Dr. Martin Ruddock has performed abortions in northern Ohio for more than 20 years, and he's thankful - on most days - for medical advances over those years.
When he started, ultrasound wasn't available. Today, he routinely uses ultrasound to guide his instruments, which means less pain for the woman, less blood loss, less infection, and fewer complications. Newer drugs also have cut down on pain during the procedure, and other new drugs decrease bleeding.
But Dr. Ruddock also worries that "technology is being misused too."
Abortion-rights opponents, he says, use ultrasound, but instead of using it as part of a medical procedure, they use the powerful, clear images to try to persuade women to not get an abortion. Lawmakers, seeing these images, have used them to push for legislation restricting abortion.
"The [new] ultrasound has been a big negative for us because the anti-choice people have co-opted it," he said.
And as infants are being kept alive at younger ages because of medical advances, politicians are bound to pick up on that, he said.
"They're trying to push back the line farther and farther toward conception," Dr. Ruddock said.
Trying, but so far, not having much luck, according to Ruth Colker, an Ohio State University law professor.
"What the court has continued to say, even though states aren't happy about it, is when states try to limit abortion after viability they still have to allow an exception for the health and well-being of the mother," she said.
Randall O'Bannon, director of education and research at the National Right-to-Life Committee, argues the use of technology by anti-abortion groups to bolster their position is more about education than co-opting, as Dr. Ruddock suggests.
"For the longest time, those pushing abortion were claiming that we're really not talking about a baby here, it's just a clump of cells, and as long as people didn't really see it or have any information, that sounded logical to them," he said. "But what's happened with the advent of ultrasound is now people can see for themselves and say, 'yeah, that's a baby.' "
Anti-abortion groups have used ultrasound and information about other medical advances to push legislative restrictions on abortion. One of the recent trends, Mr. O'Bannon said, has been "informed consent" laws that "make sure a woman is aware of the fetal development of her child."
Deirdre McQuade, director of planning and research for the anti-abortion lay committee that serves the U.S. Conference of Catholic Bishops, agreed that anti-abortion groups have used medical advances to make their case.
"Is this affecting the abortion dynamic? I think it is," she said, saying images like those to which Mr. O'Bannon refers can help change minds.
Her group is careful not to hinge its arguments on medical advances - the Catholic Church, for example, believes all abortions are wrong, regardless of the stage of pregnancy - but Ms. McQuade said medical advances can sway public opinion and legislators. She said fetal surgery, for example, is a medical technology that allows doctors to operate on a fetus in the womb, which some ethicists say could change the "moral status" of a fetus into a patient.
"You're getting more at public perception and philosophy," she said. "I think [because of medical advances] we start thinking more and more of the unborn child, even in its tiniest stages, as a patient, and it raises the question of why do we treat some of these tiny human beings as patients and some of them as disposable?"
The U.S. Supreme Court in Roe vs. Wade in 1973 ruled 7-2 that a woman had an unqualified right to an abortion in the first trimester [1 to 12 weeks]. The court also ruled states could regulate abortions in the second and third trimesters as long as they recognized the compelling interest "for the preservation of the life or health of the mother."
After that, states began to place restrictions on abortion, but those restrictions were challenged in court by abortion rights advocates.
The Supreme Court took up the issue again and in 1992 reaffirmed Roe, and said a state could regulate abortion as long as regulations do not pose an "undue burden" on women.
The court defined "undue burden" as "a substantial obstacle in the path of a woman seeking an abortion of a nonviable fetus."
Hundreds of laws, such as informed consent or mandatory counseling, have been passed by the states since then, with many of the laws taking advantage of medical advancements, according to the Alan Guttmacher Institute, a New York-based organization that studies reproductive health and policy.
One example of how states are trying to incorporate medical advances into legislation is the use of ultrasound. So far this year, nine states have introduced measures that would require that women about to get an abortion have access to some sort of ultrasound, and make abortion providers offer images of the fetus to women about to undergo an abortion.
Another major area of legislation relying in part on medical technology has been fetal pain legislation, Ms. Nash said. So far this year, 19 states have introduced legislation that, among other things, includes requirements such as giving a woman the option of having anesthesia administered directly to the fetus.
At the federal level, legislation has been introduced that would require physicians to give women seeking an abortion information about fetal pain when a fetus is 20 weeks or older, and to offer women anesthesia for the fetus. The issue of fetal pain has been controversial. Last month, the Journal of the American Medical Association published a review of scientific studies and came to the conclusion that a fetus is unlikely to feel pain before 29 weeks. Critics have attacked the study, saying it was biased because one of the study's authors works at an abortion clinic while another used to do legal work for an abortion-rights group.
Dr. Sadath Sayeed, an attorney and neonatologist in California, said aside from the federal fetal pain proposal, there's another law that worries him even more. Known as the "Born-Alive Infants Protection Act," it was signed into law by President Bush in 2002 with relatively little fanfare. The law requires that any fetus born with any signs of life, such as a heartbeat, is by definition "born alive" and must be treated.
During the law's passage, President Bush referred to advances in medical technology, saying: "Today, through sonograms and other technology, we can clearly - see clearly that unborn children are members of the human family, as well. They reflect our image, and they were created in God's own image." Abortion-rights advocates say the law hasn't had any impact and worry more about other laws.
But Dr. Sayeed, who practices at the University of California-San Francisco, argues "the reach of that law is potentially tremendous I would be shocked if it isn't used by somebody who is very vested in this issue to push the law in a certain direction. It may be used to create less freedom of choice at the borders of viability."
Much of the legal debate for fetal pain laws and other abortion legislation has centered on whether these laws are an undue burden.
In Ohio, for example, abortion-rights supporters are appealing a federal court ruling upholding state restrictions on abortion, arguing the restrictions are an undue burden. The restrictions have been on hold since being passed in 1998. They would require a doctor to discuss risks and alteratives to abortion in person with their patients at least a full day before the procedure is performed. The new law also would require a minor to get written consent from at least one parent before an abortion, and make it difficult for a minor to bypass this consent agreement in juvenile court.
Moves like Ohio's, not so much technological advances, are what concerns Vicki Saporta, president of the National Abortion Federation.
"We don't have any problem with technology, but when legislators try to misuse technology, we do," she said. "We believe that women should have access to all advances in medical technology from Plan B [emergency contraception], to RU-486, to ultrasound, to other technologies that allow women to conceive the children they desire."
Contact Luke Shockman at: firstname.lastname@example.org or 419-724-6084.
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