“Help us protect the unborn, and save women from the shame of abortion” read the invitation.
It was an invitation to a fundraising event – this writer is on a strange variety of mailing lists – for a pregnancy crisis clinic. A friend who works at the clinic, and whom I respect although our opinions about abortion are poles apart, told me they never pressure or deceive women who come to the clinic. “We just explain that we don’t counsel on abortion,” she says. The fundraiser invitation sounds decidedly less compassionate.
The Shame word tears at my soul.
Thirteen-year-old Natasha, brutalized by more than one relative, is given another chance at childhood through an early abortion at a Planned Parenthood clinic. On top of all the trauma she has borne, she is supposed to feel shame?
Or the couple with a developing fetus they desperately wanted and loved, who decide to terminate the pregnancy later in its term to spare their baby a brief life of terrible suffering. In addition to their deep sorrow, anguish and grief, they should be ashamed?
Or the countless young women in circumstances similar to my own: after choosing to end an unwanted pregnancy for widely varying, compelling, always unique, deeply personal reasons because we are rational women in control of our own bodies – we need a shameful scarlet ‘A’ tattooed on our foreheads?
The banners proclaiming “Abortion Hurts Women” – posted by groups that seek to end legal abortion – testify to this fact: The posters work, but the words lie. Abortion is in truth far safer than childbirth. It does not hurt women, it protects women. The words are not true. But they work in exactly the same way that the shame word works.
Some words, even when they lie, go straight to the emotions. Emotional appeals become tools to generate support for political positions which hurt women. They should shame those who seek to deprive women of dignity, health and autonomy.
‘Shame’, ‘hurt’ – the emotional trigger words are being used to turn the clock back to the dark ages when women had no voice, no power, no control of their own lives.
As one who has been hurt, not by abortion but by powerlessness, and who strenuously objects to shaming, I declined the invitation.
Christie White and Dan Swangard are fighting to live – and also fighting for their right to die: peacefully, at home, surrounded by those they love.
Kathryn Tucker and Nico van Aelstyn are now taking that fight to the Superior Court of the State of California; and it will be a fight worth watching.
Tucker, a distinguished attorney now serving as the executive director of the Disability Rights Legal Center, has already led a number of such battles for peace at life’s end, including defense of the Oregon Death With Dignity Act several times in the early years of that now 18-year-long success story. van Aelstyn has a similarly notable record and an award-winning history of pro bono work on end-of-life issues. Many supporters of end-of-life choice, including this writer, are optimistic about the potential outcome.
But court battles aren’t settled overnight, and White and Swangard know they may not have a lot of time left.
“My mother will tell you,” White remarked during the press conference announcing the lawsuit, “that from the time I took my first steps I wanted to be in control. I want to be in control. I am adamant about not wanting to die in a hospital, but at home, surrounded by my family. I want to be able to gather my loved ones and meet my death with some dignity and peace of mind.”
Since first diagnosed with non-Hodgkin’s lymphoma and then acute myeloid leukemia or AML Leukemia more than five years ago, White has undergone chemotherapies, radiation therapy and a bone marrow transplant. Because of those prior interventions, her medical options would be severely limited should her leukemia recur.
Dan Swangard, MD was diagnosed with tumor of the pancreas, with metastatic disease to the liver, and had major surgery in 2013. “Not to state the obvious,” he told the press, “but dying is something we all do. It can be loud, quiet, filled with anxiety, pain and suffering, at home or on the road. It can also be peaceful, filled with connections to people we love the most – if planned.”
Swangard has practiced medicine for 22 years. He has also served as a volunteer with Zen Hospice and at Laguna Honda Hospital in San Francisco, experiences that add to his own understanding of what a good death can be.
This lawsuit is about the possibility of a good death for everyone in California. Christie White and Dan Swangard are two good Californians who deserve such an option.
Is there a constitutional right to “physician-assisted suicide”? What about a “dignified death” – and what is a dignified death? Should terminally ill patients facing mental incapacitation or unbearable pain have access to fatal ingestion – also known as physician aid in dying? Or would that jeopardize our society’s progress toward more compassionate, comfort-based care?
Participants included John M. Luce, Emeritus Professor of Clinical Medicine and Anesthesia at the University of California San Francisco; Laura Petrillo, MD, a Hospice and Palliative Medicine fellow at UCSF; and program host David L. Faigman, Professor of Law at UC Hastings College of the Law and Director of the UCSF/UC Hastings Consortium on Law, Science and Health Policy.
