Abortionists discuss what to do with aborted babies’ bodies

Abortion providers talk  about the problems they have disposing of the bodies of aborted children. Undercover footage shot at National Abortion Federation conference recorded by David Daleiden. It was released on December 29, 2015:

Abortion Provider Rene Chelian:

“So in coalition, we started working with hospitals who didn’t want to be seen with us. We met them in like Denny’s restaurant, there’s not even many of those left…We talked about you know what are you guys going to do. They were terrified of a public relations nightmare. That hospital actually had big freezers with breasts and kneecaps and gallbladders and abortions or miscarriages. Um and they put all their jars together, at some point. and they go to Stericycle unless the hospital happens to have their incinerator which is rarer and rarer. The guy from Stericycle was quick to point that out to me.”

crossed-ankles-1

We were really tempted to give the fetus back. We thought we’ll give it to everybody in a gift bag, they can take it home, figure out what to do with it. It’s their pregnancy. Why is it our problem? And I’m saying that in all seriousness. Nobody wants to talk about dead bodies. Nobody but me. There was a point when Stericycle fired us that I had five months of fetal tissue in my freezers and we were renting freezers to put them in. So all I thought about, I am so consumed with fetal tissue, I was ready to drive to upper Michigan and have a bonfire. And I was just trying to figure out, you know how I wouldn’t get stopped or how far in the woods would I have to go to have this fire that nobody was going to see me. And the garbage disposal was an option, I mean, there was a point that I actually hired someone from another clinic to come in and take 20 bottles and put it into my garbage disposal.

10weeks-alive

When you look at incinerators for cremation the website descriptions are small cat, small dog, larger dog. So we were looking trying to compare our jars to various animals you might incinerate. We knew we wouldn’t need one big enough for a horse [laughter from abortionists in the crowd].… Were we going to have to go into inner-city Detroit and get a lot and put an incinerator there and then how do we transfer the waste? I mean fortunately, we have those really lax laws in Michigan, so I was going to get a license as a transporter [laughter], yet another fun thing, yup.… Got another fun thing, and there are a bunch of clinics buying an incinerator and then we can just go pick up for each other if we all got a license. I mean talk about moving on the competition.… I mean really, this is my backup plan. It’s going to have a name that is really, you know, nothing to do with anything in the universe and it’ll be really hard to find because it’s going to be in somebody else’s name, not mine.

Aborted child at 10 weeks
Aborted child at 10 weeks

So I don’t know, that’s how awful this is. I feel like the Mafia.

We actually found some green technology that is like a dishwasher. And you plug it in like a dishwasher, like a portable dishwasher, and you add some kind of chemical – I mean, I’m using the word chemical really loose – it’s green, that’s all I know. And you’re just using it because they don’t have enough cemetery, they don’t have any space. And you run this cycle and then it goes in the sewer system, which sounds like a really great idea! Although I have to say I can’t remember if that was approved.”

aborted at 20 weeks
aborted at 20 weeks

Abortion provider Karen:

“Even in our hospital in Canada, we contract out ultimately to Stericycle, and it’s going out to Portland. And Portland is a waste to energy facility. It’s a PR nightmare for us. It would end up being the front page of the paper “Fetuses Are Being Used for Energy.” I mean, I think it’s a great idea…”

Graeme
13 weeks,

Abortion provider Rene Chelian:

“When we sent to another state, it became the whole issue of, do we tell FedEx what they’re picking up? How long will it take for the antis to figure it out? And if we don’t tell them, what if there’s a bad snowstorm, like there was this winter, and UPS gets delayed or FedEx get delayed, and their truck starts stinking – I mean every state law is different.

11 weeks
11 weeks

I know what I wanted to actually put the fetal tissue in my car and drive to the crematorium in Illinois [but] I was advised by my attorneys that I was breaking several state laws and that, that really wasn’t a good idea. Although, I have a good friend in another state who is currently driving across two states, once a month, with fetal tissue to go to a funeral home and and they have an arrangement to send out for cremation.

20 weeks
20 weeks

But everything is a secret, so it’s really scary. Because we are all one incinerator away or one incineration company away from being closed. Whatever your laws are in your state, if the antis know, this could shut us down.”

Video from Students for Life

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NAF conference: abortionist Glenna Boyd on coping with second trimester abortion

This is a transcript of one of the videos leaked from the National Abortion Federation convention. These videos were recorded in secret by David Daleiden

The National Abortion Federation filed suit to keep all the videos taped at their conference away from the public, but an individual unaffiliated with the Center for Medical Progress leaked them.

I have composed this transcript after listening to the video. It may not be accurate in every detail. When I have been in doubt, I have inserted a question mark. There may be errors in this even though I did my best to be accurate.

The video is of a panel discussion entitled “2nd Trimester Providers Self Care” which featured several different speakers. I am making a separate post for each speech.

The abortionists who spoke at this panel all do late term abortions.

In order for the reader to keep in mind the business the Dr. Glenna Boyd is in, I am posting examples of the handiwork of abortionists like her  throughout the transcript.  These pictures are of what she does every day.

Transcript

The 1st thing I need to ask is, can you hear me, because I have a soft voice. Okay. Cassing (?) asked me to talk about self-care in the face of such a variety of stressful events. I actually made notes out of fear that I would get lost in the morass of this. So this is not cathartic storytelling for me. I would prefer to forget some of these experiences. [Laughter] So in general, I’m going to say just about enough of each situation to spark associations to your own experiences, real or feared. I’ve got 5 different categories.

15 weeks
15 weeks

The 1st is violence. So I’ll tell you that we’ve had 2 major arsons. Our administrative office in Dallas was burned to the ground on Christmas Eve of 1988. It was one of those Christmas presents to the baby Jesus, that we heard about in the 80s that the Reagans were so grateful for, they sent the arsonists notes in prison. The only reason (I’m not making that up), the only reason that the entire clinic didn’t go down was that there was literally a firewall between that office in the back and the remainder of the clinic.

Our entire Albuquerque clinic was burned to the ground in the night of December 7, 2007, so I don’t need to tell you that Christmas is not my favorite holiday.

The 2nd category of the fence is demonization by the media. My 1st experience with that was following a patient death in 1980. The death occurred on January 22, the 7th anniversary of the court decision legalizing abortion. A local TV news reporter and her cameraman burst into our staff meeting, with the reporter speaking into her microphone demanding that we, and I’m porting over here, “explain how we had killed a patient the previous day.” [Mutters of sympathy] we had nightly coverage at 5, 6, and 10, culminating on Friday with a heart-wrenching interview with the bereaved husband and the woman’s parents. The following week, when the office of the medical examiner in Dallas determined that the death, which was due to fulminating DIC was unpredictable and un-preventable, that was reported on page 7 of the Dallas Morning News. Again, we had a similar experience (okay, Shelley, was it this past fall or a year ago? Time flies when you’re having fun – was a 2012?) (Other abortionist: You know, one coping mechanism is to forget about it!) [Laughter]

18  weeks
18 weeks

So, either fall of 2012 or 2013.… Just before the New Mexican board ruled on charges that were brought against Doctor Sella based on complaints from Operation Rescue, the Albuquerque Journal chose to do a front-page story on the Sunday edition of the Journal, reciting Operation Rescue’s version of events. It was complete with a photo of Doctor Sella, a still taken from After Tiller, and an entire sidebar about the patient and her very tragic story, enough identifying information to violate all HIPAA regulations and literally reduce this woman’s life to a circus sideshow. When the New Mexico Board of medicine issued its ruling exonerating Doctor sella on all charges, and praising our quality of patient care 4 days later, that wasn’t front-page news.

