Reading the Grand Jury Report on the Gosnell Case

In The Brothers Karamazov, Ivan proposes a thought experiment:

Tell me yourself, I challenge you -- answer. Imagine that you are creating a fabric of human destiny with the object of of making men happy in the end, giving them peace and rest at last, but that it was essential and inevitable to torture to death only one tiny creature -- that baby beating its breast with its fist, for instance -- and to found that edifice on its unavenged tears, would you consent to be the architect on those conditions? Tell me, and tell the truth.

I was reminded of that passage this afternoon when I read the entire Grand Jury report on the Kermit Gosnell case:

pg. 101: After the baby was expelled, Cross noticed that he was breathing, though not for long. After about 10 to 20 seconds, while the mother was asleep, “the doctor just slit the neck,” said Cross. Gosnell put the boy’s body in a shoebox. Cross described the baby as so big that his feet and arms hung out over the sides of the container. Cross said that she saw the baby move after his neck was cut, and after the doctor placed it in the shoebox. Gosnell told her, “it’s the baby’s reflexes. It’s not really moving.” 

The neonatologist testified that what Gosnell told his people was absolutely false. If a baby moves, it is alive. Equally troubling, it feels a “tremendous amount of pain” when its spinal cord is severed. So, the fact that Baby Boy A. continued to move after his spinal cord was cut with scissors means that he did not die instantly. Maybe the cord was not completely severed. In any case, his few moments of life were spent in excruciating pain.

Gosnell was an eager butcher, one who was willing to torture babies for women under the desperate illusion that they could attain "peace and rest at last" through this "foundation of the unexpiated blood of a little victim", as Ivan puts it. He had a psychopathic distain for the external nicetices of the abortion business: the sterile clinic, the efficient staff, the quiet, hidden murder and the quick disposal of the bodies. It was all in the open at 3801 N. Lancaster St., insanely blatant in the sheer horrific scale of murder, murders of babies born alive, infanticide, violations of the Controlled Substances Act, hindering, obstruction, and tampering, perjury, illegal late-term abortions, violations of the Abortion Control Act, violations of the Controlled Substances Act, abuse of corpse, theft by deception, conspiracy, corrupt organization, and corruption of minors.

Think I'm exaggerating? Those are the charges recommended against Gosnell and members of his staff by the appalled Grand Jury (pg. 219).

 ***

This case is about a doctor who killed babies and endangered women. What we mean is that he regularly and illegally delivered live, viable, babies in the third trimester of pregnancy – and then murdered these newborns by severing their spinal cords with scissors. The medical practice by which he carried out this business was a filthy fraud in which he overdosed his patients with dangerous drugs, spread venereal disease among them with infected instruments, perforated their wombs and bowels – and, on at least two occasions, caused their deaths. Over the years, many people came to know that something was going on here. But no one put a stop to it. 

Let us say right up front that we realize this case will be used by those on both sides of the abortion debate. We ourselves cover a spectrum of personal beliefs about the morality of abortion. For us as a criminal grand jury, however, the case is not about that controversy; it is about disregard of the law and disdain for the lives and health of mothers and infants. We find common ground in exposing what happened here, and in recommending measures to prevent anything like this from ever happening again. (pg. 1)

The outrage of the Grand Jury is palpable throughout the entire document. Although it beggars belief, the report was even more terrible than the brief clips you may have seen quoted in articles make it out to be. For those interested in the case who want to read it, but are (like me) not eager to view graphic photos, I've noted down the pages on which the most disturbing images appear:

page 47 -- sealed trash bags containing fetal remains (not graphic, but conceptually disturbing)
page 74 -- baby feet in jars
page 85 -- baby girl, intact (looks like a newborn, stretched out, no cord, no visible mutilations)
page 102 -- baby boy A (baby curled in a box with his cord, no visible mutilations)
page 115 -- baby boy with back of his neck slit

There are other photos of the exterior and interior of the clinic in the report, and though people of conscience will be appalled that anyone was treated in such squalid circumstances, the above photos are only ones that are of babies.

Many reporters and bloggers have quoted passages on the horrors of Gosnell's practice -- the gruesome deaths of babies; the callous treatment of women; the underage employee who was sometimes the only staff member in the clinic while women were being medicated and delivering babies; the filthy clinic with its fetal remains in refrigerators, its bloody recliners and blankets for laboring women, and the stench of cat urine permeating the air -- and I won't detail those again here. Every unbelievable incident is there in the report, and is even more horrifying read in the context of Gosnell's for-profit "baby charnel house" (pg 2):

The people who ran this sham medical practice included no doctors other than Gosnell himself, and not even a single nurse. Two of his employees had been to medical school, but neither of them were licensed physicians. They just pretended to be. Everyone called them “Doctor,” even though they, and Gosnell, knew they weren’t. Among the rest of the staff, there was no one with any medical licensing or relevant certification at all. But that didn’t stop them from making diagnoses, performing procedures, administering drugs. 

Because the real business of the “Women’s Medical Society” was not health; it was profit. There were two primary parts to the operation. By day it was a prescription mill; by night an abortion mill. A constant stream of “patients” came through during business hours and, for the proper payment, left with scripts for Oxycontin and other controlled substances, for themselves and their friends. Gosnell didn’t see these “patients”; he didn’t even show up at the office during the day. He just left behind blank, pre-signed prescription pads, and had his unskilled, unauthorized workers take care of the rest. The fake prescriptions brought in hundreds of thousands of dollars a year. But this drug-selling operation is the subject of separate investigation by federal authorities. 

Our focus was on the other side of the business. 

Murder in plain sight 

With abortion, as with prescriptions, Gosnell’s approach was simple: keep volume high, expenses low – and break the law. That was his competitive edge.

Unlicensed personnel dispensing dangerous overdoses of drugs sounds like a bad, if rather remote, charge to the medically untrained ear, but section V of the report, The Death Of Karnamaya Mongar (pgs. 117-136), not only makes vividly clear what the practice and consequences of that behavior look like, but is gripping reading.

This financial angle is clear from Appendix B, a copy of the clinic's Anesthesia for Surgery form, which allows patients to select their level of medication based on price, up to an additional $150 charge for "custom sleep", which involved dosages of medications (never tailored to the individual woman) which horrified external medical examiners. The consent form and price list includes these introductory guidelines, which I've typed from the photocopy in the appendix:

You have already decided that a procedure is best for you. (Next words unclear from the copy; probably "Now you need to assess the") type of pain relief. It will probably be best to pay the extra money and be more comfortable if some of the following conditions are true for you: 

1. The decision to have the procedure is a difficult decision.
2. Medication is usually (unclear; probably "necessary for your menstrual cramps.")
3. Your decision has been forced by your parents or partner.
4. Your family members or friends "don't like pain."

Guidelines 3 and 4 make it pretty clear that Gosnell cared more about profiting from sales of medication than about the health and safety of the women who sought his care. One of the appalling factors in the case is that Kermit Gosnell had a decades-old reputation for the horrific treatment of pregnant women seeking abortions.

pgs. 96-97: Randy Hutchins testified that Gosnell told him about what has been called the “Mother’s Day Massacre.” According to a February 25, 2010, article in The Philadelphia Inquirer, Gosnell offered to perform abortions on 15 poor women who were bused to his clinic from Chicago on Mother’s Day 1972, in their second trimester of pregnancy. Unbeknownst to the women, Gosnell planned to use an experimental device called a “super coil” developed by a California man named Harvey Karman, who had run an underground abortion service in the 1950s. Hutchins related what Gosnell explained to him: 

"At the time that he agreed to do this, there was a device that he and a psychologist were working on that was supposed to be plastic – basically plastic razors that were formed into a ball. All right. They were coated into a gel, so that they would remain closed. These would be inserted into the woman’s uterus. And after several hours of body temperature, it would then – the gel would melt and these things would spring open, supposedly cutting up the fetus, and the fetus would be expelled.

"The problem was that they never tested it. They didn’t test it on any animals. They never did any – any – any other human trials. This was not something that was sanctioned by the FDA. This was just something that he decided – he and this guy decided they were going to use on these women. "

Hutchins actually was mistaken in his belief that no other human trials been conducted. According to the Philadelphia Inquirer article, Karman had tested his device on hundreds of Bangladeshi women who had been raped by Pakistani soldiers. Those women suffered a high rate of complications. Nonetheless, Karman brought his “super coil” to Philadelphia, where he found an ally in Gosnell.

It's impossible that none of these horrors could have escaped official attention, and indeed, the report finds that time and again, complaints were ignored, inspections were either not made or were too cursory to be serious, and those entrusted with public safety willfully turned a blind eye to Gosnell and his practice because his practice was abortion. The sheer scope of the malfeasance is staggering. The Grand Jury names names and calls out officials at every level of government.

pgs 215-217

WHO COULD HAVE PREVENTED ALL THIS DEATH AND DAMAGE? 

