 Good afternoon. This is the Vermont House Human Services Committee, and it is Thursday, January 20th. And this is the third segment of our committee meetings today and what we are going to spend the next hour and 45 minutes or so. So, on is hearing testimony on proposition prop five declaration of rights, the right to personal reproductive liberty, and we have five people who we look forward to hearing from and let's start with and welcome all of you. And let's start with Dr. Naska, who is a pediatrician from Milton. Nice to see you again, sir. Hi there. Can you hear me. Yes, we can. Okay, great. Thank you. Thank you. Representative Rosenquist for asking me to testify. My practice is actually in Georgia, Vermont. We don't have a post office box yet in a while. So we, we use Milton. Welcome to my office in the middle of a pandemic. I hope you're all staying well. Thanks for the house call here. I'll try to give you a quick update of who I am. My CV is. I moved here 39 years ago, my wife and I as pharmacists, and then I attended UDM medical school from 8488. And then graduated in 88 went to Syracuse and did my pediatric residency until 91 and then came back to Franklin County and I've been in private practice since 1991. I'm a clinical instructor at the College of Medicine, and I have second and third year medical students rotate through the office. I've chaired the pediatrics department at Northwest Medical Center a couple of times. I've been president of the medical staff at Northwest and I'm a member of the Board of Incorporators and Northwest Medical Center. I consider the best part of my practice to be babies. I'm very lucky to spend my time taking care of children, and I feel very lucky and blessed about that. And I particularly like babies. So I was asked to comment about proposition five and there's a lot to unpack here but I'll try to move through it quickly and I'd be happy to take any questions as we go or at the end. I'm not familiar with personal reproductive liberty as a concept I googled it and a lot of Vermont stuff came up but I don't see this as a concept that I'm seen before quite this way. In opposition, I wonder who the people are an individual's right to personal reproductive autonomy doesn't seem to be spelled out anyway in terms of age. Does a 12 year old have these rights. What about a father's rights to reproductive liberty and how does that play out. There seems to be no age restrictions. I'm also part of the Medicaid drug utilization review board for the state of Vermont. And one thing that's always sort of bothered me is that the state of Vermont provides rural contraception children below the age of consent, the consent laws in Vermont are 16 years old, unless a 15 year old is engaged in a sexual relationship with a 19 year old and it's consensual. What I worry about with this proposition is what message are we sending to teenagers about their reproductive liberties. As I understand it proposal five is touted as a law to protect abortion. The constitution according to the proposition here says chapter one article seven, the Vermont Constitution says that all people should be afforded the benefits of protections bestowed by the government. So I wonder who the people are that were protecting. I'm a pediatrician and so this is a text that I've been using for my career it's life before birth it's human development. And here's a picture of a, this is a 14 week old person who's about four and a half inches long this is a 15 week old. Some of you, some of us are old enough to remember Life Magazine, and these particularly magnificent pictures that were done in the 60s this is an 18 week old. So, to my mind, these are people. And from University of Vermont Medical College, I swore an oath on May 21 1988. That said I will maintain the utmost respect for human life, even under threat, I will not use my medical knowledge contrary to the laws of humanity. So, in my mind view, I think the baby and the womb is a person worth protecting and should have some rights. In fact, five doesn't seem to do that. There doesn't seem to be any mention of viability in the act. It gives no limits. So, in my career, I've known of two late term abortions done in Vermont, beyond the age of viability both of them for babies that had fetal anomalies. I'm very good friends with a couple who had a child who had fetal anomalies that were felt to be not compatible with life, and they chose to keep the baby and bring the baby to term. They had a very short time with their infant, but felt very coerced by the medical establishment to terminate the pregnancy and were oftentimes asked if they wanted to terminate the pregnancy. One of the things that I'm teaching when I'm teaching medical students is I, you know, talk about we learned from my mistakes, and sort of a joke about it is that, you know, when I graduated we didn't get the crystal balls was hoping that my class would be given a crystal ball but that didn't happen. So I've learned from my mistakes. I have a patient who has trisomy 18 and I sat in in this office more than a decade ago and said to the parents I didn't think their child would, would live a year. And now that child is the oldest sibling of four. They go to school. So, I was wrong. Several patients over the years with trisomy 21 down syndrome. My sister in law was told that my niece was at risk for Down syndrome and had a very troubled pregnancy, worrying about it she's a perfectly fine college graduate and teaches for teach America in New York City. In our own life, my wife and I, one of our children was born with a birth defect. It's now correctable by fetal surgery. And there are, there are 31 centers in North America that are doing fetal surgery now, the closest being Montreal and Boston. So, if the fetus is someone that we're able to spend health care dollars on and do operations on it seems to me that we ought to be protecting this person. I was on a few as a social worker from the bio that I read. And in fact, just this morning and I was going to bring the stuff DCF has an interest in infants, and I've been party to several cases where the state has stepped in at the time of delivery and taken a baby into custody because of the concerns about the mother's health and the behaviors of the mother prior to the pregnancy. So this morning, I saw a mother with her toddler who's going to the hospital to be the surrogate for her sister who needs to. She will be the primary caretaker because the babies in DCF custody. So the state, I think has an interest in the child before delivery. And I think that we need to consider that. Proposition, you know, I think it's being touted as a proposition