Author Archives: Tom Joaquin

About Tom Joaquin

Lawyer, activist, policy wonk, science nerd, lover of film, musician, book junky, theatre groupie, and general, all-around dilettante.

The New Anti-Abortion Law — Bad News For Women’s Health and Doctor’s Ethics

In an earlier post I discussed the Supreme Court’s analysis of the so-called Partial Birth Abortion Act, concluding that the Court’s decision to uphold the Act was intellectually dishonest and inequitable. This post is about the purposes of the Act, as described by Congress, and the Act’s probable consequences for the practice of medicine and the health of women.

Understanding the Act requires some minimal understanding about abortion procedures. (This explanation is more or less lifted directly from my earlier post on the Carhart decision.) The Act targets the procedure used in essentially all abortions taking place after first trimester and before viability. (Viability is the point in pregnancy when, given the current state of medicine, a premature infant has a fifty percent chance of survival. At present, viability occurs around the 23rd week.) The procedure is referred to as “dilation and evacuation” or “D&E”. A D&E is performed by first dilating the patient’s cervix for a period from a few hours to a few days. The physician then removes the fetus, placenta and related material from the uterus through the cervix, and out of the body. Often, the fetus must be removed from the uterus in pieces. Sometimes, though, the fetus can be removed from the cervix intact (called an “intact D&E” by the Court). Because the fetus is not destroyed during the intact D&E process, the physician must ‘kill’ (the word used in the Act), the non-viable fetus. The loaded term “partial-birth abortion” is thus an obvious mischaracterization of this procedure. The nonviable fetus cannot be “born,” either partially (whatever that might mean), or otherwise.

The Act makes it a crime for a physician to knowingly perform an abortion using the following procedure:

1. The physician removes the intact fetus from the woman’s body to a particular point:

In a head-first position, to the point where the entire head is outside the woman’s body;

in a breech (foot-first) position, where any portion of the fetus past the navel is outside the woman’s body; and,

2. The physician then takes an overt act that kills the fetus.

(This is my summary of the Act. The full Act can be found here.)

The Act provides no exception to preserve the health of the woman undergoing the procedure.

The Act won’t stop a single abortion from taking place. Justice Ginsburg noted during oral argument, “[W]e’re not talking about whether any fetus will be preserved by this legislation… It doesn’t preserve any fetus because you just [terminate fetal life] inside the womb instead of outside.” The US attorney defending the Act agreed with Justice Ginsburg. In other words, in order to be compliant with the Act, a physician must terminate the fetus’ life prior to delivery, even in cases where the physician believes it is safer for the mother to do otherwise.

Whether an intact D&E’ is considered medically necessary depends on a number of factors, including the age and health of the woman, especially if the woman has an underlying medical problem; the condition of the fetus; and the sophistication of the medical facilities available. Under the Act, a doctor is no longer allowed to make this decision. With the Act, Congress has overruled the the physician’s medical judgment, as well as her ethical obligation to provide the best possible medical care. Is appears the Hippocratic Oath has joined the Geneva Conventions as “quaint” obligations our government has decided can be ignored.

The trade-off Congress made in the Act and the Supreme Court appears hardly rational: Physicians must choose between following the law, on one hand, or providing the best possible care to preserve the health of the mother. What exactly has Congress achieved in return? Nothing, it seems. Abortions will not be reduced. But the Act will make abortions more dangerous and more difficult to obtain. Some physicians will likely withdraw from the practice of performing intact D&E’s rather than risk criminal charges. The health of some women will be harmed as a result, because they will not be able to obtain the best possible care. And, perhaps most troubling, those seeking to limit reproductive rights have established that their political agenda can override concerns about privacy, personal autonomy, and women’s health.

Tom Joaquin

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Filed under abortion, Advocacy, Info, and Activism, feminism, Gonzales v. Carhart, Health, News and politics, News..., pro-choice, public discourse, reproductive freedom

The Lie at the Heart of Gonzales v. Carhart

(My source for the quotations and information is Justice Kennedy’s majority decision and Justice Ginsburg’s dissent in Gonzales v. Carhart. These documents can be found here.)

