My Heart Hurts

I’m really, really, really tired of being in school. No, mom, I’m not having a mental breakdown, I’m just worn out. Have you ever read something that made you feel sick to your stomach? Make your heart ache? Well I have and rather recently too. I knew I was going to have some difficulty when my health law class got to “reproductive rights,” I just didn’t realize that it would make me feel physically ill.

The first reading was chapter 3 of the book called The Law and the Public’s Health. The chapter discussed government powers and the right to privacy rulings from 1965 to 1990. Pretty broad, a little left leaning but not obnoxious, and fairly informative about cases like Griswold v. Connecticut (1965), Roe v. Wade (1973), Doe v. Bolton (1973), and others, which have been used to shape judicial jurisprudence and precedence. At the end of the chapter the author notes the loss of using “fundamental interest” in the language of abortion rights cases, which was essential in making them so important in earlier cases of privacy law formation. I was actually encouraged by the authors last sentence of the chapter (although I’m sure they weren’t):

The resignation of Justice Brennan following the 1990 term and the appointment of his enigmatic successor, Justice Souter, as well as the resignation of Justice Marshall in 1991 and the appointment of his successor, Justice Thomas, only added to the uncertainty concerning the constitutional status of abortion in particular and privacy in general. (p. 80)

My second reading was the actual opinion of the court given by Justice Blackmun in the Roe v. Wade case. I actually found the particular arguments (holes included) to be rather interesting and thought provoking. It was also interesting to read how the decision was come to by the justices as they considered ancient attitudes, the Hippocratic Oath, common law, American law, the opinion of the health fields, and other things. I really do recommending reading it at least once, just so’s you know what it says. So, while I disagree with the outcome of the actual decision and that the Justices were out of line, I appreciate the fact that everything is spelled out so succinctly.

It was when I got to the third reading that I started to feel sick. The last article that I read came from the American Journal of Public Health and was entitled “The Supreme Court, Abortion, and the Jurisprudence of Class.” The article started out ok as it was outlining and discussion in detail a decision made about a case in Pennsylvania: Planned Parenthood of Southeastern Pennsylvania v. Casey. Now I have no fondness for an organization that was based (and in my opinion is still based) on the ideal of eugenics, but the case and the rulings were rather interesting.

Apparently there was a Pennsylvania statute that was being challenged in the case which did not criminalize abortion (as many previous challenged cases had) but instead the statute simply “imposed conditions on obtaining abortions” (Mariner, 93).

These provisions require that a woman be given certain information about abortion and childbirth, that she give her informed consent at least 24 hours before the abortion is to be performed, that a minor may not obtain an abortion without either the consent of one of her parents or a judge’s decision that she is mature enough to make the decision alone or that the abortion is in her best interests, and that records of abortion be kept and, in the case of publicly funded clinics, be made public. (93)

These provisions were upheld by the court decision and a fifth one, which required a married woman to certify that she had notified of her intent to have an abortion, was struck down (personally I think that if a couple makes all other decisions conjointly, shouldn’t it follow that they would discuss and decide this together too?…but anyways). This was of sorts the background and preamble of the article. So far so good, right?

Then I kept reading. As I did it became apparent that I was reading a paper of a very far left, knee-jerk opinion and that the author, while analyzing the case, obviously disagreed with the decision that the Supreme Court made. Ok…fine…I don’t agree with the original ruling that permitted killing children in the first place, but then the author started giving her reasons for disagreeing and that’s when I started to feel a bit sick.

First of all, let me reiterate that there is no record of words in the Constitution that states that “government does not have the power or authority to interfere with certain individual rights” or of a “realm of personal liberty” (94) in which the government has no right to interfere or regulate. A lot of these assumed rights to personal liberty come from due process laws (found in the Fourth and Fourteenth Amendments) and the abortion “rights” in particular are said to come from the Fourteenth Amendment, which actually says in section 1 that no state shall “deprive any person of life, liberty, or property, without due process of law.” (I have a copy of the constitution in a reader for the class…so I don’t have a reference right off the back for you to link to).

Now that my first official tangent is over, let’s get back to the article. The author says that no “significant new facts about abortion have been discovered in the years since Roe v. Wade was decided” (94) even though there has been a growing opposition to the decision. She then states that because of the past decisions about abortion, that there has been a growing

reliance by the social community on the liberty protected by Roe v. Wade that would render its rejection so disruptive to the social fabric. People have ‘ordered their thinking and living around that case,’ says the joint opinion (of the case)….Control of reproduction has been seen as the fundamental building block of women’s social progress. The availability of abortion, whether or not one would wish to take advantage of it, has been a reassuring symbol of personal integrity in a country whose Constitution contains no explicit statement that women have the same rights as men. (95)

At this point my jaw simply dropped. I had no idea that I was reassured of my personal integrity in the workforce based on the ability of women to chose to have an abortion or not. I was under the impression that integrity came from honesty and being an upright person with high moral values not a pseudo-right to get rid of an unwanted pregnancy. I do believe that women should have equal opportunity in the workforce and that includes not penalizing them when they do have children, but that doesn’t mean that abortion has been my social building block for joining the workforce, or the academic world for that matter, rather the building blocks are from the Nineteenth Amendment, which gave me the explicit right to vote for people who support my views and for laws that protect my rights to life, liberty, property and due process. If the Constitution needs to say something about women having equal rights as men then we need to amend it. There is a process; let’s use it.

The “right” to have an abortion, on the other hand, has got to be one of the most selfish things that I’ve ever heard of and it is not a source of reassurance for me that women are permitted to think of themselves over anything and anyone else. If we agree with the rights to abortion, why not infant abandonment as the Greeks and Romans did so long ago and which is punishable by law today?