Had state and local officials performed their duties properly, Gosnell’s clinic would have been shut down decades ago. Gosnell would have lost the medical license that he used to inflict irreparable harm on women; to illegally abort viable, late-term fetuses; and to kill innumerable babies outside the womb. 

Had DOH treated the clinic as the ambulatory surgical facility it was, DOH inspectors would have assured that the staff were all licensed, that the facility was clean and sanitary, that anesthesia protocols were followed, and that the building was properly equipped and could, at least, accommodate stretchers. Failure to comply with these standards would have given cause for DOH to revoke the facility’s license to operate. 

If inspectors had looked solely for violations of Pennsylvania’s abortion regulations, there would have been ample grounds to revoke the approval of Gosnell’s clinic as an abortion provider – as was demonstrated when DOH inspectors finally entered the facility in February 2010.

Had state inspectors reviewed patient files, they would inevitably have noticed that Gosnell was routinely performing abortions without informed consent from patients or signed consent from parents. His files revealed that he was performing numerous illegal abortions at “24.5 weeks,” in itself a confession of criminality. Gosnell, moreover, almost never had the required pathology reports for second-trimester abortions. 

Had DOH inspectors spoken to the workers, they might well have discovered that Gosnell’s procedure included severing the spinal cords of babies born alive. Revoking his approval to perform abortions would have been simple. But no one from DOH set foot in Gosnell’s clinic for over 16 years. 

The Department of State prosecutors did not even need to go looking for reasons to revoke Gosnell’s medical license. Complaints came to them. Marcella Choung, the former Gosnell employee, spelled out his entire criminal operation for them. Complaints of perforated uteruses and bowels; of a patient’s death from a botched procedure that resulted in a $900,000 settlement; and of family members physically barred from summoning emergency help, were all sent to Department of State attorneys. Yet the department considered none of these complaints serious enough to take action against Gosnell. 

Had the Philadelphia Department of Public Health reported to state officials all that its employees knew or suspected about filthy facilities, fraud, the unlicensed practice of medicine, anesthesia chosen by patients based on cost, infectious waste improperly

handled and stored, and vaccines stored next to medical waste, perhaps state authorities would have taken action against Gosnell and Women’s Medical Society. 

And had fellow doctors, the ones who treated the women after Gosnell butchered them, demanded the attention of DOH and the Board of Medicine, that too might have made a difference. 

We don’t know. We only know what happened when none of these people did what they should have.

It's not uncommon to hear, during the reporting on some scandal, the complaint, "If only women has been in charge [of the Catholic Church, of the government, of the police force, etc.], none of this would have happened." Well, here we are: an industry that purports to be about women's health, and from the Departments of Health and State down to the doctors at nearby hospitals and the local pharmacy, no one did anything. Complaints were ignored or buried -- by women.

pg 142: According to DOH witnesses, sometime after 1993, DOH instituted a policy of inspecting abortion clinics only when there was a complaint. In fact, as this Grand Jury’s investigation makes clear, the department did not even do that. 

Janice Staloski, one of the evaluators of Gosnell’s clinic in 1992, 10 years later was the Director of DOH’s Division of Home Health – the unit that is inexplicably responsible for overseeing the quality of care in abortion clinics. In January 2002, an attorney representing Semika Shaw, a 22-year-old woman who had died following an abortion at Gosnell’s clinic, wrote to Staloski requesting copies of inspection reports for any on-site inspections of the clinic conducted by DOH. Staloski wrote to the attorney that no inspections had been conducted since 1993 because DOH had received no complaints about the clinic in that time. 

Except that it had. In 1996, another attorney, representing a different patient of Gosnell’s, informed Staloski’s predecessor as director of the Home Health Division that his client had suffered a perforated uterus, requiring a radical hysterectomy, as a result of Gosnell’s negligence. The Home Health director discussed this patient with DOH Senior Counsel Kenneth Brody, and the complaint report was documented in records turned over to the Grand Jury. It was surely available to Staloski when she inaccurately told the attorney in January 2002 that DOH had received no complaints regarding Gosnell’s clinic.

pg 149-152: Without regular inspections, providers like Gosnell continue to operate; unlawful and dangerous third-trimester abortions go undetected; and many women, especially poor women, suffer. These are all consequences of DOH’s abdication of its responsibility. 

Moreover, even if Staloski was instructed not to conduct regular, annual inspections, that does not explain why she failed to order inspections when complaints were received. It is clear to us that she was made aware, numerous times, that serious incidents had occurred at Gosnell’s clinic. These incidents, which evidenced alarming as well as illegal long-standing patterns of behavior, warranted investigation. Yet, in all the years she worked at the department, Staloski never ordered even one inspection. 

Not even Karnamaya Mongar’s death triggered an inspection or investigation. 

On November 24, 2009, Gosnell sent a fax to the department, followed by a letter addressed to Staloski, notifying DOH that Karnamaya Mongar had died following an abortion at his clinic. (Gosnell’s letter inaccurately stated that the second day of her procedure was November 18.) Darlene Augustine, a registered nurse and health quality administrator in the department’s Division of Home Health, received the fax. 

Augustine, who supervises surveyors who respond to and investigate complaints at health care facilities, testified that she immediately notified her boss, Cynthia Boyne. (Boyne had become director of DOH’s Division of Home Health in 2007, when Staloski was promoted to head the Bureau of Community Licensure and Certification.) Augustine said that she told Boyne on November 25 that DOH should immediately go out to the clinic and initiate an investigation. Augustine acknowledged that she generally had the authority to send surveyors out to investigate – and she often did so within an hour of receiving a notice of a serious event such as a death. She testified, however, that she felt she needed Director Boyne’s approval because Gosnell’s notice involved an abortion clinic. 

Boyne did not give her approval. Instead, she went to the bureau director, Staloski, to discuss the matter. Augustine explained that abortion clinics were treated differently from other medical facilities because Staloski had for years overseen the department’s handling of complaints and inspections – or lack of inspections – relating to abortion clinics. Staloski, according to Augustine, was “the ultimate decision-maker” with respect to whether DOH would conduct an inspection or investigation. Augustine testified that neither Boyne nor Staloski ever gave her approval to conduct the investigation that she thought was appropriate. 

Boyne blamed Staloski. She said that her boss told her that DOH did not have the authority to investigate Mrs. Mongar’s death. Staloski apparently reached this decision on her own, without ever consulting Brody, the legal counsel. Staloski, according to Boyne, was only interested in making sure that Gosnell filed an on-line report in accordance with a 2002 law, the Medical Care Availability and Reduction of Error (MCARE) Act. That law requires health care facilities to report serious events, including deaths to DOH. 40 P.S. §313. 

Staloski’s plan, Boyne said, was to then charge Gosnell with failing to file the report in a timely and proper manner. This is absurd, and Boyne should not have accepted such a ridiculous idea. Gosnell had reported Mrs. Mongar’s death to DOH on November 24, 2009. While this was three or fours days late, and the notification came by fax and letter rather than computer, it is preposterous to think that Staloski, who had ignored two deaths and other serious injuries at the clinic, would take action against a doctor for filing a report three days late. Staloski was absolutely wrong about DOH’s lack of authority to investigate Mrs. Mongar’s death. 

Appallingly, the chief counsel for the department of health, Christine Dutton, defended Staloski’s inaction following Mrs. Mongar’s death. Dutton testified that she had reviewed the emails and documents showing that Staloski and her staff were communicating with Gosnell’s office to get him to file the MCARE form. Based on these very minimal efforts, Dutton insisted: “we were responsive.” Pushed as to whether the death of a woman following an abortion should have prompted more action – perhaps an investigation or a report to law enforcement – Dutton argued there was no reason to think the death was suspicious. “People die,” she said. 

Not only was a probe into Mrs. Mongar’s death authorized and appropriate under the Abortion Control Act, it was required under the MCARE law. 40 P.S. §306. Yet DOH did not investigate. Staloski told the Grand Jury that she remembered reviewing with Boyne the letter in which Gosnell notified DOH of Mrs. Mongar’s death. Staloski said that it was really Boyne’s responsibility to order an investigation, but acknowledged that she, as the bureau director, also failed to do so. Instead of conducting an investigation, Staloski and Boyne concerned themselves with badgering Gosnell to re-notify them of Mrs. Mongar’s death. 

Bureau Director Staloski, in fact, readily acknowledged many deficiencies in DOH’s, and her own, oversight of abortion facilities. But her dismissive demeanor indicated to us that she did not really understand – or care about – the devastating impact that the department’s neglect had had on the women whom Gosnell treated in his filthy, dangerous clinic. Staloski excused the DOH practices that enabled Gosnell to operate in the manner that killed Ms. Shaw, Mrs. Mongar, and untold numbers of babies. She simply said the abortion regulations – written by DOH – do not require DOH to inspect abortion clinics. 

