Cura personalis

Hey guys.  I haven't written in eons, but I had a conversation quite recently that has sent me racing back to my little blog, anxious to share my indignation with anyone who will listen.

This was what transpired:  I had a patient last week, a nice, older male, armed with a full set of nice, older male "family values."  Towards the end of our encounter, he told me happily of a story he had heard on the news.  To be brief, the story centered around a young pregnant woman with cancer, who forewent chemotherapy in order to deliver a healthy baby.  Due to the delay in treatment, she died soon after giving birth, a decision my patient lauded and defended.  Lest I doubt his thoughts on the matter, he added:  "Isn't that just great?  So many women would be selfish and put themselves first, and so many would even throw their babies away and have an abortion!"

http://www.turnbacktogod.com/virgin-mary-pictures-06/

Now, who knows what particular instance this man was referencing.  There are countless instances of pregnant women choosing to put the well-being of their fetuses above their own.  Choosing being the operative word.  All well and good.  Yet once this decision becomes expected of women, once we as a society make the Rick Santorum-approved assumption that a woman - endowed with hopes, dreams, life experiences, the abilities to enjoy life an to contemplate death - is worth less than the fetus she is carrying, we have come to a dangerous conclusion.

There is already a disturbing history of Catholic hospitals (which, by the way, comprise 13% of healthcare providers in the U.S.) denying life-saving care to pregnant women.  It is the Church's official policy not to provide therapeutic abortions even in cases of ectopic pregnancy.  Under the auspices of the so-called "Protect Life Act," these hospitals could continue to withhold treatment while still receiving federal dollars!  Catholic hospitals which do perform such procedures may face loss of funding, excommunication, and general Catholic self-righteousness.

Fittingly, just as I had this issue on the brain, I interviewed this morning at Georgetown's (Catholic) School of Medicine.  After a long speech about Georgetown's philosophy of "cura personalis," the "respect for the individual humanity of every patient," we sat in on a class on, of all things, complications of pregnancy.  The descriptions of ectopic and molar pregnancy were not followed by mention of treatment, in good Catholic form.  Question:  Could I really attend this school?

Answer:  Even if I don't, society's views on motherhood and the rights of women extend, alas, far beyond the nunnery walls.

First Amendment Madness in Maryland

A few weeks ago, I performed my very first "active" duty as a pro-choice activist and attended the "Summer of Choice" rally in Germantown, Maryland.  Germantown, right in my very backyard, just happens to be the home of Dr. Leroy Carhart, one of the nation's few late-term abortion providers.  Like Dr. George Tiller, Dr. Carhart is on the very vanguard of the abortion debate, often singled out and/or blacklisted by the religious right.  Since Dr. Tiller's assassination, Dr. Carhart's precarious position has been all the more apparent:  there are people, many people, who want this man dead.

Accordingly, the "Summer of Choice" rally was populated with Dr. Carhart's passionate defenders.  Some had had abortions; all were thankful that their reproductive rights were protected should they ever need one.  The pro-life representation was surprisingly small, although there were the customary crucifixes and banners depicting dismembered, bloody fetuses.  One man allegedly told the patrolling cop that he should "turn his gun into the clinic and shoot the Baby Killer."

I was most surprised by the atmosphere of anxiety and even, at times, paranoia:  it definitely served as a harsh reminder of the reality of clinic violence that I will face every day if I do become an "abortionist," as the pro-lifers so lovingly call them.  This violence will become more than mere rhetoric:  it will become my Sword of Damocles.

I will admit, however, that I was somewhat disappointed by the protest.  My primary objection was the strong preponderance of female protestors, and I initially assumed that men were largely absent because they simply did not care.  I very quickly realized, however, that a pro-choice rally is often not a comfortable place for men, with feminist rage and man-hating running rampant.  Reproductive choice, women insist, is synonymous with radical and often divisive feminism.

I take issue with this viewpoint because I feel that making reproductive rights a "women's issue" cheapens the cause, making it something that only pertains to 50% of the population, something to be sequestered to the back of the store with tampons and Vagisil.  Reproductive rights and family planning are issues for everyone, not just Women's Studies majors on summer break.  Birth control, population, quality of life - these affect us all, and we should all be invested.   

Logic & Fallacy

Confronted with any one of the many justifications for abortion, a crisis pregnancy center or other pro-life entity will have some quick, ready-made, and single-minded response at hand.    If a fetus is severely genetically deformed, a clinic protester would proclaim that it is better to suffer as long as "God sees fit" than not to live at all.  If the mother is simply unprepared or unwilling to have a child, the CPC would insist that the "baby" would still prefer to live, regardless of the conditions it would be born into.

 

Obviously, a 2-month-old fetus cannot choose anything, so a fully-developed human can only retroactively make this "choice."  In essence, the pro-life argument is that regardless of the quality of one's life, it is always better to come into existence than not to do so.  Philosophically, the water that this argument holds is pretty likely to break.  Haha. 

If my mother were, by chance, not pro-life - and the fact that she gave birth to me does not automatically negate that possibility - then I would not be conscious to regret that fact.  Now that I already exist, I suppose that I am grateful for the events that made my birth possible, but that in no way implies that the world would somehow be worse off if I had never been conceived or born. Given that a hypothetical person who does not exist is ambivalent of that fact, non-existence cannot really be a negative.  Pain and unfortunate life circumstances, however, are decidedly less neutral states of being.

The absurdity of this line of reasoning was highlighted much more aptly by everyone's favorite atheist, biologist, and sometimes pro-choice philosopher, Richard Dawkins.  Even though I think Dawkins is often unnecessarily confrontational (not to mention overly arrogant for a biologist who has essentially no significant scientific findings to his name) I have included the following fairly brilliant article below, with full rights to Dick.  Enjoy.

