Taking The "Choice" Out Of Pro-Choice

Bioethicist and writer Jacob Appel has an interesting suggestion for combating the shortage of abortion providers. Require that all OB-GYN students be pro-choice and perform abortions. Uh, what?

Although Appel notes that even pro-choice OB-GYNs have plenty of reasons to eschew performing abortion — such as the risk of murder and the constant harassment — he thinks the public good of having access to abortion should trump individual doctors' life decisions, and that the real problem is that too few doctors are actually pro-choice.

The reasons that newly-minted doctors refuse to replace their retiring colleagues in this enterprise include fear of violent reprisal (as evidenced in the high-profile murders of providers David Gunn and Barnett Slepian) and of chronic harassment from groups who believe abortion should be criminalized. While tighter law enforcement, increased training opportunities, and higher reimbursement rates might ameliorate this crisis to some degree, they do not address one of the rarely-mentioned causes of this dire shortage: the underlying problem may be that the pool of potential abortion providers is too small. During my medical training and career as a bioethicist, I have encountered many obstetricians who could never be convinced to terminate pregnancies because they were personally opposed to doing so—often for private religious or philosophical reasons.

Since the government controls the number of obstetrical residencies available to medical students, he thinks it is perfectly reasonable to employ a litmus test for the residency positions and thus limit them to doctors willing to perform abortions, since the government has for so long allowed doctors to opt out of performing abortions for conscience reasons.

In the case of abortion, the current shortage of providers justifies a limited waiver of conscience exemptions as applied to the training of new OBGYNs. If we do not act, women may find themselves in a position similar to that of the criminal defendant who in theory has the legal right to counsel, but cannot find any lawyer willing to take her case.

He isn't arguing that established OB-GYNs be forced to perform abortions, just that newly minted ones be forced to do so or be prohibited from residencies.

Unless we wish to create a nationwide shortage of all obstetricians, we will have to grandfather in abortion opponents like Tom Coburn and Ron Paul. But that is very different from requiring future OBGYNs to take part in elective terminations during their training—at least as long as the shortage of providers continues. By analogy, we might permit a lone Scientologist to enter a psychiatriac residency program, despite his religious opposition to the pharmacological treatment of mental illness, but we would not allow thousands of Scientologists do so, if the result were a national shortage of prescribers.

Um, see, actually, religion is a protected class in federal employment law, so, actually, I think that would be illegal.

The problems with this suggestion are myriad, starting with Appel's dismissal of the idea that stepping up law enforcement and increasing training opportunities could help, which it would. The recent Washington Post article on medical students and abortion pointed out that, quite often, medical schools skip or limit this part of medical training even for willing students out of a fear of reprisals. So it seems like that might be a better place to start then refusing to allow medical students with religious or moral objections to abortion to practice a certain type of medicine. Increasing reimbursement rates, commonly associated with Medicaid probably wouldn't help terribly since Medicaid only covers abortions in the case of rape, incest or life endangerment — though it is a holy grail of many doctors.

But, to get into a more philosophical objection to Appel's argument, the pro-choice movement has for years rejected the "pro-abortion" label. Choice means that women should be able to have the choice, and it becomes an untenable moniker if we begin arguing that we should remove the choice from women and men who object to abortion and wish to practice medicine. Yes, it is necessary to remove obstacles to men and women that wish to provide abortions and to encourage medical students and doctors to consider doing so — but it doesn't mean that we need to wall off a medical specialty from capable — or potentially brilliant — doctors who have moral or religious objections to abortion. In terms of the optics of Appel's suggestion, well, we might as well just raise the white flag in the public relations battle and watch poll numbers shift in favor of the anti-abortion movement if this were to be a position the pro-choice movement backed and a policy suggestion it pursued.

Medical abortions have removed some of the stigma around providing abortions by giving OB-GYNs some privacy in their decision to offer abortion services, which is one reason that the anti-abortion movement hates medical abortions with such fervor and wants to see it restricted. Increased law enforcement actions are obviously necessary in some cases and I think the pro-choice movement would be amiss if it didn't take this political climate to revisit the issue of clinic protesters who use existing bankruptcy laws to avoid paying fines for their behavior, among other actions. The fact that most medical schools don't offer training or education in abortion procedures is unconscionable and should be something about which pro-choice supporters write, agitate and protest. It just seems like there are hundreds of ways to encourage doctors to provide abortion services without taking away doctors' choices in the matter. That, in fact, seems somewhat hypocritical for the pro-choice movement to suggest.

Do We Need A Pro-Choice Litmus Test for Obstetricians? [Huffington Post]

Related: Religious Discrimination [U.S. Equal Employment Opportunity Commission]
Public Funding for Abortion: Medicaid and the Hyde Amendment [National Abortion Federation]
Schumer's Bankruptcy Amendment Fails in the Senate [Feministing]

Earlier: Abortion Clinics, Activists Fear For The Future
Medical Students