Analysis Abortion

The “No Life-Saving Abortions” Lie, and Why It Persists

Robin Marty

When Joe Walsh argued that "new technology" made abortions to save a woman's life unnecessary, he was parroting a dangerous view that could put millions of lives in jeopardy.

Illinois Congressman Joe Walsh may have shocked pundits last week when he claimed abortion is never necessary to save a woman’s life, but where exactly did his get the idea that “new technology and advances in science” have made this groundbreaking new theory possible? From Ireland, where a September symposium gathered to present their medical hypothesis that there is no circumstance in which a woman’s health is saved by terminating a pregnancy.

The International Symposium on Excellence in Maternal Healthcare, which met in Dublin, Ireland in advance of the growing discussion on whether Ireland should allow more access for women to obtain abortions when their health is at risk, brought together medical professionals from across the country to advocate on behalf of “management” techniques that could allegedly be put in place in order to prevent a woman from seeking a termination on the grounds that being pregnant endangered her health.  A press release following the conclusion of the conference read:

Dr Eoghan de Faoite of the organizing committee for the symposium said that the research presented provided clear evidence that best practice medical care for pregnant women does not involve abortion.

“It was fascinating to learn about new therapies involving the safe delivery of chemotherapy during pregnancy and the exciting field of in-utero fetal surgery” he said. “When discussing matters of pregnancy and medicine it is vital that the voices of the real experts, those that actually care for pregnant women, be heard.” 

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“This Symposium puts an end to the false argument that Ireland needs abortion to treat women, and it was encouraging to hear the international speakers commend Ireland’s high standards of maternal healthcare and low rates of maternal mortality,” he added.

“The Dublin Declaration stating that abortion is not medically necessary was a statement of fact agreed by medical experts and reflecting best medical practice in maternal healthcare,” stated the medical advisor to the Life Institute, Dr Seán Ó Domhnaill.

“This is a globally significant outcome, which shows abortion has no place in treating women and their unborn children,” he affirmed.

The conference focused on the anti-choice position that when it comes to treating pregnancies with maternal complications, not only are both mother and fetus or embryo “patients” but that the unborn patient’s “life” takes precedent over the health of the woman carrying it.

Can both “lives” be saved? Possibly, in some cases. It’s the amount of threat to a woman’s health in the process that is an acceptable risk that becomes the real gamble, and it’s a sacrifice that anti-choice medical professionals seem eager to force them into making. The most well-known trade off is the idea of the “pro-life” way to deal with an ectopic pregnancy. In the “no direct abortions ever” community, an ectopic should never be treated with a termination, traditionally an injection of methotrexate before the pregnancy progresses far enough to damage a fallopian tube. That is considered a direct abortion, where as anti-choice physicians recommend waiting to see if you miscarry naturally first (a possible outcome for all pregnancies but no more likely than any other time). The reason, besides rejection of ever terminating a pregnancy? Some physicians worry that the extremely rare case of a “hidden” twin that is yet undetected on an ultrasound could be lost in the process as well.

Holding off surgery and watchful waiting in this case might have resulted in spontaneous resolution of the tubal pregnancy or would have required surgical removal of the tubal pregnancy when the embryo was likely to be dead, but in both cases the uterine pregnancy would probably have survived.  Unfortunately, the chemical abortion killed both babies, much to the dismay of this young pro-life woman.

It is only ethical to remove the tubal pregnancy if spontaneous resolution does not occur after watchful waiting and if the physician is 100% certain that there are no twins.  At this point, the embryo in the fallopian tube is likely to be dead and, even if not, the death is unavoidable and unintentional, and the procedure is necessary to save the life of the mother. 

What about abortion in the case of a woman with cancer? The current advocacy is that the woman should simply wait and begin chemotherapy and treatment after the first trimester to reduce the risk to the fetus. It’s a choice that women and their doctors should weigh the risks and advantages of on a case by case basis. But to take it away from them all together, especially in cases of extremely advanced or aggressive illness? That is exactly what a “no exceptions” abortion ban would do. We saw what that meant in Columbia, where a teen was forced to wait until 13 weeks to receive treatment. Both the girl and the fetus she was carrying were lost as a result.

It’s no wonder that The American College of Obstetricians and Gynecologists are demanding that politicians “Get out of our exam rooms.”

Contrary to the inaccurate statements made yesterday by Rep. Joe Walsh (R-IL), abortions are necessary in a number of circumstances to save the life of a woman or to preserve her health. Unfortunately, pregnancy is not a risk-free life event, particularly for many women with chronic medical conditions. Despite all of our medical advances, more than 600 women die each year from pregnancy and childbirth-related reasons right here in the US. In fact, many more women would die each year if they did not have access to abortion to protect their health or to save their lives.

Unfortunately, inaccurately stating that abortions are “never necessary” to save the life or protect the health of a pregnant woman or girl isn’t the only danger of anti-choice legislators practicing medicine in abortion politics. When it comes to actually putting an exception into practice, the law puts medical professionals in nearly as much risk as their patients.

