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Can President Obama's "common ground" meetings between pro-lifers and pro-choicers accomplish anything? What topics and ideas should they focus on? Steve Waldman and I hash out the options, looping in our own ideas and many of the good points being made in an ongoing discussion at RH Reality Check. Abortion, birth control, surrogate pregnancy, George Tiller, and what the hell business men have talking about this stuff—it's all there. You can watch our conversation, courtesy of our friends at Bloggingheads.tv, by clicking on the video link above or by going to the Bloggingheads site. I look like I just rolled out of bed, but that's nothing new. Next time I'm gonna wear a nice shirt like Steve's and grow back some of that hair I lost.
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How could anyone kill her own newborn child?
If you talk to pregnant women or read accounts of what they say to friends and counselors, you'll notice a pattern. Those who are happy to be pregnant and expect to give birth describe what they're carrying as a baby. Those who don't want to be pregnant and are seeking or contemplating abortion avoid that word. Given the same thing at the same stage of development, we see what we want to see: a child if we want a child, an unformed embryo if we don't.
I like to think this subjective mentality is confined to the pre-viable fetus or at least to pregnancy. But what if it isn't? What if, to some people, it extends to newborns?
Infanticide is rare but not as rare as you might think. According to the U.S. Bureau of Justice Statistics, the number of infanticides in this country, defined as homicides of anyone under age 5, has ranged between 500 and 800 per year for the last three decades. Of these cases, about 40 percent involve children under the age of 1. If you have the stomach to read about such tragedies, here are articles about some of them: 2006 cases in Georgia, South Dakota, and New York; two more New York cases in 2007; and a 2008 case in Texas. Serial infanticides are the most disturbing. Here's an alleged 2005 case in California, a 2007 case in Texas, and a 2008 case in Germany.
The latest horror story is unfolding in France. Edward Cody of the Washington Post reports:
Véronique Courjault, by her own admission, smothered the two babies after giving birth to them secretly in Seoul, the first in 2002 and the second in 2003. She also has acknowledged killing a newborn and burning the body in her garden after a first secret pregnancy in 1999 ... [A]s the presiding judge pressed for an explanation—the court will have to decide whether she knew what she was doing—she offered only vague clues as to what was going through her mind at the time. "What I did is so monstrous, without explanation," she responded, according to reports from the courtroom. "For me, those children did not have a real existence." Asked how she could carry the children for nine months and still feel they had no existence, she said, "I knew it, and then I no longer knew it."
This is the danger of denying that what you're carrying is a developing baby. Is your denial based on the undeveloped state of your pregnancy or on a determined refusal to see what you don't want to see? If it's the former, then at some point, if you continue the pregnancy, you'll start to see a baby. But if it's the latter, you might not. Your denial might extend all the way to birth or even beyond it.
That's one reason why, if you're unhappily pregnant, you should look at an ultrasound of what you're carrying. That goes for the potential father, too. Nobody can make you look, nobody should make you look, and you certainly should ignore bogus "information" scripts like the one concocted by a bunch of U.S. senators two years ago. But there's nothing bogus about an ultrasound. It will make you face what's growing inside you and the urgency of deciding whether to terminate it, even if termination is still the right choice. Otherwise, you risk sliding into the mentality of denial. And there's no telling where that ends.
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Last week, when Ross Douthat made a case for "regulating abortion," I asked him and other pro-lifers how far we should go. The Partial Birth Abortion Ban Act has a maximum jail sentence of two years for doctors who perform the forbidden procedure. Is that the kind of regulation we should apply to abortions? Would the country stand for it?
Today, let's turn the tables on those of us who oppose abortion regulation. How far should we go? Would you oppose regulation even of abortions aimed at preventing the births of girls? Because there's increasing evidence that such abortions, which take place by the millions in Asia, are now being done by the thousands in the United States as well.
Let's start with the data noted here last year, when
economists Douglas Almond and Lena Edlund published an article in Proceedings of the National Academy of Sciences examining the ratio of male to female births in "U.S.-born children of Chinese, Korean, and Asian Indian parents." Among whites, the boy-girl ratio was essentially constant, regardless of the number of kids in a family or how many of them were girls. In the Asian-American sample, the boy-girl ratio started out at the same norm: 1.05 to 1. But among families whose first child was a girl, the boy-girl ratio among second kids went up to 1.17 to 1. And if the first two kids were girls, the boy-girl ratio among third kids went up to 1.5 to 1. This 50 percent increase in male probability is directly contrary to the trend among whites, who tend to produce a child of the same sex as the previous child.
A recent paper by economist Jason Abrevaya adds:
The evidence from the California natality data is particularly striking for Indian births between 1991 and 2005: second-born children are 0.9 percentage points more likely to be boys, third-born children 6.6 percentage points more likely, and fourth-born children 8.1 percentage points more likely. Moreover, Indian parents are significantly more likely to have a boy (and a terminated pregnancy since last birth) if they have had only daughters previously. The simple framework of Section 4.5 suggests that the unusually high boy percentages among third- and fourth-born Indian children in California would be consistent with gender-selective abortion rates of around 10%. ...
