Laboratories of the States: The good… and then, the very bad and ugly

This essay first appeared on Huffington Post

Will a few states rule the United States? Or fundamentally change it? And if so, who are the winners and losers? Depending on your point of view, this “laboratory-of-the-states” business is good news today… or not.

The metaphor dates to the dissenting opinion of Supreme Court Justice Louis Brandeis in a 1932 case, New State Ice Company v. Liebmann and is often used today to assert the success of one social program or another. The best most recent — and decidedly successful — laboratory-of-the-state demonstration is Oregon’s Death with Dignity law. This writer’s extraordinary attorney friend Kathryn Tucker published a paper in the 2008 Michigan Law Review, when she was Director of Legal Affairs for Compassion & Choices, titled “In the Laboratory of the States.” Tucker wrote, “Because Oregon’s Death with Dignity Act has proven both useful and harmless, this Article concludes that it is time for other states to follow Oregon’s lead and enact their own legislation to allow their citizens an alternative to what otherwise could be a prolonged and painful death from terminal illness.”

Tucker deserves much of the credit for expanding the Oregon law into the movement that now seems a clear national trend, along with Compassion & Choices (full disclosure: this writer has long been a C&C supporter, volunteer and local board member). Washington and Vermont have passed similar bills and Montana wisely concluded that it’s none of the state’s business what a doctor and patient decide to do, making physician aid in dying now legal in those states. A handful of other states have pending bills and still others are mounting strong movements. So Oregon’s laboratory of success is likely to be the nation’s overall policy in the foreseeable future, and we’re all better off for that. (Opposition has come from religious and political forces that hold onto a belief that God requires some sort of existential suffering be visited upon Her dying creatures.)

The laboratory-of-the-states pathway is both effective and well trodden, said San Jose State Professor/author Larry Gerston at a recent Commonwealth Club political panel event. The panel was looking at other current trends, but Gerston specifically cited the Oregon Death with Dignity model as an example of how it all works.

Now — what if Texas becomes a laboratory for the denial of reproductive rights?

In Texas, just for a rough overview, recent laws have passed requiring parental notification and now parental consent; requiring abortions to be performed in ambulatory surgical centers with hospital-grade operating rooms; requiring women who seek abortions to submit to ultrasounds and then wait 24 hours for the procedure. The list of harsh, medically unnecessary restrictions and requirements is long, and a clear violation of both ‘best medical practice’ and women’s rights.

It is worth noting who are the winners and losers in these state laboratories. In Oregon, the winners are we the people everywhere. Few of us would turn down the right to a humane and compassionate death, which is made a possible choice by death-with-dignity laws. Losers? No one. No one is compelled to choose a hastened death, anywhere, any time.

In Texas, however, the scorecard is seriously skewed. The winners are archconservatives that have learned that this is a good way to get votes. Winners also include those, men and women alike, whose religion teaches that life begins at conception and thus all abortion is wrong. This writer can appreciate those who hold such views, but it is not possible to uphold the rights of a fetus without denying the right of the woman in whose body it resides. Many of us come down on the side of already-alive women and on the doctrine of church/state separation.

And the losers in Texas: women. All women. Primarily they are women without money or resources, who are frequently disadvantaged and disproportionately women of color. These women are already turning to desperate measures to end unwanted pregnancies; increasingly they are turning up in emergency rooms with failed attempts to self-abort. To a lesser degree, but still worth considering, the losers include those — men, women, boys, girls — who need the other services provided by rapidly closing clinics: birth control, sex education, STD testing, breast cancer screening and many other critically important needs that will now go unmet.

It’s hard to contemplate the win-lose picture of this Texas laboratory. But if it indeed becomes a laboratory-of-the-states argument in upcoming Supreme Court cases, and elsewhere, the losers will be all of us. You and me. We the people.

The (Abortion Docs) Holiday that Wasn’t

This post first appeared on Truthout.com as a SpeakOut essay

With abortion providers and abortion rights fast disappearing, it is particularly regrettable that the National Day of Appreciation for Abortion Providers came and went on March 10 with little fanfare. It was well worth celebrating and its passage is worth noting.