The 3rd thing is a malpractice suit that was brought out against us, a physician who worked with us in Albuquerque which went to trial, jury trial, not once, but twice. This case from start to finish lasted for 10 years. We saw the patient in 1997, that’s when the complication occurred. The suit was filed in 1999 and it was 1st tried in 2000. The verdict I’ll tell you about later. The attorney then began working the case back to the Mexico courts to the Mexico Supreme Court. He began that process in 2001 and got established grounds to sue us again for the same complication. That 2nd verdict was rendered in 2007. So it was double jeopardy and the case that would not go away. Earlier today I said I create headlines and titles for lots of things. It was also a terrible complication. However, the injury to the patient occurred at the hospital not in our clinic, when an unsupervised

16 weeks
16 weeks

resident attempted to complete a 16 week abortion and perforated, didn’t recognize the perforation, and severed the patient’s ureter, and she lost a kidney. We actually thought this patient deserved compensation and our insurance carrier offer generous settlements both times, which the patient, whose life was the personification of chaos, and her Bible thumping antiabortion attorney refused. They wanted their days in court and they got them. Now part of the story was that we had transferred to University Hospital because she had an explosive temper tantrum mid-procedure and the doctor didn’t feel safe dealing with her in the clinic. There are obvious patient selection issues here, long back story which I’m going to spare you. What I will tell you is that at the 1st trial midway through she threw a similar tantrum and the entire courtroom got to see just why we had transferred her. At the 2nd trial her attorney threw the tantrum [laughter]. I couldn’t make this stuff up. Both times the juries ruled in our favor and the patient got nothing. Which I also regret. But the emotional toll on all of us was awful. And just as an aside I’m going to say that the biggest take home lesson from that case is something that all of us already know – patients sue doctors they don’t like and they accurately sense don’t like them. That’s an untold part of that story.

The 4th issue for me is the current state of affairs in the great state of Texas which is so painful that I’m not going to say anything more. Except that my working headline is, “Texas, Women’s Rights Successfully Aborted.”

24 weeks
24 weeks

I’ve done everything I can for now. We will survive and I choose not to dwell. Which is to say that suppression is a wonderful defense and I wish I was a hell of a lot better at it.

The 5th and final topic Cassing asked me to discuss was competition from other providers, something I was gonna say a book about that (?). For me, I put that on the long list of things I can’t control. I have a business which is also a social cause. So as long as we are in the cause together, which is to say I believe I’m competing for business with another provider of conscience, I have worked to maintain our (other?) relationships. Over the years I’ve done a lot of consulting and training of competitors. We have and we continue to work on political issues together. I want all of us to do the best we can for our patients, and we see us as in this war together. Among other things, that approach meant that after that Albuquerque arson, 3 other Albuquerque providers allowed us to do procedures in their space. It was, we missed one day of service. It was a logistical nightmare but we continued to see patients. And I was at the time and I continue to be very grateful to our competitors.

12 weeks
12 weeks

So when I reflect upon this assortment of lovely events, I ask myself is my actual or my ideal self-care significantly different depending on the source of the stress. And what I think is that it’s more dependent on how long the stressor lasts and that’s part of why the current situation in Texas is so grim. It’s why that malpractice case that wouldn’t go away was so wearing. I think it also for me depends on how much control I have or imagine I have, and whether or not I believe there’s a solution.

So the 1st thing that I want to stress to all of you, granting that’s a terrible pun, is that in every difficult situation, we can only be our very quirky selves. And I think it’s really important to know that. There are no universally effective prescriptions. For example, and really in many ways in contrast to Lisa, I’m an introvert and I have very low social needs, so what works for me is not going to be the same as what will work for somebody who is an extrovert and has high social needs. Social support is still going to be important to me and Mona for one was invaluable after the Albuquerque arson. She reached out and was so helpful. The physicians from the Centers for Disease Control… Were equally invaluable for both me and the Dallas medical examiner following the patient death, so I’m very grateful for that kind of support. But the truth is, I will talk less about my problems, I will seek less support, and I may even feel burdened by others’ need to help. As I say, it’s not that I’m ungrateful, it’s just that it’s more stress on me at a time when I’m already feeling overloaded. So I would say it is really wise to consider personality factors of your own when you think about how you handle stressful situations. And it’s also why having a team with different personalities and shared vision and values is so important when you’re facing big problems.

10 weeks
10 weeks

The other thing I want to say is you may not know that I did my doctoral dissertation on coping in situations of chronic stress… [Laughter] I had two particularly interesting findings and I promised myself that unlike my dear friend Uta who did a beautiful dissertation on women’s sexuality and was so sick of it by the time she finished  she never published, and I always told myself I wouldn’t do that, I would publish. By the time I finished my dissertation, I wasn’t going anywhere. So you will be among the few people who know that I actually found out a couple of useful things. 1st, the most important single factor in resilience under stress was not coping. It was a basic attitude toward life. And that attitude was, and listen to this carefully, the absence of the belief the world is basically a bad place and people basically cannot be trusted. It was not the presence of the belief that the world was a good place and that people are basically good. So being Pollyanna or Mary Poppins… Isn’t really helpful. It’s not the power of positive thinking, it’s the absence of negative thinking…

z16we
16 weeks

The 2nd thing was that the more coping strategies my subjects employed the greater their strain. Now on the face of it that is completely counterintuitive and nobody on my dissertation committee liked that…

And this leads me to a reframing of the situation… So now you got the world according to Glenna… There are plenty of situations in life that we cannot fix.,,,

The third is that defenses are greatly undervalued in popular psychology. There is wonderful work on the maturity of defense, it was done nearly 20 years ago now most notably by George Bayland of Harvard. So here I’m gonna get quirky and personal on you again.

I use a lot of suppression. I’ve never googled myself to see what the antis are saying about me. I do not read every article on abortion. I don’t spend much time on the news. I refuse to learn the names of our picketers. I don’t grant them that much standing in my inner world. They’re wallpaper. This is a conscious refusal on my part. But I gotta tell you that in a pinch I will settle for repression or even denial to buy me enough time to get a little better. And my second fall back invaluable defense is that I intellectualize. Having words and concepts for what I’m experiencing helps me, just like preparing this presentation, I’m intellectualizing. And there is research which many of you are familiar with, this is why writing and journaling can be so helpful. They now think that we move events from parts of our brain where we are overwhelmed to the frontal cortex, where in the process of verbalizing, of writing, we are manipulating that event that event which we cannot change, and experiencing a form of mastery. And that act is invaluable.

21 weeks
21 weeks

So, that’s helpful to me, I hope it’s helpful to you. And finally, for my survival basics, and there are only two

Basics at work. That’s for when the crap that swirls around our work really gets to me, I schedule myself as a counselor or nurse so I connect to the reason that I do this work. I love direct patient care. That’s my passion, it’s my gift. It’s the part of the work that feeds me. That’s not the part of the work that feeds everyone in this room, but under stress, find the part that feeds you and do as much of that is you can. And the other thing is basics in life. And that’s the task of going on with living. For me these more stressful experiences have a large element of grief in them. I’ve lost something and I’m preoccupied with the lost object. So I have to remind myself to sleep, and eat, and exercise, and snuggle, and I use that not only as a euphemism for sex, though that’s part of it, [laughter] but also for pet therapy. Snuggle with your dog, your cat, I snuggle with my bird. Pet therapy works! Oscar Wilde, who we all love for a lot of reasons, pointed out that “simple pleasures are the last refuge of the complex” so when I say is here’s to good friends, good marriages, good partnerships, good defenses, good dark chocolate, and occasional glass of good wine at the end of the day.”

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NAF Conference: Conversation between David Daleiden and abortionist Cheryl Chastine

This is a transcript of one of the videos leaked from the National Abortion Federation convention. These videos were recorded in secret by David Daleiden

The National Abortion Federation filed suit to keep all the videos taped at their conference away from the public, but an individual unaffiliated with the Center for Medical Progress leaked them.

I have composed this transcript after listening to the video. It may not be accurate in every detail. When I have been in doubt, I have inserted a question mark. There may be errors in this even though I did my best to be accurate.

This is a conversation that took place between an undercover David Daleiden, posing as a representative of a  fetal procurement company (offering to buy aborted baby’s bodies for research) and Dr. Cheryl Chastine, Witchita abortionist.

Transcript

C: Cheryl Chastine

D: David Dalieden

———————-

D: so you’re a provider.

C: yes.

D: excellent. So where are you located?

C: I’m in Wichita, Kansas. At the women’s center.

D: oh wow. Isn’t that where, uh, George Tiller was –

C: yes.

D: wow.

C: yeah, so…

D: wow. Is that safe?

C: mostly.

D: mostly?

C: I mean, there’s some security measures involved around my being there, but… He was a target because of 3rd trimester procedures, and the legislature has made that essentially impossible since then, so…

D: okay

C: that’s not been an issue at this point. Aside from various people trying to ruin my career in order to close the clinic. [Inaudible]

D: I guess every provider has to deal with that.