Using census data, Abreveya estimates that from 1991 to 2004, U.S. families of Chinese or Indian descent aborted more than 2,200 fetuses just for being girls. (For the data, see Table 13 of his paper; he explains his calculations on Pages 23-24.)
Researchers had expected sex selection among Asians to decline as they became Americans. But in today's New York Times, Sam Roberts reports:
Demographers say the statistical deviation among Asian-American families is significant, and they believe it reflects not only a preference for male children, but a growing tendency for these families to embrace sex-selection techniques, like in vitro fertilization and sperm sorting, or abortion. ... [A] number of experts expressed surprise to see evidence that the preference for sons among Asian-Americans has been so significantly carried over to this country.
Roberts quotes one woman who got pregnant with a boy after having two girls. The woman says flatly: "If the third one was going to be a girl, then I would say probably I would have terminated."
Should that abortion be allowed? And if legal intervention in such cases is unwise, should we do something short of that? Should schools teach that aborting girls is wrong? Should doctors counsel couples not to do it? Should community leaders speak out against it? The last president called for a culture of life. Should this president call for a culture of respect for women?
What about purveyors of sex selection? Roberts notes that at least one assisted reproduction provider, the Fertility Institutes, offers sex selection and "has unabashedly advertised its services in Indian- and Chinese-language newspapers in the United States." (The company has also promoted and withdrawn an offer to select embryos for "eye color, hair color and complexion.") This form of sex selection takes place when the offspring are tiny, dish-bound embryos, not fetuses. The clinic's medical director, Dr. Jeffrey Steinberg, says the practice is "not harming anyone." Is he right? Should he be allowed to continue peddling sex selection (as he does in this video) to Asian-Americans? And if it's fine to advertise this service at the embryonic stage, why not at the fetal stage?
Absolutists on both sides need to think carefully. If you're pro-life, how far are you willing to go in regulating abortion? If you're pro-choice, how far are you willing to go in leaving it unregulated?
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Banning abortions isn't just a statement of "respect for human life," as many pro-lifers imagine. It's a commitment to investigate, prosecute, and punish.
I'm all for morality, custom, compromise, and common sense. These elements of society have plenty to say about abortion, and they're saying it. But criminal law? Do we really want to go that far?
More here.
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Obama aides have convened meetings between pro-choicers and pro-lifers to seek "common ground" in the abortion debate. Already, the two sides are sniping in the press and refusing the simplest concessions. Some of the people involved in the abortion meetings are my friends or acquaintances. They all mean well, and I'm glad they're participating. But they aren't trying hard enough. They should watch the president's Cairo speech. He's making serious concessions and taking real risks. They should do the same.
More here.
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You tell yourself that abortion is murder. Maybe you even say that when a pollster calls. But like most of the other people who say such things in polls, you don't mean it literally. There's you, and then there are the people who lock arms outside the clinics. And then there are the people who bomb them. And at the end of the line, there's the guy who killed George Tiller.
If you don't accept what he did, then maybe it's time to ask yourself what you really believe. Is abortion murder? Or is it something less, a tragedy that would be better avoided?
More here.
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If you've ever been on TV, you've probably had one of those moments where something comes out of your mouth, and a few seconds later, your brain catches up and wishes you'd said it better. I had one of those moments yesterday on Hardball. Chris Matthews, Ceci Connolly, and I were talking about the murder of Dr. George Tiller. Matthews raised the point that under Roe v. Wade, abortion early in pregnancy is a personal decision, whereas later in pregnancy, "it should be more of a community decision." He suggested that "there has to be some conditions set here when you have a late-term abortion."
My response was and is that you don't have to pass laws to establish such restrictions. Conditions are in fact set, and elements of the community do in fact participate in the decision, as the pregnancy moves further along. Here's how I said it on the program:
Under the voluntary system, there are voluntary, private, doctor-by-doctor, state-by-state limits on what people will actually do, so that the numbers go down precipitously. First of all, only 12 percent of the abortions in this country happen after the first trimester. So you wipe out 88 percent of them. Of that, you`re down to about 5 percent by 16 weeks. By the time you get up to about 20 or 21 weeks, you`re down to 1, 1.5 percent of all the abortions in this country.
Well, this is a bit confused. There are at least three layers of regulation in what I was talking about, and I didn't properly sort them out. There's federal regulation, most recently in the form of the Partial Birth Abortion Ban Act. There's state regulation, which allows for more local control and variability but isn't voluntary in the sense I intended. And then there are the self-imposed restrictions of each doctor. That third layer is the main reason why very late-term abortion providers such as Tiller are so rare.
