COMMENTARY

Readers' and Authors' Responses to "The Supreme Court and the Partial-Birth Abortion Ban Act of 2003: A Political Procedure Replaces Woman-Centered Care"

William J. Pevsner, DO; Eve C. Gartner; Sarah Nordholm, L.P.N.; Suzanne T. Poppema, MD; Paul D. Blumenthal, MD, MPH; Beverly Winikoff, MD, MPH

Disclosures

August 22, 2007

To the Editor,

I don't believe the premise of the author's assertion, that since the inception of Medicare, government is not to meddle in the affairs of physicians making a "medical decision.[1]" At what point is a partial-birth abortion truly done for the health reasons of the woman other than her not wanting or being able to take care of her child?

What you are dealing with is the public's perception that you are essentially delivering a child, pithing it, and then sucking out its brains. The quasi-medical necessity is the reason to "ban" it. If government is really not to be meddling with medical practice, then malpractice reform should be included in this discussion, as it influences how we practice more than the remote times when partial-birth abortion is really necessary, which in my view it is not. If a woman's "right to choose" is paramount here, we owe Dr. Kevorkian an apology.

William J. Pevsner, DO
wpevsner@earthlink.net

Reference

  1. Blumenthal PD. Winikoff B. The Supreme Court and the Partial-Birth Abortion Ban Act of 2003: a political procedure replaces woman-centered care. MedGenMed. 2007;9:52. Available at: https://www.medscape.com/viewarticle/557053 Accessed August 17, 2007.

 


 

To the Editor,

Drs. Blumenthal and Winikoff are correct in identifying the critical ways in which the Supreme Court's decision upholding the first-ever federal law banning abortion undermines a physician's ability to provide the best medical care to her patients.[1] As the lawyer who represented Planned Parenthood doctors and patients in this case before the Supreme Court, I know all too well that the implications of the Court's ruling will be far-reaching. As the 3 federal trial courts to hear challenges to this law ruled, a substantial body of highly credentialed medical authority consider the now-banned intact D&E [dilation and evacuation] abortion method to be significantly safer for some women than other available methods. Moreover, because of the vagueness in the wording of the law, some doctors will likely be discouraged from using other safe second-trimester abortion methods as well. With this ruling, the Court has departed dramatically from Roe v. Wade, and subsequent Supreme Court abortion decisions, which have uniformly held that the health of the pregnant woman takes precedence over any other state interest in regulating abortion. Now, however, the Supreme Court has done an about-face, holding that legislatures, not doctors, can make crucial treatment decisions for pregnant women, and that abortion can be regulated in a manner that renders the health of pregnant women subservient to other state interests. Without a doubt, the ramifications of this ruling for doctors and pregnant women will be significant.

Eve C. Gartner
Deputy Director, Public Policy Litigation and Law
Planned Parenthood Federation of America
New York, NY

Reference

  1. Blumenthal PD. Winikoff B. The Supreme Court and the Partial-Birth Abortion Ban Act of 2003: a political procedure replaces woman-centered care. MedGenMed. 2007;9:52. Available at: https://www.medscape.com/viewarticle/557053 Accessed August 17, 2007.

 


 

To the Editor,

The vast majority of second-trimester and third-trimester abortions are performed for gender selection or fetal anomaly, not to save women's lives, as the old propaganda line goes. To kill an unborn child for gender preference is selfishness at its worst. Imperfect children with healthcare needs put a burden of cost on physicians, hospitals, and most obviously insurance companies. To kill an unborn child to decrease cost is greed at its worst. Banning partial-birth abortion is not chilling; it is the beginning of liberation from the horror of state-supported genocide.[1]

Sarah Nordholm, LPN
Milton, New Hampshire

Reference

  1. Blumenthal PD. Winikoff B. The Supreme Court and the Partial-Birth Abortion Ban Act of 2003: a political procedure replaces woman-centered care. MedGenMed. 2007;9:52. Available at: https://www.medscape.com/viewarticle/557053 Accessed August 17, 2007.

 


 

To the Editor,

Drs. Blumenthal and Winikoff make several vital points in their articulate and rational response to the Supreme Court decision. First, the Court's ruling clearly overturns precedent without the honesty to admit to it. Second, the Court ruthlessly abandons a woman's health needs by overtly saying that even if a medical procedure is more risky, a state may require a woman to undergo the more risky procedure. Third, the Court blatantly opens the door to unending meddling in medicine by stating that the states have an interest in promoting "respect for the fetus." It is difficult to predict to what extremes that might lead. It is also paramount to underline what Drs. Blumenthal and Winikoff point out -- that in the throes of an emergency, it is most definitely not the time for a physician to feel the government lurking over one's shoulder and second-guessing medical decisions. This is a chilling and far-reaching decision that should alarm all physicians in any specialty.[1]

Suzanne T. Poppema, MD
Chair, Physicians for Reproductive Choice and Health
Edmonds, Washington
stpopp@aol.com

Reference

  1. Blumenthal PD. Winikoff B. The Supreme Court and the Partial-Birth Abortion Ban Act of 2003: a political procedure replaces woman-centered care. MedGenMed. 2007;9:52. Available at: https://www.medscape.com/viewarticle/557053 Accessed August 17, 2007.

 


 

Authors' Response,

We welcome the opportunity to respond to these letters that express the deep and heartfelt views of their authors. We hope that our response will help to reduce confusion related both to the recently enacted law and to our opinion piece.

Dr. Pevsner is quite right to assert that the government has a role to play in the policies and overarching principles that structure medical care in our country. Malpractice and tort reform issues are examples of areas appropriate for government activity. In dealing with such issues, Congress would be deciding on policy issues that affect the delivery of medical care services but would not be dealing with decisions on clinical procedures or the practice of medicine itself. Our point was that the specific technical aspects of procedures should remain in the purview of physicians. Congress is trained to debate and create policy, but legislators, with few exceptions, are not trained to debate clinical indications and the risks and benefits of a particular procedure.

In this context it is also important to remember that the argument here has nothing to do with a woman's right to choose; that the right of the woman to have the abortion at that particular gestational age or for any reason is not the subject of the legislation. Nor does it deal with our emotional reactions to the ethics or aesthetics of any procedure.

This last point is the crux of the letters by Gartner and Poppema. As physicians, despite personal perspectives on the aesthetics of one procedure as opposed to another, we are obligated to offer the procedure that is in the best health interests of our patients. And where abortion procedures are concerned, the patient is the woman who has requested the procedure. No matter the route, the outcome for the fetus is the same. But if procedures that are arguably less safe for the woman are mandated by legislators, then the women in our care could suffer.

Unfortunately, the comments of Ms. Nordholm reflect both a misunderstanding of the statistics of second-trimester abortion in the United States and the issues at stake. Although congenital anomalies figure prominently among the reasons for later term abortion, gender selection does not. The decision to abort an affected pregnancy is intensely personal and painful and not connected with concerns about costs to insurance companies or even the state. Again, the real issue is that abortions remain legal for women who request them, and the legislation we commented on makes no change in that fact. As long as women seek abortions and receive them, shouldn't physicians be able to practice medicine in a way that best preserves the health of their patients?

Paul D. Blumenthal, MD, MPH
Professor of Obstetrics and Gynecology; Director, Family Planning Services and Research, Stanford University School of Medicine, Stanford, California; Deputy Editor, Medscape General Medicine, New York, NY

Beverly Winikoff, MD, MPH
President, Gynuity Health Projects, New York, NY

 


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