even if we were to accept the JAMA study at face value, we would be forced to accept the fact that Indiana’s law will be far less burdensome than Mississippi’s.
Providing neither support nor an analysis for his ruling, the district judge found that “the Mississippi results did not correlate at all with distance or geography” and then somehow concluded that the effects of Indiana’s statute “are likely to be equivalent to the effects of the similar law in Mississippi.” 132 F.Supp.2d at 1175. The trial judge’s finding is beyond the realm of reasonable speculation and may best be classified as unworthy of credence. Comparing Indiana to Mississippi is like comparing a turnip to a loaf of bread. As the majority observes, neither the Mississippi study nor any other evidence cited by the plaintiffs establishes that the population and demographics of Mississippi and Indiana are similar in terms of “urbanization, income, average distance from an abortion clinic, [or the] average price of abortion.” Ante at 689. Nor is there evidence of similarity between Mississippi and Indiana in terms of their availability of social support services, attitudes towards abortion, respective success with adoption *698and abortion alternative programs, or countless other factors that might allow us to equate the two states with any degree of confidence.4
The dissent spends several pages arguing the proposition that “[o]nly by ignoring key points such as the number of women” in Mississippi “who willingly undertook the burden of seeking an abortion out-of-state, where they could have the entire procedure accomplished in one visit, rather than staying in-state and enduring the two-visit burden, can the majority come to the result it does.” Post at 715-16. The dissenting judge ignores the key fact that nothing in this record answers the critical question of why some Mississippi women left the state to abort their pregnancy. A woman might very well think twice about her momentous decision if she believed that her identity were to become known within her local community. On the other hand, we are cognizant of the fact that even a small increase in the cost might dissuade an already vacillating woman living near the poverty level. Since nothing in this record distinguishes “between those incidental effects [e.g., slightly increased cost or time delay] of the statute which make the right to choose more inconvenient or costly and those direct effects which actually prevent women from obtaining an abortion,” Eubanks v. Schmidt, 126 F.Supp.2d 451, 457 (W.D.Ky.2000), it is impossible to know whether “the waiting period, as opposed to some other factor or factors, caused the negative abortion trend in Mississippi.” Karlin v. Foust, 188 F.3d 446, 488 (7th Cir.1999). It also is impossible to come to a well-reasoned and logical conclusion based on the record before us whether the laws of the state of Indiana will have a similar impact as Mississippi’s laws. See id.
For the reasons set forth above, it is apparent that the district court’s reliance upon the Mississippi data (the Henshaw study) to predict the effects of materially different legislation in Indiana (notice-and-waiting) piles a mountain of speculation upon a foundation of quicksand. I am convinced that the district judge erred when he relied on the biased JAMA study when searching for a way to enjoin Indiana’s abortion-control statute. See General Elec. Co. v. Joiner, 522 U.S. 136, 144-45, 118 S.Ct. 512, 139 L.Ed.2d 508 (1997) (expert studies based on data that was “so dissimilar to the facts presented in this litigation ” were irrelevant and inadmissible); Daubert, 509 U.S. at 591-92, 113 S.Ct. 2786 (expert studies that fail to establish “a valid scientific connection to the pertinent inquiry” before the court are irrelevant and inadmissible).
II.
A.
Even if the plaintiffs had somehow been able to produce reliable evidence in support of the trial judge’s belief that Indiana’s abortion rates will decline 10 to 13 percent as a result of the state’s informed consent laws, Indiana’s statute would still pass constitutional scrutiny, for a law enacted that seeks to promote a legitimate state interest will be deemed valid unless, “in a large fraction of the eases in which the law is relevant, it will operate as a substantial obstacle to a wom*699an’s choice to undergo abortion.” Casey, 505 U.S. at 895, 112 S.Ct. 2791 (emphasis supplied). Accordingly, I write separately to explain my disagreement with the dissent’s contention that “we would still be required to enjoin” Indiana’s statute even if it blocked a much smaller percentage of Indiana women — “ ‘only’ 1%” of the population — from exercising their “right to choose.” Post at 708.
In determining whether Indiana’s notice-and-waiting provisions are lawful, we must inquire whether women in Indiana seeking abortions, who are unable to qualify for any of the numerous exceptions to the law, will bear added costs and inconveniences from complying with the notice- and-waiting provision that are so burdensome that they will have the direct effect of preventing a “large fraction” of those women from obtaining abortions. See Casey, 505 U.S. at 894-95, 112 S.Ct. 2791; Eubanks, 126 F.Supp.2d at 456. I am of the opinion that the dissenting judge misinterprets Casey when she argues that “Casey made it clear ” that “we would still be required to enjoin [Indiana’s statute] if it affected ‘only’ 1%, the number presumptively affected by the spousal notification rule in Pennsylvania.” Post at 712. The Casey Court stated that it was enjoining Pennsylvania’s spousal notification law because a “large fraction” or a “significant number” of a subgroup of the one percent of tuomen who feared complying with the law were “likely to be deterred from procuring an abortion” — not because the law imposed some insubstantial burdens upon one percent of women in the state. Casey, 505 U.S. at 894-95,112 S.Ct: 2791.
