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.
as a family practice physician, you also bring babies into the world
and help patients who are having difficulty getting pregnant. Is it
difficult psychologically to play both roles?
Well, you always see these tremendous ironies -- kids 14 or 15 who get
pregnant at the drop of a hat and and don't want to be and other people who
desperately want to be pregnant and are doing every kind of high technology
thing to get pregnant and still can't. And sometimes you're
delivering babies into situations where you know there will be "less than
adequate parenting." Of course, I have my own personal feelings about them,
but as a physician I think my role is to try to support a woman to make
the best decision for her at that point in time. If she decides to carry a
pregnancy, I try to support her in that and try to hook her up with the
services she needs in order to be the best parent she can be. If she
decides to have a termination, my role is to deliver that in a high-quality
environment.
When the American Medical Association endorsed the recent ban on
"partial birth" abortions, it was the first time the AMA took a stand on
abortion, even going against the recommendation of the American College of
Obstetricians and Gynecologists, which opposed the ban. It seemed to open
the way for Congress to intrude in other medical decisions.
I believe that this should not be a legislative issue. I do not
believe that health-care issues are legislative issues. I think, for
example, that Bill Clinton coming out and saying that women should have
mammograms at a certain age is ridiculous. Frankly, the only reason he
chose breast cancer is because it's a big, political, physical illness,
and because of his personal experience with his mother's death. It's all based on emotion and politics, not science. Neither
Congress nor Bill Clinton have the information to make these kinds of
decisions.
Even though some "partial birth" abortions are performed before the fetus
is viable, it seemed much more difficult for the public to deal
psychologically with the nature of the procedure.
You know, they're not pleasant procedures to describe or to hear, but
frankly, a lot of what we do to people in medicine is not pleasant. When
you see CPR on TV, for example, it looks like everybody survives and it's
really an easy procedure. But in fact, its very violent. People's ribs and
breastbones get broken and there's blood and body fluids all over the place and tubes
stuck in all kinds of orifices. Much of what we do can look violent and
aggressive. Abortions done late in a pregnancy are much harder on the woman
as well, but the majority of late-term abortions are for medical reasons.
Would you be comfortable doing late-term abortions?
I really feel comfortable doing procedures that are 12 weeks and under.
Even between nine and 12 weeks there's a big jump in development, and from
12 to 16 there's another big jump. If I felt that the availability of
late-term abortions was resting on my shoulders, I might have to rethink
it. But emotionally, I would prefer not to do them.
Have you referred women for them?
I have referred women in the 20- to 21-week range who've had amnios
that show significant congenital problems. Nobody has asked me for a referral for anything less serious than that.
Some people talk about the "moral value" of the fetus becoming more
complex as it develops and edges closer to birth. Do you think there are
any circumstances where the woman's decision should not be considered
paramount?
My feeling is that if a fetus is viable outside of a mother's body at
the point when she makes her decision, then an effort should be made for
that infant to be born and survive and not be cared for by the mother, if
she doesn't want the child. The mother is going to have to go through a
procedure one way or the other in order to deliver this baby from her body,
and I think then the fetus' life at that point is a separate life.
Do you think the pro-choice side was weakened in the latest debate by
sticking to its traditional focus on the woman?
Yes, I think we have to really face the issue of what we're doing and
embrace it in all it's difficulty in order to be able to
defend it. For years, because I knew abortion was available to my patients,
I didn't really have to deal with it. I wasn't worrying about it for
myself; I was trying to get pregnant. But having started to do these
procedures again really forced me to think about what I am doing and what
we are asking people to accept. And my experience as a parent made me
understand the whole complexity of it much more than when I was supporting
it before I had children. I think people who are pro-choice have to do that
in order to be believable.
Have you worked with any men who do abortions?
Most of the providers in our area are men. One of the providers that I
respect a lot is an older guy, in his 70s, who has been around long
enough to have cleaned up after women who tried to abort themselves or who
had back room abortions. He is just a staunch believer in abortion, having
seen all those. People forget those times, because it's been legal for a
long time, but he's really seen it all. He's raised five daughters and he
still does this because he believes so strongly in it.
On the other hand, he's really an old school kind of ob-gyn in that
he always tells women, "Oh, I'm not hurting you, this isn't pain you're
feeling" -- things that I would never dream of saying to a woman. Women are
often very appreciative of having a woman there to do the procedure.
Would you have an abortion now?
After I had two children, I went back and forth about having a third
child. My husband and I tried and weren't able to and then we made a
decision not to have a third child and then I got pregnant. So it was
actually a big shock. My husband was ambivalent about having a third child
and we talked about terminating the pregnancy, but I realized that at that
time in my life, I could not make a decision to have an abortion. I did at
a previous time in my life, but I couldn't any longer, at that moment in my
life.
I saw that it would be an inconvenience, but it would not
be the make or break issue in my life. I knew that my husband could
accommodate it. I knew that our financial situation could accommodate it.
And at that point, I felt like this is a situation where I have to make
room for this child in my life.
But that doesn't change my feeling that abortion must be
available for women as a choice. I think that women need to think
about themselves and their own bodies and whether they can go through that
experience, but they also need to think about the health and balance of
their whole family. It's really destructive to bring a child into the world
that is going to unbalance a family and maybe lead to the breakup of a
family by adding more stress, emotionally and financially. You really
have to think of the well-being of the people who are here in the world at
this time.
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