Moving past the bumper stickers

pro-life-sign1Following the murder of prominent late-term abortion doctor George Tiller, gunned down in the foyer of his church, many mainstream media outlets have run articles about the controversial practice of late-term abortions and the doctors who perform them. This is a good thing. On a public policy issue as heated as late-term abortion, it’s good to provide readers with more information about the practice and who is involved.

Let’s look at some of the stories. Here’s Stephanie Simon of the Wall Street Journal, with a very balanced article on the topic. She somehow manages to move her sources beyond the “bumper sticker” level of discourse to get some meaningful quotes from both sides about the difficulty of the issue. She includes an anecdote from people who chose a late-term abortion after learning that their unborn child had a fatal form of dwarfism but she also speaks with someone who decided to continue with her pregnancy after a different fatal fetal diagnosis. The article helps show the issue’s complexity. It’s a really good story for everyone to read — no matter your views on the topic.

But Simon’s story, published a few days ago, is what got me thinking about the way some of the “facts” surrounding late-term abortion are reported. First and foremost, I’d like a definition of what constitutes late-term abortion. We use that phrase all the time but I rarely see it defined. A separate Wall Street Journal story reports that nearly 90 percent of abortions are conducted during the first trimester of pregnancy with just more than one percent conducted after 21 weeks. Simon’s story says that it’s fewer than 1 percent that are conducted late in the second or during the third trimester. When does the “late-term” of “late-term abortions” begin?

Or note that Simon writes that “perhaps 1,000 [abortions] a year” are performed in the late second or third trimesters. But that other Wall Street Journal story says:

Stanley Henshaw, a senior fellow at the Guttmacher Institute, a reproductive health-research group, told WaPo that 2001 data from 15 states and New York City suggest that as many as 2,400 abortions were performed after 24 weeks in the U.S. that year. But Henshaw said that number might have come down because there are fewer abortion providers now.

Perhaps they did decline some 60 percent in a couple years but, if so, an explanation might be in order.

Or note something about the paragraph below where Simon does her best to explain the reasons women might get a late-term abortion:

Nearly all the late-term abortions at Dr. Tiller’s clinic involved fetuses that were deformed or disabled in some way, said Peggy Bowman, who worked at the clinic as a top aide to Dr. Tiller for a decade. …

Dr. Tiller also took some late-term patients with healthy fetuses. Though the clinic’s medical records typically remain confidential, he said they were only the most desperate cases: very young girls, victims of rape, drug addicts, women in abusive relationships.

It struck me that all of this is self reported. We’re relying on one side — perhaps there’s no other option — for information about one of the most contentious topics in public debate.

The Washington Post‘s look at late-term abortions basically just quotes two other famous late-term abortion doctors (Warren Hern and Leroy Carhart) with an assist from the National Abortion Federation’s Vicky Saporta. The trio make a number of contentious claims about women who come for abortions after their fetuses are viable. And rather than speak with a doctor or three who specialize in helping women bring to term children with fetal abnormalities, we get a response from Operation Rescue, a group that doesn’t exactly represent mainstream pro-life thinking. However, the story, by reporter Rob Stein, does a fantastic job of explaining just how sketchy the data on late-term abortions are. I thank him for that. He was also one of the few reporters to actually investigate how many abortion doctors perform late-term abortions. While many media outlets reported that Tiller was one of only two or three doctors to do them, Stein reports that a survey of a couple thousand abortion practices from a few years ago found 18 clinics and 12 hospitals reported performing late abortions.

But there are some holes as well. The story begins with a heartbreaking account:

When Susan Fitzgerald went in for a routine ultrasound near the end of her pregnancy, she was expecting good news. Instead, she was stunned to learn that the fetus had a rare condition that left his bones so brittle he would live less than a day.

“It was unbelievable,” Fitzgerald said. “You think by the third trimester you’re home free. It was devastating.”

Desperate to end the pregnancy, she flew from her home in New England to Wichita, where George Tiller was one of the few doctors in the country willing to perform an abortion so late in a pregnancy.

