Category Archives: abortion

Righties and “Medical Science”: Still at Odds

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Welcome to another episode of “Righties Can’t Read.” Some rightie bloggers think they have found the smoking gun that will scuttle Elana Kagan’s Supreme Court nomination, and I have no doubt this is all we’re going to hear about Kagan for the next several days. But if you actually understand the issue in question — which leaves out righties, naturally — you’d know there is no “there” there.

The accusation comes from Shannen W. Coffin, who was the deputy assistant attorney general in charge of the defense of the federal “Partial-Birth Abortion Ban Act” during the Bush administration. This thing is so badly written it’s hard to piece together exactly what happened when, and I’m not sure if Coffin is talking about something Kagan did regarding the Clinton-era federal Partial-Birth Abortion Ban Act, which President Clinton vetoed in 1997, or Stenberg v. Carhart (2000), in which SCOTUS struck down a Nebraska ban on the D&E procedure, or what. Maybe all of that.

But here’s the story in a nutshell — in 1997, apparently in preparation for some court challenge or appearance (again, Coffin’s account of this is very muddy, so it’s hard to tell), Kagan worked with the American College of Obstetricians and Gynecologists (ACOG) on a position paper in support of keeping legal the intact dilatation and evacuation (intact D&E; sometimes referred to as intact dilation and extraction, or D&X) procedure, which righties erroneously call “partial birth abortion.” And she suggested some changes to ACOG’s statement to strengthen its argument. ACOG signed off on these changes. Now righties are screaming that Kagan’s wording somehow fudged medical science, but it didn’t.

ACOG is America’s primary professional organization for obstetricians and gynecologists, and it represents 90 percent of U.S. board-certified obstetrician-gynecologists. ACOG’s position on the D&E procedure is that under some circumstances removing the fetus intact through the uterus vagina puts less stress on the mother and has fewer risks than the alternative procedures.

The primary alternative procedures are to dismember the fetus in utero and remove it in pieces, or to remove it surgically through the abdominal wall. The first way carries a risk that surgical instruments could damage the uterus and that some piece of the fetus will be left inside, potentially becoming septic. The second way is major surgery and more stressful to the woman’s body generally. However, most of the time either of those procedures can be performed safely enough, even if D&E would be preferable. It is rare — although not unheard of — for the alternative procedures to pose substantially more risk than D&E. (In Wingnut World, of course, “rare” is the same thing as “never” when it comes to abortion risks, but in the real world that’s not quite how things are.)

Apparently an early draft of ACOG’s statement said “in the vast majority of cases, selection of the partial birth procedure is not necessary to avert serious adverse consequences to a woman’s health.” And Kagan realized that would be the only sentence in the document anyone would read. All of the rest of it explaining why D&E is sometimes preferred and occasionally necessary would be ignored. So Kagan suggested adding “An intact D&X, however, may be the best or most appropriate procedure in a particular circumstance to save the life or preserve the health of a woman” to clarify ACOG’s position.

ACOG liked this suggestion. I couldn’t find a copy of their 1997 policy statement, but here it is from 2003 (from the Maha Archives; note bolded paragraph) —

Statement on So-Called “Partial Birth Abortion” Law
The American College of Obstetricians and Gynecologists

Washington, DC — The American College of Obstetricians and Gynecologists (ACOG) continues to oppose so-called “partial birth abortion” laws, including the conference committee bill approved by the US House of Representatives yesterday and sent to the US Senate. “Partial birth abortion” is a non-medical term apparently referring to a particular abortion procedure known as intact dilatation and extraction (intact D&X, or D&X), a rare variant of a more common midterm abortion procedure know as dilatation and evacuation (D&E).

In 2000, the US Supreme Court struck down a Nebraska “partial birth abortion” law in the case of Stenberg v. Carhart, ruling that the law violated the US Constitution by (1) failing to provide any exception “for the preservation of the health of the mother,” and (2) being so broadly written that it could prohibit other types of abortion procedures such as D&E, thereby “unduly burdening a women’s ability to choose abortion itself.” The bill now before the Senate, which its supporters claim can meet any constitutional test, blatantly disregards the two-pronged test the Supreme Court carefully established in Stenberg.

As noted in a 1997 ACOG Statement of Policy, reaffirmed in 2000, and in ACOG’s amicus curiae brief filed in the Stenberg case, ACOG continues to object to legislators taking any action that would supersede the medical judgment of a trained physician, in consultation with a patient, as to what is the safest and most appropriate medical procedure for that particular patient.

