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.
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.)
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.
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