“Fetal Age” Filing to Begin In Nebraska


Nebraska’s “fetal pain” law, a new abortion restriction based on the erroneous assertion that fetuses may feel pain at 20 weeks gestation is still scheduled to go into effect in October.  In preparation for the law, doctors are being reminded that they will now need to file “fetal age” information to the state, in order to ensure they are not in fact breaking the new rule.

Via CNBC:

The fetal-pain measure (LB1103) passed by state lawmakers last year takes effect Oct. 15.

“The reporting requirements in LB1103 should lead to more accurate and reliable data for the benefit of Nebraska lawmakers and all who are interested in these issues,” said Speaker of the Legislature Mike Flood of Norfolk, who introduced the bill.

Current Nebraska law requires doctors to file reports with the state Department of Health and Human Services on each abortion performed. Those reports must include where and when the abortion was performed, the woman’s age and state of residence, the number of previous births and abortions, the length and weight of the aborted fetus, the reason for the abortion, the type of procedure used and whether there were complications.

The reporting of gestational age is optional, and Nebraska’s 2009 abortion statistics show it was included on just one of 2,551 reports. Additionally, the length and weight of the aborted fetuses — which could offer a clue as to age — were listed as immeasurable on all but one report.

As Vicki Saporta, of the National Abortion Federation, points out in the article, once a woman is in the second trimester, ultrasound equipment cannot pinpoint age as accurately, making the “20 week” rule increasingly at a doctor’s discretion.

Vicki Saporta, president of the National Abortion Federation, a professional society for North American abortion providers, said ultrasound equipment can pinpoint gestational age within three days during the first trimester and within two weeks in the second. That could mean that, because of the current ultrasound technology, a doctor could date a woman’s pregnancy at 21 weeks when she’s really at 19 and deny her an abortion under the Nebraska legislation, which Saporta said “is yet another flaw in this law.”

There is no indication yet as to whether this law will be challenged, as was a previous regulation requiring women to undergo mental health screenings and listen to erroneous abortion information before undergoing the procedure. That law was struck down in August as unconstitutional, and the state decided not to try to overturn the ruling.

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  • mechashiva

    I’m a little worried about whether or not I should share everything I’ve said in this comment, because it absolutely will fuel pro-lifers’ arguments. However, I think that it is important to face reality with regard to this issue, and I want people to be well aware of the facts of late second-trimester abortion. I genuinely see this as a separate issue from your standard first-trimester procedure, and I’m ambivalent on the subject of restrictions based on gestational age. So, with that in mind…

     

    It’s rather difficult to measure the length and weight of an aborted fetus, to be honest. It isn’t like they come out intact, and you can’t weigh everything that comes out because there’s lots of fluid and placenta as well. So, while I understand why legislators might want this information, it’s not really feasible. Now, if they would accept measurements like… fetal foot length and/or femur length (much easier to collect post-abortion) in conjunction with the BPD (taken during the ultrasound), that would work better. It would also provide better information on how accurate ultrasound measurements really are.

     

    I can definitely understand arguments for limiting late second-trimester abortion, and to be honest I have mixed feelings on the subject. I’ll tell you why. As Saporta points out, the farther along in gestation a woman is, the wider the range of error is in the ultrasound measurements (for BPD). I myself have seen this at the clinic where I used to work, and it is very upsetting for everyone involved… but not for the reasons outlined above.

     

    While Saporta points out that a woman might be earlier in gestation than the ultrasound suggests, in practice I found that wasn’t generally the case (anecdotal evidence, to be sure). When there was a discrepancy between ultrasound measurements and actual development of the fetus, it tended to be that the woman was farther along than was estimated (but it is possible that’s just because we noticed those cases while we weren’t concerned if women weren’t as far along as we thought).

     

    Underestimating gestational age can be dangerous for patients, as the number of laminaria used to dilate the cervix the previous day (and whether or not we use digoxin) is based on ultrasound estimations of gestational age. If the cervix is not dilated enough, or if digoxin is not used when it should be, it is very obvious during the surgery and afterward when the fetus is examined. Surgery is much more difficult when the cervix isn’t dilated enough and/or when the fetal tissue hasn’t degraded enough. This increases the risk for uteran perforation, as the doctor must make more passes with his/her forceps and use more force and twisting to dismember the fetus. I know this will be horrifying for some people to read, but these are the facts of late second trimester abortion.

     

    I think the wide margin for error makes a big difference ethically as well as risk-wise. The whole staff at my clinic was terribly upset when we discovered once after a surgery that we had performed an elective abortion on a 27-week (from LMP) fetus that we had measured on the ultrasound to be only 23 weeks. Though we did everything according to standard protocol, our estimation was way off, and many of us had a difficult time coming to grips with what that meant. I don’t think our reaction was unwarranted, and I think that people on both sides of the debate should be concerned about these mistakes (that word seems too benign, but it’s the honest truth… it was an unintentional mistake).

     

    So yeah, I can understand restrictions that would be based on reducing risks to patients and limiting the likelihood of overstepping ethical boundaries, but unfortunately these laws are not about that… they are about “fetal pain,” which hasn’t been demonstrated to be a viable (har, har… pardon my black humor) concern.

     

    There are legitimate arguments to be made in favor of limiting late second trimester abortions, but this law misses the mark entirely. However, I generally support the idea of keeping a record of statistics on abortion provision: who gets them, how many of them are done, how far along as estimated by ultrasound, discrepancies between ultrasound measurements and those of fetal body parts post-abortion, etc. I don’t think such information is harmful (ethically/politically) to collect. If such information is harmful to the pro-choice side of the debate, I think it is important for us to face that and perhaps re-examine what our priorities really are.

  • squirrely-girl

    Thank you for sharing your perspectives on this. I have a similar unease about late second trimester abortions for the reasons you’ve shared. However, this -

    There are legitimate arguments to be made in favor of limiting late second trimester abortions, but this law misses the mark entirely.

    - is my main problem with this bill as well. 

  • darkfemfatale

    To the two who have already commented:

    Women do not wake up in the second trimester and look down at their very pregnant bellies and say to themselves, “You know, I really should take care of this today.” That is a very naive and judgmental statement.

    Many second-trimester abortions happen to women that WANTED their babies, but severe birth defects would make this so-called fetal pain a non-issue compared to the pain their babies would experience throughout their short lives.

