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Tuesday, January 24, 2006

the freedom to choose health: abortion in national news

(note: i avoided using the words "woman" and "mother" to refer to pregnant patients in this piece out of respect for the fact that not all people who can become pregnant identify as women or mothers. just something to think about.)

Ryan Thoreson has some good analysis on the recent Ayotte v. Planned Parenthood ruling over at demapples.com, so instead of rephrasing what he's said, I'll just urge you to check out his thoughts.

But despite the seemingly heartening outcome he highlights, choice advocates shouldn't celebrate prematurely. While justices ruled unanimously--yes, unanimously, on an abortion case--that a New Hampshire law requiring parental notification and a waiting period for minors seeking abortion services must include an exception for cases in which the minor's health is in jeopardy, they did not, as they have in past instances, declare the entire law unconstitutional because it lacked such an exception. Instead, they sent it back to the Lower Court to determine whether legislators actually intended to omit an emergency medical clause from the law.

What is the significance of this difference? Well, it may serve to make Alito seem less immediately threatening to reproductive choice issues as the confirmation vote approaches. (more in expanded post)

As a result of the Ayotte ruling, the court may decline to accept other abortion restriction cases that don’t include health exceptions, instead sending them back to be reviewed. This delay takes the bite out of choice advocates’ warnings that, if confirmed, anti-Roe Alito will have the opportunity to vote on abortion-related cases during his first year on the bench. It is anticipated that three such abortion restriction cases will be pending in the coming months (two have already made their way up to the top), and will be decided only after O’Connor is out of the picture. One of them, Gonzales v. Carhart, tests the federal Partial-Birth Abortion Ban Act of 2003, which Congress passed despite the Supreme Court's unfavorable ruling on a similar Nebraska state law. The ACLU, the American College of Obstetricians and Gynecologists and others have already come out in opposition to the ban.

Few political catch-phrases irk me more than "partial-birth abortion," a term fabricated by anti-choice factions in order to conjure images of infants halfway through vaginal delivery (or as Bush put it when he signed the Ban Act into law, "children who are inches away from birth"). What irks me even more is that it’s often the sole phrase used in the media to refer to actual medical procedures of a certain kind. In the words of the immortal Jersey Slugger, "Grrr."

Let us transcend the rhetoric. The medical names for the procedures in question are intact dilation and extraction (commonly called D&X) and dilation and evacuation (a.k.a. D&E), and they are not performed in the midst of delivery contractions, but typically during the second or (rarely) early third trimester of pregnancy. (Third trimester abortions are performed only when the life or health of the patient is at grave risk, or when the fetus is not viable.) Late-term abortions are very rare (90% of abortions take place in the first trimester), and are most often wanted pregnancies in which serious and unfortunate complications have arisen. And guess what--the need for these procedures is reduced if patients have reliable access to comprehensive prenatal care. That's right: effective, affordable/universal health care could reduce demand for abortions. Ah, pipe dreams.

Supporters of the ban argue that the D&X procedure is not the only option available to patients who choose to terminate their pregnancies in later stages, so it should be nixed in favor of less 'gruesome' options. They're partly right--D&X isn't the only choice for patients and their doctors. Thing is, it appears to be the safest option in most cases: the primary alternative, a hysterotomy (not to be confused with a hysterectomy), is a major operation, akin to a caesarian section ("C-section"). Despite a dearth of information available on the relative safety of certain abortion procedures (curious--you'd think it might be an important thing to study), the available evidence was sufficient to convince the District Court of New Jersey that a hysterotomy carries a greater risk of health complications than intact dilation and extraction, and dilation and evacuation.

As with any medical treatment decisions, the first priority should be the health and well being of the patient, and the decision should be made not by politicians, but by patients and their medical practitioners who have the experience to be able to make appropriate judgments.