The day did indeed get some good coverage, including at least one excellent blog post noting the degree of vilification and abuse that providers suffer today. And it raised the hackles of a few on the right fringe: a blogger on Free Republic, for example, called it “the most disturbing holiday of the year,” – tossing in the opinion that abortion providers are “people who make lucrative piles of money for tearing babies apart.”

Not exactly. Abortion providers, many of whom work hard to keep services available to the mostly poor and voiceless women who are victims of today’s fringe politics, would be surprised to hear themselves described as making “lucrative piles of money.” What they do is in fact poorly compensated in dollars but richly rewarded by the gratitude of women who seek their services.

A National Year of Appreciation for Abortion Providers – while their ability to provide this fundamental women’s healthcare need remains – would be appropriate.

Celebrating abortion providers

This essay first appeared on Huffington Post

You’d think, what with the incessant campaigns to hobble, harass and vilify them, that abortion providers would be somewhere right up there with ax murderers, and at least lying low under the radar. But you would be wrong.

The National Day of Appreciation for Abortion Providers is at hand. It is officially celebrated on March 10 by Planned Parenthood, NARAL Pro-Choice, assorted other reproductive rights organizations and every woman whose life has been honored and restored following the decision to have an abortion. The day comes exactly 21 years after the murder of Dr. David Gunn at his clinic in Pensacola, Florida, a tragedy that was followed by the killings of Dr. John Britton and clinic escort James Barrett in 1994, Dr. Barnett Slepian in 1998 and Dr. George Tiller in 2009.

The irony of such losses is that abortion providers – who still face serious risks – save the lives of countless women every day. Is a day of appreciation enough? One day, in return for all the millions of days of life returned to millions of women? I vote for celebrating at least throughout the month of March.

My own abortion, a back-alley experience following a 1956 workplace rape, was emblematic of a time when there were no such people to honor. Luckily, I got my life back. No one will ever know how many women did not, how many were left maimed or dead because they had no safe, legal option. Since 1973, thanks to passage of Roe v Wade (but no thanks to those who are trying to send us back to the dark ages) they have had trained professionals motivated by compassion – and stories of women like me.

Early on there were individuals like Dr. Harry S. Jonas, now retired after long years of medical practice, teaching, and advocacy for family planning. Jonas speaks of a woman he met when doing an Ob/Gyn residency some years before Roe v Wade. She was dying of massive infection and multiple abscesses from a botched self-induced abortion after having endured 14 pregnancies. “I still remember that patient,” Jonas says, “I remember what she looked like. I remember the bed she was in on Ward 1418. I will never forget it.”

Today there are providers in heavily regulated states – most of whom remain anonymous for very good reasons – with similarly tragic stories. They tell of women who misuse abortion-inducing drugs because they can’t get to a clinic, or girls barely past puberty too frightened by protesters to access care that is their constitutional right. Of a 14-year-old incest victim pleading for help to reach the nearest clinic many miles distant. Of a sick, troubled mother of five having to choose between multiple required – and unnecessary – trips to the clinic and the job she desperately needs to keep. The physicians who are there for these women often face the need to treat their souls as much as their bodies.

Among those who choose to be open in their activism is my personal hero, Willie J. Parker. I have never met Dr. Parker, an African-American Ob/Gyn, other than on phone calls while researching Perilous Times: An inside look at abortion before – and after – Roe v Wade. He speaks with passion and conviction. Currently Associate Medical Director of Family Planning Associates Medical Group in Chicago, Parker grew up Southern Baptist, in a community which taught that abortion is wrong. His own views changed on hearing a sermon about the Good Samaritan preached by Martin Luther King, Jr. “(King) said that what made the good Samaritan ‘good’ was that instead of thinking about what might happen to him if he stopped to help the traveler, he thought about what would happen to the traveler if he didn’t stop to help. That led me to …place a higher value on compassion. I couldn’t stop to weigh the life of a pre-viable or a lethally flawed fetus against the life of the woman sitting across from me.” In addition to his day job, Parker offers help in other parts of the country where help is critically needed. He shrugs off questions about personal risk.

Almost any one of today’s providers could make more money, and have a far easier life, in another job. Instead, they choose to do what they do, so women can choose to control their bodies and their lives. That’s worth celebrating.