    I was denied an abortion when my son was diagnosed with hydranencephaly and multiple heart malformations…even after my water broke, putting me at great risk for infection, because I was too far along. Obviously, I was 20 weeks pregnant before we had the ultrasound or saw that my water had broken because I WANTED my baby, and so are other thousands of women–because we don’t even get the basic anatomical scan until 20 weeks!! So, I had two choices: continue the pregnancy at great risk to my own personal health and watch my baby die a slow and agonizing death, or be induced at a state hospital after they had stopped his heart. I chose the hospital, only to be told that unless I could give them $5,000 in cash that day, I had to go home and wait until I started uterine hemmorhaging or got an infection that would spread to my other organs as well as my uterus.

    In what world is it OK to tell a woman whose baby is going to die anyway, no chance of living, that they are also going to make her life at risk before anyone will help?

    This is why it is essential and important to have second trimester abortions–simply so that babies do NOT feel pain.

  • mechashiva

    Something I’ve noticed is that a lot of pro-choicers are uneasy saying anything or supporting any bills that affirm pro-life positions. This is understandable. We’re afraid of the slippery slope… give them an inch and they’ll take a mile. It’s sad, but it also seems to be true. Unfortunately, this fear fuels extremism or arguing about abortion theoretically rather than practically.

     

    One of the most disturbing aspects of the experience I described above was that nothing was done about it. On the one hand, what could be done? That was the prevailing attitude I picked up from the doc (who was furious that such a huge mistake happened in the first place) and the clinic manager (who had more of a “these things just happen sometimes” kind of attitude). On the other hand, there was no protocol in place directing us as to how to handle such a situation when it was apparently known that this kind of thing does happen from time to time, and I think that is wrong. Even though the ultrasound measurements were taken properly and we had no way of knowing something was amiss until it was too late to do anything but complete the surgery, I’m still uncomfortable with how the whole thing was dismissed.

  • mechashiva

    Women do not wake up in the second trimester and look down at their very pregnant bellies and say to themselves, “You know, I really should take care of this today.” That is a very naive and judgmental statement.

    Good thing neither of us said that.

     

    As someone who was a surgical assistant at an abortion clinic that went up to 24 weeks, I’m well aware of the points you bring up. Late second trimester abortions are sometimes necessary, and that they should be easy to access for the women who need them. However, those cases of medically-indicated abortion do not negate the ethical ambiguity of elective late second-trimester abortion (which is more common) and the wide margin for error in ultrasound measurements.

  • sharonmd

    DarkFem, though your response only points at part of what the initial post is about, stories like yours are heartbreaking — and crucial to air.  This is why second trimester abortion is vital, and why nobody should get to decide who can get one other than the woman herself. 

     

    I have had several patients with a similar situations and we were both so grateful that she had access to a second trimester procedure fairly quickly.  She didn’t have to worry about paying for it or traveling far from home to get the procedure done. 

     

    I can only imagine how hard that situation was for you, but if you can I encourage you to share your story with as many people as you are comfortable, online, by email or in person.  Your senators and representatives, both at the state and national levels, need to hear your story so they can understand why abortion access, both physically and economically, is a crucial issue for all women, even those who think they will never need it.

  • julie-watkins

    However, those cases of medically-indicated abortion do not negate the ethical ambiguity of elective late second-trimester abortion (which is more common) 

    What about the situation when the pregnant woman decides she doesn’t want to be pregnant early, but various barriers — Hyde Amendment, took weeks to raise the money, all clinics nearby closed from TRAP laws, uncooperative doctors, parental notifications laws (so a 17 year old delays until her birthday), etc. try to run out the clock until it’s nearly “too late”?

    My opinion is to trust the woman and put blame on the people and groups who made it impossible for the pregnant woman to schedule her abortion promptly.

  • crowepps

     However, those cases of medically-indicated abortion do not negate the ethical ambiguity of elective late second-trimester abortion

    That abiguity is precisely why the ethical decision making is left up to the people actually involved.  It’s real easy to decide what other people should do when you’re not in the situation, and particularly when the assumptions about what their situation is and how they arrived there are stereotypes, but it’s important to remember that unless they are causing us personally direct harm, it really isn’t any of our business.  We don’t have any right to intervene and substitute our ethical standards for theirs because we are not their ‘superiors’.

  • mechashiva

    Oh god, yes, all the various barriers to early access are the main reason I support keeping abortion legal for elective purposes throughout the second trimester. When I talked with my patients who had late second trimester abortions about why they were choosing to abort at that time, most of them indicated they had wanted to terminate sooner but were unable to for a variety of reasons.

     

    Unfortunately, a good number of them also admited to being in-denial about their pregnancy… they were too ashamed/afraid to face it and make the decision earlier, and that’s terribly sad. Those patients tended to identify… maybe not as “pro-life” perse, but anti-abortion (or they were rape victims who did not want to face their victimization). The denial of their pregnancy was their way of escaping being “one of those women who has abortions.” Once they literally had to face the music… well, you know how it goes from there. My heart went out to them, because they had a much more difficult time accepting that they knew what was right for themselves and their families due to their black-and-white version of morality, and then they felt even worse for having put it off for so long.

     

    When it comes to abortion, there are only two options: either the woman is the final arbiter of the decision, or the state is. I’m of the opinion that the woman is the better judge than an outside party. My goal as a healthcare provider is to ensure my patients’ informed consent and their safety. My goal in my general interactions is to foster that trust in women, so that they can trust themselves. Everyone ends up better off that way.

  • mechashiva

    You’ll get no argument from me on this.

  • colleen

    Thank you for clarifying what you meant by an ‘elective’ abortion. The right tends to paint women in these circumstances in a grotesque and dehumanizing light and I hope that you will not continue to feed into that myth by employing their rhetoric.

    I would not dismiss a 2nd trimester abortion when the pregnancy was the result of a rape as ‘elective’. Rape is a serious trama and a seriously dehumanizing crime. The denial you describe is predictable and particularly in a country where the victims and not the criminals are often the folks who are shamed and blamed and the crime is underreported and, even when reported, seldom prosecuted.I imagine that many of the women seeking a late term abortion in that circumstance were quite young, were they not?

