Abortion Falsehoods and Truths
The Providence Journal’s editorial on the Supreme Court’s partial-birth abortion ruling isn’t quite as deceptive/deluded as Mary Ann Sorrentino’s, but at the very least, it’s misleading (emphasis added):
The U.S. Supreme Court’s 5-to-4 decision upholding the right of the federal government to impose a ban on a certain form of rarely performed second-trimester abortion is unfortunate in two major ways.
First, it extends the role of the federal government into areas best left to physicians. The court upheld the idea that there be no medical exception in which a woman’s physician, after determining that so-called partial-birth abortion (“intact dilation and evacuation”) was necessary to protect the health of the woman, could then perform the procedure.
Apparently, allowing for the procedure in order to save the life of the mother doesn’t count as a “medical exception.” Judging from the Projo’s bizarre notion of federalism, however, one must leave open the possibility that the word “exception” is used, here, to mean “constitutional right to whatever abortionists can do.” I say this because it seems the editors feel that the federal government’s power should be limited to granting broad rights to death, thus barring states from making anything more than moderate exceptions, without its being, for some reason, as unfortunate when a state government meddles in “areas best left to physicians.” (Curious, that.)
Further, whatever you think of this procedure, that the federal government in this case has again intruded into an area that seems to us to be most properly situated close to or in domestic law — and therefore in our federal system under state jurisdiction — should trouble even many conservatives. This is part of a troubling pattern we have seen in the Bush administration of undermining the right of the states to regulate medicine within their boundaries. The Terry Schiavo case and the Oregon assisted-suicide law provide the best known cases of such, to us, inappropriate intervention.
In short, the ruling appears to be a dangerous over-reaching of federal jurisdiction, and one that we especially fear may set an unfortunate precedent for further inroads into individual rights and the relationship between physician and patient, up to and including an outright federal ban on abortion, thus overturning 1973’s Roe v. Wade protection of that right.
Contrary to the Projo’s dismissive “whatever you think of this procedure,” before conservatives — or just, you know, human beings — decide what they should be troubled about, it might be helpful for them to understand just what they’re supposed to gloss over. Here’s a passage from Gonzales v. Carhart by which future generations will have opportunity to judge us for centuries hence (citations removed):
The surgical procedure referred to as “dilation and evacuation” or “D&E” is the usual abortion method in [the second] trimester. Although individual techniques for performing D&E differ, the general steps are the same.
A doctor must first dilate the cervix at least to the extent needed to insert surgical instruments into the uterus and to maneuver them to evacuate the fetus. The steps taken to cause dilation differ by physician and gestational age of the fetus. …
After sufficient dilation the surgical operation can commence. The woman is placed under general anesthesia or conscious sedation. The doctor, often guided by ultrasound, inserts grasping forceps through the woman’s cervix and into the uterus to grab the fetus. The doctor grips a fetal part with the forceps and pulls it back through the cervix and vagina, continuing to pull even after meeting resistance from the cervix. The friction causes the fetus to tear apart. For example, a leg might be ripped off the fetus as it is pulled through the cervix and out of the woman. The process of evacuating the fetus piece by piece continues until it has been completely removed. A doctor may make 10 to 15 passes with the forceps to evacuate the fetus in its entirety, though sometimes removal is completed with fewer passes. Once the fetus has been evacuated, the placenta and any remaining fetal material are suctioned or scraped out of the uterus. The doctor examines the different parts to ensure the entire fetal body has been removed.
Some doctors, especially later in the second trimester, may kill the fetus a day or two before performing the surgical evacuation. They inject digoxin or potassium chloride into the fetus, the umbilical cord, or the amniotic fluid. Fetal demise may cause contractions and make greater dilation possible. Once dead, moreover, the fetus’ body will soften, and its removal will be easier. Other doctors refrain from injecting chemical agents, believing it adds risk with little or no medical benefit.
The abortion procedure that was the impetus for the numerous bans on “partial-birth abortion,” including the Act, is a variation of this standard D&E. The medical community has not reached unanimity on the appropriate name for this D&E variation. It has been referred to as “intact D&E,” “dilation and extraction” (D&X), and “intact D&X.” For discussion purposes this D&E variation will be referred to as intact D&E. The main difference between the two procedures is that in intact D&E a doctor extracts the fetus intact or largely intact with only a few passes. There are no comprehensive statistics indicating what percentage of all D&Es are performed in this manner.
Intact D&E, like regular D&E, begins with dilation of the cervix. Sufficient dilation is essential for the procedure. To achieve intact extraction some doctors thus may attempt to dilate the cervix to a greater degree. This approach has been called “serial” dilation. Doctors who attempt at the outset to perform intact D&E may dilate for two full days or use up to 25 osmotic dilators.
