June 20, 2014

What I’ve Seen So Far…

Posted by calemed1 under Abortion Information | Tags: , , , , |
[47] Comments 

I’ve been writing for this blog for about a year now, and in that time I’ve never written a personal post, instead trying to elucidate some of the medical and legal aspects of abortion. I’ve spent my first two years in medical school learning all I can about abortion in politics and medicine, but it’s only in the last year I’ve begun to personally experience my first brushes with the actual impact of pro-life law, regulation, and thought.

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In that time I have been continually reminded of how large a role healthcare providers play in determining female autonomy, and that goes way beyond abortion. It means pharmacists unwilling to dispense emergency contraception. It means physicians at Catholic institutions forbidden from even discussing birth control, abortion, or physician-assisted suicide for terminally ill patients. It means, from the experience of two OB/GYN residents at the school associated with my hospital, forcing a poor patient who has already spent upwards of $1000 traveling from a nearby state to take off another day of work and purchase three more nights’ stay at a hotel because none of the weekend nurse anesthetists on call are willing to sit in on a surgical abortion.

And the patient interviews I’ve conducted this year have been particularly poignant for me. It is commonplace to ask about gynecological and obstetrical issues as part of a complete history. I’d already built a rapport with the first patient to tell me she’d had an abortion; she was funny and articulate, and the interview was going well. But when I asked about previous pregnancies and she mentioned her abortion, even though I made no sign that I treated it any differently than any other part of her medical history, I could see fear in her eyes. I realized she was afraid I would judge her, maybe even afraid I would say something about the decision. She quickly changed the subject.

The second interview was even more heart-wrenching. She was pro-life, and described an extensive history of physical and sexual abuse. Falling pregnant after one of a long string of rapes by an abuser, her doctor informed her she would not survive the pregnancy if she continued it, because of a severe, possibly life-threatening medical condition he’d diagnosed. She subsequently ended the pregnancy at his recommendation. Crying, she told me her illness had felt like a “blessing in disguise” for occurring when it did, because it allowed her to end a pregnancy that would have tied her forever to her abuser. How terrible have we become, as a society, when a potentially terminal illness is a “blessing” for justifying a choice that should require no moral absolution?

Two of the pro-life physicians I’ve encountered this year have displayed prominently just how important it is to be a vocal advocate. The first I met briefing with ACOG (the American Congress of Obstetricians and Gynecologists) members prior to meeting with state legislators to urge support on several bills, including the Reproductive Parity Act. During the meeting she posed her opinion that she disapproved of “abortions as a form of birth control.”

It’s one thing to hear this carefully coded language from politicians. It’s quite another to hear it from an obstetrician who should know that the majority of women who seek abortion had been using a primary form of birth control the month they became pregnant, much less in a room full of obstetricians that include multiple abortion providers, on a day intended to support a bill that would ensure equal access to reproductive healthcare.

The second was my own (former) OB/GYN in my hometown, who I discovered was the medical director of the local pro-life CPC (crisis pregnancy center), a position he failed to advertise anywhere to the patients in his practice. Giving him the benefit of the doubt, I visited the CPC that week and picked up the brochure materials they normally dispense to patients.

There I found so many medically inaccurate statements presented as fact I cannot see how any legitimate medical professional could possibly support it even tacitly, much less as its medical director. (A sampling: Plan B is an abortifacient; having more than one sexual partner over the course of one’s life reduces or eliminates one’s physiological ability to emotionally bond; abortion increases one’s risk of breast cancer, infertility, and depression; abortion of a pregnancy resulting from rape reduces one’s ability to recover from the psychological trauma of the rape.)

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What about the doctors of tomorrow, my own classmates? Thankfully it seems to me that the vast majority of my entering class was pro-choice, if not actively interested in reproductive health advocacy. Still, there have been a few alarming moments throughout the year. In an ethics case we were asked how to proceed with a woman who refused a Caesarian section, though the baby would die without it. It was a difficult case with no satisfying answer. Still, 5% of the class voted to force the C-section regardless of the woman’s refusal, which would be assault.