    It’s unfortunate that we live in a country where more political energy is spent trying to normalize forcing pregnant rape victims to carry to term than to assure justice for the victims of rape, whatever their age but it is the reality we all live with. 

     

  • mechashiva

    You know, I hadn’t even considered the implications of the word “elective” when I was typing my response, but that’s a good point. The rhetoric used to describe abortion is important. Initially it seems cumbersome to say “non-medically-indicated,”  but that’s a better descriptor. I definitely agree that “elective” is not an appropriate word to describe the choice to abort a pregnancy concieved from rape, regardless of gestational age. I’ll be more aware of the language I use in the future.

     

    And yes, our second trimester patients (early and late) tended to be younger on average. We didn’t have any really young patients that I can recall on first trimester days, but we saw 11/12-year olds and young teens on second trimester days relatively frequently. Second trimester days were also the times we saw mentally handicapped patients. Patients who did not speak English or Spanish were more likely to be in their second trimester, as they had particular difficulty navigating the medical system. We also saw a higher incidence of drug addiction, generally methamphetamine, farther along in gestation. Not surprisingly, we also saw prison inmates primarily on second-trimester days. Second-trimester patients tended to be economically disadvantaged when compared to first trimester patients, and our worst cases of domestic violence were seen in this population as well.

     

    Basically, second trimester abortion patients were the women who had experienced the greatest hardship and suffering, which contributed to their seeking of an abortion later in gestation. Of course, all of this is just my observation, and I would actually like it if this information could be formally compiled so that our legislators had a better understanding of exactly what issues our patients face. That way no one can debate whether the above is true or not.

     

    Yeah… damn, reading that really clarifies how insulting the term “elective” is. These women may have been (mostly) physically capable of carrying to term, but they (and most of the first trimester patients) chose abortion out of necessity to prevent their lives from spiraling out of control, even if it wasn’t “medically necessary.”

     

    If we improve the quality of women’s lives, we’ll see the incidence of second trimester abortion decrease. That’s where the focus should be, not on restricting access. I may have felt awful staring a 27-week fetus in the eye after I assisted in its abortion, but I’ll tell you what…. I felt even sadder every time I saw a patient come in with any of the experiences I mentioned above.

  • jodi-jacobson

    I have other comments about this issue I would like to share, but for now with little discretionary time available only wanted to add here that we are soon to publish a piece that speaks to the very issues related above….how policies and barriers have made women delay from early pregnancy til later pregnancy to obtain an abortion for an unintended and untenable pregnancy.

     

    It is indeed the very strategy of the anti-choice, anti-woman movement to make it extremely difficult to get an early abortion, whether through medical abortion or through surgical abortion, and then to restrict second trimester abortions based on the emotionality involved in reading things such as MecaShiva has described above. I do not deny her experience or feelings; I do however think that there is no possible rational debate or policy discussion about these issues in this climate anywhere in the United States and certainly not where politicians are involved, and the danger lies in the lack of ability to have nuanced discussions, much less to apply policies in nuanced ways at the individual level, which almost never happens.

  • arekushieru

    To clarify, I think that a woman can have an abortion at any period of gestation for any reason.  If not, she does not have the full right to determine who uses her body and when and how it is used in an ongoing, informed and explicit basis.  I believe any reason a woman has an abortion is ‘non-elective’ but, I agree, that many abortions are not medically indicated, as MechaShiva stated.  And I still think that abortions should be allowed at any stage of gestation for any reason, even if it was determined that fetuses could feel pain.  We don’t deny a victim of assault their right to self-defense, simply because an inarguable human being might feel pain, if the victim does exercise their right, do we…?  And, again, this occurs regardless of the intent of the attacker, remember…. 

  • mechashiva

    See, this is exactly the kind of theoretical approach to arguing in favor of abortion rights that I find problematic. I used to make this same argument in college, but I found that working at a clinic moderated my views considerably. These kinds of arguments are easy to make until you see this shit in real life.

     

    My attitude changed after seeing this one (healthy) patient shortly after I started my job. I performed her ultrasound, and I was surprised to find her to be at least 36 weeks pregnant. When I informed her, she gave me a blank look and asked, “So… is that too far?” I had to explain to her that she could expect to go into labor by the end of the month, but potentially any day. She was disappointed as I gave her referrals to pre-natal care agencies that could assist her during and after the delivery (she wasn’t interested in adoption). After she left, I just went back into the break room and cried for more reasons than I care to go into. I’m sure anyone reading this can think of numerous ways in which the above situation is depressing.

     

    Pregnancy and abortion-related legislation is not something that should be based on theory or ideology. These are actual issues that come up in real life, and there is no good practical argument for non-medically indicated abortion in the late third trimester. None. If ending the pregnancy is important at that point, there are other options that are safer and more ethical. Though, you’d be hard-pressed to find a doc to induce labor or perform a c-section early for no good reason. I’m not sure if I think that the desire to end a pregnancy a few weeks early is a good enough reason for early induction (given the risks for all parties involved), and I don’t think anyone honestly thinks it is a good enough reason to abort at that point.

     

    There are enough arguments in favor of keeping abortion legal for the vast majority of cases based on public health. These extremist, ideologically-driven arguments only hurt the cause, fostering enmity and unwillingness to work on practical solutions to very real, common-ground problems with pregnancy care in this country.

  • prochoiceferret

    “So… is that too far?”

     

    But that’s textbook ignorance. This is the same kind of person who is surprised to find out that a Coca-Cola douche after sex does not prevent pregnancy. It’s not an argument for or against abortion; it’s an argument for meaningful sex ed that includes a discussion of abortion.

     

    Arguing that abortion should be a woman’s right at all stages of pregnancy is fine, but that is premised on the woman having half a clue about her body and how it works. It’s not much different than arguing that people should be responsible for their own health (i.e. knowing how and when to seek medical attention)—it’s a good idea, but it doesn’t work when people don’t know what they need to know. If you have a population of idiots, the only thing that will work is a heavy-handed nanny state that makes all these decisions for you. (And given conservatives’ low opinion of women’s intellects, it’s not surprising to see them opt for this approach.)

  • mechashiva

    Yeah, a patient’s ignorance is not an argument in favor of or against abortion. The good arguments against late third trimester abortion are practical (safety) and ethical (viability).

