Copyright 1996 David C. Reardon. Excerpted with permission for from Making Abortion Rare, published by Acorn Books, PO Box 7348, Springfield, IL 62791-7348 for internet posting exclusively at www.afterabortion.org. All Rights Reserved.

In the previous chapter we looked more closely at the legal and medical obligations of the abortionist with regard to screening. Now we will look more closely at his obligations with regard to recommending the safest course of action and advising the patient with regard to alternative forms of care. 

When a woman comes to a physician requesting an abortion (a form of treatment) her actual complaint (her health problem) is that she is experiencing a crisis pregnancy. But what, precisely, is this problem for which she seeking help? Is it the "crisis" or is it the "pregnancy?" 

When over 80 percent of women seeking abortions report that they would have desired, or at least been willing, to keep their pregnancies, if only circumstances were better, it is clear that the notion of her "health problem," should attach to whatever it is that is making a crisis out of her pregnancy, not the pregnancy itself. Clearly, many women would be extremely happy to keep their pregnancy if only they could be relieved of the crisis which is associated with it. Most actively desire to have children in the future. These women are self prescribing the "cure" of abortion only because they do not know how to get rid of their present problems without also sacrificing their babies.⁽¹⁾

It is the physician's duty to evaluate the presenting complaint, and identify the underlying "disease" - meaning what ever it is that is causing the "crisis" which is surrounding the woman's pregnancy. Only after doing this can a physician make a knowledgeable and responsible recommendation which will treat, and hopefully resolve, the crisis in the least dangerous and most effective manner. As we will see, just as the cause of the crisis will be unique to each woman, so will be the most effective treatment. Furthermore, we will see why it is precisely because they engage in a "one treatment fits all" type of medicine that assembly line abortion mills are inherently mistreating women. 

An Example of the Failure to Identify the Proper Alternatives

Proper alternatives counseling is perhaps best illustrated by example. This is the true story of "Terri," whose abortion of a wanted pregnancy led to drug abuse and prolonged psychological treatment. Adequate assessment of her crisis would have identified alternatives which would have spared her the injuries women experience when they feel forced to submit to the "evil necessity" of an unwanted abortion. 

Terri had become pregnant by her fiance. Both were happy about it. They had even picked out names and moved up the wedding date. But suddenly, Terri became concerned that her former husband would use the out-of-wedlock pregnancy to take away custody of her two small children. There was no provocation for this fear. Her ex-husband had never even indicated a desire to have custody. Yet this fear that he might try to take them reached overpowering proportions and drove her to seek an abortion over the objections of her fiance. 

Terri was given an abortion without any screening for the several high risk factors which are evident even in this short synopsis (a wanted pregnancy, feelings of being pressured to have an unwanted abortion, and objections from her male partner). Nor was her crisis situation accurately identified so that appropriate counseling and care could be provided. In this case, the pregnancy was not her problem; it was fear of the possibility that her ex-husband might seek custody. Proper counseling would have identified the crux of Terri's crisis. She should have been referred for legal counseling and possibly marriage counseling. 

What Terri really wanted was a way to keep her pregnancy without losing custody of her other two children. In reviewing her circumstances and options, a competent physician would have helped her to identify this need and find the means to satisfy it. And if no other resolution could be found, the physician, if he decided to recommend abortion at all, would at the very least have discussed the risk factors which exposed her the greater likelihood of post-abortion problems so that Terri could weigh these risks against the risk of losing custody of her children. 

In the end, it was only after Terri was in counseling to recover from her post-abortion psychological disabilities that she discovered that her ex-husband highly valued her as a good mother. He would never have sought to deny her custody of the children. Only in hindsight did she discover that her fears had been groundless. 

Choosing the Best Alternative

Alternatives counseling is not a service which abortion providers are free to dismiss; it is a required part of pre-abortion counseling.⁽²⁾ In the case of Terri, the abortionist failed to identify that Terri's first need was legal counsel. 

