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The cold-blooded slaughter of Dr. Tiller is a potential disaster of Kansan women. The late-term terminations of pregnancy he was bravely willing to perform in an ultra-hostile environment were life-saving for women in an otherwise impossible situation. Care providers are constantly asked to perform procedures that can be grim, unpleasant, ethically contentious and ultimately lifesaving and honorable. There is no such thing as a lightly undertaken late-term abortion.
From a JAMA article on late-term abortions:
Late abortions are fundamentally important to women's reproductive health. Antenatal fetal diagnosis, such as maternal {alpha}-fetoprotein screening and amniocentesis, is predicated on the availability of induced abortion. Although techniques such as chorionic villus sampling and early amniocentesis have allowed earlier diagnosis, by the time results of midtrimester amniocentesis or ultrasound are available, a woman may be beyond 20 weeks' gestation.Ironically, the availability of late abortion is pronatalist. About 98% of women who undergo genetic screening receive reassuring news. Without the availability of prenatal diagnosis with abortion as an option, many of these women would not have become pregnant or would have aborted all pregnancies that occurred. As noted by Cook, "Macroethical reasons favouring legal abortion in such circumstances rest on the potential to do greater good than harm in the community, and reveal the positive, life-affirming aspects of legally available abortion services."
Illnesses of women and fetal anomalies lead to requests for late abortions. Late abortion can be lifesaving for women with medical disorders aggravated by pregnancy. Conditions such as Eisenmenger syndrome carry a high risk of maternal morbidity and mortality in pregnancy, the latter ranging from 20% to 30%. In recent years, I have performed late abortions for a Kampuchean refugee with craniopagus conjoined twins and a 25-year-old woman with a 9 x 15-cm thoracic aortic aneurysm from newly diagnosed Marfan syndrome. Cancer sometimes makes late abortion necessary. For example, either radical hysterectomy or radiation therapy for cervical cancer before fetal viability involves abortion.
Incest and rape are other compelling indications. Pregnancies resulting from incest among young teenagers or among women with mental handicaps may escape detection until the pregnancy is advanced. Approximately 32000 pregnancies result from rape each year in the United States; about half of rape victims receive no medical attention, and about one third do not discover the pregnancy until the second trimester.
Some of the moral absolutists among us would like to pretend that such grim situations don't exist—that young teenagers or the mentally handicapped aren't raped or raped by family members, that the survival of a mother is at least as important as that of a fetus, or that things can horribly wrong in development. For the rest of us, the loss of brave and honorable Dr. George Tiller is a deeply saddening terrorist act against humanity. There will be more widowers, more motherless children and more misery in Kansas with his slaughter.
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