     

    Seriously, I see a big difference between allowing non-medically indicated abortion at 24 weeks, when viability is questionable, and at 36 weeks, when viability is decidedly unquestionable. There’s no reason to argue in favor of it except to avoid inconsistency with ideologically-based arguments for keeping abortion legal earlier in pregnancy. And that’s why I don’t like ideology in the first place, because you end up with crap like this.

  • prochoiceferret

    Yeah, a patient’s ignorance is not an argument in favor of or against abortion. The good arguments against late third trimester abortion are practical (safety) and ethical (viability).

     

    Yes, that’s the point. Saying that there is a right to a (non-medically-indicated) abortion at that stage doesn’t mean that it’s safe, or a good idea, or that anyone would want to do it. It just means that there’s no law against it. Just like there’s no law against non-medically-indicated amputations.

     

    The benefit of that approach is that there then are no legal hurdles to clear if a medically-indicated abortion becomes necessary. If there is a mistake, like a wrong estimate of fetal age, there may be recriminations, there may be hand-wringing, but no one’s going to end up indicted in a criminal court.

     

    And the flip side of this is why education, as well as good abortion availability, is important: so that there are no women asking for a non-medically-indicated abortion at 20+ weeks, because they’ve all had it done already at 10.

  • mechashiva

    Mm, I see the value of this approach (less government intervention), but the argument would be that there needs to be a law on the books making it a criminal action to provide a non-medically indicated abortion so that those who do put the woman at risk and kill a viable fetus will be investigated (and punished if necessary) rather than ignored until they kill a patient with their negligence.

     

    Like I said above, I was really bothered by the fact that absolutely nothing was done in the case of that 27 weeker.* With the “this just happens” attitude, it was possible for people to fudge ultrasound measurements and abort viable fetuses without medical cause. I hate to say it… but I actually have seen one particular staff member attempt to do on multiple occassions just that (the times I saw it, they failed because they just couldn’t fudge it enough) and I sometimes wonder what happened when I wasn’t there. This person’s actions were well-known by managers at all levels, but their employment was protected by higher-ups for… personal reasons that might be even more disturbing to disclose. This kind of thing really does happen, not because all abortion-providing staff are evil and want to kill viable fetuses just cuz, but because some people want to fix all their patients’ problems for them. They want it so bad, they’ll do unethical things, and there really does need to be some kind of system in place to discourage that. There needs to be some recourse when this kind of thing is covered up or overlooked by employers.

     

    I say, if intentional, non medically-indicated post-viability abortion ever happens it needs to be on the books as criminal, somehow, but perhaps not through term limits on abortion-provision. The problem is, as long as we have any term limits like we currently do, I don’t think there’s any going back. I don’t think that it is feasible to expect voters or legislators to support the idea of removing all restrictions on abortion, and pushing the argument just deepens the divide between the left and right, making it impossible for moderate policies to be enacted.

     

    *For any people wondering why I didn’t try and report any of this kind of thing to authorities: All the ultrasound pictures and measurements taken prior to the surgeries would indicate nothing untoward happened. There’s no proof of anything, which is another reason why I actually support making a database of information like the one required by this otherwise bogus law. Without a body of evidence, there’s no accountability for this kind of thing if/when it does happen.

  • prochoiceferret

    I say, if non medically-indicated post-viability abortion ever happens it needs to be on the books as criminal, somehow, but perhaps not through term limits on abortion-provision.

     

    That’s why we have medical standards and review/certification boards. Dr. Tiller was known to turn away patients like this from time to time. Likewise, if you walked into any hospital and demanded that they amputate your perfectly healthy leg, they’d more likely have you committed than get you to an OR. There’s lots of things you can do as a medical professional that will put your license in danger without drawing the ire of the law.

     

    (The discussion becomes more interesting if you talk about the legal consequences for a woman who self-induces a post-viability abortion, but I think you’d agree that it would be dicey to treat that as straight-up murder.)

     

    The problem is, as long as we have any term limits like we currently do, I don’t think there’s any going back. I don’t think that it is feasible to expect voters or legislators to support the idea of removing all restrictions on abortion, and pushing the argument just deepens the divide between the left and right, making it impossible for moderate policies to be enacted.

     

    And that’s where the art of political compromise comes in. Saying that a woman owns her body in 2010 is like saying that Blacks/Negroes are human beings with souls in 1801: way too radical for most people. But that doesn’t mean that the argument lacks merit, or that there’s nothing we can do to improve the situation in the meantime.

  • arekushieru

    (Just a note: All emphases are meant to be strictly that, not considered an angry tone.  If you took it as that, I apologize and will remove the emphases.) 

     

    I think you missed my point.  If you noticed, I DID say *informed*, ongoing and explicit consent.  I am talking about women’s RIGHTS, here.  I am talking about women’s CHOICES, here.  I am saying that they have the right to *choose* at any stage of development who uses their body and when and how it is used, via ongoing, informed and explicit consent, just as anyone else may do, even when someone else’s life is involved.  If women don’t have the same choices as everyone else, they don’t have the same rights as everyone else.  And women have the right to ongoing, *informed* and explicit consent just as anyone else does.   

     

    They have this right or they only have it when someone else ‘allows’ them to, based on their own morality.  Limiting their choices in any manner, with regard to any issue other than health, that is not in keeping with the restrictions of other’s rights, will be the latter. 

     

    ‘Common ground’?  I believe abortion is ALways moral when it is wanted, just as I believe pregnancy is ALways moral when it is wanted.  I don’t want to see a reduction in the number of abortions, I want to see a reduction in the number of unplanned pregnancies.  If the numbers of abortions are reduced, that is just a happy side effect, just as if the numbers of pregnancies are reduced, it’s just a happy side effect.  There are very few anti-choicers with whom I can find common ground on, in this matter, unlike the probability of finding anti-choicers with whom I could find common ground on, with simply the reduction in the numbers of abortions… if I came at it from that viewpoint, that is…. 

     

    As I’ve said ad nauseam, I live in Canada.   Canada is the only developed country that has no legal restrictions on abortion.  That is the only constitutional, non-sexist, way to deal with this matter, I FIRMLY believe.  It is medically regulated, as it should be.  The rates of abortion, here, are comparable to the rates in the US, I also believe.  And health indicators are what women need to be informed of (which is the complete opposite of the woman’s experience you were discussing was) what should be the only restriction, yet still within the parameters of choice (right to choose medical risk, after all), to access of a certain procedure. 

