Abortion, Medicine and the Law

[inaudible] of a pregnancy, I want your opinion. The father was syphilitic, the mother was tuberculous. Of the four children born, the first was blind. The second died, the third was deaf and dumb, the fourth also tuberculous. What would you have done? The other doctor, "I would have ended the pregnancy." "Then you would have killed Beethoven." "To introduce our first speaker for the evening, Dr. Robert Hall [speaker gestures for Dr. Hall to step up] [scuffling in background] "Mr. Chairman, ladies and gentlemen, I intend to talk to you about the medical aspects of the abortion problem. The precise incidence of therapeutic abortion in the United States is unknown. Sufficient evidence is available, however, to make the following statement:

One, the overall abortion rate is declining. In New York City, where therapeutic abortions are reported to the Department of Health, the incidence in 1943-47 was one per approximately 200 live births. In 1951-1953, one per approximately 350 live births, and in 1960-62 in New York City, one per approximately 550 live births, a decline of 65 percent in 20 years. Reports from individual hospitals elsewhere confirm this trend. At the [Sloan] Hospital for Women here, for example, there was one abortion per 69 deliveries in 1950-1955 and one per 225 in 1956-1960. Two, the reason for this decline is twofold. One, the allegedly lessened need for aborting women

with medical disease, to be sure medical care for the cardiac, the tubercular, the diabetic, and the hypertensive has improved. but proportionately these represent minor refinements. More fundamentally there's been an attitudinal change on the part of the physician. Hospitals which rarely perform abortions have shown that even a severe cardiac can be kept alive through pregnancy if placed on bed rest and given supported therapy for nine months. Abortion has become regarded as the too-easy solution to such problems. Permitting the pregnancy to progress to term has become an academic challenge. Consideration of the family's future has become largely disregarded. Secondly, among the reasons for the decline in therapeutic abortions, is [the fact] the formation of therapeutic abortion boards. In 1952, Dr. [Gootmocker] established a therapeutic abortion board at Mount Sinai Hospital in New York City. Since then the system has

been copied by most other major obstetrical services. Today, it is even recommended by the American College of Obstetricians and Gynecologists. Abortion has become the only surgical procedure that usually requires the approval of a committee. In theory. these boards serve to police the abortion practices of staff physicians, to prevent them from yielding to the pressure of undeserving patients, and to protect them from possible litigation. In fact, these boards serve as medical tribunals which often serve merely to render moral judgment. Probably more than any other single factor they, these boards, have been responsible for lowering the abortion rate. Since the establishment of such a board at some hospitals, for example, the therapeutic abortion rate has declined by one-third. A third fact that we know about the instance of abortion is [that the overall

instances, approximately one per 500 live births in 1966.] In 1960 to 1962, at New York City hospitals with approximately a half-million live births, the incidence of abortion in the hospitals was one per 555. In a 1963 review of 61 major American hospitals with approximately the same number of births, the instance was one per 503. An abortion rate of one in 500 births means that approximately 8000 therapeutic abortions are performed in this country every year. Fourth, among the facts that we know is that abortions are more commonly performed on private patients. Between 1950 and 1960 at [Sloan] Hospital, the ratio of private [toward] abortions was four to one. In a

1963 survey, which I took of 60 other major American hospitals, this ratio was found to be 3.6 to one, approximately the same. In New York City between 1960 and '62, the ratio . . . there are a lot of statistics in this paper I'm reading but these I want you to pay particular attention to as they are particularly shocking. In New York City between 1960 and 1962, the ratio of abortions and live births in proprietary hospitals was one for 256. On the private services, a voluntary hospital such as this, one in 416. On the ward services of the same voluntary hospitals, one per 1429 and in the municipal hospitals of the same city at the same time, one per 10,000. There are a number of possible explanations for this double standard. One is the tendency for clinic patients to register for antenatal

care later in their pregnancies than private patients. This could, of course, be overcome by patient education. The second possible explanation is the greater ignorance of clinic patients of their occasional right to be aborted. To be sure, the private patient is better informed on this score and, hence, is more prone to request a therapeutic abortion. This too could be rectified by education of the clinic patient. [clears throat] There is no reason why abortion requests need originate with the patient. Three, the higher incidence of abortions for psychiatric indications are more common among private patients. Whereas at [Sloan] Hospital, one therapeutic abortion was performed for psychiatric indications per 1149 deliveries on the ward service. The comparable ratio for the private service is one in 104. It would appear that private patients with unwanted pregnancies are more often referred for primary psychiatric evaluation, and/or the psychiatric justification for abortion is more

easily obtained for private patients. Four, a more lenient [clears throat] abortion policy on the private service exists than on the clinic's service. Whether this is a result of better rapport between a private patient and her physician, greater pressure of the private patient upon her doctor, greater compassion of the obstetrician for his private patient, the greater motive of financial gain in private practice, or a combination of these and other factors, the fact remains that abortions are more often performed for debatable reasons on the private service. This was also demonstrated in the [Sloan] Hospital study and confirmed by the fact that sterilization accompanied abortions more than twice as often on the board service than on the private service. As for psychiatric indications for therapeutic abortion, it is a well established fact that as the number of therapeutic abortions for medical reasons has fallen in recent past, the number for psychiatric reasons has

risen. With few exceptions, the medical literature shows that prior to 1950, psychiatric indications accounted for less than 20 percent of abortions, and since 1950 [?], 20 to 45 percent. This represents an [absolutist was a ] proportionate rise. Some hospitals have set policies against doing any abortions for psychiatric reasons, usually in the belief that emotionally disturbed patients may be harmed by an abortion, or that they are certainly rarely helped by an abortion, or that few of them undergo psychotherapy after an abortion. There is no doubt much truth in these assertions. Suicide is demonstratively rare in pregnancy. In New York City, the suicide rate among women in the reproductive age range is 5.5 per 100,000. Among pregnant women in 1950-1953, it was 0.5 per 100,000. Psychiatrists know that pregnant women rarely resort to suicide. They also know that it is usually