So light a candle. Write your congressperson. Send a few bucks to the nearest clinic and the organizations that fight for women’s reproductive rights. One national day is just a fraction of the appreciation abortion providers deserve.

On choosing one’s words…

I was taken to task, rightly so, by a reader who categorized my saying “no one… has an abortion without anguish” (you can read B’s articulate comment, and my response, in the 2/22 Comments) as “hokum.” She might also have said “hogwash.” Mea culpa. “Anguish” was a poor descriptive choice. “Serious thought” maybe; “self-reflection,” “concern.” Actually, the decision does involve anguish for many women, especially those whose rights are being denied by lack of access or harsh state restrictions.

But one word can wreak havoc.

Take the hyphenated word “pro-life,” which has been appropriated by those who are ferociously anti-woman. As if the issue of abortion — always complex and private, and occasionally anguishing — involved nothing at all beyond the (potential) life of a fetus. I consider myself ferociously pro-life, it’s just that I value the life of a woman. And am pro-woman’s-life enough to honor and trust her ability to make her own decisions about her body.

Or the emotionally charged word “suicide.” Those of us who believe in the individual’s right to a compassionate and dignified death have worked hard to get that word out of the discussion. Suicide is the desperate act of a despairing person; “physician aid-in-dying” is a compassionate choice made by a terminally ill, mentally competent adult.

Word choices took much of the focus in a fascinating panel on “Defining Death” sponsored recently by the University of California San Francisco Medical School. More about that event on HuffingtonPost as soon as I can get to it. Cases under study included the tragic, ongoing story of 13-year-old Jahi McMath, and the equally tragic story of 14-week-pregnant Marlise Munoz, whose brain-dead body was briefly kept on “life” support because the hospital and the State of Texas placed the potential life of that pre-viable fetus above the expressed wishes of her husband, parents and even Munoz herself. The distinguished UCSF panel of experts on medicine, law and ethics spoke repeatedly of how much anguish — the word definitely fits here — might have been prevented if only a few, kind words could have replaced some of the jarring words that unfortunately must eventually be said.

Imagine you’re the patient, or family, or attending healthcare worker (try to leave the lawyers out of this.) When does a moments-ago-healthy person become a “corpse”? A “dead body”? Who decides if a pre-viable fetus is a “person”? How can the average person even understand “brain-dead”? If you bring the lawyers in, you encounter “property.” In more than a dozen states there are laws on the books that say that if a pregnant woman dies her body must be maintained until the fetus can be delivered… no matter what advance directives she may have that specify her wishes to the contrary. One family fought against this outrageous miscarriage of justice by claiming their dead loved one’s body — which was, in the eyes of the law, their “property.”

It’s a scary world we live in. But that word JUSTICE. If we can only hang onto that one.

 

 

Reading the data on declining abortion rates

This essay first appeared on HuffingtonPost.com

Recently released figures from the Guttmacher Institute show a drop from 1.2 million abortions in 2008 to 1.1 million in 2011, and that’s something to cheer about.

The question is, who’s cheering, and why.

Anti-abortion forces are not even cheering very loudly. Instead, as reported in National Right to Life’s News Today, they are proclaiming that the new report “downplayed the role that public debate over the rights of unborn children have played in this trend.” Well, that role is, in itself, debatable. I would suggest that those on all sides of the issue might do well to put aside the fringes — “Abortion on demand and without apology!” as well as “The unborn must have rights!” — and focus instead on the good news: Fewer women are having abortions. Unintended pregnancy rates have dropped. Abortion has decreased to its lowest level since 1973 when Roe v Wade was decided.

As a woman who had a back-alley abortion in 1956, I hear that as good news on many counts. No one, I repeat, no one, has an abortion without anguish. The decision is always complex, difficult, unique and intensely personal. One woman may have been raped, another impregnated under equally horrendous circumstances. One woman might already have more children than she can adequately care for and know that continuing her pregnancy will threaten her own health and her children’s future. Another woman could have learned her pregnancy has severe fetal anomalies, leaving her heartbroken at the prospect of bringing a child into the world who will only suffer and quickly die. If she’s poor, her choices rapidly disappear. Like the young woman denied access and unable to end a tragic pregnancy in 2009 who told me tearfully, “we couldn’t raise the money.”

A decrease in stories like these is great good news.

