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August 22, 2008

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[Doctor]: "Mr. and Mrs. X, I have some bad news. There's a 99.9% chance that if Mrs. X carries this pregnancy to term, she will die. There is a 0.001% chance of a successful live birth. Back before the McCain Human Life Act, my advice to you would be simple--have an abortion ASAP. Now, unfortuantely, I can only recommend getting Mrs. X's estate in order . . ."

What I don't get is why he ever said anything in the first place about getting exemptions into the platform. I mean, did he really think that pro-life voters would simply fail to notice that change? Or did he think they might notice but wouldn't really care because abortion isn't very important to them?

Does he just go off spouting plans for what he would like to do with no consideration for feasibility at all?

Does he just go off spouting plans for what he would like to do with no consideration for feasibility at all?

ding ding ding!

Heck, I'm pro-choice and the rape/incest exception for abortion creeps me out. If you think abortion is murder, it implies that infanticide is OK too.

Intellectually I lean towards the explanation that the rape/incest exception is here because they're less "pro-life" and more "anti-women-having-sex", and if it "isn't her fault she's pregnant" then abortion should be OK.

Which of these implications is more vile is left as an exercise for the reader, but both are worse than a flat ban with health exceptions.

Maybe we could cast the health exceptions as killing in self-defense?

Does he just go off spouting plans for what he would like to do with no consideration for feasibility at all?

That was back when his road to victory involved sucking up all of the moderates and getting desperation votes from fundies tired of 8 years of Clinton. Pretty feasible, really.
Today, his road to victory is keeping his maverick label while adopting 95% of Bush's platform. So his positions are completely different.

It's all very easy when one has no core political principles.

Ladies and gentlemen, your Republican party: where the political incentives line up in such a way that letting women die rather than get an abortion is the smart way to go.

'Letting women die RATHER than get an abortion' is one thing. But the body-count from secret, illegal abortions would probably be even higher.

The GOP theocrats are not interested in REDUCING abortions, but in OUTLAWING them. There's a big difference.

-- TP

So McCain is taking orders about his VP from Rush Limbaugh and about his position on abortion from Tony Perkins, David Duke's pal.

Is there an ad in there somewhere?

"Maybe we could cast the health exceptions as killing in self-defense?"

I think that is exactly how they should be analyzed. If not having a particular late term abortion of an otherwise viable fetus is going to cause an appreciable increase in the risk to your life, you can have an abortion. Otherwise, no.

McMartin: Intellectually I lean towards the explanation that the rape/incest exception is here because they're less "pro-life" and more "anti-women-having-sex", and if it "isn't her fault she's pregnant" then abortion should be OK.

Exactly. Being pro forced pregnancy doesn't have anything to do with saving fetuses - the "pro-life" movement has nothing to do with universal free health care even for pregnant women, nor with universal free contraception and mandatory sex education for all children. The whole claim that pro-lifers believe "abortion is murder" is as much a lie as their claim they care for fetal lives.

The whole point of the "pro-life" movement is to force women through pregnancy and childbirth against their will. Some forced-pregnancy advocates are willing to let women off the punishment for sex if they were raped: some are only willing to let women off that punishment - forced pregnancy - if the punishment is likely to kill them. Some actually say quite clearly that providing the woman survives to give birth, she has to be forced to do so.

The illegal abortion rate in countries where abortion has been made illegal is ignored or denied: also, forced pregnancy advocates can and do argue that the women who die or are made sterile in illegal abortions, are choosing that risk: they are supposed to suffer all the way through their unwanted pregnancy and childbirth, not choose another way out.

I think that is exactly how they should be analyzed. If not having a particular late term abortion of an otherwise viable fetus is going to cause an appreciable increase in the risk to your life, you can have an abortion. Otherwise, no.

This sounds good on the surface, but the devil is in the details. What precisely is an appreciable risk? How do you determine viability? How do both of those assessments incorporate uncertainty (i.e., do you make pessimistic or optimistic decisions)? The issue here isn't that you've failed to present those details in this one blog comment, but that there doesn't seem to be any way to establish a consensus about how you would decide such things.

Even if we could settle those questions, practically implementing a regime seems hard. Who is the arbiter? Is it just the doctor with no review? Given complaints from the pro-life side about previous abortion restrictions, I doubt such a system would be acceptable. So should we entrust it to the courts? Given our experience with the failure to consistently and fairly apply judicial bypass provisions, that seems...not good. A panel of doctors perhaps? Maybe, but again, there seem to be issues with fairness here. By raising the bar, you help ensure that well-off women have no difficulty getting abortions while poor women have very great difficulty indeed. Such a state of affairs isn't really consistent with the state's interest in protecting life.

