April 26, 2007

Abortion Falsehoods and Truths

Justin Katz

The Providence Journal's editorial on the Supreme Court's partial-birth abortion ruling isn't quite as deceptive/deluded as Mary Ann Sorrentino's, but at the very least, it's misleading (emphasis added):

The U.S. Supreme Court’s 5-to-4 decision upholding the right of the federal government to impose a ban on a certain form of rarely performed second-trimester abortion is unfortunate in two major ways.

First, it extends the role of the federal government into areas best left to physicians. The court upheld the idea that there be no medical exception in which a woman’s physician, after determining that so-called partial-birth abortion (“intact dilation and evacuation”) was necessary to protect the health of the woman, could then perform the procedure.

Apparently, allowing for the procedure in order to save the life of the mother doesn't count as a "medical exception." Judging from the Projo's bizarre notion of federalism, however, one must leave open the possibility that the word "exception" is used, here, to mean "constitutional right to whatever abortionists can do." I say this because it seems the editors feel that the federal government's power should be limited to granting broad rights to death, thus barring states from making anything more than moderate exceptions, without its being, for some reason, as unfortunate when a state government meddles in "areas best left to physicians." (Curious, that.)

Further, whatever you think of this procedure, that the federal government in this case has again intruded into an area that seems to us to be most properly situated close to or in domestic law — and therefore in our federal system under state jurisdiction — should trouble even many conservatives. This is part of a troubling pattern we have seen in the Bush administration of undermining the right of the states to regulate medicine within their boundaries. The Terry Schiavo case and the Oregon assisted-suicide law provide the best known cases of such, to us, inappropriate intervention.

In short, the ruling appears to be a dangerous over-reaching of federal jurisdiction, and one that we especially fear may set an unfortunate precedent for further inroads into individual rights and the relationship between physician and patient, up to and including an outright federal ban on abortion, thus overturning 1973’s Roe v. Wade protection of that right.

Contrary to the Projo's dismissive "whatever you think of this procedure," before conservatives — or just, you know, human beings — decide what they should be troubled about, it might be helpful for them to understand just what they're supposed to gloss over. Here's a passage from Gonzales v. Carhart by which future generations will have opportunity to judge us for centuries hence (citations removed):

The surgical procedure referred to as "dilation and evacuation" or "D&E" is the usual abortion method in [the second] trimester. Although individual techniques for performing D&E differ, the general steps are the same.

A doctor must first dilate the cervix at least to the extent needed to insert surgical instruments into the uterus and to maneuver them to evacuate the fetus. The steps taken to cause dilation differ by physician and gestational age of the fetus. ...

After sufficient dilation the surgical operation can commence. The woman is placed under general anesthesia or conscious sedation. The doctor, often guided by ultrasound, inserts grasping forceps through the woman's cervix and into the uterus to grab the fetus. The doctor grips a fetal part with the forceps and pulls it back through the cervix and vagina, continuing to pull even after meeting resistance from the cervix. The friction causes the fetus to tear apart. For example, a leg might be ripped off the fetus as it is pulled through the cervix and out of the woman. The process of evacuating the fetus piece by piece continues until it has been completely removed. A doctor may make 10 to 15 passes with the forceps to evacuate the fetus in its entirety, though sometimes removal is completed with fewer passes. Once the fetus has been evacuated, the placenta and any remaining fetal material are suctioned or scraped out of the uterus. The doctor examines the different parts to ensure the entire fetal body has been removed.

Some doctors, especially later in the second trimester, may kill the fetus a day or two before performing the surgical evacuation. They inject digoxin or potassium chloride into the fetus, the umbilical cord, or the amniotic fluid. Fetal demise may cause contractions and make greater dilation possible. Once dead, moreover, the fetus' body will soften, and its removal will be easier. Other doctors refrain from injecting chemical agents, believing it adds risk with little or no medical benefit.