C: pretty much, yeah. More for me I think because of the profile of the clinic because it’s new clinic.

D: right, right. Yeah. Well thank you for doing that.

C: thank you…

[They talk about the documentary “After Tiller” which portrayed 3rd trimester abortionist in a positive light]

7 month baby,. Babies this age were killed at Tiller's clinic, and by the abortionists featured in "After Tiiller"
7 month baby,. Babies this age were killed at Tiller’s clinic, and by the abortionists featured in “After Tiiller”

C: you know, what I, the main thing, what I felt was remarkable about the emotional, what’s involved with that in the film, is that it’s not any different for the later procedures than, it’s the same, it’s the same patient reasons, and the same range of patient reactions.… And kind of the same process as far as helping them come to terms with it.

D: yeah. So what is the range that you go up to now

C: up to 22 weeks. Kansas has one of those 20 week bans now so –

D: you go to 22. Because I don’t know how much you guys talked already, so the primary demand for the stem cell sourcing is for 2nd trimester, I mean you, oftentimes there will be researches want 1st tri, but generally speaking it 2nd tri.

From an abortion at 20 weeks.
From an abortion at 20 weeks.

C: yeah.

D: and generally speaking it’s a lot of liver, thymus and bone marrow is what people want –

C: interesting.

D: Yeah- are you just doing standard D & E?

C: yeah. D&E do digoxin.[?}

D. what? When you start diging” [injecting digoxin, a poison that stops the baby’s heart before the procedure]

C: we don’t.

D: Oh you don’t do dig.

C: no.

D: at all.

C: no.

A D&E procedure. Because her clinic doesn't use digoxin, Chastin dismembers the babies alive
A D&E procedure. Because her clinic doesn’t use digoxin, Chastin dismembers the babies alive

D: oh! That’s great. That’s really good… Dig just nukes the stem cells, right?

C: yeah, I’d imagine.

D: it’s no use afterwards. That’s excellent. And have you ever participated in tissue procurement or donation or anything like that?

C: no, we have not. Everything is going to, yeah, medical waste right now.

D: okay, yeah. Yeah. Yeah.

C: so you are, we’d like to get –

D: definitely. Are you the medical director for the clinic?

C: yes.

D: so does it, do decisions like this, kind of, does the buck stop with you?

C: yeah.

D: okay.

C: I mean it’s my, it’s gonna be my call ultimately –

D: your call

C: yeah, my operations director is going to be the person you communicate with on it, but yes.

D: okay, okay. Yeah. Excellent. Yeah. We return a portion of our research fees to the facilities that work with us so then that, is like kind of a thing

C: yeah great

D: to make up for our tech being in there some days, bumbling around the-

C: sure

D: the path lab. No really they shouldn’t be bumbling. But, yeah. Very good. I am, I didn’t realize there was a provider again in Wichita so that’s-

15 weeks
15 weeks

C: we’ve been open for a year in April, this so year, just had our one year…and we’re very proud of what we’ve been doing.

D: And what would you say your procedure volume is like?

C:  Um, at this point, I’m probably seeing 40-50 patients a week, of which maybe a third or less of that Is medication abortions so as far as, like, the types of procedures your talking about, probably two to four seventeen plus week procedures-

D: per week-

C: Yeah, which just really varies from week to week. Probably you know, up to six I think and then the fourteen to sixteen there are more of those.

D: Oh yeah, that sounds very promising. do you generally get pretty good cervical dilation? What’s kind of percent intact as far as the- I know it probably varies but –

C:  Um, that depends on whether I do, cause sometimes I do same day, I do, depending on where the patient lives, they’re overnight laminaria or same day [inaudible] so the same day obviously I get less dilation usually

D: Right

C: but the tradeoff in patient convenience is so great that

D:  Oh, yeah there was a real interesting preconference workshop on that a day ago. And um you know, we’re not doctors,

C: right

D: I’m a scientist, but not a-

C: Yeah.

D: But I’m not a medical doctor, so it was real neat to see the, you know, kind of the level of discourse of the new techniques or proposals being kind of piloted, and even some kind of the discussion and even some pushback from some of the older fighters it was a real dynamic kind of, I didn’t realize there was that level of, I don’t know what to call it, I want to say, it was very thorough, you know? To have that many minds coming together to just pick apart all the different aspects of their craft so so it was very [inaudible]…

C: a lot of people very opinionated

D: yeah.

C: and very opposite directions, and they’re all convinced based on their clinical experience…

D: yeah, I’m giving a nice version of it… There were 2 providers who almost jumped down the speaker’s throat… What do you mean!!…

C: I’m going to go with Warren Hern and I don’t know who the other one –

D: actually, it was some guy from Colorado and his name was not Hern, and Doctor Hansen’s daughter, Mildred Hansen, they were like this little tagteam in the back.…

D: it was very good to meet you

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NAF conference: abortionist Lisa Harris on coping with second trimester abortion

This is a transcript of one of the videos leaked from the National Abortion Federation convention. These videos were recorded in secret by David Daleiden

The National Abortion Federation filed suit to keep all the videos taped at their conference away from the public, but an individual unaffiliated with the Center for Medical Progress leaked them.

I have composed this transcript after listening to the video. It may not be accurate in every detail. When I have been in doubt, I have inserted a question mark. There may be errors in this even though I did my best to be accurate.

The video is of a panel discussion entitled “2nd Trimester Providers Self Care” which featured several different speakers. I am making a separate post for each speech.

The abortionists who spoke at this panel do second trimester (or later) abortions, killing babies like the one below.

20 weeks
20 weeks

They are usually aborted by the D&E procedure, although some may be poisoned, after which the mother will go through labor to expel the dead baby.

de

 

Introduction

… If you attend NAF frequently enough, you realize there are only a certain number of ways that you can actually approach 2nd trimester abortion, and there are some things that come up routinely like complications, procedural methods, cervical ripening and whatnot and one issue that arose this year that several people recommended that we approach that had not been approached frequently or at least recently was the issue of Abortion Provider Self-Care. What people were interested in hearing about is how we take care of ourselves, our families, our staff, the people that we train, particularly given all of the internal and external pressures that we confront. So we decided to approach that topic. We have assembled, cajoled, persuaded, a wonderful panel of people who will follow the following format today in what we want to be a discussion. We will initially have each of the panelists give a very informal presentation regarding their particular view given their position as a provider or a director or a manager or whatnot, of 2nd trimester abortion self-care. I will introduce each of the panelists immediately before they make their comments. Again these presentations are not intended to be formal, in fact I have promised some of the people presenting that these can be informal remarks, and they are there so that they can name topics that after the presentation will serve as a jumping off point for all of us to discuss our own perspectives, our own prescriptions, for what we have learned will help us take care of ourselves and our families and our staff and those we train whenever we’re doing 2nd trimester abortions.

So, with that as an introduction, I want to introduce our 1st panelist,

Doctor Lisa Harris is well known to anyone who has attended NAF meetings. She originally trained at Harvard followed by residency at UCSF in obstetrics and gynecology and has now spent the majority of her academic career at the University of Michigan. She is not only a highly accomplished physician and running a very important, very productive  family planning program, but she also has her PhD and is an important member of the women’s studies program at the University of Michigan.… She’s one of the people I know who every time she speaks she always says something intelligent. Nothing unintelligent ever comes out of her. I really admire her for this. I think all of us know that her area, which she has gained national notoriety for is abortion stigma and the internalization of stigma not only among society at large but also among providers. So I think this is an important place for us to start, let’s welcome Doctor Harris…

Lisa Harris:

Thank you. Actually today I was planning to say something unintelligent. [Laughter] So I have been an OB/GYN and abortion provider for about 20 years, most of that time in Michigan. And I’m also a researcher, and as you heard, I study among other things, other people, abortion providers. And I never actually set out intentionally to study abortion providers, so I guess I had an unplanned but desired research career [laughter]. So that part of my journey studying providers really began over lunch, with Laura – –. I don’t know if she’s here, but she’s a physician that I worked with in Michigan and we had lunch together the day I went to buy a crib for my unborn fetus. Subsequent daughter, the one who’s controlling the display area and picking up candy, and over lunch I very hesitatingly asked the doctor what it was like for her when she was pregnant doing abortions, because she had just had a baby a few months before me. And out of us spilled all of these stories and experiences about doing the work that we did. Its sacredness, and its great rewards, and also its burden. And neither of us had ever had a conversation like that before. And from that, that conversation turned into a small private research project. Where, what eventually turned into what I now call the provider share workshop were a group of abortion providers, and I define providers broadly to include anybody who considers themselves part of a woman’s experience of abortion. Whether that means you answer the phone and set up appointments or whether that means you are a nurse in the recovery room, or physician doing procedures. So all providers. And that turned into a pilot study where providers gathered 6 times over 2 months, guided by an experienced facilitator to talk about their experiences with doing the work. And with each session there was a new theme. And then that pilot study turned into a bigger study which turned into another study and ultimately at this point over 400 US providers

….So what I want to do with the few minutes I have now is share the most important things that I’ve learned from listening to providers over these past 6 years. And I told you will of that background really so that you know that the great deal of humility that I have as I sit here now because anything I have learned about the experience of doing this work I have learned from you, and from people who have participated. Everything I’ve learned has really come from your voices. You always already know what I am about to say and all I’m doing right now is giving it voice. And if my voice turns out to be the most important theme across all of the workshops. [?]