impossible to assess the degree of suicidal risk in an individual case, but the psychiatrist is trained to assess his patient's problems in view of their complete [psychological/ecological] setting, to weigh the various situational as well as the purely medical factors involved, and to consider the future psychological interrelationships created by the birth of an unwanted child. Hence, the psychiatrist may well [?] exaggerate the suicidal risk in order to give broader meaning to a restrictive law, and the obstetrician, meanwhile, innocently hides behind the psychiatrist's pen. This sort of deception is more widely practiced in psychiatric cases because (a) the risk of death is less clear cut than in purely medical problems, and (b) the psychiatrist is more willing to admit that the end sometimes justifies the means. Once again, in many instances the clinic patient is not accorded the same treatment as

the private patient. Abortions for psychiatric indications are almost exclusively a luxury of the rich. Psychiatric care is less common among clinic patients partly because they can't afford it, partly because they can't find it, partly because they are unaware of its benefits, and partly because they're less often referred for it by the other clinic doctors. Another indication for abortion is rape and incest. In 1964, 1,504 and four cases of rape were reported to the New York City Department of Police. One can only surmise how many rape cases were unreported, how many of the reported cases were authentic, and how many resulted in pregnancy. With regard to the last speculation, [Howard *last name*] of New York has provided us with a calculation of two to four percent as the likelihood of pregnancy resulting from a single, random act of coitus. Application of the lower, that is two percent, of these figures, would suggest that thirty pregnancies resulted

from reported rape every year in New York City. Needless to say, very few of these cases are aborted, and when an abortion is performed in these cases, it is done ostensibly for psychiatric reasons. Based upon even less knowledge of incidents, the same statements probably apply to cases of incest. And now for the fetal indications for therapeutic abortion. The first being rubella, or the occurrence of german measles in the first three months of pregnancy. In recent years growing numbers of abortions have been done for fetal indications, principally maternal rubella. During most of the twenty five years that the embryonic ravages of rubella have been known, American obstetricians remained aloof to their responsibility in this matter. The first abortions for this reason were done under psychiatric guise upon the wives of insistent physicians. Now as the knowledge of rubella deformities has become widespread, the general

public has become equally insistent, and obstetricians have been forced, during recent epidemics, to comply with their demands in open defiance of the law. The prevailing practice of ignoring this problem in the nineteen forties and fifties is evidenced by the reports during those years from six major American obstetrical services which cite rubella as the indication for only 2% of their abortions. The new reversal in this policy is shown by the fact that between 1959 and 1963, 4-7% percent of the therapeutic abortions in New York City were done for rubella, and yet during the recent epidemic of rubella in 1964, in New York City, 329, or 57%, of the therapeutic abortions were done for this reason. I, my second and last slide was to have shown the list of minor indications rather than the infrequent for fetal, so-called fetal indications for rubella. Again, I will not take the time to list them for you.

Finally, we come to the issue of various hospital policies with regard to therapeutic abortion. The variation in hospital policies, this I think deserves considerable discussion. Occasionally authors actually define what the ideal abortion rights should be. Although most hospitals do not set a numerical limit, their policies result in intramural consistency and intermural chaos. Generally speaking, hospitals with therapeutic abortion boards have lowered their incidence of abortions and those without boards have not. Specifically, however, some hospitals permit abortions for rubella or for psychiatric indications and others do not. Many are reluctant to allow abortions on women not previously cared for within their own walls. And of course the attitudes of individual physicians within the same hospital is often at variance. Inevitable as this heterogeneity may seem to the medical profession, it is indefensible in terms of overall

medical care. How can it be justified, for example, for one hospital to accept the cancer patient transferred from another hospital, and yet to refuse a legitimate candidate for abortion because she comes from out of town. Further refinements in this system have been applied to the validation for a kick in cases of maternal rubella. Many hospitals require the patient to have been previously registered on their files and the disease to have been diagnosed in it's eruptive phase, by some designated authority. Sometimes however the patient is unable to see a doctor when she has her rash, yet the diagnosis is obvious in retrospect, from the history and residual adenopathy. Sometimes to her original physician or hospital is unsympathetic. Thus measures designed to deter the devious may also deprive the deserving. And lastly we come to the matter of the law. There is no federal law governing a practice of abortion. Each of the fifty states has such a law. In forty-

five states abortion is illegal, unless necessary to preserve the life of the woman. In Alabama, Oregon and the District of Columbia, abortion may be performed in order to preserve the mother's health. In Colorado and New Mexico in order to prevent serious or permanent bodily, bodily injury to her, and in Maryland, when no other method will secure the safety of the mother. The first state statute on abortion was enacted in Connecticut in 1821, the other states soon followed. No significant change in the structure of these laws has occurred in the past century and the penalty for performing an illegal abortion ranges from one year in prison in Kansas to twenty years in Mississippi. No doctor, however, has ever been convicted of having done an illegal abortion if he did it in a hospital. In actual practice these abortion laws are interpreted solely by the medical profession, without any interference from the courts.

That they are interpreted liberally is illustrated by statements such as Dr. Guttmacher's, to the effect that 85% of the therapeutic abortions performed his hospital, at Mount Sinai here in New York, were strictly speaking illegal, and by many other less specific admissions to the same effect. That the medical profession's interpretation of these laws has supplied interstate uniformity lacking in the laws themselves is illustrated by the fact and in the above mentioned survey of 61 hospital's, the ratio of abortions to deliveries at the fifty- three hospitals in states permitting abortion to preserve the mother's life is actually higher than the rate of abortion in the eight other states where the abortions are permitted to preserve the mother's health. The nature of this discrepancy is of course due to unintentional bias in sampling, but the overall fact remains that physician standard for practicing abortion is not determined by law. More specifically this means that abortions are done in all fifty states in order to

