Monday, June 01, 2009

Dr. George Tiller (1941-2009)

Dr. George Tiller was assassinated yesterday at the church where he and his wife attended. He was one of a handful of physicians known to provide what has come to be called "late term abortions." Nothing I write here is likely to change anyone's mind about abortion, but I want to make a few notes for future reference.

Sarah Robinson's response,
written in the first hours of D. Tiller's death, was both clear and swift. Recommended reading.

1. Tiller was one of the great heroes in the fight for a woman's right to choose safe, legal abortion. Late-term abortions are a terrible business for everyone concerned. Despite anti-abortion distortions to the contrary, they are very rare -- and almost never chosen for anything but the most heartbreaking of reasons, usually having to do with the life of the mother or the viability of the fetus. It's a life-changing choice for everyone concerned, and not one anybody takes lightly.

By all accounts, Tiller dealt with these horrific situations with dignity, compassion, and grace, helping women and their families deal with the loss and grief that always come with being faced with such a traumatic decision. He didn't just tend to their physical condition; he tended to their psychological and spiritual well-being, too. Most of us will be backed into life-or-death corners regarding serious medical conditions (a family member's, or our own) at some point in our lives. In those times, we are fortunate when we can find doctors with that kind of ability to understand the nuances, and help us deal with the ambiguities, and come to terms with the hard decisions we must make. Tiller was, according to his patients, one of those doctors.

2. The Terrorists Win. Tiller was one of just three doctors in the entire US who performed late-term abortions. Now, there are just two. Which means that 36 years of anti-choice terrorism is now just two assassinations away from completely ending late-term abortion in America. Violence has won out -- over the will of the people, over the courts, over the horrific logic of medical necessity. And whenever terrorists win, democracy has lost -- and is lost.

Much more at the link.
Someone in the comments thread questioned her assertion that he was one of three doctors performing late term abortions. Her reply was more circumspect.

Odds are good that there are more than one or two, but anybody else who does it doesn't do many, and isn't advertising the fact to anyone (for reasons that are all too obvious). A lot of doctors will perform controversial procedures for their regular patients, but not for other people. And unfortunately, most women don't know where their doctors draw those lines until they're hard up against them. The doctors won't talk about it even if asked.

The Wikipedia article already has a few details.

George Tiller was killed on May 31, 2009, shot to death during worship services at Reformation Lutheran Church in Wichita where he was serving as an usher.
After threatening two others who tried to prevent his departure, the gunman fled in a car. Witnesses described the vehicle as a powder-blue 1993 Ford Taurus, registered to 51-year-old Scott Roeder of Merriam, in Johnson County.

Scott Philip Roeder (born February 25, 1958) was arrested some 170 miles away in suburban Kansas City three hours after the shooting, Wichita Deputy Police Chief Tom Stolz said. The suspect had been a member of the anti-government Freemen group and was convicted in 1996 on explosives charges after police officers discovered fuse cord, a pound of gunpowder and nine-volt batteries in the trunk his car, but an appeals court overturned this conviction in 1997, ruling that the search of Roeder's car had been illegal.

The reader can do his own research about the Montana Freemen. I'm not interested.

Most conversations I hear about abortions are steeped in ignorance and extreme points of view. I know from reading that abortion statistics are nothing like what most people understand. They know there are many (even though actual numbers and sources are rarely cited) and they leap immediately to the grim details of post-viability procedures, referring to scissors, sucking out brains, etc. Words like baby-killers, murder and genocide are used carelessly with references to living newborns tossed into garbage cans to die.

A search for actual details is revealing.

In 2003, from data collected in those areas that sufficiently reported gestational age, it was found that 6.2% of abortions were conducted from 13 to 15 weeks, 4.2% from 16 to 20 weeks, and 1.4% at or after 21 weeks. Because the Centers for Disease Control and Prevention's annual study on abortion statistics does not calculate the exact gestational age for abortions performed past the 20th week, there are no precise data for the number of abortions performed after viability. In 1997, the Guttmacher Institute estimated the number of abortions in the U.S. past 24 weeks to be 0.08%, or approximately 1,032 per year.