Finally, it seems that systems like this should be subject to cost benefit analysis. Third trimester abortions comprise a very small fraction of abortions. Establishing a large regulatory structure to monitor and evaluate such procedures is going to cost cash. The consequences for implementing that system poorly are quite high (pregnant women die because of bureaucratic screw ups), so it will have to be an expensive system in order to be politically feasible. Meanwhile, the tiny number of third trimester abortions in conjunction with the low probability of viability suggests the costs might be higher than the benefits. If you have a government with limited resources, this doesn't seem like a good priority to focus on.

Now, if you assume that government resources for this sort of thing are free, or that the cost of a single "unnecessary" abortion are infinite, or that the costs of one pregnant woman dying when she otherwise wouldn't have to are zero, the conclusion changes.

"It's all very easy when one has no core political principles."

Which is precisely why it is very unlikely that I will vote for McCain. (Please Obama don't put me to the test by selecting Clinton for VP). I don't agree with some of Obama's principles, but I can usually see what they are clearly enough to weigh those I don't like fairly against those I do like and decide that Obama is worth the risk (and since he will almost certainly nominate judges which I will think will be horrible, I'm well aware of what I'm weighing out).

McCain on the other hand has no political principles that I can readily identify beyond the need for his own celebrity and success. And the few that I think I can discern, I don't like. So I can't weigh anything out in his favor.

"Third trimester abortions comprise a very small fraction of abortions. Establishing a large regulatory structure to monitor and evaluate such procedures is going to cost cash. The consequences for implementing that system poorly are quite high (pregnant women die because of bureaucratic screw ups), so it will have to be an expensive system in order to be politically feasible. Meanwhile, the tiny number of third trimester abortions in conjunction with the low probability of viability suggests the costs might be higher than the benefits. If you have a government with limited resources, this doesn't seem like a good priority to focus on."

There are very few cases, so if you set up the system properly there would be very few to review.

I would think that a panel of doctors would do just fine. As there would be very few cases for them to review, the resource usage should not be large.

Death penalty cases make a very small percentage of court cases. Should we fail to carefully review them because the cost is large? Most liberals argue for review, because the stakes are so high.

The stakes are no lower with a viable fetus. And the review is much easier, because the medical facts can be accurately determined at the time, not in retrospect like a court trial. Furthermore the evidence should be almost always available in its entirety, again completely unlike a court trial. Both of these suggest higher costs in the court system than would be found when reviewing late-term abortions.

Seb: "Which is precisely why it is very unlikely that I will vote for McCain."

*hugs* Welcome to the Dark Side!

(*giggles*)

Sebastian: There are very few cases, so if you set up the system properly there would be very few to review.

I would think that a panel of doctors would do just fine.

Yeah: women just can't be trusted to make difficult medical decisions on our own. We've got to have a panel of doctors to "review" our decisions. Otherwise, we might make wrong decisions.

The "pro-life" position is very nakedly anti-woman.

There are very few cases, so if you set up the system properly there would be very few to review.

We can't even setup a reasonable system for judicial bypass, so I'm not sure why we should be optimistic about this system. Judicial bypass cases are also supposed to be rare.

I would think that a panel of doctors would do just fine.

Interesting. Was I mistaken then in recalling that pre Roe-v-Wade, pro life groups strenuously objected to groups of doctors making these decisions? My memory is fuzzy on this point...

As there would be very few cases for them to review, the resource usage should not be large.

It seems large to me. Either you grant all sorts of exceptions for cases of medical emergencies, or you end up requiring that in major population centers, you always have the requisite number of specialist doctors on call. I mean, most doctors are not going to be equipped to make very fine grained decisions about maternal and fetal survivability, so you're already starting from a very small pool with which to staff these panels. Plus most doctors won't want to staff the panels: in order for this to be more than a rubber stamp, someone is going to have to review their decisions, right? If the state doesn't have anyone review the paperwork, then what's to stop them from colluding on certifying abortions as medically necessary? And if someone is reviewing the results, the risks of getting legally hammered go up. Most doctors don't need more of that sort of risk. Their risk in non-politically charged areas seems high enough (to them at least) as is.

Keeping a bunch of highly specialized doctors on call 24-7-365 at major population centers is really difficult. More to the point, it is extremely expensive. What happens when you don't have enough doctors to make a determination in time and the pregnant woman dies? Who is at fault then?

