Commentary Abortion

Taking Back the “Conscience” Debate: Reproductive Health Care Providers as Conscientious Actors

Kirsten Moore

The persistent failure to recognize abortion provision as “conscientious” has resulted in laws that do not protect caregivers who are compelled by their conscience to provide abortion services. 

Over the past 40 years, conservative lawmakers and legal academics have reduced a progressive vision of conscience as an act of doing something positive for social justice to one that allows health care professionals to refuse to provide or refer for contraception, abortion, or other reproductive health care. 

Dr. Lisa Harris, University of Michigan bioethicist and gynecologist and RHTP board member, lays out a compelling case in this month’s New England Journal of Medicine, about the “ongoing false dichotomization of abortion and conscience” and why the provision of care should be included in legal protections of conscience.

Harris reminds us that physicians started providing abortion care before it was legal for reasons of conscience. Citing Carole Joffe’s scholarship, Harris points out that doctors..

“…did so with little to gain and much to lose, facing fines, imprisonment, and loss of medical license. They did so because the beliefs that mattered most to them compelled them to. They saw women die from self-induced abortions and abortions performed by unskilled providers. They understood safe abortion to be lifesaving. They believed their abortion provision honored “the dignity of humanity” and was the right — even righteous — thing to do. They performed abortions “for reasons of conscience.”

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But since then, the persistent failure to recognize abortion provision as “conscientious” has resulted in laws that do not protect caregivers who are compelled by their conscience to provide abortion services. As a result:

“Though abortion providers now work within the law, they still have much to lose, facing stigma, marginalization within medicine, harassment, and threat of physical harm.”

Harris argues that the failure of our policies to recognize that conscience compels the provision of abortion care renders “conscience” an empty concept and leaves us all with no moral ground (high or low) on which to stand. You can read her full editorial here.

Commentary Family

Getting Republicans on Record About How Fetal Tissue Research Has Helped Them

Carole Joffe

Imagine if the next debate among the Republican presidential candidates started with the moderator asking all the participants who are parents to raise their hands if their children received the polio vaccine as infants.

See more of our coverage on the effects of the misleading Center for Medical Progress videos here.

Imagine if the next debate among the Republican presidential candidates started with the moderator asking all the participants who are parents to raise their hands if their children received the polio vaccine as infants. Then the candidates should be instructed to lower their hands if they would have refused this vaccination if they knew that it was developed from research using fetal tissue. Assuming the candidates responded honestly, I speculate that none would report a willingness to have forgone protecting their children against polio.

If the debate were to start this way—and sadly it probably won’t—it would expose the candidates’ hypocrisy on fetal tissue research (as well as how tortuous the larger issue of vaccines is for Republicans, leading to mixed statements on the part of many of the contenders). Americans as a whole believe in vaccines, though a vocal minority, most of which is associated with the Republican base, do not; similarly, Planned Parenthood, which has been relentlessly demonized because of the false charges of “selling” fetal tissue to researchers, is far more admired by the public than any of the Republican candidates. Yet to satisfy its base—who are the most likely to vote in primaries—the Republican candidates have been compelled to outdo each other in bashing Planned Parenthood, and by extension, fetal tissue research.

The fact that the candidate Dr. Ben Carson, currently running second in the polls behind Donald Trump, was discovered to have himself conducted such research, did not seem to matter; reminiscent of anti-abortion women who show up in a clinic for an abortion and claim that their abortions are morally justified, but that everyone else in the waiting room is a slut, Carson confusingly and erroneously tried to claim that his research using fetal tissue was legitimate, while other research of this type was obtained from abortions done specifically to obtain such tissue.