On the day of our abortion lecture, our professors played a short video of an interview with Jim Buchy, an Ohio state representative who proposed a “Heartbeat Bill” which would have banned abortion after 4-6 weeks, in which he admits he’s never considered why a woman would seek an abortion. A member of my class spoke up in support of Buchy’s stance: “If you believe a fetus is a person, I mean, it doesn’t even matter.”

I can’t help but feel that’s the overwhelming paternalistic problem with abortion opponents within the medical field: the woman’s concerns, her situation, her health, all of it “doesn’t even matter.” In the pursuit of a single moral absolute, the person most affected by their decisions simply disappears. To people who refuse to consider why a woman would seek an abortion because “it doesn’t even matter,” how can one possibly convey the desperation that would induce women to seek unsafe abortion where legal abortion is unavailable?

So what have my (admittedly few, this far into my career) experiences led me to believe about the future of medicine? It’s crucial now more than ever for pro-choice physicians to be active advocates, even if they don’t provide abortions. I worry about hospital mergers with Catholic institutions that refuse to offer even informed consent to patients, much less actual reproductive care. (In fact, the hospital associated with my medical school is undergoing just such a merger, to the worry of many students, faculty, and healthcare providers.) And while I strongly believe in the right of healthcare providers to consciously object to taking part in procedures they feel are morally wrong, I think hospitals that offer abortions should be required to have at least one member of every position required to perform the procedure on staff at any given time who do not object to helping.

And more than anything else, this last year has made me even more terrified of a future in which the pro-life movement is successful in its quest. What would this future be like for the woman who refused a C-section in our ethics case? Would forced surgery no longer be considered assault? Would it even be legal for her to refuse it? Maybe in that future, possibly terminal illnesses truly will be a “blessing” for women who do not want their pregnancies, providing not moral absolution but legal permission.

 

Sources:

1) 51% of women seeking abortions used a primary form of birth control the month they became pregnant; most either used it inconsistently due to a disruptive life event, or used a less effective method such as condoms: Jones R, Frohwirth L, Moore Ann, “More than poverty: disruptive events among women having abortions in the USA” (http://jfprhc.bmj.com/content/39/1/36.abstract). Summary available here: https://guttmacher.org/media/nr/2012/08/21/index.html

 

 

June 2, 2014

Spousal Consent to an Abortion

Posted by Pat Richards under Abortion Information
[43] Comments 

Truth be told, I love watching some of those religious stations. I just can’t help it. When I’m cruising on my remote control through my nine thousand channels, something compels me to stop when I see some sweaty, screaming preacher type railing about the horrors of abortion, homosexuality, unbalanced budgets and whatever else they want to throw in the mix. Of course, I do get a kick out of how they manage every few minutes to remind their mesmerized audience that they need a gazillion dollars for that new church that God has ordered them to build.

So, this past weekend there I was again, listening to another sermon. This one was on the role of the father of the “unborn baby” who was facing imminent “execution at the hands of the blood-sucking abortionist.” We’ve heard it all before. Does not the father, who has put so much effort into the creation of this precious little baby, have a say in whether or not that precious little baby will be EXECUTED?

“Yes! The father has rights too!” shouts the preacher to a chorus of Amens and Praise the Lords. Why shouldn’t that man who got lucky have something to say about whether the fetus lives or dies?

Scotty, beam me up.

First of all, years ago the U.S. Supreme Court declared that all spousal consent laws were unconstitutional. In the case of Planned Parenthood v Casey the Court said, well, I’m not going to waste my blogging space to review the case. You can do that. Suffice it to say the Supremes said it’s ultimately up to the woman.

But, contrary to popular belief, Supreme Court decisions are not always etched in stone. If that were the case, Plessy v Ferguson would still be the law of the land and black Americans would still be sitting in a separate section of Wendy’s. Times change. So I do not fault this preacher for advocating to change the current law.

Here’s the thing, however. The pro-life movement is very adept at arguing around the edges to suit their goals. So, for example, they will rant and rave about those later term abortions, as if they are a very common occurrence when the fact is that out of the one millions or so abortions performed every year, they constitute a small percentage of the total. Still, the pro-lifers love to show those pictures of that big beautiful baby with semi-developed extremities who is about to be aborted. That is more shocking than showing a picture of an inch long fetus. Kudos to their PR department.