According to the Court:
The analysis does not end with the one percent of women upon whom the statute operates; it begins there. Legislation is measured for consistency with the Constitution by its impact on those whose conduct it affects.... The proper focus of constitutional inquiry is the group for whom the law is a restriction, not the group for whom the law is irrelevant .... Of course, as we have said [the Pennsylvania statute’s] real target ... is married women seeking abortions who do not wish to notify their husbands of their intentions and who do not qualify for one of the statutory exceptions to the notice requirement. The unfortunate yet persisting conditions we document above will mean that in a large fraction of the cases in which [the statute] is relevant, it will operate as a substantial obstacle to a woman’s choice to undergo an abortion. It is an undue burden, and therefore invalid.
Id. (emphasis supplied). In other words, Casey held that Pennsylvania’s law was invalid not because it imposed additional burdens upon one percent of the state’s women but rather because it effectively prevented a “large fraction” of women within that group of one percent of women from obtaining abortions altogether. See id. at 895, 112 S.Ct. 2791.
The Casey plurality did not explain, and thus we refuse to peer into the dark abyss of speculation in an attempt to determine at precisely what point a fractional part of a group becomes an impermissibly “large fraction” and a statute becomes unduly burdensome. “To the extent I can discern any meaningful content in the ‘undue burden’ standard as applied in the joint opinion, it appears to be that a State may not regulate abortion in such a way as to reduce significantly its incidence.” Id. at 992 (Sealia, J., dissenting). However, even assuming in the case before us that some number of women will be burdened by the law, it is clear that a law which incidentally prevents “some” women from obtaining abortions passes constitutional muster. *700Indeed, Casey upheld a parental notification law despite the district judge’s undisputed finding that, in “some” of the 46 percent of cases where a minor can neither obtain the requisite consent of a parent nor avail herself of the judicial bypass provisions, the law “may act in such a way as to deprive [the minor] of her right to have an abortion.” Planned Parenthood v. Casey, 744 F.Supp. 1323, 1356-57 (E.D.Pa.1990) (factual findings 237 and 255). Though the requirement was likely to prevent “some” minors from exercising their right to choose, the Court refused to interfere and ruled that “the one-parent consent requirement and judicial bypass procedure are constitutional.” Casey, 505 U.S. at 899, 112 S.Ct. 2791.
The dissenting judge pushes the envelope and expounds a new theory of law without the citation of case law upholding the premise that a statute is unconstitutional if it prevents even one percent of the relevant population from obtaining an abortion, post at 712, and stretches the notion of substantive due process beyond reasonable limits. Were we to accept the dissent’s argument, we believe the Supreme Court would have found Pennsylvania’s parental consent statute to be unduly burdensome. But the Court chose not to strike down the Pennsylvania statute, and I believe it defies logic to argue that one percent of any group is a “large fraction” of that group. In light of the Justices’ repeated use of words such as “a significant number of women,” and “many women”; its estimate that millions of women would be burdened by a spousal notice law; and the most informative comments of Justice Stevens and Justice Scalia that restrictions are impermissible only if they are “severe, ” id. at 920, 112 S.Ct. 2791, and lead to “significant” reductions in abortion rates, id. at 992, 112 S.Ct. 2791, I am of the opinion that the challenged legislation before us is constitutional, even though, as the majority observes, the district court concluded that “the statute ... raises the cost (both financial and mental) of an abortion,” ante at 685, and “will reduce by 10% to 13% the number of abortions performed in Indiana.” See Memphis Planned Parenthood, 175 F.3d at 462-63. Cf. Okpalobi v. Foster, 190 F.3d 837, 354 (5th Cir.1999).
B.
