High Court adds confusion, constraint to abortion issue.

PIP: The consequences of the recent U.S. Supreme Court decision upholding a Missouri law restricting abortions in public hospitals, on the Truman Medical Center, Kansas City, Missouri, as well as selected agencies across the country, are reported. The Truman Medical Center stopped performing abortions on July 3, 1989, and had to send a woman with a 2nd trimester fetus with a severe cardiac anomaly to another state. This hospital is privately owned, but site on country-owned land. The decision reflects anticipated confusion over the Webster v Reproductive Health Services decision, in its vague and broad wording, barring public hospitals or tax-supported facilities from performing abortions, except to save the mother's life. Acute-care facilities perform 13% of U.S. abortions, mainly second trimester terminations and those for women at high risk. Some other hospitals contacted have instituted policies of not making any statements about abortion. The District of Columbia General Hospital, which had its funds for abortions for the poor cut by congress, has already seen higher costs for caring for abandoned, AIDS infected, low-birth-weight and congenitally defective infants. In Illinois, freestanding abortion clinics are facing possible requirements to upgrade their facilities to hospital standards, which will force many out of business, or out of the business of serving low income women.^ieng

Administrators face tough decisions as hospitals confront abortion issue.

PIP: Only 17% of US hospitals (265 public and 926 private hospitals) perform abortions, and hospital-based abortions represent only a small fraction of the number of abortions performed each year. Despite this low level of involvement, US hospitals have become involved in difficult situations concerning law, ethics, and standards of practice. A case in point is Baltimore's Saint Agnes Hospital, where the accreditation of the hospital's residency training program in obstetrics and gynecology was withdrawn in 1986 by the Accreditation Council for Graduate Medical Education. This decision was based on the hospital's refusal, for religious reasons, to perform abortions, sterilizations, and artificial insemination. The hospital further was cited for not providing family planning education to medical students. Saint Agnes Hospital maintained that the Council's decision represented discrimination against Catholic hospitals; as evidence, it cited the fact that, while Catholic- affiliated residency programs comprised only 10% of such programs, they accounted for 83% of programs in which deficiencies or concerns were identified by the Accreditation Council. Some Catholic hospitals deal with this situation by allowing residents to rotate to other facilities if they want to be trained in abortion services--an option Saint Agnes rejected. The number of hospitals that offer residents training in abortion has declined by 22% since 1977; at present, 13% of all gynecology-obstetrics residents have no access to such training.^ieng

Will Webster redefine Roe v. Wade? The Supreme Court could use a Missouri case to begin limiting abortion rights.

The U.S. Supreme Court's decision to review Webster v. Reproductive Health Services, a Missouri case that challenges the validity of legislative direction of public policy as outlined in Roe v. Wade, has fueled speculation that the Court will use the case to reconsider, and perhaps reverse, Roe. When the Supreme Court in Roe v. Wade opened the door to legalized abortion, it guaranteed only a woman's right to choose to terminate or continue a pregnancy without undue interference by the state--citing legitimate grounds for "due" interference by the state. In 1986 the Missouri legislature passed a statute that regulated medical practices related to abortion, including broad restrictions on the expenditure of state funds. Further, the state attempted to protect viable fetuses and directed physicians to perform certain tests to ascertain the baby's gestational age. It also contained a legislative finding that "life begins at conception." A challenge was filed almost immediately. In its application for Supreme Court review, Missouri questioned whether the Roe "trimester approach for selecting the test for which state regulation of abortion services is reviewed should be reconsidered and discarded in favor of a rational basis test." It further argued that if Missouri's statutory provisions are unconstitutional under Roe, then "Roe v. Wade should itself be reconsidered." Under current jurisprudence, it is debatable whether this formulation of the case will invite direct review of Roe. For the foreseeable future, the law will likely protect the notion that an abortion decision implicates a fundamental liberty interest.(ABSTRACT TRUNCATED AT 250 WORDS)

Coping with pro- and anti-abortion activists.

