in thanks for doctors for reproductive justice

‘So you open the chest cavity via the ribcage to expose the heart and pull back the pericardial membrane, yes?’

‘Right.’

‘Then you remove almost all of the diseased heart, leaving the left atrium behind so you can graft the new heart into the body – and this involves “carefully trimm[ing] and sew[ing]” the foreign muscle tissue until it fits the cavity left by the original organ?’

‘Right.’

The procedure remains no less shocking. The chest, held open by metal clamps, sees the surgeon’s hands reach to invade the very inviolate spaces of the patient’s innermost self. Clamps and scapulae sever muscle and veins, the exposed tissue shivering in unfamiliar fresh air, and “the specimen” when removed, and its replacement, brought into frame, look alien and wrong. It’s difficult to watch. Something deep in the centre of me is rebelling as I do so, finding it repulsive on a primal level.

And yet this is a heart transplant. It is necessary, it is routine, and it saves thousands of living adults and children every year. It is healthcare, and while I can tell you that on no account do I ever want to be either on the receiving end or the camera end of one, if I need it I will overcome my lack of enthusiasm for the unpleasantly, graphically surgical elements of the operation and thank the doctors every day for saving my life and health.

I will do the same if I ever need an abortion.

Shock tactic writing is easy to do and hard to read. Anti-choice campaigners understand this and they use it to their benefit, playing on that core of ourselves that does not like to think of our lives as things of blood and bone. It is easy and it is cheap to prey on the emotions of your audience with details from the parts of ER you watched with your eyes half shut. It is much easier than revealing the factual truth of the matter: blood is blood and tissue is tissue. You are comprised of blood and tissue. You, living adult reading right now, can describe every medical procedure you ever have in the worst terms possible, or you can say this:

I have a human right to the highest possible standard of health (Article 12).

I live in a society where socioeconomic conditions and the foresight of our forebears created a system wherein trained doctors deliver high-success, low-risk procedures to any member of the population who needs it.

These doctors train for years and then further years in a specialty to be able to handle the gory details of medicine with skill and visceral fortitude.

It demeans them and their work and the lives and health of their patients to use shock tactics to attempt to paint them as anything other than brilliant, hard-working, highly skilled individuals working on the front lines of society’s greatest needs.

Ann McElhinney’s Irish Times article is a prime example of this misdirection. In it, she endeavours to substitute raw shock value for understanding of the human rights of pregnant people. It is a fun-house mirror distortion of fact and it needs to be countered. It also demeans the work of the doctors invested in ensuring reproductive health and justice for their patients.

McElhinney has made a film about Dr Kermit Gosnell, a man who deserves neither the success nor the respect the title ‘Doctor’ should give. On this much we agree. Gosnell was not an abortion doctor. Gosnell was a criminal running a horrific, fraudulent, illegal enterprise. The Grand Jury report on his trial is incredibly difficult to read. His practice provided what he would have referred to as abortion services: in reality he delivered viable babies at a point far later in a pregnancy than would have been legal, and killed the living child after birth, making no attempt at terminating the pregnancy by medical means. He allowed women to die in his ‘care’; he left the care of women of colour and disadvantaged women to unqualified assistants but insisted he be in charge of procedures on white women; he left numerous ex-patients injured and hospitalised. He profited from administrative oversight to run a filthy, shambolic imitation of a medical practice, and he did so for years.

In terms of abortion doctors, Gosnell is to that profession what Sweeney Todd was to barbers.

Gosnell is not a benchmark by any means, but real abortion doctors in the USA are working every day under increasingly difficult conditions for themselves and their patients.

Let’s look at Oklahoma, for example, wherein McElhinney meets a young woman who was shown a foetal heartbeat by a nurse, which changed her mind about having an abortion. This is presented as an act of regulation-defying bravery according to the article, whereas in the context of Oklahoma’s abortion laws, it’s a particularly light straw on a particularly laden camel.

  • In Oklahoma a woman cannot have an abortion without mandatory counselling beforehand; this counselling includes “information designed to discourage her from having an abortion”. She must then wait 24 hours after this counselling to have the procedure.
  • Insurance, private, employer, or ACA, will only pay for abortion in the case of endangerment of the life of the pregnant person. Public healthcare will only pay for it in cases of life endangerment, rape, and incest. In the US context, this means many women – 69% in this 2013 report – are paying for abortion procedures out of pocket and thereby incurring hundreds or thousands of dollars of expense. For a young woman, this is not insignificant.
  • She must access abortion services before 20 weeks of gestation.
  • She will be accessing those services in that timeframe in one of the three clinics which look after women in her situation. They’re in Oklahoma City, Norman, and Tulsa. Oklahoma is 2.6 times the size of Ireland and has a population of 3.8million people. From 2015 until last month, it only had two abortion clinics.

Having overcome these hurdles and the incredible stress they must place on our young woman, is it any wonder that by the time the nurse breached regulations and had her patient listen to the foetal heartbeat, she could not go through with the procedure? Does it still seem like a brave act, or a medical professional placing more and greater stress on a patient in a vulnerable condition which dissuaded her from undergoing a treatment to which she had consented?

(While the focus of this post is on the misrepresentation of abortion doctors, I must also note that McElhinney does not tell us the reasons her Oklahoma interviewee gave for needing an abortion. Perhaps she does in the film, but it seems like a glaring omission from an article which presents in a negative light the decisions of two families not to continue with pregnancies which they did not wish to carry to term. Did Ms Whatley’s reasons meet with this seemingly arbitrary moral line?)

Abortion doctors in America work under difficult conditions. States have differing laws on term limits, regulations, methods, counselling, mandatory display of ultrasounds. The last five years have accounted for 30% of the new restrictions on abortion enacted since Roe v Wade in 1973 (although Whole Woman’s Health v Hellerstadt and the Supreme Court’s strike-down of overly restrictive operational requirements which were closing clinics across Texas has been a ray of light for them this year). They work in a context where they are aware that, like George Tiller, they could very well be killed for what they do; where their clinics could be bombed or be attacked by arsonists; where even on a good day they run a gauntlet of protestors who call them murderers outside the doors of their offices.

Writing an article wherein one introduces the subject via describing a man like Gosnell simply as “the Philadelphia abortion doctor convicted of murder” is unfair to them. Presenting a nurse who breaches regulations and further traumatises her patient as someone who prevented the patient “kill[ing her] baby” is unfair to them. Failing to address the innumerable lives saved by safe reproductive health procedures is unfair to them. Framing a dilation and curettage (D&C) procedure, used to empty the uterus after an aspiration termination – and indeed after a spontaneous miscarriage where tissue remains – and thereby reducing the risk of possibly life-threatening sepsis as “Any baby parts left behind could become infected and cause toxic shock” is unfair to them.

Shock tactics are easy. Medicine is hard. Reproductive health is often harder still. Legislating for reproductive justice in Ireland is going to be a fight and it’s going to be one that will take information and understanding and above all a commitment to centering the human rights of the pregnant person; a commitment to debunking the kind of scaremongering that comes from statements such as “there will… be bans on” [insert practice here]; and a commitment to understanding the role that medical professionals have in doing the difficult, unpleasant, explicit work involved in providing for our ongoing healthcare needs.