But I left out the most important regulator of abortions: women. The reason why so few abortions happen late in pregnancy is because the women who face them don't want to wait. If they know they don't want a baby, they try to end the pregnancy as fast as possible. If they're not sure, they try to reach a decision quickly. There are dawdlers, hiders, and self-deluders. But by the time you get to the late stages in which Tiller was operating, the self-regulatory system has taken care of 99 percent of abortions. And of the remaining 1 percent, a significant number are the result of nasty medical surprises along the way. So let's not pretend that in the absence of legislation, late-term abortion is out of control.
One more thing: I thought I was being original when I asked yesterday whether killing abortion providers is a logical expression of the belief that abortion is murder. I wasn't. TNR's Damon Linker (and maybe others I haven't yet found) beat me to it. Linker asked pro-lifers:
Who is the better, truer member of your movement? The man who murdered serial "baby killer" George Tiller? Or Robert George and other (comparative) moderates, who reject the use of violence to save the innocent?
Good question. This is an opportune time to recommit to nonviolence and to dialogue.
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Lots of talk yesterday about President Obama's commencement address at Notre Dame. The main topic was "common ground" on abortion. I'll post some thoughts on that later today or tomorrow. But one thing is worth pointing out now: It's a bit odd to see abortion being treated by activists and the press as an issue separate from the economy. In real life, women who get pregnant think hard about their financial circumstances. They try to figure out whether they can afford to raise a child. That's what is happening right now in Singapore, according to Agence France Presse:
Despite a national campaign to boost the birthrate, Singapore has one of Asia's most liberal abortion policies and the global financial crisis could be prompting more women to terminate pregnancies. A Ministry of Health spokeswoman said there were 12,222 abortions in the city-state last year, compared to 11,933 in 2007. No official figures are available for 2009. Gynaecologist Saifuddin Sidek said his private practice had recorded a 20 percent rise in abortion patients so far this year compared with the same period last year. "A lot of them are because of the current economic climate," he said.
The same logic applies to the United States. If you look at the chart on Page 9 of last year's report by the Alan Guttmacher Institute, "Trends in the Characteristics of Women Obtaining Abortions, 1974 to 2004," you'll see that the "abortion ratio per 100 pregnancies" rose from 1974 to the early 1980s and then steadily fell, except for the first couple of years of the 1990s and 2000s. That roughly correlates with economic indicators. The better the economy, the more likely women are to go through with their pregnancies.
At Notre Dame, Obama talked about adoption, pregnancy prevention, and other things the government can facilitate to lower the abortion rate. Good for him. But don't be surprised if abortion trends during his presidency end up having little to do with his abortion policies and a great deal to do with his management of the economy.
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What do Ross Douthat, Steve Waldman, and I have in common? Answer No. 1: None of us has a uterus. Answer No. 2: We're all noodling prospects for an abortion compromise. What better way to salute Slate's new website, Double X, than to add a male point of view. Or two. Or three ...
Steve and I have been discussing the merits of reducing the number of abortions (the approach favored by the Clintons, Third Way, and Barack Obama) versus reducing late abortions and facilitating earlier ones. Steve prefers the latter approach. In his latest post, he argues that
focusing on timing—as the Europeans do—ultimately is a better approach for the simple reason that it actually comports with the way most people make the moral calculation. Insisting on "rare" as a goal accepts the purist pro-life argument that any abortion is equally tragic. But most people do not believe that expelling a zygote in the first week is horrendous. So remind me: politically speaking, why must those types of abortions be rare? Most voters would trade a myriad zygote expulsions for a meaningful reduction in second or third trimester abortions.
Conversely, given the revulsion most people feel about "partial birth abortion" in most circumstances, having them be "rare"—instead of non-existent or virtually eliminated— is morally unsatisfying, too.
Morally, my feelings differ from Steve's. I'm more uncomfortable with early abortions than he is. At the same time, I'm more uncomfortable with government interference in late abortions than he is. Steve is right that earlier is better. But pointing out that truth, or even preaching it, is very different from criminalizing, investigating, and prosecuting abortions. My wager is that such laws would create a nightmare of moral crudity, hypocrisy, deceit, interrogations, and amateur surgery. Women make these decisions better than cops, judges, and lawmakers do.
So I'm against this trade-off on moral and policy grounds. But is Steve right about the politics? Would slamming the door on late-term abortions satisfy more Americans than an overall reduction in abortions would?
That's where Douthat comes in. Unlike Steve and me, Ross is a real pro-lifer. He's been a very fair listener to my arguments for shifting the anti-abortion cause from prohibition to reduction. But ultimately, I've hit a wall with him because I won't ban pre-viability late-term abortions. In his latest column, he writes:
Nothing that emerges from this White House is going to look like a genuine legal compromise—which would require the rollback of Roe's near-absolute guarantee of abortion rights, and a move, at the very least, toward the restrictions on second-trimester abortions that roughly two-thirds of American support.