ACOG’s Statement of Policy explains why ACOG believes such legislation to be “inappropriate, ill advised, and dangerous.” The policy statement notes that although a select panel convened by ACOG could identify no circumstances under which intact D&X would be the only option to protect the life or health of a woman, intact D&X “may be the best or most appropriate procedure in a particular circumstance to save the life or preserve the health of a woman, and only the doctor, in consultation with the patient, based upon the woman’s particular circumstances, can make this decision.”

The Statement of Policy further reads that such legislation has the potential to outlaw other abortion techniques that are critical to the lives and health of American women. This was the second basis upon which the Supreme Court struck down the Nebraska law in the Stenberg case. The Court will invariably strike down laws that are overly broad or imprecisely drawn. Bills that frequently using terms — such as “partial birth abortion” — that are not recognized by the very constituency (physicians) whose conduct the law would criminalize, and that purport to address a single procedure yet describe elements of other procedures used in obstetrics and gynecology would not meet the Court’s test.

In this case, the bill before the Senate fails to respect the Stenberg test because bill supporters flagrantly refuse to include an exception for the health of a woman. Instead, legislators try to circumvent the Court’s requirements by issuing their own opinion to the nation’s physicians and patients that such a procedure is never needed to protect a woman’s health — notwithstanding opposing opinions from the medical community.

The medical misinformation currently circulating in political discussions of abortion procedures only reinforces ACOG’s position: in the individual circumstances of each particular medical case, the patient and physician — not legislators — are the appropriate parties to determine the best method of treatment.

# # #The American College of Obstetricians and Gynecologists (ACOG) is the national medical organization representing 45,000 members who provide health care for women.

Somehow, in the fevered imagination of righties, a professional organization representing 90 percent of U.S. board-certified obstetrician-gynecologists was duped by Kagan into telling a lie, or something, and because this wording came from Kagan it must not actually reflect the views of ACOG. Coffin concludes,

Now we learn that language purporting to be the judgment of an independent body of medical experts devoted to the care and treatment of pregnant women and their children was, in the end, nothing more than the political scrawling of a White House appointee.

Miss Kagan’s decision to override a scientific finding with her own calculated distortion in order to protect access to the most despicable of abortion procedures seriously twisted the judicial process. One must question whether her nomination to the Court would have the same effect.

But no scientific finding was “overridden,” just clarified, and ACOG must have agreed with the statement or they wouldn’t have continued to repeat it in their position papers ever after.

But of course right now just about every rightie blogger in the universe is brainlessly repeating the party line, which is that there is something unethical about Kagan’s working with ACOG on their policy statement. Which leads me to question — how stupid are wingnuts, really?

More from the Maha Archives — “Late Term Confusion,” More Late Term Confusion” and “The Kennedy D&E.”

Update: See also Taylor Marsh.

Update Update: The “Most in Need of Remedial Reading Classes Award” today has to go to Betsy, of Betsy’s Page, who wrote,

Think of this: there was a doctors’ opinion that said that partial birth abortion was not necessary and she, with no medical background at all, drafted a statement that said the exact opposite and that statement became part of the final report.

This is stunning. It’s not even in the same galaxy as what actually happened. Based on this I would infer that Betsy has less than a fourth grade-level reading proficiency, except that I met her once, and I know she really does know how to read. And she may once have known how to think as well; hard to say.

When Will Liberals Figure Out What’s in Roe v. Wade?

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Liberals have been shooting themselves in the foot over the abortion issue for years, in part because they remain woefully ignorant of what Roe v. Wade actually established. And now they’re doing it again.

In 1997 Elana Kagan, then a White House adviser, wrote a memo to President Clinton supporting a bill introduced by Sen. Tom Daschle that would have banned all abortions of viable fetuses except when the physical health of the mother was at risk. The memo has come to light, and some lefties are going ballistic about it.

But the truth is that by 1997 elective post-viability abortions already were illegal in most states, and this was not in violation of Roe v. Wade as long as an exception was made for the life and health of the mother.

This gesture on Kagan’s part was not made in a vacuum. In 1997 the Republican Congress was working overtime to pass a bill that banned the intact D&E procedure, or what the Fetus People misnamed “partial-birth abortion.” In their propaganda the FPs were conflating the D&E with “late term” abortions, even though it was mostly a second-trimester procedure.