So I’m just going to kind of list some of the most interesting things that I’ve heard to give you a bit of a conceptual framework about how to think about the rest of the conversation. The 1st,  the news is really reassuring that as individuals we have really good esprit de corps. Compared to other health workers across the range of disciplines we have higher compassion satisfaction, meaning the pleasure that we get from doing our job, taking care of patients, is higher than it is for all other healthcare providers who have… taken similar surveys. So ER nurses and physicians in other disciplines. So that’s really good news.

The other thing is that we also have lower burnout. You may be surprised to hear, but we actually have, so lower long-term exhaustion and loss of interest in our work than other healthcare providers do. So that’s more good news.

That said, we feel stigmatized. Meaning, we feel marked in a negative way by our work. Marginalized, discriminated against. So I want to share now a little bit more about what this marking looks like, what this stigmatization looks like. It can take a range of forms and be experienced in a lot of levels, so we experience it in [inaudible] when I park my car in the parking lot of the hospital every day I have to go by that bumper sticker that says “Choose Life.”  You know, or “Abortion Stops Beating Heart.” Ah! I’m so mad, because why, I’m just going to work, why do I have to deal with this?  So that sort of stigma on a broad, discourse level. But, we feel it structurally in law and policy so I feel it in Michigan when they tell me insurance can’t pay me for abortion now or when legislators try to say I need a million-dollar liability malpractice liability insurance, of course, because I am so uniquely dangerous compared to all other physicians. I feel it in organizations, hospitals, right, when my hospital might not want to deal with having its own abortion clinic, uh, in the hospital. Other people may feel it in their churches or synagogues. We experience stigma in our communities or in our family and our friends. You know how willing are we to talk about our most recent case, at, say, Thanksgiving dinner when people are asking us how work is going or how we’re doing. So in all of these sort of layers and concentric circles we feel stigma.

The main consequences of that are disclosure dilemmas. Meaning, we have to make decisions constantly, consciously, unconsciously, about who we tell about our work and under what circumstances. And this is actually something that anybody who has an invisible stigmatized attribute has to do.… If it’s not apparent, what your stigma is, then you have to decide are you going to talk about it or are you not. On elevators, on planes, when you’re coming to do your slide presentation on the airplane and you can’t quite move your computer so someone can’t see your slides. [Laughter] So, disclosure, people knowing what we do comes with risks that I don’t need to enumerate for you. It comes with the risk of being judged. It comes with the risk of creating rifts and ruptures in our relationships and of course it carries the risk of harassment and violence. Although we probably feel that out of proportion to what it might be because that’s how terrorism works. But nevertheless it’s real. But if there’s one thing I’ve learned over and over in the workshop it’s that while the risks of disclosure are particularly obvious, the risks of nondisclosure are really big too. But we don’t see them so much. And this is a point that I really really want to emphasize. There are costs to us when we don’t talk about our work. People don’t know who we are, we lose connections, we lose getting to share the satisfaction of what we do, and when we don’t represent ourselves to others they represent us and those depictions are not so flattering.

This was dramatized for me just a few weeks ago actually, I was in Hawaii, doing a small speaking gig and vacationing, and so I flew back overnight, from Honolulu to Seattle, changed planes in Seattle at like 6 in the morning having not slept, I was traveling with my daughter also.  And I get on the plane really wanted to go to sleep for the next flight, and this man took up a little of my seat plus his seat sitting down beside me… And so, what you do, wants to know all about me, and at that point I really didn’t want to engage, so I said, “I teach. I teach at the University of Michigan.” Have you ever not said everything you do…? So He was very persistent and he wanted to know more. So I said I’m an OB/GYN and I also teach in the women’s studies department, and he kept pushing and pushing. So then I stopped it all by saying, “what do you do?” At that point, he did the thing I usually did. He kind of went really sheepish. And he said, “oh, well I work in the court system in Michigan.” [Laughter] oh, tell me more. And eventually, he discloses that he’s a judge. And at that point I said, oh, do you see minors at all? “Sometimes.” Well I work at Planned Parenthood. “Are you judge — and he said yes.” And so what just happened is the judge who’s been signing all my judicial bypasses is sitting next to me on the plane, and we spent the entire flight talking about this. He had never told anybody about that aside from his wife. Even people in the courthouse did not know because they have a special code, which I won’t say because it’s a little bit demeaning, for what the bypass cases are, so that even the people scheduling the bypasses don’t know what those cases are about. He, it turns out, does more bypasses than almost any judge in the country and he has never told anyone about it. He didn’t talk about it. And he all of a sudden, boom! He had this big chance to talk about it, and it was such a, it really traumatized me the importance of how we make connections, and we don’t let fear dictate our disclosures, though I understand why that happens when it happens. It just drove it home again for me. You know, there’s tremendous value in sharing.

Just a couple more points and I’m done. And then I’ll turn it over. A few other things that are really salient. If we have young kids we’re really afraid. We’re afraid that our work will adversely affect them, that they will be marked just like we’re marked, or that something will happen to us because of our work and we won’t be there to raise them. And more tears were shed in those conversations I think than in any others in the focus groups. If we don’t have kids, or as our kids get older and self-sufficient, we tend to get more bold.

Another reason we choose silence, besides protecting ourselves and our kids, is to protect the pro-choice movement. And I talked a little bit about this morning. Our stories don’t really have a place in a lot of pro-choice discourse and rhetoric, right? The heads that get stuck that we can’t get out. The hemorrhages that we manage. The patients having their 8th abortion. The patients that really fit any of the stereotypes that antiabortion people like to talk about. You know, those are all parts of our experience, but there’s no real good place for us to share those. Not only do we have self-censorship… We also have this burden of censorship because we care about this movement and we don’t want to be danger to it.

We also may not talk about our work because we suffer from overwhelmed identity. I also mentioned earlier today, meaning people will always see us as abortion providers and nothing else. Even if it’s a positive view. There’s only so many cocktail parties you want to go to or soccer games you want to go to, where everyone’s like “I’m so happy about what you do, you’re such a hero!” [laughter] you know? It’s lovely to hear but you don’t need that all the time.

If we’re physicians we often don’t disclose because we are marginalized within medicine. We feel look down upon technically or morally, by our peers in medicine. We dread complications, not just because of what it means for patients, but because of what we imagine people will say about us to our patients or to each other when those patients present to the emergency department, we dread morbidity and mortality presentations where we feel that our complications will be judged more harshly than a similar conversation, a similar complication outside abortion.

So then the point I want to end on with is – so what? Why does was stigmatized recognizing the way in which we’re stigmatized have the effect that it has on us? Why does it matter? Isn’t that a little narcissistic? Our work – this is about our patients, it’s not about us.

So I think it’s important as an end in itself, that we have these spaces to have conversations. But even if you don’t, let me just present a few other pieces of data. Guess what is best correlated, although we’re okay on burnout and compassion satisfaction, guess what is best correlated with burnout and compassion satisfaction.… Stigma. Right? The higher levels of stigma, higher levels of burnout, higher levels of compassion fatigue – lower levels of stigma and its inversely correlated with compassion satisfaction, meaning the lower our stigma, the higher our compassion satisfaction.