“It was very difficult, but I knew it was the most humane thing I could do for my baby,” Fitzgerald said. “It was absolutely the right thing to do. I’m just so grateful that Dr. Tiller was there for me.”

The name of the condition is not included in the story. Later we learn:

Under Kansas law, an abortion can be performed after a fetus is viable only if the doctor performing the procedure and an independent physician agree that the woman’s life is at risk or that continuing the pregnancy would cause “substantial and irreversible impairment of a major bodily function.”

Many are performed in cases such as Fitzgerald’s, where a major abnormality in the fetus is discovered late, Saporta and others said.

And while Stein’s article doesn’t mention how Tiller performed abortions, Simon’s article did:

Late-term abortions also are grueling. In 2007, the Supreme Court upheld a federal ban on one late-term procedure, sometimes called “partial-birth abortion,” in which the physician begins to deliver the fetus, feet-first, then punctures its skull. Doctors are still allowed to dismember the fetus in utero. Dr. Tiller’s preferred method is also legal. He stopped the fetal heart with an injection of digoxin, a drug used to treat adult heart patients. Then he would induce labor. Patients said they would wait in hotel rooms through two to three days of contractions until they were ready to deliver their stillborns at his clinic.

Okay, so after reading a number of articles on late-term abortion and the doctors who perform them, I’m left wondering a few things. How is it legal to abort an unborn child post-viability in Kansas on account of fetal abnormality or genetic defect? In other stories, Tiller says he’s conducted abortions on account of women being in abusive relationships. How is that legal? And while I understand the sensitivity of the topic of pregnancy and abortion (as I write this, I’m holding my daughter who just a month ago was a “late-term” fetus), I wonder if the reporter could include a bit of an explanation as to why the mother felt it better to fly to Kansas to have a doctor stop the heart of her unborn child and deliver him as a stillborn rather than wait for the few remaining weeks of her pregnancy and deliver him? She says she knows that she did the “right thing.” I can’t help but think that deserves a follow-up question and that the answer to that follow-up question would have merited the type of quote that Stephanie Simon gets in her stories.

I’m all for including the stories of women who have undergone late-term abortions but I’m not sure how much these anecdotes are adding to the debate. I feel like there’s this assumption that of course any woman who discovers her child has a fatal abnormality would of course consider ending his life. But as we saw in that fascinating story by Julia Duin a few weeks back, many women don’t terminate their pregnancies when they discover their unborn children have problems.

I also feel as if there’s this assumption about the vast majority of Americans who oppose late-term abortions that they just don’t understand that the women who request them are experiencing difficulties. And yet I think that assumption is probably unwise. Maybe it’s just because I’m a woman, maybe it’s just because I have a mother, maybe it’s just because I know women (perhaps you, too, fit into one or more of these categories!) … but perhaps this debate is not one that could be settled if we all realized that fetal abnormalities are heartbreaking and that pregnancy is difficult. It’s possible to sympathize with women who are carrying fetuses with abnormalities without believing that terminating their lives is just or that the practice should be legal. Simon’s story does a good job of getting that and helping the two sides speak to each other. Most other mainstream accounts, sadly, did not.

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  • dalea

    There is a distinct lack of clear definitions in the coverage. What is the differance between an abortion and a miscarriage? Saw a mention of accidentally induced miscarriage somewhere, no clue what that is. Then there is the medicine to treat something that also causes miscarriages, which might be a sneaky way of aborting. We really need a medical authority, perhaps a nurse-midwife-journalist to explain everything. Which assumes this is explainable.

    The one thing that struck me as strange, there is no discussion of costs and payments. At ProChoice sites, I have encountered explanations for choosing abortion is the economics of the situations. The posters argued that the cost of an abortion is knowable in advance, as are the costs of journeying to Witchita. The cost of carrying to term is not known; and can run into the hundreds of thousands if attempts are made to save the baby. The baby’s one day of life could put the parents in debt for decades. So, it may be that faced with the possiblility of huge debts and the near certainty of a dead baby, parents choose the less expensive method. The journalists who write about the subject ignore this entirely.

    This really is unsatisfactory journalism, it leaves us with more questions than answers.