The Great Tim Tebow Fallacy

Q: The conservative Christian group Focus on the Family is sponsoring a pro-life ad, featuring football star Tim Tebow, during Sunday's Super Bowl. Should CBS show the ad? Should CBS allow other faith-based groups to buy Super Bowl ads promoting their beliefs on social issues? Is a major sporting event, or a TV ad campaign, an appropriate venue for discussing such vital and divisive culture-war issues like abortion?

I gather that Tim Tebow is extremely good at football. That's just as well, for he certainly isn't very good at thinking. Perhaps the fact that he was home schooled by missionary parents is to blame.

The following is what passes for logic in the Tebow mind. His mother was advised by doctors to abort him, but she refused, which is why Tim is here. So abortion is a bad thing. Masterful conclusion.

It is a version of what, following the great Nobel-Prizewinning biologist Peter Medawar, I have called the Great Beethoven Fallacy.

Versions of the Great Beethoven Fallacy are attributed to various Christian apologists, and the details vary. The following is the version favoured by Norman St John Stevas, a British Conservative Member of Parliament. One doctor to another:

"About the terminating of pregnancy, I want your opinion. The father was syphilitic. The mother tuberculous. Of the four children born, the first was blind, the second died, the third was deaf and dumb, the fourth was also tuberculous. What would you have done?"

"I would have terminated the pregnancy."

"Then you would have murdered Beethoven."

It is amazing how many people are bamboozled by this spectacularly stupid argument. Setting aside the simple falsehood that Ludwig van Beethoven was the fifth child in his family (he was actually the eldest), the falsehood that any of his siblings was born blind, deaf or dumb, and the falsehood that his father was syphilitic, we are left with the 'logic'. As Peter Medawar, writing with his wife, Jean Medawar, said,

"The reasoning behind this odious little argument is breathtakingly fallacious . . . the world is no more likely to be deprived of a Beethoven by abortion than by chaste absence from intercourse."

If you follow the 'pro-life' logic to its conclusion, a fertile woman is guilty of something equivalent to murder every time she refuses an offer of copulation. Incidentally, 'pro life' always means pro human life, never animal life although an adult cow or monkey is obviously far more capable of feeling pain and fear than a human fetus. But the profoundly un-evolutionary nature of this terminology is another story and I'll set it on one side.

The sperm that conceived Tim Tebow was part of an ejaculate of (at an average estimate) 40 million. If any one of them had won the race to Mrs Tebow's ovum instead of the one that did, Tim would not have been born, somebody else would. Probably not such a good quarterback but - we can but hope - a better logician, who might have survived the home schooling and broken free. That is not the point. The point is that every single one of us is lucky to be alive against hyper-astronomical odds. Tim Tebow owes his existence not just to his mother's refusal to have an abortion. He owes his existence to the fact that his parents had intercourse precisely when they did, not a minute sooner or later. Then before that they had to meet and decide to marry. The same is true of all four of his grandparents, all eight of his great grandparents, and so on back.

Religious apologists are unimpressed by this kind of argument because, they say, there is a distinction between snuffing out a life that is already in existence (as in abortion) and failure to bring life into existence in the first place. It's not a distinction that survives analytical thought, however. Look at it from the point of view of Tim's unborn sister (let us say), who would have been conceived two months later if only Tim had been aborted. Admittedly, she is not in a position to complain of her non-existence. But then nor would Tim have been in a position to complain of his non-existence, if he had been aborted. You need a functioning nervous system in order to complain, or regret, or feel wistful, or feel pain, or miss the life that you could have had. Unconceived babies don't have a nervous system. Nor do aborted fetuses. As far as anything that matters is concerned, an aborted fetus has exactly the same mental and moral status as any of the countless trillions of unconceived babies. At least, that is true of early abortions, which means the vast majority.

The fact that the Tim Tebow advertisement is a load of unthought-through nonsense is no reason to ban it. That would infringe our valued principle of free speech. The best that the rest of us can do is point out, to anyone that will listen despite our lack of money to pay for such advertisements, that it is nonsense. As I have just done.

Doubleplus Terrifying

In sifting through a never-ending deluge of pro-life articles, blogs, and propaganda, I am particularly rankled by a particular sort of rhetoric.  My pro-life counterparts have an uncanny ability to transform seemingly positive words, such as "life" or "family," into creepy code words for what I term "breeding mentality."  That is, when used as pro-life doublespeak, these words refer to the disturbing, but not uncommon, notion that women (and men) exist for the sole purpose of reproduction and child-rearing.  Hash-tagged too are the misogyny, homophobia, and rejection of science typically associated with the "culture of life" movement.  If you don't believe me, just check out Life Site News, Focus on the Family, or Right to Life.

 

http://www.ncregister.com/blog/pro-life_group_shut_out_at_duke_university/ 

Take, for example, the so-called "Heartbeat Bill," which was passed this week by the Ohio House of Reps.  Under this law, abortions could not be performed after the first detection of a fetal heartbeat - at about 6 weeks post conception.  Thus, if ratified, this sweet-sounding bill will essentially override Roe v. Wade and spell an end to abortion rights in that state.  For other such examples, see the Protect Life Act and the unratified Sanctity of Life Act.

Well, at last someone has made a cinematic portrayal of the abject terror the pro-life movement at times elicits from me.  "The Life Zone," a pro-life horror film which premiered June 6 at the Hoboken Film Festival, is essentially a low-budget M. Night Shyamalan flick meets the Left Behind series.  Plus a good dose of Catholic-style afterlife torment.

 

The Life Zone

So, I probably won't be lining up in costume for the midnight showing of this one.  But I think that in attempting to make its point artistically, the "The Life Zone" hits a little too close to home.  For many women, the loss of reproductive rights would mean being trapped in a horrifying (virtual) Purgatory, forced to bear and raise an unwanted child.  Pro-life activists:  it may be that while you hide behind your Virgin Marys and Precious Moments dolls, your doublespeak is masking the fact that you place the rights of a fetus before those of a woman, and that you would willingly force a woman to carry a pregnancy to term.  Those are some real family values.