preserve maternal health as well as life. That these laws are recognized as unrealistic by prominent members of the legal profession is illustrated by the 1959 recommendation of the American Law Institute to the effect that "a licensed physician is justified in terminating a pregnancy if A: he believes there is substantial risk that continuation of the pregnancy would gravely impair the physical or mental health of the mother or that the child would be born with a grave physical or mental defect, or the pregnancy resulted from rape or incest. And B: that two physicians concur in this, etcetera." That these laws are recognized as unrealistic by the medical profession is illustrated by the 1943, '59, and '65 recommendations of the New York Academy of Medicine, the 1966 recommendations of the New York State Medical Society and others that the law be changed substantially and in accordance with the American Law Institute's recommendation. And by a 1964

survey of 2,285 obstetricians New York State showing that 85% of them prefer the American Law Institute's version of the abortion law to the one that presently exists in our state. But these laws are recognized as unrealistic by many of the clergy, as illustrated by the 1963 resolution of the Unitarian Universalist Association citing these laws as an affront to human life and dignity and recommending their liberalization, and also by the writing and speaking of prominent ministers and rabbis such as Dr. Joseph Fletcher in Boston, Dr. Lester Kinsolving of Los Angeles, and Rabbi Mark Israel Margolies of this city. That these laws are recognized as unrealistic by the laity at large is illustrated by the estimate that about 20% of all pregnancies in this country are aborted illegally every year. That such restrictive laws are not necessary in contemporary society is illustrated by the legalization of abortion and Japan and most communist countries, and by the liberalization of abortion laws in

Sweden, Norway, Denmark, Finland, and Iceland. The present practice of therapeutic abortion in the United States is inequitable, inconsistent, and hence inexcusable. Medicine and the law, not to mention the clergy, have to share in the responsibility for creating this situation, they should therefore share in responsibility for rectifying. The medical profession cannot dictate abortion policy. Neither it's national societies nor its local therapeutic abortion boards have this right. It is debatable whether even the individual physician is better qualified than his patient to determine whether an abortion is justified. Rarely is such a judgment rendered on purely medical grounds. The legal profession cannot dictate abortion policy either and undeniable is the fact that the present laws are flagrantly flouted more often for the rich than for the poor. Surely

this situation is untenable. If there must be abortion laws, and this is debatable, there are several alternatives. One is to outlaw abortions altogether or to enforce the present laws. Neither of which solution is feasible. Another is to liberalize the laws along the lines suggested by the American Law Institute. In other words to legitimize current medical practice. And thirdly is the possibility of legalizing abortion which would be tantamount to legitimizing current public custom. It is clear that the lawmakers will not act without provocation. Logically this provocation should arise from the medical profession. Has the time not coming, in other words, for physicians to preach what they practice.

[applause] Thank you very much Dr. Hall. The next speaker will be Dr. Edmond Sure. Thank you Mr. chairmain, , ladies and gentlemen. When a rule appears on balance to be socially harmful in its effect it is only reasonable that we should expect by way of justification something more than an appeal to tradition or abstract moral principle. We may also insist that those who view the criminal law as a means of control in the realm of private morality, as in the abortion situation, should

carry the burden of justifying such interference with individual behavior. This I would submit cannot be done satisfactorily with respect to our current abortion laws. The plain fact is that quite apart from the restrictions they impose on what many physicians consider to be proper medical practice these laws do infinitely more harm than good. It is worth stressing at the outset that these laws are patently unenforceable. The abortion situation represents what one of a number of instances of what I had elsewhere termed crimes without victims, in which an attempt is made to control by the criminal law the willing and private exchange between adults of socially disapproved but widely demanded goods or services.

Prohibition was of course a classic example but current efforts to regulate prostitution, homosexuality, gambling, and drug addiction would all fall into this category. Now it could be objected that in the case of abortion there is a victim, that is the fetus, but from the standpoint of law enforcement consequences the fact that the transaction between the abortion seeking woman and the abortionist is a consensual one is crucial. Quite simply, for this type of law violation there is no complainant. Even the woman who has found the experience of abortion extremely distasteful and frightening, as illegal abortions often are, will rarely wish to bring a complaint against the person who has provided her with the operation she desired. Thus the problem of securing

evidence in abortion cases is a formidable one. Usually information about abortion come to the attention of law enforcers through the death of an aborted woman or through clear evidence of criminal abortion in a woman who has subsequently been hospitalized. It is sometimes possible through long term surveillance of suspects and a well timed, well organized raid to come into court with a strong case against an illegal practitioner but these procedures are extremely costly and time consuming and one should consider whether they represent a sensible disposition of law enforcement resources particularly in view of the widespread unwillingness of juries and judges to convict and pass harsh sentences upon abortionists especially those who have a

formal medical training. All that can really be hope for is occasional successful prosecution of a small number of the most flagrant and persistent violators. As you probably know in many jurisdictions a woman submitting to an illegal abortion also is guilty of an offense but these provisions are almost entirely unenforced. It's most unusual to proceed against a woman in such cases and conviction is virtually unknown. Far from curbing the illegal abortionist our present polices actually establish the economic basis for his success. As Stanford law professor Herbert Packer has noted, repressive legislation such as this establishes a kind of crime tarrif through which the

entire illegal enterprise is enriched and strengthened. Abraham Raunchy put it this way in a nineteen thirty-three study of abortion and I quote. "An endless circle was set in motion. The ready willingness of women to visit an abortionist brought him immense profits. A fraction of these profits made it possible to cause an abortion with a greater degree of safety to the woman and a smaller chance of exposure of either the woman or the doctor. This led to a further appeal to women who wish to bring an abrupt termination to their pregnancies and so the chain was complete." Furthermore many law enforcement personnel accept the fact that the abortionist is performing a socially useful service and are well aware of public indifference to strong enforcement of abortion laws. Under such

circumstances it's not surprising if officials find it easy, as one analyst has stated, "to convince themselves that there's nothing morally reprehensible in accepting bribes or protection money from abortionists." Some officials insists that there's no longer extensive police corruption connected with abortion but it is widely accepted that a fair amount does in fact exit. A reason account supposedly based on abortionist own experience states, again I quote, "one reason fees are high is because the patient must absorb the payoff to police and top officials. Abortionists tell of judges, lawyers, jailers and police whom they pay for protection some of whom have brought their wives, daughters, or mistresses to the abortionist. Graft is accepted by all abortionists as a necessary annoyance and