When DOH inspectors finally entered Gosnell’s clinic in February 2010, not at Staloski’s direction but at the urging of law enforcement, Staloski seemed more annoyed than appalled or embarrassed. On the morning after the raid, she received a copy of an email that Boyne wrote to Brody the night of the raid. Boyne reported to the department’s senior counsel that, at 12:45 a.m., she had told the Department of Health staff members at the clinic to “wrap it up and secure lodging in the interest of their safety.” Boyne told Brody that the “staff walked into a very difficult setup.” She complained that a representative of the District Attorney’s Office was “badgering” DOH staff to shut down the facility immediately. Boyne was seeking Brody’s legal guidance.

Staloski’s response to Boyne’s email was: “I’d say we were used.” Boyne’s reply: “Bingo.” 

Staloksi, the woman most directly responsible for the department’s oversight of abortion facilities, told the Grand Jury: “I haven’t been in any facilities in probably – in an abortion facility in many, many years.” The citizens of Pennsylvania deserve far better from those charged with protecting public health and safety.

The malfeasance is in evidence at every level, from the policy of turning a blind eye to abortion clinic management at the highest levels to Philadephia's banal, revenue-grabbing bureaucratic infectious waste management plan program:

pgs 204-207: Years earlier, in August 2003, another branch of the city’s health department had received an anonymous complaint about Women’s Medical Society. Mandi Davis, a sanitation specialist in the environmental engineering section, wrote a memo to a colleague at the department, Ken Gruen, with a copy to then-Assistant Health Commissioner Izzat Melhem. She informed them that she had received a “rather disturbing” complaint of aborted fetuses stored in paper bags in an employee refrigerator at Gosnell’s clinic.

Davis requested that a site visit be conducted to assure that proper infectious- waste handling and disposal practices were in place. Davis further instructed Gruen: “I am not expecting a ‘wild goose chase’ for aborted fetuses.” Current Philadelphia Health Commissioner Donald Schwarz testified that notations on the memo seem to indicate that a site visit was, in fact, made.

The city health department, however, could not produce any report of that site visit. Nor is there evidence that the department took any action against Gosnell for his dangerous handling of medical waste, or for his failure to have an approved infectious waste plan, as is required by the city Health Code.

A year later, Gosnell still had no approved disposal plan. On March 28, 2004, Davis sent Gosnell a letter stating that a “plan” he had submitted was “incomplete.” In fact, it was completely blank, except for the name and address of the clinic, some contact information, and an indication that it was a medical facility. On May 3, 2004, Davis sent another letter. This one was a form letter. Davis wrote:

Several years ago all Doctors practicing in Philadelphia received a letter from former Health Commissioner Estelle B. Richman explaining the need for the Department to have an infectious waste handling and disposal plan from your practice. The Commissioner’s letter explained the necessity for infectious waste to be properly containerized, stored, transported, and disposed in a manner to preclude any hazard to you, your staff, and patients, the community or the environment.

The letter noted that the city had never received a plan or a fee from the clinic. On May 7, 2004, a city health department inspector was sent to the clinic. His

report stated that proper labels were missing from areas where waste was stored; that red bag containers for infectious waste were not lidded; that marked boxes of infectious waste were sitting on the basement floor – not raised as they should be; that red bags for pick-up were not properly stored in the basement; and that the clinic did not provide a contract with a disposal company.

Gosnell subsequently produced some more paperwork, including a copy of a contract for disposal. However, he never paid his fee. The city never approved his medical waste plan. And he never cleaned up the infectious waste. Yet five years later, he was still operating. When the Grand Jurors toured the facility in 2010, boxes of waste were still sitting on the basement floor. Gosnell still stored aborted fetuses in plastic containers in the freezer. Employees described a stench emitted by bags of fetal tissue that piled up in the clinic.

Commissioner Schwarz tried, unsatisfactorily, to explain why the city never enforced the regulations that purport to protect staff, patients, the community, and the environment. Protection of the public, according to Dr. Schwarz’s testimony, was not the real intent behind the regulations. The impetus for requiring doctors to have infectious waste plans approved by the city was not public health; it was revenue.

The city regulations required the city’s 10,000 providers to pay $100 for individuals, $250 for clinics, and $500 for institutions such as hospitals, schools, and nursing homes. But the regulations provided no guidance as to what the health department was supposed to do to enforce the plans once submitted. Dr. Schwarz related to the Grand Jury what he heard from people who were in the health department at the time:

The department was told, apparently, to collect the money, make sure the plan came in, get the fee, and not enforce, that is don’t take action against people but remind them. This is a revenue generating activity.

The department would only inspect or take action when there was a complaint about a provider’s infectious waste handling or disposal.

Then, according to what Dr. Schwarz was told, sometime in 2004 or 2005 – shortly after Davis sent to the clinic the form letter reminding delinquent medical providers to submit their waste plans and pay their fee – the department stopped trying to enforce the regulation against those who had not complied.

The health commissioner’s testimony might explain why the department did not pursue Gosnell for his failure to submit an adequate infectious waste plan or pay his fee. But it does not explain the department’s inaction after an inspector observed and reported Gosnell’s perilous storage and disposal of infectious waste in May 2004 (and probably in 2003, though we did not see that report).

There is no record to indicate that the health department ever checked to see if the dangerous conditions in the clinic had been remediated. It is clear from our investigation that they never were.

***

The report concludes with a series of fifteen recommendations for the prevention of future outrages -- note that none of these are current practice:

1. There should be no statute of limitations for infanticide.
2. The statute of limitations for illegal abortions beyond 24 weeks should be extended to five years.
3. Impersonating a doctor should be a crime. (There were two such frauds at the Gosnell clinic, "unlicensed phonies administering dangerous drugs to unsuspecting patients", pg. 248.)
4. The Abortion Control Act should be amended to prohibit the mutilation of fetal remains.
5. The Pennsylvania Department of Health should license abortion clinics as ambulatory surgical facilities.
6. The state Department of Health should update the regulations for abortion providers.
7. Pennsylvania’s Departments of Health and State should make their process for filing complaints against doctors and facilities simpler and more responsive.
8. Philadelphia’s Department of Public Health should develop a hotline to assist residents in filing complaints with the proper state and local authorities.
9. The Pennsylvania Departments of Health and State need to share information they receive that is pertinent to each other’s responsibilities.
10. The Department of State should train its prosecutors and provide the necessary tools so they can more effectively investigate complaints against doctors.
11. The Pennsylvania Departments of Health and State should be required to share with law enforcement information relevant to criminal investigations.
12. A task force including the Medical Examiner’s Office, the District Attorney’s Office, and the Police Department should work to improve protocols for investigating suspicious deaths.
13. The City of Philadelphia should enforce medical waste disposal plans that it requires from providers.
14. We recommend that the National Abortion Federation reconsider the inclusion of Atlantic Women’s Medical Services in Delaware in its membership. (Gosnell was affiliated with this clinic as well.)
15. The authorities responsible for overseeing, monitoring, or licensing Gosnell or his operation should conduct serious self-assessments to determine why their departments failed to protect the women and babies whose lives were imperiled at Gosnell’s clinic. Employees who failed to perform their jobs of protecting the public should be held accountable.

The report concludes:

pg. 261: It is not our job to say who should be fired or demoted. We believe, however, that anyone responsible for permitting Gosnell to operate as he did should face strong disciplinary action up to and including termination. This includes not only the people who failed to do the inspecting, the prosecuting, and the protecting, but also those at the top who obviously tolerated, or even encouraged, the inaction. (emphasis: original) 

The Department of State literally licensed Gosnell’s criminally dangerous behavior. DOH gave its stamp of approval to his facility. These agencies do not deserve the public’s trust. The fate of Karnamaya Mongar and countless babies with severed spinal cords is proof that people at those departments were not doing their jobs. Those charged with protecting the public must do better. 

Yes, they must.

Bias by Blackout

Writing about what the media does or does not report as news usually seems like a futile use of energy, but once in a while some act or omission is so egregious one can't help noting it. Mollie of GetReligion has an outstanding post talking about the media blackout of the trail of late term abortionist Kermit Gosnell, who is accused of performing abortions later than allowed by law, infanticide and of horrifically bad medical and sanitary practices that resulted in the deaths of several women (you know, the adult kind that abortionists aren't supposed to kill.)

That the media would really much rather not cover this sort of thing is obvious, and indeed it's been only the right leaning alternative media that's been providing national coverage of any sort. Mollie recounts her attempt to get some response out of reporters on the issue:

[S]ince tmatt has me reading the Washington Post every day, to look at how the paper’s health policy reporter was covering Gosnell. I have critiqued many of her stories on the Susan G. Komen Foundation (she wrote quite a bit about that) and the Sandra Fluke controversy (she wrote quite a bit about that) and the Todd Akin controversy (you know where this is going). In fact, a site search for that reporter — who is named Sarah Kliff — and stories Akin and Fluke and Komen — yields more than 80 hits. Guess how many stories she’s done on this abortionist’s mass murder trial.

Did you guess zero? You’d be right.

