title: "Prefacing the Script" as an Ethical Response to State-Mandated Abortion Counseling.
abstract: BACKGROUND
  Laws governing abortion provision are proliferating throughout the United States, yet little is known about how these laws affect providers. We investigated the experiences of abortion providers in North Carolina practicing under the 2011 Women's Right to Know Act, which mandates that women receive counseling with specific, state-prescribed information at least 24 hours prior to an abortion. We focus here on a subset of the data to examine one strategy by which providers worked to minimize moral conflicts generated by the counseling procedure. Drawing on Erving Goffman's work on language and social interaction, we highlight how providers communicated moral objections and layered meanings through a practice that we callprefacing the script.
  
  
  METHODS
  We conducted semi-structured interviews with 31 physicians, nurses, physician assistants, and clinic managers who provide abortion care in North Carolina. Audio-recorded interviews were transcribed verbatim and analyzed using an inductive, iterative analytic approach, which included reading for context, interpretive memo-writing, and focused coding.
  
  
  RESULTS
  Roughly half of the participants (14/31) reported that they or the clinicians who performed the counseling in their institution routinely prefaced the counseling script with qualifiers, disclaimers, and apologies that clarified their relationship to the state-mandated content. We identified three performative functions of this practice: 1) enacting a frame shift from a medical to a legal interaction, 2) distancing the speaker from the authorial voice of the counseling script, and 3) creating emotional alignment.
  
  
  CONCLUSIONS
  Prefacing state-mandated abortion counseling scripts constitutes a practical strategy providers use to balance the obligation to comply with state law with personal and professional responsibilities to provide tailored care, emotional support, and serve the patient's best interests. Our findings suggest that language constitutes a powerful resource for navigating and minimizing moral conflicts in healthcare.
authors: Department of Social Medicine, University of North Carolina at Chapel Hill, 333 S. Columbia St., 341A MacNider Hall CB 7240, Chapel Hill, NC 27599.
authors: Mara
authors: M
authors: Buchbinder
authors: Department of Anthropology, University of North Carolina at Chapel Hill, 301 Alumni Building, CB 3115, Chapel Hill, NC 27510.
authors: Dragana
authors: D
authors: Lassiter
authors: Department of Obstetrics and Gynecology, Jefferson Medical College, 833 Chestnut Street, 1st Floor, Philadelphia, PA 19107.
authors: Rebecca
authors: R
authors: Mercier
authors: Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 4002 Old Clinic Building, CB 7570, Chapel Hill, NC 27514.
authors: Amy
authors: A
authors: Bryant
authors: Department of Social Medicine, Center for Bioethics, University of North Carolina at Chapel Hill, 333 S. Columbia St. 333 MacNider Hall CB 7240, Chapel Hill, NC 27599.
authors: Anne Drapkin
authors: AD
authors: Lyerly
keywords: abortion; apologies; clinical ethics; communication; law; moral distress; qualitative research