A doctor's view of abortion wars: Women and physicians, not politicians, should decide

A doctor's view of abortion wars: Women and physicians, not politicians, should decide
© Getty Images

The political steam surrounding abortion is rising. Several southern states are pushing legislation to restrict abortion to very early in a pregnancy, or not allowing it at all, while some Northern states are going in the opposite direction with laws intended to bring abortion into the later stages of pregnancy.

Meanwhile, former vice president and current Democratic presidential candidate Joe BidenJoe BidenGOP senators balk at lengthy impeachment trial 2020 Democrats make play for veterans' votes 2020 Dems put focus on stemming veteran suicides MORE added to the confusion and lack of consensus this week by reversing his position on the Hyde Amendment, which prohibits the use of federal funds for abortion except in instances of rape, incest or a threat to the mother’s life. Biden clearly is politically conscious but is claiming that, because several states are trying to block abortions, punish doctors who perform them or restrict them to the very earliest stages of pregnancy, this somehow makes it more important that Medicaid cover abortions throughout the U.S.

I don’t agree with his argument as a justification. Federal funding already is used to support Planned Parenthood, which provides abortion services, and Federally Qualified Health Centers, which sometimes perform abortion under separate funding. In addition, many states already use Medicaid dollars to pay for abortions. 

ADVERTISEMENT

It also must be pointed out that providing insurance coverage is not the same thing as providing the actual care. Roe vs. Wade allows for abortion without authorizing the funding for it. I believe Roe vs. Wade is a good thing from a public health perspective, and it should be maintained — because it set a public health standard across the U.S. 

In the early 1970s, before Roe, illegal abortion averaged 800,000 cases per year, and complications and resultant deaths soared. It never made sense to me for a pregnant woman to rush across state lines to an unknown facility in a state where abortion was legal. 

But Roe and Planned Parenthood vs. Casey are clear: Abortion cannot be performed after a fetus is viable, and cannot be blocked before. Of course, viability is an ever-changing question, with the latest medical technology allowing both a view inside as well as support systems to sustain a fetus as young as 22 weeks. Ultrasound imagery emphasizes that a second trimester fetus appears alive, which biotechnology in neonatal ICUs intends to keep the prematurely born that way.

I can never know what a woman facing a pregnancy feels, but I have witnessed and assisted in surgical abortions as both a medical student and a resident on rotation through gynecology. I have never been comfortable with them and I doubt that I would have performed them regularly, had I chosen to become a gynecologist. 

There are exceptions, of course. Incest, rape and a mother’s life being at risk are all times when I would readily perform an abortion, if I had the skill.

ADVERTISEMENT

I am not opposed to other doctors performing abortions up to the point of viability, but not beyond — and I am absolutely opposed to any kind of punishment for doctors who perform abortions sanctioned by federal law. Still, each physician must make this decision for himself or herself, deciding where to draw the line in terms of “First, do no harm.” Where to draw the line in terms of impact on a current life versus a future one. Where to define life as beginning.

Also, it must be emphasized that two-thirds of all abortions occur at eight weeks of pregnancy or before, and 89 percent occur in the first 12 weeks. One-third of all non-hospital abortions are medication-induced (mifepristone), which is approved for up to ten weeks. I am not opposed to this treatment, though I have never prescribed it.

We physicians have a right to define our style and method of practice, based on our experience and values. And we are entitled to our differences of opinion. 

But I wish women and their doctors were making decisions about abortions, rather than politicians who are seeking the votes of their political bases.

Marc Siegel, M.D., is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. He is a Fox News medical correspondent. Follow him on Twitter: @drmarcsiegel.