So I would say, even if you don’t care about self-care, if you want to work more [inaudible] for our patients, you need to pay attention to how stigma affects us as people. The other thing is that stigma can be managed, and the workshops that my research team ran, we were able to show that stigma actually declined before and after the workshops, and that effect held up a year after the workshops finished. Which is not to say there aren’t 10 other great stigma interventions out there, but if we do something, we can strengthen our recourse and make it more resilient. I think we owe it, we owe it to ourselves, but we owe it to our patients too. If you don’t want to think about yourself, think about our patients.

And then the last thing I want to say is that self-care, my experience in these workshops is that self-care is a bit of a misnomer. Because isolation and disconnections and voicelessness are the main things that we suffer from as a community. And to heal those things requires connection. So I don’t think there is “self-care.” I think there is group care, I think there is care and connection, I think there is team care. And that when we think about what needs to happen to take care of ourselves, it’s not that we all get a therapist, although I’m sure that would help, it’s not that we all get massages or work out or do all those other things to be good to ourselves. It’s that we come together. And I think that’s why NAF is so powerful, the spaces that we have to do that are so powerful. And, to me, self-care is connection. And that is what we need.…

[Applause]

 

 

 

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NAF Conference Transcript: Planned Parenthood of Michigan Workshop

This is a transcript of one of the videos leaked from the National Abortion Federation convention. These videos were recorded in secret by David Daleiden

The National Abortion Federation filed suit to keep all the videos taped at their conference away from the public, but an individual unaffiliated with the Center for Medical Progress leaked them.

I have composed this transcript after listening to the video. It may not be accurate in every detail. When I have been in doubt, I have inserted a question mark. There may be errors in this even though I did my best to be accurate.  It was hard to distinguish which speaker said what, so I just did the best I could to estimate.

Transcript

A1: First speaker/abortion provider Lisa Harris

A2: Second speaker/abortion provider

Q: Audience member asking questions (one of four)

[starts in the middle]

On reporting child abuse …

A1: … and the theories about that, and Casey [The Supreme Court Case Planned Parenthood vs. Casey]  departed from medical practice and converted doctors into state actors, and let me briefly link back to Lisa’s talk, these regulations that we all are so familiar in working with fighting with now, challenge the moral agency of physicians. Because they turn physicians into agents of the state. We’re familiar with this with very vulnerable populations, such as making physicians mandatory reporters for child abuse, but it puts them in that same role as a state actor, saying what the state wants them to say or doing what the state wants them to do. It’s a conscription of physicians to perform state actions. In my opinion, if the state wants these things, they should print state flyers and appoint state employees to do these things, rather than force the physicians to do it on the state’s behalf.

But for the purposes of my talk, on the significance of Casey is that it allows the state to define the good and weigh in on it which is why the line drops in my slide. So my point is, the recent trend in what is sometimes called women protective abortion regulations collectively represent a reversal of 40 years of progress in bioethics toward respect for patients’ moral agency in all other areas of medicine. So that was conceptual. Let’s speak empirically.

On abortion regret….

I am part of a study that I want to just very briefly share the results with you and the reason, these results are not going to surprise anyone here, but part of the reason I want to share them, is I want to share my ambivalence about this kind of work, and ask for your feedback in the Q and A as to how to write the results up.

My colleague Lori— , a Northwestern provider who’s sorry she couldn’t be here at this meeting, but who says hello – she interviewed 30 women at Northwestern who were there for termination of fetal abnormalities in the 2nd trimester. And when asked to explain their decision to abort, we later did coding of these interviews, a hundred percent of them used reasoning that the coders recognized as reasoning used in, um, moral reasoning methods commonly accepted in the field of medical ethics. Right? So they didn’t use that exact language, but when you code for it, 100% are using medical ethics reasoning, in to, deciding, making their abortion decisions. Now, the conclusion of the study, and here’s just how it,… The conclusion is, big surprise, abortion patients are moral agents. Woo hoo. [Laughter] But they reason differently than the government, and others, [?] the moral status of the fetus appear to be less central to their decision-making process than the political conversation may suggest. So my concern is, this is super weird research. That’s like me saying my research hypothesis is that women aren’t witches. [Exclamation, Laughter] And they’re not!  I don’t think I should get applause for that. Um, so but we’re drafting this and our conclusion, talking about the findings suggests we have to reframe political efforts, attempts, to undermine the moral agency of women, but I’m worried about this idea about special proof that abortion patients really are moral reasoners. I don’t want to set that bar, well, they had anomalies, what about the ordinary abortions? So, but yet in the current climate maybe that’s useful to have that data. So I really, genuinely welcome your thoughts about that.

…  Pregnant women are different from other patients because they have a fetus inside them but however, like many of you  might agree, Casey’s insulting because the existence of the fetus doesn’t change that fact, that women are moral decision-makers. All right? So let me switch gears here and return to those ethical arguments.

I referenced that group of what we call women protective laws, but today I’m gonna analyze how the example of abortion regret erodes patients’ moral agency. And I’m choosing regret for multiple reasons. One is that I think it underlies the academic defense, at least against, the open defense against regulations like forced informed consent, such as abortion ultrasound viewing, and mandatory waiting periods. I think some of us see the underlying motivation of these laws as harassment, burdens that are intended to block abortions, but the basic academic defense of them, is the goal of informed decision. Which is ultimately meant to respect autonomy and prevent regrets, so you see that bioethics triumph, sort of then being subverted for this women protective idea.… And that’s one of the reasons the concept of regret, I do think, feels powerful. I’m also using it because it was cited by the Supreme Court by Justice Kennedy in Carhart in 2007, and so it’s a good one to be able to rebut. And it’s also becoming a slogan or theme in demonstrations in signs, and I’ve seen lots of billboards in the Midwest that say mainly that women regret their abortions. Raise your hand if you’ve seen these signs or heard this argument, about regret. Okay, so we’ve all heard of it.

So let’s situate this point. What is rarely acknowledged in the conversation or the argument or the yelling about abortion regret is how the risk of regret pervades the rest of medicine. Without perfect knowledge of the future, the possibility that a well-informed patient might later regret their choice to have back surgery, kidney transplants, vasectomy, can never be eliminated. And so I argue that framing the risk of regret as an adverse effect of abortion raises very difficult questions for the rest of medicine. If the possibility of abortion regret justifies waiting periods, forced views of sonograms, etc. why doesn’t medical ethics, and maybe even the constitutional guarantee of equal protection, require similar measures to protect patients from regret in all areas of medicine?

The 1st step in answering these questions is to think carefully about the concept of regret. I think step one is categorizing it. I have offered 2 categories and this part of this work is published, and if you can’t find it on pub med I’m happy to email it to you, let me know.

The 1st category is situational regret. This is someone who says, you know I, this is a patient who chooses knee replacement instead of joint pain but regrets all those choices he made on the football field that led to this knee injury, right? This is a patient who consents to painful chemotherapy but regrets that she ever smoked and got this cancer in the 1st place, right? If they could travel back in time to change the behaviors that got them to this moment, maybe they would, but they wouldn’t change this medical decision today. Right? Given the facts, given where they are.

And In the abortion context, poverty, the demands of school, a boyfriend’s refusal to coparent, or severe fetal anomaly are examples of factors that might inspire situational regret. Patients might regret that that they became pregnant, regret that they’re in this moment, but they don’t regret the abortion itself. It may link a medical procedure to feelings of sorrow, loss, disappointment, or dissatisfaction, but this says nothing about the physicians or with the procedure itself.

And the fact that most abortion decisions are driven by complex emotional factors or social factors, maybe there’s an increase in situational regret compared to other medical procedures, I don’t have data on that. It’s possible, but I don’t think that says anything particular about abortion itself. Because situational regret is beyond the scope of medicine. All right?

The type of regret that haunts physicians, troubles policymakers, and tests modern understandings of patient autonomy is decisional regret. I think that’s the one we need to focus on. All right? And that is that, knowing what I know now, I would go back in time and make another decision. Let’s focus on that. There was an interesting essay in the New England Journal last year in which 2 physicians reflected on decisional regret in the ICU, a patient who says, had a long complicated recovery, and says knowing what I know now, I would have never agreed to have this ventricular assist device. Right? And, so that’s something that’s difficult to think about.

