We call it ‘selective reduction’

LizaMundyIn recent weeks we’ve seen a couple of really good articles about the ethics and values of abortion supporters. Liza Mundy, a staff writer for The Washington Post Magazine, had another excellent entry that relates to the topic with her Sunday piece on women pregnant with more than one fetus who wish they had fewer.

Mundy, who just wrote the book Everything Conceivable: How Assisted Reproduction Is Changing Men, Women, and the World, speaks with mothers of multiple fetuses and one of the doctors who ends the lives of some of them. In an online chat the Post provided the day after the article ran, Mundy says she supports what advocates of the practice call “selective reduction.” Having said that, the piece balances that sympathy with some of the most shockingly straightforward details I’ve seen in abortion-related reporting. She also looks at the psychological suffering and ethical qualms of the women who end the lives of some of the fetuses inside of them. To wit:

And, sure enough, on [sonographer Rachel] Greenbaum’s screen were three little honeycombed chambers with three fetuses growing in them. The fetuses were moving and waving their limbs; even at this point, approaching 12 weeks of gestation, they were clearly human, at that big-headed-could-be-an-alien-but-definitely-not-a-kitten stage of development. Evans has found this to be the best window of time in which to perform a reduction. Waiting that long provides time to see whether the pregnancy might reduce itself naturally through miscarriage, and lets the fetuses develop to the point where genetic testing can be done to see which are chromosomally normal.

. . . So far, there was nothing anomalous about any of the fetuses. Greenbaum turned the screen toward the patient. “That’s the little heartbeat,” she said, pointing to the area where a tiny organ was clearly pulsing. “And there are the little hands. There’s the head. The body.”

“Oh, my God, I can really see it!” the patient cried. “Oh, my God! I can see the fingers!”

“Okay!” she said, abruptly, gesturing for the screen to be turned away. She began sobbing. There were no tissues in the room, so her husband gave her a paper towel, which she crumpled to her face. The patient spent the rest of the procedure with her hospital gown over her face, so she would not see any more of what was happening.

The fetus is killed — or “eliminated” and “deleted” as the Post article puts it — through an injection of potassium chloride to the heart. The article reminded me of Stephanie Simon’s excellent write-up of her day inside an abortion clinic for the Los Angeles Times. In fact, Mundy did camp out at the doctor’s office for two days while she met with women carrying multiple fetuses. One compelling story was that of lesbian couple Emma and Jane, who had decided they would terminate the lives of two of their quadruplets by looking for chromosomal abnormalities, fetal position, medical instincts and, finally, sex. All four of the fetuses were healthy:

“I used to be totally not willing to talk about gender,” elaborated [Doctor Mark] Evans, who has pieced together his own ethics during more than 20 years of practice. At the outset, he worked with a bioethicist to develop guiding principles. For years, he says, the majority of sex-selection requests came from Asian and Indian parents, who tended to want to keep the boys. That he would not do. Increasingly, however, what people want is the Holy Grail of the modern two-child family: one boy and one girl. He finds that morally acceptable.

Emma positioned herself on the table for her sonogram, while Jane scrutinized the four fetuses on the screen. “They are all tucked in really nicely into their little nests,” she said, fascinated. “The most I’ve ever looked at in utero is two.”

. . . Jane wanted to safeguard Emma’s pregnancy but was feeling some ethical qualms. “It’s killing me that we’re going to do this,” Jane said. “I never thought I would feel that. I’m the most pro-choice person. I’m vehemently pro-choice.”

It’s interesting that it’s not morally acceptable to kill a girl if it’s because Indian and Asian parents prefer boys, but it is morally acceptable to kill a girl if it’s because she already has a sister. I wish Mundy had explored that more. What is the logic behind that? The article also covers a woman from Puerto Rico whose mother pushes her to terminate one of the three girls she is carrying:

Evans worked for a while trying to get the needle into the right spot.

“I’m not in,” he said at one point, tensely. Then he pinned C with the needle, and pushed the plunger to release the chemical. The fetus, which had been undulating and waving, went still. It would remain in the womb, while the other fetuses grew and developed.