to protect abortion rights. And I guess, from my point of view, if, if we're doing that then we ought to at least call it what it is. What we have now is almost eugenics in terms of babies that have birth defects. And I know that representative Rosenquist is a Bill H 576 perhaps you will consider some time, which puts some restrictions around abortion and I think this is such a difficult issue for all of us. And I think we need to try to come up with something that brings us together. Place the reasonable limits around abortion and try to move forward in a way that people are more comfortable with and not just a blanket. Any baby can be terminated at any time. Another thing that I think is is very important. Conscience protection is important in health care. Once a constitutional right is established to abortion. Does does that trump the rights of health care workers who cannot participate in abortion. For me, and in my view, abortion takes the life of a child. And I just plain old can't be part of that. That's not why I went into medicine. You know, we all see the help wanted signs everywhere we go. And when I see a help wanted sign I think, who's the person not here to fill that position that we're looking for we. We've terminated a lot of babies in our time. And I, you know, I think in some ways we're paying the price for that now. Those are the things I wanted to say it's a complicated issue and I don't want to take a lot of your time but I'd be happy to take any questions. Thank you very much. Dr, and we have three given the number of people that we have to hear from. I did some quick math and we have three minutes for quite to give it equal to everyone we three minutes for questions for you and if anyone has any questions. I am looking. I don't see any questions and thank you very much. Good to hear from you again and I think I'm representative Rosenquist has a question because what I was going to say is I think many of us are on a listening mode. Dr Rosenquist. Thank you. Yes, I just got promoted. Okay, so I just wanted emotion. The bill I think Dr Nazca was talking about was to 248. Okay, but I'm sorry. I just wanted to clarify that and thank you for bringing it up. And the, you know, what would that bill even be possible. If the proposition five past, that would be a question I'd have maybe for others but maybe Dr Joe want to do it. This was the fetal personhood at 1824 weeks or more. Well, again, I, you know, in my view, the age of viability is now around 22 weeks. So, what is the state's interest in the life of a child begin. We spend a lot of time talking about prenatal care. So to, you know, early early on we begin to talk about the health of the baby and when we look at a photo like this of a 14 week old. It's pretty clear it's hard to deny the image. And I think we have to. And again, in my view, that's a human being and we ought to protect them. Thank you. And represent Rose and Chris. Do you have an additional question? Not at the moment. Thank you. Thank you. And thank you very much, Dr and for taking either your vacation day or time away from your patients appreciated. Next we have a Sharon Toborg, who is the policy analyst for Vermont right to life. Good to see you again. Thank you for inviting me to address the committee. As you said, my name is Sharon Toborg I am policy analyst for Vermont right to life committee. And given the brief amount of time I'm trying to focus my remarks on just a few key aspects of proposal five. And the first point I'd like to make is that proposal five goes far beyond Roe v Wade. The US Supreme Court found in Roe v Wade that the right to privacy is broad enough to encompass a woman's decision to have an abortion. The court put forth its trimester framework, whereby states could not regulate abortion at all in the first trimester, could regulate abortion for the health of the woman in the second trimester up to viability. And that after viability, they could regulate or even prohibit abortion to protect the what they term the potential life, except where necessary to protect the woman's life or health. Proposal five, however, would unequivocally protect abortion throughout pregnancy. That is the clear intent of the proposal. No human being, regardless of age of development, could be protected by law under proposal five. Yesterday Eleanor spots would from the Attorney General's office in her testimony, acknowledge this. She was clear that the legislation proposed by Representative Rosenquist, declaring fetal personhood at 24 weeks gestation would be declared unconstitutional on proposal five. She interfered with a woman's ability to obtain an abortion. And as Professor Robert George, who is the McCormick Professor of Jurisprudence at Princeton University, and I'm proud to say one of my former professors has noted specifically about proposal five people on both sides of the debate over abortion. I know that quote reproductive autonomy on quote is publicly understood to be a way of referring to an unlimited abortion license. That is elective abortion permitted through the entire nine months of gestation and pregnancy up to and including the process of birth. That is undoubtedly how this language would be interpreted by the Vermont courts. If you ask, does the reference to a compelling state interest and least restrictive means alter or modify that meaning. The answer is plainly no. And quote, and unlike row proposal five guarantees quote personal reproductive autonomy and quote to not just women but to all individuals without regard to age. With legislative intent courts will look to passage of act 47, where the Vermont legislature expressly rejected limits on abortion for minors and rejected limits on abortion later in pregnancy. And it will be impossible to complain claim that the state has a compelling state interest in protecting unborn human life at any stage when the legislature has already expressly rejected that. The second point is that proposal five goes beyond abortion. Personal reproductive autonomy has no fixed definition. This is by design. The ordinance of proposal five say it includes rights to abortion birth control and sterilization rights that are derived from various Supreme Court rulings over the years future Vermont court rulings on proposal five will continue to expand that definition. And we already can see evidence that this definition is being expanded. The way the ACLU was before this committee. They are helping to leave the charge for passage of proposal five. And they believe it already includes quote the right to decide if when and how to have children. I wanted to emphasize the how, because I really don't know what that