So I asked her about it. Here’s her response:

Hi Molly – I cover policy for the Washington Post, not local crime, hence why I wrote about all the policy issues you mention.

Yes. She really, really, really said that. As Robert VerBruggen dryly responded:

Makes sense. Similarly, national gun-policy people do not cover local crime in places like Aurora or Newtown.

So when a private foundation privately decides to stop giving money to the country’s largest abortion provider, that is somehow a policy issue deserving of three dozen breathless hits. When a yahoo political candidate says something stupid about rape, that is a policy issue of such import that we got another three dozen hits about it from this reporter. It was so important that journalists found it fitting to ask every pro-lifer in their path to discuss it. And when someone says something mean to a birth control activist, that’s good for months of puffy profiles.

But gosh darn it, can you think of any policy implications to this, uh, “local crime” story? And that’s all it is. Just like a bunch of other local stories the Washington Post also refuses to cover — local crimes such as the killing of Trayvon Martin and the killing of Matthew Shepard and the killing of students at an elementary school in Connecticut. Did the Washington Post even think of covering those local crime stories?

And this is the key thing to understand about how our media environment works. Virtually all stories are in some sense "local" stories. One of the biggest areas of media power is deciding which local stories become national "conversations". In this case, the media in its enlightened wisdom is clearly determined that there be no national discussion of that nasty underside of the abortion industry to which they are so attached.

The Problem with the "Pregnancy is Work" Argument For Abortion

Over at The Atlantic, Ta-Nehisi Coates reprints a post that he wrote two years ago which he considers to be a strong argument for the unrestricted "right to choose" abortion. This argument is basically that pregnancy is hard and sometimes dangerous work, and that women should thus not be forced to do it if they don't choose to.

Like most people, I have deep problems with the termination of life -- and that is what I believe abortion to be. Still a decade ago, I learned that those problems were abstract, and could not stand against something as tangible and imposing as death.

My embrace of a pro-choice stance is not built on analogizing Rick Santorum with Hitler. It is not built on what the pro-life movement is "like." It's built on set of disturbing and ineluctable truths: My son is the joy of my life. But the work of ushering him into this world nearly killed his mother. The literalism of that last point can not be escaped.

Every day women choose to do the hard labor of a difficult pregnancy. It's courageous work, which inspires in me a degree of admiration exceeded only by my horror at the notion of the state turning that courage, that hard labor, into a mandate. Women die performing that labor in smaller numbers as we advance, but they die all the same. Men do not. That is a privilege.

He says that since writing this, his feelings have only become more one sided on this issue:

I no longer have "deep problems" with the termination of fetal life. I don't think it's my place. I don't think I have much right to any qualms. I will never be pregnant. I will never be subject to the many biological functions that precede pregnancy and the ones that follow. I cannot know what it is to subject my body to such a process for the benefit of another. I don't believe everyone's opinion should be weighed equally. Some people carry more than others.

The thinking here seems to be that the work of being pregnant is so great that only those who have experienced it (or could) can really have an understanding of what it means. Now my first thought was: If one sees pregnancy as the big dividing line here, are women who have been pregnant more or less likely to support the "right to choose"? I consulted the General Social Survey to see if I could find out. Sure enough, all the data one needs is in there. I focused in on the question ABANY: "Please tell me whether or not you think it should be possible for a pregnant woman to obtain a legal abortion if: g. The woman wants it for any reason?" This is part of a series of questions in the survey which ask whether abortion should be legal for any reason (this question) and if it should be legal in certain specific situations (not able to afford another child, doesn't want more children, serious health problem for the mother, etc.) I filtered my data to look at women only and then I broke the data out by the number of children the woman had. The results are interesting, and basically what I expected:

Bold numbers are percentages, regular text represents absolute numbers.

Women who do not have any children (I'm not able to filter on whether they may have experienced miscarriages or abortions, but in general this should be the group of those with the least experience of pregnancy) are the most likely to support abortion on demand. Women who have experienced pregnancy (and the new life which it represents) are less likely to support abortion on demand. I tried separating the data out for married women and never-married women, but the views are almost exactly the same.

But what about the most extreme "hard case" situations? I pulled similar data for two questions in the survey dealing with pregnancy in cases of rape and pregnancies that severely threaten the health of the mother. As in the population as a whole many more women support abortion being legal in these situations. This table shows support for abortion being legal in cases of rape:

This one shows responses to the following question: "206. Please tell me whether or not you think it should be possible for a pregnant woman to obtaina legal abortion if: The woman's own health is seriously endangered by the pregnancy?"

This last is somewhat different from the others in that support for legal abortion in cases of serious health risk to the mother is virtually the same among women who have 0, 1 or 2 children, but then falls off progressively among women with three or more children. I tried splitting this out by how often she attends religious services, but while women who attend religious services weekly or more than once a week are much less likely to support abortion in cases of serious health risk than women who seldom or never attend religious services, the shape of the pattern is similar with women with 0, 1 or 2 children having fairly similar opinions and then increasing opposition to abortion as the number of children goes up from three.

While this doesn't mean that pregnancy isn't a unique and difficult experience, it seems to show that experiencing pregnancy does not make women more likely to support the "right" to "terminate a pregnancy". Indeed, it appears that pregnancy generally makes women less likely to support abortion. If, as Coates suggests, we left the question up to the veterans of pregnancy, abortion would be restricted more than it currently is.

Will Money Make Everyone Virtuous?

One of the many divides among modern Catholics is between what we might call the "moralizers" and the "justice seekers". "Moralizers" are those who emphasize the importance of teaching people moral laws and urging them to abide by them. "Justice seekers" seek to mitigate various social evils (poverty, lack of access to health care, joblessness, etc.) and believe that if only these social evils are reduced, this will encourage people to behave better.

Moralizers tend to criticize the justice seekers by pointing out that following moral laws is apt to alleviate a lot of the social evils that worry the justice seekers, arguing, for example, that if one finishes high school, holds a job and gets married before having children, one is far less likely to be poor than if one violates these norms.

Justice seekers reply that the moralizers are not taking into account all the pressures there work upon the poor and disadvantaged, and argue that it's much more effective to better people's condition than to moralize at them (or try to pass laws to restrict their actions) because if only social forces weren't forcing people to make bad choices, they of course wouldn't do so.

(I'm more of a moralizer myself, but I think that we moralizers still need to take the justice seeker critique into account in understanding where people are coming from and what they're capable of.)

One area in which the justice seeker approach seems to come into particular prominence is the discussion of abortion. We often hear politically progressive Catholics argue that the best way to reduce abortions is not to attempt to ban or restrict them, but rather to reduce poverty and make sure that everyone has access to health care. There's an oft quoted sound bite from Cardinal Basil Hume (Archbishop of Westminster) to this effect:

“If that frightened, unemployed 19-year-old knows that she and her child will have access to medical care whenever it’s needed, she’s more likely to carry the baby to term. Isn’t it obvious?”

You'd think that it was obvious, but I'm suspicious of the idea that having more money or resources makes us better or less selfish people (an idea which strikes me as smacking of a certain spiritual Rousseauian quality that doesn't take fallen human nature into account) so I thought it would be interesting to see if there's any data on this.

I was not able to find data on the relationship of abortion to health insurance, but I was able to find data on the relation of abortion to poverty, and it turns out that the Cardinal, and conventional wisdom, are wrong.

It's often pointed out that a disproportionate number of abortions are procured by women living below 200% of the poverty line (that's about $22,000/yr for a single person). This causes people to conclude that poor women are more likely to abort because they can't afford a child. As it turns out, however, poor women are less likely to abortion an unwanted pregnancy than non-poor women.

The numbers I'm looking at are from this study by the Guttmacher Institute (the research arm of Planned Parenthood -- hardly an anti-abortion source) which looks at pregnancies and abortions for unmarried women aged 20-29 from 2001 to 2008.

The study looks at unmarried women in three economic groups: Those living below the poverty line (around $11,000 per year), those living between the poverty line and 200% of the poverty line ($11,000 to $22,000), and those making more than 200% of the poverty line. For convenience, I'm going to look at the two most extreme groups, those living below the poverty line and those who make more than 200% of the poverty line. The middle group falls pretty much in the middle on all statistics.

The first thing you see is that poor women get pregnant a lot more than better off women. The pregnancy rate for unmarried women living below the poverty line was 277 pregnancies per 1000 women in 2008. For unmarried women making more than 2x the poverty line, that rate was 56 per 1000 women. So poor women are five times more likely to get pregnant.

Now, the first thing that most people would guess is: Poor women must have a lot more unintended pregnancies. They can't afford birth control, or they hadn't had good sex education, or for some other social reason they're not able to control their pregnancies.

Well, it turns out that for unmarried women between 20 and 29 a majority of pregnancies are unintended, but poor unmarried women have a lower percentage of unintended pregnancies than better off unmarried women. 67% of pregnancies of 20-29 year old unmarried women living below the poverty line were unintended in 2008 while 73% of pregnancies of unmarried women making more than 200% of the poverty line were unintended.