Tom Joaquin
The Free Lance

By now, most people are aware of the summary holding in Gonzales v. Carhart: for the first time since Roe v. Wade, the Supreme Court left standing a law proscribing a particular abortion procedure without an exception to safeguard a woman’s health. Standing alone, this is a terrible result, but understanding the rationale of the decision was made is more frightening still.

In upholding the “Partial-Birth Abortion Act” (referred to here as just “the Act”), the Supreme Court’s new majority drew upon old lies about the emotional fragility of women, and the need to protect them from their own decisions. The Court used this old myth to bypass forty years of precedent safeguarding reproductive rights. The Court allowed Congress to place political values over best medical practice, and to put women’s lives at risk. The Court’s willingness to put aside legal precedent and scientific fact in this case may encourage more attacks on constitutional rights in the future.

Understanding Carhart requires some minimal understanding about abortion procedures. The Act targets the procedure used in essentially all abortions taking place after first trimester and before viability. (Viability is the point in pregnancy when, given the current state of medicine, a premature infant has a fifty percent chance of survival. At present, viability occurs around the 23rd week.) The procedure is referred to as “dilation and evacuation” or “D&E”. A D&E is performed by first dilating the patient’s cervix for a period from a few hours to a few days. The physician then removes the fetus, placenta and related material from the uterus through the cervix, and out of the body. Often, the fetus must be removed from the uterus in pieces. Sometimes, though, the fetus can be removed from the cervix intact (called an “intact D&E” by the Court). Because the fetus is not destroyed during the intact D&E process, the physician must ‘kill’ (the Court’s word), the non-viable fetus. The loaded term “partial-birth abortion” is thus an obvious mischaracterization of this procedure. The nonviable fetus cannot be “born,” either partially (whatever that might mean), or otherwise.

The Court notes that many physicians testify that trying to remove the fetus intact is sometimes medically necessary and always preferred medical practice. Removing fetal material in pieces take longer, thus extending the time the patient must stay under anesthesia. Many small pieces of material raise the risk of uterine damage, as well as the possibility of post-surgical complications resulting from failure to remove all of the material.

The line drawn separating intact D&E’s from all others appears to originate with Congress and the Court. In any case, Congress finds the “intact D&E” procedure distasteful. Well, perhaps more than just distasteful. According to the Court, Congress says the intact D&E is a “gruesome and inhumane procedure that is never medically necessary and should be prohibited”.

Congress, however, cannot constitutionally pass a law with the primary goal of prohibiting an abortion procedure. As Justice Ginsberg points out in her excellent dissent, Congress must consider all that troublesome precedent about a woman’s right to choose, and the idea that a woman’s decision to bear a child is central to her “‘dignity and autonomy,’ her ‘personhood,’ ‘destiny,’ and her ‘conception of her place in society’”. According to over forty years of developed precedent, a law cannot constitutionally place “a substantial obstacle in the path of a woman seeking an abortion before the fetus attains viability.”

But there is a loophole: Congress can pass a law that makes it more “difficult and expensive to obtain an abortion,” as long the law’s primary purpose is not specifically to interfere with the right to have an abortion. For the Act to pass constitutional muster, Congress needs a convenient fiction about the Act’s purpose. Fortunately for Congress, the new majority in the Court is happy to oblige.

According to the Court, the Act is intended to protect “mothers,” who are emotionally sensitive and liable to regret their decision to have an abortion. There are no “women” in the Carhart decision. There are only ‘mothers, a group that includes women whose pregnancies were terminated.

The Court begins by adopting nostrums from Congress: “Respect for human life finds an ultimate expression in the bond of love a mother has for her child.” Because of the importance of this “bond of love,” the Court decides that, although there is “no reliable data to measure the phenomenon, it seems unexceptional to conclude some women come to regret their choice to abort the infant life they once created and sustained. Severe depression and loss of self-esteem can follow.”

