Editorial

Editorial Counterpoint: Two Patients, Two Persons

By ChRistina a. CiRuCCi, mD, FaCoG

In Dr. Witlin’s editorial, “It’s even more complicated,” she expresses concern with the Dobbs’ decision. I respect the years of experience in high-risk pregnancy management that Dr. Witlin brings as a maternal fetal medicine specialist. I agree that there has been confusion and conflation of terminology since the Dobbs decision. Missed abortion and spontaneous abortion are medical terms referring to miscarriage and must not be confused with elective or induced abortion. Similarly, treatment of ectopic pregnancy is not abortion. There was never any confusion about this prior to Dobbs, and there should not be now. I would like to offer a different perspective on the rest of the editorial.

Supreme Court Motives - Dr. Witlin states that the standard of care has “been upended by 5 or 6 supreme court justices championed by their personal religious views.” It is unclear on what basis she draws this conclusion. This statement assumes motive and bias. As stated by the majority opinion in Dobbs, “The critical question is whether the Constitution, properly understood, confers a right to obtain an abortion.” 1 In their lengthy opinion, the majority explains that the right to abortion is not a constitutional right, and thus they returned that decision to the people. “Abortion presents a profound moral question. The Constitution does not prohibit the citizens of each State from regulating or prohibiting abortion. Roe and Casey arrogated that authority. We now overrule those decisions and return that authority to the people and their elected representatives.” 1

The decision was made on legal grounds. The Justices stated, “Our opinion is not based on any view about if and when prenatal life is entitled to any of the rights enjoyed after birth. The dissent, by contrast, would impose on the people particular theory about when the rights of personhood begin. According to the dissent, the Constitution requires the States to regard a fetus as lacking even the most basic human right—to live—at least until an arbitrary point in a pregnancy has passed. Nothing in the Constitution or in our Nation’s legal traditions authorizes the Court to adopt that “’theory of life.’”1 The Dobbs decision was not about whether abortion is right or wrong but about whether there is a constitutional right to it. The Supreme Court concluded there is not. Assuming that the Supreme Court Justices had motives other than properly interpreting the Constitution is unjustifiable.

Life and Personhood– Dr. Witlin states that the “ethical debate encompassing elective abortions and when life begins can be entrusted to a sociology, philosophy, or religion class.” In the past, abortion advocates have denied that a pre-born baby is a human, but that is no longer the crux of the abortion debate. Basic embryology teaches that a genetically distinct human being is formed at conception. Virtually all professional bioethicists agree that life begins at conception. 2 Due to advances in scientific understanding, the abortion argument is no longer whether the pre-born baby is a life but whether the pre-born baby is a person deserving the same rights as those who live outside the womb. We know that life begins at conception, and most arguments for abortion now are instead based on the personhood theory.2 Humans are typically afforded the rights of personhood after birth, but not always before birth. Yet, we would not find poverty, rape, disability, terminal condition, or unwantedness to permit a mother to kill her toddler. There is no scientific evidence of a transformation from non-person to person between conception and birth. I find no rationale why a tiny human life should be denied the rights of personhood prior to being born.

Late-term abortions - Admitting she has no proof, Dr. Witlin states that she assumes that when pro-life advocates speak of late-term abortions, they are referring to medically or obstetrical indicated deliveries during the late second or third trimester and provides a long list of very different conditions. Late-term abortions are not limited to maternal medical and obstetrical conditions; this is not what most prolife advocates call late-term abortions, as Dr. Witlin assumes. Most late-term abortions are elective, done on healthy women with healthy fetuses, and for the same reasons given by women who have first-trimester abortions.3 As noted in the Dobbs majority decision, “only six countries besides the United States permit[ted] non-therapeutic or elective abortion-on-demand after the twentieth week of gestation.” 1 These countries are China, North Korea, Vietnam, the Netherlands, Singapore, and Canada.

Early delivery is not abortion – I agree that there are certain conditions,

such as HELLP and chorioamnionitis, in which early delivery may be necessary to save the mother’s life. If nothing is done, both mother and baby may die. Early delivery is not abortion. When the mother and her baby must be separated prematurely, neonatal resuscitation is appropriate at viability and beyond, and comfort care and perinatal hospice are appropriate prior to viability. Delivering a baby early to save a life is not abortion.