     

    I know you are a health-care provider in this field.  Your views changed in this regard, but other such health-care-providers that I know changed from the current view you hold to the one I now hold and are, in fact, some of the ones who helped shape that view I have.

  • mechashiva

    So, let’s just get this straight, then.

     

    A woman comes in at least 36 weeks pregnant and could literally deliver a healthy baby any day. She wants an abortion, even after being informed of the different options and their risks. You actually think that (if she can find a doctor willing to perform the surgery… unless you think doctor’s shouldn’t have conscience clauses either in this instance) she should be allowed to abort a perfectly healthy, viable fetus that is causing her no more physical distress than is normal in pregnancy?

  • arekushieru

    Yes.  If there are no health contraindications that would similarly restrict doctors performing other procedures in similar circumstances, then, yes (which is what I’ve been saying).  And we all know that fatal complications can and do arise without warning and make it too late to save either the woman or, thus, the fetus.  In fact, here is a blog about a woman who suffered one form of fatal complications after a home-birth: http://katyupdate.wordpress.com/

  • mechashiva

    I really don’t think that, “Sometimes things go wrong even when we have no reason to suspect they might,” is a good enough reason to abort a perfectly healthy, full-term fetus… but thanks for answering the question. I don’t have anything else to say to you on the subject.

  • prochoiceferret

    You actually think that (if she can find a doctor willing to perform the surgery… unless you think doctor’s shouldn’t have conscience clauses either in this instance) she should be allowed to abort a perfectly healthy, viable fetus that is causing her no more physical distress than is normal in pregnancy?

     

    Firstly, the standards of medical care could very well dictate that the willing doctor who performs this procedure would lose his/her license. That’s a discussion that can easily be had without touching the issue of abortion rights.

     

    Secondly, if a woman were that dead-set on doing this in spite of the risks, the lack of a willing and licensed doctor isn’t going to stop her. The question is then no longer whether you’ll allow her or not, but how in the heck are you going to stop her.

     

    The scenario you’re presenting is the equivalent of the “ticking time bomb” argument for torture. It’s an extreme corner case that doesn’t have any sort of ideal solution. The only real way to address it is to recognize that you have to solve the problem before it gets to that point. Thus, education and access.

  • mechashiva

    Firstly, the standards of medical care could very well dictate that the willing doctor who performs this procedure would lose his/her license. That’s a discussion that can easily be had without touching the issue of abortion rights.

    Not if the official policy is that the patient has the completely unfettered right to abortion, no matter what, as was the case in the ridiculously extreme hypothetical situation I outlined above.

     

    As to how to stop her? The same way we stop potentially self-harming, suicidal, or murderous patients now. Healthcare providers are mandatory reporters, and there are authorities to report such patients to. Sickening as it might sound, she could be placed in a treatment facility to prevent her from self-aborting or seeking an illegal abortion.

     

    I know the scenario I described is absurd… but that’s the position Are- was describing, so I asked her point-blank without all the dressing-up she did to make her position sound more palatable.

  • prochoiceferret

    Not if the official policy is that the patient has the completely unfettered right to abortion, no matter what, as was the case in the ridiculously extreme hypothetical situation I outlined above.

     

    Having a right to X isn’t the same thing as having a right to someone who will give you X. Technically, right now, you have the right to a non-medically-indicated amputation. (There’s no law against it, after all.) Not a lot of good that will do you if you suddenly decide you hate your left leg, and you want a proper medical facility to do the job.

     

    As to how to stop her? The same way we stop potentially self-harming, suicidal, or murderous patients now. Healthcare providers are mandatory reporters, and there are authorities to report such patients to. Sickening as it might sound, she could be placed in a treatment facility to prevent her from self-aborting or seeking an illegal abortion.

     

    That’s certainly arguable, when the (late-term, non-medically-indicated) abortion is considered in the same category as self-harm or suicide. The point, then, is no longer that the woman doesn’t own her body, or that the fetus has a “right to life,” but that the woman is showing extreme disregard for her own life and safety. Committing a person in that circumstance is not controversial.

     

    I know the scenario I described is absurd… but that’s the position Are- was describing, so I asked her point-blank without all the dressing-up she did to make her position sound more palatable.

     

    It comes down to recognizing that sometimes, the outcome we want is not served best by enshrining it in the law. That’s what we say for parental notification/consent laws, and it’s not an unreasonable position for abortion in general.

  • mechashiva

    Having a right to X isn’t the same thing as having a right to someone who will give you X.

    That’s why I included the part about conscience clauses in my question to Are, though perhaps I should have indicated a more broad ability for the physician to refuse the service.

     

    That’s certainly arguable, when the (late-term, non-medically-indicated) abortion is considered in the same category as self-harm or suicide.

    Or murder… just sayin’.

     

    It comes down to recognizing that sometimes, the outcome we want is not served best by enshrining it in the law.

    And some would argue that certain things are so unethical that they should be criminalized… like intentionally killing viable fetuses for no good reason. If we didn’t have a law on the books, the burden would be on those who would want to change the law to criminalize such procedures, but that’s not how things are. Since the current situation in America is that this is criminal, there would have to be a compelling argument to remove viability and medical-indication restrictions, and I for one haven’t been convinced. I don’t imagine a majority of people would be.

     

     

    By the way, I’ve really enjoyed the opportunity to have this debate with you. We pro-choicers hardly ever get to talk amongst ourselves about these things because antis come in with all their usual crap, and we have to argue about abortion in general rather than being able to talk about these more nuanced issues. Just wanted to voice that feel-good sentiment.

  • julie-watkins

    That’s the situation in Canada (no abortion laws). And LifeSite (which looks for scandels like elective abortions at 36 weeks to trumpet as if it Happens All the Time) … the only scandels they report on from Canada have to do with protestors. The “born alive and killed” scandels all seem to be from USA.

    The reason why I support “elective abortion to the last moment” rather than agreeing there should be “reasonable limitations” is that there’s no good way to write a law (other than “trust women and her doctors”) that will allow doctors the flexibility they need to act in sudden crisis that won’t be protested as allowing “abortion on demand”. And, if it’s Possible, groups like LifeSite are going to say it’s Probable and say it’s a Scandel.

