You Take the Pay, You Lose Your Say


May 28, 1991|By ELLEN GOODMAN

BOSTON — BOSTON--If there is any doubt about how abortion has reshuffled the political deck, consider this. On Thursday, a conservative majority on the Supreme Court delivered up a conservative's nightmare. They declared that anyone who takes money from the government, must give something back: the party line.

To put it succinctly, the government that pays your rent can buy your speech. Anyone who works in one of the 4,000 federally funded clinics that provide family planning to four million poor American women is now forbidden from using the "A" word.

Today if a patient asks about abortion, her doctor is legally required to act like a good government puppet. He or she must pull out the federal script and read: "The project does not consider abortion an appropriate method of family planning."

If the patient persists and asks for a referral, there are more scripts. Her doctor or provider has to refer her for prenatal care to those who "do not perform abortions."

This is the real-life effect of the Supreme Court ruling in a case that came to court bearing the name of Dr. Irving Rust, the medical director of a Planned Parenthood family-planning clinic in the South Bronx. A soft-spoken, Harlem-raised physician, Dr. Rust had worked since 1981 with the guidelines that forbid use of federal funds to perform abortions. But in 1988, when the Reagan administration wrote a set of regulations for Title X that banned even talking about abortion, he balked.

As Dr. Rust said last fall, what was at stake was the relationship between a doctor and a patient, the ability to talk freely and honestly. "If a woman came in with cancer of the ovary and there were three methods of treatment," he explained as an analogy, "Could I tell her the government says that chemotherapy is THE treatment, no matter what I think? "

This was the argument that seemed to worry the newest Justice, David Souter, when the case was heard in court. "You are telling us the physician cannot perform his usual professional responsibility," said Souter, "You are telling us (the government) in effect may preclude professional speech." But in the end, Souter cast the tie-breaking vote to form a 5-4 majority. In the first, chilling, indication of how he votes on the subject of abortion, Souter went with Justice Rehnquist.

These rules, wrote the Chief Justice, weren't meant to inhibit the doctor's point of view but to promote the government's "value judgment favoring childbirth over abortion." The regulations weren't made to "gag" health care providers but to "simply ensure that appropriate funds are not used for activities, including speech, that are outside the federal program's scope."

In one searing if subconscious comparison, Rehnquist showed just how political the court's own judgments have become. Funding speech about family planning but not abortion was, he wrote, like funding a center for promoting democracy. The government doesn't also have to promote "competing lines of political philosophy such as Communism and Fascism."

All this smacks more than vaguely of arguments over funding for the arts. Does the government only fund along political lines? If you're on the payroll, do you still have the right to say what you believe or know?

What is a question of medical treatment for Dr. Rust and his patients, is a matter of political philosophy for Justice Rehnquist and his majority. What is a concrete crisis in the lives of poor women becomes a wonderful abstraction in the words of the Justices.

Abortion rights supporters, who are learning the hard way not to depend on the court, will press Congress to change the regulations. There is a bill wending its way through the Senate that would reverse the guidelines and allow doctors to once again tell a poor woman all her legal options. But as it stands today, clinics can either take the hush money or cut their services. Doctors can choose between government-prescribed service to poor patients, or leaving the clinics. And poor patients will face another hurdle in a double-standard health care system.

Wasn't it the conservatives who always told us to worry about the long arm of the government? If it's uncomfortable in the examining room at the clinic these days, that's because the government has moved in and put a firm hand over the doctor's mouth.

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