Even so, surely a woman with more means is going to be more able to support an unplanned child than a truly poor women, right? Well, she may be more able, but that's not, on average, what she chooses to do. Unmarried women living below the poverty line aborted 48% of their unintended pregnancies in 2008. Unmarried women making more than 200% of the poverty line aborted 62% of their unintended pregnancies in 2008. So an unmarried woman living at more than 2x the poverty line is 30% more likely to decide to abort an unplanned pregnancy than an unmarried woman living below the poverty line.

Unmarried women are far more likely to abort unintended pregnancies (51% aborted) than married women (17% aborted), but unfortunately the Guttmacher report only provides income breakdowns of unmarried women, not married women. However, that does at least mean that the data we're looking at is not thrown off by the fact that a much greater proportion of poor women are unmarried than better off women.

So it turns out that the conventional wisdom is wrong on all fronts. A smaller percentage of pregnancies are unplanned for poor women than for better off women. And a smaller percentage of poor women who have unplanned pregnancies abortion than better off women. The only reason why a disproportionate number of abortions are obtained by poor women is that they get pregnant far more frequently than better off women.

What this underlines is something that should be fairly obvious to anyone with a Christian understanding of fallen human nature: Having more money and resources does not make us better people. Those who are better off are just as capable of doing wrong than those who are less well off. Indeed, in this case, it appears that people who are better off are more likely to do wrong than those who are less well off.

Does this mean that we shouldn't work to alleviate poverty or to make sure people are able to get the medical attention they need? Of course not. But this conventional wisdom that people only do wrong things because they're not well off is simply not the case.

UPDATE: Okay, I'm realizing that due to some odd formatting on the Guttmacher study, I hadn't realized that their data is split into two halves. First they provide overall rates of pregnancy, unintended pregnancy and abortion for all women 20-29 and break that data down into married and unmarried women. However, all of the demographic breakdowns which are provided in the lower section of each table are for unmarried women only. So the percentage of pregnancies which are unintended and the percentage of unintended pregnancies that end in abortion which I quote in the article are for unmarried women only. I've edited the article appropriately, but am leaving this update separately to make the changes clear.

Did RomneyCare Reduce Abortion?

There's a claim being made that Obama's Affordable Care Act will significantly reduce abortions, despite the concerns voiced by the US Catholic Bishops about the ACA funding abortions, on the theory that providing people with a guarantee of contraception and pre-natal care will reduce the "need for abortion."  The original basis for this claim is, so far as I can tell, a 2010 article by Patrick Whelan, the president of the Catholic Democrats, published in the New England Journal of Medicine. This article states:

The number of abortions in Massachusetts in 2006, the year before the new law was implemented, was 24,245, including 4024 among teenagers. I obtained data from the Massachusetts Department of Public Health for each of the two subsequent years.... In 2007, the first year of Commonwealth Care, the number of abortions fell to 24,128, and in 2008, it fell to 23,883 — a decline of 1.5% from the 2006 level. The number of abortions among teenagers in 2008 fell to 3726, a 7.4% decline from 2006. These decreases occurred during a period of rising birth rates, from 55.6 per 1000 women 15 to 44 years of age to 56.9 per 1000 in 2006 and 57.2 per 1000 in 2007 (the latest year for which data are available from the Massachusetts Department of Public Health), and an increase in overall population (in 2008, the Massachusetts population surpassed 6.5 million for the first time, and it was nearly 6.6 million in 2009, according to the Census Bureau). The abortion rate thus declined from 3.8 per 1000 population in 2006 to 3.6 per 1000 in 2008. Overall, since 2000, the number of abortions in Massachusetts has dropped by 12% (from 27,180 to 23,883) and by nearly 36% since 1991.

Now, as you can see from the quote, the claim here is already a little dubious. Dr. Whelan would like to attribute the last couple years drop in abortions to RomneyCare, but he of course has to admit that abortion had fallen much more in the years before, without the benefit of universal health care.

A couple days ago, Brian Fung of the Atlantic published a piece in which he appears to have updated Dr. Whelan's data using the same rough estimation methodology: getting the raw number of abortions per year from the Massachusetts Department of Public Health and dividing it by the total Massachusetts population (men and woman of all ages). Based on this update, he reports that the raw abortion rate (number of abortions divided by total population) has further reduced to 3.14 in 2011, giving a total reduction in the raw abortion rate of 17%.

Commonweal reported on the Atlantic piece writing:

Writing for The Atlantic, Brian Fung reports, “As the number of insured has gone up in Massachusetts, new state data show a corresponding decline in the number of abortions performed there since 2006.” Since passage of “Romneycare”, Massachusetts’ abortion rate has dropped 17%.

Then Vox Nova writer Mornings Minion piles on, citing the Commonweal piece and writing:

With this in mind, I thought I would share the results of two interesting new studies.

The first shows that abortion rates in Massachusetts dropped by 17 percent after the introduction of Romney’s healthcare reform. Given that the Affordable Care Act is almost identical to the Romney plan, and has some explicit pro-life measures and protections that the Romney plan did not have, we might expect the same outcome at the national level in the years ahead.

The second study tries to estimate the impact on abortion rates from overturning Roe v. Wade. It finds that the most likely outcome is that 31 states ban abortion, and that the overall abortion rate falls by 15 percent. If only 17 states banned abortion, the rate would only fall by 6 percent. In the most optimistic scenario – all but four states banned abortion – the rate would still only fall by 29 percent. That’s basically the best we can hope for.

Is this claim remotely believable?

The obvious question is: Is the decline in abortions in Massachusetts sufficiently unique to suggest that it is Massachusetts's universal health care system which is responsible for the recent decline. Determining this is made difficult by the fact that rigorously calculated data on abortion rates is not available from reputable sources like the Center for Disease Control or the Guttmacher Institute for years past 2008. However, I took a look at the change in abortion rates for a number of states from 2005 to 2008 according to the Census Bureau (2006 was not reported). The results I got showed that Massachusetts had declined in real abortion rate (the number of abortions per 1000 women aged 15 to 44) by 7.24% between 2005 and 2008. This was more than the US average, which was up by 0.86%. However, it was similar to the decreases in a number of other states:
-8.85% in Alaska
-8.96% in Mississippi
-7.15% in Maryland
-10.71% in Nebraska
-7.25% in North Carolina

Other states saw large increases:
+37.06% in Delaware
+15.37% in Kentucky
+36.59% in Louisiana
+22.22% in Pennsylvania

I picked one of the states that had performed similarly to Massachusetts from 2005 to 2008 that I was able to find data online from (Nebraska) and compared their change in raw abortion rate to that in Massachusetts. The result is very similar: Nebraska (not known for its universal health care coverage) saw a 22% reduction in its raw abortion rate from 2006 to 2011, and a 19% reduction in total abortions over those same years. The raw rate dropped from 1.66 per 1000 in population in 2006 to 1.29 in 2011.

Although each article in the above cited sequence offered stronger claims that 'researchers think' there's a link between Massachusetts's health care law and the reduction in abortions in that state, that belief seems to be based on no more than wishful thinking and interviews with low income Massachusetts residents who say they're "delighted" to have access to subsidized contraception. There certainly appears to be no evidence from the data cited to suggest that RomneyCare has reduced abortion in Massachusetts, nor is Massachusetts unique in its declining abortion rates. The claim that ObamaCare will somehow reduce abortion more than overturning Roe is, obviously, hard to prove one way or the other, since any model of what a post-Roe US would look like would be highly speculative. But at the very least, we can say that there is no real foundation for the belief.

Akin's Idiocy

You'd have to try moderately hard to come up with a dumber and more insensitive comment than Rep. Todd Akin, the Republican Senate nominee from Missouri, made the other day. Asked why he opposed abortion even in cases or rape, he responded:

It seems to me, from what I understand from doctors, that’s really rare. If it’s a legitimate rape, the female body has ways to try to shut that whole thing down. But let’s assume that maybe that didn’t work or something: I think there should be some punishment, but the punishment ought to be of the rapist, and not attacking the child.

As best as one can guess from Akin's statements (which he has apologized for since the firestorm they kicked up) his beliefs about the issue may have been inspired by studies showing that extreme emotional or physical stress can cause delayed ovulation. Thus a woman who was raped when she was otherwise about to ovulate might not ovulate on time, and thus not conceive.

The first big problem in Akin's thinking appears to have been the result of wishful thinking that is depressingly common. Having read that conception might be less likely after a sexual assault than after normal sexual intercourse, he seems to have wishfully extended this out to be virtually always the case. Akin, like other serious pro-lifers, opposes abortion even in cases of rape. However he seemingly does not want to deal with the fact that opposing one clear evil (killing an unborn child) may leave a woman who has already had her body assaulted by a rapist also unwillingly pregnant. Rather than dealing with the fact that doing the right thing often does not make us happy, he apparently wishes the problem away.

