Thursday, May 29, 2014

When access and choice collide

Although it's always been a minor theme in pro-abortion advocacy, abortion "access" has been front and center lately, particularly when it comes to state requirements that abortionists have admitting privileges at local hospitals. The goal of this legislation is to stop the practice of (literal) fly-by-night abortionists, who come into town for abortions, fly back to their homes out of state, and leave the local ER to deal with any complications that arise. (In the non-abortion context, this is known as patient abandonment.) Abortion advocates see this legislation as a bad thing, of course, because they believe that a fly-by-night abortionist is better than no abortionist at all.

But look below the surface, and the pro-life legislation is only part of their complaint.

In states like New York and California, which have a long tradition of supporting abortion much more strongly than the American population as a whole, an admitting privileges law would have little or no effect (not that it would ever pass). It would be pointless because the abortionists there are local and plentiful.

It's only in states that are already culturally pro-life that this legislation matters at all: states where most of the medical profession upholds the Hippocratic oath, and where the only abortion "services" come from fly-by-nighters who are attracted to the area by the very fact that there's no competition.

But that competition is starting to get steep everywhere. The abortion rate in the United States is at a low point, as fewer women experience unplanned pregnancies, and more of those who do choose life. The trend is the same for teenagers. (These trends actually appeared before the recent surge in pro-life legislation; the statistics are always several years behind. The true rates today are surely even lower.)

In North Dakota, the owner of the state's only abortion business freely admits that, pro-life legislation aside, it just wouldn't make financial sense for a second business to open there. North Dakota has a population of roughly 723,000 people. Let's compare it to the District of Columbia, which has a population of about 646,000. Care to guess how many abortion business D.C. has? Five. (That's not counting Maryland and northern Virginia, which have its own.) Why? Because North Dakota has a pro-life culture, and a very low abortion rate to match. In contrast, D.C. has one of the highest abortion rates in the nation.

So what happens as pro-lifers win the cultural battle, and the country as a whole becomes less like D.C. and more like North Dakota? Fewer unplanned pregnancies and fewer abortions are, we're told, what pro-choice advocates want... or at least it was, before they stopped saying "rare."

The hard truth (for them) is that we could have the beginnings of a virtuous cycle on our hands. As people use more effective contraception and the pro-life view wins more hearts and minds, abortion businesses will have to either close or hike up their prices. As a result, abortions will decline even further. Eventually, even medical school graduates who are sympathetic to abortion will focus their talents elsewhere because there's just not enough money in it. And the abortions will decline even further...

So what happens when the end of abortion "access" is caused not by legislation, but by the natural ebb and flow of culture? How, in that circumstance, can you defend abortion as a constitutional right?

The "right" to abortion is somewhat unique in that it requires another participant to "exercise" it. The only possible analogy I can think of, if I were to assume for the sake of argument that abortion were a constitutional right, is a hypothetical (and, admittedly, extremely unlikely) world in which guns have become so unpopular that it's difficult for Second Amendment enthusiasts to find sellers of firearms.

How important is it to abortion supporters that a woman in a pro-life region has "access" to abortion? Would they be willing to conscript doctors? Willing to encourage unplanned pregnancies to drum up sufficient business? These questions may seem ridiculous now, and I'll admit I've allowed my imagination to run a bit free in this article. But if current trends continue, these are the questions that the abortion movement will have to confront in the next ten or fifteen years. There is a kernel of fundamental tension between the movement for "choice" and the movement for "access." They can coexist while there are a million abortions a year. But in the long run, in order to have access, a critical mass of women have to make the "right" choice.


argent said...

I think the analogy in the minds of pro-choicers would be to medical procedures which are performed with the consent of all patients. And the reason abortion may become inaccessible while consensual medical procedures won't seems to be 1) that abortion is elective* and demand is not actually fixed and 2) that most medical professionals are unwilling to perform abortions and many are unwilling to give support to those who do.

I think you're right that pressure to abort is going to become more and more public and blatant as pro-lifers prevail, and it kind of scares me. But I think it might cause more feminists to be anti-abortion, which I think is a reason we need pro-lifers to be feminists.

*I realize that whether all abortions or just the vast majority are elective depends on one's definition of "abortion".

Kelsey said...

Expanding on that thought, I suppose the best analogy would be cosmetic surgery. Imagine that we defeat ridiculous societal expectations about female appearance, and all the cosmetic surgeons will be put out of business.
That would be... pretty freaking awesome, actually. But since nobody thinks cosmetic surgery is a constitutional right, the analogy isn't terribly useful.

frankbellamy said...

I can think of another fundamental right that very often requires another participant: religion. In some religions there is a strict theological requirement, only a catholic priest can perform a catholic mass, which catholic people are supposed to attend weekly. In other religions, like most of protestantism, the ordinary practice is basically the same even if it doesn't have the strict theological requirement behind it. And while in ordinary life that isn't a problem, there are circumstances where a scarcity of appropriate clergymen becomes a significant issue. Think about prisons or the military.

argent said...

That reminds me of an awesome quote:

"If tomorrow, women woke up and decided they really liked their bodies, just think how many industries would go out of business."
-Dr. Gail Dines

We should include the abortion industry in that list!

Kelsey said...

Good point. Prisons and the military, being government-run, pose different questions. But if the issue is that you're a Catholic who lives in Armpit, Arkansas and there are no priests anywhere (I exaggerate, of course), there's no way the government has the responsibility to bring in priests so that you can have access to your First Amendment freedom of religion...

Michelle Ewing said...