The same goes for the issue of spousal consent  The facts are that the vast, vast majority of men who have helped conceive a child are always involved in the decision whether or not to bring the baby to term. The baby was created out of an act of love and a couple in love will generally seek a consensus. Indeed, when a woman learns she is pregnant, the first person she usually informs is the father. In some cases, they will both rejoice knowing they are going to have a child. But if there are doubts about whether or not to have the baby, they are BOTH going to discuss it. If a couple cannot talk about that decision – one of the toughest of their lives – then that relationship is doomed to begin with.

So, let’s all keep our perspective if possible. Spousal consent for an abortion is already practiced in the vast majority of cases.

But lest there be any misunderstanding – when there is a disagreement between the husband and wife, well, it’s the WOMAN’s body, my friends. That’s the bottom line for me.

 

May 4, 2014

Dunkle Returns

Posted by Pat Richards under Abortion, Abortion Doctor Murder, Abortion Information | Tags: , |
[203] Comments 
Anti Choice

Anti Choice

John Dunkle is an eighty-ish year old anti-abortion activist who makes his base in the Allentown/Reading, Pennsylvania area. For way too many years, he has regularly protested outside of a few abortion clinics in the area and occasionally at the home of clinic staff people.

I became acquainted with Dunkle through this blog. When I posted my stuff, he immediately jumped into the fray. For several years he almost single-handedly carried the banner for the anti-abortion crowd. Of course, we disagreed on everything but I always gave him credit for one thing: he had energy. He always seemed to have an answer, a reply, a zinger to my posts or to the comments from others. While I never agreed with him, I was always candid about my support of his ability to protest at a clinic and even at a house within certain boundaries. Indeed, years ago when the pro-choice groups were lobbying hard for passage of the Freedom of Access to Clinic Entrances Act, I took a lot of heat because I felt the First Amendment protected most forms of protest and we ultimately got language in the law saying so.

So, Dunkle regularly ranted and raved. I always found it interesting, however, when another anti-abortion person chimed in because I always thought Dunkle resented someone else barging in on “his” terrain. Then, about 18 months ago, Dunkle signed off. I don’t remember if he gave a reason, but he basically said adios and disappeared. I actually wondered if he was ill.

I will admit that I missed him in some way. I’ve always enjoyed being in the middle of the great abortion debate and I’ve always relished the opportunity to articulate my very strong convictions on this very delicate issue. And I never hid behind the “choice” word. I went right to the meat of the issue and talked about ABORTION. And I took a bunch of hits for doing so.

Anti Choice

Anti Choice

Then, lo and behold, Dunkle reappears! Like Lazarus rising from the dead, one day he just popped up and commented on a post! WTF?

I welcomed him back, as did some of the other pro-choice commentators. We had a few back and forth repostes, no damage done, then I asked him if he was still out there protesting. He said he was, that he continued to go to two clinics and a house. It was funny because, when I read that, I almost felt sorry for him. I envisioned this worn out activist, lamely standing outside of an abortion clinic, a pathetic sight to behold, shouting to the women as they entered the facility.

And then I asked him if he felt that, after all of these years, he had accomplished anything. His answer was something like that was not for him to judge. He didn’t say he had saved any babies, that he had furthered his cause, that he had made a difference. It sounded like a tired response.

I admire anyone who stands up for a cause, as long as it is done within legal limits. At least that person stands for something and is taking part in our democratic process. But I also think of Dunkle’s family, his kids, his grandkids, his wife and other loved ones who have watched him trek on down to the local abortion clinic every Saturday. I wonder if they think he has accomplished anything?

How sad.

 

April 14, 2014

Winning Back Ground in the Culture War

Posted by calemed1 under Abortion Information | Tags: , , , , , |
[10] Comments 

Discussing the nuances of the case of Marlise Munoz, the legally dead pregnant Texas woman kept alive for weeks over her and her family’s wishes, my recent conversation with a pro-life friend continually circled back to one question of his: “But why wouldn’t she want the baby?”

Of course, the answer seemed obvious to me, but later I reflected more on his question, and realized why the concept seemed so absurd to him. To most pro-lifers, I think, it is incomprehensible that a woman who initially wanted a pregnancy might want to later terminate for almost any reason.