added expense passed on to the patient" end quote. Although some abortionist may be sufficiently well organized, cautious and mobile to persistently evade detection, it seems reasonable to assume that any abortionist who operates for any length of time undetected in a metropolitan location is in fact paying for protection. Given the widespread and relatively inelastic demand for abortion which generates somewhere between two hundred thousand and one point two million such operations in the United States each year, our restrictive laws simply divert abortion seeking women from legal to illegal channels. iIn many instances perhaps particularly among women of the lower socioeconomic strata, the first step is an attempt at self induced abortion which typically is either totally ineffective

or else extremely hazardous. The next step is to seek out someone will perform an illegal operation. At this stage particularly we see a major social dysfunction of present policy. The very close relation between the woman's socioeconomic position and the quality of the care she recieves. We know that social position sometimes influences a woman's chances of obtaining a therapeutic abortion. And some of the statistics Dr. Hall presented bear on that point. With respect to illegal abortions, the social class factor is even more blatant. In almost all cases the quality of illegal services bears directly with the woman's ability to pay. While a five dollar abortion performed by untrained operator is highly likely to lead to serious complications even death the patient who can afford

a high fee can most likely obtain the services of a skilled physician abortionist. I think we should give serious thought to the question of whether we can tolerate laws which impose such discriminatory variations in what is after all an area of potentially legitimate medical practice. All abortion seekers, whatever their social status, face a highly unpleasant as well as possibly dangerous experience. It goes without saying I think that a woman who is blindfolded and taken to a strange place where she must admit to a frightening ordeal at the hand of a stranger, who himself may be masked, is bound to find the experienced degrading and disturbing. There are of course wide variations

in the kinds and degrees of shadiness and sordidness to which abortion seekers are subjected. But except where an abortion is obtained as a favor from an otherwise legitimate practitioner or, in some cases of abortion, in a high priced abortion clinic considerable unpleasantness can be expected. The woman is extremely dependent and vulnerable. Financial exploitation is of course common but other types include even sexual exploitation may well occur. And pervading the entire proceeding is the woman's knowledge that she is committing a crime that technically she herself has become a criminal. Now it is true that some sophisticated women of means can go through abortions with a minimum of adverse impact on their self images. And

widespread belief that abortion should not really be a crime probably minimizes guilt feelings in many women. However knowledge of and cultural conditioning to the view that abortion is a crime, coupled with the sordid conditions under which the illegal operation often is obtained, cannot help but make for severe guilt feelings and unhappiness in many aborting women. Undoubtedly there are basic psychological processes that partly account for such guilt. A woman may indeed feel that she is in a way killing something that is part of her self. At the same time studies made in societies where less punitive abortion policies and attitudes prevail indicate that when the operation is legally and competently performed guilt feelings and post abortal maladjustment may be minimized.

Knowing the serious conditions which in most cases give rise to the desire for abortion and knowing the fact that relatively few women obtain such operations on purely frivolous grounds or without much soul searching and anguish perhaps we should ask ourselves whether it's really appropriate that such women be labeled as criminals. The case in favor of such stigmatizing seems to me to be very slight indeed. There are of course those who insist that any liberalization of current policies would be socially disastrous and morally untenable. The bases for such reasoning are not, I would submit, substantial and convincing. Most reform proposals urge nothing more than a

widening of the already existing exception for therapeutic abortion to include indications already accepted by leading medical authorities. And Dr. Hall has presented to you some of the reform proposals. I might just reiterate the wording of the American Law Institute model penal code proposal which is one of the most influential. A licensed physician is justified in terminating a pregnancy if he believes there is substantial risk that continuance of the pregnancy would gravely imperil the physical or mental health of the mother or that the child will be born with grave physical or mental defect or that pregnancy resulted from rape, incest, or other felonious assault. And then there are some additional explications of that and administrative points that are gone into also. It should be emphasized and

considering such reform proposals that such new provisions in the law would be purely voluntary. Abortion simply would be permitted in such cases thus, as I've indicated, bringing the statutes into line with prevailing medical opinion and probably with public opinion as well. Such a modest liberalization of existing law hardly seems to constitute a drastic change which might, as professor Bern has suggested elsewhere, somehow weaken the moral force of the law in our society and which might be, and I quote, followed by an even more far reaching break down in public morality. There's little basis for believing that a vast increase in the abortion rate would follow such reform. We do not know definitely just what would happen to the overall and illegal abortion rates under a

liberalized policy. There is some dispute, for example, among students of Scandinavian abortion policies as to whether liberal legislation there has or has not appreciably reduced the incidence of illegal abortion. It is quite possible that with broad indications for therapeutic abortion, the overall abortion rate would increase somewhat and also that a fair number of illegal abortions might still be performed. However it does seem reasonable to assume at least that with such a change a vastly increase proportion of abortions would be performed under optimum conditions. Furthermore liberal abortion legislation may be accompanied, as it is in Scandinavia, by educational guidance and welfare programs designed to encourage child rearing. And there's every reason to believe that increased knowledge of contraceptive techniques will operate

to substantially reduce the demand for abortions. Though obviously some types of cases will persist. Certain observers seem to feel that liberalizing abortion laws will in some manner open the floodgates and lead to widespread sexual immorality. Yet surely realism suggests to us that few women who do not now engage in premarital or extramarital relations would rush into such behavior if only the indications for therapeutic abortion were broadened. Indeed considering the rapidly widening knowledge of contraception availability of abortion should become an even less significant factor than it now is in influencing sexual activity. Let me emphasize that no

responsible person views abortion as a positive good to be actively encouraged. Abortion should be kept to a minimum and when necessary performed under proper medical auspices. As I have tried to indicate, our present laws simply make the problem worse rather than better. We're all mindful of the fact, I would assume, that the value of life in some form or to some extent at least, is always involved in considering the question of abortion. But this has not mean that the moral issue is a clear cut and simple one. Even if we were to assign a right to life to the fetus we would also have to consider the life, health, and sanity of the mother and in some extreme situations the reasonable prospects for health and