The abortion procedure that was the impetus for the numerous bans on "partial-birth abortion," including the Act, is a variation of this standard D&E. The medical community has not reached unanimity on the appropriate name for this D&E variation. It has been referred to as "intact D&E," "dilation and extraction" (D&X), and "intact D&X." For discussion purposes this D&E variation will be referred to as intact D&E. The main difference between the two procedures is that in intact D&E a doctor extracts the fetus intact or largely intact with only a few passes. There are no comprehensive statistics indicating what percentage of all D&Es are performed in this manner.

Intact D&E, like regular D&E, begins with dilation of the cervix. Sufficient dilation is essential for the procedure. To achieve intact extraction some doctors thus may attempt to dilate the cervix to a greater degree. This approach has been called "serial" dilation. Doctors who attempt at the outset to perform intact D&E may dilate for two full days or use up to 25 osmotic dilators.

In an intact D&E procedure the doctor extracts the fetus in a way conducive to pulling out its entire body, instead of ripping it apart. One doctor, for example, testified:

"If I know I have good dilation and I reach in and the fetus starts to come out and I think I can accomplish it, the abortion with an intact delivery, then I use my forceps a little bit differently. I don't close them quite so much, and I just gently draw the tissue out attempting to have an intact delivery, if possible."

Rotating the fetus as it is being pulled decreases the odds of dismemberment. A doctor also "may use forceps to grasp a fetal part, pull it down, and re-grasp the fetus at a higher level--sometimes using both his hand and a forceps--to exert traction to retrieve the fetus intact until the head is lodged in the [cervix]."

Intact D&E gained public notoriety when, in 1992, Dr. Martin Haskell gave a presentation describing his method of performing the operation. In the usual intact D&E the fetus' head lodges in the cervix, and dilation is insufficient to allow it to pass. Haskell explained the next step as follows:

" 'At this point, the right-handed surgeon slides the fingers of the left [hand] along the back of the fetus and "hooks" the shoulders of the fetus with the index and ring fingers (palm down).

" 'While maintaining this tension, lifting the cervix and applying traction to the shoulders with the fingers of the left hand, the surgeon takes a pair of blunt curved Metzenbaum scissors in the right hand. He carefully advances the tip, curved down, along the spine and under his middle finger until he feels it contact the base of the skull under the tip of his middle finger.

" '[T]he surgeon then forces the scissors into the base of the skull or into the foramen magnum. Having safely entered the skull, he spreads the scissors to enlarge the opening.

" 'The surgeon removes the scissors and introduces a suction catheter into this hole and evacuates the skull contents. With the catheter still in place, he applies traction to the fetus, removing it completely from the patient.' "

This is an abortion doctor's clinical description. Here is another description from a nurse who witnessed the same method performed on a 26-week fetus and who testified before the Senate Judiciary Committee:

" 'Dr. Haskell went in with forceps and grabbed the baby's legs and pulled them down into the birth canal. Then he delivered the baby's body and the arms--everything but the head. The doctor kept the head right inside the uterus... .

" 'The baby's little fingers were clasping and unclasping, and his little feet were kicking. Then the doctor stuck the scissors in the back of his head, and the baby's arms jerked out, like a startle reaction, like a flinch, like a baby does when he thinks he is going to fall.

" 'The doctor opened up the scissors, stuck a high-powered suction tube into the opening, and sucked the baby's brains out. Now the baby went completely limp... .

" 'He cut the umbilical cord and delivered the placenta. He threw the baby in a pan, along with the placenta and the instruments he had just used.' "

Dr. Haskell's approach is not the only method of killing the fetus once its head lodges in the cervix, and "the process has evolved" since his presentation. Another doctor, for example, squeezes the skull after it has been pierced "so that enough brain tissue exudes to allow the head to pass through." Still other physicians reach into the cervix with their forceps and crush the fetus' skull. Others continue to pull the fetus out of the woman until it disarticulates at the neck, in effect decapitating it. These doctors then grasp the head with forceps, crush it, and remove it.