Sociologist Katrina K— interviewed abortion patients who reported emotional difficulty around their abortion, and when I read that article only one of the 18 reactions she documents fits the category of decisional regret. Okay? One patient who says, if I could go back and change it I wouldn’t have had that abortion. No matter if the father was there or not, no matter if I was going to be a single mom struggling, I would not have had the abortion. I think I would be much more happier. All right? So any physician, or bioethicist or policymaker would feel, um, would feel sympathy for patients like that, abortion patients, whichever, that cardiac patient who later look back and say, knowing what I know now, I wish I hadn’t done that. Right? That’s a sympathetic pose.

But the question is, what should we do with their distress. And I think a helpful lens for understanding the consequences of decisional regret is a concept called the dignity of risk. This is a concept articulated in the 1970s in the disability rights movement to challenge clinicians’ impulse to withhold options for people with disabilities unless good outcomes were guaranteed. It’s shorthand for the fact there’s no opportunity for success without a right to failure. Acknowledging the dignity of risk doesn’t mean patients, physicians should stop trying to help patients, it just means when patients internalize the locus of control for their choices and actions, informed decisions they later regret are viewed as an opportunity for growth, a time where patients can redefine or strengthen life goals, devise new strategies for achieving them and develop resilience.

The dignity of risk reminds us that overprotection is harmful too. And to circle back from where I started from, American patients’ status as autonomous decision-makers in bioethical ethics, that was fought for so hard, is grounded on that premise, that adults can make choices and throw the dice and see what would happen. I think that what we have to remember is that the truth of informed consent for all procedures, is that all of our best decisions are really best guesses. I think this will be best for me, but only time will tell. Right? And so I trust that the abortion patient who was called Brandy, the cardiac patient, are being totally honest when they say I would like to, if I could go back I’d do it differently, it is also the case that we can only compare the facts of the life we chose with a hypothetical version of that alternate path. We don’t even have that information, so, there’s the grass is always greener concept, it’s just very hard to know.

It’s also the case with decisional regret that we seem to understand in the rest of our life, with life altering decisions like marriage, or job change that there’s this best guess possible concept. You know, we’ll see how it works out but in medicine, we expect a different level of clairvoyance. The physician told me the information, I should’ve known, I wish I would’ve known, it should’ve turned out differently. But yeah, imagine, using those analogies, that I had a terrible divorce, that I really regretted marriage. If my sister seemed to be making a similar marital choice based on similar reasons, I think it would be totally reasonable for me to sit down with her and say, “I regretted my marriage. I want to talk to you about how you might regret yours.” I think it would be unreasonable for me to stand outside of a church with a sign that says “I regret my marriage.” [Uproarious laughter, lasting for several seconds]

… Say don’t do it, we have resources to help you stay single! [More laughter and applause] Our circumstance is not generalized to hers.

Other people may have a different experience, they may embrace it, they may regret it, it is their lives to live, and ours to support them. I also think there’s something terribly unfair about looking back at our former selves, situations that seemed perplexing or overwhelming in our youth, often seem clearer in hindsight when we have the benefit of maturity or new knowledge that comes with time passing. And we teleport our current selves, back to our 20-year-old selves and say, it was so obvious, I should’ve known x, I ought to have done y, and I think individually that’s very unfair because you couldn’t have done that, but we sort of forget the distress of an earlier time, but I also think this happens on a legislative level. Legislators in their 50s 60s and 70s have a hard time putting themselves back in the shoes of people in their 20s. Yet 50% of abortions are performed on people who are under 24, and if you raise the number to 29 it’s 75%. So of course we think of abortion issues as issues of gender discrimination, but I’d like to propose that we consider them issues of age discrimination as well. [assent] An older generation not able to remember what it’s like to be young.

It’s virtuous to want the best for patients. And it’s painful for any physician to learn that something they did at the patient’s request, with the intention of helping them, was later experienced as harm. But the principle of bioethics encourages us to remember: physicians are instruments of change but patients are agents of change. The patient has to live with the consequence. That’s the justification for patient autonomy and it’s also its cost.

Justice Kennedy made this statement in Carhart and I want to say I don’t disagree with that. It’s the high base rate that makes his conclusion unacceptionable.[mispronunciation?} We can’t expect uniformly positive reactions from a procedure. Approximately 30% of American women ask a physician to do it sometime in their lifetime. This will be true of knee surgery as well. I don’t think it makes it abortion any different for me.

Every patient assumes some risk of physical or psychological harm when they ask a physician to alter their body. And some, hopefully few, you will work very hard to make it few, but always some will regret their decision.

All right?

So, Casey, as the law currently stands, we don’t have a legal argument that says you can’t pass, it turns out or we’re losing that legal argument, certain regulations. But we still have the ethical argument that those are unethical state regulations. And so the image I want to leave you with is the Trojan horse.[laughter] All right? States can make these laws and [inaudible] physicians and advocates should argue, of course, as we are that they shouldn’t. I think that these trends in women protective abortion regulations, they undermine patient moral agency and they, states can adopt them, but they shouldn’t. Because they represent a regressive return to rejected paradigms of paternalism, and that’s what’s inside that horse. All right? The horse is this informed consent claim, but we all know that there are arguments about fetal value and the diminishing respect for the moral agency of women inside them, and we need call that out, and get it out of the square [?]. Thank you very much.

……………………………………..

Q and A

On aborted remains

Q: hi, my name is Emily –. I work at Blue Mountain clinic in Missoula Montana. I have a question, and this kind of goes back to the dichotomy between conscience and abortion providers – in seeing that abortion providers are inherently illegitimate, so that illegitimacy paradox.

I often see, and I see this mostly on social media, I get in these arguments with people where they have the fetal imagery posted, and I respond saying, this is not a realistic representation of what fetal tissue looks like this is an extremely late procedure, which is a really small percentage, but because I’m coming from the perspective of an abortion counselor, an abortion worker, it’s like I’m automatically delegitimized. Even though we’re the experts, you know, it’s like, I literally know that’s not a 9 week gestation product of conception. because I’ve seen it. I see it every week. So how do we combat that? How do we, like, just essentially stand up and say, we are the experts on this, and you all just don’t know what you’re talking about.

A1: So I actually, and I don’t intend this as a criticism, but I actually have a different response when someone portrays those images. And I say, yeah, that some weeks actually looks like what I would expect you may have some of your facts wrong, at 9 weeks it doesn’t look like this, at 22 weeks it does look like this – but yeah, actually, that’s my week some day, some weeks, and that’s what it looks like. And I actually think, and I’ve been pretty vocal about it, so I’ll say it here, you know that, it’s been a failure of Pro – ignoring the fetus is a luxury of activists and advocates. [Laughter] if you are in there every day with women, and if you’re provider, you can’t ignore the fetus, right, because the fetus is your marker of how well, how good a job you did. Right? If you don’t account for all the parts and you don’t look carefully, you may be setting someone up for infection or hemorrhage, or whatever – the fetus matters clinically to us. Not to mention that women know what’s in there. You know about two thirds, over 60% of women are already mothers and the remainder don’t want to be mothers. They’re not stupid. They know what’s in there. So the idea, I actually think that we should be less about denying the reality of those images. More about acknowledging, that yeah, that’s kind of true. So given that we actually see the fetus the same way and given that we might actually both agree that there’s violence in here, ask me why I come to work every day. Let’s just give them all, the  violence, it’s a person, killing – let’s just give them all that. And then, the more compelling question is, so why is this the most important thing I can do with my life. let’s talk about that. And – so that’s my answer to that. I don’t think it needs to be about correcting facts, I think it can be, needs to be about moving the conversation to a different place.

[Applause]

On Conscience Clauses…

Q: I have a dilemma, which is, I was talking to a group of people after, who were doing a Q and A after “After Tiller”, and somebody said well what do you think about conscientious refusal. And I found myself saying, I don’t think people should go into OB/GYN if they’re going to refuse to do one of the most common procedures that OB/GYN do. And I’m not comfortable with my grounding for saying that, I think it but I’m not sure I can justify it. so I was asking your advice on this dilemma.