happiness of the child. Actually of course individual decisions on these issues are being made continuously by the hundreds of thousands of American women of all social classes, races and religions who feel compelled to attain abortions each year and who are not significantly deterred from this step by our repressive laws. Under these circumstances the real moral issue here it seems to me is simply this, how can we best adopt a sensible and humane approach to the practice of abortion. An approach which recognizes the widespread and often legitimate demand for terminations of pregnancy and which at the same time seeks to minimize the social harms now often associated with the performance of such operations most of which are not inevitable but rather had been imposed as consequences of

present public policy. Assigning to the abortionist, rather than to the medical practitioner, the task of managing the significant medical problem is, I would contend, morally evasive as well as socially disastrous. [applause] Our next speaker will be Dr. Hal Rosen. Dr. Rosen. Thank you. We have just heard two speakers who, without using these terms, have indicted our present abortion practices as well as our present abortion laws, as the hypocrisy of our medical,

of our legal, and of our lay mores. Now if these charges be true then it behooves us to investigate them in detail and to give them the thought and consideration they merit. If these charges be false then they should be be repudiated and rejected. We need in order to discuss this, in the detail it merits, to consider how charges of this type have been made over the years, who has made them, and who is involved. We need to consider who gets abortions, what hospitals give them, where they're obtained, the stated and the actual reasons for them, who performs them, how much they cost, and what the legal and non legal aspects of this happen to be. Now to consider some of the earlier statements charges were made as far back

back as nineteen thirty six, thirty years ago this month, when one of America's greatest obstetrician published a book on abortions. I'm referring to ?Toucy? who in no uncertain terms spoke about the flagrant, open, and universal violation of our criminal codes. And by implication he castigated the abortion laws. More recently in nineteen fifty-five the state's attourney in Chicago stated that he was convinced that the vast majority of the medical profession as winking at the state abortion laws. And in exactly the same year, in nineteen fifty five, in the ladies' home journal our abortion laws were castigated as the hypocrisy of modern medicine. Four years later in nineteen fifty nine in red book, Dr. Alan Guttmacher the chairman of the Department of Obstetrics at the Mount Sinai Hospital here whom Dr. Hall

earlier had mentioned, stated that the abortion laws are the laws that most physicians disobey. And he added that these are laws that make hypocrites of us all. And in exactly the same year but one month later Dr. Nicholson J. Eastman, in that time time chairman of the Department of Obstetrics at the Johns Hopkins University School of Medicine and now Professor Emeritus of Obstetrics there, made this statement, and I'm quoting. "These laws may have had some pertinence in the eighteen hundreds, but they have no pertinence whatsoever medically today." Now we are talking about noted physicians and what they've said. We need to consider this therefore. Dr. Hall has commented about the abortions performed in hospitals on a therapeutic basis in this country. Somewhere between eight and eighteen thousand are performed each

year. Figures vary. Now of those that he had mentioned, a few hundreds, or perhaps more than few hundreds, were preformed because women contracted a specific kind of problem during their pregnancy, rubella for instance, or there was a radiation to the pelvic organs in cases of unsuspected early pregnancy. Now these abortions were performed, not in a, what should I say, in adherence to the laws of the states in the states in which they were performed, they were extralegal, because the laws of no state take into consideration interruption of pregnancy for eugenic reasons. Now there are, I think, eight states that do mention the offspring. There are eight states that do make it legal for physicians to perform abortions for

the sake of the life of the mother or the fetus. Now I don't know how they can do this, I don't understand how you can abort a pre-viable pregnancy for the sake of the life of the fetus. You can't kill the fetus to ?abort it?. You know one of your neighboring state has this by the way, Connecticut New York does not. I can list the states if you would want it, but the nonsense, the arrogance and the inanity of the laws of all fifty states can best be seen by the laws of these eight states that word it in different ways. Let's continue though. There were a few interruptions of pregnancy, if i'm not mistaken, because of patients who had rheumatic heart disease with a history of previous cardiac failure. So far as I know that's the medical indication, if we interpret some state's laws rigidly,

because that's the only condition that I know of in which without interruption, the mother may die. Because of the advances of medical science, during the last twenty years, almost any, a patient with almost any other physical condition, if she wishes to carry the child to term and if she has all the resources of modern medicine brought to power to carry that child to term, will carry that child to term. And so practically every interruption of pregnancy for medical not, including psychiatric reasons, and any prestige and un-prestige hospital in this country during the past year, has been, with few exceptions, in violation of the laws of the individual states within those which these hospitals are located, if those laws be rigidly interpreted. Now there are other medical, including psychiatric

indications. The life of a mother, according to the laws of some states, is the only factor, so we have to consider the vast majority of interruptions for psychiatric reasons. As Dr. Hall has mentioned, the incidence of suicide among pregnant patients is less than that, when we weight statistics, to be expected from a population at large. It's very low. ?Ecblad? in considering suicides in Sweden, listed it as eight percent of the pregnant population on autopsy. For the years between nineteen twenty five and ninety four four. Fisher, the chief medical examiner of the state of Maryland, has found only one case in seven hundred suicides. In my own series of follow ups of patients for whom the recommendation of therapeutic interruption was rejected, there was only

one suicide among nine patients. The suicide was preventable as are all suicides, to a large extent at least among pregnant patients, a woman can be put in a psychiatric hospital or can be put in jail and watched carefully until she delivers and if all that we wish to do is prevent interruption of pregnancy among pregnant women, all that we need to do is to jail them. [laughter] And believe me I am not being callous. I'm speaking in accordance with what I think the law of most states, rigidly interpreted, demands. Now lets se what the actual practices are. I've commented about physician statements. I've commented about suicidal rate. I've commented about therapeutic abortions. A legislative

hearing in California, a short time ago, considered a minor liberalization of the California state statutes, if rape were involved, if incest were suspected, if the organic condition of a mother warranted it, if it were dangerous to her health, or if perhaps there would be severe organic disease in the infant, then the problem was that of liberalization of the California state's statutes. Three quarters of all the physicians who testified, stated that these were the policies being followed in their hospitals, and it was for this that abortions, therapeutically, were being performed. I'd like to emphasize that. You notice that this merely legalizes the

