Willie Parker helped me find the moral language I was missing.

How Willie Parker’s Moral Argument for Choice Made Me a Better Doctor

How Willie Parker’s Moral Argument for Choice Made Me a Better Doctor

Health and medicine explained.
May 3 2017 9:00 AM

Willie Parker’s Moral Argument for Choice Made Me a Better Doctor

His book provides the language we’ve been searching for.

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Western medicine does not have moral language.

Wavebreakmedia Media

Dr. Willie Parker’s new book, Life’s Work: A Moral Argument for Choice, has been everywhere recently—on The Daily Show, on the back of Time magazine, and at a book party with Gloria Steinem. But I think the most important place his words have been so far is in a room with me, taking care of a patient, at 3 a.m.

It was very early in the morning when I was called down for a GYN consult in the emergency department. The resident who saw her first briefed me: “We have a patient to see in the ED. New diagnosis of pregnancy at 19 weeks. She didn’t know.”

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“Nineteen weeks. Did you say 19 weeks?”

“Yeah. Nineteen weeks. She ... she’s upset.” he said, sounding upset himself.

Our patient was sitting in a windowless room downstairs, wearing a paper gown, tennis socks on her feet. She already had several kids, the youngest less than a year old. After her most recent delivery, she had received one of the newest and best forms of contraception, called a Long-Acting Reversible Contraceptive. They are so effective that the failure rate is less than 1 percent and rivals that of tubal ligation.

Some LARCs can give women irregular menses, as can breast-feeding. Because the patient was both breast-feeding and had educated herself on her birth control method, she didn’t think much of her intermittent, irregular spotting—until the day she came into the emergency room. She came because she felt the unmistakable jolts of fetal movement.

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* * *

As a doctor, I meet a lot of patients at the same time that I initiate the hardest conversations of their lives. And for those conversations, medicine is full of words that address concerns about treatment efficacy or side effects. But it has almost no words that tell a patient what they really want to know. What the patient really wants to know is if their cancer is their fault because they smoked or cheated on their spouse; what they really want to know is if the surgical complication was inevitable or an error; what they really want to know is if being in the ICU will cause suffering greater than what they will live to enjoy. What patients want is moral language, language that will help them grapple with the deeply meaningful and ethical questions that their medical decisions present.

Western medicine does not have moral language.

But Dr. Willie Parker does. Parker was born to that moral language. He lives comfortably in it as a believing and active Christian. You can read it in his book. (Though, please just start here at this beautiful profile to watch compassion and comfort in action. Then go here for a great interview.)

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Parker is also a reproductive justice advocate and abortion provider. And he uses his evangelical Christian religious language to explain why abortion can be a compassionate, ethical, morally correct act. He has moral language, and he is skilled at making it medically relevant. For me that use of language was not just new; it was a revelation.

* * *

When I entered the exam room, the patient was on the bed; her partner was over in the corner, crouched over a pizza box. Neither of them would speak above a mutter, and neither of them would look at each other or at me.

The patient had already received her options from my resident, and they included termination of pregnancy, which is legal in our state until fetal viability, somewhere around 24 weeks. After a few moments of silence, and without looking up, she hissed at me: “How can I terminate when I can feel fetal movement? I don’t want it, but it doesn’t matter what I want. It never will.” The sadness and anger in the room was palpable—real and thick and overwhelming. It took up all the space. What there wasn’t room for was any sort of choice.

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A few months ago, I might have said: “I’m so sorry. You’ve gotten your counseling, and I’m here to answer any questions you might have.” She wouldn’t have had questions, she wouldn’t have wanted to talk to me, and I would have given her a prescription for prenatal vitamins, some literature about early pregnancy nutrition, and made a first OB appointment for her. Maybe, maybe, I would have made her an appointment with the social worker a few weeks from now, for the poorly defined diagnosis of “stress.” She would have left the emergency room for home, still miserable, with no choice that had been offered in a way that she could really consider it.

But since then I had read Dr. Parker’s work. So I had different language to talk about this.

* * *

I asked her partner to leave the room. I asked her about domestic violence, which she denied. Then I sat down and said: “You seem really sad. I know my resident mentioned termination, and I just want to make sure I had talked about it with you as well. It is an option just for a bit more time. I also wanted to make sure that you know that you don't have to decide today.”

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She still wouldn’t look at me. “How can I do the thing, the thing you said? I can feel it move.”

“That’s not the way your doctors tend to think about this. If you mean the termination, I can talk to you about what the procedure would be like. But I don’t think that’s what you mean.”

She finally lifted her head up, eyes blazing, tears on her cheeks, nose running, and she said: “OK, then. Tell me what you think. What do you really think?”

I thought back to Dr. Parker’s interview and to his book. I opened my mouth and this is what I told her:

Here’s what I really think. I see a woman in front of me, and she is suffering. She has a pregnancy in her uterus, and that pregnancy is alive, but so were the sperm and eggs that made it. So life is not the real question. For right now, that pregnancy is, for most of us, and most of science, and for the current law, alive but not a person. You—YOU—are a person, and you are suffering. And if this procedure, a termination, would reduce your suffering, then I think you need to know it’s available. And if you want to continue this pregnancy, I will offer you the best prenatal care in the world, and we will help you have the healthiest pregnancy and baby you can have. What do I think? That this is your choice. No more, no less. No judgement, no shame.
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We sat with that for a moment. We breathed. We waited.

Then she looked up, and she smiled, and said, “That made sense to me. Before it didn’t.” And then she opened her arms and gave me a hug, sideways, with an IV in one arm. She said she still wasn’t sure what she was going to do, and I told her that sounded pretty reasonable, and she should take time. I also told her I was glad she was able to think about what she wanted. She was able to consider a choice.

That day, I realized I had language to talk about abortion in a new way with a patient. It was a way that addressed suffering with compassion; a way that recognized her personhood; a way suffused with ethics and morality. That’s language from Parker, and I’m very grateful to have it. That language helped me make some space for the patient to have options, options that were presented to her in a way that made them feel actually possible.

And the thing about real, possible choice is that it’s transformative. Because no matter what my patient did, handing her a real choice would mean that whatever she chose will feel volitional. It would feel like an independent decision by an individual trusted human. And I think we all know the difference between doing what you have to do because you can’t do otherwise, and doing what you’ve chosen to do. It can be the difference between resentment and resolution. And that difference can last a lifetime.

The patient left the emergency room that night. Our resident called her a day later. He messaged me through our medical record system to say he talked with her. He wrote: “She is going to keep the pregnancy. She didn’t sound happy, but she sounded certain.”

Chavi Eve Karkowsky is a specialist in high-risk pregnancy, also known as maternal-fetal medicine. Follow her on Twitter.