One in Three

If you know three or more women, then it's fairly likely that one of them has had an abortion.  According to the Guttmacher Institute, 35% of US women have undergone this procedure.  Of those women, 61% already have at least one child.

Yet you're not likely to have a happy hour conversation with your best gal pal about the abortion she had last year.  Thus, comedienne Chelsea Handler, who frequently makes light of alcoholism and celebrities' eating disorders, made some waves last week when she openly admitted to having had an abortion at the age of 16.  "Because that's what I should have done.  Otherwise, I would now have a 20 year old kid."

Chelsea Handler:  One in three.

The stigma surrounding abortion is no secret.  Thus, any woman, famous or not, who "comes out" about her abortion is likely to face some hostility or criticism.  Fortunately, the Safe Abortion Project is an organization dedicated to reversing this trend.  This group  encourages women to speak up about their experiences with abortion in order to keep the procedure safe and legal.  There are also forums, such as the National Abortion Federation's blog, which publish women's abortion stories judgment-free to shed light on the myriad reasons why a woman might choose to have an abortion.  These are steps in the right direction.

http://thephoenix.com/boston/news/68790-i-had-an-abortion/

This takes balls

The movement to "break the silence" has unfortunately been co-opted by the other side as well, with religiously-affiliated organizations like Project Rachel and Silent No More.  These groups encourage women to tell discuss their (negative) experiences with abortion in order to address the mythical "Post Abortion Syndrome," and to frighten women out of having abortions themselves.  Nevertheless, women of any religious or political leaning are still more likely than not to clam up about undergoing the most common medical procedure performed in America.

While flipping through channels on any given day, you can see around three shows about boob jobs or facelifts or weight loss surgery, and hear the claims subjects give that this procedure will raise their self esteem or better their lives in some way.  You can also choose from an enormous selection of pregnancy- and baby-related programming, including "Birth Day," "Deliver Me," "A Baby Story," and "Sixteen and Pregnant."  

But the topic of abortion will never rear its head without awkward silence and harsh judgement, because we as a society not only do not respect a woman's right to choose, but barely understand or accept that she might not fucking want to have a kid.  We can accept the idea that plastic surgery or weight loss can positively impact a woman's health or self esteem, but can't acknowledge that the prevention or termination of unwanted pregnancy could have even more profound effects on a woman's ability to support herself financially, finish her education, or better care for already existing children.   Successful women like Rep. Jackie Speier or even Chelsea Handler have attained success in part because they were able to delay childbearing in favor of education and career.  Let's see a TLC two-part special about that.

Pain in the Ass

An bill making its way through the Ohio legislature has attracted a lot of attention lately for proposing that abortions be outlawed after a fetal heartbeat can be detected - which occurs about 6 or 7 weeks after conception.  This law - HB 125 - is not only in direct defiance of Roe v. Wade (which mandates that abortion rights not be violated prior to viability, currently defined at 24 weeks of gestation), but was also recently the subject of a court case in which a pregnant woman was given a ultrasound in the courtroom when her 9-week-old fetus was called to "testify."

Similarly, many states require that a pregnant woman have an ultrasound and listen to her fetus' heartbeat prior to obtaining an abortion.  These ridiculous bills are founded on the sappily sweet "Touched by an Angel" sentiment that a beating heart on an ultrasound could never cause anything but joy and reverence.  Naturally, however, lots of organisms have circulatory organs just as complex as the heart tube found in the 7-week fetus:  the cattle and pigs we don't hesitate to slaughter for meat, for example.  Maybe McDonald's patrons should be legally required to listen to a bovine heartbeat before deciding whether to order a McRib.

As does a major myocardial infarction, fatass

What worries those of a slightly more scientific, less sentimental nature is the issue of embryonic brain development and fetal pain.  After all, no brain, no pain.  The fetal pain argument has recently led five US states (Kansas, Nebraska, Indiana, Oklahoma, and Idaho) to ban abortions after 20 weeks of gestation - once again, in direct opposition to Roe v. Wade.  Now, since I just finished writing a paper on fetal cortical development for my Developmental Biology course, I'll try to reproduce the gist of the argument here to dispel any and all concerns for fetal pain in abortion.

The cerebral cortex, the portion of the brain necessary for thought, language, and pain sensation, begins forming around 8 weeks post conception, when the anterior and posterior regions of the dorsal telencephalon start secreting signals to pattern the cortical layout.  From this point, cortical progenitor cells in the subventricular zone begin differentiating into glial cells and neurons, and neurons begin the process of migrating upward to the cortical plate.  Once they have reached their destination, they will undergo myelination and form synapses with other neurons, in a process which will continue throughout development and even after birth.

http://www.humpath.com/spip.php?article5287&id_document=4056

The brain of a 22-week-old human fetus

According to the Guttmacher Institute, 88% of abortions occur prior to 12 weeks of gestation.  At 12 weeks after conception, the regions of the cortex have been specified, but neuronal migration is just beginning, and will not be completed for at least another month.  The neuronal circuits that are needed for sensory perception will not form until much later, 24 weeks at the earliest.

Neurons beginning their migration

Neurobiologists are and have been in agreement that a fetus cannot feel pain prior to 24 weeks of gestation, since the circuits needed for sensation are simply not present before that time (seriously, no brain, no pain).  Less than 2% of abortions occur after 20 weeks of gestation, and abortions are performed after the 24-week mark only in the most dire of situations.  So, an aborted fetus can not and will not feel pain.  Questions answered?  Problems solved?  If only.