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As this sorry spectacle of manufactured hysteria about Planned Parenthood and fetal tissue research plays out, it occurs to me that many Americans now alive simply do not remember the absolute terror of contracting polio that was rampant before the vaccine became widely available in the mid-1950s. As a very young child in that era, I have memories of horror stories of children and adults in “iron lungs” ( a large respirator which allowed polio patients, whose lung muscles had been paralyzed by the polio virus, to breathe), of people’s fears of going to swimming pools and other public places because of the chance of contagion, and hearing the unspeakably sad news of deaths from this scourge. As an adult, I have seen the considerable difficulties of post-polio syndrome, progressive muscle weakness, atrophy, and fatigue, which can strike those who were fortunate enough to survive the disease—sometimes 40 years after contracting the disease itself.

In short, the development of the polio vaccine (which won a Nobel Prize for its discoverers) was one of the greatest public health triumphs of history. By 1979, the disease was eradicated in the United States. Progress in the rest of the world has been slower, but very encouraging. Africa, for example, recently marked a polio-free year, and public health experts are hopeful about a complete global eradication by the year 2018. As these experts point out, if this campaign is successful, it would only be the second time in history that a disease affecting humans has been eradicated (the other being smallpox).

And the polio vaccine was not the only one to come from fetal tissue research. Other vaccines, including those for hepatitis A, chickenpox, rubella, and rabies, have resulted from studies based on donated fetal tissue. Furthermore, fetal tissue research may also bring promising future developments, such as in the study or treatment of juvenile diabetes, Parkinson’s disease, HIV, and breast cancer.

Dismayingly, those who should be leading the defense of fetal tissue research—the scientists in the more than 50 institutions where this research takes place—have, with a few exceptions, been intimidated into silence because of fears of anti-abortion harassment and violence. A science editor for BuzzFeed recently wrote about contacting 70 researchers in this field and not finding one who would speak with her for attribution.

One scholar who has not been afraid to speak up is R. Alta Charo, a noted bioethicist at the University of Wisconsin. In a stirring defense of fetal tissue research in the New England Journal of Medicine, Charo denounced the politically motivated attacks on this research as “a betrayal of the people whose lives could be saved by the research and a violation of that most fundamental duty of medicine and health policy, the duty of care.”  

As Charo’s words suggest, the current battle over fetal tissue research is but the latest example of a longstanding feature of American politics: the war on science by the right. This includes the denial of climate change, the skepticism about evolution, the insistence that birth control pills cause abortions—the list goes drearily on. And, of course, the eagerness of the candidates to bash Planned Parenthood is an equally fundamental tenet of right-wing politics—an opposition to this organization not only because of its abortion services, but also because of its support for non-procreative sexuality that occurs outside of heterosexual marriage.  

It is an open question, however, as to how these harsh attacks on both fetal research and Planned Parenthood will fare once Republican candidates must appeal to those beyond their most fervid primary voters. One might be cautiously optimistic that even in a degraded political environment such as ours, most voters will think that getting rid of diseases is a good thing.

Commentary Abortion

We Need to Stop Punishing Women for Seeking Health Care

Sarah Roberts

The prosecution of Jennifer Whalen for purchasing her daughter abortion-inducing medication is reminiscent of the way that hospitals, Child Protective Services, and law enforcement have historically responded to drug use during pregnancy.

Jennifer Whalen is in jail for one simple reason: She took her daughter to the hospital. But as alarming as Whalen’s situation is, it is not an isolated incident. Rather, it is indicative of a broader, dangerous trend of medical professionals and law enforcement punishing women for making the apparent mistake of seeking health care.

In 2012, Whalen’s 16-year-old daughter was pregnant and did not want to be. After unsuccessfully trying to get her an appointment for an abortion, Whalen turned to the Internet for help, eventually obtaining miscarriage-inducing medications that are legal in the United States, safe, effective, and recommended by the World Health Organization. Not knowing exactly what to expect from the drugs, Whalen took her daughter to the hospital to make sure that she was OK. Her daughter was fine; even so, the institution still reported Whalen to the authorities. Now, two years later, she will spend at least nine months in jail.

The New York Times Magazine’s recent profile of Whalen correctly pointed out the changes in Pennsylvania law that have made accessing clinic-based abortion care incredibly difficult for a family facing financial and employment insecurity. The profile also noted that self-induction of abortion is likely to become more common with the current landscape of restrictions. These connections are critical to understanding the changing circumstances of reproductive care in the United States.