But it will not happen by continuing to deny access to safe procedures or creating more and more layers of restrictions. It will not happen by rolling back access to the very things that can limit the unintended pregnancy rate in the first place, like sex education and birth control. Insisting that every woman in the U.S. must be compelled to carry every pregnancy to term will not prevent unintended pregnancies, and unintended pregnancies will always drive up abortion rates.

When I began work on my recently published book, Perilous Times: An inside look at abortion before – and after – Roe v Wade, I spoke first with women like me who had had no access to safe and legal abortion. Our stories are of frightening trips in strange cars, blindfolded and defenseless, to kitchen-table abortions performed by untrained criminals. But soon I began hearing equally distressing stories from young women today, like the distraught woman above who “couldn’t raise the money.” Or the pregnant 14-year-old who was rescued by Loretta Ross of SisterSong in Atlanta after the abused child — “she was still sucking her thumb,” Ross said — had been unable to terminate her pregnancy because of time limits in her home state.

Lower abortion rates will come from more widespread use of more effective contraception. And from educating women, and men, about how to prevent unwanted pregnancies.

How can effective, non-judgmental, accurate education happen? Not through the organizations that run “Crisis Pregnancy Centers” and spread misinformation, while telling women that abortion is “murder.” If education is to be effective, it can only happen in an arena of full truth, and be built on scientific fact.

Physicians for Reproductive Health is a good place to start. This professional organization keeps its focus on women’s health. Remember when trained doctors and healthy women were the heart of the debate rather than unscientific data and political rants? The National Abortion Federation, which has a strong educational arm, is another. And finally there is — gasp — Planned Parenthood. Targeted as the Essence of Evil by anti-abortion forces because some Planned Parenthood health centers offer safe and legal abortion, in reality Planned Parenthood is the logical place to begin advocating for… planned parenthood: safe, informed ways to avoid unintended pregnancies and promote healthy women and children. The organization is already providing extraordinary services. According to PPFA’s website, “every year, more than 700 Planned Parenthood health centers provide birth control to more than two million patients from all walks of life.”

The latest Guttmacher report could be a catalyst for change. But only if those on both sides of the highly polarized and overly emotional abortion issue will use it for the good of women. And I, an eternal optimist, am not holding my breath.

End-of-life compassion slowly winning

If you think you might die some day, and you’d like to do it with as much dignity and as little pain as possible, things are looking up. Which is encouraging to me, a believer in end-of-life and reproductive rights both — and progress in one out of two causes is something to cheer about.

credit acpinternist.org
Credit acpinternist.org

The outlook for a compassionate end to this life in the U.S. continues to brighten. In a recent New York Times article summing up advances that are being made in multiple states,reporter Erik Eckholm quotes my good friend Barbara Coombs Lee, President of Compassion and Choices: “There is a quiet, constant demand all over the country for a right to die on one’s own terms, and that demand is likely to grow as the baby boomers age.”

Lee, a baby boomer herself, is in a position to know. She has been at the forefront of the death with dignity movement since it was in its infancy. We first met when I was researching Dying Unafraid (Synergistic Press, 1999) and she was head of Compassion In Dying, headquartered in Seattle. That group had formed, I learned during a weekend spent with leaders and volunteers in the late 1990s, “because we got tired of reading headlines about people with AIDS jumping off of highway overpasses. And we thought there had to be a better way to die.” Compassion In Dying later merged with End-of-Life Choices, which had itself grown out of the somewhat more in-your-face Hemlock Society, to become Compassion and Choices. (And I am proud to have been a part of C&C since its inception as a volunteer, former local board chair, current leadership council member and general cheerleader.)

In those early days, all was not optimism. While Oregon was proving that a physician-aid-in-dying law could work, efforts elsewhere were failing with heartbreaking irregularity. The one most painful to me culminated in the defeat, in 2006, of a bill which would have legalized compassionate dying — in other words, with the aid of one’s physician if one so chose — in California. Assembly members Patty Berg and Lloyd Levine introduced the legislation, and polls showed overwhelming support among Californians, including a majority of California physicians. Victory seemed all but certain, despite a vigorous and expensive campaign against the bill by the Catholic Church (not most Catholics, just Catholic officialdom) and the California Medical Association (of which a small percentage of CA doctors are members.) At the judiciary committee hearing chaired by then CA Senator Joe Dunn  — who had loudly proclaimed his support —  Dunn suddenly had a change of heart. Something about a conversation with his priest, he said in a rambling commentary. Dunn then cast the deciding vote against the bill and it died an unnatural death in committee. A few weeks later Dunn was termed out of the California legislature and took a job — surprise, surprise — as CEO of the California Medical Association. It was not my personal most encouraging experience with the democratic process.

