Primum Non Nocere: In the midst of abortion, conscience is re-born

Discomfiting panic has shaken the celebratory sentiment which columnist Anna Quindlen calls the “euphoria of having a President who thinks abortion should be legal.” Mr. Clinton’s executive performance in support of abortion “has been exemplary to date,” writes Quindlen, approvingly, and as the President ushers in his own replacement for Roe v. Wade dissenter Justice Byron White, the public might be forgiven for puzzling over the recent alarm sounded in the mega-press by Quindlen and other abortion advocates.

The abortion proponents’ new anxiety is over the shortage of physicians in the United States who are willing to perform abortions: an abortionist deficit, as it were. “For three years, there have been numerous reports about the lack of doctors and facilities for abortion,” opines abortionist Dr. Warren M. Hem in a recent New York Times opinion piece. “The right to a safe, legal abortion is meaningless if no one is able or willing to perform it.”

Hem, whose 1984 book, Abortion Practice, painstakingly coaches doctors on the minutiae of performing grisly second-trimester abortions, outlines reasons for the deficit. In his view, they include a scarcity of residential training programs for abortion techniques, as well as determined harassment by anti-abortion protestors, with attendant excessive insurance costs, security expenses, and fear of personal safety on the part of abortion providers. Significantly, Hern suggests another problem: a stigma attached to large-volume abortionists. “Increasingly, doctors have been made to feel irrelevant. Feminist abortion clinics treat doctors like technicians and are especially contemptuous of male physicians.” He adds that the status of doctors who perform abortions “has plummeted lower than that of physicians who do insurance company examinations.” However, Hem continues, “The main reason doctors have become unwilling to perform abortions is of course political. When George Bush was elected in 1988 after advocating the imprisonment of doctors who performed abortions, it did not encourage many physicians to dedicate their careers to this specialty.”

In the May 1993 issue of the Journal of the American Medical Association, Janet Benshoof spins an additional reason for the abortion-doctor shortage: the chilling effect of new laws, including reporting requirements and fully-informed consent before abortion, which states may enact under the U.S. Supreme Court’s recent Planned Parenthood v. Casey decision: “The new constitutional [undue burden] standard articulated in Casey fundamentally weakens the constitutional protections Roe afforded both women and physicians….” “The restrictions are also likely to exacerbate the shortage of physicians providing abortion services by making the procedure more costly and the providers’ jobs more dangerous.”

There is, to be sure, some truth to the spin doctors’ assertions. Recent studies by the Alan Guttmacher Institute, the National Abortion Federation, and others indicate that abortions are not provided in 83 percent of all U.S. counties, and that the pool of abortion providers has dwindled. (The accuracy of this data, however, is not verifiable because of the absence in many states of abortion-reporting requirements.) Family Planning World reports that a mere 8,000 physicians performed most of the 1.6 million abortions in 1991; this number is not expected to increase significantly, since only 13 percent of OB/GYN residency programs require training in first-trimester abortion techniques. The Wall Street Journal has reported that only 7 percent of residency programs offer second-trimester abortion procedural training. Moreover, while two-thirds of all OB/GYN residency programs offer an option of training in abortion techniques, estimates indicate that over half of residents do not participate in such instruction. Finally, as reports across the U.S. have evidenced, steady sieges of pro-life protests and persistent activism have, in fact, dampened enthusiasm for the business of abortion.

Yet long before the protests, before Operation Rescue ever existed, before a single Roe-moderating Supreme Court case was handed down, physicians began refusing to perform abortions. Sometimes quietly, sometimes publicly, for reasons scientific, ethical, religious, humanitarian, or personal, these doctors either refused from the outset to perform abortions or else became abortion providers and then discontinued the practice as their consciences stirred. Soon after Roe, clues to the logic driving these doctors’ abortion abstentions began to emerge in medical journals and even in literature authored by committed abortion advocates. For example, in her 1976 book, In Necessity and Sorrow, Dr. Magda Denes, who supports abortion rights, quotes abortion-provider Dr. Benjamin Kalish describing his performance of first-trimester abortions:

I do D & Cs here in vast quantities…. Now if you do suction, you put it in and it schooches out and you don’t really see it. When you do a D & C most of the tissue is removed by the Olden forceps or ring clamp and you actually get gross parts of the fetus out. So you can see a miniature person so to speak, and so even now I occasionally feel a little peculiar about it, because as a physician I’m trained to conserve life and here I am destroying life. But overall, I’m happy about the law [lifting restrictions].

