Supreme Court Sanctions Back-Alley Abortions

Abortion remains a sacred cow to a majority of U.S. Supreme Court justices.  The Supremes just gave abortion advocates a major victory by overturning a couple of provisions in a Texas law that had placed safety limitations on abortion.  This was the Hellerstedt decision, a 5-3 ruling by the court against what are described as "clinic shutdown" laws.

Democrats used to want abortion to be "rare."  How rare is it?  Let's use a common surgical procedure as a basis of comparison.  Cataract surgery is the most common operation performed in the U.S.  The American Academy of Ophthalmology reports about 2 million cataract surgeries done each year in the U.S.  The vast majority of those getting their cataracts removed are in the 60-90 age group, an age group that often has other medical problems.

Abortion is also quite common, occurring at a rate of over a million procedures per year – hardly "rare" at only half the rate of cataract surgery, the most common U.S. surgery.  Gallbladder removal is another common operation.  Each year, about 460,000 Americans part with their gallbladders – half the rate of mothers parting with their unborn babies.  Heart bypass surgery is performed in 395,000 people each year – another common operation, occurring less than half as often as abortion.

It's fair to say that abortion is hardly "rare"; in reality, it is one of the most commonly performed operations in America.

What about "safe"?  Like any surgical procedure, abortion carries risk, estimated to be 1 percent in first-trimester abortions and 2 percent in late-term abortions.  These risks include heavy bleeding, infection, perforation of the uterus, damage to other organs, and death.  While infection is a delayed complication, bleeding, perforation, and organ damage occur at the time of the procedure, and if they are not recognized and managed appropriately, they can lead to the ultimate complication of death.

These complications are more likely to occur in "back-alley abortions" such as Kermit Gosnell's Philadelphia clinic, where, in 2009, a 41-year-old woman went into cardiac arrest and coma, dying the next day.  Described as a "House of Horrors," Gosnell's clinic was "filthy, wretched and macabre" – exactly how one would describe a "back-alley" clinic.  Gosnell, by the way, is serving three consecutive life terms for the death of his patient as well as the murder of three newborn babies born after late-term abortions.

Could these deaths have been prevented if Gosnell's clinic had been as clean, safe, and well-regulated as a cataract surgery clinic?

Cataract surgery is typically performed in an ambulatory surgery center (ASC).  With federal and state oversight, ASCs offer a variety of outpatient surgical procedures, from eye surgery to orthopedics, plastics, endoscopy, colonoscopy, and a variety of other surgical procedures.  Surgery in an ASC is far less expensive than in a hospital setting, but since most ASCs are free-standing, meaning not physically attached to a hospital, safety concerns are paramount.

ASC safety is evaluated by three processes: state licensure, Medicare certification, and voluntary accreditation.  In order to meet certification, "[a]n ASC must comply with standards developed by the federal government for the specific purpose of ensuring the safety of the patient and the quality of the facility, physicians, staff, services and management of the ASC" – not only when the center opens, but on an ongoing basis.

Because complications can and do occur in an ASC, similar to the potential complications of an abortion, the federal government requires specific safety measures, such as the availability of CPR and "an effective means of transferring patients to a hospital for additional care in the event of an emergency."  ASCs have a "partnership" with a nearby hospital and the additional requirement that "all physicians performing surgery in the ASC must have admitting privileges at the designated hospital."

My personal experience as a retina surgeon is that the ASCs where I work are indeed safe.  I sit on committees that review all aspects of patient and staff safety, constantly tweaking rules and policies to maintain the highest levels of quality and safety.  My patients are elderly, many with concurrent medical problems such as diabetes.  On rare occasions, patients may need prompt transfer to the hospital – not because of their eyes, but because of heart or breathing problems requiring hospital care.  Having these standards and transfer policies is common sense.

All this is what makes the Supreme Court ruling all the more bizarre.  Justice Breyer believes that the safety measures that apply to all other types of surgery somehow burden women seeking abortions.  Is it a burden for those seeking joint arthroscopies, eye surgeries, or colonoscopies to have their procedures performed in a safe and clean environment, with protocols in place for hospital transfer in the unlikely event that something bad happens?  And something bad can and does happen – ask Joan Rivers, who went into cardiac arrest after minor throat surgery in New York City.  Or ask the Chicago woman who died after an abortion gone bad at a downtown Chicago Planned Parenthood clinic due to uterine perforation and extensive blood loss.

Without arguing the ethics of abortion, it is still a surgical procedure with potential serious risks.  Why would these women not be granted the same safety protections as they would have if they were undergoing a retinal detachment repair or knee arthroscopy?  Instead, the Supreme Court is happy to turn a blind eye to the safety concerns, allowing abortions, but no other surgical procedures, to be performed in unsafe, unregulated, "back-alley" facilities.

Justice Breyer wrote, "The surgical-center requirement, like the admitting-privileges requirement, provides few, if any, health benefits for women, poses a substantial obstacle to women seeking abortions, and constitutes an 'undue burden' on their constitutional right to do so."

Women should be outraged.  This is the real "war on women" – declaring that their right to an abortion is so sacrosanct that universal safety measures don't apply.  It's like saying that if a woman is driving to have an abortion, it's OK that the driver be intoxicated, texting while driving, speeding, and driving through red lights, as legislating against these only presents "obstacles," amounting to an "undue burden" to her getting to the abortion clinic.

The cost of the Supreme Court decision will paid not only by the children dispatched in subsequent abortions, but also now by women suffering injury or death as a result of having an abortion in a facility without a backup plan for hospital transfer and care if something goes wrong.  These standards, which any person would demand for his mother about to have cataract surgery, have been declared unnecessary for an abortion.  It's a ringing endorsement from the Supremes for "back-alley abortions."

Brian C Joondeph, M.D., MPS is a Denver-based retina surgeon, radio personality, and writer.  Follow him on Facebook  and Twitter.

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