Response to Dr. Gunter on Late Term Abortions

A couple weeks ago a friend sent me an article by one Dr. Jen Gunter.  She is an OBGYN who used to perform late term abortions, and with all the attention recently given to the abortion laws being passed in New York and Virginia, she wanted to speak up in defense of her trade.

Today I wanted to formulate a layman's response.  What can be said against the testimony of an expert?

Staying in Lanes:

One theme which Dr. Gunter returns to throughout her piece is the role of expertise.  She doesn't want people who aren't late-term abortion doctors to speak on the matter.  For instance, she says in various places:

"When some doctor who does not do abortions and who speaks on “Biblical Masculinity” said — incorrectly — that a third trimester abortion was never needed medically I threw up a twitter thread in hopes that would help people combat the lies."

"I’m going to walk everyone through this for what I hope (but don’t really believe) will be the last time. I have written about 3rd trimester abortion so much that I am stunned at the basic inability to grasp what is happening. However, medicine is hard so perhaps it is a good lesson in leaving medicine to those who can do it. How many people opining on abortion also opine on how their pilot should be flying planes?"

"Triploidy or mirror syndrome or a massive cystic hygroma or any other birth defect that can affect how the fetus is positioned and how it molds and bends to deliver vaginally. If you don’t know what these terms mean, then you are not qualified to discuss abortion at or after 24 weeks, so stop. Now."

Alrighty, let's talk about expertise.  Suppose I said to you:

"I'm an expert in 17th century British history, therefore there's nothing you can teach me about the physics of Isaac Newton."

What you notice there is I crossed lanes of expertise.  Yes, Isaac Newton is a part of 17th century British history, but that doesn't mean I know anything about his physics.

In similar fashion, Dr. Gunter makes statements throughout her post which go beyond her expertise.  She is an expert in the medical aspects of performing late-term abortions.  But that doesn't make her an expert in ethics, law, logic, statistics, sociology, religion, or (as her post makes clear) grammar.

So when she says stuff like:

"The New York law does not allow women to have 35 week I’m-so-bored abortions. It allows doctors to offer a full scope of appropriate health care."

... that's an assessment of a law.  Her expertise in medicine doesn't help her in that area.  And as the facts would have it... she's mostly wrong.

Asking Why:

Another area of going outside one's lane is when she says:

"As I am an expert I can tell you most of these procedures happen before 24 weeks. Most are for fetal anomalies (birth defects) and maternal health, but a few are maternal request. []  Women just don’t skip down to their doctor for 35 week pleasure abortions."

Alright, the standard narrative when it comes to late-term abortions goes like this:

"Evil pro-lifers talk about these cases as if women do it for fun.  But in reality, these are life-saving operations which are only done when the child cannot survive outside the womb, or its the only way to save women's lives.  The vile, lying pro-lifers just want to scare you!"

And that's what you see happening here.  However, research by the Guttmacher Institute (a firm which supports abortion rights) said the following in a 2013 study on late-term abortions:

"We do not know how accurately these narratives characterize the circumstances of women who seek later abortions for reasons other than fetal anomaly or life endangerment. But data suggest that most women seeking later terminations are not doing so for reasons of fetal anomaly or life endangerment."

It then goes on to describe other reasons why women sought late term abortions instead of doing it earlier.  They included:

• Not realizing they were pregnant earlier.
• They had trouble deciding whether to have an abortion or not.
• They had disagreements with the man involved in the relationship.
• They were delayed by trouble getting to a facility.
• They were delayed by finding money for the abortion.

So yeah, the women in these situations probably thought they had a good reason.  They weren't doing it for fun.  But the caricature of this being all about non-viable fetuses and mortally dangerous pregnancies is hogwash.  That might be the case at Dr. Gunter's practice, but her experience isn't representative.


Wordplay:

One of the main complains she has in her post is when folks (especially doctors) say abortion isn't necessary to save a woman's life.  The ground of her complaint is the the word "abortion" has a broader meaning than it does in popular use.