Kalish, obviously torn, then describes his experience with later-term abortions:

Well, the saline is even more gross and unpleasant…. When we do D & Cs it’s under general anesthesia, so the patient comes in and the doctor does the dirty work. And she wakes up, and it’s his sin, and she’s cured. But with a saline she’s participating in this sin, because she’s awake…. But on a number of occasions with the needle, I have harpooned the fetus. I can feel the fetus move at the end of the needle just like you have a fish hooked on a line. This gives me an unpleasant, unhappy feeling because I know that the fetus is alive and responding to the needle stab…. You know that there is something alive in there that you’re killing.

Denes also records the observations of New York abortionist Dr. John Szenes:

You have to become a bit schizophrenic. In one room you encourage the patient that the slight irregularity of the fetal heart is not important, everything is going well, she is going to have a nice baby, and then you shut the door and go into the next room and assure another patient on whom you just did a saline abortion, that it’s fine if the heart is already irregular, she has nothing to worry about, she is not going to have a live baby. I mean you definitely have to make a 180-degree turn, but somehow it evolved in my own mind gradually….

A 1979 American Journal of Obstetrics and Gynecology article titled “The impact of midtrimester abortion on patients and staff” noted that participating physicians “feel technically competent but note strong emotional reactions during or following the procedures and occasional disquieting dreams”:

The experience of participating with any abortion procedure goes directly against the medical emphasis on the preservation of life…. [A]mnio abortions are viewed by the nurses as the most upsetting experiences which occur…. The nurses found the physical contact with the fetus particularly difficult; it reminded them of the “preemies” just down the hall…. The D and E procedure was described as distasteful and many nurses preferred noninvolvement.

Abortion doctor Warren Hern admitted in his book: “Another disadvantage of the D & E procedure is that it is objectionable to physicians and their assistants…. Those providing D & E procedures must be keenly aware of their level of commitment to the availability of choice to women in this stage of pregnancy.”

Former Abortionists

It was a growing abhorrence for abortion that prompted Dr. Beverly McMillan, founder of the first abortion clinic in Mississippi, to stop performing the procedure. McMillan decided in 1969 to be an abortionist to help provide women with safe abortions, and she subsequently performed a large number of them. After performing a D & C abortion, she would make sure that the abortion was completed. McMillan recounts how she would go to the suction bottle and remove the stockinette, take it to a sink, and “pick through it with a forceps and identify the four extremities, the spine, and the skull, and the placenta.”

One day, “standing at that sink, I just started seeing these bodies for the first time. I don’t know what I did before that, I think I just counted, I was cool, blood didn’t make me sick.” Shortly thereafter, she relates, when the office manager asked to watch this process at the sink following a 12-week abortion, “as I was showing her, I remember very clearly seeing an arm and seeing the deltoid muscle, and it really struck me that day how beautiful that was. And the thought just flashed through my mind. ‘What are you doing? Here is this beautiful piece of humanity, human flesh here. What are you doing?’ And that was one of the very last ones I did.”

Neither politics nor harassment were the reasons that New York obstetrician/gynecologist Anthony Levatino quit performing abortions after providing them for eight years. Levatino learned to do abortions as part of his training. “My discomfort came at that point because there was this tremendous conflict within me” as he did D & C abortions in his office and saline abortions at the hospital whenever he was on call. “Those were horrible, because you saw a whole, intact baby being born and sometimes they were alive, and that was very, very frightening. It was a very stomach-turning kind of existence.” He and his wife were looking for a baby to adopt “and I’m throwing them in the garbage at a rate of nine and ten a week.” The little girl the Levatinos adopted later was killed in a tragic accident. “When you lose a child, your child, life is very different,” explains Levatino. “Everything changes. All of a sudden the idea of a person’s life becomes very real. It’s not an embryology course anymore…. And the old discomforts came back in spades.” He summarizes his experience this way:

I couldn’t even think about a D  E abortion anymore. No way. And you start to realize: This is somebody’s child. I lost my child. Someone who was very precious to us. And now I’m taking somebody’s child and I’m tearing them right out of their womb. I’m killing somebody’s child. That’s what it took to get me to change. My own sense of self-esteem went down the tubes. I began to feel like a paid assassin…. It got to the point where it just wasn’t worth it, the money wasn’t worth it. “Pro-women” my butt. I don’t care. This is coming out of my hide. It’s costing me too much personally. All the money in the world wouldn’t have made any difference. So I quit.

Science Converted Some

Perhaps the most renowned case of a physician who stopped performing abortions is that of Dr. Bernard Nathanson, pre-eminent trailblazer of the abortion-legalization movement. Now condemned as a turncoat by his former colleagues for publicly renouncing the practice of abortion, Nathanson had become “increasingly troubled by my own increasing certainty that I had in fact presided over 60,000 deaths.” What persuaded him to change his mind was new scientific proof: “the development of a marvelous new technology which has served to define beyond reasonable challenge the nature of intrauterine life, the inarguably and specifically human quality of that life.”

In his retrospective book, The Abortion Papers, Nathanson insists that scientific advancement alone was responsible for his awakening and subsequent defection from the ranks of fervent abortion providers:

The [post-Roe] flowering of fetology as a major medical discipline is especially important to me personally. The data and perceptions arising from fetology formed the hinge of my thinking on the abortion issue. I have repeatedly denied that my pro-life position stems from religious convictions. It sprang from nothing but hard, reproducible, scientific facts and the application of the Golden Rule to those facts.”

Dr. Joseph Randall also was moved by scientific evidence conferred by development of new technologies, particularly realtime ultrasound. Randall participated in abortions as a resident, after the chief of his department told residents that abortions were a necessary part of medical training to serve women, and “if they did not do abortions, they might as well get out of obstetrics and gynecology.”

Randall performed an estimated 32,000 abortions in Georgia over a ten-year period. “But I think the greatest thing that got to us was the realtime ultrasound, which showed the baby on TV. The baby came alive on TV and was moving, and that picture of the baby on ultrasound bothered me more than anything else.” The nurses had to assist with this procedure to estimate infant size because they were paid more as the pregnancies got larger. “We lost two nurses—they couldn’t take it. Some other staff, too, the turnover got greater. The ultrasound was a key in this.” Randall adds that “the women who are having the abortions are never allowed to look at the ultrasound, because we knew even if they heard the heartbeat, that many times they wouldn’t have the abortion. And we didn’t want that. No money in that.” Shortly thereafter, Randall stopped performing abortions.

Dr. McArthur Hill began performing abortions as a resident at Travis Air Force base in California. “I did not feel right about doing abortions, but I made no effort to distinguish legal from moral at that time. My justification was that it was legal, the patients wanted it done.” The base’s saline abortion patients were taken to the labor and delivery room. “It was there that I had the beginnings of my emotional turmoil.” In the labor and delivery room, Hill cared both for patients who had been injected with saline and patients who were in premature labor. “We used medications to try to stop the labor of women in premature labor so that the pregnancy could progress to term. Sometimes the aborted babies were bigger than the premature ones which we took to the nursery.”

Hill began to have nightmares. When he stopped doing second-trimester abortions, “there was a subtle understanding that my actions were causing others to do more than their share.” His decision to stop performing all abortions did not arise in a single instance; instead, the decision was “an evolving one,” and he now believes that he committed murder. Hill adds that his participation in abortions “was not as an avid abortion proponent, but as a reluctant puppet in a world gone berserk.”

