The Detroit News

Monday, July 30, 2007

Madalyn Ruggiero / Special to The Detroit News
Barb Yagley, 53, of Troy protests abortion outside of WomanCare,
a Lathrup Village clinic that uses digoxin to terminate pregnancies.

Abortion procedure fuels debate

Recent Supreme Court ruling prompts doctors to use method critics say increases risk and pain.

Kim Kozlowski / The Detroit News
A drug long used to help heart disease patients live -- and also to stop the heartbeat of fetuses -- is moving to the center of the nation's debate over abortion.
Providers are administering the drug, called digoxin, to more abortion patients even though they say it adds only risk, pain and inconvenience. The drug is necessary for legal reasons, they claim, because the U.S. Supreme Court recently upheld the federal Partial Birth Abortion Act, which bans a relatively rare late-term abortion procedure.
Attorneys say the law's language has a potentially wider reach, so some providers are taking steps to avoid prosecution by giving digoxin to women undergoing more common abortion procedures.
At the root of the discussion, however, is the moral debate that has made abortion so controversial -- which of the two lives is more important?
"The woman's health has taken a back seat," said Renee Chelian, executive director of Northland Family Planning Centers, which has three local offices. "The fetus is given an equal status as the woman. It's a horrible precedent that the woman's health and safety is not paramount."
Anti-abortion advocates say having to medically stop a fetus's heartbeat is a small price for ensuring that living fetuses aren't pulled from the uterus during an abortion. Others suggest it is a sign that an abortion shouldn't be happening at all.
"They are killing babies that are too old if this is the way they are doing it," said Ed Rivet of Right to Life of Michigan "If they were (performing the abortion) earlier in the pregnancy, there wouldn't be concerns at all."
The one thing both sides agree on is that the ban constitutes one step toward the eradication of the landmark 1973 Roe v. Wade decision that made abortion legal in the United States.
"It's scary," said Wixom resident Kate Palmer, a health care advocate at a local abortion clinic. "It's just a little chip. It's such a cliche to say, but it's true."

Victory for opponents

In the 34 years since abortion has been legal, anti-abortion activists have successfully fought for laws requiring parental consent, 24-hour waiting periods and other limits.
The Supreme Court's April ruling was another major victory for opponents. It was first time the High Court has outlawed a specific abortion procedure, subjecting violators to fines and up to two years in prison for performing the procedure that opponents call "partial birth" abortion.
The law bans removal of a living, intact fetus through a method known in the medical community as intact dilation and extraction. But the vague wording of the law could be interpreted to include a ban of the more common dilation and evacuation procedure, said Janet Crepps, an attorney with the New York-based Center for Reproductive Rights.
"Because certain aspects of abortion procedures are variable in ways that physicians cannot control, physicians may feel compelled to cause fetal demise in order to avoid any appearance or suggestion that they have violated the law," Crepps said. "One fail-safe way to protect against prosecution under the law is to ensure that fetal demise has occurred."
The FDA approved digoxin in 1982 for use in heart failure patients, but some abortion providers have used it off-label for years to cause fetal death, to make second trimester abortions easier and, in some cases, to assure patients that the fetus could not feel pain.
Administered with a long needle through the abdomen and into the amniotic sac, the drug poses some risks to the patient, health professionals say. There is a risk of infection, and it can cause an unexpected onset of labor, nausea, vomiting or diarrhea. It can be painful and in some cases can turn the abortion into a two-day procedure, with doctors administering the shot and sending women home with instructions to return the next day.

Local centers use drug

Ninety percent of abortions are performed in the first trimester, before 12 weeks, according to the Guttmacher Institute, a reproductive health research organization. Only a handful of Michigan's 31 abortion providers offer abortions during the second trimester. But many providers report that they are adding or expanding the use of digoxin beginning at 18 weeks, when an abortion technique could fall under the federal ban.
At the three local Northland centers, women between 20 weeks and 24 weeks always got digoxin because doctors felt it made removal of the fetus easier. But now, clinicians at Northland administer it up to six weeks earlier.
"We have to cause fetal death," Chelian said, noting that doctors previously didn't monitor fetal heartbeats because they were focused on performing the quickest and safest surgery. "It is not necessary, but it is the Supreme Court telling doctors, 'This is how you do surgery.' It's really scary that the fetus has as much weight as the woman."
At WomanCare, which has six offices in mid-Michigan and a seventh opening next month in Royal Oak, all patients between 18 weeks and 24 weeks pregnant are getting a digoxin shot. Before the federal ban, late-term abortion patients at WomanCare patients were given only laminaria, a natural product used to dilate the cervix, the day before the abortion. Now they get both.
"It was much simpler and much less dangerous than what we are doing now," said Alberto Hodari, medical director of WomanCare. "But this is now the law. It's awful. It's unnecessary. It's dangerous. It's more complicated. It makes the woman go through another procedure that's not necessary. It impacts everything we do after 18 weeks."
Madalyn Ruggiero Special to The Detroit News
Connie McKeever of Farmington Hills and Bob Roesser of Southfield join anti-abortion advocates in prayer outside WomanCare. Both sides agree the Supreme Court's decision to ban partial birth abortion moves one step closer to overturning Roe v. Wade.

What the law says

Excerpt from the federal Partial Birth Abortion Act: The term 'partial-birth abortion' means an abortion in which the person performing the abortion:
(A) deliberately and intentionally vaginally delivers a living fetus until, in the case of a head-first presentation, the entire fetal head is outside the body of the mother, or, in the case of breech presentation, any part of the fetal trunk past the navel is outside the body of the mother, for the purpose of performing an overt act that the person knows will kill the partially delivered living fetus; and
(B) performs the overt act, other than completion of delivery, that kills the partially delivered living fetus

What's at issue?

The law was intended to outlaw the rarely used intact dilation and extraction procedure. In 2000, 2,200 pregnancies were terminated with the banned procedure, accounting for 0.17 percent of the 1.3 million abortions that year, according to the Guttmacher Institute, a reproductive health research organization.
Attorneys for abortion providers say the language of the law could put physicians at risk of prosecution, so they may want to consider causing fetal death before performing an abortion.
Elizabeth Conley / The Detroit News
Dr. Alberto Hodari, medical director of WomanCare, says providing digoxin makes abortions more dangerous and complicated.

Doctors get guidance

No studies have been done to assess how providers nationally are responding, but some Michigan doctors are being trained in the safe administration of digoxin.
Meanwhile, national advocacy groups have begun providing abortion providers with legal guidance on understanding the ban. "It's unfortunate," said Vicki Saporta, president of the National Abortion Federation, which has counseled some providers that they may want to use digoxin to ensure they are within the law. "But that's what the Supreme Court decided, so physicians are making sure they can offer safe, quality abortion care to women."
As more women get digoxin, the abortion wars continue.
Many anti-abortion activists are working to pass state laws that mirror the federal ban. Michigan activists have launched their fourth such attempt in an effort to ensure that physicians who have performed prohibited procedures could be prosecuted in state jurisdictions, not just federal courts.
"We can live with this, but what's next?" Chelian said. "They'll start banning (other procedures) and they'll look to cut the gestational age when abortions can be performed."
Abortion opponents agree and promise to continue fighting to stop all abortions.
"I'm sure they are all shaking in their boots," said Sister Lois Marie Mitoraj, a Felician nun based in Livonia who protests outside abortion clinics. "Every abortion is evil. We're in need of prayer warriors so these abortion mills would be closed forever."
You can reach Kim Kozlowski at (313) 222-2024 or kkozlowski@detnews.com.
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