means and the extent that that might go through court cases. But what would it mean, would these rights be protected for Vermonters of any age unconstrained and unregulated science almost always negatively impacts the most vulnerable and proposal five would tie the hands of future legislatures and prevent them from addressing the problems that are sure to arise. Third proposal five will impact private medical providers. The ordinance of proposal five insist it will not affect private medical providers because a constitutional amendment is only a restraint on government action not the action of private bodies. But this is a fiction. It will absolutely impact private health care providers, because it will impact the ways in which government will be allowed or required to regulate them. Governmental agencies are intensely involved in every aspect of the provision of medical care, including the licensing of physicians, nurses, other health care providers and hospitals, setting budgets, funding levels and spending priorities for care, issuing certificates of need, investigating complaints against medical providers and determining what constitutes unprofessional conduct and merits revoking of medical licenses. Under proposal five any action or inaction by these government agencies that could be construed to quote interfere with reproductive autonomy would be subject to legal challenge and need to meet the strict scrutiny standard a high level legal level to overcome. In addition Vermont is one of only two states that does not provide conscience protections to medical workers in state statute, although such legislation has been proposed here. While there are some protections in federal law, they are ignored. The current administration in Washington is working to dismantle what little protections there are. There are effective protections for doctors and nurses, some healthcare organizations in Vermont are already moving toward policies to compel participation in abortion and other procedures, even if it goes against the medical providers beliefs or medical judgment. One need only look at the UVM medical centers shifting policies in this regard. In 2019 they submitted a letter of support of proposal five to this committee, which also included the statement that they quote supported the right of individual health care providers to elect not to participate in abortion procedures, and quote. Here in 2021 they've again submitted a letter in support of proposal five. But now they only support the right of employees quote to request to opt out of participating in these procedures. These changes in policies are already contributing to shortages of doctors and nurses in our state. Fourth proposal five takes policy decisions away from the legislature. Throughout the debate on proposal five one thing has been clear if enacted Vermont's courts, not the legislature will make future policy decisions regarding quote personally to productive economy and quote. Given the unprecedented nature of this amendment it's vague wording and the desire to expand its meaning, we should anticipate many court cases of proposal five is enact. These policies decision should be made by legislative deliberation, not court mandate. Just to conclude, most Vermonters do not support unrestricted unregulated abortion. Proposal five is vague. The unfamiliar compelling state interest legal term of art is easy to miscontrue, as allowing potential regulation, rather than restricting it. And putting this unclear language before the voters of Vermont is I believe irresponsible, and I urge you not to advance this proposal. Thank you. Thank you very much. I again want to turn to the committee. For any questions. Seeing no questions. Representative Rosenquist. Thank you I couldn't find my yellow hand. I was going to call and just check. Anyway, I was just curious about the question I raised yesterday with somebody and what this two Bergs answer would be to it has to do with the fact that proposition five applies to men and women of any age and one issue that we're working on yesterday was if that they would seem that a man who wants to keep a child through term and his wife doesn't want to keep it through term that it creates a conflict and is that what you were really talking about when you said it's going to be decided in the court and not by the legislature that I think actually forget who said it yesterday, but it was that if that is that if if a husband wanted to keep the child and the wife did not that it would be something that would have to be decided in the court. In fact, it might have been chair you who made that comment. I'm not 100% sure. I did tune into the testimony yesterday and I do recall that issue coming up. And I think it's interesting because chair Pew did talk about how, where there are disputes over rights, they will end up being decided in court. But I think one thing it's important to keep in mind is when you were talking about reproductive rights. There are time elements that come into play. We talk a lot about Roe v Wade get granting a right to abortion but of course, Jane Roe of Roe v Wade never had an abortion her child was. I think a couple years old by the time that court case was decided. So what I'm talking about potential court cases. I'm talking about things such as government regulation suppose an abortion facility wanted to move into Vermont and build a facility and was denied a certificate of need, they could go to court to contest that on the grounds that it interfered with personal reproductive autonomy. There are all types of of cases that could come before the court particularly when the late languages as vague as the languages and this amendment representative McFawn you have a question. Thank you madam chair. Thank you for coming in. And given this testimony. I have one question. You brought up the term, I think it was conscious protection. That's the term you brought up. Last, last time around when we received testimony from University of Vermont healthcare. Are you saying that in that particular time they were allowing people are medical personnel not to take part in abortions if they choose not to. Two years ago that was their stated policy at the time, but that has not been their practice as of late. There was actually a situation there where a nurse claims that she was compelled to participate in abortion. She filed a complaint with the federal agencies responsible for protecting conscience protection, and they found that the University of Vermont Medical Center had in fact violated her rights. However, with the change of administration in Washington. That case has been scuttled because the current