Some doctors performing an intact D&E attempt to remove the fetus without collapsing the skull. Yet one doctor would not allow delivery of a live fetus younger than 24 weeks because "the objective of [his] procedure is to perform an abortion," not a birth. The doctor thus answered in the affirmative when asked whether he would "hold the fetus' head on the internal side of the [cervix] in order to collapse the skull" and kill the fetus before it is born. Another doctor testified he crushes a fetus' skull not only to reduce its size but also to ensure the fetus is dead before it is removed. For the staff to have to deal with a fetus that has "some viability to it, some movement of limbs," according to this doctor, "[is] always a difficult situation."

D&E and intact D&E are not the only second-trimester abortion methods. Doctors also may abort a fetus through medical induction. The doctor medicates the woman to induce labor, and contractions occur to deliver the fetus. Induction, which unlike D&E should occur in a hospital, can last as little as 6 hours but can take longer than 48. It accounts for about five percent of second-trimester abortions before 20 weeks of gestation and 15 percent of those after 20 weeks. Doctors turn to two other methods of second-trimester abortion, hysterotomy and hysterectomy, only in emergency situations because they carry increased risk of complications. In a hysterotomy, as in a cesarean section, the doctor removes the fetus by making an incision through the abdomen and uterine wall to gain access to the uterine cavity. A hysterectomy requires the removal of the entire uterus. These two procedures represent about .07% of second-trimester abortions.

As one who is generally strongly supportive of states' right to differ substantively in their laws, I have to say that, as with slavery, I've no qualms about allowing the federal government to "dangerously overreach" to make blanket prohibitions of monstrosity.

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So let me get this straight . . .

The Journal believes that the law on medical issues ought to be decided by States, not by the federal government.

So . . . the Journal would support overruling Roe v. Wade, because that decision obliterated the States' ability to legislate with regard to most abortions.

What this (and other Journal editorials) demonstrates is that the E-board at the Journal is a little lacking in candle power.

Posted by: brassband at April 26, 2007 10:03 PM

"Paging Dr. Pablo Rodriguez ...

Paging Dr. Pablo Rodriguez ...

You're appointment in Hell is waiting!"

Posted by: Ragin' Rhode Islander at April 26, 2007 10:53 PM

brassband, you bring up a valid point. If the Projo were legitimately concerned about the federal government's interference, it would squarely oppose Roe. Such is not the case.

100 years from now people will read the Congressional testimony that Justin has cited and wonder how any rational person could ever have thought that a fetus was not a human being.

Funny, how we look back and wonder how people could have thought that slaves and Native Americans were anything but human, while our society is doing the same to unborn (and now newborn) children.

But, as is too often the case, when human rights clash with economic convenience, sometimes economic convenience wins out.

Whether it be a desire to own slaves so that labor costs can be kept down or a desire to abort a child so that living expenses can be kept down, the net effect is a violation of human dignity and rights.

Posted by: Anthony at April 28, 2007 5:16 AM

By the way, Justin, feel free to use the words unborn child or baby.

The pro-abortion lobby's refering to an unborn child as a fetus when talking about partial birth abortion is nothing more than another attempt to sanitize words for the public.

Posted by: Anthony at April 28, 2007 5:23 AM

Dear Anthony,

It is referred to as a fetus because that's what it is.

The pro-birth's lobby continues to attempt to turn 3 single cells into a baby. Not going to happen now or any other time.

What will happen over 100 years is we will get better at viability and predicting the exact moment that egg and sperm have joined. Both of these concepts in turn should dramatically reduce the number of abortions making sides happy.

Posted by: Bobby Oliveira at April 28, 2007 11:25 AM

Bobby, it looks like you didn't learn much at Bishop Connolly. When I went there, we wouldn't even let Ted Kennedy on campus.

Fists, partial birth abortion is a long way from 3 cells.

Second, not knowing much more about you other than your far left ideals, I wouldn't know if your sexual preference would ever afford you the opportunity to see the sonograms of your own child. If you ever have the opportunity to see the human shape and the beating heart only weeks into gestation, I doubt you'd be so flip about life.

Posted by: Perry Ellis at April 28, 2007 9:51 PM

Dear Perry,

What does sexual preference have to do with seeing sonograms? I'm straight, been married twice, and have seen many.

As an adopted person, I don't think I'm flip about life.