PIP: Anti-abortion organizations have extended their protest activities from free-standing abortion clinics to hospitals. In 1988-89, a number of US hospitals faced not only peaceful picketing, but also bomb treats, entrance blocking, and forced entry. This report describes strategies developed by security directors at North Shore Hospital (Manhasset, NY), Highland Hospital (Rochester, NY), Franklin General Hospital (Franklin Square, NY), Sutter Davis Hospital (Davis, CA), and Deaconess Medical Center (Spokane, WA) to contain the treat posed to hospital operations by these protesters. Among the measures recommended are: seriously assess each threat; maintain continuous contact with the local police and their intelligence personnel; obtain as much information as possible on the anti-abortion organizations and their future plans; give a show of strong security presence before any trouble begins; set up barriers to prevent demonstrators from entering the hospital grounds; maintain a neutral stance on the abortion issue; try to keep the mass media away from the protests, and appoint a designated spokesperson to speak to the press when it becomes necessary; and communicate frequently with the hospital's legal counsel. In the period ahead, as each state works to define its own abortion legislation, hospitals that perform abortions should anticipate accelerated protest demonstrations from both pro-and anti-abortion forces.^ieng

A woman physician views elective abortion.

In 1973, the United States Supreme Court, in a landmark decision, ruled that the 50 states could not regulate abortion up to 24-28 weeks' gestation, except as necessary to insure the safety of the woman, and severely limited state legislation of abortion after 28 weeks by a broad interpretation of the "health" restriction. This article will explore (1) the history of abortion prior to 1973, (2) the scope of the Court decision, (3) abortion from the perspective of medical ethics, and (4) the sequelae of permissive abortion 16 years after Roe v. Wade and Doe v. Bolton.

PIP: In the view of a woman physician, the Supreme Court decision in the Roe v. Wade abortion case disregarded Hippocrates as an elitist, and was not in step with ethics of the time. The medical ethics for the last 500 years in western world were formed by this document that brought the obligations of the doctor in relation to the rights of the patient. However, no American medical school takes the oath today. The 1st anti- abortion laws were passed in 1875, when 25 states and territories enacted these statutes. In 1973 the Supreme Court struck down these laws as unconstitutional. Many Americans do not realize the scope of this decision, especially in regard to the terms of meaningful life. In the 1989 Webster case the Court had its 1st chance to reverse Roe v. Wade and return abortion regulation to the states. The collective conscience of the US was blunted by the legalization of abortion on request, and increased the number of couples who take contraceptive risk. The argument about when life begins is a weak justification for abortion, when most medical authorities and even prominent family planners agree life begins at conception. New terminology has been developed to make abortion more acceptable including works like fetus, abortus, product of conception, and phrases like termination of pregnancy. Some studies indicate that women do not experience their depression until many years after the abortion. There is overwhelming evidence of low adverse mental health effects when pregnancy comes to full term and delivery, whether wanted or unwanted. There has also been a large increase in child abuse since the legalization of abortion. Society must seek a better solution to the problem since abortion is not the answer.

Resolving the abortion controversy.

This article addresses legislative attempts to reverse Roe v. Wade, U.S. abortion laws vis-á-vis those of other developed nations, socioeconomic factors figuring into the decision (or option) to abort, and the positive potential impact of improved contraceptive use.

PIP: Political efforts are underway in the US to achieve a reversal of the 1973 Roe v Wade abortion decision, either through a constitutional amendment or a reversal of the decision by the Supreme Court itself. If access to abortion is to be curtailed, the range of safe, effective contraceptive methods must be increased and contraceptive care must be more integrated into primary health care. Since the 1973 decision, over 1,500,000 US women/year have undergone induced abortion. Of 20 comparable developed countries, the US has the 3rd highest abortion rate (3 abortions/100 women/year), Those who seek abortion are likely to be young, poor, unmarried, black, or Hispanic. The abortion rate among Medicaid recipients is 3 times that of the rest of the population. Most abortions are performed due to a lack of financial resources or existing responsibilities. If the Supreme Court were to impose strict limitations on abortion, poor women would be most affected. Middle- and upper-class women would have the option of traveling to Canada or other countries where abortion is freely available. The US's high abortion rate reflects low contraceptive use. This, in turn, is a result of inadequacies in the US health care system. Fewer birth control methods are available in comparison with other countries, information about contraceptives is not widely disseminated, family planning services are expensive and inconveniently located, and contraceptive care must be obtained from a specialist who is not the woman's regular health care provider.