The Shutdown Gets Shut Down

Last week, an epic struggle over abortion rights was waged on the Senate floor, the most dramatic such debate in at least two weeks and the likes of which will only be seen five or six more times before the end of 2011.  With just an hour to go until complete and total anarchy (in the way of closed post offices and a parking free-for-all), the government shutdown was halted when the Republicans conceded defeat in their Game of Chicken and generously agreed to devote 0.008% of the federal budget to Planned Parenthood.

http://thefeministgriote.com/?p=775

Here are just a few things that we learned in the week leading up to the Shutdown:

• "Big Abortion" is something we should be worried about.
• Abortion constitutes over 90% of Planned Parenthood's services.
• You can get a mammogram and a Pap Smear at Walgreens.

http://www.newshounds.us/2011/04/12/brian_kilmeades_misogynistic_mocking_of_planned_parenthood.php

Now, while it is evidently permissible in political discourse to use absolutely any fabricated fact or preferably a bullshitted statistic to support your argument, it still remains the case that abortions constitute only 3% of Planned Parenthood's services, and Section 1008 of Title X already prohibits these abortions from being funded by federal dollars.  Yet, in just the same way that all women entering a PP facility for any reason are harassed indiscriminately, so too were the 97% of PP services that are not abortion-related to be defunded in the right's war of attrition on abortion and women's health.

This all leaves me utterly baffled as to what's truly at the root of the debate, because its clearly not the deficit.  I do, however, have my pet theories.  First:  America's religious, corn-fed middle and lower classes care more about fetuses than about women, to put it simply.  Babies have the fortune of being cute and innocent, whereas women have had sufficient time to fuck up in some aspect of life.  I can't tell you how many times I've come across this viewpoint just in perusing other Blogspot blogs and Facebook pages:  babies are sweet, innocent, and "gifts from God," and women who are not interested in producing more of them are whores, murderers, or both.

Second: America is viscerally afraid of and opposed to sex.  We are dedicated to denying that sexuality is a natural and universal aspect of life, whether we are married or single, straight or gay, trying to procreate or not.  Women's health services pertain to STDs, pregnancy, and the general state of having genitals - all of which are matters relate to sex.  Thus, Planned Parenthood falls into the category of "things your parents get awkwardly silent about and hope you don't notice," along with condom commercials and softcore porn mags.  So why devote funds to preventing the byproducts of sex - STDs, pregnancy, and cervical cancer - when these things only happen to bad people who are just getting what they deserve?

Luckily, the joke is on detractors of women's health, because donations to Planned Parenthood have increased 500% since the funding debate first began.  Evidently, there are people other than myself who feel that saving money by not providing condoms to low-income populations may not be the best cost-reduction approach in the long run.

A Call to Arms (and to Scalpels)

Three cheers for America's judicial system.  It may be the least-appreciated branch, the "Holy Spirit" of the federal government, so to speak, but for almost 40 years now it has firmly upheld Roe v. Wade against countless legal attacks to repeal and undermine it.  In the past few decades, however, slander, intimidation, and yes, even pro-life terrorism have been much more successful than legislative initiatives at chipping away at the right to choose. The pro-life side has managed, through numerous back-door approaches, to make obtaining an abortion difficult and humiliating, if still technically legal.  Today, the biggest threat to abortion rights in the US is not the legality of the procedure, but rather the logistical access to abortion services, due in large part to the near crisis-level shortage of practicing abortion providers in the US.

Abortion remains one of the most commonly-performed procedures in America, and is certainly one of the most often discussed.  Therefore, it probably surprises most people to learn that physicians who perform abortions (or "abortionists," as they are so often called) are few and far between.  As in "entire states of separation" far between.  If you need an abortion and live in Wyoming, Missouri, Mississippi, or, God forbid, Hawaii, you are shit out of luck:  these four states lack a single abortion provider.  Even in states with relatively progressive abortion laws access to abortion is hindered merely by the scarcity of providers.  In fact, the 1.21 million abortions performed in 2008 were provided by just 1,793 facilities, with half of these services provided by just 2% of OB-GYNs.  In contrast, the nation is blanketed by well over 4,000 crisis pregnancy centers.

http://www.catholicvoteaction.org/americanpapist/index.php?tag=pro-life

It's not difficult to imagine why so few physicians provide abortions.  Clinic bombings, "abortion hit lists," Bill O'Reilly's abortion witch-hunt, and the 2009 assassination of Dr. George Tiller have all achieved their intended effect:  terrifying physicians out of providing a legal and judicially-protected procedure.  There are additional factors at play as well.  Catholic hospitals, which employ around 16% of American doctors, prohibit their employees from performing abortions even to correct an ectopic pregnancy or other life-threatening complication.  Many OB-GYNs aren't even trained in the procedure, as fewer than half of residency programs require this training.  And even physicians who identify as pro-choice may be reluctant to perform abortions due to societal pressures and the awkwardness of rarely being able to discuss their work in polite conversation.

http://worstgenerationseed.blogspot.com/2009/03/truth-truck-meets-tiller-killer.html

As a very pro-choice pre-med, these matters have been on my mind for some time now.  The nation needs abortion providers.  Women need abortions, and they will not stop needing (and procuring) them just because their doctors are incompetent or untrained.  I will someday need a specialty, and I believe in providing a service that millions of women want and need.  Of course, now is not the time to commit to a career:  even by the most optimistic estimates, it will be more than five years before I have my MD.  And regardless of how passionate I am about the cause, I'm not sure whether I'm prepared for a career that will spell a lifetime of harassment, fear, disdain, and maybe even a bullet to the head.  But it's something to consider.

http://www.theologyonline.com/forums/showthread.php?t=66908&page=2

To Those Who Wait

In a grand gesture that infuriated many but shocked no one, the South Dakota legislature this week passed a new law, HB 1217, which will require that women wait a minimum of 72 hours before having an abortion - which, as many have pointed out, is less than the mandatory waiting time to purchase a handgun.  The feigned motive behind the bill is to ensure that the decision to terminate a pregnancy is "voluntary, uncoerced, and informed."  Yet no one believes for a moment that SD has taken women's informed consent and reproductive autonomy to heart.  Governor Dennis Daugaard, who signed the bill, proudly states that he hopes "women will use this three-day period to make good (i.e. correct) decisions."