Here's what I'd like to know: Would Ross go for Steve's idea? Would Steve offer him a good enough deal on restricting late abortions to win a truce, and possibly a stable consensus, on the legality of early ones? How far into the second trimester would that deal extend? And is this just three guys talking, or would our countrymen and countrywomen go along?
How about you, XXers? Katha? Emily? Christine?
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My buddy Steve Waldman has a new idea for building consensus on abortion. He calls it "safe, legal, and early."
I get to call him my buddy for two reasons. One is that he's a good guy. The other is that there aren't a lot of people willing to seriously talk compromise on abortion. So we'd better stick together.
I like his idea. I don't think it stands on its own. But it fits a larger common approach: abortion reduction.
Waldman thinks a timing approach is different and better because later abortions destroy a more developed and therefore more fully human fetus. "Success would be measured on the basis of moving abortions earlier in the gestational cycle—even if that conceivably means more overall abortions," he explains. For example, "abortion reducers would likely oppose making RU-486 readily available on the grounds that it could lead to a dramatic growth in what is technically an abortion. But if the goal is have fewer late abortions, then promoting RU-486 makes great moral sense."
Actually, pro-choice advocates of reduction support RU-486 precisely for Waldman's reasons. Any woman who uses RU-486 has chosen and is going to get an abortion. RU-486 just makes sure the abortion is an early one. The reduction framework doesn't capture this benefit. The timing framework does.
But the timing framework has two problems. One is that conceptually, it's too complicated. A few years ago, I tried it out on some pro-choice thinkers who are pretty good at assessing political messages. My version was almost word-for-word the same as Waldman's: moving abortions earlier in gestation. (I tried a later version of it here.) They squinted politely. The backward-in-time idea, while logical, was a bit hard to get across in a pithy way, they explained. And less of a bad thing is easy to understand. But a bad thing in smaller bites? Without the "less" part, it's not particularly compelling.
The other problem is that people won't take the more-but-earlier-abortions deal. Yes, they prefer earlier abortions to later ones, as Waldman's poll data show. But those data say nothing about a trade-off for more abortions. So earlier timing isn't a substitute for reduction. It's an add-on.
In fact, the timing approach logically fits the reduction framework. A nine-week abortion is better than a 12-week abortion. A six-week abortion is even better. But eventually, this trajectory takes you all the way back before conception. That's not an abortion anymore. It's birth control or abstinence. In other words, it's reduction.
I'll tell you where I really like Waldman's idea. It's a good answer to abortion-delaying restrictions. Waldman notes:
Parental notification also sounds reasonable if your goal is reducing the overall number of abortions. But these policies may have a secondary effect: increasing the number of abortions that happen later. The 2006 Guttmacher survey found that among women who said they wished they could have had their abortions earlier, the most common reason they cited for delay was that it took a long time to make arrangements. Therefore, efforts to reduce the number of abortion clinics, cut off government aid to women who want abortions, or otherwise delay the decision may reduce the number of overall abortions but also make it more likely that those abortions that do occur will happen later. According to the Journal of the American Medical Association, a requirement in Mississippi that a woman wait 24 hours between realizing she's pregnant and an abortion decision led to both a decline in the overall number of abortions and a rise in abortions performed after 12 weeks.
He's totally right about that. It's immoral, from an intelligent pro-life viewpoint, to impose restrictions that simply delay abortions, adding days or weeks of fetal development to what is already a tragedy.
But for the same reason, let's be careful about imposing such restrictions on a timing basis. Under Waldman's proposal, for instance, "Medicaid funding would be generous for first trimester abortions, minimal for second trimesters, and non-existent for the third." That sounds good. But suppose you're just past your first trimester. A second-trimester abortion is considerably more expensive than a first-trimester abortion, and now we've taken away your anticipated means of paying for it. Good luck raising the money from family and friends while your fetus develops and the eventual abortion becomes that much more awful.
I liked Bill Clinton's idea: safe, legal, and rare. I like Waldman's idea, too. Barack Obama has a task force working on such ideas. Safe, legal, early, and rare is a good place to start.
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Good news in the fight against teen pregnancy: The FDA is making to it easier for young people to get morning-after pills.
Here's the FDA's announcement:
On March 23, 2009, a federal court issued an order directing the FDA, within 30 days, to permit the Plan B drug sponsor to make Plan B available to women 17 and older without a prescription. The government will not appeal this decision. In accordance with the court's order, and consistent with the scientific findings made in 2005 by the Center for Drug Evaluation and Research, FDA notified the manufacturer of Plan B informing the company that it may, upon submission and approval of an appropriate application, market Plan B without a prescription to women 17 years of age and older.