Evans explains that what he does is not technically an abortion since that procedure “kills the fetus and empties the uterus.” Since he aims to continue a pregnancy with the dead fetus inside the woman and the living fetuses continuing to grow, it’s not an abortion. The one pro-lifer in the article mentions that this distinction isn’t that noteworthy from her perspective.

Anyway, it made me think back to the term we were using: selective reduction. Remember that big, record-breaking discussion we had when the Supreme Court upheld the federal Partial-Birth Abortion Ban Act? I do. Some readers supported mainstream media’s decision to put the term in quotes or refer to it as something only critics of the practice called it. And yet the actual medical term for what Evans is doing is chorionic villus sampling feticide or embryoctony.

Selective reduction, like partial-birth abortion, is not a medical term, but the one used by proponents of the practice. And yet it’s not put in quotes by the mainstream media. Curious. The only time I recall seeing it put in quotes was when someone critiqued a New York Times Sunday Magazine article by a woman who killed two of her triplets so she wouldn’t have to make trips to Costco or move out of the East Village. I’m not joking. The New York Times got in a bit of trouble over that piece — not because of the content but because it failed to mention the woman in question had worked for Planned Parenthood.

Anyway, Mundy gets some explicit religion in the story through the concerns of the sonogram technician who says she sometimes feels like she’s playing God. She justifies her behavior by saying her Jewish beliefs enable her to terminate fetuses for sound medical reasons.

Still, she says: “It’s a very hard procedure, because the baby is moving, and you are chasing it. That is what is very emotional — when the baby is moving and you are chasing it.

I wish the ethics and religious guidelines of each patient had been delved into more because it was fascinating each time Mundy did broach the subject. The doctor used to refuse to terminate one twin, although he is willing now since some patients only want one child. His thinking is that if it’s okay to abort a pregnancy, there’s no logical argument that means it’s not okay to reduce a pregnancy from two to one. Mundy says there is a debate about that notion but she then refers to another doctor who simply talks about how it’s possible to have a healthy pregnancy carrying multiple fetuses. That’s not a refutation of Evans’ logical argument. Mundy also mentions psychological consequences, including severe bereavement and a more complex attachment to the remaining babies.

The lesbian couple ends up selecting for sex. They want a boy and a girl. One of them is worried about the karma of what they are doing, particularly after one of the little ones they selected to terminate is moving and waving:

Evans prepared two syringes, swabbed Emma with antiseptic, put the square-holed napkin on her stomach. Then he plunged one of the needles into Emma’s belly and began to work his way into position. He injected the potassium chloride, and B, the first fetus to go, went still.

“There’s no activity there,” he said, scrutinizing the screen. B was lying lengthwise in its little honeycomb chamber, no longer there and yet still there. It was impossible not to find the sight affecting. Here was a life that one minute was going to happen and now, because of its location, wasn’t. One minute, B was a fetus with a future stretching out before it: childhood, college, children, grandchildren, maybe. The next minute, that future had been deleted.

Evans plunged the second needle into Emma’s belly. “See the tip?” he said, showing the women where the tip of the needle was visible on the ultrasound screen. Even I could see it: a white spot hovering near the heart. D was moving. Evans started injecting. He went very slowly. “If you inject too fast, you blow the kid off your needle,” he explained.

SuzannePoppemaI thought the article — including that last quote — was shockingly straightforward. I was struck by how many comments in the Washington Post chat championed the reporter for sympathizing with women who terminate some of their fetuses. It would be just as easy to praise her for shedding light on the monstrosity of “selective reduction.” I thought it was, like many of Stephanie Simon’s stories, rather balanced — which is interesting because Simon had an abortion story that wasn’t terribly balanced. So there you have it. Apparently I do not offer unending praise for 100 percent of her stories. Anyway, she writes about medical students who want to become abortion doctors.