My belief is further supported by Casey ’s forceful statements distinguishing between the constitutionality of mandatory informed consent laws (which are lawful) and mandatory spousal notification laws (which are not). Although under Casey, states may not enact spousal notification laws embodying views that are “repugnant to our present understanding of marriage and of the nature of the rights secured by the Constitution,”5 Casey, 505 U.S. at 898, 112 S.Ct. 2791, “it does not at all follow that the State is prohibited from taking steps to ensure that [the choice to end a pregnancy] is thoughtful and informed.” Id. at 872, 112 S.Ct. 2791. It is incumbent upon the federal judiciary to respect basic principles of federalism and give consider*701able deference to a state legislature’s carefully reasoned decision to “enact rules and regulations designed to encourage [the woman] to know that there are philosophic and social arguments of great weight that can be brought to bear in favor of continuing the pregnancy to full term and that there are procedures and institutions to allow adoption of unwanted children as well as a certain degree of state assistance if the mother chooses to raise the child herself.” Id
This record reflects that the Indiana General Assembly held a full panoply of hearings, engaged in extended floor debates, and considered numerous amendments offered by legislators prior to enacting the informed consent law before us today. Absent a clear constitutional violation, neither a federal district court nor an appellate court should ever take it upon itself to strike down legislation merely because it disagrees with the legislation enacted by democratically elected state representatives. Informed consent laws, having notice-and-waiting periods like Indiana’s, should thus be upheld, for the Supreme Court has held that the “idea that important decisions will be more informed and deliberate if they follow some period of reflection does not strike us as unreasonable, particularly where the statute directs that important information become part of the background of the decision” concerning the life or death of the child. Casey, 505 U.S. at 885, 112 S.Ct. 2791 (emphasis supplied). See also Planned Parenthood v. Danforth, 428 U.S. 52, 67, 96 S.Ct. 2831, 49 L.Ed.2d 788 (1976).
The Indiana General Assembly enacted its notice-and-waiting statute in an effort to alleviate a widespread problem. Witnesses at legislative hearings reported that literally hundreds of Indiana women were suffering serious regret and long-term physical, emotional, and psychological damage as a result of their choice to terminate their pregnancies without being properly informed about the risks, complications, and alternatives to the procedure. A Woman’s Choice v. Newman, 904 F.Supp. 1434, 1449 (S.D.Ind.1995).6 The intent of the legislature, according to the Supreme Court of Indiana, was to reduce the risk of abortion by “ensur[ing] that women receive the best information available” regarding the moral, social, psychological, and medical issues relevant to deciding whether to undergo the procedure. Newman, 671 N.E.2d at 111.
Included in the information that must be provided to the patient is: (1) the name of the abortionist; (2) the nature of the proposed procedure; (3) the risks and alternatives to the procedure; (4) the probable gestational age of the fetus; (4) the existence of medical assistance benefits and abortion alternatives; and (5) the father’s legal responsibility to assist in the support of the child if the child is carried to term. Ind.Code § 16-34-2-1.1. I am convinced that the Indiana General Assembly has made a reasonable and lawful decision when enacting this informed consent bill in an effort to ensure that the woman’s choice regarding the life or death of her child has *702been both knowingly and voluntarily made, after extended debate and careful reflection.
This legislation will assist women in understanding that abortion is an invasive procedure that may very well have painful psychological, physical, and moral consequences. The woman undergoing the abortion may very well experience serious psychological disorders and mental health problems in the form of depressive psychosis (including the risk of suicide) both before, during, and for many years following her decision — perhaps even for a lifetime. Added to this mental strain and anguish are the almost endless number of physical risks involved, including trauma, permanent damage to reproductive and other vital organs, dysfunction of the-cardiovascular or respiratory system, internal bleeding or hemorrhaging, embolism, and allergic reactions. Other medical factors to be considered in making a mature, informed decision include the type of abortion to be performed, the woman’s past medical and psychological history, her physical reaction to previous medical procedures, her tolerance for certain medications, the likelihood of contracting a uterine infection, the chance that the placenta and fetus will not be completely removed, the potential for future difficulties in bearing children, and even the possibility of sexual sterility. See Zbaraz, 763 F.2d at 1549-50 (Coffey, J., dissenting).
The Indiana statute requires that the name of the abortionist be made known to the patient, thus giving her an opportunity to review the credentials, qualifications, and experience of the physician, inquiring into whether he is a board-certified gynecologist, is accurate in his pregnancy term diagnosis, and is familiar with both the procedure and the myriad complications that may very well arise during the procedure. See id. at 1550. In making this decision, she is entitled to know whether the abortion procedure is being performed by “a well-trained, qualified surgeon or simply a second-rate surgeon who entered the abortion practice because he was denied hospital staff privileges by a medical peer review committee after questionable medical procedures or inferior surgical technique.” Id. at 1552. Such information is essential to making a responsible decision.