The Court then supposes, again without any factual support, that “some doctors may prefer not to disclose precise details of the means that will be used” for performing the abortion. The physician’s postulated failure to be frank about the procedure can compound already existing emotional difficulties: “It is self-evident that a mother who comes to regret her choice to abort must struggle with grief more anguished and sorrow more profound when she learns, only after the event, what she once did not know: that she allowed a doctor to pierce the skull and vacuum the fast-developing brain of her unborn child, a child assuming human form.”

This overheated language distracts from real problems with the Court’s argument. First, the story about the emotional damage that can result from having had an abortion just isn’t true. In her dissent, Justice Ginsburg provides a long list of studies from respected sources debunking the “idea that having an abortion is any more dangerous to a woman’s long-term mental health than delivering and parenting a child that she did not intend to have.”

Secondly, if a woman does come to regret her decision to terminate her pregnancy, is it likely she would prefer to learn her abortion was performed by removing the fetus from her uterus in pieces, or that it was removed intact, the safest possible method

Finally, wouldn’t it make more sense simply to require physicians to inform women of the abortion method to be used along with other information currently required by law to be provided the patient?

The Court doesn’t discuss these issues because the truth is less important than upholding the Act and setting the stage for future cases. The old argument about protecting the life of the unborn doesn’t need to be raised anymore to attack abortion. The new argument that abortion should be done away with is based upon the offensive lie: Women are emotionally fragile, and might decide on abortion, even though abortion separates them from participating in the “ultimate expression” of “respect for human life.” They may later come to regret that decision, leading to emotional illness. Learning about how the abortion was carried out will further damage these women emotionally. Therefore the practice must be eradicated.

This argument is sufficient to prohibit one method of performing abortions. Is there any reason why it won’t work to ban others?

 

This is the first of two posts discussing the Carhart case. In the next post, I’ll discuss the mechanics of the Act itself, how it allows Congressional opinion to overrule science, and the danger this poses to the health of women.

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Filed under abortion, activism, Advocacy, Info, and Activism, feminism, Gonzales v. Carhart, Health, inequality, News and politics, News..., pro-choice, public discourse, reproductive freedom

Speak out on General Pace’s disgraceful words!

This post, by Sex in the Public Square contributor Tom Joaquin, was originally published on his blog, The Free Lance.

General Peter Pace, the Chairmen of the Joint Chiefs of Staff, announced on Monday his personal opinion that simply being a gay or lesbian person is immoral, and that the military should therefore continue to refuse gays and lesbians the opportunity to serve in the military. Well, to be more precise, he supports the official military policy, that gays and lesbians can sign up, as long as they’re willing to crawl into the military closet and deny who they are.

The current “don’t ask, don’t tell” policy is immoral because it openly requires dishonesty, and treats gays and lesbians as second class citizens. It is unconstitutional because it punishes by exclusion gays and lesbians, not because of what they’ve done, but because of who they are; this type of “status crime” was years ago determined unconstitutional by the US Supreme Court.

General Pace’s delicate moral niceties are archaic. Barry Goldwater, the bastion of all that’s conservative, and 37 year veteran of the military, announced years ago his support of the right of gays and lesbians to be in the military:

The big thing is to make this country, along with every other country in the world with a few exceptions, quit discriminating against people just because they’re gay. You don’t have to agree with it, but they have a constitutional right to be gay. And that’s what brings me into it…. why the hell shouldn’t they serve? They’re American citizens. As long as they’re not doing things that are harmful to anyone else.

Vice-President Dick Cheney, while Secretary of Defense under the first President Bush, called security concerns about gays and lesbians an “old chestnut” and referred to the idea that “a gay lifestyle is incompatible with military service” as “a policy I inherited.” These comments were made by Cheney just after his assistant secretary of defense, Pete Williams was outed as a gay man.