Some Dems and a few pro-choice Republicans were talking about a simple ban on all elective post-viability abortions, regardless of the procedure used, as a kind of controlled burn to reduce the chance that a federal “partial-birth” law might pass in the future. You know, the way one was passed in 2003 and upheld by the Supreme Court in 2007.

Duh.

I am sad to say that many of my fellow liberals are too stupid to understand that being in favor of such a ban in 1997 — or now, for that matter — doesn’t mean one is anti-choice. It means one is thinking strategically. I agree with Jeff Fecke — “when we look at what Kagan actually said in her memo to Clinton, we see someone who was proposing something less than a ban on late-term abortion. Indeed, we see someone who was trying to preserve as many rights for women as possible.”

I thought the ban was a good idea at the time, for the simple reason that it would have deflated many of the FP’s misleading talking points and left intact D&E alone. In fact, I’ve thought since the 1970s that NARAL and NOW and other organizations were idiots for not pushing for a federal law that restated and reinforced what the Roe v. Wade decision established.

Instead, many pro-reproduction rights advocates took the remarkable position that they supported Roe, and supported state laws that followed the Roe guidelines, but a federal law that supported the Roe guidelines was unthinkable. And I don’t think this was because they were closet libertarians.

Yes, Roe established that states may not ban all abortions. However, Roe allows the states to ban some abortions. Specifically, states may ban elective abortions after 23 weeks’ gestation, or the point at which the fetus might be viable. A full-term pregnancy lasts for 38 weeks.

So, since 1973 states have been able to enact bans on abortions in the last 14 weeks of pregnancy, as long as exceptions are made for the life and health of the mother. According to the Alan Guttmacher Institute, 38 states have such a ban in place.

And I understand that physicians won’t perform a third trimester abortion unless there is a medical reason to do so even where it is not specifically illegal. Because terminating a pregnancy becomes much more medically complicated later in the pregnancy, as a practical matter women who are terminating for non-medical reasons should terminate as early as possible. And, in fact, 88 percent of abortions in the U.S. are performed in the first 12 weeks of gestation. Only 8% of all abortion providers in the U.S. offer abortions at 24 weeks.

I understand the one thing the Daschle ban would have changed is to place more restrictions on post-viability abortions done for mental health reasons as opposed to physical health reasons. I explained a couple of years ago that this was not necessarily a problem, as long as the legislation made clear that a pregnancy could be terminated if the fetus was severely compromised and would not long survive after birth.

And I’m going to keep explaining this as long as there’s anyone out there who is confused. Which is pretty much everybody.

Oklahoma: Statism on Steroids

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There are some things you can depend on. One of things is what I call the Mississippi Correlation — states with the strictest abortion laws also have the highest infant mortality rates. The same legislators who stay up all night worrying about the fates of frozen blastocysts can tolerate the unnecessary deaths of infants. (See also “Haley Barbour, Baby Killer.”)

So now we have Oklahoma with a new abortion law that mistakes women for Holsteins.

Though other states have passed similar measures requiring women to have ultrasounds, Oklahoma’s law goes further, mandating that a doctor or technician set up the monitor so the woman can see it and describe the heart, limbs and organs of the fetus. No exceptions are made for rape and incest victims.

A second measure passed into law on Tuesday prevents women who have had a disabled baby from suing a doctor for withholding information about birth defects while the child was in the womb.

Oklahoma fulfill’s the Mississippi Correlation nicely. Oklahoma’s infant mortality rate has been stuck at 8.0 for the past few years. The infant mortality rate for the U.S. overall in 2009 was 6.22 (CIA World Factbook).

According to the Commonweal Fund, Oklahoma ranks 39th out of 51 (the 50 states plus the District of Columbia) in infant mortality. Oklahoma also has the honor of ranking #50 in quality of health care its citizens receive (#51 is — wait for it — Mississippi. Who else?).

But never fear; last year Oklahoma took direct action to improve its state’s shoddy health care record by passing — wait for it — tort reform. So now Oklahomans not only get substandard health care; it’s now more difficult for them to sue for malpractice. Way to go, Oklahoma! As the song says,

“We know we belong to the land
And the land we belong to is grand!”

That makes you something like serfs, yes? See also John Cole.

Update: For some better news, see “‘Face’ Time: Men Convicted Of Blocking Abortion Clinic Access” at Jezebel, where I also found this video:

Expect Insanity

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First, everyone please call 1-888-876-6242. That’s the Families USA number that will route your pro-HCR phone call to your representative. Read about the right-wing threats against Families USA here.