administration does not have interest in protecting conscience rights of medical professionals. Thank you very much. Thanks again for coming in. Thank you. Representative Rosenquist, do you have a question. I can't hear you. My full proof, my full proof method of pushing the space bar is not working today, I guess anyway, the following up on what you just answered representative. What on what basis are you saying the current administration does not support the protecting medical personnel do you have some particular item that suggests. I don't doubt it, but I just wanted to know. They have issued statements as to such in terms of potential world changes affecting conscience rights of professionals and I would be glad to send that information on to you. Thank you very much. Thank you Sharon we would appreciate seeing that. Are there other questions. Thank you very much. Okay. Next we have Lucy Lerich from Planned Parenthood. Welcome Lucy good to see you again too. Thank you, Madam chair. Good afternoon everyone. My name is Lucy Lerich and the Vice President of Vermont public affairs of Planned Parenthood, Northern New England. It is my privilege to be here today to voice pp and any support for the reproductive liberty amendment or prop five, the proposed amendment that would ensure personal reproductive liberty for all Vermonters. Pp and any is the largest reproductive health care and sexuality education provider in Northern New England, where we served 15,000 patients last year throughout Vermont, and typically served 19,000 patients when we are not in a pandemic. This is to provide promote and protect access to reproductive health care and sexuality education so that all people can make voluntary choices about their reproductive and sexual health. Patients come to Planned Parenthood for high quality trauma informed non judgmental compassionate and confidential care. This includes contraceptive care, pregnancy tests, cervical cancer screenings, breast exams, gender affirming care, sexually transmitted infection tests and treatment and abortion care. The care we provide our patients is primary care and for many of our patients, pp and any is their only health care provider. The liberty amendment would protect every Vermonters right to make their own reproductive decisions, like whether and when to become a parent use temporary or permanent birth control, or seek abortion care. Passing the amendment is extremely important because we see reproductive freedom being threatened across the country events in recent years have shown us we cannot take these rights for granted. In terms of reproductive rights, we've spent generations fighting for could disappear by this summer. If row versus weight is overturned by the US Supreme Court, the ability to access safe legal abortion will be determined by the states amending the Constitution of the state of Vermont to ensure that every Vermonters afforded personal reproductive liberty is necessary to protect the health, dignity and equality of all Vermonters. The 2022 legislative session follows a year of unprecedented state level attacks on abortion rights across the country. Last year, more than 600 abortion restrictions were introduced, and more than 100 took effect. Aborting nationally with reproductive rights is dangerous and frightening. Three times now, the Supreme Court has refused to stop Texas is radical new abortion ban from taking effect, and forcing almost all abortions in Texas to end. The law bans abortion as early as six weeks into pregnancy. This is before many people even know they are pregnant with no exceptions in cases of rape or incest. In December, the Supreme Court heard the Mississippi case that could overturn row versus Wade and eliminate the right to abortion that Americans have had for half a century. That decision will likely be issued in June of 2022, and we're not hopeful that the justices will uphold this right. The row is overturned nearly half the country, including 36 million women of reproductive age, and other people who can get pregnant living in 26 states could lose access to abortion. This poses an immediate threat to patients of all across the country. According to an Associated Press and or see pole this past summer, 80% of Americans support legal abortion. Given the threat to these rights at the federal level is important the Vermont legislature makes its position known and reproductive rights, amending the Constitution to ensure that every Vermonter is afforded personal reproductive liberty will make it crystal clear where Vermont stands. PPN any firmly believes that each person is capable of and must be trusted to make their own health care decisions. The proposed amendment upholds the will of Vermonters, the right of all people to help dignity independence and freedom to determine their own life's course as it relates to reproductive health and freedom. Reproductive liberty is a human rights issue. No matter your age, gender, religion, race, sexuality or how much money you have in your bank account. We all have the right to make important decisions about our lives, our futures and our bodies. But right now those very rights are under attack in every corner of the country. And that's why the reproductive liberty amendment is so critically important. The Planned Parenthood of Northern New England to plots the efforts of both the House and Senate in getting prop five to this final vote in the legislature. We ask that you pass the reproductive liberty amendment so that Vermonters can have the final word on protecting reproductive freedom in Vermont. Thank you. Thank you. I'm now looking. I'll start with representative Rosenquist you have a question. So I was just curious why if one of the major reasons for this amendment is to protect Roe versus why wait, why doesn't it say that and the, and why does it go beyond Roe versus wait I guess that was my concern. I just crafted an amendment that would say they're protecting Roe versus wait at least in our Constitution, but I don't quite understand why this had to go so far beyond Roe versus wait and create all the, all the dissension there is on this particular amendment. I'm just asking that question representative Rosenquist because it gives me an opportunity to clear up what I think might be a little misunderstanding around what Roe v. Wade isn't has in isn't actually does Roe versus Wade was a Supreme Court decision that determined that a constitutional right to to to abortion subsequent cases allowed states if they chose to further restrict those rights as in the Casey decision and gestational limits and introducing the trimester network. So what that means is that the