On a recent trip to Washington, D.C. I was treated to short speeches and interaction with a number of physicians serving in Congress. After one speech, a physician in the audience asked whether a physician should ever be jailed for practicing medicine. The congressman looked perplexed and asked, “Are you talking about Ivermectin?”
The questioner responded, “No, I am talking about abortion.” He then went on to talk about a law in his state.
It was the proverbial urinating in the punch bowl. There was a hush over the room that had mainly been talking about pre-authorization, colorectal cancer screening, and advocacy. Later in the meeting, a former U.S. senator pointed out how an issue, specifically abortion, can disrupt almost any political discussion. He then lamented how divided the political landscape in D.C. has become.
Even the word “abortion” has a negative connotation. It is why you will see people run away from it in discourse. We are told the discussion is about “reproductive rights” or “women’s health.” The latter has been abandoned lately because nobody wants to claim a degree in biology. Best of all we are told it is about choice as if it is Coke or Pepsi.
On the other side the word “abortion” is always front and center. The spin is always negative so terms like “baby killer” and “infanticide” are thrown around. And it is always framed in the “pro-life” rhetoric. Who wants to be accused of being against life?
The fundamental difference in opinion centers around whether a developing fetus is a human being. If it is, it has rights. If it is not, there are no rights relative to the discussion. If it does have rights, is it allowed to infringe on the rights of the mother?
We are treated to regular doses of the rare cases to drive arguments. Pregnancy termination advocates cling to rape and incest to paint the opposition as extremists. According to the abortion rights advocacy group, the Guttmacher Institute, those two indications make up less than 1.5% of procedures. The argument is meant to box in their opponents into an argument most find offensive.
It works the other way as well. Many days I am treated to pictures of late term pregnancy terminations by protesters near my office. Centers for Disease Control (CDC) data indicates that is less than 1% of all procedures.
What else is in that data? Almost 93% of all pregnancy terminations occur before week 13 of gestation, according to the CDC. Over 40% of terminations are done with pharmacology. And at least three fourths of procedures are elective and due to concerns about cost or unpreparedness to have a child.
The box tends to work on everyone except the most extreme. When presented with the extreme cases activists will often talk about how rare the situations are and avoid taking a position. Only a monster would want to force a pregnancy on someone who was raped or the victim of incest. And only a monster would want to terminate a viable human being late in pregnancy.
Polls reflect that there is nuance in how people view the procedure. Most feel that the right to have a pregnancy terminated should be maintained. Only about 20% feel the procedure should be completely outlawed. And only about 20% feel it should be allowed in the third trimester without limitation. So that leaves the other 60% being pulled.
Pregnancy termination exemplifies the worst of how extremes drive the narrative in the United States. It will likely stay that way forever. It is impossible to see how defining reasonable limits on the procedure will ever be seen as acceptable to either extreme.
Discomfort abounds in the discussions.
Joe Biden, as vice president, stepped into controversy when he endorsed China’s one child policy. Most people are aware that Chinese parents often terminate pregnancies based on gender. Well, at least biological gender. This worldwide example and the 19% of patients who have more than two pregnancy terminations tend to make people uncomfortable.
I am guilty of using the discomfort. I used that Joe Biden action to paint him as waging a “war on women.” The unborn women of China.
If one looks to Europe there are limitations on the procedure that include timing, waiting periods, and exceptions based on maternal or fetal health. There is no single coherent view on managing the procedure.
This all presents a conundrum for the reasonable. Personally, I am not comfortable telling anyone they need to carry a pregnancy. However, there is something ethically disturbing when that fetus has clearly become viable. It is even more disturbing for people with strongly held religious beliefs. Is that enough to pass laws prohibiting the procedure?
The law does not have to be ethical. It is a standard society sets for itself. And in the United States those standards are often set at state and local levels by design. Still, we are a country built on protecting the rights of the minority against mob rule. Nothing says mob like people pushing their beliefs on a young woman facing a crisis. This is when the federal government typically has to insert itself.
Leaving this decision up to the states entirely could have devastating consequences. States are increasingly trying to influence policy in other states. There are already moves to prosecute patients who cross state lines to get the procedure. Governor Gavin Newsome (D – California) has proposed paying for patients from elsewhere to have the procedure done in California.
There are laws that allow behavior defined by many as unethical. It is a charged issue when that unethical behavior is viewed as murder by some. And it is equally charged when that behavior is a medical procedure being discussed between a health care provider and a patient. It gets more complicated when that patient is a minor and most other procedures universally mandate parental involvement. The passions on both sides are understandable.
As impossible as it may be, Congress has to define what we as a society find tolerable. When in pregnancy can a termination be considered unacceptable? There is great divergence on that question with Texas on one end and California and New York on the other. The constitution is silent on when life begins. That has to change. Once that happens the rest of the document will be clear as how an individual is defined.
I do not have an answer. Roe v. Wade was not an answer. The right answer is to lay down the rhetoric and to not let this be another issue that tears us apart. It takes empathy, which is in increasingly short supply on both sides of the political spectrum. Guess what? Those people you oppose are actually human beings and there is no debate on that one. This issue does not have to be urine in the punch bowl.
Dr. Brian Sweeney has practiced gastroenterology in Anchorage for 21 years, with the first three at JBER. The views presented here are his own and are not made on behalf of any organization.