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‘Partial Birth’ Abortion Ban

November 5, 2003 at 12:00 AM EDT
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GWEN IFILL: President Bush handed abortion opponents a victory today, when he signed a bill that would place the first limits on abortion since Roe V. Wade made it legal in 1973. The antiabortion activists call the now-banned procedure “partial-birth abortion”; in the president’s words, “a terrible form of violence directed at children inches from birth.”

But abortion rights activists describe the procedure, technically known as dilation and extraction, as a rare and medically necessary operation that should be an option for women and doctors. Within an hour of today’s bill signing, a federal judge in Nebraska blocked implementation of the law in that state. Other courts — and ultimately the Supreme Court — are expected to weigh in as well.

Now, with us to discuss the impact of the new abortion law are two physicians. Dr. Curtis Cook is an assistant clinical professor at Michigan State University College of Human Medicine. And Dr. Paula Hillard is a professor of obstetrics and gynecology at the University of Cincinnati College of Medicine.

Dr. Cook, as a practicing physician, what is the practical impact for you on the law that was signed today?

DR. CURTIS COOK: I think for people that practice my type of medicine, maternal fetal medicine, just taking care of complicated pregnancies, we’ve never felt the need to utilize this particular procedure for any of the patients we take care of, even the most complicated cases.

So it won’t impact my practice. There are, however, what I would consider to be rogue physicians out there performing this procedure that will no longer be able to do what we think is a heinous act against children that are just literally inches from delivery.

GWEN IFILL: Dr. Hillard, what is the practical effect as far as you can tell?

DR. PAULA HILLARD: What I would say, first of all, is that this bill is incredibly deceptive. I think American women will be absolutely outraged when they realize what this bill really says and what it will do. And what it will do is to place the government between a woman and her physician.

The law will limit the physician’s judgment in an individual situation, a situation in which they might judge this particular procedure or any other abortion procedure potentially to be appropriate for that individual woman. I think that’s a chilling effect on the practice of medicine and I think the effect is and should be viewed as chilling to American women.

GWEN IFILL: Dr. Hillard, have you ever performed one of these procedures?

DR. PAULA HILLARD: I have not.

GWEN IFILL: Dr. Cook.

DR. CURTIS COOK: No, I’ve never seen a need to perform such a procedure.

GWEN IFILL: So Dr. Hillard argues that, in fact, what the government has done is insert itself between a doctor, a woman and her own decision. You’re saying that it should never come to that decision?

DR. CURTIS COOK: Well, government is involved in medical decision-making in many ways. In FDA matters, in female genital mutilation matters — there’s several matters they’ve been involved in. And I think there are sometimes when government is compelled to draw a very bright line when you talk about defending somebody against as heinous a crime as partial birth abortion.

So I think if the medical community is not willing to police itself on a matter like this, there is a role for government. And again I think it really just impacts a very small number of what I would consider to be rogue physicians that are really operating outside the mainstream of good medical care.

GWEN IFILL: If it only affects a small number of rogue physicians, as you describe, does it affect that many people, that many patients, that many babies?

DR. CURTIS COOK: Well, even the Alan Guttmacher Institute has estimated that it runs in excess of 2,000 cases a year. And I’m sure that’s underreported. It probably more represents five to ten thousand babies a year. So I suppose it depends upon what you define as many. It’s a small percentage of total abortions but it’s several thousand children a year that will be affected.

GWEN IFILL: Actually those numbers are that 90 percent of abortions occur during the first trimester of pregnancy. Only 1 percent, or depending on how you — maybe not only — 1 percent occur after the 20th week of pregnancy which is the kind of procedure we’re talking about here. There’s a lot debate about those numbers, obviously.

DR. CURTIS COOK: Well, actually the numbers are very consistent. Everyone agrees there’s something on the order of 1.3, 1.4 million abortions a year in this country; 1 percent obviously makes up a very small number percentage-wise but you’re talking about several thousand cases. So I think several thousand cases is something that the average American would be concerned about.

GWEN IFILL: Dr. Hillard, when in your opinion is this procedure necessary?

DR. PAULA HILLARD: First of all, what I would say is in terms of this law being deceptive, it was referred to earlier on the program as a late-term abortion law. In fact, this law has absolutely no provision whatsoever relating to gestational age.

The law is vague enough that it could conceivably be construed as applying to a much more commonly performed procedure called a dilation and evacuation, a D&E, which is performed between twelve and twenty weeks of gestation. So this law is not specific to a single type of procedure. In fact, the term — the so-called partial birth abortion procedure is not recognized as a medical procedure per se.