In popular use it means:  "The direct and intentional killing of a human prior to his/her birth."  

Dr. Gunter point out that in medical parlance the term means: "The termination of a pregnancy."  

Therefore, she notes, an assortment of things can rightly be called an "abortion". Specifically, she names:  Dilation and extraction, induction of labor and delivery, and even C-section delivery.  And as far as that goes, she's correct.  That's why "miscarriage" - (when a baby dies of natural causes in the womb) - is technically called a "spontaneous abortion".

But this is where her argument devolves into a mixture of sophistry and elitism.  Because she uses the broader, medical definition of "abortion", she takes great umbrage at folks claiming abortion is never necessary to save a woman's life.  She says:

"Abortion is sometimes needed at or after 24 weeks. Sometimes a c-section is even an abortion. If you say otherwise you are ignorant, meaning unaware or unable to understand the medicine (if you are a doctor that makes you ill-trained), or a liar."

Now, if you take the medical use of the term, she's absolutely right.  Sometimes its necessary to end a pregnancy.  Does that mean all the medical professional who say "abortion isn't necessary" are ignorant or dishonest?

No, it just means they are using the popular definition ... because that's what comes naturally when communicating to a lay audience.  But to spell it out - (in the unlikely event that Dr. Gunter reads this) - they were saying:

"That thing where you directly and intentionally end of the life of a prenatal human.  That thing is never absolutely necessary to save a woman's life."

Hammers and Nails:

In her post she takes particular offense at people asking: "Why can’t they just have a c-section?"  (When confronted by a pregnancy which has become too dangerous and vaginal birth is too perilous.)

She responds by first insulting the intelligence of people who don't use the word "abortion" in the broad medical sense.  Then she lists the potential complications involved in C-sections, and why an abortion (in the vernacular meaning) is sometimes medically preferable for the mother.

Her response reminds me of the old saying: "To a hammer, everything looks like a nail."  She when asked "Why can't they just have a C-section", she thinks she's being asked a medical question.  But she's not.  When someone asks that, the person is asking an ethical question.

In other words:  "If there is some possible way of avoiding doing direct violence to a living human being... wouldn't that be the option you take?  Even it could possibly risk more side effects?"   

Because even as you read her description of why an abortion (in the vernacular meaning) may be preferable... she never says its absolutely necessary. She only ever presents it as a better option for the mother's health. In that way she seems to agree with the Pro-Life doctors who say abortion is never necessary to save a woman's life.

Even as she derides them for not using the terms the way she does.



Ethics Matter:

Which leads to my final thought.

In her discussion of fetal viability, she said something which raised my eyebrows:

"Sometimes at 25 weeks there is no chance of survival. That is why you go to OB/GYN or pediatrics school, to learn when a fetus has a chance after birth (and what painful interventions that chance might take). And you also learn (or should learn) to discuss it in a way that your own personal beliefs STAY THE HELL AWAY."

See... the concept of personal ethics has been in medicine since the Hypocritical Oath.  This ancient physician's creed is packed with personal pledges to never do anything which he believes is wrong. This is important because terrible things can occur when doctors let the cultural milieu, superior officers, or civil governments act as replacements for their consciences.

During World War II, German doctors were tasked with conducting medical experiments on living human victims as Dachau Concentration Camp.  Imagine approaching one of these doctors - in the midst of inflicting hypothermia on a prisoner - and demanding to know why he's doing something so terrible to a human being.

He says to you:

"Where is your medical degree?  Unless you are an expert in hypothermia, you have nothing of value to say about this experiment!"

No, there has to be a place where a doctor "imposes" his/her own beliefs.  And it seems reasonable that point is when you're asked to tear a human child apart, limb from quivering limb.

Far better to have a doctor who says, "I can't do that.  Even if it was the best way to resolve your condition, never that."