Other cases may present different alternatives. For example, when a woman is being pressured into an unwanted abortion by her husband (a high risk factor), marital counseling would best suit her needs and desires. Similarly, if a teenager is being pressured into an unwanted abortion by her parents, or if she is simply too embarrassed to face her parents alone, interventive family counseling would provide a safer alternative. Is she is chiefly concerned about ridicule at her work, or fears that she may lose advancement opportunities because of her boss's prejudices? Then she might feel saved from an unwanted abortion simply by being referred to the care of a job relocation service, such as those offered by The Nurturing Network, which would place her into a new and more receptive work environment. 

Is she submitting to an abortion only to keep her boyfriend from leaving her? Then she should be helped to understand that the abortion will almost certainly doom their uncommitted relationship anyway (which she will often know already in her heart but be denying in her head), in which case she will be left with nothing but the regrets. Would any responsible physician subject a patient to the 100 plus physical and psychological risks of abortion simply to satisfy the demands of an irresponsible scoundrel? 

Does she want children, but simply feels unable to have one now because she has financial problems, or concerns about finishing school? Then a referral to the appropriate social services agency might best serve her. 

Is she pregnant as the result of sexual assault? Then she should be informed that an abortion is likely to aggravate her feelings of violation and despair, adding trauma on top of trauma.⁽³⁾ She should be referred to a support group like the Life After Assault League where she can talk to women who have been in the same situation so that she can learn from their experiences.⁽⁴⁾

All of the patients in the situations described above, are actually at high risk of experiencing severe psychological sequelae from abortion. These women do not want to remain childless. They may even be filled with a longing to have the very baby which is in their womb. But these maternal feelings are being overpowered by pressures from circumstances or people which they feel powerless to resist. They are submitting to unwanted abortions because they feel as if they have no other choice. It is the role of the crisis pregnancy counselor to help the woman identify this distinction and to assist her in finding the support and resources she needs to keep her baby. 

The Crisis Pregnancy Business

While it is true that abortionists see themselves as in the business of providing abortions, in a legal and professional sense this is not what their business is really supposed to be. Instead, they are supposed to be health professionals, in the business of helping women manage crisis pregnancies.

As has been previously discussed, the Supreme Court never gave to abortionists the right to indiscriminately dispense abortions on request. It is more accurate to say that the Court insisted that physicians must be allowed to use abortion as simply one of the many treatment options which they may employ. This is an important point because it helps us to clarify precisely what standard for counseling and diagnosis should be applied to crisis pregnancies.

Given the fact that there are more than 100 physical and psychological complications associated with abortion, plus the fact that most women see their unborn child as a living being the killing of which involves great moral questions, it is clear that abortion should not be the preferred method of treatment. Instead, it seems obvious under the Hippocratic standard, "first do no harm" that the physician should, if at all possible, assist the woman in finding a way to keep her child by helping her to find ways to correct the circumstances which make her feel that she has to have an abortion.

At this point, abortionists would object, saying that they are not social workers. They provide abortions, not marital counseling or job placement. But it is precisely because they are artificially limiting the scope of their involvement in their patient's health needs that they are negligent. In Roe the Supreme Court declared that the physician's decision to treat a woman's crisis pregnancy by abortion should properly be made "in the light of all factors--physical, emotional, psychological, and the woman's age--relevant to well-being."⁽⁵⁾ It is therefore obvious that these same factors must be considered in evaluating and recommending alternatives.

While a physician who treats crisis pregnancies may not be trained to actually provide martial counseling, financial counseling, job placement, or similar services, he or she is presumed to be capable of doing a psycho-social assessment of the patient to identify the root causes of her psycho-social problem. One would also presume that a physician who is specializing in crisis pregnancy care would be capable of making appropriate referrals to outside agencies and resources.

Furthermore, the successful practices of the thousands of ob/gyns and general practitioners demonstrate that crisis pregnancies can be safely and effectively managed without abortion. These non-aborting physicians have proven themselves capable of screening and counseling women, with appropriate referrals, so that they can resolve their crises without the risks involved in abortion. The professional care that these non-aborting physicians provide women is clearly relevant to the standard of care which all pregnant women in crisis should receive.

Expert Testimony

It is one of our goals in this pro-woman/pro-life strategy, to make this issue of alternatives counseling, and the corresponding duty of recommending the best treatment option, an important issue in abortion malpractice suits. Abortionists should not be allowed to simply state in their defense that, "I simply gave her what she wanted: an abortion." Instead, they must be required to show why they believed abortion was the best choice of management options.