For the article, Simon speaks with three students and one doctor — all in her home base of Colorado. The doctor is Warren Hern, who is rather notorious for aborting babies throughout pregnancy. I was surprised at the limited scope. It also uncritically parrots the pro-choice talking points, including horror stories from pre-Roe days. She mentions that, while abortions are quite common, a decreasing number of doctors perform them. Abortion opponents suggest the reality of the procedure is too grisly. Abortion rights advocates blame picketing of doctors’ offices and “increasingly” (what does that mean, exactly?) the home:

Physicians who choose to provide abortions also chafe at a lack of autonomy. In many states, every detail of their practice is regulated: the width of clinic hallways, the number of air vents, even how often their staff must take physicals.

On the federal level, Congress has banned a particular technique for ending mid-term pregnancies, known by critics as “partial-birth abortion.” The Supreme Court last month upheld that ban; doctors can be prosecuted for using the method even if they determine it’s the safest approach for a given patient.

Every doctor I know complains about over-regulation — is this managing of hall space limited to abortion clinics? I don’t really know the answer to that, but some comparison must be made. And the second paragraph is just disappointing. That’s not a Stephanie Simon paragraph — it’s a NARAL fundraising letter.

Hern, 68, practices in Boulder, Colo., a liberal college town. Still, he’s afraid to open his blinds at night for fear of a sniper hidden in the bushes. His clinic is protected by a fence and four layers of bulletproof glass.

Abortion is so stigmatized, Hern said, that his fellow physicians shun him. Even his patients often regard him with disgust: “They’ve absorbed so much antiabortion rhetoric, they feel a sense of revulsion that they have to come into my office and seek treatment.”

Having grown up in Colorado and having attending the University of Colorado, I’m familiar with Hern. To put it as gently as I can, he’s a character. He’s completely outlandish and when I was growing up there, he was quoted all the time for his extreme statements. Think Pat Robertson for the pro-abortion crowd. If other physicians shun him, it might not just be because of his chosen line of work.

Anyway, what I love about Simon’s articles is that I learn so much about the topics she covers. She’s also just a wonderful writer who really gets her subjects and explains their perspectives well. This article was very well written, but I’m not sure how illuminating it was.

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  • http://clientandserver.com dw

    Wasn’t Hern the one guy on the Front Range who’d do third-term abortions? I remember him from my days at CU. I think he also gave some speech around that time (early 90s) saying humans were a “cancer” on the earth and implying that by being an abortionist he was doing something to stop that “cancer.” Or maybe I’m confusing him with someone else.

    I’m surprised to see ANY newspaper, much less the WaPo, be so blunt about selective reduction.

  • Chip

    Molly writes:

    Anyway, it made me think back to the term we were using: selective reduction. Remember that big, record-breaking discussion we had when the Supreme Court upheld the federal Partial-Birth Abortion Ban Act? I do. Some readers supported mainstream media’s decision to put the term in quotes or refer to it as something only critics of the practice called it. And yet the actual medical term for what Evans is doing is “chorionic villus sampling.” Selective reduction, like partial-birth abortion, is not a medical term but the one used by proponents of the practice. And yet it’s not put in quotes by the mainstream media. Curious.

    Compare with what the journalist Liza Munday wrote:

    Today, Evans performs CVS, chorionic villus sampling, on his reduction patients. In CVS, a small portion of the placenta, which shares the chromosomes of the fetus, is drawn into a hollow needle. The tissue is shipped to a lab for an overnight test for genetic birth defects. The same test can also determine the gender of each fetus. Evans also studies the position of each fetus. The point is to seek a rationale for which one, or ones, to eliminate.

    Chorionic villus sampling is used to test for birth defects; it is not the means of selective reduction.

    Molly, you are comparing apples and oranges.

  • http://www.getreligion.org Mollie


    You are right. I changed above. Also, it is worth noting that the medical staff who kill the fetuses use the euphemism “selective reduction” to explain the process to their patients.