The New York Times warns that Plan B won't solve the problem:
Contraception advocates have pushed for easy access to Plan B for girls and women of all ages because the longer a woman delays in taking the medicine after unprotected sex, the more likely she will become pregnant. Eliminating doctors from the transactions, it was hoped, would lead to far fewer pregnancies and abortions. Indeed, advocates once predicted that widespread and easy access to emergency contraceptives would cut the number of induced abortions in half and slash teenage birth rates. But young people in the United States have so much unprotected sex—one in three girls under the age of 20 will get pregnant, with 80 percent of the pregnancies unplanned—that Plan B has been little more than a sandbag on an overtopped flood wall. Even women who are given the medicine free often fail to take it after having unprotected sex. "This is not going to be a cheap cure to the unintended pregnancy epidemic in this country," said James Trussell, director of the Office of Population Research at Princeton University.
Trussell has made the same point before: Emergency contraception has
not reduced unintended pregnancies in America or anywhere else that has introduced it. There is so much unprotected sex you would have to use so much emergency contraception to make a dent. ... It is not a magic bullet. If you want to seriously reduce unintended pregnancies in the UK you can only do [that] with implants and IUDs.
Why implants and IUDs? Because you don't have to think about them. They bypass the most common cause of what we erroneously call contraceptive failure: our own failure to use contraceptives properly and consistently.
I agree that using implants to bypass human failure is the most effective way to prevent unintended pregnancies. But that's no excuse for tolerating our failure in the first place. Emergency contraception, taken promptly after sex, can be (though you shouldn't rely on it) a magic bullet. But bullets don't work unless you fire them. Technology requires human agency.
Cecile Richards, president of the Planned Parenthood Federation of America, makes precisely this point about the FDA's decision: "Providing birth control, including emergency birth control, to young women helps them make responsible decisions and avoid unintended pregnancy."
The FDA hasn't solved the problem of unintended pregnancy. It has given you one more means to solve it. Go get your emergency contraception, now. And while you're at it, ask about an implant, so you won't have to count on a last-minute pill to bail you out. The responsibility is yours.
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If we expose the people who tortured terrorism detainees, whom will we go after next? The people who execute death-row prisoners?
The scenario makes sense. Executioners, like water-boarders, act under government orders. Executioners, unlike water-boarders, aim to kill. They do kill, by the dozens. And public support for the death penalty has been declining. It's not hard to envision a world in which we look back on capital punishment the way we now look back on torture.
Facing the prospect of exposure, if you were an executioner today, what would you do?
Washington state's executioners have made their decision: They're quitting. Here's the April 2 report from the Seattle Times:
Four people who have volunteered to administer lethal injections to death-row inmates at the Washington State Penitentiary in Walla Walla quit their positions this week, apparently worried that their identities could become public as a result of an ongoing court case to decide whether lethal injection constitutes cruel and unusual punishment. The four resigned Tuesday, which was the deadline Thurston County Superior Court Judge Chris Wickham had set for the team's records—detailing the members' credentials, qualifications and experience in administering lethal drugs—to be submitted for his review. The state is now without a lethal-injection team. ... "Walla Walla is a small town, so it's not hard to figure out (someone's identity) based on their qualifications," [a state official] said. "They don't want picketers showing up on their front lawns, and they don't want offenders knowing who they are."
In a follow-up story on April 15, the Times reported that a state senator has "introduced a bill that would forbid the release of names and other identifying information of execution team members." But the president of the Washington Coalition To Abolish the Death Penalty isn't backing down. He says, "[T]he public has a right to know whether members of an execution team are qualified to do [their] job."
Is execution as bad as water-boarding? Are executioners as culpable as torturers? Even if they aren't, should their identities be known?
And here's the harder question: Would you give the same answer about people who perform abortions? Do you think it's unfair that threats of exposure and picketing have led many doctors to quit doing abortions?
In the fury of a moral backlash, naming names and holding people accountable feels like the right thing to do. But before you go down that road, remember that the choice of targets won't always be yours.
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The most interesting moment in President Obama's Tuesday night press conference is something you won't pick up from the transcript. You have to watch the video. Forty-six minutes in, John Ward of the Washington Times asks Obama about stem cells. Obama replies:
[I]t is very important for us to have strong moral guidelines, ethical guidelines, when it comes to stem cell research or anything that touches on, you know, the issues of possible cloning or issues related to, you know, the human life sciences. I think those issues are all critical, and I've said so before. I wrestle with it on stem cell; I wrestle with it on issues like abortion.
What the transcript doesn't convey is that after saying "anything that touches on," it takes Obama a full 15 seconds of stumbling, stalling, and groping before he finds the phrase "human life sciences."
Obama, unlike President Bush, knows his way around the English language. He doesn't stumble, stall, or grope for lack of words. He does it because he was about to say something but decided not to say it. The giveaway here is that he eventually settles on the phrase "human life sciences," which I've never heard before from a politician. Supporters of embryonic stem-cell research talk about "life sciences." Opponents talk about "human life." Neither side likes to focus on the other's magic word: human for pro-lifers or sciences for research proponents.