This is from the Guttmacher Institute.

  • Nearly half of all pregnancies to American women are unintended; four in 10 of these end in abortion.

  • About half of American women have experienced an unintended pregnancy, and at current rates more than one-third (35%) will have had an abortion by age 45.

  • Overall unintended pregnancy rates have stagnated over the past decade, yet unintended pregnancy increased by 29% among poor women while decreasing 20% among higher-income women.

  • In 2005, 1.21 million abortions were performed, down from 1.31 million abortions in 2000.

  • Nine in 10 abortions occur in the first 12 weeks of pregnancy.

  • A broad cross section of U.S. women have abortions:
    • 56% of women having abortions are in their 20s;
    • 61% have one or more children;
    • 67% have never married;
    • 57% are economically disadvantaged;
    • 88% live in a metropolitan area; and
    • 78% report a religious affiliation.

"For a long time, nearly 90% of abortions in the U.S. have taken place in the first trimester, but in recent years, women having an abortion have been able to do so earlier and earlier in the first trimester. Currently, more than six in 10 abortions occur within the first eight weeks of pregnancy, and almost three in 10 take place at six weeks or earlier,” says Rachel Jones, lead researcher on the new survey. “Medication abortion, which provides women with an additional option early in pregnancy, clearly reinforces this very positive trend.”

"The United States has one of the highest abortion rates in the developed world, with women from every socioeconomic, racial, ethnic, religious and age-group obtaining abortions," says Lawrence Finer, associate director for domestic research at the Guttmacher Institute. "We study abortion so we can learn more about how well current efforts to improve contraceptive use and reduce unintended pregnancy are working, the circumstances under which women have difficulty accessing abortion and, ultimately, how to reduce the need for abortion."

"Evidence from around the world shows that placing restrictions on abortion to make it harder to obtain has much more to do with making it less safe than making it rarer, " says Susan Cohen, director of government affairs at the Guttmacher Institute. "Yet in the United States, abortion opponents take credit for the mounting state and federal restrictions on abortion, rather than working to reduce unintended pregnancy to begin with."

One of the curious twists of the anti-abortion movement in America is that most of the same people seeking to reduce the number of abortions are also reluctant to promote better sex education and easier access to contraceptives. And the groups most in need of better understanding of reproduction and the proper use of contraceptives are the very groups denied both. Voices seeking common ground ("reduce the number of abortions") have a hard time getting past the biggest challenge of all, that all abortions terminate pregnancies and the way to reduce the number of abortions is to reduce the number of unintended pregnancies.

The unfortunate vocabulary that has come to be used in the debate (pro-life, pro-choice, pro-abortion, anti-abortion, anti-choice, pro-death, etc.) inflames all discussions and drives many to the extreme illustrations. In the same way that the torture debate goes off the rails with the ticking-bomb scenario, abortion discussions quickly slip from one extreme to the other. "Pro-life" advocates have come to the extreme position that "at the moment of conception" a future taxpayer, neighbor or heir has been brought into existence and anyone seeking to eliminate that embryo is guilty of murder. Moreover, the woman that the embryo now inhabits has at once forfeited all rights to do anything that would endanger that future child's growth or development.

In vitro fertilization, a widely-used reproductive technique used by couples trying to get pregnant, routinely produces multiple fertilized eggs, selecting up to four for implantation, one of which can be expected to survive. In the event that three or four appear to be holding on, the newly-pregnant mother is usually advised to allow the doctor to "deselect" the number down to twins or just one. I have yet to hear anyone referring to this procedure as a variant of abortion which, by the strict definition of "at the moment of conception" it is.

As I said at the opening, I doubt anything I write here will change any minds. But maybe by treating this man's murder as the evidence of a national sickness that it is I can get someone to think more clearly. I recall being in a college classroom the morning after Dr. King was assassinated when a student who was glad to see him dead said "I don't see why we have to make him a martyr." I pointed out to him that no one was making King a martyr. The fact that he was dead, killed for what he stood for, accomplished that. Likewise, Dr. Tiller -- whether or not the reader wants to accept it -- is now a martyr, killed for what he stood for. And anyone who thinks his death will advance the cause of those who are glad to see him dead does not understand history.