  • dalea

    The question not asked by the MSM is: what role do insurance companies and HMO’s play in late term abortions? Since they are involved in every other aspect of medicine, the press look into their role here. That they play no role defies common sense and experience.

    The press accepts the ‘patient privacy’ reason for not releasing more information. However, this assumes that records are kept only by patient name, with personal details. The press is really guillable here; they need to investigate how medical records are actually kept. Medical records are kept by patient name of course. They are also kept by medical code:

    Health information coding is the transformation of verbal descriptions of diseases, injuries, and procedures into numeric or alphanumeric designations. Originally, medical coding was performed to classify mortality (cause of death) data on death certificates. However, coding is also used to classify morbidity and procedural data. The coding of health-related data permits access to medical records by diagnoses and procedures for use in clinical care, research, and education.

    Since the implementation of the federal government’s first prospective payment system in 1983, there has been a great deal more emphasis placed on medical coding. Currently, reimbursement of hospital and physician claims for Medicare patients depends entirely on the assignment of codes to describe diagnoses, services, and procedures provided. In the 1990s the federal government attacked the problem of healthcare fraud and abuse. As the basis for reimbursement, appropriate medical coding has become crucial as healthcare providers seek to assure compliance with official coding guidelines.

    Source is the American Health Information Management Association. Website at:

  • Jerry

    Simon’s story does a good job of getting that and helping the two sides speak to each other.

    Mollie, stories like this one are all too rare. Hopefully there will be more stories like this taking the discussion to the next level.

  • Martha

    “While many media outlets reported that Tiller was one of only two or three doctors to do them, Stein reports that a survey of a couple thousand abortion practices from a few years ago found 18 clinics and 12 hospitals reported performing late abortions.”

    That may be linked to the lack of definition of how late a “late-term” abortion is; Tiller and a couple other doctors may have been willing to perform abortions later into the pregnancy than the other clinics.

    But as you say, until we get a meaningful definition and actual figures, no-one knows exactly what’s happening where.

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  • Dave

    I’ve always assumed that “late-term” refers to the third trimester, wherein Roe v Wade gives the state a lot more leeway to regulate. Like Martha, I’ve assumed that doctors like Tiller are unusually prepared to perform “really” late-term procedures.

    The numbers concerning late-term are chronically fuzzy. This worked against pro-choicers in the debate over the federal “partial-birth” ban; they came in with a low-ball estimate and the other side documented a much higher rate.

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  • dalea

    Rather than wonder what something is defined as, I decided to look for definitions online.

    From The Free Dictionary: Medical Dictionary:

    Post-viability abortion Medical ethics Any abortion performed after the fetus would be viable if delivered to a nonspecialized health center.

    Since the fetuses in question could not be viable (ie live) if delivered into a general hospital, the abortions in question do not constitute ‘late term’. Viability does not refer to just the fetus: it also includes the requirement that delivery be in a ‘regular hospital’ not one specializing in baby problems.


    Abortion: In medicine, an abortion is the premature exit of the products of conception (the fetus, fetal membranes, and placenta) from the uterus. It is the loss of a pregnancy and does not refer to why that pregnancy was lost.

    A spontaneous abortion is the same as a miscarriage. The miscarriage of 3 or more consecutive pregnancies is termed habitual abortion.

    This shows 11 different terms for the subject.

    There are also 2 types of miscarriage.

    From mediLexicon:

    1. Expulsion from the uterus of an embryo or fetus before viability (20 weeks’ gestation [18 weeks after fertilization] or fetal weight less than 500 g). A distinction made between abortion and premature birth is that premature infants are those born after the stage of viability but before 37 weeks’ gestation. Abortion may be either spontaneous (occurring from natural causes) or induced (artificially or therapeutically).
    2. The arrest of any action or process before its normal completion.


    1. Layperson’s term for spontaneous expulsion of the products of pregnancy before the middle of the second trimester; no longer accepted in clinical usage.