I think Obama settled on "human life sciences" because he was originally going to say "anything that touches on human life." And he decided at the last minute that he'd better not say that, because that would buy into the other side's framing of the issue and get him into trouble. The human-life frame, planted by Ward, was clearly in Obama's head, as evidenced by his next sentence: "I wrestle with it on stem cell; I wrestle with it on issues like abortion." But strategically, you're not supposed to accept the other side's frame. Once you group stem-cell research with abortion, you're giving away the fight. You're supposed to group stem-cell research with the Bush administration's deceptions about abstinence and global warming. It's all part of the "Republican war on science." So, after his 15 seconds of groping, Obama splits the difference and comes up with the phrase "human life sciences."
We saw the same thing two weeks ago, when Obama lifted the ban on federal funding of stem-cell research using destroyed human embryos. Most research proponents, including his own aides, stuck to the "science" message and didn't mention moral objections. But Obama did mention them. His remarks sounded a lot like what he has said about abortion and other social issues: acknowledging moral disagreement while striving for consensus or at least compromise.
On Tuesday, after Obama's initial answer, Ward asked a follow-up: "Do you think that scientific consensus is enough to tell us what we can and cannot do?" Obama replied: "No. I think there's—there's always an ethical and a moral element that has to be—be a part of this."
Obama, like the rest of us, is grappling with how to think about biotechnology. We're all familiar with social, financial, public-safety, and health-care issues. But this is a new kind of issue: It's moral, economic, and life-and-death. To some of us, it's about life sciences. To others, it's about embryonic human life. It took Obama 15 seconds to put the two perspectives together in words. If it takes him eight years to put them together in practice, that'll be one hell of an achievement.
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Yesterday I wrote about an awful story in California. A number of couples hired gestational surrogates through a fertility brokerage. They were directed to put money in trust accounts to pay the surrogates throughout their pregnancies. Now the money is gone. Andy Vorzimer, an attorney involved in the case, told the New York Times, "We've got couples in the midst of pregnancies with no ability to pay the surrogate." I ended the piece this way:
I hope the women carrying these pregnancies will see them through, even if the company that hired them doesn't. But that financial burden shouldn't fall on them alone. Here's the contact page for an attorney working the case. If you'd like to prevent abortions, help pregnant women, and facilitate reproductive choice at the same time, now's your chance.
Yesterday evening, Vorzimer sent me an e-mail to clarify the situation:
The article has obviously resonated with your readers as my inbox has been flooded with concerned people offering to donate funds so as to avoid possible abortions. I am happy to inform you that there are no situations in which a surrogate has elected to abort because of this financial scandal. While many of the surrogates will not be reimbursed for their out-of-pocket expenses lost wages or even have their medical bills paid, every single one of them has committed to moving forward.
That's great news. I'm impressed with the surrogates. I'm also impressed with all of you who contacted Vorzimer and offered your support so they wouldn't have to end their pregnancies. Pro-lifers are often accused of moralizing and interfering but not helping. You disproved the caricature. And I hope you'll stand by your offers even if no abortions are at stake.
In recent days, I've had a few curious exchanges with friends, readers, and bloggers who wonder why I keep writing about this stuff: abortions, pregnancies, IVF, surrogates—what some of my critics jokingly call "lady parts." What's my agenda? Do I have a problem with women controlling their bodies? Am I a frontman for the religious right, a useful idiot who pretends that compromise on these issues is possible when, in fact, it isn't? Even Vorzimer, in a tweet posted on his blog, initially responded to my article by remarking, "The lengths (or depths) abortion foes will go to make a point."
Vorzimer and I have had some back and forth since then, so we've come to understand each other better. But the misunderstanding was my fault, not his. I need to do a better job of explaining myself.
This may sound strange, but I don't consider myself a real abortion foe. I have friends and sparring partners who think abortions should be illegal or at least heavily restricted. To me, that's the chief dividing line in the debate. I don't feel comfortable crossing that line. I don't think a regime of abortion restrictions enacted in the name of life would make this world a better place. I think it would cause a mess—hypocrisy, deceit, interrogations, amateur home surgery, moral crudity backed by the force of law—as ugly as any war fought in the name of peace.
I don't equate abortion with murder. I don't even think it's the worst option available to a woman facing unintended pregnancy. Every abortion dilemma is different, because every situation is different. The person best situated to make the right decision is the pregnant woman. A few years ago, I wrote a whole book on this point.
So why do I keep bringing up abortion as a moral problem? Because it is a moral problem. It's the destruction of a developing human being. For that reason, the less we do it, the better. When I say abortion is bad, I'm not saying it's necessarily worse than bringing a child into the world in lousy circumstances. I'm saying it's worse than avoiding unintended pregnancy in the first place. That's why I keep pushing contraception. If you cause an unintended pregnancy and an abortion because you didn't want to wear a condom, you should be ashamed.