The law doesn't go into effect until July 1, but it already has many of us reeling.  Twenty-nine states (including my own native Georgia) currently have mandatory waiting periods for abortions, but South Dakota's is by far the longest span of time that a woman is required to "sit and think about what she's done."  I would say that the "third day" idea is some kind of Biblical allusion, but Jesus was actually only dead for 36 hours or so.

http://echealthinsurance.com/wp-content/uploads/2009/11/South-Dakota.jpg

You still have a choice in South Dakota... technically.

The implications of HB 1217 are enormous, even from a merely practical standpoint.  According to the Guttmacher Institute, 76% of South Dakotans live in counties with no abortion provider, so women facing an unwanted pregnancy in SD already have to make a pilgrimage to the state's one and only abortion clinic in Sioux Falls.  Under the new law, that trip will now require at least three nights at a hotel and four days' leave from work.  Alternatively, obtaining an abortion could necessitate driving back and forth from Sioux Falls several times in a week, scheduling multiple appointments with the abortion provider, and arranging for childcare.  Add to that ordeal a nice visit to the friendly neighborhood crisis pregnancy center.  Of course, it is useless to raise such criticisms of the bill, as these complications are precisely what SD lawmakers are hoping for.  Though they cannot overturn Roe v. Wade, they can make obtaining an abortion as difficult and annoying as possible.  I won't be surprised if we begin seeing 8- and 9-month-long waiting periods.

http://www.cafepress.com/+south-dakota-pro-choice+mugs

The waiting period, however, is not the worst part of this legislation.  Far and above more ludicrous is HB 1217's requirement that women undergo "counseling" at a state-funded, medically unlicensed crisis pregnancy center.  Ah, this is where those "good decisions" are to be made.  Furthermore, lest the pro-choice side start getting any ideas about offering counseling, the bill proffers an exact definition of a CPC:

“The pregnancy help center has a facility or office in the state of South Dakota in which it routinely consults with women for the purpose of helping them keep their relationship with their unborn children; that one of its principal missions is to educate, counsel, and otherwise assist women to help them maintain their relationship with their unborn children; that they do not perform abortions at their facility, and have no affiliation with any organization or physician which performs abortions; that they do not now refer pregnant women for abortions, and have not referred any pregnant women for an abortion at any time in the three years immediately preceding July 1, 2011.”

Thus, the establishment required to give women pre-abortion "counseling" must, by definition, be staunchly pro-life.  This clause was introduced under the widespread misconception that Planned Parenthood encourages women to have abortions, that it somehow has something to gain from doing so.  In fact, Planned Parenthood does provide counseling, including information about parenting and adoption, to women who are considering abortion.  The difference is that this counseling does not have an agenda to push, whereas CPCs are all hellfire and medically inaccurate ideology. These centers already outnumber abortion clinics eleven to one in South Dakota.  Now, under HB 1217, their presence and influence will be even more far-reaching, and they will have even more license to guilt, terrify, and bully girls into making "the right choice."

http://www.thedailybeast.com/blogs-and-stories/2010-08-01/crisis-pregnancy-centers-mislead-women-new-laws-fight-back/

One of the many tools that will be used to help you make "good decisions."

Given that these centers are unabashedly religiously-affiliated, I have no idea how this clause can be constitutional; given that they force-feed their "patients" blatant and deliberate medical lies, I feel like we may be moving quickly into a post-medical dystopian society of government-sponsored deception.  Now, before I get ahead of myself spewing conspiracy theories, the absurdity and theocratic implications of this bill have already been duly noted by nearly everyone.  Article links about HB 1217 have been popping up on my Facebook newsfeed almost continuously, and the subject has come up constantly in conversation.  Rachel Maddow has already spoken out strongly against the bill; Planned Parenthood and the American Civil Liberties Union of South Dakota have promised to take it up in court.  We haven't heard the last word on HB 1217.  Yet it's encouraging and even somewhat of a relief to hear some healthy indignation, because this is the only thing that is going to keep abortion rights in America even at a measly status quo. 

The Utility of Choice

As a matter of reason, good taste, and, well, the entire principle of separation of church and state, Bible verses have no place in political discourse.  However, it's unsurprisingly difficult, if not impossible, to disentangle the abortion debate from religion.  The Bible apparently has a lot to say on the matter, since most pro-life websites are headed with quotes from the Book of Proverbs, images of a pained and sorrowful-looking Virgin Mary, and (the ultimate trump card) the question "What if Jesus had been aborted?"

What you don't hear much of are utilitarian arguments against abortion.  In a nation faced with a growing deficit and heinous unemployment, the far right still doesn't seem interested in forming logical social and economic justifications for its endless effort to overturn Roe v. Wade.  Now, I am fully on board with decreasing the national deficit and bettering overall quality of life, so I think we would do well to transfer the abortion debate from the religious to the practical sphere.  From a small-government, fiscally-responsible standpoint, are there any positive external effects of legally requiring a woman to carry an unwanted pregnancy to term?

http://intenseproductions.blogspot.com/2010/08/practicing-your-scales-effectively.html

Weighing pro-life against pro-quality of life.

The term "utilitarianism" scares us, or at least makes us uncomfortable.  We like to fancy ourselves ethical, to think that we don't "cut our losses" when it comes to issues of morality.  Yet we make a utilitarian bargain every time we eat meat or wage war.  So how do we apply these calculations to issues of reproductive choice?

