Doctors also have right to choose
Women who choose to have abortions can have them.
Doctors who choose not to perform abortions do not have to perform them.
But at what point might the doctor’s right to choose nullify a woman’s right to choose? Put another way, if there are no doctors to perform abortions, what is the value of a law that guarantees a woman’s right to have one?
Melanie, a 42-year-old book designer, e-mailed me the other day. She was 18 weeks pregnant when she was told her fetus had Down syndrome. After several wrenching days of tears and counseling, she and her husband decided to terminate the pregnancy.
But the Kaiser Permanente hospital in Sacramento, Calif., where the couple live, could perform only an induction abortion: Melanie would be induced into labor and have to deliver the fetus. She wanted a surgical abortion called dilation and extraction, which has fewer health risks than induction and is less traumatic for the patient. But Kaiser had no doctor on its hospital staff in Sacramento suitably trained in D&E abortions. Melanie ended up traveling to a Kaiser hospital in San Jose, Calif.
“The decision to have the abortion should be the hard part, not getting access to it,’ Melanie said this week after she returned home from the hospital.
Melanie’s case points to a trend much broader than Kaiser or any HMO: The number of abortion providers has been steadily dwindling around the country.
If a woman in North Dakota wants to end her pregnancy, there is not a single doctor in her state who performs the procedure. There are just three abortion providers in Kentucky and three in West Virginia. There are only two in Mississippi.
Indeed, 85 percent of all U.S. counties have no doctors who perform abortions, according to the National Abortion Federation. Even in California, the number of providers has steadily declined from 600 in 1989 to fewer than 400 today.
Doctors often arrive at their decision whether to perform abortions much the way women arrive at their decision whether to have them. They wrestle with their beliefs about life and responsibility and freedom and conscience. And just as women who would never choose an abortion for themselves can support unequivocally the legality of it, so too do pro-choice doctors choose never to perform one.
Clearly, keeping abortion accessible is not just about keeping it legal. It is also about figuring out how to respect the individual choices of doctors while carrying out the individual choices of women. It is about figuring out how, more than 30 years after Roe v. Wade, to keep reminding doctors of what life was like before that Supreme Court decision.
As abortion providers who lived through that era retire, said UCSF medical Professor Felicia Stewart, young doctors don’t feel as obligated to step into their shoes. Because abortion has always been legal in their lifetime, many new doctors assume that if they don’t perform abortions, somebody else will because somebody else always has. And because they never had to save the life of a woman dying from a butchered back-alley abortion, they don’t see legal abortion as a critically important public health issue.
Thus the terrible irony: The further away we get from pre-Roe v. Wade America, the closer we seem to returning to it.
Joan Ryan is a columnist for the San Francisco Chronicle. Her e-mail is joanryan@sfchronicle.com.