The program kicked off with a discussion of the science of death itself – defining death being more and more problematic these days. Think Nancy Cruzan, kept alive through a feeding tube in a “Persistent Vegetative State” for nearly a decade until her family managed to convince the State of Missouri that she would never have wanted to be “kept alive.” Or Terri Schiavo, whose PVS ordeal lasted even longer. More recent is the tragic story of 13-year-old Jahi McMath, declared brain-dead by multiple physicians more than a year ago but whose body is still existing somewhere, connected to machines that keep her heart beating.
Those cases are just a few of the markers on the path toward today’s critically important death with dignity movement. This writer’s involvement in the cause began with work as a hospice volunteer in the 1980s, a member of an HIV support group in the ’90s and a volunteer with Compassion & Choices (and its predecessor organization Compassion in Dying) since the late 1990s. C&C is currently leading the fight to make aid in dying legal throughout the U.S., having won significant battles – five states now protect that right for terminally ill, mentally competent adults – with others underway in many areas.
And that issue – should medical aid in dying be legalized in California (and elsewhere) – was the heart of the two-hour program. Of the two physicians, Luce was eloquently in favor, and Petrillo was adamantly opposed. In this writer’s admittedly biased view, Luce’s lifetime of experience as a distinguished physician and professor rather embarrassingly outweighed Petrillo’s credentials, but it is possible to see her emerging-palliative-care-physician status as basis for her absolute certainty that everyone on the planet can experience graceful, pain-free death if only he or she has access to palliative care.
I am less certain. Thus my argument.
In the Q&A period, I posed this question to Petrillo: “If you were my doctor, which is unlikely, and I were dying, which is increasingly likely (I’m 81, for heaven’s sake,) and I have expressly, repeatedly made clear that I do not wish to linger – why should you have the right to insist that I linger?”
Petrillo dodged the question. “I would ask what is causing your pain,” she said. “I would try to determine if you are depressed, and talk about how we can alleviate your pain and possible depression…”
After several abortive attempts to get a response to my question, and figuring the audience had not paid good money to listen to me rant, I gave up. But here are the arguments I had for Dr. Petrillo, questions I wish the minority of physicians who do still oppose aid in dying would answer:
Why should you have the right to insist that I linger, when I am dying?
How can you presume to understand my pain better than I? And why should I have to describe it if I don’t choose to do so?
When I have watched dying people with the very best care and pain control suffer in ways I would not choose to suffer, how can you insist on my going that route?
Why should your conviction about the efficacy of your medical field trump my autonomy?
Dr. Petrillo said she is not religious, so this question would be addressed to others: Why should your religion overrule my religion? Or dictate to me?
It’s my only precious life, after all. Why should I be denied control of its precious end?
A recent report by the Guttmacher Institute took a new look at an old game being played – anew – by anti-abortion, anti-women forces. It is called the Personhood Game. If anti-women forces win, a fertilized egg becomes accepted as a person. Which means that every fertilized egg is accorded rights above those of the woman in whose body it is housed – fine for eggs, but pretty dismal for women.
Not a lot of rational people, including rational people who vote, think it makes sense for eggs to be deemed persons. This was made clear last year by the failure of such bills in several state legislatures. Not to be dismayed, players of the Personhood Game have simply switched their energies to fighting contraception. The more contraception bans succeed, the stronger the eventual case for declaring fertilized eggs sacrosanct. Why? Because contraception bans are based on religious doctrines that hold such a view. Though keeping their distance on personhood politics for now, anti-abortion groups including Americans United for Life, the Heritage Foundation, Susan B. Anthony List and the U.S. Conference of Catholic Bishops are among those working hard and widely to ban access to contraception.
Is there a disconnect here? Since effective contraception lessens the number of unwanted pregnancies, and thus the number of abortions? Well, yes. But the people playing the Personhood Game simply have their eye on the prize: Fertilized egg wins, woman loses.
Writer/blogger Joanne Valentine Simson, who is credentialed in both science and poetry, has posted a number of thoughtful and informative essays on contraception. Simson points out three critical factors seldom considered in all the arguments for and against contraception: women’s physical wellbeing, women’s social wellbeing, and overall environmental impact. “These are larger issues about long-term human survival,” Simson writes, “(than) the false debate about whether a cell (or cluster of cells with 46 chromosomes) is a human being.” To conflate contraception with abortion simply bypasses every one of them.
But the Personhood Game players are as adept at bypassing reality as they are at steering the debate.