When I read a little further the author discusses that the court opinion rejected the format of the trimester system and simply supports the viability of the child, which is the ability of the child to live outside the womb, as the dividing line between a “woman’s right to choose and the state’s authority to intervene…

…If the state’s interest in protecting fetal life can justify some limited regulation from the beginning of pregnancy, then the state can act to discourage women from choosing abortion at the time when most women are in the midst of this painful decision. (95)

In fact, the court supported the state’s power to prefer live childbirth over abortion. This actually made me quite happy and I rejoiced that I might be able to protect unborn infants using my constitutionally protected right to vote for people who represent my beliefs about the preciousness of the lives of all children.

I kept reading and didn’t get stopped again until I got to the last section of the paper: the conclusion. Having recognized early in the article, I was not surprised to read the first line: “The Casey decision both protects a woman’s liberty to choose abortion and permits the state to make it more difficult for here to exercise her choice” (98), though I don’t see where regulation and full disclosure of what abortion does to a woman psychologically as well as physically (including increasing her later chances of not being able to have children) is a bad thing. It was the next major section in the conclusion that started to really get me irate, however:

More states are enacting new restrictive laws regulating the performance of abortions and informed consent, testing the limits of governmental power to influence a woman’s choice. Women will need help complying with these new laws. In addition, since both the number of abortion providers and the amount of insurance coverage for abortion are declining, women will need more assistance in identifying providers and paying for abortions. The public health community is well suited to offer necessary aid to women in need. It has the knowledge and ability to organize and strengthen necessary services. Moreover, it contains the expertise to assess whether new laws create undue burdens on the exercise of choice—that is, whether women are being deterred from acting on their decisions or otherwise burdened because of waiting periods, residency requirements, judicial bypass procedures or other restrictive regulations. (98)

Now here’s my first comment on this one, and I’m sure the author would completely disagree with its relevance: what about gun control laws? If we can restrict who can and cannot restrict people from buying guns with waiting periods, residency requirements and other regulations in order to obtain a firearm which could potentially injure or kill another person then why in the would can’t we use the same procedures to deter the onset of abortion which is crippling our nation and stagnating our population growth? And if you think of it in the light of when life is really life, then what right does a mother have to abort a mass of cells that, if let to their own accord in the womb, would grow into a healthy infant in most cases?

Earlier the author discusses the ideas surrounding the 24 hour waiting period where the woman gives her consent to having an abortion and basically said that it discriminated against poorer women who might not be able to come back to the clinic the next day. She said that the waiting period in essence is for all practical purposes a denial of a poorer woman’s rights to choose to have an abortion causing her to suffer an undue burden of going out and getting on Medicaid (which has a special program for pregnant ladies by the way), carrying the baby to full term, and giving birth. Heaven forbid that she have to keep obviously the unwanted child (although a lot of women who do end up carrying full term and giving birth tend to keep the babies after all…something about forming connections with the unknown mass inside their uterus or something). There is always the option of adoption, and if you ask an infertility patient about abortion rights, I wouldn’t be surprised if you got punched in the nose.

The biggest thing that actually made me angry was the idea that as a public health administrator, it might be my suited duty to make sure that these “underserved women” be able receive the necessary health services of abortion. Doesn’t that just make your stomach crawl? This next and last section of the article, however, almost made me throw up and indeed did make me not want to do any more readings for my classwork. Here it is:

Public health professionals should share the joint opinion’s vision of the Constitution as a covenant promising liberty for all. It is this liberty that protects the “health values” that, as Dr. Mervyn Susser noted, guide the public health field. But if public health professionals are true to their health values, they cannot be satisfied with the jurisprudence of class. They must act to ensure that no one’s health is threatened by lack of access to important health services, including abortion. (98)

Did you gag? I sure did as I read it again. I perfectly agree with the first part, that the Constitution is a covenant; it’s a covenant between a government and its people – a social contract if you will. People give up some of their rights in order to receive the protection of the government. The government gets the right to set policing limits and to regulate things that are affecting the public as a whole. A couple of examples would be taxes and driving regulations. I do not agree, on the other hand, with the idea that in order to be a good public health professional and advocate, I am required to ensure what someone else deems an important health service. If I were to be a true advocate, why would I not advocate for the child who never has a voice or say in the matter instead of the woman, who seems to be thinking of nothing but her circumstances?

We do have problems with lack of access to important services like general wellness exams, hospital treatment, chronic illness treatment, dental and vision services, childhood screening, adequate immunization for underserved populations (like immigrants), etc. Some of these are blocked by lack of resources, money, and even things as simple as language and cultural translation between physicians and families. We have so many real access issues that affect the entire population, and I think that until we can work up some solutions to some of the other gaping problems we have to health care access, we need not worry about whether enough people have access to an abortion. These other issues are needs. If abortion is about a choice, it can wait.

As sick as the article made me feel at the end, I looked to see who the author was again as I had not looked too closely at the beginning. Wendy Mariner, the author of the article, is my professor. And now my heart hurts again. I am counting down the days until this program is over so that I can get out there and be an advocate for what I truly care about: moms and kids…all kids: born, unborn, well, sick, or handicapped. I’m so tired of being in institutions that spout bilge about “compassionate” liberal ideologies that only serve selfish purposes instead of really getting out there and helping people get back on their feet and finding hope in life. We need to do both: hand out fish to the starving as well as teach them how to fish and cook and clean and take care of themselves and their families. That is where true compassion and advocacy lies – in the thick of things, with the people who need a voice.

[Mariner. “The Supreme Court, Abortion, and the Jurisprudence of Class.” American Journal of Public Health 82:1556-1562(1992)]