Sunday, January 27, 2008

It was alive one moment and it's not the next

An intimate conversation with a woman on the front lines of America's most emotionally charged debate.

BY CAMILLE PERI | She knows it is killing, but she doesn't believe it is wrong. As a doctor, she has performed hundreds of abortions, but as a mother of three small children, she has been forced to reexamine the values that propelled her to become pro-choice. Over time, says Dr. X, who requested anonymity out of concern for her safety and that of her family, her views about abortion have changed.

That kind of admission is rare in a public debate in which the truth has generally been the first casualty. The latest battle in this epic war has raged over "partial birth" or "late-term" abortion (depending on whose language you use), with pro-life activists charging that some women are terminating their pregnancies in the final days before delivery for reasons as trivial as not being able to fit into a prom dress -- a sensational charge that was never substantiated. The pro-choice side lost some of its own credibility when Ron Fitzsimmons, executive director of the National Coalition of Abortion Providers, announced that he and his colleagues had similarly misled the public by claiming that late-term abortions were performed rarely and only on women whose lives were in danger or whose fetuses had multiple deformities -- true for last-trimester abortions, but not necessarily for those done earlier.

Ultimately, however, while pro-choice advocates adhered to their traditional stance that abortion is a women's rights issue, pro-life advocates forced the focus on the fetus, splashing their campaign with gruesome imagery that made even some veteran pro-choice supporters squeamish. Rational questions about the timing and safety of late-term procedures paled next to images of crushed skulls and suctioned-out brains.

Predictably, the crucial ethical questions about abortion that the battle raised have been lost in the angry cacophony of the debate. Does pro-choice need to mean pro-abortion at any point in a pregnancy? Is abortion solely a women's rights issue? If not, when does a fetus gain rights -- at the first sign of a heartbeat, or the first gasp of breath? Physicians such as Dr. X, who performs first-term abortions at a clinic in the Pacific Northwest, face these kinds of ambiguities every day. (For this, they are called "hired assassins" by one side and hailed as heroes on the front lines by the other.) Dr. X reflected on her views and experience -- as a woman, a doctor and a mother -- and provided some insight into some of the moral complexities that the abortion debate has thus far sorely lacked.

You have been involved with doing abortions, as an assistant and then a physician, for about 20 years. What was it that first gave you such strong convictions about abortion?

When I was very young, my cousin got pregnant. She was 15 years old. It was before abortion was readily available, and in order to have one, she had to go before two psychiatrists and testify that she would kill herself. Then she was put to sleep for the procedure and had to stay overnight in the hospital and it was really a big deal. She didn't have to go to Mexico, but it was a harsh, guilt-inducing experience for her.

When she found out she was pregnant, though, she told my aunt and my mother. I saw that my mom believed it was a really important choice for her, that she shouldn't have to bear the consequences of getting pregnant and bearing a child when she clearly was not ready to. So I came away from that experience feeling that this had been a shame-inducing experience for her, but that it also made a difference that she was supported by her mother, my mother and me.

When you began assisting in abortions, did you see abortion primarily as a women's health issue?

Yes. I got involved in women's health when I was in college in Santa Cruz in the 1970s. I was part of a group of women who started a women's health center. That was the time of the self-help movement, learning how to do your own cervical exam and all that -- it was a very exciting time. And in 1972, even though abortion was legal, there was no place that it was provided in Santa Cruz County. It was a Catholic-dominated county and the big hospital there was the Dominican hospital. A physician came down from San Francisco and asked our group for people who would help him as counselors and medical assistants and he opened an abortion clinic one day a week.

So it was during that time that all the ideology came into it for me -- that women should have the right to make choices about what happens to their bodies and that men in positions of authority shouldn't be legislating those choices. For me, that was all very clear-cut, but what was not clear to me was what it meant to be pregnant and have a child. I just felt strongly that a woman shouldn't be forced to do something against her will.

Did you stop doing abortions for a while?

Yes, when I went into family practice, I was working at a hospital where that service was provided in a separate clinic, and because all my patients had that available to them, it didn't feel necessary for me to be doing them.

Why did you start again?

A year and a half ago, I was approached by a former student who was working for an abortion clinic and she said that they were having a hard time finding physicians to do abortions and wondered if I would be interested in doing them. I said yes.

Did you have any hesitancy or qualms about it this time?

I was only hesitant because of all the intervening history of violence against abortion providers, and now I had a family to consider. Right after I started working, there were telephone threats specifically against the doctor, although not me by name, just saying that they were going to kill the doctor in the clinic. So I had to wear a bulletproof vest. Lately, however, things have actually calmed down.

Did being a mother change your views about abortion?