But that's the conventional life/choice debate. The reason I keep you posted on developments in IVF, surrogates, and embryo screening is that they're transforming the debate. They're changing the conditions on which our moral positions rely. Were you pro-choice because the embryo was in a woman? Now we have embryos in dishes. Did you support embryo screening for fatal diseases? Now we're talking about screening embryos for eye color. Does the value of an embryo depend on what its mother thinks? Now we have embryos with two mothers: a genetic one and a gestational one. Should they at least consult each other?
I got into this field because the moral questions are enduring but the facts are always changing. Technology is transforming culture. And I write about the value of unborn life because that's the problem my fellow pro-choicers don't like to talk about. I want to challenge you. Keeping the government out of these sticky moral questions doesn't make them go away. It just puts the burden on you to face them responsibly.
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What if you delivered the money to a broker, and the broker lost, stole, or squandered it? You did your part, but the surrogate is no longer being paid. And she has every legal right to end the pregnancy.
That's the scenario unfolding in California.
More here.
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Remember that bill in Georgia to restrict in vitro fertilization? The Associated Press thought it was dead. Surprise! The Georgia Senate revised it and passed it a week ago.
The bill is part of a nationwide project to regulate the emerging industry of embryo production. In one state or another—and then another and another—legislation will be filed to restrict IVF. The battles will be fought over which uses of preimplantation genetic diagnosis are acceptable. And these fights will be every bit as ugly as the preceding fights over abortion.
More here.
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Would you abort a fetus just because it wasn't yours?
The scary scenario is the one you never expect: going through IVF and discovering, weeks into your pregnancy, that your doctor put the wrong embryo in your womb.
If you think this can't happen, I have bad news: It just did.
More here.
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Two arguments have persuaded the United States to fund stem-cell research using destroyed embryos. One is that the research will save lives. The other is that the embryos, left over from fertility treatments, will otherwise be wasted.
Both arguments are now being applied to fetuses.
More here.
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Liberals want fewer unintended pregnancies and more empowerment for women. Conservatives want fewer abortions. Everybody wants to reduce HIV and other sexually transmitted infections. We can keep yapping about these things, or we can do something constructive.
Here's something constructive: female condoms. If you don't know what they are, read about them here, here, and here.
Yesterday, the Female Health Company announced FDA approval of its latest female condom. The company's previous condom was being sold for $2.80 to $4 a pop. The new one, which is made of different material (nitrile polymer instead of polyurethane) in a more automated process, will cost less. Projections range from 30 percent less to just 60 cents per condom at high volume. If a charity can cover the 60 cents, women can get it free.
With billions of male condoms in circulation, why are female condoms such a big deal? For starters, women are generally more responsible about birth control than men are. Even in the United States, 10 percent of women who end up getting abortions because they neglected contraception say their partners objected to using protection. I haven't checked the data lately, but I assure you that overseas the problem is even bigger. The more we take this decision away from men and give it to women, the more unintended pregnancies we'll prevent. That's the first thing female condoms do. They "put the power of protection in women's hands," says the Female Health Company. The director of the Center for Health and Gender Equity agrees that these condoms give "women another option in negotiating safer sex with their partners or husbands."
Second, because these condoms are designed around the vagina rather than the penis, they're unaffected by erection status. This is a big deal. Look at the company's "product" page and scroll down to the blue box outlining differences between male and female condoms. Female condoms "can be inserted prior to sexual intercourse, not dependent on erect penis," says one line of the box. Another adds: "Does not need to be removed immediately after ejaculation." Think about all the pregnancies that happen because the guy was in a rush or because the condom wasn't removed till the erection had subsided and the sperm had leaked. The female condom removes these timing problems. You put it on in advance, it's there for the duration, and you don't have to worry about the awkwardness of removing it before the guy goes limp.
In short, we're talking about a technology that compensates for human error.
Technology won't solve the whole problem of unintended pregnancies. That still requires personal and social responsibility in using contraception diligently. But better methods can certainly help us do the right thing.
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Thanks to the octuplets mom and legislative attempts to harness the backlash against her, a political framework for fighting about in vitro fertilization is beginning to take shape. This is a new issue for most of us. Here's an attempt to start making sense of who's proposing what.
You don't often get to see a new issue form before your eyes. It's kind of like the formation of a constellation. There's a big explosion, stuff flies in all directions, and gradually the pieces begin to align in relation to one another. That's what the biotech explosion is doing to politics right now. IVF regulation is one of the constellations taking shape. Let's take a look at who the players are and what they're after.
The initial battle that has brought them together is the fight over Georgia Senate Bill 169, which I wrote about Wednesday ("Crocktuplets"). On Thursday, the bill was sent to a subcommittee. The Associated Press says the bill is dead. The Los Angeles Times says it could survive in some form if a compromise is worked out by Monday.