So, with respect to the ‘partial birth abortion’ issue, I have two simple requests:

Congress, please pass laws that promote citizens' health and safety rather than imperil them. I'd be much obliged. Soon, we may not be able to rely on the Court to protect us.

And journalists, hedging statements by referring to a D&X abortion only as “a late-term procedure that critics call ‘partial birth’ abortion” doesn’t count as being objective. If you’re going to use the inaccurate, pop-culture term, at least give us the medical name as well. Actually, in the interest of fairness, I should say that I realize that the language of most ‘partial-birth abortion’ bans that have been enacted is so vague that it can apply to procedures other than D&Es and D&Xs; because of the way the laws are phrased, it’s difficult to pin down precisely what the term does and does not include. So maybe you are trying to play it safe, sticking to the precise(ly imprecise) political terminology. But that doesn’t help the rest of us to be any more informed…so bring on the nuance! Bring on the complexity! We can take it.


At 10:47 PM, Anonymous Blue Cross of California said...

Great blog I hope we can work to build a better health care system as we are in a major crisis and health insurance is a major aspect to many.

At 11:29 PM, Anonymous Anonymous said...

"(note: i avoided using the words "woman" and "mother" to refer to pregnant patients in this piece out of respect for the fact that not all people who can become pregnant identify as women or mothers. just something to think about.)"

Oh geez, give me a break!

I chose anonymous because I don't really identify with a name...

At 11:35 PM, Anonymous Anonymous said...

"Dilation and evacuation"

Isn't "evacuation" a term that the Nazis used euphemistically to refer to what they did to the Jews in gas chambers? C.f. "Conspiracy" by Pierson, Frank et al.

At 11:50 PM, Anonymous Anonymous said...

anonymous #2: is your position that anyone who feel more comfortable self-identifying differently should not have their wishes respected? Even if you disagree with their choice or find it strange, do you feel that they're doing something morally wrong? If not, don't you think their wishes should be accomodated or considered when possible?

anonymous #3: Do you host a cable television show? From zero to Nazis in just under three posts. If you have a belief, express it. It's likely that is has to do with when life begins, something so difficult to determine and painful to cope with that the entire world is constantly debating it, even, and often especially, those whose societies are deemed "more civilized." I think we should discuss it and debate it, but I think we should acknowledge the fact that it is so profoundly difficult and issue that honest and good people can disagree. The demagoguery does us no good.

anonymous #1: thank you for the insurance ad.

Katie, thank you for the intricate and informative post. I'm thining...

At 2:08 PM, Anonymous Anonymous said...

Playing the devil's advocate here: While I understand some people's choice not to identify with the word "woman," isn't it a very different thing to say that people have the choice whether or not to identify with the word "mother"? Regardless of when you believe life begins, I think the word "mother" is standardly defined to the person who donated an egg to a new life. If you believe that life starts at conception, then you cay say that people who have conceived are mothers, and if you believe that life starts at birth, you can say that people who have given birth are mothers. My point is: regardless of where you believe life begins, parenthood is a fact and not merely an identity. My mom may not like to think of herself as my mom, and I would respect that if that were the case, but the fact stands that she gave birth to me, so that's what she "is." Please correct me if I'm wrong, but this just seems like common sense. With all respect, it seems kind of sly to relegate the fact of parenthood to the realm of identity. We should be debating when life begins (which is the same as when parenthood begins), rather than implying through the sly use of language that there is no debate because parenthood is whatever people want to define it to be. I believe the abortion debate is an important one, and it troubles me to people trying to win it through semantics (inventing words like "anti-life," "anti-choice," "reproductive rights," etc.). It seems to take away from the seriousness of the debate to carry it on in the realm of semantics.

At 4:52 PM, Anonymous Anonymous said...

