Technology and Life's Dominion

The thirty years since Roe v. Wade has seen a remarkable explosion of medical technology — technology that has made abortion easier and safer, that has allowed it to move from hospital procedure to outpatient procedure, and that has brought the mortality rate down from 4.1 pr 100,000 to 0.6 per 100,000. Yet, despite the improvements, the number of physicians who are willing to perform abortions is at the lowest it has ever been in thirty years.

According to a recent study by the Alan Guttmacher Institute, only 1,819 physicians in this country, most of them gynecologists, were performing abortions in 2000. Gynecologists numbered 39,363 in 1999. That means that just 5% of them are performing the procedure.

That is, indeed, a surprising finding. Abortions have the potential to be cash cows for doctors. The average cost for an early surgical abortion is $372; for mifepristone, the abortion pill, it's $490. And the vast majority of women pay out of pocket for both procedures, meaning no administrative hassles, and better profit margins for the doctors. You would think that aortion would have taken off among gynecologists the way Botox has taken off among plastic surgeons.

But it hasn't. And it isn't because they don't know how to do it. The procedure is one that every gynecologist learns to do in the course of their training. It's the same technique they use to treat an incomplete miscarriage or to sample the lining of the uterus in cases of abnormal bleeding. And it isn't because they've been intimidated by anti-abortion violence. The same Guttmacher Institute study

found that serious harassment such as vandalism, bomb threats, and personal harassment are non-existent for private offices, and declining sharply for the large clinics.

So why are doctors forgoing this safe, legal, profitable venture? Because the same technology that has made abortion safer, easier, and quicker, has also dramatically changed the reltionship between the physician and the fetus.

In the early 1970's, when the Supreme Court considered Roe v. Wade, the womb was very much a black box. No one knew for certain what was going on in there. Obstetrical ultrasounds were crude research tools rather than a routine part of prenatal care. The earliest a premature baby could be expected to survive in the outside world was 24 weeks. Obstetricians tended to view pregnancy, especially early pregnancy, as a disease state, and their only patient the mother.

Confronted with such a state of affairs, the justices fell back on an assessment of the history of medical ethics (which they deemed "rigid"), 18th century English common law (which they argued didn't really consider abortion a crime), and the state of gynecological technology in 1973. They reasoned that r the subsequent 19th century American laws prohibiting abortion were really intended to protect the mother from the dangerous abortion procedure, not the fetus. Since technology had improved abortion techniques so that they were now safer than childbirth, there was no justification for prohibiting it in early pregnancy.

But the justices forgot to consider a few things. They forgot that our understanding of the world and how it works is constantly changing. They forgot that although we now take it for granted that newborns are human, it wasn't until the 15th century that we granted them souls. They forgot that although premature babies are now considered human, 18th century English common law classified them as "monsters" with no right to an inheritance. And they forgot to consider modern obstetrical technology with all of its promise of changes to come.

In fact, the early 1970's proved to be something of a watershed for the developmnt of new technology in the field. It was in the early 1970's that researchers unequivocally confirmed the fetal heart beat at 7 weeks gestation and that obstetrical ultrasound machines first became commercially available. It was in the early 1970's that the first diagnostic fetoscopy was performed, looking for birth defects in fetuses as young as 15 weeks. And it was in the early 1970's that perinatology, the branch of medicine devoted to the care of the fetus and the newborn, became a certified specialty.

In the thirty years since, science and technology have continued their forward march. Ultrasound has advanced from the grainy black and white shadows of yesteryear to movies in living color. Fetoscopy has evolved from a diagnostic tool to a fetal surgical instrument for correcting congenital abnormalities, in some cases as early as 14 weeks into pregnancy. In 1973, 90% of babies born at 28 weeks died, now more than 90% live. Little wonder that obstetricians no longer treat pregnancy as a disease, and now focus their attention on the well-being of both the fetus and its mother.

And it's this change in focus more than anything else that explains the reluctance of physicians to perform abortions. Who, after all, could consider a fetus as life unworthy of living, once they've held its hand?