Death penalty cases make a very small percentage of court cases. Should we fail to carefully review them because the cost is large? Most liberals argue for review, because the stakes are so high.

I don't know what most liberals would do. I'd argue for abolition given our society's inability to make the death penalty process anything but a joke. I suspect that a cost benefit analysis will show that executions do not make sense in comparison to life imprisonment, but I don't really know.

The stakes are no lower with a viable fetus. And the review is much easier, because the medical facts can be accurately determined at the time, not in retrospect like a court trial.

Huh? Medical facts can be accurately determined? In my experience, all sorts of medical facts really cannot be determined authoritatively. That's why so much of modern medicine boils down to "well, we've eliminated possibilities A, B, C, and D, but not E, F, and G, so let's start a treatment regimen that should address E and G and then see what happens".

Even when the facts are easily determinable (test A says B) they often have large error bars surrounding them. And this all assumes that you come up with a politically feasible way of deciding how to incorporate uncertainty and on what the thresholds are. I honestly don't know what a significant probability of death is in this context. Is it 1%? 5%? 25%? Do you have a principled basis for selecting that threshold?

In addition, doctors aren't particularly numerate: a large fraction of Harvard Medical School graduates can't correctly answer questions that rely on understanding Bayesian probability, so I don't see how we can expect them to make complex statistical assessments like this.

Furthermore the evidence should be almost always available in its entirety, again completely unlike a court trial. Both of these suggest higher costs in the court system than would be found when reviewing late-term abortions.

The two adjudication regimes are so different that I don't really think we can make a fair comparison.

I'm pro-choice and I understand why the rape/incest condition is in there: what woman is going to want to bring to term the physical reminder of a such a horrific act?

Health of the mother is obvious.

In other news, McCain is a joke.

lovely - party of ideas

The difference between death penalty cases and a late-term abortion is fairly obvious: there is no reason why an execution needs to be performed by a given time, so the death penalty review board can take as long as necessary to look at all the evidence.

Whereas, fairly obviously, medical decisions to be made about late-term abortion are made with an extreme time crunch - these are medical emergencies. That pro-lifers just naturally consider that a pregnant woman's medical emergencies can and should wait to be treated until a panel of doctors has decided that her health is sufficiently at risk to justify allowing her to include abortion as one of the options she may choose... well, it is an intrinsically anti-woman position. If the pregnant woman dies, the fetus dies too, but pro-lifers are not about saving fetuses: they're about forcing women.

Once upon a time, I thought requiring a second opinion prior to late-term abortions was fair. Thanks to Turb and Jes, I have serious doubts about the ability of a State to develop a workable system. In addition to Turb's comments made above, I would note that frequently time is of the essence. Urban areas are bad enough, what about rural? Is South Dakota really going to fund adequately a squad of qualified neutral ob-gyns to fly around the state on short notice?

Also, I have yet to see a federal law criminalizing travel outside the US for the purpose of obtaining an abortion ever discussed. The pro-life movement appears willing to federalize many aspects of the provision of abortions. Why not this one? Regulation of international travel is uniquely the province of the federal government, so there's no possible claim of lack of jurisdiction. Ever since the GWoT, the US Govt has criminalized all sorts of extra-territorial activities, why not this one?

Could it possibly be that the GOP recognizes that wealthy women (aka part of the "base") will insist that they can travel to Montreal, even if the poor cannot?

@ Sebastian:

"...and decide that Obama is worth the risk (and since he will almost certainly nominate judges which I will think will be horrible, I'm well aware of what I'm weighing out)."

Maybe OT in an "abortion" thread, but could you elaborate a bit on this? Are you referring to the almost-certain SCOTUS pick a President Obama will get? Or Federal Judges in general?

And, after eight years of the Bush Administration's ultra-partisan and ideologically-driven nominations to each and every bench position they could fill, exactly how "horrible" a selection do think President O. would (or could) make?

Jay C: exactly how "horrible" a selection do think President O. would (or could) make?

Judges who won't overturn Roe vs Wade.

Judges who may, on the other hand, have to decide another Loving vs. Virginia case.

No forced pregnancy: yes legal marriage for same-sex couples.

Horrible enough, if you're a Republican: gay marriage being the worse of the two.

