Please note: In addressing the issue of late term abortion, I specifically address terminations done in response to fetal anomalies which are not fatal and distinguish them from terminations for those that are. This is not because I feel that aborting in the third trimester for a fatal condition is “ok,” but because a common pro-choice argument for such procedures is that they are *only* done in response to fetal anomalies which are “incompatible with life,” such as anencephaly. Part of my aim in discussing such abortion is to address the conflation of “fatal” with “disabled” in mainstream pro-choice rhetoric, and to argue that there is little moral difference between what Gosnell did to the babies in his clinic and what is done to the disabled fetuses in these procedures.
I recently read an editorial by Reverend Harry Knox arguing that inaccessible abortion lead Gosnell’s victims to his doorstep. Now, I can understand the reasoning in his argument: Prior to the legalization of abortion, women did die during unsafe abortions, which were carried out in conditions similar to Gosnell’s. Moreover, I’m sure that All Our Lives and Reverend Knox share a lot of common ground in the matters of birth control and social support systems: I’m sure we agree that these measures help prevent many woman from feeling that they need to consider abortion in the first place. Moreover, there are conditions other than abortion access that moral people need to consider. For instance, one wonders whether these atrocities would have been able to go on for so long if the victims had not been women and infants of color. Moreover, these many of these women went to Gosnell because they felt that they couldn’t afford to raise a child and because they couldn’t afford to go someplace else. However, I have to agree with my colleagues in the pro-life movement that Knox’s primary argument, which has been made by many pro-choicers since Gosnell’s crimes came to light in 2011, does not adequately account for the facts as articulated in the Grand Jury report.
First of all, Gosnell’s second adult victim, Karnamaya Mongar, died during a legal abortion when she was 19 weeks pregnant. Injured patients and their physicians repeatedly urged federal investigators to inspect Gosnell’s clinic. This was not done. The Grand Jury’s report read:
“The callous killing of babies outside the womb, the routinely performed third-trimester abortions, the deaths of at least two patients, and the grievous health risks inflicted on countless other women by Gosnell and his unlicensed staff are not the only shocking things that this Grand Jury investigation uncovered. What surprised the jurors even more is the official neglect that allowed these crimes and conditions to persist for years in a Philadelphia medical facility. THE STATE DEPARTMENT OF HEALTH NEGLECTED ITS DUTY TO ENSURE THE HEALTH AND SAFETY OF PATIENTS IN PENNSYLVANIA’S ABORTION CLINICS.”
The report goes on to document numerous instances in which state officials failed to inspect Gosnell’s clinic even in the face of repeated complaints of patients who had contracted sexually transmitted parasites and sustained severe injuries. Even the death of 22-year-old Semika Shaw in 2002 didn’t lead them to action. The Grand Jury asserted:
“Staloski [a state official] blamed the decision to abandon supposedly annual inspections of abortion clinics on DOH lawyers, who, she said, changed their legal opinions and advice to suit the policy preferences of different governors. Under Governor Robert Casey, she said, the department inspected abortion facilities annually. Yet, when Governor Tom Ridge came in, the attorneys interpreted the same regulations that had permitted annual inspections for years to no longer authorize those inspections. Then, only complaint-driven inspections supposedly were authorized. Staloski said that DOH’s policy during Governor Ridge’s administration was motivated by a desire not to be ‘putting a barrier up to women” seeking abortions.’”
This, IMO, is what extremist ideology leads to: the principle becomes more important than the impact it has on actual people. (It is, in my view, the inverse of pro-life ideology that does not make moral or legal exceptions for abortions done in emergencies, to save the lives of pregnant women; or, perhaps, complete and utter opposition to Plan B because it *might* prevent an embryo from implanting.) I know that legislators weren’t consciously thinking, “One women dying is better than having to close an abortion clinic,” but that was essentially what happened: Karnamaya Mongar died due a lack of medical and legal regulations. If Gosnell’s clinic had been shut down in the *1980s* when his grisly practices were first reported, Karnamya Mongar would not have died there.
Moreover, just how available does Reverend Knox want third trimester abortion to be? Does he think that there should be any vetting process or restrictions at all? Or, do such restrictions inevitably lead women to people like Gosnell? Even though women don’t casually walk into abortion clinics at 32 weeks and say, “Gee, I’ve suddenly decided that I don’t want to be pregnant anymore,” I don’t think the law should even recognize a hypothetical right to do so. To affirm the morality of such an act, even in theory, is an affront to logic.