What it comes down to is this: It is not yet a human. It will never be a decision made over my body.

What I did learn at Bishop Connolly was a true passion for St. Thomas Aquinas. He taught us to never reject science. (Most Jesuits are privately pro-choice as are most, very surprisingly, Benedictians)

My views on this, or any other issue have nothing to do with silly constructs of left or right. I try to view what the Founders would have done, Madison indicates that enumerating the Rights does not limit them - hence an inherent right to privacy may exist, and then I what I understand about science.

If you've forgotten, I'm a pro-choice, pro-first and second amendments, pro death, anti capital gains tax (who believes that the state sales tax should be a robust 4%), supporter of the original Iraq resolution who believes our troops will be there for 10 years or more, member of the DLC.

How do you make left or right out of any of that?

Posted by: Bobby Oliveira at April 29, 2007 11:23 AM

This question is neither rhetorical nor sarcastic. At what point does it stop being a fetus and start being a baby?

Posted by: SusanD at April 29, 2007 11:31 AM

Dear SusanD,

One which is obvious and one where it's a total mystery:

1.) When the mommy decides she will bring it to term and therefore "lease" her body to the child.

2.) When God infuses a soul. (The Church has been all over the map on this. Life at conception, like double rapture, is really a 19th century construct) Since we can't use that for making law, we can use a "viability outside the womb" measurement.

Posted by: Bobby Oliveira at April 29, 2007 12:00 PM

Speaking of silly constructs, that is exactly what the Supreme Court did in Roe. In its attempt to justify making abortion on demand legal, it created an artificial construct to determine when human life begins.

I would suggest to you that the right to life, which is explicitly mentioned by the Founding Fathers as a bedrock of our Republic, outweighs the right to privacy, a right only recently introduced and inferred into American jurisprudence by the Supreme Court within the latter half of the 20th Century.

I grant you that it is the lawful right of the Supreme Court to make such decision, but think of it. We, as a society, allow 9 politically connected lawyers to be appointed by the President so that they may interpret a document that derives its strength from a premise that God has bestowed certain inalienable rights on all human beings.

Certainly, the Supreme Court's authority is lawful, but to suggest that it is always moral or based in science is incorrect. Cases during the period of slavery, such as the infamous Dred Scott decision highlight the moral vaccuum in which decisions are sometimes made.

If you believe that certain rights are inalienable, no human is morally entitled to abridge those rights, to include justices of the Supreme Court.

On the scientific front, we know that premature babies can live outside of the womb well past the age at which abortion is legal. We know that surgical procedures can be performed on babies still in the womb, just as they can on any other human being. That is science.

To suggest that because an unborn baby is dependent on its mother for life, it is not a human being, ignores the reality of human life. A 6 month old "born" baby is no less dependent on that same mother for both physical and emotional nourishment, but no one would suggest that a 6 month old is the "property" of his or her mother.

Science is clear that life begins at some point before a baby exits the womb. However, one can conveniently choose to interpret science differently.

Eugenics was once considered a highly scientific academic discpline at colleges and universities in the United States and research was funded by prestigious institutions such as the Rockefeller Foundation and the Carnegie Institute.

It was not that long ago that the study of Eugenics led some of the brightest scientific minds--not only in WWII Germany, as we'd like ourselves to believe, but here in the United States as well--told the world that certain races were superior to others and began developing abortion and forced sterilization policies.

The "science" of Eugenics warned against the evils of miscegenation and the need for gentic purity. The only difference between the Nazis and many American academics was that the Nazis were in a position to implement their eugenics-based policies.

Before the Nazis, the US was the leader in promoting such laws. In 1896, Connecticut passed laws prohibiting anyone who was epileptic or "feeble-minded" from marrying with the goal of stopping their reproduction. Forced sterilization laws were passed and upheld by a US Supreme Court 1927 ruling in Buck v. Bell. California alone forcibly sterilized over 60,000 people.

In the US, federal laws were passed to limit the number of "inferior stock" southern and eastern European immigrants in 1924 so as to "protect" the nation's gene pool. Following suit, Sweden forcibly sterilized ethnic and racial minorities over a 40 year period.