Roe decision does not say states shall observe gestational limits because if that were the case for month would have done that years ago when the Casey decision was was handed down. That's actually not what Roe does at all so in in very in, in, in a really solid and empirical and objective way, the amendment actually does uphold the Roe decision. And beyond that the reason why we need the language to be written as it is is because we can also see through history that they things as basic as contraception are, are at times under threat. There are small pockets of individuals and organizations in the country who would like to limit people's access to contraception. And so it is important that the amendment be written in a way that's brought enough to include other fundamental reproductive rights such as contraception, and also sterilization we know that, and for example, in the state of in the state of California involuntary for sterilizations and in the presence of some have been exposed, and there's, there's evidence that that exists in other states as well. So for sterilization is another reason why we want to make sure that there is, there are protections in the state in Vermont for other reproductive rights and decisions and so that we can be a state that upholds reproductive justice for everyone. Carl, do you have a continued questions. You have to use more than the state of the space bar. Okay. I have a question. Thank you. And I am using space bar in this time at work. Anyway, the, it has to do with the bill the proposition itself that doesn't mention women. It doesn't mention row versus way. It seems deceptive in what it's about and trying to explain this to all the people in the state of Vermont. It's going to be difficult for them to understand it doesn't mention abortion, which I think is the. And yet it's basically an anti abortion bill, but it doesn't mention that doesn't mention women doesn't mention row versus way. So, I was just curious why, why it would have been crafted that way. And doesn't it seem deceptive. And the fact that those words are not in there. I don't think it seems deceptive at all because the language was actually crafted very carefully by people who are constitutional law experts, and we really specifically did want to practice protect abortion. Absolutely. That was, that was one of the goals for this amendment. But as I said earlier, those are not the only rights that we were looking to protect. We also wanted to protect people's rights to choose or refuse contraception to be able to choose or refuse permanent sterilize permanent contraception or sterilization. And we also wanted to protect people's right to carry pregnancy to term, because we have seen historically that these rights are also attacked. I don't think it's deceptive at all. I'm sorry. You have that perception of it. I think it was written in the way that it is because we are acknowledging that abortion is not the only right we feel like we need to protect. Thank you. Are there other questions. Okay. Seeing seeing none. Thank you very much. Thank you very much. Thank you very much. Thank you very much. And we now are going to go to Norm Smith. Norm, who is an attorney. And Norm, if you could, Mr. Smith, if you could clarify, welcome. It's been a couple of years. I saw that rather the organization now was Vermonters or good government. And so I'm not quite sure who you are representing today. That is correct. It's Vermonters for good government. I don't believe that the Vermont. Vermonters for ethical healthcare even exists anymore. So thank you for clarifying that we will correct the record. Good afternoon and Madam Chairman and members of the committee. Thank you for allowing me to testify regarding proposal five declaration of rights, right of personal reproductive liberty. My name is Norman Smith. I was born in St. Johnsbury, graduating from St. John's Academy in 1973. I was born in Massachusetts Institute of Technology, graduating in 1977 with a bachelor's science degree in urban studies and planning. I then went on and studied law at the Boston University School of Law, graduating in 1980. In 1981 for Albert W. Barney Jr., the chief justice of Vermont Supreme Court. And I now serve on the Vermont Supreme Court's probate court oversight committee and the Vermont Supreme Court's probate court rules committee. When I last testified before this committee, I pointed out the problems with the proposal five as then drafted. And the reference to guaranteeing the liberty and dignity to determine one's own life course was deleted. And I'm hopeful that today's testimony will convince you not to go forward with this proposal. The proposal now guarantees personal reproductive autonomy. Several questions exist. First, is the amendment necessary. In 2019, the legislature passed Act 47, which guarantees the right to abortion. As you know, it is very difficult to amend a statute once it is in place. The likelihood of the statute being amended or even repealed is very slight. As a result, abortion rights in Vermont are protected. Second, even if the United States Supreme Court were to overturn Roe v. Wade, the law in Vermont would not change. We've heard a lot about the actions that are taking place in other states and other parts of the country. None of that's happening here in Vermont. The decision would lead to the states, the adoption of laws and regulations regarding abortion. And Vermont already has guaranteed the right to abortion. Third, proposal five, reports to protect personal reproductive autonomy. The language of the proposal is too vague. It fails to define personal reproductive autonomy. It is not defining Vermont law or federal law. And it's so open-ended, it could mean many things. If it was meant to protect abortion rights, it should have said so. If it was intended to protect other reproductive rights, it should have spelled them out. We do not know what medical procedures may occur in the future or what science may reveal. This proposal could prevent, or at least make very difficult, the legislature's adoption of appropriate laws and regulations applying to these new procedures or applying this new scientific knowledge. Fourth, as I'm sure you've heard before, proposal five could lead to abortion rights right up to the point of birth. We realize that this may be very rare, but it does not make it right. The vast majority of Vermonters, if they realize this, would be opposed to this proposal. Fifth, reproductive procedures may well change over time. Reproductive rights are not limited to abortion. They include the following, human cloning for reproductive purposes, gestational surrogacy