  • http://www.washingtontimes.com Julia Duin

    Seriously, how much research did Liza Mundy do? As the mom of a 2-months premature daughter (I adopted her much later and she is quite healthy!), I resent the inference that prematurity must be avoided at all costs. Did she even bother to interview Dr. John Elliot, co-founder of Phoenix Perinatal Associates and director of maternal medicine at Good Samaritan Regional Medical Center in Phoenix? Women with multiple high-risk pregnancies fly there from all over the country for help in keeping their pregnancies. Delivering quads is pretty passe for those folks.
    Medically, triplets are no longer considered an at-risk pregnancy. Did the author bother to check with any medical group to talk about this? Ms. Mundy could have checked out tripletconnection.org or the Quad Squad, both groups that support keeping your children. But no, there were no alternatives presented, no assumptions challenged.

  • Irenaeus

    I read stories like this, and I’m tempted to side with those evangelicals/fundamentalists who assert America’s troubles are brought on by America herself…

  • Sean

    The first time I read “There were no tissues in the room…” I thought it was a comment on the personhood of the fetus. I guess not.

  • http://www.bombaxo.com/blog Kevin P. Edgecomb

    That’s the first post on Get Religion that I’ve run into that I was simply unable to finish reading.

  • http://god-of-small-things.blogspot.com bob smietana

    The term “selective reduction” was commonly used back in the 1990s, when my wife and I went through infertility treatment. Euphemism might not be the right term for it — it’s certainly jargon in reproduction medicine. As we discussed all our options, the term selective reduction came up–our doctor was never a proponent of it, but he did say, “This is a possibility.” We did not do IVF, in part because of the ethical implications. Other friends of ours did do IVF–they told their doctor that they would never consider terminating a fetus, under any circumstances. Again, their doctor did not advocate the practice — but informed them of the possibility.

    As someone with some first hand experience as an infertility patient, as a reporter who’s written about assisted reproduction, and as someone who finds the procedure horrific, I’m still not suprised that Mundy used the term selective reduction without quotes or that other newspapers would. It’s a commonplace term in assisted reproduction practices–and not used primarily as a euphemism by advocates.

  • http://www.getreligion.org Mollie


    Thank you for your story. I think she should have used the term “selective reduction,” actually. It’s the term used by the doctor who is the centerpiece of the article and it’s also the term used by the IVF community.

    I was just pointing out how the media use it without any qualms. I’m all for plain language. And I think Mundy used plain language effectively throughout the entire piece.

  • Dave Griffey

    I did learn a bit from this one. Thanks. It was tough reading, sort of like historical examinations of the Holocaust. It takes the topic at hand, and presents it with the same detached view as describing the invention of the Cotton Gin. I was able to read the whole story, but it was hard. Very, very hard.

  • Michael

    I was just pointing out how the media use it without any qualms. I’m all for plain language. And I think Mundy used plain language effectively throughout the entire piece.

    Plain language isn’t created in the war room of the Pro-life Action League and Focus on the Family as part of a political strategy Selective reduction is what is used by those who perform the procedures, not those raising millions of dollars to influence campaigns and the Supreme Court. It is completely different from the burning desire to adopt the code words of the political advocacy groups.

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  • Christian

    “….every detail of their practice is regulated: the width of clinic hallways, the number of air vents”

    This is nothing but normal building code stuff. Every detail of all kinds of buildings is nitpicked by modern codes, so it’s a complete non-issue here.

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  • DM

    I’m someone who has no aspirations to be a mother, never really did. In fact, at times I think I’m almost child-phobic (more a response to parents who allow their kids to run around wildly in places where they could easily be hurt – near traffic, along cliffs while hiking, etc.) But when I read this article, I sobbed. God help us – how horrific.

  • Pellegri

    Posted here before as Kim K.–switching handles, but little else.

    I’m in the “almost started crying” squad on this. That’s–incredible, in the most negative sense of the word that exists. But a very interesting article (and review) nevertheless.

    It does make me wonder about iatrogenic phantom twin syndrome and the possible repercussions, though that’s a discussion for not-here.