Hilzoy put up several good posts in response to Dr. Tiller's killing.

Dr. George Tiller

...also these links... (Read this one if you don't have time for them all.)

Operation Rescue

Terror Should Not Pay


Deron S. said...

I agree with your point that many discussions about abortion involve some level of ignorance. It's a topic that generates a lot of controversy and creates divisiveness, but very few people have gone to the lengths to understand it that you have in this post alone.

I often wonder if it makes me a bad person because I don't feel strongly one way or another on the issue. I certainly wouldn't base my politcal choices on abortion because, while it is an important topic, it just doesn't have as much impact in our world as things like poverty and geopolitical unrest. It concerns me that some people base their votes solely on this issue (or any single issue for that matter).

Hoots said...

Thanks for your comment. And no, you're not a bad person because you lack strong feelings either way. My own views are painfully divided because my grasp of morality recognizes the principle that compelled behavior is extrinsic but voluntary behavior is intrinsic.

Abortion in most cases strikes me a morally reprehensible but I am "pro-choice" because I am not willing to impose my views on others. Criminalizing the procedure has nothing to do with morality. In fact, it precludes the pregnant woman's option to make a voluntary moral choice.

The discussion is confused at the national level because there are few federal guidelines other than those regarding privacy, due process, and other matters having to do with the US Constitution. Therefore Roe, Casey and Carhart become the threads of a flimsy fabric that passes for federal guidance, leaving restrictions up to the states.

One of the above readings said that abortions are already not available in 86 percent of counties in America, which reflects the widespread inflammatory effect of the issue.

Hoots said...

Naomi Freundlich, posting at Maggie Mahar's blog, has a must-read post.Late-term abortions are a flashpoint for conflict in the debate over reproductive choice. Yet in reality, they are performed infrequently: Only 1.1% of abortions are performed after 20 weeks and just 3.5% are performed between 16 and 20 weeks. In contrast, almost 90% of all abortions are performed before 10 weeks.

The debate continues because abortion opponents see it as an issue that can unite extremists and moderates into a single coalition working toward banning abortion outright. In 2003 Congress passed the federal legislation known as the “Partial Birth Abortion Ban” that outlawed a specific medical procedure that is sometimes performed as early as in the second trimester. This procedure, more accurately known as dilation and evacuation, was not used very frequently, but sometimes offered the safest approach for terminating a difficult, even life-threatening pregnancy. After several challenges, the Supreme Court upheld the federal abortion ban, even without an exemption for when a woman’s life is at stake.

This ban is considered just the first step by opponents working toward increased federal restrictions. We can imagine bans on other, specific, techniques used to terminate pregnancy that the courts decide cause moral distress for women. President Obama’s statement about removing the “mental distress” exemption from late term abortion bans feeds into the opponent’s strategy, especially as new technology pushes fetal viability back to 20 weeks or less.

Assistant Village Idiot said...

Hoots, you give the game away more than you realise, I think. You deplore the extremism of both sides, you say, but you actually only complain about one.

You accuse the pro-life people of being against "good" sex education. You have again given the game away. They aren't against "good" sex education, they are (sometimes) against what's currently offered. They don't think it's much good, and statistics bear them out. Some studies show the current common sex education curricula reduces pregnancies marginally. Some show them to increase pregnancies marginally. It's a lot of noise and effort for very little effect. The same is true for abstinence education. It doesn't change things much either. A similar uselessness can be shown for drug education, BTW. It's all mostly the symbolism of who gets to feel they're in charge of the school culture.

I don't consider the rarity of late-term abortions to be a strong argument for allowing them. Why would that be relevant?

It is unkind and unfair to suggest (actually, to approvingly quote the suggestion) that a big deal is made about opposing late-term abortions solely for the political capital of banning all abortions. It might be fair to give people credit for being horrified about what they say they are horrified about. What Naomi Freundlich imagines about pro-life folks is not persuasive.