    From my opinion (though I’m only going on hearsay, unlike MechaShiva who has experience) — I don’t think there’s a problem with late abortion that wouldn’t be better solved with medical standards instead of laws.

     

  • princess-rot

    Indeed. Canada, I think, is only country in the country in the world with no abortion laws and no restrictions. It doesn’t mean everyone is hopping into the clinic at 36 weeks and demanding non-medically required abortions, because those that wanted abortions had it done well before. This public healthcare system, sex education and subsidized health insurance plans (for those that want private healthcare) remove most of the hurdles and lack of education issues that are present in the U.S.

  • mechashiva

    Even though I do have mixed feelings about the subject, I am inclined to agree with you and would vote/campaign for the less government intervention way of handling abortion provision. From a practical standpoint, it would do a better job of actually solving problems.

     

    While I do have some scandelous stories for sure, they’re extraordinary because they happen so damn infrequently. These things don’t get shared because medical professionals (speaking for myself, anyway) are so afraid of the political climate. When anything bad happens at an abortion clinic, it doesn’t get treated the same way a similar situation in another field of medicine would be. There’s the fear that the clinic will be closed (rather than punishing to responsible individuals), and then no one will be able to access its services. It’s horrible.

  • julie-watkins

    Thanks. I think the large amount of contention and lack of agreement is an indication that it’s a bad match for a legal solution.

    My worst argument was on a mailing list. He was ranting against “abortion on demand” and ranting about women “legally killing babies right before they were born” and I insisted that didn’t happen. Women don’t wait 8 plus months and then decide, frivilously, “I want an abortion”. I didn’t know about Canada at that time, or I would have used Canada as an example.

    Well, his response was: Of course they do! Dumster babies happen All The Time, you can’t tell me women don’t do it the day before!

    He was clueless and a bully and he finally went away (or was kicked off). The situations that result in dumpster babies (& they don’t happen all the time) are tangled up in denial and desperation, which are different situations than what causes late abortion. He would have none of it. When we said there are medical reasons he just figured the women or doctors were lying or exaggerating and getting away with murder. He was also the creep who ranted “People who say ‘Safe, legal and rare’ don’t mean it about the ‘rare’ part.”

  • crowepps

    The thing you seem to be missing is that your scenario contains the assumption that there need to be laws regulating abortion because it is LIKELY that lots of women will make such absurd, irrational demands.  I am sorry to see you fall into the patriarchal error of assuming that ‘those women’ can’t be trusted to make their own decisions because they’re too stupid/ignorant/immoral to be trusted to do so and that ‘we’ who are smarter/more educated/have superior morals have the right to make their decisions for them.

     

    Happen to be reading a book about Prohibition called “Last Call” that gives a thorough explanation of the roots of the movement.  It makes it clear the the motivation behind making alcohol illegal was to prevent the ‘lower classes’ from drinking because the results of their being able to do so were annoying to the middle class and rich (who kept right on drinking throughout the ban while enforcement was concentrated towards the poor).

     

    Keep in mind that what we’re talking about with abortion bans and contraception bans is NOT getting rid of abortion or contraception altogether, but rather preventing the poor from accessing either while the middle class and rich have the ability to continue their access. 

  • carolyninthecity

    I live in Canada too, and I think the most recent abortion stats I read looked something like 90% are performed before 12 weeks, 9.6% 13-19 weeks and like 0.4% after 20 weeks. I think there’s about 100,000 abortions on average performed every year. So we’re talking about 400 abortions after 20 weeks every year if my math is correct. I’m not sure how many of those are still before 24 weeks. Probably most if I had to guess. These are from a couple years ago, maybe 2007.

     

    As it’s been stated before, you’d be hard pressed to find a doctor who would perform a non-medically indicated abortion after 24 weeks up here. And more importantly you’d be hard pressed to find a woman who wanted one. Often third trimester abortions are refered to the U.S. I think they’re also working on getting a doctor to Quebec to perform later abortions, or they were at some point (I’m in Ontario). 

     

    Having no legal restrictions, and having the procedure covered by our provincial health plans makes it much easier for women to get their abortions a.s.a.p, which is why our second and third trimester rates are so low. Access is still an issue in some provinces and rural areas obviously, so it’s not a perfect situation, but comparably we have it pretty good up here. 

     

    And I think we’re a perfect example of why abortion restrictions are so unnecessary. If you trust women and trust doctors you’ll have better outcomes then if you try to control everybody with legislation. Are there women who “abuse the system” by waiting to have an abortion for no reason just because they can? I don’t know, I find it hard to imagine. But I don’t think laws should be passed to restrict access based on this one woman possibly existing. 

  • arekushieru

    I apologize, in advance to the moderators if this post creates a problem and ask that they remove it, asap, if it does:

     

    MechaShiva, I answered your question, point-blank, in the comment just prior to this one on this thread.  Then I simply added to the answer, while reiterating my position.  You accuse me of using window-dressing, AFter you ridicule any points I make (which you incorrectly addressed probably  beCAUSE it lacked ‘window-dressing) and telling me you’re done having this conversation with me.  You know what?  I’m sure you have excellent points to make in other conversations, too, but I think we’re done having any sort of conversation, altogether, especially when our previous   conversation doesn’t bode so well for future ones, either.  So, I think that makes a good case for both of us to just… skip each other’s posts, from now on.  Agreed?

  • mechashiva

    Oh, this is such bullshit, crowepps.

     

    You know as well as I do that I am fully aware of how absurd the above hypothetical situation is. In fact, I even say so elsewhere in this thread, just like I say (again) I didn’t make it up to illustrate any points about legislation, I did it to get a simple yes-or-no answer out of Are regarding how far she would be willing to extend her ideologically-based positions in real life.

  • mechashiva

    You do what you want. I don’t make a habit of letting shit I disagree with slide, even if it comes from someone on “my side” of the abortion debate.

  • arekushieru

    That’s certainly arguable, when the (late-term, non-medically-indicated) abortion is considered in the same category as self-harm or suicide. The point, then, is no longer that the woman doesn’t own her body, or that the fetus has a “right to life,” but that the woman is showing extreme disregard for her own life and safety. Committing a person in that circumstance is not controversial.