The problem with the "life of the mother" exception is that an abortion is never medically necessary to save the life of the mother. And before sometimes brings up a ectopic pregnancy, the surgery required to address that situation is not an abortion. The purpose of the surgery is not to kill an unborn child, but to save the life of the mother. To be sure, the child will die as a result of this life-saving measure being performed, but it's not an abortion.

For more on this topic, see here:

http://www.catholic.com/thisrock/2006/0609uan.asp

Whoops! Substitute "someone" for "sometimes." Never blog and watch a two year old at the same time. :)

Feddie: so you're saying that the only reason there are no medically necessary abortions is that, by your definition, terminating a pregnancy to save the mother's life is not an abortion. Nice tautology.

You are also simply incorrect in believing that the only life-threatening pregnancies are ectopic pregnancies. From the Journal of the American Medical Association:

"Illnesses of women and fetal anomalies lead to requests for late abortions. Late abortion can be lifesaving for women with medical disorders aggravated by pregnancy. Conditions such as Eisenmenger syndrome carry a high risk of maternal morbidity and mortality in pregnancy, the latter ranging from 20% to 30%.18 In recent years, I have performed late abortions for a Kampuchean refugee with craniopagus conjoined twins and a 25-year-old woman with a 9 x 15-cm thoracic aortic aneurysm from newly diagnosed Marfan syndrome. Cancer sometimes makes late abortion necessary. For example, either radical hysterectomy or radiation therapy for cervical cancer before fetal viability involves abortion." link. (article behind subscription wall).

Also, I haven't been able to get to the actual paper, but see "Late-second-trimester pregnancy termination with dilation and evacuation in critically ill women" in the Journal of Reproductive Medicine. From the abstract:

"A review of 13 cases of second trimester termination at 20-24 weeks by dilation and evacuation after insertion of laminaria in women with critical illness is presented. The patients ranged in age from 17-41, parity from 0-5, and diagnoses covered a wide range, including hematologic, respiratory, vascular, gastrointestinal, cardiac systems, malignancies, autoimmune disorders and infections, as well as several with multiple problems, including intravenous drug use. Most were the result of late diagnosis or late presentation."

Subscription walls and the stupidity of pubmed (the terribly organized database of biology journals) are keeping me from finding more sources right now, but I'll post more if I can track them down.

To add to Anna L's info, one point that is consistently left out of statements like Feddie's (and most lists of "permissable reasons to have abortions, maybe, if you beg hard") is, "the life of the other twin."

Intact dilation & extraction (mis-named "partial birth abortion"), for instance, is generally the best way to get a dead or dying twin out of the uterus while leaving the other twin safely in the warm for a few more months. Without such procedures, the death of one twin late in pregnancy would normally mean the death of both.

The holy grail of the anti-abortion right, the human life amendment to the US constitution, could potentially bind the states, the federal courts, and even, in theory, all American citizens in or out of the United States. Two thirds of the members of each house of Congress would have to vote for such an amendment, and three quarters of the state legislatures would have to ratify it. In other words, if the legislatures of thirteen states refused to ratify a no-exceptions human life amendment, no such amendment would pass. The thirteen states I consider least likely to pass such an amendment include: California, Oregon, Washington, Minnesota, Wisconsin, Michigan, New York, Maine, Vermont, Massachusetts, New Jersey, Delaware, and West Virginia. It would surprise me if you could get such an amendment through the legislature of any but a very few states.

I do not think the human life amendment has any realistic chance of passing. I cannot say why the Republicans keep it in the platform. A proposed amendment with no chance of passing does nothing, and can do nothing, to reduce the number of abortions. I think it does express hostility against women. The advocates of a "human life amendment" can do nothing to curb the reproductive choices open to women or to reduce the number of fetuses lost to abortion; however, they can make it clear just what value they place on the life, health, happiness and freedom of a pregnant woman.

I actually consider the immoral position of the GOP politicians to be a 'make-pretend' position. They've held the White House for 25 of the 37 years since Roe v. Wade and have packed the federal courts with Republican judges at every level. And relatively speaking, they've yet to make serious dents in the right of women to choose.

Instead, they play their fundie base for fools by promising change that never gets delivered.

In doing so, however, it permits the entire party to claim a self-righteous moral superiority over the majority of Democrats, which proves a very convenient cover as it distracts from the real core principles they actually stand for: selfishness, bullying and murderousness.

Seriously, laid bare, that's precisely the savagery they practice. By claiming to be pro-life, it's rare anyone gets past that issue to examine the rotted core of what they constantly accomplish.

Turbulence: What I don't get is why he ever said anything in the first place about getting exemptions into the platform.