The bill's sponsor, state Sen. Ralph Hudgens, professes shock that it has become a flashpoint for abortion politics. "There is nothing in this law to limit abortions. I can't believe that people are reading that into it," he told the Times.
Please. We're not stupid. The bill says:
A living in vitro human embryo is a biological human being who is not the property of any person or entity. The fertility physician and the medical facility that employs the physician owe a high duty of care to the living in vitro human embryo.
And:
Nothing in this article shall be construed to affect conduct relating to abortion as provided in Chapter 12 of Title 16; provided, however, that nothing in this article shall be construed or implied to recognize any independent right to abortion under the laws of this state.
In other words, lawyers have inserted a "this doesn't affect abortion" clause so that Hudgens can claim the bill doesn't affect abortions. And we're supposed to take this seriously, even though the bill makes every embryo a human patient and stipulates that if Roe v. Wade falls, this bill can't be construed to keep abortion legal.
Did I mention that Georgia Right to Life helped Hudgens draft this supposedly abortion-neutral bill? Actually, I did. But I missed the bill's more important source: the Bioethics Defense Fund. BDF, whose self-proclaimed mission is to "address the human rights violations involved in human cloning and embryo research, abortion, and end-of-life," says two of its lawyers flat-out wrote the Georgia bill. The group adds:
BDF is grateful for the consultation and analysis provided by the National Catholic Bioethics Center, who opined that with added conscience protections and with public education on how this legislation limits violations against vulnerable human life, the Georgia bill "could be supported consistent with John Paul II's position on incremental legislation contained in his encyclical Evangelium Vitae."
A statement by Fr. Thomas Berg, L.C., Ph.D., of the Westchester Institute for Ethics and the Human Person concluded that the BDF drafted bill is "an incremental approach aimed at minimizing the harm done [and] is an essential tool for undermining the greater evils in our culture."
I know these people. I spent several days with them at the Vatican four years ago. They're as pro-life as you can get. When they call the Georgia bill an "incremental" approach toward the pope's vision, I assure you that abortion is in the crosshairs.
By the way, BDF proudly quotes a supporter's description of the Georgia bill as "model language" for legislation in other states. So you can expect more Georgia-style bills elsewhere.
That's the pro-life camp. At the other end of the spectrum, we have the American Society for Reproductive Medicine. Sean Tipton, the ASRM's public affairs director, told the Atlanta Journal-Constitution that the Georgia bill "says that decisions about how to treat [infertility] patients will not be made by patients in consultation with their physicians, but by politicians." That line comes straight out of the pro-choice playbook on abortion. It's a categorical indictment of government interference. And politically, it's highly effective.
Much of the muscle against the Georgia bill seems to have come from Resolve, a group whose mission is "to ensure equal access to all family building options for men and women experiencing infertility." Resolve may be emerging as the NARAL of IVF regulation. It says its members pumped thousands of e-mails and letters into Georgia to stop the bill and helped opponents "pack" Thursday's hearing.
In addition to the pro-life and pro-choice camps, at least two hybrid positions are taking shape. One is to broadly regulate the fertility industry, preferably under federal control. This is the agenda of the Center for Genetics and Society. CGS has a complex philosophy that could roughly be described as leftist. Here's its mission statement:
The center supports benign and beneficent medical applications of the new human genetic and reproductive technologies, and opposes those applications that objectify and commodify human life and threaten to divide human society.
The Center works in a context of support for the equitable provision of health technologies domestically and internationally; for women's health and reproductive rights; for the protection of our children; for the rights of the disabled; and for precaution in the use of technologies that could alter the fundamental processes of the natural world.
Basically, CGS is a home for people who don't trust private industry and prefer to regulate it, but from the standpoint of environmentalism, equal access, and women's rights. It's for pro-choicers who are more socialist than libertarian.
CGS wants congressional hearings and federal regulation to address the octuplets case and the fertility industry's lack of oversight. Its agenda is ambitious but unclear in its details. If you have the time, check out its proposal for "Responsible Federal Oversight of the New Human Biotechnologies."
A fourth position is to embrace government intervention but much more modestly. This is the idea behind legislation recently filed in Missouri, which would put some of the fertility industry's voluntary guidelines into law. The ASRM says self-regulation is already preventing octuplets-type abuses. But Missouri state Rep. Rob Schaaf has filed legislation to enforce these limits. Unlike the Georgia bill, Schaaf's bill is short and direct. Its operational text consists of one sentence:
When treating infertility, physicians within the state of Missouri shall not implant more embryos into a human than the current recommendations set forth by the American Society for Reproductive Medicine, or its successor.
Schaaf argues that "it is within the realm of the state to make sure that doctors don't participate in things that are harmful to people." So if you don't trust complex regulatory schemes like the Georgia bill but aren't afraid of government intervention in the fertility industry per se, piecemeal measures like this one may be the way to go.