reasons why abortions are performed in California. And it would merely legalize some of the reasons why abortions are being performed in New York City as well as some other states of the Union. For they are performed, whatever the stated reasons are, and the stated reasons sometimes are nonsense medically or psychiatrically, they are performed, in cases of incest, in cases of rape, because of the severe emotional or medical disease of the patients, or for socioeconomic, eugenic, and humanitarian reasons and the physicians who state that they are not, either do not know what they are talking about or are as hypocritical as our state enforcement laws are. And some physicians are hypocrites and some are honest. Some lawyers are hypocrites, and some are honest. Some jurorists are hypocrites and some are honest but the whole attitude towards our abortion laws are about as hypocritical as it can be. And I would like to emphasis that as I

get into the problem of criminal abortion. At least two thirds of all the physicians whom I see, obstetricians, psychiatrists, radiologists, dermatologists, and others, at least two thirds of all the lawyers whom I see, be they judges or merely practicing lawyers, at least two thirds of all individuals whom I see, who wish psychiatric investigation in order to determine whether the pregnancies of their wives or their daughters or their sisters can be psychiatrically, can be interrupted for psychiatric reasons, at least two thirds of them in advance have made arrangements for criminal or illegal interruption of those pregnancies if the psychiatric recommendation is not possible. And we can make that recommendation only for

psychiatric reason. And I'd like to emphasize that. This includes judges, it includes members of district attorneys staffs, it includes one priest, it includes rabbis, for his sister, it includes ministers. what ?Tolsic? called the open and flagrant and universal violation of our criminal statutes is present. Now I don't know how many people are here this evening but in each row in which you sit there will be at least three or four who in their families at sometimes in their lives will have an abortion. And I'd like to emphasize that. Now this sounds like an incredible figure. Let me get into the problem of criminal abortion for a moment. We need to know what the figures are. And of course there are no good figures for

this. But there is some figures that we can at least utilize. Some figures that are, at least slightly, what should I say, thought provoking. Now first of all I'd like to comment about criminal abortion, illegal abortion. There is no difference, unless infection be present, between spontaneous legal and extralegal abortions. No body can tell the difference. Secondly, when it is done, when the abortion is performed by a competent medical man, by a competent medical man let me emphasis that, not by a botch where are you carrie let me emphasize something else and a pregnancy are most pregnancies can be interrupted anytime between consumption and that the twelve months i mean they probably i'm sorry oh yeah

they provide medical care but actor leo laporte and i prefer to use that are performed for the same reason as are the same reasons aren't illegal and we are not accepting that interruptions are legal experts before we find out the united states is dr hall said about to figure to have great out of every ten pregnancies end and have a little support and these figures are fairly are your values you have in most of the rest of the world may have nothing whatsoever to do with the

religious tenets and marlowe up the particular culture aside you know whitey and patrick healy twenty seven percent of all women's hair day dr pryor the number of buyers well another country is reporting the united states and the twenty fourteen twenty five years there is new york but that's

the problem now we consider the best number of abortions reduced the problem of who for most abortions are performed on married women the creative very important to her furthermore a great many of working to perform on women and later on his side to have another job opportunity applying and who got out and who rear and we're well that ohio is it seems to me a crime report the problem not a criminal court in the problem of what can be done and for me myself or luster says one way or another what is

already there our recommendations without realizing what we i haven't seen anything about an age to be i'm is really has everyone else that i've never written an article twenty nine patients for psychiatric evaluation for her treatment twenty nine patients have their psychiatric help them live in areas of one or three years after the attack particularly a lot of the nineteen eighties giving away was one of the motivations of the precipitating event in the psychiatric

patients patients who might not have been reporting in an article known publication which look we're within a few weeks in the western reserve lord we are forty four patients who are pregnant thirty seven spoken almost the same were those thirty seven very adamant i am very indignant a result that will pressure even to have anyone talking in terms of adoption of job well as an eighteen year old hero had been right before another was a taxi driver who oppose the sister of a position of what was a white woman and i'm always you know one was a white with yours as well they refused to

consider this basically that it was not what would happen at the end of that was important was what that was doing to them right now the minister characterized his wife is a warm person none but think in terms of a current backup or nine months of giving away with a mix of things in this country that we don't take babies away from slavery anymore and they compared that the slave market and i like to give it to you for your consideration women don't likely leave their babies and baskets on hospital doorsteps police stations will likely give babies a lawyer well i think they are and that is a problem so bars are a home there are precarious

concern we all know that this has never been the solution we can go into that and the comment about oppression about consent is not the solution that they were to get one of the rotation of the law we in the medical profession have interpreted present laws so that we instead of that moralizing unlike the more reactionary than they are we have to use certain procedures some of us to prevent abortion thirty ones even when they may be indicated and the reporters typically comment about that indications are at great prices an important word responsibility originally this was a very progressive i disagree with the call this record former think what it's a finding healing move the president delayed after the

expense probably not it happened very very quickly as a not uncommon practice in new york city working just as it's not an uncommon practice in washington baltimore in chicago in philadelphia absolutely and we do not say that a patient needs an appendectomy patient needs a polish respectively after one surgeon recommend another certainly going to check on that search in the city recommended that i recommend that a poor be appointed by the hospital sussman a pediatrician and obstetrician an internist a psychiatrist and sometimes someone else who might take weeks before they can be

wrong that will consider whether or not the recommendations of the two surgeons were before and i feel very strongly about that i agree with the recommendations that the previous figures that the where are you are you i regret regretting that recommendation which has more liberal interpretations of the liberal interpretation of the abortion wars mattel and that when we think in terms of light we don't necessarily speak in terms of the immediate life and health of the individual props

there's no question we've made this recommendation but it would be repudiated but nevertheless is no our laws even in a more liberal states like maryland are some of the others are laws that they were originally applied within the civilization of ancient bargain but which would be true reactionary for the more progressive democratic civilization aisle happens at the time the parties are stuck they do not apply in present day america as you have pointed out they are not except that they are not enforced or in portugal and nobody at any prestige hospital does abortions therapeutic might recognize they are on board with us in mind i would like to read just the concluding paragraph of the other or we are dealing with mature