In an intact D&E procedure the doctor extracts the fetus in a way conducive to pulling out its entire body, instead of ripping it apart. One doctor, for example, testified:
“If I know I have good dilation and I reach in and the fetus starts to come out and I think I can accomplish it, the abortion with an intact delivery, then I use my forceps a little bit differently. I don’t close them quite so much, and I just gently draw the tissue out attempting to have an intact delivery, if possible.”
Rotating the fetus as it is being pulled decreases the odds of dismemberment. A doctor also “may use forceps to grasp a fetal part, pull it down, and re-grasp the fetus at a higher level–sometimes using both his hand and a forceps–to exert traction to retrieve the fetus intact until the head is lodged in the [cervix].”
Intact D&E gained public notoriety when, in 1992, Dr. Martin Haskell gave a presentation describing his method of performing the operation. In the usual intact D&E the fetus’ head lodges in the cervix, and dilation is insufficient to allow it to pass. Haskell explained the next step as follows:
” ‘At this point, the right-handed surgeon slides the fingers of the left [hand] along the back of the fetus and “hooks” the shoulders of the fetus with the index and ring fingers (palm down).
” ‘While maintaining this tension, lifting the cervix and applying traction to the shoulders with the fingers of the left hand, the surgeon takes a pair of blunt curved Metzenbaum scissors in the right hand. He carefully advances the tip, curved down, along the spine and under his middle finger until he feels it contact the base of the skull under the tip of his middle finger.
” ‘[T]he surgeon then forces the scissors into the base of the skull or into the foramen magnum. Having safely entered the skull, he spreads the scissors to enlarge the opening.
” ‘The surgeon removes the scissors and introduces a suction catheter into this hole and evacuates the skull contents. With the catheter still in place, he applies traction to the fetus, removing it completely from the patient.’ “
This is an abortion doctor’s clinical description. Here is another description from a nurse who witnessed the same method performed on a 26-week fetus and who testified before the Senate Judiciary Committee:
” ‘Dr. Haskell went in with forceps and grabbed the baby’s legs and pulled them down into the birth canal. Then he delivered the baby’s body and the arms–everything but the head. The doctor kept the head right inside the uterus… .
” ‘The baby’s little fingers were clasping and unclasping, and his little feet were kicking. Then the doctor stuck the scissors in the back of his head, and the baby’s arms jerked out, like a startle reaction, like a flinch, like a baby does when he thinks he is going to fall.
” ‘The doctor opened up the scissors, stuck a high-powered suction tube into the opening, and sucked the baby’s brains out. Now the baby went completely limp… .
” ‘He cut the umbilical cord and delivered the placenta. He threw the baby in a pan, along with the placenta and the instruments he had just used.’ “
Dr. Haskell’s approach is not the only method of killing the fetus once its head lodges in the cervix, and “the process has evolved” since his presentation. Another doctor, for example, squeezes the skull after it has been pierced “so that enough brain tissue exudes to allow the head to pass through.” Still other physicians reach into the cervix with their forceps and crush the fetus’ skull. Others continue to pull the fetus out of the woman until it disarticulates at the neck, in effect decapitating it. These doctors then grasp the head with forceps, crush it, and remove it.
Some doctors performing an intact D&E attempt to remove the fetus without collapsing the skull. Yet one doctor would not allow delivery of a live fetus younger than 24 weeks because “the objective of [his] procedure is to perform an abortion,” not a birth. The doctor thus answered in the affirmative when asked whether he would “hold the fetus’ head on the internal side of the [cervix] in order to collapse the skull” and kill the fetus before it is born. Another doctor testified he crushes a fetus’ skull not only to reduce its size but also to ensure the fetus is dead before it is removed. For the staff to have to deal with a fetus that has “some viability to it, some movement of limbs,” according to this doctor, “[is] always a difficult situation.”
D&E and intact D&E are not the only second-trimester abortion methods. Doctors also may abort a fetus through medical induction. The doctor medicates the woman to induce labor, and contractions occur to deliver the fetus. Induction, which unlike D&E should occur in a hospital, can last as little as 6 hours but can take longer than 48. It accounts for about five percent of second-trimester abortions before 20 weeks of gestation and 15 percent of those after 20 weeks. Doctors turn to two other methods of second-trimester abortion, hysterotomy and hysterectomy, only in emergency situations because they carry increased risk of complications. In a hysterotomy, as in a cesarean section, the doctor removes the fetus by making an incision through the abdomen and uterine wall to gain access to the uterine cavity. A hysterectomy requires the removal of the entire uterus. These two procedures represent about .07% of second-trimester abortions.
As one who is generally strongly supportive of states’ right to differ substantively in their laws, I have to say that, as with slavery, I’ve no qualms about allowing the federal government to “dangerously overreach” to make blanket prohibitions of monstrosity.