I actually had an abortion during the first year of my internship. I just felt like I couldn't have a child and be a good parent when I would be working 100 hours a week for the next three years. Then, after my medical training, when I finally felt like I had the time to put into raising children, I had some trouble getting pregnant. During that period I became acutely aware, at the first inkling of pregnancy, that this was the beginning of a life.

So when I went back to doing abortions and saw the fetus on the ultrasound, I recalled the early days of my pregnancies, when I found out I was pregnant and saw the baby on the ultrasound, and it really felt like this is a baby, a very real and potential being. Now, I do feel that this is a potential person and it does not have a life of its own outside of the mother, but I also am really aware that when you're ready to embrace a pregnancy, you can embrace it from the very moment you conceive or are aware that you are pregnant.

Faye Wattleton said recently, "I think we have deluded ourselves into believing that people don't know that abortion is killing. So any pretense that abortion is not killing is a signal of our ambivalence, a signal that we cannot say yes, it kills a fetus, but it is the women's body, and therefore ultimately her choice."

I believe that very firmly. You look at the ultrasounds and there's a fetus with a heartbeat and then after the procedure, there's the fetus, usually in pieces, in a dish. It was alive one moment and it's not the next. I don't believe it's a painful experience for the fetus because its nervous system is not "wired" so that it can feel pain at that point. I don't believe, as some anti-abortion people would have you believe, that there's a "silent scream." But it's very clear to me that it's killing a potential life. And I found that hard at first.

It never made me think that this was not the right thing to do, however. Unless there was a perfect world, where women really had safe and 100 percent effective birth control and access to it and there was no such thing as rape and if there was, if the children were born into a society where they were supported and women were supported in raising children, then maybe it would be a different story. But none of those things exist. And having been through three pregnancies and knowing what kind of physical toll that takes on people, I still believe very strongly that women should not be made to carry a child for nine and a half months when they don't want to.

Still, there was also a sadness for me about the procedure that I hadn't really felt before I'd had my own children. In a way, though, I feel that makes me a better provider because I can talk to women about the children they have, about the difficulty of the decision, and let them express their ambivalent feelings and still support them.

Are there any situations that have been particularly poignant or difficult for you?

I can think of one woman who I saw a couple of weeks ago. The whole time during the procedure, she talked about her two sons and all of their accomplishments and how wonderful they were. Clearly she was broken-hearted to be having this procedure. But her husband just could not accept having a third child and there were financial problems that would have made it very, very difficult for them and the other two children. She knew it was the right decision, but it was a painful one for her.

So there are women who are married and who have families but for one reason or another -- because of a bad relationship, or domestic abuse, or financial constraints -- it's really not a good decision to bring another child into the world. For some people, it's a fairly straightforward procedure, but for others, it clearly is a sad event.

Do you ever see women who are getting abortions for reasons that seem frivolous to you -- and does it make you angry?

What makes me angry is people who aren't being careful about birth control, who don't make an effort to get a birth control system in place for themselves and have had several abortions. But it's usually those people who also make me think, "Oh great! They're not having a child" -- even though I think it's an awful way to do your birth control. I firmly believe that I cannot use my own value judgments in deciding when it's right for a person to make this decision or not, however. Ultimately it really is the woman's decision and she is the person who has to carry all the consequences.

How did having two daughters affect your views on abortion?

Well, I hope that they won't have sex before they're mature and ready to have sex, and that they will use birth control and try to avoid becoming pregnant when they don't want to be. But if either of them becomes pregnant before they are ready, it's extremely important to me that abortion be available to them -- and available in the way that I provide it, which is in a safe, clean environment with lots of support and lots of nurturing. A situation where they're not made to feel ashamed or guilty.

Do you still see a lot of shame on the part of women who get abortions?

It's incredible to me how much shame and guilt people have about it. Women will come in, having made this decision, and say, "You know, I don't believe in abortion." I always have to stop at that point and say, "I understand this might not be a situation you ever imagined you would be in, or that this is a sad and a hard decision to make, but you really cannot say that you don't believe in abortion if you've made this decision for yourself here today. You have to tell people that you do believe in that choice for people." I can't tell you how many people tell me that. Or they'll say, "Gee, you're so much better looking than I expected," as if we were supposed to come in with hunchbacks and moles on our faces.

Sometimes they're surprised that I have children, or that I talk about my children and that I want to talk about their children. Last week a very young girl came into the room, and I was with a counselor and a medical student that I'm training to do abortions. The girl said, "Have any of you ever had an abortion?" and I said, "Yes, I have." The medical student was shocked. After we left the room, she said, "I can't believe you said that to her." I told her that I think it is really important to let people know that it happens to all kinds of people and it doesn't have to mean the end of your life, or that you're doomed to a life of bad decisions. It doesn't have to be a shameful thing.


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