Wednesday, December 3, 2008

For the "Health" of the Mother

Remember John McCain's use of air quotes in the presidential debates when he talked about abortions to preserve women's "health"? Remember how the Bush Administration is trying to push through a "conscience clause" for providers of reproductive health services that's so capacious, it would likely redefine birth control pills as abortifacients? Remember how women used to routinely die in this country during childbirth? (Okay, so you need a longer memory for that last point. A century ago, the lifetime risk of death in childbed was about 1 in 20. 'Course, that only applied to women, which might explain why McCain sees "health" as a non-issue.)

Well, as Tracy Clark-Flory reports at Broadsheet, the Bushies are making one last push during these lame duck days to put that new rule in place. The only good thing about this? The ensuing discussion is shedding light on the barriers women already face in getting decent, equitable, timely reproductive health care. From the L.A. Times:
In calling for limits on “conscientious refusals,” ACOG [American College of Obstetricians and Gynecologists] cited four recent examples. In Texas, a pharmacist rejected a rape victim's prescription for emergency contraception. In Virginia, a 42-year-old mother of two became pregnant after being refused emergency contraception. In California, a physician refused to perform artificial insemination for a lesbian couple. (In August, the California Supreme Court ruled that this refusal amounted to illegal discrimination based on sexual orientation.) And in Nebraska, a 19-year-old with a life-threatening embolism was refused an early abortion at a religiously affiliated hospital. [My emphasis.]
That last case was new to me, so I hunted it down - first via the ACOG report and then the ACLU analysis that ACOG footnoted (both are pdf files). The ACLU report had the details. Here's the story:
In the spring of 1994, a nineteen-year-old woman in Nebraska, Sophie Smith [not her real name], was admitted to the emergency room of a religiously affiliated hospital with a blood clot in her lung. Tests revealed that Smith was approximately ten weeks pregnant, and the clotting problem resulted from a rare and life-threatening condition exacerbated by the pregnancy. The hospital immediately put her on intravenous blood-thinners to eliminate the existing blood clot and to help prevent the formation of more clots that could kill Smith instantly if they lodged in her lungs, heart, or brain.

Smith’s doctors told her that she had two alternatives. She could stay in the hospital on intravenous blood-thinners for the remaining six-and-a-half months of the pregnancy. She would also need a procedure in which a doctor would insert into one of her primary veins an umbrella-like device designed to catch blood clots before they reached a vital organ. Or she could have a first-trimester abortion, switch to oral blood-thinners, and be released from the hospital.

Smith decided to have an abortion. She wanted to go home to her two-year-old child. Because she was poor, Medicaid was covering her medical expenses but would pay for an abortion only upon proof that it was necessary to save her life. Four doctors at the hospital certified that Smith needed a lifesaving abortion, and Medicaid agreed to cover it.

On the morning Smith was scheduled to have surgery, however, the hospital’s lawyer appeared in the operating room. He announced that the hospital would not permit an abortion – lifesaving or otherwise – to take place on its premises. The procedure was canceled, and Smith was wheeled back to her room.

Ten days of dangerous delay followed. Smith wanted to be transferred to a facility that would perform the abortion, but moving her increased the risk that she would throw a life-threatening blood clot. Moreover, because the blood-thinners she was taking made her prone to excessive bleeding during surgery, Smith’s doctors felt that it was in her best interest to be treated in a hospital. The hospital, however, stood by its decision not to let the abortion take place in its facilities. Notwithstanding the risks, Smith was ultimately transferred by ambulance to her doctor’s office. He performed the abortion and sent Smith back to the hospital, which provided follow-up care.
Even in a culture where a presidential candidate feels free to mock women's health, this story is shocking. It wasn't just Sophie Smith's health that hung in the balance; it was her very life.

I know someone who died in her twenties from a pulmonary embolism. One of my grandfathers died - long before I was ever born - from an embolism. If even Medicaid judged the situation to be life-threatening, you'd better believe it was. An embolism is an immediate life-or-death emergency, not some remote risk.

And yet this hospital saw fit to risk the Smith's life. Of course, if she had died, she wouldn't have been much use to her potential child, either - not to mention her actual one! But I guess that didn't occur to these morally pure hospital administrators. She did survive, but due to luck, and no thanks to the "care" she received.

Historically, of course, the woman's life was always chosen first - not because women had higher standing in the past (they didn't) but because they typically had family members who depended on their care. Even the Roman Catholic Church was on board with this policy until about 1900. After that, it began to revalue the "innocent" life of the fetus as worthier than that of the presumably sinful mother.

In Smith's case, you have to wonder if any particular "sins" exacerbated her situation. She was young. She was obviously poor enough to qualify for Medicaid. She may have been married, though given her youth, odds are that she wasn't. I'm guessing that an educated, middle-class married woman in her thirties might have had better luck. But then again, maybe not.

And remember: Smith's ordeal happened in the mid-nineties. The climate for reproductive choice has only deteriorated since then, with the emergence of new tactics such as pharmacists' concerted refusals to fill birth control prescriptions. Anyone want to imagine what new scenarios might emerge if Bush manages to ram through this new rule?

As Clark-Flory notes, Hillary Clinton and Patty Murray have vowed to fight the rule. An Obama administration won't let it stand. But repeal will take time and political capital, and it leaves women's health advocates fighting a stupid, unnecessary rear-guard battle.

Update 12/4/08: I corrected the text to keep the blame focused on the hospital administrators, where it belonged, not on the doctors. Thanks for pointing out the slippage, moioci.