First, there is the issue of population.  In a matter of months, the world's population will hit 7 billion; by 2030, it will be over 8 billion.  Needless to say, this "population bomb" will have far-reaching implications on the environment, politics, economics, and general quality of life.  Basically, everything.

http://www.blogiseverything.com/general/worlds-population-graphs/

This graph should scare the shit out of you, and if it doesn't, you probably lack basic abilities of projection.  Now add to this stunning rate of growth the fact that even in the United States, where contraception is readily available, half of pregnancies are unintended or unwanted.  This leaves us with a rapidly exploding world population of 7 billion people, at least one half of whom were born to parents who didn't want them, or didn't have the maturity or resources necessary to raise them.  Would illegalizing abortion impact these statistics positively?

Then there are the social effects of abortion.  As we learned from Freakonomics, the legalization of abortion in America corresponded with a decrease in the crime rate.  Similarly, there are indications that abortion lowers the incidence of child abuse.  Correlation doesn't imply causation, of course, and both these claims are surrounded with controversy based on statistical approachs to the questions.  Nevertheless, we can imagine how unwilling parents would be more likely to lash out at an unwanted child, and unwanted children more likely to last out at society.  And then there is the fact that abortion actually saves money:  by conservative estimates, each dollar spent on family planning saves us almost four down the road, in Medicaid and welfare costs.  Would defunding Planned Parenthood or overturning Roe v. Wade better financial stability and quality of life?

Finally, there are the effects of abortion on women themselves.  The pro-life side loves this argument, because it is a perfect opportunity for them to rail against abortion while pretending to care about women's rights and health.  From this ostensible concern has arisen the concept of "Post Abortion Syndrome," a mental-health condition which supposedly causes flashbacks, depression, and suicidal thoughts in 50% of women who have abortions.  

But alas, as much as the pro-life camp wishes that it existed, it turns out that studies which supported "PAS" were fraught with statistical errors, and it's actually just a load of shit.  When compared to women of similar socio-economic backgrounds who decided to carry their pregnancies to term, women who have had abortions actually fare the same, and often better, in terms of mental health.  Not surprisingly, being able to finish an education or further a career, remaining financially stable, and not having to bear and raise an unwanted child actually has positive effects on a woman's well-being.  And this isn't even touching the fact that Roe v. Wade ended the bloody era of coat-hanger abortions.

I haven't said a single thing here that hasn't been regurgitated time and time again.  That doesn't, however, dilute its significance.  Allowing women to take charge of their own reproduction has far-reaching positive implications, and I know not of any non-religious, practical justifications for the other side.

A fetus does not have a fully developed nervous system, lacks self-awareness, and cannot feel pain until at least 24 weeks of gestation.  In these regards, it ranks somewhere between a jellyfish and a salamander.  Thus, any concern felt for a fetus in another person's body can only be for its nebulous "soul," and thus can only be religious.  Naturally, this realization isn't likely to send shockwaves through a country of which 90% self-identifies as religious, and I would have to be fairly naive to pretend that the barrier between church and state is impermeable.  But let's make that barrier a latex barrier, and keep the pro-life separate from the pro-quality of life. 

Crisis

http://www.impact73.org/Lifeboards.php

Project Lifeboard offers you "options," but not "choice."

This week there was some good news in the world of Choice.  According to the NYC city council, Crisis Pregnancy Centers, pro-life organizations which disseminate ads like the one seen above, must now specify in their ads 1) what specific services they provide, and 2) whether or not they hold a medical license.  Baby steps, but steps in the right direction.  This is some progress, but I am far from satisfied, for numerous reasons.

These centers usually present themselves as medical clinics offering abortions and other pregnancy services, though their true purpose is to dissuade girls experiencing an unwanted pregnancy from having an abortion, and often to win Christian converts along the way.  Most centers are in fact unlicensed and staffed solely by religious volunteers and medical assistants – people who have had less than 6 months of medical training.  The only services offered are pregnancy tests and ultrasounds.  Even more absurd are the tactics used to wheedle girls into choosing to keep a baby:   “patients” at these centers are shown footage of a fetus’ beating heart, are encouraged to marry the baby’s biological father, and receive blatantly incorrect medical information about the dangers of having an abortion. 

According to the website of Ramah International, an alliance of pregnancy centers,  there are a few things I should know if I am considering an abortion:  1)  Abortion is a risky procedure, often performed in unsanitary conditions.  2)  Following an abortion, I am 33% more likely to experience an ectopic pregnancy, 50% more likely to develop breast cancer, and 600% more likely to experience abruptio placenta. 3)  Following an abortion, I have a 50% chance of developing “Post-Abortion Syndrome,” which leads to depression, anxiety, and suicide.  4) My fetus can feel pain beginning at 9 weeks.  And, most ridiculous, 5) I should first take a pregnancy test at the center, because THE DOCTOR WHO TOLD ME I WAS PREGNANT MAY HAVE LIED IN ORDER TO SELL ME AN ABORTION.

These claims are all false, as well as ridiculous (honestly, has a doctor ever told someone he had cancer in order to “sell” him a surgery?)  It is one thing to run an establishment dedicated to spewing hellfire and damnation of the religious variety on women who are in genuine distress.  It is quite another, however, to disseminate deliberately false medical information in an effort to terrify and manipulate women into making what will probably be one of the most important decision of their lives.  Imagine a scared, pregnant 16-year-old girl entering what she thinks is a medical clinic, being told that she has a ~50% chance of dying from the long-term effects of an abortion, and making a decision to keep and raise a baby based on that information.

But lest you think that this is the last stop on the Crazy Train, 20 US states currently provide funding for these Crisis Pregnancy Centers (my own native Georgia being one of them).  These are tax dollars, being spent on a service that masquerades as something it’s not and then lies directly to its clients.  This is like spending state money on a fire station which pretends to be a restaurant and then tells customers that too much friction during sex will cause a forest fire.  And these are the tax dollars we can’t afford to allocate for family planning.