Also, please note that the next several hours before tomorrow’s vote are going to be insane.

The anti-abortion block in the House remains the biggest threat. Steve Benen and Brian Beutler explain the contortions Nancy Pelosi is going through to get some of the Stupak gang on board. In a nutshell, the deal may be to allow for a separate vote on putting the Stupak amendment language back into the House bill.

Note that such a vote, if it happens, is extremely unlikely to pass, but that hasn’t stopped Jane Hamsher from using the issue to rally “progressives” against the bill.

Let us all reflect on how grand it is to have purity of principles when you’ve got plenty of money and insurance to pay for your cancer treatments.

Steve Benen writes that “There are still a few liberal Dems who voted for reform in November, including Massachusetts’ Stephen Lynch, who intend to vote with right-wing Republicans because they don’t see it as liberal enough.” If the more-progressive-than-thou types would stop grandstanding and get behind the bill, Pelosi wouldn’t need any of the Stupak votes. This is a wonderful example of how grandstanding is an indulgence progressives would be better off without most of the time.

If you aren’t disgusted enough yet, check out this Kate Pickert post at Time.com, which begins:

Marcelas Owens, a young boy who’s been appearing on TV and at press conferences with Democrats who are trying to sell their health care plan, is a new fascination for some right-wing pundits, who have been saying incredibly cruel things to and about the Owens’ family and tragic history. Owens’ mother died in 2007 of pulmonary hypertension – a rare condition that requires constant expensive medical care – after she lost her fast food restaurant job and her health insurance.

Pay special attention to the discussion in the comments on What Would Jesus Do about health care reform. My favorite:

Jesus wouldn’t go around forcing people to pay for someone else’s healthcare, either. Forced charity is theft, and it is not a Christian concept.

So who cares if a couple of talk-show hosts say something “mean” when the people they’re opposed to are committing evil?

In a just universe, the person who wrote that would spend eternity copying and re-copying the Beatitudes on parchment with a bad felt-tip pen.

Finally, Dana Milbank says a true thing — running on a promise to repeal health care reform is unlikely to be a successful strategy for Republicans.

Beyond that, it’s doubtful that opposition to the measure will ever again be as high as it is now. Fox News polling found that 45 percent of voters would favor repeal, while 47 percent say leave the reforms alone or add to them. With the big insurance subsidies years away, the initial changes stemming from the legislation would be relatively modest — and that should come as a surprise to an American public told by Republican foes of the legislation to expect a socialist takeover of the United States.

What Americans would see — or at least what Democratic ad makers say they’d put on Americans’ TV screens — are the benefits that would take effect this year: tax credits that encourage small businesses to offer health coverage; a $250 rebate to Medicare beneficiaries who hit the prescription-drug “donut hole” (the checks would start going out June 15); allowing young people up to age 26 to stay on their parents’ health policies; and, above all, a ban on refusing coverage to children with preexisting conditions.

There will certainly be ads this fall saying Republican Congressman X voted against tax breaks for small business and voted to deny Junior his life-saving treatments. These modest changes to the health system probably wouldn’t be widespread and noticeable enough to limit Democratic losses at a time of 10 percent unemployment. But, at the very least, voters would see nothing to justify the Republicans’ apocalyptic predictions.

I think that’s true, and I suspect enough of the troglodytes understand this is true, which is why they will stop at nothing to kill health care reform.

Update: I keep reading that there are something like 206 certain “yes” votes, and ten more are needed to pass. Wikipedia says there are 255 Dems in the House. If every Dem not in the Stupak gang would vote for the bill, then a compromise with Stupak would not be necessary to pass the bill. So why are people angry with Pelosi or Obama or me about Stupak? Why not get angry with the other holdouts?

Update update: It seems the Stupak attempt to use the HCR bill to further restrict abortion has been killed already. Everyone can stop hyperventilating.

Lies Lies Lies Lies Lies Lies Lies

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You probably heard about the hoax memo the GOP circulated to scare people about Democratic intentions.

Here’s another example of gross dishonesty — at Weekly Standard, a column by John McCormack titled “Read the Bill: Senate Plan Would Pay for Abortions at Community Health Centers.” So I waded into this thing expecting McCormack to explain where he found this in the bill, since he wants us to read the bill. But he doesn’t source the bill. He sources two memos, one from United States Conference of Catholic Bishops and the other from National Right to Life.

