Technology and Life's DominionSYDNEY SMITH
In the thirty years since "Roe v. Wade", science and technology have continued their forward march. Ultrasound has advanced from the grainy black and white shadows of yesteryear to movies in living color. Little wonder that obstetricians are increasingly reluctant to perform abortions. Who, after all, could consider a fetus as life unworthy of living, once they've held its hand?
thirty years since Roe v. Wade has seen a remarkable explosion of medical
technology — technology that has made abortion easier and safer, that has
allowed it to move from hospital procedure to outpatient procedure, and that has
brought the mortality
rate down from 4.1 pr 100,000 to 0.6 per 100,000. Yet, despite the improvements,
the number of physicians who are willing to perform abortions is at the lowest
it has ever been in thirty years.
According to a recent study
by the Alan Guttmacher Institute, only 1,819 physicians in this country, most
of them gynecologists, were performing abortions in 2000. Gynecologists numbered
39,363 in 1999. That
means that just 5% of them are performing the procedure.
That is, indeed,
a surprising finding. Abortions have the potential to be cash cows for doctors.
The average cost for an early surgical abortion is $372; for mifepristone, the
abortion pill, it's $490. And the vast majority of women pay out of pocket for
both procedures, meaning no administrative hassles, and better profit margins
for the doctors. You would think that aortion would have taken off among gynecologists
the way Botox has taken off among plastic surgeons.
But it hasn't. And
it isn't because they don't know how to do it. The procedure is one that every
gynecologist learns to do in the course of their training. It's the same technique
they use to treat an incomplete miscarriage or to sample the lining of the uterus
in cases of abnormal bleeding. And it isn't because they've been intimidated by
anti-abortion violence. The same Guttmacher Institute study
found that serious harassment such as vandalism, bomb threats, and personal harassment
are non-existent for private offices, and declining sharply for the large clinics.
So why are doctors forgoing this safe, legal, profitable venture? Because
the same technology that has made abortion safer, easier, and quicker, has also
dramatically changed the reltionship between the physician and the fetus.
In the early 1970's, when the Supreme Court considered Roe
v. Wade, the womb was very much a black box. No one knew for certain what
was going on in there. Obstetrical ultrasounds were crude research tools rather
than a routine part of prenatal care. The earliest a premature baby could be expected
to survive in the outside world was 24 weeks. Obstetricians tended to view pregnancy,
especially early pregnancy, as a disease state, and their only patient the mother.
Confronted with such a state of affairs, the justices fell back on an
assessment of the history of medical ethics (which they deemed "rigid"), 18th
century English common law (which they argued didn't really consider abortion
a crime), and the state of gynecological technology in 1973. They reasoned that r
the subsequent 19th century American laws prohibiting abortion were really intended
to protect the mother from the dangerous abortion procedure, not the fetus. Since
technology had improved abortion techniques so that they were now safer than childbirth,
there was no justification for prohibiting it in early pregnancy.
the justices forgot to consider a few things. They forgot that our understanding
of the world and how it works is constantly changing. They forgot that although
we now take it for granted that newborns are human, it wasn't until the 15th century
that we granted them souls. They forgot that although premature babies are now
considered human, 18th century English common law classified them as "monsters"
with no right to an inheritance. And they forgot to consider modern obstetrical
technology with all of its promise of changes to come.
In fact, the early
1970's proved to be something of a watershed for the developmnt of new technology
in the field. It was in the early 1970's that researchers unequivocally confirmed
the fetal heart beat at 7 weeks gestation and that obstetrical ultrasound machines
first became commercially available. It was in the early 1970's that the first
was performed, looking for birth defects in fetuses as young as 15 weeks. And
it was in the early 1970's that perinatology, the branch of medicine devoted to
the care of the fetus and the newborn, became a certified specialty.
the thirty years since, science and technology have continued their forward march.
Ultrasound has advanced from the grainy black and white shadows of yesteryear
to movies in living
color. Fetoscopy has evolved from a diagnostic tool to a fetal
surgical instrument for correcting congenital abnormalities, in some cases
as early as 14 weeks into pregnancy. In 1973, 90% of babies born at 28 weeks died,
now more than 90% live. Little wonder that obstetricians no longer treat pregnancy
as a disease, and now focus their attention on the well-being of both the fetus
and its mother.
And it's this change in focus more than anything else
that explains the reluctance of physicians to perform abortions. Who, after all,
could consider a fetus as life unworthy of living, once they've held
Sydney Smith. "Technology
and Life's Dominion." TCS (January 30, 2003).
This article reprinted
with permission from Tech Central Station.
Sydney Smith is a family physician who has been in private
practice since 1991. She is board certified by the American Board of Family Practice,
and is a Fellow of the American Academy of Family Practice. She is the publisher
© 2003 Tech Central