Abortion and America's ethical consciousness.

America's practice of abortion is not merely a matter of medical technology but of a changing ethical consciousness. The continuing dispute over legalized abortion since the 1973 Supreme Court decision in Roe v. Wade is a conflict between two historically different ethical views of human life. This survey shows the nature and history of this conflict and its implications for America's future.

PIP: A historical survey of the ethics of abortion from ancient Greece through early Christian writers to early American and ending with contemporary American ethicists shows a growing trend toward ethical consciousness of respect for human life. Both Plato and Aristotle wrote of state regulation of procreation by abortion and infanticide. Hippocrates' oath proscribes abortion. Roman physicians used abortion. Early Christian writers such as Barnabas, Athenagoras and Tertullian followed the Hebrew precedent, supporting the sanctity of human life. No laws regarding abortion were encoded in the U.S. until the mid 19th century. In 1967, Colorado passed the 1st permissive abortion law: until then abortion was illegal in all states. The Roe v. Wade decision, as President Reagan wrote in "Abortion and the Conscience of the Nation," denied the personhood of the fetus and permitted abortion on demand by its broad definition of the mother's health. This decision is part of a trend that could be called the utility or Hegelian ethic, in evidence since the Nazi regime began its holocaust by killing off handicapped and useless Aryan Germans. Despite the increasing incidence of euthanasia, infanticide and abortion-on-demand, the sanctity of life ethic is beginning to have a resurgence, shown by the Webster case, the annual March for Life in Washington, and "Operation Rescue" demonstrations on the part of 32 million abortion victims.

When rights collide.

Roe v. Wade has been fated to be overruled. Its demise has been guaranteed because of the evident political nature of the opinion, and because the Supreme Court will not long favor one intensely held "right" over its opposite intensely held "right." Past history shows the Court will step back from such a position. Finally, Roe v. Wade will be disposed of because it stands for certain values this country has long ago rejected.

PIP: As a decision lacking in grounding in defensible judicial doctrine, Roe v Wade is destined to be overruled. Since 1973, it has become clear to activists on both sides of the abortion debate that this decision represents more a political statement than a case with a constitutional basis. The collision of rights embodied in Roe v Wade has echoes in 2 earlier decisions: Dred Scott v Sanford, in which rights of property and freedom were counterpoised, and Lochner v New York, in which the right of contract conflicted with the right to decent working conditions. In the Roe v Wade case, the conflict is between the right to privacy and the right to potential life. All such decisions are doomed because they take 1 side in what is an irreconcilable conflict of rights. Since the form is unstable, the decision cannot be maintained. In the case of abortion, the Supreme Court decision has nothing to do with true potentiality of life; rather, its logic lies in its insistence on the point of viability at the end of the 6th or 7th month. Because a nonviable fetus is dependent on its mother, that person and no other has the right to control its fate. In contrast, a viable fetus can be dependent on any number of people for survival and can no longer be viewed as the property of the mother. Thus, under Roe v Wade, the right of privacy vis a vis abortion is a property right and the Supreme Court has, in the Dred Scott and Lochner decisions, rejected a view of a human entity as chattel property.

Of mulattos, mischlinge, and Minsky's machines.

Hegel once remarked that "what experience and history teach us is that people and governments never have learned anything from history or acted on principles deduced from it." Historically, efforts to define a human being sufficiently equipped biologically or politically to meet a set of factitious standards for inclusion in the community of mankind have invariably resulted in unspeakable injustices. The continuing exclusion of the human fetus from this community is another (and the latest) tragic example of the historical myopia of which Hegel spoke.