“The influential organizations behind this anticontraception agenda,” writes Joerg Dreweke in a recent, comprehensive Guttmacher policy review, “have compartmentalized the debate, which allows them to pick and choose when contraception should be viewed as abortion and when it should not. They are essentially able to pursue a “personhood” argument in areas where doing so is politically feasible, but at the same time feign moderation by keeping the full-fledged, politically toxic “personhood” agenda at arm’s length. This deception is part of a deliberate, long-term strategy to limit women’s access not only to safe and legal abortion, but to common methods of contraception as well.”
If this seems devious, and underhanded – well, it is. But it’s the way the game is being played.
For women – who are both pawns and victims – it is a dangerous game.
Maluki had what she thought was a minor infection in her chest. She took a couple of pain relief tablets. She is undocumented and uninsured. She had no access to a community clinic where she might have seen a doctor with no questions asked; no one in her suburban family had heard that such things exist. Within a few weeks Maluki was doubled over with pain and was rushed by a neighbor to an emergency room at a major public hospital two hours away.
Two surgeries later the 38-year-old mother of three will be out of work for a very long time. Her husband, partly disabled, works irregular hours when he can, leaving the family dependent on what money the teenaged children – all U.S. citizens – can bring in. The children still hope somehow to finish high school and attend college.
There are, by one estimate, 11.7 million undocumented immigrants in the U.S. Some have health coverage through their jobs, and a few have private coverage; but the vast majority of these are uninsured. The resulting costs, in human terms such as the case above, are inestimable; the costs in dollars are also significant. “If we get the patient into basic care for colds and flu,” said Gressman, “we save thousands in hospital care.” In California, care is widely available through publicly funded community clinics as well as nonprofits – the problem is in getting the word out and building trust. “We look at how to get the patient to care,” Hauge said, “not at anyone’s immigration status.”
While Gressman, Hauge and Lucia each brought extensive understanding of both the policy and the real-world details affecting healthcare needs of undocumented immigrants, it is the personal stories of Lucia and Latthivongskorn that illuminate the remarkable richness of our immigrant nation.
Nearly a century before she was invited to bring her expert knowledge to a Commonwealth Club panel, Laurel Lucia’s great-grandfather was a frequent speaker at the Commonwealth Club himself. Felipe N. Puente was memorialized in the Club’s Journal upon his death in January, 1951. He was, his obituary reads, “by far the most important personal tie between Northern Californians and the Republic of Mexico for nearly a quarter of a century.
“Commencing as a colorful revolutionary Mexican leader in 1917 (as Jefe de Transportacion for the late Revolutionary General Francisco Villa), he had for 25 years been a resident of San Francisco, with five children in our public schools, and the long-time Manager of the Mexican National Railways, San Francisco division, in the Monadnock Building.
“Although a railroadman by profession, his expert and sagacious advice was freely at the service of American travelers by sea, highway or air, and a letter from ‘el Puente de San Francisco’ (the San Francisco Bridge) as he was affectionately known clear down to the border of Guatemala, opened all doors in Mexico.” Great-grandfather Puente’s expertise reached beyond transportation to government affairs. In a Commonwealth Club speech broadcast over KYA Radio in 1942 he spoke of the importance of Mexican-American cooperation in the war efforts, citing cargo lanes and Mexican ores that were critical to the U.S. and quoting President Avila Camacho as saying, “Mexican soldiers are willing to shed their blood anywhere in the world where they may be needed.” His Journal obituary began and ended, “Adios, Amigo Felipe N.Puente!”
Lucia missed out on knowing her notable ancestor, “but I was quite close to his daughter, my grandmother.” She had not, she says, ever made any connection between his immigrant status and her current work – as a Policy Analyst for the UC Berkeley Labor Center – which partly seeks to strengthen the safety net for those more recently arriving on our shores.
Laurel Lucia with Moderator Weintraub
As for the other young person on the “Undocumented and Uninsured” panel, Jiryat New Latthivongskorn (hereafter identified by his familiar name, New) confesses to having been a little startled to hear himself constantly referred to during the evening as “the first undocumented student to be admitted to UCSF (the University of California San Francisco) Medical School.” But that is, in fact, part of his current resume, and a not insignificant achievement.
There were 7,453 applicants to UCSF Medical School for New’s class, out of which pool 490 were interviewed and 149 were accepted. The overall grade point average was 3.77.