    1. The premature expulsion from the uterus of the products of conception of the embryo or of a nonviable foetus. The four classic symptoms, usually present in each type of abortion, are uterine contractions, uterine haemorrhage, softening and dilatation of the cervix and presentation or expulsion of all or part of the products of conception.

    The expulsion or removal of an embryo or foetus from the mother prematurely, this can be done as an artificial procedure, but it often happens naturally when the mother’s body expels the foetus because it has died, has genetic or developmental defects, or because of infection or illness in the mother. Natural abortions are typically called miscarriages. Medically-induced abortions, which can be completed with surgery or with hormone drugs, are performed because the foetus is unwanted, deformed, not likely to live, or endangers the mother’s life or health.

    2. The premature stoppage of a natural or a pathological process.

    Getting the sort of definitive understanding we desire may be difficult. It appears that ‘miscarriage’ is now a literary term; in medicine it is lumped in with abortion. And that ‘late term’ has no settled meaning; I found definitions for the 12th up to the 32nd week. Late term seems to be a legal phrase, not medical. Viable is also complicated.

    The reason the press coverage is so confusing, is the subject itself is confusing. There seems to be two type of abortion: spontaneous and induced. But there are gradations between the two extremes. Perhaps the press should better educate us on the subject.

  • dalea

    Dave says:

    I’ve always assumed that “late-term” refers to the third trimester, wherein Roe v Wade gives the state a lot more leeway to regulate. Like Martha, I’ve assumed that doctors like Tiller are unusually prepared to perform “really” late-term procedures.

    Is trimester a medical or legal term? No idea. From what I am finding, the MSM is not investigating just what the terms they toss about mean. A good question, are the weeks referred to the mean, median or mode? What are the range of deviations from these? One term thrown out a lot is that a fetus becomes viable at 24 weeks. What is the statistical meaning of ’24′ weeks, and how does it vary? Did find out that a ‘full term’ pregnancy can be between 34 and 41 weeks. The medical literature refers to ranges and differences; the press likes to have one definitive number. Which is not helpful.

    Did see that most of the discussion of viablity rests on the assumption that delivery will be where there is a highly advanced neo-natal care unit. In such a setting, viability is signifigantly enhanced. But very few deliveries take place under such settings. The MSM should point out the artificial nature of such situations. Viability in the nurse practitioner’s Winnebago traveling clinic on the Native American reservation might be a better standard.

    In considering the issue of viability and its relationship to abortion, it became clear to me that most of Dr Tiller’s cases involve fetuses that will never become viable. Hence, these do not meet the criteria of late term abortion.

  • Jerry

    Perhaps it would be better to focus on the phrase Post-viability abortion rather than the ambiguous word “late” for multiple reasons. One is that there is a clear medical definition (would the baby survive after birth?) albeit a bit fuzzy in practice. The second is that for many people there is a moral bright line that is crossed if the fetus would live after birth.

  • dalea


    The problem is that the viability idea is so hedged and contorted that it is useless. A fetus with no brain will never be viable, regardless of what is done. So, to call the abortion of a 28 week no brain fetus post-viable is useless. To make this an intelligient discussion we need to have a definition of ‘viable’ that has some common meaning.

    To make matters even more interesting, right wing Libertarian sites (a group with whom Mollie self identifies) have stated that human life begins with sentience. This moves the discussion to a whole new level: under the understanding the right wingers bring to the table an 18 month old baby is as much a clump of cells as a recently implanted fetus. Sentience as the criteria of Human Life has an internal consistency that has much to reccomend itself.

  • Dan Berger


    What is a “right-wing Libertarian”? My understanding of “Libertarian” is that they don’t fit comfortably into the stereotypical platform of either major party. A number of Libertarian positions fit comfortably into the standard political left wing; others fit comfortably into the standard right wing. Ergo, Libertarians are neither “left-” or “right-wing,” not so?

  • Dan LaHood

    “Never become viable”. In the long run, to coin a phrase, we are all non-viable. Tiller’s target, if I had to choose one, were fetuses diagnosed with Trisomy 21, Down Syndrome or thought to be so. The fear that the medical community instills in expectant families about Down Syndrome leads many to Kansas to end their pregnancy. Who knows how many tests were accurate. My wife hears from many women who said their baby was positive for 21 and well the docs were mistaken. She also hears from families who continued and count thir child as a blessing. I notice discussions of this issue generally gets stuck on semantics, like this thread. The title here get’s it right, we are finally getting to the gist of it.