trafficking, which is achieved by in-feature of fertilization, and then followed by human embryo transfer. And after the birth, the handing over of a born human child in exchange for payment, trafficking in human embryo creation, creation of human embryo via IVF, and the subsequent sale or trade of such human embryos for implantation in another's womb for purposes of reproduction. And then there are designer babies, creation of designer embryos using gene editing, technologies and implantation and birthing of such genetically modified human beings. All of these could be come forward, they may already be coming forward, and this amendment could restrict the ability of the legislature to adopt laws and regulations regulating these matters. Additionally, the word autonomy is not defined in the proposal. This could raise the following issues. Would a minor girl's rights to personal reproductive autonomy be infringed as she were prohibited from having sexual relations with her chosen partner, or her partner was prohibited from having sexual relations with her? I participated in a legislative drafting clinic in law school. I learned that when drafting legal documents including legislation, the language should be clear and concise and provide certainty. Proposal five fails all of these tests. It is not clear. It leads the term personal reproductive autonomy undefined. As a result, it does not provide certainty. We are left to the Vermont Supreme Court to define what that means. I urge this committee to recommend against its adoption. I'm happy to take any questions from the committees. Thank you. Thank you very much. And thank you for coming back. Representative Rosenquist or Representative McFawn, do you have either you have a question? Representative Rosenquist. I don't have a question. I don't have a question. I asked this question before, but the issue over if a husband decided to wanted to keep a child and the woman did not want to keep the child. Within this bill, I think it was stated that they probably have to go to court. Is this a further complication of the way it's stated or is that the way it is now already? Thank you. Certainly a further complication from this proposal. I mean, the amendment does not specify who has the rights doesn't set forth an order of choice in representing and choosing who has the rights. So certainly it could lead to conflict and litigation regarding that issue. I actually could expand the right. I believe right now a father could not force the woman to have the child, but this amendment could be read to authorize that. Thank you. Do you have this writing and testimony on this testimony and writing and I do. I will submit it to the committee. Thank you very much. It was very enlightening. Thank you for that. Thank you, Madam chair. Mr Smith. Appreciate you coming in today. Correct me if I'm wrong. Yeah, testimony you talked about. This proposition five could restrict the legislature from enacting any abortion related legislation. Is that the gist of what you were saying. That's one of my main concerns. The other concern is the vagueness of what it's trying to authorize and protect. And I think it's going to elaborate for us on how the legislature could be restricted. Well, the way the way the proposal is written. It says that it that the right is guaranteed. Unless there is a compelling state interest and regulated by the least, I forget how the exact language. I mean, it's the least of the restrictive needs. And so, I mean that creates a very narrow window for adopting any kind of legislation. And certainly, if the legislature adopted any kind of legislation. Addressing the issue, you can be quite sure it would end up in the courts right off the back. I mean, it's a certainty. There would be arguments and and it would be up to the up to the Supreme Court to decide whether that was allowed or not. So that's what you meant by it could restrict. Yes. Yes. But not necessarily would restrict. Well, I mean, basically it would, it would, it would occur through the passage and then the subsequent litigation and then the interpretation of the statute in conjunction with the amendment and what kind of regulations could the legislature actually adopt. Thank you. I'm looking now at the folks in the room. Are there any questions and Mr Smith Thank you very much and I do appreciate your willingness to submit your comments and writing. Representative Brozenquist stated that be very important. So thank you very much. I'm happy to do so it may not be until tomorrow because I actually have a committee meeting in five minutes. Okay, well, I'm glad we got you in. Thank you. Thank you for taking the time I really appreciate it. Thank you. Our, our last witness is Jesse Barnard, who is the executive director of the Vermont Medical Society. Jesse, Ms Barnard, sorry. Oh, that's fine. Thank you. Good afternoon. Thanks for having me here to speak about Proposition five. As you said I am the executive director of the Vermont Medical Society and I know I was here a couple days ago but I'll just remind you that we are a partnership organization in the state representing over 2400 physicians, physician assistants and medical students across specialties in the state. And we after an inclusive process including full membership survey and vote adopted a position in 2019 to support a Vermont constitutional amendment to protect reproductive rights and I have attached the link to that statement. We support Proposition five as it would protect the legal rights of Vermont patients to the full range of evidence based reproductive health care and alignment with the patient's needs and goals. It recognizes a patient's fundamental right and liberty to make their own health care decisions without governmental interference, preserving the status quo that we have had in Vermont for over 45 years. By which Vermonters have had the personal autonomy to make family planning decisions regarding abortion but also other decisions regarding pregnancy, infertility, contraception, sterilization and treatment of sexually transmitted diseases. The proposal would safeguard the sanctity of the relationship between a patient and their health care professional and will keep reproductive health decisions based in private discussions of risks and benefits between patients and health care practitioners. As you've already heard from other witnesses this is about preventing government interference in these choices and conversations. While it is about abortion it's also about contraception and sterilization. And as you heard from Lucy earlier today, think even about Vermont's own past role in eugenics policies and forced sterilization