New Latthivongskorn came to this country with his parents when he was 9 years old. His parents worked in Thai restaurants every night until 11:00. But whenever he tried to help, he said in an interview on KQED Radio last May, “the answer never changed. ‘Don’t worry, and do your job.’ My job was to get an education.” So far, he appears to have done his job quite well. New never considered the idea of being a doctor until one scary incident during his junior year in high school when his mother fell gravely ill and had to be taken to the emergency room. The family had, until that time, relied on a medicine cabinet full of remedies for colds and pain and a few old antibiotics from Thailand. But in the ER, when his mother couldn’t understand the doctors and they couldn’t understand her, New realized his job might be more than just a translator.
There are those, including a few who commented on the KQED program, who argue that anyone who is in this country illegally should simply be sent back to wherever he or she came from and until then should receive no benefits – and certainly no healthcare. That may, however, be an overly simplistic – not to mention cruel and unusual – answer to a very complex issue.
“Immigrants don’t come here,” New told the Commonwealth Club audience, “for free healthcare. They come here to escape danger or terrible conditions; they come here to work.” In short, to create a better life for themselves and their families, and ultimately to give back to the communities of their new world. That was definitely true for immigrant Puente a century ago, and is demonstrated by the hard-working parents of doctor-to-be New.
Other than the Native Americans who pre-date most of us, it would be hard to find many U.S. citizens whose ancestors didn’t have similar stories.
No one was surprised by the news of Brittany Maynard’s death on November 1, as she had planned. The news arrived in my Inbox late Sunday night, November 2, in an email from Compassion & Choices, an organization I have supported — as a volunteer, Northern California board chair and in all other ways — for well over 15 years,
What Brittany did for Compassion & Choices, and for you and me, though, far exceeds what any one person might ordinarily have done. Hers was an extraordinary demonstration of how to live, and die.
More of how she lived will continue to be in the news. But it’s how she died, with generosity and grace, that is worth noticing right now. Just to touch on a few things:
Brittany, in making her own choice, showed us how to make our own choices. Demand the right to control your destiny, she was saying. Fight for legalized aid in dying. Complete your own advance directives and make sure EVERYONE in your family and circle of friends knows what your own wishes are. Death with dignity was Brittany’s choice, and she wanted it to be yours — if you choose.
“The freedom is in the choice,” Brittany said. “If the option of Death With Dignity is unappealing to anyone for any reason, they can simply choose not to avail themselves of it.”
Brittany was irate over insinuations that she had been “manipulated” by anyone. She was a strong, educated, independent, intelligent woman who led a joy-filled life and confronted its abbreviated end with remarkable courage. The reality was simply that she took control of her own final months, weeks, days, by moving to Oregon where aid in dying is legal. The reality is that she wanted her life — and death — to have meaning for all of us. She hoped that by sharing her story all of us might benefit.
It’s about freedom. Brittany, thankfully, is now free of the terrible pain her illness was bringing, a pain that was certain only to increase. Her family will mourn for a long time, but they are free of the pain and anguish that comes from watching someone you love suffer.
You and I are free to choose. We can continue to let those who hold differing views deprive us of our right to control our final weeks and days. Or we can fight to legalize our right to choose a compassionate death. Eventually, that right will prevail.
With the closing of thirteen abortion clinics in Texas, one out of six Texas women seeking an abortion will have to travel 150 miles or more, and never mind all the other obstacles about waiting periods, increased costs, hassling protesters and having to listen to medically incorrect messages. But one out of six? That’s only a small fraction, according to the United States Court of Appeals for the Fifth Circuit.
“In our circuit,” wrote Judge Jennifer Elrod, a George W. Bush appointee, “we do not balance the wisdom or effectiveness of a law against the burdens the law imposes. We do not doubt that women in poverty face greater difficulties.”
What a bother, those “women in poverty.”
Judge Elrod argued that the court had to find that “a large fraction” of women would be affected by the law – the medically unnecessary requirement that all abortion clinics in the state meet the same building equipment and staffing standards as hospital-style surgical centers. And those 900,000 women in rural Texas the judge acknowledged would be affected, well, they’re just a “small fraction.”
Judge Elrod may not know a lot about what it feels like, being part of the small fraction. Born in 1966, she grew up in the Houston-area city of Baytown, Texas, which bills itself as a city “where oil and water really do mix.” She graduated from Baylor and Harvard Law School. Her Wikipedia and Judgepedia pages make no mention of marital or family status, but presumably she never sought to have an abortion. If she had, she would have definitely been in the large fraction – women with money who always have access to safe and legal procedures, even in Texas.