Abortion, after all, is for those women, way over there, the ones you’ve heard about but never met, despite the fact that 3 in 10 American women will have an abortion by age 45, and that 65% of women who had abortions in 2008 were Protestant or Catholic. To pro-lifers, it’s the domain of “amoral” women making an “irrational” decision they’ll regret when they get to know what having a child is truly like, despite the fact that most women who have abortions already have at least one child. And they claim it’s physically and psychologically harmful, despite the much lower risk of physical complications compared to pregnancy, and the thorough debunking of the largest study purported to show a causal link between abortion and mental illness.

None of these claims are new or uncommon, and none are really reflective of reality. But for those who desperately cling to them, the eminently insulting pro-life motto of recent years, Women Deserve Better, is perhaps more understandable (if not more palatable). But what explains the huge dichotomy between reality—at least, what little of it we can interpret from statistics—and the pro-life mythos of the woman who chooses abortion?

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Well, for one thing, these stereotypes are pervasive because that’s what we tend to see. What else except the self-evident “truth” of such claims would explain the dearth of stories about elective abortion in the media—stories that humanize it and display its depth as an issue? A recent analysis of television and movies that portrayed abortion showed that 9% of women who had or even contemplated an abortion died, a gross over-exaggeration of the procedure’s risk. (The actual risk of death from legal abortion is less than 1 per 100,000.)

And in public venues (like, say, slots for public testimony before legislatures considering abortion restriction bills), it is clearly only deemed “acceptable” when a woman who had an elective abortion appears regretful, wringing her hands and gnashing her teeth. Relatively very few women are willing to testify about purely elective abortions they have obtained, even if they do not regret them, and not without cause. When they do publicly discuss it, they risk serious consequences, like Lucy Flores, the Nevada legislator who told the story of her abortion as a teenager in support of a sex education bill and was summarily subjected to a torrent of death threats.

Even more subtle and pervasive than death threats is social ousting. Only days ago I had a conversation with another friend who, while she supports legal abortion, followed that up with the postscript that abortion is still “murder” and in “scenarios where I would not support her decision [I] would most likely be forced morally to cut ties with her.” Every time a friend, neighbor, or relative expresses such a sentiment (despite the high likelihood of unwittingly saying it to someone who has had an abortion), the idea that it is unacceptable to speak about the importance of abortion to the lives of real women is reinforced.

There are sadly far, far too many examples to name, but every time a politician describes abortion as an evil only terrible sinners might contemplate, he effectively silences women as well. Being told, for instance, that you are morally inferior to a rapist since “at least the rapist’s pursuit of sexual freedom doesn’t result in anyone’s death” (I’m looking at you, Rep. Lawrence Lockman) tends to have that effect.

In turn, shame-induced silence propagates the impression of absence. The void is filled by the “socially acceptable” hand-wringers and teeth gnashers who, while they certainly represent a portion of women who obtain abortions, are not reflective of the whole, or even the majority. Pro-lifers continue seeing exactly what they expect to see, and continue advancing (and believing!) the notion that abortion is tangibly harmful, not only to fetuses, but to women.

And, very, very slowly, the pro-choice movement loses ground in the culture war.

The number of people who labeled themselves “pro-choice” in the Gallup poll on abortion, which has been tallying the estimated percentages of pro-choice vs pro-life citizens since 1995, reached an all-time low of 41% in 2012. Other polling has shown an increasing number of pro-lifers among Republicans, and more disturbingly, an increase in the number of Democratic men who oppose abortion as well. While these numbers are more complicated than they appear (for instance, a personally pro-life person may still support some or all legal abortion despite his or her views), the trends over time still have a story to tell.

The Overton window is a political theory that describes a narrow range of political beliefs that are considered acceptable. The silence of women caused by systematic social shaming and a climate of public threat, combined with an increasing number of openly hostile public remarks about abortion, seems to have shifted this window significantly further to the right in the last decade. As claims of dubious medical credibility and offensive remarks about the character of women who choose abortion become more mainstream, support of abortion up to viability is slowly coming to be perceived as an extremist view.

So how can we reverse the trend?

End the silence.

