Doctors and Abortion

Nearly thirty years ago, I published a book, Abortion and the Private Practice of Medicine, in which I sought to understand what then was already emerging as the settled pattern of access to abortion services around the country. By the 1980s, the present pattern in which abortions are performed in specialized clinics rather than in hospitals or doctors’ offices had been established. Several writers in that decade, the sociologist Kristin Luker and the anthropologist Faye Ginsburg among them, described the politics of abortion clearly dependent on how physicians were delivering those services.

The question I wanted to answer in my book was why obstetrician/gynecologists were reluctant to perform abortions, even though such a medical procedure was directly in their purview of training. Surveys of physicians’ attitudes toward abortion done in the 1970s revealed that psychiatrists were most liberal in their acceptance of a broad range of justifiable reasons to permit abortion and ob/gyn doctors were among the most conservative. I described what I called “obstetrical conservatism” as the principal explanation for the way abortion services have come to be provided. But it is the politics of abortion that arose out of the Supreme Court’s supreme blunder in 1973 that has assured that such obstetrical conservatism is encased, as it were, in the larger reluctance of the vast majority of physicians to participate in the highly charged debates about abortion. I learned this years ago when I was invited to speak to Harvard medical students about abortion and explained why, if they chose to practice obstetrics and gynecology, they would by and large be able to avoid most requests for abortion by referring patients to clinics. This, I told them, would shield them from the fierce politics that defined such work and allow them to avoid the controversy that would put them at some risk of being publically targeted. For that piece of empirically verifiable advice, I was not asked to talk to Harvard medical students again. I imagine I was expected to suggest that they lead the way in changing how the practice of abortion was organized. A physician’s reluctance to engage this contentious terrain seemed at the time, and still does, to reflect common sense.

The rejection of such common sense has long been typical of abortion’s advocates among physicians. The New Republic on July 23rd published a response by Dr. Jen Gunter about the ongoing controversy that has embroiled Planned Parenthood about undercover videos that show top executives of the organization discussing the acquisition and disposition of aborted fetal parts. Although the political debate will be about the funding of Planned Parenthood, the medical and moral debates are really quite different, and they entail an understanding of how so few proponents of Planned Parenthood’s present policies regarding the uses of aborted fetuses can have such a disproportionate impact on both left-wing political and feminist sensibilities that mock a common sense about what such policies mean to the vast majority of Americans.

Dr. Gunter, an ob/gyn and a pain medicine physician based in California and author of The Preemie Primer, a guide for parents of premature babies, begins her criticism of the undercover videos by denying that Planned Parenthood has done anything illegal, the facts and truth of which will likely be part of the continuing political debate. But she then shifts to a kind of post-modern linguistic turn by arguing that the organs (e.g., livers, brains, eyes, etc.) “are not ‘baby parts’. Whether a woman has a miscarriage or an abortion, the tissue specimen is called ‘products of conception’” referring readers to a website that defines this medical term. But the referenced website uses “products of conception” exclusively in relation to first-trimester miscarriages and the medically important concern about possible genetic factors that lead to that result. In other words, the concern is about finding ways to maintain pregnancy. Dr. Gunter could have gone back forty years to review the use of the same term then used specifically as a euphemism for aborted babies, long before the harvesting of internal organs of unborn children came within the range of acceptable, if discreet, medical practice. She then provides a lesson in fetal development that reads much like an updated version of the ancient view about when an unborn child is ensouled: “The term baby is medically incorrect as it doesn’t apply until birth. Calling the tissue [before birth] ‘baby parts’ is a calculated attempt to anthropomorphize an embryo or fetus.” It is rather simple to substitute “politically incorrect” for “medically incorrect” to understand the cover of so-called medical professionalism being invoked. The famous embryologist, George W. Corner, entitled his Yale Terry Lectures Ourselves Unborn: An Embryologist’s Essay on Man, conveying sentiments that may now be astonishing to the Dr. Gunters, but so equally astonished would the Dr. Corners have been to be told they were anthropomorphizing by using a term such as “baby parts” much less “ourselves unborn”. Imagine imputing a “self” to someone before he or she is born?

I feel a certain sympathy for Dr. Gunter. After all, she is the author of the Preemie Primer, surely devoted to the health of unborn babies as much as to premature ones. Now she finds herself trying to defy common sense in defense of a practice at which many instinctively recoil. But thinking about how to react to the sale and uses of “baby parts” requires much less in the way of sophistication and rationalization. Several decades ago, the venerable Leon Kass wrote in an article about the disgust that most of us would imagine experiencing if we were informed that the delicious caviar that we thought we were eating was in fact human “products of conception.” That was then the disgust of a common sense that remains, I would wager, pretty much in place in our culture, despite the strange contortions required to defy it. Thank goodness.

Jonathan B. Imber is Jean Glasscock Professor of Sociology at Wellesley College and Editor-in-Chief of Society. He is author of Trusting Doctors: The Decline of Moral Authority in American Medicine (paperback 2015, Princeton University Press). 

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