Abortion for fetal anomalies – In her editorial, Dr. Witlin takes issue with referring to “medically indicated terminations” for fetal anomalies as abortions. I propose that killing a baby for a fetal anomaly is neither indicated nor compassionate. Although a baby may live only minutes, hours, or days, the baby’s life is still of value. Parents of such babies have found perinatal hospice helpful in managing their grief and spending precious moments with their child. In perinatal hospice, the baby is delivered, and the parents are given time with their child before death. Disability and medical conditions should never be reasons to end a life. Dismembering a baby or withholding comfort care is not a treatment for a lethal fetal anomaly.

Women of Color - I would agree with Dr. Witlin that underprivileged women and women of color are most affected by Dobbs, but probably in the opposite way that she speaks. The sad truth is that abortion disproportionately kills black babies. The abortion rate is higher in black women (21.2 abortions per 1000 women) than in White (6.3 per 1000), Hispanic (10.9 per 1000), or other races (11.9 per 1000). 4 The latest CDC Abortion Surveillance Report states that 38.4% of reported abortions were in Black women, 4 yet the population percentage is only 13.6%.5 Curtis Hill, who served as the 43rd attorney general of Indiana and is black, said, “We can only speculate about what these innocent little black children could have become had they been given the chance to continue their lives. But we as a nation have failed miserably to properly affirm their value in the eyes of God.” 6 The abortion movement was founded on eugenics. Margaret Sanger, the founder of Planned Parenthood, said, “colored people are like weeds and need to be exterminated. We don’t want the word to get out…” 7 Let us not pretend that abortion benefits women of color or their babies.

Criminalization - Dr. Witlin states, “But you can bet there is a vigilante in the wings who will be anxious to report you or harass your patient.” As an obstetrician who is pro-life, I have no desire to report a physician or harass a patient. I want to provide the best care for my patients, both the mother and her baby. I have no desire for criminal penalties for doctors or women, and I do not know anyone who does. The motivation of my pro-life colleagues is to prevent the killing of a pre-born child. We see the unborn as a person with the same rights as all people. There will always be the rogue outsider on both sides of any debate, but looking to report a physician or harass a patient is not the motivation of anyone I know. It is best not to assume intent and motives.

As a board-certified obstetrician/ gynecologist, I have two lives to care for: the mother and her baby. We must treat both lives with dignity and respect. If we cannot save both lives, we must do what we can to save one. Sometimes maternal conditions require early delivery. Some fetal anomalies are life-limiting. Comfort care and perinatal hospice are better than abortion. Abortion is not the cure.

I appreciate that Dr. Witlin and I can have different views on abortion and appreciate that Dr. Witlin took the time to express her views. The Dobbs decision was based on a legal interpretation of the Constitution, and there is no justification for assuming bias or wrong motives of those in our highest court. I believe that personhood begins at conception, that lethal anomalies and disabilities do not justify killing, and that abortion disproportionately harms women of color and their babies. If we treat both of our patients with the care and respect they deserve as human persons, then we will always do the right thing. I agree that abortion is not essential healthcare. It is not healthcare at all.

1. Supreme Court of the United States. Dobbs,

States Health Office of the Mississippi

Department of Health, et al, v. Jackson Women’s

Health Organization et al. In: Supreme Court of the United States, editor. 19-13922022. p. 1, 38-39, 78-79.

2. Pearcey NR. Love Thy Body: Answering Hard

Questions about Life and Sexuality. Baker Books; 2018:24-25.

3. Studnicki J. Late-Term Abortion and

Medical Necessity: A Failure of Science.

Health Serv Res Manag Epidemiol.

Jan-Dec 2019;6:2333392819841781. doi:10.1177/2333392819841781

4. Kortsmit K, Mandel MG, Reeves JA, et al.

Abortion Surveillance - United States, 2019.

MMWR Surveill Summ. Nov 26 2021;70(9):1-29. doi:10.15585/mmwr.ss7009a1 5United States Census Bureau. Quick Facts.

Accessed August 5, 2022. https://www.census. gov/quickfacts/fact/table/US/RHI725221 6. Hill C. Black lives matter — including those of unborn babies. The Washington Examiner. July 2. https://www.washingtonexaminer.com/opinion/opeds/black-lives-matter-including-those-of-unbornbabies. Accessed October 10, 2022

7. King A, Tolbert LV. Life at all Costs: An Anthology of Voices from 21st Century Black Prolife

Leaders. Xlibris Corporation; 2012.