Friday, February 27, 2009

Requiring Doctors to Test All Pregnant Women for HIV/AIDS (SB09-179)

Much is being made of my comments on the floor of the Colorado Senate on Wednesday, February 25th with regard to Senate Bill 09-179 (as well as additional remarks taken out of context but printed in several media forums).

The proposed bill seeks to
require doctors to test all pregnant women for HIV/AIDS, and would allow the woman an opportunity to opt-out.

When I first heard of the bill in the Health and Human Services Committee several days earlier, I was quite moved by testimony as to how such testing could assist an unborn baby, mitigating effects of his or her mother’s HIV/AIDS condition. As a result, I voted “Yes” in supporting the bill along with the rest of the committee.

Subsequent to the committee vote, and prior to my vote of “NO” on the floor, I wrestled with a number of issues regarding the bill. I sought counsel from quite a number of people for whom I have great respect. The primary question and the one I apply whenever any issue is brought up for discussion is:
“Is this a proper role of government?”

Long-standing stigmas against out-of-wedlock sexual activity were put in place by societies to slow the spread of disease and deal with challenges of raising children without full family units. Our nation has walked away from those stigmas over the past half century…illegitimate birth rates are through the roof…some argue the true cause of poverty, criminal or substance abuse in our society can be primarily tied to the ills of out-of-wedlock births. It is a serious issue, but, as a caring nation, we try not to impose the mistakes of the parents on their children.

Related to the above, some also think society should remove long-standing stigmas against sexually-transmitted diseases regardless of the damage they inflict… However, sexually-transmitted diseases have devastated global communities for centuries. As a result, in Colorado and the rest of the United States we have set up a network of social and medical services to attempt to mitigate their spread and treat the afflicted.

Now we have HIV/AIDS. It is a very scary disease and has been since cropping up on the social scene over a quarter century ago. Its primary vector has been out-of-wedlock sexual activity. A small segment of our society has acquired the virus and suffers tremendously from it. Unfortunately, treatment of HIV/AIDS infection has been highly politicized and attempts to slow its spread with traditional community healthcare strategies have been compromised for years. I find it curious those who now seek to mandate testing
all pregnant females regardless of their potential for infection oppose testing in other circumstances where a real and actual risk exists.

But the question still remains,
“Is this a proper role of government?”

If you believe it is right and fitting to require testing for any particular health situation, should we then require it for other conditions or issues? Assuming we should test in all circumstances for HIV/AIDS, perhaps one could argue the legislature should require testing by physicians of any patient for any other variety of issues. How about residual cocaine use? Marijuana? Alcohol? I’m certain some could argue such testing would achieve lofty and compelling societal objectives, enabling doctors, health care providers, and others to know when to prescribe or direct intervention efforts. Should we then share those required test results with Children’s Protective Services? With law enforcement? Insurance companies? Our banks and credit unions? How about requiring testing for other conditions? Pregnancy for any female regardless of age? For cholesterol problems? High blood pressure? DNA testing to create a database to clear any person of alleged crime, or identify perpetrators? Should we use the results of any test to deny health care to patients deemed undeserving under any proposed national health care scheme where rationing takes place because of resource limits?

I find it interesting those who argue endlessly about a right-to-privacy are the first to demagogue on the issue, and seek intrusive testing. Unfortunately, as we have seen in the last election cycle, many think it is a government bureaucrat's role to make all decisions for us. This desire to intrude into our private personal spheres has become increasingly commonplace among lawmakers. Perhaps they think it shows they care about a particular issue more than we.

The conclusion I came to after hours of discussion and contemplation was that
requiring testing was indeed an improper role of government.

So SB 179 was the catalyst for an important discussion. For those who take the concept of personal responsibility seriously, and oppose an intrusive government, this issue is important. Unfortunately, I made a comment to a reporter in haste that misspoke my position on this issue. That happens. It’s a risk for all those who work in the public eye.

Some now try to characterize my comments as “I don’t care” what happens to the baby. Nothing could be further from the truth. I want to only pass laws that are within a proper role for government. Nothing more. These tests can be performed now without another government edict. That decision should be made by the mother and her doctor. I would hope doctors offer it to pregnant mothers under their care. Again, this can be done without any need for the passage of SB 179.

Let’s be very clear…
no doctor is prevented from administering the HIV/AIDS test today, and no mother is being prevented from the benefit of these tests. The issue here is not the availability or advisability of such a test. Rather, should State Statutes require ALL doctors attempt to administer this test to ALL pregnant mothers in Colorado, especially when the incidence of such HIV/AIDS is extremely low?

As to my comments on the Senate Floor, they were as follows:

Thank you, Madam President. You know, this was a difficult bill for me. I voted "yes" in committee on it, because of discussions surrounding the fact that - well, let me just basically say this - basically it modifies the communicable disease control laws, and it requires that health care providers to test pregnant women for HIV, unless they opt out. That's the main part of this bill. I voted “yes” on it. I was a little bit troubled with my vote, and I was just wondering, what was bothering me. I woke up the next morning - Thursday morning - at 5 a.m., and I wrestled with this bill for another hour, from 5 to 6a.m.. And I finally came to the conclusion that I'm going to be a "no" vote on this. And I'm trying to think to, what the role of government is here. And I am not convinced that part of the role of government should not be to protect individuals from negative consequences of their actions. Sexual promiscuity as we know causes a lot of problems in our state, one of which obviously is the contraction of HIV. And we have other programs that deal with the negative consequences: we put up part of our high schools where we allow students maybe 13 years old to put their child in a small daycare center there. We do seem continually to remove the negative consequences that take place from poor behavior - and unacceptable behavior, quite frankly. And I don't think that's the role of this body, and as a result of that I finally came to the conclusion that I have to be a "no" vote. Because this stems from sexual promiscuity for the most part, and I can't vote on this bill, and I wanted to explain to the body why I'm going to be a "no" vote.

The above comments express my beliefs.