that was recognized by the legislature just this fall. And that's the type of government interference this would protect against. As we have heard a lot about how it applies to abortion I do want to give a little bit more background about abortion health care in Vermont. Overall Vermont has seen a downward trend in state abortion rates since the 1980s which generally follows the same trend nationally. According to the latest statistics which are from 2019. There were 1195 abortions performed in Vermont that year which is a decline from the year before. Over almost 75% of those 73.3 were of less than nine weeks duration 90% happened within the first trimester. Only 1.5% in 2019 occurred after 21 weeks and there are currently no health care practitioners in Vermont that perform elective abortions after 23 weeks. Terminating any pregnancy is an extremely difficult deeply personal decision. And abortions later in pregnancy also involve severe medical complications for either the mother or the fetus and it's a complex decision that involves the mother physicians and families involved. Such decisions in Vermont frequently involve multidisciplinary ethics consultations and UVMMC has been referenced to submitted a letter that includes some information about how such decisions are handled in that location. Physicians enter such decisions not only considering ethical considerations but indeed bound by medical standards of care that are found on the individual state, federal and institutional levels. If you if a physician doesn't conform to the acceptable and prevailing standards of practice they can be subject to disciplinary action by the state medical board. And failure to deliver health care within the same degree of care and skill that's ordinarily exercised is the basis for malpractice cases. We do not believe that further government regulation or black and white line drawing in these difficult and emotional and ethical decisions is necessary or beneficial, just as Vermont does not legislate other difficult health care decisions. I also want to address the point about voluntary clinician involvement. Vermont facility facilities that offer termination services allow staff to choose whether to participate in any medical care that may for a variety of reasons and not just abortion care may not be in alignment with their core values and beliefs. And again UVM submitted their letter referencing their policy. Now you've heard this but I just I need to say it again the proposition five is about preventing state interference in or state limitations on patient decisions and medical practice, not about forcing actions on any individual provider or private entity. It would not dictate where or by whom procedures take place or who performs them. I was trying to think of analogies I like analogies recently and thinking about Vermont statute has we have a hospital bill of rights that says every patient has the right to pain management. That does not mean it forces every individual provider to prescribe opiates. In fact there may be a number of reasons why providers don't do that. And so similarly this is not forcing any individual provider to perform any individual service. How many does it go be there is also federal law that and that protect healthcare professional conscious rights, and I have attached the information from the US Department of Health and Human Services Office of Civil Rights where they outline those federal protections that would still be in place. And they precipitate prohibit recipients of certain federal funds from discriminating against healthcare providers who choose not to participate in the delivery of abortion related healthcare services. Hospitals are recipients of federal funding and thereby bound to comply with those federal statutes and those the handout from HHS clearly outlines which providers are protected by this which types of entities it applies to and how to exercise those rights and where to file a complaint if you think those rights have been violated. The passage of the reproductive liberty amendment again does not impact the application of those statutes it's about not having government interference in access to the services not about who has to perform those services. Important reproductive healthcare decisions should be guided by a patient's health and well being leading national medical society support access to the full range of reproductive health services. The exception has been named one of the 10 greatest public health achievements of the 20th century by improving maternal health and well being reducing maternal mortality rates, health benefits of pregnancy spacing and female engagement and the workforce and economic self sufficiency for women. We also know when restrictions are placed on abortion access women's health suffers. We ask that you support, giving the ability to the voters to vote on proposition five, as it will continue Vermont's tradition of non governmental interference and private medical decisions about reproductive healthcare will allow doctors to use their best judgment when practicing medicine and protect patients access to evidence based healthcare services. Thank you for allowing us to testify this afternoon. Thank you. Thank you very much. And we have a question from representative Rosenquist. Thank you I just wanted to understand that you're saying that health care workers would not be compelled to get it be involved in an abortion, and yet we're hearing just the opposite on this from different quarters so I'm wondering how you can clarify that for me it seems that that's one of the big issues before us is that healthcare workers against their own conscience would be required to be involved in in an abortion. If, if they were, I'll show you say it scheduled to do that. And they, if I understood you correctly they could be liable for an act of ethics violation of their oath. And that's what I understood you to say, but could you clarify that for me thank you. Happy to clarify and just say very clearly that both institutional policies and federal law protect the conscious decision conscience decisions of healthcare providers not to participate in abortion services. And institutions and their policies go beyond that and don't just address abortions it could be things like blood transfusions or other other types of procedure it could be end of life decisions so there could be variety of ethical religious reasons why certain providers may not participate or want to participate in certain procedures and if that is a truly held ethical or religious conflict then institutions have policies in place. And so the medical associations ethics guidelines