Now, however, sanity is prevailing. The option of choosing a compassionate death is legal in Washington, Vermont, Montana and New Mexico and the cause is gaining in other states. As Steve Heilig, another highly esteemed friend who is co-editor of the Cambridge Quarterly of Healthcare Ethics, points out in a current letter to the New York Times, “Progress is possible if carefully and ethically pursued.”

If only there could be a careful, ethical pursuit of progress — instead of the ongoing, reckless, politically and religiously-driven backward march we’re seeing — for reproductive rights.

Millennials and abortion rights

If abortion rights disappear, it’s the millennials who will be most affected. Some of them are worried. Many of them are unaware and unconcerned — but more of them are beginning to take up the fight for reproductive justice. Or, at the least, beginning to pay attention.

I got my first anecdotal glimpse of how the issue is playing out when I spoke to a class at Randolph-Macon College in Ashland, VA recently. It was, by and large, heartening. The students listened attentively to my own story of an illegal abortion that took place when their grandmothers were young. Most were somber or nodded in sympathy; one young woman put both hands to her cheeks, partially covering her eyes and shaking her head as if in disbelief. I read that with encouragement: maybe if more of the millennials realize how dangerous those pre-1973 days were for women they will help prevent a return.

The several young men in the class turned out to be the most vocal in support of abortion rights. I asked one of them why. “Because I don’t believe anyone should tell a woman what she can or cannot do with her own body,” he said. He knew several women of his generation who have had abortions, and he believed it was nobody’s business but their own.

Then I asked if anyone in the class — which did seem generally supportive of abortion rights — felt differently. “It’s okay,” I said. “I’m not being judgmental or argumentative; everyone’s got a right to his or her own opinion. I’d just like to hear from anyone who does not believe abortion should ever be permitted.” One courageous young woman raised her hand.

“I know three people who have had abortions,” she said in response to my request for explanation. “Two of them later had regrets, and it has ruined their lives.” And on that basis she feels no one should be allowed to have an abortion? “Yes.”

It would be ridiculous to draw any conclusions from one brief encounter with several dozen bright millennials, but I have some theories. One is that the anti-abortion spokeswoman, in addition to knowing several women “whose lives are ruined,” is rooted in a religious community that reinforces this view. It’s the stance of the religious and political right that abortion is murder — and if you’re in such a community and have an abortion you would undoubtedly feel ruined afterward. Forever? I hope not.

A second theory is that the articulate young man has been around a lot of people who encouraged him to ask questions and think things through. While the young woman was not anxious to elaborate on her views, he seemed perfectly ready to defend his.

My hopes are on the millennials who are thinking things through.

Roe v Wade: an anniversary to celebrate

right to choose
Photo Courtesy: CRoberts5, ieTheRevolution

The day has just passed, but it’s worth celebrating for a while. Especially while “Marches for Life” are going on around the country.

Aren’t we all wanting the same thing? Life?

Even those whose focus is only on the life of the fetus: many of them are at least interested in the lives of women and girls, some of them support education, family planning, healthy people. Some of them will talk about contraception, our mutual wish to make abortion rare, our mutual interest in everyone’s health. Life.

Forty-one years ago the Supreme Court made it legal: women (and girls) like me would never again face the shame, danger and often death that came from trying to end an unintended pregnancy. Though it came too late for me, I was lucky; I survived a back-alley abortion, even to have healthy, wanted children. I mourn those who did not, or who wound up maimed. I am saddened and dismayed by the efforts today to send us straight back to those dark days. It is my hope and prayer that we can find ways to make abortion rare — through diligent work on things like education and contraception — while keeping women and girls safe, healthy and autonomous with protection of the right to choose what happens to their own bodies.

Which brings us back to the celebration, of Roe v Wade.  Of life.

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