Posted by: Amelia | August 7, 2007

Agonizing Choices For Women and Doctors

In a guest column in today’s New York Times (subscription required), Judith Warner speculates that aesthetics may explain some of Americans’ reluctance to oppose the Partial Birth Abortion Act and the Supreme Court ruling that upheld it (and opened the door to other bans as well).

When the Supreme Court voted 5 to 4 to uphold the federal Partial-Birth Abortion Ban Act this spring, the ambivalently pro-choice public was largely quiescent, believing, as Congress had previously ruled, that the procedure was ”gruesome and inhuman,” medically unnecessary, highly controversial in the medical community and so rare as to be little missed.

What’s clear, however, as the ban has become a reality, is that fetuses will be spared no brutality. Second trimester abortion is still legal and the most common method for it — dismembering a fetus inside the womb before removing it in pieces — is no less awful to contemplate than the outlawed procedure, in which an intact fetus’s skull was punctured and collapsed to ease its removal.

Warner is not in any way advocating a ban on the other procedure, though clearly anti-choice activists could use the same logic to bolster support (or de-motivate opposition) for all late-term abortions. Warner writes that the criminalization of late-term abortions in which ”the fetal head or the fetal trunk past the navel is outside the body of the mother” forces doctors to compromise their patients’ health:

Once you dilate the cervix — something that must be done sufficiently in order to avoid tears, punctures and infection — a fetus can start to slip out. And if this happens, any witness — a family member, a nurse, anyone in the near vicinity with an ax to grind against a certain physician — can report that the ban has been breached. Bringing on stiff fines, jail time and possible civil lawsuits.

Justice Anthony Kennedy, writing for the court’s majority, asserted that prosecution for accidental partial births won’t occur; there has to be ”intent” for there to be a crime. But as doctors now understand it, intent could be inferred by the degree of dilation they induce in their patients. What, then, do they do? Dilate the cervix sufficiently and risk prosecution, or dilate less and risk the woman’s health? And if they dilate fully, how do they prove it wasn’t their intent to deliver an intact fetus?

This dilemma is the latest product of the awful algorithm that, in anti-choice rhetoric of the past few decades, has increasingly pitted the ”interests” of the fetus against the health of the woman. It makes the true intent of the partial-birth abortion ban clear: the point is not (in the short term) to stop seemingly brutal fetal deaths, but rather to make all abortions as burdensome, as difficult and as emotionally and physically trying for women — and for doctors — as possible.

Of course, the ban only applies to live fetuses. Thus, doctors and clinics are sometimes asking women to take a drug that will kill the fetus a day prior to the procedure. “The upshot for women will be more time-consuming and costly abortion services, additional rounds of amniocentesis, more pain and more risk of infection,” Warner writes. “And the outcome for the fetus won’t change.” Remember, too, that a disproportionate number of late term abortions are requested for medical reasons (i.e. the mother’s life or health is endangered or the fetus has developed severe or even fatal defects). For the women who choose late-term abortion, the stakes are often extremely high. Just yesterday, Cara at Feministing wrote a post about the embattled Dr. George Tiller, one of the country’s few late-term abortion providers:

Late-term abortions, contrary to what anti-abortion activists constantly profess, are not undertaken lightly. The women who receive medical care at Dr. Tiller’s facility come from all over the country; Dr. Tiller is hardly going to be their first medical consultation. They seek their abortions either due to health risks to themselves or severe fetal deformity. You’d be hard-pressed to find someone who likes late-term abortion, and that includes the women who need them.

We can all agree: abortion is not pretty. But aesthetics must not guide policy. The people who have religious or moral objections to the termination of a fetus are entitled to their opinion, but until they succeed in outlawing all abortions, particular procedures should not be taken off the table simply because they’re icky. The choice of procedure should be between a woman and her doctor, who have a better understanding of her particular medical needs than the courts, the Congress, the anti-choicers, or even the pro-choice (but sadly complacent) majority of the American public.

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