I guess, to clarify my earlier statement, I ought to say this: whereas someone's choice to self-identify as a "woman" affects nobody other than the person in question, to say that someone is or is not a "mother" is a statement that affects other people, too: in particular, the person who is usually denoted as the "child." If you believe that a fetus is not a child, that's fine, but you need to come down on the one side of the matter or the other, rather than say that's merely a matter of self-identification and the business of nobody except the egg-producer in question. For people who believe that a fetus is a child, it is unfair to the child for the mother to have the right to self-identify as a non-parent.

At 5:36 PM, Anonymous Anonymous said...

I don't think Katie was intending to disregard, or endorse the dissociation of, the idea that someone is inherently a parent when they give birth or fertilize another's egg. I think, rather, that she was simply trying to point out the gendering assumptions that go along with concepts of "motherhood" that might discomfort those who don't identify as women. I would think that they would certainly identify as parents, and even as the biologically "maternal" parent inasmuch as they carried and birthed the child, but they might not be comfortable with all of the other associations that go along with the term "mother." Just a thought.

At 5:38 AM, Blogger katie loncke said...

Hey, sorry in advance that this is really long...and it doesn't even begin to address in depth the complexity of the issues you've raised. But here goes...

Anonymous 4, I really appreciate the thoughtfulness and respectful tone of your question, in addition to the good question itself, the answer(s) to which I am still trying to sort out myself. My considerations are essentailly along the lines of Anonymous 5's point. If there is a case, for instance, in which someone who identifies as a man becomes pregnant, it becomes a little awkward to try to impose the title "mother" on him. "Patient," sure; "parent," maybe, although, as with the word "mother," the title of parent comes with significant baggage of its own, especially when it's assigned rather than accepted out of one's own volition.

I wasn't really trying to get into the question of "where life begins," a catch-phrase I view with the same suspicion as you apply to the words you mentioned. I don't object to the term because it was fabricated in the context of debate on abortion, but because in my experience it is usually one that draws focus solely to the importance of the zygote or fetus, and this narrow focus tends to obscure the physical and philosophical connections to the body and life of the woman, mother, parent, patient, person whose pregnancy is at issue, etc. I fear that the question of where life begins reduces the pregnant individual to a mere vessel, and I object to this. That said, I'm open to talking about that aspect of the abortion issue as long as it doesn't totally dominate the dialogue.

From a medical perspective, "the point when life begins" is called "fetal viability," and it typically occurs between 23 and 25 weeks into the pregnancy. This is the stage at which the fetus could feasibly remain alive outside the womb, albeit with the artificial aid of technology. The point of viability used to be slightly later, between 27 and 29 weeks, but has been adjusted to reflect changing technological capabilities.

Legally, in the U.S., viability has been upheld in the Supreme Court as a brightline before and beyond which there are different standards for what kind of abortion laws are permissible. The Court continues to mandate the inclusion of medical exceptions in all abortion regulations before and after fetal viability.

From a non-medical, philosophical and/or religious perspective, things get trickier. Some people believe that at conception, a fetus should be accorded the same rights and protections as a child. Some believe that the crucial point occurs 14 days after conception; others say 28 days after. Some people think that a fetus has no rights at all until the pregnancy is close to term. The perspective that has prevailed legally, thus far, is a system of increasing rights with advancing gestation (that's where the whole viability issue becomes important).

Beliefs about the sanctity of procreative, reproductive potential are very much rooted in culture. Some cultures place very high importance on semen, partly because of its life-giving potential. If the majority of people in this country had similar beliefs, our abortion laws might look a lot different, and spermicide might be illegal.

Fundamentally, 'when life begins' is arbitrary in the sense that there are a whole host of of logical, reasonable criteria one could use to determine it, and each would yield a logical definition. The criteria we decide on as a culture, subculture, nation, or individual depend on the distinctions we draw in the maternal-fetal relationship, and these distinctions are informed by our particular conceptions of humanity, dependency, autonomy, what constitutes an individual, etc.

But in treating abortion and reproductive choice as a total subject, it's clear that there are many more considerations involved than the point when life begins, not the least of which is the social problem of weighing the well being of the fetus against the well being of the pregnant patient, if the two are at odds (with the patient determining their own well being, and the well being of the patient being determined by a physician).