J.B. Kochanie said...

On the morning Smith was scheduled to have surgery, however, the hospital’s lawyer appeared in the operating room.

Add the figure of the Grim Reaper to those in the operating room and you could have a painting entitled: Allegory of Law Dictating the Terms of Life.

Thanks for posting this Sungold. as for redefining "birth control pills as abortifacients" -- that problem has been around for a while and has allowed certain pharmacies to deny distributing birth control pills and morning after pills as a matter of conscience. Giving such practices the force of law would be disastrous.

moioci said...

Re "But I guess that didn't occur to these morally pure doctors."

Read the text again. The doctors collectively recommended, approved, and ultimately performed the abortion. The lawyer representing hospital administration stopped it, probably because the hospital was run by a religious order. So "morally pure nuns" is more likely the right target.

John Pine said...

Much as I support Obama (although I hope he won't hold the British handling of the Mau Mau and his grandfather's part in it too much against us) I find your innuendo against McCain unfair and disingenuous in the extreme. Are you really saying that because McCain is not a woman he doesn't care about women's health or the fact that women (a century ago) died in childbirth?

As for the conscience law, it shows how inadequate laws are when things get really complicated. Gurdjieff said that you can tell how decadent a society is by the thickness of its law books. A really efficient society runs on mutual trust, not on litigation. Of course that does make conscience particularly important - it can make things a little tiresome perhaps when the doctor has to clean the surgical instruments himself or when a woman has to go to a different chemist to get her contraception. As for preventing embolisms - it's pretty loony not to be allowed to be decisive about that: but that single and very unusual instance shouldn't be allowed to colour the whole of the rest of the landscape.

Sungold said...

Kochanie, thanks for the visual! I won't be forgetting it anytime soon. Yikes. The pharmacy movement started about 5 years ago, if memory serves. If I were a doctrinaire pro-life activist, I'd have to wonder if trying to block women's access to birth control is a tactically smart move, because it reveals them as extremists and provokes a backlash from moderate Americans. I see this every time I teach about this issue: Students are appalled, and their reaction is to defend women's right to make decisions about their own bodies. And once they articulate that position, they're more likely to take a pro-choice stance on abortion as well.

Moioci, thanks for pointing out my brain fart. I've made a correction and given you attribution in the main post. I assumed that the higher-level decision-making came at least in part by doctors who've moved into administrative positions, but of course we can't know that for sure. And forget the nuns ... let's take this all the way to Ratzinger. (I lived in Germany while he was still a cardinal and so he's always Ratzinger to me.)

John, McCain's comments in the debate caused a lot of controversy at the time because he appeared to be mocking women's health as a trivial concern. I don't know if the brouhaha made it over the pond, but it was a fairly big deal here. Of course we don't know what he personally thinks and I wouldn't presume to know his innermost thoughts. At heart, he may well be more generous than his rhetoric on this issue indicates. However, his debate comments were clearly catering to his "base," which is composed of people - men and women alike - who think that a woman has surrendered some of her rights to privacy, bodily integrity, and good health once she's had sex. They see pregnancy and its attendant risks as the price she must pay. Wages of sin, and all that.

John Pine said...

I've had a look at him on Youtube and he seems be saying (if I can expand the 'subtext') that the pro-abortionists are emphasising the tiny minority of cases involving danger to the woman's health (which most people would think should be treated differently) and ignoring the vast majority of cases which involve no danger to the woman's health.

J.B. Kochanie said...

John Pine:
Are you really saying that because McCain is not a woman he doesn't care about women's health or the fact that women (a century ago) died in childbirth?

No, the fact that John McCain is a man is irrelevant when it comes to the issue of women's health.

His voting record is relevant. This link will take you to the the Planned Parenthood Action Center for a snapshot of Senator McCain's voting record on key legislation affecting women and families. As you can see, Senator McCain has voted against all key legislation designed to preserve women's reproductive freedom and health. When you compare Senator McCain's policy positions to those of
President-elect Obama
, you will see why Sungold and I consider the Bush Administration and Sen. McCain dangerous to our and our families' health.

Sugarmag said...

Great post Sungold. I was outraged by John Mccain's use of air quotes around women's health during the debate. I get mad just thinking about it.crate

Sungold said...

Thanks, Sugar Mag. It was one of those moments where McCain evidently tried to give a dog whistle to the evangelical crowd - but this time it was in a register where all of us heard it. Oops!

John, you would be correct in saying that it's a small number of cases where a woman's *life* is endangered. Health is another matter. "Health" is subject to definition. As I'm sure you're aware, threats to *mental* health became the major argument for obtaining legal abortions in the 1960s, pre-Roe, in those states where hospitals tended to view "health" liberally. I know you deplore this, while I think it was a humane step; let's just agree to disagree.

Kochanie, thanks so much for your links to the Planned Parenthood pages. When people say there's no difference between the two parties, they're of course deluded. But reproductive health is one area where the contrast is particularly stark. I really hope the next four years will bring improvements in access to contraception - that's one place where the Obama administration can make a big difference with a relatively small investment. (Even in cold economic terms, I suspect it's cheaper than what the government would shell out for TANF, food stamps, SCHIPs, etc. for unplanned babies.)

John Pine said...

The main cause of teenage pregnancy is the absence of the father in the first five years of a girl's life - making pregnancy during the teens between seven and eight times more likely. Look at

Sungold said...

Well, technically, John, it's not the direct "cause" but rather a "risk factor." :-) Nonetheless, this is an interesting study. Thanks for the link.