In fact, federal dollars can’t be used to pay for elective abortions now, and there is all kinds of language in the bill that makes it crystal clear federal policy on funding abortion will not be changed by the bill. And I can prove it — read the bill. Here’s the Senate bill; the section regarding abortion begins on page 2077.

Instead of reading the bill, McCormack cites propaganda screeds about the bill so that he can lie about what’s in the bill. Classy. You can read the memos he sites, but the arguments in them are refuted by the bill itself. For that matter, most of the arguments in the memos are refuted by the National Catholic Reporter. See also Timothy Noah.

No one at National Right to Life has ever been the least bit squeamish about making up nonsense to support the cause, but I want to make special note of the United States Conference of Catholic Bishops. At a time when sexual predation by Catholic clergy has become an international scandal, and when it’s become public that the institutional church has been covering it up and allowing it to continue for decades, the United States Conference of Catholic Bishops has some cojones producing a deceitful memo to attempt to insert their influence over U.S. health care law.

I’m saying that if the lot of them had a shred of conscience, they’d be very quietly doing penance someplace, not brazenly bearing false witness in order to control the sexual behavior of American women. It’s good to see American nuns and other Catholic organizations coming forward to say the Bishops don’t speak for all Catholics.

Criminalizing Abortion Dosn’t Stop Abortion

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This is a point I make just about every time I blog about reproductive rights, but here it is again. The BBC reports that a Guttmacher Institute survey of abortion in 197 countries shows clearly that making abortion illegal not only doesn’t stop abortion, it doesn’t even seem to slow it down.

The Guttmacher Institute’s survey found abortion occurs at roughly equal rates in regions where it is legal and regions where it is highly restricted. …

…On some continents this is particularly pronounced: well over 90% of women in South America and Africa live in areas with strict abortion laws, proportions which have barely shifted in a decade.

Where abortions are illegal, abortions go underground. Women abort themselves or find underground networks of providers. This in turn creates all manner of bad outcomes with broad impact.

The costs of unsafe abortions, which can include inserting pouches containing arsenic to back street surgery, can be high: the healthcare bill to deal with conditions from sepsis to organ failure can be four times what it costs to provide family planning services.

Every year, an estimated 70,000 women die as a result of unsafe abortions – leaving nearly a quarter of a million children without a mother – and 5m develop complications.

Anti-reproductive rights activists sometimes make the argument that abortions should be illegal because they are dangerous for women, and I’ve actually seen them cite the 70,000 annual deaths figure in support of their argument without mentioning that nearly all of those deaths occur in places where abortion is illegal.

This is not really news. It’s been obvious from the data for some time that there is no correlation between abortion rate and abortion law, and that some of the highest abortion rates in the world are in nations in which abortion is banned. What is baffling to me is why pro-reproductive rights advocates are not highlighting this fact, posting it on billboards, shouting it from rooftops. If there is any one fact that ought to shut up any argument in favor of criminalizing abortion (not that the crazies will shut up, of course) it’s this.

I realize that many reproductive-rights advocates don’t want to talk about reducing abortion rates, because this amounts to an admission that abortion is something that needs to be reduced. However, I suspect the majority of people who favor keeping abortion entirely or mostly legal feel some ambivalence about it. IMO I’m not interested in arguing whether abortion is “good” or “bad,” because as a moral choice it depends on myriad factors that are unique to every woman who considers it. The question for me is purely whether there is any reason for the government stepping in and criminalizing it, in particular a reason that somehow benefits civil order and societal good. And it’s obvious that there isn’t.

Yet, for some reason, you only find the fact that criminalizing abortion doesn’t stop it buried very deeply in pro-rights arguments. Instead, they favor arguments that women have rights, which is not persuasive to people who think that women are cows.

There is one thing that really does reduce the number of abortions, and that is access to birth control.

Western Europe is held up as an example of what access to contraceptive services can achieve, and the Netherlands – with just 10 abortions per 1,000 women compared to the world’s 29 per 1,000 – is held up as the gold standard.

In the Netherlands, abortions can be performed at any point before viability in a certified hospital or clinic.

Even the UK, which has a relatively high rate, fares well in comparison to the US, where the number of abortions is among the highest in the developed world. The institute says this rate is in part explained by inconsistencies in insurance coverage of contraceptive supplies.

In much of eastern Europe, where abortion was treated as a form of birth control, abortion rates have dropped by 50% in the past decade as contraceptives have become more widely available.

