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abortion, violence, war on women

Gosnell case not about abortion it’s about how the desperate and disadvantaged get care

Kermit Gosnell is on trial for providing grossly negligent care to many women culminating in the death of at least one. He is also accused of performing late term abortions past the point of legality. The pictures in the press look like most of his patients (or the economically disadvantaged ones anyway) were seen is what looks like a garbage dump. The story has not seen a lot of front page news and some have postulated this is because of a liberal pro-choice bias in the press.

I can’t comment on what motivates journalists, but to say that the Gosnell case is an abortion horror story and it is being ignored by a supposedly pro-choice media completely misses the point. It’s a medical horror story.

State legislators like to boast that abortion laws protect women, but laws or even legal abortion for that matter don’t prevent the unscrupulous from preying upon the disadvantaged. TRAP (targeted regulation of abortion providers) laws drive up the cost of high-quality care forcing the desperate to turn to cheaper options and charlatans. I’ve seen women maimed by legal abortion, but not because the procedure is unsafe because untrained providers in unsafe settings maim patients. If you haven’t read my post, Anatomy of an Unsafe Abortion, read it. I’ve also seen women maimed by poorly done or unindicated hysterectomies, but I don’t see any hysterectomy legislation aimed at making the procedure safer for women.

When you have no money, are afraid to ask for advice, don’t speak the language, are a victim of domestic violence, or are afraid of immigration officials (to name a few reason why a pregnant woman seeking an abortion might be medically disadvantaged) a cheaper procedure from a clinic that is flexible about providing identification and doesn’t require a contact person might seem like the only option. Well-trained providers who have done residencies and comply with the ever growing number of bizarre state laws are too expensive for many women and also require more personal information that some are able to provide.

The desperate overlook or don’t know about obvious warning signs that scream, This does not look like a safe place. How many women do you think go to their abortion alone? Abortion is so marginalized in America that having a friend or family member looking out for you is a luxury. And not everyone has a friend or family member who knows what to look out for.

However, we must not forget that bad and unsafe medical care is not an abortion-exclusive phenomenon. Didn’t we just hear about a dental shop of horrors in Oklahoma where the instruments were not sterilized, exposing potentially thousands to HIV and hepatitis? Most of those patients were economically disadvantaged. Then there was the endoscopy clinic in Las Vegas that re-used medical vials exposing patients to hepatitis C. One man died from the hepatitis C he contracted (and by the way, the news coverage has been pretty scarce). If you read enough news stories you will find plenty of accounts of bad outcomes by suspect surgeons or less than reputable surgery centers. There is also case after case of counterfeit Botox, often with disastrous and deadly outcomes.

While lack of health insurance and other economic disadvantages clearly increase the risk of bad care, even those with money are not immune. Priscilla Presley had her face injected with industrial silicone instead of cosmetic grade by an unlicensed provider.

More laws won’t prevent the Gosnells of America from taking advantage of people, just like they won’t stop plastic surgeons from buying cheap, unsafe botulinum toxin from Mexico and passing it off as the more expensive Botox. Legal abortion doesn’t guarantee safe abortion any more than legal root canals guarantees safe root canals.

I agree that we need to focus more on the Gosnell case, but not because he provided abortions. We need to talk about this case because it highlights how despite regulations providers somehow manage to game the system in state after state and that this atrocious care disproportionately affects the desperate and disadvantaged. We should also not forget that in America women who seek abortion will almost always be the most disadvantaged of all.

Discussion

10 thoughts on “Gosnell case not about abortion it’s about how the desperate and disadvantaged get care

  1. Oh it’s gotten plenty of press locally here in Philly. Your point (with which I agree wholeheartedly) was also made by several newspaper columnists. I agree the story and the discussion deserve wider attention. Not sure why I didn’t realize it wasn’t.

    Posted by Lucy Hornstein | April 13, 2013, 3:45 am
  2. thank you for writing this. I have been infuriated with the little coverage and social media chatter surrounding this case. This is not a case of an unscrupulous doctor murdering babies for fun, it’s the case of an unscrupulous doctor taking advantage of disadvantaged women for money. It’s a travesty.

    Posted by Terra Kroll | April 13, 2013, 5:49 am
  3. Sure sounds like we need to remove ALL regulation to make health care more affordable. How then would we identify poor conditions? The problem in this case is not the regulations, it is the failure to enforce them due to political ideology.

    Posted by Mike | April 13, 2013, 10:46 am
    • Mike -how often have you found yourself terrified because your period is late?

      How often have you been raped by an employer at a cash-in-hand job, who knows reporting him would only get you deported?

      How many times have you cried yourself to sleep because raising two kids under two is killing you, and your husband refuses to use a condom?