     

    That, right there, is a perfect example of what I am trying to conveigh with regards to medical standards.  Is it more self-harming to perform one procedure (in this case, abortion) over another procedure (in this case, pregnancy)?  Thanks!

  • arekushieru

    Here, let me simplify: That WASn’t what I was referring to.  IF it had been simply that, I would NOT have cared.  After all, I was doing the same with regards to your own comments.  I believe that it is the exACT same beliefs that you have espoused, that have allowed pro-lifers to get their foot in the door in the *first* place. 

     

    What I WAS referring to was your comPLAINT that I was providing window-dressing, then your actual ‘withdrawal of not standing for any ‘shit” someone displays that you disagree with when I DIDn’t provide window-dressing, then the fact that you addressed my point incorRECtly.  Thanks. 

     

    Yup, we’re done, as I’m taking a leaf from your comment on the ‘On Commenting’ thread.

  • mechashiva

    Alright, I’ll admit that the way I expressed myself was offensive. Sorry for that.

     

    I did not complain to you about “window dressing.” Not before, and not after you gave me a straightforward answer regarding a ridiculous hypothetical. In fact, I didn’t even intend to sound snippy when I said I didn’t have anything else to say to you. Seriously, you answered the question I asked… what more could I want or say?

     

    I used the phrase “dressing-up” (when talking to PCF) to refer to all the conditional statements that get attached to the ideological position of “any time, any reason, because of the right to bodily autonomy” that are used to make a strong argument in favor of that position. In your earliest comments, you did include a lot of discussion of the theory behind your position… I can see how calling that “dressing-up” would be insulting. Honestly, I was just tired and lazy, and didn’t take the time to find a more polite way of making my point that I wanted to strip the theory away, and instead it made a mess. I should have been clearer, and I am sorry that I offended you.

     

    However, I disagree that my feelings (based on my personal experiences actually working at an abortion clinic… since people seem to be confusing me for some sexist pro-lifer) are problematic. They are representative of a moderate abortion position. I think it is unfair to suggest that moderate positions are to blame for the way extremist pro-lifers with enormous lobbying power have trampled on women’s rights.

  • julie-watkins

    My ideology arguements are reserved for early abortion. Anti-abortion laws targeting 1st trimester or hospitals who won’t give or refer for emergency contraception are acting on ideology, not medical standards. I don’t like legal limits on late abortions for pragmatic reasons, not because I support “abortion on demand”. I wouldn’t be mad at a doctor who refused to do an non-medically indicted abortion at 36 weeks. I would be mad at a doctor who waited for “no fetal heartbeat” even when the pregnancy was doomed & the woman septic — that would be ideology. It is a pragmatic problem that political fears — that a clinic will be closed — is apparently stiffling self-examination. If someone on staff is habitually pushing limits, wanting to help, and there’s no correction — well, things will just get more out of whack. That is disturbing. Local medical practice and standards aren’t going to be as good as they can or should be if there’s too much political influence or too much fear of political repercussions.

  • julie-watkins

    “Julie Watkins’s distant-second-favorite talking point”

    Yes, I like “medical standards not laws. So I’m wondering what you think my 1st favorite is. I can think of two: “Nature is sexist” and “[attempting to] give birth (give life) should be a  gift not an oblication, or women and poor people are 2nd class”.

    I think the medical standards & and following best practices and not having uncomfortable pushing-of-envelopes has a better chance of happening when there are access and fiscal barriers to early abortion, when fear of political repercussions isn’t interfering with setting standards, and when reproductive care is reintergrated back into general hospitals & OB-Gyn care. When abortion clinics are isolated & under harrassment there’s less peer-oversight.

  • mechashiva

    Local medical practice and standards aren’t going to be as good as they can or should be if there’s too much political influence or too much fear of political repercussions.

    Exactly. Though, in the case of the employee I mentioned, their job was protected by the highest level of management in the company for personal reasons, not political ones. (This was not PP, by the way.) I don’t really know what to do about that kind of problem, and this is something you could see in any branch of medicine.

     

    I was thinking about this whole thread a little more last night. The big problem I see is this:

     

    Abortion is too difficult to access for women who have the worst situations. There was a feeling that if we didn’t help them, no one would. That’s not an excuse for giving misinformation or putting patients at risk. However, that desperation on the part of both patients and staff is the route of most of the bad things I’ve seen from staff (in real life, and on the tapes from undercover pro-lifers).

     

    Increasing access by removing TRAP laws and other restrictions would take pressure off of out-patient surgery clinics, because the majority of abortions (first trimester) could be performed by primary care doctors. If all of them performed a few abortions per month, clinics like mine wouldn’t have to see 100-200 patients for surgery (that’s not including pre-op appointments, which we saw on top of our surgery schedule) each week. We’d be able to schedule longer appointments for fewer patients and actually get to spend time with them. We could spend more time connecting them with outside resources if they were too far along to be safely seen.

     

    But that can’t happen until we increase the number of primary care doctors. They currently see more patients than they can handle, as well. They may not have the time or training to provide abortions. Training could be handled by actually teaching abortion techniques in medical school, and that’s a big fucking fight too. Increasing the number of primary care providers? That’s a long-term goal, but maybe we should let NPs and PAs perform first trimester surgical abortion… and that’s another huge fight.

     

    Even with all of that potential change, almost all of our patients came from Kaiser… because they won’t perform abortions in their facilities. I don’t know why, but we ended up serving the patients sent from every Kaiser hospital in the region (a lot). It made me wonder if Kaiser recieved funding that they wouldn’t get if they performed abortions on their own patients. So, that’s something to consider as well… restrictions on funding hospitals/programs/clinics based that provide abortion. Similar to the Mexico City policy fight.

     

    This whole thing is complicated enough without the morality police coming in trying to tell people what is right and what is wrong. They just muck up the situation even more by preventing us from getting to these very real problems in abortion care and the medical system in general. The restrictions they pass create more problems than they solve, but they won’t look past their ideology to see that. So, I just don’t see the current restrictions being lifted… it makes me feel very frustrated, like I don’t know if anything can/will be done to actually make things better. Worst of all, I don’t even know where to start.

  • prochoiceferret

    So I’m wondering what you think my 1st favorite is.

     

    Actually, I misspoke. It’s your distant-third-favorite talking point.