If you read the transcripts of those Nazi eugenics administrators tried at Nuremburg, they cited US forced sterilization laws as their inspiration for the Nazi-era abortion and forced sterilization programs.

My point to all this is that when you evaluate scientific evidence, you must do so by looking at the actual evidence and not the current interpretation of the evidence by particular group of scientists or an academic discipline.

You point about viability reminds us that the partial birth abortion debate is not really new.

In ancient Sparta, newborn babies were left outside for a length of time, because it was thought that those babies meant to survive would live, while those babies meant to die would perish. To Spartans, "viability" as a human meant that an infant baby needed to live, literally, outside, for a period of time without support from the mother.

The United States has always had a pro-eugenics mentality and as the partial birth abortion debate shows, we're not that far from being a modern day Sparta.

Posted by: Anthony at April 30, 2007 10:46 AM
2.) When God infuses a soul. (The Church has been all over the map on this. Life at conception, like double rapture, is really a 19th century construct) Since we can't use that for making law, we can use a "viability outside the womb" measurement.

And I'd also like to know if you are going to carry this to its logical conclusion and start espousing the belief that the Earth is at the center of the Universe and all else revolves around it because as we know, the Church has been all over the map on that one too.

Posted by: smmtheory at April 30, 2007 11:44 AM

Dear smmtheory,

If you know anything about me at all, it's that I am the biggest Separation guy out there.


We operate on all different organs in the body. Until the fetus becomes a baby, it is an extension of the female body and not an individual yet. Therefore, the fact that you COULD operate on a fetus does not make it a baby all by that fact's lonesome.

I respect your argument about the slippery slope, although I disagree that it is play here, since I use it often regarding the 1st Amendment.

I would also note by my definition that when you DO operate on a fetus, since you obviously plan to bring it to term (otherwise, why bother??) then it becomes a baby via the mother's choice.

Posted by: Bobby Oliveira at May 5, 2007 12:24 PM
Until the fetus becomes a baby, it is an extension of the female body and not an individual yet.

Not true. The fetus, even the embryo, is a genetically unique organism that will, unless removed forcibly from its natural habitat, advance in the usual course of human development of its own volition. That the female body acts as the habitat for the early stages of that development does not make the distinct organism merely an extension of it.

Posted by: Justin Katz at May 5, 2007 1:15 PM

Dear Justin,

You left out one little thing that makes a big difference: "able to survive on its own." The fetus is nothing without the womb.

If the woman chooses not to be the habitat, what is the fetus to do??

This is why outside viability is so important.

Posted by: Bobby Oliveira at May 5, 2007 6:11 PM

"Able to live on its own"? So does the convalescent live at the whim of the caretaker?

But I anticipated your question (of course). How would you — or society, for that matter — look upon a person on whom, for some reason tracing back to his or her own actions, fell the responsibility for another's life, such that a mere nine months of inconvenience and discomfort (yes, ending in some temporary pain) would mean life or death for the other, but who refused to make that sacrifice?

Suppose, for instance, a night of self-indulgence, on my part, brought a dawn that found me to be the person on whom another's very life depended. Now suppose I declare that I have no responsibility for that other person and wish him dead rather than causing me inconvenience for less than a year (at which point society would step in on my behalf, if I so chose). What would you think of me?

I'd think me a selfish person with a callous disregard for human life. And if that human life were my own offspring, I'd think myself a monster (with, of course, the opportunity for repentance and ultimate reconciliation with God).

Posted by: Justin Katz at May 5, 2007 6:44 PM

Dear Justin,

What about if the event which caused such an act was a rape?

How you love to put this all on the woman when both parties share responsibility.

Women are not second class citizens and they have a right not to bring potential life to term if they don't wish too. It is neither callous or selfish or anything else: it's just a choice.

Until it becomes your body, you shouldn't even be involved.

By the way, again for the 70th time, life at conception is a 19th Century concoction. Even the Bibe doesn't support it in it's one clue left in Leviticus.

Posted by: Bobby Oliveira at May 6, 2007 3:14 PM
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