GWEN IFILL: When the procedure we agree occurs sometimes, whether it’s 1 percent of the time or more, when is that necessary is what I’m trying to get at?

DR. PAULA HILLARD: That clearly depends on the individual situation. And individual situations in medicine vary widely. I cannot predict what that situation might be. One could talk about situations in which it has been. But the issue is that individual women are unique.

And the best person to make a decision about what is most appropriate for that woman in her situation for her health is her physician. An in fact, this law contains absolutely no provision that would be an exception for the woman’s health. So that is another major problem with this law.

GWEN IFILL: Dr. Cook, she is correct, this law doesn’t say that there are exceptions made for a woman’s health — for a woman’s life, but not her health. Is that something — why wouldn’t that be acceptable?

DR. CURTIS COOK: Well, there is a very specific reason. There’s no demonstration anywhere in any medical literature or any expert’s testimony that this procedure in any way enhances or protects a woman’s health versus any other procedure.

And in fact there is evidence that it potentially endangers a woman’s health not only during that pregnancy but potentially future fertility with the massive over dilatation of the cervix that’s involved in this procedure.

GWEN IFILL: What is the evidence of that?

DR. CURTIS COOK: The evidence being that they are putting up to 30-plus dilators at a time into a woman’s cervix, a massive mechanical over dilatation of the cervix. We know that people that have mid trimester abortions that are done with less dilation are at increased risk for cervical incompetence with later pregnancies. So even greater dilation would put them at greater risk.

I do have to take exception that actually — none less — nobody less than the National Institutes of Health and the National Library of Medicine both list online in their dictionaries the term partial birth abortion and define it as it’s been defined by the government in this legislation. They do not however include the terms intact D&E, D&X or intact D&X, so as far as the medical terminology goes, partial birth abortion is the only recognized medical term.

GWEN IFILL: Dr. Hillard, you seem to suggest there is something greater at stake here than just this procedure. What would that be?

DR. PAULA HILLARD: As I’ve indicated, the bill is vague enough that it could potentially be construed as applying to other types of abortion procedure. So that is the concern that it would apply to D&E procedures done typically between twelve and twenty weeks gestation. I think this is a time in gestation when women would be getting the results of amniocentesis and other testing such as ultra sound and other testing such as ultrasound.

Those test results might show that there are very significant fetal anomalies. At that point a woman who is given this information needs the right to choose what decision she will make for her pregnancy. Women take this decision very seriously. It is not a decision that is taken lightly. There are many women who have desired and intended pregnancies who are faced with situations that they could not have imagined previously, and that’s the medical reality. That’s a problem.

GWEN IFILL: Do you think, Dr. Hillard, that if this law is allowed to stand it will be the first brick in the wall or brick out of the wall in Roe V. Wade?

DR. PAULA HILLARD: I think that that’s very clearly the intent of those who bring this law to us.

GWEN IFILL: Dr. Cook, is that the intent?

DR. CURTIS COOK: No, not at all. Dr. Hillard is correct there’s no specific language or gestational age. This is trying merely to prohibit a certain type of heinous procedure from being performed. And that’s all it’s intended to do. I do think we need to correct the misinformation that’s put out there oftentimes.

This is done not on just emergency basis, not just abnormal babies or sick mothers. These are done predominantly on healthy babies and healthy mothers. Every medical expert that has testified has said the same thing. Even pro abortion advocates including the national director of abortion providers has admitted that. These are done predominantly on healthy mothers and healthy babies.

GWEN IFILL: If the law is overturned by the Supreme Court, if the court is consistent and acts the way it did in the Nebraska case last year, what will have been the purpose of getting this passed and signed?

DR. CURTIS COOK: Well, the law differs significantly from the Nebraska law in two areas. First of all it differs specifically in the way that it defines the procedure narrowly, which is different than the previous decision that went forward in the Sternberg decision. Also it comes forward with increasing support for medical information showing that there is no protection of a woman’s health and may put her health at risk.

GWEN IFILL: I have to get back to Dr. Hillard and ask you to respond what happens if the Supreme Court overturns this.

DR. PAULA HILLARD: I think that there will be other attempts to limit abortion in the future. I think that the huge problem in the law is the lack of an exception for the woman’s health and once again I would bring us back to the issue of the government getting between the relationship between an individual woman and her physician who is making a judgment based on his or her experience and expertise as to what is the best medical recommendation for an individual woman given her own medical and other circumstances.

GWEN IFILL: Dr. Hilliard and Dr. Cook, thank you both very much.

DR. CURTIS COOK: Thank you.