Furthermore, as a disability studies scholar I know that 32-week abortions do occur in real life. Hundreds of them are done a year in response to the discovery of a fetal anomaly late in pregnancy. Dr. Warren Hern, for example, openly admits to doing many terminations in the last weeks of the third trimester when fetal anomalies (and I mean *any* fetal anomaly) are found. For instance, one of his papers on selective abortion for fetal anomaly in the late third trimester included examples of fetuses with:
Down Syndrome and a common heart defect “3-chambered heart,” commonly corrected via surgery
This abortion was complicated by the fact that Hern’s first attempt at intra-cardiac injection failed to stop the baby’s heart. The abortion was completed 2 weeks later after a successful intra-cardiac injection, when the woman was 34 weeks pregnant.
Spina Bifida-myelomeningolcele and Arnold Chiari Malformation-Again, not fatal-many people with this disability not only survive, but lead full, active lives
Skeletal Dysplasia (Hern does not specify which kind of skeletal dysplasia the baby had, remarking only that the fetus had shortened tibia and femurs. This could indicate achondroplasia, the most common form of skeletal dysplasia. This condition is a disability, not a fatal disorder. He does not mention features that are commonly associated with fatal forms of skeletal dysplasia, such as an unusually small chest cavity (thanatophoric dysplasia) or inter-utero fractures (Osteogenesis Imperfecta, Type II). Nor does Hern mention any of the features indicative of other non-fatal forms of skeletal dysplasia, such as clubbed feet or bowed arms/legs.)
Goldenhar Syndrome-Like the case cited above, this may or may not have been a fatal form of the disorder.
At least two out of four of these conditions are NOT “incompatible with life,” the other two being open to interpretation: we don’t have enough information to know whether or not the conditions were fatal. Moreover, Hern’s own prose indicates that he does not restrict his practice to anomalies that are fatal. Hern describes the ethical ramifications of his work as follows:
“There are many ethical issues that can be raised concerning the termination of an abnormal fetus in a twin pregnancy. The one group that has reported selective terminations at the early third trimester expressed objections to the application of this technique in later pregnancy. Chervenak stated that abortion in the third trimester is morally justified only in the case of lethal or catastrophic abnormalities such as anencephaly. It is our view that the decision to choose selective abortion in the 3rd trimester can be made by a woman and her partner in the case of a valid and documented fetal abnormality. It is up to the physician to determine whether he or she accepts the potential risks and ethical questions of this procedure, and to discuss these issues with the requesting patient and her partner.”
I feel compelled to ask: Is Knox ‘ok’ with this? Does he think that there should be more clinics like this, in which such abortions are readily obtainable? Is that how he would prevent women from going to people like Gosnell? Moreover, what distinguishes Hern’s work from what Gosnell did? Does the difference lie in the location of the babies?Can Knox provide a logical reason for why ending the life of a baby in utero is ok, but ending the life of a newborn is evil? Does the difference lie in how these lives are ended? Is Hern’s work acceptable because administering KCL directly into the baby’s heart usually provides a quicker end then severing his/her spinal cord? Because Hern’s method of abortion was “cleaner,” resulting in an intact, stillborn baby instead of a bloodied corpse? These questions go to the issue of logical inconsistency in some pro-choice quarters. People on both sides of the abortion debate were horrified to learn that Gosnell killed infants who survived abortions at 22, 24.5, 26, 28, 29.5 weeks gestation. Yet, many of these same people defend a woman’s right to employ the services of Dr. Hern at 34 weeks gestation, so long as her fetus has a documented disability. (Hern will also abort fetuses for any reason at up to 26 weeks gestation, as documented on his website.) This moral distinction between a viable baby inside the womb and a viable baby outside the womb strikes me as intellectually dishonest.
What specifically makes the legality of such abortions morally superior to requiring that a woman at that stage of gestation give birth to her now-viable fetus? Is it because of “choice”? How far does choice extend? Are there any limits that Reverend Knox would consider valid? Is the woman’s right not to have a child against her will so absolute that the act of aborting a fetus at 32+ weeks receives God’s blessing?
I know that many women who obtain abortions at this point in a pregnancy are desperate, grieving people. Clearly the women who went to Gosnell were either raised in an environment in which they were taught that they didn’t deserve any better, and/or were so desperate that they were willing to subject themselves to his filthy, dangerous clinic. I know that parents who obtain abortions for fetal anomaly at Hern’s clinic are broken-hearted. However, this tells us about the woman’s feelings and motivations, it does not establish that such abortions are morally acceptable or should be allowed under the law. To do so uses feelings as a basis for practice. I’m sure Knox agrees that autonomy is not a god. Yet, I can’t help but feel that his position deifies personal sovereignty. Yes, it is immoral to ignore the conditions that lead women to Gosnell. Nevertheless, these conditions need to be addressed via increased social support and non-violent reproductive choices like birth control. Increasing the availability of late-term abortion is not a moral response to Gosnell’s actions.