A doctor's right to choose

An Israeli study of standard D&E procedures performed late (18 to 22 weeks) in the second trimester of pregnancy found no increased risk of cervical trauma or cervical incompetence in future pregnancies. However, this study did not involve any intact D&X abortions. While the majority of studies show first trimester abortion to be a very safe procedure, the jury is still out on how second trimester abortions of any kind can affect future pregnancies.

"The rule of thumb with cervical dilation is slow and easy, and we are getting better and better at this," says Dr. Eric Schaff, professor of medicine and OB/GYN at the University of Rochester School of Medicine in New York. "But more studies are absolutely needed," he says, referring to the need for comparative studies between intact D&X and standard D&E procedures to examine any differences in cervical trauma that may occur.

Grimes adds that the whole issue of whether to ban intact dilation and extraction abortion is about politics, not public health. And until the procedure is less marginalized, he says, there will be very few subjects for a comprehensive study.

Meanwhile, Dr. Nancy Romer from Dayton, Ohio, another PHACT physician, says that she would be quite pleased to see Roe vs. Wade overturned. A practicing OB/GYN for 15 years, Dr. Romer has written and voiced her dissent on the issue of the intact abortion procedure, and does not perform abortions in her practice. She does believe, however, that the intact D&X as described by Dr. Warren Hern of Colorado is an acceptable procedure for late-term abortions.

Dr. Hern's procedure involves the injection of digoxin into the fetal heart through the uterine wall to kill the fetus inside the uterus. However, because the injection takes place the day before the procedure, it often requires an additional visit to the hospital or clinic by the woman, and may subject her to increased risk of bowel perforation, according to abortion providers. (Because of the additional risk and burden to the woman, this procedure is theoretical for the most part.)

Dr. Romer also rejects the interpretation that Roe vs. Wade, in giving primacy to a woman's mental health, protects the right to late-term abortion when a fetus is found to have no chance of survival once it is born. "Even when carrying a severely malformed fetus, there is no advantage to using partial-birth abortion," Romer wrote in Nexus, a law school journal of opinion. "The medical fact is that a handicapped fetus, even one with anomalies incompatible with life after birth, is not a threat to a woman's life or health."

In an interview, Romer added that there are very real psychological benefits to delaying delivery of fetuses that will not survive, such as time to prepare for the loss.

Maureen Britell, director of the patient project for the National Abortion Federation, calls this opinion ludicrous. When she was about 26 weeks pregnant, Britell says that she was told by her doctor that her baby had no brain. The condition of her fetus, anencephaly, meant that her baby would die moments after birth.

"Prepare?" says Britell. "That would consist of months of people walking up to me and saying things like, 'How nice, you're pregnant. When is the due date?' and me having to respond time and time again, 'Well, that would be one day before the funeral.'"

In its essence, the argument about which surgical procedures should be allowed to end second trimester pregnancies is still one of choice. But it is, above all, about a doctor's right to choose. Without the option to perform a procedure that he or she deems medically safe for the patient, a doctor runs the risk of breaking a basic commitment to provide the best care available to his or her patient. In performing an abortion, the doctor has as a patient not a fetus but a woman, and it is to her that the oath "First, do no harm" applies.

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