This writer was in another large fraction: women without access to safe or legal abortion in the days before Roe v Wade. Much like today’s small fraction, faced with no viable options we took desperate measures to end unwanted pregnancies. Some of us survived, countless others did not.
This is the fate to which the three-judge panel of the Fifth Circuit is consigning the small fraction. Danger, expense, family trauma, health risks and occasional death. Even for a small fraction, that seems hardly what America is about. And hardly in tune with the antiabortion forces’ proclaimed wish to “protect women.”
Some in the small fraction will face primarily family distress and exorbitant costs (usually upwards of $1,000 or $1,500) like “Maria,” whose story is recounted by RH Reality Check Senior Political Reporter Andrea Grimes. Some will face very real danger traveling to Mexico for drugs that can cause permanent injury or death if improperly created or improperly used. Some will maim or kill themselves in efforts to self-abort.
There will be hundreds of women like Elvia Yamell Hamdan, whose story was reported in a recent New York Times article by Laura Tillman and Erick Eckholm. Ms. Hamdan, 44, showed up at the Whole Woman’s Health clinic in McAllen, TX with her husband after a three-hour drive from their home, only to find that clinic professionals could suddenly no longer provide abortions. Ms. Hamdan already has four children and three grandchildren, and seeks to end an unplanned pregnancy. The U.S. Constitution says she has a right to make that choice – but Texas law says her best remaining option is an appointment three weeks later in San Antonio, 240 miles north.
Denise Burke, Vice President of Legal Affairs for Americans United for Life, is quoted in the New York Times story as saying the Fifth Circuit decision endorses anti-abortion forces’ argument that “abortion harms women, and states may regulate in the interest of women’s health.”
“Maria” and Ms. Hamdan seem likely to secure, eventually and at significant risks to their own health and wellbeing, the safe and legal abortion guaranteed to American women. How many others will now, instead, wind up sick, maimed or dead because of this latest ruling will never be known.
Because those others are just part of “the small fraction.”
Women’s Equality Day quietly came and went recently, not quite 100 years after passage of the Nineteenth Amendment – the law that said women were equally entitled, along with men, to the right to vote. Since ratification of that groundbreaking law – women should make choices just as men do?! – an assortment of other rights have been won. But equality? Not quite.
It was the indomitable U.S. Representative “Battling Bella” Abzug who figured that all those rights – won and yet to be won – should have their own day. The New York Democrat introduced legislation establishing Women’s Equality Day, to be observed annually on August 26th in commemoration of the 1920 passage of the 19th Amendment. A lot of other indomitable women, notably Elizabeth Cady Stanton and her suffragette friends Lucretia Mott and Susan B. Anthony, laid the groundwork for the women’s movement.
Fast forward to Women’s Equality Day, 2014. In his official proclamation, President Obama mentioned “all those decades spent organizing, protesting, and agitating,” and took the occasion to list (in the proclamation) a few of the things that his administration has indeed accomplished to advance women’s equality.
But in commemorative events such as the one this writer attended in San Francisco with House Minority Leader Nancy Pelosi, there was a lot of talk about areas in which women are still not quite equal. Pelosi’s focus, she explains, is a three-pronged “Middle Class Jumpstart,” aimed at achieving equal pay for equal work, paid sick leave, and quality affordable healthcare – actions that would unquestionably boost equality for (and the lives of) women in the U.S.
What those ferocious ancestors of ours like Abzug and Anthony were fighting for was not just equality but justice. There’s not much justice if you’re a single mom having to send a sick child to school because you can’t afford to lose a day’s pay or manage a trip to the doctor. Nor is there much justice if that day’s pay is 10% less than men on the same job are getting.
There’s also not much justice for women in non-metropolitan areas who seek abortion services. Ninety-seven per cent of them have to travel long distances, navigate a maze of medically unnecessary restrictions and often also struggle through hostile protesters – assuming they can find the time and money to do this.
Are such issues – reproductive rights – equality issues? It’s hard to feel equal – to the men who don’t face these issues, or to people with more money and power than you — if you are a woman in any of the situations cited above. And given the strength of the conservatives who want to tip the scales ever farther downward, it’s hard to feel optimistic.
But Pelosi and her “Middle Class Jumpstart” plans, reproductive justice groups like NARAL, Planned Parenthood and the National Abortion Federation (to name just a few) and women’s rights organizations of every sort are hard at work trying to keep the scales from tipping farther against U.S. women. Bella Abzug would be proud.
It’s not too early to start planning for Women’s Equality Day 2015.