What George Tiller did that other abortion providers didn't.

Answers to your questions about the news.
June 1 2009 6:48 PM

What Made George Tiller So Special?

He did the abortion procedures that other doctors couldn't or wouldn't do.

Photograph of George Tiller.
George Tiller 

George Tiller, an abortion provider who became well-known for providing late-term abortions, was murdered Sunday while attending church services. What exactly did Tiller do that other abortion providers didn't?

He performed the same procedures, just later in the pregnancy. Extracting a late-second- or third- trimester fetus from the cervix is much more challenging than an early abortion. Because post-viability abortions are relatively rare—representing about 1 percent of the procedures nationwide—Tiller was among a handful of doctors who had significant experience in the area. His expertise and visibility eventually made him a one-man national referral center for post-viability abortions.

Early abortions, in which the fetus is removed through a narrow tube by suction, are so straightforward that 12 states do not even require the practitioner to be a licensed physician. Once the fetus outgrows the tube—usually at around 15 weeks—there are two higher-risk options: dilation and evacuation, and a labor-induction abortion. Tiller was renowned in both procedures.

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In a D&E, the doctor medically opens the cervix and extracts the fetus using surgical instruments. The trick is to keep the fetal body as intact as possible, so bone shards don't lacerate or perforate the cervix and other parts don't linger and cause sepsis. (The head, which is rarely small enough to fit through the cervical opening, must be collapsed.) Because a fetus is soft and not fully formed, it takes considerable skill to remove it in one piece. Doctors around the country sent patients to Tiller's clinic because of his mastery in performing the D&E procedure on larger fetuses.

In a labor induction, the doctor administers a feticidal agent, and the patient delivers the fetus down the birth canal. This procedure is longer, more painful, and far more emotionally taxing than a normal delivery, and it gets worse as the pregnancy progresses. While most hospitals can perform the procedure, many referred their late-term patients to Tiller because of his experience in treating the emotional and physical strain. Tiller also pioneered an outpatient induction technique.

Still other abortion providers referred post-viability-abortion seekers to Tiller because they feared prosecution. Roe v. Wade requires states to permit pre-viability abortions and mandates that any prohibition on post-viability abortion contain an exception to protect the life or health of the mother. However, state statutes vary in their definition of viability as well as the breadth of the life and health exception. For example, Maine permits the physician to determine the viability of the fetus and broadly allows post-viability abortions "for the preservation of the life or health of the mother." Kansas also leaves the question of viability up to the attending physician but limits post-viability abortions to cases involving "serious risk of substantial and irreversible impairment of a major bodily function." Other states link viability to a specific week of pregnancy and permit late-term abortions only to save the mother's life—although these statutes are of dubious constitutional validity. For example, Idaho permits second-trimester abortions to protect the emotional or physical health of the mother but allows third-trimester abortions only if two physicians agree that it is necessary to save the life of the mother or that the fetus has no chance of survival.

In practice, Tiller was one of just a handful of doctors in the United States who would perform these procedures after week 25 or so.

Got a question about today's news? Ask the Explainer.

Explainer thanks Caitlin Borgmann of the CUNY School of Law and Vicki Saporta of the National Abortion Federation.

Brian Palmer writes about science, medicine, and the environment for Slate and Earthwire. Email him at explainerbrian@gmail.com. Follow him on Twitter.

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