Though NYC has voted to begin regulating its centers’ advertising and similar measures have been enacted in Maryland, such legislation has failed in most staes.  Nationwide, crisis pregnancy centers outnumber abortion clinics 4 to 1, and receive approximately $25 million of state and federal assistance.  Using tax funds to encourage teens to marry and raise children, without providing them with the appropriate pre- or post-natal care or contraceptive options?  Makes fiscal sense to me.

Pregnant?  Alone?  Confused?  For the love of God, go to a real doctor.

Dividing Cells, Splitting Hairs

In his 1968 encyclical Humanae Vitae, a treatise condemning the use of contraceptives, Pope Paul VI famously established the Catholic church's official stance on all matters procreative.  In the 40-odd years since the publication of Humanae Vitae, the Church has not budged it its contra-contraception position, and Pope Paul VI's treatise has been lauded as "prophetic"for how it anticipated today's issues of reproductive ethics.  These aren't just echoes of the "be fruitful and multiply" argument, however.  Supporters of the Church claim that the Pope's views on birth control are even more relevant given that chemical contraception is "known" to induce abortions through preventing implantation of a fertilized embryo.  Thus contraception is not a lesser, separate evil, but is tantamount to abortion itself.

http://stemcells.nih.gov/info/scireport/appendixa.asp

A life begins... OR WILL IT????

It's not just the Catholics who have voiced this condemnation of the "abortifacient" properties of birth control.  The Evangelicals who fill the ranks of the pro-choice movement are similarly quick to criticize any use of "unnatural" hormonal contraceptives.  There is the outstanding example of the Duggar family, who believe that their use of the Pill caused the miscarriage of one of their pregnancies back in the '80s, and have spent the past two decades atoning for this crime by pushing the limits of human reproductive capacity.  Just a quick Google search will yield a bevy of emotionally-charged, poorly-researched, and often blatantly deceptive websites devoted to defaming all birth control use and equating contraceptives with murder.  (Notable examples including Birth Control is a Sin, Birth Control Causes Abortions, AbortionFacts.com, and perhaps most horrifying, PoisonedByThePill).  A common thread throughout these websites is that of deliberate deception at the hands of doctors and pharmacists.   Readers are urged to "read the fine print" and "wake up" - as if the entire medical profession were aligned in some giant conspiracy to kill Evangelical embryos for the good of Science and Atheism and Richard Dawkins.

From this movement has grown a plethora of misconceptions and taboos about the "Morning After Pill" and oral contraceptives.  Many women worldwide are misinformed about emergency contraception and its mechanism of action:  some actually mistake the Plan B pill with RU486, the "abortion pill."  Pro-life lobbying on this issue has also spawned “the Pharmacist’s Conscience Clause,” a provision which allows a pharmacist to withhold oral contraceptives and the "morning after pill” on moral grounds. A recent study estimated that 6% of American pharmacists actually withhold contraception - which probably makes it pretty difficult to purchase birth control in Kansas.  This poor understanding of emergency contraception deters many genuinely well-meaning women and couples from choosing Plan B following unprotected intercourse - which, of course, is the intended effect of the religious fear-mongering. 

Now, Pope Paul VI was not a doctor or a biologist, so I was interested in how he arrived at his understanding of the mechanism of action of birth control pills and emergency contraception.  So I popped on over to PubMed to see what relevant (and unbiased) information medical researchers had discovered on the topic.

But first, a little background on early embryonic development: the human embryo typically implants in the uterine wall at the blastocyst stage, approximately one week after fertilization, when it consists of 32 cells.  To prevent a subsequent pregnancy, the ovaries begin secreting progesterone, a hormone which inhibits further ovulation.  Progesterone also inhibits the process of sperm capacitation, which enables a sperm to fertilize an egg.  In addition, this hormone thins the lining of the endometrium - just like it does during the luteal phase, i.e. a menstrual period.

Both oral contraceptives and older versions of the Plan B pill (which is essentially a higher dose of the same thing) rely on progestrin, a synthetic form of progesterone, essentially to trick the body into believing that it is already pregnant.  Thus, ovulation and sperm capacitation do not occur, and the endometrial lining thins.  It is this capacity of progesterone which has conservatives jumping down throats and splitting hairs about what constitutes prevention vs. termination of pregnancy, and losing sleep over the fate of the human blastocyst.

http://www.glowm.com/?p=glowm.cml/section_view&articleid=2&SESSID=evpji2lnn7ah65gbjah4bgnc40

So let's see what a few decades of medical research have to say on the matter.  First, newer Levonorgestrel-based contraceptives (such as Plan B One-Step) can apparently only prevent ovulation, and cannot prevent pregnancy once ovulation has occurred.  No studies indicate that Levonorgestrel has any "abortifacient" capabilities.  Thus, Levonorgestrel is only 80% effective at preventing pregnancy.  The results of studies on progesterone-based pills are a little bit hazier:  some report "with mild confidence" that progesterone prevents implantation, while others deny this to be the case.  Most review articles state that the prevention of implantation is "possible in theory," but do not provide relevant statistics.  In contrast, the post-coital insertion of an IUD has been shown to prevent implantation of an embryo; Mifepristone, the "abortion pill," can be taken in small doses to produce the same effect.

The general medical consensus:  certain forms of emergency contraception (Mifepristone and IUDs) have the secondary effect of preventing embryonic implantation.  However, the most commonly-used form of emergency contraception (Levonorgestrel), does not act in this way.  In regards to the Pill, it is possible in theory that these contraceptives prevent the implantation of a fertilized embryo, but no study to date has strongly indicated that this is the case.  I speculate that the findings of such studies are complicated by the fact that, even in the absence of birth control, at least half of fertilized human ova do not successfully implant.  Here's a little graph I threw together about the prevalence possible fetal fates in the U.S.:

Needless to say, these stats are going to make Georgia Rep. Bobby Franklin's job very difficult if he in fact intends to investigate and press charges for every miscarriage that occurs in his state.  The majority of fertilized oocytes to not make it to be full-fledged humans, even without medical or chemical interventions.  Ultimately, it is difficult to determine how often emergency contraception prevents an embryo from implanting when God Himself is already doing such a good job of it.