A1: that’s okay, that’s something I’m struggling with also Susan, and the analogy I’m struggling with is like having a Jehovah witness run a blood bank. [Laughter] it’s just not the right job for you. I’m not trying to-  But then you say okay but a blood bank is run by a lot people, is there an administrative role that would make that person be comfortable. And so I struggle with that because OB/GYN’s a broad field there are many people who do lots of different things in it and it’s not because, you know whatever. But, but I do think there’s a more, there is an argument there, but I don’t know if it’s a winner.

A2: So I’m not sure I actually agree, because in all areas of my life I’ve come to realize that the best, that, diversity and inclusion, which really means we’re talking about race or ethnicity, but that those are key things to having good solutions to any kind of issue. And I don’t like to exclude anybody from anything. I do think that, and I mentioned this yesterday in the comment periods, so forgive my sort of repetitiveness. I think that as we shift our thinking from reproductive rights, abortion rights, to reproductive justice, there are a lot of rights that women and families are owed, through childhood, and through pregnancy, and through birthing, and through menopause, as we shift to be more inclusive and not just focus on abortion, there are a lot of areas of overlap, where your vision of a reproductively just world might look just like mine, right? Because we’ve done poverty elimination and we have racial justice, and we environmental justice, and we have great public education, and we have good parenting leave policies, we have all these things. So I actually think that you could be in OB/GYN who doesn’t believe that abortion is part of a reproductively just world and still overlap with 95% of a reproductively just world with mine. Now, I do think there have to be constraints on that, that if you are going to be the only person in a rural area or you’re the go to person, you have to have to set up allowances for that. But I don’t know that I would just exclude. I feel so strongly that people need to exclude [inaudible] I would rather broaden our idea of what reproductive justice means and find our areas of intersection and create some infrastructure when people disagree around abortion and there need to be referrals and [inaudible]

Q: thank you so much for this panel, like the bomb. [Laughter] and I – I if I didn’t define my work as stigma eradication in the short run, you know, I’d be a lot more stressed out. But I think in the long run, if you have these conversations, I think you know, this is the meat and potatoes of everything, Kate it’s so good to see you, ever since your talk a while ago, I constantly try to explain acts of omission, commission and dignity to various people I work with and I don’t do such a great job at it but I’m getting better. So – 2 things. One I wanted to say, I think a grand rounds tour in red state medical departments would be phenomenal for you guys to consider. I think I’ve interacted this last year with so many physicians who, by acts of omission, have chosen not to stand up for us, yet who refer their patients to us. [Sounds of agreement] and now that we’re gone, right? I mean there’s 2500 OB/GYN’s in Texas who signed on against HB 2, but now we don’t have any doctors performing abortions. Right? And the clinics are closing. So I think you’re onto something, of course, really phenomenal, but I think it would be really interesting to have this sort of ethics conversation as CME, you know accredits the hospitals and in the very hospitals that either did privilege people or denied privileges or whatever, and so whatever we could do to help that happen. The 2nd place I think it would be really interesting, for example would be at the University of Texas at Austin, that’s building a medical school and they’re in a big struggle with housing it in the Catholic hospital, [assent] and it’s in a capital city that supposed to be progressive. Right? And so this conversation I can see a symposium academically that would involve cultural historians, American studies people, medical studies people, ethicists, and some way that we can get those conversations to happen before those decisions are made behind closed doors, and they don’t affect anybody. I don’t know if you’ve done this or would be interested, or would anybody in the room be willing to help with this?

A1: we haven’t but I would predict we would be open to it if other people would set it up. We might show up. I will say part of my project, and I know my [inaudible] is like publishing in literature that’s broader than just OB/GYN or abortion so I published my regret essay in JAMA, and then I buckled up and thought okay here we go, because JAMA hadn’t published an abortion piece since Carhart, and then it had been 10 years since that, so they don’t want, if they pretend it doesn’t exist. And in Carhart was like a super – apologetic editorial, it was like we’ve got to talk about this. And so, um, I was ready for this vitriolic response, and I got only one negative response, and I got, probably, 15 emails from physicians in, not necessarily in OB/GYN or abortion provision, saying this was super useful. Surgeons, you know, neurologists. So that was shocking to me and encouraging.

A2: I especially think Lisa, your distinction between conscience and stigma, and how it shows up in that privileging conversation is brilliant. If any of you have ideas for disseminating, and ideas that may be useful, be in touch.

I had kind of wanted to say something about Lisa’s point on stigma and conscience, and I can see another way to get, I guess get this out there, I’ve definitely talked to people in residency programs where there’s some type of panel, if you’re going to consciously object to abortion you just have to go talk to the people on the panel, 2 or 3 doctors, and explain why you object, and why you won’t participate in abortion training, and I just think it would be a very interesting thing to kind of turn that discussion into a real articulation. Is this, would you consider this discomfort to fall under stigma, for the reasons they articulate you know conscience for the reasons–. And get them, get more residency programs doing that and articulating and disentangling all of that for the people that would just be a nice thing to go through.

Q: hi, I’m Linda –. I have a, I’ve been noticing this that’s happening sort of at a regulatory level, in the federal government, that’s happening to us and other health centers, those who work in [inaudible] any place that really is subjected to any federal funding or any federal regulation. It’s these patient centered medical home things that we’re supposed to be creating that we actually get visited on… We get all these regulatory bodies that come and look at what we’re doing. And what they’re looking to see is whether or not we have patient portals and whether or not we’re doing a shared decision-making with our patients, and we’re supposed to be documenting our shared decision we’re supposed to and we’re supposed to be documenting our patients’ access to their whole medical record, if they want to read it all, And I think need to totally need to start owning this language and co-opting it, because if we’re going to be patient centered and if we’re going to do shared decision-making than that means you let women decide when they are ready to parent and their not ready to parent. And if we’re not gonna do that, if we’re gonna deny that to this one subset of our patients, and that seems to be what is going against what is now promoted as the way to practice medicine. so, um, I really don’t know how we can sort of own those words but it seems like they’re completely perfect with what we do.

A2: the way we can own them is you just made this terrific suggestion, everyone in this room can pick it up, I think this – the principle of just taking an existing paradigm and, when what you do fits it, saying I’m not trying to change anything. Is very powerful.

A1: and it even feels more powerful than sort of malpractice, for bad [inaudible] . This is a JCAHO thing. You know, we turn a lot over to JCAHO if we don’t like it, and so if you can’t demonstrate shared decision-making where women got a say in what happens to their pregnant bodies, that’s a JCAHO violation. Wow, that would be very incredible.

Q: Hi I’m Maria  — from Mexico, congratulations. Your presentations were wonderful, we need you in Latin America. I have a question. [this part is very difficult to make out but she seems to be asking about the state of conscientious objection in Latin America and the US}

A1: Well, that’s very interesting to me….I’m going to answer quickly and then one last question. My sense of the times I’ve spent in Mexico or other parts of Latin America is that conscientious, issues of conscience are issues for providers more than for people who oppose abortion. That there are more conversations about, well, I’ll do medical abortions but not surgical or I’ll do surgical but just to 12 weeks, so I think that there, there are some issues about conscience that need more exploration, about what that means. But um, I guess I don’t understand the nuances of that prohibition of conscientious objection well enough, and I know that there’s a lot of contestation about whether that deserves a place in the law or not, whether the solution to that issue is in the law or is elsewhere. I guess I, I do recognize conscience. You know, for my argument to work, that conscience is part of provision, there has to be a recognition of conscientious refusals as well, but that doesn’t mean you can’t qualify it by saying that it’s just direct. You can refuse to participate directly, but you do have a moral obligation to help somebody get the care that they need. I think the other piece that might be useful is that our idea of what’s morally at stake in refusal is way too narrow. Right? So it’s not just the moral integrity of a provider that’s at stake in whether they perform an abortion or not, everything that happens to the woman after that, has moral consequences. Right, whether an early abortion turns to a later one, or whether a safe abortion turns into an unsafe clandestine one, or whether she has a child that she doesn’t want to raise or have the resources to raise. Those are all moral issues as well, so I think we need to expand our idea of what’s morally relevant and that may help in, in the conscientious refusal if you widen that then maybe will give some more clarity. I need to think more about it.

