Indifference Kills.

Two recent pieces on medical ethics and abortion

Remember, next week begins the Flowers of Fire book club presented in partnership with

Patrick T Brown

and

Fairer Disputations

. Get your copy and start reading to find out why my notes for the kickoff post say “in praise of Prohibition… what requires a civil war…” etc.

Photo by Piron Guillaume on Unsplash

I have two pieces of recent abortion-related writing to share, one short, one long.

First up, the New York Times asked me to contribute to a roundup of questions that RFK Jr. should be asked at his confirmation hearing tomorrow. Here’s what I said:

During your independent campaign to be elected president, you said you supported limits on abortion after fetal viability. But fetal viability has changed as our medicine has improved. Sixty years ago, doctors often struggled to save babies born at 34 weeks, like your cousin Patrick Bouvier Kennedy. Today, some hospitals specialize in saving children born at 22 weeks. Does viability really indicate something about the limits of fetal personhood or just the limits of our technology and our empathy?

I’ve written at greater length for the Times before about the incoherence of the viability standard. It sets women and children at odds, where every advancement in NICUs is bad news for abortion access.

I’m grateful to have gotten to contribute to the roundup, especially alongside major names in public health. I’m particularly glad the Times treated bioethics and philosophy as part of the HHS remit, alongside empirical studies.

Next up, I have a much longer piece in the newly launched Commonplace on the deaths of pregnant women that ProPublica and others have linked to pro-life laws.

I want to say up front that I’m grateful ProPublica has poured resources into the maternal mortality beat, even when I disagree with their interpretations. Their prior series “Lost Mothers” is well worth looking at.

In the end, I think their own reporting doesn’t always support their conclusions when it comes to abortion. I have a close reading of several of the cases they and others have spotlighted.

Ultimately, I think bad doctors are using abortion laws to deflect from their negligent care and illegal, EMTALA-violating patient dumping.

For Glick, her care was constrained by her poverty, her lack of insurance, and her distance from competent doctors. Even if no one raised abortion explicitly, her instructions to her mother made it clear she didn’t want to end her child’s life to improve her own prognosis. Framing her case as the fault of an abortion ban presumes that abortion is the escape clause for bad medical care.

Poverty and marginalization are the preexisting conditions that put a woman’s health at risk and make abortion “necessary.” For many women, these conditions aren’t easy to escape—it’s not a matter of diet or exercise or time. If this level of risk requires abortion, it implies that the social determinants of health make it impossible for poor women to carry safely to term. Abortion is the stopgap that is supposed to save their lives at the cost of their children’s…

Expecting poor women to rely on abortion to protect them from care deserts or underinsurance is oppression redistributed. They face unjust treatment from doctors. The proposed recourse is to destroy the child that exposed them to malpractice. The physical peril they might willingly endure is turned inward onto the child they carry. Abortion is not and cannot be seen as the solution to the way we fail vulnerable pregnant women.

This is a piece I hope can connect across the abortion divide. You can disagree with me on whether abortion is morally licit, whether it kills a child, but I hope you can agree that vulnerable women can’t be told that abortion is their primary defense against our discriminatory medical system.

My hope is that pro-choice and pro-life advocates have some shared ground where we can press for better care and clearer consequences for doctors who fail their patients. For example:

One of the doctors who discharged Crain had previously been sued in 2002 for improperly neglecting a woman with an ectopic pregnancy. When Shiketa Walker came into the office with pain, bleeding, and an empty uterus on ultrasound, Dr. William Hawkins told the nurse to send her home. She sought out a second doctor, who diagnosed her with “constipation” and sent her home. She died when her ectopic pregnancy ruptured. This was long before Texas had abortion bans of any kind, and Walker was not seeking an abortion. She died because she had two neglectful doctors.

Hawkins went on to miss other infections, harming other patients, and the Texas medical board placed him under restrictions in 2015. The board noted three patients had filed malpractice claims against him, and three additional patients had settled. Crain’s family was not able to sue because their daughter’s poor care had happened while she was in the emergency room, not as an inpatient. Texas puts an impossible barrier in front of ER malpractice victims. It’s not enough to show their doctor departed radically from the standard of care—the doctor’s actions must be “willful and wanton.” In other words, it’s enough that Dr. Hawkins didn’t actively intend to kill Crain.

I’ll be talking to

Oren Cass

about the piece for his podcast, and I’d welcome your comments and questions to inform our conversation.

What surprised you reading the Commonplace piece? What follow up questions do you have?

Where have you been best able to collaborate across the abortion divide? What’s stood in your way when you’ve tried in the past?