Interestingly, demonstrating a radically different take on the importance of reproductive choice than we're used to seeing in the U.S., Canada's highest court ruled in 1988 that any federal law regulating abortion is unconstitutional because "forcing a woman, by threat of criminal sanction, to carry a fetus to term unless she meets certain criteria unrelated to her own priorities and aspirations, is a profound interference with a woman’s body and thus a violation of security of the person." I mention this as an example of a situation in which the question of when life begins is not the major consideration in a national abortion debate.

Phew. Okay. I'm sorry that this is more information-oriented than outlining my opinion (then again, my opiions inevitably influence my choices of information to highlight). I would love to know your thoughts on the question of when life begins, both in the specific sense and contextualized within the other considerations of the abortion and health debate. And if you find other facts that conflict with mine, please share! And of course the gender question is still a fruitful one...what do you think?

At 11:04 PM, Anonymous Anonymous said...

Katie, you bring up a lot of interesting points, not all of which I have the time to address at this particular moment. For the moment, I just wanted to say that the reason I insisted on the "where life begins" issue being placed in the foreground is because the word "well-being" that you mentioned in your antepenultimate paragraph is so vague. What is meant by the "well-being of the pregnant patient"? Are we weighing the life of pregnant person against the life of the fetus? Or are we weighing the life of the fetus against the ability of the pregnant person to maintain the lifestyle/job/aspirations that he/she has become used to and which have become convenient for him/her? If it is the latter, are we ready to say that sometimes one person's convenience is more important than another person's life?

Almost everyone believes that if the life/health of the pregnant person is in danger, then this clearly outweighs any claim the fetus might have. Even the Bible says that abortion is okay if the life of the pregnant person is in danger. I'm just worried that allowing the patient to "determine their own well-being" opens the system up to all kinds of abuses, just because the pregnant person could choose to define his/her "well-being" in whatever way is most convenient to him/her. I do sympathize with the economic and social constraints that carrying a child to term puts on the life of a pregnant person, and I do think it is extremely unfair that the sperm-provider isn't constrained to bear these burdens to nearly the same extent, even though they are equally responsible for the occurrence of the pregnancy. I strongly believe that the government should do all it can to lessen this inequity, though I'm not sure what concrete steps should be taken in this direction. I understand that a society in which abortion is illegal is liable to make life harder for women than for men, and I sympathize with that. I just worry that putting the pregnant person in the ultimate position of power to decide whether or not an abortion is desirable might be overcompensation for this inequity.

I haven't really made up my mind on the "where life begins" issue, though I have some doubts about the "viability" definition, partly because of what you said--- If technological advances are able to change the definition of viability, then this seems unfair to fetuses who were conceived at a time when technological advances weren't being made as fast as they could have. It seems that things would be nicer if the definition were more absolute and independent of things such as the rate of technological progress. I'd be curious to hear what other readers believe about when life begins.

At 11:13 PM, Anonymous Anonymous said...

I guess I am just made uneasy by policies that make life better for one person at a significant cost to another person. I mean, the fetus isn't morally responsible for making the pregnant person's life harder, but nonetheless, if an abortion takes place, then the fetus is the entity that ends up paying the cost. One can argue that a lot of other liberal policies do a similar thing: make a blameless person bear the cost so that the government can alleviate another person's hardships. In some situations, I think this is okay, but I'm worried that abortion takes things too far, since the issue in question is a life-or-death issue.

At 11:46 PM, Anonymous Anonymous said...

Oh, and to broaden the scope of the discussion that's going on, I'd like to suggest a couple of (partial) solutions to pregnancy-related issues that I think are less drastic than abortion, and which I think the government should instate:

-I think the government should hold businesses to higher anti-discrimination standards, so that there isn't an economic incentive for businesses to fire female employees for getting pregnant.
-I think the state should bear the cost for at least some women's pregnancies, so that pregnancy isn't such an economic burden to women. This is in line with the general idea of developing a more universal healthcare system.