 

Sources:

1) Gallup polling on abortion, trends over time: http://www.gallup.com/poll/154838/pro-choice-americans-record-low.aspx

2) The Pew Research Religion and Public Life Project on support for legal abortion: http://www.pewforum.org/2009/10/01/support-for-abortion-slips2/

3) Guttmacher Institute factsheet, Induced Abortion in the United States: http://www.guttmacher.org/pubs/fb_induced_abortion.html

4) Guttmacher, Characteristics of US Abortion Patients, 2008: http://www.guttmacher.org/pubs/US-Abortion-Patients.pdf

5) CDC Abortion surveillance for 2009: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6108a1.htm

6) Slate, “Characters Who Have, or Just Think About Having Abortions, Often Die”: http://www.slate.com/blogs/xx_factor/2014/01/17/abortion_in_movies_and_on_tv_often_results_in_death.html

7) Article on Lucy Flores, Nevada assemblywoman who received death threats following her testimony about her abortion at 16: http://www.policymic.com/articles/33199/lucy-flores-abortion-nevada-lawmaker-faces-death-threats-after-talking-about-her-abortion

8) An excellent article I recommend, “Abortion as a Blessing, Grace, or Gift: Changing the Conversation on Reproductive Rights and Moral Values” http://rhrealitycheck.org/article/2014/04/03/abortion-blessing-grace-gift-changing-conversation-reproductive-rights-moral-values/

9) A great TedX talk on abortion stigma: https://www.youtube.com/watch?v=FxI6HGpaP3Q

 

March 31, 2014

A Stop in Pensacola

Posted by Pat Richards under Abortion Information
[10] Comments 

My 25 year old son is a former music major who played the tuba for many years. Very talented kid. He now lives in San Antonio where he teaches high school math. Recently, he asked if I could bring his tuba to Texas so he could start playing again. I couldn’t resist the opportunity to see him so I jumped in my car and headed south.
I went to Florida first because my sister just moved there and visited with her for a day. I then headed west to see my cousin, who lives in the sleepy town of Gulf Breeze. After a brief visit I started making a bee line to Texas but, before I could even get out of third gear, I found myself driving through Pensacola.

And I suddenly got the chills.

PensacolaMany of you will remember that Pensacola was a hotbed of radical anti-abortion activity years ago. Indeed, as you approach that part of the state there are still billboard after billboard with pictures of little fetuses telling us how a 10 week fetus can recite poetry and do other amazing things. Fortunately, things have gotten a little quiet in the last few years.  As David Gunn, Jr. has been reminding us in his blogs, on March 10, 1993 his father – an abortion doctor – was murdered at the Pensacola Women’s Medical Services building as he was entering the facility. A year later, in 1994, my organization – the National Coalition of Abortion Providers – organized a one year “tribute” to Doctor Gunn at the very site where he was killed. It was a truly emotional moment for the attendees. Approximately 60 of Doctor Gunn’s colleagues made the trek to Pensacola and, with security guards stationed on the rooftops of nearby buildings, we held an open air ceremony which featured an emotional speech by his son.

As I drove into Pensacola, I realized I had to stop at the site once again.

I had a very eerie feeling as I approached Cordova Square and, although the area is now a little more built up, I recognized the building immediately. The clinic is long gone and the building is now the home of several small offices, including an Allstate Insurance agent, a home decorator, a public relations firm and a website designer. But what threw me off was the actual site where Doctor Gunn died is not in its original state. On that horrible day, he parked in his reserved spot and walked towards the back of the clinic. But over the years, someone carved out a cut through road and then put up a large, long fence along the back of the building. So, the actual scene of this horrible crime is no longer recognizable.

Still, I could not help but be paralyzed as I stood there remembering what happened that day and how the murder was a front page news story for weeks and months to come. Indeed, about 18 months later, just a few blocks away, another abortion doctor was killed at another clinic in the city just a few months after NCAP’s tribute.

To try to leave on a more “positive” note, I walked across the street to the serene open air amphitheater where we had our wonderful yet sad tribute. I sat there for thirty minutes and recalled young David, who was visiting the spot where his father died for the first time, talking about “this paranoia that is Pensacola.” He made a great impression that day and we all took solace in being together for a much-need group hug.

I’m glad I stopped in Pensacola.

We must never forget. I know I never will.

 

 

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