This reminds me of when I first got treatment for my epilepsy. I was referred to a neurology center in my town. I went to a doctor and he gave me medication that I had really bad side effects to. I tried to go in to see him again, and when I did, it was a different doctor. I thought it was odd. this doctor gave me a different medication that really screwed me up! I nearly was admitted to the hospital because I was so mentally ill from the pills.I called to find out what was going on. none of the doctors there would be able to see me for months. turns out these doctors stop in for about a week at a time and take off for a few months! I now gladly pay someone to drive me or take the train 100 miles to see a doctor who doesn't travel. people from all over the country fly to her so they can get the healthcare they really need. I can honestly tell you that with things that seriously affect your health, you can't have traveling doctors. It is worth driving or flying for hours because these doctors are the best at what they do and can help you if something goes wrong. Even if I was pro-choice I would be for these laws. to me this isn't about limiting abortion access. It's about getting rid of doctors that half ass their job!

Kelsey said...

Wow, that's nuts.

Maria said...

I was actually thinking about this yesterday. I was at a panel discussion featuring several lawyers speaking about religious freedom and gay rights and whether there can be common ground between the two value sets...

Toward the end, the subject of abortion arose, and the panelists seemed to reach a consensus that the state has a different degree of compelling interest to force someone to violate their religious beliefs in regions of the country where there is less "access;" for example, New York City has less of a compelling interest to force a particular hospital to do abortions because someone could walk a few blocks away and find another location, whereas in rural Montana, if the hospital nearest you doesn't do them, you may have to travel for miles to find another place.

It seems to me, though, that that's just democracy - by the people, for the people. If there aren't doctors willing to do abortions in certain areas, you can't force unwilling doctors already there to do them for the sake of "access." People might not always like it, but that's just the way a free country works.

(I appreciate the analogy to Catholics seeking to worship in areas where there aren't Catholic churches; the state can't just force people to set up churches because Catholics there want to exercise their First Amendment rights.)

Guest said...

"How important is it to abortion supporters that a woman in a pro-life
region has "access" to abortion? Would they be willing to conscript

Absolutely they would. There is a growing push to eliminate conscientious objection to abortion, requiring all doctors to perform or at least refer for abortions and requiring all medical students to be taught how to kill. Evidently, they don't think getting prenatal care from a doctor that refuses to participate in abortion is a reproductive choice a pro-life woman should be allowed to make.

Chalkdust said...

(1) There is a huge difference between "Let's try to raise the abortion rate so that more clinics will stay open and pregnant people will have better access" and "let's stop passage of this law that will make abortion way more expensive for no valid medical reason and thus will cause clinics to close."

Some pregnant people do not want to be pregnant, and if I was queen of the world, they would all have access to whatever resources they needed to stop being pregnant. That said, even though I think abortion access is a good thing, it is not the only issue involved in reproductive justice. Abortion access decreasing because there is better use of birth control and thus fewer unplanned pregnancies? An unfortunate side effect of a good trend; we might want to mitigate this but certainly would not want to stop the good trend to remove the unfortunate side effect. Abortion access decreasing because some pro-life activist has passed a law saying that you can't prescribe mifepristone pills unless you have a fully-stocked surgery? That's a silly law that doesn't actually help anyone; throwing it out to ensure abortion access is a totally reasonable thing to do.

(2) I'm not sure where all of the strange comparisons are coming from. A much better analogy would be the right to chemotherapy, say, or any other rare medical treatment. The point of the Affordable Care Act seems to be that we want Americans to have the right to have their medical problems treated affordably---even if they are rare. Abortion access could be guaranteed the same way, if abortion rates do fall so far that "unwanted pregnancy" becomes a very rare medical condition.

ignorance_is_curable said...

The author of the article here fails to understand that there is more than one version of the "Hippocratic Oath". Any version that focuses on saving persons instead of "humans" is a version in which the doctor is allowed to perform abortion.

Consider a brain-dead human on full life-support. The PERSON is DEAD, even though the body remains alive. Saving the body just puts extra money into the pockets of the doctors, without actually benefiting anyone else --certainly not the brain-dead and has-no-chance-of-recovery human. It would actually be ethically wrong in this case for doctors to apply any version of the Hippocratic Oath that focuses on saving "humans" instead of persons! Saving a human just long enough to verify brain-death is all the saving that needs to be done (because it takes equipment not found in ordinary ambulances to determine the difference between brain death and a coma).

Unborn humans are not persons YET. Any abortion opponent that recognizes that It Is A Big Universe Out There, such that there is no reason to think that non-human persons cannot exist somewhere, or that we ourselves might in the not-distant future start building True Artificial Intelligences, understands that "personhood" depends on something different from "human-ness". The MIND is the key. Unborn humans are not persons because they only have minds equivalent to those of many ordinary animals.

The simplest way to fully understand the importance of the mind, with respect to personhood, is to think about "decapitation" and "regeneration". The latter is a technology that is being seriously researched, so that, someday, if you lose your leg in an awful accident, you can grow a new one. (They can do this with mice right now.) The former is about losing your head, literally. Do you want your head placed in a regeneration vat, to grow a new body, or do you want your body placed in the regeneration vat, to grow a new head? If you-the-person is a MIND, then you want your head saved; your body is actually irrelevant to your personhood! And unborn humans simply/only have animal-level minds; they are NOT persons.

someone45 said...

I do not see how abortion would be included in that list... What does liking ones body have to do with not wanting or wanting to be pregnant?

I can tell you I like my body and I still would not want to go through an unwanted pregnancy.