The woman also will receive information regarding economic issues, such as the father’s obligation to contribute to the support of the child, the availability of medical benefits and child care, and the right and possibility of giving up the baby to a loving-adoptive family. After receiving such information, it also is probable that the best interests of the client would be better served were she to be granted a reasonable period of time to reflect upon the information recently made known to her dealing with the possible social and psychological problems arising from the decision. Hopefully, the medical professionals who meet with the woman will be well-trained in order that they might prepare the patient to confront and resolve the possible feelings of anger, fear, depression, and confusion she may encounter towards herself and/or the father, the onset of guilt and overall withdrawal from society, and the all too frequent threat of the taking of one’s own life. See id. at 1550; ante at 701, n. 6.
It also is reasonable for a state legislature to have believed that the most efficient way to safeguard the health, safety, and well-being of the pregnant woman would be to allow her to receive the above-stated information during a face-to-face meeting with medical professionals. It was most unfortunate and inappropriate for the court to accept the proposition that voluntary consent for an abortion may be *703insured by a patient dialing an 800-phone number, touching certain digits on her keypad, and then passively taking in information through the telephone. See 904 F.Supp. at 1452.
Only a direct, face-to-face meeting will serve to allow the patient and the doctor to have a full and complete understanding of the possible problems that might arise during or after the invasive procedure. This — and only this — type of meeting is the way to determine whether the client is giving an informed consent or is conveying a wish to postpone the procedure. Personal contact is vital to any question of informed consent, for it allows the medical expert the best opportunity to observe the verbal and nonverbal behavior of the patient by focusing on her reactions and responses to questions, her facial expressions, attitude, tone of voice, eye contact, posture and body movements, confused or nervous speech patterns and countless other factors that are indiscernible by telephone but may reveal incongruities between what the patient says and what she actually feels or believes. Cf. United States v. French, 291 F.3d 945, 951 (7th Cir.2002); United States v. Mancillas, 183 F.3d 682, 701 n. 22 (7th Cir.1999).
As a result, a face-to-face consultation occurring a reasonable time before the abortion “may disclose what a telephone interview will mask: whether a woman is apprehensive, uncertain, or equivocal about whether to have an abortion; whether she needs or wishes some additional information; or whether she wishes, but may find it difficult, to ask some additional question or explore some other alternative.” 7
In the Indiana House of Representatives, the chief sponsor of this bill stated diming extensive debates that it is important for women to receive this information either in the presence of the abortionist or a well-schooled and —trained physician’s assistant, licensed practice nurse, or midwife because the patient might very well “want to talk personally to the person who may be performing” the procedure and would benefit from personal, face-to-face consultation instead of meeting the professional for the first time “on the operating table” and it is unclear whether “this is the doctor or the person you’re supposed to be talking to.” Newman, 904 F.Supp. at 1464-65.
Indeed, the need for an in-the-presence requirement was underscored by testimony at the preliminary injunction hearing, where a woman who had just recently undergone the procedure at an Indiana abortion clinic testified she never saw her doctor until he began the procedure, never saw his face (for -it was covered with a surgical mask), and never learned his name because he never spoke with her. The woman testified as follows: “[A female assisting nurse] said, ‘This is your doctor, ’ and I said, ‘Does my doctor have a name?’ And he giggled and she smiled, but I don’t know who he was. And he did the procedure. He never talked to me. He talked to her. They talked about something, I can’t even remember, and it was over. And he left.” (Tr. 416-17).
Some of the materials that the General Assembly directed the abortionist to provide to the woman, in order that she might be properly informed before making one of the most important decisions of her entire life and to minimize as best as possible the potential for future physical or psychological injuries, cannot be accurately or easily conveyed through other media, as the district judge’s injunction requires. The Gen*704eral Assembly was of the opinion that it is essential for the woman to be well-informed among other things, of the “probable gestational age of the fetus” and also be given the option of seeing a picture or drawing of the fetus and its dimensions. Ind.Code § 16-34-2-1.1.(1). It is nigh unto impossible to provide a picture or drawing of a pre-born child over the telephone unless both the patient and the abortion clinic are equipped with expensive, highly advanced videoconferencing equipment. Furthermore, any attempt to provide an illustration through the mail without having first met with the patient for a physical examination may potentially be misleading and inaccurate. The district judge’s refusal to enforce Indiana’s requirement of face-to-face meetings between the health care provider and the pregnant woman emasculates the statute and undermines the very intent of the legislature.
In my opinion, it was an abuse of discretion for the district judge to disregard controlling legal authority, cast aside the opinions of qualified medical experts and the judgment of the people of Indiana as represented by the elected members of the Indiana General Assembly, and declare that the “in the presence” requirement is not “reasonably likely to provide any genuine benefit” to Indiana women. Newnian, 904 F.Supp. at 1465. Not many judges are versed in the nuances of the practices and techniques of the medical profession. Thus, the judiciary is “ill-equipped to substitute [its] views regarding what is medically adequate, proper, or antiseptic” for those of the legislature, which acts with the full benefit of evidence received through hearings, debates, and meetings with the people of the state. Ragsdale, 841 F.2d at 1389 (Coffey, J., dissenting).
