Friday, April 27, 2007

Second opinion

A guest post by Henrietta G. Tavish

Seasoned professionals from all disciplines frequently lend their expertise to the letters section of the New York Times. This week, one Richard Zweig, M.D., weighs in on the Supreme Court's recent decision, in Carhart vs. Gonzales, on partial-birth abortion:

I am a rheumatologist caring for a patient whose lupus nephritis is flaring. Her creatinine is rising as her platelet count falls, and she has failed to improve with pulse methylprednisolone and intravenous cyclophosphamide. I am contemplating using rituximab. I would like to refer this case to the United States Supreme Court for its guidance.

Dr. Zweig presumably means to underscore the folly of state interference in the affairs of learned physicians who devote their lives to the study of medicine and the spelling of multi-syllable chemical compounds. I'm no doctor, but arguments like this make me want to reach for the nearest bottle of acetaminophen.

First, note that under his own premises, Dr. Zweig must be at least as out-of-his-league on the issue as he claims the Supreme Court to be. He's a rheumatologist, not a obstetrician. He's no more qualified, medically speaking, to prescribe a late-term abortion than Associate Justice Ginsburg -- however eager they both might be to do so. So if the high court opinion is bad medicine, Dr. Zweig's opinion of the opinion is little better.

But the opinion is law, not medicine, an area in which Zweig has far less expertise than the court to opine. Certainly his theory that the state cannot or should not regulate medicine is nonsensical. The FDA, a government agency, approves or disapproves treatments and medications all the time. Dr. Zweig could not "contemplate using rituximab" to treat lupus nephritis if the FDA forbade him. I suspect he would approve of state action to prohibit a doctor from using rituximab to treat acne, or aspirin to cure leukemia. He might even appeal to the state to interfere on his behalf if he found that some abortionist down the street was practicing rheumatology.

What Zweig really means is that he thinks the Supreme Court ignored an alleged consensus in the medical community when it upheld Congress' finding that partial birth abortion was almost never medically necessary. However, if he reads Times in addition to writing to it, he might recall the article which helped spur Congress to action in the first place:

An Abortion Rights Advocate Says He Lied About Procedure

A prominent member of the abortion rights movement said today that he lied in earlier statements when he said a controversial form of late-term abortion is rare and performed primarily to save the lives or fertility of women bearing severely malformed babies.

He now says the procedure is performed far more often than his colleagues have acknowledged, and on healthy women bearing healthy fetuses.

Ron Fitzsimmons, the executive director of the National Coalition of Abortion Providers, said he intentionally misled in previous remarks about the procedure, called intact dilation and evacuation by those who believe it should remain legal and "partial-birth abortion" by those who believe it should be outlawed, because he feared that the truth would damage the cause of abortion rights.

* * *

In the vast majority of cases, the procedure is performed on a healthy mother with a healthy fetus that is 20 weeks or more along, Mr. Fitzsimmons said. "The abortion-rights folks know it, the anti-abortion folks know it, and so, probably does everyone else."

As even former NARAL president Kate Michelman conceded in her 2004 book, With Liberty and Justice for All, "Fitzsimmons had lied, indefensibly and unnecessarily, and the credibility of every pro-choice advocate was now under suspicion." The dissent in Carhart only confirms that "medical necessity" is a largely invented issue. In discussing the primary reasons for late-term abortions, Justice Ginsburg relies on a study indicating that adolescent and indigent women simply discover their pregnancies later than most.

Dr. Zweig's complaint is little more than a variant of the old saying that every abortion, for any reason, is a matter for the woman, her doctor and her God. Retreating somewhat from that theory, the Supreme Court has offered a remedy for some of those cases in which God has left the room.