McCain has two daughters. Even Republicans love their children, you know.

Feddie knows the contortionist theology of his church well. Since abortion is not allowed under any circumstances, any allowed operation can't be an abortion. Btw, this is a relatively new trend. There were explicit theological decisions in the past that even in case of ectopic or tubular pregenacy any surgery that risks the death of the unborn was taboo. Then came the compromise that the tube including the "stuck" egg could be removed (but not the egg itself while leaving the tube in place). Since about 1980 (iirc) it is the doctor's decision in case of the mother's life being threatened (but still the baptism of the not yet dead unborn even if both lifes are lost is the "moral default" priority). St.Shyster be praised!

They may not be able to deliver everything, but they're sure aiming at something (warning: cussin'.)

I have found that all too often, the pro-life and pro-choice sides don't try to find a sort of middle ground in which abortion should be a very last resort action, accompanied by efforts to reduce the need for abortions. That is the position Barack Obama takes, and I agree with it.

The thought of late-term abortions makes me queasy. If the fetus is viable by that time, and the mother's life is at stake,
wouldn't an emergency caesarean address both problems?

The Republicans paint themselves into corner by calling themselves pro-life when it comes to prohibiting abortions, when some of their other actions are not life-affirming--such as a propensity for waging wars.

ANNE:

Of course late-term abortions make you queasy. Medical procedures often do. The reason they probably don't make me as queasy as they do you is that I've read 19th-century obstetric manuals and seen their medical instruments, and you have no idea how queasy you can get.

If the fetus is viable by that time, and the mother's life is at stake,
wouldn't an emergency caesarean address both problems?

Not usually, because:

1) often the fetus is not viable -- it may have no brain, for instance.

2) even when it is, "viable" means "50% chance of dying, 50% chance of living with major medical problems." You aren't generally going to get a healthy baby out.

3) a Caesarian is itself life-threatening. If the woman's life is at stake, one reason may be that a Caesarian will likely kill her. Caesarians are *major* surgery, with all the risks that entails -- blood loss, general anaesthesia, cutting muscles apart.

4) what about the cases with twins?

No-one is having late-term abortions because they *like* killing babies. They're doing it because it's a way of maximizing the number of healthy people you'll have by the end.

I have found that all too often, the pro-life and pro-choice sides don't try to find a sort of middle ground in which abortion should be a very last resort action, accompanied by efforts to reduce the need for abortions.

1. Can you name some pro-choice groups that do not support efforts to reduce the need for abortions (specifically, greater sex-ed, increased access to contraception, or increased availability to plan-B)? I don't think there are any, but I'd like to be proven wrong. For that matter, which pro-life groups do you know of that support these ideas?

2. Why should we assume that a middle ground is correct policy? If it is the correct policy, shouldn't you be able to argue for it on the merits rather than arguing for it solely because it is the middle ground?

The thought of late-term abortions makes me queasy.

I don't think one's subjective sense of disgust is a good basis for designing public policy. There are lots of things that make me queasy, like earrings for example. But I'm going to go lobby for laws empowering police to shoot people on sight for the crime of having ear piercings. If your queasyness can be justified with policy analysis, I would rather discuss that rather than assume we have to legislate or dictate medical outcomes based on nothing but your personal queasyness.

ANNE: I have found that all too often, the pro-life and pro-choice sides don't try to find a sort of middle ground in which abortion should be a very last resort action, accompanied by efforts to reduce the need for abortions.

Well, yeah. That's because (a) the pro-life side is not in the least bit interested in reducing the need for abortions, and (b) it is really impossible to compromise away from the pro-choice side without compromising away the most basic moral values.

Most recently that I recall in the UK, Cardinal O'Connor demonstrated how little he cares for reducing the abortion rate in the UK by firing the ethics board of a Catholic hospital in London - because the ethics board had permitted a family planning clinic to operate inside that hospital.

But there is the new example of the Republican pro-lifers who support pharmacists and doctors having the right to refuse to prevent abortions by providing contraception - wanting this right protected by legislation. They want more abortions - not any effort to reduce the need for them. They just don't want the stepped-up need for abortions that they are encouraging to be met by safe legal abortions.

So, when we see pro-life organizations eagerly championing the cause of free contraception freely available to all, and pro-lifers being the very first to condemn stupid pharmacists who think they ought to do their utmost to stop women getting access to contraception - then we can believe people who identify as pro-life actually give half a damn about preventing abortions.

Not seen any sign of it so far. Ever.

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