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