The world has moved on ahead of the US. There are at least 26 nations that allow gays and lesbians to serve, including Israel, Australia, the United Kingdom, Argentina, Columbia, and every country in the European Union, which requires all members to abolish any bans on open service.

Pace’s comparison with adultery is specious. According to files received by Salon pursuant to a Freedom of Information Act request the military, under General Pace, is currently providing waivers for at least 17% of incoming recruits, accepting recruits with civilian criminal records including domestic abuse, assault, breaking and entering and auto theft. An outstanding article by Helen Benedict, also published in Salon, documents the pervasive threat of rape and sexual harassment women soldiers in Iraq live with daily. Perhaps General Pace should focus his moral concerns on matters of real substance existing within the scope of his responsibility.

The Chairmen of the Joint Chiefs of Staff has let the world know what he thinks Department of Defense policy should be, based upon his morals. He has also provided encouragement and cover for the continued harassment and abuse of men and women by their fellows and those in their chain of command. Sounds pretty damn immoral to me.

Please note: I am personally against the action in Iraq and support plans to withdraw troops now. I am not advocating for the war in Iraq, but for the right to openly serve in the military without regard to sexual orientation. Tom

IMPORTANT: If you agree with me, write your representatives in Congress and the Senate as well as General Pace, and write your local papers. Register your disapproval with General Pace’s remarks and your support for changing military policy to allow gays and lesbians to serve openly in the military. General Pace can be reached at:

Joint Chiefs of Staff, Chairman
9999 Joint Chiefs of Staff, Pentagon
Room 4E873
Washington, DC 20318
Fax: (703) 697-8758

All or any part of this post can be used, with attribution, for any non-commercial purpose to help spread the word.

-Tom Joaquin, The Free Lance

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Q: When is a vibrator more dangerous than a gun?

A: When you’re selling one in Alabama.

According to a federal court decision announced yesterday (Valentine’s Day!), it’s perfectly fine for the state of Alabama to criminalize the sale of sex toys. Just to put this in context — 41 years after the Supreme Court decided it was unconstitutional to restrict the sale of condoms, the Court of Appeals for the 11th Circuit thinks it’s fine for Alabama to jail (up to one year for first violation) or fine (up to $50,000) anyone who gets caught selling as much as a dildo. (PDF of the statue is here.)

I don’t think anyone would argue that there is any harm worth criminalizing in selling sex toys to adults. No one’s being forced to do anything, there’s no economic harm, no harm to children. But the Attorney General of Alabama told the court that the law barring sales preserved “public morality,” and was, therefore, constitutional.

The AG’s “public morality” argument might have held up in 1999, but in 2003, the Supreme Court held, in Lawrence v. Texas, “the fact that the governing majority in a State has traditionally viewed a particular practice as immoral is not a sufficient reason for upholding a law prohibiting the practice.” And that, one would have thought, was that. If public morality alone isn’t a sufficient reason for a law, then a law making it illegal to sell sex toys just has to be unconstitutional, yes? Well, no. The Court of Appeals decided that the Lawrence holding only applied to private behavior. So Alabama couldn’t make it illegal to own or use sex toys. But it can make it illegal to sell them. The court decided that selling sex toys was like prostitution, a commercial, public activity that can be punished under the law.

Let’s get back to my opening question, comparing the sale of guns with the sale of vibrators. Alabama is one of the easiest places in the US to buy a gun. There are no state laws requiring licensing, registration, child safety locks, a mandatory waiting period or a limit on the number of weapons that can be purchased at any one time. Maybe that’s one of the reasons Alabama has the 4th highest homicide rates in the US. So let’s take a look at Alabama’s moral restrictions on commerce. Someone sells ten assault rifles to a 16 year old who just walks into the shop without proof of parental permission? Perfectly alright. Someone sells a rubber duckie vibrator to a 40 year old woman at a sex-toy party in the buyer’s home?

Better close the shades.

Tom Joaquin, Esq

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