human beings we shall be or should be accorded all the dignity the law otherwise allow secure human being women in our society are no longer attack our question was how long they will usually that sometimes they listen they always inadequately help keep them so if you're a little consideration out mother children families is i would lead us not more liberal abortion laws but we relegate them mature women were quote respect and dignity accorded mature human being should have the right to decide whether or not they wish that carry a specific pregnancy that her the responsibility and the decision right or wrong is where the actor diego a portion rate shows that they illegally already as st louis we can assume a legal abortion as a medical

procedure adviser one indicator grammatical including psychiatric reason i'd prefer no you associate likely socio economic and humanitarian reasons as well it should be taken out of our present medical and that a particular problem for women are not human beings the accord and even by lawyers the peak or foreigners it may seem to you tonight that i stand

against the verbal flamboyance of opinion which is all one mind on legalization of our abortion laws and this is not the fact there are in fact two different groups among liberal lines there is one group that will say that abortion is a resident evil very interesting i think perhaps back to sure reflected this point of view when he said let me emphasize that no responsible person views abortion as a positive good to be actively encouraged abortion should be kept to a minimum and then on the medical loss views on abortion there is

maybe he's right as long as these problematic a prestigious position and the city declared not so long ago that that society would be utopian an enlightened which would permit a woman an abortion whenever she wanted it now i think that these two groups that share very little in common event and i think with the first group i share a great deal in common now we are both i think greatly concerned about the the great number of abortions are performed when they be characterized legal argument and i think we are all interested in finding ways to minimize abortion whether they be legal or illegal when i couldn't do that their weight is not the right now let's hear about

what will happen to the illegal abortions the liberalization of the market wants to convert the three speakers the generic term that no a similar statute on what the same statue a little more detail that was an act in both denmark and sweden after fourteen years of experience and denmark leo orphans had risen from five hundred and five pounds after fourteen years illegal abortions were estimated as high as well right and sweden where the same level as it was about that specifically first then the tie all increasing illegal abortions or a somewhat longer period of its very narrow or the reduction in illegal abortions could be fat and both countries claim they were

angry now one thing we are safe and say like in statistics on illegal abortions anywhere we can only estimate one thing we do have statistics about what real estate agents say that in every country where a liberalization has occurred in the last twenty five years so beyond that in the last fifty years the overall rate of abortions has risen dramatically now you heard japan mentioned in japan is now estimated that abortions induced abortions are outnumber live births ratio or perhaps now we've been hearing horror stories we tell you what about heck let me tell you about a pregnant woman who went to a hospital for medical advice was anesthetize and we're walking up toward him

now this is in a way an everyday occurrence perhaps the first player that occur once were telling our stories let's tell the other side let's go hungry complete disregard for the fetus the reason for that he says the knowledge of and cultural conditioning believe view on abortion is that aren't contributing part two severe guilt feelings in many a board and women at least the book that as a partial port well isn't necessarily or a conclusion that the same cultural invasion conditions of the women not the second ward and if this conditioning is disappointed logical abortion

in a country where we have the estimated value well one and a quarter million abortions per year illegal and eight to eighteen thousand i should think more like a legal abortion eight thousand illegal abortions every year well the stop and think that we have a million and a quarter illegal abortions for that before liberalization every statistic in the case we will have a million and abortion illegal illegal abortions tomorrow apple mobilization with these revelations the market was doing well now we have a million two hundred and sixty eight thousand overall abortions that it for liberalization what we have to mark two million your guesses her mind but it will be a great deal more than a million in order now i know we've lived here on this we already knew about writing

award and this would say not to be that you were the polio are really pilots clearly iran something else a much addition to mention let's ask ourselves what it is we actually now let's not bandy about the aisle what is we are going to restore that in the early stages of pregnancy the fetus was a vegetable or part of a mother and a progress in scientifically the visible stages from vegetable through animal to human no more recent theory is allowing just tell us that the league is that the fetus that emulates the process of evolution of mankind saw that a very early stage of a pregnancy over sometime thereafter it is so human it really varies

we are part of all of the detroit rapper were not in the visible leaves and bam from the moment of conception throat quickening viability through her and then the trial we know it would seem that the very moment of conception of the inmates was bobby alternate post daily show while musical intelligence now back to re see my edits like dr myers clinical professor of obstetrics and gynecology university of california los angeles port of this way the embryo or fetus maybe i'm calling what is indisputable a complete and integrated in terms of its

essential elements that report nothing but food to grow in terms of a permit for the moment to maturity the number is probably going to be person is individually get back in session if this person is going to be a musical genius because a musical talent and the talent is there at conception actually really rose and about your heart through musical training that led to the great genius so yeah project i think we have to change it a little bit yeah yeah not from the moment of birth that arbitrary measure won from the moment of conception is not strange or maybe no not strange to be the law or

medicine the international code of medical ethics at a very general assembly world medical association about the nineteen forty nine contains the statement a doctor must always bear i'm on the importance of preserving human life in the time of conception until that qualitatively human from conception until that at all in a case involving a prenatal injured in the civil case when it was flying that at the time the injury was inflicted no person was in existence in the third month of pregnancy this was said by a court in nineteen thirty three you want to be safe in this respect and saying that legal center ability should be good when there is a biological separate don't know something more than the actual process eva inception and the limo now than what some of the common law cases with a song from the early days and what we know makes it and that makes it possible to demonstrate clearly

upset her ability begins at conception that is a legal entity what the legal rights leaders that the right to be awarded is a civil right of the pregnant woman is this that as far as i know in our jurisprudence i hope never enters into it no one has ever had a civil right to destroy another innocent human life quite the opposite every innocent human life is entitled to the equal protection of the law foreign goods and services unless we began to look again at human beings this happens and boredom nara morris haven't answered to say that this