     

    I forgot about the whole gift thing :-3

  • crowepps

    Oh, hey, it may be BS, or I may have just worded it badly because I was in a hurry and I was sloppy, but my point was that there seems to be an underlying assumption on many people’s parts, and I’ll admit I do this myself, that we have every right to hold philosophical discussions about what other women should do and how other people ‘deserve’ to be treated based on our opinion of their behavior.   I think it’s a basic human trait based in the need to have things make sense to US, personally, but it sure causes immense problems in a diverse society.

    “The first thing a principle does is kill somebody.” Dorothy Sayer

  • julie-watkins

    I don’t mind TL/[Did]R when I learn reading the essay.

    So, I just don’t see the current restrictions being lifted… it makes me feel very frustrated, like I don’t know if anything can/will be done to actually make things better. Worst of all, I don’t even know where to start.

    I don’t know either, so I keep pointing to Canada. I keep pointing out this is a also a class war, not exclusively sexism. As ProChoiceFerret points out, I tend to repeat certain talking points. (I think “Canada” is #4.) I call out people when they write/say misogyny or classism, and won’t back down if that person or group insists I’m mischaracterizing. I also try to use pragmatic arguements instead of ideology whenever possible — I agree with you about ideology – since ‘bad’ arguments taint good arguments. I try to ask “why?” loud and often enough that someone who does see a way to start knows they’ll have my back. I find stressing the system is classist as well as stressing how the system is sexist helps a great deal. It’s the low status of women in general that pointing out “the obvious” isn’t (sigh) and “but mothers are supposed to…” and all the cultural training. It’s harder to argue away all the classism. The injustices of the growing income gap are too obvious to explain away.

  • julie-watkins

    I like having my name in subject headers, esp when I’m not being told why my attitudes need “fixing”.

    I like the gift thing. I don’t know if it works in other languages (despite being a Tolkien fan, I can only handle English & some ASL) but I think the relation of “give a gift” and “give birth” and labor (to get money) and labor (to give birth)helps the argument continuing a pregnancy should be a choice.

  • furrfu

    I don’t know if anybody remembers this, but within my own lifetime (I’m 53) it was standard procedure to do surgery on newborn babies with no anesthetic, because it was safer, and it was assumed that they felt no pain because they didn’t cry or wiggle.  For all I know, this is still standard procedure for everything from piercing ears to open-heart surgery.  If a newborn baby feels no pain, how can you think a fetus would?

  • mechashiva

    I’ll definitely agree with that. It’s part of the reason I mostly dropped out of activist communities (online and offline) while I was working.

  • prochoicekatie

    You are correct in your assessment of newborn surgeries. The research that was done to determine whether or not fetuses could feel pain was based on the nerve structures that had developed at that point. The role of certain neurotransmitters, particularly in-utero, producing a barely conscious state (if conscious at all) is the primary reason that the studies that “prove” fetal pain are so controversial.

     

  • arekushieru

    MechaShiva, if you do continue to read this, I want to warn you, since I am unaware of what your perception of this comment might be, that it could *possibly* be triggering.  I apologize in advance if that does turn out to be the case, because that was *not* my intent.

     

    Apology accepted.  However, I’m not sure if, perhaps, the main thrust of my later argument should still stand…?

     

    Still, there is one point I want to clarify.  It was the unintended correlation between your usage of the term ‘window-dressing’ and your rejection of my statement without it that brought on the implications I so objected to.  I hope it’s understandable how I came to that (erroneous, I now recognize) conclusion, too…?

     

    A couple of other things I would like to point out, at least;

     

    1. If the right to bodily autonomy is such a theoretical and ideological argument, then should it not be similarly condemned as a blanket assessment in regards to a person’s right to determine who uses what organs and when and how they are used, regardless of circumstances (but I think anyone would be hard put to find standing to do that)? 
    2. If it is an ideological argument, why have such precedents been set within the purview of legal proceedings like Schimpf Vs McPhail (I know I spelled one or both of those names wrong)? 
    3. If it is an ideological argument, why do restrictions, in this case, hinge only on the biological functions of the female body, something a woman has no direct control over and did not acquire voluntarily, when nowhere else do similar restrictions apply? 

     

    Believe me, organ transplantees, who are indisputably human beings, do die on the waiting list.  About a quarter of them, or, at least, nearly the same percentage of deceased feoti from abortions that are performed on pregnant women, anyways.  And, just because someone wasn’t ‘deliberately’ killed, doesn’t mean that they are any less dead.  Which is why I’m pretty certain that any restriction (other than a non-abortive procedure being medically-indicated - similar to an analogy PCF made in regards to other circumstances - such as in the case of rupture of the uterus due to repeat C-sections, as mentioned in another thread, here on RHRealityCheck) to abortion only applies because of certain biological functions that women have, which I find sexist and, thus, unconstitutional. 

     

    As to your point about moderate abortion positions, I have actually been in several conversations here, and on FB, and have talked to women who held  similar conversations, where PLers have automatically assumed that just because most ProChoicers find abortion immoral at certain points, abortion, itself, is an immoral act.  That is what I meant by PLers getting their foot in the door. 

  • mechashiva

    Bodily autonomy, like any right, is a social construct that exists only because we – as a culture – believe that it should. I don’t have a problem with that.

     

    When it comes to arguments in favor of removing all legal restrictions on abortion, I simply think that practical arguments are better (just my opinion, I’m not sure if it is more effective in persuading undecided voters). When you hinge most of your points on ideology, it won’t be effective regardless of how consistently your apply that ideology. The argument may be logically sound, but it isn’t convincing to anyone other than the people who already agree with you. Case in point, the “consistent pro-life” position.

     

    Most people have some feelings about abortion that would make them sympathize with both sides. Both sides try to manipulate moderate voters, and pro-lifers tend to try and do so by playing on emotions. I’d rather not do things their way.

  • julie-watkins

    I think it’s more useful to use pragmatic arguments when there is a clash of ideology because you aren’t then arguing that the other person has to change her/his mind about her fundamental beliefs. You’re not asking her/him to back down, you’re presenting him/her with areal life situation and asking her/him to be reasonable. Plus you might get him/her to admit a bit of grey into her/his black & white viewpoint.

    In the context of a court of law, however, drilling down to foundational principles can make compelling arguments. I’m thinking of Prop 8 & California. What worked for getting the amendment passed fell apart in the courtroom.