The data that contraceptive use is the one factor that really does reduce abortion rates — far more so than criminalization — could not be clearer. Data is never clear enough for idiots, of course. But an overwhelming majority of Americans are in favor of birth control use, and the connection between birth control use and abortion rate also needs to be broadcast far and wide.

Update: More from Lynn Harris:

In other words: Bans do nothing. Except kill women. (Making their success rate, and irony factor, analogous to that of a virginity pledge.) Specifically: about 70,000 women die each year of complications from unsafe abortion, an estimate that — should it sound familiar — has hardly changed in 10 years. An estimated 8 million women per year experience complications requiring medical treatment. (Only 5 million receive that treatment. Even when quality post-abortion care is available, the study says, “distance, cost and the stigma often associated with Abortion can discourage women from seeking treatment.”) Another new Guttmacher study also found that “the costs of treating medical complications from unsafe abortion constitute a significant financial burden on public health care systems in the developing world.” (Treating complications from unsafe abortion costs Africa and Latin America alone up to $280 million each year.)

Let’s put it this way: Because of death — wholly preventable death — by unsafe abortion, an estimated quarter million children grow up without a mother. “Restrictive abortion laws are an unacceptable infringement of women’s human rights and of medical ethics,” says the study. “Eliminating unsafe abortion and providing access to safe abortion would reduce ill health, death and lost years of productivity among women, and avert the financial burden of treating related health complications. Achieving these goals would lead to enormous individual and societal benefits — for women, their families and countries as a whole.” File all that under What More Data Could You Possibly Need? (Or, depending on your mood, under “How Dare You Call Abortion a ‘Convenience'”?)

Unbelievable

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A right-wing blogger, responding to my last post on abortion, wrote,

And this notion of “underground abortion providers” is a myth in the U.S. There are untold clinics in the U.S. providing abortion services.

Let’s see if I can explain this simply enough so that a garden vegetable, or maybe even a rightie, can grasp it.

Abortion is still legal in the United States. So, there is not much in the way of an underground abortion industry here, because women prefer to get abortions in nice, legal clinics and hospitals. In countries where abortion is legal, generally there are little or no “underground” abortion services.

However, in countries where abortion is illegal, abortions are performed by “underground abortion providers.” This was true in the U.S. before Roe v. Wade. It is still very much true throughout Latin America, which has higher rates of abortion than the U.S. even though abortion is illegal nearly everywhere in Latin America.

It is true of all countries in which abortions are illegal. Well, except maybe Ireland, where women can just take a ferry ride to Britain. I’m not sure about Ireland.

If abortion were criminalized in the U.S., there would be a thriving underground abortion industry in no time, just as there was before Roe v. Wade.

I hope that is clear.

Ross Douthat’s “Stricter Legal Regime”

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Today’s New York Times column by Ross Douthat begins sanely enough. He acknowledges that the late-term abortions performed by the late Dr. George Tiller were done for hard, and heartbreaking, reasons — “women facing life-threatening complications, on women whose children would be born dead or dying, on women who had been raped, on ‘women’ who were really girls of 10.”

Then he goes south a bit, insinuating that Dr. Tiller also performed abortions for frivolous reasons, even though Kansas law requires two independent physicians to sign off on a late abortion to prevent that from happening.

And then Douthat gets into the heart of his argument — women must not be allowed to have abortions unless the government decides they have a really, really good reason.

Yes, many pregnancies are terminated in dire medical circumstances. But these represent a tiny fraction of the million-plus abortions that take place in this country every year. …

… The argument for unregulated abortion rests on the idea that where there are exceptions, there cannot be a rule. Because rape and incest can lead to pregnancy, because abortion can save women’s lives, because babies can be born into suffering and certain death, there should be no restrictions on abortion whatsoever.

No, the argument for legal and medically safe abortions — which would still be regulated, as is any medical procedure — is that there are times when pregnancy and childbirth would place an unbearable burden on a woman’s life, and so women will seek abortions. Their reasons are as infinite as the details of their lives. If abortions are not legal, they will either abort themselves or they will find underground abortion providers, medically trained or not.

And if the worldwide statistics on abortions in countries where abortions are illegal tell us anything, they tell us that making abortion illegal has little impact on the rate of abortion, just on how they are done. Instead of a medically regulated clinic, women take black market drugs, or perforate themselves with sharp objects, or flush themselves with caustic chemicals, or have themselves bludgeoned in the stomach. They take their chances on abortion providers who may have little training and even less interest in antiseptics.