The Barren Middle Ground

I am glad that I have access to adequate dental care should I need a cavity filled.  That said, having a tooth filled is a pain in the ass:  it's expensive, time-consuming, and just generally unpleasant.  This is why I floss.

Stripped of its surrounding controversy, abortion is essentially the same as a tooth filling or root canal:  it is a medical procedure you're glad is available, but you hope you won't have to take advantage of.  No matter how pro-choice you are, I can guess that you aren't hoping to be put in a position that requires you to choose an abortion.

This is a perfect example of the often-overlooked middle ground between the typically so starkly-divided choice and life camps.  Both sides agree that abortion is not an inherent good, and that the fewer that are needed, the better.  From religious, social, economic, and medical perspectives, limiting the need for and occurrence of abortions, both legal and illegal, should be a common goal.  In place of debates on the legality of late-term abortions, technicalities of "forcible rape," and issues of spousal and parental notification, discussions of preventative measures against unintended pregnancy - contraception and education - might bring us farther in the effort to improve women's health.

But those interested in achieving any degree of compromise in  are few and far between.  Instead, discussion gives way to incoherent shouting, and polarizing rhetoric fuels the fight on both sides.  Arguments addressing "a woman's right to choose" are shot down with appeals to "a child's right to life."  Clever and incendiary bumper stickers stare each other down in the nation's parking lots while accomplishing absolutely nothing.    Ultimately, the issue has polarized us so much that the idealism on both sides - but particularly on the right - refuses to bend for the sake of practicality.

http://www.bible.ca/oral-birth-control-NO.gif

The pro-life movement is generally disinterested with preventing the need for abortion through access to birth control and education, because as I've said before, this movement is as much about sex as it is about abortion.  Sex is a sin, as is abortion:  religion is not a relativist institution, and it knows not how to choose "the lesser of two evils."  For many, the sole measure acceptable for the discussion of pregnancy prevention has long been, and continues to be, abstinence.  Efforts to increase access to birth control, to develop programs for comprehensive sex education, and even to provide the potentially life-saving HPV injection to adolescent girls have all been viewed by the right-wing as an invitation to, and tacit approval of, premarital sex. Statistics that show abstinence before marriage to be an unreasonable expectation do little to change religious arguments, and sexuality continues to be discussed only in normative terms.  Pro-life leaders are too idealistic to compromise, and no solution can be acceptable if it acknowledges the inevitability of extramarital sex.

http://www.nicodetourn.com/img/abstinence-life-control.jpg

Accordingly, numerous family-planning measures have recently been felled before the unwavering sexual idealism of the right wing.  In addition to the widely-publicized defunding of Planned Parenthood, and last year's decision to continue funding abstinence-only education programs, a measure to provide monies to the the United Nations Population Fund also floundered in the House just last week.  Interestingly, this organization does not provide funds for abortion.  Instead, it grants access worldwide to family planning resources, sex education, and maternal care, with the expressed goal of decreasing the number of unsafe abortions.  This is a cause we could, and should, all get behind.  Unfortunately, this extending of the olive branch is unlikely to happen any time soon, since it would mean acknowledging that sex does not necessitate marriage, and that pregnancy need not follow sex.  Lest you were wondering, the Ten Commandments are ever-present in our legislature... though I know not of any measures based on the presumption that we do not covet.

Sex: Crime & Punishment

It appears that the U.S. is experiencing a disturbing trend with regard to beliefs on abortion.  According to the Gallup Values & Beliefs Survey, 2009 marked the first year that more Americans self-identified as "pro-choice" than "pro-life."  Remarkably, the percentage of Americans who describe themselves as "pro-life" has been climbing gradually since the mid-90's.

This change over time is so depressing to those of the pro-choice persuasion that it's barely worth talking about.  However, what I find more interesting is another result of the Gallup survey:

Evidently, the percentage of Americans who see the issue completely in black and white, who feel that abortion should be strictly legal or illegal, is relatively small.  The majority of those polled actually believe that abortion should be legal only under certain circumstances.  These "certain" circumstances always boil down to exactly two:  1) To save the life of the mother, and 2) In cases of rape or incest.

First, it is fairly difficult to find someone opposed to abortions performed to save a mother's life (although  the pale green line at the bottom of this graph indicates that these folk do indeed exist).  This is one circumstance rarely (and thankfully so!) subject to public debate.

The second clause is one that has generated a great deal of discussion, particularly recently.  Just this past month, the House got its panties into a wad over the precise definition of "rape," arguing whether federal funds should be allocated for abortions in all cases of rape, or merely for those cases John Boehner deems legitimate.

Biologically, a fetus is a fetus, whether it was conceived through rape, incest, or consensual sex; it is the same entity in question.  However, in these certain cases, an abortion crosses a fine line from the "murder of innocents" to an understandable and necessary course of action.  What is it that sways public opinion in these cases?

Ultimately, it is the willingness of the mother.  If a woman was raped, and presumably did not enjoy the violent act, then she need not be burdened further with bearing and raising a child she did not intend to conceive - she need not pay the price for a crime perpetrated against her.  On the other hand, if a woman had consensual sex, and especially enjoyable sex, then the subtle implication of the "in all cases except rape and incest" argument is that an unwanted pregnancy is the punishment she deserves.

Ultimately, the abortion debate is as much about sex as it is about the termination of pregnancy, because the one act so clearly predicates the other.  To me, this smacks not of sincere people genuinely concerned with innocent fetal life, but rather of those who view sex as a crime, and pregnancy as just desserts for loose women.  If you are going to be truly pro-life or pro-choice, at least be consistent in your arguments.  Either that, or acknowledge that the issue is a thousand shades of gray.