PIP: The search for answers to the question of how to classify, measure, and define human life has an ignoble history contaminated by political rather than moral considerations. In the US during slavery, in Nazi Germany, and in South Africa, those defined as nonwhite have been classified as nonpersons. The unspeakable social and political injustice inherent in theses chapters of history is echoed in current efforts to define the point at which a fetus becomes a human being. The 1973 US Supreme Court ruling authorizing abortion introduced the concept of viability as the criterion for human life. At the time, viability was generally considered to commence at 27 weeks; however, recent advances in neonatal intensive care technology have since reduced this to 23 weeks and, by the year 2000, viability should be in the 12-week range. This trend has led to a new standard for personhood--sufficient brain development to permit consciousness. The absurdity of this approach is demonstrated by reference to the rapidly developing artificial intelligence field. Leaders of this field assert that the difference between humans and computers is only a matter of degree; they are 2 species in the genus of information processing systems. Given the ability of supercomputers to reprogram themselves, possess artificial senses, and even produce offspring, the question of whether robots should be granted civil rights arises. To carry the consciousness standard to its logical conclusion, once technology makes it possible to extend a microcomputer cable to an 8-week fetus, that fetus should qualify for personhood. All such efforts to define a human being on the basis of its ability to meet a set of factitious standards are bound to lead to unspeakable injustices.

Post abortion syndrome: myth or reality?

What are the health effects upon a woman who has had an abortion? In his letter to President Reagan, dated January 9, 1989, Surgeon General C. Everett Koop wrote that in order to find an answer to this question the Public Health Service would need from 10 to 100 million dollars for a comprehensive study.

PIP: At a 1987 briefing for Right to Life leaders, the author--US Surgeon General C Everett Koop--was requested to prepare a comprehensive report on the health effects (mental and physical) of induced abortion. To prepare for this task, the author met with 27 groups with philosophical, social, medical, or other professional interests in the abortion issue; interviewed women who had undergone this procedure; and conducted a review of the more than 250 studies in the literature pertaining to the psychological impact of abortion. Every effort was made to eliminate the bias that surrounds this controversial issue. It was not possible, however, to reach any conclusions about the health effects of abortion. In general, the studies on the psychological sequelae of abortion indicate a low incidence of adverse mental health effects. On the other hand, the evidence tends to consist of case studies and the few nonanecdotal reports that exist contain serious methodological flaws. In terms of the physical effects, abortion has been associated with subsequent infertility, a damaged cervix, miscarriage, premature birth, and low birthweight. Again, there are methodological problems. 1st, these events are difficult to quantify since most abortions are performed in free-standing clinics where longterm outcome is not recorded. 2nd, it is impossible to casually link these adverse outcomes to the abortion per se. Resolution of this question requires a prospective study of a cohort of women of childbearing age in reference to the variable outcomes of mating--failure to conceive, miscarriage, abortion, and delivery. Ideally, such a study would be conducted over a 5-year period and would cost approximately US$100 million.

A question of honesty: Roe v. Wade, judicial decision making, and the abortion dilemma.

PIP: Perhaps the most significant aspect of the Roe V. Wade decision of the U.S. Supreme Court in 1973, the issue of the constitutional personhood of the fetus, was dispatched in only 500 words: this essay discusses that treatment and its implications for society. The Court only referred to personhood in terms of the age requirements for government office, the ability to be charged with crimes, and the individuals to be counted in the census, taxed or allowed to vote. The Court also stated that the constitution does not indicate any pre-natal application. The German, Californian and Illinois constitutions do define personhood in fetal terms. If constitutional personhood were dealt with seriously, and an essential difference were posited between the born and the unborn, serious problems would befall the Pro-Life movement. If no essential difference were found, society would be faced with reconciling dilemmas of human rights and abortional freedom. As Dr. Mortimer Adler wrote, "all humans are equal in their potentiality to develop species-specific properties," and the unborn share in the quality. The most important consequence of treating the fetus as a person is that society must deal with problems honestly, directly and courageously, since a right to life and the right to abortion cannot coexist equally.^ieng

Abortion and the sovereignty of the people.

PIP: A point often neglected in the debate over abortion is that US society and government are grounded in the sovereignty of the people. No principle has the force and power of government unless they is majority consensus. To ensure that no fundamental changes can be made in the form of government or human rights by an unrepresentative minority, the US Constitution requires a super-majority consensus. The question of whether abortion is a fundamental human right guaranteed by the Constitution is problematic because pregnancy termination was not an option in 1787. The Supreme Court relies, in such cases, on the theory of penumbra. According to this approach, if purported rights already expressed in the Constitution, and the protection of these purported rights seems necessary, the Court will confer upon them the status of Constitutional rights. However, the shortcomings of this approach became evident in situations where there is sharp disagreement among the people as to whether or not a right is sufficiently fundamental to be insulated from majority rule. The strength of anti-abortion groups will not enable the right to choose abortion to achieve Constitutional protection until pro-choice forces are able to express their will as forcefully. Toward this end, the arena for resolving the abortion debate needs to shift away from the Supreme Court--an unrepresentative body--and back to the people. State-wide referendums constitute 1 means of accurately assessing the will of the people.^ieng

Abortion.