address this and recognize that right, the Vermont Medical Society has adopted a similar statement. And so, so by ethic, ethically that is a that is protected but even beyond that there is very clear a number of very clear federal statutes that protect specific to abortion the ability of any provider at any institution that receives federal funding to opt out of such procedures so I don't know how to state it any more but I would direct you to the HHS handout it's a very clear two page handout that explains the rights that healthcare providers have not to participate now obviously there could be a dispute about whether a policy protects that adequately and that's when that provider has the right to file a complaint with HHS and have that investigated. I've seen that happen here in Vermont so it's not to say that there could be a disagreement about how that right in is being implemented but it is a very clear right that's recognized both an institutional policies and federal law. And the follow up to that your medical society approved this or how should I say recommends the passage of this, and it just seems that it's in conflict with the Hippocratic oath that all doctors take essentially to do no harm. And I was just curious how you respond to that. It's not without discussion and debate but in the end the overwhelming majority of our members who considered it supported its, its passage it was brought to our full membership for comment it was brought to a membership vote and it was a very strong way that felt that protecting this right to access medical services like any other medical service should not be regulated or limited by state government. Just again like we don't regulate even if individual providers have different decisions about should there be any when they want to participate that we don't. We don't regulate that as a state we generally as a medical society and in fact most medical societies around the country have positions that state government should not regulate the practice of medicine that that's what you learn in medical school but that's what your ethics direct. That's what the state medical board regulates, but we don't want bright line state laws that make that are then hard to change about did we make the right you know, did did we draw the right line did we make the right decisions that these should be left to conversations between patients and providers. Thank you. Thank you. I want to look around the representative McFawn. Thank you madam chair. Thank you for coming in. Did. Did I hear you say that in your testimony that at the present time. Physicians practice. Our institution performs abortions after 21 weeks. 23 weeks. Sorry, 23. Yes. Could you, could you repeat what you said about that. It is so it's in my, you'll see it's in my written testimony near the bottom of the first page that what I had said was in 2019 there were 18 or 1.5% of all abortions in 2019 occurred after 21 weeks but then that there are none. No elective abortions performed after 23 weeks. Currently. Okay. Physicians or institutions could perform an abortion after 21 weeks and Vermont. After 21 weeks, yes, and there are also federal restriction, you know, so the so called partial birth abortion ban there are also some restrictions on certain types of procedures but there is no state law prohibiting abortions after 23 weeks. Thank you. Representative Rosenquist. To clarify that you're saying that they're. Anyway, I'm sorry if I've sort of forgot my question, but it may come back to me in a minute or two. Yeah, and McFawn, another question. Representative Rosenquist was it about timing. Was it about abortion. I'm trying to help you with your question, because we're about to say if there's no other questions so I'm trying to help you remember your question. Yeah, it had to do as a follow up to toppers, but I just can't really state it right at the moment. Well happy to answer any follow up questions if you want to reach me through email or other ways and after this committee if there are no other questions. I really thank the diversity of witnesses and presenters today. And appreciate the fact that folks are going to provide us if they've not already with their remarks and writing so that we can refer to them again. So this is I'm going to this finishes our testimony related to prop five we took testimony yesterday and testimony today. And so this will complete the formal testimony and committee that we are having on prop five, we will have a public hearing. And that's from six to eight and I want to particularly make sure. Ms. Tober that you are aware that it is linked on the information is on the legislative web page as well as on the page of the Human Services Committee about the public hearing and the request that people sign up ahead of the hearing because this is similar to the public hearing that's happening tonight on the amendment related to removing slavery, this will be a hybrid hearing. So it will be on zoom, as well as it could be in person. The fact that when the hearing, when we had a public hearing two years ago, as required, there were approximately 60 people who provided public comment, we are limiting public comments to two minutes. And of course, we welcome testimony in writing, both to be given to us during the public hearing. And before that, and so that will be on Wednesday evening. And then on Thursday, the committee will discuss will share our recollections and our thoughts as to what we have heard and make a decision as to our. Our steps and our decisions. So with that, I want to say that we are going to there's seeing no other committee business. We are going to close the committee hearing and close the committee and go representative McFawn. Madam chair, I just want to make sure that we as a committee can ask for more information. Is that correct. As Jesse Barnard has indicated, if people have other questions people are to please email them so that we can get the information ahead of our discussion on Thursday. So, if you additional and otherwise we're going to discuss on Thursday, our impressions from the public hearing, and from our testimony. And. Okay, Madam chair, if I want to, if I want to question answered awesome research done by legislative council, I can get that done regardless. Correct. Absolutely. Absolutely. Okay, good. Thank you. Okay, with that. Thank you. I will see you in quotes on the floor at three o'clock tomorrow we are. Tomorrow, assuming that the floor is not that long. We started the floor at 930. The floor is scheduled training for members. And if things go as planned, we would be returning to committee at 115. And with that, thank you very much.