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Rachael,
All right, you caught me on my own overheated rhetoric (see what I get for posting at 6 p.m. on the Friday before a holiday weekend? I had a great time at Boston's beautiful fireworks, by the way—hope you had a fab weekend too!). No, I do not believe that being willing to perform abortions should be a requirement for getting and keeping a medical license. However, polls show that for the past decades, upward of 80 percent of Americans believe that abortion procedures should be legal at least in some circumstances. Presumably, then, that's also true of upward of 80 percent of physicians.
So, why aren't life-saving abortion procedures taught in medical schools' ordinary ob-gyn classes? Why don't 80 percent of women's ob-gyn practitioners offer the procedure, at least sometimes? Why must the procedure be ghettoized in special clinics, performed by only the few who are willing to risk their lives to save women from having their uteruses pierced by coat hangers, protected by extreme security procedures?
Because performing abortions at all—in any circumstances—brings in credible death threats, murder attempts, and sometimes murder. The 20 percent (or fewer) of Americans who believe it should never be legal to free a woman of an unwanted pregnancy—even if doing so would save her life—have scared the rest. That's what I mean by the overheated rhetoric. I should have added "and homicide."
EJ
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EJ,
I hope you had a great holiday weekend. I don't want to wade into general disagreement territory, either—I suppose most of us have our heels dug in deeply enough that we're not going to change one another's minds. But I wanted to address a few points that you made.
If indeed the "harsh rhetoric" has made abortion less accessible, isn't that a reflection of the unease that a large segment of the population has with the legality of abortion? Just because it's legal doesn't mean that we pro-lifers are going to sit quietly on the sidelines. And, no, just to be extra-super clear, I'm not condoning murderous scare tactics like clinic bombings. But speaking out against abortion, protesting outside clinics, and voting for pro-life candidates are fair and legal ways for pro-lifers to express our belief that abortion shouldn't be legal. It's not a perfect analogy, but death-penalty opponents haven't been quieted by court rulings that uphold the legality of executions, and indeed their protests and agitation have led to more humane executions and more challenges to the death penalty.
You ask, "Why doesn't every ob-gyn offer this surgery?" You wouldn't compel doctors to perform abortions, would you? Even I don't like the South Dakota law that forces doctors to say things they don't believe. It would be far more troubling to force doctors to perform a surgery that violates their own moral code or, in their eyes, the Hippocratic oath (which originally mentioned abortion). How many wonderful doctors would we lose because pro-lifers wouldn't go into the specialty? And what about doctors who are pro-choice but uncomfortable actually doing the deed? What an incredible internal conflict! A doctor could spend most of her day working to bring healthy children into the world and then spend another fraction of it doing the opposite. How do you walk into one exam room and tell a woman that, despite years of trying, she won't be able to have children of her own and then walk into the next room and tell someone else that you'll terminate her unintended pregnancy? Surely there are some doctors who see only the woman as their patient and can make that separation, but there have to be some who see the woman and her child as patients.
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This abortion ruling strikes me as a lot like the religious culture-war debates, where we spend a lot of time fighting about symbolics and very little about things that matter (a creche vs. faith based funding, abortion language vs. actual access) The language suggested by the South Dakota law seems wholly beside the point. For one thing, sonograms make it obsolete. By now, women requesting an abortion usually have to undergo a sonogram to make sure there is a heartbeat, etc. If that doesn't shove in your face the reality of what you're doing, I'm not sure what will. For another, this is yet another case of a liberal straw (wo)man that hasn't existed for at least 10 years, if it ever did. Things have changed a lot since the "My Body, My Choice" protest days. In the literature, in the movies, on TV, there hasn't been a portrayal of a woman casually undergoing an abortion since, since ... Murphy Brown? No wait, she was an unwed mother. Even she didn't get an abortion. ... In fact, I don't know if there ever was one. And it's been a few years since even Naomi Wolf occupied middle ground. What woman desperate for an abortion will bother reading the fine print? And if she does, what will she feel more than the pang that was already there?
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As if Emily's article hadn't left me appalled enough about South Dakota's Orwellian new abortion "disclosure" law, I actually clicked over to read the 8th Circuit's appalling decision. Fortunately, no one else was in the office—everyone's sensibly headed out for the Fourth of July holiday—so they couldn't hear the astonished and foul language erupting from my corner.
Let me add some thoughts to what Dana has been saying. First, I have trouble believing that any female in the country has failed to think about what's happening in her tummy (to use the technical term) when she's pregnant. I remember imagining it when I was in grade school, putting my hands on my tummy just like my mother did, and thinking about something growing in there. Maybe I was an unusually imaginative child, but every girl knows the story: that collection of rapidly dividing cells could become a human being if not stopped. That's the whole point of getting an abortion: to prevent that cluster of cells from becoming an actual person who is your responsibility. It is insanely paternalistic to suggest that girls and women haven't considered what they are doing—especially, as Dana suggests, if they must make the 350 mile drive to the clinic.
Second point: that 350-mile drive. Rachael, to me, the point of noting that distance isn't to decide whether or not this dearth of full ob/gyn health clinics in the state is an evil conspiracy, or a consequence of the harsh anti-abortion policies and rhetoric of the past 30 years, or just a neutral fact. The point is that a lot of thought and planning goes into making that trip, and into pulling together the gas money and funds to pay for the procedure.
