Friday, June 04, 2004

Uncommon Logic Masquerading as Common Sense 

Although not in my normal reading cycle, I recently came across a post titled Common Sense Comes to Visit at Feministe, wherein the author praised the common sense exhibited by U.S. District Judge Phyllis Hamilton’s ruling that the Partial-Birth Abortion Ban Act was unconstitutional, prompting me to comment:

For Congress to declare that a late term abortion is "never medically necessary" demonstrates just how far up their collective butts their heads are.

And for the Court to decide that necessity is irrelevant doesn't do the same? The title of this post is ironic, in that it has often been a lack of applying common sense to what is meant by "medically necessary" that requires laws to be so strongly worded. The same "common sense" that should tell one not to use a lawn mower to trim the hedge is the same "common sense" that should inform one that emotional suffering and stress are not sufficient medical cause to justify destroying a full-term baby. Unfortunately, in today's society we have abrogated our responsibility to exercise common sense and judgment in our lives to the legalistic wording of the court. After all, vesting all sense of right and wrong in what can or cannot be justified legally absolves us of having to make the hard decisions for ourselves.

While many others also questioned the evaluation of what constituted common sense, one commenter, Rad Geek, took exception to my use of the phrase "full-term baby" in reference to a procedure (more technically called an intact dilation and extraction (D&X)) most commonly performed between 20 and 24 weeks gestation, by saying:

"’Full-term’ babies are not aborted; they are delivered. (That's what ‘full-term’ means.)"

More accurately, "full-term" refers to anything past about 36 weeks gestation, the point at which one may reasonably expect a normal delivery without complications. That said, however, one could also convincingly use "full-term" to refer to the point at which any child is delivered, because, to bastardize a favorite line by Yossarian, "you don’t any more ‘full-term’ than that". But chief to many people’s objection to that specific procedure, and contrary to Rad Geek's implication, the child is delivered, the exception being that the delivery is briefly paused just long enough to suck the brains out.

Rad Geek followed with:

One of the problems that anti-abortionists seem to have is a complete lack of understanding as to the moral psychology of abortion--that is, why people who seek, or provide, abortions, do what they do and the reasons they have for their actions. (It isn't just a matter of disagreement: you can understand someone's reasons without endorsing them.) One example of this tendency is submandave's curious belief that doctors who make their living providing abortions apparently perform intact D&X not because it is, medically, the best procedure in a given circumstance, but just for the hell of it. Why does submandave believe this? Or if he does not, then why does he believe that abortion providers choose to use intact D&X when they do, and why does he think that Congress, of all people, has a better grip than the doctors and their patients on the appropriate medical decisions to make in that situation?

I will try to leave aside the rapid, off-handed categorization and condescension in this passage, as well as side-stepping that he completely missed my point concerning "common sense" and speak only to the merits (or lack thereof) of his argument.

First, the distinction between understanding and endorsing is totally irrelevant. This implies that the understanding of one’s motives confers some degree of legitimacy or validity. This addresses a bigger question of "right" and "wrong", and while some may feel any degree of absolute morality is passé, I believe most Americans do not. Just as my ability to understand why the Japanese attacked Pearl Harbor does not imply an endorsement, neither does it imply it was a just or moral act. As to why specific doctors choose this specific procedure, I don’t know, and neither is there any clear indication. What I do know is the AMA policy on Late-Term Pregnancy Termination Techniques (H-5.982) advises against intact D&X and states that "there appears to be no identified situation where intact D&X is the only appropriate procedure". I also know that the American College of Obstetricians and Gynecologists (ACOG) issued a statement saying they "could identify no circumstances under which this procedure...would be the only option to save the life or preserve the health of the woman". Although the ACOG did add the caveat that it "may be the best or most appropriate procedure" depending upon circumstances, they failed to provide any example of such a case. The bottom line is that any expression of why this specific procedure is used in any specific case is pure conjecture, as the abortion data collected by the CDC is notoriously incomplete and makes no distinction between dilation and evacuation (D&E) and intact D&X. What is known, based upon sworn testimony by abortion providers, is that the vast majority of intact D&X procedures reported on are performed for elective reasons.

Which brings me back to the real point of my original comment. If I remember, there were attempts to include provisions for the "life of the mother", but strident abortion supporters wanted nothing less that something along the lines of "health of the mother". This euphemism though has long been used as a legal loophole to account for any sort of circumstance the doctor wishes, effectively making the law pointless. In fact, one doctor specifically testified to Congress that depression was the most common "health indication" provided for the more than 2000 procedures he had performed. The lack of applying common sense to what constitutes a "health risk" in previous cases has necessitated the strong language in the existing law with which the original author of the post took exception. With what logic can a person, on the one hand, cite postpartum depression (a very real and sometimes severe condition exacerbated by the rapid chemical changes following delivery) as a leading cause of infanticide and yet, on the other, recognize depression during pregnancy (again, a not uncommon condition during a time of rapid and wild changes in body chemistry) as being a valid basis for elective termination of pregnancy? The entire interest in preserving life on the one case and ignoring it in the other seems to be entirely based upon the presence or absence of respiration. Given premature birth survival rates of up to 83% in the case of some intact D&X subjects, I fail to see how this is not recognized as completely devoid of logical basis and patentedly obscene.

Finally, the standard argument about letting doctors and their patients instead of Congress make their own health care decisions ignores the fact that there are many procedures that doctors can perform that are either illegal or controlled by the courts. May a doctor help in the administration of lethal doses of sedatives? May a doctor perform sterilization on a retarded minor solely in consultation with the parents? May a doctor remove, at a patient’s request, a limb, genitalia or other body parts? Besides, contrary to the impression given by the post author and Rad Geek, Congress did not draft this law in a vacuum, but rather with the guidance of testimony by several doctors and closely matching the policy of the AMA and expressed oppinion of the ACOG.

What we really have is the pro-choice fear of a "slippery slope", a situation not unlike the one that lead to the proposed Marriage Amendment to the Constitution. Doctors falling over themselves to say "I would never do this, but..." and activists trotting out all the familiar slogans, all the while failing to see that it is not really Congress that has rejected the intact D&X, but Americans for the most part. To induce labor, to partially deliver the child, to take a fetus that is, literally, inches from gaining all the protections of the law and full recognition of its rights to "life, liberty and the pursuit of happiness" and to then end its existence blurs the line between medical procedure and infanticide just too much for most of us.

(A great help for information, with many references well documented, was a paper written by M. LeRoy Sprang, MD and Mark G. Neerhof, DO, originally published in the Journal of the American Medical Association, Vol. 280, pp. 744-747, Aug. 26, 1998)

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