In the process, he adds insult to injury, since his words distinguish "legitimate rape" (from which he believes pregnancy virtually never results) from... Well, he doesn't say what, but the implication is clearly that he's distinguishing between a "real rape" and some sort of rape that the victim didn't actually mind all that much. Since he has magically turned less likely to almost never, the implication (one hopes unintentional) is that if a woman gets pregnant as a result of a rape, she probably didn't really mind being raped -- in other words, it wasn't really a rape.

It doesn't take any imagination to figure out why this is a very offensive implication.

When someone says something this dumb and offensive, its easy to pile on, but difficult to say anything constructive. Rebecca Kiessling provides some fairly calm and thoughtful analysis over at LifeNews. In addition tackling Akin's comments, she deals with some of the other misguidedly sunny attempts pro-lifers have made to address the issue:

The pro-life attorney says pro-life candidates need to be coached on how to answer the media’s inevitable question.

“Senator Rick Santorum, during his presidential campaign, said that he thinks that a child conceived in rape is “a gift from God,” and he was made fun of for that. Just Google images for “Santorum rape” and you’ll see all of the posters where he is mocked for this statement. While I believe it’s true that every child is a gift from God, including children conceived in rape, I don’t believe this was the best response for the interview,” she explained. “If it had been my birthmother sharing that she believes that I’m a blessing and a gift from God, she would not be mocked and ridiculed in the same way he was. And then Sharron Angle, during her Senate race in Nevada, said it’s a “lemonade situation,” which did not come across well at all. The problem is not with these candidates’ values. The problem is how they express them.”

Kiessling provides some somewhat better talking points for politicians to use, though they remain very much what they are: talking points.

My own thought is that we as Americans find these kinds of moral issues very difficult because we have no tragic sense: we labor under the illusion that doing the right thing means that bad things won't happen to you, or that if misfortune comes, doing the right thing will necessarily lessen our suffering right away. Often it doesn't.

In Honor of the March for Life: The Annunciation and the Passion

I have never been on the March for Life, but I'm praying today for those who are walking in DC today.
Last night I came across a John Donne poem that seemed appropriate for a day on which we remember the death of millions of the very youngest humans, written in 1608 on the occasion of Good Friday falling on the feast of the Annunciation (March 25).

THE ANNUNCIATION AND PASSION.
by John Donne

TAMELY, frail body, abstain to-day ; to-day
My soul eats twice, Christ hither and away. 
She sees Him man, so like God made in this,
That of them both a circle emblem is,
Whose first and last concur ; this doubtful day
Of feast or fast, Christ came, and went away ; 
She sees Him nothing, twice at once, who's all ;
She sees a cedar plant itself, and fall ;
Her Maker put to making, and the head
Of life at once not yet alive, yet dead ; 
She sees at once the Virgin Mother stay
Reclused at home, public at Golgotha ;
Sad and rejoiced she's seen at once, and seen
At almost fifty, and at scarce fifteen ; 
At once a son is promised her, and gone ;
Gabriell gives Christ to her, He her to John ;
Not fully a mother, she's in orbity ;
At once receiver and the legacy. 
All this, and all between, this day hath shown,
Th' abridgement of Christ's story, which makes one—
As in plain maps, the furthest west is east—
Of th' angels Ave, and Consummatum est. 
How well the Church, God's Court of Faculties,
Deals, in sometimes, and seldom joining these. 
As by the self-fix'd Pole we never do
Direct our course, but the next star thereto,
Which shows where th'other is, and which we say
—Because it strays not far—doth never stray,
So God by His Church, nearest to him, we know,
And stand firm, if we by her motion go.
His Spirit, as His fiery pillar, doth
Lead, and His Church, as cloud ; to one end both. 
This Church by letting those days join, hath shown
Death and conception in mankind is one ;
Or 'twas in Him the same humility,
That He would be a man, and leave to be ;
Or as creation He hath made, as God,
With the last judgment but one period,
His imitating spouse would join in one
Manhood's extremes ; He shall come, He is gone ;
Or as though one blood drop, which thence did fall,
Accepted, would have served, He yet shed all,
So though the least of His pains, deeds, or words,
Would busy a life, she all this day affords.
This treasure then, in gross, my soul, uplay,
And in my life retail it every day. 

How We See The Other Side

Kyle links to a "pro-lifers are mean" comment by pro-choice advocate Amanda Marcotte and counters that while the behavior she describes is bad, it is not typical of what he has experienced among pro-lifers, that pro-lifers tend to be focused not on disdaining women (as Marcotte seems to think) but on protecting unborn human life.

Part of the problem, I think, in each side estimating the extent of unloving attitude present in the other is that people remember slights against their side far more viscerally than slights against the other.

I went to clinic prayer vigils exactly twice in my life -- protest is not something that my intellectual and emotional makeup makes me good at, regardless of the topic, and after spending those two occasions (as a college freshman at Steubenville curious about what it was all about) standing tensely over to one side with the police officers, watching what was going on but unable to really focus on praying at all, I figured it pretty clearly wasn't the place for me.

On both occasions I noted with chagrin that some of the non-University protesters were doing things I considered counterproductive: holding pictures of aborted babies, shouting "stop killing babies" at the clinic staff as they went in in the morning.

At the same time, what I remember so viscerally that I can feel my blood rising in an instant just thinking about it is the behavior of the "pro-choice escorts" who were there to make sure that sidewalk counselors didn't dissuade anyone from getting an abortion. They wore bright yellow t-shirts over their clothes (it was winter, so we were all bundled up) saying "Pro-Choice Escort" and their basic tactic whenever a sidewalk counselor got near someone was for one to throw herself between the counselor and the woman approaching the clinic, put her arms out in basketball blocking stance, and scream as loud as possible (so that the counselor couldn't get a word in) a stream of, "She doesn't want to talk to you! Get back! If you tough me it's an assault! Get back! Officer, he's touching me! [this almost invariably a lie which the police ignored] Get back! She doesn't want to talk to you, you pervert!" etc.

The sidewalk counselors were trained to take this with equanimity, but just watching it tended to wind me up. What I really remember, however, is a a middle aged pro-choice escort with close cropped grey hair who seemed to have appointed herself the protester taunter. She zeroed in on a student who showed voice and body language signs of being retarded and imitated him all morning, as he prayed or sang hymns with a guitar. She'd prance around singing back at him in a "retard voice" and every so often pause and say, "Your mother wishes she'd come here."

I imagine that if Marcotte had been at the same protest, she would have remembered the misbehaviors of some of the pro-life protesters much better than I do, and this woman she would remember not at all, or as a minor misbehavior in a trying situation. But to me, the pro-choice movement will always be that gray haired woman taunting an apparently disabled young man that his mother must wish that she had killed him.

Information and Metaphysical Conclusions

I was struck by Kyle's post on Friday "Abortion, Rational Decision-Making, and Informed Consent", but it took me a while thinking it over to come to an explanation of exactly what I find wrong about it. Kyle is addressing the issue of "informed consent" laws which require a woman seeking an abortion to view an ultrasound of her baby or read an explanation of fetal development at the stage of pregnancy her child is at. He is concerned, however, that such laws miss the real moral point:

Catarina Dutilh Novaes explains her worry about some new laws requiring physicians to show a woman an ultrasound of the fetus and describe its status, organs and present activity before performing an abortion. She writes: “It does not take a lot of brain power to realize that what is construed here as ‘informed decision’ is in fact yet another maneuver to prevent abortions from taking place by ‘anthropomorphizing’ the fetus” and “it is of striking cruelty to submit a woman to this additional layer of emotional charge at such a difficult moment.” She’s right, I suspect, about the underlying motivation behind the laws and the suffering their practice would impose. If the legislators and activists pushing these laws recognize the suffering they may inflict, they clearly see it as justified, weighing, as they do, the vital status of the nascent life as greater than the emotional status of the expectant mother.
...
There’s something to this. The information the physician is legally required to communicate by these new laws informs in a very limited way: it doesn’t provide evidence of personhood or a right to life or any such metaphysical or moral reality. The sight and description of the fetus may give the appearance of a human life worthy of respect, but, as pro-lifers note, appearance is not indicative of moral worth. An embryo doesn’t look like a human being, but that appearance doesn’t signify anything moral or metaphysical about it.

The woman, for having this information, is not in any better position to make a rational, ethical decision. It may cause her to “see” the nascent life as human, but it doesn’t offer her a rational basis for such a perception. Her consent is no more informed after seeing and hearing the physical status of the life within her, and so these new “informed consent” laws don’t achieve what they are supposedly designed to do.

There are places conducive to informing people about the nascent life’s stages of development and about what exactly, scientifically speaking, abortion does to that life. A high school health class, for example. There, the scientific information about the unborn life and abortion can be more thoroughly considered, and once fully understood, serve in other settings as a reference point for metaphysical and moral considerations. Consent to abortion should be informed, but the information these new laws require to be communicated does not on its own result in informed consent or provide an additional basis for a rational, ethical decision. Why? Because, by itself, appearance is not ethically relevant and can also be misleading.