And we know this is true because it happens in many parts of the world, every day, in places where legal abortion is not available.

Douthat continues,

[T]he law is a not a philosophy seminar. It’s the place where morality meets custom, and compromise, and common sense. And it can take account of tragic situations without universalizing their lessons.

No, the purpose of law is to maintain conditions that allow civilizations and societies to exist and function, not to enforce morality. As I’ve argued elsewhere, many things are immoral that should not necessarily be illegal. Most of us consider adultery to be immoral, for example. But as a people who respect personal freedom, we generally think that matters involving sexual acts between consenting adults are not the government’s business. Lies (except under oath in a courtroom), envy, and countless other matters are between an individual and his spouse/friends/God/karma.

There’s a tacit understanding that some matters of morality are to be worked out in peoples’ private lives, and others are regulated by law. What’s the difference? The difference is whether an act creates a civic burden. Without enforceable contracts, for example, we’d still be living in caves. On the other hand, civilization tolerates adultery fairly well.

It so happens that most stuff that’s illegal also is generally considered immoral. Since morality is about how people relate to each other, it figures that law and morality overlap. (The venn diagram above is flawed because the blue area ought to be bigger, but I made it from the best blank venn diagram I could find.) But the purpose of law is not to enforce morality; nor is morality an argument for creating law.

One of the most fundamental requirements of a functional civilization is that there must be some restriction on killing other people. This has less to do with “sacredness” and more to do with the fact that people can’t very well live in social groups if they all can kill each other without penalty or compunction.

Through most of human history, few if any societies have banned the killing of humans outright. Rather, there were rules about who could kill whom. A nobleman could kill a serf, but a serf couldn’t kill a nobleman, for example. The notion that the life of every person is worthy of legal protection just because it’s human life is relatively recent and has little to do with how homicide came to be a criminal act.

Abortions, however, do not create a civic burden. Abortions have been practiced throughout human history. Although you can find some very old laws that restrict late abortions, there was little interest in banning abortion altogether until the 19th century. Civilization soldiered on, somehow.

So, I reject the argument that law is “the place where morality meets custom, and compromise, and common sense.” I’m not sure what “custom” Douthat refers to, since abortion has long been customary even where it is illegal. And my definition of “common sense” is “stuff I think is right even though I can’t think of an argument for it.”

Indeed, the argument that some abortions take place in particularly awful, particularly understandable circumstances is not a case against regulating abortion. It’s the beginning of precisely the kind of reasonable distinction-making that would produce a saner, stricter legal regime.

Translation: We can ban abortions and then make women petition government tribunals to receive legal dispensations in extreme cases.

Alternate translation: Hello, coat hanger.

This is “saner”?

If anything, by enshrining a near-absolute right to abortion in the Constitution, the pro-choice side has ensured that the hard cases are more controversial than they otherwise would be. One reason there’s so much fierce argument about the latest of late-term abortions — Should there be a health exemption? A fetal deformity exemption? How broad should those exemptions be? — is that Americans aren’t permitted to debate anything else. Under current law, if you want to restrict abortion, post-viability procedures are the only kind you’re allowed to even regulate.

No, the reason there’s so much fierce argument about abortion is that there are some among us who do not respect women and cannot abide the thought of permitting women to be their own moral agents.

And I love the way Douthat keeps saying he wants to “regulate” abortion. Again, abortion is regulated. It is regulated to maintain safe medical standards, for example.

What he’s really talking about is not regulating abortions, but regulating women.

If abortion were returned to the democratic process, this landscape would change dramatically. Arguments about whether and how to restrict abortions in the second trimester — as many advanced democracies already do –would replace protests over the scope of third-trimester medical exemptions.

Douthat is hallucinating. There will be no peace as long as there is a violent, extremist movement determined to ban all abortions, including first-trimester abortions, and as long as politicians cater to that movement. I would be very happy if we as a nation could come to some sort of firm decision about a gestational limit on elective abortion, as long as it’s not absurdly early and doctors are given broad discretion in matters of medical need. What’s standing in the way of that is the so-called “right to life” movement, not Roe v. Wade.

Do you want to talk “compromise,” Douthat? The only acceptable “common ground” is encouraging contraceptive use to reduce the number of unwanted pregnancies.

For a sane view, be sure to read Marie Cocco.

