Washington State enacted the Reproductive Privacy Act in 1991. The state may not deny or interfere with a woman's right to choose to have an abortion prior to viability or to protect the woman's life or health. Physicians are statutorily authorized to terminate a pregnancy in these circumstances, and health care providers are authorized to assist the physicians.
Unless authorized by these statutory provisions, any person who performs an abortion on another person is guilty of an unranked class C felony. The good faith judgment of the physician as to the viability of the fetus or as to the risk to the life or health of the woman, and the good faith judgment of a health care provider as to the duration of the pregnancy are defenses to prosecution. A health care provider is a physician or a person acting under the direction of a physician.
Several attorney general (AG) opinions have interpreted the statutory authorization for physicians to perform abortions as not necessarily limiting the ability of physician assistants (PAs) and advanced registered nurse practitioners (ARNPs) to perform abortions in Washington State. Most recently, an AG opinion was issued on February 1, 2019, concluding that the Reproductive Privacy Act allows PAs and ARNPs to perform aspiration abortions as long as it is consistent with their training, certification, and scope of practice.
The list of providers statutorily authorized to terminate a pregnancy is expanded to include a physician assistant, an advanced registered nurse practitioner, or other health care provider acting within the provider's scope of practice.
The term the health care provider is defined as a person licensed to practice health or health-related services or otherwise practicing health care services in the state consistent with state law.
The state is prohibited from penalizing, prosecuting, or otherwise taking adverse action against a woman and another individual based on her and their actual, potential, perceived, or alleged pregnancy outcomes or against an individual for aiding or assisting a pregnant woman and individual in exercising the right to reproductive freedom with her and their voluntary consent.
References to woman are changed to woman and pregnant individual.
PRO: This bill clarifies the language of existing law to ensure that the qualified abortion providers have the legal protection of the law. It establishes that those health care staff whose scopes of practice do include providing abortion care are able to provide that care with the backing of the law. Washington State statutes already regulate a provider's scope of practice and licensure to ensure that only qualified, trained providers are caring for patients. This bill does not change that fact and it does not change any providers' existing scope of practice. This bill codifies a standing Attorney General's opinion, corrects statute language to be gender-inclusive, and ensures critical health care access for Washingtonians.
This bill without the amendment added from the house ensures that people cannot be punished for ending their own pregnancy or experiencing a pregnancy loss as people of color, immigrants, and those who are low-income are likely to be the ones who are wrongly criminalized for their pregnancy outcomes. Everyone should have access to safe abortion health care. This bill ensures that we minimize the legal system's ability to punish people for their pregnancy outcomes. The new language adopted in the House prohibits the arrest or prosecution of a woman and another individual and suggests that the state cannot penalize two people at once, but it could still penalize one single individual. The new language makes the bill vague and hard to understand. The committee should pass the bill without the house amendment.
CON: There are concerns regarding patient safety and training for the individuals performing these procedures and knowing how to deal with complications such as uterine perforation, involvement with the bile duct and bladder, and post-procedural hemorrhage. Non-physicians generally lack the training to recognize and manage complications in emergencies. The bill would lower standards for women's healthcare by allowing non-physicians to perform abortions. This bill goes far beyond the recommendations from the Attorney General and it dismantles the voter-approved provision allowing only physicians to perform abortions.
There is a provision in the bill allowing abortion practitioners no matter how incompetent, negligent, or malicious to not be penalized or prosecuted for their actions. A woman's voluntary consent would be an absolute defense to any wrongdoing no matter how egregious. It takes abortion and reproductive care beyond the reach of the state's power to regulate or prosecute and makes abortion and reproductive care the only areas of medicine immune from adverse action on behalf of the state. There are many categories of licensed and other regulated health professions in the state and this bill does not limit the possibility for other health professions to expand their scopes of practice. Increasing access by allowing providers with less rigorous training has the unfortunate side effect of reducing the quality of care and safety. DOH should perform a sunrise review before this bill is enshrined into law.