Now on the basic point, I agree with Kyle: appearance is not moral worth. A person is not worthy of human dignity simply because someone looks at him or her and sees similarity. To say that would be to suggest the converse: that when someone looks at another and sees simply "other" he is justified in not treating that person with human dignity. For instance, one could imagine (though I think it is the far less likely option) a situation in which a woman is leaning against abortion because she thinks that the child inside her will look "just like a baby", she sees a fuzzy ultrasound of something that still looks like a tadpole on an umbilical cord, and she thinks, "Oh, that's all? It must not be a baby yet. I'll abort."  Clearly, in this case, the information would have led to the wrong conclusion.  An appearance of similarity or dissimilarity does not a person make.

At the same time, the suggestion that informed consent laws are a bad idea just rubs me the wrong way, not just from a pragmatic point of view but from a moral one, and when I have this kind of conflict between instinct and reason, I tend to poke at the issue until I come up with a reason why it is that the apparently reasonable explanation seems wrong to me.

Having gone through this poking exercise, I realized that the issue is that Kyle's argument seems to imply that there are two sets of information -- information which relates to personhood, and information which relates to other qualities (appearance, sound, texture, etc.) -- and that informed consent laws are problematic because they require that people be provided with the latter type of information (information about appearance) when the relevant question is one of personhood, and thus only information relating to whether the being in question is a person would be applicable to the decision being made.

This seems reasonable for a moment until you try to think what information is actually in the first set, the set of information which relates to personhood. And here lies the paradox: there is none.

As beings who are both physical and rational, we understand the metaphysical concept of "person", but the inputs which we can receive from the outside world (things which we might be informed of as "facts" via "informed consent") are all sensory inputs. We reach the conclusion metaphysical, "This other being is a person, just as I am a person," based on sensory information, not metaphysical information.

Famously, in the movie Juno the main character is persuaded not to have an abortion when her pro-life classmate tells her that her baby has fingernails. This detail is what humanizes the baby in Juno's mind and causes her to decide not to abort the baby. Responding to this example, Kyle says:

The scene in Juno shows the effectiveness of giving a description of the fetus in order to humanize it, and it’s good that she chose to keep the baby, but she didn’t exactly make an informed ethical decision. Whether or not her baby had fingernails is irrelevant to the morality of abortion. It doesn’t follow that because the baby had fingernails that it was a human being with a right to life that the law should protect, but acting as though this information about fingernails led to “informed consent” implies that it does.

At the literal level, of course, the attribute "having fingernails" is not something that makes a being a person. We would not say, "Man is an animal with fingernails." Nor, if a human being through some genetic deformity was born without fingernails would be conclude that that member of our species was not a "person" because he lacked fingernails.

And yet, it is invariably through these surface level details that information comes into our minds and allows us, eventually, to form enough of an understanding of something that we are able to form metaphysical conclusions about it.

Picture, if you will, that at this moment I were to head down to the local coffee shop, and there I found Kyle sitting at a table with a banana.

"Darwin," Kyle informs me. "This banana is actually a person. It's an intelligent space alien."

My first reaction, after ordering a triple espresso, would doubtless to be respond, "It doesn't look like an alien. It looks like a banana."

My statement would have been about appearance, and yet, it would be completely normal for me to form the metaphysical conclusion that the banana was not a person based on this appearance combined with my experience of other similarly looking fruits. If a moment later, the thing-that-looked-like-a-banana were to rise in the air and trace in glowing letters a refutation of Derrida's claim that apartheid in South Africa was a consequence of phonetic writing which, "by isolating and hypostasizing being, ... corrupts it into a quasi-ontological segregation" -- I would rapidly revise my conclusions since this would be behavior far more in keeping with my experience of persons than with my experience of bananas.

The fact is that we will invariably reach the metaphysical conclusion "this is a person" based on a grouping of non-metaphysical sensory inputs. A materialist approach would to be say that this means that metaphysical conclusions never follow from "the data" and thus should be abandoned. Since there is no specific, observable characteristic which I can say "this is what makes something a person", this approach would reject personhood as a useful concept.

I would argue, instead, that it is precisely because we are beings able to perceive metaphysical realities through our sense of reason that we are able to take in a number of pieces of sensory "information" about something outside of ourselves and use those pieces of information to reach a metaphysical conclusion. In the case of deciding whether the unborn child is a "person" in the moral sense, pieces of information which might be key would be: member of our species (human), has unique DNA different from mother than father, heart is beating, eyes have formed, moves spontaneously, etc. None of these pieces of information is metaphysical in import, and yet, from the combination of them all, many people would form the conclusion that the creature in question is "a human being".

Further, there is simply a visceral reaction to seeing someone. Recall the New York Times piece on "twin reduction" that was going around a few weeks ago:

One of Stone’s patients, a New York woman, was certain that she wanted to reduce from twins to a singleton. Her husband yielded because she would be the one carrying the pregnancy and would stay at home to raise them. They came up with a compromise. “I asked not to see any of the ultrasounds,” he said. “I didn’t want to have that image, the image of two. I didn’t want to torture myself. And I didn’t go in for the procedure either, because less is more for me.” His wife was relieved that her husband remained in the waiting room; she, too, didn’t want to deal with his feelings.

Kyle's is right in saying that appearance itself is not evidence of personhood, but he is wrong in saying that this means that an ultrasound would not form a piece of "information" which would lead to a more "informed consent" in regards to abortion. In the end, no piece of information is in and of itself evidence of personhood. And yet, it is through these incomplete clues, these pieces of information which do not themselves indicate personhood, that we know that anyone at all is a person -- indeed, that anyone at all exists.

The Shallow Pretensions of Evil

The New York Times reports on the phenomenon of women who've conceived via IVF "reducing" their twins to singletons. The quotes speak for themselves.

“Things would have been different if we were 15 years younger or if we hadn’t had children already or if we were more financially secure,” she said later. “If I had conceived these twins naturally, I wouldn’t have reduced this pregnancy, because you feel like if there’s a natural order, then you don’t want to disturb it. But we created this child in such an artificial manner — in a test tube, choosing an egg donor, having the embryo placed in me — and somehow, making a decision about how many to carry seemed to be just another choice. The pregnancy was all so consumerish to begin with, and this became yet another thing we could control.”

...

One of Stone’s patients, a New York woman, was certain that she wanted to reduce from twins to a singleton. Her husband yielded because she would be the one carrying the pregnancy and would stay at home to raise them. They came up with a compromise. “I asked not to see any of the ultrasounds,” he said. “I didn’t want to have that image, the image of two. I didn’t want to torture myself. And I didn’t go in for the procedure either, because less is more for me.” His wife was relieved that her husband remained in the waiting room; she, too, didn’t want to deal with his feelings.

...

A. and her partner were sick, physically and emotionally. Because A. had already miscarried once, her doctor worried she might not carry two to term; if she reduced, the doctor said, she had a better chance of taking a baby home. The women were tempted to reduce both pregnancies, so each woman would carry one, in part to ensure that even if one miscarried, they would have at least one baby. “But we discovered that the reality of having two pregnant moms when you have a 14-month-old is insane. We’ve both been very ill from the pregnancies, and it’s been hard to give him what he needs. At 14 months, they’re inquisitive and energetic, and it was becoming harder and harder to chase him and get him up and down the slide. There were days I’d be in the bathroom throwing up, she’d be on all fours with him, and then we’d switch. We all think we can conquer the world, but then reality hits you, and you realize you have limitations.”

For the sake of the boy they already had, they decided to reduce A.’s pregnancy to one, and right after that A.’s partner lost her whole pregnancy. “I don’t wish this on anyone,” A. says. “I’m very grateful that we had this option at our disposal, that it can be done safely and in a legal way, but it was very difficult for both of us. I still wonder, Did we choose the right one? — even though I wasn’t the one who chose. That idea, that one’s gone and one’s here, it’s almost like playing God. I mean, who are we to choose? Even as it was happening, I wondered what the future would have been if the doctor had put the needle into the other one.”

I mean, who are we to choose?

I really do believe that the people uttering these chilling words believe that they are brave, that they are enlightened, for being so honest about their motivations. But it makes one more culpable, not less, to put a name to the venal motivations for committing an evil act. And to kill a child because he or she can be equated with unwanted merchandise is evil.

In a Facebook discussion about this article, a wise friend who specializes in the bitter history of Eastern Europe, especially the region brutalized "between Hitler and Stalin", said to me:

I wonder if we are missing something when we speak of understanding? Perhaps here it is the problem that evil itself is elusive - that we cannot understand it in the same way we understand goodness because the thing itself is actually opposed to meaning? Real mysteries, holy things contain hidden depths - but it could very well be in the nature of evil to appear to be deep and complex but to be as simple?