Dr. David Brewer also began performing abortions during his medical training in New York. He assisted in his first abortion by counting aborted fetal parts: “I looked at the towel and there were parts in there of a person. I’d taken anatomy, I was a medical student, I knew what I was looking at.” He continues, “There was a little scapula and an arm, some ribs and a chest, and I saw a little tiny head and I saw a piece of a leg and I saw a tiny hand and another arm and, you know, it was like somebody put a hot poker into me. I wasn’t a Christian but I had a conscience, and that hurt.” Brewer felt the “hot poker” again when he performed his first abortion. “After a while, it got to where it didn’t hurt. My heart got calloused.” Yet, assisting in a hysterotomy abortion one day, he was traumatized by what followed. “My God, that’s a person,” Brewer thought as he observed the infant move under the uterine incision. “The reality of what was going on was finally beginning to seep into my calloused brain and heart”:

And they simply took that little baby that was making little sounds and moving and kicking over and set it on the table in a cold, stainless steel bowl. And every time I would look over while we were repairing the incision in the uterus, I would see that little person kicking and moving in that bowl. And it kicked and moved less and less as time went on.

After the surgery, Brewer remembers “going over and looking at that baby, and the baby was still alive. You could see the chest moving as the heart beat and the baby would try to take a little breath. And it really hurt [me] inside. It began to educate me as to what abortion really was.” (Brewer and his colleagues made no effort to save the infant’s life.) Brewer performed abortions as a military physician in Alabama for 10 years. He stopped doing them for moral reasons following a conversion to Christianity.

The decision by these physicians to stop doing all abortions, and not solely late-trimester abortions, mirrors the logic of the human life continuum argued by Justice Antonin Scalia in his Casey opinion:

The arbitrariness of the viability line is confirmed in the Court’s inability to offer any justification for it beyond the conclusory assertion that it is only at that point that the unborn child’s life “can in reason and all fairness” be thought to override the interests of the mother…. Precisely why is it that, at the magical second when machines currently in use… are able to keep an unborn child alive apart from its mother, the creature is suddenly able (under our Constitution) to be protected by law, whereas before that magical second it was not?

“Abortionist Burnout”

Mark Crutcher, president of Life Dynamics in Texas, has the names of America’s 450,000 physicians on his mailing list. He has methodically and painstakingly identified 1,200 “Level One” abortionists in the nation: those who do a sufficiently large volume of abortions to work in a stand-alone abortion facility or who advertise in the Yellow Pages. In a 1993 undercover investigative effort sympathetically titled “Project Choice,” Crutcher surveyed the “Level One” abortionists to gauge their attitudes. The responses provide insight into the phenomenon known as “Abortionist Burnout.” Sixty-nine percent stated that abortion providers are not respected in the medical community, 65 percent believe they are ostracized because they perform abortions, and 60 percent believe that their prestige as a physician was damaged by being identified as an abortionist. Almost one in five have been denied hospital privileges because they perform abortions, while nearly half have experienced difficulties in recruiting or keeping nurses or other staff because they perform abortions. Significantly, 38 percent expressed moral misgivings about the abortion procedure itself.

Defenders of Life

The Pro-life Action League of Chicago periodically brings together former abortion-providers, such as those cited here, to provide the public with eyewitness accounts of the adverse effects of abortion on everyone involved—patients, physicians, nurses, and the community—not to mention the unborn. However, these stories of former abortionists represent only a fraction of doctors who refuse to do abortions. Since Roe, there also have been many doctors who, from the outset, were determined dissidents swimming against the legal abortion tide. Dr. C. Everett Koop, world-renowned for his path-breaking work as a pediatric surgeon, decried “the wanton slaughter of the unborn,” and publicly joined the resistance in 1979 with his book, Whatever Happened to the Human Race? In it, he warned of rampant “personal cruelty,” a slippery slope leading to infanticide, euthanasia or genocide, and an “uglier world” brought about by the reduction of the meaning of human life. As people take “their low view of man to its natural conclusion,” he wrote, the world becomes “uglier because humanity is drastically de-humanized.”

Our question to a pro-abortion doctor who would not kill a newborn baby is this: would you kill this infant sooner, before he was born, or a minute before that, or a minute before that, or a minute before that? At what point in time can one consider life to be worthless and the next minute precious and worth saving?… The fate of the unborn is a question of the fate of the human race. We are one human family.