  • Dan LaHood

    above I meant to say

  • Julia

    ‘miscarriage’ is now a literary term; in medicine it is lumped in with abortion.

    Miscarriage was never a medical term. What is a literary term?

    There were actually two abortion cases decided the same day in 1973. Roe v Wade and Doe v Bolton. If you only read Roe you are not getting the whole picture of the S. Ct.’s decision on abortion. Check out both of them on Wikipedia.

  • Julia

    Tiller’s medical records were reviewed and redacted with names and identifying characteristics removed. This was done by the ex-attorney general of Kansas. A medical school professor reviewed the dedacted records and I read his assessment of the reasons given for abortion as stated in the records. I can’t find it on-line, any more. If I find it, I’ll come back and post it. I do remember that the vast majority were not for physical harm to the mother. Kansas law does not provide for late abortions due to defects in the fetus, but that was the reason given for many of them.

  • Jerry


    There is no hard and fast way of defining ‘late term’ or ‘viability’ and the definition of ‘viability’ is of course subject to debate. But using the principle “hard cases make bad laws” would imply that we can come up with something that would cover most situations.

  • dalea

    Dan Berger, the distinction between left and right Libertarians goes back at least to the 1960′s, and probably much further. It refers to the split between those who accept state action and those who don’t. The early Libertarian Party literature contains appeals to both sides. This is a general distinction used in Libertarian thinking while the press has allowed a right wing faction to coöpt the word. Rothbard used this to distinguish hid viewpoint from Joan Baez’s. Saw this at ReasonMagazine.

    A literary term is one used in literature but not in science. Carmen dies of consumption but that is not a medical diagnosis, it is a literary term. Same with crazy.

    Mollie asked the sensible question of what do these words mean. The press shows no real inclination to go into the subject. I decided to devote some time to finding out what the medical literature says and report on same. It was surprizing to see the range of meanings offered. Most of the differences were small but meaningful. Late term has a very large variation: from 12 weeks onwards. Viability has a very important where condition. It also has a requirement that the lungs be able to pass gases to the bloodstream, which apparently not all fetuses of that age can do. Most can, but not all. Which is why the location is so important. If the fetus arrives into a high tech neo-natal unit, the chances of making it are strong. If it is not in such a spot, low chances. Which seems to mean that a later viability point should be chosen.

    As usual, the MSM do not make the fundamental distinction between mean, median and mode. Nor do they inform us that there is large variation between individual outcomes.

  • Dave

    As I recall from the original SCOTUS language, the first trimester is that span of time in which an abortion is less risky to the pregnant woman than live birth. The third trimester that span of time in which the fetus is viable (intersting discussion here of the locational aspect of viability).

    As to what’s legal or illegal in Kansas, legislatures only write laws. Prosecutors decide who’s going to be charged with crimes. It’s possible that the prosecutors looked at the state law, looked at the relevant federal case law, and made a prudent decision (in terms of wasting resources) as to what to prosecute. At the time of his murder Tiller had just been acquitted of a 19-count lesser included offense; an anti-abortion group took credit for that prosecution.

  • Will

    Are Libertarians for Life “rightwing” or “leftwing”?
    The only mention of a “sentience” criterion I find on their site has it as the fourteenth in a list of pro-abortion “myths”.

    Labels, labels….

  • Dave

    The problem with sentience as a criterion for human-ness is that humans are probably not the only species to possess sentience. (My cat, for example…)

  • Julia

    FWIW From Wikipedia:

    The word sentient is often confused with the word sapient, which is essentially a confusion between simple perception or sensation and intelligence or thinking.

    I read in the paper the other day that, unexpededly, fish turn out to be somewhat sentient. It really does hurt them to get hooked and then experience the hook being pulled out. Who knew?

    People in comas are often not perceptably sentient.