In this regard, however, the abortion industry should not be allowed to establish its own standard of care in isolation from the rest of the medical community. Therefore, it is inappropriate for state courts to disallow as "non-expert" the testimony of physicians who do not perform abortions. This is especially so because abortion is not recognized in the law as a distinct medical specialty. Indeed, the Supreme Court has already determined that abortion is within the expertise of any physician. Requirements for specialization are not, nor can be, required.⁽⁶⁾ In essence, then, the Court has already determined that the standard of care for abortion is so routine that any licensed physician is qualified to meet this standard. Therefore, one would expect that any physician should be accepted as an expert on the standard of care for abortion. If a physician is qualified enough to perform an abortion tomorrow, he or she is certainly qualified enough to testify about the proper standard of care today.

Nor should the testimony of a qualified expert be excluded simply because he or she has never found a sufficiently compelling reason to recommend or perform an abortion. Indeed, the testimony of a physician who rarely, or never, performs abortions in their management of crisis pregnancies may be particularly relevant, especially if he or she has found that other options have always been available which pose less of a threat to the physical, emotional, psychological, or social health of the patient than abortion. Such testimony goes directly to the issue of the appropriateness of the defendant physician's recommendation for an abortion. Indeed, the jury may also consider it relevant that while many women complain that they have been exploited by abortionists, there is no evidence of women complaining against physicians who helped them find alternatives which enabled them to keep their children. This fact alone should suggest the preferred course of treatment.

Furthermore, the standard of care for crisis pregnancy counseling, alternatives counseling, and pre-abortion screening can legitimately be separated from the actual surgical procedure of abortion. This is evident from the fact that all ob/gyns and general practitioners routinely counsel women faced with unplanned pregnancies. This professional crisis pregnancy management includes supportive psychological counseling, options counseling, screening for risk factors associated with each option, and disclosure of risks and options to the patient.⁽⁷⁾
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1. Another collection of testimonies which shows how women's needs have been misdiagnosed and treated with abortion is found in Frederica Mathewes-Green, Real Choices (Sisters, OR: Multnomah Books, 1994). These and other testimonies show that the pregnancy is generally the focal point of attention, but that it is really only drawing attention to other problems in a woman's life which need to be resolved. 

2. "Prior to an abortion, the woman should be counseled on the options for management of an unwanted pregnancy." ACOG, Standards for Obstetric-Gynecologic Services Sixth Edition (Washington, DC: ACOG, 1985) p63. 

"The condition under which pregnancy counseling takes place must guarantee that the woman is provided with privacy, confidentiality, adequate information and emotional support, all of which permit her to explore alternatives and gather information to make her own decision about her pregnancy." Saltzman & Policar, The Complete Guide to Pregnancy Testing and Counseling (San Francisco: Planned Parenthood of Alameda/San Francisco, 1985) p6. 

"[While] decision counseling may or may not be offered on-site; access to such [decision] counseling must be available. If decision counseling is available through referral only, facilities must have documentation of referral sources, and staff must be knowledgeable about counseling referrals." And the purpose of decision counseling is "to assist the woman, as needed, in decision-making by helping her face the task of choosing, encouraging a careful examination of all options..." NAF, Standards for Abortion Care, Rev. (Washington, DC: National Abortion Federation, 1987) p3-4. 

3. Reardon, Aborted Women, 188-218. 

4. Life After Assault League, 1336 W. Lindbergh, Appleton, WI, 54914, (414) 739-4489, Kay Zibolsky, President. 

5. Doe v Bolton, 192. 

6. Roe, at 165. 

7. An example of how general practitioners are expected to be familiar with pre-abortion counseling and screening is found in Rosenfeld, "Emotional Responses to Therapeutic Abortion," American Family Physician, 45(1):137-140, (1992).
 

Copyright 1996 David C. Reardon. Excerpted with permission for from Making Abortion Rare: A Healing Strategy for a Divided Nation, published by Acorn Books, PO Box 7348, Springfield, IL 62791-7348 for internet posting exclusively at www.afterabortion.org. All Rights Reserved.