In round numbers, about 20% of Americans would ban all abortions, about 20% would allow all without restriction. The remaining 60% are in favor of the various restrictions that have been suggested - waiting periods, parental consent, no late-term, etc. The pro-choice people have raised the spectre of all abortions being banned for decades. It has no basis in reality. It is dishonest. Just because some people desire a complete ban does not mean that it's in the wind.

Sarah Robinsons's contention that late-term abortions are undertaken only for the most heartbreaking of reasons is unsupported. She hopes and wishes that to be true.

As to anti-choice terrorism, I don't think the sanity of any murderer of an abortion doctor has been established. If you are looking for heated rhetoric, you might start with Sarah.

Hoots said...

Thanks for visiting.
I'm not interested in giving away any game or getting into a protracted version of an already polarized argument. I'm more interested in conflict resolution. I invited you to look over this and a few other links in the event you might come across anything you may not previously have considered. Clearly I was wrong.
If you delete my comment at your post I will have no bad feelings.

Assistant Village Idiot said...

I think the link is in error - it links back to my own comments.

Conflict resolution - fair enough. You have told us what is unreasonable about the prolifers and reasonable about the prochoicers. What would be the good-faith effort in the other direction?

Hoots said...

I don't want to seem glib, but I cannot give you a brief answer. My remarks above were not aimed at being "reasonable" or taking sides. I was only pointing to a contradiction.

My views are not easy to condense into a comment thread. Maybe this will help.
Abortion -- the unmentionable word
(That is first of a series. If you have the patience, the posts are in order so clicking "Newer Post" at the end of each will call up the next one in the series.)

Prayer against abortion

Incidentally, did you check out the photo ministry?

Hoots said...

Another link along the lines of conflict resolution by Dr. Leon Hadar at CATO.

There is such a thing as a middle ground

The guy's a card-carrying Libertarian. That should count for something. Those people are famously not in bed with either of the two main political parties.

...when it comes to closing Guantanamo and outlawing torture, legalizing abortion and supporting gay rights, Mr Obama's views seem to be in line with the majority of the American people who recognize that the dilemmas which these issues pose cannot be resolved through 'either/or' decisions, but instead require painful and occasionally unsatisfactory choices. There is a middle ground.

Yep. Abortion's on the list.

Hoots said...

I see Assistant Village has yet to acknowledge my response to his question. Oh, well...

This Appeared in the Atlanta Paper June 9. Rozalyn Farmer Love is a third-year medical student at the University of Alabama at Birmingham School of Medicine.

Why I plan to emulate Dr. George Tiller

...Emily Lyons. She’s the nurse who survived the 1998 bombing of an abortion clinic in Birmingham at the hands of Eric Rudolph.

I was 14 years old when that clinic was bombed, killing a police officer and spraying Emily’s body full of hot nails and shrapnel. Back then, I lived in a small Alabama town, went to church every Sunday and was adamantly opposed to abortion. But by the time I met Emily last year, I was president of the Birmingham chapter of Medical Students for Choice, a group supporting abortion rights. Watching her walk slowly into our fund-raiser on her husband’s arm —- a woman who’d endured more than 18 operations —- I thought of all she’d been through and knew that I’d come to the right decision in my support of reproductive rights.

That conviction only became stronger after I read that Kansas physician George Tiller had been murdered at his Wichita church.

I’m a third-year medical student at the University of Alabama at Birmingham. I plan to become an obstetrician-gynecologist...

The article is too long for a comment. Go to the link for the rest.

Anonymous said...

That is really a stretch to call Tiller a great hero. And just plain balderdash to say it was the work of terrorists. One lone nut does not make a terrorist organization or movement.

I did make the point that I think it was murder, and I would not use the abortion moral arguments to try and excuse that murder.

Really, although his vocation as an abortionist, and his leadership in promoting it led directly to his murder, the issue is not about abortion - in which you dredge up tired old arguments. I was however, interested in learning the present day statistics on how abortion has advanced as a type of birth control method (which it ought not be, given its risks-just about everyone rational agrees on that).