PIP: If you are pregnant and near 40 years old there is 1/137 chance that your child may have Down's syndrome, or 1/65 chance he will have a physical or mental problem. There are tests that can indicate these problems but they increase the risk of spontaneous abortion. A woman should not be forced to carry an unwanted child, and the needs of childless couples should not be addressed in abortion discussions. The Roe v. Wade case made the distinction of not having to determine when life begins, but when it can be sustained outside the body. The Missouri statute states that human life begins at conception, an unborn child has protectable life interests and the parents of that child have protectable life interests of the unborn child in relation to life, health and its well being. States that are really concerned with the interests of unborn children should improve prenatal care, educate teens on contraception, AIDS, and be concerned about violent behavior and smoking. Voters in Michigan and Arkansas approved a law to stop the use of public funds for abortion, other than saving the mother's life. Pro- choice advocates are concerned that the conservative appointees to the supreme court will reverse the previous decision.^ieng

Sara Weddington on Roe v. Wade. Interview by Lee Stockdale.

Sarah Weddington graduated from the University of Texas Law School in 1967 at the age of twenty-one. After arguing and winning the landmark Supreme Court case, Roe v. Wade, she served three terms as a Texas state legislator before accepting a position as general counsel to the Department of Agriculture. She subsequently served as President Carter's Special Assistant on Women's Issues. Ms. Weddington presently practices law in Austin, Texas. In this interview with Health Matrix, Ms. Weddington discusses the Supreme Court decision Roe v. Wade, the right of privacy, a potential modification of the decision under a Bush administration, the genesis of the abortion rights movement, and abortion generally.

The abortion ethos: pervasive but not persuasive.

The history of the past 16 years has borne out pro-life predictions that abortion would be the precursor of an even wider assault on helpless people. The unborn initially were the victim of choice because they were, in 1973, outside our customary line of moral vision. But as a dress rehearsal for a pattern of discretionary killing what was most significant about abortion was its explicit rejection of the Declaration of Independence's principle holding that our right to life is "inalienable." Abortion taught us that the lives of some are alienable and raised the question, why not the lives of others? Contrary to stereotype, the pro-life movement is a classic reform movement, inbued with a fierce belief in the inherent worth and equality of mankind.

PIP: Although the Roe v Wade decision was based on privacy rights supposedly bestowed by the US Constitution, this ruling represented an assault on the most fundamental value of Western countries--namely, that all humans are entitled to legal protection under the law. Pro- and anti-abortion forces embody 2 divergent approaches to the issue of personhood. While abortion opponents have an inclusive approach, viewing all members of the human species as persons, abortion advocates take an exclusionary approach that insists personhood must be earned. A logical extension of the latter approach is to withhold the right to live from those whose potential has not yet developed (the fetus), newborns with limited prospects for development as a result of genetic defects, and those who are no longer functioning (the comatose). Abortion is closely related to infanticide and euthanasia in its assumption that there are categories of people whose lives are not worthy to be lived. Contributing to this depreciation of human life has been an emphasis in US medicine on cost-containment measures. Unless the Supreme Court takes steps to revoke its 1976 ruling on abortion, the anti-life ethic can be expected to extend to practices such as the harvesting of fetal tissue for transplantation, selective abortion in cases of multiple pregnancies, and pharmacological abortion. A potentially powerful challenge to the pro-abortion movement is the recent identification of the so-called post-abortion syndrome, in which abortion exerts deleterious emotional effects as long as 10 years after the procedure. History will soon demonstrate that it is the right-to-life movement, not the pro-abortion movement, that embodies the classic spirit of reform and equality basic to the country's traditions.