...I wonder if we face the kind of difficulties that made it so hard for people to face the atrocities they were committing decades ago? That dehumanization which is the precursor to personal violence actually requires us to shut down the connections between what at some level we know to be true and what is being done. For example - if we were aware that a few blocks from us there was a place where people were bringing in toddlers to be butchered, what really would deter us from gathering a posse of our friends and going there immediately to at a minimum protect any children near it - and if possible to destroy such a place? Yet we are compelled by all sorts of deeply powerful social forces and institutions to live by such institutions day in and day out, knowing that the difference between my hypothetical toddler butchery center and an abortion clinic is not that great. Yet we really are powerless and any effort to change by force our own society's violence would rebound on us and harm the unborn.

But to take it a step further - those who are murdering are successful in forcing their concepts upon us and upon the state - we face a language in which some people literally feel it is a matter of life and death to keep as muddy as the SS men and Nazi administrators worked to convince themselves and those around them that Jews really were subhuman. Again, the differences are real, but the similarities are also quite compelling when you think about it - the sustained effort to subvert, contain or delegitimize the protests of those who had a radically different way of seeing requires a great deal of commitment on the part of those who are "pro-choice."

...

I think some of it is that in my neck of the historiographical woods people tie themselves up in knots about how we can't understand the Holocaust or other deep evils. In the back of my mind there is the description in C.S. Lewis of the demon in Perelandra which "employs reason the way a soldier learns to use the bayonet" but also rather despises reason and on its free time just likes to torture animals for "fun". I also think there is that Augustinian tendency in me to think that we have gone far too far in our fascination with evil, and we forget that we are not Manichaeans - that evil is not simply the opposite of good, Satan is not God's kid brother - that evil is the movement toward non-being/nothing.

It could be there is a steep fall-off from any and all meaning when we get to the kinds of things about which you write are incomprehensible - that there really is NO meaning or content in such things - that a person "feeling two children inside of you, seeing them, and saying "kill this one, love that one." - is someone who has lost something key - and all that is there is fear and even perhaps the demonic - a force that delights in murder for the sake of murder, and is able to enter the empty place where should beat the heart of a mother and takes possession to pursue its own agendas (and needless to say, as N. points out that emptiness is enabled by the missing love of the man who should be there to both comfort the soon-to-be-mother and protect his child).

A Polish colleague is doing some good work on the demonic that proposes a good deal of our practical atheism comes not from the effort to deny God but from our denial of the devil (no, they are not equal, but in denying the possibility of radical evil I think we miss key facts about the world that blind us to other, more primary and important realities - it is the people who have never felt deeply the sting of their own sin and betrayals who I think tend to natter on and on the most about the brutality of the crucifixion - i.e. they cannot contemplate how little and great evils form links in a chain).

Choice and Gendercide

Last weekend's Wall Street Journal featured an interesting review of Mara Hvistendahl's new book Unnatural Selection: Choosing Boys Over Girls, and the Consequences of a World Full of Men. The topic is one that pro-lifers are all to familiar with -- the use of sex selective abortion throughout the world which has resulted in the death of 163 million unborn girls being aborted over the last 40 years, specifically because their parents wanted a boy instead. (In other words, over and above all of the abortions going on for other reasons.) The sheer number of "missing girls" is staggering -- imagine a number of women equal to the current total populations of France and the UK combined.

Mara Hvistendahl is worried about girls. Not in any political, moral or cultural sense but as an existential matter. She is right to be. In China, India and numerous other countries (both developing and developed), there are many more men than women, the result of systematic campaigns against baby girls. In "Unnatural Selection," Ms. Hvistendahl reports on this gender imbalance: what it is, how it came to be and what it means for the future.

In nature, 105 boys are born for every 100 girls. This ratio is biologically ironclad. Between 104 and 106 is the normal range, and that's as far as the natural window goes. Any other number is the result of unnatural events.

Yet today in India there are 112 boys born for every 100 girls. In China, the number is 121—though plenty of Chinese towns are over the 150 mark. China's and India's populations are mammoth enough that their outlying sex ratios have skewed the global average to a biologically impossible 107. But the imbalance is not only in Asia. Azerbaijan stands at 115, Georgia at 118 and Armenia at 120.
...
But oddly enough, Ms. Hvistendahl notes, it is usually a country's rich, not its poor, who lead the way in choosing against girls. "Sex selection typically starts with the urban, well-educated stratum of society," she writes. "Elites are the first to gain access to a new technology, whether MRI scanners, smart phones—or ultrasound machines." The behavior of elites then filters down until it becomes part of the broader culture. Even more unexpectedly, the decision to abort baby girls is usually made by women—either by the mother or, sometimes, the mother-in-law.

If you peer hard enough at the data, you can actually see parents demanding boys. Take South Korea. In 1989, the sex ratio for first births there was 104 boys for every 100 girls—perfectly normal. But couples who had a girl became increasingly desperate to acquire a boy. For second births, the male number climbed to 113; for third, to 185. Among fourth-born children, it was a mind-boggling 209. ...

Ms. Hvistendahl argues that such imbalances are portents of Very Bad Things to come. "Historically, societies in which men substantially outnumber women are not nice places to live," she writes. "Often they are unstable. Sometimes they are violent." As examples she notes that high sex ratios were at play as far back as the fourth century B.C. in Athens—a particularly bloody time in Greek history—and during China's Taiping Rebellion in the mid-19th century. (Both eras featured widespread female infanticide.) She also notes that the dearth of women along the frontier in the American West probably had a lot to do with its being wild. In 1870, for instance, the sex ratio west of the Mississippi was 125 to 100. In California it was 166 to 100. In Nevada it was 320. In western Kansas, it was 768.

What's at the same time interesting and dissonant is that Ms. Hvistendahl comes from entirely outside the pro-life movement, nor does her horror at the idea of people aborting girls for being girls carry through to opposition to abortion itself.

There is so much to recommend in "Unnatural Selection" that it's sad to report that Ms. Hvistendahl often displays an unbecoming political provincialism. She begins the book with an approving quote about gender equality from Mao Zedong and carries right along from there. Her desire to fault the West is so ingrained that she criticizes the British Empire's efforts to stamp out the practice of killing newborn girls in India because "they did so paternalistically, as tyrannical fathers." She says that the reason surplus men in the American West didn't take Native American women as brides was that "their particular Anglo-Saxon breed of racism precluded intermixing." (Through most of human history distinct racial and ethnic groups have only reluctantly intermarried; that she attributes this reluctance to a specific breed of "racism" says less about the American past than about her own biases.) When she writes that a certain idea dates "all the way back to the West's predominant creation myth," she means the Bible.

Ms. Hvistendahl is particularly worried that the "right wing" or the "Christian right"—as she labels those whose politics differ from her own—will use sex-selective abortion as part of a wider war on abortion itself. She believes that something must be done about the purposeful aborting of female babies or it could lead to "feminists' worst nightmare: a ban on all abortions."

It is telling that Ms. Hvistendahl identifies a ban on abortion—and not the killing of tens of millions of unborn girls—as the "worst nightmare" of feminism. Even though 163 million girls have been denied life solely because of their gender, she can't help seeing the problem through the lens of an American political issue. Yet, while she is not willing to say that something has gone terribly wrong with the pro-abortion movement, she does recognize that two ideas are coming into conflict: "After decades of fighting for a woman's right to choose the outcome of her own pregnancy, it is difficult to turn around and point out that women are abusing that right."

Late in "Unnatural Selection," Ms. Hvistendahl makes some suggestions as to how such "abuse" might be curbed without infringing on a woman's right to have an abortion. In attempting to serve these two diametrically opposed ideas, she proposes banning the common practice of revealing the sex of a baby to parents during ultrasound testing. And not just ban it, but have rigorous government enforcement, which would include nationwide sting operations designed to send doctors and ultrasound techs and nurses who reveal the sex of babies to jail. Beyond the police surveillance of obstetrics facilities, doctors would be required to "investigate women carrying female fetuses more thoroughly" when they request abortions, in order to ensure that their motives are not illegal.

Such a regime borders on the absurd. It is neither feasible nor tolerable—nor efficacious: Sex determination has been against the law in both China and India for years, to no effect. I suspect that Ms. Hvistendahl's counter-argument would be that China and India do not enforce their laws rigorously enough.

These struck me, in particular, because this odd police regime she recommends sounds very much like what pro-choice advocates often accuse pro-lifers of wanting to institute. Obviously, it takes a much more invasive regime to allow abortion but only for reasons that you approve of than simply to ban it as a legitimate medical procedure. Once again, there is a police state supporter in the room, and it's not the person standing on the right.

That said, like the reviewer, I hope that Ms. Hvistendahl's work will, contrary to her wishes, call attention through the wider culture to the shocking nature of abortion, and not leave them thinking, "It's horrible to abort a baby just because she's a girl, but on the other hand, if you want to abort her because you don't want to have to shop at Costco, well, go right ahead!" Perhaps it can even do a better job of that since it comes from the "safe" source of a pro-choice feminist.