In researching my first book this summer, I had the opportunity to talk to a variety of different providers in multiple states, all with different rules when it comes to abortion access. All of them had the same uneasiness when it came to exceptions based on medical diagnosis, as vague bills written by those who aren’t physicians make it unclear exactly when an abortion is acceptable, or when a provider could be accused of breaking the law. Most exceptions are being written only to include cases where not aborting could “result in her death or in substantial and irreversible impairment of a major bodily function.” As a result, doctors are being asked to decide at what point they must allow a woman to put her life at risk before they can justify performing an abortion without a potential arrest.

One Wisconsin provider discussed the attempt to decide when exactly an abortion can be performed as a decision of exactly how endangered her life had to be. Was a 20 percent likelihood of the patient dying enough, or did he have to wait until actual organs began to fail before he could guarantee a “justified” abortion? In both cases, a fetus prior to viability would still die, but in the former case the patient could be saved and regain her health, while in the latter her recovery may be more drawn out or even impossible.

When an abortion is allowed under these unclear medical exceptions is nearly impossible to ascertain. Just as disturbing is the way that the laws mandate how an abortion is to be performed. In Georgia, where the state legislature nearly deadlocked on a “no exceptions” 20 week post conception ban, a last-minute compromise granted a woman the ability to get an abortion if the pregnancy was “medically futile.”

The exception is extremely narrow, but the way an abortion could be performed is even more troublesome. The bill mandated that termination could only be done in a way which:

[I]n reasonable medical judgment, provides the best opportunity for the unborn child to survive unless, in reasonable medical judgment, termination of the pregnancy in that manner would pose a greater risk either of the death of the pregnant woman or of the substantial and irreversible physical impairment of a major bodily function of the pregnant woman than would another available method.

The end result? Medically futile pregnancies—designated as such because a doctor has confirmed that the fetus would have no ability to survive meaningfully outside of the womb—would be terminated in a way most inclined to produce a live birth. No drugs could be given that would stop the heart before a process is undergone. It would be likely that in the case of those fetuses on the edge of viability or a few weeks beyond, the woman carrying the fetus would be forced to undergo a cesarean section in order to facilitate a live birth.

It’s that argument that Ruth Cline, the opponent of Rep. Doug McKillip, the sponsor of the Georgia bill, has been using on the campaign trail as a reason for voting against him in November. McKillip said he was simply writing legislation to ensure, “You deliver the baby in the way that’s most likely to save both lives,” despite the fact that the fetus has already been ruled unlikely to live much beyond delivery, and that the woman would be likely to need future operations for any subsequent pregnancies as a result.

What McKillip and other lawmakers who have proposed this “best opportunity for the unborn child to survive” language have done is essentially removed exceptions all together. An “abortion” that is really just the delivery of a baby that can’t survive outside the womb by any means necessary to preserve the life of the fetus is no different than the decision to force a woman not to end an ectopic pregnancy until her tube ruptures and only then remove embryo as part of the procedure. These absolutely extremist exceptions exist not out of some form of necessity or compassion but to create medical protocol that enforces their notion that direct abortion is never a needed procedure.

McKillip, Walsh, and other anti-choice extremists are willing to put women’s health — both her immediate health and her future health and fertility—in jeopardy in order to adhere to an extremist belief that there is never a need for abortion.  It isn’t “pro-life” to force women to risk their lives on behalf of a child that may or may not survive, or to make her put herself into physical danger before she is allowed to terminate a pregnancy. If politicians were truly interested in growing families, they would be just as anxious to preserve maternal health in order for women to be able to give birth to larger families rather than put her life at risk on behalf of a child that isn’t likely to survive.

News Health Systems

Complaint: Citing Catholic Rules, Doctor Turns Away Bleeding Woman With Dislodged IUD

Amy Littlefield

“It felt heartbreaking,” said Melanie Jones. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

Melanie Jones arrived for her doctor’s appointment bleeding and in pain. Jones, 28, who lives in the Chicago area, had slipped in her bathroom, and suspected the fall had dislodged her copper intrauterine device (IUD).

Her doctor confirmed the IUD was dislodged and had to be removed. But the doctor said she would be unable to remove the IUD, citing Catholic restrictions followed by Mercy Hospital and Medical Center and providers within its system.

“I think my first feeling was shock,” Jones told Rewire in an interview. “I thought that eventually they were going to recognize that my health was the top priority.”

The doctor left Jones to confer with colleagues, before returning to confirm that her “hands [were] tied,” according to two complaints filed by the ACLU of Illinois. Not only could she not help her, the doctor said, but no one in Jones’ health insurance network could remove the IUD, because all of them followed similar restrictions. Mercy, like many Catholic providers, follows directives issued by the U.S. Conference of Catholic Bishops that restrict access to an array of services, including abortion care, tubal ligations, and contraception.

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Some Catholic providers may get around the rules by purporting to prescribe hormonal contraception for acne or heavy periods, rather than for birth control, but in the case of copper IUDs, there is no such pretext available.

“She told Ms. Jones that that process [of switching networks] would take her a month, and that she should feel fortunate because sometimes switching networks takes up to six months or even a year,” the ACLU of Illinois wrote in a pair of complaints filed in late June.

