Access & Freedom of Conscience

If I had thought about it, I would have written the following back on Opposite Day:

In Roe v Wade, the right of privacy – and that of a woman over her own body – was decided. The court, in its wisdom, determined that it was no place for the government to essentially force a woman to carry a fetus to term against her will. We have come to understand that control over one’s own body, and a woman’s control over her reproduction, is essential to full personhood.

Since that decision, a woman’s right to choice has been constantly under threat. From anti-abortion laws placing undue burden on women to networks of hospitals and health care providers refusing to offer abortion services. Too many people cling to the notion that we can place an undue burden on women by forcing them to carry fetuses to term. As a society, we have not given up on the notion that a woman’s sexuality is something to be controlled. Restricting access to abortion is merely one manifestation of that misguided – and misogynistic – idea.

It is not enough that abortion be legally permissable. For a woman to have control over her own body, she must have the ability to terminate her pregnancy. When women cannot afford the procedure, cannot find a doctor, or must confront loud and hateful voices when she can, the right to choice is not complete.

Abortion clinics were never supposed to exist. It was assumed, that once legal, it would become a part of standard training for obstetricians and many general practitioners and these procedures would be performed in community clinics and hospitals all across the country. Instead, the medical community turns its back on women, leave these provisions to standalone clinics that are subject to intimidation and violence.

Attempts have been made to train more obstetricians and general practitioners to do the procedure, but these attempts have proven largely unsuccessful. As a result, a woman that becomes pregnant in many parts of the country must arrange transportation to drive hours, often alone, into other cities and towns they have never been, in order to utilize a right guaranteed to them in the Constitition. A right over control over their own body. A right to full, autonomous, personhood.

Meanwhile, there are hospitals in the towns where they live. There are doctors in these hospitals that perform D&C procedures with regularity. They are either already capable of performing these procedures or would need only minimally more training to do so. But they choose not to.

It is not nearly so simple as to say that it should be their decision to perform, or not perform, whatever procedures they deem fit. Many of these hospitals accept preferential tax treatment. Most accept payments from Medicare or Medicaid. They required public help to become doctors in the first place, and enjoy privileged status as a result of the laws of various states and the federal government.

With these privileges come responsibilities. One such responsibility is to take care of patients. When women are forced to travel long distances to have basic – and constitutionally protected – health care, too many in the medical community are failing to live up to these responsibilites.

It therefore should be the policy of the federal government that every hospital (and any clinic of more than a certain number of physicians that offers obstetrical and gynecological services must offer a full range of services, including giving women control over their reproductive rights. Any hospital or clinic that declines to do so will lose any tax-exempt status they might have and will, at the government’s discretion, possibly be no longer be eligible for Medicare and Medicaid reimbursements.

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What bothers me about the above argument is not that it is offensive. It is not that it is absurd. In fact, it’s that the above argument is not absurd. It relies on two general premises:

1) The right to access to abortion is paramount to a woman’s health and full-personhood.

2) Any Freedom of Conscience by medical professionals, or anyone, really, does not supercede a right to a woman’s autonomous decisions regarding reproduction.

I have heard the argument for #1 many times. It is, at least arguably, the very reason for the intermittently proposed Freedom of Choice Act (FOCA)*. It rests on the notion that not only can the state not actively prohibit, but that it cannot the provisioning of facilities and services.

It has also been one of the themes of the contraception discussion. That not only should the government not prevent facilitating access to contraception, but rather that it should assist in it. To an extent, we should all assist. To do otherwise is to deny women control over their health (or their own view thereof).

The FOCA includes a religious exemption, though the recent discussions about the contraception mandate have suggested that the government’s idea of exemptions, and the provider’s idea of exemptions, may not be the same thing.

I am not particularly worried about the above coming to fruition. In large part due to the pro-life people that abortion-rights advocates love to loathe. This was, at least partially, why my initial inclinations were with the church on this. They are, when it comes to the nitty-gritty stuff, likely to be my ally.

It may seem like a frivolous fear, that one day my wife might be required to perform abortions as a part of her job**. But when it’s your wife, and your beliefs, and her beliefs, it ceases to be frivolous. And anything that moves us closer to that possibility is something to be concerned about. This is especially true when a number of the arguments being used in this case (the HHS mandate) apply to that case as well.

Ultimately, this was not a decision-maker for me. In part because the Catholic Church itself screwed up when they formed the initial argument that it was their specific prerogative as a religious organization that should exempt them from this. As it pertains to my wife, she left the Catholic Church – on bad terms – long ago. Her views are based in moral philosophy and other factors. She doesn’t have a particular religious membership to hang her exemption hat on.

But it’s also because of the differences. The difference between paying for something and doing something. The difference between contraception and abortion.

Despite all this, I do remained concerned about tomorrow will hold. My primary hope is that abortion will remain sufficiently controversial that it would be politically toxic to require provisioning on the part of physicians, nurses, and hospitals that object to the procedure. And that it would be the breaking point where hospitals would start closing down. It is something I will be keeping an eye on.

* – Also, the requirement that hospitals perform abortions for the life/health of the mother in emergency circumstances.

** – For those who don’t know, she is a physician with extensive obstetrical training that could perform abortions. Doing D&Cs with fetal remains is an unfortunate, but necessary part of her job. Taking a live fetus and doing the same is more difficult than what she does, but not something she cannot do. Anyone in the town we live in that wants an abortion has to drive three hours or more to get one.