I'm very disappointed that you believe that "most of the same people seeking to reduce the number of abortions are also reluctant to promote better sex education and easier access to contraceptives." Do you really believe that simplistic and ingenuous statement? Or was it just too easy to plug it into this post?

Hoots, we have to move off of the tired party platforms and advocate what is ethical for all concerned: maybe we see that differently, but it would provide more honest arguments.

Hoots said...

Thanks for visiting. I wasn't trying to push your buttons by pointing to other views but it looks like I miscalculated.

Please allow me to clear up a couple of items.

The "hero" and "terrorist" references were those of Sara Robinson, not me. But like it or not, she represents a serious point of view that deserves more than being dismissed lightly. For me, reconciliation is the goal and that begins with treating even the most disagreeable arguments with some measure of respect.

I don't know if you followed the links and read what she said entirely, even without drilling into the references. But I can assure you that Sara Robinson is a woman of strong convictions which were not formed carelessly. She and David Neiwert (on whose blog she writes) have been monitoring both the rhetoric and actual manifestations of violence-prone groups and individuals for years.

I do not agree with the "one lone nut" description of the killer. Like James Adkinson (last year's killing in a Knoxville Unitarian church) the man's violence was animated by extreme language from writers and broadcast personalities who relentlessly suggest that part of our society should be eliminated -- literally. Denying connections between those suggestive words and those specific actions is to be in denial of an empirical reality. Those are two dots that even the dullest observer can connect.

And yes, like it or not the issue IS about abortion. When the perpetrator SAYS it is, what more evidence is needed?

Former FBI agent Dan Jablonski says what happened can be classified as terrorism and compares the situation to Jihad. "We have people over there who are willing to give up their lives for their cause. For all practical appearances, Mr. Roder is willing to do the same thing," Jablonski said.

Before his arrest, Roeder spent time in prison for having explosives, attended anti-abortion rallies and posted comments about Tiller on websites. Jablonski says all of those activities weren't enough to red flag Roeder as a terrorist. "How much talk do people just throw out there? And what do we want in America, an FBI agent showing up asking did you say this? Did you mean it," he said.

[continued next post...]

Hoots said...

"most of the same people seeking to reduce the number of abortions are also reluctant to promote better sex education and easier access to contraceptives." Do you really believe that simplistic and ingenuous statement? Or was it just too easy to plug it into this post?

The statement is simplistic but yes, I do believe it. In fact, most people I know are anti-abortion and among them I am not aware of any who speak openly of advancing the notion of better, more open sex education in schools. And as far as I know NONE would approve of furnishing condoms to teens and instructing them how and when to use them.

I read opinion pieces and overhear conversations that get indignant over the idea of a "morning after" pill for high school girls. Perhaps mine is a sheltered and provincial environment, but all I know to believe is what I see, hear and read in the paper.

If I am wrong in my conclusions, I am ready to stand corrected. But until I see more evidence to the contrary, I have to plead guilty to having said that.

As often as I have said it, I think I must once again state my personal views about abortion. My personal view is that abortion is a morally reprehensible procedure which may in extraordinary circumstances by at best a "necessary evil" but in virtually all cases morally wrong. Having said that, the next question is whether laws can or should mandate moral behavior. That is another matter, and that is where the question becomes inflammatory.

I'm not into "tired party platforms." As far as I know neither of the two major parties has a plank specifically regarding how best to reduce abortions, although FOCA (Freedom of Choice Act) is waiting in the wings. When that inflammatory bill is tossed into the US Congress the ensuing explosion will be louder than anything yet heard.

I'm interested in discussions, not arguments. Specifically, my interest now is finding a legal definition for "viability" (probably about 20 weeks) and what limitations will be placed on post-viability abortions.

I got over the notion several years ago that morality and legality must be congruent. See my series of five posts starting with Abortion -- the unmentionable word. It may be tedious reading, but I did a lot of homework and reflecting putting them together.