In Mother Jones today, Kate Sheppard has the news that Dr. George Tiller’s abortion clinic in Wichita, shuttered after he was murdered at his church in 2009, will be reopening under the leadership of Julie Burkhart, who worked with Tiller when he was alive. In Burkhart’s conversation with Sheppard, she says that she decided to reopen the clinic in part because no one else would do it, and because she wants to reframe the debate about abortion care. “I think abortion is about motherhood,” she said. “Abortion is about motherhood because by and large women coming in to have abortions are concerned about the kind of life and the future for their children. Women are thinking in a very responsible manner when choosing that.”
These are important points, and ones made at greater length in one of the best documentaries I saw at the Sundance Film Festival in January, After Tiller. By first-time directors Martha Shane and Lana Wilson, After Tiller spends time not just with the four remaining doctors in the United States who are willing to perform late-term abortions—Burkhart’s clinic will not—but with many of their patients. It’s a set of perspectives that rarely enters the national debate about the legality of abortion procedures. The testimony of women and men who badly wanted children who have grown too sick to survive, and of doctors who help them when almost no one else will, may not convince the people who protest outside the four doctors’ clinics, and for whom the questions involved have simple and obvious answers.
But for anyone else watching the film, it will be clear, as Dr. Susan Robinson says, that no one ever wants an abortion, particularly not the kind that she and her colleagues provide. And the doctors in After Tiller are providing their services not out of some sort of attraction to the procedure that’s become their calling card, but out of a conviction that women shouldn’t be abandoned in their decision-making processes. After Tiller is a powerful reminder that abortion in America is less about desire than about need, and a matter not of carelessness, but the result of dreadful deliberations.
Many of the patients who agreed to have their consultations with the doctors filmed in After Tiller are facing the prospect of aborting children they planned to have, but whose pregnancies have gone terribly awry along the way. “It just didn’t seem fair to her,” say the parents of one child who would live in agonizing pain if she were born. Another describes a dreadful dilemma, saying “It’s guilt because we’re doing what we’re doing and guilt because if we brought him into this world he wouldn’t have any quality of life.” Monica, a patient whose child was diagnosed at 25 weeks with a debilitating illness that would cause his certain death if he were born, ultimately chooses to have an abortion rather than delay an inevitable decision to end her child’s life—better now, she ultimately decides, than to make him suffer before turning off his respirator so she can have had the experience of his brief, agonizing life. “It is hurtful because it was a planned pregnancy, and I did want this,” another patient explains.
Much of the focus of the consultations and on the planning for these families’ abortions is focused on giving them dignity and helping them process their emotions, both before and after their procedures. “The only time they get to say hello to their baby is when they have to say goodbye to it, too,” Dr. Robinson explains. As she runs through a checklist to help a couple prepare for their abortion and the burial arrangements for their child, I started to cry in the theater when the shot showed that “blanket requested” was one of the options on the list. There’s an incredible cruelty to the genetic lottery that forces parents to convert receiving blankets to burial shrouds, and an incredible courage to those parents who have their only time with a child after that child has died. Dr. Shelley Sella counsels two couples with ill children together, telling them “Both of you have babies who are really sick, and both of you have babies who would suffer a lot,” and giving them an opportunity to see that their experience is neither solitary nor shameful.
Even beyond the difficulty of the decision to have a late-term abortion itself, the procedure is daunting. Susan, a counselor who does intake at Dr. Robinson and Dr. Sella’s clinic in Albequerque, talks one patient through the fact that she’s going to have go through an actual labor and delivery. There’s no question that process is draining. But as Susan explains it, it’s necessary precisely to preserve the patients’ childbearing ability for future, unclouded pregnancies. “We want to make sure you can make a family when you cant to have a family,” she says. There’s none of the horribly stereotypical glee—much less moral distance—anti-abortion protestors ascribe to the doctors and patients whose lives they make difficult. “The woman delivers a baby. And it’s a stillborn. And that’s hard to deal with,” Dr. Sella reflects. “I think the reason that I’ve struggled is I think of them as babies. I don’t think of it as a fetus. That’s a way to distance myself from what I do.”
After Tiller also does something interesting in making clear that there are abortions the doctors won’t perform, or that they truly struggle with performing. Dr. Robinson turns down a patient from France who is 35 weeks pregnant, but has no fetal abnormalities—the woman essentially had delayed dealing with her pregnancy while traveling—and Susan counsels her to consider adoption as an alternative instead. The two women also debate whether or not Dr. Robinson should perform a procedure for a 16-year-old, pro-life Catholic who was afraid to tell her mother she was pregnant, in part because Susan is worried that the girl’s mind truly isn’t made up about having an abortion, and that her regret later could be psychologically damaging. Dr. Robinson only decides to go forward when the patient convinces her that she is determined to have an abortion.
But it’s an illustration of the challenges that stem both from respecting a woman’s decision-making process when she, herself, may not have made up her mind, and from legal requirements in some states that patients convince doctors that their pregnancies threaten them. “Kansas law required the patient to present you with a story that compelled you to believe that this pregnancy would threaten her life…I found myself being faced with patients who didn’t have the compelling reasons they had in Kansas…Where does it come from that I get to say, ‘well, why?’” Dr. Robinson asks. “What if you’re just not a good storyteller?…What I believe is that women are able to struggle with complex ethical issues and make the best decisions for themselves and their families.”
In After Tiller, there are real costs to helping women make some of the worst decisions any of us could ever be faced with, and to helping them see those choices through with compassion. Some of the doctors have paid prices in blood, whether it’s the loss of Tiller, a friend and mentor to all of them, the threats that have become sharper to Dr. Hern as he’s started his second family later in life, the stable owned by Dr. Leroy Carhart, which was burned down in 1991, killing 21 horses who were borded there, or simply the lost prospect of retirement in a world where no one appears willing to replace them.
But they persist, telling rape victims they deserve justice, telling families who are shattered by the loss of a wanted child that they owe it to themselves to be kind and to avoid self-recrimination, and performing medical procedures that echo the work many of them did bringing life into the world. Without ever needing to state it directly, After Tiller makes a forceful point that’s too easily forgotten or obscured in political debates about abortion. It’s easy to “pray for healing” for women who are having late-term abortions. But it’s abortion doctors who provide these women and their partners real physical and mental care.