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Monday, April 23rd 2007

NEJM Gives Voice To Way Off Topic Physicians

The New England Journal of Medicine published two perspectives and an editorial online today concerning the recent Supreme Court case which upheld the federal government’s 2003 ban on the intact dilation and extraction/partial birth abortion method.

Whatever my personal belief on abortion the editorials reveal an alarming, egocentric view of the abortion debate which is, unfortunately, all too common.

See what you think they have in common.

Government In Medicine

[W]ith this decision the Supreme Court has sanctioned the intrusion of legislation into the day-to-day practice of medicine.

The Intimidation of American Physicians – Banning Partial Birth Abortion

The ruling creates an intimidating environment surrounding pregnancy terminations at more advanced gestational ages. The decision to pursue a second-trimester abortion is never taken lightly and usually results only after anguished discussions among the patient, her loved ones, and her health care providers. Once the decision has been made to perform a second-trimester surgical abortion, the last thing a provider needs is to have to worry that the procedure could potentially evolve into a criminal act if a fetus in breech presentation should slip out intact through a partially dilated cervix. But this is exactly the situation created by the partial-birth abortion bill.

Sadly the soundest argument, the patient centered argument, comes from an editorial written by a lawyer: “The Partial Death of Abortion Rights

[A] federal statute outlawing the use of “partial-birth abortion” is constitutional, even though many members of the medical community believe that the procedure should be available when it is the safest option for terminating a pregnancy. No exception was made for protecting a woman’s health; only a threat to a woman’s life would excuse the use of the procedure.

Ever since the 1973 decision in Roe v. Wade, it has been understood that states may regulate pre-viability abortion and outlaw post-viability abortion completely, provided that the rules protect both the life and the health of the pregnant woman.

This balance reflects the view that a woman’s interest in preserving her own health should be protected more strongly than any state interest in preserving intrauterine life.

It isn’t merely a matter of physician’s framing the issue as one of their concern. My future profession, which tries so hard to present itself as the most selfless of all professions, often appears guilty of that I imagine. No, these are examples of how pro-lifers in general simply miss the most fundamental question.

The actual, current debate over abortion really does rise to the level of absurdity. You have two arguments being made which are, when you get down to it, unrelated. The two sides aren’t even talking about the same thing:
Pro Choice: It’s a woman’s body
Pro Life: The fetus is a life

And there in is the point. No one who defined a fetus as alive would be pro choice. At least I hope not.

And it isn’t like that debate is settled (at conception v. later). Indeed, getting more philosophical, the definition of when life begins may be fluid in the future.

And so for health care professionals, of all people, to get into the mundane argument of how the Supreme Court’s decision is bad, because it will change the way physicians practice, is…disappointing. Bring the debate to its most inherent level. There’s no pro-lifer to be convinced with the argument that “the government is intimidating physicians!

The NEJM’s perspectives show a profound lack of perspective. They can’t accomplish anything except preach to the choir. In such a case, they’re a waste of paper.

You can look at the Supreme Court case yourself or read Michael Dorf’s analysis of the decision. The original arguments before the court, back in November 2006, are here and here. Kennedy’s majority opinion is here. You can also read Thomas’ consenting opinion and Ginsburg’s dissenting opinion.