As early as 1973, Dr. Matthew J. Bulfin had quietly founded the American Association of Pro-Life Obstetricians and Gynecologists. “The number-one help to the pro-life obstetricians and gynecologists is the ultrasound,” says the Florida physician. Ultrasound provided the scientific proof of the humanity which Bulfin and his pro-life colleagues already recognized both rationally and intuitively. He indicates that probably 90 percent of abortionists who gave up performing abortions did so because they were “confronted with a womb with a view, a womb with windows in it.”

For the first time they were able to see a tiny baby jump away from the knife or the needle or whatever they were using to try to destroy it. This became more and more apparent as more abortions were being done. Burnout rate was high among abortionists even before ultrasound, but almost every former abortionist I’ve talked to makes the statement that there was no way that he could continue to destroy a life when the tiny victim was so apparent and visible on the ultrasound screen.

The pro-life doctors’ long-held convictions are “religious,” he says, in the sense of a strong principle that “taking a human life is homicide, a crime. We feel that taking life in the womb is intrauterine homicide.”

Bulfin also maintains that most physicians do not want to promote abortion as birth control. “A lot of physicians who are also conscientious are realizing that the more abortion is available, the more women are going to use it like birth control.” He suggests that the enormous number of repeat abortions—at least 43 percent of all abortions—are evidence of this trend. “It’s unfathomable to any obstetrician who sees when life begins to see women and their partners not giving any semblance of caution to use one of the 38 readily available methods of birth control—or, if hesitant for religious convictions, even the greatly improved natural family planning methods.”

Of the 28,000 members of the American College of Obstetrics and Gynecology (ACOG), nearly 1,100 OB/GYN doctors have joined Bulfin’s pro-life contingent. Bulfin says that these “represent activists, and that there are many others who have their pro-life beliefs but who don’t want to make any waves or be identified as activists for the cause.” He notes as proof a 1985 study by ACOG in which fully two-thirds of OB/GYNs reported that they did not perform abortions, and that a mere four percent did the majority of those that were performed. He reiterates that physicians are shying away from becoming abortion providers. “The more education the public has, the more obstetricians realize that they don’t want to be classified as an abortionist, when everyone knows now, and the technology confirms, that abortion is killing an unborn infant in its mother’s uterus.” He continues: “Whereas, there used to be some doubt about it and you could always say it was just a blob of tissue, now they cannot do that any longer.”

Bulfin agrees with Crutcher’s findings that most doctors do not respect abortionists. “They don’t get any respect by killing off tiny little humans who are unable to defend themselves. I don’t think you grow in stature by doing that kind of work.”

In Bulfin’s view, the leadership of ACOG has jumped on what they perceive to be a popular political bandwagon to conform with the pro-choice policies of the Clintons. Many members who are supporting ACOG’S new political advocacy of the pro-choice position “are uncomfortable about it because it’s a new look for them. They’ve never had that before, but go along with it because of the tremendous political pressures being placed on them by the pro-abortion women in the country, who all of a sudden are becoming very aggressive and very much the activists.” Bulfin believes that, if these doctors truly are political, “they are afraid of losing their positions in the hierarchy by not being ‘politically correct,’ according to the current political scene.” Still, Bulfin is undaunted and maintains that his pro-life group believes that “we are still on the right side, and that education is going to be the number-one force that will help us win again. And we certainly are not giving up on this issue.”

Challenging Euphemism

Neither the states nor the Supreme Court requires doctors who perform abortions to be obstetricians or gynecologists, but merely that they be “licensed physicians.” Thus, doctors from across the spectrum and from all disciplines have banded together in various societies to promote the preservation of human life, including prenatal life. Such organizations include Doctors for Life, the Christian Medical Society, and the American College of Physicians and Surgeons.

Dr. Curtis E. Harris is an Oklahoma internal medicine endocrinologist and past-president of the American Academy of Medical Ethics (AAME), which he founded in 1987 with Dr. Jack Wilke and Dr. Bernard Nathanson. Now at 22,000 members and growing, the physicians of the AAME are opposed to abortion on demand.