The trial judge’s questionably reasoned ipse dixit, pronounced without the support of even one citation to the record, invades the legitimate province of the legislative and executive branches and places a straitjacket upon their power to regulate and control abortion practice. As a result, literally thousands of Indiana women have undergone abortions since 1995 without having had the benefit of receiving the necessary information to ensure that their momentous choice is premised upon the wealth of information available to make a well-informed and educated life-or-death decision. I remain convinced that the trial judge abused his discretion when depriving the sovereign State of Indiana of its lawful right to enforce the statute before us. I can only hope that the number of women in Indiana who may have been harmed by the judge’s decision is but few in number.
III.
In Indiana, according to the preamble to its abortion control statute, “[cjhild birth is preferred, encouraged, and accepted over abortion.” Ind.Code § 16-34-1-1. Furthermore, “in America, we respect the sanctity of human life.” Walsh v. Mellas, 837 F.2d 789, 798 (7th Cir.1988). Pro-life legislation that fails to pose a substantial obstacle for 87 to 90 percent of a state’s women, and may have the incidental effect of reducing the demand for abortions by merely 10 to 13 percent, is reasonable, sensible, and lawful under the Constitution of the United States and the State of Indiana. Because this is the thrust of Judge Easterbrook’s reasoning, I am pleased to join his opinion.

. Moreover, it is worth noting that more than one JAMA article has exhibited hostility towards informed consent legislation in general. Indeed, a JAMA study published August 14, 2002 concluded that “requiring parental notification for obtaining prescribed contraceptives would impede adolescent girls’ use of contraceptive services and their willingness to seek screening and treatment for sexually transmitted diseases.” Girls Surveyed on Sexual-Health Services, Wall St. J., Aug. 14, 2002, at D2. Many critics declared that the parental notice study had obvious flaws, for the author inexplicably failed to interview a representative sample of the teenage population and relied instead only upon responses from teenagers who were visiting Planned Parenthood clinics in Wisconsin. According to one critic, the study showed only that "the types of kids who fool around don't tell their parents about it. That’s not surprising.” Ka-wanza L. Griffin, Girls Would Shun Sex Health Care, Milw. J. Sentinel, Aug. 14, 2002, at 1A.

. The record establishes that in 1992 there were 19 abortion providers in Indiana, or 1.44 providers per 100,000 women aged 15 to 44 years. (Ex. 221).

. The demographics of Utah also are quite different from Indiana's. More than 95 percent of Utah's abortions are performed in Sait Lake City. Only two abortion providers are located outside of Salt Lake City, and nearly all women living outside of the Salt Lake City area live more than 100 miles from an abortion clinic. (Tr. 70-72).

. Mississippi, for example, consistently ranks among the lowest states in the nation in terms of government funding for public schools (48th in 2000). As a result of this lack of funding, products of these schools obviously cannot be as well prepared as their sisters in Indiana to thoroughly understand and operate the type of electronic maze of telephonic options (as the district court suggests), particularly when the decision is joined with the life or death decision.

. Although the Casey plurality dismissed the father's interests in the life of his unborn child, it is important to note that the four dissenting Justices were of the opinion that the state “has legitimate interests both in protecting the interests of the father and in protecting the potential life of the fetus, and the spousal notification requirement is reasonably related to advancing those state interests.” Casey, 505 U.S. at 974, 112 S.Ct. 2791 (Rehnquist, C.J., dissenting in relevant part). "By providing that a husband will usually know of his spouse's intent to have an abortion, the provision makes it more likely that the husband will participate in deciding the fate of his unborn child, a possibility that might otherwise have been denied him.” Id.

. The risk of suicide for women who have abortions is both serious and real, if often under reported. See B. Garfinkel et al., Stress, Depression and Suicide: A Study of Adolescents in Minnesota (1986) (finding that a teenage girl in Minnesota was ten times more likely to attempt suicide if she had undergone an abortion in the previous six months than a comparable girl who had not had an abortion); Suicides After Pregnancy in Finland, 1987-94: Register Linkage Study, 313 British Med. J. 1431-34 (Dec. 7, 1996) (concluding that Finnish women who had induced abortions had a suicide risk three times that of the general population and si% times that of women who gave birth).

. Brief Amicus Curiae of the United States Conference of Catholic Bishops and the Indiana Catholic Conference at 7-8 (internal citations and ellipsis omitted).