I think the above two suggestions (can anyone think of any more?) are two viable alternative ways to start fixing the inequity that pregnancy currently imposes on women, and I think that feminists should focus their energies on pushing for improvements like these rather than single-mindedly advocating only abortion as a solution. OK, I'm going to stop posting for tonight.

At 2:11 AM, Blogger katie loncke said...

Hey anonymous,

Discussions on abortion seldom make me smile, but the thoughtfulness that you bring to this subject just warms my heart. So first of all, I just want to say thanks, and that I really admire your open-mindedness and genuine concern, both of which are evident in the way you make your points.

While I sympathize with your wish for a more 'absolute' definition of when a person becomes a person, as I said, I don't think there is any 'true' answer to that difficult question. So we're stuck with a difficult contestation that draws information from science, the law, philosophy, religion, and lived experience.

As you've noted, if we determine as a society that a person does indeed become a person during gestation, then the question arises of whether such a person ought to have rights under the law, and if so, what those rights ought to be. This determination is also not based on any kind of absolute, self-evident truth, but is influenced by our conceptions of how the rights of a fetus will interact with the rights of the pregnant person.

I admit that I use "well being" often without explaining what I mean by it, to such an extent that I really had to think it out again when you called me on it. I mean it as an explicit extension of the concept of 'life/health' that you have said most people support protecting. To me, mental, psychological health is just as important as other kinds of health. It seems logical to me that if the government forces a citizen to carry an unwanted pregnancy to term, it risks inflicting undue and potentially severe psychological damage on that person, not only as a result of the physical experience of birthgiving against one's will, but also because of the traumatic experience of being stripped by the government of one's autonomy over one's body (without having committed a crime). Now, I'm not claiming that people who decide or are forced to go through with unwanted pregnancies all experience psychological damage as a result, but some do. This is kind of a complicated issue for legal, medical, and ideological reasons, which I'd be happy to go into if you want, but for the sake of brevity I'll just say that I think of 'well-being' as a matter of mental health more than of mere convenience to one's life.

In terms of weighing the costs and benefits of abortion to the fetus and the pregnant person, the government doesn't prohibit pregnant people from smoking or drinking, even though both activities can cause serious, irreversable damage to a fetus, both before and after viability. You may be in favor of laws criminalizing these things, but the government has not instituted them in part because they would interfere with the liberty of the pregnant person. It also has not criminalized the act of smoking near a pregnant person, and thus subjecting them to inhalation of secondhand smoke, which could also complicate the pregnancy. We can discourage pregnant people from smoking, drinking, and engaging in other activities that are harmful to the fetus, but we have not gone so far as to outlaw them. I don't see this as a case of "making a blameless person pay the cost so that the government can alleviate another person's hardships," but rather as a recognition of, the pregnant person's rights to privacy and autonomy (it's interesting how this issue plays out in fetal homicide laws, like the one invoked in the Scott Peterson trial).

If you haven't read the actual language of Roe decision in the parts about the right to privacy and the Fourteenth Amendment, I'd recommend this article; I'd love to hear your thoughts on it.

Finally, I absolutely agree with you that feminists and non-feminists alike should also advocate for changes not specifically related to abortion, but which have indirect effects on issues of pregnancy. A little while back, there was a discussion here about Students For Choice and all the issues they could/should focus on in addition to abortion. I am 100% with you on that. I also think that it's important for people to emphasize that reforms like the ones you mention are not just about preventing abortions by making it easier for people to carry pregnancies to term, but are really issues of nondiscrimination in the workplace and healthcare, respectively.

Out of curiosity, do you think of pregnancy as a burden?

Thanks again, anonymous. And others, if you're out there, feel free to jump on in!


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