Third point: To force doctors to mouth nonsense language that they flatly can't believe about a blastocyst being a human being, or about unlikely and unproven possible consequences—well, I don't think I can finish that sentence. It's appalling. The very fact that the law must mandate such statements reminds you that there is a furious national debate over precisely this question. Which tells you outright that the 8th Circuit was on crack when it said there isn't a free speech issue here: The government is forcing doctors to mouth political beliefs that they do not agree with. What's worse is that the 8th Circuit says that a court shouldn't easily overrule duly elected representatives. Well, yes—except when the government is trying to violate an individual's basic rights. As it is trying to do here. Isn't that why we have a Bill of Rights and constitutional review: to protect the individual from the overreaching state?
Fourth, the dearth of abortion services IS a consequence of the harsh rhetoric, et al., of the past 30 years. Why doesn't every ob/gyn offer this surgery? Wouldn't they all, if they'd seen the deaths and maimings of women that came before Roe, and could see that legal, medically supervised abortion is a lifesaving procedure? Yes, I am writing this even though, for decades, I have had zero risk of accidental pregnancy. (It always used to be fun to answer a new doctor's or nurse's questions: "Are you sexually active?" Yes. "What contraception method do you use?" None. Their doubletakes were very amusing.) But I have friends, sisters, cousins who need to control their own sexuality and fertility. And I care about women being able to have a say about what happens inside their own organs.
I realize that I am aiming now into basic disagreement territory, so I will stop. Besides, it's time to start celebrating the July 4th weekend.
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Dana,
Even though we sit on opposite sides of the abortion debate, I am also uneasy with South Dakota's law compelling abortion doctors to tell women that they are terminating the "the life of a whole, separate, unique, living human being." There are a million and one better ways to reduce the number of abortions, from better sex education and better access to birth control to charities who work tirelessly to support women who choose to keep their child or keep the pregnancy and give the child up for adoption. And while I do think pre-operative counseling for women seeking abortion is beneficial and would support laws mandating such counseling (it seems like some in the pro-choice movement are acknowledging the emotional and psychological difficulties that some women who choose abortion face, as there are pro-choice groups springing up that offer counseling to women post-abortion), this particular law seems unconstitutional on First Amendment grounds.
But I'd like to address another part of your original post. The fact that there is only one abortion clinic in South Dakota is not that remarkable and I'm guessing has little to do with the state's abortion laws. South Dakota's population hovers below 800,000. North Dakota, Montana, and Wyoming—states with similarly huge square mileage and tiny populations—also have a single abortion clinic each, at least according to Abortion.com. For the Dakotas, at least, it's been that way since the late 1980s. Such a lack of services isn't limited to abortion providers. Any kind of medical specialist could be a half-day's drive away, depending on where you live. An ob-gyn can be an hour or more away. You might find the dearth of abortion providers unfortunate, but it's not a conspiracy.
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But the point, Melinda, of my hypothetical story about the pregnant woman in South Dakota is that neither she nor her doctors necessarily hold the belief that abortion is the taking of a life. The doctors who require her to sign aren't "pointing out" that there's "a person in there" (or "a human being," in the carefully parsed words of the bill). They're being compelled by the state to go through the motions of simulating that belief, which, I'm sorry, is a Stalinesque absurdity that serves no purpose I can see besides terrorizing that individual patient and driving a wedge into Roe v. Wade nationwide. Doctors in South Dakota, or anywhere else, who are morally opposed to abortion have an option: They can work in a practice that doesn't offer the procedure. In fact, that's what the vast majority of women's health practitioners in South Dakota already do. But for women seeking what is still, whatever one's personal beliefs about it, a legal medical procedure, the options in South Dakota (and if copycat legislation has its way, elsewhere as well) are rapidly narrowing.
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Emily’s piece about the new abortion bill set to go into effect in South Dakota has me madder and sadder than anything I’ve read in some time. (Actually, the last thing that got me into this state was also in Slate: In Steven Greenhouse’s story about the scarcity of vacation time in America, he mentions that the United States is one of four countries in the world without required paid maternity leave. The other three are Swaziland, Liberia, and Papua New Guinea.)
But back to South Dakota. Imagine you live there—in Rapid City, say—and you want an abortion. Who knows why? Maybe you’ve been raped; maybe you’re in an abusive relationship with a partner on whom you’re financially dependent; maybe you’re only 15. Or maybe, for reasons that are nobody’s business, you just really don’t want to have a baby right now. The point is, you need, with some urgency, to schedule a medical procedure that’s been legal in this country for 35 years.
So you get in your car, if you’re lucky enough to have one, and drive 350 miles to Sioux Falls, where the state’s lone abortion clinic is located (let me repeat that: a state with an area of 77,121 square miles has only one clinic that will perform abortions). How you get time off work to make this six-hour-each-way drive, what you tell your family about where you’re going, or how you get past the protesters screaming outside the clinic is not my concern here. No, I’m thinking of the moment when, filling out the paperwork for a procedure that (like many medical events in life) may already have you ambivalent, worried, and scared, you’re asked to sign a statement attesting that what you’re about to do will “terminate the life of a whole, separate, unique, living human being.” To translate: We’ll help you terminate that pregnancy right away, little lady—as soon as you admit in writing that you’re a murderer.
The trauma induced by this forced confession probably will scare a few women out of the clinic (hell, all it took for Juno was an ugly waiting room), and thus slightly increase the population of South Dakota. But it seems incredible that the state legislature, with its Justice Kennedy-inspired concern for the “depression” and “increased suicidal ideation” that abortion supposedly brings about, haven’t considered the harm that might come as a result of being forced to sign such a document (in the presence of a doctor who, as Emily points out, is also being legally compelled to lie about his or her beliefs). I’d hope that even those opposed to abortion, whether for themselves or as a matter of public policy, would blanch at the idea of such state-sponsored moral bullying.
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