Nearly two decades ago, Bill Clinton said he believed abortion should be “safe, legal and rare.” The “rare” part was supposed to come from greater support for birth control and better sex education for young people.

Here is how the anti-abortion movement and its supporters in Congress responded: They carried out a campaign, which continues to this day, to curtail women’s access to birth control and severely limit teenagers’ access to comprehensive sex education.

Working first through the Republicans who took over Congress in the mid-1990s and then through the Bush administration, they blocked access to emergency contraception, birth-control pills that are taken after unprotected sex. They continue to promote state legislation and a movement among anti-abortion pharmacists to allow druggists to refuse to fill birth-control prescriptions. They wish to expand the current “conscience clause” allowing medical professionals who have ethical objections to abortion to cover birth control and abortion referrals for rape victims who might be pregnant. They spent billions on abstinence-only sex education that has been proved, time and again, to be ineffective at keeping teenagers from having sex.

When the original House version of the economic stimulus bill included a bureaucratic change to make it easier for state Medicaid programs to offer family planning services to poor women, Republicans caused such a fuss that Obama prevailed upon Democratic congressional leaders to remove it. His gesture won not a single Republican vote for the stimulus package in the House.

“The common ground is family planning,” says Rep. Carolyn Maloney, D-N.Y. Yet Maloney has spent much of the past decade in the forefront of congressional efforts to push back the right-wing assault on family planning.

It is time to stop hoping that somehow, through pleasing rhetoric or even genuine efforts to build bridges, those who oppose allowing women to control their reproductive lives can be persuaded to some other view. Continuing the pretense on this point isn’t naive. It’s cynical.

Lost

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At the New York Times, Monica Davey gives us a glimpse into the whacky world of the Fetus People. Apparently the murder of Dr. George Tiller has confounded the vocational jerks who have besieged his clinic for years . Now they literally don’t know what to do with themselves.

I take it there are people who actually moved to Wichita just so they could picket Dr. Tiller’s clinic. I suppose some of them have spouses who work to earn a living, but one does wonder if they’re being paid.

This is noteworthy:

“There’s so much disagreement,” said Mark S. Gietzen, president of the Kansas Coalition for Life. Mr. Gietzen spent his time last week juggling calls from volunteers who wondered what would come of their regular shifts outside Dr. Tiller’s clinic, where they planted rows of crosses each day and tried to talk to women going in.

“If you went to a meeting, sometimes you would think the enemy was other pro-life people, not abortion,” he said.

Not all anti-abortion advocates, he said, favored the bloody “truth truck” (“Abortion is an ObamaNation,” it reads) parked outside his house or agreed on what protesters should call out to women going inside the clinic (obscenity-filled insults or offers of help) and how loudly.

Even now, Mr. Gietzen said, they were not of one mind about statements many groups here have issued condemning the killing of Dr. Tiller. “You can’t be pro-life and go around killing people, but some people are really mad at me for saying that,” he said.

In other words, it’s a culture in which hate and murder are always on the table.

Some of them don’t believe Dr. Tiller’s clinic is really going to close; or, at least, there are no immediate plans to re-open it.

Despite the family announcement about the clinic’s uncertain future, some here seem convinced that it will secretly reopen on Monday. On Sunday, Mr. Gietzen said some of his more than 600 trained volunteers already were organized in shifts for a new week, in case visiting doctors were flown in.

Picketing that clinic was their purpose in life. In some ways, they may miss it more than anyone else. I opened Eric Hoffer’s The True Believer at random and found this (pp. 14-15)

The burning conviction that we have a holy duty toward others is often a way of attaching our drowning selves to a passing raft. What looks like giving a hand is often holding on for dear life. Take away our holy duties and you leave our lives puny and meaningless. There is no doubt that in exchanging a self-centered for a selfless life we gain enormously in self-esteem. The vanity of the selfless, even those who practice utmost humility, is boundless.

If Dr. Tiller’s clinic really doesn’t re-open, eventually some of the protesters will drift away to other clinics. Some may eventually attach themselves to another cause — Hoffer believed mass movements were interchangeable, since they “draw their adherents from the same types of humanity and appeal to the same types of mind.” Either way, when Dr. Tiller died they lost the center of their lives. How can they go on?

The suspect, Scott Roeder, claims more such murders are “planned,” but this may be wishful thinking on his part. One anti-abortion leader called Roeder “a fruit and a lunatic.” Dude, if he’s the fruit, you’re the tree.