Jones hadn’t even realized her health-care network was Catholic.

Mercy has about nine off-site locations in the Chicago area, including the Dearborn Station office Jones visited, said Eric Rhodes, senior vice president of administrative and professional services. It is part of Trinity Health, one of the largest Catholic health systems in the country.

The ACLU and ACLU of Michigan sued Trinity last year for its “repeated and systematic failure to provide women suffering pregnancy complications with appropriate emergency abortions as required by federal law.” The lawsuit was dismissed but the ACLU has asked for reconsideration.

In a written statement to Rewire, Mercy said, “Generally, our protocol in caring for a woman with a dislodged or troublesome IUD is to offer to remove it.”

Rhodes said Mercy was reviewing its education process on Catholic directives for physicians and residents.

“That act [of removing an IUD] in itself does not violate the directives,” Marty Folan, Mercy’s director of mission integration, told Rewire.

The number of acute care hospitals that are Catholic owned or affiliated has grown by 22 percent over the past 15 years, according to MergerWatch, with one in every six acute care hospital beds now in a Catholic owned or affiliated facility. Women in such hospitals have been turned away while miscarrying and denied tubal ligations.

“We think that people should be aware that they may face limitations on the kind of care they can receive when they go to the doctor based on religious restrictions,” said Lorie Chaiten, director of the women’s and reproductive rights project of the ACLU of Illinois, in a phone interview with Rewire. “It’s really important that the public understand that this is going on and it is going on in a widespread fashion so that people can take whatever steps they need to do to protect themselves.”

Jones left her doctor’s office, still in pain and bleeding. Her options were limited. She couldn’t afford a $1,000 trip to the emergency room, and an urgent care facility was out of the question since her Blue Cross Blue Shield of Illinois insurance policy would only cover treatment within her network—and she had just been told that her entire network followed Catholic restrictions.

Jones, on the advice of a friend, contacted the ACLU of Illinois. Attorneys there advised Jones to call her insurance company and demand they expedite her network change. After five hours of phone calls, Jones was able to see a doctor who removed her IUD, five days after her initial appointment and almost two weeks after she fell in the bathroom.

Before the IUD was removed, Jones suffered from cramps she compared to those she felt after the IUD was first placed, severe enough that she medicated herself to cope with the pain.

She experienced another feeling after being turned away: stigma.

“It felt heartbreaking,” Jones told Rewire. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

The ACLU of Illinois has filed two complaints in Jones’ case: one before the Illinois Department of Human Rights and another with the U.S. Department of Health and Human Services Office for Civil Rights under the anti-discrimination provision of the Affordable Care Act. Chaiten said it’s clear Jones was discriminated against because of her gender.

“We don’t know what Mercy’s policies are, but I would find it hard to believe that if there were a man who was suffering complications from a vasectomy and came to the emergency room, that they would turn him away,” Chaiten said. “This the equivalent of that, right, this is a woman who had an IUD, and because they couldn’t pretend the purpose of the IUD was something other than pregnancy prevention, they told her, ‘We can’t help you.’”

Roundups Law and Policy

Gavel Drop: The Fight Over Voter ID Laws Heats Up in the Courts

Jessica Mason Pieklo & Imani Gandy

Texas and North Carolina both have cases that could bring the constitutionality of Voter ID laws back before the U.S. Supreme Court as soon as this term.

Welcome to Gavel Drop, our roundup of legal news, headlines, and head-shaking moments in the courts

Texas Attorney General Ken Paxton intends to ask the U.S. Supreme Court to reinstate the state’s voter ID law.

Meanwhile, according to Politifact, North Carolina attorney general and gubernatorial challenger Roy Cooper is actually saving taxpayers money by refusing to appeal the Fourth Circuit’s ruling on the state’s voter ID law, so Gov. Pat McCrory (R) should stop complaining about it.

And in other North Carolina news, Ian Millhiser writes that the state has hired high-powered conservative attorney Paul Clement to defend its indefensible voter ID law.

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Alex Thompson writes in Vice that the Zika virus is about to hit states with the most restrictive abortion laws in the United States, including Alabama, Louisiana, Mississippi, and Texas. So if you’re pregnant, stay away. No one has yet offered advice for those pregnant people who can’t leave Zika-prone areas.

Robin Marty writes on Care2 about Americans United for Life’s (AUL) latest Mad Lib-style model bill, the “National Abortion Data Reporting Law.” Attacking abortion rights: It’s what AUL does.

The Washington Post profiled Cecile Richards, president of the Planned Parenthood Federation of America. Given this Congress, that will likely spur another round of hearings. (It did get a response from Richards herself.)

Kimberly Strawbridge Robinson writes in Bloomberg BNA that Stanford Law Professor Pamela Karlan thinks the Supreme Court’s clarification of the undue burden standard in Whole Woman’s Health v. Hellerstedt will have ramifications for voting rights cases.

This must-read New York Times piece reminds us that we still have a long way to go in accommodating breastfeeding parents on the job.

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