What the Times Magazine article did not do, however, was note how Whalen’s case resembles the way that hospitals, Child Protective Services (CPS), and law enforcement have historically responded to drug use during pregnancy, a topic I have been researching for a decade. Earlier this year, Tennessee became the first state to pass a law allowing criminal prosecution of pregnant women who use illegal drugs, but other states have been similarly punishing women for years. At least some of these prosecutions seem to have relied on charges of drug distribution and delivery as well as child abuse and neglect—ones similar to those filed by the district attorney in Whalen’s case.

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The most striking parallel among these cases, though, is the role health-care providers played in initiating the process that eventually led to the prosecutions. Officials at Whalen’s chosen hospital, for example, reported her to CPS after she brought her daughter in. In turn, this led to an investigation by law enforcement. But why was Whalen reported to CPS in the first place? After all, her daughter had not been mistreated. Although the hospital has not released a public explanation for its staff members’ actions, one of the most likely scenarios is that care providers there were following the institutions’ protocols for pregnant patients suspected of using drugs.

Hospitals often implement such policies to help them comply with laws like CAPTA, which mandate them to report incidents to CPS of newborns affected by prenatal illicit drug exposure. Sometimes, these policies also include legal drugs taken without a prescription, such as oxycodone. This would have been the case for Whalen’s daughter, who had used the abortion medication without a prescription while pregnant. (It is not fully clear why Whalen, rather than her daughter, was ultimately prosecuted; one possibility is that the original CPS report concerned her daughter, but the subsequent police investigation led to charges levied against Whalen instead.)

Regardless, if this was indeed why the hospital chose to report the Whalens, it is important to know that their story is far from rare. The language of CAPTA itself is unclear as to whether disclosures are required in all instances of pregnant women’s drug use, or only in those where infants display health effects. Still, though, the reports are common: One Northern California study showed approximately 1 percent of newborns reported to CPS for maternal drug use. Most reports do not result in prosecutions; instead, CPS generally stages investigations, sometimes temporarily or permanently removing the child.

My research shows that these potential punishments cause some pregnant women who use drugs to avoid prenatal care. One woman in my study told me, “I didn’t want to go in [for prenatal care] all drugged up … [I was afraid that the] urine tests would’ve came out positive … and that they would take the baby away.  Call CPS right away.”

Another explained, “I missed a couple of appointments when I relapsed because, if my tests showed up dirty, then I’d have CPS involved, so I ended up not going to those appointments.”

As the American Congress of Obstetricians and Gynecologists has also pointed out, this fear of CPS and of being prosecuted creates mistrust and gets in the way of the provider-patient relationship; in turn, it can lead to women not receiving recommended health care. And research is clear that receiving adequate prenatal care is associated with improved pregnancy outcomes among women who use drugs. In short, we are effectively putting pregnant women at risk with these policies.

That is bad enough. But as the Times Magazine pointed out, as access to abortion care decreases throughout many parts of the country, more women may turn to self-induction with medications as an alternative. They, too, could be put in danger of being reported to the authorities for taking drugs without prescriptions—or, at the least, be apprehensive enough about such consequences to avoid seeking medical help if it becomes necessary. If these women, or their daughters, sisters, or friends, experience side-effects that worry them, don’t we want them to seek health care without fear of punishment?  Even in cases where self-induction is not legal, don’t we want doctors to provide treatment and not function as law enforcement?

We do not want protocols for women who may have attempted self-induced abortion to look like the current, punitive hospital policies for responding to maternal drug use. Because many institutions do not yet have such protocols in place, we have an opportunity now to create standards ensuring that women can safely receive the health care they need without fear, even when clinic-based abortion care is not accessible.

It may be too late for Whalen, but we can and should take steps to confirm that no women—including women performing their own abortions and women who use drugs during pregnancies they continue—are punished for seeking health care.

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