There is no question, says Harris, that the use of euphemisms in the abortion movement influenced the general public’s acceptance of abortion, and that words regarding the facts of abortion had to be redefined because of their moral content. Without such obfuscation, and on a purely scientific level, doctors are trained to treat a pregnant woman with a prenatal child as two patients, both in the administration of drugs and in other procedures. “The real science, the gut level reaction is, yes, this is always a human life.” Harris points out that the medical community clearly is divided over abortion, since “some will then say that this concern is overridden by the mother’s desires. Others will say that the concerns are more equal and the women should receive more intensive counseling. Still others will say no, it’s a human life. It’s not simply up to her.”

Harris emphasizes that, nevertheless, most doctors refuse to perform abortions themselves because “it is a contradiction to their normal medical practice. They feel that it is not something that they want to be labeled as being themselves, because they don’t think it is a reputable thing to be.” He thinks that many OB/GYNS will occasionally do an abortion “but that it bothers them deeply, because they understand that they’re dealing with a human life. It’s a contradiction because they normally work to bring children into the world in a healthy state, not to see them destroyed.”

Harris adds that the American Medical Academy, which has abandoned its abortion-neutrality position, has seen a steady decline in membership, in part because the society does not represent the views of many physicians. The Academy “has a lock-step type membership at the leadership level, and when you try to get opposition expressed, you can’t do it at the meetings. Every year, they have their dissident physicians there. Every year those dissident physicians are not recognized from the floor.” Such censorship partially explains why the public perceives doctors as being in favor of abortion rights.

Military Objectors

An atypical phenomenon has transpired recently: that of military physicians quietly resisting the Commander-in-Chief. Although President Clinton has lifted the ban on performing abortions in overseas military hospitals, all 44 OB/GYN physicians in the European theater are refusing to perform the procedure. Reports indicate that a similar noncompliance is taking place in Asia. The Washington Post quotes Heidelberg’s Seventh Medical Command spokeswoman Barbara Slifer as saying: “These doctors have invested their lives in giving life. It’s an extremely emotional issue.” Dr. Harris notes that, while military officers are not disposed publicly to rebuke the Commander-in-Chief, “they can quietly express their views by not doing something through a conscience clause. I think they’re screaming out their reason.”

U.S. Representative Patricia Schroeder (D-Col.) declared that the physicians’ demonstration of conscientious solidarity is an “outrage.” According to the Los Angeles Times, Schroeder said, “I find it hard to believe that every single person working overseas has a personal conscientious objection to providing abortions.”

These events and the “abortionist deficit” have led to speculation that political pressure might be brought to bear on Congress to rescind the conscience clauses in both the U.S. and Military Codes. Or, alternately, if pending legislation passes to require all publicly funded hospitals to provide abortions, then directives to provide abortions may be given to all practicing physicians at all hospitals where any person receives any public dollars—a parallel to the Grove City College precedent.

Do doctors and nurses believe so strongly about this issue that they will quit working at hospitals rather than be forced to perform abortions? “Yes,” replies Dr. Harris. “There’s such tension right now. We’re all waiting to see what they’re going to do to us on health care. If they add this sudden change as well, I think you’re going to see revolution.”

Primum non nocere, directed the pre-Roe Hippocratic oath (“first, do no harm”). Taking that charge to heart, the conviction that it is wrong willfully to destroy in a calculated method innocent and defenseless human lives has prompted tens of thousands of physicians to refuse to perform abortions or to condone the practice. Whether for humanitarian, rational, or religious reasons, the logic of their equation dictates that if prenatal life is human, then they as doctors—as healers—must not act as agents of its destruction. Science and technology, once comrades of the modern abortion movement, have begun to betray sensory and rational evidence sufficient to convince even former skeptics of the genetic and physiological humanity of the prenatal resident of the womb. With the unveiling of the astonishing evidence comes the answer to their inquiry, and no utilitarian rejoinder can convince these doctors that abortion is justifiable. As these physicians testify, the greatest chilling effect on the performance of abortions is not politics, nor harassment, nor Casey-inspired laws, but, rather, discovery of the wondrous, unrelenting humanness of the singular unborn child.

By

Anne Marie Morgan has worked as a broadcast journalist for many years and is the State Capitol Bureau Chief for Virginia Public Radio. She is an adjunct Professor of Political Science at the University of Richmond School of Professional and Continuing Studies.

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