Q: I’ll be brief. 1st of all, I enjoyedthe presentation so much, it reminded me of many conversations I’ve had with patients except that it sounded much more intelligent [?} than what I as was saying. So I wanted to just briefly invite a tangent to issues of viability, because in many states of the country abortion is legal, with many many restrictions up until “viability,” at which point, all of a sudden, many people develop a strong discomfort. Well, but she’s so late in the pregnancy, it’s already viable, why doesn’t she just have it and, one thing I think a lot of us have been trying to give that argument into that we are forcing her to continue to be pregnant for however many weeks and I’ve spoken to referring OB/GYNs and they’re trying to sort out their feelings, is this a conscientious objection that I’m wanting, am I ok, am I comfortable with this? And saying well, perhaps she is 28 weeks. If she says, doctor, induce me, I don’t want to be pregnant anymore, It’s effecting me physically, it’s effecting me emotionally, that absolutely no doctor would ever, unless it is “life of the mother” would ever even consider inducing a preterm delivery. And so I would be really interested in hearing if you’ve both explored that in a more intelligent way to talk about that.

A1: I think, no.

Q: why not?

A1: I think about viability a lot and the significance or insignificance of that line, but I haven’t really thought about it in relation to conscience except in the same sense for the same reasons that some women say you know, I’m 6 weeks pregnant my conscience won’t allow me to have a termination even though that really could be great for me, but I just can’t do it. The same conscience in operation in the other direction if a woman says I’m 28 weeks, and I still don’t think that the moral status of this fetus should trump me, to me that’s the same exercise in patient moral agency. So that’s how I would frame that, but I haven’t thought about it beyond that.

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Transcript of CMP Video: Lisa Harris Conversation

This is a transcript of one of the videos leaked from the National Abortion Federation convention. These videos were recorded in secret by David Daleiden

The National Abortion Federation filed suit to keep all the videos taped at their conference away from the public, but an individual unaffiliated with the Center for Medical Progress leaked them.

I have composed this transcript after listening to the video. It may not be accurate in every detail. Here is the video below, transcript.This video is of a conversation between David Daleiden and Lisa Harris, a late-term abortionist.

Transcript

D: David Daleiden

H: Abortionist Lisa Harris

O: David’s Assistant, a 2nd undercover pro-lifer

———————————————————–

D: so your, at your facility, how late in gestation do you…

H: 19 and 6 right now

19 week unborn baby
19 week unborn baby

D: to 19 and 6?

H: but, just because of other changes, we’re probably going to inch that up but it’ll be gradual. We don’t have a big volume of big cases.

D: oh really?

H: yeah.

D: okay.

H: what you mostly looking for?

D: We, so there’s kind of 3 basic intake questions, or kind of checkboxes… The 1st is how late you go… and because all kinds of scientists –

H: did you go to Northland Family Planning at all?

D: no, we haven’t even met them yet.

H: because we send them out [inaudible] – they’re here.… We send our… We send our family planning fellows out there… because they go all the way up to 24 weeks and they have a much bigger volume of later cases.

D: yeah, were very new literally, the past…

D:…So  generally it’s the mid to later 2nd  tri [trimester] tissues that’s in demand.… Can’t be digged. because dig –

[I believe this means the babies can’t be injected with digoxin, which is used to stop the fetal heart and ensure the baby’s death. However, the drug also contaminates the tissues and makes them unsuitable for research.  In “dig” the slang word the ‘d’ is pronounced like in ‘edge’]

H: although Northland uses dig.

D: do you know when they start diging?

H: no.

D: no.…

H: our hospital uses dig

D: yeah, um, dig just nukes the stem cells, but that’s excellent, that you’re not using-… And the 3rd is patient volume. As far as your 2nd tri cases, like approximately per week

H: it really varies. I would say anywhere between 0 to 4, [late term abortions a week] but not over that.

D: 0 to 4? And with the affiliate that you’re working with, is there just one center or, how many…

H: there’s only one that does 2nd tri cases.

D: oh okay. So it’s kind of small.

H: but Northland family planning does more but they-

D: Interesting. Yeah. Oh ok.

H: so, um, I’m happy to talk more I’m not sure we’re-

D: yeah, I wasn’t sure, because it’s… I mean those are the 3 big, is the no dig, and then going into mid-2nd tri, and then volume, is-

H: what does it mean to you? from 20? From 18?

D: that means, to me that means from 16 to 22, anywhere within that range.

20-22 wks
20-22 wks

H: I mean, we have a few but not a lot

D: Yeah, ok,  So you would recommend North land family planning?

H: potentially. But I’m pretty sure they use dig for everybody

D: for everything, oh okay.

H: I can find out.

D: yeah… do you get pretty good cervical dilation when you do the 2nd tri?

H: mmhmm. We do with some of the procedures, yeah… Do you need things more intact?

D: it depends on, it depends on how dismembered, disarticulated it is, when it comes out, so the things that are most in demand are liver, thymus, and bone marrow right now, because, those are the 3 things that are used to construct the humanized mouse models now. I don’t know if you’re familiar with those –

H: not so much.

D: it’s really cool, they have, like mutant strains of mice that are bred to have no mouse immune system, they’re immunodeficient mice, and then they would graft human fetal liver, thymus, and bone marrow into the mouse, and then it, it actually, you know, grafts in, the cells continue to reproduce it actually constitutes a functional human immune system in the mouse model. Oh, they use that for drug testing, and for HIV AIDS research, and disease testing…

H: [looking over her shoulder at someone she wants to go talk to, possibly her daughter] She’s been a trooper, and has been totally waiting for me.

D: yeah, yeah, I can imagine

H: [inaudible] so what I’d love to do is, you know how  – did I give you one of my cards?

D: Uh, do you have a card on you?

H: I’m going to give you –

D: great.

H: and, I’m not sure if we’re going to turn out to be a, I am more interested…

D: yeah, depending on the –

H: I’m more interested actually in what we talked, what we talked about in terms of the more, sort of conceptual things that get in the way, and the research regulations that get in the way, so even if you can’t turn out to –

D: you mentioned something about regulations when I introduced myself yesterday. I forget what the-

H: Subpart B [possibly some part B] regulations …

D: is that some of the HHS things we got?

H: yeah.

D: yeah, cause yeah there’s all kinds of stuff when it, when it comes to it, if you’re an academic research you’re receiving federal funding or potentially state funding is, there’s all kinds of red tape and all over.

H: well that’s kind of where my interest in this is. Are women allowed to feel like there’s a greater good that came from their abortion, those are my things, and we kind of as a society we want, I don’t want, but we want people to feel bad about it, so –

D: right.

H: the idea that there would be some good, you know to come out of it,

D: absolutely

H: when someone says they don’t want to permit women to have that,

D: yeah, no

H: so that’s sort of where my interest is… So I’m happy to talk about whether we’re a worthwhile partner for you or not, but I’m more happy to talk about the federal general regulations that get in the in the way of doing this, of what socially we let women, what experiences we let them have in conjunction with their abortion,

O: right, right. And how we can talk about that, I think, more talk about it, seems to be, I listened to your talk yesterday on how we are marked with-

H: the conscience one?

O: yes, and about how that, that plays into the patient, and that’s, so that’s my –

H: yeah. So that interests me too. And I’m sorry need to go, my daughter has been waiting for the past 2 days for me. So I have to go… Bu I’m happy to talk about any of these things-

D: what you did in the past, was that with a dedicated procurement organization?

H: no, no. That was with individual researchers who needed, either decidual tissue, or fetal, they were tr- fetal orbits, you know, specific short-term research projects.

D: is there a standard specimen charge that you guys have?

H: no, they, honestly, they’ve never charged for specimens before.…

D: oh, oh good!

H: I don’t know what they would, if they were going to partner with a more commercial agency they probably would –

D: yeah

H: think about it.

D: does that have to go through the board for your affiliate, or how does it, who kind of makes the final –

H: our VP for medical affairs oversees all research…. all research projects pay for the effort, but it’s never been like a per specimen.

D: okay that’s not how they do it. Gotcha. No we typically, I mean we, we definitely return a portion of our research fees into physicians offices, and hospitals, and clinics that we work with. The standard right now I guess is, most organizations are paying per specimen so that’s what we’re kind of familiar with it, um, ..but whatever would work out-

H: they haven’t done it like that before but they’ve had sort, of grants to the agency to cover my time…

D: Gotcha

H. But not a specimen,,,

O: Thank you for your time.

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