      Posted by neverdefiled | April 15, 2013, 7:48 am
    • Oh, and one more question. When was the last time that you were made to feel like a criminal for taking a legal medication, or for seeking a legal medical procedure?

      Kermit Gosnell’s charnel house is the end result of attitudes like yours. Trust me, it’s a lot better than what’s coming to the America you’re creating. His “clinic” will look like Johns Hopkins compared to the backstreet operations that will spring up in place of shuttered clinics.

      As long as pregnancy exists, women will need access to termination.

      Posted by neverdefiled | April 15, 2013, 8:14 am
  4. Why I Didn’t Write About the Gosnell Trial = And Why I Should Have
    http://www.thedailybeast.com/articles/2013/04/12/why-the-mainstream-media-is-not-covering-the-gosnell-abortion-trial.html

    Posted by Ben Rush MD | April 14, 2013, 3:14 pm
  5. I find it hard to believe that there is a lack of safe abortion clinics in Philadelphia that women could choose. It seems like the reason Gosnell was aborting 28 week babies is because it’s illegal after 24 weeks there.

    So what’s the solution? Make abortions legal all the way up to term? Seriously people? Quit making excuses for people.

    Posted by Jessica | April 25, 2013, 9:03 pm
    • It’s not the lack of clinics, it’s the lack of ACCESS to said clinics.

      Just how self-centered and unthinking do you have to be to realise that some people do not have a spare cent in their budget? Do you think they can afford multiple appointments (and time off work to take them), lab work, travel? No. They raise what u.they can because someone’s told them about a guy that’s cheaper than other clinics and doesn’t require consultations and follow-up appointments.

      Also, how would you cope if you were in China, or Russia? Do you speak the language well enough to navigate the healthcare system? Do you know all of the relevant laws and customs about things like terminations? If you were in a foreign country, scared and isolated, who would you turn to?

      You’d want someone who speaks your language, maybe she’s on your shift at the factory. She notices that you’re quieter than usual, that you’re pale and often running off to the toilets. Sle tells you that she knows a clinic. There are no questions asked, no forms or counselling sessions in Cantonese or Russian, and it’s one single visit. You trust her, you have no choice because you’re desperate. Maybe you’ve been trying to save up for so long that the cut.off date is looming. Maybe you have no ID and fear deportation, maybe if a real clinic requires three (or more) visits your husband will get suspicious and find out what you’re doing, and rape or kill you. You’re just running on fear.

      You have no right to judge these victimised, marginalised women. And you know what? In some places abortion does take place later than 24 weeks. It has to, it saves lives, and I’m glad it exists. The living, breathing, loved and needed woman’s needs will always be more important, more deserving of respect and consideration, than those of a foetus. People are more important than potential people in the same way that a forest is more important than a big bag de seeds.

      Posted by Boostick | April 29, 2013, 3:19 am
  6. Gosnell’s clinic was legal. Many of his patients were referred by other abortion doctors precisely because it was known that he would do illegal (because late-term) abortions. Pennsylvania did not enforce the regulations or inspect the clinic because of political pressure from pro-choice activists who were concerned that this would restrict access. That Gosnell’s clinic was a charnel house was an open secret amongst ob-gyn’s in Philly because his patients kept presenting at the ER in a terrible mess as a result of his butchery. No-one did anything for years and years.

    Any regulatory system has to balance the costs of regulation which, yes, amongst other things will restrict access because by definition it imposes costs, against no regulation which allows any charlatan to engage in gross and grotesque malpractice. In this case I am absolutely not convinced that the problem was too little regulation – or rather there was plenty of regulation but no regulatory enforcement which amounts to the same thing.

    This leads us to the next issue. PA law restricts abortion after 24 weeks. Gosnell was performing illegal abortions on women who were in some cases substantially over 24 weeks. Should this be legal? He’s being tried for murdering babies who survived his cack-handed attempts to abort them. At least some of these babies given medical care in a neo-natal unit would have survived. Read the evidence presented about how these babies reacted when they were being killed. It is excruciating.

    But if you accept that this was murder can you explain to me what the difference is between killing a baby 10 minutes after delivery and killing it in utero? And if you don’t think it’s murder, can you explain why?

    @Boostick: you claim that abortion after 24 weeks saves lives. I guess what you are arguing is that abortion should be legal when the life of the mother is jeopardised by the pregnancy. I am not arguing with this principle. A good example of the kind of situation where this would be the case is advanced pre-eclampsia. But after 24 weeks why is an abortion necessary? The mother’s life is surely jeopardised by the pregnancy, but it doesn’t follow that you have to abort. Why not just deliver? What are these mystery third trimester ailments that threaten the life of the mother and can only be cured by delivering a dead baby? I’m not being snarky (well maybe a little) – I’m genuinely curious.

    Posted by Nicola | May 10, 2013, 3:48 am

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