law repeal of this law will not force anyone to have an abortion or an opiate repeal of a lauren child abuse and forced parents to be vigilant repeal of the law against robbery forced anybody rauh the nature of the crime the war is not to mandate with to forget where it is socially i was a socially hardcore i'm reminded the mortality rate maybe among women who have illegal abortions illegal that the mortality rate in any abortion among the unborn children is one hundred percent and i think that anytime we have one hundred percent mortality rate concerned with deliberate destruction of human life we have something socially harmful they matter

there's a reason for liberalization preserving middle well as joe psychology how about the murdoch in and dr rosen of the boat said this there was his impression a pregnant woman are more apt to make a satisfactory recovering from si postseason do so more rapidly incomparable patients who are not right sounds of writers tell us that inevitably maybe not immediately but inevitably the psychological sick while i working on what's worse then when i went before now scientists agree that some say this is not always the case that cannot make a general statement that like that and some say that is the matter are weighing a measurable factor perhaps

rhapsody and psychiatric community what he what the chairman of the party of psychology at the university of san francisco so that long ago in some respects the psychiatrist is in a position somewhat the back of the obstetrician in twenty or thirty years ago who was faced with choosing the simple procedure of abortion or developing new techniques and chose the latter now i think perhaps it was a commenter that in certain psychiatric situation for all that and the water to what is an abortion or jeff watts is that commentary not an abortion now a grandson that psychiatrist thomas we should take into effect socio economic conditions which seem to a bit of the family and to which a child be born which seemed to account for about ninety percent of his estimated family of origin

the opera for socio economic reasons not the hardest for socio economic reasons which ranged from inconvenience so far and we actually this whole area near an area in the socioeconomic by some psychiatrists that this is part of the total mental health problem of the woman the other survivors tell us that meant taking into consideration such matters the psychiatry is evolving is all moral situation in connection with socioeconomic reason that tolerates enough for an abortion but somehow the poor have to go to why would they don't get it while we had her argument in a number of areas these days i should think that we can operate the conclusion that average man wants to avoid the law he

didn't do it with more hostility than obama personally i think where that discrimination is to be found is in this that the rich man is jon will not be aborted or what the poor man's trial will be important the rich man of the stakes and abortion and his trial will be violating all the format will not now where is the discrimination it seems to me it is in meeting our the protection of a lot to unborn children based upon the socio economic circumstances of their parents you get into a border issue liberal abortion legislation may be accompanied by educational minds and welfare programs designed to encourage trial are you really why the package deal like that we have a ladder without before says is only estimate

of the whole package deal of abortion in compulsory sterilization now he also says that it contraception abortion now i asked those organizations who are roughly a good job and they feel that if they're interested in promoting my perception consider that that we are not yet they let contraception even among the poor who express the thought that they do not want more children those were engaged in ordering impact except the advice find it difficult to persuade them to use the contraception it even more difficult for hillary the answer the socioeconomic problems i think that in japan where we ought all that one was looked upon as an

alternative to the other and in fact people are careless and there's no need to be careful he could always have an abortion i put it to you that perhaps that moment for use of contraception contraceptives will be for that why wider acceptability of abortion and i also caught your attention now i don't think any of us have in mind as they limit the number of children in any particular family that's not be at the end i think is the human dignity that is the family unity the family dignity several abortion and i would also point out that when we're talking about abortion so to economic reasons perhaps we would not have an ad and i perhaps we would not have had a job

families ranging from nine to twenty children and get arms and force circumstances if these were reasons for abortion now the hornets won a moment and would matter is writing and says it's very hard for me to stand up here and we have the story of eleven year old girl who was right and then say to you that we cannot have an abortion that we have compassion natural competitors like a girl we do not the course we cannot see the child to not react with in the same way it doesn't look like the job why people but we want to protect perhaps to weaken any of fortunate than i'm complainers are the ones that award with historian who wrote that certainly will protect the writers when we say that he cannot be

right right that would be that the kidnapping to give you a kind of a reasonable doubt we're beyond reasonable doubt the trial rowing and the plight of its major incentive for its growth is not guilty and grow their audience and i admit it i supported the hard to know when a criminal is let loose on society on a legal technicality that overwhelming evidence was illegally searched illegally seized but we gardeners right jealously and rightfully so one of our party the most is huge anti abortion is proposed as an independent grant independent of any mental health problems of a mother an independent

ran for terminating a live solely because prospectively it will be effective now because i suppose is the final solution to know who the defective child problem but i think we want to have better solution why don't we have our march of time for rubella or why don't we know more about these diseases why are you studying harder isn't that the answer i can hear you i'm going to be challenges the answer that would save them a gift of fine you're the answer to social economic ills is to find ways to do away with the socioeconomic go maybe it's a way to take the easy way out

these days i don't think that is what we're looking for the greatest who is it that you are committing to be still buried his votes story one side to another about determination or private sale went through journalist the second guy with earns before or soderbergh there was what would you have done in the other that pregnant then you wouldn't kill radio that musical talent was established that conception stories what that seems to maybe is not that the abortionist one million illegal abortions occur it seems to me that

our story is that there are one million abortions but there are one million abortions don't want to minimize the number of abortions changing all do it it seems to me it is the function of the law however in that situation and say to the community at large that we have a general consensus in this country that innocent human life is ineligible and we that is a lot of intention demonstrated particular application of the general consensus by law well president of precedent that we have overturned the culture of an entire segment of our population we're poor and socio economic dislocation when that's the murder

of wives of all or sleep and consuming i've been sewing procedures an unwillingness of judges and juries to convict who teach the application of the consensus principal at or men are created equal and i offer you is an alternative first of all let's unite were direct attack on whatever reports on the wars whether the socio economic disadvantage or whether the mental illness or what i'm just not going to do away with abortions while to get that no more than the boy gets murdered going to get away with murder what i would ask of all segments of society now bring to bear on these powerful forces that apparently are involving abortion is you bring them to bear the education of the public and the dangers of abortion onion desirability of abortion at most the war on the humanity a lot of being you know

we approached this as a civil rights matter which i think it is then i think we have a much better and more humane answer to the problem of work it's bleak